선행 제왕절개 후의 질식 분만시 성공군과 실패군의 비교연구

최현수(Hyun Soo Choi),이상욱(Sang Wook Yi),오영승(Young Seung Oh),진규섭(Kyu seop Jin),이보연(Bo yon Lee),이선경(Seun Kyung Lee),허주엽(Chu Yeop Huh),김승보(Seung Bo Kim) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.10

제왕 절개의 비율은 최근 까지 지난 20년동안 증가되어 왔으며 이러한 증가는 반복 제왕 절개의 증가와 관련된 것이다. 최근 제왕 절개후 질식 분만에 관한 연구에서는 반복 제왕절개시 올 수 있는 수술 후 합병증, 산모 및 태아의 이환율의 증가 등과 비교해 이 시도가 비교적 안전한 방법으로 등을 보고 하고있는 반면 또한 제왕 절개후 질식 분만시 올 수 있는 자궁 파열과 이로 인한 태아와 산모의 위험성에 관한 보고도 있다. 이에 본원에서는 제왕 절개후 질식 분만을 원해 내원한 산모를 대상으로 성공군과 실패군 사이에 여러 요인을 비교 분석하여 성공에 관여한 인자를 예측하고자 하였다. 연구 대상은 1997년 3월부터 1999년 3월까지 선행 제왕 절개 후 질식 분만을 위해 내원한 환자중 질식 분만 시도시 위험성이 적다고 판단되는 120명의 산모를 대상으로 했으며 성공군과 실패군 사이에 산모의 나이, 제태 연령, 질식 분만한 과거력의 유무, 선행 제왕 절개의 적응증, 초음파로 예측한 태아 몸무게, 신생아 몸무게, 입원시 자궁 경부 상태, Bishop score, CPD index(Cephalopelvic disproportion Index)를 비교 분석 하였다. 120명의 산모중 87명(72.5%)이 성공 하였으며 33명(27.5%)이 실패 하였고 자궁 파열이나 열개와 같은 합병증은 발견되지 않았다. 두 대조군 사이에 산모의 나이(P=0.012), Bishop score(P=0.002), CPD index(P=0.015)에서 의미있는 차이를 보였으며 기타 요인에서는 의미있는 차이를 보이지 않았다. 결론적으로 선행 제절 이후 질식 분만 시도 시에 금기가 아닌 경우 입원시 X선 골반 계측을 통한 CPD index와 Bishop score을 통해 성공 가능성에 대한 예측에 도움을 줄 수 있으며 앞으로 이 요인들과 함께 다른 요인들과의 연관성에 대한 연구를 통해 선행 제왕 절개후 질식 분만 시도시에 올 수 있는 위험성을 줄일 수 있을 것으로 생각된다. 이상과 같은 연구 결과로 또한 추후 성공의 예후 인자로 사용되어 질 수 있고, 앞으로 이 시도의 성공과 관련된 다른 인자와의 연관성을 통한 면밀한 검토가 필요할 것으로 사료된다. Objectives: Vaginal birth or trial of labor after previous cesarean section has become one of the most remarkable changes in obstetric practice. The safety and efficacy of a trial of labor and vaginal birth after previous cesarean are well documented. The purpose of this report is to predict the likelihood of vaginal birth in patients undergoing a trial of labor after previous cesarean delivery using factors known at the time of hospital admission. Method: In this retrospective study, 120 women who attempted vaginal birth at Kyung-Hee University Hospital from March 1997 to March 1999. An attempt to identify possible prognostic factors for success of such a trial was made and we evaluated the variables of significant predictive value and the patients' characteristics in the success group and failure group of women who attempted VBAC. Result: 87 cases(72.5%) in 120 cases succeeded in VBAC and 33 cases(27.5%) failed. In this comparative groups in VBAC, there was significant difference in CPD index(cephalopelvic disproportion index) and Bishop score, but no significant difference in gestational age, the estimated fetal weight by sonography and newborn birth weight. Conclusion: In this study, Bishop score and CPD index and age may be useful and valid predictor of success in VBAC and this information could be particularly valuable. The CPD index may prove most important in determining if a vaginal birth should occur after a cesarean section because it can clearly identify some patients who need a repeat cesarean section.

단기간의 금연과 일회성 유산소 운동이 흡연자의 심혈관 반응에 미치는 영향

송준경(Jun Kyung·choi),최현민(Hyun Min Choi),김종경(Jong Kyung Kim),노호성(Ho Sung Nho) 한국사회체육학회 2012 한국사회체육학회지 Vol.0 No.48

The purpose of this study was to investigate cardiovascular responses to a bout of aerobic exercise and acute smoking cessation in smoker. nine collegiate male smoker who have been smoking(duration of smoking: 7.5 ± 0.9yrs; number of cigarettes per day: 15.5 ± 1.5) participated in this study. All subjects performed PEI to stimulate Group IV metaboreceptor at immediately after smoking, 24hours after smoking cessation and smoking after a bout of aerobic exercise. they were measured SBP, DBP, HR, SV, CO, TVC using by finometer(FMS co, Netherland). As a result, compared to immediately after smoking, SBP, DBP, and MAP were significantly decreased 24-hours after smoking cessation at rest and PEI(p<0.05). In addition, smoking after a bout of aerobic exercise caused by post-exercise hypotension indicated that SBP was significantly decreased compared to immediately after smoking(p<0.05). also, the changes in DBP and MAP at rest and handgrip exercise were significantly smaller compared to immediately after smoking(p<0.05). Thus, the results showed that smoking cessation during 24-hours and a bout of aerobic exercise relieve excess blood pressure response and enhanced arterial baroreflex in collegiate male smoker. It is concluded that caused exercise pressor reflex by stimulated Group IV may be effective to improve excess blood pressure responses.

자궁 적출술 방법 결정을 위한 복식과 질식 전 자궁 적출술의 비교 연구

최현수(Hyun Soo Choi),이선경(Seun Kyung Lee),김승보(Seung Bo Kim) 대한산부인과학회 2000 Obstetrics & Gynecology Science Vol.43 No.6

자궁 적출술은 부인과 영역에서 가장 많이 시행되는 수술의 하나로 본 연구는 복식과 질식 전 자궁 적출술을 시행받은 환자의 수술의 적응증, 특징, 환자의 예후를 비교하여 자궁 적출술의 방법의 결정에 도움을 주고자 하였다. 1994년 1월부터 1999년 1월까지 본원에서 양성 자궁질환으로 복식과 질식 전 자궁 적출술을 받은 환자 각각 200명을 대상으로 하였으며 환자의 연령, 분만력, 수술전 적응증, 적출된 자궁의 무게, 총 수술 시간, 출혈량, 합병증, 동반된 수술, 입원 기간을 비교 분석 하였다. 1. 수술전 적응증은 두 비교군 모두에서 자궁 근종이 가장 많았으며 자궁 경부 상피내암, 자궁 선증, 기타(부정 출혈, 부속기 종양)등이 있었다. 2. 환자의 연령, 분만력에는 유의한 차이가 없었으며 적출된 자궁의 무게는 복식이 질식 보다 유의한 증가를 보였고 질식에서 자궁의 무게가 280gm 이상인 경우도 18%(36/200)로 나타났다. 3. 총 수술 시간, 입원 기간, 출혈량에서 질식이 총 수술 시간과(P=0.002) 입원 기간이 짧고(P=0.000), 출혈량(P=0.000)도 의미있게 적은 것으로 나타났다. 4. 수술 후 합병증은 질식 환자의 4%, 복식 환자의 7%였고 통계적 유의성은 없었다. 5. 과거 개복 수술력은 질식에서 18%(36/200), 복식에서 28.5%(57/200)의 환자가 수술력이 있었는데, 질식 전 자궁 적출술 환자중 과거 제왕 절개를 받은 환자에서 자궁이 전 복벽에 유착되어 개복 수술로 전환한 예가 있었고 97.2%(35/36)에서 성공적으로 질식 자궁 적출술이 이루어졌다. 6. 질식 전 자궁 적출술을 시행받은 환자에서 부속기 절제술을 함께 시행한 환자와 자궁 적출술만을 시행받은 환자의 총 수술시간, 출혈량, 합병증에 유의한 차이가 없었다. 환자의 자궁의 크기나 과거 수술력, 부속기 절제의 요구가 더 이상 질식 방법의 금기가 아니며 질식 전 자궁 적출술은 수술 시간과 입원 기간, 출혈량을 줄일 수 있는 안전한 수술로 앞으로 이러한 질식 전 자궁 적출술에 많은 관심과 수련으로 부인과 수술에서 더 많이 사용 되어 져야 하겠다. Objectives : The most often perfomed major operation in gynecology is hysterectomy.Our purpose was to compare the indications, charateristics and outcomes of patients undergoing total abdominal hysterectomy and total vaginal hysterectomy and to help to establish guidelines to determine the route of hysterectomy.Method : The hospital charts of 400 women who underwent elective inpatient hysterectomy at Kyung-Hee University hospital from January 1994 to January 1999, were abstracted retrospectively. Data were collected regarding patients, age, parity, preoperative indications, the route of hysterectomy, uterine weight, operative and postoperative complications and the length of stay. The operative indications were benign uterine disease except from uterine prolapse. Bisection or combined morcellation were used in most cases to obtain reduction in uterine size.Result : Patients in whom the vaginal route was successful included 18% of those with uterine weights exceeding 280gm. There was statistically significant difference for uterine weight, operative time, bleeding amount, the length of stay in two camparative group. 4% of vaginal hysterectomy and 7% of total abdominal hysterectomy has documented operative complications.Conclusion : Vaginal hysterectomy is safe operation with few intraoperative and postoperative complications without notable blood loss. Vaginal hysterectomy allow one to shorten the operating time and allows early postoperative discharge of some patients from hospital. Skilled performance of vaginal hysterectomy is worth greater attention and should be used more often in gynecological study.

일부 성인의 치과 공포감 관련 요인

김수경 ( Soo Kyung Kim ),김미희 ( Mi Hee Kim ),최현지 ( Hyun Ji Choi ),황정근 ( Jung Geun Hwang ) 한국치위생학회(구 한국치위생교육학회) 2014 한국치위생학회지 Vol.14 No.6

Objectives: The purpose of the study was to investigate the related factors to dental fear in some adults. Methods: A self-reported questionnaire was filled out by 320 adults in Seoul and Gyeonggi-do from April to June, 2013. Except 14 incomplete answers, data were analyzed by SPSS 18.0 program. The questionnaire consisted of general characteristics of the subjects(7 questions), dental fear related factor(18 questions), distrust for dentist(15 questions), and distrust for dental hygienist(11 questions). The instrument for dental treatment fear was Dental fear Survey(DFS) adapted from Kleinknecht and partly modified by Choi. Out of 20 questions, 18 questions were reconstructed and score by Likert 5 scale. Higher score means higher dental fear. Cronbach alpha was 0.959 in the study. The distrust for dentist and dental hygienist was adapted from Choi and reconstructed and score by Likert 5 scale. Higher score means higher distrust for dentist and dental hygienist. Cronbach alpha was 0.937 in distrust for dentist and 0.874 in distrust for dental hygienist in the study. Results: Those who experienced dental pain tended to have dental fear. The reasons for dental fear were as follows; bad breath(2.96 out of 5 points, hereafter represented as of 2.96/5), dental caries(2.88/5), missing teeth(2.87/5) and tooth pain(2.77/5). The distrust for the dentist was the main dental fear in the adults. Conclusions: The dental fear was closely related to gender, experience of dental pain, oral symptoms and distrust for the dentist. As the psychological pain in the patients was mainly influenced by the trustful atmosphere, it is necessary to make the patient easy before treatment.

비만증 환자에서 한약제에 의한 체중 감소효과

Oh, Seung-Joon,Jeong, In-Kyung,Kim, Young-Seol,Choi, Young-Kil,Paeng, Jeong-Ryung,Bae, Jung-Hwan,Shin, Hyun-Dae 경희대학교 동서의학연구소 1999 INTERNATIONAL SYMPOSIUM ON EAST-WEST MEDICINE Vol.1999 No.1

Seung-Joon Oh, In-Kyung Jeong, Young-Seol Kim, Young-Kil Choi, Jeong-Ryung Paeng¹, Jung-Hwan Bae and Hyun-Dae Shin²Department of internal Medicine, College Medicine, Endocrine Research Institute¹. Department of Rehabilitation, College of Oriental Medicine², Seoul, korea. Bady Fat Reduction Effects of Red Ginseng Compound Preparation on the Patients with Obesity. Proceedings of International Symposium on East-West Medicine, Seoul. 244-254, 1999.-Obesity can be defined as a metabolic disease due to an increased state of fat tissues caused by an imbalance of calorie intake and use. Recently, in Korea by improvement and westernization of food intake, along with decrease in exercise activities, the prevalence of obesity has increased greatly. Our objectives were to study stability and effects of decrease in body fat by administering red ginseng compound preparation (known to have body fat decreasing effects in laboratory animals) to obesity patients on low calorie diets. Changes in weight and body fat were measured while carrying out calorie-restricted diets on patients for 4 weeks, then administering red ginseng compound preparation for another 4 weeks. The patients were 20 people whose BMI were 25kg/㎡ or over and whose percent body fat was also 30% or over when tested by bioelectrical conductivity. 1. Changes in weight were from 70.04kg(base line) to 67.43kg(after taking red ginseng compound preparation). 2. In similar sense, BMI decreased from 27.12kg/㎡(base line) to 26.56kg/㎡(after dieting), and further to 26.01kg/㎡ (after taking red ginseng compound preparation). The BMI seemed to decrease significantly compared to the baseline after the use of red ginseng compound. 3. Waist hip ratio was changed from 0.8858(base line) to 0.8728, but it was statistically insignificant. 4. The percent body fat was 35,16%(base line), 33.87%(after dieting), and 31.68%(after taking red ginseng compound preparation). 5. Complete blood cell count and blood chemisrty remained unaffected by the administration. 6. In concern to endocrinologic studies, T3 decreased from 118.7 to 98.2ng/dL, and T4 increased from 8.8 to 9.2㎕/ dL. Epinephrine showed a tendency to decreased from 0.27 to 0.25 ng/mL, and norepinephrine increased from 0.39 to 0.44ng/mL. 7. Leptin was not changed. 8. Some patients complained adverse effects; constipation(5 patients, may be due to diet therapy), fatigue (2 patients), pruritus(2 patients), flushing(s patients), dizziness(3 patients) and epigastric discomfort(2 patients). However their symptoms were mild, so medication did not stopped. In conclusion, loss of weight without significant side effects was observed during low calorie diet and red ginseng compound preparation administration. This is thought to be in relation to sympathetic nerve system rather than adrenal gland. Also, further long0term studies should be required, since the observed results were based on short-term changes in weight.

한의진단명과 진단요건의 표준화 연구 II (표준화 실례) : 2차년도 연구결과 중간 보고

양기상,최선미,최승훈,안규석,박경모,박종현,김성우,신승호,정우열,전병훈,고현,김정범,신상우,김성훈,김동희,권영규,엄현섭,장혜옥 한국한의학연구원 1996 한국한의학연구원논문집 Vol.2 No.1

The diagnostic requirements were suggested and explained regarding the systems of differentiation of symptoms and signs in the second year study of standardization and unification of the terms and conditions used for diagnosis in oriental medicine. The systems were as follows; - differential diagnosis according to condition of body fluid, differentiation of syndromes according to the state of qi and blood, differential diagnosis according to relative excessiveness or deficiency of yin and yang(氣血陰陽津液辨證) - differentiation of diseases according to pathological changes of the viscera and their interrelation - analyzing and differentiating of febrile diseases in accordance with the theory of the six channels(傷寒辨證) The individual diagnosis pattern was arranged by the diagnostic requirements in the following order : another name(異名), notion of diagnosis pattern, index of differentiation of symptoms and signs(辨證指標), the main point of diagnosis, analysis of diagnosis pattern(證候分析), discrimination of diagnosis pattern(證候鑑別), a way of curing a diseases(治法), prescription(處方), herb in common use(常用藥物), diseases appearing the diagnosis pattern(常見疾病), documents(文獻調査). This study was carried out on the basis of the Chinese documents and references.

전국 10개 종합병원 중환자실 환자의 직장내 Vancomycin-resistant Enterococci(VRE) 보균율, 보균의 위험요인 및 유전적 다양성 조사

정희진,송준영,엄중식,김우주,최선주,최정현,이혁,정문현,이광미,신동현,손보라,최종성,우흥정,권정아,이경원,최강원,박승철 대한감염학회 2002 감염 Vol.34 No.5

위암환자에서 근치적 위절제술후 시행한 보조적 PMF 항암 화학요법에 대한 무작위 전향적 연구

최우식,신연명,최경현 고신대학교의과대학 2007 고신대학교 의과대학 학술지 Vol.22 No.2

연구 목적: 위암 수술 후 보조 항암 치료의 효과에 대하여서는 아직 논란이 있다. 전향적으로 무작위표본 추출법으로근치 절제 수술한 위암 환자에서 수술 후 cisplatin, mitomycin C 그리고 5-FU(PMF)의 주사가 5년 생존율이나 무병생존율을 증가할 수 있는지를 연구하였다. 연구 방법: 1995년 5월부터 2002년 5월까지 147명의 근치 수술된 위암 환자들 중에 병기 IB, II, IIIA, IIIB 및 IV를 대상으로 하였으나 65세 미만을 대상으로 하여 무작위적으로 2군으로 나누어, 경구 5-FU제를 투여하는 군(대조군)과, PMF 항암 주사 치료군(치료군)으로 나누어 치료하였다. 경구 5-FU항암제는 수술 후 퇴원할 시기부터 투여하였다. PMF 주사치료는 수술 후 8주 이내에 시작하며 2코스 이상 완료한 사람들을 치료군에 포함하였다. 항암 주사는 다음과 같이 진행하였다; cisplatin 30mg 정맥 주사를 제 1-5일에, mitomycin C 4mg과 5-FU 250mg정맥 주사를 주 2회 4 주간 주사하였다. 이런 주사치료를 매 4주마다 시행하였다. 이 후 5년 생존율과 무병 생존율을 Kaplan-Meier 분석과 log-rank 검정으로 구하였다. 결과: 중앙 추적기간은 36개월이었다. 전체 5년 생존율은 치료군과 대조군에서 각각 68.8%와 65.2%(p=0.26), 무병 생존율은 각각 72%와 64%(p=0.24)로 치료군에서 다소 나았으나 유의성은 없었다. 치료에 동의한 환자의 수가 적어 각 병기별 생존율보다 비교적 조기인 병기 IB와 병기 II를 A군으로, 병기 IIIA을 B군, 그리고 진행된 병기인 병기 IIIB 와 병기 IV를 C군으로 나누어 생존율 비교하여 보았다. A군과 C군은 5년 생존률이나 무병생존율의 차이가 없었으나, B군에서는 5년 생존율이 치료군에서 100%, 대조군은 40.8%(P=0.0019)로 유의한 차이가 있었고, 무병 생존율도 치료군 100%, 대조군 52.94%(p=0.005)으로 의미 있게 차이가 있었다. 항암 주사치료에 의한 부작용은 심하지 않았으며, 사망자는 없었다. 결론: 위암 수술 후 PMF에 의한 항암 보조치료는 경구 5-FU에 비하여 병기 IB, II, IIIB와 IV에서는 5년 생존율이나 무병 생존율에 차이가 없었으나 병기 IIIA에서는 5년 및 무병 생존율에 의미있게 좋았다. 앞으로 C군에 대한 수술 후 보조 항암치료법의 연구가 요망된다.

하이브리드 ? 플로워 제어를 위한 오퍼레이션 모델에 관한 연구

최경현,배창현 濟州大學校 産業技術硏究所 2000 산업기술연구소논문집 Vol.11 No.1

Manufacturing system is composed of many activities that can be monitored and controlled at different level. A shop floor can be considered as an important level to develop Computer Integrated Manufacturing(CIM). However. a shop floor is the dynamic environment where the unexpected events continuously occur. and impose changes to planned activities. In this paper. task-oriented control model. called (MuLOM(Multi-Layered Operation Model), is suggested to represent control model for a hybrid control architecture which is composed three levels. i.e.. shop floor controller(SFC). intelligent agent controller( IAC) and equipment controller( EC).

비만을 동반한 위암 환자에서 두 병을 같이 수술 치료한 경험(증례)

최경현,윤기영,문형환,신연명,서경원,안수미,송윤미,석정희,정경연,이은하 고신대학교의과대학 2008 고신대학교 의과대학 학술지 Vol.23 No.3

Obesity is growing problem in Korea. We had a case of bariatric surgery during gastric cancer operation. Patient was 29 year old Korean lady with early gastric cancer located in the lesser curvature side of the middle 1/3 of the stomach. Her body weight was 89 kg, height 163 cm, and thus body mass index was 33.5 kg/m2. Preoperative blood pressure was 130/90 mmHg, hemoglobin 12.9 g/dL, total lymphocyte count 3,280/mL, serum albumin 4.3 g/dL, CEA 1.1 ng/mL, CA 19-9 9.1 ng/mL, and alpha fetoprotein 2 ng/mL. Another associated disease was right thyroid follicular neoplasm. The chest X-ray was normal. After IM injection of 2,500 units of heparin 30 minutes before the induction of general anesthesia, she received curative subtotal gastrectomy and Roux en Y gastrojejunostomy when a malabsorption loop of 120 cm jejunum was incorporated between the Treitz ligament and the end to side jejuno-jejunostmy site at May 29th 2006. Her postoperative course was uneventful except a minor wound seroma and the elevations of serum amylase(up to 4 folds) and lipase(up to 2 folds). She lost her body weight 9 kg in 5th, 21 kg in 7th, and 27 kg in 10th postoperative months to became 61.5 kg. On follow up exams in July 2008, she gained 4 kg to overcome her weakness and fatigue. From the above result, the incorporation of a malabsorption loop during reconstruction phase of gastric cancer operation was a good option for obese gastric cancer patients especially in cases of early gastric cancer.