전립선암 진단을 위한 전립선 특이 항원 선별검사의 의의

엄상화,손혜숙,전진호,장석창,민권식,이종태 대한임상건강증진학회 2004 Korean Journal of Health Promotion Vol.4 No.3

Background Incidence and death rate of prostate cancer of male are increased gradually in Korea. For care of prostate cancer, it isneeded to observe the results of PSA test in screening and the illness behaviour after screening test.Methods For 11,061 health examinee, PSA level was checked. Among the cases with abnormal PSA, the rate of visiting urologydepartment, the performed rates of special tests for the diagnosis of cancer and the results of these tests were measured.Results The abnormal rate of PSA was 1.4% and was increased with aging in health examinee. Among 153 cases with abnormalPSA in health examinee, 17.0% had visited the urology department for more evaluation. 3 cases among 7 cases whoreceived prostate biopsy were confirmed as prostate cancer. -연구배경 우리나라 남성 암 중 빠른 속도 그 발생과 사망률이 증가하고 있는 전립선 암의 관리를 위하여 전립선 암 조기 진단 을 목적으로 실시되는 전립선 특이항원 (prostate specific antigen, PSA)의 선별검사 결과와 그 결과에 따른 전립선 암 확진을 위한 질병행태의 관찰이 필요하다 .방 법 건강검진자 11,061명을 대상으로 전립선 특이항원 검사 결과 이상률을 관찰하고 , 결과에 따른 외래 방문 정도와 전립선 암 확진을 위한 비뇨기과 외래에서의 추가적인 임상검사 실시 정도 및 암 진단 정도를 관찰하였다 .결 과 전립선 특이 항원 (PSA)가 4ng/ml 이상인 율은 1.4%였으며, 연령이 증가할수록 많았다 . 전립선 특이항원이 4ng/ml 이상인 153명 중 17% 인 26명만 전립선암을 확진하기 위하여 비뇨기과 외래를 방문하였다 . 외래를 방문한 26명 중 전립선 생검을 실시하여 전립선 암 확진된 자는 3명이었다.

지방간의 위험요인에 관한 단면적 연구

엄상화,유병철,김성준,이채언,배기택,김성천,신해림,Ohm, S.H.,Yoo, B.C.,Kim, S.J.,Lee, C.U.,Pai, K.T.,Kim, S.C.,Shin, H.R. 대한예방의학회 1993 Journal of Preventive Medicine and Public Health Vol.26 No.2

Generally fatty liver is attributed either to chronic alcoholism, diabetes mellitus, or obesity. Based upon this commonly held clinical brief, this study was conducted to investigate the contributing factors of fatty liver and odds ratio (OR) of known contributing factors. A sample of 310 male participants, who visited at Seoul Paik Automated Multiphasic Health Testing System from November 1991 to December 1991, was separated into 112 cases and 198 controls by ultrasonographic fin ding. There were statistically significant difference between fatty liver and normal in triglyceride (TG), body mass index (BMI), alanine aminotransferase (ALT), high density lipoprotein cholesterol (HDL-C), fasting blood sugar (FBS), alcohol consumption, low density lipoprotein cholesterol (LDL-C), total cholesterol, gamma-glutamyl transferase ($\gamma$-GT), duration of alcohol intake and alkaline phosphatase (Alk.P)(P<0.01, P<0.05). The statistically significant elevated odds ratio were noted for TG (4.48, confidence interval (CI) 2.66-7.55, P=0.000), alcohol consumption(3.24, CI 1.56-6.23, P=0.002), BMI(3.05, CI 1.87-4.97, P=0.000), and FBS (2.59, CI 1.53-4.40, P=0,000). In summary, it is suggested that the fatty liver could be preventive by avoiding such deleterious factors as high fat diet, alcohol and obesity.

비궤양성 소화불량에서 Helicobacter pylori 박멸치료후 증상개선에 대한 메타분석

엄상화,정귀원,신원창,조종래,손혜숙,배기택,김성준,Ohm, Sang-Hwa,Jeong, Ki-Won,Shin, Won-Chang,Cho, Jong-Rae,Shon, Hye-Suk,Pae, Ki-Taek,Kim, Sung-Jun 대한예방의학회 1999 Journal of Preventive Medicine and Public Health Vol.32 No.4

Objectives: This study was conducted to determine, by reviewing the literature, whether treatment of Helicobacter pylori infection in patients with non-ulcer dyspepsia affects symptoms. Methods: We retrieved the literature using MEDLINE search, with nonulcer dyspepsia and Hericobacter pylori and treatment as key words, which were reported from 1984 to 1998, and manual literature search. The criteria for inclusion was as follows; 1) The paper should have confirmed nonulcer dyspepsia as case definition. 2) The paper should have peformed a randomized, blind trial. 3) Confirmation of Helicobacter pylori eradication should be done 4 weeks after treatment. 4) studies with no information on measurement of symptoms after treatment were not accepted. The percentage of patients with symptom improvement after eradication therapy for Helicobacter pylori infection was calculated. Cumulative odds ratio was compared by fixed effect model and random effect model as sensitivity and funnel plot was used to evaluate publication bias. Results: The overall effect size of symptom improvement was calculated by cumulative odds ratio. Cumulative odds ratio of random effect model was 4.16(95% CI: 1.55-11.19). Before integrating each effect sizes into common effect size, the homogeneity test was conducted and random effect model was selected(Cochran's Q=41.08 (d.f=10, p<0.001)). The heterogeneity across studies was evaluated and the different methodological aspects of studies led to differences between study results Conclusions: The results suggest that the eradication of Helicobacter pylori in patients with non-ulcer dyspepsia results more symptom improvement. In studios that shows the opposite results there are methodological aspects explaining the heterogeneity.

만성 간질환 환자의 삶의 질 평가 (논평)

엄상화 ( Sang Hwa Urm ) 대한간학회 2007 Clinical and Molecular Hepatology(대한간학회지) Vol.13 No.1

2002년 부산, 울산 및 경상남도 19세 남자의 근시 유병률

이상준,엄상화,안기수,이용환,김신동,김정민,유병철 대한안과학회 2009 대한안과학회지 Vol.50 No.9

목적: 부산, 울산 및 경남지역 19세 남자의 근시 및 고도근시 유병률을 추정하고 거주지역, 학력수준, 신장, 체중 등의 영향을 분석하였다. 대상과 방법: 2002년 1월에서 12월까지 부산, 울산, 경남지역에 거주하는 징병신체검사자 중 시력이 0.8 이하인 사람 50,243명에게 시행된 자동굴절검사 결과를 분석대상으로 하였다. 굴절이상이 -0.5D 이상이면 근시로, -6.0D 이상이면 고도근시로 정의하였으며 거주지역, 학력수준, 신장, 체중 등에 따라 표준화하여 유병률을 비교하고 굴절검사 누락자를 활용하여 추정 유병률을 계산하였다. 결과: 조사대상자의 근시 유병률과 고도근시 유병률은 각각 45.60% (95% CI: 45.17~46.03), 11.50% (95% CI: 11.23~11.77)로 나타났으 며 1차 시력검사 결과 0.5 이하이면서 2차 굴절검사를 시행하지 않은 자 9,575명을 고려한 추정 근시 유병률은 54.31% (95% CI: 53.88~ 54.74)이었다. 결론: 부산, 울산 및 경남지역 만19세 남성의 근시 유병률은 45.60%, 추정 근시 유병률은 54.31%, 고도근시 유병률은 11.50%로 나타났다. Purpose: To investigate the prevalence of myopia and its influencing factors in an epidemiologic study of conscripts living in Gyeongsangnam-do, Ulsan and Busan. Methods: A cross-sectional study was conducted in 19-year-old conscripts in Gyeongsangnam-do, Ulsan and Busan. Health checkup data of the conscripts were collected and analyzed along with subjective visual acuity, noncycloplegic autorefraction test, biometric data, and social factors such as education level and residence area. Myopia and high myopia were defined as having a refractive error of more than -0.5D, -6.0D, respectively. To analyze the social and biometric effects, we classified social factors into three groups and biometric factors into five groups. The estimated myopic prevalence was calculated adding excluded conscripts who scored under 0.5 on the subjective visual acuity test and missed autorefraction data. Data analysis was performed with descriptive analysis and the chi square test for trends using the Statistical Package for the Social Sciences (SPSS) version 14.0K. Results: From 66,917 eligible conscripts, 50,243 were analyzed. The prevalence of myopia and high myopia in 19-year-old men in Gyeongsangnam-do, Ulsan and Busan were 45.60% (95% CI: 45.17~46.03) and 11.50% (95% CI: 11.23~11.77). The estimated myopic prevalence using 66,917 eligible conscripts was 54.31% (95% CI: 53.88~54.74). Conclusions: The prevalence of myopia and high myopia and the estimated prevalence of myopia in 19–year-old men in Gyeongsangnam-do, Ulsan and Busan were 45.60%, 11.50% and 54.31%, respectively.

근로자 건강진단 결과 분석과 활용 실태 조사

정귀원,엄상화,최순석,정수진,배기택,이정열 인제대학교 1998 仁濟醫學 Vol.19 No.2

산업안전보건법(근로자건강진단 실시규정) 및 의료보험법에 의거 1997년 1월 1일 부터 12월까지 서울지역 근로자 516명(남:381명, 여:135명)을 대상으로 일반건강진단시 실시한 각 검사 항목의 평균치는 모두 정상 범위에 있었고, 남녀별 비만도는 여자에서 정상율이 높았으며, 특히 여자 20대에서 93.8%로 가장 높았다. 고혈압의 경우 남녀별 평균 혈압은 116.8/78.3 mmHg, 109.9/71.6 mmHg, 유병율은 수축기 혈압의 기준치에 의하면 6.8%, 5.9%, 이완기 혈압에 의하면 16.0%, 8.9%로 남자에서 모두 높게 나타났다. 혈액검사 기준치에 따른 이상자율은 남녀별로 각각 혈색소 6.2% 5.2%, 적혈구 용적치 1.6%. 10.5%, 적혈구수 1.6%, 10.5%, 백혈구수 4.9%, 10.4%, 혈소판수 5.1%, 10.5%, AST 3.2%, 4.5%, ALT 22.3%, 5.9%, rGTP 8.1%, 12.6%, 총콜레스테롤 6.7%, 8.2%, 트리글리세라이드 22.8%, 14.1%, BUN 3.5%. 14.3%, Creatinine 1.5%, 28.0%, 공복시 혈당치 4.3%, 74%이었으며, B형간염 표면항원 양성율은 남녀별로 5.2%, 3.7%였고, 표면항체 양성율은 67.8%, 69.1%였다. 건강진단 결과에 따른 질병 유소견자들에 대한 사후 관리는 일반 질병 유소견자의 경우 근무중 치료가 60%(18명)로 가장 높았으며. 추적 정밀검사 8명(26.7%), 입원 요양치료 2명(6.7%), 금주, 금연, 식이습관 조절, 규칙적 운동 등 기타 의학적 조치 1명(3.3%)의 순으로 나타났고, 여자의 경우 근무중 치료와 추적 정밀검사가 6명중 각 3명씩 차지하였다. 질환 요주의자의 사후 관리에서는 남녀 모두 추적 정밀검사가 각각 23명(58.9%), 8명(47.0%)으로 가장 많았고, 다음이 근무중 치료 9명(23.0%), 5명(29.4%), 금주, 금연, 식이습관 조절, 규칙적 운동 등 기타 의학적 조치가 7명(20.0%), 4명(23.5%)순이었다. To survey the follow-up services and results of health examination among white collar workers who received health examination at Seoul Paik hospital, the authors analyzed some labaratory findings of blood(hemoglobin, hematocrit, RBC, WBC, platelet, AST ALT. r-GTP, tonal cholesterol. triglyceride, BUN, creatinine, fasting blood sugar), obesity index, blood pressure and follow-up services according to results of health examination of them. The subjects were 516 persons(male 381, female : 135) in total and study period was from Jan 1, 1997 to Dec 31, 1997. 1.Abnormal rates of obesity(120% and over standard body weight) among total subjects were 17.0% in male and 4.7% in female, and prevalence rate of hypertension were 6.8% in male, 5.9% in female by systolic pressure and 16.0% in male, 8.9% in female by diastolic pressure and it was gradually increasing with aging in total subjects. 2.The mean values of hematologic findings were all within normal limit but there were significant differences at WBC, Platelet. r-GTP, Total cholesterol, triglyceride, BUN, fasting blood sugar in male and hematocrit, total cholesterol in female between each age groups.(p<0.05) 3.Positive rate of Hepatitis type B surface Antigen and Antibody were 5.2%, 67.8% in male 3.7%, 69.1% in female each other. 4.Follow-up services of the subjects who were in abnormal conditions by health examination among white collar workers were insufficient to a view of practical management, those were treatment while on duty, putting on protectors and other recuperation, follow up study, a change of working places, shortening of working hours and restriction and prohibition of service.

서울 일부 지역 사무직 근로자들의 고혈압 유병률 및 고혈압 근로자들의 정밀 검사에 대한 조사

정귀원,엄상화,최순석,김정호,이종태,전진호,이채언,배기택 인제대학교 1997 仁濟醫學 Vol.18 No.1

근로 기준법 및 근로자 건강진단 실시 지침(노동부)에 의거 매년 건강진단을 받아야 하는 서울 일부 지역 근로자 1,480명(남:1.028명, 여:452명)을 조사 대상으로 고혈압의 유병률을 조사한 결과 남녀에서 각 18.8%, 6.0%였으며, 연령별로 구분한 고혈압의 비교 위험도는 40세 이상이 40세 미만보다 약 2배 높았다. 고혈압 정밀 대상자(160명)의 심전도와 안저 검사 이상율은 두항목 모두에서 정상군에 비해 높은 비율을 보였으며, 검사 항목들 간의 상관 관계에서 수축기 혈압은 이완기 혈압과, 혈청 콜레스테롤은 비만도, 중성 지질과 유의한 양(陽)의 상관 관계를 보인반면, 고밀도 지단백질은 중성 지질과 혈청 콜레스테롤과 음(陰)의 관계를 시현하였다. To determine the prevalence rate of hypertension by aging and hypertension-related factors, the authors carried out the survey of the on 1480 clerical employees and the results of detailed clinical examination (Lab data, echocardiography, fundoscopic finding) on 160 persons with hypertension in Seoul area from Jan 1, 1993 through Dec 31, 1993 The results are as follows : 1.The prevalence rate of hypertension among total subjects was 11.9% (male : 18.8%, female:6.0%), and it was gradually increasing with aging in male. 2.A prevalence rate of hypertension in subjects over 40 years old was about two times as large as that under the age of 40. 3.The prevalence rates of hypertension in obesity group(120% and over of standard body weight) and normal group(under 109% of standard body weight) were 14.1% and 6.1%. 4.The mean concentration of total cholesterol, HDL and triglyceride level in the hypertensive group were 223.7 37.1 mg/dl, 42.6 9.7 mg/dl. 197.4 61.0 mg/dl, respectively. 5.The abnormality rate in echocardiographic finding in the hypertensive group was 62.5%, and it was gradually increased as blood pressure increased. 6.The abnormality rate in fundoscopic finding of the hypertensive group was 42.5%, and it was gradually increased as systolic blood pressure increased. 7.The positivity rates of urinary protein in uristix were 1.5%(male:1.3%, female:1.7%) in normal group and 2.6% (male : 2.4%, female : 2.7% ) in hypertensive group. 8.There were positive correlation between systolic blood pressure and diastolic blood pressure; total cholesterol and index of obesity, triglyceride: and negative correlation between HDL and total cholesterol and triglyceride.

Analysis of Biologically Equivalent Dose of Stereotactic Body Radiotherapy for Primary and Metastatic Lung Tumors

박성광,엄상화,조흥래 대한암학회 2014 Cancer Research and Treatment Vol.46 No.4

PurposeThe purpose of this study was to determine the optimal biologically equivalent dose (BED)for stereotactic body radiotherapy (SBRT) by comparing local control rates in proportion tovarious total doses and fractionation schedules. Materials and MethodsThirty-four patients with early non-small-cell lung cancer and a single metastatic lung tumorwere included in this study. Differences in local control rates were evaluated according togender, primary tumor site, response, tumor size, and BED. For comparison of BEDs, theprescribed dose for SBRT was stratified according to three groups: high (BED > 146 Gy),medium to high (BED, 106 to 146 Gy), and low to medium (BED < 106 Gy). ResultsFor all patients, the overall local control rate was 85.3% at two years after treatment. Fivelocal recurrences were observed, and, notably, all of them were observed in the low tomedium BED group. Significantly higher local control rates were observed for patients witha complete response than for those with a partial response or stable disease (p < 0.001). Twenty-six patients with a tumor size of < 3 cm showed no dose-response relationship inthe low to medium, medium to high, and high BED groups, whereas eight patients with atumor size of ≥ 3 cm showed a significant dose-response relationship. The observed 2-yearlocal recurrence-free survival rates in patients with a tumor size of < 3 cm and in those witha tumor size of ≥ 3 cm were 96.2% and 50.0%, respectively, which were significantlydifferent (p=0.007). ConclusionBED > 100 Gy is required in order to achieve a > 85% local control rate regardless of tumorsize. The optimal dose for small tumors of < 3 cm appears to be within a range below 150Gy BED. Escalation of BED to high levels (> 150 Gy) may be required for patients with atumor size larger than 3 cm.

임플란트 완성 환자의 구강건강관련 삶의 질과 관련 요인

박정현,엄상화,권현숙,조갑숙,허승주,이소영,유병철,Park, Jung-Hyun,Urm, Sang-Hwa,Kwun, Hyeon-Sook,Cho, Gab-Suk,Heo, Seung-Ju,Lee, So-Young,Yu, Byeng-Chul 한국치위생학회 2011 한국치위생학회지 Vol.10 No.2

Objectives : This study was purposed to estimate the level of oral health quality of life and the relationship between health-related factors and oral health quality of life in patients with successful dental implants. Methods : This questionnaire survey was conducted during the period from December 2009 to March 2010 with 126 patients confirmed successful dental implants in Busan. The oral health related quality of life and oral health-related factors were estimated with OHIP-14 and 8 oral health characteristics, respectively. Data analysis was performed with descriptive analysis, t-test, ANOVA, multiple regression analysis using SAS(ver 9.1) program. Results : The score of oral health quality of life in patients with successful dental implants was $12.25{\pm}7.82$. The scores of subscale of the oral health quality of life were $1.24{\pm}1.35$ in social disability, $1.60{\pm}1.37$ in handicap, $1.60{\pm}1.44$ in psychological disability, $1.70{\pm}1.38$ in functional limitation, $1.81{\pm}1.35$ in physical disability, $2.14{\pm}1.46$ in physical pain, $2.17{\pm}1.46$ in psychological discomfort, respectively. The related factors of oral health quality of life in patients with successful dental implants were absence of other type prosthesis and experience of tooth brushing education. Conclusions : The oral health related quality of life in patients with successful dental implants was relatively good condition. Social supports and chances for high quality denture and tooth brushing educations are needed to improve oral health related quality of life in patients with dental implants.

자가 골연골 이식술을 이용한 Freiberg 병의 치료(1예 보고)

김형년,엄상화,서동현,박용욱,Kim, Hyong-Nyun,Eom, Sang-Wha,Suh, Dong-Hyun,Park, Yong-Wook 대한족부족관절학회 2009 대한족부족관절학회지 Vol.13 No.2

Freiberg disease is a osteochondrosis of the lesser metatarsal heads. Various surgical treatment have been recommanded including joint debridement and metatarsal head reshaping, metatarsal dorsal wedge osteotomy, metatarsal head excision and joint arthroplasty. Autogenous osteochondral graft for the treatment of Freiberg disease is an effective restorative procedure that provides early range of motion exercise, weight bearing, and reduces other morbidity. We report a case of late stage Freiberg disease treated with arthrotomy, removal of loose body and autogenous osteochondral graft.