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골격 이형증을 동반한 베체트 병에서 나타난 연조직 석회화 1예
정순명,권상창,유진택,김영환,이정욱,서유나 대한내과학회 2011 대한내과학회 추계학술대회 Vol.2011 No.1
베체트병은 반복하는 구강과 생식기 궤양, 포도막염, 피부 병변을 특징으로 하는 전신성 혈관염이다. 골격 이형성증은 비정상적으로 뼈가 성장하고 발달하여 골격이 비정상적 크기 및 모양을 보이는 질환이다.연조직 석회화는 전이성, 종양성,특발성,비정상 조직 석회화로 인해 나타 난다고 알려져 있다. 류마티스 환자의 연조직 석회증은 만성적인 조직 염증에 기인하며, 저산소증, 혈관분포감소, 구조적 손상에 따른 변화 등 에 의해 나타난다. 국내에서 연조직 석회증은 피부 근육염, 전신 경화증, 루푸스 등이 보고 되었지만, 저자들은 골격 이형성증이 동반된 베체트병 환자에게 다발성 연조직 석회화를 경험하였기에,보고하는 바이다. 55세 여자로 키 129cm, 몸무게 29kg의 저신장(Fig. 1)을 보이는 골격 이형성증으로 특별한 치료 없이 지내 왔으며, 2000년 구강 궤양, 성기 궤양 등으로 베체트병을 진단받고, 치료중 2007년 1월부터 증상이 없어 임의로 치료 중단하였다. 최근 다시 구강궤양과 관절염이 있고, 양측 ant. Tibia와 ankle에 딱딱한 것이 여러 개가 만져진다는 주소로 내원하였 다. 시행한 검사실 소견에서 CRP 0.25 mg/L, ESR 15mm/hr Rheumatoid factor(-), Anti-CCP(-), ANA (-), HLA-B51(+), HLA-B27(-), Ca 8.1 mg/dL, PTH 98.4pg/mL,Vit.D 38.98 ng/mL, CPK 130 IU/L,uric acid 5.0 mg/dL로 나타났다.X선 검사와 컴퓨터 단층촬영에서 다발성 연조직 석회화 소견이 관찰되었다.(Figure 2, 3, 4)진찰 소견과 검사실 소견으로 신성 골 형성장애, 부갑상선 기능 저하증,비타민 D 과잉섭취, 우유-알 칼리 증후군, 악성 종양 등을 배제하고 베체트병 환자에게 나타난 다발성 연조직 석회화로 진단할 수 있었다. 진단 후 대증적 치료 하면서 경과 관찰 중이다.
Two Cases of Spinal Epidural Abscess in Hemodialysis Patients
김영한,유진택,정순명,권상창,류승민,장문,최정 영남대학교 의과대학 2013 Yeungnam University Journal of Medicine Vol.30 No.1
While epidural abscesses are rare in hemodialysis patients, they can cause severe neurological complications that can be fatal because only nonspecific symptoms appear in the early stages of the infection. Their incidence increased recently due to intravenous drug abuse, invasive spinal surgery, percutaneous vertebral procedures, and the development of diagnostic modalities. The increased number of cases is related to the use of dialysis catheters in hemodialysis patients. If a patient has fever and back pain, doctors should eliminate the possibility of other common diseases and consider spinal epidural infection. Early diagnosis and proper treatment are important to prevent neurological complications. In this paper, the symptoms, blood work, magnetic resonanceimaging (MRI) findings, and clinical course of two hemodialysis patients who developed spinal epidural abscesses are described.
유진택,김영한,정순명,권상창,류승민,하준욱,이정욱 영남대학교 의과대학 2013 Yeungnam University Journal of Medicine Vol.30 No.1
Synovitis acne pustulosis hyperostosis osteitis (SAPHO) syndrome is a rare disease that involves the skin, bones and joints. It is thought to be caused by infection with low-toxicity bacteria and to be the result of reactive infectious osteitis. However, this hypothesis has not yet been clearly established. New SAPHO syndrome treatment methods are needed because the disease does not respond to treatment in many cases. In this paper, a case is reported of SAPHO syndrome with pain in the acromioclavicular joint and with squamous and pustular macules on the palms and soles. First, the patient was treated with aceclofenac, prednisolon and sulfasalazine for two weeks. However, the symptoms were not relieved, so methotrexate and pamidronate were added to the treatment. Since no improvement was seen after four weeks of treatment, adalimumab was prescribed. The skin lesions were relieved two weeks later, and the bone pain and arthralgia, four weeks later. No recurrence or adverse effects were observed at the 22-week follow-up.
하병길,김봉건,김동현,이순일,정순명,박자영,이창원,김상수,김보현,김인주 대한당뇨병학회 2012 Diabetes and Metabolism Journal Vol.36 No.6
Background: Brachial-ankle pulse wave velocity (baPWV) is known to be a good surrogate marker of clinical atherosclerosis. Atherosclerosis is a major predictor for developing neuropathy. The goal of this study was to determine the relationship between baPWV and diabetic peripheral neuropathy (DPN) in patients with type 2 diabetes. Methods: A retrospective cross-sectional study was conducted involving 692 patients with type 2 diabetes. The correlation between increased baPWV and DPN, neurological symptoms, and neurological assessment was analyzed. DPN was examined using the total symptom score (TSS), ankle reflexes, the vibration test, and the 10-g monofilament test. DPN was defined as TSS ≥2 and an abnormal neurological assessment. Data were expressed as means±standard deviation for normally distributed data and as median (interquartile range) for non-normally distributed data. Independent t-tests or chi-square tests were used to make comparisons between groups, and a multiple logistic regression test was used to evaluate independent predictors of DPN. The Mantel-Haenszel chi-square test was used to adjust for age. Results: Patients with DPN had higher baPWV and systolic blood pressure, and were more likely to be older and female, when compared to the control group. According to univariate analysis of risk factors for DPN, the odds ratio of the baPWV ≥1,600 cm/sec was 1.611 (95% confidence interval [CI], 1.072 to 2.422; P=0.021) and the odds ratio in female was 1.816 (95% CI, 1.195 to 2.760; P=0.005). Conclusion: Increased baPWV was significantly correlated with peripheral neuropathy in patients with type 2 diabetes.