기저세포모반증후군 두 증례

김재덕,서요섭,김진수 대한구강악안면방사선학회 2008 Imaging Science in Dentistry Vol.38 No.2

The basal cell nevus syndrome (BCNS) is an autosomal dominant disorder, characterized by basal cell carcinomas, odontogenic keratocysts and skeletal abnormalities. We experienced two cases that represented several characteristics of BCNS. Case 1: a thirty three year-old man visited CSU hospital. His radiographs showed four cystic lesions at both maxillary sinus and both mandibular angle, with bifid rib and ectopic calcification of falx cerebri. After marsupialization and enucleation, recurrent and newly developing tendency were found on his follow-up radiographs. Case 2: a seventeen year-old man had four large cystic lesions which were diagnosed as odontogenic keratocysts. He had craniofacial anomalies which included ectopic calcification and frontal bossing.

장시간 수술시 Propofol과 Enflurane의 마취 유지 효과 및 술후 각성도에 대한 비교

김태요,윤재승,이강창,정영표,안선연 圓光大學校 1995 論文集 Vol.30 No.2

There has not been particular attention focused on the comparative benefits and risks of propofol anesthesia with inhalation anesthesia in the operations of long duration. This study was assessed the anesthetic efficacy and the speed of recovery from propofol or enflurane anesthesia in patients undergoing the long term operations. The propofol group (n=25) receiver 2.0 - 2.5mg/kg propofol intravenously for the induction of anesthesia and followed by propofol infusion(6 - 12mg/kg/h). The enflurane group (n=25) was induced as the propofol group and followed by enflurane(1-2 MAC) addministration. All patients received nitrous oxide (50%) in oxygen immediately after tracheal intubation. All anesthetic agents were stopped at the time of last stitch. The hemodynamic changes were recorded and the recovery was assessed with the time from discontinuation of all anesthetics to extubation and the indices of consciousness at early recovery(recall name, eye opening on command, raise hand on request and coughing on request). The recovery tests showed no differences between the groups. Systolic pressure after intubation in propofol group was significantly increased (p<0.05), compared with enflurane group. In propofol group, seven patients received fentanyl because of light anesthetic depth. The frequency of nausea and vomiting was similar between the groups. In conclusion, the long propofol anesthesia was not associated with faster recovery than enflurane anesthesia and propofol as an agent of anesthetic maintenance was unfavorable.

항응고제 치료와 연관된 자발성 근육내 혈종

김수성,조재훈,이학승,박현영,장혁,김요식,조광호 원광대학교 의과학연구소 2009 圓光醫科學 Vol.24 No.1

항응고제 치료의 주된 합병증은 출혈로서 주로 뇌실질과 복강 내에 발생하며 사지 근육에 발생하는 근육내 혈종은 매우 드문 것으로 알려져 있다. 이러한 항응고제 치료 후 발생하는 자발성 근육내 혈종은 발생빈도가 드물 뿐 아니라, 심부정맥혈전증과 그 증상이 유사하여 감별하기가 쉽지 않다. 저자들은 항응고제 치료 후 운동 마비가 발생한 사지 근육에서 자발성 근육내 혈종이 발생한 증례를 경험하여 이를 보고한다. Spontaneous intramuscular hematoma(SIH) is an uncommon but serious bleeding complication of anticoagulation therapy that has received little attention. We present a patient of spontaneous muscular hematoma during anticoagulation therapy for acute stroke management. A-74-year old man was admitted with sudden onset of dysarthria and left hemiparesis. Brain MRI and MRA showed acute cerebral infarction along right middle cerebral artery territory and severe stenosis of right proximal cervical internal carotid artery. During intravenous heparin treatment, he complained acute pain and swelling on left leg. Muscular CT showed enhancing focal soft tissue mass on left gastrocnemius muscle and ultrasonography demonstrated multiple hematomas on left gastrocnemius muscle. Treatment of heparin was stopped immediately. After conservative management for hematomas, symptoms were subsided.

Papillon-Lefevre Syndrom의 임상 및 미생물학적 검사와 치료

송요한,김문현,김형섭,김재곤,백병주 大韓小兒齒科學會 1998 大韓小兒齒科學會誌 Vol.25 No.2

The Papillon-Lefevre Syndrome(PLS), a disease with autosomal recessive inheritance, is characterized by diffuse hyperkeratosis of the palms and soles, mostly prepubertal periodontitis and premature loss of primary and permanent dentition. The etiology of the destruction of periodontal tissues has not been completely clarified. In recent years, two main factors are suggested to be responsible for tooth loss : firstly, the presence of gram negative microorganisms in the periodontal pockets of the patients. The other factor suggested is cellular deficiency in chemotaxic and phagocytic function of neutrophylic granulocytes. Resent data suggestes that mechanical debridement in conjunction with antibiotic therapy may be successful in periodontal management of Papillon-Lefevre Syndrome, particularly if administered early. In this study, a Papillon-lefevre syndrome patient was studied clinically, radiologically, histopathologically and microbiologically. 5 years female patient with gingival swelling and destruction of periodontal structure on the whole dentition were examined and palmar and plantar hyperkeratosis were can be seen. On microbiological analysis, Actinobacillus actino-mycetemcomitans was performed. Concurrently, the children recieved extraction of maxillary anterior teeth and construction of removable prosthetis. The combination of professional oral hygiene care and antibiotic therapy improved the dermatologic and peridontal condition.

질소산화물 제거를 위한 V₂O_5/TiO₂촉매 코팅된 다공성 실리카 필터의 제조 및 특성

한요섭,고재철,박영구,김승호,박재구 三陟大學校 2005 論文集 Vol.38 No.-

The prepared porous support from silica coated with TiO₂ and V₂O_(5) catalysts were studied by selective catalytic reduction of NOx with NH₃ The effects of V₂O_(5) loading, reaction temperature, space velocity and filter-type(disk and sphere) on the characteristics of NOx reduction with NH₃ were mainly investigated. At space velocity 6000h^(-1), reaction temp rature 350℃, V₂O_(5) loading 6.Owt.% and oxygen content 5%, the NOx reduction was higher to about 91%. The efficiency of porous silica on V₂O_(5)/TiO₂ catalytic disk-filter was higher than that of the V₂O_(5)/TiO₂ catalytic sphere-filter. It has been experimentally observed that the V₂O_(5)/TiO₂ catalytic disk-filter has strong resistance of gas flow.

흰쥐 Nucleus Raphe Magnus에 투여한 Morphine이 척수 Serotonin 유리에 미치는 영향에 관한 연구

이신재,임요한,최영님,김형룡,정동균 대한구강생물학회 1991 International Journal of Oral Biology Vol.15 No.1

It is known that the interaction between opioid neuron and serotonergic neuron in bulbospinal pathway has an important role on pain control. This experiment was perfomed to directly measure the release of serotonin into spinal cord superfusates before and after the microinjection of morphine and its antagonist, naloxone into the NRM of rats. High performance liquid chromatography with electrochemical detection was used to quantitate the amine. The injection of morphine into the NRM induced a significant increase in the amount of serotonin released in the spinal cord, which was reversed after the intraperitioneal injection of naloxone. These results support the proposal that : the analgesia produced by morphine microinjected into the NRM is mediated by the activation of spinally projecting serotonergic neuron.

21세기 새로운 시대를 준비하는 원광대학교 의과대학의 교육목표 개정과정

이학승,김요식,송윤강,오재민,양연식,정선관 원광대학교 의과학연구소 2009 圓光醫科學 Vol.24 No.1

교육목적은 대학의 교육이 지향하는 대전제이다. 그러므로 대학교육 목적과 목표가 어떤가에 따라 교육과정과 교육방법이 달라진다. 원광대학교 의과대학의 교육목표는, '지덕겸수'로 요약되는 '과학과 도학을 겸비한 전인교육'의 건학정신과 '학술탐구'와 '덕성함양'의 원광대학교 교육목표와 일치하게 현재까지 유지되었다. 그러나 현행 교육목표의 여러 문제점이 발견되었고, 시대상의 변화에 따라 원광대학교 의과대학에서도 사회적 변화 빛 의료인에 대한 시대적 요구에 걸맞은 의학교육의 목적 및 목표의 재설정 과정을 시작하게 되었다. 그 결과 개정 작업을 통해 새로운 교육목표를 설정하게 되었으며 그 내용은 다음과 같다. 1. 기본진료능력을 지닌 의사를 양성한다. 2. 원불교 교리 이념을 반영한 윤리적, 도덕적인 의사를 양성한다. 3. 평생 학습하는 연구하는 의사 혹은 의과학자를 양성한다. 4. 사회적 책무를 수행하는 리더십을 갖춘 의사를 양성한다. 5. 지역 사회에 공헌하는 봉사정신을 갖춘 의사를 양성한다. Purpose : With the changes to the medical environments and to the medical educational systems, we aimed to evaluate the current mission statement of the School of Medicine, Wonkwang University, and to revise it. Methods : To establish the new goal and mission statement, a Special Committee for the Revision of Medical School Mission and advisory group were organized in 2008. This special committee conducted through five steps of action, which are composed of investigation, education, development, surveillance of various opinions, and announcement. Results : For the development of new goal and mission, the revised, final goal and mission statements decided through the five steps of action. The new mission of Wonkwang University School of Medicine was as follows; 1. Doctor who can diagnose and treat easily 2. Ethical and moral doctor who practice Won Buddhism 3. Doctor or Medical Scholar who studies lifelong study 4. Doctor who has leadership to social responsibility 5. Doctor who goes into service to a local community. Conclusion : The authors expect that the new goal and mission of Wonkwang University School of Medicine would be helpful in giving the guideline on the educational process of medical school and will give the information to reform the medical school system according to the rapidly changing educational environment.

WDHA(Watery diarrhea, Hypokalemia, Achlorhydria) syndrome 1예

박기룡,김현영,김지혜,임영찬,최영식,박요한,최경현,이재화,장희경 고신대학교 의학부 2003 高神大學校 醫學部 論文集 Vol.18 No.1

저자들은 부갑상선절제술 이후에도 교정되지 않는 고칼슘혈증과 계속된 수양성 설사로 인한 하지마비 및 전신쇠약을 주소로 내원한 70세 남자환자에서 일반 화학검사, 호르몬 건사, 방사선 검사 등으로 VIPoma와 동반된 MEN Ⅰ으로 진단하여 외과적 절제술 후 수양성설사, 저칼슘혈증 및 고칼슘혈증이 호전된 1례를 경험하였기에 문헌 고찰과 함께 보고하는 바이다. Multiple endocrine neoplasia I (MEN Ⅰ) is a genetic disorder that consists of neoplasia of neuroendocrine type in the parathyroid glands, in the islets of Langerhans in the pancreas, and in the anterior pituitary gland. Primary hyperparathyroidism is most common feature of the MEN I and occurs is approximately 95% of patients. Pancreatic islet cell tumors occur in 40% of MEN I patients. Most of these tumors produce excessive amounts of hormone, such as gastrin, insulin, glucagon and vasoactive intestinal polypeptide (VIP). VIP-producing pancreatic tumors (VIPoma) associated with MEN I are rare and there was only one case report in Korea so far. Recently we experienced a case of MEN I, especially VIPoma presented in a 70 year old man. He got subtotal parathyroidectomy for hyperparathyroidism 5 months ago, but his symptoms of watery diarrhea, severe general weakness and paralysis of lower limbs were not improved and hypercalcemia, hypokalemia were persisted. On computerized tomography scan of abdomen, demonstrated a mass of 3㎝ in diameter at the tail of pancreas. Serum level of VIP hormone was 250pg/㎖ (normal range : 0∼23pg/㎖). After partial pancreatectomy, his symptoms were improved dramatically and biochemical parameters such as, serum potassium, calcium, and VIP returned to the normal ranges.

말초혈액에서 Tg mRNA에 대한 역전사 중합효소 연쇄 반응법의 갑상선 재발암의 분자생물학적 진단

권성일,박기룡,김현영,신채희,임영찬,최영식,박요한,이강대,장희경,이재화,염하용 대한내분비학회 2002 Endocrinology and metabolism Vol.17 No.4

연구배경: 갑상선암은 다른 조직에 발생한 암에 비해 비교적 천천히 자라므로 대부분 예후가 양호하지만, 일부에서는 주위 조직으로 침윤하거나 혹은 원격 전이로 인하여 치명적인 결과를 초래할 수 있다. 갑상선전절제술 및 131^I 제거술 후 경과 관찰시 갑상선암의 재발과 전이의 진단에 있어 131^I 스캔과 혈청 Tg의 측정이 현재 임상에서 가장 많이 이용되고 있으나 이 방법에는 여러 가지의 결점이 있다. 최근 Tg mRNA에 대한 RT-PCR법을 이용한 여러 연구결과는 131^I 스캔과 혈청 Tg 측정의 결점을 보완할 수 있는 좋은 보조적인 진단법으로 이용할 수 있을 가능성을 제시하였다. 이에 말초혈액에서 측정한 Tg mRNA에 대한 RT-PCR법이 갑상선 절제술 및 방사성요드 치료 후 갑상선암의 재발 및 전이 유무의 진단에 유용한가를 알아보고자 이 연구 시행하였다. 방법: 분화된 갑상선암으로 진단된 후 갑상선전절제술을 시행받고 방사성요드 치료를 받은 환자 중 현재까지 한차례에 이상 추적 방사성요드 전신 스캔을 시행하고 추적관찰이 가능했던 유두선암 35예, 여포선암 5예를 대상으로 연구를 시행하였다. 대상군은 131^I 스캔 소견상 음성인 군(Group Ⅰ), 잔여조직이 있는 군(Group Ⅱ), 국소전이가 있는 군(Group Ⅲ), 및 원격전이 군(Group Ⅳ)으로 구분하였다. 정상 대조군은 갑상선질환이 없는 10예의 건강인으로 하였다. 대상환자의 말초혈액을 이용한 Tg mRNA에 대해 특이적인 primer를 이용하여 RT-PCR 및 nested RT-PCR을 시행하였다. 결과: 본 연구 결과는 다음과 같다. 1) 131^I 스캔 소견상 음성인 군 21예 중 1예에서 Tg가 양성소견을 보였다. Anti Tg Ab가 양성인 4예 모두 Tg가 음성을 보였다. 잔여조직이 있거나 국소전이 및 원격전이를 보인 군 19예 중 Tg가 양성인 경우는 4예였으나, Tg mRNA는 전예에서 양성이었다. 2) 131^I 스캔에서 국소 및 원격전이 소견을 보인 8예 중 4예에서 Tg가 음성으로 131^I 스캔과 혈청 Tg 사이에 불일치 소견을 보였다. 3) 말초혈액에서 특이적인 primer를 이용하여 RT-PCR 및 nested RT-PCR을 시행한 결과 대상군 40예 및 정상 대조군 10예 모두에서 Tg mRNA가 양성을 보였다. 결론: 본 연구에서 갑상선 절제술 및 방사성요드 치료 후 갑상선암의 재발 및 전이 유무를 평가함에 있어 역전사 중합효소 연쇄 반응법을 이용한 Tg mRNA 측정의 의의는 재평가되어야 한다고 생각된다. Background: Differentiated thyroid cancer is the most common endocrine malignancy. Despite advances in the treatment of thyroid cancer, disease recurrence and metastasis may occur in as many as 20% of patients, and so continues to pose major problems in its clinical management. Serum thyroglobulin (Tg) measurements, by immunoassay, are used to detect residual or recurrent thyroid cancer following thyriod ablation. However, the usefulness of immunoassay is limited by both the requirement for thyroid hormone withdrawal, to attain optimal test sensitivity, and interference by the antithyroglobulin antibody (Anti-Tg Ab). Recent studies have reported the clinical usefulness of reverse transcription-polymerase chain reaction (RT-PCR) detection of Tg mRNA in the peripheral blood of patients with differentiated thyroid carcinomas. We performed this study to evaluated the usefulness RT-PCR of Tg mRNA in peripheral blood of patients with thyroid carcinoma following a total thyroidectomy and radioiodine ablation therapy. Methods: Forty cases that underwent a total thyroidectomy and radioiodine ablation therapy were included in this study. Of the 40 patients, 35 were papillary carcinomas and 5 were follicular carcinomas. Ten normal control subjects were also studied. Tg mRNA was extracted. Then RT-PCR and nested RT-PCR, were run with specific Tg primers. Concurrently, DNA sequencing of the isolates was carried out to prove the isolates were identical to the nucleotide sequence of the Tg. Results: The Tg was detected in 4 of 19 patients, with either a residual thyroid bed, or metastasis, on a 131^I whole body scan and in 1 of 21 patients with a negative radioiodine scan. Surprisingly, the Tg mRNA was detected in all the patients and normal controls. Conclusion: From our results we can not recommend Tg mRNA, detected by RT-PCR in peripheral blood, as a tumor marker superior to that of the Tg serum level. We consider an intensive re-evaluation of the method is required before considering its clinical applications (J Kor Soc Endocrinol 17:501∼513, 2002).

Esmolo과 lidocaine의 혼합사용시 기관내 삽관에 따른 혈압과 심박수에 미치는 영향

하정량,손용,김태요,윤재승,송윤강 圓光大學校 醫科學硏究所 1999 圓光醫科學 Vol.15 No.1

Background: Ultrashort acting β-adrenergic antagonist, esmolol and local anesthetics, lidocaine are well known about effects of hemodynamic stabilization to tracheal intubation. But, the effects of these drugs are still controversial. The aim of the present study is to assess whether a combination of both drugs are more effective than either drug alone. Methods: Forty eight patients, ASA physical status Ⅰ or Ⅱ, were randomly assigned to one of four groups (n=12 each): control (Group S), esmolol 1 ㎎/㎏ (Group E), lidocaine 1 ㎎/㎏ (Group L) and esmolol-lidocaine combination (Group M). Anesthesia was induced with thiopental 5 ㎎/㎏ intravenously, and then saline, esmolol, lidocaine and combination drug were administered as an intravenous bolus, and immediately followed by succinylcholine 1.5 ㎎/㎏. Tracheal intubation was done 90 seconds after intravenous injection of drugs, respectively. Systolic and diastolic blood pressure and heart rate were measured before induction and every minute for 5 minutes after tracheal intubation. Results: There was a significant attenuation in systolic, diastolic arterial pressure and heart rates after tracheal intubation in esmolol-lidocaine group compared to other three groups. Conclusions: Combination of esmolol 1 ㎎/㎏ with lidocaine 1 ㎎/㎏ seems to be useful for attenuation of the increases in blood pressure and heart rates compare to either drug alone after tracheal intubation.