Factors associated with the risk of colorectal neoplasia in young adults under age 40

Ilsoo Kim,Han Hee Lee,Young Jae Ko,Ho Eun Chang,Dae Young Cheung,Bo-In Lee,Young-Seok Cho,Jin Il Kim,Myung-Gyu Choi 대한내과학회 2022 The Korean Journal of Internal Medicine Vol.37 No.5

Background/Aims: Recent epidemiologic studies have shown a continued increase in colorectal cancer incidence among younger adults. Little is known about the factors that contribute to the development of young-onset colorectal neoplasia (CRN). Methods: A cross-sectional analysis was performed for individuals younger than 40 years who underwent colonoscopy in Seoul St. Mary’s Hospital and its affiliated health screening center. High-risk CRN was defined as adenoma or sessile serrated lesion ≥ 10 mm, with three or more adenomas, villous histology, high grade dysplasia, or carcinoma. Results: Of these 13,621 included participants, 2,023 (14.9%) had one and more CRN. Young patients with CRN tended to be elderly, male, obese, smoker, having a habit of drinking, and having comorbidities such as hypertension, dyslipidemia, diabetes, and chronic kidney disease. In a multivariate analysis adjusted for age, sex, obesity, smoking status, and alcohol intake, old age (odds ratio [OR], 1.086; 95% confidence interval [CI], 1.054 to 1.119), male sex (OR, 1.748; 95% CI, 1.247 to 2.451), obesity (OR, 1.439; 95% CI, 1.133 to 1.828), and smoking (OR, 1.654; 95% CI, 1.287 to 2.127) were independent risk factors for overall CRN. Obesity and smoking as two modifiable factors increased the risk for high-risk CRN even more than for overall CRN (OR, 1.734; 95% CI, 1.168 to 2.575 and OR, 1.797; 95% CI, 1.172 to 2.753, respectively). Conclusions: Obesity and smoking were modifiable risk factors for CRN in young adults. They increased the risk for highrisk CRN even more than for overall CRN. A colonoscopy might be beneficial for young individuals with these factors.

중증 외상 환자의 골반골절에서 경피적 혈관 색전술과 Young과 Burgess 분류의 상관관계

차용한 ( Yong Han Cha ),설영훈 ( Young Hoon Sul ),김하용 ( Ha Yong Kim ),최원식 ( Won Sik Choy ) 대한외상학회 2015 大韓外傷學會誌 Vol.28 No.3

Purpose: Immediate identification of vascular injury requiring embolization in patients with pelvic bone fracture isn’t an easy task. There have been many trials finding indicators of embolization for patients with pelvic bone fracture. Although Young and Burgess classification is useful in decision making of treatment, it is reported to have little value as indicator of embolization in major trauma patients. The aim of this study is to find out Young and burgess classification on predicting vessel injury by analzyng pelvic radiograph taken from major trauma patients with pelvic bone fracture. Methods: Among major trauma patients with injury severity scores (ISS) higher than 15 who visited our emergency room from January 2011 to June 2014, 200 patients were found with pelvic bone fracture in trauma series and thus pelvic CT angiography was taken. Setting aside patients with exclusion criteria, 153 patients were enrolled in this study for analysis of Young and Burgess classification. Results: The most common mechanism of injury was lateral compression in both groups. There was no statistical significant difference in Young and Burgess classification (p=0.397). The obturator artery was the most commonly injured artery in both groups. Six patients had more than one site of bleeding. Conclusion: Prediction of transcatheter angiographic embolization using Young and Burgess classification in severe trauma patients is difficult and requires additional studies. [ J Trauma Inj 2015; 28: 144-148 ]

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.

물리학 선량법을 이용한 갑상선암의 개인별 최대안전용량 I-131 치료법 개발과 유용성 평가

김정철,윤정한,범희승,제갈영종,송호천,민정준,정환정,김성민,허영준,이명호,박영규,정준기 대한핵의학회 2003 핵의학 분자영상 Vol.37 No.2

목적 : 분화갑상선암 환자에 대한 방사성옥소(I-131) 치료는 재발율과 사망률을 감소시키는 효과적인 치료법이지만, 치료용량을 증가시킴으로써 치료율을 향상시킬 수 있는지에 대해서는 아직 논란이 있다. 본 연구에서는 최대허용선량 치료법의 효용성을 검증하고자 하였다. 대상 및 방법 : 임상적 병기가 제3, 4병기이고, 6개월 이후에 I-131 전신스캔(이하 IWBS)과 혈중 thyroglobulin (이하 Tg), anti-thyroglobulin antibody (이하 ATA), 초음파검사 (이하 US) 및 F-18 FDG PET 등을 통해 치료여부를 확인할 수 있었던 58명(남:여=9:49, 평균연령 50±11세)의 유두상갑상선암 환자를 대상으로 하였다. 이중 11명은 제4병기, 47명은 제3병기였으며, 43명(남:여=4:39), 평균연령 50±11세)은 7.4 GBq 이하의 고식적인 저용량치료법으로 치료하였고, 9.25 GBq 이상의 고용량 치료를 받은 환자는 15명(남:여=5:10, 평균연령 50±12세)으로 고용량군에서 남자가 더 많았으나 연령의 차이는 없었다. 고용량군 환자 모두에서 추적용량의 방사성옥소(평균 77±3 MBq)를 경구 투여한 후 혈중 방사능소실곡선을 통해 최대허용선량(maximum permissible dose, 이하 MPD)을 계산하였으며, 7명에서는 말초혈액림프구의 중기염색체분석법에 의해 생물학적으로 MPD를 계산하였다. 14명에서는 치료용량의 방사성옥소를 투여한 후 혈중 방사능소실곡선을 통해 MPD를 계사하였다. 완전치유(complete response, 이하 CR)는 IWBS에서 병소가 없어지고, 혈중 Tg치가 1 ng/mL 이하로 감소한 경우로 정의하였으며, 부분치유(partial response, 이하 PR)는 IWBS에서 병소가 없어졌더라도 혈중 Tg, ATA치가 높거나, US 또는 PET 검사에서 병소가 남아있는 경우로 정의하였다. 치료후 IWBS에서 병소가 오히려 증가하거나 변함없는 경우는 없었다. 방사성옥소 치료에 의한 부작용은 입원기간 중 타액선이 현저하게 붓고 통증이 있거나, 구토를 심하게 하는 경우, 그리고 퇴원후 1개월째 백혈구수가 20% 이상 감소한 경우로 정의하였다. 결과 : 양 군간에 연속적인 수치변화를 비교하는 경우는 paired t-test를 이용하였으며, 대상군간 치료효과와 부작용의 비교는 chi-square test를 이용하였다. p값 0.05 미만을 통계적으로 유의한 차이로 인정하였다. 고용량군 환자 모두에서 추적용량과 치료용량의 방사성옥소 투여 후 혈액의 피폭선량은 각각 0.012±0.3 Gy, 1.66±25 Gy였으며, 방사성옥소 투여 후 혈액에 전달되는 피폭선량은 추적용량보다 치료용량에서 더 많았고 (1.21: 166 rad, p<0.001), 방사성옥소 1 mCi당 혈액에 전달되는 피폭선량은 차이가 없었다(0.58±0.1 vs. 0.56±0.1 rad/37 MBq, p=0.34). 추적용량 방사성옥소 투여 후 구한 MPD는 평균 13.3±1.9 GBq (9.7 ~ 16 GBq) 이였고, 치료용량 방사성옥소 투여 후 구한 MPD는 평균 13.8±2.1 GBq (10.4 ~ 16.3 GBq)로 유의한 차이가 없었으며 (p=0.20), 두 수치간에는 유의한 상관 관계가 있었다(r=0.8, p<0.0001). 7명의 환자에서 말초혈액림프구 중기염색체 분석법으로 MPD를 측정하였는데 혈액의 피폭선량은 1.78±0.03 G였으며, 같은 환자에서 혈중 방사능소실곡선으로부터 구한 피폭선량은 1.54±0.03 G로 유의하게 낮았으나 (p=0.01), 두 측정치 간에는 유의한 상관관계(r=0.86, p=0.01)가 있었다. 저용량 치료군 43명 중 22명(51.2%)에서 완전치유를 보였고 21명(48.8%)에서는 부분치유를 보인 반면 고용량 치료군 15명 중 12명(80%)에서 완전치유를 보였고 3명(20%)에서만 부분치유를 보여 고용량 치료군에서 유의하게 높은 완전치유를 얻을 수 있었다(p=0.05). 한편 부작용 발생빈도는 저용량 치료군 43명 중 13(30.2%), 고용량 치료군 15명 중 6명(40%)로 양군간에 유의한 차이가 없었다(p=0.46). 임상적인 병기, 연령 및 성별에 따라서는 치유의 차이가 없었다(p>0.05). 결론 : 혈중소실곡선으로부터 MPD를 결정하고 이를 토대로 환자 개개인별로 적절한 선량을 선택하여 치료하는 방법은 부작용을 최소화하면서도 치료효과를 높일 수 있는 매우 유용한 치료법이며, 고위험군 분화갑상선 암 환자에게 가장 적절한 치료법이라고 사료되었다. Purpose: Radioiodine (1-131) therapy is an effective modality to reduce both recurrence and mortality rates in differentiated thyroid cancer. Whether higher doses shows higher therapeutic responses was still debatable. The purpose of this study was to validate curve-fitting (CF) method measuring maximum permissible dose (MPD) by a biological dosimetry using metaphase analysis of peripheral blood lymphocytes. Materials and Methods: Therapeutic effects of MPD was evaluated in 58 patients (49 females and 9 males, mean age 50±11 years) of papillary thyroid cancer. Among them 43 patients were treated with ≤7.4 GBq, while 15 patients with ≥9.25 GBq. The former was defined as low-dose group, and the latter high-dose group. Therapeutic response was defined as complete response when complete disappearance of lesions on follow-up 1-131 scan and undetectable serum thyroglobulin levels were found. Statistical comparison between groups were done using chi-square test. P value less than 0.05 was regarded as statistically significant. Results: MPD measured by CF method using tracer and therapeutic doses were 13.3±1.9 and 13.8±2.1 GBq, respectively (p=0.20). They showed a significant correlation (r=0.8, p<0.0001). Exposed doses to blood measured by CF and biological methods were 1.54±0.03 and 1.78±0.03 Gy (p=0.01). They also showed a significant correlation (r=0.86, p=0.01). High-does group showed a significantly higher rate of complete response (12/15, 80%) as compared to the low-dose group (22/43, 51.2%) (p=0.05). While occurrence of side effects was not different between two groups (40% vs. 30.2%, p=0.46). Conclusion: Measurement of MPD using CF method is reliable, and the high-dose 1-131 therapy using MPD gains significantly higher therapeutic effects as compared with low-dose therapy.

고온에서 HAN 계열 추진제 액적의 거동에 대한 연구

황창환(Chang Hwan Hwang),백승욱(Seung Wook Baek),한조영(Cho Young Han),김수겸(Su Kyum Kim),전형열(Hyung Yeol Jeon) 한국연소학회 2012 KOSCOSYMPOSIUM논문집 Vol.- No.45

The droplet behavior of 83.9 wt.% HAN water solution was investigated experimentally with various ambient temperature and nitrogen environment. At the initial stage of evaporation under thermal decomposition temperature of HAN, gradual decreasing of droplet diameter was observed. After that, the droplet started to expand due to the internal pressure build up by water nucleation inside the droplet. The micro explosion was observed at higher temperature than the decomposition temperature of HAN and the remaining droplet showed similar behavior of single composition droplet. The decreasing rate was augmented as the ambient temperature increasing.

漢江下流部 水害輕減을 爲한 調査 硏究

金漢星,高在雄,李相鎔,玄義泰,柳興根 건국대학교 1974 學術誌 Vol.17 No.1

The effect of reducing flood magnitudes, flood stages, and flood damage by upstream reservoir regulation are investigated in this study. The analytical procedures which has been established newly, are treated through this study for 7 index stations and same numbr of reaches. The method of this study could be expressed briefly as following procedures. Using stage-frequency relations and the potential damage survey data, damage-frequency relations are established, and from this, average annual flood damages computed. By holding out portions of the floods with various amounts of flood control storage in 6 reservoirs in the basin, routing were made to establish modified stage-frequency relations. From damage frequency relation, average annual damages are computed with and without condition of each control volume. The study result are concluded as follows; (1) The relationtship of corresponding water level between nearby stations are useful tools to adjust error of the data due to observation error and change of the gaging location. (2) The number of records about 10 years could not be applied for the statistical methods of flood frequency analysis. (3) The regional skew factors are recommended to apply flood frequency study by the log-Pearson Type III method. (4) The effect of damage reductions are greatly affectedin accordance with the routed flood. Therefore application of the Typical Tributary Contribution Flood are reasonable for this type of study. (5) In the North Han, effect of damage reduction due to the lacation of control point are gradually increased from upstream to downward until the confluence of North and South Han. (6) In the South Han, control effect are increased from Chungju to Yeoju where the maximum effect are analyzed and then decrease gradually until the confluence. (7) Better hydrologic and topographic combinations for the flood control are existed in South Han to compare with North Han in this study results.

선천성 일측성 폐정맥 폐쇄증 1 예

김철호,이계영,심영수,김건열,한용철,한성구,정희순,임정기,박재형 대한내과학회 1988 대한내과학회지 Vol.35 No.3

Unilateral pulmonary vein atresia is a rare congenital disease and is frequently associated with intracardiac anomalies. It is usually diagnosed in childhood and is very rarely diagnosed in adulthood. A case of unilateral pulmonary vein atresia in a 20-year old female is de- scribed. The relevant findings were symptoms of exertional dyspnea, roentgenographic evidence of decreased lung volume, increased interstitial infiltration with septal lines in the involved side (right), and aoscence of blood flow in a radionuclide perfusion scan. Pulmonary angiography showed an extremely small right pulmonary artery and thining of the peripheral branches, and nonvisualization of the draining pulmonary veins. Bronchial arteriography showed rommunication between the bronchial artery and the right pulmonary artery and it was drained to the left pulmonary artery. Cardiac catheterization showed no intracardiac anomaly. The right bronchography was normal; pulmonary function studies showed a pure restrictive pattern and markedly in creased physiologic dead space. MRI showed no visible right pulmonary vein.

복합열화환경 하에서의 단면복구재의 철근부식특성 평가에 관한 실험적 연구

김영덕,박종호,조봉석,김용로,권영진,김무한 대한건축학회 2004 대한건축학회 학술발표대회 논문집 - 계획계/구조계 Vol.24 No.1

The duties of the restorative material are to bear up against stress and to protect reinforcement corrosion. So the restorative material are estimated by various kinds of strength, permeability and etc. But to evaluate performance of the restorative material accurately, it is necessary to estimate their reinforcement corrosion directly in environment of combined deterioration. In this study, to evaluate performance of restorative materials, we compare their properties in terms of compressive and bending strength and permeability of water and air with actual reinforcement corrosion like ratio of corrosion area, weight reduction and corrosion velocity of steel bar under environment of complex deterioration. The results showed that strength and permeability of restorative materials are similar but their reinforcement corrosions are very different. And there is a case that strength and permeability of restorative material are better than normal concrete but reinforcement corrosions are worse.

Multiple myeloma 환자에서 Bortezomib치료 후 발생한 마비성 장폐색증 1례

김준영,이원식,손창학,박성길,진한영,박석주,조영완,정은욱,강명주,박정하,주영돈 인제대학교 2006 仁濟醫學 Vol.27 No.-

Bortezomib is the first clinically available proteasome inhibitor that is clinically effective in the treatment of multiple myeloma. A proteasome inhibitor acts through multiple mechanisms to arrest tumor growth, tumor spread, and angiogenesis. The main adverse effects of bortezomib are gastrointestinal symptoms, cytopenia, fatigue, and peripheral neuropathy. To date, severe paralytic ileus has not been reported as a toxic effect of bortezomib treatment in multiple myeloma. Bortezomib is a novel agent that has only been used clinically for 30 months, so a need exists to further evaluate its toxicity. We report a case of grade Ⅲ (NCI CTCAE v3.0) or grade Ⅳ(SWOG toxicity criteria) paralytic ileus in a 65-year-old man with relapsed multiple myeloma who underwent one cycle of single-agent bortezomib treatment scheduled in a 21-day cycle (1.3 mg/㎥ as a single i.v. bolus on days 1, 4, 8, and 11).

Rifampicin에 의한 것으로 추정되는 위막성 대장염1예

김수현,이은우,정종혁,문승현,김동한,양혁승,오영상,김호동,김도현,박혁,박정환,박경옥,이영직 朝鮮大學校 附設 醫學硏究所 2006 The Medical Journal of Chosun University Vol.31 No.2

Pseudomembranous colitis, caused by altering the normal colonic flora and allowing the multiplication of Clostridium difficile, is an deleterious adverse effect of antibiotics. But it is rarely reported by rifampicin. Rifampicin is one of the first line drug in the treatment of tuberculosis and many patients are exposed to its potential adverse effects. We experienced a patient that had abdominal discomfort and hematochezia due to pseudomembranous colitis after receiving antituberculous medication, and which was probably caused by rifampicin. A 82 years old man was admitted with abdominal discomfort and hematochezia for one week. On the past history he had been diagnosed as endobronchial tuberculosis about 4 months ago. Colonoscopy revealed multiple discrete whitish mucosal lesion on rectosigmoid colon, and histologic findings were consistent with pseudomembranous colitis. The antituberculous agents were discontinued and vancomycin was administered. The patient's symptoms were resolved within several days. There was no recurrence after reinstitution of the antituberculous agents excluding rifampicin. We report here on a case of pseudomembranous colitis probably due to rifampicin.