우심방을 침범한 거대 비호지킨씨 림프종 1예

강상범,진승원,이은경,박용현,최용호,김용주,박준철,김재형,홍순조,최규보,권종범,원용순,박건,이은희 대한순환기학회 2000 Korean Circulation Journal Vol.30 No.4

담석증과 당뇨병

강진경(Jin Kyung Kang),최흥재(Heung Jai Choi),김경희(Kyung Hee Kim),황용(Yong Hwang),김용범(Yong Bum Kim),이원영(Won Yung Lee) 대한소화기학회 1985 대한소화기학회지 Vol.17 No.2

N/A Most authorities agree the higher incidence of gallstones among diabetic patient. Although many reports on gallstones or diabetes mellitus have been published, and actual correlation between gallstones and diabetes mellitus remains obscure. The purpose of this reports is to know the incidence of gallstone in diabetics and of diabetics in the patients with gallstone. Authors studied prospectively and clinically the diabetics in a group of 173 patients with gallstones and gallstone in a group of 98 diabetic patients who were admitted to Yonsei University Yong-Dong Hospital for the same period of April 1983 to May 1984. The results obtained are summarized as follow: The incidence of gallstone to general admission patients is 1.5% and the prevalence of diabetes mellitus to total in-patients is 0.8% The gallstone was found in 11.0% of diabetics and were diabetic 19.4% of patients with gallstones. The age of peak incidence of gallstones is 5th decade and female was more prevalent than male with the ratio of 1.37:1. The age of peak incidence of diabetes mellitus is 6 th decade and female is less prevalent with the ratio of 0.72:l.3, The most common characteristic finding of patients of gallstones with diabetes mellitus is symptomless(42.1%)4, There is no significant difference in serum levels of cholesterol and triglyceride between diabetic and non-diabetic groups or with and without gallstones. 5. Comparative study on location of stones revealed, 72.8% in gallbladder only, 12.7% in common bile duct only, 4. 6% in intrahepatic duct only, and remainders in multiple site. There is no significant difference in terms of location of stone between diabetic and nondiabetic group.

악성 갑상선 우연종의 임상상 및 초음파 소견의 진단적 가치

강한욱,김광원,이병완,강보현,김형훈,김범진,정재훈,민용기,이명식,이문규 대한내분비학회 2002 Endocrinology and metabolism Vol.17 No.5

연구배경: 최근 갑상선 초음파 검사의 빈번한 시행으로 갑상선 우연종의 발견이 증가하고 있다. 이러한 갑상선 우연종은 임상적으로 어떻게 접근하고 치료를 해야 하는지 적지 않은 문제가 되고 있다. 본 연구에서는 직경 1.5㎝ 이하의 갑상선 우연종의 유병률, 입상적 특징 및 초음파 특성, 그리고 가장 효율적인 진단적 접근에 대해 알아 봤다. 방법: 1999년 1월부터 2000년 12월까지 삼성서울병원 내과 및 일반외과로 갑상선 결절을 주소로 내원한 1457명을 대상으로 후향적 연구를 시행하였다. 우연히 발견된 직경 1.5㎝ 이하의 갑상선 결절을 가지는 환자들에서 갑상선 결절의 촉지 유무, 갑상선 기능검사, 항갑상선 항체, 갑상선 초음파 및 미세침 흡인세포검사, 99m^Tc 갑상선 스켄, 수술 조직검사 및 병기를 검토하였다. 결과: 분석한 갑상선 결절 1475예 중 갑상선 우연종의 유병률은 13.4%(198예)였다. 갑상선 우연종에서 악성률은 28.8%(57예)으로 나왔다. 양성 및 악성 갑상선 우연종에서 나이, 성별, 갑상선 기능검사, 결절 크기에는 의미 있는 차이는 없었다. 갑상선 스켄은 갑상선 우연종의 감별에 적합하지 않았다. 갑상선 결절의 초음파 지표 점수만이 양성 및 악석 갑상선 우연종의 감별에서 초음파 지표 점수의 민감도는 88.9%, 특이도는 74.4%, 양성 예측률은 92.4%로 나왔고 진단적 정환도는 85.5%였다. 갑상선암으로 수술을 받은 50명중 stage 1은 34명, stage 2는 6명, stage 3은 10명으로 대부분의 악성 갑상선 우연종은 낮은 TNM 병기로 나타났으나, 상당수에서는 국소 침범의 소견을 보였다. TNM 병기의 3기 환자 전부는 45세 이상이였고, 주로 갑상선암의 피막 침범에 의한 것이었다. 임파절 전이는 6명의 환자에서 나왔다. 결론: 악성 갑상선 우연종은 비교적 흔히 접할 수 있는 질환이며 양성 우연종과는 임상적으로 구별이 안 된다. 악성 갑상선 우연종은 발견 당시 대부분 낮은 병기이나, 갑상선의 피막 침범 및 임파절 전이가 상당수에서 발견되었다. 갑상선 우연종의 초음파 소견은 향후의 진단 방향을 제시하는 중요한 길잡이가 될 수 있다. 초음파 지표 점수 2점 이상의 갑상선 우연종에서만 초음파 유도 미세침 흡입검사를 권장한다. Background: High-resolution ultrasonography has made the detection of asymptomatic small thyroid possible. Recent increases in the detection of incidentalomas have created a clinical dilemma on how to properly manage such incidental nodules. We investigated the prevalence, clinical and ultrasonographic characteristics, and optimal diagnostic approach toward incidentally detected benign and malignant thyroid nodules of less than 1.5㎝ in size. Methods: A retrospective review was undertaken on the 1,475 patients who had visited Samsung Medical Center, Seoul Korea between January 1999 and December 2000. The review consisted of a physical examination of the thyroid gland, thyroid function test, antithyroid antibodies, thyroid ultrasonography, fine-needle aspiration biopsy, pathology and TNA staging of the incidentally detected thyroid nodules of less than 1.5㎝ in size. Results: The prevalence of thyroid incidentalomas was 13.4% and the malignancy rate within them was 28.8%. There were no significant differences in age, sex, thyroid function test and size between the benign and malignant incidentalomas. Ultrasonographic characteristics showed meaningful diagnostic value for the detection of malignancy in incidentalomas. Most malignant incidentalomas were of a low stage. Conclusion: Occult thyroid cancers are fairly common finding. There are no clinical difference between benign and malignant thyroid nodules less than 1.5㎝; however, ultrasonographic findings can be used to decision of optimal management strategies (J Kor Soc Endocrinol 17:649∼656, 2002).

흰쥐 해마에서 경련에 의해 발현 유도된 MKP-1에 의한 MAPK 활성 조절

유범희,강웅구,안용민,정선주,전송희,박주배,김용식 大韓神經精神醫學會 1999 신경정신의학 Vol.38 No.4

연구목적 : 전기경련 충격(Electroconvulsive shock, ECS) 및 카이닌산(kainic acid)에 의한 경련은 흰쥐 해마에서 mitogen activated protein kinase(MAPK)를 활성화시키며, 동시에 MAPK 불활성화 효소인 MAPK phosphatase-1(MKP-1)의 발현을 일으킨다. 이 연구의 목적은 경련에 의해 발현된 MKP-1이 역시 경련에 의해 활성화된 MAPK의 불활성화에 관여하는지를 알아보고자 하는 것이다. 방 법 : 흰쥐에 ECS를 가하여 해마에서 MKP-1 발현을 일으킨 뒤 다시 ECS를 가하고, 두 번째 ECS에 의한 MAPK의 일시적 활성화가 MKP-1의 발현상태에 의해 영향받는지를 알아보았다. 또한 흰쥐에 지속적인 MAPK 활성화 및 MKP-1 발현을 일으키는 카이닌산을 투여한 뒤 해마에서 MKP-1의 발현과 MAPK 활성과의 관계를 알아보았다. 결 과 : ECS후 해마에서 타이로신 인산화 면역블롯 및 효소활성으로 측정한 MAPK의 인산화 및 활성은 MKP-1의 발현이 일어나 있는 경우와 그렇지 않은 경우 사이에 차이를 보이지 않았다. 카이닌산의 투여에 의해 MAPK 활성화가 일어나는 경우, 뒤이어 MKP-1 발현이 일어나지만, 이렇게 발현된 MKP-1은 MAPK 활성을 충분히 감소시키지 못하였다. 결 론 : MKP-1은 흰쥐 해마에서 ECS 및 카이닌산에 의한 MAPK의 활성화를 차단하는데 큰 역할을 하지 않는다. Objectives : Both electroconvulsive shock(ECS)- and kainic acid-induced seizures activate mitogen-activated protein kinases(MAPKs) in rat hippocampus. They can also induce the expression of MAPK phosphatase-1(MKP-1) in rat hippocampus. MKP-1 is known as a specific MAPK deactivator. This study aimed to elucidate the role of MKP-1 in the deactivation of MAPKs in rat hippocampus. Methods : In order to induce MKP-1 in the hippocampus, ECS was given to the rats. At the time points when MKP-1 was sufficiently induced, the second ECS was given to them and the subsequent phosphorylation or activation of MAPKs were measured in the hippocampus. A second group of rats were injected with kainic acid and the relationship between MKP-1 expression and MAPK phosphorylation was examined in their hippocampi. Results : The expression of MKP-1 did not influence the phosphorylation or activation of MAPKs following ECS in rat hippocampus. Kainic acid-induced expression of MKP-1 did not significantly reduce the phosphorylation of MAPKs. Conclusion : MKP-1 did not play a significant role in the deactivation of MAPKs which were activated by ECS or kainic acid in rat hippocampus.

회맹장 및 대장을 침범한 장 결핵에 있어서 바륨을 이용한 방사선 이중조영촬영 소견에 대한 연구

진용현,전혜정,이용근,강철호,조성범,김윤환,박철민,차상훈,김일영,이혜경 건국대학교 의과학연구소 2002 건국의과학학술지 Vol.12 No.-

To determine the characteristic double contrast barium enema findings of ileo-cecal and colonic tuberculosis and to make differential diagnosis from other bowel inflammatory disease. Sixty-seven patients confirmed as ileo-cecal and/or colonic-tuberculosis in six hospitals were evaluated retrospectively. The diagnosis was proven by endoscopic biopsy, surgery, and clinical follow up. Nine of 67 patients were excluded because radiologic findings were normal though endocopic biopsy examinations resulted in tuberculosis. Histopathological diagnosis were madein 58 cases as follows: endoscopic biopsy(n=29), operation(n=12), follow up examination(n=14), tissue culture(n=1), laparoscopic biopsy(n=2). There were 30 men and 28 females. The mean age were 36 yrs(range:16-67), 34 patients were in the second and third decade. The distribution of lesions, morphological characteristics, mucosal changes, ulcer shape and depth, associated with other tuberculous lesion, multiplicity were retrospectively analyzed in the findngs of double contrast barim enema. The commonest clinical symptoms were abdominal pain(n=35, 60%) and diarrhea(n=18, 31%). The chest radiography revealed association of pulmonary tuberculosis in 39 cases. Tuberculous lesions of other organs except chest were present in five cases. Double contrast barium enema findings showed a thickening and irregularity of intestinal mucosal fold(n=29, 50%), bowel contraction and/or shortening(n=26, 45%). There were small, nodular, superficial ulcers in the case of ulcer depth less than 2 mm in the depth. As many as 39 cases(67%) in this series had two or more lesions in the intestinal tuberculosis. The involved segment revealed symmetrical feature(n=21, 36%). Inflammatory pseudopolypoid lesions were noted in 30 cases(52%). The ileo-cecal region was involved in 38 cases(66%). The ascending colon(n=25, 43%) was the second commonest site with or without contiguous cecal involvement. Lesions in terminal ileum, ileo-cecal valve, transverse colon, descending colon and appendix were seen in 19, 18, 18, 12 and seven cases, respectively. Among 18 cases of ileo-cecal valve lesions, there were incompetency in nine cases(16%) and wide gapping in four cases(7%). In 14 cases, tuberculous enterocolitis was diagnosed by clinical follow-up and double contrast barium enema study. 12 out of 14 cases, the findings of double contrast barium enema of tuberculous enterocolitis were normalized after anti-tuberculous medication. However, two cases showed more aggravated state than before due to inappropriate treatment. Double contrast barium enema plays an important role in the diagnosis of tuberculous enterocolitis, determines the type, site and extent of the involvement and helps in treatment guide by using sequential studies.

수도권 지역 대학병원과 재활병원의 인턴물리치료사간 인턴 만족도 비교

강순희,전수진,정민현,정은송,이범승,최용진 韓國交通大學校 2013 한국교통대학교 논문집 Vol.48 No.-

The purpose of this study was to compare internship satisfaction of intern physical therapists working in the university hospitals with that of them working in the rehabilitation hospitals in Seoul metropolitan area. The questionnaire for internship satisfaction survey that amended from vocational interest test [Strong Interest Inventory(SII)] was used to examine satisfaction of intern physical therapists and the questionnaire was used to ask general characteristics, educational and work environment. Thirty nine intern physical therapists working in university hospital and fifty nine intern physical therapists rehabilitation hospital in Seoul metropolitan area responded. Frequency analysis, χ² test and independent t-test were conducted to evaluate differences between groups about variables of internship satisfaction survey, general characteristics, work and educational environments with using the PASW 18.0 statistical program. The results of the study were as follows. There were significant differences of intern physical therapists between university hospitals and rehabilitation hospitals in overall scores of internship satisfaction and scores of all sub-items such as duty, supervision, working condition, work mates and wages. Intern physical therapists working in the university hospitals showed higher satisfaction than that of Intern physical therapists working in the rehabilitation hospitals.

골프장 이용자의 이미지지각에 따른 이미지 포지셔닝 방안

박용범,강진형,김학신 한국스포츠리서치 2004 한국 스포츠 리서치 Vol.15 No.5

This study used Multidimensional Scaling to be useful to catch strong and wear point placing rival golf courses on the same spot and investigated golfers' responses on various services by golf courses. Finally, this study has the following results. Firstly, traffic easiness is very important for golfers positive and negative response on service by golf courses, This result means that the area of sport game is very important and events is decided by the means of traffic as street Secondly, golfers don't use a lot of golf courses and they prefer special golf course to supply some familiar and comfortable service. So, golf courses need to lead golfers' choice through their own individual and special service. They have to evaluate properly and continuously the characteristics of service of rival golf course and change of golfers' response to accept the golfers' needs.

소아의 혈관내 응고증후군

박용훈,김홍배,강덕식,이상범 慶北大學校 醫科大學 1982 慶北醫大誌 Vol.23 No.2

We have reviewed 11 cases of Disseminated Intravascular Coagulation (DIC) admitted to the Pediatric department of Kyungpook National University Hospital from January 1981 to July 1982. Age distribution showed 4 cases below, year of age including 2 neonatal cases, 2 between 1 to 5 years of age, 2 between 6 to 10 years of age and 3 between 11 to 15 years of age. Three of these 11 cases are male and the rest 8 female. DIC developed within the first 5 admission day in 7 cases, from the 6th to the 10th day in one and after the 10th in three. Factors predisposing to DIC included infection (11 cases) which were usually systemic, shock, recent surgery and malignancy. Diagnostic coagulation studies included low platelet count below 100,000/cumm (all 11 cases), prolonged PT (10 cases) and PTT (all 11 cases). All patients had abnormal hemorrhage and the majority being petechiae on the skin (8 cases) followed by oozing from the injection site (6 cases), melena (4 cases), epistaxis (3 cases), bleeding from the oral cavity (3 cases), intracranial hemorrhage (1 case) and hematuria (1 case). Local ischemic manifestations probablly due to the thrombus formation were respiratory distress (9 cases), mental disturbance (9 cases), diarrhea (8 cases), abdominal pain (7 cases) and acrocyanosis (3 cases). Shock due to systemic circulatory disturbance was also seen in 5 cases. Treatment included transfusion of fresh whole blood and Vitamin K admimistration in all cases, plalelet transfusion in 6 cases, Corticosteroid administration in 4 cases and none received Heparin. Only 3 cases showed improvement and the rest discharged hopelessly and/or died. key words: Disseminated Intravascular Coagulation.

유지 투석중인 만성 신부전환자에서 허혈성 심질환의진단 지표로서의 심장트로닌-I의 유용성

신병철,강대웅,정지용,류봉관,서영욱,김정인,김범윤,김현리,정종훈 朝鮮大學校 附設 醫學硏究所 2004 The Medical Journal of Chosun University Vol.29 No.1

Background : Coronary disease is highly prevalent in patient with end stage renal disease (ESRD) and account for much of their observed morbidity and mortality. Troponin-I consistently maintains a high sensitivity and specificity and is most sensitive marker for ischemic heart disease (IHD). Method : We examed 49 hernodialyzed patients (22 male, 27 female) without evidence of acute coronary syndrome (ACS) for 6 months. Biochemical markers were measured in serial predialysis blood samples. For analysis, we used two cardio-specific assays for troponin-T (cTnT) as well as for troponin-I (cTnI) and compared the results with CK-MB (reference value ≤ 4.0 ng/mL) concentration. Results : Myocardial ischemia was observed in 47% (23/49) of patients. cTnT level above 0.1 ng/mL. and cTnI level above 0.5 ng/mL, were observed in 22% (11/49) and 20% (10/49) of patients respectively. cTnI revealed significantly higher positive rate in patients with myocardial ischemia than the patients without myocardial ischemia (43 % vs 30%) (p<0.05). cTnT and CK-MB revealed no difference in positive rate between the patients with and without myocardial ischemia (cTnT : 30% vs 15% and CK-MB : 30% vs 19%). The sensitivity and specificity of cTnI to myocardial ischemia were higher than those of cTnT and CK-MB (sensitivity 43% vs 30% and 30%. specificity 100% vs 85% and 81%). Conclusion: Both cTnT and cTnI are useful in ruling out myocardial injury in chronic renal failure patients. But. cTnI is a more sensitivity and excellent specificity of ischemic heart disease than cTnT and CK-MB in hemodialyzed patients. In patients with ischemic heart disease, the presences of DM and advanced age were higher than those in patients without ischemic heart disease (p<0.05). Among the baseline characteristics old age, elevated LDH and diabeties were significant more frequent in the patients with elevation of cardiac troponin-I (p>0.5 ng/mL) than those with cardiac troponin-I (p<0.5 ng/mL), p=0.038, p=0.049, and p=0.045, respectively. Our results suggest that these cTnI is the potential diagnostic marker for the prediction of IHD in ESRD patients.

한국판 정신사회재활 성과 측정도구의 신뢰도 및 타당도 연구

황태연,강대엽,임영란,김명식,이원혜,박용범 용인정신의학연구소 1999 용인정신의학보 Vol.6 No.2