한국인의 이상혈색소에 관한 연구 : β-Chain anomaly 2예

강득용,조만희,변광의,김창세 순천향대학교 1983 논문집 Vol.6 No.4

We have screened 3321 cases of donor bloods, which were taken from the Clinical Pathology Department Soonchunhyang University Hospital, over the period of Sept. 1982 to June 1983, for the detection of abnormal hemoglobins by agar gel electrophoresis. We were found two cases of abnormal hemoglobins, β-chain anomaly, in Korean and the incidence was 0.06 per cent. These hemoglobin anomalies were normal in the view of clinical symptoms and hematological findings. We have carried out on the structural characterization of the β-chain anomalies but on the limitation of samples forwarding studies would be expected.

어린이의 사시교정술시 인공호흡수와 심박수와의 상관관계

강종만,김종성,김희수,염명걸 대한마취과학회 2001 Korean Journal of Anesthesiology Vol.41 No.4

Correlation between Respiratory Rates and the Degree of Bradycardia in Strabismus Surgery in Children Jong-Man Kang, M.D., Hee-Soo Kim, M.D., Chong0Sung Kim, M.D. and Myung-Kul Yum, M.D.^* Department of Anesthesiology, College of Medicine, Seoul National University, Seoul, and ^*Department of Pediatrics, College of Medicine, Hanyang University, Seoul, Korea Background: Strabismus surgery is frequent in pediatric ophthalmic surgery. Traction on the extra-ocular muscles can trigger an oculocardiac rdflex. We investigated the correlation between respiratoy rates and the degree of bradycardia to find another management for preventing oculocardiac reflex. Methods: NO premedications were administered. They were induced with thiopental and vecuronium and maintained with O_@-enflurane-N_2O. The tidal volume was 10 ml/kg. Respiratory rate of group 1 (n = 18) was fixed at 24 bpm, group 2 (n = 18) at 20 bpm, and group 3 (n = 19) at 16 bpm. We measured the mean heart rate from intubation to the beginning of surgery and defined this as the basal heart rate. We defined the lowest heart rate after traction of the extraocular muscles as the minimal heart rate. We calculated the correlation coefficient between the respiratory rate and basal heart rate, minimal heart rate, the change of heart rates and E_tCO_2. Results: There was a positive correlation between the respiratory rate and the basal heart rate, and minimal heart rate. There was no correlation between the respiratory rate and the change of heart rate. There was no difference in E_tCo_2 among the 3 groups. Conclusions: Can be increased both basal heart rate in anesthetized patients and minimal heart rate induced by oculocardiac reflex by making the respiratory rate more rapid if there is no significant difference of E_tCO_2. The oculocardiac reflex may be reduced by making respiratory rate more rapid if there is no significant influence on minute ventilation. (Korean J Anesthesiol 2001; 41: 450~454)

진행된 HIV 감염 환자에서 십이지장의 미란성 병변으로 발현한 Mycobacterium genavense 감염 1예

진상만,박종선,김홍빈,오명돈,최강원,김희연,국윤호,김남중 대한감염학회 2007 감염과 화학요법 Vol.39 No.4

Mycobacterium genauense는 최근에 알려진 미코박테륨으로서, 식욕 부진, 체중 감소, 설사, 림프절 병증 등 파종성 Myocobacterium avium-intracellulare complex 감염과 유사한 임상상을 보이며, 위장관 침범을 잘 하는 것으로 알려져 있으나 아직 국내에서 증례는 보고된 바가 없다. 저자들은 진행된 HIV 감염 환자에서 십이지장의 미란성 병변으로 발현한 Mycobacterium genavense 감염 1예를 경험하였기에 문헌 고찰과 함께 보고하는 바이다. 환자는 상복부 동통과 발열, 설사로 내원하였다. 십이지장의 미란성 병변에서 시행한 조직검사에서 항산균이 가득 차있는 거품세포가 관찰되었으며, 이 검체에서 16S rRNA 유전자의 중합연쇄반응 검사를 시행하여 Mycobacterium genavense를 확인하였다. Mycobacterium genavense, first identified in 1990, is known as a pathogen that mimics disseminated Myocobacterium avium-intracellulare complex (MAC) infection with particular propensity for the gastrointestinal tract. In Korea, no case with the organism has been reported. Herein we report a case of Mycobacterium genavense infection that manifested with erosive lesion of duodenum in a patient with acquired immune deficiency syndrome. The patient presented with epigastric pain and fever, diarrhea. Duodenal biopsy showed histiocytic infiltration with numerous acid-fast bacilli. Identification of the mycobacterial isolate by the polymerase chain reaction restriction analysis of 16S rRNA gene revealed Mycobacterium genavense.

김천산 자두의 성분과 그 특성

김순희,강병태,박동철,윤옥현,이재우,한만덕,최종동 동아시아식생활학회 2000 동아시아식생활학회지 Vol.10 No.1

Physicochemical properties and chemical compositions of two plums (Oishiwase, Formosa) produced in Kimcheon area were investigated. Chemical compositions of two plum cultivars were similar except nitrogen free extract(NFE). NFE value of Formosa was higher than Oishiwase. Alcohol insoluble substance content, total soluble pectin, total sugar content and total organic acid content of Oishiwase were 2.08%. 14,16%, 5.07% and 949.16mg%, respectively. In case of Formosa cultivar, those were 50%, 15.42%, 5.91% and 985.91mg%, respectively. Fructose content among free sugars of two plum cultivars range from 3.97~3.45% and the other were glucose, sucrose and inositol, 1.83~1.53%, 0.08~0.05% and 0,04~0.039%, respectively. Malic acid content was 35~373mg% and others were levulinic acid, lactic acid, citric acid, succinic acid and fumaric acid in the decreasing order.

산성강하물의 침착량과 동태 해명에 관한 연구 -춘천과 서울 강우의 화학조성 비교 : Comparison of Chemical Composition of Rain Water between Chunchon and Seoul

김만구,강미희,임양석,박기준,황훈,이보경,홍승희,이동수 江原大學校 附設 環境硏究所 1999 環境硏究 Vol.16 No.-

The rain water samples were collected at Chunchon and Seoul by using wet only automatic sampler from January 1996 through December 1997. The daily base rain water samples collected over than 95% rainy events during the whole period. The samples were measured both pH and conductivity, and were analysed major ionic components, SO₄^(2-), NO₃^(-), Cl^(-), NH₄^(+), Ca^(2+), Na^(+) and K ^(+), by ion chromatography. In 1996, about 77% sampled rain water showed below pH 5.6 and the 60% of rain water was lower than pH 5.0. The volume weighted average pH was 4.7 at all sites. In 1997, the volume weighted average pH was 4.6 and 4.9 at Seoul and Chunchon, respectively. Among the rain water samples, 87% and 55% of samples showed below than pH 5.6 and 5.0, respectively. The pH value of Chunchon was significantly (p<0.05) lower than Seoul at the rain samples for less than 20 ㎜ rainfall. However conductivity of the rain samples were 20.9 μS/㎝ for 1996 and 27.7 μS/㎝ for 1997 at Seoul, and 19.1 μS/㎝ for 1996 and 14.1 μS/㎝ for 1997 at Chunchon. H₂SO₄AND HNO₃CONTRIBUTED 65.9% and 29.6% of free acidity at Seoul, respectively. The ratio of [NO₃^(-)]/[nss-SO₄^(2-)] were 0.43 at Seoul and 0.51 at Chunchon for rain samples for less than 20 ㎜ rainfall. The annual wet deposition of Cl^(-), NO₃^(-), SO₄^(2-), H^(+), Na^(+), NH₄^(+), K ^(+), Mg^(2+) and Ca^(2+), respectively, 568.8 ㎏/㎢, 1489.3 ㎏/㎢, 3184.8 ㎏/㎢, 20.9 ㎏/㎢, 249.4 ㎏/㎢, 1091.2 ㎏/㎢, 189.8 ㎏/㎢, 90.2 ㎏/㎢, and 702.4 ㎏/㎢ at Seoul for 1996; 656.4 ㎏/㎢, 2029.7 ㎏/㎢, 3280.7 ㎏/㎢,27.2 ㎏/㎢, 229.4 ㎏/㎢, 1063.9 ㎏/㎢, 106.9 ㎏/㎢, 7802 ㎏/㎢, and 645.3 ㎏/㎢, at Seoul for 1997; 116.9 ㎏/㎢, 983.3 ㎏/㎢, 1797.0 ㎏/㎢, 21.4 ㎏/㎢, 83.2 ㎏/㎢, 648.1 ㎏/㎢, 78.0 ㎏/㎢, 22.2 ㎏/㎢ and 368.8 ㎏/㎢ at Chunchon for 1996; 100.2 ㎏/㎢, 1077.6 ㎏/㎢, 1754.0 ㎏/㎢, 13.4 ㎏/㎢, 146.0 ㎏/㎢, 602.3 ㎏/㎢, 88.8 ㎏/㎢, 16.2 ㎏/㎢ and 206.8 ㎏/㎢ at Chunchon for 1997.

부분 간 절제가 Dimethylnitrosamine으로 인한 간 병변에 미치는 영향에 대한 연구

은희경,김진만,강대영 충남대학교 의과대학 지역사회의학연구소 1990 충남의대잡지 Vol.17 No.1

In an attempt to elucidate the pathological effects of dimethylnitrosamine (DMN) administration following partial hepatectomy (1/3), the present study was undertaken in male Sprague-Dawley rats. The evidence of hyperplastic nodules, the number and nuclear size of dysplastic cells, and the ratio of liver weight compared to body weight were evaluated, especially emphasizing on the difference among several groups. Rats were partially hepatectomized and DMN(10mg or 20mg per Kg) was administered at 20 hours or 40 hours after partial hepatectomy, and then weekly injected three times. Eight weeks after initial DMN injection group of these animals was placed on a diet containing phenobarbital 50mg per 10ml H_20. The animals were sacrified on 60, 90, and 120 days after DMN injection. The results were as follows; 1. The hyperplastic nodules in the DMN treated groups at 20 hours after partial hepatectomy (PH) were more prominent than those of the DMN treated groups at 40 hours after PH. 2. The number of dysplastic hepatocytes increased in the DMN treated groups at 20 hours after PH, compared to those of the DMN treated groups at 40 hours after PH. 3. The hyperplastic nodules and the numbers of dysplastic hepatocytes were more prominent than those of the control, and also proportional to the amount of treated DMN. 4. The average nuclear size of dysplastic cells was much larger (about 1.5 to 1.6 times) than that of the control. 5. The ratio of liver weight compared to body weight in phenobarbital groups was much larger than that of no phenobarbital treated groups. In summary, the result obtained by the present study indicates dimethylnitrosamine(DMN) induced hyperplastic nodules accompained by liver cell dysplasia. The observation provided some evidence supporting that proliferation hepatocytes rose to a peak at the G_1-S border phase and phenobarbital promoted DMN induced liver cell hyperplasia or dysplasia.

전류 비유 모델에 의한 초등학생의 전류 개념 변화 분석

유병길,강인석,김병철,남만희,박선희,소하연,윤희정,이영아,이하룡,전병문,정승호 부산교육대학교 과학교육연구소 2000 科學敎育硏究 Vol.25 No.-

There exists a major impediment to learning electricity which may illuminate why direct presentation of scientists' ideas is too aggressive a strategy. This impediment lies in thinking that electricity is used up and in envisaging the light bulb as a consumer. This view is based on a powerful idea which summarises much of our experience; it declares that 'things get used up', 'you cannot get something for nothing', and 'intuitive thinking'. To replace this view with scientific view, we made the analogy model. It is suggested that the analogy model is more effective in teaching electricity circuits than conventional teaching method.

Mirizzi 증후군의 변형된 분류와 치료

김형철,강길호,채만규,김성용,백무준,이문수,박상흠,이문호,김창호,송옥평,조무식,박희주 순천향의학연구소;Soonchunhyang Medical Research Institute 2000 Journal of Soonchunhyang Medical Science Vol.6 No.1

Purpose : The Mirizzi syndrome is relatively rare and preoperative diagnosis of this disease is difficult. In 1978, Morelli suggested the subclassification of the Mirizzi syndrome into acute or chronic form. We experienced 5 cases of acute form. We analysed clinical features, preoperative radiologic findings and operative findings of 18 cases including acute forms which were diagnosed as Mirizzi syndrome and should suggest the modified classification of Mirizzi syndrome for choice of appropriate treatment. Method : From January 1995 to December 1998, 18 cases, of which 8 cases were diagnosed at Soonchunhyang University Chunan Hospital, and 10 cases were reported in the Korean Journal were retrospectively analysed with regard to clinical features, preoperative radiologic findings and operative findings. According to the clinical features, whole cases were divided into type Ⅰ(acute form) and type Ⅱ(chronic form) and then each type of cases were subclassified according to preoperative radiologic findings and operative findings. Results : Of 18 cases there were 5 cases in type Ⅰ(27.8%), 13 cases in type Ⅱ(72.2%). Type Ⅱb was most common. Type Ⅰa cases were treated only with cholecystectomy. We applied cholecystectomy, T-tube choledochostomy and patch technique in type Ⅰb and thpe Ⅰc cases. Cholectystectomies including removal of gallstones and internal drainage procedures were done in type Ⅱ chronic forms. Conclusion : The acute form(Type Ⅰ) of Mirizzi syndrome was suggested by Morelli might be subclassified into typeⅠa,Ⅰb and Ⅰc following the presence of the necrotic defect in common hepatic duct. Through the modified classification of Mirizzi syndrome based on clinical feature, preoperative radiologic findings and operative findings, we can choice appropriate treatment.

7개 대학 병원에서 조사한 지역사회 폐렴의 원인균

정문현,김성민,강문원,최희정,정희진,이경원,한성우,송재훈,신형식,김의종,최강원,김민자,박승철,배현주,정윤섭,김준명,백경란,신완식,이규만,김양리 대한감염학회 1997 감염 Vol.29 No.5

목 적 : 폐렴은 많이 발생하면서 사망률이 크게 줄지 않는 질환이며, 이를 적절히 치료하기 위해서는 원인균의 상대적 빈도, 기저 질환에 따른 변화, 항균제 내성률, 사망에 관련된 인자들을 알아야 한다. 원인균의 빈도는 지역마다 차이가 있고 국내에서는 항균제 내성률이 높아 지역사회에서 발생한 폐렴을 치료하기 위한 경험적 항균제 선택에 도움이 되기 위해 서울 소재 6개 대학 병원과 천안의 1개 대학 병원이 참여하여 위의 사항들에 대해 조사를 하였다. 방 법 : 1995년에 내과에 입원했던 16세 이상 환자를 대상으로 했다. 퇴원 진단명이 폐렴 또는 폐결핵인 병록지을 찾았고, 이중에서 병원 감염을 제외하였다. 특이도를 높이기 위해, 이들 중에서 호흡기 증상이 있고 발열이나 저체온이 있으면서 흉부 X-선에서 이상 음영이 있는 환자만을 대상으로 했다. 폐결핵은 위의 기준에 입원 초기에 항균제 치료를 하고 입원 7일 이후에야 항결핵제가 투여된 경우만을 폐렴의 원인균으로 하였다. 혈액 배양에서 양성, 객담에서 항상균이나 M. tuberculosis가 증명된 경우, 혈청학적으로 항체가가 4배 이상 증가된 경우, 조직에서 원인균이 진단된 경우는 확정(definitive) 원인균으로 하였고, 객담에서 배양된 균이 그람 도말과 일치할때, 항결액제에 대한 반응으로 진단한 폐결핵, 단일 항체가 양성이고 이에 대해 항균제를 사용했을 때는 가능(probable) 원인균으로 정의하였다. 다세균 감염균은 각각 다 른 원인균으로 처리하였다. 임상 조사와 함께 임상병리과에서 S. pneumoniae, H. influenzae, M. catarrhalis, mycoplasma, 항상균에 대해 검사 의뢰 건수, 배양 양성수, 항균제 감수성 결과를 조사하였다. 결 과 : 폐렴의 증례 정의에 부합하지 않은 135명과 폐결핵의 정의에 해당하지 않는 230명을 제외하고 남은 246명의 평균 나이는 58.2세이고 남성이 142명(58.2%) 이었고, 71%의 환자에서 기저 질환이 있었다. 진단 방법의 시행 횟수는 혈액 배양 77.6%, 혈청 검사 18.3%, 기관지경 검사는 4.1%였고, 세균의 항원 검사를 한 예는 없었다. 원인균이 밝혀진 예는 77명(31.3%)이었다. 다세균 감염이 4명에서 있었고, 원인균의 상대적 빈도는 결핵 20명(확정 17, 가능 3: 6개 병원 자료), 폐렴구균 18(확정8 가능 10)명과 폐렴구균이 아닌 Streptococcus 3명 (모두 확정), H. influenzae 11명(모두 가능), 그람음성간균 11명(확정 7, 가능 4) (K. pneumoniae 8건), Mycoplasma 5명(확정 1, 가능 4), S. aureus 4명(확정 2, 가능 2), mucormycosis 1명(확정)이었다. 평균 입원 기간은 19일이고, 중환자실 입원률과 인공 호흡기 사용율은 각각 18%와 9.3%였다. 사망률은 13.8%였고 사망까지 평균 기간은 14.6일 이었다. 다변량 분석에서 사망을 예측할 수 있는 인자는 저체온과 빈호흡이었다. 임상병리과에서 배양되었던 모든 폐렴구균의 Penicillin 내성률은 서울 3개 병원에서 82-88%, 천안에서 72%였다. 폐렴 환자의 혈액에서 배양된 7주는 모두 Penicillin에 감수성이 있었다. K. pneumoniae 8주 모두 cefotaxime과 gentamicin에 감수성을 보였다. 결 론 : 후향적 조사이고 병원마다 원인균 진단에 차이가 있지만, 원인이 밝혀진 경우에는 결핵과 폐렴균이 흔하였고, 무균 부위에서 배양된 폐렴구균의 항균제 내성률은 낮았다. 원인이 밝혀지지 않은 경우가 많고, 혈청검사로 진단되는 원인균이 드물며, 분리균주가 적어 항균제 내성 정도를 추정하기 어려워, 이를 밝히기 위한 전향적 조사가 필요하다. Background : Community-acquired pneumonia (CAP) is one of the leading causes of mortality and morbidity, but its management is still challenging. The limitation of diagnostic methods to identify etiologic agents rapidly make it necessary to use empiric antibiotics in almost all patients, and furthermore the discovery of new respiratory pathogens and the emergence of antibiotic-resistant organisms pose difficulties to the selection of an empiric regimen. To clarify the factors necessary for the optimal choice of empirical antibiotics, such as the frequency of etiologic agents, the attributable rates to death and antimicrobial resistance rates in the community, six university hospitals in Seoul and one university hospital in Cheonan were participating in this study. Methods : medical records of adults (>15 years of age) hospitalized for CAP or pulmonary tuberculosis between April 1995 and March 1996, were reviewed. Patients who satisfied all of the following criteria were included in the study: (1) fever or hypothermia; (2) respiratory symptoms; and (3) pulmonary infiltrates on chest roentgenogram. To exclude cases of pulmonary tuberculosis whose roentgenographic features were so typical that it could be easily differentiated from conventional pneumonia, two additional criteria were required for inclusion: antibiotic treatment during the first week of hospital admission and initiation of anti-tuberculosis medications thereafter. Organisms isolated from sterile body sites, acid-fast bacilli or Mycobacterium tuberculosis isolated from sputum, pathogens diagnosed by a 4-fold rising titer of antibodies to “atypical”pathogens, or pathogens revealed by histopathology were defined as definitive cause of pneumonia; isolates from sputum withcompatible Gram stain, pathogens diagnosed by a single diagnostic titer plus use of a specific antimicrobial agent, or tuberculosis diagnosed by clinucal response to anti- tuberculosis medications were considered probable cause of pneumonia. The records of the clinical microbiology were reviewed for isolates of S. pneumoniae, H. influenzae, M. catarrhalis, Mycobacterium or acid-fast bacilli, and Mycoplasma. Then the frequency of these agents, antimicrobial resistance rates of resiratory pathogens from all body sites, and their clinical significance were evaluated. Results: After excluding 365 patients (230 with pulmonary tuberculosis and 135 with CAP) who were screened for inclusion but did not meet the inclusion criteria,246 persons were enrolled in this study. Their mean age was 58.2 years old with slight male predominance (58.2%), and 171(71%) patients had underlying illnesses. Blood cultures were performed on 191 (77.6%) patients and serologic tests on 44(18.3%) patients. The etiologic agents were identified in 31.3%, and the list of individual agents, in decreasing order, was pulmonary tuberculosis (17 definite and 3 probable: data of six hospitals), S. pneumoniae (8 definite and 10 probable), non-pneumococci (3 definite), aerobic gram-negative bacilli (7 definite and 4 probable), Haemophilus spp. (11 probable), mycoplasma (1 definite and 4 probable), polymicrobial infections (2 definite and 2 probable: E. coli and S. agalactiae, M. tuberculosis and S. aureus, S. pneumoniae and H. influenzae and A. baumannii and K. pneumonias), S. aureus (2 definite and 2 probable) , and mucormycosis (1 definite). Among gram-negative bacilli, K. pneumoniae was the most common agent (8isolates). therates of admission to the intensive care unitand of using assisted ventilation were 18% and 9.3%, respectively. The mortality was 13.8% and logistic regression analysis showed that hypothermia and tachypnea were associated with death. Hospital stay averaged 19 days. Susceptible rates of S. pneumoniae isolated from all body sites to penicillin ranged from 8% to 28% but seven isolated from blood of patients with pneumonia were susceptible to penicillin. Also all 8 isolated of k> pneumoniae from patients with pneumonia were susceptible to cefotaxime and gentamicin. Conclusion: In Korea, in addition to S. pneumoniae, M. tuberculosis is an important agent causing community-acquired pneumonia. The low incidence of etiologic diagnosis is probably related to infrequent requesting of test "atypical" pathogens and does not represent the true incidence of infections by "atypical" pathogens, which well be answered by a prospective study. The antimicrobial resistance rates of major respiratory pathogens from sterile body sites are low, however, because of a small number of the isolates this result needs confirmation by a nationwide surveillance of antimicrobial resistance.

Case Report : Hepatoid Carcinoma of the Pancreas Combined with Neuroendocrine Carcinoma

( Ji Ye Jung ),( Yoon Jae Kim ),( Hee Man Kim ),( Hong Jeoung Kim ),( Seung Woo Park ),( Si Young Song ),( Jae Bock Chung ),( Chang Moo Kang ),( Joo Yeon Pyo ),( Woo Ick Yang ),( Seung Min Bang ) The Editorial Office of Gut and Liver 2010 Gut and Liver Vol.4 No.1

Hepatoid carcinoma is a primary extrahepatic carcinoma whose morphology, immunohistochemistry, and behavior are similar to those of hepatocellular carcinoma. The most common sites of extrahepatic carcinoma are the stomach and ovary, but nine cases of hepatocellular differentiation of the pancreas have been reported in the literature. We report another case of hepatoid carcinoma of the pancreas that was associated with the development of a pancreatic endocrine carcinoma in a 46-year-old man. Serum alpha-fetoprotein (AFP) was elevated to 262.49 IU/mL and radiological examinations revealed a mass measuring 7.5 cm in diameter in the head of the pancreas. He underwent a conventional Whipple operation, and light microscopy showed adenocarcinoma that was immunopositive for AFP, hepatocyte antigen, cytokeratin, chromogranin, synaptophysin, and alpha-1 antichymotrypsin. Although hepatoid differentiation was not shown unequivocally histologically, other immunohistochemistry findings supported the diagnosis of hepatoid carcinoma combined with neuroendocrine carcinoma. The patient was healthy and had no evidence of recurrence at 4 months after the surgery. This report describes why hepatoid carcinoma should be considered as a differential diagnosis of a pancreatic mass, especially when serum AFP is elevated. (Gut Liver 2010;4:98-102)