섬강 시험유역의 GIUH 모형에 관한 연구

박정수(Park Chung Soo),최흥식(Choi Hung Sik),문형근(Moon hyung gun) 대한토목학회 2005 대한토목학회 학술대회 Vol.2005 No.10

의약분업에 관한 정신과 환자와 가족의 견해

박정수(Jung-Soo Park),최명환(Myoung-Hwan Choi),이충경(Choong-koung Lee),정은기(Eun-Kee Chung),박용천(Yong-Chon Park),김찬형(Chan-Hyung Kim) 대한사회정신의학회 2000 사회정신의학 Vol.5 No.1

2000년 7월 1일부터 실시 예정인 의약분업은 의약품의 오·남용으로부터 국민을 보호하고 의사와 약사 두 전문 인력간의 역할구분을 명확히 하여 국민들로 하여금 정확한 의료에의 접근을 가능케 하여 궁극적으로는 국민의 건강을 보호한다는 목적을 가지고 있는데, 실제 의약분업의 목적하는 바 건강 증진의 대상인 국민조차도 의약분업에 대해서 잘 알지 못하고 있는 실정이다. 본 조사는 의약분업에 대한 정신과 환자, 보호자들의 인식과 이들이 생각하는 문제점들에 관한 것으로 각 시.도별 정신과 전문병원, 대학병원정신과, 개인 정신과 의원에 다니는 환자와 보호자를 대상으로 1999년 9월 20일부터 동년 10월30일까지 설문조사를 하였다. 설문지의 내용은 의약분업에 대한 인식도, 정신과에서의 의약분업 시 발생할 수 있는 문제점 등을 포함해서 8개 항목으로 구성되었다. 전체2,664명의 회신자료중 환자와 보호자를 구별할 수 없는 응답자 39명을 제외한 환자 응답자가 2,330명, 보호자 응답자가 295명이었다. 조사의 결과 의약분업 시행이 얼마 남지 않은 현시점에서 환자나 보호자는 의약분업이 무엇인지 정확히 알고 있는 사람이 드물었다. 또 정신과에서 의약분업 실시 때 발생할 수 있는 문제들에 대해 환자의 60.3%, 보호자의 66.4%에서 번거롭고 경제적으로 부담이 된다.고 했고, 예상 부작용에 대해서도 치료의 일관성 상실과 약물의 오·남용 심화된다.는 응답이 가장 많았다. 또 환자 보호자 대부분에서 정신과 진료에서 의약분업은 제외되어야 한다고 응답했다. 의약분업은 좋은 제도이지만 여기에는 많은 문제점이 있다. 특히 의사와 환자관계가 중요한 정신과에서는 더욱 많은 문제점들을 야기할 수 있겠다. 의약분업은 충분한 사전조사와 가능한 문제점들을 고려하여 시행되어야 할 것이다. The separation of dispensary from medical practice that is supposed be applied from July first, 2000 has two purposes. The first one is protecting people from the abuse of drugs and the second one is apparently distinguishing the roles, which are pharmacist and medical doctor, to accelerate people’s access to correct medical treatment. In this context the ultimate purpose of it could be assumed to protect people’s health. However actually people do not know much about the separation of pharmacy and clinic. This Article is about the problems that mental patients and their families could think of and the perception they might have, when the separation of pharmacy and clinic is in effect nation-wide. The mental patients and their families, who were visited from september 20th, 1999 to October 30th, 1999 in civil, national, and private hospitals, were selected for survey target. The contents of questions consist of eight items including the followings. They were the perception of mental patients and their families for the separation of dispensary from medical practice and the problems that could be expected at the time of its enforcement. The number of returned questionnaire were 2,664 and 39 of them were excluded due to the unclear distinction between patients and families. Finally the patient responders were 2,330 and the family responders were 295. As a result of survey it is very rare that patients or families know clearly what the separation of dispensary from medical practice is, the policy of the separation of pharmacy and clinic is supposed to be enforced in the near future though. For the problems that could be raised after the enforcement of it, 60.3% of patients and 66.4% of families said that they felt complicated and it would be a burden to them economically and for the expected side effect most of patients and their families answered that the loss of consistent treatment and abuse of drug would be more deepened than before. Additionally they also answered that the policy of the separation of dispensary from medical practice should be exempted in the case of psychiatric treatment. Although the separation of dispensary from medical practice is a good system, there are several problems. Actually the fact, that the doctor-patient relationship is important in the psychiatric treatment, could cause more problems. The separation of dispensary from medical practice should be enforced with the consideration of possible problems and sufficient preliminary examination.

그레이브스병의 갑상선 절제술후 합병증

박정수(Cheong Soo Park),정웅윤(Woong Youn Chung),김종관(Jong Kwan Kim),장항석(Hang Seok Chang) 대한두경부종양학회 1999 대한두경부 종양학회지 Vol.15 No.1

Introduction: The surgical treatment of Graves' disease has several advantage such as rapid and long lasting therapeutic effect, relatively low incidence of postoperative hypothyroidism and recurrence. Because of less frequent but serious postoperative complications, the operation have not been casually used for treatment of Graves' disease. Hypoclacemia, hoarseness and hematomas are common complications after operative treatment. However, the causative mechanisms of these complications have not been well explained. Objective: We aimed to analyze the risk factors affecting the occurance of complications in surgical treatment for Graves' disease and to evaluate what are the causative mechanisms of postoperative complications. Patients and Methods: From January 1985 to December 1998, a total of 668 surgically treated patients for Graves' disease were enrolled in this study. The incidence of postoperative complications were analyzed in relation to types of surgery, preoperaive preparation, specimen weight, bleeding amount and remnant weight. Results: Postoperative complication was developed in 108(16.2%) of 668 patients. The most common complication was transient hypocalcemia in 85 cases(12.7%). Other complications were: Hematoma in 9 cases(1.3%), transient hoarseness in 5 cases(0.7%), permanent hypocalcemia in 6 cases(0.9%), permanent hoarseness in 3 case(0.4%). The important etiologic factors affecting the occurance of complications were preoperative preparation, perioperative thyroid weight, and remnant thyroid weight. Since 1993, the incidence of complication was more decreased than that in before. Conclusion: To decrease the incidence of postoperative complications of Graves' disease, the patients should be selected carefully, sufficient preoperative preparation should be achieved, and the operation should be performed by well-experienced surgeons.

최소침습 갑상선절제술에서 피부절개전 Ketororac과 Bupivacaine 국소주사에 의한 진통효과

박정수(Cheong Soo Park),이해경(Hae Kyung Lee),김태진(Tae Jin Kim),정웅윤(Woung Youn Chung) 대한두경부종양학회 2000 대한두경부 종양학회지 Vol.16 No.2

The reduction of the postoperative wound pain has been a concern in recent surgery, especially in various types of minimally-invasive surgeries. This study was performed to evaluate the postoperative analgesic effect of the preincisional local anesthesia with the mixture of ketorolac(Tarasyn) and bupivacaine to the surgical site in minimally-invasive thyroid surgeries. Of 491 patients who were scheduled for minimally-invasive thyroid surgeries between October 1999 and July 2000, 244 were randomly assigned to receive a mixture of ketorolac tromethamine 15mg(0.5ml) and 0.25% bupivacaine 3ml via surgical site infiltration 3 minutes prior to the skin incision. The outcomes of these patients were compared to those of the 247 controls. Total number of patients in need of post-operative analgesic requirements(n=39, 16.0%), total dose of postoperative analgesics used(19.6±8.4mg of ketorolac) and Visual Analogue Pain Score(VAS, 2.6±1.2) of the preincisional local anesthesia group were significantly lower than those of the control group(p 1.6±0.4 days for the preincisional local anesthesia group versus 1.9±0.7 days for the control group. The preincisional local infiltration of ketorolac and bupivacaine in the minimally invasive thyroidectomies reduces postoperative wound pain thus would be more beneficial to the patients.

경골과 골절에 대한 임상적 고찰

박정수(Jung Soo park),정영기(Young Khee Chung),이기병(Ki Byung Lee),이도형(Do Hyung Lee) 대한정형외과학회 1986 대한정형외과학회지 Vol.21 No.5

이하선의 단일섬유종(Solitary Fibrous Tumor) 1예

박정수(Cheong Soo Park),양우익(Woo Ik Yang),백소야(So Ya Paik),정웅윤(Woong Youn Chung),장항석(Hang Seok Chang),황수경(Su Kyung Hwang) 대한두경부종양학회 1999 대한두경부 종양학회지 Vol.15 No.2

Solitary fibrous tumors are commonly arise in the pleura and less commonly in extrapleural sites. In head and neck area, solitary fibrous tumors can occur in nose, paranasal sinus, soft palate, epiglottis, thyroid, parotid and submandibular gland. To our knowledge, this is the 5th case of solitary fibrous tumor arising from the parotid gland in English literature. We report a case of solitary fibrous tumor occurred in the superficial lobe of right parotid gland which was successfully treated by superficial parotidectomy with preservation of the facial nerve.

최소침습 방사능 유도 부갑상선 수술

박정수(Cheong Soo Park),이종두(Jong Doo Lee),장항석(Hang Seok Chang),정웅윤(Woong Yoon Chung,) 대한두경부종양학회 1999 대한두경부 종양학회지 Vol.15 No.2

Introduction: Since 1996, Dr. James Norman has successfully performed mimimally invasive radio-guided parathyroidectomy(MIRP) using intraoperative nuclear mapping with 99m Tc sestamibi scanning and radioactivity detection probe. Objectives: We aimed to introduce this new surgical technique and evaluate it's efficacy by our own experiences. Method: From May to October 1999, five consecutive patients with primary hyperparathyroidism underwent parathyroidectomy by using modified MIRP technique. 99m Tc sestamibi scanning was performed 1.0 or 1.5 hour before operation. After intraoperative localization of the tumor under the guidance of quantitative gamma counting with a NEVIGATOR probe, an unilateral small skin incision(3.0-4.0cm) was placed. Without a skin flap, the strap muscle was directly divided with the use of a Harmonic scalpel. After careful dissection, the parathyroid tumor was removed. Result: In all patients, a single adenoma could be easily detected and removed by this new technique. Mean incision length was 3.2cm(3.0-4.0cm) and operative time ranged from 40 to 110minute. All the patients were discharged within 2 days of surgery without any complication. Conclusion: This new operative technique could become the most minimally invasive alternative to the standard operative procedure for parathyroid adenoma.

이하선에 발생한 소관 선종

박정수(Cheong Soo Park),심정연(Jeong Yun Shim),정웅윤(Woung Youn Chung),신동우(Dong Woo Shin) 대한두경부종양학회 1997 대한두경부 종양학회지 Vol.13 No.2

Parotid canalicular adenoma is a benign neoplasm that is predominantly composed of branching and interconnecting cords of single or double rows of columnar epithelium in a very loose stroma. There has been considerable confusion in the literature concerning the terminology of canalicular adenoma. However, thesedays it has been newly-recognized as a discrete entity of the monomorphic adenoma group. Canalicular adenoma has a remarkable predilection for occurrence in the minor salivary glands such as the upper lip, in contrast with basal cell adenoma that occurs predominantly in major salivary glands such as the parotid gland. We have experienced a case of canalicular adenoma of the parotid gland in a 65-year-old woman. The patient had a palpable mass on the preauricular area for the last 15 years and recently noticed a mild pain and discomfort on the mass. Neck ultrasonography showed a low echogenic mass of 1.0cm in diameter in the right parotid gland and a neck CT scan showed a well-enhanced rectangular-shaped mass. A superficial parotidectomy was performed for the lesion and the final pathologic diagnosis turned out to be 'multifocal canalicular adenoma'.

경부 악성 림프종과 동반된 유두상 갑상선암

박정수(Cheong Soo Park),정웅윤(Woong Youn Chung),장항석(Hang Seok Chang) 대한두경부종양학회 1998 대한두경부 종양학회지 Vol.14 No.2

The increasing risk of subsequent malignancy after treatment of malignant lymphoma is well known, which is mainly due to longer survival of these patients. Radiotherapy at an early stage of Hodgkin's disease or non-Hodgkin's lymphoma is accepted to be associated with future occurrence of secondary thyroid cancer. Nevertheless, the synchronous presentation of these malignancies is extremely rare. Well differentiated thyroid cancer, a slow-growing tumor that responds to therapy with surgery and radioactive iodine, is associated with prolonged survival. therefore, it is important to make this diagnosis in patients who show evidence of malignant lymphoma. Furthermore, appropriate treatment must be considered for thyroid cancer to improve the prognosis of these patients. We herein reported 4 cases of synchronous thyroid cancer and malignant lymphoma in patients who had not previously recieved radiotherapy or chemotherapy.

갑상선 결절의 Ki67과 p27 발현도에 대한 분석

박정수(Cheong Soo Park),정웅윤(Woung Youn Chung),장항석(Hang Seok Chang),이미경(Mi Kyung Lee) 대한두경부종양학회 1999 대한두경부 종양학회지 Vol.15 No.1

Objective: The expression of Ki67, a proliferation marker, and p27, a cyclin dependent kinases(CDKs) inhibitor, has been studied in various human neoplasms. This study was carried out to determine whether these markers are useful in distinguishing benign from malignant lesions of the thyroid or predicting biologic behavior of malignant lesions. Material and Methods: Using immunohistochemical techniques with monoclonal antibodies to Ki67 and p27, we analyzed the expression of Ki67 and p27 in various thyroid disorders(25 follicular adenomas, 47 follicular carcinomas, 16 papillary carcinomas, 20 adenomatous goiters and 40 normal thyroid tissues). The labeling indices(LIs) were determined by counting cells expressing these markers in 1000 cells per immunostained slide. Results: Neoplastic thyroid diseases showed higher expression of Ki67 and lower expression of p27 than non-neoplastic diseases(p LI=55.4±5.7) and follicular carcinomas( LI=23.2±10.2). There was, however, no significant correlation between the degree of Ki67 and p27labeling indices and types of carcinoma or clinical aggressiveness of diseases. Conclusion: The degree of Ki67 and p27 expression was useful in distinguishing between benign from malignant thyroid lesions, particulary between follicular adenoma and follicular carcinoma, but was not directly proportional to the tumor aggressiveness.