간호사의 한방병동 적응과정

이미헌,박형숙,하재현 한국성인간호학회 2017 성인간호학회지 Vol.29 No.6

Purpose: The purpose of this study was to understand and describe the adjustment experiences of nurses to an oriental medical unit. Methods: Fourteen nurses who worked or were working in oriental medical units participated.Data were collected through in-depth interviews from April to December, 2013. Analyses of the transcribed interviews were done using Corbin and Strauss’s grounded theory. Results: Through the constant comparative analysis method, the central phenomenon was identified as ‘constant mental fluctuation’. Nurses reported their adjustment to an oriental medical unit through four stages. The stages were described as ‘the discouraged’ stage, ‘the conflicted’ stage, ‘the restructuring’ stage and lastly ‘the coexistence’ stage. Conclusion: As the participants reported the process of adjusting, they reported continuous constant conflicts and struggles with the oriental medical doctors, the nursing department, patients and their guardians and lastly with themselves. The process of becoming integrated into an oriental medical unit is a complex study and should be studied further in terms of whether this process is the same or different adjusting to other units.

Water Jet Peening에 의한 SUS 304의 경도에 관한 연구

이미헌(Lee Mi-Heon),서병훈(Seo Byung-Hun),나승한(Na Seunghan),정성균(Cheong Seong Kyun),이명호(Lee Myeong-Ho) 한국철도학회 2009 한국철도학회 학술발표대회논문집 Vol.2009 No.11월

Material properties of the metal surface can be changed by Water Jet Peening, which uses highly pressurized water. The effect of water jet peening(WJP) on the hardness of SUS 304 is investigated in this study. The specimen was cut into 40 × 40 × 10 ㎜ and polished on one side. Two different methods were used to investigate the change of hardness on the surface of SUS 304. Water Jet Peening(WJP) and Water Cavitation Peening(WCP) methods were used to examine the difference of hardness. The distance between specimen and nozzle was also changed as an important parameter. The hardness data were examined by 40 micro meter interval. The results show that the hardness distribution is different depending on peening methods and peening distance. Water Jet Peening seems to be a good method to increase the hardness of metal surface and further research work on WJP is necessary to increase the practicality.

한국 울릉도 근해의 비브리오속의 분리연구

주진우,이미헌,김일,Ju, Jin-Woo,Lee, Mee-Heon,Kim, Il 대한미생물학회 1986 大韓微生物學會誌 Vol.21 No.3

Authors studies on the isolation of non-sucrose fermentation Vibrio species such as V. parahaemolyticus, V. vulnificus and V. damsela from sea water, shellfishes and various algae at Ulleung island in the east of Korea on summer in 1985. Authors carried out test for isolated strains to biochemical characteristics, halophilism, hemolysis and serological reaction. The results obtained were as follows: 1. Strains isolated from total specimens were 25 strains of V. parahaemolyticus, 2 strains of V. vulnificus and 1 strain of V. damsela, respectively. 2. Isolated frequency of Vibrio species from sea water and marine products was lower than on specimens in the southern sea of Korea from 1980 to 1985. 3. On hemolysis reaction on blood agar media using human and rabbit erythrocytes, 14 strains among 25 strains of V. parahaemolyticus isolated were positive, and V. vulnificus and V. damsela were positive, respectively. 4. The distributions of serotypes of V. parahaemolyticus isolated were from O1 group to O10 group, and from K 10 to K 69. The results of K serotypes were as follows ; serotype K 10 and K 33 were 2 strains, serotype K 59 and K 69 were 1 strain, respectively. And 2 strains of V. vulnificus isolated were not agglutinated by antiserum of V. vulnificus. Therefore, the probability is that 2 strains of V. vulnificus isolated were other serotypes distributed on sea weater and marine products of Ulleung island of Korea.

포스터 전시 : 간내담도암의 육종성 변이 1예

김인식,도윤경,이미헌,이승엽,김현수,백효종,이상문,박종훈,김익수,손경락 대한간학회 2003 Clinical and Molecular Hepatology(대한간학회지) Vol.9 No.3(S)

배경/목적: 원발성 간세포암의 육종성 변이는 병리학적 그리고 임상적으로 드물지 않게 보고되어져 왔다. 더욱이 간세포암의 육종성 변이는 간동맥 색전술이나 항암치료를 받은 후에 발생할 수 있다고 보고되었다. 반면에 간내담도암의 육종성 변이는 매우 드문 예로, 연자 등은 과거 간동맥 색전술이나 항암치료의 과거력 없이 발생된 간내 종괴를 주소로 내원한 환자에서 수술로 진단된 간내담도암의 육종성 변이 1예를 경험 하였기에 보고하는 바이다. 증례: 71세 남자로 2개월간의 미열과 우상복부 불편감 및 체중감소(4kg/1개월)를 주소로 내원하였다. 과거력상 특이소견은 없었고, 신체검진상 혈압 120/80 mmHg, 체온 37.5℃, 맥박 70회/분, 호흡수 18회/분이었고, 이학적검진상 우측 최하늑골의 정중 쇄골선 하방으로 10cm, 검상돌기 최하단 하방으로 8cm 정도의 매우 큰 딱딱하고 표면은 매끄러운 간종괴 소견이 있었다. 검사실소견은 말초혈액검사상 백혈구 8,990/μL, 혈색소 12.1 g/dL, 혈소판 484,000/?이었고, 혈청 생화학검사상 AST 39 IU/L, ALT 24 IU/L, total protein 5.9 g/dL, albumin 3.0 g/dL, total bilirubin 0.5 mg/dL, ALP 329 IU/L, LDH 465 IU/L였으며 prothrombin time은 정상의 166%였다. B형간염항원표지자는 음성이었고 α-fetoprotein은 1.5 ng/μL로 정상범위였으며 CA 19-9와 CEA도 11.0 ng/μL와 7.8 ng/μL로 정상 범위였다. 방사선검사상 복부 CT촬영에서 비조영증가영상상 16×12 cm 크기의 내부에 연부조직음영을 보이고 분엽상 형태를 보이는 저음영의 종괴가 간의 우엽에서 위치하고 있었다. 조영증강영상상 동맥기에 내부의 고형성 부분의 조영이 증가되었고 조영증강의 중격형성을 보였다. 문맥기와 정맥기에는 내부에 고형성 부분의 조영이 더욱 증가되었다. MRCP상 T1강조영상에서 낮은 신호강도를 보이고 내부에 중등도 신호강도의 종괴가 보였다. 조영증강 T1강조영상에서는 내부에 조영이 잘되는 고형성 부분이 보였다. T2 강조영상에서 T1에서 낮은신호강도를 보이던 부분은 높은 신호강도로 보이고 내부에 중등도 신호강도의 병변이 보였다. 그리고 담도의 확장소견은 보이지 않았다. 환자는 분엽절제술(제5, 6, 7구역)과 담낭절제술을 시행하였는데, 수술조직의 육안상 18×16×15cm 크기의 1600g의 무게를 가진 경계가 명확한 고형성 종괴로 내부에 괴사와 낭성변화의 단면을 보였다. 조직학적 소견상 종괴는 분화가 좋은 선암종과 다형성의 육종으로 구성되어 있었는데 육종 부위는 비정형성이 심한 핵을 가진 방추형의 세포로 되어있으며 종양세포 사이에 종양성 유골(osteoid)이 흔히 관찰되는 것으로 미루어 보아 골육종으로 진단되었다. 그리고 선암종과 육종은 서로 이행하는 부위가 존재하였다. 조직구축학적 검사상 선암종은 종괴 단면의 0.6% 나머지는 전부 골육종이 차지하였으며 괴사는 36%에서 나타났다. 면역조직화학염색상 선암종 부분은 high molecular & low molecular cytokeratin 및 CEA염색에 양성이었고, 육종 부분에도 cytokeratin에 대한 면역염색에서 부분적으로 양성으로 관찰되어 육종을 이루는 세포들의 상피세포 기원을 시사하는 소견으로 생각하였다. 환자는 수술후 미열과 우상복부 통증은 호전되어 현재 보존치료로 일반상태 호전을 기다리며 외래 추적관찰 중이다.

한국 울릉도 근해의 비브리오속의 분리연구

김일,주진우,이미헌 대한미생물학회 1986 大韓微生物學會誌 Vol.21 No.3

Authors studies on the isolation of non-sucrose fermentation Vibrio species such as V. parahaemolyticus, V. vulnificus and V. damsela from sea water, shellfishes and various algae at Ulleung island in the east of Korea on summer in 1985. Authors carried out test for isolated strains to biochemical characteristics, halophilism, hemolysis and serological reaction. The results obtained were as follows: 1. Strains isolated from total specimens were 25 strains of V. parahaemolyticus, 2strains of V. vulnipcus and 1 strain of V. damsela, respectively. 2. Isolated frequency of Vibrio species from sea water and marine products was lower than on specimens in the southern sea of Korea from 1980 to 1985. 3. On hemolysis reaction on blood agar media using human and rabbit erythrocytes, 14 strains among 25 strams of V. parahaemolyticus isolated were positive, and V, vulnificus and V. damsela were positive, respectively. 4. The distributions of serotypes of V. parahaemolyticus isolated were from Ol group to 010 group, and from K10 to K 69. The results of K serotypes were as follows;serotype K 10 and K 33 were 2 strains, serotype K 59 and K 69 were 1 strain, respectively. And 2 strains of V. vulnificus isol ated were not agglutinated by antiserum of V. vulnijicus. Therefore, the probability is that 2strains of V vulnificus isolated were other serotypes distributed on sea weater and marine products of Ulleung island of Korea.

포스터 전시 발표 : 소화기 ; Argon Plasma Coagulation을 이용하여 지혈한 대장 게실 출혈 1예

김민선,주동욱,이미헌,이승엽,김현수,백효종,이상문 대한내과학회 2003 대한내과학회 추계학술대회 Vol.65 No.10

정상적인 위내시경 소견을 보이는 사람의 위점막 조직에서 cagA 유전자 존재의 의의

정훈용,강경훈,남승우,윤광회,이미헌,고진규,박주상,양석균,김해련 大韓消化器病學會 1998 大韓消化器病學會誌 Vol.31 No.6

양성 갑상선 결절에서의 무수알코올치료

김홍규,김진엽,이은주,안일민,이미헌,이성진,이호규 대한내분비학회 1998 Endocrinology and metabolism Vol.13 No.3

Background: Percutaneous ethanol injection(PEI) performed in guidance of ultrasonography has been used in cases of thyroid cyst and autonomous functiong thyroid nodule(AFTN). We performed this study to determine the feasibility of PEI on the various type of benign cold nodules(solid, pure cyst, complex cyst) and AFTN. Method: Ninety patients(age 41+12 years; 83 women and 7 men) with hot and cold nodule were included in this study. All cases were subjected to FNAB, and sono-guided in cases of complex cyst, at least twice with results of colloid nodule. T4 suppression treatment was done for cold solid nodules for at least 6 months and cases which had partial response(50% or more volume reduction but no further volume decrease on T4 suppression) were included in this study. After PEI, we classified AFTN into three different response groups; complete response (normali- zation of TFT and thyroid scan finding), partial response(normalized freeT4 but suppressed TSH or persistently suppressed scan), or failure group. Each subtypes(solid, pure cyst, complex cyst) of cold nodules were also classified into three groups in accordance with volume reduction; complete response(above 90% of volume reduction), partial response(50-90%), and failure(below 50% or increase in size) group. Results: Overall responses rate of PEI for benign thyroid nodule were complete; 70(78%), partial; 18(20%), and failure; 2(2%). In 27 cold solid nodules, complete response was observed in 23(85%) and partial response in 4(15%). In 11 pure cysts, complete response was observed in 7(64%), partial response in 3(27%), and 1 case(9%) of failure was lost after 1 trial of PEI. In 45 cases of complex cyst, complete response was observed in 36(80%), partial response in 8 (18%), and 1 case(2%) of failure was subjected to operation with pathology report of Hiirthle cell adenoma. In 7 cases of AFTN, complete response was observed in 4(57%) and partial response in 3(43%). We observed complications during PEI therapy such as transient neck pain(n=10), transient unilateral vocal cord palsy(n=l), and intracavitary hemorrhage(n=2), transient hypotension during ethanol injection(n 1). Conclusion: Our data suggest that efficacy of PEI(57%) in AFTN is inferior to conventional therapies like surgery and radioiodine, but still can be an alternative therapeutic modality in selected cases. In cold nodules, especially of solid type and complex cyst, PEI may have feasibility as a therapeutic modality in restricted cases. Further studies of prolonged follow-up for the possibility of neglecting occult malignancy are warranted(J Kor Soc Endocrinol 13:373-383, 1998).

갑상선기능항진증 환자에서 병발한 심실세동 1예

김영일,이은주,안일민,이미헌,송영기,김유호 대한내분비학회 1998 Endocrinology and metabolism Vol.13 No.3

The cardiovascular manifestations in hyperthyroidism are sinus tachycardia, paroxysmal supraventricular tachycardia, atrial flutter, atrial fibrillation, atrioventricular block, bundle branch block(especially right bundle branch block), angina pectoris, heart failure and cardiomyopathy. Of these, angina pectoris is commonly seen in hyperthyroidism with coronary artery disease and the potential mechanisms have been attributed to the increased metabolic demand and consequently increased cardiac work which result in the more demand of coronary blood flow than that can be delivered via a fixed atherosclerotic coronary artery stenosis. Hyperthyroidism associated anginas without underlying coronary artery stenosis have also been reported where the mechanism of these was suspected to be the coronary vasospasm. Ventricular fibrillation may occur in the thyrotoxic patients due to myocardial ischemia such as variant angina, but it is very rare in the condition without previous heart disease. A 30-year-old male was admitted to the hospital because of palpitation, weight loss and proptosis for the previous 3 months. There was no history of effort related chest pain, syncope, drug abuse or medical illnesses such as diabetes mellitus, hypertension. The laboratory results were, TSH: 0.38uU/mL(0.4~5,0 uU/mL), free T4: 8.9ng/dL(0.8~1.9ng/dL), TSH receptor antibody: 43.6%(-15~15%), antiTPO antibody: 5000 IU/mL(0~100 IU/mL). The initial EKG showed normal sinus rhythm. He was diagnosed as Graves disease with ophthalmopathy, class 3a and was put on propylthiouracil 200 mg po tid, propanolol 40 mg po tid and started solumedrol pulse therapy for the exophthalmos on the first day of admission. He was found to have generalized tonic seizure with apnea attack on second hospital day and twice thereafter. Ventricular fibrillation was documented at that time. DC cardioversion was performed with successful response. After the attack, he was treated as accelerated hyperthyroidism namely with increased dosage of propylthiouracil, dexamethasone and Lugols solution, The echocardiogram, treadmill test, ergonovine echocardiography, coronary angiography and electrophysiologic study disclosed no abnormalities. Further episodes of ventricular fibrillation didnt occur after being euthyroid state. In conclusion, we report a case of ventricular fibrillation associated with hyperthyroidism itself without underlying coronary artery disease with brief review of literatures(J Kor Soc Endocrinol 13:459-465, 1998).

개별화된 교육이 허혈성 뇌졸중 환자의 불안과 자가간호수행에 미치는 효과

박형숙(Park, Hyoung-Sook),이미헌(Lee, Mee-Hun),하재현(Ha, Jae-Hyun) 한국재활간호학회 2013 재활간호학회지 Vol.16 No.1