http://chineseinput.net/에서 pinyin(병음)방식으로 중국어를 변환할 수 있습니다.
변환된 중국어를 복사하여 사용하시면 됩니다.
류마티스관절염 환자에서 치골골절로 발생된 복직근초 내 혈종으로 인한 복직근 근괴사 1예
윤형란,유기덕,김윤정,유태석,송순영,전재범 대한류마티스학회 2007 대한류마티스학회지 Vol.14 No.1
Rectus sheath hematoma is an uncommon cause of acute abdomen, caused by a tear in deep epigastric vessels or its branches. It occurs spontaneously, after trauma or surgery. Rectus abdominus myonecrosis is a life threatening complication of rectus sheath hematoma. We report a case with fatal rectus sheath hematoma complicated by rectus abdominus myonecrosis caused by ischial fracture in a chronic active rheumatoid arthritis patient.
류마티스 관절염 치료 시 비스테로이드성 소염제 단독 , 위장관 부작용 예방 약제 병용 투여 및 COX - 2 특이 억제제 사용의 한국 비용 - 효과 분석
윤형란(Hyung Ran Yun),(Michael Corzillius),김성윤(Seong Yoon Kim),배상철(Sang Cheol Bae) 대한내과학회 2001 대한내과학회지 Vol.60 No.6
N/A Background : Nonsteroidal anti-inflammatory drugs (NSAIDs) are used in nearly every patient with rheumatoid arthritis (RA) but their use can be associated with gastrointestinal (GI) side effects, which may be prevented with prophylactic prescription of misoprostol and omeprazole. Recently marketed COX-2 specific inhibitor (COX-2) affords protection against gastropathy. This study was performed to assess Korean cost-effectiveness of NSAIDs, NSAIDs with co-treatments to prevent GI toxicity, and COX-2 in the treatment of RA, and compare it with American cost-effectiveness analysis. Methods : Markov (state-transition) models were used to simulate a cohort of RA patients with approximately 2.5:1 female to male ratio and 50 years, taking disease modifying antirheumatic drugs, low dose steroid (prednisone ≤10 mg/day) and one of the following strategies: 1) NSAIDs without prophylaxis, 2) NSAIDs with misoprostol, 3) NSAIDs with proton pump inhibitor (PPI), or 4) COX-2. Data on incidence, USA cost and consequences of adverse events from treatments were taken from the literature. Treatment costs of adverse events in Korea were calculated based on each disease code. Health effects were expressed as quality-adjusted life years (QALYs). Sensitivity analyses of probability of GI complication and cost were performed. Costs and health outcomes were discounted at a rate of 3% per year. Results : Among the strategies to prevent GI toxicity, PPI was the most cost-effective strategy in Korea and COX-2 was in USA, respectively. The incremental C/E (cost/effectiveness) ratio between PPI and no prophylaxis was 38,068×103₩/QALY (32,044$/QALY) in Korea. The incremental
류마티스 관절염과 전신성 홍반성 루푸스가 공존하는 Rhupus 증후군의 임상적 고찰
윤형란 ( Hyung Ran Yun ),전재범 ( Jae Bum Jun ),이명호 ( Myong Ho Lee ),이혜순 ( Hye Soon Lee ),이지현 ( Ji Hyun Lee ),김태환 ( Tae Hwan Kim ),정성수 ( Sung Soo Jung ),이인홍 ( In Hong Lee ),배상철 ( Sang Cheol Bae ),유대현 ( Dae 대한류마티스학회 1999 대한류마티스학회지 Vol.6 No.4
Objective: This study was designed to evaluate clinical features of 20 patients with rhupus syndrome and compare its characteristics with systemic lupus erythematosus(SLE) and rheumatoid arthritis(RA). Methods: Patients considered to have rhupus who met the American College of Rheumatology(ACR) 1997 and 1987 revised criteria for SLE and RA, respectively and age, sex, and disease duration matched 64 patients with RA and 56 patients with SLE were selected for comparison. Results: Twenty patients were all female and their mean age was 43.7±9.6 years (range 25~68). They had 5.5 ACR criteria for RA and 5 criteria for SLE. The mean age at onset of RA was 35.2±10.5 years(19~63) and that of SLE was 38.2±10.0 years(20~63), giving a mean interval between the diagnoses of the two diseases of 3.0±5.7 years (14~(-6)). There were 2 patients(10%) with rheumatoid nodule, and 18 patients(90%) with rheumatoid factor, and 16 patients(80%) with bony erosions on hand or wrist joints. The criteria for SLE included malar rash(20%), discoid rash(0%), photosensitivity(30%), oral ulcer(45%), arthritis(100%), serositis(35%), renal disorder(15%), neurologic disorder(0%), hematologic disorder(100%), immunologic disorder(90%), and positive antinuclear antibody(100%). Anti-dsDNA was more than 7.0U/ml in 15 patients(75%). The patients with rhupus syndrome showed lower amount of 24 hour urine protein, more severe radiologic involvement, younger age at onset of arthritis, higher titer of rheumatoid factor, lower frequency of low C3, and less complicated clinical course when compared with the patients with SLE(p<0.05). More frequent anemia, Rayanud`s phenomenon, and more complicated clinical course in rhupus when compared with the patients with RA(p<0.05), but the radiologic stage of hand and wrist was similar between rhupus and RA. Conclusion: Rhupus syndrome showed something different clinical characteristics and clinical course when compared with SLE and RA.
역류성 식도염 치료에 대한 양자펌프억제제와 ranitidine 사용의 비용 - 효과 분석
윤형란(Hyung Ran Yun),정훈용(Hwoon Yong Jung),박효진(Hyo Jin Park),배상철(Sang Cheol Bae) 대한내과학회 2002 대한내과학회지 Vol.62 No.5
목적: 역류성 식도염은 만성적인 경과를 보이는 비교적 흔한 질환 중의 하나로, 치료를 위해 산 분비 억제제인 H2-수용체 길항제가 사용되었으나 염증이 심한 경우에는 그 효과가 만족스럽지 못하고 재발의 빈도가 높아 강한 산 분비 억제작용을 갖는 양자펌프억제제 (proton pump inhibitors, PPI)가 사용되고 있다. 이에 저자들은 우리나라 현 의료 환경에서 역류성 식도염 치료에 PPI와 H2-수용체 길항제를 사용한 경우, 1예를 완치하는데 소요되는 비용과 decision analytic model을 이용하여 사회학적인 관점에서 비용-효과 분석을 시행하였다. 방법: 역류성 식도염 환자 1예를 완치시키는데 소요되는 1년간의 비용을 비교하기 위해 PPI와 라니티딘으로 8주간 초치료 후 절반 용량으로 12주간 유지요법을 시행한 경우의 총 소요되는 비용을 계산하였다. 대상 환자는 Markov (state transition) 모델을 사용하여 역류성 식도염 코호트를 가정하였다. 이 코호트의 모든 환자는 1. 하루 20 mg의 PPI 2. 하루 300 mg의 라니티딘 투여 중 한 가지의 치료를 받고 약제에 대한 반응에 따라 상태가 변화하는 것으로 가정하였고, 치료 시작 후 5년 간 관찰하는 것으로 가정하였다. Markov state의 결과는 1) 치료 후 역류성 식도염의 증상이 없는 상태 2) 유지 요법 후 재발한 상태 3) 고용량 (하루 40 mg의 PPI, 600 mg 라니티딘)의 약제나 위장관운동촉진제 병용 치료에 호전되었다가 유지요법 후 재발한 상태 4) 고용량의 약제나 위장관운동촉진제 병용 치료에 호전되지 않아 더 이상의 치료를 하지 않는 상태 5) 수술 후 호전된 상태 6) 수술 후에도 증상이 지속되는 상태 7) 수술로 인한 사망 등으로 하였다. 모델에서 사용한 자료는 1966년부터 2001년까지의 MEDLINE을 이용한 의학 문헌의 면밀한 검토에 기초하였다. 비용은 직접 의료 비용을 사용하였고, 건강에 미치는 영향은 질보정수명 (Quality-adjusted life years, QALYs)으로 표시하였고 할인율은 3%를 적 용하였다. 각 치료 방법의 부작용 빈도의 범위와 가격, 할인율, 의료비, 효용 등에 대한 민감도 분석을 시행하였다. 결과: 역류성 식도염 1예 완치에 소요되는 연평균 비용은 PPI를 초치료로 사용한 경우 475,836원, 라니티딘을 초치료로 사용한 경우는 1,064,704원이다. 기본 분석에서 QALYs는 PPI 4.81, 라니티딘 4.26이었고, 가격은 PPI 155,238원, 라니티딘 214,781원이었다. 결과적으로 라니티딘은 PPI보다 가격도 비싸고 QALYs도 낮아, 역류성 식도염 치료에서 PPI가 라니티딘 보다 우월한 치료법이다. 결론: 한국의 의료 환경에서 역류성 식도염의 치료에 PPI가 라니티딘에 비해 비용-효과적이므로 역류성 식도염의 치료에 PPI를 사용하는 것이 한정된 의료자원을 효과적으로 사용하는 방법일 것으로 생각된다. Background: The aim of this study was to compare the cost-effectiveness of proton pump inhibitors (PPI) and ranitidine in gastroesophageal reflux disease (GERD) in Korea. Methods: We assessed the cost-effectiveness two ways. First, mean costs for the complete healing of one patient with GERD within one year were calculated. Second, Markov (state-transition) models were used to simulate a cohort of patients with GERD, taking one of following strategies for 5 years:1) PPI (rabeprazole 10 mg, omeprazole20 mg, or lansoprazole 30mg), 2) ranitidine 300mg per day. Data on healing rate, relapse rate, surgical complication rate, success rate of surgery were taken from the literature. Direct medical costs of each strategy and surgical complications were calculated. Health effects were expressed as quality-adjusted life years (QALYs). Sensitivity analyses using various ranges of probability of healing rates and costs were performed. Costs and health outcomes were discounted at a rate of 3% per year. Results: The mean costs for complete healing of one case within one year was ₩475,836 in PPI and ₩1,064,704 in ranitidine, respectively. In the base case analysis using Markov model, the treatment costs of PPI were ₩155,238 and ₩214,781 in ranitidine and the effects were 4.81 QALYs and 4.26 QALYs, respectively; PPI strategy was more effective and less costly than ranitidine strategy. The sensitivity analyses using varying ranges of probability, cost, discount rate and utility were robust. Conclusion: PPI was superior to ranitidine in terms of cost-effectiveness in the treatment of GERD.(Korean J Med 62:504-512, 2002)
약물 중독 시 위 세척에 의한 산 - 염기 평형 및 전해질의 변화
윤형란(Hyung Ran Yun),손동현(Dong Hyun Sohn),이창범(Chang Bum Lee),이재웅(Jae Woong Lee),양석철(Suck Chul Yang),한동수(Dong Soo Han),손주현(Ju Hyun Sohn),김순길(Soon Kil Kim),김호중(Ho Jung Kim) 대한내과학회 1998 대한내과학회지 Vol.54 No.4
N/A Objectives: There is little information on the imbalance of electrolyte and acid-base metabolism associated with gastric lavage in acute drug intoxication patients. This study was aimed to analyze the acid-base and electrolyte abnormalities associated with gastric lavage in acute drug intoxication patients. Methods: We studied 24 acute drug intoxication patients who had performed gastric lavage with 10 liters of 0.9% NaC1. Electrolyte parameters and arterial blood gas analysis were carried out before and after gastric lavage. Results: After gastric lavage, acidosis was reduced in general. But there was no significant change in pH (7.34±0.02 vs. 7.38±0.15, p=NS). In acid-base balance, the mixed form of metabolic acidosis and respiratory acidosis was reduced from 7 to 2 cases, and the simple form of respiratory acidosis was reduced from 3 to 1 case. In contrast, normal form was increased from 5 to 7 cases and the simple form of metabolic acidosis was increased from 2 to 6 cases. In electrolyte parameters, serum sodium was reduced significantly (145±1.0 mEq/L vs. 141±0.8 mEq/L, p<0.01), but there was no case of significant hyponatremia (<135mEq/L). Bicarbonate level (20±1.1 mEq/L vs. 22±0.9 mEq/L, p< 0.05) and anion gap (19±1.6 mB vs. 13±1.3 mEq/L, p< 0.01) showed significant change. But, blood levels of potassium (3.6±0.1 mEq/L vs. 3.8±0.1 mEq/L, p=NS), chloride (106±0.6 mEq/L vs. 106±0.6 mEq/L, p=NS) and F'aCO2 (36±1.mmHg vs. 37±1.5 mmHg, p=NS) were no significant change before and after gastric lavage. Conclusions: Gastric lavage with 10 liters of 0.9% NaC1 in acute drug intoxication patients did not show clinically significant changes in electrolytes and acid-base balance.
윤형란 ( Hyun Ran Yun ),정성수 ( Sung Soo Jung ),고희관 ( Hee Kwan Koh ),유태석 ( Tae Seok Yoo ),이제경 ( Je Kyung Lee ),황관표 ( Kwan Pyo Hong ),김태환 ( Tae Hwan Kim ),전재범 ( Jae Bum Jun ),이인홍 ( In Hong Lee ),배상철 ( Sang 대한류마티스학회 1997 대한류마티스학회지 Vol.4 No.2
SAPHO(synovitis, acne, pustulosis, hyperostosis, osteitis) syndrome designates a group of articular and osseous manifestations frequently combined with skin disorders. It`s fundamental component is inflammatory, pseudoinfectious, and sterile osteitis. The anterior chest wall is the most frequent localization and all the components of this structure may be involved. Palmoplantar pustulosis, psoriasis, acne conglobata, acne ulcerans, acne fulminans, pyoderma gangrenosum can be associated with the characteristic bone lesions. We report two cases of SAPHO syndrome: A 40-year-old female presented with both buttock pain with hyperostosis, costochondritis, synovitis and pustulosis palmaris and a 23-year-old male presented with migrating polyarthritis with costochondritis, synovitis, acne, Pustulosis.