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.

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

방사선 측정 및 해석 연구 : Assessment of Defected Feul by Analysis of Reactor Coolant Activities 원자로 냉각수중의 방사능해석에 의한 결합핵연료봉의 평가

이호연,오헌진,전재식,오희필,양재춘,정문규,박해용 대한방사선 방어학회 1986 방사선방어학회지 Vol.11 No.2

중성자와 우라늄의 핵반응에 의해 생성된 핵분열생성물의 물리적 특성을 이용하여 원자로 내의 핵연료 상태를 해석하는 모델을 개선하였다. 이 모델에서는 고체 핵연료 내에서 특정핵종의 핵분열 생성물의 생성과 이것이 원자로 냉각재까지 방출되는 과정을 계산하고 추적하며 방사능농도와 결합핵연료봉의 수를 관계짓는 방정식의 계수들을 결정한다. 핵분열생성물의 거동은 이탈(knock out)과 이동(migration) 두 부분으로 나누어 해석하였으며 트램프 우라늄의 영향을 분리할 수 있도록 하였다. 실측자료로는 가압 경수형 원자로인 고리 원자력발전소 1호기의 1차 냉각제를 분석해서 얻은 I-131과 I-133의 방사능 강도를 이용하였다. 이 실험자료와 위 방정식에서 구한 방사능 강도로부터 구한 결함 핵연료의 수는 제3주기에서 9.34±1.13개 제6주기에서 0.294±0.092개로 나타났다. An improved method of assessing fuel status by analysis of the fission product in the reactor coolant system is proposed. The release mechanism of specific fission products is established for determination of the coefficients in the equations which relate the radioactivities with the amount of defected fuel. Knock-out and migration models are employed in the formulation of the release mechanism. The influence of the tramp uranium is quantified. Sample calculations were made for KNU 1 reactor system using the I-131 and I-133 concentrations in the primary coolant. The estimated number of defected fuel pins in the third and sixth cycles appeared to be 9.34±1.13 and 0.294±0.092, respectively.

사업체 급식의 HACCP 제도 도입을 위한 인지도 조사

이헌옥,심재영,신현아,정덕화,엄애선 한국조리과학회 2002 한국식품조리과학회지 Vol.18 No.3

For the introduction of HACCP to industry food service, a survey was conducted from 150 dieticians and 40 managers on their recognition on HACCP system. The questionnaire of the survey included the status of current food safety management, management responsibilities, recognition on HACCP, problems in HACCP introduction. The majority of respondents was satisfied with the current food safety management, and the food service managers were more confident than dieticians in terms of food safety. Foodservice managers (100%) and dieticians (96%) recognized HACCP system; however, they responded the application of HACCP to industry food service were only 27% and 12.5%, respectively. They pointed out the reasons that they cannot introduce HACCP to their industry food service were the lack of benefits and good facilities. Dieticians strongly recognized the need of correction of food safety management in industry food service, compared with food service managers. The results suggest that the introduction of HACCP to industry food service should be accomplished by continuous education and information on food safety, improving facilities and a variety of benefits to HACCP-implemented companies from the government.

중심압축력을 받는 高强度 RC기둥의 띠철근 配筋形態에 關한 實驗的 硏究

이영인,이영호,곽노현,정헌수 중앙대학교 기술과학연구소 1998 기술과학연구소 논문집 Vol.28 No.-

An objective of this study is to experimentally investigate the strength and ductility of reinforced concrete columns under uniaxial load and several test variables. To do this, we have conducted tests on twelve 20×20×60cm specimens with 8 and 12 longitudinal steel bars subjected to monotonic uniaxial compression. The main variables considered in this test are the configuration of ties, the strength of concrete, and the space of ties. The results indicate that the strength and the ductility of reinforced concrete columns have been influenced on the configuration of ties, the space of ties, and the strength of concrete.

뇌종양 환자의 제왕절개술을 위한 전신마취 : 증례 보고 A case report

이헌근,전세현,손주태,신일우,정영균 대한마취과학회 2002 Korean Journal of Anesthesiology Vol.43 No.4

A 28-year-old primigravida at 33 weeks gestation was referred to our hospital because of aggravation of seizures which occurred intermittently for the past 2 years. A brain magnetic resonance imaging scan taken at 33 weeks gestation showed a large brain tumor (7 × 5 × 4 cm) in the left high frontal lobe. She had a cesarean section under general anesthesia at 38 weeks and 1 day gestation. General anesthesia was induced with thiopental 250 mg, succinyleholine 75 mg and lidocaine 60 mg after a vecuronium 0.8 mg intravenous injection. The hyperventilation and mannitol used to reduce increased intracranial pressure (ICP) in this patient may be harmful and detrimental to the fetus before delivery. Achieving both ICP control and fetal well being at the same time during a cesarean section can be challenging to anesthesiologists. We report the anesthetic management of a cesarean section in a patient with a large brain tumor. (Korean J Anesthesiol 2002; 43: 515~519)

다발성 골수종에서 저용량 thalidomide, cyclophosphamide, dexamethasone (TCD) 요법의 효과

류충헌,정재현,고정해,장제혁,박영진,최규남,박봉수,이상민,주영돈 인제대학교 2008 仁濟醫學 Vol.29 No.-

Background and Objectives : The immunomodulatory drug thalidomide can inhibit angiogenesis and induce apoptosis in experimental models. It can also induce marked and durable response in newly diagnosed myeloma patients. Thalidomide has been used at doses ranging from 200 to 800 mg with significant toxicity. No data are available on the impact of low-dose thalidomide, cyclophosphamide and dexamethasone as initial therapy for myeloma patients. Design and Methods : To address this issue, newly diagnosed myeloma patients were treated with 50 mg/day thalidomide continuously and cyclophosphamide 150 mg/m², days 1-4 and dexamethasone 20 mg/m², days 1-5 and day 15-19, every month. Between October 2005 and October 2006, 14 patients (median age 54.5 years) were treated with low-dose thalidomide, cyclophosphamide and dexamethasone. Results : After a minimum of two cycles of treatment, 5 patients (55.5%) showed a partial remission. After four cycles of treatment, 10 patients (83.3%) showed a partial remission (n=6) and complete remission (n=4). After a median follow-up of 15.4 months, 1 year overall survival rate was 82.0%. Thalidomide was well tolerated without serious toxic effects. Conclusions : The combination of low-dose thalidomide, cyclophosphamide and dexamethasone demonstrates favorable response rate and 1 year overall survival rate in newly diagnosed myeloma. Severe toxicities were not seen with this combination.

유기질비료 시비량에 따른 오미자 묘목의 초기 생육특성에 관한 연구

이경아,박태호,박성용,김도현,오문국,김민수,안태진,이상원,김영국,안영섭,박충범,차선우,송범헌 忠北大學校 農業科學硏究所 2015 農業科學硏究 Vol.31 No.1

This study was carried out to have basic and applied informations to find the optimum nitrogen fertilization level for organic cultivation and to investigate early growth characteristics of Schizandra chinensis Baillon. Different application levels of the organic fertilizer were based on the recommended rate of N fertilizer. Five different levels of the organic fertilizer were applied to S. chinensis and early growth responses such as the length of vine, the diameter of vine, the number of leaves, and the number of branches were investigated. Lengths of main and total vines were shown longer at the level of 1.0 time organic fertilizer than those at others. The vine length at early growth was the highest at the level of 1.0 time organic fertilizer among the treatments. Stem diameter was shown thicker level of 1.0 time organic fertilizer than others on August and September, whereas on October it was the thickest in the conventional cultivation. Number of leaf was increased higher at the level of 1.0 and 2.0 times organic fertilizer than that in the compared to conventional. The number of branches was appeared the lowest at the level of 1.0 time organic fertilizer at early growth, however they were increased through progressing their growth stages. They were not significantly difference among the treatments except for the level of 2.0 times organic fertilizer. Based on the research results, the growth of S. chinensis was commonly higher at the level of 1.0 time organic fertilizer compared to other treatments.

초등학교 급식소에서의 HACCP 적용을 위한 계절별 환경미생물학적 위해분석

권성희,이헌옥,정덕화,신원선,엄애선 한국조리과학회 2003 한국식품조리과학회지 Vol.19 No.5

Foodservice at elementary schools has been povided nation-wide. It is predictable that foodborne diseases would increase continuously. Formation of a counterplan is urgently needed. This study was designed to identify the stage which contains the critical control points (CCPs) for the microbiological management of HACCP(Hazard Analysis Critical Control Point) at the foodservice provided at elementary schools. Foodservice places at four elementary schools in Seoul were sampled and the overall hygiene of cooking, utensils and equipment, employees, and environment by season were examined. The results showed that the number of bacteria in overall samples was increased and that E. coli, Salmonella and Staphylococcus by biochemical test emerged in more diverse samples in summer than in spring. Particularly, the number of aerial bacteria in summer was three-fold greater than that in either spring or winter. E. coli 0157 was not detected, although Salmonella was identified by PCR analysis in the meat Knives, chopping boards, waste bins and meat dish at elementary school foodservice. According to this data, cross-contamination should be managed in the stage of mixing up the ingredients with improper equipments and insanitary treatments. Thus, the establishment of SSOP (Sanitation Standard Operating Procedures) and GMP (Good Manufacturing Practice) at elementary school foodservice is stringently required, along with sanitation education for workers and employees as CCPs.

상계치 이론을 이용한 장방형 개구부를 갖는 철근콘크리트 깊은 보의 전단내력 평가

양근혁,이영호,은희창,정헌수 대한건축학회 2003 대한건축학회 학술발표대회 논문집 - 계획계/구조계 Vol.23 No.2(구조계)

The purpose of this study is to evaluate the failure plane and the shear capacity of reinforced concrete deep beams with rectangular openings using upper bound theorem. A numerical optimization procedure programmed to obtain the minimum value of the shear capacity by adjusting the position of the instantaneous center according to various potential failure planes. The predictions obtained from the proposed method are in good agreement with experimental results.