내시경적 조임근절개술후에 발생한 췌십이지장 가성동맥류 1예

박수영,김윤정,박진한,전현수,박시형,이영진,이은지,김지현 仁濟大學校 白病院 2010 仁濟醫學 Vol.31 No.-

We reported a case of pancreatic pseudoaneurysm, involving pancreaticoduodenal artery, developed after endoscopic retrograde cholangiopancreatography(ERCP) with endoscopic sphinterotomy. A 54 year old woman was transferred to our hospital due to sustained hematochezia and hypovolemia. A week before admission, she underwent ERCP with endoscopic sphinterotomy for acute cholangitis in local clinics. She developed abdominal pain and hematochezia at 12 hours after the procedures. A post procedure contrast enhanced computed tomography of abdomen demonstrated a pseudoaneurysm in inferior portion of pancreatic head. This was not present on the pre procedure contrast enhanced computed tomography of abdomen and was thought to arise from the pancreaticoduodenal artery as a complication of the pre sphincterotomy. She was brought to our emergency room in a state of hypovolemia. A upper endoscopy showed active bleeding from ampula of vater. An celiac angiography demonstrated pancreatic pseudoaneurysm involving inferior pancreaticoduodenal artery and selective coil embolization of was performed.

암 환자의 혈장 Transforming Growth Factor-β1 농도

박병규,하우송,이시은,이수진,박순태,박찬후,전지현,장정순 THE KOREAN SOCIETY FOR BIOMEDICAL LABORATORY SCINE 1999 Journal of biomedical laboratory sciences Vol.5 No.2

한국인의 대표적인 성인 고형 종양인 위암, 간암, 유방암과 소아 백혈병 및 2종의 소아 고형 종양 환자로부터 혈장 transforming growth factor-ß1 (TGF-ß1) 농도를 sandwich ELISA 분석법을 이용해 측정함으로써 TGF-ß1을 이 질환들에 대한 새로운 종양표지자 (tumor marker)로 사용할 수 있는지 검토하였다. 또한 연령 및 성별에 따른 혈장 TGF-ß1 농도의 정상치를 조사하였다. 신생아에서 70대까지 혈장 TGF-ß1 농도의 차이는 없었고 남녀간의 차이도 없었다. 위암 환자의 혈장TCF-ß1 농도는 16.0±6.8 ng/ml (평균 ±표준편차)로 정상 대조군의 TGF-ß1 농도 (8.3 ±5.0 ng/ml) 보다 유의하게 높았으나 간암, 유방암 환자의 혈장 TGF-ß1 농도는 대조군과 차이가 없었다. 그리고 위암 환자 16명, 간암 환자 8명, 유방암 환자 7명 중 각각 7명 (43.7%), 1명 (12.5%), 1명 (14.3%)에서만 혈장 TGF-ß1 농도가 증가되었다. 5명의 소아 백혈병 환자에서는 관해 (remission) 여부와 상관없이 혈장 TGF-ßl 농도가 모두 정상 범위에 있었으나 2명의 소아 고형암 환자에서는 종양 절제 전에는 혈장TGF-ß1 농도가 높았다가 절제 후 정상으로 떨어졌다. 결론적으로 1)정상인의 혈장 TGF-ßl 농도는 연령 및 성별에 따른 차이가 없다는 것을 알 수 있었고, 2)성인 고형암인 위암, 간암, 유방암에서는 낮은 민감도로 인해 TGF-ß1을 진단을 위한 선별 검사로 이용하기에는 부적절한 것으로 판단되었으며, 3) 정상 대조군보다 혈장 TGF-ß1 농도가 높았던 위암 환자와 종양 절제 전후로 혈장 TGF-ß1 농도가 민감하게 변했던 소아 고형 암 환자에 대해서는 향후 표본 수를 늘려 부가적인 연구를 해 야 할 것으로 사료된다. To evaluate the usefulness of transforming growth factor-ß1 (TGF-ß1)as a new tumor marker, we determined the plasma TGF-ß1 levels using sandwich ELISA assay in cancer patients. Patients with three most common adult cancers in Korea (stomach, liver and breast cancer) and children's cancers (leukemia and two kinds of solid tumor) were enrolled for the study. Furthermore, 39 individuals were subjected to age and sex-stratified plasma TGF-ß1 analysis. No statistical difference was demonstrated with respect to age or sex. The mean plasma TGF-ß1 level (16.0 ng/ml) of stomach cancer patients was significantly higher than that (8.3ng/ml) of controls. However, there was no difference among the mean plasma TGF-ß1 levels of liver, breast cancer patients and controls. Seven of 16 patients (43.7%) with stomach cancer, one of 8 (12.5%) with liver cancer, and one of 7 (14.3%) with breast cancer showed higher TGF-ß1 levels compared to controls. Plasma TGF-ß1 concentrations of five leukemic children remained in the normal range regardless of the remission state. In contrast, initial high TGF-ß1 levels from two children with solid tumors returned to normal range on surgical resection of tumors. From the above results, we could conclude that plasma TGF-ß1 levels of apparently healthy individuals seem to be rather constant irrespective of difference in age or sex, and the plasma TGF-ß1 has the limited value as a screening test for the diagnosis of aforementioned adult cancers because of its low sensitivity. Finally, additional studies need to be pursed for the large number of stomach cancer and pediatric solid tumor patients in order to reach a secure conclusion on the usefulness of plasma TGF-ß1 as a tumor marker in these patients.

Effects of Phenytoin and Diazepam on the Seizure Activity in the Cortical Dysplasia Animal Models

Kim, Si-Hyung,Choi, In-Sun,Cho, Jin-Hwa,Park, Eun-Ju,Jang, Il-Sung,Choi, Byung-Ju,Kim, Hyun-Jung,Kim, Young-Jin,Nam, Soon-Hyeun The Korean Academy of Oral Biology 2006 International Journal of Oral Biology Vol.31 No.2

Dysplasia-associated seizure disorders are markedly resistant to pharmacological intervention. Relatively little research has been conducted studying the effects of antiepileptic drugs(AEDs) on seizure activity in a rat model of dysplasia. We have used rats exposed to methylazoxymethanol acetate(MAM) in utero, an animal model featuring nodular heterotopia, to investigate the effects of AEDs in the dysplastic brain. Pilocarpine was used to induce acute seizure in MAM-exposed and age-matched vehicle-injucted control animals. Field potential recordings were used to monitor amplitude and numbers population spikes, and paired pulse inhibition in response to stimulation of commissural pathway. Two commonly used AEDs were tested: diazepam 5, 2.5mg/kg;phenytoin 40, 60mg/kg. Diazepam(DZP) and phenytoin(PHT) reduced the amplitude of population spike in control and MAM-exposed rats. However, the amplitude of population spike was nearly eliminated in control rats as compared to the MAM-exposed rats. Pharmaco-resistance was tested by measuring seizure latencies in awake rats after pilocarpine administration(320mg/kg, i.p.) with and without pretreatment with AEDs. Pre-treatment with PHT 60 mg prolonged seizure latency in control rats, but not in MAM-exposed animals. The main findings of this study are that acute seizures initiated in MAM-exposed rats are relatively resistant to standard AEDs assessed in vivo. These data suggest that animal model with cortical dysplasia can be used to screen the effects of potential AEDs.

조혈모세포이식 환자에서 침습성 진균 감염에 대한 Micafungin의 예방 효과 및 안전성

김시현,이동건,최수미,권재철,박선희,최정현,유진홍,이성은,조병식,김유진,이석,김희제,민창기,조석구,김동욱,이종욱,민우성,박종원 대한감염학회 2010 감염과 화학요법 Vol.42 No.3

Background: Micafungin, a potent inhibitor of 1,3-β-D-glucan synthase, is a novel antifungal agent of the echinocandin class. In vitro study showed that micafungin was effective against Aspergillus species as well as Candida species, but clinical data on the prophylactic efficacy against invasive fungal infections (IFIs) other than candidiasis are still lacking. Materials and Methods: We identified 60 consecutive adult hematopoietic stem cell transplantation (HSCT) recipients who received at least 3 doses of micafungin during neutropenic period. Micafungin was started as an alternative in patients who were intolerant or had adverse events (AEs) to primary prophylactic antifungal agents. We retrospectively reviewed the medical records and analyzed the efficacy and safety of micafungin for prophylaxis against IFIs. Results: The patients either had autologous (n=9) or allogeneic (n=51: 1 syngeneic, 24 sibling, 26 unrelated donor) HSCT. Itraconazole oral solution (n=58) was the most frequently used first line antifungal agent for prophylaxis and was administered for median 11 days. The most frequent cause of switch to micafungin was vomiting (n=42). The duration of neutropenia and micafungin administration was median 13 and 12 days, respectively. A successful outcome was achieved in 45 (75%) patients. Empirical antifungal therapy was initiated in 13 (22%) patients. There were 2 cases (3.3%) of breakthrough fungal infections which comprised a probable invasive pulmonary aspergillosis and a possible invasive fungal sinusitis. There was no case of invasive candidiasis. A total of 53 (88%) patients experienced at least one AE regardless of causality during micafungin administration. The most frequent AEs were hypokalemia, vomiting, diarrhea, and elevated serum aspartate aminotransferase or alanine aminotransferase. Among the aforementioned AEs, only 1 case of diarrhea could be classified as a probable relation with micafungin when causality was assessed. There was no AEs that caused discontinuation of micafungin. Conclusions: Micafungin seems to be a safe and effective agent for prophylaxis of IFIs including aspergillosis as well as candidiasis in HSCT recipients. However, further large, prospective, and randomized comparative studies are warranted for aspergillosis.

청소년 자활지원관에서의 사례관리 적용과정에 관한 연구

이시연,박은미 한국청소년복지학회 2004 청소년복지연구 Vol.6 No.2

The purpose of this study is to review the present state of youth self-sufficiency supporting centers, to understand the importance of case management application as an effective practice methodology to support juveniles, and to apply case management application processes for youth self-sufficiency supporting centers. With this purpose, literatures were reviewed the present state of youth self-sufficiency supporting centers and to show the importance for case management application. Case study was used to show the process of case management application. Case study is known as an effective and qualitative research method. There are 25 youth self-sufficiency supporting centers nationwide. Major roles of theses centers is to support impoverished juveniles by helping them finish school, get hands-on-job training, and to provide cultural opportunities in order to prevent cycle of poverty. It has also been founded that there is a great need to develop some effective intervention methods to achieving these goals. Case management has reviewed and suggested one of the most effective intervention methods. In this research four cases were analyzed, each providing detail process information for case management application. Conclusive results show that an insufficient number of workers, lack of knowledge and skills about case management are the major limitations in implementing case management.

일부 소규모 시계조립 사업장의 상지 누적외상성장애의 유병률

장은철,김현주,권영준,박시복,이수진,송재철 大韓産業醫學會 2000 대한직업환경의학회지 Vol.12 No.4

목적 : 단순 반복작업을 하는 시계조립 사업장 근로자를 대상으로 상지 누적외상성장애의 자각증상 유병률과 상지 누적외상성장애 유병률을 파악하고자 하였다. 방 법 : 인구학적 특성, 상지의 자각증상, 사회심리적 요인은 자가 설문지법으로, 인간공학적 특성은 점검표를 이용한 면담법으로 조사하였다. 상지의 자각증상 조사와 사회심리적 요인은 각각, N10SH (1993) 설문지와 Karasek(1979)의 Job strain model을 번역하여 조사하였다. 상지 누적외상성장애 판정은 의사가 작업 현장에서 직접 환자 면담과 이학적 검사를 수행한 후, 연구에서 규정한 증례정의에 의해 수행하였다. 수집된 자료는 x2 teat와 exact test로 단별량 분석을 하였고, 이중 의미있는 변수와 위험 인자로 알려진 변수들로 다중 로지스틱 회귀분석을 시행하였다. 결 과 : 대상자들의 자각증상 유병률은 54.2 %였고, 부위별로는 목 34.9 %, 손/손목 31.3 %, 어깨 30.1 %, 팔/팔꿈치 18.0 %순이었다. 상지 누적외상성장애의 유병률은 45.8 %였고, 근막동통증후군이 26명으로 가장 많았고, De Quervain씨 병 8명, 수부/전완부의 건염 및 건활막영 8명, 수근관 증후군 5명, 이두건염 5명, 척골 신경병증 5명, 내상과 염 4명, 외상과염 2명, 경추 디스크 질환 2명, 흥곽 출구 증후군 1명순으로 나타났다. 단변량 분석시 자각증상 유병률은 작업부서 중 완성 부에서, 상지 누적외상성장애 유병률은 여자와 완성 부에서 통계학적으로 유의하게 높았다. 다중 로지스틱 회귀분석 결과 완성부와 근무긴장도가 높은 군이 상지 누적외상 성장애와 통계학적으로 유의한 결과를 보였다. 결 론 : 이 연구에서 상지 누적외상성장애 유병률은 45.8 %으로서 저강도의 단순 반복작업을 하는 시계조립 사업장 근로자에서도 누적외상성장애의 위험이 있는 것으로 생각된다. 또한, 사회심리적 요인과 작업 부서별 공정 및 환경이 유병률에 영향을 미치는 주요 요인으로 생각되며, 향후 이들에 관한 다양한 연구가 진행되어야 할 것이다. 산업보건 현장에서는 시계조립 사업장과 같이 저 강도의 단순 반복작업을 위주로 하는 사업장에 대한 지속적인 관심과 각 사업장별 위험요인을 파악하여 적절한 예방 및 관리 대책을 세워야 할 것이다. Objectives : The prevalence of cumulative trauma disorders of upper extremities mons watch assembly workers in small-scaled industry was studied. Methods. In 83 workers at five watch assembly factories, symptoms and psychosocial questionnaire, ergonomic Interview, physical examination were conducted. Results : Prevalence of self-reported symptoms was 54.2% and neck 34.9%, wrist/hand 31.3%, shoulder 30.1%, elbow/arm 18.0% by anatomical site. Prevalence of cumulative trauma disorders was 45.8%. Most common disease was myofascial pain syndrome (31.3%). The other diseases were De Quervain disease (9.6%), tenosynovitis/tendinitis at wrist/hand (9.6%), bicipital tendinitis(6.0%), fat. epicondylitis(4.8%), meIn. epicondylitis(2.4%), and cervical disc disease(2.4%). As result of ergonomic interview, repetitiveness was 79(98.8%). There were no differences in the prevalence of self-reported symptoms and cumulative trauma disorders for age, sex, marital status, duration of work In the study, The significant factors of cumulative trauma disorders were occupational task and psychosocial stress in the study. The prevalence of cumulative trauma disorders in high strain group was hlgher (68.4%) than other three groups. The prevalence of self-reported symptoms and cumulative trauma disorders in assembly task was higher (70.0%, 64.0%) than other two tasks. Conclusions : Prevalence of self-reported symptoms was 54.2%, prevalence of cumulative trauma disorders was 45.8% in watch assembly workers. In this study, factor related to self-reported symptoms was occupational task and factors relaxed to cumulative trauma disorders were occupational task and psychosocial stress. This results suggest that differences of ergonomics and environment in occupational task cause differences of prevalence of self-reported symptoms and cumulatlve trauma disorders.

류마티스성 승모판 협착증의 치료를 위한 경피적 승모판 성형술의 치료성적

김성은,조흥근,박성훈,박시훈 梨花女子大學校 醫科大學 醫科學硏究所 1999 EMJ (Ewha medical journal) Vol.22 No.4

연구목적 : 류마티스성 승모판 협착증에 대한 유용한 치료법인 경피적 승모판 성형술의 본원의 단기 치료 성적을 알아보고자 하였다. 방법: 1993년 10월에서 1999년 4월까지의 이대목동병원에 내원한 류마티스성 승모판 협착증 환자 21명에서 투시조명 하에 경피적 승모판 성형술을 시행하였다. 시술전에 경흥부심초음파와 경식도초음파가 시행되었고, 시술후에는 경흉부초음파를 사용하여 혈역학적, 임상학적 변화를 비교하였다. 연구대상의 거의 모두가 NYHA class Ⅱ에 속했고, 5명이 심방세동을 가지고 있었으며, 모두 심초음파점수가 8이하였다. 좌심방에 혈전이 있는 경우로 혈전을 용해시킨 후 시술한 경우가 2예였다. 결과 : 경피적 승모판 성형술 이후의 평균 승모판구면적은 시술전의 1.16±0.36㎠에서 2.06±0.33㎠로 증가되었다. 경승모판 이완기 평균 압력차는 시술전 11.60±5.54mmHg에서 시술 후 4.93±2.53mmHg(p<0.001). 좌심방 크기는 46.41±14.66mm에서 42.03±15.01mm로(p=0.042), 그리고 심박출량은 4.21±1.25L/min에서 6.88±9.57L/min로(p<0.0001) 의미있는 호전을 보였다. 3도 이상의 심한 승모관폐쇄부전이나 심각한 시술후 합병증은 없었다. 결론 : 본원에서 약 6년간 시행된 경피적 승모판 성형술는 그 사례가 적고 시술전 예상되는 난이도 면에서 특이한 것은 없었지만, 시술후 합병증이 거의 발견되지 않았으며 혈역학적 측정상에서도 성공적인 시술을 보여주었다. 승모판구면적에 따른 시술후 단기내 호전의 정도는 거의 예측할 수 없었으나, 심초음파점수는 모두가 8점이하로 높은 성공율의 조건을 제공하였다. Objective : Percutaneous mitral valvuloplasty(PMV) became a treatment modality or mitral stenosis because of its low morbidity, short hospital stay, and low cost. We reviewed clinical and hemodynamic results after PMV for the patients with mitral stenosis in Ewha Womans University Mokdong hospital. Methods : We compared the results of echocardiographic, hemodynamic, and clinical parameters before and after PMV. PMV was performed under fluoroscopic guidance in 21 patients(M:4, F:17, mean age 43±12 years) with mitral stenosis from October 1993 to April 1999. Transesophageal echocardiography(TEE) and Transthoracic echocardiography(TTE) were performed for the evaluation of mitral valve, chamber size, and the presence of left atrial thrombus before procedures. TIE was also used for follow-up evaluation. On presentation, all patients showed at least NYHA class Ⅱ. Five patients had atrial fibrillation. Two patients with thrombus in the left atrium were included to study group after thrombolytic treatment with coumadin. Echo-score of our patients was not greater than 8. Results : Mean mitral valve area(MVA) by 2 dimensional or Doppler echocardiography was increased from 1.16±0.36㎠ before PMV to 2.06±0.33㎠ after PMV. There were marked improvements in transmitral gradients(11.60±5.54mmHg before PMV vs 4.93±2.53mmHg after PMV, p<0.001), left atrial dimension(46.41±14.66mm vs 42.03±15.01mm, p=0.042), and cardiac output(4.21±1.25L/min vs 6.88±9.57L/min, p<0.0001) following PMV, Severe(≥GⅢ) mitral insufficiency or severe postprocedural complications were not noted. This suggested that all procedure was successful. Conclusion : The Procedural success rate of PMV in Ewha Womans University Mokdong hospital was 100%. Low echo score of our patients might explain this high procedural success rate. Long-term-follow-up is warranted in the near future.

흰쥐에서 심정지후 Pentoxifylline이 뇌의 허혈-재관류 손상에 미치는 효과

정시경,김영민,오동렬,최경호,박승현,이운정,박규남,유은영,이원재,김세경 大韓應急醫學會 1999 대한응급의학회지 Vol.10 No.2

Background: Two major events occurring in the cerebral hemodynamics after successful resuscitation from cardiac arrest are reactive hyperemia and postischemic hypoperfusion. In this study, we examined the effect of Pentoxifylline(PTX) on the rat brain following cardiac arrest. Methods: Fourteen rats were anesthetized and artificially ventilated. Cardiac arrest was produced by chest compression and clamping of tracheal tube for 3 minutes in ketamine anesthetized rats. Circulation was restored by standard cardiopulmonary resuscitation methods. In 7 rats, PTX 10mg/kg was infused at 10min after cardiac arrest(PTX group). In the other 7 rats, same amount of normal saline was infused(control group). Results: In both groups, hemodynamic variables, neurologic deficit(ND) score and histopathologic findings of hippocampal CA1 neurons were observed. Hemodynamic variables and ND score were not significantly different between two groups. Delayed ischemic neurons of hippocampal CA1 were decreased in PTX group(2.2±2.4%) compared with control group(9.1±1.2%). Conclusions: We conclude that PTX prevented development of delayed ischemic neurons in hippocampal CA1 after cardiac arrest. PTX may be useful in emergency situations following cardiac arrest.

영구적 인공 심박동기 이식에 대한 임상적 고찰

장지은,박시훈 梨花女子大學校 醫科大學 醫科學硏究所 1999 EMJ (Ewha medical journal) Vol.22 No.4

연구목적 : 영구적 심박동기 이식은 서맥성 부정맥이나 방실 전도차단로 의해 혈류역학적으로 불안정한 환자에 있어서 전 세계적으로 시행되고 있는 시술로서 이대 목동병원에서 시행된 35명 중 임상기록이 분명한 29례의 영구적심박동기 이식 결과 및 그 성적에 관해 정리해 보고자 한다. 방법 : 29명의 인공심장박동기 이식 환자의 의무기록을 열람하여 인공심박동기의 이식 적응증, 임상 증상, 심박동기의 종류, 심박동기 삽입 성적 및 합병증에대해 정리하였다. 결과 : 환자의 연령은 평균 65±15.9세였으며 남녀 비는 9:20이었다. 심박동기는 9명의 동기능부전증후군 환자와 10명의 완전 방실결전전도 차단환자, 8명의 고도망실 전도 차단, 2명의 severe Wenckebach block 환자였다. 심박동기의 종류로는 단일 심강심박동기가 17, 두심강심박동기가 12명 이었다. Mode는 14명이 VVI, 9명이 DDD, VDD가 6명이었다. 한례의 심박동기증후군 외의 심각한 합병증은 없었다. 결론 : 동기능부전증후군 환자나 고도 방실차단, 완전 방실 차단환자에서 이대 목동병원에서는 성공적으로 영구적 인공심박동기가 이식되었다. Objectives : Permanent pacemaker implantation is a worldwide procedure in patients who have hemodynamic instability due to bradyarrythmia or atrioventricular block. We summerized the results of 29 patients who have undertaken permanent pacemaker implantation in Ewha Womans University Mokdong hospital. Methods : Medical records of 29 patients who have undertaken pacemaker implantation were reviewed regarding indications, clinical findings, type of pacemakers, and the results of pacemaker implantations. Results : The patients had a mean age of 65±15.9 years(M : F=9 : 20).The indications of pacemaker implantation are as follows : sick sinus syndrome(SSS) in 9 patients ; complete atrioventricular block(AV block) in 10, high degree AV block in 8 ; severe AV Wenckebach block in 2. Types of permanent pacemakers included single chamber in 17 patients, and dual chamber in 12 patients. The modes were VVI in 14 patients, DDD in 9 patients, and VDD in 6 patients. Pacemaker syndrome was reported in one case and there were no serious complications such as wound infection, lead fracture, lead displacement, or migration of generators. Conclusion : Patients with SSS and high degree and complete AV blocks were successfully treated with permanent pacemaker implantation in Ewha Womans University Mokdong hospital.

수술실 오염도감소를 위한 수술실공조시스템에 대한 연구

김천숙,박은정,강규식,김지은,안기량,권진형,유시현,주영철,권순정 순천향의학연구소 2004 Journal of Soonchunhyang Medical Science Vol.10 No.1

Background: The OR(operating room) should provide an optimum environment that is safe for the patient and the working personnel. The air ventilation system of OR has been studied to decrease the contamination of air. We investigated the flow and contamination of the air in OR at our hospital. Method: Cultures in OR were made and the number of bacteria and fungi were calculated. A two-dimensional model for the cross-section of an operation room is developed for the CFD (computational fluid dynamics) analysis. The characteristics of air flow in the empty operation room and in the occupied operation room are calculated by using a CFD program. Results: The current air ventilation system of our hospital does not deliver the clean air to the operating site efficiently in occupied OR. Conclusions: We suggested a new location of air ventilation system which improves air venting with little increase of the cost of equipment.