한의진단명과 진단요건의 표준화 연구 II (표준화 실례) : 2차년도 연구결과 중간 보고

양기상,최선미,최승훈,안규석,박경모,박종현,김성우,신승호,정우열,전병훈,고현,김정범,신상우,김성훈,김동희,권영규,엄현섭,장혜옥 한국한의학연구원 1996 한국한의학연구원논문집 Vol.2 No.1

The diagnostic requirements were suggested and explained regarding the systems of differentiation of symptoms and signs in the second year study of standardization and unification of the terms and conditions used for diagnosis in oriental medicine. The systems were as follows; - differential diagnosis according to condition of body fluid, differentiation of syndromes according to the state of qi and blood, differential diagnosis according to relative excessiveness or deficiency of yin and yang(氣血陰陽津液辨證) - differentiation of diseases according to pathological changes of the viscera and their interrelation - analyzing and differentiating of febrile diseases in accordance with the theory of the six channels(傷寒辨證) The individual diagnosis pattern was arranged by the diagnostic requirements in the following order : another name(異名), notion of diagnosis pattern, index of differentiation of symptoms and signs(辨證指標), the main point of diagnosis, analysis of diagnosis pattern(證候分析), discrimination of diagnosis pattern(證候鑑別), a way of curing a diseases(治法), prescription(處方), herb in common use(常用藥物), diseases appearing the diagnosis pattern(常見疾病), documents(文獻調査). This study was carried out on the basis of the Chinese documents and references.

Sound Analysis in an In Vitro Endotracheal Tube Model

( Young Sik Park ),( Young Wook Kee ),( Kwang Suk Park ),( Jin Woo Lee ),( Sang Min Lee ),( Jae Joon Yim ),( Chul Gyu Yoo ),( Young Whan Kim ),( Sung Koo Han ),( Seok Chul Yang1 ) 대한내과학회 2011 The Korean Journal of Internal Medicine Vol.26 No.4

Background/Aims: Complete endotracheal tube obstruction is a medical emergency, and partial occlusion causes increased breathing rates and failure to wean off mechanical ventilation. Partial occlusion may be underestimated due to the lack of proper detection methods. We tested whether the sound of an endotracheal tube could be used to detect an endotracheal tube obstruction using an in vitro model. Methods: An endotracheal tube was connected to a ventilator on one end and a test lung on the other. Sounds were recorded with a microphone located inside the endotracheal tube via a connector. During mechanical ventilation, we changed the endotracheal tube internal diameter from 5.0 to 8.0 mm and different grades of obstruction at different sites were used along the tube. Sound energy was compared among the different conditions. Results: The energy of endotracheal tube sounds was positively correlated with the internal diameter and negatively correlated with the degree of obstruction. The rate of decline in energy differed with obstruction location. When the obstruction was more distal, the rate of decline in endotracheal sound energy was more rapid. Conclusions: Changes in the sound of an endotracheal tube can be used to detect an obstruction. Further studies are needed for clinical application.

영골(靈骨).강압혈(降壓穴) 자극(刺鍼)이 혈압(血壓)에 미치는 영향(影向)

임영남,심성용,한지완,고호연,박종형,한양희,전찬용,김동우,Yim, Young-Nam,Sim, Sung-Yong,Han, Ji-Wan,Ko, Ho-Yeon,Park, Chong-Hyeong,Han, Yang-Hee,Chun, Chan-Yong,Kim, Dong-Woo 대한한방내과학회 2004 大韓韓方內科學會誌 Vol.25 No.2

Objective : The purpose of this study is to evaluate the clinical effect of the non-pharmacological anti-hypertension method, acupuncture, for hypertensive patients. Methods : 26 patients diagnosed with hypertension were each treated by one of three methods: an anti-hypertension drug(adalat soft capsule), venepuncture, and acupuncture. In cases of rising blood pressure, patients were treated by their one of the three methods, and blood pressure was measured at regular intervals. Result : As for the group of acupuncture treated patients on Young-gol(ling-gu) and Gang-ap-hyul(jiang-ya-xue), readings dropped 18.0mmHg in systolic blood pressure and 6.50mmHg in diastolic blood pressure. This was a greater effect than that seen in the venepuncture treated patients. Blood pressure checked one hour after acupuncture treatment showed a greater difference than blood pressure checked after thirty minutes. Conclusion : Safe reductions in blood pressure were observed through the non-pharmacological method of acupuncture on Young-gol(ling-gu) and Gang-ap-hyul(Jiang-ya-xue).

포도당과 이소프로테레놀에 의한 시상하부의 소마토스타틴 분비가 갑상선자극호르몬방출호르몬에 의한 갑상선자극호르몬에 미치는 효과

박철영,양인명,오승준,김덕윤,우정택,김성운,김진우,김영설,최영길 대한내분비학회 2000 Endocrinology and metabolism Vol.15 No.4·5

당뇨병성 다발성 신경병증에 대한 Thioctic acid의 유효성 및 안정성에 관한 연구

박철영,김영설,오승준,우정택,김성운,양인명,김진우,최영길 대한당뇨병학회 2001 임상당뇨병 Vol.2 No.1

연구배경: 당뇨병성 신경병증은 당뇨병 환자에서 흔히 나타나는 합병증으로서 임상 증상은 가볍거나 없을 수도 있지만 많은 경우에 통증, 작열감, 이감각증이나 무감각증 등의 증상을 동반하지만, 이에 대한 명확한 기전이나 뚜렷한 치료방법이 없었다. 최근에 신경세포내 산화성 스트레스의 증가로 신경세포의 손상이 발생된다는 기전이 주목을 받으면서, 당뇨병성 신경병증 환자에게 항산화제인 thiotic acid를 사용하여 좋은 효과를 관찰한 논문들이 발표되었다. 이에 저자들은 한국의 당뇨병성 다발성 신경병증 환자에서 thiotic acid를 경구 투여 후에 신경병증에 의한 효과 및 안정성을 평가하였다. 방법: 모든 대상 환자에게 Thioctic acid 600㎎ 을 1일 1회 아침 식전 30분에 8주간 투여하여 당뇨병성 다발성 신경병증에 대한 TSS의 개선여부에 대한 임상적 유효성 및 이상반응, 내약성, 실험실적 지표의 변화를 통한 안정성을 관찰하였다. 결과: 치료시작 전에 관찰한 환자가 호소하는 증상은 통증이 가장 많았으며 무감각, 작열감, 이상감각 순의 빈도를 보였다. 통증, 작열감, 이감각증, 무감각증의 평균 TSS는 1차 방문시 5.8± 1.8, 2차방문시는 4.4±1.7, 3차 방문시는 3.1±1.1로 사용기판에 따라 통계학적으로 유의한 증상의 호전이 있었다. 또한 TSS의 개선 뿐만 아니라 통증, 작열감, 이감각증 및 무감각증 각각의 증상도 치료전과 치료 4주 후 및 치료 8주 후를 비교했을 때 통계학적으로 유의한 증상의 호전이 있었다. TSS가 1차 방문 시와 비교했을 때 3차 방문시에 30% 이상 개선되었을 때(1차 방문시에 TSS 4인 환자는 2점 이상 개선되었을때) 임상적으로 의미가 있는 반응으로 간주하고 계산한 반응률은 71.3%였다. 결론: 당뇨병성 다발성 신경병중 환자에 대해 항 산화제인 thioctic acid 600㎎ 경구 투여요법은 당뇨병성 신경병증의 증상완화에 유용하며, 안전한 것으로 사료된다. Background: The study was peformed to evaluate the efficacy and safety of oral treatment with the antioxidant α-lipoic acid (Thioctcid??) in diabetic patients with peripheral polyneuropathy. Methods: Thioctacid?? 600㎎ was orally administered once a day for 8 weeks in 61 diabetic patients with peripheral polyneuropathy. Neuropathic symptom(pain, burning, paresthesia, and numbness) were scored before, and of 4 and 8 weeks after treatment. In addition, neuropathy by the physician and patients at the end of treatment. The primary endpoint was the response role after 8 weeks treatment, defined as an improvement in the total symptom score of at least more than 30%. Results: Efficacy was evaluated among forty-four patients who had completely the study according to the protocol and safety was evaluated among all of 61 patients who had taken the study medication. The response rate after 8 weeks was 77.3%. The total symptom score was significantly decreased of 4-week, and further decreased of 8-week. All the individual scores for neuropathic symptom were also significantly reduced of 4-week and further decreased at 8-week. Conclusion: These finding indicate that oral treatment with thioctacid?? at a dose of 600㎎/day for 8 weeks will improve peripheral polyneuropathy in diabetic patients, without causing any serious adverse events.

Bromocriptine 과 Cyproheptadine 이 Corticotropin-releasing Factor(CRF) 로 자극된 ACTH 분비에 미치는 효과

김진우,최영길,김영설,김광원,김선우,양인명,윤현구,우정택 대한내과학회 1986 대한내과학회지 Vol.31 No.5

Our study was desinged to observe the ACTH response to ovine CRF in healthy men and to observe the effect of bromocriptine or cyproheptine on ACTH and cortisol response induced by ovine CRF in healthy men. We have hypothesis that if hromocriptine or cyproheptatine inhibits the secretion of ACTH induced by ovine CRF, they decrease the secretion of ACTH in the pituitary level. The result were followings: 1) Plasma ACTH reached a peak of 1.5 and 1.6 times the basal level in response to ovine CRF at 10 min, and 30 min, respectively and decreased to the basal level at 90 min. 2) Cyproheptadine or bromocriptine did not inhibit the response of ACTH to ovine CRF. 3) We suggest that cyproheptadine or bromocriptine does not inhibit the ACTH secretion in the normal pituitary gland.

제2형 당뇨병 남성 환자에서 유리 테스토스테론과 성호르몬 결합 글로블린 농도

남기덕,김영설,박철영,오승준,김덕윤,우정택,김성운,양인명,김진우,최영길 대한당뇨병학회 2002 Diabetes and Metabolism Journal Vol.24 No.6

연구배경:인슐린저항성은 제2형 당뇨병과 심혈관질환의 주요한 위험 인자로 성호르몬과 상호 관계가 있다고 알려져 있다. 그러나 여성과는 달리 남성에서는 연령과 인슐린저항성에 따른 유리 테스토스테론과 성호르몬 결합 글로블린 농도의 변화에 대한 연구가 부족한 실정이다. 그러므로, 본 저자등은 제2형 당뇨병 남성 환자에서 정산인과 비교해서 유리 테스토스테론과 성호르몬 결합 글로블린 농도를 측정하고 연령에 따른 변화 정도를 알아보고자 하였다. 방법:대상 환자 모두에서 연령과 체질량지수, 총 콜레스테롤, 중성지방, 공복혈당과 인슐린 농도를 측정하였다. 혈중 유리 테스토스테론 농도는 방사면역측정법(radioimmunoassay)을 이용해서 측정하였고, 혈중 성호르몬 결합글로불린은 면역방사계측측정법(immunoradiometric assay)을 이용해서 측정하였다(Diagnostic System Laoratories, Wbster, TX, USA). 결과:1)제2형 당뇨병 남성 환자에서 정상 대조군 남성에 비해 성호르몬 결합글로불린은 104.1±35.0 vs 25.7±3.5 mole×10??로 의미 있게 높았으나(p<0.001), 유리 테스토스테론은 13.7±9.5 vs 13.6±6.5 ng/dL로 차이가 없었다. 2)연령과 성호르몬 결합 글로블린 사이의 상관 계수는 제2형 당뇨병 남성 환자에서 0.40로 중등고의 양의 상관 관계를 보였고(p<0.001), 정상 대조군 남성에서 0.11로 유의한 상관 관계를 보이지 않았다. 연령과 유리 테스토스테론 사이의 상관 계수는 제2형 당뇨병 남성 환자에서 0.08, 정상 대조군 남성에서-0.17로 모두에서 유의한 상관 관계를 보이지 않았다. 3)연령과 체질량지수를 보정한 후에 제2형 당뇨병 남성 환자와 정상 대조군 남성에서 혈중 인슐린 농도, 유리 테스토스테론과 성호르몬 결합 글로블린 사이에는 상관 관계가 없었다. 결론:제2형 당뇨병 남성 환자에서 정상 남성에 비해 성호르몬 결합 글로블린 농도가 증가되어 있었으며, 유리 테스토스테론은 차이가 없었다. 연령이 증가함에 따라 성호르몬 결합 글로블린이 제2형 당뇨병 남성 환자에서 정상 남성에 비해 증가 폭이 의미있게 컸으며, 유리 테스토스테론은 변화가 없었다. Background: Insulin resistance is a risk factor for cardiovascular disease and type 2 diabetes mellitus. There are many previous studies indicating that insulin lowers serum sex hormone-binding globulin levels, and there is inverse correlation between insulin resistance and serum sex hormone-binding globulin levels in women. However, in men, a limited number of studies are available to explain the effect of sex hormone on age and insulin. Therefore, the present study was undertaken to investigate the relationship among free testosterone, hormone-binding globulin and age in type 2 diabetic men and control subjects. Method: Age, body mass index, total cholesterol, triglyceride, fasting blood sugar, and insulin concentrations were examined on 89 type 2 diabetic men and 47 control subjects. The free testosterone level was measured by commercially available double-antibody system (Radioimmunoassay). The sex hormone-binding globulin level was also measured by commercially available double-antibody system(Immunoradiometric assay). Results: 1) Sex hormone-binding globulin level was significantly increased in patients with type 2 diabetes. However, there was no significantly difference in free testosterone level between the two groups. 2) Sex hormone-binding globulin was positively correlated with age (r=0.4, p <0.001) in patients with type 2 diabetes. Sex hormone-binding globulin and free testosterone were not correlated with age in control sujects. 3) Free testosterone and sex hormone-binding globulin concentrations were not significantly related to serum insulin concentration after adjusting for age and body mass index. Conclusions: We observed increased sex hormone-binding globulin concentration in diabetes man, and was a positively related to age. Further studies are needed to understand the relationships between age, insulin resistance, testosterone, and sex hormone-binding globulin concentrations(J Kor Diabetes Asso 24:699~707,2000).

정신분열병에 대한 리스페리돈의 효과 및 안정성

이민수,김용구,김영훈,연병길,오병훈,윤도준,윤진상,이철,정희연,강병조,김광수,김동언,김명정,김상훈,김희철,나철,노승호,민경준,박기창,박두병,백기청,백인호,손봉기,손진욱,양병환,양창국,우행원,이정호,이종범,이홍식,임기영,전태연,정영조,정영철,정인과,정인원,지익성,채정호,한상익,한선호,한진희,서광윤 大韓神經精神醫學會 1998 신경정신의학 Vol.37 No.1

연구목적 : 본 시험의 목적은 임상시험 시작전에 연구자들을 대상으로 PANSS Workshop을 통하여 PANSS, ESRS에 대한 국내에서의 표준화 작업을 구축하고 새로운 정신병 치료제인 리스페리돈의 효과와 안정성을 재확인하여 리스페리돈 사용에 대한 적정화를 이루는데 있다. 연구방법 : 1996년 4월부터 1996년 9월까지 국내 39개 대학병원 정신과에 입원중인 혹은 증상이 악화되어 입원하는 정신분열병 환자 377명을 대상으로 다시설 개방 연구를 시행하였다. 1주일간의 약물 배설기간을 가진후, 리스페리돈을 8주간 투여하였고, 기준점, 1주, 2주, 4주, 그리고 8주후에 평가되었다. 용량은 제1일에는 리스페리돈 1mg씩 1일 2회, 제2일에는 2mg씩 1일 2회, 제3∼7일에는 3mg씩 1일 2회 투여하였다. 이후 환자의 임상상태에 따라 임의로 증량할 수 있으며, 최대 일일 16mg을 초과하지 않도록 하였다. 추체외로 증상을 조절하기 위한 투약을 허용하였다. 임상증상 및 부작용의 평가는 PANSS(Positive and Negative Syndrome Scale), CGI(Clinical Global Impression) 그리고 ESRS(Extrapyramidal Symptom Rating Scale)을 사용하였다. 연구결과 : 377명중 343명(91%)이 8주간의 연구를 완결하였다. 치료 종결시점인 8주후 PANSS 총점수가 20% 이상 호전된 경우를 약물 반응군으로 정의할때, 약물반응군은 81.3%였다. 리스페리돈에 반응하는 예측인자로는 발병연령, 이전의 입원 횟수, 유병기간이 관련 있었다. 리스페리돈은 1주후부터 PANSS양성, 음성, 및 일반정신병리 점수상에 유의한 호전을 보여 효과가 빨랐다. CGI의 경우도 기준점에 비해 1주후부터 유의한 감소를 나타내었다. ESRS의 경우, 파킨슨 평가점수는 기준점과 비교해 투여 1주, 2주, 4주후 유의하게 증가되었다가 8주후 기준점과 차이가 없었다. Dystonia 평가점수는 1주후만 유의한 증가를 보였으며, dyskinesia 평가점수는 유의한 차이가 없었다. 혈압, 맥박수의 생명징후 및 일반 혈액학 검사, 생화학적 검사, 심전도 검사에서 유의한 변화는 없었다. 결 론 : 이상의 다시설 개방 임상 연구를 통해 리스페리돈은 정신분열병 환자에서 양성증상뿐만 아니라 음성증상 및 전반적인 증상에도 효과적인 것으로 사료된다. 보다 명확한 평가를 위해서는 다른 항정신병약물과의 이중맹검 연구가 필요할 것으로 생각되며, 또한 장기적 치료에 대한 평가도 함께 이루어져야 하겠다. Objective : The purpose of this study was to investigate the efficacy and safety of risperidone in the treatment of Korean schizophrenic patients. Method : This multicenter open study included 377 schizophrenic patients drawn from 39 university hospitals. After a wash-out period of 1 week, the schizophrenic patients were treated with risperidone for 8 weeks and evaluated at 5 points ; at baseline, and 1, 2, 4 and 8 weeks of treatment. The dose was increased from 2mg/day(1mg twice daily) to 6mg/day(3mg twice daily) during the first week and adjusted to a maximum of 16mg/day over the next 7 weeks according to the patient's clinical response. Medication to control extrapyramidal symptoms was permitted. The psychiatric and neurological status of the patients was assessed by PANSS, CGI, and ESRS scales. Results : 343(91%) of 377 patients completed the 8-week trial period. Clinical improvement, as defined by a 20% or more reduction in total PANSS score at end point, was shown by 81.3% of patients. The predictors of response to risperidone were associated older age, shorter duration of illness, fewer previous hospitalization. Risperidone had rapid onset of action ; a significant decrease of the total PANSS and three PANSS factor(positive, negative, general), and CGI was already noticed at the end of first week. For the ESRS, parkinsonism rating scores were significantly increased until week 4 comparing with baseline. Dystonia rating scores were significantly increased until week 1, and dyskinesia rating scores were not significantly changed during the study. Laboratory parameters including vital sign, EKG, hematological, and biochemical values showed no significant changes during the trial. Conclusions : This study suggests that risperidone is generally safe and effective against both the positive and negative symptoms in our group of patients.

췌장염에 의한 가성낭종내에 생긴 가성동맥류 : 1례 보고

오연희,이채경,김승현,이성우,양창현,이정호,이영현 동국대학교 경주대학 1996 東國論集 Vol.15 No.-

만성 췌장염의 합병증으로 생긴 가성동맥류는 드문질환으로, 반복적으로 다량의 출혈을 일으킬 수 있으며, 치료를 하지 않을 경우 사망율이 높기 때문에, 조기 진단과 치료가 필수적이다. 저자들은 38세 남자 환자에서 췌장염의 합병증으로 생긴 가성낭종내에서 발생한 가성동맥류 1예를 경험하였기에 보고하는 바이다. 가성 동맥류의 색혈류도플러상 낭종내에 양방향 흐름의 와류를 볼 수 있었다. Pancreatic Pseudoaneurysm within Pseudocyst from Pancreatitis: 1 Case Department of Diagnostic Radiology and Internal Medicine, College of Medicine,DongGuk University Yeon Hee OH M.D., Chae Kyeong Lee M.D., Seoung Hyeon Kim M.D., Sung Woo Lee M.D., Chang Heon Yang M.D., Jung Ho Lee M.D., Young Hyun Lee M.D. Pseudoaneurysm from pancreatitis is uncommon, but it can cause recurrent and massive hemorrhage. Because of high morbidity and mortality, early detection and treatment of the pseudoaneurysm is needed. We report a case of pseudoaneurysm within pseudocyst from pancreatitis. Color-flow Doppler sonography shows bidirectional flow and turbulent arterial flow, within anechoic mass.

지문과 정신분열증

우숙희,정국동,최송표,조근자,양은진,김수일,박경란,이영호,김원식 충남대학교 의과대학 지역사회의학연구소 1998 충남의대잡지 Vol.25 No.1

Fingerprint patterns of 333 schizophreniacs who met with the diagnostic criterias of International Pilot Study of Schizophrenia except items associated with chronicity in exclusion criteria were studied, and the following results were obtained. 1. The frequency distribution of the fingerprint patterns in the 333 schizophreniacs was ulnar loop, whorl, twinned loop, arch, radial loop in order in both control and schizophrenia groups. 2. Finger ridge counts of both sexes were decreased significantly in schizophrenia group. 3. Dissociation of fingerprint pattern in the schizophrenia group was 51.1%, which was far greater than 6.25% of control group. Number of dissociation was greatest in the thumb, followed by index, middle, ring, and little finger in order. According to the above results, it is considered that both the number of finger ridges and degree of dissociation of fingerprint patterns were closely related with schizophrenia. Analysis of fingerprints and palmprints with the aid of chromosomal analysis would contribute the early diagnosis and prevention of schizophrenia.