전이성십이지장 내분비암으로 항암화학요법 시행 받고 완전 관해 1년 후 발생한 십이지장 선암 1예

( Bun Kim ),( Ji Hye Heo ),( Joo Won Jung ),( Moon Jae Chung ),( Jeong Youp Park ),( Seung Min Bang ),( Si Young Song ),( Seung Woo Park ) 대한내과학회 2011 대한내과학회 추계학술대회 Vol.2011 No.1

위장관내분비암으로 치료 후 동일 부위에서 선암이 발생한 예는 극히 드물다. 저자들은 전이성 십이지장 내분비암으로 항암치료 받고 완전 관해 1년 후 같은 부위에서 선암이 발생하여 보고하는 바이다. 60세 남환은과거력상 30년 전 콩팥결핵으로 결핵 치료받았다. 한달 간의 전신 무력감과 흑색변으로 2009년 6월 외부병원 내원하여 시행한 검사상 십이지장암과 간전이 의심되어 본원으로 전원되었다. 내원 당시 혈압 130/80 mmHg, 맥박 92회, 체온 36.8도이었다. 일반혈액검사상 WBC 4,730/mm3, Hb12.4 g/dL, platelet 144,000/mm3, 혈청생화학검사상 Bun/Cr 17.7/1.16 mg/dL, AST/ALT 15/13IU/L이였다. 종양표지자는 CEA 0.73 ng/mL, CA 19-9 1.8U/mL이었다. 본원에서 시행한 상부위장관내시경상 십이지장의 상부하행각에 궤양융기형 덩어리가 발견되었다. 조직검사상 십이지장에서 poorly differentiated neuroendocrine carcinoma 진단되어 십이지장 내분비암 및 간전이로 2009년 11월까지 6차례 5-FU (1000 mg/m2, Day1~3)/Etoposide(100 mg/m2, Day1~3)/Cisplatin (70 mg/mg2, Day1) 항암치료 후 영상 및 상부내시경 검사상 완전관해 소견 보였으며 이후 정기적 추적관찰 중이었다. 2011년2월 시행한 상부위장관내시 경상 이전 십이지장 병변에 새롭게 생긴 용종으로 조직 검사 시행하여 선암 진단되었다. 영상 검사상 간 S6/7,S7 두군데에 전이 의심되어 intraop RFA 고려하고 2011년 2월 28일 수술 시행하였다. 십이지장 선암은 8번, 12번, 13번 림프절 확장 소견 보여 병합절제와 췌두부 절제술을 시행하였다. 수술 중 초음파로 간종괴는 찾을 수 없었으나 수술전 시행한 MRI상 간우정맥우연을 따라 종괴가 2개 관찰되어 간우후구역절 제술을 함께 시행하였다. 수술 후 병리 조직 검사상 간 조직은 염증 소견 보이고 십이지장은 선암 진단 되었다. 최종적으로 십이지장 선암은 pT1bN0M0으로 1기로 진단되어 추가 항암치료 없이 외래 경과 관찰 중이다. 저자들은 전이성 십이지장 내분비암으로 항암치료 받고 완전 관해 되었으나 1년 후 같은 부위에서 선암이 발생하여 수술 시행후 완전 절제 되어 보고하는 바이다.

뇌실외 배액술 관리에 대한 이해 및 업무수행 실태

김정숙,윤미선,송소이,이지은,문경선,고지운,임분남,김경희,박경숙 중앙대학교 간호과학연구소 2001 중앙간호논문집 Vol.5 No.2

The objective of this study was to investigate the managing realities of EVD and provide a descriptive survey with the attempt to obtain basic data needed for the standardization of EVD management. For that purpose, 220 questionnaire copies were distributed to those nurses who were working with intensive care units at university hospitals, general hospitals, semi-general hospitals in Seoul, Kyongki-de and local areas. Of 158 returned questionnaire copies, 139 were used for analysis. Data were collected during the term of academic seminars of Neurosurgery Nursing Committee and KICA (Korea Intensive Care Association), ranging from Oct. 26 through 27. 2000. The tools utilized a structured questionnaire form consisting of 21 questions on general characteristics, the level of understanding, the level of work performance, standard management guidelines, etc. The data collected were analysed with frequency, percentage, mean vague, chi -square test using the SPSS 10.0 program Findings were revealed, as follows: For managing the prevention of EVD infection, aseptic technique was found to be of the most importance (48.9%),'the technique should be carried out at an operation room'(92.8%), but it was actually performed at intensive care units (over 51.5%). 'The term of antibiotics use should be less than 7 days' (81.8%), while it was actually executed for less than 7 days (49.5%). 'The proper time of quittance from it should be within less than 7 days'(74.1%) but actual quittance was executed only by 51.1%. 'Set exchange is needed' by 54.0% but actual exchange was implemented merely by 28.1%. 'The subject of management should be nurses' was reflected by 40% but actually 52.0% were carried out. As a result of hating analysed the understanding of the management of EVD by general characteristics, a significant difference was found in the necessity for set exchange by hospitals, in the time of quittance of a catheter, and in ablution items by work experience. The result of hating analysed the work performance levels of EVD management by general characteristics revealed that a significant difference in administration facilities of medicine by the classification of hospitals, especially the use of antibiotics and the quitting time of a catheter by the classification of intensive care units, and in the use of antibiotics and ablution items by the standard management guidelines.

CASE REPORT : Duodenal adenocarcinoma following a neuroendocrine tumor in the duodenum

( Bun Kim ),( Ji Hye Huh ),( Young Sook Kim ),( Moon Jae Chung ),( Jeong Youp Park ),( Si Young Song ),( Seung Woo Park ) 대한내과학회 2014 The Korean Journal of Internal Medicine Vol.29 No.1

Primary duodenal adenocarcinoma is a rare malignant neoplasm accounting for 0.3% of all gastrointestinal tract carcinomas. We herein present one case of duode-nal adenocarcinoma after duodenal neuroendocrine carcinoma. Poorly differenti-ated duodenal neuroendocrine carcinoma with liver metastasis (TxNxM1) was confirmed, and eight cycles of palliative chemotherapy (5-fluorouracil/etoposide/cisplatin) were administered. The patient was then in a clinically complete re-sponse status. About 1 year later, newly developed adenocarcinoma was detected at the same site. It was completely surgically resected, and the patient was cured.

사상체질별 식이 섭생이 건강에 미치는 영향 -한방건강증진센터 시범운영을 위한 기초연구-

김귀분 ( Kwuy Bun Kim ),조결자 ( Kyoul Ja Cho ),이향련 ( Hyang Yeon Lee ),신혜숙 ( Hye Sook Shin ),김광주 ( Kwang Joo Kim ),문희자 ( Heui Ja Moon ),김윤희 ( Yoon Hee Kim ),강현숙 ( Hyun Sook Kang ),박신애 ( Shin Ae Park ) 경희대학교 동서간호학연구소 2002 동서간호학연구지 Vol.7 No.1

This study, as a basic research to manage a Chinese Medicine Health Promotion Center by way of showing an example, is a before and after experiment research for simple group to verify a difference with cholesterol, health status and perception of health in order to confirm a effectiveness of diet and regimen according to the 4th status of physical constitution. Research object was chosen of 42 persons who operate a physical constitutional dietary regimen among them after selecting professors and clinical nurses (55 persons) majoring in the science of nursing who participated in Chinese Medicineoriented Nurse Training Course from Aug. of 2001 to Feb. of 2002 all over the country. Diagnostic tools for physical constitution was used of the questionary that is currently consisted of physical constitution grouping test in Eastern & Western Diagnose Center of K Medical Center, and rating of health status was used of the tool that standardized CMI(Cornell Medical Index) to be available for Korean, and perception measurement for health status was used of a visual analogue scale for the health status that each one perceive personally, and physiological status was measured of cholesterol in blood. Analysis for the collected data was carried out by percentage, χ2 test, paired t-test according to research object by using SPSS, and the results of this study are as follows. 1) There was no difference with cholesterol before or after the experiment for objects. As a result of estimation about difference with health status by areas before or after the experiment, there are more improved result in eyes, ears, digestive organs, bones and sinews organs, frequency of a disorder, habit, adaptation status, angry, healthy status than before the experiment. As a whole, after the experiment the health was more improved than before the experiment. As the result to inspect a difference of health perception between before and after experiment, after the experiment the health perception level was improved than before, however there was no meaningful differences. 2) As the result to inspect a difference of cholesterol between before and after experiment according to object`s physical constitution, in the case of So-yang-in(a person with the minimum male: according to the male and female principles(the sun and the moon) among the 4th status of physical constitution there was only meaningful difference statistically, however, after the experiment their cholesterol`s value was increased. As the result to inspect the difference of health status between before and after the experiment according to physical constitution, all of Ta-um-in(a person with maximum the female), So-yang-in(with the minimum male), So-um-in(with the minimum female) had a meaningful difference before and after the experiment, which means that in all case by physical constitutional groups, after the experiment their health status was more improved than before the experiment. As the result to inspect a difference of health perception between before and after according to physical constitutions, in the case of Tae-um-in and So-um-in, average score after the experiment was risen than before the experiment so that it means that the level of health perception was improved, however, there was no meaning statistically. According to the above results, if continuous diet and regimen by each physical constitutions could be implemented, it is certain that the health could be maintained and promoted. And, what we are healthy is for oneself to feel it subjectively. However, I think that cholesterol score in blood that we can view objectively could be changed distinctly if we can implement a strict diet and regimen. Accordingly, it is necessary for a method and period of experiment to be more strict and longer. According to the above results, I would like to suggest as follows. 1) In order to understand health status by Korean`s physical constitutions and to generalize it, these research will be repeated against much more objects that could be selected by proper grouping method to consider a representative. 2) It is necessary for a research to inspect health status by physical constitution by developing a health status measurement tool that has higher confidence and propriety based on physical constitutional theory.

흉선 증식증을 동반한 전신성 홍반성 낭창

문두섭 ( Doo Seop Moon ),김태환 ( Tae Hwan Kim ),김승영 ( Seung Young Kim ),김평남 ( Pyoung Nam Kim ),전재범 ( Jae Bun Jun ),정성수 ( Sung Soo Jung ),이인홍 ( In Hong Lee ),배상철 ( Sang Cheol Bae ),유대현 ( Dae Hyun Yoo ),최웅환 대한류마티스학회 1995 대한류마티스학회지 Vol.2 No.1

Possible association between systemic lupus erythematosus and disorders of thymus has been shown in several reposrts. But the association is clearly not common as judged by fewer than 20 case reports in the world literature. One case of systemic lupus erythematosus in a patient with thymic hyperplasia is described. The woman had been suffered from purpura, dry mouth and dry eyes and complained of chest discomfort. In this case, thymectomy did not modify the course of systemic oupus erythematosus. Systemic lupus erythematosus with thymic disorder is very rare so we report this case with a review of literatures.

성인간호학 교과내용 분석

이향련,서문자,김귀분,송미순,김정화,김행자,김순용 성인간호학회 1998 성인간호학회지 Vol.10 No.2

The purpose of this study was to analyse the current adult nursing curriculum content in diploma and baccaleureate level nursing schools. The Study was initiated by the Korean Academic Society of Adult Nursing and data were collected from these institutions from March 1997 to April 1998. The questionaire was constructed after several meetings of researchers which included course description , objectives, conceptual frame work, credits (thoery and practicum), number of teaching staffs, content and hours for each content . The questionnaire was sent to all of the nursing schools(41 baccalaureate and 62 diploma) in the nation and the response rate were 53.7% in baccalaureate and 25.8% in diloma schools. Primary analysis was took place during summer workshop of 1997 Korean Academic Socity of Adult Nursing . The second analysis was carried out after additional data of data of detailed content and hours in adult nursing course were obtained from the schools. The result of primary analysis were as below: 1) The consensus in philosophy of adult nursing was drawn. The client of adult nursing was defined as individual over 18 years who has psychological, physical, social and spiritual aspects and interacting with environment. The client is a member of family and community. The students who finished the course should be able to adapt nursing process to their clients, and to describe objectives as prevention of disease, recovery, rehabilitation, health promotion, and improve quality of life. The client , nursing process and nursing were common concepts which included in their concepptual frameworks. 2) Theory credits ranged 9-18(mean 14.1), practicum credits ranged 5-12(mean8.1). The number of teaching staffs ranged from 2-6(mean 3.2.). 3) The content which most hours assigned to were neuro/endocrine(mean 30.8 hours) gastrointestinal(mean 28.4 hours).cardiovascular(mean 28.6 hours) and respiratory(mean 22.7 hours) systems. 4) Areas taught by other profession (mostly physician) were eye, ear nose throat integumentary, radiation therapy, neuromuscular, rehabilitation, respiratory physiology, male genitourinary, pathology and anesthlesiology. 5) Contents overlap with other course content should be rearranged in each school curriculms. Improvement of RN national board examination is prerequsite in order to improve adult nursing education in Korea. The results of second analysis were as below: 1) Credits required for graduation were 130-175 in baccalaureat, 93-134 in diploma. Thirteen to Twenty-eight percent of total credits required for nursing major were credits of adult nursing. 2) Mean hours of total adult nursing lecture were 217 in baccalareuate and 212 in diploma. 3) Disease process occupied more hours than nursing process in adult nursing theory. It is suggested to include all nursing educational institutions in order to complete the survey, to delineate the core contents of adult nursing and rate of hours between theory and practise by Korean Academic Society of Adult Nursing.

P273 : Tuberous sclerosis presented only with connective tissue nevi: usefulness of genetic testing

( Sung Min Park ),( Gun Wook Kim ),( Hyun Ho Cho ),( Won Jeong Kim ),( Je Ho Mun ),( Magaret Song ),( Hoon Soo Kim ),( Hyun Chang Ko ),( Byung Soo Kim ),( Moon Bun Kim ) 대한피부과학회 2014 대한피부과학회 학술발표대회집 Vol.66 No.1

The Korean Society of Gastroenterology& SLDDS 2039 : Slide Session ; K-BP-29 : Pancreatobiliary ; Visceral Obesity is Associated with Poor Prognosis in Pancreatic Adenocarcinoma

( Bun Kim ),( Moon Jae Chung ),( Se Woo Park ),( Jeong Youp Park ),( Seung Min Bang ),( Seung Woo Park ),( Si Young Song ),( Jae Bock Chung ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: An association between obesity and unfavorable outcomes for various types of malignancy has been established. Nevertheless, the impact of visceral obesity on outcomes in pancreatic cancer is still unknown and controversial. The aim of this study was to uncover an association between visceral obesity (VO) and pancreatic cancer outcomes. Methods: We retrospectively reviewed 499 patients in pancreatic cancer who were diagnosed and treated in the Severance Hospital from January 2006 to December 2011, and collected the data of the clinical features, pathologic fi nding, staging, tumor marker and history of surgery, radiation therapy or chemotherapy. In this study, progression free survival (PFS) and overall survival (OS) were used as factors of cancer prognosis to evaluate association with visceral fat (defi ned as an abdominal fat volume distribution using CT scan obtained from a slice with a disc reference (L3-L4); the percentage of visceral fat to total fat area (VF%) at initial diagnosis. Results: Compared to the low visceral obesity group (low-VO group, n=260), the high visceral obesity group (high-VO group, n=239) was mostly male (68.2% vs. 31.8%, p<0.001), and was more likely to have current smoking status (29.7% vs. 17.7%, p<0.001), current alcohol intake status (52.3% vs. 26.4%, p<0.001) and diabetes mellitus (54.4% vs. 31.9%, p=0.028). The PFS and OS were found to be signifi cantly shorter by the Kaplan-Meier method in the high-VO group than in the low-VO group (PFS: p=0.044, OS: p=0.013). In addition, the higher percentage of visceral fat was correlated with more lymph node metastasis and shorter OS (correlation coeffi cient: 0.165, p=0.011 and -0.107, p=0.017, respectively). Conclusions: In patients with pancreatic cancer, VO at the time of diagnosis is associated with negative outcomes, such as shorter PFS and OS.

Propofol을 사용한 혼수요법 치료 중 발생한 반동 반응

김현숙,정현주,정동석,김종분,한영문,안명자,유시현,임경실 대한마취과학회 2000 Korean Journal of Anesthesiology Vol.39 No.3

Barbiturate has been used for the therapy of increased intracranial pressure (ICP) patients. However, it has some serious side effects such as rebound response or convulsion. According to recent reports, propofol can be used for coma therapy and the therapeutic result has been satisfactory. We used propofol instead of barbiturate in coma therapy and experienced a case of rebound response. On admission day, a 20-year-old female patient received an endovascular embolization for an arteriovenous malformation (AVM) in the left occipital lobe. The next day, she went into a coma and the brain CT showed a massive intracerebral hematoma at the AVM site. The patient was transferred to the operating room for decompressive surgery. At the end of the surgery, the brain edema did not subside. The patient was infused with propofol (4 mg/kg/h) after the surgery for propofol coma therapy. During the 6 day propofol therapy, ICP was effectively controlled under 20 mmHg. After completion of the propofol coma therapy, the patient was revived enough to verbally obey. 16 hours later, ICP increased to more than 30 mmHg and the patient was reinfused with propofol. We experienced a rebound response in propofol coma therapy similar to that in barbiturate coma therapy.

B형 간염시 지연성 피부과민 반응과 T cell subset에 관한 연구

김홍범,한상영,김치호,임홍섭,양웅석,문학규 부산의대 1988 부산의대잡지 - 부산대학교 의과대학 Vol.28 No.2