항인지질항체 증후군을 동반한 복합 교원성 질환

이제경 ( Je Kyung Lee ),정성수 ( Sung Soo Jung ),유태석 ( Tae Seok Yoo ),장대국 ( Dae Kook Chang ),심승철 ( Seung Chul Shim ),고희관 ( Hee Kwan Koh ),김태환 ( Tae Hwan Kim ),전재범 ( Jae Bum Jun ),이인홍,배상철 ( Sang Cheol Bae ) 대한류마티스학회 1998 대한류마티스학회지 Vol.5 No.2

The presence of antiphospholipid antibodies in systemic lupus erythematosus (SLE) and the primary antiphospholipid antibody syndrome(APS) are well-known risk factors for thrombosis. However, aCL associated with rheumatic diseases other than SLE or primary APS tend to be in low prevalence and low titer, and unassociated with clinical complications. We experienced a 31-year-old female patient with painful swelling, purpura, and intermittent claudication of both lower extremities, moderate thrombocytopenia, and persistent positive antiphospholipid antibodies(43 GPL of aCL, positive LAC). Four years prior to admission, she had been diagnosed at our hospital as a mixed connective tissue disease because of positive anti-nRNP, Raynaud`s phenomenon, swollen hands, polyarthritis, sclerodactyly. After anticoagulant therapy, she experienced remarkable symptomatic improvement. We report an unusual case of antiphospholipid antibody syndrome in mixed connective tissue disease with a review of the literature.

Raynaud씨 증상이 식도 운동에 미치는 영향

이오영 ( Oh Young Lee ),김태환 ( Tae Hwan Kim ),고희관 ( Hee Kwan Koh ),이제경 ( Je Kyung Lee ),유태석 ( Tae Seok Yoo ),장대국 ( Dae Kook Chang ),심승철 ( Seung Cheol Shim ),전재범 ( Jae Bum Jun ),정성수 ( Sung Soo Jung ),이인홍 ( 대한류마티스학회 1998 대한류마티스학회지 Vol.5 No.1

연구목적: Raynaud`s phenomenon은 교원성 질환에서 흔히 관찰되는 현상으로서 Raynaud`s phenomenon은 식도의 운동 기능의 이상과 밀접히 연관 되어 나타난다는 보고가 있지만 이에 대한 연구는 미흡한 실정 이며 더욱이 우리나라에서는 전무한 상태이다. 따라서 본 저자는 전신성 공피증, 전신성 홍반성 루푸스, 복합 교원성 질환에서 Raynaud`s phenomenon이 있는 환자와 없는 환자에서 식도 내압 소견을 비교하여 보았으며, 아울러 Raynaud`s disease환자를 대상으로 하여 식도내압 소견을 알아 보았다. 대상 및 방법: 전신성 공피증환자 21명, 전신성 홍반성 루푸스 16명, 복합 교원성 질환 14명과 Raynaud`s disease환자 5명에서 식도 내압 검사를 시행하여 Raynaud`s phenomenon의 유무에 따른 식도 내압 검사의 차이를 알아 보았다. 결과: 1) 대조군은 30명으로 남자가 21명 여자가 9명 평균연령은 31.9±5.3세 였고, 전신성 공피증환자는 21명 모두 여자로 평균연령은 44.9±9.3세, 전신성 홍반성 루푸스환자는 16명으로 모두 여자로 평균연령은 34.1±8.9세, Raynaud`s disease환자 5명은 모두 여자였고 평균연령은 36.2±7.7세 였다. 2) 식도 내압 검사를 시행한 환자중 Raynaud`s phenomenon는 전신성 공피증환자 21명중 모두에서, 전선성 홍반성 루푸스에서 16명 중 9명에서, 복합 교원성 질환 14명중 모두에서 있었다. 3) Raynaud`s phenomenon이있는 복합 교원성 질환 14명중 12명(85.7%)에서, 전신성 공피증환자 21명중 17명(80.9%)에서 식도 내압소견의 이상 있었다. 전신성 홍반성 루푸스 환자 16명에서는 Raynaud`s phenomenon이 있는 9명 중 5예 (55.5%)에서 식도 내압 소견의 이상이 있었고 Raynaud`s phenomenon이 없었던 환자 7명에서는 2예(28.6%)에서 식도 내압소견의 이상이 관찰되었다. Raynaud`s disease환자 5명에서는 3예(60%)에서 식도 내압 소견의 이상이 관찰되었다. 4) Raynaud`s phenomenon이 있는 환자는 없는 환자에 비해 식도 내압의 이상이 높은 비율로 나타나고 있음을 알 수 있었다(Odds ratio: 7.7083, 95% confidence interval: 1. 0930-38. 1297). 결론: Raynaud`s phenomenon이 있는 환자에서 없는 환자에 비해 식도 내압소견의 이상이 높은 비율로 나타나고 있음을 알수 있었고 향후 좀 더 많은 예에서 연구가 필요하리라 사료된다. Objectives: In the connective tissue disease patients, esophageal dysfunction is often closely associated with the presence of Raynaud`s phenomenon. But there are no previous reports concerning the values of esophageal manometry in the connective tissue disease with Raynaud`s phenomenon in Korea. Therefore, we performed this study to evaluate esophageal function in connective tissue disease with Raynaud`s phenomenon. Methods: Total 86 subjects were employed in this study including 30 normal control group, 14 mixed connective tissue disease(MCTD), 21 systemic sclerosis, 16 systemic lupus erythematosus(SLE), and 5 Raynaud`s phenomenon only. In each subject, esophageal manometric study was performed with lower compliance capillary infusion system. Results: The mean age(±SD) of patients and controls were as follows: MCTD 34.1(±8.9), systemic sclerosis 44.9(±9.3), SLE 32.1(±7.9), and normal controls 31.9(±5.3). All patients with MCTD and systemic sclerosis had Raynaud`s phenomenon. Twelve out of 14 patients with MCTD, 17 out of 21 patients with systemic sclerosis, were abnormal in esophageal manometry. Nine out of 16 SLE had Raynaud`s phenomenon. Among 9 SLE with Raynaud`s phenomenon, 5 patients(55.5%) were abnormal in esophageal manometry, and among 7 SLE without Raynaud`s phenomenon, 2 patients(28.6%) were abnormal in esophageal manometry. Among 5 patients with Raynaud`s phenomenon, 3 patients were abnormal in esophageal manometry. Abnormal esophageal manometry finding is more common in the connective tissue disease patients with Raynaud`s phenomenon compared with the patients without Raynaud`s phenomenon (P=0.0219). Conclusions: Abnormal esophageal manometry finding is more common in the connective tissue disease patients with Raynaud`s phenomenon compared with the patients without Raynaud`s phenomenon.

류마티스 관절염 환자에서 미립체로 구성된 거대 견봉하 점액낭염

심승철 ( Seung Cheol Shim ),전재범 ( Jae Bum Jun ),장대국 ( Dae Kook Chang ),이제경 ( Je Kyung Lee ),유태석 ( Tae Seok Yoo ),고희관 ( Hee Kwan Koh ),김태환 ( Tae Hwan Kim ),정성수 ( Sung Soo Jung ),이인홍 ( In Hong Lee ),배상철 ( 대한류마티스학회 1998 대한류마티스학회지 Vol.5 No.1

Rice bodies are numerous small fibrinous, cartilaginous-like materials which were first described in tuberculous joints. Rice bodies are common findings in joints afflicted with rheumatoid arthritis or other seronegative arthropathy. But less commonly, those can be seen in periarticular bursae or at the sites of tendon or ligament insertion. Rice bodies, thought to be a nonspecific response to synovial inflammation, probably evolve from ischemia in a proliferative synovium. Some of these bodies contain a core of collagen with a mantle of fibrin, others contain only fibrin. Subacromial bursa are sometimes involved in the patients with rheumatoid arthritis and can reach impressive dimensions before becoming clinically detectable because significant constrain is lacking. Subacromial arthrography or magnetic resonance imaging accurately delineated the existence of cartilaginous loose bodies before surgical exision. We experienced a man with rheumatoid arthritis who had massive subacromial bursitis with rice bodies. His shoulder had been swollen since 5 years ago. He felt no pain and had only mild limitation of motion. Subacromial arthrography or magnetic resonance imaging of right shoulder showed multiple rice bodies in enlarged subacromial bursa. Operation finding showed a large encapsulated mass in the subacromial bursa, and hundreds of fibrinous rice bodies were revealed, which were resected. We report this patient with a review of literatures.

3차원 전산화단층찰영 영상을 이용한 얼굴 연조직 두께 계측

정호걸,김기덕,한승호,신동원,허경석,이제범,박혁,박창서,Jeong Ho-Gul,Kim Kee-Deog,Han Seung-Ho,Shin Dong-Won,Hu Kyung-Seok,Lee Jae-Bum,Park Hyok,Park Chang-Seo 대한영상치의학회 2006 Imaging Science in Dentistry Vol.36 No.1

Purpose : To evaluate accuracy and reliability of program to measure facial soft tissue thickness using 3D computed tomographic images by comparing with direct measurement. Materials and Methods : One cadaver was scanned with a Helical CT with 3 mm slice thickness and 3 mm/sec table speed. The acquired data was reconstructed with 1.5 mm reconstruction interval and the images were transferred to a personal computer. The facial soft tissue thickness were measured using a program developed newly in 3D image. For direct measurement, the cadaver was cut with a bone cutter and then a ruler was placed above the cut side. The procedure was followed by taking pictures of the facial soft tissues with a high-resolution digital camera. Then the measurements were done in the photographic images and repeated for ten times. A repeated measure analysis of variance was adopted to compare and analyze the measurements resulting from the two different methods. Comparison according to the areas was analyzed by Mann-Whitney test. Results : There were no statistically significant differences between the direct measurements and those using the 3D images (p>0.05). There were statistical differences in the measurements on 17 points but all the points except 2 points showed a mean difference of 0.5 mm or less. Conclusion : The developed software program to measure the facial soft tissue thickness using 3D images was so accurate that it allows to measure facial soft tissues thickness more easily in forensic science and anthropology.

전방 십자 인대 등장점 설정 시뮬레이션

염진섭(Jin Sup Yeom),이광원(Kwang Won Lee),김명호(Myung Ho Kim),김영호(Yeongho Kim),김남국(Namkug Kim),이제범(Jae Bum Lee),최원식(Won Sik Choy) 대한정형외과학회 2002 대한정형외과학회지 Vol.37 No.5

전산화 단층 촬영 영상에서 컴퓨터 보조 기법을 이용한 척추경 나사의 위치 판정

염진섭(Jin Sup Yeom),정문상(Moon Sang Chung),이춘기(Choon-Ki Lee),장봉순(Bong-Soon Chang),김영호(Yeongho Kim),김남국(Namkug Kim),이제범(Jae Bum Lee) 대한정형외과학회 2003 대한정형외과학회지 Vol.38 No.2

소아기 류마티스 관절염의 임상적 특성에 관한 연구

오광택 ( Kwang Taek Oh ),정성수 ( Sung Soo Jung ),유태석 ( Tae Seok Yoo ),이제경 ( Je Kyung Lee ),송용호 ( Yong Ho Song ),정자헌 ( Ja Hun Jung ),고희관 ( Hee Kwan Koh ),김태환 ( Tae Hwan Kim ),전재범 ( Jae Bum Jun ),이인홍 ( In Ho 대한류마티스학회 1997 대한류마티스학회지 Vol.4 No.2

Objective: To investigate the clinical characteristics of Korean JRA and the possible profiles related to prognosis and to compare these data to pre-existing occidental reports. Methods: 140 cases of JRA patients were randomly selected from 1986 through 1995. Juvenile ankylosing spondylitis was excluded with the aid of modified New York criteria for ankylosing spondylitis. We used the classification of progression of rheumatoid arthritis (radiological stage III+IV/I+II+III+IV) as a index of prognosis. The study factors were sex, age, type, affected joints, degree of destruction of joint, anti-nuclear antibody (ANA), rheumatoid factor (RF), HLA-B27 and extra-articular manifestations. Chi-square test, One-way ANOVA test, and Pearson`s correlation coefficient were used as statistical methods. Results: Our study show results as follows: (1) Systemic onset type(11%) polyarthritis subset (66%), oligoarthritis subset (34%), oligoarthritis onset type(62%) sero(-)-HLA-B27(+) subset(66%), RF(+) subset(20%), not otherwise classified subset (14%) ANA (+)-chronic uveitis subset (0%), polyarthritis onset type(27%) RF(+) subset (66%), not otherwise classified subset(34%). (2) Sex ratio was M:F=1.8:1. (3) Age of onset was 11±3.6 years. (4) Affected joints were knee, ankle, hand in decreasing order of frequency. (5) Patients show seropositivity of RF in 31%, HLA-B27 in 54%, ANA in 8%. (6) Chronic uveitis was observed in 7 cases (5%) (all oligoarthritis onset type, M:F=6:1, age of onset 11±4.3 years, ANA(0%), HLA-B27(86%), 2 cases leading to blindness. (7) Destructive bone change was significantly more prominent in female(p<0.01), RF(+) (p<0.01), HLA-B27(-) (p<0.01), polyarthritis onset type (p=0.02 ). Conclusions: In this study, we obtained interesting results that are somewhat different from Occidental data in sex ratio(male dominance), age of onset(older age), profiles of HLA-B27(high positivity in spite of low HLA-B27 positivity in Korean (about 2.3%), low rate of destructive change), ANA (low positivity, older age of onset), chronic uveitis(low incidence, male dominance, older age of onset, high association with HLA-B27, not associated with ANA). This study suggests possible racial difference in clinical features of JRA. But for prove of racial difference, further multi-center trial and large scale epidemiological study should be done.

60세 이상에서 발생한 류마티스 관절염의 특징

유태석 ( Tae Seok Yoo ),김태환 ( Tae Hwan Kim ),전재범 ( Jae Bum Jun ),장대국 ( Dae Kook Chang ),이제경 ( Je Kyung Lee ),고희관 ( Hee Kwan Koh ),심승철 ( Seung Cheol Shim ),정성수 ( Sung Soo Jung ),이인홍 ( In Hong Lee ),배상철 ( 대한류마티스학회 1999 대한류마티스학회지 Vol.6 No.2

Objectives: Patients who develop rheumatoid arthritis over 60 years old (elderly-onset rheumatoid arthritis, EORA) are different from those of younger-onset disease(YORA). Several aspects are emphasized; more equal sex distribution, more often systemic complaints, more larger joints involvement, high ESR rates, and less rheumatoid factor positivity. We compared the clinical characteristics of EORA with those of YORA. Methods: Five hundred and fifty-six patients who had met the ACR criteria for rheumatoid arthritis were studied. We compared the difference with clinical manifestation, disease activity markers, serologic markers including rheumatoid factor and antiperinuclear factor, and radiologic changes between EORA and YORA. Results: EORA: YORA ratio is 49:507, no difference between male and female ratio. The age at onset of EORA is 67.3±3.9 years old, YORA is 44.9±10.5 years old, disease duration is not different in both groups. The ESR of EORA(47.65±13.8) is higher than that of YORA(39.49±6.1), the positivity of antiperinuclear factor is significantly increased in the EORA group as compared with YORA group. The comparisons of disease activity including Ritchie index; early RA in both groups showed significant difference only in rheumatoid factor titer. Conclusion: The EORA is similar to YORA except high ESR, high rheumatoid factor titer, and high positivity of antiperinuclear factor. However, we failed to demonstrate that the EORA runs different course with heterogeneous pathogenesis to the YORA.

SAPHO 증후군 2예

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.

류마티스 관절염에서 Telomerase 활성도

고희관 ( Hee Kwan Koh ),안명주 ( Myung Ju Ahn ),김태환 ( Tae Hwan Kim ),이은영 ( Eun Young Lee ),유태석 ( Tae Seok Yoo ),이제경 ( Je Kyung Lee ),장대국 ( Dae Kook Chang ),심승철 ( Seung Cheol Shim ),전재범 ( Jae Bum Jun ),정성수 ( 대한류마티스학회 1999 대한류마티스학회지 Vol.6 No.1

연구배경: 류마티스 관절염은 활막세포의 비정상적인 증식과 단핵세포의 침윤으로 인한 종양처럼 활막의 증식 등을 특징으로 하는 질환이다. Telomerase가 류마티스 관절염 환자에서 활성화되어 류마티스 관절염의 병인에 관여하는지 알아보기 위해 본 연구를 시행하였다. 방법: 류마티스 관절염 환자와 대조군으로 퇴행성 관절염 환자에서 얻은 활막조직, 배양된 활막세포, 활액에서 추출한 단핵세포 등에서의 telomerase의 활성도를 TRAP(telomeric repeat amplification protocol) assay를 이용하여 비교 관찰하였다. 결과: Telomerase 활성도는 류마티스 관절염의 활막에서 높은 활성도를 보였고(70.6%: 12/17), 퇴행성 관절염 환자의 일부(30%: 3/10)에서도 역시 관찰되었다. 그러나 배양된 활막세포는 류마티스 관절염 환자의 일부에서만(50%: 2/4) 관찰되었다. 또한 류마티스 관절염 환자의 활액에서 추출한 단핵세포는 모두 telomerase 활성도가 관찰되었다. 결론: Telomerase 활성도는 류마티스 관절염의 병인에 관여할 수 있으리라 사료되며 앞으로 류마티스 관절염에서 telomerase의 생물학적 기능과 활성기전에 대해서도 보다 많은 연구가 있어야 할 것으로 사료된다. Objective: Rheumatoid arthritis(RA) is a disease characterized by infiltration of mononuclear cells into synovium and abnormal proliferation of synovial cells leading to pannus formation, which shows tumor-like growth. To determine whether telomerase is activated in RA and telomerase might be involved in the pathogenesis of RA, we measured telomerase activity in patients with RA. Methods: Telomerase activity was measured by using TRAP(telomeric repeat amplification protocol) assay in synovial tissues obtained from 17 patients with RA and 10 patients with osteoarthritis(OA), in cultured synovial cells from 4 patients with RA and 2 patients with OA, and in extracts of mononuclear cells from synovial fluid of 6 patients with RA. Results: Twelve of synovial tissues from 17 patients with RA(70.6%) showed telomerase activity, where three of synovial tissues from 10 patients with OA(30%) showed telomerase activity with low activity. Telomerase activity was detected in two of the cultured synoviocytes from 4 patients with RA(50%), but synoviocytes from patients with OA did not reveal any telomerase activity, if any. Telomerase acivity was detected in mononuclear cells extracted from synovial fluid of all patients with RA. Conclusion: Telomerase activity is highly positive in RA synovial tissues than OA synovial tissues and in RA synoviocytes as in mononuclear cells from synovial fluid. Taken together, these findings indicate that telomerase may playa role in the pathogenesis of RA.