[18F]FDG PET을 이용한 강박증 환자에서 뇌 포도당 대사의 이상에 관한 연구

권준수,이동우,이재성,최정임,이동수,정준기,조맹제,이명철,류인균 대한신경정신의학회 2000 신경정신의학 Vol.39 No.2

연구목적: 강박증에 대한 기능적 뇌영상 연구들에서 강박증 환자들의 안와전두엽과 미상핵의 대사율 증가 소견이 비교적 일과되게 발표되어 왔으며, 전두-피질하 회로의 이상이라는 이론이 수립되기도 하였다. 그러나 기존의 연구들은 강박증의 유병기간에 따른 구분없이 시행된 연구였고, 영상분석 방법에 있어서도 관심영역 방법을 이용했다는 한계를 지니고 있다. 본 연구의 목적은 첫째, 강박증의 유병기간에 따라 환자군을 구분하여 PET 영상소견을 분석함으로써 유병 기간에 따른 차이가 있는지를 조사하였으며, 둘째, 강바증 환자의 포도당 양전자방출 단층촬영(18-Fluor-deoxyglucose Positron Emission Tomography : FDG-PET) 영상분석에 통계적 매개변수 지도법(Statistical Parametric Mapping : SPM)을 이용함으로써 강박증의 병인기전 및 강박증상과 뇌기능 간의 관계를 명확히 규명하고자 하였다. 방법: 구조적 면담도구(Structured clinical interview for DSM-IV : SCID-IV)를 적용하여 진단된 12명의 강박증 환자들과 10명의 정상 대조군에 대해 FDG-PET을 촬영하여 SPM으로 분석하였다. PET 촬영 전 적어도 4주 동안에는 약물복용을 하지 않은 상태였다. 결과: 1) 환자군과 대조군의 비교 : 강박증 환자군은 대조군에 비해 양측 두정 영역의 대사율이 유의하게 감소되어 있었으며(P<0.01). 대사증가를 보인 영역은 없었다. 강박증의 유병기간이 10년 이상인 만성강박증 환자 4명은 양측 안와전두엽에서 유의한 대사증가 소견을 보였으며(P<0.01), 양측 두정영역에서 유의한 대사감소 소견을 보였다 (P<0.01), 유병기간이 10년 이하인 환자에서는 전체 환자군의 분석에서와 마찬가지로 대조군에 비해 유의한 대사증가 소견을 보인 영역은 없었으며, 양측 두정엽 부위에서 유 의한 대사 감소 소견을 보였다.(P<0.01). 2) 강박증상의 심각도와의 상관관계 분석 : 우측 두정엽의 대사율은 강박장애 척도 점수와 유의한 음의 상관관계를 보였으며(p<0.01), 양측 시상 영역의 대사율은 예일-브라운 강박장애 척도의 강박장애척도 점수와 유의한 양의 상관관계(p<0.01)를 보였다. 결론: 본 연구는 결과는 기존의 연구들에서 보고된 안와전두엽의 대사 증가 소견이 강박증의 만성화로 인해 나타나는 2차적 장애이며, 두정엽의 대사 저하가 보다 1차적인 장애일 가능성을 시사한다. Baxter가 수립한 전두-피질하 회로 이론은 두정엽의 이상을 포함하는 전두-두정엽 복합체 이론으로 확장되어야 할 것이다. Objectives: Functional imaging studies on obsessive-compulsive disorder(OCD) subjects have repeatedly reported increased metabolism in orbitofrontal lobes and caudate nucleus, resulting in the "frontal-subcortical" circuit abnormality theory. Limitations of the previous studies to date include little consideration for the duration of illness, and the use of regions of interest methods, as an image analysis method. Our study objectives are 1) to include the duration of illness as an important study variable, and 2) to use Statistical Parametric Mapping(SPM) method in order to tap relations between the brain function and the psychopathology and symptoms of OCD. Methods: The [18] fluorodeoxyglucose positron emission tomography(FDG-PET) scans of OCD subjects and normal comparison subjects, as diagnosed by the Structured Clinical Interview for DSM-IV(SCID-IV), were analyzed using SPM. Results: 1) Comparison of OCD and control groups : OCD subjects had significantly decreased metabolism in both parietal lobes and didn't have any areas of increased metabolism in comparison to comparison subjects(p.<0.01). four OCD subjects with the illness duration of 10 years or longer, had significantly increased metabolism in both orbitofrontal lobes<p<0.01). OCD subjects whose illness duration is shorter than 10 years didn't have any areas of increased metabolism and had significantly decreased parietal lobe metabolism, as in the analyses of all subjects(p<0.01). 2) Correlation analysis between areas and symptom severity : Metabolism of both thalamic sreas showed significant positive correlation with Yale-Brown Obsessive-Compulsive Scale(Y-BOCS) scores(p<0.01). Metabolism of right parietal area showed significant negative corre lation with Y-BOCS scores(p<0.01). Conclusions: The current findings suggest that the increased metabolism in orbitofrontal lobe, previously rported, may be a secondary phenomenon due to the extended illness dur- ation and that decreased metabolism in the parietal lobes are primary abnormality in OCD subjects. Thus Baxter's fronto-subcortical circuit theory should be extended into "fronto-pari-etal" complex theory, which includes the parietal lobes.

족관절 골절의 임상적 고찰

김기용,윤준오,이수호,신헌규 울산대학교 의과대학 1992 울산의대학술지 Vol.1 No.1

The ankle joint is a modified complex hinge joint which plays an important role in weight bearing, walking and standing. So, the goals of treatment of ankle fracture are anatomical positioning of the talus in the mortise and regaining a smooth articular surface. The Lauge-Hansen classification of ankle fracture is useful because it characterized the mechanism and sequence of injury and in particular, emphasizes the associated ligamentous injuries. But, it is more complex and all fractures do not conform exactly to one of the described pattern. The Danis-Weber classification of ankle fracture is simpler, emphasized the importance of the lateral side of the ankle, and is usuful in planning surgical treatment. Initially this system did not distinguish the extent of involvement and was too inclusive. The problem has been addressed in the AO classification. The system proposed by Tile is easy to remember and emphasized the importance of assessing and relating stability to the structures that are injured. We analyzed 124 cases of ankle fracture, most of which were treated surgically by AO methods, in the Orthopedic Department, University of Ulsan Medical College, Asan Medical Center from July 1989 to March 1992. The results obtained from this study were as follows : 1. The most common victim was 3rd-5th decade's man. 2. The most common type of Danis-Weber classification was type C(36.3%) and most common type of AO classification was type C1(15.3%), C2(15.3%). According to the classification of Lauge-Hansen, the most common type was pronation-external rotation (42.7%). 3. In Danis-Weber type B and C, satisfactory results were obtained by operative treatment. 4. Danis-Weber's classification and A-O classification were very practical criteria for treatment of the ankle fracture.

少腹逐瘀湯의 效能에 關한 實驗的 硏究

金恩基,張峻福,李京燮,宋炳基 慶熙大學校 1995 論文集 Vol.24 No.-

This experiment was performed on analgesic, anti-pyretic, sedative, anti-swelling, anti-thrombotic, anti-tumor effect and response of isolated uterus by administrating high and low concentration of Sopokchukeotang's hot-water-extract to experimental animals. This administration purpose to investigate the efficacy of the Sopokchukeotang which is known as having effects on treating female genital diseases on basis of oriental medicine literature and its clinical use. The results obtained were as follows: 1. The writhing syndrome induced by acetic acid was decreased by administration of the Sopokchukeotang's hot-water-extract. However, there was no statistical significance between sample and control group. 2. The administration of the Sopokchukeotang's hot-water-extract elevated the pain threshold significantly by on hindpaw edema induced by 1% carrageenin in rat. 3. Abnormally elevated body temperature induced by thyphoid vaccine was decreased by the administration of the Sopokchukeotang's hot-water-extract. But, there was no statistical significance. 4. Sleeping time induced by Pentobarbital-sodium was prolonged by the administration of the Sopokchukeotang's hot-water-extract. However significant effect was recognized only in the treated by low concentration group(p<0.05). 5. The significant decrease of swelling induced by carrageenin was noted in the group treated by high concentration(p<0.05, p<0.01). 6. The group treated by low concentration showed significant anti-swelling effect on the swellings induced by yeast, but not in the group treated by high concentration didn't show it(p<0.05). 7. The serum FDP was decreased significantly by administrating the Sopokchukeotang's hot-water-extract to the experimental thrombosis(p<0.05, p<0.01). 8. The serum fibrinogen was increased significant by the administration of the Sopokchukeotang's hot-water-extract on the experimental thrombosis(p<0.01, p<0.001). 9. The prothrombin time was not influenced by the adminstration of the Sopokchukeotang's hot-water-extract on the experimental thrombosis. 10. The administration of the Sopokchukeotang's hot-water-extract did riot make a prolongation the survival in Saroma 180 ascitic tumor implanted Rats. 11. The administration of the Sopokchukeotang's hot-water-extract had no effect on the normal movement of the isolated uterus. However, it showed the relaxation effect on the oxytocin induced muscle contraction of the isolated uterus. According to the above results, it might be recognized that the Sopokchukeotang's hot-water-extract has the effect of analgesia, anti-pyrexia, sedation, anti-swelling, anti-thrombosis and relaxation effect on the oxytocin induced contraction of uterus muscle. However, anti-tumor effect of Sopokchukeotang's hot-water-extract was not appeared in the experiments. According to the above results. Sopokchukeotang's not-water-extract can be applied on the various inflammatory diseases in female genital organs.

애엽, 지각, 아교주 및 목향의 투여가 임신중 생쥐의 생식능력에 미치는 효과

정형민,차수경,임정묵,신태은,박찬,장준복,이경섭,송병기 경희대학교 2000 慶熙醫學 Vol.16 No.2

게이트 심근 SPECT를 이용한 좌심실의 국소탄성률 평가방법 개발 및 재현성 평가

이병일,이동수,이재성,강원준,정준기,이명철,최흥국 대한핵의학회 2003 핵의학 분자영상 Vol.37 No.6

목적: 게이트 심근 SPECT 영상에서 국소부피변화를 얻으면, 요골동맥 긴장도를 측정하여 얻은 중심 동맥의 압력 곡선으로부터 최대탄성률을 얻을 수 있다. 이 연구에서는 좌심실의 국소탄성률을 평가하기 위한 방법을 개발하고 국소탄성률 측정의 재현성을 평가하였다. 대상 및 방법: 게이트 Tc-99m MIBI 심근 관류 SPECT를 두 번 연속으로 시행한 환자 7명(남:여=5:2, 58±11.9세)을 대상으로 하였다. 국소적 부피변화를 측정하기 위하여 개발한 CSA(Cardiac SPECT Analyzer) 소프트웨어를 이용하여 좌심실의 부피변화를 측정하였으며, 시간-압력 곡선과 국소 시간-부피 곡선을 이용하여 반복연산을 통하여 구한 국소 시간-탄성율 곡선에서 국소탄성률을 얻었다. 같은 SPECT 영상에 대해서 두 번 측정한 국소탄성률의 재현성과, 같은 환자에서 연속하여 두 번 얻은 SPECT 영상에 대해서 측정한 국소탄성률의 재현성을 평가하였다. 결과: 평균 국소탄성률은 15분할모델에서 3.36±3.38 mmHg/mL이었으며, 7분할모델과 5분할모델에서 각각 3.16±2.25 mmHg/mL, 3.11±2.57 mmHg/mL이었다. 국소탄성률의 조화평균은 전체탄성률과 일치하였다. 동일한 데이터에서 두 번 측정한 국소탄성률 값의 상관계수는 모든 모델에서 0.97이상이었고, Bland Altman 도표에서 차이의 2-표준편차는 각각 1.5%, 1.0%, 0.9%였다. 동일 환자에서 두 번 연속 촬영한 SPECT 데이터로부터 측정한 국소탄성률의 상관계수는 모든 모델에서 0.95이상이었으며, Bland Altman 도표에서 차이의 2-표준편차는 각각 2.2%, 1.0%, 1.2%였다. 결론: 게이트 심근 SPECT를 이용한 좌심실의 국소탄성률을 측정하였으며 재현성 있는 결과를 얻었다. 심근 SPECT를 이용하여 얻은 국소탄성률의 평가방법은 향후 임상적인 데이터를 바탕으로 새로운 심기능 분석지표로 활용될 수 있을 것이다. Purpose: Regional contractility can be calculated using the regional volume change of left ventricle measured by gated myocardial SPECT image and curve of central artery pressure obtained from radial artery pressure data. In this study, a program to obtain the regional contractility was developed, and reproducibility of regional contractility measurement was assessed. Materials and Methods: Seven patients )male:female=5:2, 58±11.9 years) with coronary artery diseases underwent gated Tc-99m MIBI myocardial SPECT twice without delay between two scans. Regional volume change of left ventricle was estimated using CSA (Cardiac SPECT Analyzer) software developed in this study. Regional contractility was iteratively estimated from the time-elastance curve obtained using the time-pressure curve and regional time-volume curve. Reproducibility of regional contractility measurement assessed by comparing the contractility values measured twice from the same SPECT data and by comparing those measured from the pair of SPECT data obtained from a same patient. Results: Measured regional contractility was 3.36±3.38 mmHg/mL using 15-segment model, 3.16±2.25 mmHg/mL using 7-segment model, and 3.11±2.57 mmHg/mL using 5-segment model. The harmonic average of regional contractility value was almost identical to the global contractility. Correlation coefficient of regional contractility values measured twice from the same data was greater than 0.97 for all models, and two standard deviations of contractility difference on Bland Altman plot were 1.5%, 1.0%, and 0.9% for 15-, 7-, and 5-segment models, respectively. Correlation coefficient of regional contractility values measured from the pair of SPECT data obtained from a same patient was greater than 0.95 for all models, and two standard deviations on Bland Altman plot were 2.2%, 1.0%, and 1.2%. Conclusion: Regional contractility of left ventricle measured using developed software in this study was reproducible. Regional contractility of left ventricle will be a new useful index for myocardial function after analysis of the clinical data.

Postoperative Functional Outcome After Off-Pump Versus On-Pump Coronary Artery Bypass Grafting Using Gated Myocardial SPECT: A Comparison by Propensity Score Analysis

Lee, Jong-Jin,Kang, Won-Jun,Paeng, Jin-Chul,Lee, Dong-Soo,Kim, Ki-Bong,Chung, June-Key,Lee, Myung-Chul The Korea Society of Nuclear Medicine 2010 핵의학 분자영상 Vol.44 No.2

Purpose We evaluated the short-term and mid-term differences in perfusion and function after off-pump and on-pump coronary artery bypass grafting (CABG) using gated myocardial single photon emission computed tomography. Materials and Methods A total of 70 patients with coronary artery disease who underwent CABG were included based on the propensity score matching results from 165 patients. Thirty-five patients underwent off-pump and 35 patients on-pump CABG. Rest $^{201}Tl$/dipyridamole stress $^{99m}Tc$-methoxyisobutylisonitrile gated single photon emission computed tomographies were performed preoperatively and postoperatively at short-term ($103{\pm}23$ days after surgery) and mid-term follow-up ($502{\pm}111$ days after surgery). Changes in left ventricular ejection fraction, end systolic volume, stress and rest segmental perfusion, and segmental wall thickening were compared between the two groups. The segments with preoperative rest $^{201}Tl$ uptake under 60% of maximum uptake were included in the segmental analysis. Results Left ventricular ejection fraction (P=0.001) and end systolic volume (P=0.008) showed significant improvement in both groups. There were no significant short-term and mid-term differences between the two groups in terms of left ventricular ejection fraction (P=0.309) and end systolic volume (P=0.938). Likewise, segmental rest (P=0.178) and stress perfusion (P=0.071), and systolic wall thickening (P=0.241) showed significant improvement in both groups with similar time courses. Conclusion Off-pump CABG resulted in significant improvements in left ventricular ejection fraction, end systolic volume, and regional myocardial perfusion and function that are comparable to on-pump CABG at shortterm and mid-term. Gated myocardial SPECT successfully revealed that off-pump CABG is as good as on-pump CABG from the viewpoint of myocardial perfusion and function.

이산시간 Q 매개변수화 제어를 이용한 자기축수 시스템에 대한 부상과 불평형보정의 실험적 평가

Jun-Ho Lee(李浚豪),Fumio Matsumura(松村 文夫),Key-Seo Lee(李基西) 한국소음진동공학회 1998 소음 진동 Vol.8 No.5

백혈병 세포에서 Multidrug Resistance Gene-1 (mdr1)의 과발현이 99mTc-sestaMIBI 섭취에 미치는 영향

이상우,천경아,강도영,전수한,정준기,이규보,손상균,이재태,이종기 대한핵의학회 1999 핵의학 분자영상 Vol.33 No.2

Purpose: To determine whether Tc-99mMIBI is recognized by the multidrug resistant P-glycoprotein (Pgp), we have measured quantitatively Tc-99mMIBI uptake in cancer cells. The effects of various Pgp reversing agents on cellular Tc-99m-MIBI uptake were also investigated in the presence of multidrug resistance gene-1 (mdr1 gene) overexpression. Materials and Methods: We measured percentage uptake of Tc-99m-MIBI at different incubation temperatures both in mdr1 positive and negative cells. The effects of verapamil, cyclosporin, and dipyridamole on cellular uptake of Tc-99m-MIBI were also evaluated with or without overexpression of mdr1 gene in cultured murine leukemia L1210 cells. Results: The mdr1 gene expressing cell lines were effectively induced in in vitro with continuous application of low-dose adriamycin or vincristine. Cellular uptake of Tc-99m-MIBI was higher in mdr1 negative L1210 cells than those of mdr1 positive cells, and higher when incubated in 37℃ than 4℃. In the presence of verapamil, cyclospor or dipyridamole, Tc-99m-MIBI uptake was increased upto 604% in mdr1 positive cells. Conclusion: Cellular uptake of Tc-99m-MIBI is lower in leukemia cells over-expressing mdr1 gene, and MDR-reversing agents increase cellular uptake. These results suggest that Tc-99m-MIBI can be used for characterizing Pgp expression and developing MDR-reversing agents In vitro.

18F-FDG PET/CT in mediastinal lymph node staging of non-small-cell lung cancer in a tuberculosis-endemic country: consideration of lymph node calcification and distribution pattern to improve specificity

Lee, Jeong Won,Kim, Bom Sahn,Lee, Dong Soo,Chung, June-Key,Lee, Myung Chul,Kim, Soonhag,Kang, Won Jun Springer-Verlag 2009 European Journal of Nuclear Medicine and Molecular Vol.36 No.11

디피리다몰 부하 심근관류 SPECT의 장기예후 예측능

이영조,이명철,강위창,이명묵,이동수,정준기,강원준,천기정,장명진 대한핵의학회 2000 핵의학 분자영상 Vol.34 No.1

Purpose: Dipyridamole stress myocardial perfusion SPECT could predict prognosis, however, long-term follow-up showed change of hazard ratio in patients with suspected coronary artery disease. We investigated how long normal SPECT could predict the benign prognosis on the long-term follow-up. Materials and Methods: We followed up 1169 patients and divided these patients into groups in whom coronary angiography were performed and were not. Total cardiac event rate and hard event rate were predicted using clinical, angiographic and SPECT findings. Predictive values of normal and abnormal SPECT were examined using survival analysis with Mantel-Haenszel method, multivariate Cox proportional hazard model analysis and newly developed statistical method to test time-invariance of hazard rate and changing point of this rate. Results: Reversible perfusion decrease on myocardial perfusion SPECT predicted higher total cardiac event rate independently and further to angiographic findings. However, myocardial SPECT showed independent but not incremental prognostic values for hard event rate. Hazard ratio of normal perfusion SPECT was changed significantly (p<0.001) and the changing point of hazard rate was 4.4 years of follow up. However, the ratio of abnormal SPECT was not. Conclusion: Dipyridamole stress myocardial perfusion SPECT provided independent prognostic information in patients with known and suspected coronary artery disease. Normal perfusion SPECT predicted least event rate for 4.4 years. (Korean J Nucl Med 2000;34:39-54)