중독한 추체로 증상을 보인 cyclosporine에 의한 뇌증 1예

강정현,곽승근,신현영,김성은,이정호,이정찬,곽상혁,윤환중,조덕연,김삼용,김제,송창준 충남대학교 의과대학 지역사회의학연구소 2000 충남의대잡지 Vol.27 No.1

The use of cyclosporine(CsA), a potent immunosuppressive agent, is associated with numerous side effects. Neurotoxicity was earlier less well known, but with growing experience central nervous system side effects are now reported up to 40% of patients. Among various CsA-induced neurotoxicities, tremor is most common and posterior leukoencephalopathy is well characterized. An encephalopathy presenting with pyramidal weakness, however, seems to be rare and poorly documented. We report here a case of encephalopathy presenting with multiple generalized seizures followed by fluctuating quadriparesis developed a few days after starting CsA and resolved spontaneously after withdrawal of the drug . A 48-year-old woman with aplastic anemia was placed upon immmunosuppressive treatment consisting of antithymocyte globulin(ATG), CsA, and methylprednisolone. Two days after starting the therapy, she developed a generalized seizure. The next day she developed 2 more episodes of seizure and the therapy was stopped. Computed tomogram of the brain was normal. Six days after starting therapy, she developed mild motor weakness and paresthesia of both lower extremities, which progressed to a definite quariparesis confining her to a bed in 3 days. Magnetic resonance imaging(MRI) of the brain revealed asymmetric, bilateral high-signal abnormalites in the subcortical white matter of fronto-temporal areas. After reaching to a maximum with some fluactuation(14 days after starting the therapy) the motor weakness started to be resolved. She was discharged with a almost complete resolution of the weakness 45 days after starting the therapy. Five months later she did well and brain MRI was negative.

비만증 환자에서 한약제에 의한 체중 감소효과

Oh, Seung-Joon,Jeong, In-Kyung,Kim, Young-Seol,Choi, Young-Kil,Paeng, Jeong-Ryung,Bae, Jung-Hwan,Shin, Hyun-Dae 경희대학교 동서의학연구소 1999 INTERNATIONAL SYMPOSIUM ON EAST-WEST MEDICINE Vol.1999 No.1

Seung-Joon Oh, In-Kyung Jeong, Young-Seol Kim, Young-Kil Choi, Jeong-Ryung Paeng¹, Jung-Hwan Bae and Hyun-Dae Shin²Department of internal Medicine, College Medicine, Endocrine Research Institute¹. Department of Rehabilitation, College of Oriental Medicine², Seoul, korea. Bady Fat Reduction Effects of Red Ginseng Compound Preparation on the Patients with Obesity. Proceedings of International Symposium on East-West Medicine, Seoul. 244-254, 1999.-Obesity can be defined as a metabolic disease due to an increased state of fat tissues caused by an imbalance of calorie intake and use. Recently, in Korea by improvement and westernization of food intake, along with decrease in exercise activities, the prevalence of obesity has increased greatly. Our objectives were to study stability and effects of decrease in body fat by administering red ginseng compound preparation (known to have body fat decreasing effects in laboratory animals) to obesity patients on low calorie diets. Changes in weight and body fat were measured while carrying out calorie-restricted diets on patients for 4 weeks, then administering red ginseng compound preparation for another 4 weeks. The patients were 20 people whose BMI were 25kg/㎡ or over and whose percent body fat was also 30% or over when tested by bioelectrical conductivity. 1. Changes in weight were from 70.04kg(base line) to 67.43kg(after taking red ginseng compound preparation). 2. In similar sense, BMI decreased from 27.12kg/㎡(base line) to 26.56kg/㎡(after dieting), and further to 26.01kg/㎡ (after taking red ginseng compound preparation). The BMI seemed to decrease significantly compared to the baseline after the use of red ginseng compound. 3. Waist hip ratio was changed from 0.8858(base line) to 0.8728, but it was statistically insignificant. 4. The percent body fat was 35,16%(base line), 33.87%(after dieting), and 31.68%(after taking red ginseng compound preparation). 5. Complete blood cell count and blood chemisrty remained unaffected by the administration. 6. In concern to endocrinologic studies, T3 decreased from 118.7 to 98.2ng/dL, and T4 increased from 8.8 to 9.2㎕/ dL. Epinephrine showed a tendency to decreased from 0.27 to 0.25 ng/mL, and norepinephrine increased from 0.39 to 0.44ng/mL. 7. Leptin was not changed. 8. Some patients complained adverse effects; constipation(5 patients, may be due to diet therapy), fatigue (2 patients), pruritus(2 patients), flushing(s patients), dizziness(3 patients) and epigastric discomfort(2 patients). However their symptoms were mild, so medication did not stopped. In conclusion, loss of weight without significant side effects was observed during low calorie diet and red ginseng compound preparation administration. This is thought to be in relation to sympathetic nerve system rather than adrenal gland. Also, further long0term studies should be required, since the observed results were based on short-term changes in weight.

고실 사구종 1례

신현수,윤태현,장희종,남정권 대한이비인후과학회 1998 대한이비인후과학회지 두경부외과학 Vol.41 No.3

치아 맹출전 시행한 기관 삽관이 유치열기에 미치는 영향에 대한 증례보고

신윤경,Hyun, Hong-Keun,김영재,김정욱,장기택,이상훈,김종철,한세현 大韓小兒齒科學會 2008 大韓小兒齒科學會誌 Vol.35 No.3

유치 맹출전에 치조융기에 가해진 외상은 유치의 맹출 지연 및 형태이상,치배의 변위 등을 일으킬 수 있으며 심한 경우 구개의 흠 형성,절치의 결함 및 후천성 구개열 등을 야기할 수 있다. 본 증례는 치아가 맹출하기 전에 수차례의 기관 삽관을 시행한 병력이 있는 심한 저체중아에서 맹출지연,형태이상,법랑질 저형성,영구치 치배 등의 변위가 관찰되어 이를 보고하는 바이다. Delayed eruption and abnormal morphology of the primary incisors following intubation may be due to follicular displacement and localized trauma caused by the process of intubation. Result of such damage included palatal groove formation, defective incisors and acquired clefts. This clinical report presents effect of intubation on the primary dentition of premature low-birth-weight children prior to tooth eruption.

폐렴구균 감염증에서 항생제 내성의 임상적 의미 : Asian Network for Surveillance of Resistant Pathogens(ANSORP) Study

정숙인,기현균,손준성,고관수,김나영,장현하,오원섭,백경란,이남용,김신우,이혁,--,송재훈 대한감염학회 2003 감염과 화학요법 Vol.35 No.5

목적 : 전 세계적으로 폐렴구균의 페니실린을 포함한 β-lactam과 마크로라이드 및 퀴놀론 계열의 항생제에 대한 내성이 급격히 증가하여 임상적으로 문제가 되고 있으나, 시험관내 내성이 실제 임상적 예후에 미치는 영향에 대해서는 아직까지 논란이 되고 있다. 본 연구는 폐렴구균의 항생제 내성률이 높은 아시아 지역에서 항생제 내성이 폐렴구균 감염증의 임상경과에 미치는 영향을 평가하기 위하여 시행되었다. 방법 : ANSORP에서 주관한 전향적 임상 연구로서 1999년 11월부터 2001년 8월까지 아시아 지역 11개국의 14개 기관에서 진단된 침습성 폐럼구균 감염증 환자를 대상으로 내성 균주 감염의 위험요인, 임상양상, 예후 등의 임상적 분석을 시행하였다. 결과 : 총 646명 환자의 평균연령은 30.1세(6일-89세)였고, 이전 3개월 내에 항생제 사용력이 있는 환자는 159명(32.4%)이었다. 질환별로는 폐렴이 377예(58.4%)로 가장 많았고, 중이염 67예, 뇌수막염 66예(10.2%), 일차성 균혈증 65예(10.1%)였다. 총 646균주 중 347균주(53.7%)가 페니실린 비감수성(중등도 내성 23.1%, 고도 내성 23.1%)이었고, 페니실린에 대한 MIC_(90)은 0.03㎍/mL에서 4㎍/mL까지의 분포를 보였다. 페니실린 비감수성 균주에 의한 감염증과 차이가 없었다. 페니실린 내성 폐렴구균 폐렴에 의한 사망률은 페니실린 감수성 폐렴구균 폐렴에 의한 사망률과 차이가 없었다(p=0.846). Erythromycin에 대한 고도 내성을 보이는 균주의 비율이 매우 높았으나, 실제 임상상이나 치사율에는 영향을 미치지 않았다(p=0.092). 페니실린 비감수성 폐렴구균에 의한 뇌수막염의 치사률도 감수성 균주에 의한 사망률과 차이가 없었다(p=0.059). 결론 : 본 연구의 결과 페니실린 및 베타 락탐 제제에 대한 시험관 내성은 폐렴구균 폐렴이나 뇌수막염의 임상상이나 치사율에 영향을 미치지 않는 것으로 확인되었다. 이는 내성의 정도와 연관될 것으로 생각되므로, 향후 고도 내성 균주가 증가할 때 추가 검증을 요한다. 아울러 macrolide 및 퀴놀론계 항생제 내성의 임상적 의미에 대한 후속 연구가 필요할 것으로 사료된다. Background : Despite the widespread emergence of antimicrobial resistance among pneumococcal strains worldwide, clinical implications of in vitro resistance still remain an open question. To evaluate the clinical impact of pneumococcal resistance in Asian countries where the prevalence of pneumococcal resistance was reported to be highest in the world, ANSORP has performed a prospective, multinational surveillance study with cases with invasive pneumococcal diseases in Asian countries. Methods : In vitro susceptibility of pneumococcal isolates was determined by broth microdilution tests with 16 antimicrobial agents. All enrolled cases of pneumococcal infections were analyzed with regard to demographic data, clinical features, risk factors and mortality. Results : A total of 646 patients with pneumococcal infections were enrolled from 14 centers in 12 countries between the period from November 1999 to August 2001. Pneumonia (58.4%) was the most common clinical disease followed by bacteremia (33.4%), otitis media (10.4%), and meningitis (10.2%). Among 646 isolates, 347 (53.7%) were penicillin non-susceptible (intermediate 23.1%, resistant 30.7%). MIG_(90)s for penicillin ranged from 0.03 (India) to 4.0 ㎍/mL (Korea, Taiwan, Vietnam, and Hong Kong). Overall mortality from pneumococcal diseases by penicillin non-susceptible strains was not different from that by susceptible strains. Pneumococcal pneumonia caused by penicillin- or erythromycin-resistant strains showed similar mortality, severity of illness, or complications to that by susceptible strains. Mortality from pneumococcal meningitis caused by penicillin non-susceptible strains was also similar to that by susceptible strains. Conclusion : Data suggest that current situation of in vitro resistance to penicillin or macrolides may not affect the mortality from pneumococal pneumonia or meningitis caused by antibiotic-resistant strains.

비만을 동반한 위암 환자에서 두 병을 같이 수술 치료한 경험(증례)

최경현,윤기영,문형환,신연명,서경원,안수미,송윤미,석정희,정경연,이은하 고신대학교의과대학 2008 고신대학교 의과대학 학술지 Vol.23 No.3

Obesity is growing problem in Korea. We had a case of bariatric surgery during gastric cancer operation. Patient was 29 year old Korean lady with early gastric cancer located in the lesser curvature side of the middle 1/3 of the stomach. Her body weight was 89 kg, height 163 cm, and thus body mass index was 33.5 kg/m2. Preoperative blood pressure was 130/90 mmHg, hemoglobin 12.9 g/dL, total lymphocyte count 3,280/mL, serum albumin 4.3 g/dL, CEA 1.1 ng/mL, CA 19-9 9.1 ng/mL, and alpha fetoprotein 2 ng/mL. Another associated disease was right thyroid follicular neoplasm. The chest X-ray was normal. After IM injection of 2,500 units of heparin 30 minutes before the induction of general anesthesia, she received curative subtotal gastrectomy and Roux en Y gastrojejunostomy when a malabsorption loop of 120 cm jejunum was incorporated between the Treitz ligament and the end to side jejuno-jejunostmy site at May 29th 2006. Her postoperative course was uneventful except a minor wound seroma and the elevations of serum amylase(up to 4 folds) and lipase(up to 2 folds). She lost her body weight 9 kg in 5th, 21 kg in 7th, and 27 kg in 10th postoperative months to became 61.5 kg. On follow up exams in July 2008, she gained 4 kg to overcome her weakness and fatigue. From the above result, the incorporation of a malabsorption loop during reconstruction phase of gastric cancer operation was a good option for obese gastric cancer patients especially in cases of early gastric cancer.

자동차 프레스공정의 자동검사/계측시스템

정원,신현명,박종락 한국경영과학회 1999 經營 科學 Vol.16 No.2

This paper presents an automated visual inspection/measuring system for the door inner panel manufacturing process The main objective of this research is to develop inspection applications with a machine vision system related to the determination or quantification of parameters such as dimension, shape, quality of surfaces, number of holes in a panel, and presence or absence of specific features For quality measurements, we showed a subpixel image processing technology that will improve the consistency of results and level of precision Also presented is a data analysis method to detect process shifts so that corrective action can be undertaken before more defective units are manufactured

어린이에서 함치성 낭과 연관된 매복 소구치와 대구치의 치료

신차욱,김영재,김정욱,장기택,이상훈,김종철,한세현 大韓小兒齒科學會 2008 大韓小兒齒科學會誌 Vol.35 No.4

치아 매복은 어린이 환자 진료시에 자주 관찰되는 맹출 장애이다. 어린 환자에서 매복된 치아가 존재하는 경우,함치성 낭과 연관이 있을 가능성이 높다. 함치성 낭은 제3대구치를 제외하고는 상악 견치,하악 소구치 부위에서 가장 호발하며,점진적인 증식으로 악골이 팽윤되어 안모를 변화시키며,주위 악골의 파괴와 치근의 흡수를 야기하거나 침범된 치아의 변위를 유발할 수 있으므로,조기 진단과 적절한 치료가 무엇보다도 중요하다. 함치성 낭과 연관된 치아가 과잉치나 지치라면,치아의 발거를 포함한 완전한 낭종 적출술이 적절한 치료라 할 수 있지만,그렇지 않은 경우에는 환자의 심리적,정선적 외상을 예방하기 위해 원인 치아의 보존이 고려되어야 할 것이다. 이뿐만 아니라,치아의 변위 정도,골 파괴 정도,치근의 성숙도,주위 치아와의 관계,환자의 교합과 구강 악안면 영역의 성장 양상 등도 같이 고려되어야 할 것으로 생각된다. 본 증례에서는 위와 같은 사항들을 고려하여,함치성 낭과 연관된 매복 소구치와 대구치블 낭종 적출술 후 공간 유지,외과적 수술과 교정적 견인,외과작 발거 후 교정적 배열 등의 방법을 통해 양호한 치료 결과를 얻었기에 보고하는 바이다. Tooth impaction is a frequently observed eruption anomaly in pediatric dental practice. Young patients with impacted or unerupted teeth have more prediction for dentigerous cyst formation. Dentigerous cyst presents radiographic features. unilocular or multilocular radioluscency. Cysts occur most frequently in the premolar region except third molar. Dentigerous cysts can grow to a considerable size, and large cysts may be associated with a painless expansion of the bone in the involved area. Extensive lesions may result in facial asymmetry, osseous destruction, root resorption of proximal teeth and displacement of associated tooth. The nature of the causative tooth influences the type of surgical treatrnent required for the dentigerous cyst. If the cyst is associated with a supernumerary or wisdom tooth. complete enucleation of the cyst along with extraction of tooth may be the first treatment choice. Otherwise. preservation of the associated teeth should be considered to prevent a young patient from psychological and mental trauma because of the loss of tooth. We should consider the degree of tooth displacement. osseous destruction and growth pattern of oromaxillofacial area when planning treatment. Thus a proper and logical treatment planning can help a proper growth and development of oromaxillofacial area and can save the patient from a psychological and mental trauma. This report describes 4 cases of the management of impacted premolars and molars associated with dentigerous cysts in children.

일개 대학병원에서 경험한 방선균증의 임상상

정숙인,김연숙,기현균,김춘관,김신우,이혁,김성민,백경란,송재훈 대한화학요법학회 1999 대한화학요법학회지 Vol.17 No.3

배경 : 방선균증은 혐기성의 그람양성 간균에 의한 만성 화농성 감염으로, 경안면부, 흉부, 복부, 골반부 등을 주로 침범한다. 최근 구강 위생의 향상과 항생제의 사용으로 인해 방선균증의 빈도의 감소와 함께 그 임상양상 또한 크게 변화하였다. 저자들은 국내에서의 방선균증의 임상상을 분석하기 위해 본 연구를 시행하였다. 방법 : 1995년 5월부터 1998년 9월까지 삼성서울병원에서 방선균증으로 진단받은 환자를 대상으로 임상기록지를 토대로 감염병소와 임상경과 등을 후향적으로 조사하였다. 결과 : 방선균증 환자는 모두 12명으로 경안면부 1례, 흉부 3례, 복부 3례, 골반부 5례였다. 임상양상은 주로 종괴의 형태로 나타나 진단을 내리기까지 종양과의 감별에 어려웠으며 진단은 모두 조직검사나 흡인액에서 유황과립을 확인함으로써 이루어졌다. 방선균증으로 진단된 환자는 모두 호전소견을 보였다. 결론 : 국내에서도 방선균증이 드물지 않게 발생하고 있으며 임상양상이 다양하여 가장 많이 오진되는 질환 중의 하나이다. 방선균증은 조직검사나 균배양검사를 통해 진단하고 항생제를 통해 완치될 수 있는 질환이므로 환자 진단에 관심을 가지면 불필요한 수술을 피할 수 있을 것으로 생각된다. Background: Actinomycosis is an indolent, slowly progressive bacterial infection, caused by Actinomyces. a gram-positive, non-spore-forming anaerobic or microaerophilic rod. Actinomycosis affects nearly every organ and body site. The disease is classically divided into four types, depending on the anatomic sites involved: cervicofacial, thoracic, abdominal, and pelvic. It has been considered as a rare disease, and only several cases have been reported in Korea. We performed this study to analyse the clinical manifestations of actinomycosis in Korea. Method: We retrospectively reviewed the medical records of patients with actinomycosis at the Samsung Medical Center from May 1995 to December 1998. Results: During the study period, actinomycosis was diagnosed in 12 patients: 1 patient had cervicofacial lesion, 3 thoracic, 3 abdominal, and 5 pelvic. The male and female ratio was 1 : 2 and the mean age was 47.2 years. Sulfur granule was observed in the pathologic specimens from all cases, but organism did not grow at all. It was very difficult to differentiate actinomycosis from tumorous conditions without pathologic diagnosis. All patients were clinically improved with antibiotics or surgical procedures. Conclusion: Actinomycosis is not a rare disease nowadays and has various clinical manifestations. It can be diagnosed by pathologic examination or culture and cured by antibiotics without surgical management.

항공 예약시스템(CRS)운영 개선방안 : TOPAS와 ABACUS를 중심으로

신강현,이정철 남서울대학교 경영연구센터 2001 경영연구 Vol.3 No.-

Recently, in the environment of the CRS, the user need is varied, high-standard service is required, and an timely offer of the quick information is indispensable. Also, competition between the similar CRS is deepening. In order to find, control, and maintain of either the new customer or the present customer, the importance of the CRS as the most efficient, positive management tool is becomes powerful in the Airlines & Whole sellers. Thus, it is very important subject that the efficiently improvement of the CRS operation, then can be contributed to the development of the Korea tourism. This study started under the assumption that the CRS is to be a premise in order to accomplish the purpose of securing the superiority in competition. Thus, this study presented the alternatives of the efficient operation on the basis of the analysis in the TOPAS & ABACUS system. The purpose of this study is focused on contributing to secure the customer and the pursuit of profits as the new strategies, is suitable at the information era, by finding the problems of our CRS system and improving the these, and to develop the high value-added industry by supplying the highly quality information service though the renovation of the CRS. The structure of this study is follows: Chapter 1. Introduction Chapter 2. The theoretical background of CRS Chapter 3. A situation of the TOPAS & ABACUS Chapter 4. A compared study of the TOPAS & ABACUS Chapter 5. Conclusion The limitation of this study is to not deeply research the hardware part and did not accomplished the empirical study, especially little lack to verify the relationships of the airlines and whole seller, in the future, following study to solve these limitations is expected. Finally, desire eagerly the results of this study are helpful to the development of the CRS in Korea.