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.

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.

영구형 항서맥 심박조율기 환자의 장기추적관찰

최현석,이무용,최영진,최성준,김효수,손대원,오병희,이명묵,박영배,최윤식,이영우,이명용 대한순환기학회 1998 Korean Circulation Journal Vol.28 No.5

FET형 반도체 마이크로센서 개발(Ⅱ)

손병기,이흥락,박이순,조진호,이성필,최평,서화일,고성택,박재윤,서장수,김창수 경북대학교 센서기술연구소 1994 연차보고서 Vol.1994 No.-

현재 의료진단, 화학공정의 모니터링이나 환경공학적 감시 및 제어 등의 분야에서 사용되고 있는 기존의 센서는 고가이며 용적이 클 뿐만 아니라 분석시간이 길고 사용하기 까다로운 것 등 여러 가지 문제점이 있다. 또한 측정환경에 영향을 주지 않을 만큼 충분히 작으며 빠른 분석시간을 가진 센서를 필요로 하고 있다. 본 연구에서는 기존의 센서들의 난점을 극복할 수 있는 새로운 형태의 FET형 전해질(electrolyte : H^+, K^+, Ca^2+, Na^+)분석 시스템, 용존가스(O_2, CO_2)분석 시스템의 개발을 중점적으로 추진하며, FET형 압력센서, 습도센서, 방사형 온도센서 등의 개별 FET형 센서에 관한 연구도 병행하고자 한다. Recently various kinds of sensors have been developed, being applicated to their own purpose. There are lots of difficulties to apply them to measurements in which the real-time monitoring is required without disturbing the surrounding environment. FET type semiconductor sensors, fabricated by the semiconductor integration technologies, have many advantages for their miniaturization, standardization, mass-production and in vivo/in situ monitoring. They also hold a very proper configuration for multi-functional sensors or integrated smart sensors, and wide availability by forming various kinds of physical or chemical sensing materials onto their sensing gates.

요골동맥을 이용한 관동맥 조영술의 유용성

윤정한,이승환,이한요,김장영,김일회,최윤종,이형준,이명옥,김승년,황성오,홍인수,최경훈 대한순환기학회 1998 Korean Circulation Journal Vol.28 No.10

방광 크롬친화세포종과 동반된 배뇨후 벼락두통

하윤석,강성진,허소영,이지현,김민정,김종국,김광수 고신대학교 의과대학 2009 고신대학교 의과대학 학술지 Vol.24 No.1

Thunderclap headache is a hyperacute, severe headache that is so named because the pain strikes suddenly and severely, and is sometimes a sign of a medical emergency. We report a case of pheochromocytoma in the urinary bladder in a 48-year-old woman who presented with recurrent thunderclap headache after voiding and exercise. So we think thunderclap headache during or immediately after micturition may be an important diagnostic clue of bladder pheochromocytoma.

CaO-SiO₂계 수열반응의 속도론적 고찰

이희수,정윤중,신현택 연세대학교 대학원 1980 延世論叢 Vol.17 No.1

For the study of kinetics and the rate determining stage on the hydrothermal reaction between CaO-SiO2 and CaO-SiO2-slag systems, the mole ratio of CaO/SiO2 was made to be 0.8 and slag was combined with same weight percentage of CaO/SiO2 mixture. For this study, discs were piled up one on another compactly for intercepted the steam penetration, exept one direction, and had autoclave treatment for 2,6, 10, 14 and 24 hrs. at reaction temperature 80,152 and 181℃. Contents of free lime and free silica were detected by quantitative analysis for the reaction conversion. And from this result reaction constant and activation energy were calculated. It was found that the rate determining stages are changed from phase boundary controlled reaction to diffusion controlled reaction in process of 10 hrs. at reaction temperature 80 and 152℃ for CaO-SiO2 system and at 152 and 181℃ for CaO-SiO2-slag system. And also was found that activation energy for CaO-SiO2 system is 6.6 kcal/mole and for CaO- SiO2 - slag system is 12.2kca1/mole.

방광파열의 진단에서 전산화단층촬영술의 의의

이윤길,김현수,오태희 大韓應急醫學會 1998 대한응급의학회지 Vol.9 No.4

Background: Computerized tomography(CT) is the method of choice for establishing patients with abdominal and/or pelvic trauma. However, the sensitivity of CT for detecting bladder rupture has been questioned. We investigated the roles of CT as the initial evaluation of abdominal and pelvic trauma in diagnosis of bladder rupture. Methods: We reviewed the medical records and radiographs of 53 patients with bladder rupture for last 5 years. And among them, all radiographs of 30 patients who underwent both CT and retrograde cystography were evaluated independently by two urologists who had no knowledge of the patients' final diagnosis. Results: Among 30 patients, all of patients were correctly diagnosed by retrograde cystography, but the CT diagnosis was correct in only 23 patients(76.7%), who were 17 patients(85.0%) with intraperitoneal rupture and 6 patients(60%) with extraperitoneal rupture. And of the 7 patients who were negative by the CT, all showed the sign of inadequate bladder distension. Conclusion: We suggest that CT, if properly performed with adequate bladder filling, is as sensitive for detection of bladder injuries as conventional cystography. Especially, in trauma patients with hematuria and suspected other organ injury, CT-cystography with retrograde filling may be as accurate as conventional cystography and obviate the need for an additional plain film cystography.

Platon의 政治哲學 : 그의 正義槪念을 中心으로

李壽允 弘益大學校 1976 弘大論叢 Vol.8 No.-

Political thought begins with the Greeks. The basic problem of Greek political pbilosophy was the concept of justice. Plato pursued this problem in accordance with the Greek tradition. The concept of justice in Plato divided in two principles. The first is the principle of specialization. The second is the principle of mean. The two principle are not quite separate, but are closely related. The relation shows the develepment of Greek philosopaby before plato. For the milesians justice means the non-intervention between different elements. The principle of the specialization depends on it. The concept of justice in the milesian was modified by Pythagoras. He found a spot which could satisfy all the different elements, and called it the mean The second principle of Platos concept of justice reflects this and this principle of mean has been the fundamental idea of all the western political thought.

소장 질환이 의심되는 환자에서 캡슐내시경과 CT 소견의 비교

이성수,홍성숙,김정훈,김연수,김진오,권석범,박성태,장윤우,최득린,권귀향 순천향의학연구소 2007 Journal of Soonchunhyang Medical Science Vol.13 No.1

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