초극소 저체중 출생아에서의 저알부민혈증

목적: 본 연구에서는 초극소 저체중 출생아에서 저알부민혈증의 발생 및 임상 양상을 조사하여 사망률을 비롯한 예후와의 관련성을 확인하고 알부민 투여의 효과를 평가하고자 한다. 방법: 2008년 1월부터 2012년 12월까지 본원 신생아 중환자실에 입원한 1.000 g 미만의 초극소 저체중 출생아 83명을 대상으로 의무기록을 후향적으로 조사하였다. 혈중 알부민 2.5 g/dL 이상(정상 알부민혈증, n=42)과 2.5 g/dL 미만(저알부민혈증, n=41)인 두 군으로 나누어 임상적 특징을 조사하였고, 저알부민혈증군을 알부민을 투여한 군(n=36)과 투여하지 않은 군(n=5)으로 나누어 임상적 특징과 알부민 투여 후 예후를 조사하였다. 결과: 총 83명의 초극소 저체중 출생아 중에서 41명이 저알부민혈증군으로 분류되었다. 저알부민혈증과 관련된 임상적 상태로 동맥관개존증은 19.5%, 뇌실 내 출혈(≥grade III)은 4.9%, 괴사성 장염(≥stage IIa)은 46.3%, 폐렴은 4.9%, 패혈증은 24.4% 였다. 단변수 분석에서 저알부민혈증군과 정상 알부민혈증군에서 재태연령(26+6±2+1 vs. 26+0±1+5,P=0.045)과 출생체중(868±117 vs. 783±121, P=0.002)의 유의한 차이가 있었으나, 동맥관개존증, 뇌실 내 출혈, 괴사성장염, 기관지폐 이형성증 등의 주요 합병증 및 사망률의 차이는 유의한 차이가 없었다. 다변수 로지스틱 회귀분석에서는 어린 출생체중이 유일하게 저알부민혈증과 연관된 인자로 밝혀졌다(OR .995, 95% CI .990-.999, P=.019). 저알부민혈증군에서 알부민 투여 여부가 사망률(47.2% vs. 0%, P=0.065)을 비롯한 예후에 영향을 미 치치는 않았다. 결론: 초극소 저체중 출생아에서 저알부민혈증군과 정상 알부민혈증군 사이에 합병증 및 사망률은 차이가 없었다. 다만, 저알부민혈증과 관련한 유일한 인자는 작은 출생체중이 있었다. 또한 저알부민혈증에서 알부민 투여의 여부에 따른 합병증 및 사망율에 차이는 없었다.Purpose: We investigated the incidence and clinical course of hypoalbuminemia and identified relevance of prognosis including mortality in extremely low birth weight infants (ELBWIs). Also, we assessed the efficacy of intravenous albumin infusion. Methods: A retrospective study including 83 preterm infants <1,000 g of birth weight who were admitted to Ajou university hospital`s neonatal intensive care unit from January 2008 to December 2012 was performed. Patients were divided into the normoalbuminemia (≥2.5 g/dL serum albumin, n=42) group and the hypoalbuminemia (<2.5 g/dL serum albumin, n=41) group, and also the hypoalbuminemia group were subdividedinto the intravenousalbumin infusion group (n=36) and the control group (n=5). Results: Of those 83 ELBWIs, 41 infants (49.4%) were classified as the hypoalbuminemia group. Associated conditions with hypoalbuminemia were patent ductus arteriosus (PDA, 19.5%), intraventricular hemorrhage(IVH, ≥grade III, 4.9%), necrotizing enterocolitis (NEC, ≥stage IIa, 46.3%), pneumonia (4.9%), sepsis (24.4%). Inunivariate analysis, there were no statistically significant differences in major morbidities such as PDA, IVH, NEC, bronchopulmonary dysplasia and mortality between the normoalbuminemia and the hypoalbuminemia groups except gestational age (26+6±2+1 vs. 26+0±1+5, P =0.045) and birth weight (868±117 vs. 783±121,P =0.002). In multivariate logistic regression, birth weight is the only meaningful factor associated with hypoalbuminemia(OR .995, 95% CI .990-.999, P =0.019). The mortality (47.2% vs. 0%, P =0.065) and morbidities did not differ between the intravenous albumin infusion and the control group. Conclusion: In ELBWIs, there were no significant differences in major morbidities and mortality between thehypoalbuminemia and the normoalbuminemia groups. The lower birth weight is the only factor associated with hypoalbuminemia. In addition, major morbidities and mortality rate were not affected by the albumin infusion

수동피부아나필락시스 시험, immunoblot, 식품알레르기 생쥐모델에 의한 난백 처리물의 알레르기성 평가

난백의 알레르겐을 감소시키기 위해서 여러 가지 처리를 실시하고 처리난백의 알레르기성의 변화를 평가하고자 passive cutaneous anaphylaxis(PCA) test, immunoblot, 생쥐모델에 의한 알레르기 유발시험을 실시하였다. PCA test결과 열처리(121oC, 30 min)한 난백은 처리하지 않은 난백에 비하여 그 항원성이 1/8 정도로 감소되었으며, NaOH처리군은 0.3%와 1%에서 각각 1/4, 1/8로 항원성의 감소를 보였다. 특히, NaOH처리 후 열처리(70oC, 15 min)를 추가적으로 복합처리한 난백의 경우, NaOH 0.3%(w/v)에서는 1/8 정도로, NaOH 1%(w/v)에서는 1/32 정도로 강력하게 항원성이 감소 되었다. 계란 알레르기 환자의 IgE 항체를 이용하여 immunoblot을 실시한 결과 121oC로 열처리한 시료에서 난백의 주요 단백질 band가 흐려지는 것으로 나타났고 NaOH와 열로 복합처리한 난백의 경우에도 NaOH 0.1%(w/v) 이상에서 band들이 대부분 소실되는 것으로 나타났다. 생쥐모델에 의한 시험을 실시한 결과, 난백으로 유도한 전신알레르기 증상의 평균점수는 1.85이었으나 복합처리한 난백의 경우 그 점수가 0.20로 현격하게 감소되었다. 결론적으로, 상기 3종의 시험에서 공통적으로 가장 효과적인 난백의 알레르기성 저감화 방법은 복합처리(NaOH(1%, w/v) 및 열(70oC, 15min))임이 확인되었다.The allergenicity of treated chicken egg whites (EW) was evaluated by a passive cutaneous anaphylaxis (PCA) test, immunoblot analysis, and a mouse model of food anaphylaxis. The results of the PCA test revealed that treatment with 0.3% NaOH (w/v) decreased the antigenicity of native EW to 1/4. In addition, treatment with heat (121oC, 30 min) or 1% NaOH (w/v) decreased the antigenicity to 1/8 and combined treatment with 1% NaOH (w/v) and heat (70oC, 15 min) decreased the antigenicity to 1/32 of that of the native EW. Immunoblot analysis revealed that the density of EW protein bands decreased in response to heat treatment, and were almost not detectable following the combined treatment. Finally, the murine model of EW anaphylaxis revealed that the mean score of systemic anaphylactic symptoms in EW challenged mice was 1.85, while the mean score in mice challenged with EW that that had been subjected to the combined treatment was only 0.20. The results of this study indicate that the most effective method of reducing EW allergenicity is combined treatment with 1% NaOH (w/v) and heat (70oC, 15 min)

급성호흡부전를 유발한 거대 흉골하 갑상선종 1예

Substernal goiter is defined as a thyroid mass of which more than half is located below the thoracic inlet. As substernal goiter enlarges within the bony thoracic cavity, and vascular and visceral structures may slowly become compressed and compromised. Airway obstruction can occur due to the compression or the displacement of the trachea. Tracheal compression may rarely lead to severe respiratory compromise. Recently, we experienced a case of huge substernal goiter causing acute respiratory failure in a 63-year old female. We present this case with a review of the literature

뇌농양 환자에서 전신마취 유도 동안 발견된 결핵성 기관지식도루

We report a case of bronchoesophageal fistula detected during induction of general anesthesia in brain abscess patient. Bubbling sound at substernal area and gas bubble at oral cavity during manually assisted mask ventilation, especially inspiration, were detected. Barium esophagography, gastroscopy and bronchoscophy were performed to know the nature of fistula after neurosurgical operation. The patient had a bronchoesophageal fistula due to unproperly treated old pulmonary tuberculosis. Esophageal opening of fistula located at midesophagus about 27 cm distance from incisor, while bronchial opening located at apical segment of right superior bronchus. It depends on the size, location, and duration of fistula to manifest clinical symptom. In bronchoesophageal fistula, the size of opening tends to be small and gradual symptom onset while relatively large and early in TEF. Therefore, knowledge of the differences of two types of fistula are essential to manage the patient who have these types of fistula

급성 및 아급성 골다공증성 척추 골절의 자기공명영상 유형

Study Design: This is a retrospective radiologic study Objectives: The aim of this study is to analyze the signals and configurations of the MRI findings of osteoporotic vertebral fractures and the clinical consequences of each type of the MRI findings. Summary of Literature Review: There have been some reports that have focused on the MR findings for the differentiation of osteoporotic and metastatic fractures, but there are few reports on the characteristics of the early stage of osteoporotic vertebral fractures. Materials and Methods : From July 2002 to April 2008, the MRI findings and medical records of 97 patients who were diagnosed with acute or subacute osteoporotic vertebral fractures and who were followed-up for more than 1 year were analyzed. The patients with minor trauma within 3 months before obtaining MRIs and they had decreased bone density were included in this study. Those with fractures due to severe trauma or pathologic causes or normal bone density were excluded. Three spine surgeons evaluated, at three times per each surgeon, the T1-weighted, T2-weighted and fat suppression T1-enhanced sagittal images for the signal of the vertebral body bone marrow and the type of the intravertebral body lesion shape. The relationships between the type of MRI findings and the time from the trauma and the follow up clinical consequences were analyzed. Results: The MRI patterns of 97 patients with 111 fractures of the vertebrae were divided into three types. There were 56 cases of Type I (50.5%), which was defined as diffuse typical signal intensity in the vertebral body, 39 cases (35.1%) of Type II, which was defined as geographic low signal in the center of the vertebral body with typical signal changes, and 16 cases (14.4%). of type III, which was defined as atypical signal intensity or a shape of lesion that did not correspond to type 1 nor type 2. The average time from trauma was 10.8±19.0days (0~90) for type I, 19.1±24.9days (0~90) for type III and 37.5±31.1days (0~90) for type III, which showed differences among each types (p<0.001). Conclusions: The analysis of the relationship between the time from trauma and the signal intensity and the type of lesion on MRI examination revealed that the low signal intensity in the typical vertebral body signal or an atypical signal or shape were poor prognostic factors of osteoporotic vertebral fracture.연구계획: 후향적 방사선학 연구 연구목적: 골다공증성 척추골절의 수상 시간에 따른 자기공명영상의 신호 및 형태 양상을 분석하고 각 유형에 따른 임상적 결과를 알아보고자 하였다. 대상 및 방법: 2002년 7월부터 2008년 4월까지 흉추나 요추의 급성 또는 아급성 골다공증성 척추 골절로 진단되어 치료 받고, 1년 이상 추시된 환자 97명의 자기공명영상과 의무기록을 분석하였다. 자기공명영상을 시행하기 전 3개 월 이내의 경미한 외상력이 있으며, 골밀도 검사상 골밀도 감소 소견을 보이는 환자들을 포함하였다. 낙상이나 교통 사고 등 심한 외상에 의한 골절이나 종양 및 감염에 의한 병적 골절, 골밀도 검사상 정상인 환자들은 제외하였으며, 수상기간이 3개월 이상이거나 불유합, 진구성 골절 등은 제외하였다. 세 명의 척추 전임의가 각각 독립적으로 세번 씩 대상 환자들의 T1WI, T2WI 및 지방 억제 T1-조영 시상면 영상을 이용하여 척추체의 골수 신호 및 골절 추체내 병 변부 형태에 따른 유형을 분류하고, 각 유형에 따른 수상시간, 추시 결과를 분석하였다. 결과: 총 97명 환자에서 111례의 골절 척추체를 분석하여 세 유형으로 분류하였다. I형은 전형적 신호 강도가 추체내 미만성으로 나타나는 경우로 56례(50.5%)가 이에 해당하였으며, II형은 지방 억제 T1-조영 시상면 영상에서 전형적 추체 신호 강도 내에 중심부에 국소적(geographic)으로 저신호를 보이는 경우로 39례(35.1%)가 해당되었다. III형은 신호 강도나 골절부 형태가 I형이나 II형에 해당하지 않는 경우로 16례(14.4%)가 해당되었다. 수상일로부터 I형의 평 균 수상 시간은 10.8±19.0일(0~90), II형은 19.1±24.9일(0~90), III형은 37.5±31.1일(0~90)로서 각 유형간에 수상 시 간의 차이를 나타내었다(p<0.001). 추시된 증례 분석에서 I형은 94.3%에서 만족스런 임상 결과 및 유합을 보였으며, II형과 III형은 불유합이나 통증의 악화로 추체성형술을 시행한 빈도가 높았다. 결론: 골다공증성 척추골절의 수상 시간에 따른 자기공명영상의 신호 및 형태 양상을 분석한 결과, 지방 억제 T1-조 영 시상면 영상에서 추체 부종 신호 내에 국소적 저신호 강도를 보이는 경우나 비전형적 신호 및 형태를 보이는 경우 예후가 불량하였다

건강검진에서 증가된 전립선특이항원(PSA)의 임상적 의의

Background : As prostate cancer in men is increasing in Korea, the need for early detection by mass screening has become an important issue. Screening tests for early detection of prostate cancer are digital rectal examination, transrectal ultrasonography (TRUS) and prostate specific antigen (PSA) test. PSA test has been mainly used for prostate cancer screening in health promotion centers. However, PSA has a high sensitivity but low specificity. Therefore, PSA concentration can be increased not only in prostate cancer, but also in several benign prostate diseases such as benign prostate hyperplasia (BPH), prostatitis, and prostate ischemia. Also, PSA concentration can increase in the elderly. Therefore, we investigated the results of follow-up PSA tests, in the cases of increased PSA concentration on screening. Methods : In 538 cases, the PSA concentration were increased over 2.5 ng/ml among total 17,302 males checked up on screening test at Ajou University Hospital from January 1999 to December 2001. Two hundred and four cases followed up with TRUS or prostate biopsy were chosen. We investigated 89 cases who performed follow- up PSA test. On the basis of the results of biopsy or TRUS, the subjects were classified into non-disease group, benign prostate disease group and prostate cancer group (possible or confirmed prostate cancer group). Results : The mean age of non-disease group was 35.5 5.9 years, which was significantly lower than that of benign prostate disease group and prostate cancer group (P＜0.05). Compared to the mean age of prostate cancer group (60.6 10.4 years) and non-prostate cancer group (53.1 12.3 years), prostate cancer group was significantly older than non prostate cancer group (P=0.005). When the lower limit of age was set to 40 years (mean-2SD), confirmed prostate cancer group was significantly older than other groups (p＜0.001). The PSA concentration of confirmed prostate cancer group (11.33 7.58 ng/ml) was significantly higher than that of non-prostate disease group (4.35 2.22 ng/ml) and possible prostate cancer group (4.44 2.29 ng/ml) (P＜0.05). The follow-up PSA level of confirmed prostate cancer group (10.13 6.13 ng/ml) was significantly higher than that of non-prostate disease group (2.55 0.97 ng/ml), BPH group (4.33 3.80 ng/ml), prostatitis group (3.61 2.17 ng/ml), prostate cyst group (3.00 1.86 ng/ml) and possible prostate cancer group (3.81 2.82 ng/ml) (P＜0.05). Conclusion : It is recommended that screening test for prostate cancer be performed after the age of 40. While follow-up PSA test is needed when the PSA is increased up to less than 10 ng/ml, prostate biopsy may be desired in the PSA value of 10.0 ng/ml or greater

고지혈증 환자에서 Atorvastatin (Lipitor±)의 혈청지질 강하 효과

Background : Recently, the incidence of cardiovascular diseases has increased in Korea. Hypercho-lesterolemia is a major risk factor for cardiovascular diseases. Atorvastatin (Lipitor±) is prescribed for the treatment of hyperlipidemia in Korea, but its effect has not been studied. Therefore, we investigated the lipid lowering effect of atorvastatin in Koreans. Methods : This study included 82 hypercholesterolemic patients who visited the Department of Family Practice of Ajou University Hospital from January 1, 2000 to December 31, 2001. The mean age of the subjects was 47.8 years in the range of 27 to 66 years. Our study included 41 controls and 41 subjects who were administered atorvastatin 20 mg daily for 3 months. Fasting serum lipid levels were measured at baseline and at 3 months. Specific dietary and exercise interventions were not instructed. Results : At 3 months, the serum total cholesterol and LDL were significantly lower in atorvastatin group than in the control group (Total cholesterol; -5.5±16.7%, vs 25.5±15.8%, P＜0.05, LDL cholesterol; 1.4±28.5%, vs -30.1±28.9%, P＜0.05). The serum triglyceride in atorvastain group showed no significant difference relative to the controls (Control: -5.8±34.2%, Atorvastatin: -3.5±54.8%, P=0.81). But, Serum triglyceride level decreased by -14.3±33.2% in the control and -39.0±23.2% in the atorvastatin group among the patients whose baseline triglyceride level was over 200 mg/dl (P＜0.05). There was no significant differences in HDL-cholesterol (Control: 3.0±22.6%, Atorvastatin: -0.9±18.8%, P=0.38). The effect of atorvastatin was not influenced by age, sex, BMI and other risk factors. Conclusion : Atorvastatin lowered significantly the serum total cholesterol, LDL and triglycerides in Korea. Regardless of age, sex, BMI, but had no effect on HDL level

전신마취 동안 Solar 8000M®의 Tram 800SL 모듈로 측정한 비침습적 진동식 혈압과 AutoTransducer®의 AMK 250으로 측정한 침습적 동맥혈압의 일치도 평가

Background: Blood pressure (BP) varies considerably during general anesthesia. Accurate BP measurement is critical for appropriate treatment, especially during hypotension and hypertension. Here we evaluated whether the noninvasive oscillometric BP measurement technique accurately reflects BP measured by the direct intraarterial technique. Methods: A total of 256 samples were extracted from 10 patients operated on under general anesthesia. Systolic, diastolic and mean BP were analyzed according to the level of BP; hypotension, normotension, and hypertension. Repeatability of the noninvasive BP measurement were analyzed with repeatability coefficients and percent errors. Agreement between the two BP measurements were analyzed with a Bland-Altman and Modified Bland-Altman analysis. Results: The repeatability coefficient for mean BP of the noninvasive oscillometric BP measurement was 6.34. Percent errors of mean BP were smaller than those of systolic and diastolic BP. All biases were less than 5 mmHg at all BP levels. Most BP agreements were larger than 8 mmHg except all-range mean BP (7.7), hypotensive diastolic BP (6.7), and mean BP (6.2). During hypotension, only mean BP was within the 95% of confidence interval (CI) of bias and limit of agreement. During hypertension, only systolic BP could meet the criteria. Conclusions: Only mean BP during hypotension and systolic BP during hypertension accurately reflect the direct intraarterial BP. But, diastolic BP does not reflect the direct intraarterial BP over all BPs

에피테제를 이용한 인공이개 재건 2예

One of the most common uses of osseointegration has been to supply patients with craniofacial defects with a bone-anchored epitheses (BAE). BAEs are usually used in the craniofacial defects such as congenital external ear anomalies or facial defects after cancer surgeries or trauma. We report a case of a 26 year-old woman with traumatic auricular amputation due to a traffic accident 4 years ago and a case of 23 year-old man with congenital ear deformity. They took osseointegrated implantations for an auricular prosthesis and are using it without complications. BAEs can be used with good functional and esthetic outcome for artificial auricular reconstruction

군 병사들에서 인터넷 중독 경향에 따른 입대 후 심리특성 변화

Objectives : The aim of this study was to find out the psychological changes associated with internet addiction between before and after the military drill among the young male army recruits. Methods : All 1091 participants were army recruits aged from 19 to 22 years who participated in the 5-week military drill. They were assessed with some self-reported questionnaires [Sociodemographic questionnaires, Young's Internet Addiction Scale (IAS), the State-Trait Anxiety Inventory (STAI), the Beck Depression Inventory (BDI), the Barratt Impulsiveness Scale (BIS), the Attention-Deficit/Hyperactivity Disorder Self-Rated Scale (ASRS)]. They were divided into two groups, One is the internet addiction tendency group and the other is non-addiction group according to the IAS score. And the severity of the internet addiction tendency, depression, anxiety and impulsiveness were evaluated by the IAS, the STAI, the BDI, the BIS, the ASRS before and after military drill. Results : The result of the paired t-test shows that the IAS, the STAI, the BDI, the BIS, the ASRS scores decreased after military drill in both non-addiction group and internet addiction tendency group. The result of the repeated measures ANOVA shows that there is an interaction effect between the changes of ASRS-hyperactivity (F = 23.437, p < 0.001), ASRS-impulsiveness (F = 4.896, p = 0.027), BIS-total (F = 4.057, p = 0.044), BIS-motor impulsiveness (F = 13.609, p < 0.001) scores and groups. The result of the generalized estimating equation shows that internet addiction tendency is associated with ASRS-inattention (β = 0.075, p < 0.001), ASRS-hyperactivity (β = 0.092, p = 0.002), STAI-trait anxiety (β = 0.046, p < 0.001), BIS-motor impulsiveness (β = 0.119, p = 0.028). Conclusions : The results show that psychopathologies such as internet addiction tendency, depression, anxiety, impulsiveness may improve after military drill regardless of the groups. Internet addiction tendency may be related to the ASRS-inattention, ASRS-hyperactivity, STAI-trait anxiety, motor-impulsiveness. So these findings may be considered in the treatment of internet addiction in terms of the impulsiveness control