경도지적장애 학생의 이야기 쓰기 분석

예지원 ( Ye Ji-won ),김화수 ( Kim Wha-soo ),이근용 ( Rhee Kun-yong ) 대구대학교 특수교육재활과학연구소 2017 특수교육재활과학연구 Vol.56 No.2

본 연구는 경도지적장애 학생의 이야기 쓰기의 특성을 알아보기 위하여 말없는 단편 애니메이션을 활용하여 언어연령을 일치시킨 일반학생과 비교하였다. 이야기 쓰기의 특성으로 이야기 문법, 전체 단어 수, 구문 복잡성, 어휘다양도, 정확도(철자오류, 비문사용)를 분석하였다. 연구의 대상은 경도지적장애 학생 중 다른 중복장애가 없으며 쓰기에 문제가 없고, 언어연령이 9-11세인 학생으로 하였다. 연구 결과, 경도지적장애 학생은 이야기 문법, 전체단어 수, 어휘다양도, 비문사용률에서 유의미한 차이를 보였고, 구문복잡성, 철자오류에서는 유의미한 차이가 없었다. 경도지적장애 학생 집단 내 성별 간에는 유의미한 차이가 없었다. 이야기 문법의 하위 범주에서는 배경, 시도, 결과, 계기사건, 내적반응 순으로 많이 산출하였다. 본 연구의 결과를 통해 경도지적장애 학생의 이야기 쓰기 능력을 보면 다양한 이야기 문법과 어휘로 이야기를 표현하는 것에 어려움을 가지며, 문장 산출 시 비문사용이 높다는 것을 알 수 있다. The purpose of this study is using non-verbal animation to inquire the narrative writing abilities of the students with mild intellectual disability group. Narrative writing abilities were analyzed by story-grammar, syntactic complexity, semantic abilities, and finally syntactic accuracy. Among students with mild intellectual disabilities, the students who are 9 to 11 years old in language age and have not multiple disabilities. According to the study results, students with mild intellectual disability group obtained lower score than the same language age group in the story-grammar, total number of words, number of different words, syntax error. In the case of subcategory of story grammar, there can be listed according to frequency in a sequence of setting, attempts, consequence, initiating event and internal response When comparing these study results with other previous studies of narrative writing with mild intellectual disability subjects, there were have a narrative writing abilities but not using various words. Through these study results, it was found that student with a mild intellectual disability have a difficulty to express story with various story grammar, words and syntax errors.

진행된 두경부암에서 다분할 방사선치료

김진희(Jin Hee Kim),예지원(Ji Won Ye) 대한방사선종양학회 2003 Radiation Oncology Journal Vol.21 No.2

목 적: 진행된 두경부암을 대상으로 다분할 방사선치료를 시행한 후 실패양상 및 생존율을 분석하고 다분할 방사선 치료의 효과를 알아보고자 한다. 대상 및 방법: 1990년 9월부터 1995년 10월 사이에 계명대학교 동산의료원 방사선종양학과에서 진행된 두경부암으로 다분할 방사선치료를 시행한 환자 24명을 대상으로 하였다. 환자의 연령분포는 38세에서 71세로 중앙값 56세이었다. 병기별로3기 11명,4기 13명이었으며 남자가 21명이었고 비인두암 6명, 하인두암 6명, 후두암 5명,구강인두암 3명, 부비동암 3명,구강암 1명이었다. 방사선치료는 6 MV x-선으로 1일 2회,최소 6시간 간격으로 분할조사량 1.2 Gy 시행하여 총 치료선량은 64.4 Gy에서 76.8 Gy로 평균 총 방사선량은 72Gy이었다.추적관찰기간은 3개월에서 136개월이었고 중간 추적관찰기간은 52개월이었다. 결 과:전체환자의 3년 생존율과 5년 생존율은 각각 66.7%, 52.4%이었고 전체환자의 3년 무병생존율은 66.7%,5년 무병생존율은 47.6%이었다. 병기별로 3년, 5년 무병생존율은 3기는 81.8%, 63.6%,4기는 53.8%, 32.3%이었다. 국소 재발이나 원격전이의 소견 없이 생존해있는 환자가 10명이며 원격전이는 25%, 국소재발은 12.5%로 원격전이가 주된 실패 원인이었다. 원격전이인지 국소 재발인지 분명하지 않은 경우가 2명, 다른 원인으로 사망한 경우가 3명이었다. 원격전이 장소는폐 3명,뼈 1명,간 2명이었으며 1명에서 식도에 2차암이 발생하여 사망하였다. 추적관찰기간중 1명에서 방사선치료 후 58개월에 하악골괴사로 수술한 경우를 제외하고 중등도 이상의 심각한 만성부작용이 발생한 환자는 없었다. 결 론: 대상 환자의 수는적으나 진행된 병기의 두경부암에서 다분할 방사선치료법이 급성부작용은 다소 증가하나 만기부작용의 증가 없이 국소 재발의 감소와 무병생존율을 증가시킬 수 있을 것이라고 생각한다. Purpose: The effects of hyperfractionation radiation therapy, such as the failure pattern and survival, on the treatment results in advanced stage head and neck cancer were studied. Materials and Methods: Between September 1990 and October 1998, 24 patients with advanced stage (III, IV) head and neck cancers, were treated using hyperfractionation radiation therapy in the Department of Radiation Oncology at the Keimyung University Dongsan Medical Center. The male to female ratio was 7:1, and the age range from 38 to 71 years with the median of 56 years. With regard to the TNM stage, 11 patients were stage III and 13 were stage IV. The sites of primary cancer were the nasopharynx in six, the hypopharynx in 6, the larynx in five, the oropharynx in three, the maxillary sinus in three, and the oral cavity in one patient. The radiotherapy was delivered by 6 MV X-ray, with a fraction size of 1.2 Gy at two fractions a day, with at least 6 hours inter-fractional interval. The mean total radiation doses was 72 Gy, (ranging from 64.4 to 76.8 Gy). Follow-up periods rangedbetween 3 and 136 months, with the median of 52 months. Results: The overall survival rates at 3 and 5 years in all patients were 66.7% and 52.4%. The disease-free survival rates at 3 and 5 years (3YDFS, 5YDFS) in all patients were 66.7% and 47.6%. The 3YDFS and 5YDFS in stage III patients were 81.8% and 63.6%, and those in stage IV patients were 53.8% and 32.3%. Ten patients were alive with no local nor distant failures at the time of analyses. Six patients (25%) died due to distant metastasis and 12.5% died due to local failure. Distant metastasis was the major cause of failure, but 2 patients died due to unknown failures and 3 of other diseases. The distant metastasis sites were the lung (3 patients), the bone (1 patient), and the liver (2 patients). One patient died of second esophageal cancer. There were no severe late complications, with the exception of 1 osteo-radionecrosis of the mandible 58 months after treatment. Conclusion: Although this study was performed on small patients group, we considered hyperfractionated radiation therapy for the treatment of advanced stage head and neck cancer might improve the disease free survival and decrease the local failure with no increase in late complications despite of the slight increase in acute complications.

자궁경부 신경내분비암의 임상적 특징과 치료 결과

김옥배(Ok Bae Kim),김진희(Jin Hee Kim),차순도(Soon Do Cha),최태진(Tae Jin Choi),예지원(Ji Won Ye) 대한방사선종양학회 2004 Radiation Oncology Journal Vol.22 No.2

목 적: 자궁경부의 신경내분비암은 비교적 드문 질환으로 본원에서 광학현미경 및 면역조직화학적 진단을 받고, 치료받은 환자를 대상으로 임상적 특징, 예후 및 치료방침에 대해 알아보고자 한다. 대상 및 방법: 1994년 5월부터 2001년 10월까지 본원에서 조직학적으로 자궁경부 신경내분비암으로 진단받은 환자 13예를 대상으로 하였다. 환자의 평균 연령은 56세(32∼78세)이며, 병기분포는 IB 5명, IIA 5명, IIB 3명이었다. 수술을 시행한 환자는 5명으로 이 중 3명은 수술 후 방사선치료를 추가하였다. 근치적 방사선치료를 시행한 환자는 9명이며, 이 중 1명은 방사선치료 후 근막외 자궁적축술을 시행하였고, 선행 혹은 동시항암화학요법을 시행한 환자는 9명이었다. 방사선치료는 병기에 따라서 전골반부 4,500∼5,400 cGy까지 외부조사 후, 강내조사를 주 2회, Apoint에 1회당 500 cGy로 3,000∼3,500 cGy를 조사하였다. 결 과: 추적관찰기간은 3개월에서 104개월로 평균 36개월이었다. 5년 생존율은 61.5%이었으며, 병기별 5년 생존율 은 병기 IB 60.0%, IIA 60.0%, IIB 66.7%로 통계적으로 유의한 차이가 없었다(p=0.99). 전체 13명 중 5명(38.5%)이 사 망하였으며, 이 중 4명에서 골반부위 및 복부대동맥 주위 임파절 전이가 확인되었고, 이들 모두 원격장기 전이로 사망하였다. 사망자의 평균생존기간은 6개월이며, 임파절 전이 유무에 따라서 통계적으로도 유의한 차이(p=0.0001) 를 관찰할 수 있었다. 나머지 8명은 무병생존 중이다. 결 론: 자궁경부의 신경내분비암은 초기병기일지라도 임파절전이와 원격전이가 많고 병의 진행이 급속히 이루어지는 양상을 보이므로 국소치료인 수술이나 방사선치료와 함께 전신적인 복합항암화학요법을 병행하는 것이 좋을것으로 생각되며 적절한 병합치료가 환자의 생존율을 향상시킬 것으로 생각된다. Purpose: To evaluate the clinical findings, prognosis and treatment strategy of patients with neuroendocrine carcinoma of cervix. Materials and Methods: Thirteen patients with neuroendocrine carcinoma of cervix were included in this study, as confirmed histologically and immunohistochemically at the Dongsan Medical Center, Keimyung University, between May 1944 and October 2001. The mean age of patients was 56 years with a range of 32 to 78 years of age. According to the FIGO staging system, there were 5 patients with stage IB carcinoma, 5 patients with IIA, and 3 patients with stage IIB. Four patients underwent radical hysterectomy with pelvic lymphadenectomy, 3 of these patients also received postoperative radiotherapy, and one patient underwent extrafascial hysterectomy after radiotherapy. Primary radiotherapy was done in 9 patients, and 3 were irradiated postoperatively. Nine patients received chemotherapy, 7 received neoadjuvant and 2 received concurrent chemoradiotherapy. The radical purpose of radiotherapy consisted of external irradiation to the whole pelvis (4,500∼ 5,400 cGy) and intracavitary irradiation (3,000∼3,500 cGy). Results: The mean follow up duration was 36 months with a range of 3 to 104 months. The overall 5-year survival rate was 61.5% and the 5-year survival rates for stage IB, IIA, IIB were 60.0%, 60.0%, and 66.7% respectively (p=0.99). Eight patients are still alive without disease, and all of the 5 patients with recurrence are dead due to distant metastasis. Conclusion: Neuroendocrine carcinoma of cervix is highly aggressive, with early lymphatic dissemination and a high rate of distant recurrence. Therefore, an aggressive therapeutic strategy is required to obtain pelvic and distant disease control. Multimodal therapy should be considered at the time of initial diagnosis.

식도암의 관내 근접 방사선 치료

김진희,이호준,예지원,최태진,김옥배 계명대학교 의과학연구소 2000 계명의대학술지 Vol.19 No.2

Purpose : To evaluate efficacy of intraluminal irradiation and external beam radiation in locally advanced esophageal cancer. Methods and Materials : Ninteen patients who were treated with intraluminal irradiation for locally advanced esophageal cancer between January 1989 and October 1993 at the Department of Radiation Oncology, Keimyung University Hospital were included in this study. There were 17 males and 2 females with median age of 60.5 years (range 47-82 years). According to American Joint Committee on Cancer(AJCC) staging system, there were 5(26.3%) patients in stage Ⅱa, 14(73.7%) patients in stage Ⅲ and the pathologic classification showed 17 patients of squamous cell carcinoma. External beam radiation dose were 5400-6660 cGs for 6-7.5weeks at primary tumor bed, mediastinum and locoregional lymphatic system. Intraluminal irradiation with 192Ir were applicated to 8 patients by high dose rate and 11 patients by low dose rate at 1cm from esophageal mucosal surface(450-1500cGy/1-3fr). Neoadjuvant chemotherapy with CDDP(100mg/m2, D1) and 5-FU(1g/m2, D1-D5) every 4weeks interval were admitted to 12 patients for 1 -3 cycles, All patients were followed up for 6-135 months (median 11 months, mean 25 months), The survival rates were calculated by actuarial methods and the statistical signifcance of survival was analysed by the log-rank test. Results : Local control rate was 42.1%(8/19), median survival was 11 months and 1-year, 2-year and 5-year survival rates were 39.9%, 11.4% and 11.4% respectively. The survival difference according to age and local control were statistically significant (p<0.05). Local control was the most significant prognostic factor (median survival: 17months for positive local control and 7 months for negative local control, p=.0000). Dose rate was not statistically significant but high dose rate was more longer median survival than low dose rate (13months, 8months, p=0.13). Neoadjuvant chemotherapy was not significant but less median survival time than no neoadjuvant chemotherapy (10months, 17months). Complications included mild esophagitis In four patients, moderate esophagitis in one patient and mild esophageal stenosis in three patients. Conclusion : We considered that the intraluminal irradiation for locally advanced esophageal cancer patients was well tolerated and increase of locoregional control rate may result in longer survival and better quality of life.