단일공법 복강경하 질식자궁절제술 110예의 고찰 및 다공법과의 비교

박병준 ( Byung Joon Park ),김용욱 ( Yong Wook Kim ),노덕영 ( Duck Yeong Ro ),김태응 ( Tae Eung Kim ),류기성 ( Ki Sung Ryu ),김장흡 ( Jang Heup Kim ) 대한산부인과학회 2010 Obstetrics & Gynecology Science Vol.53 No.7

목적: 통상적인 복강경기구만을 사용한 단일공법 복강경하 질식자궁절제술을 다공법 복강경하 질식자궁절제술과 비교하여 안전성 및 유용성을 평가하고자 하였다. 연구 방법: 2007년 4월부터 2009년 11월까지 인천성모병원에서 자궁근종 또는 자궁샘근증의 질환으로 단일공법 복강경하 질식 자궁절제술을 시행받은 환자 110명과 다공법 복강경하 질식자궁절제술을 시행받은 환자 110명, 총 220명의 환자를 대상으로 하였다. 우리는 모든 수술에서 통상적으로 사용되는 구부러지지 않는 일직선의 복강경기구를 사용하였다. 또한 단일공법 및 다공법 복강경하 질식자궁절제술 둘 다에서 수술자 (Kim, YW)의 이름을 따서 명명한 새로운 질단부 봉합 방법인 김씨 질구개 현수법 (Kim`s Vaginal Vault Suspension Method)을 사용하였다. 결과: 환자 나이, 수술 시간, 자궁의 무게, 혈색소 수치의 변화, 수혈 빈도, 수술 후 발열에서 두 군 간에 유의한 차이를 보이지 않았다. 환자들의 평균 나이는 46.7±7.0세(단일공법)와 45.5±6.3세(다공법)이었다. 평균 수술 시간은 87.2±21.0분(단일공법)과 83.3±20.3분(다공법), 평균 자궁의 무게는 261.4±139.7 g(단일공법)과 257.8±132.9 g(다공법), 평균 혈색소 수치의 변화는 1.1±0.7 g/dL(단일공법)와 1.2±0.6 g/dL(다공법)이었다. 두 군 모두에서 수술 중 장 또는 요로의 손상은 없었다. 두 군 모두에서 각각 한 건의 개복수술로의 전환이 있었다. 단일공법을 시행한 군에서 입원 기간이 유의하게 짧았다(2.6±0.6일 [단일공법], 3.3±0.7일 [다공법], P<0.05). 결론: 통상적으로 사용하는 구부러지지 않는 일직선의 복강경기구를 이용한 단일공법 복강경하 질식자궁절제술은 다공법 복강경하 질식자궁절제술에 대한 안전하고 유용한 대체 수술이 될 수 있다. Objective: To evaluate the safety and feasibility of single-port access laparoscopically assisted vaginal hysterectomy (SPA-LAVH) using conventional laparoscopic instruments compared to multi-port access laparoscopically assisted vaginal hysterectomy (MPA-LAVH). Methods: We reviewed the medical records of 220 patients with uterine leiomyoma or adenomyosis who underwent 110 SPA-LAVH and 110 MPA-LAVH in Incheon St. Mary`s Hospital between April 2007 and November 2009. We performed SPA-LAVH with conventional rigid straight laparoscopic instruments in all cases. We also performed a new vaginal cuff closure method, Kim`s Vaginal Vault Suspension Method, named after the operator (Kim, YW) in both SPA-LAVH and MPA-LAVH. Results: There was no significant difference in patients` age, operating time, uterine weight, hemoglobin change, frequency of blood transfusion, and incidence of postoperative fever between the two groups. The patients` mean age was 46.1±7.0 years (SPA-LAVH) and 45.5±6.3 years (MPA-LAVH). The mean operating time was 87.2±21.0 minutes (SPA-LAVH) and 83.3±20.3 minutes (MPA-LAVH). The mean uterine weight was 261.4±139.7 g (SPA-LAVH) and 257.8±132.9 g (MPA-LAVH). The mean hemoglobin change was 1.1±0.7 g/dL (SPA-LAVH) and 1.2±0.6 g/dL (MPA-LAVH). Neither bowel injury nor urinary tract injury occurred during the operation in the two groups. One of the SPA-LAVH and one of the MPA-LAVH cases were converted to abdominal total hysterectomy. The mean hospital stay time was shorter with SPA-LAVH (2.6±0.6 days [SPA-LAVH] and 3.3±0.7 days [MPA-LAVH], P<0.05). Conclusion: SPA-LAVH using conventional rigid straight laparoscopic instruments can be offered as a safe and feasible alternative to MPA-LAVH.

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.

개에서 발생한 폐수종의 치료 증례

김유수,심재현,김건우,김지용,이병희,송근호,이영원,김덕환 충남대학교 수의과대학 동물의과학연구소 2004 動物醫科學硏究誌 Vol.12 No.-

A 9 months intact male American bull dog with chief complaints of dry cough, dyspnea and fever was referred to the Veterinary Teaching Hospital, Chungnam National University. Based on the findings of physical examination, radiological examination, and blood and blood chemical examinations, the present patient was diagnosed into pulmonary edema secondary to primary bacterial and aspiration pneumonia. The patient was hospitalized and treated with buscopan, cephazolin and furosemide for 1 week. His activity and appetite was returned to normal and thoracic radiographs revealed that Jung was recovered to the normal condition after treatment for 7 days. The present patient was a case with pulmonary edema showed favorable therapeutic responses to proper medication.

면양에서 개량된 제1위 누관 형성술 1례

김명철,김종만,김용국,김덕환,이영원 충남대학교 수의과대학 동물의과학연구소 1999 動物醫科學硏究誌 Vol.7 No.-

We performed rumen fistula operation in a sheep. In sheep, the procedure for a rumen fistula is quite successful, but choice of an appropriate cannula is of prime importance. The sheep was anesthetized by xylazine(0.1 ㎎/㎏ IM) administration 5 minutes after administration of atropine sulfate(0.1 ㎎/㎏ IM). We inserted rubber cannula in rumen incised and put rubber ring after employing purse-string suture in rumen. We marked the area for the puncture incision in the body wall through which the cannula is drawn. We drew the cannula as near the transverse process of the lumbar vertebrae as possible to minimize leakage. We isolated the cannula by fixing the stainless washer which has small holes. The sheep was given postoperative penicillin(20,000 IU/㎏ IM) to prevent secondary infection for 3 days. There were not observed the leakage of rumen contents, the entering of rubber cannula into abdominal cavity, and necrosis on incision site and skin, over months after surgery.

급성신부전증 이환견에 대한 복막투석 치료 1례

김건우,이병희,김유수,심재현,김지용,이영원,김덕환,송근호 충남대학교 수의과대학 동물의과학연구소 2004 動物醫科學硏究誌 Vol.12 No.-

A fourteen-month-old intact female Poodle was referred to the Veterinary Teaching Hospital, College of Veterinary Medicine, Chungnam National University. The patient was presented with history of vomiting, inappetence, ataxia, insomnia, tachypnea and convulsion for 5 days. Biochemical examination revealed BUN (254.2 mg/dl), creatinine (9.22 mg/dl) and phosphate (14 mg/dl). Epithelial cells of urinary tract, neutrophils, macrophages, a large number of gram negative and smaller number of gram positive bacteria were presented on urine test. Ultrasonographic findings show hyperechogenic kidney and indistinguishableness of renal cortex and medulla. Based on the results of examination described above, this case was diagnosed as acute renal failure with interstitial nephritis by urinary tract infection (UTI). Treatments with fluids therapy, diuretics, and peritoneal dialysis during hospitalization showed good results with no clinical signs.

보험사기조사의 효과성에 관한 실증연구 : 미국의 주 보험사기국을 중심으로 Evidence from State Insurance Fraud Bureau of USA

김용덕,안철경 한국보험학회 2002 保險學會誌 Vol.61 No.-

보험산업의 모럴해저드, 역선택이 구체적 범죄행위로 나타나는 보험사기는 제도적인 일탈행위로서, 보험산업적 차원에서는 보험제도 자체의 근본을 흔드는 중요한 이슈로서 점차 확대되고 있다. 국내의 보험사기 규모의 급격한 증대 및 이로 인한 사회적 파급효과가 심각하고, 아울러 점차적으로 사기유형의 다기화 및 전문화에 따라 이를 효과적으로 대처하기 위한 제도적 지원이 시급히 이루어져야 할 필요성이 제기된다. 본 연구는 보험사기 적발의 효과성을 미국의 주보험사기국의 보험사기 법제관련 Data를 토대로 실증분석하고, 이를 통해 국내 보험사기 조사업무의 실효성을 제고하기 위한 시사점을 도출한다. 본 논문은 사용 데이터가 미국의 보험사기국 자료이며 종속변수에 대한 여러 가정하에 이루어진 실증분석이라는 한계성에도 불구하고, 최근 국내 보험사기에 대처할 제도가 필요해진 시점에 제도적 지원의 핵심으로 부각되고 있는 조사권 확보, 검찰 임용권 및 보험회사의 지속적인 투자 등의 효과를 분석하여 새로운 제도의 틀을 짜는데 근거를 삼을 수 있도록 하였다. Concerns about the insurance fraud, a concrete expression of moral hazard in the insurance industry, are increasing more and more. In particular, the scale of insurance fraud in the domestic insurance industry is significantly growing and impacts on the entire society. This article executed an empirical study with regard to the correlations between efforts against insurance fraud and the detection activities in view of institutional, legal and professional aspects. It also gives an important suggestion with regard to the effects of inspection of insurance fraud. As a result, we can draw a conclusion that investigation authority and prosecutor assignment are significantly correlated with the effectiveness of detection of insurance fraud. In addition, other observable variables such as budget per case, the location of primary home and the number of personnel are also correlated with that. But due attention is required when the main result of this article is applied to the domestic situation because data set used in this article is from the State Insurance Fraud Bureau. Nonetheless, it gives meaningful results with regard to the effectiveness of investigation authority and the prosecutor assignment which can be said to be the main issues of domestic insurance fraud detective system.

Lady Windermere's Fan의 구조와 주제

김용덕 東亞大學校 1999 東亞論叢 Vol.36 No.-

This is an attempt to study the thematic structure of Oscar Wilde's first successful comedy, Lady Windemere's Fan through the close examination of the play. There is no denying that Wilde was interested not only in matters of technique, but also in the themes used by his predecessors. Wilde used not only a topical and conventional dramatic theme - that of the 'woman with a past' of thesis play but also the popular forms inherited from the French well - made plays and other contemporary plays to appeal to the Victorian audience. Yet Wilde did not simply borrow material but used the plot mechanism and characters of the traditional dramas of the fallen woman and delinquent mother to produce a complex and revolutionary play. Individualism is its true doctrine, a doctrine subtly disguised by the surface melodrama of the play. Even the plot of the play is most remarkable for what does not happen unlike the Victorian melodramas. The truth is imparted to the audience and the expectation is underlined for the audience whenever the information is given. But the pattern of anticipation followed by frustration on the part of the audience recurs throughout the play from the threat of striking-with-the-fan in the exposition to the incomplete revelation in the denouement. Here Wilde is rejecting any blatant imitation of a particular theatrical tradition and constructing a more subtle variation on familiar themes and patterns. One striking principle of construction in Lady Windermere's Fan is the way in which it is organized by means of hierarchy of wit based on traditional English comedy of manners. Such a scheme would place the chief spokemen of Wildean dandyism such as Mrs Erlynne, Lord Darlington, Dumby, and Cecil Graham in the highest rank, their tone being echoed by choric figures and the earnest at the bottom. Thus Mrs. Erlynne, the true individualist rejects the maternal role, preferring her freedom to the restrictive duties of a mother. In a denouement of incomplete revelation, Mrs. Erlynne, once the 'fallen woman' is the only character with complete knowldege. And the 'good' Lady Windermere's matured classification of Mrs. Erlynne as 'good' rather than 'infamous' is also small step on the road to the conversion of the conventional into the radical.

An Ideal Husband의 구조와 주제

김용덕 동아대학교 인문과학대학 영어영문학과 1996 동아영어영문학 Vol.12 No.-

This is an attempt to study the theme and structure of Oscar Wilde's third comedy, An Ideal Husband by a close examination of the play. Many critics have complained about Wilde's indebtedness and adherence to a tradition that was already established in comic drama; post- romantic French drama and the plays of his English contemporaries. Our superficial understanding of this play might lead to the false conclusion that his achievement lay merely in putting together melodramatic situations, using techniques from the well-made play, and projecting them onto a background of social criticism in the problem play. The real problem of the play is the tension between men and women, the individual and society, between public and private life, and between established norms and their deliberate violation. The guilty secret which in the previous two plays had been sexual and focussed on a woman is here concerned with money and politics and centered upon a man in the main plot. Yet it is the sub-plot of Mabel Chiltern, Sir Robert's sister and the elder statesman, Lord Caversham which gives the play its chief distinction and delight. And also the shared mask of frivolity between Lord Goring and Mable Chiltern, a preliminary sketch for Cecily and Algernon in the Importance of Being' Earnest, serves as a refreshing contrast to the solemnity of Lady Chiltern's attitude to life in the main plot.. A Wildean idea given especially strong emphasis in An Ideal Husband is that life is as capable of artistic form and meaning as a painting or a poem. The imagery of masks which so permeates this drama and the paradoxes of dandies not only reinforce the life-as-art-form theme but support the plot in several other ways. Even the moralistic plot does not jar so sharply against the anti-philistine and dandiacal elements. This harmony is achieved by making Lord Goring the ally of the principal characters in their struggle against the wicked Mrs. Cheveley and by providing the spectators with a critical perspective through the duality and polarity of plot and achieving ironic dramatic effect. The political satire also helps to dissipate the discord that existed in the earlier comedies between the comic themes and the serious ones. Despite the fact that Wilde continually touches on the conflict between public and private life, we cannot assign his comedies to the genre of the problem play like that of Henrik Ibsen. The tradition of problem play did not suit Wilde at all, for it ran contrary to his ant-realistic concept of art and he was not really interested in social reform. However, there is no denying that he was interested not only in matters of technique, but also in the themes used by his predecessors. Wilde even yielded to the epidemic temptation to rewrite Ibsen, such as taking over dramatic situations in Ibsen, but more often added something distinctive of his own - a comic twist or a transformation of Ibsen's text to make an effect and a poink uniquely his. Oscar Wilde is less conventional in the mechanics of plot construction in An Ideal Husband than was Ibsen in Pillars of Society. Although the patched-together happy ending, by which the guilty Sir Robert Chiltern retains both his good wife and his good name is subversive, there is a revolutionary nature in the play, which demeans practically every ideal but love itself. To sum up Wilde realized his ambitious self-conception as the 'peer of Ibsen' in An Ideal Husband by producing shock waves capable of reaching us today through shaking the pillares of society.

충남대학교병원에서 분리된 병원성 세균의 항생제 감수성 검사에 관한 고찰

양석환,김덕배 대한임상병리사협회 2001 대한임상병리사회지 Vol.21 No.1

Henvy IV(I,Ⅱ)의 통일성 문제

金容德 동아대학교 인문과학대학 영어영문학과 1990 동아영어영문학 Vol.6 No.-

My purpose in this paper is to study the problem of unity in Henry Ⅳ(Ⅰ, Ⅱ) by a close examination of each play. The action of Henry Ⅳ alternates between two morally distinct but dramatically coexistent worlds, the world of the court and the world of the tavern. The world of the court includes not only the King and his allies but the rebels as well. The world of the tavern revolves around Falstaff and is peopled with an amazing array of his satellites who reflect his comic glory. One of Falstaff's functions is to clarify the relationship between appearance and reality. He divests filings of their ideological masks. He acts as a comic regent on honor, truth and all the ideals of the world of the court which often serve as delusions covering criminal motives and acts. Falstaff, operating on a comic as well as satiric level, is Shakespeare's imaginative response to the abuse of power. Through Falstaff we come to see how flawed the public world is. Prince Hal's oscillation between the two worlds provides the main narrative link, but the unity of the play depends rather on the way that Shakespeare has juxtaposed the scenes of the tavern with those of the court, so that the political machinations of Henry's reign are satirically reflected in the mirror of the Falstaffian comic world. Throughout part Ⅰ and part Ⅱ, the theme of Henry's Machiavellism and Prince Hal's wilier Machiavellism through his role playing is predominant. There is no "education" theme on the part of Prince Hal, but he is a cunning Machiavellian from his first appearance on the stage as demonstrated in his first soliloquy. Falstaff serves to expose, through his comic perspective, the emptiness and deceit of politics undermining and subverting the false values and pretensions of the court. In this sense, al's rejection of Falstaff reflects power's preference for the barren cruelty that underlies the Realpolitik of Henry Ⅳ and Henry Ⅴ. Henry Ⅳ is a "dramatic objectification of the conflict between what Freud called the reality-principle of Prirnce Hal and the pleasure principle of Falstaff." The theme of Henry Ⅳ(Ⅰ, Ⅱ) is the morally corruptive influence of power, the cruelty and deceit that inevitably infect those who wear the crown. This is the Machiavellian divorce of public from private morality which manifests itself in the Lancastrian leaders' constant concern with their public image. But Shakespeare particularly emphasizes the moral effect of the Machiavellian Realpolitik. This theme has been worked out in each play by the strucrue of offering a cuntervailing value to the inhumarlity arising from the exercise of power. In the process of the development of theme, human motivation is more stressed than either Providence or Fortune, and the conflict in personalities and the values they represent is embodied within the plays, providing their unity.