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.

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.

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.

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.

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

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.

오스카 와일드의 Vera;or, The Nihilists의 구조와 주제

김용덕 東亞大學校 2001 東亞論叢 Vol.38 No.-

This is an attempt to study the thematic structure of Oscar Wilde's romantic tragedy; Vera; or, The Nihilists by a close examination of each play, on the assumption that the term 'structure' includes both content and form. Vern is the first example of Wilde's interest in the bizarre and individualism which produced Dorian Gray and Salome. Each of the five scenes of Vera is a genuine unit in spite of the weakness in characterization and plot construction that are caused by Wilde's inexperience as a dramatist; each has its own climax; and each leads inevitably into the one that follows. Act I, for all its improbability, lays the basis for the action, and the climactic assassination of Act II places the heroine in her classic dilemma of love or honor. In Act III she resolves it in favor of honor, and in Act IV we have the expected peripetea, and love conquers all. Vera's suicide is the supreme act of the Romantic individual's will. Vera, for whom life is at first valuable only as a form through which to realize her ethical and social idealism, makes her own life perfect by ending it at the perfect moment. Vera; or, The Nihilists was Oscar Wilde's first performed play, a work, as Wilde described it, "not of polities but of passion," expressing "cry of peoples for Liberty." Liberty as subject --and the rhetoric of republicanism that made liberty a catchword --came naturally to Wilde, as son of the Irish patriot Speranza and as an aesthetic individual. But Wilde was also professionally ambitious. By writing a wordy tragedy of self-sacrifice with Russia and the Nihilist movement as background, Wilde hoped to appeal to popular taste in the theatre and to capitalize on public interest in current affairs, with a woman as the hero. Wilde's feminism is one of the least commonly recognized aspect of his progressive ideas. He was, however, a consistent champion of women's rights both in his life and his work, supporting all the primary demands of late nineteenth-century feminism. His doctrine was in essence that of a utopian anarchist, preaching the doctrine of individualism and aestheticism. Wilde always liked to create manly women and womanly men, as a challenge to the stratified thinking of his day and demonstrates that the gender-antitheses of the age were almost meaningless through the characterization of female leads. Many critics have complained about Wilde's indebtedness and adherence to a tradition that was already established in drama; romantic tragedy, post-romantic French drama and the plays of his English contemporaries. Our superficial understanding of his plays might lead to the false conclusion that his achievement lay merely in putting together melodramatic situations, using techniques from the French well-made play and romantic tragedy, and projecting them onto a background of social criticism in the problem play. The real problem of his plays is the tension between the individual and society, between public and private life, between established norms and their deliberate violation. The subject-matter and the conflict in Vera, however, lies in not only her classic conflict between her love for an individual named Alexis and her loyalty to a cause involving others, that is, nihilism but rather in the classic motif of the character ton psychically between equal and opposing internal forces - a theme implied by the play's title itself. Ultimately the natural physical consummation of their love is replaced by the heroine's suicide, in which she faces the knowledge of her real desires and of her true nature, fulfilling herself independently of the pressure to conform. Through the aesthetic of the play, Wilde communicates what he understood about the transgressive power of love and commitment in human relationships. What makes the play an integral step in Wilde's transgressive aesthetic is the character of Vera, In sum, Vera is a non-traditional woman who is in a process of self-discovery, which will lead her to an individualism connecting her with the larger life of humanity.

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.

오스카 와일드의 희극에 미친 여러 가지 영향

김용덕 東亞大學校 1996 東亞論叢 Vol.33 No.-

This is an attempt to study influences on Oscar Wilde's comedies; the French influence by comparing French thesis play with Wilde's Lady Windmere's Fan An Ideal Husband, Ibsen's influence by contrasting Pilars of a Society with An Ideal Husband and that of the English comedy of manners by analyzing A Woman of No Importance. 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 his plays 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 his plays is the tension between men and women, the individual and society, between public and private life, and between established norms and their deliberate violation. There is little denying that in his first three comedies Wilde was burdened with the tradition of French thesis play. But compared with the theses of Dumas fils and Augier, Wilde's were less conventional. In all his three comedies there is a secret that either sets the plot in motion or at least has a decisive influence on its course. Futhermore, this secret always concerns something in conflict with social or moral convention, that is, the indiscretions of Mrs Erlynne and Mrs Arbuthnot in lady Windmere's Fan and A Woman of No Importance, and the corruption of Robert Chiltern in An Ideal Husband. In particular the moral scheme of the plot in An Ideal Husband has, demonstrably, some unusual implications, which reflect the tolerance and compromise of Lady Windmere's fan rather than the moral absolutes of A Woman of No Importance. In Lady Windmere's Fan and A Women of No Importance Wilde attacked an uncompromising attitude, such as Dumas and Augier took, towards the demi-mondaine, and in An Ideal Husband the demi-mondaine, though foiled, is not humiliated. But It is only with his complete escape from the thesis play in The Importance that Wilde realized his potentiality in comedy Despite the fact that Wilde continually touches on the conflict between public and private life, we cannot assign leis 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 anti-realistic concept of art and he was not really interested in social reform. The impact of Ibsen on England helped to develop the English "problem play" of the nineties, when English drama lagged so far behind French drama that the first effect of Ibsen on English drama was merey to encourage it in going as far as Augier and Dumps. Like Shaw, Barrie, Jones, Fryers. and the rest. Wilde yielded to the epidemic temptation to rewrite Ibsen, such as taking overt drammatic situations in Ibsen, but more often added something distinctive of his own - a comic twist or like Austin Fryers, a transformation of Ibsen's text to make an effect and a point uniquely his. Especially in An Ideal Husband Wilde realized his ambitious self-conception as the peer of Ibsen' by producing shock waves capable of reaching us today through shaking the pillares of society. It should not be supposed that Wilde is attempting to imitate any one genre rather than anther; however, the Individua1 kind of comedy which he initiated and developed has even stronger affinities with the English than with the French trandition. One striking principle of construction In his comedies, which corroborates such a view, is the way in which it is organized, in part, by means of hierarchy of wit based on traditional English comedy of manners. Such a scheme would place the chief spokesmen of Wildean dandyism such as Mrs Erlynne, Lord Darlington, Lord Illingworth and Lord Goring, and two couples of lovers in The Importance in the highest rank, their tone being echoed by choric figures and the sincerely earnest at the bottom. In A Woman of No Importance Wilde created the world of a next-restoration conclict by restating a number of the standard situations of Restoration comedy, and using the stock antitheses of the genre - town and country, wits and sentiment, libertine and courtly attitudes, men and women, cits and aristos - as thc basis of reference for a critical treatment of some of the real issues of the age' There is no denying that he was interested not only in matters of technique, but also in the themes used by his predecessors; however, he made two vital contributions to the development of British drama: a new style of language and a new critical perspective. His alternation of techniques in style of language - non-commitment, witty aphonsms, paradoxes, hidden dialogue and direct expression - was the original feature that emanated directly from his own peculiar gifts, and his new critical perspective consisted in his scepticism as regards the efficiency of communication at a time when social consensus was becoming increasingly difficult, his focus on the dilemma of a the Individual seeking meaningful identity in the clash between public and private life, and his undermining of traditional conventions. Thus the works of T. W. Robertson, S. Grundy, H. A. Jones and countless other nineteenth-century playwrights have been more or less forgotten, whereas Oscar Wilde's comedies have load an asset of tremendous value, that of appealing to the common man.

토끼의 Aflatoxin B₁중독증에 대한 인삼엑기스의 효과 : 임상, 생리적 및 병리학적 변화 Clinical, Physiological and Pathological Changes

김차용,변유성,문평일,정덕화,김종수 慶尙大學校 1987 論文集 Vol.26 No.1

Chinchilla 계통 1~1.5㎏ 되는 토끼 30마리를 5군 으로 나누어 체중㎏당 제 1군은 대조군으로서 Cornoil 0.3ml 씩 제 2군은 aflatoxin B? 0.03mg과 인삼 엑기스 8mg을 제 5군은 aflatoxin B? 0.06mg과 인삼엑기스 8mg을 3주동안 카테타로 경구 투여하여 임상, 혈액학적 및 병리학적 변화를 관찰하였다. 1.사료소비량 감소, 침울, 쇠약, 혼수, 체중증가율감소등과 같은 임상증상은 대조군을 제외한 전 처리군에서 독을 투여후 3일째 부터 전처리기간을 통하여 나타났으나 aflatoxin B? 단독처리군에서 인삼엑기스 혼합처리군보다 더 현저하게 나타났다. 2. 혈청 효소와 AST, ALT는 독물투여후 7일부터 인삼엑기스 혼합투여군 보다 aflatoxin B? 단독 투여군에서 높게 증가하였다. 3.전처리군에서 적혈수용적, 헤모글로빈농도는 영향을 받지 않았고, 혈장단백질은ㅇ 독물투여후 14일이후 aflatoxin B?단독 처리군에서 현저하게 감소하였다. 4. Aflatoxin B?과 인삼엑기스 혼합 투여군 보다 aflatoxin B? 단독투여군에서 간장의 공포변성,담관증생, 핵농축, 붕괴, hepatic fibrosis와 임파절 및 비장에서 현저한 임파양 세포의 소실을 나타내었다. The present study has been carried out to investigate the effectsof ginseng extract on induced chronic aflatoxicosis in rabits. Groups of rabbits were treated orally with aflatoxin B? and mixture of ginseng extract for 21 days with a dosage of 0.03mg, 0.06mg of the toxin and 0.03mg or o.o6mg of the toxin mixture of 8mg of ginseng extract or 0.3ml corn oil s place to per kg body weight. The results obtained were is follows. 1. Sings o toxicosis included reduction of feed consumption emaciation, decrese of body weight and coma revealed in both groups treated with 0.03mg pr 0.06,mg of aflatoxin B?/Kg/B.W than groups 4.5 after days 3. 2. In groups 2, 3(aflatoxin B? 0.03, 0.06mg), Activity of asparate aminotransferase(AST) and alanine aminotransferase (ALT)were increased sigificantly in dats7, 14 and 21. 3. In all groups, Mean values for packed cell volume(PCV)and hemogobin were unremarkasble, but plasma total protein were decreased in groups 2,3than 4,5 groups on days 14 and 21. 4. The rabits treated with aflatoxin B?(2,3 groups)showed markedly degenerative chasnges ranging from swelling and decreaseed granularity to marked vacuolation, hepatic necrosis, fibrosis and bile duct, Proliferation and depletion of lymphocytes in lymphocytes in lymphonde, spleen than groups 4,5.

작업자의 손목비와 수근관증후군 위험도

김덕수,정해관,권용욱 대한산업의학회 2001 대한직업환경의학회지 Vol.13 No.3

목적 : 손목의 반복적 동작을 해야하는 사업장에서 근무하는 근로자군에서 수근관증후군 유병률과 위험요인을 알아보고, 손목 형태와 수근관증후군과의 관련성을 알아보고자 하였다. 또한 손목 측정치가 수근관증후군 발생에 미치는 예측 정도를 확인하여 수근관증후군 예방에 도움을 주고자 본 연구를 수행하였다. 방법 : K시에 위치한 자동차 방음제를 생산하는 사업장의 근로자 남성 45명, 여성 16명, 총 61명을 대상으로 2000년 4월 설문 조사, 이학적 검사, 근전도 검사를 통하여 다음과 같은 결과를 얻었다. 결과 : 수근관증후군의 유병률은 100명당 26.2명이었다. 수근관증후군 위험요인 단변량 분석에서 연령이 증가할수록, 학력이 낮을수록 교차비가 증가하는 소견을 보였다(p<0.01). 사무직에 비하여 생산직에 근무할수록, 특히 진공작업에 근무할수록 교차비가 유의하게 높게 나타났다(p<0.01). 손목비가 0.74 이상인 군에서 0.74 미만인 군에 비하여 교차비가 유의하게 높았다(p<0.05). 수근관증후군과 관련있는 변수를 알아보기 위하여 로지스틱 회귀분석한 결과 사무직에 비하여 생산직 I (시상작업), 생산직 II (진공작업)에 근무할수록 교차비가 유의하게 높았다(p<0.01). 작업부서를 통계변수로 한 근전도 검사결과와 손목비의 편상관계수 분석에서 여성의 정중 및 척골 감각신경 전도검사의 원위잠시 차이와 손목비와는 유의한 양의 상관 관계를 보였다(p<0.05). 결론 : 손목비는 수근관증후군의 발생과 연관설이 있는 것으로 나타났으나 예측력이 높지 않아 감수성의 예측지표로 직접 이용하는 것은 무리가 있다. 이러한 문제점을 보완한 측정 방법과 예측력이 높은 지표를 개발해야 할 것이다. Objectives : To evaluate the risk factors of the cabal tunnel syndrome (CTS) and the impad of the wrist ratio on the prevalence of CTS in workers on repetitive work over a long term. Methods : Study subjects consisted of 45 mail and 15 female workers in a company that produces soundproof material in Gyeongju. We conducted a physical examination, a self-reported questionnaire survey and a nerve conduction study. CTS cases were defined as those subjects that had a positive finding in both the nerve conduction study and the physical examination done by a doctor specializing in rehabilitation medicine. Results : Prevalence of CTS among the study subjects was 26.2/100 persons. The prevalence of CTS was positively associated with increasing age (p<0.01, usiug the chi square test for trend) and female gender (OR=6.98, 95% CI=1.66-31.0), but was negatively associated with the educational level (p<0.01 by the chi-square for trend). Workers in the production area had a higher prevalence of CTS compared to those in the clerical area (OR=10.8 in the frame manufacturing process, OR=32.2 in the vacuum molding process). Patients with CTS had a narrower mean wrist width and a shorter mean hand and palm length, compared to those that had no disease (p<0.01 by the Student's t-test). The number of subjects who had a wrist ratio of 0.74 or more was significantly higher in cases of CTS (OR=4.0, 95% CI=1.01-16.3). However, a multiple logistic regression analysis showed only that the type of work was a significant variable after adjusting for the other variables. Conclusions : The writs ratio, a surrogate of carpal tunnel configuration, can represent individual susceptibility to CTS. However this study shows that the use of the wrist ratio for predicting CTS risk is not adequate. The development of a new carpal tunnel configuration index based on more direct measurements of the tunnel shape will provide a better predictor of individual susceptibility to CTS.