근거중심 의학의 사상 : 의학철학의 입장에서

권상옥(KWON Sang-Ok) 大韓醫史學會 2004 醫史學 Vol.13 No.2

복수를 동반한 간경변증 2예에서의 분만 3회

권상옥(Sang Ok Kwon),이광훈(Kwang Hoon Lee),장우익(Woo Ik Jang),조한선(Han Seon Cho),차신웅(Sin Woong Cha),민병철(Byoung Chul Min),진춘조(Choon Jo Jin) 대한소화기학회 1989 대한소화기학회지 Vol.21 No.4

Pregnancy is rarely encountered in women with cirrhosis since cirrhosis is less common in women and usually developes after the childbearing years. Additionally, cirrhosis in young women is often accompanied by severe menstrual irregularities and infertility with disturbance of estrogen metabo- lism. The managernent of the liver disease in pregnant patients is the sarne as that of normal people. Studies have shown that while pregnancy may result in a normal healthy infant, the risk of variceal hemorrhage is high, especially in the second and third trimesters. Cirrhosis seems to have an adverse effect on fetal outcome with a high incidence of stillbirths and prematurity in pregnant women. We report our experience of three episodes of pregnancy in two cases of liver cirrhosis and ascites with brief review of literatures.

간경변증 환자의 비정형 선종성 증식성 결절 ( Atypical Adenomatous Hyperplastic nodule ) 에서 발생한 소 간세포암

권상옥(Sang Ok Kwon),노병선(Byoung Seon Rhoe),장우익(Woo Ick Jang),이동기(Dong Ki Lee),이용규(Yong Gyu Lee),한병근(Byoung Geun Han),심영학(Young Hak Sim),조미연(Mi Yeon Cho) 대한소화기학회 1993 대한소화기학회지 Vol.25 No.4

Adenornatous hyperplasia (AH), defined as a sizable parenchymal nodules that may follow acute or chronic liver injury, has been reported as precursor lesion of hepatocellular carcinoma in the cirrhotic liver. These lesions often coexist with obvious rnalignant foci as small nodule-in-nodule. Morphologically AH can be divided into 'ordinary' and atypical (AAH)' types. The former consisted of hepatocytes similar to those of the surrounding liver. The latter type was composed of hepatocytes showing nuclear, cellular and structural atypia relative to the surrounding liver, and shoved irregular or sparse portal tracts. Cytological and structural pattens are characteristically heterogenous within a nodule. Now AAH are considered to be precancerous lesion evolving to early hepatocellular carcinoma. Authots report one case of hepatocellular carcinoma eithin an atypical adenomatous hyperplastic nodule in 55-years-old male with a review of literatures.

수술로 치유된 간성수흉증 ( Hepatic Hydrothorax )

권상옥(Sang Ok Kwon),홍인수(In Soo Hong),이동기(Dong Ki Lee),배선우(Sun Woo Bae),이성우(Sung Woo Lee),오중환(Joong Hwan Oh) 대한소화기학회 1993 대한소화기학회지 Vol.25 No.4

Hepatic hydrothorax is defined as the presence, in approxirnately 6% of patients with cirrhosis, of a large pleu, al effusion in the absence of primary pulmonary or cardiac disease. Clinical ascites is almost always evident and the pleural effusion is usually right-sided. A 36-yr-old woman with clinical and labolatory evidence of hepatitis B surface antigen-positive liver cirrhosis was admitted hecause of respiraton distress. A moderate amount of ascites w noted on physical i xamination arid the right hydrothorax was re:ealed on the chest X-ray film. Diagnosis was confirmed by the intraperitoneal and intrapleural injction of radioisotope Tc-tin colloid that demonstratcd the one-way transdiaphragmatic flow of fluid from the peritoneal to pleural cavity. We report on a casw of refractory hepatic hydrothroax, wiiich was succesfully treated with surgical closure of diaphragmatic defect and chemical pleurodesis.

비장에 이식된 간세포의 조직학적 특성과 알부민 유전자의 발현

권상옥(Sang Ok Kwon),이동기(Dong Ki Lee),김준명(Jun Myeong Kim),박의련(Eui Ryun Park),심광용(Kwang Yong Shim),정필호(Phil Ho Jung),조미연(Mee Yon Cho),허만욱(Mann Uk Hur) 대한내과학회 1997 대한내과학회지 Vol.53 No.4

N/A Background: The morphological characteristics of hepatocytes transplanted into the spleen have been studied. However few attempts has been made to determine the expression of genes in intrasplenically transplanted hepatocytes. The aim of this study was to explore whether the pattern of expression of albumin gene in intrasplenically transplanted hepatocytes is similar to that in adult liver, resulting in the long-term expression of this hepatocyte-specific gene. Methods: Hepatocytes isolated from liver of syngeneic Fischer 344 rats and transplanted into the spleen of rats from the same strain survived for 12 months in the absence of immunosuppressive drugs. Microscopic examination of intrasplenic hepatocytes and Northern blotting for albumin gene expression of RNA extracted from liver and spleen was performed. Results: Microscopy demonstrated that hepatocytes attached themselves only in the red pulp of the spleen and isolated hepatocytes preserved the fine structures characteristic of normal hepatic parenchymal cells. Throughout the 12 months period, intrasplenically transplanted hepatocytes expressed albumin mRNA. Conclusions: Intrasplenically transplanted hepatocytes represent a unique in vivo system of extrahepatic maintenance of hepatocytes. This novel transplantation system could be used to investigate hepatocyte engraft, proliferation and gene expression.

급성 간부전과 용혈성 빈혈로 증상 발현을 보인 Wilson 씨병

권상옥(Sang Ok Kwon),이광훈(Kwang Hoon Lee),심영학(Young Hak Shim),박진현(Jin Hyun Park),장우익(Woo Ik Jang),전근제(Geun Jae Jeon),최승옥(Seoung Ok Choi) 대한소화기학회 1989 대한소화기학회지 Vol.21 No.1

The first manifestations of Wilsons disease are usually neuropsychiatric disorders and less fre- quently, hepatic disorders (cirrhosis or chronic hepatitis) or transient hemolytic anemia. The purpose of this work is to describe a less well known mode of onset of the disease characterized by the association of intravascular hemolysis and acute liver failure. The diagnosis of Wilson's disease was based in the presence of the Kayser-Fleischer ring and decreased serum ceruloplasmin, and acute intravascular hemolysis was based in the sudden develop- ment of anemia, the high value for the reticulocyte count, the absence of demonstrable bleeding, unconjugated hyperbilirubinemia. Necropsy revealed active liver cirrhosis, micronodular type with marked cholestasis. The mechanism of this syndrome is unknown. A hypothetical explanation might result from hepatic cell necrosis due to accumulation of copper, the consequences being acute liver failure and destruction of erythrocytes by the large amounts of copper released from the necrotic hepatic cells to the plasma. In conclusion: 1) The syndrome of acute intravascular hemolysis and acute liver failure is very suggestive of Wilsons disease. 2) This association can be the first clinical manifestation of the disease. 3) The treatment is generally unsuccessful, and the outcome is usually fatal.

Clonidine의 굴근반사(屈筋反射) 억제작용(抑制作用)

권상옥(Kwon, Sang-Ok),고상돈(Koh, Sang-Don),신홍기(Shin, Hong-Kee),김기순(Kim, Kee-Soon) 대한생리학회 1987 대한생리학회지 Vol.21 No.1

Effect of intravenously injected clonidine on the flexion reflex was studied in 15 decerebrated and spinalized cats. The flexion reflex was elicited by electrical stimulation of the tibial nerve or the common peroneal nerve and it was recorded as single unit activity from filaments of the L6 or L7 ventral roots. In order to obtain the late flexion reflex discharges, Aδ and C afferent fibers were stimulated with single or train electrical pulses respectively. The flexion reflex, especially the late component, was markedly inhibited after intravenous administration of clonidine. The clonidine-induced inhibition of the flexion reflex was compared before and after treatment of the animals respectively with yohimbine and naloxone. The inhibitory effect on the flexion reflex of clonidine was not altered by naloxone, a μ-opioid receptor blocker, whereas it was completely blocked by yohimbine, an α₂-adrenergic antagonist. These results indicate that clonidine inhibits the flexion reflex through excitation of α₂-adrenoceptors even at the spinal cord level.

의료 인문학의 성격과 전망

권상옥(Sang-Ok Kwon) 한국의철학회 2008 의철학연구 Vol.5 No.-

과학적 의학은 1960년대에 이르러 생명 의료 기술의 발전과 병원의 대형화 추세로 의료의 비인간화 및 질병으로부터 환자의 소외 현상을 낳게 되었다. 더욱이 관리 의료와 기업 의료의 출현은 의사의 전문직업성을 위협하여, 의사가 환자와 사회로부터 신뢰와 권위를 잃게 만들었다. 이처럼 의학의 위상이 크게 흔들리면서 의학계는 의학에 대한 반성과 함께 해결책을 모색하게 되었다. 이들은 의학이 과학적 의학을 지향하면서 환자보다 질병에만 관심을 기울여 의학의 인간적인 측면을 등한시한 것이 문제였다고 판단하고 이를 보강하여 인간적인 의학(humane medicine)을 만들고자 하였다. 의학에서 의술의 중요성이 다시 제기되었고, 의학 교육에 의료 인문학 교육이 도입되었다. 영국의 의료 인문학 협회는 의료 인문학이란 의료의 인간적인 측면 그리고 환자와 의사 관계를 포함하여 환자와 의사가 겪는 의료 경험을 의료, 교육 그리고 연구의 측면에서 학제간으로 탐구하는 학문이라고 정의하였다. 학제간 접근 주제로서 관심을 끄는 예로는 질환과 질병(illness and disease), 고통(suffering), 몸, 건강, 죽음과 죽어감(death and dying), 의사됨(doctoring) 등을 들 수 있다. 이러한 주제는 생물학적 사실일 뿐만 아니라 심리적, 문화적, 사회적 혹은 철학 적인 의미를 함께 지니고 있기 때문이다. 의료 인문학은 인간적인 의사(humane doctor) 혹은 배려가 깊고 환자와 마음이 통하는 의사(compassionate and communicative doctor)의 양성을 교육 목표로 삼고 있다. 인간 적인 의사란 환자를 깊이 이해할 뿐만 아니라 개성이나 가치관의 차이를 인정하고, 윤리적인 문제를 해결할 수 있으며, 의료 경험이나 지식을 비판할 수 있는 의사를 말한다. 의학이 과학과 의술이라는 두 축에 근거하고 있다는 점을 감안하면, 지금은 과학을 강조하던 의학에서 의술을 강조하는 의학으로 돌아가고 있는 상태이다. 그 동안 의학이 과학을 강조한 것에 대한 일종의 반동 현상으로 의학이 균형을 잡아가는 과정이라고 할 수 있다. 앞으로도 의학은 의술과 과학 사이를 시계추처럼 움직이면서 시대정신에 맞추어 끊임없이 중심을 잡으리라 생각한다. Recent technologic advances and improvements have had an overwhelming effect on the practice of medicine. physicians literally can treat patients without seeing them. Western science has devised technologies in which a computer can make the diagnosis without human “interference”. However, since the 1960s the assumptions underlying the authority of modern scientific medicine have themselves begun to be questioned. At the same time, an alternative current to reassert humanistic values in medicine has emerged as medical ethics in the 1960s and medical humanities in the 1970s. The medical humanities is a broad area of study and practice encompassing all nontechnical or ‘human’ aspects of medicine. The medical humanities serve three main goals: the study of the human aspects of medicine from within traditional arts disciplines of history, philosophy, sociology and literature, the intersection of medicine and the literature appreciating the many excellent works of physician writers, the movies and the training of more insightful and compassionate doctors. Here the medical humanities allow us to probe the delicate balance between scientific empiricism and critical thinking. Historically the first and most obvious feature of this inquiry was the modern exploration of medical ethics. “The medical humanities” is the name of a more inclusive inquiry, though one that embraces ethics. One of the aims of recent curriculum reform has been to release medical education from its scientific straitjacket and to reintroduce a more liberal, expansive curriculum that pays attention to both the cognitive and affective elements of clinical practice. I am convinced that we can stress the humane aspects of our profession without depreciating or neglecting the role of technology. In doing so we will offer to our patients a reassuring blend of humanity and modern medical technology.

한국에서 의철학하기

권상옥(Sang-ok Kwon) 한국의철학회 2006 의철학연구 Vol.2 No.-

의료 인문학의 개념과 의학 교육에서의 역할

권상옥(Sang Ok Kwon) 한국의학교육학회 2005 Korean journal of medical education Vol.17 No.3