지난 2년간의 학회지 "신경정신의학" 심사 평가보고

김찬형,김세주,김도관,김성곤,박원명,송동호,박용천,이영문,오강섭,정영철,이상열,김주한,이동영,이헌정,함병주,김율리,김문두,김정진,이강욱,천근아,김재진,홍진표,홍승철 大韓神經精神醫學會 2007 신경정신의학 Vol.46 No.6

Characterization of Antihypertensive Angiotensin I-Converting Enzyme Inhibitor from Recombinant E. coli

Kim, Jae-Ho,Jeong, Seung-Chan,Lee, Dae-Hyoung,Lee, Jong-Soo 배재대학교 자연과학연구소 2005 自然科學論文集 Vol.16 No.1

안지오텐신(ACE) 저해제는 항고혈 효과를 갖고 있으므로 오랫동안 고혈압의 예방이나 치료에 이용되어 왔다. 본 연구는 재조합 대장균으로부터 새로운 ACE 저해제를 생산하고 정제하며 나아가 이들이 구조-기능 관P를 규명하기 위해 수행되었다. Saccharomyces cerevisiase의 ACE 저해 펩타이드 유전자를 함유하고 있는 재조합 pGEX-4T-3을 대장균 BL21(DE3)로 형질전환 시켰다. 재조합 pGEX-4T-3을 갖고 있는 대장균 BL21(DE3)로부터 생산된 Glutathione-s 전이효소 (GST) 융합 단백질을 얻어서 그중 ACE저해 펩타이드를 Sephadex G-25 컬럼 크로마토그래피로 정제하였다. 정제된 ACE 저해 펩타이드는 타이로신-아스파틱엑시드-그리신-글리신-발린-패닐알라린-아르기닌-발린-타이로신-트레오닌의 서열을 가진 새로운 decapeptide이었고 ACE에 대하여 경쟁적으로 저해하였다. The angiotensin I-converting enzyme (ACE) inhibitor has anti-hypertensive effects and has long been used as prevention or remedy of hypertension. This study were carried out to produce and purify a new ACE inhibitor from recombinant E. coli and further elucidate its structure-function relationship. Recombinant pGEX-4T-3 containing ACE inhibitory peptide gene of Saccharomyces cerevisiae was transformed into E. coli BL21(DE3). Glutathione-S transferase (GST) fusion protein from E. coli BL21(DE3) harboring the recombinant pGEX-4T-3 was obtained and the ACE inhibitory peptide was purified with Sephadex G-25 column chromatography. The purified ACE inhibitory peptide was a novel decapeptide with sequence Tyr-Asp-Gly-Gly-Val-Phe -Arg-Val-Tyr-Thr which shows very low similarity to the other ACE inhibitory peptide sequence. The purified ACE inhibitor competitively inhibited ACE.

항암화학요법 중 호중구감소증이 발생한 저위험군 발열 환자들을 대상으로 한 경구 항균제 요법의 임상적 유용성 및 안정성에 대한 연구

김연숙,이혁,기현균,김춘관,김신우,김성민,백경란,김원석,윤성수,이홍기,강원기,박찬형,박근칠,송재훈 대한화학요법학회 2000 대한화학요법학회지 Vol.18 No.1

목적 : 항암화학요법 중 호중구감소증을 동반한 발열이 발생하는 암환자들을 치료하기 위한 다양한 항균제와 여러 가지 방법들이 시도되고 있는 가운데, 합병증과 사망률의 발생가능성이 적은 저위험군 환자들을 대상으로 초기 72시간동안 정주 항균제를 투여한 이후 경구 항균제로 전환하는 요법의 유용성과 안정성을 평가해보고자 본 연구를 시행하였다. 방법 : 1998년 2월부터 1999년 9월까지 본원에서 항암화학요법 중 호중구감소증과 발열이 발생한 환자들 가운데 기저 암질환이 고형암이거나 림프종이고, 입원당시 패혈증의 증후가 없으며 입원 72시간이내에 해열되고 백혈구수치가 증가 추세인 환자들을 대상으로 하여 72시간 동안 정주 항균제를 투여한 이후 경우 ciprofloxacin 750㎎을 하루 2회씩 투여하여 총 4일간 투여하였다. 모든 환자들은 열이 떨어지고 호중구감소증이 회복될 때까지 입원하도록 하였다. 결과 : 총 38명 환자의 40예가 등록이 되었고, 환자들의 기저암 질환은 고형함이 72.5%, 림프종이 27.5%였다. 입원당시 평균 호중구치수는 156/㎕였고, 호중구수치가 100/㎕미만인 경우는 65%였으며, 호중구감소증이 지속된 기간의 평균은 2.4일이었다. 40예 중 39예가 항균제의 변형이나 추가 없이 호중구감소증과 발열로부터 회복이 되어 97.5%의 성공율(95% 신뢰구간: 86.8-99.9%)을 보였다. 부작용으로 피부발진이 있었던 경우가 한 예 있었는데, 증상이 경하여 경구 항균제를 지속할 수 있었다. 심와부의 동통으로 복용을 지속할 수 없어서 대상에서 제외된 예가 또 한 예 있었다. 결론 : 항암요법 중 호중구감소증과 발열을 동반한 환자들 가운데 저위험군 환자들에서 항균제 72시간정주 이후 경구 항균제로의 전환요법은 효과적이고도 안전한 치료방법이라고 할 수 있다. Background : Oral antibiotic therapy following empirical intravenous antibiotics may be effective and safe for febrile neutropenic patients with lowrisk for complications. Methods : We conducted a prospective clinical trial of oral antibiotic therapy in the patients with neutropenia and fever during chemotherapy for cancer. Underlying malignancies were solid tumor or lymphoma with short duration of neurtropenia and the patients had no evidence of clinically or microbiologically documented infections. Oral ciprofloxacin was given to the patients who lacked signs of sepsis on admission, had a rising tendency of neutrophil count (ANC >100 /㎕ ) at 72 hours, and were afebrile at 72 hours. All patients were hospitalized until neutropenia and fever resolved. Results : A total of 40 episodes of 38 patients were enrolled from February 1998 to September 1999. The mean neutrophil counts on admission were 156/㎕ and the mean duration of neutropenia was 2.4 days. The episodes which had neutrophil count below 100 /㎕ were 26 (65%). Treatment was successful in 39 of 40 episodes (97.5% : 95 % confidence interval, 86.8% to 99.9%). Adverse reactions of oral ciprofloxacin were skin rash and epigastric soreness in two cases, respectively. There were no deaths during the study. Conclusions : For low-risk febrile patients with neutropenia during cancer chemotherapy, switch therapy to oral ciprofloxacin at 72 hours following intravenous broad-spectrum antibiotics is effective and safe,

좌각차단을 동반한 심부전증 환자에 실시한 양심실 심박조율기 치료 : 증례 보고

김찬욱,차태준,김성만,김민대,권성일,서수홍,최병주,주승재,이재우 고신대학교 의학부 2002 高神大學校 醫學部 論文集 Vol.17 No.1

Epidemiological studies suggest that 30-50% of patients diagnosed with symptomatic congestive heart failure(CHF) have electrocardiographic evidence of a major intraventricular conduction delay, which may worsen left ventricular systolic and diastolic dysfunction through asynchronous ventricular contraction and paradoxical interventricular septal wall motion. Biventricular pacing is an emerging therapy allowing simultaneous electrical stimulation of the both ventricles with an implantable pacing system and it improves hemodynamics and well-being of patient by reducing ventricular asynchrony. Recently, we underwent biventricular DDD pacemaker implantation in a patient with CHF and Left bundle branch block and was significantly improved exercise tolerance and quality of life in that patient.

제왕절개술 환자에서 수술전 투여한 ketamine의 혈청 interleukin-6 및 수술후 통증에 대한 효과

김진수,김유재,안기량,김천숙,김일호,한찬수 순천향의학연구소 1997 Journal of Soonchunhyang Medical Science Vol.3 No.2

The inflammatory reaction to tissue damage during surgery may induce central sensitization followed by hyperalgesia. Previous studies suggest that central sensitization is related to N-methyl-D-aspartate (NMDA) receptor activation, which can be blocked with NMDA antagonist, ketamine. Thus, we compared the effect of preoperative intravenous and epidural low doses of ketamine with placebo on serum interleukin-6 (IL-6) level and postoperative pain. ASA class I and II women scheduled for C-sections received intravenous ketamine 0.15mg/kg(group 2) or placebo(group 1), or epidural ketamine(0.15 mg/kg) before the operation. IL-6 levels were measured before and during the operation, and 8, 24, and 48 hrs after the operation. Visual Analogue Scales(VAS) and Verbal Ration Scales(VRS) were measured at 8, 24, and 48 hrs after the operation. Serum IL-6 levels at 8, 24, and 48 hrs after the operation were significantly lower in the intravenous ketamine and epidural ketamine groups than in the control group. VAS at 8 hrs and 48 hrs after the operation were significantly lower in the epidural ketamine group. VAS at 8 hrs and 48 hrs after the operation were significantly lower in the epidural ketamine group than in the control and intravenous ketamine groups. In conclusion, in the preoperative intravenous and epidural administration of low doses(0.15mg/kg) of ketamine, both are effective in reducing postoperative IL-6 levels. Epidural Ketamine is more effective than intravenous ketamine in postoperative pain control.

기도이물에 관한 임상적 고찰

한찬수,김태정,김일호,김유재,김천숙,안기량 순천향의학연구소 1996 Journal of Soonchunhyang Medical Science Vol.2 No.2

Aspiration of a foreign body in the airway is common cause of sudden obstructive breathing, crouping cough, hoarseness, and wheezing. Especially that caused serious problem in case of the young children. A past history of foreign body aspiration is itself an indication for bronchoscopic examination of the airway, because some children with aspirated foreign bodies are without symptoms and chest X-ray films may not show abnormalities. So the anesthesiologist should take a notice of removing foreign body in the anesthetic procedure. The author have experienced 36 cases removal of foreign bodies in the airway under general anesthesia from July, 1982 to January, 1996 in Chunan Hospital, College of Medicine, Soonchunhyang University. The results were as follows 1) Among the 36 cases, 25 cases(69.7%) were under the age of 5. The ratio of male and female was 1.8 : 1. 2) In duration of lodgement, there was most frequent within one day in 15 cases(41.7%) and the longest duration was 20 days. 3) The most common symptom, sign and auscultation finding were cough 19 cases(52.8%). chest retractions 7 cases(19.4%) and decreased breathing sound 20 cases(55.6%) 4) Abnormalities in the chest X-ray were found in 15 cases(41.7%) among 36 cases. 5) Vegetable foreign bodies, expecially peanut were the most common airway foreign body(28.7%), followed by plastic foreign body(14.4%) and mucous plug(11.3%). 6) The foreign body involved the right bronchus 16 cases(45.7), left bronchus 10 cases(28.6%), trachea 5 cases(14.3%), and larynx 4 cases(11.4%). 7) Foreign body induced complications occurred in 9 cases(25.0%); pneumonia 8 cases and pneumomediastinum 1 case, and all of postoperative complication was pneumonia(25.0%). 8) 34 foreign objects(94.4%) were removed by endoscopy but tracheostomy was required in two patients.

최근 8년간 K지방대학병원 응급실로 내원한 치과 응급환자에 관한 임상적 연구

유재하,김종배,김태우,문선재,권혁찬,김승범 大韓顎顔面成形再建外科學會 2001 Maxillofacial Plastic Reconstructive Surgery Vol.23 No.6

The delivery of the proper care to the emergency dental patients is more important in the aspdect of community dental service. To attain such a purpose requires the sacred duty to the training of oral and maxillofacial surgeons. This is a retrospective study on the characteristics of dental injuries and diseases in emergency patients. Ths study was based on a series of 2,649 patients treated as dental emergency patients at K country hospital of medical college, from Jan. 1, 1993, to Dec. 31, 2000. The obtained results were as follows. The trauma(71.6%) was the most frequent cause in dental emergency patients, odontogenic infection and oral hemorrhage were next in order of frequency. The primary interdental wiring and transpalatal wiring were frequent proper methods with rubber drainage for prevention of hemorrhage and infection in the primary care of jaw fracture. The peak incidence(45.0%) about the infection group was occurred in the pulpitis of advanced dental caries, and common treatments were the medication of antibiotics & anagesics and I&D. In the dentoalveolar hemorrhage group, a major cause was postoperative hemorrhage(57.9%) and hemostasis was obtained by pressure dressing, suture and drainage of infected wound. About TMJ disorder group, the peak incidence was showed in the post-traumatic myofascial pain dysfunction syndrome and its primary care was medications(anagesics & sedatives). In the other groups, various irritable specific pains were complained, such as trigeminal neuralgia-form pain, acute stomatitis, chemical burn, terminal stage neuritis of head & nech cancer and their primary care methods were various individually. For the rapid and correct care of the emergency dental disease above, well-trained education should be presented in the intern and resident curriculum of oral & maxillofacial surgery.

QT연장 증후군 환자에서 Head-Up Tilt Test에 의해 유발된 Torsades De Pointes 1례

전익수,차태준,김길수,김동완,김규종,김찬욱,김성만,주승재,이재우 대한순환기학회 2000 Korean Circulation Journal Vol.30 No.8

선인장 양심실 보조장치의 설계 및 임상적용을 위한 평가

민병구,박찬영,최재순,이혁수,황창모,김삼성,윤걸중,김종원,선경,이경갑,정종태,김원곤 제주대학교 인공심장이식연구소 2001 인공심장 연구 Vol.2 No.1

현재 개발되고 있는 맥동형 이식형 인공심장은 완전이식형 인공심장과 좌심실보조장치 뿐이다. 좌심실보조장치를 장착한 환자의 10~15%가 우심실의 보조를 필요로하고 완전이식형 인공심장의 장착을 위해서는 자연심장을 제거해야하는 상황에서 이식형 양심실보조장치에 대한 필요성이 대두되고 있다. 본 연구진은 완전이식형 인공심장으로 개발된 한국형 인공심장을 개선하여 양심 실 보조장치를 개발하였다. 양심실보조장치는 이동형 작동기식 미케니즘을 이용하고 있으며 에너지 변환장치와 감속기로 구성된 작동기와 혈액주머니, 그리고 내장형 제어기로 구성되어 있다. 선인장 펌프로 명명된 KAH350은 캐뉼라의 연결을 위한 커넥터를 포함하여 길이 177mm, 폭 164mm, 높이 67 이고 무게 780g이며 최대 심박출량은 5L/min 이다. 양심실보조장치로 개발된 선인장펌프는 좌심실보조장치로도 응용이 가능하다. 이식적합성과 생체적합성을 평가하기 위하여 좌심실보조장치로 5회, 양싱실보조장치로 6회의 동물실험을 수행하였다. 각각 최장 28일간 생존하였으며 11회의 동물실험중 장치의 결함에 의한 것이 3회 있었는데 이들은 모두 전자장치의 결함과 방수처리문제였다. 현재 이식적합성과 일박출량을 향상시킨 KAH400모델이 개발중이다. The types of pulsatile implantable artificial hearts that are on the way of development and have been developed are totally implantable artificial heart and implantable left ventricular assist device (LVAD). Approximately 10% to 15% of all patients Implanted with wearable VADs have required right heart support with another device. And it is reluctant to patient who should remove his or her own heart to be implanted with total artificial heart. These situations drive the development of implantable bi-ventricular assist device (BVAD). The Korean BVAD was develophed by modifying the moving actuator type Korean artificial heart. This electro-mechanical BVAD comprises actuator including energy converter and reduction gear train, blood sacs, and internal motor and energy controllers. The KAH350 which is named as 'Cactus Pump' is 177mm in length, 164mm in width, and 67mm in thickness including connectors and nuts. The weight and maximum cardiac output of Cactus Pump is 780g and 5L/min, respectively. The Cactus Pump that was developed as BVAD could be used as LVAD by attaching compliance caps on the 2 ports of one ventricle. The animal experiments were undergone 5 times for LVAD, and 6 times for BVAD. The best records were 28 days survival in both applications. There were 3 times of device failure and they were all associated with electrical connection and hermetic sealing. The KAH400 that has improved anatomical fitting characterisitcs and stroke volume is on development.

심혈관계 질환으로 관상질환 집중치료실에 입원한 환자들의 혜후 측정을 위한 APACHEⅢ점수 체계의 임상적 유용성

이공섭,이창선,최현주,홍종서,강지향,김도형,이민영,오인균,김병엽,김상억,김학찬,한승혜,이재용,지영우,안경주 대한순환기학회 2000 Korean Circulation Journal Vol.30 No.8