근막통 증후군을 지닌 조선업근로자들에서 스트레스생활사 정도에 따른 통증의 비교

송혜란,김진하,,이용환 KOSIN UNIVERSITY COLLEGE OF MEDICINE 2006 高神大學校 醫學部 論文集 Vol.21 No.1

Background : Myofascial pain syndrome is a regional pain syndrome which is abruptly developed by psychological stress or physical stress causing direct muscular trauma or muscular tension. Shipbuilding workers are suffering from pain caused by the hard works treating heavy materials or keeping in an uncomfortable position for a long time in addition to the psychological stress which happened on the life events. This study was performed to survey the psychological feature and the degree of pain according to the stressful life event values of the shipbuilding workers who are suffering from the myofascial pain syndrome. Methods : The study subjects were 61 workers who worked at one of the shipbuilding industrial company. They were diagnosed as a myofascial pain syndrome in April 2002. For the close examination these workers visited in the department of occupational environmental medicine of the Kosin University. They were classified as high stressful group and low stressful group using Holmes and Rahe stressful life event values. We compared high stressful group with low one by visual analogue scale (VAS). Results : In high stressful and low stressful groups according to stressful life event values, mean age was 43.7 years and 43.4 years, and mean working duration was 13.9 years and 14.3 years respectively, which doesn't show significant difference statistically. There was no significant difference in alcohol drinking in those two groups, on the other hand, in high stressful group the frequency of smoking is higher as 21 (87.5%)people than in low stressful group as 16 (43.2%)people. The number of patients who reported severe pain which affected the daily life is 12 (50%) in high stressful group and 17 (45.9%) in low stressful group, and the number of patients who felt pain even by the small amount of daily activity is 5 (20.8%) in high stressful group and 13 (35.1%) in low stressful group, which shows no statistical significance. The duration of pain more than 5 hours was 17 (70.8%) and 26 (70.3%) in each group, and visual analogue scale was higher in high stressful group than in low stressful group as 6.3 points ans 5.6 points each without statistical significance. As a result of physical examination, the number of palpable trigger points was 14 (58.3%) in high stressful group and 27 (73.0%) in low stressful group. As a result of EMG, the case of positive findings was 8 (33.3%) in high stressful group and 13 (35.1%)in low stressful group. Conclusion : As a result of classifying the stressful life event values into high stressful group and low stressful group in the case of myofascial pain syndrome, objective findings(EMG, palpable trigger point) were not significantly different between high stressful group and low stressful group, but visual analogue scale was higher in high stressful group than in low stressful group. Therefore, it is assumed that in order to reduce the pain considered the most severe problem in the case of myofascial pain syndrome, we should analyze the cause of stress caused by daily lives and need proper psychological treatment and intervention as well as reduce the bruden on the parts of body.

한랭 손상 후 발생한 Fournier's gangrene 1예

조성진,이승현,,윤주원,안병권,백승언,서영민 KOSIN UNIVERSITY COLLEGE OF MEDICINE 2006 高神大學校 醫學部 論文集 Vol.21 No.1

Fournier's gangrene is a polymicrobial, both aerobic and anaerobic, synergistic necrotizing fasciitis of the perineal, genital or perianal regions. Predisposing factors include diabetes mellitus, chronic alcoholism, local trauma, paraphimosis, periurethral extravasation of urine, perirectal or perianal infections, and surgery such as circumcision and herniorrhaphy. Treatment of this disease includes wide excision of devitalized tissue with one or more debridements, and parenteral administration of broad-spectrum antibiotics. Estimated mortalilty reported in literature ranges from 20 to 75%. Here we reported a case of Fournier's gangrene after cold injury at the perineal region in a 58-year-old man. The patient had full-thickness skin necrosis developed in the perianal and scrotal region. Several debridements and diverting colostomy were required.

The significance of pS2 gene alteration in the early gastric cancer

Chang, HeeKyung KOSIN UNIVERSITY COLLEGE OF MEDICINE 2006 高神大學校 醫學部 論文集 Vol.21 No.1

Background and Purpose : The expression of pS2 gene in normal human tissue is restricted to the stomach. But its role in tumor development is not elucidated yet. The purpose of this study is to evaluate the functional role of pS2 protein in early gastric carcinomas(EGC), by investigating prevalence of the gene and analysing its expression with histologic types and differentiation. Material and Method : The formalin-fixed and paraffin-embedded tissue obtained from 100 patients with EGC who underwent gastrectomy by using immunohistochemistry. Results : In the non-neoplastic tissue adjacent to the tumor, the immunoreactivity for pS2 was observed in the cytoplasms of superficial and foverolar epithelium and a few chief cells, while intestinalmetaplastic epithelium showed negative immunoreactivity. The neoplastic tissue revealed cytoplasmic positive staining of tumor cells. The overall immunoreactivity for pS2 in 100 EGC cases is 56%. The expression of pS2 was significantly higher in diffuse type(65.9%) than interstinal type(48.2%)(p<0.05) and also higher than in poorly-differentiated type(62.1%) than in well-differentiated type(47.6%)(p<0.05). The expression rates of tumors invading to mucosa was 53.1% (17/32) and tumors invading to submucosa was 46.9%(15/32). Conclusion: These results mean that the expression of pS2 is correlated to the histologic type and grading, while is not related to the depth of tumor invasion. And it is indicated that pS2 protein has a yet undescribed role in gastric foveolar epithelium and pS2 gene expression may be more important role in diffuse type cancer than in intestinal type cancer of stomach

SR-B1의 유전적 변이와 대사증후군간의 관련성

박춘호,유병철,이용환 KOSIN UNIVERSITY COLLEGE OF MEDICINE 2006 高神大學校 醫學部 論文集 Vol.21 No.1

Background and Objectives: Several lifestyle habits may predispose to the metabolic syndrome. Among them there is evidence that quality and quantity of fatty acids could play a key role in the development of metabolic syndrome. There is also evidence for the involvement of genetic factors in the etiology of this condition. The association between polymorphism in the scavenger receptor class B type Ⅰ(SR-BI) gene and variations in basal plasma concentrations of cholesterol in humans recently has been described. The objective of this study was to determine whether the exon 1 variant (G→A) at the locus of SR-BI gene is associated with metabolic syndrome. Methods: A total of 364 health screen examinees were enrolled in this study who were examined in Kosin University Gospel Hospital from December 2004 to July 2005. The height, weight, waist circumference, and systolic and diastolic blood pressure of the subjects were examined and fasting blood glucose, total cholesterol, HDL cholesterol, LDL cholesterol, and triglyceride were measured by sampling in venous blood. The metabolic syndrome was defined as the presence of three or more of the following: waist circumference in men ≥90 cm, in women ≥80 cm, blood pressure ≥130/85 mmHg, fasting glucose ≥110 mg/dL, HDL cholesterol in men <40 mg/dL, in women <50 mg/dL, and triglyceride ≥150 mg/dL. The blood pressure, fasting glucose, HDL cholesterol, triglyceride were evaluated by using the criteria of NECP ATP Ⅲ and waist circumference was assessed by using the criteria of WHO Asia-Western Pacific. Allelic discrimination of the SR-BI exon 1 was performed by PCR-RFLP method. Results: The frequences of AG of the SR-BI exon 1 polymorphism were 29.0% for the metabolic syndrome, 16.7% for the control, and 25% in total subjects. There were no significant differences in the comparisons of components of metabolic syndrome according to polymorphism at the SR-BI exon 1 locus. Conclusion: It is necessary to study about the relationship between polymorphism exon 1 variant at the locus of SR-BI gene and metabolic syndrome.

검도와 연관된 근골격계 통증

하호성,김기찬,,정호중 KOSIN UNIVERSITY COLLEGE OF MEDICINE 2006 高神大學校 醫學部 論文集 Vol.21 No.1

Background : The purpose of this study is to understand the distribution of Kumdo related pain and associated factors Materials and Methods : A clinical evaluation was done by a physiatrist with radiography. 119 men and 11 women were interviewed about Kumdo experience, daily and weekly practice time, pain complaint, anatomical disturbance of pain by total 15 question at January, 2006. Result : Lower limb was the most common area of pain complaints, followed by upper lims, spine in orders. Tendinitis (5 cases) on wrist was most common in upper limb and plantar fascitis (7 cases) was most common at lower limb. Conclusion : Kumdo related pains were more disturbance in lower limb, followed by upper limb. And most common disease was plantar fascitis of foot.

집먼지 진드기(Dermatophagoides farinae) cDNA expression library로 부터 분리한 group Ⅲ 알레르기 유전자 정보 분석

김봉진,김선미,유태현,옥미선 KOSIN UNIVERSITY COLLEGE OF MEDICINE 2006 高神大學校 醫學部 論文集 Vol.21 No.1

우리나라에 서식하고 있는 집먼지 진드기의 알레르겐으로 작용하는 유전자의 정보를 알아보기 위하여 Dermatophagoides farinae cDNA를 집먼지진드기 알레르기 환자의 혈청과 반응시켜 clone Df0를 얻었다. Df0 clone의 cDNA는 BLAST search에서 serine계 단백분해효소로 동정되었다. 이 유전자의 총길이는 802bp였고, deduced한 아미노산은 240개였으며 3' 의 종결코돈(TAA)과 poly(A) signal (AATAAA)은 확인할 수 있었으나 5' 의 개시코돈 및 modification은 찾아 볼 수 없었다. 그러나 trypsin-like serine protease의 histidine active site 및 serine active site는 잘 보존되어 있었다. Background The house dust mite is one of the most important etiologic risk factors for IgE-mediated allergic respiratory illness throughout the world. Respiratory allergic patients of 50-80% show positive response to house dust mite allergens in Korea. Among many species of mites, Dermatophagoides farinae were recorded one of the predominant species in Korea. Methods cDNA library was constructed from D. farinae mRNA and screened by the perennial rhinitis patients's sera to clone and characterize D. farinae allergens in order to better define their role in allergic disease. Results A partial cDNA (Df0) was isolated, subcloned, and sequenced. Sequence analysis showed that clone Df0 encodes partial serine protease preproenzyme from D. farinae. The selected cDNA clone Df0 codes for 802bps and 240 deduced amino acid sequences. BLAST analysis of the deduced amino acid sequence showed high homology (46-24%) between clone Df0 and serine proteases (group 3 allergens) from domestic dust mites. Both the histidine active site (VTAAHC) and the serine active site (DSCQGDSGGPLV) of serine proteases were highly conserved. Conclusion Further study on this gene including full-length sequence and recombinant protein will help determining the role of proteolytic enzymes in the pathophysiology of allergic asthma.

건강검진 수진자에서의 대사증후군 관련 생활습관

김철훈,유병철,이용환 KOSIN UNIVERSITY COLLEGE OF MEDICINE 2006 高神大學校 醫學部 論文集 Vol.21 No.1

Background: Metabolic syndrome is caused by interplay between genetic and many environmental factors. Some behaviors or lifestyle patterns including physical activity, cigarette smoking, and diet, particularly carbohydrate and fat intake are associated with the metabolic syndrome. The objective of this study was to identify the relationship between metabolic syndrome and some lifesyle behaviors. Methods: A total of 635 medical check-up examinees who were examined in Kosin University Gospel Hospital from December, 2004 to July, 2005 were enrolled in this study. The height, weight, waist circumference, and systolic and diastolic blood pressure of the subjects were examined and on concentrations of fasting blood glucose, total cholesterol, HDL cholesterol, LDL cholesterol, and triglyceride in peripheral venous blood were measured. The metabolic syndrome was defined as the presence of three or more of the following; waist circumference men ≥90 cm, women ≥80 cm, blood pressure ≥130/85 mmHg, fasting glucose ≥110 mg/dL, HDL cholesterol, men <40 mg/dL, women <50 mg/dL, and triglyceride ≥150 mg/dL. The blood pessure, fasting glucose, HDL cholesterol, triglyceride were evaluated by using the criteria of NECP ATP Ⅲ and waist circumference was assessed by using the criteria of WHO Asia-Western Pacific. Self-administered questionnare was conducted on smoking, alcohol drinking, educational level, exercise, and dietary practices. Results: The prevalence of the metabolic syndrome was 37.5%. High fat intake was significantly associated with an increased risk of having the metabolic syndrome. In women, low educational level and high carbohydrate intake were associated with an increased risk of having the metabolic syndrome. High fat intake was significantly associated with an increased risk of having the metabolic syndrome in body mass index ≥25/0 kg/m2 or 50-59 years group. Conclusion: Low educational level, high fat and high carbohydrate intake were significantly associated with an increased risk of having the metabolic syndrome.

비음주 수진자들에서 지방간과 대사증후군과의 연관성

김길수,최영식,,박요한 KOSIN UNIVERSITY COLLEGE OF MEDICINE 2006 高神大學校 醫學部 論文集 Vol.21 No.1

Background: Nonalcoholic fatty liver disease (NAFLD) is liver disease characterized by diffuse fatty infilteration and inflammation. NAFLD is closely related with metabolic syndrome such as diabetes, obesity, hyperlipidemia, and hypertension. Definitive diagnosis of NAFLD still requires a liver biopsy. So, it is difficult to diagnosis of NAFLD in the health screen examinees. The aim of this was to assess the association fatty liver diagnosed by ultrasonography and components and parameters of metabolic syndrome in the non-alcoholic health screen examinees. Methods: A total of 3,829 health screen examinees (1,985 men, 1,844 women) who participated in health screening at health promotion center in Kosin Medical Center from March, 1997 to December, 2003 were enrolled in this study. All participants was no evidence of viral hepatitis and alcohol abuse. The examinees were divided two group, fatty liver and nonfatty liver group and the clinical, biochemical and metabolic parameters analyzed by multiple regression and logistic methods. Results: Almost of all variables (age, weight, blood pressure, body mass index (BMI), waist circumference (WC), total cholesterol, triglyceride, fasting blood glucose, gamma glutamyltransferase (γGTP) except high density lipoprotein (HDL) cholesterol were significantly high in the fatty liver group than nonfatty liver group (p,0.05). There was a significant positive correlation between WC and weight, blood pressure, BMI, total cholesterol, triglyceride (p<0.01). The age adjusted odds ratio between WC and fatty liver was 1.614 in men and 2.906 in women (p<0.01). As subjects were grouped according to their number of components metabolic syndrome, the development of fatty liver was increased according to the numbers of components of metabolic syndrome (p<0.05). γGTP was a significant positive correlation with WC, weight, blood pressure, BMI, total cholesterol, triglyceride (p<0.01). When subjects were grouped according to the γGTP level, group Ⅰ (≤20 U/L) and group Ⅱ (20 U/L~40 U/L) and group Ⅲ (>40 U/L). Significant differences was notice in almost of all variables (weight, blood pressure, BMI, WC, total cholesterol, triglyceride, fasting blood glucose) among each group (p<0.000). Conclusion: These results suggested that fatty liver in non alcoholic health examinees is closely associated with metabolic syndrome and number of components of metabolic syndrome. Among the metabolic parameters, the author noticed that γGTP is not a marker of alcohol induced liver disease but may also a independent and reliable marker of metabolic syndrome.

일개 내과 의원을 방문한 고혈압 환자의 고혈압 질환에 대한 인지도

공은희,최종순 KOSIN UNIVERSITY COLLEGE OF MEDICINE 2006 高神大學校 醫學部 論文集 Vol.21 No.1

Background : Hypertension is one of the most important risk factors of cardiovascular disease and coronary artery disease. Awareness of hypertension by patients is important in controlling of the disease. The purpose of this study was to compare awareness regarding hypertension by demographic and socio-economic status of the patients. Methods : This study involved 71 hypertensive patients who visited a physician's out-patient clinic from November 1 to November 30, 2005. All subjects were drawn up a questionnaire including demographic characteristics and awareness of hypertension, and compared by age, sex, education and economic status. Results : The correct rate to the questions concerning 'cause of hypertension' and 'protection of hypertension' were significantly higher in men(P<0.05). The correct rate to the questions concerning 'blood pressure need to be once checked per day', 'anti-hypertensive medication should be taken for life' and 'weight control is essential' were significantly different by the age(P<0.05). It was significantly different that the questions about 'blood pressure check one per day', 'cause of hypertension', 'symptom of hypertension', 'regular anti-hypertensive medication', and 'modification of life style' were correctly answered by the high level of education(P<0.05). Conclusion : In order to correct wrong awareness of hypertension, the necessity of developing special program to achieve better compliance of hypertensive patients is mandatory.

외과적으로 치료한 폐국균종증의 임상분석

김종인,조성래 KOSIN UNIVERSITY COLLEGE OF MEDICINE 2006 高神大學校 醫學部 論文集 Vol.21 No.1

Background: Pulmonary aspergillosis usually results from the colonization in the existing lung lesions by chronic pulmonary diseases, such as tuberculosis. Most cases of pulmonary aspergilloma have been treated surgically for many years because it is a potentially life threatening disease causing massive hemoptysis. Here we reviewed our surgical results for 45 cases of pulmonary aspergillomas. Methods: We reviewed 45 cases which were surgically treated from 1986 to 2003 retrospectively. This investigation were designed to illustrate distribution of age and sex, symptom and sign, underlying disease, anatomic location of lesion, roentgenographic findings of aspergilloma, surgical indication and operative procedures, postoperative complications. Results: Peak incidence of age lies 4th and 5th decades. Most common presenting symptom was hemoptysis (77.3%), and pulmonary tuberculosis (24 cases) was the most common underlying disease. The anatomic location of lesions were 23 cases in right side, 21 cases in left side, and 1 case in both side and more in upper lobes(32 cases) than in lower lobe (14 cases). The most common chest roentgenographic finding was cavity with fungal ball in 30 cases and simple aspergilloma in 29 cases, complex aspergilloma in 17 cases according to roentgenographic classification by Belcher and Plummer. The performed operative procedures were lobectomy (conventional and video assisted thoracic surgery) in 33 cases, segmentectomy in 3 cases, pneumonectomy in 3 cases, wedge resection in 3 cases, cavernostomy with myoplasty in 3 cases, and bilobectomy in 1 case. There were 20 complications, empyema with bronchopleural fistula in 7 cases, wound infection in 7 cases, prolonged air-leakage in 2 cases, reoperation due to massive hemorrhage in 2 cases, recurred aspergilloma during follow-up in one case and postoperative death due to acute respiratory distress syndrome in 1 case. Conclusion: Surgical resection is the treatment of choice for symptomatic aspergilloma with acceptable complications, even though it has only minimal hemoptysis.