Gilbert 증후군에서 열량 제한 시험과 Phenobarbital 자극 시험의 의의(14예)

이헌영,채경훈,정재훈,강윤세,김연수,문희석,박기오,이엄석,김선문,김석현,성재규,이병석,이강욱 충남대학교 의학연구소 2003 충남의대잡지 Vol.30 No.2

Gilbert 증후군은 인구의 7%에서까지 나타날 수 있는 매우 흔한 증후군으로서 비진행성인 양성의 만성적 경과를 치하며, 간질환의 증상과 징후가 없는 경한 비포합형 고빌리루빈혈증이 특징인 일종의 체질적인 증상으로서 혈장 빌리루빈 농도에 대한 사춘기의 영향 때문에 10대와 20대에 자주 진단이 된다. 따라서 임상적인 중요성은 미약하지만 높은 빈도가 예상되는 점에 그 중요성이 부여되어야 할 것이다. 따라서 적정한 임상적 진단법으로 기왕에 소개된 열량제한 시험과 phenobarbital 유도 시험을 시행하고 이들의 진단적 가치를 알아보기 위하여 본 연구를 시행하였다. 1990년 7월부터 1999년 4월까지 충남대학교병원에 내원하여 HBsAg, IgG anti-HBc 및 anti-HCV가 음성이고, 간 초음파 스캔에서 이상이 없으며, 혈청 AST, ALT 및 AP가 정상인 비음주자에서 경한 비포합형 고빌리루빈혈증이 있는 14예의 환자들을 대상으로 ^(99m)Tc-DISID 스캔을 시행하였으며, 기저 치 총빌리루빈 및 포합형 빌리루빈 치를 측정한 다음에 하루에 400Kcal로 48시간동안 제한한 열량 제한 시험을 시행하였고, phenobarbital을 하루 60mg씩 5일간 투여한 후에도 각각 총빌리루빈과 포합형 빌리루빈 치를 검사하여 비포합형을 구하였다. 대상 환자들은 모두 14예로서 남자가 11예(78.6%)였고 여자가 3예(21.4%)여서 3.7:1로 남자에서 많았으며, 20대가 6예(42.9%), 30대가 역시 6예(42.9%) 및 40대가 2예(14.2%)로서 2,30대가 대부분(85.8%)이었다. 열량 제한 시험 후의 총빌리루빈 치, 비포합형 및 포합형 빌리루빈 치들은 평균 각각 5.5±2.7, 4.2±2.3 및 1.3±10mg/dL 로서, 시험 전 치들인 3.0±0.8, 2.2±0.8 및 0.7±0.4mg/dL 보다 유의하게(p=0.001, p=0.001, p=0.023) 상승하였다. 포합형 빌리루빈 치도 유의하게 상승하였으나 비포합형의 상승보다는 훨씬 낮아서 주로 비포합형이 증가하였다. phenobarbital 투여 중 설사가 발생하여 중단한 1예를 제외한 13예에서 열량 제한 시험 후에 상승하였던 총, 비포합형 및 포합형 빌리루빈 치가 phenobarbital 유도 시험후에는 2.0±1.1, 1.5±0.8 및 0.5±0.4mg/dL로서 열량 제한 시험 결과보다 유의하게 낮아졌고(p=0.00, p=0.000, p=0.001), 열량 제한 시험 전의 기초치들인 3.0±0.8, 2.2±0.8 및 0.7±0.4mg.dL 보다도 더욱 낮아졌으며 유의한 차이(p=0.001, p=0.02, p=0.005)를 나타내었다. 14예에서 시행한 ^(99m)-Tc DISIDA 스캔에서 9예(64.3%)가 정상이었고, 5예(35.7%)에서는 심장 및 신장으로의 간외 섭취가 3예였고, 60분까지 소장 배출이 없는 배설 지연 예와 담낭 수축 불량 예가 각각 1예 씩 발견되었다. Phenobarbital 투여시험에서 민감도가 열량제한시험에 비해 더 높았다(92.3%와 50.0%). Gilbert 증후군에서 1일 400 Kcal로 48시간의 열량제한 시험과 1일 60mg의 phenobarbital을 5일간 투여하는 유도 시험은 편리하고 유용한 임상적인 진단법으로 이용할 수 있다고 생각된다. 그러나 열량 제한 시험에서는 증가 기준의 통일이 필요하다고 유추되며 phenobarbital 유도 시험이 민감도가 더 높은 것으로 생각된다. Gilbert's syndrome is very frequent and benign chronic process characterized by mild, intermittent, unconjugated hyperbilirubinemia without any symptom and sign of liver disease. Previously intoduced caloric restriction test and phenobarbital stimulation test as two appropriate clinical tests had been examined and their diagnostic values were reevaluated. Fourteen patients with mild, persistent, unconjugated hyperbilirubinemia were included. Subsequently caloric restriction has been applicated by 400 Kcal/day for 48 hours and phenobarbital has been prescribed by 60 mg/day for 5 days. Therafter serum levels of total and direct bilirubin were measured. Most of the patients were third and fourth decade(85.8%) and male predominant. Each basal serum levels of total, indirect and direct bilirubin were 3.0±0.8, 2.2±0.8 and 0.7±0.4 mg/dL. After caloric restriction test, each levels were increased significantly to 5.5±2.7, 4.2±2.3 and 1.3±1.0 mg/dL(p=0.001, p=0.001, p=0.023). After phenobarbital stimulation test for 13 patients had been practiced, increased levels of each bilirubin after caloric restriction test were decreased significantly to 2.0±1.0, 1.5±0.8 and 0.5±0.4 mg/dL(p=0.000, p=0.000, p=0.001) and these levels were significantly lower than basal levels(p=0.001, p=0.02, p=0.005). The sensitivities of caloric restriction test were 85.7%, 50.0%, and 71.4%, 35.7%(1.0, 1.5 mg increase of total bilirubin and 1.0, 1.5 mg/dL increase of indirect bilirubin). The sensitivities of phenobarbital stimulation test were 93.2% and 92.3% at criteria of 1.5 mg/dL increase of total bilirubin and indirect bilirubin. On the diagnosis of Gilbert syndrome, caloric restriction test and phenobarbital stimulation test are convenient and useful diagnostic tools in clinical face. And also phenobarbital stimulation test has higher sensitivity than caloric restriction test. Furthermore, standardization of bilirubin increment would be necessary in caloric restriction test.

간세포암과 감별이 어려웠던 악성중피종 치험 1예

김선문,허원석,채경훈,강윤세,정재훈,김연수,박기오,문희석,이엄석,김석현,성재규,이병석,이헌영,신경숙,조준식,송인상,강대영 충남대학교 의학연구소 2003 충남의대잡지 Vol.30 No.2

Malignant peritoneal mesothelioma is a rare neoplasm that arises from the mesothelium of a serosal cavity and is a rapidly fatal disease with a median survival of 4 to 12 months for untreated cases. Recently, we experienced a case with malignant peritoneal mesothelioma who was suspected hepatocelluar carcioma by abdominal CT scan and was confirmed by biopsy including immunohistochemical stain(calretinin) after surgery. We performed tumor excisions and wedge resection of the liver(segment Ⅷ)and inserted Tencoff catheter in abdominal cavity at 25th day of post-operation. We treated with intraperitoneal paclitaxel(25mg/m^(2)/day for 5 days) six courses monthly. She was well tolerable and is still living without any evidence of recurrence for 14th month of post-operation.

平生體育을 위한 스포츠 活動의 育成方安에 關한 硏究

李揆文,崔淙洙,李鍾珏,金鍾聲,李永熙,金圭碩 忠北大學校 平生體育硏究所 1985 平生體育硏究所 論文集 Vol.1 No.-

This study is a survey of development methods of sports activity for life sports which was conducted with questionaire of 17 items during the months of January and February 1985. The selection of subjects is based on the random sampling method, and 1928 ?? of the questionaire were distributed to the Chung-Buk inhabitants during the period from March to June 1985. Among them 1622 sheets(84.1%) were returned, and 142 ?? which made an error in answers were all removed, and 1480 sheets were turned into effect. This research, aimed the the investigation and expansion of sports to the ??of socity, obtained the following conclusions. 1. The necessity and recongnition of life sports is unknown generally. The design and conduct of any fitness program for populace adults must consider age and physical characteristics, envirommental condition and must act any support under the new system with the manager, local administration, a territorial society. Also, the goal of the program should emphasize self-improvement within the physical status of the participant, rather than the attainment of fitness levels based upon the norms or the achievments of population samples. 2. The contents of activition in sports have general a tendency to complication and diversity. There were no sufficient facilities and equipments of sports. Therefore, In order to achieve the expansion of sports to the lowest stratum of society, must be improved various environmental conditions that consist of extrinsic motivation and concrete project. 3. The items of sports must be improved on the based of interest, age, local charac-teristics and sports facilitie must be expanded for to health, welfare of one's place of work and enterprise.

MgCl₂溶液內에서 STS 304 HP Stainless Steel 熔接部의 破壞擧動에 對한 硏究

金永奭,丁太權,朴昌彦,洪錫柱,梁仁榮,金基玉,朴煥奎,李茂錫,曺圭宰,鄭在康 조선대학교 생산기술연구소 1983 生産技術硏究 Vol.1983 No.-

This paper is based on an experiment analysing the stress corrosion cracking behaviour of welding specimens compared to that of non-welding specimens of STS 304 HP stainless steel in corrosion solution. As a corrosion condition, stainless steel has been known to be the most fragile in a solution of 42% MgCl₂heated to the boiling point, therefore the experiment was carried out in this condition. The experiment was carried out with argon gas TIG welding specimens and non-welding ones made of stainless steel plates, thickness 2mm, by tensile force. At this time, the tensile force was taken to be the value of the yield strength of the tensile test specimens divided by the safety factor of 3.0 to 3.5, 4.0, 4.5, and 5.0. In this paper, the relations between Time of Initial Crack, Time of Failure, Time of Final Fracture and Crack Propagation Length were investigated and then plotted. Furthermore, the relations between Stress Intensity Factor K proposed by Irwin and the Time of Initial Crack, the Time of Failure, the Time of Final Fracture were calculated and plotted. At the last, all the relations plotted were expressed to normal equations by computer, and the equations were used to analyse the data obtained in the experiment. The conclusions obtained in this study are as follows: 1. Welding materials, compared with non-welding ones, as the Time of Initial Crack, the Time of Failure, and the Time of Final Fracture were generally very fast, appeared to be a phenomenon of unstable brittleness fracture. 2. Non-welding materials, compared with welding ones, as the safety factor was larger or the working stress was smaller, appeared to be a phenomenon that the longer had had greater durability. Therefor, welding materials must be considered enough to be used in heate affected and stress corrosion atmosphere. 3. The normal equations of the Time of Initial Crack and the variation rate to the same Stress Intensity Factor K are as follows: (A) Non-welding T =259702.4-5451.2 K+28.386 K² T = -5451.2+28.386 K (B) Welding T= -332.693+28.043 K-0.211 K² T' =28.043-0.211 K here, T; Time of Initial Crack, T'; Variation Rate of Time of Initial Crack to Stress Intensity Factor K, K ; Stress Intensity Factor.

직업적 연폭로에서 혈중 연량 수준에 따른 선별검사로서의 혈중 ZPP 검사의 타당도

한구석,안현철,김용배,리갑수,김화성,황규윤,장봉기,이성수,안규동,이병국 순천향대학교 산업의학연구소 1999 순천향산업의학 Vol.5 No.1

In order to evaluate the validity of current screening criteria of lead exposure and to provide effective information for the better health management of lead workers, author investigated the interrelationship between blood lead and blood zinc protoporphyrin(ZPP) and evaluate the validity of blood zinc protoporphyrin as the screening test and blood lead as gold standard of diagnostic test. The total of 2245 lead workers (male workers: 1982, female workers : 263) from 12 lead using industries were studied. Blood lead, ZPP, hemoglobin and hematocrit were selected as lead exposure variables. Personal information on sex, age and work duration were also checked. Blood lead was measured with flameless atomic absorption spectrometry (model: Hitachi 8100) using standard addition method. Blood ZPP was measured with portable hematoflurometer (model: Aviv 206). The results obtained were as follows: 1. The mean blood lead of all lead workers were 0.7±14.3㎍/㎗(Male: 31.0±14.4㎍/㎗, Female: 28.2±12.9㎍/㎗), whereas the mean blood ZPP of those were 68.1±47.5㎍/㎗(Male: 63.9±43.7㎍/㎗, Female: 100.1±61.0㎍/㎗). The mean value of hemoglobin and hematocrit of all lead workers were 14.5±1.5g/㎗(Male: 14.7±1.3g/㎗, Female: 12.3±1.2g/㎗) and 45.4±3.6(Male: 46.2±2.8, Female: 39.5±3.1) respectively. 2. Validity of test using blood zinc protoporphyrin as screening test for blood lead levels of 30㎍/㎗ as gold standard of diagnostic test revealed that the highest validity value for male and female lead workers were 50 and 90 ㎍/㎗ of ZPP respectively, showing 50 and 60 ㎍/㎗ of ZPP for all lead workers. While those test for blood lead levels of 40㎍/㎗ as gold standard of diagnostic test revealed that the highest validity value for male and female lead workers were 60 and 90 ㎍/㎗ of ZPP respectively, showing 60 ㎍/㎗ of ZPP for all lead workers, those test for blood lead levels of 50 and 60㎍/㎗ as gold standard of diagnostic test revealed that the highest validity value for male and female lead workers were 60 or 70 and 100 ㎍/㎗ ZPP respectively, showing 60and 70 or 80 ㎍/㎗ of ZPP for all lead workers. 3. Predictive value of test using blood zinc protoporphyrin as the screening test for different blood lead levels of 30, 40, 50 and 60㎍/㎗ as gold standard of diagnostic test revealed that positive predictive value of screening test were decreased by the increase of blood lead level regardless of csreening criteria value ZPP and negative predictive value of screening test were increased accordingly regardless of screening criteria value of ZPP. On the other hand, within same blood lead level as a gold standard positive predictive values were inceased by the increase of screening criteria value of ZPP, whereas the negative predictive value were decreased accordingly by the the increase of screening criteria value of ZPP. 4. The correlation analysis of all lead workers among study variables revealed that CPbB and natural log transformation ZPP(LZPP) were better correlated with other variables and found to be better estimate than PbB and ZPP themselves. The age was correlated with all other variables, but the work duration was not. The correlation analysis of male and female workers among study variables revealed the same results with all lead workers. 5. The slope of simple linear regression of CPbB (independent variable) with ZPP in female workers(3.223)was steeper than in male workers(2.144). That of lead workers with work duration of less than 1 year was steeper than that of lead workers whose work duration was more than 1 year. But there was no slope difference between two groups divided by their work duration of 2 years less and more. The slope of simple linear regression of CPbB lead (independent variable)with ZPP in lead workers whose blood lead were higher than 30㎍/㎗and 40㎍/㎗ were steeper than those whose blood lead were less than 30㎍/㎗ and 40㎍/㎗. 6. The slope of simple linear regression of CPbB (independent variable) with ZPP in lead industries with low mean blood lead were less steeper than those with high mean blood lead. 7. The slope of simple linear regression of CPbB (independent variable) with LZPP in female workers(0.0308was steeper than in male workers(0.0253). That of lead workers with work duration of less than 1 year was steeper than that of lead workers whose work duration was more than 1 year. But where was no slope difference between two groups divided by their work duration of 2 years less and more. While the slope of simple linear regression of CPbB lead (independent variable) with LZPP in lead workers whose blood lead were hogher than 30㎍/㎗ was not steeper than those whose blood lead were less than 30㎍/㎗, there was no slope difference between two groups whose blood lead were less than 40㎍/㎗ and more than 40㎍/㎗. 8. The slope of simple linear regression of CPbB (independent variable) with LZPP in lead industries with low mean blood lead were less steeper than those with high mean blood lead, but the difference was not significant then that of CPbB and ZPP. With above results, it is recommended that the screening criteria value of ZPP should be down to 60-70㎍/㎗ from 100㎍/㎗ for male lead workers and screening criteria of ZPP for female lead workers was all right with current value of 100㎍/㎗. So it is recommended to make different screening criteria of ZPP for male and female workers like the hemoglobin and hematocrit screening criteria. It is also preferable to use CPbB and LZPP rather than uncorrected PbB and ZPP in the evaluation of lead exposure for lead workers.

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.

동일한 환자에서 조혈모세포이식 전후의 호중구감소 기간 중 감염양상에 대한 비교연구 : 중심정맥관 관련 패혈증을 중심으로 Based on Central Venous Catheter Related Septicemia

류재호,노규태,이영석,이영호,권혁찬,김재석,김효진,이영민,박혜원,박근희 대한조혈모세포이식학회 2002 대한조혈모세포이식학회지 Vol.7 No.1

연구배경: 동일한 환자를 대상으로 조혈모세포이식 전 일반 병실에서의 관해유도 항암제치료 및 강화요법으로 인한 호중구감소 기간의 감염양상과 고용량 항암제치료 후 무균실에서의 조혈모세포이식 시 호중구감소 기간의 감염양상을 중심정맥관 관련 패혈증을 중심으로 비교 연구함으로써 효율적인 감염관리지침을 마련하고자 하였다. 대상 및 방법: 1999년 1월부터 2001년 7월까지 2년 7개월간 동아대학교병원 일반병실에서 악성혈액질환으로 항암제 치료를 받다가 조혈모세포이식을 시행받았던 22명을 대상으로 중심정맥관 관련 패혈증의 형태를 비교분석하였다. 결과: 대상 환자들의 일반병실과 무균실에서의 입원기간은 각각 32±13일, 33±19일, 호중구 감소기간은 15±12일, 17±18일, 호중구 감소기간의 발열 횟수는 14회, 14회로서 입원병실의 종류에 따른 차이는 없었다. 환자들의 중심정맥관 사용일수는 일반병실에서 29일(7~545일), 무균실에서 100.5일(25~606일)이었으며, 총 사용일수는 각각 1,515일, 3,250일로서 무균실에서의 중심정맥관 사용일수가 의미 있게 길었다(P=0.001). 중심정맥관 사용 일수에 대한 감염률은 각각 5.28/1,000일, 3.08/1,000일로서 일반병실에서 그 빈도가 높았으나 통계적 유의성은 보이지 않았다(P=0.141). 결론: 중심정맥관 삽입 후 일반병실에서 항암제 치료를 받던 환자가 조혈모세포이식을 위하여 무균실에 입원하는 경우, 중심정맥관을 교체하는 것이 감염관리를 위하여 바람직할 것으로 생각된다. Background: We compared the incidence of central venous catheter (CVC) related septicemia during neutropenic period in the same patient, which developed following chemotherapy for remission induction and consolidation, or hematopoietic stem cell transplantation (HSCT). Methods: We retrospectively reviewed the medical records and laboratory data of 22 patients with hematologic malignancies who received anticancer chemotherapy followed by HSCT at Dong-A University Hospital between January, 1999 and July, 2001. We investigated the duration of hospitalization, duration of neutropenic period, duration of catheterization, microbiologically documented organisms and incidence of CVC related septicemia. Results: The data in general ward (before HSCT) and laminar air flow room (after HSCT) were as follows: duration of hospitalization was 32±13 days and 33±19 days, duration of neutropenic period was 15±12 days and 17±18 days, median duration of catheterization was 29 days (7~545 days) and 100.5 days (25~606 days) (P=0.001), and incidence of CVC related septicemia was 5.28/1000 days and 3.08/1000 days, respectively. In the CVC related septicemia, the most common etiologic organism was coagulase negative staphylococcus. Conclusion: We suggest that the exchange of CVC before admission to laminar air flow room could decrease the incidence of CVC related septicemia in HSCT recipients.

양측 쇄골하동맥 및 양측 신동맥 협착을 동반한 Takayasu 동맥염 1예

임선호,임수빈,오석규,이재홍,정진원,박양규,박옥규,소병준,노병석 대한순환기학회 1997 Korean Circulation Journal Vol.27 No.8

순차프로그램의 스피드업에 관한 연구

이강두,박석규 진주여자전문대학 1996 論文集 Vol.19 No.-

In this paper, a function was suggested by the Queueing theory and proved for the parallel processing of the nested do-loops from Fortran. To prove its validity on object program was selected randomly, and its analytical results were carefully compared with the calculated results of do-loops. The results obtained are as follows: 1. Though some overheads are necessary for changing the nested do-loops into single ones, they are quite small, compared with the communication cost needed for the parallel processing. 2. The results of the simulation were the sane as the calculated results.

치과용 임프란트의 박막코팅 표면처리

이기대,최석규 대구보건대학 2003 대구보건대학 論文集 Vol.23 No.-

This study was performed to examine the effect of electro-chemical treatment on the precipitation of apatite-like calcium phosphate in simulated body fluid. Titanium plates were polished from #600 to #2,000 sand paper and one surface of each specimen was received an additional polishing sequence through 0.1㎛ alumina paste. To improve the activity of titanium plates, they were electro-chemically treated at 100㎃ for 20min in an electrolyte containing the calcium and phosphate ions, and the temperature of electrolyte was held constantly in the range of 20∼80℃ during the treatment. All specimens were soaked in the (Hanks solution) with pH 7.4 at 36.5℃ for 30 days, and the surfaces were examined with XRD, SEM, XPS. Precipitation of calcium phosphate and CaO were observed on the electro-chemically treated titanium surface in a simulated body fluid after treatment at 600℃. Precipitation of calcium phosphate was densified and coarsened with increasing the temperature of the electrolyte solution in the range of 20∼80℃. The calcium phosphate contained phosphate in the form of PO₄^(3-), HPO₄^(2-) and H₂PO₄^(-1).