가토에서 일측 요관 부분 및 완전폐색시 신장과 요관의 조직학적 변화

김상현,김용웅,육승모,한동석,노안식,임재성,김홍식,나용길,설종구 충남대학교 의학연구소 2003 충남의대잡지 Vol.30 No.2

This study was designed to clarify histologic changes in the experimental rabbit kidney and ureter after unilateral partial or complete ureteral obstruction. A total of 20 adult white rabbits were divided into 4 subgroups in the partial obstruction followed by 2 weeks, the partial obstruction followed by 4 weeks, the complete obstruction followed by 2 weeks, and the complete obstruction followed by 4 weeks. The normal control group was consisted of 5 adult white rabbits. The kidneys and ureters for light microscopy were fixed in 10% neutral formalin, embedded in paraffin and stained with hematoxylin and eosin. Abnormal histologic fingings showed in ipsilateral kidney and ureter of all subgroups(such as dilatation of uriniferous tubule, focal necrosis and desquamation of epithelium, interstitial fibrosis, glomerular congestion, widening of Bowman's space, dilatation of ureter, epithelial cell atrophy or loss, interstitial fibrosis and interstitial inflammation). These findings were most severe in the group of the complete-obstructed ureter for 4 weeks. No significant changes showed in contralateral ureter of all subgroups. The degree of obstruction was severe and period of obstruction was long, the histological changes in ipsilateral side were severe. Despite of changes in ipsilateral side no abnormal findings showed in contralateral side. We suggest that long term experimental investigation of histologic changes in ipsilateral side and compensatory changes in contralateral side have to be studied.

가토에 있어서 편측 요관 폐색시 환측, 반대측 요관에 대한 변화 : 조직학적 소견을 중심으로

설종구,김용웅,육승모,노안식,김홍식,김상현,이충식 충남대학교 의과대학 의학연구소 2003 충남의대잡지 Vol.30 No.1

This study was designed to clarify histological changes in the experimental rabbit ureter after unilateral prartial or complete ureteral obstruction. A total of 20 adult white rabbits were divided into 4 subgroups in the partial obstruction followed by 2 weeks, partial obstruction followed by 4 weeks, complete obstruction followed by 2 weeks, complete obstruction followed by 4 weeks. The normal control group consisted of 5 adult white rabbits. The H & E stain. light microscopy were used. Abnormal histological fingings were showed in ipsilateral ureter of all subgroups; dilatation of ureter, epithelial cell atrophy or loss, interstitial fibrosis, interstitial inflammation. These findings were most severe in the complete-obstructed ureter for 4 weeks. There were no significant changes in contralateral ureter of all subgroups. Despite of progressive histological changes in ipsilateral ureter no abnormal findings were showed in contralateral ureter. We suggest that long term experimental investigation for histological changes in ipsilateral ureter and compensatory changes in contralateral ureter should be done.

표재성 방광암에서 Bacillus Calmette-Guerin 방광 내 주입요법 : 장기적 추적결과 Long-term Follow up Results

김용웅,왕세환,육승모,한동석,노안식,나용길,설종구 충남대학교 의학연구소 2003 충남의대잡지 Vol.30 No.2

To evaluated the results of long-term follow up of superficial bladder cancer patients who were treated with transurethral resection and intravesical BCG therapy. Between April 1989 and December 1997, 65 patients with superficial bladder cancer were treated with TUR-B(Transurethral resection of bladder tumor) and intravesical BCG instillation, and follow-up was performed for 5 years longer, and the mean follow-up duration was 82 months. Of 65 patients, pathologic stage were Ta in 17 cases and T1 in 48 cases and grade were G Ⅰ in 22 cases, G Ⅱ in 35 cases and G Ⅲ in 8 cases. The tumor recurred in 22(33.8%) at the median of 21.8 months and the tumor progressed in 9(13.8%) at the median of 20.8 months. Most of the recurrences and progression were within 3 year(838 and 77%). Progression is more likely in higher grade(G Ⅱ, G Ⅲ) and higher stage(T1). The complete response rate after first and second courses of BCG therapy were 53% and 73% and the 5 and 10 year disease specific survival rates were 89.5 and 78% respectively. The complete response rate after first and second courses of BCG therapywere 53% and 73%. Most of recurrences and progressions were within 3 years of the BCG therapy, but some cases occured after 5 years. Therefore, close long-term follow up is needed.

여성요도구협착의 수술적 교정

오범석,김도완,오철규,노안식,박석산 白中央醫療院 2005 仁濟醫學 Vol.26 No.1

Objective: We describe various clinical presentations of female urethral meatal stricture, which may mimic other pelvic floor disorders and result in diagnostic delay. Diagnosis, management, and outcome results are reported Materials and Methods: We reviewed retrospectively 26 consecutive cases of female urethral meatal stricture. Patient characteristics, history, clinical presentation, symptom score, maximal flow rate, residual urine, diagnosis, management and short-term follow up are reported. Results: Mean patient age plus or minus standard deviation was 54 years. Most 21 (81%) cases were referred as diagnostic dilemmas with symptoms present for 1 month to 30 years. Mean interval between onset of symptoms to diagnosis was 5.8 years. The most common symptoms were residual urine sensation (77% of cases), frequency (54%), pelvic pain (46%), dysuria (46%), weak stream urine (27%), urgency (15%) and 17 patients (65%) have combined symptoms. 16 patients (62%) had been treated with oral and/or vaginal medication and/or psychotherapy. The female urethral meatal stricture was visible on physical examination in 21 patients (81%) and cystoscopy in 5 patients (19%). Of these visible urethral meatal stricture, 11 patients (45%) contained recurrent urinary tract infection, 9 patients (35%) contained urethral mucosal prolapse, 7 patients (27%) contained urethral diverticulum, and 3 patients (12%) contained stress urinary incontinence. 18 patients (69%) who has been treated with oral and/or vaginal medication or psychotherapy was not successfully improved. Treatment consist of urethral meatal excision and/or everted urethral mucosal excision and/or urethral diverticulum excision and/or anti-incontinence surgery when indicated. Subsequently 24 patients (92%) had improved symptom score, but 2 patient was not changed. In 9 patients new symptom developed. Conclusions: Female urethral meatal stricture have several urinary symptoms and may mimic other pelvic floor disorders. This condition should be considered in women with frequency, residual urine sensation, pelvic pain, dysuria and etc. Medical treatment is not sufficient but surgical treatment is usually simple, safe and effective in alleviation associated symptoms.

전립선 비대증 진단에 있어서 전립선 이행대 용적 지수의 유용성

임재성,노안식,김용웅,육승모 충남대학교 의과대학 의학연구소 2003 충남의대잡지 Vol.30 No.1

Purpose : Prostate volume has been poorly correlated to various parameters used to assess benign prostatic hyperplasia (BPH), including symptom score, peak urine flow and detrusor pressure at peak urine flow. The purpose of this study was 2-fold: 1) to determine if transrectal ultrasound measurement of the transition zone of the prostate served as a better proxy for determining prostate size and correlated better with IPSS, peak urine flow and detrusor pressure and 2) if the parameter transition zone index (the ratio between transition zone volume and prostate volume) was useful in evaluating clinical prostatism. Materials and Methods: We prospectively evaluated 30 men with symptomatic BPH (mean age 65.4 years) according to symptom sore, peak urine flow, pressure/flow study, transrectal ultrasound volume of the entire prostate and the transition zone and calculation of the transition zone index. Results : There was a week correlation between prostate volume and symptom score, peak urine flow and detrusor pressure at peak urine flow: a stronger correlation between volume of transition zone and symptom score (r=0.679 p=0.03), and peak urine flow (r=-0.672 p=0.05) and a significant correlation (p=0.001) between transition zone index and symptom score (r=0.868), and peak urine flow(r=-0.870). Conclusion : Transition zone index is a parameter that correlates siginificantly with parameters of BPH and may serve as a useful proxy for evaluating worsening obstruction. Studies are underway to determine whether transtion zone index can be used prospectively to predict and correlate response with therapies designed to ablate prostatic tissue medically or surgically.

제대군인 취업지원 프로그램 구안

정철영,서우석,김성호,이예성,최동선,이종범,이성식,이건남,양안나,김성남 한국직업능력개발원 2007 직업능력개발연구 Vol.10 No.1

이 연구의 목적은 중·장기복무를 마치고 제대하여 재취업하고자 하는 제대군인들의 원활한 전직을 돕기 위한 제대군인 취업지원 프로그램의 개발방향과 개발안을 제시하는 데 있다. 이를 위해 국내·외에서 이루어지고 있는 제대군인 취업지원 프로그램의 실태를 분석하였고, 제대군인 취업지원 프로그램에 대한제대예정군인 및 제대군인과 기업체의 요구를 분석하여 시사점을 도출하였다. 그리고 이를 기초로 제대군인 취업지원 프로그램의 기본방향과 전체 흐름도, 세부 프로그램 개발안을 제시하였다. 이를 위해서 활용된 연구의 방법은 문헌연구, 조사연구, 전문가협의회 등이다. 이 연구를 통해서 제시된 제대군인 취업지원 프로그램의 개발방향과 개발안을 토대로, 일관되고 지속적인 수요자 중심의 제대군인 취업지원 프로그램의 개발이 가능할 것이다. The purpose of this study is to suggest plans and directions for developing. job-seeking support program for military veterans. The study is conducted through literature review, survey and interview. The results of this study are as follows: ⒧ basic development directions and flowchart of job-seeking support program for military veterans are suggested; and ⑵ development plans for sub-programs are suggested.

고위험군의 원발성 전신성 유전분증 1례 보고 및 조혈모세포이식에 대한 문헌고찰

심준,박수정,엄현석,김기영,박은정,강인중,조병식,이안희,한치화 대한조혈모세포이식학회 2001 대한조혈모세포이식학회지 Vol.6 No.2

저자 등은 클론성 형질세포질환과 동반된 젊은 연령의 원발성 전신성 유전분증 환자를 진단하였기에 다발성 골수종과의 감별 진단, 치료 , 예후 및 고용량 항암화학요법과 조혈모세포이식에 관하여 문헌고찰과 함께 보고하는 바이다. Primary systemic amyloidosis (AL) is a rapidly fatal disorder related to plasma cell dyscrasia. Conventional dose of melphalan, which prolongs the duration of survival by about 10 months, does not improve the functions of impaired organs in most cases. The high dose chemotherapy followed by autologous hematopoietic stem cell rescue for AL, in spite of its high treatment-related mortality, is a new approach to achieve high response rate and better survival. We experienced a 35-year old man with AL(involving heart, liver, stomach, kidneys, peripheral nerve, and rectum) who did not respond to the standard schedule of melphalan plus prednisone and had rapidly fatal course with organ failure. Hence, we evaluate its availability by reviewing the recent reports of high dose chemotherapy in AL.

요로조영상에서 요관폐색 및 음영결손을 보인 환자에서의 요관경검사

염규영,하용원,노안식,손성용,김진겸,설종구 충남대학교 의과대학 지역사회의학연구소 2000 충남의대잡지 Vol.27 No.2

Purpose: To evaluate the clinical value of ureteroscopy for the ureteral filling defect or obstruction on the excretory or retrograde pyelogram(RGP). Materials and Methods: The 72 patients with filling defect or intrinsic obstruction ureteral lesion on the excretory urogram or RGP underwent ureteroscopy to examine and treat the lesions. We used the 9.5Fr. or 11.5Fr. rigid ureteroscope with 5Fr. working channel. Results: The results were as follows; I. Among the 72 patients, 39 were male and 33were female. The mean age of patient was 45.7 years. 2. Ureteroscopy was successfully performed in 70 cases(97%) out of 72. In 2 cases, the advance of ureteroscope was failed. 3. Among 70 successful cases, ureteroscopy revealed 45 radiolucent stones, 9 ureteral stricture, 2 ureteral TCC. I metastatic tumor, 3 blood clot, each case of ureteral polyp, epithelial hyperplasia and Von-Brunn's nest. In 7 cases, no causative lesions were identified. 4. 41 out of 45 radiolucent stones were successfully removed by ureteroscopic procedure and 9 ureteral strictures were dilated. 6 cases of ureteral mass were successfully biopsied for pathological diagnosis. 5. 23 cases of post-operative or fever were treated conservatively and 10 cases of mucosal tearing and 1 case of ureteral perforation were treated with double-J stent indwelling. Conclusions: The ureteroscopy is effective modality to evaluate and treat in the ureteral filling defect or obstruction on the excretory urogram.

표재성 방광 이행상피세포암에 있어서 방광내 항암제주입요법 밀 면역요법

설종구,신보현,하용원,김윤종,노안식,손성용 충남대학교 의과대학 지역사회의학연구소 1999 충남의대잡지 Vol.26 No.2

Intravesical chemotherapy and immunotherapy will commonly eradicate residual papillary transitional cell carcinoma or carcinoma in situ(CIS) and clearly reduce the short-term incidence and rate of tumor recurrence. So I reviewed the effects and complications of different therapeutic agents(thiotepa, mitomycin-C, epirubicin, adriamycin, bacillus Cal mette-Cue'rin(BCG)) in superficial bladder cancer confirmed with histopathology, with the literatures. Bladder cancer were recurred more commonly in multiple tumors(50.6-56.3%), high grade tumors(52.6%) rather than in single(30.9%) and low grade(31.6%). And recurrence rates according to therapeutic agents were 83.3% in mitomycin-C, 71.4% in thiotepa, 50.0% in epirubicin, 46.6% in adriamycin and 32.6% in BCG. But incidence of complications were highest in BCG(50.5%). So sufficient preventive manuevers should be needed before intravesical theraphy, especially in BCG immunotherapy.

외상으로 인한 지연성 두개강내 혈종의 임상분석

김갑득,박준석,류명곤,강명희,이종안,김승렬,장인성,박상문,현석천,송화식 대한응급의학회 1998 대한응급의학회지 Vol.9 No.1

Experinece in the management of 74 patients with delayed traumatic intracranial hemorrhage(DTICH) of 474 head injury from January 1996 to December 1996 is presented with emphasis on the incidence, occurring time, risk factors and outcome. The incidence of DTICH was 15.6% of all hospitalized head-injury patients. After an injury, every patient had an immediate computerized tomography(CT) scan to diagnose intracranial pathology and then CT follow-up was carried out according to intial CT finding and neurological deficit. The lesion was almost occurred in patients with initial abnormal CT finding(85.1%). 82.4% of DTICH were noted within 72 hours after injury. The delayed epidural hematoma and intracerebral hemorrhage were almost noted in first 72 hours(>90%), but the delyed subdural hemorrhage was found after a time interval varying from 6 hours to 10 days. So we strongly recommend CT follow-up in 4-8hour, 24-72 hour, and then 7th day after head injury, especially in patients with initial abnormal CT findings. The risk factor of the delayed lesion was not hypotension, hypoxia, and consciousness level, but age of patients and the initial CT finding. The development of DTICH was not heralded by neurological deterioration. The prognosis of DTICH was not worse than non-DTICH. The patient with delayed subdural hemorrhage was better than the patient with non-delayed lesion(including hemorrhage and normal CT finding).