이행성 협심증 환자에서 운동부하 심전도 검사

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

목적 : 관상동맥의 경련에 의한 이형성 협심증환자에 있어서 운동부하 심전도 검사의 결과는 매우 다양하다. 이에 저자들은 충남대학교병원 순환기내과에서 관상동맥조영술상 이형성 협심증으로 확진된 환자를 대상으로 운동부하 심전도 검사를 시행하여 이에 대한 결과를 연구하였다. 방법 : 1995년 1월부터 2002년 3월까지 흉통을 주소로 충남대학교병원 순환기 내과에 입원하여 관상동맥조영술을 시행하여 관상동맥의 내경이 50% 미만의 협착이 있고, 에르고노빈(ergonovine) 유발검사도 이형성 협심증으로 진단을 받은 233명중 운동부하 심전도 검사를 시행 받은 183명의 환자를 연구 대상으로 하였다. 운동부하 심전도 검사 결과의 판독시 발생할 수 있는 오류를 줄이기 위해서 운동부하 심전도 검사를 시행하기전 심전도상 ST분절의 상승(5예)이나 하강(8예)이 있는 경우 EH한 T파의 역위(19예)가 있는 32명의 환자를 제외한 총 151명의 환자를 대상으로 하였다. 운동부하는 Marquette사의 case 15 답차를 이용하였고, Bruce protocol에 따라 증상이 나타날 때까지 최대로 실시하였으며 각 stage 및 운동후의 혈압을 측정하고 12 유도 심전도를 기록하였다. 결과 : 1) 임상적 특성 - 내원시 임상 상은 안정형 협심증이 39예(25.8%), 불안정형 협심증이 103예(68.2%), 심근경색증이 9예(6.0%)이었다. 운동부하 심전도 검사 결과 양성 군과 음성군간에 있어서 당뇨병, 고혈압, 비만도, 총 혈청콜레스테롤치, 현재의 흡연 여부, 병력상 운동시 흉통의 유무, 내원시 임상적 진단, 협착의 정도, 연축의 수 등을 조사하였는 바 어떠한 인자들도 유의한 차이를 발견할 수 없었다. 2) 운동부하 심전도 검사 - 운동부하 심전도 검사를 시행 받은 151명의 환자중 음성인 경우는 134예(88.8%)이었고, 양성인 경우는 17예(11.2%)이었다. 양성 소견을 보인 환자들중 ST 분절의 상승이 4예(2.6%), ST 분절의 하강이 13예(8.6%)이었다. 3) 관상동맥조영술 - 관상동맥조영술상에서 혈관 경력 위치는 우관상동맥이 70예(46.1%), 좌전하동맥이 44예(28.9%), 좌회선동맥이 17예(11.2%)의 순으로 나타났다. 운동부하 심전도 검사상 ST 분절의 상승이 있었던 예중 Ⅱ, Ⅲ, aVF에서 ST 분절의 상승이 있었던 1예는 관상 동맥조영술상 우관상동맥에서 경련이 발생하였고, V2-V4에서 ST 분절의 상승이 있었던 2예중 관상동맥조영술상에도 좌전하행동맥에서 경련이 나타난 예는 1예이었으며 다른 1예는 좌회선동맥에서 경련이 나타났고, V5-V6에서 ST 분절의 상승이 있었던 1예는 관상동맥조영술상에도 좌회선동맥에서 경련이 나타났다. 운동부하 심전도 검사상 V5 또는 V6에서 ST 분절의 하강이 있엇던 13예중 6예(46.1%)는 관상동맥조영술상 우관상동맥에서 경련이 발생하였고, 3예(23.1%)는 좌전하행동맥에서, 1예(7.7%)는 좌회선동맥에서, 나머지 3예(23.1%)는 2개의 혈관이나 기타 분지에서 경련이 발생하였다. 결론 : 1) 이형성 협심증 환자는 운동부하 심전도 검사에서 11.2%의 양성소견을 보였다. 이중 ST 분절의 상승은 2.6%이었고, ST 분절의 하강은 8.6%이었다. 2) 이형성 환자중 운동부하 심전도 검사를 실시하여 음성을 보이는 경우 다혈관 관상동맥질환이기 보다는 이형성 협심증일 가능성이 더 높다고 예측할 수 있을 것으로 생각된다. 3) 이형성 협심증 환자중 운동부하 심전도 검사를 실시하여 ST 분절의 상승을 보이는 경우 다혈관 관상동맥질환이기 보다는 이형성 협심증일 가능성이 더 높다고 예측할 수 있을 것으로 생각된다. 4) 운동부하 심전도 검사 결과에 대한 당뇨병, 고혈압, 비만도, 총 혈청콜레스테롤치, 현재의 흡연여부, 병력상 운동시 흉통의 유무, 내원시 임상적 진단, 협착의 정도 등 어떠한 인자들도 3그룹(ST 분절의 상승, ST 분절의 하강, 음성)간에 유의한 차이를 발견할 수 없었다. 5) ST 분절의 상승 부위와 관상동맥조영술상 관상동맥의 연축이 일어나는 혈관과의 상관관계는 매우 높았다. No reports in the literature describe the results of exercise testings in a large number of patients with pure variant angina(coronary stenosis <50%) in Korea. In this report, We present the results of treadmil exercise testing in 151 patients with variant angina. 151 patients with angiographically proven coronary artery spasm underwent a treadmil exercise test. The clinical characteristics of variant angina patients classified according to ST-segment response to exercise were analyzed. Of 151 patients underwent a treadmil exercise test, negative result was seen in 134 patients(88.8%) and positive result was in 17 patients(11.2%). Of 17 patients saw positive result, exercise-induced ST segment elevation was present in 4 patients(2.6%) and ST segment depression was seen in 13 patients(8.6%). There was not a significant relationship between the ST segment response to exercise and the clinical variables(diabetes, hypertension, obesity, total cholesterol, current smoking, effort angina, clinical diagnosis, and degree of stenosis) assessed. Of 4 patients with ST segment elevation in treadmil exercise test, 1 patient with ST segment elevation in Ⅰ,Ⅲ,aVF had spasm in right coronary artery(100%) on coronary angiography, of 2 patients in V2-V4 had spasm in left anterior descending coronary artery in 1 patient(50%) and 1 patient in V5-V6 had spasm in left circumflex artery(100%). Positive treadmil exercise test was present in 11.2% of variant angina patient. If we have negative treadmil exercise result in patients with clinical manifestation of unstable angina at admission, we may have a suspicion of variant angina rather than multi-vessel disease. If we have exercise-induced ST segment elevation in patients with clinical manifestation of unstable angina at admission, we have a suspicion of variant angina rather than multi-vessel disease. Our result suggests that the correlation between the site of the ST segment elevation and the artery involved is quite good.

삼탄(三灘) 이승소(李承召) 제화시(題畵詩)의 형상화(形象化) 양상 -화의(畵意)의 표현방법을 중심으로-

이정규 ( Jeong Gyu Lee ) 충남대학교 인문과학연구소 2012 인문학연구 Vol.39 No.1

이 논문은 15세기 관료문인의 일인으로 문명을 떨친 삼탄 이승소의 시세계를 탐색하는 일환으로 그의 제화시의 형상화 양상을 살펴본 것이다. 15세기는 제화시 창작이 가장 성행한 시기이며 삼탄의 제화시 또한 수적으로 상당히 많다. 또한 인물화에서 산수화에 대한 관심으로 서화에 대한 애호의 경향이 바뀌어가고 있으며, 그림의 가상성을 인식하고 이를 바라보는 시인의 내면에 관심을 돌리고 시인의 모습을 주제화하는 모습을 보이고 있다. 삼탄은 서화를 대할 때 그것의 眞·假에 함몰되지 않고 또 그것에 전념[留意]하는 것이 아니라 자유로이 뜻을 붙이는[寓意] 행위로 이해하며, 서화를 마음으로 보아 그것의 본질을 꿰뚫어 보는 태도를 견지하고, 그 안에서 정신적인 즐거움을 찾았던 것으로 보인다. 한 폭을 그림을 대하고 그것을 시로 재산출할 때는 그 대상에 따라 畵意를 유가적 관념이나 상징을 바탕으로 형상화하기도 하였으며 상상을 통해 혹은 자신의 주관적 해석에 따라 화의를 덧붙이기도 하였다. 그 가운데 화면을 묘사하면서도 화의를 주관적으로 재해석하는 제화시들은 삼탄의 개성이 더욱 드러나 있다. The Aspect of Configuration in the Titled Paintings by Yi Seung-so with the Pen Name of Samtan Lee, Jeong-gyu This thesis examines the aspect of configuration in the titled paintings by Yi Seung-so with the pen name of Samtan to explore the poetic world of the 15th-century courtier and man of letters. The period abounded more in titled paintings than in any other time period, and the poet produced a good number of them. The era`s preference in paintings was shifting from portraits to landscape paintings, while it recognized the virtual reality of a picture and gave attention to the interior topography of the poet observing it. It seems that as he faced a painting, Samtan wasn`t absorbed in its truth or falsehood. He did not focus on it(留意) but construed it as an allegorical act of freely attaching meanings (寓意). The poet appeared to maintain a stance of looking at a painting work with his heart to perceive its essence, while descrying spiritual joy in there. When he was faced with a piece of painting to reconfigure it as a poem, the poet configured the meaning of the painting based on the Confucian ideas or symbols, or added a meaning to the work through imagination or in his subjective interpretation. Of all his painting works, those applying subjective interpretation to their meaning demonstrate Samtan`s personality more distinctively.

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.

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.

중학교 가정교과의 열린교육 활성화를 위한 수업 모듈 및 웹 기반 교육자료 개발

신상옥,유태명,한규정,윤지현,홍정숙,김유정,양정혜 한국 가정과 교육 학회 2000 한국가정과교육학회지 Vol.12 No.3

This study is about open and secondary level Home Economics Education which is applicable to field and which includes the characteristics, purpose and problems of each open education. secondary education and home economics education. Based on the ideology of open education, this study will identify the meaning of openness in terms of Home Economics Education reconstructing meaning. purpose, characteristics, curriculum paradigm and curriculum. The instructional model and module which use web, will be Presented as the results of the reconstruction works. The open instructional module in Home Economics Education, which will be operated on the web, is consisted of 1)setting the orientation of curriculum development, 2)instructional model development. 3)rebuilding the Home Economics Education curriculum 4)development of instructional modules and web-based materials and 5)construction of the web-site . Six instructional module begin with critical/emancipatory curriculum Paradigm in open Home Economics Education. use module as a unit of class management instead of 1 class. facilitates nest-type integration which is applied from open education keeping the nature of Home Economics Education. and focus on practical problem and problem solving through reconceptualization with dialectical perspective on individual, family and society. The practical problem solving model has four steps : Identifying practical problems. Understanding the contexts of Problem, Searching for solutions and examining its consequences . Action and evaluation . The web-site has to be developed based on the six instructional module includes those issues : self-identification for reinforcing autonomy and self-esteem. living with famity. living with friends, autonomous living. healthy living, and understanding sexuality.

흑인종의 모세, Booker T. Washington

정찬규 진주산업대학교 1979 論文集 Vol.17 No.-

Booker T. Washington born to slavery between a Negro cook for the slaves working at a plantation, Virginia, and a nearby whiteman whose exact name was not clarified in 1858 or 1859, outgrew from his slavery with an impassioned desire to learn, acquired his own education with serious efforts, won his surroundings' confidence with his diligence and faithfulness, received recognition of his superb ability, got the whites' sympathy and co-operation with his self-sacrificing services to help others and a modest compromise against the whites' discrimination, brought substantial emancipation based on intelligence and economy through indispensable education for their fundamental necessity for the social promotion of the black people after the legal emancipation, and became a famous Negro Moses not only within the U.S.A. but throughout the world.

CFRP복합재료의 적층수와 드릴직경에 따른 가공 특성

정성택,박종남,조규재 한국공작기계학회 2003 한국공작기계학회 춘계학술대회논문집 Vol.2003 No.-

CFRP composite has a lot of merits such as mechanical characteristic, light weight, and thermal resistance. For these merits CFRP is applied to so many industrial area. In this paper, the relationship between the stack thickness and drill diameter is examined from the drilling experiment, which is the drilling of 16, 32, 48plies specimen with the φ8, φ10, φ12mm cemented carbide drill. The results are analyzed with consideration of cutting force, stack thickness and drill diameter.

CFRP복합재료의 적층수와 드릴직경에 관한 연구

정성택,박종남,조규재 한국공작기계학회 2003 한국생산제조학회지 Vol.12 No.6

CFRP composite has a lot of merits such as mechanical characteristic, light weight, and thermal resistance. For these merits CFRP is applied to so many industrial area. In order for the composite materials to be used in the air& structures or machine elements, accurate surfaces for bearing mounting or joints must be provided, which require precise machining. In this paper, the relationship between the stack thickness and drill diameter is examined from the drilling experiment, which is the drilling of 16, 32, 48plies specimen with the φ8, φ10, φ12mm cemented carbide drill. The results are analyzed with consideration of cutting force, stack thickness and drill diameter.

효소에 의한 꿩고기 가수분해물의 제조

정재홍,김기준,이규희,이석건,오만진 충남대학교 농업과학연구소 1998 농업과학연구 Vol.25 No.1

This studies was carried out to investigate the processing possibility of pheasant meat extracts treated with proteases. The crude protein, aminonitrogen, degree of hydrolysis, yield and amino acid composition of pheasant meat extracts when it was treated with proteases at various temperature and reaction time were analyzed. The crude protein contents of pheasant meat extracts processed in 130℃ were more than when it was done in 100℃, but the contents of aminonitrogen were not quite different between two processing temperature. The content of crude protein and aminonitrogen when pheasant meat was hydrolyzed with protease NP and prozyme A. The yields of pheasant meat extracts, when pheasant meat were treated at 100℃ and 130℃, were from 2.24 to 7.10% and from 5.51 to 10.45%, respectively. And the yield of extraction depended on extraction temperature, kinds of enzyme, amount of enzyme, extraction time. The content of aminonitrogen in pheasant meat extracts treated with enzyme was much higher than any other treatments. And it depended on amount of enzyme, extraction time and temperature. The amount of the amino acids in pheasant meat extracts treated by protease NP were eminently higher than by heat at 100℃ or 130℃.

동종 골수이식 후 만성 이식편대숙주질환과 동반되어 신증후군으로 발현된 IgA 신병증 1예

정철권,김현수,박준성,정성현,조도연,최진혁,남동기,임호영,김명성,신규태,임현이,김효철 대한조혈모세포이식학회 1999 대한조혈모세포이식학회지 Vol.4 No.2

동종 골수이식 후 발생하는 신기능부전은 원인이 다양하여 감별에 어려움이 있다. 만성 GVHD는 흉선의 기능저하에 따른 면역관용의 실패로 발생되는 자가면역현상에 의해 발생되는 것으로 알려져 있으며 드물게 신장을 침범하여 신증후군을 일으키기도 한다. CaA의 용량을 줄이거나 투약중지 후 발생한 만성 GVHD에 동반된 신증후군의 경우 조기에 신조직검사를 시행하여 감별진단하고 CsA의 용량을 증량하거나 재투약하여 좋은 치료 결과를 보일 것으로 기대된다. 저자들은 문헌고찰을 통해 동종 골수이식 후 발생된 신증후군이 유사한 임상양상을 보이며 발생기전에 만성 GVHD와 자가면역현상이 연관되어 있음을 확인하였으며 동종 골수이식 후 신증후군의 임상양상을 보이는 환자에서 병리조직학적으로 lgA 신병증을 진단하고 이러한 lgA 신병증이 발생기전에 만성 GVHD와 자가 면역현상이 연관되어 있을 가능성을 최초로 확인하였으며 CsA를 이용하여 성공적으로 치료한 경험을 하였기에 보고하는 바이다. Renal insufficiency is occasionally encountered in allogeneic bone marrow transplantation and its cause is difficult to ascertain. Chronic graft-versus-host disease (GVHD) related to thymic dysfunction is immune-mediated and involves autoreactivity of T-lymphocytes derived from donor marrow to recipient's major histocompatibility complex(MHC) minor antigens. The clinical mainifestations of chronic GVHD are similar to those of autoimmune disease but kidney involvement is rare. Few cases of nephrotic syndrome with membranous nephropathy or minimal change nephrotic syndrome have been reported to be associated with chronic GVHD in allogeneic bone marrow transplant recipient especially after cyclosporine A(CsA) withdrawal, and these cases have responded well to CsA. Therefore, it is prudent to differentiate the cause of post-transplant renal insufficiency using renal biopsy and to start CsA in a case of nephrotic syndrome associated with chronic GVHD as early as possible. We report a case who had a massive proteinuria during the post-allogeneic marrow transplantation period. The cause of nephrotic syndrome was diagnosed as IgA nephropathy by renal biopsy. The patient was successfully treated with reintroduction of CsA.