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.

흰쥐 시상에서 Epidermal growth factor receptor면역반응 신경세포의 생후 발달에 관한 연구

박영란,정윤영,김종중,문정석,오재욱,정영욱,김주수 조선대학교 2003 The Medical Journal of Chosun University Vol.28 No.1

Background and Objectives : Epidermal growth factor receptor (EGFR), a 170-kDa transmembrane glycoprotein, appears to mediate epidermal growth factor (EGF) activity. Transforming growth factor-α and EGF produce their biological effects in numerous systems by stimulating the EGFR In this study, we examine the postnatal development of EGFR immunoreactivity in the different regions of the thalamus of the rat Materials and Methods : The present study is based on 28 postnatal cases of rat thalamus ranging from the day of birth, postnatal day 0 (P0) to 30 days (P3, P5, P10, P15, P20, P30), and these cases were compared with adult rat thalamus. Cryostat sections were processed free-floating with monoclonal antibody by immunohistochemistry Results : EGFR immunoreactivity in the thalamus of the rat showed very different patterns according to postnatal ages and thalamic areas. EGFR-immunoreactive cells appeared in the first two postnatal weeks, except the ventral posterior thalamic nuclei. In the early postnatal days, EGFR-immunoreactive cells appeared thalamic midline structures, increased progressively in the first two postnatal weeks, and followed mediolateral gradient. The mature patterns of EGFR-immunoreactive cells were achieved at P20 Conclusion : These data indicate that the maturation of EGFR-immunoreactive cells requires a relatively prolonged period of time to achieve an adult configuration. Many growth factors probably play protective or neurotrophic roles at EGFR-immunoreactive neurons of thalamus both young and adult rats In addition to difference in time of appearance in thalamic nuclei and developing pattern with mediolateral gradient suggest that EGFR-immunoreactivities are correlated with the appearance of the related functional.

척수를 손상시킨 후 꼬리정맥에 주입한 사람탯줄혈액세포가 뇌줄기에 미치는 영향

김종중,정윤영,박영란,문영민,현영식,정영욱,문정석 朝鮮大學校 附設 醫學硏究所 2007 The Medical Journal of Chosun University Vol.32 No.1

Background and Objectives: Stem cells are a valuable resource for treatment of many disease, but limited access to stem cells in some organs such as brain restricts their utility. Many approaches have been attempted to restore the function following brain stem injury (BSI) and spinal cord injury (SCI). The use of the human umbilical cord blood cells (hUCB) - a rich source of nonembryonic or adult stem cells - has recently been reported to ameliorate the behavioral consequences of stroke. Mateiials and Methods: Forty rats were divided into 8 groups: (1) SCI l+hUCB (infused 1 day post injury); (2) SCI 2+hUCB (infused 2 days post injury); (3) SCI 3+hUCB (infused 3 days post injury); (4) SCI 4+hUCB (infused 4 days post injury); (5) SCI 5+hUCB (mfusedt 5 days post injury); (6) SCI 6+hUCB (infused 6 days post injury); (7) LO+hUCB (laminectomy+hUCB); and (8) LO (laminectomy only). SCI was produced by compressing the spinal cord for one minute with an aneurysm clip calibrated to a closing pressure of 50 g. We report here that immunhistotochemical identification of fluorescent hUCB positive cells in the brain stem after compressed spinal cord injury using mouse anti-human mitochondria monoclonal antibody (MAB1273). Results: All SCI+hUCB (1-8) groups contained fluorescent hUCB positive cells in the all area of the brain stem. But especially a large number of fluorescent hUCB positive cells were observed in the whole area of the brain stem of the experimental 5 (SCI 5+hUCB) and 6 (SCI 6+hUCB)groups. No hUCB positive cells were found in the brain stem of group with non-injured spinal cord of these animals and group with laminectomy only. Conclusion: These results suggest that hUCB are potentially useful as a vector for treating a variety of the central nervous system disorders, and we are sure that continuous of stem cell study will give an best opportunity to treat the uncurable disorders in the future.

모체 Thyroxine 투여가 태아알코올효과를 가진 흰쥐 대뇌겉질 및 해마에서 NPY함유 신경세포의 생후 발달에 미치는 영향

김복,박상기,박영란,김종중,문정석,김주수,문영민,현영식,천관영,정윤영 朝鮮大學校 附設 醫學硏究所 2005 The Medical Journal of Chosun University Vol.30 No.2

Background and Objectives: Maternal alcohol abuse is considered to be one of the most prominent cause of neurobiological malformations in the postnatal and adult life of the offspring. In this study, we investigated the effects of maternal alcohol drinking on the postnatal development of NPY-containing neuron, and, the influence of thyroxine treatment on the cerebral cortex and hippocampus of pups of alcohol abused mother. Materials and Method: Time-pregnant rats were divided into three groups. Alcohol-fed group A received 35 calories of liquid alcohol diet daily from gestation day 6; control pair-fed group B was fed a liquid diet in dextrin replaced alcohol isocalorically: alcohol + T4 group C received 35 calories liquid alcohol diet and exogenous thyroxine subcutaneously. Results: Group C showed prominent NPY immunoreactivity in the cerebral cortex compared to group A and B at P7. In group C, NPY-containing neurons were widely distributed in the all layers of cerebral cortex after P14. Besides, numerical decrease of NPY-containing neuron as age increases was not found in group C. However, the decrease of NPY-containing neuron was clearly observed in group A compared to group C after P14. In hippocampus, group Band C were appeared similar patterns after P7. Additionally, in group C, NPY immunoreactivity was prominently appeared in CA2 and CA3 at P14 as compared to group B. Conclusions: The present results showed the increase of intensity and number of NPY-containing neurons in cerebral cortex and hippocampus of pups of exogenous T₄ supplemented alcohol-exposed dams as compared to control pair-fed and alcohol-exposed pups at P7. It presumably suggest that NPY-containing neurons might be regulated by the early postnatal growth stimulatory effect of the exogenously supplemented T₄. Therefore, the increase of NPY synthesis caused by maternal administration of exogenous thyroxine may ameliorate fetal alcohol effect, one of the ill effects as a result of the dysthyroid state following maternal alcohol abuse.

척추마취에 적용한 0.2%와 0.5% Plain Bupivacaine의 비교

문봉기,이영석 아주대학교 의과학연구소 1996 아주의학 Vol.1 No.1

Background: The extent of sensory and motor block following subarachnoid injection of local anesthetic is thought to depend on several factors such as total dosage and volume of solution. This study was an evaluation of the effects of varying doses and concentrations of plain bupivacaine: 15㎎ given as 3㎖ of 0.5% or as 6㎖ of 0.25% solution. Methods: In a double-blind trial, 40 patients scheduled for lower extremity surgery were administered, spinal anesthesia using 15 mg bupivacaine, given either as 3.0 ㎖ of plaine 0.5% solution(group 1) or 6ml of 0.25% solution(group 2). The patients were in a lateral position during the injection and for 3 minutes after. Results: 1) No significant differences were found in onset time and uppermost dermatome level of sensory anesthesia between the two groups. 2) The onset time to complete motor block was 11.6±1.2(group 1), 11.0±1.4(group 2)([Mean±SE] minutes) in the nondependent leg and 19.0±l.l(group 1) 18.4±2.0(group 2)([Mean±SE] minutes) in the dependent leg. These differences between nondependent and dependent leg were statistically significant but there were no significant differences between the group 1 and group 2. 3) The systolic and diastolic arterial pressures and heart rate decreased only by about 10 to 15% in both groups; only 3 patients(two in group 1 and one in group 2)required a vasopressor because systolic arterial pressure had decreased by 30% from the preanesthetic value and symptoms resulting from the hypotension and bradycardia were evident. 4) Anesthesia was satisfactory in all patients. Conclusions: In terms of anaesthetic efficacy, there was no significant difference according to either volume or concentration of the plain bupivacaine solution. Either plain 0.25% or 0.5% bupivacaine solution were suitable for lower extremity surgery.

전경대원에서 발생한 결핵의 임상 양상

문창기,박상준,조민구,김영중,김소연,김윤권,정준오,안석진,김은실,서승오,김지훈,최원제,이윤영,박형기,최규영,김현근 대한감염학회 2006 감염과 화학요법 Vol.38 No.6

Background: The purpose of this study was to document the incidence and clinical characteristics of patients with tuberculosis (TB) in combat and auxiliary police, living in a group, in Korea where the incidence rate of active TB in a general population is higher than in Western countries. Materials and Methods:We retrospectively reviewed the medical records of all tuberculosis patients diagnosed at National Police Hospital from January 2002 through December 2004. Results:In 2002-2004, a total of 156 cases of tuberculosis were identified with the mean (Standard deviation) age of 20.6 (±1.0) years. Of these, 134 (85.9%) patients were registered as new cases, 11 (7.1%) as relapse, 2 (1.3%) as failure, 5 (3.1%) as treatment-after-default cases whereas 4 (2.6 %) patients were not included in any categories. Average annual new TB rate and smear-positive TB rate were 86.5/10^(5) and 17.4/10^(5) person-years, respectively. In 12 of 31 smear-positive cases, time from onset of symptoms to diagnosis was more than 30 days. Two multidrug-resistance TB cases were identified and two suspected outbreak episodes of TB had occurred during 3 years. Conclusion:There was no statistically significant difference in the incidence rate of new cases of TB between the general population aged 20 to 29 years and combat and auxiliary police in Korea. 배경 : 국내 결핵의 발생은 감소 추세에 있으나 여전히 후진국형 발생양상을 보이고 있다. 특히 집단생활을 하는 젊은이들에서 발생하는 결핵의 유행이 간헐적으로 알려지고 있어 우려를 낳고 있다. 이에 저자들은 최근 전경대원의 결핵 발병 양상에 대해 알아보고자 본 연구를 시행하였다. 재료 및 방법 : 2002년 1월부터 2004년 12월까지 3년간 경찰병원에서 결핵 진료를 받은 전경대원의 의무기록을 후향적으로 분석하여 연도별 결핵 신환발생률, 도말양성결핵 신환율, 진단 지연, 집단발병, 다제내성결핵을 조사하였다. 결과 : 연도별 결핵 신환자 수(10만명당 발생추정치)는 2002년 50명(83.6명), 2003년 42명(83.7명), 2004년 42명(93.5명)이었고 도말양성 폐결핵 신환자 수는 2002년 10명(16.7명), 2003년 11명(21.9명), 2004년 6명(13.4명)이었다. 3년간 도말양성 폐결핵 환자는 31명이 있었고 그 중 12명은 호흡기 증상 발생 30일이 지나서 진단을 받았다. 다제내성 결핵은 2명이 있었으며 결핵의 집단발병이 의심되는 사례는 2차례 있었다. 결론 : 전경대원과 20-29세 연령군 일반인의 결핵 신환발생률, 도말양성 폐결핵 발생률의 통계적으로 유의한 차이는 없었다.

[논문]EAF Slag 잔골재를 사용한 콘크리트의 황산염침식 저항성에 관한 실험적 연구

박문수,김영수 釜山大學校生産技術硏究所 2008 生産技術硏究所論文集 Vol.67 No.-

본 연구에서는 전기로슬래그를 사용한 콘크리트의 황산염침식 저항성을 평가하는데 그 목적이 었다. 전기로슬래그의 에이징 방법(공기중,촉진에이징) 및 치환율(0,10, 20, 30, 50%)을 달리하여 10% 의 황산마그네숨 용액에 침지한 후 각 재령에 따른 콘크리트의 황산염 침식 저항성을 평가하였다. 각각의 시편에 대한 콘크리트의 압축강도,황산염 열화지수(S.D.F),중량변화율,미세구조를 분석한 결과,촉진에이정 처리한 전기로슬래그가 공기중에이징 처리한 전기로슬래그보다 우수한 성능을 보임을 알 수 있었으며,촉진에이징 전기로슬래그의 치환율이 30% 까지 증가할 수록 황산염 침식 저항성을 우수해 짐을 알 수 있었다.

Increased expression of P53 and Bax in the spinal cords of rats with experimental autoimmune encephalomylitis

문창종,김승준,위명복,김희석,정종태,박전홍,지영흔,Tanumab, Naoyuki,Matsumoto, Yoh,신태균 濟州大學校 農科大學 動物科學硏究所 2000 動物科學論叢 Vol.15 No.1

The expression of pro-apoptotic molecules, p53 and Bax, in the spinal cord of rats with experimental autoimmune encephalomyelitis (EAE) was examined. Apoptosis was confirmed by the terminal deoxynucleotidyl transferasemediated dUTP nick end-labeling (TUNEL) method. TUSEL (+) apoptotic cells were mainly either ED1 (+) macrophages or T-cells in the parenchyma of E N . Western blot analysis showed that both p53 and Bax expression significantly ( p < 0.01) increased in the spinal cords of EAE rats at the peak stage, and thereafter declined. An immunohistochemical study showed that inflammatory cells (notably T cells) in the parenchyma express p53 and Bax, while brain cells, includng neurons and glia, were devoid of these nuclear staining of these molecules. The nuclear expression of p53 largely matches apoptotic cells in the parenchyma of EAE. These finchngs suggest that pro-apoptotic molecules, p53 and Bax, may play an important role in eliminating T cells in the parenchyma in EAE.

수도권의 통행수단별 지역연결체계

남영우,한문희,우광석 한국도시지리학회 2005 한국도시지리학회지 Vol.8 No.1

본고는 사람트립을 분석지표로 통행수단에 따른 수도권의 지역연결체계로 파악되는 지역구조의 파악에 주안점을 두었다. 이를 위해, 본고에서는 직접연결을 고려하는 원자료행렬과 직접연결과 간접연결까지 고려하는 인접행렬에 의한 통행수단별 연결체계를 비교하였다. 그 결과 원자료행렬과 인접행렬의 연결체계는 통행수단별로 상이한 결과를 나타내었다. 즉 원자료행렬과 인접행렬에 의한 연결체계가 승용차통행에서는 각각 11개와 12개, 버스통행에서는 각각 17개와 12개, 지하철통행에서는 각각 3개와 1개, 그리고 총통행에서는 각각 13개와 9개로 추출되었다. 이러한 지역연결체계를 파악함에 있어 직접연결뿐만 아니라 간접연결까지 고려한 인접행렬에 의한 연결체계 분석이 직접연결법보다 효과적인 것으로 나타났다. This paper aims to analyze the regional linkage systems and nodal regional structures of Seoul Metropolitan Area by trip mode using person trip as the analyzing index. The findings from the comparison of the raw data matrix with the direct linkage on the one hand and the adjacency matrix with the direct and indirect matrix on the other are as follows: the regional linkage systems of the raw data matrix and the adjacency matrix differ according to trip mode. The linkages drawn from the raw data matrix and the adjacency matrix are eleven and twelve in car trip, seventeen and twelve in bus trip, three and one in subway trip, and thirteen and nineteen in total mode trip respectively. This shows that the analysis of regional systems based on the direct as well as indirect linkage are more effective than the direct connection method in grasping the regional linkage systems.