집중치료실에서 지속적 뇌파검사의 뇌파 패턴 분석

김천식,Kim, Cheon-Sik 대한임상검사과학회 2017 대한임상검사과학회지(KJCLS) Vol.49 No.3

The aim of this study was to detect the status of epilepticus and seizure based on the initial patterns observed in the first 30 minutes of continuous electroencephalogram (cEEG) monitoring. An cEEG was recorded digitally using electrodes applied according to the International 10~20 System. The EEG data were reviewed from January 2014 to December 2015. The baselines of the EEG patterns were characterized by lateralized periodic discharges, generalized periodic discharges, burst suppression, focal epileptiform, asymmetric background, generalized slowing, and generalized periodic discharges with a triphagic wave. The etiology was classified into five categories. The subjects of this study were 128 patients (age: $56.9{\pm}17.5years$, male:female, 74:54). The mean cEEG monitoring duration was $5.5{\pm}5.1$ (min:max, 1:33) days. The EEG pattern categories included lateralized periodic discharges (N=7), generalized periodic discharges (N=10), burst suppression (N=6), focal epileptiform (N=19), asymmetric background (N=24), generalized slowing (N=51), and generalized periodic discharges with a triphagic wave (N=11). The etiological classifications of the patients with status epilepticus were remote symptomatic (N=4), remote symptomatic with acute precipitant (N=9), acute symptomatic (N=6), progressive encephalopathy (N=2), and febrile seizure (N=1). cEEG monitoring was found to be useful for the diagnosis of non-convulsive epileptic seizures or status epilepticus. The seizure was confirmed by the EEG pattern.

주간졸음증 환자로부터 기면증 1예 보고

김천식 ( Cheon Sik Kim ),김대식 ( Dae Sik Kim ) 대한임상검사과학회 2005 대한임상검사과학회지(KJCLS) Vol.37 No.3

We report a case of narcolepsy. A 25-year-old man has had excessive daytime sleepiness of about 10 years durations. He awakens daily feeling exhausted and continually falls asleep during the day while engaged in such situation like reading and watching television. He has exhibited cataplexy, a sudden loss of muscular tone, brought on by emotion, usually laughter. Polysomnogram revealed increased sleep stage 1, 2 and decreased deep sleep. Multiple sleep latency test (MSLT) showed that sleep latency was 1.33 minutes and there were 3 noted sleep onset rapid eye movement (SOREM) on 5 trials. The epworth sleepiness scale (ESS) was 17/24. Typing of HLA haplotype that was positive for the DQB1*0602 allele, and hypocretin-1 (orexin A) could not be detected in cerebrospinal fluid (CSF). Brain MRI showed normal image. We diagnosed his case as narcolepsy based on history of cataplexy, and three occurances of SOREM, and positive of HLA haplotype.

뇌사의 진단과 진단을 위한 보조적 검사

김천식 ( Cheon Sik Kim ) 대한임상검사과학회 2004 대한임상검사과학회지(KJCLS) Vol.36 No.1

Brain death is defined as the irreversible cessation of all brain function. The diagnosis of brain death is primarily based on a careful neurological examination demonstrating unresponsiveness, absent of brain stem reflexes, and no respiratory activity. Several conditions which may mimic brain death must be excluded. In some cases investigations such as electroencephalography, angiography, transcranial doppler or evoked potentials can contribute to the diagnosis. The brief review will introduce medical technologist and clinician to the key issues in the definition and management of brain death.

폐쇄성 수면 무호흡-저호흡증후군 환자에서 과도한 주간졸음증과 혈압 사이의 연관성

김천식 ( Cheon-sik Kim ),김대식 ( Dae-sik Kim ) 대한임상검사과학회 2016 대한임상검사과학회지(KJCLS) Vol.48 No.3

수면무호흡-저호흡를 가지고 있는 환자에서 과도한 주간졸음증의 표현형과 혈압 사이의 관계를 조사하고자 한다. 환자는 수면다원검사 결과에 따른 무호흡-저호흡지수가 5미만인 그룹은 코골이 그룹(n=108), 5∼15 사이는 경도 무호흡 그룹(n=186), 15∼30사이는 중증도 무호흡 그룹(n=179), 30 이상인 그룹은 중증 무호흡그룹(n=233)으로 나누었다. 혈압 측정은 검사 시작 전과 후에 똑바로 누운 자세에서 3분 간격으로 2회 측정 후 평균값으로 야간 혈압과 아침 혈압을 측정하였다. 주간졸음증군과 비주간졸음증군의 수면 파라미터와 혈압과의 상관관계를 측정하였다. 수면 파리미터와 혈압과의 이변량 상관관계에서 평균 동맥혈압과 체질량지수, 무호흡-저호흡지수, 총 각성지수는 양의 상관관계로 나타났고(r=0.099, r=0.142, r=0.135, p<0.01, p<0.01, p<0.01), 최저산소포화도는 음의 상관관계로 나타났다(r=.0.258, p<0.01). 주간졸음증군은 비주간졸음증군에 비해 나이가 어리고(47.2±11.3 vs 50.3±11.4, p=0.023), 이완기 혈압이 높고(야간 이완기혈압과 아침 이완기혈압, 83.1±9.7 vs 81.4±8.8, 86.4±9.2 vs 83.6±9.7)(p=0.031,p=0.047), 수축기혈압도 높았다(야간 수축기혈압, 아침 수축기혈압, 126.7±11.2 vs 123.4±12.4, 128.9±12.4 vs 125.3±12.9)(p=0.021, p=0.021). 무호흡-저호흡를 가지고 있으면서 고혈압이있고, 주간졸음증을 함께 가지고 있는 그룹은 그렇지 않은 그룹에비해 나이가 어리고, 총 각성숫자가 높고, 아침과 야간 수축기 및 이완기혈압이 높았다(p<0.005, p=0.008, p<0.001, p<0.001). 결론적으로 주간졸음증의 표현형은 나이가 어리고, 아침 및 야간 수축기혈압과 이완기혈압이 높고, 수면 중 산소포화도가 더 떨어졌다. The purpose of this study was to investigate the relationship between excessive daytime sleepiness (EDS) and blood pressure (BP) in patients with obstructive sleep apnea-hypopnea (OSAH). Patients were classified into four groups based on their severity of polysomnographic data: the snoring group (n=108).characterized by Apnea-Hypopnea Index (AHI<5); the mild OSA group (n=186).AHI 5≤AHI<15; the moderate OSA group (n=179). AHI 15≤AHI<30; and the severe OSA group (n=233).AHI≥30. On the same night of polysomnography (PSG), BP levels were measured before sleeping (bedtime BP) and immediately after waking up on the following morning (morning BP). EDS was recognized as ESS (epworth sleepiness scale)≥9. The differences and correlations between BP and PSG parameters in the EDS and non-EDS groups of OSAH patients were analyzed. MAP was positively correlated with BMI, AHI, and total arousal (r=0.099, r=0.142, r=0.135, p<0.01, p<0.01, p<0.01), while negatively correlated with mean SaO2 (r=.0.258, p< 0.01). The EDS group had overall younger population (47.2±11.3 vs 50.3±11.4, p=0.023), higher DBP (both bedtime and morning, 83.1±9.7 vs 81.4±8.8 and 86.4±9.2 vs 83.6±9.7)(p=0.031, p=0.047), and higher SBP (both bedtime and morning, 126.7±11.2 vs 123.4±12.4, 128.9±12.4 vs 125.3±12.9)(p=0.021, p=0.021) than compared with the non-EDS group. In hypertensive OSAH patients, patients with EDS were also younger and had higher total arousal number, as well as higher morning and bedtime DBP and SBP than compared with the non-EDS group (p<0.005, p=0.008, p<0.001 and p<0.001). EDS in OSAHS patients is a special phenotype characterized by younger age, higher DBP, more severe desaturation, and hypertension.

소아와 성인의 난치성 간질 환자에서 미주신경 자극술의 효과

김천식 ( Cheon Sik Kim ),노영주 ( Yeong Joo Ro ),최상용 ( Sang Yong Choi ),김대식 ( Dae Sik Kim ) 대한임상검사과학회 2006 대한임상검사과학회지(KJCLS) Vol.38 No.2

Vagal nerve stimulation (VNS) has been proposed as a possible way to improve the control of refractory epilepsy. We report the effects following VNS treatment in patients with refractory epilepsy. Seventeen patients with a mean age of 12.8 years, ranging from 5 to 29 years, underwent the implantation of vagal nerve stimulation (Cyberonics, Houston, TX). We reviewed the clinical findings before and after VNS in seizure frequency, number of antiepileptic drugs (AED), and quality of life (QOL). All of the patients had intractable seizures, eleven of the patients had additional medical complications, three had hippocampus atrophy, one had encephalomalacia, five had encephalitis, one had pachygyria, and one had schizencephaly. Thirteen patients had symptomatic partial epilepsies, three patients had Lennox-Gastaut syndrome and one had cryptogenic partial epilepsy. The mean follow up duration was 35 months. The mean reduction of seizure frequency compared with baseline before VNS was 26.1% after 3 months (p<0.005), 41.9% after 6 months (p<0.001), 46.9% after 1 year (p<0.001), and 53% at the latest follow-up (p<0.001). Twelve patients showed an improvement of QOL such as mood, language, alertness, expression, and motor function. The most common side effects were transient hoarseness or voice change or cough, which was detected in six patients (35%) and wound infection in one patient (5%). This study has shown a good anti-seizure effect of VNS, decrease in seizure frequency and improvements in QOL. We concluded that VNS is a beneficial therapy in refractory epilepsy with a non-resectable epileptic focus. Further studies should be focused on the prediction of unresponsiveness and the adjustment of VNS parameters for maximum efficacy in patients with various medical histories.

중학생 태권도 수련참가자의 운동욕구 분석

김천식(Cheon Sik Kim) 한국사회체육학회 2005 한국사회체육학회지 Vol.0 No.24

폐쇄성 수면무호흡 증후군과 목둘레 및 체질량 지수와의 상관성 연구

김천식 ( Cheon Sik Kim ),김대식 ( Dae Sik Kim ) 대한임상검사과학회 2007 대한임상검사과학회지(KJCLS) Vol.39 No.2

Obstructive Sleep Apnea-Hypopnea Syndrome (OSAHS) is a disorder characterized by the repetitive collapse of the pharyngeal airway during sleep, which leads to oxygen desaturation, sleep fragmentation, daytime sleepiness, and increased risk for hypertension and stroke. We investigated the clinical factors related to the severity of OSAHS. Polysomnography was performed in three hundred and ninety five consecutive adult patients with clinical symptoms of obstructive sleep apnea syndrome. All patients completed the sleep questionnaire and the Epworth Sleepiness Scale before polysomnography. Patients were classified into four groups based on the severity of their polysomnographic data: Non-OSA group, characterized by Apnea-Hypopnea Index (AHI) < 5; mild OSA group, by AHI 5.15; moderate OSA group, by AHI 16-30; and severe OSA group, by AHI > 30. Neck circumference was also measured at the cricothyroid level. A total of 395 patients (336 men and 59 women) were studied. In the non-OSA group, there were 55 patients; their mean neck circumference was 39.63 ±4.24 cm and mean BMI was 24.48 ± 3.53. In the mild group, there were 101 patients; their mean neck circumference was 41.93 ± 3.75cm and mean BMI was 25.33 ± 2.94. In the moderated group, there were 93 patients; their mean neck circumference was 43.27 ± 3.50 cm and BMI was 25.90 ± 2.88. In the severe group, there were 146 patients; their mean neck circumference was 44.94 ± 3.93 cm and mean BMI was 26.81 ± 3.76. Men had significantly larger neck circumference than women (Mean ± SD, 43.72 ± 3.83 vs 39.17 ± 4.30, p < 0.001), and higher AHI than women (29.12 ± 22.65 vs 14.63 ± 14.11, p < 0.001). Multiple regression analysis revealed that neck circumference was the most significant predictor of AHI. Neck circumference and BMI were positively correlated with the severity of OSAHS. The severity of OSAHS was greater in men than in women.

난치성 간질 환자에서 미주신경자극술 치료결과 분석(레녹스-가스토 증후군 환자)

김대식 ( Dae Sik Kim ),김천식 ( Cheon Sik Kim ) 대한임상검사과학회 2007 대한임상검사과학회지(KJCLS) Vol.39 No.1

Lennox-Gastaut syndrome(LGS) is a severe age-specific epilepsy syndrome that causes medication-resistant seizures in childhood. Vagal nerve stimulation (VNS) has been proposed as a possible way to improve the treatment of refractory epilepsy. We treated 9 patients with Lennox-Gastaut syndrome between the ages of 2 and 11 years (mean 5.8 years), by using the vagus nerve stimulation. The mean follow-up duration was 35 months. The mean reduction of seizure frequency compared with baseline before VNS was 52% after 6 months (range, 0% to 89%; P<0.011), and 58% after 1 year (range 0% to 89%; P<0.012). Seven patients showed improvements of quality of life (QOL) such as alertness, mood, and language skills. The most common side effects were transient hoarseness (6 patients) and drooling (1 patient). Our results suggest that the vagus nerve stimulation could be an effective and safe adjunct therapy for the treatment of Lennox-Gastaut syndrome.

집중치료실에서 치료한 중첩성 경련 환자의 신경생리학적 결과 분석

김대식 ( Dae Sik Kim ),김천식 ( Cheon Sik Kim ) 대한임상검사과학회 2005 대한임상검사과학회지(KJCLS) Vol.37 No.2

Status epilepticus is a medical emergency, so that rapid and vigorous treatment is required to prevent neuronal damage and systemic complication. Status epilepticus is generally defined as a continuous or intermittent seizure or an unconscious condition after the onset of seizure, lasting for 30 minutes or more. We report here the outcome of status epilepticus. We retrospectively reviewed medical record of 15 patients who were diagnosed with status epilepticus at the Asan Medical Center from January 2003 to February 2004. This outcome was evaluated considering various factors such as age of patients, history of seizures, neurologic impairment, etiology, mortality, return to baseline and initial electroencephalogram (EEG) findings. The range of age was between 1 to 79 years old and the longest duration of treatment was 118 days. Most patients were treated by using pentobarbital, midazolam, phenobarbital and other antiepileptic drugs. The overall mortality was 5 (33%) out of 15 patients. The mortality was related to etiology, underlying other medical conditions and initial EEG findings. 5 (55%) out of the 9 patients with acute etiology, 5 (71%) out of the 7 patients with a multifocal or burst-suppression EEG activity, and 3 (60%) out of the 5 patients with other medical disease were related to mortality. This data demonstrate high mortality due to status epilepticus. Mortality is related to etiology, other medical conditions and abnormalities on the initial EEG.

퍼지 및 신경망 알고리즘을 이용한 엔진오일 교환 시기 예측 방법에 관한 연구

남상엽,홍유식,김천식,Nam, Sang-Yep,Hong, You-Sik,Kim, Cheon-Shik 대한전자공학회 2005 電子工學會論文誌 IE (Industry electronics) Vol.42 No.4

엔진오일 교환 시기 예측은 엔진의 수명을 연장하고 연비를 증가시킨다. 그러나, 엔진오일의 교환 시기는 자동차를 주행한 거리나, 장거리를 운행한 차량, 단거리를 운행한 차량, 엔진오일의 종류 등에 따라서 크게 달라진다. 본 논문에서는 엔진오일 교환 시기를 예측함에 있어서 단지 주행 거리나 엔진오일의 색깔의 변화 등의 데이터를 퍼지 및 신경망 알고리즘을 이용하여 값을 구하였다. 모의실험결과, 지능형 엔진오일 교환 시스템이 기존의 사람이 예측하여 결정하는 방식 보다는 더 정확하게 엔진 오일을 교환할 수 있음을 입증할 수 있었다. 따라서 지금의 자동차에 이러한 알고리즘을 적용한다면 보다 편리한 차량이 될 것으로 기대한다. If we can forecast the replacement time of engine oil, we extend the life-time of our engine and increase the continued ratio. But, the replacement times of engine oil is influenced by the following elements: the distance that cars or vehicles travel, vehicles that run a short range, types of engine oil etc. that run a long distance. In this paper, We forecast engine oil replacement times by using fuzzy neural network algorithm. This algerian uses the data of distance covered, color of engine oil etc. Through a sequence of simulation, the exchange system of intelligence style engine oil decides on the replacement times of engine oil quite accurately. Therefore, We expect vehicles to become more convenient if the above algorithm is a lied to the present types of cars.