단일공법 복강경하 질식자궁절제술 110예의 고찰 및 다공법과의 비교

박병준 ( Byung Joon Park ),김용욱 ( Yong Wook Kim ),노덕영 ( Duck Yeong Ro ),김태응 ( Tae Eung Kim ),류기성 ( Ki Sung Ryu ),김장흡 ( Jang Heup Kim ) 대한산부인과학회 2010 Obstetrics & Gynecology Science Vol.53 No.7

목적: 통상적인 복강경기구만을 사용한 단일공법 복강경하 질식자궁절제술을 다공법 복강경하 질식자궁절제술과 비교하여 안전성 및 유용성을 평가하고자 하였다. 연구 방법: 2007년 4월부터 2009년 11월까지 인천성모병원에서 자궁근종 또는 자궁샘근증의 질환으로 단일공법 복강경하 질식 자궁절제술을 시행받은 환자 110명과 다공법 복강경하 질식자궁절제술을 시행받은 환자 110명, 총 220명의 환자를 대상으로 하였다. 우리는 모든 수술에서 통상적으로 사용되는 구부러지지 않는 일직선의 복강경기구를 사용하였다. 또한 단일공법 및 다공법 복강경하 질식자궁절제술 둘 다에서 수술자 (Kim, YW)의 이름을 따서 명명한 새로운 질단부 봉합 방법인 김씨 질구개 현수법 (Kim`s Vaginal Vault Suspension Method)을 사용하였다. 결과: 환자 나이, 수술 시간, 자궁의 무게, 혈색소 수치의 변화, 수혈 빈도, 수술 후 발열에서 두 군 간에 유의한 차이를 보이지 않았다. 환자들의 평균 나이는 46.7±7.0세(단일공법)와 45.5±6.3세(다공법)이었다. 평균 수술 시간은 87.2±21.0분(단일공법)과 83.3±20.3분(다공법), 평균 자궁의 무게는 261.4±139.7 g(단일공법)과 257.8±132.9 g(다공법), 평균 혈색소 수치의 변화는 1.1±0.7 g/dL(단일공법)와 1.2±0.6 g/dL(다공법)이었다. 두 군 모두에서 수술 중 장 또는 요로의 손상은 없었다. 두 군 모두에서 각각 한 건의 개복수술로의 전환이 있었다. 단일공법을 시행한 군에서 입원 기간이 유의하게 짧았다(2.6±0.6일 [단일공법], 3.3±0.7일 [다공법], P<0.05). 결론: 통상적으로 사용하는 구부러지지 않는 일직선의 복강경기구를 이용한 단일공법 복강경하 질식자궁절제술은 다공법 복강경하 질식자궁절제술에 대한 안전하고 유용한 대체 수술이 될 수 있다. Objective: To evaluate the safety and feasibility of single-port access laparoscopically assisted vaginal hysterectomy (SPA-LAVH) using conventional laparoscopic instruments compared to multi-port access laparoscopically assisted vaginal hysterectomy (MPA-LAVH). Methods: We reviewed the medical records of 220 patients with uterine leiomyoma or adenomyosis who underwent 110 SPA-LAVH and 110 MPA-LAVH in Incheon St. Mary`s Hospital between April 2007 and November 2009. We performed SPA-LAVH with conventional rigid straight laparoscopic instruments in all cases. We also performed a new vaginal cuff closure method, Kim`s Vaginal Vault Suspension Method, named after the operator (Kim, YW) in both SPA-LAVH and MPA-LAVH. Results: There was no significant difference in patients` age, operating time, uterine weight, hemoglobin change, frequency of blood transfusion, and incidence of postoperative fever between the two groups. The patients` mean age was 46.1±7.0 years (SPA-LAVH) and 45.5±6.3 years (MPA-LAVH). The mean operating time was 87.2±21.0 minutes (SPA-LAVH) and 83.3±20.3 minutes (MPA-LAVH). The mean uterine weight was 261.4±139.7 g (SPA-LAVH) and 257.8±132.9 g (MPA-LAVH). The mean hemoglobin change was 1.1±0.7 g/dL (SPA-LAVH) and 1.2±0.6 g/dL (MPA-LAVH). Neither bowel injury nor urinary tract injury occurred during the operation in the two groups. One of the SPA-LAVH and one of the MPA-LAVH cases were converted to abdominal total hysterectomy. The mean hospital stay time was shorter with SPA-LAVH (2.6±0.6 days [SPA-LAVH] and 3.3±0.7 days [MPA-LAVH], P<0.05). Conclusion: SPA-LAVH using conventional rigid straight laparoscopic instruments can be offered as a safe and feasible alternative to MPA-LAVH.

면양에서 개량된 제1위 누관 형성술 1례

김명철,김종만,김용국,김덕환,이영원 충남대학교 수의과대학 동물의과학연구소 1999 動物醫科學硏究誌 Vol.7 No.-

We performed rumen fistula operation in a sheep. In sheep, the procedure for a rumen fistula is quite successful, but choice of an appropriate cannula is of prime importance. The sheep was anesthetized by xylazine(0.1 ㎎/㎏ IM) administration 5 minutes after administration of atropine sulfate(0.1 ㎎/㎏ IM). We inserted rubber cannula in rumen incised and put rubber ring after employing purse-string suture in rumen. We marked the area for the puncture incision in the body wall through which the cannula is drawn. We drew the cannula as near the transverse process of the lumbar vertebrae as possible to minimize leakage. We isolated the cannula by fixing the stainless washer which has small holes. The sheep was given postoperative penicillin(20,000 IU/㎏ IM) to prevent secondary infection for 3 days. There were not observed the leakage of rumen contents, the entering of rubber cannula into abdominal cavity, and necrosis on incision site and skin, over months after surgery.

위절제술 환자의 표준진료지침 개발 및 적용 효과

김은희,김철규,이순교,김순덕,이혜옥,권정순,이경미,이민미,심순미,유용만,신종식,강은희,이상일,김병식,오성태,육정환,박수길 한국의료QA학회 2003 한국의료질향상학회지 Vol.10 No.2

Background : Gastric cancer is the most common malignant tumor in Korea. surgical operation is one of the major treatment modalities for gastric cancer patients. Therefore, gastrectomy is one of the most common procedures in General Surgery. There were variation in length of hospital stay and medical treatment for gastrectomy between three surgeons at Asan Medical Center. Clinical pathways have received considerable attention as a tool for recucing the medical practice variation, increasing the efficiency of care process, and improving the quality of care. The aim of this study was to evaluate the effect of a clinical pathway for gastrectomy in gastric cancer patients. Methods : The clinical pathway for gastrectomy was developed and implemented by a multidisciplinary group in Asan Medical Center. A computerized clinical pathway program was developed and revised after a pilot test. A total of 145 patients underwent gastrectomy by three surgeons at Asan Medical Center. We compared the length of hospital stay, patient satisfaction, and unplanned readmission rate between the pre-pathway group(n=67) and the post-pathway group(n=78). We also investigated the degree of satisfaction among the physicians and nurses who were main end-users of the clinical pathway. Results : The clinical pathway was applied to all target patients. The average length of hospital stay was shortened from 12.7days to 10.6days(p<0.01). The degree of patient satisfaction with the care process changed from 90.3% to 89.2% after the implementation of the clinical pathway, but the difference was of satistically significant(p=0.761). Unplanned readmission rate was 2.9% in the pre-pathway group. More than 90% of physicians and nurses answered that the clinical pathway had been a useful tool in their medical practice. Conclusions : The findings of the study demonstrated that implementation of the clinical pathway for gastrectomy produced substantial reduction in the length of hospital stay while improving the quality of patient outcomes. The computerized clinical pathway program can be used as one of the powerful patient management tools for reducing the practice variations and increasing the efficiency of care process in Korea hospital settings.

급성신부전증 이환견에 대한 복막투석 치료 1례

김건우,이병희,김유수,심재현,김지용,이영원,김덕환,송근호 충남대학교 수의과대학 동물의과학연구소 2004 動物醫科學硏究誌 Vol.12 No.-

A fourteen-month-old intact female Poodle was referred to the Veterinary Teaching Hospital, College of Veterinary Medicine, Chungnam National University. The patient was presented with history of vomiting, inappetence, ataxia, insomnia, tachypnea and convulsion for 5 days. Biochemical examination revealed BUN (254.2 mg/dl), creatinine (9.22 mg/dl) and phosphate (14 mg/dl). Epithelial cells of urinary tract, neutrophils, macrophages, a large number of gram negative and smaller number of gram positive bacteria were presented on urine test. Ultrasonographic findings show hyperechogenic kidney and indistinguishableness of renal cortex and medulla. Based on the results of examination described above, this case was diagnosed as acute renal failure with interstitial nephritis by urinary tract infection (UTI). Treatments with fluids therapy, diuretics, and peritoneal dialysis during hospitalization showed good results with no clinical signs.

개에서 발생한 폐수종의 치료 증례

김유수,심재현,김건우,김지용,이병희,송근호,이영원,김덕환 충남대학교 수의과대학 동물의과학연구소 2004 動物醫科學硏究誌 Vol.12 No.-

A 9 months intact male American bull dog with chief complaints of dry cough, dyspnea and fever was referred to the Veterinary Teaching Hospital, Chungnam National University. Based on the findings of physical examination, radiological examination, and blood and blood chemical examinations, the present patient was diagnosed into pulmonary edema secondary to primary bacterial and aspiration pneumonia. The patient was hospitalized and treated with buscopan, cephazolin and furosemide for 1 week. His activity and appetite was returned to normal and thoracic radiographs revealed that Jung was recovered to the normal condition after treatment for 7 days. The present patient was a case with pulmonary edema showed favorable therapeutic responses to proper medication.

오스카 와일드의 희극에 미친 여러 가지 영향

김용덕 東亞大學校 1996 東亞論叢 Vol.33 No.-

This is an attempt to study influences on Oscar Wilde's comedies; the French influence by comparing French thesis play with Wilde's Lady Windmere's Fan An Ideal Husband, Ibsen's influence by contrasting Pilars of a Society with An Ideal Husband and that of the English comedy of manners by analyzing A Woman of No Importance. Many critics have complained about Wilde's indebtedness and adherence to a tradition that was already established in comic drama; post-romantic French drama and the plays of his English contemporaries. Our superficial understanding of his plays might lead to the false conclusion that his achievement lay merely in putting together melodramatic situations, using techniques from the well-made play, and projecting them onto a background of social criticism in the problem play. The real problem of his plays is the tension between men and women, the individual and society, between public and private life, and between established norms and their deliberate violation. There is little denying that in his first three comedies Wilde was burdened with the tradition of French thesis play. But compared with the theses of Dumas fils and Augier, Wilde's were less conventional. In all his three comedies there is a secret that either sets the plot in motion or at least has a decisive influence on its course. Futhermore, this secret always concerns something in conflict with social or moral convention, that is, the indiscretions of Mrs Erlynne and Mrs Arbuthnot in lady Windmere's Fan and A Woman of No Importance, and the corruption of Robert Chiltern in An Ideal Husband. In particular the moral scheme of the plot in An Ideal Husband has, demonstrably, some unusual implications, which reflect the tolerance and compromise of Lady Windmere's fan rather than the moral absolutes of A Woman of No Importance. In Lady Windmere's Fan and A Women of No Importance Wilde attacked an uncompromising attitude, such as Dumas and Augier took, towards the demi-mondaine, and in An Ideal Husband the demi-mondaine, though foiled, is not humiliated. But It is only with his complete escape from the thesis play in The Importance that Wilde realized his potentiality in comedy Despite the fact that Wilde continually touches on the conflict between public and private life, we cannot assign leis comedies to the genre of the problem play like that of Henrik Ibsen. The tradition of problem play did not suit Wilde at all, for it ran contrary to his anti-realistic concept of art and he was not really interested in social reform. The impact of Ibsen on England helped to develop the English "problem play" of the nineties, when English drama lagged so far behind French drama that the first effect of Ibsen on English drama was merey to encourage it in going as far as Augier and Dumps. Like Shaw, Barrie, Jones, Fryers. and the rest. Wilde yielded to the epidemic temptation to rewrite Ibsen, such as taking overt drammatic situations in Ibsen, but more often added something distinctive of his own - a comic twist or like Austin Fryers, a transformation of Ibsen's text to make an effect and a point uniquely his. Especially in An Ideal Husband Wilde realized his ambitious self-conception as the peer of Ibsen' by producing shock waves capable of reaching us today through shaking the pillares of society. It should not be supposed that Wilde is attempting to imitate any one genre rather than anther; however, the Individua1 kind of comedy which he initiated and developed has even stronger affinities with the English than with the French trandition. One striking principle of construction In his comedies, which corroborates such a view, is the way in which it is organized, in part, by means of hierarchy of wit based on traditional English comedy of manners. Such a scheme would place the chief spokesmen of Wildean dandyism such as Mrs Erlynne, Lord Darlington, Lord Illingworth and Lord Goring, and two couples of lovers in The Importance in the highest rank, their tone being echoed by choric figures and the sincerely earnest at the bottom. In A Woman of No Importance Wilde created the world of a next-restoration conclict by restating a number of the standard situations of Restoration comedy, and using the stock antitheses of the genre - town and country, wits and sentiment, libertine and courtly attitudes, men and women, cits and aristos - as thc basis of reference for a critical treatment of some of the real issues of the age' There is no denying that he was interested not only in matters of technique, but also in the themes used by his predecessors; however, he made two vital contributions to the development of British drama: a new style of language and a new critical perspective. His alternation of techniques in style of language - non-commitment, witty aphonsms, paradoxes, hidden dialogue and direct expression - was the original feature that emanated directly from his own peculiar gifts, and his new critical perspective consisted in his scepticism as regards the efficiency of communication at a time when social consensus was becoming increasingly difficult, his focus on the dilemma of a the Individual seeking meaningful identity in the clash between public and private life, and his undermining of traditional conventions. Thus the works of T. W. Robertson, S. Grundy, H. A. Jones and countless other nineteenth-century playwrights have been more or less forgotten, whereas Oscar Wilde's comedies have load an asset of tremendous value, that of appealing to the common man.

병재배 폐톱밥을 이용한 양송이 복토재료 개발에 관한 연구

김홍규,이희덕,김용균,한규홍,문창식,김홍기 충남대학교 생물공학연구소 1999 생물공학연구지 Vol.7 No.-

애느타리 병재배후 탈병한 톱밥을 3월 중순 퇴적하여 부숙시킨 결과 퇴적기간에 따른 폐톱밥의 부숙정도는 퇴적 30일이후에 가장 컸으며 부숙 소요일수는 최소 48일이었다. 퇴적 기간에 따른 폐톱밥의 pH 및 총 질소 함량은 부숙이 진전됨에 따라 증가하는 경향이었고 총 탄소 및 C/N율은 시간이 경과함에 따라 감소하는 경향이었다. 식양토에 부숙이 완료된 톱밥을 부피 비율로 10, 30, 50%씩 첨가하여 복토 재료로 사용한 결과 30% 첨가시 식양토 단용 처리보다 A. bisporus 균사 생장이 촉진되고 초발이 소요일수가 5일 빠르며, 수량에 있어서도 28% 증수되었다. After bottle culture of Pleurotus ostreatus, sawdust was taken out from the bottle and accumulated in the middle of March, and then composted. As the result, Y value was decreased rapidly 30 days after composting, and it was decreased slowly after 30 days. It is considered that 118 days is required for composting, however, it is possible to use for casing material after at least 48 days composting. The pH and total nitrogen content of sawdust based on composting period had tendency to increase as composting was processed. Total carbon and C/N rate had tendency to decrease as time went on. Based on the rate of 10, 30 and 50%, each sawdust was added to clay loam used as casing material for culturing A. bisporrus. Among various treatments, the mycelial growth of A. bisporus was more favorable in the treatment of 30% sawdust than in the single treatment of clay loam. Based on the date necessary for primodium formation of A. bisporus, the primodium formation in the treatment of 30% sawdust was reduced to about 5 days as compared with that of any other treatments When 30% sawdust was added to clay loam used as casing material for culturing A. bisporus, the yield of its fruiting body was increased to 28%.

복합열화환경 하에서의 단면복구재의 철근부식특성 평가에 관한 실험적 연구

김영덕,박종호,조봉석,김용로,권영진,김무한 대한건축학회 2004 대한건축학회 학술발표대회 논문집 - 계획계/구조계 Vol.24 No.1

The duties of the restorative material are to bear up against stress and to protect reinforcement corrosion. So the restorative material are estimated by various kinds of strength, permeability and etc. But to evaluate performance of the restorative material accurately, it is necessary to estimate their reinforcement corrosion directly in environment of combined deterioration. In this study, to evaluate performance of restorative materials, we compare their properties in terms of compressive and bending strength and permeability of water and air with actual reinforcement corrosion like ratio of corrosion area, weight reduction and corrosion velocity of steel bar under environment of complex deterioration. The results showed that strength and permeability of restorative materials are similar but their reinforcement corrosions are very different. And there is a case that strength and permeability of restorative material are better than normal concrete but reinforcement corrosions are worse.

韓國 古典小說에 나타난 道仙的 生死觀

金容德 漢陽大學校 人文科學大學 1983 人文論叢 Vol.5 No.-

The aim of this paper is to survey the Taoistic view of birth and death in the Korean classic novels. The main concern lies in the study of birth and death expressed in the beginning and conclusion of the works. There are four types of Taoistic view of birth and death; one views birth and death as the same, another views life as eternal, another views birth and death as phantastic, the other views birth and death as a cycle cosmos. These views are described as a subject, a biographt, or a theme of the works. The Taoistic view of birth and death are mostly a subject matter of the work when it is dealt with in the novels. The exemples of a subject matter are following; Fifst, a star, a dragon and a fairy are advented on the earth. Second, a flower and a bead are personified. Third, the dead can be resurected by a panacea. Biography is the expression of desire to be immortal. Every human being wants to live for a long time, which is depicted in the novels. In the works 'Choigounjeon' (崔孤雲 傳) and 'Jeonuchi Jeon' (田禹治 傳) are representitive cases. The theme is the expression of idea to transend birth and death, which is the main thought of 'Noza'(老子) and 'Chany Ja'(莊子) This concept consists of the theme of novels, which can be seen in such works as 'Kuunmony'(九雲夢) and 'Ogrunnoy' (玉樓夢) The Korean classic novels necessarily deal with birth and death, so that I believe this paper dealing with the problem will serve to understand the essence of them.

A Woman of No Importance의 구조와 주제

김용덕 동아영어영문학회 1998 동아영어영문학 Vol.14 No.-

This is an attempt to study the thematic structure of Wilde's second successful society drama, A Woman of No Importance, through the close examination of the play. Wilde's doctrine was in essence that of a utopian anarchist, preaching the doctrine of individualism and aestheticism. Wilde always liked to create manly women and womanly men, as a challenge to the stratified thinking of his day and demonstrates through the characterization of female leads that the gender-antitheses of the age were almost meaningless. The play appears to be a conventional melodrama of seduction and judgement, a play whose only originality is to plea for greater leniency for repentant fallen women and harsher punishment for fallen men. Yet with the construction of A Woman of No Importance Wilde attempted to find a dramatic method for the presentation of thought as action, to challenge the century's convention. A consequence of this radical experiment is that the play suffers from inconsistencies of style and it has been underestimated in Wilde's canon. A Woman of No Importance is not a play of 'action', a traditionally male preserve, but 'a woman's play' of female leads. Female characters dominate the play and three types of 'new woman' are delineated in the characters of Mrs. Arbuthnot, Hester, and Mrs. Allonby. Together they act out a confrontation with all sexual laws and restrictions, showing them to be both ineffectual against the power of passion and impulse. Whereas the women of Hanstanton take advantage of their supposedly weaker status to manipulate the men around them, Mrs. Arbuthnot struggles with an absolute morality which denies all her true instincts as a woman Thus every woman in this play is an individualist in her own way, while male dandy Lord Illingworth leaves the stage, defeated and insulted not for interfering Hester's puritan standards but for compromising his own, that is, for lack of true individualism.