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.

말과제와 인지과제 동시수행이 정상성인 및 말더듬성인의 유창성에 미치는 영향

이혜란(Hye-Ran Lee),황민아(Mina Hwang) 한국언어청각임상학회 2001 Communication Sciences and Disorders Vol.6 No.2

본 연구에서는 말더듬성인 9명과 정상성인 10명이 두 종류의 말과제와 세 종류의 인지과제를 각각 혹은 동시에 수행하였을 때 말더듬빈도와 인지과제의 반응시간 및 반응정확도에 어떠한 변화가 나타나는지 살펴보았다. 이야기 말하기에서 정상집단은 이야기만 할때에 비하여 이야기와 인지과제를 동시에 할 때 말더듬빈도가 유의하게 증가하였다. 이는 동시과제 조건에서 인지적 요구(demand)가 증가하였고, 이것이 유창한 말을 유지할 수 있는 능력(capacity)을 초과하여 말더듬빈도가 증가한 것으로 설명할 수 있다. 한편, 말더듬집단은 동일한 조건에서 유의한 차이를 보이지 않았는데, 이는 말더듬집단의 개인차가 컸던 점과 관련될 수 있을 것으로 보인다. 모든 조건의 반응시간 및 반응정확도에서는 유의한 집단간 차이가 나타나지 않아 말더듬집단이 더 유의하게 말에 대한 선택적인 주의를 기울였다고 말하기는 어렵다. The purpose of the present study was to test whether stutterer s speech disfluencies changed when they concurrently performed 3 kinds of cognitive tasks with different levels of demands- - a detection task, and two discrimination tasks with different number of choices. The effect of the increasing demand on stutterers disfluencies were measured in 2 different speech tasks- - counting which was thought to require minimum resources and story retelling which was thought to resemble our daily life discourse requiring higher demands. Nine adult stutterers and 10 non- stuttering adult s participated in the study. Inconsistent with demand and capacity model of stuttering, stutterer s disfluencies did not increase significantly when the demand increased with concurrent performance cognitive tasks. This result was found regardless of the difficulties of cognitive tasks and the types of speech tasks. Interestingly, concurrent performance of cognitive tasks did significantly increase non- stutterers disfluencies during story- retelling. Because no significant group differences were noted either in RT or in the accuracy of the cognitive tasks, it is not likely that the stutterers kept their speech performance at the cost of cognitive task performance. The examination of stutterer s individual data in story- retelling showed a wide variability among the participant s. Such result s indicated that although non- stutterer s speech fluency is generally affected by the demand of cognitive tasks, there may be substantial individual differences in the stutterer s susceptibility to the increased cognitive demand.

영국 헤리티지 산업에 대한 문화적 개입과 수정-V.S. 나이폴의 『당혹스러운 도착』

이혜란 ( Hye Ran Lee ) 한국현대영미소설학회 2015 현대영미소설 Vol.22 No.2

This paper explores the way Naipaul critically engages in the cultural politics of 1980s in England which is represented by the Heritage Industry through analysing how The Enigma of Arrival describes the English country house and the rural landscape. The Heritage Industry, supported strategically by Thatcher government, encouraged the English people to search “Englishness” through consuming cultural goods concerning “national heritages.” As a response to the post-imperial decline and the rush of immigrants from the former British colonies, the Heritage Industry reveals the conservative defensive psychology of the English society. The narrator of the novel, an Indian immigrant from the Caribbean, settles in the Edwardian manor, the ancient heart of England, and observes the English landlord to find out that he is still living in the imperial past. Naipaul``s narrator realizes the morbid aspects of his landlord who is hypnotized by the images of the past and lost the capacity for creative changes. Naipaul suggests the English society confront the post-imperial realities from the perspective of “change” and “flux” instead of being obsessed by the idealized past. Through The Enigma of Arrival, Naipaul criticizes the cultural stream of the Heritage Industry and claims his own territory as an immigrant in the post-imperial English society.

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.

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.’

교통사고 이후 발증한 후천적 말더듬 치료 사례 보고

이혜란(Lee Hye-ran) 한국재활심리학회 2009 재활심리연구 Vol.16 No.2

This study reports the onset of stuttering after a car accident and discusses the nature of acquired stuttering. A 34-year-old man showed depression and moderate stuttering after a car accident but had no other neurological or cognitive problems. Six months later he manifested little stuttering in his speech but showed unnatural prosody. Another five months later his speech became fluent again and was relatively natural with a certain Korean provincial accent. This case indicates that stuttering after a car accident may result from a psychological problem rather than a neurological problem for the following reasons. First, he showed no abnormal pattern on neurological examination (no abnormalities in his brain MRI and PET). Second, a car accident can bring about emotional trauma, and the car accident was temporally related to the onset of his stuttering. Third, he showed accompanying psychiatric/psychological problems. Fourth, his coping strategy was unusual. Finally, the stuttering symptom itself was resolved in the early stages following the accident.

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

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

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.