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임은주,김병욱 대한내과학회 2013 대한내과학회 추계학술대회 Vol.2013 No.1
Endoscopic submucosal dissection (ESD) is now accepted as an alternative to surgery for the treatment of early gastric cancer (EGC). Because the incidence of complications, such as bleeding or perforation, are high, the utility of this treatment modality can be limited in patients with a high probability of bleeding. A 52-year-old male patient, who had previously been diagnosed with myelodysplatic syndrome (MDS) 13 years ago, was admitted to our hospital for ESD of EGC. On initial gastroscopy, an EGC lesion was noted at the posterior wall of the gastric antrum. A well-differentiated adenocarcinoma was confirmed histopathologically. On endoscopic ultrasound, this lesion was limited in the mucosa. No extragastric metastatic lesions were found through abdominal computed tomography. The patient`s laboratory data showed a hemoglobin level of 8.6 g/dl and a platelet count of 21,000/mm3. Three hours before ESD, six units of platelet concentrates were transfused, and the procedure was performed successfully without any complications. The entire procedure took 44 minutes. An additional six units of platelet concentrates were administered to the patient the next day. The resected lesion measured 6.0×4.5 cm. A well-differentiated adenocarcinoma limited to the mucosa was confirmed by histopathologic mapping upon complete resection. Intravenous pantoprazole 40 mg was administered before the procedure. This regimen was continued for three days at which point the regimen was changed to oral pantoprazole 40 mg per day for six weeks. A follow-up gastroscopy, which was performed eight weeks after ESD, showed complete healing of the lesion. ESD can be performed successfully in a patient with MDS. This is the first report of successful ESD for EGC in the world.
임은주,김병욱 대한내과학회 2013 대한내과학회 추계학술대회 Vol.2013 No.1
Endoscopic snare papillectomy (ESP) for ampulla of Vater tumor (AVT) has been performed successfully instead of surgical ampullectomy (SA) because ESP is a less invasive procedure than SA. Hemorrhage, perforation and pancreatitis are relatively common complications of ESP and other rare complications such as cholangitis, liver abscess has been reported. A 52-year-old man presented for the management of adenoma arising from ampulla of Vater which was found incidentally in routine health check up. He denied any previous medical history and wanted an endoscopic management for the lesion. Under conscious sedation with midazolam and meperidine, the lesion was approached with side-viewing scope. After injection of normal saline and epinephrine mixture in the submucosal layer, ESP was performed successfully. followed by insertion of a pancreatic duct stent. Total procedure time was less than 40 minutes. Adenoma with low grade dysplasia was confirmed histopathologically and the margin was clear. Conservative management with intravenous fluid administration and nil per os was maintained. Five days after ESP, the patient complained right upper quadrant pain and the body temperature was elevated to 38.2°C. On laboratory examination, white cell was counted to 20,710/mm3 and amylase was measured to 24 IU/L. AST and ALT was measured to 17 IU/L and 20 IU/L, respectively. Total bilirubin was 1.7 mg/dl and direct bilirubin was 0.6 mg/dl. Abdominal CT showed distended gall bladder with edematous change of the wall without any evidence of biliary stone, which suggested an AAC without any evidence of cholangitis. Percutaneous cholecystostomy tube was inserted (Fig. 3) and drained under fluoroscopic guidance and intravenous cefoperazone with sulbactam was administered. Ten days after insertion of percutaneous cholecystostomy tube, the patient`s condition improved and laboratory studies returned to normal value. The patient was discharged after removal of percutaneous cholecystostomy tube. Acalculous cholecystitis even can develop after ESP for small AVT and the endoscopists should be aware of this rare complication. It can be managed successfully with percutaneous cholecystectomy and intravenous antibiotics.
중·고등학교 무용전공 희망학생들의 전문무용역량에 관한인식 탐색
임은주,김대진 한국무용교육학회 2018 韓國舞踊敎育學會誌 Vol.29 No.1
The purpose of this study was to explore the cognition of middle and high school students hoping to major in dance. To accomplish the purpose of the study total ten middle and high school students hoping to major in dance were selected as research participants; five middle and five high school students respectively. Also one of the researcher of this study was conducted as a participant observer. Data were collected through in-depth interviews using an open questionnaire on the cognition of Specialized Dance Competency and field notes of the participant observer. Collected data were processed by transcribing and categorical analysis. Trustworthiness of the data was established by experts and triangulation. The result of the study as follows; i) the participants made great effort to dance skill improvement rather than developing Specialized Dance Competency, ii) although the participants felt pressure in doing dance and schoolwork simultaneously, they wanted to keep practicing dance because they love dance, iii) because the students did not have deep understanding about dance creativeness or integrated understanding of dance, they felt their lack of knowledge about dance theory and skill, iv) although the arousal level would be peak during their real dance performance situation, they did not get an appropriate arousal control treatment by their teacher or leader, v) the participants were uncertain to their future career, however, they had interest and passion to the future career. In other words, it might be difficult to understand the trend of dance and challenge to new career, they would challenge to it. Some suggestions were made through this study. Firstly, development of more valid index for Specialized Dance Competency is needed to diagnose Specialized Dance Competency more correctly. Secondly, Integrated learning support system should be provided in order to improve Specialized Dance Competency for the candidates hoping to major in dance. Lastly, exploration of cognition on Specialized Dance Competency for the dance leaders should be conducted as follow-up study.