상염색체우성 다낭신의 임상경과 및 합병증

이상주,이영모,이한규,최대은,박기현,이강욱,신영태 충남대학교 의학연구소 2001 충남의대잡지 Vol.28 No.2

Autosomal dominant polycystic kidney disease(ADPKD) is one of most common hereditary disorder. It is potentially fatal and the major mobilities are hypertension and renal failure. To elucidate clinical characteristics and outcomes of ADPKD, 67 ADPKD patients were analyzed retrospectively. The male to female ratio was 48 years for males and 42 years for females. The factors leading to the dignosis of ADPKD were flank or abdominal pain (46%), palpable abdominal mass (24%), incidental findings (18%), gross hematuria and headache. Urinalysis result showed hematuria (31%), proteinuria (19%), pyuria (18%). Among renal complications hypertension (67%) was the most common. Other complications were urolithiasis (16%) upper urinary tract infection (9%), cyst infection (7%). Azotemia was observed in 24% of cases. Echocardiography showed left ventricular hypertrophy in 24% and valvular regurgitation in 18% of cases, but there was no mital valve prolapse. Cerebrovascular events occurred in 6 cases (2 cases of intervertebral hemorrhage and 4 cases of cerebral infarction). Hipatic cyst were observed in 64% of cases. Eighteen cases culminated in end stage renal failure (ESRF) at an of 47. According to this study, the most common complications of ADPKD was hypertension (67%), ESRF (27%), and cerebrovascular event (9%). Hypertension was more frequently observed in increased creatinine group than normal.

청장년에서 관찰된 관상동맥의 비죽종성 석회화와 동맥류 : 부검증례보고

이지신,이영직,박종태 大韓法醫學會 1997 대한법의학회지 Vol.21 No.1

Coronary artery calcification(CAC) is found frequently in the atheromatous plaques. CAC is known to have increased frequency above 40 years. CAC without evidence of atherosclerosis in young adults is quite rare, however, CAC combined with aneurysms in young adults have been infrequently reported in patients with a past history of a Kawasaki disease in child. We report an autopsy case showing CAC and aneurysm in the absence of macroscopically identified atherosclerotic lesions in a healthy 23-year-old man. The autopsy examination revealed aneurysmal dilatation of the right coronary artery, which was connected with calcified lesion. A calcified lesion of the left anterior descending coronary artery was aslo noted. Microscopically, aneurysmal wall was non-specific except for hyalinized wall and foci of calcification. A striking histologic finding of calcified mass was ring calcification along the wall of the coronary artery. Antecedent Kawasaki disease in the past was suggestive as other reports.

국가예방접종전산등록체계 개발을 위한 민간의료 기관 하부구조 및 환경 조사연구

이무식,김은영,이건세,이석구,홍지영,김건엽,김대경,신의철,이연경,기몽서,나백주,김영택 한국모자보건학회 2003 한국모자보건학회지 Vol.7 No.2

개에서 결직장 연접부의 림프종 1례

이재일,이수진,김영석,김명진,조성환,신상태,이영원,김명철 충남대학교 수의과대학 동물의과학연구소 2003 動物醫科學硏究誌 Vol.11 No.-

A five years old female Shih-tzu was referred to the veterinary medical teaching hospital at Chungnam national university with soft bloody diarrhea and tenesmus. On rectal palpation, solid mass was palpated in colorectal region. In radiographs, small intestine was deviated cranially, descending colon and rectal junction were deviated caudoventrally in lateral projection of the abdomen. In ultrasonographs, hypoechoic nodulation of mesenteric lymph node in colorectal junction, mixed echoic thickening of colorectal wall and irregular margination were observed. Rectal endoscopy revealed that colorectal men was partially obstructed due to compression of the mass. Also, severe ulceration, inflammation and hemorrhage were also observed in descending colon. The mass was resected through the laparotomy. In histopathology, it was diagnosis of lymphoma in the colorectal junction.

중증 재생불량성 빈혈 환자의 동종골수이식 후에 병발한 간정맥폐색질환(Hepatic Veno-Occlusive Disease)의 임상 경과 및 혈액응고 인자들의 변화

이제환,이규형,최성준,민영주,김신,이정신,김상희,박찬정,지현숙,김우건 대한조혈모세포이식학회 1999 대한조혈모세포이식학회지 Vol.4 No.2

연구배경: 재생불량성 빈혈 경우에는 조혈모세포 이식 후 VOD의 발생에 관한 보고가 거의 없는 실정이다. 저자 등은 cyclophosphamide와 antithymocyte globulin으로 전처치 후에 동종골수이식을 시행한 재생불량성 빈혈 환자들을 대상으로 하여 VOD의 발생과 임상 양상, 혈액응고 인자들의 변화에 관하여 분석하여 보았다. 방법: 재생불량성 빈혈로 동종골수이식을 시행 받은 13예 환자를 대상으로 하였다. 임상적 기준에 따라 VOD를 진단하였으며 임상 경과에 따라서 경중을 분류하였다. Protein C, protein S, antithrombin Ⅲ, tPA, PAI-1 등의 혈액응고 인자들을 전처치 투여전, 골수 주입당일, 이식 후 제7, 14, 21일에 측정하였다. 결과: 7예(53.8%)에서 VOD가 발생하였으며, 경증 5예, 중등도 2예였다. VOD군에서 혈소판치가 20.000/㎕ 이상을 유지하는 데까지 걸리는 시간이 더 길었다(p=0.026). 또한 VOD군에서 적혈구 및 혈소판의 수혈 요구량이 각각 유의하게 많았다(p=0.025, 0.015). 혈액응고 인자들의 변화를 보면, 제 0일에 VOD군에서 PAI-1의 혈중 농도가 유의하게 더 높았다.(p=0.034). 결론: 재생불량성 빈혈환자에서도 조혈모세포 이식 후에 VOD의 높은 발생률을 관찰하였으며, 대부분이 경증이었다. VOD 환자에서의 혈액응고 인자들의 변화는 PAL-1이 VOD의 감별 진단을 위하여 이용될 수 있음을 시사하고 있다. Background: There are few reports about the occurrence of hepatic veno-occlusive disease(VOD) after bone marrow transplantation (BMT) for severe aplastic anemia (SAA). We analyzed the incidence and clinical outcomes of VOD and changes of coagulation factors in patients with SAA who were conditioned with cyclophosphamide plus ATG and underwent allogeneic BMT. Methods: Thirteen patients with SAA who underwent allogeneic BMT were included. A diagnosis of VOD was made according to clinical criteria, and severity of VOD was classified according to clinical course. Plasma levels of protein C, protein S, antithrombin Ⅲ, t-PA, and PAI-1 were determined before preparative chemotherapy, in the day of marrow infusion, and days 7, 14, and 21. Results: VOD occurred in 7/13(53.8%). Five were mild VOD and two were moderate VOD. Time to platelet ≥20,000/L was slower (p=0.026) and red cell and platelet transfusion requirements were higher (p=0.025,0.015) in patients with VOD . The mean plasma level of PAI-1 at 0 were higher in patients with VOD (p=0.034). Conclusion: We observed the high incidence of VOD after allogeneic BMT in patients with SAA. A majority of cases of VOD were mild. The changes of PAI-1 after BMT may be useful marker of hepatic VOD

영·유아 언어, 인지, 사회·정서 발달 평가도구 문항 개발을 위한 예비연구

이종숙,신은수,박은혜,김영태,유영의,최일선,유흥옥 이화여자대학교 교육과학연구소 2009 교육과학연구 Vol.40 No.3

본 연구는 만 2~5세 영·유아의 발달 상태를 객관적으로 평가함과 동시에 발달이 지연된 영·유아를 선별할 수 있는 발달평가도구 문항을 개발하기 위한 예비연구이다. 이를 위해 문헌고찰 및 발달관련 평가도구들을 비교 분석하여 발달지표를 선정하고, 만 2세~5세까지의 영·유아의 언어, 인지, 사회·정서발달영역을 교사관찰에 기초하여 평가할 수 있는 문항을 개발하였다. 연구대상은 대도시, 중소도시, 읍면 소재지 별로 표집 된 만 2세부터 5세까지 총 13개 유아교육기관에 다니는 435명의 영·유아들이며, 본 연구에서 최종 개발된 평가도구의 문항은 총 141문항이다. 평가도구 문항은 언어, 인지, 사회·정서발달영역별로 영·유아의 행동과 언어를 중심으로 교사가 관찰하고, 관찰하기 어려운 문항에 대해서는 단서와 kit를 제시하여 평가할 수 있도록 구성하였다. 개발된 평가도구 문항의 적절성을 알아보기 위하여 내용 타당도와 내적 신뢰도를 살펴본 결과 비교적 양호한 것으로 나타났다. This was a preliminary study to construct a developmental rating scale for understanding children's objective developmental levels and screening developmental disabilities. For this purpose, a developmental indicator was selected by a literature review and comparative analysis of related developmental assessment tests. An assessment scale based on teacher's observations to measure language, recognition, and social-emotional developmental areas was developed. The subjects were 435 young children aged 2 to 5 who lived in both urban and rural areas. A trial test consisted of 141 assessment items in the language, recognition, and social-emotional developmental domains. The developmental scale was evaluated by teachers who observed children's behavior and language, and used clues and kits. Tests on validity and reliability for confirming the appropriateness of the developed assessment scale showed that content was relatively valid and internally consistent.

톡소포자충 배양시 약제투여에 따른 Toxoplasma P30 유전자의 발현

이상걸,이영하,김계영,나영언,신대환 충남대학교 의과대학 지역사회의학연구소 1996 충남의대잡지 Vol.23 No.2

To know the drugs effect on gene expression and its regulating mechanism by RT-PCR and southern blot hybridization assay based on detection of the P30 gene encoding the major surface antigen, P30 of Toxoplasma gondii and the DNA synthesis in T. gondii infected HeLa cells. The experiment was performed and the results were as follows. 1. The thymidine incooperation in DNA of HeLa cell and T. gondii infected HeLa cell reached peak level at 36 hours and suddenly decreased at 48 hours. The uracil incooperation in DNA of T. gondii reached peak level at 48 hours. 2. The decrease of P30 gene expression began from 24 hours after pyrimethamine treated and 36 hours after methotrexate treated in T. gondii. The results were some what different. Pyrimethamine was more sensitive and acted earlier to T. gondii than Methotrexate did. The decrease of P30 gene expression of T. gondii was regulated these drugs in dose dependent manner. 3. The effects of dibutyryl cyclic AMP on P30 gene expression increased peak at 24 hours and on contrary decreased at 60 hours after treatment in dose dependent manner, but at 10mM high concentration of dibutyryl cAMP, P30 gene expression was supressed. 4. Actinomycine D supressed the P30 gene expression of T. gondii in HeLa cell. As the results, we presume pyrimethamine acts more powerful and earlier to supresses P30 gene expression than methotrexate, and it is regulated at transcription level. The results of RT-PCR were in agreement with that of southern blot hybridization.

영아급사증후군과 소아급사증후군

이한영,양경무,이주한,강신몽 內務部 國立科學搜査硏究所 2002 國立 科學 搜査 硏究所 年報 Vol.34 No.-

췌장암 환자에서 알코올 내장신경 신경파괴블럭 후 발생한 간염

이상은,최석환,김영환,임세훈,이정한,이근무,정순호,최영균,김영재,신치만 인제대학교 2008 仁濟醫學 Vol.29 No.-

Splanchnic neurolytic block(SNB) with alcohol improves the management of pancreatic cancer pain. Adverse effects of alcohol SNB which include regional pain, hypotension, diarrhea, and acute alcohol intoxication are common, but acute hepatitis caused by alcohol neurolytic block is rare. A 63-year-old patient with pancreatic head cancer and liver metastasis had complete pain relief after both retrocrural tansdiscal SNB with 100% alcohol 10 ml. But, 1 day later, liver function test showed a high elevation in the aspartate aminotransferase (AST, 2182 IU/L) and alanine aminotransferase (ALT, 1807 IU/L). The patient had slight jaundice, general weakness, chilling, nausea and vomiting after SNB. Both AST and ALT decreased to 46 and 119 IU/L within 10 days with only supportive therapy. But, 19 days later, the patient died due to pneumonia. Our case illustrates the importance of clinical surveillance especially in patient with hepatic disease after alcohol SNB.

성인에서 Haemophilus influenzae 감염증의 임상양상과 미생물학적 특성

이종섭,황병연,정희진,김우주,박승철,이도현,이창규,신종희,황규잠,이영희 대한화학요법학회 2000 대한화학요법학회지 Vol.18 No.2

목적 : H. influenzae는 성인에서 흔히 호흡기 감염을 일으키는 균주로, 최근 ampicillin 내성 β-lactamase 생성 균주들이 지속적인 증가를 보이고 있어, 이에 국내 성인에서 H. influenzae에 의한 감염의 임상양상과 분리된 균주들의 미생물학적 특성을 조사하고자 하였다. 방법 : 1998년 3월부터 1999년 9월까지 고려대 구로병원에 내원한 환자중에서 H. influenzae가 분리된 68명을 대상으로 임상양상을 조사하고 항균제 감수성 검사를 시행하였다. 분리된 33주에 대해서 혈청형, 생물형, 세포외막 단백분석을 시행하였고, β-lactamase 생성여부에 따른 감염 환자군간 임상상 및 예후의 차이를 비교하였다. 결과 : 환자의 평균연령은 68세였고, 지역사회 획득감염이 전체의 85%를 차지하였다. 폐렴과 기관지염과 같은 하기도 감염이 전체환자의 75%를 차지하였고 분리 검체 역시 객담이 84%로 가장 많았다. 환자의 71%가 기저질환을 가지고 있었으며, 그 중에 만성 폐쇄성 폐질환, 심혈관 질환, 악성종양, 당뇨병이 대부분이었다. 혈청형으로는 nontypeable 형이 68%로 가장 많았고 b형은 한 예도 없었다. β-lactamase 생성율은 63.2%였고, β-lactamase 양성균주의 항균제 내성율이 음성균주에 비하여 높았으나 β-lactamase 생성 여부에 관계없이 cefotaxime, azithromycin, ciprofloxacin에 대하여 100%의 감수성을 나타내었고 cefaclor, cefuroxime에 대해서는 10% 이하의 낮은 내성율을 보여 이들 항균제들이 치료에 효과적일 것으로 사료된다. 세포외막 단백분석에서는 C형과 D형이 전체의 64%로 가장 많았으며, 혈청형과의 유의한 연관성은 보이지 않았다. 결론 : 성인에서 H. influenzae는 주로 만성 기저질환자에서 급성 호흡기감염 또는 만성 폐쇄성 폐질환의 급성 악화를 유발한다. 기존의 보고에 비해 β-lactamase 양성율이 증가하였고, 이에 따른 항균제 내성율도 증가하여 항균제의 선택에 유의하여야 할 것으로 생각된다. 세포외막 단백분석상 특정한 유형의 균주에 의해 감염이 집중적으로 발생하고 있어 향후 역학 조사의 도구로 이용할 수 있겠다. Purpose : H. influenzae is one of the common causative microorganisms of respiratory tract infections in adults. Recently. β-lactamase producing, ampicillin-resistant H. infiuenzae has become worldwide problem as well as in Korea. We studied to investigate the clinical features and microbiologic characteristics of H. infiuenzae infections in adults. Materials & Methods : From March 1998 to September 1999, 68 patients were enrolled in this study. Clinical features of H. infiuenzae infections were investigated, 68 isolates were subjected to the β-lactamase test, and 33 isolates were used for serotyping. biotyping, antibiotic susceptibility and outer membrane protein (OMP) analysis. Results : Mean age of study patients was 68 years-old and the acquisition rate in community was 85%. Pneumonia and bronchitis were the most common type of infection such as 80%, sputum was the most common clinical specimen for H. mQuenzae isolation. 70% of patients had chronic underlying diseases. Non-typeable strains were 68% and β-lactamase producing rate was 63%. There was no difference in the clinical features and prognosis of H. influenzae infection between the β-lactamase positivie and -negative groups. The susceptibility of cefotaxime, azithromycin, and ciprofloxacin was 100% and that of cefaclor, cefuroxime was under 10% in spite of β-lactamase positivity. In OMP analysis, C and D types were dominant (64%). Conclusion : H. influenzae caused acute respiratory infections in adults with chronic underlying disorders. This study shows higher β-lactamase producing rate and antibiotic-resistance rate than that were reported previously. OMP analysis shows that two major types of strains cause clinical infections intensively.