Gilbert 증후군에서 열량 제한 시험과 Phenobarbital 자극 시험의 의의(14예)

이헌영,채경훈,정재훈,강윤세,김연수,문희석,박기오,이엄석,김선문,김석현,성재규,이병석,이강욱 충남대학교 의학연구소 2003 충남의대잡지 Vol.30 No.2

Gilbert 증후군은 인구의 7%에서까지 나타날 수 있는 매우 흔한 증후군으로서 비진행성인 양성의 만성적 경과를 치하며, 간질환의 증상과 징후가 없는 경한 비포합형 고빌리루빈혈증이 특징인 일종의 체질적인 증상으로서 혈장 빌리루빈 농도에 대한 사춘기의 영향 때문에 10대와 20대에 자주 진단이 된다. 따라서 임상적인 중요성은 미약하지만 높은 빈도가 예상되는 점에 그 중요성이 부여되어야 할 것이다. 따라서 적정한 임상적 진단법으로 기왕에 소개된 열량제한 시험과 phenobarbital 유도 시험을 시행하고 이들의 진단적 가치를 알아보기 위하여 본 연구를 시행하였다. 1990년 7월부터 1999년 4월까지 충남대학교병원에 내원하여 HBsAg, IgG anti-HBc 및 anti-HCV가 음성이고, 간 초음파 스캔에서 이상이 없으며, 혈청 AST, ALT 및 AP가 정상인 비음주자에서 경한 비포합형 고빌리루빈혈증이 있는 14예의 환자들을 대상으로 ^(99m)Tc-DISID 스캔을 시행하였으며, 기저 치 총빌리루빈 및 포합형 빌리루빈 치를 측정한 다음에 하루에 400Kcal로 48시간동안 제한한 열량 제한 시험을 시행하였고, phenobarbital을 하루 60mg씩 5일간 투여한 후에도 각각 총빌리루빈과 포합형 빌리루빈 치를 검사하여 비포합형을 구하였다. 대상 환자들은 모두 14예로서 남자가 11예(78.6%)였고 여자가 3예(21.4%)여서 3.7:1로 남자에서 많았으며, 20대가 6예(42.9%), 30대가 역시 6예(42.9%) 및 40대가 2예(14.2%)로서 2,30대가 대부분(85.8%)이었다. 열량 제한 시험 후의 총빌리루빈 치, 비포합형 및 포합형 빌리루빈 치들은 평균 각각 5.5±2.7, 4.2±2.3 및 1.3±10mg/dL 로서, 시험 전 치들인 3.0±0.8, 2.2±0.8 및 0.7±0.4mg/dL 보다 유의하게(p=0.001, p=0.001, p=0.023) 상승하였다. 포합형 빌리루빈 치도 유의하게 상승하였으나 비포합형의 상승보다는 훨씬 낮아서 주로 비포합형이 증가하였다. phenobarbital 투여 중 설사가 발생하여 중단한 1예를 제외한 13예에서 열량 제한 시험 후에 상승하였던 총, 비포합형 및 포합형 빌리루빈 치가 phenobarbital 유도 시험후에는 2.0±1.1, 1.5±0.8 및 0.5±0.4mg/dL로서 열량 제한 시험 결과보다 유의하게 낮아졌고(p=0.00, p=0.000, p=0.001), 열량 제한 시험 전의 기초치들인 3.0±0.8, 2.2±0.8 및 0.7±0.4mg.dL 보다도 더욱 낮아졌으며 유의한 차이(p=0.001, p=0.02, p=0.005)를 나타내었다. 14예에서 시행한 ^(99m)-Tc DISIDA 스캔에서 9예(64.3%)가 정상이었고, 5예(35.7%)에서는 심장 및 신장으로의 간외 섭취가 3예였고, 60분까지 소장 배출이 없는 배설 지연 예와 담낭 수축 불량 예가 각각 1예 씩 발견되었다. Phenobarbital 투여시험에서 민감도가 열량제한시험에 비해 더 높았다(92.3%와 50.0%). Gilbert 증후군에서 1일 400 Kcal로 48시간의 열량제한 시험과 1일 60mg의 phenobarbital을 5일간 투여하는 유도 시험은 편리하고 유용한 임상적인 진단법으로 이용할 수 있다고 생각된다. 그러나 열량 제한 시험에서는 증가 기준의 통일이 필요하다고 유추되며 phenobarbital 유도 시험이 민감도가 더 높은 것으로 생각된다. Gilbert's syndrome is very frequent and benign chronic process characterized by mild, intermittent, unconjugated hyperbilirubinemia without any symptom and sign of liver disease. Previously intoduced caloric restriction test and phenobarbital stimulation test as two appropriate clinical tests had been examined and their diagnostic values were reevaluated. Fourteen patients with mild, persistent, unconjugated hyperbilirubinemia were included. Subsequently caloric restriction has been applicated by 400 Kcal/day for 48 hours and phenobarbital has been prescribed by 60 mg/day for 5 days. Therafter serum levels of total and direct bilirubin were measured. Most of the patients were third and fourth decade(85.8%) and male predominant. Each basal serum levels of total, indirect and direct bilirubin were 3.0±0.8, 2.2±0.8 and 0.7±0.4 mg/dL. After caloric restriction test, each levels were increased significantly to 5.5±2.7, 4.2±2.3 and 1.3±1.0 mg/dL(p=0.001, p=0.001, p=0.023). After phenobarbital stimulation test for 13 patients had been practiced, increased levels of each bilirubin after caloric restriction test were decreased significantly to 2.0±1.0, 1.5±0.8 and 0.5±0.4 mg/dL(p=0.000, p=0.000, p=0.001) and these levels were significantly lower than basal levels(p=0.001, p=0.02, p=0.005). The sensitivities of caloric restriction test were 85.7%, 50.0%, and 71.4%, 35.7%(1.0, 1.5 mg increase of total bilirubin and 1.0, 1.5 mg/dL increase of indirect bilirubin). The sensitivities of phenobarbital stimulation test were 93.2% and 92.3% at criteria of 1.5 mg/dL increase of total bilirubin and indirect bilirubin. On the diagnosis of Gilbert syndrome, caloric restriction test and phenobarbital stimulation test are convenient and useful diagnostic tools in clinical face. And also phenobarbital stimulation test has higher sensitivity than caloric restriction test. Furthermore, standardization of bilirubin increment would be necessary in caloric restriction test.

사무직 근로자의 수면의 질 및 직무스트레스와 우울과의 관련성

강미나,강수영,권수정,김현주,배재원,이보연,이예진,임의롬,정다영,조한솔 이화여자대학교 간호과학대학 2013 이화간호학회지 Vol.- No.47

Purpose: The purpose of this study was to understand the degree of depression, sleep quality, job stress and their association among office workers. Method: A self-administered questionnaire was distributed to 147 workers employed in 5 big enterprises, and 5 small and medium enterprises from October 21 to November 21, 2012. The questionnaires included socio-demographic and health-related characteristics, job-related characteristics, sleep quality, job stress (KOSS) and depression (CES-D). Result: Among all subjects, 23.1% was in the depression group (21 points and over in the CES-D score). Depressive level was positively correlated with job stress and quality of sleep. The adjusted odd ratio for the effects of sleep quality and job stress on depression significantly increased in the depression group compared to that of the normal group. Multiple regression analysis revealed that the following factors of influence had combined explanatory powers on depression: BMI, life satisfaction, quality of sleep, and job stress. Conclusion: The study revealed that complicated influences were exerted on the level of depression by variable factors, as well as socio-demographic characteristics, health-related characteristics, quality of sleep, and job stress. Specifically, the level of depression was influenced by the quality of sleep and job stress.

심폐소생술중 심실기능 및 판막운동의 평가

이부수,김영식,이강현,황성오,임경수,박금수,윤정한,안무업,최경훈 대한응급의학회 1994 대한응급의학회지 Vol.5 No.2

Background : Mechanism of blood flow during cardiopulmonary resuscitation(CPR) in humans remains controversial and poorly understood, although cardiac or thoracic pump theory was proposed. We investigated cardiac movement, ventricular function and atrioventricular valve motion with aid of transesophageal echocardiography during precordial compression during CPR in humans. Methods and results : During CPR transesophageal echocardiography was performed in 14 patients with non-traumatic cardiac arrest. Manual precordial compression during CPR was performed according to American Heart Association guidelines. Mitral valve closed in 9 and did not close in 5 patients during "compression systole". Tricuspid valve closed during compression systole. Compression vector directed to right ventricle, basal portion of interventricular septum and left atrium. The heart rotated clockwise and the apex was more displaced than the base("swing motion"). Fractional shortening(FS) and ejection fraction(EF) of right ventricle exceeded those of left ventricle(FS : 55±9% vs 18±8%, p<0.05), EF : 79±9% vs 37±16%, p<0.05). FS and EF of left ventricle was higher in patients with systolic mitral valve closure than patients with persistent systolic opening of mitral valve(FS : 21±7 vs 13±7%, EF : 45±12 vs 22±12%, p<0.05), but FS and EF of right ventricle was not different. Conclusion : During precordial compression, the heart rotated clockwise and displaced. Systolic function of right ventricle exceeded left ventricle. Marked compression of right ventricle and systolic closure of tricuspid valve suggested that right ventricle functioned as a pump generating blood flow during precordial compression. Closure of mitral valve was dependant on systolic function of the left ventricle.

Detection of Individuals Restoring Fertility by DNA Fragment Converted into STS (sequence tagged site) in Red pepper

Lee,Jang-Soo,Lee,Keun-Hyang,Kim,Yeo-Song,Kang,Kwon-Kyoo,Nou,Ill-Sup,Hirata,Yutaka 한국자원식물학회 2004 Plant Resources Vol.7 No.2

Co-segregation of male fertility with DNA markers selected by RAPD analysis as being potentially linked to the restorer gene (Rf) for Cytoplasmic male sterility (CMS) was analyzed using segregating F2 population. One RAPD marker directly linked to the Rf locus was identified. Amplification of OPT-02/570 using the STS primers generated a monomorphic band of each fertile plants randomly selected F2 progenies. From these results, this specific marker would be strongly linked to be restoring gene. The use of STS marker is effective in overcoming the reliability of the RAPD phenotype and improving their utility for MAS, co-dominant STS markers are especially very useful.

다발성 외상환자에서 필수적 단순 방사선검사의 의의

임경수,황성오,임종천,이부수,이강현,이진웅 대한응급의학회 1995 대한응급의학회지 Vol.6 No.2

In the guidelines of Advanced Trauma Life Support(ATLS), essential plane roentgenograms (chest AP vIew, cervical spine lateral view and pelvis AP view) are recommanded when primary survey and resuscitation phase are finished in care of multiple injured patients. A prospective study was carried on 376 multiple trauma patients who admitted to Wonju Christian Hospital from July, 1995 to October. We analyzed clinical significance of essential X-ray in multiple trauma patients, and classified the patients by their status of mentality. The one is alert group when their Glasgow Coma Scale(GCS) is over 13 point, the other is disoriented mentality group when their GCS are below 12 point. The alert group was redivided by presence of clnical symptoms and/or signs, and clinical significances of essential X-ray were analyzed. Among the 376 patients, 330 patients are alert group that their GCS score is over 13 point and 46 patients are disoriented group who's GCS were below 12 point. The detection rate of abnormality in essential X-ray is higher in disoriented group than alert group(cervical-spine lateral view : 13.5% vs 3.0% cheat AP view : 0.4%, pelvis AP view : 0%). This study suggests that their are no needs of taking essential X-ray in patients who is alert in mental state and have no clinical symptoms and/or signs.

심정지환자에서 epinephrine투여시 혈중 catecholamine의 변화

임경수,황성오,이부수,이강현,이진웅,임종천,김영식,김선만,김 현 대한응급의학회 1995 대한응급의학회지 Vol.6 No.1

Background : Cardiac arrest is a potent stimulus for the release of endogenous catecholamine and high plasma catecholamine concentration has been reported during cardiopulmonary resuscitation(CPR). Few data were present about the clinical effect of high plasma catecholamine and endogenous catecholamine response to exogenous epinephrine administration during CPR. Purpose : This study was designed to evaluate endogenous catecholamine response to cardiac arrest and exogenously administered epinephrine during CPR. Method : In 21 cardiac arrest victims, blood sample for epinephrine and norepinephrine was drawn before and 1 minute after each epinephrine administration during CPR. 1mg of epinephrine was administered immediately after intravenous access and 3 minute interval during CPR. Plasma catecholamines were quantitated by high-performance liquid chromatography. Result : Baseline plasma epinephrine concentraqtion was higher in patients with cardiac arrest than normal controls (985±1627 vs 194±173 pg/ml, p<0.05). Baseline plasma norepinephrine concentration was also elevated in patients with cardiac arrest than normal controls, although statistically insignificnat(1965±4915 vs 360±250 pg/ml). Plasma epinephrine concentration in cardiac arrest patients was significantly elevated after exogenous administration of epinephrine, but its response was blunted after the third does of epinephrine. Plasma norepinephrine concentration in cardiac arrest patients was also elevated, but its response was observed only after the first epinephrine administration. Plasma epinephrine concentration was persistently higher in patients with return of spontaneous circulation (ROSC) than patients without ROSC. there was no significant difference of plasma norepinephrine concentration whether spontaneous circulation was restored or not. Endogenous epinephrine response to exogenous epinephrine was not observed in patients having prolonged arrest time over 20 minutes. Conclusion : Results of this study suggests that significant amount of catecholamine is released by exogenous epinephrine administration in spite of high plasma catecholamine concentration, and degree of endogenous catecholamine response influences resuscitation outcome.

혼수상태의 외상환자에서 초음파를 이용한 흉부 및 복부손상의 진단

임경수,이강현,이진웅,이부수,황성오,유수영,강성준 대한응급의학회 1995 대한응급의학회지 Vol.6 No.1

The need for rapid diagnosis and treatment of life-threatening thoracic and intra-abdominal injury result in controversy over the appropriate triage of unconscious blunt trauma patients. To aid in early decisions for these patients, a prospective analysis of 98 patients with glasgow coma scale(GCS) scores≤8 was undertaken. Although intra-thoracic and intra-abdominal injuries were frequently identified based on systolic blood ressure, the use of clinical signs alone resulted in more missed injuries than did using the emergency ultrasonography. In normotensive patients(n=34), intra-thoracic injuries was identified in one patient(2.9%), and intra-abdominal injuries were in 7 patients(20.6%). In shock(systolic blood pressure<90mmHg) Pa-tients(n=64), thoracic injuries and intra-abdominal injuries were diagnosed in 8(12.5%) and 27 patients(42.3%), thoracic and abdominal combined injuries were identified in 11 patients(17.2%). The sensitivity, specificity, and accuracy of emergency ultrasonography were 96.3%, 91.7%, 94.9%. This study suggests that all unconscious trauma patients undergo immediate emergency ultrasonography to prevent missing life-threatening injuries.

Functional Properties of Permeate Fractions Obtained from Bastard Halibut Roe Extracts by Ultrafiltration and It’s Biological Activities

Gyoon-Woo Lee1,In Seong Yoon,Su Gwang Lee,Jung-Suck Lee,Young-Mi Kang,Jin-Soo Kim,Min Soo Heu 한국수산해양기술학회(구 한국어업기술학회) 2016 한국수산해양기술학회 학술발표대회 Vol.2016 No.10

횡문근융해증과 급성 신부전 및 범발성 혈관내 응고장애를 동반한 열사병 1예

최대은,박수진,권오경,이한규,이영모,이상주,나기량,이강욱,신영태 충남대학교 의학연구소 2003 충남의대잡지 Vol.30 No.2

Heat stroke is a life-threatening illness characterized by an elevated core body temperature that rises above 40% and central nervous system dysfunctions that results in delirium, convulsions, or coma. Heat stroke is subdivided into two forms, classic and exertional. Since strenuous exercise is one of the major exacerbating and precipitating factors, the incidence of exertional heat stroke is high among young adult, especially military personnel undergoing military training. Exertional heat stroke commonly causes rhabdomyolysis, lactic acidosis, acute renal failure, shock and pulmonary edema. We report a case of heat stroke with rhabdomyolysis, acute renal failure, disseminated intravascular coagulopathy(DIC) after strenuous exercise. A 18 year old man was admitted to the hospital because of loss of consciousness. He was a wrestler and he had tried to lose 6kg in weight by jogging and strenuous exercise on that summer day with hot temperature. The development of this illness was favoured by much clothes inappropriate for that environmental condition with a purpose to enhance sweating, and by restricted intake of water and food. On admission, the blood pressure was 80/50mmHg, and body temperature was 39.4℃ with stuporous mentality. Laboratory finding were as follows : in complete blood cell count, hemoglobin was 16.7g/dL and platelet count was 158,000/ mm³. In blood chemistry, AST 1061U/L, ALT 201U/L, BUN 30mg/dL, Cr 2.2mg/dL, LDH 941IU/L, CK 696IU/L were resulted. In arterial blood gas analysis, pH 7.39, pCO₂ 30mmHg pO₂ 86mmHg, HCO₃ 18.4mEq/L, O₂ saturation 96.7% were resulted. In urinalysis, specific gravity 1.025, protein 3+, erythrocyte 2+ were resulted. In brain imaging study, brain CT finding was normal. After appropriate treatments with rapid cooling, hydration and supportive care, he improved with alert mental status. On 2nd hospital day, in laboratory result, thrombocytopenia and coagulopathy were appeared and renal insufficiency was aggravated. So he was treated with platelet concentrate and fresh frosen plasma for DIC, and enough hydration for appropriate urine volume preservation. After all, On 22nd hospital day, he fully recovered and discharged. Nowadays, with followed for some duration, he is wellbeing with no complications.

Paraquat 중독환자의 초기검사로서 sodium dithionite를 이용한 소변내 paraquat검출의 임상적 의의

윤갑준,임경수,이진웅,김영식,이부수,박덕우,김선만,이강현,황성오,안무업 대한응급의학회 1995 대한응급의학회지 Vol.6 No.1

Background : Mortality from paraquat intoxication depends upon plasma paraquat concentration. To know the severity of paraquat intoxication is important for directing therapeutic modality and predicting prognosis. Sodium dithionite test for urinary paraquat provides an easy and simple method to determine the severity of paraquat intoxication in emergency department. purpose : To determine whether the result urinary paraquat test by sodium dithionite can predict outcome in patients with paraquat intoxication in emergency department. Subjects : 48 patients(male 31, female 17, mean age 37 years) who had exposure to paraquat and presented within 24 hours after exposure. Result : Thirty five patients were positive in paraquat urine test and thirteen patients were negative. Clinical manifestations were more severe in positive patients than in negatives. Complication was much more in positives than in negatives. 28 of 35 patients(80%) in positives and 2 of 13 patients(15%) in negatives died. Conclusion : Positive test for urinary paraquat is associated with high mortality and morbidity from paraquat intoxication, and qualitative test for urinary paraquat by sodium dithionite is an useful method to determine the severity of paraquat intoxication in emergency department.