Cortisone acetate 투여한 마우스의 Pneumocystis carinii 감염양상 및 세포매개성 면역반응에 관한 연구

김충현,이영하,나영언,신대환 충남대학교 의과대학 지역사회의학연구소 1991 충남의대잡지 Vol.18 No.2

This study was attempted to find the cell-mediated immune responses and infection aspects of Pneumocystis carinii in immunosuppressive mice. The experimental groups were administered the suppressive regimen consisting of cortisone acetate 2.5mg injected subcutaneously twice a week, a low(8%) protein diet, and tetracycline in the drinking water(1mg/ml) for 10 weeks. From the 1st week after cortisone acetate injection, the number of P. carinii cysts in the lung specimens were examined by Gomori's methenamine silver stain at 1 week interval for 10 weeks. And the blastogenic response of spleen cells treated with Con. A (5.0㎍/ml) was examined by [^3H]-thymidine incorporation assay at the same time. The results obtained in this study were as follows: 1. The number of P. carinii cysts were remarkably increased in the lungs from 2 weeks to 4 weeks, and thereafter was slowly increased throughout the experiment. 2. The blastogenic response of Con. A treated-splenocytes from mice injected with cortisone acetate was significantly declined as compared with those of the control mice(p<0.05). 3. There were not correlation between the number of P carinii cysts in the lung specimens and the blastogenic responses of splenocytes to Con. A(correlation coefficient, r=0.38285, p<0.2749).

Oxantel/Pyrantel 合劑 및 Mebendazole에 依한 腸內線蟲類 驅蟲效果에 對한 比較實驗

金鍾煥,辛大煥,林定圭 충남대학교 의과대학 지역사회의학연구소 1978 충남의대잡지 Vol.5 No.1

A total of 63 subjects with multiple intestinal nematode infection: T. trichiura, A. lumbricoides, E. vermicularis and T. orientalis were treated with Oxantel/Pyrantel suspension and Mebendazole. The administration of Oxantel/Pyrantel suspension was 15mg/kg body weight in a single dose and Mebendazole was 600mg, divided by 100mg, twice daily for three consecutive days regardless of the body weight or ages. The results of present trials are summarized as follows: 1. The egg negative conversion rates for Oxantel/Pyrantel suspension were 100% in 20 cases of Ascariasis and in 3 cases of T. orientalis infection, and 92.3% in 26 cases of Enterobiasis. The egg reduction rate of T. trichiura was 84.8%. 2. The Mebendazole treated group showed the egg negative conversion rates of 100% in 27 cases of Ascariasis and one case of Trichostrongyliasis, 88.5% in 26 cases of Enterobiasis and 19.4% is 32 cases of Trichuriasis. The egg reduction rate of T. trichiura was 89.4%. 3. With the Oxantel/Pyrantel treated group, adult worms were found T. trichiura 1449 (average 45.3), A. lumbricoides 81 (av. 4.1) and E. vermicularis 249 (av. 9.6) worms. In Mebendazole treated group demonstrated the number of adult worms: 406(av. 13.1) of T. trichiura, 79 (av. 2.9) of A. lumbricoides and 134 (av. 5.2) of E. vermicularis, respectively. 4. Side effects of both Oxantel/Pyrantel and Mebendazole were few and mild.

관상동맥 스텐트 시술 후의 재협착에 관한 연구

김윤철,이정우,김보영,강정아,임대승,이민수,김정희,성보영,최성준,성인환,전은석 충남대학교 의과대학 지역사회의학연구소 2000 충남의대잡지 Vol.27 No.1

Coronary stent implacement is known as an effective treatment in the intimal dissection after percutaneous transluminal coronary angioplasty and the prevention of restenosis. However, In-stent restenosis still remains a major concern in clinical stenting. The stents were placed in 103 patients from July 1996 to March 1999 and performed follow-up coronary angiograms in 59(57.3%) patients. To identify the clinical, angiographic and procedurerelated variables 'which predict late restenosis within the stented artery, 59 patients(58.3±9.9, M:F= 41:18) were studied. The clinical characteristics of the patients were stable angina in 23(39.0%), unstable angina in 14(23.7%), acute myocardial infarction in 21(35.6%) and old myocardial infarction in 1(1.7%). Coronary stenting was performed in 1 patient(1.7%) for primary lesion, 50 patients(84.7%) for suboptimal results after PTCA, 6 patients(10.2%) for bail-out procedure, and 2 patients(3.4%) for restenotic lesions. All patients were treated with aspirin and ticlopidinc. The follow-up angiograms were obtained at 7±4 months. The overall in-stent restenosis rate was 27.1%. The coronary angiographic findings were 32 single vessel(54.2%), 19 two vessel(32.2%) and 8 three vessel disease(13.6%). The angiographic morphological characteristics were type A in 33(55.9%), type B in 14(23.7%), type C in 12(20. 3%) cases. Variables of 16 patients with restenosis were compared with those of 43 patients without restenosis. Previously known predictors for in-stent restenosis were multiple stenting, stenting for restenotic lesions, residual stenosis after stenting, stenting for total occlusion lesions, reference diameter, balloon to vessel ratio, acute gain and minimal luminal diameter after procedure, design and characteristics of stents, ostial lesion of aorta, high pressure method for stenting, lesion length, diabetes mellitus, size of artheroma, saphenous vein grafts, ulcerlating lesions and calcified lesions. In this study, Reference diameter before stenting(2.43±0.54mm vs. 2.88±0.65mm, p=0.016) and balloon-to-artery ratio(1.28±0.26 vs. 1.11±0.18, p=0.006) were predictors for in-stent restenosis. 1) The overall in-stent restenosis rate was 27.1%. 2) In the analysis of predictors for in-stent restenosis, there was no significant differences in clinical, angiographic factors between group with restenosis and without restenosis. But, Only reference diameter before stenting and balloon-toartery ratio were predictors of late in-stent restenosis. In conclusion, stenting is effective revascularisation method for selected patients with ischemic heart disease, and to minimize in-stent restenosis rate, stent implanting is achieved in a large vessel on the basis of an artery-to-stnet ration of 1:1, if possible.

PCR을 이용한 Rat 기관지 세척액에서의 Pneumocystis carinii DNA의 검출 : 기초실험 A pilot study

김주옥,홍석철,한표성,이종진,김선영,이영하,신대환 충남대학교 의과대학 지역사회의학연구소 1994 충남의대잡지 Vol.21 No.1

Background: Pneumocystis carinii (PC) is a opportunistic pathogen causing serious pneumonia (Pneumocystis carinii pneumonia : PCP) in immunosuppressed patients including AIDS. Laboratory diagnosis of PCP is dependent on microscopic demonstration of the PC by using cytochemical staining or by immunocytochemical staining with monoclonal antibodies. However, these staining methods are not highly sensitive. The development of the polymerase chain reaction (PCR) has made it possible to detect very small numbers of pathogens in clinical specimens. To establish the usefulness of PCR for detection of PC DNA, We performed PCR as a pilot study. Methods: PCP was induced on Spraque-Dawley rats with prednisolone 5mg IM twice a week. Bronchial lavages, impression smears, and permanent sections were performed from the 3rd week to 7th week of cortisonized rats. PC DNA was extracted with bead beater / 10% CTAB method. Results: Impression smears showed PC cyst after the 4th week (100%, 28/28 rats), and permanent sections showed 27/28 rats. Control rats showed some PC cysts (2/7). PCR result was positive only one case among the 6th week rats (1/7), But positive 6 cases at the 7th week rats, (6/7). Among control rats. 2 cases were positive (2/7). ??This data is a pilot study for the PC DNA detection using a PCR. PCP were successfully cortisonized rats. If adequate bronchial washing technique will be used, PCR can be a sensitive for PC DNA detection.

위장질환에 따른 H.pylori 감염빈도와 검사방법의 비교분석

김대현,조재현,금민수,최성곤,이창형,탁원형,권영오,김성국,최용환,정준모 慶北大學校 醫科大學 1997 慶北醫大誌 Vol.38 No.2

목적 : H. pylori가 위장관 질환의 병인에 깊은 관련이 있어 이의 적절한 진단 및 치료가 중요하게 대두되고 있다. 이에 저자들은 소화기 증상을 주소로 내원한 환자들을 대상으로 내시경 검사를 실시하여 H. pylori검출을 위한 CLO검사, IgG 항체검사 및 H&E 염색 등을 시행하여 각 질환별로 H. pylori 감염의 양성율을 알아보고 검사법에 따른 민감도 및 특이도를 그 유용성에 대하여 조사하였다. 대상 및 방법 : 1996 4월에서 8월까지 경북대학교병원에 소화기증상을 주소로 내원한 총 313명의 환자를 대상으로 내시경 검사를 실시하여 H. pylori 검출을 위한 CLO 검사, IgG 항체검사, 조직염색 검사를 실시하였다. 결과 : 전체 대상 환자수는 313명이었고 연령별 분포는 16세부터 80세 까지 다양하였으며 그중40대, 50대, 60대가 각각 69예(22%), 73예(23.3%), 65예(20.8%)로 전체 환자중 66%를 차지하였다. 남녀비는 2.07 대 1로 남자가 많았다. 대상환자의 평균나이는 52±15세였고, 전체 대상환자에서 H. pylori 양성군과 음성군의 평균나이는 각각 50±15세, 54±15세 였고, 궤양환자군에서 H. pylori 양성군과 음성군사이의 평균나이는 각각 49±14.8세, 55±13.8세로 나타났다. 각 질환별분포는 위염이 72명(23%), 십이지장 궤양이 85명(27.2%), 위궤양이 80명(25.6%), 위암이 20명(6.4%), 비궤양성 소화불량이 13명(4.2%), 기타가 43명(13.7%)이었으며, H. pylori 감염 양성율은 위염이 71%, 십이지장 궤양이 86.8%, 위궤양이 58.3%, 위암이 75%, 비궤양성 소화불량이 75%였으며 특히 유문륜 궤양에서는 100%의 양성율을 보였다. 소화성 궤양군과 비궤양군에서의 H. pylori 양성율을 비교해 본 결과 궤양군에서는 73.1%, 비궤양군에서는 72%로 통계학적으로 차이는 없었다(P=0.91). 소화성 궤양환자에서 출혈이 동반된 군과 동반되지 않은 군에서의 H. pylori 양성율을 비교해 본 결과 출혈이 동반된 군에서의 양성율은 54.5%였고, 출혈이 동반되지 않은 군에서는 77.5%의 양성율을 보여 출혈이동반되지 않은 군에서 통계학적으로 유의하게 높았다(P=0.014). 나이에 따른 양성율을 알아본 결과 50세 이하에서는 78.5%였고, 50세 이상에서는 67.5%로서 양성율이 낮았으나 통계학적으로 유의성은 없었다(P=0.052). 각 검사법에 따른 민감도 및 특이도는 전체 환자중에서는 CLO검사가 88.9%, 96.1%, IgG항체검사 90.8%, 58.5%, H&E 염색검사 86.9%, 79.2%로서 민감도는 비슷하게 나왔으나 CLO검사는 상대적으로 특이도가 다른 검사법에 비해 높았다. 궤양군에서의 CLO검사의 민감도와 특이도는 92.0%, 95.6%였고, 비궤양군에서의 민감도와 특이도는 84.3%, 96.8%로서 비궤양군에서는 CLO검사의 민감도는 약간 낮았다. 나이에 따른 CLO 검사의 민감도 및 특이도는 50세 이하에서는 91.5%, 93.1% 였고, 50세 이상에서는 86.3%, 97.9%로서 50세 이상에서는 상대적으로 CLO검사의 민감도가 낮았다. 결론 : 본 연구에서는 위장질환에 따른 H. pylori 양성율을 알아보았는데, 다른 보고에서 처럼 높게 나왔으며, 진단 방법으로 사용한 CLO검사, IgG항체 검사, 조직염색검사 등은 모두 비교적 높은 예민도를 나타냈고, 그중 CLO검사가 간편하고 경제적이라는 면에서 임상적으로 유용한 검사로 여겨지나 상대적으로 CLO검사의 민감도가 낮은 비궤양성 질환과 50세 이상의 환자군에서는 CLO검사 외에 다른 검사방법을 병행함으로써 H. pylori의 진단율을 높일 수 있을 것으로 사료된다. Background: Gastric colonization by Helicobacter. pylori is common among patients with peptic ulcer and gastritis. And various diagnostic tests are available in confirming H. pylori infection. The aim of this paper is to estimate the prevalence of H. pylori infection in Gastroduodenal disorders and compare the sensitivity and specificity of the most widely available tests. Methods: A total of 313 patients were tested for H. pylori infection by IgG Ab, CLO test and H&E stains. Results: The prevalence of H. pylori infection was significantly higher in duodenal ulcer(86.8%) than in gastric cancer(75%), gastritis(71%) and gastric ulcer(58.3%)(P=0.009). The sensitivity and specificity of each test was as follows: CLO test(88.9%, 96.1%), IgG Ab test(90.8%, 58.5%), H&E stain(86.9%, 79.2%). Sensitivity of CLO test in peptic group was 92.0%, whereas in non-peptic group, it was 86.3%. Sensitivity of CLO test in age under 50 was 91.5%, that over 50 it was 86.3%. Conculsions: There is a strong association between H. pylori and gastrointestinal disorders. CLO tests have relatively high sensitivity and specificity, especially in peptic group and younger age(below 50 yr)group. But in those patients in which CLO tests are less sensitive (age>50 or non-peptic group), more than one test may be necessary to diagnose the presence of the organism.

Prostacyclin synthase 유전자의 C1117A 다형성과 이형협심증과의 관련성

성인환,임대승,김정희,이재환,최시완,정진옥 대한내과학회 2004 대한내과학회지 Vol.66 No.4

목적 : Thromboxan A2의 혀관수축반응을 저해하는 prostacylin synthase exon 8 C117A의 변이가 관동맥 연축과 관련성이 있는지를 알아보고자 하였다. 방법 : 1998년 1월 1일부터 2000년 12월 31일까지 충남대학교병원 순환기내과에서 관동맥조형술과정맥내 에르고노빈 유발검사를 시행하여 관동맥 연축이 확진된 이형협심증 환자군(45예)과 정상 대조군(59예)을 대상으로 중합효소 연쇄반응법 및 restriction fragment length polymorphism을 이용하여 분석하였다. 결과 : Prostacyclin synthase exon 8 C117A 유전자형의 빈도는 대조군에서 A/A : A/C : C/C =3.4% : 30.5% : 66.1%, 이형협심증 환자군에서 A/A : A/C : C/C = 8.9% : 42.4% : 48.9%로 두 군간에 유의한 차이가 없었다. 대조군에 비해 변이형 협심증 환자군에서 남자의 비율과 흡연률이 높았지만, prostacyclin synthase exon 8 C117A 유전자형에 따른 군에서 당뇨병, 고혈압, 흡연, 고지혈증, 비만 등의 유의한 차이는 없었다. 결론 : 한국인에서 prostacyclin synthase exon 8 C117A 유전자 다형성과 관동맥 연축이 있는 이형협심증과의 유의한 연관성은 발견할 수 없었다. Backround : Coronary artery spasm plays an important role in the pathogenesis of variant angina(VA). Prostacyclin is one of the endothelium derived relaxing factors. The association between the novel single nucleotide polymorphism in the prostacyclin synthase gene and VA is not known. Therefore, we investigated the association between VA and the polymorphysm in the prostacyclin synthase gene. Methods : We compared 45 variant angina patients who had positive intravenous ergonovine test by coronary angiography with 59 control subjects who had negative intravenouis ergonovine test and normal coronary angiogram. Using the polymerase chain reaction-single-strand conformation polymorphism analysis, we identified a single nucleotide polymorphism, C117A, in exon 8. This nucleotide change did not cause an amino acid change in codon 373. Results : There was no significant difference in characteristics between the control group and the VA group, and there was no significant difference in the genotype distributions between the control group and the VA group. Conclusion : The C117A polymorphism in exon 8 of the prostacyclin synthase gene is not associated with variant angina.

혈액 투석 환자에서 중심정맥 협착에 대한 스텐트 삽입술 : Wallstent Placement

임대승,노상필,이유선,정승현,김보영,이정우,강정아,김정희,이민수,정준용,최시완,정진옥,성인환,이강욱,신영태 충남대학교 의과대학 의학연구소 2002 충남의대잡지 Vol.29 No.1

Stenosis of central vein is a common complication arising after percutaneous subclavian vein catheter insertion performed for temporary vascular access in chronic renal failure patients undergoing hemodialysis. There are several treatment methods for the condition like percutaneous angioplasty(PTA), stent insertion, and surgery, but recent trend is toward PTA and stents. Among the patients diagnosed with chronic renal failure from March 1993 to May 2002 and undergoing hemodialysis through AV fistula, the 14 Patients in whom central vein stenosis arose were selected for the study. A total of 28 percutaneous interventions(5 PTA and 23 stent placement) were performed, and restenosis rate and the time taken till the restenosis in de novo lesions and instant lesions were compared. All 28 cases were operated successfully. The 14 cases that received both anigioplasty and stent placement initially. (de novo lesion : 14 cases), Among the 10 cases with de novo lesion that followed up more than 1 year, 3 cases are currently undergoing hemodialysis without restenosis, and the remaining 7 cases have recurred stenosis with the mean time to restenosis of 10.9 months. In the 7 cases in whom stenosis recurred, 11 interventions were done(instent lesion: 11 cases). 4 of these were using only ballon angioplasty with 100% restenosis rate and the mean time of 3 months until restenosis. The remaining 7 cases were using both balloon angioplasty and stent placement, also with 100% restenosis rate but with the mean time of 12 months until restenosis, which was later than the group receiving only balloon angioplasty. In treating the patients with central vein stenosis, stent placement seems to be more advantageous over PTA in terms of restenosis rate and the mean duration of patency. In the case of instent lesion, inserting the stent for the second time after stenosis recurred lengthened the duration of patency compared to performing balloon angioplasty alone.

굽은 경골 교합성 골수강내 금속정 : 1예 보고 A Case Report

정환용,이우석,김대환 대한골절학회 2003 대한골절학회지 Vol.16 No.1

경골 골절에서 골수강내 금속정 치료 후 이차적인 수상으로 발생한 파손된 골수강내 금속정에 관한 보고는 간간히 있었으나, 굽은 골수강내 금속정에 대한 보고는 극히 드물었다. 저자들은 이전에 경골 골절로 골수강내 금속정으로 수술한 후 교통사고로 발생한 굽은 골수강내 금속정 환자 1예를 치험하였기에 보고하는 바이다. Broken tibial intramedullary nails caused by secondary trauma have been infrequently reported, but bent intramedullary tibial nail was extremely rare. We describe a rare case of a bent intramedullary tibial nail due to a traffic accident who had previously operated with intramedullary tibial nail

K 강선 및 긴장대 강선을 이용한 원위 쇄골 제 2형 골절의 치료

정환용,이우석,전택수,김대환,김광균,임재우 대한골절학회 2003 대한골절학회지 Vol.16 No.2

목 적: 쇄골 윈위부 제 Ⅱ형 골절의 치료에 있어 견봉 쇄골 관절을 통과하지 않고 직접 골편을 고정시키는 K 강선 및 긴장대 강선을 이용한 고정술로 치료한 환자에서 임상 결과를 후향적으로 분석하여 보고하고자 한다. 대상 및 방법: 2000년 5월부터 2001년 5월까지 쇄골 원위부 제 Ⅱ형 골절로 관혈적 정복술 및 K 강선 및 긴장대 강선을 이용한 고정술을 실시한 12례 중 최소 1년 이상 추시가 가능한 11례를 대상으로 하였다. 임상적 평가를 위해 최종 추시에서 변형된 견관절 기능 평가법을 사용하여 결과를 분석하였고 골유합 상태, 합병증, 견관절 운동범위를 측정하였다. 결 과: 전례에서 골유합을 얻었으며, 수술 후 골 유합까지의 기간은 평균 10주 (8~12주)였다. 최종 추시 상 견관절의 운동범위는 모두 정상 소견이었고, 변형된 견관절 기능 평가상 우수 9례, 양호 2례였다. 결 론: 쇄골 원위부 제 Ⅱ형 골절에서 K 강선 및 긴장대 강선을 이용한 고정술은 좋은 치료 방법 중 하나로 사료된다. Purpose: This is retrospective study to analyze the clinical results of the usefulness of K-wires and tension band wiring that fix the fracture fragment directly without passing the acromioclavicular joint in distal clacivle type Ⅱ fractures. Materials and Methods: From May 2000 to May 2001, eleven patients with distal clavicle type Ⅱ fracture were treated by open reduction and internal fixation with K-wires and tension band wiring. The clinical results were analyzed according to modified shoulder rating scale for distal clavicle freacture. Radiological union, complication, and range of motion of the shoulder were assessed. Results: All fractures were united at 10 weeks (8~12 weeks) in average. Finally, full range of motion of the shoulder joint was achieved in all patients. No complication was found and the modified shoulder rating scale for distal clavicle fracture were as follows: excellent 9 and good 2. Conclusion: K-wires and tension band wiring can be a good treatment method for distal clavicle type Ⅱ fractures.

고양이의 Toxoplasma 抗體價 測定 및 腸內 奇生蟲 感染에 關한 硏究

辛大煥,金明海,李英河,羅榮彦 충남대학교 의과대학 지역사회의학연구소 1988 충남의대잡지 Vol.15 No.2

In order to confirm the intestinal helminthes, protozoa and Toxoplasma antibody titers from 41 cats, author performed the autopsy, stool examination, and Sabin & Feldman dye Test. 1. Total infection rates were 68.3%, and double infection rates were 29.3%. From 41 cats, 8 species were identified to Isospora felis(2.4%), Toxocara cati(7.3%), Ancylostoma sp(2.4%), Taenia taeniaeformis(51.2%), Diphyllobothrium mansoni(19.5%), Hymenolepis nana(2.4), Clonorchis sinensis (7.3,%), and metagonmus yokogawai(4.9%). 2. Habored region of each parasites was mainly small intestine, especially duodenum, and only Clonorchis sinensis was harbored in liver and bile duct. 3. Egg occurrence rate was 33.3% (T. taeniaeforis), 66.7(C. sinensis), and 100%(D. mansoni, M. yokogawai, I. felis). 4. Sabin & Feldman dye test titer was positive reaction in 14 cases corresponding to 34.190, and 27 cases were considered as negative.