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신기능 저하 환자에서 위막성 대장염 발생의 임상적 특징
정성원 ( Sung Won Jung ),이유민 ( Yu Min Lee ),정덕은 ( Duk Eun Jung ),이재훈 ( Jae Hoon Lee ),김현정 ( Hyun Jung Kim ),이지은 ( Ji Eun Lee ),송주흥 ( Ju Hung Song ),박도심 ( Do Sim Park ),안선호 ( Seon Ho Ahn ) 대한신장학회 2009 Kidney Research and Clinical Practice Vol.28 No.2
목적: Clostridium difficile-associated diarrhea (CDAD)는 항생제 사용 후 장내세균 변화로 인해 C. difficile 독소 A에 의해 발생되는 위막성 대장염에 의한 것으로 알려져 있다. 본 연구는 대장내시경 후 조직검사를 통해 위막성 대장염으로 확진된 CDAD 환자에서 임상적 및 검사실적 소견의 분석을 통해 신기능의 저하가 CDAD 발생에 어떤 영향을 미치는지 알아보고자 하였다. 방법: 1998년 1월부터 2006년 12월까지 원광대학교 의과대학 병원에서 2일 이상 묽은 변과 고열이 발생한 환자에서 CDAD가 의심되어 C. difficile 독소 A를 시행하고 대장내시경을 통해 조직학적으로 CDCA로 확진된 환자 56명을 대상으로 신기능 저하, 당뇨 및 악성종양의 유무를 조사하여 항생제 투여 기간에 따른 CDAD 발생 빈도를 비교하였다. 결과: 연구 기간 동안 CDAD가 의심되어 C. difficile 독소 A를 검사한 환자는 452명이었으며, 이중 양성 환자 416명 (92.03%), 음성 환자 36명 (7.96%)이었다. 452명 중 대장내시경을 시행한 환자는 92명 (20.7%)이었고, 이중 조직검사에서 위막성 대장염으로 진단된 환자는 56명 (60.8%)이었다. 조직 검사로 진단된 위막성 대장염 환자 56명 (남자 26명; 여자 30명)이었고, 이중 신기능 저하 환자 8명 (14.2%), 당뇨환자 10명 (17.8%), 악성종양 환자 13명 (23.2%)이었다. 또한 독소 A가 음성인 환자는 36명 (64.3%)었다. 조직검사로 확진된 신기능 저하 환자 8명 중 5명 (62.5%)은 C. difficile 독소 A 검사에서 음성으로 신기능 저하 유무에 따른 독소 반응의 차이는 없었다 (62.5% vs. 64.6%). 신기능이 저하된 환자에서 당뇨 2명 (25%), 악성종양 환자 1명 (12.5%)이었다. CDAD 발생까지의 항생제 투여 기간은 신기능이 정상인 환자 보다 신기능이 저하된 환자에서 짧았고 (23.44±3.28일 vs. 11.13±2.386일, p=0.034), 당뇨 및 악성 종양 유무에 따른 비교에서 (20.85±2.221일 vs. 25.50±13.07일; 23.30±3.67일 vs. 16.31±2.31일) 차이가 없었다. 결론: 면역력이 저하된 당뇨 및 악성종양 환자에 비해 신기능이 저하된 환자에서 CDAD 발생까지의 항생제 투여 일수가 적어 신기능 저하 상태에서 특히 항생제 투여에 주의가 필요하다. 또한 항생제 투여 후 발생된 설사 환자에서 C. difficile 독소 A가 음성이라 할지라도 환자가 대장내시경을 시행할 수 있는 상태인 경우 반드시 대장내시경과 조직검사를 시행하여 CDAD를 감별해야 할 것으로 생각한다. Purpose: Clostridium difficile-associated diarrhea (CDAD) is a potentially life-threatening illness which has been shown to be more common and more severe in patient with chronic renal failure. The aim of this study was to investigate clinical characteristics of renal insufficiency patients with clostridium difficile-associated pseudomembranous colitis. Methods: We reviewed charts of fifty-six patients with clostridium difficile-associated pseudomembranous colitis, who have clostridial toxin A assay in stool and a diagnosis made on histology of colonic biopsies. Results: There was no difference in age, serum albumin, C-reactive protein (CRP) and negative incidence of clostridial toxin A between patients who had renal insufficiency with serum creatinine more than 1.5 mg/dL and those who did not. But duration of antibiotic use administered prior to development of the clostridium difficile infection was more shorter in patients with impaired renal function than in patients with normal renal function. Conclusion: These data suggest that it may take a short period to development of the clostridium difficile infection in patients with impaired renal function, and histologic evaluation by sigmoidoscopy should be performed to make a diagnosis in CDAD-suggested patients, who have impaired renal function and even negative clostridial toxin A.
증례 : 신장 ; Silicone 재질 복막투석 도관의 자발적 파손 1예
정성원 ( Sung Won Jung ),차정민 ( Jeong Min Cha ),김현정 ( Hyun Jung Kim ),이유민 ( Yu Min Lee ),변승재 ( Seung Jae Byun ),송주흥 ( Ju Hung Song ),안선호 ( Seon Ho Ahn ) 대한내과학회 2009 대한내과학회지 Vol.77 No.3
복막투석 도관과 관련된 도관 주변으로의 누수, 배액 장애, 출구 또는 피하터널의 감염은 흔하게 일어나는 합병증이지만, 복막투석 도관의 자발적 파손은 흔하지 않으며 발생한 경우에도 대부분 polyurethane 재질의 복막투석 도관을 사용한 경우였다. 저자들은 silicone 재질 복막투석 도관과 관련된 자발적 파손을 경험하였기에 이를 보고하는 바이다. Major peritoneal catheter-related complications include pericatheter leaks, outflow failure, and infection of the exit site or tunnel. We experienced a rare spontaneous fracture of a silicone peritoneal catheter. A 39-year-old man undergoing continuous ambulatory peritoneal dialysis (CAPD) developed peripheral edema and peritoneal outflow failure. He had no signs of exit-site infection, trauma, or peritonitis. The kidney-ureter-bladder radiograph suggested a fractured peritoneal catheter. We removed the catheter in an emergency operation and inserted a new peritoneal catheter. No obvious reason could explain why the catheter had broken, although the patient`s nephew was known to frequently jump on his abdomen Based on this case, mechanical stress should be avoided in CAPD patients with increased intra-abdominal pressure. (Korean J Med 77:359-361, 2009)
진단 및 치료 대장 내시경의 합병증으로 발생한 대장 천공의 치료에 대한 임상적 고찰순천향대학교 의과대학 내과학교실 소화기 연구소, 대전 속편한 내과
정성원 ( Song Won Jung ),유창범 ( Chang Beom Ryu ),송민수 ( Yon Soo Kim ),김연수 ( Min Soo Song ),고봉민 ( Bong Min Ko ),차상우 ( Sang Woo Cha ),류권호 ( Kwon Ho You ),홍수진 ( Soo Jin Hong ),김영석 ( Young Seok Kim ),문종호 ( Jon 대한장연구학회 2004 Intestinal Research Vol.2 No.1
Colonoscopy is used increasingly because the indication for therapeutic colonoscopy has been increased and the technique has been developed continuously as well as colonosopy is useful for diagnosis of colonic disease. Therefore, It is important understanding precisely about the complication of colonoscopy and managing the complication immediately and properly. In particular, colon perforation is the most fatal, emergency case and have needed surgical treatment, generally. Recently, the case treated with endoscopic clipping and conservative management has been reported. but until now, when perforated, wheather the endoscopic clipping or the surgical management at each other case is beneficial is not confirmed.
송태복 ( Tae Bok Song ),김상현 ( Sang Hyun Kim ),이연길 ( Yung Hil Lee ),정성원 ( Sung Won Jung ) 한국농림기상학회 2013 한국농림기상학회지 Vol.15 No.3
이 논문에서는 산지사면에서 나타나는 수문과정의 이해를 증진하기 위해서 관측된 토양수분의 분포와 거동을 수치지형분석을 통한 지형요소와의 상관관계를 연구하였다. 계절에 따른 강우 및 토양구조의 차이가 영향을 주는 사면 깊이 별 토양수분의 변동을 상관성분석을 통해 도출하였다. 경기도 파주시 설마천 유역에 위치하고 있는 사면에서 봄, 여름, 가을 등 각 3계절을 대상으로 4월, 7월, 10월 기간의 토양수분 시계열 관측 자료를 사용하여, 지표면과 기반암의 표고모형을 사용하여 다방향 흐름 알고리즘과 경사도, 곡률 등 18개 요소와의 상관관계를 분석하였다. 도출된 지형과 토양수분의 상관관계는 계절별로 강우의 양상과 토양 깊이에 따라 상이한 양상을 보여 주고 있다. 이러한 상관관계를 통해 사면에서 토양수분의 분포 및 흐름선을 예측하여 공간적인 분석을 도모하고, 토양수분의 거동을 가장 적합하게 모사하는 모형과 지형요소를 평가하고 도출할 수 있을 것이다. Spatio-temporal distribution of soil moisture was studied to improve understanding of hydrological processes at hillslope scale. Using field measurements for three designated periods during the spring, summer and autumn seasons in 2010 obtained from Beomryunsa hillslope located at the Sulmachun watershed, correlation analysis was performed between soil moisture measurements and 18 different terrain attributes (e.g., curvatures and topographic index). The results of correlation analysis demonstrated distinct seasonal variation features of soil moisture in different depths with different terrain attributes and rainfall amount. The relationship between predicted flow lines and distribution of the soil moisture provided appropriate model structures and terrain indices.
송종법(Jong-Beop Song),최일경(Il-kyung Choi),정효경(Hyo-kyung Jung),권순홍(Soon-Hong Kwon),권순구(Soon-Gu Kwon),박종민(Jong-Min Park),김종순(Jong-Soon Kim),정성원(Sung-Won Jung),최원식(Won-Sik Choi) 한국산업융합학회 2017 한국산업융합학회 논문집 Vol.20 No.2
Dental implants are required to have biomechanical functions and biostability in order to perform authoring, pronunciation, and aesthetic functions in the oral cavity. In terms of biostability, pure titanium for medical have good biostability and no rejection in the alveolar bone. with appropriate strength in terms of strength as well as biocompatibility. In recent years, various surgical methods and devices have been developed to improve the convenience and safety of the procedure. However, as the number of procedures increases, the screw loosening of the abutment screw connecting the artificial root and the abutment There are many reports of artificial root and abutment fracture. Fig. 1 is an example of a case where the upper part of the abutment screw is arbitrarily modified to remove the abutment by the abutment fracture due to the loosening of the abutment screw. The fundamental cause of abduction of the abutment screw is caused by the slight movement due to the lowering of the retention force of the abutment screw. It is necessary to minimize loosening of the abutment screw to avoid problems such as fracture during the period of using the implant. The purpose of this study is to investigate the structure of the abutment screw to prevent the loosening of the abutment screw by forming 0.5mm slot
흰쥐 좌골신경에 신경파괴제 주입 후 초래되는 하지 운동과 신경조직학적 변화
전재규(Jae Kyu Cheun),송선옥(Sun Ok Song),정성원(Sung Won Jung) 대한통증학회 2001 The Korean Journal of Pain Vol.14 No.1
N/A Background: This study was undertaken to observe the functional changes of the hind limb and histopathological changes in the sciatic nerve after an injection of alcohol or phenol, which are commonly used neurolytic agents, highlighting the time of recovery. Methods: Forty-eight Sprague-Dawley rats weighing 200-300g were used for the experiment. Histopathological changes under the electron microscope, were observed in the distal part of the sciatic nerve, into which O. 1 ml of alcohol or phenol was injected. This was severed in 3 rats of each group at 10 minutes, 1 hour, 24 hours, 3 days, 1, 2, 4 and 6 weeks later. The functional changes in the hind limbs were observed for 6 weeks by noting their walking pattern. Results: Following the injection of alcohol or phenol into the right sciatic nerve, the right hind limb showed a severe pronounced motor weakness and obvious gait changes. About 2 weeks later, gradual improvement of gait changes began, and after 6 weeks, the motor weakness and gait changes were no longer perceptible in both groups. The findings of any histopathological change were similar in both alcohol or phenol groups. At 10 minutes after injection, destructive lesions were confined to the immyelinated fibers and the myelin sheath of small the myelinated fibers. On the 3rd day and at 1 week, pathologic changes in axonal fibers and Schwann cells were in being phagocytized in spite of myelin restitution. From 2 to 4 weeks, axonal regeneration and remyelination appeared at the same time a myelin disintegration and axonolysis. At 6 weeks, neural regeneration was similar to that of the contralateral control group. Conclusions: These results suggest that functional and histopathological changes, after injection of neurolytics into the peripheral nerves, are quite similar in both alcohol and phenol groups. The progression of functional and histopathological changes become more obvious according to the time interval following the injection. Consequently, side effects that develop following the use of alcohol or phenol may begin to improve around the time that nerve regeneration occurs, i.e., two to four weeks later.