곰쓸개 복용 후 발생한 육안적 혈뇨와 신유두부 괴사증 1예

김우진,한민석,김수항,박인형,박진석,선제형,홍세인,박옥영,신정현,이숭,신병철 朝鮮大學校 附設 醫學硏究所 2006 The Medical Journal of Chosun University Vol.31 No.3

Renal papillary necrosis occurs most commonly in association with urinary tract infection, diabetes mellitus, sickle cell disease, vascular disease, and analgesic nephropathy. Clinical presentation may be related to symptoms of pyelonephritis such as flank pain, renal colic, hematuria, Proteinuria, recurrent fever. The necrotic tissue may be sloughed off, and the diagnosis can sometimes be made by finding piece of renal medullary tissue in the urine. Pyelography may demonstrate cavities and sinuses in the resion of papillae. Anuria & oliguria can lead to the acute renal failure, and especially prognosis and progress may be affect influenced by urinary infection. We report a case of renal papillary necrosis with ingestion of bear gallbladder. On pyelography, Persistent contrast is diagnostic clue of renal papillary necrosis. This case is not be related to urinary tract infection, but occurred acute renal failure. Expectant treatment was gone.

위축성 비염(AR) 이환돈에서 분리된 Bordetella bronchiseptica의 성상

박세종,장경수,전무형 충남대학교 수의과대학 동물의과학연구소 1994 動物醫科學硏究誌 Vol.2 No.-

During 2 years from 1992 to 1994, prevalence of atrophic rhinitis(AR) in the pig herds located in the Western Chungnam was investigated, and isolation of B bronchiseptica was attempted for the pigs manifested with the clinical signs of atrophic rhinitis. The isolates were characterized and identified in aspects of biochemical properties, antigenicity, drug sensitivity and pathogenicity. The results through the experiments are summarized as follows; 1. The prevalence of clinical cases of artrophic rhinitis was recorded by 12.7% in the group that is the sows and piglets vaccinated, 28.9% in the group that is the sows only vaccinated and 39.8% in the group of the non-vaccinated groups. In th slaughter house, 53(24.8%) of 214 pigs examined exhibit the AR lesions. 2. A total of 189 strains of B bronchiseptica were isolated from the pig herds. Isolation rates were 12.6% in the group that is the sows and piglets vaccinated, 34.1% in the group that is the sows only vaccinated and 45.7% in the group of the non-vaccinated groups. Isolation rate in the specimen from the slaughter house was 93(43.5%) of 214 pigs examined. Of the AR-non-vaccinated group, the piglets aged between 61 to 90 days revealed the highest isolation rate of 58.5%. 3. Biochemical and serological propertities of 189 isolates were very similar to those of the reference B bronchiseptica phase I type, indicating that most of isolates are B bronchiseptica phase I type. 4. In antimicrobial drug susceptibility, 87.3% of 189 isolates was susceptible to chloramphenicol, 79.9%, to amikacin, 64.6%, to cephalothin and less than 35.4% to others. 5. The whole cells and bacterial filtrates of the isolates were inoculated to guinea pigs and mice. The isolates showed the high pathogenicity and dermonecrotoxicity. 6. In SDS-PAGE analysis, the isolates presented the identical protein profiles to the reference standard strains.

초기 성공적인 심폐소생술후 혈청 Interleukin-6 농도의 발현양상

박규남,박승현,황두영,김형국,이환,최경호,이원재,정욱성,김학주,김세경 大韓應急醫學會 1998 대한응급의학회지 Vol.9 No.4

Objective : To investgate patterns of serial serum interleukin-6(IL-6) concentrations after initial successful cardiopulmonary resuscitation, and to access differences in serum IL-6 concentrations in patients with Cerebral Performance Category(CPC, 1-2) and CPC(3-5) at the 5th day after cardiacpulmonary resuscitation(CPR). Methods : We studied prospectively 12 patients with spontaneous circulation after cardiopulmonary resuscitation. Venous blood samples were taken 2, 4, 12, 24, 48 and 72 hours after restoration of spontaneous circulation to measure serum IL-6 levels by the enzyme-linked immunosorbent assay. Results : Serum IL-6 concentrations in the severe neurolgically disabled group(CPC, 3-5) were significantly increased at 2, 24 and 48 hours after restoration of spontaneous circulation compared with the less neurolgically disabled group. Also, serum IL-6 concentrations in the severe neurolgic disabled group showed dual peak at 4 and 24 hours. Conclusion : Our study demonstrates significant increase of serum IL-6 in patients with CPC(3-5) after successful cardiopulmonary resuscitation and the significant correlation between early increase of serum IL-6 and poor neurologic outcome. It suggests that early increase of serum IL-6 can be used as a prognostic marker after successful cardiopulmonary resuscitation.

근적외선을 이용한 두개강내 혈종의 진단

박정율,홍기선,김상대,김세훈,임동준,조태형 대한체열학회 2003 대한체열진단학회지 Vol.3 No.1

경골 골수정 고정술후 교합나사의 파단

박형빈,강번중,송해룡,구경회,정순택,조세현 대한골절학회 2002 대한골절학회지 Vol.15 No.4

목 적 : 경골 골절에서 골수정 고정술후 발생하는 교합나사 파단의 빈도와 발생 원인을 밝히고자한다. 대상 및 방법 : 1995년 3월부터 2000년 10월까지 골수정으로 치료하였던 경골 간부골절 82예중 내고정물 파단이 발생하거나 골유합이 이루질 때까지 추시 가능하였던 75예를 대상으로 하였다. 내고정물 파단 빈도와 위치, 골절의 양상, 술후 골절부 신연 및 골유합 이상 여부를 조사하였다. 결 과 : 교합나사 파단은 7예였고 (9.3%), 근위부 두 번째 나사의 파단이 가장 흔하였다. 교합나사으 ㅣ파단은 AO분류 B형과 C형 골절, 술후 골절부가 신연된 경우, 개발성골절, 자연유합 및 불유합의 경우 발생하였다. 결 론 : 교합나사 파단의 주된 요인은 골절부의 골과 골 접촉이 불안정하기 때문이며, 개방성 골절, 지연유합 및 불유합도 교합나사 파단의 위험인자라고 생각한다. 교합나사 파단을 예방하기 위해서는 수술시 골절부 신연을 피해야하며 골절부 골접촉이 불안정한 경우 완전 체중부하를 골유합시까지 제한하여야할 것으로 생각한다. Purpose : The aims of this study were to investigate the prevalence and the causes of crew breakage in tibia nailing. Materials and Methods : Between 1995 and 2000, eighty-two tibial diaphyseal fracture were treated with interlocking nails. The loss of follow-up was 7 cases. We retrospectively reviewed seventy-five cases. We investigated the rate and location of metal failure and evaluated the fracture pattern, the presence of distraction after nailing and union abnormality. Results : Screw breakage was identified in seven cases (9.3%) and most frequently occurred on the second proximal locking screw. Screw breakage occurred in AO type B or C type fractures, fracture site distraction after nailing, open fracture, delayed union and nonunion. Conclusion : The main cause of screw breakage is unstable bone to bone contact on the fracture site caused by comminution of distraction. The open fracture, delayed union, and nonunion also contributing factors for screw breakage. For preventing screw breakage, it is necessary to avoid fracture site distraction and delay full weight bearing in cases having unstable fracture site contact.

저혈량성 쇼크를 동반한 자발성 복직근초 혈종

박상현,오동렬,김형국,김세경,박승현 대한응급의학회 2000 대한응급의학회지 Vol.11 No.4

Background: Intermediate myasthenia syndrome(IMS) is thought to have clinical importance because it may cause sudden respiratory failure during the recovery phase of a cholinergic crisis of organophosphate poisoning. We designed this study to identify the prevalence, the inducing agent, clinical predictor, and the proposed treatment of IMS. Methods: Patients who had admitted with the diagnosis of acute organophosphate poisoning from 1992 to 1998 at two teaching hospitals were enrolled in this study. We selected the cases of IMS based on a review of medical records using modified He' s criteria. Results: Twelve(12) out of 110 patients with acute organophosphate poisoning were diagnosed for a prevalence at 10.9%. The drug inducing IMS were identified as dichlorvos, fenthion, EPN, methidathion, and phosphamidon. The occurrence of IMS was not related to either the initial treatment with atropine and pralidoxime, or the level of serum cholinesterase. Complications were pneumonia, sepsis, pancreatitis, and pseudomembranous colitis, etc. Eleven(11) patients were discharged without sequelae, and one patient was discharged as a hopeless case. Conclusion: This study suggests that IMS is not rare, so close observation is required to detect IMS in organophosphate-poisoning patients. Also, more studies are required to find predictors and treatments.

노랑초파리 발생과정에서 sta 유전자의 발현 양상에 관한 연구

박지권,정형복,김세재 제주대학교 생명과학연구소 2000 제주생명과학연구 Vol.3 No.-

Drosophila stuvarista(sta) gene encodes the ribosomal protein D-p40, consisting of 270 amino acids. The D-p40 is highly conserved between such evolutionarily distinct organisms as human(63% identity) and hydra(58% identity) and has the effect of Minute phenotype such as other ribosomal proteins. We identified the sta gene in the process of Drosophila cDNA library screening and analyzed the developmental expression pattern of sta gene in the transcription level using in situ hybridization. Each animal stage and tissues of 3rd instar larva and adults were showed ubiquitously expression pattern. These results were similar to other ribosomal proteins that represented Minute phenotype. Also, we expressed the 31kDa recombinant proteins of D-p40 using his-tag expression system in E. coli and purified by affinity chromatography. Immunoblot result of the developmental stages was showedthat strongly detection only the stage of embryo and pupa. This result suggested that the expression of sta gene were regulated in the level of post-translation modification ailed considered that sta gene had to other function during development as well as to function as a core ribosomal component.

응급센터에서 기관내 삽관을 시행하지 않은 호흡곤란 환자의 동맥혈 이산화탄소분압과 호기말 이산화탄소분압의 연관성분석

김형국,박승현,오동렬,박규남,이원재,황두영,최승필,이운정,정시경,김세경 大韓應急醫學會 1998 대한응급의학회지 Vol.9 No.4

Background: The end-tidal carbon dioxide tension(ETCO₂) is defined as a partial pressure of carbon dioxide at the end of an exhaled breath. The purpose of this study is to determine the correlation between ETCO₂and arterial carbon dioxide tension(PaO₂) in nonintubated patients with respiratory distress in emergency department(ED). Methods: A prospective non-blind study was performed in ED of our university hospitals. Participants included all nonintubated adult patients with respiratory distress requiring arterial blood gas analysis. ETCO₂was measured with a capnography monitor during tidal volume breathing. ETCO₂were recoreded at the time of arterial blood gas sampling. The correlation between ETCO₂and PaCO₂was analyzed in all patients and in subgroups by simple linear regression. Results: Sixty patients were enrolled. In all patients, ETCO₂was 5.72mmHg lower than PaCO₂and correlated well with PaCO₂(r²=0.716). ETCO₂correlated best with PaCO₂in patients who were either acidotic or non-smoking. Conclusion: ETCO₂correlate well with PaCO₂in nonintubated patients with respiratory distress in ED. ETCO₂may be sufficient to reflect PaCO₂in selected patients and obviate the need for repeat arterial blood gas determination.

항생제 혼합 시멘트 정을 이용한 장관골 감염성 불유합의 이단계 치료

조세현,정순택,박형빈,황선철,하용찬,황인환 대한골절학회 2004 대한골절학회지 Vol.17 No.4

목적: 장관골 감염성 불유합의 치료 시 항생제 혼합 시멘트 정을 이용한 이단계 재건술의 결과를 분석하고자 한다. 대상 및 방법: 1998년 1월부터 2002년 9월까지 장관골 감염성 불유합으로 이단계 재건 수술을 받은 41예 (대퇴골 26예, 경골 15예)를 대상으로 하였다. 일단계 수술에서는 광범위한 변연 절제술, 부골 제거 및 세척술과 기존 고정 장치의 제거 또는 외고정 장치로의 교환을 시행한 후 시공 (dead space)과 불유합 주변 연부조직 내 항생제 혼합 시멘트 정을 삽입하였다. 임상적 감염 증상이 호전된 평균 8.7주 (3주~32주) 후 이단계 재건술로서 Ⅰ군은 내고정 장치 (금속판 5예, 골수강내 금속정 8예), Ⅱ군은 외고정 장치 (Ilizarov 25예, Monofixator 3예)로 각각 고정하고 17예에서는 골내 이동술이나 골 연장술을 시행하였다. 양군 모두 필요한 경우 골 이식과 시멘트 정의 교환을 추가하였다. 추시 기간은 16개월에서 최장 71개월로 평균 45개월 이었다. 치료 결과는 골유합 기간 및 Paley 방법에 의한 방사선상 골유합 상태와 하지 기능으로 평가하였다. 결과: Ⅰ군 13예 전부와 Ⅱ군 28예 중 26예에서 감염의 치료와 골유합을 얻었다. 이단계 재건술 후 골 이식술, 골 소파술, 외고정 핀 교환과 각변형 교정술, 피부 이식 또는 근육 피판 회전술 등의 보조적 시술이 Ⅰ군은 평균 2회, Ⅱ군은 평균 6.2회 추가되었다. 평균 골유합 기간은 Ⅰ군이 19.3주이고 Ⅱ군이 23.1주로 내고정군이 더 빨랐다. 방사선상 Paley 골유합 상태는 Ⅰ군이 우수 8예, 양호 5예이었고, Ⅱ군이 우수 18예, 양호 7예, 보통 1예, 불량 2예 이었다 (p=0.492). 기능적 결과는 Ⅰ군에서 우수 6예, 양호 6예, 보통 1예 이었고, Ⅱ군에서는 우수 10예, 양호 13예, 보통 3예, 불량 2예 이었다 (p=0.267). 결론: 항생제 혼합 시멘트 정의 골수염 치료 효과가 관찰되었으며, 감염이 호전된 후 내고정 장치로 교환해 준 군이 외고정을 유지한 군에 비하여 추가 수술 횟수가 적고, 골유합 기간도 빨랐다. Purpose: To evaluate treatment results between internal na external fixation groups in two-stage reconstruction of infected nonunion of long bones using antibiotics-impregnated cement beads. Materials and Methods: In the first stage, preexisting hardwares were removed and radical debridement was done. The dead space was filled with antibiotics -impregnated cement beads and the nonunion sits was immobilized by external fixation, cast or skeletal traction. In the second stage, all cases were divided into two groups; the nonunion was fixed by internal fixation in group Ⅰ versus external fixation in group Ⅱ. The intervening period between the first and second stage was average 8.7 weeks (range, 3~23 weeks). Results: The follow-up period was average 45 months (range, 16~71 months). Infection control and bone union were achieved in all 13 cases of group Ⅰ. Infection recurred in two of 28 cases in group Ⅱ, one underwent above-knee amputation and the other case was lost in follow-up. The mean number of supportive operations including repeated curettage, augmentation and change of infected pins, angular correction, and soft tissue flap was average 2 and 6.2 times respectively in group Ⅰ and group Ⅱ. Bony union period was average 19.3 and 23.1 weeks in each group. According to Paley's classification, group Ⅰ was similar to group Ⅱ in bony and functional result (p>0.05). Conclusion: Antibiotics-impregnated cement beads provided positive effect on infection control. Internal fixation group showed less number of additional operations and earlier bony union than external fixation group.

만성폐쇄성폐질환의 중증도와 폐고혈압 및 폐성심으로 진행과의 상관관계

김형호,박철진,이준,장광표,하성일,이재록,하재화,권세훈,권용운,윤성호,이승일 朝鮮大學校 附設 醫學硏究所 2007 The Medical Journal of Chosun University Vol.32 No.2

Background: From many previous studies, Pulmonary hypertension is the known independent predictive factor of the mortality in COPD. Also pulmonary hypertension is the major cardiovascular complication of COPD and is associated with the progression to cor pulmonale and poor prognosis. Author want to analyze the correlation between pulmonary hypertension and the severity of COPD which are classified by forced expiratory volume in one second, and the extent of progression to corpulmonale. Methods: Retrospectively we investigated the medical records of 118 patients with COPD who had pulmonary function test and echocardiogaphy more than one times during one-year follow-up (from June, 2005 to May, 2006) at respiratory division in chosun university hospital, and then 50 patients were enrolled in this study. We classified the severity from FEVl in pulmonary function test based on the GOLD guideline, also this was comparably analyzed with RVSP, RVIDd, Visual Grading from echocardiography. Results: 16 patients out of 50 were classified as moderate severity, 25 patients were severe, and 9 patients were very severe group. RVSP was higher in more severe groups than less severe groups but when it comes to pulmonary hypertension that RVSP is over 35 mmHg, there was no valid difference lies in those groups. As FEVl decreases RVSP and RVIDd increases, and observed relationship between RVSP which was classified as below 35 mm and above 35 mm groups and visual grading which was classified as normal and dilatated groups revealed valid correlation, Conclusion: As pulmonary function decreases, progression to pulmonary hypertension and cor pulmonale increases but there was no remarkable difference of prevalence in above moderate severity groups. 연구배경 폐고혈압은 이전의 많은 연구에서 만성폐쇄성폐질환에서 독립적인 사망의 예측인자로 알려져 있다. 또한 폐고혈압은 만성폐쇄성폐질환의 주요한 심혈관계 합병증이며, 폐성심으로의 진행 및 불량한 예후와도 관련되어 있다. 이에 저자는 폐고혈압과 1초간 노력성호기량으로 분류되는 만성폐쇄성폐질환의 중증도 및 폐성심으로의 진행 정도를 비교 분석하여 이들의 상관관계를 밝혀보고자 한다. 방법 2005년 6월부터 2006년 5월까지 1년 동안 본 병원 호흡기 내과에서 폐기능검사와 심장초음파 검사를 각각 1회 이상 시행한 적이 있는 118명에 한하여 의무기록을 후향적으로 조사하여 이 중에서 50명을 대상으로 하였다. 폐기능검사 시행 결과 얻은 1초간 노력성호기량을 바탕으로 GOLD guideline에 따라 중증도를 분류하였으며 이를 심초음파 시행 결과 얻은 우심실수축기압, 확장기말 우심실내부간격, 시각등급과 비교분석하였다. 결과 대상 환자 50명중 16명은 중등증, 25명은 중증, 9명은 최고중증 그룹으로 분류되었다. 우심실수축기압은 중증도가 높은 그룹에서 낮은 그룹에 비해 더 높게 나타났으나 폐고혈압에 해당하는 우심실수축기압이 35 mmHg이상인 환자에 있어사는 각 그룹간에 유의한 차이를 보이지 않았으며, 확장기말 우심실내부간격, 시각등급 또한 중증도와 유의한 차이를 보이지 안항ㅆ다. 1초간 노력성호기량이 감소함에 따라서는 우심실수축기압, 시각등급은 증가하였으며 우심실수축기압을 35mmHg 미만과 이상인 그룹으로, 시각등급을 정상과 확장이 있는 그룹으로 분류하여 비교한 결과에서는 유의한 상관관계를 나타냈다. 결론 폐기능이 감소할수록 페고혈압 및 폐성심으로의 진행이 증가하였으나 폐기능검사에서 중등도 이상의 그룹에서 유병률의 차이는 크지 않았다.