이하선 종양 수술 후 신경계 합병증 발생에 관여하는 인자들에 대한 연구

조재식(Jae Sik Cho),제갈영종(Young Jong Jaegal),윤정한(Jung Han Yoon),최낙선(Nak Seon Choi) 대한두경부종양학회 1999 대한두경부 종양학회지 Vol.15 No.2

Objectives: Injuries of neurologic structures during parotid surgery are sometimes unavoidable even in benign tumors. Since the major postoperative neurologic complications such as facial nerve palsy and Frey's syndrome give a serious and heavy burden to both patients and surgeons, it is very important to know detailed information concerning risk factors, the incidence of complication, possibility of recovery, and the term before complete recovery. Materials and Methods: This report was based on 95 patients with parotid gland tumor who had been treated and followed up over 1 year at department of surgery and otolaryngology, chonnam university hospital. Results: 1) Among total 95 cases, the facial nerve palsy developed in 18 cases(l8.9%) and Frey's syndrome in 6 cases(6,3%). 2) The incidence of facial nerve palsy increased in cases with large tumor size, and in those operated with bipolar method. However, we didn't find out relationships between the incidence of facial palsy, localization, and histologic type. 3) The incidence of Frey's syndrome showed an increasing tendency in the cases with large tumor size, benign nature, and in those underwent superficial lobectomy with posterior approach, without a statistical significance. Conclusions: Risk of facial nerve palsy, especially a transient form, seems to be related to tumor size and bipolar coagulation method. Although Frey's syndrome tends to develop easily in the cases treated with superficial lobectomy under the diagnosis of benign tumor, a futhermore study is suggested to obtain a statistical significance.

갑상선질환에서 혈청 Lipoprotein ( a )

조재식(Jae Sik Cho),이은직(Eun Jig Lee),김경래(Kyung Rae Kim),이경미(Kyeong Mi Lee),남문석(Moon Suk Nam),조재화(Jae Hwa Cho),신은택(Eun Tack Shin),임승길(Sung Kil Lim),이현철(Hyun Chul Lee),허갑법(Kap Bum Huh),김정호(Jeong Ho Kim),송경 대한내과학회 1994 대한내과학회지 Vol.47 No.1

N/A Background: Thyroid hormone closely relates with lipid metabolism and especially Hypothyroidism associates with hypercholesterolemia which accelerates atherosclerosis. The purpose of this study was to determine the relationship between thyroid disease and Lp (a). Methods: We evaluated 14 patients with hypothyroidism, 24 patients with hyperthyroidism and 50 normal subjects. Serum Lp (a) was measured by ELISA (IM- MUNOZYM GMBH, Germany), thyroid hormones were measured by ELISA and other lipid profiles by conventional methods. Results: Serum Lp(a) concentrations (median) of hypothyroidism (29.3 mg/dl) were significantly higher than those of hyperthyroidism (4 mg/dl and controls (10 mg/dl)(p<0.05), Total cholesterol and LDL-cholesterol of hypothyroidism (199.0±75.7 mg/dl, 134.6±57.5 mg/dl) were patients had higher total cholesterol (136.1±31.2 mg/dl) and LDL-cholesterol (66.7±31.4 mg/dl) than controls (p<0.05). Serum Lp (a) concentration had negative correlation with the levels of serum T₃, T₄, FT₄ and positive correlation with TSH (p<0.05). Conclusion: These results suggest that thyroid hormones have an influence on Lp (a) concentration.

Deep Q-Network기반의 가상 시뮬레이션을 이용한 LoRa Network Service 향상 방안

조재식(Jae-Sik Cho),황동엽(DongYeop Hwang),김기형(Ki-Hyung Kim) 한국통신학회 2018 한국통신학회 학술대회논문집 Vol.2018 No.6

경련성 골반상 증후군의 임상적 연구

박효진(Hyo Jin Park),조재식(Jae Sik Cho),배희동(Hee Dong Bae),정준표(Jun Pyo Chung),이상인(Sang In Lee),박인서(In Suh Park),지훈(Hoon Ji),손승국(Seung Kook Sohn) 대한소화기학회 1994 대한소화기학회지 Vol.26 No.3

N/A The spastic pelvic floor syndrome is a functional disorder due to abnormal contraction in- stead of relaxation of the pelvic floor muscle during straining. This inhibits defecation and gives rise to constipation. We carried out the clinical and psychologic analysis, defecogram, electrophysiologic tests, and treatment in 17 patients with spastic pelvic floor syndrome. The mean age of patients was 48.2+10.1 years. The male to female ratio was 1:7.5. Prirnary com plaints were incomplete evacuation 82.3%, constipation 52.9%, tenesmus 41.2%, straining 41.2 %, and dysuria 29.4%. The patterns of personality using the MMPI showed somatization type in 7 cases and psychophysiologic reaction type in 4 cases. Defecogram revealed paradoxical contraction of puborectalis in 100.0% of cases,incomplete evacuation 76.5%, rectocele 58.8%, incontinence 17.6%, intussusception 5.9%, and excessive pelvic floor descent 5.9%. The ano- rectal angle in patients did not increase during straining and rernained about 90. The mean maximum resting and squeezing anal canal pressures were 94.4 + 48.4mmHg, and 136.4 + 28.8 mmHg. Seven patients(70.0%) were unable to expel a balloon. The pudendal neuropathy re- vealed in 4 patients(40.0%). Seven patients underwent a EMCr-based biofeedback therapy. Four among them(57.1%) had increased bowel frequency and improved the symptom of in- complete evacuation. In conclusion, careful history taking, physical examination and colorectal motility tests perrnit diagnosis of spastic pelvic floor syndrome. This disease is related with incoordination of pelvic floor muscle, so treatment should be aimed at restoration of normal muscle function through biofeedback.(Korean J Gastroenterol 1994; 26: 482 490)

우리나라 이비인후과 외래환자의 인.후두 역류증상 발병빈도 조사(One Week Survey 결과)

최홍식,김형태,서장수,왕수건,조재식,최건,홍기환,김석일,이원철,Choi, Hong-Sik,Kim, Hyung-Tae,Seo, Jang-Soo,Wang, Soo-Gun,Cho, Jae-Sik,Choi, Gun,Hong, Ki-Hwan,Kim, Seok-Il,Lee, Won-Chul 대한후두음성언어의학회 2000 대한후두음성언어의학회지 Vol.11 No.1

1999년 4월 일주일간 전국 101개 병의원의 이비인후과 외래를 방문한 신환을 대상으로 설문을 실시하고 이비인후과 전문의의 진찰을 통하여 인.후두 위산역류중(LPR)의 발병빈도와 그와 관련된 사항들을 조사하여 다음과 같은 결과를 얻었다. 1) 이비인후과 신환 전체 진단 병명의 24%, 이비인후과 신환 환자 중 25%에서 LPR 관련 증상 또는 진찰소견이 확인되었다. 2) LPR 관련 진단명으로는 인두이물감증후군(Glo-bus syndrome)이 27%로 가장 많았으며, 역류성후두염, 만성후두염 등의 순이었다. 3) 여성에서 남성보다 많았으며, 40, 50, 60대에 흔하여 노인성 변화와의 관련이 의심되었다. 4) 비만도와는 큰 상관관계가 없었음. 5) LPR의 3대 주증상은 인두이물감, 만성적 목청소, 원인모를 쉰 목소리였음. 6) LPR을 악화시키는 요인으로는 피곤함, 정신적 스트레스, 술, 담배, 자극성있는 음식, 커피 등이었음. 7) 목소리를 직업적으로 쓰는 사람에서 LPR 증상의 발현이 높았음. 8) 과거 병력상 위질환과 잦은 편도염이 많았음. One week survey to investigate the prevalence rate and clinical characteristics of laryngopharyngeal reflux symptoms in Korea. The subject(n=7,704 patients) was newly enrolled patients at the out patient clinic in 90 ENT departments of resident training hospitals and 11 local clinics, which were voluntarily participated in the study 1) Twenty five percent of all enrolled patients has LPR-related symptoms or clinical findings from the examination by ENT specialists. 2) Among e name of LPR-related diagnosis, globus syndrome was e most common, and follows by reflux laryngitis, and chronic laryngitis. 3) Women was more prevalent than men, and it is common in 5th, 6th, and 7th decades, which seems to be related with aging process. 4) Most popular symtoms of LPR. were globus sensation, conic throat clearing, and hoarseness of unknown origin. 5) Aggravating factors of LPR-related symptoms were tiredness, mental stress, drink alcohol, cigarettes smoking, spicy food, and drinking coffee. 6) LPR-related symptoms were more common in professional voice users. 7) In past medical history, diseases of stomach and tonsillitis were most common.

비인두암의 국소 종양 치유와 생존율에 관한 예후 인자 분석

정웅기(Woong-Ki Chung),조재식(Jae-Shik Cho),박승진(Seung Jin Park),이재홍(Jae-Hong Lee),안성자(Sung Ja Ahn),남택근(Taek Keun Nam),최찬(Chan Choi),노영희(Young Hee Noh),나병식(Byung Sik Nah) 대한방사선종양학회 1999 Radiation Oncology Journal Vol.17 No.2

목 적 : 비인두암 환자에서 항암화학요법과 방사선치료 후 국소종양제어율, 생존율, 무병생존율에 미치는 예후 인자를 알아보고자 하였다. 대상 및 방법 : 1986년 7월부터 1996년 6월까지 약 10년간 전남대학교병원에서 비인두암으로 확진되어 근치적 목적으로 치료를 받은 47명의 환자를 대상으로 후향적 분석을 시행하였다. 대상 환자의 연령 분포는 16세에서 80세까지였고 중앙 값은 52세였다. 성별 분포는 남자가 33명(70%), 여자가 14명(30%)이었다. WHO의 기준에 의한 조직학적 유형은 제1형(케 라틴형성 편평세포암)이 3례(6%), 제2형(비케라틴형성 편평세포암)이 30례(64%), 제3형(미분화암)이 13례(28%)였고 나머 지 1례(2%)는 조직학적 유형이 알려지지 않았다. 미국암합동위원회(1997)의 병기분류법에 따라 후향적으로 다시 분류한 병기는 T1, T2a, T2b, T3, T4에서 각각 11례(23%), 6례(13%), 9례(19%), 7례(15%), 14례(30%)였다. 그리고 림프절 침범 상태는 N0, N1, N2, N3에서 각각 7례(15%), 14례(30%), 21례(45%), 5례(10%) 있었다. 병기군별 분포는 Stage I, IIA, IIB, III, IVA, IVB에서 각각 2례(4%), 2례(4%), 10례(21%), 14 례(30%), 14례(30%), 5례(11%) 있었다. 방사선치료 전에 항암제 치료를 받은 환자는 42례이며 5례는 항암제 치료가 시행되지 않았다. 방사선치료는 선형가속기의 6MV와 10MV X-ray 및 9 MeV 전자선을 사용하였으며 원발 병소에 조사된 총방사선량은 6120- 7920cGy(중앙값: 7020cGy)였다. 항암화학요법은 Cisplatin+5-Fluorouracil(25명), Cisplatin+Pepleomycin(17명)으로 1회에서 3회까지 시행하였다. 국소종양제어율, 생존율, 무병생존율을 Kaplan-Meier법에 의하여 산출하였으며 두 군간의 생존율의 차이는 Generalized Wilcoxon test를 이용하여 검증하였다. 영향을 주는 인자의 다변량분석에는 Cox 모델을 이용하였다. 결 과 : 국소종양 제어율은 2년에 89%, 5년에 81%이었다. 5년 생존율은 60%(범위; 6-132개월, 중앙값; 32개월)이었다. 예후에 영향을 미치는 위험 인자로 연령, 성별, 두개신경침범, 병리조직학적 유형, 병기군, 항암화학요법, 항암화학요법과 방사선치료 사이의 간격, 방사선량, 방사선치료기간을 다변량분석에 포함시켰다. 국소종양제어율에는 두개신경침범(P=0.004)만이 의의 있는 것으로 나타났다. 생존율과 무병생존율에는 병기군(P=0.006, P=0.003)과 총방사선량(P=0.012, P=0.008)이 의의 있는 것으로 나타났다. 치료 후 합병증은 구강건조증, 치아손상, 이증상 등이 많았으며 2례의 갑상선기능저하증이 있었다. 결 론 : 비인두암에서 예후에 영향을 미치는 인자로서 국소종양제어율은 두개신경침범 여부가, 생존율 및 무병생존율에는 총방사선량 과 병기군, 특히 N 병기가 의의 있는 것을 알 수 있었다. 사용된 항암화학요법과 방사선치료는 심각한 부작용이 없이 효과적으로 이용될 수 있음을 알 수 있었다. Purpose : This study was performed to find out the prognostic fac tors affecting local control, survival and disease free survival rate in nasopharyngeal carcinomas treated with chemotherapy and radiation therapy. Materials and Methods : We analysed 47 patients of nasopharyngeal carcinomas, histologically confirmed and treated at Chonnam University Hospital between July 1986 and June 1996, retrospectively. Range of patients' age were from 16 to 80 years (median; 52 years). Thirty three (70%) patients was male. Histological types were composed of 3 (6%) of keratinizing, 30 (64%) of nonkeratinizing squamous cell carcinoma and 13 (28%) of undifferentiated carcinoma. Histological type was not known in 1 patient (2%). We restaged according to the staging system of 1997 American Joint Committee on Cancer. Forty seven patients we re recorded as follows: T1; 11 (23%), T2a; 6 (13%), T2b; 9 (19%), T3; 7 (15%), T4; 14 (30%), and N0; 7 (15%), N1; 14 (30%), N2; 21 (45%), N3; 5 (10%). Clinical staging was grouped as follows: Stage I; 2 (4%), IIA; 2 (4%), IIB; 10 (21%), III; 14 (30%), IVA ; 14 (30%) and IVB; 5 (11%). Radiation therapy was done using 6 MV and 10 MV X- ray of linear accelerator. Electron beam was used for the lymph nodes of posterior neck after 4500 cGy. The range of total radiation dose delivered to the primary tumor was fro m 6120 to 7920 cGy (median; 7020 cGy). Neoadjuvant chemotherapy was performed with cisplatin+5-fluorouracil (25 patients) or cisplatin +pepleomycin (17 patients) with one to three cycles. Five patients have not received chemotherapy. Local control rate, sur vival and disease free survival rate were calculated by Kaplan- Meier method. Generalized Wilcoxon test was used to evaluate the difference of survival rates between groups. Multivariate analysis using Cox proportional hazard model was done for finding prognostic factors. Results : Local control rate was 81% in 5 year. Five year survival rate was 60% (median survival; 32 months). We included age, sex, cranial nerve deficit, histologic type, stage group, chemotherapy, elapsed days between chemotherapy and radiotherapy, total radiation dose, period of radiotherapy as potential prognostic factors in multivariate analysis. As a result, cranial nerve deficit (P=0.004) had statistical significance in local control rate. Stage group and total radiation dose were sig nificant prognostic factors in survival (P=0.006, P=0.012), and in disease free survival rates (P=0.003, P=0.008), respectively. Common complications were xerostomia, tooth and ear problems. Hypothyroidism was developed in 2 patients. Conclusion : In our study, cranial nerve deficit was a significant prognostic factor in local control rate, and stage group and total radiation dose were significant factors in both survival and disease free survival of nasopharyngeal carcinoma. We have concluded that chemothe rapy and radiotherapy used in our patients were effective without any serious complication.

음주에 따른 음성 변화에 대한 고찰

김정현,윤제환,조형호,조연,조재식,Kim, Jung-Hyun,Yoon, Je-Hwan,Cho, Hyung-Ho,Cho, Yeon,Cho, Jae-Sik 대한후두음성언어의학회 2002 대한후두음성언어의학회지 Vol.13 No.1

Background and Objectives : It has been pointed out that alcohol intake in human beings induces changes in voice register and maximum phonation time. These changes supposedly result from injection of the vibratory vocal folds. The purpose of this study was to clarify the voice changes associated with alcohol intake and the changes of laryngeal mucosa. Materials and Methods : The subjects included 29 volunteers, including 20 men and 9 women ranging in age from 22 to 31 years. Alcohol intake was accomplished by oral administration of 23% soju 1 bottle (255cc). Serum alcohol concentration levels were evaluated hourly for 3 h after ingestion of alcohol. Seven measurements were performed at pre-alcohol intake and post-alcohol intake hourly : fundamental frequency, jitter, shimmer, noise to harmonic ratio as the acoustic analysis, maximal phonation time, mean flow rate, and subglottal pressure as the aerodynamic analysis. The changes of laryngeal mucosa were evaluated by flexible laryngoscope at each measurement. Results : By comparing the acoustic and aerodynamic data and laryngeal mucosa before and after alcohol intake, there were not remarkable changes (p>0.05). Conclusion : The voice and laryngeal mucosa have not remarkably changed according to alcohol concentration in this study. Furthermore studies on the voice change induced by multiple alcohol concentrations are required.

성문상부암의 방사선치료

남택근(Taek-Keun Nam),정웅기(Woong-Ki Chung),조재식(Jae-Shik Cho),안성자(Sung-Ja Ahn),나병식,(Byung-Sik Nah) 오윤경(Yoon-Kyeong Oh) 대한방사선종양학회 2002 Radiation Oncology Journal Vol.20 No.2

Purpose : A retrospective study was undertaken to determine the role of conventional radiotherapy with or without surgery for treating a supraglottic carcinoma in terms of the local control and survival. Materials and Methods : From Jan. 1986 to Oct. 1996, a total of 134 patients were treated for a supraglottic carcinoma by radiotherapy with or without surgery. Of them, 117 patients who had completed the radiotherapy formed the base of this study. The patients were redistributed according to the revised AJCC staging system (1997). The number of patients of stage Ⅰ, Ⅱ, Ⅲ, ⅣA, ⅣB were 6 (5%), 16 (14%), 53 (45 %), 32 (27%), 10 (9%), respectively. Eighty patients were treated by radical radiotherapy in the range of 61.2∼79.2 Gy (mean : 69.2 Gy) to the primary tumor and 45.0∼93.6 Gy (mean : 54.0 Gy) to regional lymphatics. All patients with stage Ⅰ and ⅣB were treated by radiotherapy alone. Thirty-seven patients underwent surgery plus postoperative radiotherapy in the range of 45.0∼68.4 Gy (mean : 56.1 Gy) to the primary tumor bed and 45.0∼59.4 Gy (mean : 47.2 Gy) to the regional lymphatics. Of them, 33 patients received a total laryngectomy (±lymph node dissection), three had a supraglottic horizontal laryngectomy (±lymph node dissection), and one had a primary excision alone. Results : The 5-year survival rate (5YSR) of all patients was 43%. The 5YSRs of the patients with stage Ⅰ+Ⅱ, Ⅲ+Ⅳ were 49.9%, 41.2%, respectively (p=0.27). However, the disease-specific survival rate of the patients with stage I (n=6) was 100%. The 5YSRs of patients who underwent surgery plus radiotherapy (S+RT) vs radiotherapy alone (RT) in stage Ⅱ, Ⅲ, ⅣA were 100% vs 43% (p=0.17), 62% vs 52% (p=0.32), 58% vs 6% (p<0.001), respectively. The 5-year actuarial locoregional control rate (5YLCR) of all the patients was 57%. The 5YLCR of the patients with stage Ⅰ, Ⅱ, Ⅲ, ⅣA, ⅣB was 100%, 74%, 60%, 44%, 30%, respectively (p=0.008). The 5YLCR of the patients with S+RT vs RT in stage Ⅱ, Ⅲ, ⅣA was 100% vs 68% (p=0.29), 67% vs 55% (p=0.23), 81% vs 20% (p<0.001), respectively. In the radiotherapy alone group, the 5YLCR of the patients with a complete, partial, and minimal response were 76%, 20%, 0%, respectively (p<0.001). In all patients, multivariate analysis showed that the N-stage, surgery or not, and age were significant factors affecting the survival rate and that the N-stage, surgery or not, and the ECOG performance index were significant factors affecting the locoregional control. In the radiotherapy alone group, multivariate analysis showed that the radiation response and N-stage were significant factors affecting the overall survival rate as well as locoregional control. Conclusion : In early stage supraglottic carcinoma, conventional radiotherapy alone is an equally effective modality compared to surgery plus radiotherapy and could preserve the laryngeal function. However, in the advanced stages, radiotherapy combined with concurrent chemotherapy for laryngeal preservation or surgery should be considered. In bulky neck disease, all the possible planned neck dissections after induction chemotherapy or before radiotherapy should be attempted. 목 적 : 성문상부암에서 방사선 단독치료 또는 수술 후 방사선치료를 받은 환자를 대상으로 방사선치료의 역할을 국소종양제어율과 생존율을 중심으로 후향적으로 분석하고자 하였다. 대상 및 방법 : 1986년 1월부터 1996년 10월까지 134명이 성문상부암으로 진단되어 방사선단독 또는 수술 후 방사선치료가 시행되었고 이 중 계획된 방사선량을 조사 받은 117명의 환자를 대상으로 하였다. 1997년의 AJCC 병기분류체계에 의하여 재분류하였고 병기 Ⅰ, Ⅱ, Ⅲ,ⅣA, ⅣB의 환자 수는 각각 6 (5%), 16 (14%), 53 (45%), 32 (27%), 10 (9%)이었다. 전체 환자 중 80명은 근치적 목적의 방사선치료로 원발병소에 61.2∼79.2 Gy (평균 : 69.2 Gy), 경부림프절에 45.0∼93.6 Gy (평균 : 54.0 Gy)를 조사하였다. 전체 환자 중 병기 Ⅰ과 ⅣB 환자는 모두 방사선 단독치료를 시행하였다. 37명의 환자에서 수술 후 방사선치료를 받았고 원발병소 절제부위에 45.0∼68.4 Gy (평균 : 56.1 Gy), 경부 림프절에 45.0∼59.4 Gy (평균 : 47.2 Gy)를 조사하였다. 수술방법으로서 33명은 전후두적출술(±경부림프절 청소술), 3명은 부분후두적출술(±경부림프절 청소술), 나머지 1명은 원발병소만의 절제술이었다. 결 과 : 전체환자의 5년 생존율은 43%이었다. 병기 Ⅰ+Ⅱ와 Ⅲ+Ⅳ의 5년 생존율은 49.9%, 41.2%이었으나(p=0.27), 병기 I (n=6) 환자의 종양특성생존율은 100%이었다. 수술 후 방사선치료군(S+RT)과 방사선단독 치료군(RT)의 5년 생존율은 병기 Ⅱ에서 100% 대 43%, 병기 Ⅲ에서 62% 대 52%이었으나 유의한 차이는 없었고(p=0.17, p=0.32), 병기 ⅣA에서 58% 대 6%로 S+RT군의 생존율이 유의한 차이로 양호하였다(p<0.001). 전체 환자의 국소종양 제어율은 57%이었다. 병기별 국소종양제어율은 병기 Ⅰ, Ⅱ, Ⅲ, ⅣA, ⅣB에서 각각 100, 74, 60, 44, 30%이었다(p=0.008). S+RT군과 RT군의 국소종양제어율은 병기 Ⅱ에서 100% 대 68%, 병기 Ⅲ에서 67% 대 55%로 유의한 차이는 없었으나(p=0.29, p=0.23), 병기 ⅣA에서는 81% 대 20%로 유의한 차이가 있었다(p<0.001). 방사선 단독치료를 받은 80명의 환자 중 방사선치료반응에 따른 국소종양제어율은 완전관해, 부분관해, 부분관해미만 군에서 각각 76, 20, 0%이었다(p<0.001). 전체환자에서 생존율에 영향을 미치는 예후인자는 다변량 분석을 시행한 결과 N 병기, 수술 여부, 나이였고 국소종양 제어율에 영향을 미치는 유의한 인자는 N 병기, 수술 여부, ECOG 활동도였다. 방사선 단독치료군에서 다변량 분석결과 생존율과 국소종양제어율 모두에 유의한 인자는 방사선치료 후 종양반응과 N 병기였다. 결 론 : 조기 병기의 성문상부암에서는 통상적인 방사선단독치료로 후두기능을 보존하면서 수술군과 대등한 종양제어율을 보여주었다. 그러나 진행된 병기의 경우에는 수술과 방사선치료의 병용요법 또는 후두기능의 보존적 측면에서의 동시적 항암화학방사선요법이 고려되어야 할 것으로 생각된다. 특히 진행된 림프절 병소에 대해서는 가능한 한 방사선치료 전 또는 유도화학요법 후 계획된 경부림프절 청소술을 고려해야 할 것으로 생각된다.

방사선치료를 받은 조기 성문암 환자의 국소 종양 제어에 관한 예후 인자

정웅기(Woong-Ki Chung),안성자(Sung Ja Ahn),남택근(Taek Keun Nam),나병식(Byung Sik Nah),조재식(Jae-Shik Cho),임상철(Sang-Chull Lim) 대한방사선종양학회 2000 Radiation Oncology Journal Vol.18 No.4

목 적 :방사선 단독 치료를 받은 조기성문암 환자에서 국소종양제어율에 영향을 주는 예후 인자를 알아보고자 하였다. 대상 및 방법 : 1986년 7월부터 1995년 12월 까지 전남대학교병원에서 조기성문암으로 확진되어 근치적 목적의 방사선치료를 받은 37명의 환자를 대상으로 후향적 분석을 시행하였다. 대상 환자의 연령 범위는 30세에서 73세였으며 중앙값은 59세였다. 성별 분포는 남자가 35명(95%), 여자가 2명(5%)이었다. 조직학적 유형은 모두 편평세포암이었다. 미국 암합동위원회의 병기분류법(1997)에 따라 다시 분류한 병기는 T1a, T1b, T2가 각각 27명(73%), 3명(8%), 7명(19%)이었다. 방사선치료는 선형가속기의 6 MV X- ray를 이용하였다. 후두에 조사된 총방사선량은 5,040 cGy에서 7,020 cGy 범위였으며 중앙값은 6,600 cGy였다. 추적기간의 중앙값은 80개월이었고 생존율과 국소종양제어율을 Kaplan-Meier 법에 의하여 산출하였으며 두군간의 비교는 generalized Wilcoxon test를 이용하여 검증하였다. 국소종양제어율에 영향을 줄 수 있는 인자들의 다변량분석에는 Cox 모델을 이용하였다. 결 과 :전체 환자 37명의 5년 생존율은 89%였고 국소종양제어율은 74%였다. 국소종양제어율에 영향을 줄 수 있는 인자들로 연령, T-병기, 전연합침범, 일회조사량, 총방사선량, 방사선치료기간을 분석에 포함시켰다. 단변량분석에서 치료기간이 50일 미만인 경우 5년 국소종양제어율이 93%, 50일 이상인 경우 60%로서 통계학적 의의가 있었다(p=0.026). 다변량분석에서도 치료기간만이 통계학적 의의가 있었다(p=0.017). 치료 후 합병증은 1명에서 갑상선기능저하증이 나타났다. 결 론 :조기성문암에서 근치적 방사선치료시 치료기간이 국소종양제어율에 영향을 줄 수 있는 인자로 분석되었다. Purpose :This study was performed to find out the prognostic factors affecting local control in early glottic cancer treated with radiation therapy alone. Mate ria ls and Me thods :We analysed 37 patients of histologically confirmed early glottic cancer treated at Chonnam National University Hospital between July 1986 and December 1995, retrospectively. Age of patients ranged from 30 to 73 years (median; 59 years). Thirty- five (95%) patients were male. Histological type was all squamous cell carcinoma. According to the staging system of 1997 American Joint Committee on Cancer, 37 patients were restaged as follows: T1a; 27 (73%), T1b; 3 (8%), T2; 7 (19%). Radiation therapy was done using 6 MV X- ray of linear accelerator. The range of total radiation dose delivered to the glottic lesion was between 5,040 cGy and 7,020 cGy (median; 6,600 cGy). Median follow- up period was 80 months. Local control rates were calculated by Kaplan-Meier method. Generalized Wilcoxon test was used to evaluate the difference of control rates between comparable groups. Multivariate analysis using Cox proportional hazard model was done to find out prognostic factors affecting local control. Results :5 year survival rate of 37 patients was 89%. Local control rate of 37 patients was 74% in 5 years. We included age, T- stage, anterior commissure involvement, fraction size, total radiation dose, treatment time of radiotherapy as potential prognostic factors in univa riate and multivariate analysis. As a result, treatment time had statistical significance in local control rate in both univariate (p=0.026) and multivariate (p=0.017) analysis. Complication was not recorded except one patient with hypothyroidism. Conclusion :This study revealed that overall treatment time of radiation was a significant factor affecting local control rate.

연구자로서의 교사 개념에 대한 이론적 고찰

조재식 한국교육인류학회 2002 교육인류학연구 Vol.5 No.2

이 글은 교육 변화의 계획과 실행 과정을 논의함에 있어서 가장 중요하게 고려하여야할 측면을 교사의 일과 역할에 대한 반성적 이해로 보고, 교사가 자신의 교실을 일상적 장면 속에서 연구함으로서 얻게 될 교육 개선의 의미를 고찰한 것이다. 이를 위하여, 첫째, 교사의 전문성은 어디에서 찾을 수 있으며, 교사 연구의 궁극적 목적이 무엇이며, 그리고 교사들 간의 협동적 작업이 왜 필요한지 살펴보았다. 둘째, 현장 연구 방법론을 패러다임에 비추어 개관한 후, 본 연구자가 생각하는 현장 연구의 일반적 모형을 제시하였고 절차를 설명하였다. 끝으로, 교육 변화의 주체로서 교사 연구자는 어떠한 삶을 영위할 수 있는지 수단과 목적을 통합한 관점에 비추어 다섯 가지 유형으로 분류하여 각각의 특성을 탐색하였다. 결론적으로 이 글은 교육 변화를 생각함에 있어서 거시적으로는 교사에 대한 이미지를 긍정적으로 바라다봄과 동시에 미시적으로는 교사들도 자신들의 교실 변화에 적극적으로 참여해야할 필요성을 강조하였다. This paper was concerned with clarifying the concept of "Teacher as Researcher" in ways that explored the reflective meaning of teachers’ work and role in conjunction with educational change. More specifically, this paper was aimed at examining why teachers needed to be researchers in their classroom and school contexts. To do so, first, such things as elements of what makes teaching a professional activity, long-term purposes of teacher research, and the necessity of collaboration among educators were reviewed. Secondly, this paper introduced inquiry paradigms basic for teachers as researchers, followed by an action research model that included several components ranged from problem identification through reflection to ways of sharing practical knowledge. And finally, this paper suggested a typology that identified different lives of teachers as researchers with the different means and ends, which ought be equally recognized by our educational community. In conclusion, it was argued that teachers’ images in action needed to be positively viewed from the macro perspective and, at the same time, teachers needed to keep redefining their work and role toward making a difference of educational practice from the inside of the classroom.