아세틸 콜린 유발 검사시 허혈성 심전도 변화와 흉통의 발생이 내피세포 기능장애에 미치는 영향

최철웅(Cheol Ung Choi),나승운(Seung-Woon Rha),김선원(Sun Won Kim),나진오(Jin Oh Na),임홍의(Hong Euy Lim),김진원(Jin Won Kim),김응주(Eung Ju Kim),한성우(Seong Woo Han),박창규(Chang Gyu Park),서홍석(Hong Seog Seo),오동주(Dong Joo Oh) 대한임상노인의학회 2010 대한임상노인의학회지 Vol.11 No.4

연구배경: 아세틸 콜린 유발 검사시 발생하는 흉통과 허혈성 심전도 변화가 아세틸 콜린에 의해 발생하는 관상동맥의 내피세포 기능에 어떤 영향을 주는지 알아보고자 했다. 방법: 흉통으로 내원하여 관상동맥 조영술과 아세틸 콜린 유발검사를 시행받은 1,085명의 환자를 대상으로 하였다. 아세틸 콜린 유발 검사를 하는 동안 허혈성 심전도 변화 및 흉통의 발생 유무에 따른 관상동맥 내피세포 기능의 특징을 비교하였다. 결과: 539명의 환자에서 아세틸 콜린 검사시 내피세포 기능 장애가 발생 하였다. 허혈성 심전도 변화가 있었던 그룹이 심전도 변화가 없었던 그룹보다 흉통이 더 많았고(78.1% vs. 60.8%, P=0.007), 관상동맥 조영술상 다발성 관상동맥 경련이 빈번하였고(59.4% vs. 40.6%, P=0.004), 관상동맥의 경련 정도도 더 심하였다(64.1% vs. 46.5%, P=0.006). 흉통이 있었던 그룹이 흉통이 없었던 그룹보다 허혈성 심전도 변화의 빈도가 더 높았다(14.7% vs. 7.5%, P=0.007). 또한 흉통이 있었던 그룹이 관상동맥 경련이 다발성으로 발생하는 경우가 많았고 (50.7% vs. 29.5%, P<0.001), 미만성으로 발생하는 경우가 많았고(87.1% vs. 75%, P<0.001), 관상동맥의 경련의 정도도 더 심하였다(51.6% vs. 43.5%, P=0.041). 결론: 아세틸 콜린 유발검사시 발생하는 허혈성 심전도 변화와 흉통은 관상동맥 경련의 정도와 경련이 발생하는 관상동맥 개수와 연관이 있다. Background: ECG changes and chest pain during acetylcholine (Ach) provocation tests may constitute important clinical parameters for Ach-induced endothelial dysfunction. We investigated the association between ischemic ECG changes and chest pain during the Ach-provocation test and angiographic characteristics of Ach-induced endothelial dysfunction. Methods: A total of 1,085 patients with anginal symptoms underwent diagnostic coronary angiography (CAG) and Ach-provocation tests. We compared angiographic characteristics of Ach-induced endothelial dysfunction according to the presence of ECG change and chest pain. Results: A total of 539 patients experienced Ach-induced endothelial dysfunction. Patients who experienced ECG change group suffered more frequent chest pain (78.1% vs. 60.8%, P=0.007), angiographically more frequent multiple coronary artery spasm (59.4% vs. 40.6%, P=0.004), and more severe coronary artery spasm (64.1% vs. 46.5%, P=0.006) than patients without ECG change. However, there was no difference in the length of endothelial dysfunction between the groups. The incidence of ischemic ECG changes in patients with chest pain was higher than in patients without chest pain (14.7% vs. 7.5%, P=0.007). Patients who experienced chest pain more often experienced multiple (50.7% vs. 29.5%, P<0.001), diffuse (87.1% vs. 75%, P<0.001), and severe coronary artery spasm (51.6% vs. 43.5%, P=0.041) than patients without chest pain. Conclusion: Ischemic ECG changes and chest pain during the Ach-provocation test are associated with multi-vessel involvement and severe coronary artery spasm. Chest pain is associated with the length of endothelial dysfunction, but ischemic ECG change is not.

경상남도 창녕에서 집단 발생한 피부 탄저병의 임상양상

박찬원,박정래,정종윤,이선희,장철훈,오차재,조병만,임재영,오창근,권경술 대한감염학회 2002 감염 Vol.34 No.4

정신분열병에 대한 리스페리돈의 효과 및 안정성

이민수,김용구,김영훈,연병길,오병훈,윤도준,윤진상,이철,정희연,강병조,김광수,김동언,김명정,김상훈,김희철,나철,노승호,민경준,박기창,박두병,백기청,백인호,손봉기,손진욱,양병환,양창국,우행원,이정호,이종범,이홍식,임기영,전태연,정영조,정영철,정인과,정인원,지익성,채정호,한상익,한선호,한진희,서광윤 大韓神經精神醫學會 1998 신경정신의학 Vol.37 No.1

연구목적 : 본 시험의 목적은 임상시험 시작전에 연구자들을 대상으로 PANSS Workshop을 통하여 PANSS, ESRS에 대한 국내에서의 표준화 작업을 구축하고 새로운 정신병 치료제인 리스페리돈의 효과와 안정성을 재확인하여 리스페리돈 사용에 대한 적정화를 이루는데 있다. 연구방법 : 1996년 4월부터 1996년 9월까지 국내 39개 대학병원 정신과에 입원중인 혹은 증상이 악화되어 입원하는 정신분열병 환자 377명을 대상으로 다시설 개방 연구를 시행하였다. 1주일간의 약물 배설기간을 가진후, 리스페리돈을 8주간 투여하였고, 기준점, 1주, 2주, 4주, 그리고 8주후에 평가되었다. 용량은 제1일에는 리스페리돈 1mg씩 1일 2회, 제2일에는 2mg씩 1일 2회, 제3∼7일에는 3mg씩 1일 2회 투여하였다. 이후 환자의 임상상태에 따라 임의로 증량할 수 있으며, 최대 일일 16mg을 초과하지 않도록 하였다. 추체외로 증상을 조절하기 위한 투약을 허용하였다. 임상증상 및 부작용의 평가는 PANSS(Positive and Negative Syndrome Scale), CGI(Clinical Global Impression) 그리고 ESRS(Extrapyramidal Symptom Rating Scale)을 사용하였다. 연구결과 : 377명중 343명(91%)이 8주간의 연구를 완결하였다. 치료 종결시점인 8주후 PANSS 총점수가 20% 이상 호전된 경우를 약물 반응군으로 정의할때, 약물반응군은 81.3%였다. 리스페리돈에 반응하는 예측인자로는 발병연령, 이전의 입원 횟수, 유병기간이 관련 있었다. 리스페리돈은 1주후부터 PANSS양성, 음성, 및 일반정신병리 점수상에 유의한 호전을 보여 효과가 빨랐다. CGI의 경우도 기준점에 비해 1주후부터 유의한 감소를 나타내었다. ESRS의 경우, 파킨슨 평가점수는 기준점과 비교해 투여 1주, 2주, 4주후 유의하게 증가되었다가 8주후 기준점과 차이가 없었다. Dystonia 평가점수는 1주후만 유의한 증가를 보였으며, dyskinesia 평가점수는 유의한 차이가 없었다. 혈압, 맥박수의 생명징후 및 일반 혈액학 검사, 생화학적 검사, 심전도 검사에서 유의한 변화는 없었다. 결 론 : 이상의 다시설 개방 임상 연구를 통해 리스페리돈은 정신분열병 환자에서 양성증상뿐만 아니라 음성증상 및 전반적인 증상에도 효과적인 것으로 사료된다. 보다 명확한 평가를 위해서는 다른 항정신병약물과의 이중맹검 연구가 필요할 것으로 생각되며, 또한 장기적 치료에 대한 평가도 함께 이루어져야 하겠다. Objective : The purpose of this study was to investigate the efficacy and safety of risperidone in the treatment of Korean schizophrenic patients. Method : This multicenter open study included 377 schizophrenic patients drawn from 39 university hospitals. After a wash-out period of 1 week, the schizophrenic patients were treated with risperidone for 8 weeks and evaluated at 5 points ; at baseline, and 1, 2, 4 and 8 weeks of treatment. The dose was increased from 2mg/day(1mg twice daily) to 6mg/day(3mg twice daily) during the first week and adjusted to a maximum of 16mg/day over the next 7 weeks according to the patient's clinical response. Medication to control extrapyramidal symptoms was permitted. The psychiatric and neurological status of the patients was assessed by PANSS, CGI, and ESRS scales. Results : 343(91%) of 377 patients completed the 8-week trial period. Clinical improvement, as defined by a 20% or more reduction in total PANSS score at end point, was shown by 81.3% of patients. The predictors of response to risperidone were associated older age, shorter duration of illness, fewer previous hospitalization. Risperidone had rapid onset of action ; a significant decrease of the total PANSS and three PANSS factor(positive, negative, general), and CGI was already noticed at the end of first week. For the ESRS, parkinsonism rating scores were significantly increased until week 4 comparing with baseline. Dystonia rating scores were significantly increased until week 1, and dyskinesia rating scores were not significantly changed during the study. Laboratory parameters including vital sign, EKG, hematological, and biochemical values showed no significant changes during the trial. Conclusions : This study suggests that risperidone is generally safe and effective against both the positive and negative symptoms in our group of patients.

자궁근종에서 Phospholipase C 동종효소들의 발현에 관한 연구

윤혜원,류임주,김창미,심재철,서영석 대한해부학회 1995 Anatomy & Cell Biology Vol.28 No.4

기관에서 발생한 전이성 갑상선 유두상 암종 1례

장선호,박철규,이병돈,장혁순,강주원 순천향의학연구소 1995 Journal of Soonchunhyang Medical Science Vol.1 No.2

Papillary adenocarcionma has been common malignant tumor of human thyroid gland, and metastasize to the lung and bone as well. But endotracheal meastasis of papillary adenocarcinoma is very unusual. A 75 years old woman was presented with a metastatic papillary thyroid adeno- carcinoma in the trachea, 10 years after total thyroidectomy. The tumor mass was located in the anterior wall of tracheal lumen. The mass was confirmed with pathologic finding. We describe a case of tracheal papillary adenocarinoma of thyroid gland origin and discuss the current recommendation for management.

한국형 교정치료용 Bracket의 개발에 관한 연구

장영일,양원식,남동석,문성철 대한치과교정학회 2000 대한치과교정학회지 Vol.30 No.5

한국인의 치열의 특성을 고려한 Straight-Wire Appliance(SWA)의 제작을 위한 자료를 얻기 위하여 18세 이상 25세 사이의 한국인 성인 정상교합자를 1) 구강악안면부에 기능장애가 없고, 2) 양호한 치열궁 형태와 긴밀한 구치부 교합 관계를 가지며, 3) 교합이 전후방적으로 앵글 분류 I급의 관계를 가지며, 4) 간단한 수복 치료 외에 교정치료나 보철치료를 받지 않았으며, 특히 치아의 순면과 협면의 형태에 변형을 초래한 치과 치료를 받지 않았으며, 5) 단정한 안모를 가진 자를 선발 기준으로 정하여 선발하였다. 선정된 정상 교합자의 상, 하악 인상을 채득하고, 교정용 석고 모형을 제작하였다. 얻어진 치과 석고모형을 분석하여, Andrews의 Six keys to optimal occlusion에 부합되는 표본을 5 명의 숙련된 교정의사들이 선별하여 한국인 성인 정상교합자 치열의 석고 모형 155 쌍(남자 92쌍, 여자 63쌍)을 얻었다. 이들을 대상으로 정밀측정장비인 Coordinate Measuring Machine(CMM, MPC802, WEGU-Messtechnik, Germany)을 이용하여 3차원 digitization을 시행하고, 계측프로그램을 작성하여 SWA 제작을 위하여 필요한 Angulation, Inclination, In-and-Out, Molar offset angle, Arch-form 등을 측정하였다. 측정을 시행하기 전에, CMM을 이용한 3차원 digitization의 오차에 대한 검증을 실시하였고, 3차원 digitization과 컴퓨터를 이용한 형태학적 분석법과 기존의 수작업에 의한 분석법의 신뢰도에 대한 분석을 실시하였다. 이상의 연구를 통하여 얻은 결론은 다음과 같다. 1.치과 석고모형의 3차원 digitization에 CMM을 적용하여 mesh size 0.25 mm,0.5 mm, 1.0 mm로 등간격 디지타이징하는 것은 모두 받아들일 수 있으며, 측정의 효율성을 고려할 때 1.0 mm 간격으로 등간격 디지타이징 하는 것이 바람직하다. 2.3차원 digitization과 컴퓨터를 이용한 방법이 Andrews의 방법에 기반한 수작업 방법보다 신뢰성이 높다. 3.3차원 digitization과 검퓨터를 이용한 방법으로 한국인의 치열의 형태학적 특성에 맞는 SWA의 제작을 위한 자료를 채득하였다. The aim of this study was development of the Straight-Wire Appliance(SWA) suitable for the treatment of Korean. To accomplish the object of this study, Korean adult with normal occlusion were selected with following criteria : 1) no functional abnormality in the craniofacial area, 2) good dental arch form and posterior occlusal relationship, 3) Angle Class I occlusal relationship, 4) no experience of orthodontic, nor prosthodontic treatment, especially, no dental treatment on labial and buccal surfaces of teeth, 5) good facial profile. Impression were taken for upper and lower dental arches of the selected normal occlusion samples and the orthodontic dental stone models were fabricated. 5 well-trained orthodontists had examined the acquired dental stone models to select study samples which satisfy the Six keys to optimal occlusion of Andrews. 155 pairs of dental stone models (92 pairs of Male, 63 of Female) were finally selected. 3 dimensional digitization were performed with the Coordinate Measuring Machine(CMM, MPC802, WEGU-Messtechnik, Germany) and measuring of Angulation, Inclination, In-and-Out, Molar offset angle and Arch form were accomplished with a measuring software to achieve data for the development of SWA. Before the measurement, error study was performed on the 3 dimensional digitization with CMM, and the analysis of reliability of computerized measuring method adapted in this study and conventional manual method presented by Andrews was performed. Results of this study were as follows : 1.Equi-distance digitization with mesh size 0.25 mm, 0.5 mm and 1.0 mm were acceptable in 3 dimensional digitization of dental stone model with the CMM, and the digitization with 1.0 mm mesh size was recommendable in terms of efficiency. 2.Computerized measuring method with 3 dimensional digitization was more reliable than manual measuring method of Andrews. 3.Data were collected for the development of SWA suitable for the morphological characteristics of Korean with the computerized measuring method with 3 dimensional digitization.

응급실로 내원한 장중첩증의증 환아의 진단방법에 대한 임상적 고찰

원형섭,박정배,표창해,김형수,박철완,이근 대한응급의학회 1995 대한응급의학회지 Vol.6 No.2

The purpose of this study is to evaluate the appropriate diagnostic methods for the patients with suspected intussusception. Intrssusception is a state that a portion of alimentary tract is telescoped into a segment just caudad to it, and has a characteristic symptoms of cyclic irritability, vomiting, bloody stools and palpable mass, It is the most common cause of acute or acquired intestinal obstruction in infants and children, and needs early diagnosis and immediate treatment. Authors reviewed retrospectively medical records of 411 infants & children with suspected intussusception from January 1, 1992 to December 31, 1994 and report the results with literature reviews. The results were as followings; 1) 263 cases were definite intussusception(DI) out of 411 suspected intussusception(SI). 2) The male to female ratio was 2.3 : 1 in SI and 2.8 : 1 in DI. 3) The distribution of age revealed that 85% of SI and 84% of DI were under 24 months old, and the most common age was 8 months in SI and 10 months in DI. 4) There were upper respiratory infection in 84 cases(2)%), gastroenteritis in 32 cases(8%) and bronchiolitis in 8 cases(2%) as preceding diseases. 5) The simple X-ray showed gaseous bowel distension in 212 cases(52%). 6) The most common symptoms and signs were cyclic irritability and abdominal pain(94%), bloody stools(72%), palpable abdominal mass(47%), in order. 7) Of 411 patients, 252 cases(61%) were diagnosed and treated by air enema(228 cases) and/or exploration(24 cases). Among 296 cases(72%) who showed bloody stools in digital rectal examination and glycerin enema, 245 cases(83%) were confirmed as intussusception through air enema and/or operative intervention, and that corresponds to 93% of DI. 8) Intestinal perforation as complication occurred in 3 of 393 cases who underwent air and barium enema, but all of them recovered without any sequelae after operation. Conclusively, it is thought that air enema preceded by digital rectal examination and glycerin enema is safe and useful method in diagnosis and treatment of infants and children with SI.

경고막적 및 고막외적 전극위치에 따른 와우전위의 비교연구

장동임,박철규,이병돈,장혁순,강주원 순천향의학연구소 1995 Journal of Soonchunhyang Medical Science Vol.1 No.1

Electrocochleography is a method of the measurement of electrical events generated either within the cochlea or by primary afferent neurons. It includes measures of summating potential(SP) and cochlear microphonics(CM) from the cochlea, and action potential(AC) from the auditory nerve. There are severval diffefent ways to measure the potentials, mainly transtympanic and extratympanic methods. The purpose of this study is to provide a normal data of eletrocochleography in adults and compare the results obtained by extratympanic and transtympanic methods. The following results were obstained: 1. As the intensity of sound was increased, the SP amplitude and AP amplitude were increased. There was no significant difference between extratympanic and transtympanic method. 2. As the intensity of sound was increased, the SP latency and AP latency were shortened without significant difference between two different methods. 3. As the intensity of sound was increased, the SP/AP ratio was increased without difference in both methods which was less than o.30. 4. Non-invasive method of electrocohleography, the extratympanic method, can be one of the easy method an can be used widely clinically.

요추 추간판 절제술 후 발생한 화농성 척추염에 대한 Chuinard & Peterson 골 이식술을 이용한 전방 유합술 및 경피적 후관절 나사못 고정술

장상범,이상호,이승철,신송우,김원중 대한척추신경외과학회 2004 Neurospine Vol.1 No.1

Objective: To describe the surgical techniques and the preliminary results of anterior fusion with Chuinard & Peterson bone graft and posterior percutaneous facet screw fixation for pyogenic spondylitis following lumbar discectomy. Methods: From April to October 2003, five consecutive patients underwent anterior lumbar interbody fusion with Chuinard & Peterson bone graft and posterior percutaneous facet screw fixation for the treatment of pyogenic spondylitis that developed after primary lumbar disc surgery. There were three males and two females. The mean age was 49.8 years(range, 28-75 years). Three patients had persistent inflammation with neurologic deterioration and two had severe back pain despite of less invasive interventions. The mean interval from the primary operation to fusion was 3.3 months(range, 1.5~7 months). All patients were allowed to ambulate immediate postoperatively with a lumbar orthosis, which was kept for three months. Intravenous and oral antibiotics were continued until hematologic profiles normalized. All patients were followed up clinically and radiologically. Results: The mean operating time, blood loss, and post-operative hospital stay were 210 mins, 890 ml, and 27 days, respectively. Four patients showed a solid fusion at 3 monthes and one patient showed fusion at 4 monthes postoperatively. M patients showed remission of infection and significant clinical improvement of back pain. Conclusions: Anterior fusion using Chuinard & Peterson bone graft and posterior facet screw fixation may be employed for postoperative pyogenic spondylitis without prolonged cast immobilization or risk of persistent infection caused by instrumentation.

한국 연안 퇴적물에서 ^137Cs, ^90Sr 및 Pu 동위원소의 분포

최석원,진현국,김철수,노정환,김창규,노병환 대한방사선 방어학회 2002 방사선방어학회지 Vol.27 No.2

한국 주변 연안 15개 정점의 퇴적물(0∼20 cm)에서 ^137Cs, ^90Sr, ^239+240Pu 의 농도와 농도비를 조사했다. ^137Cs, ^90Sr, ^238Pu 및^239+240Pu의 평균 방사능 농도는 각각 2.24±0.79 Bq·kg^-1-dry, 0.20±0.04 Bq·kg^-1-dry, 0.009±0.005 Bq·kg^-1-dry 및 0.27±0.17 Bq·kg^-1-dry이다. ^137Cs/^90Sr, ^239+240Pu/^137Cs 및 ^238Pu/229+240Pu의 평균 농도 비와 ^239Pu/240의 평균 원자 비는 각각 11.2±2.9, 0.123±0.053, 0.033±0.01 및 0.218±0.036이다. 퇴적물에서 핵종의 농도 범위와 핵종간의 농도 비는 그 동안 주변국가의 퇴적물에서 조사한 값과 비슷하였다. 퇴적물에서 ^137Cs과 ^239+240Pu의 상관계수는 0.80이다. ^137Cs과 SOM, ^239+240Pu과 점토 함량과의 상관계수는 각각 0.69, 0.67 이다. The concentrations and activity ratios of ^137Cs, ^90Sr, ^238Pu and ^239+240Pu in sediment(0∼20 cm) at 15 coastal stations of Korea were determined. The mean concentrations of ^137Cs, ^90Sr, ^238Pu and ^239+240Pu are 2.24±0.79 Bq·kg^-1-dry, 0.20±0.04 Bq·kg^-1-dry, 0.009±0.005 Bq·kg^-1-dry and 0.27±0.17 Bq·kg^-1-dry, respectively. The mean activity ratios of ^137Cs/^90Sr, ^239+240Pu/^137Cs and ^238Pu/^229+240Pu and atomic ratio of ^240Pu/^239Pu are 11.2±2.9, 0.123±0.053 and 0.033±0.017 and 0.218±0.036, respectively. The concentrations and activity ratios in sediment samples are similar to those reported from neighbouring country in the northern hemisphere. The correlation coefficient of ^137Cs and ^239+240Pu is 0.80. The correlation coefficient of ^137Cs and soil organic matter(SOM), and ^239+240Pu and clay content are 0.69 and 0.67, respectively.