열공형과 비열공형 피질하 혈관성 치매에서 위험인자의 차이에 관한 비교 연구

배희준,정지향,유경호,나덕렬,김상윤,최경규,양동원,손의주,이상도,김재우,박경원,김응규,이재홍,박미영,한일우,함동석,최문성,하충건,최성혜,이애영,이병철,한설희 대한치매학회 2003 Dementia and Neurocognitive Disorders Vol.2 No.2

Backgrounds and Objectives: Vascular dementia is a group of dementing disoders arising from various stroke syndrome. Among these. subcortical ischemic vascular dementia (SIVD) is regarded as a relatively distinct clinical entity. However, MRI patterns of SIVD are not homogenous. In some patients, lacunes are dominant, and in others, subcortical white matter changes are. This study was designed to compare risk factor profiles between SIVD with and without multiple lacunes. Methods: We divided 47 subjects (22 males, mean age. 68 years) recruited from VADAPET (Multicenter Trial For Evaluation Of The Changes In the PET Images Of Subcortical Vascular Dementia Patient) study into two groups one with more than 5 lacunes in deep gray matter (lacune group) and the other with 5 or less(non-lacune group) Clinical characteristics and laboratory findings of two groups were compared. Results: Nineteen of 47 patients (40%) belonged to the lacune group. The lacune and non-lacune groups d d not differ in the following variables: age, hypertension, diabetes mellitus, hyperlipidemia heart disease, history of stroke or TIA, history of trauma or major surgery, family history of hypertension stroke, or dementia, age at diagnosis of dementia, body mass index, white blood cell count, ESR, CRP, fibrinogen, hemoglobin A1C, total cholesterol. LDL cholesterol creatinine, proteinuria, glucosuria, and microhematuria. However, male sex, smoking alcohol. hemoglobin, and HDL cholesterol were possibly associated more with lacune group SIVD than with non-lacune group (p<0 1) Multivariate analyses revealed that smoking, hemoglobin, and HDL cholesterol were independent predictors of SIVD with multiple lacunes Conclusion: Our study suggests that SIVD with multiple lacunes may be significantly different in smoking habits hemoglobin, and HDL cholesterol from SIVD without multiple lacunes.

근위 경골과 골절의 수술적 치료에서 예후 인자

최의성,박경진 충북대학교 의과대학 충북대학교 의학연구소 1997 忠北醫大學術誌 Vol.7 No.2

경골과 골절로 치료받은 17예의 환자를 대상으로 골절의 유형, 치료 방법, 정복의 정도, 골이식의 방법 및 동반 손상의 유무 등을 중심으로 치료 결과를 분석하여 예후에 영향을 미치는 인자를 조사하고자 하였다. 경골 외과의 분리 또는 설상형 골절의 제 1형이 가장 많았으며, 13예에서 수술적 정복 및 내고정이 시행되었다. 88%의 환자에서 만족할 만한 결과를 얻었는데, 동반 손상은 수술적으로 치료되었고, 결과에는 큰 영향이 없는 것으로 생각되었다. 경골과 골절에서 예후에 가장 영향을 미치는 인자는 골절의 정복 정도인 것으로 생각되었으며, 정확의 방법이나 고정 기간은 크게 문제되지 않았다. 5mm 이상의 관절면 불일치는 불만족한 결과를 초래하였다. 골이식과 만족한 결과와는 상관 관계는 보이지 않았으나, 큰 골 결손이 있는 경우 골이식은 꼭 필요할 것으로 생각되었다. Seventeen patients with fractures of the tibial plateau were reviewed and assessed in terms of fracture type, treatment method, adequacy of reduction, type of bone graft, associated ligamentous and meniscal injury, and overall result in an attempt to define factors important in the prediction of outcome. Cleavage or wedge-type fractures of lateral condylar plateau(type I) were the most common(29%). Thirteen of the 17 fractures were treated by open reduction and internal fixation, and three were treated by closed methods. Overall, 88% of the patients had a satisfactory result. Ligamentous and meniscal injuries were treated surgically and did not influence the final outcome. The single most important factor in predicting outcome in a patient with a tibial plateau fracture was the adequacy of reduction. The method of achieving the reduction and the length of the immobilization period of the knee were not as crucial. A residual step of greater than 5mm on the weight-bearing area was universally associated with an unsatisfactory result. Even there was no correlations between the satisfactory result with bone graft, bone graft to the large bone defect of tibial plateau fracture is seemed mandatory.

Effect of Ionizing Radiation on Rat Tissue: Proteomic and Biochemical Analysis

Park*, Eui‐,Chul,Yoon, Jong‐,Bok,Seong*, Jin‐,Sil,Choi, Kyoung‐,Soo,Kong, Eung‐,Sik,Kim, Yun‐,Jeong,Park, Young‐,Mee,Park, Eun‐,Mi Taylor Francis 2006 Preparative biochemistry & biotechnology Vol.36 No.1

<P>Reactive oxygen species (ROS), generated by ionizing radiation, has been implicated in its effect on living tissues. We confirmed the changes in the oxidative stress markers upon irradiation. We characterized the changes in the proteome profile in rat liver after administering irradiation, and the affected proteins were identified by MALDI-TOF-MS and ESI-MS/MS. The identified proteins represent diverse sets of proteins participating in the cellular metabolism. Our results demonstrated that proteomics analysis is a useful method for characterization of a global proteome change caused by ionizing radiation to unravel the molecular mechanisms involved in the cellular responses to ionizing radiation.</P>

만성 요통 환자의 심리사회적 특성

김용민,원중희,최의성,서중배,이호승,허윤무 충북대학교 의학연구소 2001 忠北醫大學術誌 Vol.11 No.2

연구목적: 만성 요통 환자의 많은 수가 직업 등 주변 환경과 심리 상태의 영향을 받는 것으로 추정되나 그 연관성은 아직 논란이 많다. 본 연구에서는 설문 조사를 통하여 만성 요통 환자의 심리사회적 특성을 알아보고자 하였다. 대상 및 방법. 1997년 7월부터 1998년 12월까지 6주 이상 지속된 만성 요통으로 본원 정형외과 외래를 내원한 환자들 중 기질적 원인이 불명확한 62명의 환자들에서 직업, 유발요인, 치료 등 요통 관련 요소 설문과 Minnesota Multiphasic Personal Inventory (MMPI)를 실시하였다. 요통 관련 사항에는 통증의 기간, 정도, 통증이 유발 또는 심해지는 자세, 그리고 본인이 생각하는 요통의 원인 등을 포함하였다. MMPI는 전체 평균을 이용한 방법과 two-code 방법을 이용하여 평가하였다. 결과: 만성 요통환자의 직업 상 실내에서 앉아 일하는 직업이 가장 맡았으며 일정한 자세를 오래 유지하며 앉거나 서 있는 경우 증상이 악화되는 것으로 기술되었다. MMPI에서는 건강 염려증, 우울증, 히스테리의 세 척도의 평균이 55이상으로 상승되어 있었다. Two-code 방법에서는 92% (46/50)의 환자에서 위 세 척도 중 적어도 하나 이상 상승되어 있었다. 결론: 만성 요통 환자들에서 일상 생활의 자세와 직업이 요통의 발생 및 악화에 영향이 있을 것으로 보여졌다. MMPI를 통한 심리 인성 검사 상 건강 염려증, 우울증, 히스테리의 성향이 증가되어 있어 요통의 발생과 만성화에 심리적 요소가 영향을 미치는 것으로 보여졌다. 사회경제학적, 정신심리학적 요인이 만성 요통에 미치는 영향의 규명을 위한 다양하고 심도 있는 연구가 필요하다고 생각된다. Purpose : Socioeconomic and psychologic factors seem to affect incidence, severity, and chronicity of low back pain. Purpose of this study is to survey socioeconomic factors and document psychoneurotic traits via MMPI in chronic low back pain patients. Materials and Methods : From July 1997 to December 1998, questionnaire about low back pain-related factors such as duration, severity, posture, occupation etc. and MMPI were given to patients who visited our department for chronic low back pain()6weeks). 62 patients completed, and 50 of them completed MMPI. The answers were analyzed. MMPI scores were evaluated in mean±SD method and two-code method. Results : Sedentary workers were the most common. And symptoms were told to be elicited by long sitting or standing posture(job) . Hs, D, Hy scales of MMPI, which are know as "neurotic triad by two-code method was observed in 92% (46/50) . Conclusion : It seemed that job and posture had Important role in chronic low back pain. And, it seemed that chronic low back pain patients had some psychoneurotic traits especially in hypochondriasis, depression, and hysteria. More investigations to document the influences of socioeconomic and psychoneurotic factors in chronic low back pain seems to be necessary.

고관절 전치환술시 응용프로그램을 이용한 수술 전 계획

원중희,김용민,최의성,손현철,박경진,남기세,정재중 대한고관절학회 2003 Hip and Pelvis Vol.15 No.3

흉요추부 굴곡-신연 손상에서의 후추 손상의 분포 및 양상

김용민,김동수,최의성,손현철,박경진,정경일 대한척추외과학회 2004 대한척추외과학회지 Vol.11 No.2

상완골 근위부 분쇄 골절에서의 상완골 두 치환술

서중배,원중희,김용민,최의성,이호승,홍윤철 대한견.주관절학회 2000 大韓肩.주關節學會誌 Vol.3 No.2

7개 대학 병원에서 조사한 지역사회 폐렴의 원인균

정문현,김성민,강문원,최희정,정희진,이경원,한성우,송재훈,신형식,김의종,최강원,김민자,박승철,배현주,정윤섭,김준명,백경란,신완식,이규만,김양리 대한감염학회 1997 감염 Vol.29 No.5

목 적 : 폐렴은 많이 발생하면서 사망률이 크게 줄지 않는 질환이며, 이를 적절히 치료하기 위해서는 원인균의 상대적 빈도, 기저 질환에 따른 변화, 항균제 내성률, 사망에 관련된 인자들을 알아야 한다. 원인균의 빈도는 지역마다 차이가 있고 국내에서는 항균제 내성률이 높아 지역사회에서 발생한 폐렴을 치료하기 위한 경험적 항균제 선택에 도움이 되기 위해 서울 소재 6개 대학 병원과 천안의 1개 대학 병원이 참여하여 위의 사항들에 대해 조사를 하였다. 방 법 : 1995년에 내과에 입원했던 16세 이상 환자를 대상으로 했다. 퇴원 진단명이 폐렴 또는 폐결핵인 병록지을 찾았고, 이중에서 병원 감염을 제외하였다. 특이도를 높이기 위해, 이들 중에서 호흡기 증상이 있고 발열이나 저체온이 있으면서 흉부 X-선에서 이상 음영이 있는 환자만을 대상으로 했다. 폐결핵은 위의 기준에 입원 초기에 항균제 치료를 하고 입원 7일 이후에야 항결핵제가 투여된 경우만을 폐렴의 원인균으로 하였다. 혈액 배양에서 양성, 객담에서 항상균이나 M. tuberculosis가 증명된 경우, 혈청학적으로 항체가가 4배 이상 증가된 경우, 조직에서 원인균이 진단된 경우는 확정(definitive) 원인균으로 하였고, 객담에서 배양된 균이 그람 도말과 일치할때, 항결액제에 대한 반응으로 진단한 폐결핵, 단일 항체가 양성이고 이에 대해 항균제를 사용했을 때는 가능(probable) 원인균으로 정의하였다. 다세균 감염균은 각각 다 른 원인균으로 처리하였다. 임상 조사와 함께 임상병리과에서 S. pneumoniae, H. influenzae, M. catarrhalis, mycoplasma, 항상균에 대해 검사 의뢰 건수, 배양 양성수, 항균제 감수성 결과를 조사하였다. 결 과 : 폐렴의 증례 정의에 부합하지 않은 135명과 폐결핵의 정의에 해당하지 않는 230명을 제외하고 남은 246명의 평균 나이는 58.2세이고 남성이 142명(58.2%) 이었고, 71%의 환자에서 기저 질환이 있었다. 진단 방법의 시행 횟수는 혈액 배양 77.6%, 혈청 검사 18.3%, 기관지경 검사는 4.1%였고, 세균의 항원 검사를 한 예는 없었다. 원인균이 밝혀진 예는 77명(31.3%)이었다. 다세균 감염이 4명에서 있었고, 원인균의 상대적 빈도는 결핵 20명(확정 17, 가능 3: 6개 병원 자료), 폐렴구균 18(확정8 가능 10)명과 폐렴구균이 아닌 Streptococcus 3명 (모두 확정), H. influenzae 11명(모두 가능), 그람음성간균 11명(확정 7, 가능 4) (K. pneumoniae 8건), Mycoplasma 5명(확정 1, 가능 4), S. aureus 4명(확정 2, 가능 2), mucormycosis 1명(확정)이었다. 평균 입원 기간은 19일이고, 중환자실 입원률과 인공 호흡기 사용율은 각각 18%와 9.3%였다. 사망률은 13.8%였고 사망까지 평균 기간은 14.6일 이었다. 다변량 분석에서 사망을 예측할 수 있는 인자는 저체온과 빈호흡이었다. 임상병리과에서 배양되었던 모든 폐렴구균의 Penicillin 내성률은 서울 3개 병원에서 82-88%, 천안에서 72%였다. 폐렴 환자의 혈액에서 배양된 7주는 모두 Penicillin에 감수성이 있었다. K. pneumoniae 8주 모두 cefotaxime과 gentamicin에 감수성을 보였다. 결 론 : 후향적 조사이고 병원마다 원인균 진단에 차이가 있지만, 원인이 밝혀진 경우에는 결핵과 폐렴균이 흔하였고, 무균 부위에서 배양된 폐렴구균의 항균제 내성률은 낮았다. 원인이 밝혀지지 않은 경우가 많고, 혈청검사로 진단되는 원인균이 드물며, 분리균주가 적어 항균제 내성 정도를 추정하기 어려워, 이를 밝히기 위한 전향적 조사가 필요하다. Background : Community-acquired pneumonia (CAP) is one of the leading causes of mortality and morbidity, but its management is still challenging. The limitation of diagnostic methods to identify etiologic agents rapidly make it necessary to use empiric antibiotics in almost all patients, and furthermore the discovery of new respiratory pathogens and the emergence of antibiotic-resistant organisms pose difficulties to the selection of an empiric regimen. To clarify the factors necessary for the optimal choice of empirical antibiotics, such as the frequency of etiologic agents, the attributable rates to death and antimicrobial resistance rates in the community, six university hospitals in Seoul and one university hospital in Cheonan were participating in this study. Methods : medical records of adults (>15 years of age) hospitalized for CAP or pulmonary tuberculosis between April 1995 and March 1996, were reviewed. Patients who satisfied all of the following criteria were included in the study: (1) fever or hypothermia; (2) respiratory symptoms; and (3) pulmonary infiltrates on chest roentgenogram. To exclude cases of pulmonary tuberculosis whose roentgenographic features were so typical that it could be easily differentiated from conventional pneumonia, two additional criteria were required for inclusion: antibiotic treatment during the first week of hospital admission and initiation of anti-tuberculosis medications thereafter. Organisms isolated from sterile body sites, acid-fast bacilli or Mycobacterium tuberculosis isolated from sputum, pathogens diagnosed by a 4-fold rising titer of antibodies to “atypical”pathogens, or pathogens revealed by histopathology were defined as definitive cause of pneumonia; isolates from sputum withcompatible Gram stain, pathogens diagnosed by a single diagnostic titer plus use of a specific antimicrobial agent, or tuberculosis diagnosed by clinucal response to anti- tuberculosis medications were considered probable cause of pneumonia. The records of the clinical microbiology were reviewed for isolates of S. pneumoniae, H. influenzae, M. catarrhalis, Mycobacterium or acid-fast bacilli, and Mycoplasma. Then the frequency of these agents, antimicrobial resistance rates of resiratory pathogens from all body sites, and their clinical significance were evaluated. Results: After excluding 365 patients (230 with pulmonary tuberculosis and 135 with CAP) who were screened for inclusion but did not meet the inclusion criteria,246 persons were enrolled in this study. Their mean age was 58.2 years old with slight male predominance (58.2%), and 171(71%) patients had underlying illnesses. Blood cultures were performed on 191 (77.6%) patients and serologic tests on 44(18.3%) patients. The etiologic agents were identified in 31.3%, and the list of individual agents, in decreasing order, was pulmonary tuberculosis (17 definite and 3 probable: data of six hospitals), S. pneumoniae (8 definite and 10 probable), non-pneumococci (3 definite), aerobic gram-negative bacilli (7 definite and 4 probable), Haemophilus spp. (11 probable), mycoplasma (1 definite and 4 probable), polymicrobial infections (2 definite and 2 probable: E. coli and S. agalactiae, M. tuberculosis and S. aureus, S. pneumoniae and H. influenzae and A. baumannii and K. pneumonias), S. aureus (2 definite and 2 probable) , and mucormycosis (1 definite). Among gram-negative bacilli, K. pneumoniae was the most common agent (8isolates). therates of admission to the intensive care unitand of using assisted ventilation were 18% and 9.3%, respectively. The mortality was 13.8% and logistic regression analysis showed that hypothermia and tachypnea were associated with death. Hospital stay averaged 19 days. Susceptible rates of S. pneumoniae isolated from all body sites to penicillin ranged from 8% to 28% but seven isolated from blood of patients with pneumonia were susceptible to penicillin. Also all 8 isolated of k> pneumoniae from patients with pneumonia were susceptible to cefotaxime and gentamicin. Conclusion: In Korea, in addition to S. pneumoniae, M. tuberculosis is an important agent causing community-acquired pneumonia. The low incidence of etiologic diagnosis is probably related to infrequent requesting of test "atypical" pathogens and does not represent the true incidence of infections by "atypical" pathogens, which well be answered by a prospective study. The antimicrobial resistance rates of major respiratory pathogens from sterile body sites are low, however, because of a small number of the isolates this result needs confirmation by a nationwide surveillance of antimicrobial resistance.

악관절 융기 증강술을 통한 습관성 악관절 탈구환자의 치험례

김일규,신주호,오성섭,최진호,김형돈,오남식,김의성 대한악안면성형재건외과학회 2000 Maxillofacial Plastic Reconstructive Surgery Vol.22 No.2

Recurrent mandibular dislocation is frequent morbidity of temporomandibular joint relatively. There are many etiologic causes in TMJ disorders but, difficult to find obvious one. Various treatment methods have been utilized for a mandibular dislocation. It is categorized into two groups broadly - nonsurgical or surgical methods. The basic rationale of the surgical method is to allow free movement of the condyle by reducing height of articular eminence or to limit anterior excessive movement of the condyle by increasing height of articular eminence or soft tissue anchoring procedure. In this case, 69 year-old woman was treated by augmentation of the articular eminence with mandibular symphysial bone graft leading to osteosynthesis without difficulty. As a result, favorable postoperative outcome was obtained functionally without any complication or recurrence.

구강악안면 영역의 치성 감염 환자에 대한 세균학적 연구

김일규,윤승환,오성섭,최진호,오남식,김의성,이성호,배수환,강문수 대한악안면성형재건외과학회 2000 Maxillofacial Plastic Reconstructive Surgery Vol.22 No.4

Oral & maxillofacial infections are most commonly odontogenic in origin. Although such infections are usually self-limiting, they may occasionally spread deeply into fascial spaces or planes far from the initial site of involvement. If early diagnosis and appropriate therapy is delayed, complications such as mediastinal extension, retropharyngeal spread and airway obstruction could happen to the patients. For the study of the microbiology, we have retrospectively analysed the oral & maxillofacial infected patients in the Dept. of Oral & Maxillofacial Surgery, In-Ha University Hospital from 1997 September to 2000 April. The results were as follows 1.The male patients were more common than female, with male 61.9% and female 38.1%. 2.Dental originated infections were most common cause with the incidence of 62%. 3.Most common fascial space involved was buccal space 42cases(37.2%) followed by submandibular space 13cases(11.5%), infraorbital space 13cases(11.5%), masseteric space 11cases(9.7%) , periapical abscess 11cases(9.7%) . 4.The causative organisms isolated from the pus culture were Gram Positive Bacterial species, which were 46cases(31.9%) of Streptococcus viridans, 16cases(8.6%) of α and β-hemolytic streptococcus, 4cases(3.1%) of Strep.-group D non enterococci, 7cases(5.1%) of Staphylococcus Coa. Neg., 5cases(3.9%) of Staphylococcus aureus, 3cases(2.3%) of Enterococcus faecalis, 1case(0.8%) of Bacillus species, 1case(0.8%) of Peptostreptococcus, 1case(0.8%) of Clostridium and Gram negative bacterial species, which were 4cases(3.1%) of Acinetobacter baumannii, 2cases(1.6%) of Pseudomonas aeruginosa, 2cases(1.6%) of Burkholderia cepacia, 1case(0.8%) of Neisseria species, 1case(0.8%) of Klebsiella pneumoniae, 1case(0.8%) of Klebsiella oxytoca, 1case(0.8%) of Escherichia coli. 5.In drug sensitivity test, high resistant tendency was found in Penicillin system(Penicillin G 83.3%, Ampicillin 60%) and Aminoglycosides (Gentamycin 50%, Tobramycin 45.5%), but tertiary Cephalosporin system(Cefoperazone 9.1%, Ceftazidime 18.2%), and glycopeptides system (Teicoplanin 0% , Vancomycin 0%) showed lower resistancy.