Acute Abdominal Emergencies

김종일(JI Kim) 대한산부인과학회 1979 Obstetrics & Gynecology Science Vol.22 No.1

지명토론자 : 황태식 [질문1] Uterune rupture에 있어서 simple suture와 tubsl ligation하는 경우에 어떤 원칙을 가지고 있는가? [질문2] Previous Cesarean section시 이화대학 병원의 분만방법은 어떤 원칙으로 하고 있읍니까? [질문3] 임신중 자궁근종의 red degeneration의 증상으로 myomectomy를 한경우가 있었는지? [질문4] Ovarian cyst가 분만중 파열된 경우 수술전 진단은 어떻게 하는가?

모성 산욕이환율에 관한 임상적 고찰

김종일(JI Kim),유한기(HK Yoo),김재욱(JU Kim) 대한산부인과학회 1973 Obstetrics & Gynecology Science Vol.16 No.4

1971년1월1일부터 12월31일까지 만 1년간 연세대학교 의과대학 산부인과에서 분만한 총 2748명의 산모중 이환되었던 200예에서 다음과 같은 결과를 얻었다. 1. 이환율의 발생빈도는 5.64%였고 이중 질식분만예에서는 3.60%였다. 2. 연령분포별로는 20세 이하군과 35세이상군에서 현격한 증가를 보였다. 3. 입원당시 파막유무에 따른 이환율은 파막된 예에서 14.1%로 정상군에 비해서 2배의 이환율의 증가를 보였다. 4. 질식분만시 분만방식에 따른 이환율은 겸자분만과 같은 수술적 방법에 의한 경우가 비교적 높은 이환율을 보였다. 5. 질식분만시 적응증에 따른 이환율은 태아절박사와 같은 응급수술을 요하는 예에서 현격히 증가했고 태반조기박리와 전치태반과 같이 출혈을 동반한 경우에는 높은 빈도를 보였다. 6. 임신중독증시에 정상군에 비해 높았고 특히 전자간중증시에 높은 이환율을 보였다. 7. 입원단시 이환예의 빈혈빈도는 20.5%였고 분만 제3일째 빈혈빈도는 46%로 이환예의 높은 빈혈빈도를 보였다. 8. 태반자연만출시 이환율은 3.5%, 태반용수박리시에는 29%로 증가하였다. 9. 이환예의 발열원인중 자궁내막염이 20.0%로 제일 많았고 회음부절개술면의 감염이 15.5%, 수술창면의 감염이 5.5%였다. Standard morbidity of American Committee of Maternal Welfare is a temperature of 100.4 F. on any two postpartum days following the first 24 hours through the tenth postnatal days. A clinical analysis has been made on 200 cases of maternal morbidity based on 2,748 deliveries at the Dapartment of Obstetrics and Gynecology of Severance Hospital from Jan. 1, 1971 to Dec. 31, 1971. The results are as follows; 1. The incidence of over all maternal morbidity rate was 5.6%. 2. Morbidity rate was increased in group of less than 20 year old and more than 35 year old. 3. Morbidity rate of ruptured fetal membrance on admission was 14.1%. 4. Morbidity rate was increased in operative vaginal delivery as compare to normal spontaneous vaginal delivery. 5. Morbidity rate was markedly increased in emergency C-section such as fetal distress and hemorrhagic diseases as placenta previa or abruptio placentae. 6. Morbidity rate was increased in toxemia of pregnancy especially in pre-eclampsia severe form. 7. Antepartum anemia was present in 20.5% of the morbidity cases. 8. Morbidity rate was increased 8 times in mannual removal of placenta than normal spontaneous expulsion of placenta. 9. Main causes of morbidity were endometritis, episiotomy wound infection and operative wound infection.

임신과 동반한 재생불량성 빈혈 1 예

김종일(JI Kim),황명심(MS Hwang),김영인(YI Kim),김정현(JH Kim),안기범(KB Ahn),왕영미(YM Wang),조경훈(KH Cho),박종규(JK Park) 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.11

Pregnancy-associated aplastic anemia is an uncommon problem and conditions in which an acellular or markedly hypocellular bone marrow results in pancytopenia(anemia, neutropenia, and thrombocytopenia). In most cases, aplastic anemia and pregnancy appear to have been a chance association. We experienced one case of pregnacy-associated aplastic anemia and so we present it with brief review of literature.

국소마취하에 Le Fort Operation에 의한 자궁탈교정술

김종일(JI Kim),장병우(BW Chang) 대한산부인과학회 1996 Obstetrics & Gynecology Science Vol.39 No.12

Objective: Our purpose was to evaluate and compare the Le fort partial colpocleisis in the medically compromized elderly population using intravenous sedation and local anesthesia, and conventional surgical repair using general anesthesia. Study design: A retrospective data collection sequential seriese of 10 patients performed Le Fort partial colpocleisis using local anesthesia. The patients age, operative time, change in hemoglobin, days of hospitalization, medical illness, duration of catheter insertion, complication and follow up of are retrospective group of 23 women with complete uterine prolapse who had a vaginal hysterectomy, anterior with posterior colporrhaphy performed by the same surgical team during same period. Result: The median age of Le fort partial colpocleisis was 71.2 years(range 64 to 82 years), wherease median age in the vaginal hysterectomy group was 59.6 years(range 45 to 75 years)(p

임신중 급성복부질환

김종일(JI Kim) 대한산부인과학회 1979 Obstetrics & Gynecology Science Vol.22 No.1

급성복부질환 환자의 주소와 경과는 짧아, 단 시간 내에 정확한 진단과 치료를 요하는 질환으로, 진단이 지연되므로 사망율과 이환율이 증가된다. 특히 임신시 급성복부질환이 생겼을 때는 임신으로 모체의 새리적 및 신체적인 변이로 정확한 진단이 어려워지고 오진율의 증가로 모체사망율 및 이환율이 증가되고 태아에 미치는 영향으로 유산 및 조기진통을 유발하여 태아 생존율을 감소시킨다. 그러므로 임신이 어떤 급성 복부질환에 및치는 영향과 급성복부 질환이 임신 자체에 미치는 영향을 잘 파악하여 환자를 처ㅣ하는 것이 중요하다. 수술 자체로 인한 태아 사망율은 예상 유산유르 보다 높지 않고 수술지연으로 인한 합병증이 생겼을때 태아 사망율 미 유산의 빈도가 증가한다. 임신중 모체의 생리적 신체적 변화 임신중에는 Table 1에서와 같이 커진 임신자궁에 의한 복강내 장기가 압박되는 기계적인 영향과 progesterone과 같은 홀몬 변화에 의한 생리적인 변화가 있어 오진하거나 진단이 지연되는 수가 많다.

선천성기형에 대한 연구

김종일(JI Kim) 대한산부인과학회 1992 Obstetrics & Gynecology Science Vol.35 No.12

This report was based on the 211 cases of the congenital anomalies of newborn infant among 22384 cases of deliversies from Jan. 1. 1981 to Dec. 31. 1990 at Ewha Womans University Hospital. The analyzed result were as follows; 1. The overall incidences of the congenital anomalies were 211 cased (0.96%) among 22384 cases of deliveries. 2. The incidence of congenital anomalies of over 35 year old group was 1.23%, that of 30-34 year old group was 1.04%, and that of 25-29 year old group was 1.02% and that of under 24 year old group was the lowest (0.46%). 3. The incidence of the congenital anomalies according to parity was the highest in the para 2 groups (1.09%), and that of nullipara group was 0.09% and that of para 1 group was 1.00% and that of over para 3 group was 0.91%. 4. The frequency of the congenital anomalies in male baby (1.00%) was slightly higher than that of female baby (0.88%). 5. The incidence of the congenital malformed premature babies (3.66%) was higher than that in matured babies (0.68%). 6. The incidences of the type of congenital anomalies was 23.2% in central nervous system, 21.8% in digestive system, 17.0% in multiple anomaly, 13.7% in musculoskeletal system, 11.3% in cardiovascular system and 3.3% in skin. 7. The incidence of the perinatal death of the congenital anomalies was the highest in the central nervous system (77.5%), and then the next incidence of multiple anomaly was 72.2%, and chromosomal anomaly 33.3%, musculoskletal anomaly 20.7%, digestive anomaly 17.4%, but none in skin anomaly and urogenital anomaly. 8. Among women who had delivered at least one baby with congenital anomaly, 4.3% of all women was abnormal in chromosomes and 43 women were exposed to adverse environmental factors. 39 cases of women had histories of taking various medications, especially herb drugs which took during the first trimester of pregnancy. But 73.9% of all women had shown unknown causes.

빈혈을 동반한 자궁근종 환자에서 경구용피임약을 이용한 자가수혈효과에 대한 임상연구

김종일(JI Kim),장병우(BW Chang) 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.11

Oral contraceptive user had less menstrual blood loss, which reduced the risk of iron dei- ficiency anemia by 50%. The incidence of menorrhagia, irregular menses and intermenstrual bleeding is also singificantly reduced in the user of oral contraceptives. In most women with leiomyomas, low-dose oral contraceptive use provide the noncontraceptive benefit of a reducti-on of menstrual flow, with resultant improvement in hematocrit. So, we confirmed that anemic leiomyoma patients with oral contraceptive use showed autotransfusion effects given by preo-perative administration orally during some period.

In-vitro와 Ex-vivo MTT Assay를 통한 직장암의 방사선치료 감수성 예측 가능성 검증

김지은(Ji Eun Kim),김미숙(Mi-Sook Kim),강창모(Chang Mo Kang),김종일(Jong Il Kim),신혜경(Hye Kyung Shin),최철원(Chul Won Choi),서영석(Young-Seok Seo),지영훈(Young-hoon Ji) 대한방사선종양학회 2008 Radiation Oncology Journal Vol.26 No.3

목 적: 암환자의 방사선 치료 전 방사선에 대한 감수성을 미리 측정할 수 있다면 임상적으로 많은 도움이 될 것이 다. 본 연구는 전 임상 실험을 통하여 MTT assay가 세포집락 측정기법과 비교해서 방사선 감수성을 예측할 수 있 고, 직장암 환자의 조직에 사용할 수 있는지 가능성을 확인하고자 하였다. 대상 및 방법: 대장암 세포 주인 HCT-8, LoVo, CT-26, WiDr을 이용하여 세포집락 측정기법을 통해 세포생존곡선 및 2 Gy에서의 세포생존확률(SF2)을 구하였다. 세포 주 자체를 대상으로 MTT assay를 시행하는 실험(in vitro) 및 환자의 암 조직과 같은 상태를 만들기 위하여, 누드 마우스에 세포 주를 주입하여 암 조직을 형성한 후 in vitro와 같은 방식으로 MTT assay를 시행(ex vivo)하였다. 이 두 실험에 대한 흡광도 값에 따른 저해율(inhibition rate, %)을 구하였다. 결 과: SF2 및 세포생존곡선에 따르면 CT-26 및 LoVo가 HCT-8, WiDr에 비해 방사선에 민감하였다(p<0.05). In vitro MTT assay 결과 WiDr, HCT-8, LoVo와 CT-26의 방사선 저해율이 각각 17.3%, 21%, 30%, 56.5%를 나타내었다. 또한 ex vivo MTT assay의 저해율은 HCT-8, WiDr, LoVo와 CT-26에서 각각 23.5%, 26%, 38%, 53%를 나타내었다. 통계적인 차이를 감안하였을 때 세포생존곡선을 통해 얻은 방사선 감수성의 결과와 동일한 순서를 가졌다.결 론: 4개의 세포 주의 방사선의 감수성의 순서가 세포집락 측정기법 및 in vitro와 ex vivo MTT assay 결과에서 거의 일치함을 보였다. 이는 직장암 환자에서 MTT assay를 통해 방사선 감수성을 예측할 수 있는 가능성을 제시하였다. Purpose: The measurement of radiosensitivity of individuals is useful in radiation therapy. Unfortunately, the measurement of radiation survival using a clonogenic assay, which is the established standard, can be difficult and time consuming. The aim of this study is to compare radiosensitivity results obtained from the MTT and clonogenic assays, and to evaluate whether the MTT assay can be used on clinical specimens. Materials and Methods: HCT-8, LoVo, CT-26, and WiDr were the colon cancer cell lines used for this study. The clonogenic assay was performed to obtain the cell survival curves and surviving fractions at a dose of 2 Gy (SF2) as the standard technique for radiosensitivity. Also, the MTT assay was performed for each of the cell lines (in vitro). To simulate clinical specimens, the cell lines were inoculated into nude mice, removed when the tumors reached 1 cm in diameter, and chopped. Next, the tumors were subjected to the same process involved with the MTT assay in vitro. The inhibition rates (IR) of 10 Gy or 20 Gy of irradiation for in vitro and ex vivo were calculated based on the optical density of the MTT assay, respectively. Results: According to SF2 and the cell survival curve, the HCT-8 and WiDr cell lines were more resistant to radiation than LoVo and CT-26 (p<0.05). The IR was measured by in vitro. The MTT assay IR was 17.3%, 21%, 30% and 56.5% for the WiDr, HCT-8, LoVo and CT-26 cell lines, respectively. In addition, the IR measured ex vivo by the MTT assay was 23.5%, 26%, 38% and 53% in the HCT-8, WiDr, LoVo and CT-26 tumors, respectively.Conclusion: The radiosensitivity measured by the MTT assay was correlated with the measures obtained from the clonogenic assay. This result highlights the possibility that the MTT assay could be used in clinical specimens for individual radiosensitivity assays.

폐경전 자궁적출술을 시행받은 여성과 자연폐경 여성에서 에스트로겐 단독투여와에스트로겐+프로게스틴의 지속적 병합투여시 지질 및 고밀도의 변화에 대한 연구

김희옥(Hee Ok Kim),유민영(Min Young Yoo),김연정(Youn Jung Kim),박지은(Ji Eun Park),양훈진(Hoon Jin Yang),유은희(Eun Hee Yoo),전선희(Sun Hee Chun),김종일(Chong Il Kim),유한기(Han Ki Yu) 대한산부인과학회 2000 Obstetrics & Gynecology Science Vol.43 No.10

Objective : Our purpose was to investigate the effect of single estrogen and continuous combined estrogen + progestin on lipid profile and bone mineral density.Method : We have treated two groups of menopausal women for 4 years, ; Group 1(hysterectomised women) received conjugated equine estrogen(CEE) 0.625mg per day for 30 days ; Group 2(natural menopausal women) received continuous combined therapy(CEE 0.625mg and MPA 2.5mg per day) for 30 days.We compared pre-and poststudy serum lipid profile and bone mineral density in two groups.Result : The data demonstrated a beneficial effect in lipoprotein profile that total cholestrol decreased in two groups by 9.9% and 10.8% from the baseline values. Low density lipoproten(LDL)-cholesterol decreased in two groups by 20.1% and 16.3% in post HRT 48 months, high density lipoproten(HDL)-cholesterol increased in two groups by 21% and 31.9%. And HRT shows the beneficial effect in bone mineral densities. Lumbar BMD increased in two groups by 11.6% and 14.9% and femur BMD increased in two groups by 12.9% and 14.9% from the baseline value.Conclusion : Our result suggest that single estrogen therapy and continuous combined estrogen-progestin therapy has beneficial effect on cardiovascular disease and osteoporosis. Their effects were not significantly different among two groups. So we suggest that continuous combined estrogen-progestin therapy is preferable to single estrogen therapy.

경부 경막외 차단을 이용한 연속성 딸꾹질의 치험 3예

이지향(Ji Hyang Lee),김종일(Jeng Il Kim),민병우(By 대한통증학회 1997 The Korean Journal of Pain Vol.10 No.2

Persistent hiccup is defined as duration lasting longer than 48 hours. Reflex arc of hiccup is divided into three parts: afferent, central, efferent. Afferent portion of the neural pathway of hiccup formation is composed of vagus nerve, phrenic nerve, and sympathetic chain arising from T6 to T12. Efferent limb is phrenic nerve. Hiccup center is located in brain stem, midbrain, reticular system and hypothalamus. Persistent hiccup is very difficult to treat by conventional methods. We performed cervical epidural block of the phrenic nerve root for three patients suffering from persistent hiccup. The therapeutic effect was perfect. The mechanism of the cervical epidural block is not yet defined however it is thought to block the efferent nerve fibers and suppress the reflex arc of hiccup. We conclude cervical epidural block is relatively safe and very effective for treating persistent hiccup.