Guillain-Barre 증후군의 임상적 및 전기생리학적 연구

윤성환 ( Sung Hwan Yun ),하정상 ( Jung Sang Hah ),주성균 ( Sung Gyun Joo ),조용국 ( Yong Kook Cho ),김정현 ( Jung Hyun Kim ),정지윤 ( Ji Yeun Chung ) 영남대학교 기초/임상의학연구소 2005 Yeungnam University Journal of Medicine Vol.22 No.1

Background: Guillain-Barre syndrome is defined as a recognizable clinical entity that is characterized by rapidly evolving symmetric limb weakness, the loss of tendon reflexes, absent or mild sensory signs, and variable autonomic dysfunctions. This study evaluated the clinical and electrophysiological findings retrospectively. Materials and Methods: Forty-five patients with Guillain-Barr? syndrome, who were admitted to the Yeungnam University Hospital for six years from Jan. 1994 to Dec. 1999 were investigated. The correlation between the clinical manifestation and the electrophysiological study was evaluated. Results: The male to female ratio was 1.8:1 and there was a peak seasonal incidence in the winter. A preceding illness was noted in 66.7 % of cases, and an upper respiratory tract infection was the most common one. The most common clinical manifestations were a loss of tendon reflex and ascending muscle weakness and paralysis. The cerebrospinal fluid examinations revealed, albuminocytologic dissociation in 33 cases (73.3 %). Intravenous immunoglobulin therapy was performed in 29 cases (64.4 %). The sequential electrophysiological abnormalities were most marked at 2 to 4 weeks after onset. At that time the most significant change was a decrease in the compound muscle action potential amplitude. These 45 patients with Guillain-Barr? syndrome were subclassified using the clinical and electrophysiological data. Conclusion: The result in this study, concured with other research on the clinical and electrophysiological data of Guillain-Barr? syndrome. However, an extensive and dynamic investigation is necessary to determine the reason for the peak seasonal incidence in winter.

천마의 GABA-benzodiazepine 수용체 복합체에 대한 조절작용

허근(Keun Huh),용철순(Chul Soon Yong),하정희(Jeoung Hee Ha),이동웅(Dong Ung Lee),어경윤(Kyung Yoon Eah),하정상(Jung Sang Hah),김현주(Hyun Ju Kim) 한국응용약물학회 1997 Biomolecules & Therapeutics(구 응용약물학회지) Vol.5 No.4

Methanol extract of G. elata inhibited the binding of [³H]Ro15-1788, a selective benzodiazepine receptor antagonist, to benzodiazepine receptor of rat cortices. Saturation experiments followed by Scatchard analysis of the results showed that the inhibition of [³H]Ro15-1788 binding by G. elata. appeared to be competitive. These competitive inhibiton of the butanol fraction was observed to be higher than the methanol extract. Methanol extract of G. elata inhibited a [³H]flunitrazepam, a selective benzodiazepine receptor agonist, binding to benzodiazepine receptor. GABA significantly enhanced the inhibition of [³H]flunitrazepam binding by G. elata, and these positive GABA shift supported the strong possibility of agonistic activity to benzodiazepine receptor. Butanol fraction was observed to be higher than crude extract by methanol in an agonistic activity to benzodiazepine receptor, furthermore enhanced the binding of [³H]SR95531 to GABA_A, receptor. Butanol fraction of G. elata significantly diminished the pentylenetetrazole-induced lethality of mice. From these results, it can be concluded that substance or substances with neurochemical properties characteristic of a benzodiazepine receptor agonist may be important components, and contribute to the anticonvulsant property of G. elata.

손목굴증후군의 임상증상 정도와 전기 생기학적 척도와의 관계

도현철 ( Hyun Chul Do ),이준 ( Jun Lee ),이세진 ( Se Jin Lee ),박미영 ( Mee Young Park ),하정상 ( Jung Sang Hah ) 영남대학교 기초/임상의학연구소 2007 Yeungnam University Journal of Medicine Vol.24 No.2S

Background:To investigate the relationship between clinical grading and electrophysiological parameter in carpal tunnel syndrome. Materials and Methods:This studies examined 75 outpatients (100 hands) who were diagnosed as carpal tunnel syndrome at neurologic clinic from March to July in 2006. They were divided into three groups by clinical grading and then each groups were compared with sensory nerve conduction velocity (SNCV) and sensory compound nerve action potential (CNAP) amplitude of I-W, F-W, and P-W segments, motor terminal latency (TL), motor compound muscle action potential (CMAP) amplitude of distal segment, and disto-proximal ratio on the third finger. 1) Results:The first group(mild) was 46 (51 hands) patients, second group(moderate) was 29 (35 hands) patients, and the third group (severe) was 14(14 hands) patients. The mean ages were 55.9, 57.4 and 57.0 years in each group, and there were no statistical differences in age and sex between 3 groups. SNCV of I-W, F-W and P-W segments and motor TL were different significantly between 3 groups, but disto-proximal ratio on the third finger was not different significantly(P<0.05). Motor TL was correlated with clinical grading. And also sensory CNAP amplitude of I-W, F-W, and P-W segments, and motor CMAP amplitude of distal segment were different significantly between 3 groups. Especially, sensory CNAP amplitude of P-W segment and motor TL were correlated with higher clinical grading groups(2, 3 groups)(p<0.05). Conclusion:SNCV of F-W and P-W segments, motor TL, motor CMAP amplitude of distal segment and sensory CNAP amplitude of each segments were correlated with the clinical grading of carpal tunnel syndrome.

Becker형 선천성 근긴장증 1례

윤성환,이준,하정상 영남대학교 의과대학 1999 Yeungnam University Journal of Medicine Vol.16 No.1

저자들은 최근 25세 여자 환자로 뚜렷한 가족력이 없으면서 3-4세경부터 발생한 근육의 강직현상과 현저한 근비대소견이 있는 환자를 경험하였다. 임상적으로 타진성 근긴장증을 보이고 전기생리적 검사로 새끼손가락 외향근에서의 운동과 반복신경자극에서 복합근육활동전위의 감소를 보였으며, 이두박근의 근생검 소견상 용적이 증가된 근섬유와 중심핵화현상이 관찰되었다. 환자는 mexiletin 경구 투여후 근육의 강직현상이 다소 호전되었다. 이에 문헌고찰과 함께 Becker형 선천성 근긴장증 1례를 보고하는 바이다. Congenital myotonia is a hereditary disorder of the skeletal muscle. The most characteristic features of the disease are myotonia and variable muscular hypertrophy. Molecular biologic investigations have revealed that mutations in the gene of the human skeletal muscle chloride ion channel protein are a cause of the disease. The Becker's type congenial myotonia is clinically similar to the autosomal dominantly inherited congenital myotonia (Thomsen's disease). Both disorders are characterized electrophysiologically by increased excitability of muscle fibers, reflected in clinical myotonia. In general, Becker's type congenital myotonia is more severe than Thomsen's disease in muscular hypertrophy and weakness. The authors recently experienced a 25-year-old female patient who has no family-related disease history and who has conspicuous muscular hypertrophy and the stiffness with muscles which occurred from the age of 3 or 4. Clinically she showed the authors a percussion myotonia. On electrophysiological study, exercise and repetitive stimulation of the abductor digiti quinti muscle disclosed a decline in the compound muscle action potential. Biopsy of biceps muscle revealed enlargement of muscle fibers with marked nuclear internalization. After the oral taking the Maxiletine, the patient showed a favorable turn a little with her stiffness of muscles. So we authors are reporting one case of Becker's type congenital myotonia with review of literatures.

허혈성 뇌졸중에서의 항혈전 치료

하정상,이준 영남대학교 의과대학 2003 Yeungnam University Journal of Medicine Vol.20 No.1

Ischemic stroke is among the principal causes of death and disability in the elderly. Although control of blood pressure, decreased cigarette smoking, and modified dietary habits are among important reasons for stroke decline, the use of antithrombotic therapy, rigorously prescribed. Several antiplatelet agents are approved to reduce the risk of recurrent stroke. Aspirin is the best-studied and most widely used antiplatelet agent for stroke prevention; it provides approximately 15% to 25% relatively risk reduction for secondary prevention of stroke or the major vascular death. Combining 2 antiplatelet agents with different mechanism of action was demonstrated to provide a substantial increase in efficacy in several studies. Anticoagulation should be considered first with potential cardiac sources of embolism. Heparin reduces development of erythrocyte-fibrin thrombi that form in regions of vascular stasis especially within the heart, in severely stenosed arteries sometimes engrafted on white thrombi, in acute arterial occlusion. Heparin should not be indiscriminately given to all acute brain ischemia patients, but may contribute to treatment of large artery occlusion and severe stenosis, cardiogenic embolism with a high acute recrrence risk, and dural sinus and cerebral venous thromobosis.

광범위한 뇌 석회침착을 수반한 특발성 부갑상선 기능저하증 1례

김욱년,하정상 영남대학교 의과대학 1997 Yeungnam University Journal of Medicine Vol.14 No.1

저자들은 경련을 주소로 내원한 특발성 부갑상선 기능저하증에서 뇌기저핵, 소뇌, 뇌실 주위의 광범위한 석회침착을 보인 환자를 치험하여 방사선학적 뇌단층촬영상 특징적 소견과 그 병태생리 및 임상증상과의 연관관계를 문헌고찰과 함께 보고 한다. Idiopathic hypoparathyroidism is frequeutly associated with intracranial calcification and neuropsychiatric abnormalities. The most commonly recognized central nervous system manifestations of chronic hypoparathyroidism are seizure, alteration of mental function and extrapyramidal signs. We present a case of hypoparathyroidism, demonstrating extensive intracranial calcification, not only basal ganglia, but also outside the extrapyramidal system. An 58-year-old woman presented with 30 year history of seizure and memory disturbance. The physical examination and several laboratory studies disclosed normal. However hypocalcemia, hyperphosphatemia with hypocalciuria and decreased parathormone level were demonstrated. Clinical symptoms and signs showed improvement after supplementary calcium and Vit D₃therapy.

부분성 간질환자에서 난치성에 관여하는 인자

이세진,이영기,변영주,박미영,하정상 영남대학교 의과대학 1995 Yeungnam University Journal of Medicine Vol.12 No.2

영남대학교 의과대학 부속병원 신경과에서 1991년 1월부터 1993년 8월 사이에 발작의 임상양상이나 뇌파검사에서 부분성 발작으로 진단된 환자들 중에서 대상 기준 및 제외기준은 만족하는 비조절군 45례와 조절군 68례를 대상으로 하여 난치성에 관련된 임상변수들을 분석하여 다음과 같은 결과를 얻었다. 부분성 복합발작, 다종의 발작형, 군집성 발작양상이나 중첩성 발작형의 병력이 있는 경우에 약물치료에 대한 반응이 불량하였다(P<0.01). 치료전의 발작횟수가 많을 수록 항경련제 치료에 잘 반응하지 않았다(P<0.01). 경련의 명확한 원인이 규명된 경우, 신경학적 이상소견 및 정신심리적인 결함이 있는 경우에 치료에 잘 반응하지 않았다(P<0.01, P<0.05, P<0.01). 뇌파검사에서 배경파의 서파화, 국소성 서파, 간질파 및 이차적 양측성 동기화등의 이상소견이 있으면 치료에 대한 반응이 불량하였다.(P<0.01). 성별, 발병연령, 간질병소의 분포, 치료전의 유병기간, 가족력 및 신경방사선적 이상소견 등은 치료에 대한 예후와는 무관하였다. 이상의 결과에 비추어 보아, 난치성과 관련된 임상변수를 적어도 4개 이상 가진 환자에서는 치료에 잘 반응하지 않는 난치성 간질로 될 가능성이 크다고 할 수 있다. To evaluate the intractability of partial epileptic patients by variables, the author studied 113 patients (uncontrolled: 45, controlled:68) who were admitted to the Department of Neurology, College of Medicine, Yeungnam University from January, 1991 to August, 1993. The results were as follows. The items related to complex partial seizures, multiple seizure types and a histories of status epilepticus or clusters of seizures were significantly associated with drug- refractoriness (P<0.01). A high frequency of seizures before evaluation was associated with a poor outcome (P<0.01). The presences of known etiology of seizures, neurologic abnormalities and psychiatric disturbance were associated with limited treatment responses (P<0.01, P<0.05, P<0.01). An abnormal EEG findings such as background slowing, focal slowing, epileptiform discharges or secondarily bilateral synchrony were statistically significant (P<0.01). Age at onset, sex, distribution of epileptic foci, duration of seizure before evaluation, family history and abnormal neuroradiologic findings were not statistically significant. By these results, it was suggested that having at least four factors of the above variables were associated with limited treatment response.

Sturge-Weber 증후군 1례

하정상,박충서 최신의학사 1986 最新醫學 Vol.29 No.10

중증 근무력증 52례에 대한 임상적 고찰

박건주,하정상,이준,도현철,박승권,서상덕,기병수,김진국 영남대학교 의과대학 1996 Yeungnam University Journal of Medicine Vol.13 No.1

1985년 8월부터 1996년 1월까지 중증근무력증으로 진단받은 환자 52례에 대한 임상적 고찰을 통하여 다음과 같은 결론을 얻었다. 1. 전체 환자 중 남자가 19례(35.8%), 여자가 33례(64.2%)이넜고 11세에서 20세 사이가 12례(23%)로 가장 높은 빈도를 보였다. 2. 환자의 초기증상으로는 안검하수, 복시 등의 안구증상이 37례(71.2%)로 가장 많았고 modified Osserman의 분류에 따라서도 가장 증상이 가볍고 약물치료에 잘 반응하는 1군이 36례(69.3%)로 가장 많았다. 3. 환자가 호소하는 증상의 비특이성과 회복과 재발을 거듭하는 질병의 특성으로 인해 발병이후 진단될 때까지의 시간은 비교적 오래 걸렸고 1년이상 경과하며 진단된 경우도 16례(30.8%)나 되었다. 4. 자가면역질환이 7.6%에서 동반되었는데 갑상선기능 항진증이 2례(3.8), 인슐린의존형 당뇨 2례(3.8%)였고 종격동 전산화 단층촬영소견에서 흉선의 비대가 의심되었던 환자는 6례(11.5%), 흉선종이 발견 되었던 경우는 3례였다. 5. 환자의 치료는 대부분 항콜린에스테라제나 부신피질호르몬을 병용하는 내과적 치료를 하였으며 약물의 치료에 반응이 미비하거나 악화되는 경우 혹은 종격동 전산화 단층촬영상에서 흉선의 이상 소견이 보인 경우에 2례(3.9%)에서는 흉선절제술이, 1례(1.9%)에서는 혈장여과요법이 추가 되었고 흉선절제술과 혈장여과요법이 같이 병합 치료된 경우도 3례(5.9%)있었다. 6. 전체 환자중 2명에서 자연치유의 경과를 보였으며 이들은 모두 1군이였다. 그리고 흉선절제술과 부신피질 호르몬 투여로 완치된 예가 1례있었다. The authors experienced 52 patients with myasthenia gravis who were diagnosed at the Department of Neurology, Yeungnam University Hospital from August 1985 to January 1996. The following results were obtained through diagnostic evaluation and treatment. 1. The ratio of male to female was 1:1.7 and the most prevalent age group was second decade. 2. The most common initial presentation symptom was ocular(71.2%) and the peak incidence group was stage I(69.3%) according to the modified Osserman's classification. 3. In 16 patients(30.8%), it took more than a year to diagnose due to symptoms which were relapsed and remitting. 4. Of 52 patients, 2 cases were associated with thyroid disease(3.8%) and 2 with insulin-dependent diabetes mellitus(3.8%). 5. All of those who received anticholinesterase and corticosteroid therapy were improved with the exception of 5 cases which were improved after thymectomy and/or plasmapheresis. 6. Spontaneous remission was occured in 2 cases(3.8%) of ocular myasthenia gravis. And 1 case of group II was cured through thymectomy and long-term corticosteroid therapy.

Carbamazepine 투여가 간질환자의 혈청면역 글로불린에 미치는 영향에 대한 연구

변영주,박미영,하정상 최신의학사 1993 最新醫學 Vol.36 No.7