비만을 동반한 위암 환자에서 두 병을 같이 수술 치료한 경험(증례)

최경현,윤기영,문형환,신연명,서경원,안수미,송윤미,석정희,정경연,이은하 고신대학교의과대학 2008 고신대학교 의과대학 학술지 Vol.23 No.3

Obesity is growing problem in Korea. We had a case of bariatric surgery during gastric cancer operation. Patient was 29 year old Korean lady with early gastric cancer located in the lesser curvature side of the middle 1/3 of the stomach. Her body weight was 89 kg, height 163 cm, and thus body mass index was 33.5 kg/m2. Preoperative blood pressure was 130/90 mmHg, hemoglobin 12.9 g/dL, total lymphocyte count 3,280/mL, serum albumin 4.3 g/dL, CEA 1.1 ng/mL, CA 19-9 9.1 ng/mL, and alpha fetoprotein 2 ng/mL. Another associated disease was right thyroid follicular neoplasm. The chest X-ray was normal. After IM injection of 2,500 units of heparin 30 minutes before the induction of general anesthesia, she received curative subtotal gastrectomy and Roux en Y gastrojejunostomy when a malabsorption loop of 120 cm jejunum was incorporated between the Treitz ligament and the end to side jejuno-jejunostmy site at May 29th 2006. Her postoperative course was uneventful except a minor wound seroma and the elevations of serum amylase(up to 4 folds) and lipase(up to 2 folds). She lost her body weight 9 kg in 5th, 21 kg in 7th, and 27 kg in 10th postoperative months to became 61.5 kg. On follow up exams in July 2008, she gained 4 kg to overcome her weakness and fatigue. From the above result, the incorporation of a malabsorption loop during reconstruction phase of gastric cancer operation was a good option for obese gastric cancer patients especially in cases of early gastric cancer.

입원 환자 영양검색 전산 프로그램 개발

안수미,윤기영,신연명,최경현,임근승,장문경,송윤미,공은희 고신대학교의과대학 2008 고신대학교 의과대학 학술지 Vol.23 No.2

Background : About 30% of patients in the hospital are under nourishment. A large portion of people are undernourished when they are admitted to the hospital and in the majority of these, undernutrition develops further while in hospital. Patient-Generated subjective global assessment(PG-SGA), a method of nutritional assessment based on clinical judgment, has been widely used to assess the nutritional status of adults for both clinical and research purposes. Modified PG-SGA can be used as a nutrition screening tool, and a comprehensive nutrition assessment is desirable for those who are malnourished. The purpose of this study is to develop a simple, reliable and valid nutrition screening program(NSP). Methods : We applied the nutrition screening program(NSP) to adult inpatients who are at risk of malnutrition using the Modified Patient-Generated subjective global assessment(PG-SGA) and objective assessment(electrical medical record data). Results : Therefore simple and beneficial NSP is developed for patients with severe malnutrition. Using NSP. nutritional information of the severe malnutrition patient should be shared with the physicians and they should be taken care of by clinical dietitians to improve their nutritional status. Conclusion : The Modified PG-SGA and nutrition screening tool are simple, reliable and valid nutrition screening program(NSP).

Propofol 정맥 주사 시 Metoclopramide의 통증 완화 효과

김수진,박은지,안승원,김웅,김미운,임현술 대한마취과학회 2002 Korean Journal of Anesthesiology Vol.43 No.5

Background: Propofol is a good induction agent. but it has a disadvantage of pain on intravenous injection. Pretreatment of metoclopramide or lidocaine have been reported to reduce pain on injection. thus, we have evaluated the quantity and quality of anagesic effect of metoclopramide and lidocaine. We observed differences in quality of pain according to venous cannula sizes and intravenous injection sites as well as nausea and vomiting in the postoperative state. Methods: Eighty patients scheduled for an elective operation by general anesthesia were chosen according to ASA (Ⅰ or Ⅱ) and divided into four groups randomly. Each group was injected through venous cannulas with normal saline (control group), metoclopramide 5 mg (group 1), netoclopramide 10 mg (group 2), or 2% lidocaine 40 mg (group 3) respectively. Then, propofol was injected of a 2 mg/kg dose with 0.5 ml/sex to all groups and we asked questions about injection pain after 10 seconds. Results: Pain relief was shown in all groups compared with the control. but metoclopramide 10 mg and lidocaine 40 mg pretreatment groups showed significant pain reief. Pain was relieved significantly when the drug was injected in the antecubital area. Postoperative nausea and vomiting were not observed. Conclusions: Metoclopramide 10 mg or lidocaine 40 mg pretreatment to induction by propofol revealed a good analgesic effect for propofol injection pain. (Korean J Anesthesiol 2002; 43: 558~565)

기저세포암 및 편평세포암에서 미세혈관밀도와 p53 단백 발현에 관한 연구

어수락,조규성,안호범,김대영,이삼용,조백현 大韓成形外科學會 1999 Archives of Plastic Surgery Vol.26 No.3

Basal cell carcinoma(BCC) and squamous cell carcinoma (SCC) are very prevalent neoplasms of the human skin. Ultraviolet radiation in sunlight is a well-established mutagen of the p53 gene and is one of basal cell carcinoma and squamous cell carcinoma. The newly-formed vascular network is important for neoplasms to grow beyond a size of about 1 ㎣. Recent reports have suggested the hypothesis that a mutant p53 protein is closely related with capillary density. Immumohistochemistry for p53 protein and CD34 was performed in 20 cases of BCCs and 14 SCCs to evaluated the relationship between p53 protein and capillary density. The results were as follows:1. The microvessels stained by CD34 were mainly located in the interface of tumor cells and stroma. 2. There was no difference in the microvessel density according to the histologic types and age of the patients, but a higher microvessel density was noted in male patients. 3. The aggressive BCCs and the less-differentiated SCCs showed higher p53 immunostaining. 4. The mean microvessel density of cases showing strong positive immunostaining of the p53 gene(54.73±17.75) was higher than that of others(39.75±18.30). These results suggested that p53 protein expression and microvessel density are not related to the histologic types and age of the patients, but that differentiation and biologic behavior such as the infiltrating property of tumors and the microvessel density are closely related to p53 protein expression.

말단 비대증의 임상적 특성

박은미,안용환,김현정,김병수,임종주,김하영,박병현,조정구 圓光大學校 醫科學硏究所 2004 圓光醫科學 Vol.19 No.2

한국인 상염색체 우성 다낭신 가계에서의 유전자 아형분석

이중건,안규리,황대연,황영환,어현선,채회진,이은주,조종태,김연수,한진석,김성권,이정상 대한신장학회 2000 대한신장학회잡지 Vol.19 No.4

急速凝固한 高純度 Fe―C―Si合金중의 Carbide共晶의 過冷却凝固 시뮬레이션

김영직,서수정,안현모 成均館大學校 科學技術硏究所 1991 論文集 Vol.42 No.1

This paper decribes a study of the solidification simulation with supercooling of levitation melted and rapidly solidified high purity Fe--C-Si alloys with emphasis on carbide eutectic. Newly designed growth model of carbide eutectic is proposed. From the simulation model, calculated cooling curves are derived by means of a personal computer, and compared with experimental data. The results calculated are influenced remarkably by coefficient of heat tranfer(h), latent heat of solidification(L), growth rate constant(n) and range of temperature of mushy zone. After suitable choice of h, L, n and especially temperature range of mushy zone as 100K, experimental cooling curves are duplicated by calculated. As the cooling rate exceed about l0^3K/s, graphite crystal is not formed in the high purity Fe -C-Si melts.

랫드에서 인체 재조합 적혈구 조혈인자, rHuEPO의 13주 정맥투여 아만성독성에 관한 연구

김형식,곽승준,천선아,박현선,한하수,임소영,안미영,김원배,김병문,안병옥,홍성렬,이병무 성균관대학교 약학연구소 1998 成均藥硏論文集 Vol.10 No.1

A recombinant human erythropoietin (rHuEPO) was administered intravenously at dosage levels of 0, 100, 500, and 2500 IU/㎏/day for a period of 13 weeks. There were no observed clinical signs and deaths related to treatment in all groups tested. Decreases in body weight gain and food consumption were observed only in males of 2,500 IU/㎏ group after 2 weeks. In hematological parameters, erythrocyte content, hematocrit values and hemoglobin concentration were dose-dependently increased in rHuEPO treated groups. The ratio between kidney weight and whole body weight was significantly increased in females of 500 and 2,500 IU/㎏ groups. The spleen weight was also increased in both sexes of 500 and 2,500 IU/㎏ groups. However, the absolute weight change of other organs was not observed. In histopathological examinations, the renal tubular basophilia was observed only in males and females of 2,500 IU/㎏ groups. From these results, it is concluded that the no-observed adverse effect level(NOAEL) of rHuEPO is 100 IU/㎏ in rats in the present study.

업무 관련성 견갑상 포착 신경증이 의심되는 3례

정두신,성기범,신현길,안무영,김형수,홍영의 大韓産業醫學會 1999 대한직업환경의학회지 Vol.11 No.4

Objectives : Entrapment of the suprascapular nerve is frequently overlooked in the differential diagnosis of shoulder pain. Methods : Suprascapular entrapment neuropathy is a well-defined clinical entity and EMG and NCV is used to confirm a diagnosis. But the diagnosis typically not considered until patients develop severe weakness secondary to atrophy of the spinous musculature that the nerve supplies. Results : A narrow suprascapular notch has rarely been reported as a work-related factor of this entrapment neuropathy. Diagnosis of suprascapular entrapment neuropathy is based on the patients' clinical course, neurologic, radiologic, and electrophysiologic findings. One of the most helpful evaluations was anteriorposterior projection with the X-ray tube angled 15-30 degree caudally. The suprascapular entrapment neuropathy is relatively uncommon entity of shoulder discomfort(pain, weakness, and atrophy). Conclusions : If the worker who used his shoulder joint repetitiously having the shoulder pain and muscle weakness, we must rule out the suprascapular entrapment neuropathy. And it is needed to evaluate the motions which cause suprascapular entrapment neuropathy as the ergonomic factor.

당뇨병 환자에서 혈장 Thrombin-Antithrombin Ⅲ 및 Plasmin-α_2-Plasmin Inhibitor 복합체의 임상적 의의

김경욱,김은숙,정상수,윤수지,박우일,이준희,남수연,안철우,문병수,김경래,차봉수,송영득,임승길,이현철,허갑범 대한당뇨병학회 2002 Diabetes and Metabolism Journal Vol.25 No.5

연구배경:당뇨병 환자에서 혈액응고 및 섬유소용해 체계의 이상경향이 있어 그 결과로 여러 혈관합병증의 발생위험이 높다는 사실은 널리 알려져 있다. 그 기전은 아직 확실히 밝혀지지 않았으나, 고혈당으로 인한 혈장 단백질들의 비효소성 당화작용이나 산화성 스트레스로 인한 유리 라티칼 작용으로 응고항진이나 섬유소용해 활성의 저하를 유발하는 것으로 생각되고 있다. 최근 응고 및 용해인자와 그 억제자의 복합체들의 증가가 이 상태를 비교적 예민하게 반영한다고 알려져 있다. 방법:본 연구에서는 당뇨병 환자 101명과 정상 대조군 20명에서 혈장내 thrombin­antithrombin complex(TAT)와 plasmin­α₂­plasmin inhibitor complex(PIC)를 측정하여 비교하고, 당뇨병 환자에서 미세혈관 합병증과 대혈관합병증의 유무에 따른 차이와, 이미 혈관 질환의 위험인자로 알려져 있는 인자들간의 상관성을 알아보고자 하였다. 결과:1. 환자의 분포를 살펴보면 혈관합병증이 있는 군은 85명, 혈관합병증이 없는 군은 16명이었고, 평균연령은 각각 57.9±14.1세, 49.9±16.6세로 혈관 합병증이 있는 군에서 더 나이가 많았고, 체질량지수는 23.2±3.4㎏/㎡, 24.1±3.4㎏/㎡로 두 군간 유의한 차이는 없었다. 또 두 군간의 혈압 및 HbA1c, 공복혈당 및 인슐린과 C­peptide, 총 콜레스테롤, 중성지방, HDL­콜레스테롤, Lp⒜는 유의한 차이가 없었고, 미세혈관합병증이 있는 군에서 당뇨병의 유병기간이 길었다. 2. TAT 및 PIC의 농도는 정상 대조군에서는 2.8±1.2 ng/mL, 240.4±69.7 ng/mL이었고, 당뇨병 환자군에서는 9.5±22.6 ng/mL, 472.2±258.7 ng/mL이었다. TAT와 PIC 모두 당뇨병 환자군에서 정상 대조군에 비해 유의하게 증가되어 있었고(p<0.001), TAT/PIC ratio는 두 군간 차이가 없었다. 3. 당뇨병 환자의 혈관합병증에 따른 TAT 및 PIC, fibrinogen 농도는 합병증이 없는 군은 각각 4.1±2.4ng/mL, 362.2±272.0ng/mL, 322.7±102.4mg/mL으로 PIC와 fibrinogen의 증가를 보였으나, 연령을 보정한 후에는 통계학적 유의성은 없었다. 또 대혈관 합병증군에서는 각각 6.0±4.9 ng/mL, 507.4±321.6 ng/mL, 427.1±194.7 mg/dL이었으며 미세·대혈관 합병증군에서는 10.4±6.4 ng/mL, 484.8±269.7 ng/mL, 388.4±132.4 mg/dL으로 TAT의 증가를 보였으나 역시 연령을 보정한 후에는 통계학적 유의성은 없었다. 4. 미세혈관합병증군에서 HbA1c(>8%)가 높은 군의 PIC 농도가 유의하게 높았고(p=0.049), 대혈관합병증군에서 HbA1c(>8%)가 높은 군의 총 콜레스테롤 농도가 유의하게 높았다(p=0.042). 5. 총 당뇨병 환자군에서 PIC는 fibrinogen과 HbA1c와 양의 상관관계를, BMI와 음의 상관관계를 보였으며(r=0.47, 0.31,-0.25), 혈관 합병증이 없는 당뇨병 환자군에서만 TAT는 HbA1c와 양의 상관관계를 보였다(r=0.67). 결론:이상의 결과에서 혈장 TAT 및 PIC 농도는 당뇨병 환자에서 정상 대조군에 비해 의미있게 증가되어 있었고, 당뇨병 환자군에서는 연령의 증가와 유병기간이 혈액응고항진 및 용해의 장애에 큰 역할을 함을 알 수 있었으며, 총 당뇨병 환자군에 PIC와 HbA1c와 양의 상관관계를, BMI와 음의 상관관계를 보였으며 혈관 합병증이 없는 당뇨병 환자군에서만 TAT는 HbA1c와 양의 상관관계를 보였다. 따라서 당뇨병 환자에서 혈액응고 및 용해의 장애가 동반되어 있다고 볼 수 있으며, 혈장 TAT 및 PIC는 혈관합병증으로의 진행을 예측하는 지표로서 유용하리라 생각된다. 또 혈당조절정도와 상관성이 있으므로 혈당조절후에 추적검사를 시행하여 합병증의 예방이 가능한지 추후 연구가 필요하리라 생각된다. Background : Abnormality of coagulation and fibrinolystic system is known as a predisposing factor of vascular complication in diabetes. Although the pathogenesis is not well known, non-enzymatic glycation reaction and the increase in production of free radicals due to an increased oxidative stress may be linked to the hypercoagulibility and hypofibrinolytic activity. As indices of abnormality in coagulation and firinolysis in peripheral blood, plasma thrombin-antithrombin Ⅲ complex (TAT) and plasmin-α_2-plasmin inhibitor complex (PIC) were measured. The purpose of this study was to clarify whether hypercoagulability exists in diabetic patients with or without vascular complication. Methods : In our study, we measured plasma thrombin-antithrombin Ⅲ compelx (TAT) and plasmin-α_2-plasmin inhibit or complex (PIC) in 101 diabetic subjects and 20 controls. Comparing TAT and PIC levels in diabetic microvascular complication group, diabetic macrovascular complication group and controls, we examined correlation between risk factors associated with diabetic vascular complication. Results : 1. The group with diabetic vascular complication was older than group without complication. There was no significant difference in BMI, blood pressure, HbA_ic, blood sugar level, insulin, C-peptide, serum creatinine, total cholesterol, triglyceride, HDL-cholesterol, Lp (a) between two groups. The group with diabetic microvascular complication had longer duration of diabetes. 2. Concentration of TAT and PIC were 2.8±1.2 ng/ mL, 240.4±69.7 ng/ mL in controls and 9.5±22.6 ng/ mL, 472.2±258.7 ng/ mL in diabetic patients, respectively. TAT and PIC were significantly higher in diabetic patients than in control (p<0.001). But TAT/PIC ratio was no significant difference between two groups. 3. In diabetic patients, concentration of TAT and PIC and fibrinogen were respectively 4.1±2.4 ng/ mL, 362.2±272.0 ng/ mL, 322.7±102.4 mg/ dL in group without vascular complication and 5.3±4.1 ng/ mL, 529.5±258.7 ng/ mL, 374.9±106.2 mg/ dL in group with microvascular complication, which group had increase in PIC and Fibrinogen but no significance after correction of age. Concentration of TAT and PIC and Fibrinogen were 60.±4.9 ng/ mL, 507.4±321.6 ng/ mL, 427.1±194.7 mg/ dL in macrovascular complication, and 10.4±6.7 mg/ mL, 484.8±269.7 ng/ mL, 388.4±132.4 mg/ dL in combined vascular complication which group showed increase of TAT but also had no significant increase after correction of age. 4. In diabetic microvascular complication patients, group of high HbA_1c (>8%) (p=0.049) had significant high PIC concentration. In diabetic macrovascular complication patients, group of high HbA_1c (>8%) (p=0.042) had significant high total cholesterol concentration. 5. In all diabetic patients, PIC was positively correlated with fibrinogen and HbA_1c and negatively correlated BMI (r=0.47, 0.31, -0.25). Only in daibetic patients without angiopathy, TAT was positively correlated with HbA_1c (r=0.67). Conclusion : In this study, plasma TAT and PIC concentration significantly increased in diabetic patients compared with controls, and PIC was increased in group with microvascular complication, TAT were increased in group with combined micro macrovascular complication. However, there was no significance relationship existed when correctinf for age. PIC was correlated with HbA_1c. TAT was correlated with HbA_1c only in the group without angiopathy. Abnormality of coagulation and fibrinolysis were combined in diabetes, plasma TAT and PIC can be used as an index of vascular complication. Also we found the correlation with the degree of the blood glucose control. Therefore we need follow up study for the possibility of prevention of vascular complication after controlling the blood glucose to age-matched patients (J Kor Diaabetes Asso 25:354~363, 2001).