면역적합성 환자에서 비결핵 항산균 폐질환: 흉부 전산화단층촬영에서의 다양한 영상 소견

신효현,선현주,김목희,최송,송상국,신상수,김윤현,박진균 대한영상의학회 2010 대한영상의학회지 Vol.63 No.2

Purpose: The aim of this study was to evaluate the chest CT features of nontuberculous mycobacterial (NTM) disease regardless of the specific organisms. Materials and Methods: This study included 74 consecutive patients (35 men, 39 women; mean age, 63 years; age range, 25-89 years) who were diagnosed with NTM disease according to the American Thoracic Society Guidelines (1997 and 2007) between January 2005 and July 2007. Chest CT images were randomly reviewed by two radiologists with consensus. Results: The most common organism associated with NTM disease is M. avium-intracellulare complex (87.8%), followed by M. abscessus, M. kansasii, and M. chelonae. The most common chest CT finding was a nodular bronchiectatic lesion (n = 35, 46.7%), followed by a cavitary lesion of the upper lobe (n = 21, 28.0%), combined lesions of two prior subtypes (n = 6, 8.0%), consolidative lesion (s) (n = 5, 6.7%), a bronchogenic spreading pulmonary tuberculosis-like lesion (n = 5, 6.7%), a cavitary mass lesion with small satellite nodules (n = 2, 2.7%), and a miliary nodular lesion (n = 1, 1.3%). More than 5 segments were involved in 60 cases (81.1%). Conclusion: The nodular bronchiectatic lesion or cavitary lesion of upper lobe presents with multi-segmental involvement and the occurrence of combined consolidation is indicative of NTM disease. 목적: 비결핵 항산균 폐질환의 흉부 전산화단층촬영에서의 영상 소견을 균주에 관계없이 알아보고자 했다. 대상과 방법: 2005년 1월부터 2007년 7월까지 비결핵 항산균 폐질환으로 진단되고 흉부 전산화단층촬영을 시행한 74명(남:여 = 35:39)을 대상으로, 영상소견을 후향적으로 분석했다. 결과: 가장 흔한 균주는 M. avium-intracellulare complex (87.8%)이었고, 이외 M. abscessus, M. kansasii, 그리고 M. chelonae 가 있었다. 흉부 전산화단층촬영에서 주된 소견들은 결절성기관지확장증(46.7%), 상엽에 공동성 질환(28.0%), 그리고 두 소견의 병합(8.0%)이었다. 이 외에도 주로 경화성 병변 만을 보인 예, 주변의 위성 소결절과 동반된 공동성 종괴를 보인 예, 기관지 내 파급만을 보인 예 그리고 속립성 질환을 보인 예가 있었다. 81.1%에서 5분절 이상의 침범이 이었다. 결론: 다 분절을 침범하면서 결절성기관지확장증과 동반된 기관지주변 경화성 병변이 있거나 상엽의 파괴성 또는 비파괴성 공동성 병변이 있는 경우 비결핵 항산균 폐질환을 시사하는 소견이라 할 수 있다.

유아의 인지조망수용능력에 따른 또래교수 상황에서 교수자로서의 능력

신효현(Shin, Hyohyun),김희진(Kim, Heejin) 한국육아지원학회 2020 육아지원연구 Vol.15 No.4

본 연구의 목적은 유아의 인지조망수용능력과 또래교수 상황에서 교수자로서의 능력에 대한 전반적인 경향을 살펴보고, 유아의 인지조망수용능력에 따라 교수자로서의 능력에 차이가 있는지 밝히는 것이다. 연구대상은 서울과 경기지역 유치원에 재원 중인 만 4세 학급 유아 64명이다. 인지조망수용능력검사 결과를 기반으로 상 ․ 하위 20%의 유아에게는 교수자 역할을, 나머지 60%의 유아에게는 학습자 역할을 부여하여 교수자-학습자 쌍을 구성한 후, 또래교수 과제를 통해 인지조망수용 능력이 높은 유아와 낮은 유아의 교수자로서의 능력을 평정하였다. 자료분석을 위해 범위, 평균(표준편차), 독립표본 t검정을 실시하였다. 연구결과 첫째, 다양한 수준의 인지조망수용능력을 가진 만 4세 학급 유아는 또래 교수 상황에서 효과적인 교수를 수행할 수 있는 능력을 가진 것으로 나타났다. 둘째, 유아의 인지조망수용능력에 따라 또래교수 상황에서 교수자로서의 능력에 차이가 있는 것으로 나타났다. 이를 통해 유아를 가르치는 현장의 교사에게 유아 또한 효과적인 교수자로서 역할을 할 수 있다는 점을 시사함으로써 실제 교수-학습 과정에서 유아의 역량과 주체성을 높이기 위한 토대를 제공하였다는데 본 연구의 의의가 있다. The goal of this study was to investigate children’s cognitive perspective-taking and their teaching capability in a peer tutoring situation and to examine the effect of the former on the latter. A total of 64 children participated in this study: they were all four-year old and enrolled in public and private kindergartens located in Seoul and Gyeonggi-do, Korea. Children were divided into two groups based on their cognitive perspective-taking test results: 1) a teacher group (the top and bottom 20% of the test), and 2) a learner group (the middle 60% of the test). Teacher-learner pairs were created and then each pair were given a peer-tutoring task, during which teaching capabilities of those taking a teacher’s role were evaluated. For data analysis, descriptive statistics, including range values, means, standard deviations, and an independent sample t-test were examined. The study results are as follows. First, both children with high and low levels of cognitive perspective-taking were able to teach effectively in peer tutoring. Second, there were significant differences in children’s teaching capabilities depending on their levels of cognitive perspective-taking. These results demonstrate that children’s role and participation in the teaching-learning processes should be expanded considering their observed competencies and agency as an effective teacher.

The Diagnostic Utility of Prone Position Chest CT for the Evaluation of Esophageal Cancer

이종은,김윤현,신효현,정원기,나국주 전남대학교 의과학연구소 2020 전남의대학술지 Vol.56 No.1

The aim of this study was to assess the potential of a prone chest CT for the evaluation of esophageal cancer, as compared with a routine supine chest CT. 69 patients (67±18 years old) with pathologically confirmed esophageal cancers underwent MDCT in the supine and prone positions. The supine CT was performed first, followed by the prone position. Localization and staging of individual esophageal lesions on both the prone and supine CTs were assessed by two thoracic radiologists, using a scoring system that consisted of three confidence scales, and the results were correlated with the endoscopic and surgical findings. The mean confidence score for the detection of esophageal cancer was higher in the prone position (2.58±0.74) than that in the supine position (2.42±0.83) with statistical significance (p=0.002). The mean confidence score for predicting local invasion in the selected patients (n=18) who underwent esophagectomy was also higher in the prone position (2.39±0.85) than that in the supine position (2.06±0.73) with statistical significance (p=0.01). In 10 of 11 cases that showed definitive determination for periesophageal infiltration or adjacent organ invasion on the prone CT (score 3), the corresponding findings were also observed in the post-operative evaluations. In conclusion, prone chest CT for evaluating esophageal cancer could have advantages in regards to the localization of esophageal cancer and predicting local invasion compared to that of routine supine CT and can improve the diagnostic accuracy of chest CTs.

복부 대동맥류와 복부 장기 악성종양에 동시에 이환된 환자의 혈관 내 스텐트 삽입결과: 초기 경험

최유리,신효현,임남열,오현준,장남규,김재규,최수진나,정상영 대한영상의학회 2010 대한영상의학회지 Vol.63 No.4

Purpose: To assess the outcomes of endovascular aortic aneurysm repair (EVAR) for the treatment of an abdominal aortic aneurysm in patients undergoing curative surgical treatment for concomitant abdominal malignancy. Materials and Methods: The study included 12 patients with abdominal neoplasia and an abdominal aortic aneurysm (AAA), which was treated by surgery and stent EVAR. The neoplasm consisted of the gastric, colorectal, pancreas, prostate, and gall bladder. The follow up period was 3-21 months (mean 11.8 months). All medical records and imaging analyses were reviewed by CTA and/or color Doppler US, retrospectively. Results: Successful endoluminal repair was accomplished in all twelve patients. The mean interval time between EVAR and surgery was 58.6 days. Small amounts of type 2 endoleaks were detected in two patients (17%). One patient developed adult respiratory distress syndrome after Whipple’s operation 20 days after surgery, which led to hopeless discharge. No procedure-related mortality, morbidity, or graft-related infection was noted. Conclusion: Exclusion of AAA in patients with accompanying malignancy show with a relatively low procedure morbidity and mortality. Hence, endoluminal AAA repair in patients with synchronous neoplasia may allow greater flexibility in the management of an offending malignancy. 목적: 복부 대동맥류와 복부 장기 악성 종양에 동시에 걸린 환자에서 복부 대동맥류에 대해 시행한 인조혈관스텐트삽입술의 초기 경험에 대해 평가하고자 하였다. 대상과 방법: 복부 대동맥류와 복부 장기 악성 종양으로 인조혈관스텐트삽입술과 종양에 대한 수술적 치료를 받은 환자 12명을 연구 대상으로 하였으며, 이 중 8명은 수술 전에 스텐트를 삽입하였고 4명은 수술 후에 삽입하였다. 나이는 53-82세(평균 71세)이며 남자 11명, 여자 1명이었다. 복부 장기 악성 종양 종류는 위, 결장직장, 췌장, 전립선, 담낭 등이었다. 추적 관찰 기간은 3-21개월(평균 11.8개월)로 전산화단층동맥조영술 또는 색도플러초음파로 검사하였다. 결과: 12명 환자 모두에게 성공적으로 인조혈관스텐트삽입술을 시행하였으며, 인조혈관스텐트 삽입술과 종양 수술과의 시간 간격은 6일에서 180일(평균 58.6일) 이였다. 추적 관찰 기간 도중 2명(17%)의 환자에서 제2형 내강 누출이 있었다. 췌장암 환자 1명에서 수술받은 20일 후 급성성인호흡곤란증후군이 발생하여 회복 가능성 없어 퇴원하였다. 시술 관련 사망이나 스텐트 감염 등은 없었다. 결론: 복부 대동맥류와 복부 장기 악성 종양에 동시에 걸린 환자에서 복부 대동맥류에 대한 인조혈관스텐트삽입술을 이용한 혈관 내 중재적 치료법은 낮은 사망률과 적은 합병증을 보이며, 두 질환을 동시에 갖는 환자에서 치료 계획을 세우는 데 있어 도움을 줄 것으로 생각한다.

신규간호사를 위한 맞춤형 멘토 프로그램(새싹프로그램)의 개발 및 적용 : 일개 대학병원 중환자실을 중심으로

권은옥,조정숙,송경자,최스미,장선주,김주희,박승현,신효연,유미,김정아 대한간호학회 간호행정학회 2009 간호행정학회지 Vol.15 No.4

Purpose: The purpose of this study was to develop specialized mentor program to improve adaptation for new nurses of intensive care unit and to identify the effect of the program on early resignation rate. Methods: The study adopted nonequivalent control group, non synchronized design. Based on the identification of problems and the needs of new nurses, a 6 month specialized mentor program was developed. The program was consisted of three parts; developing knowledge, improving interpersonal relationship and increasing coping competency for emergency situation. Data were collected between July 2006 and 2008 from 37 nurses and the early resignation rate was compared before and after the implementation of the mentoring program. Results: Early resignation rate of the nurses who received the mentor program was significantly lower than that of the nurses who didn't. The resignation rate within 1 year dropped from 44.5% to 8.3%(p=.034). Conclusions: The specialized six month mentoring program was effective in reducing early resignation rate.

항인지질항체 증후군에서 발생한 골수부종 증후군 1예

이경은,박현범,강지현,박동진,김태종,박용욱,신효현,이신석 대한류마티스학회 2013 대한류마티스학회지 Vol.20 No.3

Bone marrow edema is a common and nonspecific finding on magnetic resonance imaging (MRI) and results from various diseases including infection, inflammation, neoplasm, injury, and osteoarthritis. However, bone marrow edema syndrome (BMES) represents a distinct entity with specific clinical and imaging features such as diffuse extensions, the lack of other morphologic alterations, no history of trauma, and reversible disease courses. BMES is caused by ischemic changes, and thus, it is postulated to occur as a result of the thrombosis in a patient with primary anti-phospholipid syndrome (APS). Here, we present a case of 67-year-old male with a history of stroke, being presented with fever of unknown origin and pain on both knees. He had high titers of IgG and IgM anti-cardiolipin antibodies which titers didn’t change after 3 months. He was diagnosed as having a BMES due to typical MRI findings. After the introduction of anticoagulation, fever and joint pain were subsided. Our case suggests that BMES can develop within a patient with APS, thus early detection of differentiations is essential to avoid unnecessary treatments.