간내 담석과 동반된 간내 담도암에서의 p53과 Ki-ras의 발현

김명환,이성구,서동완,이승규,남승우,박능화,민영일,김연석,심기남,공경엽 대한소화기학회 1997 대한소화기학회지 Vol.30 No.5

Background/Aims: Hepatolithiasis or primary intrahepatic stones may be accompanied later by intrahepatic cholangiocarcinoma. This cancerous lesion is frequently associated with atypical hyperplastic epithelium that was suspected of being precancerous. To investigate the Ki-ras or p53 mutation may play a role in carcinogenesis, and to determine whether atypical hyperplastic epithelium may be precancerous, this study was performed in intrahepatic cholangiocarcinomas associated with hepatolithiasis. Methods: We examined 12 patients with intrahepatic cholangiocarcinomas associated with hepatolithiasis. Ki-ras point mutations were assessed by direct DNA sequencing. Expressions of p53 protein were immunohistochemically assessed. The overexpression of p53 and point mutation of Ki-ras were examined in normal, hyperplastic, atypical hyperplastic, and can- cerous tissues separately. Results: The expressions of p53 protein were detected in 4 (33%) of 12 cholangiocarcinomas and Ki-ras point mutations at codon 12 were found in 2 (17%) of 12 cholangiocarcinomas. In those two carcinoma cases which contained the mutant sequence of Ki-ras, the same point mutation from wild type GGT (glycine) to GAT (aspartic acid) was. found in the associated atypical hyperplastic epithelium. However, none of the normal and hyperplastic epithelium harbored Ki-ras or p53 mutations. Conclusions: The overexpression of p53 may play a part in the carcinogenesis of some intrahepatic cholangiocarcinomas associated with hepatolithiasis, whereas the role of Ki-ras mutations in those cases is dubious. However, Ki-ras point mutation at codon 12 may be responsible for either cancer or atypical hyperplastic epithelium associated with hepatolithiasis in certain cases, suggesting atypical hyperplastic epithelium may give rise to carcinoma.

Clinical Significance of Tissue Levels of Matrix Metalloproteinases and Tissue Inhibitors of Metalloproteinases in Gastric Cancer

심기남,정성애,주양희,유권 이화여자대학교 의과대학 2005 EMJ (Ewha medical journal) Vol.28 No.2

목적: 본 연구는 암의 침윤과 전이에 필수적인 기질단백분해효소(matrix metalloproteinases, MMPs)와 억제인자(tissue inhibitor of metalloproteinase, TIMPs)의 발현정도를 위암의 생검조직에서 확인하고 임상적, 병리학적 소견과의 상관관계를 분석하여 임상적 유용성을 평가하고자 하였다. 방법: 2003년 8월부터 2004년 7월까지 본원에서 위암으로 진단되어 근치적 치료를 받은 30명의 환자를 대상으로 하였다. 조직은 위내시경 검사시 정상 점막 및 암으로 진단한 병변에서 생검겸자를 이용하여 얻었다. 역전사중합효소연쇄반응(RT-PCR)을 이용하여, 정상조직을 기준으로 암조직에서의 MMP-W, MMP-9, MT1-MMP, TIMP-1, TIMP-2의 발현정도를 반정량법으로 비교하였다. 결과: MT1-MMP의 발현정도는 위암의 분화도, 림프혈관계 침윤, 림프절 전이 및 암의 병기와 유의한 상관관계가 있었다.(p<0.05). 그 외의 MMP-2, MMP-9, TIMP-1,TIMP-2의 발현은 임상적 소견과 유의한 관계를 보이지않았다. 결론: 반정량적 역전사중합효소연쇄반응을 이용하여 MT1-MMP의 발현 증가 유무를 확인하는 것은 위암의 공격적 특성을 예측하는데 유용할 것으로 생각되며, 이러한 검사는 수술 전에 얻어진 생검조직을 이용하여 가능하므로 암의 공격성에대한 정보를 수술 전에제공할 수 있을 것으로 사료된다.

예절과 언어행위 (1)

남기심 연세대학교 인문과학연구소 1997 人文科學 Vol.76-77 No.-

예절과 언어 행위(Ⅱ)

남기심 연세대학교 인문과학연구소 1998 人文科學 Vol.79 No.-

건설현장 근로자들의 안저예방실태와 사고예방과의 개선요인 조사연구

심규범,남철현,최상복,이송권,이정희,이순자,문기내,김문환 慶山大學校 保健福祉硏究所 2003 保健福祉硏究 Vol.8 No.-

This study was conducted to examine aspects of health and safety education and demand level of safety education in construction job sites in order to provide direction of safety education development. The subjects of this study were 566 workers who were working in construction job sites located in Daegu City and Kyungbuk Province. Data were collected from June 1, 2002 to August 30, 2002. The results of this study can be summarized as follows. 1. According to safety education by experience methods, the proportion of education by lecture was highest (90.6%). The proportion of education by field practice was 13.1%. 2. Among the education methods which they thought as the most desirable method, the proportion of audio-visual education was 39.4% and the proportion of education by experience was 37.5%. Those who had more monthly income and higher education level preferred audio-visual education, while those who were younger and less educated preferred education by experience. 3. In the case of the contents of the safety education which they thought as the most important one, the proportion of enhancement of safety awareness and education of risk factors was highest (24.7%). The groups of older workers, having longer working period, and belonging to higher education level preferred these contents. 4. According to the factors which were most important to increase effectiveness of the safety education were workers' voluntary participation (27.7%), 40 to 49 years old (27.7%), and monthly income of one million, five hundred thousand won to one million, nine hundred ninety thousand won (32.0%). The proportions of lower educated workers and working as daily workers were also high. 5. The variable which most influenced the safety education was age. The safety awareness of construction job sites was the second highest influential variable. From above results, it is clear that the workers' participation in the safety education was low since most of the safety educations were formal education by lecture. Although they participated in the education, the education was also not effective because they compulsorily participated in it. Therefore, it can be concluded that effective alternative policies must be formulated.

문법의 숙제 몇 가지

남기심 국어국문학회 2004 국어국문학 Vol.- No.138

In this paper I raised questions such as the following. 1. Is it really possible to classify the cases into grammatical case and semantic case? 2. It seems that in some cases an argument noun is selected not by the predicate only but by the predicate plus the case marker selected by the predicate. Is it correct? 3. A semantic case marker such as '-e(-에)' is used with different meanings according to its linguistic environments. Is it possible to formalize a rule to deduce how the meaning of that case marker changes in a given environment? 4. There is a selectional restriction between the two argument nouns in a small clause. Is that selectional restriction given by the predicate of the sentence which have the small clause as its argument? etc.

중·고등학생들의 보건교육 요구도 조사연구

문기내,남철현,김귀희,위광복,박경옥,이미경,심규범,장영진 慶山大學校 保健福祉硏究所 2003 保健福祉硏究 Vol.8 No.-

This study was conducted to examine middleㆍhigh school 720 students in seven regions of middleㆍsmall city and town, Myon for 2 months from March 2 through April 30, 2002 in order to realize a side of school health education in middleㆍhigh school and health education need as well as health education specialist in school in the future. The results of this study can be summarized as follows. 1. Health condition is now 'normal' is 51.0%, 'good' is 45.0%, 'not good' is 4.1% and health condition of children is good as much as education level of mother is higher. 2. Experience to learn health education in school for one year recently is 'no' is 39.6%, 'don't know' is 32.6%, 'yes' is 27.8% and it represents health education in school doesn't work well and experience to learn health education is lower and lower in town and Myon. 3. Health education ways to work in school now are 'Movie, Video, Slide' is 40.7%, 'education as groups of nurse-teacher' is 38.6%, 'to distribute health education material and book' is 7.7%, 'education by setting an example' is 3.4%, 'the others' is 9.7%. 4. Time of appropriate health education for one time is 'about a hour' is 56.7%, 'about 30 minute' is 33.8%, 'about two hour' is 7.6%, it represents this situation is because of what students' time is lack and burden about a curriculum in an education administratin and school classed of a focused school score. 5. The average score of satisfaction of health education in school is 16.99±0.58, 'men' is 1.79±0.60, 'women' is 1.61±0.55 as the distinction of sex, satisfaction level of men is higher than women. 6. Learning route about health information is 'through mass media' is 59.9%. 'through family, friend' is 15.0% 'health education lecture' is 7.2%, 'printing media' is 6.1%, 'medical institution' is 5.6%, 'the others' is 5.1%, 'public health center' is 1.0%, 'through mass media' is the highest percent as each 59.1% and 60.6% in all of men and women. 7. The most efficient education way of health education is 'movie, video, slide' is 32.6%, 'health education specialist who works school' is 21.9%, 'school health education by nurse-teacher' is 16.0%, 'way through mass communication' is 11.6%. 8. The appropriate health education specialist in the future is 'health education specialist who has qualifications' is the highest as 64.5%, 'nurse-teacher' is 12.4%, 'medical personnel(doctor, a physician of oriental medicine etc.,)' is 11.0%, 'staff in public health center' is 7.2%, people in other regions(health and medical professor etc.,) is 7.0%, it represents school health education is not actual and is formal now in second hand. 9. The most necessary health education program is 'program of stress solution' is the highest as 24.9%, 'program of no smoking' is 22.7%, 'sexual education program' is 19.8%, 'school violence program' is 8.8%, 'isolate from their friends prevention program' is 8.0%, solution program of stress which gives student by school score was very necessary. Therefore, school health education is formal and inefficient because school education focuses on an entrance exam, so middleㆍhigh school students decrease concern and interest about health education. Furthermore, reliance is gotten down about nurse-teacher who takes charge of school health, a charged person of school health education wants more chargeable health education staff. And a solution program of stress that gives students by school score was very necessary. According to active concern and planned, systematic school health education is necessary to give right health knowledge, health maintenanceㆍpromotion and setting of appropriate health education specialist is very urgent.

Wolff-Parkinson-White증후군의 임상상 및 전기생리학적 소견

안신기,이문형,장양수,오동진,최인석,하종원,임세중,김병옥,정남식,심원흠,조승연,김성순 대한순환기학회 1997 Korean Circulation Journal Vol.27 No.9

대사성 산증을 동반한 알코올성 간질환 환자의 단기 예후

배기선,유권,조유경,심기남,정성애,문일환 대한간학회 2004 Clinical and Molecular Hepatology(대한간학회지) Vol.10 No.2

목적: 알코올성 간질환에서의 대사성 산증은 지속적인 과량의 알코올 섭취로 인한 당 신생 합성의 억제와 BOHB/AcAc 비율의 증가, 단기간의 금식으로 인한 저혈당, 인슐린 분비 저하, 유리 지방산과 케톤체 형성의 증가, 구토와 수분 섭취 부족에 의한 심한 탈수에 의해 발생하는 것으로 알려져 있다. 알코올성 케톤산증과 감별할 질환으로는 당뇨병성 케톤산증, 젖산증, 살리실레이트, 메탄올, 에틸렌글리콜 중독 등이 있다. 본 연구는 대사성 산증을 동반한 알코올성 간질환으로 내원하여 입원한 환자들을 대상으로 생존군과 사망군에서 임상적 양상 및 검사 소견들의 차이를 비교하여 단기 예후와 연관 있는 인자들을 알아보고자 하였다. 대상과 방법: 만성 알코올 남용자이면서 대사성 산증을 동반하여 입원한 알코올성 간질환 환자 29명을 생존군(18명)과 사망군(11명)으로 나누어 임상 소견과 검사실 소견을 비교하였다. 결과: 1) 대상 환자군은 연령은 36-65세였으며, 성별은 남자가 26명이었고 여자가 3명이었다. 2) 임상 증상은 의식저하, 복통, 구토, 호흡 곤란, 토혈, 흉통 등 다양하게 나타났으며, 신체검사 소견은 탈수, 황달, 빈혈, 간비대, 복수, 부종 등이었고 두 집단을 비교했을 때 사망군에서 복수가 유의하게 더 많은 빈도로 관찰되었다. 일일 평균 음주량은 사망군에서 유의하게 더 많았고(198 vs. 123, P=0.034) 음주 기간과 총 음주량은 두 군 간에 유의한 차이를 보이지 않았다. 4) 내원시 혈액검사 소견을 비교하였을 때 사망군에서 동맥혈 산염기 차이가 유의하게 낮았고 헤모글로빈, 혈소판도 유의하게 낮았다. 사망군에서 총 비리루빈, 크레아티닌, 무기인, 암모니아가 유의하게 높았고 알부민, 클로라이드가 유의하게 낮았다. 사망군에서 프로트롬빈 시간이 유의하게 연장되었으며 섬유소원은 유의하게 낮았고 D dimer는 유의하게 높았다. 결론: 대사성 산증을 동반한 알코올성 간질환 환자에서 일일 알코올 섭취량을 파악하고 복수의 유무, 동맥혈 산염기 차이, 헤모글로빈, 혈소판, 총 빌리루빈, 알부민, 크레아티닌, 무기인, 클로라이드, 암모니아, 프로트롬빈 시간, 섬유소원, D dimer 등을 검사하는 것이 단기 예후를 예측하는 데 도움이 될 것으로 사료된다. 향후 많은 환자들을 대상으로 하여 예후 관련 인자들에 대한 전향적이고 체계적인 연구가 요망된다. Background/Aims: Alcoholic liver disease with metabolic acidosis may have possible causes such as alcoholic ketoacidosis, diabetic ketoacidosis, lactic acidosis. Salicylate, methanol, and ethylene glycol intoxication should also be considered. The aim of this study was to investigate the short-term prognostic factors in patients with alcoholic liver disease with metabolic acidosis. Methods: Clinical data related to twenty-nine patients with alcoholic liver disease and metabolic acidosis was analysed retrospectively. Patients were divided into two groups according to the outcome (survival or death). Past medical history, and physical, laboratory and radiologic data at admission were compared. Results: The amount of daily alcohol intake differed significantly between the two groups (P=0.034), but duration and total amount of alcohol intake did not differ significantly between the two groups (P=0.128; P=0.360). The presence of ascites differed significantly between two the groups (P=0.019). On laboratory testing, the following differed significantly: base excess (P=0.038), hemoglobin (P=0.019), platelet (P=0.040), total bilirubin (P=0.007), albumin (P=0.012), creatinine (P=0.014), phosphorus (P=0.021), chloride (P=0.010), ammonia (P=0.003), prothrombin time (P=0.033), fibrinogen (P=0.011) and D-dimer (P=0.024). Review of the medical history of the patients showed diabetes (10/29), cirrhosis (10/29), and hepatocellular carcinoma (1/29). Combined conditions at admission were sepsis (8/29), pneumonia (7/29), acute renal failure (6/29), rhabdomyolysis (5/29), gastrointestinal hemorrhage (4/29), acute pancreatitis (3/29), acute respiratory distress syndrome (2/29), and acute myocardial infarction (1/29). Conclusions: The amount of daily alcohol intake, base excess, hemoglobin, platelet, total bilirubin, albumin, creatinine, phosphorus, chloride, ammonia, prothrombin time, fibrinogen and D-dimer seemed to be useful parameters in predicting short-term prognosis of patients with alcoholic liver disease with metabolic acidosis. Further study is needed to define the significance of these factors. (Korean J Hepatol 2004;10:117-124)

식도암과 위암이 동시에 발생한 원발성 중복암 1예

윤혜원,심기남,나선경,송도경,정정화,정가영 이화여자대학교 의과학연구소 2012 EMJ (Ewha medical journal) Vol.35 No.2

Double primary cancers are two independently developed cancers in an individual. There have been some reports on double primary cancer since Billroth reported it for the first time in 1879. Double primary cancer of the stomach and esophagus has been revealed a very low incidence worldwide. The incidence of an esophageal cancer with another primary cancer is reported to be 9.5∼27%, but double primary cancers in the esophagus and stomach have been rarely reported to our knowledge. In this study, we present here a case of double primary esophageal and stomach cancer in a 66-year-old man because of progressive dysphagia.