FORREST II 궤양 출혈의 적절한 치료 유용성 : 전향적 무작위 연구

김성은,이선영,신정은,주미순,전정현,이경은 이화여자대학교 의과대학 2003 EMJ (Ewha medical journal) Vol.26 No.2

Objectives : This study is to compare the clinical and cost effectiveness of various pharmacologic therapies with of without endoscopic procedure in the Forrest II ulcer. Methods : Between May 2001 and June 2002, total of 58 Forrest II bleeding activity patients (37 cases of NBVV, 6 adherent blood clots, 9 flat red spot, and 6 flat black spot) with gastric ulcer(32 cases) and duodenal ulcer(26 cases) were analyzed. UGI endoscopy was performed within 12 hours of the first bleeding episodes, and underwent repetitive endoscopy after 48h. All the patients were randomly assigned to receive somatostatin(group I), PPI(omeparzole : group II), only H2 blocker (famotidine, group III), or endoscopic injection therapy followed by famotidine (group IV). We compared with rebleeding rates, changes of ulcer size, and modified estimated costs for 3 day-hospital in four groups respectively. Results : 1) Twelve patients experienced rebleeding(20.7%). 2) The rates of rebleeding were 16.6% (2/12) in group I, 28.6%(4/14) in group II, 5.9%(1/17) in group III, 26.7% in group IV. There was no significant difference in rebleeding rate among the groups, but there was low rebleeding tendency in group III, compared with group II(p=0.087).3)Type of stigmata including non-bleeding visible vessels and adherent clots were associated with an increased rate of recurrent bleeding(p=0.01).4) When modified estimated costs were calculated, group III could be treated at the lowest cost(p<0.05). Conclusion : In Forrest II bleeding ulcer, medical therapy, especially famotidine could be suggested prudently as a proper treatment modality for this lesion, considering the cost-effecti-veness. 목적: 위십이지장의 궤양성 출혈은 대부분 특별한 치료없이 보존적인 치료만으로 지혈된다. 그러나 활동성 출혈이 있는 Forrest II 궤양의 경우는 흔히 내시경적인 치료를 하게 되는데 최근 여러 연구에서 약물치료와 비교 연구가 있었으나 다양한 약물들과 내시경 치료의 효과 및 비용-효용성의 비교는 이루어지지 않았다. 방법: 2001년 5월부터 2002년 6월가지 Forrest II 궤양출혈 환자 68명을 전향적으로 포함시켰고 이중 위암으로 진단된 경우와 내시경의 추적 검사를 거부한 경우 또는 다른 중증의 내과적 질환이 동반된 경우를 제외시켜 58명의 환자를 대상으로 하였다. 대상 환자 58명은 위궤양이 32명이고 십이지장 궤양이 26명으로 비출혈성노출 혈관 37명, 신선 부착 혈괴 6명, 적색반 9명, 그리고 흑색반 6명이었다. 초기 상부 위장관 내시경은 내원 후 12시간 이내에 이루어졌고 추적 검사는 48시간 이후에 시행되었다. 치료는 네 개의 군으로 나누어 무작위로 소마토스타틴 투여군(1군), 프로톤펌프 억제제 투여군 (2군), H₂수용체 차단제 투여군(3군), 그리고 내시경적 지혈제 주사군(4군)으로 치료하였고 각 군의 재출혈 여부, 혈압, 수혈, 궤양의 크기, 급성 출혈 흔적 등을 비교 관찰하였고 입원 3일간의 입원치료비용을 계산하였다. 결과: 1) 재출혈은 12명(20.7%) 에서 발생하였다. 2) 각군에서의 재출혈은 제1군이 16.6%(2/12), 제2군에서 28.6%(4/14), 제3군이 5.9%(1/17), 제4군이 26.7%(4/15)로 각 군의 재출혈 빈도는 차이가 없었으나 제3군에서 제2군에 비해 재출혈이 낮은 경향을 보였다.(p=0.087).3) 재출혈에 영향을 미치는 인자는 노출 현환과 신선 혈괴였다(p=0.01). 4)평균 입원치료 비용은 제3군이 가장 적어 높은 치료 비용-효과를 보였다.(p<0.05).

2.9% 과산화수소를 함유한 부착형 미백제의 임상적 효능과 안정성에 관한 연구

박은숙,성소래,홍성태,김지은,이소영,황수연,이신재,진보형,손호현,조병훈 大韓齒科保存學會 2006 Restorative Dentistry & Endodontics Vol.31 No.4

2.9%의 과산화수소를 함유한 시험용 부착형 미백제(Medison dental whitening strip, Samsung medical Co.,Anyang,Korea)를 실험군 피험자 23명, 시험용 미백제에서 과산화수소를 제외한 동일한 제재를 대조약으로 대조군 피험자 24명에게 매일 1시간 30분씩, 2주간 적용하여 임상적 효능과 안전성을 평가하였다. 미백 효과는 Shade Vision, Chroma Mete 및 Vitapan classical shade guide를 이용하여 색변화를 측정하여 다음과 같은 결론을 얻었다. 1. 실험군에서의 전체 치아의 색변화량(ΔE^(*))은 세 가지 측정법에서 모두 대조군에 비해 통계적으로 유의한 차이를 보였고 (p < 0.05). 쉽게 인지할 수 있는 정도였다. 2. 색변화는 색좌표 상에서 명도의 증가와 녹색조 및 청색조로의 변화에 의해 얻어졌다. 3. 치아별로는 어두운 견치의 색변화량이 가장 컸고, 측절치, 중절치 순으로 감소하였다. 4. 47명의 피험자 중 5명이 경도의 과민증을 경험하였으나 곧 완화되었다, 치은염증지수와 전기치수검사 결과 시험 전후에 차이가 없어 안전성을 확인하였다. This study evaluated the effectiveness and safety of an experimental bleaching strip (Medison dental whitening strip, Samsung medical Co., Anyang, Korea) containing 2.9% hydrogen peroxide. Twenty-three volunteers used the bleaching strips for one and a half hour daily for 2 weeks. As control group, the same strips in which hydrogen peroxide was not included were used by 24 volunteers with the same protocol. The shade chang (ΔE^(*), color differnce) of twelve anterior teeth was measured using Shade Vision (X-Rite Inc., S. W. Grandville, MI, USA), Chroma Meter (Minota Co., Ltd. Osaka, Japan) and Vitapan classical shade guide (Vita Zahnfabrik, Germany). The shade change of overall teeth in the experimental group was significantly greater than that in the control group (p < 0.05) and was easily perceivable. The change resulted from the increase of lightness (CIE L^(*) value) and the decrease of redness (CIE a^(*) value) and yellowness (CIE b^(*) value). The shade change of individual tooth was greatest in canine, can smallest in central incisor. The safety of the bleaching strip was also confirmed. 〔J Kor Acad Cons Dent 31(4):269-281, 2006〕

Bortezomib과 Dexamthasone으로 치료한 골수외 형질세포종 4예

백종현,이은영,장리라,손창배,신은경,서정아,이지숙,이호섭,이상민,신성훈,김양수 고신대학교의과대학 2007 고신대학교 의과대학 학술지 Vol.22 No.2

Despite the use of aggressive local and systemic treatment including autologous stem cell transplantation in multiple myeloma, extramedullary recurrences are common and the prognosis of these patients is poor. Many novel drugs such as thalidomide, lenalidomide and bortezomib improve the response of treatment of multiple myeloma, but some reports failed to describe thalidomide has effect in extramedullary plasmacytoma. Recent data report on the successful treatment plasmacytomas with bortezomib in patients with advanced multiple myeloma. We treated 4 relapsed or refractory extramedullary plasmacytomas with bortezomib at our institution. We recognized all these extramedullary plasmacytomas decreased and showed more than partial response. This report lends support to the efficacy of bortezomib in the treatment of plasmacytoma and describes the safe use of bortezomib. Responses may, however, be of short duration. Therefore, despite our limited experience, we propose that bortezomib may be considered a therapeutic option for such patients who have risk of radiation therapy

한국 정신장애의 역학 조사 연구[I] : 각 정신장애의 유병률

조맹제,함봉진,김장규,박강규,정은기,서동우,김선욱,조성진,이준영,홍진표,최용성,박종익,이동우,이기철,배재남,신정호,정인원,박종한,배안,이충경 大韓神經精神醫學會 2004 신경정신의학 Vol.43 No.4

Objectives : This study aims to estimate the prevalence of the DSM-IV psychiatric disorders in Korean population using the Korean version of Composite International Diagnostic Interview (K-CIDI). Methods : Subjects were selected by taking multi-stage, cluster samples of 7,867 adult household residents, 18 to 64 years of age, in ten catchment areas. Total 78 trained interviewers administered the K-CIDI to the selected respondents, from June 1 to November30,2001. Results : Total 6,275 respondents completed the interview. Some 33.5% of respondents reported at least one lifetime disorder, 20.6% reported at least one-year disorder, and 16.7% reported at least one-month disorder. The most common lifetime disorders were alcohol abuse/dependence (17.24%), nicotine dependence/withdrawal (11.19%), specific phobia (5.16%), and major de-pressive disorder (4.25%). The lifetime prevalence of substance abuse/dependence (0.25%) and schizophrenia (0.16%) was very low. Nicotine and alcohol use disorder showed very high male/female ratio. Mood disorder and anxiety disorder were more prevalent among female than male. Conclusion : The prevalence of psychiatric disorders was high. In comparison with other studies, remarkable differences in distributions of psychiatric disorders across the areas and times were observed.

알파인 스키 국가대표선수와 국가대표 상비군 선수의 요부 및 슬관절의 등속성 근력에 관한 비교 연구

이종희,허승은,이재문 경희대학교 체육과학연구소 2001 體育學論文集 Vol.29 No.-

The current study aims at determining the effect of fitness and suggesting basic information necessary for training the National Alpine ski team through comparing the uniform nature lumbar joint and a knee joint muscular function in 20 Alpine ski racers based on race results. We divided the group into A (National team) and B (National reserve team) groups, and we used the result obtained by a body component analysis programs such as In Body 3.0 and Biodex system 3, which were further examined statistically by SPSS/PC+ program. The difference of uniform nature lumbar joint and a knee joint muscular function from the race in each team was analyzed through Independent Samples t-test, and the results are as follows: 1. The uniform nature the absolute lumbar region of a protractor and the flexor muscular strength in National Alpine ski team was notably higher than that of National reserve team, but there was little difference in relative vague per weight. 2. The uniform nature of lumbar region muscular stamina of National Alpine ski team was comparatively higher than that of the reserve team, but there was little difference in rate of muscle. 3. The average power of uniform lumbar region in National Alpine ski team showed a sizable difference at 60 degrees per second (p〈.01), and at 180 degrees per second there was a sizable difference between groups (p〈.01). 4. The left and right protractor of uniform nature knee joint and maximum muscular strength in National Alpine ski racers was notably high, but there was little difference in relative value per weight. 5. The uniform nature left and right of protractor and muscular stamina flexor knee joint in National Apline ski racers was notably high (p〈.01), but there was little diffrence between groups in muscular stamina of the right flexor. 6. The rate of muscle of uniform nature knee joint and the rate of muscle of both of National Alpine ski racers was not much different from that of National reserve team. 7. The average power of the left and right protractor and the uniform nature knee joint of flexor of National Alpine ski racers at 60 degrees per second was notably high (p〈.01). However, though the average power of the left and right of protractor and the right of flexor was notably high at 180 deg per second (p〈.05) there was little difference in the left flexor.

요양병원 환자분류체계 개발

이지윤,윤주영,김정회,송성희,주지수,김은경 대한간호학회 간호행정학회 2008 간호행정학회지 Vol.14 No.3

Purpose: To develop the patient classification system based on the resource utilization for reimbursement of long-term care hospitals in Korea. Method: Health Insurance Review & Assessment Service (HIRA) conducted a survey in July 2006 that included 2,899 patients from 35 long-term care hospitals. To calculate resource utilization, we measured care time of direct care staff (physicians, nursing personnel, physical and occupational therapists, social workers). The survey of patient characteristics included ADL, cognitive and behavioral status, diseases and treatments. Major category criteria was developed by modified delphi method from 9 experts. Each category was divided into 2-3 groups by ADL using tree regression. Relative resource use was expressed as a case mix index (CMI) calculated as a proportion of mean resource use. Result: This patient classification system composed of 6 major categories (ultra high medical care, high medical care, medium medical care, behavioral problem, impaired cognition and reduced physical function) and 11 subgroups by ADL score. The differences of CMI between groups were statistically significant (p<.0001). Homogeneity of groups was examined by total coefficient of variation (CV) of CMI. The range of CV was 29.68-40.77%. Conclusions: This patient classification system is feasible for reimbursement of long-term care hospitals.

만성 간질환에 대한 DDB(Biphenyl Dimethyl Dicaboxylate)의 임상적 효과

이헌영,임의혁,김성걸,김진희,육은주,성자원,김병호,정형용,강대영,김영건 충남대학교 의과대학 지역사회의학연구소 1994 충남의대잡지 Vol.21 No.2

To investigate the effects of short-term administration of DDB(Biphenyl Dimethyl Dicarboxylate) for decreasing elevated serum aminotransferase levels in chronic liver diseases, authors applied 3 capsules of DDB per day at each meal time for 35 patients and compared with 35 patients treated with other conservative management. The following results were obtained. 1. Serum alanine aminotransferase (ALT) levels significantly decreased from 247.1± 180.0 IU/L of pretreatment level to 96.6±126.0 IU/L, 61.1±62.7 IU/L and 38.0±26.8 IU/L after 1, 3 and 6 months of treatment(p<0.05) and effective rates were observed in 60.0%, 71.4% and 88.6% of patients after 1, 3 and 6 months of treatment. 2. Serum aspartate aminotransferase (AST) levels decreased also significantly from 167.8±96.9 IU/L of pretreatment levels to 124.4±155.0 IU/L, 77.9±49.6 IU/L, 60.6± 46.9 IU/L after 1, 3 and 6 months of treatment(p<0.05), but decreasing pattern of serum AST was less significant than that of serum ALT. 3. No significant difference were observed in the serum ALT and AST changes according to the cause and duration of hepatitis. 4. No significant adverse effects were observed in whole patients treated with DDB. It is suggested that small dose administration of DDB is effective for decreasing serum aminotrans ferase levels in chronic liver disease in which other conservative management was not effective.

DHA의 lipoxygenation에 의한 17-H(P)DHA 의 제조 및 LC/MS/MS를 이용한 구조분석

이은실,이은주,강종성 충남대학교 약학대학 의약품개발연구소 2007 藥學論文集 Vol.22 No.-

Docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) are essential fatty acids and necessary for the development of brain, nerve system and retina. Recently, novel hydroxy compounds generated from DHA and EPA showing various biological activities were reported. In this study, hydroperoxy compound of DHA was prepared by incubating 15-lipoxygenase (15-LOX) and DHA, and was purified and analyzed by HPLC. The purified compound (MW 360) with the absorption maximum of 238 nm was identified as 17-hydroperoxy DHA (17-HPDHA). 17-HPDHA was reduced to a hydroxy compound by sodium borohydride and identified as 17-hydroxy DHA (HDHA) by LC/MS/MS. This method could afford to gain the commercially unavailable precursor of biologically active mediator.

<화엄경>을 통해 본 소설적 상상력과 영화적 상상력

이은성 청람어문교육학회 2004 청람어문교육 Vol.29 No.-

문학교육의 중요한 목표 중 하나인 상상력의 고양은 문학작품을 제대로 읽음으로써 이루어진다. 나아가 우리 주변의 기호(또는 그 작용)를 읽어내는 능력에 의해서도 확장될 수 있다. 영상문학은 문자문학과 달리 처음부터 기호를 사용하지 않는다. 소설의 경우 1차적으로 기호(문자언어)로부터 문학 텍스트가 구성 되지만 영화에서는 텍스트가 먼저 구성되고 이 텍스트로부터 2차적으로(혹은 동시적으로) 기호작용이 생겨서 영화 언어가 만들어진다. 소설 화엄경과 영화 화엄경은 창작 단계에서부터 원전과 상호텍스트성을 보이는데, 작가가 원전에서 해석해낸 의미는 소설과 영화의 장르적 성격에도 간섭해 들어간다. 소설의 서술방법은 작가가 이를 서사시로 여긴 것과 관련이 있으며, 영화의 대사가 대부분 소설의 대사 그대로인 것은 영화가 원작으로 삼은 것이 경전이 아니라 소설이기 때문이다. 소설의 장대한 문자의 서사를 이미지로 압축한 영화 <화엄경>의 영화적 상상력이 보여준 이미지는 소설 <화엄경>과 얽어 읽음으로써 해석할 수 있다. 그리고 두 작품에서 공통적으로 드러나는 사실은 작가의 강렬한 의도가 장르적 관습에 어떻게 간섭할 수 있는가를 보여주고 있다는 점이다. 문학교육의 중요한 목표중의 하나인 상상력의 고양은 1차적 기호(문자 언어)와 2차적 기호(영화 언어)를 함께 읽을 수 있을 때 더욱 풍부해 질 것이다. The development of imagination is one of the important aims in literary education. This development can be achieved by the reading of literary works judiciously and also extended by the interpretation of sign or sign's interaction in our life. Image literature is different from letters literature, in the view point of use of signs. In the case of letters literature, the text is primarily compose of letters language. While, in image literature, the text is made ahead, the cinema language is made of the text which is resulted from the interactions of sign. The cinema Hwaumkyeong shares Buddhist scriptures Hwaumkyeong with novel Hwaumkyeong and have intertextuality of Buddhist scriptures Hwaumkyeong in the level of creation. This explanation shows that the Buddhist scriptures Hwaumkyeong have an influenced on a genre of the cinema as well as novel. In novel, the author have described the original text as narrative. Meanwhile, the author, in film, have described the scenario as the same lines of novel. This result shows that the film is created based on the novel, not the original text. Hwaumkyeong in film is implied by imagine of the novel. When reader find the intertextuality between the imagine of film and narrative of novel, they can interpret the imagine of film readily. The common characteristics of two genres is that author's purpose has been intervened in the acceptable usage of two genres. The development of imagination, which is regarded as one of the important aims in literary education, could be enhanced by the readers, having the ability of reading the letters language and the cinema language at the same times.

아동의 문학평가능력 향상을 위한 동화비평문 쓰기 프로그램 개발아동의 문학평가능력 향상을 위한 동화비평문 쓰기 프로그램 개발

이성은,권성숙 한국초등국어교육학회 2006 한국초등국어교육 Vol.31 No.-

본 연구는 아동의 문학평가능력 향상을 위해 동화비평문 쓰기에 효과적인 프로그램을 개발․적용하여 실제 어떤 변화가 있는지 알아보는데 그 목적이 있다. 다양한 문학작품을 통해 배운 경험은 아동의 발달에 큰 영향을 끼친다. 이에 7차 교육과정에서도 아동의 문학교육을 강조하고 있다. 그러나 실제 초등학교에서는 문학수용능력 향상에만 치중하고 문학평가능력을 위한 구체적인 학습은 미흡한 실정이다. 이를 위해 요구조사를 실시하여 프로그램의 목표를 설정하고, 목적에 따른 내용을 선정 및 조직하며 수업 모형과 평가방법을 개발하였다. 개발된 프로그램은 초등학교 5학년 한 학급을 선정하여 동화비평문 쓰기 프로그램을 8주 동안 적용하여 그 효과를 사전․사후 검사를 통해 알아보았다. 연구 결과, 동화비평문 쓰기 프로그램은 문학평가능력 향상에 긍정적인 영향을 준 것으로 나타났다. 해석력과 비판력으로 구분 된 문학평가능력 중 특히 비판력의 향상에 더욱 긍정적인 역할을 하는 것으로 나타났다. 후속 연구로, 더 많은 아동과 여러 학년을 대상으로 장기간에 걸쳐 다양한 동화를 선정하여 적용하는 방안을 개발하는 연구가 이루어지도록 제언하였다. The purpose of this study was to develop writing literary criticism instruction based on children's literature program for advancing the literature evaluation abilities. For this purpose, the survey was carried out on teachers and students in order to find out on literature evaluation abilities. After survey, the objectives of this program have been established on the 7th Korean language curriculum. This program was applied to 43 fifth grade students of ‘Y' elementary school in Seoul, 29 sessions during 8 weeks. As a results, participating children showed quite meaningful improvements in the four categories of literature evaluation abilities; 'Causal Relationship Analysis', 'Inferential the Context', 'Judgment of Literature' and 'Bring Good-reasons' except 'Comparison and Contrast Analysis', It means that the program is effective for development of literature criticism writing. In conclusion, although this research does not complete the improvement of teaching method and lacks broadness in variations such as different participants and contexts, it shows an open possibility of future development and more progressive research for the teaching method of children's literature evaluation.