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Gilbert 증후군에서 열량 제한 시험과 Phenobarbital 자극 시험의 의의(14예)
이헌영,채경훈,정재훈,강윤세,김연수,문희석,박기오,이엄석,김선문,김석현,성재규,이병석,이강욱 충남대학교 의학연구소 2003 충남의대잡지 Vol.30 No.2
Gilbert 증후군은 인구의 7%에서까지 나타날 수 있는 매우 흔한 증후군으로서 비진행성인 양성의 만성적 경과를 치하며, 간질환의 증상과 징후가 없는 경한 비포합형 고빌리루빈혈증이 특징인 일종의 체질적인 증상으로서 혈장 빌리루빈 농도에 대한 사춘기의 영향 때문에 10대와 20대에 자주 진단이 된다. 따라서 임상적인 중요성은 미약하지만 높은 빈도가 예상되는 점에 그 중요성이 부여되어야 할 것이다. 따라서 적정한 임상적 진단법으로 기왕에 소개된 열량제한 시험과 phenobarbital 유도 시험을 시행하고 이들의 진단적 가치를 알아보기 위하여 본 연구를 시행하였다. 1990년 7월부터 1999년 4월까지 충남대학교병원에 내원하여 HBsAg, IgG anti-HBc 및 anti-HCV가 음성이고, 간 초음파 스캔에서 이상이 없으며, 혈청 AST, ALT 및 AP가 정상인 비음주자에서 경한 비포합형 고빌리루빈혈증이 있는 14예의 환자들을 대상으로 ^(99m)Tc-DISID 스캔을 시행하였으며, 기저 치 총빌리루빈 및 포합형 빌리루빈 치를 측정한 다음에 하루에 400Kcal로 48시간동안 제한한 열량 제한 시험을 시행하였고, phenobarbital을 하루 60mg씩 5일간 투여한 후에도 각각 총빌리루빈과 포합형 빌리루빈 치를 검사하여 비포합형을 구하였다. 대상 환자들은 모두 14예로서 남자가 11예(78.6%)였고 여자가 3예(21.4%)여서 3.7:1로 남자에서 많았으며, 20대가 6예(42.9%), 30대가 역시 6예(42.9%) 및 40대가 2예(14.2%)로서 2,30대가 대부분(85.8%)이었다. 열량 제한 시험 후의 총빌리루빈 치, 비포합형 및 포합형 빌리루빈 치들은 평균 각각 5.5±2.7, 4.2±2.3 및 1.3±10mg/dL 로서, 시험 전 치들인 3.0±0.8, 2.2±0.8 및 0.7±0.4mg/dL 보다 유의하게(p=0.001, p=0.001, p=0.023) 상승하였다. 포합형 빌리루빈 치도 유의하게 상승하였으나 비포합형의 상승보다는 훨씬 낮아서 주로 비포합형이 증가하였다. phenobarbital 투여 중 설사가 발생하여 중단한 1예를 제외한 13예에서 열량 제한 시험 후에 상승하였던 총, 비포합형 및 포합형 빌리루빈 치가 phenobarbital 유도 시험후에는 2.0±1.1, 1.5±0.8 및 0.5±0.4mg/dL로서 열량 제한 시험 결과보다 유의하게 낮아졌고(p=0.00, p=0.000, p=0.001), 열량 제한 시험 전의 기초치들인 3.0±0.8, 2.2±0.8 및 0.7±0.4mg.dL 보다도 더욱 낮아졌으며 유의한 차이(p=0.001, p=0.02, p=0.005)를 나타내었다. 14예에서 시행한 ^(99m)-Tc DISIDA 스캔에서 9예(64.3%)가 정상이었고, 5예(35.7%)에서는 심장 및 신장으로의 간외 섭취가 3예였고, 60분까지 소장 배출이 없는 배설 지연 예와 담낭 수축 불량 예가 각각 1예 씩 발견되었다. Phenobarbital 투여시험에서 민감도가 열량제한시험에 비해 더 높았다(92.3%와 50.0%). Gilbert 증후군에서 1일 400 Kcal로 48시간의 열량제한 시험과 1일 60mg의 phenobarbital을 5일간 투여하는 유도 시험은 편리하고 유용한 임상적인 진단법으로 이용할 수 있다고 생각된다. 그러나 열량 제한 시험에서는 증가 기준의 통일이 필요하다고 유추되며 phenobarbital 유도 시험이 민감도가 더 높은 것으로 생각된다. Gilbert's syndrome is very frequent and benign chronic process characterized by mild, intermittent, unconjugated hyperbilirubinemia without any symptom and sign of liver disease. Previously intoduced caloric restriction test and phenobarbital stimulation test as two appropriate clinical tests had been examined and their diagnostic values were reevaluated. Fourteen patients with mild, persistent, unconjugated hyperbilirubinemia were included. Subsequently caloric restriction has been applicated by 400 Kcal/day for 48 hours and phenobarbital has been prescribed by 60 mg/day for 5 days. Therafter serum levels of total and direct bilirubin were measured. Most of the patients were third and fourth decade(85.8%) and male predominant. Each basal serum levels of total, indirect and direct bilirubin were 3.0±0.8, 2.2±0.8 and 0.7±0.4 mg/dL. After caloric restriction test, each levels were increased significantly to 5.5±2.7, 4.2±2.3 and 1.3±1.0 mg/dL(p=0.001, p=0.001, p=0.023). After phenobarbital stimulation test for 13 patients had been practiced, increased levels of each bilirubin after caloric restriction test were decreased significantly to 2.0±1.0, 1.5±0.8 and 0.5±0.4 mg/dL(p=0.000, p=0.000, p=0.001) and these levels were significantly lower than basal levels(p=0.001, p=0.02, p=0.005). The sensitivities of caloric restriction test were 85.7%, 50.0%, and 71.4%, 35.7%(1.0, 1.5 mg increase of total bilirubin and 1.0, 1.5 mg/dL increase of indirect bilirubin). The sensitivities of phenobarbital stimulation test were 93.2% and 92.3% at criteria of 1.5 mg/dL increase of total bilirubin and indirect bilirubin. On the diagnosis of Gilbert syndrome, caloric restriction test and phenobarbital stimulation test are convenient and useful diagnostic tools in clinical face. And also phenobarbital stimulation test has higher sensitivity than caloric restriction test. Furthermore, standardization of bilirubin increment would be necessary in caloric restriction test.
장기간 Risperidone 투여후 지연성으로 발생한 Neuroleptic Malignant Syndrome 1례
이헌정,조방현,김인,이민수 大韓神經精神醫學會 1999 신경정신의학 Vol.38 No.4
Risperidone은 비교적 최근에 개발된 항정신병약물이며, 그것이 가진 도파민 D2 수용체와 세로토닌2 수용체를 차단하는 작용기전, 추체외로 부작용과 지연성 운동장애가 적다는 점, 정신분열병의 음성증상에도 효과가 있다는 점에서 흔히 비전형적 약물로 불리운다. 그러나 이러한 비전형성에도 불구하고, 이미 전세계적으로는 15개 정도의 risperidone에 의한 신경이완제 악성증후군(neuroleptic malignant syndrome : NMS)의 보고가 있으며. 국내에서도 최근 하나의 증례가 보고되었다. 저자들은 정신분열병으로 장기간 risperidone으로 치료받던 젊은 남자 환자에서 치료 1년 9개월만에 발생된 NMS 1례를 경험하였기에 관련문헌의 고찰과 더불어 증례보고하고자 한다. Risperidone is a relatively new antipsychotic agent. It is often referred to as 'atypical', because it has a mechanism of action that blocks post synaptic dopamine-2 and serotonin-2 receptors, it is associated with fewer extrapyramidal side effects, it is not yet associated with tardive dyskinesia, and it may have some efficacy on negative symptoms of schizophrenia. In despite of its 'atypical' nature, there are already more than 15 reports of risperidone-induced neuroleptic malignant syndrome. Only one case of risperidone-induced NMS was reported recently in Korea. We report one case of delayed risperidone-induced neuroleptic malignant syndrome in young male patient and review the related articles.
중심압축력을 받는 高强度 RC기둥의 띠철근 配筋形態에 關한 實驗的 硏究
이영인,이영호,곽노현,정헌수 중앙대학교 기술과학연구소 1998 기술과학연구소 논문집 Vol.28 No.-
An objective of this study is to experimentally investigate the strength and ductility of reinforced concrete columns under uniaxial load and several test variables. To do this, we have conducted tests on twelve 20×20×60cm specimens with 8 and 12 longitudinal steel bars subjected to monotonic uniaxial compression. The main variables considered in this test are the configuration of ties, the strength of concrete, and the space of ties. The results indicate that the strength and the ductility of reinforced concrete columns have been influenced on the configuration of ties, the space of ties, and the strength of concrete.
李載胎,鄭憲瑩,琴坰樹,朴炅 한국전통의학연구소 1999 한국전통의학지 Vol.9 No.1
This fasciale, a remainder of So Moon(素問) with Bon Byung Ron(本病論), is a part of the theory of the Five Circuit Phases and the Six Atmospheric Influences(五運六氣學) that studied and discussed the rules of the weather change in ancient oriental medicine. The change in weather is one of the most important factors which influence man's health therefore the theory is worth while to study further. This fascicle explains the cause of diseases occured by irregular and exceptional change of weather and acupunctural treatment methods to prevent and cure those kinds of disease as its title -Ja Bup Ron(刺法論)-suggests. During Tang Dynasty(唐) when Wang Ping(王氷) commentated the So Moon(素問) only the title of this fascicle was kept but the contents of it was lost differing from Seven volumes of the Five Circuit Phases and the Six Atmospheric Influences(運氣七篇). However in the times of the North Song Dynasty(北宋) when Kao Pao-Heng(高保衡), Lin I(林億) and the other scholars studied and compared medical books this fasciale and another lost fasciale-Bon Byung Ron(本病論) appeared with theirs notes. So these two fascicles called Lost Volumes of So Moon(素問遺篇). But we can infer these two fascicles were written by a certain Taoist during the ninth and tenth century A.D. - the former times of Kao Pao-Heng(高保衡), Lin I(林億) and the other scholars studied and compared medical books during the North Song Dynasty(北宋) since Wang Ping(王氷) because this fascicle connots the Taoism training methods such as Pe Gi(閉氣), Jon Sang Bup(存想法) and Oi Dan Bup(外丹法) and so on. This thesis runs as follows; Chapter 1 deals with acupuncture treatment to prevent and cure UI(鬱) disease occuerd by Sung Gi Bu Jun(升之不前) of the Six Atmospheric Influence(六氣). Chapter 2 deals with acupuncture treatment to prevent and cure diseases due to Bul Chun Jung(不遷正) and Bul Toi Wui(不退位) of the Six Atmospheric Influence(六氣). Chapter 3 deals with acupuncture treatment of an epidermic(疫癘) due to the deviation of the Five Ciecuit Phases from the regularity(五運失守). Chapter 4 deals with the symptomes of an epidemi and the preventive treatments such as Jon Sang Bup(存想法), Vomitory treatment(吐法), respiratory treatment(汗法) and So Kum Dan Bang(小金丹方). Chapter 5 deals with the interaction among the five viscera and the six bowels as well as the principle of the acupuncture.
이화운,김유근,정우식,오은주,임헌호,노순아,반수진,최현정,김민선,김헌숙 부산대학교 환경문제연구소 2002 環境硏究報 Vol.20 No.-
In the view of the results investigated the effect of air pollutants that is emitted from a new generator facilities, the total estimated concentration which is the summation of a contributional concentration and observational concentration is much less than that of atmospheric environment criterion for the air pollutants. So we can predict that the operation of the new generator facilities with mitigation equipment don't seriously affect around environment. At the same time, we compared the contributional concentration of before mitigation equipment with that of after it to examine the decreasing amount due to mitigation equipment. The result showed that the concentration of SO2, NO2 and PM-10 is reduced to 25%, 30% and 26% of original value, respectively.
가와사끼 질환에서 감마글로불린의 대량 정주 용법의 효과에 관한 연구
이경희,하태선,박범수,한헌석,하성훈 충북대학교 의과대학 충북대학교 의학연구소 1994 忠北醫大學術誌 Vol.4 No.1
가와사끼병으로 진단받고 고용량의 감마글로불린(2 gm/㎏)을 정맥주사 받은 17명의 환아를 대상으로 임상적 효과와 관상동맥의 변화에 미치는 영향을 연구하여 다음의 결과를 얻었다. 1. 대상 환아의 연령은 평균 2.03세로 3개월에서 5세 사이에 분포하였고, 2세 이하가 58.8%를 차지하고 남여의 비는 1.125 : 1이었다. 2. 가와사끼 진단 기준의 6가지 주증상 중 5가지는 전환아에서 나타났으며, 경부 림프선 종창만 64.7%에서 나타났다. 발생 계절은 봄과 겨울에 76.5%의 환아가 발생하였다. 3. 대량의 감마글로불린 주사 직후 평균 11.4시간에 고열이 없어지고 다른 주증상들도 없어지기 시작하였으며, 대부분(82.3%)이 주사후 20시간 이내에는 소실되었다. 주사중 3례(17.6%)에서 오한 및 일시적인 체온의 상승을 보였으나 주사를 중단할 필요는 없었다. 4. 발병 4주 이내에 관상동맥의 확장이 관찰된 경우는 8례(47.1%)였으나, 이들은 모두 경도의 확장이었다. 발병 2개월 후에 시행한 심초음파도에서는 2명(11.7%)에서만 경도의 확장을 보였고, 나머지는 모두 정상으로 회복되어 있었다. 5. 최저 헤모글로빈치, 최대 C-반응성 단백질, 최대 총백혈구수, 최고 적혈구 혈침속도, 혈소판 최고치는, 발병 4주 이내와 2개월 후에 관상 동맥의 변화가 있는 군과 정상인 군 사이에 의미 있는 차이는 없었다. 이상의 결과로 가와사끼병의 치료에 있어서 단일 고용량의 감마글로불린을 정맥주사하는 방법이 심각한 부작용 없이 임상적 증세를 빨리 호전시키며, 관상동맥의 합병증을 줄이는데 효과적임을 알 수 있었다. 따라서 모든 가와사끼병의 급성기에 가능한 빨리 단일 고용량의 감마글로불린을 정맥주사하는 것을 추천한다. The authors studied the effect of single high-dose intravenous gammaglobulin(2 gm/㎏) on the clinical symptoms and coronary artery abnormalities in seventeen Kawasaki patients and obtained the following results. 1. The patients' ages ranged from 3-month to 5-year, with mean age of 2.03-year. The patients under 2-years comprised 58.8%. The ratio of male to female was 1.125. 2. All of the patients showed 6 major diagnostic criteria with one exception of cervical lymphadenopathy(64.7%). The disease occurred mainly spring and winter season(76.5%). 3. Fever subsided within 20 hours' of intravenous gammaglobulin infusion in most of the patients(82.3%) with mean value of 11.4 hours, Transient side effects such as fever and chilling sense, developed in 3 cases(17.6%), but there was no need to quit infusion. 4. Echocardiographically, mild coronary arterial dilation was observed in 8 cases(47.1%) within 4 weeks' of onset. After 2 months' of onset, only 2 cases(11.7%) showed mild dilation. 5. There were no significant difference between coronary arterial dilation group and normal group before 4wk and after 2 mo of onset, in terms of hemoglobin nadir, maximal CRP, maximal WBC count, peak ESR, and peak platelet count. Conclusively, single high dose intravenous gammaglobulin infusion in Kawasaki disease showed effective improvement of clinical symptoms and decrease of coronary arterial abnormality. There fore all the children with Kawasaki disease should be treated with single high-dose intravenous gammaglobulin infusion as soon as possible.
李玗珍,鄭憲瑩,琴坰樹,朴炅 대한한의진단학회 1998 大韓韓醫診斷學會誌 Vol.2 No.2
In Mac Hae Pyun(脈解編), pathological mechanisms are explained on the basis of the so-called "Eum-Yang (陰陽)"theory. In this paw, sentenses referred in "Hwang Je Nae Kyung(黃帝內經)" are construed as "soyue(所謂), and the six kyung diseases(六經病)-TaeYang(太陽)·YangMyung(陽明). SoYang(少陽)·TaeEum(太陰)·SoEum(少陰)·GuiIEum(厥陰)- are interpreted as elements belong to each month. Summerizing the contents of the "Mac Hae Pyun(脈解編)" in reference to the contents of successive generation note, the contents were as follows; What attracts our attention in chapter Ⅰ is pathologic explanations on the diseases which are catagorised as "the diseases of the TaeYang Meridian(太陽經脈病)", such as the edema of lumber and pain of gluteaI(종요수통), badger(跛), pain of nape(項强), sonitus(이오), insanily(顚狂), anepia(음) and anepia-badger(음비). What attracts our attention in chapter Ⅱ is pathologic explanations on the diseases which are catagorised as "the diseases of the YangMyung Meridian(陽明經脈病)", such as the pain of cardia and hypochondrium(心脇痛), cannot rotate body(不可反側), hyperpraxia(躍). What attracts our attention in chapter Ⅲ is pathologic explanations on the diseases which are catagorisedr as 'the diseases of the SoYang Meridian(少陽經脈病)", such as algor(振寒), paranalgesia(脛腫而股不收), arthma and edema(上喘而爲水), pain of thorax(胸痛少氣), pallor(??), agitated(獨閉戶??而居), psychosis(乘高而歌??依而走), headache and rhinostegnosis and edema of of celiac(頭痛????腹腫). What attracts our attention in chapter IV is pathologic explanations on the diseases which are catagorisedl as 'the diseases of the TaeEum Meridian(太陰經脈病)", such as meteorism(脹滿), eructation(噫), vomiting(嘔吐). What attracts our attention in chapter Ⅴ is pathologic explanations on the diseases which are catagorised as "the diseases of the SoEum Meridian(少陽經脈病)", such as the pain of lumber(腰痛), vomiting and tussis and arthma(구토해흠천식), vertigo(目無所見). anger(善怒), pallor(恐怖), anorexia(惡聞食臭), blackface and emptysis(面黑咳血), rhinostegnosis(????). What attracts our attention in chapter VI IS pathologic explanations on the diseases which are catagorisedl as "the diseases of the GuilEum Meridian(厥陰經脈病)", such as hernia and hypogastrium edema of female(퇴산귀인소복종), pain of lumber and vertebral(腰脊痛), hernia and dermedema(퇴륭산??창), fauces xeransis(익건).
李載胎,鄭憲瑩,琴坰樹,朴炅 대한한의진단학회 1998 大韓韓醫診斷學會誌 Vol.2 No.2
Young Chou O Sa(靈樞 五邪) described the symptoms of a disease when injurious factors permeated the five viscera and the location of a meridian point and the acupuncture in curing them according to the five viscera. When there are injurious factors within the lungs, you ought to acupuncture Woon Moon Hul(雲門穴), Joong Bu Hul(中府혈穴), Pae Soo HuI(肺輸穴 B13), and Geol Boon Hul(缺盆穴 S12), when there are injurious factors within the liver, acupuncture Hang Gan HuI(行間穴 LIV2) and Jok Sam Ri HuI(尺三里穴 S36), within the spleen, do acupuncture Yong Chul HuI(湧泉穴 K1) and Gon Ryun HuI(崑崙穴 B60), and when there are injurious factors within the heart, do so in the place of Shin Moon Hul(神門穴 H7).
한국인에서 도파민 D4 수용체 다형성과 Novelty Seeking 성격 특성의 연관성
이헌정,이홍석,강화연,김린,이민수,서광윤,변영찬 大韓神經精神醫學會 2002 신경정신의학 Vol.41 No.4
연구목적 : 저자들은 한국인에서 도파민 D4 수용체(DRD4) 유전자의 다형성과 성격의 관련성을 알아보고자 본 연구를 시행하였다. 방 법 : 173명의 건강한 한국인 여자 청소년(13.88±0.29세)을 대상으로 하여 성격 기질 설문지(Temperament and Character Inventory : TCI)를 작성하도록 하였으며, 이들에서 DRD4 exon Ⅲ 48-bp VNTR(variable numbers of tandem repeats) 다형성을 분석하였다. 결 과 : DRD4 exon Ⅲ Vntr에서 긴 대립유전자(≥5 repeats)를 가진 군이 긴 대립유전자를 가지지 않은군에 비하여 Novelty Seeking 척도 점수가 유의하게 높았다(t=2.11,p=0.037). 결 론 : 본 연구 결과는 DRD4-exon Ⅲ의 긴 대립유전자가 Novelty Seeking 성격과 관련이 있다는 기존의 외국에서의 연구결과를 다시금 확인해주는 것이다. Objectives : We investigated the relationship of personality traits with dopamine D4 receptor(DRD4) exon Ⅲ polymorphism in a Korean population. Methods : We analysed DRD4 exon Ⅲ 48-bp repeats polymorphism in 173 Korean heakthy female adolescents(age=13.88±0.29years) who also completed Temperament and Charater Inventory(TCI). Results : Novelty seeking score of the TCI was significantly higher in the subjects with DRD4 long alleles(≥5 repeats) compares with the subjects without these (t=2.11, p=0.037). Conclusion : The present study supports the previous reports that long repeats of the DRD4-exon Ⅲ polymorphism are relatedwith Novelty Seeking personality.