영·유아 언어, 인지, 사회·정서 발달 평가도구 문항 개발을 위한 예비연구

이종숙,신은수,박은혜,김영태,유영의,최일선,유흥옥 이화여자대학교 교육과학연구소 2009 교육과학연구 Vol.40 No.3

본 연구는 만 2~5세 영·유아의 발달 상태를 객관적으로 평가함과 동시에 발달이 지연된 영·유아를 선별할 수 있는 발달평가도구 문항을 개발하기 위한 예비연구이다. 이를 위해 문헌고찰 및 발달관련 평가도구들을 비교 분석하여 발달지표를 선정하고, 만 2세~5세까지의 영·유아의 언어, 인지, 사회·정서발달영역을 교사관찰에 기초하여 평가할 수 있는 문항을 개발하였다. 연구대상은 대도시, 중소도시, 읍면 소재지 별로 표집 된 만 2세부터 5세까지 총 13개 유아교육기관에 다니는 435명의 영·유아들이며, 본 연구에서 최종 개발된 평가도구의 문항은 총 141문항이다. 평가도구 문항은 언어, 인지, 사회·정서발달영역별로 영·유아의 행동과 언어를 중심으로 교사가 관찰하고, 관찰하기 어려운 문항에 대해서는 단서와 kit를 제시하여 평가할 수 있도록 구성하였다. 개발된 평가도구 문항의 적절성을 알아보기 위하여 내용 타당도와 내적 신뢰도를 살펴본 결과 비교적 양호한 것으로 나타났다. This was a preliminary study to construct a developmental rating scale for understanding children's objective developmental levels and screening developmental disabilities. For this purpose, a developmental indicator was selected by a literature review and comparative analysis of related developmental assessment tests. An assessment scale based on teacher's observations to measure language, recognition, and social-emotional developmental areas was developed. The subjects were 435 young children aged 2 to 5 who lived in both urban and rural areas. A trial test consisted of 141 assessment items in the language, recognition, and social-emotional developmental domains. The developmental scale was evaluated by teachers who observed children's behavior and language, and used clues and kits. Tests on validity and reliability for confirming the appropriateness of the developed assessment scale showed that content was relatively valid and internally consistent.

기관지 방선균증의 임상 1례

이은영,장태원,정만홍,옥철호,이규원,손창배,이지숙,신은경,서정아,백종현,김영옥 고신대학교의과대학 2007 고신대학교 의과대학 학술지 Vol.22 No.2

Actinomycosis is a chronic suppurative infection, whitch infiltrates mucosa-associated tissues. Thoracic, pelvic and cervicofacial infections of actinomyces are not uncommon, but endobronchial actinomycosis is rarely reported. We report a case of a 29 year old man who presented with a recurrent pneumonia and chronic cough. Fiberoptic bronchoscopy revealed occlusion of the right. lower medio-basal segment bronchus with exophytic endobronchial mass. The diagnosis was confirmed histologically by demonstration of sulfur granules in the bronchoscopic biopsy of the mass. Intravenous administration of amoxacillin and clindamycin followed by oral amoxacillin and clindamycin therapy resulted in complete recovery.

상염색체우성 다낭신의 임상경과 및 합병증

이상주,이영모,이한규,최대은,박기현,이강욱,신영태 충남대학교 의학연구소 2001 충남의대잡지 Vol.28 No.2

Autosomal dominant polycystic kidney disease(ADPKD) is one of most common hereditary disorder. It is potentially fatal and the major mobilities are hypertension and renal failure. To elucidate clinical characteristics and outcomes of ADPKD, 67 ADPKD patients were analyzed retrospectively. The male to female ratio was 48 years for males and 42 years for females. The factors leading to the dignosis of ADPKD were flank or abdominal pain (46%), palpable abdominal mass (24%), incidental findings (18%), gross hematuria and headache. Urinalysis result showed hematuria (31%), proteinuria (19%), pyuria (18%). Among renal complications hypertension (67%) was the most common. Other complications were urolithiasis (16%) upper urinary tract infection (9%), cyst infection (7%). Azotemia was observed in 24% of cases. Echocardiography showed left ventricular hypertrophy in 24% and valvular regurgitation in 18% of cases, but there was no mital valve prolapse. Cerebrovascular events occurred in 6 cases (2 cases of intervertebral hemorrhage and 4 cases of cerebral infarction). Hipatic cyst were observed in 64% of cases. Eighteen cases culminated in end stage renal failure (ESRF) at an of 47. According to this study, the most common complications of ADPKD was hypertension (67%), ESRF (27%), and cerebrovascular event (9%). Hypertension was more frequently observed in increased creatinine group than normal.

췌장암 환자에서 알코올 내장신경 신경파괴블럭 후 발생한 간염

이상은,최석환,김영환,임세훈,이정한,이근무,정순호,최영균,김영재,신치만 인제대학교 2008 仁濟醫學 Vol.29 No.-

Splanchnic neurolytic block(SNB) with alcohol improves the management of pancreatic cancer pain. Adverse effects of alcohol SNB which include regional pain, hypotension, diarrhea, and acute alcohol intoxication are common, but acute hepatitis caused by alcohol neurolytic block is rare. A 63-year-old patient with pancreatic head cancer and liver metastasis had complete pain relief after both retrocrural tansdiscal SNB with 100% alcohol 10 ml. But, 1 day later, liver function test showed a high elevation in the aspartate aminotransferase (AST, 2182 IU/L) and alanine aminotransferase (ALT, 1807 IU/L). The patient had slight jaundice, general weakness, chilling, nausea and vomiting after SNB. Both AST and ALT decreased to 46 and 119 IU/L within 10 days with only supportive therapy. But, 19 days later, the patient died due to pneumonia. Our case illustrates the importance of clinical surveillance especially in patient with hepatic disease after alcohol SNB.

톡소포자충 배양시 약제투여에 따른 Toxoplasma P30 유전자의 발현

이상걸,이영하,김계영,나영언,신대환 충남대학교 의과대학 지역사회의학연구소 1996 충남의대잡지 Vol.23 No.2

To know the drugs effect on gene expression and its regulating mechanism by RT-PCR and southern blot hybridization assay based on detection of the P30 gene encoding the major surface antigen, P30 of Toxoplasma gondii and the DNA synthesis in T. gondii infected HeLa cells. The experiment was performed and the results were as follows. 1. The thymidine incooperation in DNA of HeLa cell and T. gondii infected HeLa cell reached peak level at 36 hours and suddenly decreased at 48 hours. The uracil incooperation in DNA of T. gondii reached peak level at 48 hours. 2. The decrease of P30 gene expression began from 24 hours after pyrimethamine treated and 36 hours after methotrexate treated in T. gondii. The results were some what different. Pyrimethamine was more sensitive and acted earlier to T. gondii than Methotrexate did. The decrease of P30 gene expression of T. gondii was regulated these drugs in dose dependent manner. 3. The effects of dibutyryl cyclic AMP on P30 gene expression increased peak at 24 hours and on contrary decreased at 60 hours after treatment in dose dependent manner, but at 10mM high concentration of dibutyryl cAMP, P30 gene expression was supressed. 4. Actinomycine D supressed the P30 gene expression of T. gondii in HeLa cell. As the results, we presume pyrimethamine acts more powerful and earlier to supresses P30 gene expression than methotrexate, and it is regulated at transcription level. The results of RT-PCR were in agreement with that of southern blot hybridization.

청장년에서 관찰된 관상동맥의 비죽종성 석회화와 동맥류 : 부검증례보고

이지신,이영직,박종태 大韓法醫學會 1997 대한법의학회지 Vol.21 No.1

Coronary artery calcification(CAC) is found frequently in the atheromatous plaques. CAC is known to have increased frequency above 40 years. CAC without evidence of atherosclerosis in young adults is quite rare, however, CAC combined with aneurysms in young adults have been infrequently reported in patients with a past history of a Kawasaki disease in child. We report an autopsy case showing CAC and aneurysm in the absence of macroscopically identified atherosclerotic lesions in a healthy 23-year-old man. The autopsy examination revealed aneurysmal dilatation of the right coronary artery, which was connected with calcified lesion. A calcified lesion of the left anterior descending coronary artery was aslo noted. Microscopically, aneurysmal wall was non-specific except for hyalinized wall and foci of calcification. A striking histologic finding of calcified mass was ring calcification along the wall of the coronary artery. Antecedent Kawasaki disease in the past was suggestive as other reports.

Contribution of stress and coping strategies to problematic Internet use in patients with schizophrenia spectrum disorders

Lee, Ju-Yeon,Chung, Young-Chul,Song, Je-Heon,Lee, Yo-Han,Kim, Jae-Min,Shin, Il-Seon,Yoon, Jin-Sang,Kim, Sung-Wan Elsevier 2018 Comprehensive psychiatry Vol.87 No.-

<P><B>Abstract</B></P> <P><B>Introduction</B></P> <P>Internet use is already high and increasing rapidly among people with psychotic disorders, but there have been few studies on problematic Internet use (PIU) among patients with schizophrenia spectrum disorders. This study aimed to measure the prevalence of PIU and identify the factors associated with PIU among patients with schizophrenia spectrum disorders.</P> <P><B>Methods</B></P> <P>A cross-sectional survey was performed that included 368 outpatients with schizophrenia spectrum disorders: 317 with schizophrenia, 22 with schizoaffective disorder, 9 with schizophreniform disorder, and 20 with other schizophrenia spectrum and psychotic disorders. The severity of psychotic symptoms and levels of personal and social functioning were assessed by the Clinician-rated Dimensions of Psychosis Symptom Severity (CRDPSS) scale and the Personal and Social Performance (PSP) scale, respectively. PIU was evaluated using Young's Internet Addiction Test (IAT). Additionally, the Hospital Anxiety and Depression Scale (HADS), Perceived Stress Scale (PSS), Rosenberg Selfesteem Scale (RSES), and Brief Coping Orientation to Problems Experienced (COPE) Inventory were administered.</P> <P><B>Results</B></P> <P>PIU was identified in 81 (22.0%) of the 368 patients with schizophrenia spectrum disorders. Subjects with PIU were significantly younger and more likely to be male. Scores on the HADS, PSS, and dysfunctional coping dimension of the Brief COPE Inventory were significantly higher, and RSES scores were significantly lower, in the PIU group. Logistic regression analysis indicated that PIU in patients was significantly associated with scores on the PSS and dysfunctional coping dimension of the Brief COPE Inventory.</P> <P><B>Conclusions</B></P> <P>Patients with schizophrenia spectrum disorders and PIU were significantly more likely to have high levels of perceived stress and dysfunctional coping strategies. Patients with schizophrenia spectrum disorders who also engage in PIU may benefit from interventions that help them to develop appropriate skills for coping with stress.</P> <P><B>Highlights</B></P> <P> <UL> <LI> Patients with schizophrenia spectrum disorders showed a high prevalence (22.0%) of problematic internet use (PIU). </LI> <LI> High levels of perceived stress rather than psychopathology itself contributes to the development of PIU in stabilized patients with schizophrenia. </LI> <LI> Our results indicate that managing stress and developing coping strategies are important for the prevention of PIU among this group of patients. </LI> </UL> </P>

암환자에서 다른 신경학적 증상이 동반되지 않는 두통 : 예비 보고

이성형,안미영,백신혜,이형석,신동익,이상수 충북대학교 의과대학 충북대학교 의학연구소 2010 忠北醫大學術誌 Vol.20 No.1

연구목적 : 암환자에서 신경학적 결손이나 발작 등이 동반되지 않는 두통의 원인과 이런 경우 심각한 두개내 질환에 의한 이차두통을 의심할 수 있는 소견의 진단적 유용성을 알아보고자 하였다. 대상 및 방법 : 2005년 10월부터 2009년 1월까지 신경학적 결손이나 발작을 동반하지 않는 두통이 발생한 71명의 암환자를 대상으로 하였다. 자세한 병력을 청취하고 신경학적 검사를 하였으며, 환자의 상황에 따라 적절한 조합의 뇌MRI, 뇌CT, 및 뇌척수액 검사를 시행하였고, 최소한 3개월 이상 추적 관찰하였다. 이 소견을 종합하여 두통의 국제분류 기준(The International Classification of Headache Disorders, second edition) 에 따라 두통을 진단하였다. 또한 심각한 두개내 질환에 의한 이차두통을 의심할 수 있는 소견인 있는 환자군과 없는 환자군 사이에 중추신경계로의 전이빈도가 차이가 나는지 알아보았다. 결과 : 71명 중에 8.5%인 6명에서 중추신경계로의 전이가 관찰되었는데 심각한 두개내 질환에 의한 이차두통을 의삼할 수 있는 소견이 있었던 18명 중에 4명(22.2%), 이런 소견이 없었던 53명 중에 2명(3.8%)이었다. (상대위험도 5.89, 95% 신뢰구간 1.18-29.49). 두통의 다른 원인으로는 지주막하 출혈이 1명, 중추신경계 이외의 감염에 의한 두통이 6명, 항암제에 의한 두통이 1명, 고혈압성 두통이 1명, 방사선 치료와 관련된 두통이 1명, 원발성 찌름두통이 3명, 긴장성 두통이 51명이었다. 결론 : 심각한 두개내 질환에 의한 이차두통을 의심할 수 있는 소견의 유무가 암환자에서 발생하는 두통의 감별진단에 유용하며, 이러한 소견이 동반되지 않는 경우의 두통은 대부분 양성이다. 하지만 이러한 결론을 바탕으로 향후 보다 많은 대상 환자군을 통한 연구가 필요할 것이다. Purpose: Headache in patients with systemic malignancy is a great concern to neurologists. We performed this study to investigate the frequency of metastasis as the cause of headache in the patients with systemic malignancy and the usefulness of symptoms suggesting underlying serious pathologies especially when headaches do not accompany any other neurological symptoms. Materials and Methods: From October 2005 to January 2009, we prospectively collected 71 patients with systemic malignancy complaining headache but not having any other accompanying neurological symptoms. After thorough history taking and neurological examination, we performed a neuroimaging (MRI or CT) and CSF study according to the clinical situations of individual patients and followed them at least 3 months and diagnosed headaches according to The International Classification of Headache Disorders, second edition (ICHD-II). We compared the incidence of intracranial metastasis between headaches with symptoms suggesting underlying serious illness and those without. Results: Six (8.5%) out of 71 patients had intracranial metastasis: 4(22.2%) out of 18 patients with symptoms suggesting underlying serious illness, 2(3.8%) out of 53 patients without them (relative risk 5.89, 95% confidence interval 1.18-29.49). Other causes included subarachnoid hemorrhage (1 patient), headache attributed to infection (6), headache attributed to drug (2), hypertensive headache (1), headache attributed to radiotherapy (1), primary stabbing headache (3), and tension headache (51). Conclusion: This study suggests that headache symptoms suggesting underlying serious disorder are valuable in differentiating the causes of headache without any other accompanying neurological symptoms in patients with systemic malignancy and headaches without those symptoms might be usually benign. However, more broad study should be made for these value and relationship.

전신마취 후 발생한 악성고열증 환자의 치료 경험

이근무,정승환,이정한,정순호,최영균,김영재,신치만,박주열,이영민 白中央醫療院 2005 仁濟醫學 Vol.26 No.1

Malignant hyperthermia is the disorder of calcium regulation within skeletal muscle associated predominantly with anesthesia. It is triggered by volatile anesthetics and depolarizing neuromuscular blocking agents. We experienced a case of malignant hyperthermia. 50 years old female patient was transferred to our emergency room that she was developed tachyarrhythmia and high fever. She was taken arthroscopic examination under the general anesthesia with enflurane and succinylcholine. We suspected malignant hyperthermia and promptly treated her with dantrolene sodium. She was developed disseminated intravascular coagulopathy and acute renal failure then we were intensive care to her. She was discharged without sequela. We experienced successful management of malignant hyperthermia.

중증 재생불량성 빈혈 환자의 동종골수이식 후에 병발한 간정맥폐색질환(Hepatic Veno-Occlusive Disease)의 임상 경과 및 혈액응고 인자들의 변화

이제환,이규형,최성준,민영주,김신,이정신,김상희,박찬정,지현숙,김우건 대한조혈모세포이식학회 1999 대한조혈모세포이식학회지 Vol.4 No.2

연구배경: 재생불량성 빈혈 경우에는 조혈모세포 이식 후 VOD의 발생에 관한 보고가 거의 없는 실정이다. 저자 등은 cyclophosphamide와 antithymocyte globulin으로 전처치 후에 동종골수이식을 시행한 재생불량성 빈혈 환자들을 대상으로 하여 VOD의 발생과 임상 양상, 혈액응고 인자들의 변화에 관하여 분석하여 보았다. 방법: 재생불량성 빈혈로 동종골수이식을 시행 받은 13예 환자를 대상으로 하였다. 임상적 기준에 따라 VOD를 진단하였으며 임상 경과에 따라서 경중을 분류하였다. Protein C, protein S, antithrombin Ⅲ, tPA, PAI-1 등의 혈액응고 인자들을 전처치 투여전, 골수 주입당일, 이식 후 제7, 14, 21일에 측정하였다. 결과: 7예(53.8%)에서 VOD가 발생하였으며, 경증 5예, 중등도 2예였다. VOD군에서 혈소판치가 20.000/㎕ 이상을 유지하는 데까지 걸리는 시간이 더 길었다(p=0.026). 또한 VOD군에서 적혈구 및 혈소판의 수혈 요구량이 각각 유의하게 많았다(p=0.025, 0.015). 혈액응고 인자들의 변화를 보면, 제 0일에 VOD군에서 PAI-1의 혈중 농도가 유의하게 더 높았다.(p=0.034). 결론: 재생불량성 빈혈환자에서도 조혈모세포 이식 후에 VOD의 높은 발생률을 관찰하였으며, 대부분이 경증이었다. VOD 환자에서의 혈액응고 인자들의 변화는 PAL-1이 VOD의 감별 진단을 위하여 이용될 수 있음을 시사하고 있다. Background: There are few reports about the occurrence of hepatic veno-occlusive disease(VOD) after bone marrow transplantation (BMT) for severe aplastic anemia (SAA). We analyzed the incidence and clinical outcomes of VOD and changes of coagulation factors in patients with SAA who were conditioned with cyclophosphamide plus ATG and underwent allogeneic BMT. Methods: Thirteen patients with SAA who underwent allogeneic BMT were included. A diagnosis of VOD was made according to clinical criteria, and severity of VOD was classified according to clinical course. Plasma levels of protein C, protein S, antithrombin Ⅲ, t-PA, and PAI-1 were determined before preparative chemotherapy, in the day of marrow infusion, and days 7, 14, and 21. Results: VOD occurred in 7/13(53.8%). Five were mild VOD and two were moderate VOD. Time to platelet ≥20,000/L was slower (p=0.026) and red cell and platelet transfusion requirements were higher (p=0.025,0.015) in patients with VOD . The mean plasma level of PAI-1 at 0 were higher in patients with VOD (p=0.034). Conclusion: We observed the high incidence of VOD after allogeneic BMT in patients with SAA. A majority of cases of VOD were mild. The changes of PAI-1 after BMT may be useful marker of hepatic VOD