HBeAg 음성 만성 B형 간질환에서 Lamivudine의 치료 효과

정인두,박능화,김병철,박지현,서광원,김대현,주광로,김도하 대한간학회 2003 Clinical and Molecular Hepatology(대한간학회지) Vol.9 No.2

목적: HBeAg 음성 만성 B형 간질환 환자에서 라미부딘 치료 효과, 내성 발생률, 치료 종료 후 재발률 및 각각의 예측 인자를 알아보고자 하였다. 대상과방법: HBeAg 음성, anti-HBe 양성이나 HBV DNA가 양성인 HBeAg 음성 만성 B형 간질환으로 진단 받은 환자 중에서 혈청 ALT치가 상승되어 있는 59명을 대상으로 라미부딘을 1일 100mg씩 6개월(평균 14개월)이상 투여하였다. 평균 연령은 42.1세였고 남녀 비는 52:7이였다. 치료 전 혈청 ALT평균치는 368 IU/L, HBV DNA평균치는 494 pg/mL였다. 치료 전, 치료 개시 후 및 종료후 1-2개월 간격으로 간기능 검사, HBeAg, anti-HBe, HBV DNA를 측정하였다. 치료 반응군은 반응이 일어난 시점을 기준으로 1-2개월 간격으로 2번 이상 반응이 유지되는 것을 확인한 후 투약을 중지하고 재발 유무를 추적 관찰하였다. 결과: 라미부딘 투여 후 50명 중 56명(94.9%)에서 혈청 HBV DNA가 음전되었으며 누적 음전율은 1개월후 27%, 2개월 후 71%, 3개월 후 90%, 5개월 후 95%였다. 혈청 ALT치는 52명(88.2%)에서 정상으로 회복되었으며 대부분 6개월 내에 이루어졌다. 혈청 ALT치의 누적 정상화율은 2개월 후 30%, 3개월 후 47%, 6개월 후 78%, 10개월 후 86%였다. 혈청 HBV DNA가 음전되고 혈청 ALT치가 정상으로 유지된 치료 반응은 52예(88.1%)에서 일어났으며, 누적 치료반응률은 2개월 후 10%, 4개월 후 49%, 6개월 후 66%, 10개월 후 80%, 18개월 후 88%였다. 라미부딘 총 투여 기간이 유일한 치료 반응 예측 인자였다(p=0.000). 변이형의 출현은 5예(8.5%)에서 일어났고 누적 발생률은 10개월 후 8%, 16개월 후 13%였다. Breakthrough발생 예측인자와 관련된 유의한 인자는 없었다. 치료 반응군중 투여 중지한 34명 중 17명(50%)에서 재발하였으며(평균추적기간: 6개월, 범위: 1-22개월) 대부분 투여중지 6개월 내에 재발하였다. 누적 재발률은 3개월 후 24%, 6개월 후 47%, 10개월 후 66%였다. 재발과 관련된 예측 인자는 치료 반응후 추가적인 라미부딘 누여만이 유의한 인자였다(p=0.019). 특히 12개월 이상 유지한 7명 모두에서 재발하지 않았다. 결론: 라미부딘은 HBeAg 음성 만성 B형 간질환에서 높은 치료효과와 낮은 breakthrough를 보였으며 라미부딘 투여 기간만이 유일한 치료 반응 예측 인자이었다. 그러나 치료 종료 후 많은 예에서 재발하였으며 치료 반응 후 추가적인 라미부딘 투여 기간만이 유일한 재발 예측 인자였으며 재발을 막기 위해서는 장기간의 추가적인 라미부딘 투여가 필요할 것으로 사료된다. Background/Aims: Lamivudine therapy is effective in inhibiting HBV replications in patients with HBeAg-negative chronic liver disease. However, the sustained response rate appears to be particularly poor, because the vast majority of patients relapse soon after cessation of therapy. The aim of this study was to evaluate the efficacy of lamivudine, the breakthrough rate, and the relapse rate of discontinuing therapy after response in patients with HBeAg-negative chronic liver disease. Methods: Fifty-nine patients with HBeAg-negative chronic liver disease who have received lamivudine for at least 6 months, were studied. The mean duration of treatment was 14 months. Complete response was defined as undetectable serum HBV DNA by bDNA and normalization of ALT levels. Once HBV DNA disappearance and ALT normalization were observed, lamivudine therapy was continued for at least two additional months. The mean follow-up after cessation of treatment was 6 (1-22) months. Results: Fifty-six patients were undetectable HBV DNA. The cumulative HBV DNA loss rates at 3 months and 5 months were 90% and 95%, respectively. The ALT normalization was observed in 52 patients. The cumulative ALT normalization rates at 6 months and 10 months were 78% and 86%, respectively. The complete response was observed in 52 patients. The cumulative rates of complete response at 10 months and 18 months were 80% and 88%, respectively. A predictive factor for complete response was only the duration of lamivudine treatment. Virological breakthrough was observed in 5 (8.5%). Thirty-four patients stopped taking lamivudine after 7.7 (2-15) months of the additional therapy. Seventeen of those patients (50%) experienced relapse. The cumulative relapse rates at 3 months, 6 months and 10 months were 24%, 47% and 66%, respectively. The only predictive factor for relapse was the duration of additional lamivudine treatment after response. Conclusions: Lamivudine was an effective treatment of HBeAg negative chronic liver disease. Relapse, however, was usually observed after cessation of lamivudine. Our results showed that long-term lamivudine therapy is required in order to decrease the high relapse rates in patients with HBeAg-negative chronic liver disease.

자동차차체 및 부품제조업 산업장의 작업환경실태에 관한 조사 연구

서준호,문덕환,김정호,이채관,황용식,손병철,김대환,이창희,김휘동,이채언 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.5

Objectives: For the purpose of preparing the fundamental data and control the working environment and assessing the status of working environmental in manufacturing industry of bodies for motor car and of parts. Methods and Materials: Accessories for motor car and its engines the auther measured the noise level, concentration of dust, heavymetals, organic solvents, chemicals to 99 industries(24 working processes) form Feb. 2000 to Oec. 2000. Results: The results were as follows : 1. Mean noise level cutting, grinding, pressing, foundries and shot-blast was exceeded to threshold limit value(TLV) of noise. 2. Mean concentration of total dust was not exceeded to TLV. 3. Mean concentration of Mn in welding process and Pb in drying, welding, fabricating, rolling was exceeded to TLV. 4. Mean concentration for chemicals and organic solvents were not exceeded to TLV. 5. Mean concentration of dust and heavymetals were statistical significant difference between with local ventilation system and without local ventilation system. Conclusion: Above results, author suggest to prepare more passively control to working environment where exceeded the TLV.

個人所藏 銀製葡萄獸禽文小甁에 관한 硏究

서정호,송현정,김대환 공주대학교 문화재보존과학연구소 2004 문화재과학기술 Vol.3 No.1

銀製葡萄獸禽文小甁 新例는 통일신라의 대표적인 문양으로 구성된 것이며, 그 제작기법이 우수하고 예술성도 뛰어나 금속세공기술 연구에 있어서 중요한 자료이다. 또한 출토사례가 많지 않아 매우 희귀한 예라고 할 수 있다. 이 병은 개인 소장품으로 출토당시부터 어깨부 한쪽이 부식되어 박락되어 있었다. 장기 보존을 위해서나 전시를 위해서는 추가 부식을 방지하기 위한 保存方案이 필요하다. 유물의 내부구조와 상태를 파악한 후에 유물이 최대한 원형을 유지할 수 있도록 적절한 처리가 이루어져야 할 것이다. The new case of Silver Bottle is composed of representative design of Unified Silla, and because the production technique is superior and the artistic as well, it is the important material for the study of metalwork technique. And it is the rare case, for there aren‘t many excavated cases. This bottle is personal possession and one side of shoulder is corroded and exfoliated at the time of excavation. For the long-term preservation or display, conservation method which prevents additional corrosion is needed. After catching the inner structure and state, proper treatment should be done in order that remains can retain its original form.

분자역학적 방법을 이용한 부산시내 대형건물 냉각탑수의 레지오넬라균의 형별 분류

김정만,정석훈,서대영,박은희,송은주,최재철,이은엽,장철훈 대한임상미샐물학회 2004 Annals of clinical microbiology Vol.7 No.1

남성화를 보이는 여성에서 발견된 난소의 Steroid Cell Tumor 1예

조인호,정대훈,박영미,서영진,손영실,정철회,강영미,정수전,김영남,이경복,성문수,김기태 인제대학교 2006 仁濟醫學 Vol.27 No.-

Steroid cell tumor is a rare ovarian sex cord-stromal tumor which accounts for 0.1% of all ovarian tumors. Until now, only 4 cases have been reported in domestic literatures. Steroid cell tumor often secrets testosterone and presents virilization in adult women or precocious puberty in children. Treatment is often performed by surgical removal, adjuvant chemotherapy and radiation, but completely accepted treatment was not existed. We experienced a case of steroid cell tumor, which was manifested by typical virilization in a 43-year old patient, who was previously performed hysterectomy and unilateral oophorectomy. So, we present with a brief review of the literatures.

개심술(開心術)의 임상적 고찰 : 치험 200예 200 Cases

최형호,서홍주,임영혁,김정중,배대양,이석기,임진수 조선대학교 부설 의학연구소 2002 The Medical Journal of Chosun University Vol.27 No.2

Background and Objectives: Two hundred cases of the open heart surgery due to congenital and acquired heart disease were done using the cardiopulmonary bypass in the Department of Thoracic and Cardiovascular surgery, Chosun University Hospital from November, 1980 to June, 2001. Material and Methods: The number of congenital heart disease was 132 cases. 68 cases were acquired heart disease. 'The age of the congenital heart disease was from 22 days to 45 years. In the acquired heart disease, the age was from 14 to 72 years. Result: Congenital heart disease consisted of 113 congenital acyanotic heart disease, 19 congenital cyanotic heart disease. Corrective operation was done for congenital heart disease with 4. 5 % operative mortality. Of 68 cases acquired heart disease, 44 patients were valvular heart disease, 3 cardiac tumors, 9 ischemic heart diseases, 12 aortic dissections and etc. The operative mortality was 13%. Conclusion: The postoperative complications were appeared in 68 cases and the complications were wound infection, occipital alopecia, low cardiac output syndrome, arrhythmia, septicemia etc. The mortality after open heart surgery was 15 cases and the causes of death were low cardiac output syndrome, septicemia, respiratory failure and left ventricle rupture.

하악골에 발생된 Low grade 골육종:증례보고

조현이,정종철,김호성,최재욱,성대경,서지훈,김성범,이계혁 大韓顎顔面成形再建外科學會 2000 Maxillofacial Plastic Reconstructive Surgery Vol.22 No.1

Osteosarcoma is a primary malignant tumor arising most often in the long bone, but rare in jaw bone. Especially osteogenic sarcoma of the mandible is a rare tumor, comprising less than 0.5% of all head and neck tumors. Osteosarcoma occurs cheifly in young persons, and presenting very survival rates. Histopathologically this tumor can be classified three types, osteoblastic, fibroblastic, chondroblastic and classified from low grade to high grade by anaplasia or mitosis of the tumor cells. Sometimes, the exact diagnosis of osteosarcoma is difficult especially in low grade osteosarcoma, even if clinical or radiographical findings suggest to osteosarcoma. So suspcious to malignant bone tumor in clinical or radiological findings, biopsy should be taked from deep portion and multiple area, and sharing the patient history and radiographs with pathologist will assist in the development of the diagnosis. We report a case of low grade osteosarcoma on the mandible initially difficulty in accurate diagnosis. The patient visited our hospital for routine dental treatment but radiographic findings displayed ill-defined radiolucency with osteoid formation on the mandible. Final diagnosis was difficulty in initial biopsy but subsequent biopsy taked from deep portion presented infiltrative growth and mitosis of the tumor cell in some area with small osteoid bone formation, so we could reach final diagnosis as low grade sarcoma. We treated this patient with bloc resection of the mandible and immediate reconstruction with iliac corticocancellous block.

정신분열병 및 정신분열형 장애에 대한 올란자핀의 효과와 안전성

안용민,강대엽,권준수,김창윤,김철응,반건호,신영민,이기철,이동우,이중서,조현상,채정호,김용식 大韓神經精神醫學會 2001 신경정신의학 Vol.40 No.4

연구목적 : 본 다기관 공동임상연구는 국내 환자를 대상으로 새로운 항정신병약물인 올라자핀의 치료 효과와 안전성을 확인하고자 시행되었다. 방 법 : 1999년 7월부터 2000년 3월까지 국내 10개 병원에 방문한 정신분열병 및 정신분열형 장애 105명을 대상으로 비대조 개방 임상연구를 시행하였다. 중등도 이상의 정신병 증상을 지니거나, 부작용으로 약물교체가 필요한 경우 또는 기분장애 증상의 치료가 필요한 환자를 대상으로 하였다. 2∼7일간의 약물 배설기간 후에 1일 10mg의 올란자핀을 투여하였고, 이후로 3∼7일 간격으로 용량을 조절하여 총 8주간 투여하였다. 치료 효과는 PANSS(Positive and Negative Syndrome Scale), BPRS(Brief Psychiatric Rating Scale), CGI(Clinical Global Impression-Severity), MADRS(Montgomery-Asberg Depression Rating Scale), HAM-A(Hamilton Rating Scale for Anxiety)로 판정하였다. 안전성 평가는 자발적인 이상반응 보고, 활력징후와 혈액 검사 및 SAS(Simpson-Angus Scale), BARS(Barnes Akathisia Rating Scale), AIMS(Abnormal Involuntary Movement Scale)척도를 이용하였다. 결 과 : 105명중에서 85.7%인 90명이 8주간의 치료를 완료하였다. 평균 최빈 용량은 일일 16.1(±4.7)mg이었고, 종료시점에서의 BPRS전체 점수가 기저 상태에 비해 40%이상 감소된 반응군은 69.5%이었다. PANSS의 양성 증후군과 일반정신병리 뿐만 아니라 음성 증후군 소척도에서도 유의한 감소를 보였으며, 이 감소들은 치료 초기부터 나타나서 8주간 지속되었다. 43.8%의 피험자가 중등도 이상의 우울증상을 같이 지니고 있었으며, 올란자핀에 의해 MADRS와 HAM-A가 유의하게 감소하였다. 치료 기간 동안에 활력징후에는 뚜렷한 변화가 없었으나 체중은 8주간 지속적으로 증가하였다. SAS와 AIMS는 감소하였으며, 정좌불능증을 제외한 나머지 추체외로 증상의 발생비율도 낮았다. 임상적인 증상이나 징후를 동반하지 않는 ALT/SGPT의 상승을 보였지만 프로락틴을 포함하는 대부분의 혈액 검사상 뚜렷한 이상 변화는 없었다. 결 론 ; 비록 본 임상연구가 비대조 개방 임상연구로서 많은 제한점을 가지고 있지만, 올란자핀이 기존 약물에 내약성을 보이거나 기분증상을 동반하는 정신병에 치료 효과가 있었다. 그리고 기존 항정신병약물 치료시에 문제가 되었던 추체외로 증상과 고프르로락틴 혈증을 포함하는 대부분의 부작용면에서 안전성을 보여 주었다. Objective : This multicenter clinical trial was carried out to investigate the efficacy and the safety of olanzpine for the treatment of Korean patients. Mothod : 105 patients with schizophrenia and schizophreniform disorder, visited at 10 mental or university hospitals, had received an open and non-comparative treatment with olanzapine for 8 weeks. Patients had psychotic or depressive symptoms with the severity above moderate degree or intolerable side effects to previous antipsychotics. After a wash-out period of 2-7 days, 10mg olanzapine was prescribed initially to all the patients, and then the dosage could be adjusted within the range of 5-20mg/day of olanzapine by 3-7 days. Results : 90(85.7%) of 105 patients completed the 8-weeks trial and the mean modal dose of olanzapine was 16.1(±4.7%)mg/day. At the end of the trial, 73 patients(69.5%) were classified as responder, which was defined as 40% or more improvement in BPRS(Brief Psychiatric Rating Scale) score comparing to baseline. There was a significant reduction in the scores of PANSS(Positive and Negative Syndrome Scale)and subscales including negative symptom scores and CGI. Also weekly analysis showed that the reductions in scores were kept on for the whole period of the trial. 43.8% of all the patients had depressive symptoms at the baseline and total scores of MADRS(Montgomery-Asberg Depression Rating Scale) and HAM-A(Hamilton Rating Scale for Anxiety) were also reduced after the trials. Vital signs revealed no clinically significant changes but continuous weight gain was observed during the treatment with olanzapine. The scores of SAS(Simpson-Angus Scale) and AIMS(Abnormal Involuntary Movement Scale) for assessing the EPS(extrapyramidal symptoms)and tardive dyskinesia respectively were significantly decreased and only a few patients reported EPS as adverse events. Although mild and clinically non-significant of ALT/SGPT was observed, most laboratory parameters including plasma prolactin level showed to significant changes during the trial. Conclusions : Although this trial had many limitations because it was a non-comparative and open study, olanzapine showed high efficacy on the positive, negative and depressive symptoms in schizophrenia and schizophreniform disorder.In addition to that, olanzapine showed a substantially favorable safety profile, such as low incidence of EPS and hyperprolactinemia.

서초동(서울시 서초구)의 거미상

김주필(Joo Pil Kim),정혜리(Hye ri Jeong),김대희(Dae Hee Kim),박동우(Dong Woo Park),서재웅(Jae Woong Seo),이현우(Hyun woo Lee) 한국거미연구소 2017 한국거미 Vol.33 No.1

2016년 3월 31일부터 7월 31일까지 서울특별시 서초구 서초동에 위치한 서울고등학교 교정 일대를 서울고등학교 환경생물부 부원들이 채집 조사한 결과 20과 43속 53종의 거미가 조사 연구되어 이에 보고하는 바이다. From March 31st to July 31st in 2016, members of an environmental biology club at Seoul High School located in Seocho-gu, Seoul, Dae-Hee Kim, Dong-Woo Park, Jae-Woong Seo and Hyun-woo Lee, collected 20 families 43 genera 53 species of spiders and report the result of the study here.

고혈압·당뇨병 신규 환자 발견 이후 지역사회 협력을 통한 등록관리가 치료순응도 및 혈압 및 혈당 조절에 미치는 영향

홍두호(Duho Hong),서화정(Hwa-jeong Seo),강경희(Kyoung-hee Kang),김은주(Eun-ju Kim),임정수(Jeong-Soo Im),오대규(Dae-kyu Oh),임준(Jun Yim) 한국농촌의학 지역보건학회 2008 농촌의학·지역보건 Vol.33 No.3

인천광역시의 2개 지방자치단체에서 고혈압과 당뇨병의 관리를 위해 민간의료기관과 함께 만든 만성질환등록관리체계의 효과를 평가하였다. 만성질환등록관리체계에 등록관리가 이루어지고 있는 군이 미등록군에 비해 치료순응도와 혈압 및 혈당의 조절 정도가 좋은지를 평가하였다. 자료분석은 로짓회귀모형을 구축하여 이루어졌고, 다단계 변수 선택법을 사용하여 교차비와 95% 신뢰구간을 구하였다. 연구결과 등록관리군이 미등록군에 비해 치료순응도가 5.5배 높았고, 혈압 및 혈당의 조절이 3.78배 더 잘 되었다. 향후 이러한 효과가 인천광역시 전체 사업으로 확대된 후에도 지속되는지를 평가할 필요가 있다. Objectives : Incheon metropolitan city has set a model program of community partnership for hypertensive or diabetic patients detection and follow-up since 2005. This study examines the effects of the model on the compliance and the control of blood pressure or blood sugar level Methods : Telephone-surveys were done for 140 persons selected from 408 patients who were detected newly as hypertensive or diabetic patients at Gangwha-Gun and Seo-Gu in Incheon between January 1st and August 31th in 2006, and finally completed in 110 patients(78.6%). Survey questionnaires included socio-demographic(age, gender, and educational level), health behavioral (smoking, drinking, physical activity, and diet), and therapy-related (registration state, compliance, blood pressure or blood sugar control) variables. Odds ratio and 95% CI were derived from logistic regression model. Results : Registered group exhibited high compliance and well managed blood pressure or blood sugar level. The odds ratio of registration were 5.55(95% CI:1.83~16.89) for compliance and 3.78(95% CI:1.43~9.99) for blood pressure or blood sugar control after adjusting for age, gender, disease, and area Conclusions : It is independently related to compliance and blood pressure or blood sugar control whether the patient is registered or not. To control hypertension or diabetes mellitus in terms of compliance and control state, a community-based registration program through community partnership could be a powerful tool.