• 가정간호학회지
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• 제10권1호
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• pp.58-72
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• 2003

The purpose of this study was to describe the perceived burden of the terminally III patients's caregiver and to analyze relationship between the perceived burden and the various demographics, illness characteristics, family relationships, and economic factor of the family & patients. The sample of 132 caregivers who care for the terminally III patients Kyung-Gi province, Seoul, Korea. The period of this study was from August to September, 2002. The perceived burden of the family caregiver was measured by the burden scale(20 items, 4 point scale) developed by Montgomery et al. (1985). The Data was analyzed using SAS-program by t-test and ANOVA. The results were as follows; 1. The mean of the family caregiver's burden score was 3.02. The score showed that caregivers perceive severe the level of burden. The hight items of the family caregiver's burden were' I feel it is painful to watch patient's diseases'(3.77). 'I feel afraid for what the future holds for my patients'(3.66), 'I feel it reduced to amount of privacy time'(3.64). 2. The caregiver's burden was significantly related to patient's gender(F=3.17, p= 0.0020), patient's job(F=2.49, p=0.0476), caregiver's age(F=4.29, p=0.0030), and caregiver's job(F=2.49, p=0.0476). 3. The caregiver's burden according to illness characteristics showed no significant difference. 4. The caregiver's burden was significantly associated with patient's family relationship (F=4.05, p=0.0041), patient's care mean period in a day(F=47.18,

• 생물환경조절학회지
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• 제22권2호
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• pp.146-153
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• 2013

토마토 접목순화장치 개발을 위한 기초실험의 일환으로 대목의 종류 및 활착실내의 온습도가 접목활착율에 미치는 영향을 조사하였다. 접목활착실의 온도는 $23^{\circ}C>17^{\circ}C>20^{\circ}C>26^{\circ}C$ 순으로 초기 활착율과 최종활착율이 높은 것으로 조사 되었으며, 상대습도는 높을수록 활착율은 양호한 결과를 나타냈다. 단 상대습도가 90% 이상 처리구에서는 곰팡이병에 의한 이병주 발생도 같이 증가하는 경향을 나타냈다. 대목의 종류에 따른 초기활착율은 'Kanbarune'의 $26({\pm}1)^{\circ}C$와 'Solution'의 $20({\pm}1)^{\circ}C$를 제외하고는 대목의 종류와 관계없이 모든 온도 처리구에서 83% 이상 양호한 활착율을 보였으나, 최종 활착율에서는 처리 온도간에 뚜렷한 유의적 차이를 나타내, $23({\pm}1)^{\circ}C$에서만 대목의 종류와 관계없이 85%에서 90%전후의 활착율을 보였고, $20({\pm}1)$와 $26({\pm}1)^{\circ}C$에서는 65~75% 정도로 활착율이 저하되었다. 특히, $27({\pm}1)^{\circ}C$에서는 이병주의 증가로 건묘생산율은 모든 대목처리구에서 65% 이하였다. 일반적으로 알려져 있는 고온기 접목활착 최적온도인 $23({\pm}1)^{\circ}C$에서는 대목의 종류에 따른 건묘생산율은 84~88% 전후로 대목 품종간 유의적 차이는 없었다. 접목활착실내 상대습도 조건에 따른 최종 접목활착율은 초기 2~3일간은 상대습도를 90%로 유지하고 나머지 7~8일간은 75% 정도로 유지하는 처리구에서 100% 접목활착 성공율을 나타냈고, 전기간 90%로 유지한 처리구와 1일 90%, 9일간은 75%로 유지한 처리구에서는 90%전후의 성공률을 나타냈다. 전반적으로 높은 상대습도 유지기간이 길수록 초기 활착율은 증가하는 경향을 보였으나, 고습도에서 장기간 묘를 양생할 경우, 곰팡이병 발생 등으로 최종 건묘생산율은 감소하므로, 초기 2~3일간만 90% 전후로 유지하고 나머지 구간은 75% 전후로 유지하는 것이 고온기 토마토 접목 활착율 향상을 위한 바람직한 조건이라 판단되었다. 각 처리간 묘소질에는 큰 차이를 나타내지 않았으나, 전반적으로 활착율이 양호했던 처리구에서 묘소질이 타 처리구에 비해 상대적으로 좋았으며, 이러한 경향은 특히 근권부의 형태적 특성을 조사한 결과에서 명료하게 나타났다. 이상의 결과 고온기 토마토 활착실내의 환경관리는 23도 전후의 온도에서 $80({\pm}5)%$의 상대습도로 관리하는 것이 건묘생산에 적합할 것으로 판단되었다.

• 한국수산과학회지
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• 제29권5호
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• pp.689-700
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• 1996

1992년 국민총생산의 $1.85\%$를 차지하는 한국수산업을 자연환경과 경제활동을 하나의 시스템에서 동일한 가치 척도인 태양에너지로 나타내는 EMERGY 분석을 이용하여 자연환경의 기여도와 EMERGY지표를 작성하였다. 한국수산업의 전체 EMERGY유입량은 $634.64\times10^{20}\;sej/yr$이고, 이중 태양에너지는 전체 EMERGY의 $2.54\%$, 바람은 $1.21\%$, 비는 $23.55\%$, 조석은 $7.67\%$, 파도는 $9.77\%$, 하천은 $26.27\%$, 연료 $6.17\%$, 원양어획물은 $16.19\%$, 수입수산물은 $5.19\%$ 그리고 재화와 용역은 $1.44\%$를 나타내고 있었다. 자연환경 에너지원과 경제적인 에너지원의 점유율은 전체 수산업의 경우 $66\%,\;34\%$, 일반해면어업의 경우 $92\%,\;8\%$로 자연환경의 의존도가 높은 구조적인 특성을 잘 반영하고 있으며, 천해양식업의 경우 $44\%,\;56\%$을 차지하고 있어 일반해면어업과는 대조적으로 경제활동에 의존도가 높은 산업적 특성을 나타내고 있다. Net EMERGY yield ratio의 평가에서 전체 수산업, 일반해면어업, 천해양식업의 경우, 각각 2.98, 11.85, 1.78의 값을 나타내고 있어 한국의 일반해면어업의 경우는 뉴우질랜드 트롤어업의 자원으로서의 가치 보다는 적으나 1986년, 1987년도 시가로 원유와 석탄에 준하는 자원으로서의 가치를 나타내고 있었다. EMERGY investment ratio는 0.50, 0.09, 1.28로 나타나 바다라는 자연환경을 대상으로 하는 1차 산업의 특성때문에, 자연환경에 대한 경제적인 개발과 투자가 다른 시스템 (선진 공업국, 육상의 대도시)에 비해 적게 이루어지고 있음을 나타냈다. EMERGY exchange ratio로 전체 수산업, 일반해면어업, 천해양식업의 생산물을 평가하면 각각 6.93, 10.63, 1.25로, 소비자의 측면에서 보면 수산물에 내재된 자연환경 활동의 가치는 제대로 지불하지 않은 채로 인간의 경제활동에 대한 가치만 화폐로 지불하여 소비함으로 6.93, 10.63, 1.25배 만큼의 EMERGY 이득을 보고 있음을 나타났다. EMERGY 분석을 통한 한국수산업의 거시경제적인 가치 (Macroeconomic value)와 시장경제에 의한 평가사이에는 전체 수산업, 일반해면어업, 천해양식업의 경우 각각 6.98, 10.69, 1.25배의 가치 평가에 있어서 차이를 보이고 있었다.

• 무역상무연구
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• 제31권
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• pp.27-56
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• 2006

Today's financial institutions usually take environmental issues seriously into consideration as they could not evade lender liability in an increasing number of cases. On the international scene, a brand-new concept of the "Equator Principles" in the New Millenium has driven more and more international banks to adopt these Principles in project financing. Sustainable development has been a key word in understanding new trends of the governments, financial institutions, corporations and civic groups in the 21st century. The Equator Principles are a set of voluntary environmental and social guidelines for sustainable finance. These Principles commit bank officers to avoid financial support to projects that fail to meet these guidelines. The Principles were conceived in 2002 on an initiative of the International Finance Corporation(IFC), and launched in June 2003. Since then, dozens of major banks, accounting for up to 80 percent of project loan market, have adopted the Principles. Accordingly, the Principles have become the de facto standard for all banks and investors on how to deal with potential social and environmental issues of projects to be financed. Compliance with the Equator Principles facilitates for endorsing banks to participate in the syndicated loan and help them to manage the risks associated with large-scale projects. The Equator Principles call for financial institutions to provide loans to projects under the following circumstances: - The risk of the project is categorized in accordance with internal guidelines based upon the environmental and social screening criteria of the IFC. - For Category A and B projects, borrowers or sponsors are required to conduct a Social and Environmental Assessment, the preparation of which must meet certain requirements and satisfactorily address key social and environmental issues. - The Social and Environmental Assessment report should address baseline social and environmental conditions, requirements under host country laws and regulations, sustainable development, and, as appropriate, IFC's Environmental, Health and Safety Guidelines, etc. - Based on the Social and Environmental Assessment, Equator banks then make agreements with borrowers on how they mitigate, monitor and manage the risks through a Social and Environmental Management System. Compliance with the plan is included in the covenant clause of loan agreements. If the borrower doesn't comply with the agreed terms, the bank will take corrective actions. The Equator Principles are not a mere declaration of cautious banks but a full commitment of lenders. A violation of the Principles in the process of project financing, which led to an unexpected damage to the affected community, would not give rise to any specific legal remedies other than ordinary lawsuits. So it is more effective for banks to ensure consistent implementation of the Principles and to have them take responsible measures to solve social and environmental issues. Public interests have recently mounted up with respect to environmental issues on the occasion of the Supreme Court's decision (2006Du330) on the fiercely debated reclamation project at Saemangeum. The majority Justices said that the expected environmental damages like probable pollution of water and soil were not believed so serious and that the Administration should continue to implement the project seeking ways to make it more environment friendly. In this case, though the Category A Saemangeum Project was carried out by a government agency, the Supreme Court behaved itself as a signal giver to approve or stop the environment-related project like an Equator bank in project financing. At present, there is no Equator bank in Korea in contrast to three big banks in Japan. Also Korean contractors, which are aggressively bidding for Category A-type projects in South East Asia and Mideast, might find themselves in a disadvantageous position because they are generally ignorant of the environmental assessment associated with project financing. In this regard, Korean banks and overseas project contractors should care for the revised Equator Principles and the latest developments in project financing more seriously. It's because its scope has expanded to the capital cost of US$10 million or more across all industry sectors regardless of developing countries or not. It should be noted that, for a Korean bank, being an Equator bank is more or less burdensome in a short-term period, but it must be conducive to minimizing risks and building up good reputation in the long run.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제27권5호
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• pp.403-414
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• 2005

The purpose of this study was to identify the effectiveness of the modified distraction osteogenesis (DO) method with the concept of overdistraction and compression stimulation which have been previously suggested by the authors in 2002 and to explore the optimal distraction-compression ratio and appropriate latency period for the compression force application during consolidation. The experimental specimens were assessed with radiography, histologic findings, and dual energy x-ray absorptiometry (DEXA) after the conventional DO method and the modified DO technique had been applied on rat mandibles. Total 60 rats were used for the study. In experimental group of 54 adult rats, mandibular osteotomies between the first and second molar areas were performed and customized external distractors were applied. The surgeries on 6 rats of control group also were done with same osteotomy technique and DO device application. Final amount of distraction was set-up as 2 mm on both groups. But, in a experimental group of 54 rats, distraction osteogenesis with a compression force were performed with the different distraction-compression ratio and variant latency periods for compression. The three ratio-subgroups were made as distraction 4 mm group with compression 2 mm, distraction 3 mm group with compression 1 mm, and distraction 2.5 mm group with compression 0.5 mm. In addition, The three subgroups with 3, 7, 11 days latency period prior compression were allocated on each ratio-subgroups. Total 9 subgroups consisted of 6 rats on each subgroup. In control group of 6 rats, conventional distraction technique were routinely performed. The rats of control groups were sacrificed on postoperative 3, 6 weeks after 2 mm distraction. The rats in the experimental groups also were sacrificed on the same euthanasia days of control groups to compare the wound healing. Final available specimens were 55 rats except 5 due to osteomyelitis, device dislodgement. Distraction-compression combined group on 6 weeks generally had showed increased bone mineral density than the same period group of conventional distraction technique on the DEXA study. More matured lamellar bone state and extended trabecular pattern in the combined group than those of control group were also observed in the histologic findings on 6 weeks. In the distraction-compression combined groups, the bone density of 2.5 mm distraction subgroups with 0.5 mm compression showed the highest value on the DEXA study among various force ratio groups. In the distraction-compression combined groups, the bone density of 3 day latency period subgroups showed the highest value on the DEXA study among various latency period groups for the compression application. From this study, we could deduce that 1/5 force ratio for the compression versus distraction, 3 day latency period prior compression application would be the most effective condition if modified distraction osteogenesis technique might be applicable. The modified DO method with a compression force may improve the quality of bone regenerate and shorten total treatment period in comparison with conventional DO technique clinically.

• Journal of Periodontal and Implant Science
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• 제27권4호
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• pp.867-882
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• 1997

Safflower(Carthamus tinctorius $Linn\acute{e}$ has been traditionally used for the treatment of blood stasis, and Dipsasi Radix has been used as a drug for fracture in Chinese medicine. The purpose of present study was to examine the biologic effects of safflower extract and Disasi radix extracts on the periodontal. ligament cells and osteoblastic cells and on the wound healing of rat calvarial defect. The ethanolic extract of safflower blossom, safflower seed and Dipsasi Radix(125, 250, and 500 ${\mu}g/ml$) were prepared as test group, and PDGF-BB(lOng/ml) and unsafonifiable fraction of Zea Mays L.(125, 250, and 500 ${\mu}g/ml$) were employed as positive control. The effects of each agents on the growth and survival, ALPase activity, expression of PDGF-BB receptor, chemotactic response of PDL cell and ATCC human osteosarcoma MG63 cells in vitro were examined. The tissue regenerative effect of each extracts was evaluated by histomorphometric measuring of newly formed bone on the 8mm defect in rat calvaria after oral administration of 3 different dosages groups : 0.02, 0.1 and 0.35g/kg, per day. It was also employed the same dosages of unsaponifiable fraction of Zea Mays L. as positive controls. Safflower blossom extract, safflower seed extract, and Dipsasi Radix extract stimulate the cellular activity of MG63 cells in concentration range of $125-500{\mu}g/ml$, and safflower bolssom extract and safflower seed extract stimulate also the cellular activity of periodontal ligament cells in concentration range of $250-500{\mu}g/ml$. In activity of ALPase, $250-500{\mu}g/ml$ of safflower blossom extracts showed significant stimulating effects on MG63 cells, and the same concentration range of safflower seed extracts showed significant effect on periodontal ligament cells. In the recovery on PDGF-BB receptor expression which was depressed by $IL-1{\beta}$, $125-250{\mu}g/ml$ of safflower blossom extracts and $250-500{\mu}g/ml$ of safflower seed extracts showed significant increasing effect on MG63 cells, and $500{\mu}g/ml$ of safflower blossom extract and $250-500{\mu}g/ml$ of safflower seed extracts showed significant effect on periodontal ligament cells. In chemotactic response, among all tested group, safflower seed extracts only were chemotactic to MG63 cells and periodontal ligament cells in concentration range of $125-500{\mu}g/ml$. Also in the view of bone regeneration in rat calvarial defect model, the only group that was orally administrated 0.35g/kg, day of safflower seed extract showed significant new bone formation. These results suggested that safflower extracts might have a potential possibilities as an useful drug for adjunct to treatment for regeneration of periodontal defect.

• Journal of Korean Neurosurgical Society
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• 제30권9호
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• pp.1094-1102
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• 2001

Objective : During the trans-condylar or trans-jugular approach for the lesion of cranio-cervical junction(CCJ), its necessary to identify the accurate locations of vertebral artery(VA), internal jugular vein(IJV) and its related lower cranial nerves. These neurovascular structures can also be damaged during the operation for vascular tumor or traumatic aneurysm around extra-jugular foramen, because of their changed locations. To reduce the neurovascular injury at the operation for CCJ, morphometric relationship of its surrounding neurovascular structures based on the tip of the transverse process of atlas(C1 TP), were studied. Materials & Methods : Using 10 adult formalin fixed cadavers, tip of mastoid process(MT) and TPs of atlas and axis were exposed bilaterally after removal of occipital and posterior neck muscles. Using standard caliper, the distances were measured from the C1 TP to the following structures : 1) exit point of VA from C1 transverse foramen, 2) branching point of muscular artery from VA, 3) entry point of VA into posterior atlanto-occipital membrane(AOM), 4) branching point of C-1 nerve. In addition, the distances were measured from the mid-portion of the posterior arch of atlas to the entry point of the VA into AOM and to the exit point of the VA from C1 transverse foramen. After removal of the ventrolateral neck muscles, neurovascular structures were exposed in the extra-jugular foraminal region. Distances were then measured from the C1 TP to the following structures : 1) just extra-jugular foraminal IJV and lower cranial nerves, 2) MT and branching point of facial nerve in parotid gland. In addition, distance between MT and branching point of facial nerve was measured. Results : The VA was located at the mean distance of 12mm(range, 10.5-14mm) from the C1 transverse foramen and entered into the AOM at the mean distance of 24mm(range, 22.8-24.4mm) from the C1 TP. The mean distance from the mid portion of the C1 posterior arch was 20.6mm(range, 19.1-22.3mm) to the entry point of the VA into AOM and 38.4mm(range, 34-42.4mm) to the exit point of the VA from C1 transverse foramen. Muscular artery branched away from the posterior aspect of the transverse portion of VA below the occipital condyle at the mean distance of 22.3mm(range, 15.3-27.5mm) from the C1 TP. The C-1 nerve was identified in all specimens and ran downward through the ventroinferior surface of the transverse segment of VA and branched at the mean distance of 20mm(range, 17.7-20.3mm) from the C1 TP. The IJV was located at the mean distance of 6.7mm(range, 1-13.4mm) ventromedially from the lateral surface of the C1 TP. The XI cranial nerve ran downward on the lateral surface of the IJV at the mean distance of 5mm(range, 3-7.5mm) from the C1 TP. Both IX and X cranial nerves were located in the soft tissue between the medial aspect of the internal carotid artery(ICA) and the medial aspect of the IJV at the mean distance of 15.3mm(range, 13-24mm) and 13.7mm(range, 11-15.4mm) from the C1 TP, respectively. The IX cranial nerve ran downward ventroinferiorly crossing the lateral aspect of the ICA. The X cranial nerve ran downward posteroinferior to the IX cranial nerve and descended posterior to the ICA. The XII cranial nerve was located between the posteroinferior aspect of the IX cranial nerve and the posterior aspect of the ICA at the mean distance of 13.3mm(range, 9-15mm) ventromedially from the C1 TP. The distance between MT and C1 TP was 17.4mm(range, 12.5-23.9mm). The VII cranial nerve branched at the mean distance of 10.2mm(range, 6.8-15.3mm) ventromedially from the MT and at the mean distance of 17.3mm(range, 13-21mm) anterosuperiorly from the C1 TP. Conclusion : This study facilitates an understanding of the microsurgical anatomy of CCJ and may help to reduce the neurovascular injury at the surgery around CCJ.

• Journal of Korean Neurosurgical Society
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• 제46권4호
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• pp.370-377
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• 2009

Objective : There is no definite adjustment protocol for patients shunted with programmable valves. Therefore, we attempted to find an appropriate method to adjust the valve, initial valve-opening pressure, adjustment scale, adjustment time interval, and final valve-opening pressure of a programmable valve. Methods : Seventy patients with hydrocephalus of various etiologies were shunted with programmable shunting devices (Micro Valve with $RICKHAM^{(R)}$ Reservoir). The most common initial diseases were subarachnoid hemorrhage (SAH) and head trauma. Sixty-six patients had a communicating type of hydrocephalus, and 4 had an obstructive type of hydrocephalus. Fifty-one patients had normal pressure-type hydrocephalus and 19 patients had high pressure-type hydrocephalus. We set the initial valve pressure to $10-30\;mmH_2O$, which is lower than the preoperative lumbar tapping pressure or the intraoperative ventricular tapping pressure, conducted brain computerized tomographic (CT) scans every 2 to 3 weeks, correlated results with clinical symptoms, and reset valve-opening pressures. Results : Initial valve-opening pressures varied from 30 to $180\;mmH_2O$ (mean, $102{\pm}27.5\;mmH_2O$). In high pressure-type hydrocephalus patients, we have set the initial valve-opening pressure from 100 to $180\;mmH_2O$. We decreased the valve-opening pressure $20-30\;mmH_2O$ at every 2- or 3-week interval, until hydrocephalus-related symptoms improved and the size of the ventricle was normalized. There were 154 adjustments in 81 operations (mean, 1.9 times). In 19 high pressure-type patients, final valve-opening pressures were $30-160\;mmH_2O$, and 16 (84%) patients' symptoms had nearly improved completely. However, in 51 normal pressure-type patients, only 31 (61%) had improved. Surprisingly, in 22 of the 31 normal pressure-type improved patients, final valve-opening pressures were $30\;mmH_2O$ (16 patients) and $40\;mmH_2O$ (6 patients). Furthermore, when final valve-opening pressures were adjusted to $30\;mmH_2O$, 14 patients symptom was improved just at the point. There were 18 (22%) major complications : 7 subdural hygroma, 6 shunt obstructions, and 5 shunt infections. Conclusion : In normal pressure-type hydrocephalus, most patients improved when the final valve-opening pressure was $30\;mmH_2O$. We suggest that all normal pressure-type hydrocephalus patients be shunted with programmable valves, and their initial valve-opening pressures set to $10-30\;mmH_2O$ below their preoperative cerebrospinal fluid (CSF) pressures. If final valve-opening pressures are lowered in 20 or $30\;mmH_2O$ scale at 2- or 3-week intervals, reaching a final pressure of $30\;mmH_2O$, we believe that there is a low risk of overdrainage syndromes.

• Journal of Nutrition and Health
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• 제47권1호
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• pp.33-44
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• 2014

본 연구는 서울특별시에 소재한 한양대학교병원에서 혈액투석을 시행중인 만성 콩팥병 환자를 대상으로 일상식품군의 섭취량과 혈청 인, 칼륨 농도와의 상관관계를 살펴봄으로써 혈액투석 중의 합병증 예방 및 관리에 필요한 기초자료를 제공하고자 하였다. 1) 본 연구 대상자는 총 48명 (남: 20명, 여: 28명)으로 평균 혈청 인 농도는 $4.50{\pm}1.52mg/dl$, 평균 혈청 칼륨 농도는 $4.74{\pm}0.73mEq/l$였다. 전체 대상자 중 고인산혈증을 보인 환자는 45.8%, 고칼륨혈증을 보인 환자는 35.4%였다. 2) 식이요법 실천율은 남자가 여자보다 유의하게 높았고, 대상자 중 약물치료만 시행하는 군보다 약물치료에 식이요법을 병행하는 군에서 혈청 인 농도가 유의하게 낮았다. 3) 투석기간에 따른 혈청 칼륨 농도는 5년 미만 투석자보다 5년 이상 투석자에서 유의하게 높았다. 4) 백미를 섭취한 군이 잡곡을 섭취하는 군보다 혈청 인, 칼륨 농도가 유의하게 낮았다. 감자와 고구마의 섭취량이 증가할수록 혈청 칼륨 농도가 유의하게 높았으며, 일주일에 3회를 초과하여 섭취한 군의 경우 혈청 칼륨 농도가 정상범위를 넘어섰다. 5) 생선의 섭취량이 증가할수록 혈청 칼륨 농도가 유의하게 높았으며, 특히 일주일에 3회를 초과하여 섭취한 군의 경우 혈청 칼륨농도가 정상범위를 넘어섰다. 콩자반과 두유의 섭취량이 증가할수록 혈청 인 농도가 유의하게 높았으며, 콩자반의 경우 일주일에 1회 이상, 두유의 경우 일주일에 3회 보다 많이 섭취한 군의 경우 혈청 인 농도가 정상범위를 넘어섰다. 6) 채소의 섭취량이 증가할수록 혈청 칼륨 농도가 유의하게 높았으며, 특히 고칼륨 채소의 섭취가 많을수록 혈청 칼륨 농도가 유의하게 더 높았다. 버섯의 섭취량이 증가할수록 혈청 칼륨 농도가 유의하게 높았으며, 일주일에 3회 보다 많이 섭취한 군의 경우 혈청 칼륨 농도가 정상범위를 넘어섰다. 7) 잡곡과 두유의 섭취는 혈청 인 농도와 유의한 양의 상관관계를 보였으며, 투석기간, 잡곡, 감자, 생선, 고칼륨 채소의 섭취는 혈청 칼륨 농도와 양의 상관관계를 보였다. 한편 쌀의 섭취는 혈청 칼륨 농도와 유의한 음의 상관관계를 보였다. 이와 같은 결과를 통하여 혈액투석 환자들의 식이요법 실천은 혈청 인 농도 조절에 긍정적인 효과가 있었으며, 투석기간이 길어질수록 혈청 칼륨 농도가 높아지는 것으로 보아 지속적인 식이요법이 필수적인 것으로 생각된다. 일상식품군의 섭취와 혈청 인, 칼륨 농도와의 상관관계에서 잡곡의 섭취는 혈청 인, 칼륨 농도와 유의한 양의 상관관계를, 백미의 섭취는 혈청 칼륨 농도와 유의한 음의 상관관계를 보여주었다. 이를 통해 잡곡의 섭취를 줄이고 백미를 섭취하는 것이 혈청 인, 칼륨 농도 감소에 긍정적인 효과가 있는 것으로 나타났다. 두유의 섭취는 혈청 인 농도와 유의한 양의 상관관계를 보였으며, 감자 및 생선의 섭취는 혈청 칼륨 농도와 유의한 양의 상관관계를 보였다. 정상 혈청 인, 칼륨 농도의 유지를 위해서는 이들 식품의 1인 1회 섭취 분량을 하루에 0.5회 이하로 나누어 섭취하되, 일주일에 3회를 초과하여 섭취하지 않을 것을 권장한다. 한편 고칼륨 채소의 섭취는 혈청 칼륨 농도와 유의한 양의 상관관계를 보였으며, 다른 채소 섭취에 비해 혈청 칼륨 농도를 정상범위 이상으로 증가시키는 것으로 보아 가급적 섭취를 제한할 것을 권장한다.

• Clinical and Experimental Pediatrics
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• 제50권7호
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• pp.672-677
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• 2007

목 적 : 두통과 간질은 소아기에 흔한 질환이다. 두통 환자에서 간질의 발생이 높고, 간질 환자에서 두통 발생이 높다. 소아 간질 환자에서 동반된 두통과 간질 발작과 동반되는 두통에 대한 보고는 드물다. 실제 임상에서 간질 환자와 의사들은 간질의 치료에 관심을 갖고 있기 때문에, 간질에 동반된 두통의 평가와 치료를 적절히 하지 못하고 있는 실정이다. 이에 저자는 소아청소년 간질 환자에 동반된 두통과 편두통의 빈도, 임상적인 특징과 치료에 대해서 알아보고자 하였다. 방 법 : 조선대학교병원 소아과 간질 클리닉의 초진과 재진 간질 환자 229명(남녀 비 1.1:1.0)을 대상으로 전향적으로 연구 하였다. 평균 나이는 $10.0{\pm}4.1$세(나이 범위 4-17세)이었다. 간질 환자 중 두통 환자는 86명(남녀 비 1.05:1.0)이었고, 평균 나이는 $10.7{\pm}3.6$세이었다. 두통 환자 중 편두통 환자는 64명(남녀 비 1.0:1.0)이었고, 평균 나이는 $10.6{\pm}3.7$세이었다. 대상 환자 모두에게 질문지를 배포하여 환자와 보호자가 상의하여 답하게 하였고, 질문지를 통하여 간질에 동반된 두통과 간질 발작시 두통에 대하여 자세히 조사하였으며, 두통의 심한 정도의 평가는 VAS (visual analogue scale; 0-10; 0, 통증 없음, 10, 가장 심한 통증)를 사용하였다. 두통에 의한 장애는 PedMIDAS를 사용하여 평가하였다. 두통의 분류는 2004년에 개정된 국제 두통 질환분류를 이용하였다. 간질의 분류는 1981년 항간질연맹(ILAE)에서 발표한 분류법을 사용하였다. 결 과 : 소아 간질 환자에서 동반된 두통은 229명 중 86명(37.6%)이었고, 편두통은 64명(27.9%)이었다. 두통의 유형은 편두통이 74.4%로 가장 흔하였으며, 전조 편두통이 48.8%로 가장 높았다. 두통 환자의 한 달 평균 빈도는 $7.2{\pm}8.4$이었고, 평균 지속 시간 $2.2{\pm}4.0$, 평균 심한 정도(VAS) $5.2{\pm}2.2$이었으며, 두통에 의한 장애는 평균 PedMIDAS $13.0{\pm}35.4$이었다. 간질에 동반된 두통은 부분발작의 69.8%(복잡 부분 발작 51.2%, 단순 부분 발작 18.6%)이었고, 전신발작의 30.2%로 두통의 동반은 부분 발작에서 통계학적으로 의미 있게 높았으며(P=0.025), 특히 복합 부분 발작에서 통계학적으로 의미 있게 높았다(P=0.007). 간질에 동반된 편두통은 부분 발작, 특히 복잡 부분 발작에서 높았으나 통계학적인 의미는 없었다. 편두통과 동반된 발작 후 두통은 18.8%이었으며, 발작 전 두통은 17.2%, 발작 중 두통 7.8 %이었다. 간질과 동반된 두통의 치료는 처방전을 받아서 치료하고 있는 경우는 8.1%로 매우 적었으며, 처방전 없이 진통제를 복용하는 경우 59.3%, 약물을 복용하지 않는 경우도 22.1%이었다. 간질과 동반된 두통 환자 중 간질 진단 후에 두통이 발생하는 경우는 66.3%이었고, 초진 환자인 경우보다 재진인 경우에 두통 발생이 더 높았고, 초진인 경우 여자에서 더 높았다. 두통 발생 후에 간질 발작이 있는 경우는 33.7%이었고, 초진 환자인 경우에 재진인 경우보다 두통 발생이 더 높았고, 초진인 경우 남자에서 두통 발생 후 간질 발작이 많았다. 결 론 : 간질에 동반된 두통의 유병률은 일반 소아에서의 두통의 유병률보다 높고, 이 중에서 편두통이 가장 많았다. 이것은 피질의 과흥분이 피질의 확산 억제를 증가시킨다는 점으로 설명되어진다. 간질 환자에 동반된 두통은 간질의 예후에 나쁜 영향을 주기 때문에 임상의들은 간질을 진단하고 치료할 때 두통을 염두에 두고 간질 발작 동안이나 간질 간기의 두통에 대한 질문과 적절한 치료를 하여야 한다. 더 나아가 항경련제 반응으로 각각의 약물에 따른 두통의 빈도, 심한 정도와 지속 시간의 효과를 알아보고자 한다.