Surgical technique for single-port laparoscopy in huge ovarian tumors: SW Kim`s technique and comparison to laparotomy

( Jeong Sook Kim ),( In Ok Lee ),( Kyung Jin Eoh ),( Young Shin Chung ),( Inha Lee ),( Jung-yun Lee ),( Eun Ji Nam ),( Sunghoon Kim ),( Young Tae Kim ),( Sang Wun Kim ) 대한산부인과학회 2017 Obstetrics & Gynecology Science Vol.60 No.2

Objective This study aimed to introduce a method to remove huge ovarian tumors (≥15 cm) intact with single-port laparoscopic surgery (SPLS) using SW Kim`s technique and to compare the surgical outcomes with those of laparotomy. Methods Medical records were retrospectively reviewed for patients who underwent either SPLS (n=21) with SW Kim`s technique using a specially designed 30×30-cm2-sized 3XL LapBag or laparotomy (n=22) for a huge ovarian tumor from December 2008 to May 2016. Perioperative surgical outcomes were compared. Results In 19/21 (90.5%) patients, SPLS was successfully performed without any tumor spillage or conversion to multi-port laparoscopy or laparotomy. There was no significant difference in patient characteristics, including tumor diameter and total operation time, between both groups. The postoperative hospital stay was significantly shorter for the SPLS group than for the laparotomy group (median, 2 [1 to 5] vs. 4 [3 to 17] days; P<0.001). The number of postoperative general diet build-up days was also significantly shorter for the SPLS group (median, 1 [1 to 4] vs. 3 [2 to 16] days; P<0.001). Immediate post-operative pain score was lower in the SPLS group (median, 2.0 [0 to 8] vs. 4.0 [0 to 8]; P=0.045). Patient-controlled anesthesia was used less in the SPLS group (61.9% vs. 100%). Conclusion SPLS was successful in removing most large ovarian tumors without rupture and showed quicker recovery and less immediate post-operative pain in comparison to laparotomy. SPLS using SW Kim`s technique could be a feasible solution to removing huge ovarian tumors.

석청(Mad-honey) 복용 후 유발된 부정맥 1예

김용철,김남호,김승환,최준호,박은미,이상재,이은미,유남진,윤경호,오석규,정진원 圓光大學校 醫科學硏究所 2008 圓光醫科學 Vol.23 No.2

석청에 포함된 grayanotoxin에 의해 독성 작용이 나올 수 있으며, 이러한 독성 작용은 일반적으로 24시간 이내 저절로 회복된다. 최근에 본 저자들은 석청 복용 후 발생한 심실빈맥을 경험하였기에 보고하는 바이다. 49세 남자가 호흡곤란으로 내원하였으며, 내원당시 분당 40회 정도의 동성 서맥이 관찰되었고, 수액을 투여하던 중 심실 빈맥이 발생하였다. 항부정맥제를 투여 후 정상 동율동으로 전환되었으며, 특별한 이상 없이 4일 후 퇴원하였다. Mad-honey intoxication caused by the consumption of honey producted from the nectar of rhododendrons. The grayanotoxins cause the intoxication. The toxic effects of mad-honey poisoning are rarely fatal and generally last for no more than 24 hours. We experienced one case, a 49 years-old man who presented with dyspnea after ingestion of mad-honey. He showed marked sinus bradycardia with < 40 beats per minute on admission. The cardiac rhythm was changed to ventricular tachycardia immediately. These features resolved completely in 24 hours with continuous infusion of amiodarone(600 mg per day) and fluids. We report the case of intoxication of mad-honey as a presentation of fatal cardiac arrhythmia.

병원획득 Klebsiella pneumoniae 균혈증 분석을 통해 본 Ciprofloxacin 내성과 Extended-Spectrum β-Lactamase생성 간의 연관성

김미영,추은주,곽이경,송문희,나성수,송태준,김성혜,전재범,최상호,정진용,김남중,김양수,우준희,류지소 대한감염학회 2004 감염과 화학요법 Vol.36 No.5

목적 : K. pneumoniae는 ciprofloxacin내성 증가가 전세계적으로 문제가 되고있는 extended-spectrum beta-lactamase (ESBL)를 생성하는 대표적인 세균으로 최근 외국에서 ciprofloxacin 내성과 ESBL 생성사이에 관련이 있다는 2-3편의 보고들이 있었다. 본 연구에서는 병원획득 K. pneumoniae 패혈증이 있었던 환자들을 대상으로 ciprofloxacin 내성과 관련된 인자를 알아보고자 하였다. 재료 및 방법 : 2001년 1월 부터 2002년 12월 사이에 2200병상의 3차 의료기관인 한 대학병원에서 입원 후 72시간 이후에 나간 혈액배양에서 K. pneumoniae가 배양된 입원환자를 대상으로 의무기록과 전산기록을 분석하여 환자의 성별, 나이, 병동, 기저질환, 이전의 항생제 사용력, 패혈증 발생당시까지의 재원기간, 이전 입원력, 원인균의ESBL 생성유무 등을 파악하였고 이들 변수가 ciprofloxacin 내성과 관련이 있는지를 분석하였다. 재발성 패혈증의 경우는 첫 번째 경우만을 분석에 포함하였다. 결과 : 연구대상 환자는 총154명이었고 K. pneumoniae의 ciprofloxacin에 대한 내성률은 28.6% (44/154)였다. Ciprofloxacin 내성균주 중 ESBL 생성균주의 비율은 95.5% (42/44)였고 ciprofloxacin 감수성균주에서 ESBL 생성균주의 비율은 24.5% (27/110)였다(P<0.001). ESBL생성외에 단변량 분석에서 유의한 관련을 보인 변수로는 남자, 나이가 많은 경우, 패혈증 당시 중환자실 재원, 기저질환이 고형암, 혈액암, 담도계 질환인 경우, 패혈증 발생이전 1달 이내의 항생제 사용력, 3세대 cephalosporin, metronidazole, fluroquinolone, carbapenem 투여력이 있었다. 다변량 로지스틱 분석을 시행 하였을 때는 나이가 많은 경우(Adjusted odds ratio[A0R]; 1.04, 95%confidence interval[CI]; 1.01-1.06)와 ESBL 생성(AOR; 81.35, 95% CI; 17.76-372.53)이 유의하게 ciprofloxacin 내성과 관련이 있었다. 결론 : 패혈증을 일으킨 병원획득 K. pneumonias에서의 ciprofloxacin 내성은 ESBL 생성과 유의한 관련을 보였고 향후 이에 관련된 원인이나 기전을 분석하기위한 분자역학적·분자생물학적 연구가 필요하겠다. Background : Strains of ciprofloxacin-resistant Klebsiella pneumoniae have emerged worldwide. We investigated the epidemiology of ciprofloxacin resistance and its relationship to ESBL production in nosocomial K. pneumoniae bacteremia. Materials and Methods : Using the computerized database of clinical microbiology, we identified all patients whose blood culture had yielded K. pneumoniae between January 2001 and December 2002 at a 2200-bed university-affiliated tertiary-care hospital. During the study period, total of 392 episodes of K. pneumoniae bacteremia were documented of which 163 episodes were acquired nosocomially. 9 cases of recurrent episodes were excluded. Results : The resistance rates to ciprofloxacin was 28.6% (44/154). ESBL-production was significantly more common in ciprofloxacin-resistant isolates than in ciprofloxacin-susceptible isolates (95.9% [42/44] vs. 24.5% [27/110], P<0.001). In univariate analysis, following factors were significantly associated with resistance to ciprofloxacin: older age, male sex, ICU admission at the time of bacteremia, prior use of antibiotics within 1 month before bacteremia, solid tumor, hematological malignancy, or biliary disease as underlying disease, and ESBL-production. The prior use of 3^(rd)-generation cephalosprins, metronidazole, fluroquinolone, or carbapenem were also risk factors. Independent risk factors for ciprofloxacin resistance were older age (adjusted odds ratio [AOR]; 1.04, 95% confidence interval [CI]; 1.01-1.06) and ESBL production (AOR; 81.35, 95% CI; 17.76-372.53). Conclusion : The close relationship between ciprofloxacin resistance and ESBL production was documented in nosocomial K. pneumoniae bacteremia. Further epidemiological and molecular studies to determine factors and mechanisms involved in the relationship are needed.

2형 당뇨 환자에 있어서 C형 간염의 유병률에 관한 연구

김구영,서광섭,유광렬,임병욱,채선애,강남훈,김창훈,권영우,김희수,류성태,이정환,박성우,오웅식,김정한 중앙대학교 의과대학 의과학연구소 2003 中央醫大誌 Vol.28 No.1

Background: We have doubt about the truth that Type 2 DM is associated with chronic hepatitis C infection. The aim of our study was to prove a close relationship between chronic HCV infection and type 2 DM in korean patients. Methods: We reviewed the out-patient's medical records of 466 patients with type 2 DM who visit the Sung-ae hospital from March 2000 to August 2001. Diabetic patients were analyzed for the following variables: age, sex, waist circumference, weight, waist/hip ratio, using of self monitoring of blood glucose, method of therapy, duration of disease, experience of previous transfusion, major surgical procedure, accompanied disease, liver function tests (LFT), HbA1 c. We ruled out patients with liver cirrhosis. Results: Hepatitis C virus infection was observed more frequently in patient with Type 2 DM. Of 466 Type 2 DM patients, 13 patients were infected with Hepatitis C virus (2.79%). Compared with mean prevalence of Korean population (1.3~1.6%), it's value is very high. the other hand, 21 patients were infected with Hepatitis B virus (4.5%). Such results are similar to mean prevalence of the general public (4~5%). Conclusions: Prevalence of hepatitis C was closely associated in korean patients with type 2 DM. And an increased prevalence is independent of cirrhosis.

2003년도 해양스포츠 체험활동을 통한 소아건강교실 사례 발표

김현준,이상엽,이가영,곽현,이남수,김혜선,김윤진,김인주,김용기,대한비만학회 부산분과학회 일동 대한비만학회 2003 The Korean journal of obesity Vol.13 No.4

부산에 소재한 3개 초등학교 청소년단체 소속의 초등하교 3학년부터 6학년까지 구성된 172명을 대상으로 청소년단체 지도자, 초등학교교사, 자원봉사자, 의사와 영양사가 1박 2일간의 해양스포츠 체험활동 을 통한 건강교실을 시행하였다. 대상자의 체질량지수, 체지방량을 측정하여 비만정도를 평가하였으며, 칼로리 섭취에 대한 강의를 시행하였고, 설문지 조사를 통해 대상자의 식이 섭취 습관에 대한 조사를 시행하였고, 본 건강교실에 대한 만족도를 측정하였다. 대상자중 남자에서는 40%, 여자에서는 25.69%에서 비만 경향을 보였다. 대상자의 대부분에서 시행된 건강교실에 긍정적 반응을 보였으며, 향후 체계적인 구성과 철저한 사전계획이 병행되어 본 증례 보고와 같은 건강교실을 시행한다면, 비만아동에서 거부감 없이 비만에 대한 교육을 실시할 수 있으며, 정상 체중 아동군에서도 비만에 대한 예방교육을 시행할 수 있는 프로그램이 될 것이다. 172 elementary school students involved this health program. This subjects were learened about obesity that affect health problem, ideal eating habits, calories that contained in the children's favorite foods by doctors and nutritionist. And this stubjects were checked heights, weight, body fat percent. Obesity is 40% in the boys and 25.69% in the girls. Most subjects were satisfactory with this health program. So we will effectively educate obese children without resistance and prevent normal weight children from obesity through structured and well-designed health program that similar to this program.

볼트장력으로 보강된 철근 콘크리트 기둥의 실험적 연구

김도훈,원학재,김성배,김상모,이창남,김상섭 대한건축학회 2003 대한건축학회 학술발표대회 논문집 - 계획계/구조계 Vol.23 No.1(구조계)

As time goes up, structural capacity of members decreases in reinforced concrete structures. The deterioration of the capacity is mainly due to the corrosion of materials, poor construction and environmental pollution, etc. This deterioration is unavoidable, thus it is necessary to develop the method for repair and retrofit of structures in order to ensure structural safety of members. The purpose of this paper is to investigate the load-deflection, ultimate strength, failure mode, and energy absorption effect. For the test, the specimen size of column is 20cm×20cm×90cm reinforced with 4 number of main bars of 13mm diameter, tied bars of 6mm diameter. The test results show that the increasement of bolt and bolt tension's quantity improve the ultimate strength and energy absorption capacity.

An introduction to the recently excavated Chunggang Medical Records and research on their medical value

Kim, Nam-Il,Yun, Seng-Yick,Hong, Sae-Young,Ahn, Sang-Woo,Cha, Wung-Seok Kyung Hee Oriental Medicine Research Center 2007 Oriental pharmacy and experimental medicine Vol.7 No.2

This study is a report on recently discovered medical records based on traditional medicine in the 1900s. First, the contents of the records and their significance are described in detail. Next, a simple example of the research follows, in order to explain the medical and historical significance the records contain and to answer the question of how this historical document can contribute to future medical and historical studies. The documents dealt with in this study, the Chunggang Medical Records, are medical records compiled by a Korean doctor of oriental medicine by the name of Younghun Kim who practiced in the center of Seoul for a period of over 60 years. The records, which eventually amounted to over 1,500 books, were made known to the academic world when the descendents recently donated them to Kyunghee University. The reason these medical records attract so much attention from academic circles, even though they are the work of one individual, is that they contain abundant information on general public medical health at the time, in addition to the fact that Kim Younghun was a well known figure among Oriental Medicine doctors in Korea. The medical records start in 1915 and continue until Kim Younhun's death in 1974, though they have some damaged or missing parts. Kim's medical records are a gold mine not only for scholars studying the medical history of the early 1900s, but also for doctors trying to emulate the techniques embedded in a great predecessor's medical practice.

일렬 자가조혈모세포이식을 받은 다발성 골수종 환자에서 발생한 뇌 톡소포자충증 1례

김계형,송경호,전재현,박완범,박상원,김홍빈,김남중,김인호,오명돈 대한감염학회 2010 감염과 화학요법 Vol.42 No.3

Toxoplasmosis is a rare but fatal complication in hematopoietic stem cell transplant recipients, usually associated with allogeneic hematopoietic stem cell transplantation (HSCT). We report a case of cerebral toxoplasmosis in a patient with multiple myeloma, following tandem autologous stem cell transplantation. A 55-year-old Korean male presented with weakness in both legs that had progressed to both arms. A magnetic resonance imaging scan of the brain revealed multiple, variablesized ring-enhancing lesions with surrounding edema in the cerebral hemispheres and brain stem. Stereotactic biopsy revealed bradyzoites of Toxoplasma gondii in the brain tissue. The patient received trimethoprim-sulfamethoxazole, followed by pyrimethamine and sulfadiazine, accompanying treatment for progressive multiple myeloma. Cerebral toxoplasmosis should be considered as one of the differential diagnoses in patients with neurologic signs following autologous HSCT.

균혈증을 동반한 Klebsiella pneumoniae 이하선염 1예

김자영,이상오,최상호,김남중,최승호,우준희,김양수,류지소 대한감염학회 2003 감염과 화학요법 Vol.35 No.3

급성 세균성 이하선염은 주로 노인 환자들에게서 흔히 나타나며, 여러 가지 위험인자가 있을 경우 발생 빈도가 증가한다. 원인균으로는 S. anureus 등의 그람 양성균이 가장 흔하지만 그 외 그람 음성균과 혐기성균에 의한 경우도 증가하고 있다. 급성 세균성 이하선염의 치료로는 기저질환에 대한 치료와 함께 적절한 항균제를 사용하는 것이다. 저자들은 급성 세균성 이하선염에 동반된 Klebsiella pneumoniae 균혈증 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Acute bacterial parotitis is primarily a disease of the aged and clinically ill patients. Dehydration, dry mouth resulting from surgery or medication use, sialotithiasis, malnutrition and systemic illness are prominent predisposing factors. Staphylococcus aureus is the most common pathogen associated with acute bacterial parotitis. However, streptococci, gram-negative bacteria, and anaerobes have also been reported to be associated with the disease. Nevertheless, acute parotitis caused by Klebsiella pneumoniae has never been earlier reported in Korea. We describe a case of acute parotitis which developed in a 73 year-old women with K. pneumoniae bacteremia. In this case, the patient initially received supportive care. Oral amoxicillin/clavulanic acid were initiated because the painful swelling of the left parotid gland, and overlying erythema was aggravated and pus from Stensen's duct was drained. She complained of fever in spite of oral amoxicillin/claulanic acid administration for 4days. Then, the antibiotics were switched to intravenous ampicillin/sulbactam, and the patient recovered fully after 2 weeks of intravenous antibiotics therapy.

子宮內膜搔爬術 21例의 鍼麻醉效果에 대한 臨床的 硏究

金在圭,金相佑,李宜暻,金建植,金相佑,南相永 경희대학교 1997 慶熙醫學 Vol.13 No.1