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당질코르티코이드성 골다공증 환자의 골절의 Paradox 와 부갑상선 호르몬의 특징적 변화
이창범(Chang Beom Lee),백인규(In Kyu Baik),고희관(Hee Kwan Koh),이동석(Dong Suk Lee),이창화(Chang Hwa Lee),문두섭(Du Sup Moon),박용수(Yong Soo Park),최웅환(Woong Hwan Choi),김태화(Tae Wha Kim),안유헌(You Hern Ahn),김묵현(Mok Hyun Kim 대한내과학회 1996 대한내과학회지 Vol.50 No.5
N/A Objectives: The authors studied the relationship between patients who had fractures due to glucocorticoid induced osteoporosis and their conventionally measured bone mineral density. We also studied the charicteristic changes of parathyroid hormone in glucocorticoid induced osteoporosis. Methods: We analyzed 354patients with osteoporosis who had been taking Triamcinolone in doses greater than 2mg per day for 6months or more. BMD was measured by QCT and the fractures were diagnosed by lateral CT films. We measured the intact parathyroid hormone(intact PTH) by IRMA (Immunoradiometric assay). Results: In patients whose BMD measured 10 -69mg/Cm3, 35-80% had fractures. Patients with BMD in the range of 70-89mg/Cm3 showed a decreased percentage of fractures, while those with BMD over 140mg/Cm3 revealed an still remained percentage of fractures. The intact PTH averaged 42.3pg/ml in the 7th decade, 443pg/ml in the 8th decade, and 40.2pg/ml in the 9th decade. We couldn't find an increased level of intact PTH with aging. Patients with increased intact PTH levels of 90-99pg/ml and 110-119pg/ml, showed normal alkaline phosphatase levels of 77.7U/L and 66.0U/L respectively. We found one patient in the 5th decade, four in the 6th decade and three in the 7th decade, whose BMD according to their age was above normal range although their intact PTH levels were also above normal. Conclusion This study reveals that the BMD of trabecular vertebra measured by conventional QCT cannot show the histomorphometric stucture of the bone which is a major determining factor of in fractures. And the authors suggest that intact PTH donot increase in age dependant type II osteoporosis even when the patients were on glucocorticoids.
Coproporphyrin 簡易 定量法의 改善에 關한 硏究
李昌和,宋東彬,車喆煥 고려대학교 의과대학 1984 고려대 의대 잡지 Vol.21 No.1
Rimington (1971) developed a satisfactory method for quantitative determination of urinary coproporphyrin (CP), which is essentially needed for diagnosis of lead poisoning in suspected persons. But it is found to be unsuitable for a mass screening because it is Iaborious and complex in its procedures. Soulsby (1974) modified the method into a simple and convenient one by reducing the steps in extraction procedure. In spite of its simplicity and usefulness for screening purpose, aythor experienced that CP determination by the method was inconsistent and erroneous. Thus, it was not satisfactory and acceptable if accurate determination of CP is needed as in screening test for lead poisoning. The present study was performed to find a simple and accurate method that is applicable for the quantitative determination and mass screening by modifying Soulsby’s method. The results were as follows: 1. The amount of CP extracted with diethylether was shown to be highly dependent on urine pH, when extraction was performed one time instead of three times. The optimal pH was 5.4 where 98% of CP was recovered with one time extraction. 2. When the diethylether layer was washed with distilled water, it was possible to avoid interference in UV-spectrophotometry caused by contaminated organic materials. 3. With modification as above, average recovery rate of CP from urine was 99.5% with a coefficient of variance 2.1% on vaiidity test. 4. The results suggested that Soulsby’s method can be improved to a method with both simplicity and accuracy by simple modifications, i.e., one time extraction with adjusting the urine pH to 5.4 and washing the diethylether later containing CP with distilled water.
2 CASES OF RABBIT SYNDROME : 토끼증후군 2례
민병근,이창화,안준호,천두욱,김헌수 울산대학교 의과대학 1994 울산의대학술지 Vol.3 No.2
The application of neuroleptics to schizophrenic and other psychotic patients in the early 1950's led to the therapeutic revolution into the psychiatry, on the other hand neuroleptic-related adverse effects did frequently occur. The authors experienced 2 cases of rabbit syndrome producing by rare complication of neuroleptic medication. Two cases were examined for the rabbit syndrome by the description of Villeneuve(1972) and Sovner and DiMascio(1977). The reciprocal coordination test and the finger-tapping technique to worsen the symptoms also were applied to two patients. The authors emphasized two issues of rabbit syndrome as follows. First, though the literature search showed that the majority of patients presented with rabbit syndrome which is usually seen after a prolonged exposure to neuroleptic medication with the more potency in the middle or elderly aged are over 45 years old, we suggest that this syndrome might be linked to the younger age factor and the low potency thioridazine in our patient. Second, the rabbit syndrome is in the importance of the clinical practice because of being readily reversible with antiparkinsonian agents or anticholinergic drugs. In addition, recognizing this condition and differentiating it from tardive dyskinesia helps in the choice of the proper treatment of orofacial disorders following neuroleptic medication for the long time.
다발성 골수종 환자에서 척추주위 수질외 형질세포종으로 재발한 1례
정소연,장재식,정희철,천우정,이창화,김성욱,나득영,이상권,박건욱 東國大學校醫學硏究所 2001 東國醫學 Vol.8 No.-
다발성 골수종은 면역글로불린을 분비하는 세포의 클론을 만드는 B림프 전구세포의 형질 전환과 그 증식으로 야기되는 종양이다. 다른 형질세포 종양으로는 골 단독의 형질세포종과 수질외 형질세포종이 있다. 이 종양들은 공통된 기원임에도 불구하고 이들 종양사이엔 병리적, 임상적 차이가 있고 종양간의 관련성에 대해서 잘 알려져 있지 않다. 저자들은 화학치료로 부분 관해를 보인 다발성 골수종 환자에서 혈청이나 요의 골수종 단백질의 증가없이 비전형적인 방식으로 다발성 수질외 형질세포종으로 진행된 1례를 경험하였기에 문헌고찰과 함께 보고하는 바이다. 본 증례는 척수 압박을 야기한 척추주위 종괴로 재발된 경우이다. Multiple myeloma is a neoplastic disorder caused by the proliferation of transformed B lymphoid progenitor cell that gives rise to a clone of immunoglobulin-secreting cells. Other plasma cell tumors include solitary plasmacytoma of bone and extramedullary plasmacytoma(EMP). Despite the common origin, there exists pathological and clinical differences between these neoplasms and associations between them are not completely understood. We are reporting a case of multiple myeloma which, after an initial response to chemotherapy, progressed in an atypical manner, with the development of multiple EMP and abscence of protein of serum or urine. Our case is unusual because the patient had a recurrent paravertebral mass that caused compression the spinal cord.