臨床生化學의 精度管理에 對한 考察 : 血中尿素窒素, 總蛋白 및 티몰 混濁度를 中心으로 BUN, total protein and thymol turbidity

尹錫漢,李昌珪,金仁仙,白承龍 최신의학사 1980 最新醫學 Vol.23 No.9

교정치료에 따른 사춘기 성장 아동의 상기도 폭경과 안면 성장 변화와의 관계 연구

김윤지,복규석,이규홍,황용인,박양호 대한치과교정학회 2009 대한치과교정학회지 Vol.39 No.3

본 연구의 목적은 아동에서 사춘기 성장 동안 기도의 변화가 안면 성장에 미치는 영향을 평가하는 것이었다. 9 - 11세(평균 10.7세)의 교정환자 36명을 대상으로 하여 초진 시(T1)와 치료 종료 시(T2)에 각각 측모두부방사선사진과 수완부 방사선 사진을 촬영하였다. 측모두부방사선사진상의 기도 폭경을 기준으로 하여 대상을 세 그룹으로 나누었다; 폭경이 좁은 그룹(AW-Narrow: 5.2 - 8.6 mm), 중간 그룹(AW-Medium: 8.9 - 11.5 mm), 넓은 그룹(AW-Wide: 11.7 - 16.0 mm). T1과 T2시기에 각 그룹 간의 안면 계측치의 차이를 비교하였으며 T1 - T2 사이의 계측치의 변화량을 각 그룹별로 비교하여 성장을 평가하였다. 각 그룹의 기도 폭경 증가량은 AW-Narrow, AW-Medium, AW-Wide group에서 각각 4.55 mm, 3.84 mm, 1.94 mm였으며 통계적으로 유의한 차이를 보였다. T1시기의 각 그룹 간의 비교에서 AW-Narrow group에서 다른 그룹에 비해 PFH가 유의하게 작은 값을 나타냈다. T1 - T2 사이의 성장 평가에서는 AW-Narrow group에서 다른 그룹에 비해 PFH/AFH, facial axis, ANS (T1 - T2), and Gn (T1 - T2)의 변화가 유의하게 큰 값을 보였다. 이 시기의 안면 성장 기간 동안 기도 폭경이 좁은 그룹에서 기도 폭경 및 안면 성장의 보상성 변화가 일어난 것으로 생각된다. 바람직하지 않은 안면 성장을 예방하기 위한 외과적 기도 처치를 고려할 때 자발적인 개선 가능성을 고려하여 좀 더 신중한 평가가 필요할 것으로 생각된다. Objective: The purpose of this study was to evaluate how airway changes influence facial growth during puberty in Korean children. Methods: Thirty-six patients aged 9 to 11 (mean age: 10.7 years) were selected. Cephalograms and hand-wrist x-rays were taken at pre-treatment (T1) and post-treatment (T2). The sample was divided into narrow (5.2 . 8.6 mm, AW-Narrow), medium (8.9 . 11.5 mm, AW-Medium), and wide (11.7 . 16.0 mm, AW-Wide) groups according to the airway width at T1. Cephalometric measurements at T1, T2 and growth from T1 to T2 were compared between groups. Results: The degree of increase in airway size in each group was 4.55 mm, 3.84 mm and 1.94 mm in the AW-Narrow, AW-Medium, and AW-Wide groups, respectively. Moreover, the differences were statistically significant. The significant smallest posterior facial height was found in the AW-Narrow group at T1. For the growth values from T1 to T2, the AW-Narrow group showed significantly larger values of PFH/AFH, facial axis, ANS (T1 - T2), and Gn (T1 - T2) than the AW-Medium group. Conclusions: The compensational changes in the airway width and facial growth were found in the narrow group. Surgical approach of the airway to prevent unfavorable facial growth in these years of age should be carried out, but with careful deliberation because these problems may be improved naturally.

정신분열병 환자에서 가족력, 산과적 합병증 및 신체미세기형의 관련성에 관한 연구

안용민,김용식,정희연,신지용,윤세창,배안,이중서,주은정,이창인 大韓神經精神醫學會 1999 신경정신의학 Vol.38 No.2

연구목적 : 저자들은 태생기 동안에 받는 유전외적 요인, 즉 환경적 요인이 산발성 정신분열병 환자들의 발병에 크게 관여할 것이라고 가정하였다. 이를 검증하기 위하여 형제 중 1인 이상이 발병하여 가족력을 분명히 알 수 있는 정신분열병 환자군(이하 형제 환자군)과 가족력이 없는 산발성 정신분열병 환자군(이하 산발성 환자군) 및 정상대조군을 대상으로 산과적 합병증, 신체미세기형 및 정신분열병의 임상 양상을 비교하였다. 방 법 : 연구 대상은 형제 환자군 43명(남 22명, 여 21명), 산발성 환자군 43명(남 23명, 여 20명), 정상대조군 43명(남 20명, 여 23명)이었다. 산과적 합병증은 Lewis 척도를 이용하여 평가하였고 신체미세기형은 Waldrop 척도를 이용하여 측정하였다. 임상 양상으로서 발병 연령, 병전 기능 수준, 정신병리, 약물에 대한 반응, 회복시의 전반적 기능 수준, 지연성 운동장애의 유무를 평가하였다. 결 과 : 정상대조군과 정신분열병 환자군 전체를 비교하였을 때 산과적 합병증과 신체미세기형의 총점과 각 소항목의 점수에 차이가 없었다. 산발성 환자군과 형제 환자군을 비교하였을 때 산과적 합병증의 전체 점수에서는 유의한 차이가 없었으나, 출생 당시에 태아가 받은 스트레스 항목의 점수가 산발성 환자군에서 유의하게 높았다. 신체미세기형에서는 전체 점수 및 입의 미세기형 점수가 산발성 환자군에서 유의하게 높았다. 신체미세기형의 전체 점수가 4점 이상인 환자수도 산발성 환자군에서 높은 경향성을 보였다. 산과적 합병증과 신체미세기형 사이의 상호 연관성은 찾을 수 없었다. 정신분열병의 임상 양상 중에서는 Krawiecka 척도의 총점 및 양성 증상 점수와 회복시의 전반적 기능 수준만이 형제 환자군에 비해 산발성 환자군에서 유의하게 높았다. 성별에 따라서는 형제 환자군에서 남자 환자의 산과적 합병증이 유의하게 높았다. 결 론 : 본 연구를 통해 산과적 합병증 및 신체미세기형 연구가 정신분열병의 원인을 규명하기 위한 유용한 방법임이 시사되었지만, 가족력, 산과적 합병증 및 신체미세기형의 관련성에 대해서는 분명한 결론을 내리지 못하였다. The authors hypothesized that sporadic schizophrenic patients had more chances of receiving environmental insults during the fetal neural development compared with familial schizophrenics. We tested our hypothesis by comparing obstetric complications(OCs), minor physical anomalies(MPAs) and other clinical features, and examining the correlation between OCs and MPAs in schizophrenic patients who had one or more sibling with schizophrenia(sibling group) and sporadic schizophrenics(sporadic group) and normal controls. OCs were evaluated by the scale of Lewis, and MPAs were measured by the Waldrop scale. There were no significant difference in OCs and MPAs between schizophrenic and control groups. Sporadic group had significantly higher fetal distress, total Waldrop score and Waldrop score for mouth than sibling group. And there was a tendency that the number of subjects having the Waldrop score over 4 points was greater in the sporadic group. No significant correlation was observed between CCs and MPAs. The scores of initial psychopathology and post-treatment functioning were much higher in the sporadic group, but the other clinical feature showed no difference. Although male patients had more OCs than female patients in sibling group, no sex difference were observed as a whole. Our results suggest that, if the methodological weakness were complemented, OCs and MPAs would be useful tools in the search for the cause of schizophrenia.

개 시상하부의 Neuropeptides에 대한 면역조직화학적 연구

장인엽,정윤영,김종중,문정석,김준수,모근석,임용,유호진 朝鮮大學校 附設 醫學硏究所 1996 The Medical Journal of Chosun University Vol.21 No.1

The distribution and localization of somatostatin(SOM), neuropeptide Y(NPY), vasopressin(VP), and oxytocin(OT) were studied with a immunohistochemical technique in the canine hypothalamus. The SOM-immunoreactive perikarya were concentrated in the anterior periventricular and the arcuate nuclei. Immunoreactive terminals were observed in the arcuate, the ventromedial hypothalamic, the suprachismatic nuclei and the external layer of the median emmence. A great number of NPY-immunoreactive cell bodies were found in the arcuate nucleus and NPY fibers were located throughout the hypothalamus with the highest concentration especially in the paraventricular (PVN) and the acuate nuclei. Moderately or densely stained fibers were also observed in the median eminence, the suprachiasmatic. the periventricular, the ventromedial hypothalamic, the dorsomedial hypothalamic and the medial preoptic nuclei, and the stria terminalis. Both VP-and OT-containing perikarya were found mainly in the PVN and supraoptic nucleus(SON). but a few were seen in the perifornical area, the lateral hypothalamus, the dorsal hypothalamic and the periventricular nucleus. The fibers originated from the PVN were projected to the SON via ventral or dorsal area of the fornix.

우리나라 연 작업자들의 연폭로 수준에 관한 연구

조인숙,김용배,리갑수,김화성,황규윤,장봉기,이성수,안규동,이병국 순천향대학교 산업의학연구소 1999 순천향산업의학 Vol.5 No.1

To assess lead exposure in Korean lead workers, 2047 male lead workers in 17 lead using industries were studied. Study population were divided into 4 occupation categories such as storage battery industry(type 1), secondary smelting and litharge making industries(type 2), PVC stabilizer making industries(type 3) and primary smelting and related industries (type 4). Blood lead and zinc protoporphyrin in whole blood (ZPP) were selected as an index of lead exposure. Hemoglobin and hematocrit were also checked. Fifteen questionnaires of lead related symptoms were provided to all lead workers and filled up by themselves and confirmed by medical doctors. Personal variables such as age, work duration, smoking and drinking habits were also collected. the results were as follows. 1) The mean blood lead, ZPP and hemoglobin of all lead workers were 29.7+12.6㎍/100㎖, 56.5+38.6㎍/100㎖ and 14.6+1.3 gm/100㎖ respectively. 2) While the mean blood lead of lead workers in type 1, 2, 3 and 4 were 28.6+11.6㎍/100㎖, 46.2+15.3 ㎍/100㎖, 46.8+12.1 ㎍/100㎖ and 26.2+10.2 ㎍/100㎖, the mean value of blood ZPP of those workers were 53.6+32.6 ㎍/100㎖, 108.1+87.1 ㎍/100㎖, 98.9 +54.9 ㎍/100㎖ and 45.8+19.5 ㎍/100㎖ respectively. 3) The percents of lead workers whose blood lead were 40-59.9 ㎍/100㎖ and over 60.0 ㎍/100㎖ were 17.6% and 2.1% respectively. Those whose blood lead were 40-59.9 ㎍/100㎖ and over 60.0 ㎍/100㎖ were 15.18% and 0.96% for type 1, 43.59% and 21.79% for type 2, 58.89% and 12.22% for type 3 and 11.82% and 0% for type 4 respectively. 4) The percents of lead workers whose blood ZPP were 100-149 ㎍/100㎖ and over 150 ㎍/100㎖ were 5.17% and 3.17% respectively. Those whose blood ZPP were 100-149 ㎍/100㎖ and over 150 ㎍/100㎖ were 4.66% and 2.04% for type 1, 10.26% and 25.64% for type 2, 23.33 and 13.33% for type 3 and 1.28% and 0.32% for type 4 respectively. 5) The prevalence rate of smoking and drinking of male lead workers in all lead industries were 70.8% and 71.0% respectively. While the mean blood lead of smoker, non-smoker, drinker and non-drinker were 30.24+12.58 ㎍/100㎖, 28.35+12.7 ㎍/100㎖, 30.24 ㎍/100㎖ and 28.74 ㎍/100㎖ respectively, the mean blood ZPP of those were 55.7+37.1 ㎍/100㎖, 58.4+41.9 ㎍/100㎖, 55.7+36.5 ㎍/100㎖ and 58.4+43.3 ㎍/100㎖ respectively. 6) While the correlation of hematocrit corrected blood lead with other lead exposure variables were higher than non-corrected blood lead, the correlation of log-transformed ZPP with other lead exposure variables were higher than non-corrected blood ZPP. 7) The most frequent symptom among 15 lead related symptom questionnaires was 'general fatigue' and the next one was 'feeling irritated with disturbance' and least one was 'acute abdominal pain around the umbilicus' in all lead workers. The overall prevalence of lead workers in storage battery industry and primary lead smelting industry were higher than secondary lead smelting and PVC stabilizer making industries. 8) The prevalence of lead related symptoms was a little higher in 13 symptoms in smokers than non-smokers and in 14 symptoms in drinker than non-drinkers, but they were not statistically significant. 9) Stepwise multiple regression analysis, using overall symptom prevalence as a dependent variable blood lead, blood ZPP, hemoglobin, age, work duration, drinking and smoking habits as independent variables, indicated that smoking habit, drinking habit and age were significantly contributed to the dependent variable. 10) The slopes of simple linear regression of blood lead (independent variable) with blood ZPP and log-transformed ZPP as dependent variable were different among 4 types of lead industries. The slope of lead industries with low mean blood lead were less steeper than those with high mean blood lead.

췌담관 합류이상이 있는 환자에서 담도계 손상 기전에 대한 연구

정인호,정용식,김지훈,최수윤,김정운,김욱환,홍정,왕희정,유병무,김진홍,한재호,김영배,김재근,김명욱 한국간담췌외과학회 2003 한국간담췌외과학회지 Vol.7 No.2

성인 IgA 신병증의 임상적 고찰

김영학,권용은,허경무,윤채중,김종인,김건영,배학연,정종훈 조선의대 1998 The Medical Journal of Chosun University Vol.23 No.1

ERK1/2-Mediated Schwann Cell Proliferation in the Regenerating Sciatic Nerve by Treadmill Training

Seo, Tae Beom,Oh, Myung-Jin,You, Byoung-Gun,Kwon, Ku-Birm,Chang, In-Ae,Yoon, Jin-Hwan,Lee, Chan-Yong,Namgung, Uk Mary Ann Liebert 2009 JOURNAL OF NEUROTRAUMA - Vol.26 No.10

<P>Proliferation of Schwann cells in the injured peripheral nerve supports axonal regeneration, and physical training in experimental animals has been shown to promote nerve regeneration. Extracellular signal-regulated kinase 1/2 (ERK1/2) activity can mediate neuronal responses to lesion signals, but its role in non-neuronal cells in the injured area is largely unknown. Here we report that treadmill training (TMT) facilitates axonal regeneration via the upregulation of phospho-ERK1/2 protein levels in Schwann cells in the injured sciatic nerve. Low-intensity, but not high-intensity, TMT increased neurite outgrowth of dorsal root ganglion (DRG) sensory neurons and potentiated Schwann cell proliferation. TMT elevated levels of GAP-43 mRNA and protein, and phospho-ERK1/2 protein in the injured sciatic nerves. TMT also enhanced phospho-c-Jun protein levels in the injured nerve. In-vivo administration of the ERK1/2 inhibitor PD98059 eliminated phospho-c-Jun, suggesting ERK1/2 phosphorylation of the c-Jun protein. PD98059 treatment decreased levels of BrdU-labeled proliferating Schwann cells in the distal portion of the injured nerve, and delayed the axonal regrowth that was promoted by TMT. The present data suggest that increased ERK1/2 activity in Schwann cells may play an important role in TMT-mediated enhancement of axonal regeneration in the injured peripheral nerve.</P>

Is renal replacement therapy necessary in deceased donor liver transplantation candidates with hepatorenal syndrome?: a 2-year experience at a high-volume center

Gil-Chun Park,Shin Hwang,Dong-Hwan Jung,Gi-Won Song,Chul-Soo Ahn,Ki-Hun Kim,Deok-Bog Moon,Tae-Yong Ha,Young-In Yoon,Hui-Dong Cho,Jae-Hyun Kwon,Yong-Kyu Chung,Sang-Hyun Kang,I-Ji Jung,Jin Uk Choi,Sung- 대한외과학회 2020 Annals of Surgical Treatment and Research(ASRT) Vol.98 No.2

Purpose: Hepatorenal syndrome (HRS) is a fatal complication in patients with end-stage liver disease awaiting liver transplantation (LT). HRS often develops in patients with high model for end-stage liver disease (MELD) score. This study investigated the outcomes of peritransplant management of HRS in a high-volume LT center in Korea for 2 years. Methods: A total of 157 recipients that deceased donor liver transplantation (DDLT) from January 2017 to December 2018 were included. In-hospital mortality (IHM) was analyzed in relation to pre- and posttransplant application of renal replacement therapy (RRT). Results: Primary diagnoses for DDLT were alcoholic liver disease (n = 61), HBV-associated liver cirrhosis (n = 48), retransplantation for chronic graft failure (n = 24), and others (n = 24). Mean MELD score was 34.6 ± 6.2 with 72 patients at Korean Network for Organ Sharing MELD status 2 (45.9%), 43 at status 3 (27.4%), 36 at status 4 (22.9%), and 6 at status 5 (3.8%). Pretransplant RRT was performed in 16 patients (10.2%) that did not show IHM. Posttransplant RRT was performed in 69 patients (44.0%), for whom IHM incidence was 15.9%. In 53 patients that had undergone de novo posttransplant RRT, IHM incidence increased to 20.8%. IHM in the 88 patients not requiring RRT was 2.3%. Conclusion: The majority of adult DDLT recipients in Korean MELD score-based allocation system have very high MELD scores, which is often associated with HRS. Pretransplant RRT appears to improve posttransplant survival outcomes. We thereby recommend that, if indicated, pretransplant RRT be performed while awaiting DDLT.

정신분열병 환자의 우울증에서 Paroxetine과 삼환계 항우울제 병용치료

심주철,공보금,박정환,윤영란,신재국,김정익,안동성,김용관,차인준,김영훈 大韓神經精神醫學會 1997 신경정신의학 Vol.36 No.4

저자들은 마산동서병원에 입원중인 우울증이 동반된 정신분열증 환자 10명을 대상으로 사용중인 항정신병약물에 paroxetine과 저용량의 삼환계 항우울제를 6주간 병용투여한 후 우울증상에 대한 효과와 치료의 안전성 및 약물상호작용을 알아보았다. Paroxetine은 고정량의 항정신병약물과 삼환계 항우울제에 부가하여 일일 20㎎을 6주간 병용하게 하였으며, 임상상태는 HDRS, HARS, UKU Side Effect Rating Scale등의 평가척도를 사용하여 평가하였다. 또한 약동학적 약물상호작용은 삼환계 항우울제들의 혈장농도를 HPLC로 측정하여 분석하였다. 결과는 다음과 같다. 1) 10명의 전체 대상환자에서의 HDRS 평균점수는 TCA와 paroxetine 병용투여 6주후에 통계적으로 유의하게 감소되었다. 이중 40%의 환자에서는 병용투여 6주후에 HDRS 점수상 50% 이상의 감소를 보여, 일부의 환자들에서는 정신분열병에 동반된 우울증상의 치료에 소량의 삼환계 항우울제와 paroxetine의 병용치료가 효과가 있음을 확인하였다. 2) 두 명의 환자에게서 심각한 약물독성이 발생하였다. 이중 한 명은 삼환계 항우울제의 높은 혈중농도로 인한 항콜린성 위기(anticholinergic crisis) 소견을 보였으며, 다른 한 명은 인지기능 및 의식수준은 명료하였으나 망상과 환각증상이 약화되는 소견을 보였다. 따라서 본 연구에서 시도된 복합적 약물치료의 경우, 삼환계 항우울제의 혈중농도의 측정을 포함한 세심한 임상적 추적이 필요하다고 생각된다. 3) 기저치의 amitriptyline과 그 대사물인 nortriptyline의 농도합. imipramine과 대사물인 desipramine의 농도합은 각각 47.8-226.5ng/㎖. 80.5-395.6ng/㎖였으며 일반적으로 이들 약물들의 단독사용시에 문헌에 보고된 혈중농도를 훨씬 상회하고 있었다. 이는 병용투여된 항정신병 약물 약시 강력한 CYP2D6 효소억제제로서 기저치의 삼환계 항우울제들의 혈장농도를 이미 상당히 증가시켰던 것으로 판단되며, 그러한 결과로 인해 본 연구에서는 paroxetine이 이전의 문헌보고들과는 달리 뚜렷하게 삼환계 항우울제들의 혈장농도를 증가시키지 못하였다. 본 연구는 SSRI와 삼환계 항우울제의 병합 투여가 우울증의 개선 효과를 빠르게 하고, 치료역을 넓히고, 약물상호작용의 결과 paroxetine이 삼환계 항우울제의 혈중농도를 증가시킨다는 기존의 연구결과를 이용하여 정신분열병 우울증상의 치료에 parotextine과 소량의 삼환계 항우울제를 병용하는 방법을 시도해 본 연구이다. 저자들은 이러한 약물치료가 일부의 환자들에게서 효과가 있음을 관찰하였으나, 항정신병약물과 삼환계 항우울제를 병용투여 할 경우는 물론 이에 paroxetine과 같은 선택적 세로토닌 재흡수 억제제를 병용할 경우 복합약물상호작용의 결과로 약물독성의 위험성이 크며 세심한 주의가 필요함을 경험하였다. Depression is well-known to comorbid with several psychiatric disorders. Many schizophrenics also suffer from depression in the course of their illness. Combined therapy of SSRI and tricyclic antidepressants were reported to have benefits in some depressed patients. Paroxetine, a potent CYP2D6 inhibitor, increases the blood levels of tricyclic antidepressant markedly. Using paroxetine, we tried this combined therapy in the treatment of depressive symptoms in 10 chronic schizophrenic inpatients and evaluated its efficacy and drug interactions between paroxetine and tricyclic antidepressants. The following results were obtained : 1) The mean score of Hamilton's Depression Rating Scale(HDRS) was reduced significantly after 6 weeks-trials of this combined therapy for the mild depressive symptoms in 10 chronic schizophrenics. In four patients, 50% or more reductions in the scores of HDRS were noticed at final evaluation. 2) Two among our 10 subjects experienced severe toxic behavioral problems. Anticholinergic crisis with toxic confusion due to high blood levels of tricyclics was found in one patient and the other showed rapid clinical deterioration in his psychotic symptoms such as delusion and hallucination without any consciousness alternation. 3) Baseline plasma levels of tricyclics before adding paroxetine were higher than expected in our chronic schizophrenic subjects maintained with their antipsychotic medications. Several antipsychotics were also known as a potent CYP2D6 inhibitors and to increase the blood levels of tricyclics. Because the blood levels of tricyclics had already increased significantly by the use of antipsychotics, adding paroxetine to antipsychotics and tricyclic antidepressant in our subjects could increase the blood levels of tricyclics not so much as previously reported in the literatures.