untitled

Size: px
Start display at page:

Download "untitled"

Transcription

1 ORIGINAL ARTICLE ISSN (Print) ISSN (Online) Korean J Endocr Surg 2015;15: The Korean Journal of Endocrine Surgery 부갑상선점수가갑상선전절제술후저칼슘혈증을예측할수있을까? 경북대학교의학전문대학원외과학교실박진희ㆍ박호용ㆍ정진향ㆍ황승욱ㆍ이지연ㆍ권택주ㆍ김완욱 Can Parathyroid Score Expect Hypocalcemia after Total Thyroidectomy? Purpose: The aims of this study were to investigate whether parathyroid score can predict hypocalcemia after total thyroidectomy with central lymph node dissection (CLND) and to determine clinical value of parathyroid score for treatment of hypocalcemia. Methods: A prospective review of 209 patients who underwent total thyroidectomy with CLND for papillary thyroid cancer from January to December 2012 was conducted. Parathyroid score was designed based on the number and color of parathyroid preservation (Save and intact color of a parathyroid was 2; Save but mild discoloration was 1.5; Not identification was 1.2; Autotransplantation was 1.0; Sacrifice was -1). Results: The mean numbers of parathyroid glands were as follows: save & intact color was 2.0; save & mild discoloration was 0.8; not identification was 0.8; autotransplantation was 0.4. The average parathyroid score was 6.54±0.69 (range ). The average PTH was 16.3 at the 1 st POD. Transient and permanent hypocalcemia were 33.4% (70/209) and 0.9% (2/209), respectively. Parathyroid score was 6.78±0.54 in patients without transient hypocalcemia, 5.93±0.67 with hypocalcemia, parathyroid score was significantly lower in transient hypocalcemia, abnormal PTH at the 1 st POD (P<0.001, P<0.001). Conclusion: Parathyroid score may predict patients at risk of developing transient hypocalcemia after total thyroidectomy with CLND. Key Words: Hypocalcemia, Parathyroid hormone, Parathyroid score, Total thyroidectomy 중심단어 : 갑상선절제술, 부갑상선점수, 부갑상선호르몬, 저칼슘혈증 Jin Hee Park, Ho Yong Park, Jin Hyang Jung, Seung Ook Hwang, Jeeyeon Lee, Taek Ju Kwon, Wan Wook Kim Department of Surgery, School of Medicine, Kyungpook National University, Daegu, Korea Received March 16, 2015, Revised April 29, 2015, Accepted May 18, 2015 Correspondence: Wan Wook Kim Department of Surgery, School of Medicine, Kyungpook National University, 807 Hoguk-ro, Buk-gu, Daegu , Korea Tel: Fax: kww1324@naver.com 서론 다양한갑상선수술의기법이발전되고있지만갑상선전절제술후의가장흔한합병증은부갑상선기능저하증으로일시적인저칼슘혈증의발생빈도는 %, 영구적인저칼슘혈증은 0 13% 로보고되고있다.(1) 이러한술후저칼슘혈증은수술시직접적인부갑상선의손상또는의도하지않은제거, 부갑상선으로가는혈류차단, 혈종, 부갑상선박리후기절현상 (stunning), 칼시토닌 ( 부갑상선호르몬억제 ) 의분비또는혈액 의희석등이주된원인으로보고되고있으며, 그외에저칼슘혈증의위험인자로갑상선전절제술, 광범위한절제술, 악성종양, 림프절절제술, 흉골하갑상선선종, 그레이브스질병등이관여하는것으로알려져있다.(2-6) 대부분의경우, 저칼슘혈증은수술후약 2 3개월이지나부갑상선의기능이회복되면서정상화되는것으로알려져있으며, 영구적인부갑상선기능저하증은 0.5 5% 정도로드물게나타난다.(4,7) 부갑상선기능저하로인한저칼슘혈증은손발의저림, 입주변의감각이상, 심한경우손발근육, 안면근육의경련등을유발하여환자의재원기간을 Copyright 2015 Korean Association of Thyroid and Endocrine Surgeons; KATES. All Rights Reserved. cc This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

2 박진희외 : Parathyroid Score after Total Thyroidectomy 35 늘리고환자의삶의질에나쁜영향을미치는중요한원인이되고있다.(8,9) 수술후저칼슘혈증을예방하기위해갑상선전절제술을받는모든환자에게관례적으로칼슘제를투여함으로써저칼슘혈증을예방할수있다고보도한바있다.(6,8) 하지만모든환자에게칼슘제를투여할경우치료가필요하지않는대부분의환자에게불필요한치료를하게되고칼슘제투여에따른부작용을경험할수있다. 그리고최근들어갑상선수술을전문으로하는숙련된외과의에의한갑상선절제술이시행되고, 부갑상선해부학에대한이해도가높아져부갑상선을보존하는갑상선술기발전으로인해부갑상선손상으로인한저칼슘혈증은과거보다많이줄어든양상이다. 이러한갑상선절제술후의저칼슘혈증을예측하기위한지표들로서수술후총칼슘수치, 이온화칼슘수치, 수술중또는수술후부갑상선호르몬 (parathyroid hormone, PTH) 수치등을이용한방법들이보고되고있으나정확도가높지않고검사를위해반복적인채혈로인한불편감이있었다.(6,10-13) 조기에저칼슘혈증을정확히예측할수록불필요한칼슘제투여를줄이고, 저칼슘혈증이있을경우빠른치료를할수있어저칼슘혈증증상의경험을예방하고빠른회복으로조기퇴원을할수있겠다. 본연구에서는지금까지보고된바없는부갑상선점수가갑상선전절제술후저칼슘혈증을예측할수있는지를전향적분석을통해살펴보고저칼슘혈증치료에있어서부갑상선점수의임상적유용성을알아보고자하였다. 방법 2012년 1월부터 12월까지칠곡경북대학교병원유방갑상선외과에서전통적인절개법으로갑상선전절제술및중심경부림프절절제술을시행받은 209명의갑상선유두암환자를대상으로하여전향적으로연구로진행하였다. 이기간중로봇수술을받은경우, 여포성또는양성종양으로수술한경우, 변형적경부 림프절곽청술 (modified radical neck dissection) 또는측경부의선택적림프절절제술 (selective neck dissection) 을시행받은경우와수술범위가일엽절제술로축소된경우, 중심경부림프절절제술을생략한경우는제외하였다. 그리고수술전골다공증등의이유로칼슘제를복용하였거나부갑상선기능이상 ( 항진증, 저하증 ), 만성신부전증, 요로결석, 이전에경부수술을받은과거력, 경부방사선치료과거력, 입원전 7일이내에아스피린또는혈액응고억제제의복용력이있는환자도본연구에서제외하였다. 모든수술은동일한갑상선외과전문의 1명 ( 김완욱 ) 에의해시행되었고수술은 Ultrasonic activated shears (Harmonic Focus R, Ethicon Endo-Surgery, Inc, Seoul, Korea) 또는 LigaSure Small Jaw R (Covidien, Energy-based Devices, Boulder, Colorado, USA) 를사용하여시행하였다. 에너지를이용한수술시주변구조물의열손상을막기위해반회후두신경으로부터최소 3 mm, 부갑상선으로부터 2 mm 이상의안전거리를두고기구를작동하였다. 모든부갑상선점수는수술중집도의에의해평가되었다. 부갑상선점수는술중부갑상선의확인및보존여부, 보존된부갑상선의색깔, 부갑상선의자가이식을근거로산출하였는데부갑상선이보존되고온전한색깔일경우 2점, 보존되었지만약간변색이있을경우 1.5점, 확인하지못한경우 1.2점, 자가이식 (Autotransplantation) 한경우 1점, 확인했으나암의침윤등으로살리지못하고절제한경우는 1점으로점수화했다 (Fig. 1). 부갑상선을보존하였으나약간변색이있는경우는수술종료시점까지관찰하여더이상의변색이없을경우자가이식없이수술을마쳤다. 갑상선절제술및림프절절제술후에조직내에함께적출된부갑상선이있는지찾도록노력하였으며부갑상선을제자리에살리지못하고예기치않게함께절제된경우또는살렸으나혈류장애등으로변색이심한경우에는괴사가능성이높으므로부갑상선을적출하여 1 mm 이하로작게절편하여반대측흉쇄유돌근 (sternocleidomastoid muscle) 에자가이식하였다. Fig. 1. Gross status of parathyroid gland according to color of it. Surgeon saved parathyroid with intact color (A); parathyroid could be save and it became mild discolored (B); parathyroid could be saved but it became severe discolored (C).

3 36 Korean J Endocr Surg 2015;15:34-40 journal.kates.or.kr 수술후혈중 PTH, 총칼슘및이온화칼슘, 인수치등을측정하였는데이중혈중총칼슘, 이온화칼슘및인수치는수술직후, 수술후 1일, 2일, 10일 ( 첫외래방문시기 ), 2개월및 6개월에측정했으며, PTH 수치는수술후 1일, 10일, 2개월및 6개월에측정하였다. 환자는갑상선수술후저칼슘혈증의증상으로양측손발의저린감및감각이상, 입주위의감각이상, 근육경련, 강직, Trousseau s sign, Chvostek s sign 등이나타나는지를확인하였다. 재원기간중 1회라도저칼슘혈증의증상이나타나거나재원기간중혈중총칼슘수치 ( 범위 : mg/dl) 가 8.0 mg/dl 미만또는이온화칼슘수치 ( 범위 : mmol/l) 가 1.0 mmol/l 미만으로떨어지면저칼슘혈증으로분류하여칼슘제투여를하였고, 술후 1일째 PTH 수치가 5 pg/ml ( 범위 : pg/ml) 미만인경우에는증상이없고칼슘이정상이어도수술후 2일째부터칼슘이떨어지는임상적경험을바탕으로저칼슘혈증증상의경험을막기위해예방적으로칼슘제를미리투여하였다. 치료가필요한저칼슘혈증에는 calcium carbonate (500 mg 3 T 3번 / 하루, Carnit R, Jinyang Pharm co., Seoul, Korea), calcitriol (0.25 μg 1 C 2번 / 하루, Bonky R, Yu Yu Pharmaceutical Co., Seoul, Korea) 을복용하도록하였다. 정맥내칼슘주사는중증의저칼슘증상 (Trousseau s sign 양성, tetany, carpopedal spasm) 이있거나총칼슘 <6.0 mg/dl 또는이온화칼슘 <0.8 mmol/l 인경우에시행하였다. 술후 6개월후 PTH가정상이하 (<14 pg/ml) 시영구적저칼슘혈증으로분류했다. 수술후 2일째출혈및장액종소견이없으며저칼슘혈증증상이없고총칼슘 >8.0 mg/dl, 이온화칼슘 >1.0 mmol/l이고배액량이 30 cc/ 일이하인경우에배액관을제거후퇴원하도록하였다. 통계처리는 SPSS Version 22 (SPSS Inc., Chicago, IL, USA) 을사용하였고연속형변수는 independent t-test 또는 Mann-Whitney test를범주형변수는 Chi-square test 또는 Fisher s exact test로검증하였고부갑상선점수의유용성과절단값 (cut-off value) 을판단하기위해 Receiver Operating Characteristic (ROC) curve를이용하였고 P <0.05 인경우를통계적으로유의하게간주하였다. 결과 환자의임상병리학적특성은 Table 1에서보여지고있다. 총 209예중남자와여자의비율은 1:5.9였고, 평균연령은 49.3 세 ( 범위 : 15 77세 ) 였다. 평균수술시간은 103.4±19.9분 ( 범위 : 분 ) 이었으며평균재원기간은 3.3±0.1일이었다. 갑상선암의평균크기는 0.9±0.1 cm ( 범위 : cm) 였다. 절제된중심경부림프절개수는평균 9.5±0.4개 ( 범위 : 1 31개 ) 이며그중이후병리조직검사상림프절전이로확인된경우는평균 1.3±0.1개 ( 범위 : 0 12개 ) 였다. TNM 병기상 I, II, III가각각 114예, 2예, 92예있었다. 수술후합병증으로일시적인반회후두신경마비가 6예 (2.8%), 영구적인마비가 2예 (0.9%) 있었다. 일시적저칼슘혈증은 70예 (33.4%) 에서있었지만대부분 2달이내에회복되었고 6 개월이상지속되는영구적저칼슘혈증은 2예 (0.9%) 에서있었다. 수술후출혈및장액종이각각 1예씩있었다. 수술후총칼슘및이온화칼슘수치의변화는다음과같다 (Fig. 2). 수술후 1 2 일째최저점으로떨어졌다가상승하기시작하여수술후 10일이후로거의정상으로회복되었다. 수술후 1일째 PTH 평균값은 16.3±15.1 pg/ml ( 범위 : pg/ml) 고정상범위이하로떨어진경우는 88예 (42.1%) 에서있었다. PTH 수치도칼슘과비슷하게수술후 10일째지나면서회복이되기시작하였고수술 10일째평균 21.6±18.8 pg/ml ( 범위 : pg/ml) 였고, 정상범위이하로떨어진경우는 63예 (30.3%) 다. 부갑상선점수에따른부갑상선의평균개수및합산은다음과같다 (Table 2). 수술건수당평균적으로부갑상선을보존하고온전한색깔을지닌것이 1.95개, 보존하였지만약간변색이있는것이 0.85개, 확인안된것이 0.78개, 자가이식한것이 0.39개였다. 술중부갑상선의확인및보존여부, 보존된부갑상선의색깔, 부갑상선의자가이식에따라술자의판단에따른가중도를근거로산출한부갑상선점수의평균은 6.54±0.69 ( 범위 : ) 이었다. 일시적저칼슘혈증이없던환자에서부갑상선점수는 6.78±0.54였고저칼슘혈증이있던환자에서는 5.93±0.67이었으며통계적으로의미있는차이를보였다 (P <0.001) (Table 3). 또한수술후 1일와 10일째 PTH 수치가정 Table 1. Clinicopathologic characteristics of patients Age (years) 45 <45 Characteristics Total (n=208) (range or %) 49.3±0.8 (15 77) 126 (60.6%) 82 (39.4%) Gender (male:female) 1:5.9 Tumor size (cm) <1 cm Multiple tumor Hashimoto s thyroiditis 0.9±0.1 ( ) 138 (66.3%) 89 (42.8%) 45 (21.6%) Extrathyroidal extension Central lymph node metastasis 123 (59.8%) 85 (40.9%) Number of retrieved lymph node (n) 9.5±0.4 (1 31) Number of metastatic lymph node (n) 1.3±0.1 (0 12) Operation time (min) 103.4±1.3 (68 230) Hospital stay (day) 3.3±0.1 (2 7) Total drain amount (ml) 114.5±5.1

4 박진희외 : Parathyroid Score after Total Thyroidectomy 37 Fig. 2. Changes of Serum total calcium (A) and ionized calcium (B) level according to postoperative day. Serum total calcium and ionized calcium level were decreased at postoperative #1, 2 days and recovered after postoperative #10 days. Table 2. Parathyroid score based on the preservation and color of parathyroid, mean number of parathyroid Gross status of parathyroid Parathyroid score Mean number of parathyroid Sum of parathyroid score Preservation of parathyroid with intact color Preservation of parathyroid with mild discoloration Non-identification of parathyroid Autotransplantation of parathyroid Sacrifice of parathyroid Sum Table 3. Comparison parathyroid score according to PTH level, hypocalcemia Characteristics PTH at POD #1 Normal Abnormal PTH at POD #10 Normal Abnormal Hypocalcemia No Transient Permanent Sum of parathyroid score 6.8± ± ± ± ± ± ±0.11 P value <0.001 <0.001 < PTH = parathyroid hormone; POD = postoperative day. 상수치보다낮았던환자에서도부갑상선점수가의미있게낮았다 (P<0.001, P<0.001). 하지만, 영구적저칼슘혈증이없던환자에서부갑상선점수는 6.55±0.70, 있던환자에서는 6.13±0.11이었으나통계적인차이를보이지않았다 (P=0.305). 일시적인저칼슘혈증을상태변수로하고부갑상선점수를검정변수로 ROC curve를산출하였을때영역범위 (area under the Fig. 3. ROC (Receiver Operating Characteristic) curve and AUC (Area under the curve) of parathyroid score for transient hypocalcemia. curve, AUC) 는 였고점근유의수준은 0.000, 95% 신뢰구간은하한 0.808, 상한 0.923이었다 (Fig. 3). 절단값 (cut-off value) 수치를 6.3으로하였을때이에따른민감도, 특이도는 82.6%, 83.1% 였다.

5 38 Korean J Endocr Surg 2015;15:34-40 journal.kates.or.kr 고찰 과거에비해외과의사의기술기법의발전과수술도구의개발로갑상선수술이안전하게시행되고있지만저칼슘혈증은갑상선수술후의가장흔한합병증중의하나이다. 수술후저칼슘혈증의위험인자로는그레이브스병, 갑상선의크기, 갑상선염, 광범위한림프절절제술, 진행된병기, 나이, 여성, 수술전총칼슘수치및혈중비타민D 수치등이있다고알려져있다.(3,4,14) 그리고저칼슘혈증의원인으로는수술중부갑상선손상, 술중공급되는수액에의한비특이적혈액희석, 술후비타민D 대사의변화, Endothelin 1의분비에의한 PTH의분비저하, 장시간의수술로인한체온의저하등이있다.(5) 이런원인들가운데수술중부갑상선손상에의한경우가대부분이다. 이는부갑상선의위치변이가많아수술중찾기가어려울수있어부갑상선의보존이쉽지않고그뿐만아니라부갑상선의혈관을보존하지못하는데에따른혈류장애도중요한원인이된다. 부갑상선은일반적으로좌우각각 1쌍으로총 4개의상, 하부갑상선이존재하나 2개에서 9개까지보고된바도있다. 상부갑상선의위치는보통갑상선의후외방에존재하나, 설골하부에서부터상부종격동까지어디든지위치할수있으며, 약 7% 내외에서는갑상선내에존재할수도있다.(15) 상부갑상선은일반적으로갑상선의후면부위위치하고하갑상선동맥과반회후두신경이교차하는점에서상방 2 cm 이내에위치하게되며주위지방조직에쌓여있는경우가많다. 하부갑상선은좀더위치변이가심한데주로갑상선의하부나갑상선흉선인대근처에있는경우가가장많고흉선안에위치하고있는경우도드물지않게있다. 일반적인경우상부갑상선은반회후두신경후방에, 하부갑상선은신경전방에주로위치한다.(16,17) 부갑상선을잘살리기위해서는먼저부갑상선을잘찾고림프절, 지방과구분할수있어야한다. 부갑상선은색깔, 모양으로지방, 림프절과구분하는데부갑상선은지방보다좀더어둡거나짙은노랑색이고림프절보다부드럽고후물거리는양상을하고있다. 부갑상선은갑상선피막에쌓여있는경우가종종있고부갑상선으로가는혈관을잘살리기위해위에서섬세한피막박리 (capsular dissection) 를통한부갑상선혈류보존이필수적이다. 혈류보전을위해서는부갑상선으로가는혈관들을잘확인하고혈관을근위부에서결찰하지않고갑상선에가깝게원위부에서결찰하여부갑상선으로가는혈관을보존하도록한다. 특히상부갑상선의경우상 / 하갑상동맥의분지에서혈류를공급받지만, 하부갑상선은하갑상동맥의분지에서만혈류를공급받기때문에하갑상동맥의보존이특히중요하다. 그리고부갑상선주변에지방조직과함께살리면좀더좋은결과를얻을수있 고흉선내부갑상선이위치해있을수있으므로흉선은제거하지않도록한다. 갑상선발생의변이를생각하여갑상선내에부갑상선이존재할가능성도염두에두도록한다.(15) 만약, 의도하지않게부갑상선이함께제거되었거나혈류장애로부갑상선의변색이있는경우는부갑상선을적출해서절편하여흉쇄유돌근이나요골근에반드시자가이식을하는것이장기적으로부갑상선기능저하를예방하는데도움이된다.(15,18,19) 그러므로갑상선절제및림프절절제술후조직과함께제거된부갑상선이있는지찾아보는것이중요하다. Thomusch 등 (20) 은저칼슘혈증을예방하기위해적어도 2개이상의부갑상선이기능적으로보존되어야하며 3개이상보존은큰이득이없다고보고했으며다른연구에서는적어도 3개이상의부갑상선이보존되어야한다고보고된적있다.(21,22) 반면, 적어도 1개이상의부갑상선이보존되면영구적저칼슘혈증을일어나지않는다는연구결과도있다.(23) 또한부갑상선자가이식만으로는장기적으로관찰하였을때 43% 까지만회복되기때문에가능한잘보존하도록노력해야한다는보고도있으며변색된부갑상선의기능은일시적으로손상된것이며술후짧은시간내에회복된다는보고도있다.(24,25) 수술후저칼슘혈증이생길가능성을대비하여술후 PTH, 총칼슘, 이온화한칼슘수치및저칼슘혈증증상여부등의지속적인추적관찰이필요하며, 술후최소 2일이상자세한추적관찰을시행하여야한다. Kim 등 (26) 은또한혈중이온화칼슘수치는술후 2일째가장낮게나타나기때문에이때까지주의를기울여야함을보고하였다. 하지만이는환자들에게매일채혈을해야하는경우환자에게불편감및경제적인부담을줄수있다. 일부논문에서는모든환자들에게동일한칼슘제제를투여함으로써퇴원을보다안전하고빠르게할수있다고보고하였으나, 모든환자들에게칼슘제제를투여하는것은경제적으로도효과가없을뿐아니라환자들에게불필요하게투여함으로써칼슘제의부작용을경험하게할수있다.(27) 그러므로저칼슘혈증을정확하게예측하는것은치료가불필요한환자에게서칼슘제투여를막고증상이있을환자에게미리칼슘제를투여함으로써저칼슘혈증증상을최소화하고퇴원을빨리할수있도록도와주기때문에중요한문제라할수있겠다. 부갑상선기능저하증예측인자로수술중에 PTH 수치를측정하여 10 pg/ml 이하인경우에저칼슘혈증이발생할가능성이높으므로조기에비타민 D를투여하면저칼슘혈증의증상을줄이는데도움이된다는보고도있다.(28) 지금까지의연구에서는부갑상선의개수, 자가이식한부갑상선의점수가갑상선전절제술후저칼슘혈증과어떠한관련이있는지에대한보고들은있었지만본연구에서처럼부갑상선의개수, 변색, 자가이식, 확인수, 적출한수를점수화하여술후저칼슘혈증과의관련성을

6 박진희외 : Parathyroid Score after Total Thyroidectomy 39 연구한논문은없었다. 이에대해본저자는갑상선전절제술후발생하는저칼슘혈증을예측하기위한새로운접근으로수술중부갑상선의보존에대해육안적판단하여부갑상선점수를합산을하여이를술후저칼슘혈증발생을미리예측할수있는지를알아보고자했으며칼슘치료에도움이되는지, 그리고일시적저칼슘혈증치료를위한부갑상선점수의절단값 (cut off value) 를확인해보고자하였다. 부갑상선점수는술자의경험및참고문헌을참고로정하였는데, 변색없이부갑상선을잘보존한경우 2점, 부갑상선의약간의변색이있고더이상변색이진행되지않은경우일시적인기능저하증은있으나곧회복이되어어느정도기능을할것이므로 1.5점으로하였다. 부갑상선을확인하지못한경우의도적으로부갑상선을찾으려고더이상애쓰지않아서부갑상선위치의변이에의해어딘가에남겨져있을가능성이있고, 적은빈도이지만수술시조직과함께제거될가능성도있으므로 1.2점을주었고, 자기이식을한경우부갑상선은약 43% 정도기능을회복하고그기간까지최소 1주이상, 평균 3개월정도소요되므로 1점을주었다. 본연구에서는수술시평가한부갑상선점수를각각환자임상증상, 수술후이온화칼슘, 칼슘농도를근거로본연구에서정의한일시적인저칼슘혈증및술후 1일째 PTH 수치와연관관계를비교했으며모두유의한상관관계가있었다. 영구적인저칼슘혈증의빈도가 2예로적어서부갑상선점수로정확하게예측하기어려웠다. 절단값을높일수록민감도는낮아지고특이도는높아지게되는데적정한민감도, 특이도를위해서절단값을 6.3으로선택하였다. 본연구의결과를바탕으로부갑상선점수를임상치료에적용하기위해갑상선전절제술후칼슘치료에대한알고리즘을고안하였다. 수술후 PTH 수치가정상인경우에는저칼슘혈증이있는경우가거의없어더이상칼슘제치료는필요없을것으로생각하였다. PTH 수치가정상이하인경우 부갑상선점수를계산하여절단값인 6.3 초과인경우칼슘복용없이지켜보고이중저칼슘혈증증상이있는경우와부갑상선점수가 6.3 이하인경우에칼슘제복용을하도록하였다 (Fig. 4). 이와같이부갑상선점수를임상에적용할경우갑상선수술후필요한환자에게만칼슘제복용을하도록하여불필요한칼슘치료를줄이고, 필요한환자에게보다빨리적절한칼슘치료를하여수술후 1 2일째부터올수있는저칼슘혈증증상경험을줄이고늦게칼슘복용을시작할경우칼슘수치회복을위한재원기간이길어질수있는데빠른치료로재원기간을줄일수있고불필요한혈액검사를줄일수것으로사료된다. 부갑상선점수는술자의경험및노력에따라정확도, 민감도가달라질수있으므로 PTH 수치, 칼슘수치와절대적으로비교하여우월한지여부를알기어렵다. 그리고혈중 PTH와칼슘수치를대치할정도로민감하고정확하기는어려우나부갑상선점수를잘평가하면 PTH가약간떨어져있으나저칼슘혈증증상이없어칼슘복용을할지결정하기어려운환자들의치료전략에보조적으로사용할수있을것으로사료된다. 부갑상선점수에대한본연구에는몇가지제한점이있다. 첫째, 저자가정한부갑상선의보존상태에따른부갑상선점수는개인적인경험및논문에따른것이지만이에명확한근거가없어통계학적힘 (power) 를결정하기어렵다는점이다. 둘째, 집도의의경험의차이에따라부갑상선점수를매기는기준및정확도가차이가있을수있고주관적일수있다는것이다. 지방, 림프절을부갑상선으로잘못인식하거나부갑상선의혈류장애에따른변색에정도에따라점수가달라질수있다. 부갑상선점수가적은빈도수로생긴영구적부갑상선기능저하증이있는환자의평가에크게도움은되지않았다. 마지막으로부갑상선점수는전체개수를 4개를기준으로한점수체계이므로부갑상개수에변이가있을수있을경우 (5 20%) 점수에영향을줄수있다. 부갑상선점수를임상적으로잘적용하기위해서는집도의의많은경험과정확한평가를하기위한노력그리고향후많은환자를대상으로한추가연구가필요할것으로사료된다. 결론 Fig. 4. Algorism for calcium supplement based on parathyroid hormone (PTH) at postoperative (POD) #1 day and parathyroid score. 부갑상선보존및상태에근거한부갑상선점수는갑상선전절제술후일시적인저칼슘혈증및 PTH 수치와상관관계가높았다. 부갑상선점수는수술후일시적인저칼슘혈증이올수있는위험도가높은환자를미리예측하는데도움이되었으며갑상선수술후불필요한칼슘치료를줄이고저칼슘혈증으로칼슘치료가필요한환자에게보다빨리적절한칼슘치료를하는데도움이될것이다.

7 40 Korean J Endocr Surg 2015;15:34-40 journal.kates.or.kr REFERENCES 1. Randolph GW. Postoperative considerations: Postoperative complications. In: Randolph GW, editor. Surgery of the thyroid and parathyroid glands. Philadelphia: Saunders; p Kim YS. Impact of preserving the parathyroid glands on hypocalcemia after total thyroidectomy with neck dissection. J Korean Surg Soc 2012;83: Sousa Ade A, Salles JM, Soares JM, Moraes GM, Carvalho JR, Savassi-Rocha PR. Predictors factors for post-thyroidectomy hypocalcaemia. Rev Col Bras Cir 2012;39: Pattou F, Combemale F, Fabre S, Carnaille B, Decoulx M, Wemeau JL, et al. Hypocalcemia following thyroid surgery: incidence and prediction of outcome. World J Surg 1998;22: Pradeep PV, Ramalingam K, Jayashree B. Post total thyroidectomy hypocalcemia: A novel multi-factorial scoring system to enable its prediction to facilitate an early discharge. J Postgrad Med 2013;59: Roh JL, Park CI. Routine oral calcium and vitamin D supplements for prevention of hypocalcemia after total thyroidectomy. Am J Surg 2006;192: Shindo ML, Sinha UK, Rice DH. Safety of thyroidectomy in residency: a review of 186 consecutive cases. Laryngoscope 1995;105: Nemade SV, Rokade VV, Pathak NA, Tiwari SS, Sonkhedkar SJ. Comparison between perioperative treatment with calcium and with calcium and vitamin d in prevention of post thyroidectomy hypocalcemia. Indian J Otolaryngol Head Neck Surg 2014;66(Suppl 1): Kim JH, Chung KW, Kim MB, Jeong HS, Baek CH, Son YI. Parathyroid hormone as an early predictor of post-thyroidectomy hypocalcemia. Korean J Otolaryngol-Head Neck Surg 2006;49: Richards ML, Bingener-Casey J, Pierce D, Strodel WE, Sirinek KR. Intraoperative parathyroid hormone assay: an accurate predictor of symptomatic hypocalcemia following thyroidectomy. Arch Surg 2003;138: Cmilansky P, Mrozova L. Hypocalcemia - the most common complication after total thyroidectomy. Bratisl Lek Listy 2014;115: Le TN, Kerr PD, Sutherland DE, Lambert P. Validation of 1-hour post-thyroidectomy parathyroid hormone level in predicting hypocalcemia. J Otolaryngol Head Neck Surg 2014;43: Chindavijak S. Prediction of hypocalcemia in postoperative total thyroidectomy using single measurement of intra-operative parathyroid hormone level. J Med Assoc Thai 2007;90: Praženica P, O'Driscoll K, Holy R. Incidental parathyroidectomy during thyroid surgery using capsular dissection technique. Otolaryngol Head Neck Surg 2014;150: Cernea CR, Brandão LG, Hojaij FC, De Carlucci D, Montenegro FL, Plopper C, et al. How to minimize complications in thyroid surgery? Auris Nasus Larynx 2010;37: Tae K, Lee HS, Jeong YG, Kim KT, Lee SH, Park YS, et al. Hypocalcemia and recurrent laryngeal nerve injury after thyroid surgery. Korean J Otolaryngol-Head Neck Surg 2002;45: Libutti SK, Bartlett DL, jaskowiak NT, Skarulis M, Marx SJ, Spiegel AM, et al. The role of thyroid resection during reoperation for persistent or recurrent hyperparathyroidism. Surgery 1997;122: Page C, Strunski V. Parathyroid risk in total thyroidectomy for bilateral, benign, multinodular goitre: report of 351 surgical cases. J Laryngol Otol 2007;121: Olson JA Jr, DeBenedetti MK, Baumann DS, Wells SA Jr. Parathyroid autotransplantation during thyroidectomy. Results of long-term follow-up. Ann Surg 1996;223: Thomusch O, Machens A, Sekulla C, Ukkat J, Brauckhoff M, Dralle H. The impact of surgical technique on postoperative hypoparathyroidism in bilateral thyroid surgery: a multivariate analysis of 5846 consecutive patients. Surgery 2003;133: El-Sharaky MI, Kahalil MR, Sharaky O, Sakr MF, Fadaly GA, El-Hammadi HA, et al. Assessment of parathyroid autotransplantation for preservation of parathyroid function after total thyroidectomy. Head Neck 2003;25: Oh EM, Chung YS, Ryu J, Lee YD. Clinical characteristics for early recovery from temporary hypoparathyroidism in patients undergoing total thyroidectomy. Korean J Endocr Surg 2014;14: Pattou F, Combemale F, Fabre S, Carnaille B, Decoulx M, Wemeau JL, et al. Hypocalcemia following thyroid surgery: incidence and prediction of outcome. World J Surg 1998;22: Kihara M, Yokomise H, Miyauchi A, Matsusaka K. Recovery of parathyroid function after total thyroidectomy. Surg Today 2000;30: Promberger R, Ott J, Kober F, Mikola B, Karik M, Freissmuth M, et al. Intra- and postoperative parathyroid hormone-kinetics do not advocate for autotransplantation of discolored parathyroid glands during thyroidectomy. Thyroid 2010;20: Kim JY, Park JJ, Choi SH, Kim SY, Nam SY. Postoperative change of ionized calcium level after total thyroidectomy and risk factors of postoperative permanent hypoparathyroidism. Korean J Otolaryngol-Head Neck Surg 2004;47: Moore FD Jr. Oral calcium supplements to enhance early hospital discharge after bilateral surgical treatment of the thyroid gland or exploration of the parathyroid glands. J Am Coll Surg 1994;178: Quiros RM, Pesce CE, Wilhelm SM, Djuricin G, Prinz RA. Intraoperative parathyroid hormone levels in thyroid surgery are predictive of postoperative hypoparathyroidism and need for vitamin D supplementation. Am J Surg 2005;189:306-9.

Lumbar spine

Lumbar spine Lumbar spine CT 32 111 DOI : 10.3831/KPI.2010.13.2.111 Lumbar Spine CT 32 Received : 10. 05. 23 Revised : 10. 06. 04 Accepted : 10. 06. 11 Key Words: Disc herniation, CT scan, Clinical analysis The Clinical

More information

황지웅

황지웅 Comparison of Laparoscopy and Exploration in the Distal Pancreatectomy BACKGROUND: To determine the benefits of laparoscopic surgery compared with exploration, the clinical outcomes of open and laparoscopic

More information

05.Kaes001.hwp

05.Kaes001.hwp 혈액투석환자에서삼차성부갑상선기능항진증으로부갑상선절제술후발생한 Hungry Bone Syndrome 1 예 A Case of Hungry Bone Syndrome after Parathyroidectomy in Patient with Tertiary Hyperparathyroidism and Hemodialysis Patient Myoung Won Son, M.D.,

More information

untitled

untitled 대한내분비외과학회지 : 제9권제2호 Vol. 9, No. 2, June 2009 원저 Ultrasonically Activated Shears 를이용한갑상선수술에대한전향적연구 성균관대학교의과대학삼성서울병원외과 김완욱ㆍ허성모ㆍ김성훈ㆍ이세경ㆍ임혜인ㆍ최재혁ㆍ김상민ㆍ이정언ㆍ김정한ㆍ김지수ㆍ남석진양정현ㆍ최준호 Thyroidectomy Using Ultrasonically

More information

Jkbcs016(92-97).hwp

Jkbcs016(92-97).hwp Expression of bcl-2 and Apoptosis and Its Relationship to Clinicopathological Prognostic Factors in Breast Cancer - A Study with Long Term Follow-up correlated with the survival rate.(journal of Korean

More information

( )Jksc057.hwp

( )Jksc057.hwp 직장암환자의전직장간막절제술의 예측인자분석 : 불완전절제와절제시간에영향을미치는인자에관한연구 Analysis of Factors Affecting the Degree of Difficulty in Total Mesorectal Excision for Rectal Cancer: Investigation of the Factors Affecting Incomplete

More information

김범수

김범수 Analysis of Outcomes after Resection of Sarcomatous Hepatocellular Carcinoma Purpose: Sarcomatous hepatocellular carcinoma (HCC) is rare. Therefore, the clinicopathologic characteristics and prognosis

More information

386-390.hwp

386-390.hwp 386 HANYANG MEDICAL REVIEWS Vol. 29 No. 4, 2009 우리나라 미숙아의 통계와 의료비용 Statistics and Medical Cost of Preterm in Korea 윤혜선 을지대학교 노원을지병원 소아청소년과학교실 Hye Sun Yoon, M.D., Ph.D., Department of Pediatrics, Nowon

More information

012임수진

012임수진 Received : 2012. 11. 27 Reviewed : 2012. 12. 10 Accepted : 2012. 12. 12 A Clinical Study on Effect of Electro-acupuncture Treatment for Low Back Pain and Radicular Pain in Patients Diagnosed with Lumbar

More information

Table 1. Distribution by site and stage of laryngeal cancer Supraglottic Glottic Transglottic Total Stage Total 20

Table 1. Distribution by site and stage of laryngeal cancer Supraglottic Glottic Transglottic Total Stage Total 20 KISEP Head and Neck Korean J Otolaryngol 1999;42:1284-9 후두암수술환자에대한치료성적 송달원 김희준 정현수 김영한 안재현 이복수 박선호 Treatment Result in Laryngeal Cancer Patients Submitted to Surgical Treatment Dal Won Song, MD, Hee Jun

More information

전립선암발생률추정과관련요인분석 : The Korean Cancer Prevention Study-II (KCPS-II)

전립선암발생률추정과관련요인분석 : The Korean Cancer Prevention Study-II (KCPS-II) 전립선암발생률추정과관련요인분석 : The Korean Cancer Prevention Study-II (KCPS-II) 전립선암발생률추정과관련요인분석 : The Korean Cancer Prevention Study-II (KCPS-II) - i - - ii - - iii - - iv - - v - - vi - - vii - - viii - - ix - -

More information

노영남

노영남 Purpose: Delayed massive hemorrhages from pseudoaneurysm rupture of the peripancreatic large arteries, after pancreaticoduodenectomy, are fatal. We reviewed the clinical course and outcome of bleeding

More information

untitled

untitled 대한내분비외과학회지 : 제7권제4호 Vol. 7, No. 4, December 2007 원저 갑상선수술후합병증인애성, 저칼슘혈증및혈종에대한임상적연구 광주기독병원일반외과 범우성ㆍ문덕진ㆍ김준식ㆍ박범석 A Clinical Study of Thyroidectomy Complications: Hoarseness, Hypocalcemia and Hematoma Wooseong

More information

1..

1.. Volume 12, Number 1, 6~16, Factors influencing consultation time and waiting time of ambulatory patients in a tertiary teaching hospital Jee-In Hwang College of Nursing Science, Kyung Hee University :

More information

<283732372D3733312920B4D9C3CAC1A120BCD2C7C1C6AEC4DCC5C3C6AEB7BBC1EEC0C720B3EBBEC8C0C720BDC3B7C2BAB8C1A4BFA120B4EBC7D120C0AFBFEBBCBA20C6F2B0A1283035292E687770>

<283732372D3733312920B4D9C3CAC1A120BCD2C7C1C6AEC4DCC5C3C6AEB7BBC1EEC0C720B3EBBEC8C0C720BDC3B7C2BAB8C1A4BFA120B4EBC7D120C0AFBFEBBCBA20C6F2B0A1283035292E687770> 대한안과학회지 제 49 권 제 5 호 2008 J Korean Ophthalmol Soc 49(5):727-731, 2008 DOI : 10.3341/jkos.2008.49.5.727 다초점 소프트콘택트렌즈의 노안의 시력보정에 대한 유용성 평가 김현경 1 김효명 2 정성근 1 가톨릭대학교 의과대학 성모병원 안과학교실 1, 고려대학교 의과대학 안암병원 안과학교실

More information

암센터뉴스레터1

암센터뉴스레터1 CANCER HOSPITAL News News Letter For Yonsei University Gangnam Severance Hospital http://gs.iseverance.com 2012.06.21 2012.08.16 2012.09.19 2012.10.04 2012.10.25 CONTENTS 2012.07.27 2012.10.06 2012.11.06

More information

Kjhps016( ).hwp

Kjhps016( ).hwp Surgical Extent and Types in Pancreatic Cancer Song Cheol Kim, M.D. Department of Surgery, Ulsan University College of Medicine & Asan Medical Center, Seoul, Korea Pancreatic cancer continues to pose a

More information

A 617

A 617 Special Issue Diabetic Retinopathy Won Ki Lee, M.D. Department of Ophthalmology The Catholic University of Korea College of Medicine Kangnam St. Mary s Hospital E mail : wklee@catholic.ac.kr Abstract R

More information

<30312DC1A4BAB8C5EBBDC5C7E0C1A4B9D7C1A4C3A52DC1A4BFB5C3B62E687770>

<30312DC1A4BAB8C5EBBDC5C7E0C1A4B9D7C1A4C3A52DC1A4BFB5C3B62E687770> Journal of the Korea Institute of Information and Communication Engineering 한국정보통신학회논문지(J. Korea Inst. Inf. Commun. Eng.) Vol. 19, No. 2 : 258~264 Feb. 2015 ID3 알고리즘 기반의 귀납적 추론을 활용한 모바일 OS의 성공과 실패에 대한

More information

지원연구분야 ( 코드 ) LC0202 과제번호 창의과제프로그램공개가능여부과제성격 ( 기초, 응용, 개발 ) 응용실용화대상여부실용화공개 ( 공개, 비공개 ) ( 국문 ) 연구과제명 과제책임자 세부과제 ( 영문 ) 구분 소속위암연구과직위책임연구원

지원연구분야 ( 코드 ) LC0202 과제번호 창의과제프로그램공개가능여부과제성격 ( 기초, 응용, 개발 ) 응용실용화대상여부실용화공개 ( 공개, 비공개 ) ( 국문 ) 연구과제명 과제책임자 세부과제 ( 영문 ) 구분 소속위암연구과직위책임연구원 지원연구분야 ( 코드 ) LC0202 과제번호 1110550 창의과제프로그램공개가능여부과제성격 ( 기초, 응용, 개발 ) 응용실용화대상여부실용화공개 ( 공개, 비공개 ) ( 국문 ) 연구과제명 과제책임자 세부과제 ( 영문 ) 구분 1 2 3 소속위암연구과직위책임연구원 성명류근원전공외과 세부과제명 세부과제책임자 성명 소속 ( 직위 ) 전공 총연구기간 2011

More information

Kaes025.hwp

Kaes025.hwp 고위험군유두상갑상선암환자에대한방사성옥소최대허용선량측정법및치료법의검증 Verification of Measurement Methods and Therapeutic Efficacy of Maximum Permissible Dose of I-131 in High Risk Patients with Differentiated Papillary Thyroid Cancer

More information

( )Jkstro011.hwp

( )Jkstro011.hwp 비인강암의방사선치료결과및생존율에관한예후인자분석 2005 2 1 2005 3 28. :, Tel: 053)250-7665, Fax: 053)250-7984 E-mail: jhkim@dsmc.or.kr 정영연외 2 인 : 비인강암의예후인자분석 정영연외 2 인 : 비인강암의예후인자분석 Carcinoma of the nasopharynx treated by radiotherapy

More information

- i - - ii - - iii - - iv - - v - - vi - - 1 - - 2 - - 3 - 1) 통계청고시제 2010-150 호 (2010.7.6 개정, 2011.1.1 시행 ) - 4 - 요양급여의적용기준및방법에관한세부사항에따른골밀도검사기준 (2007 년 11 월 1 일시행 ) - 5 - - 6 - - 7 - - 8 - - 9 - - 10 -

More information

139~144 ¿À°ø¾àħ

139~144 ¿À°ø¾àħ 2 139 DOI : 10.3831/KPI.2010.13.2.139 2 Received : 10. 04. 08 Revised : 10. 04. 26 Two Case Report on Wrist Ganglion Treated with Scolopendrid Pharmacopuncture Accepted : 10. 05. 04 Key Words: Wrist Ganglion,

More information

433대지05박창용

433대지05박창용 Recent Changes in Summer Precipitation Characteristics over South Korea Changyong Park* JaYeon Moon** Eun-Jeong Cha*** Won-Tae Yun**** Youngeun Choi***** 1958 2007 6 9 6 9 10 10 10 10 10 Abstract This

More information

untitled

untitled 대한내분비외과학회지 : 제11권제4호 Vol. 11, No. 4, December 2011 원저 갑상선절제술시하시모토갑상선염동반여부에따른임상적특징 왈레스기념침례병원외과 이미진ㆍ임양수 Clinical Features of Patients Who Undergo Thyroidectomy with and without Hashimoto s Thyroiditis Mi-Jin

More information

Abstract Musculoskeletal Symptoms and Related Factors for Nurses and Radiological Technologists Wearing a Lead Apron for Radiation Pro t e c t i o n Jung-Im Yoo, Jung-Wan Koo 1 ) Angio Unit, Team of Radiology,

More information

Kaes017.hwp

Kaes017.hwp 갑상선의 Poorly Differentiated (Insular) Carcinoma Insular Carcinoma: An Aggressive Subtype of Differentiated Thyroid Neoplasms Seok-Jin Nam, M.D., Sang-Dal Lee, M.D., Hal-lin Park, M.D., Young-Ryun Oh, M.D.

More information

Jkbcs032.hwp

Jkbcs032.hwp Clinical Correlation of HER-2/neu Overexpression in Patients with Breast Cancer Sung Yong Kim, Tae Yoon Kim, Jae Jun Kim, Chang Ho Kim, Ok Pyung Song, Min Hyuk Lee, Eui Han Kim 1, and Moo Sik Cho Departments

More information

연하곤란

연하곤란 2015.03.04 부울경소화기내시경지회 Intramucosal gastric cancer: The rate of lymph node metastasis in signet ring cell carcinoma was as low as that in welldifferentiated adenocarcinoma 인제대부산백병원 소화기내과 지삼룡 Signet ring

More information

- iii - - i - - ii - - iii - 국문요약 종합병원남자간호사가지각하는조직공정성 사회정체성과 조직시민행동과의관계 - iv - - v - - 1 - - 2 - - 3 - - 4 - - 5 - - 6 - - 7 - - 8 - - 9 - - 10 - - 11 - - 12 - - 13 - - 14 - α α α α - 15 - α α α α α α

More information

DBPIA-NURIMEDIA

DBPIA-NURIMEDIA 한국소음진동공학회 2015추계학술대회논문집년 Study of Noise Pattern and Psycho-acoustics Characteristic of Household Refrigerator * * ** ** Kyung-Soo Kong, Dae-Sik Shin, Weui-Bong Jeong, Tae-Hoon Kim and Se-Jin Ahn Key Words

More information

Can032.hwp

Can032.hwp Chromosomal Alterations in Hepatocellular Carcinoma Cell Lines Detected by Comparative Genomic Hybridization Sang Jin Park 1, Mahn Joon Ha, Ph.D. 1, Hugh Chul Kim, M.D. 2 and Hyon Ju Kim, M.D. 1 1 Laboratory

More information

Jkbcs012( ).hwp

Jkbcs012( ).hwp Complications and Reasons for Dissatisfaction in Augmentation Mammoplasty - Analysis of 42 Cases of Re-operation - Sangdal Lee M.D. Clinic Purpose: Breast augmentation has recently become a common plastic

More information

03이경미(237~248)ok

03이경미(237~248)ok The recent (2001-2010) changes on temperature and precipitation related to normals (1971-2000) in Korea* Kyoungmi Lee** Hee-Jeong Baek*** ChunHo Cho**** Won-Tae Kwon*****. 61 (1971~2000) 10 (2001~2010).

More information

(JBE Vol. 21, No. 1, January 2016) (Regular Paper) 21 1, (JBE Vol. 21, No. 1, January 2016) ISSN 228

(JBE Vol. 21, No. 1, January 2016) (Regular Paper) 21 1, (JBE Vol. 21, No. 1, January 2016)   ISSN 228 (JBE Vol. 1, No. 1, January 016) (Regular Paper) 1 1, 016 1 (JBE Vol. 1, No. 1, January 016) http://dx.doi.org/10.5909/jbe.016.1.1.60 ISSN 87-9137 (Online) ISSN 16-7953 (Print) a), a) An Efficient Method

More information

歯1.PDF

歯1.PDF 200176 .,.,.,. 5... 1/2. /. / 2. . 293.33 (54.32%), 65.54(12.13%), / 53.80(9.96%), 25.60(4.74%), 5.22(0.97%). / 3 S (1997)14.59% (1971) 10%, (1977).5%~11.5%, (1986)

More information

04조남훈

04조남훈 Received : 2011. 11. 16 Reviewed : 2011. 11. 25 Accpeted : 2011. 12. 5 A Case Report of Prescribing Yanghyeolgeopung-tang(yangxuequfeng-tang) to Two Patients with Cervical Disc Herniation and Headache

More information

<342EBEC8BCBABFAD2CB9DAC7E2C1D82E687770>

<342EBEC8BCBABFAD2CB9DAC7E2C1D82E687770> 大 韓 癩 學 會 誌 : 第 41 卷, 第 1 號 2008 Korean Leprosy Bulletin, Vol. 41, No. 1, June, 2008 마비성 하안검 외반증에 대한 lateral tarsal strip의 재조명 안성열 성형외과의원 1), 제일병원 피부과 2) 안성열 1), 박향준 2) - Abstract - Reappraisal of the

More information

DBPIA-NURIMEDIA

DBPIA-NURIMEDIA The e-business Studies Volume 17, Number 4, August, 30, 2016:319~332 Received: 2016/07/28, Accepted: 2016/08/28 Revised: 2016/08/27, Published: 2016/08/30 [ABSTRACT] This paper examined what determina

More information

Abstract Background : Most hospitalized children will experience physical pain as well as psychological distress. Painful procedure can increase anxie

Abstract Background : Most hospitalized children will experience physical pain as well as psychological distress. Painful procedure can increase anxie Volume 12, Number 1, 92~102, An Intervention Study of Pain Reduction during IV Therapy in Hospitalized Children Myo-Jin Kim 1), Joung-Hae Bak 1), Won-Seok Seo 2) Mi-Young Kim 3), Sun-Kyoung Park 3), Jai-Soung

More information

Kaes010.hwp

Kaes010.hwp 갑상선자극호르몬이갑상선암세포의 VEGF, 신생혈관형성, 성장, 침윤및전이에미치는영향 Effects of TSH on the Production of VEGF, Angiogenesis, Growth, Invasion and Metastasis in Thyroid Cancer Cells Euy Young Soh, M.D., Hee Boong Park, M.D.,

More information

<31372DB9DABAB4C8A32E687770>

<31372DB9DABAB4C8A32E687770> 김경환 박병호 충북대학교 도시공학과 (2010. 5. 27. 접수 / 2011. 11. 23. 채택) Developing the Traffic Severity by Type Kyung-Hwan Kim Byung Ho Park Department of Urban Engineering, Chungbuk National University (Received May

More information

이형석외

이형석외 KISEP Head and Neck Korean J Otolaryngol 2004;47:1146-50 성문암종에서수직부분후두절제술 한양대학교의과대학이비인후과학교실 이형석 김기태 민현정 박철원 태경 Vertical Partial Laryngectomy in Glottic Cancer Hyung Seok Lee, MD, Ki Tae Kim, MD, Hyun Jung

More information

(49-54)Kjhps004.hwp

(49-54)Kjhps004.hwp Biliary Cystadenoma and Cystadenocarcinoma of the Liver Jae Hoon Lee, M.D., Dong Ho Choi, M.D. 1, Kyeong Geun Lee, M.D., Hwon Kyum Park M.D. and Kwang Soo Lee, M.D. Department of Surgery, College of Medicine,

More information

DBPIA-NURIMEDIA

DBPIA-NURIMEDIA The e-business Studies Volume 17, Number 6, December, 30, 2016:275~289 Received: 2016/12/02, Accepted: 2016/12/22 Revised: 2016/12/20, Published: 2016/12/30 [ABSTRACT] SNS is used in various fields. Although

More information

Jkbcs030(10)( ).hwp

Jkbcs030(10)( ).hwp Treatment of Breast Fibroadenoma with Interstitial Laser Photocoagulation Doo Min Sohn, Hyo Won Lee, Tae Yun Kim, Dan Song, Sung Yong Kim, Chul Wan Lim and Min Hyuk Lee Department of Surgery, College of

More information

005송영일

005송영일 Received : 2015. 12. 09 Reviewed : 2015. 12. 16 Accepted : 2015. 12. 16 Sternal Fracture occurred after Thai Massage : A Case Report Young-Il Song, K.M.D. 1, Dong-Eun Kim, K.M.D. 1 1 Department of Rehabilitation

More information

- i - - ii - - iii - - iv - - v - - 1 - - 2 - - 3 - - 4 - - 5 - - 6 - - 7 - - 8 - - 9 - - 10 - - 11 - - 12 - - 13 - - 14 - - 15 - - 16 - - 17 - - 18 - - 19 - α α - 20 - α α α α α α - 21 - - 22 - - 23 -

More information

Analysis of objective and error source of ski technical championship Jin Su Seok 1, Seoung ki Kang 1 *, Jae Hyung Lee 1, & Won Il Son 2 1 yong in Univ

Analysis of objective and error source of ski technical championship Jin Su Seok 1, Seoung ki Kang 1 *, Jae Hyung Lee 1, & Won Il Son 2 1 yong in Univ Analysis of objective and error source of ski technical championship Jin Su Seok 1, Seoung ki Kang 1 *, Jae Hyung Lee 1, & Won Il Son 2 1 yong in University & 2 Kang Won University [Purpose] [Methods]

More information

590호(01-11)

590호(01-11) T H E K O R E A N D O C T O R S W E E K L Y www.docdocdoc.co.kr I N S I D E 38 3 5 6 7 10 13 28 29 30 31 38 41 42 2 Advertisement Government & Medicine 3 Government & Medicine 4 Government & Medicine Government

More information

Analyses the Contents of Points per a Game and the Difference among Weight Categories after the Revision of Greco-Roman Style Wrestling Rules Han-bong

Analyses the Contents of Points per a Game and the Difference among Weight Categories after the Revision of Greco-Roman Style Wrestling Rules Han-bong Analyses the Contents of Points per a Game and the Difference among Weight Categories after the Revision of Greco-Roman Style Wrestling Rules Han-bong An 1 & Kyoo-jeong Choi 2 * 1 Korea National Wrestling

More information

자기공명영상장치(MRI) 자장세기에 따른 MRI 품질관리 영상검사의 개별항목점수 실태조사 A B Fig. 1. High-contrast spatial resolution in phantom test. A. Slice 1 with three sets of hole arr

자기공명영상장치(MRI) 자장세기에 따른 MRI 품질관리 영상검사의 개별항목점수 실태조사 A B Fig. 1. High-contrast spatial resolution in phantom test. A. Slice 1 with three sets of hole arr Original Article pissn 1738-2637 J Korean Soc Radiol 2012;67(2):129-134 The Survey of Magnetic Resonance Imaging Quality according to in Korea 1 자기공명영상장치(MRI) 자장세기에 따른 MRI 품질관리 영상검사의 개별항목점수 실태조사 1 Hyun-Hae

More information

44-4대지.07이영희532~

44-4대지.07이영희532~ A Spatial Location Analysis of the First Shops of Foodservice Franchise in Seoul Metropolitan City Younghee Lee* 1 1 (R) 0 16 1 15 64 1 Abstract The foodservice franchise is preferred by the founders who

More information

04김호걸(39~50)ok

04김호걸(39~50)ok Journal of Environmental Impact Assessment, Vol. 22, No. 1(2013) pp.39~50 Prediction of Landslides Occurrence Probability under Climate Change using MaxEnt Model Kim, Hogul* Lee, Dong-Kun** Mo, Yongwon*

More information

untitled

untitled 대한내분비외과학회지 : 제10권제3호 Vol. 10, No. 3, September 2010 원저 갑상선미세유두암에서종양크기의구분에따른임상병리학적특징의분석 가톨릭대학교의과대학대전성모병원외과학교실 조윤정ㆍ이동호ㆍ이상철ㆍ김세준ㆍ김정구ㆍ안창준ㆍ이관주 Analysis of Clinicopathologic Features of Papillary Thyroid Microcarcinoma

More information

Kbcs002.hwp

Kbcs002.hwp Does Real-time Compound Imaging Improve Evaluation of reast Cancer Compared to Conventional Sonography? o Kyoung Seo, M.D., Yu Whan Oh, M.D., Kyu Ran Cho, M.D., Young Hen Lee, M.D., Hyung Joon Noh, M.D.,

More information

달생산이 초산모 분만시간에 미치는 영향 Ⅰ. 서 론 Ⅱ. 연구대상 및 방법 達 은 23) 의 丹 溪 에 최초로 기 재된 처방으로, 에 복용하면 한 다하여 난산의 예방과 및, 등에 널리 활용되어 왔다. 達 은 이 毒 하고 는 甘 苦 하여 氣, 氣 寬,, 結 의 효능이 있

달생산이 초산모 분만시간에 미치는 영향 Ⅰ. 서 론 Ⅱ. 연구대상 및 방법 達 은 23) 의 丹 溪 에 최초로 기 재된 처방으로, 에 복용하면 한 다하여 난산의 예방과 및, 등에 널리 활용되어 왔다. 達 은 이 毒 하고 는 甘 苦 하여 氣, 氣 寬,, 結 의 효능이 있 대한한방부인과학회지 THE JOURNAL OF ORIENTAL OBSTETRICS & GYNECOLOGY VOL.17, NO.2 : 115-122 (2004) 달생산이 초산모 분만시간에 미치는 영향 * 북경한의원, ** 윤산부인과의원, *** 최은림산부인과의원, 상지대학교 한의과대학 부인과학교실 ****, 경희대학교 동서의학대학원 김성준 *****, 윤왕준

More information

±èÇ¥³â

±èÇ¥³â 533 Fig. 1. Dead zone. Nine echoes are positioned 2-10 mm below the scan surface with 1 mm distance. All nine echoes are clearly visualized. 534 Fig. 2. Vertical and horizontal measurement. 10 cm distance

More information

Head and Neck Korean J Otorhinolaryngol-Head Neck Surg 2018;61(1):42-6 / pissn / eissn

Head and Neck Korean J Otorhinolaryngol-Head Neck Surg 2018;61(1):42-6 / pissn / eissn Head and Neck Korean J Otorhinolaryngol-Head Neck Surg 2018;61(1):42-6 / pissn 2092-5859 / eissn 2092-6529 https://doi.org/10.3342/kjorl-hns.2017.00682 Partial Superficial Parotidectomy via Retroauricular

More information

원위부요척골관절질환에서의초음파 유도하스테로이드주사치료의효과 - 후향적 1 년경과관찰연구 - 연세대학교대학원 의학과 남상현

원위부요척골관절질환에서의초음파 유도하스테로이드주사치료의효과 - 후향적 1 년경과관찰연구 - 연세대학교대학원 의학과 남상현 원위부요척골관절질환에서의초음파 유도하스테로이드주사치료의효과 - 후향적 1 년경과관찰연구 - 연세대학교대학원 의학과 남상현 원위부요척골관절질환에서의초음파 유도하스테로이드주사치료의효과 - 후향적 1 년경과관찰연구 - 연세대학교대학원 의학과 남상현 원위부요척골관절질환에서의초음파 유도하스테로이드주사치료의효과 - 후향적 1 년경과관찰연구 - 지도김석원교수 이논문을석사학위논문으로제출함

More information

09È«¼®¿µ 5~152s

09È«¼®¿µ5~152s Korean Journal of Remote Sensing, Vol.23, No.2, 2007, pp.45~52 Measurement of Backscattering Coefficients of Rice Canopy Using a Ground Polarimetric Scatterometer System Suk-Young Hong*, Jin-Young Hong**,

More information

16_이주용_155~163.hwp

16_이주용_155~163.hwp 사상체질의학회지 2008;20(2):155-163 J of Sasang Constitutional Medicine Vol. 20, No. 2, 2008:155-163 http://www.esasang.com 腦 梗 塞 으로 발생한 少 陽 人 半 身 舞 蹈 病 患 者 치험 1례 이주용 이한얼 한경수 안택원 Abstract 대전대학교 한의과대학 사상체질과 A Soyangin

More information

THE JOURNAL OF KOREAN INSTITUTE OF ELECTROMAGNETIC ENGINEERING AND SCIENCE. vol. 29, no. 10, Oct ,,. 0.5 %.., cm mm FR4 (ε r =4.4)

THE JOURNAL OF KOREAN INSTITUTE OF ELECTROMAGNETIC ENGINEERING AND SCIENCE. vol. 29, no. 10, Oct ,,. 0.5 %.., cm mm FR4 (ε r =4.4) THE JOURNAL OF KOREAN INSTITUTE OF ELECTROMAGNETIC ENGINEERING AND SCIENCE. 2018 Oct.; 29(10), 799 804. http://dx.doi.org/10.5515/kjkiees.2018.29.10.799 ISSN 1226-3133 (Print) ISSN 2288-226X (Online) Method

More information

Journal of Educational Innovation Research 2018, Vol. 28, No. 1, pp DOI: * A Analysis of

Journal of Educational Innovation Research 2018, Vol. 28, No. 1, pp DOI: * A Analysis of Journal of Educational Innovation Research 2018, Vol. 28, No. 1, pp.99-117 DOI: http://dx.doi.org/10.21024/pnuedi.28.1.201803.99 2015 * A Analysis of the Characters and Issues about the 2015 Revised Social

More information

A Study on Married Female Immigrants Life Style and Marriage Satisfaction in Terms of Preparing Their Old Age in Chungcheongnam-do Department of Gerontology, Hoseo University Doctoral Student : Hi Ran

More information

untitled

untitled 대한내분비외과학회지 : 제9권제4호 Vol. 9, No. 4, December 2009 원저 갑상선수술에서 Harmonic TM, Ligasure TM 혈관결찰술의유용성및안전성비교 전통적봉합사매듭에의한 충남대학교의과대학외과학교실 유정미ㆍ한재은ㆍ김용훈ㆍ김제룡 A Comparison of the Usefulness and Safety of the Harmonic

More information

,,,.,,,, (, 2013).,.,, (,, 2011). (, 2007;, 2008), (, 2005;,, 2007).,, (,, 2010;, 2010), (2012),,,.. (, 2011:,, 2012). (2007) 26%., (,,, 2011;, 2006;

,,,.,,,, (, 2013).,.,, (,, 2011). (, 2007;, 2008), (, 2005;,, 2007).,, (,, 2010;, 2010), (2012),,,.. (, 2011:,, 2012). (2007) 26%., (,,, 2011;, 2006; ,,.. 400,,,,,,.,,, -, -, -., 3.. :, Tel : 010-9540-0640, E-mail : sunney05@hanmail.net ,,,.,,,, (, 2013).,.,, (,, 2011). (, 2007;, 2008), (, 2005;,, 2007).,, (,, 2010;, 2010), (2012),,,.. (, 2011:,, 2012).

More information

(

( 317 318 319 320 1 3 5 5 5 5 2 321 : 1.,,,,, 06 2. X-ray beam penetration (density) (contrast) 03 3. patch coating, precipitation, flaking 03 4. centering 03 5. Esophagus, cardia, fundus, body, angle, antrum,

More information

DBPIA-NURIMEDIA

DBPIA-NURIMEDIA The e-business Studies Volume 17, Number 6, December, 30, 2016:3~20 Received: 2016/12/04, Accepted: 2016/12/27 Revised: 2016/12/27, Published: 2016/12/30 [ABSTRACT] This study aims to comprehensively analyze

More information

DBPIA-NURIMEDIA

DBPIA-NURIMEDIA The e-business Studies Volume 17, Number 6, December, 30, 2016:237~251 Received: 2016/11/20, Accepted: 2016/12/24 Revised: 2016/12/21, Published: 2016/12/30 [ABSTRACT] Recently, there is an increasing

More information

THE JOURNAL OF KOREAN INSTITUTE OF ELECTROMAGNETIC ENGINEERING AND SCIENCE Feb.; 29(2), IS

THE JOURNAL OF KOREAN INSTITUTE OF ELECTROMAGNETIC ENGINEERING AND SCIENCE Feb.; 29(2), IS THE JOURNAL OF KOREAN INSTITUTE OF ELECTROMAGNETIC ENGINEERING AND SCIENCE. 2018 Feb.; 29(2), 93 98. http://dx.doi.org/10.5515/kjkiees.2018.29.2.93 ISSN 1226-3133 (Print) ISSN 2288-226X (Online) UHF-HF

More information

THE JOURNAL OF KOREAN INSTITUTE OF ELECTROMAGNETIC ENGINEERING AND SCIENCE Nov.; 26(11),

THE JOURNAL OF KOREAN INSTITUTE OF ELECTROMAGNETIC ENGINEERING AND SCIENCE Nov.; 26(11), THE JOURNAL OF KOREAN INSTITUTE OF ELECTROMAGNETIC ENGINEERING AND SCIENCE. 2015 Nov.; 26(11), 985991. http://dx.doi.org/10.5515/kjkiees.2015.26.11.985 ISSN 1226-3133 (Print)ISSN 2288-226X (Online) Analysis

More information

(Exposure) Exposure (Exposure Assesment) EMF Unknown to mechanism Health Effect (Effect) Unknown to mechanism Behavior pattern (Micro- Environment) Re

(Exposure) Exposure (Exposure Assesment) EMF Unknown to mechanism Health Effect (Effect) Unknown to mechanism Behavior pattern (Micro- Environment) Re EMF Health Effect 2003 10 20 21-29 2-10 - - ( ) area spot measurement - - 1 (Exposure) Exposure (Exposure Assesment) EMF Unknown to mechanism Health Effect (Effect) Unknown to mechanism Behavior pattern

More information

Jkcs022(89-113).hwp

Jkcs022(89-113).hwp 대한배뇨장애 및 요실금 학회지 J. Korean Continence Society 2004;8:89-113 Bristol Female Lower Urinary Tract Symptom 설문지의 한국어 번역 및 번역본의 언어 타당도 Seung-June Oh*, Hyung Geun Park*, Sung Hyun Paick, Won Hee Park and Myung-Soo

More information

Journal of Educational Innovation Research 2017, Vol. 27, No. 2, pp DOI: : Researc

Journal of Educational Innovation Research 2017, Vol. 27, No. 2, pp DOI:   : Researc Journal of Educational Innovation Research 2017, Vol. 27, No. 2, pp.251-273 DOI: http://dx.doi.org/10.21024/pnuedi.27.2.201706.251 : 1997 2005 Research Trend Analysis on the Korean Alternative Education

More information

THE JOURNAL OF KOREAN INSTITUTE OF ELECTROMAGNETIC ENGINEERING AND SCIENCE Dec.; 27(12),

THE JOURNAL OF KOREAN INSTITUTE OF ELECTROMAGNETIC ENGINEERING AND SCIENCE Dec.; 27(12), THE JOURNAL OF KOREAN INSTITUTE OF ELECTROMAGNETIC ENGINEERING AND SCIENCE. 2016 Dec.; 27(12), 1036 1043. http://dx.doi.org/10.5515/kjkiees.2016.27.12.1036 ISSN 1226-3133 (Print) ISSN 2288-226X (Online)

More information

???춍??숏

???춍??숏 Suseong gu Council Daegu Metropolitan City www.suseongcouncil.daegu.kr Contents SUSEONG GU COUNCIL DAEGU METROPOLITAN CITY 10 www.suseongcouncil.daegu.kr 11 SUSEONG GU COUNCIL DAEGU METROPOLITAN CITY

More information

Journal of Educational Innovation Research 2017, Vol. 27, No. 2, pp DOI: * Review of Research

Journal of Educational Innovation Research 2017, Vol. 27, No. 2, pp DOI:   * Review of Research Journal of Educational Innovation Research 2017, Vol. 27, No. 2, pp.79-102 DOI: http://dx.doi.org/10.21024/pnuedi.27.2.201706.79 * Review of Research Trends on Curriculum for Students with Severe and multiple

More information

03-서연옥.hwp

03-서연옥.hwp 농업생명과학연구 49(4) pp.31-37 Journal of Agriculture & Life Science 49(4) pp.31-37 Print ISSN 1598-5504 Online ISSN 2383-8272 http://dx.doi.org/10.14397/jals.2015.49.4.31 국가산림자원조사 자료를 적용한 충남지역 사유림경영율 추정 서연옥

More information

γ

γ 경락경혈학회지 Vol.27, No.1, pp.87 106, 2010 Journal of Meridian & Acupoint Dept. of 1 Meridian & Acupoint, 3 Acupuncture & Moxibustion, College of Oriental Medicine, Daejeon University 2 Division of Clinical

More information

한국성인에서초기황반변성질환과 연관된위험요인연구

한국성인에서초기황반변성질환과 연관된위험요인연구 한국성인에서초기황반변성질환과 연관된위험요인연구 한국성인에서초기황반변성질환과 연관된위험요인연구 - - i - - i - - ii - - iii - - iv - χ - v - - vi - - 1 - - 2 - - 3 - - 4 - 그림 1. 연구대상자선정도표 - 5 - - 6 - - 7 - - 8 - 그림 2. 연구의틀 χ - 9 - - 10 - - 11 -

More information

<30345F283439372D353034295F313135375FC0CCB5BFC8F15FB5B5B7CEC5CDB3CEC0C720B0BBB1B8BACE20B0E6B0FCBCB3B0E8B0A120C5CDB3CE20B3BBBACEC1B6B8ED2E687770>

<30345F283439372D353034295F313135375FC0CCB5BFC8F15FB5B5B7CEC5CDB3CEC0C720B0BBB1B8BACE20B0E6B0FCBCB3B0E8B0A120C5CDB3CE20B3BBBACEC1B6B8ED2E687770> J of Korean Tunn Undergr Sp Assoc 15(5)497-504(2013) eissn: 2287-4747 http://dx.doi.org/10.9711/ktaj.2013.15.5.497 pissn: 2233-8292 도로터널의 갱구부 경관설계가 터널 내부조명에 미치는 영향에 관한 연구 이미애 1 ㆍ이동희 2 * 1 아이라이트 대표이사 2

More information

10(3)-09.fm

10(3)-09.fm w y wz 10«3y 253~258 (2010.12.) Journal of Korean Society of Urban Environment ³ w Á» Á Á y w y œw (2010 11 22, 2010 12 9 k) Study on Determine of Detention Pond in Small Developed Area In-Soo Chang ½

More information

Journal of Educational Innovation Research 2019, Vol. 29, No. 1, pp DOI: * Suggestions of Ways

Journal of Educational Innovation Research 2019, Vol. 29, No. 1, pp DOI:   * Suggestions of Ways Journal of Educational Innovation Research 2019, Vol. 29, No. 1, pp.65-89 DOI: http://dx.doi.org/10.21024/pnuedi.29.1.201903.65 * Suggestions of Ways to Improve Teaching Practicum Based on the Experiences

More information

IL-1β, IL-1RN, IL-8, MUC, NAT, GST 등 ) IL-1β, IL-1RN, IL-8, MUC, NAT, GST 등 ) IL-1β, IL-1RN, IL-8, MUC, NAT, GST 등 ) l l l α β α β β α β β α β 목적 (Background/Aims): 위암의가족력과 Helicobacter pylori 감염은각각위암발생의위험인자로알려져있으나,

More information

878 Yu Kim, Dongjae Kim 지막 용량수준까지도 멈춤 규칙이 만족되지 않아 시행이 종료되지 않는 경우에는 MTD의 추정이 불가 능하다는 단점이 있다. 최근 이 SM방법의 단점을 보완하기 위해 O Quigley 등 (1990)이 제안한 CRM(Continu

878 Yu Kim, Dongjae Kim 지막 용량수준까지도 멈춤 규칙이 만족되지 않아 시행이 종료되지 않는 경우에는 MTD의 추정이 불가 능하다는 단점이 있다. 최근 이 SM방법의 단점을 보완하기 위해 O Quigley 등 (1990)이 제안한 CRM(Continu 한 국 통 계 학 회 논 문 집 2012, 19권, 6호, 877 884 DOI: http://dx.doi.org/10.5351/ckss.2012.19.6.877 Maximum Tolerated Dose Estimation Applied Biased Coin Design in a Phase Ⅰ Clinical Trial Yu Kim a, Dongjae Kim

More information

?

? http://kfaexpo.kr/ The 40th Korea Franchise Business Expo 2017 JUNE - Vol.23 2017 JUNE - Vol.23 2017 in Busan COVER STORY SPEACIAL REPORT GUIDE POST PEOPLE & STORY ASSOCIATION NEWS Ҷ

More information

:,,.,. 456, 253 ( 89, 164 ), 203 ( 44, 159 ). Cronbach α= ,.,,..,,,.,. :,, ( )

:,,.,. 456, 253 ( 89, 164 ), 203 ( 44, 159 ). Cronbach α= ,.,,..,,,.,. :,, ( ) :,,.,. 456, 253 ( 89, 164 ), 203 ( 44, 159 ). Cronbach α=.83.91.,.,,..,,,.,. :,, (402-751) 253 E-mail : yspark@inha.ac.kr ..,.,.,. Bandura(1997),.,,,,., (,,, 2009), (,,,, 2014).?.,,,.. Bandura (1995) (Resiliency

More information

°ø±â¾Ð±â±â

°ø±â¾Ð±â±â 20, 30, 40 20, 30, 40 1 2 3 4 5 6 7 8 9 10 3.1 6.3 9.4 12.6 15.7 18.8 22.0 25.1 28.3 31.4 2.4 4.7 7.1 9.4 11.8 14.1 16.5 18.8 21.2 23.6 7.1 14.1 21.2 28.3 35.3 42.4 49.5 56.5 63.6 70.7 5.9 11.9 17.8 23.7

More information

The characteristic analysis of winners and losers in curling: Focused on shot type, shot accuracy, blank end and average score SungGeon Park 1 & Soowo

The characteristic analysis of winners and losers in curling: Focused on shot type, shot accuracy, blank end and average score SungGeon Park 1 & Soowo The characteristic analysis of winners and losers in curling: Focused on shot type, shot accuracy, blank end and average score SungGeon Park 1 & Soowon Lee 2 * 1 Program of Software Convergence, Soongsil

More information

Jkbcs042.hwp

Jkbcs042.hwp Invasive Ductal Carcinoma Arising from Axillary Accessory Breast Tae Wan Kim, Sang Wook Kang, Ji Young Park 2, Seung Sang Ko 1, Min Hee Hur 1, Hae Kyung Lee 1, Sung Soo Kang 1, and Jee Hyun Lee 1 Department

More information

03-ÀÌÁ¦Çö

03-ÀÌÁ¦Çö 25 3 (2004 9 ) J Korean Oriental Med 2004;25(3):20-31 1), 2), 3) 1) 2) 3) Grope for a Summary Program about Intellectual Property Protection of Traditional Knowledge (TK)etc. Discussed in WIPO Hwan-Soo

More information

14.531~539(08-037).fm

14.531~539(08-037).fm G Journal of the Korea Concrete Institute Vol. 20, No. 4, pp. 531~539, August, 2008 š x y w m š gj p { sƒ z 1) * 1) w w Evaluation of Flexural Strength for Normal and High Strength Concrete with Hooked

More information

Jksvs019(8-15).hwp

Jksvs019(8-15).hwp Grade I Grade II Grade III 12 대한혈관외과학회지 : 제 20 권 제 1 호 2004 Control Group A Group B Fig. 4. Microscopic findings of vein wall in control, group A and group B on the day of 7 after venous occlusion. The

More information

( )Kjhps043.hwp

( )Kjhps043.hwp Difference of Fistula Maturation Degree and Physical Property by the Types of Tube Material: An Experimental Study Sang Koo Kang, M.D. 1, Hee Chul Yu, M.D. 1,4, Woo Sung Moon, M.D. 2,4, Ju Hyoung Lee,

More information

27 2, 1-16, * **,,,,. KS,,,., PC,.,,.,,. :,,, : 2009/08/12 : 2009/09/03 : 2009/09/30 * ** ( :

27 2, 1-16, * **,,,,. KS,,,., PC,.,,.,,. :,,, : 2009/08/12 : 2009/09/03 : 2009/09/30 * ** ( : 27 2, 1-16, 2009. * **,,,,. KS,,,., PC,.,,.,,. :,,, : 2009/08/12 : 2009/09/03 : 2009/09/30 * ** (: jjhkim@cau.ac.kr) 2 한국교육문제연구제 27 권 2 호, 2009 Ⅰ.,. 2008 3,536, 10 99.9% (, 2008). PC,, (, 2007). (, 2008),.,

More information

<35335FBCDBC7D1C1A42DB8E2B8AEBDBAC5CDC0C720C0FCB1E2C0FB20C6AFBCBA20BAD0BCAE2E687770>

<35335FBCDBC7D1C1A42DB8E2B8AEBDBAC5CDC0C720C0FCB1E2C0FB20C6AFBCBA20BAD0BCAE2E687770> Journal of the Korea Academia-Industrial cooperation Society Vol. 15, No. 2 pp. 1051-1058, 2014 http://dx.doi.org/10.5762/kais.2014.15.2.1051 멤리스터의 전기적 특성 분석을 위한 PSPICE 회로 해석 김부강 1, 박호종 2, 박용수 3, 송한정 1*

More information

서론 34 2

서론 34 2 34 2 Journal of the Korean Society of Health Information and Health Statistics Volume 34, Number 2, 2009, pp. 165 176 165 진은희 A Study on Health related Action Rates of Dietary Guidelines and Pattern of

More information

노인정신의학회보14-1호

노인정신의학회보14-1호 제14권 1호 통권 제23호 www.kagp.or.kr 발행인 : 정인과 / 편집인 : 이동우 / 발행처 : 정인과 (152-703) 서울특별시 구로구 구로동 80번지 고려대학교 구로병원 정신과 / TEL : 02-818-6608 / FAX : 02-852-1937 발행일 : 2008년 4월 30일 / 제 작 : (주)엠엘커뮤니케이션 140-846 서울특별시

More information