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      • SCOPUSSCIEKCI등재

        Adult Patients with Congenital Muscular Torticollis Treated with Bipolar Release : Report of 31 Cases

        Lee, Gun Sang,Lee, Myung Ki,Kim, Woo Jae,Kim, Ho Sang,Kim, Jeong Ho,Kim, Yun-Suk The Korean Neurosurgical Society 2017 Journal of Korean neurosurgical society Vol.60 No.1

        Objective : We assessed the surgical results of bipolar release in 31 adult patients with uncorrected congenital muscular torticollis (CMT) and more than 12 months of follow-up. Methods : Thirty-one patients underwent a bipolar release of the sternocleidomastoid muscle (SCM) and were retrospectively analyzed. The mean follow-up period was 14.9 months (range, 12-30). The mean age at time of surgery was 30.3 years (range, 20-54). Patients were evaluated with a modified Lee's scoring system, cervicomandibular angle (CMA) measurement, and a global satisfaction rating scale using patient self-reporting. Results : The modified Lee's scoring system indicated excellent results in 4 (12.9%) patients, good in 18 (58.1%), and fair in 9 (29.0%) at the last follow-up after surgery. The improvements in neck movement and head tilt were statistically significant (p<0.05). The preoperative mean CMA was $15.4^{\circ}$ (range, 5.4-29.0), which was reduced to a mean of CMA of $6.3^{\circ}$ (range, 0-25) after surgery (p<0.05). The global satisfaction rating scale was 93.7% (range, 90-100). A transient sensory deficit on the ipsilateral lower ear lobe was noted in three cases. No significant permanent complications occurred. Conclusion : Bipolar release of the SCM is a safe and reliable technique for the treatment of CMT in adults.

      • 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.

      • 비강 및 비인두에 발생한 도립유두종과 편평상피암종의 p53단백 및 세포증식능에 관한 연구

        한주호,윤기중,이재규,신대균,박근호,조향정,문형배 圓光大學校 醫科學硏究所 1996 圓光醫科學 Vol.12 No.2

        The inverted papilloma and squamous cell carcinoma are common neoplasia in the sinonasal cavity and nasopharynx, but the incidence of these tumors are very low and the study on the oncogenesis or biological activity of the tumor cells are not well known. This study was designed to evaluate the oncogenic roles of the p53 gene and the proliferative activity of the tumor cells in the inflammatory polyp, inverted papilloma and squamous cell carcinoma. The experiment was carried by the immunohistochemical stains about the p53 protein, PCNA and Ki-67, histochemical stain about the AgNORs. and flow cytometric analysis about the DNA ploidy using the formalin fixed paraffin embedded tissues. The frequency of the expression of p53 protein was 0%(0/16 cases) in the inflammatory polyps, 18.8% (3/16 cases) in the inverted papillomas, and 87.5%(14/16 cases) in the squamous cell carcinomas. The labelling index(%) of the PCNA and Ki-67 was 5.3% and 3.3% in the inflammatoy polyps, 29.6% and 25.2% in the inverted papillomas, and 51.9% and 36.8% in the squamous cell carcinoma. The expression of the PCNA and Ki-67 was distributed in the periphery of the tumor islands of the inverted papilloma and was distributed in the both of center and periphery of the tumor islands of the squamous cell carcinoma. The number of nuclear AgNORs was increased in the order of inflammatory polyps (0.96), inverted papillomas(1.34) and squamous cell carcinoma(2.09). The frequency of the DNA aneuploidy was 0%(0/16 cases) in the inflammatory polyps, 18.8%(3/16 cases) in the inverted papillomas. and 12.5%(2/16 cases) in the squamous cell carcinomas. Above results indicates that the changes of the p53 gene and proliferative activity of the tumor cells are involved on the oncogenesis and the biological activity of the inverted papilloma or squamous cell carcinoma in the nasopharynx and sinonasa cavity.

      • 筋小胞體의 ATPase Kinetics에 關한 硏究

        朴映淳,李承兩,朴泰水,庾基洙,李 弘,金允坤 圓光大學校 1982 論文集 Vol.16 No.2

        본 연구에서는 토끼 골격근 소포체에서 분리한 근소포체의 ATPase활성에 대한 일반적 특성과 수종의 2가 양이온(??)의 영향에 관한 연구를 하였다. ATPase활성과 Ca uptake에 미치는 2가 양이온의 저해 효과와 저해기작은 Dixon plot, Lineweaver-Burk plot, Hanes-Woolf plot, Woolf-Augustinsson-Hofstee plot, Eadie-Scatchard plot, Arrhenius plot등을 이용하여 분석하였으며 그 결과는 다음과 같다. 1. 근소포체의 ATPase는 ??과 ??의 존재하에서 활성화 되어지며 ??의 농도가 4mM일 때 ??의 최적 농도는 0.1mM이었다. 2. 근소포체의 ATPase는 ??-ATPase와 (??)-ATPase로 구성되어 있고 (??) - ATPase의 활성은 ??-ATPase의 활성보다 높았다. 3. ATPase의 활성화 에너지는 약 19Kcal/mol이었다. 4. ATPase 활성에 미치는 2가 양이온은 12.5㎛과 400㎛의 범위 내에서 이온 농도가 증가됨에 따라서 활성도는 점점 감소되었다. 5. ATPase활성율 50% 저해시키는데 2가 양이온의 농도는 Ki값과 같아서 ??, ??, ?? Pd ??에 대한 각각의 농도는 10㎛, 30㎛, 130㎛ 및 350㎛이었다. 특히 ??은 저 농도에서 (12.5-100㎛)는 활성제로, 고농도에서 (200-400㎛)는 저해제로 작용하는 것 같다. 6. 2가 양이온은 ATPase의 Km에는 변화를 주지 않으나 Vmax의 저하를 일으키는 것으로 보아 비경쟁 저해제임이 판정되었다. 7. 2가 양이온은 가역적 저해제임이 판명되었다. 8. Ca 吸收能에 대한 CuCl₂의 阻害는 50~500㎛의 CuCl₂농도에서 현저히 나타났으며 이 현상은 Ca 吸收能과 ATPase 活性과 밀접한 관계를 보여주는 것이다. General properties of the ATPase and the effects of the divalent cations (??) on the total ATPase activity of the fragmented sarcoplasmic reticulum (FSR) isolated from rabbit skeletal muscle were investigated in the present resent research. The inhibitory effect of divalent cations on the FSR ATPase activity and its mechanism were analyzed by various plots such as Dixon plot, Lineweaver-Burk plot, Hanes-woolf plot, Eadie-Scatchard plot and Arrhenius plot. The results obtained were as follows: 1. The FSR ATPase is activated by ?? and ??; the optimum concentration of is 0.1 mM in the presence of 4 mM MgCl₂. 2. The FSR ATPase could be distinguished as ??-ATPase and (??)-ATPase. The activity of (??)-ATPase predomiant over that of ??-ATPase. 3. The apparent energies of activation for total ATPase was approximately 19Kcal/mole. 4. The inhibitory effects of the divalent cations on the enzyme activity increased as the concentrations of the divalent cations increased in the concentrations between 12.5 and 400㎛. 5. Concentration of 50% inhibition for each divalent cation was almost identical with the inhibition constant (ki). The Ki's were 10,30,130, and 350㎛ for ??, ??, ??, and ??, respectively. ?? seemed to be anactivator at lower concentrations and an inhibior at higher concentratios. 6. The divalent cations did not change the Km but decreased the Vmax of the FRS ATPase, suggesting that they are noncompetitive inhibitors on the FSR ATPase. 7. The divalent cations were also found to be revesible inhibitors on the FSR ATPase. 8. The inhibitory effect of CuCl₂on a uptake increased as the concentration CuCl₂increased in the range between 50㎛.

      • 당뇨병과 동반된 화농성 간농양의 임상상 및 예후인자

        오은숙,강무일,이원영,오기원,임동준,이소영,이정민,고승현,김성래,안유배,손현식,윤건호,차봉연,이광우,손호영,강성구 대한당뇨병학회 2000 임상당뇨병 Vol.1 No.1

        연구배경: 감염질환은 혈관질환과 함께 당뇨병의 중요한 사망원인의 하나이며, 혈당조절이 불량할수록 감염 빈도가 증가됨은 잘 알려져 있다. 간농양의 발생이 있어서도 당뇨병은 중요한 기저질환 중의 하나이다. 일반적으로 간농양의 가장 흔한 원인균은 Escherichi coli라고 알려져 있으나, 최근 당뇨병을 가진 간농양 환자에서 Klesiella pneumoniae의 검출이 증가되고 있다. 또 최근 연구에 의하면 K.pneumonie가 간농양의 가장 흔한 원인균이며, K. pneumoniae에 의한 간농양은 K.pneumoniae 이외의 균주에 의한 간농양보다 당뇨병과 밀접히 관련되어 있다고 보고된 바 있다. 이에 저자들은 간농양 환자를 대상으로 당뇨병환자의 빈도를 알아보고, 그 원인균 및 특징을 비당뇨병 환자들의 경우와 비교해 보고자 하였다. 방법: 1992년 1월부터 1999년 6월까지 방사선학적 검사 혹은 수술에 의해 간농양이 확인되거나, 경피적 천자나 수술을 통한 배농액 배양, 혹은 혈액 검사에서 원인균이 증명된 182명의 환자를 대상으로 후향적 임상고찰을 실시하였다. 결과: 화농성 농양을 가진 167명의 환자(남:94명, 여:73명)중 당뇨병을 가진 환자는 54명 (남:30명, 여:24명)으로 32.3%를 차지하였다. 환자의 평균나이는 당뇨군에서 62.1 ± 13.4세, 비당뇨군에서는 55.1 ±15.5세로 당뇨군에서 높았으며(p=0.0021), 남녀간의 평균나이 비교 시 두 군 모두 여성의 나이가 의미있게 높았다. 비당뇨군에 비하여 당뇨군의 경우 저알부민혈증의 빈도와 aspartate transaminase가 증가되어있었다. 원인균주는 K. pneumoniae (당뇨군54%, 비당뇨군 39.1%), E. coli(당뇨군 17.5%, 비당뇨군 18.8%), Pseudomonas aeruginosa, Streptococcus viridans, Enterococcus 순이었으며 두 군간의 의미는 차이는 없었으나 K. pneumoniae의 경우 다른 균종에 비해 단독감염의 빈도가 높았다(82.8%). 사망률은 당뇨군에서 16.7%, 비당뇨군에서 7.1%로 당뇨군에서 의미있게 높았으며(p=0.019), 당뇨군에서의 사망환자는 모두 패혈증이 동반되어 있었다. 당뇨환자의 사망군은 생존군에 비해 당뇨병 이환기간이 길고 혼합감염의 빈도가 높았다(p=0.046). 검사실 소견에서는 총 빌리루빈 및 알카리성 포스파타제의 증가가 관찰되어 있었다. 결론: E. coli가 간농양의 주된 원인균이라는 기존 보고와는 달리 당뇨군과 비당뇨군 모두 K. pneumoniae가 간농양의 주된 원인균이었다. 또한 당뇨 유병기간이 길고 당뇨조절이 불량한 환자에서 혼합감염이며 총 빌리루빈 및 알카리성 포스파타제의 증가등과 같은 위험인자가 존재할 경우 사망률이 증가될 수 있으므로 이들 군에서는 적극적인 치료가 필요할 것으로 사료된다. Background: Liver abscesses are commonly associated with underlying disease, particularly diabete mellitus. The number of the liver abscesses caused by Klebslella pneumoniae in diabetic patient has been increased in Korea nowadays. This study was conducted to clarify the clinical presentation and prognostic factors of pyogenic liver abscesses, especially in diabetic patients and to determine the proportion of K. pneunomiae as a pathogen in liver abscess in Korea. Methods: Medical records of 167 patients treated for pyogenic liver abscess from January, 1992 through June, 1999 were reviewed retrospectively in detail. Major Pathogenic organism, clinical manifestations, prognostic factors, the importance of diabetes mellilus as an underlying disease and its effect on clinical features and prognosis were analyzed. Results: Among 167 cases of pyogenic liver abscess, underlying diabetes mellitus was present in 32.3%. The mean age of patients was 62.7 13.4 years in diabetic liver abscess group and 55.1 15.5 years in non-diabetic liver abscess group. Most liver abscesses were cryptogenic in origin or secondary to the billary tree diseases. The clinical presentations among the two groups were not significantly different. When compared to patients without diabetes, patients with diabetes had significantly higher proportions of hypoalbuminemia and elevated aspartate transaminase level. The most common organism of the pyogenic abscess was K. pneumoniae in both groups. Percutaneous drainage of the abscess with appropriate antibiotics was the most commonly used therapeutic modality in liver abscess. The mortality rate of diabetic liver abscess is 16.1 % and 7.1% in nondiabetic liver abscess. Complications, especially septicemla, were found more frequently in patients with diabetes than in patients without diabetes (64.8% vs 28.3%, septicemia : 31.5% vs 9.7%). The factors influencing mortality in the diabetic liver abscess were disease duration, mixed infection, presence of septicemia, elevated bilirubin and alkaline phosphatase. Conclusions: In contrast to prior report that the E. coli was the most common pathogen in liver abscess, we found that K. pneumoniae was the most common organism cultured in liver abscess. Diabetic patients have more complications and higher mortality than patients without diabetes. Early detection and proper treatment are needed to improve the outcome for diabetic patient with liver abscess.

      • Focal adhesion kinase and src expression in premalignant and malignant skin lesions

        ( Ju Yeon Choi ),( Jae Yun Lim ),( Han Saem Kim ),( Jung Min ),( Jung In Kim ),( Hyun Min Seo ),( Sang Hyeon Hwang ),( Chong Won Choi ),( Yoon Hwan Kim ),( Jin Hee Sohn ),( Hyunjoo Lee ),( Won Serk Ki 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.2

        Background: Focal adhesion kinase (FAK) and Src are non-receptor tyrosine kinases. FAK and Src play a critical role in inducing malignant transformation in tumor cells. Objectives: We performed immunohistochemical staining for total and phosphorylated forms of FAK and Src, to evaluate the role of FAK and Src in the development of premalignant and malignant skin lesions. Methods: A total of 59 facial skin samples (30 actinic keratoses, 10 Bowen``s diseases, 13 squamous cell carcinomas and six perilesional skins) were immunohistochemically stained for Ki-67, total (t) and phosphorylated (p) form of FAK and Src. Methods: A total of 59 facial skin samples (30 actinic keratoses, 10 Bowen``s diseases, 13 squamous cell carcinomas and six perilesional skins) were immunohistochemically stained for Ki-67, total (t) and phosphorylated (p) form of FAK and Src. Results: Cells positive for t-Src, p-Src-y530, t-FAK and pFAK-s722 were detected in premalignant intra-epithelial lesions (PELs) and squamous cell carcinomas (SCCs), but not in the perilesional skin. There was a tendency towards high correlation between Ki-67 and t-FAK or pFAK-s722, suggestive of the active role of FAK in cell proliferation. Conclusion: Our findings of higher t-Src and p-Src-y530 positive cells in PELs, as compared to SCCs (with higher Ki-67 level), are suggestive of the other role of Src in tumor formation and progression, which requires further investigation.

      • KCI등재

        초음파 영상 데이터를 활용한 내장기 추나요법 시술 부위 탐색 연구

        이상진 ( Sang-jin Lee ),기성훈 ( Sung-hoon Ki ),고동균 ( Dong-kyun Koh ),이상훈 ( Sang-hun Lee ),임형호 ( Hyoung-ho Lim ),송윤경 ( Yun-kyung Song ) 한방재활의학과학회 2022 한방재활의학과학회지 Vol.32 No.2

        Objectives This study was conducted to confirm anatomical information near the treatment areas of visceral chuna manual therapy and to secure stability and effectiveness during the treatment. Methods For 50 healthy adult men and women, a total of 13 ultrasound images were taken of the 7 treatment areas which are the representative treatment areas of visceral Chuna manual therapy. Results The treatment area of the bottom of the liver can be palpated around the right side ST19 and CV14. The treatment area of the gallbladder and the common bile duct can be palpated around the right side SP16 and ST20. The treatment area of the cardia and the pylorus can be palpated around the left side KI21, right side ST20, ST21, KI19, KI20, CV12, and CV13. The origin point of the mesentery root can be moved to the left and lower left from CV12 and can be palpated. The treatment area of the ileocecal valve and the cecum can be palpated around the right side SP14. The treatment area for the colic flexure can be palpated around the both side LR13. The treatment support point for the kidneys can be palpated around both side BL51. Conclusions It is thought that if the ultrasound image data from the meridians around the treatment site is used as an auxiliary, it will be more effective in terms of safety and effectiveness during the treatment of visceral Chuna manual therapy. (J Korean Med Rehabil 2022;32(2):139-154)

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