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혈액 투석 환자에서 중심정맥 협착에 대한 스텐트 삽입술 : Wallstent Placement
임대승,노상필,이유선,정승현,김보영,이정우,강정아,김정희,이민수,정준용,최시완,정진옥,성인환,이강욱,신영태 충남대학교 의과대학 의학연구소 2002 충남의대잡지 Vol.29 No.1
Stenosis of central vein is a common complication arising after percutaneous subclavian vein catheter insertion performed for temporary vascular access in chronic renal failure patients undergoing hemodialysis. There are several treatment methods for the condition like percutaneous angioplasty(PTA), stent insertion, and surgery, but recent trend is toward PTA and stents. Among the patients diagnosed with chronic renal failure from March 1993 to May 2002 and undergoing hemodialysis through AV fistula, the 14 Patients in whom central vein stenosis arose were selected for the study. A total of 28 percutaneous interventions(5 PTA and 23 stent placement) were performed, and restenosis rate and the time taken till the restenosis in de novo lesions and instant lesions were compared. All 28 cases were operated successfully. The 14 cases that received both anigioplasty and stent placement initially. (de novo lesion : 14 cases), Among the 10 cases with de novo lesion that followed up more than 1 year, 3 cases are currently undergoing hemodialysis without restenosis, and the remaining 7 cases have recurred stenosis with the mean time to restenosis of 10.9 months. In the 7 cases in whom stenosis recurred, 11 interventions were done(instent lesion: 11 cases). 4 of these were using only ballon angioplasty with 100% restenosis rate and the mean time of 3 months until restenosis. The remaining 7 cases were using both balloon angioplasty and stent placement, also with 100% restenosis rate but with the mean time of 12 months until restenosis, which was later than the group receiving only balloon angioplasty. In treating the patients with central vein stenosis, stent placement seems to be more advantageous over PTA in terms of restenosis rate and the mean duration of patency. In the case of instent lesion, inserting the stent for the second time after stenosis recurred lengthened the duration of patency compared to performing balloon angioplasty alone.
뇌졸중 환자에게 적용된 흡기근 훈련에 관한 국내 연구 동향 분석 : 체계적 고찰
유영대(Young-Dae Yoo),양회송(Hoe-song Yang),정찬주(Chan-Joo Jeong),강효정(Hyo-Jung Kang),김민규(Min-Kyu Kim) 대한심장호흡물리치료학회 2021 대한심장호흡물리치료학회지 Vol.9 No.2
Purpose : This study aimed to analyze the effectiveness of inspiratory muscle training(IMT) studies for stroke patients conducted over the past 10 years(2011–2020) in Korea. Methods : Previous literature was electronically searched using the RISS, KISS, KCI, and NDSL databases. Tree databases were searched for stroke IMT articles. A total of 12 studies were selected according to the PRISMA guidelines, and the Jeong’g qualitative evaluation criteria were used to refer to the checklist presented by the Scottish Intercollegiate Guideline Network. Results : Twelve studies met the criteria. In a qualitative evaluation on the papers, one study scored 8 out of 10, seven scored between 6 and 7, and four scored 5. Intervention sessions were conducted between 20 and 30 min, each at a frequency of three to five sessions per week, for a total of 4–8 weeks. The results indicated that IMT effectively improved respiratory function, physical activity, and respiratory muscle function in stroke patients. Conclusion : IMT was found to have a positive effect on respiratory function, physical activity, and respiratory muscle function in stroke patients.
남성화를 보이는 여성에서 발견된 난소의 Steroid Cell Tumor 1예
조인호,정대훈,박영미,서영진,손영실,정철회,강영미,정수전,김영남,이경복,성문수,김기태 인제대학교 2006 仁濟醫學 Vol.27 No.-
Steroid cell tumor is a rare ovarian sex cord-stromal tumor which accounts for 0.1% of all ovarian tumors. Until now, only 4 cases have been reported in domestic literatures. Steroid cell tumor often secrets testosterone and presents virilization in adult women or precocious puberty in children. Treatment is often performed by surgical removal, adjuvant chemotherapy and radiation, but completely accepted treatment was not existed. We experienced a case of steroid cell tumor, which was manifested by typical virilization in a 43-year old patient, who was previously performed hysterectomy and unilateral oophorectomy. So, we present with a brief review of the literatures.
쌍태아에서 제 1태아의 분만 후 제 2태아의 지연분만 : 중례보고
김주환,서민정,유희정,노권일,조대현,박정규,이정헌,조성남,손영수 朝鮮大學校 附設 醫學硏究所 2005 The Medical Journal of Chosun University Vol.30 No.3
With the widespread use of fertility medications and techniques of in vitro fertilization, multiple gestation has become epidemic in modern obstetric practice. Delivery of the initial fetus in a multiple gestation usually is followed by delivery of the subsequent fetus or fetuses shortly thereafter. However in rare circumstances, the delivery is delayed for days due to disappearance of uterine contraction after delivery of the first fetus. When uterine activity ceases after the delivery of the first neonate, a policy of nonintervention may be considered in case of an immature or very premature delivery, in order to achieve a gestational age for the remaining fetus(es) more compatible with neonatal survival. We report a case of twin gestation with prolongation of the delivery interval between the twins for 46 days.
정종식,김정대,이재복 대한상하수도학회 2003 상하수도학회지 Vol.17 No.6
Objectives of this study were to investigate the characteristics of average flow rate, average specific resistance, cake compressibility coefficient, and medium resistance in order to estimate the dewaterability of sludge by electrodewatering for waterworks sludge. Applied sludge pretreatment processes for this research were chemical coagulation, electrocoagulation, and electrolysis. The process of filtration was performed using pressure filtration or electrodewatering. The average flow rate depends upon the pressure drop in pressure filtration. When the electrodewatering process was applied, the average specific resistance was not increased with pressure increase. The cake compressibility coefficient was 0.75 for the thickened sludge, and was 0.51 for the pretreated sludge by electrocoagulation. It was observed that the medium resistance was increased with pressure drop. Electrocoagulation or electrolysis as sludge pretreatment technique and the electrodewatering were evaluated as the most effective combination system through the analysis of average specific resistance, cake compressibility coefficient, and medium resistance.
정지용,윤나라,강대웅,오종찬,장재현,선길홍,박경희,정종훈,김현리 朝鮮大學校 附設 醫學硏究所 2005 The Medical Journal of Chosun University Vol.30 No.1
Aplastic anemia is a disease characterized by pancytopenia in the peripheral blood and hypocellular bone marrow with the fatty infiltration. The causes of the acquired aplastic anemia were usually related to drugs and immune-related diseases. A 34-years old man was admitted due to general weakness. He has been going hemodialysis for 2 years because of end stage renal disease (ESRD) due to chronic glomerulonephritis. At admission, laboratory tests showed hemoglobin 6.2 g/dL, hematocrit 18.0 %, WBC 5,710mm (neutrophil 71.8%, lymphocyte 19.1%, monocyte 5.9%), reticulocyte 1.9%, platelet 93,000/mm, Fe 12.8 ug/dL, TIBC 204 ug/dL, ferritin 941.47 ng /ml, haptoglobin 0.72 g/L, vitamin B12 508.17 pmol/L, folate 24 ng/mL, total protein 6.54 g/dL, albumin 3.76 g/dL, Alk. pohsphatase 79 IU/L, AST 30.0 IU/L, ALT 39.7 IU/L, total bilirubin 0.57 mg/dl, BUN 79.4 mg/dl and creatinine 10.18 mg/dl. Peripheral blood smear showed the normocytic normochromic anemia with anisocytosis. Anemia was diagnosed but it was irresponsive to the recombinant human erythropoietin (EPO) and blood transfusion. In the bone marrow aspiration smear were there the hypoplastic myeloid and erythroid precursors. The bone marrow biopsy section showed the hypoplasia of all components (10-20%) and the fatty infiltration. We have experienced one case of the idiopathic aplastic anemia in a patient going through hemodialysis and we just report it with documentary records. 저자들은 혈액 투석 중인 환자에서 약물, 면역계 이상등의 원인을 발견할 수 없었음에도 재생 불량성 빈혈이 발생한 1예를 경험하여 문헌 고찰과 함께 보고하는 바이다.
Multiple Spinal Intradural Schwannomas Combined with Sequestered Lumbar Disc Herniation
김대용,김진욱,정주호,조재훈 고신대학교 의과대학 2008 고신대학교 의과대학 학술지 Vol.23 No.2
In this report, we describe a case of multiple intradural schwannomas in the spine combined with a upward sequestered disc herniation at L4-L5. It is often difficult to differentiate this tumor from lumbar disc herniation, especially a sequestered hernia. Gadolinium-enhanced MR images were a useful preoperative examination modality for differentiating these lesions from other diseases. Microscopically, the intradural tumors were successfully removed. The dura maters of the L2 and S1 were opened microsurgically, allowing the nerve fibers involved in the tumor to be identified. The involved fibers were cut around the tumor, and the lesion was resected while the intact nerve fibers were preserved. An upward sequestered lumbar disc herniation at L4-L5 was also successfully removed. Based on histological examination of the resected specimen, the tumors were diagnosed as schwannomas. Microsurgery allowed the tumors to be removed with minimal impairment from cutting of nerve fibers in the each nerve root.
HBeAg 음성 만성 B형 간질환에서 Lamivudine의 치료 효과
정인두,박능화,김병철,박지현,서광원,김대현,주광로,김도하 대한간학회 2003 Clinical and Molecular Hepatology(대한간학회지) Vol.9 No.2
목적: HBeAg 음성 만성 B형 간질환 환자에서 라미부딘 치료 효과, 내성 발생률, 치료 종료 후 재발률 및 각각의 예측 인자를 알아보고자 하였다. 대상과방법: HBeAg 음성, anti-HBe 양성이나 HBV DNA가 양성인 HBeAg 음성 만성 B형 간질환으로 진단 받은 환자 중에서 혈청 ALT치가 상승되어 있는 59명을 대상으로 라미부딘을 1일 100mg씩 6개월(평균 14개월)이상 투여하였다. 평균 연령은 42.1세였고 남녀 비는 52:7이였다. 치료 전 혈청 ALT평균치는 368 IU/L, HBV DNA평균치는 494 pg/mL였다. 치료 전, 치료 개시 후 및 종료후 1-2개월 간격으로 간기능 검사, HBeAg, anti-HBe, HBV DNA를 측정하였다. 치료 반응군은 반응이 일어난 시점을 기준으로 1-2개월 간격으로 2번 이상 반응이 유지되는 것을 확인한 후 투약을 중지하고 재발 유무를 추적 관찰하였다. 결과: 라미부딘 투여 후 50명 중 56명(94.9%)에서 혈청 HBV DNA가 음전되었으며 누적 음전율은 1개월후 27%, 2개월 후 71%, 3개월 후 90%, 5개월 후 95%였다. 혈청 ALT치는 52명(88.2%)에서 정상으로 회복되었으며 대부분 6개월 내에 이루어졌다. 혈청 ALT치의 누적 정상화율은 2개월 후 30%, 3개월 후 47%, 6개월 후 78%, 10개월 후 86%였다. 혈청 HBV DNA가 음전되고 혈청 ALT치가 정상으로 유지된 치료 반응은 52예(88.1%)에서 일어났으며, 누적 치료반응률은 2개월 후 10%, 4개월 후 49%, 6개월 후 66%, 10개월 후 80%, 18개월 후 88%였다. 라미부딘 총 투여 기간이 유일한 치료 반응 예측 인자였다(p=0.000). 변이형의 출현은 5예(8.5%)에서 일어났고 누적 발생률은 10개월 후 8%, 16개월 후 13%였다. Breakthrough발생 예측인자와 관련된 유의한 인자는 없었다. 치료 반응군중 투여 중지한 34명 중 17명(50%)에서 재발하였으며(평균추적기간: 6개월, 범위: 1-22개월) 대부분 투여중지 6개월 내에 재발하였다. 누적 재발률은 3개월 후 24%, 6개월 후 47%, 10개월 후 66%였다. 재발과 관련된 예측 인자는 치료 반응후 추가적인 라미부딘 누여만이 유의한 인자였다(p=0.019). 특히 12개월 이상 유지한 7명 모두에서 재발하지 않았다. 결론: 라미부딘은 HBeAg 음성 만성 B형 간질환에서 높은 치료효과와 낮은 breakthrough를 보였으며 라미부딘 투여 기간만이 유일한 치료 반응 예측 인자이었다. 그러나 치료 종료 후 많은 예에서 재발하였으며 치료 반응 후 추가적인 라미부딘 투여 기간만이 유일한 재발 예측 인자였으며 재발을 막기 위해서는 장기간의 추가적인 라미부딘 투여가 필요할 것으로 사료된다. Background/Aims: Lamivudine therapy is effective in inhibiting HBV replications in patients with HBeAg-negative chronic liver disease. However, the sustained response rate appears to be particularly poor, because the vast majority of patients relapse soon after cessation of therapy. The aim of this study was to evaluate the efficacy of lamivudine, the breakthrough rate, and the relapse rate of discontinuing therapy after response in patients with HBeAg-negative chronic liver disease. Methods: Fifty-nine patients with HBeAg-negative chronic liver disease who have received lamivudine for at least 6 months, were studied. The mean duration of treatment was 14 months. Complete response was defined as undetectable serum HBV DNA by bDNA and normalization of ALT levels. Once HBV DNA disappearance and ALT normalization were observed, lamivudine therapy was continued for at least two additional months. The mean follow-up after cessation of treatment was 6 (1-22) months. Results: Fifty-six patients were undetectable HBV DNA. The cumulative HBV DNA loss rates at 3 months and 5 months were 90% and 95%, respectively. The ALT normalization was observed in 52 patients. The cumulative ALT normalization rates at 6 months and 10 months were 78% and 86%, respectively. The complete response was observed in 52 patients. The cumulative rates of complete response at 10 months and 18 months were 80% and 88%, respectively. A predictive factor for complete response was only the duration of lamivudine treatment. Virological breakthrough was observed in 5 (8.5%). Thirty-four patients stopped taking lamivudine after 7.7 (2-15) months of the additional therapy. Seventeen of those patients (50%) experienced relapse. The cumulative relapse rates at 3 months, 6 months and 10 months were 24%, 47% and 66%, respectively. The only predictive factor for relapse was the duration of additional lamivudine treatment after response. Conclusions: Lamivudine was an effective treatment of HBeAg negative chronic liver disease. Relapse, however, was usually observed after cessation of lamivudine. Our results showed that long-term lamivudine therapy is required in order to decrease the high relapse rates in patients with HBeAg-negative chronic liver disease.