이암의 공학적 특성과 이암층에서의 터널시공사례

강한욱,곽현준,정한중,김영근 한국터널지하공간학회 2001 자연, 터널 그리고 지하공간 Vol.3 No.4

대구-포항간 고속도로 건설공사

강한욱,권재석 대한토목학회 2002 대한토목학회지 Vol.50 No.8

악성 갑상선 우연종의 임상상 및 초음파 소견의 진단적 가치

강한욱,김광원,이병완,강보현,김형훈,김범진,정재훈,민용기,이명식,이문규 대한내분비학회 2002 Endocrinology and metabolism Vol.17 No.5

연구배경: 최근 갑상선 초음파 검사의 빈번한 시행으로 갑상선 우연종의 발견이 증가하고 있다. 이러한 갑상선 우연종은 임상적으로 어떻게 접근하고 치료를 해야 하는지 적지 않은 문제가 되고 있다. 본 연구에서는 직경 1.5㎝ 이하의 갑상선 우연종의 유병률, 입상적 특징 및 초음파 특성, 그리고 가장 효율적인 진단적 접근에 대해 알아 봤다. 방법: 1999년 1월부터 2000년 12월까지 삼성서울병원 내과 및 일반외과로 갑상선 결절을 주소로 내원한 1457명을 대상으로 후향적 연구를 시행하였다. 우연히 발견된 직경 1.5㎝ 이하의 갑상선 결절을 가지는 환자들에서 갑상선 결절의 촉지 유무, 갑상선 기능검사, 항갑상선 항체, 갑상선 초음파 및 미세침 흡인세포검사, 99m^Tc 갑상선 스켄, 수술 조직검사 및 병기를 검토하였다. 결과: 분석한 갑상선 결절 1475예 중 갑상선 우연종의 유병률은 13.4%(198예)였다. 갑상선 우연종에서 악성률은 28.8%(57예)으로 나왔다. 양성 및 악성 갑상선 우연종에서 나이, 성별, 갑상선 기능검사, 결절 크기에는 의미 있는 차이는 없었다. 갑상선 스켄은 갑상선 우연종의 감별에 적합하지 않았다. 갑상선 결절의 초음파 지표 점수만이 양성 및 악석 갑상선 우연종의 감별에서 초음파 지표 점수의 민감도는 88.9%, 특이도는 74.4%, 양성 예측률은 92.4%로 나왔고 진단적 정환도는 85.5%였다. 갑상선암으로 수술을 받은 50명중 stage 1은 34명, stage 2는 6명, stage 3은 10명으로 대부분의 악성 갑상선 우연종은 낮은 TNM 병기로 나타났으나, 상당수에서는 국소 침범의 소견을 보였다. TNM 병기의 3기 환자 전부는 45세 이상이였고, 주로 갑상선암의 피막 침범에 의한 것이었다. 임파절 전이는 6명의 환자에서 나왔다. 결론: 악성 갑상선 우연종은 비교적 흔히 접할 수 있는 질환이며 양성 우연종과는 임상적으로 구별이 안 된다. 악성 갑상선 우연종은 발견 당시 대부분 낮은 병기이나, 갑상선의 피막 침범 및 임파절 전이가 상당수에서 발견되었다. 갑상선 우연종의 초음파 소견은 향후의 진단 방향을 제시하는 중요한 길잡이가 될 수 있다. 초음파 지표 점수 2점 이상의 갑상선 우연종에서만 초음파 유도 미세침 흡입검사를 권장한다. Background: High-resolution ultrasonography has made the detection of asymptomatic small thyroid possible. Recent increases in the detection of incidentalomas have created a clinical dilemma on how to properly manage such incidental nodules. We investigated the prevalence, clinical and ultrasonographic characteristics, and optimal diagnostic approach toward incidentally detected benign and malignant thyroid nodules of less than 1.5㎝ in size. Methods: A retrospective review was undertaken on the 1,475 patients who had visited Samsung Medical Center, Seoul Korea between January 1999 and December 2000. The review consisted of a physical examination of the thyroid gland, thyroid function test, antithyroid antibodies, thyroid ultrasonography, fine-needle aspiration biopsy, pathology and TNA staging of the incidentally detected thyroid nodules of less than 1.5㎝ in size. Results: The prevalence of thyroid incidentalomas was 13.4% and the malignancy rate within them was 28.8%. There were no significant differences in age, sex, thyroid function test and size between the benign and malignant incidentalomas. Ultrasonographic characteristics showed meaningful diagnostic value for the detection of malignancy in incidentalomas. Most malignant incidentalomas were of a low stage. Conclusion: Occult thyroid cancers are fairly common finding. There are no clinical difference between benign and malignant thyroid nodules less than 1.5㎝; however, ultrasonographic findings can be used to decision of optimal management strategies (J Kor Soc Endocrinol 17:649∼656, 2002).

포스타 전시 발표 : 내분비-대사 ; 제2형 당뇨병 환자에서 고요산 혈증과 대사증후군과의 연관성

하창영,강한욱,정인경,노정현,이명식,민용기,이문규,김광원 대한내과학회 2001 대한내과학회 추계학술대회 Vol.61 No.-

고유수용성감각기관들을 자극하는 운동법들이 소아 측만 각도 변화에 미치는 효과

양재만,강한욱,Jae-Man Yang,Han-Wook Kang 대한고유수용성신경근촉진법학회 2023 PNF and Movement Vol.21 No.3

Purpose: The purpose of this study was to compare changes in pediatric Cobb's angle resulting from using the modified scoliosis exercise method to promote proprioception. Methods: There were 32 participants in this study. Cobb's angle was measured automatically using a ZeTTA PACS Viewer through a digital computer program with whole-body x-ray anterior to posterior. Scoliosis was diagnosed by a Cobb's angle of 10° or higher. Modified scoliosis exercises were used as the program for the three-stage method used in the study: the preparation phase (warm-up), actual exercise phase (main exercise), and final clean-up phase (cool-down). In this study, exercises that can promote proprioception, including muscle strengthening, stretching, equilibrium, myofascial release, balance taping, and traction, were applied, and their effects before and after treatment were compared. After implementing the exercise methods once a week-15 times total for about 4 months-the changes in Cobb's angle were measured. Results: After having the pediatric scoliosis patients practice the modified scoliosis exercises for four months, it was found that the Cobb's angle of the spine significantly decreased. Conclusion: The results of this study show that the modified pediatric scoliosis exercise, which is capable of promoting proprioception, is also effective in improving Cobb's angle.

관상동맥질환에서의 당뇨병 환자의 임상적 고찰

이병완,강보현,강한욱,김형훈,김현진,노정현,지재환,하창영,정재훈,민용기,이명식,이문규,김광원 대한당뇨병학회 2002 임상당뇨병 Vol.3 No.3

당뇨병은 관상동맥질환의 중요 위험인자이다. 당뇨병의 유병률의 증가와 더불어 관상동맥질환 환자에서의 당뇨병 환자 비율은 점차 증가추세에 있다. 본 연구에서 관상동맥질환의 위험인자는 당뇨병, 나이, 비만, 고혈압, 흡연 그리고 관상동맥질환의 가족력이었다. 관상동맥질환 환자에 서 당뇨병군과 정상 혈당군간에는 나이, 고혈압, 흡연, 관상동맥질환의 가족력, 고밀도지단백 콜레스테롤, 중성지방, fibrinogen, t-PA, PAI-1이 통계적 유의한 차이가 있었다. 심근경색 환자를 대상으로 시행한 연구에서 당뇨병군과 정상 혈당군간에는 흡연, 지질강하제 복용, homocysteine,t-PA, PAI-I 그리고 CRP가 유의한 차이를 보였다. 혈당조절을 잘된 환자군과 잘되지 못한 환자군의 비교에서는 요산과 고밀도지단백 콜레스테롤만이 유의한 차이를 보였다. 당뇨병 환자에서의 지질 수치 중 고밀도지단백 콜레스테롤이 관상동맥질환의 주요 예측인자이며 위험인자라고 생각된다. 당뇨병 환자에서는 특히 금연과 혈압 그리고 혈당수치를 철저히 조절해야 한다. 당뇨병이 발생한 이후 혈당조절을 잘하는 것이 관상동맥질환의 발생과 사망률을 감소시킬 수 있을 지, 그리고 당뇨병 환자에서 혈당조절 이외의 어느 인자를 교정하는 것이 관상동맥질환을 예방하는데 도움이 될지 앞으로 전향적 연구가 필요하리라 사료된다. Background: Diabetes is a very important risk factor of coronary artery disease. The prevalence of diabetes in Korea is increasing steadily. The objective of this study was to establish the prevalence and cardiovascular risk factors of diabetes in coronary artery disease in Korean type 2 diabetes. Methods: Of the patients enrolled in SMC-coronary artery angiography protocol, we investigated 1143 subjects (from Jan. 1st to Dec.31th, 2001) with suspicious coronary artery disease reflected from symptoms of chest pain, EKG and enzyme abnormalities, and thallium scan. Sociodemographic characteristics and laboratory data were investigated using retrospective analysis. Results: The prevalence of diabetes in coronary artery disease patients was 37.49 %. The risk factors of coronary artery disease were diabetes, old age, obesity, hypertension, smoking and family history of coronary artery disease in our study. Among patients with coronary artery disease, there were significant differences in age, hypertension, smoking, family history of coronary artery disease, and levels of HDL-C, triglyceride, fibrinogen, t-PA, PAI-1 between diabetic patients and normo-glycemic patients. In the comparison of patients with myocardial infarction, there were significant difference in smoking, prescription of lipid-lowering drugs, homocysteine, tPA, PAI-I, and CRP between diabetic patients and normo-glycemic patients. Only the levels of uric acid and HDL-C showed meaningful difference between diabetic patients with well-controlled blood sugar and poorly-controlled blood sugar. Conclusion: With the increase in the prevalence of diabetes, the proportion of diabetic patients in coronary artery disease has also increased. Among patients with coronary artery disease, the risk factors of coronary artery disease were age, hypertension, smoking, family history of coronary artery disease, and levels of HDL-C, triglyceride, fibrinogen, t-PA, PAI-1 in diabetic patients compared to normo-glycemic patients. Diabetic patients must stop smoking and maintain strict control of blood pressure and blood glucose level. In addition, HDL-C was very important predictive risk factor for coronary artery disease.

구연 : 내분비-대사 ; 비당뇨병 성인에서 연령과 비만도에 따른 인슐린 분비능과 저항성의 평가

김지연,지재환,강한욱,이병완,김현진,정재훈,민용기,이명식,이문규,김광원 대한내과학회 2003 대한내과학회 추계학술대회 Vol.65 No.10

Activin A 과발현에 의한 췌장 성체줄기세포의 분화유도

이경희,박미경,강한욱,김현진,정인경,유형준,정재훈,민용기,이명식,김광원,이문규 대한당뇨병학회 2004 Diabetes and Metabolism Journal Vol.28 No.1

Streptozotocin을 포함한 약물치료의 실패후 재수술로 완치된 Nesidioblastosis 1예

김형훈,정인경,강보현,강한욱,이병완,신상엽,조덕신,윤종욱,김범진,정재훈,민용기,이명식,이문규,오영륜,서연림,박미경,김광원 대한내분비학회 2002 Endocrinology and metabolism Vol.17 No.5

Nesidioblatosis is a term that describes small clusters of pancreatic islet cells budding off exocrine ducts, and is commonly reported in infants with intractable idiopathic hypoglucemia. The onset of nesidioblastosis in adults is an extremely rare entity associated with hypersecretion of insulin and the treatment of choice is pancreatic resection. Medical treatment, including somatostatin, propranolol, diazoxide, hydrochlorthiazide and streptozotocin have achieved limited success. We experienced a case of adult nesidioblastosis that underwent reoperation after the failure of medical treatment following an inappropriate first operation.A 54-year old man was admitted due to intermittent hypoglycemic symptoms, which had been relieved by carbohydrate ingestion. Hyperinsulinemic hypoglycemia was documented during a prolonged fast. Image studies found no localized lesion, so a distal pancreatectomy was performed. The pathological examination of the resected pancreas revealed irregularly sized islets and a scattering of small endocrine cell clusters throughout the acinar tissue and ductuloinsular complex.攀접수일자: 2002년 8월 2일통과일자: 2002년 10월 8일 공복시 반복되는 발한, 진전을 주소로 내원하였던 54세 남자 환자에서 고인슐린성 저혈당으로 판별되어 distal pancreatectomy를 시행후 nesidioblastosis를 진단 받은 환자에서 술후 저혈당이 재발하여 streptozotocin을 포함한 여러 약물의 내과적 치료를 시행하였으나 저혈당의 증상이 소실되지 않아 near total pancreatectomy를 시행 받은후 완치된 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

당뇨병성 케톤산증 및 고중성지방혈증으로 인한 급성 췌장염으로 발현한 말단비대증 환자 1예

민용기,이춘영,이문규,이선영,홍성노,김형훈,강보현,강한욱,이병완,박유정,이명식,김광원,김종현 대한내분비학회 2002 Endocrinology and metabolism Vol.17 No.1

Secondary diabetes mellitus caused by increased growth hormone secretion (GH) has well been known. There is a close association between glucose intolerance and GH secretion, and increased GH level itself probably worsens the blood glucose control and lipid profile by increasing glycogenolysis and / or gluconeogenesis and by suppressing lipase activity. We report a case of acromegaly with diabetic ketoacidosis as and hypertriglyceridemia-induced acute pancreatitis. A 38 year old male, previously diagnosed to have acromegaly and diabetes, presented with nausea, vomiting, diffuse abdominal pain and altered mentality. There was no history of drug or alcohol consumption, blood gas analysis showed severe acidosis and urinanalysis for ketone was positive. His serum blood glucose, amylase and lipase levels were 494 ㎎/dL, 331 U/L, and 1288 U/L, respectively (reference values: 70∼110 ㎎/dL, 13∼100 U/L and 13∼190 U/L, respectively). The patient was diagnosed as having diabetic ketoacidosis and acute pancreatitis. With the serum concentration of triglyceride being 1488 ㎎/dL and the absence of any obvious precipitating factors, we considered hypertriglyceridemia to be the cause of acute pancreatitis. He was treated with continuous intravenous insulin infusion, lipid lowering agent, and fluid replacement. After conservative management, general condition gradually improved and his serum amylase, lipase and triglyceride levels were all normalized. GH level was not suppressed under 2 ng/mL during oral glucose loading test, and basal GH and IGF levels were 231 ng/mL and 29.5 ng/mL, respectively. Sella MRI showed a 3.7 ㎝ sized pituitary mass. On the 55th day of admission, transsphenoidal surgery was performed. In immunohistochemical staining, the pathologic tumor specimen was proved to be GH positive pituitary adenoma. This is the first case reported in the English literature of an acromegaly presenting with diabetic ketoacidosis and acute pancreatitis