급성심근경색후 발생한 심실중격결손 2례

김태희,이재호,김애란,허민영,문치숙,정수룡,김대경,김두일,김동수 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.4

Ventricular septal defect remains an infrequent but devastating complication of acute MI. Approximately 1∼3% of cases of acute myocardial infarction are complicated by ventricular septal rupture in the prethrombolytic era and the incidence has decreased to 0.2% with reperfusion therapy. This mechanical complication usually occurs within the first 10 to 14 days when necrotic tissue is most abundant and the collateral coronary circulation is not well developed. This lesion is generally associated with complete coronary obstruction rather than severe stenosis. Rupture of the ventricular septum is a severe mechanical complication of acute myocardial infarction, usually resulting in death unless surgical repair is performed. The bad prognosis of this event within the first 2 weeks indicates the need for early surgical rapair. This complication is more frequent after the first acute myocardial infarction in the elderly and secondary to a transmural myocardial infarction. We report two cases of ventricular septal rupture after acute myocardial infarction.

부산 ·경남지역 중학교 남학생의 학년에 따른 컴퓨터 음란물 접촉실태에 관한 연구

김혜옥,손혜숙,김대환,이종태 韓國保健敎育 ·健康增進學會 1999 보건교육건강증진학회지 Vol.16 No.2

To evaluate the status of the contact to lascivious computer programs and sexual attitude and behaviour by the grades of middle school boy students, the questionnaire survey was done on 715 students of five middle schools in Pusan and Kimhae area from December 15 to December 24, 1997. The data were analyzed by PC SAS; X² -test. The level of significance was 0.05. 404 students (56.5%) had a personal computer in their home. 516 students (72.2%) have experienced of using a computer program. 294(57%) of them usually played a game with computer. 514 students(71.9%) had experiences of the contact to a lascivious computer program, which increased with the grades of the students(p〈0.05). The first exposure to a lascivious program was when they were elementary school students in 24.6% of first grade middle school students, 13.8% of second grade, and 11.3% of 3rd grade students. 92% of the students was introduced to first contact through their friends. 63.7% of them watch the program at their friends home. The most common drives to contact to a lascivious programs were curiosity (53%). Sexual desire was a higher drive in third grade students (20.6%) than lower grades. After contacting to a computer lascivious program, desire of masterbation was more frequent in lower grade students, and feeling disgust was more frequent in higher grade students (p〈0.05). Frequence of masterbation or sexual intercourse was higher in high grade students(p〈0.05). In conclusion, distribution and popular use of computer attributes to the increased exposure to lascivious programs and lowering the age of first exposure. there was the difference according to the grades in the feeling and sexual behaviour after contacting to computer lascivious program. Appropriate methods to protect young students to contact a lascivious program should be sought. The use of computer should be educated in elementary school students accompanied by proper sex education.

심한 척추후측만증 환자의 대퇴골절 복원술을 위한 부위마취 : 증례보고 A case report

김지은,박대용,유시현,강규식,권진형,김천숙,안기량 순천향의학연구소 2004 Journal of Soonchunhyang Medical Science Vol.10 No.2

Kyphoscoliosis is a disease manifested as lateral curvature of spine and accompanying rotation of the vertebrae, resulting in distortion of rib cage. Restrictive lung disease and pulmonary hypertension progressing to cor pulmonale are the major cause of mortality in patients with kyphoscoliosis. We had experienced a successful spinal and caudal epidural anesthesia for the open reduction and internal fixation with plate of fractured femur shaft in two patients with severe kyphosoliosis. We had chosen regional anesthesia as an anesthetic method because of there poor pulmonary function and severe deformities of thoracolumbar spine. We could achieve the adequate anesthetic sensory dermatome level, T_(5) and T_(8), for operation without any significant deterioration of blood pressure and respiration. We recommended that regional anesthesia is a useful anesthetic method for a patients with severe kyphoscoliosis when the operation on hip or lower extremity is required.

원발성 두개골내 수막종 : 1예 보고 A Case Report

김대호,홍현숙,조준희,박재성,박성진,차장규,백상현,이혜경 순천향의학연구소 2004 Journal of Soonchunhyang Medical Science Vol.10 No.2

Primary intraosseous meningioma of skull is rare, and often confused with a primary bone tumor. We report a case of a 71 years old female patient with an intraosseous calvarial meningioma of frontal bone presenting as a solitary osteolytic skull lesion. Plain skull radiograph, CT and MR images show sharply marginated expansile bony lesion in frontal skull vault, and a small well enhanced soft tissue mass within bone. The mass is extracranially protruded to scalp, and is partially attached to the underlying dura. Outer and inner table of skull vault is slightly bulged out, suggesting intradiploic origin of the tumor. The tumor was treated with surgical excision and cranioplasty. Histological examination revealed fibrous meningioma.

재발 또는 불응성 비호즈킨 림프종 환자에서 CDME 구제항암화학요법 후 고용량 항암화학요법 및 자가말초혈액 조혈모세포이식의 효과

김세형,한강원,배상병,김찬규,이남수,이규택,박성규,원종호,홍대식,박희숙 순천향의학연구소 2004 Journal of Soonchunhyang Medical Science Vol.10 No.1

Background and objectives : The long-term survival in patients with non-Hodgkin's lymphoma (NHL) after conventional dose chemotherapy is about 35% and the rest of the patients tend to have relapse. So, in relapsed or refractory NHL, we compared the outcome of patients undergoing high-dose chemotherapy with autologous peripheral blood stem cell transplantation(APBSCT) with only salvage chemotherapy of cisplatin, dexamethasone, mitoxantrone, and etoposide(CDME). Materials and methods : From June 1993 to December 1999, 25 patients with relapsed or resistant NHL were treated with CDME regimen as salvage chemotherapy. Twelve patients were received four cycles of CDME chemotherapy, and 13 patients were received high-dose chemotherapy with APBSCT following two cycles of CDME chemotherapy. Results : The median follow-up duration was 12.8 months(range:4-68). The overall response rate was 41.7% (complete response rate 25%, partial response rate 16.7%) in 12 patients with CDME only. Thirteen patients who were treated with high-dose chemotherapy with APBSCT achieved 61.5% complete response rate and 15.4% partial response rate, with an overall response rate of 76.9%. The estimated 3-year progression-free survival rate was significantly higher among patients who received high-dose therapy than patients who received CDME only(41.5% vs 20.0%, p<0.05). And, 3-year overall survival rate was significantly higher among patients who received high-dose therapy(51.3% vs 25.0%, p <0.05). Conclusions : In relapsed or refractory NHL, CDME chemotherapy is an effective salvage chemotherapy and allow peripheral blood stem cell collection. Also, high-dose chemotherapy with APBSCT following CDME is superior to CDME salvage chemotherapy only.

위발성 위장관 악성림프종 환자에서 항암치료의 효과

김찬규,신영록,김현정,배상병,이남수,이규택,박성규,원종호,홍대식,박희숙 순천향대학교 2006 Journal of Soonchunhyang Medical Science Vol.12 No.1

Purpose: The gastrointestinal (GI) tract is the most common site of extranodal non-Hodgkin's lymphoma (NHL), which is increasing in incidence, but there is no established optimal treatment modality. Thus, this study was investigated the clinicohistologic feature, the therapeutic modalities, and the prognosis for GI-NHL, as well as the factors affecting it. Methods: We retrospectively analyzed 45 patients who had been diagnosed as having GI-NHL and had been followed up from July 1994 to February 2005 at Soonchunhyang University Hospital. The patients were divided into groups according to the site of origin and to various other features, and the survivals of the various groups were compared. The modified Ann Arbor system and WHO classification were adopted for staging and histopathologic classification, respectively. Results: GI-NHL of the stomach, small bowel, ileocecal region, and colon occurred in 28 patients (62.2%), 5 patients (11.1%), 3 patients (6.7%), and 8 patients (17.8%), respectively, In one patient, the entire gastrointestinal tract was diffusely involved. The median age of patients was b5 years (25~78 years), and male-to-female ratio was 1:1.1. Fourteen patients were in stage Ⅰ, 24 in stage Ⅱ, 4 in stage Ⅲ, and 3 in stage Ⅳ. Surgical resection was performed in 19 patients, and combination chemotherapy was performed in 43 patients. Surgical resection only was performed in 4 patients, Chemotherapy only was performed in 26 patients. The expected overall 5 year survival of 45 patients was 39.6%, and there was a significant survival difference between the stages, but between sites of origin (p=0.842). The most important factors influencing the survival was the stage and other factors were not significant. Conclusion: The stomach was the most common site of GI-NHL. Most GI-NHL were localized Stage was the most important prognostic factor. However, Prospective randomized studies are needed to approve the therapeutic modality.

생쥐의 바이러스성 심근염에서 합병증 동반 유무에 따른 조직 및 혈청내 금속단백효소억제자의 발현 차이

김성숙,엄대운,우영주,서재희,허주령,홍영미,최인표 대한병리학회 2001 Journal of Pathology and Translational Medicine Vol.35 No.3

장수군 주민의 핵심역량 수준 분석

조영숙,김병진,황대용,강경하 한국농업교육학회 2008 농업교육과 인적자원개발 Vol.40 No.3

이 연구는 농촌사회 속에서 살아가는 성인들의 삶의 현장 속에서 직업을 갖고 살아가는데 주어진 과제를 성공적으로 수행하기 위해 펼요한 핵심역량 수준을 진단하고 개인 특성에 따른 핵심역량 보유수준의 차이를 분석함으로써 핵심역량 향상을 위한 시사점을 탐색하고 제언하는 데 목적이 있다. 이를 위해 선행연구를 바탕으로 개발한 농촌주민의 핵심역량 설문지를 가지고 층화무작위추출(One-Staged Stratified Random Sampling)과 체계적 표집방법을 사용하여 선정된 600명의 장수군 농촌주민을 대상으로 핵심역량을 측정하였다. 이 연구의 주요 결과는 다음과 같다. 첫째, 장수군 농촌주민의 핵심역량은 전반적으로 직업기초능력이 가장 높았고, 그 다음으로 시민의식 능력, 기초문해능력, 직업전환능력, 전문직업능력, 여가문화능력 순으로서 전문직업능력과 여가문화능력이 낮게 나타났다. 따라서 농업기술센터 등 교육기관에서는 전문직업능력과 여가문화능력에 대한 교육 기회 확대나 강화가 펼요하다. 둘째, 6개 핵심역량 보유수준은 직업교육 경험이 없는 층보다 경험있는 층이, 비농가보다 농가가, 여자보다 남자가, 40대 이하와 60대 이상보다 50대에서, 저학력층보다 고학력층, 주부, 무직보다는 농업과 직장인 층에서, 소농보다는 대농과 중농에서 더 높은 것으로 나타났다. 따라서 농촌지역 성인의 현재 직업기초능력 수준을 정확히 진단하고 대상층의 특성과 요구를 명확히 파악하여, 그 결과를 토대로 교육프로그램을 개발하고 제공하는 노력이 필요하다. 이상의 연구결과를 바탕으로 몇 가지 제언을 하였다. 국어 및 컴퓨터 활용 교육 등 기초문해능력 향상을 위한 교육프로그램 개발 및 운영 강화, 자기주도적 학습능력, 문제해결능력 등 핵심역량 향상을 위한 교육프로그램의 개발·운영 등이 필요하다. The purpose of this study was to find core competencies necessary for successful performance of tasks given to rural resident in the age of human resource development and to determine whether the level of core competencies were different according to individual background. For these purpose, we analyzed domestic and foreign literature, and derived core competencies required to rural adult. We surveyed rural resident's perception about their level of vocational competencies. We conducted a questionnaire survey of 600 rural residents living in Jangsu gun sampled by One-Staged Stratified Random Sampling and systematic sampling. The result of this study was summarized as follows. First, rural residents' level of core competencies were generally low. Out of core competencies, basic vocational competency is high, professional competency and leisure culture competency is low. Second the level of core competencies was perceived highly by experienced vocational education, farm house, male, 50's, high educated, farmer and worker, large and middle size farm house. Thus the opportunity for developing the core competencies for these the vulnerable have to be enlarged. Based on the results of this study, we proposed several tasks to be promoted as a part of regional human resources development in Jangsu Gun: 'develop and strengthen education program for basic literacy competency such as literacy and computer', 'expand the opportunity to develop professional competency and leisure culture competency'.

특수교육 정보화 체제 구축 방안 연구

김종무,강경숙,강대식,Kim-Sung, Kellie K. 국립특수교육원 2001 연구보고서 Vol.- No.8

본 연구는 특수교육 정보화 관련 국내 · 외 문헌자료와 사례를 소개하고, 국내 특수교육정보화 실태 조사를 실시하여 첫째, 기초 통계자료를 확보하고 둘째, 효율적이면서도 실제적인 정보화체제 구축방안을 제시하는데 그 목적이 있다. 그동안 국내에서 광범위하게 추진되었던 교육정보화 사업에 있어서 전체 학교 학내망 설치와 같은 가시적인 정보화기반 구축 사업에 대해서는 전반적으로 성공적이라는 평가를하고 있지만 특정 수요 집단에게는 정보격차의 심화 및 접근성 문제의 심각성 등 부정적인 결과를 초래하기도 하였다. 이에 본 연구에서는 국내·외 특수교육 정보화 사례와 자료를 소개하고, 국내 특수교육정보화 실태를 파악하기 위한 설문조사를 실시하였다. 설문조사 대상은 특수학교 교사, 학생, 장애학생 부모, 장애인관련 단체 및 기관, 시 · 도교육청이었고, 조사 결과 특수학교 교사의 경우 컴퓨터 보유, 인터넷 사용 등에 있어서는 매우 양호하게 나타났으나 정보 활용기술에 해당하는 영역 즉, 장애학생을 교수하기 위한 자료의 제작과 교수-학습과정에서의 적용 수준에서는 저조하게 나타났다. 비장애학생과 비교할 수는 없지만 장애학생의 컴퓨터보유와 인터넷 사용 유 ·무에 관해서는 40~60%의 응답자가 긍정적으로 응답하였고 체계적인 지원이 수반된다면 좋은 결과가 있을 것으로 분석되었다. 본 연구에서는 정보화 지원 체제 구축 방안으로 크게 예산지원과 행정지원을 포함하여 특수학교, 교사, 학부모, 장애학생, 행정가, 장애인관련 기관 등의 요소로 구분하여 지원 방안을 제시하였다. 소개된 지원내용을 간략히 정리하면 다음과 같다. 첫째, 특수교육정보화 체제 구축을 위한 예산 지원은 외국의 사례에서도 나타났듯이 안정성과 지속성을 확보하기 위하여 '초·중등교육법', '특수교육진흥법'을 통해 지원에 관한 세부 사항을 법으로 규정해야한다. 둘째, 특수교육 정보화 사업과 관련된 부처간 행정 협조체제의 수립과 사업 중복성 등을 피하기 위하여 전담기구나 기관의 지정이 요구된다. 셋째, 특수학교의 경우, 학내망 설치와 더불어 장애인 접근성 문제의 해결을 위한 프로그램 개발과 하드웨어 장비의 지원, 교실간 네트워크 구축, 학교간 WAN 구축 등의 사업이 추진되어야 하며, 특수학급의 경우는 정보화 환경구축이 미흡하기 때문에 소속 교육청 과의 네트워크 구축을 통한 정보공유 및 행정업무의 연계가 필요하고, 다양한 교수-학습자료의 지원이 절실히 요구된다. 넷째, 특수교육 교사의 연수 기회를 확대하고 전문성을 키워줄 수 있는 연수내용과 방법의 개선이 필요하다. 장애학생 교육을 위한 학습자료 제작 기법, 장애인용 프로그램 사용법, 특수단말 장비 및 정보매체 활용 기법 등의 프로그램을 개발하여 집체+원격+화상 형태의 입체적인 연수가 요구된다. 다섯째, 장애학생 부모를 위한 정보화 지원은 학교-교육청간 협력하에 부모 교육 프로그램을 개발하여 우선, 학교와 인근 지역의 장애인관련 기관을 활용하여 정보소양 교육을 실시하고, 언제, 어디서나 교육이 가능한 원격이나 사이버시스템 등을 매개로 부모의 여건을 배려해줄 수 있는 편리한 교육방법이 준비되어야 한다. 여섯째, 교육청별 특수교육 담당장학사의 정보화 수준은 양호한 것으로 평가되지만 특수교육 정보화를 위한 특수학교(급) 교사의 연수지원을 위한 예산규모의 확보나 프로그램 개발 지원 등은 매우 부족한 것으로 나타났는데, 교육부(국립특수교육원)를 중심으로 전체 교육청의 특수교육 정보화 업무를 단일 체제로 묶는 인프라를 구축하여 예산, 프로그램, 네트워크 등을 공유토록 하여 효율성을 확보해야 한다. 일곱째, 장애인관련 단체는 정보화 업무 담당자를 배치하여 장애인과 일반인을 대상으로 활발한 정보화 교육이 이루어지고 있었지만 재정지원이 아직도 부족하고, 장애인용 프로그램과 기기의 보급이 부족하여 한계가 있는 것으로 드러났는데, 마찬가지로 장애인관련 기관을 하나로 묶는 인프라의 구축을 통해 사용되는 프로그램을 표준화시키고 예산지원의 중복성을 피해야하며 기관 이용자에 대한 관리의 편리성도 함께 도모해야 할 것이다. This study intends to collect baseline data and to present effective and practical methods of establishing special education IT system. An extensive review of both domestic and foreign literature and case studies of best practices were conducted for this research as well as the evaluation of the current state of technology usage and adoption in special education in Korea. Previous nationwide educational technology projects have accomplished notable and successful results such as building Intranet for schools. However, such efforts have, in away, created and aggravated the disproportionate gap, often called as the digital divide, against certain groups of people with unique needs. Also, the accessibility to such technology and information has emerged as a serious problem as the role of technology expanded. This study introduced both domestic and foreign examples of technology in special education and relevant resources, and conducted a large-scale survey to examine the current stage of technology adoption and usage in special education in Korea. The survey was administered to special education teachers, students, parents of students with disabilities, disability-related organizations and relevant agencies, and to municipal and provincial department of education. The results found satisfactory levels of computer ownership and usage of Internet among special education teachers. However, utilizing and incorporating such Information and technology into classroom activities and into teaching material development were still limited. Although the data were not comparable to those from students without disabilities, about 40 to 60 percent of the respondents showed positive attitudes toward computer ownership and Internet usage of students with disabilities, suggesting desirable outcomes with appropriate systematic support. Based on the findings, this study recommended detailed methods of building broad financial or budgetary assistance systems for special education schools, teachers, parents, students, administrators, and disability-related organizations. First, as shown in the experiences of foreign countries, financial support from the government to establish the system for the special education information technology has to be mandated under the 'Elementary and Secondary Education Act', the 'Special Education Promotion Act' to ensure and enhance stability and continuity. Second, designation of a single commanding and responsible agency is called for to efficiently coordinate inter-agency collaboration among governmental agencies and departments, and to avoid redundancy of work. Third, for special education schools, tasks such as building school-wide Intranet, development of software solving accessibility issues, subsidizing funds for computer hardware purchase, connecting classrooms through networking system and establishing inter-school WAN are of critical importance. Fourth, the contents and methods of professional development and training for special education teachers should be improved to professionalize teachers, and expansion of such opportunities are also called for. Fifth, IT support for parents of students with disabilities is also important. Parent education and training programs should be developed through active collaboration between local department of education and schools, and such training programs may be offered at schools or disability-related facilities. Distance learning or online courses, which the parents can access regardless of time or location, are other feasible alternatives. Sixth, the results found that administrative staffs of special education at each local department of education displayed satisfactory competence levels. However, the amount of budget assigned for special education teacher training or program development was seriously insufficient. Therefore, the Ministry of Education (or KISE) should build a universal infrastructure of IT, which encompasses and shares budget, program and network systems across all the IT offices of the local department of education. Seventh, although most disability organizations have IT specialist and offered IT education programs for both persons with and without disabilities, they have been experiencing continued problems of insufficient financial support and lack of adaptive technology devices and accessible programs. Therefore, building a universal infrastructure across disability organizations is called for to standardize programs, to prevent overlaps in funding, and thus, to enhance administrative efficiency.

간세포암과 감별이 어려웠던 악성중피종 치험 1예

김선문,허원석,채경훈,강윤세,정재훈,김연수,박기오,문희석,이엄석,김석현,성재규,이병석,이헌영,신경숙,조준식,송인상,강대영 충남대학교 의학연구소 2003 충남의대잡지 Vol.30 No.2

Malignant peritoneal mesothelioma is a rare neoplasm that arises from the mesothelium of a serosal cavity and is a rapidly fatal disease with a median survival of 4 to 12 months for untreated cases. Recently, we experienced a case with malignant peritoneal mesothelioma who was suspected hepatocelluar carcioma by abdominal CT scan and was confirmed by biopsy including immunohistochemical stain(calretinin) after surgery. We performed tumor excisions and wedge resection of the liver(segment Ⅷ)and inserted Tencoff catheter in abdominal cavity at 25th day of post-operation. We treated with intraperitoneal paclitaxel(25mg/m^(2)/day for 5 days) six courses monthly. She was well tolerable and is still living without any evidence of recurrence for 14th month of post-operation.