신약성경에 나타난 하나님의 선교

박창환(Chang-whan Park) 주안대학원대학교 2014 미션네트워크 Vol.4 No.-

다발성 장기 경색을 동반한 폐선암 1례

박창환 ( Chang Whan Park ),이정훈 ( Chung Hoon Lee ),황준화 ( Jun Wha Whang ),장일권 ( Il Gwon Jang ),박형관 ( Hyeong Kwan Park ),김영철 ( Young Chul Kim ),박경옥 ( Kyung Ok Park ) 대한결핵 및 호흡기학회 1997 Tuberculosis and Respiratory Diseases Vol.44 No.5

알레르기성 기관지천식환자의 말초 혈액 T세포, NK세포 TNK세포의 Der p 2 항원의 자극에 의한 interferon gamma의 생산

맹선희 ( Sun Hee Maeng ),이지수 ( Ji Soo Lee ),박창환 ( Chang Whan Park ),조영주 ( Young Joo Cho ) 대한천식알레르기학회 2003 천식 및 알레르기 Vol.23 No.2

Background:Asthma is a chronic inflammatory disease of the bronchial mucosa and is associated with excess production of Th2 cytokines (IL-4, IL-5) relative to Th1 cytokine (IFN-γ). The NK cell and TNK cell are supposed to be involved in the pathogenesis o

유리 광배근피판을 이용한 안면부 복합재건 치험례

성만호(Man Ho Sung),김명래(Myung Rae Kim),박창환(Chang whan Park),김선종(Sun Jong Kim) 대한구강악안면외과학회 1994 대한구강악안면외과학회지 Vol.20 No.2

This is to report a case of Latissimus Dorsi myocutaneous free flaps used to reconstruct the paralyzed cheek defect. The patient who had been sufferred from congenital facial nerve paralysis and accompanied muscular atrophy showing horse-face mask appearance was treated by bilateral LD Neuro-Musculo-Cutaneous free flaps. The clinical applications of LD neuro-muscular free flaps and the results were as follows; 1. Two LD free flaps(15×3cm) with longer vascular stalk (8,10cm in length) were raised and transferred to both cheeks. 2. The thoracodorsal arteries feeding the LD-flaps were as big as 1.5~2.5mm in diameter, and the surgical risk of failure in vascular anastomosis could be very low. 3. Color of the LD-flaps matched good to the facial skin. 4. Muscle flaps containing the motor nerves responsed to nerve stimuli, but the facial expression could not be recovered due to the prolonged degeneration of proximal facial nerve. 5. The complications of donor site were minimal, and the function of arms were recovered soon postoperatively.

악교정 골성형술후 약관절 장애의 변화

김명래,박창환,성만호 大韓顎顔面成形再建外科學會 1993 Maxillofacial Plastic Reconstructive Surgery Vol.15 No.3

Sixty four patients were followed-up for over 6 months following the orthognathic surgeries and were examined for the Temporo-mandibular joint dysfunction. The results are as follows: 1. Of 64 patients, 9(14.1%) had been suffered from TMD preoperatively : 47% in the prognathism and 46.2% in the laterognathism. 2. Following the orthognathic surgeries, 7 of 64 patients(10.9%) complained TMD, and 55.6% of the TMD patients resulted in significant improvement. 3. By the type of deformities, laterognathism with TMD could be expected to be improved in 30.8%, while 7.7% in the prognathism. 4. Non-rigid fixation resulted in higher incidence of TMD than the Rigid fixation after the SSRO ; 4 of 15(26.5%) and 2 of 25(8.0%) respectively.

알레르기 병력이 없는 젊은 여성에서의 집먼지 진드기 감작률 및 천식 유병률

김희선,박창환,이지수,조영주 대한천식 및 알레르기학회 2004 천식 및 알레르기 Vol.24 No.1

Background : During the past few decades, the prevalence of allergic disorders has increased worldwide. We attempted to reveal the sensitization rate of dust mite allergens, which is one of the most important allergens in Korea, and the prevalence of mite-sensitized asthma in healthy young women who had no history of allergic diseases. Methods : We performed the skin prick test with two mites (Dermatophagoides farinae. Df : Dermatophagoides pteronnyssinus, Dp) in 24-26 years old 172 women who had no history of allergic diseases. We also performed the methacholine bronchial provocation test (MBPT) and the questionnaire survey of positive skin responders. Results : The 55.2% of subjects showed positive skin responses to house dust mites. The positive rate to MBPT was 54.7% with average PC20 of 15.97±7.68㎎/㎖ and 48.4% had asthma symptoms in the questionnaire survey. Among the methacholine positive population, 6.3% had no asthma symptoms. The history of 3-week cough after upper airway infection was most important, but the most specific item was wheezing. Conclusion : The prevalence of dust mite-sensitive bronchial asthma in healthy young women is 26.7%, which is higher than that of previous studies. (J Asthma Allergy Clin Immunol 24 : 103-9, 2004)

쯔쯔가무시병 120예의 임상적 고찰

백강우,김기태,박창환,류도현,최성규,유종선,윤종만,문범 대한감염학회 1995 감염 Vol.27 No.3

연구배경:쯔쯔가무시병은 1986년 이 등에 의해 국내에서는 처음 보고된 이후 최근 전국적으로 가을에 많은 발병이 보고되고 있으며, 렙토스피라증이나 출혈성 신 증후군과 감별을 요하는 급성 열성 질환이다. 전남 지방에서도 많은 환자가 발새하고 있어서 이의 임상적 및 역학적 고찰을 하였다. 방법:저자들은 1990년부터 1993년 가을에 급성 열성 질환으로 전남대학교병원, 광주한국병원, 목포의료원, 순천의료원, 영광병원 등 전남지방 종합병원 내과에 입원한 환자중 임상적으로 쯔쯔가무시벼으로 진단된 120예에 대한 역학적 특성, 임상소견, 검사성적 및 치료결과를 후향적으로 분석하여 다음과 같은 결과를 얻었다. 결과: 1) 120예중 남자가 43.3%, 여자가 56.6%로 여자의 발생빈도가 약간 높았고, 연령은 20대에서 80대까지 분포하였으며, 50대(32.5%), 60대(21.6%), 70대(21.6%)의 순이었다. 월별로는 9월 2.5%, 10월 40.8%, 11월 53.4%, 12월 3.3%의 빈도로 발생하여 11월에 가장 높은 빈도를 보였다. 2) 내원당시 임상증상은 고열 및 오한(83.9%), 두통(55.8%), 근육통(55.0%), 복통(22.5%), 기침 (21.6%), 인후통(15.0%)의 순으로, 신체검사 소견으로는 가피(75.0%), 피부발진(52.5%), 간비장종대(8.3%), 임파선 종대(8.3%) 등의 순으로 관찰되었다. 3) 검사소견으로는 간기능 검사상 75%에서 이상소견이 관찰되었고, 심전도상 이상소견은 29.1%에서 보였다. 간접 염역형강항체법 검사상 70%의 양성률을 보였고, 한탄바이러스와의 혈청학적 교차반응은 4예(3.4%)에서, 렙토스피라와의 혈청학적 교차반응은 2예(1.7%)에서 관찰되었다. 4) 치료는 doxycycline에 좋은 반응을 보였으며, 해열까지의 평균 기간은 doxycycline은 4.0일이었다. 5) 합병증으로는 Guillain-Barre 증후군 2예와 급성 심근염 1예가 관찰되었으나 모두 완쾌되었다. 결론: 가을에 두통 및 근육통을 호소하는 급성 열성 질환 환자의 경우에서 피부발진 및 가피를 관찰함으로써 쯔쯔가무시병을 조기 진단을 할 수 있었고, doxycycline치료에 좋은 반응을 보이기 때문에 특징적인 임상 소견에 근거를 둔 조기 치료가 필요할 것으로 사료되었다. Background: As tsutsugamushi disease is one of the endemic febrile illness during fall season in Korea, it is necessary to distinguish clinically tsutsugamushi disease from leptospirosis or hemorrhagic fever with renal syndrome for early adequate treatment. Methods:One hundred and twenty cases of tsutsugamushi disease were analyzed clinically and epidemiologically, which were diagnosed at Chonnam University hospital, Kwangju Hankook hospital, Mokpo hospital, Sooncheon hospital and Yeonggwang hospital inChonnm province from 1990 to 1993. Results: 1) For one hundred and twenty cases, the age distribution ranged from the twenties to eighties and the disease was most common in the 6the decade(32.5%), 7th decade(21.6%) and 8th decade(21.6%). Male to female ratio was 1:1.3. The monthly distribution rate was highest in November(53.4%), followed by 40.8% in October, 3.3% in December, and 2.5% in September. 2) The percentages of frequency of major symptoms were as follows: fever and chills, 83.9%; headache, 55.8%; myalgia, 55.0%. Eschar, rash and conjunctival injection were present in 75.0%, 52.5% and 15.8%, respectively. 3) Abnormal liver function test, chest X-ray, and EKG were present in 75.0%, 17.5% and 23.3% respectively. The serologic diagnosis was made by indirect immunofluorescent antibody test in 70% of cases; serologic cross reactions with Hantavirus or Leptospira in 3.4% and 1.7% of cases, respectively. 4) All of the patients were satisfactorily cured with doxycycline. However, the uncommon complications were myocarditis in one case and Guillain-Barre syndrome in two cases, which were recovered without sequelae. Conclusion: Tsutsugamushi disease is an acute febrile illnes which is characterized by fever, chills, headache, myalgia, rash and eschar during autumn. Therefore, we have to make every effort to make early clinical diagnosis and to start empirical treatment before the serologic diagnosis.

간폐증후군 1 예

김영철,박경옥,이정훈,박종춘,강광원,김준우,황준화,장일권,박형관,박창환 대한내과학회 1997 대한내과학회지 Vol.53 No.4

Hepatopulmonary syndrome consists of a triad of liver dysfunction, intrapulmonary vascular dilatation, and hypoxemia. This is one of the main causes of arterial hypoxemia in patients with chronic liver disease. The vascular abnormalities are precapillary dilatation, direct arterial-venous communication, and dilated pleural vessels. In this article, we report a case of hepatopulmonary syndrome in a 62-year-old woman who had complained progressively worsening dyspnea, platypnea, and orthodeoxia. She had huge splenomegaly, clubbing fingers and cyanosis of lip and fingers. Arterial blood gas analysis showed refractory arterial hypoxemia and orthodeoxia suggesting right-to-left $quot;shunting$quot;. Chest X-ray showed increased interstitial markings on the lower part of right lung, In ^(99m)Tc-labeled macroaggregated albumin (MAA) lung perfusion scan, there was no perfusion defect in the lung, but labeled radionuclide were taken up in the intraabdominal organs, kidney, liver and spleen. The amount of shunted radionuclide were about 58 percent. In contrast echocardiography, microbubbles which were injected via cephalic vein were visualized in the left atrium at 4 cardiac cycles after leaving the right ventricle indicating intrapulmonary right-to-left $quot;shunting$quot; rather than intracardiac shunt. Pulmonary angiographic finding revealed diffuse blotchy arterial dilatation on both lung fields, especially lower lobes of both lungs. Current modalities of treatment of hepatopulmonary syndrome are the therapeutic embolization of direct arterial-venous communication for focal vascular dilatations, and TIPSS (Transjugular intrahepatic porto-systemic shunt) or liver transplantation for diffuse intrapulmonary vascular dilatations. Despite our recommendation of TIPSS, she refused the procedure and is under home oxygen therapy.

Vibrio vulnificus 감염증으로 확진된 92예의 임상적 고찰

유종선,문범,지미선,최성규,백강우,김기태,박창환,윤종만 대한감염학회 1995 감염 Vol.27 No.4

목적: V. vulnificus 감염증은 전남지방에서 매년 발생하고 있고 지속적인 계몽과 집중적인 치료에도 불구하고 아직도 높은 치사율을 나타내고 있어 1983년부터 1994년까지의 전남지방의 V. vulnificus 감염증의 임상상과 역학적인 특성을 분석 검토해보았다. 방법:1983년부터 1994년 9월 까지 전남대학병원에 내원한 환자중 균 배양검사로 V. vulnificus 감염증으로 확진된 92예를 대상으로 세균학적 검사소견, 역학적 특성, 임상소견을 분석 검토하였다. 혈액배양은 BACTEC blood culture system(Bekton Dickinson)을 이용하였고, 피부병변 조직배양은 혈액한천배지, MacConkey agar, Thioglycolate broth에 접종 배양한 후 배양된 세균을 ATB 32GN(biome-rieux. France)과 API 20E(biomerieux. France)로 동정하였다. 항생제 감수성은 Kirby-Bauer 디스크(BBL Sensi disc)확산법으로 검사하였다. 결과: 1) V. vulnificus는 혈액배양에서 20예(22%), 조직배양에서 43예(47%), 혈액과 조직에서 27예(29%), 혈액과 복수에서 1예(1%), 혈액과 뇌척수액에서 1예(1%)가 배양되었다. 원판 확산법에 의한 균 감수성검사에서는 tetracycline, chloramphenicol, ampicillin, gentamicin, piperacillin, cefoperazone, cefotaxime, ciprofloxacin등은 100%의 감수성을 나타냈고 amikacin, kanamycin, carbenicillin등은 약 85%, cephalothin은 77%의 감수성을 나타냈으며 colistin은 전 균주에서 내성을 나타냈다. 2) 연도별 발생빈도는 85년에 21예로 가장 많았고, 94년 12예, 89년 10예, 87년 9예, 91년 8예, 93년 8예의 순이었다. 월별로는 5월에서 10월 사이에 발생하였으며 특히 7월에서 9월 사이에 78예(85%)로 집중적으로 발생하였다. 지역별로는 해안지방과 인접 내륙지방에 주로 발생하는 경향을 보였다. 3) 간질환이나 중등도 이상의 음주력이 있는 40-50대의 남자에서 어패류를 생식 또는 불충분하게 조리하여 섭취했을때 많이 발생하였다. 환자 발생시기의 남서해안 근해 평균수온은 16.3℃-28.7℃였으며 특히 22.0℃-23.9℃시기의 발생이 전체의 54%를 차지하였고 해수온도가 상승함에 따라 발생빈도가 증가하는 경향을 보였다(r=0.43 p=0.006). 4) 대부분이 원발성 패혈증 증세를 보였고 하지의 부종과 수포등 피부병변만 나타나고 패혈증 증세가 없었던 창상감염증 1예와 뇌막염 증세를 동반한 패혈증이 1예 관찰되었다. 임상증상으로는 주로 피부병변(96%), 사지통(56%), 저혈압(52%), 발열(47%), 오한(43%), 설사(33%), 복통(26%), 구토(25%)등이 나타났고, 심한 경우에는 핍뇨(9%), 호흡곤란(7%), 혈변(2%)도 나타났다. 피부병변으로는 수포(56%), 부종(52%), 홍반(51%), 괴사(18%), 자반(11%), 구진(7%), 농포(2%), 등이 관찰되었고 주로 하지(73%)에 많이 발생하였다. 5) 사망률은 전체적으로는 57.6%이였고, 점차 감소화 하는 추세를 보였다. 사망군과 생존군간에는 생명징후, 잠복기에 따른 차이는 없었으나 백혈구수와 혈소판수가 감소할수록, AST가 높을수록 사망률이 높았다 결론:V. vulnificus 감염증은 일단 패혈증이 발생하면 병의 진행이 빠르고 감수성 있는 항생제로 집중적인 치료를 해주어도 사망률이 높기때문에 발병후 치료보다 예방이 훨씬 중요하리라 사료된다. Background:V. vulnificus infection is a highly fatal disease prevailing in Chonnam area. To increase understanding of V. vulnificus infection, we investigated clinical and epidemiological characteristics of V. vulnificus infection in Chonnam area. Methods:We retrospectively reviewed the clinical recores of 92 cases with V. vulnificus infection which admitted to Chonnam University Hospital from 1983 to 1994 and bacteriologically were confirmed. Results: 1) V. vulnificus was isolated from blood in 22%, tissue in 47%, blood and tissue in 29%, blood and peritoneal fluid in 1%, and blood and cerebrospinal fluid in 1% of the cases. All the isolates were susceptible to tetracycline, chloramphenicol, ampicillin, gentamicin, piperacillin, cefoperazone and cefotaxime. About eighty-five pervent of the isolates were susceptible to amikacin, kanamycin and carbenicillin and seventy-seven percent to cephalothin. All the isolates were resistant to colistin. 2) The yearly distribution was 21 cases in 1985, followed by 12 in 1994, 10 in 1989, 9 in 1987 in decreasing. The monthly distribution was each 27 cases in July and August, followed by 24 in September, 8 in June, 5 in October, 1 in May. The majority of cases occurred in coastal areas and nearly inlands of Chonnam province. 3) All of V. vulnificus infections occurred in association with ingestion of raw seafoods. The age and sex distribution ranged from the thirties to the eighties and occurred mainly in adult males in the fifties(48%) and the forties(24%). Of ninety-two cases, 73 cases had underlying liver diseases and 67 cases were heavy alcohol consumers. 4) Almost all cases showed primary septicemia except one which had wound infection without septicemia. One case showed septicemia with meningeal symptoms. Clinical manifestations included skin lesion(96%), pain in the extremities or myalgia (56%), hypotension(52%), fever(47%), chills(43%), diarrhea(33%), abdominal pain(26%), oliguria(9%), dyspnea(7%) and melena(2%). Skin lesions included vesicles or bullae(56%), edema(52%), erythema(51%), necrosis(18%), purpura(11%), macules(7%) and pustules(2%). Most of the skin lesions developed in the lower extremities. 5) The average sea water temperature ranged from 16.3℃ to 28.7℃ which was provided by National Fisheries Research & Developement Agency from 1983 to 1994, when V. vulnificus infection occurred. As sea water temperature rose, the incidence of V. vulnificus infection tended to be increased(r=0.43 p=0.006) 6) The overall case fatality rate was 57.6%. There were no significant differences between survivors and non-survivors in vital signs, incubation period, arrival time, and liver function test except aspartate aminotransferase. However, leukocyte and platelet counts were significanty lower in non-survivors (p<0.05). Conclusion:In spite of the susceptible antibiotics therapy and intensive care, V. vulnificus infection was highly fatal. Therefore, we stress that prevention is more important rather than treatment of the disease.