Gilbert 증후군에서 열량 제한 시험과 Phenobarbital 자극 시험의 의의(14예)

이헌영,채경훈,정재훈,강윤세,김연수,문희석,박기오,이엄석,김선문,김석현,성재규,이병석,이강욱 충남대학교 의학연구소 2003 충남의대잡지 Vol.30 No.2

Gilbert 증후군은 인구의 7%에서까지 나타날 수 있는 매우 흔한 증후군으로서 비진행성인 양성의 만성적 경과를 치하며, 간질환의 증상과 징후가 없는 경한 비포합형 고빌리루빈혈증이 특징인 일종의 체질적인 증상으로서 혈장 빌리루빈 농도에 대한 사춘기의 영향 때문에 10대와 20대에 자주 진단이 된다. 따라서 임상적인 중요성은 미약하지만 높은 빈도가 예상되는 점에 그 중요성이 부여되어야 할 것이다. 따라서 적정한 임상적 진단법으로 기왕에 소개된 열량제한 시험과 phenobarbital 유도 시험을 시행하고 이들의 진단적 가치를 알아보기 위하여 본 연구를 시행하였다. 1990년 7월부터 1999년 4월까지 충남대학교병원에 내원하여 HBsAg, IgG anti-HBc 및 anti-HCV가 음성이고, 간 초음파 스캔에서 이상이 없으며, 혈청 AST, ALT 및 AP가 정상인 비음주자에서 경한 비포합형 고빌리루빈혈증이 있는 14예의 환자들을 대상으로 ^(99m)Tc-DISID 스캔을 시행하였으며, 기저 치 총빌리루빈 및 포합형 빌리루빈 치를 측정한 다음에 하루에 400Kcal로 48시간동안 제한한 열량 제한 시험을 시행하였고, phenobarbital을 하루 60mg씩 5일간 투여한 후에도 각각 총빌리루빈과 포합형 빌리루빈 치를 검사하여 비포합형을 구하였다. 대상 환자들은 모두 14예로서 남자가 11예(78.6%)였고 여자가 3예(21.4%)여서 3.7:1로 남자에서 많았으며, 20대가 6예(42.9%), 30대가 역시 6예(42.9%) 및 40대가 2예(14.2%)로서 2,30대가 대부분(85.8%)이었다. 열량 제한 시험 후의 총빌리루빈 치, 비포합형 및 포합형 빌리루빈 치들은 평균 각각 5.5±2.7, 4.2±2.3 및 1.3±10mg/dL 로서, 시험 전 치들인 3.0±0.8, 2.2±0.8 및 0.7±0.4mg/dL 보다 유의하게(p=0.001, p=0.001, p=0.023) 상승하였다. 포합형 빌리루빈 치도 유의하게 상승하였으나 비포합형의 상승보다는 훨씬 낮아서 주로 비포합형이 증가하였다. phenobarbital 투여 중 설사가 발생하여 중단한 1예를 제외한 13예에서 열량 제한 시험 후에 상승하였던 총, 비포합형 및 포합형 빌리루빈 치가 phenobarbital 유도 시험후에는 2.0±1.1, 1.5±0.8 및 0.5±0.4mg/dL로서 열량 제한 시험 결과보다 유의하게 낮아졌고(p=0.00, p=0.000, p=0.001), 열량 제한 시험 전의 기초치들인 3.0±0.8, 2.2±0.8 및 0.7±0.4mg.dL 보다도 더욱 낮아졌으며 유의한 차이(p=0.001, p=0.02, p=0.005)를 나타내었다. 14예에서 시행한 ^(99m)-Tc DISIDA 스캔에서 9예(64.3%)가 정상이었고, 5예(35.7%)에서는 심장 및 신장으로의 간외 섭취가 3예였고, 60분까지 소장 배출이 없는 배설 지연 예와 담낭 수축 불량 예가 각각 1예 씩 발견되었다. Phenobarbital 투여시험에서 민감도가 열량제한시험에 비해 더 높았다(92.3%와 50.0%). Gilbert 증후군에서 1일 400 Kcal로 48시간의 열량제한 시험과 1일 60mg의 phenobarbital을 5일간 투여하는 유도 시험은 편리하고 유용한 임상적인 진단법으로 이용할 수 있다고 생각된다. 그러나 열량 제한 시험에서는 증가 기준의 통일이 필요하다고 유추되며 phenobarbital 유도 시험이 민감도가 더 높은 것으로 생각된다. Gilbert's syndrome is very frequent and benign chronic process characterized by mild, intermittent, unconjugated hyperbilirubinemia without any symptom and sign of liver disease. Previously intoduced caloric restriction test and phenobarbital stimulation test as two appropriate clinical tests had been examined and their diagnostic values were reevaluated. Fourteen patients with mild, persistent, unconjugated hyperbilirubinemia were included. Subsequently caloric restriction has been applicated by 400 Kcal/day for 48 hours and phenobarbital has been prescribed by 60 mg/day for 5 days. Therafter serum levels of total and direct bilirubin were measured. Most of the patients were third and fourth decade(85.8%) and male predominant. Each basal serum levels of total, indirect and direct bilirubin were 3.0±0.8, 2.2±0.8 and 0.7±0.4 mg/dL. After caloric restriction test, each levels were increased significantly to 5.5±2.7, 4.2±2.3 and 1.3±1.0 mg/dL(p=0.001, p=0.001, p=0.023). After phenobarbital stimulation test for 13 patients had been practiced, increased levels of each bilirubin after caloric restriction test were decreased significantly to 2.0±1.0, 1.5±0.8 and 0.5±0.4 mg/dL(p=0.000, p=0.000, p=0.001) and these levels were significantly lower than basal levels(p=0.001, p=0.02, p=0.005). The sensitivities of caloric restriction test were 85.7%, 50.0%, and 71.4%, 35.7%(1.0, 1.5 mg increase of total bilirubin and 1.0, 1.5 mg/dL increase of indirect bilirubin). The sensitivities of phenobarbital stimulation test were 93.2% and 92.3% at criteria of 1.5 mg/dL increase of total bilirubin and indirect bilirubin. On the diagnosis of Gilbert syndrome, caloric restriction test and phenobarbital stimulation test are convenient and useful diagnostic tools in clinical face. And also phenobarbital stimulation test has higher sensitivity than caloric restriction test. Furthermore, standardization of bilirubin increment would be necessary in caloric restriction test.

국가예방접종전산등록체계 개발을 위한 민간의료 기관 하부구조 및 환경 조사연구

이무식,김은영,이건세,이석구,홍지영,김건엽,김대경,신의철,이연경,기몽서,나백주,김영택 한국모자보건학회 2003 한국모자보건학회지 Vol.7 No.2

전기 기계적 해리로부터 회복된 쯔쯔가무시병에서의 급성 전격성 심근염

정영학,이민주,이경화,이지훈,김석형,이병권 이화여자대학교 의과학연구소 2016 EMJ (Ewha medical journal) Vol.39 No.1

Scrub typhus, caused by Orientia tsutsugamushi , is an acute febrile illness. Characteristics of tsutsugamushi disease are fever, rash and eschar. However, severe complications might rarely occur, such as acute fulminant myocarditis caused by scrub typhus. Thus, there are few reports of recovery from seriously complicated cases. We report on an adult male with scrub typhus complicated with acute fulminant myocarditis with no previous comorbid illness who recovered successfully with proper treatment including antibiotics, ventilator support, percutaneous cardiopulmonary support, and continuous renal replacement therapy.

Young-Ki Kim

Sun-young Park,Youngjae Lee,Jinyoung Song,Seok-ho Jeon,Ji-yoon Jeong,강병택,강지훈,장진화,장동우 한국임상수의학회 2016 한국임상수의학회지 Vol.33 No.3

Signalment: An 8-month-old female Alaskan malamute was presented for progressive cluster seizure disorder. Results: There were no abnormalities on neurological examination, survey radiographs, or blood analysis. Magnetic resonance (MR) imaging and computed tomography revealed extension of the olfactory bulb and frontal lobe into the nasal cavity. They also confirmed abnormal anatomy of the nasal turbinates within the rostral part of the nasal cavity and the absence of a cribriform plate. On T2-weighted and fluid-attenuated inversion recovery images, the herniated brain showed heterogeneous and hyperintense signals consistent with intraparenchymal edema. Transverse MR images showed brain herniation into the right frontal cavity and an asymmetrical lateral ventricle because of a left midline shift. On contrast-enhanced MR images, the protruding brain parenchyma was mildly enhanced. Ethmoidal encephalocele was suspected as the final diagnosis. Despite symptomatic treatment, the dog continued to exhibit seizures and was euthanized. Clinical relevance: Ethmoidal encephalocele is a rare disease in dogs. However, it could be considered as a cause of seizure in young dogs.

Superconducting MgB2 Wire Drawing Considering Anisotropic Hardening Behavior and Hydrostatic Effect

Young‑Seok Oh,Ho Won Lee,Kook‑Chae Chung,Duck‑Young Hwang,Seong‑Hoon Kang,Jeong Whan Yoon 대한금속·재료학회 2022 METALS AND MATERIALS International Vol.28 No.7

Numerical modeling was conducted to investigate the deformation behavior of powder mixture during multi-pass drawingprocesses for multi-filamentary MgB2wire. A modified Drucker-Prager Cap (DPC) model with an elliptical cap surface usingthe new material characterization method was developed to capture the anisotropic hardening behavior and hydrostatic effectof the powder mixture. A number of uniaxial die compaction, cold isostatic pressing, diametrical compression, and uniaxialcompression tests were conducted using different powder densities to characterize the modified DPC model. A commercialfinite element software ABAQUS with a user subroutine was used to simulate the drawing of the MgB2wire. The densityand area fraction of the powder mixture during the wire-drawing process were verified with experimental results. The differencein packing density at the inner and outer filaments of the MgB2wire was successfully captured by simulation. Inaddition, the effect of the initial packing density on the superconducting properties of MgB2wire was numerically studied. It is shown that the increase in the superconducting area, which results from a high initial packing density, should be moreeffective compared to the increase in the grain connectivity in enhancing the critical current properties for the MgB2wirewhen the final packing density is saturated after a number of drawing processes.

크론병에 대한 CoPPLX의 방어효과에 대한 연구

이호학,김유림,문창기,이재일,양병윤,김종수,이정민,정재혁,안석진,박상준,김윤권,김소연,김영중,조민구,최영자,장성조 圓光大學校 醫科學硏究所 2005 圓光醫科學 Vol.20 No.1

8-hydroxyguanine이 전립선비대증 발생에 미치는 효과

이재원,이석영,이형래,이상철,김용태,김원재 충북대학교 의학연구소 2002 忠北醫大學術誌 Vol.12 No.2

연구목적: 전립선비대증은 노화현상에 의해 발생하는 질환으로서 임상적으로 주로 50세 이상에서 증상이 나타난다. 산소 라디칼은 DNA의 염기에 다양한 손상을 미칠 수 있다. 산소 라디칼에 의한 DNA의 변화에는 여러 가지 형태가 있으며 이러한 변화들 가운데서 guanine이 8-oxoguanine (8-hydroxyguanine, oh8Gua)으로의 수산화(hydroxylation) 반응은 가장 흔히 관찰되는 형태로서 노화 및 만성 퇴행성 질환, 기타 여러 질환의 중요한 병인으로 인식되고 있다. 세포에 유해한 영향을 주는 oh8Gua의 생성으로부터 유전자를 보호하는 수복효소 중 8-oxoguanine-DNA glycosylase (OGG1)가 주된 역할을 하는 것으로 알려져 있는데 이 효소를 생산하는 유전자인 hOGG1은 사람마다 유전자형이 다르다. 따라서 본 연구에서는 전립선비대증이 노화와 관련된 hOGG1 유전자형에 따라서 발생에 차이가 있는지를 조사하였다. 대상 및 방법: 충북대학교 병원에서 전립선비대증으로 진단 받고 입원하여 경요도전립선절제술을 받은 환자로 병리 조직학적으로 전립선비대증이 확인된 81명을 환자군으로 하였으며, 충청북도내 10개 군에서 50세 이상의 건강한 성인 남자 764명을 대상으로 실시한 전립선 무료검진에서 경직장 초음파 검사상 전립선 크기 20 gm 이하, 국제 전립선 증상 점수(IPSS) 7점 이하, 요속 10 ㎖/s 이상, 전립선 특이 항원(PSA) 4.0 ng/㎖ 이하인 81명을 대조군으로 설정하였다. 이들에서 채취한 혈액에서 genomic DNA를 얻은 후 PCR-SSCP (polymerase chain reaction-single stranded conformation polymorphism), 직접 염기서열분석(direct DNA sequencing) 및 RFLP (restriction fragment length polymorphism)를 통해서 두 군 사이의 hOGG1 유전자의 다형성을 분석하였다. 결과: 대조군에서 codon 326형은 Ser326Ser형이 12례(14.8%), Ser326Cys형이 51례(63.0%), Cys326Cys형이 18례(22.2%)였으며 전립선비대증 환자군에서는 Ser326Ser형이 15례(18.5%), Ser326Cys형이 34례(42.0%), Cys326Cys형이 32례(39.5%)로 두 군 사이에 통계적인 유의성이 관찰되었다(p=0.022). 또한 Cys326Cys형과 나머지(Ser326Ser, Ser326Cys)형으로 나누어 시행한 통계 분석에서도 대조군에서는 각각 18례(22.2%), 63례(77.8%)였으며 전립선비대증 환자군에서는 32례(39.5%), 49례(60.5%)로 통계적인 유의성이 관찰되었다(p=0.017, OR=2.286, 95% CI=1.149-4.546). 결론: hOGG1 유전자의 형태와 전립선비대증의 발생과는 밀접한 관련이 있었다. 즉 hOGG1 Cys326Cys형을 가진 사람에서 전립선비대증이 발생한 가능성이 높을 것으로 사료된다. Purpose: 8-oxoguanine DNA glycosylase (OSS1) rapairs DNA by removing 8-oxoguanine (oh8Gua), a highly mutagenic oxidative DNA adduct. Recently, the human gene for OGG1 (hOGG1) was cloned and several genotypes have been reported. However, the implications of such genotypes in benign prostatic lyperplasia have not been demonstrated. To assess the involvement of hOGG1 associated with the aging process on the developing of BPH, we analyzed the genetic polymorphisms of hOGG1. Materials and Methods: We studied the hOGG1 gene polymorphisms in 81 cases of BPH and 81 cases of normal controls. We performed the SSCP, PCR-based restriction fragment length polymorphism (RFLP) and direct sequencing to characterize the genetic polymorphisms of hOGG1 in both BPH patients and controls. Results: We found two polymorphic sites. A serine326/cysteine polymorphism at codon 326 (1a type) in exon 7 was associated with an exchange of amino acid. Another polymorphic site at codon 324 (1b type) in exon 6 was silent. We found that the distribution of hOGG1 genotypes in BPH patients (Ser326Ser type 18.5%, Ser326Cys type 42.0% and Cys326Cys type 39.5%) was significantly different from that in controls (14.8%, 63.0% and 22.2%, respectively) (p=0.022). Homozygosity for the Cys326Cys genotype significantly increased the risk of developing BPH, with the odds ratio (OR) being 2.286 (95% confidence interval [CI]=1.149-4.546) Conclusion: Our results suggest that the hOGG1 Cys326Cys genotype might play a important role in the development of BPH.

백당으로 가교된 폴리아크릴산 하이드로겔의 In vitro 점막부착력 평가

이재휘,김선영,이은석,이민석,김형수,최영욱 한국약제학회 2006 Journal of Pharmaceutical Investigation Vol.36 No.2

Study on Aging Effect of Adhesion Strength Between Polyimide Film and Copper Layer

Seok‑Bon Koo,Chang‑Myeon Lee,Sang‑Jun Kwon,Jun‑Mi Jeon,Jin‑young Hur,Hong‑Kee Lee 대한금속·재료학회 2019 METALS AND MATERIALS International Vol.25 No.1

This paper experimentally confirmed that the adhesion strength of the copper layer formed on the surface of the polyimidefilm by wet plating greatly changes with the aging time. The adhesion strength of the copper layer showed a rapid increasefrom 4 to 10 h after aging had begun and then converged to a value without a significant change. The adhesion enhancementbetween polyimide film and copper layer by aging is due to the interlocking effect caused by the volume expansion of copperoxide (CuO) formed in the polyimide, the increased mobility of copper particles enlarged by the decrease of impuritiesin the copper layer grain boundaries, and the consequent change of the crystal structure of the copper layer leading to theinternal stress reduction. Such adhesion improvement can be confirmed by the progress of the cohesive failure indicatingthe breakdown of the polyimide film.

중환자실에서 기계적 환기를 시행받는 환자들의 기관내삽관 튜브의 기낭내압

이영주,윤장운,문봉기,이규완,박미미,이영석 아주대학교 1997 아주의학 Vol.2 No.2

Background and Objectives : High volume, low pressure (HVLP) cuffed tubes have been substituted for low volume, high pressure (LVHP) cuffed tubes in order to reduce complications created by the cuffed endotracheal tubes contact with the tracheal wall. Several physidans, however, prefer to use the LVHP cuff for habitual or economic reasons. Even so, careless cuff Inflation of the HVLP cuff could also induce complications. The purposes of this study were to see whether there are any differences between the usual intracuff pressure (UICP) and the Optimum intracuff pressure (OICP), to compare the OICP of three groups, and to study the correlation between the OICP and the peak inspiratory pressure (PIP) of three kinds of endotracheal tubes under mechanical Ventilation. Methods : 82 adult patients, upon admission of the ICU, were divided into 3 groups with different cuffed tube types according to the following: Portex Profile group (n=66), HVLP cuffed tube; Portex Regular group (n=11), LVHP cuffed tube; Rusch Red group (n=5), LVHP cuffed tube. We used the Portex cuff pressure manometer for Portex Profile group, the Hewlett-Packard pressure transducer for Portex Regular, and Rusch Red group to measure the intracuff pressure (ICP). The OICP was measured with the minimal leak technique (MLT). Intracuff pressure difference (ICPD) was calculated by subtracting OICP from UICP. Results : UICP and OICP of Portex Profile group were 33.12±22.25 ㎝H₂O, 22.02±12.5㎝H₂O, Portex Regular group, 70.09±30.88 ㎝H₂O, 69.45±30.41 ㎝H₂O and Rusch Red group, 378.40±38.60 ㎝H₂O, 337.60±74.45 ㎝H₂O. Significant difference was shown among the groups (p < 0.05). The significant difference of the PIP was not seen among the groups. Significant correlation between OICP and PIP (regression = 0.463, p < 0.01) was demonstrated only in Portex Profile group. ICPD of three groups were as high as 84 ㎝H₂O to as low as -56 ㎝H₂O. About 40% of the patients showed the allowable range. Conclusions : This study suggests that routine check-ups of ICP are needed when the patients are admitted to the ICU. The OICP of the HVLP cuffed tube is 1/3 -1/15 of the LVHP cuffed tube. Therefore, the routine use of the HVLP tube is highiy recommended. The OICP shows positive correlation with the PIP. This suggests to make every effort to reduce the PIP.