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이성지 ( Sung Ji Lee ),서성례 ( Seong Rye Seo ),이호준 ( Ho Jun Lee ),이경은 ( Kyung Eun Lee ),김태종 ( Tae Jong Kim ),박용욱 ( Yong Wook Park ),이신석 ( Shin Seok Lee ) 대한류마티스학회 2010 대한류마티스학회지 Vol.17 No.2
Turner`s syndrome (TS) is characterized by short stature and gonadal dysgenesis. It is often associated with systemic manifestations, such as cardiovascular, gastrointestinal, and musculoskeletal disorders. Although very rare, it is possible for TS to accompany autoimmune disease, including thyroid disease, inflammatory bowel diseases, diabetes mellitus, psoriatic arthritis, and juvenile rheumatoid arthritis. A 39-year-old woman was referred for symmetric polyarthritis of her hands and feet. She had been diagnosed with Turner`s syndrome with 46,XO,-X,+fragment before the age of 22 years and had developed autoimmune hypothyroidism treated with thyroid hormone replacement. At the time of first visit, she had polyarthralgia with morning stiffness for more than 3 months. The musculoskeletal examination revealed symmetrical polyarthritis affecting the metacarpophalangeal, proximal interphalangeal, and metatarsophalangeal joints, fulfilling the ACR 1987 revised criteria for rheumatoid arthritis (RA). Here, we present an unusual case of RA associated with TS. It is important to pay meticulous attention to patients with TS so that inflammatory arthritis is not neglected and the diagnosis is not delayed.
박성창 ( Seong Chang Park ),박승환 ( Seong Hwan Park ),이호준 ( Ho Jun Lee ),이경은 ( Kyung Eun Lee ),박동진 ( Dong Jin Park ),조영난 ( Young Nan Cho ),이성지 ( Sung Ji Lee ),서성례 ( Seong Rye Seo ),김태종 ( Tae Jong Kim ),이신석 대한류마티스학회 2010 대한류마티스학회지 Vol.17 No.2
Brucellosis is an endemic zoonotic disease, particularly in the Middle East and Mediterranean regions, and can involve many organs and tissues. Recently, the incidence of human brucellosis has increased rapidly in Korea. Brucellosis may often appear as other infections and asymptomatic conditions because of its range of clinical manifestations. Therefore, its diagnosis is frequently missed or delayed. Early diagnosis of brucellar spondylitis is important for reducing the number and intensity of complications. Therefore, it should be included in a differential diagnosis of back pain with an unknown origin. Brucellosis is normally transmitted to humans by direct contact with infected animals or by the ingestion of unpasteurized dairy products. We report an unusual case of brucellar spondylitis complicated by acupuncture.
증례 : 류마티스 ; 메토트렉세이트와 아자치오프린 투여 후 호전된 피부근염에서의 지방층염
서성례 ( Seong Rye Seo ),임성륜 ( Sung Ryoun Lim ),이성지 ( Sung Ji Lee ),김태종 ( Tae Jong Kim ),박용욱 ( Yong Wook Park ),윤숙정 ( Sook Jung Yun ),이신석 ( Shin Seok Lee ) 대한내과학회 2011 대한내과학회지 Vol.80 No.1
피부근염은 피부와 근육에 침착된 자가 항체와 면역 복합체에 의해 비화농성 염증이 생기는 자가 면역 질환으로 피부 병변은 잘 알려져 있으나 피하지방 병변의 임상양상과 조직학적 소견은 잘 알려져 있지 않다. 1924년 Weber에 의해 피부근염에 동반된 지방층염이 보고된 이래 지금까지 23예의 증례가 보고되어 있다. 저자들은 내원 7년전 피부근염으로 진단되어 외래에서 경과추적을 하고 있던 27세 여자 환자에서 양측 상지와 안면부를 포함한 전흉부에 통증을 동반한 경화성 결절을 발견한 후 피부 조직 생검을 통해 지방층 염으로 진단하였고, 고용량의 프레드니솔론과 메토트렉세이트를 투여함에도 피부 병변의 호전이 없어 아자치오프린을 추가하였고, 이후 호전을 경험하였기에 문헌고찰과 함께 보고하는 바이다. Dermatomyositis is an autoimmune disease wherein autoantibodies and immune complexes cause non-suppurative inflammation in skin and muscle. Although the skin lesions of this disease are well known, the clinical and pathological features of subcutaneous fat lesions remain uncharacterized. Since Weber (1924) reported the development of panniculitis in a patient with dermatomyositis, 23 subsequent cases have been reported. Here, we present the case of a woman who had been diagnosed with dermatomyositis 7 years previously, and presented with diffuse, painful, indurated nodules on her face and upper limbs. A skin biopsy allowed us to diagnose these nodules as panniculitis. The patient was initially treated with high doses of prednisolone and methotrexate. She responded inadequately to these medications, so azathioprine was added to the regimen. The skin lesions subsequently improved and the patient has remained disease-free for 1 year. Here, we present the clinical profile of this patient and review the relevant literature. (Korean J Med 2011;80:122-127)
쇼그렌 증후군에 동반된 1형 신세뇨관 산증 및 골연화증 1예
이호준 ( Ho Jun Lee ),이성지 ( Sung Ji Lee ),박성창 ( Seong Chang Park ),박동진 ( Dong Jin Park ),김태종 ( Tae Jong Kim ),이신석 ( Shin Seok Lee ),박용욱 ( Yong Wook Park ) 대한류마티스학회 2012 대한류마티스학회지 Vol.19 No.4
Sjogren`s syndrome is a chronic autoimmune disease characterized by decreased function of the lacrimal and salivary glands. In addition, many other organs can be involved in patients with Sjogren`s syndrome. Overt or latent renal tubular acidosis is an uncommon extraglandular manifestation in Sjogren`s syndrome, and osteomalacia is a rare complication of renal tubular acidosis. It has been rarely reported that osteomalacia is associated with distal renal tubular acidosis in patients with Sjogren`s syndrome. We report a case of a 34-year-old female patient who was initially presented with muscle weakness in both lower extremities. The patient was then diagnosed with Sjogren`s syndrome complicated by osteomalacia and renal tubular acidosis.
정해영 ( Hae Young Jung ),최인선 ( In Seon Choi ),이우진 ( Woo Jin Lee ),반희정 ( Hee Jeong Ban ),이성지 ( Seong Ji Lee ) 대한천식알레르기학회 2009 천식 및 알레르기 Vol.29 No.1
Background: Approximately 10% of patients with near-fatal asthma (NFA) die within a year of an attack, and close follow-up is helpful to prevent fatal events. Objective: To investigate the clinical outcomes of acute severe asthma and whether close follow-up may help to improve clinical outcomes. Method: Asthma patients (N=225), who were hospitalized due to severe exacerbation during the period 1998∼2006, were followed up using questionnaires or phone interviews. The 146 patients, who had regularly visited our hospital until the examination, were assigned as regular hospital visitor. Result: Twenty-two (9.8%) of the total patients and 7 (15.9%) of 44 NFA patients died (mean follow-up period: 138.9 weeks). The mortality rate was significantly lower in regular hospital visitors than in the others (total: 6.2% vs. 16.5%, P<0.05; NFA: 3.4% vs. 40.0%, P<0.01). The regular hospital visitors controlled their asthma better (controlled/partly controlled/uncontrolled: 75/38/33 vs. 20/28/31; P<0.001), had better knowledge of asthma (9.7±0.2 vs. 8.5±0.3, P<0.01) and used inhaled steroid more frequently (74.7% vs. 55.7%, P<0.001) than the others. Conclusion: Not a few patients with acute severe asthma die after discharge from hospital. However, close follow-up and adequate asthma control seem to help in the reduction of asthma mortality. (Korean J Asthma Allergy Clin Immunol 2009;29:27-32)
류마티스관절염 양상으로 발현된 췌장암의 부종양성 증후군
김태종 ( Tae Jong Kim ),김영일 ( Young Il Kim ),이호준 ( Ho Jun Lee ),이경은 ( Kyung Eun Lee ),박용욱 ( Yong wook Park ),최선규 ( Seon Gyu Choi ),이신석 ( Shin Seok Lee ),서성례 ( Seong Rye Seo ),이성지 ( Sung Ji Lee ) 대한류마티스학회 2011 대한류마티스학회지 Vol.18 No.1
Paraneoplastic cancer polyarthritis is a very rare manifestation of musculoskeletal disorders associated with several solid and hematologic malignancies. We describe a 71-yearold woman who presented initially with an abrupt onset of rheumatoid arthritis-like symmetrical polyarthritis. The patient was diagnosed with pancreatic cancer with multiple hepatic metastases approximately six months later. Her symptoms of polyarthritis improved after the introduction of medication including non-steroidal anti-inflammatory drugs and disease modifying anti-rheumatic drugs. This case suggests that a hidden malignancy should always be considered in elderly patients, who present with an abrupt onset of symmetric polyarthritis for the first time in their life.
정상 혈청 총 IgE치를 보이는 알레르기 천식환자의 임상적 특성
최인선 ( In Seon S. Choi ),김옥기 ( Ok Ki Kim ),정성훈 ( Seong Hoon Jeong ),이우진 ( Won Jin Lee ),이성지 ( Seong Ji Lee ),신홍준 ( Hong Joon Sin ),한의령 ( Eui Ryoung Han ),정지민 ( Ji Min Jeong ) 대한천식알레르기학회 2009 천식 및 알레르기 Vol.29 No.2
Background: Although allergic diseases occur through IgE-mediated reaction, about 20% of allergic asthmatics have normal total serum IgE levels. Objective: To characterize the allergic asthmatics with normal total serum IgE levels. Method: Medical records of 430 consecutive allergic asthmatics, who received the tests for both total IgE and allergen-specific IgE in the serum or on the skin, were reviewed. According to the total and specific IgE levels, the subjects were classified to 4 groups (I, increased/strong; II, normal/strong; III, increased/weak; IV, normal/weak). Result: The Dermatophagoides farinae-specific IgE level in the serum was significantly related to the total serum IgE level (r=0.322, P<0.001). The D. farinae-specific IgE levels were significantly lower in the group II than in the group I (3.27±0.14 vs. 1.83±0.30, P<0.01) and the group IV than in the group III (0.79±0.05 vs. 0.44±0.13, P<0.01). The results for D. pteronyssinus and sum of checked allergens were similar. The proportion of the patients sensitized to single allergen to total subjects was 7.5%/13.5%/33.0%/40.0% for I/II/III/IV groups (χ2=44.5, P<0.001). Conclusion: The allergic asthmatics with normal total serum IgE levels had lower allergen-specific IgE levels and a higher proportion of the patients sensitized to single allergen. The levels of total serum IgE may be determined by the degree of sensitization in allergic asthma. (Korean J Asthma Allergy Clin Immunol 2009;29:96-104)