아세틸 콜린 유발 검사시 허혈성 심전도 변화와 흉통의 발생이 내피세포 기능장애에 미치는 영향

최철웅(Cheol Ung Choi),나승운(Seung-Woon Rha),김선원(Sun Won Kim),나진오(Jin Oh Na),임홍의(Hong Euy Lim),김진원(Jin Won Kim),김응주(Eung Ju Kim),한성우(Seong Woo Han),박창규(Chang Gyu Park),서홍석(Hong Seog Seo),오동주(Dong Joo Oh) 대한임상노인의학회 2010 대한임상노인의학회지 Vol.11 No.4

연구배경: 아세틸 콜린 유발 검사시 발생하는 흉통과 허혈성 심전도 변화가 아세틸 콜린에 의해 발생하는 관상동맥의 내피세포 기능에 어떤 영향을 주는지 알아보고자 했다. 방법: 흉통으로 내원하여 관상동맥 조영술과 아세틸 콜린 유발검사를 시행받은 1,085명의 환자를 대상으로 하였다. 아세틸 콜린 유발 검사를 하는 동안 허혈성 심전도 변화 및 흉통의 발생 유무에 따른 관상동맥 내피세포 기능의 특징을 비교하였다. 결과: 539명의 환자에서 아세틸 콜린 검사시 내피세포 기능 장애가 발생 하였다. 허혈성 심전도 변화가 있었던 그룹이 심전도 변화가 없었던 그룹보다 흉통이 더 많았고(78.1% vs. 60.8%, P=0.007), 관상동맥 조영술상 다발성 관상동맥 경련이 빈번하였고(59.4% vs. 40.6%, P=0.004), 관상동맥의 경련 정도도 더 심하였다(64.1% vs. 46.5%, P=0.006). 흉통이 있었던 그룹이 흉통이 없었던 그룹보다 허혈성 심전도 변화의 빈도가 더 높았다(14.7% vs. 7.5%, P=0.007). 또한 흉통이 있었던 그룹이 관상동맥 경련이 다발성으로 발생하는 경우가 많았고 (50.7% vs. 29.5%, P<0.001), 미만성으로 발생하는 경우가 많았고(87.1% vs. 75%, P<0.001), 관상동맥의 경련의 정도도 더 심하였다(51.6% vs. 43.5%, P=0.041). 결론: 아세틸 콜린 유발검사시 발생하는 허혈성 심전도 변화와 흉통은 관상동맥 경련의 정도와 경련이 발생하는 관상동맥 개수와 연관이 있다. Background: ECG changes and chest pain during acetylcholine (Ach) provocation tests may constitute important clinical parameters for Ach-induced endothelial dysfunction. We investigated the association between ischemic ECG changes and chest pain during the Ach-provocation test and angiographic characteristics of Ach-induced endothelial dysfunction. Methods: A total of 1,085 patients with anginal symptoms underwent diagnostic coronary angiography (CAG) and Ach-provocation tests. We compared angiographic characteristics of Ach-induced endothelial dysfunction according to the presence of ECG change and chest pain. Results: A total of 539 patients experienced Ach-induced endothelial dysfunction. Patients who experienced ECG change group suffered more frequent chest pain (78.1% vs. 60.8%, P=0.007), angiographically more frequent multiple coronary artery spasm (59.4% vs. 40.6%, P=0.004), and more severe coronary artery spasm (64.1% vs. 46.5%, P=0.006) than patients without ECG change. However, there was no difference in the length of endothelial dysfunction between the groups. The incidence of ischemic ECG changes in patients with chest pain was higher than in patients without chest pain (14.7% vs. 7.5%, P=0.007). Patients who experienced chest pain more often experienced multiple (50.7% vs. 29.5%, P<0.001), diffuse (87.1% vs. 75%, P<0.001), and severe coronary artery spasm (51.6% vs. 43.5%, P=0.041) than patients without chest pain. Conclusion: Ischemic ECG changes and chest pain during the Ach-provocation test are associated with multi-vessel involvement and severe coronary artery spasm. Chest pain is associated with the length of endothelial dysfunction, but ischemic ECG change is not.

Causes and Predictive Factors Associated with "Diagnosis Changed" Outcomes in Patients Notified as Tuberculosis Cases in a Private Tertiary Hospital

Kang, Byung Ju,Jo, Kyung-Wook,Park, Tai Sun,Yoo, Jung-Wan,Lee, Sei Won,Choi, Chang-Min,Oh, Yeon-Mok,Lee, Sang-Do,Kim, Woo Sung,Kim, Dong Soon,Shim, Tae Sun The Korean Academy of Tuberculosis and Respiratory 2013 Tuberculosis and Respiratory Diseases Vol.75 No.6

Background: The aim of our study was to evaluate the "diagnosis changed" rate in patients notified as tuberculosis (TB) on the Korean TB surveillance system (KTBS). Methods: A total of 1,273 patients notified as TB cases on the KTBS in one private tertiary hospital in 2011 were enrolled in the present study. Patients were classified into three groups: "diagnosis maintained", "diagnosis changed" (initially notified as TB, but ultimately diagnosed as non-TB), and "administrative error" (notified as TB due to administrative errors). Results: Excluding 17 patients in the "administrative error" group, the "diagnosis maintained" and "diagnosis changed" groups included 1,097 (87.3%) and 159 patients (12.7%), respectively. Common causes of "diagnosis changed" were nontuberculous mycobacterial (NTM) disease (51.7%, 61/118), and pneumonia (17.8%) in cases notified as pulmonary TB, and meningitis (19.5%, 8/41) and Crohn's disease (12.2%) in cases notified as extrapulmonary TB. Being older than 35 years of age (odds ratio [OR], 2.18) and a positive acid-fast bacilli stain (OR, 1.58) were positive predictors and a TB-related radiological finding (OR, 0.42) was a negative predictor for a "diagnosis changed" result via multivariate logistic regression analysis in pulmonary TB cases. Conclusion: Because of a high "diagnosis changed" rate in TB notifications to the KTBS, the TB incidence rate measured by the KTBS may be overestimated. Considering the worldwide trend toward increased NTM disease, the "diagnosis changed" rate may increase over time. Thus, when reporting the annual TB notification rate in Korea, the exclusion of "diagnosis changed" cases is desirable.

Causes and Predictive Factors Associated with “Diagnosis Changed” Outcomes in Patients Notified as Tuberculosis Cases in a Private Tertiary Hospital

( Byung Ju Kang ),( Kyung Wook Jo ),( Tai Sun Park ),( Jung Wan Yoo ),( Sei Won Lee ),( Chang Min Choi ),( Yeon Mok Oh ),( Sang Do Lee ),( Woo Sung Kim ),( Dong Soon Kim ),( Tae Sun Shim ) 대한결핵 및 호흡기학회 2013 Tuberculosis and Respiratory Diseases Vol.75 No.6

Background: The aim of our study was to evaluate the “diagnosis changed” rate in patients notified as tuberculosis (TB) on the Korean TB surveillance system (KTBS). Methods: A total of 1,273 patients notified as TB cases on the KTBS in one private tertiary hospital in 2011 were enrolled in the present study. Patients were classified into three groups: “diagnosis maintained”, “diagnosis changed” (initially notified as TB, but ultimately diagnosed as non-TB), and “administrative error” (notified as TB due to administrative errors). Results: Excluding 17 patients in the “administrative error” group, the “diagnosis maintained” and “diagnosis changed” groups included 1,097 (87.3%) and 159 patients (12.7%), respectively. Common causes of “diagnosis changed” were nontuberculous mycobacterial (NTM) disease (51.7%, 61/118), and pneumonia (17.8%) in cases notified as pulmonary TB, and meningitis (19.5%, 8/41) and Crohn`s disease (12.2%) in cases notified as extrapulmonary TB. Being older than 35 years of age (odds ratio [OR], 2.18) and a positive acid-fast bacilli stain (OR, 1.58) were positive predictors and a TB-related radiological finding (OR, 0.42) was a negative predictor for a “diagnosis changed” result via multivariate logistic regression analysis in pulmonary TB cases. Conclusion: Because of a high “diagnosis changed” rate in TB notifications to the KTBS, the TB incidence rate measured by the KTBS may be overestimated. Considering the worldwide trend toward increased NTM disease, the “diagnosis changed” rate may increase over time. Thus, when reporting the annual TB notification rate in Korea, the exclusion of “diagnosis changed” cases is desirable.

선천눈꺼풀처짐 교정술 후 발생한 난시변화

이동섭,김준모,우경인,장혜란,Dong Sub Lee,Joon Mo Kim,Kyung In Woo,Hae Ran Chang 대한안과학회 2006 대한안과학회지 Vol.47 No.9

Purpose: To determine postoperative astigmatic changes after surgery for congenital ptosis and the astigmatic changes depending on surgical method and to discern cases of postoperatively developed anisometropia or amblyopia. Methods: Fifty-one patients who underwent surgery due to congenital ptosis were reviewed. Refraction or cycloplegic refraction was conducted preoperatively and 3 to 6 months after surgery to measure astigmatic changes. Astigmatic changes in operated eyes were compared to control eyes. Astigmatic changes were compared depending on surgical method. Results: The mean astigmatism was 1.33±1.29D preoperatively and 1.48±1.13D postoperatively (P=0.10) and the mean astigmatic change in the ptotic and control eye was an increase in cylinder +0.56±0.55D and +0.68±0.72D (P=0.37). The mean astigmatic change of patients receiving frontalis sling was +0.57±0.67D which was similar to those who received levator resection (+0.56±0.50D). Newly developed anisometropia was found in three patients postoperatively due to an increase in astigmatism, but newly developed amblyopia was not found. Conclusions: The increase of astigmatism by ptosis surgery was not statistically significant and there was no statistically significant difference when accounting for surgical method. However, it is necessary to monitor refractive error carefully in younger patients to prevent amblyopia because postoperative increase of astigmatism can cause anisometropia.

Diagnostic Significance of Brainstem Auditory Evoked Potentials in Microvascular Decompression of Patients with Hemifacial Spasm or Trigeminal Neuralgia

( Sang-koo Park ),( Sung-hyuk Lim ),( Chan-woo Park ),( Jin-woo Park ),( Sung-ho Chang ),( Keun-hye Park ),( Hae-ja Park ),( Ji-hye Song ),( Dong-ok Uhm ),( Ki-bong Kim ) 대한임상검사과학회 2011 대한임상검사과학회지(KJCLS) Vol.43 No.1

The purpose of this study was to analyse brainstem auditory evoked potentials (BAEP) wave change data during microvascular decompression (MVD). The nerve function of Cranial Nerve VIII is at risk during MVD. Intraoperative monitoring of BAEP can be a useful tool to decrease the danger of hearing loss. Between January and December 2009, 242 patients had MVD for hemifacial spasm (HFS) and trigeminal neuralgia (TN). Among intraoperative BAEP changes, amplitude of V-V’ was the most frequently observed during cerebellar retraction and decompression step of the MVD procedure. 138 patients (57%) had no BAEP change while 104 patients (42.98%) had BAEP change. 69 patients (28.5%) had Type A-I, 16 patients (6.6%) had Type A-II, 5 patients (2.1%) had Type B, and 13 patients (5.37%) had Type C. MVD is a surgical procedure to relieve the symptoms (e.g. pain, muscle twitching) caused by compression of a nerve by an artery or vein. During BAEP intraoperative monitoring, the surgical step is important in interpreting the changes of wave V. Several potential mechanisms of injury may affect the cochlear nerve, and complete loss of BAEP is often associated with postoperative hearing loss. Intraoperative BAEP monitoring may provide an early warning of hearing disturbance after MVD.

Diagnostic Significance of Brainstem Auditory Evoked Potentials in Microvascular Decompression of Patients with Hemifacial Spasm or Trigeminal Neuralgia

Park, Sang-Koo,Lim, Sung-Hyuk,Park, Chan-Woo,Park, Jin-Woo,Chang, Sung-Ho,Park, Keun-Hye,Park, Hae-Ja,Song, Ji-Hye,Uhm, Dong-Ok,Kim, Ki-Bong 대한임상검사과학회 2011 대한임상검사과학회지(KJCLS) Vol.43 No.1

The purpose of this study was to analyse brainstem auditory evoked potentials (BAEP) wave change data during microvascular decompression (MVD). The nerve function of Cranial Nerve VIII is at risk during MVD. Intraoperative monitoring of BAEP can be a useful tool to decrease the danger of hearing loss. Between January and December 2009, 242 patients had MVD for hemifacial spasm (HFS) and trigeminal neuralgia (TN). Among intraoperative BAEP changes, amplitude of V-V' was the most frequently observed during cerebellar retraction and decompression step of the MVD procedure. 138 patients (57%) had no BAEP change while 104 patients (42.98%) had BAEP change. 69 patients (28.5%) had Type A-I, 16 patients (6.6%) had Type A-II, 5 patients (2.1%) had Type B, and 13 patients (5.37%) had Type C. MVD is a surgical procedure to relieve the symptoms (e.g. pain, muscle twitching) caused by compression of a nerve by an artery or vein. During BAEP intraoperative monitoring, the surgical step is important in interpreting the changes of wave V. Several potential mechanisms of injury may affect the cochlear nerve, and complete loss of BAEP is often associated with postoperative hearing loss. Intraoperative BAEP monitoring may provide an early warning of hearing disturbance after MVD.

Chlorhexidine varnish 처치 후 고정식 교정장치 장착 환자의 치태내 균주 변화 양상에 대한 장기간 관찰 연구

장영일,양원식,남동석,김태우,백승학 대한치과교정학회 2000 대한치과교정학회지 Vol.30 No.3

본 연구의 목적은 chlorhexidine varnish를 고정식 교정장치 장착 환자의 치면에 도포한 후 나타나는 치태내 균주의 변화 양상을 장기간 관찰하는 것이다. 서울대학교병원 치과진료부 교정과에서 고정식 교정장치로 치료하기로 하였던 환자 100명중에서 32주까지 장기간 추적 (follow-up) 되었던 21명을 최종 연구대상으로 선정 하였다. 실험군(12명)은 chlorhexidine varnish를 1주일 간격으로 4회 도포한 후 고정식 교정장치를 부착하였고, 대조군(9명)은 chlorhexidine varnish처치를 하지 않고 고정식 교정장치를 부착하였다. 그리고 실험군에서는 20주 째에 chlorhexidine varnish를 1회 처치하였다. 두 군에서 고정식 교정장치 부착 직전과 부착 후 4, 8, 20, 32주의 치태내 균주의 변화 양상을 간접면역 형광 현미경법으로 분석하고 SAS 통계프로그램을 사용하여 다음과 같은 결과를 얻었다. 1.Streptococcus mutans는 실험군에서 전 실험기간동안 통계학적으로 유의성 있게 억제되었고 (p〈0.01), 대조군에서 전 실험기간동안 통계학적으로 유의성 있게 증가하였다 (p〈0.05). 2.Streptococcus sanguis, Streptococcus mitis, Actinomyces viscosus, Actinomyces naeslundii는 실험군과 대조군에서 통계학적으로 유의성 있는 변화를 보이지 않았다. 따라서 고정식 교정장치를 사용할 환자에서 chlorhexidine varnish를 처치할 경우 치아 우식의 주 원인균인 Streptococcus mutants를 장기간 선택적으로 억제할 수 있을 것으로 생각된다. The authors observed the long term effects of chlorhexidine vanish treatment on microbial change of dental plaque in orthodontic patients with fixed appliances. The initial sample was 100 patients who were arranged to be treated with fixed orthodontic appliances. The final sample consisted of 21 patients who could be traced for 32 weeks after application of fixed orthodontic appliances. They were classified into the experimental group (12 patients) and the control group (9 patients). The experimental group was treated with chlorhexidine vanish once a week for 4 weeks before application of fixed orthodontic appliance. The control group was not treated with chlorhexidine varnish before application of fixed orthodontic appliance. The experimental group was treated once more after 20 weeks. The microbial changes of dental plaque were analysed by indirect immunofluorescence technique at pre-treatment, post-treatment 4, 8, 20, and 32 weeks. The results were as follows. 1.In the experimental group, streptococus mutans was significantly suppressed during experimental period.(p〈0.01) But, in the control group, streptococcus mutants was significantly increased after placement of fixed orthodontic appliances during experiment period.(p〈0.05) 2.Streptococcus sanglus, Streptococcus mitis, Actinomyces viscosus, and Actinomyces naeslundii did not show significant change between the experimental and the control group during experiment period. So, if we treat the orthodontic patients with chlorhexidine varnish before application of fixed appliances, we may suppress the major cariogenic bacteria, Streptococcus mutans, selectively for long period.

Safety of a Traditional Korean Medicine, Cheonggan extracts (CGX)

Jang-Woo Shin,Jung-Hyo Cho,Dong-Seok Seo,Nak-Won Sung,Min Kwon,Chang-Gue Son 대한한의학회 2009 대한한의학회지 Vol.30 No.6

서울대학교 치과병원 교정과에 내원한 부정교합 환자의 최근 경향

임동혁,김태우,남동석,장영일 대한치과교정학회 2003 대한치과교정학회지 Vol.33 No.1

최근 치의학이 눈부시게 발전하고, 소득이 증가하면서 이에 따라 일반인의 의식이 점차 변하면서 외모에 대한 관심도도 점차 높아지고 있다. 본 연구는 내원환자의 부정교합의 유형, 치료방법의 변화를 파악하여 내원환자와 보다 적절한 의사소통을 위한 정보를 제공하고, 교정치료 요구의 특성을 파악하여 부정교합의 역학적 자료를 제공하고자 본 연구를 시행하였다. 이를 위해 2002년 상반기와 1992년 상반기에 서울대학교 치과병원 교정과에 내원한 환자중 진료기록부가 잘 보존된 676명을 대상으로 하여 부정교합의 유형과 내원 환자의 지역분포 및 주소의 변화, 치료방법의 변화를 조사 연구한 결과 다음과 같은 결론을 얻었다. 1. 내원 환자의 남녀 비율은 1992년 1:2.1에서 2002년 1:1.5로 남자환자가 많이 증가했음을 알 수 있다. 2. 연령별 내원 환자의 분포에서 2002년에는 7세에서 12세군이 32.0%로 가장 높게 나타났으며, 그 다음으로는 19세에서 24세군이 24.0%, 13세에서 18세군이 21.6%, 25세 이상군이 14.2%, 4세에서 6세군이 5.8%, 0세에서 3세군이 2.4%로 가장 낮았다. 1992년도 내원 환자의 연령 분포와 비교시 성인 환자의 비중이 증가하였다. 3. Angle 분류법에 의한 내원환자의 분포에서 2002년에는 Ⅲ급 부정교합이 48.1%로 가장 높게 나타났으며, Ⅰ급 부정교합이 25.0%, Ⅱ급 1류 부정교합이 20.9%, Ⅱ급 2류 부정교합이 3.4%로 나타났다. 4. 내원환자의 지역별 분포에서 서울 북동지역의 환자가 37.0%, 서울 남동지역이 13.2%, 서울 남서지역이 12.3%, 서울북서지역의 환자가 6.5%로 나타났다. 1992년도와 비교시 서울 북동지역환자의 내원 비율이 증가하고 그 외 지역내원 환자의 비율은 감소한 것으로 나타났다. 5. 주소(chief complaint)별 내원 환자의 분포는 2002년에 하악 전돌이 17.5%로 가장 높게 나타났으며, 크라우딩이 14.2%, 안면 비대칭이 11.8%로 나타났다. 1992년의 주소별 내원 비율과 비교시 안면 비대칭을 주소로 내원한 환자의 비율이 유의하게 증가하였고, 내원 동기가 매우 다양해졌다. 6. 2002년도 내원 환자의 치료방법은 고정식 장치가 38.0%, 악교정 수술이 25.0%, 성장 관찰이 13.0%로 나타났다. 1992년도와 비교시 chin cap의 사용이 줄었으며, 상대적으로 악교정 수술과 성장관찰을 요하는 환자의 비중이 유의할 만하게 증가하였다. Over the past decades, the number of patients seeking orthodontic treatment has increased markedly with socioeconomic development and change of recognition on appearance. The purpose of this study was to provide an epidemiologic data base related to the orthodontic treatment need. We could take an adequate information regarding the characteristics of orthodontic patients, and the changing trends about treatment mordality. Distrubution and treands were investigated in 676 patients who had been examined and diagnosed at Departnent of orthodontics, Dental Hospital, Seoul National University from January to June in 1992 and 2002. 1. Sex distribution of patients changed from 1:2.1 to 1:1.5(male:female). 2. In 2002, age distribution had shown 7∼12 vear-old group being the largest (32.0%) and percentage of 19∼24, 13∼18, over 25, 4∼6, 0∼3 year-old group were 24.0%, 21.6%, 14.2%, 5.8%, 2.4% respctively. Compared with data in 1992, the number of adult patients highly increased. 3. With regard to angle classification, each percentage of ClassⅠ, Class Ⅱ div 1, Class Ⅱdiv 2, and Class Ⅲ malocclusion were 25.0%, 20.9%, 3.4%, and 48.1% respectively in 2002. 4. Geographic distribution showed that most of the patients visited (37.0%) lived in northeast of Seoul in 2002. 5. Mandibular prognathism showed the highest percentage in chief complaints. The percentages of crowding and facial asymmetry were 14.2% and 11.8% in 2002. Patients with facial asymmetry increased significantly. 6. Percentages of patients treated with fixed appliance and orthognathic surgery were 38.0% and 25.0% in 2002. Patients needed to observe the growth pattern comprised 13.0% with increasing trends. The use of chin cap reduced and the percentage of orthognathic surgery and growth observation increased significantly.

중증 고혈압증의 임상적 관찰

육동민(Dong Min Yook),곽시영(Si Young Kwak),김성식(Seong Sik Kim),이성숙(Seong Sook Lee),홍관표(Kwan Pyo Hong),최창필(Chang Pil Choi),이재우(Jae Woo Lee),이시래(Si Rhae Lee) 대한내과학회 1987 대한내과학회지 Vol.33 No.2

N/A Clinical studies were carried out in the 110 cases of severe hypertension who had been admitted from January 1979 to August 1985 and the following results were obtained: 1) Underlying diseases of severe hypertension were essential hypertension in 67 cases, renal parenchymal hypertension in 36 cases, and renovascular hypertension in 7 cases. 2) Plasma renin activity was the highest in the group of renovascular hypertension which was 22.07±9.20 ng/ ml/hr, and as a whole, the higher diastolic blood pressure, the higher plasma renin activity was. Plasma renin activity in the group of K-W grade IV retinopathy was higher than those of the other groups. 3) The incidence of ventricular hypertrophy fullfilling voltage criteria and with accompanying ST-T changes on electrocardiolgram was 81.5% in the group of essential hypertension and there was no difference in relation to the level of pressure or fundoscopic changes. 4) The serum creatinine level was the highest in the group of renal parenchymal hypertension (7.93±2.98 mg/dl), and in the group of K-W grade IV retinopathy (6.86±3.50mg/dl), but there was no significant difference in relation to the level of diastolic blood pressure, 5) There were no significant difference in cardiothoracic ratio on chest X-ray in relation to underlying diseases, diastolic blood pressure or fundoscopic changes. 6) The major complications were congestive heart failure (49.1%), hypertensive encephalopathy (17.3%), and cerebrovascular accident (8.2%). 7) In the group of essential hypertension blood pressure was controlled by conservative treatment in 81.0% but in 35.7% in the group of renal hypertension. The patients of chronic renal failure who were treated with dialysis blood pressure was controlled in 87.0%. In all 6 cases with renal transplantation, nephrectomy or renal angioplasty blood pressure was well controlled. 8) In cases refractory to triple antihypertensive regimen blood pressure was controlled by minoxidil in 66.7% and by captopril in 75.0%. 9) In 45 cases who were followed up for more than 6 months diastolic blood pressure was controlled under 100mmHg in 77.8% and there were improvement of renal function, fundoscopic findings and electrocardiographic findings in 20.0%, 33.3% and 16.7%, respectively.