증례 : 류마티스 ; 류마티스관절염 양상으로 발현된 말초 골결핵 1예

곽주희 ( Joo Hee Kwak ),이주현 ( Joo Hyun Lee ),김상헌 ( Sang Heon Kim ),주경빈 ( Kyung Bin Joo ),전재범 ( Jae Bum Jun ),성윤경 ( Yoon Kyoung Sung ) 대한내과학회 2014 대한내과학회지 Vol.87 No.3

A 30 year-old female visited our out-patient clinic with painful joint swelling in both hands and feet. Because she had tested positive for rheumatoid factor, and her inflammatory markers were elevated, the case was initially classified as rheumatoid arthritis RA), according to the 2010 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) classification criteria. However, radiographic examinations, including simple radiography and MRI, revealed that her peripheral bone lesions were compatible with bone tuberculosis. The patient also exhibited pulmonary tuberculosis (TB) on chest X-ray and CT examinations. She was treated with isoniazid (INH), rifampicin (RFP), ethambutol (EMB), and pyrazinamide (PZA), and exhibited a good response to these medications. The patient was diagnosed as having bone TB, and her peripheral bone lesions were resolved using anti-TB treatment. This was an uncommon case of bone TB mimicking RA. (Korean J Med 2014;87:373-378)

자기공명 영상 및 3차원 영상을 이용한 견관절 관절낭-인대의 해부학적 연구. 역동학적 생체연구

박태수,최일용,주경빈,김선일,김준식,백두진,Park Tae-Soo,Choi Il-Yong,Joo Kyung-Bin,Kim Sun-Il,Kim Jun-Sic,Paik Doo-Jin 대한관절경학회 2000 대한관절경학회지 Vol.4 No.2

목적 : 정상견관절의 각기 다른 위치에 따른 관절와 상완 인대들의 해부학적 구조 변화를 관찰하고자 하였다. 대상 및 방법 : 정상 견관절 9례에 대하여 생리식염수를 주입하고 외전 및 외 회전의 위치를 달리하여(각각 $0^{\circ}$ 및 $0^{\circ},\;45^{\circ}$ 및 $25^{\circ},\;90^{\circ}$ 및 최대 외 회전) 자기공명 영상을 각각 촬영하고 이를 이용하여 3차원 영상을 재구성한 후 관절와상완 인대 특히 중 및 하 관절와 상완 인대를 관찰하였다. 결과:. 중 관절와 상완 인대는 $0^{\circ}$ 외전 및 $0^{\circ}$ 외 회전시 상완골 두의 전면 적도를 중심으로 상하부에 걸쳐 이중 곡선 모양으로 비스듬히 위치하였다가, 외전 및 외 회전이 점차 증가하여 $45^{\circ}$ 및 $25^{\circ}$에 이르면 점차 상완골 두의 전면 적도 부근에 신장되어 거의 직선에 가까운 비스듬한 주행을 보였으며, $90^{\circ}$ 외전 및 최대 외회전시 상완골 두의 전면 적도의 상부 위치에 다시 곡선 모양을 보였다. 반면 하 관절와 상완 인대는 $0^{\circ}$ 외전 및 $0^{\circ}$ 외 회전시 상완골 두의 전면 하부에서 완만한 곡선 모양으로 위치하였으며, 외전 및 외회전이 증가함에 따라 상완골 두의 전면 적도 아래에 위치하면서 아래쪽으로 볼록한 곡선 모양을 보였다가, $90^{\circ}$ 외전 및 최대 외 회전시 상완골 두의 전면 하부에 거의 직선에 가깝도록 신장되어 비스듬히 위치하였다. 결론 : 견관절을 $45^{\circ}$ 외전 및 $25^{\circ}$ 외 회전 할 때와 $90^{\circ}$ 외전 및 최대 외 회전 시 중 관절와 상완 인대 및 하 관절와 상완 인대가 각각 신장되어 관절와 상완 관절의 중요한 정적 안정화 구조물로서 작용한다고 사료된다. Purpose : The purpose of this study is to demonstrate changes in the orientation ortho glenohumeral ligaments(GHL) in different degrees of abduction and rotation of the normal healthy individuals. Materials and Methods : Saline Magnetic Resonance(MR) arthrography of nine consecutive shoulders of normal healthy adults were checked. At that time, MR images were obtained in three different positions of abduction and external rotation($0^{\circ}C\;and\;0^{\circ},\;45^{\circ}C\;and\;25^{\circ}C,\;90^{\circ}$ and maximum, respectively). From a series of consecutive MRI, three-dimensional images were reconstructed after detecting the location of the middle glenohumeral ligament(MGHL) and the inferior glenohumeral ligament(IGHL) using workstation computer. Results : The shape of the MGHL was taken in double curved, and straight, and finally curved again in three different positions of the shoulder in sequence. On the other hand, the shape of the IGHL was obliquely positioned, and curvilinear, and finally straight and extended at lower part of the anterior surface of the humeral head. Conclusions : At $45^{\circ}$ of abduction and $25^{\circ}$ of external rotation, and at $90^{\circ}$ of abduction and maximal external rotation of the shoulder, the MGHL and the IGHL had the role of the most important static stabilizer of the glenohumeral joint repectively.

소아 급성 림프구성 백혈병의 치료 중간파 후에 보이는 뇌의 이상 영상 소견

이경주,이승로,박동우,주경빈,김장욱,함창곡,김기중,이항,Lee, Kyung-Joo,Lee, Seung-Rho,Park, Dong-Woo,Joo, Kyung-Bin,Kim, Jang-Wook,Hahm, Chang-Kok,Kim, Ki-Joong,Lee, Hahng 대한영상의학회 2001 대한영상의학회지 Vol.45 No.3

목적: 소아 급성 림프구성 백혈병의 치료 중간과 후에 발생될 수 있는 뇌의 영상 이상을 알아보고자 하였다. 대상과 방법: 소아 급성 림프구성 백혈병 환자 중 최근 10년간 백혈병의 중추 신경계 재발에 대한 예방적 치료를 받고, 진단 당시 뇌에 대한 컴퓨터 단층 촬영으로 기본 영상 검사를 시행한 후, 중추신경계 증상 유무와 상관없이 1회 이상추적 검사를 한 30명(남아 여아 = 19 : 11, 평균 연령 64개월)을 대상으로 하였다. 이중 뇌에 이상 영상 소견을 보인 경우는 영상 이상의 종류. 치료 방법 . 연관된 중추 신경계 증상. 최초의 진단일 에서 뇌에 이상 영상이 발견될 때까지의 기간 등을 후향적으로 분석하였다 결과: 30명중 15명(50%; 남아 여아 = 9 6, 평균 연령 77개월)에서 뇌 이상 영상 소견이 보였는데 뇌 위축이 9예, 뇌 경색이 4예. 뇌 출혈이 1예, 무기질 침착성 미세혈관병증이 2예, 백질 연화증이 3예였다. 뇌 위축이 있었던 9명 중 4명에서는 다른 영상 이상이 동반되었는데, 백질 연화증 2예, 경색 1예. 미세혈관병증이 1예였다. 뇌척수액에서 백혈병 세포가 발견된 1명을 제외한 14명은 동일한 치료를 받았다. 중추 신경계 증상은 6명에서 있었다. 뇌 이상 영상이 있었던 15명에서 이상 영상이 발견될 때까지의 기간은 1개월에서 4년까지였다. 뇌 위축을 보인 1명을 제외한 14명에서 이상 영상 소견이 치료 종결 후에도 남아 있었다. 결론: 소아 급성 림프구성 백혈병 치료중간과 후에 다양한 뇌 이상 영상이 나타나고 장기간 지속되므로. 급성 림프구성 백혈병 환자들의 뇌 이상을 평가하기 위해 추적 검사가 필요하리라 생각된다 Purpose: We evaluated the imaging abnormalities of the brain observed during and after treatment of acute childhood Iymphoblastic leukemia. Materials and Methods: The study group consisted of 30patients (male: female = 19:11; mean age, 64months) with acute childhood Iymphoblastic leukemia during the precious ten-year period who had undergone prophylaxis of the central nervous system. Irrespective of the CNS symptoms, base-line study of the brain involving CT and follow-up CT or MRI was undertaken more than once. We retrospectively evaluated the imaging findings, methods of treatment, associated CNS symptoms, and the interval between diagnosis and the time at which brain abnormalities were revealed by imaging studies. Results: In 15(50% ; male female =9:6 ; mean age,77months) of 30 patients, brain abnormalities that included brain atrophy (n = 9), cerebral infarctions (n=4), intracranial hemorrhage (n = 11, mineralizing microangiopathy (n =2), and periventricular leukomalacia (n= 3) were seen on follow-up CT or MR images. In four of nine patients with brain atrophy, imaging abnormalities such as periventricular leukomalacia(n = 2), infarction (n= 1) and microangiopathy (n= 1) were demonstrated. Fourteen of the 15 patients underwent similar treatment; the one excluded had leukemic cells in the CSF. Six patients had CNS symptoms. In the 15 patients with abnormal brain imaging findings, the interval between diagnosis and the demonstration of brain abnormalities was between one month and four years. After the cessation of treatment, imaging abnormalities remained in all patients except one with brain atrophy Conclusion: Various imaging abnormalities of the brain may be seen during and after the treatment of acute childhood Iymphoblastic leukemia and persist for a long time. In children with this condition, the assessment of brain abnormalities requires follow-up study of the brain.

일차성 부갑상선 기능항진증으로 인한 칼슘피로인산 결정침착 질환

손창남 ( Chang Nam Son ),이지영 ( I Young Lee ),김담 ( Dam Kim ),주경빈 ( Kyung Bin Joo ),이승훈 ( Seunghun Lee ),송영수 ( Young Soo Song ),김동선 ( Dong Sun Kim ),태경 ( Kyung Tae ),유태석 ( Tae Seok Yoo ),전재범 ( Jae Bum Jun 대한류마티스학회 2014 대한류마티스학회지 Vol.21 No.2

Calcium pyrophosphate dihydrate (CPPD) deposition disease is a heterogeneous group of diseases with CPPD crystal deposition. Aging is the most common risk factor for CPPD deposition, followed by osteoarthritis and previous injury. Occasionally, CPPD depositions are associated with familial predisposition and metabolic diseases, including hemochromatosis, primary hyperparathyroidism, hypophosphatasia, and hypomagnesemia. CPPD deposition diseases associated with primary hyperparathyroidism in Koreans have rarely been reported. Thus, we report a case of a relatively young female patient with CPPD deposition disease associated with primary hyperparathyroidism, which was diagnosed through a polarized microscopic examination of the synovial fluid and a subtotal parathyroidectomy.

요추와 엉치엉덩관절염을 동반한 통풍

방소영 ( So Young Bang ),정종헌 ( Jong Heon Jeong ),주경빈 ( Kyung Bin Joo ),전재범 ( Jae Bum Jun ),성윤경 ( Yoon Kyoung Sung ) 대한류마티스학회 2009 대한류마티스학회지 Vol.16 No.4

Although gout often initially affects the peripheral joints, gout may also involve the axial joints. The radiologic changes of axial gout are more common than are clinically recognized. According to a recent report, when the spine CT images of peripheral gout were reviewed for features of axial gout, there was about a 14% frequency of suspected axial gout. The vertebral level and the finding with the most common spinal gouty changes were L4 and lumbar facet joint erosions. We describe here the case of a 36-year-old gout patient with low back and right buttock pain and his lesions were unexpectedly diagnostic of lumbar facet joint arthritis and right sacroiliitis.

소아의 고관절 질환에서 초음파 검사의 임상적 이용

김성준(Sung Joon Kim),황건성(Kuhn Sung Whang),정현기(Hyun Kee Chung),주경빈(Kyung Bin Joo),임종선(Jong Sun Leem) 대한정형외과학회 1989 대한정형외과학회지 Vol.24 No.1

류마티스 관절염 환자에서 혈청 creatine kinase의 활성도

전재범 ( Jae Bum Jun ),황관표 ( Kwan Pyo Hong ),김태환 ( Tae Hwan Kim ),정성수 ( Sung Soo Jung ),이인홍 ( In Hong Lee ),배상철 ( Sang Cheol Bae ),유대현 ( Dae Hyun Yoo ),주경빈 ( Kyung Bin Joo ),김성윤 ( Seong Yoon Kim ) 대한류마티스학회 1997 대한류마티스학회지 Vol.4 No.1

Objective: Our objective was (1) to determine if serum creatine kinase (CK) activity is reduced in rheumatoid arthritis (RA) compared with that of noninflammatory rheumatic diseases, (2) to examine the recently described association of low CK activity and disease variables in our RA population, and (3) to examine the influence of steroid on serum CK activity in patients with RA. Methods: Cross sectional and longitudinal retrospective analyses of clinical and biochemical data of consecutive patients with RA and noninflammatory arthropathies. In all subjects we evaulated age, sex, weight, and, only for patients with RA, history of use of corticosteroids and Ritchie index. C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), hemoglobin, and platelet count were simultaneously determined as variables of disease activity. CK activity was determined by automated biochemical analyzer (Hitachi 747, Japan). Results: Serum CK activity was significantly reduced in RA (mean±SD: 45.7±24.2 IU/L) compared to controls (81.3±33.9 IU/L) (p<0.001). Ritchie index, CRP, and platelet count correlated inversely with CK values (correlation coefficient: -0.31, p<0.01; -0.45, p<0.001; -0.42, p<0.001, respectively). Patients taking steroids had lower CK activity than those without steroid, but not statistically significant. Conclusion: Serum CK activity is significantly reduced in RA. Serum CK activity correlates well with various indices of disease activity for rheumatoid arthritis. So, Inflammatory activity seems to play the major role in this phenomenon. Multiple regression analysis showed that CRP, but not steroids, was the major independent factor influencing CK activity.

신경학적 증상 없이 통풍성 관절염만으로 발현된 Lesch-Nyhan Syndrome 1례

여유미 ( Yoo Mi Yeo ),최은영 ( Eun Young Choi ),윤혜진 ( Hyae Jin Yoon ),정소담 ( So Dam Jung ),김담 ( Dam Kim ),이승훈 ( Seung Hun Lee ),주경빈 ( Kyung Bin Joo ),전재범 ( Jae Bum Jun ) 대한류마티스학회 2014 대한류마티스학회지 Vol.21 No.4

Deficiency of hypoxanthine-guanine phosphoribosyltrans-ferase is a purine nucleotide disorder and is the most common genetic cause of uric acid overproduction. This disease has a wide range of spectrum with regard to neurological features depending on the extent of the enzymatic deficiency. Complete deficiency of hypoxanthine-guanine phosphoribosyltransferase, called Lesch-Nyhan syndrome, is presented with hyperuricemia and characteristic neurological manifestation and self-mutilation. Partial hypoxanthine-guanine phosphoribosyltransferase--deficient patients are presented with a various intensities of the aforementioned symptoms, from almost normal neurologic manifestation to a severe form along with hyperuricemia. We report a twenty-year-old man with complete hypoxanthine- guanine phosphoribosyltrans-ferase mutation and Lesch-Nyhan sydrome, who manifested gouty arthritis without neurologic symptom.

폐경 여성에서 호르몬 대체 요법과 Tibolone 투여 후 유방 엑스선 사진의 변화

김성희 ( Sung Hee Kim ),이성훈 ( Sung Hoon Lee ),최재호 ( Jae Ho Choi ),남동국 ( Dong Guk Nam ),김훈일 ( Moon Zi Kim ),김관우 ( Kwan Woo Kim ),주경빈 ( Kyung Bin Joo ),조수현 ( Su Hyun Jo ) 대한폐경학회 2004 대한폐경학회지 Vol.10 No.2

한국인에서 류마토이드 관절염과 제 2 형 조직적합항원과의 연관성에 관한 연구

유대현(Dae Hyun Yoo),서정대(Jeong Dai Suh),배상철(Sang Cheol Bae),김성윤(Seong Yoon Kim),김목현(Mok Hyun Kim),김신규(Thin Kyou Kim),주경빈(Kyung Bin Joo) 대한내과학회 1991 대한내과학회지 Vol.40 No.5

N/A Rheumatoid arthritis is a chronic inflammatory disease characterized as destructive polyarthritis and has evidence of immunogenetic and environmental elements in its etiologic factors. Many studies document that one of the key genetic elements is closely linked to the class II major histocompatibility complex located in chromosome 6. Although it is not. known precisely how HLA genes contribute to disease susceptibility, many studies document a close association between rheumatoid arthritis and the specific histocompatibility marker, HLA-DR4. However, studies of HLA-DR4 in disease severity have yielded conflictiing results. Association between HLA- DR4 and the rheumatoid factor, earlier age of onset, increased general disease severity and more erosive radiographic changes have been reported, but these associations have not been confirmed in other studies. In addition, there has been no report regarding the association between rheumatoid arthritis and class II MHC in Koreans. Therefore this is the first epidemiologic study regarding the association between rheumatoid arthritis and class II MHC. The disrtibution of class II major histocompatibility complex and association between HLA- DR4 and disease severity were analyzed in 206 Korean patients with rheumatoid arthritis in this study. The results were as follows: 1) HLA-DR4 was associated with rheumatoid arthritis in 61.6% of the patients studied. The relative risk and etiologic fraction of HLA-DR4 were 2.47 and 0.367, respectively. HLA-DR1 was positive in 11.1% and the etiologic fraction of HLA-DR1 was 0.008. Therefore HLA-DR4 was associated strongly with rheumatoid arthritis in Koreans, similar to other ethnic populations, but HLA-DR1 was not associated with rheumatoid arthritis in Koreans. 2) HLA-DR2 was positive in 19.9% and the preventive fraction of HLA-DR2 was 0.205. HLA-DR7 was positive in 4.3% and the preventive fraction of HLA- DR7 was 0.011. Hence HLA-DR2 was the most preventive class II MHC against the development of rheumatoid arthritis in this study. 3) HLA-Dgw3 was positive in 62.1% and the relative risk of HLA-DQw3 was 1.65, HLA-DQw7, which was known as HLA-DQw3.1, was positive in 20.5% and HLA-DR4 Dgw7 haplotype was positive in 15% of the total number of patients. 4) HLA-DR4 was significantly associated with a more advanced ARA anatomical grade and more severe radiographic changes, including bony erosion, joint space, narrowing and total radiographic score. 5) The rheumatoid facor was positive in 84.3% of the HLA-DR4 positive patients and positive in 82.3% of the HLA-DR4 negative patients. HLA-DR4 v as positive in 62.2% of the 172 seropositive patients and positive in 58.8% of the 34 seronegative patients. Therefore HLA-DR4 was not associated significantly with the presence of a rheumatoid factor in this study. 6) HLA-DR4 was not associated significantly with joint count (Ritchie index), ARA functional class, ESR, C-reactive protein or other demographic data. HLA-DR4 was not associated significantly with the positive rate of ANA, cryoglobulin. 7) Homozygous HLA-DR4 patients were 31 out of 127 DR4-positive patients and showed more advanced ARA anatomical stage and radiographic changes than heterozygous DR4 patients, but the difference was statistically insignificant. In summary, HLA-DR4 was significantly associated with rheumatoid arthritis in Koreans, similar to other ethnic populations, Also HLA-DR4 was significantly associated with more destructive arthritis, but not associated with rheumatoid factor positivity and the parameters representing disease activity of rheumatoid arthritis.