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( Ji Hyun An ),( Young Suk Lim ),( Kiae Kim ),( Dan Bi Lee ),( Ju Hyun Shim ),( Kang Mo Kim ),( Han Chu Lee ),( Young Hwa Jung ),( Yung Sang Lee ) 대한간학회 2012 춘·추계 학술대회 (KASL) Vol.2012 No.-
Background: It has been suggested that the existence of large spontaneous porto-systemic shunt is frequent cause of recurrent hepatic encephalopathy (HEP). Occlusion of the shunt may prevent the recurrence of HEP. However, little is known about its effect and suitable candidates. Methods: Data of 20 patients who underwent occlusion of porto-systemic shunt for recurrent HEP between 2006 and 2011 in a single tertiary referral hospital were analyzed. Results: Median age of patients was 63 years (range, 48-79 years), and 11 (55%) were males. The number of patients with Child-Turcott-Pugh (CTP) class B and C was 12 and 8, respectively. Shunt occlusion failed technically in 3 patients, and all of them had CTP class C. There was significant difference in overall survival after shunt occlusion between patients with CTP B and C (1-year survival 89% vs. 20%, p < 0.01). The median survival time for patients with CTP C was 4 months. The number of HEP episodes and hospitalization due to HEP during 3 months before and after shunt occlusion significantly decreased in patients with CTP B (4.83 vs. 0.08, p<0.01 and 1.67 vs. 0.08, p < 0.01, respectively). Among patients with CTP class B, CTP and MELD score improved in 9 (75.0%) and 6 (50.0%) patients, respectively, within 3 months after shunt occlusion. Hepatic decompensation and hepatorenal syndrome after occlusion occurred only in 3 patients with Child C. Conclusions: Occlusion of spontaneous porto-systemic shunt is effective in preventing HEP particularly in patients with CTP class B. In some patients with CTP class B, improvement of liver function can also be expected. However, it should be carefully considered in patients with CTP class C.
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테네시 윌리엄즈의 개작(改作) 스타일: 『천사들의 싸움』과 『오르페우스의 하강』, 『여름과 연기』와 『나이팅게일의 기행』
김기애 ( Kim¸ Ki-ae ) 현대영미어문학회 1996 현대영미어문학 Vol.14 No.-
Williams revised Battle of Angels(1940) and Summer and Smoke(1948) and entitled them Orpheus Descendingi(1957) and The Eccentricities of a Nightingale(1951) respectively. In these two revised plays can be found some common characteristics of Williams’ dramaturgy and style. The purpose of this paper is to examine and compare those characteristics. Williams was mostly concerned about the plot, the characterization, and the use of symbols and theatrical devices in revising the plays. In his early works, the plot does not have organic unity and is episodic. This drawback is corrected in the revised plays where unrelated incidents are either deleted or modified. Thus the plot of the revised plays are fightly constructed. The characters in his early plays are either underdeveloped or not well tied in the plot. However, in the revised plays, they are fully developed and the relationships between them are set in such a way that the relationship can cause the inevitability of some incidents. Besides, in his early plays, Williams uses lots of symbols and theatrical devices at emotional peaks, whereas he applied more constraints on the use of them in the revised plays.
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