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홍경욱,이정아,김원진,박철민,권혜리,박혜원,엄중식 대한감염학회 2007 감염과 화학요법 Vol.39 No.5
국내의 토착형 말라리아는 삼일열 말라리아로, 1993년부터 재유행이 시작되었다. 말라리아의 중요한 합병증으로 드물지만 비장 파열이 있는데, 이는 주로 삼일열 말라리아에 의해서 발생되며, 국내에서는 1999년 말라리아에 의한 비장 파열로 비장 절제술을 시행한 예가 보고된 바 있다. 현재까지는 비장 파열이 있을 때 비장 절제술이 일차적인 치료로 되어 있으나, 비장 절제술 후의 감염 위험성이 크므로, 활력 징후가 불안정하거나, 출혈이 지속되는 소견이 보이지 않으면 가급적 보존적 치료를 하는 것이 추천된다. 저자들은 비장 파열이 동반된 말라리아 환자에서 비장 절제술을 시행하지 않고 보존적 치료로 호전된 예를 경험하여 보고하는 바이다. Plasmodium vivax has been the predominant Plasmodium species in the Republic of Korea and reemerged in 1993. Spontaneous rupture of malarial spleen is a rare but important complication associated with P. vivax infection. Only one case of spontaneous rupture of malarial spleen was reported in Korea in 1999. Splenectomy is still accepted as the treatment of choice in cases of spontaneous rupture of the spleen. But, considering increased risk of postsplenectomy infecion, splenectomy should be reserved for those patients with severe rupture or those with continued or recurrent bleeding. And conservative treatment should be considered in selected, closely monitored patients. We report a patient with P. vivax malaria who developed a spontaneous splenic rupture and was improved by conservative treatment.
Clinical effects of tocilizumab in patients with active rheumatoid arthritis
( Jeong-Won Lee ),( Kyung-eun Lee ),( Dong-jin Park ),( Tae-jong Kim ),( Yong-wook Park ),( Shin-seok Lee ),( Ji-eun Kim ),( Ki-jeong Park ),( Hye-mi Jin ),( Young-nan Cho ),( Jeong-hwa Kang ),( Hyun- 대한내과학회 2015 대한내과학회 추계학술대회 Vol.2015 No.1
Objective: The purpose of this study is to evaluate the clinical and hematological effects of tocilizumab in active rheumatoid arthritis (RA) patients. Methods: Fourteen patients with active RA were enrolled in this study. The patients received tocilizumab 8 mg/kg intravenously every four weeks for 6 months. Disease activity, anemia-related factors including serum hepcidin-25, and hematological parameters were monitored at baseline and at 1, 3, and 6 months after the initiation of treatment. Results: Significant reductions in tender joint count, swollen joint count, visual analogue scale, erythrocyte sedimentation rate, C-reactive protein plus reductions in a 28-joint disease activity score were seen within one month after the first tocilizumab treatment. These effects lasted throughout the six-month study period. In addition, significant improvements in anemia related factors such as hepcidin- 25, ferritin, iron, hemoglobin, red blood cell counts and mean corpuscular volume were observed during the treatment period. Moreover, hematological parameters were improved reductions in counts for leukocytes, monocytes, neutrophils, and platelets. The lymphocyte counts and their subset numbers were unchanged. Changes in hepcidin levels significantly correlated with changes in C-reactive protein, erythrocyte sedimentation rate, ferritin, hemoglobin and counts for red blood cells, leukocytes and neutrophils during the treatment period. Conclusions: This study demonstrates that tocilizumab significantly and meaningfully reduces disease burden in patients with active RA patients. In addition, tocilizumab diminishes the levels of inflammatory anemia in the patients by inhibiting hepcidin production. These clinical data provide evidence of a favorable outcome from the tocilizumab in RA.
Reference intervals of thyroid hormones during pregnancy in Korea, an iodine-replete area
( Hye Jeong Kim ),( Yoon Young Cho ),( Sun Wook Kim ),( Tae Hyuk Kim ),( Hye Won Jang ),( Soo-youn Lee ),( Suk-joo Choi ),( Cheong-rae Roh ),( Jong-hwa Kim ),( Jae Hoon Chung ),( Soo-young Oh ) 대한내과학회 2018 The Korean Journal of Internal Medicine Vol.33 No.3
Background/Aims: Maternal thyroid dysfunction has been associated with adverse pregnancy outcomes. The purpose of our study was to establish trimester-specific reference intervals for thyroid hormones in pregnant women in Korea, where iodine intake is more than adequate and to examine pregnancy and perinatal outcomes in their offspring. Methods: Among 459 healthy pregnant women who were screened, we enrolled 417 subjects who had negative results for thyroid autoantibodies. Serum thyroid stimulating hormone (TSH) and free thyroxine were measured using an immunoradiometric assay. Urine iodine concentration was measured using inductively coupled plasma-mass spectrometry in 275 women. Reference ranges of thyroid hormones were determined according to the guidelines of the National Academy of Clinical Biochemistry. Pregnancy and perinatal outcomes were compared according to maternal thyroid function. Results: The reference ranges of serum TSH were 0.03 to 4.24 mIU/L in the first trimester, 0.13 to 4.84 mIU/L in the second trimester, and 0.30 to 5.57 mIU/L in the third trimester. Pregnancy and perinatal outcomes did not vary in mothers with subtle changes in thyroid function. Conclusions: Trimester-specific thyroid hormone reference intervals in Korean pregnant women differ from those of other countries with different iodine nutrition status and ethnicity. The establishment of population-based, reliable trimester-specific reference intervals is critical for the interpretation of thyroid function in pregnant women to avoid unnecessary tests and treatments.