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.

이청준 소설에 나타나는 성적 모티프의 담론화 방식 연구

이현석(Hyun Seok Lee) 한국현대소설학회 2008 현대소설연구 Vol.- No.38

Although the sex motif in the novels by Lee Cheong-jun has received intensive attention of discussion through psychoanalysis, there is a tendency for the sex motif to be regarded as a marginal element in the analysis of narrative structures or themes. The reason might be that most of the sexual elements in his novels have been analyzed in the relations with socially critical subjects like the relationships between individuals and society or with aesthetic discussions. What try to discuss in this study is that the sexual elements in Lee`s novels play essential functions both in the aspect of narrative construction and that of theme interpretation. The sexual elements implied in the confession formats and repentance, which make frequent appearances in his novels, show that how the characters connect sex with power. In his later novels, Lee demonstrates that power can be criticized through sex by manifesting abstinent figures. Those analysis results of the relationships between sex and power shed some light onto why Lee`s perception of the world and criticism of the society are presented in his personal contexts.

간세포암과 감별이 어려웠던 악성중피종 치험 1예

김선문,허원석,채경훈,강윤세,정재훈,김연수,박기오,문희석,이엄석,김석현,성재규,이병석,이헌영,신경숙,조준식,송인상,강대영 충남대학교 의학연구소 2003 충남의대잡지 Vol.30 No.2

Malignant peritoneal mesothelioma is a rare neoplasm that arises from the mesothelium of a serosal cavity and is a rapidly fatal disease with a median survival of 4 to 12 months for untreated cases. Recently, we experienced a case with malignant peritoneal mesothelioma who was suspected hepatocelluar carcioma by abdominal CT scan and was confirmed by biopsy including immunohistochemical stain(calretinin) after surgery. We performed tumor excisions and wedge resection of the liver(segment Ⅷ)and inserted Tencoff catheter in abdominal cavity at 25th day of post-operation. We treated with intraperitoneal paclitaxel(25mg/m^(2)/day for 5 days) six courses monthly. She was well tolerable and is still living without any evidence of recurrence for 14th month of post-operation.

폐경기 여성에서 호르몬 대치 요법시 병행 투여된 프로제스토젠 투여 방법에 따른 혈청 지질 및 지단백에 미치는 영향

이임순,전섭,이순곤,이해혁,이권해,정집광,이석민 순천향의학연구소 1998 Journal of Soonchunhyang Medical Science Vol.4 No.1

Objective : The purpose of our study is to evaluate the effect of different administration method of progestogen on lipid profiles including total cholesterol, LDL(low density lipoprotein)-cholesterol, HDL(high density lipoprotein)-cholesterol, triglycerides during hormone replacement therapy in postmenopausal women. Methods and Materials : Seventy-one postmenopausal women who were assigned to following groups (Group I : conjugated equine estrogen(CEE), 0.625 mg/day plus continuous medroxyprogesterone acetate (MPA), 2.5mg/day, Group II : CEE, 0.625 mg/day plus cyclic MPA, 5mg/day for 12days/month. And we measured serum total cholesterol, high density lipoprotein (HDL)-cholesterol, low density lipoprotein (LDL)-cholesterol, and triglycerides before hormone replacement therapy(HRT) and 12 months later after hormone replacement therapy. Results: 1. Total cholesterol decreased in group I,III. 2. HDL-cholesterol increased in group I,II,III. 3. LDL-cholesterol decrease in group I,II. 4. Triglycerides increased in group I,II,III. There was significance in serum total cholesterol and LDL-cholestrerol among three groups. Conclusions : Estrogen alone or in combination with progestogen both in cyclic and continuous use improves lipid profiles, so medroxyprogesterone acetate(MPA) does not seem to blunt estrogenic effect on lipid profiles.

Changes in the Ultrastructure of the Acinar Cell of Rat Parotid Gland During Proliferation and Its Reversal

Lee, Seok Woo The Official Publication of Korean Academy of Oral 1993 International Journal of Oral Biology Vol.17 No.1

Previous studies showed that β-agonist isoproterenol(ISO) induced proliferation of rat parotid acinar cells, mediated by cell surface galactosyltransferase(Gal-Tase). The proliferation was reversed by the addition of Gal-Tase modifiers. α-lactalbumin(α-LA) and trifluoperazine(TFP). In earlier study(Lee. et al.. 1992). it was observed that expression of proto-oncogenes induced by isoproterenol treatment was down-regulated with chronic treatment of Gal-Tase modifiers. In the present study. changes in the ultrastructure of rat parotid acinar cells were investigated with transmission electron microscopy. when they were treated with isoproterenol and Gal-Tase modifiers. α-LA and TFP. Electron micrograph showed remarkable differences in acinar cell morphology among samples. Control parotid acinar cells showed numerous electron-dense secretory granules. characteristic of rat parotid acinar cell. around the lumen. In samples treated with isoproterenol for 24 hr (ISO-24). there was a tremendous decrease of the number of secretory granules. Samples treated with the combination of α-LA or TFP with isoproterenol for 24 hr (α-LA/ISO-24, TFP/ISO-24) showed similar morphology to ISO-24. In the sample treated with isoproterenol for 3 days (ISO-72), it was observed that enlarged. electron-lucid secretory granules filled the whole cytoplasm. indicating active cellular proliferation. There was a dramatic disappearance of electron-lucid granules in samples treated with α-LA or TFP in combination with ISO for 3 days (α-LA/ISO-3d, TFP/ISO-3d); only limited number of electron-dense secretory granules were observed. Ultrastructural changes observed in this study support that ISO administration stimulates exocytosis of secretory granules and development of immature granules, leading to cellular proliferation in rat parotid gland. This dramatic morphologic change was reversed with the addition of α-LA and TFP. The results of this study are well in accordance with those of earlier study (Lee et al.. 1992), which showed that ISO-induced acinar cellular proliferation was reversed with substances blocking cell surface Gal-Tase activity.

다산부에서 자간전증의 임상적 고찰

이주롱,이석민,한효상,이해혁,이임순,이권해 순천향의학연구소 2001 Journal of Soonchunhyang Medical Science Vol.7 No.2

목적 : 전자간증 산모에서 초임신부와 다산부 각각의 임상적 특징을 조사하여 비교 분석하고자 하였다. 연구방법 : 1998년 1월부터 1999년 12월까지 2년간 순천향대학 서울병원에서 입원 분만한 임신성 고혈압성 질환 환자중 초임신부 106명과 다산부 50명, 총 150명을 대상으로 임상통계학적으로 조사 분석하였다. 결과 : 분만까지 임신기간의 비교시 초임신부에서는 33-36주에서 17.9%였고 다산부에서는 34.0%로, 다산부에서 조기분만의 예가 의의있게 많았다. 신생아 체중이 2500g 미만인 군이 초임신부군에서는 36.8%였고 다산부군에서는 62.0%로 다산부군에서 더 많았다. 임신성 고혈압성 질환의 중등도를 보면 중증자간전증의 초임신부에서 35.8%와 다산부에서는 44.0%로, 초임신부에 비해 다산부군의 중증 자간전증의 비율이 많았다. 결론 : 중증 임신성 고혈압성 질환이 다산부군에서 더 많았으며 적은 주수에서 제왕절개술을 시행해 출생아의 체중이 초임신부군에 비해 더 작았고 Apgar 점수도 더 낮았다. Objective : To study the clinical differences of primiparous and multiparous preeclamptic patients. Methods : We statistically analyzed 106 primiparous and 50 multiparous preeclamptic patients who were admitted to the Soonchunhyang University Hospital from January 1998 to December 1999. Results : It was statistically found that multiparae were more likely to give premature birth than primiparae: Thirty four percents of multiparae gave birth in the period between the 33rd and the 36th gestational weeks while 17.9% of primiparae did in the same period. Sixty two percents of the newborn babies of multiparae weighed less than 2500g. Among primiparae, the ratio was 36.8%. In addition, more multiparae(44.0% vs. 35.8%) suffered from severe preeclampsia. Conclusion : severe preeclampsia was found more frequently among multiparae. Since they gave birth earlier by cesarian section than primiparae, their babies weighed less and had lower apgar scores.

자궁내 태아사망의 임상적 고찰

이권해,이정재,조현철,이석민,이임순,이해혁,김권대,이순곤,남계현 순천향의학연구소 1999 Journal of Soonchunhyang Medical Science Vol.5 No.2

Objective: This study was designed to evaluate diagnosis and complication, prognosis during clinical study of cases of intrauterine fetal death. Methods and materials: This is a clinical study of 56 cases of the intrauterine fetal death among 8064 deliveries at Seoul Sunchunhyang university hospital during 5 years from January, 1994 to December, 1998. Results: The incidence was 0.7%. The age distribution of mothers was 18 - 44 years and was highest in the 25 - 29 years range(46.4%). The parity was the most highest in the nulliparous group(51.8%). The most common gestational weeks was 20 - 28 weeks gestational period(46.4%), and most common presentation was cephalic(73.5%). The most common weights of the intrauterine fetal death was from 5,00gm to 1,000g(48.2%). The mode of the most common delivery was the induction of delivery(57.2%). The etiologic factors were: unknown(42.9%), preeclampsia(17.9%), chorioamnionitis(14.3%), congenital anomaly(12.5%), abruptio placenta(7.1%), cord complication(3.6%), placenta previa, death of one for twin. There were 2 cases of maternal complication(DIC, Uterine atony). Conclusion : Intrauterine fetal death should be diagnosised early and treated properly to reduce risk of the maternal complication.

조선조 척사위정론의 연원

이재석(Lee Jae-Seok) 한국동양정치사상사학회 2014 한국동양정치사상사연구 Vol.13 No.1

이 논문은 조선조 말기 전개된 척사위정론의 연원을 조선조의 도학적 전통에서 찾아보려는데 목적이 있다. 이 연구는 다음과 같은 이유로 시도되었다, 첫째, 지금까지 한국근대사에서 척사위정론과 척사운동이 차지하는 중요성에 따라 많은 연구가 행해졌음에도 불구하고, 그 연원을 찾아보는 연구가 소홀했다고 보기 때문이다. 지금까지 조선 주자학의 도통과 도의 옹호와 부지를 위한 이단 비판론, 중화사상 또는 춘추대의에 대한 깊이 있는 연구가 많이 이루어졌으나, 그 연구들은 해당 주제자체의 분석에 초점을 둔 연구이었으므로 척사위정론의 연원과 연관성을 밝히려는데 목적을 두지 않은 것이었다. 둘째, 척사위정론의 논리는 “숭정학벽이단, 존중화양이적”의 두 개의 논리를 포함하고 있는데, 기존의 연구는 벽이단론이나 존중화론을 통합해서 파악하려 하지 않은 한계를 보이고 있고, 주자학은 정학으로부터 출발하지만 완성은 지치가 이루어지는 정치사회 실현을 지향하기 때문에, 척사위정론의 연원과 종지를 규명하기 위해서는 두 개의 논리를 종합할 필요가 있다. 셋째, 척사위정론을 주창한 대표적인 사림은 화서학파로, 그 종장인 이항로는 우암 송시열, 정암 조광조, 포은 정몽주를 존숭했는데, 이들의 이단비판론 및 존중화론과 척사위정론의 연관성에 대한 분석이 그간에 소홀히 되었기 때문이다. 그러므로 이 글에서는 정몽주, 조광조, 송시열, 이항로를 중심으로 그들의 숭정학벽이단론과 존중화양적론을 검토해 조선조 척사위정론의 사상적 연원을 밝히려 한다. 그리고 그 과정에서 조선조 말기 하나의 이념으로 등장해 주자학의 도와 유교문명국 조선을 정으로 규정하고 그것을 지키기 위해 척사운동을 지속적으로 벌이도록 한 이념인 척사위정론의 힘의 근원을 밝히려 한다. This study aims at analyzing the Origin of Cheoksawijeong Theory(斥邪衛正論) as an ideology in the Chosun Dynasty. As we know well, it was a political ideoloy that intended to defend the right, namely Confucian learning(正學) and Chosun Dynasty as a country civilized by Confucian civilization(中華) and to repulse the wrong, namely western learning(西學, Catholic in narrow meaning) and western invasion(and after Japanese invasion). It"s origin is founded in the ancient Chinese classics, for example Confucius writing in the Annals(春秋), the Discourses of Confucius(論語), The Works of Mencius(孟子). But it was succeeded by many Neo-Confucian scholars in Koryo and Chosun Dynasty in traditional Korea. Among them, Jeong Mong-ju(정몽주), Jo Gwang-jo(조광조), Song Si-yol(송시열) was the famous scholars and officials to learn and practice Neo-Confucian learning. They were sincerely eager to construct and maintain idealized Confucian Moral State, criticizing Buddhism (in case of Jeong Mong-ju), Taoism (in case of Jo Gwang-jo), and different view on the Golden Mean(中庸) by Yoon Hew(윤휴) and so on. Especially Song Si-yol was earnest to reject Ching(淸) Dynasty"s tributary rule over Chosun dynasty and to maintain the Chinese World Order by initiated Myng(明) Dynasty believing in the guiding principle of Confucius in writing the Annals(春秋大義). They can be called to be forerunners of Cheoksawijeong Theory in the true sense of the word, for they lived to life as an ideal type of intellectual loyal to tao(道). Lee Hang-ro(이항로) was a scholar who initiated to assert the ideology of Cheoksawijeong. He asserted to defend Confucian learning and Chosun Dynasty by rejecting western learning and by repulsing western invasion. His students for his doctrine also joined in the movement against western learning and western and Japanese invasion for over half centuries. Why did they dare to resist the wrong at the risk of their death? (Jeong Mong-ju, Jo Gwang-jo, Song Si-yol and Choi Ik-hyon(최익현), Lee"s famous student really were killed or died resulting from their cause). As for me in short, their religiously ideological faith made them to prepare for death to defend Confucian orthodoxy from heresy for Confucian Moral State.

온열요법과 기치유요법이 어깨근통증 압통역치에 미치는 영향

이석복 ( Lee Seok Bok ),이민선 ( Lee Min Sun ),이형환 ( Hyung H Lee1 ) 한국자연치유학회 2014 Journal of Naturopathy Vol.3 No.1

In this study, we wanted to understand the influence of thermotherapy, Qi-therapy, and their combination therapy on the oppressive muscular pains in shoulders. For the clinical study, 102 subjects were divided into 3 groups of thermotherapy, Qi-therapy, and the combination therapy to see the differences in the therapeutic effects. The treatments were taken 5 times for 2 weeks in 3-day intervals and pre- and post-treatment assessments were undertaken for the visual pain assessment (VAS, visual analogue scale) and experimental pressure threshold in 8 points in the relevant muscles (PPT). VAS score was decreased by 39% after thermotherapy, 66.5% after Qi-therapy, and 72.3% after combination therapy, all with significance (p<.05). The experimental pressure thresholds of shoulder muscles, the upper trapezius muscles, the lower trapezius muscles, the anterior trapezius muscles. the supraspinous muscles, the greater pectoral muscles, and the sternocleidomastoid muscles were increased by 4.3~11.3% after thermotherapy, 5.9~19.9% after Qi-therapy, and 9.3~25.4% after combination therapy. The experimental pressure thresholds in the 8 points in the relevant muscles did not show a significant difference between the Qi-therapy and combination therapy in the upper and lower trapezius muscles, however, did show a significant difference to the thermotherapy. In the shoulder muscles, anterior and posterior trapezius muscles, supraspinous muscles, supraspinous muscles, greater pectoral muscles, and sternocleidomastoid muscles, there were significant superiorities in Qi-therapy over thermo therapy, and in the combination therapy over Qi-therapy. In conclusion, it could be understood that both thermotherapy and Qi-therapy have been effective in the improvement of pains, and especially combination therapy showed better effectiveness. It is expected to apply these natural therapies to the pain treatment of human body to contribute to the improvement of health and welfare.

Special Issue of Professor Kiehwa Lee`s Retirement: Geophysical Environments of the Korean Peninsula : Articles ; Geoelectrical Structure of the Kyongsang Basin from Magnetotelluric Sounding

( Choon Ki Lee ),( Heui Soon Lee ),( Byung Doo Kwon ),( In Ky Cho ),( Seok Hoon Oh ),( Yoon Ho Song ),( Tae Jong Lee ) 대한지구물리학회 2006 지구물리 Vol.9 No.3