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의료법학 20주년 회고와 전망(의료형법 분야) (Retrospect and Prospect of Medical Law 20th Anniversary (Medical Criminal Law))

  • 하태훈
    • 의료법학
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    • 제20권3호
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    • pp.47-79
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    • 2019
  • 대한의료법학회는 지난 20년 동안 의료법 관련 학회의 향도로서, 학술활동과 그 축적된 업적, 그리고 학회 회원 구성의 다양성 및 전문성, 학계에 미치는 영향력 면에서 전문학술단체의 역할을 충실히 수행해 왔다. 대한의료법학회의 활동과 학술지 『의료법학』은 의료법학 관련 학술정보 및 의견교류의 플랫폼으로 기능하고 있다. 의료과오로 인한 갈등과 분쟁이 잦아지고 증가하는 상황, 의료에 대한 법제화와 법적 강제가 의료인을 직업수행에 압박으로 다가오는 상황 속에서 『의료법학』은 시작되었다. 의학과 법학의 조우와 융합을 통해서 서로 상생하는 방안을 찾고자 노력했던 것이다. 의료형법은 생명 및 신체보호의 영역에서 발생하는 전통적인 범죄에서 더 나아가 생명의료기술의 발전에 따른 생명윤리위반 행위와 의료영역에서의 부패 및 경제범죄 등으로 넓어지고 있다. 의료법학은 의료, 보건, 생명윤리, 생명과학기술 등에서 제기되는 법적 문제를 다루는 포괄적 법영역으로 발전하였다. 법적인 측면에서 보면 민법, 행정법, 형법, 사회법, 민·형사소송법 등 전통적인 법영역이 독립적이거나 중첩적으로 관련된 영역으로서 독자적인 법영역은 아니다. 그러나 이제는 법학 내에서의 여러 분야뿐만 아니라 의학, 생명윤리, 생명과학 등과의 융합법학으로서 자리하게 되었다. 법학, 의학, 윤리학, 사회학, 경제학 등 협업이 필요한 영역이 되었다. 의료형법은 지난 20년간 역동적인 발전을 거듭했다. 의학과 의료기술발전에 따라 새롭고 혁신적인 진단 및 치료방법을 제공하고 있다. 생명공학·유전공학과 의학의 혁명적 발전이 가져온 성과와 위험은 병존한다. 질병퇴치와 건강개선이라는 인류가 바라던 눈부신 성과가 있는 반면 원치 않은 부수적 효과와 인간에 대한 위험이 야기된다. 윤리적 및 법적 원칙들을 재고해야 할 필요성이 대두된다. 환자의 주체성과 자율성의 발견과 발전은 의사와 환자의 관계를 변화시켰다. 더 나아가 환자·의사·보험이라는 삼각관계로 법적인 문제도 복잡해진 것이다. 법제화의 필요성이 대두되는 이유다. 형사처벌 규정도 필요하다. 의료법 및 (생명)의료관계법령은 충분한 제·개정절차가 진행되기보다는 사회적 이슈와 시민의 요구, 의료인 등 이익단체의 요구가 있을 때마다 행해지는 모자이크식 입법으로 체계성과 정합성이 흠결되어 있다. 재정비가 필요한 부분인데, 이것이야말로 학회의 장점인 학제 간 협업으로 가능한 일이다.

이온크로마토그래프를 이용한 조제유류 및 영아용·성장기용 조제식 중 콜린 함량 분석법 연구 (Establishment of Choline Analysis in Infant Formulas and Follow-up Formulas by Ion Chromatograph)

  • 황경미;함현숙;이화정;강윤정;윤혜성;홍진환;이현영;김천회;오금순
    • 한국식품위생안전성학회지
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    • 제32권5호
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    • pp.411-417
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    • 2017
  • 본 연구는 "축산물의 가공기준 및 성분규격"에 기준규격은 설정되어 있지 않으나, 국제 기준과의 조화를 위해 콜린의 분석법을 마련하고자 수행하였다. 조제유류에 함유된 콜린 함량 분석을 위해 IC를 이용한 분석법을 확립하고 시중에 유통 중인 제품을 대상으로 적용성을 검토하였다. 콜린 표준품을 이용하여 IC를 이용한 기기분석조건을 확립하고 시료중의 콜린을 추출하여 분석하였다. 분석법 검증은 특이성, 직선성, 검출한계 및 정량한계, 정확성, 정밀성에 대해 수행되었다. 0.5~10 mg/L의 농도범위에서 $R^2=0.999$ 이상의 우수한 직선성을 확인할 수 있었으며, LOD와 LOQ는 각각 0.14, 0.43 mg/L였다. CRM (NIST SRM 1849a) 및 표준물질 첨가법을 이용하여 정확성을 검토하였으며, CRM에서 95%, 조제분유에서 90~91%, 조제우유에서 81~98%의 회수율을 확인할 수 있었다. 정밀성을 검토한 결과 시료 채취량에 따른 반복성은 RSD값이 조제분유 0.4~2.0%, 조제우유 0.5~1.5%, 영아용조제식 0.6~1.0%, 성장기용조제식 0.8~2.7%,로 확인하였으며, 실험일자에 따른 재현성은 조제분유 3.1%, 조제우유 2.5%, 영아용조제식 4.8%, 성장기용조제식 2.7%로 확인하였다. 본 연구에서 확립된 분석법을 적용하여 조제분유 11건, 조제우유 2건, 성장기용조제분유 9건, 영아용조제식 2건, 성장기용조제식 8건 등 국내 유통 중인 조제유류 및 영아용 성장기용조제식 등 32건에 대해 적용성 검토를 실시한 결과 전체 시료에서 분석이 용이하였으며, 모두 표시기준에 적합함을 확인하였다.

이산화탄소 해양 지중저장사업의 환경위해성평가관리 방안 (Scheme on Environmental Risk Assessment and Management for Carbon Dioxide Sequestration in Sub-seabed Geological Structures in Korea)

  • 최태섭;이정석;이규태;박영규;황진환;강성길
    • 한국해양환경ㆍ에너지학회지
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    • 제12권4호
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    • pp.307-319
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    • 2009
  • 이산화탄소를 포함하는 온실가스의 증가로 인한 기후변화 영향을 저감하기 위해 최근 이산화탄소의 포집 및 저장(CCS)과 관련된 많은 연구들이 이루어지고 있다. 포집된 이산화탄소의 저장은 저장용량이 큰 육상/해상의 유 가스전, 대수층, 석탄층과 같은 지질구조를 이용한다. 이산화탄소의 포집 및 저장과정에서 예상되는 가장 중요한 문제는 이산화탄소의 환경 중 유출에 의해 발생할 수 있다. 사업과정 또는 이후의 이산화탄소의 유출은 잠재적으로 환경 변화 및 서식 생물에 심각한 위해를 미칠 수 있는 것으로 우려된다. 저장된 이산화탄소의 유출에 의한 환경 위해를 최소화하고 과학적으로 관리하기 위해서는 환경위해성평가 결과를 바탕으로 위해도 저감 및 관리가 이루어져야 할 것이다. 위해성평가는 기본적으로 효율적인 위해도 관리를 위한 정책 결정 도구로 활용되며, 예상되는 위해요인과 인간 및 생태계에 미치는 영향과의 관계에 대한 신뢰성 있는 자료를 바탕으로 노출평가와 영향평가를 수행한 후 위해도를 산정하는 과정이다. 최근 국제해사기구(IMO)는 해저 지중저장 사업을 위한 위해성평가 체계에 대한 일반 지침서를 제시하였고, 모든 해저 지중저장 사업의 수행 주체는 이 지침서를 기본으로 사업 수행 전 과정에 대한 위해성평가관리 체계를 마련하도록 요구하고 있다. 이 지침서는 이산화탄소의 해저 지중저장에 대한 환경위해성평가는 저장 지역에 대한 특성파악, 유출시나리오에 기반한 노출평가, 누출된 이산화탄소에 의한 생물에 대한 직접적인 영향 및 환경 변화에 의한 간접적인 영향이 고려된 영향평가 등을 포함한다. 국내에서 시도되는 이산화탄소의 포집 및 해저 지중저장사업 또한 IMO의 지침서를 기반으로 하되 사업과 환경 특성에 적합한 위해성평가관리 시스템을 구축할 필요가 있다. 국내의 이산화탄소 해양 지중저장사업에 대한 위해성평가관리 체계 마련을 위해서는, 후보지역의 환경 특성에 대한 연구를 바탕으로 해양환경에서 이산화탄소의 물리화학적 거동에 대한 이해, 육상 및 해양환경의 배경 조건 및 특성 파악, 포집 후 수송, 지중저장 지질구조에 적합한 개연성 있는 유출시나리오에 기반을 둔 노출평가와 국내 생물종을 이용한 생태영향평가 자료의 생산과 DB화, 그리고 유출 감시 및 환경 모니터링 기법 개발 등이 반드시 이루어져야 한다.

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인구동태신고 및 통계조사의 개선방안 (A Study on Improvement of Vital Registration and Statistics System in Korea)

  • 신윤재
    • 한국인구학
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    • 제11권1호
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    • pp.58-75
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    • 1988
  • 1.Objectives of the Study It is a well known fact that a prompt and reliable data on demographic information is essential in a proper planning and evaluation of any program of national or community level. Especially vital statistics are an important demographic component among demographic information. Realizing the importance of vital statistics, the government has made some efforts for years to improve the vital registration system which has a close relationship with the production of vital statistics. However, it is still observed that there are some limitations in utilizing vital registration data due to considerable amount of vital events which are never registered and registered but not in time or inaccurately, even though vital registration system in Korea has sound legal basis. In this connection, the objectives of the study is as follows :(1) To examine some problems of the vital registration system in various aspects, (2) To make improvement programme of continuous Demographic Survey as a supplementary source of vital statistics, and (3) To find out some alternatives for making it possible to produce and utilize the reliable vital statistics by developing analytical methodologies on that. 2. Current Situation of Vital Registration System All the vital events, i.e. births, deaths, marriages and divorces, are to be registered in time under the Civil Registration Law, Statistics Law and Regulation on Vital Statstics as a duty of people. Some recent tendencies in each of recent registration are summarized as below: (1) The completeness of vital registration .Out of all births which are occurred during a year, around 75% of those compared to the estimates are registered in the year of occurrence. .In case of death registration, the percentage of registration in the year of occurrene has been gradually increased from 86.2% in the year of 1980, but it is still below the level of 90% compared to the estimates. .The percentage of registration for marriages and divorces in the year of occurrence out of total registered numbers was revealed to be 69% and 73% respectively in 1985. (2) Continuous Demographic Survey .It is a kind of sample survey for the purpose of producing reliable vital statistics which could not be provided by the vital registration. .It covers about 17, 000 sample households at national level and important information for vital events are collected in every month by 323 expertized enumerators who are regular staff of the government. .Although the result of the survey seems to be more reliable than of vital registration, the reliability of the data is still bellow the acceptable level if compared with relevant information from other sources such as population census or special surveys. 3. Problems of Vital Registration System There are four major obstacles in improving vital registration system in Korea; (1) In general, policy priority is not given on any programme of improving vital registration system. It is, therefore, very difficult to formulate comprehensive programme through having cooperation from related authorities and sufficient financial assistance. (2) In all the laws related and system itself, there is substantial degree of overlap and irrationality. Registration of each vital event is maintained according to several laws and regulation such as Civil Registration Law, Statistics Law, Resident Registration Law and Regulation on Vital Statistics. However they are mutually overlapped and overall supervision can not be done systematically due to lack of co-operation among the authorities concerned. (3) The administration of vital registration system seems to be working inefficiently, because of most of civil servants who are in charge of vital registration are lacking of conception on vital statistics and also there is a certain extent of regidity in handling the works. Therefore, they are doing their jobs in a passive way. (4) A substantial proportion of vital events occurred is not registered within the legal time limit (i.e. within one month after the occurrence in case of birth and death) or not registered forever. Some of social customs and superstitution seem to be the potential causes especially in case of births and deaths. 4. Recommendations for the Improvement of Vital Statistics (1) Reporting systems such as civil registration, vital statistics and resident registration should be integrated under the single law. Also, administrative supervision, personnel and budget with regard to the registration system should be under the control of a single ministry. (2) It is necessary to simplify the procedures and methods of reporting vital events, i.e., reducing number of sheets of the form, making corrections easily, reducing registration items, etc. (3) Continuous Demographic Survey as a supplementary source of vital registration should be improved and special ad-hoc surveys should be conducted wth regular interval. (4) In-depth analysis should be done using various sources of data on vital statistics. 5. Concluding Remarks From this study, we can notice that temporary campaign and motivation programs are not sufficient to improve the quality of vital statistics. Strong intentions and continuous efforts of the government are needed for the improvement of the vital registration system. Furthermore, most of the data collected through the registration are not properly analyzed and utilized, partly due to the lack of appreciation among high-level governmental officials of the need for vital statistics. It is, therefore, requested that long-term improvement programs of vital statistics be implemented with policy priority and continuous efforts be given to this purpose as a long-term goal of development in Korea.

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봉독이 피부 노화에 미치는 영향 (The Effect of Bee Venom Therapy on Skin Aging)

  • 김진명;김윤범
    • 한방안이비인후피부과학회지
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    • 제23권2호
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    • pp.27-40
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    • 2010
  • Background and Objective : Increasing interest in anti-aging and anti-wrinkling agents for the skin has triggered the recent outflow of researches and studies in this field. This study was designed to investigate the effects of bee venom on skin wrinkling and skin aging by testing the skin wrinkling, skin elasticity, trans-epidermal water loss (TEWL), free radical level, anti-oxidative agent level, and skin tissue after infusion of bee venom on hairless mouse. Materials and Methods : Fifteen hairless mice aged between 36~40 weeks were divided randomly into 3 Group; the Bee Venom Syringe Group, the Bee Venom Needle Group, and the control group. The Bee Venom Syringe Group were injected subcutaneously with bee venom (0.1cc in total) using an insulin syringe on three spots in the lumbar spine (one spot on the center and two spots 1~2cm to the side bilaterally). The Bee Venom Needle Group were pricked with bee venom-smeared acupuncture needles on three longitudinal spots in the lumbar spine each 1cm apart, after which the needles were removed 10 minutes later. The Control Group did not receive any form of intervention. All procedures took place thrice a week for four weeks, during which the mice were allowed free access to water and fodder. The mice were measured and compared in the weight, skin wrinkling scale, skin elasticity, and TEWL before and after the experiment. After the experiment, blood samples were taken to measure the free radical and anti-oxidative agent level, and the skin tissue was sliced for examination. Data was analyzed using the SPSS program (ver 12.0). The ANOVA analysis was used to compare and contrast the three groups, and t-test for paired samples was used to evaluate skin-wrinkling before and after experiment. The cut-off p-value of significance was set at p<0.05. Results : 1. Administration of bee venom did not cause serious weight loss or gain. 2. Compared to the control group, the Bee Venom Syringe Group and the Bee Venom Needle Group both showed a decrease in skin wrinkling scale after intervention. Especially, the Bee Venom Syringe Group showed a significant decrease (p<0.05). 3. Compared to the control group, the Bee Venom Syringe Group and the Bee Venom Needle Group both showed an increase in skin elasticity. Especially, the Bee Venom Syringe Group showed a significant increase (p<0.05). 4. No significant change in TEWL was found in the mice in all the three groups before and after experiment. 5. Free radical level was normal in all 15 mice in all the three groups, and anti-oxidative agent was not significantly different across the three groups. 6. The Bee Venom Syringe Group, the Bee Venom Needle Group, and the control group did not show any significant difference in the thickness of epidermis and dermis, infiltration of inflammatory cells, and skin wrinkling. The epidermis layer was relatively better preserved in the Bee Venom Syringe Group as compared to the Bee Venom Needle Group and the control group. Conclusion : Direct injection of bee venom on the hairless mouse using a syringe was found to improve wrinkling of the skin and increase skin elasticity but did not show effectiveness on skin dryness due to water loss. The bee venom appears to have suppressive effects on skin wrinkling, one of the symptoms of skin aging, through a process independent of suppression of free radicals or increase of anti-oxidative agent.

올리브유의 잔류농약 모니터링 및 노출량 조사 (Monitoring of Residual Pesticides and Exposure Assessment of Olive Oil Products Sold on the Market)

  • 손미희;김재관;이유진;김지은;백은진;김병태;이성남 ;박명기 ;박용배
    • 한국식품위생안전성학회지
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    • 제38권4호
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    • pp.211-216
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    • 2023
  • 시중 유통 중인 올리브유 100건의 잔류농약을 조사한 결과 64건에서 8종(difenoconazole, deltamethrin, oxyfluorfen, kresoxim-methyl, phosmet, pyrimethanil, tebuconazole, trifloxystrobin)의 잔류농약이 검출되었다. 검출된 농약을 중심으로 확인한 시험법의 결정계수(R2)는 0.998 이상 이었으며, 검출한계는 0.004 mg/kg-0.006 mg/kg, 정량한계는 0.012 mg/kg-0.017 mg/kg이었다. 0.01-0.02, 0.1 0.5 mg/kg 수준으로 측정한 회수율(n=5)은 66.8-119.5%, relative standard deviation (RSD)는 ±5.7% 이하로 나타나 식품등 시험법 마련 표준절차에 관한 가이드라인'에 적합한 수준임을 확인하였다. 검출된 농약 8종의 %ADI는 0.0001-0.1346으로 안전한 수준으로 나타났다. 본 연구는 유통 중인 올리브유의 잔류농약을 모니터링 함으로서 올리브유의 안전확보를 위한 기초자료를 제공하고자 하였으며 본 연구에서 이용한 분석법은 식품 자체가 기름으로 구성되어 있는 올리브유 등 식용유지에서 잔류농약을 효과적으로 분석할 수 있는 방법으로 활용될 수 있을 것으로 기대된다.

Modern Paper Quality Control

  • Olavi Komppa
    • 한국펄프종이공학회:학술대회논문집
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    • 한국펄프종이공학회 2000년도 제26회 펄프종이기술 국제세미나
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    • pp.16-23
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    • 2000
  • The increasing functional needs of top-quality printing papers and packaging paperboards, and especially the rapid developments in electronic printing processes and various computer printers during past few years, set new targets and requirements for modern paper quality. Most of these paper grades of today have relatively high filler content, are moderately or heavily calendered , and have many coating layers for the best appearance and performance. In practice, this means that many of the traditional quality assurance methods, mostly designed to measure papers made of pure. native pulp only, can not reliably (or at all) be used to analyze or rank the quality of modern papers. Hence, introduction of new measurement techniques is necessary to assure and further develop the paper quality today and in the future. Paper formation , i.e. small scale (millimeter scale) variation of basis weight, is the most important quality parameter of paper-making due to its influence on practically all the other quality properties of paper. The ideal paper would be completely uniform so that the basis weight of each small point (area) measured would be the same. In practice, of course, this is not possible because there always exists relatively large local variations in paper. However, these small scale basis weight variations are the major reason for many other quality problems, including calender blacking uneven coating result, uneven printing result, etc. The traditionally used visual inspection or optical measurement of the paper does not give us a reliable understanding of the material variations in the paper because in modern paper making process the optical behavior of paper is strongly affected by using e.g. fillers, dye or coating colors. Futhermore, the opacity (optical density) of the paper is changed at different process stages like wet pressing and calendering. The greatest advantage of using beta transmission method to measure paper formation is that it can be very reliably calibrated to measure true basis weight variation of all kinds of paper and board, independently on sample basis weight or paper grade. This gives us the possibility to measure, compare and judge papers made of different raw materials, different color, or even to measure heavily calendered, coated or printed papers. Scientific research of paper physics has shown that the orientation of the top layer (paper surface) fibers of the sheet paly the key role in paper curling and cockling , causing the typical practical problems (paper jam) with modern fax and copy machines, electronic printing , etc. On the other hand, the fiber orientation at the surface and middle layer of the sheet controls the bending stiffness of paperboard . Therefore, a reliable measurement of paper surface fiber orientation gives us a magnificent tool to investigate and predict paper curling and coclking tendency, and provides the necessary information to finetune, the manufacturing process for optimum quality. many papers, especially heavily calendered and coated grades, do resist liquid and gas penetration very much, bing beyond the measurement range of the traditional instruments or resulting invonveniently long measuring time per sample . The increased surface hardness and use of filler minerals and mechanical pulp make a reliable, nonleaking sample contact to the measurement head a challenge of its own. Paper surface coating causes, as expected, a layer which has completely different permeability characteristics compared to the other layer of the sheet. The latest developments in sensor technologies have made it possible to reliably measure gas flow in well controlled conditions, allowing us to investigate the gas penetration of open structures, such as cigarette paper, tissue or sack paper, and in the low permeability range analyze even fully greaseproof papers, silicon papers, heavily coated papers and boards or even detect defects in barrier coatings ! Even nitrogen or helium may be used as the gas, giving us completely new possibilities to rank the products or to find correlation to critical process or converting parameters. All the modern paper machines include many on-line measuring instruments which are used to give the necessary information for automatic process control systems. hence, the reliability of this information obtained from different sensors is vital for good optimizing and process stability. If any of these on-line sensors do not operate perfectly ass planned (having even small measurement error or malfunction ), the process control will set the machine to operate away from the optimum , resulting loss of profit or eventual problems in quality or runnability. To assure optimum operation of the paper machines, a novel quality assurance policy for the on-line measurements has been developed, including control procedures utilizing traceable, accredited standards for the best reliability and performance.

제조방법에 따른 떫은감 (Diosyros kaki Thumb.)의 대사체 프로파일링과 중성지질/콜레스테롤 대사 관련 유전자발현 연구 : in vitro 및 in vivo 연구 (Metabolites profiling and hypolipidemic/hypocholesterolemic effects of persimmon (Diosyros kaki Thumb.) by different processing procedures: in vitro and in vivo studies)

  • 박수연;오은경;임예니;신지윤;정희아;박송이;이진희;최정숙;권오란
    • Journal of Nutrition and Health
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    • 제51권4호
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    • pp.275-286
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    • 2018
  • 본 연구는 떫은감 청도반시의 분말을 열수 추출하고 칼럼 추출하는 과정에서 획득한 PWE와 TEP에 대한 대사체 프로파일을 분석하고, 유리지방산을 처리한 HepG2 세포와 식이로 고지혈증을 유도한 Wistar계 흰쥐의 간조직을 사용하여 중성지질 및 콜레스테롤 대사 관련 유전자 발현을 측정하였다. 대사체 분석은 가스크로마토그래프-질량분석법과 액체크로마토그래프-질량분석법을 사용하였으며, PLS-DA 분석과 heatmap 분석을 실시한 결과 PWE는 떫은감 분말과 비교적 유사한 대사체 프로파일을, 그리고 TEP는 떫은감 분말과 매우 다른 대사체 프로파일을 가지고 있음을 확인하였다. 세포실험과 또한 세포실험에서 얻어진 결과를 검증하기 위해 수행된 동물실험에서 PWE와 TEP는 모두 SREBP1c와 FAS 유전자 발현을 감소하여 간의 지방축적을 감소시키는 것으로 관찰되었으나, 콜레스테롤 축적을 억제하는 효능은 PWE에 비해 TEP에서 우세하게 증가하는 것이 관찰되었다. 특별히 TEP는 SREBP2, HMGCR 유전자 발현을 억제하고 LDLR 유전자 발현을 촉진하는 것으로 나타났다. TEP는 탄닌 중 Gallic acid 그리고 장쇄지방산아미드인 Oleamide와 Palmitamide 함량이 유의하게 증가되었으므로, 향후 이들 성분과 타깃 유전자의 상관성을 분석하고, 이를 통해 시스템네트워크로 나타내어 대사체 프로파일에 따른 지질 및 콜레스테롤 대사 간 상호 영향을 추가적으로 연구해야 할 것으로 사료된다.

전립선암의 근치적 방사선치료 (Radical Radiotherapy for Carcinoma of the Prostate)

  • 전하정;이명자
    • Radiation Oncology Journal
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    • 제19권1호
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    • pp.40-44
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    • 2001
  • 목적 : 전립선암 환자에서 외부 방사선치료의 효과 및 안전성을 평가하고 최적의 방사선치료 방법을 알아보고자 함이 본 연구의 목적이다. 재료 및 방법 : 1987년 9월부터 2000년 3월까지 본원에서 근치적 목적의 외부 방사선치료를 시행한 50명의 환자를 후향적으로 분석하였다. 요도관통 전립선 절제술 및 초음파를 이용한 조직검사를 시행하여 조직학적 진단을 확인하였다. 진단시의 주된 증상은 직장촉진시 전립선의 종괴 촉지, 빈뇨 및 급뇨, 소변시 통증호소 등이었다. 환자 나이의 분포는 51세부터 87세 이었고 중앙값은 63세이었다. A병기 환자는 6명, B병기 환자는 20명, C병기 환자는 26명, D1병기 환자는 8명이었다. 모든 환자는 10 백만볼트 에너지의 선형가속기를 이용하여 치료하였다. 4문대항 골반 상자 치료기법을 사용하여 $45\~50.4\;Gy$를 전골반부위에 조사 후 조사야를 축소하여 총조사량 $66\~70\;Gy$까지 추가조사를 실시하였다. 추적기간은 1년 내지 8년이었다. 결과 : A병기, B병기, C병기 및 D1병기 환자에서 5년 및 7년 실질 생존율은 각각 $100\%$$84\%,\;83\%$$72\%,\;67\%$$54\%,\;40\%$$30\%$이었다. 각각의 병기에서 5년 및 7년 무병생존율은 $84\%$$84\%,\;77\%$$67\%,\;48\%$$40\%,\;33\%$, 및 $25\%$이었다. B병기 환자에서 조직학적 분화에 따른 5년 무병생존율이 $ 80\%,\;80\%$$50\%$이었고, C병기 환자에서는 각각 $64\%,\;44\%$$33\%$이었다. 생존 5년시의 국소 제어율은 A, B, C, D1병기에서 각각 $84\%,\;85\%,\;78\%$$50\%$이었다. 경증 및 중등도의 합병증은 $22\%$의 환자에서 관찰되었고, 수술적 처치를 요하는 중증의 합병증은 $3\%$의 환자에서만 발생하였다. 결론 : 본 연구는 전립선암 환자에서 근치적 목적의 외부 방사선치료가 효과적이고 안전한 치료 방법임을 확인하였고 국소제어 및 생존율에서 만족할 만한 결과를 나타내었다.

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장티브스에 관한 임상적 관찰 (Clinical review of Typhoid Fever Patients)

  • 최정신
    • 대한간호학회지
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    • 제6권1호
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    • pp.60-71
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    • 1976
  • The author reviewed the medical records of 96 typhoid fever patients who were diagnosed, admitted, and treated at Sea grave Memorial Hospital from January 1 , 1973 through August 31, 1975. Diagnosis was determined by clinical observation, aerology and bacteriology, eighty patients were treated medically, the remaining 16 patients required surgical intervention. The following results were obtained: 1) The age distribution of the patients revealed that 33.3% wert between 10 and 19 years old 21.9% were between 20 and 29, and 19.8% were between 30 and 39. The majority of patients were from these more active age groups. Male to female sex ratio was 1.3 : 1 2) Seasonal distribution was observed. Most illness occurred in the summer and autumn month 5. 3) 84. 3%of the patients came from farm families. 4) Duration between onset and admission averaged 16.0 days. The group without compilations was admitted after an average of 15. 1 days; The group with complications was ad-matted after an average of 19.4 days. 5) Methods of treatment before admission were as follows: 10.4% at medical clinics, 61, 5% at pharmacies (antibiotics 47.9%, other. drugs 13.5%), 7.3% by herb medications, 20.8% had no treatment. 6) Main clinical symptoms were as follows: fever 93.8%, headache 47.9%, abdominal pain 47.9%, chills 38.5%, cough 36.5%, general weakness 26.0%, nausea e vomiting 24.0% and generalized pain 21.9%. 7) Temperature of patients on admission: 22.9% were 39f or more, 67.6% were between 37℃ and 38℃, and 9.4% were 37℃ or less. 8) Occurrence of intensional bleeding after onset of disease averaged 9.3 days; perforation occurred at an average of 19. 1 days. 9) Interval between onset of major complication and surgical intervention averaged 2.8 days. 10) Among the 68 patients who underwent the bacteriological test the positive rate was 44.1% (30). The positive ,ales to, each separate culture method were as follows: 20.4% in the blood culture, 40.4% in the stool culture and 6.7% in the urine culture. Among these bacteriological positive patients 15 patients had a negative results or less than 160 titer of vidal reaction. 11) The initial vidal test of the total group showed a counts of 160 titer or more in 60.4% and less than 160 titer in 39.6%, 12) W. B. C. Counts in the uncomplicated group indicated that 32.5% were 6,000/㎣ or less, 47.5% were between 6,000 and 10,000, arid 20.0% were 10,000/㎣ or more. In the complicated group, 37.6% were 6,000/㎣ or less, 25,0% were 6,000-10,000/㎣ and 37.6% were 10,000/㎣ or more. 13) Duration of hospital stay of the patients averaged 6.4 days in the uncomplicated group and 12.7 days in the complicated group. 14) Subdiaphragmatic free air simple X-ray was found in 91.7% of the perforated cases. 15) Duration of antibiotic therapy until an febrile state was attained averaged 4.8 days in the uncomplicated group and 6.5 days in the complicated group. 16) Operative procedures were as follows: one layer simple closure of their perforation with or without debasement in 56.3%, drainage only in 6.3%, small bowel resection with primary anastomosis in 18.8% , externalization in 6.3%, cholecystectomy in 6.3%, The clinical findings of this study suggest the following recommendations. According to Top's report; 1% of typhoid fever patients treated with chlorarnphenicol and 2% of patients treated with other drugs become chronic carriers. Therefore, importance should be given to the strict control of these carriers. Immunization, improvement of sanitation and living standards are all needed for the prevention and treatment of disease, but a more serious problem is a lack of knowledge on the part of patients and their families. Thus it is most urgent to enlighten the citizens about the transmission and hygiene related to contagious disease. Legal restriction of sale of antibiotics at drug stores without a physician's prescription is an urgent matter for public health administrators. An even more important nursing responsibility is the reemphasis on health education both in the clinical setting and in the home.

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