원위부 위아전절제술 후 원형문합기를 이용한 위십이지장 문합술 - 문합부 합병증과 예방책 -

이문수,강길호,조규석,김용진,김형수,이화수,김성용,백무준,김창호,조무식,Lee, Moon-Soo,Kang, Gil-Ho,Cho, Gyu-Seok,Kim, Yong-Jin,Kim, Hyung-Soo,Lee, Hwa-Soo,Kim, Sung-Yong,Baek, Moo-Jun,Kim, Chang-Ho,Cho, Moo-Sik 대한위암학회 2006 대한위암학회지 Vol.6 No.2

목적: 원위부 위아전절제술 후 원형문합기를 이용한 위십이지장 문합술은 안정성과 간편함, 신속성 등 여러 장점으로 인해 점점 그 선호도가 증가되고 있다. 이에 기계문합술 후 발생할 수 있는 합병증의 고찰을 통해 이 술식의 안전성을 위해 보완해야 될 점을 알아보고자 하였다. 대상 및 방법: 1998년 1월부터 2004년 12월까지 위암으로 근치적 원위부 위아전절제술 후 원형문합기를 이용하여 위십이지장 문합술을 시행한 594명을 대상으로 하였다. 문합부위의 출혈유무를 육안으로 확인하기 시작하였던 2001년 1월을 기점으로 그 이전을 제1군(n=219), 그 이후를 제2군(n=375)으로 분류하여 각 군 간의 임상적 특징과 문합부와 관련된 술후 합병증을 비교하였다. 결과: 두 군 간 합병증 비교에서, 문합부의 누출은 제1군이 4예(1.8%), 제2군이 3예(0.8%) 발생하였고(P=0.196), 문합부 협착은 두 군 모두 발생하지 않아 두 군 간 차이는 없었다. 출혈은 제1군이 43예(19,6%), 제2군이 2예(0.5%)로 제1군에서 많게 나타났다(P=0.019). 결론: 위암 환자의 원위부 위아전절제술 후 원형문합기를 이용한 위십이지장 문합술은 이 술식이 갖는 여러가지 장점으로 권장되는 술식이나, 문합부 출혈이 중요한 문제점으로 지적될 수 있어 술 중 문합부 출혈 유무를 육안적으로 확인하는 것이 기계문합법의 안전성을 향상시킬 수 있으리라 생각한다. Purpose: The circular stapled Billroth I gastrectomy has been gradually popularized because of several advantages. Thus, this study aims to identify what to be supplemented for the safety of this technique by examining the potential complication after the circular stapled Billroth I gastrectomy. Materials and Methods: This study selected 594 patients who underwent the circular stapled Billroth I gastrectomy because of the gastric cancer in our department of surgery from Jan. 1998 to Dec. 2004 as the subjects. As of Jan. 2001 when the bleeding on the anastomosis site was visually checked through the small incision at the opposite curvature to the lesion of the stomach to be resected and so the operation was completed, the patients were divided into the Group I (n=219) and Group II (n=375), which were the patients before and after Jan. 2001, respectively. Then, the clinical characteristics and postoperative anastomotic complications of both groups were compared. Results: For the comparison of complications between two groups, the anastomotic leakage was found in four cases in Group I and three cases in Group II (p=0.196). The stenosis on the anastomosis region was not observed in both groups. The bleeding on the anastomosis region illustrates the statistically significant difference between Group I and Group II, with 43 cases and 2 cases, respectively (P=0.0019). Conclusion: The circular stapled Billroth I gastrectomy is recommended because of several advantages of this technique. However, the bleeding on the anastomosis site may be indicated as the critical issue. Accordingly, the visual check on the bleeding on the anastomosis site during the operation will improve the safety of circular stapler.

편재하중을 받는 점토지반과 강널말뚝의 거동해석

이문수,이병구,정진섭,김찬기,Lee, Moon Soo,Lee, Byoung Koo,Jeong, Jin Seob,Kim, Chan Kee 대한토목학회 1994 대한토목학회논문집 Vol.14 No.4

본 연구는 연약지반상에 sand drain을 타설하고 성토하여 교대 및 교각을 시공하는 진월 인터체인지에서 기초지반의 침하, 융기 및 이미 시공된 교각기초부분의 수평방향 변위를 측정한 실측치와 Sekiguchi의 탄 점소성모델을 Biot의 압밀방정식과 결합하여 2차원 평면변형용조건으로 유한요소해석한 결과를 비교 검토하였다. 이때 교각기초인 강판말뚝은 등가의 강널말뚝벽으로 환산하였다. 그리고 환산한 벽체에 축력의 변화, 강성의 변화, 지지조건의 변화 및 고정점위치의 변화 동에 따른 기초지반의 거동과 강널말뚝벽체의 거동 특성을 밝혔다. In this paper, the comparisons between field measurments and numerical results ware performed for the settlements, lateral displacement in Jinwol interchange works on the Honam express way whose site was improved by sand drain for the constructions of over bridges, piers and abutments. The computer program was developed by coupling Biot's equation with Sekiguchi's elasto-viscoplastic model under plane strain conditions. Steel pipe piles for piers were replaced into the equivalent steel sheet pile wall. The characteristics of behavior for both the soil foundations and the sheet piles wall were investigated with the variation of axial force on the wall, rigidity of the wall, supported condition of sheet pile into hard strata and the location of anchored point.

Cis-9-Octadecenoic acid와 trans-9-Octadecenoic acid의 열분해에 관한 연구

이문수,이운철,곽재진,Lee, Moon-Soo,Lee, Un-Cheoul,Kwag, Jae-Jin 한국연초학회 1987 한국연초학회지 Vol.9 No.1

The pyrolysis of geometrical isomers of 9-octadecenoic acid were conducted at $600^{\circ}C$ under nitrogen, and its pyrolytic behaviors were investigated. The pyrolytic products of both fatty acids, cis-9-octadecenoic acid(oleic acid) and trans-9-octadecenoic acid(elaidic acid), were analyzed using a gas chromatograph and GC/MS spectrometer. Twenty-seven different compounds were identified from these pyrolyzates, and the chief products of them were ketones, alcohols and aromatic hydrocarbons. And also, the pyrolytic mechanisms of two geometrical isomers of this fatty acid were discussed by a comparison of experimental results.

황색종 잎담배의 건조과정중 비휘발성 유기산과 지방산의 변화에 관한 연구

이문수,이운철,Rhee, Moon-Soo,Lee, Un-Chul 한국연초학회 1982 한국연초학회지 Vol.4 No.2

During the process of curing of the tobacco (Nicotiana tabacum L. ) leaves the concentration change of Nonvolatile organic acids and Higher fatty acids of the flue-cured tobacco leaves was observed. The contents of Nonvolatile organic acids in flue-cured tobacco leaves were as follows, malic> oxalic>malonic>citric>succinic acid. Higher fatty acids was linolenic>Palmitic>oleic >stearic$\geqq$linoleic acid, Citric acid content of last curing time was increased about 4~5 times in compare to before curing tobacco. It was concluded that significant changes of three variety flue-cured tobacco but a significant difference was observed in the composition of Daegu gold variety.

여대생에서의 월경전기증후군 및 월경전불쾌장애의 특성

이문수,양재원,고영훈,고승덕,조숙행,Lee, Moon-Soo,Yang, Jae-Won,Ko, Young-Hoon,Ko, Seung-Duk,Joe, Sook-Haeng 한국정신신체의학회 2012 정신신체의학 Vol.20 No.1

연구목적 : Premenstrual Symptoms Screening Tool(PSST)를 통해서, DSM-IV상의 월경전불쾌장애(premenstrual dysphoric disorder, PMDD)에 대한 진단기준을 사용하여 월경전기증후군(premenstrual syndrome, PMS) 및 PMDD의 빈도, 기능장애, 위험인자들, 월경에 대한 태도, PMS 및 PMDD의 발현 양상 들을 조사하여 보았다. 방 법 : 서울 및 수도권의 중소도시인 수원에 소재하는 대학교에 다니는 여학생들을 대상으로 하여 월경에의 태도 질문지, PSST를 사용한 단면 조사연구를 시행하였다. 결 과 : 총 1410명에게 질문지가 배부되었으며, 그 중 1063부에 대하여 분석하였다. 응답자들은 PSST의 결과에 따라 3군[정상/경도 PMS군(n=759, 71.4%), 심한 PMS군(n=180, 16.9%), PMDD군(n=124, 11.7%)]으로 분류하였다. 각 군별로는 기본적인 역학적 변수 및 위험 인자(음주, 커피 소비, 월경통의 강도, PMS의 가족력)들의 분포에서 유의한 차이가 있었다. 응답자들을 또한 월경에 대한 태도에 따라 3군으로 구분하였다[긍정적 태도군(n=168), 부정적 태도군(n=122), 양가적 태도군(n=773)]. 심각한 월경전기 증상들을 호소하는 이들의 비율은 이 3가지 태도군 간에 유의한 차이가 있어서, 부정적 태도군은 다른 군들에 비해 더 많은 월경전기 증상들을 보고하였다. 결 론 : PMS와 PMDD는 한국의 젊은 여성들에서 널리 발견된다. 일부 응답자들은 그들이 PMDD에 대한 DSM-IV의 진단기준을 완전히 충족시키지 못하였음에도 유의한 기능손상을 보고하였다. 일반적으로, 월경에 대한 부정적인 태도는 더 많은 월경전기 증상들의 경험과 관련이 있었다. Objectives : We investigated the prevalence and functional impairment of premenstrual dysphoric disorder (PMDD) and premenstrual syndrome(PMS) in young women. Methods : A total of 1063 female college students were recruited from two urban areas(Seoul and Suwon) of Korea. Questionnaires for sociodemographic data and risk factors of PMDD, attitude about menstruation, and the Premenstrual Symptoms Screening Tool(PSST) were applied. Results : The prevalence of severe moderate to severe PMS and PMDD were 16.9% and 11.7%, respectively. There were differences in the alcohol and coffee consumption, severity of menstrual cramp, and family history of PMS among the moderate to severe PMS, PMDD, and no/mild PMS groups. Although some participants did not fulfill diagnostic criteria for PMDD, they showed significant functional impairment. Participants with negative attitude about menstruation reported premenstrual symptoms more frequently than those with positive or ambivalent attitude about menstruation. Conclusion : These results suggest that PMS and PMDD were prevalent and associated with functional impairment in young females. Some participants reported significant functional impairments although they did not meet the full DSM-IV diagnostic criteria for PMDD. Negative attitude about menstruation was associated with more premenstrual symptoms experiences.

천공성 위암의 수술 방법과 치료 결과

이문수,채만규,김태윤,조규석,김성용,백무준,정일권,박경규,김창호,송옥평,조무식,Lee, Moon-Soo,Chae, Man-Kyu,Kim, Tae-Yun,Cho, Gyu-Seok,Kim, Sung-Yong,Baek-Moo-Jun,Chung-Il-Kwon,Park, Kyung-Kyu,Kim, Chang-Ho,Song-Ok-Pyung,Cho, Moo-Sik 대한위암학회 2002 대한위암학회지 Vol.2 No.2

Purpose: Perforated gastric cancer (PGC) is rare and occurs in $1\∼4\%$ of all gastric cancers. Possible dissemination of tumor cells at the time of perforation of the gastric carcinoma has been a matter of concern. The intraoperative determination of what kind of operation should be done and how extensive the lymphnode dissection should be still remains controversial. The purpose of this study is to evaluate the factors influencing the survival and to determine the optimal treatment for PGC. Materials and Methods: A total of 42 patients were operated on for a perforated gastric carcinoma at Soonchunhyang University Chunan Hospital from 1983 to 2000. the age and the sexes of the patients, the location of perforation, the diameter of perforation, the histologic type of the tumor, the depth of wall invasion, the absence or presence of lymph node metastasis / distant metastasis, the stage of disease, the type of operation, and the outcomes were examined. Statistically significant differences were analyzed by using Fisher's exact test. Results: The stage distributions according to the UICC classification were 1 case of stage I, 6 cases of stage II, 17 cases of stage III, and 11 cases of stage IV. An emergency gastrectomy was done in 26 patients ($61.9\%$), with a 5-yr survival rate of $44\%$. The survival of patients was significantly influenced by the depth of wall invasion, the lymphnode metastasis, distant metastasis, the stage of disease, and the type of operation. Conclusions: an emergency gastrectomy is the treatment of choice for most patients with resectable PGC. Choosing more a optimistic surgical approach for potentially curative cases of PGC should be one way to increase the patient's survival rate.

Duvatrienediol의 열변성화합물의 분리 및 확인

이문수,이운철,곽재진,Rhee, Moon-Soo,Lee, Un-Cheoul,Kwag, Jae-Jin 한국연초학회 1987 한국연초학회지 Vol.9 No.2

$\alpha$, $\beta$-4.8.13-Duvatriene-1, 3-diols was identified as the major component of diterponoid extracted from Nicotiana Tabacum L. The isolated duvatriendiol was thermolyged at 300'c under a stream of nitrogen. The approximately 20 compounds were separated from the thermolyzates and the 9 compounds of them were identified with GC/MS. However, the thermolyzates identified in this study differed in distribution from the products under the condition of a different temperature or photooxidation.

뚜렛 증후군에서의 경두개 자기자극술

이문수,Lee, Moon-Soo 한국정신신체의학회 2010 정신신체의학 Vol.18 No.1

뚜렛 증후군은 주로 아동기에 발생하는 만성적인 운동 및 음성 틱을 주소로 하는 질환이다. 기저핵-시상-피질 회로에서의 이상이 비자발성 틱의 병태생리에 중요한 역할을 하는 것으로 생각된다. 뚜렛 증후군은 흔히 주의력 결핍 과잉행동장애나 강박장애와 병존한다. 경두개 자기자극술은 연구용으로 많이 사용되는 신경생리학적 기법이다. 이 기법이 피질의 활성을 변화시킬 수 있다는 증거들이 많아서, 반복적 경두개 자기자극술은 피질의 활성도를 바꾸어서 결과적으로 내재한 서로 연결된 피질-피질하 회로에 영향을 주기 위하여 치료적 목적으로도 사용된다. 우리는 본 논문에서 경두개자극술의 여러 신경생리학적 변인들과 임상적 응용에 관하여 기존의 연구보고들을 고찰하여 보고자 한다. Gilles de la Tourette syndrome is a chronic motor and vocal tic disorder of childhood onset. Abnornmalities in basal ganglia-thalamo-cortical circuits may play an important role in the pathophysiology underlying the involuntary tics. It is often complicated by comorbid attention-deficit/hyperactivity disorder or obsessive-compulsive disorder. Transcranial magnetic stimulation(TMS) is a neurophysiologic technique with research ap-plication. As there is good evidence that this technique can modify cortical activity, repetitive TMS is also used for treatment to change the cortical excitability and therefore affect underlying interconnected cortical-sub-cortical loop. We reviewed the neurophysiologic parameters and the clinical applicability of TMS and rTMS.

항우울제의 복약 순응도

이문수,고영훈,조숙행,Lee, Moon-Soo,Ko, Young-Hoon,Joe, Sook-Haeng 대한생물정신의학회 2010 생물정신의학 Vol.17 No.1

Depressive disorder is a chronic disabling condition with recurrent episodes. Medication noncompliance is a significant problem for effective management of depressive disorder. However, compliance with antidepressant medication is poor. There are difficulties in assessing compliance accurately. Various methods for assessing compliance are in use. A patient's compliance with antidepressant may be affected by many factors including the clinical characteristics of depression, pharmacologic properties of antidepressants, patients' characteristics, accessibility treatment, and doctor-patient relationships. For enhancing the treatment compliance, psychotherapeutic considerations in patient-therapist relationship are needed.

진행성 위암으로 오인된 조기위암 천공 1예

이문수,김성용,오상현,채만규,정일권,백무준,박경규,김창호,조무식,Lee Moon Soo,Kim Sung Yong,Oh Sang Hyun,hCae Man Kyu,Chung Il Kwon,Baek Moo Jun,Park Kyung Kyu,Kim Chang Ho,Cho Moo Sik 대한위암학회 2001 대한위암학회지 Vol.1 No.1

An exceedingly rare case of perforated early gastric cancer is reported. A 68-year-old man developed peritonitis due to perforation of early gastric cancer. An emergency radical operation was performed and was followed by an uneventful recovery. Histologic examination of the surgical specimen showed type III early gastric cancer composed of a signet ring cell carcinoma. Five years after surgery, the patients was alive with no evidence of tumor recurrence. The rarity of this complication in early gastric cancer is discussed, and a review of the literature is presented.