결핵흉막염 치료 중에 발생한 역설적 반응에 대한 연구

송은주 ( Eun Ju Song ),백대현 ( Dae Hyun Baek ),정준영 ( Jun Young Jung ),이상렬 ( Sang Ryul Lee ),이명하 ( Myong Ha Lee ),이성혁 ( Sung Hyuk Lee ),이재형 ( Jae Hyung Lee ),이기덕 ( Ki Deok Lee ),이병훈 ( Byoung Hoon Lee ),김상훈 대한결핵 및 호흡기학회 2008 Tuberculosis and Respiratory Diseases Vol.64 No.6

연구배경: 결핵환자에서 항결핵제 치료 중 초기에 병변의 호전 이후 방사선학적, 임상적으로 이전의 병변이 악화 되거나 새로운 병변이 발생하는 경우를 역설적 반응이라 정의한다. 결핵흉막염에서의 역설적 반응 발생과 이와 관련된 인자에 대해서 알려진 바는 많지 않다. 방 법: 2004년 1월부터 2006년 12월까지 결핵흉막염으로 진단받고 4개월 이상 항결핵제를 복용한 환자를 대상으로 하였다. 항결핵제 투약 전과 투약 후 흉부 방사선의 변화를 연속적으로 살펴보고 치료시작 2주 후에 이전의 병변의 악화나 새로운 병변이 생긴 경우를 역설적 반응이 발생한 것으로 판정하였다. 역설적 반응군이 발생하였던 환자군과 발생하지 않았던 환자군 간의 임상적인 특성과 흉수, 혈액 검사를 비교하였다. 결 과: 대상환자 77명 중 역설적 반응을 보인 환자는 16명(21%)이었다. 역설적 반응을 보인 시기는 항결핵제 사용 후 평균 38.6일이었으며, 병변의 크기가 줄어드는데 걸리는 시간은 평균 32.1일이었다. 역설적 반응은 젊은환자에서(30.5세 vs 39.0세), 그리고 흉수의 백혈구 중 림프구의 백분율이 높았던 경우에서(82.1% vs 69.6%) 많이 발생하였다. 결 론: 결핵흉막염의 항결핵제 치료 중에 발생하는 역설적 반응은 드물지 않았으며 환자의 연령과 흉수의 백혈구 중 림프구의 백분율이 역설적 반응의 발생빈도와 관련이 있었다. Background: A paradoxical response is defined as the radiological and clinical worsening of a previous lesion or the development of new lesion after initial improvement during theprocess of antituberculous treatment. The related factors for the development of a paradoxical response in patients with tuberculous pleurisy are not certain. Methods: We selected patients with tuberculous pleurisy who had been treated for more than 4 months. The changes onthe serial chest X-ray findings before and after treatment were reviewed. Paradoxical responses were regarded as any worsening or development of new lesion at least 2 weeks after the initiation of treatment. The baseline clinical characteristics and laboratory findings of the peripheral blood and pleural fluid were compared between the patients with a paradoxical response and the patients without a paradoxical response. Results: Paradoxical responses appeared in sixteen patients (21%) among the 77 patients.It took a mean of 38.6 days after the treatment and the time to resolve the paradoxical response was a mean of 32.1 days. For the patients with a paradoxical response, the median age was younger (30.5 years vs 39.0 years, respectively) and the lymphocytic percentage of white blood cells in the pleural fluid was higher (82.1% vs 69.6%, respectively) than for the patients without a paradoxical response. Conclusion: The development of a paradoxical response during the treatment of patients with tuberculous pleurisy was not rare and this was related with the age of the patients and the percentage of lymphocytic white blood cells in the pleural fluid.

토마스 킹의 『푸른 초원, 흐르는 강물』에 나타난 가면 쓰기와 가면 벗기―라이오넬의 실수를 중심으로

이명하 ( Myeongha Lee ) 21세기영어영문학회 2017 영어영문학21 Vol.30 No.1

Thomas King is one of the best-known contemporary Native writers in Canada helping provide Canadian literature with a wide range of cultural backgrounds. His second novel, Green Grass, Running Water deals with several stories about the First Nations people in a Blackfoot community in Alberta, Canada. Among the stories, the life of Lionel is especially worthy of notice with three mistakes that he had made from his childhood to middle-age. The mistakes show that he has imitated white people by disguising his Indian identity with clothes he wears, an effect of colonialist ideology which promotes white supremacy over colored people. His mistakes of the past have a lasting influence on his presence and are related to white people, which justifies the presence and role of trickster characters in the novel. With the help of the trickster, who serves as a saviour or healer in Native American mythology and literature, Lionel successfully finds his right place and purpose in his life by restoring his identity as a Blackfoot Indian. His life suggests the question of the unhealed past and its lasting influence on the present reflecting the fate of the whole aboriginal people. This analysis takes a closer look at how Lionel`s masking and unmasking is portrayed as a process of healing and restoration for the whole indigenous community.

패트릭 캐바나의 시에 나타난 회복과 화해

이명하 ( Lee Myeongha ) 대한영어영문학회 2016 영어영문학연구 Vol.42 No.3

Patrick Kavanagh stands as a transitional figure bridging the gap between the Irish literary revivalists led by W. B. Yeats and the new generation of post-Yeatsian poets. Kavanagh's greatest literary achievement lies in his ability to demythologize the revivalist posture by being the first poet to deal very realistically with Irish rural life through the lens of an insider. In his poetic masterpiece, The Great Hunger, Kavanagh bitterly mocks the revivalists' idealizations of the local peasantry by showing the grimmer and more tragic reality of a 65-year-old farmer named Patrick Maguire. However, his poems written in the late 1960s demonstrate how his later poetic world stays away from the social discontent apparent in the middle period and instead moves toward personal satisfaction based on his poetic concepts of parochialism and comic spirit. Among his later poems, "In Memory of My Mother" serves as a good example to prove this shift by presenting many similarities with and differences from The Great Hunger. The differences between the two similar yet different poems written in different times can be interpreted in terms of ‘restoration’ and ‘reconciliation.’ In this sense, by comparing and contrasting the two poems, this paper aims to take a closer look at how Kavanagh’s poetic landscape is fully completed through a series of restoration and reconciliation steps: “the harmony between ego and reality,” “the expansion of spaces and interaction,” and “the restoration of ordinariness.” (Chonnam National University)

임상간호사의 역할스트레스와 이직의향의 관계

이명하(Myungha Lee),김정희(Junghee Kim),김기미(Gimi Kim) 대한스트레스학회 1997 스트레스硏究 Vol.5 No.2

의료기관의 서비스지향성 측정도구의 신뢰도와 타당도 평가

이명하(Myung Ha Lee),박숙경(Sook Kyoung Park),이옥주(Ok Joo Lee) 한국간호행정학회 2014 간호행정학회지 Vol.20 No.4

The purpose of this research was to develop and test the validity and reliability of the Service Orientation Scale for Health Care Organization. Methods: The Service Orientation Scale for Health Care Organization, SERV*OR, was developed through forward-backward translation methods. Internal consistency and reliability, construct and criterion validity were calculated using SPSS Statistics WIN 17.0. Survey data were collected from 283 clinical nurses in a general hospital in J province. Results: The Service Orientation Scale for Health Care Organization showed reliable internal consistency with Cronbach`s α`s for the total scale ranging from .85~.91. Factor loading of the 30 items on four sub-scales ranged from .67~.83. The sub scales were named service leadership, service system, customer focus, and service control. Item convergent and discriminant validity were also established for the Service Orientation Scale for Health Care Organization. Criterion validity showed a significant correlation with customer orientation. Conclusion: The findings of the study demonstrate that the Service Orientation Scale for Health Care Organization has satisfactory construct and criterion validity, and reliability and can be used to measure service orientation.

병원의 조직문화유형과 조직유효성의 관계

이명하(Myung Ha Lee) 한국간호행정학회 1998 간호행정학회지 Vol.4 No.2

교양의 부재로서의 비속성 ―헨리 제임스의 『프린세스 카사마시마』

이명하 ( Myeongha Lee ) 21세기영어영문학회 2021 영어영문학21 Vol.34 No.1

In The Princess Casamassima, London is portrayed as a contradiction; on the bright side, it is a prosperous and splendid city, but on the dark side it is a hotbed of poverty and crime. The two sides of London are projected onto Hyacinth Robinson, who was born from a morganatic marriage between an aristocrat father and a lower-class criminal mother. Hyacinth, who has a dual identity as an aristocratic descendant and a member of the urban working class, experiences two worlds without fully belonging to either of them. Through the eyes of Hyacinth, who inherited an aesthetic sensibility from his father, the crowding and deindividuation of the urban mob are captured as a sign of vulgarity, lacking taste or culture. He fails to understand the vulgarity of the two worlds, and the nature of beauty and ugliness by associating vulgarity only with lower-class and idealizing the aristocracy as an absolute beauty, which indicates his dichotomous preconceptions about the two classes. However, later he realizes and accepts that vulgarity or ugliness coexists with culture or beauty in human life, and the coexistence rather enhances the values of beauty.

증례 : 신장 ; 과음 후 발생한 자발성 방광파열 1예

이명하 ( Myoung Ha Lee ),정준영 ( Jun Young Jung ),백대현 ( Dea Hyun Beak ),박영숙 ( Young Sook Park ),유탁근 ( Tag Keun Yoo ),성수아 ( Su Ah Sung ),황영환 ( Young Hwan Hwang ) 대한내과학회 2009 대한내과학회지 Vol.76 No.3

자연 방광파열은 매우 드물지만 조기에 진단하지 못하면 치명적인 합병증을 유발할 수 있으므로 알코올 섭취의 병력과 복통, 원인 불명의 복수, 핍뇨성 신부전의 양상을 보이는 환자에서 방광파열도 감별진단에 포함하여 복수 크레아티닌 검사를 시행하고 의심이 되면 확진 및 수술로 예후의 향상을 가져올 수 있겠다. Spontaneous urinary bladder rupture is uncommon, but is associated with significant morbidity and mortality because of delayed diagnosis. A 65-year-old man was admitted to the emergency room because of low abdominal pain and abdominal distention of sudden onset. The previous night, he had consumed a bottle of alcohol and fallen asleep. Diagnosed as peritonitis of unknown origin, he was prescribed antibiotics empirically. However, the ascites progressed and oliguric acute renal failure developed. On the fifth day, we measured the creatinine level in the ascitic fluid and performed retrograde cystography. He was diagnosed as idiopathic spontaneous bladder rupture and underwent a primary repair successfully. When a patient presents with acute abdominal pain, ascites, and oliguric acute renal failure without definite causes, physicians should consider idiopathic spontaneous bladder rupture, measure the creatinine level in the ascitic fluid immediately, and perform retrograde cystography to obtain an early diagnosis. (Korean J Med 76:370-373, 2009)

소화기 ; 관상동맥조영술이 정상인 비심인성 흉통 환자의 상부위장관내시경 소견

이명하 ( Myoung Ha Lee ),박영숙 ( Young Sook Park ),김남인 ( Nam In Kim ),정준영 ( Jun Young Jung ),송은주 ( Eun Ju Song ),조윤주 ( Yun Ju Jo ),김성환 ( Seong Hwan Kim ),전대원 ( Dae Won Jun ),최재웅 ( Jae Ung Choe ),유승기 ( Seun 대한내과학회 2009 대한내과학회지 Vol.77 No.2

목적: NCCP의 정의, 원인 등이 매우 모호하고 광범위한 상태에서 식도 질환에만 주로 초점이 맞춰진 것은 서구에서 식도 질환의 높은 빈도 때문이다. 그러나 인접한 중국, 일본 등에서 NCCP의 원인으로 GERD의 빈도는 서구에 비해 낮고, 소화성 궤양의 경우는 서구보다 높게 보고하였다. 따라서 저자들도 우리나라에서 NCCP의 원인으로 GERD 외에 위십이지장 질환의 빈도를 알아보고자 이번 연구를 진행하였다. 방법: 2004년 1월부터 2008월 1월까지 본원에서 관상동맥 조영술로 심인성 원인이 배제된 NCCP 환자 중 추가로 상부위장관 내시경 검사를 시행한 89명 환자들의 의무기록을 후향적으로 검토하여 식도, 위십이지장 질환을 분석하였다. 결과: 89예의 내시경 검사결과에서 GERD는 18예(20.2%)였고, GERD의 정도는 미세변화가 9예, LA 분류 group A가 3예, group B가 4예, group C가 2예였다. 위궤양은 13예(14.6%), 십이지장 궤양은 3예(3.3%)였고, 그 외 미란성 위염 17예(19.1%), 발적성 위염 12예(13.5%), 위축성 위염 21예(23.6%)였으며 정상 2예(2%), 위암, 위 점막하종양, 위용종이 각각 1예씩(1%) 관찰되었다. 소화성 궤양으로 진단된 16예 중 조직 검사나 CLO test를 시행한 환자는 11예(68.7%)였으며 그 중 H. pylori 양성은 6예(54%), 음성은 5예(46%)였다. 결론: 국내의 경우 H. pyroli 감염률이 높고 소화성 궤양의 빈도가 높으며 상대적으로 GERD의 빈도가 서구에 비해 낮다. 이런 비율은 NCCP 환자에도 적용될 수 있으며 이번 연구에서도 NCCP의 원인으로 소화성 궤양의 비율은 17.9%로 20.2%인 GERD의 비율과 유사하였다. 결국 우리나라에서 소화성 궤양은 GERD와 같이 NCCP의 중요한 원인임을 알 수 있으며 소화성 궤양의 경우 H. pyroli 제균의 필요성, PPI 투약기간의 차이점이 있기 때문에 예후의 향상을 위해선 상부위장관 내시경 검사로 소화성 궤양과 GERD를 감별하려는 노력이 필요하겠다. Background/Aims: Noncardiac chest pain (NCCP) mainly results from esophageal lesions in the developed world. By contrast, gastroesophageal reflux disease (GERD) is a less frequent cause of NCCP than peptic ulcer disease in China and Japan. Therefore, both esophageal lesions and stomach and duodenal lesions are likely to be important causes of NCCP in Korea. We used upper gastrointestinal endoscopy to evaluate lesions of the esophagus, stomach, and duodenum in NCCP patients after cardiac chest pain was ruled out by coronary angiography (CAG). Methods: From the patients who underwent CAG between 2004 and 2008, we identified 89 patients who had normal CAG or minimal disease. We retrospectively analyzed the endoscopic findings of these 89 patients who were diagnosed with NCCP. Results: At endoscopy for the 89 patients, the percentages of GERD, gastric ulcer, and duodenal ulcer were 20.2% (n=18), 14.6% (n=13), and 3.3% (n=3) respectively. Of the 16 cases diagnosed as peptic ulcer, 11 were evaluated by biopsy or the Campylobacter-like organism (CLO) test for suspected Helicobacter pylori infection. Six (54%) cases were positive for H. pylori and five (46%) were negative. Conclusions: In Korea, the incidence of peptic ulcer disease (17.9%) as a cause of NCCP is similar to that of GERD (20.2%). Consequently, we should perform endoscopy to determine the cause of NCCP. (Korean J 77:187-192, 2009)

재취업 베이비부머의 진로자본이 직무착근도에 미치는 영향 - 일 가치감의 조절효과

이명하(Lee Myungha),김고은(Kim Goeun) 한국노인복지학회 2020 노인복지연구 Vol.75 No.4

이 연구는 재취업 베이비부머의 진로자본이 직무착근도에 미치는 영향을 살펴보고, 일 가치감에 대한 인식이 이를 조절하는지를 살펴보고자 하였다. 이를 위해 서울에 거주하는 퇴직후 재취업한 1차 베이비부머들을 대상으로 설문조사를 실시하였고, 위계적 회귀분석을 통해 그 영향력과 조절효과를 분석하였다. 연구결과, 재취업한 베이비부머의 직무착근도는 3.58점(5점 만점)이었고, 진로자본은 재취업한 직장의 직무착근도를 높였다. 또한 베이비부머가 인식하는 일 가치감은 진로자본이 직무착근도에 미치는 영향력을 조절하였다. 즉, 이전 직장으로부터 축적된 진로자본이 부족하더라도 새로운 일에서 인식하는 일 가치감이 높으면 재취업한 직장에서의 직무착근도를 높일 수 있는 것이다. 이러한 결과를 토대로 일 가치감을 중심으로 베이비부머들이 재취업한 직장에서 오랜 시간 잔류하며 고용을 유지할 수 있는 실천적인 함의를 논의하였다. The purpose of this study was to examine the effect of career capital of re-employed baby boomers on job embeddedness, and to determine whether perceived value of work controls this. To this end, a questionnaire survey was conducted for baby boomers who re-employed after retiring from a major job in Seoul, and the impact and moderating effects were analyzed through hierarchical regression analysis. As a result of the study, the job embeddedness of re-employed baby boomers was 3.58 points, and career capital increased the job embeddedness of re-employed workplaces. In addition, the perceived value of work by baby boomers adjusted the influence of career capital on job embeddedness. In other words, even if there is little career capital accumulated in the previous job, if the perceived value of work by the new job is high, it is possible to increase the job embeddedness in the re-employed job. Based on these results, we discussed practical implications for baby boomers to stay for a long time in re-employment and maintain employment focusing on perceived value of work.