수완진동 증후군에서 신경장해의 조기진단을 위한 객관화된 방법

윤재국,이헌,최나리,김석환,박형욱,이지호,유철인 大韓産業醫學會 2009 대한직업환경의학회지 Vol.21 No.2

목적: 통각과 진동감각 역치검사 및 수부와 수지의 악력, 그리고 수지의 운동기능검사(태평) 등과 근로자들이 호소했던 증상에 대한 HAVS의 스톡홀름 워크샵 분류와의 관련성을 통해 좀 더 객관화된 신경학적 조기검사 방법을 찾고 타당성을 검증하고자 하였다. 방법: 2000년 1월부터 2007년 12월까지 수부진동에 폭로되고 수부의 불편함을 호소하여 진동 장해에 대한 검사를 시행한 497명의 근로자를 대상으로 하였다. 일차적으로 문진을 통해 직업력에 대해 알아보고 과거력을 조사했다. 대상자들의 스톡홀름 워크샵 분류에 따른 소견을 확인하고 수부의 말초 순환기능 검사(손톱압박, 수지피부 온도), 신경기능 검사(통각과 진동각 역치), 운동기능 검사(악력, 태평) 등을 시행하였다. 다른 질환의 감별을 위한 몇 가지 이학적 검사를 실시하고 스톡홀름 워크샵 분류에 따른 검사 결과들을 분석하였다. 결과: 사용 도구는 그라인더 단독 사용이 265명 (67.3%)으로 가장 많았으며 평균 노출 연수는 14.8년이었다. 통각과 진동감각에서 스톡홀름 워크샵 분류 단계에 따른 역치가 증가하는 경향을 보였으나 통각은 양측 모두 통계적인 유의성이 없었고, 진동감각은 125와 250 Hz에서 양측 모두 유의했다(p=0.006-0.038). 수부와 수지의 악력은 단계가 올라갈수록 감소하는 경향을 보였지만 수부와 수지 모두 우측에서만 통계적으로 유의했다 (p=0.041, p<0.01, p=0.034). 태평 첫수는 단계가 올라 가면서 전반적으로 태핑 첫수가 감소하였으며 좌측에서만 통계적으로 유의했다(p=0.002-0.019). 결론: 본 연구는 수부 진동 노출자들의 수부 불편함에 대한 신경계통을 초기에 정량적으로 객관화하여 진단할 수 있는 단일 방법은 아직 없으며 일상생활의 불편함과 스톡홀름 워크샵 분류 등을 통한 주관적인 증상에 더하여 수지 통각과 진동감각 역치검사, 수부와 수지 악력검사, 운동기능검사(태핑) 등을 통합하면 초기에 객관적으로 진단하는 것이 가능할 것으로 판단된다. Objectives: In order to determine find out the best methods for a more objective detection of neurologic abnormality in early hand ann vibration syndrome(HAVS), early with analyzing the validity of each of the detection methods was analyzed. We evaluated the relationships between the sensorineural stage of Stockholm-revised vibration syndrome classification and the results of several tests. Methods: 497 workers were investigated for symptom, exposure duration, the types of tools used, and medical history from January 2000 to December 2007. Pain sense threshold, vibrotactile threshold, hand grasp force, finger grasp force, and a finger tapping frequency test were performed by the workers. Results: The grinder(67.3%) was the most commonly used tool and the mean exposure duration was 14.8 years. Although the pain sense and vibrotactile threshold level tended to increase according to sensorineural stage of the Stockholm classification, there was statistically significant difference in the vibrotactile threshold of 125, 250 Hz (P=0.006~0.038) but not in the pain sense threshold. Hand and finger grasp force tended to decrease according to the sensorineural stage of Stockholm classification and there was statistically significant difference(P=0.041, <0.001, 0.034) only on the right hand side. The tapping frequency also generally decreased according to the sensorineural stage of the Stockholm classification and there was statistically significant difference (P=0.002~0.019) only on the left hand side. Conclusions: Although there is no single standardized method that can objectively diagnose the Sensorineural component of early HAVS early, the combination of subjective symptoms, the sensorineural stage of Stockholm classification, the pain and vibrotactile threshold test, the hand and finger grasp force, and the finger agility (tapping) test can objectively detect sensorineural component of HAVS early.

라미부딘 내성 만성 B형 간염 환자에서의 아데포비어의 치료 효과

이지숙,장리라,이상욱,한병훈,윤병철 고신대학교의과대학 2008 고신대학교 의과대학 학술지 Vol.23 No.2

Backgrounds/Aims : Adefovir dipivoxil(ADV) has been shown to be effective against lamivudine resistant strain of hepatitis B virus. But continuation of lamivudine therapy or switching to Adefovir dipivoxil in patients with viral breakthrough after long term lamivudine therapy are controversial. To find efficacy of adefovir dipivoxil, we retrospectively assessed clinical course after lamivudine resistance in patients who changed adefovir dipivoxil and continued lamivudine therapy. Methods : 58 patients with lamivudine resistant HBV mutants after at least 6 months of lamivudine treatment were included in this study. 24 of the 58 patients were treated with ADV and rest of them were continued the lamivudine therapy after lamivudine resistance. The continuous lamivudine treatment group (n=34) was divided into two groups according to ALT count (ALT≧40, n=19 vs ALT<40, n=16) The clinical course and the biochemical and virological response of the switching adefovir group were compared with those of continuing lamivudine group. HBV genotypes and YMDD mutation site was anaylzed by TRUGENE HBV Genotyping. Results : At twelve months, the levels of median serum HBV DNA and ALT was decreased and albumin was improved significantly(P<0.01) in adefovir switching group compared with lamivudine sustained group, especially ALT was elevated more than 40. There is no significant differences between adefovir switching group and lamivudine sustained group (ALT<40, n=15). This study showed that adefovir dipivoxil reduces HBV replication and improves not only biochemical markers of disease activity, but also liver function. HBV genotypes of 58 patients were all C and rtM204I/V mutant was the most common. Conclusion : This study provides an evidence that adefovir dipivoxil can be effective in the treatment of lamivudine-resistant HBV mutants, especially ALT elevated.

정신분열병 환자에서 Risperidone에 의해 유발된 조증 2례

정두훈,윤도준,유희정,송지영 大韓神經精神醫學會 1998 신경정신의학 Vol.37 No.2

저자들은 정 신분열병 환자에서 risperidone에 의해 유발된 조증, 경조증 각 1례를 경험하였기에 국내에서는 최초로. 문헌고찰과 함께 보고한다. 증례 1은 22세의 여자 긴장형 정신분열병 환자로 3년전 발병 당시 약물치료후 유지요법 없이 지내다가 4∼5개월 전부터 사회적 위축, 식사량 저하. 말수가 줄어드는 등의 음성증상이 심해져 외래에서 risperidone 2mg을 일 주일간 처방하였다. 환자는 약물순응도가 낮아서 모두 6회에 걸쳐 억지로 투약하여 이 기간에 총 6∼8mg복용후 2∼3일 만에 조증이 발생되었다. 입원후 risperidone을 중단하고 lithium과 고용량의 정형 항정신병약물(chlorpromazine 1200mg 또는 haloperidol 20mg)을 10일간 투여하여 일부 조증이 호전되었다. 증례 2는 29세 남자로 3년 전부터 피해망상, 독극망상을 보이는 망상형 정신분열 병으로 항정신병약물을 처음 투여한 환자였다. 38일간 2mg 사용 시에는 양성증상 및 음성증상의 호전을 보이다가 3mg으로 증량된 후 일 주일만에 뚜렷한 경조증을 보였다. Risperidone을 중단하고 chlorpromazine 300mg을 투여하자 5일 만에 경조증이 완전히 회복되었다. 두 예 모두 risperidone 단독투여에 의한 것이었고, 기분안정제 병합투여, 약물남용 정신질환의 병력이나 가족력, 동반 신체질환은 없었다. Risperidone의 세로토닌(5-HT₂) 차단효과는 도파민(D₂) 차단작용과 함께 정신분열 병에서 음성증상과 정동중상을 호전시킬 뿐 아니라 항우울효과를 나타내며. 일부 환자에서 조증 및 경조증을 유발시키는 것으로 보인다. 기분장애와 분열정동장애에서도 risperidone에 의해 조증이 유발 또는 기존 조증중상이 악화되었다는 증례보고가 있고. 강박장애 등 다른 정신질환으로도 적응증이 확대되고 있으므로, 임상의들은 드물지만 이런 정신과적 부작용의 발생 가능성에 대해 알아야 하겠고. 특히 기분장애나 분열정동장애에서 사용할 경우 기분안정제의 병합투여와 최소 치료용량으로 서서히 증량할 것을 권하는 바이다. 또한 조증유발의 위험인자가 있는 경우는 기분안정효과가 있는 clozapine의 사용이 권장된다. We report the first two cases of manic and hypomanic episodes respectively induced by risperidone treatment done to schizophrenics in Korea. One case was a 22-year-old woman with catatonic schizophrenia. Since 3 years ago, she had shown psychotic symptoms, but with was poor treatment compliance. She had mainly negative symptoms such as social withdrawal, decreased food intake, mutism, and symptoms had been worsened since last 4-5 months. Prior to closed ward admission, she was prescribed 2mg/d of risperidone for a week at OPD. Two days artier taking medicine totally 6-8mg, she revealed manic features. After hospitalization, risperidone was discontinued and then, lithium 900mg/d and high dosage of conventional antipsychotics(chlorpromazine 1200mg/d or haloperidol 20mg/d) were prescribed . About on the l0th day of hospitalization, there was limited improvement of her manic symptoms. The other case was a 29-year-old man with a 3-year history of paranoid schizophrenia. He was never exposed to antipsychotics before. His main symptoms were delusions of being poisoned and of persecution. His positive and also negative symptoms were alleviated by 38 days of risperidone 2mg/d trial. However, one week after dosage increment to 3mg/d, hypomanic symptoms appeared. Risperidone medication was discontinued and was replaced by chlorpromazine 300mg/d. The hypomanic episode was resolved over 5 days. In both of the two cases, manic episodes occurred by monotherapy of risperidone without mood stabilizer, and there were no history of substance abuse and other psychiatric disorders, family history of psychiatric disorders, and comorbid physical illnesses. It is hypothesized that the potent blockade effect on serotonin(5-HT₂) receptor of risperidone causes antidepressant effect as well as therapeutic effect for negative and affective symptoms in schizophrenia. Risperidone would induce manic or hypomanic features in schizophrenic patin of preexisting manic symptoms by risperidone treatment in mood disorder and schizoaffective disorder. Risperidone is being used more widely, even for obsessive-compulsive disorder and other psychiatric disorders. It is necessary for clinicians to recognize manic switch, one of psychiatric side effects by risperidon trial. It is recommended that the combination of mood stabilizer wish risperidone or usage of talc minimum effective dose of risperidone may bewefal especially in the patients with mood disorders or schizoaffective disorders. Clozapine which has mood-stabilizing properties is also beneficial in risk groups of risperidone-induced mania.

두개강내로 전이된 Adenoid Cystic Carcinoma 2례 : 증례보고 Report of Two Cases

송재욱,윤상민,이창훈,장지수,이승훈,조경자,강신광 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.10

The authors describe two cases of unusual intracranial metastatic adenoid cystic carcinomas. A 42-year-old woman had a right pariental epidural metastatic mass. presumed hematogenous. spread from a primary tumor in the parotid gland. In second case, a 32-year-old man had a intracranial metastatic adenoid cystic carcinoma mimicking calcified psammomatous meningioma on CT scans. We present these unusual cases with a review of relevant literature and a discussion of possible pathogenesis.

히스토아크릴을 이용한 십이지장 궤양 출혈의 지혈 후 발생한 급성췌장염

유재훈,문원,노지훈,구동영,조영화,김기수,윤준모 고신대학교 의과대학 2010 고신대학교 의과대학 학술지 Vol.25 No.1

Upper gastrointestinal bleeding is common and potentially life threatening medical emergency. Emergency endoscopy is the first choice of diagnostic and treatment measure for patients with active upper gastrointestinal bleeding. Histoacryl should be considered a second-line treatment modality when conventional treatments were failed. However, it might cause several complications. Herein, we report a case of acute pancreatitis developed after histoacryl injection therapy for active duodenal ulcer bleeding. A 71-year-old man was admitted with melena and hematemesis. On emergency endoscopy, a 2 cm sized active ulcer with bleeding from an exposedvessel was seen at the duodenal bulb. Attempts to arrest the bleeding with hemoclipping and submucosal epinephrine injection were tried, but failed. We changed the method to endoscopic histoacryl injection, and obtained hemostasis immediately. A few hourslater, after successful hemostasis, patient complained diffuse abdominal pain. Ultrasonography revealed hyperechoic heterogenous diffuse pancreatic enlargement and right pararenal space fluid collection, this ultrasonographic findings and elevated serum pancreatic enzymes are compatible with acute pancreatitis.

소방대원들의 실내, 실외 근무 형태에 따른 유산소 운동능력 및 등속성 근력

김남익,장지훈,성기홍,윤성 한국유산소운동과학회 2002 대한스포츠융합학회지 (jcses) Vol.6 No.1

The purpose of study was to investigate the influence of cardiopulmonary function and isokinetic knee joint muscle strength on duty form in the fm fighters. 28men who aged 30-40 years were measured by resting pulmonary function test, exercise stress test(Q4500, Quinton, Co.) and isokinetic knee joint muscle strength testing(Cybex 6000 dynamometer system). Subjects were divided into the 2 groups that were indoor duty group and outdoor duty group. Statistical analysis was performed using analysis of variance t-test. Major findings and conclusion are as follows: In body fat test, outdoor duty groups was showed lower than that of indoor duty group. For the lung function test at rest, lung volume, vital capacity, MVV, FEVO.5-1.0, expiratory and inspiratory flow rate were checked. In results, outdoor duty group was showed higher than that of indoor duty group. During exercise stress test, heart rate, ventilation, and oxygen uptake, were checked by automatic gas analyzer. In results, outdoor duty group was showed higher than that of indoor duty group. In isokmetic knee joint muscle strength, peak torque and average power of indoor duty group was showed significantly lower than that of outdoor duty group. At Comparison of right and left knee joint, isokinetic strength, isokinetic power and isokimtic endurance of right knee joint was showed significantly higher then that of left knee joint, but in 60 degree per second, left knee joint was showed higher then that of right knee joint. Result from this investigation show greater personal training and fire quell a not, emergency rescue activity was increased knee joint muscle strength. Therefore, physical fitness and health maintenance programs for fire fighters have been developed, implemented and proven to reduce morbidity and mortality and financial expenditures.

말기신부전 환자에서 혈액투석 전후의 QT간격분산 비교

강대웅,정지용,윤나라,안치용,김종오,신병철,정종훈,김현리 朝鮮大學校 附設 醫學硏究所 2006 The Medical Journal of Chosun University Vol.31 No.2

Background: Some cases of QT interval, corrected QT interval (QTc), QT dispersion (QTd) and corrected QT dispersion (QTcd) have been reported in ESRD, but these results are variable and the influence of a hemodialysis is still controversial, In this study, we investigated the effect of hemodialysis on QT and QTc interval and QT and QTc dispersion in patients with ESRD 15 min before and 15 minute after each hemodialysis. Methods: Sixty-seven patients with ESRD (men 33 & women 34) on three-times stable hemodialysis (>3 months) were randomly enrolled. Fifty control subjects with a similar age and normal renal function were enrolled from this hospital. Routine biochemical studies were measured pre- and post dialysis, at the time of the ECG. Plasma Na+, K+, BUN, creatinine, ionized calcium and phosphate were checked. Twelve-lead electrocardiographs were performed at 10㎜/mv and 50㎜/s using a HewIett-Packard Pagewriter 100, before and after a single hemodialysis session.The QT interval was measured from the onset of the QRS complex to the end of the T wave. If the end of the T wave was not clear in a particular lead then it was excluded from analysis. When U waves were present, the end of the T wave was taken as the nadir between the T and U waves. Each QT interval was corrected for heart rate using Bazett's formula (QTc==QT/√(RR)) (ms). The difference between maximal and minimal QT interval duration was defined as QT dispersion (QTd) in each of the 12 leads. Result: This study demonstrates that QT, QTd, QTcd is higher in hemodialysis patients compared with control subjects, and QT and QTd rise postdialysis to levels comparable to those seen acutely following myocardial infarction, when patients are at greatly increased risk of potentially fatal ventricular arrhythmias, Conclusions: QT interval and QT dispersion, markers of risk for arrhythmias and sudden death, are elevated in hemodialysis patients, and rise postdialysis. QT interval and QT dispersion is an easily obtainable, noninvasive, simple, inexpensive, and widely available method of risk stratification in uremic patients receiving chronic dialysis. Additional studies are needed to clarity whether increased postdialysis QT dispersion results in an increased occurrence of arrhythmias.

혈액투석중인 말기신부전 환자에서 Fludrocortisone acetate (FCA) 투여 후 혈청 칼륨 저하 효과

류봉관,강대웅,정지용,윤나라,신병철,박경희,정종훈,김현리 朝鮮大學校 附設 醫學硏究所 2005 The Medical Journal of Chosun University Vol.30 No.1

Background: Hyperkalemia is a commonly encountered problem in dialysis patients with end-stage renal disease. In this study we evaluated the effect of mineralocorticoid therapy (fludrocortisono acetate) on serum potassium level in the serum of hyperkalemic end-stage renal disease patients. Methods: Fourteen patients on hemodialysis receiving fludrocortisone acetate (FCA) 0.1 mg/day were observed for 2 months periods. Consecutive monthly biochemical profiles were compared for the druration of the pre-and post-treatment of FCA. Result: Fourteen patients with mean age (±SE) of 51.5 years (4 males and 10 females) and mean hemodialysis period of 51.9 months were studied. Mean serum potassium levels significantly fell (p<0.05) during the post-FCA period (5.2±0.66 mEq/L) compared with potassium levels during the pre-FCA (5.8±0.43 mEq/L) period. Pre-and post-FCA values were not different for sodium, chloride, protein, albumin, AST/ALT, glucose, blood nitrogen, creatinine, phosphate and calcium. Conclusions: FCA appears to decrease serum potassium value in patients with end-stage renal disease. These results suggested that FCA could be effective to treat hyperkalemia without any adverse effect in patients undergoing hemodialysis.

서울의 Penicillinase Producing Neisseria Gonorrhoeae 발생빈도(1996)

김재홍,황동규,전재홍,김윤석,김중환,김용준,이창균,임동진,김현수,조창근,김경문,박상훈,전우형,김희성,이호정,차명수,김갑형,김형석,김석우,황지환,박병순,권오상,이민수,송기훈,성소영,이인섭,부태성 대한화학요법학회 1999 대한화학요법학회지 Vol.17 No.2

Background : In recent years, gonorrhea has been panedemic and remains one of the most commom STDs in the world, especially in developing countries. Objective & Methods: For the detection of a more effective therapeutic regimen and assessing the prevalence of PPNG, we have been trying to study the patients who have visited the VD Clinic of Choong-Ku Public Health Center in Seoul since 1980 by means of the chromogenic cephalosporin method. Results: In 1996, 139 strains of N. gonorrhoeae were isolated, among which 53(39.0%) were PPNG. Conclusion: Our results suggests that after a peak of 74.3% in 1993, the prevalence of PPNG in Seoul is gradually declining.

GC-ECD를 이용한 유기염소계 및 Pyrethroid계 농약 동시 분석법

김우성,이선화,김재이,정지윤,이명자,박영채,이영자,정성욱,이봉헌,박흥재 한국환경과학회 2003 한국환경과학회지 Vol.12 No.4

Pesticides were extracted from samples with 70% acetone and methylene chloride in order, and then cleaned up via open-column chromatography apparatus packed with florisil, and finally analyzed simultaneously the organochlorine and pyrethroid pesticides using GC(ECD). An ultra-2 fused silica capillary column was used to separate and identify the products. The resolution between the last isomeric peak of cypermethrin(59.987min) and the first isomeric peak of flucythrinate(60.043min) was not satisfactory. The last isomeric peak of fenvalerate(62.344min) and the first isomeric peak of fluvalinate(62.397min) were overlapped. Recoveries of soybean sample for the most pesticides were 73.3% to 102.4%. Detection limits were between 0.004 and 0.063 ㎍/㎎ when this method was used.