완전 방실차단을 동반한 급성 심근염

이유선,정진옥,박용규,박형서,노상필,정승현,김정희,이재환,최시완,성인환 충남대학교 의학연구소 2003 충남의대잡지 Vol.30 No.2

급성 심근염환자에서 발행한 완전 방실차단을 영구 심장박동 조율기로 치료한 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Myocarditis, an inflammatory process involving the myocardal wall, may be caused by most infectious agents. Irrespective of its etiology, it presents commonly with evidence of heart failure, hypotension, and various electrocardiographic abnormalities. Patient with myocarditis may be asymptomatic or may have a rapidly progressive fatal disease. Medical management of patients with myocarditis includes specific therapy for underlying infection and control of the complication of myocarditis such as congestive heart failure and arrhythmia. Recently we had experienced myocarditis with complete atrioventricular block in 37-year-old man. Although he had shown complete recovery of heart failure, he had shown complete atrioventricular block, so we inserted permanent pacemaker. We report it with review of the literature.

혈액 투석 환자에서 중심정맥 협착에 대한 스텐트 삽입술 : Wallstent Placement

임대승,노상필,이유선,정승현,김보영,이정우,강정아,김정희,이민수,정준용,최시완,정진옥,성인환,이강욱,신영태 충남대학교 의과대학 의학연구소 2002 충남의대잡지 Vol.29 No.1

Stenosis of central vein is a common complication arising after percutaneous subclavian vein catheter insertion performed for temporary vascular access in chronic renal failure patients undergoing hemodialysis. There are several treatment methods for the condition like percutaneous angioplasty(PTA), stent insertion, and surgery, but recent trend is toward PTA and stents. Among the patients diagnosed with chronic renal failure from March 1993 to May 2002 and undergoing hemodialysis through AV fistula, the 14 Patients in whom central vein stenosis arose were selected for the study. A total of 28 percutaneous interventions(5 PTA and 23 stent placement) were performed, and restenosis rate and the time taken till the restenosis in de novo lesions and instant lesions were compared. All 28 cases were operated successfully. The 14 cases that received both anigioplasty and stent placement initially. (de novo lesion : 14 cases), Among the 10 cases with de novo lesion that followed up more than 1 year, 3 cases are currently undergoing hemodialysis without restenosis, and the remaining 7 cases have recurred stenosis with the mean time to restenosis of 10.9 months. In the 7 cases in whom stenosis recurred, 11 interventions were done(instent lesion: 11 cases). 4 of these were using only ballon angioplasty with 100% restenosis rate and the mean time of 3 months until restenosis. The remaining 7 cases were using both balloon angioplasty and stent placement, also with 100% restenosis rate but with the mean time of 12 months until restenosis, which was later than the group receiving only balloon angioplasty. In treating the patients with central vein stenosis, stent placement seems to be more advantageous over PTA in terms of restenosis rate and the mean duration of patency. In the case of instent lesion, inserting the stent for the second time after stenosis recurred lengthened the duration of patency compared to performing balloon angioplasty alone.

관상동맥 질환에서 SDF-1α의 농도

김보영,박용규,박형서,노상필,정승현,이유선,이정우,이재환,최시완,정진옥,성인환 충남대학교 의과대학 의학연구소 2003 충남의대잡지 Vol.30 No.1

Atherosclerosis is now viewed as an inflammatory disease of the vascular system. Expression of several chemokines, including monocyte chemoattractant protein(MCP)-1, MCP-4, RANTES(regulated on activation normal T-cell expressed and secreted), and interleukin-8(IL-8) are increased in human atherosclerotic plaques compared with normal vessels. They are involved in the pathogenesis of atherosclerosis and plaque rupture by activating and directing leukocytes into the atherosclerotic lesions. However, some are involved in homeostatic functions such as normal leukocyte traffic and growth regulation. SDF-la is a multi-functional cytokine that is involved in myelogenesis, hematopoiesis, angiogenesis and injured gastric mucosal regeneration in the gastric ulcer patient. SDF-la is recently shown to be highly expressed in atherosclerotic plaques and a potent platelet agonist. At least in high concentrations, SDF-la may mediate antiinflammatory and matrix stabilizing effects in unstable angina. Many studies are going on to know the function of SDF-la in coronary artery diseases. I investigated the difference of the plasma level of SDF-la between control group and coronary artery disease group. Total 75 subjects were enrolled. The diagnosis of coronary artery disease was confirmed in all patients by coronary angiography. Control subjects in this study were confirmed normal by coronary angiography. Clinical profile and risk factors were also reviewed. Control subjects in this study were 27 (M=10, F=17). Plasma for the study was collected before the angiography and centrifuged. SDF-la analysis was performed by ELISA. Plasma level of SDF-la is significantly increased in patients with stable angina(n=20) and unstable angina group(n=28) compared with healthy control group(n=27). the risk factors do not influence the plasma level of SDF-la in coronary artery diseases. In this study, plasma level of SDF-la is increased in patients with stable angina and unstable angina groups compared with healthy control group(P<0.05). the risk factors do not influence the plasma level of SDF-la in coronary artery diseases.

항파상풍 톡소이드 주사후 항파상풍 항체 역가

이한식,하영록,구홍두,장석준,심호식,김승환,이정운 대한응급의학회 1996 대한응급의학회지 Vol.7 No.2

Objective : Tetanus decreased in prevalence since the systemic vaccination began in 1940s. Despite of the improvement in treatment like critical care with ventilatior or antibiotics, the mortality rate resides around 45%. Currently the tetanus prevention protocol recommends immunization in infancy and boosters every tenth years. Thereafter the immunization with toxoid only or toxoid plus immunoglobulin injections is recommended according to the type of injury. In most of ED in Korea, only tetanus immunoglobulin is given without any basis. Previously we proved the effect that passive immunization with the immunoglubulin 250 IU last long for only a month. At this time we measured the effect of the active immunization with toxoid and its effect was compared to the effect of the tetanus immunoglobulin to find out the logical tetanus prevention after an injury. Method: 20 healthy adult volunteers were injected with tetanus toxoid and their anti-tetanus antibody titers measured before the injection, 1 week and 4 weeks after the inection. No volunteers have taken any medication for chronic illness(e.g. hepatits, tuberculosis) or had an tetanus immunization or booster in the last 6 months. Antibody titers were measured by IMMUNOZYM??-TETANUS and t-test was performed on the results, Results: 1. Total 20 volunteers(12 males and 8 females) were participated. 2. Subjects` ages were 21 to 44 years old and there were no relevance to the antibody titer. 3. The antibody titers of before the anti-tetanus toxoid injection and 1 week, 4 weeks after the injection revealed significant difference and the antibody titers of the first and the forth week after the injection also showed a significant difference. Conclusion: Currently in Korea, the tetenus immunoglobulin 250 IU given alone as tetanus prevention was injected, but it did not elevate the anti-tetanus antibody titer for 4 weeks where as tetanus toxoid injected intramuscularly did significantly. Therefore, tetanus toxoid should be given on the dirty injuries with additional tetanus immunoglobulin injection to accomplish the correct method of tetanus, tetanus toxoid prevention.

췌장암 환자에서 알코올 내장신경 신경파괴블럭 후 발생한 간염

이상은,최석환,김영환,임세훈,이정한,이근무,정순호,최영균,김영재,신치만 인제대학교 2008 仁濟醫學 Vol.29 No.-

Splanchnic neurolytic block(SNB) with alcohol improves the management of pancreatic cancer pain. Adverse effects of alcohol SNB which include regional pain, hypotension, diarrhea, and acute alcohol intoxication are common, but acute hepatitis caused by alcohol neurolytic block is rare. A 63-year-old patient with pancreatic head cancer and liver metastasis had complete pain relief after both retrocrural tansdiscal SNB with 100% alcohol 10 ml. But, 1 day later, liver function test showed a high elevation in the aspartate aminotransferase (AST, 2182 IU/L) and alanine aminotransferase (ALT, 1807 IU/L). The patient had slight jaundice, general weakness, chilling, nausea and vomiting after SNB. Both AST and ALT decreased to 46 and 119 IU/L within 10 days with only supportive therapy. But, 19 days later, the patient died due to pneumonia. Our case illustrates the importance of clinical surveillance especially in patient with hepatic disease after alcohol SNB.

요배부 수술 실패 증후군에서 자기공명영상의 이용

이준규,안재성,권순태,김환정,정제택 충남대학교 의과대학 지역사회의학연구소 1997 충남의대잡지 Vol.24 No.2

This study was compared pre-operative MRI finding with operative finding on 36 cases with the failed back surgery syndrome (FBSS) retrospectively. The purpose of this study was to determine the accuracy of the MRI on the FBSS including early complications such as hematoma of infection. Of the 51 patients with FBSS, we analyzed pre-operative MRI finding compared with operative finding on 36 cases excluding nonunion, instability, metal failure and pseudoarthrosis who underwent an operation for the FBSS from December 1994 to June 1997. There were 25 men (69.4%) and 11 women (30.6%), aged from 16 to 68 years (average 43.6 years). These were divided into 5 sub-groups and calculated sensitivity, specificity and positive predictability. MRI accuracy in recurred disc was 84%, scar adhesion, recurred or developed stenosis, infection and hematoma 100% each and all, overall accuracy of the MRI 93%, respectively. Average interval of re-operation in FBSS WAS 4.3 years. In the 18 cases (50%), symptoms persist without pain-free interval after first operation. Early complications including hematoma and infection are easily detected with MRI. Especially if patient complains of severe leg pain or neurologic deficit, it is a good diagnostic procedure to check the MRI. The MRI is a useful method for evaluation of most cases of the FBSS, but it has limitations to evaluate recurred disc or scar adhesion only in T1, T2 weighted image. Therefore Gd-DTPA enhancement is necessary for the accurate diagnosis.

중학교 과학 수업에서 협동을 위한 협동학습 모형의 적용 방안 연구

김인환,이승민,차정호 대구대학교 2006 대구대학교 학술논문집 Vol.1 No.2

과학 수업을 더욱 의미 있는 학습 경험으로 구성하기 위해서는 학생들의 능동적인 수업참여와 활발한 토의를 유도할 수 있는 교수-학습 전략이나 학습 환경에 대한 연구가 필요하다. 우리나라에서는 다양한 협동학습 방법이 소개되었으나 과학과에 적용된 수업 모형으로는 STAD, LT, Jigsaw, 등에 국한되어 있는 것으로 나타나고 있다. 따라서 과학과 수업에 적용해 볼 수 있는 좀 더 변화된 수업 모형 적용에 관하여 연구해 볼 필요가 있다. 본 연구에서는 학생들 사이의 협동기술을 증진시킬 수 있는 과학과에서의 새로운 협동학습 모형으로 협동을 위한 협동학습(Co-op Co-op)모형을 선정하여 적용가능성을 탐색해 보고 일선 교육 현장에서 곧바로 활용할 수 있는 교수-학습 자료를 개발하고자 하였다. 이 수업 모형이 중학교 과학과에 적합한지, 중학교 교과 수업에 적합한지, 중학교 교과에 적용시 기대되는 효과는 어떠한 것들이 있는지에 관하여 검토하였으며, 중학교 과학1 교과 '물질의 세가지 상태' 단원을 적용시켜 6차시 분량의 수업지도안과 탐구 활동지를 개발하였다. 협동을 위한 협동학습(Co-op Co-op)모형은 교사들이 교단에서 쉽게 적용할 수 있는 수업 모형으로 적절히 사용한다면 과학 수업에서 결여된 협동성과 사회성이 가미되어 과학과 탐구 실험 활동에서 보다 나은 참여와 효과적인 수업이 될 수 있다고 생각된다. 본 연구에서는 중학교 교과에서 협동을 위한 협동학습(Co-op Co-op)모형의 적용가능성을 검토했지만, 더 나아가 고등학교 교과에 적용 시킬 수 있는 연구도 요구된다. A study is needed on strategies or learning environment to form science classes as meaningful learning experience. In our country, various methods of cooperative learning have been introduced, but learning models applied in the science subject are limited in STAD, LT, Jigsaw, etc. Thus, it is neccessary to study application of more changed learning models for science classes. In this study, Co-op Co-op model was selected as a new cooperative learning model to promote cooperative technique between students in the science subject and its applicability was examined. Based on this process, this study purposed to develop teaching-learning material which can be directly used in the educational field. Accordingly, whether this learning model is suitable to the science subject of middle school was examined. Laying emphasis on whether Co-op Co-op model is fit for the science subject and classes of middle schools, and what effects are expected when it is applied in subjects of middle schools, a study and an analysis were conducted and teaching plan, research activity sheet and assessment sheet of the sixth session were developed by applying it in the unit of "three states of material" of the science subject of middle schools. Co-op Co-op model should be conducted with a class model which is fit for our actual situations and the most suitable to students, and teachers easily apply in the class instead of applying cooperative learning in science classes unconditionally. If this is implemented, cooperation spirit and sociality that science classes lack in are added and it is expected that better participation and effective learning are performed in experimental activity. In this study, applicability of Co-op Co-op model was examined only in subjects of middle schools, alternative plans are demanded to apply it in subjects of high schools.

국내선 항공여객교통 수요예측

김경환,이정호 慶尙大學校生産技術硏究所 1996 生産技術硏究所論文集 Vol.12 No.-

The purpose of this study is not only to establish models and methods for forecasting the demand of domestic air transportation passengers but also to provide useful data for forecasting the demand of air passengers through statistical test. The first step of this study was analyzing the demand of air passengers by using the gravity and the abstract models that generally used for city-pair travel demand studies. The second step was analyzing the demand of air passengers by using the multinomial logit model that calculates the split rate of each mode by using travel service variables. And the estimated air passengers by these models and the observed air passengers were compared. The third step was estimating the changed modal split that caused by introducing the High Speed Rail. In order to estimate the change, the Pivot-Point Method was applied. The results of this study are as follows: - The statistical significance of the gravity model is not high enough. - The statistical values of the abstract and the logit models are significant, but the logit model is more realistic than the abstract model, based on estimated values. - It is estimated that the air passengers of Seoul-Pusan and Seoul-Taegu routes may be decreased by 88% and 90% respectively by introducing the High Speed Rail.

Prostacyclin synthase 유전자의 C1117A 다형성과 이형협심증과의 관련성

성인환,임대승,김정희,이재환,최시완,정진옥 대한내과학회 2004 대한내과학회지 Vol.66 No.4

목적 : Thromboxan A2의 혀관수축반응을 저해하는 prostacylin synthase exon 8 C117A의 변이가 관동맥 연축과 관련성이 있는지를 알아보고자 하였다. 방법 : 1998년 1월 1일부터 2000년 12월 31일까지 충남대학교병원 순환기내과에서 관동맥조형술과정맥내 에르고노빈 유발검사를 시행하여 관동맥 연축이 확진된 이형협심증 환자군(45예)과 정상 대조군(59예)을 대상으로 중합효소 연쇄반응법 및 restriction fragment length polymorphism을 이용하여 분석하였다. 결과 : Prostacyclin synthase exon 8 C117A 유전자형의 빈도는 대조군에서 A/A : A/C : C/C =3.4% : 30.5% : 66.1%, 이형협심증 환자군에서 A/A : A/C : C/C = 8.9% : 42.4% : 48.9%로 두 군간에 유의한 차이가 없었다. 대조군에 비해 변이형 협심증 환자군에서 남자의 비율과 흡연률이 높았지만, prostacyclin synthase exon 8 C117A 유전자형에 따른 군에서 당뇨병, 고혈압, 흡연, 고지혈증, 비만 등의 유의한 차이는 없었다. 결론 : 한국인에서 prostacyclin synthase exon 8 C117A 유전자 다형성과 관동맥 연축이 있는 이형협심증과의 유의한 연관성은 발견할 수 없었다. Backround : Coronary artery spasm plays an important role in the pathogenesis of variant angina(VA). Prostacyclin is one of the endothelium derived relaxing factors. The association between the novel single nucleotide polymorphism in the prostacyclin synthase gene and VA is not known. Therefore, we investigated the association between VA and the polymorphysm in the prostacyclin synthase gene. Methods : We compared 45 variant angina patients who had positive intravenous ergonovine test by coronary angiography with 59 control subjects who had negative intravenouis ergonovine test and normal coronary angiogram. Using the polymerase chain reaction-single-strand conformation polymorphism analysis, we identified a single nucleotide polymorphism, C117A, in exon 8. This nucleotide change did not cause an amino acid change in codon 373. Results : There was no significant difference in characteristics between the control group and the VA group, and there was no significant difference in the genotype distributions between the control group and the VA group. Conclusion : The C117A polymorphism in exon 8 of the prostacyclin synthase gene is not associated with variant angina.

일부 농촌지역 여성들의 혈청지질치와 관련요인에 대한 조사

임정환,조영채,이동배 한국농촌보건회 1997 농촌의학·지역보건 Vol.22 No.1