전남대학교 의과대학 졸업 후 진로지도 프로그램 설계와 운영

한의령,정은경,Eui-Ryoung Han,Eun-Kyung Chung 연세대학교 의과대학 2024 의학교육논단 Vol.26 No.1

Chonnam National University Medical School has designed and implemented two career planning programs: a three-phase curriculum-based program and a longitudinal non-curricular program over the course of 6 academic years. The three phases of the curriculum-based career planning program are self-assessment, career exploration, and field experience. The non-curricular career counseling program operates through a faculty advisor system, with each faculty member guiding a group of students from each academic year, and students in each year forming a mentor-mentee relationship. The non-curricular career exploration program consists of a student research support program, an international practice program in basic and clinical medicine, and a specialty exploration fair. A survey conducted among 38 graduates (54.3%) working as interns at Chonnam National University Hospital revealed that graduates preferred autonomous elective subjects within the curriculum-based program. They also responded positively to the faculty advisor system, through which they maintained close relationships. A focus group interview with three interns indicated that subjects providing direct experience in fields of interest and courses that students could choose freely were helpful in career decisions. Through follow-up research, it is necessary to design and operate a systematic career planning program based on an analysis of the needs of graduates taking part in a residency training program after selecting a medical specialty.

천식 의심환자에서 기도과민성과 관련된 공기 매개성 알레르겐

한의령 ( Eui Ryoung Han ),최인선 ( Inseon S. Choi ),이석 ( Seok Lee ),조영욱 ( Yeong Wook Cho ) 대한천식알레르기학회 2007 천식 및 알레르기 Vol.27 No.2

Background: House dust mites and cats are major allergens causing asthma, and grass pollens are more closely related to allergic rhinitis. Objective: To investigate which aeroallergens are related to airway hyperresponsiveness (AHR), a characteristic feature of asthma, in Korean patients. Method: Medical records of suspected asthmatics, who performed both skin prick tests using common aeroallergens and the methacholine bronchoprovocation test between 2001 and 2007, were reviewed. A positive response to an allergen was defined as allergen/histamine wheal ratio of ≥1. A positive and a ≥moderate AHR were defined as 20% fall in FEV1 to ≤25 and ≤2 mg/mL of methacholine, respectively. The relative risks (adjusted odds ratio) for AHR compared to non-atopy were determined by a multivariate logistic regression analysis. Result: House dust mites were the most prevalent allergens in both asthma (n=238) and non-asthma (n=149) patients. The AHR severity was significantly related to the sensitization rates to house dust mites in asthmatics. The relative risks for ≥moderate AHR of subjects sensitized to Dermato-phagoides farinae and hazel were 1.21 (P<0.01) and 0.72 (P<0.05), respectively. Conclusion: Sensitization to a house dust mite, D. farinae, might be a significant risk factor for AHR, but hazel sensitization was protective and might be related to allergic rhinitis. (Korean J Asthma Allergy Clin Immunol 2007;27:105-110)

의과대학 학생의 소진에 대한 지도사례 분석

정은경,최기오,한의령,Chung, Eun-Kyung,Chay, Kee-Oh,Han, Eui-Ryoung 연세대학교 의과대학 2014 의학교육논단 Vol.16 No.2

Medical students often need high levels of specialized institutional and personal support to recover from a burnout experience and to prevent student failure. This study aimed to present approaches to supporting medical students who had experienced burnout using case studies. The study subjects were 45 burnout cases who had been supported by the student support system and committee in one medical school. The factors associated with burnout include poor social network: the lack of belongingness, immature sense of identity, poor mental health, a lack of intrinsic motivation and aptitude, or a major personal crisis. We summarized some tips according to the factors associated with burnout. These tips should provide guidance to organizations and individual support providers to encourage the best quality support for medical students with burnout experiences.

소세포폐암에서 Etoposide 투여 후 발생한 아나필락시스

김영일 ( Young Il Kim ),김규식 ( Kyu Sik Kim ),한의령 ( Eui Ryoung Han ),권용수 ( Yong Soo Kwan ),오인재 ( In Jae Oh ),임성철 ( Sung Chul Lim ),김영철 ( Young Chul Kim ) 대한결핵 및 호흡기학회 2009 Tuberculosis and Respiratory Diseases Vol.67 No.2

Etoposide is a semi-synthetic derivative of podophyllotoxin that is effective against many cancers including small cell lung cancer. We report a case of etoposide-induced anaphylaxis in a 51-year-old woman who tolerated etoposide during her first cycle chemotherapy regimen. During the second cycle, she complained of generalized urticaria and dyspnea 5 minutes after being infused with etoposide. She recovered completely with antihistamine, corticosteroid and fluid replacement. The intradermal skin test with etoposide showed a clear positive immediate reaction. This case suggests that etoposide can induce IgE-mediated anaphylaxis.

증례 : 알레르기 ; 만성 호산구성 폐렴의 임상양상을 동반한 급성 호산구성 폐렴 1예

김성수 ( Sung Soo Kim ),고영일 ( Young Il Koh ),한의령 ( Eui Ryoung Han ),위정욱 ( Jeong Ook Wi ) 대한내과학회 2010 대한내과학회지 Vol.79 No.6

본 증례를 통하여 급성 호산구성 폐렴은 아토피질환 존재등의 만성 호산구성 폐렴의 임상양상을 일부 동반할 수 있으며, 만성 호산구성 폐렴과의 감별이 어려운 경우 기관지폐 포세척술을 시행하여 세척액내 호산구뿐만 아니라 림프구 및 호중구의 증가 소견을 증명하면 급성 호산구성 폐렴의 진단에 도움이 될 수 있을 것으로 생각된다. Acute eosinophilic pneumonia (AEP) represents a clinical entity distinct from chronic eosinophilic pneumonia (CEP). In contrast with CEP, AEP is characterized by duration of symptoms less than 5 days, hypoxemic respiratory failure, no blood eosinophilia at presentation, no atopic background or history of asthma, and no recurrence. However, we report a case of AEP with some features of CEP. A 33-year-old man presented with respiratory symptoms for 4 days. He was diagnosed with AEP based on hypoxemic respiratory failure, diffuse alveolar-interstitial chest X-ray infiltrates, and eosinophilia, lymphocytosis and neutrophilia from bronchoalveolar lavages. However, he had two atopic diseases, asthma and atopic dermatitis. In addition, he presented with blood eosinophilia, which are all features of CEP. Thus, there might be some overlap of clinical features between AEP and CEP. The presence of increased lymphocytes and neutrophils in the bronchoalveolar lavage can be an important finding to help distinguish between AEP versus CEP in difficult cases. (Korean J Med 79:724-728, 2010)

혈관염을 동반한 DRESS증후군

위정욱 ( Jeong Ook Wi ),진남철 ( Nam Chul Jin ),한의령 ( Eui Ryoung Han ),윤병조 ( Byung Jo Yoon ),박상훈 ( Sang Hun Park ),고영일 ( Young Ll Koh ) 대한천식알레르기학회 2010 천식 및 알레르기 Vol.30 No.4

Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is a drug hypersensitivity syndrome characterized by fever, skin rash, blood eosinophilia and multiple organ involvements including liver and kidney developed following drug administration. Vasculitis could be infrequent one of manifestations of DRESS syndrome. Mortality rate of DRESS syndrome is at least 10%. Here, we reported a case of DRESS syndrome with vasculitis. A 67-year-old man with essential hypertension presented with fever and maculopapular rash after being given allopurinol over 2 weeks for gout. He had severe oral mucositis. He had peripheral blood eosinophilia and abnormal hepatic and renal functions. A skin biopsy showed leukocytoclastic vasculitis. Gastroduodenoscopy showed spontaneous mucosal oozing in mid-to-lower esophagus. He was diagnosed as having DRESS syndrome with vasulitis. Allopurinol was stopped and systemic corticosteroid was administrated. His clinical manifestations improved gradually. However, he died of sudden onset of massive intracranial hemorrhage. The case suggests that DRESS syndrome could sometimes present manifestations of vasculitis, which might be fatal. (Korean J Asthma Allergy Clin Immunol 2010;30:320- 324)

천식에서 외부 저항 부하와 기관지수축 유발에 의한 호흡곤란 인지능 측정 비교 연구

최인선 ( Inseon S. Choi ),정성훈 ( Seong Hoon Cheong ),정대호 ( Dae Ho Cheong ),이우진 ( Woo Jin Lee ),한의령 ( Eui Ryoung Han ) 대한천식알레르기학회 2007 천식 및 알레르기 Vol.27 No.2

Background: Since blunted perception of dyspnea may predispose to fatal asthma attacks, dyspnea perception should be measured in severe asthma. Few studies have compared the testing methods. Objective: To investigate whether the degree of dyspnea perception depends on the testing method in asthma. Method: The Borg scale-based dyspnea perception scores during breathing through an inspiratory muscle trainer, and during bronchoprovocation tests using histamine or methacholine were measured in asthma patients and normal volunteers. The relationships between Borg scores and atopy markers were determined. Result: The △Borg scores induced by the external resistive loads were significantly lower in subjects with moderateto-severe airway hyperresponsiveness (AHR) to histamine than in those with negative AHR (P=0.021). Among the patients with AHR to both histamine and methacholine (n=19), the △Borg scores/△lung function ratio induced by histamine was significantly higher than that by methacholine (15.6±2.3 vs. 9.5±2.1, P<0.05). The load-induced △Borg scores were significantly related to serum total IgE levels (r=0.541, P<0.05). Conclusion: Dyspnea perception depends on AHR severity. Histamine induces more severe dyspnea than methacholine, and allergy may affect dyspnea perception. Dyspnea perception vary according to the testing methods. (Korean J Asthma Allergy Clin Immunol 2007;27:111-117)

반복 입원 천식환자에서 호흡곤란 인지능의 변화

서일국 ( Il Kook Seo,),최인선 ( In Seon S. Choi ),김상훈 ( Sang Hoon Kim ),한의령 ( Eui Ryoung Han ) 대한천식알레르기학회 2011 천식 및 알레르기 Vol.31 No.1

Background: Anti-asthma treatments correct impaired dyspneaperception. Objective: To investigate whether dyspnea perception in asthmatics vary whenever they are hospitalized. Method: We retrospectively analyzed the medical records of 64 patients (32 men and 32 women) with acute asthma who were hospitalized at least twice and assessed using the Borg scale-based dyspnea perception score while breathing through an inspiratory muscle trainer at each admission. Poor perceiver was defined as a Borg score of ≤5 at the highest resistive load (HR) and HR-induced ΔBorg score of ≤3. Result: Between the first and econd admissions, the relationship of forced expiratory volume in 1 s (r=0.773, P <0.001) and the concordance of severity of asthma attack (κ=0.503, P<0.001) were significant, but the relationship of HR-induced ΔBorg score and the concordance of poor perceivers were not. During the first admission, as lung function increased gradually, the HR-induced ΔBorg score became higher in poor perceivers (1.83±0.39→3.42±0.57→4.00±0.67, P=0.048). Conclusion: Although asthmatic patients who suffered from a severe asthma attack tended to have a severe attack again at the following admission, dyspnea perception differs among the admissions. Impaired dyspnea perception during acute asthmatic attack would be correctable with anti-asthma treatments. (Korean J Asthma Allergy Clin Immunol 2011;31:20-26)

무증상 폐침윤과 중심성 기관지확장증을 보인 알레르기성 기관지폐 아스폐르길루스증

이우진 ( Woo Jin Lee ),김창성 ( Chang Seong Kim ),윤병조 ( Byoung Jo Yoon ),위정욱 ( Jeong Ook Wi ),한의령 ( Eui Ryoung Han ),고영일 ( Young Il I. Koh ) 대한천식알레르기학회 2009 천식 및 알레르기 Vol.29 No.4

알레르기성 기관지폐 아스페르길루스증(allergic bronchopulmonary aspergillosis, ABPA)에서 일시적 또는 영구적인 폐병변이 나타날 수 있다. 저자들은 ABPA 증상 악화 없이 새로운 폐침윤과 중심성 기관지확장증이 발생한 증례를 경험하여 이를 보고하는 바이다. 46세 남자로 천식으로 진단받고 규칙적으로 항천식약물을 복용하고 있던 중, 추적관찰 목적으로 검사한 흉부방사선사진에서 우연히 우상엽에 고립성 폐결절이 관찰되었다. 호흡기증상 또는 폐기능 악화의 소견은 동반되지 않았다. 말초혈액 호산구, 혈청 총 IgE, Aspergillus fumigatus-특이 IgG 등이 증가되었고, 경흉부세침생검 검사에서 폐결절은 ABPA 폐침윤이었다. 폐침윤은 경구용 스테로이드 사용 후 없어졌으며, 흉부 고해상전산화단층사진에서 폐침윤이 생겼던 부위에 과거에 보이지 않았던 중심성 기관지확장증 병변이 새롭게 발견되었다. 본 증례를 통하여 ABPA 환자에서 악화 증상이 없더라고 단순 흉부방사선 추적관찰은 폐침윤을 조기에 발견할 수 있으며, 결국 영구적 폐손상을 예방 또는 최소화하는데 도움이 될 수 있을 것으로 생각된다. (Korean J Asthma Allergy Clin Immunol 2009;29:293-297)

항원출처 유발검사로 진단된 건초더미에 의한 과민성폐렴

김창성 ( Chang Seong Kim ),이우진 ( Woo Jin Lee ),윤병조 ( Byung Jo Yoon ),정해영 ( Hye Young Chung ),한의령 ( Eui Ryoung Han ),최인선 ( Inseon S. Choi ),고영일 ( Youngil I. Koh ) 대한천식알레르기학회 2008 천식 및 알레르기 Vol.28 No.3

Hypersensitivity pneumonitis (HP) is an immunologically mediated disease which is developed by repeated exposure to sensitizing agents, such as organic dusts or chemicals. The majority of cases occur in the occupational or agricultural setting. We report a case of HP caused by stored hay for feeding cows. A 47-year-old woman has suffered from repeated episodes of cough and dyspnea accompanied by flu-like symptoms, which developed or worsened during feeding cows. Provocation tests with stored hay dusts revealed decreased FEV1 and FVC, blood leukocytosis and lymphocytosis in bronchoalveolar lavage fluid with decreased CD4+/CD8+ ratio. This case suggests that provocation tests with the antigen sources would be valuable when the diagnosis is unclear or when clinical data are insufficient. (Korean J Asthma Allergy Clin Immunol 2008;28:226-230)