내시경적 점막절제술로 치험한 식도 과립상 세포종 1례

강혁주,김성욱,최석진,이중현,장재식,서영범,윤병구,박건욱,김성자,김용섭,강승완,이구,양창헌,이창우,김욱년,이광헌,서정일 동국대학교 의학연구소 2000 東國醫學 Vol.7 No.-

과립상 세포종은 Schwann 세포 기원으로 생각되며 인체에 비교적 드물게 발생한다. 과립상 세포종은 전신 어느 곳에서나 발견될 수 있으나 주로 혀, 구강, 피부 혹은 유방 등에서 호발하며 드물게 위장관에서 발견된다. 위장관에서는 식도에서 가장 호발하며 다음으로 위, 대장 순이다. 과립상 세포종은 대부분, 특히 위장관에서는 양성이며 소수의 악성 병변이 보고되었다. 이러한 이유와 함께 수술 전의 진단이 어렵기 때문에 과립상 세포종에 대한 근본적인 치료는 현재까지 외과적 절제술이다. 최근에 시도되는 치료방법들로는 내시경적 레이저 치료, 용종절제술, 내시경적 점막 절제술 등이 있다. 저자들은 상부 소화관 내시경검사를 시행하여 식도 과립상 세포종을 진단하고 내시경적 점막 절제술을 시행하여 합병증 없이 퇴원하여 현재 재발없이 경과 관찰중인 1례를 경험하였기에 보고하는 바이다. Granular cell tumors, which occur infrequently, are probably of Schwann cell origin. They can occur almost anywhere in the body but usually affect the tongue, oral cavity, skin, or breasts and are rarely found in the gastrointestinal tracts. The esophagus is the most frequent gastrointestinal site, followed by the stomach and the colon. Granular cell tumors are generally benign, especially in the gastrointestinal tract, some malignant lesions have been reported. For this reason, and also because preoperative diagnosis is difficult, the standard treatment for granular cell tumor has until now been surgical excision. In recent years, other therapeutic methods is endoscopic laser therapy (ELT), polypectiomy, endoscopic mucosal resection (EMR). We report a case of esophageal granular cell tumor which was diagnosed by an endoscopy and managed using an endoscopic mucosal resection without complication.

악성 갑상선 우연종의 임상상 및 초음파 소견의 진단적 가치

강한욱,김광원,이병완,강보현,김형훈,김범진,정재훈,민용기,이명식,이문규 대한내분비학회 2002 Endocrinology and metabolism Vol.17 No.5

연구배경: 최근 갑상선 초음파 검사의 빈번한 시행으로 갑상선 우연종의 발견이 증가하고 있다. 이러한 갑상선 우연종은 임상적으로 어떻게 접근하고 치료를 해야 하는지 적지 않은 문제가 되고 있다. 본 연구에서는 직경 1.5㎝ 이하의 갑상선 우연종의 유병률, 입상적 특징 및 초음파 특성, 그리고 가장 효율적인 진단적 접근에 대해 알아 봤다. 방법: 1999년 1월부터 2000년 12월까지 삼성서울병원 내과 및 일반외과로 갑상선 결절을 주소로 내원한 1457명을 대상으로 후향적 연구를 시행하였다. 우연히 발견된 직경 1.5㎝ 이하의 갑상선 결절을 가지는 환자들에서 갑상선 결절의 촉지 유무, 갑상선 기능검사, 항갑상선 항체, 갑상선 초음파 및 미세침 흡인세포검사, 99m^Tc 갑상선 스켄, 수술 조직검사 및 병기를 검토하였다. 결과: 분석한 갑상선 결절 1475예 중 갑상선 우연종의 유병률은 13.4%(198예)였다. 갑상선 우연종에서 악성률은 28.8%(57예)으로 나왔다. 양성 및 악성 갑상선 우연종에서 나이, 성별, 갑상선 기능검사, 결절 크기에는 의미 있는 차이는 없었다. 갑상선 스켄은 갑상선 우연종의 감별에 적합하지 않았다. 갑상선 결절의 초음파 지표 점수만이 양성 및 악석 갑상선 우연종의 감별에서 초음파 지표 점수의 민감도는 88.9%, 특이도는 74.4%, 양성 예측률은 92.4%로 나왔고 진단적 정환도는 85.5%였다. 갑상선암으로 수술을 받은 50명중 stage 1은 34명, stage 2는 6명, stage 3은 10명으로 대부분의 악성 갑상선 우연종은 낮은 TNM 병기로 나타났으나, 상당수에서는 국소 침범의 소견을 보였다. TNM 병기의 3기 환자 전부는 45세 이상이였고, 주로 갑상선암의 피막 침범에 의한 것이었다. 임파절 전이는 6명의 환자에서 나왔다. 결론: 악성 갑상선 우연종은 비교적 흔히 접할 수 있는 질환이며 양성 우연종과는 임상적으로 구별이 안 된다. 악성 갑상선 우연종은 발견 당시 대부분 낮은 병기이나, 갑상선의 피막 침범 및 임파절 전이가 상당수에서 발견되었다. 갑상선 우연종의 초음파 소견은 향후의 진단 방향을 제시하는 중요한 길잡이가 될 수 있다. 초음파 지표 점수 2점 이상의 갑상선 우연종에서만 초음파 유도 미세침 흡입검사를 권장한다. Background: High-resolution ultrasonography has made the detection of asymptomatic small thyroid possible. Recent increases in the detection of incidentalomas have created a clinical dilemma on how to properly manage such incidental nodules. We investigated the prevalence, clinical and ultrasonographic characteristics, and optimal diagnostic approach toward incidentally detected benign and malignant thyroid nodules of less than 1.5㎝ in size. Methods: A retrospective review was undertaken on the 1,475 patients who had visited Samsung Medical Center, Seoul Korea between January 1999 and December 2000. The review consisted of a physical examination of the thyroid gland, thyroid function test, antithyroid antibodies, thyroid ultrasonography, fine-needle aspiration biopsy, pathology and TNA staging of the incidentally detected thyroid nodules of less than 1.5㎝ in size. Results: The prevalence of thyroid incidentalomas was 13.4% and the malignancy rate within them was 28.8%. There were no significant differences in age, sex, thyroid function test and size between the benign and malignant incidentalomas. Ultrasonographic characteristics showed meaningful diagnostic value for the detection of malignancy in incidentalomas. Most malignant incidentalomas were of a low stage. Conclusion: Occult thyroid cancers are fairly common finding. There are no clinical difference between benign and malignant thyroid nodules less than 1.5㎝; however, ultrasonographic findings can be used to decision of optimal management strategies (J Kor Soc Endocrinol 17:649∼656, 2002).

주정중독 환자 배우자의 불안과 우울 성향 및 가정생활

강병조,임완빈,김승팔 大韓神經精神醫學會 1986 신경정신의학 Vol.25 No.4

The study was designed to investigate the anxious and depressive trends in the wives of alcoholic patients. For the purpose of assessment of anxiety and depression, Zung's self-rating anxiety-(SAS) and depression scales (SDS) were applied to the fifty wives of alcoholics, the latter were admitted to the psychiatric wards of Taegu Catholic Hosp. and Kyungpook National Univ. Hosp. from Jan 1 '84 to Sep. 30 '85 and were diagnosed according to DSM- criteria. And the two scales were also applied to the fifty wives of social drinkers as a control group. The results were as follows; 1) The mean SAS scores were 53.06±9.66 in the wives of alcoholics and 38.64±8.75 in the control group and so the difference was significant in anxious trends (p<0.01) between two groups. 2) The mean SDS scores were 54.00±10.20 in the wives of alcoholics and 42.64±7.80 in the control group and so the difference was significant in depressive trends (p<0.01) too between two groups. 3) As for the frequency order of the SAS items in the wives of alcoholics, they were apprehension, insomnia, restlessness and fear. As for the frequency order of the SDS items in the wives of alcoholics, they were confusion, decreased libido, decreased appetite and psychomotor retardation. 4) As for the wife's attitude toward her husband, nagging and interfering attitude was commonest(46%) in the wives of alcoholics in contrast to the gentle and tender attitude(48%) in the wives of social drinkers. 5) 62% of wives of alcoholics were dissatisfied with their sexual life but the degree of dissatisfaction was low to 8% in the wives of social drinkers.

평균 유효 세율의 결정 요인에 관한 연구

宣炳完,崔康得 全北大學校 1994 論文集 Vol.38 No.-

A number of empirical studies have used effective tax rate(ETR) measures calculated from financial statement information to examine the relations between taxes, firm decisions, and firm characteristics. Studies using the average effective tax rate to measure corporate tax (dis) advantage have played a critical role in tax legislation. Recent research, however, has questioned the effectiveness of the ETR for this purpose. Previous research on corporate ETRs identified three important findings : (1)ETRs vary across firms(industries), (2) ETRs change over time, and (3) variances of ETRs differ across industries. These findings were explained solely in terms of cross-sectional and intertemporal differences in tax preferences. All other factors were implicitly assumed to be unimportant. This paper challenged the existing explanation by deriving the ETR as a function of the marginal tax rate and two variables : tax preferences and (pre-tax accounting)income. The model demonstrated how changes in the ETR can occur under two alternative assumptions about the relationship between tax preferences and income. Specifically, when tax preferences and income are perfectly correlated, the model showed that changes in the ETR are caused solely by changes in tax preferences. In the absence of perfect correlation, however, the model indicated that both tax preferences and income are capable of causing the ETR to change.

관해유도 항암요법을 받는 백혈병 환자에서 진균 감염증의 예방 : 무작위 배정법과 이중 눈가림법에 의한 Fluconazole과 Nystain의 효과에 관한 다기관 공동연구 A Randomized, Double-blind, Multicenter Trial to Compare Fluconazole with Nystatin

최강원,오명돈,배현주,백경란,박선양,김병국,신완식,강문원,진종률,박종원,김춘추,김동집,한지숙,민유홍,이선주,고윤웅 대한화학요법학회 1993 대한화학요법학회지 Vol.11 No.2

Fluconazole의 진균 감염증 예방 효과와 안전성에 관하여 3개 대학병원에서 관해유도화학요법을 받는 급성 백혈병환자를 대상으로 무작위 배정법과 너도나도 누가림법에 의하여 연구하였다. 모두 62명의 환자에게 fluconazole(100㎎ bid) 또는 nystatin(1,000,000IU/day)을 무작위로 투여하였다. 투약은 관해유도화학요법과 같은 날짜에 시작하여 호중구수가 1,000㎣이상으로 회복되거나 진균 감염증이 확인되거나 의심되어 Amphotericin-B를 시작하거나, 약과 관련된 부작용이 나타날 때까지 계속하였다. 진균 colonization은 fluconazole군에서 감소하였으나 nystqatin군에서는 증가하였다, 표재성 진균감염증으로 nystatin군에서 C. albicans 진균혈증 1례와 C.parasilosis 진균혈중 1례가 발생하였다. 경험적 항진균요법으로 Amphotericin-B를 투여한 경우는 fluconazolerns 34명중 7례(21%), nystatinrns 28명중 10례(36%)였다(p<0.05). Fluconazole군과 nystatin군 사이에 부작용이나 사망률에 차이는 없었다. 결론적으로, fluconazole은 관해유도화학요법을 받는 급성 백혈병환자에서 진균의 colonization을 줄이는데 효과적이고 안전한 항진균제이다. We made a randomized, double-blind, multicenter trial to compare the efficacy and safety of fluconazole with nystatin for prevention of fungal infections in patients with acute leukemia. Sixty-two adult undergoing remission induction chemotherapy for cute leukemia were enrolled. Patients were randomly assigned to receive either fluconazole (100㎎ bid) or nystatin(1,000,000IU×6/day) with corresponding placebo. The study drug was started in initiation of chemotherapy and continued until recovery of neutrophil counts(>1,000/㎣), development of proven or suspected invasive fungal infection, or the occurrence of drug-related toxicity. Fungal colonization decreased in fluconazole(F) group, however increased in nystain(n) group. Superficial fungal infection occurred in 1 of 34 F group, whereas invasive fungal infection developed in 3 of 28 N group. Empirical amphotericin-B therapy was given in 7 of 34(21%) F group and 10 of 28(36%) N group(p>0.05). The incidence of drug-related side effects and overall moratlity were similar in both study groups.

사과 열과(裂果)의 원인과 그 방지에 관한 연구

권병규,강영호,이우승,성민웅,한강원 경북대학교 1971 生産技術 Vol.5 No.-

On the basis of our hypothesis about the causes of cracking has obtained in our 1969's study, we investigated the relations among the cracking and the microelements, the environmental factors, and the treatment of IAA and GA in two selected orchards. We analyzed and compared with the contents of microelements (Mn, B, zn, and Cu) in leaves and soils of two test orchards (Taegu and Yungju). The results of the study which the causes of cracking of apples are examined through the above three procedures, are as follows: 1. The contents of Mn in soil of Taegu test orchard were total Mn 435.9 ppm, soil sol'n Mn 6.2ppm, and total Mn 284.6 pm in leaves. That of Yungju test orchard were total Mn 595.1ppm, soil sol'n Mn 6.2ppm and total Mn 144.2ppm in leaves. Comparing with Mn optimum contents in leaves Mn contents of Taegu test orchard were higher than the optimum concentration, while those of Yungju were approximately satis-factory. 2. The contents of B in leaves were 3.7ppm in Taegu and 4.6ppm in Yungju. These contents were lower ten times than the optimum contents and were the same deficiency in both test orchards. 3. The contents of Zn in leaves were 5.7ppm in Taegu and 3.8ppm in Yungju. Those contents were both the same deficiency as comparing with the optimum contents. 4. The contents of Cu in leaves were 29.3ppm in Taegu test orchard and 10.6ppm in Yungju test orchard. Comparing with the optimum contents, the contents of Cu were excess in Taegu test orchard, while that of Cu were approximately satisfactory in Yungju 5. The diameter of Ralls apple fruits were increased 1.1% in IAA spraying treatment and 3.1% in GA spraying treatment as comparing with control group 6. The thickness of cuticle layer of Ralls apple fruits were highest and the cuticle treated with IAA and GA was thinner than the control group. 7. New branches of tree with higher cracking rate tended to decrease in length, in figure and size of leaves. 8. The change of diameter in fruits were decreased in higher cracking fruits during day and night. The change of that in IAA and GA group were increased 6.1% and 1.2% respectively compared with the control group. 9. The application of IAA and GA solution slowed the cracking rate by 2.2 and 0.8% respectively compared with the control group 10. In 1970 year the cracking rate of Ralls apple fruit were 6.53% in Taegu and 4.31% in Yungju test orchard. 11. We obtained linear regression of rate of cracking and the summation of temperature during May to August in Taegu area. The summation of temperature was 2428.1℃ during June to August in 1970. When the summation of temperature was increased more than above that of tempera ture, we could expect that it was possible to increase the rate of cracking Ralls apple. An equation in the summation of temperature and the rate of cracking fruits during May to August were obtained y=0.074x-157.50. 12. The investigation indicates that a method of preventing the cracking of Ralls apple is: a. to spray at the optimum time growth hormone which increases the elasticity and elongation of cell wall. b. to alter the composition of soil by putting the organic fertilizer deeply in the ground. c. to replace Ralls apples with new varieties which is strong against cracking and have high quality and economical productivity.

동종 골수이식 후 만성 이식편대숙주반응 환자에서 발생한 폐렴구균에 의한 수막뇌염 1예

신완식,김병욱,유진홍,김동집,김춘추,박종원,이종욱,김동욱,강문원,김양리 대한감염학회 1993 감염 Vol.25 No.3

Graft-versus-host disease (GVHD) is a frequent complication after bone marrow transplantation. Infectious complications are common in GVHD patients due to defect in cell-mediated immunity. A rare case of S. pneumoniae meningoencephalitis occured in a patient with extensive form of chronic GVHD after allogeneic bone marrow transplantation. He was immediately treated with full dosage of ceftriaxone and ampicillin. He suffered from various complications such as sepsis, acute renal failure, atelectasis, and seizure. Despite of aggressive treatment, he died probably due to renal shutdown and massive subacute cerebral infarction of left cerebral hemisphere. This report showed two unusual and rare features. First, the infection site was CNS rather than respiratory system. Second, the causative organism was S. pneumoniae, which is rare cause of CNS infection in immunocompromised patients.

Methotrexate 치료를 받고 있는 활동성 류마티스 관절염 환자에서 etanercept의 유효성과 안전성에 관한 연구

최병렬,강태영,정청일,이혜순,엄완식,김태환,전재범,유대현,배상철 대한내과학회 2004 대한내과학회지 Vol.66 No.5

목적 : 류마티스 관절염을 앓고 있는 한국인 중에 기존 DMARDs로 치료 실패하였고, 고정용량의 MTX를 복용하고 있는 환자들에 있어서 etanercept의 유효성과 안전성을 평가하고자 하였다. 방법 : 기존 DMARDs로 치료 실패한 활동성 류마티스 관절염 환자 76명을 대상으로 하여 단일군, 공개시험을 하였다. 대상 환자들은 고정용량의 MTX를 복용하면서 etanercept 25 mg을 1주일에 두 번 피하 주사하였으며 12주간 투여하였다. 유효성은 ACR 20, ACR 50,조조강직 시간으로 평가하였고, 약제의 안전성은 이상반응 등으로 평가하였다. 결과 : 대상 환자는 총 76명으로 평균 연령은 45.2세, 남자 5명, 여자 71명이었다. 84.4%인 54명이 12주째에 ACR 20을 만족하였고, 53.1%인 34명이 12주째에 ACR 50을 만족하였다. 조조 강직 시간은 치료 전 203.3분에서 치료 12주째 42.6분을 평균 74.5% 호전되었다. 가장 흔한 이상반응은 주사부위 반응이었다. 이외에도 상기도 감염, 오심, 안면부종 등이 발생하였으나 심각한 부작용은 없었다. 결론 : etanercept는 효과적이고, 안전한 류마티스 관절염 치료 방법이며 특히 MTX치료에도 불구하고 활동성인 류마티스 관절염에 기대되는 치료라고 할 수 있다. Background : This study was performed to investigate the efficacy and safety of etanercept in active rheumatoid arthritis patients with stable dose of methotrexate in Korean. Methods : In a 12 week, single arm, open trial, we assigned 76 patients with active rheumatoid arthritis who had an inadequate response to disease-modifying antirheumatic drugs. Patients received twice-weekly subcutaneous injections of etanercept 25 ㎎ while containing to receive methotrexate at a stable dose of 7.5~25 ㎎ per week. The clinical response was defined as the percent improvement in disease activity according to the criteria of the American Collage of Rheumatology (ACR) at 12 weeks. Results : Etanrecept led to significant improvements in disease activity and was safe and well tolerated. At 12 week, 84.4% of the patients receiving 25 ㎎ of etanercept achieved a 20% ACR response, and 53.1% of those receiving etanercept achieved a 50% ACR response. The most common adverse event was injection-site reaction. Other advanse events were upper respiratory infection, nausea, and facial edema, but there were no serious adverse events associated with etanercept. Conclusion : In active rheumatoid arthritis patients, etanercept was safe, well tolerated, and provided rapid clinical improvements.

열린교육을 위한 초등학교 자연과 수준별 학습자료 개발에 관한 연구

김광명,강태완,이대형,장병기,김남일,이면우 춘천교육대학교 과학교육연구소 1998 과학교육연구 Vol.22 No.-

혈액 내 구리, 아연 및 ceruloplasmin 농도에 흡연, 음주 및 신체적 활동이 미치는 영향

홍연표,강은용,신인철,최병선,박정덕,장임원,박진완 大韓産業醫學會 1999 대한직업환경의학회지 Vol.11 No.4

Objectives : To investigate the influence of smoking, alcohol ingestion, and physical activity on copper and zinc in RBC and serum and serum ceruloplasmin, this study was performed in a cross-sectional study in 113 healthy men aged 20 to 40 years who had no symptomatic liver, heart, gastrointestinal, and other chronic diseases. Methods : At the men's entry into the study, blood samples were drawn from each subject and immediately centrifuged for analysis of copper, zinc, iron, ceruloplasmin, total cholesterol, and hematocrit. Each man completed a questionnaire that provided information on smoking, amount of alcohol intake, and physical activity. Partial regression analysis was performed on confounding variables such as age, body mass index, hematocrit, serum cholesterol, and serum iron. Results : In general linear models, adjustment for confounding variables did not show statistical differences, and there was only an increasing tendency in serum copper in heavy smoker(P=0.0678). There was no difference between high physical activity with mild smokers and lower physical with heavy smokers. Conclusions : This study suggested that copper, zinc and ceruloplasmin were not good biomarker for early effect by smoking, alcohol intake and physical activity in young adult. However, selection bias should be considered in evaluation of this result, and a large prospective study will be needed in advance on usefulness of copper, zinc and ceruloplasmin as a marker for risk factors and early change of atherosclerosis.