설림(設林) : 문화의 시대 그림읽기 독화[讀畵]와 여백(餘白)

변영섭 ( Young Sup Byun ) 고려대학교 역사연구소 (구 역사학연구회) 2012 사총 Vol.75 No.-

Perfecting of Sa-Vi <寫意, ``expression of ideals``) is one of the highly pursued artistic achievements in East Asian painting tradition. At the core of those ideals expressed lies the concept of Do <道, ``the Truth``). As a way of effectively portraying and conveying the ideals of Do, the application of Yea-Baek <餘白, ``void space``) is regarded important. This article intends co examine some key issues in understanding the aesthetics of Yea-Baek. In-depth understanding of Yea-Baek style makes up a crucial part of the fine art of Dok-Hwa (讀畵, ``reading a painting``). According to Eastern philosophy, the Truth, or Do, cannot be represented in any language or symbol. This notion is well summarized as ``the ineffability of Do (道可道非常道)`` in Too Te Ching (道德經) by Lao Tzu <老子, early 5th century BCE), a leading Chinese thinker. Once you depict something, the depicted image is no longer of the object. In that sense, Yea-Baek or the void is something ``depicted without the act of depicting.`` Yea-Baek is never a fixed, stationary space, but one ``of dynamic, ever-changing nature, filled with energy`` (氣部生動). A specific method to present this characteristic of Yea-Baek is the technique of Hong-Woon-Tak-Wol(烘雲托月), in which, in order co reveal the moon, an artist paints only the surrounding space of the moon, leaving the moon itself untouched. The purpose of such rendering is to achieve ``the ultimate clear, lucid, and tranquil state`` (空靈). In the East Asian concept of ``reading a painting`` (讀畵), looking at the painter`s brushwork (筆墨) is virtually the same as looking at the empty space or Yea-Baek of the composition. The brushwork and the empty space are not two separate matters. They are closely interconnected with each other, both philosophically as well as aesthetically. Although often underestimated as mere ``background``, Yeo-Baek or the void space, which in many cases takes up a large pan of the pictorial space, plays a role as significant as that of the brushwork. Thus, the visually empty space in aesthetic sense becomes no longer ``empty.`` The Korean painting tradition has not only exemplified the features of Yea-Baek, an aesthetic ideal shared in the whole East Asian an tradition, but even went further to intensify and innovate it. In Korean paintings, the effect of Yea-Baek was made prominent by maximizing the effect of harmonization of a larger space (e.g. one as a main background) and smaller spaces (e.g. ones within objects such as mountains, rocks, tree trunks, and so on). Using a mixture of larger and smaller spaces in a painting composition not only creates the aesthetic effect of providing breezy, fluid, and open feelings to the painting, but also expresses the philosophical notion that each object is not separate from the space or other objects, and that everything, including the space, is all interconnected. It is crucial to note that the Korean painting tradition not merely shares ideals common among the East Asia cultures, such as Sa-Vi and Yeo-Baek, but at the same time, also demonstrates a good number of unique quality and characteristics entirely of its own.

姜世晃의 〈知樂窩圖〉

邊英燮(Byun Young-sup) 한국미술사학회 1989 美術史學硏究 Vol.- No.181

스승과 제자, 강세황(姜世晃)이 쓴 김홍도(金弘道) 전기

변영섭(Byun Young-sup) 한국미술사학회 2012 美術史學硏究 Vol.- No.275·276

관상동맥질환자의 유산소 운동과 Statin계 악물이 염증 반응에 미치는 영향

김영주 ( Young Joo Kim ),김철 ( Chul Kim ),안재기 ( Jae Ki Ahn ),방인걸 ( In Keol Bang ),이건주 ( Kun Joo Rhee ),김병옥 ( Byung Ok Kim ),이병권 ( Byoung Kwon Lee ),고충원 ( Choong Won Gho ),변영섭 ( Young Sup Byun ),신영오 ( Youn 대한스포츠의학회 2006 대한스포츠의학회지 Vol.24 No.1

급성관상동맥증후군(ACS) 환자에서 유산소운동과 스타틴 약물이 혈중지질과 hsCRP에 미치는 영향

김영주 ( Young Joo Kim ),김철 ( Chul Kim ),안재기 ( Jae Ki Ahn ),방인걸 ( In Keol Bang ),이건주 ( Kun Joo Rhee ),김병옥 ( Byung Ok Kim ),이병권 ( Byoung Kwon Lee ),고충원 ( Choong Won Goh ),변영섭 ( Young Sup Byun ),신영오 ( Youn 한국스포츠정책과학원(구 한국스포츠개발원) 2005 체육과학연구 Vol.16 No.4

본 연구는 급성관상동맥증후군(Acute coronary syndrome; ACS) 환자에 대한 유산소운동과 스타틴약물 요법이 혈중지질과 hsCRP에 미치는 영향을 알아보고자 시행되었다. 연구대상자는 관상동맥증후군으로 입원하여 약물처방 및 경피적 관상동맥 중재술(Percutaneous coronary intervention; PCI)을 받고 운동 프로그램에 의뢰된 환자들로서, 실험군은 스타틴요법과 운동요법을 병행한 병행요법군(n=15)과 운동요법만 시행한 운동요법군(n=14) 그리고 스타틴요법만 시행한 약물요법군(n=8)으로 구성되었다. 실험기간은 병원 내에서 감독 하에 실시한 유산소운동 기간 6주와 자가운동 기간 8주의 총 14주 이었으며 실험기간 동안 지속적인 위험인자 관리 및 운동에 대한 상담을 실시하였다. 실험 전후에 혈중지질(TC, TG, LDL-C, HDL-C) 및 high-sensitivity C-reactive protein(CRP)과 그 밖에 체질량지수(body mass index, BMI), 최대산소섭취량(VO2max) 변화를 확인하기 위하여 연구대상자들에게 실험기간 전후에 각각 채혈, 인체계측, 운동부하검사를 실시하였다. 연구결과 얻어진 자료는 윈도우용 SPSS/PC+version 11.0 통계패키지를 이용하여 처리하였다. 염증반응 지표인 hsCRP를 포함한 혈중지질, BMI, VO2max 변인들의 기간별 집단별 차이를 알아보고자 반복측정에 의한 이원배치 분산분석을 실시하였고, 사후검증으로 t-test와 Bonferroni`s 검정을 적용하였다. 연구 결과는 다음과 같다. 실험 전후에 있어서, 병행요법군에서 HDL-C, hsCRP 수치가 유의하게 증가(p<.05), 감소(p<.01)되었고, VO2max 또한 유의하게 향상되었다(p<.01). 운동요법군에서도 HDL-C 수치가 유의하게 증가되었으며(p<.05), VO2max가 유의하게 향상되었으나(p<.05), 약물요법군에서는 혈중지질을 비롯해 hsCRP, BMI, VO2max 모두에서 의미 있는 차이가 나타나지 않았다. 이상의 결과로 보아, 운동요법과 스타틴요법의 병행요법이 향후 심혈관 질환자의 재발 방지에 긍정적인 효과가 있을 것으로 사료된다. This study was designed to evaluate the effect of aerobic exercise and statin therapy on blood lipids and high-sensitivity C-reactive protein (hsCRP) in patients who had undergone successful percutaneous coronary intervention (PCI). Thirty seven male and female patients were studied. All subjects consist of three groups; 1) treated with statin and exercise (SE, n=15), 2) treated only with exercise (EO, n=14), 3) treated only with statin (SO, n=8). All patients were received medication once daily (aspirin and clopidogrel with or without statin) and completely performed supervised aerobic exercise for 6 weeks and home exercise program for 8 weeks. Instruction for diet and exercise was given continuously during experiment. Laboratory measurement includes serum lipids (TC, TG, HDL-C, LDL-C), hsCRP and body mass index (BMI). Cardiopulmonary capacity (VO2max) was assessed by symptom-limited exercise test. All measurements were performed at baseline and after 14 weeks. The results were as follows. In SE, HDL-C (p<.05) and VO2max (p<.01) were significantly improved, and hsCRP (p<.01) was significantly deceased after therapy. And also, HDL-C (p<.05) and VO2max (p<.05) in EO were significantly improved. But there was no alteration of blood lipids, hsCRP, BMI and VO2max in SO. These findings suggested that combination of exercise and statin therapy was the best rehabilitation in patients treated PCI.

증례 : 순환기 ; 적혈구 증가증에서 거대 심혈관 혈전의 심혈관내 혈전 용해 및 혈관 성형술

이혜영 ( Hye Young Lee ),김병옥 ( Byung Ok Kim ),변영섭 ( Young Sup Byun ),고충원 ( Choong Won Goh ),김정훈 ( Jeong Hoon Kim ) 대한내과학회 2014 대한내과학회지 Vol.87 No.6

The benefit of thrombus aspiration during percutaneous coronary intervention in patients with acute myocardial infarction (AMI) is well established, however, the optimal management strategy for patients with a large thrombus burden after repeated thrombectomy (i.e., “failed” thrombectomy) is unknown. Here, we report the case of a 67-year-old male with polycythemia vera who was treated with intracoronary thrombolytic therapy in combination with mechanical thrombectomy. Repeated aspiration thrombectomy did little to reduce the coronary thrombus burden, thus, intracoronary urokinase infusions were applied to the thrombus containing lesion. Repeat coronary angiography 4 days later revealed markedly improved antegrade flow in the infarct-related artery, and successful revascularization was performed. This case demonstrates the potential utility of intracoronary thrombolytic therapy for select AMI patients with a large thrombus burden who are in a hypercoagulable state. (Korean J Med 2014,87:728-732)

증례 : 순환기 ; 수술 중에 경흉부 심초음파로 진단된 우심방 혈전을 동반한 폐색전증 1예

조성우 ( Sung Woo Cho ),김태훈 ( Tae Hoon Kim ),서희영 ( Hee Young Seo ),황미원 ( Mee Won Hwang ),김정훈 ( Jeong Hoon Kim ),변영섭 ( Young Sup Byun ),박경민 ( Kyoung Min Park ) 대한내과학회 2010 대한내과학회지 Vol.78 No.5

우심방 혈전은 비교적 드물며, 대부분 폐색전증과 관련되어 나타나고, 즉각적인 진단과 치료를 하지 않을 경우 사망률이 높다고 알려져 있다. 특히 심초음파에서 다발성 및 가동성을 나타내는 경우 급격한 폐색전증으로 진행되어 예후가 나쁜것으로 보고되어 있다. 국내에서는 우심방 혈전과 동반된 폐색전증으로 생존한 경우가 1예 보고되어 있으나, 수술 중에 경흉부 심초음파로 진단하여 성공적으로 치료한 경우는 국내뿐만 아니라 전세계적으로 본 증례가 유일하다. 저자들은 패혈성 슬관절로 전신마취하에 수술 도중 심인성 쇼크로 발현된 우심방의 다발성 및 가동성 혈전을 동반한 폐색전증을 응급 경흉부 심초음파로 진단하였고, 혈전용해 및 항응고요법으로 치료한 1예를 경험하였기에 이를 문헌고찰과 함께 보고하는 바이다. Right atrial (RA) thrombi are rarer than left atrial thrombi; they are frequently associated with major pulmonary embolism and carry a very high risk of mortality, requiring prompt diagnosis and treatment. In particular, multiple, mobile right atrial thrombi have a very poor prognosis because of the high incidence of massive pulmonary embolism. Echocardiography is useful in the diagnosis of RA thrombi. The treatment options for RA thrombi are anticoagulation, thrombolysis, and thrombectomy. Here, we report a case of multiple, mobile right atrial thrombi and pulmonary embolism that presented as cardiogenic shock during arthroscopic lavage of a septic knee. It was diagnosed using transthoracic echocardiography and treated successfully with thrombolytics and anticoagulants. (Korean J Med 78:624-629, 2010)

증례 : 순환기 ; 심실 제세동 직후 ST 분절 상승이 소실된 급성심근경색 1예

조성균 ( Sung Kyun Cho ),강윤정 ( Yoon Jung Kang ),김태훈 ( Tae Hoon Kim ),이혜영 ( Hye Young Lee ),조성우 ( Sung Woo Cho ),황미원 ( Mee Won Hwang ),변영섭 ( Young Sup Byun ) 대한내과학회 2011 대한내과학회지 Vol.80 No.6

본 증례는 최초 ST 분절 상승 급성심근경색이 발생하였고, 이후 심실세동 및 의식 소실이 발생하였으나 제세동 실시 직후 의식 회복과 흉통 및 ST 분절의 상승이 사라졌으며 내원 당시 시행한 심근 효소의 상승도 관찰되지 않았던 환자였다. 이는 일반적으로 폐쇄된 관상동맥의 재관류 시 보이는 임상상과 다른 양상을 보였던 사례로 최초 내원 시 이형협심증에 의한 심근 경색의 가능성이 높다고 판단하였던 환자였다. 하지만 이후 임상경과 및 관상동맥 조영술상 중위부좌전하행지에 협착 및 잔류 혈전이 관찰되었다. 이에 저자들은 최초 급성심근경색을 유발하였던 관상동맥 내 혈전이 제세동에 의해 제거되어 이형협심증의 임상양상을 보였던 사례를 경험하였기에 보고하는 바이다. A 38-year-old man presented with typical squeezing-type anterior chest pain. An initial electrocardiogram (ECG) showed prominent ST-segment elevation (V1-V4 lead, 3 mm). Suddenly, the patient fell unconscious and had no pulse. At that time, the ECG showed polymorphic ventricular fibrillation (VT). After direct current (DC) cardioversion, the patient regained vital signs and defibrillation converted the VT into an accelerated idioventricular rhythm with resolution of the ST-segment elevation. The patient was referred to our hospital for close observation and further evaluation. At our hospital, an ECG showed normal sinus rhythms and cardiac enzymes were within normal limits. We diagnosed the patient with variant angina rather than ST elevation myocardial infarction (STEMI), because his clinical manifestations were quite distinct; ST-segment elevations disappeared slowly at the reperfusion stage. However, the patient`s final diagnosis was STEMI because coronary angiography showed severe eccentric tubular stenosis (85%) with remnant thrombus in the middle left anterior descending artery. Defibrillation likely removed thethrombus, which led to STEMI. (Korean J Med 2011;80:708-711)

조선 전기 화론 이해의 몇 가지 문제

변영섭 고려대학교 민족문화연구소 1999 民族文化硏究 Vol.32 No.-

이글의 출발부터 예견된 일이지만 화론 연구에 대한 개인적인 한계로 인하여 별다른 성과를 가져오지는 못하였다. 다만 아직까지 한국화론 연구의 시작이나 다름없는 상황에서 조선 전기 화론을 올바르게 이해하기 위한 관점의 문제는 언제든 필요하다는 생각에서 살펴 본 정도이며, 고려 화론과의 관계나 각각의 개인별 이론을 좀더 구체적으로 검토하는 일, 이론과 작품을 총체적으로 연구하는 일 등 산적한 문제를 앞으로의 과제로 넘기고자 한다.

저인산염혈증 골연화증을 동반한 성인형 Fanconi 증후군 1예

변영섭,이지현,김진,허갑범,이현철,임승길,김경래,송영득,남문석,차봉수,육종인 대한내분비학회 1996 Endocrinology and metabolism Vol.11 No.1

The Fanconi syndrome is characterized by generalized disturbance of tubular function. It leads to excessive losses of amino acids, glucose, phosphate, bicarbonate, and other organic and inorganic substrates handled by the proximal tubules. The metabolic consequences are acidosis, hypophosphatemia, hypocalemia, dehydration, rickets, osteomalacia, osteoporosis, and growth retardation. This syndrome may either be congenital or acquired, primary or secondary. Acquired Fanconi syndrome may result from multiple myeloma, Wilsons disease, primary amyloidosis, light chain nephropathy, and heavy metal poisoning such as lead, mercury, and cadmium. A 33-year-old female presented with multiple bone pain, and progressive proximal muscle weakness for 15 months. The blood urea nitrogen, creatinine, calcium, phosphate, and uric acid were 12.1 mg/dL, 1.5 mg/dL, 8.4 mg/dL, 1.8 mg/dL, and 1.7 mg/dL, respectively. The urine volume, protein, calcium, phosphate, and creatinine clearance were 2,330 ml, 343.7 mg, 146 mg, 424 mg, and 44.6 ml/min, respectively in 24 hour collection urine study. The tubular reabsorption rate of phosphate was decreased. In arterial blood gas analysis study, pH was 7.348, bicarbonate was 17.6 mmol/L, which means metabolic acidosis. In chest X-ray, fracture was seen in eighth and ninth left ribs. The whole body bone scan revealed hot uptake at both first and second ribs, right third rib, both eighth and ninth ribs, left sacroiliac joint and right hip joint. Bone densitometry showed moderate osteopenia in spine and femur neck. After NE4Cl loading, the urine pH was decreased below 5.0 at two and third hour, which means proximal renal tubular acidosis. Amino acid such as, hydroxyproline, threonine, serine, asparagine, glutamine excreted much more than normal in 24 hour urine. Bone biopsy showed the presence of increased osteoid volume and osteoid seam width and marked decreased mineral appositional rate as evidence for osteomalacia. The patients symptoms, including bone pain and proximal muscle weakness, were relieved after supplement of calcitonin, Vitamin D and calcium carbonate. We report a case of Fanconi syndrome with hypophosphatemic osteomalacia with brief review of literature(J Kor Soc Endocrinol 11:93-101, 1996).