쿠싱증후군 환자에서 당 대사 이상 정도에 따른 인슐린 감수성과 인슐린 저항성의 변화

정인경,김성훈,정재훈,민용기,이명식,이문규,유형준,안규정,노정현,김동준,김광원 대한내분비학회 2003 Endocrinology and metabolism Vol.18 No.4

연구배경 당질 코르티코이드는 당 대사에 매우 중요한 호르몬으로 내인성 당질 코르티코이드 과다상태인 쿠싱증후군에서는 말초조직에서 인슐린 저항이 증가하고 이를 보상하고자 인슐린 분비의 증가로 고인슐린혈증이 동반된다고 보고되고 있다. 하지만 생체 내에서와 달리 시험관내에서는 췌도세포에 당질 코르티코이드를 장시간 처리하면, 인슐린 분비 및 생합성이직접적으로 억제됨이 확인된 바 있어 쿠싱증후군 환자에서 당뇨병의 원인으로는 아마도 말초조직에서 증가된 인슐린 저항성 뿐 아니라 이를 충분히 보상하지 못하는 췌장에서의 인슐린 분비 저하가 같이 동반되어있지 않을까 하는 가설을 세우게 되었고, 아직까지 당질코르티코이드가 당대사 이상을 일으키는 기전에 대해 쿠싱증후군을 당대사 정도에 따라 인슐린 감수성과 분비능을 분석한 연구는 없었기에 이를 알아보고자 하였다. 방법: 삼성서울병원에서 쿠싱증후군으로 진단 받은 환자 15명을 대상으로 하였다. 이에 대한 대조군으로는 쿠싱증후군 환자와 같은 성별 그리고 체질량지수를 갖은 15명의 건강한 성인을 대상으로 비교 하였다 쿠싱증후군 환자를 대상으로 경구당부하 검사를 통해 당대사 정도를 정상군, 내당능장애군, 그리고 당뇨병군으로 나눈 후 정맥 당부하 검사를 시행하여 각군의 인슐린 저항성과 인슐린 분비능의 지표를 비교하고, 수술 후 쿠싱증후군이 완치된 상태에서 수술 전후의 당대사 지표의 변화를 조사하였다. 결과: 1) 쿠싱증후군 환자 중 정상인은 20%, 내당능 장애는 27%, 그리고 당뇨병은 53%였다. 체질량지수, 나이, 그리고 발병 기간은 세 군간에 의미 있는 차이가 없었으나, 24시간 소변검사의 코르티솔 농도는 당뇨병군에서 의미있게 높았다. 2) 정맥당부하 검사 결과, 인슐린 감수성 지표인 Sl는쿠싱증추린」서 1.58±0.10[×10^(-4)(min^(-1)(μU/mL)^(-1)]로 정상 대조군의 3.37±0.49[×10^(-4)(min^(-1)(μU/mL)^(-1)]에 비해 의미있게 낮았으나(P=0.024), 쿠싱증후군 환자 중 NGT, IGT, DM 군간에 서로 통계적인 차이는 없었다. 3) SG는 정상 대조군과 쿠싱증후군 환자간에는 의미있는 차이가 없었고, 쿠싱 증후군에 있어서 당대사가 악화될수록 감소하는 경향을 보였으나 의미있는 차이는 없었다. 4) 인슐린 분비능의 지표인 AIRg는 정상인에 비해 전체 쿠싱증후군 환자의 경우 증가하는 경향을 보였으나 의미있는 차이는 없었다. 하지만 쿠싱증후군 환자중에서 당대사 상태에 따라 NGT군은 1299 (1297∼1310)(mu/g/min ×10^(-2))로 정상 대조군(368.9±98.6[mu/g/min ×10^(-2)]) 보다도 의미있게 높았고, DM군{202.2 (91.1~371.4) [mu/g/min ×10^(-2)}은 NGT군에 비해 의미있게 낮았다(P=0.0031). 5) 15명중 현재 완치 상태에 있는 6명에 대해 수술전과 후로 비교하였다. 수술 전 당대사 상태가 1명은정상, 1명은 내당능 장애, 그리고 4명은 당뇨병이었으나 수술 후 시행한 경구 당부하 검사상 모두 정상 당대사 상태를 보였다. 6) 수술 후 완치된 환자 6명에 있어 인슐린 감수성지표인 Sl는 수술전에 중앙값이 1.22[×10^(-4)(min^(-1)(μU/mL)^(-1)]로 대조군에 비해 의미있게 감고』어 있었으나(p.0.05), 수술후 10.95 [×10^(-4)(min^(-1)(μU/mL)^(-1)]로 정상 수준으로 회복되었고(P=0.0022), 인슐린 분비능을 나타내는 AIRg [mu/g/min ×10^(-2)] 값도 정상수준으로 회복되었다. 특히 인슐린 분비능의 회복양상은 혈당농도에 따라 판이하게 나타나서, 정상과 내당능장애 상태에 있던 2명은 수술전에 1201 [mu/g/min ×10^(-2)]로 증가되어 있던 AIRg 값이 수술 후 정상 수준으로 감소하였고, 수술 전에 당뇨병 상태에 있던 4명의 경우 245.9 [mu/g/min ×10^(-2)]로 인슐린 분비능이 감고il어 있었는데 이들은 수술 후 모두 정상 수준으로 증가되었다 (P=0.0286). 결론: 쿠싱증후군 환자에서 당대사 이상은 80%로 높은 유병률을 보였다. 모든 쿠싱증후군환자에서 인슐린 감수성은 정상인에 비해 저하되어 있어 말초조직의 인슐린 저항이 선행됨을 시사하며, 인슐린 분비능은 당대사의 정도에 따라 다르게 나타났는데, 정상 당대사군에서는 인슐린의 저항성을 극복할 만큼 정상 대조군보다 더 많은 양의 인슐린 분비를 하다가 고코르티솔혈증이 심할수록 인슐린 분비능의 감소로 당뇨병으로 진행됨을 확인할 수 있었고, 이런 인슐린 저항성과 인슐린 분비장애는 수술 후 다시 회복되는 가역적인변화를 보였다. Background: Glucocorticoid plays an important role in the control of carbohydrate metabolism. Patients with Cushing's syndrome have been reported to have an increased incidence of carbohydrate intolerance due to peripheral insulin resistance and hyperinsulinemia, although the exact incidence and nature of this disorder have remained unclear. Few results have been published about insulin resistance and insulin secretion according to the level of glucose concentration, or about the reversibility of such defects in patients with Cushing's syndrome. Methods: To assess the effect of glucocorticoid on the insulin sensitivity and insulin secretion in Cushing's syndrome, 15 patients with Cushing's syndrome were classified into 3 groups (normal glucose tolerance: NGT, impaired glucose tolerance: IGT, diabetes: DM) according to the degree of glucose tolerance based on the oral glucose tolerance test (OGTT). Insulin modified, frequently sampled, intravenous glucose tolerance test (FSIGT) was performed before and after curative surgery on these patients and on 15 healthy control subjects. Data were evaluated by non-parametric statistical analysis. Results: 1) Among the 15 patients with Cushing's syndrome, 3 (20%) were NGT, 4 (27%) IGT, and 8 (53%) DM, based on OGTT. Twenty-four hour urinary free cortisol (UFC) was significantly higher in the DM group. 2) Insulin sensitivity index (SI) of Cushing's syndrome was significantly lower than that of the control group p=0.0024), but was not significantly different among the three Cushing's syndrome groups of NGT, IGT and DM. 3) Glucose mediated glucose disposal (SG) (Ed- confirm this abbreviation; it does not seem to match the definition) of Cushing's syndrome was not significantly different from that of the control group. 4) Insulin secretion (AIRg) of Cushing's syndrome tended to be high, but it was not significantly different from that of control. However, according to the level of glucose concentration there was significant difference in AlRg among the three Cushing's syndrome groups p=0.0031); AIRg of DM was significantly lower than that of NGT. 5) After surgical treatment, parameters of insulin sensitivity and insulin secretion were normalized in 6 cured patients; 1 with NGT, 1 with IGT, and 4 with DM, preoperatively. Median SI of all 6 patients was significantly improved up to the normal range postoperatively p=0.0022). Median AIRg of these 6 patients was balanced around that of normal control postoperatively p=0.0286). Conclusion: Eighty percent of patients with Cushing's syndrome had abnormality of carbohydrate metabolism. Insulin sensitivity was significantly decreased in Cushing's syndrome. Insulin secretion was significantly higher only in the NGT and IGT groups of Cushing's syndrome. As the hypercortisolemia is exacerbated, insulin secretion is significantly decreased and causes DM, suggesting that glucocorticoid has a direct or indirect toxic effect on the pancreatic beta cell (J Kor SOC Endocrinol 18:392-403, 2003).

황복(Takifugu obscurus)에 대한 중금속, 유기주석화합물 및 다환방향족탄화수소(PAHs)의 급성 독성

이정석,이규태,김동훈,김진형,한경남 한국환경독성학회 2004 환경독성보건학회지 Vol.19 No.2

We exposed juvenile puffer fish, Takifugu obscurus(30 days after hatching) to various aqueous pollutants including 4 kinds of inorganic metals(Ag, Cd, Cu and Hg), 2 organotin compounds(tributyltin [TBT] and triphenyltin [TPhT]) and 5 polycyclic aromatic hydrocarbon(PAH) compounds(chrysene, fluoranthene, naphthalene, phenanthrene and pyrene) to estimate median lethal concentrations(LC50s) of each pollutant after the 96-hour acute exposure. Among the inorganic metals, Hg(52㎍/L; 96-h LC50) was most toxic to test animals and followed by Ag(164㎍/L), Cu(440㎍/L) and Cd(1180㎍/L). Aqueous TBT was more toxic between the two organotins; the 96-h LC50 for TBT(5.1㎍/L) was 3 times lower than that of TPhT(17.3㎍/L). The acute toxicity of PAH compounds was highest for chrysene(1.5㎍/L; 96-h LC50) and decreased in the order of pyrene(65㎍/L)>fluoranthene (158㎍/L)>phenanthrene(432㎍/L)>naphthalene(8690㎍/L). The toxicity of PAH compounds was closely related to their physico-chemical characteristics such as K_(ow) and water solubility, and well explained by simple QSAR relationship. The sensitivity of puffer fish to various inorganic and organic pollutants was generally comparable to various fish species widely used as standard test species in previous studies and further evaluation should be conducted to develop adequate testing procedures for T. obscurus when used in various toxicity tests.

복직근 및 박근 근피판술을 이용한 골반 및 서혜부 연부조직 결손의 재건

이재화,정윤규,김주봉,유대현,황성관,이훈범,김석원 大韓成形外科學會 1997 Archives of Plastic Surgery Vol.24 No.6

Many operations for the reconstruction of the pelvic area have been studied until now. The local muscle flap is often used for the closure of these complex wound. But, these local muscle flaps may not be available for reconstruction due to the factors of infection, radiation, and surgical trauma. Since rectus abdominis muscle and gracilis muscle were introduced, their use has been steadily increased for the reconstruction of soft tissue defect of the pelvic area. Inferiorly based rectus abdominis muscle flap and the gracilis muscle flap have been adopted for well-vascularized soft tissue coverage of the defect of pelvis and groin area. These techniques were utilized in seven patients. Of these patients, rectus abdominis muscle flap was used on four patients and three patients were treated with gracilis muscle flap. Among these, chronic osteomyelitis of pelvic bone has been managed with inferiorly based rectus abdominis muscle flap in three patients. No complication has been found. The mean postoperative follow-up period was 26 months, with a range of 12 to 39 months. In conclusion, these muscles are functionally expandable , and provide adequate tissue volume with sufficient blood supply away from the zone of injury, and readily transposed into the pelvis and groin area through subcutaneous tunnel, and serve as an antibiotic delivery system that aids in the eradication of infection. These findings suggest a reconstructive option for the defect of pelvis and groin, and/or bone infection in this area.

TSC 합성보의 제작방법에 따른 구조적 거동에 관한 실험적 연구

이지운,김도훈,김성배,이창남,김상섭,김규석 대한건축학회 2004 대한건축학회 학술발표대회 논문집 - 계획계/구조계 Vol.24 No.1(구조계)

Composite action can be achieved by providing shear connectors between steel top flange and concrete topping. Composite sections have larger stiffness than the summation of the individual stiffness of slab and beam, therefore, can carry larger load or similar loads with appreciably smaller deflection and are less prone to transient vibration. T-type Steel Composite beam(TSC-beam) is developed and tested. To make the part of steel beam, we used the way of welding two steel plates as well as the way of folding one steel plate.

초미세 마이크로 소성성형 가공시스템 기술 개발

이낙규,최태훈,이혜진,최석우,박훈재,나원기 한국공작기계학회 2005 한국공작기계학회 춘계학술대회논문집 Vol.2005 No.-

In this paper Research development about a micro metal forming manufacturing system has been developed. A micro forming system has been achieved in Japan and it's developed micro press is limited to single forming process. To coincide with the purpose to be more practical, research and development is necessary about the press which the multi forming process is possible. We set the development of the equipment including micro deep drawing, micro punching and micro restriking process to the goal. To achieve this goal, Research about micro forming process to be related to multi process forming must be preceded first. Material selection and analysis about micro forming process are accomplished in this paper. And the basis research to make actual system is accomplished.

朝鮮時代 鄕校建築의 樣式에 關한 硏究 : 忠南地方 鄕校의 大成殿을 中心으로

李達勳,金賢錫,姜圭敏 대전대학교 산업기술연구소 1999 산업기술연구소 論文集 Vol.10 No.1

This paper, studying about Taesongjeon (the great shrine) which is in 11 Hyang-kyo (local school annexed to the confucian shrine) Architecture in Chung Nam local province, understands the meaning of 'Taesongjeon' from inspecting the specific regional feature of its construction type by analyzing various peculiarities and proposes the preservation of Hyang-gyo Architecture. The results of this paper are as following : 1) Generally, the placement types of Hyang-gyo Architecture in Chung Nam local province is 'School in the front and shrine in the back' 2) The shape of Taesongjeon plane has a open plane figure to worship and can be divided into 3 kans in front and 3 kans on sides. 3) The type of Gong-po of Taesongjeon is Mu-Chul-Mok Yi-Ikkong system and the form of the frame has been built with a higher pillar type.

Fabrication and High-Temperature Compressive Behavior of Unique Multi-Sheet Stacked Block Ni–Cr–Al Metallic Foam

Kyu‑Sik Kim,Tae‑Hoon Kang,박만호,Kee‑Ahn Lee 대한금속·재료학회 2021 METALS AND MATERIALS International Vol.27 No.5

Large unique block Ni–Cr–Al superalloy foam was fabricated using a combination method of powder-alloying, multi-sheetstacking, and hot compression processes. Subsequently, the compressive properties and deformation behaviors of multi-sheetstacked block metallic foam were investigated from room temperature to 1073 K. The analysis of the resulting structuralcharacteristics of the block foam showed that the interfaces between the sheets have complex strut interactions, such ascontacted (deformed) and intersected struts. The relative density was measured as 2.93% for sheet foam and 4.90% for blockfoam. The compressive deformation of sheet and block Ni–Cr–Al foams showed the typical compressive stress–strain curvesof plastically deformable metallic foams regardless of foam type. However, different deformation behaviors in the plateauregions were detected based on the type of foam. It is noteworthy that the yield strength of block foam showed a relativelylower value than that of sheet foam, even though the block foam had higher relative density. The existence of unique interfacesin the multi-sheet stacked block foam may have affected strength and plastic deformation. Finally, distinct compressivebehaviors related to the structural and microstructural characteristics of block Ni–Cr–Al foam are discussed.

선천성 수근관 증후군 1례 보고

이규훈,황치문,김민석,김희상,안경회 大韓再活醫學會 1998 Annals of Rehabilitation Medicine Vol.22 No.3

특수학교 재량활동 교육과정의 편성과 운영

이유훈,김경진,김규선,김형일 국립특수교육원 2000 교육과정의 편성과 운영 Vol.- No.1

본 연구는 제7차 특수학교 교육과정에서 많은 비중을 차지하고 있는 재량활동이 각 특수학교에서 보다 효율적으로 운영될 수 있도록 지원하기 위해 시도되었다. 이를 위해 본 연구에서는 각 시ㆍ도 교육청의 재량활동에 관한 지침서를 분석하였고, 전국 특수학교를 대상으로 재량활동 교육과정 편성ㆍ운영 방안에 대한 현장 교사들의 의견을 수렴하였다. 이러한 자료를 통해 나타난 요구와 시사점을 토대로 특수학교 재량활동 편성ㆍ운영방안을 제시하였다. 본 연구에서 다른 연구내용별 주요 연구결과를 정리하면 다음과 같다. 시ㆍ도 교육청 재량활동 지침 각 시ㆍ도 교육청에서는 특수학교 교육과정 편성ㆍ운영지침을 작성하여 이를 관내의 지역교육청과 각 학교에 제시하고 있었다. 분석한 결과에 따르면, 편제 및 시간배당 기준은 국가수준과 동일한 배정을 하고 있었다. 그리고 대부분의 시ㆍ도 교육청에서는 재량활동 시간확보 및 운영, 평가의 질 관리, 치료교육, 평가내용과 방법에 대하여 그 강조점을 두고 있었다. 그러나 일부 영역을 제외하고는 시ㆍ도 교육청 지침의 내용이 국가수준에서 제시한 재량활동의 내용과 거의 동일하였다. 따라서 지역교육청 나름의 특성을 살린 재량활동 지침을 제시할 필요가 있다고 본다. 재량활동 교육과정 편성ㆍ운영을 위한 교사요구 분석 재량활동 교육과정 편성ㆍ운영에 대한 실태조사에서 특수학교 대부분이 재량활동을 계획하고 운영하는데 있어 애로를 느끼고 있었다. 그 이유로는 재량활동에 대한 프로그램의 부재와 재량활동에 대한 교사들의 인식부족, 계획 수립 및 운영 미숙, 시설ㆍ재정적 지원의 부족을 들고 있었다. 이러한 애로점을 해소하기 위해서는 무엇보다도 먼저 재량활동에 대한 다양한 편성ㆍ운영방안과 교육 프로그램이 개발ㆍ제공되어야 한다는 것이다. 특수학교들의 재량활동 운영주체로는 학교 교육과정 운영위원회를 들고 있고, 재량활동을 편성 할 때 '학생들의 능력과 특성', 학부모 및 교사들의 의견이 반영되어야 한다는 의견이 재배적이었다. 그리고 재량활동 시간배당에 있어서는 국가수준에서 제시한 시간만으로도 충분한 것으로 여기고 있으며, 기본교육과정은 교과 재량활동과 창의적 재량활동 구분 없이 융통성 있게 활용하기를 원하고 있다. 재량활동의 지도주체에 대해 정신지체ㆍ정서장애학교에서는 담임으로 응답한 반면, 시각ㆍ청각ㆍ지체부자유학교 교사는 따라 다양한 반응을 보이고 있었다. 그러나 장애역역에 관계없이 재량활동의 하위영역에 따라 다양한 지도주체를 모색할 필요가 있다고 본다. 이것은 학습진단 구성과도 연관될 수 있는데, 많은 교사들은 현재의 집단편성 방식에서 벗어나 재량활동의 모든 하위영역에서 활동중심의 집단편성을 원하고 있었고, 특히 창의적 재량활동에서는 좀더 다양한 집단으로 구성해야 한다는 반응을 보이고 있었다. 시간운영에 있어서는 매주 정해진 날에 실시해야 한다는 반응이 대부분이었지만, 시각ㆍ청각ㆍ지체부자유학교의 범교과 학습과 자기주도적 학습에서는 좀더 다양한 시간배정이 이루어지기를 원하고 있었다. 특히, 자기주도적 학습에서 각 특수학교들이 특정한 정해진 날에 체험학습의 날이나 책가방 없는 날과 같이 별도계획으로 운영해야 한다는 학교들도 있었다. 이러한 시간 운영과 관련한 지도방법에 있어서는 하위영역에 구분됨이 없이 모든 학교가 견학과 체험학습을 선호하고 있었다. 지도내용에 있어서는 기본적인 교과목에 대한 이해를 중심으로 이루어져야 한다는 시각ㆍ청각ㆍ지체부자유학교의 반응을 제외한다면, 사회생활 적응을 위한 기초생활 지도와 일상생활 적응, 그리고 현장학습과 같은 체험학습을 통한 내용을 대부분 선호하였다. 각 특수학교에서 제시한 재량활동 프로그램을 분석한 결과 일부학교를 제외하고는 그 유형들이 비슷하고 영역도 특별활동이나 사회교과 영역과 크게 구분이 되지 않은 것으로 나타났다. 재량활도에 대한 평가는 학생들의 다양한 활동과정을 평가할 수 있는 포트폴리오 방식을 선호하고 있었다. 기타 요구사항 재량활동의 활성화 방안에 있어서는 '교수ㆍ학습자료의 개발 및 보급이 우선되어야 한다'는 반응이 가장 많았으며, 그 다음으로 '학교장의 관심과 적극적인 자원', '학교의 잡무감소', '학급당 인원의 감소'등을 요구하였다. 시ㆍ도 교육청에 대한 요구사항으로는 역시 '프로그램의 개발 보급', '잡무 감소', '체험학습 활동에 대한 경비 자원', '교과전담 교사 확보' 및 '다영한 전무교사의 확보', '교사에 대한 재량활동 관련 연수기회 제공', '학교간 재량활동 운영에 관한 정보교환 및 공동 프로그램 운영지원'등을 들고 있었다. 재량활동 편성ㆍ운영방안에 있어서는 단위학교에서 재량활동을 편성할 때 기본적인 도움이 될 수 있도록 하기 위하여 하위영역별 사항과 이에 따른 운영방안을 제시하였다. 이를 위하여 첫째, 재량활동 편성ㆍ운영방안을 하위영역별로 나누어 하위영역별 편성방향, 시간배당, 지도내용, 집단구성, 지도방법, 평가내용을 제시하였다. 둘째, 각 하위영역별 시간배당, 지도내용, 집단구성, 지도방법, 평가방안에 대한 여러가지 가능한 방안을 제시하였다. 셋째, 일반학교와 특수학교에서 실제로 활용하고 있는 다양한 예시자료를 제시하였다. 넷째, 일반학교의 재량활동 운영과 관련된 우수 연구보고서와 특수학교에서 운영히고 있는 재량활동 사례를 정리하여 부록에 제시 하여 다양한 실천 자료를 참고할 수 있도록 하였다. This study aims at groping for effective application methods of optional activities for special schools. For this purpose, a close analysis was made on the guidelines for optional activities published by Metropolitan and Provincial Office of Education(MPOE), and extensive opinion on schemes for organizing and implementing the curriculum were collected from school teachers. The data gathered in this process present requirements and suggestions for optimal designs for organizing and implementing optional activities in special schools. The results of this study can be summarized as follows: Clarification of theoretical backgrounds of optional activities. Through clarifying various theoretical backgrounds, we identified its related meaning of character, organization, implementation process and assessment. Guidelines of the Metropolitan and provincial Office of Education(MPOE) Each MPOE has worked out and provied schools with its own guiding principles on the organization and implementation of special education curricula. The systems of organization and the standards of subject time alloment are almost the same as those of state level issued by the ministry of education. Most MPOE give directions that each school should secure and implement optional activities with an emphasis on enhancing the quality of assessment management, therapy education, as well as the contents and methods of assessment. Except some areas, most directions for optional activities from MPOE of education are not much different from those of the Ministry of Education. It is, therefore, necessary that each MPOE should provide its own directions as to optional activities. Analysis of teachers' needs about effective application method of optional activity. An investigation into actual condition activities reveals that most special schools have difficulty in planning and operating the activities, because of lack of diverse programs, shortage of knowledge about the activities, unskilled planning and implementation of the activities, insufficient facilities and financial support. The first thing to break these obstacles is to develop and provide diverse programs and devices for the organization and operation of the activities. The curriculum steering committee is regared as the primary implementation body for optional activities in special schools. Optional activities should reflect each student's ability and specially as well as the opinions of his/her parents and teachers. The time allotted by the Ministry of Education is regarded enough for individual school's optional activities. There are two kinds of optional activities: one by subject matters and the other by creative optional activities, but basic curriculum requires flexible application of both. As to the measurement of optional activities, schools for mentally retarded or handicapped students responded their home-room teachers should take the initiative, but school for the blind, the deaf, or the crippled said that different teachers in different fields should take the lead in their respective major subjects. Regardless of handicap degrees, it is necessaty to set various teaching intiatives according to sub-areas of optional activities, which is closely related to the organization of learning groups. Many teachers wanted to form groups geared to focus on more creative optional activities in sub-areas rather than their present groupings. Most teachers reponded that the time for the activities should be fixed on a specific weekday. Teachers also wanted that more various time should be allotted to the integrated study and self-directed study of the schools for the blind, the deaf, or the crippled. Some special schools had the opinion that self-directed study should be operated on a fixed day as the same way as the day for learning through experience or the day without schoolbag goes. As to the teaching methods, all the schools preferred the field study or learning through experience without regard to the division of sub-areas of optional activities. The contents of special school teaching were maintained to be focused on understanding the basic subjects, but most schools wanted optional activities to comprise learning the basic social life, getting acquainted with everyday life, and on-the-spot learning. An analysis on optional activities of special school showed that most activity types of the schools are nearly the same, and their areas of activities are not greatly different from those of club activities or social science subjects designed by the Ministry of Education. As for the assessment method for optional activities, the protfolio system is most preferred because it assesses each student's process of diverse activities. Other requirements In order to activate the optional activities, most schools preferred the development and distribution of teaching-learning materials. Next comes the school principal's concern and support for the activities, diminishing teachers' sundry duties, and reducing class-size. Teachers also required that each MPOE should take active measures to develop and distribute diverse teaching programs, reduce teachers' odd jods, give more financial support for discretionary activities, secure subject teachers, provide training opportunities for optional activities, exchange information on the operation of optional activities among schools, and support joint operation programs. Designs and various examples of its organization and implementation. With analyais of these results, we developed the designs of its organization and implementation method of optional activities for special schools. First, in our designs of its organization and implementation, we approached the sub-activity divisions which composed of two. the first one is optional activities of subject matters which involves the in-dept and supplementary study of therapy education activities and the in-dept and supplementary study of elective-centered subject matters. the second one is creative optional which involves integrated and self-directed study. Second, we conducted to figure out various possible methods in each sub-activities about time allotment, learning group, class time management, teaching method, teaching contents, assessment method. Third, when design of organization and implementation of optional activity, we usually use diverse optional activity examples from regular and special schools. Forth, in appendix of this book, we provided the cases of discretionary activity of regular and special schools's. So, it enables teachers to use as practice resource material, in their schools.

전신성 홍반성 루프스에서 고용량 경정맥 당질코르티이드로 치료된 단백질 소실성 장질환 1예

이규형,권창모,김현도,윤대영,이재웅,홍여훈,이충기 영남대학교 의과대학 2005 Yeungnam University Journal of Medicine Vol.22 No.2

Generalizes edema and hypoalbuminemia are relatively common presenting manifestations in many clinical situations. The differential diagnosis of hypoalbuminemia include; Kwashiorkor, synthetic dysfunction of the liver, and excessive protein loss as in nephrotic syndrome. In systemic lupus erythematosus (SLE), hypoalbuminemia and generalized edema are most commonly due to protein loss associated with lupus nephritis; gastrointestinal involvement is uncommon, and therefore protein loss through the gastrointestinal tract is quite rare. We report a case of a protein losing enteropathy (PLE) associated with SLE. The patient was referred to out hospital for generalized edema, arthralgia and facial rash. After clinical evaluation, the patient met the criteria for the SLE diagnosis; hypoalbuminemia with general edema was consistent with a protein losing enteropathy. After two weeks of therapy with parenteral high dose glucocorticoid, the patients was improved in laboratory findings as well as clinical symptoms.