백서모델에서 방사선 직장염 유발인자로서의 Nitric oxide의 역할

PURPOSE: Proctitis is one of acute complications encountered when radiotherapy was applied to the pelvis. Radiation-induced proctitis represents similar microscopic findings that are observed in inflammatory bowel disease (IBD). Nitric oxide (NO) plays an important role in the inflammatory process and many data suggest a close relationship between NO production and gastrointestinal inflammation. This study was aimed to establish the optimal radiation dose for radiation-induced proctitis in rat and to find a relationship between radiation proctitis and NO production. MATERIALS AND METHODS: Female Wistar rats, weighing from 150 to 220 g, received various doses(10-30 Gy) of radiation to the rectum. On the 5th and 10th day after irradiation, rectal specimens were evaluated grossly and microscopically. In addition, the degree of NO production by irradiation dose was evaluated by study with NOS expression and nitrite production in the irradiated rectal tissue. To evaluate relationship between radiation proctitis and NO, we administered aminoguanidine, iNOS inhibitor and L-arginine, substrate of NOS to rats from 2 days before to 7 days after the irradiation. RESULTS: There were obvious gross and histological changes after 17.5 Gy or higher radiation dose but not with 15 Gy or less radiation dose. Twenty Gy or higher dose of radiation caused Grade 4 damage in most of rectal specimens which were more likely to be related to the late complications such as fibrosis, rectal bleeding and rectal obstruction. A single fraction of 17.5 Gy to the rat rectum is considered to be an optimal dose to produce commonly experienced proctitis in the clinic. The result demonstrated that severity of microscopic damage of rectal mucosa from irradiation significantly correlated with iNOS overexpression. However, administration of iNOS inhibitor or substrate of iNOS did not influence the degree of rectal damage. CONCLUSION: A single fraction of 17.5 Gy irradiation to the rat rectum considered to be an optimal dose for radiation induced proctitis model. These results indicated that an excess production of NO contributes to pathogenesis of radiation-induced proctitis in part but was not the direct cause of rectal damage.목적 : 방사선 직장염은 골반부위에 방사선치료를 받는 환자에서 나타나는 급성부작용 중의 하나이다. 이러한 방사선 직장염은 병리학적으로 염증성 대장질환과 유사한 소견을 보인다. 따라서 염증성 대장질환의 유발인자로서 최근 활발하게 연구되고 있는 nitric oxide (NO)의 과다생성이 방사선 직장염을 유발하는 주요 원인일 수도 있다. 이를 검증하기 위하여 본 연구자들은 적절한 방사선 직장염 동물모델을 확립하고 이 모델에서 NO의 과다생성과 직장점막의 손상 정도의 상호 관련성을 연구하였다. 대상 및 방법 : 암컷 백서(Wistar)의 직장에 10\~30Gy의 다양한 선량의 방사선을 조사하였다. 방사선조사 후 5일 및 10일째에 직장조직을 얻어 점막의 형태학적 변화를 육안적으로 및 조직학적으로 관찰하였다. 방사선에 의한 손상에 대한 NO의 과다 생성이 미치는 영향을 평가하기 위하여 iNOS의 발현과 nitrite 측정을 시행하였고 iNOS의 억제제 및 기질을 경구투여한 후 점막 손상의 변화를 형태학적 및 생화학적으로 관찰하였다. 결과 : 육안적으로나 조직학적으로 17.5 Gy 이상의 선량에서는 직장 점막에 명백한 손상이 발생하였으나 15 Gy 이하에서는 일부 검체에서만 경미한 정도의 변화를 나타냈다. 20 Gy 이상의 방사선을 조사한 후에는 검체 대부분에서 등급 4의 조직학적 변화를 보였기 때문에 임상에서 흔히 경험하는 방사선 직장염을 재현할 수 있는 가장 적절한 일회 방사선조사량으로 17.5 Gy를 선택하였다. 직장 점막의 조직학적 손상정도가 방사선량 및 iNOS의 과발현과 유의한 상관관계를 보였다. 그러나 iNOS의 기질 및 억제제의 경구투여시 iNOS 발현양상, NO 생성 뫼 조직 손상 정도의 차이는 없었다. 결론 : 임상에 적용할 수 있는 방사선 직장염 연구를 위한 동물모델로서 적절한 일회 방사선조사량은 17.5 Gy임을 확인하였다. 또한 덜 연구결과는 NO의 과다생성이 방사선에 의한 염증 및 손상 정도와는 연관성을 가지나 직접적인 원인이 아님을 시사하고 있다

경부 괴사성 근막염의 치료

Background and Objectives: Cervical necrotizing fasciitis (CNF) is a rare but potentially life-threatening soft tissue infection primarily affecting the superficial fascial planes. The purpose of this study was to report various causes, courses of the disease, and outcomes of treatment. Subjects and Method: A retrospective chart review of 12 cases treated between January 2000 and January 2004 was done. All of them were studied with CT scan and treated with intravenous antibiotics. We discussed histories, diagnostic points and treatment of each cases, and analyzed them. Results: There were 9 male and 3 female patients. The age distribution was from 17 to 81 years. Three patients had diabetes mellitus, one patient was a heavy alcoholics, and one patient had Buerger’s disease. Two patients were expired due to lung abscess and sepsis, but others were discharged with no complication. Wide debridement was performed in all cases. Wound reconstruction was done in two patients. Conclusion: Treatment consists of early diagnosis, aggressive surgical debridement and drainage of the involved necrotic fascia and tissue along with broadspectrum intravenous antibiotics coverage

보완대체요법의 국내외 연구 동향 비교

Purpose: This study was done to describe the research trend of Complementary and Alternative Medicine(CAM) in Korea and internationally. Method: A Systematic review of CAM related literature published from 2000 to 2005 was done. A comprehensive search by using 34 CAM modalities as search terms to identify all articles dealing with CAM was undertaken from 4 databases: PubMed, RICHIS, KoreaMed, and Riss4U. A Total of 588 abstracts and 223 original articles were reviewed by two independent reviewers using systematic analysis guidelines. Data regarding the types of study design, characteristics of subjects and researchers, and classification of CAM modalities was recorded. The outcome measures of CAM were identified. Results: CAM research has been rapidly increasing worldwide in the last decade. In Korea, nursing(53.5%) followed by medicine(42.7%) occupied the majority of CAM research in comparison to medicine(42.9%) and disciplines in CAM(25.0%), like homeopathy, internationally. Prevailing research designs in Korea were experimental and quasi-experimental, however, randomized clinical trials were found. Internationally, survey research was dominant, with the exception of randomized clinical trials that were mostly an experimental design. Conclusion: The findings suggest that a robust research design in CAM research is needed to accumulate strong scientific evidence and to adopt nursing interventions from CAM modalities

TEOAE를 이용한 신생아 청각선별검사

BACKGROUND AND OBJECTIVES: Hearing impairment is a common congenital disability of the newborn, which has an incidence of 1.5 to 3 per 1,000 infants each year. The identification of this problem is difficult and many of these children are not identified until 2-3 years of age if not screened at birth. The purpose of this study is to establish a common screening method adjusted to our country and to emphasize the importance of early diagnosis of neonatal hearing loss. MATERIALS AND METHODS: TEOAE were performed in 1,459 infants from March to December, 1998 at Ajou university hospital. The tests were performed daily until discharge if the infant had failed the first test, and were followed at the outpatient clinic. Hearing loss was confirmed by ABR. RESULTS: The average test time of TEOAE was 102.6 seconds. Test time after 24 hours of birth was shorter than before 24 hours, and was shorter in female compared to male infants. Pass rate after 24 hours was higher than before 24 hours and 86% of tested infants passed during admission. Thirty-one out of 213 infants failed to follow-up at the outpatient clinic. Two were diagnosed with unilateral hearing loss on ABR. CONCLUSION: TEOAE is a simple and useful screening method for the identification of hearing loss in infants

네비게이션을 이용한 슬관절 전치환술 시 압박대의 감압 시기에 따른 실혈량에 대한 영향

목적: 컴퓨터 네비게이션을 이용한 슬관절 전치환술에서 압박대의 감압시기에 따른 실혈량의 변화를 비교하고자 하였다. 대상 및 방법: 1군은 31예로 피부 봉합 및 압박 소독을 시행한 후 압박대를 감압하였으며, 2군은 32예로 치환물을 삽입하기 전 압박대 감압 및 지혈을 시행하였다. 술 전 및 술 후 24, 48시간의 혈색소량 및 적혈구 용적률을 조사하였고, 양 군 간의 총실혈량, 술 후 배액관을 통한 실혈량, 감춰진 실혈량, 가시적 실혈량 및 수술 시간을 비교하였다. 결과: 술 후 24, 48시간의 혈색소(p=0.371, p=0.247) 및 적혈구 용적률의 변화량(p=0.428, p=0.125)은 양 군 간 통계적으로 유의하지 않았다. 술 후 24시간의 흡입 배액된 실혈량(p=0.381)과 총실혈량(p=0.126)은 양 군 간에 유의한 차이가 없었고, 가시적인 실혈량(p=0.023), 감춰진 실혈량(p=0.045) 및 수술시간(p=0.005)은 유의한 차이를 보였다. 결론: 네비게이션을 이용한 슬관절 전치환술에서 압박대의 감압 시기에 따른 총실혈량 및 술 후 배액되는 실혈량의 차이가 없으며, 수술 후 압박대를 감압하는 방법은 수술 중 압박대를 감압하는 방법에 비해 시야 확보 및 수술 시간을 단축하는 측면에서 유용한 방법이라고 생각한다.Purpose: The aim of this study is to evaluate the effects of timing of tourniquet release on blood loss in navigation assisted total knee arthroplasty. Materials and Methods: A total of 63 consecutive patients, who underwent navigation assisted total knee arthroplasty, were divided into two groups; 31 patients (31 knees, group I) were operated with tourniquet release after wound closure and applied compression dressing, and another 32 patients (32 knees, group II) were operated with tourniquet release and hemostasis before implantation of the polyethylene insert. We examined hemoglobin concentration and hematocrit at three points in time, preoperatively, 24 hours and 48 hours postoperatively. We compared the two groups of patients in terms of total blood loss, postoperative drained blood loss, hidden blood loss, visible blood loss and operation time. Results: There were no significant differences between the two groups in the hemoglobin concentration at 24 hours and 48 hours postoperatively (p=0.371, p=0.247), and hematocrit at 24 hours and 48 hours postoperatively (p=0.428, p=0.125). No statistically significant differences between the two groups in the postoperative drained blood loss (p=0.381) and total blood loss (p=0.126) were found. We found statistically significant differences in the visible blood loss (p=0.023), hidden blood loss (p=0.045) and operation time (p=0.005). Conclusion: The releasing time of tourniquet have no effect on the actual total blood loss, and postoperative drained blood loss in navigation assisted total knee arthroplasty. We concluded that compared with intraoperative tourniquet release, postoperative tourniquet release are useful for making the broader operation field and less operation time

전문간호사 교육의 전략에 관한 연구

Purpose: This study was aimed at exploring the current status of graduate programs for an advanced practice nurse(APN) to recommend future directions of APN education. Methods: A total of 142 students enrolled in seven APN specialty programs, 67 professors who were involved in APN education, and nine nurse administrators participated in the study. Data was collected by questionnaires and focus group interviews. Results: The current definition of APN was found not to be specific enough to represent expected roles of APN in regards to knowledge, attitudes, roles, and skills. Standard curricula employed regardless of the area of APN specialty, lack of qualified clinical practice settings, as well as prepared instructors were found to be problematic. Conclusion: The following needs to be addressed: 1. redefining of APN roles, 2. tailoring specialty areas of APN, 3. consolidating educational programs, and 4. ensuring APN role models and faculty. Suggesting a CNS role in Korean APN, areas of APN should be rearranged toclarify their roles and educational programs need to be further developed to meet the expectations and quality of APNs. It is necessary to ensure APN’s employment in the health care system by laws and policies to perform advanced nursing roles

국소진행성 직장암에서 Irinotecan을 이용한 술전보강화학방사선치료 시 UGT1A1 유전자 다형태의 유용성

Purpose: Irinotecan (CPT-11) is hydrolyzed to an active SN-38, which is further detoxicated to SN-38G through conjugation by uridine diphosphate glucuronosyltransferase 1A1 (UGT1A1) enzymes. There are many reports that UGT1A1 polymorphisms are associated with irinotecan related dose-limiting toxicity. The aim of the present study is to determine whether UGT1A1 polymorphisms affect individual variations of the toxicity due to and the tumor response to irinotecan via the alteration of bioavailability of SN-38 in Korean patients with locally advanced rectal cancer. Methods: Twenty patients with locally advanced rectal cancer, who had received surgery after irinotecan- containing chemoradiation from 2003 to 2006, were enrolled. We analyzed the association of UGT1A1 genotypes with toxicity and tumor response to chemoradiation therapy. A tumor response was assumed when a tumor regression grade I or II was obtained. Toxicity was graded in accordance with the NCI common toxicity criteria. Results: The frequence of -53(TA)6＞7 (UGT1A1*28), 211G＞A (UGT1A1*6), 686C＞A (UGT1A1*27), -3279T＞G (UGT1A1*60), and -3156G＞A were 25% (5/20), 25% (5/20), 0% (0/20), 55% (11/20), and 20% (4/20), respectively. There were five grade III neutropenia and one severe diarrhea. Patients with UGT1A1*28 and -3156G＞A showed higher complete tumor response rates (40% vs. 6.7%, P=0.07; 50% vs. 6.3%, P=0.08), but there was no differences in toxicity and tumor response between responders and non-responders. Patients with -3279T＞G (UGT1A1*60) showed a tendency for lower tumor response in tumor responders, but there was no statistically significant difference (P=0.07). Conclusions: This study suggested that -3279T＞G (UGT1A1*60) may be useful in predicting tumor response of irinotecan. In the future, further study is warranted using large numbers of cases to reach statistical significance

결장 전절제술 및 회장 직장 문합술 후 합병증, 사망률 및 배변 기능변화

Purpose: This study reviews the feasibility of a total colectomy with ileo-rectal anastomosis (TCIRA) and the functional outcome following the operation. Methods: The cases of a total of 50 patients (31 men and 19 women) with a median age of 61 who underwent a TCIRA were reviewed retrospectively. The median follow-up time was 28 months (4∼72). The clinical records were reviewed to analyze the postoperative complications and bowel function. The clinical outcomes were examined directly from patients’ scoring. Results: The indications of TCIRA were metachronous or synchronous colorectal cancer (34 percent), multiple polypoid lesions (22 percent), malignant colon obstruction (24 percent), ischemic colitis (2 percent), Crohn’s disease (6 percent), and tuberculosis colitis (2 percent). The overall mortality and morbidity rates were 0 and 31 percent, respectively. The morbidity included postoperative bleeding, obstruction, intra-abdominal abscess formation, pneumonia, and wound complications. We used the CCIS index to evaluate postoperative functional bowel habit change. The CCIS index evaluation revealed perfect continence in 57 percent of the patients with short-term follow up (＜6 months) and in 83 percent of the patients who had undergone a TCIRA more than 2 years ago. Conclusions: Most patients were satisfied with their bowel function on long-term follow up, and we think the TCIRA is a safe operation, and the clinical outcomes are relatively satisfactory

땅콩 알레르기 생쥐모델에서 항 알레르기 효과가 있는 Lactobacillus 균주의 선별

Purpose : To evaluate the anti-allergic effects of intragastric treatment with various strains of lactobacillus, we undertook this study in the murine model of peanut allergy. Methods : Ten groups of mice were sensitized and boosted with 1 mg/dose of crude peanut intragastricly at day 1, 2, 3, 7 and 21. Also, each groups of mice was treated with various strains of lactobacillus or PBS starting on the 1st day of sensitization, for 3 weeks daily. During the experiment, peanut specific serum IgE, IgG1, IgG2a were measured at weekly intervals, and compared at week four which is one week after the end of lactobacillus treatment. Results : By treatment with various strains of lactobacillus, peanut specific IgE levels were decreased in all treated groups of mice compared to sham-treated mice. And at least six of the 10 groups of mice treated with various strains of L. casei or L. acidophilus showed remarkable down-regulatory effects on the production of peanut specific IgE antibodies, while the regulatory effects on specific IgG1, and IgG2a antibodies were variable. Especially, L. casei IBS041 showed harmonized regulatory effect on the productions of peanut specific IgE, IgG1 and IgG2a. Conclusion : We selected and partly confirmed several strains of lactobacillus which showed anti-allergic effects in the production of antigen specific IgE in the murine model of peanut allergy.배 경: 유산균(lactic acid bacteria, LAB)은 건강한 사람의 소장과 대장에서 서식하는 주된 정상균총으로서 최근 유산균의 면역조절 및 면역강화 효과에 대한 연구들이 보고되었다. 유산균의 면역 조절 효과는 아토피피부염이나 식품 알레르기의 예방 혹은 치료와 관련하여 관심을 모으고 있으며 주로 연구되는 유산균은 lactobacillus이다. 목 적: 이에 연구자들은 전 임상 단계에서 땅콩 알레르기 생쥐 모델을 이용하여 감작항원 특이 IgE 항체 생성 감소를 유도하는 알레르기 면역 조절 효과가 현저한 lactobacillus 균주를 선별하는 것을 목적으로 본 연구를 시행하였다. 방 법 : 5 주령의 암컷 C3H/HeJ 생쥐에 땅콩 단백 1 mg을 실험 제 0, 1, 2, 7, 21에 위장관 투여에 의하여 감작시켰으며, 감작 기간 3주 동안 매일 10 의 lactobacillus 단클론 배양 균주를 각 군별로 위장관내 투여하였다. 실험기간 동안 매주 생쥐의 혈청을 얻어 땅콩 특이 IgE, IgG1, IgG2a를 측정하였고 최종 효과 판정을 위하여 실험 4주째 결과를 각 군별로 비교하였다. 결 과: 10종류의 lactobacillus strain 투여에 의하여 정도의 차이는 있으나 땅콩 특이 IgE 생성이 모두 감소하였고, 이중 6종(L. casei IBS041, L. casei 346, L. casei 699, L. acidophilus 507, L. acidophilus 3142, L. acidophilus AD031)에 의해서는 대조군에 비하여 IgE 항체 생성이 50% 이상 감소함을 알 수 있었다. 반면 땅콩 특이 IgG1, IgG2a의 조절효과는 strain 마다 다양하였고 IgG와 IgE 항체 생성 조절의 일관성은 L.casei strain IBS041에서만 관찰되었다. 결 론 : 항체 생산에 초점을 두었다는 제한점은 있지만, 본 연구를 통하여 10종의 lactobacillus 배양 strain 중에서 성공적으로 IgE 생성을 감소시키는 6종의 strain을 선별할 수 있었고 이러한 결과는 추후 임상 연구를 시행하기 위한 기본 자료로 사용될 수 있으리라 기대된다

폐색성 좌측 대장암에서 Stent 삽입의 종양학적 안정성

Purpose:There is a controversy about the treatment of left-sided obstructive colorectal cancer. Recently, experience using an expandable metallic stent for relief of the obstruction has been increasing, but its oncological safety has not been confirmed. Therefore, we designed this study to evaluate the oncological safety of a metallic stent for the treatment of left-sided obstructive colorectal cancer. Methods: Forty-six patients with left-sided obstructive colorectal cancer who underwent a curative resection from 1994 to 2004, were retrospectively evaluated. Nineteen emergency operations (1994～2003) and 27 metallic stent insertions (2000～2004) were compared based on clinicopathologic features, postoperative complications, recurrence rates, and survival rates. Results: There were no significant differences in age, location, sex, and recurrence rate between the two groups. The complication rate in the emergency group was higher than it was in the stent group, but this difference was not statistically significant (26.3% vs. 14.8%; P=0.33). The overall and the disease-free survival rates were not significantly different. Conclusions: Because there was no significant differences in survival rate and recurrence rate between the two groups, metallic stent insertion can be used safely in the preoperative treatment of obstructive left-sided colorectal cancer