진행된 HIV 감염 환자에서 십이지장의 미란성 병변으로 발현한 Mycobacterium genavense 감염 1예

진상만,박종선,김홍빈,오명돈,최강원,김희연,국윤호,김남중 대한감염학회 2007 감염과 화학요법 Vol.39 No.4

Mycobacterium genauense는 최근에 알려진 미코박테륨으로서, 식욕 부진, 체중 감소, 설사, 림프절 병증 등 파종성 Myocobacterium avium-intracellulare complex 감염과 유사한 임상상을 보이며, 위장관 침범을 잘 하는 것으로 알려져 있으나 아직 국내에서 증례는 보고된 바가 없다. 저자들은 진행된 HIV 감염 환자에서 십이지장의 미란성 병변으로 발현한 Mycobacterium genavense 감염 1예를 경험하였기에 문헌 고찰과 함께 보고하는 바이다. 환자는 상복부 동통과 발열, 설사로 내원하였다. 십이지장의 미란성 병변에서 시행한 조직검사에서 항산균이 가득 차있는 거품세포가 관찰되었으며, 이 검체에서 16S rRNA 유전자의 중합연쇄반응 검사를 시행하여 Mycobacterium genavense를 확인하였다. Mycobacterium genavense, first identified in 1990, is known as a pathogen that mimics disseminated Myocobacterium avium-intracellulare complex (MAC) infection with particular propensity for the gastrointestinal tract. In Korea, no case with the organism has been reported. Herein we report a case of Mycobacterium genavense infection that manifested with erosive lesion of duodenum in a patient with acquired immune deficiency syndrome. The patient presented with epigastric pain and fever, diarrhea. Duodenal biopsy showed histiocytic infiltration with numerous acid-fast bacilli. Identification of the mycobacterial isolate by the polymerase chain reaction restriction analysis of 16S rRNA gene revealed Mycobacterium genavense.

안면 비대칭의 평가를 위한 기준에 관한 정보 두부 방사선 계측학적 연구

백선호,안병근,김선해,손홍범,한호진,강수만 대한치과교정학회 1993 대한치과교정학회지 Vol.23 No.1

This study was undertaken to investigate the middle having the least difference between the right and left structures among the lines that had been used in the study of the craniomaxillofacial asymmetry. The sample of this study consisted of twenty six Korean girls(average 18.9 years old) having normal facial appearance and occlusion. On the frontal cephalometric films of the sample, we divided the whole craniomaxillifacial area into four portions, i.e., cranial, upper facial, lower facial, and dental portion. So, we have found the midlines having the least difference in the whole craniomaxillofacial area itself, and in the each divided four portions, furtherly in the other portions from aimed portion. The findings were as follow : 1. In the whole craniomaxillofacial area, the connecting line between crista galli and anterior nasal spine and the perpendicular bisecting line between right and left foramen rotundrums were suitable for the midline. 2. In the cranial portion, established all six lines were suitable for midlines. In the other portions, the perpendicular bisection line between both condylion, the line passing the contact point between right and left mandibular central insisiors among the perpendicular lines between right and left mandibular central incisial tips were suitable midlines for evaluating the asymmetry of cranial portion. 3. In the upper facial portion, the perpendicular bisecting line between right and left zygions was the most suitable midline. In the other portions, the line between the crista galli and the most superior point of the odontoid process, the perpendicular bisecting line between right and left gonions, the perpendicular bisecting line between right and left condylions, and perpendicular bisecting line between right and left foramens rotundum were suitable midlines for evaluating the asymmetry of the upper facial portion. 4. In the dental portion, the perpendicular bisecting lines between right and left buccal cusps of both maxillary first molars and between right and left mandibular first molars were suitable midlines. In the other portions, the perpendicular bisecting line between right and left landmarks crossing the lesser wing of the connecting line between crista galli and prosthion were suitable midlines for evaluating the asymmetry of dental portion. 5. In the lower facial portion, the perpendicular bisecting lines between right and left condylions and between right and left gonions were suitable midlines. In the other portions, the line between the crista galli and anterior nasal spine, the perpendicular bisecting line between right and left foramen rotundums, and the perpendicular bisecting lines between right and left buccal cusps of both mandibular first molars and between right and left maxillary first molars were suitable midlines for evaluating the asymmetry of the lower facial portion.

다발성 외상시 응급 초음파검사의 의의

이강현,임경수,김선만,김영식,황성오,유수영,강성준 대한응급의학회 1995 대한응급의학회지 Vol.6 No.1

The Evaluation of blunt abdominal trauma is clinically challenging. Abdominal computed to-mography(CT) and diagnostic peritoneal lavage(DPL) has become primary diagnostic modali-ty in advanced trauma life support(ATLS). But DPL is invasive study with potential for the patients. Monitoring and resuscitation are usually suboptimal during there examinations. We examined the efficacy and role of emergency ultrasonographic(US) studies in the initial abdominal evaluation of blunt trauma patients. A prospective study was carried out on 101 blunt trauma patients from 1994, June to September. 101 patients underwent real-time US ex-amination of the chest and abdomen. Indication for emergency US included the cases of shock (systolic blood pressure<90mmHg) or tachycardia (pulse rate/min.>100) in blunt trauma pa-tients. US showed a sensitivity of 96.2%, specificity 98%, accuracy 97% in regard to indica-tion for surgery in case of blunt abdominal or thoracic trauma. US saves time, and it can be performed during the emergency care in the emergency department. US showes high sensitivity and specificty, and is the method of first choice in the evaluation of blunt trauma.

저칼슘식이로 사육한 생쥐의 골수세포 배양에 의한 파골세포양세포의 형성

박주철,강선주,임도선,김현만,고재승 대한구강해부학회 1995 대한구강해부학회지 Vol.19 No.1

Although it is now well established that osteoclasts are derived from mononuclear hematopoietic stem cells, most likely within the granulocyte-macrophage lineage, the exact differentiation process of osteoclast precusors has only been partially discovered. This study was carried out to investigate the following topics by examining the osteoclast-like cell formation from the calcium-deficient mouse bone marrow cells; 1) the effect of calcium deficiency on the formation of the mononuclear phagocytes and the mononuclear precusors of the osteoclast in the mouse bone marrow; 2) the effect of TNF (tumor necrosis factor)-α on the differentiation of osteoclast-like cells from the calcium-deficient mouse bone marrow culture; 3) the formation of the osteoclast-like cell from the calcium-deficient mouse bone marrow mononuclear cells and the relationship between the osteoblast cell line(MC3T3E1) and osteoclast-like cell formation; 4) formation of the osteoclast-like cells from the mononuclear cells which were col1ected from PTH-pretreated mouse bone marrow cells to investigate the relationship between PTH and calcium deficiency in osteoclast-like cell formation. Bone marrow cells were isolated from marrow of mouse feeding normal diet or calcium deficient diet for 7 and 14 days. Bone marrow mononuclear cells were fractionated by cetrifugation on Hypaque-Ficoli density gradients. PTH-pretreated mouse bone marrow mononuclear cells were obtained by collecting the nonadherent cells after the culture of normal mouse marrow cells with PTH for 6 days. The prepared cells were cultured on dentin disc at the concentration of 1.5-2 X 10^(6) cells per 0.5ml of a-MEM containing 10% FCS for 3, 5 and 7 days. Thereafter, TRAP staining, NSE staining, effect of calcitonin on the osteoclast-like cell and scanning electron microscope analysis of resorption lacunae on the dentin disc were performed. The results were as follows; 1. Number of the osteoclast precusors and mononuclear phagocytes in bone marrow was increased by calcium-deficient diet. 2. More osteoclast-like cells were formed from the calcium-deficient mouse bone marrow cells than from normal cells. 3. Formation of osteoclast-like cells was significantly stimulated by TNF-α in normal mouse bone marrow cells and calcium-deficient mouse bone marrow cells at concentration of l0ng/ml and 100ng/ml. 4. Osteoblast cell line(MC3T3E1) did not play an important role in osteoclast-like cell formation. 5. Formation of the osteoclast-like cells from the mononuclear cells which were collected from PTH-pretreated mouse bone marrow cells was similar to that of calcium-deficient mouse bone marrow mononuclear cells, which suggests that the effect of calcium deficiency in osteoclast formation may be mediated by PTH.

전류 비유 모델에 의한 초등학생의 전류 개념 변화 분석

유병길,강인석,김병철,남만희,박선희,소하연,윤희정,이영아,이하룡,전병문,정승호 부산교육대학교 과학교육연구소 2000 科學敎育硏究 Vol.25 No.-

There exists a major impediment to learning electricity which may illuminate why direct presentation of scientists' ideas is too aggressive a strategy. This impediment lies in thinking that electricity is used up and in envisaging the light bulb as a consumer. This view is based on a powerful idea which summarises much of our experience; it declares that 'things get used up', 'you cannot get something for nothing', and 'intuitive thinking'. To replace this view with scientific view, we made the analogy model. It is suggested that the analogy model is more effective in teaching electricity circuits than conventional teaching method.

일부 부인과 양성 질환자의 지방조직 및 혈청의 PCBs와 DDE 농도

박성균,이강숙,노영만,구정완,민선영,한진구,고원경,김미란,정재근,이종승,김진홍 大韓産業醫學會 2000 대한직업환경의학회지 Vol.12 No.1

목적 : 본 연구는 지방조직과 혈청의 PCBs와 DDE 농도를 측정하고, 이에 영향을 미치는 것으로 알려진 요인들과의 관련성을 평가하고자 하였다. 방법 : 유방암, 자궁내막증 등 유기염소계 화합물의 영향이 있는 것으로 알려진 호르몬 관련 질병을 제외한 부인과 환자 52명을 대상으로 지방조직과 혈청을 분석하였으며, 설문조사를 통하여 연령, 교육수준, 직업, 비만도, 흡연과 음주, 출산력, 수유력등을 조사하였다. 지방조직과 혈청의 PCBs와 DDE 농도는 가스크로마토그래피를 사용하여 측정하였다. 결과 : 지방조직의 경우, 13개 PCBs congeners 농도의 합은 중앙값이 48.29 ng/g, 기하평균값이 56.78 ng/g이었고, DDE 농도는 중앙값이 142.89ng/g, 기하평균값이 117.06 ng/g이었으며, 혈청의 경우는 PCBs congeners 농도의 합은 중앙값이 4.67 ㎍/L, 기하평균값이 4.85 ㎍/L이었고, DDE 농도는 중앙값이 1.75 ㎍/L, 기하평균값이 2.09 ㎍/L로 나타났다. 지방조직과 혈청의 DDE 농도 사이는 높은 상관성을 보였으나(r²=0.310, p=0,0002), PCBs는 상관성이 약한 것으로 나타났다(r²=0.029, p=0.2582). 영향요인을 범주화한 후 로그변환 시킨 지방조직과 혈청의 PCBs, DDE 평균의 차이를 분석한 결과, 지방조직의 DDE만이 출산자녀수(p=0.015), 초산연령 (p=0.014), 비만지수(p=0.035)와 연관성이 발견되었다 다중회귀분석의 결과 지방조직의 DDE는 출산자녀수가 적을수록, 초산연령이 늦을수록 증가하는 경향을 보였다. 결론 : 출산자녀수와 초산연령, 비만도가 지방조직의 DDE와 관련성을 보였으며, 또한 유기염소계 화합물의 장기간의 노출에 의한 영향을 평가하는데 있어서 혈청보다 지방조직이 더 유용한 생물지표임을 알 수 있었다. Objectives : This study was purposed to determine the levels of PCBs and DDE in adipose tissue and serum and to evaluate the relations with factors affecting these levels. Methods : We analyzed adipose tissues and sera from 52 gynecologic benign disease patients aged 27-78 years, except hormonal diseases such as breast cancer and endometriosis. We also surveyed age, education, occupation, body mass index (BMI), smoking, drinking, number of children, and duration of breastfeeding by questionnaires. Tissue and serum levels of PCBs and DDE were measured using gas chromatography. Results : The median and geometric mean levels of PCBs were 48.29 ng/g, 56.78 ng/g for adipose tissue and 4.67 ㎍/L, 4.85 ㎍/L for serum, and those of DDE were 142.89 ng/g, 117.06 ng/g for adipose tissue and 1.75 ㎍/L, 2.09 ㎍/L for serum, respectively. Adipose tissue and serum levels for DDE showed high correlation (r²=0.310, p=0.0002), but those of PCBs didn't (r²=0.029, p=0.2582). In analyses of the differences of the means of log transformed adipose tissue and serum PCBs and DDE levels for groups of potential covariates, only adipose tissue DDE levels were significantly associated with number of children (p=0.015), age at first birth (p=0.074) and BMI (p=0.035). In multiple regression analysis, adipose tissue DDE levels were significantly increased with decreasing number of children and increasing age at first birth. Conclusions : This study suggested that parity and adiposity were associated with levels of DDE in adipose tissue, and adipose tissue is a better biomarker than serum for evaluating the long-term exposure of organochlorines.

다이빙 조사에 의한 가을철 가거도 연안의 어류상

명정구,조선형,박정호,백상규,김종만,강필선 한국어류학회 2003 韓國魚類學會誌 Vol.15 No.3

1. 2002년 10월 16∼17일에 스쿠버다이빙, 수중 촬영을 통하여 전라남도 신안군 가거도 주변 가을철 연안의 어류상을 조사한 결과 총 5목 23과 40종이 확인되었고, 지금까지 기재 된 어종 이외에 18종이 추가로 확인되었다. 2. 어종 구성으로 보면 양볼락과가 7종으로 가장 많았으며, 그 다음으로 둑중개과가 4종, 자리돔과가 3종 순이었다. 3. 가거도 주변에서 지금까지 확인된 어종들은 온대성 어종이 대부분이었지만, 그 외에 노랑자리돔, 청황베도라치 및 파랑돔 등 난류성 또는 아열대 어종이 확인되어 제주도나 독도와 마찬가지로 대마난류의 영향도 받고 있음을 나타내었다. The fish fauna in the coastal waters of Gageodo Island, South-west Sea, was investigated by SCUBA diving in October 16 and 17, 2002. The fishes observed were classified into 40 species in 23 families. In Autumn, subtropical fishes in such as families as Pomacentridae, Pomacanthidae and Apogonidae, represented 12.5% of the total, while eurythermal species represented 72.5%.

AVPU scale과 Glasgow Coma Scale의 상관관계 : 외상환자의 의식상태 평가법 THE EVALUATION METHODS OF MENTAL STATUS IN TRAUMA

김 현,임경수,이강현,김영식,김선만,황성오 大韓應急醫學會 1996 대한응급의학회지 Vol.7 No.1

Background: The emergency treatment of multiple trauma patient includes rapid evaluation of mental status, triage and resuscitation. The principles of Advanced Trauma Life Support consist of primary survey & resuscitation, secondary surveys and definitive cares. In primary survey, the mental status is evaluated by AVUP scale, and GCS(Glasgow coma scale) is used in secondary survey because the calculation of GCS needs more times than AVPU scale. Purposes: Is there a correlation between AVPU scale and GCS as an evaluation method of mental status in trauma? Subjects: 434 injured patients(male 321, female 113, mean age 35.9 years) who had visited the emergency center of Wonju Christian Hospital was evaluated prospectively. The mental status was evaluated by AVPU scale and GCS by emergency physician as soon as the patients was admitted to emergency center. Results: Alert patients as AVPU scale were ranged from 14 to of GCS, patients who responded to verbal command were from 9 to 14 of GCS, patients who responded to pain stimuli were from 4 to 10 of GCS, and patients who did not respond to pain stimuli were from 3 to 5 of GCS. The linear correlation of AVPU scale and GCS was seen(r2=0.90). Conclusion: This study suggest that AVPU scale was vey closely correlated with GCS.

심정지환자에서 epinephrine투여시 혈중 catecholamine의 변화

임경수,황성오,이부수,이강현,이진웅,임종천,김영식,김선만,김 현 대한응급의학회 1995 대한응급의학회지 Vol.6 No.1

Background : Cardiac arrest is a potent stimulus for the release of endogenous catecholamine and high plasma catecholamine concentration has been reported during cardiopulmonary resuscitation(CPR). Few data were present about the clinical effect of high plasma catecholamine and endogenous catecholamine response to exogenous epinephrine administration during CPR. Purpose : This study was designed to evaluate endogenous catecholamine response to cardiac arrest and exogenously administered epinephrine during CPR. Method : In 21 cardiac arrest victims, blood sample for epinephrine and norepinephrine was drawn before and 1 minute after each epinephrine administration during CPR. 1mg of epinephrine was administered immediately after intravenous access and 3 minute interval during CPR. Plasma catecholamines were quantitated by high-performance liquid chromatography. Result : Baseline plasma epinephrine concentraqtion was higher in patients with cardiac arrest than normal controls (985±1627 vs 194±173 pg/ml, p<0.05). Baseline plasma norepinephrine concentration was also elevated in patients with cardiac arrest than normal controls, although statistically insignificnat(1965±4915 vs 360±250 pg/ml). Plasma epinephrine concentration in cardiac arrest patients was significantly elevated after exogenous administration of epinephrine, but its response was blunted after the third does of epinephrine. Plasma norepinephrine concentration in cardiac arrest patients was also elevated, but its response was observed only after the first epinephrine administration. Plasma epinephrine concentration was persistently higher in patients with return of spontaneous circulation (ROSC) than patients without ROSC. there was no significant difference of plasma norepinephrine concentration whether spontaneous circulation was restored or not. Endogenous epinephrine response to exogenous epinephrine was not observed in patients having prolonged arrest time over 20 minutes. Conclusion : Results of this study suggests that significant amount of catecholamine is released by exogenous epinephrine administration in spite of high plasma catecholamine concentration, and degree of endogenous catecholamine response influences resuscitation outcome.

위절제술 환자의 표준진료지침 개발 및 적용 효과

김은희,김철규,이순교,김순덕,이혜옥,권정순,이경미,이민미,심순미,유용만,신종식,강은희,이상일,김병식,오성태,육정환,박수길 한국의료QA학회 2003 한국의료질향상학회지 Vol.10 No.2

Background : Gastric cancer is the most common malignant tumor in Korea. surgical operation is one of the major treatment modalities for gastric cancer patients. Therefore, gastrectomy is one of the most common procedures in General Surgery. There were variation in length of hospital stay and medical treatment for gastrectomy between three surgeons at Asan Medical Center. Clinical pathways have received considerable attention as a tool for recucing the medical practice variation, increasing the efficiency of care process, and improving the quality of care. The aim of this study was to evaluate the effect of a clinical pathway for gastrectomy in gastric cancer patients. Methods : The clinical pathway for gastrectomy was developed and implemented by a multidisciplinary group in Asan Medical Center. A computerized clinical pathway program was developed and revised after a pilot test. A total of 145 patients underwent gastrectomy by three surgeons at Asan Medical Center. We compared the length of hospital stay, patient satisfaction, and unplanned readmission rate between the pre-pathway group(n=67) and the post-pathway group(n=78). We also investigated the degree of satisfaction among the physicians and nurses who were main end-users of the clinical pathway. Results : The clinical pathway was applied to all target patients. The average length of hospital stay was shortened from 12.7days to 10.6days(p<0.01). The degree of patient satisfaction with the care process changed from 90.3% to 89.2% after the implementation of the clinical pathway, but the difference was of satistically significant(p=0.761). Unplanned readmission rate was 2.9% in the pre-pathway group. More than 90% of physicians and nurses answered that the clinical pathway had been a useful tool in their medical practice. Conclusions : The findings of the study demonstrated that implementation of the clinical pathway for gastrectomy produced substantial reduction in the length of hospital stay while improving the quality of patient outcomes. The computerized clinical pathway program can be used as one of the powerful patient management tools for reducing the practice variations and increasing the efficiency of care process in Korea hospital settings.