간세포암의 고주파 열치료 후 천자침 경로를 통한 전이 1례

조영완,박석주,진한영,김준영,이재익,강명주,박정하,윤정희,박성재,지삼룡,이연재,이상혁,설상영 인제대학교 2006 仁濟醫學 Vol.27 No.-

Radiofrequency ablation(RFA), as a form of minimally invasive therapy for hepatocellular carcinoma, has become an important treatment modality. Because of limitation of surgery, RFA has become standard therapy for hepatocellular carcinoma in some situations. But there are some complications of RFA such as bleeding, infection, hematoma, adjacent organ thermal damage including intestinal perforation, needle track seeding, and so on. There are few reports in the literature that systematically evaluate the incidence of needle tract seeding and its associated risk factors. And only 2 cases of needle tract seeding of hepatocellular carcinoma after RFA were reported in Korea. We report a case of needle tract seeding of hepatocellular carcinoma after RFA.

비만증 환자에서 한약제에 의한 체중 감소효과

Oh, Seung-Joon,Jeong, In-Kyung,Kim, Young-Seol,Choi, Young-Kil,Paeng, Jeong-Ryung,Bae, Jung-Hwan,Shin, Hyun-Dae 경희대학교 동서의학연구소 1999 INTERNATIONAL SYMPOSIUM ON EAST-WEST MEDICINE Vol.1999 No.1

Seung-Joon Oh, In-Kyung Jeong, Young-Seol Kim, Young-Kil Choi, Jeong-Ryung Paeng¹, Jung-Hwan Bae and Hyun-Dae Shin²Department of internal Medicine, College Medicine, Endocrine Research Institute¹. Department of Rehabilitation, College of Oriental Medicine², Seoul, korea. Bady Fat Reduction Effects of Red Ginseng Compound Preparation on the Patients with Obesity. Proceedings of International Symposium on East-West Medicine, Seoul. 244-254, 1999.-Obesity can be defined as a metabolic disease due to an increased state of fat tissues caused by an imbalance of calorie intake and use. Recently, in Korea by improvement and westernization of food intake, along with decrease in exercise activities, the prevalence of obesity has increased greatly. Our objectives were to study stability and effects of decrease in body fat by administering red ginseng compound preparation (known to have body fat decreasing effects in laboratory animals) to obesity patients on low calorie diets. Changes in weight and body fat were measured while carrying out calorie-restricted diets on patients for 4 weeks, then administering red ginseng compound preparation for another 4 weeks. The patients were 20 people whose BMI were 25kg/㎡ or over and whose percent body fat was also 30% or over when tested by bioelectrical conductivity. 1. Changes in weight were from 70.04kg(base line) to 67.43kg(after taking red ginseng compound preparation). 2. In similar sense, BMI decreased from 27.12kg/㎡(base line) to 26.56kg/㎡(after dieting), and further to 26.01kg/㎡ (after taking red ginseng compound preparation). The BMI seemed to decrease significantly compared to the baseline after the use of red ginseng compound. 3. Waist hip ratio was changed from 0.8858(base line) to 0.8728, but it was statistically insignificant. 4. The percent body fat was 35,16%(base line), 33.87%(after dieting), and 31.68%(after taking red ginseng compound preparation). 5. Complete blood cell count and blood chemisrty remained unaffected by the administration. 6. In concern to endocrinologic studies, T3 decreased from 118.7 to 98.2ng/dL, and T4 increased from 8.8 to 9.2㎕/ dL. Epinephrine showed a tendency to decreased from 0.27 to 0.25 ng/mL, and norepinephrine increased from 0.39 to 0.44ng/mL. 7. Leptin was not changed. 8. Some patients complained adverse effects; constipation(5 patients, may be due to diet therapy), fatigue (2 patients), pruritus(2 patients), flushing(s patients), dizziness(3 patients) and epigastric discomfort(2 patients). However their symptoms were mild, so medication did not stopped. In conclusion, loss of weight without significant side effects was observed during low calorie diet and red ginseng compound preparation administration. This is thought to be in relation to sympathetic nerve system rather than adrenal gland. Also, further long0term studies should be required, since the observed results were based on short-term changes in weight.

당뇨병 백서의 간세포에서 Glucokinase 활성도 및 유전자 발현에 대한 인슐린의 영향

강성이,팽정령,서광식,안규정,우정택,김성운,양인명,김진우,김영설,김광원,최영길 경희대학교 유전공학연구소 1993 遺傳工學論文集 Vol.5 No.-

목적 당대사의 조절 상태에 따른 생체 변화를 분자 수준에서 이해하고자 식이 조건을 달리한 정상 백서와 화학적으로 유도된 당뇨병 백서의 간조직에서 혈당수준과 인슐린치료 정도에 따라 나타나는 글루코키나제 활성도 및 유전자 발현을 분석하였다. 방법 스트렙토조토신 정맥투여 후 당뇨병의 유발을 확인하고, 인슐린을 1일 3회 3일간 복강내로 투여하여 상태를 안정시킨 후, 인슐린 투여군은 인슐린 투여 6시간이내에 그리고 인슐린 비투여군은 24시간 후 단두하여 채혈하고 복강을 열어 간조직을 채취하였다. 채취한 간조직에서 글루코키나제 활성도는 인산화된 포도당에서 NADH의 형성을 형광분광계로 측정하였으며, 글루코키나제 유전자 mRNA발현은 Northern 분석법을 이용하였다. 성적 정상 백서에서 공복상태와 식이를 섭취한 경우에 간조직의 글루코키나제 효소의 활성은 차이가 없었으나, 글루코키나제 유전자 mRNA 발현은 증가되었다. 당뇨병이 유발된 백서의 간조직에서 글루코키나제 효소의 활성 및 글루코키나제 유전자의 mRNA 발현은 정상 백서에 비하여 낮았다. 인슐린 투쳐 후 글루코키나제 효소의 활성 및 글루코키나제 유전자의 mRNA 발현이 증가되었고, 특히 혈당이 정상화된 경우에서 글루코키나제 유전자의 mRNA 발현이 증가도었다. 결론 인슐린에 의한 간조직에서 글루코키나제 효소의 활성 및 글루코키나제 유전자의 mRNA을 증가를 볼수 있었다. 당뇨병 백서에서 인슐린 투여 후에 혈당조절이 안된 경우 간조직의 글루코키나제 유전자의 mRNA 발현이 증가가 없는 것으로 보아 글루코키나제 mRNA의 발현에는 인슐린 이외의 다른 요소가 관여할 것으로 생각된다. The liver-specific hexokinase isoenzyme, referred to as glucokinase, is thought to play a key reglulatory role in hepatic glucose metabolism. The glucokinase gene is, therefore, of interest both because of its tissue-specific expression and because of the several regulatory processes that can be analyzed. The level of hepatic glucokinase activity appears to be determined essentially by regulation of the rate of enzyme synthesis, with insulin playing a leading role as an inducer. We investigated the role of insulin for the induction of glucokinase in the liver of diabetic rats. Experimental diabetes was induced by injection of streptozotocin 7 days before the experiment. Regular insulin was given by three days intraperitoneal injection at 8-h interval. The glucokinase mRNA in the liver was estimated by Nothern blot assay, as well as by fluorometric enzyme activity assay. Glucokinase activity was not reduced in the liver of normal fasting rats as compared to normal fed rats. And glucokinase activity was reduced in the liver of diabetic rats as compared to normal rats. In diabetic rats treated with insulin, glucokinase enzyme activity were increased. But glucokinase mRNA expression was only increased in normoglycemic diabetic rat with treated with insulin as compared to hyperglycemic rat. These data indicate that insulin stimulates hepatic glucokinase enzyme activity and mRNA expression. But other hormonal or metabolic factors may be contribute to regulation of glucokinase mRNA expression.

심한 골병변으로 발현된 기능성 낭종성 부갑상선 선종

전숙,김영희,박지영,고관표,박철영,김덕윤,우정택,김성운,김진우,김영설,고석환 대한내분비학회 2003 Endocrinology and metabolism Vol.18 No.2

낭종성 부갑상선 선종과 심한 골병변을 동반한 부갑상선 기능항진증은 매우 드문 질환으로서, 저자들은 양측 고관절의 통증을 초기 주소로 내원한 환자에서 고칼슘혈증과 부갑상선 호르몬 증가, 골병변의 방사선적 소견을 통해 부갑상선 기능항진증을 진단하고, 경부 초음파와 컴퓨터 단층 촬영, 부갑상선 스캔검사 및 수술중 부갑상선 낭종액 검사 등을 통해 기능성 부갑상선 낭종의 한 종류인 낭종성 부갑상선 선종을 진단하고 수술적 제거를 통하여 정상화된 1예를 경험하였다. A cystic parathyroid adenoma is rare. A case of primary hyperparathyroidism, with the cystic formation of a parathyroid adenoma and a severe bony lesion, is reported. A 52-year-old male was admitted due to pain in both hips and for evaluation of hypercalcemia. The plasma level of the intact parathyroid hormone (iPTH) was elevated to 1424 pg/mL. Ultrasonography and the computed tomography revealed a parathyroid cyst on the left thyroid lower pole. Parathyroid scintigraphy detected a parathyroid adenoma. A radiograph showed a subperiosteal bone resorption on the phalanges, and a brown tumor (osteitis fibrosa cystica) on the femur shaft was noted. A surgical excision of the parathyroid adenoma was performed. The PTH level in the cystic fluid was increased. A histological examination confirmed a cystic parathyroid adenoma. The PTH level was normalized after the operation (J Kor SOC Endocrinol 18:214-220, 2003).

정상 한국인에서 CRH, GHRH와 TRH를 이용한 복합뇌하수체 자극시험에 대한 성별 연령별 반응

이상훈,김성운,고관표,오승준,우정택,양인명,김진우,김영설 대한내분비학회 2004 Endocrinology and metabolism Vol.19 No.1

연구배경: 인슐린을 대신하여 부신피질 자극호르몬 방출호르몬 (CRH)과 성장호르몬 방출호르몬 (GHRH)으로 복합뇌하수체 자극검사가 시행되고 있으나, 한국인에 있어서 정상 반응치에 관한 연구가 없고, 각각의 자극 호르몬의 연령이나 성별에 대한 반응의 차이는 보고되었지만 복합 자극검사에서의 연령별 성별 차이가 확립되지 않아 이를 알아보고자 본 연구를 시행하였다. 방법: 정상인 50대 남자 7명, 20대 남자 7명과 50대 여자 7명, 20대 여자 7명을 대상으로 CRH 100㎍,GnRH 100㎍, GHRH 100㎍, TRH 200㎍을 순서대로 동시에 정맥주사한 후 ACTH, GH, TSH, PRL, LH, FSH를 15∼30분 간격으로 2시간 동안 측정하였다. 결과: 1) TSH, PRL, LH의 분비 정도는 20대 남성과 50대 남성간의 유의한 차이가 관찰되지 않았으나, ACTH와 FSH는 50대 남성에서, GH는 20대 남성에서 통계학적으로 유의하게 높게 나타났다. 2) 20대 여성과 50대 여성을 비교했을 때, FSH만 50대 여성에서 통계학적으로 유의하게 높았고, 나머지 호르몬들의 결과에서는 통계학적으로 유의한 차이는 없었다. 3) 50대군에서 GH와 LH는 남녀간의 유의한 차이를 보이지 않았으나, ACTH는 남성에서 높게 나타났으며, Prolactin, FSH, TSH는 여성에서 통계학적으로 의미 있게 높았다. 결론: 연령, 성별과 월경주기 등에 따른 한국인의 복합뇌하수체 반응에 관한 더 자세한 연구가 요망된다. Backgroud: It has been already known that each trophic hormone in combined pituitary responsiveness according to gender and age brings about variable response, but in Korea, there has been no actual data. In this study, in order to assess the pituitary responsiveness, a combined pituitary stimulation test was performed in Korean subjects with the variation in CRH, GHRH, GnRH, and TRH according to their age and gender. Were these the variables that were changed according to age and gender? Clarify that. Also, it might be good to write out the abbreviations.) Method: Fourteen physically and mentally healthy male subjects and fourteen female subjects, also physically and mentally healthy, underwent the combined anterior pituitary stimulation test by CRH, GHRH, LHRH, and TRH. Each gender group was divided further into young (meanSE; male: 231, female: 221) and old (mean; male: 513, female: 522) groups. Results: There were significant differences between the gender and age groups. The Peak GH level and maximal GH increment were significantly increased in young men compared to old men. The Peak ACTH level and maximal ACTH increment were significantly increased in old men as opposed to young men. The Peak PRL level, maximal PRL increment, Peak TSH level, and maximal TSH increment were significantly increased in old women compared to old men. The Peak FSH level was significantly increased in the two old groups compared to the young groups, which showed independence in gender, and the maximal FSH increment was significantly increased in old men when compared with the young men. Conclusion: These results show that in order to for accurate interpretation of the response from the combined pituitary stimulation test, it is necessary to consider age and gender of the subjects. We suggest response values of the combined pituitary stimulation test in terms of age and gender in healthy Korean subjects (J Kor Soc Endocrinol 19:24∼32, 2004).

직장 Dieulafoy 병변으로 다량의 혈변을 보인 1 예

김태영;이상헌;김지현;배영환;정은주;김승만;지삼룡;설상영 인제대학교 2011 仁濟醫學 Vol.32 No.-

Dieulafoy’s lesion is very rare cause of gastrointestinal bleeding, Deiulafoy’s lesion is exposure of non ulcerative, abnormally large tortuous, thick- walled artery in the muscularis mucosa through a small submucosal defect. It is usullay found on stomach antrum and lesser curvature side of the proximal body, and possibly found on any sites throughout whole gastrointestinal tract, but rarely on rectum. The principal of treating Dieulafoy’s lesion was the surgical resection of lesion, but recently remarkable advances in endoscopic technique make endoscopic approach more popular. We report a case of rectal Dieulafoy’s lesion successfully treated with endoscopic hemoclipping in an elderly female patient.

혈당측정기 GlucoDr™ System의 평가

박철영,류미숙,우정택,김성운,김진우,김영설,안규정 대한당뇨병학회 2002 임상당뇨병 Vol.3 No.2

연구배경: 당뇨병 환자에서 엄격한 혈당조절은 환자의 예후와 밀접한 관련이 있다. 혈당조절을 철저히 하기 위해서는 자가 혈당 측정기의 사용이 필수적이라 할 수 있다. 또한 저혈당이 빈번하게 발생하거나, 위험요소가 있는 환자들에게도 유용하게 사용될 수 있다. 이에 저자들은 전기화학감지법의 원리를 이용하여 국내에서 처음 생산된 자가혈당측정기인 GlucoDr™ blood Glucose Testing System(ALL Medicus, Co, Korea)를 현재 국내에서 시판되고 있는 다른 제품과 비교, 평가하여 임상적 유용성을 살펴보고자 하였다 방법: 혈당측정기준장비는 YSI 2300 STAT Plus(YSI Incorporated, USA)를 사용하였으며 GlucoDr™외에 Glucocard(KDK, Japan), Precision QID(Abbott Laboratories, Co, USA), Glucotrend(Roche, USA), Surestep(Lifescan, USA)의 다른 혈당측정기를 같이 평가하였다. 정밀도, 직선성, 비교방법과의 상관관계 평가, 검체량에 따른 영향, 헤마토크리트에 따른 영향, 검사자에 따른 영향, 항응고제에 따른 영향들을 평가하였다. 결과: 본 연구에서의 주된 평가대상인 GlucoDr™의 평가결과, 정밀도를 나타내는 검사 내, 검사 간 변이계수는 8%이내였으며, 45~500mg/dL 범위에서 R²=0.9906, 0.9984 정도의 직선성을 나타내었다. 본 연구에 있어 비교방법으로 이용한 YSI 2300 STAT Plus와의 상관관계 및 정확도는 y = 1.0058x + 0.453, R = 0.9853인 것으로 나타났다. 검체량이나 검사자 및 항응고제에 따른 측정값에는 유의할만한 차이가 없는 것으로 나타났으나, 헤마토크리트가 증가 또는 감소함에 따라 최소 10%에서 최대 26% 가량의 영향을 받는 것으로 관찰되었다. 결론: GlucoDrTM는 국내 사용되는 다른 혈당측정기와 비교하여 유용할 것으로 생각된다. Background: Self-monitoing blood glucose devices are sidely used in monitoring and point-of-care testing for the management of diabetic patients. We performed the present study to evaluate the performance of the GlucoDr™ blood glucose testing system using an electrochemical technique. Method: The GlucoDr™ was evaluated for linearity, precision, comparison of method, the effect of sample volume, hematocrit concentration, reapplication, operator and application methods. Results: The GlucoDr™ showed good linearity for glucose concentrations ranging from 52mg/dl to 475mg/dl(r²=0.971). The single day, and day-to-day, CV were within 8%. Excellent correlation was found between the GlucoDr™ and YSI 2300 STAT Plus(y=1.0058x + 0.453, r²=0.9710). The sample volume, reapplication, operator and application method produced no significant effect on the test result. An overestimation in the glucose values was found with low hematocrit concentrations. There was no significant effect by the anticoagulants, with the exception of citrate. Conclusion: The GlucoDr™ showed good linearity, precision and correlation with the reference method and provided rapid and reliable result for blood glucose levels. Therefore, the GlucoDr™ seems appropriate for clinical use in the management of diabetic patients.

사람의 비후성 반흔에서 면역조직화학기법에 의한 형질전환인자 알파와 표피성장인자 발현의 차이에 관한 면역조직화학적 연구

박영란,김현곤,김종중,문정석,송준섭,설경수,정윤영 朝鮮大學校 附設 醫學硏究所 2008 The Medical Journal of Chosun University Vol.33 No.2

Background and Objectives: Transforming growth factor-α (TGF-α) and epidermal growth factor (EGF) are polypeptides which interact with the epidermal growth factor receptor (EGFR) to produce their biological effects. The aim of the present investigation was to elucidate the immunolocalization of TGF-α and EGF in normal human skin, hypertrophic scar with skin graft on soft tissue defect, and postburn hypertrophic scar without graft. Methods: The data presented in this paper focused attention on differences of expression between two kinds of hypertrophic scars in relation to skin graft using immunohistochemistry. Formalin-fixed and paraffin-embedded tissues from 3 normal skin tissues, 3 hypertrophic scars after skin graft and 8 postburn hypertrophic scars without graft were immunolabelled with antibodies directed against TGF-α and EGF. Results: In normal epidermis of skin, strong TGF-α immunoreactivity (IR) was observed in all epidermal layers except the stratum (S.) basale, whereas EGF was immunopositive in a few cells over all epidermal layers. The staining for TGF-α was found in cell membrane, and EGF was seen either diffuse cytoplasmic or peripheral part of cells in normal epidermis. In hypertrophic scar after six months postoperation, TGF-α IR was observed in the upper part of S. spinosum and S. corneum, whereas EGF was diffusely expressed in the S. spinosum, also its intensity was slightly increased compared to normal skin. In hypertrophic scar without skin graft, very strong expression of EGF was detected in the S. spinosum and S. corneum, and intensity of EGF was increased when compared to normal skin and postoperative hypertrophic scar. EGF and TGF-α coexisted in the cells of S. spinosum in normal skin as well as hypertrophic scars. Double-labeled cells were increased in postburn hypertrophic scar compared to normal skin and postoperative hypertrophic scar. In addition, intensity of EGF and TGF-α double IR was the strongest in postburn hypertrophic scar. Conclusion: These results indicate that EGF may have a more complex regulatory role not only in the early stages of wound healing but also in hypertrophic scar.

‘병동 중심의 처치수가 산정지침 개발’ 등을 통한 간호업무 표준화 및 그 효과

한혜정,설미진,김영주,박소영,박아리스,문한경,이현영 한국의료QA학회 2009 한국의료질향상학회지 Vol.15 No.1

문제: 병동 처치수가 산정 부정확 및 누락으로 인한 부적절한 재고관리로 진료차질, 불필요한 업무발생 및 수익이 감소한다. 목적: 병동 처치수가 산정 정확화를 위한 업무 표준화 도구 및 시스템을 개발하여 적정 재고관리를 통한 수익증대 및 직무만족도를 향상시킨다. 의료기관: 서울시 종로구에 소재한 대학병원 질 향상 활동: 병동중심의 처치 산정지침 개발 및 수가물품의 적정재고 관리방안을 모색하였다. 개선효과: 병동중심의 처치수가 산정 지침서를 제작하여 업무표준화를 기하였음. 응급청구 품목 및 수량이 ’07년 대비 71%감소하고 타 병동 차용품목이 활동 전에 비해 61% 감소, 수량은 77% 감소함. 응급청구 총소요시간이 활동 전에 비해 ’07년 대비 77% 감소하고 타 병동 차용 총 소요시간이 61% 감소함. 전년 동기간 대비 수익이 4% 증가하였으며 또한 54병동과 보험 심사팀에서 직원들의 직무만족도가 향상되었다.

인슐린 주사제의 고충실 액체색층기 분석

우정택,팽정렬,김성운,양인명,김진우,김영설,김광원,최영길 최신의학사 1993 最新醫學 Vol.36 No.8