경피적 강선고정을 이용한 요골 원위부 관절내 분쇄골절의 치료

안의환,오정환,신규철 건국대학교 의과학연구소 1997 건국의과학학술지 Vol.- No.7

혈중 감마지티피 상승의 임상적 의의

신주연,김용규,박신구,이지나,김환철,임종한,홍윤철 大韓産業醫學會 2005 대한직업환경의학회지 Vol.17 No.1

목적: 혈중 감마지티피는 주로 알코올 섭취와 간세포 손상의 지표로서 이용되어져 왔으나 최근에는 혈중 감마지티피가 체내의 산소성 스트레스를 민감하게 반영하는 지표이며, 혈중 감미지티피를 이용하여 만성질환의 발생을 조기에 예측할 수 있다는 주장들이 있다. 이에 본 연구에서는 일반 인구 집단을 대상으로 한 건강검진 자료를 분석하여 혈중 감마지티피의 상승에 영향을 미치는 요인들을 분석하고 혈중 감마지티피와 산소성 스트레스와의 관련성 및 임상적인 이용 가능성을 알아보고자 한다. 방법: 2001년부터 2003년까지 한 대학병원 산업의학과에서 건강검진을 실시한 15,546명을 대상으로 하였고 신체계측, 혈액검사 그리고 설문지의 정보를 분석하였다. 총 15,546명 중 남성은 9,660명 이었고 여성은 5,886명 이었다. 연령, 성별, 체질량지수, 흡연, 음주, 운동량 비타민 복용 여부에 따른 혈중 감마지티피의 평균을 분석하였고, 성별에 따른 다변량 분석을 실시하였다. 다변량 분석에는 연령, 체질량지수, 음주빈도, 흡연량, 혈색소, 이완기혈압, 공복시혈당, 총콜레스테롤, ALT를 포함하였다. 결과: 연구 대상자들의 혈중 감마지티피의 평균은 남성에서 평균(±2SD)이 47.51(±111.62)이었고, 여성에서는 19.09(±42.02) 으로서, 대체적으로 정상 범위에 있다고 보여 지나 개인차가 상당히 크다는 사실을 알 수 있었다. 다변량 분석의 결과에서는 혈중 감마지티피의 상승에 영향을 미치는 요인이 성별에 따라 다소 달랐으나 남녀 모두에게 연령, 음주빈도, 흡연량, 이완기혈압, 공복시혈당, 총콜레스테롤, ALT가 유의한 영향이 있음을 확인할 수 있었다. 그리고 다변량 로지스틱회귀분석의 결과에서 '임상적 비정상'을 예측함에 있어 혈중 감마지티피가 진단적 유용성이 있음을 확인하였다. 결론: 긴존에 일반적으로 알려져 있는 것처럼 혈중 감마지티피를 단순히 알코올 섭취와 간세포 손상의 지표로서만 볼 수 없으며, 성별, 연령, 흡연, 고지혈증, 당뇨, 고혈압 등 많은 다른 요인들에 의해서 영향을 받으며, 혈중 감마지티피를 산소성 스트레스를 반영하는 생물학적 지표로 해석할 수도 있다. 따라서 혈중 감마지티피의 상승을 임상적으로 해석할 때는 (비록 정상인 범위에 있다하더라도), 알코올 섭취나 간세포 손상 뿐 아니라 다른 여러 요인들을 함께 고려해야 한다. 더욱이 혈중 감미지티피의 상승을 만성질환 즉, 고혈압, 당뇨, 고지혈증 등의 발생을 조기에 발견할 수 있는 지표로서 임상영역이나 건강검진시 유용하게 활용할 수 있을 것이다. Objectives: Incresed gamma-glutamyltransferase (GGT) concentration has mainly been used as a biologic marker of alcohol drinking and liver diseases. However, some recent reports have suggested that serum GGT concentration may be an early biomarker of oxidative stress and associated with chronic diseases like hypertension, DM, hyperlipidemia, CHD, stroke etc. In this study, we analysed the factors associated with increased serum GGT level and evaluated the clinical application of serum GGT in predicting the risk of chronic diseases. Methods: The data were collected from 15,546 periodic health examinations, 9,660 males and 5,886 females, done at one university hospital from 2001 to 2003. We analysed self-questionnaire, physical examination and laboratory data. Statistical analyses(t-test, ANOVA, Pearson's correlation analysis, multiple regression analysis and logistic regression analysis) were done by SPSS for windows 10.0. Results: Mean serum GGT levels were quite different according to age, sex, BMI, smoking and alcohol drinking (all P-value <0.001), but were not different by regular vitamin intake or not (P-value = 0.117). There was significant correlation between serum GGT level and the variables (of age, BMI, blood pressure, Hb, fasting blood sugar, total cholesterol, AST and ALT) (all P-value <0.001). In sex-specific multiple regression analysis, increased serum GGT level was significantly associated with age, alcohol drinking, smoking, blood pressure, fasting blood sugar and ALT in males (all P-value <0.001), and with age, alcohol drinking, smoking, Hb, blood pressure, total cholesterol and ALT in females (all P-value <0.05). In sex-specific logistic regression analysis, increased serum GGT level was significantly associated with risk of 'clinical abnormalities'. This risk increased about 13-fold in males and 4.6-fold in females for serum GGT level over the third quatile, compared with under the first quartile. Conclusions: Serum GGT level is increased not only by alcohol drinking or liver diseases, but also by many other factors associated with chronic diseases and behavioral factors. Thus many factors should be considered in evaluating an increase in GGT level, even when within the upper normal range. Serum GGT level may be a predictor for the early development of chronic diseases.

경피적 강선고정을 이용한 요골 원위부 관절내 분쇄골절의 치료

안의환,오정환,신규철 건국대학교 의과학연구소 1997 건국의과학학술지 Vol.7 No.-

From March 1991 to August 1995, twenty-eight cases of intraarticular comminuted distal radius fractures were treated by percutaneous pinning with closed reduction under fluoroscopy. From all cases, twenty two fractures(79%) were healed satisfactorily with no special problems. But in cases of fractures showing severe comminution or osteoporosis, the result was not good. We conclude that percutaneous pin fixation is an excellent technique for an unstable fractures in combination with external immobilization, provided the distal radius is not severly comminuted or osteoporotic.

양극성 정동장애 및 정신분열증 환자군에서 성별에 따른 TRH 자극검사

이규환,신석호,백인호 大韓神經精神醫學會 1991 신경정신의학 Vol.30 No.1

This study was designed to evaluate the hypothalamic-pituitary-thyroid axis abnormalities and the possible influence of gender on the TSH response to TRH in bipolar patients and schizophrenics by using TRH stimulation test. The subjects were consisted of 34 bipolar patients(male : 14, female : 20) and 24 schizophrenics(male : 11, female : 13). The results were as follows ; 1) There was a significant difference in the baseline TSH level of female subjects before TRH administration between bipolar patients and schizophrenics. 2) The TSH levels at 60 and 90 minutes after TRH administration in female bipolar patients were significantly higher from those of female schizophrenics(P〈0.05). 3) In female subjects, the response of TSH level after TRH administration was significantly different between the two groups(P〈0.005).

대퇴골 전자간 골절을 동반한 고령의 환자에서 시행한 슬관절 전치환술

고덕환,김동헌,김규현,신주용,양준호 건국대학교 의과학연구소 2001 건국의과학학술지 Vol.11 No.-

Purpose: To analyze the clinical results of total knee arthroplasty In elderly patients who had arthritic knees and intertrochanteric fractures. Materials and Methods: From fan 1992 to March 1999, 27 cases of the patients with arthritic knees and associated intertrochanteric fractures were treated by total knee arthroplasties and we evaluated the patients by Knee Score of American Knee Society. Results: Flexion contracture was improved from 10.3 degree to 5.2 degree, KSS score was improved from 57.4 points to 78.6 points, authors' evaluation system score was improved from 50.3 points to 73.2 points. Conclusion: In elderly patients with arthritic knees and associated intertrochanteric fractures, total knee arthroplasty seemed to decrease the rehabilitation time and allow earl weight bearing, so provide an improvement in quality of life.

슬개골 골절과 동반된 후방 십자인대 손상

오정환,신규철 건국대학교 의과학연구소 1994 건국의과학학술지 Vol.4 No.-

Patellar fractures result from direct and/or indirect forces. The majority of the patellar fractures result from direct injuries and a fall on the knee or a direct blow sustained in the vehicular trauma is one of the common causes. Patellar fractures from indirect forces occur when the intrinsic strength of the patella is exceeded by the pull of the musculotendinous and ligamentous units attaching to it and typically occurs in the act of stumbling or partially falling. Posterior cruciate ligament disruption is generally caused by a posteriorly directed force on the proximal tibia, and hyperextension with abduction or external rotation movements have been also described in the production of posterior cruciate ligament injuries. Posterior cruciate ligament injuries are apt to be negelected frequently, and ipsilateral femoral shaft fracture or posterior dislocation of the hip also may be seen with direct injuries to the patella, but patellar fractures are rarely associated with posterior cruciate ligament injuries. So we are reporting four cases of the posterior cruciate ligament injuries as one of the combined entity, which had been neglected and associated with the patellar fracture after a review of the literatures.

유기성자원의 퇴비원료로 활용 가능성 평가방법 개발

임동규,이승환,성기석,소규호,신중두,이정택 한국환경농학회 2006 한국환경농학회지 Vol.25 No.1

抗精神病藥物에 依한 無顆粒細胞症 治驗 1例

吳東財,申榮宇,張煥一,趙京杉,朴康圭 大韓神經精神醫學會 1985 신경정신의학 Vol.24 No.1

The authors experienced a female schizophrenic patient who revealed severely decreased leucocytes (350/㎣) with the manifestation of high fever, chillness and sore throat after the oral administration of neuroleptics. Agranulocytosis induced with the use of neuroleptic drugs has been well known complication in psychiatric practice although it is quite rare. In this case, following the combined use of neuroleptics (thioridazine halopondol and chlorproonazine), severe decrement of leucocytes (mainly lymphocytes with few neutrophils) was noticed on peripheral blood and marked decrement of erythroid series, especially of myeloid series, with decrement of total cellular elements were confirmed through the biopsy of bone marrow. She did not responded at all to the massive administration of antibiotics, but dramatic improvement was noticed both clinically and in the follow-up biopsy findings of bone marrow after two times trial of leukapheresis.

여성 알코올 의존 환자의 임상적 특성에 관한 연구 : - 일 정신병원 입원환자를 중심으로 -

성상경,신동환,송종호,이규항 大韓神經精神醫學會 1999 신경정신의학 Vol.38 No.6

연구목적: 남. 여 알코올의존 환자의 인구통계학적 특성, 음주력, 가족력, 음주양상, 음주동기, 공유질병 등을 포함하는 임상적 특성의 차이 및 여성 알코올의존에 대한 질병양상과 그 가족의 태도를 파악함으로써 향후 여성 알코올의존 환자의 치료 대책수립을 위한 기초자료를 제공하는데 그 목적이 있다. 방 법: 1991년 1월1일부터 1996년 5월31일까지 일 정신병원에 입원 치료한 남. 여 각각 51명의 알코올의존 환자를 연구대상으로 하였으며, 연구방법으로 병력기록지 및 설문지 조사를 통한 자료 수집을 이용하였다. 양군간의 비교를 위해 남. 여 인원 및 나이를 통제하였고, 여성 알코올의존자의 평균 연령은 44.45±11.02세였고 남성 환자군의 평균 연령은 44.17±10.08이었다. 진단은 DSM-Ⅲ-R에 의해 이루어졌으며 대상자 모두는 알코올 의존의 진단기준을 만족하였다. 결 과: 여성 알코올의존자는 남성 알코올의존자에 비해 음주시작 연령이 늦었고 과거 음주기간은 짧았으며 일 음주량이 적었다. 그리고 여성 알코올의존자는 남성 알코올의존자에 비해 자발적 입원이 많았으며 입원후 금단증상, 알코올성 간염, 당뇨등 신체적 합병증이 적었다. 또한, 입원후 가족의 태도에서 가족의 이혼위협 등 치료에 비협조적인 경우가 남성 알코올의존자에 비해 많았으며, 과거력상 사별, 이혼, 남편의 구타 등 상실의 경험이 많았다. 결 론: 남. 여 알코올의존자간에 인구통계학적 특성, 임상 특성, 가족의 태도 등 여러가지 면에서 차이가 나는 것으로 나타났다. 여성 알코올의존자 집단은 가족의 죽음, 부부생활의 갈등과 같은 심리 사회적 좌절 경험이 더 많고 가족들이 더 비협조적이었다. 그러므로 치료자는 이러한 여성알코올의존자의 특성을 치료와 예방에 반영하고 이들에 대한 세심한 배려를 해야할 것이다. Objectives: This study aimed to provide a basic data of female alcoholics by understanding the gender differences of the clinical characteristics including demographic characteristics, alcoholic history, family history, drinking patterns, reasons for drinking, and comorbidity in male and female alcoholics. It also ained to establish the therapeutic plans through understanding the patterns of disease and the patterns of family cooperation in female alcoholics. Methods: The study subjects consisted of 51 male and female alcoholics admitted to a mental hospital from January 1, 1991 to May 31, 1996. Subjects were age-and sex-matched. We reviewed patients charts and administered questionaires. Mean age of female alcoholics was 44.45±11.02 years and that of male alcoholics was 44.17±10.08 years. All male and female patients met with the DSM-Ⅲ-R criteria of alcohol dependence. Results: Female alcoholics were later in drinking-onset age, and to had shorter duration of previous drinking history and less average amount of daily drinking than male alcoholics. And female alcoholics were found to seek treatment more voluntarily, and to have less frequent delirium tremens after admission and less medical complications such as hepatitis and diabetes mellitus. Also female alcoholics had more frustration experiences of separation such as death of family member, divorce, and husband`s physical abuse. Female alcoholic`s families had more uncooperative attitude toward treatment such as threat to divorce after admission. Conclusions: There were many differences between male and female alcoholics of demographic characteristics, clinical characteristics, and patterns of family cooperation. Female alcoholics were found to have more experiences of psychosocial frustration including death of family member and marital conflicts, and more uncooperative attitude of her family members. Therefore, it is required that therapists consider the characteristics of female alcoholics upon treatment and prevention, and have more concern about female alcoholics.

만성정신질환자의 계속입원치료 심사에 관한 연구

정인원,박환규,정연복,김수일,원구연,김교형,신철진 大韓神經精神醫學會 1999 신경정신의학 Vol.38 No.6

연구목적: 정신보건법에 근거하여 매월 정기적으로 개최된 충청북도 정신보건심판위원회를 통하여 정신질환자의 계속입원치료 청구 심사의 현황과 문제점을 파악하고 개선사항을 지적함으로써 정신질환자의 효율적인 관리를 유도하고 인권남용의 여지를 차단하고자 한다. 방 법: 충청북도 내의 정신의료기관에서 계속입원치료 심사청구서 및 진단서, 보호의무자의 동의서 등을 제출한 정신질환자들을 대상으로 계속입원치료 청구에 대한 승인 여부를 매달 정기적으로 심사하였다. 1년 6개월여동안 심사한 자료를 정리하여 진단 및 보호의무자, 의료보장별 특성과 불승인률 등을 분석하였다. 결 과: 충청북도 심판위원회에 계속입원치료를 청구한 정신질환자는 21차례의 위원회 동안 총 7,981명이었으며, 진단별로 정신분열병은 80.9%, 알콜중독은 8.1%, 치매 등 기타는 11.0%이었다. 또한 보호의무자는 시장 또는 군수가 29.8%, 부모가 26.9%, 형제가 26.1%, 부부가 6.3%, 자녀가 5.9%, 기타가 5.0%로 나타났으며, 의료보장은 의료보호가 73.0%, 의료보험이 27.0%이었다. 이들 중에서 196명이 계속입원치료를 불승인받아서 전체 불승인률은 2.46%이었으며 정신분열병과 알콜중독 환자의 진단별 불승인률은 각각 0.73%와 17.6%이었다. 결 론: 정신과 병상의 대부분이 장기적으로 입원하는 만성 정신질환자들로 구성되어 있어서 이들에 대한 별도의 대책이 시급하다. 또한 계속입원치료가 불승인되어 퇴원한 환자들의 재활 및 사회적응을 위한 사회적 지지 체계가 부족하며, 특히 환자의 인권보호를 위한 구체적인 기준 등이 필요하다. Objectives: This study was to develop effective managements and to avoid the abuse of human rights in mentally-ill patients. The Mental Health Judgement Board of Chungchongbuk-do province has been held monthly since August, 1997 according to the Mental Health Act. In this study, the procedures and the problems of judging continuing hospitalization of chronic mentally-ill patients were reviewed. Methods: The mentally-ill patients who submitted the request for continuing hospitalization with the certificate of charged doctor and the agreement of caregiver were reviewed by the Mental Health Judgement Board of Chungchongbuk-do province. The analysis of the diagnoses, caregivers, medical care systems, and rejection rate for the patients were done. Results: Total mumber of mentally-ill patients who requested for continuing hospitalization were 7,981 from twenty-one monthly meetings. The diagnostic distributions were 80.9% for schizophrenic patients, 8.1% for alcoholics and 11.0% for others including dementia. As for the caretakers, the rate of majors was 29.8%, parents 26.9%, sibling 26.1%, spouse 6.3%, offspring 5.9%, and others 5.0%. And 73.0% of the patients were on Medicaid and 27.0% were insured. The patients who got the rejection for continuing hospitalization were 196 at the rate of 2.46%. And the rejection rates of schIzophrenic and alcoholic patients were 0.73% and 17.6%, respectively. Conclusions: New policies for decreasing longterm hospitalization of chronic mentally-ill patients are required. And the social support systems for psychiatric rehabilitation and readjustment are presently insufficient for the already discharged mentally-ill. Moreover, the practical guidelines for human rights of patients remains to be suggested.