물리치료 임상실습 교육의 현황과 인식

안성자,안소윤,An, Seong-Ja,Ahn, So-Youn 대한물리치료과학회 2012 대한물리치료과학회지 Vol.19 No.2

Purpose : This study is performed to investigate the status and recognition of the education for physical therapy clinical practice. Method : This study used a descriptively designed survey in which 328 clinical instructor, 55 professors and 404 college trainee students in Korea are participated. The research instruments developed by Kim(2004) and Park(1997) are used. The collected data were analyzed by SPSS/PC+12.0. Results : 1. Trainees are in favor of practicing in the university hospital, but more needed to practice in various clinical institutions. 2. Clinical practice period is 400-600 hours. The time of clinical practice has been shifted to the summer vacation, so it is needed to be scattered along semester evenly. 3. The categories of diseases should be determined, by which trainees to experience the assessment and treatment through clinical practice. 4. For the case of accident during clinical practicing, an insurance contract is required for trainees. 5. Through school and clinical institutions, the common and standardized clinical practice manuals or instructions are needed. Conclusion : Clinical institutions and college for student training to improve efficiency are forced to study systematically.

Short-Term Results of Non-Small Cell Lung Cancer with Curative Radiotherapy

안성자,박승진,정웅기,나병식,Ahn Sung Ja,Park Seung Jin,Chung Woong Ki,Nah Byung Sik The Korean Society for Radiation Oncology 1990 Radiation Oncology Journal Vol.8 No.2

1985년 8월부터 1988년 10월까지 전남대학교병원 치료방사선과에서 근치목적의 방사선치료를 받은 비소세포성 폐암환자 102명에 대하여 후향적 분석을 시행하였다. 대상환자들에 대한 추적조사기간은 1개월에서 37개월이었고 중간값은 15개월이었다. 전체환자군의 1년 및 2년 생존율은 각각 $28\%,\;5\%$였으며 임상적 병기별로 보면 II, IIIA, IIIB기 환자군의 평균생존기간은 각각 10개월, 6개월, 9개월이었고 2년 생존율은 각각 $12.5\%,\;12.5\%,\;12.1\%,\;0\%$였다. 방사선치료후 치료실패가 확인된 32명에 대하여 분석을 하여보면 국소실패군이 $28\%$(9명)였으며 원격실패군이 $72\%$ (23명)로 폐암환자의 사망의 대부분은 전신적인 원격전이에 의함을 알 수 있었다. 치료당시의 전신적 건강상태를 생존율에 유의한 영향을 주었으나(p<0.01), 방사선 치료선량에 따른 생존율의 유의한 차이는 보이지 않았다(p>0.05). A retrospective analysis was performed or 102 patients with non-small cell lung cancer who received the curative radiotherapy from August 1985 to October 1988 at the Department of Therapeutic Radiology of Chonnam University Hospital. The follow-up period was ranged from 1 to 37 months and the median follow-up time was 15 months. The acturial 1 and 2 year survival rate of all the patients was $28\%\;and\;5\%$, respectively. The median survival was 10 months for stage II, 6 months for stage IIIA, and 9 for IIIB and the actuarial 2 year survival tate was $12.5\%,\;12.1\%,\;and\;0\%$ respectively. The treatment failure was identified in 32 patients and the locoregional failure was seen in 9 patients ($28\%$) and the distant failure in 23 patients ($72\%$). The initial performance status was related to the survival with statistical significance (p<0.01), but the survival difference by the radiation dose was not statistically significant (p>0.05).

The result of Radiotherapy in Malignant Thymona

안성자,박찬일,Ahn, Sung-Ja,Park, Charn-Il The Korean Society for Radiation Oncology 1990 Radiation Oncology Journal Vol.8 No.2

1979년부터 1987년까지의 서울대학교병원 치료방사선과에서 흉선암으로 근치목적의 방사선치료를 받은 21명을 대상으로 조사하였다. 전체환자의 3년생존율은 $80.5{\%}$, 3년 무병생존율은 $78.6{\%}$였다. 근무력증을 동반한 환자는 $43.5{\%}$였고 치료후 $40{\%}$ (4/10)에서 증상의 호전을 보였다. 증상의 유무에 따른 3년생존율을 비교하여보면 각각 $90{\%}$, $78.8{\%}$였으며 근무력증이 예후에 나쁜 영향을 주는 인자가 아님을 알 수 있었다. 방사선치료후 완전관해율은 절제술을 시행한 경우는 $100{\%}$(3/3)인 반면, 절제가 불가능한 경우는 $20{\%}$(3/15)였다. 완전관해율 및 부분관해율은($33{\%}$ vs $56{\%}$) $89{\%}$였고 이에 따른 3년생존율은 각각 $89.8{\%},\;81.7{\%}$로 통계학적으로 유의한 차이는 보이지 않았다. 수술정도에 따른 치료실패율을 비교하여보면 절제가 가능한 환자에서는 치료실패가 없었으나, 절제가 불가능하였던 환자 15명중 4명에서 국소실패, 1명이 골전이 소견을 보였다. 국소치료실패가 대부분으로 원격전이율은 낮은 양상을 보였다. Twenty one patients of malignant thymoma treated with curative aim at the Department of Therapeutic Radiology of Seoul National University Hospital from 1979 to 1987 were analysed retrospectively. The 3 year overall and relapse free survival rate was $80.5\%\;and\;78.6$, respectively. Myasthenia gravis (MG) was seen in $43.5\%$ at presentation and disappeared in $40\%$ (4/10) after radiotherapy with or without operation. The 3 year cumulative survival rate with and without MG was $90\;and\;78.8\%$, respectively. We could consider that MG was no longer adverse prognostic factor. The complete response rate after partial resection was $100\%$ (3/3), and that after biopsy was $20\%$(3/15). The overall local control rate including complete and partial response rate ($33\;vs\;56\%$)was$89\%$ and the 3 year actuarial survival rate by the response rate was $88.9\%\;and\;81.7\%$, respectively. There was no statistically significant survival difference between two groups. The crude rate of relapse at 3 years was $23.8\%$ (5/21), and $80\%$ (4/5) were locoregional failures. All failures were observed in biopsy only group, while no failure was observed in resected group. The major pattern of the treatment failure was the locoregional failure and the distant metastases was rarely observed.

[논문발표] 자취하는 남녀 고등학생의 영양지식과 식생활 관리 및 식사실태

안성자,김영남 한국생활과학회 1996 한국생활과학회지 Vol.5 No.2

Breast cancer

안성자 대한종양외과학회 2011 대한임상종양학회 학술대회지 Vol.2011 No.5

Irradiation Alone in Stage IB, IIA, and IIB Cervix Cancer : I Analysis of Survival and Failure Patterns

안성자,정웅기,나병식,남택근,최호선,변지수,Ahn Sung Ja,Chung Woong Ki,Nah Byung Sik,Nam Taek Keun,Choi Ho Sun,Byun Ji Soo The Korean Society for Radiation Oncology 1997 Radiation Oncology Journal Vol.15 No.2

목적 : 본병원에서 방사선 단독치료를 받은 자궁경부암 환자의 생존율 및 재발 양상을 분석 하고 이에대한 결과를 비교 분석함으로서 치료방법에 대한 평가를 하고자 하였다. 대상 및 방법 : 1987년 5월부터 1991년 12월까지 자궁경부암병기(FIGO) IB, II A, II B 로 근치목적의 방사선치료를 완료한 220명의 환자를 대상으로 후향적 분석을 시행하였다. 이중 병기 IB환자는 1995년에 개정된 FIGO 분류법에 의해서 분석당시 IB1과 IB2로 재분류를 시행하였다. 방사선치료는 외부방사선치료와 강내조사를 병용하였으며 방사선치료 후 6개월에서 국소종양의 치유여부를 판정하였다. 추적기간은 3개월에서 115개월까지 였으며 평균 62개월이었고 추적율은 $93.6\%$(206/220) 였다. 결과 : 병기별 5년 생존율은 IB1(N=50), IB2(N=15), II A(N=58), II B(N=97)에서 각각 $94\%,\;87\%,\;69\%,\;56\%$였다. 생존과 관계있는 예후인자로는 병기(p=0.00), 진단시 혈색소치(p=0.00), 진단시 종양표지자 수치(p=0.02), 종양의 크기(0.00), 골반단층촬영에서의 임파선전이(p=0.04) 등이 통계적인 유의수준을 보였으나 다요인 분석에서는 병기만이 유일하게 통계적인 유의수준의 차이를 보였다. 판정이 가능한 214명의 방사선치료에 따른 국소종양제어율은 $81\%$였으며, 병기별로보면, IBI, IB2, II A, II B 각각 $100\%,\;86.7\%,\;84.5\%,\;68.1\%$의 결과를 보였다. 치료 후 재발율은 $15.5\%$(27/174)였으며, 병기별로 보면 IBI, IB2, II A, II B 각각 $8\%,\;0\%,\;22.4\%,\;19.4\%$였다. 결론 :촌기 자궁경부암 환자의 치료결과는 이미 보고되어 있는 다른 결과와 비교시 비슷한 수준을 보이나 진행된 II B 환자에서는 낮은 생존율의 결과를 보이고 있으며 이에대한 원인분석과 치료방법의 개선이 필요하다 하겠다. Purpose : We analyzed the survival and failure patterns of cervix cancer patients treated with irradiation alone to evaluate our treatment method and to compare with the others Methods and Materials : Two hundred and twenty cervical cancer patients, Stage IB, II A, and II B who completed the planned treatment between Mar 1987 and December 1991 were analyzed retrospectively. The Stage IB patients were restaged to the Stage IB1 and IB2 by the recently revised FIGO classification, Patients were treated with a combination of external irradiation and the intracavitary brachytherapy Determination of the tumor control was done at the time of 6 months Postirradiation. The follow-up time was ranged from 3 to 115 months and the mean was 62 months and the follow-up rate was $93.6\%$(206/220) Results : The overall 5-year survival rate of Stage IB1 (N=50), IB2(N: 15). II A(N=58), and II B(N=97) was $94\%,\;87\%,\;69\%,\;and\;56\%$. respectively. In the univariate analysis of prognostic factors, stage(0.00), initial Hg level (P=0.00), initial TA-4(tumor-associated) antigen level(p= 0.02), initial CEA level(p=0.02), barrel-shaped tumor(p=0.02), whole cervical involvement (0.00), pelvic tyrnphadenopathy(LAP) in CT(p=0.04), and Post-irradiation adiuvant chemotherapy(P=0.00) were statistically significant in survival analysis. In a while multivariate analysis showed that the stage was the most powerful Prognostic indicator and the Post-irradiation chemotherapy factor also showed the statistical significance. The overall local control rate was $81\%$ and by the stage, $100\%$ in Stage IBI, $86.7\%$ in Stage IBS, $84.5\%$ in Stage IIA, and $68.1\%$ in Stage IIB, respectively The overall tumor recurrence rate was $15.5\%$(27/174) and by the stage, $8\%$(4/50) in Stage IB1, $0\%$(0/l3) in Stage IB2, $22.4\%$(l1/49) in Stage II A, and $19.4\%$(12/62) in Stage II B, respectively. Conclusions : We obtained the similar treatment results to the other's ones in early stage cervical cancer patients. But in Stage II B, the local control rate was lower than that of the other institutes and also the survival was poorer. So it seems to be necessary to reevaluate the treatment method in advanced cervical cancer patients.

Results of Postoperative Irradiation in Patients with Carcinoma of Uterine Cervix Stage IB and IIA

안성자,남택근,정웅기,나병식,최호선,변지수,Ahn Sung Ja,Nam Taek Keun,Chung Woong Ki,Nah Byung Sik,Choi Ho Sun,Byun Ji Soo The Korean Society for Radiation Oncology 1995 Radiation Oncology Journal Vol.13 No.1

목적 :조기 자궁경부암 환자에서 보조적 방사선치료요법은 근치적수술을 시행하고 재발의 위험이 높은 불량한 예후를 갖는 환자에서 시행되고 있다. 이에 저자는 수술후 방사선치료를 받았던 환자의 생존과 치료실패에 영향을 주는 예후인자를 분석하고자 하였다. 대상 및 방법 :전남대학교병원 치료방사선과에서 1985년 8월부터 1988년 12월까지 수술후 방사선치료를 받았던 자궁경부암 병기 IB와 IIA환자 106명중 기록이 충분한 90명을 대상으로 후향적 분석을 시행하였다. 추적율은 $88\%$(78/90)였고 추적기간의 중간간은 64개월이었다. 결과 : 90명에 대한 5년 생존율및 5년 무병생존율은 각각 $80.0\%$, $80.2\%$였다. 다변량생존분석에서 65명을 대상으로 환자의 연령, 병기, 조직학적 분류, 수술전 혈중 CIA 농도, 출산력, 경부침윤정도, 종양의 육안적 크기, 종양의 궤양성 유무, 임파선 전이 유무, 수술절단면의 소견, 항암제치료 유무를 변수로 분석결과 수술절단면의 조직학적인 소견(p=0.005), 임파선전이유무(p=0.005)가 통계학적으로 의미있는 예후인자였다. 추적기간중 13명에서 재발이 확인되었고 부위별로 보면 골반내 국소재발이 5명, 원격전이가 8명 이었으며 수술후 3개월에서 39개월사이에 발견되었으며 중간값은 19개월이었다. 골반내 전이는 선암(p=0.034)과 경부침윤 10mm 이상(p=0.02) 그리고 항암제치료(p=0.023)를 시행하였던 환자군에서, 원격 전이에 있어서는 임파선전이와 수술절단면에서 암세포가 양성을 보였던 환자군에서 각각 더 높은 전이율을 보였다. 치료에 의한 합병증을 호소하였던 환자는 15명이었으며 가장 흔한 증상은 혈변이나 혈뇨였고 중증의 합병증을 보인 환자는 없었다. 결론 : 이에 저자는 조기자궁경부암 IB와 IIA환자에서 수술병리학적소견중 임파선전이와 불충분한 수술적절제가 예후에 있어서 가장 큰 영향을 보임을 알 수 있었으며 이러한 소견을 보인 환자는 보다 적극적인 보조치료가 필요하리라 사료된다. Purpose : The adjuvant postoperative radiotherapy has been usually applied to the patients with unfavorable prognostic factors after radical operation in early cervical cancer. We focused on the evaluation of the survival status and failure patterns of the patients with postoperative radiotherapy. Materials and Methods : We retrospectively analyzed ninety patients with FIGO stage IB and IIA cervix cancer who received postoperative pelvic irradiation at Chonnam University Hospital between August 1985 and December 1988, Seventy-eight patients had adequate follow-up information for survival analysis. Median follow-up time of these patients was 64 months. Results : The 5 year overall and disease free survival rate of ninety patients was $80.0\%$ and $80.2\%$, respectively. The prognostic significance to the survival was determined by multivariate analysis. Adequacy of resection margin(p=0.005) and lymph node status(p=0.005) appeared to be independent prognostic factors. Recurrence occurred in 13 patients, 5 in the pelvis and 8 at distant sites. The median time to recurrence was 19 months(range:3-39 months). The pelvic recurrence was more prevalent in the group of patients with adenocarcinoma, depth of stromal invasion more than 10mm and use of chemotherapy. The distant failure was more prevalent in the group of positive resection margin or positive lymph node with statistical significance. Conclusion : Patients with pelvic lymph node or surgical margin involvement clearly constitute a high risk group in this analysis and should be considered as candidates for some form of adjuvant therapy.

A Study on The Effects of Aerobic and Foam Roller Exercise Programs on Body Balance in Senior Women

안성자,권해연 국제물리치료연구학회 2017 Journal of International Academy of Physical Ther Vol.8 No.2

The purpose of this study was conducted with senior women of ages 65 in Community Center to identify effective exercise methods for preventing falling accidents by enhancing balancing skills through aerobic and foam roller exercise programs. There were 24 subjects : 11 aerobics group and 13 foam roller group. 30 minute exercise programs were conducted against both groups 12 times 6 weeks. Various tests, including Time up and go test , Forward reach test, One-leg standing with eyes open/closed and Y-Balance were conducted prior to commencing the exercise program. Wilcoxon’s Signed-ranks test was executed to analyze the changes in balance of the aerobic and foam roller exercise group prior to and after the experiment, and Mann-Whitney test was executed to compare the difference between the two groups. The Y-Balance(post. medial) show statistically significant differences in the amount of change before and after exercise between the two groups, except for Timed up and go test, Forward reach test, YBalance( ant.), and Y-Balance(post. lateral), which did not showed statistically significant difference (p<0.05). Foam roller exercises are effective methods to enhance the balancing skills in senior women to prevent falling accidents.

닫힌 역학적 사슬운동에서 무릎관절 각도에 따른 넙다리네갈래근의 근활성도 변화 비교

안성자,An, Seong-Ja 대한고유수용성신경근촉진법학회 2012 PNF and Movement Vol.10 No.3

Purpose : This study was intended to compare muscle activity in relation to knee joint angles on closed kinetic chain. Methods : A total of 13 subjects consisting of 5 adult males and 8 adult females were made to make movements maintaining knee joint angles at $30^{\circ}$, $45^{\circ}$ and $90^{\circ}$ on closed kinetic chain and the muscle activity occurring in their vastus medialis, rectus femoris and vastus lateralis was measured. Statistical data were analyzed using oneway ANOVA. Results : On closed kinetic chain, the muscle activity of the vastus medialis, rectus femoris and vastus lateralis increased the most at $90^{\circ}$ among the knee joint angles with statistically significant differences(p<0.05). Conclusion : On closed kinetic chain, it could be seen that as the angle of the knee joint increased, the muscle activity increased.

Results of Curative Radiation Therapy with or without Chemotherapy for Stage III Unresectable Non-Small Cell Lung Cancer

안성자,김영철,김규식,Kyung-Ok Park,정웅기,남택근,나병식,송주영,윤미선 대한암학회 2005 Cancer Research and Treatment Vol.37 No.5

Purpose: We retrospectively analyzed the patients who received curative radiotherapy for unresectable stage III NSCLC to investigate the impact of chemotherapy.Materials and Methods: From 1998 to 2001, the records of 224 patients who completed curative radiotherapy for NSCLC were reviewed. There were 210 males and 14females, and their median age was 64 years (range 38 ∼83). 54 patients had stage IIIA disease and 170 patients had stage IIIB disease. Conventional radiotherapy wasgiven and the radiation dose ranged from 50∼70 Gy with a median of 60 Gy, and chemotherapy was combined for 116 patients (52%).Results: The median survival, the 2-year, and 5-year actuarial survival rates of all 224 patients were 15 months, 30%, and 7%, respectively. The median survival of thepatients with stage IIIA and IIIB disease were 21 months and 13 months, respectively (p=0.14). The median survival of patients who received chemoradiation was 18months compared to 14 months for the patients who received RT alone (p=0.02). Among the chemoradiation group of patients, the median survival time of the patients who received 1 to 3 cycles of chemotherapy was 16 months and that for the patients who received more than 3 cycles was 22 months (p=0.07). We evaluated the effects of the timing of chemoradiation in 57 patients who received more than 3 cycles of chemotherapy. The median survival of the patients with the concurrent sequence was 25 months and that for the patients with the sequential chemotherapy was 19 months (p=0.81).Conclusions: For advanced stage III non-small cell lung cancer patients who completed the curative radiotherapy, the addition of chemotherapy improved thesurvival compared to the patients who received radiotherapy alone. Purpose: We retrospectively analyzed the patients who received curative radiotherapy for unresectable stage III NSCLC to investigate the impact of chemotherapy.Materials and Methods: From 1998 to 2001, the records of 224 patients who completed curative radiotherapy for NSCLC were reviewed. There were 210 males and 14females, and their median age was 64 years (range 38 ∼83). 54 patients had stage IIIA disease and 170 patients had stage IIIB disease. Conventional radiotherapy wasgiven and the radiation dose ranged from 50∼70 Gy with a median of 60 Gy, and chemotherapy was combined for 116 patients (52%). Results: The median survival, the 2-year, and 5-year actuarial survival rates of all 224 patients were 15 months, 30%, and 7%, respectively. The median survival of thepatients with stage IIIA and IIIB disease were 21 months and 13 months, respectively (p=0.14). The median survival of patients who received chemoradiation was 18months compared to 14 months for the patients who received RT alone (p=0.02). Among the chemoradiation group of patients, the median survival time of the patients who received 1 to 3 cycles of chemotherapy was 16 months and that for the patients who received more than 3 cycles was 22 months (p=0.07). We evaluated the effects of the timing of chemoradiation in 57 patients who received more than 3 cycles of chemotherapy. The median survival of the patients with the concurrent sequence was 25 months and that for the patients with the sequential chemotherapy was 19 months (p=0.81).Conclusions: For advanced stage III non-small cell lung cancer patients who completed the curative radiotherapy, the addition of chemotherapy improved thesurvival compared to the patients who received radiotherapy alone.