반복적 부동화 스트레스가 신경활성 Steroid의 GABAА 수용체 조절작용에 미치는 영향

강헌구,강병조,하정희 대한생물치료정신의학회 1999 생물치료정신의학 Vol.5 No.2

신경활성 steroid들은 중추신경계의 말초성 benzodiazepine 수용체에서 합성되고, GABAA 수용체 복합체상의 독립적인 인지부위에 작용하여, GABAA 수용체에 대하여 효현활성을 나타내며, 스트레스에 대응하여 유리되는 내인성 조절자로 시사되고 있다. 그러나 신경활성 steroid의 신경전달조절 활성을 스트레스에 대한 반응도(reactivity)와 연관시켜 연구한 것은 아직 미흡한 실정이다. 이에 본 연구에서는 Sprague-Dawley rat에 2주간의 반복적인 부동화 스트레스를 부하한 후 반복적 스트레스에 의한 신경활성 steroid 활성의 변화를 검색하고자 하였다. 그리고 스트레스에 대하여 과도한 반응성을 보일 것으로 보고된 borderline-hypertensive rat을 대상으로 신경활성 steroid의 억제성 신경전달계인 GABA성 신경전달 조절활성을 비교 관찰함으로써, 반복적 부동화 스트레스에 대한 실험동물의 반응성에 대한 연구의 일환으로 신경활성 steroid의 신경조절작용을 검색하고자 하였다. 이를 위하여 Sprague- Dawley rat의 대뇌피질세포막에 있는 GABAA-benzodiazepine 수용체 복합체에서 대하여 신경활성 steroid인 pregnanolone의 [³H]flunitrazepam 결합반응을 항진효과를 비교, 검색하였다. 본 실험결과, Sprague-Dawley rat의 대뇌피질세포막에 있는 GABAA-benzodiazepine 수용체 복합체에서 신경활성 steroid인 pregnanolone은 [³H]flunitrazepam 결합반응을 항진시킴으로써 GABAA 수용체에 대하여 효현 활성을 나타내었으며, 2주간의 반복적인 부동화 스트레스에 의해 이러한 pregnanolone의 활성은 증강되었다. 한편, 스트레스에 대하여 과도한 반응성을 보인다고 알려진 borderline-hypertensive rat의 뇌조직에서도 Sprague-Dawley rat에 비하여 항진된 GABA성 신경조절활성이 관찰되었으며, 스트레스 부하에 대해서도 유사한 반응성을 나타내었다. 이상의 결과로부터 반복적인 부동화 스트레스는 스트레스에 대한 반응성의 일환으로 신경활성 steroid인 pregnanolone의 GABA성 신경전달 항진작용을 증강시킨다고 생각되었으며, 스트레스 유발 고혈압의 질환모델로 보고된 BHR에서는 동일한 스트레스에 대하여 과도한 반응성을 나타냄으로써 스트레스 관련 말초질환에서의 중추성 병인인자의 참여 가능성을 시사해주었다. Pregnanolone[5β-pregnan-3α-ol-one(pregnanolone)] is one of neuroactive steroids that are reduced metabolites of progesterone. Pregnanolone synthesis in the neuron or glia was regulated by peripheral benzodiazepine receptor agonist, which was consistently observed to be upregulated in the acutely stressed animals and humans. Pregnanolone is a potent positive modulator of the γ-aminobutyric acid(GABA) response that enhance the binding of [³H] flunitrazepam to the GABAA receptor. Recently, it was reported that chronic treatment with pregnanolone uncouples allosteric interactions between steroid and benzodiazepine recognition sites in cultured neurons. The present study was designed to assess the effect of repeated stress on the modulation of neuroactive steroid on the GABAA receptor. The effect of steroid on the ligands binding to GABAA receptor was investigated using cerebral cortices of unstressed and repeatedly immobilized Sprague-Dawley rats and borderline-hypertensive rats. Pregnanolone enhanced the binding of [³H]flunitrazepam to GABAA receptor in both of unstressed and repeatedly stressed Sprague-Dawley rats. However, repeatedly stressed rats showed significantly lower values in EC50 and higher values in Emax of enhancement binding of [³H] flunitrazepam than those of unstressed rats. Borderline-hypertensive rats, which are known to be overreactive to stress, showed higher basal binding of [³H]flunitrazepam to GABAA receptor, similar to those of stressed Sprague-Dawley rats. Borderline-hypertensive rats, in both control and stressed groups, showed similar pharmacological activity of pregnanolone with Sprague-Dawley rats. From these findings, it can be concluded that repeated immobilization stress enhanced the positive modulation of neuroactive steroid on the GABAA-receptor complex, and these pharmacological activity of neuroactive steroid might be a defensive reactivity to stress of individuals.

정신분열병의 생물학적 원인

강병조,원승희,김상헌 대한생물치료정신의학회 1998 생물치료정신의학 Vol.4 No.2

The authors reviewed the biological etiologies of schizophrenic disorder such as genetic, viral, neurodevelopmental, neural network, sunspots and cerebral diabetic hypothesis. The etiology of schizophrenic disorder remains to be confirmed. Although genetic possibilities were suggested by many investigators, the genetic genes and their transmission methods have not been clarified yet. The neurodevelopmental hypothesis was reviewed in detail. This hypothesis includes genetic hypothesis, viral hypothesis, obstetrical complication hypothesis, neutritional deficience theory, NMDA receptor hypofunction theory and neural network theory. The neurdevelopmental hypothesis means that several developmental trajectories, related to early brain insults as well as the genetic factors affection postnatal neurodevelopment, possibly lead to this illness. An excessive pruning of the prefrontal corticocortical, and corticosubcortical synapses, perhaps involving the excitatory glutaminergic inputs to pyramidal neurons, may underlie schizophrenia.

Plused Spark Chamber의 제작과 그 특성조사

강영호,차병헌 慶北大學校 自然科學大學 1983 自然科學論文集 Vol.2 No.-

A pulsed spark chamber with sensitive area 19cm×19cm and 17 gaps is constructed and its characteristics are investigated. The chamber frame is made by lucite plate and 0.1mm aluminum foil is used for electrode. The side of lucite frame is highly polished to obtain the optical transparency. In the chamber, 99.99% argon gas is filled and gas-flowing method is used for eliminating the contamination of O_2. The clearing field of 150V/cm D.C. is applied for obtaining the clean spark images. The constructed spark chamber has the rise time of 100nsec and the delay time of 0.9㎲ec with operating voltage of 12KV, tracks of the cosmic rays has been photographed and particles can be selectively detected by coincidence circuit with scintillation counter.

내시경적 점막절제술로 치험한 식도 과립상 세포종 1례

강혁주,김성욱,최석진,이중현,장재식,서영범,윤병구,박건욱,김성자,김용섭,강승완,이구,양창헌,이창우,김욱년,이광헌,서정일 동국대학교 의학연구소 2000 東國醫學 Vol.7 No.-

과립상 세포종은 Schwann 세포 기원으로 생각되며 인체에 비교적 드물게 발생한다. 과립상 세포종은 전신 어느 곳에서나 발견될 수 있으나 주로 혀, 구강, 피부 혹은 유방 등에서 호발하며 드물게 위장관에서 발견된다. 위장관에서는 식도에서 가장 호발하며 다음으로 위, 대장 순이다. 과립상 세포종은 대부분, 특히 위장관에서는 양성이며 소수의 악성 병변이 보고되었다. 이러한 이유와 함께 수술 전의 진단이 어렵기 때문에 과립상 세포종에 대한 근본적인 치료는 현재까지 외과적 절제술이다. 최근에 시도되는 치료방법들로는 내시경적 레이저 치료, 용종절제술, 내시경적 점막 절제술 등이 있다. 저자들은 상부 소화관 내시경검사를 시행하여 식도 과립상 세포종을 진단하고 내시경적 점막 절제술을 시행하여 합병증 없이 퇴원하여 현재 재발없이 경과 관찰중인 1례를 경험하였기에 보고하는 바이다. Granular cell tumors, which occur infrequently, are probably of Schwann cell origin. They can occur almost anywhere in the body but usually affect the tongue, oral cavity, skin, or breasts and are rarely found in the gastrointestinal tracts. The esophagus is the most frequent gastrointestinal site, followed by the stomach and the colon. Granular cell tumors are generally benign, especially in the gastrointestinal tract, some malignant lesions have been reported. For this reason, and also because preoperative diagnosis is difficult, the standard treatment for granular cell tumor has until now been surgical excision. In recent years, other therapeutic methods is endoscopic laser therapy (ELT), polypectiomy, endoscopic mucosal resection (EMR). We report a case of esophageal granular cell tumor which was diagnosed by an endoscopy and managed using an endoscopic mucosal resection without complication.

가족력이 있는 만성정신분열증 환자의 인간조직적합성 항원(HLA)

강헌구,강병조 大韓神經精神醫學會 1988 신경정신의학 Vol.27 No.6

The authors studied the frequencies of HLA antigens (A,B,C and DR) in 20 chronic schizophrenic patients who had one or more schizophrenic patient(s) among their first degree relatives. The data of these study subjects were compared with those of patient controls and normal controls. The patient controls were composed of 20 chronic schizophrenic patients who had no family history of schizophrenia HLA-A, B, C antigens of normal controls came from 196 healthy Korean volunteers and HLA-DR antigens came from 205 healthy Korean volunteers. The diagnoses of schizophrenics were made according to RDC and Family History-RDC. The results were as follows: 1) The frequencies of B??,B??,DR₃and DR?? antigens were significantly higher in total schizophrnic patients than the control group. 2) The frequencies of A₃,A?? and B??, DR?? antigens were higher in schizophrenic patients with family history than the control group. Especially, the frequency of DR antigen was the highest. 3) The frequencies of B??,C??,DR₂,and DR?? antigens increased significantly in schizophrenic patients without family history. 4) DR?? is the only antigen that showed significantly higher frequency in patients with family history than those without one. 5) Consequently, these results suggest that DR?? locus is probably related to genetic or biological marker of Korean familial chronic schizophrenics

화학제재를 이용한 우식상아질 제거 효과 및 레진과의 결합강도에 관한 연구

강덕일,이병채,설재헌 조선대학교 구강생물학연구소 2003 口腔生物學硏究 Vol.27 No.1

The aim of this study was to evaluate the effect of chemo-mechanical caries removal system(CarisolvTM, Medi Team. Sweden) for resin adhesion to carious primary and Permanent dentin compared with conventional drilling method. The buccal surface of 92 Primary molars and 92 permanet molars were used. Exposed dentins were occurred artificial caries. 32 tooth of primary molars and 32 tooth of permanet molars were prepared to observe treated dentin surface with CarisolvTM and conventional drilling method by SEM. Other tooth were prepared to measure resin-dentin shear bonding strength according to caries removal methods and dentin adhesive system. Two adhesive systems and a composite resin were used: single bonding agent(Scotchbond Multi-Purpose Plus, 3M) and self-etching bonding system(Prompt L-Pop, 3M ESPE), and a composite resin(Z-250, 3M) The results were as follows : 1. The effect of CarisolvTM on primary dentin was stronger than that to permanent dentin, and dentin surface became rougher with treated CarisolvTM than drilling method. 2. Acid-etched dentin surfaces were showed smoothing without smear layer. 3. In specimen applied single bonding system hybrid layer and adhesive layer were 3-4㎛ and 10-15㎛ in thickness, whereas self-etching bonding system hybrid layer were 1-2㎛ 4. The shear bonding strength of group applied single bonding agent was higher than that applied self-etching priming system(P<0.05). 5. The shear bonding strength of group applied CarisolvTM and self-etching priming system were slightly higher than that applied conventional drilling method and self-etching priming system(P>0.05).

Gilbert 증후군에서 열량 제한 시험과 Phenobarbital 자극 시험의 의의(14예)

이헌영,채경훈,정재훈,강윤세,김연수,문희석,박기오,이엄석,김선문,김석현,성재규,이병석,이강욱 충남대학교 의학연구소 2003 충남의대잡지 Vol.30 No.2

Gilbert 증후군은 인구의 7%에서까지 나타날 수 있는 매우 흔한 증후군으로서 비진행성인 양성의 만성적 경과를 치하며, 간질환의 증상과 징후가 없는 경한 비포합형 고빌리루빈혈증이 특징인 일종의 체질적인 증상으로서 혈장 빌리루빈 농도에 대한 사춘기의 영향 때문에 10대와 20대에 자주 진단이 된다. 따라서 임상적인 중요성은 미약하지만 높은 빈도가 예상되는 점에 그 중요성이 부여되어야 할 것이다. 따라서 적정한 임상적 진단법으로 기왕에 소개된 열량제한 시험과 phenobarbital 유도 시험을 시행하고 이들의 진단적 가치를 알아보기 위하여 본 연구를 시행하였다. 1990년 7월부터 1999년 4월까지 충남대학교병원에 내원하여 HBsAg, IgG anti-HBc 및 anti-HCV가 음성이고, 간 초음파 스캔에서 이상이 없으며, 혈청 AST, ALT 및 AP가 정상인 비음주자에서 경한 비포합형 고빌리루빈혈증이 있는 14예의 환자들을 대상으로 ^(99m)Tc-DISID 스캔을 시행하였으며, 기저 치 총빌리루빈 및 포합형 빌리루빈 치를 측정한 다음에 하루에 400Kcal로 48시간동안 제한한 열량 제한 시험을 시행하였고, phenobarbital을 하루 60mg씩 5일간 투여한 후에도 각각 총빌리루빈과 포합형 빌리루빈 치를 검사하여 비포합형을 구하였다. 대상 환자들은 모두 14예로서 남자가 11예(78.6%)였고 여자가 3예(21.4%)여서 3.7:1로 남자에서 많았으며, 20대가 6예(42.9%), 30대가 역시 6예(42.9%) 및 40대가 2예(14.2%)로서 2,30대가 대부분(85.8%)이었다. 열량 제한 시험 후의 총빌리루빈 치, 비포합형 및 포합형 빌리루빈 치들은 평균 각각 5.5±2.7, 4.2±2.3 및 1.3±10mg/dL 로서, 시험 전 치들인 3.0±0.8, 2.2±0.8 및 0.7±0.4mg/dL 보다 유의하게(p=0.001, p=0.001, p=0.023) 상승하였다. 포합형 빌리루빈 치도 유의하게 상승하였으나 비포합형의 상승보다는 훨씬 낮아서 주로 비포합형이 증가하였다. phenobarbital 투여 중 설사가 발생하여 중단한 1예를 제외한 13예에서 열량 제한 시험 후에 상승하였던 총, 비포합형 및 포합형 빌리루빈 치가 phenobarbital 유도 시험후에는 2.0±1.1, 1.5±0.8 및 0.5±0.4mg/dL로서 열량 제한 시험 결과보다 유의하게 낮아졌고(p=0.00, p=0.000, p=0.001), 열량 제한 시험 전의 기초치들인 3.0±0.8, 2.2±0.8 및 0.7±0.4mg.dL 보다도 더욱 낮아졌으며 유의한 차이(p=0.001, p=0.02, p=0.005)를 나타내었다. 14예에서 시행한 ^(99m)-Tc DISIDA 스캔에서 9예(64.3%)가 정상이었고, 5예(35.7%)에서는 심장 및 신장으로의 간외 섭취가 3예였고, 60분까지 소장 배출이 없는 배설 지연 예와 담낭 수축 불량 예가 각각 1예 씩 발견되었다. Phenobarbital 투여시험에서 민감도가 열량제한시험에 비해 더 높았다(92.3%와 50.0%). Gilbert 증후군에서 1일 400 Kcal로 48시간의 열량제한 시험과 1일 60mg의 phenobarbital을 5일간 투여하는 유도 시험은 편리하고 유용한 임상적인 진단법으로 이용할 수 있다고 생각된다. 그러나 열량 제한 시험에서는 증가 기준의 통일이 필요하다고 유추되며 phenobarbital 유도 시험이 민감도가 더 높은 것으로 생각된다. Gilbert's syndrome is very frequent and benign chronic process characterized by mild, intermittent, unconjugated hyperbilirubinemia without any symptom and sign of liver disease. Previously intoduced caloric restriction test and phenobarbital stimulation test as two appropriate clinical tests had been examined and their diagnostic values were reevaluated. Fourteen patients with mild, persistent, unconjugated hyperbilirubinemia were included. Subsequently caloric restriction has been applicated by 400 Kcal/day for 48 hours and phenobarbital has been prescribed by 60 mg/day for 5 days. Therafter serum levels of total and direct bilirubin were measured. Most of the patients were third and fourth decade(85.8%) and male predominant. Each basal serum levels of total, indirect and direct bilirubin were 3.0±0.8, 2.2±0.8 and 0.7±0.4 mg/dL. After caloric restriction test, each levels were increased significantly to 5.5±2.7, 4.2±2.3 and 1.3±1.0 mg/dL(p=0.001, p=0.001, p=0.023). After phenobarbital stimulation test for 13 patients had been practiced, increased levels of each bilirubin after caloric restriction test were decreased significantly to 2.0±1.0, 1.5±0.8 and 0.5±0.4 mg/dL(p=0.000, p=0.000, p=0.001) and these levels were significantly lower than basal levels(p=0.001, p=0.02, p=0.005). The sensitivities of caloric restriction test were 85.7%, 50.0%, and 71.4%, 35.7%(1.0, 1.5 mg increase of total bilirubin and 1.0, 1.5 mg/dL increase of indirect bilirubin). The sensitivities of phenobarbital stimulation test were 93.2% and 92.3% at criteria of 1.5 mg/dL increase of total bilirubin and indirect bilirubin. On the diagnosis of Gilbert syndrome, caloric restriction test and phenobarbital stimulation test are convenient and useful diagnostic tools in clinical face. And also phenobarbital stimulation test has higher sensitivity than caloric restriction test. Furthermore, standardization of bilirubin increment would be necessary in caloric restriction test.

급성심근경색증의 조기진단에 있어서 Myoglobin의 진단적 의의

이정헌,김종근,정병천,서강석,박정배,조용근,류재근,전재은,채성철,박의현 大韓應急醫學會 1999 대한응급의학회지 Vol.10 No.2

Background: Exact and early diagnosis of acute myocardial infarction (AMI) is essential for the subsequent routine management of this frequent cardiovascular disease. Currently, AMI has been diagnosed using the combination of the history, electrocardiogram(ECG), and biochemical markers of myocardial necrosis. At present, many biochemical markers are used to diagnose AMI. In this study, the predictive values of serum myoglobin and creatine kinase-MB(CK-MB) were compared in the emergency department. Methods: Fifty-four consecutive patients who presented within 12 hours from onset of chest pain of presumed cardiac origin were enrolled into the study. Patients with trauma or renal failure were excluded. The serial serum myoglobin and CK-MB levels were obtained prospectively at admission and 2, 4, 6, 12, 24 and 48 hours after admission. We compare the levels of serum myoglobin and CK-MB within 2, 4, 6, 8, 10, 12, 24, and 48 hours after symptom onset respectively. And we compare the sensitivity, specificity, positive predictive value, and negative predictive value of myoglobin and CK-MB. Results: using World Health Organization criteria, 28 AMI patients were identified. Mean time from symptom onset to presentation was 4.1±1.3 hours. The predictive values of serum myoglobin were better than those of CK-MB within 6 hours after symptom onset. But, 6 hours after symptom onset, the predictive values of CK-MB were better than those of serum myoglobin. The false positive cases of serum myoglobin were 3-one was lung cancer with pleural effusion and the others were unstable angina. The false positive cases of CK-MB were 6-one case was viral myocarditis and the ohters were unstable angina. Conclusion: To compare the serum myoglobin and CK-MB in the diagnosis of AMI, serum myoglobin had better predictive values than CK-MB within 6 hours after symptom onset and useful in the early diagnosis of AMI. But, 6 hours after symptom onset, CK-MB had better predictive values than serum myoglobin and useful in following up.

위의 유암종과 선종의 병발 1례

장재식,강혁주,이중현,서영범,윤병구,김용섭,이구,서정일,양창헌,이창우,김정란,윤환중 東國大學校醫學硏究所 2000 東國醫學 Vol.7 No.-

유암종은 전신에 퍼져 잇는 장크롬친화성 세포에서 기원하는데 위의 유암종은 비교적 드문 질환으로 모든 유암종의 1.9~2.2%에 해당하며 위에 발생하는 종양의 1% 미만에서 보고되고 있다. 유암종은 일반적으로 증상이 비특이적이고 면역조직화학검사에 의해서 진단되기 때문에 과거에는 드물게 발견되었으나 최근 내시경 기기 및 술기의 발전과 검사 빈도의 증가 및 면역조직화학검사의 발달로 진단율이 증가 추세에 있으며, 드물지만 유암종에서 선암과 공존하는 예들이 보고되고 있다. 저자들은 심와부 동통을 주소로 내원한 70세 남자 환자의 상부위장관내시경 검사에서 위체상부의 대만곡에서 0.4×0.4 cm 크기의 중간 함몰을 가진 Yamada 1형의 용종과 함께 전정부의 전벽에서 0.8×0.5 cm 크기의 융기된 점막 소견을 보여 조직학적으로 각각 위유암종 및 위선종임을 확진한 후 내시경적 용종 절제술로 치료한 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Carcinoid tumors are arisen from enterochromaffin cells, which are scattered throughout the body. These tumors are composed of variable numbers of cells that contain endocrine granules in their cytoplasm, which can be identified by immunohistochemistry and electron microscopy. Gastric carcinoid tumors are relatively rare tumor, the reported incidence being 1.9~2.2% of all carcinoid tumors and less than 1% of all gastric tumors. Sometimes, composite carcinoid tumors and adenocarcinoma is reported. We experienced a case of the coincidence of carcinoid tumor and adenoma at the other site of the stomach in a 70 year old male patient. Gastrofiberscope showed 0.4×0.4 cm sized Yamada type I polyp with central depression on the greater curvature of the proximal body and 0.8×0.5 cm sized focal slightly elevated mucosa on the anterior wall of the antrum. The endoscopic biopsy specimens revealed carcinoid tumor and tubular adenoma with moderate atypism, respectively. The carcinoid tumor and adenoma were removed by endoscopic polypectomy. According to the follow-up gastrofiberoscopy after 7 month later, both lesions were nearly normal mucosa except whitish atrophic change after polypectomy.

월경주기 증상의 요인 분석

이수일,유태혁,강종선,안석철,이병욱,김헌,석재호 大韓神經精神醫學會 1986 신경정신의학 Vol.25 No.1

404 nurses and nurse-aids rated their experiences of 45 symptoms(Moos' Menstrual Distress Questionnaire) of the menstrual, premenstrual and intermenstrual phase on a 4 point scale separately. The 45 symptoms were inter-related and factor analyzed separately for each phase. six common clusters of symptoms emerged from 3 phases, which were labeled concentration, motor tension, pain, pleasurable affect, autonomic reactions and water retention. Four clusters of symptoms emerged from premenstrual phase. These clusters were labeled instabillity, withdrwal reactions, depression and headache. The factor named unpleasurable affect emerged from intermenstrual and menstrual phase. Above findings were differed from the results of Moos' study in which eight basically replicated clusters of symptoms emerged from three phases. Through discussion of validity of this scale, and differences between results of Moos' and this study, we came to the conclusion that sampling of subjects, prospective longitudinal symptoms reporting, amount of variance in a symptom over the course of menstrual cycle and proper choice of factor analysis method would be salient variables to construct valid scale for measuring menstrual cycle symptoms.