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유시현 ( Sie Hyun You ),윤주희 ( Joo Hee Yoon ),신은영 ( Eun Young Shin ),유영옥 ( Young Oak Lew ),김대훈 ( Dae Hoon Kim ) 대한산부인과학회 2007 Obstetrics & Gynecology Science Vol.50 No.5
목적: 수술과 창상은 다양한 사이토카인 생산에 변화를 야기한다. 본 연구의 목적은 부인과 질환자에게 시행된 복강경 수술이 면역 체계에 미치는 영향을 평가하는 것이다. 연구방법: 부인과 질환으로 개복 수술을 받은 환자 20명과 복강경 수술을 받은 환자 33명을 대상으로 연구하였다. 환자들의 혈청 C-reactive protein (CRP)값, Interleukin-1β (IL-1β), Interleukin-6 (IL-6), Interleukin-8 (IL-8), Interleukin-10 (IL-10) 그리고 TNF-α 농도를 ELISA법으로 측정하였다. 부가적으로 fibrinogen, transferrin, albumin, hemoglobin 그리고 hematocrit을 측정하였다. 그 측정값은 Mann-Whitney U test와 Kruskal-Wallis test를 통해 분석하였다. 결과: CRP, IL-6 그리고 IL-8 값이 개복 수술 환자군과 복강경 수술 환자군에서 통계적으로 유의한 차이를 보였다. CRP와 IL-8값이 개복 수술 환자군에서 수술 후 24시간 뒤에 현저한 상승을 보였고 그 차이는 통계적으로 유의하였다 (p<0.05). 결론: 수술은 면역체계의 변화를 유발하며 이것은 사이토카인 반응을 통해 평가될 수 있다. 복강경 수술은 개복 수술에 비해 CRP와 IL-8의 활성을 적게 유발한다. Objective: Elective surgical approaches and trauma cause changes in the production of different cytokines. The aim of this study was to evaluate the effects of laparoscopic surgery on the immune system of patients with gynecologic diseases. Methods: We recruited the open surgery group (n=20) and laparoscopic surgery group (n=33). In a prospective study we examined the C-reactive protein (CRP) level, the production of the cytokines Interleukin-1β (IL-1β), Interleukin-6 (IL-6), Interleukin-8 (IL-8), Interleukin-10 (IL-10) and TNF-α concentrations by ELISA. In addition the fibrinogen, transferrin, albumin, hemoglobin and hematocrit were measured. Statistical analysis was made by Mann-Whitney U test and Kruskal-Wallis test. Results: There were significant statistical differences in the CRP, IL-6 and IL-8 between the open surgery group and laparoscopic surgery group after surgery. The CRP and IL-8 showed a more distinct increase in open surgery group 24 hours after surgery, the differences between the two surgical approaches were significant (p<0.05). Conclusion: Elective surgical approaches cause changes in the immune system, which can be evaluated by the reaction of cytokines. Laparoscopic surgery cause less activation of the CRP and IL-8 than open surgery.
김두만 ( Du Man Kim ),유시현 ( Sie Hyun You ),윤주희 ( Joo Hee Yoon ) 대한산부인과학회 2006 Obstetrics & Gynecology Science Vol.49 No.9
The incidence of all malignant tumor in pregnancy is 0.07-0.1%. The most frequent tumors in pregnancy are breast cancer, gynecologic tumors (cervical cancer, ovarian cancer), melanoma and lymphomas. Any malignant tumor in pregnancy has a diagnostic and therapeutic problem. Melanoma is 8% of all malignancies in pregnancy. Surgery is a definitive therapy for early-stage disease. Melanoma in pregnancy metastasize early and rapidly. So we have difficulty in making therapeutic plan. Most frequent metastatic lesions are liver and lung. We experienced melanoma of liver in pregnancy. This report represents melanoma in pregnancy with a review of literature.
복강경하 병기설정 수술을 시행한 난소의 Sertoli-Leydig Cell Tumor, 1예
서민정 ( Min Jung Suh ),유시현 ( Sie Hyun You ),최주혁 ( Joo Hyuk Choi ),오은경 ( Eun Kyeong Oh ),남궁정 ( Jeong NamKung ),박미선 ( Mi Sun Park ),지은영 ( Eun Young Ji ),강영화 ( Young Hwa Kang ),윤주희 ( Joo Hee Yoon ) 대한산부인과학회 2007 Obstetrics & Gynecology Science Vol.50 No.7
Sertoli-Leydig cell tumor는 난소 종양 중 0.5% 이하를 차지하는 드문 성색간질 종양이으로, 대부분 젊은 여성 (30-40세)이고, 1% 이하에서 양측성을 보이기 때문에 종양의 보존적 절제와 환측 난관의 절제가 치료이다. 최근 개인 산부인과 병원에서 Sertoli-Leydig cell tumor, pooly differentiated, Stage Ia, grade III로 진단되었으나, 불충분한 수술 후 본원에 전원되어 복강경하에 성공적으로 병기설정수술을 시행한 1예를 경험하여 문헌고찰과 함께 보고하는 바이다. Sertoli-Leydig cell tumors are rare sex cord-stromal tumors. These tumors account for less than 0.5% of all ovarian tumors. Because these tumors appear predominantly in young women (between the age of 30 and 40) and are bilateral in less than 1% of cases, conservative removal of the tumor and adjacent fallopian tube is justifiable. Recently, we experienced a case of successful laparoscopic surgical staging in patient of Sertoli-Leydig cell tumor which was previously incompletely evaluated in local OBGY clinic. There are no solid data to suggest that usefulness and risk of laparoscopic surgical staging and adjuvant therapy with stage I disease of these tumors until now. So we present it with a brief review of literature.
각 (脚)이 있는 거대 점막하 자궁근종의 질외 탈출에 의한 자궁내반 (內反)의
송민종 ( Min Jong Song ),유시현 ( Sie Hyun You ),서민정 ( Min Jung Suh ),국일영 ( Ill Young Kook ),윤주희 ( Joo Hee Yoon ) 대한산부인과학회 2007 Obstetrics & Gynecology Science Vol.50 No.2
Uterine leiomyomas are the most common uterine tumors. They are estimated to be present in approximately 20% of all women of reproductive age. They may be present in subserosal, intramural, or submucosal in location within the uterus, or located in the cervix, in the broad ligaments, or on a pedicle. Many studies report that the malignant potential of a preexisting uterine leiomyoma is extremely rare, occuring in less than 0.5%. Uterine leiomyomas may cause a range of syptoms, for example, severe anemia from abnormal uterine bleeding, dysmenorrhea, constipation from rectosigmoid compression, dysuria, frequency, residual sensation due to bladder compression. Patients with those symptoms or cancer phobia should be treated. Rare but severe symptoms associated with uterine leiomyomas are rectosigmoid compression, with intestinal obstruction, thrombophlebitis of lower extremities from venous stasis, polycythemia, ascites, severe pain from torsion and infection of prolapsed pedunculated submucosal myoma and uterine inversion from prolase of pedunculated submucosal leiomyoma. Now we report a rare case of uterine inversion resulted from prolapse of huge pedunculated uterine submucosal leiomyoma, which caused hypovolemic shock due to massive uterine bleeding.
기관내 삽관시 Isoflurane과 Albuterol의 동반투여가 폐 저항에 미치는 효과
최종호(Jong Ho Cho),유시현(Sie Hyun You) 대한마취과학회 1997 영문부록 Vol.- No.-
서 론: 기관내 삽관후 0.6 MAC 또는 1.1 MAC의 isoflurane을 투여받는 환자에서 albuterol의 추가 투여가 폐 저항에 미치는 효과를 보기 위하여 실험을 실시하였다. 방 법: 67명의 환자를 fentanyl(2 g/kg), thiopental(5 mg/kg),succinylcholine(1 mg/kg)을 투여후 기관내삽관을 실시하고 폐저항을 측정후 0.6또는 1.1MAC isoflurane과 O2:N20(40:60)로 마취유지 10분후 폐저항을 측정하고 이후 두군 각각 albuterol 또는 placebo를 2,5,10 puffs 씩 10분 간격으로 마취회로를 통하여 흡입시키고 폐저항을 측정하였다. 결 과: 1.1.MAC isoflurane은 기관내삽관후 23 5% 저항치 감소를 가져왔고 0.6 MAC isoflurane 투여군은 7 5% 저항 감소를 보였다(P<0.01). 2puffs의 albuterol은 12 3% 저항 감소를 보인반면 placebo 투여군은 2 4% 감소를 보였다(P<0.05). 5puffs 이상의 albuterol은 추가적인 폐저항 감소를 보이지 않았다. 결 론: Isoflurane은 기관내 삽관후 증가한 폐저항을 투여농도에 비례해서 낮추었으며 albuterol투여에 의한 폐저항 감소효과는 2 puffs 투여에서 최대의 이완효과를 나타냈다. (Korean J Anesthesiol 1997; 33: S14∼S19)
길기철 ( Ki Cheol Kil ),정재은 ( Jae Eun Chung ),유시현 ( Sie Hyun You ),박미선 ( Mi Sun Park ),권동진 ( Dong Jin Kwon ),유영옥 ( Young Ok Yoo ),윤주희 ( Joo Hee Yoon ) 대한산부인과학회 2007 Obstetrics & Gynecology Science Vol.50 No.11
The incidence of all transverse vaginal septum is 1:2,100 - 1:72,000. The transverse vaginal septum is a developmental defect of vagina which may be fused incompletely between the Mullerian duct component and the urogenital sinus component of vagina. Serious complications may be hematocolpos, hematometra and hematosalpinx. Simple surgical excision or simple incision have been developed to treat congenital transverse vaginal septa, but also caused common complications such as secondary tissue contracture. Garcia technique using eight vaginal mucosa flaps was developed to avoid common complication of secondary vaginal stenosis. Here, we present a case of contracted transverse vaginal septum who has been performed a simple incision 13 years ago, successfully performed the modified Garcia technique without serious postoperative complication.
증례보고 : Nuss 방법에 의한 오목가슴 술 후 발생한 수축성심막염 환자에서 금속막대 제거 및 심막절제술에 의한 심장천공과 혈흉
서은정 ( Eun Jung Seo ),안기량 ( Ki Ryang Ahn ),김천숙 ( Chun Sook Kim ),강규식 ( Kyu Sik Kang ),유시현 ( Sie Hyun You ),정진헌 ( Jin Hun Chung ),정지원 ( Ji Weon Chung ),이승진 ( Seung Jin Lee ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.4
Nuss procedure offers excellent outcome effect in the cosmetic point of view, but the complications such as cardiac perforation, pericardial effusion, constrictive pericarditis, hemothorax, pneumothorax and bar displacement sometimes occur. We experienced a 13-year-old-male, who showed the profound hypotension with bradycardia due to the cardiac perforation and the lung laceration during the pericardiectomy and the removal of pectus bar. Emergent partial cardiopulmonary bypass was initiated and then, ruptured right atrium and lung laceration were repaired without the remarkable complications. In anesthetic management of the pectus excavatum. This case reveals that special attention should be paid to those with cardiac perforation and lung laceration. (Korean J Anesthesiol 2007; 53: 539∼43)