흰쥐에서 심정지후 뇌의 허혈-재관류 손상과 Tumor Necrosis Factor-α의 상관관계

최승필,박규남,박승현,박상현,정시경,김세경 대한응급의학회 1999 대한응급의학회지 Vol.10 No.4

Background : Tumor necrosis factor-α(TNF-α) has been thought to play a major role in neurological injury during global brain ischemia and subsequent reperfusion following resuscitation in cardiac arrest. So, we hypothesized that the elevation in TNF-α was dependent upon the duration of the global brain ischemia, and related to delayed neuronal damage. Methods : Fourteen rats were divided two groups ; 1 minute-cardiac arrest group(n=7) and 3 minute-cardiac arrest group(n=7). we induced cardiac arrest by chest compression and clamping of tracheal tube for 1 minute and 3 minutes respectively. And then, resuscitation was initiated. To measure the plasma activity of TNF-α, blood samples were drawn before and at the end of cardiac arrest, and 30, 60, 90, and 120 minutes after initiation reperfusion. At 72 hours after resuscitation, the ND(neurologic deficit) score was determined and the histopathologic outcome of hippocampal CA1 neuron was observed by the percent dead hippocampal CA1 neurons. Results : 1. TNF-α level during the early reperfusion period(<2h) was significantly increased in 3 min-cardiac arrest group compared with 1 min-cardiac arrest group(p=0.0001). 2. There was a no significant difference of neurologic deficit score between 1 min-and 3 min-cardiac arrest. 3. Percent dead hippocampal neurons were significantly increased in 3 min-cardiac arrest group compared with 1 min-cardiac arrest group(9.1±1.2% vs 1.2±0.9%, p<0.05). Conclusions : The results suggest that longer duration of global brain ischemia causes a more profound increase in plasma TNF-α level during the early reperfusion period(<2h) and more delayed neuronal damage than lessor duration of global brain ischemia, and that increase in TNF-α level during the early reperfusion period(<2h) is related to delayed neuronal damage.

응급의료센터의 단기입원치료실 활용경험

최승필,박승현,정시경,박규남,김영민,김세경,이운정,이환 大韓應急醫學會 1999 대한응급의학회지 Vol.10 No.2

Overcrowding of emergency department is a serious and growing problem at St. Mary's Hospital. This has motivated the development of short-stay unit(SSU) as an alternative ward to routine hospital admission and ED discharge. In our hospital a SSU begun to admit patients in January 6, 1997. The SSU received 247 patients from the ED during the eight month interval(January 6, 1997 to August 31, 1997). To examine the utilization of the SSU in ED, we retrospectively analyzed 247 patients admitted in SSU from the ED, and compared the average hours per patient with acute gastroenteritis spent in the ED during the 2-month intervals before(July-August 1996) and after(July-August 1997) the establishment of the SSU. The following results were obtained; 1. The total patients consist of EM 92(37.2%), GS 48(19.4%), IM 24(9.7%), PS 21(8.5%), OS 20(8.1%), OBGY 14(5.7%) and others 28(11.3%) 2. The results of EM patients admitted in SSU from ED 1) Sex ratio of male to female was 1:1.1 and the mean age was 37.3±16years 2) In diagnosis, acute gastroenteritis was 29 cases(31.5%), multiple contusion 14 cases(15.2%), drug intoxication 12 cases(13%), limb laceration 6 cases(6.5%), tendon rupture of hand 6 cases(6.5%), and others 19 cases(20.6). 3) Mean length of stay in ED was 9.18 hours. 4) Among 92 patients to the SSU, 79 patients(85.9%) were discharged, 11 patients(11.9%) formally admitted to hospital and 2 patients(2.2%) transferred to otherhospital. The mean hospital stay time of the patients admitted to SSU was 2.6 days. 3. There was a significant reduction in the average stay time spent in the ED by treat-and-releasing patients with acute gastroenteritis after the establishment of the SSU(from 14.65±9.6 to 7.52±5.4 hr/patient, p<0.001). Conclusively, the establishment of the SSU can shorten the average stay time that treat-and-releasing patients spend in the ED, and reduce the number of admitted patients waiting in the ED.

응급의료센터에서 신경색의 조기진단

최경호,오동렬,이원재,박규남,박승현,황두영,김형국,정시경,김영민,김세경 大韓應急醫學會 1998 대한응급의학회지 Vol.9 No.4

To evaluate appropriate diagnostic studies for renal infartion in emergency medical center, we analysed 33 patients of renal infarction treated in this hospital for last 8 years. Eleven patients, 4 trauma associated and 7 aortic disease associated patients were excluded. They are 11 males and 11 females with a mean age of 51 years. Fourteen came to the emergency medical center and seven came to the outpatient department, in the other one patient renal infarction was developed during hospitalization with other disease. On their past history they had hypertension in 9, valvular heart disease in 5, and diabetic mellitus in 4 patients. Abdominal or flank pain was noted in 17 of 22(77%). The other symptoms were vomiting, nausea, fever and so on. On microscopic examination of initial urine in hospital, 5 patients showed more than 10 red blood cells by high power field examination. The mean lactic dehydrogenase level was 1,239 I.U/L(normal range 218-472 I.U/L), while the mean aspartate aminotransferase and mean alanine aminotransferase were 51 I.U/L(normal range 13-36 I.U/L) and 44 I.U/L(normal range 5-33 I.U/L). Abdominal ultrasonography showed positive findings in 5 of 16(31%), of which 3 were confirmed by Doppler ultrasonography. In 18, computed tomography was done and all those showed positive findings of renal infarction(100%). In conclusion, it is important that identify the elevated lactic dehdrogenase level in case of any suspicion about renal infarction and confirm by computed tomography.

The Effect of Recombinant Human Bone Morphogenetic Protein-4 Concentration on Bone Regeneration in Rat Calvarial Defects

( Eun Kyoung Pang ),( Se Ung Im ),( Chang Sung Kim ),( Seong Ho Choi2 ),( Jung Kiu Chai1 ),( Chong Kwan Kim ),( Soo Boo Han ),( Kyoo Sung Cho ) 대한치주과학회 2003 대한치주과학회 학술대회자료집 Vol.2003 No.2

흰쥐에서 심정지후 Pentoxifylline이 뇌의 허혈-재관류 손상에 미치는 효과

정시경,김영민,오동렬,최경호,박승현,이운정,박규남,유은영,이원재,김세경 大韓應急醫學會 1999 대한응급의학회지 Vol.10 No.2

Background: Two major events occurring in the cerebral hemodynamics after successful resuscitation from cardiac arrest are reactive hyperemia and postischemic hypoperfusion. In this study, we examined the effect of Pentoxifylline(PTX) on the rat brain following cardiac arrest. Methods: Fourteen rats were anesthetized and artificially ventilated. Cardiac arrest was produced by chest compression and clamping of tracheal tube for 3 minutes in ketamine anesthetized rats. Circulation was restored by standard cardiopulmonary resuscitation methods. In 7 rats, PTX 10mg/kg was infused at 10min after cardiac arrest(PTX group). In the other 7 rats, same amount of normal saline was infused(control group). Results: In both groups, hemodynamic variables, neurologic deficit(ND) score and histopathologic findings of hippocampal CA1 neurons were observed. Hemodynamic variables and ND score were not significantly different between two groups. Delayed ischemic neurons of hippocampal CA1 were decreased in PTX group(2.2±2.4%) compared with control group(9.1±1.2%). Conclusions: We conclude that PTX prevented development of delayed ischemic neurons in hippocampal CA1 after cardiac arrest. PTX may be useful in emergency situations following cardiac arrest.

홍피증 환자 39명에 대한 임상 소견 및 원인 규명에 관한 연구

안세진,장경애,문기찬,성경제,최지호,고재경 대한피부과학회 1999 大韓皮膚科學會誌 Vol.37 No.5

Background: Erythroderma may result from different causes. Almost all the published original clinical series of erythroderma originated from western countries. Objectives: The objective was to evaluate various causes of erythroderma in our environment, frequency, clinical and laboratory findings, and patient evolution. Method: We reviewed the clinical and laboratory findings including biopsy materials of 39 patients diagnosed as erythroderma and treated during the last 9 years (from 1989 to 1998). Results: The male-female ratio was 3 to 1. The mean age at diagnosis was 54 years. Drug reaction and undetermined cause were the most frequent cause (30.8%, respectively), followed by the pre-existing dermatoses (28.2%), and malignancies (10.3%). Elevated erythrocyte sedimentation rate was found in 70.4% of the patients. Eight patients were resistant to treatment. In the patients with the persistent erythroderma, leukocytosis, elevated erythrocyte sedimentation rate, and cosinophilia were the common findings. Conclusions: Half of the patients with the erythroderma of undetermined cause showed the protracted course. Two patients diagnosed as cutaneous T-cell lymphoma and Se´zary syndrome had the history of generalized erythroderma of more than 3 years. The close follow-up for the erythroderma of undetermined cause with frequent laboratory and histopathological evaluations would be mandatory.

유치원과 초등학교 연계교육활동에 참여한 초등학교 교사의 경험

유세경,최기영 한국교원대학교교육연구원 2006 敎員敎育 Vol.22 No.4

급성기 뇌졸중 환자 자살 사고

김세주,김영신,최낙경,서동향,이병철,이만홍 大韓神經精神醫學會 2001 신경정신의학 Vol.40 No.2

연구목적: 일반적으로 자살과 자살 사고의 가장 주된 위험 인자는 우울증, 불안장애와 같은 정신과적 질환의 동반 유무이다. 그러나 정신과적 질환 외에 신체적 질환의 동반 유무 또한 자살 및 자살 사고에 영향을 미치는 것으로 알려져 있다. 일반적인 신체 질환과 마찬가지로 뇌졸증 환자들에 있어 자살율이 증가한다는 몇몇의 보고들이 있다. 그러나 우리나라에서는 뇌졸중 환자의 자살 사고에 대한 연구가 보고된 바가 없다. 따라서 본 연구에서는 급성기 뇌졸중 환자들을 대상으로, 자살 사고의 발현율을 조사하고, 자살 사고 유무에 따른 사회문화적 변인 및 신경과적, 정신과적 임상 양상에 있어서의 차이에 대해 알아보고자 하였다. 방법: 1999년 7월부터 2000년 6월까지 한림대학교 성심병원 뇌졸중 센터에 입원한 77명의 급성기 뇌졸중 환자를 대상으로 하였다. Beck Suicidal Ideation Scale(BSIS)을 이용하여 자살 사고를 평가하였고, 우울 증상과 불안 증상은 각각 Beck Depression Inventory(BDI)와 Beck Anxiety Inventory(BAI)를 사용하였다. 사회적 지지체계의 정도는 사회적 지지체계 척도(Social Support Scale)를 사용하였으며, 뇌졸중 후 신경학적 장애의 정도는 National Institutes of Health Stroke Scale(NIHSS)와 Barthel's Index를 사용하였다. 결과: 약 35%의 뇌졸중 환자들이 심한 자살 사고를 보고하였다. 심한 자살 사고군에서 심하지 않은 자살 사고군에 비해 BDI, BAI 그리고 사회적 지지체계 척도 점수가 높은 반면, Barthel's index와 NIHSS는 두 군간에 유의한 차이를 보이지 않았다. 심한 자살 사고를 지닌 뇌졸중 환자의 대부분은 우울 증상이나 불안 증상을 가지고 있었으나, 일부의 환자들은 우울 증상이나 불안 증상 없이 자살 사고를 보고하였다. 결론: 급성기 뇌졸중 환자들의 많은 수가 정신과적 평가와 개입이 필요한 자살 사고를 가지고 있었다. 따라서 모든 급성기 뇌졸중 환자들을 대상으로 정기적으로 불안 및 우울 증상에 대한 평가와 더불어 직접 또는 간접적인 방법을 통한 자살 사고의 평가가 반드시 필요할 것으로 생각된다. Objective: The presence of psychiatric disorders including depression and anxiety disorders is considered to be the most important risk factor of suicide. Also, suicidal risk is known to be increased in patients who have serious medical illnesses. Like in patients with other medicalillness, some authors reported that suicidal risk is increased in patients with stroke. But there have been no reports with korean patients. The aim of this study is to investigate the frequency of suicidal ideation of patients in the acute stage of stroke, and to examine the demographic characteristics, and psychiatric and neurological symptoms between the patients with and without suicidal ideation. Method: Seventy seven hospitalized stroke patients at the Hallym Stroke Center from July of 1999 to June of 2000 were included in this study. Beck Suicidal Ideation Scale(BSIS) was used to evaluate suicidal ideation. Beck Depression Inventory(BDI) and Beck Anxiety Inventory(BAI) for depression and aniety, and Social Support Scale(SSS) for social support system of the stroke patients were used. Neurologic disabilities were rated with National Institutes of Health Stroke Scale(NIHSS) and Barthel's Index. Results: Thirty five percent(N=27) of the stroke patients reported severe suicidal ideation. Scores of BDI, BAI and SSS were higher in the patients with severe suicidal ideation than their counterpart. There were no differences in Barthel's index score and NIHSS between two groups. Most patients with severe suicidal ideation had depressive or anxiety symptoms. But patients without depressive or anxiety symptoms also reported severe suicidal ideation. Conclusions: Thirty five percent of stroke patients in acute stage of their illness have severe suicidal ideation that requires careful psychiatric evaluation and intervention. Inclusion of routine assessment of suicidal ideation in these patients is recommended.

대학 운동선수의 정체성과 성취목표가 수행전략에 미치는 효과

유경호(Yoo, Kyoung-Ho),장세용  (Jang, Se-Yong),최경아(Choi, Kyung-A),김승철(Kim, Seung-Chul) 한국체육과학회 2013 한국체육과학회지 Vol.22 No.1

The aim of this study was to examine the effect of college athletes’ achievement goal and identity on performance strategy. The participants of this study were 300 of college athletes in Seoul and Kyoung-gi area. For the analysis of data, exploratory factor analysis, multivariate analysis of variance (MANOVA), two-way ANOVA, and hierarchical multiple regression were used. The results were as follows. First, the significantly important predictor variables of athletic identity were condition control, emotion control, self-talk, and imegery/goal setting predictor variable. Condition control, tense relaxation, and self-talk were significantly important predictor variables of achievement goal. Condition control, emotion control, and imegery/goal setting were significantly important predictor variables of athletic career, skillfulness, and performance avoid goal Two, athletic identity, and performance approach goal interacted and affected self-talk for the athletes among two-way, and three-way interaction variables.

치아 수복용 불소함유 glass filler의 제조 및 특성

김대성,최세영,김경남,김광만,김중곤 대한치과기재학회 1998 대한치과재료학회지 Vol.25 No.3

The purpose of this study was the reaching test of restorative glass according to composition. Mixtures of SrF₂, CaF₂and SiO₂were fused in platinum crucible. The glasses were ground and fraction which passed through a 400 mesh (38㎛) sieve were collected. The powder specimens were analyzed by a DTA and XRD. Then powder specimen were inserted to D. I. water with various of dissolution time and composition at 37℃. Fluoride ion, cation release, solubility, and pH change were estimated. It was clear that the glasses were formed except S0.65. In S0.40, Tg, Ts, and Tc were 630, 672, and 813℃ respectively. In initial 0.5 hrs., amounts of released fluoride ion and cation were about 90% of total released amounts and released rate was decreased with dissolution time. Amount of released fluoride ion and cation were increased with decreasing SiO₂ in glass filler. And released rate was decreased rapidly by adding CaF₂. This was caused by structural variation in glass filler. Solubility was similar tendency with ion released. The pH of D.I. water was 4.5. But in intial 0.5 hrs., pH was 8.2∼9.8., and decreased according to dissolution time. This is caused by ionic changing with cation and H* ion.