• The Korean Society of Law and Medicine
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• v.18 no.2
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• pp.105-138
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• 2017

This is case comments of several representative legal cases regarding self- determination right of patient. In a case in which an intoxicated patient attempted suicide refusing treatment, the Supreme Court ruled that the medical team's respect for the patient's decision was an act of malpractice, and that in particular medical situations (medical emergencies) the physician's duty to preserve life supersedes the patient's rights to autonomy. Afterwards, at the request of the patient's family, and considering the patient's condition (irrecoverable death stage, etc.) consistent with a persistent vegetative state, the Supreme Court deduced the patient's intention and decide to withdraw life-sustaining treatment. More recently, regarding patients who refuse blood transfusions or other necessary treatment due to religious beliefs, the Supreme Court established a standard of judgment that can be seen as conferring equal value to the physician's duty to respect patient autonomy and to preserve life. An empirical study of legal precedent with regard to cases in which the physician's duty to preserve life conflicts with the patient's autonomy, grounded in respect for human dignity, can reveal how the Court's perspective has reflected the role of the patient as a decision-making subject and ways of respecting autonomy in Korean society, and how the Court's stance has changed alongside changing societal beliefs. The Court has shifted from judging the right to life as the foremost value and prioritizing this over the patient's autonomy, to beginning to at least consider the patient's formally stated or deducible wishes when withholding or withdrawing treatment, and to considering exercises of self determination right based on religious belief or certain other justifications with informed refusal. This will have a substantial impact on medical community going forward, and provide implicit and explicit guidance for physicians who are practicing medicine within this environment.

• Journal of Chest Surgery
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• v.29 no.3
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• pp.322-325
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• 1996

ABO incompatible allografting is contraindicated in most organ transplantations including heart because of the hyperacute and acute rejections caused by preexisting antibodies. However several reports showed that ABO incompatible organ transplantation could be managed successfully by plasmapheresis, antibody adsorption, immunosuppression, splenectomy, and so on. We experienced one success in ABO incompatible cardiac transplantation by means of plasmapheresis and immunosuppression. However, this does not justify heart transplantation across ABO blood group barriers. Because the effect of ABO incompatibility on continued acute rejection or chronic rejection has not been fully understood, long-term follow-up study is required.

• Radiation Oncology Journal
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• v.4 no.1
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• pp.15-20
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• 1986

From 1979 to 1984, 39 local allograft irradiations were given to 29 patients: 10 irradiations were administered for prevention and 29 for reversal of acute rejection of transplanted kidney. Three doses of 150 cGy every other day were combined with high-dose of methylprednisolone pulse (1 gm/day) for 3 days. For prevention of acute rejection, local irradiation was delivered on the days 1, 3, and 5 after the transplantation, and for reversal, irradiation started after the diagnosis of acute rejection. Eight out of 10 patients irradiated for prevention had acute allograft rejection, and, what is more, there was no surviving graft at 15 months after transplantation. Reversal of acute rejection was achieved in $71\%$. When the pre-irradiation level of serum creatinine was below $5.5mg\%$, the reversal rate was $93\%$, but above $5.5mg\%$ the reversal rate was only $17\%$ (p<0.01). Reirradiation after failure was not successful. Among 15 reversed patients, $7(47\%)$ had subsequent rejection (s). The functional graft survivals at 6 month, 1, 2, and 3 year were $70\%,\;65\%,\; 54\%,\;and\;54\%$, respectively. Therapeutic irradiation resulted in better graft survival when serum creatinine was below $5.5mg\%$ (p<0.001) or when irradiation started within 15 days after the diagnosis of acute rejection (p<0.001).

• The Journal of the Korea Contents Association
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• v.15 no.12
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• pp.355-369
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• 2015

Purpose: This study aimed to identify on the attitudes toward the life support care among elderly people using Q methodology. Methods: Thirty-nine elderly people classified 34 selected Q statements into a shape of normal distribution using a 9 point scale. The obtained data were analyzed by using a PQ Method PC program. Results: Principal component analysis identified 4 types of the attitudes toward the life support care among elderly people. Type I is "Situational & Self-determination linear type", type II is "Destiny & Life support care denied type", type III is "Avoidant & Family decision emphasis type" and type IV is "Respect for life & life support care approved type". Most of elderly people have been attitude that wish to receive honor their own decisions toward the prolongation treatment. Conclusion: The findings indicate a need to policy guidelines and public information that express self-determination of elderly people.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.19 no.4
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• pp.362-366
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• 1997

골의 퇴축 혹은 수술시의 절제로 인해 임플란트를 식립하기엔 불충분한 악골을 가진 환자에 있어서 골 이식술의 필요성은 오랫동안 논의 되어왔다. 골이식술은 악골의 전체 두께(full thickness)결손시 연결성(continuity)의 수복, 혹은 표면(surface)에서의 골상실시 보강(augmentation)목적으로 쓰일 수 있다. 따라서 술자들은 임플란트를 식립하기에 불충분한 악골을 가진 환자에 있어 골 이식술에 권유하게된다. 그러나, 골 이식술은 donor site 의 morbidity혹은 수술에 대한 두려운, 추가되는 비용에 대한 염려등으로 인해 환자에 의해 거부될 때가 종종 있다. 악골 결손으로 인해 골이식없이는 임플란트를 식립하기 어려운 경우에 있어서도 임플란트 술식이 여전히 해결책이 될 수 있을까? 다음의 두가지 증례를 통해 저자등은 골이식술 없이는 임플란트르 식립하기 어려운 경우에 있어서도 임플란트 술식이 여전히 치료방법으로서 의미가 있었음을 보고하는 바이다.

• Korean Journal of Clinical Pharmacy
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• v.9 no.2
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• pp.81-87
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• 1999

췌장이식의 성공률은 지난 10년 동안 상당히 상승되었다. International Pancreas Transplant Registry에 따르면 1995년 이래 미국에서만 매년 1,000건 이상의 췌장이식이 실시되고 있다. 장기이식후 나타나는 급성 거부반응은 이식 후 6개월 이내에 가장 높은 빈도수로 나타난다. 췌장이식환자에서는 신장을 이식한 것보다 두배나 높은 거부반응을 나타나며 이로 인한 입원율의 증가 항림프제(antilyinphocyte) 사용과 감염의 증가로 이환율이 높다. 더구나 Cyclosporine (CsA)을 기초로 한 면역억제제요법의 사용은 높은 급성 거부반응률(acute graft rejection)을 초래하여 이식한 장기의 조직손실이 문제가 되고 있다. 새로운 면역억제제인 Tacrolimus (FK506)의 사용은 이식환자에서의 거부반응을 감소시켜 생존율을 증가시키는 것으로 알려져 있다. Tacrolimus는 neutral macrolide로 cyclic peptide인 CsA과는 화학 구조는 매우 다르나 비슷한 면역억제 효과를 보인다. 하지만 Tacrolimus의 사용시 신경독성, 신독성, 특히 고혈당증의 발생률이 높아 일부 이식센터에서는 장기 이식 후에 사용하기를 꺼리기도 한다. 하지만 여러 연구논문에서 간과 신장 이식 후 급성 거부반응 예방에 Tacrolimus는 CsA에 비해 이점이 있는 결과를 발표하였다. 결과적으로, 현재 췌장이식 후 Tacrolimus를 기초로 한 면역억제의 효과에 대한 연구가 활발히 진행중이다. 따라서 본 연구에서는 1994-1996년 사이에 Tacrolimus 또는 CsA를 기초로 한 면역억제요법을 투여 받은 췌장이식환자 101명을 후향적으로 조사하여 Tacrolimus (n=54)와 CsA(n=57)의 급성 거부반응 예방 효과와 신부전 발생률을 비교하였다. 모든 환자는 항림프구 약물, Azathioprine, Prednisone을 이식 후 면역억제제로 투여 받았다 기준선으로부터 $20\%$ 이상의 혈청 creatinine의 상승이 있는 환자에서는 급성 신부전으로 정의하였고 신장생검법으로 거부반응을 진단하였다 Matched-pair analysis에 따르면 췌장이식환자의 6개월 생존율은 CsA군에서 $97\%$, Tacrolimus군에서 $96\%$로 별다른 차이가 없었으며 (p=0.57), 6개월간의 이식한 췌장의 보존율은 CsA군에서는 $88\%, Tacrolimus에서 $91\%$. 유의한 차이는 없었다(p=0.29). 췌장이식 후 6개월 동안 Tacrolimus의 사용은 생검으로 증명되는(biopsy-proven) 급성 거부반응의 발생빈도는 CsA보다 유의하게 낮았을 뿐만 아니라 (p<0.05) 거부반응 증상의 심각도 또한 감소시켰다 (p=0.03). 급성거부반응 발생빈도의 감소로 Tacrolimus군에서 antilymphocyte 치료가 유의하게 줄어들었다(p=0.01). CsA군에서 Tacrolimus보다 신부전의 발생률이 높았으나 통계학적 차이는 없었다. 췌장이식후의 최적의 면역억제요법의 결정하기 위해서는 향후 Tacrolimus와 CsA을 비교하는 전향적 무작위 연구가 필요하다.

• Journal of Chest Surgery
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• v.43 no.1
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• pp.73-76
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• 2010

Cardiac allograft vasculopathy (CAV) is a major factor that limits the long-term survival after cardiac transplantation. Because the main feature of CAV is a diffuse stenosis that predominantly develops in the distal arteries, reperfusion therapy has shown poor outcomes. The results of cardiac retransplantation for CAV are better than that for acute resection and the survival is identical to that of patients who undergo primary transplantation. We describe a case of performing cardiac retransplantation in a 28 year-old male patient with refractory CAV and who underwent primary transplantation due to dilated cardiomyopathy 8 years previously.

• The Journal of the Korea Contents Association
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• v.21 no.4
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• pp.248-261
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• 2021

The purpose of this study is to verify the mediating effect of rejection sensitivity and relationship addiction in the relationship between abandonment anxiety and psychological dating violence. For this purpose, data of 400 adult were collected and analyzed, and the structural equations were used to verify them. The measurement tools were the Abandonment Anxiety Scale, the Rejection Sensitivity Questionnaire Scale, Relationship Addiction Questionnaire-30 and Psychological Dating Violence Scale, which were the Revised Conflict Tactics Scales-2 and Appraisal of Partner Control Scale. The results of the study are as follows: First, there was a significant corelation among abandonment anxiety, rejection sensitivity, relationship addiction, and psychological dating violence. Second, there was no direct effect on the relationship between abandonment anxiety and psychological dating violence, but it had an effect on psychological dating violence by double mediating rejection sensitivity and relationship addiction. Based on these results, we confirmed the psychological path that abandonment anxiety affects psychological dating violence, and discussed the need for therapeutic intervention and educational approach in negative interpersonal patterns that are not visible.

• Korean Journal of School Psychology
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• v.18 no.3
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• pp.351-370
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• 2021

This study investigated the effect of parental psychological control on relational aggression among middle school students, the mediating effects of rejection sensitivity and friendship jealousy, and whether there were differences in these variables by the demographic characteristics of gender and family form. Data of 554 middle school students living in Daegu and Gyeongsangbuk-do were used for the final analysis. There were two major results. The first major result was what rejection sensitivity and friendship jealousy sequentially mediated the relationship between parental psychological control and relational aggression. The second major result was gender differences which was shown by a multi-group analysis to examine in the path from parental psychological control to rejection sensitivity, the path from parental psychological control to relational aggression, and the path from friendship jealousy to relational aggression. This study was meaningful in that it expanded the understanding of relational aggression and identified directions for therapeutic interventions.

• The Monthly Diabetes
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• s.218
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• pp.56-59
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• 2008

몇 년 전부터 '웰빙'에 대한 사회적 관심과 언론매체에서 제공되는 당뇨병에 관한 다양한 정보는 당뇨인 뿐만 아니라 일반인에게까지 당뇨병의 위험성과 혈당조절의 중요성을 깨닫게 해주었다. 그러나 수명의 증가는 당뇨병과 더불어 살아가야 할 삶의 기간을 늘렸고, 또한 앞으로 합병증과 함께 살아가야 할 시간도 더욱 늘어나게 될 것이다. 당뇨합병증은 일반적으로 혈당조절 정도와 반비례해서 발생한다. 당 조절이 잘되면 합병증이 안 오거나 늦게 생긴다. 그러나 조절이 안 되는 경우 합병증이 빨리 오고 빨리 진행한다. 그래서 최근에는 과거보다 더욱 엄격한 혈당조절 목표를 제시하고 있어, 좀 더 일찍 몇 가지 혈당강하제를 병합하는 치료(조기 병합치료)를 선택하거나 혹은 좀 더 일찍 인슐린 주사치료(조기 인슐린 치료)를 시작하고 있다. 그러나 이러한 시도들, 특히 조기 인슐린 치료는 환자들의 강력한 저항에 부딪혀 실패하곤 한다. 이러한 저항은 대부분 인슐린 치료에 대한 공포(두려움)나 오해 때문에 발생하며 혈당조절을 어렵게 만든다. 따라서 필자는 당뇨병 발생과 치료에 있어 인슐린의 역할을 설명하고, 거부감 없이 인슐린 치료를 쉽게 할 수 있는 방법을 알아보고자 한다.