• 대한핵의학회지
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• 제8권1_2호
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• pp.1-11
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• 1974

The author in an attempt to evaluate hemodynamic changes in the clinical stages of Korean hemorrhagic fever measured plasma volume, cardiac output and effective renal plasma flow utilizing radioisoto es during various phases of the disease. Cardiac output was measured by radiocardiography with external monitoring method using RIHSA. Effective renal plasma flow was obtained from blood clearance curve drawn by external monitoring after radiohippuran injection according to the method described by Razzak et al. The study was carried out in thirty-eight cases of Korean hemorrhagic fever and the following conclusions were obtained. 1. Plasma volume was increased in the patients during the oliguric-and hypertensive diuretic phases, while it was normal in the patients during the normotensive-diuretic phase. 2. Cardiac index was increased in the patients during the oliguric phase and was slightly increased in the patients at the hypertensive diuretic phase. It was normal in the other phases. 3. Total peripheral resistance was increased in the hypertensive patients during diuretic phase, while it was normal in the rest of phases. 4. Effective renal plasma flow was significantly reduced in the patients during the oliguric and diuretic phases as well as at one month after the oliguric onset. There was no significant difference between the oliguric and the early diuretic phases. Renal plasma flow in the group of patients at one month after the oliguric onset was about 45% of the normal, however, it returned to normal level at six months after the onset. 5. Clinical syndrome of relative hypervolemia was observed in some patients during the oliguric phase or hypertensive diuretic phase. Characteristic hemodynamic findings were high cardiac output and normal to relatively increased peripheral resistance in these cases. Relatively increased circulating blood volume due to decreased effective vascular space was suggested for the mechanism of relative hypervolemia. 6. Cardiac hemodynamic alteration returned to normal during late stage of the diuretic phase, while renal hemodynamic changes were normalized at six months after the onset.

• Journal of Chest Surgery
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• 제32권8호
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• pp.693-701
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• 1999

최근 혈관 질환의 진단을 위한 비침습적 영상이 발달하면서, 기존의 도자술은 중재적 치료에 국한되는 실 정이다. 그러나 관상동맥이나 우회로는 작은 직경, 심박동 움직임 등으로 도자술이 아직도 진단에 필수적이 며, 비침 응\ulcorner영상 진단의 마지막 도전 영역이다. 전자선 단층 촬영기는 높은 시간 해상능으로 심장 영상을 얻을 수 있다. 전자선 단층 촬영을 이용하여 모관상 동맥 협착이나 관상동맥 우회로 이식술 후 개존성의 평 가가 시도되고 있으며, 이중 관상동맥 우회로술 평가의 정확도는 매우 높아서 임상 적용이 가능하다. 저자와 다른 연구자의 경험에 의하면 복재 정맥은 넓은 직경, 비교적 짧고 직선적인 경로, 심박동에 덜 영 향 받음으로써 EBT조영술의 정확도가 높았다. 전향적 민감도와 특이도가 각각 92%, 97%를 보였다. 그러나 위양성과 위음성을 보인 두 예는 후향적으로 분석 할 때 경험 부족에 의한 초기의 판독 오류로 사료되어 복 재 정맥의 경우 후향적으로는 100%의 정확도를 보였다. 반면 내유동맥 이식혈관은 작은 내경과 주변의 수술 클립에 의한 인공산물로 개존성을 확인하기가 대체로 어려웠고, 역동적 검사를 병행하여 우회로내 혈류를 확인하는 것이 필요하다. 내유동맥의 경우 상대적으로 정확도가 낮아 민감도, 특이도가 각각 100%, 80%를 보였으며, 위양성을 보인 2예는 후향적으로도 개존을 확인할 수 없었다. 전자선 단층 촬영 혈관 조영술은 관상 동맥 우 막\ulcorner이식술 후의 우회 혈관 개존성의 평가, 특히 복재 정맥 우회로의 경우 매우 정확도가 높은 비침습적 검사로써, 임상 적용이 기대된다. 앞으로 촬영 기기와 영상 재구성 software의 발달로 정확도를 더욱 높일 수 있는 잠재성이 있다.

• 대한두경부종양학회지
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• 제17권2호
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• pp.205-209
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• 2001

Purpose: Most cases of primary hyperparathyroidism are due to parathyroid adenoma or parathyroid hyperplasia. Parathyroid carcinoma is a very rare cause of hyperparathyroidism. Although the diagnosis of parathyroid carcinoma is usually established by pathologic criteria especially of vascular or capsular invasion, some clinical and biochemical features differentiate it from benign forms of hyperparathyroidism. We under-took a retrospective study in 6 patients with parathyroid carcinoma, with the aim of conveying experience from management for this rare cause of hyperparathyroidism. Methods: Clinical symptoms, biochemical laboratory, radiologic, and intraoperative findings, local recurrence and distant metastasis were analyzed in 6 patients diagnosed pathologically as a parathyroid carcinoma after operation from 1992 to 2001. Results: Mean age was 50.2 years (33.0-60.0 years) and male to female ratio was 1:1. Neck mass was found in 5 patients, multiple bone pain in 3 patients and renal stone in 1 patient. One case has suffered from chronic renal failure for 19 years. Although preoperative laboratory evaluations showed the aspects of hyperparathyroidism in all cases, mean serum calcium level was 11.2mg/dl(10.5-12.1mg/dl), slightly elevated. Laboratory values after surgery were within the normal range in 5 cases. However, in one case with chronic renal failure, serum PTH levels, serially checked, were above the normal range. Any of imaging methods failed to suggest a parathyroid carcinoma preoperatively. Parathyroid adenoma was suspected in 3 cases, thyroid cancer in the other cases before surgery. The extent of resection was radical resection of parathyroid lesion with more than unilateral thyroid lobectomy and central compartment neck node dissection and in 2 cases, the resection of recurrent laryngeal nerve or strap muscles was added. During follow-up period, any local or systemic recurrence were not evident in all the cases. Conclusion: Although parathyroid carcinoma is a rare disease and its preoperative diagnosis, in our experience, could not easily be made, the understanding of characteristic clinical and biochemical feature could help diagnosis at first surgery. Radical resection without remaining residual tumor is most important for the management of the parathyroid cancer.

• Asian Pacific Journal of Cancer Prevention
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• 제16권6호
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• pp.2465-2472
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• 2015

Background: The Quality Audit (BQA) program of the Breast Surgeons of Australia and New Zealand (NZ) collects data on early female breast cancer and its treatment. BQA data covered approximately half all early breast cancers diagnosed in NZ during roll-out of the BQA program in 1998-2010. Coverage increased progressively to about 80% by 2008. This is the biggest NZ breast cancer database outside the NZ Cancer Registry and it includes cancer and clinical management data not collected by the Registry. We used these BQA data to compare socio-demographic and cancer characteristics and survivals by ethnicity. Materials and Methods: BQA data for 1998-2010 diagnoses were linked to NZ death records using the National Health Index (NHI) for linking. Live cases were followed up to December $31^{st}$ 2010. Socio-demographic and invasive cancer characteristics and disease-specific survivals were compared by ethnicity. Results: Five-year survivals were 87% for Maori, 84% for Pacific, 91% for other NZ cases and 90% overall. This compared with the 86% survival reported for all female breast cases covered by the NZ Cancer Registry which also included more advanced stages. Patterns of survival by clinical risk factors accorded with patterns expected from the scientific literature. Compared with Other cases, Maori and Pacific women were younger, came from more deprived areas, and had larger cancers with more ductal and fewer lobular histology types. Their cancers were also less likely to have a triple negative phenotype. More of the Pacific women had vascular invasion. Maori women were more likely to reside in areas more remote from regional cancer centres, whereas Pacific women generally lived closer to these centres than Other NZ cases. Conclusions: NZ BQA data indicate previously unreported differences in breast cancer biology by ethnicity. Maori and Pacific women had reduced breast cancer survival compared with Other NZ women, after adjusting for socio-demographic and cancer characteristics. The potential contributions to survival differences of variations in service access, timeliness and quality of care, need to be examined, along with effects of comorbidity and biological factors.

• 대한물리치료과학회지
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• 제8권1호
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• pp.787-798
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• 2001

This study was performed to investigate the necessity and the features of adequate services of home visiting physical therapy for chronic ill patients. The study subjects were physical therapist visited in Taejon for Korea Physical Therapy Association Seminar on March 19, 2000. Authors developed questionnaire and distributed it to each physical therapist attended at the Seminar. The number of distributed questionnaire was 1,500, and 487 questionnaire were collected and 388 questionnaire analysed finally. 1. The rate of necessity for home visiting physical therapy by kinds of disease was 70.6% in cerebral palsy, 84.3% in spinal cord injury, 89.7% in cerebral vascular accident and traumatic brain injury, 20.1 % in other diseases. 2. The rate of necessity of education for home visiting physical therapy was 94.5% of men, 97.3% of women. 54.4% of answerer replied that the best education method was that developed clinical program. 3. In the general features of adequate service for home visiting physical therapy, 70.9% of men and 69.1 % of women want special isolated physical therapy center, 61.8% of men and 63.7% of women want distance of 15minutes-29minutes by car. 59.4% of men and 47.5% of women want 3 times per week in frequency(P<0.05), 70.9% of men and 61.0% of women want 30-60minutes in treatment duration. and 47.2% of men and 51.6% of women want to teach only evaluation and treatment method. 4. In the payment of adequate service for home visiting physical therapy, 47.9% of men and 49.3% of women want insurance with private charge (P<0.05), 58.8% of men and 55.2% of women want insurance direct charge and traffic fee and visiting fee for the private charge. 37.0% of men wants 4,000won-4,900won and 32.7% of women wants 2,000won-2,900won for the traffic fee. 43.0% of men wants 5,000won-9,900won and 48.0% of women wants 5,000won-5,900won for the visiting fee. 5. In the qualifications for home visiting physical therapy, 44.8% of men wants to have license and learn home treatment method but 47.1% of women wants to have license and career and learn home treatment method(P<0.05). In the career, 38.8% of men wants above 5 years, 39.5% of women wants above 3 years(P<0.01). 63.0% of men and 66.4% of women answered with unconcern but 18.8% of men wants physical therapist worked in general hospital and 20.6% of women wants in welfare center(P<0.01). 92.7% of men and 92.4% of women answered no interested in physical therapist's gender. The most preferential age of home visiting physical therapist was also no interested in physical therapist's age.

• Clinical and Experimental Pediatrics
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• 제49권4호
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• pp.455-459
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• 2006

급성 호흡곤란 증후군은 다양하게 유발되는 신체의 손상에 대한 방어기전으로 염증반응이 유발되어 생성되는 폐포 내의 부종으로 인해 호흡곤란과 저산소증이 초래되는 질환이다. 이 질환에서 표면활성제의 결핍과 폐포 표면 장력의 증가로 인해 폐포 동원에 장애가 오는 것이 결정적인 병인이고 표면활성제의 보충이 저산소증을 개선시킴으로써 중요한 치료 방안이 될 수 있다는 가설이 제시되었고 실제로 소아 환자들에서 저산소증을 개선시키고 증상의 호전을 얻었던 보고들이 여러 차례 있었다. 또한 이 질환의 주요 병인인 폐에서의 염증 반응에 주안점을 두고 스테로이드를 투여해 본 연구들에서 저용량 methylprednisolone으로 증상이 호전되고 생존율이 향상되었다는 결론을 얻은 바 있으나 두 치료 모두 ARDS에서 일반적인 적용은 확립되어 있지 않은 실정이다. 저자들은 급성 호흡곤란 증후군으로 진단받은 61일된 소아가 인공 호흡기 등의 보존적인 치료에 반응하지 않고 지속적으로 증상의 악화를 보이다가 표면활성제 120 mg/kg를 기도 내로 주입한 후 호흡곤란 증상과 저산소증 호전되고 $PaO_2/FiO_2$ 상승, 이후 저용량 methylprednisolone을 투여(2 mg/kg 14일간, 1 mg/kg 7일간, 0.5 mg/kg 7일간, 0.25 mg/kg 2일간, 0.125 mg/kg/d 2일간)한 후 2개월간의 추적 관찰에서 증상의 재발없고 방사선학적 검사상 섬유화 등의 합병증을 보이지 않았던 1례를 보고하는 바이다.

• 사상체질의학회지
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• 제12권1호
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• pp.228-239
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• 2000

1. 연구목적 소음인(少陰人) 성향정기산(星香正氣散)은 "동의수세보원(東醫壽世保元)"의 곽향정기산(藿香正氣散)에 남성(南星)과 목향(木香)의 두 가지 약물이 가미되어 이루어진 처방이다. 이는 소음인이한병(少陰人裏寒病)을 치료하는 처방으로 근래에는 뇌졸중을 비롯한 중추신경계통 질환에 많이 사용되고 있다. 이러한 소음인(少陰人) 성향정기산(星香正氣散)의 용도를 과학기기를 이용하여 기전을 규명하고자 하였다. 2. 연구방법 백서를 urethane으로 마취시키고 소음인(少陰人) 성향정기산(星香正氣散)을 투여한 후 Pressure Transduer와 Laser-Doppler flowmetry를 이용하여 백서의 혈압과 국소뇌혈류량을 측정하였으며 이를 구성약물까지 진행하였다. 또한 소음인(少陰人) 성향정기산(星香正氣散)의 대뇌혈류에 관한 기전 규명을 위하여 propranolol과 methylene blue로 전처치한 후 소음인(少陰人) 성향정기산(星香正氣散)을 투여하여 이를 분석하였다. 3. 결과 및 결론 소음인(少陰人) 성향정기산(星香正氣散)의 투여로 혈압의 유의한 변화는 없었으며, 국소뇌혈류량은 유의하게 증가되었다. 구성약물 중 소엽(蘇葉), 창출(蒼朮), 대복피(大腹皮), 남성(南星)은 국소뇌혈류량을 유의하게 증가시켰으며 목향(木香)은 국소뇌혈류량을 유의하게 감소시켰다. 이 실험으로 소음인(少陰人) 성향정기산(星香正氣散)의 국소뇌혈류량 증가의 기전은 교감신경 ${\beta}$-수용체와 cyclic GMP의 생성효소인 guanylyl cyclase의 작용과 관련이 있는 것으로 생각된다.

• 사상체질의학회지
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• 제12권1호
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• pp.216-227
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• 2000

1. 연구목적 태음인(太陰人) 청심연자탕(淸心蓮子湯)은 "동의수세보원(東醫壽世保元)" 태음인병 24처방 중에 기재된 신정방으로 태음인 간조열증(肝燥熱證)에 응용되는 처방이다. 근래에는 뇌졸중을 비롯한 중추신경계통 질환에 많이 사용되고 있다. 이러한 태음인(太陰人) 청심연자탕(心蓮子湯)의 용도를 과학기기를 이용하여 기전을 규명하고자 하였다. 2. 연구방법 백서를 urethane으로 마취시키고 태음인(太陰人) 청심연자탕(淸心蓮子湯)을 투여한 후 Pressure Transducer와 Laser-Doppler flowmetry를 이용하여 백서의 혈압과 국소뇌혈류량을 측정하였으며 이를 구성약물까지 진행하였다. 또한 태음인(太陰人) 청심연자탕(淸心蓮子湯)의 대뇌혈류에 관한 기전 규명을 위하여 propranolol과 methylene blue로 전처치한 후 태음인(太陰人) 청심연자탕(淸心蓮子湯)을 투여하여 이를 분석하였다. 3. 결과 및 결론 태음인(太陰人) 청심연자탕(淸心蓮子湯)의 투여로 혈압의 유의한 변화는 없었으며, 국소뇌혈류량은 유의하게 증가되었다. 구성약물 중 연자육(蓮子肉), 맥문동(麥門冬), 천문동(天門冬), 원지(遠志), 산조인(酸棗仁), 룡안육(龍眼肉), 나복자, 감국(甘菊)은 국소뇌혈류량을 유의하게 증가시켰다. 이 실험으로 태음인(太陰人) 청심연자탕(淸心蓮子湯)의 국소뇌혈류량 증가의 기전은 교감신경 ${\beta}$-수용체와 cyclic GMP의 생성효소인 guanylyl cyclase의 작용과 관련이 있는 것으로 생각된다.

• Asian Pacific Journal of Cancer Prevention
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• 제14권3호
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• pp.1715-1720
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• 2013

Background: The discovery that microRNAs (miRNAs) regulate proliferation, invasion and metastasis provides a principal molecular basis of tumor heterogeneity. Microvessel distribution is an important characteristic of solid tumors, with significant hypoxia occurring in the center of tumors with low blood flow. The distribution of miR-374a in breast tumors was examined as a factor likely to be important in breast cancer progression. Methods: Breast tissue samples from 40 patients with breast cancer were classified into two groups: a highly invasive and metastatic group (HIMG) and a low-invasive and metastatic Group (LIMG). Samples were collected from the center and edge of each tumor. In each group, six specimens were examined by microRNA array, and the remaining 14 specimens were used for real-time RT-qPCR, Western blot and immunohistochemical analyses. Correlation analysis was performed for the miRNAs and target proteins. Follow-up was carried out during 28 months to 68 months after surgery, and survival data were analyzed. Results: In the LIMG, the relative content of miR-374a was lower in the center of the tumor than at its edge; in the HIMG, it was lower at the edge of the tumor, and miR-374a levels were lower in breast cancer tissues than in normal tissues. There was no difference between VEGF-A and VCAM-1 mRNA levels at the edge and center of the tumor; however, we observed a significant difference between VEGF-A and VCAM-1 protein expression levels in these two regions. There was a negative correlation between miR-374a and target protein levels. The microvessel density (MVD) was lower in the center of the tumor than at its edge in HIMG, but the LIMG vessels were uniformly distributed. There was a significant positive correlation between MVD and the number of lymph node metastases (Pearson correlation, r=0.912, P<0.01). The median follow-up time was 48.5 months. LIMG had higher rate of disease-free survival (100%, P=0.013) and longer median survival time (66 months) than HIMG, which had a lower rate of 75% and shorter median survival time (54 months). Conclusions: Our data demonstrated miR-374a to be differentially distributed in breast cancer; VEGF-A and VCAM-1 mRNA had coincident distribution, and the distribution of teh respective proteins was uneven and opposite to that for the miR-374a. These data might explain the differences in the distribution of MVD in breast cancer and variation in breast cancer prognosis.

• Journal of Chest Surgery
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• 제37권4호
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• pp.342-348
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• 2004

말기 신부전 환자의 생명 유지를 위한 혈액투석 치료에 있어서 지속적으로 개존상태가 유지되고 충분한 혈액이 관류되는 투석 경로의 확보는 매우 중요하다. 동정맥루 조성술 시행 후 조기 폐쇄로 인해 투석을 시행하지 못하는 경우, 환자는 경정맥 또는 대퇴정맥 등의 중심 정맥 삽관을 반복적으로 시행 받아 혈액투석을 유지해야 하며 경제적, 시간적 손실을 감수해야 하는 어려움을 겪게 된다. 대상 및 방법: 자가 혈관을 이용한 동정맥루 조성술에 있어 조기개존율에 영향을 미치는 요인을 파악하고, 이를 향상시키기 위해서 2002년 6월부터 2003년 5월까지 1년 간 말기 신부전 환자에게 시행한 총 85예의 동정맥루 수술 중 두부정맥(cephalic vein)과 요골동맥(radial artery)의 단측문합(end-to-side anastomisis)을 시행한 49예를 대상으로 임상분석을 하였다. 걸과: 연구대상 49예에서 조기개존율은 79.6%였다. 환자의 나이나 성별, 고혈압과 당뇨병 유무에 따른 개존율의 차이는 없었으며 환자의 체질량지수 및 고혈압과 당뇨의 유병기간, 술 전 듀플렉스 검사로 측정한 요골동맥의 직경에 따른 조기개존율의 차이는 통계적으로 유의하지 않았다. 수술 전 듀플렉스 검사로 측정한 두부정맥의 직경과 수술 시 측정한 동정맥루의 혈류량이 조기개존율과 유의한 양의 상관관계를 나타내었고, 특히 혈관직경 2.7mm가 초과되는 군에서는 조기 폐쇄 없이 개존율이 100%로 유지되었으며 동정맥루의 혈류량이 100mL/min 이하인 군에서는 조기개존율 33.3%로 100 mL/min초과인 군의 82.2%와 비교할때 유의하게 조기개존율이 낮았다. 결론: 동정맥루에 사용되는 정맥의 직경은 개존율과 밀접한 관련이 있어 가능한 한 직경이 큰 정맥을 선택해야 하며 연구에 따라 다양한 기준이 보고되어 왔으나 보다 정확한 예후 판단을 위해서는 정맥의 직경뿐 아니라 혈관 유출로의 혈류와 협착상태 등에 대한 파악이 필요할 것으로 생각된다. 본 연구에서 측정한 수술 시 동정맥루의 혈류량을 기준으로 판단할때, 100 mL/min 이하의 혈류량을 나타내는 radiocephalic fistula에서는 혈류량 감소의 원인을 찾아 교정술을 시행하고 그 이후에도 혈류량이 증가하지 않을 경우 다른 부위의 혈관 또는 인조혈관의 사용을 고려하여야만 할 것이다.