제 6번 뇌신경 마비 증상으로 발현된 비소세포성 폐암 : 이차성 사대 전이 골수 변화 Secondary to metastatic clivus bone marrow change

정두신 순천향의학연구소 2004 Journal of Soonchunhyang Medical Science Vol.10 No.2

Isolated abducens nerve palsy usually occurs in the vasculopathic age group. It is often associated with diabetes mellitus, hypertension, and atherosclerosis. But also it occurred in the head trauma and skull base tumor. A 71-year-old man with diplopia was admitted. He had suffered from right temporo-orbital sided mild headache without nausea and vomiting. Physical and neurological examination revealed a right lateral rectus paralysis. Simple X-ray skull series showed unusual opacitic lesion on right side(Fig 1.). Brain MRI and temporal bone CT showed diffuse bone marrow change in right clivus(Fig 2, 3). He was discharged and transferred the Korea Cancer Center Hospital(KCCH). He was evaluated in department of oncology, KCCH. Chest CT finding was ill-defined margined lung cancer. The pathologic findings were non-small cell lung cancer. Ten months after follow-up, he was expired.

상지의 분절성 운동 마비 증상을 나타낸 대상포진 감염 1예

정두신,이은아 순천향의학연구소 2004 Journal of Soonchunhyang Medical Science Vol.10 No.2

Herpes zoster is a viral disease that produces inflammatory lesions in the posterior root ganglia with pain and skin eruptions of affected ganglia. It has been rarely associated with motor paralysis of extremity. But involvement of motor nerve is in a small percentage(1-5%) in the herpes zoster infection. A 61-year-old woman presented with painful grouped vesicular eruptions on the right posterior neck and shoulder area. And she complained of weakness of shoulder joint and arm with painful skin lesions. Neurologic examination showed weakness of right shoulder muscles. EMG/NCV studies suggest cervical radiculopathy(C5, 6, 7). The cervical spine MRI study and CSF examination were carried at seven days after symptoms. The CSF study showed pleocytosis(WBC=144), increased protein level(103mg%), and positive antibody of HZV-Ig G & M. The motor weakness finding cleared forty days later. We report a patient of herpes zoster infection with segmental motor paresis of right shoulder muscles and positive CSF HZV-Ig G & M.

부천시 한 종합 병원의 응급실 진료 내용 분석

정두신 순천향의학연구소 2001 Journal of Soonchunhyang Medical Science Vol.7 No.1

Background & objectives : In recent, with the increasing need for medical treatment and changing life styles for personal health care, the need of emergency utilization for the patient seems to be growing. But there are few studies related with emergency room services in the secondary local general hospital. This study was conducted to obtain the basic clinical data of clinical contents of the emergency department utilization at a 250-bed local general hospital for systemic, efficient management of emergency medical services and the better medical planning. Method : This study is an analysis of 11,884 patients in the emergency department at a 250-bed local general hospital in Bucheon city Kyungki province from Mar. 1 1999 to Feb. 28 2000. The patient charts were reviewed and analyzed. Results : The results are follows : 1) Distributions of age and sex in the patients were frequent in 20-29(22.1%), 30-39(18.9%), 40-49(17.5%), under 9(16.6%) and males(60%) were more than females(40%). 2)Distributions of visiting hour in the patients were the most frequent in 8:00(PM)-0:00(AM). 3)Distributions of day of week in the patients were frequent Sunday, Saturday, and Friday in order but admission rates were frequent in Thursday(29.8%), Friday(27.7%), and Wednesday(27.4%). 4)In classifying disease and chief complaints by system, musculoskeletal, digestive, neurologic, and respiratory system were ranked. 5)The results of the patients were classified simple care and medication(75.07%), general ward admission(20.25%), ICU admission(3.89%), and emergency operation(0.29%). 6)The department distributions of the patients were internal medicine, orthopedic surgery, neurosurgery, pediatrics, and general surgery. Conclusion : These findings suggest that emergency room visit in a secondary general hospital was more frequent non-urgent with the sole purpose of a medication or simple care.

제 6번 뇌신경 마비 증상으로 발현성 비소세포성 폐암 : 이차성 사대 전이 골수 변화

정두신 순천향대학교 의학연구소 2004 Journal of Soonchunhyang Medical Science Vol.10 No.2

..

알코올 금단 발작 환자에서 진전 섬망 예방에 대한 Nimodipine과 Chlordiazepoxide의 효과 비교

정두신,양광익,이보람,방차옥,이태경,성기범,안무영,박형국 순천향의학연구소 2001 Journal of Soonchunhyang Medical Science Vol.7 No.1

Background & objectives : An increase of calcium influx during alcohol withdrawal state may contribute to neuronal hyperexitability, which cause delirium tremens(DT). Some investigators have found calcium channel blockers effects in prevention of DT in experimental animals. Therefore we evaluated the preventive effects of calcium channel blocker(nimodipine) and benzodiazepine(chlordiazepoxide) on the development of DT in alcohol withdrawal seizure(AWS) patients. Method : A total 59 patients with AWS were divided into three groups according to the management nimodipine-treated, chlordiazepoxide-treated, and control(no specific medication) groups. We compared the incidence rates of DT in the three groups. Results : Total incidence rate of DT was 30.5%(18 of 59 patients). There were 6 DTs of 18 patients(33.5%) in nimodipine-treated group, 4 of 21 patients(22.5%) in chlordiazpoxide-treated group, and 8 of 20 patients(44.0%) in control. Conclusion : The control group(44.0%) showed the highest incidence rate of DT. And nimodipine-treated(33.5%) and chlordiazepoxide-treated group(22.5%) were followed. However, this result failed to demonstrated statistically significant differences due to small numbers size.

뇌간 경색증 후 핵간 안근마비를 동반한 수구증후군

정두신,이보람,조상걸,박형국,신현길,성기범 대한신경과학회 1998 대한신경과학회지 Vol.16 No.2

중립적 의료감정이란 무엇인가?

정두신 대한신경과학회 2023 대한신경과학회지 Vol.41 No.3

An independent medical examination (IME) is a medical evaluation performed by a medical professional on a patient who was not previously involved in the treatment of that patient, to evaluate the patient’s course of prior treatment and current condition. IMEs are conducted by doctors, psychologists, and other licensed healthcare professionals in essentially all medical disciplines, depending on the purpose of the exam and the claimed injuries. Such examinations are generally conducted in the context of a legal or administrative proceeding, at the request of the party opposing the patient’s request for benefits. Conducting an independent medical examination does not establish a typical doctor-patient relationship as exists when a clinician treats a patient. Thus, a “limited doctor-patient relationship” exists when conducting independent medical examinations.

장애평가의 목적 -보상/배상/복지-

정두신,정한용 대한의사협회 2009 대한의사협회지 Vol.52 No.6

An impairment evaluation by the independent medical examination is requisite for the preparation of reparation, compensation, and welfare. The reparation is defined: 1) something done or given as amends or satisfaction, 2) the payment of damages restoration to good condition, 3) the making of amends for wrong or injury done. Compensation means that something given or received as an equivalent for services, debt, loss, injury, suffering, lack, and others. Welfare is a very popular term in recent modern society. It is a goal of the ministry for health, welfare and family affairs’ policies. It means the health, comfort, happiness and general wellbeing of a person or social group. An independent medical examination is possible when a doctor who has not been involved in a patient’s care examines the patient. It may be conducted to determine the cause, extent and medical treatment of a work-related injury; whether a worker has reached maximum benefit from treatment; and whether any permanent impairment remains after treatment. Independent medical examinations serve valuable individual and social goals, but participating physicians must appreciate the legal exposure they create. Given the realities of our medical malpractice system, physicians’ employment decisions, like patients’ treatment decisions, should be adequately informed.

뇌전증 환자의 사회 및 산업 활동

정두신,김도의 대한직업환경의학회 2014 대한직업환경의학회 학술대회 논문집 Vol.2014 No.11

연취급 근로자의 연폭로 수준에 따른 주관적 자각증상 호소율

정두신,김화성,안규동,이병국,Jeong, Du-Shin,Kim, Hwa-Sung,Ahn, Kyu-Dong,Lee, Byung-Kook 대한예방의학회 1993 Journal of Preventive Medicine and Public Health Vol.26 No.2

연폭로의 정도와 자각증상과의 관계를 알아보기 위하여 435명의 연폭로 남자 근로자와 212명의 일반 사무직 남자 근로자를 대상으로 연폭로 지표가 되는 혈중 연, 혈중 Zinc Protoporphyrin(ZPP), 요중 Delta-aminolevulinic acid(DALA), 혈색소, 혈구 용적 측정을 위한 혈액 시료 및 소변 시료를 채취하여 분석하였고, 연관련 자각증상 조사는 14개의 증상 조사 항목을(표 3 및 별첨 1) 피검자가 응답 하도록하여 상담 의사의 면접을 통한 확인을 거쳐 수집 하였다. 수집된 각 항목은 인체 조직계 증상군별로 1) 위장관계 증상 2) 신경과 근육 및 관절계 증상 3) 일반 체질적 증상 4) 정신과적 증상으로 구분하여 연폭로 지표 수준과 연폭로 작업 여부에 따른 자각증상 호소율을 비교 조사하여 얻은 결론은 다음과 같다. 1. 연폭로군에서 대조군보다 유의하게 높은 자각증상 호소율을 보인 증상군은 신경과 근육 및 관절계 증상으로 "손이나 발이 저리거나 쥐가 잘난다", "관절이 아프거나 쑤신다", "손가락, 손, 발 등에 힘이 없다", "근육통을 느낀다" 순 이었다. 2. 연폭로군과 대조군의 자각증상 호소율에 가장 큰 차이를 보인 증상 항목은 "손이나 발이 저리거나 쥐가 잘 난다"였으며, 전체 조사 대상에서 가장 높은 증상 호소율을 보인 증상 항목은 일반 체질적 자각 증상군의 "전보다 피곤감을 느낀다"였다. 3. 전체 조사 대상의 혈중 연과 혈중 ZPP 수준에 따른 연폭로량의 증가와 자각증상 호소율의 증가를 보인 증상 항목은 신경과 근육 및 관절계 증상군의 "손이나 발이 저리거나 쥐가 잘난다", "관절이 아프거나 쑤신다", "손가락. 손 발 등에 힘이 없다", "근육통을 느낀다"와 위장관계 증상군의 "아랫배가 아파서 고생한 적이 있다"였다. 4 연폭로군에서 혈중 연과 혈중 ZPP 수준에 따른 연폭로량의 증가와 자각증상 호소율의 증가를 보인 증상 항목은 신경과 근육 및 관절계 증상으로 혈중 연의 증가에 따라 증상 호소율이 증가하였다. 5. 연폭로군에서 39세 이하 와 40세 이상 연령군으로 나누어 비교시 39세 이하 군의 증상 호소율이 40세 이상 군보다 높게 나왔으며. 신경과 근육 및 관절계 증상이 39세이하 군에서 혈중 연의 증가와 함께, 40세 이상 군에서 혈중 ZPP의 증가와 함께 자각증상 호소율의 증가를 나타냈다. 6. 연폭로 지표에 따른 폭로수준과 증상 호소율과의 관계를 알아보기 위하여 대조군에 대한 폭로군, 연폭로군의 저농도 폭로군에 대한 고농도 폭로군의 교차비를 산출한 결과 신경과 근육 및 관절계 증상군의 "손이나 발이 저리거나 쥐가 잘난다", "관절이 아프거나 쑤신다", "손가락, 손, 발 등에 힘이 없다", "근육통을 느낀다"와 위장관계 증상군의 "아랫배가 아파서 고생한 적이 있다"가 연폭로량의 증가에 따른 교차비의 증가를 보여 양-반응의 관계를 추정할 수 있었다. The relationship between lead related subject symptoms and lead exposure indices was studied in 435 male lead workers in thirteen lead using industries. 212 male office workers who were not exposed to lead occupationally were also studied as a control group. Fourteen lead related symptoms were selected. They were further subdivied into 4 sub-symptom groups such as 1) gastrointestinal, 2) neuromuscular and joint 3) constitutional, and 4) psychological symptoms. Symptom questionnaires were provided to the workers and filled up by themselves and reconfirmed by interviewer(doctor). The test used fer the evaluation of lead exposure were blood lead(PbB), zinc protoporphyrin in whole blood(ZPP), hemoglobin(Hb), hematocrit (Hct), delta-aminolevulinic acid in urine(DALA). The results obtained were as follows; 1. The higher prevalence rate in the sub-group of neuromuscular and joint symptoms was observed in occupationally lead exposed subjects than non-exposed subjects. Among the sub-groups, the most frequent symptom was 'numbness of finger, hands or feet', and the prevalence of the symptom of 'arthralgia', 'weakness of fingers, hands or feet' and 'myalgia' were higher in order. 2. While the symptom which showed the biggest difference of prevalence rate among the 14 symptoms between exposed and non-exposed subjects was 'numbness of fingers, hands or feet', the symptom which showed the highest prevalence rate was 'feeling tired generally' in exposed and non-exposed subjects, but no statistical difference of symptom prevalence were observed. 3. In total study population, PbB and ZPP had dose-response relationship with 4 symtoms of neuromuscular and joint symptoms ('numbness of finger, hands or feet', 'arthralgia', 'weakness of fingers, hands or feet' and 'myalgia') and one symptom of gastrointestinal group('intermittent pains in lower abdomen'). 4. In lead exposed workers, only neuromuscular and joint symptoms group showed dose-response relationship with PbB and ZPP, 5. In lead exposed workers, the prevalance rate of overall symptoms of lead workers with age below 39 years was higher than that of lead workers with age above 40. While neuromuscular and joint symptoms group had a dose-response relationship with PbB in former group, it had a dose-response relationship with ZPP in latter group. 6. Age adjusted odds ratios of symptoms of non-exposed with exposed and odds ratios of low exposed with high exposed workers showed the dose-response relationship of lead exposure with neuromuscular and joint symptoms group('numbness of fingers, hands or feet', 'arthralgia', 'weakness of fingers, hands or feet' and 'myalgia') and gastrointestinal symptoms group('intermittent pains in lower abdoman').