전신성 홍반성 루푸스 환자에서 자가항체 검출을 위한 이중면역확산법, ELISA, Western Blot법의 비교 및 자가항체와 임상양상의 연관에 관한 연구

유창달 ( Chang Dal Yoo ),차훈석 ( Hoon Seok Cha ),김성욱 ( Seong Wook Kang ),이은봉 ( Eun Bong Lee ),백한주 ( Han Joo Baek ),임용성 ( Yong Seong Im ),김현아 ( Hyun A Kim ),신찬수 ( Chan Su Shin ),송영욱 ( Yeong Wook Song ),최강원 대한류마티스학회 1996 대한류마티스학회지 Vol.3 No.2

Objective: To investigate the autoantibody profile and its clinical association in patients with systemic lupus erythematosus. Methods: The frequency and clinical correlation of autoantibodies were studied in 73 patients with systemic lupus erythematosus who have been followed in Seoul National University Hospital. Double immunodiffusion, ELISA and immunoblot were used for the detection of autoantibodies. Results: The frequency of each autoantibody measured by double immunodiffusion was as follows; anti-Ro 53.4%, anti-La 11.0%, anti-Sm 20.5%, anti-U1 RNP 20.5%. The frequency of each autoantibody by ELISA was as follows; anti-Ro 69.9%, anti-La 27.4%, anti-Sm 54.8%, anti-Ul RNP 68.5%, anti-dsDNA 72.6%, anti-cardiolipin 47.2% (IgG 43.1%, igM 15.3%). The frequency of each autoantibody by immunoblot was as follows; anti-Ro 15.1%, anti-La 42.5%, anti-Sm 46.6%, anti-Ul RNP 42.5%. anti-ribosomal P(P0) 27.4%. Anti-Ro was associated with decreased frequency of nephrotic syndrome. Anti-Ul RNP was associated with increased frequency of malar rash, Raynaud phenomenon and decreased frequency of nephritis. Patients with both anti-Ro and anti-La had more frequent serositis than those with anti-Ro only. Patients with both anti-Sm and anti-Ul RNP had less frequent thrombocytopenia than those with anti-Ul RNP only. And patients with anti-Sm and anti-dsDNA had more frequent arthritis than those with only one of both antibodies. There was a positive correlation of autoantibody titers between anti-Ro and anti-La, anti-Sm and anti-Ul RNP, anti-dsDNA and anti-cardiolipin (IgG). Taking the result of immunoblot as a standard, both of double immunodiffusion and ELISA showed low sensitivity but high specficity for anti La. As for anti-Sm and anti-Ul RNP, double immunodiffusion showed low sensitivity but high specificity, whereas ELISA showed high sensitivity but low specificity. Conclusions: In our study, some autoantibodies (anti-Ro, anti-Ul RNP) were associated with certain clinical manifestations while others not. Immunoblot being used as a standard method, ELISA showed higher sensitivity but lower specificity for anti-La, anti-Sm and anti-Ul RNP compared with immunodiffusion. It is recommended that in interpretating the laboratory findings of these autoantibodies these parameters of each method should be considered.

진동밀로 개질한 고로 슬래그 시멘트를 적용한 고강도 콘크리트 파일의 특성고찰

유창달(You, Chang Dal),류득현(Ryu, Deug Hyun),김도균(Kim, Do Kyun),유동우(Yoo, Dong Woo),민경산(Min, Kyung San),김상윤(Kim, Sang Yun) 한국콘크리트학회 2009 한국콘크리트학회 학술대회 논문집 Vol.2009 No.5

폐경후 골다공증 환자에서 Etidronate 주기요법과 Estrogen 단독요법의 비교

이윤종 ( Yun Jong Lee ),유창달 ( Chang Dal Yoo ),신기철 ( Ki Chul Shin ),강성욱 ( Seong Wook Kang ),이은봉 ( Eun Bong Lee ),백한주 ( Han Joo Baek ),김현아 ( Hyun A Kim ),최수희 ( Soo Hee Choi ),임경실 ( Kyung Sil Lim ),최영민 ( Yo 대한류마티스학회 1999 대한류마티스학회지 Vol.6 No.1

Objectives: To evaluate the effect of intermittent cyclic etidronate therapy on bone mineral density in Korean women with postmenopausal osteoporosis by comparison with continuous estrogen therapy. Methods: Twenty-one patients took oral etidronate in a dosage of 400mg/day for 2 weeks at intervals of 13 weeks and eighteen patients received continuous estrogen(conjugated estrogen 0.625mg/day) therapy. Calcium carbonate was administered in all patients. Bone mineral density(BMD) was measured by dual energy X-ray absorptiometry(DEXA) before and 12 months after treatment. Complete blood counts, liver function test including alkaline phosphatase, serum creatinine, and serum calcium/phosphate were also assessed. Results: After 12 months, the patients receiving etidronate had significant increases in BMD of lumbar spine(mean 4.2%; p<0.05), femur neck(3.3%; p<0.005) and greater trochanter(3.3%; p<0.05). In estrogen group, BMD of lumbar spine, femur neck and greater trochanter increased significantly by 5.0%(p<0.005), 3.3%(p<0.05) and 4.8%(p<0.05), respectively. However, BMD changes at Ward`s triangle in both groups were not significant. There was no difference in bone density changes of lumbar spine, femur neck, and trochanter between two groups. Etidronate as well as estrogen therapy significantly reduced the level of alkaline phosphatase. Conclusion: There was significant increase in BMD of lumbar spine, femur neck, and greater trochanter in both estrogen and etidronate groups. These results suggest that etidronate be alternative to estrogen in postmenopausal osteoporosis when hormone therapy is contraindicated or refused by patients.

고칼슘애시를 첨가한 친환경 모르타르의 강도 특성

김훈상(Kim, Hoon Sang),유창달(Yoo, Chang Dal),황해정(Hwang, Hae Jeong),백철우(Baek, Chul Woo),전준영(Jeun, Jun Young),류득현(Ryu, Deug Hyun) 한국콘크리트학회 2012 한국콘크리트학회 학술대회 논문집 Vol.2012 No.5

건선 관절염의 빈도 및 임상 양상에 관한 연구

백한주 ( Han Joo Baek ),유창달 ( Chang Dal Yoo ),신기철 ( Ki Chul Shin ),이윤종 ( Yun Jong Lee ),강성욱 ( Seong Wook Kang ),이은봉 ( Eun Bong Lee ),한창완 ( Chang Wan Han ),김현아 ( Hyun Ah Kim ),송영욱 ( Yeong Wook Song ),윤재일 대한류마티스학회 1998 대한류마티스학회지 Vol.5 No.2

Objective: To evaluate the prevalence of psoriatic arthritis(PsA) in Korean patients with psoriasis and to determine the clinical features of PsA. Methods: We examined 356 patients with psoriasis who visited dermatology clinic in Seoul National University Hospital between January 1 and April 28, 1997. Thirty-two patients were determined to have PsA. Nineteen cases of PsA, who were diagnosed in rheumatology clinic of the same hospitial from January 1983 to November 1997, were added to these patients and total 51 cases of PsA were analysed for clinical, laboratory and radiologic features. Results: The prevalence of PsA among patients with psoriasis was 9%(32/356). Male to female ratio of psoriatic arthritis was 1.1:1. Median age at onset of psoriatic arthritis was 34.5 years(range 9-63 years) and mean duration of psoriatic arthritis was 5.8±6.0 years. Psoriasis preceded arthritis in 73.5% of subjects, arthritis preceding psoriasis in 14.3%. Silmultaneous onset of both joint and skin disease was found in 12.2% of subjects. Nail changes, dactylitis and enthesopathy were detected in 37.1%, 21.6% and 33.3% of patients with PsA, respectively. Frequently involved joints in PsA were sacroiliac joints(51%), knees(49%), proximal interphalangeal joints of hands(33.3%), ankles(25.5%). About thirteen percent of patients with PsA were in ACR functional class III/IV. Patients with PsA were older than those with psoriasis alone(39 vs 35 [years], p=0.034). There were no significant differences between patients with PsA and those with psoriasis alone in age at onset of psoriasis, duration, family history, nail involvement, initial extent or type of psoriasis. Higher prevalence of anemia, leukocytosis, and increased ESR was found in patients with PsA compared to psoriasis alone(26% vs 6.3%, 28% vs 5%, and 40% vs 10.3%, p<0.001, respectively). ANA positivity and radiologic sacroiliitis were more frequent in patients with PsA than those with psoriasis alone(35.7% vs 16.7%, p=0.015 and 45.5% vs 1.1%, p=0.001, respectively). Patterns of PsA according to Moll and Wright criteria were as follows: spondylitis was present in 54.9% of patients; oligoarthritis in 25.5%, polyarthritis in 9.8%, predominant DIP involvement in 5.9%. Three cases of SAPHO syndrome were also found in our series. Age at onset of psoriasis and arthritis in spondylitis group was significantly lower than that in non-spondylitis group(23 vs 30 and 28 vs 44 [years], p<0.05, respectively). HLA-B27 was more prevalent in patients with PsA and spondylitis group compared to normal Koreans(19.5% vs 5.7%, p=0.024 and 29.2% vs 5.7%, P=0.0027, respectively), but HLA-B27 was not increased in non-spondylitis group. Conclusions: The clinical features of PsA in our series showed some differences from previous reports. Spondylitis was the commonest pattern of PsA. Nail changes and enthesopathy were less common compared to previous reports. Anemia, leukocytosis, increased ESR, ANA positivity, and radiologic sacroiliitis were more frequent in patients with PsA than in those with psoriasis alone. Age at onset of psoriasis and arthritis in spondylitis group was significantly lower than that in non-spondylitis group. The prevalence of HLA-B27 was increased in patients with PsA, especially in spondylitis group.

통풍성 관절염의 임상 양상에 관한 연구

백한주(Han Joo Baek),이은봉(Eun Bong Lee),유창달(Chang Dal Yoo),김현아(Hyun An Kim),송영욱(Yeong Wook Song),임용성(Yong Seong Lim) 대한내과학회 1997 대한내과학회지 Vol.52 No.6

N/A Objectives: The aim of this study is to enhance understanding the clinical features, pathogenesis, diagnosis and treatment of gouty arthritis in Korea by analyzing the clinical manifestations of the patients with urate crystal-proven gouty arthritis. Methods: 78 cases who had been diagnosed as gouty arthritis by confirming the urate crystals in synovial fluids or tophi in Seoul National University Hospital between January 1, 1989 and July 31, 1995 were analysed for their histories, symptoms, signs, laboratory data, and X-ray findings. Results: 1) Male to female ratio was 18.5:1. The mean age of onset is 49.3±14.5 years(range 11-83 years); the mean duration of disease 6.5±7.0 years(range 0-30 years); the mean duration of gouty attack 7.2±5.5 days(range 1-30 days). 2) The frequent precipitating factors of gouty arthritis were hospitalization(37%) and alcohol drinking(15%). The most frequent accompanying disease was hypertension(24%). Obesity, diabetes, chronic renal failure, hyperlipidemia, ischemic heart diseases, or cerebrovascular diseases were also accompanied by gouty arthritis. 3) The patterns of joint involvement were devided into 3 groups: monoarthritis; 42%, oligoarthritis; 35%, polyarthritis; 23%, The most frequent site of the first gouty attack was the 1st toe(65%). The most frequently involved joint at gouty attack was also the 1st toe(68%). While only lower extremities were involved in most cases with monoarthritis and oligoarthritis(91% and 78%, respectively), both lower and upper extremities were involved in most cases with polyarthritis(78%). 4) Hyperuricemia was found in 74% of the cases at gouty attack. But serum uric acid level was normal in 26%. With respect to pathogenesis of hyperuricemia, 14% of the cases had uric acid overproduction and 86% had uric acid underexcretion. 5) Bony changes in radiologic findings were found in 47% of the cases and tophi in 33%. Bony changes and tophi was significantly related to the younger age of gouty onset and higher serum uric acid level at gouty attack. 6) Acute gouty arthritis responded well to colchicine and NSAIDs. There was no difference in efficacy and the frequency of side effects between them. Conclusion: The clinical features of the gouty arthritis in Korea showed no difference from those in foreign studies except higher prevalence of oligo-/polyarthritis and tophi. To be remarkable, 26% of the patients with gouty arthritis did not have hyperuricemia at gouty attack. This finding indicates that urate crystals should be confirmed by synovial fluid examination for diagnosis of gouty arthritis.

내과 영역 세균 감염증 환자에 대한 Flomoxef의 효과 및 안전성에 관한 제 3상 임상 시험 : Phase Ⅲ clinical trail

김성민,김남중,유창달,백한주,이은봉,오명동,최강원 대한화학요법학회 1994 대한화학요법학회지 Vol.12 No.2

새로운 oxacephem계 항생제인 flomoxef의 효과 및 안전성을 ceflotaxim과 비교 평가하기 위해 서울대학교 병원 내과에 입원한 세균 감염증 환자를 대상으로 제3상 임상 시험을 실시하였다. 대상 환자는 flomoxef군 25명과 cefotaxime군 25명이였으며, 이 두 군사이에 연령, 기저 질환, 감염증의 종류 및 원인균에 있어서 유의한 차이는 없었다. Flomoxef군과 cefotaxime군의 감염증은 각각 균혈증 4,3; 원발성 복막염 6,9;요로 감염증 4,5;하부 호흡기 감염증 4,3; 피부 및 연조직 감염증 3,2;담도 감염증 2, 2였다. 임상적 치료 효과는 flomoxef군에서 86%(19/22), cefotaxime군에서 83%(19/23)으로 양군간에 유의한 차이는 없었다. 미생물학적 반응은 flomoxef군중 67%(4/6)에서, cefotaxime군에서 75%(3/4)에서 균제거 효과가 있었다. 부작용으로 flomoxef군에서 간효소치의 상승이 2예 관찰되었으나, 일시적이고 경미하여 투약을 중단할 정도는 아니였으며, cefotaxime군에서 피부발진 1예가 관찰되었다. 결론으로 flomoxef는 세균 감염증을 치료하는데 안전하고 효과적인 항생제로 생각된다. To evaluate efficacy and safety of flomoxef, a new oxacephem antibiotics, apahase 3 clinical trial was done. Fifty patients with proven or presumptive bacterial infections were randomly assigned to either flomoxef or cefotaxime. Age and sex distributions, underlying diseases and type of infections were similar in two treatment groups. types of the infections of flomoxef group and cefotaxime group were bacteremia 4, 3; spontaneous bacterial peritonitis 6, 9; UTI 4, 5; pneumonia 4, 3; skin and soft tissue infections 3, 2; and cholangitis 2, 2, respectively. Clinical response rate was 86% in flomoxef group, and 83% in cefotaxime group. One patient from each group, who was infected with E.faecalis infection, did not respond to the treatment. Two of the flomoxef group had transient elevation of transaminase, and one of the cefotaxime group developed skin rash, which subsided 2 days after discontinuation of the drug. In conclusion, flomoxef may be safe and effective in the treatment of patients with bacterial infections.

악관절과 그 주위에 발생한 칼슘피로인산염 침착질환

이은봉,송영욱,임용성,유창달,백한주 대한내과학회 1996 대한내과학회지 Vol.51 No.4

Calcium pyrophosphate dihydrate (CPPD) deposition disease has various patterns of clinical manifestation ranging from an absence of symptoms to a severely dertructive arthropathy. The occurrence of CPPD deposition disease at the tempormandibular joint accompanied by mass formation around the joint is very rare, with only 5 previous reports worldwide. Our report points out the importance of considering pathologic entities other than parotid tumor and osteogenic neoplasm in the differential diagnosis of a preauricular mass. We report a case of CPPD deposition disease at and around the tempormandibular joint diagnosed by polarized microscopic examination of surgical specimen.

중증 근무력증과 동반된 전신성 홍반성 루푸스 1 예

이은봉,김현아,송영욱,백한주,강성욱,차훈석,유창달,임용성 대한내과학회 1997 대한내과학회지 Vol.53 No.2

Myasthenia gravis(MG) is an autoimmune disorder characterized by the presence of anti-acetylcholine receptor antibody and weakness of voluntary muscles. The pathogenesis of MG is decreased numbers of acetylcholine receptors at postsynaptic membranes of neuromuscular junctions. It has been reported that MG often coexists with other autoimmune disorders. This is a case report of systemic lupus erythematosus coexisting with MG in a 23 year old female patient presenting with dysarthria, dysphagia, and limb weakness. We report the case with relevant literature review.