가토에서 CCNU 로 유발된 골수 저형성증의 혈액학적 소견과 골수스캔의 변화에 관한 연구

김승택,이명철,최두혁,고창순,김병국,이문호,박선양,최성재,김노경,최영희 대한내과학회 1986 대한내과학회지 Vol.30 No.1

To understand systematically the hematological changes including the bone marrow changes in chemotherapeutic agent-induced bone marrow hypoplasia and to define the relationship between hematological and bone marrow scan findings and prognosis of the hypoplasia, CCNU (lomustine) was given orally to 44 rabbits to induce hypoplasia of the bone marrow. And serial changes of peripheral blood and bone marrow findings and (111)In Cl(3)((111)In scan)/(99m)Tc tin colloid bone marrow scan((99m)Tc scan) were checked before and after induction of hypoplasia. With assessment of 28 evaluable rabbits, the following results were obtained: 1) Significant hypoplasia of the bone marrow developed around day 4 of CCNU administration and recovered around day 14(cellularity 51,4±13.5% and 24. 5±14.97o before and after CCNU respectively, p<005). Megakaryocyte count was significantly depressed from 95.67,26% to 36.7$gt;31.82%(P$lt;0.005). M: E ratio was decreased from 162±1.19 to 0, 0.5$lt;0. 43(p±0.005). Shift to left(475), maturation a(40%), naked nucleus and degenerated cells(20%), increase of lymphocytes(47%), monocytes and reticulum cells were also found. 2) The uptake ratio of the 99(m)Tc tin colloid bone marrow scan was markedly increased in contrast to the depression of the bone marrow(4.4±2.12 and 14.1±7.06 before and 4 days after CCNU, respectively, p40. 005). Tc scan uptake ratio was inversely related to the cellularity(r=-0.442, p$lt;0.05) and megakaryocyte number of the bone marrow(r= 0.89, p< 0.01) and peripheral blood granulocyte (r = 0. 54. Pg0.01) and platelet count(r=0.40, p$lt;0.05). There was not significant correlation between (111)In scan uptake ratio and hematologic parameters. 3) The amplitude of the change of the (99m)Tc scan uptake ratio was significantly related to the prognosis of the rabbits with experimentally induced hypoplasia of the bone marrow(dead 5.1±2,67, survivors 2,5±0.96, P<0.01). The change of the (111)In scan uptake ratio was not related to the prognosis of these rabbits. In experimentally induced rrow hypoplasia, morphologic changes in addition to the numerical changes of the bone marrow elements were observed. And serial (99)Tc scan of the bone marrow appears to be helpful assessing the severity and predicting the outcome of bone marrow hypoplasia.

Mycobacterium Avium - in tracellulare Complex 와 M . Fortuitum 에 의한 폐항산균증(肺抗酸菌症) 3예

김상재,홍수표,배길한,김성진,진병환,정충모 대한미생물학회 1982 大韓微生物學會誌 Vol.17 No.1

Two cases of pulmonary disease in a 54 year-old female and a 70 year-old male patient due to Mycobacterium avium-intracellulare complex (MAIC) and a case of pulmonary infection in a 69 year-old male patient due to M fortuitum (MF) were found recently in this institute. All three patients bad a long history of anti-tuberculous chemotherapy because they were initially diagnosed as pulmonary tuberculosis. A 70 year-old male patient infected with MAIC had an unsuccessful chemotherapy history of isoniazid (INH), para-aminosalicylic acid (PAS) and streptomycin (SM) with an incomplete, temporary, symptomatic improvement, for three years since 1964 when he was first diagnosed as pulmonary tuberculosis on physical examination. A 54 year-old female patient infected with MAIC also had an unsuccessful chemotherapy history with the various anti-tuberculous drugs since 1958. Both patients discharged large number of MAIC in their sputum specimens for at least more than one year, but no M tuberculosis at all. A 69 year-old male patient infected with MF was diagnosed as moderately advanced pulmonary tuberculsis in 1977. Combined chemotherapy with INH+PAS+pyrazinamide (PZA) improved his clinical symptoms, however, his chest radiograph was deteriorated again in 1980 one year after he stopped therapy. Therefore he started chemotherapy again with INH+ethionamide (TH)+cycloserine(CS) but no improvement was noticed. MF was cultured from his sputum in August 1983 and he continuously discharged the same baeilli until last examination of January l982. Whether all three patients were initially infected with nontuberculous mycobacteria or complicated with predisposing tuberculosis was not clear because there were no reliable bacteriological Examination records.

급성 골수성 백혈병(M6)에 합병된 중추성 요붕증 1 예

김성연,조보연,이홍규,고창순,민헌기,김병국,김노경,신찬수,이명식,강덕현,조종태 대한내과학회 1989 대한내과학회지 Vol.37 No.2

Leukemia is known to be an extremely rare cause of diabetes insipidus. We report a case of diabetes insipidus as a complication of leukemia. An 18 year-old man was admitted because of polyuria polydipsia and fever. Bone marrow aspiration and biopsy revealed the diagnosis of acute erythroleukemia (AML, M6). On the water deprivation test, the diabetes insipidus was confirmed to be of the central type. He was managed with intranasal vasopressin for diabetes insipidus with good response. Induction chemotherapy was administered without response, and the patient died of septicemia and respiratory failure 2 months after initial diagnosis. A short review of the literature related to this subject is also presented.

PTA 법에 의한 스텔라이트 12 합금 육성층의 조직과 경도에 미치는 전류와 예열온도의 영향

정병호,김민영,김무길,김규덕,이성열 한국열처리공학회 2000 熱處理工學會誌 Vol.13 No.4

Stellite 12 alloy-powder was overlaid on 410 stainless steel valve seat using plasma transferred arc(PTA) process. Variation of characteristic of microstructure and hardness of deposit with current(90-150A) and preheat temperature(R.T.∼400℃) was investigated. Important conclusion obtained are as follows; All welding conditions used produced a sound deposit layer with no defect in single pass welding. The maximum deposit had 4.0∼4.8㎜ in thickness and its bead width was increased with increase of current and preheat temperature. The deposit showed hypoeutectic microstruture, which was consisting of primary cobalt dendrite and networked M_7C₃type eutectic carbides. The amount of eutectic carbides was decreased and its dendritic secondary arm spacing was increased with increase of current. Hardness of the deposit was decreased with increase of current. Preheat temperature up to 400℃, however, showed little influence on the hardness and microstructure. The hardness was also influenced by diluted Fe content near the interface in addition to microstructure and dendritic secondary arm spacing. Hot hardness at 500℃ showed higher than 300HV.

갑상선자극 호르몬 분비에 대한 Dopaminergic Control에 관한 연구

이정상,이문호,고창순,김응진,김명덕 대한핵의학회 1978 핵의학 분자영상 Vol.12 No.2

1978년 4월부터 1978년 8월사이에 서울대학교병원 내과에 내원하였던 원발성 갑상선기능저하증 환자 9명과 일반신체검사 및 갑상선기능검사상 전혀 이상이 발견되지 않은 의과대학생 6명과 수련의 1명 총 16명을 대상으로 Dopamine 수용체를 선택적으로 차단하는 Metoclopramide와 Dopamine 수용체를 선택적으로 자극하는 Bromergocryptine(CB-154)을 각각 혹은 함께 투여해서 다음과 같은 결과를 얻었다. 1) Metoclopramide(Moxolonⓡ) 10mg을 정맥으로 주사했을때 원발성 갑상선기능저하증 환자들에서는 투여후 20분에 말초혈액에서 갑상선자극호르몬이 통계학적으로 유의하게 증가되었으며, 60분에도 계속 증가되었다. 그 이후 180분까지 계속 증가된 장태를 유대했으며, 중증보다 경증에서 더욱 현저하게 증가되어 나타났다. 그러나 정상인에서는 이러한 증가가 나타나지 않았다. 2) Bromergocryptine(CB-154)을 2mg 경구투여했을때 원발성 갑상선기능저하증 환자들에서는 투여후 120분에 말초혈액에서 갑상선자극호르몬이 현저하게 감소되었고, 240분 및 360분까지 계속 감소되었으며, 중증보다 경증에서 더욱 현저하게 감소되어 나타났다. 그러나 정상인에서는 이러한 감소가 나타나지 않았다. 3) Bromergocryptine(CB-154) 2mg을 경구투여한 후 120분에 Metoclopramide(Moxolonⓡ) 10mg을 정맥 주사했을때 원발성 갑상선기능저하증 환자들에서는 Bromergocryptine을 투여한 후 120분에 말초혈액에서 갑상선자극호르몬이 감소했으며, Metoclopramid를 투여한 후에 약간 증가하는 추세였으나, Metoclopramide를 단독으로 투여했을 때와 같은 현저한 증가는 나타나지 않았으며, 정상인들에서는 Bromergocryptine 및 Metoclopramide를 투여했을때 뚜렷한 증가나 감소는 보이지 않았다. 4) 생리식염수 2ml를 정맥주사했을 때 원발성 갑상선기능저하증 환자들 및 정상인들에서 갑상선자극호르몬이 말초혈액에서 뚜렷한 증가 내지 감소는 보이지 않았다. 5) Metoclopramide와Bromergocryptine을 각각 혹은 함께 투여했을때 및 생리염수를 투여했을 때 혈중 Triiodothyronine 및 Thyroxine치는 각각의 기저치들에 비해 통계학적으로 유의한 증가나 감소를 보이지 않았다. 이상의 결과에서 갑상선자극호르몬의 분비가 Dopaminergic Control을 받는다는 사실을 알 수 있었다. 본 연구를 실시함에 있어 물심양면으로 협조해주신 동아제약에 사의를 표하는 바이다. To e1ucidate the depaminergic control of T.S.H. secretion, we analized the pattern of T.S.H secretion in seven normal controls and nine primary hypothyroid subjects, before and after single or combined administration of specific dopaminergic receptor blocker, metoclopramide, and specific depaminergic receptor stimulant, bromergocryptine (CB-154). The results obtained were as follows: 1) There was a significant rise in T.S.H. levels after intravenous injection of metocioramide(10mg) in hypothyroid subjects. But there was no significant rise in T.S.H. levels in normal controls. The T.S.H. response to metoclopramide varied considerably, being large in mild cases and small in severely hypothyroid subjects. 2) There was a significant fall in T.S.H. levels after oral administration of bromergocryptine(2mg) in hypothyroid subjects, but there was no significant fall in T.S.H. levels in normal controls. 3) There was no significant fluctuation in T.S.H. levels after combined administration of both metoclopramide and bromergocrytine. 4) There was no significant fluctuation in T.S.H. levels after intravenous injection of normal saline(2ml) in both hypothyroid and normal subjects. 5) There was no significant change in serum T3 and T4 after administration of metoclopramide and bromergocryptine respectively and serially. These data support the fact that there is a dopaminergic control in the secretioI1 of T.S.H. in the human.

당뇨병에서의 혈장 Renin 활성에 관한 연구

이정상,이문호,김성권,최강원,표희정,박정식 대한핵의학회 1979 핵의학 분자영상 Vol.13 No.1

당뇨병에서의 고혈압 및 신합병증에 따른 Renin Angiotensin-Aldosterone계의 동태를 밝히기 위하여 40예의 당뇨병 환자에서 기저 및 furosemide 정주 2시간 후의 PRA를 측정하였다. 1) 40예의 당뇨병 환자는 신합병증과 고혈압의 유무에 따라 4군으로 분류하였으며, 임상적인 합병증이 없는 Ⅰ군에는 15명, 신합병증이 있는 Ⅱ군에는 7명, 신합병증과 고혈압이 같이 있는 Ⅲ군에는 8명, 고혈압만 있는 Ⅳ군에는 10명의 환자가 속하였다. 2) 각 군의 24시간 요중 Na배설량의 평균치 사이에는 유의한 차이가 없었다. 3) 기저 PRA치는 Ⅰ군이 1.53±1.09ng/ml/hr(Mean±S.D), Ⅱ군이 0.63±0.59ng/ml/hr, Ⅲ군이 0.79±0.62ng/ml/hr, Ⅳ군이 1.11±0.80ng/ml/hr로서 Ⅱ군과 Ⅲ군은 Ⅰ군에 비하여 유의하게 저하되어 있으나(P$lt;0.05), 다른 군들 간에는 유의한 차를 볼 수 없었다. 4) furosemide 정주 2시간 후의 PRA치는 Ⅰ군이 2.72±1.96ng/ml/hr, Ⅱ군이 0.92±0.78ng/ml/hr, Ⅲ군은 1.03±0.76ng/ml/hr, Ⅳ군은 1.73±1.39ng/ml/hr로써 Ⅰ군과 Ⅱ군사이에서만 유의한 차이를 보이고(P$lt;0.05), 다른 당뇨병 환자군 사이에서는 유의한 차를 볼 수 없었다. 5) furosemide 정주에 의한 Renin 분필 자극시험에 대한 반응도 Ⅱ군과 Ⅲ군에서는 둔화되어 있는 양상을 보이나, 시험대상도 적고하여 통계적 유의성에는 미치지 못하였다. 이상의 성적에서 신합병증이 있는 당뇨병에서는 혈장 Renin활성이 저하되며 furosemide 정주에 의한 Renin 분필자극시험에 대한 반응도 둔화됨을 알 수 있었다. 또한 당뇨병성 신합병증에 의한 고혈압에서도 혈장 Renin활성은 저하되는 경향을 보여서 이 경우의 고혈압은 Renin이외의 다른 요인이 작용할 것으로 보인다. To evaluate the renin-angiotensin-aldosterone system in diabetes mellitus, basal plasma renin activity(PRA) and its response to intravenous furosemide were determined in 40 diabetic subjects. The diabetics were divided into 4 groups according to the pressence of nephropathy and/or hypertension. Uncomplicated diabetics(Group I) were taken as control group and the results of the other groups were compared to this group. In diabetics viith nephropathy alone(Group Ⅱ), and with nephropathy and hypertension (Group Ⅲ), basal PRA values were 0.63±0.59ng/ml/hr., and 0.79±0.62ng/ml/hr., respectively, both significantly lower than control group. (1.53±1.09ng/ml/hr.). (P$lt;0.05) In both of the above groups, the responses to intravenous furosemide tended to be blunted. On the other hand, in diabetics, with hypertension only (Group Ⅳ), the basal and stimulated PRA were not significantly different from control. Above results suggests that nephropathy may be one of the factors which suppress renin activity in diabetes me.

Bhattacharya법에 의한 혈청 Ca, Zn, Mg, Cu의 정상치

김영기,서진태,박명희,김상인 대한병리학회 1981 Journal of Pathology and Translational Medicine Vol.15 No.3

Gentamicin 투여에 따른 혈중 및 요중 β2-Microglobulin 동태에 관한 연구

이정상,신영태,정순일,이문호,김병국,김승택,최경원 대한핵의학회 1980 핵의학 분자영상 Vol.14 No.2

저자는 1980년 3월부터 7월까지 서울대학교병원 내과에 입원하여 게타마이신을 투여받았던 각종 감염증환자 10예를 대상으로 겐타마이신의 혈중농도, 혈청크레아티닌, 혈중 및 24시간 요 베타-2-마이크로글로불린을 측정하여 다음과 같은 결론을 얻었다. 1) 겐타마이신의 혈중농도는 최고농도(peak level)는 4.5∼8.2μg/ml, Trough치는 0.2∼2.1μg/ml를 유지하여 안전치료 영역내에 있었다. 2) 혈청 크레아티닌(creatinine)치는 겐타마이신 투여기간중 대상 전원에서 통계학적으로 유의한 증가를 보이지 않았다. 3) 혈중 베타-2-마이크로글로블린치는 겐타마이신 투여기간중 대상 전원에서 통계학적으로 유의한 증감을 보이지 않았다. 4) 24시간 요 베타-2-마이크로 글로블린은 겐타마이신 투여후 전예에서 통계학적으로 유의한 증가를 보여 제 5일에 기저치보다 평균 5.8±1.62배 증가하였으며, 그 이후로는 감소하는 경향을 보였다. 이상의 결과를 종합하면 24시간 요 베타-2-마이크로글로블린 측정은 겐타마이신의 초기 신독성을 예민하게 반영한다는 사실을 알 수 있었으며, 이의 임상적 신독성과의 관계는 앞으로 추시가 필요하다고 생각된다. Gentamicin is useful to the Gram negative bacterial infection, but its nephrotoxicity is a serious problem and the incidence is probably increasing. The toxicity of gcntamicin to the kidney is site-specific to the proximal tubule. In this study, we measured daily peak and trough level of gentamicin, serum creatinine, serum Beta2-microglobulin and 24-hr urine Beta2-microglolbulin in 10 gentamicin treated patients. All the patients had their peak levels of gentamicin in the safe therapeutic range, and their trough level showed no evidence of gentamicin accumulation. There was no patient who showed his daily serum creatinine and Beta2-microglobulin rise significantly. But 24-hour urine Beta2-microglobulin showed significant rise from basal level(mean 5.8±1.62×) on the 5 th day of gentamicin treatment. Thus, serial monitoring of proximal tubular function with urinary Beta2-microglobulin excretion has potential value in the assessment of insults of gentamicin to this site. But clinical significance of raised uriry Beta2-microglobulin excretion in relation to the serum creatinine should be further studied.

중등도 및 중증고혈압에서 Nifedipine 설하투여의 강압효과에 관한 연구

김영훈,서순규,최인석,김열홍,안희권,심완주,노영무 대한내과학회 1986 대한내과학회지 Vol.31 No.5

In order to assess the efficacy of sublingual nifedipine in the acute treatment of moderate to severe hypertension, a single blind test was done in 30 patients, 10 males and 20 females, aged 40 to 76 years, with moderate to severe hypertension. The patients with mean sitting blood pressure(BP) of more than J40 mmHg received sublingual placebo, and BP and pulse rate(PR) were measured in sitting position 10,20 and 30 minutes after the sublingual placebo was given. The patients with post-placebo 30 minutes sitting mean BP of less than 13pmmHg were excluded from the study. The placebo treatment period was followed by the administration of 10mg of sublingual nifedipine, and BP and PR were measured 10,20,30 and 45 minutes after nifedipine was given. BP decreased with placebo treatment(p$lt;0. 01 by paired t-test, preplacebo vs. post-placebo 30 minutes). With sublingual nifedipine BP started to fall in 10 minutes and reached the lowest levels in 30 or 45 minu1es. The systolic BP decreased from 198.0±21.4mmHg to 159±20.4mmHg, diastolic BP from 122.5±13.0 mmHg to 103.2±14.4 mmHg and mean from 147.7±13.4 mmHg to 121.7±14.8 mmHg 45minutes after nifedipine(p$lt;0.01 by paired t-test). The average fall in systolic BP/diastolic BP/mean BP 45 minutes after nifedipine was 39/19/26 mmHg(p$lt;0. 001, by paired t-test). The maximal fall in systolic BP correlated better with pretreatment value(r=0.42) than the maximal fall in diastolic pressure(r=0.21), PR increased from 79±12 to 87±11/minute with nifedipine(p$lt;0.001, by paired t-test). Side effects were mild facial flushing(16.7%) and palpitation (3.3%). The findings suggest that a dose of 10mg of sublingual nifedipine is a simple, effective and safe method for the acute treatment of moderate to severe hypertension and can be used as a non-injecting alternative agent for the treatment of hypertensive emergency.

급성췌장염에 의한 췌장가성남종에서 내시경적 배액술후 발생한 췌장가성남종과 십이지장 및 대장에 발생한 내부 췌장루 1예

김연수,이문성,김진오,조영덕,이영홍,봉형근,조주영,이준성,심찬섭,황성규,전기원,변재호,장재영 대한소화기학회 1996 대한소화기학회지 Vol.28 No.1