Gilbert 증후군에서 열량 제한 시험과 Phenobarbital 자극 시험의 의의(14예)

이헌영,채경훈,정재훈,강윤세,김연수,문희석,박기오,이엄석,김선문,김석현,성재규,이병석,이강욱 충남대학교 의학연구소 2003 충남의대잡지 Vol.30 No.2

Gilbert 증후군은 인구의 7%에서까지 나타날 수 있는 매우 흔한 증후군으로서 비진행성인 양성의 만성적 경과를 치하며, 간질환의 증상과 징후가 없는 경한 비포합형 고빌리루빈혈증이 특징인 일종의 체질적인 증상으로서 혈장 빌리루빈 농도에 대한 사춘기의 영향 때문에 10대와 20대에 자주 진단이 된다. 따라서 임상적인 중요성은 미약하지만 높은 빈도가 예상되는 점에 그 중요성이 부여되어야 할 것이다. 따라서 적정한 임상적 진단법으로 기왕에 소개된 열량제한 시험과 phenobarbital 유도 시험을 시행하고 이들의 진단적 가치를 알아보기 위하여 본 연구를 시행하였다. 1990년 7월부터 1999년 4월까지 충남대학교병원에 내원하여 HBsAg, IgG anti-HBc 및 anti-HCV가 음성이고, 간 초음파 스캔에서 이상이 없으며, 혈청 AST, ALT 및 AP가 정상인 비음주자에서 경한 비포합형 고빌리루빈혈증이 있는 14예의 환자들을 대상으로 ^(99m)Tc-DISID 스캔을 시행하였으며, 기저 치 총빌리루빈 및 포합형 빌리루빈 치를 측정한 다음에 하루에 400Kcal로 48시간동안 제한한 열량 제한 시험을 시행하였고, phenobarbital을 하루 60mg씩 5일간 투여한 후에도 각각 총빌리루빈과 포합형 빌리루빈 치를 검사하여 비포합형을 구하였다. 대상 환자들은 모두 14예로서 남자가 11예(78.6%)였고 여자가 3예(21.4%)여서 3.7:1로 남자에서 많았으며, 20대가 6예(42.9%), 30대가 역시 6예(42.9%) 및 40대가 2예(14.2%)로서 2,30대가 대부분(85.8%)이었다. 열량 제한 시험 후의 총빌리루빈 치, 비포합형 및 포합형 빌리루빈 치들은 평균 각각 5.5±2.7, 4.2±2.3 및 1.3±10mg/dL 로서, 시험 전 치들인 3.0±0.8, 2.2±0.8 및 0.7±0.4mg/dL 보다 유의하게(p=0.001, p=0.001, p=0.023) 상승하였다. 포합형 빌리루빈 치도 유의하게 상승하였으나 비포합형의 상승보다는 훨씬 낮아서 주로 비포합형이 증가하였다. phenobarbital 투여 중 설사가 발생하여 중단한 1예를 제외한 13예에서 열량 제한 시험 후에 상승하였던 총, 비포합형 및 포합형 빌리루빈 치가 phenobarbital 유도 시험후에는 2.0±1.1, 1.5±0.8 및 0.5±0.4mg/dL로서 열량 제한 시험 결과보다 유의하게 낮아졌고(p=0.00, p=0.000, p=0.001), 열량 제한 시험 전의 기초치들인 3.0±0.8, 2.2±0.8 및 0.7±0.4mg.dL 보다도 더욱 낮아졌으며 유의한 차이(p=0.001, p=0.02, p=0.005)를 나타내었다. 14예에서 시행한 ^(99m)-Tc DISIDA 스캔에서 9예(64.3%)가 정상이었고, 5예(35.7%)에서는 심장 및 신장으로의 간외 섭취가 3예였고, 60분까지 소장 배출이 없는 배설 지연 예와 담낭 수축 불량 예가 각각 1예 씩 발견되었다. Phenobarbital 투여시험에서 민감도가 열량제한시험에 비해 더 높았다(92.3%와 50.0%). Gilbert 증후군에서 1일 400 Kcal로 48시간의 열량제한 시험과 1일 60mg의 phenobarbital을 5일간 투여하는 유도 시험은 편리하고 유용한 임상적인 진단법으로 이용할 수 있다고 생각된다. 그러나 열량 제한 시험에서는 증가 기준의 통일이 필요하다고 유추되며 phenobarbital 유도 시험이 민감도가 더 높은 것으로 생각된다. Gilbert's syndrome is very frequent and benign chronic process characterized by mild, intermittent, unconjugated hyperbilirubinemia without any symptom and sign of liver disease. Previously intoduced caloric restriction test and phenobarbital stimulation test as two appropriate clinical tests had been examined and their diagnostic values were reevaluated. Fourteen patients with mild, persistent, unconjugated hyperbilirubinemia were included. Subsequently caloric restriction has been applicated by 400 Kcal/day for 48 hours and phenobarbital has been prescribed by 60 mg/day for 5 days. Therafter serum levels of total and direct bilirubin were measured. Most of the patients were third and fourth decade(85.8%) and male predominant. Each basal serum levels of total, indirect and direct bilirubin were 3.0±0.8, 2.2±0.8 and 0.7±0.4 mg/dL. After caloric restriction test, each levels were increased significantly to 5.5±2.7, 4.2±2.3 and 1.3±1.0 mg/dL(p=0.001, p=0.001, p=0.023). After phenobarbital stimulation test for 13 patients had been practiced, increased levels of each bilirubin after caloric restriction test were decreased significantly to 2.0±1.0, 1.5±0.8 and 0.5±0.4 mg/dL(p=0.000, p=0.000, p=0.001) and these levels were significantly lower than basal levels(p=0.001, p=0.02, p=0.005). The sensitivities of caloric restriction test were 85.7%, 50.0%, and 71.4%, 35.7%(1.0, 1.5 mg increase of total bilirubin and 1.0, 1.5 mg/dL increase of indirect bilirubin). The sensitivities of phenobarbital stimulation test were 93.2% and 92.3% at criteria of 1.5 mg/dL increase of total bilirubin and indirect bilirubin. On the diagnosis of Gilbert syndrome, caloric restriction test and phenobarbital stimulation test are convenient and useful diagnostic tools in clinical face. And also phenobarbital stimulation test has higher sensitivity than caloric restriction test. Furthermore, standardization of bilirubin increment would be necessary in caloric restriction test.

혼합형 자가면역성 용혈성 빈혈을 동반한 전신성 홍반성 루푸스 1예

이승철,김선임,이승훈,이현경,조남국,한성훈,유영진,조종래 인제대학교 2000 仁濟醫學 Vol.21 No.2

A 17-year-women developed mixed warm and cold antibody type autoimmune hemolytic anemia associated with systemic lupus erythematosus. The patients was admitted to our hospital for syncope. Jaundice was observed. Urinalysis revealed protein and hemoglobin. Her hemoglobin was 4.6g/dl and reticulocytes were 10%. Total bilirubin was elevated, while haptoglobin and complement were abnormally reduced. ANA and mitochondrial Ab were detected. The direct and indirect Coombs test were positive. The direct antiglobulin test was positive ; IgG and C3d were detected on the red cell surface. The cold agglutinin(CA) titer was 128. The patients was initially treated with high dose steroid therapy. However the patients did not responded to high dose steroid therapy. We treated the patients with plasmapheresis and synchronized cyclophosphamide therapy. Clinical remission of hematologic complications was achieved in this patients. We report a case of mixed type autoimmune hemolytic anemia with SLE that responded plasma pheresis and synchronized cyclophosphamide therapy.

GC-ECD를 이용한 유기염소계 및 Pyrethroid계 농약 동시 분석법

김우성,이선화,김재이,정지윤,이명자,박영채,이영자,정성욱,이봉헌,박흥재 한국환경과학회 2003 한국환경과학회지 Vol.12 No.4

Pesticides were extracted from samples with 70% acetone and methylene chloride in order, and then cleaned up via open-column chromatography apparatus packed with florisil, and finally analyzed simultaneously the organochlorine and pyrethroid pesticides using GC(ECD). An ultra-2 fused silica capillary column was used to separate and identify the products. The resolution between the last isomeric peak of cypermethrin(59.987min) and the first isomeric peak of flucythrinate(60.043min) was not satisfactory. The last isomeric peak of fenvalerate(62.344min) and the first isomeric peak of fluvalinate(62.397min) were overlapped. Recoveries of soybean sample for the most pesticides were 73.3% to 102.4%. Detection limits were between 0.004 and 0.063 ㎍/㎎ when this method was used.

녹비작물재배에 따른 고려인삼의 생육특성

Bong Jae Seong,Sun Ick Kim,Ka Soon Lee,Moo Geun Jee,Hyun Ho Kim,Jun Yeon Won 한국약용작물학회 2016 한국약용작물학술대회 발표집 Vol.2016 No.05

Background : The authors of this study analyzed the effect of the green manures cultivated in the soil of the preparation field in order to select the green manures suitable for ginseng cultivation and the effect of the green manures on the variation of ginseng growth development, the content of crude saponin and yield ability with the aim to use the results as the primary data for improving the quality of ginseng. Methods and Results: To analyze the effect of the application of green manures on the growth of ginseng, the authors cultivated 4 varieties of green manures and installed blue polyethylene sheet and one-layered black polyethylene net+three-layered blue polyethylene net(OBPNTB) and sun-shading material on the managed soil by re-applying green manures and then cultivated ginseng. The results suggested that the growth of ginseng was excellent in the barley+hairy, barely and rye cultivation plot in the plot treated with OBPNTB rather than the cultivation plot teated with Blue polyethylene sheet(BPS) and two-layered blue & two-layered black polyethylene net(TBTBPN), and the growth of leaf length and stalk diameter was excellent in barely + hairy vetch material. For the underground root weight, the growth was the most excellent(30.19g) in the barley+ hairy vetch cultivation plot treated with OBPNTB. For the underground red discoloration and root rot, the incidence rate was the lowest in the plot treated with BPS in which the water leak in a levee was small than in the test plot treated with sun-shading net. For the ginsenoside content in the cultivation plot treated with TBTBPN, the ginsenoid content was the highest in the rey cultivation plot, and it was the highest in the cultivation plot treated with OBPNTB. Conclusion : The results of study suggested rye among green manures is the most suitable for the growth of ginseng; underground growth was the most prominent in the plot treated with sun-shading net material (black 1 + blue 3) and the underground ginsenoside content was the most prominent in the rye cultivation plot and the plot treated with the sun-shading sheet.

서울의 Penicillinase Producing Neisseria gonorrhoeae 발생빈도(1998)

김재홍,김준호,반재용,이정우,황성주,정준규,정성태,강진문,조흔정,홍창의,정혜신,이한승,김이선,이봉길,이종호,선영우,한기덕,윤성필,이성훈,안종성,박석범,문승현,조항래,김형섭,류지호,황재영,박준홍,손상욱 한양대학교 의과대학 2001 한양의대 학술지 Vol.21 No.1

In recent years, gonorrhea has been pandemic and remains one of the most common STDs in the world, especially in developing countries. For the detection of a more effective therapeutic regimen and assessing the prevalence of Penicillinase Producing Neisseria gonorrhoeae(PPNG), we have been trying to study the patients who have visited the Venereal Disease Clinic of Choong-Ku Public Health Center in Seoul since 1980 by menas of the chromogenic cephalosporin method. In 1998, 93 strians of N. genorrhoeae were isolated, among which 60(64.5%) were PPNG. The prevalence of PPNG in Seoul, which had been decreased to 39% in 1996 after a peak of 74.3% in 1993, is increased to 64.5% in 1998.

골다공증의 위험인자 : 아산시 지역 주민을 대상으로

김용배,장원기,황보영,김화성,안규동,이병국,이용진,이남수,이상건,이상범,이상우,이선정,이성수 순천향대학교 2006 Journal of Soonchunhyang Medical Science Vol.12 No.1

Objective : As the average lifespan of human increases, osteoporosis and osteoporosis-related fractures have become major health care problems. Despite recent advances in medical treatment, few studies have assessed the recognition of osteoporosis in general adults. This study examined the recognition of osteoporosis and analyzed the relating factors. Method : A population-based sample of 1086 adults in Asan-city, Korea was investigated with questionnaires and height, weight, Information regarding the general characteristics(gender, age, economic state), lifestylef exercise, smoking, alcohol),medical history(progestin, GH, steroid, calcitonin, PTH), demographic parameter, obesity, stress, and family history was collected through an interview using a structural questionnaire. The level of obesity was measured by the body mass index(BMI). BMD(Bone mineral density) at the lumbar spine and femoral neck was measured by dual energy X-ray absorptiometry. Osteoporosis was considered to be T-score below -2.5. Results : The prevalence of osteoporosis increased progressively with age, decreased with BMI and predominant in women by the result of x^(2) -test, T-test. Age, weight, BMI were significantly correlated with osteoporosis by the result of Pearson correlation ana1ysis(P<0.05). And age, gender, BMI, family history of osteoporosis were proved to be significant risk factors of osteoporosis by the result of multiple logistic regression(P<0.05). Conclusion : These results suggest that age, gender, BMI might be the most important risk factors of osteoporosis. And the history taking about family history of osteoporosis is helpful for diagnosing osteoporosis.

고추 가공 및 저장중 辛味成分 변화

李宙相,黃聖淵,曺哉銑 慶熙大學校 1993 論文集 Vol.22 No.-

The capsaicinoids of Korean red peppers were varied with cultivars from 30 mg% to 257mg%, highest in ˝Chungyang˝and medium in ˝Dabock˝ which is most popular to Korean and major capsicinoids were capsaicin and dihydrocapsaicin which are 88.5-94.8% of total capsaicinoids in red peppers. The capsaicinoids of red pepper were distributed 46% in placenta and septum and remainder were in pericarp, seed and stem in the order. The changes in capsaicinoids content of red peppers was not significant during hot-air drying at 65-75℃and sun drying. Fluorescent light was more destructive to capsaicinoids than incandescent light when red pepper powder was exposed to those lights. The larger amount of capsaicinoids was extracted with higher concentration of salt solution, but the water extractability was not affected by pH changes. During storage at 4,25,40℃ for 180 days, capsaicinoids content of red peppers was changed.

개에서 발생한 양파 섭취에 의한 하인즈 소체 용혈성 빈혈 증례

이미선,윤기영,서경원,최호정,정성목,송근호,조종기,박성준 忠南大學校 獸醫科大學 附設 動物醫科學硏究所 2012 動物醫科學硏究誌 Vol.19 No.1

A 10 month-old Yorkshire Terrier was referred to the Veterinary Medical Teaching Hospital of Chungnam National University with the history of lethargy, bile pigment in urine and anorexia. Blood smear showed Heinz body, polychromatocytosis, schistocytosis, anisocytosis, which were the results from the oxidative injury. Hematology demonstrated a moderate anemia(PCV 22.4%, reference rage 35-55%), which was regeneration based on the degree of RPI (4.03, reference rage > 1). Serum biochemistry demonstrated mild elevation in total bilrubin, and mild decrease in total protein and albumin concentration. A diagnosis of Heinz body hemolytic anemia secondary to onion ingestion was made and treated with fluid therapy, oxygen and antioxidant drugs. The dog recovered without any complication.

중합효소연쇄반응을 이용한 도말양성 폐결핵 환자에서의 결핵균 DNA 검출방법에 관한 연구

이종진,김애경,조해정,한표성,홍석철,김주옥,김선영 충남대학교 의과대학 지역사회의학연구소 1994 충남의대잡지 Vol.21 No.2

Polymerase chain reaction (PCR) is the most sensitive and rapid method for the diagnosis of M.tuberculosis infection. Many reports have shown different methods for mycobacterial DNA extraction, but revealed many differences in simplicity and time-consumption. We studied which method was the best among 7 different ones for DNA extraction from 32 smear-positive sputa, using PCR of targeting 123bp DNA fragment of IS6110. The methods were the following : SDS-Microwave oven method, NaOH Lysis method, Triton X-100, Proteinase K method, Lysis buffer method. SDS-Proteinase K method, Bead Beater method, and Bead Beater/CTAB method. The amplification products were identified by electrophoresis on ethidium bromide-stained agarose gels, and confirmed by restriction enzyme, Southern blot hybridization, and DNA sequencing. All 32 cases were positive (100%) by the 7 different methods. It took 1 hour or more to detect DNA in SDS-Microwave oven method, NaOH Lysis method, and Bead beater/CTAB method. It took 2 hours or less in the others. SDS-Proteinase K method and Bead Beater/CTAB method were simpler and more convinient than the others. These results suggest that SDS-Proteinase K method and Bead Beater/CTAB method might be better than the others for the extraction of mycobacterial DNA in terms of simplicity and time-consumption, although all the methods were sensitive.

하악골 골절에 대한 임상통계학적 연구

이성훈,김기영,조규승,소광섭,박홍주,조요기,오희균,유선열 大韓顎顔面成形再建外科學會 1998 Maxillofacial Plastic Reconstructive Surgery Vol.20 No.1