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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.
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.
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.
한국인에서 Adult Onset Still`s Disease의 임상상과 예후 인자에 관한 연구
조균석 ( Kyoon Seok Cho ),유대현 ( Dae Hyun Yoo ),윤형란 ( Hyung Ran Yun ),이명호 ( Myong Ho Lee ),이제경 ( Je Kyung Lee ),심승철 ( Seung Cheol Shim ),장대국 ( Dae Kook Chang ),유태석 ( Tae Seok Yoo ),고희관 ( Hee Kwan Koh ),김태 대한류마티스학회 1998 대한류마티스학회지 Vol.5 No.1
Objective: This study was undertaken to review the disease course, clinical and laboratory manifestations, prognosis and treatment of adult onset Still`s disease (AOSD) in Korea. Methods: Thirty-two patients with AOSD were enrolled from 1986 to 1997 in Hanyang University Hospital. Diagnosis of AOSD was based on the criteria proposed by Yamaguchi. We classified the disease course into self-limited, intermittent, or chronic disease course. Results: Twenty-four (75%) patients were female. Skin rash occurred in 28 (88%) patients, lymphadenopathy in 8 (25%), hepatomegaly in 4 (13%), and pericarditis in 2 (6%) out of 32 patients. The most commonly affected joints were knee joints (88%). Elevated LDH was seen in 18 (60%) patients and decreased CK in 17 (61%) patients. Rheumatoid factor was detected in 4 (13%) patients and ANA in 12(38%) patients. Anemia (Hb<10 g/dL) was seen in 13 (41%) patients and hypoalbuminemia (<3.5 g/dL) in 14 (52%) patients. Elevated ferritin (≥300 ng/mL) level was seen in 23 (79%) patients. Twenty-five (78%) patients had elevated serum transaminase. Bone marrow studies were performed in 16 patients. Nine out of 16 patients showed hyperplasia of the myeloid series and 2 patients displayed the features of a hemophagocytic syndrome. The mean duration of follow up of 32 patients was 32 months (range 3-108). Eight (27%) patients had a self-limited, 9 (30%) an intermittent, and 13 (43%) a chronic disease course. The hypoalbuminemia was significantly associated with an intermittent or chronic disease group(p<0.05). Thirty-two patients received systemic corticosteroids and 21 patients received single or combination of disease modifying antirheumatic drugs. Conclusion: We found that hypoalbuminemia at presentation was significantly associated with an unfavorable outcome, intermittent or chronic disease group. The clinical manifestations and disease course of AOSD in Korea were similar to those previously reported in other countries except significantly lower incidence of lymphadenopathy, hepatomegaly, and pericarditis.
고용량의 면역 글로불린 주사 치료로 호전된 Salmonella 그룹 D 균혈증과 골수섬유증을 동반한 전신성 홍반성 루푸스
이혜순 ( Hye Soon Lee ),배상철 ( Sang Cheol Bae ),윤형란 ( Hyung Ran Yun ),이지현 ( Ji Hyun Lee ),정유성 ( Yu Seong Jeong ),배윤상 ( Yun Sang Bae ),김태환 ( Tae Hwan Kim ),전재범 ( Jae Bum Jun ),정성수 ( Sung Soo Jung ),이인홍 ( I 대한류마티스학회 2000 대한류마티스학회지 Vol.7 No.1
A 22-year-old woman presented with fever and pancytopenia. One year ago, she was diagnosed as Salmonella group D bacteremia and myelofibrosis associated with SLE at another hospital. She was placed on high dose steroid, however, there was no improvement. Two months ago, she was diagnosed as recurrent Salmonella group D bacteremia. After admission to our hospital, she was placed on intravenous antibiotics and high dose intravenous immunoglobulin. A significant improvement in laboratory and clinical condition occurred and bone marrow biopsy showed complete resolution of fibrosis. We report a case of SLE with myelofibrosis and recurrent Salmonella group D bacteremia.
급성 췌장염 예후인자로서 APACHE III 점수의 임상적 유용성
박준용,박경남,한동수,이민호,조윤주,최호순,손주현,함준수,문광호,기춘석,윤형란,양석철 대한소화기학회 1998 대한소화기학회지 Vol.32 No.4
Background/Aims: The various prognostic parameters for predicting the severity and prognosis of acute pancreatitis were used, but these were unfit for clinical utilization. We evaluated a clinical utility of the APACHE III score as a prognostic parameter of acute pancreatitis. Methods: We conducted a retrospeetive review of 40 patients with acute pancreatitis. We compared APACHE III score with Ranson's score, Glasgow's score, CT grading, the severity of complication, and hospital day. Results: The sensitivity of these prognostic parameters for predicting the severity of acute pancreatitis was 69.57% in APACHE III score ($gt;23), 47.83% in Glasgow's score ($gt;3), 39.13% in Ranson's score ($gt;3) and 73.91% in CT pading ($gt;3). The specificity was 64.71% in APACHE III score, 76.41% in Glasgow's score, 64.71% in Ranson's score and 41.18% in CT grading. The positive predictive value of APACHE III score in predicting the severity of acute pancreatitis was 72.73%. We found a good correlation between the severity of complication and APACHE III seore (r =0.607). The severity of complication is poorly correlated with other parameters: Glasgow's score (r=0.387), Ranson's score (r=0.402) and CT grading (r =0.273). There was not statistically significant difference in the APACHE III score (32.41 vs. 22.94, p=0.089) between the groups of alcohol (n =22 cases) and biliary (n =16 cases) associated pancreatitis. Conclusions: The APACHE III score showed a higher sensitivity and specificity than the other prognostic parameters and excellent correlation with the severity of complication and clinically initial systemic states in the acute pancreatitis.