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.

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.

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.

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

Halo 구조의 MOSFET에서 이동도 감소 현상

이병헌,이기영 충북대학교 컴퓨터정보통신 연구소 2004 컴퓨터정보통신연구 Vol.12 No.2

소오스와 드레인 근처에 포켓이온이 주입된 halo구조의 MOSFET에서 전송자의 이동도 감소는 포켓이온주입의 조건에 따라 쿨롱(Coulomb)산란의 증가에 의한 이동도의 감소량보다 큰 이동도의 감소가 관측될 수 있다. 또, 게이트 바이어스에 대한 이동도의 특성변화도 기존의 일차적 효과에 의한 해석과 비교하여 상이한 결과가 나타날 수 있음이 실험적으로 확인되고 있다. 이와 같이 포켓이온 주입에 의하여 Coulomb산란원이 되는 유효불순물 농도의 증가에 따른 일차적인 이동도의 감소효과를 벗어난 이동도 특성을 일반적으로 설명할 수 있는 개선된 해석적 방법이 MOSFET 소자의 성능향상 모색 및 CAD모델 개발 측면에서 요구되고 있다. 본 연구에서는 일차원 영역구분의 근사적인 해석방법을 사용하여 포켓이온 주입에 의한 채널의 반전충 전하분포 및 채널방향의 전게의 분포가 채널전류에 미치는 영항을 분석하였으며, 이러한 효과에 의해서 유효이동도가 추가적으로 감소함을 확인하였다. Additional dopants due to pocket ion implantation cause the Coulomb scattering rate to increase and the increased effective impurity is well known to give rise to a reduction of the effective mobility of halo MOSFETs. However, further decrease of the effective mobility can be observed in pocket implanted MOSFETs above the mobility reduction due to the Coulomb impurity scattering and the gate bias dependency of the effective mobility can also differ from the simple model describing the mobility in terms of the effective impurity. To develop MOSFET devices of the improved conductances and CAD models reflecting the real physic-based phenomena, it is necessary to find an analytical model of the general mobility degradation behavior in the scaled pocket implanted MOSFETs. In this paper, using the 1-D regional approximation, the effect of the inhomogeneous distribution of the inversion charge along the channel on the drain current is investigated. The inhomogeneous channel charge distribution is shown to be effective in the further reduction of the effective mobility in halo MOSFETs.

수술 전 설하신경마비를 동반하지 않은 설하신경초종 : 2례보고 Report of 2 Cases

이동엽,이상형,유헌,정희원,한대희,조병규 대한신경외과학회 1999 Journal of Korean neurosurgical society Vol.28 No.12

洪水流出 豫測模型의 媒介變數 改善에 關한 硏究

이은태,고병욱,이주헌 慶熙大學校 1995 論文集 Vol.24 No.-

In order to improve the runoff simulation program for the Nakdong river system, which had been developed based upon the storage-function model and started its roll in 1987, the watershed and channel parameters have been reevaluated using T/M hydrologic data collected from 1987 to 1993. This paper presents the analysis of the problems found during the reevaluation of the parameters and the verification of the runoff simulation for the historical flood events using the re-evaluated parameters.

B형 만성 활동성 간염 환자에서 Prednisolone 단기이탈 및 Alpha Interferon 병합요법의 효과

이종선,김병호,성자원,허승식,이기천,정현용,이헌영,김영건 충남대학교 의과대학 지역사회의학연구소 1991 충남의대잡지 Vol.18 No.2

To evaluate the safety and efficacy of Pd withdrawal followed by recombinant alpha- Interferon 2b therapy. Nine patients were given a single daily subcutaneous injection of ^α-Interferon at a dose of 3 x 10 exp(6) units/day for first weeks and thrice weekly for next 15 weeks (maintenance) after pd tappered over 6 weeks. To evaluate the efficacy of therapy, we measured serum aminotransferase activities monthly during and after therapy, and also measured serm HBsAg, HBeAg and DNA probe before and after therapy. To evaluate the safety of therapy, all patients checked peripheral blood WBC, Hemoglobin, Platelet, BUN and Creatinine. The results were as follows : 1. In control group, the normalization of s-AST & ALT level, negative seroconversion of DNA probe & HBeAg were observed in 1/12(8%) & 7/10(17%), 0/10(0%) & 0/12(0%) at 6 months later, and maintained response in 1/11(9%) & 1/11(9%), 2/9(22%) & 2/11(18%) until 1 years later. 2. In treatment group, Serum AST and ALT returned to normal in 8/9 & 8/9 cases (89%) after 1 montns Tx. (mean serum AST : 33±8, ALT : 34±12 IU/ml) and maintained to normal response in 5/9(56%) & 6/9 cases(67%)after 6 months Tx. (mean s-AST : 55±43, ALT : 66±84 IU/ml), 3/9(33%) & 4/9 cases(44%) after 1 years Tx. It was statistically significant reponse except s-AST of after 1 years Tx. 3. In treatment group, s- HBeAg returned to normal in 3/9 cases(33%) after 1 months Tx., and maintained to normal response in 1/7 & 1/4 cases among follow up patients in after 6 & 12 months Tx. Serm DNA probe level were observed significantly negative seroconversion in 8/9 cases(89%) after 1 months Tx. (p<0.003), and maintained to negative response in 2/6 & 1/3 cases after 6 & 12 months Tx. 4. Serum AST, ALT, HBeAg and DNA probe were not significantly correlated with therapeutic response in relation to histologic diagnosis. 5. Fever and myalgia were noted in 9(100%) & 6(67%) cases. Headache, mild hair loss, anorexia, nausea, facial flushing & diarrhea were noted in few cases. Peripheral WBC(3cases) & platelet counts(3cases) were decreased transiently. This study shows that Pd withdrawal followed by recombinant alpha Interferon 2b therapy may be safe and effective in decrease the level of s-DNA probe, transaminase activity, loss of HBeAg and less adverse effect of clinical and hematologic examinations in patients with CAH type B. But it was necessary for study with large number of patients, more prolonged follow up duration and more strict control study.

산처리에 의한 정수슬러지 감량화

이병문,권재현,안규홍,이석헌,권대영 대한상하수도학회 2003 상하수도학회지 Vol.17 No.1

The acidic treatment of waterworks sludge released organic materials as well as inorganics such as Al, Fe and Mn. Through solubilization as mentioned above, the content of suspended solids reduced by 18% at final pH 3.5. It also increased thickening efficiency and dewaterability of sludge. However overdosing of H_2SO_4 made dewaterability deteriorated. It showed that the optimal condition of acidic treatment be as follows; 5.5㎖ dose of H_2SO_4(97%)/1 sludge, final pH 3.5 and 15minutes of reaction time. Under these conditions, reduction efficiencies of sludge through thickening and dewatering were 57% and 92.2% respectively and then 7.8% of raw sludge released as cake compared to 10.5% without acidic pre-treatment. Therefore, mass of dewatered cake decreased by 26% through acidic treatment. Water content of dewatered cake was reduced from 71% to 62% due to this treatment. The changes of sludge properties including particle size, zeta-potential and bound water by acidic treatment appear to be important keys in assesment of the improvement of sludge dewaterability.

월경주기 증상의 요인 분석

이수일,유태혁,강종선,안석철,이병욱,김헌,석재호 大韓神經精神醫學會 1986 신경정신의학 Vol.25 No.1

404 nurses and nurse-aids rated their experiences of 45 symptoms(Moos' Menstrual Distress Questionnaire) of the menstrual, premenstrual and intermenstrual phase on a 4 point scale separately. The 45 symptoms were inter-related and factor analyzed separately for each phase. six common clusters of symptoms emerged from 3 phases, which were labeled concentration, motor tension, pain, pleasurable affect, autonomic reactions and water retention. Four clusters of symptoms emerged from premenstrual phase. These clusters were labeled instabillity, withdrwal reactions, depression and headache. The factor named unpleasurable affect emerged from intermenstrual and menstrual phase. Above findings were differed from the results of Moos' study in which eight basically replicated clusters of symptoms emerged from three phases. Through discussion of validity of this scale, and differences between results of Moos' and this study, we came to the conclusion that sampling of subjects, prospective longitudinal symptoms reporting, amount of variance in a symptom over the course of menstrual cycle and proper choice of factor analysis method would be salient variables to construct valid scale for measuring menstrual cycle symptoms.