Rat의 복강내에 투여한 5-fluorouracil-polyglycolic acid 제형이 장기에 미치는 영향에 관한 연구

강대영,송규상,최정목,노승무,정경수,오정연,김진향,양준묵,최선웅,이진호,조준식,민병무,김용백,김창식,박근성,김승영,김학용,인현빈 충남대학교 의과대학 지역사회의학연구소 1998 충남의대잡지 Vol.25 No.1

For more effective intraperitoneal chemotherapy, the authers made 5-fluorouracil-polyglycolic acid composite disks(FU-PGA disks) with 5-fluorouracil and polyglycolic acid, a biodegradable polymer. We inserted the FU-PGA disk into the peritoneal cavites of Sprague-Dawley male rats, the control and three experimental groups; one FU-PGA disk insert group(300mg/kg), two FU-PGA disk insert group(600mg/kg), and three FU-PGA disk insert group(900mg/kg). The control group received a similar number of PGA disk inserts. A pharmacokinetic study was performed to measure the 5-fluorouracil concentration in the peritoneal fluid, blood, and tissues(liver, kidney and heart) at 24 hours, 72hours and 168 hours after insertion of the FU-PGA disk. Light and electron microscopic studies were done. The results were as follows: 1) The number of white blood cells and platelets decreased after FU-PGA insertion. The degree was proportional to the duration and amounts inserted. The change in the number of red blood cells varied slightly. 2) Light microscopically, slight changes were noted at 168 hours in the 3 disk insert group (900mg/kg). Mild fatty change and hepatocyte degeneration around the central veins of the liver were noted, with vacuolar degeneration in the proximal convoluted tubules of the kidney. 3) Electron microscopically,the liver showed focal increases of lipid droplets in the hepatocytes, and irregular nuclear membrane with focal nucleolar segregation of the fibrillar and granular elements. Also the double membranous structure of the hepatocytes and Kupffer cells was widened with bleb formation. The kidney showed wide separation of the nuclear double membrane in the proximal convoluted tubular cells and mesangial cells, with vacuolation and myelin figure formation in the mitochondria of the proximal convoluted tubular cells, at 72 hours and 168 hours in the 2 to 3 FU-PGA insert groups. The heart showed focal loss of cristae,vacuolation and myelin figure formation in the mitochondria of the 2 to 3 FU-PGA insert groups. In conclusion, despite the large amont of FU-PGA inserted, the histopathological changes in the liver, kidney and heart were slight, and consonant with the very low amount of 5-fluorouracil concentrations detected in the liver, kidney and heart. The above results suggest that the FU-PGA composite can serve as a new device for releasing drugs in a controlled manner and easily targeted to intraperitoneal organs. This device can improve the efficacy of intraperitoneal chemotherapy for gastric cancer.

2003년 국내 중증급성호흡기증후군 진료 현황 및 문제점 분석

이진수,김은실,정문현,백제중,정선화,안주희,최영화,이선희,고철우,김성범,김민자,박승철,기현균,송재훈,최상호,김양수,이상오,조용균,박영훈,정숙인,김연숙,이흥범,손창희,장성희,정희진,김우주 대한감염학회 2004 감염과 화학요법 Vol.36 No.3

목적 : 2002년 말 중국에서 SARS가 발생한 이후 국내에서도 2003년 10월까지 총 3명의 추정환자, 17명의 의심환자가 보고되었다. 향후 추가적인 SARS의 유행이 우려되는 상황에서, 그간의 SARS 환자 진료에 있어서의 실질적인 준비사항, 진료 현황 등에 대한 조사를 통해 문제점을 파악하여, 향후 더 나은 대비가 될 수 있도록 개선점을 제시하고자 하였다. 재료 및 방법 : SARS로 의심되는 환자를 진료 경험이 있는 병원의료진을 대상으로 2003년 10월에 설문조사를 실시하였다. 설문에는 SARS 환자 진료 시의 실질적인 조치, 진료 현황, 병실, 응급실 및 외래에서의 격리 시설과 준비사항, 보건당국의 관리와 지원에 관한 사항을 포함하였다. 결과 : 대상이 되는 22개 병원 중 17개(17/22, 77.2%) 병원이 설문에 응하였다. SARS 환자를 위한 격리실은 응급실, 외래, 일반병실 및 중환자실에서 각각 9개(9/17, 52.9%), 5개(5/17, 29.4%), 15개(15/16, 93.7%), 4개(4/16, 25%) 병원에서 음압처리가 되어있지 않은 일인실 혹은 다인실이 사용되었고, 1개(1/16, 6.3%) 병원에서만 일반병실에서 음압격리실이 운영되었다. 입원환자의 진찰 시 개인보호구의 착용은 거의 모든 의료기관에서 이루어졌다. 보건당국에서 SARS지정병원의 시설 등을 사전에 확인한 곳은 1곳(1/12, 8.3%)이였고, 14개 병원(14/15, 93.3%)에서는 보건당국에 의뢰한 검사결과를 통하 받지 못하였다. 결론 : 의료기관에서 SARS 환자용 격리실뿐만 아니라 기존의 격리실 설비 등이 미흡하였으며, 특히 중환자실 및 외래의 준비가 더욱 부족하였다. 보건당국의 의료기관에 대한 종합적인 지원이 부족하였고, 병원과의 원활한 연계가 잘 이루어지지 않았다. SARS 만이 아닌 격리를 필요로 하는 질환의 적절한 진료를 위해 향후 병원 시설의 정비와 정부차원에서의 보다 구체적이고 실질적인 대책마련이 필요하다. Background : There was an worldwide outbreak of the Severe Acute Respiratory Syndrome (SARS) originated from China in late 2002. During that period three cases of suspected SARS and 17 cases of probable SARS were reported in Korea. With the concerns about the reemergence of SARS-coV transmission, it is important to be prepared for any possibility. So, this study is aimed to analysis the past measures in managing SARS and propose the amendatory plans to improve the preparedness. Materials & Methods : Questionnaires were collected among clinicians with any experience in managing the probable or suspected SARS cases in Oct. 2003. 17 out of 22 hospitals responded to the questionnaire. The contents in the questionnaire were practical activities, personal equipments, response plans, isolation facilities in emergency centers, outpatient clinics, general wards and intensive care units, and relationship with the public health department. Results : The dedicated isolation rooms in emergency centers, outpatient clinics, general wards, and intensive care units were prepared in 9 (9/17, 52.9%), 5 (5/17, 29.4%), 15 (15/16, 93.7%), and 4 (4/16, 25.0%) hospitals, respectively. Except for one hospital that newly made negative pressure room for SARS, single or multi-bed rooms without airborne infection control were used in all the other hospitals. The personal precaution principles were kept quite well in general wards. Before the designation of SARS hospital by the public health department prior evalution to see if the hospital was suitable for managing SARS was conducted in only 1 (1/12, 8.3%) hospital. The results of laboratory diagnosis were reported back in 1 (1/15, 6.6%) hospital. Conclusions : The isolation facilities which can control airborne infection were almost deficient not only for SARS but also for other respiratory transmissible diseases. For the infection control of transmissible diseases including SARS, more investment is needed on medical facilities and comprehensive support from the public health department required.

혈액투석시 Double Lumen Silicone Rubber Catheter ( = Permcath ) 사용의 임상적 경험

차대룡(Dae Ryong Cha),김선숙(Sun Sook Kim),이영호(Young Ho Lee),권영주(Young Joo Kwon),조원용(Won Yong Cho),김형규(Hyoung Kyu Kim),선경(Kung Sun),김정숙(Jung Sook Kim),함인귀(In Gui Ham),김미경(Mi Kyung Kim) 대한내과학회 1994 대한내과학회지 Vol.46 No.4

Background: Repeated, long-term access of the vascular system is a prerequisite for successful extended care of the patients with end stage renal disease (=ESRD) treated with hemodialysis. Despite recent technical advances in percutaneous venous cannulation, vascular access remains a major problem in patients requiring acute Hemodialysis. Although the subclavian cannula has gained a large clinical acceptance in recent years, it carries specific risks such as hemothorax, pneumothorax, venus stenosis, thrombus formation and infection. Recently, a double-lumen, central venous catheter made of Silicone Rubber (=Perm cath) has developed for use as a vascular access device, This device is particularly useful in patients who have exhausted other vascular access sites or who have severe cardiovascular disease. Methods: A total of 23 dual-lumen silicone rubber catheters were placed through the internal jugular vein in 23 patients as a vascular access at our institution during the period of April, 1992 through November, 1992. The perm-cath (Hemocath, Quinton, Seattle) is 36 Cm long and each lumen has an internal diameter of 2 mm. Implantation of the catheters occurred in the operating room and under strict aseptic conditions through the right internal jugular vein. A 10 cm subcutaneous tunnel was then created, which extended from the in-cison to a point 2 cm above the ipsilateral clavicle. The catheter was passed out through the upper portion of the subcutaneous tunnel with the Dacron cuff placed 2 cm from the lower end of the tunnel, acting as both an anchor and a barrier to infection. The tip of the catheter was inserted through an internal jngular vein terminating in the right atrium under EKG monitoring. Each lumen of the catheter was filled with 1000 units of heparin sodium (1.5 ml in venous line, 1.5 ml in arterial line) and capped. Results : The mean duration of catheter use was 24±16 days (8 to 119 days), and the complication of perm-cath occurred in 3 cases such as venous thrombosis in 1 case, catheter exit site infection in 1 case, and exit site hematoma in 1 case. During hemodialysis, blood flow rate ranged from 190 to 313ml/min (mean:235±26ml/ min), and venous retrun pressure ranged from 20 to 150 mmHg(mean:65±16mmHg). Total 14 catheters were removed during treatment and the causes of catheter removal were patient death in 8 cases, venous thrombosis 1, recovery from acute rena1 failure 2, fistula maturation 2, infection 1. Conclusion: Internal jugular vein cannulation with silastic catheter which offers a new percutaneous method was provided safe and reliable as the temporary central vein access. The catheters are well tolerated by the patients and have the advantages of immediate use after placement, high blood flow rates, no repetitive venipuncture, and no cardiac dysfunction. Permcath is particulary useful in patients who have exhausted other vascular access site, severe cardiovascular disease, and terrified by repetitive venipuncture. Though our initial experience has been favorable, there will be needed to evaluate the outcome of permcath over longer period of time.

Effects of Phenytoin and Diazepam on the Seizure Activity in the Cortical Dysplasia Animal Models

Kim, Si-Hyung,Choi, In-Sun,Cho, Jin-Hwa,Park, Eun-Ju,Jang, Il-Sung,Choi, Byung-Ju,Kim, Hyun-Jung,Kim, Young-Jin,Nam, Soon-Hyeun The Korean Academy of Oral Biology 2006 International Journal of Oral Biology Vol.31 No.2

Dysplasia-associated seizure disorders are markedly resistant to pharmacological intervention. Relatively little research has been conducted studying the effects of antiepileptic drugs(AEDs) on seizure activity in a rat model of dysplasia. We have used rats exposed to methylazoxymethanol acetate(MAM) in utero, an animal model featuring nodular heterotopia, to investigate the effects of AEDs in the dysplastic brain. Pilocarpine was used to induce acute seizure in MAM-exposed and age-matched vehicle-injucted control animals. Field potential recordings were used to monitor amplitude and numbers population spikes, and paired pulse inhibition in response to stimulation of commissural pathway. Two commonly used AEDs were tested: diazepam 5, 2.5mg/kg;phenytoin 40, 60mg/kg. Diazepam(DZP) and phenytoin(PHT) reduced the amplitude of population spike in control and MAM-exposed rats. However, the amplitude of population spike was nearly eliminated in control rats as compared to the MAM-exposed rats. Pharmaco-resistance was tested by measuring seizure latencies in awake rats after pilocarpine administration(320mg/kg, i.p.) with and without pretreatment with AEDs. Pre-treatment with PHT 60 mg prolonged seizure latency in control rats, but not in MAM-exposed animals. The main findings of this study are that acute seizures initiated in MAM-exposed rats are relatively resistant to standard AEDs assessed in vivo. These data suggest that animal model with cortical dysplasia can be used to screen the effects of potential AEDs.

중년기 우울증 여성의 생활사건, 대처방식, 사회적 지지 및 가족관계

김동인,이진욱,김임,이선미,은헌정 大韓神經精神醫學會 1997 신경정신의학 Vol.36 No.4

국문초록본 연구는 중년기 우울증 여성의 생활사건 스트레스, 대처 방식, 사회적 지지, 가족 관계 등의 정신사회적 요인들을 알아보기 위한 것으로 각 변인들이 어떻게 우울과 관계가 있는지를 우울증 환자 집단과 정상인 집단으로 나누어서 비교 연구하였다. 이를 위해 35세 이상 64세 이하의 116명의 우울증 환자와 113명의 정상인을 대상으로 Beck 우울 질문지(BDI), 생활사건 질문지, 대처방식 척도, 대인관계 지지 평가척도(ISEL), 가정환경척도 등의 검사를 하였고 다음과 같은 결과를 얻었다. 1) 최고 스트레스는 환자 집단의 경우 결혼생활 스트레스(42명, 36.2%), 정상인 집단의 경우는 가정생활 스트레스(44명, 38.9%)였다. 2) 소극적 대처(t=0.93, p=.35)만을 제외하고 환자 집단과 정상인 집단에서 BDI 우울 점수(t=15.94, p<.0001), 생활사건 스트레스 점수(t=4.73, p<.0001), 적극적 대처점수(t=6.29, p<.0001), 사회적 지지점수(t=7.20, p<.0001), 가족 관계 점수(t=5.75, p<.0001)에서 유의한 차이를 보였다. 3) 우울증 환자 집단에서 BDI 우울 점수는 생활사건 스트레스(r=.24, p<.01) 변인과 유의한 정적 상관을 보였고, 적극적 대처(r= -.22, p<.01) 변인, 사회적 지지(r= -.35, p<.001) 변인, 가족관계(r= -.30, p<.001) 변인과는 유의한 역 상관을 보였다. 4) 우울증 환자 집단에서 BDI 우울에 대한 각 변인들의 중다회귀분석은 사회적 지지(12.3%, β= -.281, T= -3.162, P=.002, 생활사건 스트레스(5.1%, β=.279, T=3.195, P=.002), 적극적 대처(3.5%, β= -.204, T= -2.225, P=.028) 변인이 합하여 20.9%의 설명력을 나타냈다. 5) 중년기 여성에서 생활사건 스트레스는 가족 관계에서 겪는 스트레스가 가장 큰 스트레스였고, 대처방식은 우울과의 관계에서 일관성이 부족하였으며, 사회적 지지는 우울에 영향을 주는 가장 중요한 요인이었고, 가족관계는 양 집단에서 유의한 차이는 있었으나 우울에 대하여 의미있게 설명하지 못하고 있다. ABSTRACTLife Events, Coping Styles, Social Support, and Family Relationships of Middle-Aged Depressed Women Jin-Wook Lee, M.D., Yim Kim, M.D., Sun-Mi Yi, M.S., Dong-In Kim, M.D., Heon-Jeong Eun, M.D. Department of Neuropsychiatry, Presbyterian Medical Center, Chonju The objective of this study was to explore the psychosocial factors such as life events, coping styles and family relationships in middle-aged depressed women. This study was designed to compare how different variables relate to depression in two different test groups : a depressed patient group and a normal group. The Beck Depression Inventory(BDI), The Ways of Coping Checklist, Interpersonal Support Evaluation List(ISEL), Family Environment Scale were administered to 116 depressed patients and 113 normal persons between the ages of 35 and 64. The results were as follows : 1) The highest stress was marital stress(n=42, 36.2%) in patient group and family stress(n=44, 38.9%) in normal group, respectively. 2) There were significant differences between patient group and normal group in BDI scores(t=15.94, p<.0001), life events(t=4.73, p<.0001), active copinig(t=6.29, p<.0001), social support(t=7.20, p<.0001), and family relationships(t=5.75, p<.0001) except for passive coping(t=0.93, p=.35). 3) In depressed patient group, BDI scores had a significantly positive correlation with the scores of the life events(r=.24, p<.01) and negative correlation with active coping(r= -.22, p<.01), social support(r= -.35, p<.001) and family relationships(r= -.30, p<.001). 4) In depressed patient group, multiple regression analysis showed that social support(12.3%, β= -.281, T= -3.162, P=.002), life events(5.1%, β=.279. T=3.195, P=.002), and active coping(3.5%, β= -.204, T= -2.225, P=.028) had predictability on the BDI scores and the total predictability was 20.9%. 5) Stress experienced in family relationships were highest in life events and there was a lack of consistency(in the BDI scores of the coping styles). Social support was the most important factor and there were no significant differences between the two groups in family relationships.

Condylar positioning changes following unilateral sagittal split ramus osteotomy in patients with mandibular prognathism

Kim, Myung-In,Kim, Jun-Hwa,Jung, Seunggon,Park, Hong-Ju,Oh, Hee-Kyun,Ryu, Sun-Youl,Kook, Min-Suk Korean Association of Maxillofacial Plastic and Re 2015 Maxillofacial Plastic Reconstructive Surgery Vol.37 No.-

Background: This study was performed to evaluate three-dimensional positional change of the condyle using three-dimensional computed tomography (3D-CT) following unilateral sagittal split ramus osteotomy (USSRO) in patients with mandibular prognathism. Methods: This study examined two patients exhibiting skeletal class III malocclusion with facial asymmetry who underwent USSRO for a mandibular setback. 3D-CT was performed before surgery, immediately after surgery, and 6 months postoperatively. After creating 3D-CT images by using the In-vivo $5^{TM}$ program, the axial plane, coronal plane, and sagittal plane were configured. Three-dimensional positional changes from each plane to the condyle, axial condylar head axis angle (AHA), axial condylar head position (AHP), frontal condylar head axis angle (FHA), frontal condylar head position (FHP), sagittal condylar head axis angle (SHA), and sagittal condylar head position (SHP) of the two patients were measured before surgery, immediately after surgery, and 6 months postoperatively. Results: In the first patient, medial rotation of the operated condyle in AHA and anterior rotation in SHA were observed. There were no significant changes after surgery in AHP, FHP, and SHP after surgery. In the second patient, medial rotation of the operated condyle in AHA and lateral rotation of the operated condyle in FHA were observed. There were no significant changes in AHP, FHP, and SHP postoperatively. This indicates that in USSRO, postoperative movement of the condylar head is insignificant; however, medial rotation of the condylar head is possible. Although three-dimensional changes were observed, these were not clinically significant. Conclusions: The results of this study suggest that although three-dimensional changes in condylar head position are observed in patients post SSRO, there are no significant changes that would clinically affect the patient.

불안과 뇌파와의 관계에 관한 연구

김홍석,김인선 경희대학교 사회체육연구소 1996 體育科學論叢 Vol.- No.9

This study was interested in how different the type pf EEG(Electroencephalograph) is according to the levels of trait and/or state anxiety. Particularly, & respinse of EEG In each anxiety level (high - and low level) was mesaured, and each anxiety level was compared in terms of the ratio of the & wave to the total wave. Two hypotheses were postulated as follows: Ⅰ. & respponse would be different according to trait anxiety level. The ratio of & response to the wave of high anxiety group would be higher than that of low anxiety group in resting situation. Ⅱ. & response would be different according to anxiety level in stressful situation. Junior high school students (48 girls) with the age range of 15 to 16 years were given by questoinnaire to measure the anxiety level. Some items were selected from PIC (the Personality Inventory for Children)and revised for the young students. The upper 10% of the score was selected as high anxiety group (5 girls) and the lower 10% as low anxiety group (5 girls). In both resting - and stressful sityation, EEG was recorded and compaired to both high anxiety - and low anxiety group. The results were that 1) in resting situation, the & response to the total wave on Cz and T3 in high anxiety group was higher than tnat in low anxiety group 2) in stressful situation, & response Cz and T3 in low anxiety group was not any significant change although & response in high anxiety group was increased, and 3)there was not significant difference in & response on O1, known as a part that & response is frequently recorded, in terms of anxiety and experimental condition, These results supported both hypotesis Ⅰ and Ⅱ, and were consistent with the prvious data of Siciliani(1975) and Nowak(1981). The study, as first study to examine the realtionship between anxiety and physiological data, showed that physiological index could be useful in testing of the problems of young students in school.

[Ca(2+)]-dependent generation of intracellular reactive oxygen species mediates maitotoxin-induced cellular responses in human umbilical vein endothelial cells.

Yi, Sun-Ju,Kim, Kyung Hwan,Choi, Hyun Jung,Yoo, Je Ok,Jung, Hyo-Il,Han, Jeong-A,Kim, Young-Myeong,Suh, In Bum,Ha, Kwon-Soo Korean Society of Molecular Biology 2006 Molecules and cells Vol.21 No.1

<P>Maitotoxin (MTX) is known as one of the most potent marine toxins involved in Ciguatera poisoning, but intracellular signaling pathways caused by MTX was not fully understood. Thus, we have investigated whether intracellular reactive oxygen species (ROS) are involved in MTX-induced cellular responses in human umbilical vein endothelial cells. MTX induced a dose-dependent increase of intracellular [Ca(2+)]. MTX stimulated the production of intracellular ROS in a dose- and time-dependent manner, which was suppressed by BAPTA-AM, an intracellular Ca(2+) che-lator. Ionomycin also elevated the ROS production in a dose-dependent manner. MTX elevated transamidation activity in a time-dependent manner and the activation was largely inhibited by transfection of tissue transglutaminase siRNA. The activation of tissue transglutaminase and ERK1/2 by MTX was sup-pressed by BAPTA-AM or ROS scavengers. In addition, MTX-induced cell death was significantly de-layed by BAPTA-AM or a ROS scavenger. These results suggest that [Ca(2+)]-dependent generation of in-tracellular ROS, at least in part, play an important role in MTX-stimulated cellular responses, such as activation of tTGase, ERK phosphorylation, and in-duction of cell death, in human umbilical vein endothelial cells.</P>

Concurrent Chemoradiation Therapy in Stage III Non-small Cell Lung Cancer

김인아(In Ah Kim),최일봉(Ihl Bhong Choi),강기문(Ki Mun Kang),장지영(Jie Young Jang),문한림(Han Lim Mun),송정섭(Jung Sub Song),이선희(Sun Hee Lee),곽문섭(Mun Sub Kuak),신경섭(Kyung Sub Shinn) 대한방사선종양학회 1997 Radiation Oncology Journal Vol.15 No.1

목 적 : 국소진행된 III기 비소세포성 폐암에서 방사선감작제로서의 저용량 Cisplatin과 방사선 동시병합요법의 효과를 알아보고자하여, 관해율, 전체생존율, 무병생존율 및 치료에 따른 부작용을 방사선 단독치료군과 후향적으로 비교분석하였다. 대상 및 방법 : 1992년 4월부터 1994년 3월까지 32명의 III기 비소세포성 폐암환자(IIIa 12명, IIIb 20명)가 항암제 및 방사선동시병합요법을 받았다. 방사선치료는 3000cGy/ 10회를 2주간에 걸쳐 시행한 뒤 3주후에 2500cGy/ 10회를 추가하였으며, 방사선감작제로 cis platin 6mg/m2를 매일 방사선치료 전에 정맥주사하였다. 추적관찰기간은 13개월에서 48개월로 중간값은 24개월이었다. 방사선단독치료군 32명(IIIa 13명, IIIb 19명)은 매일 170- 200cGy씩 총 5580- 7000cGy (중간값 5960cGy) 치료받았으며, 추적관찰기간은 36개월에서 105개월로 중간값은 62개월이었다. 결 과 : cis platin- 방사선동시요법군이 방사선 단독치료군에 비해 유의하게 높은완전반응률(18.8% vs . 5.6%)및 낮은 조사야내 재발율(25% vs . 47%)을 나타내었다. 2년 전체생존율은 Cisplatin- 방사선동시요법군이 17%, 방사선단독치료군이 9.4%로 유의한 차이는 보이지 않았다.국소재발 없는 2년 무병생존율(16.5% vs. 5.3%) 및 원격전이 없는 2년 무병생존율(17% vs. 4.6%)도 두군간에 유의한 차이를 보이지 않았다. 그러나 Karnofsky performance scale 80 이상인 환자군만을 대상으로 분석한 결과, cisplatin- 방사선동시요법군이 방사선단독치료군에 비해 유의하게 높은 2년 전체생존율을 보였다(62.5% vs. 15.6%). 전체생존율에 영향을 미치는 예후인자로 cisplatin- 방사선동시요법군에 있어서는 performance status 및 조직학적 진단유형(상피세포암 vs. 비상피세포암)으로 나타났고, 방사선단독치료군에 있어서는 performance status 및 병기(IIIa vs. IIIb)로 나타났다. 치료에 따른 급성부작용으로 RTOG/ECOG grade 2 이상의 오심, 구토는 cisplatin- 방사선동시요법군이 방사선단독치료군 (22% vs. 6%)에 비해 유의하게 높은 빈도를 나타내었다. Gra de 2 이상의 혈액학적 독성은 Cis platin- 방사선동시요법군에서 방사선단독치료군에 비해 높은 빈도를 나타내었다(25% vs. 15.6%). 방사선단독치료군에 비해 cis platin- 방사선동시요법군에서, RTOG/ECOG Grade 2 이상의 폐독성의 빈도(31% vs. 19%)나 WHO Grade 3 이상의 폐섬유화의 빈도(38% vs. 25%)의 유의한 증가는 관찰되지 않았다. 방사선치료부위의 면적이 200cm2 이상이었던 경우, 두군 모두에서 폐독성 빈도의 유의한 증가를 보였다. 결 론 : cisplatin- 방사선동시병합요법이 방사선단독치료군에 비해 높은 국소제어율을 나타내었으나, 전체생존율이나 무병생존율의 유의한 증가는 보이지 않았다. KPS 80이상인 환자군에 있어서는 cisplatin- 방사선동시요법군이 방사선단독군에 비해 높은 전체생존율을 보였다. cisplatin- 방사선동시병합요법군에서 급성부작용이 증가되는 경향을 보였으나, 방사선에 의한 폐독성의 유의한 증가는 관찰되지 않았다. cisplatin- 방사선동시병합요법군이 방사선단독치료군에 비해 1년 이내에 조기사망율이 높은 반면, 2년이상 장기생존율이 높은 경향을 보여, 이러한 환자군에 대한 장기적인 추적조사를 통해 생존율에 대한 본 치료의 영향을 좀더 명확하게 평가할 수 있을것으로 기대되며, 향후 치료효과를 증가시키기위해 large fraction size의 split course RT 대신 continuous course의 conventional RT 혹은 hyperfractionated RT와 Cisplatin의 동시병합요법 등이 고려되어야할 것으로 사료된다. Purpose : This study was tried to evaluate the potential be nefits of concurrent chemoradiation therapy (low dose daily cisplatin combined with split course radiation therapy) compared with conventional radiation thera py alone in stage III non- small cell lung cancer. The end points of analyses were responserate , overalls urvival, survival without locoregional failure , survival without distant metastasis , prognostic factors affecting survival and treatment related toxicities. Materials and Methods : Between April 1992 and March 1994, 32 patients who had stage III non-small cell lung cancer were treated with concurrent chemoradiation therapy. Radiation therapy for 2 weeks (300cGy given 10 times up to 3000cGy) followed by a 3 weeks rest period and then radiation therapy for 2 more weeks (250cGy given 10 times up to 2500cGy) was combined with 6mg/M2 of cisplatin. Follow-up period ranged from 13 months to 48 months with median of 24 months . Historical control group consisted of 32 patients who had stage III non-small cell lung cancer were received conventionally fractionated (daily 170- 200cGy) radiation therapy a lone. Total radiation dose ranged from 5580cGy to 7000cGy with median of 5940cGy. Follow-up period ranged from 36 months to 105 months with median of 62 months . Results : Complete reponse rate was higher in chemoradiation therapy (CRT) group than radiation therapy (RT) group (18.8% vs. 6.3%). CRT group showed lower in-field failure rate compared with RT group(25% vs. 47%). The overall survival rate had no significant differences in between CRT group and RT group(17.5% vs. 9.4% at 2 years). The survival without locoregional failure (16.5% vs. 5.3% at 2 years) and survival without distant metastas is (17% vs. 4.6% at 2 years) also had no significant differences . In subgroup analyses for patients with good performance status (Karnofsky performance scale 80), CRT group showed significantly higher overall survival rate compared with RT group (62.5% vs. 15.6% at 2 years). The prognostic factors affecting survival rate were performance status and pathologic subtype (squamous cell cancer vs. nonsquamous cell cancer) in CRT group. In RT alone group, performance status and stage (IIIa vs IIIb) were identified as a prognostic factors . RTOG/EORTC grade 2-3 nausea and vomiting(22% vs. 6%) and bone marrow toxicities (25% vs. 15.6%) were significantly higher in CRT group compared with RT alone group. The incidence of RTOG/EORTC grade 3-4 pulmona ry toxicity had no significant differences in between CRT group and RT group (16% vs. 6%). The incidence of WHO grade 3-4 pulmonary fibrosis also had no significant differences in both group(38% vs . 25%). In analyses for relationship of field size and pulmonary toxicity, the patients who treated with field size beyond 200cm2 had s ignificantly higher rates of pulmonary toxicities. Conclusion : The CRT group showed significantly higher local control rate than RT group. There were no significant differences of survival rate in between two groups. The subgroup of patients who had good performa nce status showed higher overall survival rate in CRT group than RT group. In spite of higher incidence of acute toxicities with concurrent chemoradiation therapy, the survival gain in subgroup of patients with good pe rformance status were encouraging. CRT group showed higher rate of early death within 1 year, higher 2 year survival rate compared with RT group. The refore, to evaluate the accurate effect on survival of concurrent chemoradiation therapy, systematic follow-up for long term survivors are needed.

남북한 국사교과서에 등장하는 왕국 왕족의 인물 비교

김인식(In Sik Kim),김선규(Sun Gyu Kim) 한국교육과정학회 2000 교육과정연구 Vol.18 No.2

The purpose of this study was to analyze the historical characters appearing in national history textbooks of South and North Korea, and to compare their similarities and differences in terms of quantitative dimension and qualitative dimension, In order to achieve these goals, this study overviewed the existing curricular structure and history education of South and north Korea, and analyzed the following three history textbooks ; <Junghak Kooksa> which is the history textbook for middle schools of South Korea, <Kogyo Kooksa> , which is the history textbook for high schools of South Korea, <Josun Ryuksa> which is the history textbook for secondary education of North Korea. As the quantitative approach, this study counted the frequency of all characters appearing in the textbooks, and divided them into a group of commonly appearing characters and a group of characters appearing in one part among three textbooks. Then, the frequency and the rate of all characters` appearance were calculated separatedly and compared with each other. As a result, some quantitative differences were founded in total counts of appearing characters in three textbooks. In total frequency of characters appearing in textbook, the history textbook of South Korea (<Junghak Kooksa> : 393, <Kogyo Koodsa> : 512) contained much more characters than North Korea`s (<Josun ryuksa> : 348). And, commonly appearing characters in three comparative textbooks were 133, which amounted to only 18% of total numbers of appearing characters(735). It means that there are lots of differences between south Korea and north Korea in the number of appearing characters. And, as the qualitative approach, this study tried to analyze and discuss the similarities and difference of commonly appearing characters in three textbooks in terms of a character`s activity area and role, description and weight of him/her, and historical evaluation of him/her as a whole. As a result, much more similarity was found in character`s activity area and role any other aspects. On the other hand, in the aspect of description and weight of a character, difference between three textbooks was much more than similarity, and partially accordant characters were the most in historical evaluation of characters. Nowadays waking to the unification of South and North is faster and faster. So when we compare and study south and north Korean history education and characters in textbooks, we need to study more about `how same` than `how different`. Since appearing characters in textbook were deeply connected with their historical background and situation, how to describe a character would greatly influence on the historical interpretation. Therefore, in order to identify the reality of a character, we need a careful analysis on the historical viewpoint of textbook writers. It exceeds. however, the task and the focus of this study. In other word, based on the results of this study, a much more in-depth analysis on types of characters, modes of explaining them, and socio-cultural context should be continued in the future.