기종성 신우신염 1례

이재욱,구정태,서정일,양창헌,이정호,이동철,이영현,이활,이경섭 동국대학교 경주대학 1997 東國論集 Vol.16 No.1

기종성 신우신염은 주로 당뇨병환자나 폐쇄성 요로질환을 가진 환자에 발생하며 특징적으로 신실질 및 그 주위조직에 가스를 형성하면서 심한 조직괴사를 일으키는 매우 드문 급성 화농성 신감염으로 사망률이 높은 질환이다. 이 질환은 1989년 Kelly와 MacCallum에 의해 처음 보고된 이래 외국문헌에 약 90례 정도가 보고되어 있으며 국내에는 28례가 보고되어 있다. 수액 및 전해질 보충, 인슐린 투여를 통한 적절한 혈당조절 및 항생제 투여등의 내과적 치료와 절개배농 및 신적출술등의 수술적 치료 방법이 있다. 내과적 치료로 가스의 감소가 없는 경우에는 즉각적인 수술적 치료를 시행하여야하므로 이 가스변화에 대한 추적관찰이 중요하다 하겠다. 본 저자들은 당뇨병환자에서 발생한 기종성 신우신염 1례를 내과적 요법을 치험하였기에 문헌고찰과 함께 보고하고자 한다. Emphysematous pyelonephritis is rare, life-threatening infection of the renal parenchyma and perirenal tisseue. This disease is characterized by the production of intrarenal and perirenal gas and is frequently encountered in patients with diabetes mellitus or urinary obstruction. We experienced a case of emphysematouse pyelonephritis in a 62 years old women with poorly controlled diabetes mellitus who had been managed with medical theraphy. So we report this case with a review of the referenced literatures.

위암 환자에게 세포성 면역 기능에 관한 연구

이재익,윤일국,이종선,김종완,장준,안정기,송민호,정현용,이헌영,김상용,김영건 忠南大學校 癌共同硏究所 1991 癌共同硏究所 硏究誌 Vol.1991 No.-

위암 환자에서 세포성 면역 기능에 관한 연구

이재익,윤일국,이종선,김종완,장준,안정기,송민호,정현용,이헌영,김삼용,김영건 충남대학교 암연구소 1991 癌共同硏究所 硏究誌 Vol.1 No.1

We performed a variety of lymphocyte stimulation tests, delayed hypersensitivity skin tests, and enumeration of several lymphocyte subpopulations in 21 patients with gastric cancer who did not receive any form of anticancer therapy, and in 20 healthy controls. The gastric cancer patients had significantly decreased number and total score of positive reactions in delayed hypersensitivity skin tests compared with the healthy controls. The percent of CD_(4) positive lymphocytes in the gastric cancer patients was significantly decreased compared to the normal control subjects, but it had no correlation with the total score of delayed cutaneous hypersensitivity reactions. The ratio of helper to suppressor cells was lower in the cancer group. The uptake of 3H-thymidine was markedly depressed in cancer patients when stimulated with various mitogens. There was little correlation between any of the stimulation tests and any of the lymphocyte subpopulation proportions to delayed hypersensitivity cutaneous reactions. Optimal proliferative response was found in lymphocytes stimulated with 10 micrograms of concanavalin-A and 10 microgram of phytohemagglutinin. Advanced stage patients had greatly depressed delayed hypersensitivity skin reactions and proliferative responses to mitogens compared with localized diseases. These results suggest that gastric cancer patients have depressed cellular immune functions, which mainly result from the decreased helper cells and defects in functional proliferative response to mitogens. Interleukin-2 and interferon-gamma restored the in vitro proliferative response of lymphocyte in patients with gastric cancer.

보존적 치료로 회복된 망경색에 의한 급성복증 1예

김정념,이숭환,김정식,김진호,배윤오,박성규,윤상정,한현영,이헌영 충남대학교 의과대학 의학연구소 2003 충남의대잡지 Vol.30 No.1

Omental infarction, the end result of impaired perfusion to the greater omentum, is a rare benign self-limiting clinical entity. The main clinical symptom is non-specific localized abdominal pain with a moderately raised white blood cell and erythrocyte sedimentation rate. These findings often mimic an abdominal surgical emergency. This condition is often misdiagnosed as acute appendicitis or cholecystitis. The characteristic feature of CT scan and ultrasonography provide non-invasive diagnosis in most patients with omental infarction. We report a case of patient whose CT scan showed the characteristic finding of omental infarction. The patient was improved spontaneously only with conservative care.

Predicting postoperative total calcium requirements after parathyroidectomy in secondary hyperparathyroidism

( Byung Heon Kang ),( Soon Young Hwang ),( Jeong Yeop Kim ),( Yu Ah Hong ),( Mi Yeon Jung ),( Eun Ah Lee ),( Ji Eun Lee3 ),( Jae Bok Lee ),( Gang Jee Ko ),( Heui Jung Pyo ),( Young Joo Kwon ) 대한내과학회 2015 The Korean Journal of Internal Medicine Vol.30 No.6

Background/Aims: To prevent hypocalcemia after parathyroidectomy (PTX), parenteral calcium is required in addition to oral calcitriol and calcium. After switching to oral calcium, patients can be discharged from the hospital. The aim of this study was to analyze the clinical characteristics and outcomes of PTX performed at a single Korean center and to investigate the associated laboratory factors used to analyze the total amount of postoperative calcium required. Methods: We enrolled 91 hemodialysis patients undergoing PTX from November 2003 to December 2011. We collected clinical and laboratory data preoperatively, 12 and 48 hours postoperatively, at discharge, and 3 and 6 months postoperatively. Results: In total, 59 patients underwent PTX with autotransplantation (AT), 6 underwent total PTX without AT, 11 underwent subtotal PTX, and 15 underwent limited PTX. Total PTX without AT showed the lowest recurrence rate. At all postoperative time points, the mean levels of serum calcium, phosphorus, and intact parathyroid hormone (iPTH) decreased significantly, compared with preoperative levels; however, alkaline phosphatase (ALP) increased significantly from 48 hours postoperatively to discharge (p < 0.001). On multiple linear regression analysis, the total amount of injected calcium during hospitalization showed a significant correlation with preoperative ALP (p < 0.001), preoperative iPTH (p = 0.037), and Δphosphorus at 48 hours (p < 0.001). We developed an equation for estimating the total calcium requirement after PTX. Conclusions: Preoperative ALP, preoperative iPTH, and Δphosphorus at 48 hours may be significant factors in estimating the postoperative calcium requirement. The formula for postoperative calcium requirement after PTX may help to predict the duration of postoperative hospitalization.

중년기 우울증 여성의 생활사건, 대처방식, 사회적 지지 및 가족관계

김동인,이진욱,김임,이선미,은헌정 大韓神經精神醫學會 1997 신경정신의학 Vol.36 No.4

국문초록본 연구는 중년기 우울증 여성의 생활사건 스트레스, 대처 방식, 사회적 지지, 가족 관계 등의 정신사회적 요인들을 알아보기 위한 것으로 각 변인들이 어떻게 우울과 관계가 있는지를 우울증 환자 집단과 정상인 집단으로 나누어서 비교 연구하였다. 이를 위해 35세 이상 64세 이하의 116명의 우울증 환자와 113명의 정상인을 대상으로 Beck 우울 질문지(BDI), 생활사건 질문지, 대처방식 척도, 대인관계 지지 평가척도(ISEL), 가정환경척도 등의 검사를 하였고 다음과 같은 결과를 얻었다. 1) 최고 스트레스는 환자 집단의 경우 결혼생활 스트레스(42명, 36.2%), 정상인 집단의 경우는 가정생활 스트레스(44명, 38.9%)였다. 2) 소극적 대처(t=0.93, p=.35)만을 제외하고 환자 집단과 정상인 집단에서 BDI 우울 점수(t=15.94, p<.0001), 생활사건 스트레스 점수(t=4.73, p<.0001), 적극적 대처점수(t=6.29, p<.0001), 사회적 지지점수(t=7.20, p<.0001), 가족 관계 점수(t=5.75, p<.0001)에서 유의한 차이를 보였다. 3) 우울증 환자 집단에서 BDI 우울 점수는 생활사건 스트레스(r=.24, p<.01) 변인과 유의한 정적 상관을 보였고, 적극적 대처(r= -.22, p<.01) 변인, 사회적 지지(r= -.35, p<.001) 변인, 가족관계(r= -.30, p<.001) 변인과는 유의한 역 상관을 보였다. 4) 우울증 환자 집단에서 BDI 우울에 대한 각 변인들의 중다회귀분석은 사회적 지지(12.3%, β= -.281, T= -3.162, P=.002, 생활사건 스트레스(5.1%, β=.279, T=3.195, P=.002), 적극적 대처(3.5%, β= -.204, T= -2.225, P=.028) 변인이 합하여 20.9%의 설명력을 나타냈다. 5) 중년기 여성에서 생활사건 스트레스는 가족 관계에서 겪는 스트레스가 가장 큰 스트레스였고, 대처방식은 우울과의 관계에서 일관성이 부족하였으며, 사회적 지지는 우울에 영향을 주는 가장 중요한 요인이었고, 가족관계는 양 집단에서 유의한 차이는 있었으나 우울에 대하여 의미있게 설명하지 못하고 있다. ABSTRACTLife Events, Coping Styles, Social Support, and Family Relationships of Middle-Aged Depressed Women Jin-Wook Lee, M.D., Yim Kim, M.D., Sun-Mi Yi, M.S., Dong-In Kim, M.D., Heon-Jeong Eun, M.D. Department of Neuropsychiatry, Presbyterian Medical Center, Chonju The objective of this study was to explore the psychosocial factors such as life events, coping styles and family relationships in middle-aged depressed women. This study was designed to compare how different variables relate to depression in two different test groups : a depressed patient group and a normal group. The Beck Depression Inventory(BDI), The Ways of Coping Checklist, Interpersonal Support Evaluation List(ISEL), Family Environment Scale were administered to 116 depressed patients and 113 normal persons between the ages of 35 and 64. The results were as follows : 1) The highest stress was marital stress(n=42, 36.2%) in patient group and family stress(n=44, 38.9%) in normal group, respectively. 2) There were significant differences between patient group and normal group in BDI scores(t=15.94, p<.0001), life events(t=4.73, p<.0001), active copinig(t=6.29, p<.0001), social support(t=7.20, p<.0001), and family relationships(t=5.75, p<.0001) except for passive coping(t=0.93, p=.35). 3) In depressed patient group, BDI scores had a significantly positive correlation with the scores of the life events(r=.24, p<.01) and negative correlation with active coping(r= -.22, p<.01), social support(r= -.35, p<.001) and family relationships(r= -.30, p<.001). 4) In depressed patient group, multiple regression analysis showed that social support(12.3%, β= -.281, T= -3.162, P=.002), life events(5.1%, β=.279. T=3.195, P=.002), and active coping(3.5%, β= -.204, T= -2.225, P=.028) had predictability on the BDI scores and the total predictability was 20.9%. 5) Stress experienced in family relationships were highest in life events and there was a lack of consistency(in the BDI scores of the coping styles). Social support was the most important factor and there were no significant differences between the two groups in family relationships.

지난 2년간의 학회지 "신경정신의학" 심사 평가보고

김찬형,김세주,김도관,김성곤,박원명,송동호,박용천,이영문,오강섭,정영철,이상열,김주한,이동영,이헌정,함병주,김율리,김문두,김정진,이강욱,천근아,김재진,홍진표,홍승철 大韓神經精神醫學會 2007 신경정신의학 Vol.46 No.6

중년기 우울증 여성의 생활사건, 대처방식, 사회적 지지 및 가족관계

이진욱,김임,이선미,은헌정,김동인 예수병원 1998 예수병원학술지 Vol.19 No.-

장기간 Risperidone 투여후 지연성으로 발생한 Neuroleptic Malignant Syndrome 1례

이헌정,조방현,김인,이민수 大韓神經精神醫學會 1999 신경정신의학 Vol.38 No.4

Risperidone은 비교적 최근에 개발된 항정신병약물이며, 그것이 가진 도파민 D2 수용체와 세로토닌2 수용체를 차단하는 작용기전, 추체외로 부작용과 지연성 운동장애가 적다는 점, 정신분열병의 음성증상에도 효과가 있다는 점에서 흔히 비전형적 약물로 불리운다. 그러나 이러한 비전형성에도 불구하고, 이미 전세계적으로는 15개 정도의 risperidone에 의한 신경이완제 악성증후군(neuroleptic malignant syndrome : NMS)의 보고가 있으며. 국내에서도 최근 하나의 증례가 보고되었다. 저자들은 정신분열병으로 장기간 risperidone으로 치료받던 젊은 남자 환자에서 치료 1년 9개월만에 발생된 NMS 1례를 경험하였기에 관련문헌의 고찰과 더불어 증례보고하고자 한다. Risperidone is a relatively new antipsychotic agent. It is often referred to as 'atypical', because it has a mechanism of action that blocks post synaptic dopamine-2 and serotonin-2 receptors, it is associated with fewer extrapyramidal side effects, it is not yet associated with tardive dyskinesia, and it may have some efficacy on negative symptoms of schizophrenia. In despite of its 'atypical' nature, there are already more than 15 reports of risperidone-induced neuroleptic malignant syndrome. Only one case of risperidone-induced NMS was reported recently in Korea. We report one case of delayed risperidone-induced neuroleptic malignant syndrome in young male patient and review the related articles.

고속핵에서 GABA가 동맥압에 미치는 영향

이정헌,오기화,안동국,박재식 慶北大學校 醫科大學 1996 慶北醫大誌 Vol.37 No.3

목적 : NTS (nucleus tractus solitarius)는 압감수성 반사 구심성 신경이 처음 시냅스를 형성하는 곳으로 동맥압 조절에 중요한 역할을 한다. NTS에서 어떤 특정 물질이 동맥압 조절에 관여하는지는 정확히 밝혀지지는 않았지만, NTS에 존재하는 많은 물질들이 이들 과정에 관여하고 있다. 그중 하나인 GABA성 약물이 NTS에서 순환계에 미치는 영향을 구명하고자 본 실험을 시행하였으며 아울러 반대편 NTS를 lidocaine으로 억제하였을 경우의 변화를 관찰하여 NTS에서 신경회로 일단을 밝히고자 하였다. 대상 및 방법 : 실험동물은 체중 300-500g 되는 숫컷 Wistar쥐를 사용하였다. 동맥압 측정과 약물 주입을 위하여 대퇴 동정맥에 삽관하였다. 이어서 기관지절개술을 시행하였으며 체온을 36-37℃ 되게 열판을 이용하여 조절하였다. 쥐를 뇌 정위 고정 장치에 두고 머리를 45°숙여 NTS를 노출시킨 다음 약물을 10초간에 걸쳐 80nl주입하였다. 결과 : 인공 뇌척수액을 주입하면 동맥압의 변화가 거의 없었으나 동량의 GABA를 NTS에 주입하면 동맥압이 증가하였다. GABA에 의해 동맥압이 증가된 상태에서 반대측 NTS에 lidocaine을 주입하여 한쪽 기능을 억제시키면 동맥압이 더욱 증가하였다. 또한 lidocaine주입 후 반대쪽의 건전한 NTS에 GABA를 재차 주입하면 동맥압 증가가 적었다. 그리고 GABA를 NTS에 주입 후 정맥으로 nitroprusside를 주입하면 GABA 주입이 없는 대조군에 비해 동맥압 감소가 더 컸으며, lidocaine으로 마취하여 한쪽 NTS의 기능을 차단한 후 반대쪽 건전한 NTS에 GABA를 주입한 경우는 동맥압 감소가 적었다. 동일한 방법으로 lidocaine을 주입한 후 phenylephrine으로 승압을 시키면 동맥압 증가가 적었다. 압감수성 반사는 NTS에 GABA를 주입하거나 또는 반대편 NTS를 lidocaine으로 마취하여 기능을 억제시킨 경우에 둔화되었다. 결론: NTS에서 GABA가 동맥압의 조절 인자로 작용하며, 양쪽 NTS는 상호작용하고 있는 것으로 보인다. The nucleus tractus solitarius (NTS), the site of termination within the brain of baroreceptor afferent fibers, has been shown to be involved in the regulation of arterial pressure (AP). Many neuroactive substances present within the NTS have been shown to be involved in this process, although the manner in which any specific neurotransmitter acts physiologically in the regulation of AP has not been completely elucidated. The present study was intended to clarify the mechanism of action of GABA in the NTS and also to examine the cardiovascular response to inhibition of the contralateral NTS by lidocaine. Male Wistar rats weighing 300-500 g were employed for the experiment. The femoral artery and vein were cannulated to record the arterial pressure (AP) and to inject nitroprusside or phenylephrine, respectively. The tracheotomy was performed and body temperature was kept to 36-37℃. Rats were mounted in a stereotaxic frame with the head flexed downward to an angle of 45°. After the NTS was exposed. GABA or lidocaine was microinjected into the NTS in a volume of 80 nl over 10 seconds through a glass micropipette (outer diameter of the tip 50 ㎛) connected to a 1 ㎕ Hamilton microsyringe. The results obtained are summarized as follows. Microinjection of artificial CSF into the ipsilateral NTS did not alter basal AP. In contrast, microinjection of the same volume of GABA into the NTS produced a significant increase in the AP. The results presented thus far indicated that the volume injected did not affect AP. In animals with elevated AP by GABA injection, injection-of lidocaine into the contralateral NTS resulted in a further increase in AP. After the contralateral NTS was inhibited with lidocaine. injection of GABA into the NTS produced a less increase in AP. After microinjection of GABA into the NTS, the nitroprusside administered i.v. accentuated the increase of AP but not after microinjection of lidocaine into the contralateral NTS. Similar results were obtained with i.v. injection of phenylephrine after pretreatment of lidocaine into the NTS. The baroreflex sensitivity was reduced by microinjection of GABA into the NTS or microinjection of lidocaine into the contralateral NTS. These results suggest that alterations in GABA-mediated neural transmission in the NTS contribute to the regulation of AP and the NTS of both sides have a mutual interaction.