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황유정 ( Yu Jeong Hwang ),진석재 ( Suk Je Jin ),정용진 ( Yong Jin Jeong ),명형준 ( Hyung Joon Myung ),신혜영 ( Hae Young Shin ),김호동 ( Ho Dong Kim ),주영은 ( Young Eun Joo ) 대한소화기학회 2021 대한소화기학회지 Vol.78 No.5
A 54-year-old man was transferred from another hospital due to a hematoma in the third portion of the duodenum on abdomen CT. He had been admitted for 2 weeks due to vomiting at another hospital. He had abdominal discomfort and nausea without abdominal pain when he visited the Gwangyang Sarang Hospital. Other than a distended abdomen and mild general abdominal tenderness, the results of physical examination were unremarkable. Abdominal CT revealed an approximately 9 cm thick walled hematoma at the anteroinferior site of the duodenal third portion. Upper endoscopy revealed stenosis of the third portion of the duodenum without mucosal lesions. The endoscope was not advanced through the narrowed duodenal lumen. A retroperitoneal hematoma was diagnosed, and his state was classified as subacute rather than acute based on the duration. The surgeon did not recommend surgical treatment. Urgent treatment was unnecessary; he was managed conservatively. The size of the hematoma decreased from 9.0 cm to 5.8 cm on the following CT. He could begin to eat food on the 26th admission day, and he was discharged on the 31st admission day. The hematoma disappeared entirely on the following CT. This paper describes a rare case of idiopathic retroperitoneal hematoma with a spontaneous resolution. (Korean J Gastroenterol 2021;78:295-299)
Gerbil 삼차신경절에서 허혈-재관류 후 calbindin D-28k와 calretinin 면역반응의 경시적 변화
황인구(In Koo Hwang),박정훈(Jeong-Hoon Park),최우제(Woo-Je Choi),박노진(Noh-Jin Park),오해수(Hae-Soo Oh),안성진(Sung Jin An),박승국(Seung-Kook Park),윤대근(Dae-Kun Yoon),이원학(Won-Hak Lee),강태천(Tae-Cheon Kang),원무호(Moo Ho Won) 대한해부학회 2002 Anatomy & Cell Biology Vol.35 No.5
허혈에 대한 연구는 중추신경계통에서 대부분을 차지하고 있다. 그러나 허혈은 중추신경 뿐 아니라, 말초신경에도 많은 영향을 미칠 것으로 생각된다. 특히 머리 부분에 있는 대부분 장기들의 일반감각을 담당하는 삼차신경절은 매우 중요할 것으로 생각한다. 신경전달물질의 분비와 감각의 조절 등에 중요한 칼슘결합단백질은 세포질내 칼슘을 조절하여 감각의 전달에 매우 중요하다. 따라서 본 연구는 Mongolian gerbil의 삼차신경절에서 인위적으로 허혈-재관류를 유발하여 calbindin D-28k (CB)와 calretinin (CR)의 경시적인 변화와 그 의미를 연구해 보고자 하였다. 정상군에서 CB과 CR 면역반응은 큰 크기, 중간 크기, 작은 크기의 신경세포에서 관찰되었다. 허혈-재관류 후 12시간까 지는 면역반응세포 수의 변화에 큰 차이를 관찰할 수 없었다. 허혈-재관류 후 1일 경에는 CB과 CR을 함유한 큰 신경세 포의 수가 급격하게 증가하였으며, 그 이후부터 CB 면역반응세포는 감소하였고, CR 면역반응세포는 허혈-재관류 후 4일 경에 중간 크기 신경세포가 정상군보다 3배 가량 증가하였다. 이상의 연구 결과는 허혈-재관류 후 1일 경에 큰 신경세포에서 CB와 CR 면역반응의 증가가 있었는데, 큰 신경세포들 은 A fibers를 함유하고 있으므로, 이 시기에 CB와 CR이 기계적 자극의 전도에 영향을 줄 것으로 생각이 된다. 또한 허 혈-재관류 후 4일 이후에 중간 크기의 신경세포에서 CR 면역반응 세포의 증가는 이들이 Aδ 또는 C fiber를 함유하고 있 으므로, 이 시기에는 통증이나 온도 감각에 CR이 관여할 것으로 생각된다. Many researches have focused upon temporal changes of neurotransmitters and/or neuromodulators in the central nervous system after ischemic insult. In sensory neurons, the spatial and temporal alterations of neurotransmitters have been little studied. Calbindin D-28k (CB) and calretinin (CR) have been suggested to play a role in the transmission of neurotransmitters. Therefore, in the present study we investigated the chronological alteration of CB and CR immunoreactivity in the trigeminal ganglion cells of the Mongolian gerbil after ischemic insult. In the sham operated group, CB and CR immunoreactivities were found in small-, medium- and large-sized neurons. One and two days after ischemia-reperfusion, small and large-sized CB immunoreactive neurons increased significantly. Thereafter, number of the CB immunoreactive neurons decreased markedly. Furthermore, five days after ischemia-reperfusion, CB immunoreactivity was detected in a few neurons, and its immunoreactivity was also very weak in the cytoplasm. Number of the large-sized CR immunoreactive neurons increased significantly one day after ischemia-reperfusion. Thereafter, the number of the large-sized CR immunoreactive neurons decreased. Especially, the number of the medium-sized CR immunoreactive neurons increased dramatically 4 days after ischemia-reperfusion. These results suggest that an increase of CB and CR may play an important role in modulating the mechanoception 1 day after ischemia-reperfusion, because the immunoreactivities increased in large-sized neurons which have the myenlinated A fibers. These results also suggest that significant increase of CR expression in medium-sized neurons 4 and 5 days after ischemia-reperfusion may provoke CR in modulating the nociception or thermoception because the medium-sized neurons which have the myenlinated Aδ or C-fibers.
만성 C형간염 환자에서 인터페론 알파와 리바비린 병합요법의 치료 효과와 합병증
황상연 ( Sang Youn Hwang ),이혜정 ( Hae Jung Lee ),박기태 ( Kee Tae Park ),김경엽 ( Kyung Yup Kim ),이선미 ( Sun Mi Lee ),박찬원 ( Chan Won Park ),김태오 ( Tae Oh Kim ),김광하 ( Gwang Ha Kim ),허정 ( Jeong Heo ),강대환 ( Dae Hwan 대한소화기학회 2007 대한소화기학회지 Vol.49 No.3
목적: 만성 C형간염 환자의 인터페론 혹은 페그인터페론과 리바비린 병합요법의 치료 효과는 잘 알려져 있다. 그러나 치료에 따른 합병증을 중점으로 다룬 연구는 많지 않다. 이번 연구는 다양한 범주의 만성 C형간염 환자를 대상으로 인터페론과 리바비린 병합요법의 효용성과 합병증을 연구하고자 하였다. 대상 및 방법: 2001년 1월부터 2005년 1월까지 부산대학교병원에서 인터페론과 리바비린을 투여 받은 240명의 만성 C형간염 환자를 대상으로 치료 합병증을 평가하였고, 그중 치료를 종결한 154명의 환자를 대상으로 이들의 치료종결반응(end of treatment resoponse, ETR)과 지속바이러스반응(sustained virologic response, SVR)을 후향으로 평가하였다. 투여기간은 유전자 1형은 12개월, 비 1형은 6개월로 하였고, 인터페론 알파 300만 단위를 주 3회 피하주사로, 리바비린 800-1,200 mg을 매일 경구로 투여하였다. 결과: 총 240명의 환자의 남녀비는 143:97였고, 유전자 1형은 111명, 비 1형은 106명, 검사하지 않았거나 분석할 수 없었던 경우가 23명이었다. 치료를 완료한 154명의 ETR, SVR은 각각 79.2%, 61.0%였고, ETR을 보인 환자 중 SVR에 관한 추적관찰을 하지 못한 13명을 제외하였을 때 SVR은 66.7%였다. 치료를 조기에 중단한 환자는 35.8%로 순수 치료 부작용으로 인한 경우가 15.4%, 추적방문 실패로 인한 경우가 7.9%, 치료 경과 중 바이러스 음전실패 및 돌파현상으로 인한 경우가 11.3%, 그 외 원발 복막염, 간세포암종, 심근경색의 경우가 1.2%였다. 부작용으로 치료를 중단했던 경우는 간기능 악화가 8명, 우울증과 관련된 증상이 10명 (식욕부진 5명, 무력감 및 피곤함 2명, 자살충동 2명, 불면증 1명), 체질증상이 7명, 탈모 4명, 피부발진 2명, 혈소판 감소 2명, 그 외 피부 소양증, 설사, 흉통, 체중 감소가 각각 1명이었다. 빈혈로 인해 리바비린을 감량한 경우는 37명(15.4%), 백혈구 감소와 혈소판 감소로 인터페론을 감량한 경우는 각각 21명(8.8%)과 11명(4.6%)이었다. 결론: 치료를 완료한 환자들의 SVR은 61.0%였고, 환자의 약 3분의 1이 치료반응 부족, 부작용 및 순응도 부족으로 치료를 조기 중단하였다. Background/Aims: The effectiveness of combination therapy with conventional or pegylated interferon alpha and ribavirin in patients with chronic hepatitis C is well understood. However, the profound investigation about complications of the treatment has been rarely reported in Korea, where patients have broader spectrum of disease manifestations. The aim of this study was to evaluate the effectiveness and complications of the combination therapy of interferon alpha and ribavirin in patients with chronic hepatitis C. Methods: Two hundred and forty patients with chronic hepatitis C were included. All patients were treated with interferon alpha (3 million units thrice a week) in combination with ribavirin (800-1,200 mg, depending on body weight). Patients were treated for 6 or 12 months according to the genotypes (genotype 1; 12 months, non-1; 6 months). We retrospectively evaluated ETR (end of treatment response) and SVR (sustained virologic response) on the basis of intent-to-treat in patients completing the therapy. Results: In 154 patients who had completed the therapy, ETR was 79.2% and SVR was 61.0%. Multivariate analysis showed that genotype and early virologic response at 3 months of treatment were indepedent predictive factors of SVR. Due to insufficient response, 11.3% of the patients discontinued the therapy. In addition, 24.5% of the patients prematurely discontinued the therapy due to adverse events including aggravated liver function (15.4%), failure to return (7.9%), and others (1.2%). Dose modifications of interferon alpha or ribavirin were required due to anemia (15.4%), neutropenia (8.8%), or thrombocytopenia (4.6%). Conclusions: The overall SVR of patients who had completed the combination therapy with interferon alpha and ribavirin was 61.0%. However, about one third of the patients discontinued the therapy prematurely due to insufficient response, adverse events and/or noncompliance. (Korean J Gastroenterol 2007;49:166-172)
황정해,조성현,김창엽,서정돈,한만청,이정예,Hwang, Jeong-Hae,Cho, Sung-Hyun,Kim, Chang-Yup,Seo, Juag-Don,Han, Man-Chung,Lee, Jeong-Ye 한국의료질향상학회 1997 한국의료질향상학회지 Vol.3 No.2
Background : It is a primary goal for hospital personnel to improve the quality of patient care. In Korea the concept of quality assurance has been spread over the last five years. Many hospitals have implemented quality assurance programs that fit their own philosophy and needs. As a result, they are supposed to have different experiences and attitudes toward quality assurance. To investigate their diversity will be helpful to have a direction to the future and to enhance the quality assurance activities in Korean hospitals. Objectives : The aim of this study is to obtain information about hospital personnel's attitude and opinion toward quality assurance in hospitals. Methods : A questionnaire was developed which consisted of five parts; the general characteristics of respondent, the concepts of quality assurance, need for quality assurance program, current status of quality improvement activities, and participation in programs. Using the registry of Korean hospitals, 102 hospitals with more than 400 beds were selected. Questionnaires were mailed to hospital staffs of each hospital; top managers, clinical department heads, registered nurses, medical recorders, and administrators. Results : Of 2038 questionnaires sent, 877 were returned, giving response rate of 44%. Most respondents(70%) regarded quality assurance as efforts to provide patient with care in highest quality and to improve effectiveness or resource utilization. Ninety-nine percent of respondents agreed to need for quality assurance in their hospitals. There were current quality improvement programs implemented in the department of 553 respondents(62%), and most of the(85%) have participated in at least one program. Lack of motivation was pointed out as a barrier to implement the programs. Conclusion : Although most respondents have known of the concept and need for quality assurance, this study suggests that education and motivation of hospital personnel be needed to activate the quality assurance programs in hospitals.