• 제목/요약/키워드: history of Korean medicine

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『비급천김요방(備急千金要方)』 장부온병(臟腑溫病)의 기전과 치법에 대한 고찰(考察) (A Study on the Mechanism and Treatment of the Zang-fu Warm Disease in the BeijiQianjinYaofang)

  • 安鎭熹
    • 대한한의학원전학회지
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    • 제37권2호
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    • pp.49-76
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    • 2024
  • Objectives : The purpose of this paper is to examine the mechanism and treatment of the Zangfu warm disease in the Beijiqianjinyaofang. Methods : This study examined the Zangfu warm disease content in the Beijiqianjinyaofang, Shanghanzongbinglun, Saninfang, based on the Neijing explanation of the pathological mechanism. Treatment was analyzed among the three texts in terms of their similarity and difference. Results & Conclusions : 1. Zangfu warm disease is caused by seasonally inappropriate qi, which is infectious, epidemic, and seasonal. 2. While the Qingjinqian disease pattern was explained in terms of the relationship between Shaoyin and Shaoyang, the actual disease pattern happened more in the Taiyang channel, and partly in the Shaoyang channel. For treatment of Fu deficiency pattern, the Chaihudihuangtang was listed in the Qianjinyaofang and the Shanghanzongbinglun, while in the Sanyinfang, the formula was modified to extinguish heat and thin phlegm, while reinforcing healthy qi. 3. The Chimaifei disease pattern was explained in terms of the relationship between Shaoyin and Taiyang that is deeply associated with Wei qi. For treatment of Fu deficiency the Qianjinyaofang and Shanghanzongbinglun used the Shigaodihuangtang, while the Sanyinfang reinforced healthy qi and eliminated pathogenic qi. 4. The Huangrousui disease pattern was explained as being caused by problems in the Taiyin and Yangming, in which the Triple Burner fails to control and manage cold dampness. In treating Zang excessiveness, the Qianjinyaofang and Shanghanzongbinglun used the Xuanshenhanshuishitang, while the Sanyinfang instructed to reinforce healthy qi and eliminate pathogenic qi. In treating Fu deficiency, the Sanyinfang instructed to warm the center and dry dampness, tonifying the Spleen and reinforcing qi. 5. The Baiqili disease pattern was explained within the relationship between Taiyin and Taiyang. In treating Fu deficiency, the Qianjinyaofang and Shanghanzongbinglun used the Shigaoxingrentang, while the Sanyinfang instructed to reinforce healthy qi and eliminate pathogenic qi. In treating Zang excessiveness, the Qianjinyaofang and Shanghanzongbinglun used the Shigaocongbaitang, while the Sanyinfang instructed to reinforce healthy qi and eliminate pathogenic qi. 6. The Heiguwen disease pattern was explained as being caused by stagnation and obstruction in the Triple Burner due to clash between Taiyang and Shaoyin. In treating Zang excessiveness, the Qianjinyaofang and Shanghanzongbinglun used the Kushenshigaotang, while the Sanyinfang instructed to reinforce healthy qi and eliminate pathogenic qi. The Zangfu Warm Disease is a infectious disease concept which is based on the Five Zang that integrates the meridian aspect together with the Six Fu with which there is an external/internal relationship. This concept and treatment could be considered in dealing with COVID-19.

풍(風)의 본질(本質)과 의학(醫學)에서의 운용(運用)에 관(關)한 고찰(考察) (Study on true nature of the Fung(風) and that of application to the medicine)

  • 백상룡;박찬국
    • 대한한의학원전학회지
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    • 제7권
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    • pp.198-231
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    • 1994
  • Up to now, after I had examined the relation between the origin of Fung(風) and Gi(氣) and the mean of Fung in medical science, I obtained the conclusion being as follows. The first, Fung(風) means a flux of Gi(氣) and Gi shows the process by virtue of the form of Fung, namely, Fung means motion of Gi. In other words, it is flow of power. Accordingly, the process of all power can give a name Fung. The second, Samul(事物) ceaselessly interchange with the external world to sustain the existence and life of themselves. And they make a adequate confrontation against the pressure of the outside. This the motive power of life action(生命活動) is Gi and shows its the process on the strength of Fung. The third, Samul(事物) incessantly releases power which it has to the outside. Power released to the outside forms the territory of the established power in the environment of them and keep up their substance(實體) in the space time(時空). It can be name Fung because the field(場) of this power incessantly flows. The fourth, man operates life on the ground of the creation of his own vigor(生氣) for himself as the life body(生命體) of the independence and self-support. The occurence of this vigor and the adjustment process(調節作用) is supervised by Gan(肝). That is to say, Gan plays a role to regulate and manage the process of Fung or the action of vigor with Fung-Zang(風臟). The fifth, because the Gi-Gi adjustment process(氣機調節作用) of Gan is the same as the process of Fung, Fung that operates the cause of a disease is attributed to the disharmony of the process of the human body Gi-Gi. Therefore, the generating pathological change is attributed to the extraordinary of the function by the incongruity of Gi-Gi(氣機) or the disorder of the direct motion of Gi-Hyul(氣血). Because the incongruity of this Gi-Gi of the human body gives rise to the abnormal of Zung-Gi(正氣) in the human body properly cannot cope with the invasion of 'Oi-Sa(外邪). Furthermore, Fung serves as the mediation body of the invasion of other Sa-Gi(邪氣) because of its dynamics, By virtue of this reason, Fung is named the head of all disease. And because the incongruity of the Gi-Gi has each other form according to Zang-Bu(臟腑), Kyung-Lak(經絡), and a region, the symptoms of a disease appear differently in line with them as well. The sixth, Fung-byung(風病) is approximately separated Zung-Fung(中風) and Fung-byung(猍義의 風病). Zung-fung and Fung-byung is to be attributed to the major invasion of each Jung-gi and Fung-sa(正氣와 風邪). But these two kinds stir up the problem to the direct motion of Gi-hyul(氣血) and the harmony of Gi-Gi in the human body. When one cures it, therefore, Zung-fung has to rectify Gi-Gi and the circulation of Gi-hyul on the basis of the supplement of Jung-gi(正氣) and Fung-byung must make the harmony of Gi-Gi with the Gu-fung(驅風). -Go-gi(調氣), Sun-Gi(順氣). Hang-Gi(行氣) - All existing living things as well as man maintain life on the ground of the pertinent harmony between the soul(精神) and the body(肉體). As soon as the harmony falls down, simultaneously life disappears as well. And Fung which means the outside process between Gi(氣) and Gi(氣) makes the action of their life cooperative and unified, Accordingy, the understanding of Fung, first, has to start wi th the whole thought that not only all Samul(事物) but also the soul and the body are one.

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面疱 患者에 對한 臨床的 硏究 (The clinical study of acne patients)

  • 채병윤
    • 한방안이비인후피부과학회지
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    • 제11권1호
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    • pp.251-268
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    • 1998
  • 125 Cases of Acne were treated by Acupuncture and Herb-med treatment during a three months duration from April 1996 to February 1998 in Kyung Hee Univ. Department of Ophthal, Otolaryngology. College of Oriental Medicine. We have observed the cases and the results as follows: 1. The age of average was 24.55 age : 21.91 in males, 24.55 in females. and in these, the gulf between males and females were showed statically significant diference. In the age of onset, averag was 16.96 age and mode was 18 age and male's average was 16.96 age, minimun was 11 age, maximum 40 age and female's average was 20.14 age, minimun was 10 age, maximum 40 age. and these were showed statically significant diference between males and females. 2. In the distribution of season, winter was the most with $37.8\%$ of out patients, the rest was similar to difference of each other. but there was clear difference between males and females. 3. In the duration of history, the average was 5.10 years and male's average was 5.13 years. on the other hand female's was 5.09 years but there is no any significant difference have a resemblance with each other. 4. In blood type, O type was the most with $35.20\%$ and there was in the order of A type was $26.40\%\;B\;type\;was\;23.20\%,\;AB\;type\;was\;15.20\%$ but these were not significant difference by the chi-tend and analysis of variance with total cases, males and females. 5. In select of the preference food, patients of the prefer worm food was $42.40\%\;and\;cool\;food\;was\;38.40\%,\;tepid\;food\;was\;24\%$ but these were no significant difference by the chi-test and ANOVA of each other. 6. the state of pulse classified into 11 type and average was 7.2 times, maximum was 29 times with Hyun Sae, at the same time, the female's average was 6.73 times, maximum was 27 times and male's average was 1.5 times. The result of test with each other, these were showed statically significant difference as compared total cases with males but there were not females ones. 7. In the frequency of the major cause, oversensitiveness was the most with $34.93\%$. secondly there was in order of indigestion $30.82\%$ and menstrual irregularity and menstruation pain $23.28\%$. constipation $10.96\%$ and these showed statically significant difference as compared the females with males on the result of test for difference with each other. 8. In frequency of the symptoms, itching was the most with $31.97\%$ and there was in order of nodule $20.49\%$, pustule $18.85\%,\;papule\;15.58\%,\;flare\;13.12\%$ and also these showed statically significant difference as compared the females with males 9. for the Distribution of acne region, face was the most with $64.06\%$ and there was in order of back $14.29\%,\;upper-chest\;11.69\%,\;neck\;7.79\%$ and there was no significant difference as compared total cases with males and females. 10. Acne applied 30 prescription to 4 weeks and over and 20 weeks and over was $23.3\%$, 30 weeks and over was $16.67\%$ and average of administration duration were 4.2 weeks(male's average 5.78, maximum 96 weeks and female's average 3.85, maximum 23 weeks) maximum was 96 weeks, minimum was 1 week. 11. In the acupuncture treatment, $96.6\%$ applied to acupuncture and average was 5.44 times, maximum 46 times, minimum 1 time(male's average 4.64, female's 5.62) but these were not any significant differeence. 12. for the medication, author made a investigation and comparison between control group with treated group in order to observe for the therapeutic effect during the 1 month and 2, 3. From these results, we can see that acne was improved by the oriental treatment. in the 1 month, average of control group was 13.24 and treated group was 11.78. these showed statically significant decrease in P<0.02 as compared the treated group with control group. In the 2 months, average of control group was 13.43 and treated group was 9.03. these showed statically significant decrease in P<0.003 as compared the treated group with control group. In the 3 months, average of control group was 13.78 and treated group was 8.06. these showed statically significant decrease in P<0.008 as compared the treated group with control group.

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복부대동맥류 치료의 임상적 고찰; 후복막 접근법과 경복막 접근법의 비교 (Clinical Study of the Treatments for Abdominal Aortic Aneurysm; Comparison between the Retroperitoneal and Transperitoneal Approaches)

  • 손봉수;정성운;이상권
    • Journal of Chest Surgery
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    • 제42권1호
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    • pp.34-40
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    • 2009
  • 배경: 1960년대 이래로 복부 대동맥류의 주된 수술적 접근 방법은 경복막 접근법이나, 최근에는 후복막 접근법을 이용한 향상된 수술 성적들이 보고되고 있다. 하지만 후복막 접근법과 경복막 접근법의 비교에 대한 국내 연구는 제한적이다. 대상 및 방법: 2001년 1월부터 2007년 7월까지 복부대동맥류로 진단 받고 수술적 대동맥 치환술을 받은 36명 중 후복막 접근법을 이용한 17명과 경복막 접근법을 이용한 19명의 수술 전 위험인자, 술 후 합병증, 수술 사망률을 비교 분석하였다. 전체 36명의 환자에서 수술사망의 위험인자를 조사하고 Kaplan-Meier 생존 분석을 이용한 술 후 장기 생존율 조사하였다. 결과: 대상 환자 중 두 군간에 성별, 연령, 동반 질환의 유무, 흡연력, 파열 유무, 술 전 증상간의 유의한 차이는 없었으며, 대동맥 재건술식, 수술시간 및 술 후 합병증의 발생빈도에서도 유의한 차이가 없었다. 그러나 후복막 접근법 군에서 술 후 금식 기간 및 비위관 제거 기간이 짧았으며(p<0.05), 중환자실 재실 기간에서도 경복막 접근법 군에 비하여 유의하게 짧았다(p<0.05), 수술 사망은 총 6명(16.7%)이었으며 그 중 5명이 술 전 파열된 경우로, 단변량 분석에서 수술 전 1.8 mg/dL 이상의 혈중 크레아티닌 수치를 보이는 경우(p=0.016)및 파열된 복부 대동맥류(p<0.001)가 유의한 수술 사망의 위험 인자로 조사되었다. Kaplan-Meier 생존율 조사에서는 두 군간의 장기생존율의 차이는 없었으며 전체 환자의 5년 생존율은 57.5%였다. 결론: 본 연구 결과 후복막 접근법이 경복막 접근법에 비하여 중환자실 재실 기간이 짧고 술 후 금식 기간 및 비위간 거치 기간이 짧은 장점이 있었다. 따라서 후복막 접근법에 대한 특별한 금기가 없다면 후복막 접근법을 일차적으로 고려하는 것이 좋을 것으로 사료된다.

소아정신과 환아 부모의 부부관계에 대한 연구 (A STUDY ON THE PARENTAL MARITAL RELATIONSHIP OF CHILD PSYCHIATRIC PATIENTS)

  • 임계원;홍강의;이근후
    • Journal of the Korean Academy of Child and Adolescent Psychiatry
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    • 제2권1호
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    • pp.160-175
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    • 1991
  • 본 연구의 목적은 가족의 기본이 되는 부부관계에 초점을 맞추어 부부관계와 부모자녀 관계 사이의 연관성을 알아보고자 1987년 7월부터 9월사이에 소아 정신과에서 치료받은 환아의 부모들과 일반 아동이 부모들을 대상으로 결혼 만족도 검사(Marital Satisfaction Inventory ; MSI)와 부부 적응도 척도(Dvadic Adjustment Scale ; DAS)의 두가지 설문지를 이용하였다. 환아 부모군은 환아의 진단면에 따라 정신증, 신경증, 틱, 자폐증, 정신지연의 5군으로 분류하였고 각군의 결과가 평가되었다. 1) 환아부모군은 대조군보다 결혼만족도가 낮다. 2) 환아부모군은 대조군보다 부부 적응도가 유의하게 낮다(P<0.01). 3) 환아부모군, 대조군에서 여자가 남자보다 역할개념이 더 진보적이며 환아부모군에서 역할부담이 여자에게 편중됨으로써, 양육갈등(conflict in child rearing)은 모성 우월현상과 연관됨을 시사한다. 4) 원래 가족의 고통스러운 가족력(Family History of Distress)는 결혼의 정서적 의사소통, 성생활, 자녀양육과 연관이 깊다. 5) 결혼 만족도 검사(Marital Satisfaction Inventory ; MSI)의 전반적 고통 척도(Global Distress Scale ; GDS)에 의하면 정신증, 신경증, 자폐증, 정신지체, 틱의 순서로 불만족도를 보였다. 6) 부부 적응도 척도(Dvadic Adjustment Scale ; DAS)에 의하면 정신증, 신경증, 틱, 자폐증, 정신지체의 순서로 부적응도를 보였다. 7) 틱군은 자녀양육 갈등 및 양육태도에 문제점을 시사하였고 부부관계 자체는 유의한 장애를 보이지 않았다. 위의 결과로서 부부의 부적응 및 불만족은 자녀양육 및 자녀문제와 밀접한 연관성이 있음을 시사하며 소아의 정신증과 신경증군의 발병요인은 결혼 불만족과 부적응과 관련이 깊으며 자폐증이나 정신지연군의 발병요인은 결혼 불만족과 부적응과 관련이 깊지 않음을 시사한다.

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『포박자내편(抱朴子內篇)』의 양생사상 연구 (A Study on the Regimen thought of Baopuzi inner chapters)

  • 신진식
    • 한국철학논집
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    • 제43호
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    • pp.231-266
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    • 2014
  • "포박자내편(抱朴子內篇)"의 주요 내용은 도(道)와 일(一)과 현(玄)을 중심으로 한 우주본체론을 중심으로 전개되는 신선이론과 '사람마다 도를 닦아 선을 이룰 수 있다'는 주장의 근거가 되는 '신선존재의 논증' 문제, 도교법술(道敎法術), 그리고 연단술(煉丹術)을 설명하는 고대과학(古代科學)등으로 이루어져 있다. 다시 말해서 "내편(內篇)"은 신선(神仙)의 도(道), 선인(仙人)이 되기 위한 약의 처방, 귀신요괴 변화의 여러 가지 상(相), 불노장수(不老長壽)를 얻는 방법 그리하여 사악(邪惡)을 벗어나고 화(禍)를 피하는 방법을 서술하고 있다. 이렇게 "내편"은 신선이론을 바탕으로 하는 양생사상, 수도(修道)의 철학적 함의 그리고 그 신비주의적 종교의 근거를 제시하고 있다. "내편"은 선진시대의 도가철학과 진한시대와 위진시대를 아우르는 신선사상을 종합하여 현실적으로 불노장생의 신선에 도달하는 방법을 구체적으로 제시하였다. 그리고 "내편"은 내단과 외단 도교 수행체계의 전형이 제시되어 있어서 도교(양생)사상사에서 중요한 위치를 점하고 있다. 양생사상은 바로 "내편"의 매우 중요한 내용이고 이는 갈홍이 건립한 신선도교의 중요한 이론적 기초를 이룬다. "내편"은 도교의 양생사상을 한 눈에 살펴볼 수 있다는 점에서 연구의 필요성이 절실하게 요구 된다. 이 논문은 바로 "내편" 속에 나타난 양생사상의 전체 모습을 밝히는 것을 목적으로 한다. 본문에서는 "내편"에 나타난 양생사상의 이론적 기초인 도론(道論), 형신론(形神論), 성명론(性命論), 신선론에 대한 분석 작업을 먼저 진행한 후에 이를 바탕으로 행기법(行氣法), 도인법(導引法), 조식(調息), 폐기(閉氣), 태식(胎息), 복기(服氣), 토납(吐納), 사신수일법(思神守一法), 현일(玄一), 진일(眞一), 금액환단법(金液還丹法), 방중술(房中術) 등의 양생법의 구체적 내용을 하나하나 살펴보았다. 그리고 끝으로 "내편" 양생사상의 특징을 밝혀보고 그 가치를 따져보았다.

종합병원 외래환자 진료시 의사의 보건교육활동 평가 (An Evaluative Study on Physician's Health Education Activities in Outpatient Medical Care)

  • 김숙자
    • 보건교육건강증진학회지
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    • 제2권1호
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    • pp.56-80
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    • 1984
  • The main objectives of the present study is to evaluate Physician's Health Education Activities by means of physician's direct response to the prepared questionnaire and patient's perception to the physician in the course of medical care. For the data collection, the present study was conducted from Aug. 16 to Oct. 7, 1983 for 739 patients and 91 physicians who were attended outpatient clinics of 5 general hospitals in Seoul. The major findings are summarized as follows: 1. Self-evaluation on Physician's Health Education Activities (1) In consideration of health education services for the patient, the data revealed that 9.9% of the sampled physician wanted to strength public health and preventive medicine lecture in the curricula at medical education. On the other hand, only 1.1% expressed that they wanted to make it short. (2) In consideration of the necessity of health education service, it was shown that 95.6% of physicians agreed to take it into consideration. Self expression for the practice of health education was placed on the 3.15 score when 5 point scale used. (3) To evaluate the degree of an explanation about medical care for the patient, Index score with 4 point scale was employed. The Index score for the first time was shown that scale was placed on 3.23 for 'diagnosis', 3.12 for 'progress of the disease', 3.11 for 'discription of procedure' and 3.02 for 'cause of the disease' respectively. In comparison of the physician's explanation about the status of disease for the first and the second visitors to clinic, they evaluated themselves as giving more detailed explanation for the second visitors rather than the first visitors. 2. Physician's Health Education Services evaluated by patients (1) To evaluate physician-patient communication at beginning time for taking history about disease, the Index score with 5 point scale was employed. The data on taking history have shown that the score placed on 3.07 for those patients who visited the first time and 2.53 for second visitors. And the score about listening from the patients was placed on 3.52 and 3.42 respectively. (2) The Index score with 5 point scale, as used before, was also employed to evaluate medical care services for the patient. The data evaluated by the patients was shown that the score placed on 4.21 for patient treatment in general, 4.58 for physician's credibility, and 3.6 for physician's kindness. However, approximately 80% of those who failed to understand physician's explanation was caused by highly sophisticated medical terminology. (3) According to the Index score with 4 point scale, to evaluate physician's explanation, the data was shown that the patient who visited the first time gave 2.51 for 'diagnosis', 2.35 for 'progress', 2.11 for 'cause of the disease' and so on. It is acknowledged on the whole that the patients who visited the second time have more satisfaction in physician's explanation about their disease, than those who visited the first time. 3. Comparison of self-evaluation of Physician's Health Education Activities and patient's perception. (1) There was communication barriers between physicians and patients in expressing some medical terminology. For example physician understood that they explained more than 50% of medical terminology into common words for the patient, but 30% of patient complained medical terminology used by physician. (2) Comparing the index score of health education practice recognized by patients and physicians for both first visit and revisit groups, it was shown that the Index score of health education activities evaluated by physicians themselves were slightly higher than the score evaluated by patients.

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IARS2 유전자 연관 리 증후군(Leigh syndrome) 여아에서 방광기능장애 증례 (A Case of Urologic Manifestation of IARS2-associated Leigh Syndrome)

  • 이현주;나지훈;이영목
    • 대한유전성대사질환학회지
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    • 제23권1호
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    • pp.25-30
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    • 2023
  • 아미노아실-tRNA 합성효소는 단백질을 만드는 번역(translation)단계에서 아미노산을 활성화시키고 적절한 아미노산을 해당 tRNA에 결합을 시키는 중요한 효소이며, IARS2 유전자는 미토콘드리아에서 작용하는 isoleucylt-RNA 합성효소를 코딩하는 핵의 유전자이다. IARS2 유전자의 돌연변이는 백내장, 성장 호르몬 결핍, 감각 신경병증, 감각신경성 난청, 골격 형성 이상 증후군의 특징을 보이는 CAGSSS (MIM#616007)라는 희귀 질환의 원인으로 상염색체 열성으로 유전된다. 현재까지 이 증례 보고를 포함하여 29명의 환자만이 보고가 되었음에도 단지 백내장의 증상만 나타냈던 환자, 그리고 신경학적 증상이 두드러지는 Leigh 증후군을 유발하면서 여러 장기에 영향을 주는 환자 등 다양한 임상 증상의 환자가 보고되었다. Leigh 증후군은 드문 진행성 신경 퇴행성 미토콘드리아 질환이다. 이 연구는 IARS2 연관된 Leigh 증후군의 환자에서 방광 기능의 이상의 표현형을 보고하는 첫 증례 보고로 의미가 있다. 5세의 한국인 여아는 복부 팽만을 동반한 복통으로 응급실에 내원하였으며, 복부CT에서 명백한 폐쇄 증상, 급성 신장염, 요로감염의 징후가 보이지 않으면서 현저하게 팽창된 방광이 확인 되었다. 여아의 발달 상태는 발달 저하를 보이면서, 6개월에 뒤집기가 가능하였지만 이후는 신경학적 퇴행으로 내원당시에는 목 가누기도 되지 않고, 의미 있는 단어를 말하지도 못하는 전반적인 발달 지연 상태였다. 2세에는 양쪽 눈의 백내장이 발생하여 수술한 과거력이 있었다. 뇌 MRI T2 강조영상에서는 양쪽에 대칭적으로 기저핵(basal ganglia)에 고신호를 보였고, 이는 Leigh 증후군에 전형적인 영상의 특징이다. Whole mitochondrial genome의 유전자검사를 시행했지만 의미 있는 돌연변이가 확인되지 않았으므로, Whole exome sequencing 검사를 시행했으며, IARS2 유전자의 이중대립유전자 돌연변이(biallelic mutation), c.2446C>T (p. Arg816Ter)와 c.2450G>A (p. Arg817His)가 확인이 되었고 부모님은 보인자였다. 현재까지 IARS2 유전자의 돌연변이를 가지는 환자 중에서 신경학적 발달 저하, 인지장애 등의 증상이 동반된 환자는 신체의 다중장기질환의 증상으로 심비대, 부정맥, 빈혈, 측만증, 청력 저하, 뇌전증, 부갑상선저하증이 알려졌으나, 이 연구에서 IARS2 유전자 돌연변이를 가진 환자에서 배뇨근의 이상을 동반한 과민성방광증상을 확인하여 방광이상증상을 처음 보고를 한다. IARS2 유전자의 이상이 확인된 환자에서는 하부요로이상증상이 동반 가능성에 대해서 인지하는 것이 필요하고, 증상이 보이면 배뇨 일지나 요역동학검사를 통해서 조기에 진단 및 치료가 환자의 관리에 필요할 수 있다. 이 증례 보고는 IARS2 유전자의 임상 양상의 확대 및 유전자의 이해를 넓히는데 기여할 것으로 기대된다.

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1개 종합병원 환자의 낙상에 관한 조사 (A Study on Fall Accident)

  • 이현숙;김매자
    • 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.

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일반의약품과 전문의약품 의도적 음독 자살 시도자 특성 분석 연구 (A Study on the Characteristics of Intentional Self-Poisoning Patients : Comparison between Non-Prescription and Prescription Drugs)

  • 조을아;조지현;조경형;심현보
    • 정신신체의학
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    • 제28권2호
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    • pp.116-125
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    • 2020
  • 연구목적 자살시도로 응급실에 내원한 환자들 중 음독이 가장 높은 빈도를 보이고 있다. 본 연구에서는 음독 의약품에 따른 자살 시도자들의 특성을 분석하여 향후 임상 진료 현장에서 도움이 될 제언과 자살 예방 정책을 마련하는데 기초자료를 제공하고자 하였다. 방 법 2011년부터 2019년까지 서울 소재 1개 종합 병원 응급실에 음독 자살 시도 후 내원한 환자 574명의 의무기록을 후향적으로 검토하였다. 의무기록을 통해 인구통계학적 정보 및 자살 과거력, 정신건강의학과 과거력, 정신질환 외 기저질환력, 음독 약물의 종류 및 양, 획득 경로, 단일 혹은 혼합 음독여부 등에 대해서 조사 후 카이제곱 검정 및 독립표본 t-검정을 사용하여 통계 분석하였다. 유의한 결과에 대해서는 위험률 산출을 위해 오즈비를 구하였다. 결 과 일반의약품 음독군이 전문의약품 음독군에 비해 연령은 유의하게 낮았으며 국민건강보험 외 비율은 낮고 배우자가 있는 비율은 유의하게 높았다. 전문의약품 음독군은 일반의약품 음독군에 비해 비자발적 응급실 내원, 정신질환력 및 정신질환 외 기저질환력에서 높은 비율을 보였다. 전문의약품 중 벤조디아제핀 음독군은 비음독군에 비해 본인 처방 비율이 높은 반면 졸피뎀 음독군은 타인처방 비율이 높았다. 벤조디아제핀, 졸피뎀, 항우울제 단독 음독군이 복합 음독군에 비해 유의하게 정신질환력이 없는 비율이 높았다. 결 론 일반의약품 판매 규제에 대한 가이드라인이 필요할 것이며 임상 현장에서 자살 고위험군의 특성을 유념한 면담이 필요하다. 또한 자살 위험성이 높은 환자들에게 전문의약품 처방 시 추적 관찰 기간 및 처방 기간, 포장 방식에 대한 적극적인 고려가 필요할 것으로 보인다.