관상동맥질환 환자에서 스텐트 시술 후 재협착에 관한 연구

강진환,권영주,박상호,한대희,이상철,김명구,변정득,최병조,심규혁,온영근,현민수,김성구 순천향의학연구소 2001 Journal of Soonchunhyang Medical Science Vol.7 No.2

Background and aims : In the coronary artery disease, a rate of restenosis was much decreased by placement of coronary stent than when percutaneous transluminal coronary angioplasty has been applied, but there are still important clinical problems of restenosis. There has been many progressive studies about various factors contributed to this restenosis. So, we studied a relation between restenosis after placement of coronary stent in the coronary artery disease and many clinical factors, characteristics of stenotic lesion and procedural factors, and also assessed the restenosis rate of various coronary stents. Methods : Total 58 lesions(46 cases of patients ; man 30, woman 16) were evaluated, which has been performed a follow-up coronary angiography after 6 months (mean 188 days) since coronary stent had been placed. Various stents were implanted and assessed a relation between restenosis and many factors. Results : Of 58 lesions were target stenotic studies, there were 22 of restenotic lesions(37.9%), and the restenosis rate wes statistically significant difference in the relation with diabetes mellitus(p<0.05), group of acute myocardial infarction(p<0.05) among clinical diagnosis of ischemic heart disease(stable angina, unstable angina and acute myocardial infarction) in clinical factors and with high dilation pressure of stent(p<0.05) in procedural factors. When the rate of restenosis was evaluated among implanted stents, it was lowest in the Multilink^(®) stent and highest in the Nir Royal^(®) stent(60%). Conclusion : In this study of restenosis and various factors after placement of stents in the coronary artety disease, factors such as diabetes mellitus, group of acute myocardial infarction and a dilation pressure of stent were significant related with restenosis and the restenosis rate of Multilink^(®) stent was lowest and the highest restenosis rate was of Nir Royal^(®) stent.

아동기 가정 내 스트레스가 공동의존성에 미치는 영향 및 공동의존성과 정신병리와의 관련성

곽운환,손지욱,한규희,박철수,김장락,김붕년,김봉조,강여화,하형래 대한생물치료정신의학회 2003 생물치료정신의학 Vol.9 No.1

연구목적: 본 연구는 공동의존성에 영향을 미치는 아동기 가정내 스트레스 요인과 공동의존성과 다른 병리와의 연관성을 규명하고자 하였다. 더불어 특정한 질환에서의 공동의존성의 평가가 가지는 의의를 탐색해 보고자 하였다. 방 법: 연구 대상은 정상 일반인 남성집단 88명과 알코올리즘 남성 집단 76명으로 구성되어 있다. 평가도구는 본 저자가 직접 작성한 '아동기 가정내 스트레스 요인 측정용 설문'과 공동의존 척도(RPS), 간이증상 진단검사(SCL-90-R)를 사용하였다. 통계적 분석은 Mann-Whitmey test, Kruskall- Wallis test, Multiple linear regression analysis, Spearman correlation analysis를 이용하였다. 결 과: 1) 정상 일반인 군과 알코올리즘 군의 공동의존성 평균값은 각각 49.12점(표준편차=15.41)과 88.31점(표준편차=17.48)이었다. 2) 정상 일반인 군에서는 '아동기 부모 사별'(p<0.01) '부모의 알코올리즘'(p<0.01) '부모의 상습적 구타'(p<0.01)의 3가지 요인에서, 알코올리즘 군에서는 '어린시절 부모 사별'(p<0.01) '부모의 알코올리즘'(p<0.01) '부모의 상습적 구타'(p<0.01) '부도의 도박'(p<0.01) '사회 병질자 부모의 존재'(p<0.05)의 5가지 요인에서 스트레스 유무에 따라 공동의존성에 유의한 차이를 보였다. 3) 두 집단 동시에 SCR-90-R의 8개 소척도 중 '대인관계 예민성'이 공동의존성과 가장 높은 연관성(rs>0.06, p<0.01)을 보였다. 이외에도 '우울증' '불안증'등이 두 집단 모두에서 통계적으로 유의한 연관성을 보였다. 결 론: 본 연구는 부모의 알코올리즘뿐만 아니라 여러 가정 내 스트레스 요인이 공동의존성의 발생에 영향을 미칠 수 있음과 공동의존성이 높은 집단이 다른 정신과 질환을 동반할 가능성이 높음을 증명한다고 할 수 있다. Objectives : The aim of this study was to examine the relationships of codependency with family stressors in childhood and psychopathology. Methods : Subjects were a group of 88 normal adult males and a group of 76 alcoholic males. The degree of codependency was assessed with the Korean version of Recovery Potential Survey(RPS). All subjects filled out questionnaires regarding demographic information and family stressors. The psychopathology was measured by self-administred questionnaires using Symptom Check List-90-Revision(SCL-90-R). Results : 1) There were no significant differences in codependency levels by sociodemographic characteristics in two groups, but obvious difference in mean of codependency scores(normal group : 49.12±15.41, alcoholism group : 88.31±17.48). 2) There were significant differences in codependency levels between the presence and absence of parental physical abuse, parental death, and parental alcoholism(p<0.01) in both groups. 3) Among family stressors, parental physical abuse had the largest contribution to codependency level in multiple linear regression. 4) There were significant correlations between the codependency levels and the scores of SCL-90-R's subscales of interpersonal sensitivity, depression, and anxiety in both groups. Conclusion : The codependency levels were related to some family stressors such as parental physical abuse, parental death, and parental alcoholism and the high-level codependency was correlated with higher level of psychopathology in both normal and alcoholism group. These results suggested that various family stressors, as well as parental alcoholism may be predictors of codependency, and codependency also may be a predictor of other psychiatric disorders.

서울시내 고등학교 위탁급식의 급식비와 투자비의 실태 및 위탁업체의 기대수준 비교 분석

양일선,배환미,김현아,신서영,조미나,박수연,차진아,이보숙 한국식생활문화학회 2002 韓國食生活文化學會誌 Vol.17 No.5

The purposes of this study were to a) find out the operational characteristics of the contract-managed highschool foodservice in Seoul, b) investigate the expected level of meal-price and facilities investment cost perceived by contract-managed highschool foodservice managers c) compare the present level and expected level of meal-price and facilities investment cost. From October 12 to November 13 in 2001, the questionnaires were mailed to 249 high schools which was managed by contract foodservice company with respondent rate 40.2%. Data were analyzed using SPSS Win(10.0) for descriptive analysis and one group paired t-test. The results of this study were as follows ; 1. The student enrollment of highschools run by contract-managed foodservice was 1,243 with 72.6% participation rate of school lunch program. The average meal-price was 2,138 won. The average annual period of school foodservice operation was 156.78 days per year. The average contracting period was about 3 years. 2. The average cost concerned in the facilities investment amounts 169,578,180 won at the initial investment and 25,204,092 won at the repairs and maintenance cost in the course of operation. 3. The present level of meal-price and facilities investment cost were respectively 2,136won/meal and 171,157,336.72 won. And expected level.of meal-price and amount of facilities investment cost were 2,418.75 won and 121,353,215.19 won. Comparing the present level with expected level of the meal-price and facilities investment cost, expected level of meal-price was significantly higher than the present level of meal-price(p<.001) and expected level of facilities investment cost was significantly lower than present level of facilities investment cost(p<.001).

항암제 처리한 백혈병 세포주에서의 Apoptosis 발현

김삼용,윤소현,김현수,김종숙,윤환중,김진경,조덕연 충남대학교 암연구소 1998 癌共同硏究所 硏究誌 Vol.2 No.1

The bcl-2 proto-oncogene encodes a 26 kD protein that promotes cell survival by blocking apoptosis. The bax protein is a member of the bcl-2 familly, now known to form heterodimers with the bcl-2 protein. The ratio of bax to bcl-2 is be critical in determining the fate of the cell in response to stimuli that can induce apoptosis. Extract of Pulsatilla Koreana (SB-31) showed promising antitumor activity in vitro with Topo I inhibitory action. In the present study, the relationship between apoptosis and the apoptosis related proteins, bcl-2 and bax were investigated in human leukemic cell lines HL-60, U-937 and CEM-CM3. All anticancer drugs(adriamycin, etoposide, camptothecin, SB-31) induced extensive apoptosis in HL-60, U-937 cells and CEM-CM3 cells. The expression of bcl-2 and bax protein were determined in cell lines by western blotting before and after incubation with anticancer drugs at different time points. 1) In HL-60 or U-937 cell lines, down regulation of bcl-2 and up-regulation of bax were found after incubation with ADR, VP-16 or camptothecin. 2) In HL-60 or U-937 cell lines, no significant change in bcl-2 or bax protein expression resulted after incubation with SB-31. 3) In CEM-CM3 cells, virtually no change was noted in bcl-2/bax expression after incubation with ADR, VP-16, camptothecin or SB-31. It is suggested that different leukemic cell lines use different pathways of apoptosis activation and a given cell may utilize different pathways of apoptosis activation in response to different cytotoxic agents.

동일한 국제예후지표(International Prognostic Index)를 나타내는 미만성 대형 B-세포 림프종에서 Bcl-2와 p16의 임상적 중요성

박상은,박수진,곽승근,박남숙,천재민,윤환중,조덕연,김삼용,김진만 충남대학교 의학연구소 2003 충남의대잡지 Vol.30 No.2

In Korea, malignant lymphoma is a common cancer, comprising about 2.7% of all malignant neoplasm. Diffuse large B cell lymphoma is the most common lymphoma, representing about 50% of all Non-Hodgkin's lymphoma. Diffuse large B-cell lymphoma is usually considered as heterogeneous group of neoplasms rather than a single clinicopathological entity. Clinical prognostic systems, including the International Prognostic Index (IPI), although useful to assess overall prognosis, embrace patients with heterogeneous prognoses. But International Prognostic Index scoring system is not sufficiently predict the prognosis. It is likely that the prognostic assessment of patients with diffuse large B-cell lymphomamight be improved by using biological features. Bcl-2 protein and p16 protein expression is recognized as useful biologic markers predicting the prognosis of patients with diffuse large B-cell lymphoma. To determine the clinical significance and prognostic value of bcl-2 and p16 proteins expression patterns, we studied 18 patients with de novo DLBL, whose archival pathology specimen were available for immunohistochemistry studies, atChungnam National University Hospital from September 1992 to December 2000. Archival specimens from each patient were immunostained with respective antibodies for bcl-2, p16. The results are as follows; 1) The median age was 54(rage : 37-69). There were 12 male patients(66.7%) and 6 female patients(33.3%) The 'B' symptom was abscentin all patients. The stages were as follows : Ⅰ, 2 patient(11.1%), Ⅱ, 10 patient(55.6%), Ⅲ, 4patient(22.2%) and Ⅳ, 2patient(11.1%). 3 patients(16.8%) had the elevated LDH level, 14 patients(77.8%) had the normal LDH level and 1 patients(5.6%) was not identified the LDH level. 2 patients(11.1%) had the bulky disease and 16 patients(88.7%) had no bulky diease. The distribution of ECOG status were O, 2 patients(11.1%c), 1, 14patients(77.8%) and 2, 2patients(11.1%). 2) Theimmunohistochemistry results are as follows bcl-2:+,10 patients(55.6%), bcl-2:-, 8patinets(44.4%), p16:+,3 patients(16.7%), p16:-, 15patients(83.3%) 3) After a median follow UP durations of 67 months, the median survival time was 57 months with a rage of 7-100+ months. 5-years overall survival rates was 44% by Kaplan-Meier method. 4) Reduced overall survival was demonstrated in the patients who expressed bcl-2 protein(P=0.0174). 5-year overall survivial rate was 12%(bcl-2 expression) versus 88%(no bcl-2 expression) 5) Among diffuse large B-cell lymphoma patients with IPI score 0-1, reduced overall survival was demonstrated with bcl-2 expression(P=0.023). 5-year overall survival rate was 18%(bcl-2 expression group) versus 100%(no bcl-2 expressiongroup) 6) Median survival durtation of diffuse large B-cell lymphoma patients negative for p16 expression was 57 months whereas p16 postive patients' median survival duration was not reached(P=0.4478). In diffuse large B-cell lymphoma patients with identical IPI scores, bcl-2 expression had additional prognostic value.

Cybex를 이용한 8주간의 isokinetic training이 하지근력이 저하된 사람의 근력 및 대퇴위 변화에 미치는 효과

김양수,김창환,임영조,서수진,윤진환,강성철 최신의학사 1995 最新醫學 Vol.38 No.4

혈관중심성 T세포/자연살상세포 림프종의 임상적 고찰

이정찬,박수진,박상은,곽승근,신현영,김성은,이정호,윤환중,조덕연,김삼용 충남대학교 의과대학 지역사회의학연구소 2001 충남의대잡지 Vol.28 No.1

Although the Working Formulation is commonly used to classify NHL in Korea, it has been recognized as imperfect for primary extranodal lymphoma, expecially for patients with nasal, paranasal disease because of their histological characteristics. Angiocentric T/NK cell lymphoma remains rare clinical presentation in North America and Europe but is more common in Asia and Latin America. The optimal mode of treatment has also not been decided on, probably because of their rarity and limited understanding of its natural course. The aim of this study was to analyze our experience with 14 patients with angiocentric lymphoma seen at the Chungnam Natioanl University Hospital over the last 5 years. We reviewed the records of 14 patients who were treated at the Chungnam National University Hospital between January, 1996 and December, 2000. The angiocentric T/NK cell lymphoma accounted for about 8.2% of NHL. The median age was 52.5 (range 36-71) years. Sex ratio was equal. According to the Ann Arbor staging system, disease was classified as stage Ⅰin 3 patients, stage Ⅱ in 8 patients and stage Ⅳ in 3 patients. Systemic B symptoms were present in only four patients in only four patients. All patients has extranodal involvement. The most frequently involved extranodal sites were nasal cavity followed by paranasal sinuses and orpharynx. The most common presenting symptoms were nasal obstruction with purupent rhinorrhea followed by dysphagia. According to the International prognostic index (IPI), most patients was in low-risk group (11 patients). Nine patients responded completely. Seven patients were received combination chemotherapy and 2 patients had radiation therapy as a initial treatment. Five patients were relapsed. After a median follow-up of 660.5 days, the overall survival and disease-free survival rates at 3 years was 56.8% and 42.9% respectively. The median survival time was not yet reached. The median overall survival time was 1338.5 (range 1212-1564) days for non-relapsed and 733.4 (range 302-1008) days for relapsed patients. The median time from CR to relapse was 100.5 (range, 39-159) days. There were limitations to know enough about the characteristics of angiocentric T/NK cell lymphoma because of a small number of patients. In the future, multicenter trials will be neccesary to identify clinical characteristics, optimal treatment mordalities and their responses, and prognostic factors.

미만성 대형 B-세포 림프종에서의 예후인자에 관한 연구

김삼용,곽승근,박상은,윤환중,조덕연,김진만 충남대학교 의학연구소 2003 충남의대잡지 Vol.30 No.2

미만성 대형 B-세포 림프종은 가장 흔한 악성 림프종의 한 종류로서 우리나라에서는 전체 비호지킨 림프종의 50%를 차지한다. 비호지킨 림프종에서 병기는 호지킨병과는 달리 예후 인자로서의 유용성이 적다. 따라서 병기만을 예후 인자로서 평가하는 한계를 극복하기 위해 국제예후지표(International Prognostic Index)가 도입되었다. 특정 환자에서 IPI 점수와 함께 그 환자의 림프종의 생물학적 특성을 분석한다면 예후 예측에서 정확도가 높아질 것이다. 본 연구에서는 미만성 대형 B-세포 림프종에서 국제예후지표의 유용성을 확인하고자 하였으며, 각종 생물학적 지표의 면역화학염색을 통하여 이들을 배세포 중심 아형(germinal center subgroup : 이하 GC양 아형으로 약함)과 활성화 B-세포 아형(post-germinal center subgroup; 이후 pGC양 아형으로 약함)으로 분류하고 이들의 예후 예측에 대한 적절성을 평가하였다. 결과는 다음과 같다. 1. 연령분포는 37세에서 69세로 중앙치는 56세이었으며, 남자는 17예(65.4%), 여자가 9예(34.6%)였다. 병기는 Ⅰ, Ⅱ, Ⅲ, Ⅳ기가 각각 2예(7.7%), 11예 (42.3%), 5예(19.2%), 8예(30.8%)였다. 'B'증상은 5예(19.2%)에서 양성이었다. 진단 당시 혈청 LDH치가 상승한 경우가 11예(42.3%)였고, 거대종양(직경이 10㎝이상)을 갖는 경우가 5예(19.2%)이었다. ECOG 수행등급은 0이 2예(7.7%), 1이 18예(69.2%), 2가 5예(19.2%), 3이 1예(3.8%)이었다. 2. 면역조직화학염색 상 bcl-2의 양성은 17예(65.4%), bcl-6의 양성이 20예(76.9%)이었다. CD10이 양성인 경우가 5예(19.2%)이었다. IRF-4가 양성인 경우는 8예(30.8%)였다. 26명의 환자에서 bcl-6, CD10과 IRF-4를 이용하여 GC양 아형과 pGC양 아형으로 분류 하였는데, GC양 아형은 14예(53.8%)이었고, pGC양 아형은 7예(26.9%), 분류가 되지 않는 경우가 5예(19.3%)이었다. 3. 평균 48개월 동안 추적한 결과 중앙생존기간은 44개월이었고 생존기간은 1~100+개월에 분포하였다. Kaplan-Meier법에 의한 5년 누적 생존률은 32%이었다. 4. 병기, 'B' 증상, 혈청 LDH 농도, ECOG 수행등급, 거대종양유무가 통계학적으로 의미있는 임상적 예후 인자였다. 5. 면연조직화학염색에서는 bcl-2만이 통계학적으로 유의한 예후인자였다. 6. GC양 아형은 pGC양 아형에 비해 생존기간은 좋았으나, 통계학적 유의성은 없었다. 7. 다변량 분석결과 bcl-2 발현과 혈청 LDH치만이 예후에 영향을 미쳤다. Clinical Significanceof Expression of Biomarkers in Patients with Diffuse Large B-cell Lymphoma Diffuse large B-cell lymphoma(DLBL) is the most common type of lymphoma in Korea, representing about 50% of non-Hodgkin's Lymphomas. Although DLBL is usually considered as a specific category, the diversity in clinical presentation, morphology, genetic and molecular alterations strongly suggest that these tumors represent a heterogeneous group of neoplasia rather than a single clinicopathological entity. Clinical prognostic systems, including the International Prognostic Index (IPI), although useful to assess overall prognosis, embraces patients with heterogeneous prognoses. It is likely that the prognostic assessment of patients with DLBL might be improved by using biological features. During the last decade, most studies dealing with the heterogeneity of DLBL have focused on individual protein expression and molecular alterations. The expression of individual antigens related to different stages of B-cell differentiation, including CD10, bcl-6, and IRF-4, may help to define groups of tumors with different clinical and pathological characteristics. To determine the clinical significance and prognostic value of individual biomarker expression and the biomarker expression patterns according to germinal center subgroup or post-germinal center subgroup of DLBL as defined by a relatively small number of single antigens, we studied 26 patients with de novo DLBL, whose archival pathology specimen were available for immunohistochemistry studies, atChungnam National University Hospital from September 1992 to December 2000. Archival specimens from each patient were immunostained with respective antibodies for CD10, bcl-6, IRF-4, bcl-2 antigens. Two immunophenotyping profiles were distinguished according to the pattern of differentiation; germinal center(GC;CD10/Bcl-6+/IRF-4-) subgroup or postgerminal center (pGC ; CD10/bcl-6/IRF4+) subgroup. The results are as follows; 1) Baseline characteristics of patients were ; median age of patients was 56(range ; 37-69). 17 patients(65.4%) were male. 5 patients(l9.2%) had 'B' symptoms. Stages were as follows ; stage Ⅰ2 patients(7.7%), stage Ⅱ 11 patients(42.3%), stage Ⅲ 5 patients(l9.2%), stage Ⅳ 8 patients(30.8%). 11 patients (42.3%) had elevated LDH levels. 25 patients(96.2%) had ECOG performance grade 0-Ⅱ and 1 patient had grade Ⅲ. 5 patients(l9.2%) bad bulky disease. 2) The results of immunohistochemical study were as follows ; positive bcl-2 staining in 17 patients(65.4%), positive bcl-6 in 20 patients(76.1%), positive CD10 in 5 patients(l9.2%), positive IRF-4 staining in 8 patients (30.8%). 3) After a median follow up duration of 48 months, the median survival duration was 44 months with a range of survival of 1-100+ months. 5-year overall survival rate was 32% by Kaplan-Meier method. 4) The clinical factors affecting survival were elevated serum LDH level, B symptoms, bulky disease, stage at diagnosis and ECOG performance status 5) Among the biomarkers, only bcl-2 expression affected survival of DLBL patients 6) The germinal center like subgroup had superior survival than post-germinal center like subgroup but had no statistical significance. 7) Multivariate analysis showed that bcl-2 and serum LDH level had siginificance on survival Conclusion In addition to the known clinical prognostic factors, immunohistochemically defined characteristics such as bcl-2 expressionin DLBL is important and subgroups(germinal center or post-germinal center subgroup) of DLBL may have importance in predicting prognosis of DLBL patients

경도관 동맥색전술을 이용한 비정상 자궁출혈의 치료

양승부,최교창,이상진,정영진,임한혁,한효상,황인철,조환성 순천향의학연구소 2005 Journal of Soonchunhyang Medical Science Vol.11 No.1

Objective : Our purpose of this study is to evaluate the effectiveness of the transcatheter arterial embolization for the management of abnormal uterine bleeding. Materials and Methods : 14 patients with massive or recurrent uterine bleeding underwent percutaneous transcatheter arterial embolization between February 2003 and September 2004. We reviewed 14 cases of uterine artery or internal iliac artery embolization using gelfoam or PVA particles. Results : Good management of uterine bleeding was achieved in 13 of 14(93%) cases. The cause of abnormal uterine bleeding was myoma(5 case), post D & E bleeding(3), acquired vascular malformation(3), pseudoaneurysm(1), adenomyosis(1), and endometrial hyperplasia(1). Conclusion : Transcatheter artery embolization is an effective and life-saving procedure in massive or recurrent uterine bleeding. Early diagnosis and prompt transcatheter arterial embolization is a useful mangement of uterine bleeding.

거대적아구성빈혈의 임상적 고찰

곽승근,천재민,박남숙,박상은,박수진,윤환중,김삼용,조덕연 충남대학교 의학연구소 2003 충남의대잡지 Vol.30 No.2

Megaloblastic anemias are disorders caused by impaired DNA synthesis and chara-cterized by the presence of megaloblastic cells. Clinical data on these disorders in Korea are limited. The aim of this study was to analyze clinical characteristics of megaloblastic anemias caused by vitamin B12 deficiency. We identified 40 cases who were diagnosed as megaloblastic anemia from January 1993 to December 2002 in a retrospective study on the basis of chart review. We investigated the annual distribution of diagnosed patients, clinical manifestations and response to treatment. 19 cases were complicated with a previous total gastrectomy(gastrectomy group) and 21 cases had no history of surgical operation(non-gastrectomy group). The most common presenting complaint was generalized weakness. The median age at diagnosis was 7(range: 38-79) years in non-gastrectomy group. The mean pos-toperative duration was 7(range: 4-25)years in group of total gastrectomy and mean level of serum vitamin B12 was lower than 100 pg/mL in both group. Peripheral blood revealed thrombocy-topenia, macrocytic anemia and hypersegmented neutrophil in all cases. After treatment of pareliteral vitamin B12, Their clinical symptoms and hematologic findings improved except two patients who had bone marrow with lower cellularity. Cobalamin replacement after total gastrectomy is still missing. Diagnoses are made too late in a population of patients, resulting in irreversible neurological sequale, and we suggest that Pernicious anemia seems not to be very rare in Korea.