말기암환자에서 통증 외 증상의 관리: 최신 NCCN(National Comprehensive Cancer Netweork) 권고안을 중심으로

이혜란,Lee, Hye Ran 한국호스피스완화의료학회 2013 한국호스피스.완화의료학회지 Vol.16 No.4

말기암환자들은 암의 진행으로 인한 여러 가지 육체적, 정신적 증상들로 고통 받고 있으며, 통증뿐만 아니라 피로감, 쇠약감, 식욕부진, 오심 구토, 호흡곤란 등은 말기암환자의 삶의 질 감소에 큰 영향을 미친다. 피로감은 여러 기전 및 원인에 의하여 발생하는데, 치료 가능한 원인으로는 약물부작용, 빈혈, 심한 통증, 수면장애, 우울증 또는 불안감, 영양부족, 내과적 동반질환 등이다. 피로감의 주 기전으로는 사이토카인의 조절이상 및 시상하부-뇌하수체-부신축의 기능부전, serotonin의 조절이상 생체리듬의 파괴, ATP에서의 변화 등이다. 치료는 치료 가능한 원인을 제거하고 환자의 에너지를 보존할 수 있게 하는 방향으로 활동을 계획하고, 교육해야 하며, 약물 치료로는 corticosteroid와 psychostimulants를 사용할 수 있다. 식욕부진과 악액질도 여러 가지 치료 가능한 원인이 있을 수 있는데, 구내염, 구강 캔디다증, 구강 herpes, 구강건조, 변비, 통증과 호흡곤란같이 조절이 안 되는 증상, 섬망, 오심 구토, 우울증, 위장관 운동기능 장애, 역류성 식도염, 내분비 장애가 포함 된다. 식욕부전의 기전은 음식섭취를 조절하는 뇌의 생리적 기전의 이상과 관련, serotonin 분비 증가, IL-$1{\alpha}$, IL-1, IL-6, IL-8 TNF-${\alpha}$와 관련이 있다. 악액질의 기전은 에너지와 기질(substrate metabolism)에서의 변화, 종양에서 생산된 지질분해요소와 단백질 분해요소, 호르몬 이상, 암세포로부터 세포성장에 필요한 영양분을 빼앗기는 것, 에너지 섭취의 감소 등이다. 치료는 정신과 상담 및 환자와 가족의 교육인데, 교육할 때는 환자와 그 가족에게 식욕부진과 악액질이 암으로 인한 임종과정 중 일어나는 자연적인 현상이라는 것을 알리며, 다른 행동으로 환자를 돌보는 방법 등을 교육한다. 약물치료로는 megestrol acetate와 dronabinol, steroid를 사용할 수 있다. 오심 구토의 원인 중 치료가 가능할 수도 있는 것으로는 약물, 요독증, 감염, 불안증, 변비, 상부위장관 폐쇄, 고칼슘혈증, 저나트륨증이 있고, 치료는 metoclopramide, haloperidol, olanzapine 또는 ondansetron 등을 사용해 볼 수 있다. 말기 암에서 호흡곤란의 증상은 폐의 특별한 병변이 없이도 환자가 호소할 수 있는데, 이 경우 opioids가 효과적이다. 말기 암환자에서 환자의 증상을 경감시켜주기 위한 완화치료는 매우 중요하며, 환자의 증상을 잘 평가하고 적절한 치료 및 관리를 해 줌으로써 환자의 삶의 질을 향상시킬 수 있다. 따라서 이들 환자의 증상 호소에 더욱 관심을 갖고 적극적으로 치료하고 관리하여야 할 것이다. Most terminally ill cancer patients experience various physical and psychological symptoms during their illness. In addition to pain, they commonly suffer from fatigue, anorexia-cachexia syndrome, nausea, vomiting and dyspnea. In this paper, I reviewed some of the common non-pain symptoms in terminally ill cancer patients, based on the National Comprehensive Cancer Network (NCCN) guidelines to better understand and treat cancer patients. Cancer-related fatigue (CRF) is a common symptom in terminally ill cancer patients. There are reversible causes of fatigue, which include anemia, sleep disturbance, malnutrition, pain, depression and anxiety, medical comorbidities, hyperthyroidism and hypogonadism. Energy conservation and education are recommended as central management for CRF. Corticosteroid and psychostimulants can be used as well. The anorexia and cachexia syndrome has reversible causes and should be managed. It includes stomatitis, constipation and uncontrolled severe symptoms such as pain or dyspnea, delirium, nausea/vomiting, depression and gastroparesis. To manage the syndrome, it is important to provide emotional support and inform the patient and family of the natural history of the disease. Megesteol acetate, dronabinol and corticosteroid can be helpful. Nausea and vomiting will occur by potentially reversible causes including drug consumption, uremia, infection, anxiety, constipation, gastric irritation and proximal gastrointestinal obstruction. Metoclopramide, haloperidol, olanzapine and ondansetron can be used to manage nausea and vomiting. Dyspnea is common even in terminally ill cancer patients without lung disease. Opioids are effective for symptomatic management of dyspnea. To improve the quality of life for terminally ill cancer patients, we should try to ameliorate these symptoms by paying more attention to patients and understanding of management principles.

한우태자의 축추골 몸통과 첫째 척추사이 원반의 발달

이혜란,안동춘,김인식,양홍현,백영기,Lee, Hye-ran,Ahn, Dong-choon,Kim, In-shik,Yang, Hong-hyun,Paik, Young-ki 대한수의학회 1997 大韓獸醫學會誌 Vol.37 No.1

The histological and histochemical study of the body of axis and 1st intervertebral disc in the Korean native cattle fetus was attempted to early developmental process. The experimental animals used in this study were collected from fetus of the Korean native cattle ranging from 50mm to 180mm in Crown-Rump length(CR-length). The results were summerized as follows: 1. The ossification centers appeared centrum 1 and centrum 2 of the axis in 110mm CR-length fetus of the Korean native cattle. The centrum 2 was formed little earlier than the centrum 1. 2. The histochemical reactions for collagenous fibers in the axis revealed negative in 50mm CR-length, mild positive in 90mm CR-length, and strong positive in 110mm CR-length, respectively. 3. Dense collagenous fibers were observed in the notochord through the centrum 2, and intervertebral disc developed into cuneiform dorsoventrally, It's contour looks like an annual ring. These fiber bundle arranged lamellar formation. 4. The intervertabral disc of 50mm CR-length fetus was composed mainly mesenchymal cells, and these cell showed aggregation in the central portion. The intervertebral disc of 110mm CR-length fetus was consisted of pricipally fibroblast, and notochordal sheath formed with two layers in the center.

실시간 시선 추적과 거리 측정 기법을 활용한 눈 보호 앱 개발

이혜란(Hye-Ran Lee),이준표(Jun Pyo Lee) 한국컴퓨터정보학회 2019 한국컴퓨터정보학회 학술발표논문집 Vol.27 No.2

한식상차림의 색채분석 연구

이혜란 ( Hye Ran Lee ),김혜원 ( Hye Won Kim ),조우균 ( Woo Kyoun Cho ) 한국식생활문화학회 2013 韓國食生活文化學會誌 Vol.28 No.1

「쥐좆도 모른다」의 분석심리학적 연구 -여성 인물의 심리분석을 중심으로-

이혜란 ( Lee Hye Ran ) 한양대학교 동아시아문화연구소(구 한양대학교 한국학연구소) 2019 동아시아 문화연구 Vol.76 No.-

본 연구는 「쥐좆도 모른다」 유래담을 분석심리학적 관점으로 분석하여 작품의 의미를 해명하는 데 있다. 「쥐좆도 모른다」 유래담은 전국적으로 분포되어 있으며 쥐의 둔갑, 진가쟁주, 쥐의 퇴치 세국면으로 동일한 구조를 보이고 있다. 변이 양상에서 주목되는 것은 여성의 시각이 반영되어 윤색되었을 가능성이다. 주변인물이라 할 수 있는 여성은 주체적으로 쥐를 양육하고 있었으며, 진가를 가리는 질문의 내용과 결미는 여성이 바라는 남편의 관점과 가짜를 알아보지 못한 여성의 대상화에 따라 유형이 나뉘고 있어 여성의 심리학적 측면의 해석이 필요하다. 쥐의 둔갑의 빌미를 주체적으로 제공하는 여성은 남성주인공의 부재(不在)한 상황에서 환상을 키워나간다. 그 환상은 정욕의 결핍에 의한 것으로, 쥐를 양육하는 것으로 나타난다. 이는 당대 조혼의 풍속과 사회적 관계로의 가족 이데올로기 과정, 그리고 삼종지도에 따른 지배적 규범이 설정한 바람직한 여성상으로 인해 결핍으로 작용하였으며, 부부가 아닌 며느리 입장에서도 가부장적 질서에 대한 강박증은 여성을 환상이라는 쥐를 양육하면서 무의식에 사로잡혀 현실과 멀어지게 된다. 무의식에 사로잡힌 여성은 쥐로 둔갑한 ‘가짜’를 자신이 원하는 남편으로 투사하여 무의식을 체험한다. 이는 여성의 내적인격인 ‘아니무스’의 체험으로, 여성의 바람에 의한 투사상으로 볼 수 있다. 이렇듯 무의식에 사로잡힌 여성이 이를 극복하는 방법은 고통을 수반한 투사에 의한 인식이다. 육체의 욕망과 감정에 사로잡힌 여성들은 결국 ‘쥐좆도 모르냐’며 비난과 책망의 대상이 되기도 하지만 서사에서 주목되는 것은 남편과 함께 행복해지는 결말이다. 물론 여성의 적극성이 나타나지 않고 남편의 이해에 비롯되지만 이를 통해 서사는 완정한 가족관계를 제시하고 있다. 더 나아가 완정한 가족관계를 위해 여성의 전체성을 이루기 위한 아니무스의 발달을 강조하며, 완정한 가족 관계의 지표로서의 여성상을 제시하고 있는 서사가 바로 「쥐좆도 모른다」 유래담이다. This paper aims to analyze the meaning of the folk tale on a Korean saying, “You don’t know even a rat’s penis”, in the perspective of analytical psychology. The folk tale with variation behind the saying, “You don't know even a rat's penis” is found nationwide, and all the variated tales are based on the same structure, consisting of three phases including the transformation of a rat, a quarrel over who is real and who is fake, and the eradication of the rat. One of the noticeable points in the variations is the addition of feminine perspectives. In such tales, a female character, the wife of the man whose appearance is stolen by the rat, voluntarily raises the rat. This female character has also variations which are divided into several types depending on what questions she asks to the two men who look the same, what she wishes for her husband, or how she is targeted due to her false selection on the fake. These features require the interpretation on the folk take in the perspective of feminine psychology. Since the absence of her husband, the female character has raised the rat, developing her own fantasy, and the rat finally transforms into a man. The fantasy comes from the social suppression of her sexual desire, and it is represented as a rat rearing. This suppression reflects the idea of family combined with the tradition of early marriage, relevant social relationships, and predominant norms imposed on women following ‘Three Obediences (三從之道).’ That is, the obsession toward the patriarchal norms makes the female character seized with the unconscious fantasy, even in the position of a daughter-in-law losing her husband. When the rat transforms into a man, this woman possessed with the unconscious fantasy projects what she has wished for her husband to this transformed rat. This is called the ‘animus’ experience, reflecting her inner personality. Projecting women's humble wishes toward their husbands, the variations led by a female character honestly reveals women's perspectives. Like in the female version of the folk tale, women who are seized with their unconscious fantasy can come over the situation by perceiving what projects their practical wishes. Sometimes women obsessed with lust and emotions would be blamed with the words, “You don’t know even a rat’s penis” but the core of such narratives is the happy ending where the female characters get back a happy life with their husbands. While the female characters do not show active actions sufficiently, and finally follow their husbands, the female variations present meaningful implications on the perfect appearance of family relationships. Furthermore, this folk tale emphasizes the development of animus to complete women’s integrity for the perfectness of family relationships.

중년층 라인댄스 참여자의 동기가 정서와 심리적 안녕감에 미치는 영향

이혜란(Lee, Hye-Ran),윤인애(Yoon, In-Ae),윤용진(Yoon, Yong-Jin) 한국체육과학회 2013 한국체육과학회지 Vol.22 No.5

The purpose of this research is to know the relation of psychological well-being through participative motivation of line dance in the middle-aged, and also how to apply emotional experience psychological well-being. This research represents the dancers participating in line dance competition and uses judgment sampling method. 300 questionnaire was distributed, and got rid of four questionnaire which are unreliable response. Finally, 296 questionnaire was used in data collected. for analysis, frequency analysis, exploratory factor analysis, Cronbach’s a, reliability analysis, hierarchical regression and path analysis were used by computer using the statistical program SPPSS Version 15.0 and Amos. The result of research is as follows. First, participative motivation of line dance participants has an impact on emotional experience. Second, participative motivation of line dance participants has an impact on psychological well-being. Third, emotional experience of line dance participants has not an impact on psychological well-being Finally, getting technical development, a sense of achievement, health, strength, pleasure, external show off and sociability by participating line dance made the psychological well-being to the line dance participants Therefore, it is important to let the middle-aged enjoy participating line dance rather than controlling their emotional experience.

영어영문학21제26권 2호 : 포스트아파르트헤이트 시대의 "탈정체화"-나딘 고디머의 『줄라이의 사람들』

이혜란 ( Hye Ran Lee ) 21세기영어영문학회 2013 영어영문학21 Vol.26 No.2

In July`s People, Nadine Gordimer considers post-apartheid as a revolutionary ‘interregnum’ in the history of South Africa, and pays attention to a great diversity of ‘morbid symptoms’ in the post-apartheid era. The novel traces to the inner changes of Maureen and Bam, a liberal white couple who are shipwrecked in ‘homeland,’ which is one of black people`s reservations and their servant July`s hometown. In July`s People, Gordimer examines the possibility of whites` coexistence with blacks in the post-apartheid era when the black power establishes a new social, political order. The purpose of this paper is to analyse the moments of rupture of Maureen`s and Bam`s identities in the perspective of ‘de-identification,’ which is one of main notions of Jacques Ranciere. In Ranciere`s definition, an identity is something given by ‘police community,’ and ‘political subjectivation’ can be achieved by the process of dismantling the identity distributed by this ‘police community.’ From this perspective, this paper interprets Maureen`s choice in the end of the novel as a step of becoming a ‘political subjectivation’ which the new political order demands South African whites in the post-apartheid era. Maureen`s action can be interpreted as a kind of initiation in which she tries to throw herself into ‘July`s people’ in ‘the age of July.’

장미 에탄올 추출물의 항산화성 및 항균성

이혜란(Hye Ran Lee),이지민(Ji Min Lee),최남순(Nam Soon Choi),이종미(Jong Mee Lee) 한국식품과학회 2003 한국식품과학회지 Vol.35 No.3

IPA 기법을 활용한 OSC 프로젝트의 운반 시스템 관리 역량 도출 및 분석

이혜란(Lee, Hye-Ran),이준성(Yi, June-Seong) 대한건축학회 2021 대한건축학회 학술발표대회 논문집 Vol.41 No.2

Off-site Construction(OSC) is a new construction method based on factory production. Researches such as OSC-related design and production standardization, transport methods are actively conducted all over the world as this new method has an edge over existing methods in terms of productivity, economy and quality. As the emergence of this new area requires reasonable management, an analysis of competency of OSC project management is required accordingly. Therefore, this study aimed to determine management competence factors of OSC transportation system, and to analysis of its priority using Importance Performance Analysis(IPA). The result of this study can be utilized by OSC project performers to assess and improve the management competence of OSC transportation system.

소멸하는 질서와 새로운 질서의 경계에서 글쓰기 -나딘 고디머의 『보호주의자』

이혜란 ( Hye Ran Lee ) 21세기영어영문학회 2016 영어영문학21 Vol.29 No.4

In The Conservationist, Nadine Gordimer creates renewed writing space by implementing ingenious literary styles in the form of the South African traditional Plaasroman genre. This paper demonstrates that Gordimer reveals her knowledge of the situation of South Africa in the 1970s and, by delving into a white man`s dislocated and collapsed consciousness, demands that whites change their way of thinking to conform to the emerging order of black people in South Africa. Although the protagonist Mehring, a pig-iron industrialist and owner of a suburban farm, pretends to be a conservationist of South African nature, he appears instead to be a conservationist of the conventional world instituted by Apartheid. However, Mehring`s `actual world` as a `closed system` experiences irrevocable disrupture when he encounters an unknown black body in the field of his farm, which signifies the Lacanian `real` annulled and eliminated by the laws and languages of Apartheid. Mehring is forced to disclose his lack of awareness of the land and people of South Africa. He is incapable of perceiving other languages beyond Apartheid and fails to make relationships with other people since he cannot escape the order and the language of Apartheid. Mehring`s predicament exemplifies the situation of whites in South Africa who are being enmeshed in an obsolescent order and language system of white dominance. In The Conservationist, Gordimer urges South African whites to recognize the loss of their power of language and order and to prepare to accept the coming new order of black people.