관상동맥내 스텐트 삽입후 발생한 관상동맥류 2례

제인수,허민영,문치숙,이재호,정수룡,조길현,이영민,김대경,김두일,김동수 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.3

Coronary artery aneurysms are detected with increasing frequency because of the routine use of coronary angiography in the diagnosis and management of coronary artery disease. Although some coronary artery aneurysms are congenital or inflammatory, most are atherosclerotic. The prognosis of atherosclerotic coronary artery aneurysm may depend on the morphology of the aneurysm or the presence of coexisting obstructive disease. Coronary artery aneurysms have been also reported to occur after ballon angioplasty, directional athrectomy, laser angioplasty, and stent implantation with a frequency of 2% to 4%. The long-term outcome of post-intervention coronary artery aneurysm is unknown. We report two cases of the development of a coronary aneurysm 6 months after stent implantation as a treatment of severe obsructive coronary artery disease.

전격성 경과를 취한 만성 호산구성 폐렴 환자 1예

윤호상,진춘조,유광하,이상엽,이수인,정상만,김선두,이순제,이길도,전혜정 건국대학교 의과학연구소 2000 건국의과학학술지 Vol.10 No.-

Chronic eosinophilic pneumonia(CEP) is a rare disease of unknown etiology characterized by chronic infiltration of the lung with eosinophils. It presents with profound systemic symptoms comprising fever, night sweats, weight loss, dyspnea and blood eosinophilia with nonsegmental air-space consolidation confined to the outer third of the lung, the "photographic negative of pulmonary edema". Histopathologic features of chronic eosinophilic pneumonia are intraalveolar and interstitial infiltrations with eosinophils, histiocytes, giant cells, scattered lymphocytes and plasma cells. Glucocorticoid therapy cause prompt resolution of symptoms as well as disappearans of blood eosinophils, elevated serum Ig E levels and the roentgenographic lesions. Infrequent radiographic findings include nodular infiltrates, consolidations, cavitations, atelectasis and pleural effusions. Deaths from CEP although rare, have been reported, but the majorities of CEP have benign courses and do not need a therapy with ventilator. We report a case of chronic eosinophilic pneumonia, which had a sudden course associated with diffuse pneumonic consolidations on the both lung and bilateral pleural effusion.

당뇨병 환자에서 혈장 Thrombin-Antithrombin Ⅲ 및 Plasmin-α_2-Plasmin Inhibitor 복합체의 임상적 의의

김경욱,김은숙,정상수,윤수지,박우일,이준희,남수연,안철우,문병수,김경래,차봉수,송영득,임승길,이현철,허갑범 대한당뇨병학회 2002 Diabetes and Metabolism Journal Vol.25 No.5

연구배경:당뇨병 환자에서 혈액응고 및 섬유소용해 체계의 이상경향이 있어 그 결과로 여러 혈관합병증의 발생위험이 높다는 사실은 널리 알려져 있다. 그 기전은 아직 확실히 밝혀지지 않았으나, 고혈당으로 인한 혈장 단백질들의 비효소성 당화작용이나 산화성 스트레스로 인한 유리 라티칼 작용으로 응고항진이나 섬유소용해 활성의 저하를 유발하는 것으로 생각되고 있다. 최근 응고 및 용해인자와 그 억제자의 복합체들의 증가가 이 상태를 비교적 예민하게 반영한다고 알려져 있다. 방법:본 연구에서는 당뇨병 환자 101명과 정상 대조군 20명에서 혈장내 thrombin­antithrombin complex(TAT)와 plasmin­α₂­plasmin inhibitor complex(PIC)를 측정하여 비교하고, 당뇨병 환자에서 미세혈관 합병증과 대혈관합병증의 유무에 따른 차이와, 이미 혈관 질환의 위험인자로 알려져 있는 인자들간의 상관성을 알아보고자 하였다. 결과:1. 환자의 분포를 살펴보면 혈관합병증이 있는 군은 85명, 혈관합병증이 없는 군은 16명이었고, 평균연령은 각각 57.9±14.1세, 49.9±16.6세로 혈관 합병증이 있는 군에서 더 나이가 많았고, 체질량지수는 23.2±3.4㎏/㎡, 24.1±3.4㎏/㎡로 두 군간 유의한 차이는 없었다. 또 두 군간의 혈압 및 HbA1c, 공복혈당 및 인슐린과 C­peptide, 총 콜레스테롤, 중성지방, HDL­콜레스테롤, Lp⒜는 유의한 차이가 없었고, 미세혈관합병증이 있는 군에서 당뇨병의 유병기간이 길었다. 2. TAT 및 PIC의 농도는 정상 대조군에서는 2.8±1.2 ng/mL, 240.4±69.7 ng/mL이었고, 당뇨병 환자군에서는 9.5±22.6 ng/mL, 472.2±258.7 ng/mL이었다. TAT와 PIC 모두 당뇨병 환자군에서 정상 대조군에 비해 유의하게 증가되어 있었고(p<0.001), TAT/PIC ratio는 두 군간 차이가 없었다. 3. 당뇨병 환자의 혈관합병증에 따른 TAT 및 PIC, fibrinogen 농도는 합병증이 없는 군은 각각 4.1±2.4ng/mL, 362.2±272.0ng/mL, 322.7±102.4mg/mL으로 PIC와 fibrinogen의 증가를 보였으나, 연령을 보정한 후에는 통계학적 유의성은 없었다. 또 대혈관 합병증군에서는 각각 6.0±4.9 ng/mL, 507.4±321.6 ng/mL, 427.1±194.7 mg/dL이었으며 미세·대혈관 합병증군에서는 10.4±6.4 ng/mL, 484.8±269.7 ng/mL, 388.4±132.4 mg/dL으로 TAT의 증가를 보였으나 역시 연령을 보정한 후에는 통계학적 유의성은 없었다. 4. 미세혈관합병증군에서 HbA1c(>8%)가 높은 군의 PIC 농도가 유의하게 높았고(p=0.049), 대혈관합병증군에서 HbA1c(>8%)가 높은 군의 총 콜레스테롤 농도가 유의하게 높았다(p=0.042). 5. 총 당뇨병 환자군에서 PIC는 fibrinogen과 HbA1c와 양의 상관관계를, BMI와 음의 상관관계를 보였으며(r=0.47, 0.31,-0.25), 혈관 합병증이 없는 당뇨병 환자군에서만 TAT는 HbA1c와 양의 상관관계를 보였다(r=0.67). 결론:이상의 결과에서 혈장 TAT 및 PIC 농도는 당뇨병 환자에서 정상 대조군에 비해 의미있게 증가되어 있었고, 당뇨병 환자군에서는 연령의 증가와 유병기간이 혈액응고항진 및 용해의 장애에 큰 역할을 함을 알 수 있었으며, 총 당뇨병 환자군에 PIC와 HbA1c와 양의 상관관계를, BMI와 음의 상관관계를 보였으며 혈관 합병증이 없는 당뇨병 환자군에서만 TAT는 HbA1c와 양의 상관관계를 보였다. 따라서 당뇨병 환자에서 혈액응고 및 용해의 장애가 동반되어 있다고 볼 수 있으며, 혈장 TAT 및 PIC는 혈관합병증으로의 진행을 예측하는 지표로서 유용하리라 생각된다. 또 혈당조절정도와 상관성이 있으므로 혈당조절후에 추적검사를 시행하여 합병증의 예방이 가능한지 추후 연구가 필요하리라 생각된다. Background : Abnormality of coagulation and fibrinolystic system is known as a predisposing factor of vascular complication in diabetes. Although the pathogenesis is not well known, non-enzymatic glycation reaction and the increase in production of free radicals due to an increased oxidative stress may be linked to the hypercoagulibility and hypofibrinolytic activity. As indices of abnormality in coagulation and firinolysis in peripheral blood, plasma thrombin-antithrombin Ⅲ complex (TAT) and plasmin-α_2-plasmin inhibitor complex (PIC) were measured. The purpose of this study was to clarify whether hypercoagulability exists in diabetic patients with or without vascular complication. Methods : In our study, we measured plasma thrombin-antithrombin Ⅲ compelx (TAT) and plasmin-α_2-plasmin inhibit or complex (PIC) in 101 diabetic subjects and 20 controls. Comparing TAT and PIC levels in diabetic microvascular complication group, diabetic macrovascular complication group and controls, we examined correlation between risk factors associated with diabetic vascular complication. Results : 1. The group with diabetic vascular complication was older than group without complication. There was no significant difference in BMI, blood pressure, HbA_ic, blood sugar level, insulin, C-peptide, serum creatinine, total cholesterol, triglyceride, HDL-cholesterol, Lp (a) between two groups. The group with diabetic microvascular complication had longer duration of diabetes. 2. Concentration of TAT and PIC were 2.8±1.2 ng/ mL, 240.4±69.7 ng/ mL in controls and 9.5±22.6 ng/ mL, 472.2±258.7 ng/ mL in diabetic patients, respectively. TAT and PIC were significantly higher in diabetic patients than in control (p<0.001). But TAT/PIC ratio was no significant difference between two groups. 3. In diabetic patients, concentration of TAT and PIC and fibrinogen were respectively 4.1±2.4 ng/ mL, 362.2±272.0 ng/ mL, 322.7±102.4 mg/ dL in group without vascular complication and 5.3±4.1 ng/ mL, 529.5±258.7 ng/ mL, 374.9±106.2 mg/ dL in group with microvascular complication, which group had increase in PIC and Fibrinogen but no significance after correction of age. Concentration of TAT and PIC and Fibrinogen were 60.±4.9 ng/ mL, 507.4±321.6 ng/ mL, 427.1±194.7 mg/ dL in macrovascular complication, and 10.4±6.7 mg/ mL, 484.8±269.7 ng/ mL, 388.4±132.4 mg/ dL in combined vascular complication which group showed increase of TAT but also had no significant increase after correction of age. 4. In diabetic microvascular complication patients, group of high HbA_1c (>8%) (p=0.049) had significant high PIC concentration. In diabetic macrovascular complication patients, group of high HbA_1c (>8%) (p=0.042) had significant high total cholesterol concentration. 5. In all diabetic patients, PIC was positively correlated with fibrinogen and HbA_1c and negatively correlated BMI (r=0.47, 0.31, -0.25). Only in daibetic patients without angiopathy, TAT was positively correlated with HbA_1c (r=0.67). Conclusion : In this study, plasma TAT and PIC concentration significantly increased in diabetic patients compared with controls, and PIC was increased in group with microvascular complication, TAT were increased in group with combined micro macrovascular complication. However, there was no significance relationship existed when correctinf for age. PIC was correlated with HbA_1c. TAT was correlated with HbA_1c only in the group without angiopathy. Abnormality of coagulation and fibrinolysis were combined in diabetes, plasma TAT and PIC can be used as an index of vascular complication. Also we found the correlation with the degree of the blood glucose control. Therefore we need follow up study for the possibility of prevention of vascular complication after controlling the blood glucose to age-matched patients (J Kor Diaabetes Asso 25:354~363, 2001).

의·간호계 종사자 및 학생들의 죽음 인지도에 관한 연구

이길홍,김헌수,나철,권혜진,김성희,민병근 중앙대부설한국의과학연구소 1983 한국의과학 Vol.15 No.3

근로청소년의 산업재해와 음주양상과의 상호관계에 관한 산업정신의학적 연구

이길홍,김헌수,이규항,민병근 중앙대부설한국의과학연구소 1983 한국의과학 Vol.15 No.1

청소년 정신장애에 관한 정신의학적 연구

이길홍,김헌수,나철,민병근 중앙대부설한국의과학연구소 1983 한국의과학 Vol.15 No.2

제한속도 규제와 그 영향에 대한 분석

이원영,성낙문,박길수 한국안전교육학회 2002 한국안전교육학회지 Vol.5 No.2

This study purposes to provide a rational direction to the policies associated with speed limits of Korea through literature reviews. As a result of analysis, it is generally accepted that the higher running speed and speed limit bring about the more traffic accident frequencies and the higher severity. Traffic safety experts strongly confirm that speed variances affect the occurrences of the traffic crashes. An inappropriate speed limit increases the speed variances and becomes a factor of the occurrences of traffic crashes. Accordingly, the speed limit should be determined in appropriate manner. This means that speed limit should be installed considering running speeds of vehicles and geometries of the road. There have not been reliable researches related to speeds and traffic crashes in Korea, even though the speeds have an very important role for the occurrence of traffic crashes. Therfore it is required that researches related to the traffic crash and traffic safety should be conducted actively in Korea.

호흡기 완자의 대조군의 혈청학적검사에 의한 Chlamydia Pneumoniae의 감염률

이해숙,천병력,진수희,이원길 대한임상미샐물학회 2004 Annals of clinical microbiology Vol.7 No.1

단독주택의 외관형태와 이미지평가에 관한 연구

이청웅,박화수,박길우,이향미 朝鮮大學校 建設技術硏究所 2002 建設技術硏究 Vol.22 No.1

This study analyzes the types of external forms of detached housing buildings, and conducts the S.D test with it and is to structurize the image of external form of buildings. Types of 24 detached housing buildings are analyzed in this vein and the results are as follows: (1) Mass type in the primary cognitive factor of building is mostly simple or multiple box type. (2) As a result of analyzing the secondary cognitive factor of building, horizontal type is most and it shows that it is the favorable structure in the stability of form. Roof shape and side pattern are mostly gable and plat roofs and it is known that traditional gable roof and flat roof influenced by modern construction are shown in housing. (3) To examine the tertiary cognitive factor, surface shape is mostly flat type and it shows a little monotonous composition. Also finishing materials are concrete and brick. S.D test of detached houses doesn't show the extreme psychological test disposition and does somewhat affirmative evaluation. As a result of conducting the factor analysis based on S.D test, nine psychological factors including 「originality」, 「pleasantness」, 「harmony」, 「ornamentation」, 「openness」, 「balance」, 「rhythm」, 「stability」 and 「orientation」. These can be called psychological factor axis which can evaluate the modern detached house.

학생청소년의 문제행동과 가정의 심리풍토 특성과의 관계에 관한 상관분석

이길홍,김헌수,민병근 大韓神經精神醫學會 1982 신경정신의학 Vol.21 No.4

The purpose of the study was aimed to examine the relationship between the adolescent problem behaviors and their family climate among high school students in Korea, and to collect baseline data for the establishment of effective measures to prevent delinquent acting-out. In order to achieve these aims, sampling were made by three stage clustered random sampling method, and questionnaires were finally supplied to a total 1620 high school student. These data were statistically analysed by simple correlation coefficient and stepwise multiple regression analysis in order to reveal the relationship between 8 types of factor structures of male & female problem behaviors created through factor analysis of 57 problem behaviors, and 5 categories of psychological climate of family. The collected data were analysed by CDC-174 Computer of KIST, using SPSS program, and their results of the study were presented below; 1. The principal factor structures of problem behaviors among adolescent school boys and girls were classified as follows : The socialized nonaggressive, neurotic withdrawal, overt impulsive sexual, adult modelling, socialized latent sexual, school-norm avoidant, narcissistic sexual, and under-socialized latent aggressive behaviors. Among them, the socialized non-aggressive behavior and the narcissistic sexual behavior were predominantly observed in the male students, on the other hand, the socialized latent aggressive behavior and the socialized non-aggressive behavior were more common in females. From these results, we proposed that studies on causation of problem behavior and measures for guidance should be applied differently by their sex categories. 2. The defective psychological climate of family tended to affect their children's problem behaviors, and their degree of influence was more influential in male students than female students. The family stability, family member's satisfaction with home, and parent-child relation showed more significant correlation with their children's problem behavior comparing with parental child rearing practices. 3. The psychological instability of family tended to be positive correlation with their children's problem behavior. The familial tenseness, coldness, disharmony, uncooperativeness, and parental marital discord revealed significant correlation with their children's socialized latent aggressive behavior and neurotic withdrawal behavior. 4. The family member's dissatisfaction with home tended to bear significant relationships with their children's problem behavior, that is, their children's neurotic flighting behaviors including the socialized non-aggressive, neurotic withdrawal, and school-norm avoidant behavior. 5. The disharmonious parent-child relationships were positively correlated with their children's problem behavior. Particularly, parental rejection of children's opinions, children's rejection of parental opinions, alienated parent-child relationship, lesser degree of devotion, and paternal loss of affection were significantly correlated with their children's problem behaviors such as son's neurotic withdrawal behavior and daughter's socialized non-aggressive behavior. 6. The defective parental child rearing practices tended to affect their children's problem behavior. Particularly, parental mistrust to their children, parent-centered approach, authoritative approach, punishment oriented system, rigid discipline, and parental closed-mindedness were significantly correlated with their son's narcissistic sexual behavior & neurotic withdrawal behavior or daughter's school norm avoidant & undersocialized latent aggressive behavior. 7. In comparison of both parent in the degree of influence on their children's problem behavior, it was revealed that father's was more influential than mother's. Particularly, the parental child rearing practices showed more significant correlations with their son's problem behaviors comparing with their daughter's behaviors, and showed higher correlations with their same-sex children than their opposite sex children. 8. Among 7 types of parental child rearing practices, parental mistrust toward their children was most important factor. These mistrust attitude toward their children showed higher correlations with neurotic flighting types of behavior than antisocial fighting types of behavior.