기종성 신우신염 1례

이재욱,구정태,서정일,양창헌,이정호,이동철,이영현,이활,이경섭 동국대학교 경주대학 1997 東國論集 Vol.16 No.1

기종성 신우신염은 주로 당뇨병환자나 폐쇄성 요로질환을 가진 환자에 발생하며 특징적으로 신실질 및 그 주위조직에 가스를 형성하면서 심한 조직괴사를 일으키는 매우 드문 급성 화농성 신감염으로 사망률이 높은 질환이다. 이 질환은 1989년 Kelly와 MacCallum에 의해 처음 보고된 이래 외국문헌에 약 90례 정도가 보고되어 있으며 국내에는 28례가 보고되어 있다. 수액 및 전해질 보충, 인슐린 투여를 통한 적절한 혈당조절 및 항생제 투여등의 내과적 치료와 절개배농 및 신적출술등의 수술적 치료 방법이 있다. 내과적 치료로 가스의 감소가 없는 경우에는 즉각적인 수술적 치료를 시행하여야하므로 이 가스변화에 대한 추적관찰이 중요하다 하겠다. 본 저자들은 당뇨병환자에서 발생한 기종성 신우신염 1례를 내과적 요법을 치험하였기에 문헌고찰과 함께 보고하고자 한다. Emphysematous pyelonephritis is rare, life-threatening infection of the renal parenchyma and perirenal tisseue. This disease is characterized by the production of intrarenal and perirenal gas and is frequently encountered in patients with diabetes mellitus or urinary obstruction. We experienced a case of emphysematouse pyelonephritis in a 62 years old women with poorly controlled diabetes mellitus who had been managed with medical theraphy. So we report this case with a review of the referenced literatures.

위암 환자에게 세포성 면역 기능에 관한 연구

이재익,윤일국,이종선,김종완,장준,안정기,송민호,정현용,이헌영,김상용,김영건 忠南大學校 癌共同硏究所 1991 癌共同硏究所 硏究誌 Vol.1991 No.-

위암 환자에서 세포성 면역 기능에 관한 연구

이재익,윤일국,이종선,김종완,장준,안정기,송민호,정현용,이헌영,김삼용,김영건 충남대학교 암연구소 1991 癌共同硏究所 硏究誌 Vol.1 No.1

We performed a variety of lymphocyte stimulation tests, delayed hypersensitivity skin tests, and enumeration of several lymphocyte subpopulations in 21 patients with gastric cancer who did not receive any form of anticancer therapy, and in 20 healthy controls. The gastric cancer patients had significantly decreased number and total score of positive reactions in delayed hypersensitivity skin tests compared with the healthy controls. The percent of CD_(4) positive lymphocytes in the gastric cancer patients was significantly decreased compared to the normal control subjects, but it had no correlation with the total score of delayed cutaneous hypersensitivity reactions. The ratio of helper to suppressor cells was lower in the cancer group. The uptake of 3H-thymidine was markedly depressed in cancer patients when stimulated with various mitogens. There was little correlation between any of the stimulation tests and any of the lymphocyte subpopulation proportions to delayed hypersensitivity cutaneous reactions. Optimal proliferative response was found in lymphocytes stimulated with 10 micrograms of concanavalin-A and 10 microgram of phytohemagglutinin. Advanced stage patients had greatly depressed delayed hypersensitivity skin reactions and proliferative responses to mitogens compared with localized diseases. These results suggest that gastric cancer patients have depressed cellular immune functions, which mainly result from the decreased helper cells and defects in functional proliferative response to mitogens. Interleukin-2 and interferon-gamma restored the in vitro proliferative response of lymphocyte in patients with gastric cancer.

Predicting postoperative total calcium requirements after parathyroidectomy in secondary hyperparathyroidism

( Byung Heon Kang ),( Soon Young Hwang ),( Jeong Yeop Kim ),( Yu Ah Hong ),( Mi Yeon Jung ),( Eun Ah Lee ),( Ji Eun Lee3 ),( Jae Bok Lee ),( Gang Jee Ko ),( Heui Jung Pyo ),( Young Joo Kwon ) 대한내과학회 2015 The Korean Journal of Internal Medicine Vol.30 No.6

Background/Aims: To prevent hypocalcemia after parathyroidectomy (PTX), parenteral calcium is required in addition to oral calcitriol and calcium. After switching to oral calcium, patients can be discharged from the hospital. The aim of this study was to analyze the clinical characteristics and outcomes of PTX performed at a single Korean center and to investigate the associated laboratory factors used to analyze the total amount of postoperative calcium required. Methods: We enrolled 91 hemodialysis patients undergoing PTX from November 2003 to December 2011. We collected clinical and laboratory data preoperatively, 12 and 48 hours postoperatively, at discharge, and 3 and 6 months postoperatively. Results: In total, 59 patients underwent PTX with autotransplantation (AT), 6 underwent total PTX without AT, 11 underwent subtotal PTX, and 15 underwent limited PTX. Total PTX without AT showed the lowest recurrence rate. At all postoperative time points, the mean levels of serum calcium, phosphorus, and intact parathyroid hormone (iPTH) decreased significantly, compared with preoperative levels; however, alkaline phosphatase (ALP) increased significantly from 48 hours postoperatively to discharge (p < 0.001). On multiple linear regression analysis, the total amount of injected calcium during hospitalization showed a significant correlation with preoperative ALP (p < 0.001), preoperative iPTH (p = 0.037), and Δphosphorus at 48 hours (p < 0.001). We developed an equation for estimating the total calcium requirement after PTX. Conclusions: Preoperative ALP, preoperative iPTH, and Δphosphorus at 48 hours may be significant factors in estimating the postoperative calcium requirement. The formula for postoperative calcium requirement after PTX may help to predict the duration of postoperative hospitalization.

보존적 치료로 회복된 망경색에 의한 급성복증 1예

김정념,이숭환,김정식,김진호,배윤오,박성규,윤상정,한현영,이헌영 충남대학교 의과대학 의학연구소 2003 충남의대잡지 Vol.30 No.1

Omental infarction, the end result of impaired perfusion to the greater omentum, is a rare benign self-limiting clinical entity. The main clinical symptom is non-specific localized abdominal pain with a moderately raised white blood cell and erythrocyte sedimentation rate. These findings often mimic an abdominal surgical emergency. This condition is often misdiagnosed as acute appendicitis or cholecystitis. The characteristic feature of CT scan and ultrasonography provide non-invasive diagnosis in most patients with omental infarction. We report a case of patient whose CT scan showed the characteristic finding of omental infarction. The patient was improved spontaneously only with conservative care.

중년기 우울증 여성의 생활사건, 대처방식, 사회적 지지 및 가족관계

김동인,이진욱,김임,이선미,은헌정 大韓神經精神醫學會 1997 신경정신의학 Vol.36 No.4

국문초록본 연구는 중년기 우울증 여성의 생활사건 스트레스, 대처 방식, 사회적 지지, 가족 관계 등의 정신사회적 요인들을 알아보기 위한 것으로 각 변인들이 어떻게 우울과 관계가 있는지를 우울증 환자 집단과 정상인 집단으로 나누어서 비교 연구하였다. 이를 위해 35세 이상 64세 이하의 116명의 우울증 환자와 113명의 정상인을 대상으로 Beck 우울 질문지(BDI), 생활사건 질문지, 대처방식 척도, 대인관계 지지 평가척도(ISEL), 가정환경척도 등의 검사를 하였고 다음과 같은 결과를 얻었다. 1) 최고 스트레스는 환자 집단의 경우 결혼생활 스트레스(42명, 36.2%), 정상인 집단의 경우는 가정생활 스트레스(44명, 38.9%)였다. 2) 소극적 대처(t=0.93, p=.35)만을 제외하고 환자 집단과 정상인 집단에서 BDI 우울 점수(t=15.94, p<.0001), 생활사건 스트레스 점수(t=4.73, p<.0001), 적극적 대처점수(t=6.29, p<.0001), 사회적 지지점수(t=7.20, p<.0001), 가족 관계 점수(t=5.75, p<.0001)에서 유의한 차이를 보였다. 3) 우울증 환자 집단에서 BDI 우울 점수는 생활사건 스트레스(r=.24, p<.01) 변인과 유의한 정적 상관을 보였고, 적극적 대처(r= -.22, p<.01) 변인, 사회적 지지(r= -.35, p<.001) 변인, 가족관계(r= -.30, p<.001) 변인과는 유의한 역 상관을 보였다. 4) 우울증 환자 집단에서 BDI 우울에 대한 각 변인들의 중다회귀분석은 사회적 지지(12.3%, β= -.281, T= -3.162, P=.002, 생활사건 스트레스(5.1%, β=.279, T=3.195, P=.002), 적극적 대처(3.5%, β= -.204, T= -2.225, P=.028) 변인이 합하여 20.9%의 설명력을 나타냈다. 5) 중년기 여성에서 생활사건 스트레스는 가족 관계에서 겪는 스트레스가 가장 큰 스트레스였고, 대처방식은 우울과의 관계에서 일관성이 부족하였으며, 사회적 지지는 우울에 영향을 주는 가장 중요한 요인이었고, 가족관계는 양 집단에서 유의한 차이는 있었으나 우울에 대하여 의미있게 설명하지 못하고 있다. ABSTRACTLife Events, Coping Styles, Social Support, and Family Relationships of Middle-Aged Depressed Women Jin-Wook Lee, M.D., Yim Kim, M.D., Sun-Mi Yi, M.S., Dong-In Kim, M.D., Heon-Jeong Eun, M.D. Department of Neuropsychiatry, Presbyterian Medical Center, Chonju The objective of this study was to explore the psychosocial factors such as life events, coping styles and family relationships in middle-aged depressed women. This study was designed to compare how different variables relate to depression in two different test groups : a depressed patient group and a normal group. The Beck Depression Inventory(BDI), The Ways of Coping Checklist, Interpersonal Support Evaluation List(ISEL), Family Environment Scale were administered to 116 depressed patients and 113 normal persons between the ages of 35 and 64. The results were as follows : 1) The highest stress was marital stress(n=42, 36.2%) in patient group and family stress(n=44, 38.9%) in normal group, respectively. 2) There were significant differences between patient group and normal group in BDI scores(t=15.94, p<.0001), life events(t=4.73, p<.0001), active copinig(t=6.29, p<.0001), social support(t=7.20, p<.0001), and family relationships(t=5.75, p<.0001) except for passive coping(t=0.93, p=.35). 3) In depressed patient group, BDI scores had a significantly positive correlation with the scores of the life events(r=.24, p<.01) and negative correlation with active coping(r= -.22, p<.01), social support(r= -.35, p<.001) and family relationships(r= -.30, p<.001). 4) In depressed patient group, multiple regression analysis showed that social support(12.3%, β= -.281, T= -3.162, P=.002), life events(5.1%, β=.279. T=3.195, P=.002), and active coping(3.5%, β= -.204, T= -2.225, P=.028) had predictability on the BDI scores and the total predictability was 20.9%. 5) Stress experienced in family relationships were highest in life events and there was a lack of consistency(in the BDI scores of the coping styles). Social support was the most important factor and there were no significant differences between the two groups in family relationships.

지난 2년간의 학회지 "신경정신의학" 심사 평가보고

김찬형,김세주,김도관,김성곤,박원명,송동호,박용천,이영문,오강섭,정영철,이상열,김주한,이동영,이헌정,함병주,김율리,김문두,김정진,이강욱,천근아,김재진,홍진표,홍승철 大韓神經精神醫學會 2007 신경정신의학 Vol.46 No.6

B형 만성 활동성 간염 환자에서 Prednisolone 단기이탈 및 Alpha Interferon 병합요법의 효과

이종선,김병호,성자원,허승식,이기천,정현용,이헌영,김영건 충남대학교 의과대학 지역사회의학연구소 1991 충남의대잡지 Vol.18 No.2

To evaluate the safety and efficacy of Pd withdrawal followed by recombinant alpha- Interferon 2b therapy. Nine patients were given a single daily subcutaneous injection of ^α-Interferon at a dose of 3 x 10 exp(6) units/day for first weeks and thrice weekly for next 15 weeks (maintenance) after pd tappered over 6 weeks. To evaluate the efficacy of therapy, we measured serum aminotransferase activities monthly during and after therapy, and also measured serm HBsAg, HBeAg and DNA probe before and after therapy. To evaluate the safety of therapy, all patients checked peripheral blood WBC, Hemoglobin, Platelet, BUN and Creatinine. The results were as follows : 1. In control group, the normalization of s-AST & ALT level, negative seroconversion of DNA probe & HBeAg were observed in 1/12(8%) & 7/10(17%), 0/10(0%) & 0/12(0%) at 6 months later, and maintained response in 1/11(9%) & 1/11(9%), 2/9(22%) & 2/11(18%) until 1 years later. 2. In treatment group, Serum AST and ALT returned to normal in 8/9 & 8/9 cases (89%) after 1 montns Tx. (mean serum AST : 33±8, ALT : 34±12 IU/ml) and maintained to normal response in 5/9(56%) & 6/9 cases(67%)after 6 months Tx. (mean s-AST : 55±43, ALT : 66±84 IU/ml), 3/9(33%) & 4/9 cases(44%) after 1 years Tx. It was statistically significant reponse except s-AST of after 1 years Tx. 3. In treatment group, s- HBeAg returned to normal in 3/9 cases(33%) after 1 months Tx., and maintained to normal response in 1/7 & 1/4 cases among follow up patients in after 6 & 12 months Tx. Serm DNA probe level were observed significantly negative seroconversion in 8/9 cases(89%) after 1 months Tx. (p<0.003), and maintained to negative response in 2/6 & 1/3 cases after 6 & 12 months Tx. 4. Serum AST, ALT, HBeAg and DNA probe were not significantly correlated with therapeutic response in relation to histologic diagnosis. 5. Fever and myalgia were noted in 9(100%) & 6(67%) cases. Headache, mild hair loss, anorexia, nausea, facial flushing & diarrhea were noted in few cases. Peripheral WBC(3cases) & platelet counts(3cases) were decreased transiently. This study shows that Pd withdrawal followed by recombinant alpha Interferon 2b therapy may be safe and effective in decrease the level of s-DNA probe, transaminase activity, loss of HBeAg and less adverse effect of clinical and hematologic examinations in patients with CAH type B. But it was necessary for study with large number of patients, more prolonged follow up duration and more strict control study.

귀리 수용성 추출물의 성분과 점도특성

정헌상,강태수,박희정,정익수,이항영 한국산업식품공학회 2004 산업 식품공학 Vol.8 No.1

귀리 단백 다당체의 산업적 활용 가능성을 검토하고자 추출온도(40~60℃), 에탄올 농도(0~20%0 및 pH(5~9) 조건을 조합하여 중심합성계획법에 따라 얻은 귀리 추출물의 이화학적 특성을 분석하였다. 귀리 추출물의 수율은 6.4~17.9% 범위로 추출온도는 증가할수록 에탄올 농도는 감소할수록 증가하였고 중성일 때 보다 알칼리성이나 산성일 때 수율은 증가하는 경향을 보였다. β-glucan 및 단백질 함량은 각각 21.8~38.3% 및 23.8~29.0% 범위였고 추출온도는 낮을수록 에탄올농도는 높을수록 증가하는 경향을 보였으나 pH에 의한 영향은 없는 것으로 나타났다. 귀리 추출물 수용액은 저온 및 고농도일수록 점도가 증가하였으나 일반적으로 낮은 범위였으며, 전단속도에 따라 감소하는 의소성을 나타내었다. 본 연구결과 저농도 에탄올을 용매로 사용하여 귀리 추출물중의 단백 다당체 함량비를 조절할 수 있었고, 그 수용액 또한 식품용으로 적합한 유체 특성을 갖는 것으로 나타나 산업적인 활용가치가 높을 것으로 기대된다. To examine the utilization of the soluble proteoglucan in oats as a nutraceutical ingredient, soluble components were extracted from Oat Bran Concentrate (OBC) by varying the experiment factors such as temperature (40∼60℃), ethyl alcohol concentration (0∼20%), and pH (5∼9), and then analzed gor their compositions and viscosity. The total yield of iat solube extracts ranged between 6.4∼17.9 and the contents of β-glucan, protein, lipid, and ash in oat extracts were 21.4∼38.3%, 23.2∼29.0%, 8.3∼11.8%, and 5.9∼7.9%, respectively. The exreaction yield increased with the extraction temperature, but decreased with the alchohol concentration and pH. The β-glucan and protein contents increased with increasing temperature and decreasing ethaol concentration. However, the pH level did not influenced those contents. The viscosity of 2% oat extract solution ranged between 8.6∼83.1 cp at different share rates, showing the pseudo-plastic flow properties. Results suggested that extraction condition could be controlled the purity of β-glucan and protein and applied commercially to the large-scale process.

자연기흉의 임상적 고찰

이정헌,서강석,김종근,윤영국 大韓應急醫學會 1997 대한응급의학회지 Vol.8 No.1

Spontaneous pneumothorax is an accumulation of air in the pleural space with collapse of the lungs in the absence of external chest trauma. In this study, 175 cases of spontaneous pneumothorax experienced at emergency room of Kyungpook University Hospital from July 1995 to June 1996 were analyzed retrospectively. The results were summarized follows: 1. Sex ratio of male to female was 6.6:1 and the mean age was 36.7 years. 2. In clinical symptoms, dyspnea was 85 cases(48.6%), chest pain 67 cases(38.3%), chest discomfort 18 cases(10.3%), coughing 2 cases(1.1%), and others 3 cases(1.7%). 3. In etiology of spontaneous pneumothorax, primary spontaneous pneumothorax was 118 cases (67.4%) and secondary spontaneous pneumothorax 57 cases(33.6%). The underlying pathologic lesion of secondary spontaneous pneumothorax showed pulmonary tuberculosis in 50 cases(28.6%), COPD in 5 cases(2.9%), bronchial asthma in 1 case(0.6%), and pneumoconiosis in 1 case(0.6%). 4. The incidence of recurrence was as follows; no previous history in 123 cases(70.3%), second attack in 35 cases(20.0%), third attack in 15 cases(8.6%), fourth attack in 1 case(0.6%), and fifth attack in 1 case(0.6%). 5. The interval of recurrence after last attack was as follows; less than 6 months in 36 cases(69.2%), between 6 minths and 1 year in 5 cases(9.6%), between 1 and 2 years in 3 cases(5.8%), between 2 and 3 years in 2 cases(3.8%), and greater than 3 years in 6 cases(11.5%). 6. In distribution of the lesion sites, left was 93 cases(53.1%), right 80 cases(45.7%), and bilateral 2 cases(1.1%). 7. In degree of lung collapse, 17 cases(9.7%) were small(<20%), 127 cases(72.6%) moderate(20-40%), and 31 cases(17.7%) large(>40%). 8. The accompanied diseases of spontaneous pneumothorax were found in 17 cases, in which hydrothorax were 14 cases and homothorax were 3 cases. 9. The employed management were as follows; bed rest with oxygen inhalation in 6 cases(3.4%), thoracentesis in 4 cases(2.3%), closed thoracostomy in 136 cases(77.7%), and open thoracotomy in 29 cases(16.6%). 10. The reexpansion time after chest tube insertion was as follows; less than 1 day in 147 cases(89.6%), between 1 and 2 days in 12 cases(7.3%), between 2 days and 1 week in 4 cases(2.4%), and greater than 1 week in 1 case(0.6%). 11. The duration of chest tube insertion was as follows; less than 1 week in 102 cases(62.2%), between 1 and 2 weeks in 34 cases(20.7%), between 2 and 3 weeks in 14 cases(8.5%), between 3 and 4 weeks in 7 cases(4.3%), and greater than 4 weeks in 7 cases(4.3%). 12. The complications of closed thoracostomy were as follows; incomplete lung expansion in 4 cases and empyema in 1 case. 13. The indications of open thoracotomy were as follows; bleb or bullae on chest X-ray in 12 cases(14.4%), persistent air leak in 8 cases(27.6%), recurrent pneumothorax in 4 cases(13.8%), incomplete lung expansion in 3 cases(10.3%), and contralateral pneumothorax history in 2 cases(6.9%). 14. The duration of hospitalization was as follows; less than 1 week in 100 cases(57.1%), between 1 and 2 weeks in 29 cases(16.6%), between 2 and 3 weeks in 22 cases(12.6%), between 3 and 4 weeks in 9 cases(5.1%), and greater than 4 weeks in 15 cases(8.6%).