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증례 : 감염 ; 신장 경색을 동반한 Streptococcus agalactiae 감염 심내막염 1예
김주일 ( Joo Il Kim ),조현정 ( Hyon Joung Cho ),서종구 ( Jong Goo Seo ),김진용 ( Jin Yong Kim ),박윤수 ( Yoon Soo Park ),서일혜 ( Yiel Hae Seo ),조용균 ( Yong Kyun Cho ) 대한내과학회 2009 대한내과학회지 Vol.77 No.5S
저자들은 별다른 기저 질환이 없던 건강한 성인 남성이 GBS에 의한 신장경색이 동반된 감염 심내막염을 최초로 경험하였기에 문헌고찰과 함께 보고한다. 최근 GBS에 의한 침습적 감염이 당뇨병이나 악성 종양 및 간경화와 같은 만성 기저질환이나 고령과 연관하여 증가하고 있다. 하지만 이와 같은 위험인자가 없는 환자에서도 GBS에 의한 감염이 발생할 수 있으며 GBS 감염 심내막염은 신장 경색을 포함한 전신적 색전증이나 다른 합병증이 빈번하게 발생하여 예후가 좋지 않을 수 있기 때문에 조기에 수술을 포함한 적극적으로 치료를 고려하여야 한다. Group B streptococcus (GBS, Streptococcus agalactiae) is categorized as a Lancefield Group B beta-hemolytic streptococci. GBS is a recognized cause of sepsis and meningitis in newborns and pregnant women. However, the incidence of GBS disease in nonpregnant adults is increasing, particularly in the elderly and those with significant underlying diseases. GBS infective endocarditis is generally characterized by an acute onset, the presence of large vegetations, rapid valvular destruction, and the frequent development of complications. Here we report the first case of GBS infective endocarditis associated with kidney infarction. (Korean J Med 77:S1328-S1331, 2009)
흉통의 양상에 따라 분류한 불안정형 협심증 환자의 임상적 소견의 비교
김명수,김성구,정호석,온영근,신원용,김철현,최태명,현민수,권영주 순천향의학연구소 2001 Journal of Soonchunhyang Medical Science Vol.7 No.1
Background and aims : The clinical syndrome unstable angina pectoris that encompasses a variety of symptoms and clincal presentations of transient episode of myocardial ischemia, was devided to several subgroups. Also, it has variable pathophysiologic factors to cause myocardial ischemia. According to clincal presentation, coronary angiographic finding and prognostic factor, the result of unstable angina pectoris is variable. In fact, there were a few data reported on the prognosis of wide spectrum of patients with unstable angina. However, the precise risk of subgroups according to classitication has not been established because it was difficult to compare between studies. We classified unstable angina pectoris by clinical nature of chest pain, and performed to establish and compare the clinical presentations, coronary angiographic findings, treatement and prognosis of patients with unstable angina within subgroups of classification. Methods : Retrospenctive data for 164 unstable angina pectoris patients admitted to the Internal Cardiology Division of Soon Chun Hyang University Hospital from May 1996 to July 1999 was analyzed. The patients were classified into one of the following categories: Class I, new onset of severe angina; Class II, acceleration of previous chronic stable angina; Class III, angina at rest. Clinical presentations, echocardiographic findings, coronary angiographic findings, treatment and prognosis were compared. Results : From the total 164 patients, the subjects of classes were as follows : Class I, 46 cases (28.1%); Class II, 74 cases (45.1%); Class III, 44 cases (26.8%). In view of age distribution, the 7th decade had the highest incidence, and then, 6th, 8th decades were followed. There was no baseline differences among the 3 classes with respect to gender, number of risk factors. Significantly, class II showed more severe findings in abnormal Q wave 15 cases (20.8%), total occclusive lesion 10 cases (20.8%) and three vessel coronary disease 11 cases (22.9%) than other classes. The change of ST segment was significantly apparent (p<0.02) among class I 28 cases (60.8%), class III 26 cases (59.0%), comparing with class II 30 cases (40.5%). Class III had the higher incidence of one vessel coronary artery disease than class I and III. The heparin treatment was performed in 99 cases (60.1%). The incidence of nonfatal myocardial infarction was much more in class I and III, each 4 cases (8.7%, 9.8%) than in class II 1 cases (1.4%). In-Hospital death was occurred in class I and II, each 1 case. Conclusion : The patients with the acclerated angina from chronic stable angina had more severe coronary artery disease than other classes, but they had better in-hospital prognosis.
( Seung Joo Chon ),( Bo Hyon Yun ),( Yeon Soo Jung ),( Si Hyun Cho ),( Young Sik Choi ),( Suk Young Kim ),( Byung Seok Lee ),( Seok Kyo Seo ) 대한산부인과학회 2012 대한산부인과학회 학술대회 Vol.99 No.-
A decrease in estrogen levels in postmenopausal women is considered to be associated with unfavorable changes in lipid profiles, having effects on cardiovascular complications. Metabolic syndrome is a clinical entity of substantial heterogeneous traits which is a risk factor of acute cardiovascular disease. However, studies evaluating the prevalence of metabolic syndrome and its risk factors in postmenopausal women are still lacking. Therefore, we are to evaluate the effects of 25(OH)D levels on metabolic syndrome with its risk factors in postmenopausal women. This study was performed using data from KNHANES 2008-2010 consisting of 10907 (6543 premenopausal, 4364 postmenopausal) women. Clinical and other objective characteristics, seasonality, components and presence of metabolic syndrome were evaluated according to 25(OH)D levels among postmenopausal Korean women. Vitamin D deficiency was dominant in young aged group, whereas prevalence of metabolic syndrome tends to increase in elderly people. The prevalence of metabolic syndrome did not show any correlation with the levels of vitamin D. Although there were no correlations in between the levels of vitamin D and the prevalence of metabolic syndrome, sufficient 25(OH)D level seemed to have some associations with lower odds of abdominal obesity (OR=0.75(0.59-0.95); p for trends=0.052), and also significant association with lower odds of elevated TGs (OR=0.74(0.58-0.93); p for trends=0.041) in age, seasonality adjusted model among postmenopausal women. We conclude increased levels of 25(OH)D in Korean postmenopausal women do not entirely mean they have a lower risk of having metabolic syndrome. However, maintaining sufficient levels of 25(OH)D represent they do have some associations with components of metabolic syndrome. This shows the metabolic syndrome itself is related to its components, but might also be associated with other aspects, such as molecular pathophysiology which have not been clearly identified.
( Seung Joo Chon ),( Jin Young Heo ),( Bo Hyon Yun ),( Yeon Soo Jung ),( Seok Kyo Seo ) 대한폐경학회 2016 대한폐경학회지 Vol.22 No.3
Objectives: Menopause is a natural aging process causing estrogen deficiency, accelerating atherogenic processes including dyslipidemia. Prevalence of thyroid dysfunction is also high in postmenopausal women, and it is known to elevate the risk of cardiovascular disease (CVD). Therefore, we are to study on the associations in between serum thyroid stimulating hormone (TSH) and prevalence of CVD in postmenopausal women who have normal thyroid function. Methods: We performed a retrospective review of 247 Korean postmenopausal women who visited the health promotion center from January, 2007 to December, 2009. Postmenopausal women with normal serum TSH were included in the study. Coronary atherosclerosis was assessed by 64-row multidetector computed tomography. Results: In multiple linear regression analysis, serum TSH was associated with serum triglyceride (TG) (β = 0.146, P = 0.023). In multiple logistic regression analysis, increasing age and serum TSH were associated with an increased risk of coronary atherosclerosis in euthyroid postmenopausal women (odds ratio [OR] = 1.107 [1.024-1.197], P = 0.011 and OR = 1.303 [1.024-1.658], P = 0.031, respectively). Conclusions: It revealed that significant predictor of serum TSH was serum TG, and increasing age and TSH were found to have associations with an increased risk of coronary atherosclerosis in euthyroid postmenopausal women. Screening and assessing risks for CVD in healthy postmenopausal women would be helpful before atherosclerosis develops. (J Menopausal Med 2016;22:146-153)
RE-16 : Associations between Serum Thyrotropin and Metabolic Syndrome
( Yeon Soo Jung ),( Bo Hyon Yun ),( Seung Joo Chon ),( Young Sik Choi ),( Byung Seok Lee ),( Seok Kyo Seo ) 대한산부인과학회 2012 대한산부인과학회 학술대회 Vol.99 No.-
Thyrotropin levels are outside normal reference range in subclinical thyroid disease. Metabolic syndrome (MetS) involves clustered cardiovasucular risk factors, including abnormal lipids, insulin resistance, and hypertension. The aim of this study was to investigate associations of serum thyrotopin (thyroid stimulating hormone, TSH) with lipid concentrations and metabolic syndrome in Korean women. We reviewed medical records of 4265 Korean women who visited the health promotion center for a routine checkup between January 2011 and December 2012, retrospectively. Clinical, hormonal, and metabolic parameters were evaluated. Metabolic syndrome was defined according to the National Cholesterol Education Program- Third Adult Treatment Panel (NCEP-ATP III) criteria. Participants were classified into subclinical hypothyroidism (< 0.40 mU/L, n=462), subclinical hyperthyroidism (4.0-10 mU/L, n=92), and the euthyroid groups (0.4-4.0 mU/L, n=3711) according to TSH levels. In euthyroid subjects, TSH levels correlated positively with systolic blood pressure (SBP), trigylcerides (TG) and creatinine. In subclinical hyperthyroid subjects, TSH levels correlated negatively with high density lipoprotein cholesterol (HDL-C), incidence of low HDL-C, and elevated blood pressure (BP). There were significant associations were seen between metabolic syndrome (MetS) prevalence and TSH levels in subclinical hyperthyroid group. No significant correlations were found between TSH levels and variables in the subclinical hypothyroid group. In the entire study population, TSH levels correlated positively with SBP/DBP, and creatinine. In subclinical hyperthyroidism, TSH levels had significant associations with prevalence MetS (especially low HDL-C, hypertension). Therefore, subclinical hyperthyroid woman with a lower TSH level may need further evaluation of metabolic syndrome and cardiovascular risk.
( Bo Hyon Yun ),( Seung Joo Jeon ),( Yeon Soo Jung ),( Young Sik Choi ),( Si Hyun Cho ),( Byung Seok Lee ),( Seok Kyo Seo ) 대한산부인과학회 2012 대한산부인과학회 학술대회 Vol.99 No.-
Toll-like receptors (TLRs) are innate immune receptors that mediate the pattern recognition of, and response toward pathogens and host-derived danger signals. We examined whether endogenous ligands released by damaged cells such as high-mobility group box-1 (HMGB-1) signaling through TLR4 may play a pathogenic role in endometriosis. HMGB-1 and TLR4 expression in endometrium were analyzed using immunohistochemistry with HMGB-1, a specific endogenous ligand of TLR4 to activate TLR4 signaling. The effect of HMGB-1-TLR4 signaling on cell proliferation was examined. Specific inhibitor of NF-κB signaling pathway was used to explore the role of NF-κB signaling pathway in HMGB-1-TLR4 pathway. During the menstrual cycle, TLR4 protein was highly expressed. HMGB-1 significantly enhanced cell proliferation in endometrial stromal cells by TLR4 dependent fashion. HMGB-1-TLR4 signaling was associated with regulation on the activation of NF-κB signaling pathway. Our results suggest that HMGB-1-TLR4 signaling may play an important role in establishment of endometriosis through NF-κB signaling pathway.
간세포암종 진단에 있어서 자동화 분석기로 측정한 AFP - L3 와 PIVKA - 2 의 임상적 유용성
박영수,김철,김현숙,한재용,송건훈,전재윤,문영명,백용한,이관식,전태주,이현웅,박정엽,정재연,한광엽,이경률 대한간학회 2001 Clinical and Molecular Hepatology(대한간학회지) Vol.7 No.4
Background / Aims : Prothrombin induced by Vitamin K Antagonist-Ⅱ(PIVKA-Ⅱ)and alpha-fetoprotein(AFP)subtype reacting with Lens Culinaris Agglutinin(AFP-L3)are known as specific tumor markers for HCC. Recently a more sensitive ELA method for PIVKA-Ⅱand an automatic analyzer with Liquid Phase Binding Assay method(LBA method)for AFP-L3 have been developed. The aim of this study was to evaluate the feasibility of PIVKA-Ⅱ and AFP-L3 measured by newly developed methods as complementary tumor markers to AFP in the diagnosis of HCC. Methods : The serum concentration of AFP, PIVKA-Ⅱ, and a fraction of AFP-L3 were determined from 188 patients with HCC and 118 patients with various liver diseases including tumors of the liver. AFP was measured by EIA, PIVKA-Ⅱ by sensitive EIA, and AFP-L3 by the LBA method with LiBASys Auto-analyzer. The cutoff values for AFP, PIVKA-Ⅱ, AND AFP-L3 WERE 400ng/mL, 40 Mau/mL, AND 15%, respectively. Results : The sensitivity and specificity of serum PIVKA-Ⅱwere 69.2% and 76.5%, respectively. Sixty-two(51.2%) of 121 patients with HCC, in which AFP was less than 400ng/mL were PIVKA-Ⅱ positive. The specificity and specificity of serum AFP-L3 were 48.8% and 90.8%, respectively. When AFP-L3 was used in combination with PIVKA-Ⅱ,31(46.3%) of the 67 patients with small less than 3cm HCC were positive for at least one of these markers. Conclusion : PIVKA-Ⅱ measures by sensitive EIA may be useful for the diagnosis of HCC with low AFP level. AFP-L3 and PIVKA-Ⅱ may improve the detection rate of small HCCs less than 3cm.