• 재활간호학회지
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• 제2권2호
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• pp.257-270
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• 1999

The purpose of this study is to investigate factors related to the intent of using home nursing of chronic disease patients who got out of a university hospital. For the purpose, the study selected 153 patients who were hospitalized and left K university hospital with diagnoses of cancer, hypertension, diabetes and cerebral vascular accident and ordered to be discharged and performed interviews with them and surveys on their medical records to obtain the following results. For this study a direct-interview survey and medical record review was conducted from June 28 to Aug. 30, 1998. The frequency and mean values were computed to find the characteristics of the study subjects, and $X^2$-test, t-test, factor analysis and multiple logistic regession analysis were applied for the analysis of the data. The following results were obtained. 1) When characteristics of the subjects were examined, men and women occupied for 58.8% and 41.2%, respectively. The subjects were 41.3 years old in aver age and had the monthly aver age earning of 0.99 million won or below, which was the most out of the total subjects at 34.6%. Among the total, 87.6% resided in cities and 12.4 in counties. The most left the hospital with diagnosis of cancer at 51.6%, followed by hyper tension at 24.2%, diabetes at 13.7% and cerebral vascular accident at 7.2%. 2) 93.5% of the selected patients had the intent of using home nursing and 6.5%, didn't. Among those patients having the intent, 85.6% had the intent of paying for home nursing and 14.4%, didn't. The subjects expected that the nursing would be paid 9,143 won in aver age and 47.7% of them preferred national authorities as the main servers. 86.3% of the subjects thought that home nursing business had the main advantage of making it possible to learn nursing methods at home and thereby contributing to improving the ability of patients and their facilities to solve health problems. 3) Relations between the intent of use and characteristics of the subjects such as demography-related social, home environment, disease and physical function characteristics did not show statistically significant differences among one another. Compared to those who had no intent of using home nursing, the group having the intent had more cases of male patients, the age of 39 or below, residence in cities, 5 family member s or more, no existence of home nursing servers, leaving the hospital from a non-hospitalized building, disease development for five months or below, hospitalization for ten days or more, non-hospitalization with in the recent one month, two times or over of hospitalization, leaving the hospital with no demand of special treatment, operation underwent, poor results of treatment, leaving the hospital with demand of rehabilitation services, physical disablement and high evaluation point of daily life. 4) Among those patients having the intent of using home nursing, 47.6% demanded technical nursing and 55.9%, supportive nursing. As technical nursing,' inject into a blood vessel ' and 'treat pustule and teach basic prevention methods occupied for 57.4%, respectively, topping the list. Among demands of supportive nursing, 'observe patients 'status and refer them to hospitals or community resources as available, if necessary' was the most with percent age point of 59.5. Regarding the intent of paying for home nursing, 39.2% of those patients wishing to use the nursing responded paying for technical services and 20.2, supportive services. In detail, 70.0% wanted to pay for a service stated as 'inject into a blood vessel', highest among the former services and 30.7%, a service referred to as 'teaching exercises needed to make the body of patients move', highest among the latter. When this was analyzed in terms of a relation between the need(the need for home nursing) and the demand(the intent of paying for home nursing), The rate of the need to the demand was found two or three times higher in technical nursing(0.82) than in supportive nursing(0.35). In aspects of tech ical nursing, muscle injection(1.26, the 1st rank) was highest in the rate while among aspects of supportive nursing, a service referred to as 'teach exercises needed for making patients move their bodies normally'(0.58, the 1st rank). 5) factors I(satisfaction with hospital services), II(recognition of disease state), III(economy) and IV(period of disease) occupied for 34.4, 13.8, 11.9 and 9.2 percents, respectively among factors related to the intent by the subjects of using home nursing, totaled 59.3%. In conclusion, most of chronic disease patients have the intent of using hospital-based home nursing and satisfaction with hospital services is a factor affecting the intent most. Thus a post-management system is needed to continue providing health management to those patients after they leave the hospital. Further, supportive services should be provided in order that those who are satisfied with hospital services return to their community and live their in dependent lives. Based on these results, the researcher would make the following recommendation. 1) Because home nursing becomes more and more needed due to a sharp increase in chronic disease patients and elderly people, related rules and regulations should be made and implemented. 2) Hospital nurses specializing in home nursing should be cultivated.

• 핵의학기술
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• 제18권1호
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• pp.98-103
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• 2014

갑상선 분화암 환자의 방사선 치료에서 I-131의 유효반감기는 환자에게 투여하는 양의 계산뿐만 아니라 환자의 격리 입원기간의 결정, 환자로부터 가족들이 받게 되는 선량을 계산하는데 유용한 값이다. 하지만 이 값은 물리적반감기와는 달리 실측을 해야만 얻을 수 있어 입원 격리중인 환자에게 계측하기가 기술적으로 어려운 문제가 있다. Dual time I-131 whole body scan의 초기촬영과 지연촬영 사이의 체내잔류방사능량을 이용하여 전신과 갑상선에 유효반감기를 추정해 보았다. 또한 혈중 크레아티닌 농도, GFR, 투여량이 유효반감기와 상관관계가 있는지 알아보았다. 유효반감기 측정을 위해 전신에 체내잔류방사능량과 갑상선의 잔류방사능량을 측정하기 위해 환자의 전신을 흥미영역으로 설정한 후 배후방사능을 보정하여 전신의 체내잔류방사능량을 획득하였고, 갑상선 부위에 ROI를 설정한 후 배후 방사능을 보정하여 갑상선의 잔류방사능량을 획득하였다. 초기영상과 지연영상의 측정값 사이의 비율을 계산하여 전신과 갑상선의 유효반감기를 구하였다. 또한 유효반감기와 GFR, 혈중크레아티닌 농도, I-131 투여량과의 상관관계를 분석하였다. 전신의 체내잔류방사능량을 측정한 값의 유효반감기는 $17.06{\pm}5.50$시간으로 나타났고 갑상선의 잔류방사능량을 측정한 값의 유효반감기는 $17.22{\pm}5.41$시간으로 나타났으며 두 유효반감기는 유의한 차이를 보이지 않았다(P=0.887). GFR 값이 올라갈수록 전신의 유효반감기(r=-0.407, P=0.003)와 갑상선 유효반감기(r=-0.473, P=0.001) 모두 유의하게 감소하였으며 혈중크레아티닌 농도가 올라갈수록 전신의 유효반감기(r=0.309, P=0.029)와 갑상선 유효반감기(r=0.371, P=0.008) 모두 유의하게 증가하였다. 투여량은 두유효반감기와 상관관계를 보이지 않았다. 본 연구를 통해 고용량 방사성요오드 치료환자 입원기간의 최적화 연구와 기존 유효반감기를 구하기 위해 종사자의 피폭 및 복잡성을 보완하여 간편하게 측정을 할 수 있을 것이라 생각한다. 또한 분석된 갑상선의 유효반감기를 적용한 MIRD schema의 내부피폭선량 평가 연구에도 활용할 수 있을 것으로 사료된다.

• Journal of Chest Surgery
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• 제42권1호
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• pp.14-21
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• 2009

배경: 심방세동은 관상동맥우회로술후 흔히 발생하는 합병증으로, 대부분 일시적이고 양호한 경과를 보이나, 혈전색전증의 위험성을 증가시키며, 유병률의 증가와 재원기간의 증가로 인하여 의료비용의 증가를 초래할 수 있다. 대상 및 방법: 1994년 1월 1일부터 2007년 12월 31일까지 단독관상동맥우회술을 시행한 190명의 환자 중 수술 후 심방세동이 발생한 군(1군: n=139)과 발생하지 않은 군(2군: n=51)을 나누어 수술 후 심방세동 발생율, 환자의 특성, 수술관련 인자 및 수술 후 심방세동 발생으로 인한 결과를 의무기록을 토대로 후향적으로 분석하였다. 결과: 수술 후 심방세동의 발생율은 26.8%였으며, 퇴원전까지 정상동방결절리듬으로 회복된 경우는 82.4%였고, 심방세동 발생 환자의 82.4%는 수술 후 3일 이내에 발생하였다. 술후 심방세동군에서는 나이가 유의하게 많았으며, 대동맥겸자 차단시간의 차이는 없었으나, 대동맥 겸차차단 해제시 자발적으로 정상 심전도를 회복하지 못한 경우가 많았으며, 체외순환시간이 더 긴 것으로 나타났다. 수술후 베타차단제의 사용이 심방세동의 발생을 감소시키는 것으로 나타났으며, 재원기간의 차이는 없었으나, 중환자실 체류기간은 심방세동군에서 유의하게 길었다. 다변량 분석에서는 연령, 대동맥겸차 해제후 자발적 심박동 회복여부, 중환자실 재원기간 및 술후 베타 차단제의 사용이 유의한 인자로 분석되었다. 결론: 관상동맥우회로술후 심방세동은 매우 흔한 합병증으로 유병률이 증가되며, 중환자실 재원기간의 증가를 초래한다. 따라서, 술후 심방세동의 발생을 예방하기 위한 조치들이 필요할 것으로 생각되며, 특별한 금기사항이 없다면, 술후 베타 차단제를 적극적으로 사용하는 것이 좋을 것으로 생각된다.

• Journal of Acupuncture Research
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• 제17권2호
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• pp.41-51
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• 2000

Clinical observation was made on 44 cases of stable thoracolumbar compression fracture that were confirmed through simple x-ray and neurological examination. They were hospitalized and treated by acupuncture and moxibustion, bed rest, herb medicine and physical therapy. If necessary, patient was given an enema. The results obtained are as follows. 1. The patient distribution ratio, in regard to sex, was shown to be 1: 13.7 for males to females. In regard to age, it was shown that people in their 60's was the most predominant case, followed by people in their 70's, 80's, 50's and 40's, respectively. 2. In regard to contributing factors, it was observed that accidental falls were most frequent, followed by reasons unknown, repetitive lifting of heavy objects, overlaboring and bruise in that order. 3. In regard to duration of illness before treatment, it was found that treatment within 1 week was most predominant, followed by over 4 weeks, and 1-2 weeks, respectively. 4. With regard to the duration of hospitalization, hospitalization within 2 weeks was found to be most predominant, followed by 2-4 weeks. 5. In regard to the level of the affected vertebral body; The affected vertebral bodies distributed between T3 to L5 except for T7; T12 was found to be most predominant, followed in turn by L1 and L5. 6. In regard to the number of affected vertebral bodies, 2 was the most frequent followed by 1 and 3, in that order. The average of the number of affected vertebral bodies was observed to be 2.8 and single vertebral body compression fracture was shown to have no clinical and statistical difference as compared with multiple vertebral body compression fractures. 7. In regard to the grade of the seriousness of symptoms, it was found that Grade IV was most predominant, followed by Grade III. 8. With regard to signs at the first medical examination, low back pain was seen in the highest number, and followed in order by gait disturbance, flank pain, flexion-extension disturbance, disturbance of rotation to right or left, and bowel dysfunction. 9. Concerning the effect of treatment, good results were most predominantly seen, and 95.5% of total patients showed fair results. 10. The duration of admission treatment due to the grade of clinical symptoms was as follows; In the case of the Grade IV, it was observed that within 2 weeks was most predominant and for Grade III was 2-4 weeks. It was also found that the grade of clinical symptoms was not in proportion to the duration of admission treatment. 11. In regard to the result of treatment due to the grade of clinical symptoms; It was found that in the case of Grade IV, within 2 weeks was most predominant, and for Grade III, it was found to be 2-4 weeks. 12. Intestinal obstruction was shown in 50% of total patients; In the case of duration of constipation, more than 1 week was found to be most predominant, followed by 2 and 4 days respectively. 13. With regard to the treatment of intestinal obstruction, using acupuncture and moxibustion, herb - medicine and enema together were found to be most effective. 14. Intestinal obstruction was mostly seen in the case of Grade IV.

• Pediatric Infection and Vaccine
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• 제15권1호
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• pp.59-67
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• 2008

목 적 : 2008년 WHO 보고에 따르면, 전세계적으로 결핵의 유병률, 발생률, 사망률은 감소하고 있다. 우리나라에서 시행된 제 7차 전국결핵실태조사에서도 결핵 유병률이 감소하였으나, 최근 소아결핵 환자에 대한 보고는 드문 실정이다. 이에 저자들은 최근 20년간 결핵으로 서울대학교 어린이병원 소아청소년과에 입원한 환자들을 대상으로 소아결핵의 동향을 파악하고자 한다. 방 법 : 1988년부터 2007년까지 서울대학교 어린이병원 소아청소년과에 결핵으로 진단받고 입원 치료를 받은 만 15세 이하 환자의 임상 양상, 검사 소견, 방사선학적 소견 등을 의무 기록을 통해 후향적으로 분석하였다. 또, 5년 단위로 4개의 분기로 나누어 분기별 입원 환자 비율 및 주요 침범 부위의 변화를 분석하였다. 결 과 : 연구기간 중 결핵으로 입원치료 받은 환아는 총 186명으로, 남자가 59.1%였다. 진단시 나이의 중간 값은 55세(범위 : 10일-15세)였다. 결핵의 주요 침범 부위로는 폐가 54례(29%), 중추 신경계 49례(26.3%), 속립성 32례(17.2%), 림프절 15례(8.1%), 흉막 12례(6.5%), 골 및 관절 9례(4.8%), 장관 5례(2.7%), 복막 5례(2.7%), 심낭 2례(1.1%), 기타 3례(1.6%)이었다. 분기별 소아 전체 입원 환자에 대한 결핵 입원 환자의 비율은 1988-1992년의 0.61%에서 2003-2007년 0.09%로 통계적으로 의미있게 감소하였다(P for trend<0.001 by linear-by-linear association). 분기별 소아 전체 입원환자에 대한 폐결핵, 결핵성 수막염, 속립성 결핵 및 기타 폐외결핵 환자의 비율 또한 통계적으로 의미있게 감소하였다(P for trend<0.001, <0.001, 0.002, 0.008 by linear-by-linear association). 결 론 : 본 연구 결과 최근 20년간 서울대학교 어린이병원의 소아결핵 입원 환자비율은 감소하는 추세임을 확인하였다. 앞으로 소아결핵에 대한 국가적 또는 다기관 차원의 연구가 이루어져야 할 것으로 생각된다.

• 대한간호
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• 제36권5호
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• pp.45-62
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• 1998

The study was conducted from November 1995 to May 1996 at the one general hospital in Seoul. The total subjects of this study were 412 patients who have the experience of fall accident, among them 31 was who have fallen during hospitalization and 381 was who visited emergency room and out patient clinic. The purposes of this study were to determine the characteristics, risk factors and results of fall accident and to suggest the nursing strategies for prevention of fall. Data were collected by reviewing the medical records and interviewing with the fallers and their family members. For data analysis, spss/pc+ program was utilized for descriptive statistics, adjusted standardized $X^2$-test. The results of this study were as follows: 1) Total subjects were 412 fallers, of which 245(59.5%) were men and 167(40.5%) were women. Age were 0-14 years 79(19.2%), 15-44 years 125(30.4%), 45-64 years 104(25.2%), over 65 years 104(25.2%). 2) There was significant association between age and the sexes ($X^2$=39.17, P=0.00). 3) There was significant association between age and history of falls ($X^2$=44.41. P= .00). And history of falls in the elderly was significantly associated with falls. 4) There was significant association with age and medical diagnosis ($X^2$=140.66, P= .00), chief medical diagnosis were hypertension(34), diabetis mellitus(22), arthritis(11), stroke(8), fracture(7), pulmonary tuberculosis(6), dementia(5) and cataract(5), 5) There was significant association between age and intrinsic factors: cognitive impairment, mobility impairment, insomnia, emotional problems, urinary difficulty, visual impairments, hearing impairments, use of drugs (sedatives , antihypertensive drugs, diuretics, antidepressants) (P < 0.05). But there was no significant association between age and dizziness ($X^2$=2.87, P=.41). 6) 15.3% of total fallers were drunken state when they were fallen. 7) Environmental factors of fall accident were unusual posture (50.9%), slips(35.2%), trips (9.5%) and collision(4.4%). 8) Most of falls occurred during the day time, peak frequencies of falls occurred from 1pm to 6pm and 7am to 12am. 9) The places of fall accident were roads(22.6%), house-stairs 06.7%), rooms, floors, kitchen (11.2%), the roof-top, veranda, windows(10.9%), hospital(7.5%), ice or snowy ways(5.8%), bathroom(4.9%), playground, park(4.9%), subway-stairs(4.4%) and public-bathrooms (2.2%). 10) Activities at the time of fall accident were walking(37.6%), turning around or reaching for something(20.9%), going up or down stairs09.2%), exereise, working07.4%), up or down from a bed(2.7%), using wheelchair or walking aids, standing up or down from a chair(2.2%) and standing still(2.2%). 11) Anatomical locations of injuries by falls were head, face, neck(31.3%), lower extremities (29.9%). upper extremities(20.6%), spine, thorax, abdomen or pelvic contents(l1.4%) and unspecified(2.9%). 12) Types of injures were fracture(47.6%), bruises03.8%), laceration (13.3%), sprains(9.0%), headache(6.6%), abrasions(2.9%), intracranial hemorrage(2.4%) and burns(0.5%). 13) 41.5% of the fallers were hospitalized and average of hospitalization was 22.3 days. 14) The six fallers(1.46%) died from fall injuries. The two fallers died from intracranial hemorrage and the four fallers died of secondary infection; pneumonia(2), sepsis(1) and cell lulitis(1). It is suggested that 1) Further study is needed with larger sample size to identify the fall risk factors. 2) After the fall accident, comprehensive nursing care and regular physical exercise should be emphasized for the elderly person. 3) Safety education and safety facilities of the public place and home is necessary for fall prevention.

• Clinical and Experimental Pediatrics
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• 제48권9호
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• pp.986-990
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• 2005

목 적 : Lactobacilli의 일부 균주는 급성 설사의 회복을 도와 준다. Lactobacillus reuteri는 인간에서 비롯된 균주로 위장관 내에 자연적으로 집락형성을 한다. 특히 유아설사를 일으키는 로타바이러스를 억제하여 영유아 설사를 완화시켜주고 장내 다른 유익한 유산균 수를 증가시켜준다는 보고가 있다. 본 연구에서는 경구로 L. reuteri를 투여하였을 때 급성 설사에서 치료적 효과가 있는지 여부를 확인하고자 하였다. 방 법 : 급성 설사로 입원한 6개월에서 36개월 사이의 영유아 50명(40% 로타바이러스)을 대상으로 하였다. 환아들을 각 25명씩 무작위로 $10^8$ colony-forming unit(CFU)를 투여하는 L. reuteri군과 위약을 투여하는 위약군으로 나누어 하루에 2회 L. reuteri나 위약을 입원 기간 동안 혹은 최대한 5일간 투여하였다. 임상적인 평가로 입원 후 수양성 설사 기간, 입원 기간, 수양성 설사 일수 및 횟수, 구토 일수 등을 조사하였다. 결 과 : 설사 후 수양성 설사의 평균 기간은 L. reuteri군에서 2.3일이었으며 위약군에서 2.9일로 L. reuteri군에서 짧았으나 통계적 차이가 없었다(P=0.072). 치료 2병일째 수양성 설사는 L. reuteri군에서 64%이었으며 위약군에서 84%로 통계학적 차이가 있었다(P=0.006). 치료 2병일째 평균 수양성 설사횟수는 L. reuteri군에서 1.9회이었으며 위약군에서 3.4회로 통계학적 차이가 있었다(P=0.046). 치료 2병일째 구토는 L. reuteri군에서 16%이었으며 위약군에서 40%로 통계학적 차이가 있었다(P=0.031). 결 론 : 이상의 결과는 Lactobacillus reuteri가 영유아 설사에 치료효과가 있다는 것을 시사한다.

• Journal of Chest Surgery
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• 제43권3호
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• pp.285-291
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• 2010

배경: 흉부외상은 개발도상국인 나라에서 이환율과 사망률의 가장 많은 원인 중에 하나이다. 흉부둔상으로 발생하는 늑골골절은 외상의 중증도를 나타내는 중요한 지표이다. 연구의 목적은 늑골 골절을 치료시 이환율과 사망률을 확인 하고자 하였다. 대상 및 방법: 2002년 5월부터 2008년 12월까지 입원 후 3일 이내 타 병원으로 전원을 간 환자를 제외한 둔상으로 인한 늑골골절이 발생한 환자를 대상으로 후향적으로 연구하였다. 이 기간 동안 474명이 입원하였고, 454명이 연구에 포함되었다. 남자가 356명 여자가 9명이었고 평균나이는 53세(5~90세)였다. 결과를 예측하는 요소로 손상기전, 늑골 골절수, 중환자실 입원기간 그리고 ISS, 입원기간, 폐 합병증과 사망률을 조사 하였다. 결과: 외상의 기전으로 교통사고 189명(41.7%), 보행 중 넘어짐 103명(22.7%), 추락 85명(18.7%) 그리고 농기계 사고 30명(6.6%), 산업재해 32명(7.0%), 폭행 15명(3.3%)였다. 흉부내 손상으로 혈흉 269명(59.3%), 기흉 144명(31.7%) 폐좌상 95명(20.9%) 그리고 피하기종 29명(6.4%), 큰 혈관손상 5명(0.1%)이 있었다. 대부분의 환자는 보존적인 치료를 하였고, 흉관 삽관술 시행은 234명(51.5%)이었으며, 개흉술은 18명(4.0%)이었다. 평균 흉관삽관 기간은 $5.2{\pm}6.2$일이었다. 대부분의 환자는 일반 병동에서 치료를 하였으며, 평균 입원기간은 $22.5{\pm}20$일이었다. 평균 ISS 수치는 $14.8{\pm}10.9$ (3~75)였고 사망률은 4.9% (22명)였다. 입원기간에 영향을 주는 것은 늑골골절 수, 흉관삽관 기간, 폐질환 동반 그리고 산재보험 이었고, 사망에 영향을 미치는 요인으로는 폐좌상, ISS가 예후에 영향을 주는 주요한 요인이었다. 결론: 늑골 골절은 중증손상을 나타내는 지표이다. 합병증과 동반된 손상 때문에 늑골골절 환자들은 입원하여 치료하는 것이 좋다고 생각한다. 최근의 연구에서 40대 이하의 젊은 환자도 노년층의 환자와 같이 늑골골절로 인한 이환율과 사망률이 증가 한다고 한다. 우리의 연구에서는 ISS와 페좌상이 사망률에 영향을 주고 있다. 늑골골절이 1개 또는 이상인 늑골 골절만 있는 환자도 입원치료를 하는 것이 좋을 것으로 생각 한다.

• Journal of Chest Surgery
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• 제44권6호
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• pp.392-398
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• 2011

Background: The tetralogy of Fallot (TOF) with pulmonary atresia (PA) and a ductus-dependent pulmonary circulation (no major aorto-pulmonary collateral arteries (MAPCAs)) has been treated with staged repair or primary repair depending on the preference of surgeons or institutions. We evaluated the 19-year outcome of staged repair for this anomaly to find out whether our surgical strategy should be changed. Materials and Methods: Forty-four patients with TOF/PA with patent ductus arteriosus (PDA) who underwent staged repair from June 1991 to October 2010 were included in this retrospective study. The patients with MAPCAs were excluded. The average age at the first palliative shunt surgery was $40.8{\pm}67.5$ days (range: 0~332 days). Thirty-one patients (31/44, 70%) were neonates. The average weight was $3.5{\pm}1.6$ kg (range: 1.6~8.7 kg). A modified Blalock-Taussig (BT) shunt was performed in 38 patients, classic BT shunt in 4 patients, and central shunt in 2 patients. Six patients required concomitant procedures: pulmonary artery angioplasty was performed in 4 patients, pulmonary artery reconstruction in one patient, and re-implantation of the left pulmonary artery to the main pulmonary artery in one patient. Four patients required a second shunt operation before the definitive repair was performed. Thirty-three patients underwent definitive repair at $24.2{\pm}13.3$ months (range: 7.3~68 months) after the first palliative operation. The average age at the time of definitive repair was $25.4{\pm}13.5$ months (range: 7.6~68.6 months) and their average weight was $11.0{\pm}2.1$ kg. For definitive repair, 3 types of right ventricular outflow procedures were used: extra-cardiac conduit was performed in 30 patients, trans-annular patch in 2 patients, and REV operation in 1 patient. One patient was lost to follow-up after hospital discharge. The mean follow-up duration for the rest of the patients was $72{\pm}37$ months (range: 4~160 months). Results: Ten patients (10/44, 22.7%) died before the definitive repair was performed. Four of them died during hospitalization after the shunt operation. Six deaths were thought to be shunt-related. The average time of shunt-related deaths after shunt procedures was 8.7 months (range: 2 days~25.3 months). There was no operative mortality after the definitive repair, but one patient died from dilated cardiomyopathy caused by myocarditis 8 years and 3 months after the definitive repair. Five-year and 10-year survival rates after the first palliative operation were 76.8% and 69.1%, respectively. Conclusion: There was a high overall mortality rate in staged repair for the patients with TOF/PA with PDA. Majority of deaths occurred before the definitive repair was performed. Therefore, primary repair or early second stage definitive repair should be considered to enhance the survival rate for patients with TOF/PA with PDA.

• Clinical and Experimental Pediatrics
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• 제48권2호
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• pp.186-190
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• 2005

목 적 : 두개 내 생식 세포종 환자를 진단 시 저위험군 및 고 위험군으로 분류하여 화학요법의 강도에 차이를 두어 치료 반응 및 독성을 관찰하고자 하였다. 방 법 : 2002년 10월부터 2003년 12월까지 삼성서울병원에서 두개 내 생식 세포종으로 진단되고 화학요법으로 먼저 치료한 소아 환자 14례를 대상으로 하였다. 배아 세포종이면서 AFP가 정상이고 beta-hCG가 50 mIU/mL 이하이면 저위험군, 그 외에는 고위험군으로 분류하였다. 화학요법은 저위험군의 경우(cisplatin $20mg/m^2/day$ on days 0-4, 42-46; VP-16 $100mg/m^2/day$ on days 0-4, 42-46; cyclophosphamide $1g/m^2/day$ on days 21-22, 63-64; vincristine $1.5mg/m^2/day$ on day 21, 28, 35, 63, 70, 77)에 비해 고위험군에서는 cisplatin과 cyclophosphamide의 용량을 두 배로 사용하였다. 화학요법 종결 후 방사선 치료를 시행하였다. 결 과 : 진단 방법으로 생검 10례, 아전절제 2례, 부분절제 1례, 종양 호르몬의 상승으로만 진단한 경우가 1례였다. 진단 시 중앙연령은 11.6세(1.2-18.7세)였고 고위험군 9례, 저위험군 5례였다. 7례(50%)에서 요붕증이 동반되었다. 종양 호르몬의 상승을 보였던 10례 모두 화학요법 후 정상화되었으며, 저위험군 중4례(80%)와 고위험군 중 7례(77.8%)가 화학요법에 완전반응을 보였다. 화학요법 후 부분반응 상태였던 3례 중 2례는 방사선 치료 후 완전관해에 도달하였고 고위험군 1례는 방사선 치료 전이차 수술을 시행하여 원발 종양은 제거되었으나 척수에 재발하여 구제요법을 시행 중이다. 저위험군 4례(80%)와 고위험군 전예에서 감염증으로 인하여 2-4회의 입원이 필요하였다. 고위험군 9례 중 4례(44.4%)에서 이명과 청력장애 증상이 발생하였고 치료 종결 후에도 지속되었다. 이 중 3례에서는 감각신경성 난청으로 진행되었다. 청력장애를 보인 4례 중 3례는 요붕증이 동반된 환자였다. 1례를 제외한 13례가 정중 추적 기간 13.9개월(8.1-22.3개월)간 무사건 생존 중이다. 결 론 : 고용량의 cisplatin을 근간으로 한 치료 방법으로 고위험군에서도 고무적인 치료 반응을 유도할 수 있었다. 그러나 치료 독성의 빈도가 높아 치료 방침의 수정이 필요할 것으로 사료된다.