간세포암종에서 간절제술 후 이환율과 사망률에 영향을 미치는 위험 인자

김완욱,이광웅,최성호,허진석,김용일,김성주,이대성,이환효,백승운,고광철,이준혁,최문석,유병철,조재원 대한간학회 2004 Clinical and Molecular Hepatology(대한간학회지) Vol.10 No.1

목적: 간세포암종은 우리나라에서 간절제의 가장 흔한 적응증이다. 그러나 간경변을 동반한 경우가 많아 수술 후 이환율과 사망률이 높아 수술 전후 처치에 주의를 요한다. 최근에는 외과적 술기의 발전과 수술 전 및 수술 후 처치의 향상으로 이환율과 사망률이 감소하고 있으나 다른 수술에 비해 여전히 높다. 이에 본 연구에서는 간세포암종의 수술 중 위험 인자를 알아보고 수술 후 이환율과 사망률을 줄일 수 있는 방법을 찾아보고자 하였다. 대상과 방법: 1994년 11월부터 2001년 12월까지 간세포암종으로 진단받고, 간절제술을 시행받은 환자 510명을 대상으로 하였다. 대상 환자의 평균 연령은 51.6세였고, 남녀 비는 4.01 : 1이었다. 수술 전 HBsAg (+)는 76.0%, 수술 전, anti-HCV (+)는 8.2%였으며 종양의 크기는 평균 5.19 ㎝이었다. 환자 중 26.2%에서 수술 전 경도자 동맥색전술의 병력이 있었으며 8.7%에서 수술 전 경피적 간문맥색전술을 시행받았다. 시행받은 수술은 종양절제술 55예, 분절절제술 127예, 구역절제술 77예, 반간절제술 214예, 동반 혹은 확대 반간절제술 37예였다. 위험 인자로 나이, 성별과 각종 임상 지표(간기능 수치, 프로트롬빈시간, 혈청 알부민, 혈당, 알파태아단백, ICG 검사, 수술 전 경도자 동맥색전술, 경피적 간문맥색전술 시행 여부) 등의 수술 전 인자, 수술의 종류, 수술 시간, 수혈량 등의 수술 인자, 그리고 종양의 크기, 종양의 수, 간경변 여부 등의 병리조직학적 인자 등을 분석하였다. 분석자료는 대상 환자들의 의무기록을 통해 후향적 방법으로 조사하였다. 수술 사망은 수술 후 30일 이내에 사망한 경우로 정의하였고, 입원 사망은 수술 후 합병증으로 퇴원하지 못하고 사망한 경우로 정의하였다. 단변량 분석은 student t test와 x² test를 이용하였으며, 다변량 분석은 logistic regression을 이용하였다. 결과: 수술 후 합병증은 총 56예(10.5%)에서 나타났으며, 조절되지 않는 복수 19예, 호흡기 합병증 10예, 상처 합병증 8예, 간기능 이상으로 인한 고빌리루빈혈증 6예, 출혈 5예, 고질소혈증 4예 등이었다. 수술 사망은 5예(0.98%), 입원 사망은 수술 사망을 포함하여 6예(1.1%)였다. 이중 간부전과 연관된 사망이 5예였고, 간부전과 동반된 흡인성 폐렴으로 사망한 예가 1예 있었다. 이환율에 영향을 미치는 인자를 다변량 분석을 통해 알아본 결과, 수술 중 수혈량(P=0.002), 프로트롬빈시간(P=0.038), 혈당 수치(P=0.002)가 통계학적으로 의미가 있었고, 다변량 분석 상 수술 후 사망률과 관련된 인자로는 나이(P=0.028), 혈당 수치(P=0.011), 수술 전 경도자 동맥색전술 시행 여부(P=0.046) 등이 의미 있는 것으로 나타났다. 결론: 위의 위험 인자 분석을 통해 간세포암종에서 간절제시에 수술 후 이환율을 중이기 위해 가능한한 수술 중 출혈을 최소화하면서 불필요한 수혈을 피하고, 당뇨 환자에서는 수술 후 이환율과 사망률이 상대적으로 높고, 고령 환자에서는 사망률이 상대적으로 높으므로 수술 전후 처치에 세심한 주의가 필요함을 알 수 있었다. 수술전 경도자 동맥색전술 시행 여부가 수술 후 사망률과 유의한 상관성이 있었고 이에 대한 지속적인 연구가 필요하리라 생각된다. Background/Aims: Recently, mortality following surgical resection for hepatocelluar carcinoma has been reduced significantly. Morbidity, however, is still significant. This study evaluated the risk factors leading to morbidity and mortality. Methods: 510 patients who had a hepatic resection form Nov. 1994 to Dec. 2001 were included. The patient demographics showed a mean age of 51.6 years with a male to female ratio of 4:1. The HBsAg was positive in 76.0% and the anti-HCV was positive in 8.2%. The mean tumor size was 5.2 cm, 26.2% of patients had preoperative transcatheter arterial embolization (TAE), and 8.7% had preoperative percutaneous transhepatic portal embolization (PTPE). Limited resection was performed in 259 cases (50.7%), and major resection was conducted in 251 cases (49.1%). Risk factors included age, sex, laboratory findings (liver function test, prothrombin time, albumin, glucose, α-fetoprotein, ICG test), preoperative TAE, PTPE, operation type, operation time, intraoperative transfusion, tumor size, and cirrhosis. Results: The morbidity was 10.5% (54 cases). Operative death occurred in 5 cases (1.0%). Hospital death, including operative death, occurred in 6 cases (1.2%). Five cases were associated with hepatic failure and 1 case was associated with aspiration pneumonia accompanying hepatic failure. Transfusion (P=0.002), glucose (P=0.002), and prothrombin time (P=0.038) were significantly related to morbidity. Age (P=0.028), glucose (P=0.011), and TAE (P=0.046) were significantly related to mortality. Conclusions: Intraoperative transfusion, which is mainly related to intraoperative bleeding, should be reduced if possible to decrease morbidity. Diabetes mellitus patients and the elderly need careful perioperative management.(Korean J Hepatol 2004;10:51-61)

경락(經絡)과 정신양생(精神養生)의 관계 설정(設定)에 대(對)한 고찰(考察)

백진웅,김광호,Baek Jin-Woong,Kim Kwang-Ho 대한예방한의학회 2001 대한예방한의학회지 Vol.5 No.2

It is thought that Kim Hong-kyeong followed the existing theory of Meridian(經絡) and supplemented his unique perspectives in interpreting it. And he tried to relate Meridian with hygiene of mind. I took up with the research on the assumption that the review of Kim's method can present new perspectives to the study of relationship between Meridian and hygiene of mind. The results of my study are as follows: 1. Kim followed common theory of Meridian and then added his unique perspectives to it. His method of interpretation has one characteristic. By introducing Idealism(唯心論), he understood 'Meridian' as the path of the mind and the emotion. Especially I think his hypothesis that acupuncture can be widely used in mental diseases as well as body related diseases and its applications to treatment are very valuable. 2. Meridian and hygiene of mind are close together. I think Kim's unique trial is something new in studying relationship between Meridian and hygiene of mind but requires more research on it.

Evaluation of Renal Toxicity by Combination Exposure to Melamine and Cyanuric Acid in Male Sprague-Dawley Rats

Son, Ji Yeon,Kang, Yoon Jong,Kim, Kyeong Seok,Kim, Tae Hyung,Lim, Sung Kwang,Lim, Hyun Jung,Jeong, Tae Cheon,Choi, Dal Woong,Chung, Kyu Hyuck,Lee, Byung Mu,Kim, Hyung Sik Korean Society of ToxicologyKorea Environmental Mu 2014 Toxicological Research Vol.30 No.2

Melamine-induced nephrotoxicity is closely associated with crystal formation in the kidney caused by combined exposure to melamine (Mel) and cyanuric acid (CA). However, there are few dosage-finding studies for toxicological evaluation of chronic co-exposure to Mel and CA. The objective of this study was to investigate the possible mechanism by which a Mel and CA mixture lead to renal toxicity in rats. Mel and CA were co-administered to rats via oral gavage for 50 days. Nephrotoxicity was determined by measuring blood urea nitrogen (BUN) and serum creatinine (sCr) levels. Relative kidney weights were significantly increased in rats after co-exposure to Mel+CA (63/6.3 or 630/6.3 mg/kg) mixtures. BUN and sCr levels were significantly increased after Mel and CA co-exposure. Taken together, significant increase in KIM-1, NGAL, and calbindin levels were observed in the urine of rats exposed to Mel+CA (63/6.3 or 630/6.3 mg/kg) compared with the corresponding control group. Histological analysis revealed epithelial degeneration and necrotic cell death in the proximal tubules of the kidney after co-exposure to Mel+CA (63/6.3 or 630/6.3 mg/kg). Our data suggest that Mel-mediated renal toxicity may be influenced by CA concentrations in Mel-contaminated milk or foods.

Evaluation of Renal Toxicity by Combination Exposure to Melamine and Cyanuric Acid in Male Sprague-Dawley Rats

Ji Yeon Son,Yoon Jong Kang,Kyeong Seok Kim,Tae Hyung Kim,Sung Kwang Lim,Hyun Jung Lim,Tae Cheon Jeong,Dal Woong Choi,Kyu Hyuck Chung,Byung Mu Lee,Hyung Sik Kim 한국독성학회 2014 Toxicological Research Vol.30 No.2

Melamine-induced nephrotoxicity is closely associated with crystal formation in the kidney caused by combined exposure to melamine (Mel) and cyanuric acid (CA). However, there are few dosage-finding studies for toxicological evaluation of chronic co-exposure to Mel and CA. The objective of this study was to investigate the possible mechanism by which a Mel and CA mixture lead to renal toxicity in rats. Mel and CA were co-administered to rats via oral gavage for 50 days. Nephrotoxicity was determined by measuring blood urea nitrogen (BUN) and serum creatinine (sCr) levels. Relative kidney weights were significantly increased in rats after co-exposure to Mel+CA (63/6.3 or 630/6.3 mg/kg) mixtures. BUN and sCr levels were significantly increased after Mel and CA co-exposure. Taken together, significant increase in KIM-1, NGAL, and calbindin levels were observed in the urine of rats exposed to Mel+CA (63/6.3 or 630/6.3 mg/kg) compared with the corresponding control group. Histological analysis revealed epithelial degeneration and necrotic cell death in the proximal tubules of the kidney after co-exposure to Mel+CA (63/6.3 or 630/6.3 mg/kg). Our data suggest that Mel-mediated renal toxicity may be influenced by CA concentrations in Mel-contaminated milk or foods.

濟州地域語의 口蓋音化에 대한 一硏究

金光雄 제주대학교 1985 논문집 Vol.22 No.2

k-palatalization occurs most naturally when those phonemes are combined with ◁그림삽입▷ vowels. When /k/, /k^h/, /k’/ are combined with hi-syllabic single lexical morphemes, the phenomenon of palatalization does not arise. The comination of those morphemes above with grammatical morphemes does not allow palatalization in spite of the number of increased syllables to more than three Complex words with free morphemes preceding other morphemes prevent palatalization. /i/ which is derived from a diphthong does not cause k-palatalization, but pure/i/ does k-palatalization of Chinese characters occurs naturally at the initial position of words. t-palatalization occurs only at a morpheme boundary. /i/ derived from a diphthong except pure /i/ does not bring about t-palatalization. t-palatalization is blocked when a word boundary marker exists. h-palatalization occurs most naturally at the initial position of words. /l/ which is derived from a diphthong except for pure /l/, does not cause h-palatalization. The phenomenon of Fortition Palatalization exists in Chejudo dialects.

부모권력구조에 대한 아동기 경험이 여대생의 결혼태도에 미치는 영향

김광웅,조유진 숙명여자대학교 건강·생활과학연구소 2004 生活科學硏究誌 Vol.- No.21

The purpose of this study was to investigate how marital attitudes of female college students were related to their childhood experiences of parental power structure. Questionnaire survey was conducted with 425 female college students regarding their childhood experiences of parental power structure and their marital attitudes. The results of the analysis are as follows; First, the female college students formed different marital attitudes dimensions only in home economy area when their experiences of parental power hierarchy were measured individually in subfactors(family events and relative-related, child education, and home economy). Second, multi-response logit analysis was used in order to take into account of all the subfactors of parental power structure at the same time. As a result, childhood experiences of parental power hierarchy on child education, and on home economy were found to be closely related to the marital attitudes in the female college students. That is, the female college students, whose fathers had power on their children's education through active participation and decision-making, were likely to develop negative image of marriage. On the other hand, those whose mothers had power in home economy were likely to develop negative image of marriage.

규칙적인 유산소성 운동이 비만아동들의 신체구성 및 호흡순환기능에 미치는 영향

김태운,신군수,김종인,이광무,김성헌,안병철,고기준,한재웅,이재규 釜山大學校 附設 體育科學硏究所 1997 體育科學硏究所 論文集 Vol.13 No.-

The purpose of this study was to examined the effect of supervised regulary aerobic exercise program with cardiorespiratory function of obese children. The subjects were 16 obese Childrens(elementary school 4∼5 grade), and engaged in regulary aerobic exercise program for 9 weeks(5 days/week, 100 min/day, 60∼70% HRmax) with mountain climbing, basketball and football. The items of cardiorespiratory function measured VEmax, HRmax, RQmax, VCO₂max, VCO₂max, VCO₂max/kg and BFmax after treadmill exercise load. The conclusion of this study was as follows ; 1. In body composition, there were significant decrease(P<0.001) after aerobic exercise for 9 weeks in body weight, percent body mass index 2. In cardiorespiratory function, there were significant increase(P<0.001) after aerobic exercise for 9 weeks in VEmax and VCO₂max by treadmill exercise load. 3. In cardiorespiratory function, there were significant increase(P<0.001) after aerobic exercise for 9 weeks in VO₂mex and RQmax by treadmill exercise load. 4. In cardiorespiratory function, there were significant increase(P<0.001, P< 0.01) after aerobic exercise for 9 weeks in VO₂max/kg and BFmax by treadmill exercise load.

지각 성향에 따른 아동의 타인 인상 평가와 양육 태도에 대한 어머니와의 지각 불일치 정도

김광웅,이지항 숙명여자대학교 2000 生活科學硏究誌 Vol.15 No.-

The question as to the influence of parental attitude on subsequent personality development of their children is a contentious one. Some researchers indicate that parental attitude is perceived distortedly or exaggeratedly by the cognitive trait of the child. In this connection, people are often perceived erroneously due to biased perceptual trait of the individual and the distention in the perception of other people and parental attitude on rearing can be understood in this context. In this study, it was assumed that the individual difference in the child's preception of parental attitude on rearing is due to perception trait as in the case of person perception. In this context it is attempted to clarify the degree of difference in the perception of the mother's warm rearing attitude between mother and child and difference in the person perception due to the perception trait of the child, also, the relation between the difference in perception of mother and child and the person perception is investigated. The subjects are a set of 444 students of universities in Seoul metropolitan area. Questions for testing perceptual trait of students proposed by Jung-Hoon Choi(1972) are used to test perceptual traits of children and 22 pairs of adjectives modified by the authors among 100 pairs of adjectives of Sung-Youn Lee(1988) are used for person perception. 17 questions about the warm rearing attitude among 32 questions about the test of rearing attitude of parents proposed by Young-Mi Lee(1991) are use to measure the warm rearing attitude of mothers perceived by mother and child. The data is analyzed by t-test, paired t-test, and correlation analysis. The result of this study may be summarized of main issues as followed. First, there exists a difference in the person perception due to perceptual trait of the child. Child of positive perceptual trait is more positive in the person perception than child of negative perceptual trait. Second, there exists a difference between the mother and the child in the perception of warm rearing attitude of the mother and the degree of perception of the mother is greater than child's. Third, there exists a differnce in the degree of perception of warm rearing attitude between mother and child due to the perceptual trait of child. The difference in perception of warm rearing attitude of mother between the mother and child is smaller for a child of positive perceptual trait than a child of negative perceptual trait whose level of perception is less than that of the mother. Forth, a child having positive person perception is more positive in the perception of the warm rearing attitude of a mother than mother and child having negative person perception is more negative in the perception of the warm rearing attitude of a mother than a mother.

원형질체 융합에 의한 체세포 잡종의 형질 발현에 관한 연구 : Ⅰ. Nicotiana tabacum과 N. sylvestris의 원형질체 융합에 의한 체세포 잡종의 생성 및 형질 발현 Ⅰ. Somatic Hybrids by Protoplast Fusion between Nicotiana tabacum and N. sylvestris

김준철,원종락,이광웅 慶尙大學校 기초과학연구소 1987 基礎科學硏究所報 Vol.3 No.-

담배재배종인 Nicotina tabacum cv.Nc 2326과 야생종인 N.sylvestris 간의 원형질체 융합에 의한 체세포 잡종을 생성하고 이들 잡종의 유전 및 형태적 특성을 모식물체와 비교한 결과는 다음과 같다. 1. 체세포 잡종식물의 엽조직에서의 peroxidase 밴드패턴을 부분적으로 함께 나타내고 있었다. 2. 꽃의 색깔과 길이, 초장은 모식물체의 중간형이었고 잎배열은 N.tabacum에 엽맥의 색깔은 N.sylvestris에 가까웠으며 그밖의 형질은 일정한 경향이 없었다. 3. 체세포 잡종식물은 개화는 되었으나 종자의 결실은 되지 않았다. Somatic hybrids were produced in the callus derived from the fused cells between Nicotiana tabacum cv. NC 2326 and N. sylvestris. In biochemical analysis of the somatic hybrids the peroxidase isozyme patterns in the leaf partly showed the profiles of both parents. In the hybrids the flower colour and length, and plant height were the intermediate form of both parents. In leaf arrangement the hybrids were similar to N. tabacum and in colour of mid vein they were similar to N. sylvestris. The other phenotypes had no tendency as compared to their parents. The hybrid plants had flowers but could not set seeds.

共産國과 民主國의 近代化에 관한 比較硏究

金光雄 서울대학교 사회과학연구소 1982 社會科學과政策硏究 Vol.4 No.2