정신분열병에 대한 리스페리돈의 효과 및 안정성

이민수,김용구,김영훈,연병길,오병훈,윤도준,윤진상,이철,정희연,강병조,김광수,김동언,김명정,김상훈,김희철,나철,노승호,민경준,박기창,박두병,백기청,백인호,손봉기,손진욱,양병환,양창국,우행원,이정호,이종범,이홍식,임기영,전태연,정영조,정영철,정인과,정인원,지익성,채정호,한상익,한선호,한진희,서광윤 大韓神經精神醫學會 1998 신경정신의학 Vol.37 No.1

연구목적 : 본 시험의 목적은 임상시험 시작전에 연구자들을 대상으로 PANSS Workshop을 통하여 PANSS, ESRS에 대한 국내에서의 표준화 작업을 구축하고 새로운 정신병 치료제인 리스페리돈의 효과와 안정성을 재확인하여 리스페리돈 사용에 대한 적정화를 이루는데 있다. 연구방법 : 1996년 4월부터 1996년 9월까지 국내 39개 대학병원 정신과에 입원중인 혹은 증상이 악화되어 입원하는 정신분열병 환자 377명을 대상으로 다시설 개방 연구를 시행하였다. 1주일간의 약물 배설기간을 가진후, 리스페리돈을 8주간 투여하였고, 기준점, 1주, 2주, 4주, 그리고 8주후에 평가되었다. 용량은 제1일에는 리스페리돈 1mg씩 1일 2회, 제2일에는 2mg씩 1일 2회, 제3∼7일에는 3mg씩 1일 2회 투여하였다. 이후 환자의 임상상태에 따라 임의로 증량할 수 있으며, 최대 일일 16mg을 초과하지 않도록 하였다. 추체외로 증상을 조절하기 위한 투약을 허용하였다. 임상증상 및 부작용의 평가는 PANSS(Positive and Negative Syndrome Scale), CGI(Clinical Global Impression) 그리고 ESRS(Extrapyramidal Symptom Rating Scale)을 사용하였다. 연구결과 : 377명중 343명(91%)이 8주간의 연구를 완결하였다. 치료 종결시점인 8주후 PANSS 총점수가 20% 이상 호전된 경우를 약물 반응군으로 정의할때, 약물반응군은 81.3%였다. 리스페리돈에 반응하는 예측인자로는 발병연령, 이전의 입원 횟수, 유병기간이 관련 있었다. 리스페리돈은 1주후부터 PANSS양성, 음성, 및 일반정신병리 점수상에 유의한 호전을 보여 효과가 빨랐다. CGI의 경우도 기준점에 비해 1주후부터 유의한 감소를 나타내었다. ESRS의 경우, 파킨슨 평가점수는 기준점과 비교해 투여 1주, 2주, 4주후 유의하게 증가되었다가 8주후 기준점과 차이가 없었다. Dystonia 평가점수는 1주후만 유의한 증가를 보였으며, dyskinesia 평가점수는 유의한 차이가 없었다. 혈압, 맥박수의 생명징후 및 일반 혈액학 검사, 생화학적 검사, 심전도 검사에서 유의한 변화는 없었다. 결 론 : 이상의 다시설 개방 임상 연구를 통해 리스페리돈은 정신분열병 환자에서 양성증상뿐만 아니라 음성증상 및 전반적인 증상에도 효과적인 것으로 사료된다. 보다 명확한 평가를 위해서는 다른 항정신병약물과의 이중맹검 연구가 필요할 것으로 생각되며, 또한 장기적 치료에 대한 평가도 함께 이루어져야 하겠다. Objective : The purpose of this study was to investigate the efficacy and safety of risperidone in the treatment of Korean schizophrenic patients. Method : This multicenter open study included 377 schizophrenic patients drawn from 39 university hospitals. After a wash-out period of 1 week, the schizophrenic patients were treated with risperidone for 8 weeks and evaluated at 5 points ; at baseline, and 1, 2, 4 and 8 weeks of treatment. The dose was increased from 2mg/day(1mg twice daily) to 6mg/day(3mg twice daily) during the first week and adjusted to a maximum of 16mg/day over the next 7 weeks according to the patient's clinical response. Medication to control extrapyramidal symptoms was permitted. The psychiatric and neurological status of the patients was assessed by PANSS, CGI, and ESRS scales. Results : 343(91%) of 377 patients completed the 8-week trial period. Clinical improvement, as defined by a 20% or more reduction in total PANSS score at end point, was shown by 81.3% of patients. The predictors of response to risperidone were associated older age, shorter duration of illness, fewer previous hospitalization. Risperidone had rapid onset of action ; a significant decrease of the total PANSS and three PANSS factor(positive, negative, general), and CGI was already noticed at the end of first week. For the ESRS, parkinsonism rating scores were significantly increased until week 4 comparing with baseline. Dystonia rating scores were significantly increased until week 1, and dyskinesia rating scores were not significantly changed during the study. Laboratory parameters including vital sign, EKG, hematological, and biochemical values showed no significant changes during the trial. Conclusions : This study suggests that risperidone is generally safe and effective against both the positive and negative symptoms in our group of patients.

島嶼敎育 計劃을 爲한 調査硏究 : 沃溝郡 島嶼地域을 中心으로 For the islanders of Okku-kun,Chunpuk

吉基烈,申鐵淳 群山敎育大學 1968 論文集 Vol.2 No.-

1. Introduction We have done this survey in order to find out the problems for improving the planning of the islanders' education. In this survey, we tried to study the actual conditions and problems of the island communities and schools. We used the method of the observation, the interview, the questionnaire, and the analysis of documentary data. We have done the survey from August 10, 1968 to August 25, 1968 with the 31 students of Kunsan Teachers' college. The result of the survey is as follows, Ⅱ. Result of survey 1. The actual condition and problems of the island communities 1) Geographical condition of islands There are 11 inhabited islands and 32 uninhabited islands, total 43 islands. These island are located in the range of 126˚15' to 126˚34' East Longitude and 35˚40' to 36˚10' North Latitude. These islands are the west direction from Kunsan. 2) Population and occupation The population of the island is 9,506 (male-4,704, female-4,803) and the number of the households is 1,466 according to the census of december 1966. most of the islanders are engaged in fishery 50%, and the others are engaged in the farming, the commerce and the liberal profession. It is a great problem that they can not earn their livings with their main occupations whole year around. About 65% of the inhabitants are half unemployed because of the defect of fishery funds and the need of the farmers' side lines in their leisure seasons. 3) Area of the farm and necessary cereal The area of the farm is 992.79ha and the yield of rice and other cereal a year is about 5,512.78hl. The necessary total amount of rice and other cereal a year is 7,316.87hl, and they have to purchase the needed cereal about 1,480hl from the land every year. 4) Traffic condition The traffic between the land and the islands is accomplished by a passenger boat 45t built by the budget of the government and that of the county on March, 1963. And it is able to connect between the land and islands only twice a month. The Board of Education built a boat 30t for the supervision of the island schools. But the islanders need to improve the traffic conditions of their community. 5) Religion In these islands, the majority of at least 80% of the inhabitants still believe in the primitive Shamanism, 12% of them Christianity, 5% of them Buddhism, and 3% of them others. As the shamanism flourishes remarkably in these islands, most of their customs are superstitious. It is one of the problems which we have to break down in order to improve ways of their life. 6) Standards of living The inhabitants' income is less than 60% of the national income of 1968. And their livings are so poor that about 86% cf them live on miscellaneous cereal such as burley and potatoes without rice the whole year around. The fact suggests that most of the children are under the malnutrition. 7) Point of view of life The point of view of life has been influenced by Confucianism for a long period. According to the Survey, we can see the characteristic point of view of life. For example, they have the point of view of predominance of man over woman. And most of them want to have their children as follows : four sons and two daughters. The fact suggests that they do not believe the idea of the equality of man and woman and the idea of respect of human beings. 8) Collective shape of the island communities The collective shape of the community is the natural village and village community. The trait of the consciousness of the inhabitants is closing and competitive to others. And the Agricultural-Cooperative-Union and the Fishery-Cooperative-Union can not accomplish their services. 9) Local patriotism Most of the islanders 60% have no local patriotism and they want to remove to the land. The reasons are as follows : 1. Their economic conditions are poor. 2. They think the fishery and farming in the islands are not the desirable occupations for promoting their living standards. 3. There are no secondary schools for the education of their children. 4. In the island, it is difficult to get the necessaries of life. 10) Concern with their children's education Most of the parents 80% want to teach their children elementary school course because of their economic difficulties, 15% junior high school, 5% senior high schooi, and few college education. The fact suggests that their living standards are low and they have no abilities to support their children. 2. Actual condition and problems of the island school education There are 8 schools and 9 branch schools in these island communities. The school population is 26% of all island population. There are 55 classes, and 59 teachers. The average number of the pupils for a school is 147 and the average number of the teachers for a school is 3. Most of the classes are multiple-grade-type-classes. According to the above statements, we can find out the following educational problems. 1) Teachers' absence from school Most of the teachers are often absent from the school because of inconvenience of traffic and lodging houses. It is one of the problems to be solved for improving the island education. 2) Personnel administration and morale of teachers In the personnel administration, a regulation for the teachers decided to rotate every teacher in Okku-kun to serve in a island school for a year, but for the school principals is not decided. It is a very serious problem of the island education that the changes of teachers are frequently in force. But contrarily, teachers whish to frequent changes, because they can go back to the land soon. It is necessary to improve the island education and to raise moral of the teachers at the same time in the personnel administration. In order to achieve the two objects at the same time, it is desirable to pay the teachers better island regional allowance in comparision with the present system. 3) School facilities and teaching materials. Most of the schools have no essential facilities for elementary education. They must improve the conditions of facilities, school plants, school grounds, and teaching materials and so on. According to the survey, 7 schools out of 17 schools have organs for their music education. It is one of the serious problems of the island education, and we must try to solve immediately. 4) Curriculum organization and teaching method All the teaching activities are accomplished by the multiple - grade - type system. One teacher teaches two or three classes in a class room at the same time. According to the above statements, teachers have many problems in curriculum planning, organizing, and teaching. In order to improve the teaching method of the education, we must do the in-service-education and special educational researches for the island education continually. And the educational administrators must try to solve those problems continually, too. 5. School public relation Most of the parents and islanders are not cooperative for the school education. The reason are as follows : they are under the difficulties of economic status and the schools have not helped the community people improve their lives. It is necessary to improve the school public relation in order to improve the island education and island peoples life by increasing citizen understanding of educational needs and practices and encouraging intelligent citizen interest and cooperation in the work of improving school, and by opening the school and school facilities to the island adult education and social education. Ⅲ. Conclusion As the above statement, there are many problems in the island communities and school. In the following, we are going to suggest the methods of improving the planning of the islanders' education briefly. 1. To do the planning of the island education specially, and to carry it into effect. 2. To establish a pre-service education course and in-service-education course for the island education. 3. To help the teacher keep in the balance of his life by paying better island regional allowance according to the special system. 4. To rotate the teacher to serve in a island at least for two or three years. 5. To open the island schoolsand school facilities for the island adult education and social education.

제2형 당뇨병 남성 환자에서 유리 테스토스테론과 성호르몬 결합 글로블린 농도

남기덕,김영설,박철영,오승준,김덕윤,우정택,김성운,양인명,김진우,최영길 대한당뇨병학회 2002 Diabetes and Metabolism Journal Vol.24 No.6

연구배경:인슐린저항성은 제2형 당뇨병과 심혈관질환의 주요한 위험 인자로 성호르몬과 상호 관계가 있다고 알려져 있다. 그러나 여성과는 달리 남성에서는 연령과 인슐린저항성에 따른 유리 테스토스테론과 성호르몬 결합 글로블린 농도의 변화에 대한 연구가 부족한 실정이다. 그러므로, 본 저자등은 제2형 당뇨병 남성 환자에서 정산인과 비교해서 유리 테스토스테론과 성호르몬 결합 글로블린 농도를 측정하고 연령에 따른 변화 정도를 알아보고자 하였다. 방법:대상 환자 모두에서 연령과 체질량지수, 총 콜레스테롤, 중성지방, 공복혈당과 인슐린 농도를 측정하였다. 혈중 유리 테스토스테론 농도는 방사면역측정법(radioimmunoassay)을 이용해서 측정하였고, 혈중 성호르몬 결합글로불린은 면역방사계측측정법(immunoradiometric assay)을 이용해서 측정하였다(Diagnostic System Laoratories, Wbster, TX, USA). 결과:1)제2형 당뇨병 남성 환자에서 정상 대조군 남성에 비해 성호르몬 결합글로불린은 104.1±35.0 vs 25.7±3.5 mole×10??로 의미 있게 높았으나(p<0.001), 유리 테스토스테론은 13.7±9.5 vs 13.6±6.5 ng/dL로 차이가 없었다. 2)연령과 성호르몬 결합 글로블린 사이의 상관 계수는 제2형 당뇨병 남성 환자에서 0.40로 중등고의 양의 상관 관계를 보였고(p<0.001), 정상 대조군 남성에서 0.11로 유의한 상관 관계를 보이지 않았다. 연령과 유리 테스토스테론 사이의 상관 계수는 제2형 당뇨병 남성 환자에서 0.08, 정상 대조군 남성에서-0.17로 모두에서 유의한 상관 관계를 보이지 않았다. 3)연령과 체질량지수를 보정한 후에 제2형 당뇨병 남성 환자와 정상 대조군 남성에서 혈중 인슐린 농도, 유리 테스토스테론과 성호르몬 결합 글로블린 사이에는 상관 관계가 없었다. 결론:제2형 당뇨병 남성 환자에서 정상 남성에 비해 성호르몬 결합 글로블린 농도가 증가되어 있었으며, 유리 테스토스테론은 차이가 없었다. 연령이 증가함에 따라 성호르몬 결합 글로블린이 제2형 당뇨병 남성 환자에서 정상 남성에 비해 증가 폭이 의미있게 컸으며, 유리 테스토스테론은 변화가 없었다. Background: Insulin resistance is a risk factor for cardiovascular disease and type 2 diabetes mellitus. There are many previous studies indicating that insulin lowers serum sex hormone-binding globulin levels, and there is inverse correlation between insulin resistance and serum sex hormone-binding globulin levels in women. However, in men, a limited number of studies are available to explain the effect of sex hormone on age and insulin. Therefore, the present study was undertaken to investigate the relationship among free testosterone, hormone-binding globulin and age in type 2 diabetic men and control subjects. Method: Age, body mass index, total cholesterol, triglyceride, fasting blood sugar, and insulin concentrations were examined on 89 type 2 diabetic men and 47 control subjects. The free testosterone level was measured by commercially available double-antibody system (Radioimmunoassay). The sex hormone-binding globulin level was also measured by commercially available double-antibody system(Immunoradiometric assay). Results: 1) Sex hormone-binding globulin level was significantly increased in patients with type 2 diabetes. However, there was no significantly difference in free testosterone level between the two groups. 2) Sex hormone-binding globulin was positively correlated with age (r=0.4, p <0.001) in patients with type 2 diabetes. Sex hormone-binding globulin and free testosterone were not correlated with age in control sujects. 3) Free testosterone and sex hormone-binding globulin concentrations were not significantly related to serum insulin concentration after adjusting for age and body mass index. Conclusions: We observed increased sex hormone-binding globulin concentration in diabetes man, and was a positively related to age. Further studies are needed to understand the relationships between age, insulin resistance, testosterone, and sex hormone-binding globulin concentrations(J Kor Diabetes Asso 24:699~707,2000).

횡성댐 水沒地域內의 植生에 關한 硏究 : 移植對象區域을 中心으로 Centered with Subdivided Area to Select Plants Capable of Transfer

이우철,이기의,서옥하,조현길,백원기,김경진 江原大學校 森林科學硏究所 1997 Journal of Forest Science Vol.13 No.-

본 조사 연구는 江原道 橫成郡 甲川面과 橫成邑 일부를 포함하는 지역에 횡성댐이 건설됨에 따라 수몰되어질 自然生態系의 復元과 保存計劃의 일부로 수행되어졌다. 移植對象區域인 7개소를 중심으로 綠地自然度, 植生現存量 및 생산량 種組成과 植生에 관해 조사하였으며 그 결과는 다음과 같다. 1. 綠地自然度를 등급별로 사정한 결과 등급 0(3.01%), 1(5.3%), 2(28.2%), 3(0.1%), 5(0.2%), 7(4.6%), 7(44.7%), 및 8(13.8%)의 8개 등급으로 구분되었다. 2. 전체조사지역의 現存量과 生産量은 각각 88,436.3 ton/year 과 12,960.3 ton/year 이었다. 3. 조사지역의 陸上植物의 種組成은 86科, 221屬, 306種, 1變種, 3品種의 총 310種으로 조사되었다. 4. 선정된 7개의 植生調査地點에서는 소나무군락이 憂占하며, 그밖에 신갈나무군락, 떡갈나무군락, 상수리나무군락으로 나타났다. This study was carried out in a part of conservative plans recovering natural ecosystem which will be submerged, as Hoengseong dam is being constructed around Hoengseong-Eup and Gabcheon-Myun. The submerged area was divided into 7 small areas to figure out what kinds of species of plants are and will be according to detailed geographic characteristics. In the center of the subdivided areas. Degree of Green Naturality, standing biomass, net 36production per year, and composition of plant species were investigated. The results are as following; 1. The surveyed area was classified into 8 degree by Degree of Green Naturality, and the appeared degree and the rate of occupation were 0(3.01%), 1(5.3%), 2(28.2%), 3(0.1%), 5(0.2%), 7(4.6%), 7(44.7%), 및 8(13.8%). 2. Standing biomass was 88,436.3 ton/year and net production per year was 12,960.3 ton/year. 3. The list of vascular plants identified in this study consisted of 86 families, 221genera, 1 variety, 3 formae and 306 species, totally summiting upto 310 species. 4. The 7 surveyed areas were largely occupied by Pinus community. In addition, there were Quercus mongolica, Quercus dentata, and Quercus acutissima communities.

사매가 Ovalbumin감작으로 유발된 천식 생쥐 모델에서 기관지염증 억제에 미치는 영향

임중근,노성수,길기정,이영철,서영배 대한본초학회 2005 大韓本草學會誌 Vol.20 No.1

Asthma is a chronic inflammatory disease of the airways, characterized by airway eosinophilia, goblet cell hyperplasia with mucus hypersecretion, and hyper-responsiveness to both inhaled allergens and nonspecific stimuli. Eosinophil are important in the pathogenesis of asthma, with release of inflammatory mediators such as histamine, leukotrienes, cytokines, and IgE after exposure to allergen. Objectives : This research investigates the effect of the extract of Duchesnea chrysanta (EDC) on OVA-indued asthma murine model. Methods : After i.p of C57BL/6 mice, OVA sensitization (day 0) were challenged intratracheally with OVA on days 8 and 21. EDC administered weeks 8, blocked the airway inflammatory response to OVA assessed 24 h after the last OVA challenge on day 22. Results : The CC chemokine receptor 3 (CCR3) is expressed by eosinophils, mast cells, and Th2 cells. The role of CCR3 in a murine model of allergic skin inflammation induced by repeated epicutaneous sensitization with ovalbumin (OVA), and characterized by eosinophil skin infiltration, local expression of Th2 cytokines, and airway hyperresponsiveness (AHR) to inhaled antigen. The administration of EDC during OVA inhalation significantly reduced CCR3 plays an essential role in eosinophil recruitment to the skin and the lung and in the development of AHR.. EDC extract reduced total lung cells and eosinophils in bronchoalveolar lavage fluid, airway tissue eosinophilia, goblet cell hyperplasia, mucus secretion, and peribronchial edema. The inhibitory effect on airway eosinophilia and AHR was associated with reduced levels of IL-4, IL-5, and IL-13 in the bronchoalveolar lavage fluid as well as reduced serum levels of OVA-IgE. We show that OVA inhalation following OVA immunization increased airway responsiveness to induced IL-113, IL-4 and IL-5 mRNA expression in the lung tissue. The administration of EDC during OVA inhalation significantly reduced this increased airway hyperresponsiveness and also inhibited airway inflammation. Conclusions : These results support EDC as a therapeutic target in asthma and indicate that selective EDC inhibitors can reduce allergic airway inflammation.

실내 스모그 챔버의 설계 및 성능평가

배귀남,김민철,이승복,송기범,진현철,문길주 한국대기환경학회 2003 한국대기환경학회지 Vol.19 No.4

A multi-functional indoor smog chamber was designed and evaluated lo investigate photochenical or water vapor reaction mechanisms of air pollutants. Various smog chamber experiments could be conducted using ambient air or purified air in this smog chamber. The smog chamber consisted of a housing, a Teflon bag, blacklights, injection ports, sampling ports, and utility facilities. The characteristics of light source, the wall losses of air pollutants, and the quality of purified air were experimentally investigated. The maximum NO₂ photolysis rate was 1.10min^(-1). In a 2.5-m³ Teflon bag, the wall losses of ambient O₃, NO, and NO₂were 1.2~2.4×10^(-3)min^(-1), 0.7~2.0×10^(-3)min^(-1), and 0.4-2.0×10^(-3)min^(-1), respectively. The wall loss of ambient particles ranging 0.05 to 0.2㎛ was 1.8~5.4×10^(-3)min^(-1), which was slightly higher than those of ambient gaseous species. The purified air supply system provided high quality of air with NO₂, < 1 ppb, and total hydrocarbons <5 ppb.

Case Reports : A case of recurrent giant cell tumor with lung metastasis during pregnancy

( Ki Cheol Kil ),( Jin Young Yoo ),( Sun Young Nam ),( Jae Eun Chung ),( Young Lee ) 대한산부인과학회 2010 Journal of Womens Medicine Vol.3 No.2

Giant cell tumor (GCT) is a locally aggressive tumor that primarily occurs in young female adults. These tumors rarely present in the spine, recur locally, and may be present during pregnancy because of growth promoting receptors. A 28-year-old pregnant woman presented to us at 28 weeks` gestation with abdominal pain and severe back pain. Radiographs of the chest suggested a tumor recurrence in the previous thoracic vertebra giant cell tumor and lung metastasis. She was performed preterm emergency cesarean section of a 1.33 kg baby because of preterm premature rupture of membranes and fetal distress. On postpartum 6th week, she was performed tumor excision and vertebrectomy. This is an unusual presentation of thoracic spine during pregnancy.

충남 태안 패류생산해역에서의 세균학적 위생안전성 평가

송기철 ( Ki Cheol Song ),이두석 ( Doo Seng Lee ),심길보 ( Kil Bo Shim ),임치원 ( Chi Won Lim ),목종수 ( Jong Su Mog ),변한석 ( Han Seok Byun ),박영제 ( Young Je Park ),조기채 ( Ki Chae Cho ) 한국수산학회 2008 한국수산과학회지 Vol.41 No.3

자궁경부 종양 환자에서 세포진 검사, 질확대경조준하생검, 원추절제술의 진단적 정확도와 원추절제술 후 잔류 종양의 예측인자

길기철(Ki Cheol Kil),허수영(Soo Young Hur),이귀세라(Gui Se Ra Lee),양용재(Yong Jae Yang),이지현(Jee Hyun Lee),이희중(Hee Joong Lee),김사진(Sa Jin Kim),김은중(Eun Jung Kim),송승규(Seung Kyu Song),남궁성은(Sung Eun NamKoong),김수평(Soo P 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.9

목적: 세포진 검사, 질확대경 검사, 질확대경 조준하생검, 원추절제술 및 자궁적출술을 연속적으로 시행한 자궁경부 종양 환자에서 각각의 검사 결과를 조직병리학적으로 비교하여 상호간의 정확도를 분석하고 원추 절제술 후 잔류 종양의 예측 인자를 조사하여 자궁경부 초기암 환자의 진단과 치료 관리에 도움을 주고자 본 연구를 시작하였다. 연구방법: 1993년 1월부터 1998년 8월까지 가톨릭대학교 의과대학 부속 성가병원 산부인과를 방문하여 자궁경부 세포진 검사 및 질확대경 검사에서 이상 소견을 보이는 환자 중에서 질확대경 조준하생검 후, 적응증에 따라 연속적으로 원추 절제술과 자궁적출술을 시행한 167명을 대상으로 하였다. 결과: 세포진 검사의 진단적 정확도(완전 일치율)는 59.3%(99/167), 질확대경 조준하생검의 진단적 정확도(완전 일치율)는 71.3%(119/167), 원추 절제술과 자궁적출술 후 조직 소견을 비교한 결과 자궁적출술 조직 소견 중 51예(30.1%)에서 잔류 종양이 확인되었는데, 동일한 병변이 잔류한 것이 46예(90.2%), 원추절제술보다 낮은 병변이 잔류한 경우가 4예(7.8%)이었고 더 진행된 병리 소견을 보이는 경우는 1예(2.0%)이었다. 원추절제술 후 조직의 절제면에서 종양 세포의 침범 유무와 추후 실시한 자궁적출술 후 조직병리검사에서 잔류 종양 유무와의 상관관계를 관찰한 바 침범이 있었던 군에서 잔류 종양이 더 많음을 확인할 수 있었다(P<0.001). HPV 16 혹은 18 DNA 검출과 잔류 종양의 존재와는 관계가 없었다. 결론: 세포진 검사와 질확대경 조준하생검이 자궁경부 종양 환자의 진단에 유용하지만 자궁경부 상피내종양 III 또는 미세침윤암이 의심되는 경우에는 원추절제술을 시행하여 병변을 정확히 판단하여야 하며 원추절제술 후 절제면에서 종양 침범이 발견된 경우 잔류 종양의 가능성이 높으므로 보다 적극적인 치료가 필요 할 것으로 생각된다. Objective: This study was performed to evaluate the diagnostic accuracy of cytology, colposcopically directed biopsy and conization and to analyze predictive factors for residual tumor after conization in patients with cervical neoplasia. Methods: We reviewed 167 patients who had undergone cytology, colposcopically directed biopsy and conization followed by subsequent hysterectomy depending on their current disease status at the Department of Obstetrics & Gynecology, Catholic University of Korea Medical College, Holy Family Hospital from January, 1993 to August, 1998. The diagnostic accuracy of cytology, colposcopically directed biopsy and conization were investigated. Also, we investigated the significance of the margin status and the presence of HPV which were used to predict residual tumors in hysterectomy specimens after conization. Results: The results of each methods were analyzed with regard to the histopathologic findings of the surgical specimen. The accuracy rates of cytology, and colposcopically directed biopsy were 59.3% (99 of 167) and 71.3% (119 of 167), respectively. After conization, residual tumors were found in 30.1% of subsequent hysterectomized specimens (51 of 167). Underestimation by conization occurred in 2.0% of cases (1 of 51) and overestimation in 7.8% (4 of 51). Residual tumors were significantly more frequent in patients with positive conization margins than in those with negative margins (P<0.001). But the presence of HPV was not significant. Conclusion: These results suggest that diagnostic conization seems to be essential procedure in patients showing abnormal results by cytology and colposcopically directed biopsy, especially in those with CIN III or microinvasion, for the further proper management of cervical neoplastic lesion and margin status is useful in predicting residual tumor after conization.

증례 : 임신 제 2삼분기에 합병된 급성 간질성 폐렴 2예

길기철 ( Ki Cheol Kil ),이귀세라 ( Lee Gui Se Ra ),이세연 ( Se Yeon Lee ),최정수 ( Jung Soo Choi ),유희정 ( Hee Jung Yu ),권동진 ( Dong Jin Kwon ),신종철 ( Jong Chul Shin ) 대한주산의학회 2006 大韓周産醫學會雜誌 Vol.17 No.4

임신 제 2삼분기에 발생한 급성 간질성 폐렴을 기계호흡과 고용량 corticosteroid로 치료한 경험을 보고하고자 한다. 임상 양상, 검사 및 영상 진단 기술. 증례 1) 29세 G1P1 임신 24+3주의 산모가 3주간 지속된 기침, 객담, 호흡 곤란과 흉통을 주소로 내원하였다. 양쪽 폐에서 수포음을 동반한 거친 호흡음이 들렸으며 흉부 방사선 검사에서 폐렴을 의심하여 시행한 HRCT에서 ARDS를 동반한 급성 간질성 폐렴을 의심하는 소견을 보여 기계 호흡 치료 및 기관 절개를 시행하였고 항생제와 고용량 corticosteroid 치료를 시행하였으며 제왕 절개로 사산아를 출산 후 증상이 좋아져 corticosteroid 용량을 줄인 후 퇴원하였다. 증례 2) 33세 G1P1 임신 24+4주의 산모가 3개월간의 지속적인 기침과 객담, 호흡 곤란 주소로 내원하였다. 양쪽 폐에서 거친 호흡음이 청취되었고 흉부 방사선 검사에서 간질설 폐렴을 의심하는 소견을 보여 시행한 HRCT에서 ARDS를 동반한 급성 간질성 폐렴 혹은 좁쌀 결핵의 소견을 보여 즉각적으로 항생제 및 고용량 corticosteroid를 정주하였지만 호전이 없고 호흡 곤란 심해져 기관 삽관 후 기계호흡 치료를 시행하였으며 임신 26+1주에 분만을 하였고 분만 후 DIC가 발생하여 사망하였다. 급성 간질성 폐렴은 매우 드물며 치명적인 질환으로 59~100%의 사망률을 보인다. 임상 양상, 검사실 소견, 치료 방법이 아직 확립이 되지 않은 상태이다. 흉부 방사선 검사와 HRCT가 진단에 도움이 되며 고용량 steroid와 면역억제 요법이 사용되지만 그 효과는 장담할 수 없다. We present two cases of acute interstitial pneumonia (AIP) during the second trimester of pregnancy managed by mechanical ventilation, high dose corticosteroids. We described clinical course, laboratory data and imaging studies. Case 1) A 29-year-old woman, G1P1, was referred for aggravated continuous coughing, sputum and dyspnea, pleuritic chest pain and mild fever for 3 weeks at 24+3 weeks of gestation. There were coarse breathing sounds with crackles on the both lung field. Her chest X-ray showed diffuse haziness in both lungs with suspicious nodular opacities and suggested pneumonia. HRCT showed diffuse ground glass opacities with interstitial thickening and suspicious fine nodular infiltration in both lungs suggesting acute interstitial pneumonia combined with ARDS. Because her symptoms were more aggravated, she was performed mechanical ventilation treatment. After that, she was performed cesarean hysterotomy and delivered a dead male 850grams. After her symptoms were much more improved. All antibiotics were stopped and reduced the doses of steroids, she was discharged with t-tube capped state. Case 2) A 33-year-old woman, G1P1, was referred for continuous coughing, sputum and dyspnea for 3 months and low abdominal discomfort at 24+4 weeks of gestation. There were coarse breathing sounds with rales on the both lung field. Her chest X-ray showed diffuse haziness in both lungs with suspicious nodular opacities and suggested interstitial pneumonia. HRCT showed diffuse ground glass opacities with some intralobular and interlobular interstitial thickening and suspicious fine nodular infiltration in both lungs suggesting acute interstitial pneumonia or miliary TBc combined with ARDS. She was treated with antibiotics, oxygen, high dose corticosteroids, and tocolytics. There was no evidence of TBc in the bronchoscopy. She showed decreased mentality and decreased O2 saturation below 90% in spite of mechanical ventilation, high dose steroids and IVGV therapy. She delivered a boy of 870 g (Apgar score 1/5). After delivery, she was expired due to combined aggravating DIC. Her baby was expired at the next day, too. The outcome of AIP is fatal, reporting 59~100% mortality rate. The clinical course, laboratory data and treatment are not well established due to rarity of this disease entity. Chest X-ray and HRCT may be helpful in diagnosis and high dose steroid and immunosuppressive agents usually used but the efficacy is not guaranteed.