2011 해외의료봉사_몽골 1차 2011.5-14~21 - 몽골에 다녀와서

한선애,Han, Seon-Ae 한국가톨릭의료협회 2011 Health & mission Vol.25 No.-

Characterization of the mouse α3 integrin gene

한선애(Seon Ae HAN),(Tsutomu Tsuji) 생화학분자생물학회 1997 생화학분자생물학회 춘계학술발표논문집 Vol.- No.-

위암에서 E-cadherin과 $\beta-catenin$ 발현과 유전자 돌연변이에 관한 연구

김광일,박성혜,한선애,채양석,김인선,Kim Kwang Il,Park Sung-Hye,Han Sun-Ae,Chae Yang-Seok,Kim Insun 대한위암학회 2001 대한위암학회지 Vol.1 No.4

Purpose: When cancer cels invade the stroma, they should be dissociated from the adjacent cells at first. E-cadherin and $\beta-catenin$ constitute an important protein complex associated with cellular adhesion, development, and differentiation, especially in epithelial cells. The role of E-cadherin and $\beta-catenin$ in gastric carcinogenesis were studied. Materials and Methods: The expression of E-cadherin and $\beta-catenin$ in gastric adenocarcinomas by using immunohistochemical staining and the mutation by using polymerase chain reaction- single stranded conformation polymorphism (PCR-SSCP) and sequencing were performed in 40 adenocarcinomas and 5 dysplasia of stomach. Thirteen cases, which had lymph node metastasis, were also included for immunohistochemical staining. Results: Inappropriate cytoplasmic and/or nuclear expression of a E-cadherin-$\beta-catenin$ complex was more frequent in poorly differentiated, diffuse type signet ring cell carcinomas than in well-differentiated, intestinal type adenocarcinomas (P<0.05). However, the expression was not related with clinical stage or lymph node metastasis. Mutation of E-cadherin was detected in 4 cases by using PCR-SSCP, whereas mutation of $\beta-catenin$ was detected in 2 cases. Conclusion: E-cadherin and $\beta-catenin$ seem to be important in gastric carcinogenesis, especially in poorly differentiated diffuse type.

말기 암 환자에서의 하지 부종

심병용,홍석인,박지찬,홍숙희,최강현,조홍주,김선영,한선애,이옥경,김훈교,Shim, Byoung-Yong,Hong, Seok-In,Park, Ji-Chan,Hong, Sug-Hui,Choi, Gang-Heun,Cho, Hong-Joo,Kim, Seon-Young,Han, Sun-Ae,Lee, Ok-Kyung,Kim, Hoon-Kyo 한국호스피스완화의료학회 2005 한국호스피스.완화의료학회지 Vol.8 No.2

Purpose: The lower extremity edema (LEE) is a common distressful symptom in advanced cancer patients and is hard to manage. We analyze the characteristics of LEE in patients with advanced cancer to provide the basic information of causes and adequate management. Methods: Physical examination, assessment of the location and severity of edema, blood chemistry (albumin, creatinine), Doppler Sono for patients with suspecting deep vein thrombosis (DVT), and abdomen CT scan for patient with suspecting lymph edema were performed. Severity of edema was classified according to NCI lymph edema scaling and improvement was defined as lowering at least 1 grade of edema after management. Results: Among 154 patient who had been admitted to Hospice Ward from Mar 2003 to Jan 2004, 33 had LEE, and 6 had both upper extremity edema and LEE except generalized edema. Their underlying cancers were stomach (7), lung (6), biliary tract (5), liver (5), colorectal (5), pancreas (2), and others (9). There were 12 patient with grade I, 20 patients with grade II, and 7 patients with grade III edema. The causes were hypoalbuminemia (11), lymph edema (10), DVT (7), obstruction of inferior vena cava (IVC) or portal vein (6), and dependent edema (5). The common managements were including leg elevation and diuretics. Elastic stocking was applied for patients with DVT and leg massage and pneumatic compression was used for lymph edema. The 2/3 patients were improved after management. Conclusion: The incidence of LEE in terminal cancer pts was high (25.3%) and their causes were variable including lymph edema, DVT, hypoalbuminemia and dependent edema. Active noninvasive management according to causes could result in good palliation. 목적: 하지 부종은 진행된 말기 암 환자에서 흔하게 발생하는 증상이며 치료하기 어렵다고 생각되고 있다. 우리는 말기 암 환자에서 하지 부종의 특성을 분석하고 원인과 치료에 관한 기본 정보를 얻기 위해 연구를 하였다. 방법: 하지 부종이 있는 환자에서 이학적 검사를 시행하고 부종의 범위, 정도, 혈액 검사(creatinine, albumin)을 시행하였다. 심부정맥 혈전증이 의심되는 환자는 Doppler 초음파를 시행하고 림프부종이 의심되는 환자는 복부 컴퓨터 단층 촬영을 시행하였다. 부종 정도는 NCI의 림프부종 평가를 이용하여 시행하였으며 증상의 호전은 부종의 정도가 1 이상 감소한 경우 호전이라 하였다. 결과: 2003년 3월부터 2004년 1월까지 총 154명의 호스피스 입원 환자 중 하지부종 환자는 39명이었으며 이 중 6명은 상지부종과 하지부종이 모두 있었다. 이 들의 원인 질환은 위암(7명), 폐암(6명), 간담도암(5명), 간암(5명), 대장암(5명), 췌장암(2명), 기타(9명)이었다. 원인으로써는 저알부민혈증(11명), 림프부종(10명), 심부정맥혈전증(7명), 하대정맥 또는 문정맥 폐쇄(6명), 의존성 부종(5명)이었다. 치료로는 하지 거상과 이뇨제를 사용하였으며 심부정맥 혈전증이 있는 경우는 탄력 스타킹을, 림프부종이 있는 경우에는 맛사지와 공기 압축을 이용한 재활 치료를 하였다. 전체 2/3환자에서 증상 호전이 관찰되었다. 결론: 말기 암 환자에서 하지 부종의 빈도는 25.3%로 높으며 원인 질환으로는 저알부민 혈증, 림프부종, 심부정맥혈전증, 의존성 부종 등 다양하다. 적극적인 비침습적 치료로 충분한 증상호전을 가져 올 수 있다.

호스피스 병동에서 시행되는 말기 암 환자의 DNR (Do-Not-Resuscitate) 동의

심병용,홍석인,박진민,조홍주,옥종선,김선영,한선애,이옥경,김훈교,Shim, Byoung-Yong,Hong, Seok-In,Park, Jin-Min,Cho, Hong-Joo,Ok, Jong-Sun,Kim, Seon-Young,Han, Sun-Ae,Lee, Ok-Kyung,Kim, Hoon-Kyo 한국호스피스완화의료학회 2004 한국호스피스.완화의료학회지 Vol.7 No.2

배경: 보편적으로 호스피스 병동에서 말기 암 환자에 있어서, DNR 동의가 흔하게 취득되고 있다. 그러나 말기 암 환자에 대한 현황과 실태 분석에 관한 국내 연구는 아직 드문 현실이다. 최근 저자 등은 보호자가 DNR 동의를 거부하여 심폐소생술 후 인공호흡기 치료를 시행하여 2개월 간 중환자실에서 치료 후 사망한 환자를 경험하면서 지금 까지 진행된 DNR 동의의 현 실태와 앞으로 시행될 DNR 동의의 보완점을 마련하기 위해 본 연구를 시작하였다. 방법: 2003년 1월부터 6월까지 6개월 동안 성빈센트병원 호스피스 병동에 입원한 말기 암 환자 60명을 대상으로 후향적으로 의무기록과 DNR 동의서를 조사하였다. 대상 환자들의 나이, 성별,진단명, DNR 동의 시간, 사망까지의 시간, DNR 동의에 참여한 보호자, DNR 결정 당시 환자 상태, 사망장소, DNR 결정 당시의 치료와 DNR 결정 전후 치료의 변화 등을 조사하였다. 치료 단계는 3단계로 분류하였다. 결과: 중앙 연령은 66세($31{\sim}93$세) 였고 남자가 31명, 여자가 29명이었다. 폐암 12명, 위암 12명, 담낭암 및 담도암 7명, 대장암 6명, 췌장암 4명, 기타 19명이었다. DNR 동의서에 서명한 사람은 아들이 22명, 배우자가 19명, 딸이 16명, 기타가 3명이었다. 이 중 환자가 DNR 동의서에 동의한 경우는 한 명도 없었다. 60명 중 30명이 입원 시에, 30명은 입원 기간 중에 DNR 동의서에 서명하였다. 입원 기간 중에는 증상의 악화 19명, 활력 증후 변화 4명, 다기관 기능부전 3명, 기타 상태 4명 등으로 DNR이 결정 되었다. DNR 동의 후 사망까지의 시간은 13명이 5일 이내에 사망하였다. 사망 장소는 60명 중 한 명을 제외하고는 모두 본원이었다. DNR이 시행되었을 당시 치료 단계는 2명을 제외하고 1단계였고 2단계와 3단계가 각각 1명씩이었다. 결론: 환자의 존엄성과 권리라는 측면에서 DNR 동의의 환자 참여가 국내에서도 신중하게 고려되어야 하겠다. 또 이를 위해 DNR 동의의 의미, 경과, 동의 철회 등의 사항이 포함된 문서화된 동의서에 의해서 환자와 보호자에게 설명되어야 하겠다. Purpose: DNR order is generally accepted for cancer patients near the end of life at Hospice Ward. It means not only no CPR when cardiopulmonary arrest develops but no aggressive meaningless medical interventions. Usually on admission, we discuss with the patients' family about DNR order at the Hospice Ward. Recently, we experienced a terminal lung cancer patient who had been on the ventilator for two months after pulmonary arrest. CPR and artificial ventilation were performed because patient's family refused DNR order. There is no consensus when, who, and how DNR order could be written for terminal cancer patients in Korea, yet. Methods: Hospice charts of 60 patients who admitted between Jan and Jun 2003 to Hospice Ward were reviewed retrospectively. Results: The median age was 66(range $31{\sim}93$) and there were 31 males and 29 females. Their underlying cancers were lung (12), stomach (12), biliary tract (7), colon (6), pancreas (4) and others (19). The persons who signed DNR order were son (22), spouse(19), daughter (16) and others (3). But, there was no patients who signed DNR order by oneself. Thirty families of 60 patients signed on day of admission and 30 signed during hospitalization when there were symptom aggravation (19), vital sign change (4), organ failure (3) and others (4). There were 13 patients who died within 5 days after DNR order. Most of patients died at our hospice ward, except in 1 patient. The level of care was mostly 1, except in 2 patients. (We set level of care as 3 categories. Level 1 is general medical care: 2 is general nursing care: 3 is terminal care.) Conclusion: We have to consider carefully discussing DNR order with terminal cancer patients in the future & values on withholding futile intervention.

자궁내막 증식증과 자궁내막 선암에서의 K-ras와 p53 유전자 돌연변이

김혜옥(Hye Ok Kim),이주한(Joo Han Lee),이인우(In Woo Lee),한선애(Sun Aee Han),박미자(Mee Ja Park),조현득(Hyun Deuk Cho),김인선(In Sun Kim),김철환(Chul Hwan Kim) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.10

Endometrial adenocarcinoma is the third common malignancy of female genital tract and categorized as estrogen-dependent tumor (type I) or not (type II). Type II endometrial adenocarcinoma more frequently occurs in oriental, which may arise from genetic alterations such as K-ras and p53. To identify whether the K-ras and p53 mutational activation are occurred during endometrial carcinogenesis, we examined point mutations of K-ras codon 12, 13, 61 (PCR-RFLP) and p53 exon 5, 6, 7, 8 (PCR-SSCP) in the 19 samples of endometrial adenocarcinoma. The 9 samples of normal endometrium and 24 samples of endometrial hyperplasia were also examined. K-ras codon 12 mutations were found in one of 3 cases of atypical hyperplasia (33.3%) and three of 19 cases of endometrial adenocarcinoma (15.7%). The correlation with K-ras mutation and endometrial hyperplasia/adenocarcinoma was statistically insignificant(p=0.306). p53 mutation was found in only one case of endometrial adenocarcinoma which concomitantly occurred with K-ras mutation. It could not be determined that K-ras mutation was early or late event during endometrial carcinogenesis due to a few cases of atypical hyperplasia and no K-ras mutation in the benign endometrial hyperplasia. The endometrial adenocarcinoma with K-ras mutation was observed in postmenopausal old age groups, and revealed moderate to severe histologic grade, early clinical stage, and negative lymph node metastasis.

기관지천식의 중증도에 따른 안지오테신 전환효서 유전자 다형에 관한 연구

조재연(Jae Youn Cho),차대룡(Dae Ryoung Cha),한선애(Seon Ae Han),이상엽(Sang Yeub Lee),이신형(Shin Hyung Lee),강세용(Sea Yong Kang),심재정(Jae Jeong Shim),강경호(Kyeong Ho Kang),유세화(Se Hwa Yoo),인광호(Kwang Ho In) 대한천식알레르기학회 1998 천식 및 알레르기 Vol.18 No.4

Background: The angiotensin-converting enzyme (ACE) has a major role in the degradation of bradykinin, tachykinin, substance P which are associated with bronchial hyperresponsiveness and inflammation. The other role of ACE is the genesis of angiotensin II which causes bronchial smooth muscle contraction. The deletion polymorphism of ACE gene(DDtype) may be related to the high serum level of ACE. Objective: We studied to evaluate an association between the insertion /deletion polymorphism of the ACE gene and asthma, and its severity. Materials and methods: Sixty asthmatic patients and 44 healthy controls were enrolled. Severity of asthma was classified by the guideline of NHLBI/WHO workshop. The ACE genotypes of all the subjects were determined by polymerase chain reaction. Results: The distribution of ACE genotypes were not significantly different between healthy controls and asthma group (p)0.05). In asthmatic patients, the genetic polymorphism was similar between different severity groups (p) 0.05). Conchcsion: It is suggested that I/D polymorphism of the ACE gene may not be associated with development of asthma. The severity of asthma may not be influenced by I/D polymorphism of the ACE gene.

아스피린 유발성 천식환자에서 leukotriene C4 ( LTC4 ) 합성효소 유전자 다형에 관한 연구

조재연(Jae Youn Cho),이상엽(Sang Yeub Lee),한선애(Seon Ae Han),유세화(Se Hwa Yoo),김선신(Sun Sin Kim),박해심(Hae Sim Park),박중원(Jung Won Park),홍천수(Chein Soo Hong),인광호(Kwang Ho In) 대한천식알레르기학회 1999 천식 및 알레르기 Vol.19 No.4

Background: Aspirin/NSAIDs can release cysteinyl-leukotriene (cys-LTs) into airways and precipitate asthmatic symptoms in aspirin - induced asthma(AIA). It has been reported that there is profound overexpression of LTC4 synthase in their bronchial mucosa, compared to aspi- rin-tolerant asthma. Objective : We observed whether genetic polymorphism of LTC4 synthase may be predisposed to LTC4 synthase overexpression in AIA. Subject and method: Forty - four AIA patients having positive responses on lysin aspirin bron choprovocation tests and 47 non - aspirin induced asthma ( non - AIA ) patients having negative challenges and 32 healthy controls were enrolled. The genotypes of the promoter LTC4 synthase gene ( A,C transversion ) were determined by polymerase chain reaction and restriction frag- ment length polymorphism ( RFLP ) method. Results : LTC4 synthase promoter polymorphism ( A444C btransversion) was not significantly dif - ferent between non - AIA and AIA patients (p 〉0.05). Conclusion These findings suggest that genetic polymorphism of LTC4 synthase promoter may not be predisposed to LTC, synthase overexpression in AIA.

무시멘트 알칼리 활성 고로슬래그 콘크리트의 배합에 따른 재료 역학적 특성

송진규(Song, Jin Kyu),이강석(Lee, Kang Seok),한선애(Han, Sun Ae),김용인(Kim, Young In) 한국콘크리트학회 2008 한국콘크리트학회 학술대회 논문집 Vol.2008 No.5

수리남 여행 후 발생한 치쿤구니야

장회수 ( Hoe-soo Jang ),정종훈 ( Jong-hun Chung ),김조아 ( Joa Kim ),한선애 ( Sun Ae Han ),윤나라 ( Na-ra Yun ),김동민 ( Dong-min Kim ) 대한내과학회 2016 대한내과학회지 Vol.90 No.3

Chikungunya infection is caused by an arbovirus transmitted by the Aedes mosquito. A 19-year-old man who had traveled to the Republic of Surinam to perform volunteer work complained of a fever, arthralgia, articular stiffness, and a skin rash on both the arm and trunk. Chikungunya fever was diagnosed using a Chikungunya virus specific IgM antibody in an enzyme-linked immunosorbent assay (ELISA) using blood samples obtained during follow-up visits. In this report, we describe a case of imported Chikungunya fever that presented with arthralgia and a skin rash, with islands of normal skin, that occurred following travel to Surinam, South America. (Korean J Med 2016;90:262-265)