외음부와 자궁에 생긴 평활근종 1예

박혜인,이해혁,김태희,김정식,남계현,이권해,고은석 순천향의학연구소 2004 Journal of Soonchunhyang Medical Science Vol.10 No.2

The leiomyomas of the vulva are rare benign tumors the incidence is 0.024%~0.55% in women. There are no relationship between leiomyomas of the vulva and uterus. But there are some reports that leiomyomas of the vulva and uterus simultaneously. The leiomyomas of the vulva present without symptoms and excision with biopsy is treatment of choice. Tumors of the gynecological apparatus may present without symptoms, or they may mimic other common gynecological conditions. Because of this, any vulva mass must be considered cautiously. We reported this case with a brief review of the concerned literatures.

골반 내 농양 1예

조인숙,이해혁,김태희,이권해,남계현,이임순,김정식,박성진 순천향의학연구소 2004 Journal of Soonchunhyang Medical Science Vol.10 No.2

Pelvic inflammatory disease (PID) is a disease that affects young, sexually active, reproductive age women. Most pathogens are Chlamydia trachomatis and Neisseria Gonorrheae transmitted sexually. One of serious acute complication of PID is tubo-ovarian abscess (TOA) that involves the fallopian tube, ovary and adjacent structures (eg, bowel, pelvic peritoneum). The microbiology of TOAs is polymicrobial with anaerobic organisms and causal organisms of PID. Common anaerobic organisms are Peptostretococcus spp, Bacteriodes spp, Prevotella spp, Escherichia coli and aerobic streptococci. Treatment is necessary to admission for intravenous broad-spectrum antibiotics and surgery is often reserved for patients with suspected rupture or patients who fail to respond to antibiotics. So, we reported this case found pelvic abscess due to ruptured tube-ovarian abscess.

복식 전자궁적출술후 절단부에 발생한 난관탈출증 1예

송은석,이해혁,김태희,김정식,남계현,이권해,고은석 순천향의학연구소 2004 Journal of Soonchunhyang Medical Science Vol.10 No.2

Prolapse of the fallopian tube into the vaginal vault after hysterectomy is a rare complication. Since most of cases may resolve before detection or remain undiagnosed, the exact incidence is still unknown. Though most common sign of tubal prolapse is tender friable tissue in vaginal cuff, with the simptoms of lower abdominal pain, dysparenunia, vaginal discharge, or postcoital spotting. The definitive diagnosis should be confirmed histologically Recently, we experienced a case of fallopian tube prolapse after abdominal hysterectomy in a 41-year-old woman and report with a brief review of the literature.

초음파로 진단된 자궁동정맥 기형 2예

최홍준,이해혁,김태희,김정식,남계현,이권해,박성진 순천향의학연구소 2004 Journal of Soonchunhyang Medical Science Vol.10 No.2

Arteriovenous fistula of uterus is a very rare cause of massive uterine bleeding. However, it is important to make a rapid and precise diagnosis when it does occur, because life-threatening massive vaginal bleeding may occasionally be a symptom of this disease. Uterine curettage or surgical trauma can cause vascular abnormalities, including pseudoaneurysms, acquired ateriovenous malformations, ateriovenous fistulas, and rupture of vessels. The diagnosis is made by angiography, and gray scale ultrasonography, color and duplex doppler ultrasonography, computed tomography, magnetic resonance imaging is helpful. Ultrasonography is the most commonly performed initial imaging examination for evaluation of abnormal uterine bleeding. Color and duplex Doppler US is an appropriate modality for the detection and diagnosis of uterine ateriovenous malformations and for follow-up after embolization. Transcatheter embolization has replaced hysterectomy as the treatment of choice in women wish to retain thier fertility. A case of arteriovenous malformation of the uterus which was diagnosed by ultrasonography. So reported this case with a brief review of the literature.

임신 중 발견된 대망 종괴 1례

조인숙,김태의,김정식,이해혁,이권해,김희경,남계현 순천향의학연구소 2004 Journal of Soonchunhyang Medical Science Vol.10 No.2

A case of omental mass during Pregnancy Omental cyst is a rare lesion and occur primarily during childhood and young adulthood. When encountered, most of them are benign and intraabdominal masses. It shows a large mass but not palpable and often asymptomatic. The precise diagnosis is made by most commonly at surgery or during pathologic examination. So, we report this case with brief review of literatures.

여호와의 증인 환자에서 산과적 출혈 후 무수혈 치료 2예

김재령,여소진,이해혁,김정식,김태희,남계현,이권해,이임순,박진화,황경호 순천향의학연구소 2004 Journal of Soonchunhyang Medical Science Vol.10 No.2

Jehovah's Witness comprise a unique obstetric population. Their refusal of blood stems from an interpretation of a literal translation of the Bible, and it is this belief that puts them at an increased risk of morbidity and mortality if hemorrhage occurs. We report two cases of a Jehovah's Witness who bled massively due to obstetric hemorrhage, refused blood transfusion and had profound anemia. The patients were treated with recombinant human erythropoietin, parenteral iron and oxygen. And they were treated on an intensive care unit with intermittent positive pressure ventilation. We reviewed with literature considering the therapy for acutely anemic patients who refuse transfusion to decrease the duration of the most severe anemia.

원발성 난소 소세포암 2례

조인숙,남계현,김태희,김정식,이해혁,이권해,권계원 순천향의학연구소 2004 Journal of Soonchunhyang Medical Science Vol.10 No.2

Two cases of primary small cell carcinoma of the ovary occurred. One was a case of 43-year-old woman associated with hypercalcemia and the other was a case of 40-year-old woman with pulmonary type. Ovarian small cell carcinoma of the hypercalcemic type have clinicopathological, immunohistochemical, ultrastructural, and flow cytometric features that from differ from those of small cell carcinomas of the pulmonary type. It is important for therapeutic reasons to distinguish these two types of ovarian tumors from each other and from a variety of malignant small cell tumors that ovary primarily or secondarily. So, we reported these cases with a brief review of the concerned literatures.

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.

다발성 대장암 간전이 환자의 간절제를 위한 새로운 시도

주종우,김형철,임철완,신응진,조규석,유기원,송옥평,홍대식,박성진,조준희,이혜경,김희경,권계원,고은석 순천향의학연구소;Soonchunhyang Medical Research Institute 2004 Journal of Soonchunhyang Medical Science Vol.10 No.2

Multiple bilobar liver matastases (MBLM) are the main cause of low resectability in the colon cancer liver metastases. The authors experienced one case of initially non-resectable colon cancer liver metastases. He was curatively and safely treated with a two-stage hepatectomy using the new method of future remnant liver volume growing. A 54-year-old man was referred to our department with the sigmoid colon cancer combined with MBLM, which were checked in two small metastatic lesions in the left lobe and five large sized lesions in the right lobe in the computed tomogram (CT). A laparoscopic assisted anterior resection was primarily performed. We performed the 1^(st) stage hepatectomy 3 weeks after the colon resection. Intra-operative Ultrasonogram (US) found 9 small superficial metastatic lesions in the left lobe. All that lesions were completely removed by non-anatomical wedge resection. An occlusion ballon catheter was placed in the right portal vein through a small branch of the inferior mesenteric vein at that time. The future remnant liver volume was sufficiently increased 3 weeks after the 1^(st) hepatectomy. A right hepatectomy was safely performed 22 days after the 1^(st) hepatectomy. The patient received a regional chemotherapy (interleukin2 based immuno-chemotherapy through hepatic artery) for 4 months, then received 9 cycles of systemic chemotherapy (biweekly Oxaliplation, leucovorin, plus 5-fluorouracil) without any recurrence evidence.

A New Method for Sclerotial Isolation of Two Species of Sclerotium from Infested Soils

Kwon, Mi-Kyung,Shim, Hong-Sik,Yeh, Wan-Hae,Kim, Taek-Soo,Cho, Weon-Dae,Kim, Choong-Hoe,Kim, Yong-Ki The Korean Society of Plant Pathology 2004 Plant Pathology Journal Vol.20 No.4

White rot on Allium crops recently had a high incidence with incrensed cultivating areas of tropical garlic types in Korea. Two types of Sclerotium have known as causal agents that produce different size and shapes of sclerotia in infested fields. Therefore, we developed a new method for isolation of sclerotia from infested field soils that can be used for ecological study of Sclerotium spp. and establishment of control strategy. Soil samples collected from heavily infested fields were evenly mixed and placed on a automatic sieve shaker connected with tap water, After 10 min of shaking, residues on 0.5 mm and 0.25 mm sieves were separately collected and suspended with 70% sugar solution, which method floats sclerotia in aqueous layer, Then, floated fraction was carefully separated and mixed with a same volume of 1% sodium hypochlorite solution to differentiate with organic materials. This method provides a direct count of sclerotia under a dissecting microscopy.