• 제목/요약/키워드: a-SiH

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근치적 절제 후 재발한 1,2기 비소세포폐암 환자의 임상상 (Clinical Characteristics of Recurred Patients with Stage I,II Non-Small Cell Lung Cancer)

  • 함형석;강수정;안창혁;안종운;김호철;임시형;서지영;김관민;정만표;김호중;김진국;권오정;심영목;이종헌
    • Tuberculosis and Respiratory Diseases
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    • 제48권4호
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    • pp.428-437
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    • 2000
  • 배경 및 방법 : 근치적 절제술 후 재발한 비소세포폐암 환자의 임상적 특징과 재발 양상을 알아보고자 1994년부터 삼성서울병원에서 근치척 절제술을 시행한 1,2기 비소세포폐암환자 256명중 1년 이상 추적 관찰이 가능하였던 234명을 대상으로 후향적 조사를 하여 다음과 같은 결과를 얻었다. 결 과 : 1) 전체 환자의 남녀 비율은 3.1:1이었고 연령의 중앙값은 63세로서 평균 추척 기간은 732일(365일~1,695일)이었다. 234명중 재발한 환자는 62명으로 26.5%였고 재발 기간은 수술후 평균 358.8일이었다. 2) 재발군과 비재발군의 임상양상을 비교하면 재발군의 연령이 많았으며($63.2{\pm}8.8$세 vs. $60.3{\pm}9.8$세, p=0.043), 재발율은 2기 환자가 1기 환자보다 높았다(6.0% vs. 21.2%, p<0.001). 원발암의 크기는 비재발군($3.74{\pm}1.75\;cm$)이 재발군($5.45{\pm}3.22\;cm$) 보다 작았고(p<0.001), 2cm 미만에서 재발이 발견된 경우는 없었다. 3) 원격 재발군과 국소성 재발군과의 분석에서 빈도는 원격 재발(66.1%)이 국소성 재발(33.9%)보다 많았고, 원격 재발은 여자가 남자보다 많았다(11/12명, 91.7% vs. 30/50 명, 60.0%. p=0.037). 선암이 편평세포상피암보다 원격 재발율이 높았고(20/25명, 80.0% vs. 15/29 명, 51.7%. p=0.030). 뇌전이 발생율이 선암(50.0%)에서 편평세포상피암(13.3%)보다 높았다(p=0.024). 4) 평균 생존 기간은 $1437.6{\pm}40.3$일이었고, 병기가 높을수록 생존기간이 길었다(log rank p<0.001). 결 론 : 1,2기 비소세포폐암의 근치적 절제술 후 재발은 26.5%에서 일어났고 종양의 크기 및 병기가 재발에 관련된 인자였다. 원발암의 크기가 2cm미만일 경우 재발된 경우가 없어 예후가 좋을 것으로 기대되며, 재발암 중에서는 여성과 선암에서 원격 재발율이 높았고 특히 뇌전이는 선암에서 많이 발생하여 수술 전 뇌영상 검사에 대한 전향적 연구가 필요할 것으로 생각된다.

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통상성 간질성 폐렴과 비특이성 간질성 폐렴의 임상적 감별 진단 (Clinical Differential Diagnosis of Usual Interstitial Pneumonia from Nonspecific Interstitial Pneumonia)

  • 안창혁;고영민;정만표;서지영;강수정;강경우;안종운;임시영;김호중;한정호;이경수;권오정;이종헌
    • Tuberculosis and Respiratory Diseases
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    • 제48권6호
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    • pp.932-943
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    • 2000
  • 배경 : 비특이성 간질성 폐렴(Nonspecific interstitial pneumonitis ; NSIP)은 통상성 간질성 폐렴(usual interstitial pneumonitis ; UIP)에 비해 치료에 대한 반응과 예후가 좋으므로 반드시 감별 진단하여 적극적인 치료가 필요하나 아직까지 일괄적 폐생검 이외에는 확실한 감별이 되지 않는 실정이다. 이에 외과적 폐생검으로 확진 된 NSIP와 UIP 환자들에서 임상적 특징과 방사선학적 소견의 차이점을 비교하고, 미국흉부학회에서 2000년에 제시한 IPF의 임상 진단기준을 적용하여 진단기준의 유용성올 평가해 보고자 본 연구를 시행하였다. 방법 : 1996년 7월부터 2000년 3월까지 삼성서울병원에서 조직검사 상 UIP와 NSIP로 확진된 60명을 대상으로 후향적 조사를 하였다. 각 환자들의 임상 증상과 폐기능 검사, 동맥혈가스분석, BAL 및 흉부HRCT 소견을 비교하고, 미국흉부학회에서 제시한 IPF의 임상 진단기준에 적용하여 임상적 진단율을 비교해 보았다. 결과 : 1) 전체 60명 중 UIP 환자는 42명, NSIP 환자는 18명이었다. 2) UIP 환자의 평균 연령은 59.5$\pm$7.1세(45~74세)였고, NSIP 환자는 55.2$\pm$8.4세(44~73세)였으며 (p=0.046), UIP는 남자 33명, 여자 9명이었으나 NSIP는 남자 1명, 여자 17명이었다(p=0.001). 3) 호흡기 임상 증상의 유무 및 종류에는 차이가 없었으나, 동반 증상 중 발열은 NSIP 환자에서 많았고(p=0.034), 곤봉지는 UIP 환자에서 많았다 (p=0.023). 4) BAL의 세포 구성비는 NSIP 환자에서 림프구가 많았고(23% vs. 11% ; p=0.0001), CD4/CD8의 비는 NSIP가 더 낮았다(0.76$\pm$0.49 vs. 9.71$\pm$0.25 ; p=0.045). 5) HRCT 소견 상 봉와양 음영은 UIP 환자에서 더 흔히 보였다(86% vs. 0%; p=0.0001). 6) 미국흉부학회의 IPF 임상 진단기준에는 UIP 환자에서는 23.3 %(7/30명)가, NSIP 환자에서는 18.8% (3/16 명)이 만족하였다(p>0.05). 결론 : 나이가 비교적 적은 여자이면서 임상 증상 기간이 짧고 발열이 있으며 곤봉지의 소견이 없고, BAL에서 림프구가 많으며, HRCT 상 봉와양 음영이 없을 경우에는 NSIP를 더 시사하는 소견이며, 미국흉부학회의 IPF 임상 진단기준은 한국에서 유용성이 떨어져 앞으로 한국적인 임상 진단기준의 마련이 필요한 것으로 사료된다.

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지하수 관개에 의한 수도의 멸준양상과 그 방지책에 관한 연구 (Studies on the Rice Yield Decreased by Ground Water Irrigation and Its Preventive Methods)

  • 한욱동
    • 한국농공학회지
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    • 제16권1호
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    • pp.3225-3262
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    • 1974
  • The purposes of this thesis are to clarify experimentally the variation of ground water temperature in tube wells during the irrigation period of paddy rice, and the effect of ground water irrigation on the growth, grain yield and yield components of the rice plant, and, furthermore, when and why the plant is most liable to be damaged by ground water, and also to find out the effective ground water irrigation methods. The results obtained in this experiment are as follows; 1. The temperature of ground water in tube wells varies according to the location, year, and the depth of the well. The average temperatures of ground water in a tubewells, 6.3m, 8.0m deep are $14.5^{\circ}C$ and $13.1^{\circ}C$, respercively, during the irrigation period of paddy rice (From the middle of June to the end of September). In the former the temperature rises continuously from $12.3^{\circ}C$ to 16.4$^{\circ}C$ and in the latter from $12.4^{\circ}C$ to $13.8^{\circ}C$ during the same period. These temperatures are approximately the same value as the estimated temperatures. The temperature difference between the ground water and the surface water is approximately $11^{\circ}C$. 2. The results obtained from the analysis of the water quality of the "Seoho" reservoir and that of water from the tube well show that the pH values of the ground water and the surface water are 6.35 and 6.00, respectively, and inorganic components such as N, PO4, Na, Cl, SiO2 and Ca are contained more in the ground water than in the surface water while K, SO4, Fe and Mg are contained less in the ground water. 3. The response of growth, yield and yield components of paddy rice to ground water irrigation are as follows; (l) Using ground water irrigation during the watered rice nursery period(seeding date: 30 April, 1970), the chracteristics of a young rice plant, such as plant height, number of leaves, and number of tillers are inferior to those of young rice plants irrigated with surface water during the same period. (2) In cases where ground water and surface water are supplied separately by the gravity flow method, it is found that ground water irrigation to the rice plant delays the stage at which there is a maximum increase in the number of tillers by 6 days. (3) At the tillering stage of rice plant just after transplanting, the effect of ground water irrigation on the increase in the number of tillers is better, compared with the method of supplying surface water throughout the whole irrigation period. Conversely, the number of tillers is decreased by ground water irrigation at the reproductive stage. Plant height is extremely restrained by ground water irrigation. (4) Heading date is clearly delayed by the ground water irrigation when it is practised during the growth stages or at the reproductive stage only. (5) The heading date of rice plants is slightly delayed by irrigation with the gravity flow method as compared with the standing water method. (6) The response of yield and of yield components of rice to ground water irrigation are as follows: \circled1 When ground water irrigation is practised during the growth stages and the reproductive stage, the culm length of the rice plant is reduced by 11 percent and 8 percent, respectively, when compared with the surface water irrigation used throughout all the growth stages. \circled2 Panicle length is found to be the longest on the test plot in which ground water irrigation is practised at the tillering stage. A similar tendency as that seen in the culm length is observed on other test plots. \circled3 The number of panicles is found to be the least on the plot in which ground water irrigation is practised by the gravity flow method throughout all the growth stages of the rice plant. No significant difference is found between the other plots. \circled4 The number of spikelets per panicle at the various stages of rice growth at which_ surface or ground water is supplied by gravity flow method are as follows; surface water at all growth stages‥‥‥‥‥ 98.5. Ground water at all growth stages‥‥‥‥‥‥62.2 Ground water at the tillering stage‥‥‥‥‥ 82.6. Ground water at the reproductive stage ‥‥‥‥‥ 74.1. \circled5 Ripening percentage is about 70 percent on the test plot in which ground water irrigation is practised during all the growth stages and at the tillering stage only. However, when ground water irrigation is practised, at the reproductive stage, the ripening percentage is reduced to 50 percent. This means that 20 percent reduction in the ripening percentage by using ground water irrigation at the reproductive stage. \circled6 The weight of 1,000 kernels is found to show a similar tendency as in the case of ripening percentage i. e. the ground water irrigation during all the growth stages and at the reproductive stage results in a decreased weight of the 1,000 kernels. \circled7 The yield of brown rice from the various treatments are as follows; Gravity flow; Surface water at all growth stages‥‥‥‥‥‥514kg/10a. Ground water at all growth stages‥‥‥‥‥‥428kg/10a. Ground water at the reproductive stage‥‥‥‥‥‥430kg/10a. Standing water; Surface water at all growh stages‥‥‥‥‥‥556kg/10a. Ground water at all growth stages‥‥‥‥‥‥441kg/10a. Ground water at the reproductive stage‥‥‥‥‥‥450kg/10a. The above figures show that ground water irrigation by the gravity flow and by the standing water method during all the growth stages resulted in an 18 percent and a 21 percent decrease in the yield of brown rice, respectively, when compared with surface water irrigation. Also ground water irrigation by gravity flow and by standing water resulted in respective decreases in yield of 16 percent and 19 percent, compared with the surface irrigation method. 4. Results obtained from the experiments on the improvement of ground water irrigation efficiency to paddy rice are as follows; (1) When the standing water irrigation with surface water is practised, the daily average water temperature in a paddy field is 25.2$^{\circ}C$, but, when the gravity flow method is practised with the same irrigation water, the daily average water temperature is 24.5$^{\circ}C$. This means that the former is 0.7$^{\circ}C$ higher than the latter. On the other hand, when ground water is used, the daily water temperatures in a paddy field are respectively 21.$0^{\circ}C$ and 19.3$^{\circ}C$ by practising standing water and the gravity flow method. It can be seen that the former is approximately 1.$0^{\circ}C$ higher than the latter. (2) When the non-water-logged cultivation is practised, the yield of brown rice is 516.3kg/10a, while the yield of brown rice from ground water irrigation plot throughout the whole irrigation period and surface water irrigation plot are 446.3kg/10a and 556.4kg/10a, respectivelely. This means that there is no significant difference in yields between surface water irrigation practice and non-water-logged cultivation, and also means that non-water-logged cultivation results in a 12.6 percent increase in yield compared with the yield from the ground water irrigation plot. (3) The black and white coloring on the inside surface of the water warming ponds has no substantial effect on the temperature of the water. The average daily water temperatures of the various water warming ponds, having different depths, are expressed as Y=aX+b, while the daily average water temperatures at various depths in a water warming pond are expressed as Y=a(b)x (where Y: the daily average water temperature, a,b: constants depending on the type of water warming pond, X; water depth). As the depth of water warning pond is increased, the diurnal difference of the highest and the lowest water temperature is decreased, and also, the time at which the highest water temperature occurs, is delayed. (4) The degree of warming by using a polyethylene tube, 100m in length and 10cm in diameter, is 4~9$^{\circ}C$. Heat exchange rate of a polyethylene tube is 1.5 times higher than that or a water warming channel. The following equation expresses the water warming mechanism of a polyethylene tube where distance from the tube inlet, time in day and several climatic factors are given: {{{{ theta omega (dwt)= { a}_{0 } (1-e- { x} over { PHI v })+ { 2} atop { SUM from { { n}=1} { { a}_{n } } over { SQRT { 1+ {( n omega PHI) }^{2 } } } } LEFT { sin(n omega t+ { b}_{n }+ { tan}^{-1 }n omega PHI )-e- { x} over { PHI v }sin(n omega LEFT ( t- { x} over {v } RIGHT ) + { b}_{n }+ { tan}^{-1 }n omega PHI ) RIGHT } +e- { x} over { PHI v } theta i}}}}{{{{ { theta }_{$\infty$ }(t)= { { alpha theta }_{a }+ { theta }_{ w'} +(S- { B}_{s } ) { U}_{w } } over { beta } , PHI = { { cpDU}_{ omega } } over {4 beta } }}}} where $\theta$$\omega$; discharged water temperature($^{\circ}C$) $\theta$a; air temperature ($^{\circ}C$) $\theta$$\omega$';ponded water temperature($^{\circ}C$) s ; net solar radiation(ly/min) t ; time(tadian) x; tube length(cm) D; diameter(cm) ao,an,bn;constants determined from $\theta$$\omega$(t) varitation. cp; heat capacity of water(cal/$^{\circ}C$ ㎥) U,Ua; overall heat transfer coefficient(cal/$^{\circ}C$ $\textrm{cm}^2$ min-1) $\omega$;1 velocity of water in a polyethylene tube(cm/min) Bs ; heat exchange rate between water and soil(ly/min)

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