외상후 발작의 위험인자에 대한 조사

이재학,배학근,윤석만,도재원,이경석,윤일규,최순관,변박장 순천향의학연구소 2001 Journal of Soonchunhyang Medical Science Vol.7 No.1

Risk Factors for Posttraumatic Seizure The authors evaluate the risk factors for posttraumatic seizures. this prospective study was performed in a series of 470 head injured patient from January 1996 to Decomber 1998. The patients who were dead within 1 week of injury or children from 3 years old and under were excluded. There were 358 male and 112 female with a mean age of 35.2±22.8 years (range, 4-88 years). The results were as follows : 1). Of the 470 patients, pasttraumatic seizure occurred in 48 patients(10.2%): early seizure in 28(6%) and late seizure in 20 patients(4.2%). 2). The clinical risk factors for posttraumatic seizure were poor consciousness at admission, presence of brainstem herniation signs, poor GCS score, and posttraumatic amnesia more than 24 hours after trauma(p<0.001). 3). The radiological risk factors for posttraumatic seizure were subdural hematoma(p<0.001), intracerebral hematoma (p<0.02), mutiple intracranial CT lesions(p<0.001), or delayed lesions on follow-up CT scans(p<0.001). the incidence of seizure increased according to the severity of diffuse brain lesion(p<0.001), and the seizure rate in mass lesion was higher than that in diffuse lesion(p<0.001). 5). Hypoxia and coagulopathy had a statistically significant influence on posttraumatic seizure(p<0.05). Hypoxia had a infuence on occurrence of late seizure(p<0.05). 6). The incidence of posttraumatic seizure signiticantly increased in surgical group compared with coservative group(p<0.001) and significantly increased in patient who underwent decompressive craniectomy compared with those who underwent craniotomy(p<0.001) 7). Preventive administration of antiepileptic drugs decreased the incidence of early seizure, but did not affect on the reduction of late seizure. 8). Multivariate logistic regression analysis showed the subdural hematoma, GCS score, delayed lesion, and intracerebral hematoma in order of importance for seizure risk. in conclusion, the risk factors affecting on the occurrence of seizure were clinical status at admission, CT lesions, and severity of diffuse brain inJury. Considering that hypoxia affected on the late seizure, it is necessary to detect and treat it immediately after trauma. In addition, the patients who underwent decompressive craniectomy should be carefully followed to evaluate the risk of late seizure. Even though preventive administration of antiepileptic drugs had a tendency to decrease the incidence of early seizure, it is unclear whether administration of antiepileptic drugs can reduce the incidence of posttraumatic seizures. Prospective study will be needed in the selected patients.

Squalene Adjuvant를 이용한 단백질 항원의 세포성 면역반응 유도

도현주,김성열,안종성,하영주,이승찬,오재택,장명호,정홍석,문홍모,박해준 大韓免疫學會 1996 大韓免疫學會誌 Vol.18 No.3

To investigate the role of adjuvant for cytotoxic T lymphocytes (CTL) induction, squalene-based adjuvant was studied its capability eliciting to the induction of cellular immunity as well as humoral immunity to exogeneous proteins. Ovalbumin (OVA) was used as model proteins. It was demonstrated that antigen formulation consisted of metabolizable oil squalene mixed with Tween 80 and pluronic L121 (S/TJ121) could induced the antigen specific CTL responses and antibodies irrespective of immunization routes in mice. We also demonstrated that this antigen formulation was a inducer of CD8+, major histocompatibility complex(MHC) class I-restricted, and antigen-specific C;1'Ls. These data suggest that the squalene-based emulsion system is a potent adjuvant inducing cellular immunity as well as humoral immunity.

수도권 매립지 주변의 지표수 오염에 관한 연구

이인현,장원,백영,도갑수,최재규 한국환경과학회 1997 한국환경과학회지 Vol.6 No.6

In order to analyze the water quality variation of surface water around the Sudokwon landfill site, seasonal variations of water temperature, pH, DO, BOD, COD, SS, NH_3-N. NO_2-N, and NO_3-N were examined at 10 sites from January to December, 1996. It was found that the estimates of COD, DO, SS, and NH_3-N were increased compared with the results of environmental impact assessment carried out in 1988. Higher estimates of COD, DO, and SS were due to industrial and agricultural wastewater, and the increase of NH_3-N at Jangdo reservoir site was due to the leachate from the landfill. In particular, the estimate of SS was found to be increased by the soil wash from the landfill during the heavy rainy days.

Risperidone이 백서의 Schedule-Induced Polydipsia에 미치는 영향

이기철,이정호,윤도준,최영민,전성일,김태수,정홍경,하준명,정재현 大韓神經精神醫學會 2000 신경정신의학 Vol.39 No.3

연구목적 : 강박장애의 원인론중 세로토닌-도파민 가설에 기초하여 강박장애 동물모형으로 고려되는 고정된 시간 간격으로 평소의 먹이섭취량보다 작은 양의 음식물을 백서에게 장기간 공급하여 다음중(schedule-induced polydipsia : SIP)을 유발시켰다. SIP모형에 강박장애에 효과적이라고 알려진 선택적 세로토닌 재흡수 차단제로서 fluoxetine을 장기 투여하고, 신경절후 5-HT²와 도파민 D² 수용체를 동시에 차단하는 risperidone을 투여하고, 신경절후 도파민 수용체 차단제인 haloperidol을 투여하였다. 그결과로서 risperidone이 강박장애 동물모형으로 고려되는 SIP에서 어떤 영향을 미치는지 알아보았다. 방 법 : SIP를 유발하기 위해 각각의 사육상자에 1정당 90㎎의 사료를 자동급이장치 (automatic dispenser)에서 60초당 1정씩 고정된 시간 간격으로 하루에 150분씩 공급하였다. 4주간 고정된 시간 간격으로 머기를 공급하고 매주 음수량과 체중을 측정한 실험 동물과 동등한 사료의 양을 한번에 덩어리로 공급받은 통제 집단의 체중과 음수량을 비교하였다. SIP 행동변화를 보인 실험 동물들을 fluoxetine 5㎎/㎏(N=8), risperidone 0.1㎎/㎏(N=8), haloperidol 0.1㎎/㎏(N=8), 그리고 vehicle 대조군 1㏄/㎏(N=8)으로 나누고 각각의 실험 동물군에서 3주간에 걸쳐서 실험 약물을 매일 복강내 주사하였다. 매주 실험 동물의 음수량과 체중을 측정, 비교하였다. 결 과 : 1) 고정된 시간 간격으로 제한된 먹이를 공급한 실험 동물군은 1주부터 4주에 걸쳐서 기저치보다 유의한 음수량의 증가를 보였다. 반면 통제 집단은 2주째 음수량이 일시적으로 증가한 소견 이외에 4주간의 실험 기간중 유의한 변화는 보이지 않았다. 실험 동물과 통제 집단간의 음수량에서 3주와 4주째에 실험 동물이 통제 집단보다 유의하게 높은 음수량을 보였지만 양군간에 체중의 차이는 보이지 않았다. 2) 각각의 실험 동물군 내에서 risperidone 0.1㎎ 투여군은 약물 투여 2주부터 3주까지 기저치 음수량과 비교하여 유의한 저하를 보였다. Risperidone 0.5㎎ 투여군은 약물터여 3주에서 기저치의 음수량과 비교하여 유의한 저하를 보였다. Fluoxetine 투여군은 약물 투여 시작 1주부터 3주에서 기저치의 음수량과 비교하여 유의한 저하를 보였다. 한편, haloperidol 투여군과, vehicle은 3주간에 걸친 약물 투여에서 각각의 기저치 음수량과 비교하여 차이를 보이지 않았다. 3) 실험 동물 각 군간에 약물 투여 시간 경과에 따른 음수량을 비교한 바, 약물투여 1주에서 각 군간에 유의한 차이는 없었다. 약물 토여 2주에서 fluoxetine 투여군, risperidone 0.1㎎ 투여군, 그리고 risperidone 0.5㎎투여군이 haloperidol 투여군과 비교하여 유의한 차이를 보였다. 약물투여 3주째에 fluoxetine투여군, risperidone 0.1㎎ 투여군, 그리고 risperidone 0.5㎎투여군이 haloperidol 투여군, vehicle과 비교하여 유의한 음수량의 저하를 보였다. 결 론 : 백서의 강박 행동은 fluoxetine, risperidone에 의해 효과적으로 억제되었으나 haloperidol에는 반응이 없었으므로, 임상에서 난치성 강박장애의 치료에 비정형 항정신병 약물 투여를 고려해 볼 수 있다고 제안한다. Objectives : This study was designed to evaluate the effects of risperidone on the schedule-induced polydipsia(SIP) which is one of animal model of obsessive-compulsive disorder in rats. We administered risperidone as a serotonin and dopamine blocking agent, fluoxetine as a selective serotonin reuptake inhibitor, and haloperidol as a dopamine antagonist to rats which showed schedule-induced polydipsic behaviour. Methods : Sprage-Dawley rats weighing 200∼250gm were individually housed and maintained and allowed free access to water. The rats were placed on a restricted diet. To induce polydipsia, rats were placed in the cage where a pellet dispenser automatically dispensed 90㎎ pellets on a fixed-time 60 seconds(FT 60s) feeding schedule over 150 minute test session per day. Water was available at all times in the cage. After 4 weeks of daily exposure to the FT 60s feeding schedule, experimental rats met a predetermined criterion for polydipsic behavior(greater than 3 times of water per session on average). 5 groups of rats were administered risperidone(0.1㎎/㎏, i.p), risperidone(0.5㎎/㎏, i.p), fluoxetine(5㎎/㎏, i.p), haloperidol(0.1㎎/㎏, i.p), and vehicle(1㏄/㎏, i.p) for 3 weeks. The rats were tested once a week to access schedule induced polydipsic behavior. Water bottles were weighed before and after the 150-minute test session. The chronic effects of administration of experimental drugs on schedule induced polydipsic behavior were analyzed with ANOVA and Scheffe test as a post-hoc comparison. In order to measure water consumption in non-polydipsic food-deprived rats, a separate group of rats(N=8) was individually housed and given a single bolus(14.5gm) of food per day which maintained them at their average body weight. Results : The results were as follows ; 1) After 4 weeks of scheduled feeding procedure, the experimental group showed significant differences than the bolus control in the amount of water consumption as compared with their average water intakes for 4 weeks. At the same periods, there were no differences between the experimental group and the bolus control in the body weight. 2) The fluoxetine group showed significant decrease in the amount of water intake at 1st, 2nd, and 3rd weeks of drug treatment as compared with their average amount of polydipsic water intakes. The risperidone 0.1㎎ group and the risperidone 0.5㎎ group showed significant decrease in the amount of water intake at the 3rd weeks of drug treatment as compared with their baseline of polydipsic water intakes. However, the haloperidol group and the vehicle control group showed no changes of amounts of water intake for 3 weeks of treatment as compared with their baseline of polydipsic water intakes. 3) The fluoxetine group(22.5±10.4ml) showed significantly lower amounts of water intake than haloperidol group(41.3±7.1ml) at 2nd weeks of drug treatment. And also the fluoxetine group(18.8±3.5ml) showed significantly lower amounts of water intake than the haloperidol group(35.0±11.7ml) and the vehicle control(34.4±6.8ml) at 3rd weeks of drug treatment. The risperidone 0.1㎎ group and the risperidone 0.5㎎ group showed significantly lower amounts of water intake than the haloperidol group(35±11.7ml) at 2nd weeks and the vehicle control(37.5±12.5, 34.4±6.8ml) at 2nd and 3rd weeks of drug treatment. Conclusions : Above findings suggest that the fixed time feeding procedure for schedule induced polydipsia could be applied as an effective animal model of obsessive compulsive disorder for the evaluation of pharmacological challenge study. We confirmed that chronic treatment with risperidone revealed antipolydipsic effect as effective as fluoxetine on the schedule-induced polydipsic behaviour but the onset of effect was later than fluoxetine.

60세 이상 환자의 척추수술

윤석만,이경석,도재원,배학근,윤일규 순천향의학연구소 2001 Journal of Soonchunhyang Medical Science Vol.7 No.1

Objective: Advances in surgical technique, anesthesia and perioperative patient management, coupled with the rapid increase in the population of patients reaching their 60s or older, have led to a signiticant rise in spinal precedures. The objective of this study was to evaluate frequency of the disease, surgical results and postoperative complications of the aged patients who underwent spinal surgeries. Methods : We reviewed all spinal procedures for spinal lesions including degenerative diseases, trauma, tumor and others in patients aged 60 years or older between January 1 1994 and October 1 1998(56 men and 26 women), retrospectively. Final outcome was assessed by telephone interview with the patient or the family in 67.1%(55/82). Results : There were 56 male patients and 26 female patients. There were 57 cases of degenerative diseases, 14 cases of trauma, 5 cases of metastaisis, 4 cases of infection and 2 cases of others. According to the level of surgical procedures, there were 20 cases fo cervical spine, 8 cases of thoracic spine, 54 cases of lumbar spine. Postoperaive complications included the following(17/82): 7 dural tears, 2 sepsis, 2 nerve root injury and 6 others. There were no operation-related deaths. During follow up period, ten patients(12.2%) had died, 45 patients(54.9%) were contacted and 27 patients(32.9%) could not be located. Mean follow up period for the 45 patients contacted was 26.1±15.7 months. Of the 45 persons contacted, 34(75.6%) reported improvement, 6(13.3%) no change and 5(11.1%) aggravation of their preoperative symptoms. Conclusion: Spine surgery in patients aged 60 years or older has higher complication rate compare to the younger but it is reasonable to consider the surgical procedures even in the elderly if it is needed. We should give attention not to tear the dura during the surgical procedures, especially in the elderly.

타타늄의 열처리 조건에 따른 동전위 양극분극특성 및 표면 미세구조 변화

주동현,이용렬,정영화,양홍서,박상원,이도재,송호준,박영준 大韓齒科器材學會 2002 대한치과재료학회지 Vol.29 No.2

The corrosion resistance of metallic implants is essential for successful implant osseointegration. Moreover, the implant surface should have appropriate surface roughness for the attachment of the osteoblast and collagen fibrils. When titanium is exposed to air a thermodynamically very stable oxide film is formed at once. This oxide is very thin and yet it protects the metal from corrosion instantaneously. However, the oxide would not be ideal, and it would be supposed that the state of oxide film would be various by the different conditions when it is formed. The objective of this study was to evaluate the electrochemical properties and surface microstructural changes of titanium after passivation treatment or exposure to high heat (in vacuum or in air). ASTM grade 2 commercially pure titanium (Ti) disks of 10㎜ diameter were wet ground and polished with 240 and 600 grit SiC, and then ultrasonically cleaned with distilled water and ethanol. Cleansed as-received samples (As-R group) were passivated with 30% nitric acid solution at 50℃ for 15 minutes to make the Pas group. The Std-V samples were made by treating the Ti disks in vacuum quartz tube (10^-8 Torr) at 530℃ for 40 min for stress relieving, followed by annealing at 700℃ for 90 min, and then slow cooling to room temperature. The Std-A samples undergo identical procedure as the Std-V group except that it is done in air. For 530℃-V samples, Ti disks were heated at 530℃ for 40 minutes and slow cooled to room temperature. The 1000℃-V samples were produced by heating Std-V specimens again at 1000℃ for 2 hr, followed by cooling to room temperature. 530℃-A and 1000℃-A samples were also prepared. Potentiodynamic anodic polarization measurement, SEM, AFM and XRD analysis were performed to evaluate the effects of the various treatments. The difference in the mean values of E_corr between groups showed statistically significant difference (P<0.05), but that of I_corr did not show significance (P>0.05). When Ti surface was passivated there was a shift of corrosion potential (E_corr) in the noble direction and a lower corrosion current density (I_corr) value. Std-A samples showed most noble E_corr value among the tested groups. 530℃-V samples showed more noble E-corr than other tested groups except Std-A group. 1000℃-V samples showed more noble E-corr than those of Std-V sample. In the case of Std-, 530℃- and 1000℃-groups, -A sub-groups showed better corrosion resistant characteristics than -V sub-groups in regard to E-corr and I_corr values. In the SEM observations, the surfaces of the As-R samples showed only scratch line on smooth surface. In Pas samples, thick oxide layer covered the surface under high magnification observation. 530℃-A samples were covered by oxide granules, and Std-A samples had 25~50 nm-thick acicular oxides. The 1000℃-A samples were covered by coarse oxide crystals with a granule diameter of 0.1~0.6 μm having a gross appearance of milky white color, which was identified by XRD as a rutile. On the other hand, 1000℃-V samples showed an Widmansta¨tten structrue of which the orientation of the lattice is formed along crystallographic planes of the parent crystals. On the AFM observation, 530℃-A samples showed RMS roughness of 79.38 nm which is 5 times rougher than those of the As-R samples. Std-A sample had a roughness of 330.47 nm which is about 20-times rougher than that of the As-R sample. 1000℃-A samples were covered by coarse granular oxides and the roughness were about 0.56 μm. Vacuum sub-group samples showed a more smooth surface than air sub-group samples, and the oxide film was more dense. Due to variability of the surface treatment and heat treatment conditions, the process of the oxide formation seems to be affected thereby making the corrosion properties and surface micro-morphology different. However, more various electrochemical analysis together with surface analysis, and an investigation for the effects of those on the osteoblast cell adhesion and calcium phosphate apposition are needed for the improvement of the osseointegration rates of the titanium implants.

치과용 갈륨합금의 조성변화가 부식 및 기계적특성에 미치는 영향

박영준,이용렬,이도재,Norling, Berry K,Rawls, H Ralph 대한치과기재학회 2001 대한치과재료학회지 Vol.28 No.2

This study was performed to evaluate the effects of compositional variations of dental gallium alloys on their corrosion and mechanical behaviors. 60Ag-28Sn-12Cu wt% (ST group) was prepare by atomization. ST-Pd and ST-Pt groups were prepared by substituting part of tin (Sn) with Pd (2 wt%) and Pt (0.05 wt%), respectively. Low-and high-copper amalgam alloys (LCA and HCA) were also prepared by atomization method for comparison. Alloy powders of each group were mixed with liquid gallium alloy that was composed of 61.98Ga-24.99In-12.98Sn-0.05Bi wt%. Specimens were made according to ADA specification no. 1. Corrosion behavior was evaluated by potentiodynamic anodic polarization test together with X-ray diffractometry (XRD), and scanning electron microscopy/energy dispersive spectroscopy (SEM/EDS). 24 hour-compressive strengths and dimensional changes were measured. Following results were obtained. ST-Pd group showed most anodic behavior with the corrosion potential (E□) of-707 mV (vs. SCE), which is a significant shift in the noble direction from the -883 mV(vs.SCE) of the ST group (p<0.05). Among the specimens of St-Pd group, one specimen even had an E□ of -580 mV showing pronounced improvement in corrosion resistance. LCA group showed the worst corrosion resistance, having E□ of -896 mV. Set specimens had multi-phase microstructures consisting of Ag9In4, CuGa₂, □-Sn, Ag□₂Ga₂□, AG₄Sn and Cu3Sn, and all the groups showed similar XRD patterns. Ag9In4 was the main reaction matrix phase showing strongest XRD peak. CuGa2 phase surrounded the unreacted powder particles. A mixture of light Ag9In4 phase and a dark gray Ga42.3-Cu17.1-Ag16.8-Bi0.2 wt% solid solution appeared in the intergranular layer. ST-Pd group required the shortest mixing time. The intensity of the Ag4Sn peak of unreacted powder was lower and peak intensity of Ag□Ga₂□ phase, which is more corrosion resistant, was higher when compared to that of ST group. Sn(Cu)-Cl corrosion products having various morphologies were formed on corroded specimen surfaces. ST-Pd group had lesser deposition of corrosion product compared to other groups. LCA group specimens corroded more than HCA group specimens. 27-hour ST-Pd group showed highest value compared to those of other groups (p<0.05). HCA group showed higher compressive strength compared to that of LCA group. 24-hour setting expansions were ST-Pd*****(0.24%)<<LCH(0.43%)<ST-Pt(0.51%) <ST(0.56%)<<HCA(1.33). ST-Pd group showed significantly lower setting expansion (p<0.014). HCA group having 28 wt% Cu in alloy powder showed 1.33% setting expansion value which is significantly higher than those of other groups (p<0.01). In summary, substituting 2 wt% palladium for 2 wt% tin in the alloy powder improved the corrosion resistance and compressive strength, and reduced the degree of setting expansion. High-copper content induced excessive setting expansion. This finding indicates that there is still room for further improvement of the corrosion resistance and mechanical properties of dental gallium alloys through composition modification. With furher research, there is still a possibility for gallium alloy to become a successful substitute for dental amalgam.

재발된 고혈압성 뇌실질내 출혈

배학근,정두신,도재원,이경석,윤일규 대한신경외과학회 1999 Journal of Korean neurosurgical society Vol.28 No.3

T1 강조 영상에서 선조체 고신호강도를 보이는 당뇨 환자에서의 편측무도증

정승철,이병철,김상윤,배재천,황성희,도화범,박종호 대한신경과학회 1997 대한신경과학회지 Vol.15 No.1

자발성 뇌지주막하 출혈 환자에서 최초 뇌실 크기의 임상적 의의

신일영,윤일규,윤석만,도재원,이경석,배학근,최순관,변박장 순천향의학연구소 2001 Journal of Soonchunhyang Medical Science Vol.7 No.1

The purpose of this study is to invesetigate the clinical significance of initial enlargement of ventricle in the patients who had aneurysmal SAH. Of the total 821 patients with aneursmal SAH who were registerd in SAH data bank system between 1989-1999, 307 patients who had been already measured in the size of ventricle at the time of admission, were studied retrospectively. The size of ventricle was calculated by bifrontal index. Normal size of ventricle was defined as 30% or less, mild enlargement was defined as 31 to 39%, and moderate enlargement of vertricle was defined as more than 39% in bifrontal index. The sizes of ventricle using bifrontal index were analysed according to the age, sex, blood pressure, consciousness at admission, medical history of hypertension, location of ruptured aneurysm, Fisher's grade on CT(computerized tomography) scan at the time of admission, cerebral vasospasm, intraventricular hemorrhage (IVH), performance of external ventricular drainage (EVD), and prognosis at discherge. Chi-square test and ANONA were used in the statistical evaluation. The results were as follows : 1) Of the 307 patients, 235(76.5%) had a mild to moderate enlargement of ventricle at the time of admission (more than 30% in bifrontal index). 2) The size of ventricle was enlarged according to the increase of age (p<0.05). 3) In the patients who had ruptured aneurysm on anterior cerebral artery, the size of ventricle significantly increased and showed a higher incidence in mild enlargement compared with moderate enlargement of ventricle (p<0.05). 4) The size of ventricle increased in th patients who had IVH and the EVD was more frequently performed in th patients who had the enlarged ventricle associated with IVH (p<0.05). 5) In the patients who had high Fisher's grade, the size of ventricle had a tendency to increase, but there was no statistical significance. 6) In the patients who had poor prognosis, the size of ventricle had a tendency to increase, but there was no statistical significance. Conclusively, the initial size of ventricle was enlarged in th aged patients, ruptured aneurysm on anterior communicating artery, high FIsher's grade, patients associated with IVH. Considering those factors, prediction for the enlargement of ventricle size may help to treat the patients suffering aneurysmal SAH.