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SEMM방식에 의한 골반경 자궁적출술 ( CISH ) 의 임상적 경험 43 예
손찬우(CW Son),유은희(EH Yoo),고창원(CW Ko),이기훈(KH Lee),김희수(HS Kim),심재욱(JU Shim),이승호(SH Lee) 대한산부인과학회 1994 Obstetrics & Gynecology Science Vol.37 No.11
Classical intrafascial SEMM hysterectomy (CISH) is a synthesis of cervical conization, supracervical amputation and operative laparoscopy to constitute a new type of hysterectomy compatible with the concept of minimally invasive and organ preserving surgery. We have experienced of 43 cases of CISH at Cheil General Hospital from November, 1992 to April, 1994. There were three cases where CISH was stopped and total abdominal hysterectomy was done because of the following reasons: the size of the uterus being too large to apply endoloop around the cervico-corporeal junction, severe pelvic adhesion and subcutaneous emphysema. The average age of patients was 43 years old. Indication were 17 cases of uterine myoma(42.5%), 15 cases of adenomyosis(37.5%), 5 cases of ovarian tumor(12.5%), 2 cases of abnormal uterine bleeding(5.0%) and 1 case of endometiral hyperplasia(2.5%). In size of uteri, 8 gestational weeks size was the most common, being 14 cases(35.0%), and the size of uteri varied from 6 to 12 gestational weeks. We have performed subtotal hysterectomy preserving the cervix whereas squamo-columnar junction and endocervical glands being revomed to prevent potentia occurrence of cervical cancer in future. The cervical shell connected by uterine ligaments was preserved to maintain the normal pelvic floor to minimize postoperative infection and to accelerate early recovery. Initially, the mean operation time was 310 minutes. With accumulation of operators experience it was reduced to 198 minutes. The hemoglobin was reduced by 1.66 gm/dl and the hematocrit by 4.57%. There were 2 cases of massive bleeding during operation and 3 cases of minimal cervical bleeding, 2 cases of dysuria, 1 case of febrile morbidity and 1 case of severe headache postoperatively. The average hospitalization was 6 days. The average days of return to domestic activity was 21.5 days. In conclusion, CISH was compatible with minimally invasive and organ preserving surgery and showed shorter operation time with subsequent quick recovery of patients and the reduction of complications. Moreover, hospitalization can be shortened. The important factors in maximizing these advantages of CISH were the experience of the operator, the size of the uterus, and the degree of the pelvic adhesion.
조직학적으로 확진된 자궁경부 상피내종양 및 침윤암 1000예에서 평가한 자궁경부 세포진검사의 위음성률에 관한 연구
김희수,백희수,손찬우,이기헌,심재욱,박종택,전종수,박인서,김희숙,박종숙 대한부인종양 콜포스코피학회 1995 Journal of Gynecologic Oncology Vol.6 No.1
The cervical smears represent the most effective technique to detect and prevent cancer of the uterine cervix, its false-negative rate is still a reason of concern among pathologists and gynecologists. This study was performed to determine the false - negative rate in cervical smears and to evaluate the causes for false negatives. The histologically confirmed consecutive 1,000 cases of Squamous Intraepithelial Lesion(SIL) and Squamous Cell Carcinoma(SCC) of the uterine cervix from the surgical files of Department of Pathology, Cheil General Hospital, from January 1992 to June 1993 were collected. All cervical smears of 1,000 cases, which obtained prior to pathologic diagnosis made, were evaluated based on cyto-histologic correlation. The false negatives were identified and cervical smears were reviewed. The reasons for false negatives were analysed as well. 'I'he results are as follows : 1. Histologic diagnoses of 1,000 cases include 252 cases of Low grade SIL(LSll.), 484 cases of High grade SlL(HSIL) and 284 cases of SCC. 2. 60 cases were identified as false negatives. The false - negative rate was 6%(60/1000). Those 60 cases of false negatives were 31 cases(51.7%) of LSIL, 23cases (38.3) of HSIL and 6 cases(10%) of SCC. 3. False- negative rate were 12.3%6(31/252) of LSIL, 4.8%(23/484) of HSII. arid 2.1%(6/284) of SCC. 4. In 58 of 60 eases reviewed, the sampling error were 75.9%(44/58) and screening error were 24.1%(14/58). 5. Sampling error were 65.9%(29/44) of LSIL and 2.3%(1/44) of SCC. 6. Screening error were 4 cases of LSIL, 6 cases of HSIL and 4 cases of SCC. In conclusion, the major of false negatives was sampling error and the major lesion of false negativity and sampling error was LSIL. These findings suggest that LSIL should require further investigation by colposcopy, cervicography and HPV Test in order tx reduced the false-negative rate. The supporting of sufficient clinical informations, good supervision and training of cytotechnologist, use of automated cytologic screening system in order to reduced false-negative rate in HSIL and SCC.
손영관(Young Kwan Sohn),손찬우(Chanwoo Sohn),윤우석(Woo Seok Yoon),정종옥(Jong Ok Jeong),윤석훈(Seok-Hoon Yoon),조형성(Hyeongseong Cho) 대한지질학회 2021 대한지질학회 학술대회 Vol.2021 No.10
송악산은 제주도 남서부 연안에 만들어진 현세의 응회환이다. 송악산 응회환은 대부분 대기 하 환경에서 화쇄난류에 의해 쌓였으나 기저부와 중간 부분에는 파도의 작용으로 쌓인 층이 협재되어 있다. 기저부의 층은 송악산 분화 초기 조간대에 쌓인 화산재가 평소 날씨의 파도 및 조석 작용에 의해 형성되었다. 중간의 층은 분화 도중 발생한 폭풍해일의 영향으로 해수면이 높아진 상태에서 파도의 작용을 받아 형성되었다. 송악산 응회환은 하모리층으로 명명된 해성퇴적층에 의해 덮여 있는데, 이 층은 송악산의 분화가 끝난 후 응회암이 침식 및 재동되어 해수면 변동의 영향을 받으며 형성된 층이다. 이처럼 송악산은 분화 이전부터 이후까지 고해수면의 기록을 잘 간직하고 있다. 송악산 분화 도중 내습한 태풍을 전후하여 쌓인 응회암 내에서는 화산쇄설물의 화학조성, 입자조성(이질물질의 함량), 그리고 조직의 큰 변화가 관찰된다. 태풍에 수반한 기압 변화나 육지/해양의 조석작용을 새로운 마그마의 상승 그리고 이에 따른 화산쇄설물의 화학조성 변화와 연관 짓기는 어려웠으나 화산쇄설물의 조직 변화는 태풍과 밀접한 연관이 있었던 것으로 해석된다. 태풍 이전에 분출한 화산쇄설물은 물에 불포화되어 있어 점착력에 의해 서로 들러붙은 조직을 보여주고 있으나 태풍 기간 중에 분출한 화산쇄설물은 화산쇄설물이 물에 포화되어 있어 이런 조직을 보여주지 않는 대신 응회암 내부에 기공을 포함하고 있다. 따라서 태풍의 내습에 의해 응회환 하부 다이아트림의 내부 환경에 큰 변화가 있었던 것으로 보인다. 태풍에 수반된 강우가 응회환의 분화구 내부로 직접 유입되거나 지하 경로로 스며들어 다이아트림을 채우고 있던 화산쇄설물이 일시적으로 물에 과포화되는 일이 발생하였을 가능성이 높아 보인다. 따라서 송악산은 화산이 주변 환경과 서로 밀접하게 상호작용을 하며 형성된 특이한 사례로 평가된다.