한국인에게서 그레이브스병 약물치료의 적정기간

이형숙,이동훈,정희선,이종우,김정은,신승수,정윤석,이관우,김현만 대한내분비학회 2003 Endocrinology and metabolism Vol.18 No.1

연구배경: 그레이브스병의 치료에는 항갑상선제, 수술 및 방사성 요오드법이 선택되어 사용되고 있다. 이중 항갑상선제는 가장 많이 선호되고 있으나 낮은 관해율과 높은 재발율로 장기간 치료기간이 요구된다. 저자들은 그레이브스병 환자에게서, 선택되는 치료법의 선호도와 각 치료법의 관해율을 조사하고자 본 연구를 시행하였다. 또한 본 연구에서는 항갑선제 치료의 적정기간을 평가하고자 하였다. 방법: 아주대학교병원에 내원한 환자 중 1년 이상 추적관찰이 가능한 205명의 그레이브스병 환자를 대상으로 조사하였다. 항갑상제군, 수술군 및 방사성 요오드군은 각각 170명, 29명 그리고 6명이었다. ROC curve를 이용하여 약물치료의 예후예측인자를 분석하였다. 결과: 1) 그레이브스병 환자의 치료 방법의 선택은 항갑상선제군, 수술군 및 방사성 요오드군 각각 170명(83.0%), 29명(14.1%) 그리고 6명(2.9%)으로 항갑상선제 치료가 가장 선호되었다. 2) 그레이브스병의 관해율은 항갑상선제군, 수술군 및 방사성 요오드군에서 각각 60.0%(102/170명), 96.5%(28/29명) 그리고 83.0%(5/6명)으로 수술군이 가장 높았다. 3) ROC curve의 AUC는 치료기간과 진단시 TBII가 각각 0.709 및 0.648이었고 적절한 약물투여 추적 관찰기간은 26개월이었다. 결론: 그레이브스병의 일차 치료법으로는 항갑상선제가 선호되고 있으나 수술 및 방사성 요오드 치료군에 비해 상대적으로 낮은 관해율을 보였다. 따라서 항갑상선제 치료로 26개월 이상 관해가 되지 않을 경우에는 치료 방법의 변경을 고려하는 것이 관해율을 높이는데 도움이 될 것으로 생각된다. Background: Graves' disease in an organ specific autoimmune disease. Three kinds of therapeutic modalities (antithyroid drugs, ablation with radioactive iodine and subtotal thyroidectomy) are frequently performed for the management of this disease. The most popular therapeutic policy for the disease in Korea is antithyroid treatment. We analysed and compared the remission rates of all three modalities for Graves' disease, and evaluated the antithyroid modality to determine the correct duration of treatment. Subjects & Methods : The medical records of 205 patients with Graves' disease were reviewed. For the evaluation of the antithyroid modality medical treatment, antithyroid drugs were administered for more than 1 year. The prognostic factors associated with remission were analysed by means of an ROC curve. Results: 1) Of the 205 patients, proportions that received medical therapy, subtotal thyroidectomy and radioiodine therapy were 83.0, 14.1 and 2.9%, respectively. 2) The remission rates of the medical therapy, surgery and radioiodine therapy were 60.0, 96.5 and 83.0%, respectively. 3) The remission rate of the medical therapy was associated with the duration of medication and TBII activity. The determined proper duration for the antithyroid treatment was 26 months from the ROC curve analysis. Conclusion: The above results suggest that the proper duration of antithyroid treatment for Graves' disease is 26 months, after which time the subtotal thyroidectomy or radioiodine therapy should be considered if the disease has not remitted (J Kor Soc Endocrinol 18:24∼31, 2003).

제2형 당뇨병 환자에서 적극적 환자 교육이 혈당조절에 미치는 효과

이윤욱,황원선,최선정,이동훈,김도현,이은희,홍은경,노혜림,정윤석,이관우,김현만 대한내분비학회 2003 Endocrinology and metabolism Vol.18 No.1

연구배경: 현재까지의 당뇨병 교육에 대한 노력은 제한되었으며, 연구 결과를 보면 식사 조절 교육과 체중 조절 프로그램을 수행한 환자들 중 적극적이고 기간이 긴 교육을 받은 경우, 성공적 결과가 나타남을 알 수 있었다. 자가관리나 체중감량 등의 당뇨병 치료의 중요한 목표는 적극적이고 긴 기간의 교육 없이는 시행되기 어렵다. 본 연구에서는 외래에서 당뇨병 환자를 대상으로 시행할 수 있는 행동 및 식사 교육 등의 적극적 교육 프로그램을 개발하여 제2형 당뇨병 환자들을 대상으로 이들에게 식사 조절 방법에 대한 목표설정과 문제에 직면하였을 때의 해결 방법 등을 교육해서 궁극적으로는 적극적 자아관리에 연결될 수 있도록 도와주는 것을 목적으로 기존의 통상적 교육과 보다 적극적인 교육이 당뇨병 환자의 혈당 조절에 어떠한 영향을 미치는지에 대해 알아보기 위해 다음과 같은 연구를 시행하였다. 방법: 본 연구는 아주대학교 병원 내분비 대사 내과를 처음으로 방문하여 치료받았던 58명의 제2형 당뇨병 환자를 대상으로 하였다. 내원 환자들을 무작위하게 추출하여 진찰권 번호 끝자리에 따라 홀수는 통상적 교육군(conventional education group, CE)과 짝수는 적극적 교육군(intensive education group, IE)으로 나누어 교육하고, 3개월후에 교육의 효과를 평가하였다. 결과: 1) 연구 대상자들의 교육 전과 후의 공복혈당, 식후2시간 혈당 및 HbA_lc 치는 IE군과 CE군 모두 각 그룹 내에서, 유의적으로 감소하였다(p<0.05). IE군에서는 공복혈당이 12.4nmol/L에서 7.7nmol/L로, 식후2시간 혈당이 20.3nmol/L에서 10.9nmol/L으로, HbA_lc치가 9.4%에서 7.0%로 모두 교육 전에 비하여, 교육 후에 감소(p<0.05)하였고, CE군도 공복혈당은 10.9nmol/L에서 9.4nmol/L로, 식후2시간 혈당은 17.1nmol/L에서 14.6nmol/L으로 HbA_lc가 8.5%에서 7.3%으로 모두 교육 후에 감소하였다(p<0.05). 또한, 교육 전에 비하여 교육 후에 공복 혈당 및 HbA_lc치가 감소하는 정도는 IE군에서의 감소가 CE군에 비해 더 현저하였다Op<0.05). 2) 식사에 대한 태도는 3부분으로 나누어 식사에 대한 규칙성, 식사 내용의 균형성, 식사에 대한 태도 등으로 나누어 각각의 점수 및 총점을 비교하였으며 교육 전에 비해 교육 후에 연구 대상자들의 식태도가 향상되었음을 알 수 있었다. 두 그룹간의 차이를 분석한 결과 식사의 균형성 항목에서와 총점에서 유의적으로 두 그룹의 차이를 보여서 IE군에 CE군에 비해 식사의 균형성 측면이 향상되었고, 전체적인 식태도가 좋아졌음을 알 수 있었다(p<0.05). 결론: 비교적 긴 기간은 아니지만 적극적 교육을 받은 당뇨병 환자들이 통상적 교육을 받은 군보다 혈당 및 HbA_lc, 식태도 점수등의 수치의 호전뿐만 아니라 당뇨병 환자의 삶에서 중요한 부분을 차지하는 식사요법 관리 부분에 있어 향상됨을 알 수 있었다. Background: To this date, efforts to develop effective methods for the education of diabetic patients have been limited. The important goal of self-management and weight control for diabetic treatment can not be attained without long and intensive period of education. This study was undertaken to assess the effectiveness of an intensive educational program, of behavior and diet control, which was carried out on subjects with type 2 diabetes, on and out-patient basis. we compared the effectiveness of an intensive education programme with that of a conventional education programme for the self-management of type 2 diabetic patients. Methods: Subjects with type 2 diabetes were randomly selected, and allocated to one of two groups. One group received a conventional education programme of self-management(the CE group), and the second group received an intensive education progammes for three months, after which the effectiveness of the programmes were evaluate. Results: 1) The levels of fasting blood sugar(FBS), postprandial 2 hour blood sugar(PP2h) and HbA1c were significantly lowered in both groups following the intervention(p<0.05). In the IE group, the FBS declined from 12.4nmol/L to 7.7nmol/L, PP2h declined from 20.3nmol/L to 10.9nmol/L, and the HbA_lc showed a similar decline from 9.4 to 7.0% after intervention(p<0.05). In the Ce group, the FBS declined from 10.9 to 9.4nmol/l, the PP2h decreased from 17.1 to 14.6nmol/l, and the HbA_lc also decreased from 8.5 to 7.3% after intervention(p<0.05). The decrease in the FBS and HbA_lc following the educational intervention was more pronounced in the IE group than the CE group(p<0.05). 2) The effectiveness of the education programmes in promoting appropriate dietary behavior in the diabetic subjects was assessed by a scoring system in three parts: a regularity score, a balance score and an attitude score. From a comparative study of the three scores, the patients attitudes were observed to be much improved in both the groups following the intervention compared to before the programmes, but the balance and total scores were significantly higher in the IE group than the CE group(p<0.05). Conclusion: We can conclude that the intensive diabetic education programme is more effective than a conventional programme, not only in improving the patients' levels of glucose, HbA_lc, and dietary score, but also the diabetic patients self-control abilities, promoting behavioral change, and prompting problem solving capabilities in respect to the everyday problems that they have to face throughout their lives(J Kor Soc Endocrinol 18:63∼72, 2003).

Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy in management of peritoneal carcinomatosis: Single center experience in Korea

Hee Ju Lee1,HyungJoo Baik1,박요한,서상혁,김광희,Ki Beom Bae,Kwan Hee Hong,김기향,변정미,Dae Hoon Jeong,Kyung Bok Lee,오민경,조광래,안민성 대한종양외과학회 2019 Korean Journal of Clinical Oncology Vol.15 No.2

Purpose: Peritoneal carcinomatosis (PC) has been considered a terminal condition and cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIEPC) is regarded as an alternative therapeutic option. This study aimed to evaluate the 30-day clinical outcomes of CRS/HIPEC and the feasibility of the surgery by investigating the morbidity and mortality in Inje University Hospital. Methods: Data were retrospectively collected from 19 patients with PC who underwent CRS/HIPEC at Inje University Hospital in 2018. We evaluated pre-, intra-operative parameters and postoperative clinical outcomes and early complications. Results: The mean operating time was 506.95 minutes and the mean blood loss was 837.11 mL. Six cases (31.58%) had morbidity of grade III or above. A longer operating time (≥560 minutes, P=0.038) and large blood loss (≥700 mL, P=0.060) were positively correlated with grade III or worse postoperative complications. Conclusion: Our early experience with CRS/HIPEC resulted in a 31.58% morbidity rate of grade III and above, with risk factors being longer operating time and greater intraoperative blood loss. As the surgical team’s skills improve, a shorter operating time with less intraoperative blood loss could result in better short-term outcomes of CRS/HIPEC.

경사 슬래브교의 지간/폭, 경사각에 따른 응력 상관성

남문희,정희효,이관희,이수경 慶尙大學校生産技術硏究所 1996 生産技術硏究所論文集 Vol.12 No.-

Skewed slab bridge have designed a width beam, stress of skewed slab bridge is quite different in according with skew and width /length. Especially in case that we analyse skewed slab bridge as a width beam, stress of right angle direction against axis of bridge is not analysed. In this study we will present the stress of transverse axis to longitudinal axis of bridge according to skew and width/length.

Discordance in Spirometric Interpretations Based on Korean and Non-Korean Reference Equations

Nami Kim,Mi-Hee Park,Se-yeong Kim,Chunhui Suh,Sangyoon Lee,Kun-Hyung Kim,Chae-Kwan Lee,Dae-Hwan Kim,Jong-Tae Lee 대한직업환경의학회 2013 대한직업환경의학회지 Vol.25 No.-

Objectives: Korean regression models for spirometric reference values are different from those of other ethnic groups. The purpose of this study was to evaluate discordance in spirometric interpretations based on using Korean reference equations versus non-Korean reference equations. Methods: Spirometry was performed on 825 Korean male workers from April 2009 to November 2011. The spirometric patterns and disease severity were evaluated using two Korean equations (Choi’s and Lee’s) and three equations for Caucasians (NHANES III, Morris’s, and Knudson’s), and the results of Choi’s equation were compared with the non-Korean equations. The spirometric patterns were defined as normal, restrictive, and mild and moderate obstructive. Results: The mean differences in the FEV1% and FVC% between the two Korean equations were 2.0 ± 1.3% and 3.5 ± 2.2%, respectively. Morris’s equation had the greatest difference in the FEV1% from Choi’s equation: 32.9 ± 8.5%. Knudson’s equation had the greatest difference in the FVC% from Choi’s equation: 10.5 ± 6.5%. Conclusions: The two Korean equations shared similar characteristics of spirometric interpretation. The spirometric interpretations of Choi’s equation were significantly different from those of Morris’s equation and Knudson’s equation.

역사문화경관의 반복체험에 관한 연구

이관희 한국전통조경학회 2003 한국전통조경학회지 Vol.21 No.1

The purpose of the research programme was to compare the difference of experiences of the historical and cultural landscapes with the periodicity. Final results suggest that the experience of a particular landscape could be significantly influenced with the time interval or past experience. And it is also found that the experience would be gradually decreased by a time factor. In order to get more confident results from the experiment, the researchers should depend upon the repeated experiences of landscape. According to the research results, it is often very dangerous for us to criticize the landscapes that have been created or found in our environment without the outcome of the research resulted from repeated experience. The average mean of repeated experiences to each landscape was gradually decreased.

전달행렬에 의한 탄성지반에 놓인 축대칭 원추-원통형 탱크 해석

이관희,정성태,박준용,남문희 慶尙大學校生産技術硏究所 1997 生産技術硏究所論文集 Vol.13 No.-

Even though there are many analysis methods of circular tanks on elastic foundation, the finite element method requires a number of memory spaces computation time to solve large stiffness equations, In this study many the simplified methods are applied to analyze a cone-cylinder tank on elastic foundation. By the given analysis methods, direct stiffness method and foundation matrix method, the con-cylinder tank was transformed into the skeletonized frame structure. The frame structure was drivided into several finite elements. The stiffness matrix of a finite element is related with the transfer matrix of the element. Thus, the transfer matrix of each finite element utilized the transfer matrix method to simplify the analysis of the tank. There were no significant difference in the results of two methods, the finite element method and the transfer matrix method. The transfer matrix method applied to a circular tank on elastic foundation resulted in four simultaneous equations to solve completely

중추도파민신경활성에 미치는 뇌기능개선 후보약물의 행동약리학적 연구

이순철,유관희,山本經之 충남대학교 약학대학 의약품개발연구소 1995 藥學論文集 Vol.11 No.-

The present study was undertaken to elucidate the behavioral characteristics of nootropic candidates, centrophenoxine, N-methyl-D-glucamine, piracetam and red ginseng saponin components on stereotyped sniffing behavior induced by apomorphine in rats. Apomorphine, a direct dopaminergic receptor agonist, induced stereotyped behaviors including sniffing, licking, gnowing and biting in a dose dependent manner, and that behaviors were completely inhibited when measured at 1 week after 6-hydroxydopamine(6-OHDA) treatment. Centrophenoxine, N-methyl-D-glucamine, red ginseng total sapomin (TS), panaxatriol (PT), and Rg_1 enhanced but panaxadiol (PD) inhibited, whereas priacetam and Rb1 were not effective of the stereotyped sniffing behavior induced by apomorphine (1 ㎎/㎏). The enhanced stereotyped behavior by centrophenoxine, N-methyl-D-glucamine, red ginseng total saponin, panaxatriol(PT), and Rg_1 was blocked by pretreatment of 6-OHDA. These results suggest that dopaminergic neuronal activity plays an important role in the action of some nootropic candidates. Red ginseng total saponin, panaxatriol and Rg_1 seems to have a similiarity to centrophenoxine, N-methyl-D-glucamate in modulating of dopaminergic neuronal activity and also may be useful for the nootropic candidates.

홍삼 조사포닌 성분의 중추작용

이순철,이수정,정경수,유관희,김학성 충남대학교 약학대학 의약품개발연구소 1995 藥學論文集 Vol.11 No.-

The present study was undertaken to elucidate the characteristics of red ginseng total saponin in behavioral changes on ambulation, forced swim test and convulsion in mice. The ambulation and the duration of immobility on forced swim test were not affected by red ginseng total sapinin. On the other hand, the duration of immobility induced by DMI, PGL but not CIP was significantly decreased, and the onset of convulsion induced by pentylenetetrazole was significantly shortened by preadminstration of red ginseng total saponin. These results suggest that red ginseng total saponin component may play an important role in modulation synergism with drugs acting on depression and convulsion, and that the characteristics of synergetic effect induced by red ginseng total saponin potentiate the central norepinephrine neuron activity.

일측성선조체의 6-OHDA손상 후 도파민효능약물 투여로 발현된 회전운동의 특성

이순철,문민선,이수정,유민,윤철호,유관희 충남대학교 약학대학 의약품개발연구소 1997 藥學論文集 Vol.13 No.-

The present study examined the characteristics of behavior induced by dopamine agonists following treatment with 6-hydroxydopamine(6-OHDA) unilaterally into left striatum in rats. 6-OHDA was administered at doses of 8.16 and 24 ㎍/2㎕(in 0.1% ascorbic acid) into dopaminergic neurons in left striatum of 7 weeks old rat under anesthetic. Locomotor activity was significantly decreased at 1 week following 6-OHDA-administration in 7 weeks old rats. The contralateral circling behaviour was inducd by apomorphine(5 ㎎/㎏, I.p.) after 1 week following 6-OHDA(24 ㎍/2㎕) treatment, and was further increased by repeated administration of apomorphine at 2, 3 and 4 weeks. The contralateral circling behavior was also induced by lisuride and 1-dopa in a dose dependent manner, but not by SK & F 82526 in 7 weeks old rats treated with 6-OHDA, The contralteral circling behavior ws significantly higher in 21 weeks old rats but significantly lower in 35 weeks old rats when compared with 7 weeks old rats. The contralateral circling behavior induced by apomorphine did not differ significantly in and 35 weeks old male and female rats. These results suggest that 6-OHDA treatment into left striatum causes remarkable destruction of intrastriatal dopaminergic neurons leading to dopaminergic receptor supersensitivity. Thus, the contralateral circling behavior induced by apomorphine may be used as indicator for neurodegenerative diseases.