특발성 세균성 복막염 환자의 예후 결정 인자에 관한 연구

문중갑,이승주,이정웅,정찬수,강종식,이준상 大韓消化器病學會 1991 大韓消化器病學會誌 Vol.23 No.2

대동맥 이첨판을 동반한 대동맥륜 하부 대동맥류 1 예

이승주,문중갑,강종식,이정웅,정찬수,임승균 대한내과학회 1991 대한내과학회지 Vol.40 No.6

Annular subvalvular left ventricular aneurysm is a rare cardiac malformation occurring predominantly in blacks, and the developmental aspects of this malformation are not known. In Korea there has been one case report accompanied with subacute bacterial endocarditis. We experienced a case of subannular aortic aneurysm with bicuspid aortic valve in a 21-year-old man who had been diagnosed as subacute bacterial endocarditis. To our knowledge, this is the fourth report in the world of subannular aortic aneurysm with congenital bicuspid aortic valve. We speculate about the cause of the malformation in our patient. The deformed bicuspid aortic valve may have caused high pressure in the left ventricle, and the associated congenital disorder of the connective tissue in the wall near the atrioventricular groove may have caused herniation of the endocardium and formation of a subannular aortic aneurysm under this high pressure.

고혈압의 치료순응과 그 관련요인에 대한 지역사회 추적조사

김장락,문중갑,강경희,이명순,홍대용 대한보건협회 1997 대한보건연구 Vol.23 No.1

본 연구는 지역사회의 고혈압 의심자 및 확정 고혈압자에서 자신의 고혈압에 대한 인지율, 치료율 및 관리율을 파악하고, 1차 조사후 3-5개월간의 치료순응 및 그 관련요인을 규명하여 지역사회의 고혈압 관리사업에 필요한 자료를 얻고자 실시되었다. 1차 설문조사 및 혈압 측정의 기간은 1996년 3월 6일부터 1996년 4월 29일이었으며, 선정된 의령군 연구지역의 주민등록상 20세 이상 지역 거주자 3,140명에 대하여 2,171명을 조사함으로써 조사율은 69.1%였다. 이중 혈압측정에서 혈압이 정상범위보다 높은 624명과 혈압은 정상이지만 혈압강하제를 투여받는 사람 35명(총 659명)은 2차 고혈압의 치료순응 연구의 대상자였다. 2차 자료 수집은 1차 설문조사가 끝난 뒤 최소한 3개월이 경과한 8월중에 각 면 단위로 1차 조사를 담당하였던 보건요원들이 실시하였다. 치료순응 관련요인의 분석을 위한 연구의 변수들은 건강신념모형 및 다른 연구들을 참고하여 선정하였다. 우리나라 농촌 지역사회의 고혈압자(고혈압 의심자 및 확정 고혈압자) 중 고혈압 인지율은 32.8% (48.2%), 고혈압자 중 치료율은 19,1% (33.5%), 고혈압 인지자 중 치료율은 61.4% (70.8%), 고혈압자 중 관리율은 5.3% (18.2%), 고혈압 인지자 중 관리율은 16.4% (36.7%), 치료자 중 관리율은 36.7 % (53.5%)였다 (괄호안은 WHO 기준으로 고혈압을 분류했을 때 비율이다). 혈압이 높았던 사람들에서 향후 3-5개월간의 치료 순응률은 52.0%로 고혈압 의심자에서 38.7%, 확정 고혈압자들에서 78.2%였다. 다변량분석 결과 치료순응 관련요인으로 유의한 변수들은 고혈압 의심자군에서는 농부증 점수, 동거 세대수, 고혈압의 정도, 고혈압 치료는 간단한지에 대한 생각, 친지중 고혈압 또는 중풍이 있었는지 여부였다. 확정 고혈압자군에서는 자동차 소유 여부, 동거 세대수, 고혈압이 잘 치료되는지에 대한 생각, 증상의 경험 유무였다. 결론적으로 우리나라 농촌 지역사회에서의 고혈압에 대한 인지율, 치료율 및 관리율은 매우 낮다. 치료순응 관련요인에서는 아직도 경제적, 지리적 또는 시간적으로 의료인에 대한 접근도에서 문제가 있다고 할 수 있다. 따라서 지역사회의 고혈압 관리를 위한 체계적이고 적극적인 보건사업이 절실히 요구된다. 고혈압자의 환자 교육 측면에서는 고혈압의 심각성을 강조하는 겁주기(fear arousing)보다는 고혈압의 치료 과정이 간단하지만 평생해야 함을 강조하는 것이 필요하다. This study was carried out to estimate the proportions of the awareness, treatment, and control of hypertension, and to identify the compliance rate within 3-5 months follow-up and its determinants among the hypertensives in the community. 2,171 (69.1%) of the 3,140 adults above 20 years old who had lived in the selected 20 villages in Uiryong County of Kyungnam Province were screened for hypertension (defined as systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure 90mmHg and/or self-reported taking of antihypertensive medications) and interviewed regarding the variables in the Health Belief Model from March 6 through April 29, 1996. The second interview about compliance which was defined as having visited health professionals since the screening was completed in 573 (86.9%) of 659 hypertensive persons in August, 1996. The proportions of awareness, pharmacological treatment, pharmacological treatment on awareness, control, control on awareness, and control on pharmacologic treatment among the hypertensives were 32.8% (48.2%), 19.1% (33.5%), 61.4% (70.8%), 5.3% (18.2%), 16.4% (36.7%), 28.9% (53.5%), respectively (% in parentheses are those when hypertension was defined as systolic blood pressure ≥ 160mmHg and/or diastolic blood pressure ≥ 95mmHg or self-reported taking of antihypertensive medications). The compliance rate within 3-5 months was 52.0% in all hypertensives. That in suspected hypertensives (persons defined as systolic blood pressure ≥ 140mmHg and/or diastolic blood pressure ≥ 90mmHg in those who had not been aware of their hypertension) was 38.7%. That in definite hypertensives (defined as self-reported taking of antihypertensive medications and/or systolic blood pressure ≥ 140mmHg and/or diastolic 90mmHg in those who had been aware of their hypertension) was 78.2%. In a logistic regression model of the suspected hypertensives, those with a higher farmer's disease score, larger number of generations living together at home, hypertension stage II or above, thinking that treatment of hypertension was simple, or having a hypertensive or cerebrovascular patient in their acquaintance were more compliant. Among definite hypertensives, those having a car, with larger number of generations living together at home, thinking that the cure of hypertension was different from person to person or impossible, or having experienced symptoms from hypertension were more compliant. These findings demonstrated that hypertension awareness, treatment, and control in the rural community was still very low. There seemed to be barriers in the accessibility of patients to health professionals in terms of economy, distance and time. This study implicates that more systematic and active health services are required for hypertension control in a community. For health education of hypertensive patients, we suggest, emphasis should be placed on delivering the fact that treatment of hypertension is simple but should be continued during lifetime, rather than on arousing fear.

회장의 평활근종 파열에 의한 복막강내 출혈 1예

신윤원,문중갑,이형룡,강종식,이준상,백옥지 大韓消化器病學會 1989 大韓消化器病學會誌 Vol.21 No.4

중년 남성 근로자에서 신체 적합도, 여가중 신체 활동과 혈중 지질 농도

김장락,남복동,김주호,이송권,문중갑,이장호,홍대용,Kim, Jang-Rak,Nam, Bock-Dong,Kim, Ju-Ho,Lee, Song-Kwon,Moon, Joong-Kap,Lee, Jang-Ho,Hong, Dae-Yong 대한예방의학회 1996 예방의학회지 Vol.29 No.2

본 연구는 40세 이상 중년의 남자 근로자 253명을 대상으로 신체 적합도 및 여가중 신체 활동과 혈중 지질 중 심혈관질환 발생에 특히 중요한 혈중 총콜레스테롤 값, HDL 콜레스테롤 값 및 총콜레스테롤/HDL 콜레스테롤 비와의 관련성을 알아 보기 위하여 시도된 단면조사연구이다. 단순분석에서 혈중 총콜레스테롤 값과 유의한 상관 관계가 있는 변수는 신체 적합도(r=-0.27), 비만지수(r=0.27)였다. 여가중 신체 활동은 총콜레스테롤 값이 170mg/dl 이상군에서만 총콜레스테롤 값과 유의한 상관관계(r= -0.20)가 있었다. HDL 콜레스테롤 값과 유의한 상관관계가 있는 변수들은 신체 적합도(r=0.15), 비만지수(r=-0.22)및 1주간 음주량(r=0.14)이였다. 총콜레스테롤/HDL 콜레스테롤 비와 유의한 상관관계가 있는 변수들은 신체 적합도(r=0.23), 비만지수(r=0.32), 총흡연지수(r=0.13), 1주간 음주량(r=-0.13) 및 야채 선호도(r=0.13)이었다. 신체 적합도는 안정시 맥박수와 중등도의 상관관계(r=-0.66)가 있었고, 여가중 신체 활동(r=0.19)및 비만지수(r=-0.18)와도 유의한 상관관계가 있었다. 다중회귀분석(Multiple linear regression) 결과 혈중 총콜레스테롤 값과 유의한 관련성을 보이는 변수는 신체 적합도(beta=-0.23)와 비만지수(beta=0.18)이었다. HDL 콜레스테롤 값과 유의한 관련성을 보이는 변수는 비만지수(beta=-0.25)뿐이었다. 총콜레스테롤/HDL 콜레스테롤 비와 유의한 관련성을 보이는 변수는 비만지수(beta=0.30)와 신체 적합도(beta=-0.16) 및 야채선호도(beta=0.14)이었다. 결론적으로 중년 남성 근로자들에서 신체 적합도는 비만지수와 함께 혈중 총콜레스테롤 값, HDL 콜레스테롤 값, 총콜레스테롤/HDL 콜레스테롤 비의 중요한 관련 요인이었다. 여가중 신체 활동은 혈중 총콜레스테롤 값이 170mg/dl 이상인 군에서만 혈중 총콜레스테롤 값과 관계가 있었고, 신체 적합도와는 관련성이 유의하지만 크지 않았다. 따라서 신체 적합도가 여가중 신체 활동보다 혈중 지질 농도의 더 중요한 관련요인이며, 앞으로 신체 활동에 관련된 역학적 연구에서 신체 적합도가 독립적이고 중요한 요인으로 추가되어야 할 것이다. This is a cross-sectional study to evaluate the relationships between physical fitness, leisure time physical activity, and serum lipid levels in middle-aged male workers. Physical fitness was measured by a step test score, and leisure time physical activity was self-reported on a questionnaire. Serum total cholesterol was negatively related to physical fitness(r=-0.27), and positively to obesity index(r=0.27). But leisure time physical activity was related to total cholesterol negatively(r=-0.20) only in subjects whose total cholesterol levels were above 170mg/dl. High density lipoprotein(HDL) cholesterol was positively related to physical fitness(r=0.15), negatively to obestiy index(r=-0.22), and positively to weekly alcohol consumption(r=0.14). Total cholesterol/HDL cholesterol ratio was related to physical fitness(r=-0.23), obesity index(r=0.32), total cigarette index (r=0.13), weekly alcohol consumption(r=-0.13), and vegetable preference(r=0.13). Physical fitness was also related to leisure time physical activity(r=0.19) and obesity index(r=-0.18). In multiple linear regression models, physical fitness(beta=-0.23) and obesity index(beta=0.18) were significantly associated with total cholesterol, obesity index(beta=-0.25) with HDLcholesterol, and obesity index(beta=0.30), physical fitness(beta=-0.16) and vegetable preference (beta=0.14) with total cholesterol/HDL cholesterol ratio. In conclusion, as physical fitness has a stronger relationship with serum lipid levels than leisure time physical activity, and the association between physical fitness and leisure time physical activity is modest, physical fitness should be added as an important variable in addition to activity in future epidemiologic studies.

^(32)P-postlabelling法을 이용한 有機溶劑 작업장 근로자의 遺傳毒性 評價

홍대용,김장락,이장호,문중갑,이한우,김동일,박성학,정주화,이홍근 한국환경독성학회 1994 환경독성보건학회지 Vol.9 No.1

To evaluate the genotoxicities of workers exposed to glue and glue cleaning solution, ambient air monitoring of working place, animal study and human monitoring were carried out. By GC-MS analysis, air samples collected from shoesmaking plant were found to be toluene, xylene, cyclohexane, n-hexane, methyl ethyl ketone, trichloroethylene, butylacetate, isopropyl alcohol. Glue and glue cleaning solution from shoesmaking plant were applicated topically to the CD-1 mice. DNA was isolated from skin 24 hr following the application and analysed for DNA-adducts using the nuclease P₁ version of ^(32)P-postlabelling assay. RAL (Relative Adduct Labelling, adducts/10^(8) nucleotides) was significantly increased in a dose-dependent manner in the glue cleaning solution treated mice skin. Peripheral blood DNA-adducts of workers exposed to glue and glue cleaning solution were also analysed by the same method, but there were not significant differences in the peripheral blood DNA-adducts level between exposed and control workers. In addition, glue cleaning solution from shoes factory was evaluated for mutagenicity in the Salmonella plate incorporation assay using strains TA 100 and TA 1535 in the presence and absence of Arochlor 1254-induced rat liver S_(9). There was evident mutagenicity for cleaning solution in TA 100 regardless of S_(9), but TA 1535 showed positive only in the absence of S_(9) when predicted by Stead model of mutagenicity prediction (p=0.0000). The urine concentrates from workers and controls were also assayed for mutagenicity towards strain TA 100 of Salmonella typhimurium in the presence of S_(9) using Kado's microsuspension assay, but their mutagenic activities were not found to be significant. These data suggest that shoesmaking workers are exposed to genotoxic compounds and need to be monitored by testing the mutagenicity of human urines. However, ^(32)P postlabelling application requires further validation for the routine monitoring of human exposure.

간장 ( 肝臟 ) 및 담도 ( 膽道 ) : 특발성 세균성 복막염 환자의 예후 결정 인자에 관한 연구

강종식(Jong Sik Kang),문중갑(Joong Kap Moon),이승주(Seung Ju Lee),이정웅(Jung Woong Lee),정찬수(Chan Su Jeong),이준상(Jun Sang Lee) 대한소화기학회 1991 대한소화기학회지 Vol.23 No.2

N/A We examined 34 cases of spontaneous bacterial peritonitis retrospectively to evaluate the factors influencing prognosis in spontaneous bacterial peritonitis. The obtained results were as follows. The groups with higher serum bilirubin, lower ascitic glucose concentration, more abnormal y-GTP, combined hepatic encephalopathy and positive ascitic culture showed poor prognosis significantly. Also, the groups with increased frequency of admission by spontaneous bacterial peritonitis and cultured enteric organism (esp.E.coli) in ascites tended to show poor prognosis. But, fever, serum creatinine level, PMN fraction in ascites or peripheral blood, and postitive blood culture were not related to prognosis statistically.

회장의 평활근종 파열에 의한 복막강내 출혈

이준상(Joon Sang Lee),강종식(Jong Sik Kang),신윤원(Youn Won Shin),문중갑(Joong Kab Moon),이형룡(Heung Ryeong Lee),백옥지(Ok Ji Paik) 대한소화기학회 1989 대한소화기학회지 Vol.21 No.4

A 68-year-old womam, adrnitted with hemoperitoneum due to leiomyoma rupture of the ileum, required emergency operation. After a successful resection for the tumor, the patient was discharged with normal blood values and she has remained we]l. We should consider small bowel tumors in the evidence of chronic or repeated bouts of acute intestinal bleeding in the face of negative conventional X-rays and freedom from symtoms except those due to bleeding. The rarity of this case is emphasized and the literature reviewed.