<30322EBFF8C0FA30322DB1B8C0DABFF82E687770>

Size: px
Start display at page:

Download "<30322EBFF8C0FA30322DB1B8C0DABFF82E687770>"

Transcription

1 J Korean Balance Soc 2008;7(2): 한국에서메니에르병의치료방침에대한다기관연구 분당서울대학교병원이비인후과 1, 부산대학교병원이비인후과 2, 인하대학교병원이비인후과 3, 가톨릭대학교강남성모병원이비인후과 4, 건국대학교병원이비인후과 5, 경상대학교병원이비인후과 6, 울산대학교서울아산병원이비인후과 7, 연세대학교세브란스병원이비인후과 8, 고려대학교안암병원이비인후과 9, 단국대학교병원이비인후과 10, 성균관대학교삼성서울병원이비인후과 11, 가천의과대학교길병원이비인후과 12, 고려대학교구로병원이비인후과 13, 서울대학교감각기관연구소 14 홍성광 1, 고의경 2, 김규성 3, 박경호 4, 박홍주 5, 안성기 6, 안중호 7, 이원상 8, 임기정 9, 정재윤 10, 정원호 11, 한규철 12, 채성원 13, 구자원 1,14 Multicenter study on the treatment pattern of Ménière s disease in Korea Sung Kwang Hong, MD 1, Eui-Kyung Koh, MD 2, Kyu-Sung Kim, MD 3, Kyoung Ho Park, MD 4, Hong Ju Park, MD 5, Seong Ki Ahn, MD 6, Joong Ho Ahn, MD 7, Won-Sang Lee, MD 8, Gi Jung Im, MD 9, Jae-Yun Jung, MD 10, Won-Ho Chung, MD 11, Gyu Cheol Han, MD 12, Sung Won Chae, MD 13, Ja-Won Koo, MD 1,14 1 Department of Otorhinolaryngology, Seoul National University Bundang Hospital, Gyeonggi-do, Korea 2 Department of Otorhinolaryngology, Pusan National University Hospital, Busan, Korea 3 Department of Otorhinolaryngology, Inha University Hospital, Incheon, Korea 4 Department of Otorhinolaryngology, Catholic University, Kangnam St. Mary s Hospital, Seoul, Korea 5 Department of Otorhinolaryngology, Konkuk University Hospital, Seoul, Korea 6 Department of Otorhinolaryngology, Gyeongsang National University Hospital, Gyeongsangnam-do, Korea 7 Department of Otorhinolaryngology, Ulsan University, Asan Medical Center, Seoul, Korea 8 Department of Otorhinolaryngology, Yonsei University, Severance Hospital, Seoul, Korea 9 Department of Otorhinolaryngology, Korea University, Anam Hospital, Seoul, Korea 10 Department of Otorhinolaryngology, Dankook University Hospital, Chungcheongnam-do, Korea 11 Department of Otorhinolaryngology, Sungkyunkwan University, Samsung Seoul Hospital, Seoul, Korea 12 Department of Otorhinolaryngology, Gachon University, Gil Hospital, Incheon, Korea 13 Department of Otorhinolaryngology, Korea University, Guro Hospital, Seoul, Korea 14 Research center for Sensory Organs, Medical research Center, Seoul National University, Seoul, Korea Background and Objectives: It is hard to determine the efficacy of several treatment options of Ménière s disease since dynamic course of the disease and diverse rate of recurrence. Few modalities are regarded as effective in the viewpoint of evidence based medicine. Study was conducted to know the current status of treatment options for Ménière s disease. Address for correspondence: Ja-Won Koo, MD Department of Otorhinolaryngology, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do , Korea Tel: , Fax: jwkoo99@snu.ac.kr 174

2 홍성광외 13 인 Materials and Methods: A multicenter survey was conducted using questionnaires to collect information on current status of treatment patterns in Ménière s disease. The questionnaire answered by neurotologic surgeons working at 12 institutes in Korea was analyzed. Results: Low salt diet was always instructed to their patients, but 8 out of 12 responders (67%) did not emphasis on the amount of dietary salt. Duration of pharmacotherapy was ranged from 3 to 12 months. Intratympanic steroid injection was performed in 8 institutes (67%). Every institute agreed on the role of intratympanic gentamicin application. Treatment options for intractable patients were asked. Endolymphatic sac surgery, intratympanic steroid, Meniette device and intratympanic aminoglycoside injection were answered in patients who hope to preserve residual hearing. On the contrary, in patients without serviceable hearing, intratympanic jnjection of aminoglycosides (9/12, 75%) dominated as the next treatment option. Conclusions: Most institutes provide similar patterns of practice in medical treatment. The application of intratympanic aminoglycoside is also agreed in intractable patients without serviceable hearing. However, thoughts about the role and detailed methods of the surgical and adjunctive treatment options were not agreed, especially in intractable patients with good hearing. Further clinical studies and discussions would be necessary to provide consensus for the best treatment of Ménière s disease in Korea. Key words : Ménière s disease, Pharmacotherapy, Surgery, Aminoglycosides 서론메니에르병의치료에있어서약물요법및수술등다양한치료가시도되고있지만다음과같은제한을가지고있다. 첫째는내림프수종이발병기전으로알려져있으나원인을잘모르므로병인의근본적인치료가어렵다는것이고, 둘째는병의진행과정에서자연적회복이많기때문에치료후수개월혹은수년동안재발이나타나지않는것이치료효과때문인지자연적회복때문인지평가하기가어렵다는점이다. 대부분의약물요법과비파괴적수술적치료의효과가대조군에비해유의하게높다고보고하면서도메니에르병환자의 10~25% 에서치료실패를보이는연구결과는이러한치료가위약효과일수도있음을시사하는것이다. 1 이러한이유때문에약물치료의기간이나수술적방법의선택에있어서메니에르병의치료는대부분치료자의경험에의존하게되는경우가많게되는것이다. 그러나최근들어개인적인경험이나숙련도에의존하기보다는임상시험의결과를토대로한근거중심의의학 (evidence-based medicine) 의필요성이증대되었고, 1993년 Cochrane library가 설립되어이러한근거를바탕으로한여러연구결과의자료들이축적됨에따라단순히경험적인치료보다는나름대로객관적인증거에기인한처방이더중요시되고있다. 그러나다양한유병기간과임상양상을보이는메니에르병의특성상 Cochrane database 내에그동안메니에르병의치료로사용되어왔던약들의대부분이 증거가없음 또는 연구결과부족 등으로평가되고있어 2,3 근거중심의처방을임상에서엄격하게적용하기에는무리가있는것처럼보인다. 따라서메니에르병에대한경험이있는치료자들의치료성적이나경향을서로공유하고이를살펴보는것은메니에르병의효과적인치료를위해중요한과정이라할수있겠다. 따라서본연구의목적은설문지를통해현재국내에서시행하고있는메니에르병의치료적접근방법및치료방법선택의기준과경향을알아보고자하였다. 재료및방법 메니에르병치료에관련된총 14문항으로이루어진설문지 (Table 1) 를대한평형의학회소속이과전문교 175

3 메니에르병의치료방침에대한다기관연구 Table 1. Questionnaire on treatment of Ménière s disease. 1. 귀병원에서년간 definte Meniere s disease 와 delayed hydrops로진단되는환자는각각얼마나되십니까? 2. 보존적치료 A. 저염식은얼마나엄격하게적용하십니까? I. 싱겁게먹는것이좋다고설명만한다. ii. 하루 10 g 이하로설명한다. iii. 하루 5 g 이하로하라고설명한다. iv. 하루 2 g 이하로엄격하게지키라고교육한다. B. 수분섭취를많이하도록설명하십니까? I. 예 ii. 아니오 3. 약물치료 A. 처음부터약물치료를시작하십니까? 아니라면어떤기준으로약물치료를시작하십니까? B. 선택약물에는어떤약물이있습니까? ( 예, hydrochlorothiazide, amiloride, sibellium, beta-blocker 등 ) C. 약물치료의기간은보통얼마나지속하십니까? 4. 메니에트 A. 사용한경험이있으십니까? B. 어떤경우에사용하십니까? C. 전체환자에대한적용비율은얼마나됩니까? 5. 환기관만삽입해도증상의호전이있다는보고도있는데귀하께서는경험이있으십니까? 치료경험이있으시면경과및결과에대해기술을부탁드립니다. 6. intratympanic steroid A. 어떤경우에시행하십니까? B. 어떤성분을사용하십니까? 7. intratympanic gentamicin A. 본치료의적용에동의하십니까? B. 본치료를하신다면적응은어떻게잡고계십니까? C. Injection 전약물치료는얼마나시도하십니까 D. definite Meniere나 delayed hydrops환자의몇 % 가본치료를받게되나요? E. Gentamicin 의농도는? ( 원액혹은다른 media에희석하여 ) : F. Injection의회수와주기는? 8. Endolymphatic sac수술에대해 A. 귀하는본수술의임상적역할에동의하십니까? B. 본수술의적응은어떻게잡고계십니까 / 9. Vestibular neurectomy A. 귀하는본수술의임상적역할에동의하십니까? B. 어떤 approach를선호하십니까? C. 본수술의적응은어떻게잡고계십니까? 10. Labyrinthectoy A. 귀하는본수술의임상적역할에동의하십니까? B. 어떤 approach를선호하십니까? C. 본수술의적응은어떻게잡고계십니까? 11. 얼마나많은환자들이다음수술을받게되는지요? A. Endolymphatic sac decompression B. Vestibular neurectomy C. Labyrinthectomy 12. 청력보존을해야하는기준을얼마로잡으십니까? 13. 약물치료에도증상호전이없거나약만끊으면재발하는경우귀하가선택하시는다음 modality 로는어떤단계적조치를취하십니까? A. 청력을보존해야하는경우 B. 청력이나쁜경우귀하의다음단계는어떤 modality를선택하십니까? 14. 양쪽메니에르병에대해서는어떤치료방침을가지고계십니까? 176

4 홍성광외 13 인 Fig. 1. Number of new patients diagnosed as having definite Ménière s disease (A) and delayed endolymphatic hydrops (B) per year. Fig. 2. Instruction to the patients regarding dietary salt intake (A) and water intake (B) in Ménière s disease. 수가있는전국의과대학병원이과전담교수에게발송하였고그중설문지에응답한 12개병원의의견을종합하여결과를비교분석하였다. 문항에따라중복으로응답했거나일부누락된항목도관찰되었다. 결과 1. 연간경험하게되는메니에르병환자의수 1995년 AAO-HNS의진단기준에따라연간명확한메니에르병 (definite Ménière s disease) 으로진단되는환자의수는 4개의병원에서 21~40명정도라고응답하였고 100명이상으로응답한병원도 2개의병원이있었다. 반면지연성내림프수종 (delayed endolymphtic hydrops) 으로진단되는빈도는이보다적어 9개병원중 6개병원에서 5명이내 (67%) 였고진단기준의모호 함으로따로분류해서진단하지않는병원도한곳이있었다 (Fig. 1). 2. 식이요법모든병원에서저염식의역할은인정하면서도 1일섭취소금의양을 2 g 이하로엄격하게지키도록하는곳은 2개의병원에불과했고 (17%), 8개병원 (67%) 에서는 싱겁게먹는것이좋다 는정도의설명만하는것으로조사되었다 (Fig. 2A). 수분섭취에대해서는 8개의병원에서 (67%) 수분섭취를장려하고있는것으로조사되었다 (Fig. 2B). 3. 약물요법의적용대부분의병원에서는명확한메니에르병으로진단되면처음부터약물치료를시작하는것으로조사되 177

5 메니에르병의치료방침에대한다기관연구 Fig. 3. Duration of pharmacotherapy. Fig. 4. The concentration of gentamicin used for intratympanic injection in Ménière s disease. SM, streptomycin, dexa, dexamethasone. 었으며 (10개병원, 83%), 1개의병원에서는증상이자주재발되는경우에, 다른 1개의병원에서는글리세롤검사나퓨로세마이드검사의반응여부에따라투약여부를결정한다고대답하였다. 사용되는약제는 12개병원공통적으로이뇨제, betahistine, 칼슘채널차단제등을환자의반응에따라가감하여사용하는것으로조사되었고, 추가적으로혈액순환제, 항구토제그리고진정제등을사용한다는응답이있었다. 투약기간에대한응답은약물을최소 3개월이상투여하는병원이 8곳이었으며 (67%) 6개월이상, 1년이상투여하는병원도각각 1곳이었다. 약물투여를절대적인기간을정하지않고증상의소실후 2주혹은 2 개월정도투약기간을더유지하는, 즉증상에따라기간을조절하는병원이각각 1개및 2개병원이있었다 (Fig. 3). 4. 고실내약물의주입고실내스테로이드투여 (intratympanic injection of steroid) 는 8개병원 (67%) 에서시행하고있다고응답하였으며, 이에대한적응증으로는약물치료의실패한경우, 급성청력저하, 심각한이명, 양측성등다양한경우에다중응답하였다. 고실내겐타마이신주입 (intratympanic injection of gentamicin) 의치료역할에대해서는모든병원에서동의를하였고 11개의병원에서 (91%) 시행되고있었다. 이에대한적응증들로서는대부분어느정도청력저하가있는경우, 약물치료에도반복적으로현훈발작이있는경우, Tumarkin 발 작이있는경우를주적응으로하였으며이독성약물주입전경구용약물치료의기간은 3개월이상이 7개병원, 1년이상이 3개병원이었다. 고실내이독성약물주입의대상환자의빈도는무응답한곳을제외하고, 2개의병원 (2/11, 18%) 의병원에서명확한메니에르병환자의 2.5% 라고응답하였고, 5% 가 2개 (2/11, 18%), 10% 가 4개병원 (4/11, 36%) 이었으며, 명확한메니에르병환자의 50% 및 70% 에게고실내이독성약물을주입한다고대답한곳도각각 1개병원씩있었다. 주입하는이독성약물의농도는 40 mg/ml의겐타마이신원액을사용하는경우가 8개병원 (8/11, 73%), 20 mg/ml이 1개 (1/11, 9%), 겐타마이신 20 mg/ml과 dexamethasone 0.5 ml을같이주입하는경우가 1개 (1/11, 9%) 의병원에서있었고, 또한겐타마이신대신에스트렙토마이신분말 10 mg을투여하는병원도 1 곳있었다 (Fig. 4). 투여횟수로는 3개의병원 (3/11. 27%) 에서단 1회투여하며 1회시도후환자의상태에따라추가로투여여부를고려하는병원이 5 (5/ 11.45%) 개였으며 3개의병원 (3/11. 27%) 에서는 2~3회투여한다고응답하였다. 반복투여를하게되는경우투여간격은 1주가 4곳 (4/8,50%), 2주가 1곳 (1/8, 12.5%), 3주가 2곳 (2/8, 25%) 이었으며, 한달간격으로시행하는경우도 1곳 (1/8, 12.5%) 있었다. 5. 수술적치료메니에르병의치료로내림프낭감압술의치료역할에동의하는병원은 9곳이었고 (75%), 전정미로적출술 178

6 홍성광외 13 인 은 6곳 (50%), 전정신경절제술은 5곳 (42%) 이었다. 내림프낭갑압술의적응증으로는 12개병원공통으로약물치료나고실내약물투여같은보존적인치료에실패한청력이양호한군으로한정한다고응답하였으며일부에서는 50 db 이상의감각신경성난청이있더라도고실내겐타마이신투입또는다른치료에대하여추가청력소실에대한우려를보이는환자를대상으로도선별적으로시행한다고하였다. 전정신경절제술도청력이양호한환자중보존적인치료에실패한군에시도할수있겠으나실제적인 2개의병원에서제한적으로시행된다고하였다. 그리고미로절제술의경우에도다른모든치료에반응이없는난청환자의경우시행할수있다고응답하였지만실제적으로는 3 개의병원에서만시행되고있었다. 6. 약물치료에증상호전이없거나약만끊으면재발하는경우의치료파괴적시술의기준이되는감각신경성난청의정도는 50 db이 6개병원 (50%), 40 db를기준으로하는병원이 3곳 (25%), 55 db, 70 db, 80 db를기준으로하는병원이각각 1곳씩 (8%) 으로조사되었다. 청력을보존해야하는경우에는내림프낭감압술 (5/12, 42%), 고실내스테로이드투여 (4/12, 33%), 메니에트 (2/12, 17%) 등의치료법을고려한다고다중응답하였고청력이파괴적시술의기준에미치지못하더라도고실내젠타마이신의투여를고려해야하는경우도있었다고대답한 1개병원이있었다. 청력이나쁜경우는고실내이독성약물의투여 (9/12, 75%) 혹은고실내스테로이드투여 (4/12, 33%), 전정신경절제술과미로절제술도각각 1곳에서고려한다고다중응답하였다. 7. 양측성질환치료및기타치료양측성메니에르병의치료는경험이없다고응답한 1곳을제외하고약물치료를우선적으로고려하는하는병원이 8곳이었으며 (8/11, 73%) 고실내겐타마이신투여가 2곳 (2/11, 17%), 기타고실내스테로이드투여, 고실내스트렙토마이신투여, 메니에트의사용, 내림프낭감압술등의방법등으로다중응답되었다. 메니에트를사용하고있는병원은 2곳이었고, 중이환기관삽입술만을메니에르병의치료목적으 로사용하는기관은없었다. 고찰 우리나라의경우메니에르병의유병률에대한정확한통계는없지만이질환의연간발병률은인구 10 만명당 4.3~157명, 4-8 유병률은 10만명당 17~218명으로다양하게보고되고있는데이러한차이가인종에따른차이에의한것보다는자료수집방법과진단기준의차이때문으로해석되고있다. 9 따라서이러한상황을고려해볼때우리나라의경우도결코적지않은환자가메니에르병으로고통받고있다는것을짐작할수있다. 더욱이호발연령이사회나가정에서가장왕성하게활동할나이인 40~50세인것을감안한다면 10 메니에르병으로인한부작용을최대한작게하면서보다빠르고효과적인치료법을선택하는것이치료에있어서중요하다하겠다. 현재까지메니에르병의치료기전에대해서는정확히알려져있지는않지만 10 1일섭취소금의양을 2 g 이하로권장하는저염식요법이메니에르병의치료에효과적이라는사실은여러환자대조군연구 (case control study) 를통하여보편적으로동의가된내용이다. 11,12 그러나 2 g이라는기준은우리나라의음식습관을고려할때엄격히적용하기에는쉽지가않다. 이에실제로대부분의병원에서는환자에게 싱겁게먹는것이좋다 라고설명만하는것으로조사되었고 2 g 이하의저염식이를철저히강조하는병원은 2곳에불과하였다. 과거에는내림프수종의완화를위해수분섭취의제한이권장되었으나얼마나제한해야하는지에대해서도정해진기준은없다. 만약이뇨제를먹고있고저염식이를엄격하게적용하고있는환자라면하루에 8잔정도의정상적인수분섭취만으로도체내의나트륨을낮추는데충분하다. 13 그러나실제적으로저염식이를엄격히적용하기가힘들고최근충분한수분섭취가항이뇨호르몬의감소를통해내림프수종을호전시킬수있다는가설에근거하여하루 35 ml/kg 이상의수분섭취만으로도반복발작이감소하였다는보고가있은후 14 수분섭취를권장하는병원이늘어가고있는데우리나라의경우에도 8개의병원 (67%) 에서는수분섭취를장려하고있는것으로나타났다. 179

7 메니에르병의치료방침에대한다기관연구 이뇨제가메니에르병의치료에일차적인처방이지만 Cochrane database에따르면이뇨제뿐만아니라 betahistine, 혈류개선제의효용성에대해서는 과학적인증거는부족하다 라고제시되어있고 2,3 그외다른치료제에대해서는구체적인연구결과가없어아직언급되어있지않다. 그럼에도불구하고이뇨제와베티히스틴제, 혈류개선제는대부분의임상의가메니에르병의일차적인치료제로선호하고있다. 우리나라 12개의병원에서도공통적으로이뇨제, 베타히스틴, 혈류개선제, 칼슘채널차단제등을환자의반응에따라가감하여사용되고있는것으로조사되었고급성기증상완화를목적으로필요에따라항구토제그리고진정제등을사용한다고하였다. 고실내스테로이드주입의치료효과에대해서는 Shea 등 15 의보고에의하면난치성메니에르병환자에서 66.7% 의어지럼개선효과를얻었으며, Boleas- Aguirre 등 16 에의해서도 91% 에서증상의호전을보였기때문에다른치료를대신할수있다고보고하고있다. 그러나다른내과적치료나수술적치료에비해뚜렷한어지럼개선효과는아직입증되지않았고우리나라의경우 8개의병원에서 (67%) 시도되고있었으며심각한부작용발생의가능성이적어급성청력의소실이나이명이동반되어있는경우에고려해볼만한술식으로생각된다. 고실내이독성약물의주입에의한치료역할은응답을한모든병원에서동의하고있다. Chia 등 17 이시행한 meta-analysis에서현훈에대한효과는 90% 로다른보존적인술식에비해월등하며, 청력소실은평균 25% 정도로보고되었다. 청력소실을줄이기위해서는저농도의약물주입과역가를적정하게측정 (titration) 하는주입방법이추천되고있지만저농도를사용할경우현훈조절면에서는효과가떨어짐을알수있다. 메니에르병의치료로내림프낭감압술의치료역할에대해서도대부분동의하고있다. Thomsen 등 18 은내림프낭의수술적치료효과에대해단순유양돌기절제술과비교하여더나은결과를얻을수없어이러한치료에대하여위약효과로보고한후본술식은논란의대상이되어왔다. 그러나그이후에도내림프낭감압술은비파괴적방법으로현훈을조절할수있는효과적인술식으로서많은술자들에의해지속적 으로시행되고있다. 한연구에따르면내림프낭감압술전단계인유양돌기절제술동안조기유발전위상에서전기와우도의변화가있는것을확인함으로유양돌기절제술은의미없는단계가아니라중이강내의감압이증상의호전에영향을미칠수있을것이라고설명하고있다. 19 우리나라에서도 9개의병원에서 (75%) 치료효과를기대하고시술하고있는것으로응답을하였다. 전정신경절제술과전정미로절제술은일부병원에서치료역할은인정하고있지만시술한경우는많지않았다. 전정신경절제술의경우두개저수술에대한부담과원심성신경의차단으로청력저하가초래될수있다는점등의이유로시술을많이하지않는것으로추정되지만, 대부분이러한수술의전단계의치료법만으로도증상의조절이이루어짐을시사하기도한다. 1999년 FDA에서승인된메니에트기기 (Medtronic Xomed Inc., USA) 는비파괴적인보존적인방법으로치료효과가보고되어있다. 20 아직까지국내에서는보편적으로시행되고있지는않고있지만양측성질환에대한대책으로향후그역할이증가될것으로생각된다. 1977년 Torok 1 의보고이후보편화된스테로이드나이독성약물의고실내주입, 메니에트장치등은현훈의조절에있어서메니에르병의치료법에대한선택을넓혀주었다. 비파괴적인방법의단일치료로서는대부분의방법이 70~80% 를넘지못하는것도사실이지만보조적인치료방법을병행함으로써보고된기존의치료율을보다높일수있음을알수있다. 또한양측성인경우도동시에발현하지않는것이통례이므로충분한관찰기간이필요하고치료방법의선택에도신중을기하여야한다. 결 본연구를통해내과적인치료법에대해서는대부분의임상의가비슷한처방을내리지만고실내약물주입과수술적치료, 장치의사용에있어서는상당히다른기준에따라진료를하고있는것을알수있었다. 메니에르병의치료에있어가장최상또는최적의치료선택에대한의견의일치를구하기위해서는추 론 180

8 홍성광외 13 인 가적인임상연구와논의가필요하다고생각된다. 중심단어 : 메니에르병약물치료, 수술, 아미노글리코사이드 REFERENCES 1. Torok N. Old and new in Meniere disease. Laryngoscope 1977;87: James AL, Burton MJ. Betahistine for Meniere s disease or syndrome[database on the internet]: The Cochrane collaboration; 2008[cited 2001 Jan 22]. Available from: /articles/cd001873/frame.html 3. Thirlwall AS, Kundu S. Diuretics for Meniere s disease or syndrome[database on the internet]: The Cochrane collaboration; 2008[cited 2006 Jul 19]. Available from: /articles/cd003599/frame.html 4. Kotimaki J, Sorri M, Aantaa E, Nuutinen J. Prevalence of Meniere disease in Finland. Laryngoscope 1999;109: Wladislavosky-Waserman P, Facer GW, Mokri B, Kurland LT. Meniere's disease: a 30-year epidemiologic and clinical study in Rochester, Mn, Laryngoscope 1984;94: Stahle J, Stahle C, Arenberg K. Incidence of Meniere s disease. Arch Otolaryngol 1978;104: Watanabe Y, Mizukoshi K, Shojaku H, Watanabe I, Hinoki M, Kitahara M. Epidemiological and clinical characteristics of Meniere s disease in Japan. Acta Otolaryngol 1995;519: Cawthorne T, Hewlett AB. Meniere s disease. Proc R Soc Med 1954;47: da Costa SS, de Sousa LC, Piza MR. Meniere s disease: overview, epidemiology, and natural history. Otolaryngol Clin North Am 2002;35: Sajjadi H, Paparella M. Meniere s disease. Lancet 2008; 372: Furstenberg AC, Lashmet SH, Lathrop F. Menieres Symptom complex: medical treatment. Ann Otol rhinol Laryngol 1934;43: Santos PM, Hall RA, Snyder JM, Huges LF, Dobie RA. Diuretics and diet effect on Menieres disease evaluated by the 1985 Committee on hearing and equilibrium guidelines. Otolaryngol Head Neck Surg 1993;4: Thai-Van H, Bounaix MJ, Fraysse B. Meniere s disease: pathophysiology and treatment. Drugs 2001;61: Naganuma H, Kawahara K, Tokumasu K, Okamoto M. Water may cure patients with Meniere disease. Laryngoscope 2006;116: Shea J. The role of dexamethasone or streptomycin perfusion in treatment of Meniere's disease. Otolaryngol Cin N Am 1997;30: Boleas-Aguirre MS, Lin FR, Della Santina CC, Minor LB, Carey JP. Longitudinal results with intratympanic dexamethasone in the treatment of Meniere's disease. Otol Neurotol 2008;29: Chia SH, Gamst AC, Anderson JP, Harris JP. Intratympanic gentamicin therapy for Me nie`re s disease: a meta-analysis. Otol Neurotol 2004;25: Thomsen J, Kerr A, Bretlau P, Olsson J, Tos M. Endolymphatic sac surgery: why we do not do it. The nonspecific effect of sac surgery. Clin Otolaryngol Allied Sci 1996;21(3): Arenberg IK, Serkowsky M, Mihalco L, Wu CM, Moorhead JF. Danish sham surgery recisited: Intraoperative electrocochleographic evidence that mastoidectomy/drilling actively changes hydrops. In: Filipo R, Barbara M, editors. 3rd ed. Amsterdam: Kugler;1994. p Gates GA, Verrall A, Green JD, Tucci DL, Telian SA. Meniett clinical trial: long-term follow-up. Arch Otolaryngol Head Neck Surg 2006;132:

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

<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

untitled

untitled Research in Vestibular Science Vol. 15, No. 2, June 2016 Original Article pissn 2092-8882, eissn 2093-5501 메니에르병환자의치료에서 Isosorbide의유용성평가를위한다기관무작위연구 1 삼성서울병원이비인후과, 2 연세대학교의과대학세브란스병원이비인후과, 3 인하대병원이비인후과,

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

(

( 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

( )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

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

<30372EC0CCC0AFC1F82E687770>

<30372EC0CCC0AFC1F82E687770> 산전 초음파상 진단된 단독 대조확장증의 출생 후 예후 울산대학교 의과대학 서울아산병원 산부인과학교실 이유진 원혜성 박상민 조현진 정 의 김선권 심재윤 이필량 김 암 Yu-Jin Lee, M.D., Hye-Sung Won, M.D., Sang-Min Park, M.D., Hyun-Jin Cho, M.D., Eui Jung, M.D., Sun-Kwon Kim,

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

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

Jkafm093.hwp

Jkafm093.hwp 가정의학회지 2004;25:721-739 비만은 심혈관 질환, 고혈압 및 당뇨병에 각각 위험요인이고 다양한 내과적, 심리적 장애와 연관이 있는 질병이다. 체중감소는 비만한 사람들에 있어 이런 위험을 감소시키고 이들 병발 질환을 호전시킨다고 알려져 있고 일반적으로 많은 사람들에게 건강을 호전시킬 것이라는 믿음이 있어 왔다. 그러나 이런 믿음을 지지하는 연구들은

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

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 대한마취과학회지 2008; 55: 190~6 Korean J Anesthesiol Vol. 55, No. 2, August, 2008 임상연구 대한민국의 마취통증의학 임상실습 현황 연세대학교 의과대학 마취통증의학교실 및 마취통증의학연구소 장동진ㆍ안소운ㆍ안지원ㆍ김종훈 The current status of anesthesiology clerkship in Korea

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

- 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

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

untitled

untitled Research 이병민 in 외 Vestibular 5인. 돌발성난청에서 Science Vol. 메니에르병으로의 17, No. 3, September 진행 2018 빈도 O riginal A rticle pissn 2092-8882, eissn 2093-5501 https://doi.org/10.21790/rvs.2018.17.3.95 돌발성난청에서메니에르병으로의진행빈도

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

Àå¾Ö¿Í°í¿ë ³»Áö

Àå¾Ö¿Í°í¿ë ³»Áö Disability & Employment 55 Disability & Employment 56 57 Disability & Employment 58 59 Disability & Employment 60 61 Disability & Employment 62 63 Disability & Employment 64 65 Disability & Employment

More information

( )Kju269.hwp

( )Kju269.hwp 만성세균성전립선염모델흰쥐에서 의항염효과 Anti-inflammatory Effect of Lycopene on Chronic Bacterial Prostatitis Rat Model Cho Hwan Yang, Dong Wan Sohn, Yong-Hyun Cho From the Department of Urology, The Catholic University

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

16(1)-3(국문)(p.40-45).fm

16(1)-3(국문)(p.40-45).fm w wz 16«1y Kor. J. Clin. Pharm., Vol. 16, No. 1. 2006 x w$btf3fqpsu'psn û w m w Department of Statistics, Chonnam National University Eunsik Park College of Natural Sciences, Chonnam National University

More information

Meniere s Disease and Related Objective Tests Song JJ, et al. 니에르병으로 진단될 수 있고 이 질환의 특징인 변동성 난청 이명 등이 없어도 메니에르병으로 진단될 수 있다는 문제를 갖고 있어서 최근 이를 극복하기 위한 다양

Meniere s Disease and Related Objective Tests Song JJ, et al. 니에르병으로 진단될 수 있고 이 질환의 특징인 변동성 난청 이명 등이 없어도 메니에르병으로 진단될 수 있다는 문제를 갖고 있어서 최근 이를 극복하기 위한 다양 online ML Comm Clinical Review Korean J Otorhinolaryngol-Head Neck Surg 2012;55:476-81 / pissn 2092-5859 / eissn 2092-6529 http://dx.doi.org/10.3342/kjorl-hns.2012.55.8.476 The Diagnosis Criteria of Meniere

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

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

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

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

<BFACBCBCC0C7BBE7C7D02831302031203139292E687770>

<BFACBCBCC0C7BBE7C7D02831302031203139292E687770> 延 世 醫 史 學 제12권 제2호: 29-40, 2009년 12월 Yonsei J Med Hist 12(2): 29-40, 2009 특집논문 3 한국사회의 낙태에 대한 인식변화 이 현 숙 이화여대 한국문화연구원 1. 들어가며 1998년 내가 나이 마흔에 예기치 않은 임신을 하게 되었을 때, 내 주변 사람들은 모두 들 너무나도 쉽게 나에게 임신중절을 권하였다.

More information

12이문규

12이문규 Review on Conservative Treatment of Spinal Scoliosis Moon-kyu Lee, O.M.D., Gil-jae Lee, O.M.D., Yun-kyung Song, O.M.D., Hyung-ho Lim, O.M.D. Dept. of Oriental Rehabilitation Medicine College of Oriental

More information

패션 전문가 293명 대상 앙케트+전문기자단 선정 2010.1 Fashionbiz CEO Managing Director Creative Director Independent Designer

패션 전문가 293명 대상 앙케트+전문기자단 선정 2010.1 Fashionbiz CEO Managing Director Creative Director Independent Designer READY-TO-WEAR Fashionbiz 2010.1 패션 전문가 293명 대상 앙케트+전문기자단 선정 2010.1 Fashionbiz CEO Managing Director Creative Director Independent Designer READY-TO-WEAR Fashionbiz 2010.1 1 2 3 4 5 6 7 8 9 9 2010.1 Fashionbiz

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

-07-......

-07-...... A Depth Interview on Qualification, Role, and Professionalism of Infant/Toddler Teachers Department of Child & Family Studies, Kyung Hee University Associate Professor : Ahn, Sun Hee Department of Early

More information

튦 NO. 2155 Since 1969 2016. 06. 15 www.catholicfound.org www.cmc.or.kr blog.naver.com/cmc_health twitter.com/cmcmedicalnews www.facebook.com/cmcmedicalnews 02 CATHOLIC MEDICAL TIMES Vol.2155 2016.06.15 03

More information

목 차 회사현황 1. 회사개요 2. 회사연혁 3. 회사업무영역/업무현황 4. 등록면허보유현황 5. 상훈현황 6. 기술자보유현황 7. 시스템보유현황 주요기술자별 약력 1. 대표이사 2. 임원짂 조직 및 용도별 수행실적 1. 조직 2. 용도별 수행실적

목 차 회사현황 1. 회사개요 2. 회사연혁 3. 회사업무영역/업무현황 4. 등록면허보유현황 5. 상훈현황 6. 기술자보유현황 7. 시스템보유현황 주요기술자별 약력 1. 대표이사 2. 임원짂 조직 및 용도별 수행실적 1. 조직 2. 용도별 수행실적 用 役 指 名 願 금번 貴 社 에서 실시하고자 하는 用 役 에 참여하고자 當 社 의 指 名 願 을 提 出 하오니 審 査 하시고 指 名 하여 주시면 감사하겠습니다. 2014년 (주)하우드 엔지니어링 종합건축사사무소 대표이사 문 홍 길 대표이사 채 희 대표이사 이 재 규 대표이사 김 성 우 SUBMISSION We are submitting our brochure

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

Fig. 1. Laryngoscopic findings according to Yonekawa Fig. 2. possible etiologic factors. 2A Smoking, 2B Gastroesophageal reflux symptom, 2C Skin

Fig. 1. Laryngoscopic findings according to Yonekawa Fig. 2. possible etiologic factors. 2A Smoking, 2B Gastroesophageal reflux symptom, 2C Skin KISEP Head and Neck Korean J Otolaryngol 2000;43:873-7 라인케부종의원인및음성학적고찰 안중호 남순열 Possible Etiology and Voice Analysis of Reinke s Edema Joong Ho Ahn, MD and Soon-Yuhl Nam, MD Department of Otolaryngology,

More information

DIABETES FACT SHEET IN KOREA 2012 SUMMARY About 3.2 million Korean people (10.1%) aged over 30 years or older had diabetes in 2010. Based on fasting g

DIABETES FACT SHEET IN KOREA 2012 SUMMARY About 3.2 million Korean people (10.1%) aged over 30 years or older had diabetes in 2010. Based on fasting g DIABETES FACT SHEET IN KOREA 2012 Korean Diabetes Association (KDA) / Korea Centers for Disease Control and Prevention (CDC) DIABETES FACT SHEET IN KOREA 2012 SUMMARY About 3.2 million Korean people (10.1%)

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

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

???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

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

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

대한한의학원전학회지24권6호-전체최종.hwp

대한한의학원전학회지24권6호-전체최종.hwp 小兒藥證直訣 의 五臟辨證에 대한 小考 - 病證과 處方을 중심으로 1 2 慶熙大學校大學校 韓醫學科大學 原典學敎室 ㆍ 韓醫學古典硏究所 白裕相1,2*1)2) A study on The Diagnosis and Treatment Using The Theory of Five Organs in Soayakjeungjikgyeol(小兒藥證直訣) 1 Dept. of Oriental

More information

7 1 ( 12 ) 1998 ( ) ( ) ( ) ( ) ( ). ( ) ( ). ( ) ( ) ( ). ( ). ( ) ( ) ( ) 3).., 16 ( ) ( ) ( ) ( ) ( ) ( ) ( ). 4). ( ) ( ) ( ),., 4-5, 6-7, 5) 6) (

7 1 ( 12 ) 1998 ( ) ( ) ( ) ( ) ( ). ( ) ( ). ( ) ( ) ( ). ( ). ( ) ( ) ( ) 3).., 16 ( ) ( ) ( ) ( ) ( ) ( ) ( ). 4). ( ) ( ) ( ),., 4-5, 6-7, 5) 6) ( 7 1 ( 12 ) : 75-96, 1998 K orean J M ed H ist 7 : 75-96, 1998 ISSN 1225-505X (2)* ** *** ** 1. (4) 2. (5) (1) (6) (2) (7) (3) 5. 3. (1) ( ) 4. ( ) (2) (1) (3) (2). ( ) (3) 6. 4. ( ) 6 1). ( ), ( ).. (1)

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

2 1896 2 26 ( ) 2 7-20 2) 1897 1898 ( )3) 6 1902 8 1904 10 10 (19 05-1914 ) ( ) ( ) 4) 1915 ( ) ( ) 1917 2) 3) 4) 285

2 1896 2 26 ( ) 2 7-20 2) 1897 1898 ( )3) 6 1902 8 1904 10 10 (19 05-1914 ) ( ) ( ) 4) 1915 ( ) ( ) 1917 2) 3) 4) 285 13 2 ( 25 ) 2004 12 Korean J Med Hist 13 284 296 Dec 2004 ISSN 1225 505X 1) * ** ** 1 1920 1930 40 ( 1896-1973) 80 * ** 1) 2003 284 2 1896 2 26 ( ) 2 7-20 2) 1897 1898 ( )3) 6 1902 8 1904 10 10 (19 05-1914

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

975_983 특집-한규철, 정원호

975_983 특집-한규철, 정원호 Focused Issue of This Month Gyu Cheol an, MD Department of Otolaryngology ead & Neck Surgery, Gachon University of College Medicine E - mail : han@gilhospital.com Won-o Jung, MD Department of Otolaryngology

More information

7 1 ( 12 ) 1998. 1913 ( 1912 ) 4. 3) 1916 3 1918 4 1919. ( ) 1 3 1, 3 1. 1.. 1919 1920. 4) ( ), ( ),. 5) 1924 4 ( ) 1. 1925 1. 2). ( ). 6). ( ). ( ).

7 1 ( 12 ) 1998. 1913 ( 1912 ) 4. 3) 1916 3 1918 4 1919. ( ) 1 3 1, 3 1. 1.. 1919 1920. 4) ( ), ( ),. 5) 1924 4 ( ) 1. 1925 1. 2). ( ). 6). ( ). ( ). 7 1 ( 12 ) : 1-11, 1998 K orean J M ed H ist 7 : 1-11, 1998 ISSN 1225-505X * **.,.., 1960.... 1) ( ) 1896 3 2 ( ) ( ) ( ) ( ) 2. 1), 14 1909 1,. 14 17 1913. 2)..,. ( ) ( ),. * 1998 (1998. 5. 7). ** 1).

More information

2009;21(1): (1777) 49 (1800 ),.,,.,, ( ) ( ) 1782., ( ). ( ) 1,... 2,3,4,5.,,, ( ), ( ),. 6,,, ( ), ( ),....,.. (, ) (, )

2009;21(1): (1777) 49 (1800 ),.,,.,, ( ) ( ) 1782., ( ). ( ) 1,... 2,3,4,5.,,, ( ), ( ),. 6,,, ( ), ( ),....,.. (, ) (, ) Abstract Kim Dal-Rae, Kim Sun-Hyung* Dept. of Sasang Constitutional Medicine, College of Oriental Medicine, Kyung-Hee Univ. *Dept. of Sasang Constitutional Medicine, East-West Neo Medical Center, Kyung-Hee

More information

슬라이드 1

슬라이드 1 Proposed Korean guideline for the diagnosis of BPH Hyun Woo Kim The Catholic University of Korea BPH Guideline AHCPR guideline on BPH (1994) AUA guideline on BPH (2003) EAU guideline on BPH (2004) International

More information

-06-......,......

-06-......,...... Analysis of the Current Condition of Student Childcare Training in Korea: Student Childcare Training Centers, Guidance Teachers, Student Teachers and Student Childcare Training Fees Department of Childcare

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

16(2)-7(p ).fm

16(2)-7(p ).fm w wz 16«2y Kor. J. Clin. Pharm., Vol. 16, No. 2. 2006 ü t xy y w tœ ½ BÁ x BC B y w w w C y w w w Current Status and Expectations of Orphan Drugs in Korea -In point of supplying medicines for the rare

More information

서론

서론 - i - - ii - - iii - - iv - - v - - vi - - 1 - - 2 - - 3 - - 4 - - 5 - - 6 - - 7 - - 8 - - 9 - - 10 - - 11 - - 12 - - 13 - - 14 - - 15 - - 16 - - 17 - - 18 - - 19 - - 20 - - 21 - - 22 - - 23 - - 24 - -

More information

untitled

untitled Research in Vestibular Science Vol. 17, No. 2, June 2018 Original Article pissn 2092-8882, eissn 2093-5501 https://doi.org/10.21790/rvs.2018.17.2.44 메니에르병에서경부 Vestibular Evoked Myogenic Potential 과반응의양상

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

<31382D322D3420BDC5B1D4C8AF5FB3EDB9AE28C3D6C1BEBABB292E687770>

<31382D322D3420BDC5B1D4C8AF5FB3EDB9AE28C3D6C1BEBABB292E687770> 醫 史 學 제18권 제2호(통권 제35호) 2009년 12월 Korean J Med Hist 18ː57 72 18ː173-188 Dec. Dec. 2009 2009 C 大 韓 醫 史 學 會 ISSN ISSN 1225 505X 1225-505X 지방병 연구와 식민지배 : 1927년 영흥 및 해남지역 에메틴 중독사건을 중심으로 신 규 환* 1. 머리말 2. 일제의

More information

제5회 가톨릭대학교 의과대학 마취통증의학교실 심포지엄 Program 1 ANESTHESIA (Room 2층 대강당) >> Session 4 Updates on PNB Techniques PNB Techniques for shoulder surgery: continuou

제5회 가톨릭대학교 의과대학 마취통증의학교실 심포지엄 Program 1 ANESTHESIA (Room 2층 대강당) >> Session 4 Updates on PNB Techniques PNB Techniques for shoulder surgery: continuou 제5회 가톨릭대학교 의과대학 마취통증의학교실 심포지엄 (Room 2층 대강당) >> Session 4 Updates on PNB Techniques PNB Techniques for shoulder surgery: continuous vs single injection, interscalene vs supraclavicular approach 의정부성모병원

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

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

Treatment and Role of Hormaonal Replaement Therapy

Treatment and Role of Hormaonal Replaement Therapy Treatment and Role of Hormone Replacement Therapy Chung-Ang University Hospital Chee Jeong Kim 7.2 5.3 6.4 5.6 7.3 5.5 1 1 2 3 4 10 11 7 34 49 122 123 1.0 - - 10. 2001 1998 1998 Improvement of postmenopausal

More information

세란봄호(2010).qxd

세란봄호(2010).qxd (선) 선택진료, 진료, 수술 진 료 시 간 표 진료과 내 과 정형외과 신경외과 신경과 전문의 구내 전화 장 준 희 201 전 상 현 202 박 상 미 205 변 대 근 203 오덕순(선) 225 박 찬 수 228 궁 윤 배 223 이 원 용 222 원 정 훈 222 오명수(선) 226 박 홍 준 227 박 상 우 227 김 창 현 226 박지현[선] 250

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

À±½Â¿í Ãâ·Â

À±½Â¿í Ãâ·Â Representation, Encoding and Intermediate View Interpolation Methods for Multi-view Video Using Layered Depth Images The multi-view video is a collection of multiple videos, capturing the same scene at

More information

약수터2호최종2-웹용

약수터2호최종2-웹용 Contents 06 08 11 14 17 17 18 19 23 28 28 33 37 41 45 45 51 56 59 64 66 72 80 26 29 31 34 35 35 38 39 40 42 43 43 46 46 47 49 50 51 52 53 54 56 57 59 60 61 62 69 73 74 77 78 79 14 15 25 36 48 06 07 08

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

ECG & EP CASES Young-Keun On, MD, PhD Division of Cardiology, Department of Medicine Cardiac & Vascular Center, Samsung Medical Center Sungkyunkwan University School of Medicine, Seoul, Korea A case of

More information

<30322EBABBB9AE2E687770>

<30322EBABBB9AE2E687770> Research in Vestibular Science Vol. 9, Suppl. 1, June 2010 Symposium pissn 2092-8882, eissn 2093-5501 수술적방법을통한어지럼의치료 성균관대학교의과대학이비인후과학교실 정원호, 문일준 Surgical Treatment of Vertiginous Diseases Won-Ho Chung,

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

인문사회과학기술융합학회

인문사회과학기술융합학회 Vol.5, No.5, October (2015), pp.471-479 http://dx.doi.org/10.14257/ajmahs.2015.10.50 스마트온실을 위한 가상 외부기상측정시스템 개발 한새론 1), 이재수 2), 홍영기 3), 김국환 4), 김성기 5), 김상철 6) Development of Virtual Ambient Weather Measurement

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

04_이근원_21~27.hwp

04_이근원_21~27.hwp 1) KIGAS Vol. 16, No. 5, pp 21~27, 2012 (Journal of the Korean Institute of Gas) http://dx.doi.org/10.7842/kigas.2012.16.5.21 실험실의 사례 분석에 관한 연구 이근원 이정석 한국산업안전보건공단 산업안전보건연구원 (2012년 9월 5일 투고, 2012년 10월 19일

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

Pharmacotherapeutics Application of New Pathogenesis on the Drug Treatment of Diabetes Young Seol Kim, M.D. Department of Endocrinology Kyung Hee Univ

Pharmacotherapeutics Application of New Pathogenesis on the Drug Treatment of Diabetes Young Seol Kim, M.D. Department of Endocrinology Kyung Hee Univ Application of New Pathogenesis on the Drug Treatment of Diabetes Young Seol Kim, M.D. Department of Endocrinology Kyung Hee University College of Medicine & Hospital E mail : ycell2@yahoo.co.kr Abstract

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

(01) hwp

(01) hwp Journal of Life Science 2013 Vol. 23. No. 2. 157~166 ISSN (Print) 1225-9918 ISSN (Online) 2287-3406 DOI : http://dx.doi.org/10.5352/jls.2013.23.2.157 α μ δ κ 158 생명과학회지 2013, Vol. 23. No. 2 Journal of

More information

4 5 6 7 8 9 10 11 12 13 14 15 조 희 영 선 생 님 고 맙 습 니 다 16 17 18 19 가정간호 장선미 간호사님 감사합니다 20 21 22 23 24 25 U l 26 27 p SEOUL MEDICAL CENTER NEWS 28 29 30 31 32 33 34 35 36 37 홍보실장이란 신동규 원고를 기다립니다

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

........-55..9.30

........-55..9.30 MYONGJI ST. MARY S HOSPITAL EXCELLENT STROKE TREATMENT CENTER The president of Myongji St. Mary s Hospital M.D. HUH, CHOON WOONG Graduated from Seoul Catholic Medical College. Achived M.D. in Neurosurgeon.

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

00약제부봄호c03逞풚

00약제부봄호c03逞풚 경희대학교 동서신의학병원 약품 정보지 2 0 0 7. S P R I N G. V O L. 0 1 신약 소개 02 Journal Review 03 Special Subject 04 복약 지도 06 의약품 안전성 정보 07 약제부 알림 07 약제부 업무 소개 08 E A S T - W E S T N E O M E D I C A L C E N T E R 본 약품

More information

저작자표시 - 비영리 - 변경금지 2.0 대한민국 이용자는아래의조건을따르는경우에한하여자유롭게 이저작물을복제, 배포, 전송, 전시, 공연및방송할수있습니다. 다음과같은조건을따라야합니다 : 저작자표시. 귀하는원저작자를표시하여야합니다. 비영리. 귀하는이저작물을영리목적으로이용할

저작자표시 - 비영리 - 변경금지 2.0 대한민국 이용자는아래의조건을따르는경우에한하여자유롭게 이저작물을복제, 배포, 전송, 전시, 공연및방송할수있습니다. 다음과같은조건을따라야합니다 : 저작자표시. 귀하는원저작자를표시하여야합니다. 비영리. 귀하는이저작물을영리목적으로이용할 저작자표시 - 비영리 - 변경금지 2.0 대한민국 이용자는아래의조건을따르는경우에한하여자유롭게 이저작물을복제, 배포, 전송, 전시, 공연및방송할수있습니다. 다음과같은조건을따라야합니다 : 저작자표시. 귀하는원저작자를표시하여야합니다. 비영리. 귀하는이저작물을영리목적으로이용할수없습니다. 변경금지. 귀하는이저작물을개작, 변형또는가공할수없습니다. 귀하는, 이저작물의재이용이나배포의경우,

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

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

보고서_pdf로.hwp

보고서_pdf로.hwp 9:30-10:00 10:00-10:10 INTRODUCTION 10:10-11:40 ISSUES IN DIETARY ASSESSMENT IN COHORT STUDIES Alan Kristal (Fred Hutchinson Cancer Research Center, U.S.A.) Developing adiet questionnaire for alarge cohort

More information

02이용배(239~253)ok

02이용배(239~253)ok A study on the characteristic of land use in subcenter of Seoul. - Cases of Yeongdeungpo and Kangnam Ok Kyung Yuh* Yong-Bae Lee**,. 2010,,..,.,,,,.,,.,,.,,,, Abstract : This study analyzed the land use

More information

,......

,...... The Impact of Personal Traits, Family Characteristics, and Job Satisfaction on the Psychological Well-Being of Middle Aged Men from the Baby Boomer Generation Working in Large Corporations Department of

More information

Journal of Educational Innovation Research 2016, Vol. 26, No. 3, pp.1-16 DOI: * A Study on Good School

Journal of Educational Innovation Research 2016, Vol. 26, No. 3, pp.1-16 DOI:   * A Study on Good School Journal of Educational Innovation Research 2016, Vol. 26, No. 3, pp.1-16 DOI: http://dx.doi.org/10.21024/pnuedi.26.3.201612.1 * A Study on Good School and School Evaluation Purpose: This study was to examine

More information

Analysis of teacher s perception and organization on physical education elective courses Chang-Wan Yu* Korea Institute of curriculum and evaluation [Purpose] [Methods] [Results] [Conclusions] Key words:

More information

YI Ggodme : The Lives and Diseases of Females during the Latter Half of the Joseon Dynasty as Reconstructed with Cases in Yeoksi Manpil (Stray Notes w

YI Ggodme : The Lives and Diseases of Females during the Latter Half of the Joseon Dynasty as Reconstructed with Cases in Yeoksi Manpil (Stray Notes w 497 의사학 제24권 제2호(통권 제50호) 2015년 8월 Korean J Med Hist 24 ː497-532 Aug 2015 c대한의사학회 http://dx.doi.org/10.13081/kjmh.2015.24.497 pissn 1225-505X, eissn 2093-5609 역시만필( 歷 試 漫 筆 ) 의 사례로 재구성한 조선후기 여성의 삶과 질병

More information

04원저-028.hwp

04원저-028.hwp Research in Vestibular Science Vol. 10, No. 1, March 2011 Original Article pissn 2092-8882, eissn 2093-5501 메니에르병에서 Cochlear Hydrops Analysis Masking Procedure 검사의진단적유용성 한림대학교성심병원이비인후 - 두경부외과학교실 1, 한림국제대학원대학교청각학과

More information

Journal of Educational Innovation Research 2017, Vol. 27, No. 1, pp DOI: * The

Journal of Educational Innovation Research 2017, Vol. 27, No. 1, pp DOI:   * The Journal of Educational Innovation Research 2017, Vol. 27, No. 1, pp.243-268 DOI: http://dx.doi.org/10.21024/pnuedi.27.1.201703.243 * - 2001 2015 - The Research Trends on Peer Counseling in Elementary and

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

DBPIA-NURIMEDIA

DBPIA-NURIMEDIA 27(2), 2007, 96-121 S ij k i POP j a i SEXR j i AGER j i BEDDAT j ij i j S ij S ij POP j SEXR j AGER j BEDDAT j k i a i i i L ij = S ij - S ij ---------- S ij S ij = k i POP j a i SEXR j i AGER j i BEDDAT

More information

<BFACB1B85F323030352D30335FB0E6C1A6C0DAC0AFB1B8BFAA2E687770>

<BFACB1B85F323030352D30335FB0E6C1A6C0DAC0AFB1B8BFAA2E687770> 연구보고서 2005-03 경제자유구역에서의 보건의료시장 개방의 파급효과와 정책방향 2005 韓 國 保 健 社 會 硏 究 院 머 리 말 우리나라는 2003년 경제자유구역의지정및운영에관한법률 을 제정하여 인천, 부산-진해, 광양만 등 3개 지역에 경제자유구역 개발을 추진하고 있다. 이 법에 는 경제자유구역에 외국 의료기관이 진출할 수 있다는 내용이 규정되어 있으

More information