피부 병변을 동반한 악성조직구증 1예

조은택,박용관,김진호,강정원,천영욱,전익섭,박유환,전춘해 조선대학교 1995 The Medical Journal of Chosun University Vol.20 No.1

Malignant histiocytosis, originally described in 1939 as histiocytic medullary reticulosis by Scott and Robb-Smith, is a rare histiocytic proliferative disorder that often shows an acute onset and used to progress to death within a few months. This disorder characterized clinically by fever, generalized weakness, lymphadenopathy and hepatosplenomegaly, and shows a variable range of pancytopenia. Extranodal involvement is common, with an incidence ranging from 50% to as high as 90%, skin involves8ment was noted in 10% to 15%. Typical skin lesions were mainly founded in extremity. i.e. erythematous papule and nodule occasionally become to necrosis and ulceration. We experienced one case of malignant histiocytosis in a 46-years-old female. The major clinical findings are fever, malaise, hepatosplenomegaly and erythematous skin lesion. In the laboratory study, pancytopenia is noted on the peripheral blood. And also aggregation of many atypical histiocytes were shown on skin and bone marrow biopsy. So we reported one related case with malignant histiocytosis as well as reviewing literature .

혈압측정의 정확성 평가

조성현,황정해,김은경,오병희,김창엽 한국의료QA학회 1996 한국의료질향상학회지 Vol.3 No.1

Background : Blood pressure is an important indicator in diagnosis and assessing treatment of a patient. Clinical staffs use blood pressure on the assumption that measured value is accurate and reliable. However, whether measured blood pressure is accurate has been rarely investigated in Korea. Objectives : The aims of this study are to evaluate clinical staffs' knowledge and technique as well as accuracy of sphygmomanometer. Also the program to improve the measurement is developed. Methods : Seventy-three registered nurses were asked nine multiple choice questions including Korotkoff sound, cuff size, and deflation rate. Simultaneously characteristics of nurses were examined age, working place, duration of employment and academic degree. A testing videotape(Standardizing Measurement Video-Tutored Course) was used for evaluating the accuracy of measurement. Testees were to read and record the 12 cases of blood pressure measurement, watching a falling mercury column and hearing Korotkoff sounds. After 10 minutes' education, they were again tested with the same cases. Additionally, 83 mercury sphygmomanometers were checked to find defects such as inaccurate calibration and zero setting, leaky bladder, etc. Results : For the knowledge testing correct response rate was 41.1%. They were the lowest in selecting the proper cuff size and Korotkoff sound. In examining accuracy of blood pressure with videotape, nurses had 67.7% correct response rate. The correct response rate was significantly improved by a session of education. About 23% of sphygmomanometers was without discemable defects. Conclusion : The knowledge and skill of clinical staffs along with the accuracy of equipment have to be improved. A properly designed education program would contribute to the accuracy improvement of blood pressure measurement. Also, more concerns should be given to the precision and maintenance of equipment.

소아에서의 급성 파종성 뇌척수염의 임상적 고찰

조수진,박은애,유은선,김혜순,손세정,서정완,이승주,한후재 이화여자대학교 의과대학 2003 EMJ (Ewha medical journal) Vol.26 No.2

목적: 급성 파종성 뇌척수염은 감염이나 예방 접종 후 발생하는 중추 신경계의 급성 자가 면역 염증성 질환으로 탈수초를 일으킨다. 신경학적인 증상으로 발현되고 대부분 환전히 회복되지만 신경학적 후유증을 남기거나 사망 할 수도 있다. 이에 저자들은 본원에서 발생 한 14명을 분석하여 조기 진단과 치료에 도움을 주고자 하였다. 대상과 방법: 1998년 3월부터 2003년 8월까지 이대목동병원에서 급성 파종성 뇌척수염으로 진단 받은 14명의 의무기록을 후향적으로 조사하였다. 결과: 환자들의 평균 발생 연령은 5±7.8개월이였고, 특정계절이나 연도에 집중되어서 나타나지는 않았다. 선행질환은 주로 비특이적인 상기도 감염이 가장 많았고, 초기증상으로는 경련이 가장 많았다. 그 외에 의식저하나 운동장애도 있었다. 뇌척수액 검사에서 백혈구 증가증이 발견된 경우는 있었으나 단백이 증가된 경우는 없었다. 뇌 자기공명 촬영에서 T2 증강시 뇌백질과 기저핵에 고음영의 다발성 병소가 발견되었고 추적 촬영에서 대부분에서 소실되었다. 뇌파 검사가 시행되었던 경우 전반적인 서파가 가장 많았고 국소적인 극파가 나온 경우도 한 명 있었다. 환자들은 정맥 면역 글로블린과 메틸프레드니졸론으로 치료하였고 치료 시작 후 3~7일내 증상이 호전되었다. 모든 환자를 2달 이상 추적 관찰하였고 항경련제가 지속적으로 필요한 정도의 경련성 질환이 두 명, 신경아교증이 남아잇는 경우가 한 명, 외래에서 다발성 경화증이 의심되는 경우가 한 명 있었다. 결론: 급성 파종성 뇌척수염은 침범 부위에 따라서 다양한 임상 상으로 나타나며 면역 글로블린과 메틸프레드니졸론이 치료에 효과적이였다. 본 연구에서는 대상 환자수가 적어 신경학적 후유증의 위험요소는 밝힐 수는 없으나, 예후는 검사소견과 연관되어 있지는 않았고, 대부분에서 양호하여 완전히 회복되었으나, 신경학적 후유증이 남은 경우도 있었다. Objective:Acute disseminated encephalomyelitis(ADEM) is an acute demyelinating autoimmune inflammatory disease of the central nervous system which develops after infection of vaccination. It may be fatal, and produce a permanent residual static disability or fully recover. We retrospec-tively studied 14 cases to investigate the clinical findings and outcome of ADEM. Methods : 14cases of ADEM diagnosed at Ewha Womans University Mokdong Hospital from 1998 to 2003 were retrospectively reviewed. Results : The age of onset was 5years±7.8 months and no seasonal clustering was found. The time of onset of symptoms was between 3 to 30 days. The preceding events were nonspecific upper respiratory infections in 9 cases, aseptic meningitis in 4 cases, and gastroenteritis in one case..The initial symptoms were seizure, altered consciousness, hemiparesis, fever, headache, and vomiting. Brain MRI showed multifocal high signal intensity lesions on T2 weighted image mainly in the cerebral whith matter, basal ganglia and periventricular white matter. EEG was performed in some cases and showed generalized or focal slow waves and only one case showed focal spikes. Patients were treated with IV globulin and methylprednisolone and the symptoms improved within 3-7 days after treatment. All patients were followed up for more than 2 months and most of them fully recovered except two. Conclusion : ADEM presents in various clinical manifestations depending on its involvement of the brain lesions. Most cases recovered fully but in some cases, residual permanent neurologic sequelae remained.

일 도시 고등학생의 음주동기와 음주문제

강혜영,신경은,장현지,나영화,조은희 韓國學校保健學會 2004 韓國學校保健學會誌 Vol.17 No.2

Purpose : The purpose of this study was to investigate drinking motives and the drinking-related problems of Korean high school students at a city in Jeonbuk province. Methods : There were 657 students from two academic and two vocational high schools at J city in Jeonbuk province. The sample was collected using a stratified sampling method and the data was collected from June 30th to July 16th 2003. The study instrument used to examine drinking motive was a 20.item summated scale (Cronbach's α = .95) and for drinking-related problems was an 18 item summated scale (Cronbach's α = .91). The data was analyzed using SPSS/PC+ by percentage, χ2.test, t-test and correlations. Results : 1. Drinking experience: Among the high school students, 74.3% of them had drinking episodes. Female students started drinking later (χ2 = 12.857, p = .002) and had more drinking friends (χ2 = 7.785, p = .020) than males. Vocational school students drank more frequently (χ2 = 32.138, p = .001), had more heavy drinking episodes (χ2 = 40.370, p = .001). 2. Drinking motives & Drinking-related problems: The mean score of drinking motives was 31.2 ± 11.12 out of 80 and that of drinking-related problems was 21.8 ± 5.85 out of 72 points. Neither score were stronger was significantly different according to gender and grade. On the other hand, both drinking motives (t = .4.077, p = .001) and drinking-related problems (t = .3.423, p = .001) were stronger in vocational school students than in academic school students. The correlation between drinking-related characteristics and problems were weak (from r = .286 to r = .520) but the correlation within the subcategories of drinking motives was high such as between enhancement and coping (r = .822) and enhancement and social motives (r = .822). Conclusion : The majority of Korean high school students start to drink during their junior high school days. Drinking motives and drinking-related problems were not serious but the drinking motives and the drinking-related problems are stronger among vocational school students. As a result, school-based health education and counseling programs should focus on solving drinking motives than on drinking-related problems.

생약성분을 첨가한 소시지의 저장성에 대한 연구

임혜경,조은자 동아시아식생활학회 2002 동아시아식생활학회지 Vol.12 No.3

This study was conducted to investigate the effects of medicinal plants with additives on storage characteristics of sausage. The water activity of the sausage with the additives tended to decrease with the storage time; the highest value was shown in the Angelica added sausage samples, in both cases added with dried powder as well as with extracted powder. The Paeonia extract powder added sausage had the lowest pH value. The herbal plant added sausages showed the lowest cooking and storage losses among all. The values of TBA (thiobarbituric acid value) and VBN (volatile basic nitrogen) increased with storage time, but the values of the sample with the extract powder additive were lower than those of the freeze-dry powder additive. Total plate counts of bacteria increased with storage time for all samples, but those for the samples with Pueraria, Platycodon, Angelica, Bupleurum and Paeonia additives exhibited lower values than the control. From the above results, the sausages with medicinal plant additives showed the superior storage safety and quality characteristics.

백내장 수술환자의 진료결과에 미치는 요인 : 사전 연구를 중심으로 Pilot study

박은철,홍영재,임승정,강형곤,최윤정,김한중,조우현,손명세 한국의료QA학회 1998 한국의료질향상학회지 Vol.5 No.1

Backgroud : This study is to identify preoperative patient characteristics associated with a lack of improvement on one or more measures perioperatively, postoperative 3-4 months, and postoperative 12 months. Methods : For the assessment, prospective study was performed with 92 patients who had undergone either one eye or both eye cataract surgery by 3 ophthalmologists practicing at a university hospital. The criteria of improvement were (1) Snellen visual acuity, (2) a cataract-related symptom score(possible range: 0. 0 of 6 symptoms present or bothersome, to 18. all 6 symptoms very bothersome), and (3) VF-14 score - a measure of functional impairment in patient with cataract - (possible range: 0, inability to perform any of the applicable activities, to 100, no difficulty in performing any of the applicable activities). Results : Although 14 patients (15.2%) failed to improve on one or more of the outcome measures assessed, no one failed to improve on all three measures. Both eyes of surgery than one eye, preoperative cataract symptom score of 1-4, 5 or higher than 0 were associated independently with the increased likelihood of improvement (odds ratio 8.95, 7.16, 8.87 respectively). And the preoperative level of Snellen visual acuity was not associated with the likelihood of improvement Conclusion : We conclude that specific preoperative characteristics (both eyes, cataract symptom score) are independent predictors of patient outcome after cataract surgery,

흰쥐 대뇌피질에서의 Cholecystokinin Octapeptide의 分布

황정한,조희중,김은희,박매자,배용철,홍해숙,주강 慶北大學校 醫科大學 1990 慶北醫大誌 Vol.31 No.4

흰쥐 대뇌피질에서 cholecystokinin octapeptide(CCK-8)의 분포를 관찰하기 위하여 간접면역형 광법을 행하여 관찰해 본 결과 다음의 많은 부위에서 CCK-8양성세포 및 양성섬유를 관찰할 수 있었다. 신피질: CCK-8양성세포는 주로 제2, 3층에서, 양성섬유는 제2, 3 그리고 6층에서 저밀도를 나타내었다. 후구: 전후핵에서 많은 CCK-8양성세포 및 양성섬유를 관찰하였다. 이상엽 및 후내야: 양성세포는 주로 제2층에서 관찰되었으며 양성섬유는 제2층에서 중밀도 제3층에서 저밀도로 관찰되었다. 해마체: 많은 양성세포 및 고밀도의 양성섬유가 원추세포층에서 관찰되었다. In order to investigate the distribution of immunoreactive cholecystokinin octapeptide (CCK-8) containing neurons in the cerebral cortex of the rat, brains of the rats were processed for indirect immunofluorescent technique. The results obtained were as follows. Neocortex; CCK-8 immunoreactive cell bodies were found in layer Ⅱ and Ⅲ and immunoreactive axon terminals were heaviest in layers Ⅱ, Ⅲ and Ⅵ. Olfactory bulb; The anterior olfactory nucleus contained numerous CCK-8 immunoreactive cell bodies and a moderate density of immunoreactive axon terminals. Piriform and entorrhinal cortex; CCK-8 immunoreactive neurons and axon terminals were observed in layer Ⅱ and Ⅲ. However, they were more frequent in layer Ⅱ. Hippocampus; CCK-8 immunoreactive cell bodies and axon terminals were found in pyramidal layer.

흰쥐 腦의 中心扁桃核에서의 Substance P 및 Enkephalin 함유구조의 형태학적 특징

마도훈,조희중,김은희,박매자,배용철,홍해숙,주강 慶北大學校 醫科大學 1990 慶北醫大誌 Vol.31 No.4

흰쥐 뇌의 중심편도핵에서의 substance P (SP) 및 Enkephalin (ENK) 함유신경세포 및 축삭종말의 분포를 관찰하기 위하여 peroxidase antiperoxidase법을 행하여 다음의 결과를 얻을 수 있었다. SP함유신경세포는 중심편도핵의 medial zone에 분포하였고 SP함유축삭종말은 lateral capsular zone에서 고밀도로 관찰되었다. SP함유신경세포는 원형 내지는 타원형이었고 2∼3개의 근위수상돌기(proximal dendrite)를 가졌다. ENK함유신경세포 및 축삭종말은 공히 central 및 lateral capsular zone에 존재하였다. ENK함유 신경세포는 직경이 약 17-24㎛ 정도였고 3∼4개의 근위수상돌기를 관찰할 수 있었다. The central amygdaloid nucleus is rich in a number of neuropoptides. The present study examines the distribution and morphological characteristics of substance P (SP) and leucine-enkephalin (ENK) containing neurons in this nucleus. The results obtained were as follows: SP immunoreactive cells were observed within the medial zone and SP immunoreactive axon terminals were heaviest within the lateral capsular zone. The immunoreactive cells were round or oval shape (diameter, 15-20㎛) and had two or three proximal dendrites. ENK immunoreactive cells and axon terminals located within central and capsular zones. The immunoreactive cells were round or oval shape (diameter, 17-24㎛) and had three or four proximal dendrites.

유방암과 섬유선종의 방사선학적 소견 : 유방 단순촬영술과 유방 초음파검사 소견의 비교 연구 Studies on mammographic and ultrasonographic findings evaluation

임한혁,최득린,고은석,이혜경,임철완,이상진,홍현숙,최교창,김영화,박재성 순천향의학연구소 1997 Journal of Soonchunhyang Medical Science Vol.3 No.2

Purpose : To evaluate the utility of mammography and ultrasonography in study of morphologic differential diagnosis between malignant and benign mass. Materials and Methods : Average age of patients with breast cancer was 48.4 year-old, and that of fibroadenoma was 29.4 year-old. The equipments used for examination were MF-159 high frequency mammography(Bennet Co.) and Acoustic image 5200S. We evaluated mammographic findings about breast parenchymal pattern, calcification, margin and size of the mass associated tumor nature, and ultrasonographic findings about shape, height and width, internal homogenicity and echo pattern, wall contour, boundary echo, and posterior shadow in breast mass. Thirty-seven of mammographic findings and 34 cases of ultrasonogreaphic findings in pathologically proven breast cancer and 34 case of mammographic findings and 71 cases of ultrasonographic findings in breast fibroadenoma were reviewed retrospectively. Results : In mammographic study, the parenchymal patterns of breast cancer according to Wolfe classification were NI(16.2%), PI(24.3%), P@(37.8%), and DY(21.6%) and those in fibroadenoma were NI(3.1%), Pl(11.7%), P2(35.2%),and DY(50%). Mammographic findings about presence of calcification were as follows; only calcification(16.2%), only mass(51.3%), and mass with calcification(32.5%) in breast cancer, and only mass(91.2%), mass with calcification(8.8%) in fibroadenoma. The features of mass margins were classified as ill-defined margin(45.9%), well-defined(5.4%), and well-defined with partial spiculation(48.6%) in breast cancer and ill-defined(20.5%), well-defined(73.5%), and well-defined with partial spiculation(5.8%) in fibroadenoma. The mass were grouped by size; 1-2cm(37.8%), 2-4cm(45.9%), and 4-6cm(16.3%) in breast cancer and 1-2cm(79.4%), 2-4cm(17.6%), and 4-6cm (3.0%) in fibroadenoma. On ultrasonographic study, the shape of masses in breast cancer were lobulated(82.3%),oval(14.7%), and round(3.0%),and those in fibroadenoma were lobulated(14.0%), oval(57.7%), and round(18.3%). The cases that the height was longer than width were 32.3% in breast cancer and 0% in fibroadenoma. The findings about homogenecity and echo patterns were as follows; hypoechoic(52.9%) and mixed(47.1%) in breast cancer and hypoechoic(2.8%), hypoechoic(63.4%), and mixed(33.8%) in fibroadenoma. The margin of masses were smooth in 85.9% of fibroadenoma, and irregular in 73.6% of breast cancer. The boundary echoes of masses and decreased posterior echo shadow were seen only in 61.8% and 55.9% of breast cancer, respectively. Conclusion: The margin and calcifications are more clearly delineated on mammography but breast cancer and fibroadenoma, both are more commonly developed in dense parenchymal pattern(P2+DY),and there findings are easily obscured in mammography. So ultrasoography is very useful in these masses evaluation, especially amoung young patients.

비호지킨 림프종의 임상적 고찰

김태원,조은택,조기섭,정재용,허재봉,장영,박유환,정춘해 조선대학교 1995 The Medical Journal of Chosun University Vol.20 No.1

A retrospective clinical and histologic study of 30 non-Hodgkin's lymphomas diagnosed at the Department of Hemato-oncology of the Chosun University from January 1989 to December 1993 is presented. Among total 30 cases whose sexes were mentioned, male were 18 and female were 12 and the ratio is 1.5:1. The peak incidence of non-Hodgkin's lymphoma was found in the third decade. The case distributions by Working formulation were summarized in table 3. The most common histopathologic type of non-Hodgkin's lymphoma was the diffuse large cell type of intermediate grade. The presenting symptoms at the time of first visit to the hospital were summarized in table 4. The most common symptoms were palpable mass. Lymph node enlargements were found in 87 %, and most frequently on cervical area(35%). The incidence of primary nodal lymphoma is more frequent than extranodal lymphoma, 1.2:1. The most common primary site of extranodal lymphoma is the gastrointestinal tract. In the laboratory findings, the data of hemoglobin and hematocrit were summarized in table 8, 9, Values of hemoglobin and hematocrit of female patients greater than those of male patients. The results of the immunophenotypings of nodal and extranodal lymphoma indicates that the B-cell lymphoma are predominant(B:T=1.4:1). The clinical stage was Ⅱ in 9 cases(30%) Ⅲ in 9 cases(30%), Ⅳ in 8 cases(26.7%), Ⅰin 4 cases(13.3%), 28 cases were treated with CHOP regimen. Among them, 17 cases(60.8%) achieved a complete remission. 5 cases had a partial response. The most frequent toxicities were toxic hepatitis.