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윤녕훈,박석돈 圓光大學校 醫科學硏究所 2002 圓光醫科學 Vol.17 No.2
배경 : 펠라그라는 피부와 위장관, 신경계를 침범하는 만성 질환으로, niacin이나 이의 전구체인 트립토판 결핍이 주요 원인이다. 서구에서는 대부분의 환자가 알콜 중독자에서 발생하는 것으로 알려져 있다. 목적 : 저자들은 펠라그라 환자의 임상적 특징 및 원인, 조직학적 특징을 알아보고자 하였다. 방법 : 1985년 1월부터 2002년 6월까지 약 18년동안, 펠라그라로 진단된 26명의 임상기록과 임상사진, 조직 슬라이드를 후향적으로 검토하여 평균 연령, 성별, 피부염의 형태, 동반 증상, 조직 소견 등을 분석하였다. 결과 : 1. 남녀 비는 3.3:1로 남자에서 많이 발생하였으며, 평균 연령은 61세였다. 2. 만성적인 음주에 의한 경우(69%)와 결핵약(isoniazid) 복용(15%)이 가장 많은 발생 원인이었다. 3. 노출 부위에 홍반을 보이는 광과민성 발진(100%)과 뼈 돌출부위의 비후 또는 색소 침착(12%)이 흔한 피부염의 형태였다. 4. 설사와 식욕 부진, 변비 등의 소화기 증상이 5명(20%)에서 발생하였고, 손의 진전, 진전 섬망, 인격 장애 같은 신경계 증상이 8명(32%)에서 동반되었다. 5. 피부 병변은 손등에 발생한 경우가 23예(88%)로 가장 많은 부위를 차지하였고, 발등 15예(58%), 그리고, 팔과 얼굴 등에 발생하였다. 6. 과각화증(94%)과 혈관 확장 및 혈관 주위 염증 세포 침윤(94%), 기저 세포의 공포성 변성(47%), 표피내 공포성 변화(41%) 등이 흔한 병리조직학적 소견이었다. 결론 : 대부분의 환자는 만성적인 음주를 하는 남자였으며, 직업은 농업이 가장 많았다. 광과민성 발진이 가장 흔한 피부염이었으며, 주로 여름과 가을에 악화되는 특징을 보였다. Background : Pellagra is chronic disease affecting the skin, the gastrointestinal tract and the nervous system, which is caused by a deficiency of niacin or its precursor, the essential amino acid, tryptophan. In the developed countries, most cases of pellagra occur in alcoholics. Objective : The purpose of this study was to elucidate the clinical and histopathological features of pellagra in Korea. Methods : During 18-year-period from 1985 to June, 2002, the clinical charts, photographics and histopathological finding of 26 patients which was clinically diagnosed as pellagra were reviewed. And also age and sex distribution, clinical types of dermatitis associated symptoms and histopathological findings were evaluated. Results : 1. The male to female ratio was 3.3:1. The average age was 61 years old. 2. Chronic alcoholism (69%) and antituberculosis drug (isoniazid)(15%) were by far the most common etiologic factors. 3. The common clinical features were photosensitive eruption (100%), thickening and pigmentation over bony prominences (12%). 4. Gastrointestinal symptoms including diarrhea, anorexia, and constipation occurred in 5 patients (20%). Eight patients (32%) developed neurologic symptoms such as tremor, personality disorder, and delirium tremens. 5. The skin lesions occurred on the backs of the hands (88%), backs of the feet (58%), arms and face, in decreasing order of frequency 6. The frequent histopathologic findings were perivascular lymphocytic inflammatory infiltrate and telangiectasia (94%), hyperkeratosis (94%), vacuolar degeneration of the basal layer (47%), vacuolar change of the keratinocytes in the upper layer of the stratum malpighii (41%). Conculsion : Most cases of pellagra occur in male farmer with alcoholics. The most characteristic skin lesion is the photosensitive skin eruption, which worsens in the summer and autumn.
( Jin Nyoung Kim ),( Jae Young Jang ),( Soung Won Jeong ),( Jin Woo Choo ),( Soon Ha Kwon ),( Sae Hwan Lee ),( Sang Gyune Kim ),( Sang Woo Cha ),( Young Seok Kim ),( Young Deok Cho ),( Hong Soo Kim ) 대한간학회 2012 춘·추계 학술대회 (KASL) Vol.2012 No.1
Background/Aim: Detection and characterization of focal lesions in the liver is critical for screening patients with liver cirrhosis. The aim of this study was to investigate the sensitivity of magnetic resonance imaging (MRI) and spiral computed tomography (CT) for the diagnosis of hepatocellular carcinoma (HCC) and relation between radiologic findings and histopathology in HCC. Methods: One hundred four consecutive patients with HCC diagnosed by liver biopsy or hepatectomy were included. Radiologic findings such as CT and MRI were compared with histopathology. Typical radiologic finding of HCC was defined as early enhancement and early wash-out. Tumor cell differentiation was evaluated using Edmondson-Steiner criteria in liver cores. Results: Thirty one HCCs (29.8%) were grade 1 and 2, seventy three HCCs (70.9%) were grade 3 and 4. The sensitivity for detection of HCC was 83.7% for CT alone, 92.9% for MRI alone, 87.9% for both CT and MRI together, and 96% for either CT or MRI. Typical radiologic finding of HCC on CT has a tendency of well differentiated HCC (p=0.060), and typical findings of HCC on CT and MRI showed a significantly increased well differentiated HCC (p=0.013). Clinical variables were no significantly different according to the histopathology. Conclusion: Typical early enhancement and early wash-out pattern on CT and MRI showed a significantly increased well differentiated hepatocellular carcinoma on histopathology.
( Jin Nyoung Kim ),( Jae Young Jang ),( Soung Won Jeong ),( Jin Woo Choo ),( Soon Ha Kwon ),( Sae Hwan Lee ),( Sang Gyune Kim ),( Sang Woo Cha ),( Young Seok Kim ),( Young Deok Cho ),( Hong Soo Kim ) 대한간학회 2012 춘·추계 학술대회 (KASL) Vol.2012 No.1
Background/Aim: Measurement and assessment of portal hypertension are very important in the caring of patients with liver cirrhosis and in predicting relevant prognosis. This study compared the prognostic values of hepatic venous pressure gradient (HVPG), model for end-stage liver disease (MELD)- Na, and Child-Pugh score for the prediction of mortality in patients with liver cirrhosis. Methods: We investigated 136 patients with liver cirrhosis who underwent HVPG between July 2009 and March 2012. Clinical variables including laboratory data, presence of ascites, HVPG, MELD-Na, and Child-Pugh score were collected and analyzed. Cox regression model was developed to identify predictors of mortality. Accuracy of prediction was analyzed using the area under the receiver’s operating characteristics curve (AUROC). Results: HVPG, MELD-Na, Child-Pugh score, hemoglobin, HDL, albumin, and PIVKA2 significantly predicted overall mortality (univariate analysis, p<0.05). MELD-Na was an independent prognostic factor for prediction of overall mortality (multivariate HR; 23.569; p=0.043). Additionally, ascites was an independent prognostic factor for 6 month mortality (multivariate HR; 5.160; p<0.001), MELD-Na and ascites were independent prognostic factors for 12 month mortality (multivariate HR; 1.845, 1.974; p=0.030, p=0.016). AUROC was 0.698 for HVPG, 0.705 for MELD-Na, 0.591 for Child-Pugh score, respectively (p=0.015, p=0.012, p=0.266). Conclusion: MELD-Na is superior than HVPG and CTP score for the prediction of mortality in patients with liver cirrhosis.
케토프로펜 첩포제 ( 케토톱 (R) ) 에 의한 접촉 피부염
윤녕훈(Nyoung Hoon Yun),유동오(Dong O You),이상원(Sang Won Lee),박석돈(Seok Don Park),차승훈(Seung Hoon Cha) 대한피부과학회 2001 대한피부과학회지 Vol.39 No.7
Ketoprofen is an nonsteroidal anti-inflammatory drug derived from propionic acid. It has been widely used as topical preparations, as gel or patch. It has been reported that topical ketoprofen can cause contact dermatitis and photocontact dermatitis. We experienced five cases of contact dermatitis, developed after applying ketoprofen patch (Ketotop®, Pacific pharmaceutical Co., Korea) for the control of oste omuscular or joint pain. While one patient had generalized urticarial eruption, the rest of patents showed localized erythematous pruritic eczematous skin eruptions. It was verified through intradermal skin test and pin prick test that ketoprofen itself was not the causative drug for the skin eruption. Patch test excluded the possibility of allergic skin reaction to rubber compounds. It should be elucidated which compounds are allergic or toxic to the skin, contained in woven fabrics. (Korean J Dermatol 2001;39 (7): 794-797)