완전 방실차단을 동반한 급성 심근염

이유선,정진옥,박용규,박형서,노상필,정승현,김정희,이재환,최시완,성인환 충남대학교 의학연구소 2003 충남의대잡지 Vol.30 No.2

급성 심근염환자에서 발행한 완전 방실차단을 영구 심장박동 조율기로 치료한 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Myocarditis, an inflammatory process involving the myocardal wall, may be caused by most infectious agents. Irrespective of its etiology, it presents commonly with evidence of heart failure, hypotension, and various electrocardiographic abnormalities. Patient with myocarditis may be asymptomatic or may have a rapidly progressive fatal disease. Medical management of patients with myocarditis includes specific therapy for underlying infection and control of the complication of myocarditis such as congestive heart failure and arrhythmia. Recently we had experienced myocarditis with complete atrioventricular block in 37-year-old man. Although he had shown complete recovery of heart failure, he had shown complete atrioventricular block, so we inserted permanent pacemaker. We report it with review of the literature.

혈액 투석 환자에서 중심정맥 협착에 대한 스텐트 삽입술 : Wallstent Placement

임대승,노상필,이유선,정승현,김보영,이정우,강정아,김정희,이민수,정준용,최시완,정진옥,성인환,이강욱,신영태 충남대학교 의과대학 의학연구소 2002 충남의대잡지 Vol.29 No.1

Stenosis of central vein is a common complication arising after percutaneous subclavian vein catheter insertion performed for temporary vascular access in chronic renal failure patients undergoing hemodialysis. There are several treatment methods for the condition like percutaneous angioplasty(PTA), stent insertion, and surgery, but recent trend is toward PTA and stents. Among the patients diagnosed with chronic renal failure from March 1993 to May 2002 and undergoing hemodialysis through AV fistula, the 14 Patients in whom central vein stenosis arose were selected for the study. A total of 28 percutaneous interventions(5 PTA and 23 stent placement) were performed, and restenosis rate and the time taken till the restenosis in de novo lesions and instant lesions were compared. All 28 cases were operated successfully. The 14 cases that received both anigioplasty and stent placement initially. (de novo lesion : 14 cases), Among the 10 cases with de novo lesion that followed up more than 1 year, 3 cases are currently undergoing hemodialysis without restenosis, and the remaining 7 cases have recurred stenosis with the mean time to restenosis of 10.9 months. In the 7 cases in whom stenosis recurred, 11 interventions were done(instent lesion: 11 cases). 4 of these were using only ballon angioplasty with 100% restenosis rate and the mean time of 3 months until restenosis. The remaining 7 cases were using both balloon angioplasty and stent placement, also with 100% restenosis rate but with the mean time of 12 months until restenosis, which was later than the group receiving only balloon angioplasty. In treating the patients with central vein stenosis, stent placement seems to be more advantageous over PTA in terms of restenosis rate and the mean duration of patency. In the case of instent lesion, inserting the stent for the second time after stenosis recurred lengthened the duration of patency compared to performing balloon angioplasty alone.

Prostacyclin synthase 유전자의 C1117A 다형성과 이형협심증과의 관련성

성인환,임대승,김정희,이재환,최시완,정진옥 대한내과학회 2004 대한내과학회지 Vol.66 No.4

목적 : Thromboxan A2의 혀관수축반응을 저해하는 prostacylin synthase exon 8 C117A의 변이가 관동맥 연축과 관련성이 있는지를 알아보고자 하였다. 방법 : 1998년 1월 1일부터 2000년 12월 31일까지 충남대학교병원 순환기내과에서 관동맥조형술과정맥내 에르고노빈 유발검사를 시행하여 관동맥 연축이 확진된 이형협심증 환자군(45예)과 정상 대조군(59예)을 대상으로 중합효소 연쇄반응법 및 restriction fragment length polymorphism을 이용하여 분석하였다. 결과 : Prostacyclin synthase exon 8 C117A 유전자형의 빈도는 대조군에서 A/A : A/C : C/C =3.4% : 30.5% : 66.1%, 이형협심증 환자군에서 A/A : A/C : C/C = 8.9% : 42.4% : 48.9%로 두 군간에 유의한 차이가 없었다. 대조군에 비해 변이형 협심증 환자군에서 남자의 비율과 흡연률이 높았지만, prostacyclin synthase exon 8 C117A 유전자형에 따른 군에서 당뇨병, 고혈압, 흡연, 고지혈증, 비만 등의 유의한 차이는 없었다. 결론 : 한국인에서 prostacyclin synthase exon 8 C117A 유전자 다형성과 관동맥 연축이 있는 이형협심증과의 유의한 연관성은 발견할 수 없었다. Backround : Coronary artery spasm plays an important role in the pathogenesis of variant angina(VA). Prostacyclin is one of the endothelium derived relaxing factors. The association between the novel single nucleotide polymorphism in the prostacyclin synthase gene and VA is not known. Therefore, we investigated the association between VA and the polymorphysm in the prostacyclin synthase gene. Methods : We compared 45 variant angina patients who had positive intravenous ergonovine test by coronary angiography with 59 control subjects who had negative intravenouis ergonovine test and normal coronary angiogram. Using the polymerase chain reaction-single-strand conformation polymorphism analysis, we identified a single nucleotide polymorphism, C117A, in exon 8. This nucleotide change did not cause an amino acid change in codon 373. Results : There was no significant difference in characteristics between the control group and the VA group, and there was no significant difference in the genotype distributions between the control group and the VA group. Conclusion : The C117A polymorphism in exon 8 of the prostacyclin synthase gene is not associated with variant angina.

청소년의 컴퓨터게임 이용실태, 부모양육방식, 개인의 정신병리

전성일,류정환,김영미,정홍경,조아라,이정호,최영민,이기철 대한소아청소년정신의학회 2000 소아청소년정신의학 Vol.11 No.1

연구목적 : 오늘날 컴퓨터게임은 청소년기의 보편적 놀이도구가 된 상황임에도 불구하고 이들이 게임에 몰두하는 이유와 개인특성에 관한 정신과적 연구는 드문 실정이다. 이러한 필요성에서 본 연구는 중학교 2년 생을 대상으로 청소년의 컴퓨터게임 사용실태를 파악하고, 연관된 개인정신병리와 부모의 양육방식과의 관계를 밝히고자 하였다. 방법 : 이 연구는 서울시 노원구에 위치한 중학 2년생 124명을 대상으로 하였다. 정신병리의 측정을 위하여 한국판 간이정신진단검사(SCL-90-R)을 사용하였고, 부모자녀 결합형태 조사(PBI)를 통하여 부모양육태도를 알아보았다. 결과 : 1) 비록 과도한 시간을 들여 컴퓨터게임을 하더라도, 컴퓨터게임과 연관된 특정 정신병리는 발견할 수 없었으며 따라서 콤퓨터게임은 청소년기에 있을 수 있는 일상적인 놀이문화이다. 또 한대 부분의 청소년은 컴퓨터게임이 문제가 되지 않는다고 인신하고 있었다. 2) 남학생은 게임빈도, 게임시간, 게임방에서 보내는 시간, 게임을 한 번 할 때 지속하는 시간 등에서 여학생에 비해 통계적으로 의미 있게 높은 수치를 보였다. 3) 청소년의 신체증상호소, 타인간의 관계에서 나타나는 불편감, 우울증, 불안증의 정신병리는 컴퓨터 오락으로 인한 부작용과 의미 있는 관계를 보였다. 4) 게임빈도와 FBI상의 어머니 과보호척도는 정적인 상관관계를 보였다. 5) 게임을 하는 이유로는 공부, 학교 생활 등의 복잡한 것을 잊고 몰두하기 위해가 가장 많았고, 가장 심리적으로 부담이 되어 피하고 싶은 것으로는 학업문제였다. 6) 청소년은 게임방을 주로 친구들과 어울리는 공간으로 사용하고 있었지만 그 기능을 다하기에는 아직 보완해야 할 점이 많다. 결론 : 게임으로 인한 부모, 교사와의 다툼, 잦은 지각/결석, 친구들과 어울리지 못하는 등의 문제가 많은 경우에는 청소년 자체의 정신별리를 의심해 보아야 하며, 게임의 빈도가 의미 있게 높은 청소년의 경우에는 둥반되는 정서상의 문제와 함께 부모양육태도도 함께 세심하게 살피는 것이 필요하다. Objects : This study was designed or studying of current Korean adolescents computer game playing habits and exploring associations with parental rearing patterns and individual psychopathology. Methods : One hundred twenty our adolescents(age 13-15) who reside in urban area completed self-report questionnaires containing Questionnaires designed by authors, Symptom Checklist-90-Revision of Korean Version(SCL-90-R) and Parental Bonding Instrument(PBI). Results : 1)Computer game playing appears to be one of the social and leisure phenomena in these days. Although Adolescents spend a lot of times on computer game, Many of them perceive not problematic. 2)Compared with females, Male play computer games more regularly, more longer, spent more times in gamebang. 3)There was positive relationship between anxiety subscale in SCL-90-R and detrimental effects of computer game. 4)There was positive relationship between game frequency and maternal overprotection. 5)The main reasons for playing are "for an avoidance of stressful life events" , academic burden was the most troublesome issues in korean adolescents. 6)Many adolescents use gamebang as a social place, but they thought that gamebang is not good places to have a good time. Conclusion : This papers shows that computer game playing is a popular social leisure activity in Korean adolescents. And, Most of korean adolescents reported that they are suffered from pressure of academic achievements. They use computer game mainly by means of relieving academic pressures. In a heavy game users who have many conflicts with parents, teacher and who has frequent truancy and social withdrawal show significant anxiety. Maternal overprotection was observed in heavy game users. Authors recommended that clinicians should be careful in examining heavy computer game behaviors. Both underlying affective states and environmental influences, including family situations should be vicariously examined. KEY WORDS : Computer game · Gamebang · Game habits · Psychopathology · Parental rearing pattern.

관상동맥 스텐트 시술 후의 재협착에 관한 연구

김윤철,이정우,김보영,강정아,임대승,이민수,김정희,성보영,최성준,성인환,전은석 충남대학교 의과대학 지역사회의학연구소 2000 충남의대잡지 Vol.27 No.1

Coronary stent implacement is known as an effective treatment in the intimal dissection after percutaneous transluminal coronary angioplasty and the prevention of restenosis. However, In-stent restenosis still remains a major concern in clinical stenting. The stents were placed in 103 patients from July 1996 to March 1999 and performed follow-up coronary angiograms in 59(57.3%) patients. To identify the clinical, angiographic and procedurerelated variables 'which predict late restenosis within the stented artery, 59 patients(58.3±9.9, M:F= 41:18) were studied. The clinical characteristics of the patients were stable angina in 23(39.0%), unstable angina in 14(23.7%), acute myocardial infarction in 21(35.6%) and old myocardial infarction in 1(1.7%). Coronary stenting was performed in 1 patient(1.7%) for primary lesion, 50 patients(84.7%) for suboptimal results after PTCA, 6 patients(10.2%) for bail-out procedure, and 2 patients(3.4%) for restenotic lesions. All patients were treated with aspirin and ticlopidinc. The follow-up angiograms were obtained at 7±4 months. The overall in-stent restenosis rate was 27.1%. The coronary angiographic findings were 32 single vessel(54.2%), 19 two vessel(32.2%) and 8 three vessel disease(13.6%). The angiographic morphological characteristics were type A in 33(55.9%), type B in 14(23.7%), type C in 12(20. 3%) cases. Variables of 16 patients with restenosis were compared with those of 43 patients without restenosis. Previously known predictors for in-stent restenosis were multiple stenting, stenting for restenotic lesions, residual stenosis after stenting, stenting for total occlusion lesions, reference diameter, balloon to vessel ratio, acute gain and minimal luminal diameter after procedure, design and characteristics of stents, ostial lesion of aorta, high pressure method for stenting, lesion length, diabetes mellitus, size of artheroma, saphenous vein grafts, ulcerlating lesions and calcified lesions. In this study, Reference diameter before stenting(2.43±0.54mm vs. 2.88±0.65mm, p=0.016) and balloon-to-artery ratio(1.28±0.26 vs. 1.11±0.18, p=0.006) were predictors for in-stent restenosis. 1) The overall in-stent restenosis rate was 27.1%. 2) In the analysis of predictors for in-stent restenosis, there was no significant differences in clinical, angiographic factors between group with restenosis and without restenosis. But, Only reference diameter before stenting and balloon-toartery ratio were predictors of late in-stent restenosis. In conclusion, stenting is effective revascularisation method for selected patients with ischemic heart disease, and to minimize in-stent restenosis rate, stent implanting is achieved in a large vessel on the basis of an artery-to-stnet ration of 1:1, if possible.

서울의 Penicillinase Producing Neisseria Gonorrhoeae 발생빈도(1994)

김재홍,안진균,정성재,김영태,김중환,김시영,이석종,이홍렬,서호석,김경훈,권혁진,정우권,고우석,이용석,안필수,오준규,오용섭 대한화학요법학회 1996 대한화학요법학회지 Vol.14 No.1

Background : In recent years gonorrhoea has been panendemic and remains one of the most common Sexually Transmitted Diseases in the world, especially in developing countries. Objective & Method : For the detection of a more effective therapeutic regimen and assessing the prevalence of Penicillinase Producing Neisseria Gonorrhoeae(PPNG), Ive have been trying to study the patients who have visited the VD Clinic of Choong-Ku Public Health Center in Seoul since 1980 by means of the chromogenic cephalosporin method. Results : In 1994, 168 strains of N. gonorrhoeae were isolated, among which 109 (64,9% ) were PPNG. Conclustion : Our results suggests that the prevalence of PPNG in Seoul is still increasing.

개 비장 질환의 미세세침흡입술을 통한 세포병리학 검사 4례

김현아,윤기영,최호정,정성목,이영원,조성환,박성준 忠南大學校 獸醫科大學 附設 動物醫科學硏究所 2011 動物醫科學硏究誌 Vol.18 No.1

To evaluate the accuracy and diagnostic significance of cytopathological diagnosis of canine splenic disorders, cytopathological examination throgh fine-needle aspiration(FNA) referred to Veterinary Medical Teaching Hospital of Chungnam National University were retrospectived. Splenic neoplasm, hemolymphatic neoplasm, hyperplasia, extramedullary hematopoiesis and splenitis were diagnosed canine splenic disorders through cytopathological examination. The patient should be identified what coagulation profile are normal before aspiration, because complication such as hemorrhage could happen. The 4 cases were identified symmetric, asymmetric splenomegaly on abdominal ultrasonography and then were performed ultrasound-guided FNA. The 4 cases were diagnosed hemangiosarcoma(2), hyperplasia(1) and extramedullary hematopoiesis(1) by clinical signs, hematological examination, and cytopathological examination. Cytopathological examination through FNA was cost-effective, no gneral anesthesia, no complication, and non-invasive method of diagnosis for canine splenic disorders.

세침 흡인술을 이용한 종창된 림프절의 세포학적 평가

백강현,윤기영,최호정,정성목,이영원,조성환,박성준 忠南大學校 獸醫科大學 附設 動物醫科學硏究所 2011 動物醫科學硏究誌 Vol.18 No.1

Fine needle aspiration(FNA) cytology is considered as the diagnostic technique of choice in the assessment of swellen lymph nodes. The aim of this study is to determine the indication and diagnostic method of FNA of lymph node lesions performed at Veterinary Medicine Teaching Hospital of Chungnam National University. The records of 16 patients which had undergone FNA during the study period were retrieved. The cytological results were classified as lymphadenitis, lymphoid hyperplasia and lymphoma. Lymphoma cases were classified as B-cell origin and T-cell by immunophenotyping. The result of the FNA cytological diagnosis showed that nine (56%) of the patients were lymphoma, five (31%) of the patients were lymphoid hyperplasia and two (13%) of the patients were lymphadenitis.

Clozapine이 백서의 억제된 자발적 교대 행동에 미치는 영향

천강훈,이기철,이정호,최영민,전성일,정홍경,류정환,최미 大韓神經精神醫學會 1998 신경정신의학 Vol.37 No.5

연구목적 : 강박장애의 생물학적 원인론중 세로토닌-도파민 상호작용 가설에 적합한 5-HT₂ 수용체와 도파민 D₂수용체를 동시에 차단하는 약물의 일종인 cloazpine과 세라토닌 재흡수 차단약물인 clomipramine, 그리고 도파민 D₂수용체 차단 약물인 haloperidol을 실험백서의 강박장애 동물모형에 투여하여 자발적 교대 행동에 미치는 영향을 비교, 측정하였다. 그 결과로서 1) 세라토닌 수용체와 도파민 수용체를 동시에 차단하는 약물의 효과를 확인하고, 2) 세라토닌과 도파민 수용체 동시차단 약물의 효과가 확인되면 임상적으로 기존의 세라토닌 재흡수 차단약물에 반응을 보이지 않는 강박장애 환자 치료에 세라토닌 수용체와 도파민 수용체를 동시에 차단하는 비전형적인 항정신병 약물들이 강박장애의 치료에 유용하게 사용될 수 있는 가능성을 제시하고자 하였다. 실험재료 및 연구방법 : 실험동물은 동일한 배에서 출생한 수컷 Spraque-Dawley 백서를 사용하였다. 자발적 교대 행동(spontaneous alternation behaviour : 이하 SAB)을 시험하기 위해 SAB의 기준치를 구하고 난 후, SAB을 차단하기 위한 방법으로 비선택적 세라토닌 순응제인 5-MeODMT(5-methoxy-N, N-dimethyltrytamine)를 투여하였다. 실험백서들을 clomipramine(5㎎/㎏), clozapine(10㎎/㎏), clozapine(20㎎/㎏), haloperidol(0.1㎎/㎏), 그리고 saline(0.2cc) 투여군으로 나누고 21일에 걸쳐서 복강내 주사하였다. 실험약물 투여가 끝난 다음날인 22일째에 5-MeODMT(5-methoxy-N, N-dimethyltryptamine : 1.25㎎/㎏/IP)를 각각의 실험동물군에게 투여하고 실험약물의 만성투여가 5-MeODMT 투여로 억제되는 SAB을 얼마나 호전시키는 지를 측정하였다. 모든 자료는 SPSS for window 7.5으로 통계처리 하였다. SAB의 기준치 5-MeODMT 투여로 억제되는 SAB의 효과, 실험약물의 만성투여에 따른 SAB의 변화는 일원분산분석을 사용하였으며, 사후검증은 Scheffe 검증을 적용하였다. 각 군내에서 기준치와 5-MeODMT 투여로 억제되는 SAB의 변화, 그리고 실험약물의 만성투여에 따른 SAB의 변화는 다중변량분석을 시행하였다. 결과 및 결론 : 역구결과 실험동물은 T-형 미로의 SAB에서 평균 1.33±0.36회의 훈련 기준치를 보였다. 5-MeODMT 주사후 , 실험동물의 SAB치는 3.12±0.63회를 보여 강박행동이 유발하였다. 21일간의 실험약물 투여후, 22일째에 5-MeODMT 주사에 대한 SAB의 반응은 clozapine 투여군과 clomipramine 투여군이 halo-peridol 투여군과 saline 투여군에 비하여 유의하게 낮은 수치를 보여 5-MeODMT투여로 억제된 SAB을 호전시키는 소견을 나타냈다. 각 실험동물군 내에서 각각의 SAB 훈련 기준치와 실험약물 투여 전후에 5-MeODMT 투여로 인한 SAB을 비교한 바, clomipramine 투여군은 약물투여 전에 5-MeODMT로 억제된 SAB이 약물투여후 의미있게 호전되었다. 한편, clozapine 투여군도 약물 투여전에 5-MeODMT로 억제된 SAB가 약물투여후 의미있게 호전되었으며, 이런 SAB의 호전은 clomipramine 투여군보다 우수하였다. 이상의 연구결과로 보아, 강박장애의 생물학적 병리론을 이해하는데 있어 세라토닌-도파민 상호작용 가설이 의미가 있음을 추정할 수 있었다. 향후, 강박장애의 임상치료에서 전형적인 SSRIs 치료에 반응치 않는 환자들에게 세라토닌-도파민 동시차단제인 비전형적인 약물의 단독투여를 시행하는 후속연구를 기대해 본다. Objectives : This study was designed to evaluate the role of the 5-HT₂and dopamine D₂antagonist on spontaneous alteration behaviour which is an animal modal of obsessive-compulsive disorder in rat. On the basis of serotonin-dopamine interaction hypothesis, the effect of clozapine was evaluated by applying the suppressed spontaneous alternation behaviour model. Methods : The apparatus for spontaneous alternation behaviour was a black plexiglas T-maze with distinctive black and white goal boxes. Black guillotine doors separated the start box and the goal boxes from the main body of the T-maze. Small cups of chocolate milk were placed in the corners of both goal boxes. At 24 hours prior to experiment, rats(Spraque-Dawley) food-deprived. The food-deprived rats were put into T-maze, in which both goal boxes were baited with small amounts of chocolate milk. Each rat was given 2 set of 7 trials during which it was placed in the start box and allowed to choose one of the goal boxes for each time. The mean number of choices until the occurrence of spontaneous alternation behaviour were checked. After baseline of the number of choices of spontaneous alternation behaviour was stabilized, the spontaneous alternation was disrupted by nonselective 5-HT agonist, 5-MeODMT(1.25mg/Kg/IP), The experimental animals were stratified into 5 groups :clomipramine(5mg/Kg/IP), clozapine(10mg/Kg/IP), clozapine(20mg/Kg/IP), haloperidol(0.1mg/Kg /IP), and saline(0.2cc/IP) control groups. They all went through 21 days fo treatment(intraperitoneal). The protective effects against the 5-MeODMT-induced disruption of spontaneous alternation behaviour were evaluated on the next day of drug treatment in each group. Results : 1) SAB was suppressed by 5-MeODMT injection. 2) After 21 days of the drug treatment, the clozapine and the clomipramine groups showed significant difference from the haloperidol and the saline control groups in the reversal of 5-MeODMT-induced suppression of spontaneous alternation behaviour. 3) The clozapine (20mg/kg/IP) group was superior to the clomipramine group in the protective effect of 5-MeODMT-induced suppression of spontaneous alternation behaviour. Conclusion : In clinical situation, the we think that atypical antipsychotic drugs those acting as serotonin and dopamine receptor antagonist with no extrapyramidal side effect can be beneficial to improve the symptoms of obsessive-compulsive disorder.

원발성 폐암 환자의 생존율에 관한 보고

김현태,이상무,어수택,박춘식,정성환,허승재,남충희,강창희,김용훈 순천향대학교 1994 논문집 Vol.17 No.4

We analysed 404 patients with primary lung carcinoma who were treated at Soonchunhyang University Hospital from July, 1985 to september, 1993 in order to investigate the survival rate and epidemiolgical properties of primary lung cancer. They were 330 males and 74 females. The most prevalent decade was seventh. In terms of cell type, the squamous cell was 225 patients (55%), and adenocarcinoma, small cell, mixed type was 21%, 19%, 4%, respectively. Among non-small cell lung carcinoma, stage Ⅲa was the most prevalent one(92%). In case of small cell carcinoma, the limited stage was 64%. The 12-, 24-, 36- month survival rate of total patients was 57%, 31%, 22%, respectivley and median sruvival time was 15 months. The 36-month survival rate tended to be longer in non-small cell lung carcinoma than that of small cell lung cancer, but there was no difference between two groups, statistically. In non-small cell carcinoma, The 36-month survival rate and meidan survival time were longer in the stage Ⅰ and Ⅱ than those of Ⅲa, Ⅲb, Ⅳ (80% versus 38%, 22%, 0%, p<0.05). According to involvement of lymph node, the 36-month survival rate was longer in NO and N1 than those of N2, N3 (61.9%, 48.7% versus 17.7%, 17.3%, p<0.05). In small cell carcinoma, The 36-month survival rate and median survival rate were higher and longer in limited stage than those of extensive stage(16.1% and 13 month vs 10% and 8 month, p<0.05). In conclusion, we report here the incidence of primary lung carcinoma and the survival rate of paients with primary lung carcinoma who were treated in Soonchunhyang University Hospital.