• 제목/요약/키워드: Serious loss

검색결과 686건 처리시간 0.029초

공익사업시행(公益事業施行)으로 인한 어업(漁業)의 간접피해(間接被害) 보상액(補償額) 산출방법(算出方法)에 관(關)한 연구(硏究) (A Study on Calculation Method of Compensation for Indirect Damage of Fishery by Undertaking Public Project)

  • 김기대;김병호
    • 수산경영론집
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    • 제37권1호
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    • pp.25-44
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    • 2006
  • Under the provision of Article 63 of the Enforcement Regulation of the Act on Acquisition and Compensation of Land and Others for Public Project that is recently enacted and implemented (hereinafter referred to as the 'Lend Compensation Act') the compensation is required to make 'When the Actual Damage Amount' is confirmed for the damage in fishery affairs that is outside of the public project area. The compensation for fishery business on the indirect damage area has been excluded from the advance compensation subject to conflict with the existing laws on fishery business compensation with the controversy in method, procedure, time and others to confirm the actual damage amount, and it lacks the standard of calculation for detailed compensation on partial damages outside of business implementation area, which caused the ceaseless conflicts and straggles between the project implementation party and the victimized fishermen regarding the calculation method of damages, standard, compensation period and others. In particular, from the numerous problems in damage compensation in fishery on the indirect damage area, the most recent problem emerged is the issue on application method of damage period in calculating the damage compensation amount that the struggle has been deepened with the differences between the project implementation party and the victimized fishermen without the stipulation on the compensation, that caused the difficulties in carrying out the public project and other serious social problems. In this study, the reasonable application method for the damage period and the calculation plan of the damage amount for calculating the damages on fishery industry outside of the public project implementation zone that is not fully specified under the Land Compensation Act, and the indirect damage area is not influenced for the notification of project recognition, and the compensation to undertake with the damage in the fishery industry in project implementation area to have the nature of damage compensation, the right to engage in fishery industry has the perpetual nature of rights, the fishery damage compensation system of Japan also recognizes the perpetual right on fishery industry to calculate the compensation amount, and the compensation for damage amount has been exercised for the period of actual damage occurrence period regardless of remaining effective period for most of fishery permit and license for fishery compensation outside of the project implementation area following the recent various public projects as well as the development process of theory on fishery loss compensation that the calculation of damage amount on the fishery industry outside of the project implementation zone would be prudent to compensate by calculating the applicable damages during the period of actual damages, and by doing so, the 'just compensation' guaranteed under the Constitution may be materialized. Therefore, the calculation of the damages from the implementation of the public project shall consider the actual period of damages and the degree of damage from the public project to calculate by the income capitalization method, however, considering the equitable consideration with the compensation following the cancellation, it shall not exceed the compensation following the termination of the applicable fishery businesses. Furthermore, the calculation method of partial damage amount on the fishery business following the project implementation shall apply, depending on the period of damage occurrence, by (1) the case of calculating the future damage amount at the present time, and (2) calculating the damage from the past to the present time as well as the damage to be incurred later, by selecting the calculation method for damages following the damage occurrence type.

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Bankart 수술 후 발생한 금속 봉합 나사못 합병증의 관절경적 치료 (Arthroscopic Treatment of Metallic Suture Anchor Failures after Bankart Repair)

  • 신상진;정재훈;김성재;유재두
    • 대한관절경학회지
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    • 제10권1호
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    • pp.70-76
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    • 2006
  • 목적: 금속 봉합 나사못을 이용한 견관절 습관성 전방 탈구 수술 후, 여러 원인에 의하여 발생한 금속 봉합 나사 못 돌출 합병증을 보고하고 발생 원인, 임상 양상 및 관절경적 치료에 대하여 알아보고자 하였다. 대상 및 방법: 견관절 습관성 전방 탈구로 봉합 나사못을 이용한 Bankart 수술을 시행 받은 후 운동시 들리는 관절내 마찰음 및 통증 또는 불안정성을 호소하며 내원하여 관절경 재수술을 시행받은 환자 5명을 대상으로 하였다. 처음 수술 이후 재수술까지의 평균 기간은 5.2개월이었다. 환자들은 관절경 재수술시 봉합 나사못의 돌출이 확인되었으며 관절경 술식을 이용하여 돌출 봉합 나사못을 제거하였다. 결과: 주 증상은 4명에서 통증을 동반한 관절내 마찰음이었으며 이 마찰음은 외전 및 외회전시 분명하게 들렸다. 1명은 통증과 함께 견관절 불안정성을 호소하였다. 견관절 운동 범위는 외회전만 약간 감소되었을 뿐 거의 정상 소견을 나타내었다. 돌출되었던 봉합 나사못의 위치는 5시 방향 1명, 4시 방향 2명, 2시 및 3시 방향 각각 1명씩이었다. 그 중 2명은 전방 관절와연에서 5 mm 정도 내측 관절면 위에 위치하였다. 나머지 3명은 올바른 위치에 삽입되어 있었으나 나사못 주변의 연골 마모 및 골소실이 관찰되었다. 재수술시 5명 모두 상완골두에 연골 손상이 발견되었으며 1명은 관절와에도 연골 결손이 동반되었다. 재수술 후 2년째 추시 결과 재탈구나 불안정성을 보이는 환자는 없었으며 통증에 대한 VAS 점수는 수술 전 3.4에서 수술 후 1.2로 감소되었다. Constant 점수는 수술 전 65점에서 수술 후 89점으로 증가하였으며 ASES 점수도 수술 전 67점에서 수술후 88점으로 증가하였다. 결론: 봉합 나사못 합병증으로 인한 증상은 불안정성을 동반하지 않는 경우가 많으며 대부분 재활 운동 시점부터 증상이 나타나지만 정상적인 수술 후 통증과 구분이 어려운 경우가 많다 그러나 돌출된 봉합 나사못은 상완골두 연골의 파괴를 유발하는 심각한 합병증을 초래하므로 봉합 나사못 돌출이 의심되면 관절경을 통하여 관절내의 변화를 관찰하며 돌출된 봉합 나사못을 다시 삽입하거나 제거하여야 한다. 봉합 나사못 제거에 본 수술 방법을 사용하면 용이하게 봉합 나사못 제거가 가능하리라 사료된다.

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류마티스 관절염 환자의 지식, 자기효능감 및 치료이행과의 관계연구 (A study on knowledge, self-efficacy and compliance in Reumatic arthritis Patients)

  • 김순봉
    • 근관절건강학회지
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    • 제5권2호
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    • pp.238-252
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    • 1998
  • Reumatic arthritis is a disease with joint pain being one of the key symptoms. The patient suffers from the pain, stiff sensation and edema due to the inflammation taking Place In one or more joints. Accompanying these problems are fatigue, unusual exhaustion, fever, tachycardia and weakness. Inaddition, joints are often deformed and muscles shrink along with the progress of edema, coupled with depression and psychological instability resulting from the loss of the mobile function and limitations on the daily life. Some patients become fed up with the long and hard flight with the disease and just give up, which aggravates the symptoms. Others come to the hospital only when the conditions have become serious. We need to prevent these and guide the patients in the right direction. Against this backdrop, this study aims to look into the relations between the knowledge on the part of the patients together with their feeling of self-efficacy and the compliance. The results are expected to help the patients improve their life, In addition to providing useful materials for setting up appropriate plan for nursing intervention. The study was conducted by distributing questionnaire to 88 patients selected from the out-patient department of a university hospital in Inchon, from April 6 to 27, 1998. The following tools were used the yardstick of self-efficacy, developed in 1997 by the Society for the Health of Rheumatism Patients, was used for measuring the levels of knowledge and the feeling of self-efficacy. The degree of compliance was measured by the data collected from documents in addition to the results of the analysis of the interviews with the patients. The reliability of the tools was confirmed. In the analysis, the general characteristics were expressed in figures and percentages. The levels of knowledge, feeling of self-efficacy, and compliance were expressed in the average values and standard deviations. The relations among the variables following the general characteristics were analysed by the t-test and one-way ANOVA. The Pearson correction coefficient was used for the analysis of factors. Multiple-loop analysis was used to identify the variables affecting the compliance. The following are the results of this study. 1. Among the 88 patients, 18 were men and the remaining 70 were women, with a ratio 1 : 3.87. Regarding the age groups, 23 were between 50 and 59 years old, with those between 50 and 69 accounting for 51.1% of the total. High school graduates or higher amounted to 58%. Religious patients was 67% or 59 persons. Fifty nine percent were unemployed, and 58.3% (49 persons) had two children or fewer. The period of suffering from rheumatism varied between 2 months and IS years, with 70% less than years. 2. The average figure In relation to the of knowledge was 17.63 points over 30 or 58. 76%, which means a medium level. 3. The average figure of the feeling of self-efficacy was 60.06 points. 4. The level of compliance was 3.26, which was above average. 5. The relation between the feeling of self-efficacy and compliance showed an "r" value of 0.37, which was significant. It means that the higher the feeling, the greater the compliance points. 6. The analysis of the knowledge level revealed that the difference is found only between the college graduates and junior-high graduates or lower. 7. The feeling of self-efficacy varied along with the age and education level. 8. The general characteristics of patients as discussed above did not show significant difference with the compliance. 9. Regarding the elements influencing the compliance, the number of children, period of suffering, income, age, feering of self-efficacy, knowledge, and compliance had 54% of significance. In conclusion, rheumatism victims can lead a better life if they are appropriately educated, based on efficient training program from the early days of the disease ; if they become able to manage themselves thanks to the training ; and if they are helped by a program focusing on the increase of the feeling of self-efficacy aimed at changing patient's behavior.

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반복 하중이 Full veneer crown의 유지력에 미치는 영향에 관한 연구 (THE EFFECT OF CYCLIC LOADING ON THE RETENTIVE STRENGTH OF FULL VENEER CROWNS)

  • 김기연;이선형;정헌영;양재호;허성주
    • 대한치과보철학회지
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    • 제38권5호
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    • pp.583-594
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    • 2000
  • Dislodgement of a crown or extension bridge and the loosening of a retainer of a bridge is a serious clinical problem in fixed restoration. Generally these problems are considered to be associated with deformation of the restoration. During biting, the restoration is subjected to complex forces and deforms considerably within the limit of its elasticity. Deformation of the restoration under the occlusal force induces excessive stress in the cement film, which then leads to the cement fracture. Such a fracture may eventually cause loss of the restoration. Because most of the past retention tests for full veneer crown were done without fatigue loading, they were not exactly simulating intraoral environment. And the purpose of this study was to evaluate the effect of cyclic cantilever loading on the retentive strength of full veneer crowns depending on different type of cements and taper of prepared abutment. Steel dies with $8^{\circ}\;or\;16^{\circ}$ convergence angle were fabricated through milling and crowns with the same method. These dies and crowns were divided into 8 groups. Group 1 : $16^{\circ}$ taper die, cementation with zinc phosphate cement, without loading Group 2 : $16^{\circ}$ taper die, cementation with zinc phosphate cement, with loading Group 3 : $8^{\circ}$ taper die, cementation with zinc phosphate cement, without loading Group 4 : $8^{\circ}$ taper die, cementation with zinc phosphate cement, with loading Group 5 : $16^{\circ}$ taper die, cementation with Panavia 21, without loading Group 6 : $16^{\circ}$ taper die, cementation with Panavia 21, with loading Group 7 : $8^{\circ}$ taper die, cementation with Panavia 21 without loading Group 8 : $8^{\circ}$ taper die, cementation with Panavia 21, with loading After checking the fit of die and crown, the luting surface of dies and inner surface of crowns were air-abraded for 10 seconds. The crowns were cemented to the dies, with cements mixed according to the manufacturer's recommendations. A static load of 5kg was then applied for 10 minutes with static loading device. Twenty-four hours later, group 1, 3, 5, 7 were only thermocycled, group 2, 4, 6, 8 were subjected to cyclic loading after thermocycling. Retentive tests were performed on the Instron machine. From the finding of this study, the following conclusions were obtained 1. Panavia 21 showed significantly higher retentive strength than zinc phosphate cement for all groups (p<0.05). 2. There was a significant difference in the retentive strength between $8^{\circ}\;and\;16^{\circ}$ taper for zinc phosphate cement(p<0.05), but no significant difference for Panavia 21 (p>0.05). 3. Cyclic loading significantly decreased the retentive strength for all groups(p<0.05). 4. For zinc phosphate cement, there was 35% reduction of the retentive strength after loading in the $16^{\circ}$ taper die, 25% in the $8^{\circ}$ taper die, and for Panavia 21, 21% in the $16^{\circ}$ taper die, 18% in the $8^{\circ}$ taper die.

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노인의 근력강화운동이 일상생활기능 및 삶의 질에 미치는 효과 (An Effect of Muscle Strength Training Program on Muscle Strength, Muscle Endurance, Instrumental Activities of Daily Living and Quality of Life in the Institutionalized Elderly)

  • 김희자;홍여신
    • 지역사회간호학회지
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    • 제6권1호
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    • pp.55-73
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    • 1995
  • An Effect of Muscle Strength Training Program on Muscle Strength, Muscle Endurance, Instrumental Activities of Daily Living and Quality of Life in the Institutionalized Elderly Recent statistics shows that the aged are the fastest growing segment of our population by increasing life span. The age group of over 60 shows multiple health problems and the most serious handicapping problem of these. are related to the changes in muscular skeletal system. With aging, people lose. their muscle mass and muscle strength resulting from biological changes and physical inactivity. Studies documented a 30-50% loss of muscle mass in an advanced age and thus, ordinary life activities can be seriously affected due to weakened muscle strength. Preservation of muscle strength of lower limb is especially important in the aged. Since it is readily affected from reduced physical activity in old age, sometimes to the detriment of moving or walking. So muscle strength exercise program designed for the elderly to improve leg muscle strength and leg muscle endurance. The research design used was nonequivalent control group pretest - protest design. The purposes of this study were to test the effect of muscle strength exercise program utilizing Leg Press on muscle strength, muscle endurance, instrumental activities of daily living(IADL), cognitive perceptual variables and quality of life. Forty nine subjects participating in this study consisted of twenty four male and twenty five female. Twenty four experimental group subjects were selected from C-institution in Chung Buk province, and twenty five control group subjects were selected from O-institution in Chung Nam province. The mean age of subjects was 72.8 years. Muscle strength training program utilizing Leg Press for the experimental group was carried out three times a week for 9 weeks. The data was collected from August, 1993 to October, 1993. Data were analyzed with $X^2-test$, t-test, ANCOVA test, Kruskal Wallis 1-Way ANOVA test using SPSS PC program. Results were obtained as follows : 1) The experimental group showed significantly higher scores on muscle strength (leg lift strength, back lift strength and grip strength) and muscle endurance than control group after the experiment $\ulcorner$F=52.35(p=.001), F=54.07(p=.001), F=6.97(p=.011), F=18.17(p=.001)$\lrcorner$ 2) Experimental group were significantly higher scores on IADL than control group(F=7.51, p=.009). 3) Experimental group showed significantly higher scores on economical state and self esteem aspects of the quality of life scale than control group $\ulcorner$F=10.59(p=.002), F=6.97(p=.011)$\lrcorner$. But there were no differences in emotional state, physical and functional state and relationship with reatives in the quality of life between groups. 4) Scores on IADL showed a significant difference with the level of muscle strength and muscle endurance $\ulcornerx^2=7.73(p=.025),\;x^2=8.86\;(p=.011)\lrcorner$ 5) Scores on self esteem and physical and functional state aspects of the quality of life scale showed a significant difference with the level of IADL $\ulcornerx^2=11.39(p=.003),\;x^2=9.02(p=.011)\lrcorner$. 6) Scores of experimental group after the experiment in cognitive perceptual variables (perceived benefit on exercise, perceived health status, self efficacy, emotion on exercise) were significantly higher than those of control group $\ulcorner$F=32.09(p=.001), F=5.07(p=.029), F=20.63 (p=.001), F=30.38(p=.001)$\lrcorner$. As a result of this study, the effect of strength training exercise program with Leg. Press had improved muscle strength, muscle endurance, IADL, and the perception of self esteem, physical and funtional state, and economical state. Thus strength training program could be beneficially applied for the prevention of disablity and promotion of health and wellbeing in the aged easily and safely. The subjects in the experimental group have maintained their exercises till six months after the cessation of the experiment. This seem to illustrate that changes in cognitive perceptual variables and the improvement in health status have reinforced motivation for the continuation of voluntary exercises. A further study is necessary to determine the factors affecting maintainance of muscle strength exercise and to assess the effect of weight training program on bone density.

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포장방법에 따른 팽이버섯의 선도유지 효과 (Effect of Packaging Methods on Enoki Mushroom Qualities)

  • 신세희;정주연;최정희;김동만;정문철
    • 한국식품저장유통학회지
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    • 제16권2호
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    • pp.179-185
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    • 2009
  • 팽이버섯의 선도유지를 위한 적정 포장방법을 구명하기 위하여 팽이버섯의 호흡특성과 필름두께에 따른 기체조성을 사전 조사한 다음 현행 포장방법인 일반필름포장(PM)과 진공포장(VM), 그리고 $CO_2$ 25%와 50%, $O_2$ 10%와 20%를 각각 혼합하여 충전한 가스포장(AM)을 $1^{\circ}C$에서 12일 동안 저장하면서 선도유지특성을 비교하였다. 팽이버섯의 호흡 속도는 $0^{\circ}C$에서 $26.4\;mL{\cdot}CO_2/kg/hr$, $10^{\circ}C$ $80.0\;mL{\cdot}CO_2/kg/hr$, $20^{\circ}C$에서 $130.9\;mL{\cdot}CO_2/kg/hr$, $30^{\circ}C$에서 $173.5 \;mL{\cdot}CO_2/kg/hr$로 조사되었으며, 기체투과율이 좋은 LDPE 필름을 사용할 경우 40 및 $60{\mu}m$ 보다 $20{\mu}m$의 두께가 저장 12일까지도 생육최저산소농도를 훨씬 상회하는 안정된 상태를 나타내었다. 따라서 팽이버섯을 $20{\mu}m$의 LDPE 필름에 상기 각각의 포장방법을 적용하여 저장한 결과 AM에서는 고농도의 $CO_2$에 의한 호흡율 억제효과가 있었으며 진공포장을 제외한 모든 포장방법에서 저장 종료시점(12일)까지도 혐기적 호흡의 발생우려는 없었다. 중량감소율과 표면색은 $O_2$가 없는 VM에서 가장 억제되었으나 산소함유 포장방법 중에서는 50:10($%CO_2:%O_2$)의 AM이 가장 우수한 억제력을 나타내었다. 그러나 VM은 저장 2일경 심한 이취발생으로, PM은 저장 5일 경 높은 자루의 신장율로 상품성을 소실한 반면 AM의 여러 가스조성 중 50:10의 비율이 저장 12일 동안 이취, 변색 및 곰팡이 발생 등이 발생하지 않으면서 상품성을 유지하는 효과가 가장 높게 나타났다.

사막화방지(沙漠化防止) 및 방사기술개발(防沙技術開發)에 관한 연구(硏究)(I) - 중국(中國)의 사막화현황(沙漠化現況) 및 방지대책(防止對策) - (Studies on the Desertification Combating and Sand Industry Development(I) - Present Status and Countermeasures for the Combating Desertification in China -)

  • 우보명;이경준;전기성;김경훈;최형태;이승현;이병권;김소연;이상호;전정일
    • 한국환경복원기술학회지
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    • 제3권3호
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    • pp.45-76
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    • 2000
  • The purposes of this study were to investigate and understand the present status of various types of "deserts", such as sand desert, gravel desert, rock desert, earth desert, salt desert, desert, rocky desert, gobi desert, sandy desert, clay desert, etc., and the general countermeasures for the combating "desertification" "desertization", and to develop the technologies on the revegetation and restoration for the combating desertification in China. The methods of this study were mainly composed of field surveys on the several experimental sites and research institutes related to combating desertification in China, and examinations on the various technologies for the combating desertification at the Daxing Experimental Station of Beijing Forestry University. The conclusion from this study may be summarized as follows; 1. Status and tendency of desertification in China : China is one of the countries seriously threatened by desertification. Desertification affected areas in China are mainly distributed in arid, semi-arid and dry sub-humid areas in China, covering the most regions of the Northeast China (eastern region of Inner-Mongolia), the northern part of the North China (middle and western region of Inner-Mongolia, Shaanxi, Ningsha, Gansu) and the western part of the Northwest China (Xinzang, Qinghai, Xizang). The total area affected by desertification in China is approximately 2.622 million $km^2$. It covers 27.3% of the total territory of China. Until recently, it is estimated that the annual spreading ratio of desertification in China is 2,460 $km^2$. Therefore, desertification is mostly serious problems facing to the Chinese people. 2. The causes and environmental effect of desertification : The desertification in China is mainly caused by compound factors, including natural condition and human activities. In China, the desertification is started by the decrease of precipitation, continuous dry and drought, strong wind, wind and water erosion, land degradation and loss of natural vegetation caused by climate variation, and accelerated by the human activities, such as over-cultivating, over-grazing, over-cutting of woods, irrational use of water resources. Because desertification has affected the geographical features, soil nutrients contents, salinity, vegetation coverage and the functions of ecosystem, the environmental deteriorations in the desertification affected areas are very seriously. 3. The fundamental strategies of combating desertification in China are the increase of education and awareness of people through various mass media, the revision of laws to guarantee operation of Desertification Combating Law and to improve many relating laws and regulations, the application of advanced technologies and training of experts, the establishment of discriminative policies, and increasing arrangement of budget-investment, and so on. China, as a signed country in UNCCD, has made efforts for the combating desertification. Korea is also signed country in UNCCD, so we should play an important role in the desertification combating projects of China for the northest asia and global environmental conservation as well as environmental conservation of Korea.

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만성염증성 폐질환에서 전폐절제술의 임상적 평가 (Clinical Analysis of Pleuropneumonectomy for Chronic Inflammatory Lung Disease)

  • 최필조;방정희;김시호;조광조;우종수
    • Journal of Chest Surgery
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    • 제39권6호
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    • pp.462-469
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    • 2006
  • 배경: 염증성 폐질환을 위한 전폐절제술은 동반된 합병증률과 사망률로 인해 흉부외과의에게는 난제이며 늑막외전폐절제술의 경우는 더욱 그러하다. 이 연구의 목적은 늑막외전폐절제술을 시행 받은 환자에서의 수술 성적과 합병증 등을 단순 전폐절제술을 받은 환자와 비교분석하고 이들 환자에서의 합병증 발생에 영향을 미치는 요인에 대해 알아보고자 보고자 하였다. 대상 및 방법: 1992년 1월부터 2004년 12월까지 만성염증성폐질환으로 전폐절제술을 시행 받은 98명을 대상으로 후향적 분석을 시행하였다. 늑막외전폐적출술(A군)은 48명에서, 단순 전폐절제술(B군)은 50명에서 시행되었다. 두 군 환자의 임상적 특징, 수술 후 성적 및 합병증 등을 비교 분석하고 늑막외전폐절제술(A군)을 받은 환자에서 수술 후 합병증 발생에 영향을 미치는 인자를 수술 전, 수술 중 요인으로 나누고 이들의 유의성을 단변량 및 다변량 분석을 통하여 평가하였다. 결과: 수술로 인한 조기 사망은 1명으로 수술 후 성인성 호흡곤란증후군(adult respiratory distress syndrome, ARDS)으로 인한 경우였다. 21명(21.4%)의 환자에서 23예의 주요 수술 후 합병증을 나타내었다. 가장 흔한 합병증으로는 수술 후 출혈로 인해 재개흉이 필요했던 경우 8예, 농흉(기관지-흉막루 포함)의 발생 8예였다. A군 48명 중 14명(29.2%)의 환자에서, B군 50명 중 7명(14.0%)에서 각각 합병증을 보였다. 높은 합병증을 보인 A군의 경우, 농흉(기관지-흉막루 포함)의 발생 6예, 수술 후 출혈로 인해 재개흉이 필요했던 경우 6예로 가장 흔한 합병증이었고, 수술 후 합병증 발생의 위험인자를 알기 위해 단변량 분석을 시행한 결과, 우측 전폐절제술(p=0.0022), 완성전폐절제술(p=0.023), 1,000 mL 이상의 출혈(p=0.005), 수술 중 흉강 내 오염(p=0.035) 등이 위험인자로 판명되었고, 다변량 분석에서는 수술 중 흉막강 내 오염이 되었던 경우가 통계적 유의성을 보였다(p=0.028). 결론: 만성 염증성 폐질환의 치료를 위한 전폐절제술은 만족할 만한 사망률과 합병증률을 보였다. 그러나 늑막외전폐절제술은 수술 술기상 고난도이며 고위험군의 수술임을 확인할 수 있었다. 특히 수술 중 세심한 박리 조작으로 폐병소부위의 파열로 인한 흉막강 내의 오염의 발생을 최소화하기 위한 수술 중의 특별한 노력이 필요함을 알 수 있었다.

성인 급성 A형 간염 환자들의 임상 양상 (Clinical Characteristics of Adult Patients with Acute Hepatitis A)

  • 은종렬;이헌주;김태년;장병익;문희정
    • Journal of Yeungnam Medical Science
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    • 제24권2호
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    • pp.170-178
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    • 2007
  • 성인에서 항체 보유율이 급감하는 것에 비례하여 급성 A형 간염 환자는 증가하고 있다. 대구지역에서의 급성 A형 간염의 역학과 임상 양상에 관한 자료를 얻고자 하였다. 1998년 1월부터 2007년 6월까지 영남대학교병원에 급성 간염으로 입원하여 IgM anti-HAV 양성으로 급성 A형 간염이 확진된 55명의 환자들(남/녀 34/21)의 의무기록을 후향적으로 검토하였다. 평균 연령은 $29.7{\pm}10.3$세(범위 17~65세)였고, 20대와 30대에 78.2%가 발생하였다. 만성 B형 간염이 4명 (7.3%)에서 동반되어 있었으나, 모두 비증식상태로 임상경과는 양호하였다. 1998년부터 2002년 사이에 9.1%가 발생한 데 반해 2003년부터 2007년 6월까지 90.1%가 발생하였고, 계절적으로는 3~6월 사이에 31명 (56.1%)으로 가장 많이 발생하였다. 여행력이 있는 7명(12.7%)을 제외하고는 감염원을 추정하기가 힘들었다. 임상증상은 식욕부진과 오심, 구토38예(69.1%), 열/오한 27명(49.1%), 전신근육통 26명(47.3%), 체중감소 26명(47.3%), 피로감 22명(40.0%), 복통이 20예(36.4%), 설사 5명(9.1%), 소양감 3명(5.5%) 등이었다. 54명은 합병증 없이 자연회복되었으나 1명은 전격성 간염이 발생하여 간이식을 받고 회복되었다. 평균 재원일은 $8.6{\pm}3.4$일(범위 3~20일)이었다. 성인에서의 급성 A형 간염은 입원으로 인한 사회, 경제적 비용이 적지 않고 때로는 치명적인 결과를 초래할 수도 있으므로 능동면역을 받지 않은 30대 이전의 젊은 연령에서는 항체의 확인과 함께 능동면역을 고려해야 할 것으로 생각한다.

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선형가속기를 이용한 뇌종양 46예의 뇌정위다방향방사선치료 성적 (Clinical Report of 46 Intracranial Tumors with LINAC Based Stereotactic Radiosurgery)

  • 윤세철;서태석;김성환;강기문;김연실;최병옥;장홍석;최규호;김문찬;신경섭
    • Radiation Oncology Journal
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    • 제11권2호
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    • pp.241-247
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    • 1993
  • 가톨릭 의과대학 강남성모병원 치료방사선과에서는 1988년 7월부터 1992년 12월 사이에 뇌종양 환자 45명의 뇌내 46개 병소에 대한 뇌정위다방향방사선치료를 실시하였으며, 이들에 대한 영상학적 및 임상적 추적조사 결과를 후향적으로 분석하였다. 뇌종양에 대한 뇌정위다방향방사선치료는 병소가 생명중추에 인접되어 있거나 다른 전신질환과 함께 있어 종양의 수술적 제거가 어려운 경우, 수술후 잔류 병소가 남아 있거나 재발된 경우, 또는 종래 부터 해오던 방사선치료에도 불구하고 잔류병소가 남아있거나 환자가 수술을 거부할 경우 등에서 실시하게 된다. 이는 수술이나 유사한 다른 치료와 비교하여 동일한 치료효과를 얻으면서도 간편하고 비침습적 이며 또한 상대적으로 저렴한 치료 경비가 소요됨으로, 최근 방사선치료장비 및 치료계획 프로그램의 개발과 함께 그 치료성적이 관심의 대상이 되고 있다. 환자 분포는 남녀 비가 22:33 이며, 연령 분포는 5-74세 (중앙값 : 43세)이었고, 추적조사 기간은 2-55개월 (중앙값 : 35개월)이었다. 6 MV 선형 가속기를 사용하여 조사야 용적은 $0.13-42.88\;cm^3$(중앙값 : $7.26\;cm^3)$이었으며, 최대치료선량은 5-35.5 Gy(중앙값 : 20.9 Gy)이었다. 종양 별로는 뇌하수체종양15예, 청각신경종 8예, 수막종 7예, 뇌교종 6예, 두개인두종 4예, 송과선종 3예, 혈관아세포종 2예, 및 뇌전이 암 1예 씩이었다. 총 46예 중 18예$(39.1\%)$에서 추적 영상검사상 종양의 소실 및 위축을 관찰하였으며, 10예$(34.8\%)$에서는 종양크기의 정지상태를 나타냈다. 임상적으로는 34예$(73.9\%)$에서 방사선치료 전보다 양호한 전신상태 및 수행능력을 유지하고 있었으며, 이중 4예 $(8.7\%)$에서는 추적 검사상 종양 크기가 약간 커졌음에도 불구하고 임상적으로는 안정된 상태이었다. 영상학적으로나 임상적으로 악화된 경우는 2예$(4.4\%)$에서 있었다. 치료에 따르는 부작용으로는 치료 직후, 일시적 두통을 호소하였으나 스테로이드 및 진통제 투여로 개선되었으며 경미한 일시적 탈모를 3예$(6.6\%)$에서 경험하였으며 향후 좀더 정밀 추적검사가 필요할 것으로 생각된다.

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