만성 두부외상 환자에서 99mTc - HMPAO Brain SPECT의 임상적 유용성

서정호(Jung Ho Suh),김동익(Dong Ik Kim),정태섭(Tae Sub Chung),이종두(Jong Doo Lee),박창윤(Chang Yoon Park),정진일(Jin Ill Chung),김영수(Young Soo Kim) 대한핵의학회 1992 핵의학 분자영상 Vol.26 No.1

N/A Minima1 deterioration of cerebral perfusion or microanatomical changes were undetectable on conventional Brain CT or MRI. So evaluation of focal functional changes of the brain parenchyme is essential in chronic head injury patients, who did not show focal anatomical changes on these radiological studies. However, the patients who had longstanding neurologic sequelae following head injury, there had been no available imaging modalities for evaluating these patients precisely. Therefore we tried to detect the focal functional changes on the brain parenchyme using Tc-99m-HMPAO Brain SPECT on the patients of chronic head injuries. Twenty three patients who had suffered from headache, memory dysfunction, personality change and insomnia lasting more than six months following head injury were included in our cases, which showed no anatomical abnormalities on Brain CT or MRI. At first they underwent psychological test whether the symptoms were organic or not. Also we were able to evaluate the cerebral perfusion changes with Tc-99m-HMPAO Brain SPECT in 22 patients among the 23, which five patients were focal and 17 patients were nonfocally diffuse perfusion changes. Thus we can predict the perfusion changes such as local vascular deterioration or functional defects using Tc-99m-HMPAO Brain SPECT in the patients who had suffered from post-traumatic sequelae, which changes were undetectable on Brain CT or MRI.

Brain SPECT 영상의 Attenuation Correction 방법들에 대한 비교

조진우,김창호,나수경,이귀원,Jo, Jin U,Kim, Chang Ho,Na, Soo Kyung,Lee, Gui Won 대한핵의학기술학회 2012 핵의학 기술 Vol.16 No.2

이 연구의 목적은 Brain SPECT (Single Photon Emission Computed Tomography)의 Non-attenuation correction (AC-non) 영상에 대한 attenuation correction(AC) 방법 중 Chang's method와 CT based attenuation correction(AC-CT) 사이의 count를 비교하기 위함이다. phantom study는 증류수로 채워진 hoffman 3D phantom에 $^{99m}Tc$ 37Mbq을 투여하였고, patient study는 normal volunteer에 $^{99m}Tc$-HMPAO 750Mbq를 정맥주입하고 Siemens사의 Symbia T6로 Brain SPECT 영상을 획득하였고 뇌 정량 분석을 하였다. 각각의 방법들을 적용한 transverse image는 같은 위치에서 재구성 되었으며 각각 10, 20, 30번째 slice에서 6개의 region of interest(ROI)를 그려 AC-non 과 AC-CT 그리고 Chang's method의 count를 비교하였다. phantom study에서 AC-non, AC-CT, Chang's method의 각각 평균 count는 $4606.8{\pm}511.3$, $16794.6{\pm}2429.4$, $8752.6{\pm}896.5$이었으며 patient study에서 $5460.8{\pm}519.6$, $15320{\pm}1171.6$, $12795{\pm}1422.1$이었다. phantom study에서 AC-CT와 AC-non 사이의 비는 3.70이고 Chang's method와 AC-non 사이의 비는 1.92였으며 patient study에서는 각각 2.85, 2.38이었다. 우리는 이 연구를 통하여 AC-CT가 Chang's method보다 더 높은 AC을 해준다는 걸 알 수 있었다. 그리고 Chang's method는 patient study에서의 AC 값이 phantom study에서의 AC값보다 더 높다는 것을 알 수 있었다. brain SPECT/CT를 시행하는 경우 scatter correction을 같이 시행하고 bone에 의한 감쇠 정보를 반영할 수 있는 AC-CT가 chang's method보다 정확하다 할 수 있겠다. Purpose : The purpose of this study was to compare count between Chang's method and CT-based attenuation correction (AC-CT) among the attenuation correction (AC) methods for non-attenuation correction (AC-non) images of Brain SPECT (Single Photon Emission Computed Tomography). Materials and Methods : We injected $^{99m}Tc$ 37Mbq in a Hoffman 3D phantom filled with distilled water in the phantom study, and injected intravenously $^{99m}Tc$-HMPAO 740Mbq in a normal volunteer in the patient study, and then obtained Brain SPECT images with Symbia T6 of Siemens and conducted quantitative brain analysis. Transverse images to which each method was applied were rebuilt at the same position, and 6 regions of interest (ROI) were drawn on each of Slice No. 10, 20 and 30 and then the counts of AC-non, AC-CT and Chang's method were compared. Results : The mean counts of AC-non, AC-CT and Chang's method were $4606.8{\pm}511.3$, $16794.6{\pm}2429.4$, and $8752.6{\pm}896.5$, respectively, in the phantom study and $5460.8{\pm}519.6$, $15320{\pm}1171.6$ and $12795{\pm}1422.1$, respectively, in the patient study. In the phantom study, the ratio of AC-CT to AC-non was 3.70 and the ratio of Chang's method to AC-non was 1.92, and in the patient study, they were 2.85 and 2.38, respectively. Conclusion : From this study, we found that AC-CT makes higher AC than Chang's method. In addition, when Chang's method was used, AC in the patient study was higher than that in the phantom study. These results need to be considered also in other examinations.

사염화탄소 투여 흰쥐에서 간섬유화 진행에 따른 Propranolol 의 약동학적 지표들의 변화

이민호,강주섭,강문수,윤병철,이오영,함준수,변재원,윤창옥 대한간학회 2001 Clinical and Molecular Hepatology(대한간학회지) Vol.7 No.2

Background/Aims : This study was designed to determine the effect of hepatic fibrotic severity on pharmacokinetics of propranolol in CC1q - treated rats. Methods - 1 mL/kg of 10% CC14 in olive oil was injected intramuscularly to rats twice weekly for 4, 6, 8 and 10 weeks, respectively (n=6). Control (n=6) was a sham - injected equal dose of olive oil for 10 weeks. After intravenous bolus injection of 2 mg/kg propranolol to rats, the serum propranolol concentrations were analyzed for 4 hours at various time points by a HPLC - fluorimetric system, and pharmacokinetic parameters such as Co, MRT, AUC, Vdss, tl/2(p) and CLp were determined. Then, a small amount of hepatic tissue was obtained and subjected to determination of the hepatic 4 - hydroxyproline content, which confirmed the hepatic fibrotic severity. Results : The serum concentrations of propranolol at 0.5, 1, 2 and 4 hours were significantly increased in CC1q-treated rats (p$lt;0.01). In proportion to the duration of CC4 treatment, Co and AUC were significantly increased, and Vdss and CLp were significantly decreased (p$lt;0.001). But MRT and t1/2(β) were not significantly changed. The hepatic 4 -hydroxyproline content was gradually increased in CC4-treated rats (p$lt;0.001). Conclusion - Gradual changes in pharmacokinetic parameters of propranolol were seen to be dependent on the hepatic fibrotic severity. We suggest that gradual dosage modification, according to their hepatic fibrotic severity, is necessary for many drugs administered to patients with chronic liver disease.(Korean J Hepatol 2001;7:181-188)

한국인 직무 스트레스 측정도구의 개발 및 표준화

장세진,고상백,강동묵,김성아,강명근,이철갑,정진주,조정진,손미아,채창호,김정원,김정일,김형수,노상철,박재범,우종민,김수영,김정연,하미나,박정선,이경용,김형렬,공정옥,김인아,김정수,박준호,현숙정,손동국 大韓産業醫學會 2005 대한직업환경의학회지 Vol.17 No.4

Background and Purposes: Over the past three decades, numerous studies performed in Korea have reported that job stress is a determinant risk factor for chronic diseases and work disability. Every society has its own culture and occupational climate particular to their organizations, and hence experiences different occupational stress. An occupational stress measurement tool therefore needs to be developed to estimate it objectively. The purpose of this study is to develop and standardize the Korean Occupational Stress Scale (KOSS) which is considered to be unique and specific occupational stressors in Korean employees. Subjects and Methods: Data were obtained from the National Study for Development and Standardization of Occupational Stress (NSDSOS Project: 2002-2004). A total of 12,631 employees from a nationwide sample proportional to the Korean Standard Industrial Classification and the Korean Standard Occupational Classification were administered. The KOSS was developed for 2 years (2002-2004). In the first year, we collected 255 items from the most popular job stress measurement tools such as JCQ, ERI, NIOSH and OSI, and 44 items derived from the a qualitative study (depth interview). Forty-three items of KOSS, in the second year, were retained for use in the final version of the KOSS by using Delphi and factor analysis. Items were scored using conventional 1-2-3-4 Likert scores for the response categories. Results: We developed eight subscales by using factor analysis and validation process: physical environment (3 items), job demand (8 items), insufficient job control (5 items), interpersonal conflict (4 items), job insecurity (6 items), organizational system (7 items), lack of reward (6 items), and occupational climate (4 items). Together they explained 50.0% of total variance. Internal consistency alpha scores were ranged from 0.51 to 0.82. Twenty-four items of the short form of the KOSS (KOSS-SF) were also developed to estimate job stress in the work setting. Because the levels of the subscales of occupational stress were gender dependent, gender-specific standard norms for both the 43-item full version and the 24-item short form using a quartile for the subscales of KOSS were presented. Conclusion: The results of this study suggest that KOSS might be an appropriate measurement scale to estimate occupational stress of Korean employees. Further and more detailed study needs to be conducted to improve the validity of this scale.

Cronkhite-Canada 증후군 1예

이수걸,문창형,김무영,최성호,여동승,강필중,송철수,조몽,양웅석,허윤,문한규 대한내과학회 1992 대한내과학회지 Vol.42 No.2

저자들은 Cronkhite-Canada 증후군 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Cronkhite-Canada syndrome is a disease entity, including such characteristics as gastrointestinal polyposis associated with ectodermal changes-alopecia, hyperpigmentation of the skin and atrophy of the nails. But it has no familial tendency. In 1955, a report of 2 patients by Cronkhite and Canada established this entity as clinically distinct from any of the other known forms of gastrointestinal polyposis. Since that time, at least 53 similar casas has been described in the world literature, but no case has been reported in Korea.

Rat의 복강내에 투여한 5-fluorouracil-polyglycolic acid 제형이 장기에 미치는 영향에 관한 연구

강대영,송규상,최정목,노승무,정경수,오정연,김진향,양준묵,최선웅,이진호,조준식,민병무,김용백,김창식,박근성,김승영,김학용,인현빈 충남대학교 의과대학 지역사회의학연구소 1998 충남의대잡지 Vol.25 No.1

For more effective intraperitoneal chemotherapy, the authers made 5-fluorouracil-polyglycolic acid composite disks(FU-PGA disks) with 5-fluorouracil and polyglycolic acid, a biodegradable polymer. We inserted the FU-PGA disk into the peritoneal cavites of Sprague-Dawley male rats, the control and three experimental groups; one FU-PGA disk insert group(300mg/kg), two FU-PGA disk insert group(600mg/kg), and three FU-PGA disk insert group(900mg/kg). The control group received a similar number of PGA disk inserts. A pharmacokinetic study was performed to measure the 5-fluorouracil concentration in the peritoneal fluid, blood, and tissues(liver, kidney and heart) at 24 hours, 72hours and 168 hours after insertion of the FU-PGA disk. Light and electron microscopic studies were done. The results were as follows: 1) The number of white blood cells and platelets decreased after FU-PGA insertion. The degree was proportional to the duration and amounts inserted. The change in the number of red blood cells varied slightly. 2) Light microscopically, slight changes were noted at 168 hours in the 3 disk insert group (900mg/kg). Mild fatty change and hepatocyte degeneration around the central veins of the liver were noted, with vacuolar degeneration in the proximal convoluted tubules of the kidney. 3) Electron microscopically,the liver showed focal increases of lipid droplets in the hepatocytes, and irregular nuclear membrane with focal nucleolar segregation of the fibrillar and granular elements. Also the double membranous structure of the hepatocytes and Kupffer cells was widened with bleb formation. The kidney showed wide separation of the nuclear double membrane in the proximal convoluted tubular cells and mesangial cells, with vacuolation and myelin figure formation in the mitochondria of the proximal convoluted tubular cells, at 72 hours and 168 hours in the 2 to 3 FU-PGA insert groups. The heart showed focal loss of cristae,vacuolation and myelin figure formation in the mitochondria of the 2 to 3 FU-PGA insert groups. In conclusion, despite the large amont of FU-PGA inserted, the histopathological changes in the liver, kidney and heart were slight, and consonant with the very low amount of 5-fluorouracil concentrations detected in the liver, kidney and heart. The above results suggest that the FU-PGA composite can serve as a new device for releasing drugs in a controlled manner and easily targeted to intraperitoneal organs. This device can improve the efficacy of intraperitoneal chemotherapy for gastric cancer.

Effect of epidural corticosteroid injection on magnetic resonance imaging findings

( Min Soo Kim ),( Tae Yoon Jeong ),( Yu Seon Cheong ),( Young Wook Jeon ),( So Young Lim ),( Seong Sik Kang ),( In Nam Kim ),( Tsong Bin Chang ),( Hyun Ho Seong ),( Byeong Mun Hwang ) 대한통증학회 2017 The Korean Journal of Pain Vol.30 No.4

Background: Magnetic resonance imaging (MRI) of the spine is the preferred diagnostic tool for pathologic conditions affecting the spine. However, in patients receiving epidural corticosteroid injection (ESI) for treatment of spinal diseases, there is a possibility of misreading of MR images because of air or fluid in the epidural space after the injection. Therefore, we defined the characteristics of abnormal changes in MRI findings following an ESI in patients with low back pain. Methods: We reviewed the medical records of 133 patients who underwent MRI of the lumbar spine within 7 days after ESI between 2006 and 2015.All patients were administered an ESI using a 22-gauge Tuohy needle at the lumbar spine through the interlaminar approach. The epidural space was identified by the loss of resistance technique with air. Results: The incidences of abnormal changes in MRI findings because of ESI were 54%, 31%, and 25% in patients who underwent MRI at approximately 24 h, and 2 and 3 days after ESI, respectively. Abnormal MRI findings included epidural air or fluid, needle tracks, and soft tissue changes. Epidural air, the most frequent abnormal finding (82%), was observed in 41% of patients who underwent MRI within 3 days after injection. Abnormal findings due to an ESI were not observed in MR images acquired 4 days after ESI or later. Conclusions: Pain physicians should consider the possibility of abnormal findings in MR images acquired after epidural injection using the interlaminar approach and the loss of resistance technique with air at the lumbar spine. (Korean J Pain 2017; 30: 281-6)

유입부하 변동 대응 A₂O 및 MBR 복합공정의 장기운영 평가

장재영 ( Chang Jae Young ),이민수 ( Lee Min Soo ),차재훈 ( Cha Jae Hun ),김성호 ( Kim Seong Ho ) 한국수처리학회 2017 한국수처리학회지 Vol.25 No.2

This study was carried out for evaluating stability and utility of expansion for sewage wastewater treatment plant throughout long term operation data of A₂O + MBR hybrid process without additional expansion site. Due to the lack of capacity of the existing treatment facilities by the increase of the number of facilities & students in the treatment area, it was required to expand the existing treatment facilities without expanding the site. Therefore, the treatment facility was expanded through two stages. In the first stage, the membrane was immersed in the aeration tank of the existing treatment facility, and the capacity of the expanded MBR process are changed to 1,200 ㎥/d from 600㎥/d. In addition, in the second stage expansion, the untreated mixture of MLSS & influent in the MBR were separated by using the sedimentation basin not used at the first stage expansion, and the process was changed to the A₂O + MBR hybrid process mixed & discharged with MBR treated water. The expanded sewage treatment facilities was operated from 2009 to 2015 and the treated water quality of the hybrid sewage treatment facilities has been stably operating such as BOD₅ 0.6mg/L, T-N 10.7mg/L, T-P 0.49mg/L, and SS 0.4mg/L. Due to characteristics of facilities installed in university, there are a lot of influent characteristics variation in season. Therefore, depending on influent load variation of the operating rate of hybrid process were changed. As a result, it could be able to reduce loading of membrane and operating expenses such as cleaning chemicals and electricity cost.

전치의 후방견인에 따른 입술과 주위 연조직의 수직적 변화

강창수,김경호,최광철 대한치과교정학회 2000 대한치과교정학회지 Vol.30 No.2

입술의 돌출을 해소하고자 하는 환자들은 자신의 안모 개선을 안모의 측면보다는 거울로 볼 수 있는 정면을 통하여 느끼는 것이 보편적이다. 안모의 정면에서 평가가 이루어질 때에는 입술이 후방으로 들어간 정도와 함께 입술과 그 주위 조직의 수직적 변화에 의해서도 큰 영향을 받을 수 있으므로 교정치료 진단이나 치료 후 평가를 위한 측모두부방사선 사진 분석 시 전통적으로 중요시되고 있는 입술의 시상적 이동뿐만 아니라 흔히 간과하기 쉬운 수직적인 변화에 관해서도 평가가 이루어져야 한다. 따라서 본 연구에서는 입술 돌출을 주소로 내원한, 성장이 완료된 성인 여성 61명을 대상으로 측모두부 방사선 사진을 촬영하여 전치의 후방견인시 나타나는 입술과 주위 연조직의 수직적 변화를 계단식 다중 회귀 분석법을 이용하여 조사한 결과 다음과 같은 결론을 얻었다. 1.상, 하순의 philtrum길이 (SnLs, LiB') 는 전치의 후방견인 후 증가하였고, 상, 하순의 vermilion height (LsStms, StmiLi) 와 vermilion length (LsLi) 는 감소하였다. 2.상, 하순의 길이 (SnStms, StmiB')와 연조직의 하안면 고경 (SnMe')은 치료 후 유의성 있는 변화를 보이지 않았다. 3.상순의 philtrum길이 증가에 상악 전치의 정출 △UIV 이 가장 큰 영향을 주었으며 하순의 philtnlm길이 증가에는 치료 전 overjet이 가장 큰 영향을 주었다. 4.상, 하순의 vermilion height감소에 상순의 두께 감소가 가장 큰 영향을 주었다. Patients who want to reduce their lip protrusion usually estimate the severity of the lip protrusion on the frontal aspect. Most orthodontists have a perplexed experience of a reduced thin line of vermilion border on the frontal aspect as incisors are retracted, even though the lip protrusion is thought to be reduced favorably on the sagittal aspect. Some patients also look older after orthodontic treatment because of severe lip thinning. This unaesthetic reduction of vermilion border urges us to study the vertical lip change during orthodontic procedure. The purpose of this study was to evaluate the vertical lip and perioral soft tissue changes in respect to incisor retraction in an effort to analyze which factors might be responsible for their vertical changes, using the multiple regression analysis. The results were as follows. 1.Upper and lower lip philtrum length(SnLs, LiB') were increased after retraction of anterior teeth, where as upper and lower vermilion height(LsStms, StmiLi), and vermilion length(LsLi) were decreased. 2.Upper and lower lip length(SnStms, StmiB'), and soft tissue lower anterior facial height(SnMe') did not show any significant difference after treatment. 3.The increase of the upper lip philtrum length was mainly influenced by the extrusion of upper anterior teeth(△UIV), and the increase of the lower lip philtrum length was mainly influenced by the initial overjet before treatment. 4.The decrease of the upper and lower lip vermilion height was mainly influenced by the decrease of upper lip thickness.

응급실에서 시행한 상용심전도의 효용성에 대한 고찰

도호석,이창현,이삼범,도병수 대한응급의학회 1995 대한응급의학회지 Vol.6 No.1

Study objectives : To determine whether routine performance of an ECG could have been safely avoided in a subset of ED(emergency department) patients admitted to a university hospital. Design : Retrospective consecutive case series. Setting : University teaching hospital. Type of participants : All patients admitted through Yeungnam university hospital during a three month period. Methods and interventions : Acceptable indications for an admission ECG were prospectively developed. Charts of all patients were reviewed to determine whether any of these were present, whether an admission ECG performed, and whether an admission ECG resulted in a change in patients management or outcome. Measurements and main result : There were 984 admissions through ED during the study period. Of these 608 patients had an ECG performed at ED. Of the 608 patients 140(23.0%) had at least one acceptable indication and 468(77.0%) had no for an ECG. Among the 140 who had an indication for an ECG at ED, 56(40.0%) patients ECG were interpreted abnormal (95% confidence interval[CI], 32%∼48%). Among the 468 who had no indications, only 3(0.64%) patients ECG were interpreted abnormal (95% CI, 0%∼1.36%) and the ECG result in a change in management, but no change in outcome (95% CI, 0%∼0.64%). Conclusion : The routine or admission ECG could have been avoided in no acceptable ED indication. We should have to try continuously for making acceptable criteria of ECG in ED of Korea, and then we have to prevent needless ECG and cardiac work up that increasing the cost and evacuation time from ED.