난황낭종 환자에서 보존적 수술 및 항암 화학요법 후 성공적인 자연임신

정은환, 홍승화, 박연진, 지일운, 김학순 충북대학교 의과대학 충북대학교 의학연구소 2012 忠北醫大學術誌 Vol.22 No.1

침윤성 난소암의 경우 생식력의 보존이 중요한 도전이라고 할 수 있다. 20대 중반의 여성에서 거대 한 난황낭종이 발견되어 생식력의 보존을 위해 보존적 수술과 복합항암화학요법을 시행한 후 임신 및 출산에 성공한 증례를 경험하였기에 문헌고찰과 함께 보고한다.

부산시 일개구 지역주민의 위암선별검사 수검 및 반복수검 실태 및 관련요인조사

정인숙,배은숙,천동환,전진호,이화자,박남희 韓國保健敎育.健康增進學會 2003 보건교육건강증진학회지 Vol.20 No.1

The importance of repeat screening for stomach cancer is well known to decrease deaths from stomach cancer. This study was aimed at assessing practice behaviors and to identify related factors in the aspects of demographic factors, health status and cancer risk recognition, attitude to cancer screening, health behaviors, and inhibiting or facilitating factors to stomach cancer screening in an urban area. Data was collected through self-administered questionnaires from 403 people aged 40 to 69 years from April 23th to May 15th, 2002. Practice behaviors were classified as :"ver"r "ver"and "peat"r "t repeat"rouped based on a recent 5 year screening history. The results were as follows: 1. Among the 403 subjects: "e ever group"as 23.8% and "e repeat group"as 4.0%. The rates of screening were 20.5% for men, 27.8% for those women, and 27.3% for aged 40-49, 24.5% for those aged 50-59, 19.0% for those aged 60-69. The rates of repeat screening were 4.0% for men, 4.1% for women, and 2.9% for those aged 40-49, 6.3% for aged 50-59, 2.5% for those aged 60-69. 2. The main factors associated with adherence to gastric cancer screening were education(post high school vs below : OR=2.44), previous cancer screening(yes vs no : OR=2.61), belief in personal health(no vs yes : OR=2.72), health status(unhealthy vs healthy : OR=3.40), possibility of cancer compared to others(low vs not low : OR=2.56), and regular exercise(yes vs no : OR=2.94). The main factor associated with adherence to gastric cancer repeat screening was other cancer screening (yes vs no : OR=6.33). Consequently, there is a need to change the recognition of the importance and necessity of stomach cancer screening in healthy conditions through health education, and to perform multiple screening tests each visit.

임신중기 양수천자에 의한 태아의 세포유전학적 연구

정은환,김학순 충북대학교 의과대학 충북대학교 의학연구소 2003 忠北醫大學術誌 Vol.13 No.2

연구목적: 태아의 염색체 질환을 산전에 진단하기 위한 임신중기 양수천자의 효용성을 분석하고자 하였다. 대상 및 방법: 1995년부터 2002년까지 충북대학교병원에서 임신중기에 양수천자를 시행한 443명의 임부를 대상으로 태아 염색체 검사의 적응증, 이상소견, 및 합병증 유무에 따라 분류하고 비교하였다. 결과: 18명의 임부에서 의미있는 태아 염색체 이상이 발견되었으며 심한 합병증은 없었다. 종류별로는 숫적 이상이 11례, 구조적 이상이 5례, 모자이시즘이 2례였다. 결론: 임신중기 양수천자는 임상적으로 적응증이 되는 경우에는 반드시 시행해야 할 안전하고 정확한 방법임을 확인하였다. Purpose: This study was performed to analyse the efficacy of second trimester genetic amniocentesis for prenatal diagnosis of fetal chromosomal anomaly. Materials and Methods: Fetal karyotype, indications for genetic amniocentesis, and complications were analysed in 443 amniocentesis cases which were performed at Chungbuk National University Hospital from 1995 to 2002. Results: Clinically significant chromosomal abnormalities were found in 18 cases including 11 numerical abnormalities, 5 structural rearrangments, and 2 mosaisms. There was no significant complication. Conclusion: Second trimester genetic amniocentesis is a safe and accurate method to detect fetal chromosomal anomalies and should be performed if clinically indicated.

췌장암 환자에서 알코올 내장신경 신경파괴블럭 후 발생한 간염

이상은,최석환,김영환,임세훈,이정한,이근무,정순호,최영균,김영재,신치만 인제대학교 2008 仁濟醫學 Vol.29 No.-

Splanchnic neurolytic block(SNB) with alcohol improves the management of pancreatic cancer pain. Adverse effects of alcohol SNB which include regional pain, hypotension, diarrhea, and acute alcohol intoxication are common, but acute hepatitis caused by alcohol neurolytic block is rare. A 63-year-old patient with pancreatic head cancer and liver metastasis had complete pain relief after both retrocrural tansdiscal SNB with 100% alcohol 10 ml. But, 1 day later, liver function test showed a high elevation in the aspartate aminotransferase (AST, 2182 IU/L) and alanine aminotransferase (ALT, 1807 IU/L). The patient had slight jaundice, general weakness, chilling, nausea and vomiting after SNB. Both AST and ALT decreased to 46 and 119 IU/L within 10 days with only supportive therapy. But, 19 days later, the patient died due to pneumonia. Our case illustrates the importance of clinical surveillance especially in patient with hepatic disease after alcohol SNB.

결장직장암 환자의 임상적 고찰 : 조선대학교 부속병원의 10년 간의 결과

나은종,문성표,장정환,김권천,민영돈,김성환,조현진,김정용,김경종 朝鮮大學校 附設 醫學硏究所 2005 The Medical Journal of Chosun University Vol.30 No.2

Background and Objectives: The colorectal cancer rates 4th in the total cancer prevalence in Korea. The clinical patient demographics were considered with the incidence rate of the colon and rectal cancer. The clinicopathological factors were analyzed for the 5 year survival rate. Materials Methods: Of the 282 patients who were operated from Jan. 1, 1992 to Dec. 31, 2001 and diagnosed by pathological biopsy as colo-rectal cancer, 234 patients were followed up. The age, sex, location of the cancer, TNM stage, operation method, histopathological classification, metastatic region, complications after operation and the survival rate were investigated. Results: Of the 234 patients, male and female consisted of 120 cases (51.3%) and 114 cases (46.7%), with an average age of 61.6 years. The average follow up period was 52.3 months and the peri operative mortality was 5.6%. The site of the cancer was most frequent at the rectum with 127 cases (54.3%). The patients were classified according to the TNM stages with 38 cases of stage 1 (16.2%), 98 cases of II (41.9%), 72 cases of III (30.8%) and 26 cases of IV (11.1%). The 5 year survival rate in the age group older than 50 was 63.3 % and 73.5% in the group younger than 50. In regard to the operation type, the 5 year survival rate was 65.4% for elective operation and 65.8% for emergency operation. The 5 year survival rate for well differentiated, moderately differentiated, poorly differentiated cancer, and mucinous adenocarcinoma was 73.7%, 60.2%, 58.3%, and 92.6%, respectively. The 5 year survival rate of each of the TNM stage is 81.1%, 74.8%, 57.0%, and 11.5% for Classes I, II, III, and IV, respectively. Conclusion: The clinical factors were analyzed for the 5 year survival rate with no statistical significance for the age, sex, and location of the cancer. The TNM stage and histopathological differentiation were statistically significant. The colon cancer showed better prognosis compared to the rectal cancer.

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.

선천성 대사 이상 환아에서 발생한 대사 위기의 복막 투석 치료 효과

강정혜,이동환,문철,김은미 순천향의학연구소 1996 Journal of Soonchunhyang Medical Science Vol.2 No.2

Purpose : We have evaluated the outcomes of peritoneal dialysis in patients with metabolic crises caused by in born error of metabolism. Methods : There are 6 patients(8 episodes, 4 males and 2 females) who had inherited inborn errors of metabolism and were admitted to the department of pediatrics, Shoonchunhyang university hospital in Seoul from December 1991 to December 1994. The technique of dialysis is discribed, in short: A Tenckhoff catheter was inserted surgically in all patients through the lateral abdominal wall. Commerically available dialysate solutions(Peritosol, Korea Green Cross Co.) was applied to 5 patients(7 cases) with hyperammonemia. In a patient with propionic acidemia, we used a special custiom made dialysate that replaces lactate by bicarbonate. Results : 1) The mean age was 5.3 months old. There were 6 patients with 8 episodes. Six cases had Ornithin transcarbamylase deficiency. The remaining cases are Multiple carboxylase deficiency and Propionic acidemia (Table 1) 2) In 7 cases with hyperammonemia, mean levels of pre and post 24hrs peritoneal dialysis serum ammonia were 1000.2±310.9 ㎍/dl and 388.8 ±156.7 ㎍/dl at 24 hours respectively. Time on serum ammonia levels reached below 300 ㎍/dl was 88.7 ±39.6 ㎍/dl hours. 3) Four out of seven cases were a recorvert of mental status. Each episode of serum ammonia mean levels was 388.8 ±156.7 ㎍/dl after 19.7 ±5.8 hours of peritoneal dialysis (Table 3). 4) Peak serum ammonia levels of the survived group reached 1356.5 ㎍/dl, higher than the expired group of 847.5 ㎍/dl and time period of starting peritoneal dialysis after onset of the survived group was 15.5 hours earlier than the expired group of 23 hours(P>0.05)(Table 4). 5) 3 out of 7 cases of hyperammonemia died. The cause if death were 3 brain edema, 1 hyperkalemla and 1 intracranlal hemorrhage. 6) In onecase with Multiple carboxylase deficiency, serum ammonia level was normalized after 12 hours of peritoneal dialysis. The reduction of serum levels of the branched amino acid was also observed. 7) In a case of Propionic acidemia with severe metabolic acidosis, the prior serum bicarbonate level was 8 mmol/L and was increased up to 18 mmol/L by peritoneal dialysis lasting 19 hours. 8) Among 8 cases, complications of peritoneal dialysis were 5 hypoalbuminemia, 4 hyoercalcemia, 4 hyperglycemia and leakage of peritoneal dialysate. Conclusions : In cases of hyperammonemia, survival rate is 57.1%. They are showed excellant efficacy of treatment of peritoneal dialysis for metabolic crises. In a case of propinic acidemia is fastly corrected by peritoneal dialysis. But unfortunally clinical manifestations is not improved. Therefore, further studies is required with treatment of severe metabolic acidic conditions.

피부 병변을 동반한 악성조직구증 1예

조은택,박용관,김진호,강정원,천영욱,전익섭,박유환,전춘해 조선대학교 1995 The Medical Journal of Chosun University Vol.20 No.1

Malignant histiocytosis, originally described in 1939 as histiocytic medullary reticulosis by Scott and Robb-Smith, is a rare histiocytic proliferative disorder that often shows an acute onset and used to progress to death within a few months. This disorder characterized clinically by fever, generalized weakness, lymphadenopathy and hepatosplenomegaly, and shows a variable range of pancytopenia. Extranodal involvement is common, with an incidence ranging from 50% to as high as 90%, skin involves8ment was noted in 10% to 15%. Typical skin lesions were mainly founded in extremity. i.e. erythematous papule and nodule occasionally become to necrosis and ulceration. We experienced one case of malignant histiocytosis in a 46-years-old female. The major clinical findings are fever, malaise, hepatosplenomegaly and erythematous skin lesion. In the laboratory study, pancytopenia is noted on the peripheral blood. And also aggregation of many atypical histiocytes were shown on skin and bone marrow biopsy. So we reported one related case with malignant histiocytosis as well as reviewing literature .

초등학생의 성격유형과 수학적 성향의 관계

김정혜,노은환 晋州敎育大學校 科學敎育硏究院 2006 科學敎育硏究 Vol.29 No.-

MMTIC (Murphy-Meisgeir Type Indicator for Children), which is a tool to measure the inborn psychological functions of children and adolescents, was developed based on Jung's theory of psychological patterns for the use by children and adolescents in their everyday life. We can use the tool to understand differences in personality type among people and to achieve educational goals in the field of education. The purposes of the present study were to survey the distribution of personality type of elementary students in the Sancheong -gun area, which is exposed to natural environment relatively much, to examine the relation between their personality type and their mathematical disposition, and to understand differences in personality type of people and use them for teaching- learning, adjustment to school life, counseling, etc. in the field of education. For these purposes, we formulated research questions as follows. 1. How is the distribution of personality type of elementary students in the Sancheong-gun area? 2. In the personality type of elementary students in the Sancheong-gun area related to their mathematical disposition? 2-1. How are the four preference indexes of personality type related to mathematical disposition? 2-2. How are the four psychological functions of personality type related to mathematical disposition? 2-3. How are the four temperaments of personality type related to mathematical disposition? In order to answer these questions, we surveyed 207 sixth-grade students in six elementary schools in Sancheong-gun, Personality type was tested MMTIC. and mathematical disposition was measured with a test composed of 22 questions, which was developed by the author and the reliability of which was confirmed through a preliminary test. Each question in the mathematical disposition test was on a scale of 4 points. A high score meant high mathematical disposition. MMTIC was analyzed by a special institution, and data for examining the relation between personality type and mathematical disposition were processed using SPSS 10.0. In order to examine the distribution of children's personality type by preference index, by psychological function and by temperament, we calculated frequencies and percentages. In addition, t-test was made to determine the significance of the relation between the preference indexes of personality type and mathematical disposition, and F-test was made to determine the significance of the relations between the psychological functions of personality type and mathematical disposition, and F-test was made to determine the significance of the relations between the psychological functions of personality type and mathematical disposition and between the temperaments of personality type and mathematical disposition. From the results of this study were drawn conclusions as follows. First, when children were compared based on preference indexes, a significantly larger number of students were external(E) in the external-internal(EI) index, intuition(N) in the sensing- intuition(SN) index. feeling(F) in thinking-feeling(TF) index, and perceptive in judging-perceiving(JP) index. In the distribution of psychological functions, intuition- feeling(NF) children were most frequent and, next, sensing-feeling (SF), intuition-thinking(NT) and sensing-thinking(ST) children. In the distribution of temperament, the percentage of children with intuition-feeling(NF) temperament was highest and it was particularly as high as 15.9% among male students and, next, the percentages of children with sensing-perception(SP), sensing-judging(SJ) and intuition-thinking(NT) temperaments in their order. Second, in order to examine the relation of mathematical disposition with the preference indexes(EI, SN, TF, JP) and the psychological functions(ST, SF, NT, NF) of personalty type, we conducted t-test and F-test. According to the results, no statistically significant difference was observed at significance level of 0.05 although there were slight differences of the means in all of the four types. Third, in order to examine the relation between mathematical disposition and the four temperaments (SP, SJ, NT, NF) of personal type, we conducted F-test. According to the results, statistically significant differences were observed at significance level of 0.05 and mathematical disposition was high in order of NT>NF>SJ>SP. Data collected through this research can be a guideline for establishing education plans for elementary students in Sancheong-gun. That is , because there are relatively many students with external disposition in the EI index, education may be focused more on activities. Because there are more students with emotional disposition in the TF index, small- group learning may be emphasized more than individual learning. With regard to the JP index, because most students have perceptive disposition, the tendency may be considered in teaching for higher educational effects. People who prefer the perceptive type generally want to adjust themselves to situations and to live with our restriction, tend to make efforts to understand life rather than control life, adjust themselves at a moment, and like to be openhearted. In addition, as they are fond of various opportunities, they can adapt themselves well to unorganized and uncertain situations. Moreover, they often fail to complete works and to be late in task performance. What is more, whenever such things happen, they usually cope with the situations appropriately by themselves. Understanding students' personality type does not necessarily mean better education. However, it is also absurd to establish education plans and give classes without knowing their characteristics. On the whole, research must begin with the identification of students' unique characteristics so that students' potential for future development can be acknowledged and their development can be promoted properly. Because students' mathematical disposition has a significant effect on their achievement in mathematics, this research began with the identification of students' personality type and explored the relation between students' personality type and their mathematical disposition. Researches should be continued on personality type and various factors affecting students' academic achievements. Such researches will enable customized education.

대동맥판폐쇄부전으로 나타난 Supraaortic Ridge와 Subaortic Membrane의 증례

류정곤,김윤철,성보영,김준경,정준용,성인환,전은석,나명훈,이영 대한순환기학회 1998 Korean Circulation Journal Vol.28 No.8