김환기의 근대기 작품에 나타난 체험과 감각

김인아(Kim In-ah) 한국근현대미술사학회 2015 한국근현대미술사학 Vol.29 No.-

It is prevalent opinion that Kim Whan?ki from the 1930s to the early 1940s was an abstract artist. As well known, Kim had strong ties with the avant-garde communities of Japan when he was a student there as well as when back to Korea while producing abstract works. Kim later formed a neorealism community with Yoo Youngkuk and Lee KyuSang, where he seeked the ‘Neo-Reality’. He also reflected his interest in korean tradition and antiques in his work while having made an exchange with artists, poets, and writers who had worked through ‘Munjang’ that is literature magazine. That much of the academic literature on Kim’s paintings from this period have been focused on abstract and avant-garde art and orientalism may be a natural consequence of his historical trajectory as the above. As the advanced researches tell, Kim Whan?ki’s interest is not the departure from an object but the way ‘abstractifying’ an object, while pursuing the abstract art. This study also begins from the premise that the key element necessary for interpreting Kim’s abstract art is the way rather than the concept. I would like to go even a step further to argue that the form and content of the abstract in Kim’s work reflect the artist’s personal experiences and emotional sensations. And I’ll argue that such personal experiences-which exist on the outskirts of Kim’s abstract art-are imbued with a kind of romanticism. To illuminate these points, I analyze the abstract features of Kim’s work that appear as geometrical designs in conjunction with the social atmosphere of the era, and also interpret the artist’s personal experiences reflected in the work through references to articles, photographs, and related written works published in the literary magazines of the day. I attempt to show that Kim Whan-ki’s painting which abstractly portrayed the city and machines-symbols of the most cutting-edge elements of civilization- are not simply a matter of style but concrete expressions of the artist’s existential interpretations of nature, life, and modern civilization. It may seem unusual for an artist who interprets the world through the lens of existentialism to pursue such an abstract style. However, at that time, this is not unusual. This is because the avant-garde discourse in those days was developed in each artist’s personal understanding. The experiences of the 1930s that appear in Kim’s work were personal and everyday experiences of modern civilization, and this is why his artwork includes hints at the modernist emotional connection with urban life. Kim’s nostalgia for the modern lifestyle he experienced during his student years in Tokyo occasionally appears as a landscape that is in turn representational or contemplative. These approach is similar to imagism in literature. Kim Gi-rim, a leading Korean modernist poet, defines poetry as the expression of not the mental but the “real” world in writing. Similarly, Kim Whan?ki’s work is an expression of reality as created through the artist’s memories and experiences.

국소재발된 두경부종양의 무고정틀 정위적 분할방사선치료

김인아(In Ah Kim),최일봉(Ihl Bhong Choi),장지영(Ji Young Jang),강기문(Ki Mun Kang),조승호(Seung Ho Jho),김형태(Hyung Tae Kim),이경진(Kyung Jin Lee),최창락(Chang Rak Choi) 대한두경부종양학회 1998 대한두경부 종양학회지 Vol.14 No.2

Background & Objectives: Frameless fractionated stereotactic radiotherapy(FFSRT) is a modification of stereotactic radiosurgery(SRS) with radiobiologic advantage of fractionation without losing mechanical accuracy of SRS. Local recurrence of head and neck cancer at or near skull base benefit from reirradiation. Main barrier to successful palliation is dose limitation secondary to normal tissue tolerance. We try to evaluate the efficacy and safety of FFSRT as a new modality of reirradaton in these challenging patients. Materials & Methods: Seven patients with recurrent head & neck cancer involving at or near skull base received FFSRT from September 1995 to November 1997. Six patients with nasopharyngeal cancer had received induction chemotherapy and curative radiation therapy. One patient with maxillary sinus cancer had received total maxillectomy and postoperative radiation therapy as a initial treatment. Follow-up ranged from 11 to 32 months with median of 24 months. Three of 7 patients received hyperfractionated radiation therapy(1.1-1.2Gy/fraction, bid, total 19.8-24Gy) just before FFSRT. All patients received FFSRT(3-5Gy/fraction, total 15-30Gy/5-10fractions). Chemotherapy(cis-platin 100mg/m(2)) were given concurrently with FFSRT in four patients. Second course of FFSRT were given in 4 patients with progression or recurrence after initial FFSRT. Because IF(irregularity factor; ratio of surface area of target to the surface area of sphere with same volume as a target) is too big to use conventional stereotactic RT using multiple arc method for protection of radiation damage to critical normal tissue, all patients received FFSRT with conformal method using irregular static ports. Results: Five of 7 patients showed complete remission in follow-up CT &/or MRI. Three of these five patients who developed marginal, in-field, and out-field recurrences, respectively. Another one of complete responders has been dead of G-I bleeding without evidence of local recurrence. One partial responder who showed progressive disease 15 months after initial FFSRT has received additional FFSRT, and then he is well-being with symptomatic improvement. One minmal responder who showed progression of locoregional disease 9 months after 1st FFSRT has received 2nd FFSRT, and then he is alive with stable disease. Five of 7 case had showed direct invasion to skull base and had complaint headache and various symptoms of cranial nerve involvement. Four of these five case showed improvement of neurologic symptoms after FFSRT. No significant neurologic complicaltion related to FFSRT was observed during follow-up periods. Tumor volumes were ranged from 3.9 to 50.7 cc and surface area ranged from 16.1 to 114.9cm(2). IF ranged from 1.21 to 1.74. The average ratio of volume of prescription isodose shell to target volume was 1.02 that indicated the improvement of target coverage and dose distribution with FFSRT with conformal method compared to target coverage with FFSRT with multiple arc method. Conclusion: Our initial experience suggests that FFSRT with conformal method was relatively effective and safe modality in the treatment of recurrent head and neck cancer involving at or near skull base. Treatment benefit included good palliation of symptoms and reasonable radiographic response. However, more experience and additional follow-up are needed to better assess its ultimate role in treating these challenging patients.

Concurrent Cisplatin-Radiation Therapy in Locally Advaced Head & Neck Cancers

김인아(In Ah Kim),최일봉(Ihl Bhong Choi),조승호(Seung Ho Cho),홍영선(Young Seon Hong),최병옥(Byung Ok Choi),강영남(Young Nam Kang) 대한방사선종양학회 2001 Radiation Oncology Journal Vol.19 No.3

목 적 :국소진행된 두경부종양 환자에서 방사선감작제로서 cisplatin을 방사선치료와 동시병용하였을때, 반응율과 독 성을 알아보고 국소재발율 및 단기생존율을 분석해 보고자 하였다. 대상 및 방법 : 1995년 1월부터 1998 8월까지 AJCC 병기 II- IV의 국소진행된 두경부종양으로 근치적방사선치료중 cisplatin 동시화학요법을 받은 환자 29명을 대상으로 하였다. 비인강암이 16예였고 구인두암이 5예, 하인두암과 후두 암이 각각 4예씩이었다. 대상환자의 연령분포는 22세에서 74세로 중앙값은 56세였고 남녀비는 22:7이었다. 방사선치료는 6 MV와 15 MV X선 및 9∼14 MeV 전자선을 사용하여 원발병소와 전이된 임파절에 총 7,000∼7,560 cGy (중앙값 7,020 cGy)까지 조사하였다. Cisplatin은 100 mg/m2을 방사선치료와 동시에 매 3주 간격으로 3회까지 투여하는 것을 원칙으로 하였다. 결 과 :치료에 대한 반응율은 완전관해가 21예(72.4%), 부분관해가 5예(17.2%), 경미한 반응이 3예(10.4%)로 나타났다. 치료 후 잔여임파절병변에 대한 경부곽청술이 2예에서 시행되었다. 추적관찰기간(5∼55개월, 평균 37개월)중 8례에서 원발병소 혹은 임파절에서 재발하여 국소재발율은 27.6%였고, 원격전이가 4예(13.8%)에서 관찰되었다. 3년무병 생존율은 60%였으며 원발병소가 비인강암인 경우나 치료에 완전반응을 보였던 경우가 무병생존율이 유의하게 높은 것으로 나타났다. 치료에 다른 급성독성으로 10예(34.5%)에서 grade 3의 점막염, 5예(17.2%)에서 grade 3의 백혈구감소증이 관찰되었다. 전체 환자 중 21예(72.4%)가 3회의 Cisplatin 화학요법을 완료하였다. 3예에서는 grade 3의 백혈구 감소증, 2예는 전신상태불량으로 cisplatin이 2회만 투여되었고, 다른 3예는 신기능이상 및 신경독성으로 인해 치료중간에 5- FU로 대치되었으며, 전체치료기간이 2주 이상 지연되는 major deviation은 3예(10.3%)에서 관찰되었다. 결 론 :국소진행된 두경부 종양환자에서 Cisplatin을 근치적방사선치료와 동시에 병용하는 치료전략은 비교적 높은치료반응율, 국소제어율 및 생존율을 나타내었다. 급성치료독성의 빈도가 높았으나 치료에 대한 순응도는 비교적 양호하였다. 향후 좀더 많은 증례의 수집 및 장기추적관찰과 함께 원발병소에 따른 독립적인 연구가 필요할 것으로 사료되었다. Purpose : This study tried to evaluate the effectiveness of combined treatment us ing radiation therapy and concurrent cisplatin as a radiosens itizer in the management of locally advanced head and neck cancer. Materials and methods : From January 1995 to August 1998, 29 evaluable patients with locally advanced head & neck cancers (AJCC stage II∼IV) were received curative radiation therapy (total 70∼75.6 Gy/35∼42 fractions , 1.8∼2 Gy/fraction) and concurrent cisplatin chemotherapy (100 mg/m2 , D1, D22, D43). The neck dissections were performed for res idual lymphadenopathy. Follow- up ranged from 5 to 55 months (median 24 months). Results : Twenty-one (72.4%) patients achieved clinical complete responses . The partial response and minimal response rates were 17.2% and 10.4%, respectively. Locoregional failure rate was 27.6%, and included 6 patients with local failures , 4 patients with regional failures , and 2 patients with combined local and regional failures . Four of 29 patients (13.8%) developed distant metastas is . The disease free survival rate at 3 years was 60%. Nasopharyngeal primary tumors or complete responders showed s ignificantly higher disease free survival rate. The grade 3 mucos itis and nausea/vomiting was noted in 34.5%, respectively. Major prolongation of radiation therapy duration was inevitable in three patients . Twenty- one patients (72.4%) completed 3 courses of cisplatin and 5 patients received 2 courses of cisplatin. Three patients received only one course of cisplatin due to nephrotoxicity and neurotoxicity, and then changed to 5- FU regimen. Conclusions :Concurrent cisplatin- radiation therapy in locally advanced head and neck cancer showed high response rate, reasonable locoregional control, and survival rate. As expected, acute toxicities were increased, but compliance to treatment was acceptable. Assessment of the effect of the combination in this setting requires further accrual and follow- up.

Prophylactic Cranial Irradiation for Acute Lymphoblastic Leukemia in Childhood

김인아(In Ah Kim),최일봉 (Ihl Bohng Choi),강기문 (Ki Mun Kang),신경섭 (Kyung Sub Shinn),김학기 (Hack Ki Kim) 대한방사선종양학회 1996 Radiation Oncology Journal Vol.14 No.2

목 적: 소아 급성임파모구성 백혈병 환자에 있어 예방적 전뇌방사선조사 및 척수강내화학요법후 중추신경계 재발율, 재발양상, 중추신경계 무병생존율, 전체무병생존율 및 이에 영향을 미치는 예후인자들을 알아보고자 하였다. 대상 및 방법: 1987년 7월부터 1992년 6월까지 예방적 전뇌 방사선조사를 받은 급성 임파구성 백혈병 환아 90예를 대상으로 후향적 분석을 시행하였다. 3명을 제외한 모든 환자들이 일일 180 cGy 씩 총 1800 cGy의 전뇌방사선치료를 받았고, 방사선 치료중 척수강내 화학요법이 병행되었다. 결 과: 추적관찰기간 36-96개월 (중앙값 60개월)동안 90명의 환아중 9례에서 중추신경계 재발을 보였으나, 골수재발이 선행되었던 3례를 제외하면 중추신경계 재발율은 6.7%로 나타났다. 중추신경계 재발환자의 89% 에서 골수재발이 동반되었으며, 11%에서 고환재발이 동반되었다. 골수완전관해로부터 중추신경계 재발까지의 경과기간은 16개월 (중앙값)이었고, 78%의 중추신경계 재발이 관해유지요법중에 발생하였다. 2년 및 5년 중추신경게 무병생존율은 각각 68%, 42 % 였고, 중앙값은 43개월이었다. 중추신경계 무병생조율에 영향을 미치는 예후인자는 진단당시의 백혈구수 (5만 기준), FAB 분류군, CALGB 위험분류기준으로 나타났다. 2년 및 5년 전체무병생존율은 각각 61%, 39%였고 중앙값은 34개월이었다. 전체무병생존율에 영향을 미치는 예후인자는 진단당시의 백혈구수 (5만 기준), FAB 분류군, CALGB 및 POG 위험분류군으로 나타났다. 결 론: 본 연구에서 중추신경계 재발율은 6.7%로 다른 연구들에서 보고하는 범위에 속하여 효과적인 중추신경계 예방요법으로 판단 되었다. 진단당시의 나이 및 백혈구수를 기준으로 한 위험분류기준 중 POG 및 CALGB 위험분류기준이 중추신경계 무병생존율 및 전체무병생존율에 유의한 예후인자로 나타났다. 부작용을 최소화하면서도 효과적인 중추신경계예방요법을 알아내기 위해서는 각 위험분류군에 따른 중추신경계 예방요법의 차별화에 대한 전향적인 연구 및 장기 생존자들에 대한 체계적인 신경 심리학적 추적 조사가 필요할 것으로 사료된다. Purpose: This report is the result of retrospective analysis for children who received prophyactic cranial irradiation combined with intrathecal chemotherapy. Materials and Methods: Ninety children with ALL who had got bone marrow remission after induction chemotherapy received PCI. All but 3 children were treated with a dose of 1800 cGy as a standard regimen. While the PCI was given, all patients received intrathecal chemotherapy. Results: Nine of 90 patients experienced CNS relapse during the duration of follow-up ranged from 36 to 96 months (median 60 months). Three children experienced BM relapse prior to CNS relapse. Therefore, CNS relapse rate as the first adverse event was 6.7%. Median time interval of CNS relapse was 16 months from the first day of hematologic complete remission. Eighty-nine percent of patients who had CNS relapse were associated with hematologic relapse, and 78% of CNS relpase occurred during maintenance chemotherapy (on-therapy relapse). The CNS RFS at 2 and 5 years are 68% and 42%, respectively with median of 43 months. The prognostic factors affecting CNS RFS are initial WBC count (cut-off point of 50,000/μl), FAB subtype and CALGB risk criteria. The DFS at 2 and 5 Years are 61% and 39%, respectively with median of 34 months. The prognostic factors affecting DFS are initial WBC count(cot-off point of 50,000/μl), FAB subtype, POG and CALGB risk criteria. Conclusion: In our study, 6.7% of CNS relapse rate as a first adverse event was comparable with other studies. Various risk criteria was based on age at diagnosis and initial WBC count such as POG and CALGB criteria, had prognostic significance for CNS RFS and DFS. Prospective randomized trial according to prognostic subgroup based on risk criteria and systematic study about neuropsychologic function for long term survivors, are essential to determine the most effective and least toxic form of CNS prophylaxis.

Concurrent Chemoradiation Therapy in Stage III Non-small Cell Lung Cancer

김인아(In Ah Kim),최일봉(Ihl Bhong Choi),강기문(Ki Mun Kang),장지영(Jie Young Jang),문한림(Han Lim Mun),송정섭(Jung Sub Song),이선희(Sun Hee Lee),곽문섭(Mun Sub Kuak),신경섭(Kyung Sub Shinn) 대한방사선종양학회 1997 Radiation Oncology Journal Vol.15 No.1

목 적 : 국소진행된 III기 비소세포성 폐암에서 방사선감작제로서의 저용량 Cisplatin과 방사선 동시병합요법의 효과를 알아보고자하여, 관해율, 전체생존율, 무병생존율 및 치료에 따른 부작용을 방사선 단독치료군과 후향적으로 비교분석하였다. 대상 및 방법 : 1992년 4월부터 1994년 3월까지 32명의 III기 비소세포성 폐암환자(IIIa 12명, IIIb 20명)가 항암제 및 방사선동시병합요법을 받았다. 방사선치료는 3000cGy/ 10회를 2주간에 걸쳐 시행한 뒤 3주후에 2500cGy/ 10회를 추가하였으며, 방사선감작제로 cis platin 6mg/m2를 매일 방사선치료 전에 정맥주사하였다. 추적관찰기간은 13개월에서 48개월로 중간값은 24개월이었다. 방사선단독치료군 32명(IIIa 13명, IIIb 19명)은 매일 170- 200cGy씩 총 5580- 7000cGy (중간값 5960cGy) 치료받았으며, 추적관찰기간은 36개월에서 105개월로 중간값은 62개월이었다. 결 과 : cis platin- 방사선동시요법군이 방사선 단독치료군에 비해 유의하게 높은완전반응률(18.8% vs . 5.6%)및 낮은 조사야내 재발율(25% vs . 47%)을 나타내었다. 2년 전체생존율은 Cisplatin- 방사선동시요법군이 17%, 방사선단독치료군이 9.4%로 유의한 차이는 보이지 않았다.국소재발 없는 2년 무병생존율(16.5% vs. 5.3%) 및 원격전이 없는 2년 무병생존율(17% vs. 4.6%)도 두군간에 유의한 차이를 보이지 않았다. 그러나 Karnofsky performance scale 80 이상인 환자군만을 대상으로 분석한 결과, cisplatin- 방사선동시요법군이 방사선단독치료군에 비해 유의하게 높은 2년 전체생존율을 보였다(62.5% vs. 15.6%). 전체생존율에 영향을 미치는 예후인자로 cisplatin- 방사선동시요법군에 있어서는 performance status 및 조직학적 진단유형(상피세포암 vs. 비상피세포암)으로 나타났고, 방사선단독치료군에 있어서는 performance status 및 병기(IIIa vs. IIIb)로 나타났다. 치료에 따른 급성부작용으로 RTOG/ECOG grade 2 이상의 오심, 구토는 cisplatin- 방사선동시요법군이 방사선단독치료군 (22% vs. 6%)에 비해 유의하게 높은 빈도를 나타내었다. Gra de 2 이상의 혈액학적 독성은 Cis platin- 방사선동시요법군에서 방사선단독치료군에 비해 높은 빈도를 나타내었다(25% vs. 15.6%). 방사선단독치료군에 비해 cis platin- 방사선동시요법군에서, RTOG/ECOG Grade 2 이상의 폐독성의 빈도(31% vs. 19%)나 WHO Grade 3 이상의 폐섬유화의 빈도(38% vs. 25%)의 유의한 증가는 관찰되지 않았다. 방사선치료부위의 면적이 200cm2 이상이었던 경우, 두군 모두에서 폐독성 빈도의 유의한 증가를 보였다. 결 론 : cisplatin- 방사선동시병합요법이 방사선단독치료군에 비해 높은 국소제어율을 나타내었으나, 전체생존율이나 무병생존율의 유의한 증가는 보이지 않았다. KPS 80이상인 환자군에 있어서는 cisplatin- 방사선동시요법군이 방사선단독군에 비해 높은 전체생존율을 보였다. cisplatin- 방사선동시병합요법군에서 급성부작용이 증가되는 경향을 보였으나, 방사선에 의한 폐독성의 유의한 증가는 관찰되지 않았다. cisplatin- 방사선동시병합요법군이 방사선단독치료군에 비해 1년 이내에 조기사망율이 높은 반면, 2년이상 장기생존율이 높은 경향을 보여, 이러한 환자군에 대한 장기적인 추적조사를 통해 생존율에 대한 본 치료의 영향을 좀더 명확하게 평가할 수 있을것으로 기대되며, 향후 치료효과를 증가시키기위해 large fraction size의 split course RT 대신 continuous course의 conventional RT 혹은 hyperfractionated RT와 Cisplatin의 동시병합요법 등이 고려되어야할 것으로 사료된다. Purpose : This study was tried to evaluate the potential be nefits of concurrent chemoradiation therapy (low dose daily cisplatin combined with split course radiation therapy) compared with conventional radiation thera py alone in stage III non- small cell lung cancer. The end points of analyses were responserate , overalls urvival, survival without locoregional failure , survival without distant metastasis , prognostic factors affecting survival and treatment related toxicities. Materials and Methods : Between April 1992 and March 1994, 32 patients who had stage III non-small cell lung cancer were treated with concurrent chemoradiation therapy. Radiation therapy for 2 weeks (300cGy given 10 times up to 3000cGy) followed by a 3 weeks rest period and then radiation therapy for 2 more weeks (250cGy given 10 times up to 2500cGy) was combined with 6mg/M2 of cisplatin. Follow-up period ranged from 13 months to 48 months with median of 24 months . Historical control group consisted of 32 patients who had stage III non-small cell lung cancer were received conventionally fractionated (daily 170- 200cGy) radiation therapy a lone. Total radiation dose ranged from 5580cGy to 7000cGy with median of 5940cGy. Follow-up period ranged from 36 months to 105 months with median of 62 months . Results : Complete reponse rate was higher in chemoradiation therapy (CRT) group than radiation therapy (RT) group (18.8% vs. 6.3%). CRT group showed lower in-field failure rate compared with RT group(25% vs. 47%). The overall survival rate had no significant differences in between CRT group and RT group(17.5% vs. 9.4% at 2 years). The survival without locoregional failure (16.5% vs. 5.3% at 2 years) and survival without distant metastas is (17% vs. 4.6% at 2 years) also had no significant differences . In subgroup analyses for patients with good performance status (Karnofsky performance scale 80), CRT group showed significantly higher overall survival rate compared with RT group (62.5% vs. 15.6% at 2 years). The prognostic factors affecting survival rate were performance status and pathologic subtype (squamous cell cancer vs. nonsquamous cell cancer) in CRT group. In RT alone group, performance status and stage (IIIa vs IIIb) were identified as a prognostic factors . RTOG/EORTC grade 2-3 nausea and vomiting(22% vs. 6%) and bone marrow toxicities (25% vs. 15.6%) were significantly higher in CRT group compared with RT alone group. The incidence of RTOG/EORTC grade 3-4 pulmona ry toxicity had no significant differences in between CRT group and RT group (16% vs. 6%). The incidence of WHO grade 3-4 pulmonary fibrosis also had no significant differences in both group(38% vs . 25%). In analyses for relationship of field size and pulmonary toxicity, the patients who treated with field size beyond 200cm2 had s ignificantly higher rates of pulmonary toxicities. Conclusion : The CRT group showed significantly higher local control rate than RT group. There were no significant differences of survival rate in between two groups. The subgroup of patients who had good performa nce status showed higher overall survival rate in CRT group than RT group. In spite of higher incidence of acute toxicities with concurrent chemoradiation therapy, the survival gain in subgroup of patients with good pe rformance status were encouraging. CRT group showed higher rate of early death within 1 year, higher 2 year survival rate compared with RT group. The refore, to evaluate the accurate effect on survival of concurrent chemoradiation therapy, systematic follow-up for long term survivors are needed.

P53 Overexpression and Outcome of Radiation Therapy in Head & Neck Cancers

김인아(In Ah Kim),최일봉(Ihl Bhong Choi),강기문(Ki Mun Kang),장지영(Ji Young Jang),김경미(Kyung Mi Kim),박경신(Kyung Shin Park),김영신(Young Shin Kim),강창석(Chang Suk Kang),조승호(Seung Ho Cho),김형태(Hyung Tae Kim) 대한방사선종양학회 1999 Radiation Oncology Journal Vol.17 No.1

목 적:실험적으로 p53 종양억제유전자는 세포의 방사선에 대한 반응을 조절하는 것으로 알려져 있는데, 임상에서 p53의 변화와 방사선치료 후의 예후와의 상호관련성은 아직 명확하게 규명되지 않은 상태이다. 이에 두경부종양환자에서 흔히 관찰되는 p53의 변화가 방사선치료결과에 어떤 영향을 미칠 수 있는지를 알아보고자 하였다. 재료 및 방법:두경부종양으로 진단되어 근치적 방사선치료를 받은 55명의 환자를 대상으로 임상결과를 후향적으로 분석하였다. 각 환자의 치료전 종양조직의 paraffin section을 human p53단백질에 대한 monoclonal antibody (D-07)로 면역조직화학염색하여 labeling Index (number of labelded nuclei/total number of counted nuclei x100)를 구하여, 임상결과와 연관지어 분석하였다. 결 과:전체환자의 67.2%에서 p53의 기능이상을 시사하는 과발현 소견을 보였다. 원발병소에 따른 과발현 빈도는 oral cavity, larynx, hypopharynx, nasopharynx순으로 각각 100%, 76%, 67%, 67%, 38%로 나타났다. 흡연자가 비흡연자에 비해 유의하게 높은 과발현 빈도를 보였다 (78.6%, 30.8%). 원발병소, 병기 및 Karnofsky performance status가 방사선치료에 대한 반응율과 유의한 연관을 보였으며, p53의 과발현여부는 치료반응율에 유의한 영향을 미치지 못하는 것으로 나타났다. 무병생존율 및 전체생존율에 영향을 미치는 인자는 원발병소와 병기였고, p53의 과발현여부는 유의한 연관을 보이지 못하였다. 결 론:근치적 방사선치료를 받은 두경부종양 환자에서, 면역조직화학염색에 의한 p53의 과발현율은 원발병소, 병기 및 흡연여부와 유관하였으며, 과발현여부가 치료반응율 및 생존율에 유의한 영향을 미치지 못하였다. Purpose:Experimental studies have implicated the wild type p53 in cellular response to radiation. Whether altered p53 function can lead to changes in clinical radiocurability remains an area of ongoing study. This study was performed to investigate whether any correlation between change of p53 and outcome of curative radiation therapy in patients with head and neck cancers. Methods:Immunohistochemical analysis with a mouse monoclonal antibody (D0-7) specific for human p53 was used to detect to overexpression of protein in formalin fixed, paraffin-embedded tumor sample from 55 head and neck cancer patients treated with curative radiation therapy (median dose of 7020 cGy) from February 1988 to March 1996 at St. Mary's Hospital. Overexpression of p53 was correlated with locoregional control and survival using Kaplan-Meier method. A Cox regression multivariate analysis was performed that included all clinical variables and status of p53 expression. Results:Thirty-seven (67.2%) patients showed overexpression of p53 by immunohistochemical staining in their tumor. One hundred percent of oral cavity, 76% of laryngeal, 66.7% of oropharyngeal, 66.7% of hypopharyngeal cancer showed p53 overexpression (P=0.05). The status of p53 had significant relationship with stage of disease (P=0.03) and history of smoking (P=0.001). The overexpression of p53 was not predictive of response rate to radiation therapy. The locoregional control was not significantly affected by p53 status. Overexpression of p53 didn't have any prognostic implication for disease free survival and overall survival. Primary site and stage of disease were significant prognostic factors for survival. Conclusions:The p53 overexpression as detected by immunohistochemical staining had significant correaltion with stage, primary site of disease and smoking habit of patients. The p53 overexpression didn't have any predictive value for outcome of curative radiation therapy in a group of head and neck cancers.

초등학교 통합학급에서의 지적장애학생에 대한 일반학생의 태도

김인아(In-Ah Kim),김정연(Jeongyoun Kim) 조선대학교 교과교육연구소 2015 敎科敎育硏究 Vol.36 No.1

이 연구의 목적은 일반학교 통합학급 수업 경험이 초등학생의 장애학생에 대한 수용태도 및 인식에 미치는 영향을 밝히는데 있다. 이를 위해 학년별, 성별, 통합 경험 유무별로 통합학급과 비 합 학급의 일반 초등학생을 대상으로 장애학생 수용태도를 조사하였다. 이 연구의 대상은 전라북도 전주시에 소재한 초등학교 4, 5, 6학년 400명의 학생이다. 본 연구를 통해 도출된 결과는 다음과 같다. 첫째, 일반학생의 지적장애학생에 대한 수용 태도는 통합학급 경험 유무에 따라 유의한 차이가 있는 것으로 나타났다. 통합학급의 경험이 있는 학생들이 통합경험이 없는 학생들에 비해 장애학생에 대한 태도와 인식이 전반적으로 더 긍정적인 것으로 나타났다. 둘째, 일반학생의 지적장애학생에 대한 수용 태도는 성별 요인에 따라 유의한 차이가 나타나지 않았다. 셋째, 일반학생의 지적장애학생에 대한 수용 태도는 학년별 요인에 따라 유의한 차이가 나타났다. 일반학생의 장애 수용 태도는 저학년일수록 더 긍정적인 것으로 나타났다. 논의에서는 연구 결과를 바탕으로 성공적인 통합교육 환경을 만들고 장애학생에 대한 일반학생들의 태도를 증진시키기 위한 방안을 제안하였다. The purpose of this study was to examine the effects of inclusive education and the receptive attitudes and perceptions of elementary school students toward intellectual disabilities. Therefore, this study was conducted to see whether grade levels, gender and the presence of inclusive education experience affects the acceptance of students with disabilities in inclusive and non-inclusive classrooms. This study examined four hundred 4th, 5th and 6th grade elementary school students in Jeonju, Jeollabuk-do. The results were as follows. First, there was a statistically significant difference in the receptive attitudes toward the intellectual disabilities according to the experience of participating in an integrated education class. The study found that inclusive classroom students were shown to have a more positive perceptions and attitude toward disabilities than non-inclusive classroom students in overall acceptance. Second, there was no statistically significant difference in receptive attitudes toward the intellectual disabilities according to gender. Third, there was a statistically significant difference in receptive attitudes toward the intellectual disabilities according to grade. The lower grade students have more positive recognition than that of the higher grades. Based on these results, the researcher suggested some ideas about how to improve students attitude toward disabilities and develop the better inclusive environment.

조기 위암의 위벽단축:상부 위장관 조영술과 병리 소견의 비교

김인재,최철순,김은아,김규선,윤구섭,김호철,배상훈,강구,신형식,Kim, In-Jae,Choi, Chul-Soon,Kim, Eun-Ah,Kim, Kyu-Sun,Yun, Ku-Sub,Kim, Ho-Chul,Bae, Sang-Hun,Kang, Gu,Shin, Hyung-Sik 대한영상의학회 1995 대한영상의학회지 Vol.32 No.1

Purpose : To investigate the causes of gastric wall shortening in ealy gastric cancer, upper gastrointestinalstudy was correlated with pathologic findings. Materials and Methods : We evaluated 41 cases (m:F=1.7:1, averageage=49) of early gastric cancer, retrospectively. The gastric wall shortening were classified as Grade I;none,Grade II;intermediate, and Grade III; prominent. Pathologic findings such as size of lesions, depth of tumorinvasion, degree of the submucosal fibrosis, degree of thickness of the submucosa and muscularis propria, andmorphologic patterns of lesions including conversing mucosal folds were correlated with the degree of gastric wallshortening on upper gastrointestinal series. Results : Submucosal fibrosis was present in 4 cases in Grade I(n=21), 4 cases in Grade II (n=6) and 8 cases in Grade III (n=10), Positive conversing mucosal folds were seen in 5cases in Grade I (n=17), 0 case in Grade II (n=2) and 9 cases in Grade III (n=9), Gastric wall shortening wassignificantly associated with submucosal fibrosis and conversing mucosal folds of early gastric cancer. (p=.0001and p=.002, respectively) Conclusion : Upper gastrointestinal finding of gastric wall protrusion in patients withearly gastric cancer should not misinterprete as advanced gastric cancer sine the finding could be a result ofsubmucosal fibrosis.

The Radiation Therapy for Spinal Cord Compression in Hematologic Malignancy

김인아(In Ah Kim),최일봉(Ihl Bohng Choi),정수미(Su Mi Chung),강기문(Ki Mun Kang),계철승(Chul Seong Kay),최병옥(Byung Ok Choi),장지영(Ji Young Jang),신경섭(Kyung Sub Shinn),김춘추(Chun Choo Kim) 대한방사선종양학회 1994 Radiation Oncology Journal Vol.12 No.3

최근 혈액암에 있어서 적극적인 복합항암요법및 골수이식등으로 장기 생존자의 수가 증가함에따라 과거에 흔하지 않았던 합병증, 특히 척추 신경의 침범으로 인한 압박증상을 보이는 환다들의 수가 점차 증가하고 있다. 혈액종양과 고혈종양간에 방사선 감수성의 현저한 차이가 있음에도 불구하고, 척수압박증상에 관한 대부분의 보고들이 혈액종양을 따로 구분하여 분석하지 않았으며, 충분한 수의 혈액종양환자를 대상으로 한 보고가 드문 실정이다. 이에 저자들은 1988년부터 1993까지 척수압박으로인해 응급방사선치료를 받은 32명의 혈액종양 환자를 대상으로 후향적 분석을 시행하여 치료결과 및 예후인자를 알아보고자하였다. 신경학적 진찰이나 방사선학적 검사 (척수조영술, 전산화단층촬영, 자기공명영상촬영)로 진단된 경우가 27례 이었고, 환자가 호소하는 증상을 중심으로 'high index of suspicion'으로 진단한 5례를 포함하였다. 발병당시 조직학적 진단이 없어 수술을 시행한 1례를 제외한 모든 환자가 방사선 단독으로 치료받았으며, 조사량의 범위는 800CGy 에서 4000 cGy로 중앙값은 2000 cGy 이었따. 혈액종양의 방사선 감수성을 고려하여 200 cGy이하의 분할조사량이 사용되었으며, 신경학적 증상의 진행속도가 빠른 13례에 있어서는 치료초기 2회 내지 3회에 걸쳐 250 cGy 이상의 고분함선량이 사용되었다. 전체환자의 50%에서 좋은 반응을 보였고, 37.5%에서 부분반응을 보였으며, 12.5%는 치료에 반응이 없었다. 이러한 반응율은 문헌에 보고된 고형암에 비해 높았으며, 혈액종양만을 대상으로한 다른 보고들과 유사하였다. 진단당시 신경학적증상의 정도가 치료결과에 영향을 미치는 가장 중요한 예후인자였고, 증상의 출현에서 치료시작까지 소요된 기간도 치료결과에 유의한 영향을 미치는 것으로 나타났다. 반면에 조직학적 진단의 종류, 총방사선량, 초기고분할선량의 사용여부등에 따른 치료결과의 차이는 관찰되지 않았다. Spinal cord compression, an oncologic emergency is a rare complication of hematologic malignancy. Our experience was obtained with a series 32 patients following retrospective analysis for assessing the role of radiation therapy and identifying the prognostic factors affecting on treatment outcome. Diagnosis was usually made by means of radiologic study such as myelography or computerized tomography (CT) or magnetic resonance imaging (MRI) and neurologic examination. Five cases were diagnosed by subjective symptom only with high index of suspicion. In 31 cases, the treatment consisted in radiation therapy alone and the remained on patient had laminectomy before radiation therapy because of diagnostic doubts. Total treatment doses ranged from 800 cGy to 400 cGy with median of 2000 cGy. Initially large fraction size more than 250 cGy wre used in 13 patients with rapidly progressed neurologic deficit. The clinical parameters considered in evaluating the reponse to treatment were backache motor-sensory performance and sphincter function. Half of all patients showed good response. Partial response and no response were noted in 37.5% and 12.5% respectively. Our results showed higher response rate that those of other solid tumor series. The degree of neurologic deficit at that time of diagnosis was the most important predictor of treatment outcome. The elapsed time from development of symptoms to start of treatment was significantly affected on the outcome. But histology of primary tumor, total dose and use of initial large fraction size were not significantly affect on the outcome. These results confirmed the value of early diagnosis and treatment especially in radiosensitive hematologic malignancy.

The Effect of Intermittent Craniospinal Irradiation and Intrathecal Chemotherapy for Overt Meninggeal Leukemia

김인아(In Ah Kim),최일봉(Ihl Bhong Choi),정수미(Su Mi Chung),신경섭(Kyung Sub Shinn) 대한방사선종양학회 1993 Radiation Oncology Journal Vol.11 No.2

가톨릭대학교 의과대학 성모병원 치료방사선과에서 1988년부터 1992년도까지 적절한 중추신경계 예방요법후 뇌척수액내 재발을 경험한 급성 임파구성 백혈병 환자 7명을 대상으로 간헐적인 전중추신경계 방사선조사 및 척수강내 화학요법(IIIC)을 실시하였다. 추적관찰기간은 8개월에서 41개월이었고 그 중앙값은 20개월이었다. 7명의 대상환자중 3명이 다시 뇌척수액내 재발을 경험하였고, 중추신경계 관해유지기간은 각각 8, 9, 13, 20, 34, 36개월이었다. 무병 생존기 간은 2개월에서 36개월로 그 중앙값은 11개월이었다. 생존율은 8개월에서 41개월로 그 중앙값은 28개월이었다. 5명이 치료기간중 골수재발에 따른 패혈증 및 출혈로 사망하였고, 2명의 생존자는 치료종료 10개월 및 11개월째 다시 뇌척수액내 재발을 경험하였다. 치료결과를 향상시키기 위해서는 치료중 휴식기간을 단축시키고, 치료후에도 일정기간동안 척수강내 유지화학요법을 연장하여 실시하는등 치료계획의 변형이 필요할 것으로 사료되었다. Between 1988 and 1992, seven patients with overt meningeal leukemia who had received adequate central nervous system (CNS) prophylaxis were treated with intermittent craniospinal irradiation and intrathecal methotrexate (IIIC). Follow-up time ranged from 8 months to 41 months with median of 20 months. Three of 7 patients developed subsequent CNS relapse. CNS remission durations were 8, 9, 13, 20, 28, 34, 36 months from diagnosis of CNS leukemia for which IIIC was given. Disease free survival after CNS relapse ranged from 2 to 36 months with median of 11 months. Overall survival after CNS relapse ranged from 8 to 41 months with median of 28 months. Five patients died of sepsis and bleeding secondary to bone marrow relapse. Two patients are alive at present. But they developed recurrent CNS disease 10 to 11 months after completion of IIIC. To improve the outcome, modification of IIIC by reduction of rest period and prolonged administration of intrathecal chemotherapy after completion of IIIC are required.