가토의 신장기능과 Renin 분비에 미치는 Adenosine수용체 차단제의 영향

이건수(Rhee, Keon-Su),김영진(Kim, Young-Jin),김선희(Kim, Suhn-Hee),조경우(Cho, Kyung-Woo) 대한생리학회 1989 대한생리학회지 Vol.23 No.2

Recently it was suggested that the endogenous adenosine might be the mediator for the intercellular communication in the regulation of tubuloglomerular feedback control and renin release. Even though the previous data showed more important regulatory roles in the renal hemodynamics and renin release for the A1 adenosine receptor, it has not yet been settled down about the functional subclassification of renal adenosine receptors. The purpose of the present experiment was to clarify the importance of the renal adenosine receptors for the regulations of the hemodynamic, excretory and secretory functions. Experiments have been done in unanesthetized rabbits. Intrarenal arterial infusion of A1 adenosine antagonist, 8-phenyltheophylline, 3 ~ 30 nmole/min, increased urine flow, renal hemodynamics and urinary excretion of sodium. Intrarenal arterial infusion of Al antagonist, 1-3-diethyl-8-phenylxanthine (DPX), 10 ~ 100 nmole/min, increased renal hemodynamics and excretory functions. Non-specific adenosine antagonist, theophylline, 30 ~ 300 nmole/min, resulted in dose dependent increases in renal hemodynamics and excretory function. All of the three adenosine antagonists for the increases in renal hemodynamics, excretory and secretory functions was 8-phenyltheophylline > DPX > theophylline. These results suggest that the endogenous adenosine is important for the intrinsic regulatory roles for the renal functions through the adenosine receptors, and that the A1 adenosine receptor is more important than the A2 receptor in the regulation of renal hemodynamics, excretory and renin secretory functions.

좌측 측두엽에 방사선 괴사가 발생한 뇌간 교종 1례

이형신(Hyoung Shin Lee),이건수(Keon Su Rhee) 대한소아신경학회 1996 대한소아신경학회지 Vol.3 No.2

Cerebral radiation necrosis is classified according to the time of appearance of symptoms after therapy. Acute injury appears during radiation therapy as a transient worsening of symptoms and has little prognostic significance. Early delayed injury occurs a few weeks to 3 months after therapy and also is transient in most cases. By contrast late radiation injury, which occurs a few months to 10 or more years after therapy, is irreversible, progressive, and sometimes fatal, and constitutes the major, dose-limiting complication of cerebral irradiation. There are two main forms of late radiation injury : focal necrosis and diffuse white matter injury. Authors experienced a case of pontine glioma with radiation necrosis on left temporal lobe about 2 months after radiation therapy of total 4300rad. We presented this case with a brief review of literatures.

뇌막염에서 뇌척수액 LDH 효소활성에 대한 고찰

문신혜(Shin Hye Moon),이건수(Keon Su Rhee) 대한소아신경학회 1993 대한소아신경학회지 Vol.1 No.2

The 100 cases of meningitis were reviewed that admitted to Chung Nam National University Hospital from May, 1991 to July, 1993, emphasizing on CSF LDH. The results were as follows; 1) The 100 cases of meningitis were consisted of aseptic meningitis of 77 cases and bacterial meningitis of 23 cases by diagnosed as clinical manifestaions, peripheral blood examination, and CSF study. 2) Common chief complaints were fever, vomiting, and headache and on physical examination, neck stiffness, Kernig's sign, and Brudzinski's sign were common. 3) Mean value of CSF LDH in bacterial meningitis and aseptic meningitis were each 276.5±621.5 IU/L and 64.2±39.0 IU/L, respectively and CSF LDH were significantly increased in bacterial meningitis. 4) CSF LDH were related to CSF WBC, but not to CSF protein or CSF sugar. 5) In bacterial meningitis, 4 cases were revealed CSF organism by culture, Streptococcus(3cases) and Hemophilus influenza(1case) and CSF LDH in these cases was marked increased from 501 IU/L to 3521 IU/L. Above findings suggest that CSF LDH is valuable in the differential diagnosis of bacterial and aseptic meningitis and follow-up of bacterial meningitis.

진행성 근이영양증의 임상적 고찰

신수왜(Soo Wae Shin),이건수(Keon Su Rhee) 대한소아신경학회 1994 대한소아신경학회지 Vol.2 No.1

We performed this prospective study to analyse the clinical findings on twenty patients who were diagnosed as progressive muscular dystrophy(PMD) at department of Pediatrics. Chungnam national university hospital from January, 1988 to February, 1994. The results were as follows : 1. In the age and sex distribution at the diagnosis, all patients were male and the group of 6-10 years of age accounted for 75%. 2. In the age distribution at the onset, the group of 1-5 years of age was 85%. 3. With regard to family history,a positive history was present in 15% of patients. 4. In the clinical symptoms and signs, 3 leading ones in order of frequency were Gower sign, muscular pseudohypertrophy, gait disturbance. 5. In the serum enzyme levels, the muscular enzymes-CPK. LDH. SGOT and SGPT were increased in almost of all patients. 6. Abnormal EKG findings were 62.5% of patients. 7. abnormal muscle biopsy and EMG findings were present characteristics of myopathic changes in all patients. 8. On the classification of progressive muscular dystrophy. Duchenne type were occupied more than 80%. Therefore , we noted that clinical findings, serum enzyme levels. EKG. EMG and muscle biopsy findings were important in the diagnosis of progressive muscular dystrophy.

소아자폐증에 관한 연구

김현곤(Hyeon Gon Kim),이건수(Keon Su Rhee) 대한소아신경학회 1996 대한소아신경학회지 Vol.3 No.2

연구배경 : 자폐증 인구 1만명당 4-5명에서 발생하는 비교적 흔한 질환이고 75%에서 정상생활을 하지 못하며, 사회적으로도 많은 문제점을 갖고 있음에도 불구하고 현재 국내에는 이에 대한 연구가 드물고, 어느 진단기준이 좋은지에 대한 비교 연구는 없다. 방법 : 이에 저자는 1992년 1월부터 1994년 12월까지 만 2년동안 충남대학교병원 소아과 외래 및 병동에 입원하였던 환아증, 발달장애, 행동장애, 언어장애등을 주소로 내원한 환아 104명을 대상으로 하여 Diagnosis and Staistical Mannual of Mental disorders(DSM-IVTM)에 의한 자폐증 및 Autism Behavior Checklist(ABC)에 의한 진단 기준으로 구분하여 자폐아의 빈도, 주소, 두 방법과의 차이점, ABC subtitle의 의의, 검사소견, 동반질환등을 알아보고, 임상적 응용 여부를 알아볼 목적으로 본 연구를 시행하였다. 결과 : 1. 104명의 환아중 DSM-IV™에 의한 경우 자폐증은 36명(34.6%)이었고 ABC에 의한 경우는 22명(21.2%)으로 DSM_IV에 의한 경우가 ABC에 의한 진단기준보다 의의(P<0.01)있게 자폐증이 많았으며, 남녀비는 각각 3.6:1과 3.1:1로서 남아에서 많았고, 나이는 2-3세에서 가장 많았다. 2. 내원환자의 주소는 delayed speech가 31명(86.1%)으로 가장 많았으며, 그다음 solitary play, mental retardation, hyperactivity, delayed development등의 순으로 나타났다. 3. ABC의 5 subtitle에 대한 점수는 전항목에서 의의(P<0.01)있게 자폐증에서 높았다. 특히 세부항목중에 Social Self Helpgkdahr은 전체점수 25점중에서 자폐증환아 평균은 15.92로서 63.7% 나타내어Trhm 다음항목은 Language로서 51.4%를 나타내어 자폐증환아에서 유의성 있게 높았다(P<0.01). 4. 검사소견은 자폐증환아에서 뇌파이상 33.3%, 염색체검사상 이상소견은 autism에서만 1례 양성으로 나왔다. Auditory evoked potential response(AEPR)은 autism 환자의 10%에서 양성을, KWIST 검사는 20%에서 이상을 보였고, brain MRI에서는 16.7%의 이상소견을 보였다. 5. 동반질환은 Attention Deficit Disorder(27.8%), epilepsy(19.4%), prematurity(16.7%)등의 순이었다. 6. ABC Score는 Sensory, Relating, Body Concept, Language 및 Social Self Help의 5개의 subtitle로 구성되며, 전체 57가지의 세부항목중 3번, 4번 35번, 45번 및 47번 항복이 자폐증환아에서 다른군에 비해 유의할 만하게 높아서 자폐아진단에 유용하게 사용될 것으로 사료된다. 결론 : 자폐증이 의심되는 환아는 비교적 쉽고 객관성이 있는 ABC를 통해 초기에 진단하여 적극적인 치료로서 예후의 호전을 가져올 것으로 사료된다. A clinical study was made on 104 patients, who were diagnosed by ABC and DSM-IVTM, with speech delay, developmental delay and mental retardation. They admitted to pediatric Dept. or OPD of Chungnam National University Hospital from January,1992 to December, 1994. The results were as follows: 1. Among the 104 patient, 36(34.6%) cases were noticed as noticed by DSM-IV and 22(21.2%) cases by ABC. The patient of DSM-IV were higher than that of ABC(P<0.01). The ratio of male to female patients was 2.6:1, 2.1:1 respectively. The most common ages were 2-3 years old. 2. The most common chief complaint of study group was delayed speech(86.1%). The rest of study group was orderly composed solitary play, mental retardation, Hyperactivity and developmental delay. 3. Scores of ABC 5 subtitles were significantly high on autism(P<0.01). Specially, the mean score of Social Self Help subtitle was 63.7% and that of Language subtitle was 51.4% 4. In autism, abnormal laboratory findings were seen as follows; EEG(12 cases, 33.3%) chromosomal abnormality(only 1 case), AEPR(10%), KWIST(20%) and brain MRI(16%). 5. The associated disorders were attention disorder(27.8%), epilepsy(19.4%) and prematurity(16.7%). 6. The score of ABC is composed of Sensory, Relating, Body Concept, Language and Social Self Help. The 3rd item, 4th item, 36th item, 45th item and 47th item were meaningfully high enough on autism. We conclude that the early diagnosis of autism should be made by ABC and early treatment of the should be a good prognosis.

한가족 삼 남매에서 발병된 Wilson씨병 3례

정상덕(Sang Deug Chung),이건수(Keon Su Rhee) 대한소아신경학회 1994 대한소아신경학회지 Vol.2 No.1

Wilson's disease is an autosomal recessive disorder with a genetic mutation recently localized on chromosome 13. The primary defect is impaired biliary excretion of copper, leading to its accumulation in the liver, brain, and other tissue(kidney, eye, etc......). We have experienced three cases of Wilson's disease developed in one family. In all patients, Kayser-Fleisher ring and mild elevated SGOT/SGPT with negative HBsAg are observed, but neurologic symptoms are not associated. Other familial members are negative in laboratory test for Wilson's disease. In case 2, acute fulminant hepatitis are developed, so he died despite of aggressive management such as D-penicillamine, albumine and pyridoxine administration, and intravenous hyperalimentation. In other cases, symptoms and laboratoy findings are improved after D-penicillamine and pyridoxine administration. We report 3 patients with Wilson's disease in one family with related literatures.

뇌출혈을 동반한 무뇌수두증 1례

이효영(Hyo Young Lee),이건수(Keon Su Rhee) 대한소아신경학회 1995 대한소아신경학회지 Vol.2 No.2

Hydranencephaly is a congenital abnormality characterized by complete or almost absence of cerebral hemisphere, which is replace by a cerebrospinal fluid filled cavity. The midbrain and brainstem are relatively intact. The prognosis for development is hopeless and that for survival may be poor, most children within months. Authours experienced a case of hydranencephaly combined with intracerebral hemorrhage. which is diagnosed by clinical evaluation, brain ultrasonogram and magnetic resonance imaging. We presented this case with a brief review of literatures.

소아 수두증의 임상적 고찰

문신혜(Shin Hye Moon),이건수(Keon Su Rhee) 대한소아신경학회 1995 대한소아신경학회지 Vol.2 No.2

1. 연구배경 소아 수두증은 중추신경계의 가장 흔한 기형으로 여러 원인에 의해 선천적으로 다른 기형과 동반되거나 또는 종양이나 감염에 의해 이차적으로 발생하는 질환으로 원인, 동반기형, 임상양상, 치료, 그리고 예후를 비교 분석하였다. 2. 방법 수두증으로 진단받은 생후1일에서 10세사이의 환아 28례를 대상으로 후향적으로 조사하였다. 3. 결론 1) 대상환아는 28례로 남아 12례와 여아 16례로 남녀비는 1:1.3 이었으며 발병 연령은 생후 1일에서 10세사이로 1세 이하가 18례(64%)로 가장 많았으며, 이중 1개월 이하가 12례(42%)이였다. 2) 원인으로 선천성인 경우 도수관 폐쇄 4례와 Mo-nro공의 폐색 1례가 있었으며, 후천성인 경우 뇌막염 4례와 뇌종양 4례이였다. 3) 동반된 기형으로는 수막척수류 4례와 지방 수막척수류 3례순이었으며, 그 외 지주막 낭종, Dandy-Walker 증후군, 잠복고환, 제대탈장, 서혜부탈장, 신경섬유종 등이 관찰되었다. 4) 증상으로는 구토 10례, 발달지연 4례, 경련 3례, 두통 3례순이었으며 그 외 포유저하, 죠변실금, 기면, 무호흡, 걸음장애, 혼수등이 관찰되었다. 징후로는 대천문이 열려 있으면서 팽창되지 않은 경우가 5례, 심부건반사 항진 5례, 대두증 3례, Sun-set eye 3레순이었으며 그 외 대천문 팽창, 두개봉합선 확장, 대광반사 저하등이 관찰되었다. 5) 치료는 뇌실복강 단락술 14례, 종양제거술 3례, 항생제와 항결핵제 치료 4례, 뇌실외배액술 2례이였다. 6) 추적가능한 환아는 9레이었으며 이중 7례에서 증상이 호전되었으며, 나머지 2례에서는 호전이 안되었다. Background : Hydrocephalus is common malformation of central nervous system and cuase of hydrocephalus include many disorders, congenital and acquired. We performed this study to investigate etiology. associated anomaly, clinical features, treatment, and prognosis. Methods : 28 cases of hydrocephalus who were diagnosed in the department of pediatrics and neurosurgery, Chungnam National University Hospital from January 1982 to July 1994 were reviewed. Results : Male to female ratio was 1:1.3. Onset occurred mostly less than 1 year. Among 28 cases. congenital hydrocephalus were 20 cases( aqueductal stenosis : 4 cases, obstruction of foramen Monro : 1 case) and acquired cases were 8 cases(meningitis : 4 cases, brain tumor : 4 cases). Associated anomaly were included meningocele, lipomeningomyelocele, arachnoid cyst. Dandy-Walker syndrome. neurofibromatosis, cryptochidism, umbilical hermia, and inguinal hermia. Symptoms were vomiting, developmental delay, seizure, and headache in order of frequency. Signs were open and not bulging fontanelle, increased DTR, macrocephaly. and sun-set eye in order of frequency. Treatment were consisted ventriculoperitoneal shu수. mass removal, extravenricular drainage. and medication(antibiotics and antituberculous drugs). Of 9 patients who were followed up. 7 patients had improved clinical features.

소아의 실용적인 뇌압측정 방법

정상덕(Sang Deug Chung),이건수(Keon Su Rhee) 대한소아신경학회 1993 대한소아신경학회지 Vol.1 No.2

Lumbar puncture has been to obtain CSF fluid for analysis and to measure CSF pressure, But, it is often difficult to measure CSF pressure in children. The flow of CSF through a spinal needle is described by equation: Flow = pressure/(needle constant X relative vescosity). Thus, the CSF flow rate(drops.30 sec) during lumbar puncture can be used to estimate CSF pressure. The CSF viscosity was approximately the same as the viscosity of 0.9% NaCI(relative viscosity = 1.02 at between 20℃ and 37℃). Based on this characterstics, normal saline was used to model CSF flow in vitro. The counting drops of CSF and 26℃ 0.9%NaCI for 30 sec through three spinal needle(22G, 21G, 20G, 3.5 inches) was measured at a given pressure (CmH2O). From January 1993 to jun 1993, the authers measured CSF pressure in a series of 80 children with CNS disease, leukemia, and other malignancy who admitted at dept. of pediatrics, college of medicine, Chungnam national university hospital, The summary of results were as follows: 1. The needles constants(mean + SD) for the 22-gauge 3.5 inch, 21- gauge 3.5 inch, and 20-gauge 3.5 inch spinal needles were 1.534 ± 0.066, 0.905 ± 0.038. 0.476 ± 0.013 CmH2O/Drop/30 sec, respectively. Above results were simply descrbed by the equation; P ≒ 1.5 X D, P ≒ 0.9 X D, P ≒ 0.5 X D(P = pressure CmH20, D = drops/ 30sec, G = gauge). 2. Dripping rate was related linearly to pressure for each size needle. 3. Bacause viscosity is temperature-dependent, flow rate through a spinal needle was increased at a high thmperature. Because the drops can bo counted while fluid is being collected, this method is more convenient tham manometric pressure measurement. Eliminating the use of manometer also simplifies the proceduer, reduces supply cost and time, and may avoid the problem of manometric pressure measurement such as pain or air bubbles.

Near-Drowning 환아의 예후 판정에 대한 초기 Glucose의 의의

차상원(Sang Won Cha),이건수(Keon Su Rhee) 대한소아신경학회 1993 대한소아신경학회지 Vol.1 No.2

To validate the prognostic significance of initial blood glucose level in near-drowning, we have researched the relationship between initial blood glucose level and complications of 21 patients under 15 years with near-drowning, who admitted to the Department of Pediatrics, Chungnam National University Hospital from Jan. 1985 to Dec. 1992. The results were as follows ; 1) In distribution of sex, male was 15 cases and female was 6 cases and male to female ratio was 2.5:1. 2) The most common age group of incidence was under 3 years(8 cases:38.0%) 3) The most common season of incidence was summer(16 cases:76.6%) 4) The mean blood glucose level of subjects was 198mg/dl. 5) The group of prolonged period of submersion was significantly higher initial blood glucose level than short period of submersion. 6) The initial blood glucose level of patients with complications(224.30mg/dl) was significantly higer than patients without complications(157.25mg/dl). The results suggest that initial blood glucose level is one of the important prognostic predictor of near-drowning patients.