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Development and validation of novel digitalized cervicography system
김수녕 ( Soo-nyung Kim ),김윤환 ( Yun Hwan Kim ),( Kye-hyun Nam ),( Seon-kyung Lee ),( Tae Sung Lee ),( Ho-sun Choi ),( Sei-jun Han ),( Seung-cheol Kim ) 대한산부인과학회 2017 대한산부인과학회 학술대회 Vol.103 No.-
Objective: Digital cervicography systems would be expected to reduce the costs of film cervicography, and provide the opportunity for “telemedicine-based” screening. We aimed to develop web-based digital cervicography system, and validate it compared with conventional film cervicography. Methods: A hundred cases from five centers were prospectively included, and cervical images (analogue, digitalized by scanning analogue, and digital) were taken separately using both analogue (Cerviscope) and digital camera (Dr. Cervicam) in each patient. Nine specialists evaluated the three kinds of images of each case with time interval between evaluations of each image. To validate novel digitalized system, we analyzed intra-observer variance among evaluation results of three kinds of images. Results: Sixty-three cases were finally analyzed after excluding technically defective cases that cannot be evaluable on analogue images. The generalized kappa for analogue versus digital image was 0.83, for analogue versus scanned image 0.72, and for digital versus scanned image was 0.71; all were in excellent consensus. Conclusion: Digitalized cervicography system can be substituted for the film cervicography very reliably, and can be used as a promising telemedicine tool for cervical cancer screening.
국산통계풀그림으로 우리 나라 의학 학술지에서 사용하는 통계를 해결할 수 있을까?
김수녕(Soo-Nyung Kim),허 선(Sun Huh) 한국의학교육학회 2002 Korean journal of medical education Vol.14 No.1
Purpose & Methods: Papers in six kinds of medical journals from Korea were examined on statistical methods to know what kinds of statistical methods had been used. We also tried to know how much Korean statistical program, dBSTAT can cover those statistical methods. Results: Out of 841 papers, statistical methods were used in 415 (49.4%) ones. Cumulative number of statistical methods is 869. According to the category of statistical methods, they were classified as following: Distribution analysis 6 (0.7%), comparative statistics 577 (66.4%), correlation analysis 66 (7.6%), regression analysis 106 (12.2%), classification analysis 3 (0.3%), survival analysis 48 (5.5%), genetic analysis 10 (1.2%), and etc 53 (6.5%). Conclusion: From above result, it can be said that dBSTAT can cover 92.7% of whole statistical methods in this study. These results also can be used for the goal of curriculum of medical statistics for undergraduate, graduate course and resident training program.
질식 자궁절개술로 치료된 제왕절개 반흔 부위에 발생한 자궁외임신
박수경 ( Soo Kyung Park ),김영진 ( Young Jin Kim ),김수녕 ( Soo Nyung Kim ),권한성 ( Han Sung Kwon ),손인숙 ( In Sook Sohn ),이선주 ( Sun Joo Lee ),이지영 ( Ji Young Lee ) 대한산부인과학회 2008 Obstetrics & Gynecology Science Vol.51 No.7
Implantation of a pregnancy within the scar of previous cesarean section is the rarest form of ectopic pregnancy. Delayed diagnosis and treatment can lead to uterine rupture, hemorrhage and maternal morbidity. But diagnosed early by transvaginal sonography, treatment options are capable of preserving the uterus and subsequent fertility. Suction curettage, exploratory laparotomy, laparoscopic surgery, systemic or local injection of methotrexate is the treatment method currently performed. In this report, we treated a case of this patient by transvaginal hysterotomy. This is the first case report in the recent literature. By this surgery, we could successfully remove gestational sac from the implantation site and repair the defect by primary suture and preserve uterus.
자궁경부암 선별진단에 있어서 자궁경부확대촬영술의 유용성
최원석(Won Suk Choi),김수녕(Soo Nyung Kim),손인숙(In Sook Sohn),이지영(Ji Young Lee) 대한산부인과학회 2001 Obstetrics & Gynecology Science Vol.44 No.7
N/A Objective :Although incidence of the cervical cancer has been very high, it is possible to detect the early cervical cancer with screening methods. Among the screening methods of cervical cancer, Papanicolaou smear has lower sensitivity and higher false negative rate. The goal of this study is to evaluate the usefulness of cervicography in cervical cancer screening. Methods :The data of Papanicolaou smear and cervigram has been obtained from 292 patients. The age range varied between 20 and 78 years with the average age of 42. Histologic specimens were obtained from patients whose abnormalities were detected by either Papanicolaou smear or cervigram. A total of 101 patients received a biopsy. We calculated sensitivity, specificity, positive predictive values, negative predictive values, false negative rates and false positive rates. Results . Results for Papanicolaou smear are as follows; sensitivity, 60.8%, specificity, 93.4%, positive predictive values, 66.0%, negative predictive values, 91.8%, false negative rates, 39.2% and false positive rates, 6.6%. In cervicography, sensitivity, 70.1%, specificity, 85.5%, positive predictive values, 56.3%, negative predictive values, 94.5%, false negative rates, 23.5% and false positive rates, 11.6%. Results for the combined methods are sensitivity with 82.4%, specificity with 92.5%, positive predictive values with 51.9%, negative pedictive values with 97.0%, false negative rates with 11.8% and false positive rates with 16.2%. Conclusion Cervicography is an effective method to screen cervical cancer. When cervicography is used with Papanicolaou smear, the detection rate of cervical cancer will be increased.
자궁경부상피내종양 치료 후 재발 예측인자로서 인유두종 바이러스 검사
김지연 ( Ji Yeon Kim ),김수녕 ( Soo Nyung Kim ),이선주 ( Sun Ju Lee ),권한성 ( Han Sung Kwon ),전경훈 ( Kyung Hun Zun ),이지영 ( Ji Young Lee ),손인숙 ( In Sook Sohn ),이효표 ( Hyo Pyo Lee ) 대한산부인과학회 2009 Obstetrics & Gynecology Science Vol.52 No.10
목적: 인유두종 바이러스 (Human papillomavirus, HPV) 검사가 CIN 치료 후 재발 및 잔류병소의 예측을 위한 검사로 유용한지를 확인하는데 있다. 연구 방법: 대상 환자는 전체 561예 중 끝까지 추적되어 유용한 정보를 가진 452예가 되었고, 자궁경부 세포진 검사와 HPV DNA 검사 그리고 질확대경하 조직검사가 시행되었다. 여기서 HPV DNA 검사와 자궁경부 세포진 검사 (Papanicolaou smear test, Pap smear)의 민감도와 특이도 및 우도비를 비교하였다. 결과: 조직검사결과 14예가 재발 및 잔류병소로 나타났다. 조직학적으로 mild dysplasia-CIN 1이 7예에서, moderate dysplasia-CIN 2가 5예에서 그리고 severe dysplasia-CIN 3이 2예로 판명되었다. HPV DNA 검사의 민감도와 특이도는 각각 92.9% (95% 신뢰구간 68.5, 98.7), 75.3% (71.1%, 79.1%)이었고 세포진 검사의 민감도와 특이도는 71.4% (45.4%, 88.3%), 92.5% (89.6%, 94.6%)였다. HPV DNA 검사의 양성 우도비는 3.77 (3.03,4.69)이었고 음성 우도비는 0.09 (0.01,0.63)였다. 세포진 검사의 양성 우도비는 9.48 (5.95,15.11)이었고 음성 우도비는 0.31 (0.13.0.71)였다. HPV DNA 검사와 세포진 검사의 정확도는 각각 78.3%, 94.7%였다. HPV DNA와 세포진 검사를 동시에 본 병합 검사의 민감도, 특이도, 양성 우도비 및 음성 우도비는 각각 92.9% (68.5%, 98.7%), 73.1% (68.7%, 77.0%), 3.45 (2.79,4.26), 0.10 (0.01,0.65)이었다. 결론: HPV DNA 검사는 민감도가 높고 음성 우도비가 낮아 검사 결과가 음성인 경우 재발 및 잔류병소의 가능성이 매우 낮다고 여겨진다. HPV DNA 음성인 경우 특이도가 낮아 정확도를 높이기 위해서는 세포진 검사가 필요하다. 두 검사 모두에서 음성인 경우 정기적인 검사를 할 수 있다. Objective: The aim of this study was to evaluate high-risk (HR) HPV DNA test to predict recurrence/residual disease in patients treated for CIN (cervical intraepithelial neoplasia). Methods: Four hundred and fifty-two patients treated with LLETZ (large loop excision of the transformation zone) were followed by HR HPV DNA test, cytology and colposcopy. The sensitivity, specificity and diagnostic odds ratios in predicting recurrence/residual disease were compared to those of cytology and HPV DNA test. Results: Fourteen patients (3.1 %) developed recurrent/residual disease, during follow up. Of these women, 7 were diagnosed at the time of recurrence with a CIN 1 lesion, 5 with a CIN 2 lesion, and 2 with a CIN 3 lesion. The sensitivity and specificity of the HPV DNA test were 92.9% (CI 68.5%, 98.7%) and 75.3% (71.1%, 79.1%). The sensitivity and specificity of the cytology were 71.4% (45.4%, 88.3%) and 92.5% (89.6%, 94.6%), respectively. The likelihood ratio of a positive and negative HPV DNA test were 3.77 (3.03, 4.69) and 0.09 (0.01, 0.63). And the likelihood ratio of a positive and negative cytology were 9.48 (5.95, 15.11) and 0.31 (0.13, 0.71). The accuracy of cytology and HPV DNA test were 94.7% and 78.3%. The sensitivity and specificity of the combination test (PAP and/or HPV DNA test) were 92.9% (68.5%, 98.7%) and 73.1% (68.7%, 77.0%). The likelihood ratio of a positive and negative combination test were 3.45 (2.79, 4.26) and 0.10 (0.01, 0.65). Conclusion: Cytology remains the base in the follow up after of CIN. HPV DNA test increase the sensitivity of cytology. Negative HPV test can rule out recurrent/residual disease.