혈관질환 정보관리 시스템

김동익,김덕경,허세호,이병붕,김용신,김은숙,문지영,도영수,신성욱,김동수,김만태,진재욱,김용신 대한혈관외과학회 2002 Vascular Specialist International Vol.18 No.1

As medical technology progresses rapidly, there is a rise in the average age along with the Korean dietary lifestyle becoming more westernized, which leads to an increase in the number of vascular disease patients in Korea. Thus, we need to manage the medical information of a disease systematically in order to diagnose and treat constructively. However, since there has been no standardized method of man agement to date, a great deal of information could not be properly utilized nor studied. Therefore, the departments of Cardiology, Radiology and Neurology of Samsung Seoul Hospital recently got together to develop an information management system called the Vascular Data System. This program was developed to be run on win98 O/S, upper Pentium Ⅲ, and upper 128 MB Memory, and its source code is Dephi 4.0. It was configured for the user to set the configurations as well as do a variety of search and analysis. If this program were to be updated continuously, it may be used extensively as well as in various parts of clinical research activities.

Angiotensin Concerting Enzyme 유전자의 유전적 다형성(Genetic Polymorphism)이 관상동맥 질환 위험인자에 따른 혈중 Plasminogen Activator Inhibitor-1의 농도에 미치는 영향

김덕경,김종원,권현절,류재춘,박승우,김준수,이상훈,홍경표,박정의,이원로 대한고혈압학회 1996 대한고혈압학회지 Vol.2 No.2

당뇨병 환자에서 혈장 Thrombin-Antithrombin Ⅲ 및 Plasmin-α_2-Plasmin Inhibitor 복합체의 임상적 의의

김경욱,김은숙,정상수,윤수지,박우일,이준희,남수연,안철우,문병수,김경래,차봉수,송영득,임승길,이현철,허갑범 대한당뇨병학회 2002 Diabetes and Metabolism Journal Vol.25 No.5

연구배경:당뇨병 환자에서 혈액응고 및 섬유소용해 체계의 이상경향이 있어 그 결과로 여러 혈관합병증의 발생위험이 높다는 사실은 널리 알려져 있다. 그 기전은 아직 확실히 밝혀지지 않았으나, 고혈당으로 인한 혈장 단백질들의 비효소성 당화작용이나 산화성 스트레스로 인한 유리 라티칼 작용으로 응고항진이나 섬유소용해 활성의 저하를 유발하는 것으로 생각되고 있다. 최근 응고 및 용해인자와 그 억제자의 복합체들의 증가가 이 상태를 비교적 예민하게 반영한다고 알려져 있다. 방법:본 연구에서는 당뇨병 환자 101명과 정상 대조군 20명에서 혈장내 thrombin­antithrombin complex(TAT)와 plasmin­α₂­plasmin inhibitor complex(PIC)를 측정하여 비교하고, 당뇨병 환자에서 미세혈관 합병증과 대혈관합병증의 유무에 따른 차이와, 이미 혈관 질환의 위험인자로 알려져 있는 인자들간의 상관성을 알아보고자 하였다. 결과:1. 환자의 분포를 살펴보면 혈관합병증이 있는 군은 85명, 혈관합병증이 없는 군은 16명이었고, 평균연령은 각각 57.9±14.1세, 49.9±16.6세로 혈관 합병증이 있는 군에서 더 나이가 많았고, 체질량지수는 23.2±3.4㎏/㎡, 24.1±3.4㎏/㎡로 두 군간 유의한 차이는 없었다. 또 두 군간의 혈압 및 HbA1c, 공복혈당 및 인슐린과 C­peptide, 총 콜레스테롤, 중성지방, HDL­콜레스테롤, Lp⒜는 유의한 차이가 없었고, 미세혈관합병증이 있는 군에서 당뇨병의 유병기간이 길었다. 2. TAT 및 PIC의 농도는 정상 대조군에서는 2.8±1.2 ng/mL, 240.4±69.7 ng/mL이었고, 당뇨병 환자군에서는 9.5±22.6 ng/mL, 472.2±258.7 ng/mL이었다. TAT와 PIC 모두 당뇨병 환자군에서 정상 대조군에 비해 유의하게 증가되어 있었고(p<0.001), TAT/PIC ratio는 두 군간 차이가 없었다. 3. 당뇨병 환자의 혈관합병증에 따른 TAT 및 PIC, fibrinogen 농도는 합병증이 없는 군은 각각 4.1±2.4ng/mL, 362.2±272.0ng/mL, 322.7±102.4mg/mL으로 PIC와 fibrinogen의 증가를 보였으나, 연령을 보정한 후에는 통계학적 유의성은 없었다. 또 대혈관 합병증군에서는 각각 6.0±4.9 ng/mL, 507.4±321.6 ng/mL, 427.1±194.7 mg/dL이었으며 미세·대혈관 합병증군에서는 10.4±6.4 ng/mL, 484.8±269.7 ng/mL, 388.4±132.4 mg/dL으로 TAT의 증가를 보였으나 역시 연령을 보정한 후에는 통계학적 유의성은 없었다. 4. 미세혈관합병증군에서 HbA1c(>8%)가 높은 군의 PIC 농도가 유의하게 높았고(p=0.049), 대혈관합병증군에서 HbA1c(>8%)가 높은 군의 총 콜레스테롤 농도가 유의하게 높았다(p=0.042). 5. 총 당뇨병 환자군에서 PIC는 fibrinogen과 HbA1c와 양의 상관관계를, BMI와 음의 상관관계를 보였으며(r=0.47, 0.31,-0.25), 혈관 합병증이 없는 당뇨병 환자군에서만 TAT는 HbA1c와 양의 상관관계를 보였다(r=0.67). 결론:이상의 결과에서 혈장 TAT 및 PIC 농도는 당뇨병 환자에서 정상 대조군에 비해 의미있게 증가되어 있었고, 당뇨병 환자군에서는 연령의 증가와 유병기간이 혈액응고항진 및 용해의 장애에 큰 역할을 함을 알 수 있었으며, 총 당뇨병 환자군에 PIC와 HbA1c와 양의 상관관계를, BMI와 음의 상관관계를 보였으며 혈관 합병증이 없는 당뇨병 환자군에서만 TAT는 HbA1c와 양의 상관관계를 보였다. 따라서 당뇨병 환자에서 혈액응고 및 용해의 장애가 동반되어 있다고 볼 수 있으며, 혈장 TAT 및 PIC는 혈관합병증으로의 진행을 예측하는 지표로서 유용하리라 생각된다. 또 혈당조절정도와 상관성이 있으므로 혈당조절후에 추적검사를 시행하여 합병증의 예방이 가능한지 추후 연구가 필요하리라 생각된다. Background : Abnormality of coagulation and fibrinolystic system is known as a predisposing factor of vascular complication in diabetes. Although the pathogenesis is not well known, non-enzymatic glycation reaction and the increase in production of free radicals due to an increased oxidative stress may be linked to the hypercoagulibility and hypofibrinolytic activity. As indices of abnormality in coagulation and firinolysis in peripheral blood, plasma thrombin-antithrombin Ⅲ complex (TAT) and plasmin-α_2-plasmin inhibitor complex (PIC) were measured. The purpose of this study was to clarify whether hypercoagulability exists in diabetic patients with or without vascular complication. Methods : In our study, we measured plasma thrombin-antithrombin Ⅲ compelx (TAT) and plasmin-α_2-plasmin inhibit or complex (PIC) in 101 diabetic subjects and 20 controls. Comparing TAT and PIC levels in diabetic microvascular complication group, diabetic macrovascular complication group and controls, we examined correlation between risk factors associated with diabetic vascular complication. Results : 1. The group with diabetic vascular complication was older than group without complication. There was no significant difference in BMI, blood pressure, HbA_ic, blood sugar level, insulin, C-peptide, serum creatinine, total cholesterol, triglyceride, HDL-cholesterol, Lp (a) between two groups. The group with diabetic microvascular complication had longer duration of diabetes. 2. Concentration of TAT and PIC were 2.8±1.2 ng/ mL, 240.4±69.7 ng/ mL in controls and 9.5±22.6 ng/ mL, 472.2±258.7 ng/ mL in diabetic patients, respectively. TAT and PIC were significantly higher in diabetic patients than in control (p<0.001). But TAT/PIC ratio was no significant difference between two groups. 3. In diabetic patients, concentration of TAT and PIC and fibrinogen were respectively 4.1±2.4 ng/ mL, 362.2±272.0 ng/ mL, 322.7±102.4 mg/ dL in group without vascular complication and 5.3±4.1 ng/ mL, 529.5±258.7 ng/ mL, 374.9±106.2 mg/ dL in group with microvascular complication, which group had increase in PIC and Fibrinogen but no significance after correction of age. Concentration of TAT and PIC and Fibrinogen were 60.±4.9 ng/ mL, 507.4±321.6 ng/ mL, 427.1±194.7 mg/ dL in macrovascular complication, and 10.4±6.7 mg/ mL, 484.8±269.7 ng/ mL, 388.4±132.4 mg/ dL in combined vascular complication which group showed increase of TAT but also had no significant increase after correction of age. 4. In diabetic microvascular complication patients, group of high HbA_1c (>8%) (p=0.049) had significant high PIC concentration. In diabetic macrovascular complication patients, group of high HbA_1c (>8%) (p=0.042) had significant high total cholesterol concentration. 5. In all diabetic patients, PIC was positively correlated with fibrinogen and HbA_1c and negatively correlated BMI (r=0.47, 0.31, -0.25). Only in daibetic patients without angiopathy, TAT was positively correlated with HbA_1c (r=0.67). Conclusion : In this study, plasma TAT and PIC concentration significantly increased in diabetic patients compared with controls, and PIC was increased in group with microvascular complication, TAT were increased in group with combined micro macrovascular complication. However, there was no significance relationship existed when correctinf for age. PIC was correlated with HbA_1c. TAT was correlated with HbA_1c only in the group without angiopathy. Abnormality of coagulation and fibrinolysis were combined in diabetes, plasma TAT and PIC can be used as an index of vascular complication. Also we found the correlation with the degree of the blood glucose control. Therefore we need follow up study for the possibility of prevention of vascular complication after controlling the blood glucose to age-matched patients (J Kor Diaabetes Asso 25:354~363, 2001).

Comparison of Characteristics of Soybean Varieties Grown in a Green House and open Field for Leaf Use

Kim, Yong_Duk,Yang, Young_Taek,Kim, Kyung_Ho,Kim, Sung_Taek,Kang, Hyoung_Shick 한국작물학회 2008 한국작물학회 학술발표대회 논문집 Vol.2008 No.10

Jeju islanders consume soybean leaves as a wrapping for slices of raw fish and pork, eating mainly the young, raw, but fully extended leaf. These leaves are known to contain several kinds of functioning compounds, such as amino acids, isoflavones, flavonoids and pterocarpans. Farmers grow soybean leaves, but different soybean varieties and their characteristics for soybean leaf production have not been studied. Therefore, this study compared agronomic characteristics and iso flavones among varieties grown in a green house and in an open field. The results were as follows: There were differences in agronomic characteristics among the varieties and between places grown; generally, indoor growing produced bigger and more abundant leaves of higher quality. There were also differences in isoflavone contents in soybean leaves. Soybean leaves harvested earlier contained higher amounts in total concentration. Plants grown outside showed slightly higher but, different concentrations of the compunds studied. These results indicate that it is possible to control the isoflavone levels with varieties used, and harvest time and place.

중증 허혈성 지체질환 환자에서 시행된 vascular endothelial growth factor의 혈관신생 유전자치료 1예

김현중,장신이,김종묵,김선영,김병문,김원배,김덕경 대한내과학회 2003 대한내과학회지 Vol.64 No.1

저자 등은 기존의 치료에 반응하지 않은 중증 허혈성 지체질환 환자를 대상으로 하여 vascular endothelial growth factor를 이용한 혈관신생 유전자 치료를 시행하였다. 치료 후 환자의 허혈에 의한 하지 통증이 현격하게 감소하고 상처의 진행이 측부혈관이 많이 증가됨이 관찰되어 이에 문헌고찰과 함께 보고하는 바이다. We report VEGF-induced angiogenic gene therapy in a patient with critical limb ischemia, who did not respond to conventional treatment. This patient was the first case in a dose-escalating series of phase I clinical trial. The patient had severe resting pain, gangrene and diffuse ulcer in his left foot. Total 1,000㎍ of naked DNA encoding human VEGF165 was administered intramuscularly to 8 sites of the loft lower extremity. Four weeks after the first 1,000㎛ was administered to the same sites (total dose: 2,000㎛). After gene therapy, resting pain gradually reduced and the amount of analgesics taken by the patient decreased. The ischemic wound of lower extremity slightly improved. However, there was no complete wound healing at 12 weeks of treatment. Digital subtraction angiography at 12 weeks after gene therapy showed an increase in collateral vessels at the mid-tibial, ankle and foot arch levels. Immediately and up to 12 weeks, there was no complication related to gene therapy. These findings may be cautiously interpreted to indicate that intramuscular injection of naked plasmid DNA of VEGF_165 may induce therapeutic angiogencsis in a patient with critical limb ischemia. Further clinical evaluation of VEGF-induced gene therapy is needed to evaluate the safety and efficiency of this treatment.(Korean J Med 64:85-90, 2003)

안지오텐신 변환효소 억제제와 안지오텐신 II 수용체 차단제 투여 후 발생한 급성 신부전과 폐부종으로 전원된 선천성 단일신 환자의 치료 1예

백두현,김경진,홍성철,강석형,송하응,김혜인,김수현,오현정,강혜원,김서우,유민아,류동열,최규복,강덕희 이화여자대학교 의과대학 2010 EMJ (Ewha medical journal) Vol.33 No.1

Blockers of renin-angiotensin system(RAS) including ACE inhibitor or ARB are one of the most frequently prescribed medications for the treatment of hypertension, heart failure and proteinuria. One of the major side effects of these RAS blockers is the deterioration of renal function, mainly due to a reduction of intraglomerular pressure. Therefore, close monitoring of renal function is recommended when RAS blockers are initially prescribed, especially for the patients with impaired renal function. We report a patient who was transferred to our hospital due to the sudden development of oliguria and dyspnea after treatment for hypertension with ACEi and ARB. She was finally diagnosed as RAS blocker-induced acute renal failure with pulmonary edema complicated on congenital solitary kidney. After hemodialysis and conservative treatment, her renal function was recovered with maintenance of normal urine output. Conclusion:This case highlights the necessity of the functional and structural evaluation of kidney to prevent the serious complication such as acute renal failure before the administration of ACEi and/or ARB.

열공형과 비열공형 피질하 혈관성 치매에서 위험인자의 차이에 관한 비교 연구

배희준,정지향,유경호,나덕렬,김상윤,최경규,양동원,손의주,이상도,김재우,박경원,김응규,이재홍,박미영,한일우,함동석,최문성,하충건,최성혜,이애영,이병철,한설희 대한치매학회 2003 Dementia and Neurocognitive Disorders Vol.2 No.2

Backgrounds and Objectives: Vascular dementia is a group of dementing disoders arising from various stroke syndrome. Among these. subcortical ischemic vascular dementia (SIVD) is regarded as a relatively distinct clinical entity. However, MRI patterns of SIVD are not homogenous. In some patients, lacunes are dominant, and in others, subcortical white matter changes are. This study was designed to compare risk factor profiles between SIVD with and without multiple lacunes. Methods: We divided 47 subjects (22 males, mean age. 68 years) recruited from VADAPET (Multicenter Trial For Evaluation Of The Changes In the PET Images Of Subcortical Vascular Dementia Patient) study into two groups one with more than 5 lacunes in deep gray matter (lacune group) and the other with 5 or less(non-lacune group) Clinical characteristics and laboratory findings of two groups were compared. Results: Nineteen of 47 patients (40%) belonged to the lacune group. The lacune and non-lacune groups d d not differ in the following variables: age, hypertension, diabetes mellitus, hyperlipidemia heart disease, history of stroke or TIA, history of trauma or major surgery, family history of hypertension stroke, or dementia, age at diagnosis of dementia, body mass index, white blood cell count, ESR, CRP, fibrinogen, hemoglobin A1C, total cholesterol. LDL cholesterol creatinine, proteinuria, glucosuria, and microhematuria. However, male sex, smoking alcohol. hemoglobin, and HDL cholesterol were possibly associated more with lacune group SIVD than with non-lacune group (p<0 1) Multivariate analyses revealed that smoking, hemoglobin, and HDL cholesterol were independent predictors of SIVD with multiple lacunes Conclusion: Our study suggests that SIVD with multiple lacunes may be significantly different in smoking habits hemoglobin, and HDL cholesterol from SIVD without multiple lacunes.

복부 대동맥 가성동맥류를 동반한 Behcet 씨 병 : 증례 보고

김동익,이병붕,조진현,이순정,도영수,김덕경 대한혈관외과학회 1999 Vascular Specialist International Vol.15 No.1

Behcet's disease is a multisystem disorder presenting with recurrent oral and genital ulcerations as well as ocular involvement. The etiology and pathogenesis of this disease remain obscure; it is considered an autoimmune disease since vasculitis is the main pathologic lesion and circulating autoantibodies to human oral mucous membrane are found in approximately 50 percent of the cases. Vascular lesions with Behcet's disease may include deep venous thrombosis, superficial thrombophlebitis, arterial obstruction, or arterial aneurysms. Although arterial aneurysmal lesions are uncommon in patients with Behcet's disease, they may pose serious, life-threatening therapeutic problems due to the risk of rupture. Here, we report a case of Behcet' s disease, involving abdominal aorta with review of literature.

경주지역 여고생의 초경과 체성장간의 관계

김준섭,권오구,박진석,오종수,박정현,박제식,안세한,이용환,서정호,신태섭,최영배,김덕수,이관,박수경 東國大學校醫學硏究所 2002 東國醫學 Vol.9 No.1

본 연구는 경주지역 1개 고등학교 3학년 여고생을 대상으로 초경 시작 전인 초등학교 4학년부터 고등학교 2학년까지의 키, 몸무게, 가슴둘레 수치와 초경 연령을 파악하여 여성의 초경이 빠를수록 체성장 속도의 변화가 있을 것이라는 가설을 기초로 두 요인간의 관련성을 파악하고자 시행되었다. 경주시 1개 여자고등학교 3학년생 총 317명에 대해 ㅊ경 나이, 초경시 심리 상태, 초경이 시작되었을 때의 상담 여부와 상담하였던 사람, 부모 신장과 초경전후의 식사 규칙성, 다이어트 경험, 수면시간, 스트레스, 음주/흡연 여부, 질병력 등에 대한 설문 조사를 시행하였고, 초등학교 4학년부터 고등학교 2학년까지의 키, 몸무게, 가슴둘레에 대한 정보는 건강기록부에서 확보하였다. 상기 대상자 중 건강기록부가 분실된 39명, 초경나이에 대해 응답하지 않았던 29명 및 결석 등으로 조사를 하지 못하였던 42명을 제외한 조사 대상자는 206명으로 선정하였다. 대상자들의 초경연령 평균값(Mean±SD)은 13.0±1.11이었고, 초등학교 4학년부터 고등학교 2학년까지의 초경 이후 신장 성장률은 감소하였으며, 초경연령이 빠른 군이 초등학교 때는 신장에 있어서 우위를 차지하나 고등학교에 오면서 신장은 비슷한 수준이 되었다. 초경후 1-2년 사이에 체중과 흉위의 증가율은 감소하였고, 초경연령이 빠른 군이 초등학교와 고등학교 사이에 체중과 흉위에서 모두 우위를 차지하였다. 본 연구의 결과는, 흔히 이차 성징의 시작 시점 혹은 사춘기의 시작 시점으로 보고있는 초경 연령이 청소년기의 성장과 밀접한 관련성이 있고, 특히 체중과 흉위의 성장 속도와 밀접한 관련성이 있음을 시사한다. To understand the onset of menarche in relation to changes in physical growth that take place during female adolescence, especially the changes in height and weight velocity. The 207 senior in one women high school of Kyongju were investigated in April 3 to 8, 2001. We collected the information, relation in the age at menarche, height & weight of parents, regularity of eating, and obesity diet, duration of sleeping, sickness & stress near age at menarche, by self-recording. The status of height, weight & chest circumference between the 4th grade of primary school and the junior of high school was collected by individual Health Record. The results were followed; The average age at menarche was 12.95±1.11 years old and the most frequent age of menarche is 13 years. After menarche, the velocity of height, weight and chest circumference were decreased. The most rapid group of menarche hold dominant position in height during elementary school. As time passed, they dont hold dominant position in height. The most rapid group of menarche get an advantage in the weight and the girth of chest after elementary school. The height of subjects is directly proportional to the height of their parents. These results suggest that the starting age at menestuation can be closely associated with physical growth and development.

Digora 영상시스템을 이용한 인접면 인공 치아우식병소의 진단능에 관한 연구

김재덕,오경란,최의환 大韓口腔顎顔面 放射線學會 1998 Imaging Science in Dentistry Vol.28 No.2

Digora system is an intraoral indirect digital radiography system utilizing storage phosphor image plate. It has wide dynamic range which allows it to decrease the patient's exposure time and may increase diagnostic ability through image processing (such as edge enhancement, grey scale conversion, brightness change, and contrast enhancement). And also, ti can transmit and storage image information. The purpose of this study was to evaluate the diagnostic ability of artificial proximal caries between Conventional radiograph and Digora images(unenhanced image, brightness & contrast controlled image, and edge enhanced image). ROC(Receiver Operating Characteristic) analysis, paired t-test, and F-tests were done for the statistical evaluation of detectability. The following results were acquired: 1. In Grade I lesions, the mean ROC areas of Conventional radiograph, Digora unenhanced image, Digora controlled image, and Digora edge enhanced image were 0.953, 0.933, 0.965, 0.978 (p>0.05). 2. In Grade II lesions, the mean ROC areas of Conventional radiograph, Digora unenhanced image, Digora controlled image, and Digora edge enhanced image were 0.969, 0.964, 0.988, 0.994. Among theses areas, there was just statistical significance between Diagnostic abilities of Digora edge enhanced image and Conventional rediograph(p<0.05). 3. In the Interobserver variability, the ROC curve areas of Digora edge enhanced image was lowermost in these areas, regardless of the Carious lesion depths. In conclusion, intraoral indirect digital system, Digora system has the potential possibility as an alternative of Conventional radiograph in the diagnosis of proximal caries.