표층확대형 조기위암 1예

고성만,김기훈,서호종,서광섭,유광렬,채선애,임병욱,김홍자,김호정,김진승,허병원,김해경 중앙대학교 의과대학 의과학연구소 2001 中央醫大誌 Vol.26 No.3

The superficial spreading type of early gastric cancer has usually been defined as an early gastric cancer in which the product of the longest diameter and the diameter perpendicular to it was greater than 25㎠. Although the superficial spreading type of early gastric cancer is histologically aggressive compared with those without such histological aggressiveness, the 5 year survival rate is as good as a non-superficial spreading types of early gastric cancers if the wide surgical resection with extensive lymph node dissection is performed as a treatment. We experienced a case of superficial spreading early gastric cancer in a 59-year-old man. This case is reported with a brief review of related literature.

석면관련 폐질환의 진단에 있어서 흉부고해상도전산화단층촬영검사(HRCT)의 유용성

이현재,손지언,,홍영습,,이영일,예병진,유창훈,정갑열,김상훈,임형준,장은철,김정만,김준연 大韓産業醫學會 2006 대한직업환경의학회지 Vol.18 No.2

목적: 석면에 노출된 근로자에서 석면관련 폐질환의 양상을 분석하고 진단에 있어 HRCT의 유용성을 연구하여 석면에 대한 의학적 감시프로그램의 개발에 기여하고자 하였다. 방법: 석면에 직접 노출되는 작업자 68명과 간접 노출되는 작업자 94명 등 총 162명에 대해 OSHA 석면 표준, 의학적 감시 프로그램에 따라 단순 흉부방사선검사, 폐활량검사 및 우리나라 실정에 맞게 일부 수정한 의학적 설문지를 통해 면접조사의 방식으로 환자에 관한 정보를 수집하였으며, 자료의 신뢰성을 확보하기 위하여 면접조사는 1달 이상의 기간을 두고 2차례에 걸쳐 실시된 후 확인, 수정하였다. 또한, 석면관련 폐질환을 확진하기 위하여 HRCT를 추가적으로 실시하였다. 결과: HRCT결과 석면관련 폐질환의 유병율은 162명의 근로자중 17명으로 10.5%였는데, 직접 노출군에서 10명 (14.7%), 간접 노출군에서 7명 (7.4%)이었다. HRCT와 비교할 때 단순 흉부방사선검사의 민감도와 특이도는 각각 70.6%와 98.6%이었고, 양성 예측도와 음성 예측도는 각각 85.7%와 96.6%으로, HRCT는 단순흉부방사선검사에 비해 민감도가 높아 초기 석면관련 폐질환을 진단하는데 효과적이었다. 석면관련 폐질환의 진단에 있어 HRCT와 폐활량검사 사이에 유의한 관련성이 관찰되었다. HRCT 결과 석면관련 폐질환의 유무와 의학적 설문조사 결과의 빈도분석을 실시한 결과, 유의한 변수는 작업기간, 흡연량, 호흡기질환의 과거력, 기침, 호흡곤란이었다. 결론: HRCT는 석면관련 폐질환의 진단에 있어 단순 흉부방사선검사와 비교하여 민감도가 높아 초기 진단에 유용하므로 단순 흉부방사선선검사 결과 석면관련 폐질환소견을 보일 때뿐만 아니라, 정상소견을 보이더라도 폐활량 검사결과와 근무력, 흡연력, 호흡기질환의 과거력, 기침, 호흡곤란 등의 호흡기 증상을 참고하여 HRCT검사를 고려해야 한다. 또한, 본 연구에서 관련성이 없었던 요인들에 대해서도 향후 연관성을 규명하는 광범위한 전향적 연구가 필요하다. Objectives: This study was carried out to improve the medical surveillance program of workers exposed to asbestos by examining the usefulness of High Resolution Computed Tomography (HRCT) in the diagnosis of asbestos-related lung disease. Methods: The study subjects comprised 162 workers in a ship-repairing yard, 68 of whom had been directly exposed to asbestos and 94 indirectly exposed. The 'Occupational Safety & Health Administration (OSHA) asbestos standard, medical surveilance program' and HRCT were conducted to analyze the aspects of the asbestos-related lung disease. The OSHA asbestos standard, medical surveilance program consists of simple chest x-ray, spirometry and medical questionnarie. Results: Seventeen (10.5%) of the 162 subjects, 10 (14.7%) directly exposed and 7 (7.4%) indirectly exposed, revealed asbestos-related lung disease on HRCT. The sensitivity and specificity of simple chest x-ray for asbestos-related lung disease were 70.6% and 98.6%, and the positive and negative predictive values were 85.7% and 96.6% respectively, as compared with HRCT, HRCT was an effective diagnostic tool especially to detect early asbestos-related lung disease. The study results indicated a relative significant association between the results of spirometry and HRCT. The variables significantly associated with asbestos-related lung disease on HRCT were work duration, smoking history (pack-years), past history of respiratory disease, cough and dyspnea. Conclusions: In the diagnosis of asbestos-related lung disease, HRCT should be considered not only for workers with positive findings on simple chest x-ray, but also workers with specific findings on spirometry, occupational history, smoking history, and past history of respiratory disease, or with respiratory symptoms such as cough and dyspnea.

좌각차단을 동반한 심부전증 환자에 실시한 양심실 심박조율기 치료 : 증례 보고

김찬욱,차태준,김성만,김민대,권성일,서수홍,최병주,주승재,이재우 고신대학교 의학부 2002 高神大學校 醫學部 論文集 Vol.17 No.1

Epidemiological studies suggest that 30-50% of patients diagnosed with symptomatic congestive heart failure(CHF) have electrocardiographic evidence of a major intraventricular conduction delay, which may worsen left ventricular systolic and diastolic dysfunction through asynchronous ventricular contraction and paradoxical interventricular septal wall motion. Biventricular pacing is an emerging therapy allowing simultaneous electrical stimulation of the both ventricles with an implantable pacing system and it improves hemodynamics and well-being of patient by reducing ventricular asynchrony. Recently, we underwent biventricular DDD pacemaker implantation in a patient with CHF and Left bundle branch block and was significantly improved exercise tolerance and quality of life in that patient.

단기교육으로 시행가능한 심실기능평가법

김원,임경수,오병연,홍은석,김영식,김선만,이부수,현석천,김영득 대한응급의학회 2000 대한응급의학회지 Vol.11 No.4

Background: The initial history, physical examination, and ECG assessment should focus on identification of potentially serious noncardiac or cardiac disorders, including coronary artery disease, congestive heart failure, and electrical instability at the emergency room. additionally, it is essential to define disease severity, stability and need for emergency therapy. echocardiography is a useful tool for this purpose. especially Doppler echocardiography may be more sensitive and time-saving diagnostic tool for the evaluation of patients presenting with cardiogenic symptoms. So we evaluate the feasibility of the echocardiographic measurement by emergency physicain after short-term course. Method and Results: Twenty volunteers(10 male, 38.8±9.3 years) were included in the study for measurement of myocardial performance index and established parameters of ventricular function using conventional echo-Doppler methods. Myocardial performance index: (ICT+IRT)/ET, was obtained by subtracting ejection time(ET) from the interval between cessation and onset of the mitral inflow velocity to give the sum of isovolumic contraction time(ICT) and isovolumic relaxation time(IRT). The most of mean values of echocardiogrphic parameters were not significantly different between those of cardiologist and those of emergency physicians(p<0.01). The duration for measuring myocardial performance index was shortest among echocardiographic parameters. the validity of echocardiographic parameters measured by emergency physicians was proved relatively good. Conclusion: It is proved to be feasible for emergency physician to perform echocardiographic evaluation of ventricular function after short-term course

급성기 뇌졸중 환자 자살 사고

김세주,김영신,최낙경,서동향,이병철,이만홍 大韓神經精神醫學會 2001 신경정신의학 Vol.40 No.2

연구목적: 일반적으로 자살과 자살 사고의 가장 주된 위험 인자는 우울증, 불안장애와 같은 정신과적 질환의 동반 유무이다. 그러나 정신과적 질환 외에 신체적 질환의 동반 유무 또한 자살 및 자살 사고에 영향을 미치는 것으로 알려져 있다. 일반적인 신체 질환과 마찬가지로 뇌졸증 환자들에 있어 자살율이 증가한다는 몇몇의 보고들이 있다. 그러나 우리나라에서는 뇌졸중 환자의 자살 사고에 대한 연구가 보고된 바가 없다. 따라서 본 연구에서는 급성기 뇌졸중 환자들을 대상으로, 자살 사고의 발현율을 조사하고, 자살 사고 유무에 따른 사회문화적 변인 및 신경과적, 정신과적 임상 양상에 있어서의 차이에 대해 알아보고자 하였다. 방법: 1999년 7월부터 2000년 6월까지 한림대학교 성심병원 뇌졸중 센터에 입원한 77명의 급성기 뇌졸중 환자를 대상으로 하였다. Beck Suicidal Ideation Scale(BSIS)을 이용하여 자살 사고를 평가하였고, 우울 증상과 불안 증상은 각각 Beck Depression Inventory(BDI)와 Beck Anxiety Inventory(BAI)를 사용하였다. 사회적 지지체계의 정도는 사회적 지지체계 척도(Social Support Scale)를 사용하였으며, 뇌졸중 후 신경학적 장애의 정도는 National Institutes of Health Stroke Scale(NIHSS)와 Barthel's Index를 사용하였다. 결과: 약 35%의 뇌졸중 환자들이 심한 자살 사고를 보고하였다. 심한 자살 사고군에서 심하지 않은 자살 사고군에 비해 BDI, BAI 그리고 사회적 지지체계 척도 점수가 높은 반면, Barthel's index와 NIHSS는 두 군간에 유의한 차이를 보이지 않았다. 심한 자살 사고를 지닌 뇌졸중 환자의 대부분은 우울 증상이나 불안 증상을 가지고 있었으나, 일부의 환자들은 우울 증상이나 불안 증상 없이 자살 사고를 보고하였다. 결론: 급성기 뇌졸중 환자들의 많은 수가 정신과적 평가와 개입이 필요한 자살 사고를 가지고 있었다. 따라서 모든 급성기 뇌졸중 환자들을 대상으로 정기적으로 불안 및 우울 증상에 대한 평가와 더불어 직접 또는 간접적인 방법을 통한 자살 사고의 평가가 반드시 필요할 것으로 생각된다. Objective: The presence of psychiatric disorders including depression and anxiety disorders is considered to be the most important risk factor of suicide. Also, suicidal risk is known to be increased in patients who have serious medical illnesses. Like in patients with other medicalillness, some authors reported that suicidal risk is increased in patients with stroke. But there have been no reports with korean patients. The aim of this study is to investigate the frequency of suicidal ideation of patients in the acute stage of stroke, and to examine the demographic characteristics, and psychiatric and neurological symptoms between the patients with and without suicidal ideation. Method: Seventy seven hospitalized stroke patients at the Hallym Stroke Center from July of 1999 to June of 2000 were included in this study. Beck Suicidal Ideation Scale(BSIS) was used to evaluate suicidal ideation. Beck Depression Inventory(BDI) and Beck Anxiety Inventory(BAI) for depression and aniety, and Social Support Scale(SSS) for social support system of the stroke patients were used. Neurologic disabilities were rated with National Institutes of Health Stroke Scale(NIHSS) and Barthel's Index. Results: Thirty five percent(N=27) of the stroke patients reported severe suicidal ideation. Scores of BDI, BAI and SSS were higher in the patients with severe suicidal ideation than their counterpart. There were no differences in Barthel's index score and NIHSS between two groups. Most patients with severe suicidal ideation had depressive or anxiety symptoms. But patients without depressive or anxiety symptoms also reported severe suicidal ideation. Conclusions: Thirty five percent of stroke patients in acute stage of their illness have severe suicidal ideation that requires careful psychiatric evaluation and intervention. Inclusion of routine assessment of suicidal ideation in these patients is recommended.

백서에서 신 허혈성 손상에 미치는 칼슘 길항제의 효과

문철웅,정종훈,박천국,이승일,배학연,장경식,김만우,정춘해,홍순표,이병래,김호중 朝鮮大學校 附設 醫學硏究所 1993 The Medical Journal of Chosun University Vol.18 No.1

Renal ischemia is one of the most common causes of acute renal failure. Four factors related to the pathogenesis of acute renal failure are vasoconstriction, decreased glomerular filtration rate, tubular back leak of filtrate, and intratubular obstruction. The cellular response to renal ischemic insults include decreased content of adenosine trihosphate, lipid peroxidation induced membrane degradation, alteration in cellular pH, and calcium or phospholipase induced mitochondrial dysfunction. Much attention has been given to the role of increased cellular calcium as a pathogenetic contributor to cell injury during ischemia. Author studied the protective effects of calcium antagonists on cellular injury during renal ischemia in rat. To investigate the protective role of these agents, author measured the amount of malondialdehyde(MDA) and the enzyme activities of free radical scarvengers-superoxide dismutase(SOD), catalase and glutathione peroxidase from non-pretreated group and calcium antagonists pretreated groups in control, ischemia and reflow subgroups. The results were summerized as follows: 1) The amount of MDA in non-pretreated group was higher in the reflow compared with the control(<p<0.01). But, in all pretreated groups, there was no statistically difference in the amount of MDA. 2) The SOD activity in non-pretreated group was lower in both the ischemia and the reflow compared with the control (P<0.05). But, in both verapamil and trifluoperazine-pretreated groups, there was no statistically difference in the SOD activity. 3) Both catalase and glutathione peroxidase activities in non-pretreated group were lower in both the ischemia and the reflow compared with the control (P<0.05). But in all pretreated groups, there was no statically difference in both catalase and glutathione peroxidase activities. These results suggest that free radical mediated ischemic injury by renal artery clamp in rat can be protected by intraperitoneal pretreatment with calcium antagonists. As trifluoperazine has a protective effect in renal ischemia, the calcium activated calmodulin dependent enzyme may play a role in renal ischemic injury.

급성기 뇌졸중 환자의 삶의 질

김세주,김영신,최낙경,이윤영,이병철,이만홍 한국정신신체의학회 2002 정신신체의학 Vol.10 No.1

Cooperative Protective Effect of Melatonin and Dipyridamole on Hepatotoxicity Induced by Carbon Tetrachloride

Hong, Choong Man,Yoon, Chang Yong,Hong, I Jin,Ahn, Byung Woo,Kim, Dae Joong,Min, Hon Gi,Kim, Chuel Kyu 한국수의공중보건학회 2000 예방수의학회지 Vol.24 No.4

소아 야제에 대한 추나요법 효과 체계적 문헌고찰

황만석 ( Man Suk Hwang ),신병철 ( Byung Cheul Shin ),허광호 ( Kwang Ho Heo ),허인 ( In Heo ),김병준 ( Byung Jun Kim ),김기봉 ( Ki Bong Kim ),천진홍 ( Jin Hong Cheon ),박재홍 ( Jae Hong Park ),황의형 ( Eui Hyoung Hwang ) 한방재활의학과학회 2015 한방재활의학과학회지 Vol.25 No.3

Objectives To evaluate the evidence supporting the effectiveness of Chuna manual therapy for nocturnal crying. Methods We conducted search across the 3 electronic databases (Pubmed, CAJ and Oasis) to find all of randomized controlled clinical trials(RCTs) that used Chuna manual therapy as a treatment for nocturnal crying. The methodological quality of each RCTs was assessed using the Cochrane Risk of Bias tool and nRCTs was assessed using the Cochrane Risk of Bias Assessment tool for Non-randomized Study tool. Results Two RCTs and three nRCTs met our inclusion criteria. The meta-analysis showed positive results for the use of Chuna manual therapy in terms of the efficacy rate when compared to medication treatments alone. Positive results were also obtained, in terms of the efficacy rate, when comparing Chuna manual therapy combined with acupoint application therapy to Chuna manual therapy alone, but was not statistically significant. Conclusions Our systematic review found encouraging but limited evidence of Chuna manual therapy for nocturnal crying. We recommend clinical trials which compare the effectiveness of Chuna manual therapy with usual care to obtain stronger evidence without the demerits of trial design. (J Korean Med Rehab 2015;25(3):51-57)

역경사 형태를 가진 방조제 성토층 단면에서의 침출현상 연구

홍변만 ( Hong Byung Man ) 한국농공학회 1998 韓國農工學會誌 : 전원과 자원 Vol.40 No.5

In design and management of sea0dikes, engineers need to study various transient seepage conditions through dikes not only for the sea water infiltration into dikes due to cyclic rises of sea water level also for the seepage flow out from dikes toward the sea due to cyclic drawdown of sea water level. Characteristics of seepage flow toward the sea from dikes are more complicated than as known and remained unclearly. The case of such seepage flow may be explained by figuring out seepage characteristics in filter as a part of sea-dikes. Filters in most sea-dikes in Korea are inevitably placed with reversely inclined shape due to field construction conditions. Most computer programs for seepage analysis based on the various numerical methods give practically acceptable results, but for the case of reversely inclined section of filters any verification to apply them might be needed. In this study, large scaled model tests were executed to verify and understand seepage flow through earth-filled sea-dikes. The results from numerical analysis and model tests show some remarkable differences in pore pressure distribution under cyclic changes of see level, and some of the results need to be considered in design and construction practices with further study.