이행성 협심증 환자에서 운동부하 심전도 검사

이정우,박형서,박용규,노상필,이유선,정승현,김보영,이재환,최시완,정진옥,성인환 충남대학교 의과대학 의학연구소 2003 충남의대잡지 Vol.30 No.1

목적 : 관상동맥의 경련에 의한 이형성 협심증환자에 있어서 운동부하 심전도 검사의 결과는 매우 다양하다. 이에 저자들은 충남대학교병원 순환기내과에서 관상동맥조영술상 이형성 협심증으로 확진된 환자를 대상으로 운동부하 심전도 검사를 시행하여 이에 대한 결과를 연구하였다. 방법 : 1995년 1월부터 2002년 3월까지 흉통을 주소로 충남대학교병원 순환기 내과에 입원하여 관상동맥조영술을 시행하여 관상동맥의 내경이 50% 미만의 협착이 있고, 에르고노빈(ergonovine) 유발검사도 이형성 협심증으로 진단을 받은 233명중 운동부하 심전도 검사를 시행 받은 183명의 환자를 연구 대상으로 하였다. 운동부하 심전도 검사 결과의 판독시 발생할 수 있는 오류를 줄이기 위해서 운동부하 심전도 검사를 시행하기전 심전도상 ST분절의 상승(5예)이나 하강(8예)이 있는 경우 EH한 T파의 역위(19예)가 있는 32명의 환자를 제외한 총 151명의 환자를 대상으로 하였다. 운동부하는 Marquette사의 case 15 답차를 이용하였고, Bruce protocol에 따라 증상이 나타날 때까지 최대로 실시하였으며 각 stage 및 운동후의 혈압을 측정하고 12 유도 심전도를 기록하였다. 결과 : 1) 임상적 특성 - 내원시 임상 상은 안정형 협심증이 39예(25.8%), 불안정형 협심증이 103예(68.2%), 심근경색증이 9예(6.0%)이었다. 운동부하 심전도 검사 결과 양성 군과 음성군간에 있어서 당뇨병, 고혈압, 비만도, 총 혈청콜레스테롤치, 현재의 흡연 여부, 병력상 운동시 흉통의 유무, 내원시 임상적 진단, 협착의 정도, 연축의 수 등을 조사하였는 바 어떠한 인자들도 유의한 차이를 발견할 수 없었다. 2) 운동부하 심전도 검사 - 운동부하 심전도 검사를 시행 받은 151명의 환자중 음성인 경우는 134예(88.8%)이었고, 양성인 경우는 17예(11.2%)이었다. 양성 소견을 보인 환자들중 ST 분절의 상승이 4예(2.6%), ST 분절의 하강이 13예(8.6%)이었다. 3) 관상동맥조영술 - 관상동맥조영술상에서 혈관 경력 위치는 우관상동맥이 70예(46.1%), 좌전하동맥이 44예(28.9%), 좌회선동맥이 17예(11.2%)의 순으로 나타났다. 운동부하 심전도 검사상 ST 분절의 상승이 있었던 예중 Ⅱ, Ⅲ, aVF에서 ST 분절의 상승이 있었던 1예는 관상 동맥조영술상 우관상동맥에서 경련이 발생하였고, V2-V4에서 ST 분절의 상승이 있었던 2예중 관상동맥조영술상에도 좌전하행동맥에서 경련이 나타난 예는 1예이었으며 다른 1예는 좌회선동맥에서 경련이 나타났고, V5-V6에서 ST 분절의 상승이 있었던 1예는 관상동맥조영술상에도 좌회선동맥에서 경련이 나타났다. 운동부하 심전도 검사상 V5 또는 V6에서 ST 분절의 하강이 있엇던 13예중 6예(46.1%)는 관상동맥조영술상 우관상동맥에서 경련이 발생하였고, 3예(23.1%)는 좌전하행동맥에서, 1예(7.7%)는 좌회선동맥에서, 나머지 3예(23.1%)는 2개의 혈관이나 기타 분지에서 경련이 발생하였다. 결론 : 1) 이형성 협심증 환자는 운동부하 심전도 검사에서 11.2%의 양성소견을 보였다. 이중 ST 분절의 상승은 2.6%이었고, ST 분절의 하강은 8.6%이었다. 2) 이형성 환자중 운동부하 심전도 검사를 실시하여 음성을 보이는 경우 다혈관 관상동맥질환이기 보다는 이형성 협심증일 가능성이 더 높다고 예측할 수 있을 것으로 생각된다. 3) 이형성 협심증 환자중 운동부하 심전도 검사를 실시하여 ST 분절의 상승을 보이는 경우 다혈관 관상동맥질환이기 보다는 이형성 협심증일 가능성이 더 높다고 예측할 수 있을 것으로 생각된다. 4) 운동부하 심전도 검사 결과에 대한 당뇨병, 고혈압, 비만도, 총 혈청콜레스테롤치, 현재의 흡연여부, 병력상 운동시 흉통의 유무, 내원시 임상적 진단, 협착의 정도 등 어떠한 인자들도 3그룹(ST 분절의 상승, ST 분절의 하강, 음성)간에 유의한 차이를 발견할 수 없었다. 5) ST 분절의 상승 부위와 관상동맥조영술상 관상동맥의 연축이 일어나는 혈관과의 상관관계는 매우 높았다. No reports in the literature describe the results of exercise testings in a large number of patients with pure variant angina(coronary stenosis <50%) in Korea. In this report, We present the results of treadmil exercise testing in 151 patients with variant angina. 151 patients with angiographically proven coronary artery spasm underwent a treadmil exercise test. The clinical characteristics of variant angina patients classified according to ST-segment response to exercise were analyzed. Of 151 patients underwent a treadmil exercise test, negative result was seen in 134 patients(88.8%) and positive result was in 17 patients(11.2%). Of 17 patients saw positive result, exercise-induced ST segment elevation was present in 4 patients(2.6%) and ST segment depression was seen in 13 patients(8.6%). There was not a significant relationship between the ST segment response to exercise and the clinical variables(diabetes, hypertension, obesity, total cholesterol, current smoking, effort angina, clinical diagnosis, and degree of stenosis) assessed. Of 4 patients with ST segment elevation in treadmil exercise test, 1 patient with ST segment elevation in Ⅰ,Ⅲ,aVF had spasm in right coronary artery(100%) on coronary angiography, of 2 patients in V2-V4 had spasm in left anterior descending coronary artery in 1 patient(50%) and 1 patient in V5-V6 had spasm in left circumflex artery(100%). Positive treadmil exercise test was present in 11.2% of variant angina patient. If we have negative treadmil exercise result in patients with clinical manifestation of unstable angina at admission, we may have a suspicion of variant angina rather than multi-vessel disease. If we have exercise-induced ST segment elevation in patients with clinical manifestation of unstable angina at admission, we have a suspicion of variant angina rather than multi-vessel disease. Our result suggests that the correlation between the site of the ST segment elevation and the artery involved is quite good.

AHP 접근법에 의한 마케팅 의사결정

崔洛煥,杜政玩 全北大學校 1997 論文集 Vol.43 No.-

It makes the rational decision making more critical that the complexity, importance of marketing decision and the radical change of marketing environment followed by technical innovation. Therefore, this study aim to review the Analytic Hierarchy Process which could help a marketing manager to come to a rational decision making, to study the analyzing procedure by the software of AHP for personal computer applied to the case of marketing decision which developed for this study. For the purpose, we premised the decision making as a consecutive three process; intelligence, design and choice. Analytic Hierarchy Process should be an useful tool for the third one. From the application of the case of marketing decision to AHP, it revealed that the analytical and systematic approach were essential. Expert Choice, which is a software of AHP for personal computer, compelled the decision maker to analyze the case in terms of at least three hierarchies; goal, objectives and alternatives. In short, AHP enable the decision maker to incorporate all the facts, and to compare of which through addition and subtraction so that he/she could lead to a reasonable decision or re-evaluate it for an advanced decision.

레트 증후군 환아의 제증상에 관한 증례보고

최영철,이긍호,황정환 大韓小兒齒科學會 1998 大韓小兒齒科學會誌 Vol.25 No.4

저자는 치아우식증을 주소로 경희의료원 소아치과에 내원한 레트 증후군 환아를 전신마취 하에서 치료를 시행하고 다음과 같은 치의학적 소견을 얻었다. 1. 본 증례에 보고된 레트 증후군 환아들은 비정상적인 저작, 이갈이, 과다한 타액분비, 높고 깊은 상각 구개, 혀의 전방 변위등의 구강 증상을 보였다. 2. 본 증례에서 보고된 레트 증후군 환아들은 입과 손을 사용하는 습관- 손깨물기, 손등을 핥거나 입술로 문지르기, 손가락빨기- 을 갖고 있으며 흔히 손을 씻는 듯한 특징적인 상동증 사이에 이러한 동작을 반복하였다. 3. 이상과 같은 진단적 요건을 숙지한다면 레트 증후군의 조기발견에 도움이 될 수 있으며, 치과적 처치시에도 조기치료 및 예방술식을 시행할 수 있어 진정요법이나 전신마취의 필요성을 감소시킬 수 있을 것으로 판단된다. Rett syndrome is a progressive neurological disorder that occurs exclusively in females. The syndrome is characterized by regression of language, motor development, and stereotypic hand movement. Autisitc behavior, breathing irregularities, gait dyspraxia, scoliosis, and seizure are also accompanied. The cause of Rett syndrome is unknown, however, it is believed that the X-chromosome might play a significant role in the development of the syndrome. Patients with this syndrome have unusual oral and /or digital habits such as abnormal chewing pattern, bruxism, hypersalivation, micrognathia, high vaulted palate, tongue protrusion with lower posture of tongue, hand biting, digit- hand sucking. Dentists who are aware of distinct manifestations of Rett syndrome will be able to aid in early diagnosis and treatment of the syndrome. Prior to dental treatment for a panient with the Rett syndrome under sedation or general anesthesia, one should assess the degree of hypersalivation,apnea, severity of autism, expected life span. Early recognition of the syndrome and also dental treatment with established strict preventive guidelines for parants with the Rett syndrome may obviate the necessity of sedation or general anesthesia. Two cases with the Rett syndome were reported. Both patients had most of the above mentioned typical manifestatons of the syndrome. Dental treatment for the case 1(8-year-old) including caries control, stainless steel crown, sealant application was performed under general anesthesia. The case 2 could not be undergone the dental treatment due to poor general conditions.

餘暇生活 實態 推移에 관한 文獻考察

崔淙洙,韓正煥 忠北大學校師範大學附設 平生體育硏究所 1993 平生體育硏究所 論文集 Vol.6 No.-

The role and the function for the modern people are being deversified and varied in many ways owing to the material culture. With the representative books selected for the definite period, the wants I have considered the variation of the leisure are follows; 1) Accordign to the industrialization, the working hour is decreasing and leisure time is increasing, but the activity for this situation is not enough. 2) Female sex has more leisure time than male sex, but the leisure activity for female is wanting. 3) the ones who are over thirties have more leisure time than any other ages. 4) There are much different quantities of leisure time according to the kind of their vocation, so the leisure activity program for his own job is necessary. As a result of my studying for these situations. I have got the follwing conclusions. 1) The need for sports and creative recreations increasing. 2) Male is sleeping much time in sports, travel, and other activities, but female is spending her time in sleeping and domestic chore. 3) More educated people are enjoying more creative activities and sports, but less educated people are spending their time in sleeping, domestic chore, and watchig TV. A rural area has worse leisure time than a urban one an this present situation has been depended in the modernization of korea. Therefore the betterment should be made after due consideration of the difference of leisure time and quality of leisure action.

전유전체 서열 분석과 가시화를 위한 워크벤치 개발과 응용

최정현,진희정,김철민,장철훈,조환규 한국유전학회 2002 Genes & Genomics Vol.24 No.2

An increasing number of genome sequencing projects results in explosive growth of whole genome sequences. Furthermore the number of studies on the functions of individual genes has also been rapidly increased. However on-memory algorithms are not applicable to the analysis of whole genome sequences, since the size of individual whole gene a ranges from several million base pairs to hundreds billion base pairs. In order to effectively manipulate the huge sequence data, it is necessary to use the indexed data structure for external memory. In this paper, we introduce the development and application of the workbench for the analysis and visualization of whole genome sequences using string B-tree that is suitable for the analysis of huge data. This system consists of two main parts, the analysis query part and the visualization part. The query system supports various transactions such as pattern matching, k-occurrence, and k-mer analysis. The visualization system helps biologists to easily understand whole genome structure and specificity by various kinds of visualization such as whole genome sequence viewer, annotation viewer, CGR (Chaos Game Representation) viewer, k-mer viewer, RWP (Random Walk Plot) viewer, and map viewer. We can find the relationships among organisms, support gene prediction in a genome, and study the function of junk DNA using our workbench. In this paper, we apply our workbench to investigating specific sequence such as avoided sequence, common sequence, and classifiable sequence.

환경친화성 계면활성제를 이용한 어병균의 살균효과

최상원,정관용,오남희,김은영,방정환,김정우,여문환 한국환경과학회 2000 한국환경과학회지 Vol.9 No.5

The antibacterial effect amino acid-copper(Ⅱ) surfactant on fish pathogens was studied. Fish pathogens of Edwardsiella tarda, Vibrio anguillarum, Aeromonas hydrophila and Streptococcus sp. were selected, cultured in nutrient agar and adjusted at 2 × 10 exp (5)∼10 exp (6) CFU/㎖ in phosphate buffer saline before the addtion of amino acid-copper(Ⅱ) surfactant with different concentrations. All tested pathogens died within 1 hour with 1 ppm of amino acid-copper(Ⅱ) surfactant. In comparison with formalin and ET, amino acid-copper(Ⅱ) surfactnat was more effective in antibacterial capacity.

成績 比較·分析을 위한 統計的 方法 硏究 : T-檢定, F-檢定을 中心으로 by T-test and F-test

정환태,최규정 조선대학교 통계연구소 2000 統計硏究所論文誌 Vol.2 No.1

This paper is to help a teacher carry out the test about whether or not his teaching method is more effective, compared with existing method or other teacher's method. In this paper, the followings are shown : 1. We derived a probability density function of multivariate normal distribution and arranged 1-dimensional, 2-dimensional, and 3-dimensional normal distribution. 2. We described the theory on student's t-distribution and F-distribution, the mean, and the variance. 3. We described t-test theory used in comparison and analysis of one sample mean or two sample means, and F-test theory used in comparison and analysis of several means. 4. Finally, we showed t-test and F-test with the example and described the method of comparison and analysis using SAS.

지속적 외래 복막투석 환자에서 복막염과 출구감염의 임상상 및 위험인자에 관한 임상적 고찰

최영환,김응석,김용섭,이정호 동국대학교 의학연구소 2000 東國醫學 Vol.7 No.-

지속적 외래복막투석(CAPD)은 전세계적으로 말기 신부전 환자에서 널리 시행되고 있는 신대체 요법으로 지속적으로 증가하는 추세이다. 하지만 복막투석에 대한 이해, 수술 기법의 발달, 연결 기구와 도관에 대한 끊임없는 개발에도 불구하고 복막염과 도관 관련 합병증 등은 아직도 중요한 문제로 남아 있으며 복막투석의 실패 원인의 대부분을 차지하고 있으나 복막염과 출구감염의 위험 인자에 대한 보고는 미흡한 실정이다. 이에 저자들은 1994년 4월부터 1998년 12월까지 동국대학교 경주병원 신장내과에서 CAPD를 시행한 말기 신부전증 환자 51명을 대상으로 복막염과 출구감염의 임상상 및 위험인자에 대한 후향적 조사를 시행하였다. 복막염의 발생빈도는 환자당 0.73회/년 이었고 57.3%에서 원인균이 배양되었으며 동정된 균으로는 Staphylococcus aureus(20.4%), Staphylococcus epidemidis(14.9%), Steptococcus species(11.2%) 순 이었고 전체적으로 그람양성 균주가 68%, 복합 균주가 배양된 경우가 17.1% 였다. 복막염의 치료 결과는 항생제로만 치유된 경우가 83.4%, 도관제거 14.8%, 사망 1.8%였고 외래 치료가 44.4%, 입원하여 치료한 경우가 55.6% 였다. 위험인자에 대한 비교에서는 50세 이하환자에서 0.88 회/년, 51세 이상에서 1.21 회/년으로 고령군에서 더 높았으며(p=0.043) 활동성이 있는 군과 없는 군은 각각 0.78회/년, 1.21 회/년으로 활동성이 없는 군에서 더 높았으며(p=0.044) 직업이 없는 군에서 1.12 회/년, 직업이 있는 군에서 0.93 회/년으로 직없이 없는 군에서 발생빈도가 더 높았다(p=0.041). 또한 당뇨군에서는 연평균 1.22 회/년, 비당뇨군에서는 0.99 회/년으로 당뇨군에서 더 발생빈도가 높았고( p=0.039), 출구 감염이 있는 군에서 1.19 회/년,없는 군에서 9.98 회/년으로 출구감염이 있는 군에서 더 발생빈도가 높았다(p=0.047). 그 외 성별, 학력, 거주지, 투석액의 종류 및 도관 종류에서는 통계적 의의가 없었다. 출구감염은 환자당 0.37 회/년의 발생빈도 및 88.6%의 원인균 배양율을 보였으며, 동정된 균으로는 Staphylococcus aureus(34.3%), Staphylococcus epidermidis(17.1%), Sterptococcus species (8.6%) 순 이었고 전체 63개의 도관중 21개(33.3%) 제거되었으며 가장 많은 원인은 복막염 8예(38.1%) 와 출구감염 6예(28.6%)였다. 출구감염에 영향을 주는 인자에 대한 분석에서는 농촌에 거주하는 경우, 당뇨병이 있는 경우, Tenckhoff 카테터를 사용하는 경우에 다소 빈도가 높은 것으로 나타났으나 통계학적 유의성은 없었고 그 외에 나이, 성별, 활동성, 직업의 유무, 학력과도 연관성이 없었다. 이상의 결과로 CAPD 시행 시 환자선정에 있어 나이, 당뇨병 유무, 거주지, 직업 등의 인자를 특히 고려하여 시행해야 할 것으로 생각된다. Objectives : CAPD has established itself as an effective therapeutic modality as hemodialysis or renal transplantation in the treatment of patients with end stage renal disease. Although much progress of technology of CAPD has been made, peritonitis or catheter-related complications are still important problem until now. Therefore, we investigated about risk factors which are related to peritonitis and exit infection in CAPD patients. Methods : We analysed retrospectively the clinical results of 51 patients on CAPD at Dongguk University Kyoung-ju Hospital from April 1994 to December 1998. Results : 1) There were 31 male and 20 female patients who are 28 to 79 age-old(mean age 55.4±11 years). 2) Underlying disorders of CAPD patients were diabetic nephropathy(33.3%), hypertensive nephrosclerosis(27.5%) and glomerulonephritis(17.7%) 3) The incidence of peritonitis was 0.73/year/patient and peritonitis free interval period was 9.3±1.4 months. The isolation rate of microorganisms from patients with peritonitis was 57.3% and the order of frequency of isolated organims was Staphylococcus aureus, Staphylococcus epiermidis, Steptococcus species, Pseudomonas species and Acinetobacter species. The peritonitis was treated with antibiotics only(83.4%), catheter removal(14.8%) and death(1.8%) 4) The incidence of peritonitis was higher in patients with older age(>50yr), DM, exit site infection and without occupation, physical activity according to univariate analysis (p<0.05). 5) The incidence of exit site infection was 0.37/year/patient and the order of frequency of isolated organisms was Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus species, and Pseudomonas species. The statistical analysis for risk factor of exit site infection had no significant value. The exit site infection was treated with antibiotics only(45.7), external cuff externalization(8.6%), external cuff removal(28.6%), and catheter removal(14.8%). 6) 21 of catheters(33.3%) were removed. The peritonitis and exit site infection or tunnel infection were main causes of catheter removal. The catheter survival rate was 82%, 73%, 68% and 50% at one, two, three and four years, respectively. Mean survival time of all catheters was 39.3±1.4 months. 7) The causes of death were most frequently cardiac disease(28.4%), followed by vascular disease(14.4%), malignancy(14.4%) and infections(14.4%). The patient survival rate was 92%, 82%, 78% and 70% at one, two, three and four years, respectively. Mean survival time of all patients was 61.2±1.8 months. Conclusion : Although CAPD is an effective therapeutic modality in the treatment of patients with end stage renal disease, CAPD peritonitis and exit site infection are the most important pitfalls of CAPD. From the above results, we can know that the risk factors significantly affecting the incidence of peritonitis were old age, no occupation, no physical activity, DM, and exit site infection. Therefore, we most consider the risk factors affecting the incidence of peritonitis and exit site infection when we choose the renal replace therapy in end stage renal failure.

조기위암의 형태학적인 분류에 따른 임파절 전이 양상

최은서,강길,박정희,장정환,김권천,김경종,민영돈 朝鮮大學校 附設 醫學硏究所 2004 The Medical Journal of Chosun University Vol.29 No.1

Currently, in the limited cases of early gastric cancer (EGC), endoscopic mucosal resection (EMR) is used for curative treatment. However, its completeness is still controversial. The purpose of this study was to review the suggested indications of EMR. We retrospectively analyzed 234 patients with EGC who underwent curative (RO) gastrectomy. The enrolled cases were further classified into mucosal and submucosal types, and mucosal EGC were further classified according to the size, gross type and histologic pattern. 133 patients had mucosal cancers and 101 patients submucosal. The overall incidence of positive lymph node was 14.1% (33/234), the incidence of mucosal cancer was 8. 3% (11/133), which was significantly lower than that of submucosal, 22% (22/101). Of 133 patients with mucosal EGC, 90 were smaller than 2㎝ in size and the incidence of lymph node metastasis was 5.6% (5/90), compared to 43 of larger than 2㎝ with the incidence of 14% (6/43). According to the gross type classification of mucosal cancer, incidence of lymph node metastasis in protruded type (EGC type Ⅰ, Ⅱa, Ⅰ+Ⅱa) was 15.4% (4/26), nat type(EGC type Ⅱb) 2. 9% (1/35), depressed type (EGC type Ⅱc, Ⅲ) 8.3% (6/72). Lymph node metastasis in differentiated type of mucosal cancer was 6.9% (5/72) and undifferentiatcd type 9.8% (6/61). In this study, there was no single indication free from lymph node metastasis, It is thought that the selection of EMR for the curative treatment of EGC should be considered carefully and more clinical studies with long-term follow up are necessary for EMR to be generally acceptable.

한국어 화자의 영어 첨가음 발화에 관한 연구

최태환,한정임 서울대학교 어학연구소 2003 語學硏究 Vol.39 No.3

The present study investigates Korean speakers' production of the optional phonetic variation such as stop epenthesis between the sonorant and fricative segments in American English. Specifically this study investigates; 1) whether English epenthetic stops are produced by native Korean listeners, given the fact that Korean does not allow consonant clusters in onsets as well as codas; and 2) whether production of the epenthetic stops could be varied according to the place of articulation of the preceding sonorants. Twelve native Korean speakers and two native American English speakers recorded 120 English non-words with mono-syllabic of CVC₁C₂ where C₁=/m, n, ŋ, 1/, and C₂=/s, e, ∫/, and measurements of the closure durations and epenthetic bursts were made. The results of the present study show that native Korean speakers produced less epenthetic stops than native American English speakers as expected, showing that first, stop epenthesis is influenced by language-specific syllable structure constraints, and thus English stop epenthesis is not phonetic implementation. However, the production of epenthetic stops was shown to be affected by several factors, including final cluster types and the acoustic cues for epenthetic stops.