근막 결손의 복원과 자궁천골인대 고정을 통한 전자궁적출술 후 질탈출의 성공적 교정

문화숙(Hwa Sook Moon),최진국(Jin Koo Choi),김경서(Kyung Seo Kim),박근식(Kyun Sik Park),황지영(Ji Young Hwang),문성은(Sung Eun Moon),한지원(Ji Won Han),김상국(Sang Gook Kim),김상갑(Sang Gap Kim) 대한산부인과학회 2002 Obstetrics & Gynecology Science Vol.45 No.7

목적 : 본 연구는 전자궁적출술 후 질탈출을 부위-특이적인 결함의 개념에 입각하여 치골경부 근막과 직장질 격막의 연결을 통한 골반내 근막의 복원과 자궁천골인대 고정술을 이용한 질탈출의 성공적인 수술적 교정의 방법과 결과를 보고하고자 한다. 연구 방법 : 1999년부터 2001년 8월까지 자궁적출술 후 질궁탈출 증상으로 문화병원 산부인과를 내원, 탈출된 질의 근막을 재건시킨 다음, 이를 자궁천골인대에 고정시킴으로써 질의 부위-특이적인 교정술을 받은 3명의 환자를 대상으로 하였다. 3명중 1명은 개복술을 하였고 2명은 내시경 수술을 하였다. 결과 : 환자의 연령 분포는 49-67세였으며, 수술시간은 평균 113분 (105-125)이었다. 세 환자 모두 수술 후 질의 상태가 해부학 및 기능적으로 정상이었으며, 9일째 특이사항 없이 퇴원하였다. 수술 후 HRT를 시행한 1명을 포함한 3명 모두 각각 24개월, 12개월, 7개월간의 추적 검사에서도 특이한 합병증이나 재발 없이 좋은 경과를 보였다. 결론 : 골반 근막 결손의 복원과 자궁천골인대 고정술은 전자궁적출술 후 질탈출의 교정에 매우 안전하고 효과적이며, 기능적인 방법으로 사료되며, 자궁천골인대를 질탈출 교정에 이용한 연구는 본 연구가 국내에서 처음이다. Objective : To report the method and efficacy of the site specific-defects repair in the endopelvic fascia and uterosacral ligament suspension for the correction of posthysterectomy vaginal vault prolapse. Methods : This study was performed in 3 patients with posthyterectomy vaginal vault prolapse who underwent the surgery for the reconstruction of endopelvic fascia and the correction of vault prolapsed vagina by using uterosacral ligament suspension at the department of Obstetrics and Gynecology in Moon-Hwa Hospital. Among them, 1 patient was treated by laparotomy, and 2 patients were treated by laparoscope. Results : The age of patients ranged from 49 to 67 years. The mean operation time was 111 minutes (105-120 minutes). The status of postoperative vagina was normal in all 3 patients, who were discharged 9 days after operation without symptoms. No complication or recurrence were found in them despite long-term follow-up for 24 months, 12 months, 7 months, respectively after operation. One patient has been treated with HRT therapy. Conclusion : The reconstruction of the defect of endopelvic fascia and uterosacral ligament fixation may be very safe, effective, and functional in the correction of vaginal vault prolapse. This study reports the treatment of vaginal vault prolapse using uterosacral ligament within Korea for the first time.

부산광역시의 대기질 변화경향 및 특성에 관한 연구

이화운,김유근,원경미,홍정혜,문윤섭,장난심,정우식 부산대학교 환경문제연구소 1997 環境硏究報 Vol.15 No.1

핑거형 신축이음장치의 연결부에 대한 안전성 검토

김운학,유영화,박문식 안성산업대학교 2002 論文集 Vol.34 No.-

Several considerations on structural safety of connection part in Finger-Type expansion joint system were presented in this paper. Special considerations were focused on the compressive strength of sealant concrete, the stress of anchor bolt through introducing prestressing force and he reasonability on the magnitude of prestressing force. Tow-and three-dimensional finite element analyses using MIDAS have been performed to check the structural safety of the expansion joint system. The analysis results showed that the excessive compressive stress acting on concrete can be dispersed or reduced only when over 40% of maximum tensile stress acting on bolt obtained by hand calculation is added to the prestressing force. And the design compressive strength of sealant concrete over 400 kgf/㎠ is reasonable, but more attention should be paid to quality control and construction management even though he design value of 500 kgf/㎠ in original design can improve a structural safety.

고혈압성 뇌출혈의 임상분석

김갑득,박상문,송화식 大韓應急醫學會 1996 대한응급의학회지 Vol.7 No.1

A series of 100 cases of hypertensive intracerebral homorrhage (ICH) admitted to Dankuk University Hospital from June 1994 to Mat 1995 was reviewed to assess outcome and its influencing factors. The Site of hemorrhage gas clssified according to their anatomical site on computerized tomography. The outcome was assessed on their basis of activity of daily living at 6 months after attack. The results were as follows: 1. The age distribution was ranged from fourth decade to nineth decade, and 66% of them was in sixth decade and seventh decade. 2. Putaminal hemorrhage was frequent(49%), and then followed by thalamic(25%), subcortical(10%), cerebellar(9%), pontine(7%) hemorrhage in order 3. The outcome was very strongly associated with initial Glasgow coma scale(GCS) and compressed finding of basal cisterns in CT. The other prognostic factors were hematoma site, hematomavolume, intraventtricular extension of hemorrhage, and herniation sign. 4. The mortality rate of outcome of consevative treatment and operative treatment was 35% and 56% respectively, But there was not significant statistical difference to outcome.

마산연안지역의 국지풍 순환 및 대기오염물질 확산에 관한 연구

김유근,이화운,문윤섭,김해동,원경미,정우식,오인보 부산대학교 환경문제연구소 1997 環境硏究報 Vol.15 No.1

To investigate a horizontal windrose and the mixing height in Masan coastal area, a local atmospheric flow and the concentration of air pollutants were analyzed by abserved data from AWS, airsonde and air sampler. The land-sea breeze model and the ISCST2 model of U. S. EPA(Environmental Protection Agency) were used to predict the concentration of air pollutants such as SO2 and TSP. As a result, during spring the principal wind direction in the Masan region is mainly represented by windrose of the WNW and NW, which can be induced by land breeze and the SE and SSW of sea breeze even if weak wind speed. The mixing height during the measurement was marked with the range from 400 m(0900 LST) to 1450 m(1500 LST), and the height of an inverse layer was presented as the range from 30 m(2100 LST) to 150 m(0300 LST). It is very important to cosider the local wind field for the accurate diffusion and movement of air pollutants in coastal urban area. The atmospheric flow was simulated by the two-dimensional local wind model upon considering the orographic characteristics such as land-sea contrast, mountain valley and urban building. The result of air quality simulated by ISCST2 support that the dispersion pattern of the pollutants in that area was followed as local circulation system in coastal urban area.

두부 외상 환자의 고혈당과 예후와의 상관관계

현석천,이종안,박준석,박상문,김갑득,장인성,김승열,송화식 대한응급의학회 1996 대한응급의학회지 Vol.7 No.2

Severe head injury is associated with a stress response that includes hyperglycemia, which has been shown to worse outcome during cerebral ischemia. To better define the relationship between head injury and hyperglycemia, admission glucose level were analyzed in 150 head injured patients from January 1995 to December 1995. Our retrospective study demonstrated a higher glucose level in patients with low Glasgow Coma Scale(GCS) score, especially at 3-5 GCS score, compared to those with high GCS scores. Also a higher glucose level was noted in patients with vegetative state and dead than in those with good recovery and moderate disability. Hyperglycemia(serum glucose level≥200mg%) was associated with decreased level of consciousness and a poor outcome. We conclude that admission hyperglycemia is a significant indicator of severity of injury(p<0.001), but not significant predictor outcome from head injury. After controlling for the influence of the GCS score, glucose levels do not have an independent effect on outcome.

Lidocaine, Thrombin, Epinephrine 의 항균효과

김진우,이동건,전혜선,김승준,김석찬,안중현,김치홍,권순석,김영균,김관형,문화식,신완식,송정섭,박성학 대한감염학회 2005 감염과 화학요법 Vol.37 No.6

목적 : 기관지내시경 검사에서 흔히 사용되는 국소마취제인 lidocaine과 내시경시 지혈목적으로 사용되는 thrombin과 epinephrine이 각종 균주에 미치는 항균효과에 대해 알아보고자 하였다. 재료 및 방법 : 균주는 가톨릭대학교 성모병원에서 2004년 3월부터 2004년 9월까지 임상검체 에서 동정된 S. aureus, S. pneumoniae, K. pneumoniae, P. aeruginosa 각각 42, 42, 42, 43주를 대상으로 하였다. Lidocaine, thrombin, epinephrine 감수성 검사는 National Committee for Clinical Laboratory Standards (NCCLS, 2002)의 기준에 따랐다. 결과 : Lidocaine은 S. aureus, S. pneumoniae, P. aeruginosa에서 MIC_(50), MIC_(90) 모두 20,000 ㎍/mL 이었다. K. pneumoniae는 각각 10,000 ㎍/mL이었다. Thrombin은 S. aureus와 P. aeruginosa에서 MIC50 500 lU/mL 과 MIC_(90) 500 IU/mL 이상이었고, K. pneumoniae에서는 MIC_(50)과 MIC_(90)이 모두 500 lU/mL이상이었으나 S. pneumoniae에서는 MIC_(50)과 MIC_(90)은 125 IU/mL이었다. Epinephrine은 K. pneumoniae, S. pneumoniae에 대한 MIC_(50), MIC_(90)가 모두 >500 ㎍/mL이었고, S. aureus와 P. aeruginosa에 대한 MIC_(50), MIC_(90)가 모두 500 ㎍/mL이었다. 결론 : 기관지 내시경 검사에서 흔히 쓰이는 lidocaine, thrombin, epinephrine 등의 약제들이 호흡기 질환의 흔한 병원균인 S. aureus, S. pneumoniae, K. pneumoniae, P. aeruginosa 균주들에 대해 항균 효과가 있을 수 있어 세균배양검사에 영향을 미칠 수 있겠다. Background : We performed this stody to find out about antimicrobial effect of lidocaine which is commonly used local anesthetic, and thrombin and epinephrine used for hemostasis during bronchoscopic procedures. Materials and Methods : The microorganisms that were cultured from specimens obtained during bronchoscopy were Staphylococcus aureus (n=42), Streptococcus pneumoniae (n=42), Klebsiella pneumoniae (n=42), and Pseudomonas aeruginosa (n=43) collected from St. Mary's Hospital, from March to Sep 2004 were used for susceptibity testing. Susceptibility to lidocaine, thrombin, and epinephrine were tested according to the National Committee for Clinical Laboratory Standards. Result : MIC_(50) and MIC_(90) of lidocaine for S. aureus, S. pneumoniae, P. aeruginosa were all 20,000 ㎍/mL and that for K. pneumoniae were 10,000 ㎍/mL. MIC_(50) and MIC_(90) of thrombin for both S. aureus and P. aeruginosa was 500 IU/mL and above 500 IU/mL, respectively; that for K. pneumoniae were all above 500 IU/mL and for S. pneumoniae they were 125 IU/mL, MIC_(50) and MIC_(90) of epinephrine for K. pneumoniae and S. pneumoniae were above 500 ㎍/mL; that for S. aureus and P. aeruginosa were 500 ㎍/mL. Conclusion : We observed possible antimicrobial effect of lidocaine, thrombin, and epinephrine in vitro against pathogens such as S. aureus, S. pneumoniae, K. pneumoniae, P. aeruginosa, which are common respiratory microorganisms. The use of these agants could affect the result of bacterial culture.

The Comparison of Phytohemagglutinin and Purified Protein Derivatives Lymphocyte Stimulation Indices in Mycobacterium Tuberculosis-inoculated Guinea Pigs and Rabbits

Moon, Hwa Sik,Song, Jung Sup,Park, Sung Hak,Pyun, Hae Won CATHOLIC MEDICAL CENTER 1985 Bulletin of the Clinical Research Institute Vol.13 No.1

This experiment was conducted to investigate the immunological mechanism of the difference of susceptibility between guinea pigs and rabbits to Mycobacterium tuberculosis. There was no difference in PHA stimulation indices between control guinea pigs and rabbits. In inoculated guinea pigs, the values were significantly lower than controls after inoculation. But there was no difference in rabbits between control group and inoculated groups. There was no difference in PPD stimulation indices between control guinea pigs and rabbits. In inoculated guinea pigs, the values were significantly higher than controls. But there was no difference in rabbits between controls and inoculated rabbits. The PHA stimulation indices were increased by adding supernatants obtained from the PPD-stimulated lymphocyte cultures of Mycobacterium tuberculosis-inoculated guinea pigs and rabbits, in a normal guinea pig and a rabbit. The numbers of CFU in inoculated guinea pigs were increased, but there was no difference in rabbits. In inoculated guinea pigs, tuberculous granulomas were found in spleen and lung tissues, but there was no granuloma formation in spleen and lung tissues of inoculated rabbits. These results indicate that there is a striking difference of cellular immune reactions between guinea pigs and rabbits to Mycobacterium tuberculosis, and suggest that the decrease of PHA stimulation indices in inoculated guinea pigs is not due to the effect of suppressive lymphokines derived from the PPD stimulated lymphocytes.

Film Session Q&A 2 : Suspension operation for uterine prolapse with cystocele and rectocele via mesh anchored to both sides of inferior portion of pubic ramus combined with levator ani and perineal myorrhaphy

( Hwa Sook Moon ),( Sang Gab Kim ),( Gun Sik Park ),( Hyun Sik Youm ) 대한산부인과학회 2012 대한산부인과학회 학술대회 Vol.98 No.-

Uterine prolapse is the herniation of the uterus into or beyond the vagina as a result of weakness of the endopelvic fascia, the pelvic ligaments, and changes in pelvic connection tissues. It usually coexists with cystocele and rectocele. Tranvaginal hysterectomy with A-P repair is the traditional surgical method for uterine prolapse. Recently, many surgical treatment have been developed including supracervical hysterectomy followed by cervicosacropexy. We present more simple way of minimally invasive surgical procedures for pelvic oragn prolapse to keep the uterus, bladder and rectum in their normal position using mesh anchoring to both side of inferior portion of public ramus combined with levator ani and perineal myorrhaphy.

The Comparison of Phytohemagglutinin and Purified protein Derivatives Lymphocyte Stimulation Indices in Mycobacterium Tuberculosis-Inoculated Guinea Pigs and Rabbits

Moon, Hwa-Sik,Song, Jung-Sup,Park, Sung-Hak,Pyun, Hae-Won Catholic Medical Center 1985 Bulletin of the Clinical Research Institute Vol.13 No.-