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    ๊ธฐ์—…๋‚ด๋ฌด์—ญ์˜ ๊ฒฐ์ •์š”์ธ๊ณผ ๋ฌด์—ญ ๋ถˆํ™ฉ์— ๋Œ€ํ•œ ์‹œ์‚ฌ์ 

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    ํ•™์œ„๋…ผ๋ฌธ(์„์‚ฌ)--์„œ์šธ๋Œ€ํ•™๊ต ๋Œ€ํ•™์› :๋†์—…์ƒ๋ช…๊ณผํ•™๋Œ€ํ•™ ๋†๊ฒฝ์ œ์‚ฌํšŒํ•™๋ถ€(๋†๊ฒฝ์ œํ•™์ „๊ณต),2019. 8. ๊น€ํ•œํ˜ธ.With the help of the Information Technology and freer international trade environment, Multinational Corporations have been able to disintegrate their production process physically and geographically. Multinational Corporations that intend to distribute parts of their production process abroad face the choice of ownership: whether to operate internally or to assign to unrelated local companies. A firms choice of vertical integration involves intra-firm trade, while its choice of international outsourcing involves arms length trade. Exploiting the firm-level data of Korean manufacturing industry, this study contributes to existing knowledge of two important topics on intra-firm trade: the determinants and implications for trade slump. In the first analysis, this study focuses on the property rights model predictions that are raised from Antras and Helpman (2004) and Antras and Helpman (2006). This study investigates the determinants of extensive and intensive margins of intra-firm trade by separating the international ownership structure between Outward FDI and Inward FDI. The overall results indicate that Koreas empirical evidence only supports the prediction of productivity, but not headquarter intensity and contractibility. The implications of this analysis can be summarized as the following. First, the determinants of intra-firm trade may considerably differ from country to countries. Second, the simple distinction between headquarter producer and intermediate input supplier in the property rights theories may not explain the complex nature of global value chains. Third, the imports under Inward FDI, which is not explained by the property rights theory, maybe mainly dominated by the transaction of final goods for sale to Korean consumers. Fourth, the significant and negative coefficients of distance suggest that distance-related factors such as transportation costs or cultural differences between countries can be important for a firms organizational choices. In the second analysis, this study delves further into the role of intra-firm trade in times of Koreas trade slump (2012-2016). The fixed-effects panel regression reveals that firms with high intensity in intra-firm trade are more likely to suffer lower trade growth but the negative effect is significantly reduced during the trade slump. When the descriptive statistics are considered together, the regression results may imply that intra-firm trade has a stabilizing effect and is more resilient compared to the arms length trade.์ •๋ณด๊ธฐ์ˆ (IT)์˜ ๋ฐœ๋‹ฌ๊ณผ ๋ณด๋‹ค ์ž์œ ๋กœ์šด ๊ตญ์ œ ๋ฌด์—ญํ™˜๊ฒฝ์„ ๋ฐ”ํƒ•์œผ๋กœ ๋‹ค๊ตญ์ ๊ธฐ์—…๋“ค์˜ ์ƒ์‚ฐ๊ณต์ •์€ ๋ฌผ๋ฆฌ์ ์ด๊ณ  ์ง€๋ฆฌ์ ์ธ ํ•ด์ฒด๊ฐ€ ๊ฐ€๋Šฅํ•ด์กŒ๋‹ค. ํ•ด์™ธ์—์„œ ์ƒ์‚ฐ๊ณต์ •์˜ ์ผ๋ถ€๋ฅผ ์‹ค์‹œํ•˜๋ ค๋Š” ๋‹ค๊ตญ์  ๊ธฐ์—…๋“ค์€ ์ƒ์‚ฐ๊ณต์ •์„ ๊ธฐ์—… ๋‚ด๋ถ€์ ์œผ๋กœ ์šด์˜ํ•  ๊ฒƒ์ธ์ง€ ํ˜น์€ ๋…๋ฆฝ์ ์ธ ํ•ด์™ธ ํ˜„์ง€ ๊ธฐ์—…์—๊ฒŒ ์œ„ํƒํ•  ๊ฒƒ์ธ์ง€์™€ ๊ด€๋ จํ•˜์—ฌ ์†Œ์œ ๊ถŒ ์„ ํƒ์˜ ๋ฌธ์ œ๋ฅผ ์ง๋ฉดํ•˜๊ฒŒ ๋˜์—ˆ๋‹ค. ๋‹ค๊ตญ์  ๊ธฐ์—…์ด ํ•ด์™ธ ์ƒ์‚ฐ ๊ณต์ •์˜ ์ˆ˜์ง์  ํ†ตํ•ฉ(Vertical Integration)์„ ์„ ํƒํ•œ๋‹ค๋ฉด ๊ธฐ์—…๋‚ด๋ฌด์—ญ(Intra-firm Trade)์ด ์ด๋ฃจ์–ด์ง€๊ณ , ํ•ด์™ธ ์œ„ํƒ์ƒ์‚ฐ(International Outsourcing)์„ ์„ ํƒํ•œ๋‹ค๋ฉด ๋…๋ฆฝ๊ธฐ์—…๊ฐ„๋ฌด์—ญ(Arm's Length Trade)๊ฐ€ ๋ฐœ์ƒํ•˜๊ฒŒ ๋œ๋‹ค. ํ•œ๊ตญ ์ œ์กฐ์—…์˜ ๊ธฐ์—…๋‹จ์œ„ ๋ฐ์ดํ„ฐ๋ฅผ ํ™œ์šฉํ•˜์—ฌ ๋ณธ ์—ฐ๊ตฌ๋Š” ๊ธฐ์—…๋‚ด๋ฌด์—ญ์˜ ๊ฒฐ์ •์š”์ธ ๋ถ„์„๊ณผ ๊ธฐ์—…๋‚ด๋ฌด์—ญ์ด ๋ฌด์—ญ์นจ์ฒด๊ธฐ์— ๊ฐ€์ง€๋Š” ํ•จ์˜ ๋ถ„์„์ด๋ผ๋Š” ๋‘ ๊ฐ€์ง€ ์ฃผ์ œ๋ฅผ ์ค‘์ ์ ์œผ๋กœ ๋‹ค๋ฃจ์—ˆ๋‹ค. ์ฒซ๋ฒˆ์งธ ๋ถ„์„์œผ๋กœ ๋ณธ ์—ฐ๊ตฌ๋Š” Antras and Helpman (2004) ์™€ Antras and Helpman (2006)์˜ ์žฌ์‚ฐ๊ถŒ ์ด๋ก (Property Rights Theory)์—์„œ ๋‚˜ํƒ€๋‚˜๋Š” ๊ธฐ์—…๋‚ด๋ฌด์—ญ์— ๋Œ€ํ•œ ์ด๋ก ์  ์˜ˆ์ธก๋“ค์„ ๊ฒ€์ฆํ•˜์˜€๋‹ค. ํ•ด์™ธ์ง์ ‘ํˆฌ์ž(Outward FDI) ๋ฐ ์™ธ๊ตญ์ธ์ง์ ‘ํˆฌ์ž(Inward FDI)์— ๋”ฐ๋ฅธ ๊ธฐ์—…์ง€๋ฐฐ๊ตฌ์กฐ๋ฅผ ๊ตฌ๋ถ„ํ•˜์—ฌ ํ‘œ๋ณธ์„ ๊ตฌ์„ฑํ•˜์˜€๊ณ , ๊ฐ๊ฐ์˜ ํ‘œ๋ณธ์— ๋Œ€ํ•˜์—ฌ ๊ธฐ์—…๋‚ด ๋ฌด์—ญ์˜ ์™ธ์—ฐ(Extensive Margin) ๋ฐ ๋‚ด์—ฐ(Intensive Margin)ํšจ๊ณผ์˜ ๊ฒฐ์ •์š”์ธ์„ ๋ถ„์„ํ•˜์˜€๋‹ค. ํ•œ๊ตญ ์ œ์กฐ์—… ์ž๋ฃŒ๋ฅผ ํ™œ์šฉํ•œ ์‹ค์ฆ๋ถ„์„ ๊ฒฐ๊ณผ, ์ƒ์‚ฐ์„ฑ ๋ณ€์ˆ˜์˜ ๊ฒฝ์šฐ ์ด๋ก ์˜ ์˜ˆ์ธก๊ณผ ์ผ์น˜ํ•˜๋Š” ๊ฒƒ์„ ํ™•์ธํ•  ์ˆ˜ ์žˆ์—ˆ๋‹ค. ๊ทธ๋Ÿฌ๋‚˜ ๋ณธ๋ถ€์ง‘์•ฝ๋„(Headquarter Intensity)์™€ ๊ณ„์•ฝ๊ฐ€๋Šฅ์„ฑ(Contractibility) ๋ณ€์ˆ˜๋Š” ์ด๋ก ์˜ ์˜ˆ์ธก๊ณผ ์ผ์น˜ํ•˜์ง€ ์•Š์•˜๋‹ค. ์ฒซ๋ฒˆ์งธ ๋ถ„์„์„ ํ†ตํ•ด ๋‹ค์Œ๊ณผ ๊ฐ™์€ ํ•จ์˜๋ฅผ ๋„์ถœํ•  ์ˆ˜ ์žˆ์—ˆ๋‹ค. ์ฒซ์งธ, ๊ธฐ์—…๋‚ด๋ฌด์—ญ์˜ ๊ฒฐ์ •์š”์ธ์€ ๊ตญ๊ฐ€๋งˆ๋‹ค ์ƒ๋‹นํžˆ ๋‹ค๋ฅผ ์ˆ˜ ์žˆ๋‹ค. ๋‘˜์งธ, ์žฌ์‚ฐ๊ถŒ ์ด๋ก ์—์„œ๋Š” ๊ธฐ์—…์„ ๋ณธ์‚ฌ ์ƒ์‚ฐ์ž์™€ ์ค‘๊ฐ„์žฌ ๊ณต๊ธ‰์ž ๋‘ ๊ฐ€์ง€๋กœ ๋‹จ์ˆœํ•˜๊ฒŒ ๊ตฌ๋ถ„ํ•˜๋Š”๋ฐ ์ด๋Š” ๊ธ€๋กœ๋ฒŒ ๊ฐ€์น˜ ์‚ฌ์Šฌ์˜ ๋ณต์žกํ•œ ํŠน์„ฑ์„ ์ œ๋Œ€๋กœ ์„ค๋ช…ํ•˜์ง€ ๋ชปํ•  ์ˆ˜ ์žˆ๋‹ค. ์…‹์งธ, ์žฌ์‚ฐ๊ถŒ ์ด๋ก ์€ ์™ธ๊ตญ์ธ์ง์ ‘ํˆฌ์ž์— ์˜ํ•œ ๊ธฐ์—…๊ตฌ์กฐ์—์„œ ๋ฐœ์ƒํ•˜๋Š” ์ˆ˜์ž…์„ ์ด๋ก ์ ์œผ๋กœ ์„ค๋ช…ํ•˜์ง€ ๋ชปํ•˜๊ณ  ์žˆ์œผ๋‚˜, ์ด๋Ÿฌํ•œ ์ˆ˜์ž…์˜ ์ƒ๋‹น ๋ถ€๋ถ„์€ ํ•œ๊ตญ ์†Œ๋น„์ž์—๊ฒŒ ํŒ๋งคํ•˜๊ธฐ ์œ„ํ•œ ์ตœ์ข…์žฌ์ผ ์ˆ˜ ์žˆ๋‹ค. ๋„ท์งธ, ๊ฑฐ๋ฆฌ ๋ณ€์ˆ˜์— ๋Œ€ํ•˜์—ฌ ์œ ์˜ํ•œ ์Œ์˜ ๊ณ„์ˆ˜๋ฅผ ์–ป์—ˆ๋Š”๋ฐ, ์ด๋Š” ์šด์†ก๋น„ ๋˜๋Š” ๊ตญ๊ฐ€ ๊ฐ„ ๋ฌธํ™”์  ์ฐจ์ด์™€ ๊ฐ™์€ ๊ฑฐ๋ฆฌ ๊ด€๋ จ ์š”์ธ๋“ค์ด ๊ธฐ์—…์˜ ๊ตฌ์กฐ ์„ ํƒ์— ์ค‘์š”ํ•œ ์—ญํ• ์„ ํ•  ์ˆ˜ ์žˆ์Œ์„ ์‹œ์‚ฌํ•œ๋‹ค. ๋‘ ๋ฒˆ์งธ ๋ถ„์„์—์„œ ๋ณธ ์—ฐ๊ตฌ๋Š” ๋ฌด์—ญ ์นจ์ฒด(2012~2016๋…„) ์‹œ๊ธฐ์˜ ๊ธฐ์—…๋‚ด๋ฌด์—ญ์˜ ์—ญํ• ์„ ํƒ๊ตฌํ•˜์˜€๋‹ค. ๊ณ ์ •ํšจ๊ณผ ํŒจ๋„ ํšŒ๊ท€ ๋ถ„์„์€ ๊ธฐ์—…๋‚ด๋ฌด์—ญ์˜ ๋น„์ค‘์ด ๋†’์€ ๊ธฐ์—…๋“ค์ด ๋‚ฎ์€ ๋ฌด์—ญ ์„ฑ์žฅ๋ฅ ์„ ๋ณด์ผ ๊ฐ€๋Šฅ์„ฑ์ด ๋” ๋†’์ง€๋งŒ, ๋ฌด์—ญ ์นจ์ฒด๊ธฐ์—๋Š” ์ด์™€ ๊ฐ™์€ ๊ธฐ์—…๋‚ด๋ฌด์—ญ์˜ ๋ถ€์ •์ ์ธ ์˜ํ–ฅ์ด ํฌ๊ฒŒ ์ค„์–ด๋“ ๋‹ค๋Š” ๊ฒƒ์„ ๋ณด์—ฌ์ฃผ์—ˆ๋‹ค. ๊ธฐ์—…๋‚ด๋ฌด์—ญ์˜ ๊ทธ๋ž˜ํ”„ ์ž๋ฃŒ๋ฅผ ํ•จ๊ป˜ ๊ณ ๋ คํ•˜์˜€์„ ๋•Œ, ํŒจ๋„๋ถ„์„ ๊ฒฐ๊ณผ๋Š” ๊ธฐ์—…๋‚ด๋ฌด์—ญ์ด ๋ฌด์—ญ์นจ์ฒด ์‹œ๊ธฐ์— ๋ฌด์—ญ๊ฐ์†Œ๋ฅผ ์•ˆ์ •ํ™”์‹œํ‚ค๋Š” ํšจ๊ณผ๋ฅผ ๊ฐ€์งˆ ์ˆ˜ ์žˆ์œผ๋ฉฐ ๋…๋ฆฝ๊ธฐ์—…๊ฐ„๋ฌด์—ญ์— ๋น„ํ•ด ํšŒ๋ณต๋ ฅ์ด ๋” ๋†’์€ ๊ฒƒ์œผ๋กœ ํ•ด์„ํ•  ์ˆ˜ ์žˆ๋‹ค.1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 2. Literature review . . . . . . . . . . . . . . . . . . . . . . . . . . 7 2.1 The determinants of intra-firm trade . . . . . . . . . . . . . . . . . . 7 2.1.1 Theoretical backgrounds . . . . . . . . . . . . . . . . . . . 8 2.1.2 Empirical studies . . . . . . . . . . . . . . . . . . . . . . . 13 2.2 Intra-firm trade during the trade slump . . . . . . . . . . . . . . . . 15 2.2.1 Theoretical backgrounds . . . . . . . . . . . . . . . . . . . 15 2.2.2 Empirical studies . . . . . . . . . . . . . . . . . . . . . . . 16 3. Data and descriptive statistics . . . . . . . . . . . . . . . . . . 18 3.1 Trends of Korean intra-firm trade . . . . . . . . . . . . . . . . . . . 19 3.2 International ownership structure of Korean firms . . . . . . . . . . 24 4. Econometric specification and result . . . . . . . . . . . . . . 30 4.1 Analyzing the determinants of intra-firm trade . . . . . . . . . . . . 30 4.1.1 Estimation strategy for Outward FDI . . . . . . . . . . . 31 4.1.2 Estimation results for Outward FDI . . . . . . . . . . . . 34 4.1.3 Estimation strategy for Inward FDI . . . . . . . . . . . . 40 4.1.4 Estimation results for Inward FDI . . . . . . . . . . . . . 41 4.2 Analyzing the intra-firm trade and the trade slump . . . . . . . . . 46 4.2.1 Estimation strategy . . . . . . . . . . . . . . . . . . . . . 46 4.2.2 Estimation results . . . . . . . . . . . . . . . . . . . . . . 47 5. Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 Appendix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 A Summary statistics . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 B List of manufacturing sub-sectors . . . . . . . . . . . . . . . . . . . 57 C List of trading countries . . . . . . . . . . . . . . . . . . . . . . . . . 58Maste

    The Influence of the Uses of Text including Teachers' Travel Experiences on Primary Students Academic Interest in Geography Lessons

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    ํ•™์œ„๋…ผ๋ฌธ (์„์‚ฌ)-- ์„œ์šธ๋Œ€ํ•™๊ต ๋Œ€ํ•™์› : ์‚ฌ๋ฒ”๋Œ€ํ•™ ์‚ฌํšŒ๊ต์œก๊ณผ(์ง€๋ฆฌ์ „๊ณต), 2018. 8. ๋ฅ˜์žฌ๋ช….2015 ๊ฐœ์ • ์ดˆยท์ค‘ยท๊ณ  ์‚ฌํšŒ๊ณผ ๊ต์œก๊ณผ์ •์—์„œ๋Š” ํ•™์ƒ๋“ค์˜ ํ•™์Šต ํฅ๋ฏธ์™€ ๋™๊ธฐ๋ฅผ ํšจ๊ณผ์ ์œผ๋กœ ์ด๋Œ์–ด๋‚ด๊ธฐ ์œ„ํ•ด, ์—ฌํ–‰ ์‚ฌ์ง„, ์—ฌํ–‰๊ธฐ, ์—ฌํ–‰ ์„ค๊ณ„์™€ ๊ฐ™์€ ํ‚ค์›Œ๋“œ๋ฅผ ๊ตฌ์ฒด์ ์œผ๋กœ ๋ช…์‹œํ•˜์—ฌ ๋ณด๋‹ค ์ ๊ทน์ ์ธ ์˜๋ฏธ์—์„œ ์—ฌํ–‰ ๊ด€๋ จ ๊ต์ˆ˜ยทํ•™์Šต ์ž๋ฃŒ์˜ ํ™œ์šฉ์„ ์ œ์•ˆํ•˜๊ณ  ์žˆ๋‹ค. ์ด๋Š” ๊ตํ†ตยทํ†ต์‹ ์˜ ๋ฐœ๋‹ฌ, ์†Œ๋“ ์ˆ˜์ค€๊ณผ ์—ฌ๊ฐ€ ์ƒํ™œ ๋งŒ์กฑ๋„ ํ–ฅ์ƒ์— ๋”ฐ๋ฅธ ์—ฌํ–‰์— ๋Œ€ํ•œ ์‚ฌํšŒ์ ์ธ ๊ธฐ๋Œ€์— ๋ถ€์‘ํ•˜๊ณ , ์—ฌํ–‰์„ ํ†ตํ•œ ๊ต์œก์˜ ์ค‘์š”์„ฑ์„ ์ธ์ •ํ•œ ๊ฒƒ์œผ๋กœ ๋ณผ ์ˆ˜ ์žˆ๋‹ค. ์„ธ๊ณ„ ์ง€๋ฆฌ ํ•™์Šต์„ ๊ฒฝํ—˜ํ•˜๊ธฐ ์‹œ์ž‘ํ•˜๋Š” ์ดˆ๋“ฑํ•™๊ต ํ•™์ƒ๋“ค์€ ์ž๊ธฐ ์ •์ฒด์— ๋Œ€ํ•œ ์˜์‹์ด ๋šœ๋ ทํ•˜์ง€ ์•Š์€ ๊ณผ๋„๊ธฐ์  ์ƒํƒœ์— ์žˆ๊ธฐ ๋•Œ๋ฌธ์—, ์ง์ ‘์ ์ธ ์—ฌํ–‰ ๊ฒฝํ—˜์ด ์—†๋Š” ๋‚ฏ์„  ์ง€์—ญ์˜ ์ง€๋ฆฌ์  ํŠน์„ฑ์— ๋Œ€ํ•˜์—ฌ ๋…ผ๋ฆฌ์ ์ธ ์ถ”๋ก ์„ ํ•˜๊ธฐ๊ฐ€ ์–ด๋ ต๋‹ค. ์ด ๋•Œ, ๋‚ด๋Ÿฌํ‹ฐ๋ธŒ์˜ ์†Œ์žฌ๋กœ์„œ, ๊ต์‚ฌ์˜ ์—ฌํ–‰๊ธฐ๋ฅผ ์žฌ๊ตฌ์„ฑํ•œ ํ…์ŠคํŠธ ๋ฐ ์‚ฌ์ง„ ์ž๋ฃŒ๋Š” ๊ณต๊ฐ„ ์ง€๊ฐ ๋Šฅ๋ ฅ์ด ๋ถ€์กฑํ•œ ์ดˆ๋“ฑํ•™์ƒ๋“ค์—๊ฒŒ ์ ๊ทน์ ์ธ ๊ฐ์ • ์ด์ž…์„ ํ†ตํ•ด ์—ฌํ–‰์„ ํ†ตํ•œ ์ƒˆ๋กœ์šด ๊ฒฝํ—˜๊ณผ ํ•™์Šต์„ ๊ธฐ๋Œ€ํ•˜๊ฒŒ ํ•˜๋Š” ๋“ฑ ํ˜„์‹ค๊ฐ ์žˆ๋Š” ํ•™์Šต ๊ฒฝํ—˜์„ ์ œ๊ณตํ•  ๋ฟ ์•„๋‹ˆ๋ผ, ์‚ฌ์  ์ง€๋ฆฌ์™€ ๊ณต์  ์ง€๋ฆฌ๋ฅผ ๊ด€๋ จ์ง€์–ด ์ƒˆ๋กœ์šด ๊ฒฝ๊ด€๊ณผ ์ง€๋ฆฌ์  ๋งฅ๋ฝ์„ ์ดํ•ดํ•˜๋Š” ๋ฐ ๋งค์šฐ ์ค‘์š”ํ•œ ์—ญํ• ์„ ํ•œ๋‹ค. ์ด๋Ÿฌํ•œ ๋งฅ๋ฝ์—์„œ, ์ง€๋ฆฌ ์ˆ˜์—…์„ ํ•˜๋Š” ์ดˆ๋“ฑ ๊ต์‚ฌ์—๊ฒŒ ์žˆ์–ด ๋ณด๋‹ค ๊ตฌ์ฒด์ ์ด๊ณ  ์ƒ์ƒํ•œ ๊ต์ˆ˜ยทํ•™์Šต ์ž๋ฃŒ ์ˆ˜์ง‘์„ ๋ชฉ์ ์œผ๋กœ ํ•˜๋Š” ์—ฌํ–‰ ๊ฒฝํ—˜์€ ํฐ ์˜๋ฏธ๊ฐ€ ์žˆ๋‹ค. ์„ ํ–‰ ์—ฐ๊ตฌ๋ฅผ ํ†ตํ•ด, ์—ฌํ–‰์˜ ์งยท๊ฐ„์ ‘์  ๊ฒฝํ—˜์€ ํ•™์ƒ์˜ ํฅ๋ฏธ๋ฅผ ์ž๊ทนํ•  ์ˆ˜ ์žˆ๊ณ  ์‹ค์ƒํ™œ๊ณผ ์ง€๋ฆฌ ํ•™์Šต์„ ์—ฐ๊ณ„ํ•  ์ˆ˜ ์žˆ๋‹ค๋Š” ์ ์—์„œ ์œ ์šฉํ•œ ๊ต์œก์  ๋Œ€์•ˆ์ด ๋  ์ˆ˜ ์žˆ์Œ์ด ๋ฐํ˜€์กŒ๋‹ค. ํ•˜์ง€๋งŒ, ์ด๋ฅผ ๋ณด๋‹ค ์‹ค์ œ์ ์ธ ์ฐจ์›์—์„œ ํšจ๊ณผ์ ์ด๊ณ  ํšจ์œจ์ ์ธ ์ดˆ๋“ฑ ์ง€๋ฆฌ ํ•™์Šต ์ž๋ฃŒ๋กœ์„œ ํ™œ์šฉํ•˜๊ธฐ ์œ„ํ•œ ๋ฐฉ๋ฒ•์  ์—ฐ๊ตฌ๋Š” ๋ถ€์กฑํ•˜๋‹ค. ์ด์— ๋ณธ ์—ฐ๊ตฌ๋Š” ๊ต์‚ฌ์˜ ์—ฌํ–‰ ๊ฒฝํ—˜ ๋ฐ˜์˜ ์‚ฌ์ ์ง€๋ฆฌ ํ…์ŠคํŠธ ๋ฐ ์‚ฌ์ง„ ์ž๋ฃŒ๊ฐ€ ์ดˆ๋“ฑํ•™์ƒ์˜ ์ง€๋ฆฌ ํ•™์Šต ํฅ๋ฏธ์™€ ์ง€์—ญ ์„ ํ˜ธ๋„ ํ–ฅ์ƒ์— ๋ฏธ์น˜๋Š” ์˜ํ–ฅ์„ ์‹คํ—˜ ์—ฐ๊ตฌ๋ฅผ ํ†ตํ•ด ๊ฒ€์ฆํ•˜์˜€๋‹ค. ์‹คํ—˜์€ ๊ฒฝ๊ธฐ๋„ ์šฉ์ธ์‹œ ์†Œ์žฌ ๊ณต๋ฆฝ ์ดˆ๋“ฑํ•™๊ต 2๊ณณ์˜ 6ํ•™๋…„ ํ•™์ƒ 188๋ช…์„ ๋Œ€์ƒ์œผ๋กœ ์ด๋ฃจ์–ด์กŒ์œผ๋ฉฐ, ์—ฐ๊ตฌ ์ฐธ์—ฌ์ž๋“ค์€ ์‹คํ—˜ 1์—์„œ๋Š” ๊ณต์  ์ง€๋ฆฌ ํ…์ŠคํŠธ์™€ ์‚ฌ์  ์ง€๋ฆฌ ํ…์ŠคํŠธ, ์‹คํ—˜ 2์—์„œ๋Š” ์‚ฌ์  ์ง€๋ฆฌ ํ’๊ฒฝ ์‚ฌ์ง„ ํ…์ŠคํŠธ์™€ ์‚ฌ์  ์ง€๋ฆฌ ์ธ๋ฌผ ์‚ฌ์ง„ ํ…์ŠคํŠธ, ์ด๋ ‡๊ฒŒ ๊ฐ ์‹คํ—˜์—์„œ ์ง‘๋‹จ ๋‚ด ๋ณ€์ธ์œผ๋กœ 2๊ฐ€์ง€ ํ…์ŠคํŠธ ์œ ํ˜• ์ค‘ ์–ด๋Š ํ•œ ์œ ํ˜•์— ๋ฌด์„  ๋ฐฐ์ •๋˜์—ˆ๋‹ค. ๊ทธ๋ฆฌ๊ณ  ์ˆ˜ํ–‰ ๊ณผ์ œ๋กœ์„œ ํ•™์ƒ๋“ค์€ ๋Ÿฌ์‹œ์•„ ์ง€์—ญ์— ๋Œ€ํ•œ ํ…์ŠคํŠธ๋ฅผ ์ฝ๊ณ  ํ•™์Šต ํฅ๋ฏธ๋„์™€ ์ง€์—ญ ์„ ํ˜ธ๋„๋ฅผ ์ธก์ •ํ•˜๋Š” 7์  ๋ฆฌ์ปคํŠธ ์ฒ™๋„์˜ ๊ฐ๊ด€์‹ ๋ฌธํ•ญ์— ์‘๋‹ตํ•˜์˜€๋‹ค. ๋ณธ ์‹คํ—˜์„ ํ†ตํ•ด ์–ป์€ ๊ฒฐ๊ณผ๋Š” ๋‹ค์Œ๊ณผ ๊ฐ™๋‹ค. ์ฒซ์งธ, ๊ต๊ณผ์„œ ์† ์ง€์‹ ์ „๋‹ฌ ์ค‘์‹ฌ์˜ ๊ณต์  ์ง€๋ฆฌ ์„ค๋ช…์  ํ…์ŠคํŠธ์ผ์ง€๋ผ๋„, ๊ต์‚ฌ์˜ ์ง์ ‘์ ์ธ ์—ฌํ–‰ ๊ฒฝํ—˜์—์„œ ๋น„๋กฏํ•œ ์˜ˆ๋ฅผ ๋“œ๋Š” ๊ฒƒ๋งŒ์œผ๋กœ๋„ ๊ณต์  ์ง€๋ฆฌ๋ฅผ ์‚ฌ์  ์ง€๋ฆฌ์™€ ๊ด€๋ จ์ง€์–ด ์ ๊ทน์ ์ธ ๊ฐ์ • ์ด์ž…์„ ํ•˜๊ฒŒ ํ•จ์œผ๋กœ์จ ํ•™์Šต ํฅ๋ฏธ๋„ ํ–ฅ์ƒ์— ์œ ์˜๋ฏธํ•œ ์˜ํ–ฅ์„ ๋ฏธ์น˜๋Š” ๊ฒƒ์œผ๋กœ ๋‚˜ํƒ€๋‚ฌ๋‹ค. ๋‘˜์งธ, ๋ฌธ์ž๋กœ๋งŒ ๊ตฌ์„ฑ๋œ ํ…์ŠคํŠธ์— ๋น„ํ•ด ์‚ฌ์ง„ ์ž๋ฃŒ๋ฅผ ์‚ฝ์ž…ํ•˜์—ฌ ๊ธ€๊ณผ ์‚ฌ์ง„์ด ํ•จ๊ป˜ ์ œ๊ณต๋˜์—ˆ์„ ๋•Œ, ํ•™์Šต ํฅ๋ฏธ๋„๊ฐ€ ๋” ํฌ๊ฒŒ ๋‚˜ํƒ€๋‚ฌ๋‹ค. ์ด๋Š” ์ง€์—ญ ์„ ํ˜ธ๋„ ๋น„๊ต์—์„œ๋„ ๋™์ผํ•œ ๊ฒฐ๊ณผ๋ฅผ ์–ป์„ ์ˆ˜ ์žˆ์—ˆ๋‹ค. ์…‹์งธ, ์ž์—ฐ์„ ์ดฌ์˜ํ•œ ํ’๊ฒฝ ์‚ฌ์ง„์— ๋น„ํ•ด, ์ธ๋ฌผ์ด ํฌ์ฐฉ๋œ ์ธ๋ฌผ ์‚ฌ์ง„์ด ํ•™์Šต ํฅ๋ฏธ ๋ฐ ์ง€์—ญ ์„ ํ˜ธ๋„์— ๊ธ์ •์ ์ธ ๊ด€๋ จ์„ฑ์ด ์žˆ์—ˆ๋‹ค. ํŠนํžˆ, ์‚ฌ์ง„์— ํฌํ•จ๋œ ์ธ๋ฌผ์ด ๊ต์‚ฌ, ์นœ๊ตฌ ๋“ฑ ํ•™์Šต์ž์™€์˜ ์‹ฌ๋ฆฌ์  ๊ฑฐ๋ฆฌ๊ฐ€ ๊ฐ€๊นŒ์šด ์‚ฌ๋žŒ์ผ์ˆ˜๋ก ๊ทธ ํšจ๊ณผ๋Š” ์ปค์ง„๋‹ค๊ณ  ํ•ด์„ํ•  ์ˆ˜ ์žˆ์—ˆ๋‹ค. ์ด๋Ÿฌํ•œ ์‹คํ—˜์—ฐ๊ตฌ ๊ณผ์ •์€ ๊ต์‚ฌ์˜ ์—ฌํ–‰ ๊ฒฝํ—˜์ด ๋ฐ˜์˜๋œ ์‚ฌ์  ์ง€๋ฆฌ ์ž๋ฃŒ์˜ ํšจ์œจ์ ์ธ ํ™œ์šฉ์„ ์œ„ํ•œ ๋‹จ์„œ๋ฅผ ์ œ๊ณตํ•  ๋ฟ๋งŒ ์•„๋‹ˆ๋ผ, ์•ž์œผ๋กœ ๊ต์‚ฌ๋“ค์ด ์—ฌํ–‰ ์—ฐ์ˆ˜๋ฅผ ํ†ตํ•ด ์ˆ˜์ง‘ํ•˜๊ณ  ๊ฐœ๋ฐœํ•  ์ž๋ฃŒ๋ฅผ ๋”์šฑ ํšจ๊ณผ์ ์œผ๋กœ ๋””์ž์ธํ•˜๋Š” ๋ฐฉ์•ˆ์— ์ผ์ •ํ•œ ์‹œ์‚ฌ์ ์„ ์ œ๊ณตํ•  ์ˆ˜ ์žˆ์„ ๊ฒƒ์ด๋‹ค. ๋‚˜์•„๊ฐ€, ๊ต์‚ฌ์™€ ํ•™์ƒ๋“ค์˜ ์—ฌํ–‰ ๊ฒฝํ—˜ ๋นˆ๋„๊ฐ€ ๋Š˜์–ด๋‚˜๋ฉด์„œ ์—ฌํ–‰ ์ฝ˜ํ…์ธ ์˜ ๊ต์œก์  ํšจ๊ณผ๋ฅผ ๋†’์ด๊ธฐ ์œ„ํ•œ ๋‹ค๊ฐ์ ์ธ ํ™œ์šฉ ๋ฐฉ์•ˆ ๋ชจ์ƒ‰์ด ์ ˆ์‹คํ•œ ํ˜„ ์‹œ์ ์—, ์ง€์† ๊ฐ€๋Šฅํ•œ ์ง€๋ฆฌ ๊ต์œก ํ™œ๋™ ์‹ค์ฒœ์„ ์œ„ํ•œ ํ•œ ๊ฐ€์ง€ ๋Œ€์•ˆ์„ ์ œ์‹œํ•˜์˜€๋‹ค๋Š” ๋ฐ ๊ทธ ์˜์˜๊ฐ€ ์žˆ๋‹ค. ์ฃผ์š”์–ด : ์—ฌํ–‰, ๊ต์‚ฌ์˜ ์—ฌํ–‰ ๊ฒฝํ—˜, ์‚ฌ์  ์ง€๋ฆฌ, ํ…์ŠคํŠธ, ๊ต์ˆ˜ยทํ•™์Šต์ž๋ฃŒ, ํ•™์Šต ํฅ๋ฏธ ํ•™ ๋ฒˆ : 2015-21585๋ชฉ ์ฐจ โ… . ์„œ ๋ก  1 1. ์—ฐ๊ตฌ์˜ ํ•„์š”์„ฑ 1 2. ์—ฐ๊ตฌ ๋ชฉ์  4 3. ์—ฐ๊ตฌ ์ ˆ์ฐจ 5 โ…ก. ์ด๋ก ์  ๋ฐฐ๊ฒฝ 8 1. ์—ฌํ–‰์˜ ์ง€๋ฆฌ ๊ต์œก์  ์˜๋ฏธ ๊ณ ์ฐฐ 8 ๊ฐ€. ์—ฌํ–‰์˜ ์ง€๋ฆฌ ๊ต์œก์  ๊ฐ€์น˜ 8 ๋‚˜. ์ดˆ๋“ฑ ์ง€๋ฆฌ๊ต์œก์—์„œ์˜ ์—ฌํ–‰์˜ ๊ต์œก์  ํ•จ์˜ 12 2. ์ง€๋ฆฌ ํ•™์Šต ํฅ๋ฏธ ํ–ฅ์ƒ์„ ์œ„ํ•œ ํ…์ŠคํŠธ์˜ ์—ญํ•  14 ๊ฐ€. ํ•™์Šต ํฅ๋ฏธ ์ด๋ก  14 ๋‚˜. ์ง€๋ฆฌ ํ•™์Šต ์ž๋ฃŒ๋กœ์„œ ํ…์ŠคํŠธ์˜ ํšจ๊ณผ์„ฑ 17 ๋‹ค. ์ƒํ™ฉ์  ํฅ๋ฏธ๋ฅผ ์œ ๋ฐœํ•˜๊ธฐ ์œ„ํ•œ ํ…์ŠคํŠธ์˜ ๊ตฌ์„ฑ 22 โ…ข. ์‹คํ—˜ 1 : ๊ต์‚ฌ ์—ฌํ–‰๊ธฐ์ฒด ํ…์ŠคํŠธ์˜ ํšจ๊ณผ์„ฑ ๊ฒ€์ฆ 24 1. ๋ฐฉ๋ฒ• 24 2. ๊ฒฐ๊ณผ 34 3. ๋…ผ์˜ 39 โ…ฃ. ์‹คํ—˜ 2 : ๊ต์‚ฌ ์ธ๋ฌผ์‚ฌ์ง„-ํ…์ŠคํŠธ์˜ ํšจ๊ณผ์„ฑ ๊ฒ€์ฆ 40 1. ๋ฐฉ๋ฒ• 40 2. ๊ฒฐ๊ณผ 47 3. ๋…ผ์˜ 52 โ…ค. ๊ฒฐ ๋ก  53 1. ์š”์•ฝ 53 2. ์—ฐ๊ตฌ์˜ ํ•œ๊ณ„ 54 3. ๊ต์œก์  ์‹œ์‚ฌ์  ๋ฐ ์ œ์–ธ 56 ์ฐธ๊ณ ๋ฌธํ—Œ 58 ๋ถ€๋ก 64 Abstract 70 ํ‘œ ๋ชฉ ์ฐจ ์—ฌํ–‰ ๊ด€๋ จ ์ฃผ์š” ์šฉ์–ด 9 ํ˜„๋Œ€ ์ด๋ก ๊ฐ€๋“ค์˜ ํฅ๋ฏธ 15 ์ง€๋ฆฌ ๊ต์œก์šฉ ํ…์ŠคํŠธ ์ž๋ฃŒ์˜ ์œ ํ˜• 18 ์ง€๋ฆฌ ๊ต์œก์šฉ ์‚ฌ์ง„ ์ž๋ฃŒ์˜ ์œ ํ˜• 20 ์‹คํ—˜ 1์˜ ๊ฒ€์‚ฌ ๋„๊ตฌ์˜ ๊ตฌ๋ถ„ 27 ์‹คํ—˜ 1์˜ ์ƒํ™ฉ์  ํฅ๋ฏธ๋„ ๊ฒ€์‚ฌ ๋ฌธํ•ญ 30 ์‹คํ—˜ 1์˜ ์ง€์—ญ ์„ ํ˜ธ๋„ ๊ฒ€์‚ฌ ๋ฌธํ•ญ 30 ์‹คํ—˜ 1์˜ ์‚ฌ์ „ ์ง‘๋‹จ ๊ฐ„ ๋™์งˆ์„ฑ ๊ฒ€์‚ฌ ๋ฌธํ•ญ 31 ์‹คํ—˜ 1์˜ ์‚ฌ์ „ ๊ฒ€์‚ฌ ๊ธฐ์ˆ  ํ†ต๊ณ„์น˜ 35 ์‹คํ—˜ 1์˜ ์ง‘๋‹จ ๊ฐ„ ๊ฐœ์ธ์  ํฅ๋ฏธ๋„ ์ฐจ์ด ๋น„๊ต 36 ์‹คํ—˜ 1์˜ ์ง‘๋‹จ ์ •๊ทœ์„ฑ ๊ฒ€์ • 37 ์‹คํ—˜ 1์˜ ์ƒํ™ฉ์  ํฅ๋ฏธ์— ๋Œ€ํ•œ ์ ์ˆ˜ ๋น„๊ต 38 ์‹คํ—˜ 1์˜ ๋Ÿฌ์‹œ์•„ ์ง€์—ญ ์„ ํ˜ธ๋„์— ๋Œ€ํ•œ ์ ์ˆ˜ ๋น„๊ต 38 ์‹คํ—˜ 2์˜ ๊ฒ€์‚ฌ ๋„๊ตฌ์˜ ๊ตฌ๋ถ„ 43 ์‹คํ—˜ 2์˜ ์‚ฌ์ „ ๊ฒ€์‚ฌ ๊ธฐ์ˆ  ํ†ต๊ณ„์น˜ 48 ์‹คํ—˜ 2์˜ ์ง‘๋‹จ ๊ฐ„ ๊ฐœ์ธ์  ํฅ๋ฏธ๋„ ์ฐจ์ด ๋น„๊ต 49 ์‹คํ—˜ 2์˜ ์ง‘๋‹จ ์ •๊ทœ์„ฑ ๊ฒ€์ • 50 ์‹คํ—˜ 2์˜ ์ƒํ™ฉ์  ํฅ๋ฏธ์— ๋Œ€ํ•œ ์ ์ˆ˜ ๋น„๊ต 51 ์‹คํ—˜ 2์˜ ๋Ÿฌ์‹œ์•„ ์ง€์—ญ ์„ ํ˜ธ๋„์— ๋Œ€ํ•œ ์ ์ˆ˜ ๋น„๊ต 51 ๊ทธ ๋ฆผ ๋ชฉ ์ฐจ [๊ทธ๋ฆผ โ… -1] ํ˜„์žฅ ์‹คํ—˜ ์—ฐ๊ตฌ ์ ˆ์ฐจ 7 [๊ทธ๋ฆผ โ…ข-1] ์‹คํ—˜ 1์˜ ๊ต๊ณผ์„œ ํ…์ŠคํŠธ ์ถ”์ถœ ๊ทผ๊ฑฐ 25 [๊ทธ๋ฆผ โ…ฃ-1] ์‹คํ—˜ 2์˜ ๊ต๊ณผ์„œ ํ…์ŠคํŠธ ์ถ”์ถœ ๊ทผ๊ฑฐ 41Maste

    Recurrent Esophageal Stricture Caused by Candidiasis in an HIV-Infected Patient

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    Esophageal candidiasis is a common opportunistic infection that develops in human immunodeficiency virus (HIV)-infected patients. It is usually effectively treated with fluconazole, and the occurrence of an esophageal stricture in association with esophageal candidiasis has rarely been reported in HIV-infected patients. In the case presented here, a 49-year-old man was diagnosed with severe esophageal candidiasis with HIV infection. At the time of the HIV diagnosis, he had immunodeficient status with a CD4+ T lymphocyte count of 150 cells/mm3. He received antifungal treatment with fluconazole and combined antiretroviral therapy. Although the esophageal candidiasis improved with rapid recovery of the CD4+ T lymphocyte count, a recurrent esophageal stricture developed. To treat the recurrent esophageal stricture, the patient received repeated balloon dilatation and stent insertion. We report this rare case of severe esophageal stricture complication of esophageal candidiasis in an HIV-infected patient.ope

    Correlation between Soluble Triggering Receptor Expressed on Myeloid Cells-1 and Endoscopic Activity in Intestinal Behรงet's Disease

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    PURPOSE: The serum levels of soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) have recently been shown to be correlated highly with disease activity in patients with intestinal Behรงet's disease (BD). However, it remains unclear whether sTREM-1 levels reflect endoscopic activity in intestinal BD. This study aimed to evaluate the correlation of sTREM-1 levels with endoscopic activity in intestinal BD. MATERIALS AND METHODS: A total of 84 patients with intestinal BD were enrolled. Endoscopic activity was compared with sTREM-1 levels as well as other laboratory findings, including erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). RESULTS: sTREM-1 levels were significantly increased in intestinal BD patients compared with controls (37.98ยฑ27.09 pg/mL vs. 16.65ยฑ7.76 pg/mL, p=0.002), however, there was no difference between endoscopically quiescent and active diseases (43.53ยฑ24.95 pg/mL vs. 42.22ยฑ32.68 pg/mL, p=0.819). Moreover, serum sTREM-1 levels did not differ in terms of number, shape, depth, size, margin, or type of ulcer in patients with intestinal BD. However, mean ESR and CRP levels in patients with active disease were significantly higher than those in patients with quiescent disease (p=0.001, p<0.001, respectively). In addition, endoscopic activity scores for intestinal BD were correlated significantly with both CRP levels (ฮณ=0.329) and ESR (ฮณ=0.298), but not with sTREM-1 levels (ฮณ=0.166). CONCLUSION: Unlike CRP levels and ESR, serum sTREM-1 levels were not correlated with endoscopic activity in patients with intestinal BD.ope

    Synchronous development of intrahepatic cholangiocarcinoma and hepatocellular carcinoma in different sites of the liver with chronic B-viral hepatitis: two case reports

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    BACKGROUND: Synchronous development of primary hepatocellular carcinoma and intrahepatic cholangiocarcinoma has been reported rarely. In literature review, there have been only 35 reported cases of synchronous hepatocellular carcinoma and intrahepatic cholangiocarcinoma, and most of these tumors developed in patients with hepatitis C-related liver cirrhosis. Here, we present synchronous development of hepatocellular carcinoma and intrahepatic cholangiocarcinoma in two patients with chronic B-viral hepatitis. CASE PRESENTATION: Two patients with chronic hepatitis B were referred to our hospital due to a hepatic mass. Patient 1 had a 6.4 cm multinodular hepatic mass in the left lobe and a small nodule in the right lobe. Patient 2 had a 4.3 cm hypervascular mass in the right lobe and a 1.1 cm nodule in the left lobe. The pre-operative diagnosis of both cases was hepatocellular carcinoma with metastatic nodule, however, surgical resection pathology revealed that hepatocellular carcinoma and intrahepatic cholangiocarcinoma existed independently in the other side of the liver in both cases. Additionally, the background liver histology of both cases was hepatitis B-related chronic hepatitis without cirrhotic change. CONCLUSION: Our cases suggest that hepatitis B virus infection can also predispose to development of double liver cancers.ope

    Prognostic Indicators for Acute Liver Failure Development and Mortality in Patients with Hepatitis A: Consecutive Case Analysis

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    PURPOSE: Due to the seroepidemiological shift in hepatitis A (HA), its severity, mortality, and complications have increased in recent years. Thus, the aim of this study was to identify predictive factors associated with poor prognosis among patients with HA. MATERIALS AND METHODS: A total of 304 patients with HA admitted to our institution between July 2009 and June 2011 were enrolled consecutively. Patients with complications defined as acute liver failure (ALF) were evaluated, and mortality was defined as death or liver transplantation. RESULTS: The mean age of patients (204 males, 100 females) was 32 years. Eighteen (5.9%) patients had progressed to ALF. Of the patients with ALF, 10 patients (3.3%) showed spontaneous survival while 8 (2.6%) died or underwent liver transplantation. Multivariate regression analysis showed that Model for End-Stage Liver Disease (MELD) and systemic inflammatory response syndrome (SIRS) scores were significant predictive factors of ALF. Based on receiver operating characteristics (ROC) analysis, a MELDโ‰ฅ23.5 was significantly more predictive than a SIRS scoreโ‰ฅ3 (area under the ROC: 0.940 vs. 0.742, respectively). In addition, of patients with a MELD scoreโ‰ฅ23.5, King's College Hospital criteria (KCC) and SIRS scores were predictive factors associated with death/transplantation in multivariate analysis. CONCLUSION: MELD and SIRS scoresโ‰ฅ23.5 and โ‰ฅ3, respectively, appeared to be related to ALF development. In addition, KCC and SIRS scoresโ‰ฅ3 were valuable in predicting mortality of patients with a MELDโ‰ฅ23.5.ope

    Orthotopic liver transplantation after the combined use of locoregional therapy and sorafenib for advanced hepatocellular carcinoma

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    Abstract: We herein report a patient with advanced hepatitis B virus-related hepatocellular carcinoma (HCC) beyond the Milan criteria. He underwent orthotopic liver transplantation after successful HCC downstaging that satisfied the University of California, San Francisco criteria, using concurrent chemoradiation therapy with a combination of repeated hepatic arterial infusion chemotherapy (HAIC) and sorafenib. A 52-year-old male was diagnosed with advanced hepatitis B virus-related HCC beyond the Milan criteria. He underwent concurrent chemoradiation therapy (50 Gy with 20 fractions over 5 weeks with HAIC using 5-fluorouracil at a dose of 500 mg/day, which was administered during the first and fifth weeks of radiation therapy) as an initial treatment modality. This was followed by the combined use of HAIC using 5-fluorouracil (500 mg/m2 for 5 hours on days 1โ€“3) and cisplatin (60 mg/m2 for 2 hours on day 2) every 4 weeks (twelve cycles) and sorafenib (from the third to the twelfth cycle of HAIC) to treat the remaining HCC. Because a remarkable decrease in the tumor burden that satisfied the University of California, San Francisco criteria was observed after these combination treatments, the patient underwent orthotopic liver transplantation with curative aim and survived for 11 months without evidence of HCC recurrence.ope

    The Rebleeding Risk and Prognostic Factors of Acute Hemorrhagic Rectal Ulcer

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    Background/Aims: Acute hemorrhagic rectal ulcer (AHRU) is an important etiology of lower gastrointestinal bleeding in intensive care unit patients and hospital inpatients. Moreover, with increasing elderly populations, and improved survival in critically ill patients, the incidence of AHRU has increased. The aim of this study is to determine rebleeding risk and prognostic factors of AHRU patients. Methods: We retrospectively reviewed 32 patients with AHRU in Severance Hospital from February 2006 to October 2010, collected clinical data, and analyzed their association with the recurrence of bleeding and mortality of patients. Results: The mean age of patients was 65.5 years, and 27 patients (84.4%) showed Eastern Cooperative Oncology Group performance status 3-4. Nineteen patients (59.4%) had recurrent bleeding. Hypoalbuminemia (โ‰ค2.5 g/dL) was a risk factor of rebleeding in univariate and multivariate analysis. For patients with chronic liver disease, hypoalbuminemia (โ‰ค2.5 g/dL), renal dysfunction (>2 mg/dL) and thrombocytopenia (40 seconds) increased mortality (P=0.028, P=0.008 and P=0.027, respectively) and the patients with rebleeding showed a tendency toward higher mortality, compared to those without (57.9% vs. 23.1%, P=0.051). Conclusions: In AHRU patients, hypoalbuminemia was a risk factor of rebleeding, and chronic liver disease, hypoalbuminemia, renal dysfunction, thrombocytopenia and no endoscopic treatment at the first bleeding event was correlated with relatively earlier rebleeding.ope

    Recurrent Acute Pericarditis Induced by 5-aminosalicylates in a Patient with Inflammatory Bowel Disease

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    Inflammatory bowel disease (IBD) is an idiopathic chronic inflammation of the intestines. IBD treatment may require anti-inflammatory agents such as sulfasalazine or 5-aminosalicylate (5-ASA) and immunomodulators to control the symptoms. However, these agents have a variety of common adverse effects such as nausea, vomiting, skin rash, leukopenia, thrombocytopenia, and infections. Moreover, rare side effects such as nephrotic syndrome, pneumonitis, and pericarditis can occur. A 21-year-old male was admitted to the hospital due to acute chest pain, fever, and sweating. The patient had a history of Crohn's disease and had been taking mesalazine for 3 weeks. Chest x-ray, echocardiography, and clinical manifestations revealed that the patient had acute pericarditis. However, we did not recognize the relationship between these findings and 5-ASA at that time. Two years later, the patient took 5-ASA again, and similar symptoms occurred, which led us to confirm that he suffered from pericarditis induced by this drug. We report a case of acute recurrent pericarditis that developed after taking 5-ASA for IBD treatment with a review of the literature.ope

    (A) study on the retired, elderly, chronically ill patient's ability self-care and family's burden

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    ๊ฐ„ํ˜ธํ•™๊ต์œก/๋ฐ•์‚ฌ[ํ•œ๊ธ€] ํ˜„๋Œ€์‚ฌํšŒ๋Š” ์–‘์งˆ์˜ ๋ณด๊ฑด์˜๋ฃŒ, ์ƒํ™œ์–‘์ƒ๋“ฑ์— ์˜ํ•œ ์‚ฌ๋ง์œจ์˜ ์ €ํ•˜, ํ‰๊ท ์ˆ˜๋ช…์˜ ์—ฐ์žฅ, ์งˆ๋ณ‘์–‘์ƒ์˜ ๋ณ€ํ™”๋กœ ๊ณ„์†์ ์ธ ์น˜๋ฃŒ์™€ ๊ด€๋ฆฌ๊ฐ€ ์š”๊ตฌ๋˜๋Š” ๋งŒ์„ฑํ‡ดํ–‰์„ฑ์งˆํ™˜์„ ์ง€๋‹Œ ๋…ธ๋…„์ธต ์ธ๊ตฌ๊ฐ€ ๊ณ„์†ํ•ด์„œ ์ฆ๊ฐ€ํ•˜๋Š” ์ถ”์„ธ๋กœ ์šฐ๋ฆฌ๋‚˜๋ผ๋„ ์ธ๊ตฌ์˜ ๋…ธ๋ นํ™”์— ๋”ฐ๋ฅธ ๋…ธ์ธ์˜ ๊ฑด๊ฐ•์„ ๋น„๋กฏํ•˜์—ฌ ์—ฌ๋Ÿฌ๊ฐ€์ง€ ๋ฌธ์ œ๊ฐ€ ์‹ฌ๊ฐํ•˜๊ฒŒ ๋Œ€๋‘๋˜๊ณ  ์žˆ๋‹ค. ๋…ธ์ธ์˜ ๊ฑด๊ฐ•๋ฌธ์ œ๊ฐ€ ๋งŒ์„ฑ ํ‡ดํ–‰์„ฑ์งˆํ™˜์œผ๋กœ ๊ณ„์†์ ์ธ ์น˜๋ฃŒ์™€ ๊ด€๋ฆฌ๊ฐ€ ์š”๊ตฌ๋˜๋ฉฐ, ๋˜ํ•œ ๋…ธ์ธ์€ ๋…ธํ™”๊ณผ์ •์— ๋”ฐ๋ฅด๋Š” ์œก์ฒด์  ์žฅ์•  ์ž์ฒด๋กœ๋„ ์˜์กด์ ์ด๊ฒŒ ๋˜๋ฏ€๋กœ ์ด๋กœ ์ธํ•ด ๋…ธ์ธํ™˜์ž๋ฅผ ๋Œ๋ณด๋Š” ๊ทธ ๊ฐ€์กฑ์€ ์ž์‹ ์˜ ์ƒํ™œ๊ตฌ์กฐ์™€ ๊ธฐ๋Šฅ์„ ๋ณ€๊ฒฝํ•˜๊ฒŒ ํ•˜๋ฉฐ ์ด๋ฅผ ๋ถ€๋‹ด์œผ๋กœ ๊ฒฝํ—˜ํ•˜๊ฒŒ ๋œ๋‹ค. ๋”ฐ๋ผ์„œ ๋ณธ ์—ฐ๊ตฌ์—์„œ๋Š” ๋งŒ์„ฑ์งˆํ™˜์„ ๊ฐ€์ง„ ์žฌ๊ฐ€ ๋…ธ์ธํ™˜์ž์˜ ์ž๊ธฐ๊ฐ„ํ˜ธ ๋Šฅ๋ ฅ์„ ์ฆ์ง„์‹œํ‚ค๊ณ  ์•„์šธ๋Ÿฌ ๊ฐ€์กฑ์˜ ๋ถ€๋‹ด๊ฐ์„ ์ค„์ผ ์ˆ˜ ์žˆ๋Š” ์ค‘์žฌ ๋ฐฉ๋ฒ•์„ ๋งˆ๋ จํ•˜๋Š”๋ฐ ๊ธฐ์ดˆ์ž๋ฃŒ๋ฅผ ์ œ๊ณตํ•˜๊ณ ์ž ์—ฐ๊ตฌ๋ฅผ ์‹œ๋„ํ•˜์˜€๋‹ค. ์—ฐ๊ตฌ๋ฐฉ๋ฒ•์€ 1993๋…„ 1์›” 1์ผ๋ถ€ํ„ฐ 12์›” 31์ผ๊นŒ์ง€ 1๋…„์‚ฌ์ด์— ๋งŒ์„ฑ์งˆํ™˜์œผ๋กœ ์ง„๋‹จ๋ฐ›๊ณ  ์ž…์›ํ–ˆ๋˜ ๋…ธ์ธํ™˜์ž ์ค‘์— ํ˜„์žฌ ๊ฐ€์ •์— ์žˆ๋Š” ๋…ธ์ธํ™˜์ž์™€ ์ด๋“ค์„ ๋Œ๋ณด๋Š” ๊ฐ€์กฑ ์ด 96์„ธ๋Œ€๋ฅผ ์—ฐ๊ตฌ๋Œ€์ƒ์œผ๋กœ 1994๋…„ 3์›” 21์ผ๋ถ€ํ„ฐ 4๋ญ˜ 9์ผ๊นŒ์ง€ 20์ผ๊ฐ„ ์„ค๋ฌธ์ง€๋ฅผ ์ด์šฉํ•˜์—ฌ ์ž๋ฃŒ๋ฅผ ์ˆ˜์ง‘ํ•˜์˜€๋‹ค. ๋ณธ ์—ฐ๊ตฌ์— ์‚ฌ์šฉ๋œ ๋„๊ตฌ๋Š” ์†ก๋ฏธ์ˆœ์ด ๊ฐœ๋ฐœํ•œ 4์  ํ‰์ ์ฒ™๋„์˜ 13ํ•ญ๋ชฉ์œผ๋กœ ๊ตฌ์„ฑ๋œ ์ž๊ธฐ๊ฐ„ํ˜ธ ๋Šฅ๋ ฅ์„ ์‚ฌ์ •ํ•˜๋Š” ๋„๊ตฌ์™€ ์ด์ˆ™์ž๊ฐ€ ์‚ฌ์šฉํ–ˆ๋˜ 4์  ํ‰์ ์ฒ™๋„์˜ ์ด 30ํ•ญ๋ชฉ์˜ ๋ถ€๋‹ด๊ฐ ์ธก์ •๋„๊ตฌ๋ฅผ ์‚ฌ์šฉํ•˜์˜€๋‹ค. ์ž๋ฃŒ์˜ ๋ถ„์„์„ ์œ„ํ•ด ์‹ค์ˆ˜, ๋ฐฑ๋ถ„์œจ, ํ‰๊ท , ํ‘œ์ค€ํŽธ์ฐจ๋ฅผ ๊ตฌํ–ˆ๊ณ  ๋ณ€์ˆ˜๊ฐ„์˜ ์ƒ๊ด€๊ด€๊ณ„๋Š” Pearson correlation coefficient๋ฅผ ์ด์šฉํ•˜์—ฌ ๋ถ„์„ํ•˜์˜€๋‹ค. ๋ณธ ์—ฐ๊ตฌ์˜ ๊ฒฐ๊ณผ๋Š” ๋‹ค์Œ๊ณผ ๊ฐ™๋‹ค. 1. ๋งŒ์„ฑ์งˆํ™˜์„ ๊ฐ€์ง„ ์žฌ๊ฐ€ ๋…ธ์ธํ™˜์ž์˜ ์ž๊ธฐ๊ฐ„ํ˜ธ ๋Šฅ๋ ฅ์€ 13์ ์—์„œ 52์ ์˜ ๋ฒ”์œ„์—์„œ ์ตœํ•˜ 13์ ์—์„œ ์ตœ๊ณ  52์ ๊นŒ์ง€ ๋ถ„ํฌํ•˜๊ณ  ์žˆ์—ˆ์œผ๋ฉฐ, ํ‰๊ท ์€34.69์ ์œผ๋กœ ์ž๊ธฐ๊ฐ„ํ˜ธ ๋Šฅ๋ ฅ์ด ๋†’๊ฒŒ ๋‚˜ํƒ€๋‚ฌ๋‹ค. 2. ๋Œ€์ƒ ๊ฐ€์กฑ์˜ ์˜์—ญ๋ณ„ ๋ถ€๋‹ด๊ฐ์˜ ํ‰๊ท ์ ์ˆ˜๋ฅผ ๋ณด๋ฉด ์‹œ๊ฐ„-์˜์กด ๋ถ€๋‹ด๊ฐ์˜์—ญ์ด 4์  ์ฒ™๋„์—์„œ 2.54์ ์œผ๋กœ ๊ฐ€์žฅ ๋†’์€ ๊ฒฝํ–ฅ์ด์—ˆ์œผ๋ฉฐ ๊ทธ ๋‹ค์Œ์€ ์‹ ์ฒด์  ๋ถ€๋‹ด๊ฐ(1.93), ๋ฐœ๋‹ฌ ๋ถ€๋‹ด๊ฐ(1.86), ์žฌ์ •์  ๋ถ€๋‹ด๊ฐ(1.80), ์ •์„œ์  ๋ถ€๋‹ด๊ฐ(1.62), ์‚ฌํšŒ์  ๋ถ€๋‹ด๊ฐ(1.47)์˜ ์ˆœ์œผ๋กœ ๋‚˜ํƒ€๋‚ฌ๋‹ค. 3. ๋Œ€์ƒ ๊ฐ€์กฑ์˜ ๊ฐ ํ•ญ๋ชฉ๋ณ„ ๋ถ€๋‹ด๊ฐ์„ ์ „์ฒด์ ์œผ๋กœ ๋น„๊ตํ•ด๋ณด๋ฉด '๋…ธ์ธ์„ ๋Š์ž„์—†์ด ์ง€์ผœ๋ด์•ผ ํ•œ๋‹ค(2.98)', '๋…ธ์ธ์˜ ๋งŽ์€ ๊ธฐ๋ณธ์ ์ธ ๊ธฐ๋Šฅ์„ ๋„์™€์•ผํ•œ๋‹ค(2.89)', '๋…ธ์ธ์ด ์˜์กด์ ์ด๋ผ๊ณ  ์ƒ๊ฐ๋œ๋‹ค(2.80)', '๋‚˜๋Š” ๋…ธ์ธ์˜ ์žฅ๋ž˜๊ฐ€ ์–ด๋–ป๊ฒŒ ๋ ์ง€ ์—ผ๋ ค๋œ๋‹ค(2.75)'์˜ ์ˆœ์œผ๋กœ ๋†’๊ฒŒ ๋‚˜ํƒ€๋‚ฌ๋Š”๋ฐ ์ด์ค‘์—์„œ '๋‚˜๋Š” ๋…ธ์ธ์˜ ์žฅ๋ž˜๊ฐ€ ์–ด๋–ป๊ฒŒ ๋ ์ง€ ์—ผ๋ ค๋œ๋‹ค'๋ฅผ ์ œ์™ธํ•œ ๋‚˜๋จธ์ง€๋Š” ๋ชจ๋‘ ์‹œ๊ฐ„-์˜์กด ๋ถ€๋‹ด๊ฐ ์˜์—ญ์— ํ•ด๋‹น๋˜๋Š” ๋‚ด์šฉ์ด์—ˆ๋‹ค 4. ๋งŒ์„ฑ์งˆํ™˜์„ ๊ฐ€์ง„ ์žฌ๊ฐ€ ๋…ธ์ธํ™˜์ž์˜ ์ž๊ธฐ๊ฐ„ํ˜ธ ๋Šฅ๋ ฅ๊ณผ ๊ฐ€์กฑ์˜ ๋ถ€๋‹ด๊ฐ๊ฐ„์—๋Š” ์œ ์˜ํ•œ ์ƒ๊ด€๊ด€๊ณ„๋ฅผ ๋‚˜ํƒ€๋‚ด์„œ(r=.802, p<0.001) ๋…ธ์ธํ™˜์ž์˜ ์ž๊ธฐ๊ฐ„ํ˜ธ ๋Šฅ๋ ฅ์ด ๋‚ฎ์„์ˆ˜๋ก ๊ฐ€์กฑ์˜ ๋ถ€๋‹ด๊ฐ์ด ๋†’๋‹ค๊ณ  ๋ณผ ์ˆ˜ ์žˆ๋‹ค. [์˜๋ฌธ] Due to improved of medical care, decreases in the death rate, extension of the average span of life and changes in the impact of diseases in modem society, there is a trend toward population increase in the elderly group who have chronic degenerative diseases which require treatment and management on a long-term base. This raises various serious problems including problems of the health of the elderly. Among the problems of the health of the elderly, one is that their chronic degenerative diseases require continuous long-term medical care and management. Since the elderly frequently become dependent due to physical disability related to the aging process, other family members who must care for them, must change their lifestyle and function, and therefore may experience burden. Accordingly, this study was done to increase understanding of the self-care ability of the elderly who have a chronic disease and the burden of the other family members, to identify the correlations between them, and to supply basic data in order to provide methods by which the elderly can increase their self-care ability and thereby decrease the burden on other family members. Data were collected from a total of 96 persons including elderly people who had once been diagnosed and hospitalized for a period and were now staying at home and other family members who were taking care of the elderly at home. The questionnare that was used included two tools - the first, made up of 13 question items with 'a 4 points Likert measure', which was developed by Song, Mi Soon, measured self-care ability, and the second made up of a total of 30 question items with 'a 4 points Liken measure', which was developed by Lee, Sook Ja, measured the burden to other family members. For data analysis, real numbers, percentages, mean values, and standard deviations were calculated, and the correlations between variables were analysed, using Pearson Correlation Coefficient. The results are as follows: 1. The self-care ability measure had a possible total score of 52 points. The score achieved by the retired elderly patients ranged from 13 points to 52 points with an average score of 34.69 which indicated high self-care ability. 2. Regarding the burden to the other members of the family, for each question item, respectively, time-dependent burden of the elderly had the highest score of 2.54 points, followed by physical burden at 1.93, then development burden, at 1.86, then financial burden at 1.80, emotion burden at, 1.62, and social burden, at 1.47. 3. In general, a comparison of each question item, respectively, showed that the order ranked from the highest score 'the elderly should be continuously taken care of(2.98)', then 'it is deemed that the elderly are dependent(2.80)', then 'the future of the elderly is questionable and worrysome(2.75)'. With the exception of' the future of the elderly is questionable and worrysome(2.75) 'the above items all relate to time-dependent burden. 4. The results showed that the lower He self-care ability of the chronic, elderly patient was, the higher the level of burden felt by other members of the family(r=-.802, p<0.001).restrictio
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