증례 : 내분비-대사 ; 아급성 갑상선염이 동반된 갑상선 자율기능성 결절 1예

강미자 ( Mi Ja Kang ),권혁상 ( Hyuk Sang Kwon ),최윤희 ( Yoon Hee Choi ),윤건호 ( Kun Ho Yoon ),차봉연 ( Bong Yun Cha ),손호영 ( Ho Young Son ),정찬권 ( Chan Kwon Jung ) 대한내과학회 2009 대한내과학회지 Vol.77 No.5

아급성 갑상선염은 갑상선의 바이러스 감염에 의해 유발되는 질환으로 수주에서 수개월 동안 갑상선 부위의 동통과 발열등 상기도 감염 유사 증상을 보인다. 그러므로 처음부터 갑상선 질환을 의심하는 경우보다는 상기도 감염으로 치료 중 호전을 보이지 않거나 갑상선의 결절이 촉지되면서 갑상선 질환을 의심하여 진단되는 경우가 많다. 저자 등은 압통성 갑상선 결절과 인후통을 주소로 내원한 환자에서 아급성 갑상선염으로 진단하고 치료 중 갑상선 스캔 검사에서 단일결절이외 조직에 방사능 섭취가 전혀 없는 갑상선 자율기능성 결절을 추가로 진단하였다. 저자들은 이들 질환의 병인에 대한 고찰을 통하여 연관성을 확인해보았으며, 특히 갑상선 자율기능성 결절에서 치료가 필요한 중독성 선종의 감별 진단법을 확인해 보았다. 정상 기능의 갑상선 자율기능성 결절도 아급성 갑상선염처럼 갑상선자극 호르몬이 억제되는 상태에서는 열 결절로 나타나게 되므로 추가 검사 없이도 자율성을 확인할 수 있었고, 서로 다른 병인을 가지기 때문에 드물게 볼 수 있는 아급성 갑상선염과 정상 기능을 갖는 갑상선 자율기능성 결절이 동반된 증례가 아직까지 국내에서 발표된 바 없어서 희귀한 증례로 보고하는 바이다. The most common cause of thyrotoxicosis is Graves` disease, followed by toxic adenoma, multiple nodular toxic goiter, and temporary thyroiditis. At initial presentation, however, it is often difficult to recognizinge subacute thyroiditis as a thyroid disease is often difficult. In many cases, subacute thyroiditis may be mistaken for certain upper respiratory infectious diseases, due to their similar clinical manifestations. Additionally, when subacute thyroiditis coexists with a thyroid nodule or is accompanied by severe thyrotoxicosis, it can be misdiagnosed as a thyroid tumor, toxic adenoma, or Graves` disease. Here we report the case of an autonomously functioning thyroid nodule combined with subacute thyroiditis, which was nearly misdiagnosed as toxic adenoma. This is the first reported case in Korea of a patient who had an autonomously functioning thyroid nodule combined with subacute thyroiditis, which was nearly misdiagnosed as toxic adenoma. (Korean J Med 77:630-636, 2009)

불교에서 본 정신분석(Psychoanalysis) -무아(無我)를 중심으로-

강미자 ( Mi Ja Kang ) 동아시아불교문화학회 2012 동아시아불교문화 Vol.12 No.-

본고는 정신분석치료에서의 자아와 심리치료방법을 불교교리 가운데 특히 무아(無我)의 관점에서 살펴보았다. 불교심리치료란 불교의 이론하에 심리를 치료하는 것이라 정의하고, 그 이론적 토대로 연기적 관계의 ``무아’를 제시하였다. 연기적 관계의 무아란 상호의존적·상대적으로만 존재하는 실체가 없는 관계속의 자아라고 정의하였다. 관계 중심의 연기적 무아는 네가 나의 존재 근거이므로 더불어 살아 가야할 존재라는 뜻이다. 결국 불교심리치료에 있어서 ``관계 문제``를 해결하는 이론은 연기적 무아에 근거한 자비심이라고 보았다. 반면에 서양에서는 자아 강화, 자아 존중을 위한 치료를 하기 때문에, 몸과 마음의 연결이나 다른 사람과의 관계에 중점을 두지 않았다. 불교에서 관계 속에서만 존재하는 자아가 대상에 대해 일으키는 마음인 탐심, 진심, 치심을 정신분석에서 자아인 이드(id), 에고(ego), 슈퍼에고(superego)와 연결 지어 고찰하였다. 즉 정신분석에서 본능의 자아인 이드는 불교에서의 탐심으로 보았다. 현실적인 자아인 에고는 진심으로, 도덕적 자아인 슈퍼에고는 치심으로 관련 지어서 설명하였다. 자아와 3독심의 문제를 해결하는 심리치료 방법으로 정신분석치료에서의 ``자유연상``과 불교에서의 ``통찰명상``을 비교하였다. 자아를 강화시키기 위해 정신분석치료에서는 자유연상을 활용하여 무의식을 의식화 하여 심리적인 문제를 해결한다. 반면에 자아의 실체 없음인 무아를 통찰하여 3독심을 없애기 위해 불교에서는 통찰명상을 활용하여 집착하는 마음을 제거하고 고통에서 벗어나고자 한다. 자유연상과 통찰명상은 심리적인 문제를 해결한다는 의미에서는 같지만, 자유연상은 근원적인 고통의 문제를 해결하지는 못한다. 따라서 자유연상이 갖는 한계를 통찰명상이 보완해줄 수 있다고 보았다. 통찰 명상을 통한 체험적 깨달음은 진정한 변화를 가져오기 때문이다. 즉 나[我]와 나의 것[我所]에 대한 無我의 통찰을 통해서 치심이 제거된 지혜를 얻어 욕망인 탐심을 소멸하고 분노의 마음인 진심에서 벗어 나면 고통에 대한 근원적인 문제를 해결할 수 있다. This paper describes the definition of Buddhist psychotherapy and its theoretical base. Comparing self of psychoanalysis and psychotherapy with Buddhism, this paper considers the characteristics of Buddhist psychotherapy. First, Buddhist psychotherapy refers to psychotherapy through Buddhist theories and its theoretical core is Anatma(no-self): suggest that the theoretical base is no-self of interdependent arising, which makes much of relationship. Second, it is considered that id, or instinctive self of Freud is connected with greed, which is one of Tri- dosapaha-citta(three poisonous mind) of Buddhism, and ego as realistic self is related to hatred. Superego to search for ethical self is estimated to be bodhi-citta(a human`s mind that seeks utmost enlightenment) of Buddhism, which get rid of ignorance and then attain enlightenment. Thirdly, Freud approached psychological problem on the basis of mental determinism and the unconscious about human beings. He divided human`s mind into the conscious, the preconscious, and the unconscious, regards human beings as unconscious beings, and adopts free association as a method to free oneself from unconscious domination. Free association can be compared to Vippasana(insight meditation). In conclusion, the point of contact between psychoanalysis and Buddhist psychotherapy is insight meditation. Experiential enlightenment leads to true change. Finally we attain prajna(wisdom), which eliminates desire and then escapes from hatred through insight of no-self about “I” and “mine”.

입원 노인을 돌보는 가족원의 스트레스에 관한 연구

김강미자(Kim Kang Mi Ja) 기본간호학회 1996 기본간호학회지 Vol.3 No.2

한용운의 민족주의와 근대주의에 대한 일고찰

강미자(Kang Mi-Ja) 부산경남사학회 2006 역사와 경계 Vol.58 No.-

As a nationalist of colonial days, Han yong-un had thought as follows about nationalism and modernism.<br/> First, Han yong-un was in anguish on a theory of national liberation and its putting in practice as the leftist's point of view. He was also very much in anguish on subjectivity of nationalism to obtain power of resistance. Han yong-un put an importance to tradition of Cho-sun dynasty. Likewise Park eun-sik's theory on national spirit and Shin choe-ho's theory on nangga, he emphasized national self-existence which was passed down from ansestors.<br/> Second, Han yong-un thought the mass of people will put national liberation in practice. To Han yong-un, saving the world is giving rise to historical appointed task of the mass of people. Therefore, the mass of people are those who will solve national problems. That is to say, the mass of people are the motive power of social change and development. Through that point, the mass of people can solve the problem of national liberation. And from a broader viewpoint he did altruism and through that he tried to save the mass of people of the world from all kinds of pressure and bondage. And he also tried to realize peaceful society and social freedom and equality which was not violated from outer force. He thought the mass of people of Cho-sun dynasty who was passed down from blood lineage must be those who was subjective power of national liberation. That is Han-yong-un's theory of saving the world.<br/> Third, Han yong-un tried to analyze western modernism as viewpoint of the general trend. He tried to apply freedom and equality which was from Buddhism to those of modernism. That is to say, he considered Buddhism which was traditional thought as the religion which was very much close to the mass of people. Because of that, he thought national emotion had the power of subjectivity of modernism.<br/> Fourth, Han yong-un thought freedom, equality and peace which is main point of Buddhism must be realized in the future. He also thought that realization must be done subjectively by the revolution of the mass of people by degrees. Therefore, he basically denied outer interference and aggression.

류마티스 관절염 양상으로 발현된 Churg-Strauss 증후군

김홍기 ( Hong Gi Kim ),박성환 ( Sung Hwan Park ),최민호 ( Min Ho Choi ),강미자 ( Mi Ja Kang ),고동훈 ( Dong Hoon Ko ),조철수 ( Chul Soo Cho ),김호연 ( Ho Youn Kim ),김진아 ( Jean A Kim ) 대한류마티스학회 1998 대한류마티스학회지 Vol.5 No.1

Churg-Strauss syndrome (CSS) or allergic angiitis and granulomatosis is a disorder characterized by pulmonary and systemic small-vessel vasculitis, extravascular granulomas, and hypereosinophilia. It occurs in individuals with asthma and allergic rhinitis. The diagnosis of CSS is made on the basis of clinical and pathologic features. According to 1990 American College of Rheumatology(ACR) criteria for the classification of CSS, 6 criteria were developed. The presence of 4 or more of these criteria yielded a sensitivity of 85% and a specificity of 99.7%. We describe a case of CSS in a 62-year-old female who met all of 1990 ACR criteria, but presented as like a as rheumatoid arthritis initially. Clinical symptoms, laboratory and roentgenographic findings gradually responded to high dose prednisolone treatment and resolved 3 weeks later. After discharge, she has been treated with oral prednisolone in a tapering course. Although polyarthritis with eosinophilia, vasculitis, and neuropathy are clinical manifestations of rheumatoid arthritis, those maniestations frequently occur during the vasculitic phase of the CSS. This case suggests that thorough differentiation of extra-articular manifestations of RA from clinical manifestations of CSS is considered when we meet a patient who have polyarthritis and vasculitis.

한국에서 당뇨병 관리를 위한 유헬스케어 시스템

조재형(Jae-Hyoung Cho),김헌성(Heon-Sung Kim),강미자(Mi-Ja Kang),최윤희(Yoon-Hee Choi),윤건호(Kun-Ho Yoon) 한국통신학회 2009 한국통신학회 학술대회논문집 Vol.2009 No.6

인터넷과 무선통신등의 발달이 기존의 의료시스템에 접목됨으로써 새로운 질환관리 시스템으로 개발되어오고 있다. 특히 당뇨병과 같은 만성질환 관리에 이용되고 그 임상적 효과가 알려지면서, 관련된 새로운 센서, 기기개발뿐만아니라 다양한 질환에까지 확대 적용 되고 있다. 본 논문에서는 한국에서 그 임상효과가 알려진 IT기반 당뇨관리 시스템을 소개하고 향후 발전 방향에 대해 논의하였다.

항결핵 치료과정에서 호전되었다가 악화된 뇌 결핵종 1예 보고

이대훈,유진홍,강미자,김홍기,김선화,고동훈,천지성,유원종 대한화학요법학회 1997 대한화학요법학회지 Vol.15 No.3

In spite of nationmide tuberculosis control program, tuberculosis is still prevalent in Korea. Accordingly, tuberculous meningitis also poses one of the main trouble some problems. Recently, We experienced a perplexing case of tuberculous menin-gitis and tubercdoma in a 24-year old female patient. She was admitted to our hospital owing to meningeal irritation sign, aphasia, VI nerve palsy, and ,fever. CSF analysis showed a finding consistent with that of presumptive tuberculous meningitis.. Initial MRI of the brain revealed a large mass(tuhercu1oma) on left parieto-temporal area. Antitubeculous regimen(1soniazid (INH), rifampin(RMP), ethambutol(EMB), pyrazinamide(PZA)} of meningeal dose was given immediately, and her symptoms and signs were dramatically disappeared with a few days after treatment. She was discharged with improved condition and under maintenance treatment of tuberculosis. Follow-up one year after treatment. revealed that the previous lesion was nearly diminished. She showed no symptom at all until she recognized a total blindness of sudden onset on her left eye a t the 18th month of treatment. Brain MRI checked at that time showed multiple masses of tuberculoma scattered over the brain base and one of them invaded left optic nerve. In our opinion, the cause of relapse in this patient might he explained by the selection and ultimate replication of a minor population of resistant strain. Although such relapse is an extremely rare event, we think that we should always pay attention to this possible resistance problem every time we meet patients with tuberculous meningitis.

항암제 요법을 수행하는 암환자의 환자역할 행위에 관한 연구

金江美子,金炳佑 全南大醫大 1986 전남의대학술지 Vol.23 No.1

노인대상 자원봉사자 교육을 위한 기초 조사

김강미자,임혜경,정여숙,정하숙,김세령 노인간호학회 2001 노인간호학회지 Vol.3 No.2

The purpose of this study was to identify the educational needs of volunteers caring for the elderly through investigation of their activities and the level of knowledge. The subjects of this study were 142 volunteers who were working at an institute for the elderly in J city. Data were collected using self-report questionnaires from October 1 to November 20, 2000. The data was analyzed by SPSS/PC. The results of this study were as follows ; 1. The most frequent activities of volunteers were physical care, followed by spiritual care, environmental care, and psychosocial care. 2. The areas revealing relatively high level of volunteers' knowledge were psychological and social characteristics of the elderly and social welfare for the elderly. Those areas which showed relatively low level of knowledge were nutrition, elimination, and skin care. In conclusion, those volunteers who work for the elderly were lacking in consistency of activities and knowledge. They were also lacking in the clinical practice. Therefore, education for volunteers need to emphasize practice with the aged people.

영성(Spirituality)의 개념분석

김강미자,이병숙 성인간호학회 1998 성인간호학회지 Vol.10 No.3

The purpose of this is to understand the aspect of human spirituallity and its general meaning to nursing practice. This conceptual analysis has been defined thus : 1) spirituality is a basic human attribute 2) spirituality gives meaning to life 3) spirituality is a relationship between the omnipotent and the supernatural. Spirituality assumes these : 1) all human beings possess a spiritual nature 2) it is the sourse of human power 3) it assumes mutual relationship between the individual and others 4) conviction etc... And the result of spirituality leads to : 1) petition 2) peacefulness 3) hope 4) love between the self and the surrounding others and etc... The experience of the spirituality refers to the relationship between the self, others, and with environment as well as the relationship with God. And that positive and assertive mentality and attitude will result in a desirable spiritual relationship between the caregiver(the nurse) and the receiver.