• 제목/요약/키워드: First-visit

검색결과 926건 처리시간 0.027초

지역사회중심 가정간호 시범사업 성과평가를 위한 기초연구- 서울시 간호사회 주관 - (A Preliminary Study for Evaluating on Demonstration Project of Community-based Home Health Care Nursing Services by the Seoul Nurses Association)

  • 유호신;이소우;문희자;황나미;박성애;박정숙;최행지;정기순;한상애
    • 대한간호학회지
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    • 제30권6호
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    • pp.1488-1502
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    • 2000
  • This study, based on current home nursing services, aims at promoting measures for establishing a community-based home nursing system derived from the pilot home nursing demonstration project conducted by the Seoul Nurses Association. The study was based on an analysis of home nursing records from march 1993 to December 1999. The following is a summary analysis, based on individual characteristics of the patients, the organization, which recommended the service for their patients and personnel services. 1. The service has been used by many elderly people 60years of age or older(66.4%). and married people(60.9%). The average number of visits by service personnel for patients of city government was 23.5. This is 2.5 times as many visits by general patients. General patients(20.2%) had only one visit from service personnel, while 65.5% of patients of city government had 10 or more visits. Particularly, for government recommended patients, 72.7% of the patients were recommended by nurses, while only 21.9% where referred to the services by doctors. The main focus of a home nursing service was to maintain present health status (53.4%), and hospice(11.6%). Also to increase hospital-based home nursing services focused on recovery(55.9%) and maintain present health conditions (19.0%). 2. For general patients, 42.0% of patients were suffering from problems related to CVA, 11.3% from high blood pressure, and for patients referred from city, 21.2% from skeletal muscular disease. Results of home nursing services 29.4% of patients were able to recover or maintain their health status, but 48.9% of the patients died. Another main point of community-based home nursing services is medication(6.7%), other basic nursing services(6.1%), special treatment, instructions on how to use medical devices(5.9%), change of physical posture(4.6%), and training on changing physical positions(4.7%). As mentioned above there were some differences between the characteristics of patients who used the pilot home nursing service conducted by the Seoul Nurses Association and those hospital-based service users. The results are believed to be useful to support a community-based home nursing service model. Particularly, patients under medical supervision and patients recommended by government-run health clinics show a higher frequency and longer use of home nursing services compared to general patients or hospital-based home nursing service users. According to the study, nurses accounted for a large number of recommendations for home nursing services. Many patients with CVA, high blood pressure, skeletal muscular disease and bedsores used community-based home nursing services, while others used the service for minor treatments or maintaining their current health status. Based on the study, the researchers make several suggestions to establish a community- based home nursing service system. First, different ways of setting up a community-based home nursing system have to be mapped out based on the evaluation of the pilot home nursing service conducted by the Seoul Nurses Association. Secondly, a new, community-based, home health care nursing service model, and reimbursement payment system have to be developed. This is based on the outcome of the analysis, and implemented policy. Accordingly, efforts are needed to develop a community- based home nursing system with an intermediary role to promote the visiting nursing services of government-run health centers.

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고등학교 학생들의 성에 관한 인식과 성교육에 대한 요구 조사 연구 (A Study on the Perception about Sex and Sex Education Needs of High School Students)

  • 김화자;남선영;정연강;박경숙
    • 한국학교보건학회지
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    • 제8권2호
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    • pp.233-243
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    • 1995
  • A survey has conducted on two hundred high school students of the first and second grade by way of questionnaine in Seoul. The purpose of this study on the information from the survey is to cstimate the level of awareness and probe how they feel and what they wish on sex. X2 inspection is designed to assess general aspects of responded contents by way of percentage and examine degree of satisfaction on previously experienced sex education and demand for sex education. The result is as follows. 1. As a result of the examination of degree of awareness on sex of respondents, 62% delines sex as human relationship including moral values for harmony between men and women. 64% of the men and 70% of the women say that sex is a natural thing. It comes to the conclusion that most of the respondent sgenerally consider sex positive. On chastity, 68.5% of the respondent answer that it means physical chastity, 12.5% that chastity before marriage should be kept, and 43% that it should be kept as far as possible. Most of them pespond that it should be kept. 2. As a result of the examination on the contents of sex, they answer they know well in the order of masturbation(72%), pregnancy(76%), and sex(63%). Contraception, abortion and ejection are contents they poorly informed of. 3. As a result of the examination on experienede of sex education, 83% of men and 100% of women have experienced sex, education, but their degreeof satisfaction to it is very low. And 49% of the whole is dissatisfactory to it. There is some difference between male and female students.(p=0.000) That result translates that female studeuts are educated on sex tjhrough more systematic subjects than male ones. In addition, it turns out that teenagers get most information on sex through friends, seniors, and mass media such as videos, TV and radios. Correct and systematic sex education is need because wrong information on sex culd be taught and bring them to misbehave. 4. 87.5% of the respondents answer that sex education is necessary, so that degree of necessity for sex education, turns out to be very high. Also the main subject that should perform sex education is in the order of school(50%), Society(24.5), home(18.5%). They respond that most appropriated period for the beginning of sex education is about elementary school age(43%), and 34% believes it to be put ahcad of elementary school age. Anurse teacher accounts for 54% for the main subject that addresses sex education, to male students visit teachers are most favored for 50%. As a result of those, it could be concluded that most high school students want sex education from responsible persons who have systematic and professional knowledge on sex. 5. In order to perform proper sex education by the above results, better educational effects are obtained when characteristics and natures of teenagers are known and most wanted knowledge by them is taught in priority in times of planning sex education. Besides, the contents of sex education suitable for each school should be planned before elementary school age and sex education should be performed in accordance with students' demand. In addition, sex education should be attentively performed by home, all organizations of society as well as school. Therefore, sex education will play a great role in making teenagers reestablish their conception on sex when the traditional and moral value systems of our country and the new value systems which are being formed under the influence of the western culture are in harmony.

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자연휴양림과 체험마을 연계를 위한 이용객의 선택속성 인식 연구 (A Study on Users' Recognition of Selection Attributes for Connection between Recreational Forest and Rural Tourism Village)

  • 이용학;조영은;강은지;김용근
    • 한국조경학회지
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    • 제44권1호
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    • pp.16-28
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    • 2016
  • 본 연구는 자연휴양림과 체험마을 이용객의 여가목적지 선택속성에 대한 중요도와 만족도의 비교분석에 관한 연구로 이용객의 이용행태를 파악하여 자연휴양림과 체험마을의 연계 당위성을 확인하고 여가목적지 선택을 위한 물리적 선택소성, 프로그램 선택속성, 서비스 선택속성의 인식차이와 중요도-만족도분석(IPA 분석)을 통해 연계방안을 도출하였다. 주요 결과 및 시사점은 다음과 같다. 첫째, 자연휴양림은 가족단위의 이용객이 휴식 및 정서함양을 위해 방문하고 단순 산림공익적 기능을 활용한 체험프로그램 경험이 이루어지고 있는 반면, 체험마을은 가족, 친구 및 동료, 단체 및 동호회 등이 연중 다양한 프로그램을 경험하고 지역문화를 이해하기 위해 방문하고 있었다. 이를 통해 다변화한 국민의 여가수요 충족을 위한 자연휴양림과 체험마을의 연계 필요성을 확인하였다. 둘째, 단순 휴식이 주 방문목적이었던 자연휴양림 이용객에게 체험마을과 연계 시 긍정적인 방문의향이 나타났으며 체험프로그램 참여, 자녀교육, 안전한 숙박시설 확보 등 다양한 이용이 예측되었다. 즉, 자연휴양림과 체험마을의 연계는 실질적 수요와 이용객의 수준 높은 산림휴양활동을 야기하는 대안이라 할 수 있다. 셋째, 자연휴양림 이용객의 경우 모든 선택속성에 대하여 중요도보다 사후 만족도가 낮았으므로 전반적인 개선 필요했다. 특히, 프로그램의 다양성, 유익성, 홍보, 지역성(테마성)의 개선과 숙박 및 편의시설의 공급, 예약시스템 및 지역특산물 구입 체계 구축을 위한 노력, 운영관리인의 전문성 확보가 필요했다. 반면, 체험마을의 프로그램 선택속성의 만족도는 높았으므로 체험마을 프로그램 속성이 자연휴양림 이용활성화를 위한 주요 연계대상임을 알았다. 넷째, IPA 분석에서 이용객의 높은 기대와 만족을 주는 숙박 및 편의시설과 인근 관광지와의 적절한 연계는 유지해야 할 속성이었고 소득창출이 주요 목적인 체험마을의 목적을 달성하고 방문객의 예약시스템 및 특산품 판매기회 만족 증진을 위한 공동의 노력이 요구됐다. 이 외에 자연휴양림 이용요금 체계의 유지, 체험마을 프로그램의 다양성 및 지역성의 유지가 이용객의 여가목적지 선택유도를 위해 필요한 사항으로 고찰되었다.

Changes in Blood Lipid Profile and Hepatic Enzyme Levels after Oriental Medical Treatment to Metabolic Syndrome Patients with Abnormal Liver Function

  • Kim, Dong-Woung
    • 동의생리병리학회지
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    • 제22권6호
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    • pp.1626-1632
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    • 2008
  • Among patients who are receiving treatments at an oriental medical hospital for various symptoms and diseases, patients whose main disease is accompanied by metabolic syndrome with abnormal liver function. This research was performed in order to observe the progression of changes in the liver function and serum lipid profile after the oriental medical treatments to patients who have been receiving oriental medical treatment for various other diseases and have been diagnosed as having metabolic syndrome at their first visit to the hospital based on NCEP ATP III diagnosis criteria and WHO Asia Pacific region criteria. Total number of subject patients were 39cases(mean age:55.58${\pm}$2.09 years) which had 20 male and 19 female. For the references for hepatic enzyme levels and blood lipid profile were measured in before treatment and four times after treatments(every 2.31${\pm}$06.17 weeks). Serum AST was 48.86${\pm}$7.46 IU/L before oriental medical treatment. After the treatment, 40.63${\pm}$4.69, 43.12${\pm}$5.46, 37.82${\pm}$4.52 IU/L were measured where although the level decreased to the normal level compared to pre-treatment, the value was not significant statistically(P>0.05). ALT was 66.26${\pm}$11.01 IU/L before oriental medical treatment. After the treatment 62.10${\pm}$8.20, 61.10${\pm}$8.76, 43.79${\pm}$5.68 were measured where although the level decreased, abnormally high level was maintained. The last result was significant statistically(P<0.05) compared to pre-treatment. ALP was 193.06${\pm}$14.20 IU/L before oriental medical treatment. After the treatment, 176.80${\pm}$6.48, 177.46${\pm}$11.81, 162.41${\pm}$9.06 where although compared to pre-treatment the last result was significant statistically(P<0.05), the change was within the normal range. ${\gamma}$-GGT was 87.83${\pm}$12.59 IU/L before oriental medical treatment. After the treatment, progressively near normal level was achieved with 118.73${\pm}$46.45, 85.03${\pm}$17.12, 70.64${\pm}$10.93 and the last result was statistically significant compared to pre-treatment (P<0.05). Blood triglyceride was 217.63${\pm}$32.18 mg/dL before oriental medical treatment. After treatment 215.09${\pm}$22.18, 189.93${\pm}$22.44, 191.22${\pm}$18.51 where abnormal values continued even after treatment although results was not statistically significant compared to pre-treatment(P>0.05). Total-cholesterol was 197.28${\pm}$9.24 mg/dL before oriental medical treatment, after treatment 201.55${\pm}$11.13, 186.87${\pm}$8.77 and 186.68${\pm}$7.61 were measured that results were not statistically significant compared to pre-treatment(P>0.05). HDL-cholesterol was 41.88${\pm}$2.38 mg/dL before oriental medical treatment, after treatment 48.75${\pm}$4.22, 44.10${\pm}$1.91, 48.00${\pm}$2.06 the results were not statistically significant compared to pre-treatment(P>0.05). LDL-cholesterol was 111.66${\pm}$13.08 mg/dL before oriental medical treatment, after treatment 109.94${\pm}$10.18, 101.79${\pm}$8.63, 104.00${\pm}$6.98 the results were not statistically significant compared to pre-treatment(P>0.05). With such results, even if common oriental medical treatments were given to metabolic syndrome patients with abnormal liver function, the liver function was confirmed not to be aggravated, and the concentration of lipids in the blood was confirmed not to be affected in most patients.

Group A-beta Hemolytic Streptococci에 의한 소아 인두편도염에 있어서 Cefprozil의 항균력과 임상적 및 세균학적 효과에 관한 연구 (Clinical and Bacteriologic Efficacy of Cefprozil on Pharyngitis and Pharyngotonsilitis caused by Group A Beta Hemolytic Streptococci in Children)

  • 김민우;안영민;장성희;마상혁;안병문;김종덕;이종국;김미란;장진근;박진영;배종우;차성호
    • Pediatric Infection and Vaccine
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    • 제8권2호
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    • pp.206-212
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    • 2001
  • 최근 소아의 인두염 및 인두편도염에서 EM-resistant group A streptococci가 15~40%까지 보고가 되고 있으며, 같은 계통의 macrolide제제들의 대한 내성도 점차 증가하고 있는 양상이 나타나고 있다. 따라서 세균성 인두편도염이 의심되는 환아의 치료에 있어서 경구용 항생제를 선택할 때는 항생제에 대한 내성과 경제성 및 환아의 순응도를 고려하여 항생제를 선택하여야 하겠다.

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페르낭 크노프(Fernand Khnopff)의 작품에 나타난 벨기에 상징주의와 내셔널리즘 (Fernand Khnopff's Belgian Symbolism and Nationalism in I Lock My Door upon Myself)

  • 정연심
    • 미술이론과 현장
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    • 제9호
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    • pp.171-193
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    • 2010
  • This paper examines Fernand Khnopff's Symbolism, focusing on the I Lock My Door upon Myself as a manifesto of his artistic credo in style and theme. Its title was originally in English, originating from the poem "Who Shall Deliver Me?" by Dante Gabriel Rossetti's sister Christina Rossetti. I use the term "Social Symbolism" which combines a nationalist perspective with traditional French Symbolism, in order to explain how the image of Bruges is represented in his oeuvre. Symbolism calls for psychological introspection evoking death, love, silence, and solitude and recluse from realty in pursuit of the Unknown and the Ideal. Although Khnopff shared this idea, he departed from symbolist tradition by incorporating a political milieu in his paintings. First, I discuss Khnopff's early stage in the formation of his artistic concept, including his family background as well as his early opportunity to visit the Exposition Universelle in Paris where he formed his early interests in aesthetics, philosophy, literature, mythology and Egyptian art. His early works, La Painture, la Musique, la Poesie(1880-1881), Le Crise(1881), and En ecoutant Schuman(1883) reveal his favorite subjects which were quite prevalent in the symbolist traditions of both Belgium and France. By looking at Khnopff's paintings, I endeavor to situate his Symbolism in the context of the development of Belgian modernity and cultural nationalism. Second, my analysis of Khnopff creates a new overview of Symbolism in Europe, especially in Belgium. In the absence of socio-political integration, the Symbolist painter adds nostalgic meaning to the landscape of Bruges. The scene of Bruges illuminates the social atmosphere in Belgium at that time. Since Belgium became an independent country, it tried to differentiate its own cultural and national identity from France. There was a powerful social movement for Belgium to claim its own identity, language, and culture. Bruges was, for Symbolists, the epitome of Belgium's past glory. This encouraged the formation of Belgian nationalism centering on Brussels, as I demonstrate in Khnopff's Bruges-la-Morte(1892). The relationship between Symbolist artist and writers is crucial for understanding this development. Khnopff, for instance, illustrated or provided frontispieces for many Symbolist writers such as Rodenbach, Peladan, Spencer and Le Roy. Khnopff did not objectify the exact meaning, but rather provided his own subjective interpretation. In this respect, I Lock My Door, inspired by Rossetti, started from the same motif, but Khnopff seeked escape into silence and death while Rossetti searched for Christian salvation. Finally my paper deals with the social context in which Khnopff worked. He was a founding member of Les XX in 1883 and later La Libre Esthethetique he also participated in the exhibition of le Salon de la Rose + Croix. Les XX was not a particular school of art and did not have a uniform manifesto, but its exhibitions focused on decorative arts by encompassing art for all people via common, everyday objects. The Periodical, L'art moderne was founded to support this ideal by Edmond Picard and Maux. Les XX declared art as independent art, detached from all official connections. Khnopff designed the 1890 catalogue cover of Les XX and the 1891 cover. These designs show decorative element of Art Nouveau in an early example of "modern poster." Les XX pursued all art including graphic arts, prints, placard, posters and book illustrations and design. These forms of art were l'art social and this movement was formed by the social atmosphere in Belgium in terms of social reforms and strikes by working class. Khnopff designed the book cover for la Maison du Peuple. The artist, however, did not share the ideal egalitarianism of the working class to a certain degree, while he was working in his villa he designed under the ideal motto, "on n'a pas que," he expressed the nihilistic emotions toward society by the theme of interiority such as solitude, silence, narcissism, introspection, and introversion. In the middle of his Symbolism, we find the "cultural nostalgia" or longing that the artist develops in the I Lock My Door upon Myself. Khnopff's longing toward the lost city of "Bruges" form the crux of his "Social Symbolism."

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스키마 관점에서 살펴본 인터넷 쇼핑몰 선택에 대한 소비자행동의 이해: Bricks & Clicks와 Pure-Player 인터넷 쇼핑몰 비교를 중심으로 (Empirical Analysis of Consumer Behavior on the Internet Shopping Mall Choice from the Schema Perspective: Comparison Between Bricks & Clicks and Pure-Player Shopping Mall)

  • 정남호;이건창
    • Asia pacific journal of information systems
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    • 제17권4호
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    • pp.165-186
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    • 2007
  • With the advent of a wide variety of Internet shopping malls, consumers can choose a best appealing shopping mall from among the Bricks-and-Clicks and Pure-Player malls. Pure-Players launched their operation grandiosely with the early stage of Internet use in 1995. However, after the burst of Dot-com company bubbles in 1997, Pure-Players introduce various types of business models to meet potential needs of consumers. While Pure-Players suffer skeptical views from market analysts as well as consumers, traditional offline companies learned important lessons from Dot-com companies collapse phenomena, and expanded their business channels into online in the name of Bricks-and-Clicks. Nowadays, Bricks-and-Clicks successfully establish in the market as one of reliable business partners among consumers. Therefore, it is no surprise that recent competitions between Bricks-and Clicks and Pure-Players become fiercer than ever to attract potential customers to their websites. In this situation, consumers can choose a shopping mall to their best satisfaction. Consumers can enjoy both offline and online options for shopping because Bricks-and Clicks provide both offline and online channels to consumers, which is compared with Pure-Players offering only online channel. Offline channel is unique in providing consumers with chances to touch and feel target products and services. Meanwhile, online channel is considered very viable and convenient shopping options for consumers. In this respect, it is easily assumed that consumers will show different online shopping behavior when they have to choose either Bricks-and-Clicks mall or Pure-Player mall for the sake of shopping. Remaining research issue in this case is how much consumers' schema would influence online shopping behavior between Bricks-and-Clicks and Pure-Players. Basically, schema is a framework for synthetic information recognition that individual consumers have and is very characteristic in that it focuses not on fragmentary facts but on the combination of various causes affecting results. Consumers' schema is closely represented by trust, structural assurance, and perceived relative advantage towards a specific type of shopping mall. In literature, there exist a lot of studies comparing Bricks-and-Clicks and Pure-Players. However, there is no study to pursue the analysis of consumer behaviors comparing Bricks-and Clicks and Pure-Players from the schema perspective. Therefore, this study aims to investigate this research gap. Empirical analysis is adopted by garnering valid questionnaires from 514 Internet shopping mall users. 237 were mainly using Bricks-and-Clicks for shopping, while 277 were found to visit Pure-Players for shopping. PLS was applied to analyze the survey data to verify the proposed research hypotheses. Findings from the empirical test results are as follows. First, consumers perceive more trust and relative advantage in Pure-Players, comparing with Bricks-and-Clicks. This result is against widely-accepted perception that Bricks-and-Clicks would be perceived by consumers as more trustworthy and relatively advantageous because they have offline reputation and stores. Therefore, it becomes more obvious that Internet is becoming daily necessaries, and consumers increasingly feel very comfortable in using the Internet for their own personal purposes. Second, consumers have firm faith in transaction safety, regardless Bricks-and-Clicks and Pure-Players. This seems due to the fact that most of shopping malls showing dubious transaction safety have no place in the market. In a nutshell, empirical results tell us that Pure-Players will grow very much in the future, to the extent that consumers perceive no difference in comparison with Bricks-and-Clicks. Besides, consumers' schema accumulated through trust and perceived relative advantage plays crucial role in determining consumer behavior.

악성 골 종양의 초기 증상 (Initial Symptoms of Malignant Bone Tumors)

  • 오주한;이상훈;서성욱;이호규;김한수
    • 대한골관절종양학회지
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    • 제9권1호
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    • pp.18-23
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    • 2003
  • 목적: 골 육종, 연골 육종은 흔한 질환이 아니므로, 일차 진료 현장에서 명확한 진단이 신속히 이루어지지 않고, 진단의 지연이나 오진으로 인해 문제를 야기할 수 있다. 따라서, 상기 질환에 대한 초기 증상과 임상적 특징을 조사하여 이를 확인하고, 조기 진단에 도움을 주고자한다. 대상 및 방법: 본원에서 진단된 골 육종이나 연골 육종 환자로, 기록 검토와 설문지 조사가 가능한 139명을 대상으로 하였다. 골 육종 환자가 108명, 연골 육종이 31명이었고, 남자가 86명, 여자가 53명이었으며, 평균 연령은 골 육종이 20.2세, 연골 육종이 42.4세이었다. 결과: 병원을 방문하게 된 초기 증상은 두 질병 군 모두에서 동통이 가장 많았는데, 골 육종은 101명(93.5%), 연골 육종은 19명(61.3%)이었다. 이들 중 골 육종의 49명(48.5%), 연골 육종의 1명(5.3%)에서 통증이 외상과 관련되어 시작되었으며, 야간 동통이 골 육종의 77명(76.2%), 연골 육종의 11명(57.8%)에서 있었다. 처음 방문한 진료 기관에서 악성 골 종양으로 진단된 경우는 골 육종에서는 66명(61.1%), 연골 육종에서 20명(64.5%)이었고, 오진된 경우는 골 육종에서는 골절로 본 경우가 18명(16.7%)으로 가장 많았으며, 연골 육종에서는 골 감염으로 본 경우가 6명(19.4%)으로 가장 많았다. 초진 시에 방사선 촬영을 시행한 경우 골 육종과 연골 육종 모두에서 진단율이 유의하게 높았고(p=0.009, p=0.014), 성인 군에서의 진단율이 높았다(p=0.037). 연골 육종에서 골 육종보다 환자와 의사에 의한 지연이 모두 길었다. 진단의 의사 지연을 길게 하는 요소로는 초진 시에 단순 방사선 사진을 촬영하지 않는 것과 골반 등 축성골에 종양이 위치하는 것이었고, 외상과 미성년 환자는 진단의 환자 지연을 단축시킬 수 있는 요소로 파악되었다. 결론: 악성 골 종양의 조기 진단을 위해서는 외상이나 야간 동통 등의 병력 청취를 소홀히 하지 않아야 할 것이며, 초진시의 단순 방사선 촬영과 주기적인 경과 관찰 및 방사선 사진의 비교 등으로 조기 진단의 정확성에 힘써야 할 것이다.

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성장호르몬 자극검사가 정상인 성장 장애 소아 환자에게서 성장호르몬 투여에 따른 성장속도의 변화 (Growth responses to growth hormone therapy in children with attenuated growth who showed normal growth hormone response to stimulation tests)

  • 김재현;정혜림;이영아;이선희;김지현;신충호;양세원
    • Clinical and Experimental Pediatrics
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    • 제52권8호
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    • pp.922-929
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    • 2009
  • 목 적 : 성장 장애는 영아 및 소아에서 성장 속도가 같은 성별, 연령 보다 현저히 작은 경우를 지칭하며 여러 가지 원인에 의해서 발생할 수 있다. 저신장을 주소로 내원한 환자 중 성장 장애를 보이지만 성장호르몬 자극검사가 정상인 환자들의 임상적 특성 및 성장호르몬 치료에 대한 반응을 알아보고자 하였다. 방 법 : 1990년 1월부터 2008년 6월까지 서울대학교 어린이병원 소아청소년과에 내원한 어린이 중에서 성장속도가 연간 4 cm 미만이면서, 2가지 서로 다른 약제로 성장호르몬 자극검사를 시행하였을 때 정상 소견을 보이는 환자를 대상으로 하였다. SGA군과 AGA군으로 나누어 임상적인 특성을 비교하였으며, 성장호르몬 투여군에 대한 분석을 시행하였다. 결 과 : 총 39명의 환자가 연구에 포함되었으며, 남자가 25명(64%), 여자 14명(36%)이었고, SGA군 11명(28%), AGA군 28명(72%), 성장호르몬 투여군 16명(41%), 비 투여군 23명(59%)이었다. SGA군과 AGA군 모두에서 골연령이 역연령에 비하여 지연되어 있었으나(P=0.028), 두 군간의 차이는 없었다. 모든 환자에서 성장호르몬 자극검사 후 성장호르몬의 최고 농도는 10 ng/mL 이상이었고, clonidine을 사용하였을 때 성장호르몬의 최고농도가 30.4 (6.2, 92.0) ng/mL로 다른 약제에 비하여 유의하게 높았다(P=0.03). 성장호르몬 치료받은 환자 16명의 1년간 성장 속도는 7.7 (4.9, 11.1) cm/yr, 치료 받지 않고 추적관찰 된 6명은 3.7 (2.7, 4.5) cm/yr으로 유의한 차이가 있었다(P<0.001). 또한 성장호르몬 투여군에서 치료 1년 동안 신장 SDS는 0.3 (-0.1, 0.9) 증가하였고(P<0.001), 성장 속도의 변화는 4.8 (2.1, 7.7) cm/yr로 의미있게 증가하였다(P<0.001). 성장호르몬으로 치료받은 환자 중, 치료 후 1년간 성장속도는 SGA군에서 7.1 (5.1, 8.5) cm/yr, AGA군에서 8.2 (4.9, 11.1) cm/yr로 두 군 모두에서 성장호르몬 사용 전 1년 간의 성장 속도보다는 유의하게 증가하였다. 성장호르몬 치료를 시작할 때의 신장의 SDS가 -3 이상인 군과 -3 미만인 군으로 나누어 분석해 보았을 때, 성장호르몬 자극검사시의 IGF-I 농도가 SDS가 -3 미만인 군에서 유의하게 낮게 측정되었다(P=0.023). 결 론 : 성장 속도가 연간 4 cm 미만으로 감소하였으나 성장호르몬 자극검사가 정상인 환자들이 단기간의 성장호르몬 투여로 성장 속도의 증가가 있었으나 이들에서의 장기적인 성장호르몬 효과에 대하여는 향후 더 추적관찰이 필요하다. 또한 이들에서 부분적 인 성장호르몬 저항성 증후군의 가능성이 있으므로, 추후 이러한 환자들을 대상으로 IGF-I 생성 검사를 포함한, GH-IGF-I 축에 대한 검사를 시행하여 성장 장애의 원인을 밝혀야 할 것이다.

Alport 증후군의 예후와 관련된 위험요인 분석 (Risk Factor's Affecting long-term Outcome of Alport syndrome)

  • 변지윤;백승연;이영목;김지홍;이재승;김병길;홍순원;정현주;김순일;김유선;박기일
    • Childhood Kidney Diseases
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    • 제5권2호
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    • pp.164-175
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    • 2001
  • 목 적 ; Alport 증후군은 1927년 Alport에 의해 처음 보고된 유전성 신질환으로 전신적으로 기저막에 영향을 미쳐 계속적으로 진행하는 신질환과 감각신경성 난청, 눈의 이상, 전자현미경상 특징적 소견, 그리고 대부분의 경우 가족력 동반을 특징으로 한다. 저자들은 Alport 증후군 환아의 임상적 특징을 중심으로 관찰하여 이 질환의 예후에 관련된 위험요인을 알아보고자 후향적 조사를 시행하였다. 대상 및 방법 : 1980년 1월부터 1999년 12월까지 20년동안 소아과에서 시행한 신장조직검사에서 Alport 증후군으로 진단 후 추적관찰이 가능하였던 환아 24명을 대상으로 하였다. 처음 내원 당시와 현재의 신장기능을 비교하여 현재까지 정상의 신장기능을 유지하고 있는 군(Group I)과 만성신부전으로 진행한 군(Group II)으로 나누어 Group I과 Group II간의 여러 가지 임상양상을 비교하였으며 통계학적 방법으로는 비모수검정법을 이용하였다. 결 과 : 24명의 환아 중 남녀의 비는 3:1이였고 신증상 발현시의 연령은 평균 $5.2{\pm}3.6세$였으며 내원 당시 나이는 평균 $7.8{\pm}4.4세$였다. 처음 내원 당시의 주증상은 육안적 혈뇨가 15예($62\%$)로 가장 많았고, 진단 당시의 환아들의 임상양상으로는 가족력이 있는 경우가 17예($70\%$), 육안적 혈뇨는 18예($75\%$), 단백뇨가 있었던 경우가 14예($58\%$), 부종은 14예($58\%$), 고혈압은 6예($25\%$)에서 관찰되었다. 전체 24명의 환아 중 만성신부전으로 진행된 경우는 11예($46\%$)였고, 이 중 말기신부전으로 진행되어 신장이식 후 관찰 중인 경우가 7예($29\%$) 있었다. 청각이상소견을 보인 경우는 12예($50\%$)였으며, 안과적 정밀검사상 이상소견을 보인 경우는 5예($21\%$)였다. 신증상 발현이후 계속해서 신장기능이 유지되고 있는 집단을 Group I(n=13), 만성신부전으로 진행한 집단을 Group II(n=11)라고 할 때, 이 두 집단 사이의 진단당시의 임상양상의 차이를 보면 고혈압, 단백뇨 및 부종의 빈도가 Group I에서 통계적으로 유의하게 증가되어 있으며, 임상병리검사 소견에서는 혈중 총단백량, 알부민, creatinine 청소율이 Group I에서 통계적으로 유의하게 감소되어 있고, BUN, creatinine은 통계적으로 유의하게 증가되었다. 결 론 : Alport 증후군 환아에서 임상적으로 유의미한 예후와 관련된 위험요인으로는 진단시의 고혈압, 부종, 단백뇨 유무 여부와 혈중 총단백량, 알부민, BUN, creatinine, 사구체 여과율이 중요하며, 이런 가능한 위험요인의 분석과 관찰이 Alport 증후군 환아의 치료와 예후 인지에 많은 도움이 되리라 사료된다.

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