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.

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.

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.

셰익스피어 사극의 제 2 사부작 연구 : Thematic Structure를 중심으로

金容德 東亞大學校 1983 東亞論叢 Vol.20 No.1

My purpose in this paper is to study the thematic structure of Shakespeare's second tetralogy by a close examination of each play, on the assumption that the term 'structure' includes both content and form. This dissertation begins with a presentation of Machiavellism as the ideological background of the kings and the politicians in the second tetralogy. Historical critics propose, based on the Elizabethan World Order, that these plays are primarily moralistic tracts in dramatic format in consonance with conventional Tudor attitudes and Machiavelli argues that the exercise of power is independent not only of theology but of morality as well. As against these views, I argue that the plays themselves do not conform to such interpretations but, in fact, often contradict them. I then proceed to a detailed examination of the plays, and this examination will show that far from reflecting any political ideology or any partisan moral outlook the plays are committed to dealing with the moral effect the exercise of power has upon the individual man wields it and upon his people. In Richard Ⅱ, "the chiasmic structure of the drama on the thematic axis of power reflects the nature of politics and Shakespeare's theme, "and allows us to see Richard in dual roles: as both power's wielder and power's victim. Superficially the plot of the personal conflict between Richard and Bolingbroke seems to dominate the play, but in fact RichardⅡ is constructed so that Richard, in dual roles, is the focus of our interest. In the process of Richard's rise and fall, the theme of human motivation represented by the imagery of 'two buckets" is prominent rather than that of Providence or Fortune. Richard's downfall is not due to his poetic disposition or his over-dependence on divine kingship, but rather to his own maladministration and Bolingbroke's ambition. After his return from Ireland our interest is his reaction to the changed political situation, not his ability as a ruler. Within that structure Shakespeare directs our responses and his answer to power is poetry of truth. Indeed, the poetry is always directed against whoever is in power, whether it is Richard or Bolingbroke. Thus in the first section of the play, when Richard is still secure as King and using his power for cruel and violent ends, the poetic voices cry out against him through the laments of the Duchess of Gloucester, Mowbray's deeply felt emotion against Richard's cruel banishment, Gaunt's great and moving paean to England, York's violent protest against Richard's disinheritance of Bolingbroke, and the three nobles' complaints before their desertion. The most effective voice, however, is Richard's after he has fallen from power. Our sympathy for Richard is effected not only through Carlisle's protest and prophesy, the Queen's laments and plea, the simple groom's affection for Richard and the Yorks' conflict, but chiefly through Richard's self-dramatized poetry. As he becomes victimized by Bolingbroke's ambition, his character grows more human, more pitiable, until finally we sympathize with him out of our increasing sense of the brutality and callousness of power. The action of HenryⅣ 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 things 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 (even how evil) 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 Ⅰand partⅡ, the theme of Henry's Machiavellism and Prince Hal's wilier Machiavellism through his roleplaying 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, Hal'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 Prince Hal and the pleasure-principle of Falstaff." Even in Henry Ⅴ, the alternation of history and comedy seeks to satirize the political world by the ironic reflection of the policies of the court in the mirror of the Tavern. In Henry Ⅴ Shakespeare's manipulation of a double perspective is most apparent in the person of Henry and in our reaction to him. Just as he was in Henry Ⅳ, Henry is a cold-hearted hypocrite who glosses over his political realism with a veneer of majesty. From the first mention of a foreign war in Henry Ⅳ to the Chorus' final reminder of its ultimate futility, Shakespeare undermines the French campaign with corrosive irony. It is evident that, whatever Shakespeare may say about Henry, in his heart he regarded him as a murderer. Faced with the demand to depict such a man as a hero, he took refuge in the irony which permeates the whole play, and constantly juxtaposed the fine talk of honour and religion with the realities of human greed and cruelty. Shakespeare's final view of Henry is much like Marlowe's of Tamburlaine. Shakespeare's Henry is a consummate power politician, the truest, most accomplished Machiavelian he created. What is lacking in Henry Ⅴ is a striking personality in whom the irony of the play could be focused, a satiric voice to counter with dramatic effectiveness the King's specious rhetoric. There is no question that Machiavellism is the choice the makers of history have made; but there is also no question what this choice has made of history. The dilemma between the two antithetical forces-humanity and power-forms the tension of Shakespeare's history plays. The theme of the second tetralogy 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 Richard's and the Lancastrian King's 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 structure of offering a countervailing value to the inhumanity arising from the exercise of power. Irreconcilable as the antinomies of humanity and power are, Shakespeare chooses humanity. We are always reminded of Richard's poetry of agony in Henry Ⅱ, Falstaff's wit and humor rather than Prince Hal's successful career in Henry Ⅳ, the humane voices of Falstaff's friends, and Williams in Henry Ⅴ. 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.

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.

셰익스피어 사극의 제 1 사부작에 나타난 마키아벨리즘

김용덕 동아대학교 인문과학대학 영어영문학과 1997 동아영어영문학 Vol.13 No.-

My purpose in this paper is to study Machiavellism in Shakespeare's first tetralogy-1, 2, 3 Henry Ⅵ and Richard Ⅲ--by a close examination of each play. Historical critics profuse, based on the Elizabethan world order, that these plays be primarily moralistic tracts in dramatic format in consonance with conventional Tudor attitudes and Machiavelli argues that the exercise of power is independent not only of theology but of morality as well. A detailed analysis of the plays shows that far from reflecting and political ideology or any partisan moral outlook the plays are committed to dealing with the moral effects of power. In 1 Henry Ⅵ the struture of the play is built upon a clash between "chivalric patriotism and Machiavellian egocentricity" and the carefully designed soliloquies and asides give coherence to the fundamental theme. Shakespeare establishes in the minds of his audience a cause-and-effect relationship and the pattern of human motivation through the simple device of haying an incident of discord followed by an announcement of loss. In 2 Henry Ⅵ Shakespeare achieves a more dramatic coherence by centering the action on two individuals-the fall of Gloucester and the rise of York. Unlike in Hall the personal motives underlying York's destuctive Machiavellism surface in the opening scene and Shakespeare deliberately emphasizes Henry Ⅵ's role in creating political chaos. In 3 Henry Ⅵ Shakespeare achieves themantic unity through a series of scenes which force the audience alternatively to respond with antipathy to pro-Langcastrian and pro-Yorkist figures, based on the external pattern of repugnance to the physical atrocities of war and man's brutality. And the personal motives underlying Richard, Duke of Gloucester's destructive Machiavellism is presented throughout the play. Richard Ⅲ is clearly linked to three parts of Henry Ⅵ by the steady political theme but it is not simply a dramatic presentation of the Tudor view of history. It is an elaborately formal dramatization of power-seeking in a corrupt world, held together by the basic pattern of retributive justice. By juxtaposing Richard's stylized Machiavellism with his victims' moral sensitvity, Shakespeare provokes increasing sympathies for the victims of the struggle of the power and reinforces the theme of moral anarchy due to Machiavellian Realpolitik. The dilemma between the two antithetical forces-power and humanity-forms the tension of the first tetralogy. In the process of this thematic development, human motivations are stressed more than Providence and the values they represent are embodied within the play, providing the unity.

Cerebrovascular Complications of Rhinocerebral Mucormycosis

김용재,박기덕,최경규,구혜수 이화여자대학교 의과대학 2003 EMJ (Ewha medical journal) Vol.26 No.2

모균증은 진균 감염증의 하나로 급성으로 진행되며 사망률이 높은 질환이다. 다양한 임상 양상으로 나타나며 두부 모균증이 가장 흔한 형태이다. 두부 모균증의 임상 경과는 감염의 해부학적 위치에 따라 두통, 안면 부종, 압통부터 안구 돌출, 안구 마비, 시력 소실 등 다양하게 나타난다. 모균증은 혈관계를 잘 침범하며, 두부 모균증의 경우 해면 정맥동의 침범뿐 아니라 아주 드물게 내 경동맥이나 두강 내 혈관을 침범하는 경우도 있다. 저자들은 뇌혈관 질환이 동반된 두부 모균증의 드문 합병증 3예를 경험하였기에 문헌 고찰과 함께 보고하는 바이다.

3 Henry VI의 구조

김용덕 동아대학교 문과대학 영어영문학과 1986 동아영어영문학 Vol.2 No.-