스트레스 대처방식이 조혈모세포 이식 환자의 우울과 불안에 미치는 영향

윤수정,이철,임성후,채정호,전태연,김광수 한국정신신체의학회 2002 정신신체의학 Vol.10 No.1

사망 진단서(시체 검안서) 작성의 문제점

김규석,임용수,이중의,서길준,윤여규,어은경,염석란,정연권,이윤성 대한응급의학회 2000 대한응급의학회지 Vol.11 No.4

Background: This study was conducted to analyze the current problems in completing death certificates and to identify the correct method for completing death certificates Methods: We reviewed 262 death certificates in three hospitals from March 1 to April 30, 2000, and 119 death certificates in one hospital from March 1 to 31, 2000. We identified major and minor errors and analyzed and compared them retrospectively. Results: A total of 381 death certificates were reviewed: 59 in Seoul National University Hospital,101 in Ewha Woman's University Hospital, and 102 in Gachon Medical College Hospital, which has no education program for completing death certificates in postgraduate training, and 119 in Samsung Medical Center which has an education program for completing death certificates. 358 certificates(94.0%) had at least one error. There were only 23 death certificates(6.0%) without an error. In 182 cases(47.8%), there was one major error. In 321 death certificates(84.3%), there were more than two errors. A comparison of Samsung Medical Center with the other hospitals showed that the number of total errors was statistically different(p=0.001). Conclusion: There were few death certificates without an error in this study. In a hospital which has postgraduate training in completing death certificates, there are fewer errors than in other hospitals which have no training course. Emergency physicians actually certify many deaths, so they must know the correct method of completing death certificates for statistics on morbidity and mortality.

기분장애를 주소로 내원한 Binswanger씨 병 1례

채정호,전태연,윤수정,최성빈,김대진,김광수 대한생물치료정신의학회 2000 생물치료정신의학 Vol.6 No.1

We report a 70 year-old man with Binswanger's disease associated with mood symptoms. He was apparently well until 15 years ago when the treatment-resistant atypical mood symptoms had been appeared. He showed a fluctuating course in mental disturbance, such as irritable and labile affect, emotional incontinence, and irritable behavior. Two years ago, he was diagnose as hypertension, renal failure, and heart failure. He was admitted to psychiatric ward due to irritable mood, dysarthria, lack of bladder control, gait disturbance, and impulsive behaviors, which had been aggravated during the last 2 months. In physical examination, he had hypertension and both pretibial pitting edema was revealed, and also in neurological examination, exaggeration of deep tendon reflexes and weakness of extremities were found. On mental status examination, he showed irritable and labile mood with mild cognitive disturbances. Brain MRI demonstrated multifocal high signal intensity in periventricular white matter, both basal ganglia, and thalami on the T2 imaging. These findings were compatible with Binswanger's disease with mood symptoms.

유도초음파를 이용한 2.25Cr-1Mo재의 열화도 평가

박익근,박은수,이상용,권숙인,조윤호,윤승현 한국비파괴검사학회 2001 한국비파괴검사학회지 Vol.21 No.4

고온에서 장시간 사용으로 인하여 발생되는 경년열화 평가에는 파괴적인 방법이 신뢰성이 높지만 시험편 채취의 어려움이 있다. 그러므로 비파괴적인 방법에 의한 열화도 평가가 바람직하다. 본 연구에서는 2.25Cr-1Mo강에 대하여 장시간 등온열처리로 모의 열화시험편을 제작하여 고온설비부재에서 발생되는 탄화물의 석출 및 조대화, 불순물의 입계편석 등 금속학적 미세조직을 관찰하고, 미세조직의 변화와 유도 초음파의 전파특성과의 상관관계를 규명하고, 파괴시험치와 그 결과를 비교하여 초음파 비파괴평가에 의한 고온부재의 열화도 평가의 가능성을 실험적으로 검증하고자 한다. The destructive method is reliable and widely used for the estimation of material degradation but, it have time-consuming and a great difficulty in preparing specimens from in-service industrial facilities. Therefore, the etimation of degraded structural materials by nondestructive evaluation is strongly desired. In this paper, the use of guided wave was suggested for the evaluation of thermally damaged 2.25Cr-1Mo steel as an alternative way to compensate for limitations of fracture tests. The observation of microstructure variations of the material including carbide precipitation increase and spheroidization near gain boundary was conducted and the correlation with the guided wave features such as energy loss ratio and group velocity changes was investigated. Through this study the feasibility of ultrasonic guided wave evaluation for thermally damaged materials was explored.

노인에서 신체질환과 불면증 간의 전향적 연관성

김재민,김성완,양수진,김선영,배경열,조준영,윤탁,신일선,윤진상 大韓神經精神醫學會 2008 신경정신의학 Vol.47 No.5

Objectives : This study aimed to investigate the associations between physical disorders and prevalent/incident insomnia m a community dwelling older population. Methods : 1,204 people aged 65 or over evaluated at baseline. Insomnia was defined as difficulty in initiation or maintenance of sleep on at least three nights per week over the last month. Reported physical disorders covering 11 common and generally chronic health problems were ascertained. Covariates included were age, gender, education, housing, Past occupation, current employment, and depression. Of 879 without insomnia at baseline, 651 (74%) were followed 2 years later, and incident insomnia was evaluated. Results : Prevalent insomnia was significantly associated with 10 of 11 physical disorders. Incident insomnia was associated with 2 physical disorders : eyesight problems and hearing difficulty. Both prevalent and incident insomnia were significantly associated with increased number of physical disorders. Conclusion : Certain physical disorders were comorbid and precipitating factors of insomnia in elders.

당뇨병 환자에서 혈장 Thrombin-Antithrombin Ⅲ 및 Plasmin-α_2-Plasmin Inhibitor 복합체의 임상적 의의

김경욱,김은숙,정상수,윤수지,박우일,이준희,남수연,안철우,문병수,김경래,차봉수,송영득,임승길,이현철,허갑범 대한당뇨병학회 2002 Diabetes and Metabolism Journal Vol.25 No.5

연구배경:당뇨병 환자에서 혈액응고 및 섬유소용해 체계의 이상경향이 있어 그 결과로 여러 혈관합병증의 발생위험이 높다는 사실은 널리 알려져 있다. 그 기전은 아직 확실히 밝혀지지 않았으나, 고혈당으로 인한 혈장 단백질들의 비효소성 당화작용이나 산화성 스트레스로 인한 유리 라티칼 작용으로 응고항진이나 섬유소용해 활성의 저하를 유발하는 것으로 생각되고 있다. 최근 응고 및 용해인자와 그 억제자의 복합체들의 증가가 이 상태를 비교적 예민하게 반영한다고 알려져 있다. 방법:본 연구에서는 당뇨병 환자 101명과 정상 대조군 20명에서 혈장내 thrombin­antithrombin complex(TAT)와 plasmin­α₂­plasmin inhibitor complex(PIC)를 측정하여 비교하고, 당뇨병 환자에서 미세혈관 합병증과 대혈관합병증의 유무에 따른 차이와, 이미 혈관 질환의 위험인자로 알려져 있는 인자들간의 상관성을 알아보고자 하였다. 결과:1. 환자의 분포를 살펴보면 혈관합병증이 있는 군은 85명, 혈관합병증이 없는 군은 16명이었고, 평균연령은 각각 57.9±14.1세, 49.9±16.6세로 혈관 합병증이 있는 군에서 더 나이가 많았고, 체질량지수는 23.2±3.4㎏/㎡, 24.1±3.4㎏/㎡로 두 군간 유의한 차이는 없었다. 또 두 군간의 혈압 및 HbA1c, 공복혈당 및 인슐린과 C­peptide, 총 콜레스테롤, 중성지방, HDL­콜레스테롤, Lp⒜는 유의한 차이가 없었고, 미세혈관합병증이 있는 군에서 당뇨병의 유병기간이 길었다. 2. TAT 및 PIC의 농도는 정상 대조군에서는 2.8±1.2 ng/mL, 240.4±69.7 ng/mL이었고, 당뇨병 환자군에서는 9.5±22.6 ng/mL, 472.2±258.7 ng/mL이었다. TAT와 PIC 모두 당뇨병 환자군에서 정상 대조군에 비해 유의하게 증가되어 있었고(p<0.001), TAT/PIC ratio는 두 군간 차이가 없었다. 3. 당뇨병 환자의 혈관합병증에 따른 TAT 및 PIC, fibrinogen 농도는 합병증이 없는 군은 각각 4.1±2.4ng/mL, 362.2±272.0ng/mL, 322.7±102.4mg/mL으로 PIC와 fibrinogen의 증가를 보였으나, 연령을 보정한 후에는 통계학적 유의성은 없었다. 또 대혈관 합병증군에서는 각각 6.0±4.9 ng/mL, 507.4±321.6 ng/mL, 427.1±194.7 mg/dL이었으며 미세·대혈관 합병증군에서는 10.4±6.4 ng/mL, 484.8±269.7 ng/mL, 388.4±132.4 mg/dL으로 TAT의 증가를 보였으나 역시 연령을 보정한 후에는 통계학적 유의성은 없었다. 4. 미세혈관합병증군에서 HbA1c(>8%)가 높은 군의 PIC 농도가 유의하게 높았고(p=0.049), 대혈관합병증군에서 HbA1c(>8%)가 높은 군의 총 콜레스테롤 농도가 유의하게 높았다(p=0.042). 5. 총 당뇨병 환자군에서 PIC는 fibrinogen과 HbA1c와 양의 상관관계를, BMI와 음의 상관관계를 보였으며(r=0.47, 0.31,-0.25), 혈관 합병증이 없는 당뇨병 환자군에서만 TAT는 HbA1c와 양의 상관관계를 보였다(r=0.67). 결론:이상의 결과에서 혈장 TAT 및 PIC 농도는 당뇨병 환자에서 정상 대조군에 비해 의미있게 증가되어 있었고, 당뇨병 환자군에서는 연령의 증가와 유병기간이 혈액응고항진 및 용해의 장애에 큰 역할을 함을 알 수 있었으며, 총 당뇨병 환자군에 PIC와 HbA1c와 양의 상관관계를, BMI와 음의 상관관계를 보였으며 혈관 합병증이 없는 당뇨병 환자군에서만 TAT는 HbA1c와 양의 상관관계를 보였다. 따라서 당뇨병 환자에서 혈액응고 및 용해의 장애가 동반되어 있다고 볼 수 있으며, 혈장 TAT 및 PIC는 혈관합병증으로의 진행을 예측하는 지표로서 유용하리라 생각된다. 또 혈당조절정도와 상관성이 있으므로 혈당조절후에 추적검사를 시행하여 합병증의 예방이 가능한지 추후 연구가 필요하리라 생각된다. Background : Abnormality of coagulation and fibrinolystic system is known as a predisposing factor of vascular complication in diabetes. Although the pathogenesis is not well known, non-enzymatic glycation reaction and the increase in production of free radicals due to an increased oxidative stress may be linked to the hypercoagulibility and hypofibrinolytic activity. As indices of abnormality in coagulation and firinolysis in peripheral blood, plasma thrombin-antithrombin Ⅲ complex (TAT) and plasmin-α_2-plasmin inhibitor complex (PIC) were measured. The purpose of this study was to clarify whether hypercoagulability exists in diabetic patients with or without vascular complication. Methods : In our study, we measured plasma thrombin-antithrombin Ⅲ compelx (TAT) and plasmin-α_2-plasmin inhibit or complex (PIC) in 101 diabetic subjects and 20 controls. Comparing TAT and PIC levels in diabetic microvascular complication group, diabetic macrovascular complication group and controls, we examined correlation between risk factors associated with diabetic vascular complication. Results : 1. The group with diabetic vascular complication was older than group without complication. There was no significant difference in BMI, blood pressure, HbA_ic, blood sugar level, insulin, C-peptide, serum creatinine, total cholesterol, triglyceride, HDL-cholesterol, Lp (a) between two groups. The group with diabetic microvascular complication had longer duration of diabetes. 2. Concentration of TAT and PIC were 2.8±1.2 ng/ mL, 240.4±69.7 ng/ mL in controls and 9.5±22.6 ng/ mL, 472.2±258.7 ng/ mL in diabetic patients, respectively. TAT and PIC were significantly higher in diabetic patients than in control (p<0.001). But TAT/PIC ratio was no significant difference between two groups. 3. In diabetic patients, concentration of TAT and PIC and fibrinogen were respectively 4.1±2.4 ng/ mL, 362.2±272.0 ng/ mL, 322.7±102.4 mg/ dL in group without vascular complication and 5.3±4.1 ng/ mL, 529.5±258.7 ng/ mL, 374.9±106.2 mg/ dL in group with microvascular complication, which group had increase in PIC and Fibrinogen but no significance after correction of age. Concentration of TAT and PIC and Fibrinogen were 60.±4.9 ng/ mL, 507.4±321.6 ng/ mL, 427.1±194.7 mg/ dL in macrovascular complication, and 10.4±6.7 mg/ mL, 484.8±269.7 ng/ mL, 388.4±132.4 mg/ dL in combined vascular complication which group showed increase of TAT but also had no significant increase after correction of age. 4. In diabetic microvascular complication patients, group of high HbA_1c (>8%) (p=0.049) had significant high PIC concentration. In diabetic macrovascular complication patients, group of high HbA_1c (>8%) (p=0.042) had significant high total cholesterol concentration. 5. In all diabetic patients, PIC was positively correlated with fibrinogen and HbA_1c and negatively correlated BMI (r=0.47, 0.31, -0.25). Only in daibetic patients without angiopathy, TAT was positively correlated with HbA_1c (r=0.67). Conclusion : In this study, plasma TAT and PIC concentration significantly increased in diabetic patients compared with controls, and PIC was increased in group with microvascular complication, TAT were increased in group with combined micro macrovascular complication. However, there was no significance relationship existed when correctinf for age. PIC was correlated with HbA_1c. TAT was correlated with HbA_1c only in the group without angiopathy. Abnormality of coagulation and fibrinolysis were combined in diabetes, plasma TAT and PIC can be used as an index of vascular complication. Also we found the correlation with the degree of the blood glucose control. Therefore we need follow up study for the possibility of prevention of vascular complication after controlling the blood glucose to age-matched patients (J Kor Diaabetes Asso 25:354~363, 2001).

정신장애인 치료에 중요 역할 담당자의 정신질환에 대한 태도조사

김병후,정선욱,강연화,김윤,김창엽,홍진표,한오수,조맹제,김용익 大韓神經精神醫學會 1996 신경정신의학 Vol.35 No.5

Objectives : Attitudes of families of mentally ill, health personnels and community leaders to the mentally ill after the development and utilization of the community mental health program and reintegration of the chronically ill patients into society. This study was designed to compare the attitudes toward the mentally ill patient of the persons who have important role in treating the mentally ill and to find the variables influencing the attitudes. Methods : We measured attitudes toward mental illness in psychotic patients' families(N=139), community leaders(N=180) and health personnels(N=324) including mental health personnels before the implementation of community mental health services in Yonchon county and Seodaemun district area. The instrument used to measure attitudes was Opinion about Mental Illness(O. M. I.) scale. Results : 1) Health personnel showed lower Authoritarianism(Factor A) and higher Benevolence(Factor B) scores on the average than community leaders and psychotic patients families. 2) Current residence affect the attitudes in psychotic patients' families, not in community leaders and health personnels. Families in urban area showed lower Authoritarianism(Factor A) and Social Restrictiveness(Factor D) and higher Benevolence(Factor B) scores than in the rural areas. 3) Many patient variables were correlated to the attitudes of families. Duration of illness, number of recurrence, number of admission, age of patient and family burden were positively correlated mainly to Social Restrictiveness(Factor D). 4) Sex and religion of respondents showed no or weak relationship with the factor scores. Conclusions : Education for community leaders and families is required to achieve successful community mental health services. Community support program should be developed for chronic, recurrent and burdensome psychiatric patients in the first place.

PD-1H Is a Novel Negative Checkpoint Regulator for Hepato-cellular Carcinoma Immunotherapy

( Su Jong Yu ),( Kyoung Wan Yoon ),( Young Youn Cho ),( Eun Ju Cho ),( Jeong-hoon Lee ),( Yoon Jun Kim ),( Jung-hwan Yoon ) 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1

Aims: The field of hepatocellular carcinoma (HCC) immunotherapy has made progress whereas negative checkpoint regulators restrict T-cell responses. Programmed death-1 homolog (PD-1H) has been shown to suppress T-cell responses but little is known in the role of PD-1H on cytokine-induced killer (CIK) cells that are ex vivo expanded T-cells expressing both NK- and T-cell markers. Thus, this study aimed to determine the role of PD-1H in CIK cell immunotherapy targeting HCC. Methods: Murine (MH134) and human (Huh-7) HCC cell lines were cultured under normoxic or hypoxic culture conditions. Murine CIK cells were generated from C3H mice splenocytes and human CIK cells were generated from blood of patients with HCC. RT-PCR and immunoblotting were used to determine the expression of PD-1H. Cytotoxicity assay was performed in the presence or absence of PD-1H siRNA transfection. The potential synergistic effect of CIK cells combined with anti-mouse PD-1H blocking antibody was evaluated in the murine HCC model. Results: Both in mouse and human, PD-1H was expressed on HCC and CIK cells. Moreover, PD-1H was significantly overexpressed in hypoxic than normoxic conditions. Cytotoxicity of CIK cells over HCC cells was significantly suppressed in a hypoxic condition, but blocking of PD-1H by siRNA transfection restored cytotoxicity of CIK cells both in normoxic and hypoxic conditions. Finally, PD-1H blockade augmented antitumor CIK-cell responses in the murine HCC model (P=0.028). Conclusions: These findings show that PD-1H, a novel negative im-munoregulatory molecule, has functional activities that are nonredundant with other Ig superfamily members and may play a role in HCC immunotherapy.

포스터전시 : 자발성 세균성 복막염 환자에서 혈청 CRP의 임상적 의미 (초)

( So Youn Park ),( Jeong Hoon Lee ),( Ju Hee Park ),( Hyuk Yoon ),( Ji Yeon Kim ),( Eun Sun Jang ),( Eun Ju Cho ),( Min Sun Kwak ),( Su Jong Yu ),( Yoon Jun Kim ),( Jung Hwan Yoon ),( Hyo Suk Lee ) 대한간학회 2010 Clinical and Molecular Hepatology(대한간학회지) Vol.16 No.3(S)

S-98 Renal subcapsular hematoma after endoscopic mucosal resection of colon polyp

( Woong-su Yoon ),( Ki Bae Kim ),( Keunmo Kim ),( Yonghyeok Choi ),( Joung-ho Han ),( Soon Man Yoon ),( Hee Bok Chae ),( Seon Mee Park ),( Sei Jin Youn ) 대한내과학회 2016 대한내과학회 추계학술대회 Vol.2016 No.1

A 69-year-old man presented with voiding difficulty, nocturia, and fever for 2 days. He had hypertension, diabetes mellitus, and benign prostate hyperplasia. On physical examination, there were no both costovertebral angle tenderness (CVAT). But urinalysis resusts show blood in urine and the extended-spectrum β-lactamase (ESBL)-producing Escherichia coli grow from the urine culture. He had undergone endoscopic mucosal resection (EMR) for about 3cm sized distal ascending-colon (A-colon) polyp that was later revealed to be intramucosal adenocarcinoma with free resection margins. Prophylactic hemoclips had been placed to prevent delayed bleeding after the procedure. Abdomen and pelvic computed tomography (CT) scan show right renal subcapsular hematoma with suspicious ureteritis and cystitis. Hemoclips on distal A-colon EMR site may induce traumatic right subcapsular hematoma because his distal A-colon is located near the right kidney. And the iatrogenic right renal subcapsular hematoma might make him susceptible to urinary tract infection. The patient had taken intravenous carbapenem antibiotics during hospitalization. The patient was discharged without fever and lower urinary tract symptoms. Such renal subcapsular hematoma following colon EMR is rare, and clipping on colon EMR site may be rare cause of retroperitoneal injury.