관상동맥 시술 도중 발생한 좌주간부 관상동맥 박리에 대한 스텐트 삽입 치료의 단장기 임상 결과 : acute and long-term results

이세환,이승환,홍명기,김영학,이철환,한기훈,송종민,강덕현,송재관,김재중,박성욱,박승정 대한내과학회 2004 대한내과학회지 Vol.66 No.6

목적 : 심도자 사용 시술과 관련된 좌주간부 관상동맥박리에 대한 적절한 치료는 아직 확실히 정립되지 않은 상태이다. 이에 본 연구는 좌주간부 관상동맥 박리에 대한 스텐트 삽입술의 단장기 임상결과를 후향적으로 분석하였다. 방법 : 좌주간부 관상동맥 박리에 대한 치료로 즉각적인 스텐트 삽입술을 시행하는 것이 안전하고 효과적인 방법임을 가설하였고, 이러한 즉각적인 스텐트 삽입을 시행한 10명의 환자를 대상으로 단장기적 임상경과를 의무기록 고찰과 전화 면담을 통해서 평가하였다. 결과 : 전체 환자 모두 처음부터 좌주간부 관상동맥에 유의한 협착을 가진 환자는 없었으며, 8명의 환자는 심도자의 조작으로 인한 박리가 발생한 경우였고(진단적 혈관 조영술 중에 3명, 유도 도자 조작 중에 5명), 나머지 2명은 다른 병변에 스텐트 삽입시술을 하는 중에 박리가 발생하였다. 이 10명의 환자에서 모두 즉각적인 스텐트 삽입술이 시행되었고, 4명의 환자에서 시술 도중 혈압 저하로 Intra-aortic Ballon Pump (IABP)를 장착하였다. 모든 환자에서 성공적으로 스텐트가 삽입되었고, 병원내 사망은 1명도 없었다. 6개월 추적 관상동맥 조영술은 8명의 환자에서 시행되었다. 혈관 조영상의 재협착(직경 협착 50% 이상)은 8명 모두에게서 관찰되지 않았으며, 퇴원 후 평균 31±25개월의 추적관찰 결과 주요 심장사건은 1건도 발생하지 않았다. 결론 : 비록 대상 환자가 적은 연구였지만 좌주간부 관상동맥 박리에 대한 스텐트 삽입술은 기술적으로 안전하고 빠르게 시행 할 수 있으며, 훌륭한 단장기적인 치료 효과를 보여준다. Background : The optimal treatment of patients with left main coronary artery (LMCA) dissection during catheter-based procedure remains uncertain. We retrospectively analyzed the acute and long-term results of bail-out stenting for LMCA dissection. Methods : In cases with significant LMCA dissection occurring during catheter-based procedure, prompt stent implantation may be safe and associated with favorable clinical outcome. We evaluated the acute and long-term results of bail-out stenting for LMCA dissection occurring during catheter-bases procedure in 1- patients. Results : Initially, there was significant stenosis of LMCA segment in these patients. Catheter-induced dissection occurred in 8 patients (during diagnostic angiography in 3 patients and guiding catheter manipulation in 5 patients). Two patients suffered dissection in the setting of stent deployment in other vessels. Therefore, bail-out stenting LMCA dissection was performed in a total of 10 patients. In 4 patients, hypotension developed and intra-aortic balloon pump was placed during procedure. Stents were successfully deployed in all patients. There was no in-hospital mortality. Six-month angiographic follow-up was performed in 8 patients. Angiographic restenosis(diameter stenosis 50%) was not observed in all patients at follow-up study. During a mean follow-up of 31±25 months after hospital discharge, there was no major adverse cardiac event (death, myocardial infarction, and target lesion revascularization). Conclusion : Bail-out LMCA stenting is technically feasible, and showed good acute and long-term results in a small series of patients.

담관계 감염증에서 혈액 및 담즙배양 균주의 특성과 항생제 감수성

송재훈,이철환,김양수,이성구,이근찬,민영일,김명환 대한감염학회 1994 감염 Vol.26 No.1

During a three-year period, 600 patients were admitted to the Asan Medical Center because of biliary tract diseases. Both aerobic and anaerobic cultures were performed in 313 patients with cholangitis (bile : 253, blood : 113, both : 53). Of these patients, 189 were positive(bile 159. blood 68. both 38). The most common organisms were E. coli, K pneumoniae, and P. aeruginosa in both bile(respectively, 49.7%, 20.8%, 51.5%) and blood cultures(respectively, 45.6%, 26.5%, 22.1%). Antibiotic therapy did not sterilize bile, but selectively increased the proportions of P. aeruginosa. There was no significant difference in biliary bacteriology according to the history of biliary surgery, or the presence of percutaneous biliary drainage or underlying disease. More than 95% of gram-negative organisms isolated was highly susceptible to imipenem and amikacin. P. aeruginosa was resistant to ceftazidime in 63.3% which might be associated with overuse of the drug during the study period. Further studies will be necessary in patients with cholangitis to determine whether newer antibiotics replace previous combination therapy.

관동맥연축의 진단을 위한 Ergonovine Echocardiography의 안전성 및 임상적 유용성

송재관,박성욱,강덕현,조구영,나득영,이내희,이철환,홍명기,김재중,박승정 대한순환기학회 2000 Korean Circulation Journal Vol.30 No.8

mRNA의 3' end processing에 대한 mRNA 중합요소 인산화의 영향

권대환,박재현,송영하,안성훈 한양대학교 이학기술연구소 2006 이학기술논문지 Vol.9 No.-

RNA 중합효소의 C-terminal은 YSPTSPS의 반복적인 아미노산 서열을 갖고 있으며, 이들의 인산화는 전사의 개시, 중합, 또는 종결단계에 중요하다고 알려져 있다. 본 연구에서는 이러한 RNA 중합효소의 인산화가 mRNA의 3' end processing에 미치는 영향을 조사하였다. C-terminal domain (CTD) of RNA polymerase Ⅱ contains a repeated heptameric sequence (YSPTSPS) which is phosphorylated at serine 2 and 5. Phosphorylation of CTD in elongating RNA polymerase Ⅱ has been suggested to play a role in transcriptional initiation, elongation or termination. In the present study, we investigated the effect of RNA polymerase Ⅱ CTD phosphorylation on the 3' end processing of mRNA.

서울의 Penicillinase Producing Neisseria Gonorrhoeae 발생빈도(1996)

김재홍,황동규,전재홍,김윤석,김중환,김용준,이창균,임동진,김현수,조창근,김경문,박상훈,전우형,김희성,이호정,차명수,김갑형,김형석,김석우,황지환,박병순,권오상,이민수,송기훈,성소영,이인섭,부태성 대한화학요법학회 1999 대한화학요법학회지 Vol.17 No.2

Background : In recent years, gonorrhea has been panedemic and remains one of the most commom STDs in the world, especially in developing countries. Objective & Methods: For the detection of a more effective therapeutic regimen and assessing the prevalence of PPNG, we have been trying to study the patients who have visited the VD Clinic of Choong-Ku Public Health Center in Seoul since 1980 by means of the chromogenic cephalosporin method. Results: In 1996, 139 strains of N. gonorrhoeae were isolated, among which 53(39.0%) were PPNG. Conclusion: Our results suggests that after a peak of 74.3% in 1993, the prevalence of PPNG in Seoul is gradually declining.

사람폐암세포주 (PC-14)에서 Cyclosporin A에 의한 Adriamycin 내성의 극복

김영환,홍원선,송재관,강윤구,이진오,강태웅,김건열,한용철 대한내과학회 1990 대한내과학회지 Vol.38 No.3

Cyclosporin A and verapamil were tested using MTT assay to evalute the modification effect on the resistance to adriamycin in a human lung cancer cell line(PC-14) and its resistant subline(PC-14/A). PC-14/A was derived by the continuous exposure of PC-14 to incremental concentrations of adriamycin. PC-14/A was 2.5 times more resistant to adriamycin in terms of ICso than PC-14. Cyclosporin A alone, at a concentration of 2.5㎍/㎖, inhibited the growth of PC-14 to 68.3%. 2.5㎍/ ㎖ and 5.0㎍/㎖ of cyclosporin A showed an increase in the cytotoxicity of adriamycin (p<0.01) with 5.0㎍/㎖ being greater than 2.5㎍/㎖(p<0.01). Excluding the direct cytotoxic effect, however, cyclosporin A did not increase in the sensitivity of PC-14 to adriamycin but only showed an additional cytotoxic effect with adriamycin. Verapamil (up to 6.0㎍/㎖) did not inhibit the growth of PC-14. 3.0㎍/㎖ of verapamil did not increase the cytotoxic effect of adriamycin. The combination of cyclosporin A and verapamil with adriamycin enhanced the cytotoxicity of adriamycin, but the result was similar to that of cyclosporin A with adriamycin. 5.0㎍/㎖ of cyclosporin A modified the adriamycin resistance of PC-14/A(SR, 3.2). However, 3.0㎍/㎖ of verapamil did not significantly reverse the adriamycin resistance of PC-14/A. The modified effect of the combination of 5.0㎍/㎖ of cyclosporin A and 3.0㎍/㎖ of verapamil was similar to that of 5.0㎍/㎖ of cyclosporin A alone in PC-14/A. These results demonstrate that cyclosporin A has an additional cytotoxic effect with adriamycin in PC-14 and PC-14/A and has overcome the acquired resistance to adriamycin in PC-14/A. They also suggest that cyclospoin A may have the therapeutic potential in the treatment of human lung cancer.

Ba-Ferrite를 이용한 자기 연마재 개발

김희남,송승기,정윤중,윤여권,김희원,조상원,심재환 한국안전학회 2003 한국안전학회지 Vol.18 No.2

The magnetic polishing is the useful method to finish some machinery fabrications by using magnetic power. This method is one of the precision techniques and has an aim for clean technology in the transportation of the pure gas in the clean pipes. The magnetic abrasive polishing method is not so common in the field of machine that it is not known to widely. There are rarely researcher in this field because of non-effectiveness of magnetic abrasive. Therefore, in this paper we deals with the development of the magnetic abrasive with the use of Ba-Ferrite. In this development, abrasive grain WA has been made by using the resin bond fabricated at low temperature. And magnetic abrasive powder was fabricated from the Ba-Ferrite which was crushed into 200 mesh. The XRD analysis result shows that only WA abrasive and Ba-Ferrite crystal peaks were detected, explaining that resin bond was not any more to contribute chemical reaction. From SEM analysis, we found that WA abrasive and Ba-Ferrite were strongly bonding with each other.

골수구성 백혈병 환자에게 발생한 결핵성 림프절염

이창섭,송진수,최평균,조재현,방지환,박경화,박완범,김홍빈,김남중,윤성수,박선양,김병국,오명돈,최강원 대한감염학회 2006 감염과 화학요법 Vol.38 No.5

혈액질환 가운데 결핵 발생이 증가한다고 알려진 것은 호지킨 림프종을 포함한 림프증식성질환 그리고 모양세포성 백혈병 등이 있다. 또한 동종 골수이식을 받은 환자에서도 결핵은 증가한다고 알려져있다. Kaplan 등은 골수구성 백혈병 환자에서 결핵 발생이 증가한다고 보고하였다. 그러나 골수구성 백혈병 환자에서 결핵의 발생이 증가하는 이유에 대해서는 아직까지 정확하게 밝혀지지 않았다. 저자들이 2년 동안 후향적으로 조사한 180명의 성인 골수구성 백혈병 환자들 가운데 결핵이 발생한 환자는 4명이었고, 발생 부위는 모두 림프절이었다. 결핵은 골수구성 백혈병의 특정 아형에만 국한되어 발생하지 않았지만, 50%에서 FAB 분류에 의한 M4였다. 림프절이 종대된 골수구성 백혈병 환자에서 특히, 결핵의 유병율이 높은 나라에서는 결핵성 림프절염도 감별진단에 포함시켜야 한다. During the neutropenic phase, leukemia patients receiving chemotherapy are prone to bacterial and, fungal infections; occasionally mycobacterial, viral and protozoal organisms may also cause infections. Mycobacterium tuberculosis infection was reported very rarely in these patients. This report describes four patients with M. tuberculosis infection identified from 185 adult patients who were diagnosed myelogenous leukemia between January 2003, and December 2004. There was no patient with M. tuberculosis infection from 44 lymphoid leukemia and 11 acute biphenotypic leukemia patients. Sites of infection were all lymph nodes. Three among four patients were presented with lymphadenopathy at initial diagnosis of leukemia, and the other one presented with lymphadenopathy after induction chemotherapy. There was no patient presented with lymphadenopathy during the neutropenic phase. Tuberculous lymphadenitis was presented in a patient with three acute myelogenous leukemia (FAB class 2 M4, 1 M2) and a chronic myelogenous leukemia, accelerated phase. An acute myelogenous leukemia patient had a leukemic cell and tubercle bacilli in the same lymph node. Tuberculosis should also be included as a differential diagnosis in myelogenous leukemia patient with lymphadenopathy, especially in the countries in which the disease is endemic.

상행 대동맥을 이환한 대동맥 벽내출혈과 대동맥 박리의 임상적 비교

김현숙,송재관,강덕현,김준,이철환,홍명기,김재중,박성욱,박승정 대한순환기학회 2000 Korean Circulation Journal Vol.30 No.4

수부의 외상성 중수지 관절 탈구의 치료

이승구,송석환,이주엽,문창윤,오재찬 대한골절학회 2003 대한골절학회지 Vol.16 No.2

목적 : 수부의 중수지 관절 탈구의 관혈적 정복이 필요했던 예에서는 정복을 방해하는 구조물에 대해 분석하고 도수 정복이 가능했던 예에서는 성별 및 탈구 형태에 따른 특성에 대해 알아보고자 하였다. 대상 및 방법 : 총 27예의 수부 중수지 관절 탁구 환자 (무지 11예, 이지 14예, 소지 2예)를 대상으로 연구하였다. 탈구된 중수지 관절의 정복을 방해하는 해부학적 구조는 수술시에 확인을 하였으며, 도수 정복이 가능하였던 예들에서도 연령과 손상된 구조물, 그리고 최종적인 임상 결과를 평균 7개월간 추시 관찰하였다. 결과 : 무지 중수지 관절의 탈구 11예 중 파열된 전방 관절낭, 수장판과 단무지 굴건의 파열을 동반한 복합 탈구가 8예 있어 관혈 정복을 시행하였으며, 2예에서만 도수 정복이 가능하였다. 관절염이 있던 1예는 관절 유합술을 시행하였다. 다른 수지의 중수지 관절의 탈구는 Kaplan의 개념에 따라 탈구를 수술 정복하였고 파열된 수장판을 복원하였으며, 1예에서 수술시 표재 중수 횡인대만의 절개와 이완으로 정복할 수 있었다. 소지 중수지 관절 탈구의 2예에서 파열된 요측 측부인대가 수술시 관찰되었고 이를 복원하여 수지의 불안정성을 예방하였다. 이들의 최종 결과는 특별한 운동 제한이나 불안정성 없이 좋은 결과를 보였다. 결론 : 적절한 국소 마취하에 도수 정복을 1~2회 시행할 수 있지만 단순 정복이 가능한 탈구가 부적절한 견인으로 정복이 불가능한 복합 탈구로 진행할 수 있다. 그리고 복합 탈구는 대부분 관혈적 정복이 필요하기 때문에, 정복 방해 구조물에 대한 충분한 이해와 적절한 조치가 필요하다. Purpose : To analyse the obstacles to prevent the reduction for dislocation of the metacarpophalangeal (MP) joints of the hand and evaluate the relationship between the sex and dislocation type in closed reduction case. Materials and Methods : Total 27 cases of MP joint dislocation of the hand (11 cases of thumb, and 14 index and 2 little finger) were reviewed retrospectively. The anatomical structures to prevent the reduction were confirmed at operation and the cases which were reduced immediately were also analysed for their ages and differences of damaged structures, and finally their complications or outcome were reviewed for average 7 months after reduction. Results : In 11 cases of thumb MP joint dislocations, the complex dorsal dislocations in which the protruded metacarpal neck was caught by buttonhole of torn anterior joint capsule, volar plate and FPB were reduced by open method in 8 cases, and closed reduction was done in 2 cases but one old case required arthrodesis. In other finger MP joint dislocations, the Kaplan's concept to prevent the reduction was confirmed. But reduction of torn volar plate and incision of transverse metacarpal ligament were sufficient to reduce the dislocation with gentle longitudinal traction during the operation. In two cases of little finger MP joint dislocation, the ruptured radial collateral ligaments were noted after open reduction and it must the repaired to prevent the finger instability later. Their overall end results were good without any significant restriction of MP joints motions and finger instabilities. Conclusion : One or two times of closed reduction with proper local anesthesia could be tried, but simple reducible dislocation can be converted to complex irreducible ones by the inappropriate traction method, and so proper reduction technique by closed or even in open way is important with the knowledge of anatomical obstacles to prevent the reduction of the metacarpophalangeal joints.