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비후성 심근병증에 동반한 좌회선지 원위부에서 기시한 우관상동맥
Hyeon Cheol Koh,Dae Hee Hahn,Tae Seob Jung,Kyung Deuk Park,Moo Hyun Lee,Gi Soo Park,Gyung Jung Kim,Sang Chil Lee 조선대학교 의학연구소 2014 The Medical Journal of Chosun University Vol.39 No.3
The isolated single coronary artery is a rare congenital anomaly, in which both coronary arteries arise from a solitary ostium. Diagnosis of coronary anomalies and identification of the exact anatomy of coronary arteries has significant clinical importance, hence, myocardial ischemia or sudden cardiac death is usually related to its course of anomalous coronary artery. Most patients with a single coronary artery are asymptomatic and have normal electrocardiogram and negative stress tests. However, if the patient has other structural abnormalities, for example, ventricular hypertrophy, the exam is determined. This report describes a case of single coronary artery, where the right coronary artery originated from the distal left circumflex artery in a patient with hypertrophic ardiomyopathy.
NCCN 암성 통증 가이드라인에 따른 폐암 환자의 암성 통증 조절
김현태 ( Hyeon Tae Kim ),고경원 ( Kyung Won Koh ),김여명 ( Yeo Myeong Kim ),강민수 ( Min Soo Kang ),노희선 ( Hee Sun Noh ),김혜련 ( Hye Ryoun Kim ),김철현 ( Cheol Hyeon Kim ),이재철 ( Jae Cheol Lee ) 대한결핵 및 호흡기학회 2009 Tuberculosis and Respiratory Diseases Vol.67 No.3
Background: Pain is one of the most troublesome problems caused by malignancy. We evaluated the change in pain status according to observance of NCCN guidelines in lung cancer patients. Methods: Lung cancer patients complaining of pain at admission were examined. The pain was assessed with visual analogue scale (VAS) for 20 days and moderate-to-severe pain was defined as more than VAS level 3. The guideline observance was classified as high (more than 80%), medium (50∼79%) and low (less than 50%). Results: Among the total 91 lung cancer patients with pain, 34 patients (37%) had moderate-to-severe pain. Their average VAS score at admission was 5.6. It decreased to 2.9 after a 20-day period of pain management. The time to reach a VAS less than 3 was 3 days in a high guideline observance group, while it took 6 days in a low observance group. In addition, the pain in the high observance group was controlled to less than 3 VAS level in 86% of patients, whereas only 25% of patients in the low observance group succeeded. Conclusion: Pain was more effectively controlled when the dose of drugs was modified according to NCCN guidelines in lung cancer patients indicating the importance of guideline observance in pain management.
고경원 ( Kyung Won Koh ),김현태 ( Hyeon Tae Kim ),장상언 ( Sang Eon Jang ),김여명 ( Yeo Myeong Kim ),진민선 ( Min Sun Jin ),김상범 ( Sang Bum Kim ),김혜련 ( Hye Ryoun Kim ),김철현 ( Cheol Hyeon Kim ),이재철 ( Jae Cheol Lee ) 대한결핵 및 호흡기학회 2009 Tuberculosis and Respiratory Diseases Vol.67 No.1
Lung cancer frequently metastasizes to distant organs. However, solitary metastasis to the pancreas, with lung cancer as the source, is very rare. Most metastatic cases of the pancreas tend to be discovered in patients with widely disseminated malignant disease. In addition, patients with pancreatic metastases are often asymptomatic, the metastatic lesions are found incidentally, and are misdiagnosed as primary pancreatic tumors. We described the case of a 63-year-old man who presented with abdominal pain and a pancreatic nodule. The patient underwent resection of primary lung cancer followed by pylorus preserving pancreatoduodenectomy. The pancreatic nodule was confirmed as a solitary metastasis from lung cancer.
RN-BSN 과정생들의 통제소재와 창의적 행동이 셀프리더십에 미치는 영향
고명숙(Koh, Myung Suk),석정원(Suk, Jung Won),정현철(Jeong, Hyeon-Cheol),전경덕(Jeon, Kyeong Deok),최대호(Choi, Dae Ho) 한국산학기술학회 2013 한국산학기술학회논문지 Vol.14 No.10
목적 : 본 연구는 RN-BSN 과정에 있는 간호사들의 통제위와 창의적 행동이 셀프리더십에 미치는 영향을 파 악하고자 시도되었다. 연구방법: 본 연구는 조사연구로서 서울시내 두 대학의 RN-BSN 과정생 135명으로 과정이 시 작되기 직전 설명을 통하여 본 연구에 동의한 자를 연구대상으로 하였다. 연구결과: 평균은 통제소재 1.42점, 창의적 행동 3.26 점, 셀프리더십은 3.63 점으로 나타났다. 일반적 특성에 따른 변수간 차이는 통제소재는 병원근무자가 (t=-2.53, p=.012) 창의적 행동은 20대보다 30대가(t=-2.271, p=.024), 일반간호사보다 책임간호사가 유의하게 높았다 (t=.012, p=.030). 셀프리더십은 20대보다 30대가 (t=-2.845, p=.005), 일반간호사보다 책임간호사가 유의하게 높았다 (t=1.120, p=.031). 근무 년 수는 10년 이상군이 3년 이하 군에 비하여 높게 나타났으며(F=3.083, p=.049), 내적통제위 와 창의적 행동은 셀프리더십을 43.1% 설명하였다. 결론: 간호조직에서는 간호사들의 셀프리더십을 향상시키고자 할 때 내적통제소재와 창의적 행동을 고려하여야 할 것이다. The purpose of this study was to learn the impact of creative action and locus of control on the self-leadership among RN-BSN students. 135 RN-BSN students participated after being told the research information. The results were as follows: first, mean of locus of control was 1.42, creative action was 3.26, and self-leadership was 3.63. Second, the differences according to general characteristics for the variable of locus of control, workers at hospitals were higher than non workers. For creative action, and self-leadership, those over age 30 and charge nurses rated higher than those below 20 and staff nurses. The last, locus of control and creative action had influence on the self-leadership. The conclusion was that if each nursing organization wants to improve its nurses’ self leadership, it must consider nurses’ locus of control, and creative action.
통풍환자에서 Allopurinol 투여 후 나타난 간기능이상
서기현 ( Gi Hyeon Seo ),안홍준 ( Hong Joon Ahn ),차훈석 ( Hoon Suk Cha ),김진석 ( Jin Seok Kim ),고광철 ( Kwang Cheol Koh ),고은미 ( Eun Mi Koh ) 대한류마티스학회 1999 대한류마티스학회지 Vol.6 No.1
Objective: To investigate the incidence and clinical course of the patients who had liver function test abnormalities during treatment with allopurinol. Methods: 62 patients who were diagnosed as gout and were treated with allopurinol at Samsung Medical Center between 1995 and 1997 were reviewed. In these patients, liver function tests were checked before and during treatment for 6 months. The term of `abnormalities of liver function test` was defined when there was an increase of more than 1.5 times of upper limit of normal values or baseline values in anyone of bilirubin, asparate transaminase, alanine transaminase and alkaline phosphatase. Results: During treatment with allopurinol, 25 patients(40.2%) showed abnormalities of liver function test. 10(25.0%) of 40 patients who had normal liver function tests before treatment showed abnormalities of liver function tests during treatment, while 15(68.2%) of 22 patients who had abnormal liver function tests before treatment showed abnormalities during treatment. In 12 of the 25 patients who showed abnormalities of liver function tests during treatment with allopurinol, allopurinol was stopped and all patients showed improvement of liver function tests. In remaining 13 patients, 10 patients were improved and other 2 patients showed only mild abnormalities of liver function tests despite of continuing allopurinol and 1 patient was lost during follow-up. Conclusions: Abnormalities of liver function tests were common during treatment with allopurinol. Most patiensts who had mild abnormalities of liver functions tests during treatment with allopurinol were improved regardless of continuing allopurinol.
이재철 ( Jae Cheol Lee ),이병준 ( Byoung Jun Lee ),김혜련 ( Hye Ryoun Kim ),김철현 ( Cheol Hyeon Kim ),고재수 ( Jae Soo Koh ) 대한내과학회 2010 대한내과학회지 Vol.79 No.6
70세 여자 환자가 가슴 앞쪽 피부 밑에 생긴 결절을 주소로 내원하였다. 이 환자는 1년 전 1 cm 크기의 폐 종양이 생겨(그림 1A)조직 검사를 시행하였고 비소세포폐암으로 진단되어 수술을 받았다. 수술 후 병기는 T1N0M0였다. 피부 밑에 만져지는 결절은 2 cm 크기로 흉벽에 고정되어 있지는 않았고 약간 단단한 느낌을 주었으나 결절을 덮고 있는 피부에는 이상 소견이 없었다. 통증 등 동반된 증상도 없었으나 1년 전 조직 검사 시 바늘이 들어간 자리와 일치하여 조직 검사 도중 일부 암세포가 피부밑에 이식된 것으로 판단되었다. 흉부전산화 단층촬영에서 피부 밑 결절이 확인되었고 종격동에 여러 개의 커진 림프절이 발견되어 폐암도 재발되었음을 알 수 있었다(그림 1B). 18FDG-PET/CT에서 결절과 종격동 림프절의 SUV는 각각 9.7, 7.7이었다 (그림 1C). 피부 밑 결절은 간단한 수술로 제거하였고(그림 1D, 1E) 종격동에는 방사선치료를 시행하기로 하고 퇴원하였다. 나이와 전신 상태 등을 고려하여 항암화학요법은 시행하지 않기로 결정하였다. 세침 조직 검사는 비교적 간단하고 심각한 부작용도 적어 폐암을 진단하는데 매우 중요한 검사이다. 기흉, 출혈 등은 흔히 발생하지만 대부분 쉽게 해결되어 임상적으로 큰 문제가 되지 않는다. 이 환자처럼 바늘이 지나간 자리에 암세포가 이식되는 경우는 매우 드물어, Sinner와 Zajicek에 따르면 5,300예 중에서 0.02%의 빈도를 보였다1). 이식이 된 경우, 조직 검사 후 6~24개월 정도에서 발견이 되며 대부분 수술로 제거될 수 있다2). 하지만 흉막에 이식되어 치료가 어려울 수도 있다3). 액와부위에 근접하여 병변이 있는 경우에는 액와부 림프절도 모두 제거하는 것이 바람직한데 이는 액와부 림프절에 전이가 있었다는 보고들이 있기 때문이다4). 국소적 재발을 줄이기 위해 수술 후 방사선 치료를 시행하는 경우도 있으나 효과는 아직 검증되어 있지않다. 바늘, 흉관, 내시경 등을 이용하여 암에 대해 어떤 시술을 행한 경우 드물지만 암세포가 이식될 수 있다는 점을 인지하여야 하며 환자가 그 부위에 이상 증상을 호소하거나 이상 소견이 발견되는 경우 이식형 전이의 가능성을 염두에 두고 검사를 시행하는 것이 바람직할 것으로 보인다.