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연명치료 중단 자문에 대한 대학병원 의료윤리위원회의 역할
고윤석 ( Youn Suk Koh ),강정민 ( Jeong Min Kang ),( John D. Armstrong Ii ) 한국의료윤리학회 2005 한국의료윤리학회지 Vol.8 No.2
최근의 집중치료의 발전은 치유는 되지 않은 채 사망에 이르는 시간만 연장시키는 경우들을 초래하여 연명치료의 지속여부와 관련한 윤리적 갈등을 야기하고 있다. 의료인들은 흔히 의료윤리 문제를 개개인의 의료윤리 지식이나 가치관 혹은 동료의사의 의견을 참고하여 해결하여 왔으나 사회는 의료인들이 보다 전문적이고 체계적으로 의료윤리 문제들에 접근 할 것을 요구하고 있다. 연명치료의 중단과 관련된 의료윤리 문제의 해결에 병원윤리위원회가 중요한 역할을 수행할 수 있으나 국내의 현실은 그렇지 않은 것으로 추정된다. 이에 한 병원윤리위원회에서 연명치료 중단에 연관된 윤리 문제를 다룬 경험을 통하여 국내 병원윤리위원회와 연관된 문제점들을 고찰하고자 한다.
원발성 간암환자에서 간동맥 색전술의 치료효과 - 2. 중간 추적 생존율 -
고윤석(Youn Suck Koh),노임환(Im Hwan Roe),안정경(Jung Kyung Ahn),함준수(Joon Soo Hanm),이민호(Min Ho Lee),기춘석(Choon Suhk Kee),박경남(Kyung Nam Park),이은희(Eun Hee Lee),서흥석(Heung Suk Seo) 대한내과학회 1988 대한내과학회지 Vol.35 No.3
N/A Currently, primary hepatocellular carcinoma (HCC) is the second most common cause of cancer death in men in Korea. Generally, the tumor is unresectable due to underlying liver cirrhosis. As a palliative therapy of HCC, transcatheter arterial embolization (TAE) was performed in 53 patients (57 times) from April 19S5 until December 1986 at Hanyang University hospital, of which the conditions of only 35 patients could be followed after TAE therapy. We have analyzed the effectiveness of TAE therapy on these 35 patients. The results were as follows: In patient who didn't have tumor thrombosis in the first or second portal branches, the mean 8 months survival was 58.2%, while in patients with tumor thrombosis, it was 8.3%. The ratio of the tumor size to the liver measured by a planimeter in hepatic angiography was found to be meaningful in the prognosis; In patients with a ratio below 20%, the 6 months survival rate was 66.7%, and in patients with a ratio of 20% or more, it wis 43.4%, The results suggest that TAE is more beneficial in unresectable HCC which doesn't have tumor thrombosis in the first or second portal branches, and which has a ratio of tumor size to liver below 20% as measured by angiography.
우리나라 일부 병원에서 환자, 보호자, 의료진의 연명치료 중지 관련 의사결정에 관한 태도 연구
권복규 ( Ivo Kwon ),고윤석 ( Youn Suck Koh ),윤영호 ( Young Ho Yun ),허대석 ( Dae Seog Heo ),서상연 ( Sang Yeon Seo ),김현철 ( Hyeon Chul Kim ),최경석 ( Kyung Suk Choi ),배현아 ( Hyun A Bae ),안경진 ( Kyung Jin Ahn ) 한국의료윤리학회 2010 한국의료윤리학회지 Vol.13 No.1
A survey was conducted from September to December 2008 to examine the attitudes of patients, family members, and physicians toward the withdrawal of medical treatment for terminal patients and other related issues. The subjects for the study were 91 cancer patients, 96 family members of cancer or other terminally ill patients, and 140 physicians. Most subjects acknowledge the need for an appropriate regulatory framework for the withdrawal of treatment for terminal patients. However, some discrepancies were found among the different groups (patients, family members, physicians) in this study. Patients showed a stronger preference for the withdrawal of treatment than did family members. Also, most patients claimed they wanted to receive the diagnosis of a terminal illness from their physician, while most family members seem to think it is their own duty to convey such a diagnosis to the patient. Both groups prefer co-decision-making about the withdrawal of treatment over individual decision-making by the patient. However, most family members admit that they do not know much about the patient`s wishes and lack the time for sufficient conversation with the patient. Physicians are skeptical of the authenticity of the decisions made by family members, and some physicians also regard hospital ethics committees as being ineffective for resolving these issues. The results of this study paint a unique picture of clinical culture in Korea, where family members still exert strong influence on clinical decision-making and little information is shared between patients, family members, and physicians. The study points to a need for greater public education in Korea on the practical and ethical issues surrounding the withdrawal of treatment for terminal patients.
위장관 ( 胃腸管 ) : 상부 위장관 내시경 검사시 동맥혈 산소 포화도의 변화에 관한 연구
민영일(Young Il Min),이영상(Young Sang Lee),김해련(Hae Ryun Kim),고윤석(Youn Suck Koh),김명환(Myung Hwan Kim),두영철(Young Cheoul Doo),정영화(Young Hwa Joung),양석균(Suk Kyun Yang),김우성(Woo Sung Kim),김원동(Won Dong Kim) 대한소화기학회 1990 대한소화기학회지 Vol.22 No.3
N/A Gastrointestinal endoscopy is one of the most frequent procedures, but relatively little is known about its pulmonary effects. Pulse oximeter is a convenient and non-invasive methods which monitors SaO2 and pluse rate. So, we studied the change of SaO2 and pluse rates during esophagogas-troduodenoscopy in the patients with impaired plumonary function and normal controls by pluse oximeter. In conclusion, the drop in SaO2 during endoscopy could occur in the pulmonary disease patients with mild to moderate imparied pulmonary function, but this change was transient and recovered rapidly during examination. So, we suppese that specific therapy such as O2 supply may not be requried durging endoscopy in these patients.
결핵성 및 암성 흉수의 감별진단에서 흉수내 SC5b - 9 농도 측정의 진단적 의의
서동완(Dong Wan Seo),곽승민(Seung Min Kwak),김우성(Woo Sung Kim),김동순(Dong Soon Kim),서을주(Eul Ju Seo),민원기(Won Ki Min),김원동(Won Dong Kim),고윤석(Youn Suk Koh) 대한내과학회 1994 대한내과학회지 Vol.47 No.6
N/A To evaluate the diagnotic value of pleural SCSb-9 in the differential diagnosis of tuberculous and malignant pleural effusion, we measured pleural ADA activity and SCSb-9 concentration in 71 cases of pleural effusions due to tuberculosis (n=35) and malignancy (n=36). And we also measured pleural C4d fragment and Bb fragment concentration to determine by which pathway the complement activation occurs in pleural space. The results were as follows: 1) The median value of pleural SC5b-9 concentration of tuberculous effusion was 6.4 ug/ml (interquartile range 2.6~11.7) and was significantly higher than that of malignant effusion (p<0.005). 2) The median values of pleural C4d fragment concentration were 15.5 mg/ml (9.9~18.9) in tuberculous effusion and 12.8 mg/ml (7.3~19.6) in malignant effusion. There were no significant difference between two groups. The median value of pleural Bb fragment concentration of tuberculous effusion was 7.8 mg/ml (5.5~12.8) and was significantly higher than that of malignant effusion (p<0.01). 3) The SC5b-9 concentration showed no significant correlation with C4d fragment concentration both in tuberculous effusion and malignant effusion. But the SC5b-9 concentration showed significant correlation with Bb fragment concentration both in tuberculous effusion (r=0.48, p<0.005) and malignant effusion (r=0.72, p<0.001). 4) The median value of pleural ADA activity of tuberculous effusion was 64.3 U/L (40.9~103.5) and significantly higher than that of malignant effusion (p<0.001). 5) Pleural ADA activity showed significant correlation with pleural SC5b-9 concentration in tuberculous effusion (r=0.53, p<0.005). 6) According to the receiver-operating characteristic curve analysis, the measurement of pleural ADA activity is superior to that of pleural SC5b-9 concentration in the differential diagnosis of tuberculous and malignant effusion. In conclusion, the measurement of pleural SC5b-9 concentration can be used as an adjunctive test in the differential diagnosis of tuberculous and malignant effusion but pleural ADA activity measurement was superior to pleural SC5b-9 concentration measurement. And pleural SC5b-9 concentration of tuberculous effusion was higher than that of malignant effusion and it seems to be due to the difference in activation of alternative pathway activation of complement in two groups.