정신과에 대한 한 의과대학 졸업반 학생들의 태도조사

박인호,이철,한오수,김창윤,박희관 울산대학교 의과대학 1994 울산의대학술지 Vol.3 No.1

정신과에 대한 의대생들의 태도를 조사하기 위해서 정신과 임상실습을 마친 S대학교 의과대학 본과 4학년 학생들 중에서 본 연구의 설문조사에 자원응답한 70명의 자료를 분석하였다. 의대생들의 56%는 정신과가 비과학적이고 애매한 학문이라는 견해를 부정하였다. 또한 90%는 환자의 감정적 문제를 다룰 필요가 있다고 보았다. 타과의사들과 수입을 비교할 때 반수정도가 보통이라고 하였다. 83%의 의대생들은 정신과에 매력을 느끼고, 69%는 지적 성취를 할 수 있다고 보았다. 그러나, 정신과 의사의 역할과 임상심리학자나 사회사업가의 역할을 구분하는데 혼동이 있었다. 결과는 대부분의 의대생들이 정신과 의사와 직업으로서의 정신과에 대해 긍적적인 태도를 가진 것으로 나타났다. The attitudes of medical students towards psychiatry are important as they influence recruitment to psychiatry and clinical practice. In order to evaluate the attitudes of medical students towards psychiatry, the authors administered a questionnaire to 70 senior student volunteers of College of Medicine, Seoul National University. The results are summarized as follows; Psychiatrists are .not regarded by most medical students as unclear thinkers. Medical students don't think that psychiatrists abuse patients' legal rights, treat only relatively healthy patients. Most medical students affirm the importance of dealing with their patients' emotional problems. But, the roles of psychiatrists are confused with those of psychologists and social workers. Psychiatry, as a vocation, is not regarded by most medical students as unscientific, imprecise, ineffective and low in status. Most medical students don't agree that stigmatization or pressure to choose another field are common. This study showed that most senior medical students are favorable about psychiatrists and psychiatry.

Graves씨병의 외과적 치료

송영기,박건춘,이종남,안세현,이문호 울산대학교 의과대학 1994 울산의대학술지 Vol.3 No.1

1989년 7월부터 1992년 12월까지 울산대학교 의과대학 서울중앙병원 외과에서 Graves씨병으로 수술치료를 받고 추적관찰이 가능하였던 35명의 환자를 대상으로 다음과 같은 결과를 얻어 문헌고찰과 함께 보고하는 바이다. 1) 남녀비는 1:2.9로 여자에게 호발하였으며 중간 연령은 26세로 20대 17명(48.6%), 30대 5명(14.3%)으로 20대와 10대에서 가장 호발하였다. 2) 임상증상과 이학적소견상 경부종물이 전환자에서 관찰되었으며 빈맥은 32예(91.4%), 발한은 30예(87.5%), 피로감은 22예(62.9%), 체중감소는 21예(60.0%), 안구돌출은 16예(45.7%), 진전은 14예(40.0%)였다. 3) 갑상선기능검사는 최초의 혈청 T₃의 평균치가 501.2ng/dl, T₄의 평균치가 14.7ng/dl, TSH의 평균치가 3.14uu/ml였고 수술후의 평균검사치는 T₃가 138.9ng/dl, T₄가 7.66ug/dl, THS가 5.53uu/ml로 정상범위로 회복되었다. 면역학적 검사는 thyroglobulin 항체가 48.3%, microsome 항체가 89.7%의 양성률을 보여 가장 높은 적중률을 보였다. 갑상선주사검사상 전 예에서 방사선섭취의 증가를 관찰할 수 있었다. 4) 수술적응증은 항갑상선제제요법에 반응이 좋지 않았던 예가 14예, 내과치료후 거대갑상선종이 11예로 가장 많았고 수술 전처치로는 22예(62.9%)에서 propranolol, Lugol solution, 항갑선상제제를 병합투여했으며, 13예(37.1%)에서는 Lugol solution와 항갑상선제제를 투여하였다. 5) 수술방법은 19예에서 양엽아전절제술, 15예에서 일측엽전절제술 및 반대측 아전절제술, 1예에서 일측엽전절제술 및 협절제술을 시행하였으며 잔여조직은 평균 5.6gm였고 전 예에서 회귀후두신경을 확인 보존하였다. 6) 수술후 합병증은 일시적 저칼슘협증이 6예로 가장 많았고 일시적인 목소리변성이 2예 있었다. 재수술을 요하는 출혈이나 창상감염은 없었으며 사망 역시 발생하지 않았다. 7) 수술후 정상 갑상선기능을 보인 예가 22명(62.9%)으로 가장 많았고, 잠복성 갑상선기능저하는 9명(25.7%), 갑상선기능항진은 3명(8.6%), 갑상선기능저하는 1예(2.9%)에서 발견되었다. 8) 결론적으로 Graves씨병의 수술치료는 수술전 처치의 발달과 안정된 수술수기로 인하여 치료효과가 높은 치료방법이나 수술후 갑상선기능의 가장 중요한 인자로 인정되는 잔여갑상선의 양을 신중히 고려해야 하며 수술후 정기적 추적관찰이 필수적이며 이에 따른 적절한 치료가 필요하다고 사료되는 바이다. A clinical study on Graves' disease was made to 35 patients who received operation at the department of surgery of Asan medical center from July. 1989 to Dec. 1992. The results were as follows. 1) Male to female ratio was 1:2.9 and median age at operation was 26 years with highest incidence in the second and first decade. 2) Almost all of patients had neck mass, palpitation and sweating. Other symptoms were fatigue, weight loss, exophthalmus, tremor, nervouness, irregular mentruation, headache, and dyspnea in the order of decreasing frequency. 3) In thyroid function test, initial mean value of T₃and T₄was 501.2ng/dl and 14.7ug/dl, postoperative mean value of T₃and T₄was 138.9ng/dl and 7.66 ug/dl espectively. Radioiodine uptake was increased in all cases. 4) As a preoperative preparation, antithyroid drug, Lugol solution and propranolol were given to 22 patients(62.9%) and antithyroid drug and Lugol solution were given to 13 patients(37.1%). 5) Methods of operation were bilateral subtotal thyroidectomy in 19 patents, unilateral total and contralateral subtotal lobectomy in 15 patients, and lobectomy with isthmectomy in 1 patient. The estimated average weight of remaining thyoid tissue was 5.6 grams. 6) Postoperative complications were symptomatic transient hypocalcemia in 6 cases(17.1%) and transient voice change in 2 cases(5.7%) but there was no permanent hypoparathyroidism, recurrent laryngeal nerve injury or postoperative death. 7) Follow up period was 3 to 36 months(mean 8.5 months) and there were euthyroids in 22 patients(62.9%), latent hypothroids in 9 patients(25.7%), hyperthyroids in 3 patients(8.6%), and hypothyroid in 1 patient(2.9%).

수지골에 발생한 골막성 연골종 3례 보고

김기용,윤준오,조용선 울산대학교 의과대학 1993 울산의대학술지 Vol.2 No.1

본 울산대학교 의과대학 정형외과학 교실에서는 수지골에 발생한 3레의 골막성 연골종을 치험하였기에 문헌고찰과 함께 보고하는 바이다. Periosteal chondroma is a slowly growing benign cartilage tumor of limited size, which develops within and beneath the periosteal connective tissue and characteristically erodes and induces sclerosis of the contiguous cortical bone. The typical morphology of this tumor consists in an area of outer cortex scalloping involving the metaphyseal lesion of a long bone with slightly overhanging edges and a small amount of cartilage calcified matrix adjacent to the scalloping. Histologically this benign tumor can mimic chondrosarcoma. Awareness of this fact is important in order to avoid overdiagnosis and resultant overtreatment of the benign lesion. We report three cases of periosteal chondromas arising in the phalangeal bones of the hand. All were treated by curettage. No local recurrence was seen following this treatment.

Large Paraclinoid Aneurysms Treated By Combined Extradural and Intradural Approach

Whang, C. Jin,Kim, Chang Jin 울산대학교 의과대학 1992 울산의대학술지 Vol.1 No.1

1992년 5월부터 1992년 6월까지 상상돌기주위 경동맥에 생긴 큰 뇌동맥류 환자 3명을 치료하였다. 3명의 환자 모두에서 경막외 및 경막내 접근법으로 뇌동맥류를 성공적으로 결찰하였다. 2명은 여자였고, 1명은 남자였다. 3명중 1명에서는 입원당시 지주막하출혈이 있었고 2명에서는 국부종괴 병변에 의한 시신경 압박증상이 있었다. 수술후 환자들은 잘 회복되었고, 한명에서는 시력장애가 발생되었으나 점차 회복되었다. 수술전 시력장애는 수술후 호전되었다.

요통환자에서의 자기공명영상 소견과 근전도 소견과의 비교 연구 : 추간판 탈출증을 중심으로

서원희,남용현,성인영 울산대학교 의과대학 1992 울산의대학술지 Vol.1 No.1

The 80% of the general population experience low back pain once in a life. The causes of the low back pain are variable and the herniated nucleus pulposus(HNP) is one of common cause. Recently the usage of MRI in diagnosing the HNP and evaluating it's severity is increasing, but the EMG is still necessary to find the deficit of the involved root functionally. We compared the findings of MRI and EMG from the 87 patients with the low back pain from May 1990 to October 1992. The results were as follows : 1) Disease distribution on MRI was HNP 59 cases, spinal stenosis 8 cases, Tuberculous spondylitis 4 cases, degenerative change 2 cases, metastatic tumor 1 case, and 13 cases were normal. 2) The severity of HNP was classified on the MRI findings, according to Masaryk, bulging 19 cases, protrusion 17 cases, extrusion 16 cases, sequestration 7 cases. 3) Fifty-five of the 59 cases of HNP were diagnosed radiculopathy by needle EMG and 40 cases showed abnormal conduction studies.(motor nerve conduction or H-reflex) 4) There is no significant correlation between the severity of lesion on MRI and abnormal spontaneous activities on needle EMG in 46 cases of HNP-symptomatic duration more than 2 weeks.

B형간염 백신의 소량접종에 의한 면역효과

김영식,김철준 울산대학교 의과대학 1992 울산의대학술지 Vol.1 No.1

Hepatitis B virus infection is one of the most important health problems not only in morbidity but in mortality among Korean people. But high cost of hepatitis B vaccine could have interfered the introduction of the universal vaccination programme. To evaluate the efficacy of low dose hepatitis B vaccination we performed comparative study of immunogenicity of hepatitis B vaccination among three groups of low dose intradermal (LD-ID), low dose intramuscular (LD-IM) and usual dose intramuscular(control) immunization. The numbers of vaccinees of LD-ID, LD-IM and control group are 64(mean age:36.8 years), 22(mean age:37.4 years) and 48(mean age:34.6 years) respectively. In LD-ID group, plasma-derived hepatitis B vaccine(Hepavax-B) 0.1ml was administered intradermally on volar side of forearm at 0, 1, 2 months. In LD-IM and control group, Hepavax-B 0.1ml and 1.0ml were adminstered intramuscularly on deltoid muscle at 0, 1, 2 months, respectively. HBsAg, anti-HBc were tested by radioimmunoassay at 1 month after third vaccination. The seroconversion rate of anti-HBs in LD-IM group(50.0%) is significantly lower than those of LD-ID(89.1%) and control group(83.3%)(P<0.05). The geometric mean of anti-HBs titer in LD-IM group (34 RIA units; 95% CI:13-87) is significantly lower than those of LD-ID(578 RIA units, 95% CI:374-893) and control group(272 RIA units ; 95% CI : 138-533). The side reactions in LD-ID group are local skin reactions such as pain and pigmentation. As a cost-effective preventive measure of hepatitis B virus infection in adults, the low dose intradermal method is comparable with usual dose intramuscular method in the aspects of anti-HBs serconversion rate and anti-HBs titer.

전염성 연속종의 임상적 고찰 및 지연형 피부면역반응 검사소견에 관한 연구

최지호,서정화,윤문수,성경제,고재경 울산대학교 의과대학 1992 울산의대학술지 Vol.1 No.1

Molluscum contagiosum is a benign infectious acanthoma caused by molluscum contagiosum virus which has structural features intermediate between the orthopoxvirus group, e.g. vaccinia, and the parapoxvirus group, e.g. orf. There are few reports on the clinical and immunological features of molluscum contagiosum in Korea. This study was aimed to investigate the clinical manifestations of 207 molluscum patients and to evaluate the delayed cutaneous hypersensitivity responsiveness by the Multitest CMI kit(Pasteur Merieux) of 158 molluscum patients and 19 healthy persons as control. The results were summarized as follows : 1. The relative frequency of molluscum contagiosum on the hospital base in 1989-1992 was 1.1% and molluscum patients visited more frequently in winter and spring than summer and autumn. 2. Among 207 patients, 97(46.7%) were males and 110(53.1%) were female. The peak age of incidence was between 6-10 years of age and 83.6% were under 10 years of age. 3. The mean duration of skin lesion was 4.5 months and back was the most common in volved site(65.7%). 4. Atopic dermatitis(29%) was the most common combined skin disease and 43.9% of the patients had itching sensation. 5. The intensity of reaction(IR) and rate of reaction(RR) in molluscum patients were not significantly reduced than in controls.

유리피판 33례 분석

고경석,윤근철 울산대학교 의과대학 1992 울산의대학술지 Vol.1 No.1

31 patients(26 males and 5 females) aged 14 to 70 years underwent 33 microvascular free tissue transfers from April 1990 to July 1992(27 months) in the plastic surgical unit in Asan Medical center. We evaluated our cases based on the diagnosis, anatomic locations of recipient and donor site, morbidity and results. Among 24 cases in head and neck regoin, 19 cases were tumors and four were acquired deformities, and one was a congenital hemifacial microsomia. 6 cases were reconstructions of extremities and one for a radiation ulcer in the sacral area. The selection of donor site was based upon the location of defect and the volume of tissue required ; the forearm free flap was used in 11 cases, the rectus abdominis in 5, the groin in 4, the latissimus dorsi in 3, the parietotemporalis fascia in 3, the jejunum in 2, and the occipital scalp, the first toe web space, the serratus anterior, the dorsails pedis and the omentum were in one respectively. The average postoperative hospital day was 26.6 days and all complications were reversible with hematoma removal and conservative treatment. The free tissue transfers were primarily indicated in all patients in our series and there was no flap failure. A free flap is not only the most expedient method of reconstruction but also either the most reliable or the only available one in the majority of our cases.

중이 진주종의 면역조직학적 고찰

윤태현,이봉재,이기천,추광철 울산대학교 의과대학 1992 울산의대학술지 Vol.1 No.1

저자들은 진주종조직과 비진주종 조직에서 Langerhans 세포와 T림프구의 아형들의 분포를 면역조직학적 방법에 의해 관찰하고, 임상적으로 이루의 존재 유무와 연관시켜 고찰하여 다음과 같은 결과를 얻었다. 1) 비진주종성 조직 5례에서 Langerhans 세포들은 상피층에 나타나는 빈도가 적고 주로 상피층의 상기저부에 국한되어 있었으며, T림프구는 거의 관찰할 수 없었다. 2) 진주종조직 32례에서 Langerhans 세포들은 상피층에서는 항상 관찰되었으나, 상피하층에서는 25례에서만 관찰되었다. 3) 진주종조직에서 Langerhans 세포들은 상피층에서 상피하층으로 갈수록 분포밀도가 감소하였다. 4) 진주종 조직에서 T림프구의 아형들은 주로 상피하층에서 발견되었고, 조력 T림프구가 억제 T림프구보다 출현 빈도가 많았다. 5) 진주종 환자에서 임상적으로 이루가 있던 경우 Langerhans 세포의 분포밀도가 없던 경우에 비하여 높았으나, T림프구 아형들의 분포는 양군간에 차이가 없었다. The etiopathogenesis of cholesteatoma is still unknown;however, it has been reported that Langerhans' cells and T-lymphocytes play an important role in the pathogenesis of aural cholesteatoma. The authors performed immunohistological study to identify the distribution of the Langerhans' cells and T-lymphocytes in 32 cases of cholesteatoma tissue and in 5 cases of chronic inflammation of aural skin, and to correlate with clinical symptom of otorrhea. CD1 monoclonal antibody was used to demonstrate Langerhans' cells, CD4 for helper T-lymphocytes, and CD8 for suppressor T-lymphocytes. Our results showed that Langerhans' cells and helper T-lymphocytes were found abundantly in the cholesteatoma tissue than in noncholesteatoma skin, and the proportion of Langerhans' cells in cholesteatoma tissue was higher in cases with otorrhea than in cases without otorrhea.

췌장이식

한덕종,김인구,김석구,박건춘,민병철 울산대학교 의과대학 1992 울산의대학술지 Vol.1 No.1

Primary candidate for pancreas transplantation is patients with type Ⅰ diabetes mellitus of juvenile oneset. At present the patients selected for transplantation often have end stage renal disease, far advanced vascular disease and diabetic neuropathy. In these days, the survival of pancreas transplantation for treatments of patients with type Ⅰ diabetes mellitus has been improved especially in simultaneous pancreas and kidney transplantation. Various innovations in immunosuppression, management of the pancreatic ductal exocrine secretion, recipient selection and HLA matching have been contributed to achieve a reasonable outcome in pancreas transplantation compared with other organ transplantation. Current improved graft survival has stimulated many centers in the world to start pancreas transplantation program. Recently we successfully performed the first case of simultaneous pancreas and kidney transplantation in Korea. After 5 cases of pancreas transplantation in our department in type Ⅰ DM, we think that it is the time to review the pancreas transplantation to give an insight of this new field to our colleagues.