피부과 영역에서의 CO₂레이저수술의 활용

송준영,이규석,김창욱,김병천,류영욱,박준형 啓明大學校 醫科大學 1999 계명의대학술지 Vol.18 No.1

저자들은 계명대학교 의과대학 피부과학 교실에서 약3년간 파장 10,600nm의 CO₂레이저를 이용하여 여러 피부질환을 치료하여 얻은 결과를 바탕으로 여러 피부질환을 치료하여 얻은 결과를 바탕으로 피부과 영역에서 CO₂레이저 사용의 실제적 적응과 발생될 수 있는 부작용을 살펴본 바 20가지의 피부질환에 대하여 CO₂레이저치료가 시행되고 있으며 질환별로는 색소성 모반 118명, 사마귀(심상성, 편평, 수장, 족저 사마귀 및 첨규 콘딜롬 포함) 80명, 흑자 65명, 여드름반흔 42명, 한관종 32명, 지루각화증 28명 등의 순이었다. 이중 대부분의 질환에서 치료효과가 양호이상의 판정을 받았으며 치료시 레이저광의 출력이나 pulse 그리고 치료횟수는 질환에 따라 그리고 병변의 깊이와 넓이에 따라 큰 차이를 보였다. 부작용으로는 과색소침착, 저색소증, 반흔형성, 위축, 감염등이 있었으나 대부분의 경우 국소치료와 항생제등의 경구투여로 조절할 수 있었고 레이저 시술후의 스테로이드경구투여와 항생제 연고 도포가 부작용의 방지에 도움이 되었다. 그러므로 레이저시술에 앞서 시술에 이용되는 CO₂레이저의 특성을 잘 이해하고 병변의 종류와 범위 그리고 환자의 피부상태를 면밀히 파악하여 적절한 pulse와 출력으로 치료하고 추적관찰하여 부작용이 발생할 경우 조기에 치료하는 것이 중요하다고 생각된다. CO₂laser emits energy in the mid portion of the infrared spectrum at a wavelength of 10,600nm. The CO₂laser is the workhorse laser in the treatment of cutaneous disease With water as the chromophore (light-absorbing compound), CO₂laser light is highly absorbed in biologic tissue in which water comprises between 75-90%. The CO₂laser is superficially absorbed by tissue water, with little scatter, limiting penetration into the skin to less than 0.1 mm. The beam can be delivered with a large spot size by using silk touch(TM)-computerized scanner and with little thermal damage to the tissues by using superpulsed mode recently. The purpose of this study is to evaluate the variety of cutaneous diseases treated by CO₂laser and the therapeutic effects of the CO₂laser on various skin diseases. MATERIALS AND METHODS : 459 cases of various skin diseases treated by CO₂laser between 1996 and 1998 were subjected to detailed analysis. The CO₂laser is candela laser system (U.S.A) Model 20C. The laser produces power output that ranges from 0 to 30 W of continous wave and from 0.5 to 7.0 W of superpulsed mode. The effectiveness of treatment was measured into 4 groups-excellent, good, fair, poor by estimating the clinical improvement with initial image of photograph. RESULTS : 1. In 459 cases of various skin diseases treated by CO₂laser the case of pigmented nevus (118), wart (80), lentigo (65) and acne scar (42) comprise the large portion of patient compositon. 2. The excellent and good response above 50% of patient was observed in most of the cutaneous diseases. Especially in pigmented nevus, wart, acne scar and xanthelasima palpebrum the excellent and' good response was observed above 90% of patient. CONCLUSION : The CO₂laser is actually used in treatment for wide ranges of cutaneous disorders such as pigmented nevus, wart, acne scar and lentigo even including basal cell carcinoma and hailey-hailey disease. The CO₂laser with silk touch(TM) and superpulse mode is a very effective modality for the various skin disorders such as pigmented nevus, wart, acne scar and lentigo.

啓明大學敎 醫科大學 放射線科學敎室

金洪,徐修之,李珍雨,朱亮求 啓明大學校 醫科大學 1988 계명의대학술지 Vol.7 No.2

It is important to determine the normal range of the spinal cord dimension for screening or localizing spinal pathologic processes which could change the size of cord, such as intramedullary tumor, syringomyelia, radiation and trauma. Although CT has been used extensively for the evaluation of spinal disease, the spinal cord cannot be defined from th subarachnoid space and dura without intrathecal injection of a contrast medium. A few studies have been reported that determined the dimensions of normal spinal cord and subarachnoid space, and moreover, a cross-sectional area of the thoracic cord has not yet been known. CT measurements of coronal and sagittal diameters including the coss-sectional area in the thoracic spines were obtained in 31 cases of normal Korean adults who were undergoing the contrast (Isovist) myelography without any pathology in the thoracic spines. The results were as follows: 1. The transverse diameters of the thoracic cord were 9.1mm(SD 1.1) in level (T1), 7.9mm(SD 0.8) in level 2(T5) and 7.3mm(SD 0.7) in level 3(T9). The sagittal diameters were 7.0mm(SD 0.9) in level 1, 6.1mm(SD 0.8) in level 2, and 6.3mm(SD 0.7) in level 3. 2. The transeverse diameters of the thorthratic subarachnoid space were 15.8mm(SD 1.4) in level 1, 14.3mm(SD 1.6) in level 2, and 13.9mm(SD 1.3) in level 3. The sagittal diameters were 12.9mm(SD 1.5), 12.3mm(SD 1.6) and 11.6mm(SD 1.5) in order of the levels. 3. The cross-sectional areas of the thoracic cord and the subarachnoid space were 58.0㎟(SD 7.5) and 165.4㎟ (SD 27.5) in level 1, 46.4㎟(SD 6.2) and 147.1㎟(SD 27.3) in level 3 separately. 4. The shape of the thoracic cord was elliptical in the upper thoracic spines, then became more round in the lower thoracic levels. The cross-sectional area of the thoracic cord is relatively smaller in the midthoracic spines than those of the upper and lower thoracic spines.

난소난관 절제술후 복벽수술 반흔에 발생한 자궁내막증 1예

이탁,서영욱,김택훈,곽주견 啓明大學校 醫科大學 1984 계명의대학술지 Vol.3 No.2

금번 계명대학교 의과대학 산부인과학교실에서 난소 난관절제수술후 수술반혼에 생긴 자궁내막증 1예를 치험하였기에 간단한 문헌적 고찰과 함께 이에 보고하는 바이다. Endometriosis of abdominal scar is a very rare case. We experienced a case of endometriosis of abdominal scar after salpingo-oophorectomy and present this case with a brief review of concerned literatures.

하악전돌증의 악교정수술후의 회귀성향에 관한 연구

서연호,서혜경,문선혜,박노부,이용오 啓明大學校 醫科大學 1993 계명의대학술지 Vol.12 No.2

저자등은 악교정수술후에 발생하는 희귀성향에 관한 연구를 위하여 계명대학교 의과대학 치과학교실에 내원하여 하악전돌증으로 진단되어 하악후퇴술을 받은 7명의 환자를 대상으로 하여 수술전, 후의 경조직의 변화를 계측, 분석하여 다음과 같은 결과를 얻었다. 수술직후 Gn(H)는 평균 8.2mm 후방이동되었고 SNB는 평균 4.4 감소하였다. SNB는 장기간 경과후 수술직후보다 평균 0.9 증가되었으며 21.1%의 희귀율을 나타내었다. Gn(H)는 장기간 경과후 수술직후보다 6례에서 평균 1.3mm 전방희귀되었으며 나머지 1례에서 4mm 후방이동되었다. SN-MP 및 gonial angle 은 장기간 경과후 수술 직후보다 각각 평균 2.2 ,5.8 증가되었다. Gn(V)는 장기간 경과후 수술직후와 비교하여 변화가 없는 경우가 4례, 증가 2례, 감소 1례로 나타났다. 상하악 중절치는 장기간 경과후 수술직후보다 각각 순측 혹은 설측으로 경사되었다. This study was undertaken to examine relapse tendency after mandibular setback. Seven cases were selected from patients who underwent orthodontic treatment and mandibular setback surgery in our department. The serial lateral cephalogram of each patient were obtained and analyzed: The result were as follows; 1. By operation, Gn(H) moved backward (average 8.2mm), SNB angle decreased(average 4.4˚). 2. When the long term follow-up measurements were compared with the immediate postop, mesurements. ·SNB angle increased on average by 0.9˚and relapse tate was 21.1%. ·GN(H) returned foward on average by 1.3mm in 6 cases, moved backward by 4mm in 1 case. ·SN-MP and gonial angle increased on average by 2.2˚, 5.8˚respectively. ·Gn(V) stayed unchanged in 4 cases, increased in 2 cases, decreased in 1 case. ·Upper and lower incisors slightly moved labially or lingually.

전이성 경부암의 임상적 고찰

김인호,강중신,배옥석 啓明大學校 醫科大學 1985 계명의대학술지 Vol.4 No.2

저자들은 1980년 1월부터 1984년 12월까지 만 5년간 계명대학교 의과대학 외과학 교실에서 조직검사로 확진되었고 병력지 관찰이 가능했던 전이성 경부암 267예를 분석 고찰하여 다음의 결과를 얻었다. 1) 남녀의 비는 1.3:1로 남자에 많았으며 연령별로는 남녀공히 50대에 가장 많았다. 2) 종류의 위치는 일촉성인 경우가 89.5%로 많았으며 그중 좌측이 많았고 종류의 수는 단발성이 72.7%로 많았다. 3) 원발병소 분포를 보면 확인된것이 183예(68.5%)였고 이중 좌측은 위, 폐, 자궁경부, 간, 유방 등의 순이었고 우측은 폐, 자궁경부, 간, 유방, 갑상선 등의 순이었고 양측성인 경우는 폐, 비인두등의 순이었다. 원발병소 불명이 84예였으며 이중 추적조사는 17예에서 실시되었으나 찾지 못하였고 나머지 67예서는 환자의 비협조로 실시하지 못했으며 철저한 조사로 대부분의 경우에서 원발병소를 확인할 수 있다고 생각한다. Physical examination discloses a mass or masses in the neck but diagnosis must be usually based cn the histologic examination. The authors made statistical analysis on the pathologically diagnosed 267 cases of metastatic neck masses during the period from January, 1980 to December, 1984. The results of analysis are here summarized. 1) The highest age incidence was in the 6th decade(33.3%)and sex ratio of male to female was 1.3 : 1. 2) of 267 cases, the unilateral mass was noted in 239 cases (89.5%), which were 152 cases in left side of the neck and 87 cases in the right. Bilateral masses were noted in 26 cases (9.7%). 3) Analysis by the size of the mass revealed that mass under 4.0㎝ in diameter were 239 cases and that mass over 4.0㎝ in diameter were 28 cases. 4) Primary sites were known in 183 cases (68.5%). In the order of frequency, they were stomach, lung, cervix, liver and others for the left side and lung, cervix, breast and others for the right side. 159 cases (86.9%) had their origin below the clavicle and only 24 cases (13.1%) had their primary sites above it. Of the 84 cases of unknown primary sites, only 17 cases were studied for searching the primary sites. With the better cooperation of the patients, we believe we can clarify more originating lesions in those cases of unknown primary sites.

대구시의 3개 의과대학을 대상으로 한 임상실습중의 의과대학생 학대 실태조사

박영규,이태희,이충원,윤능기,서석권,정명현,이무식,도영록 啓明大學校 醫科大學 1992 계명의대학술지 Vol.11 No.4

Authors administered a questionnaire to the 4th-year medical students in 3 medical school in Taegu to assess the prevalence, sources and correlates of reported medical student abuses July to September 1992 when clerkship was finished. Questionnaire was completed by 226 of the 361 students in 3 medical schools, a response rate of 62.6%. Six students excluded due to missing data, totaling to 220(male 162, female 58). 96.3% of males and 89.7% of females reported at least one verbal abusive experience during clerkship. Physical abuse or threats were reported in 49,4% of males and 44.8% of females and psychological mistreatments were noted in 92.6% of males and 82.8% of females. About forty percent of male students reported at least one sexual abuse while 94.8% of female students did. Male students reported more abusive episodes of being cursed or swored and assigned tasks as punishment(p<0.05) while females were significantly more likely than males to report sexual abuse(p<0.05). Males and females alike reported being abused most often by interns and residents and reported surgical, medical, other departments as the most frequent source of abusive episodes in that order. With respect to the effects of abuse on students,87.0% of males and 70.7% of females reported negatively. Hostility was significantly related to all of 4 categories of abuses. Students of C university reported more to be abused than A university students in verbal, physical and psychological abuse categories and students of B university reported more being physically and sexually abused than A university. Females reported more to be sexually abused than males. These results suggest that medical student abuse may be prevalent and certain measures to reduce it are urgently needed.

Ethanol 投與가 運動負荷後 心搏數, 血壓, 呼吸數와 血中乳酸 및 血中 etanol 濃度에 미치는 效果

朱永恩,李元晶,金亨鎭,黃樹寬,安成勳 啓明大學校 醫科大學 1982 계명의대학술지 Vol.1 No.1

Ethanol이 運動에 미치는 影響을 알고자 20~22歲의 男子大學生 100名을 1) EOH 群, 2) 運動群 및 3)EOH+運動群으로 區分하였다. Ethanol 投與는 25% ethanol을 體重 ㎏ 當 2㎖ 씩을 投與하였고, 運動負荷는 rebounder에서 垂直뛰기를 1分에 約 80回로 3分間 實施하였으며, ethanol 投與로 運動負荷後 恢復期에서 心博數, 血壓, 呼吸數와 血中乳酸 및 血中 ethanol 濃度의 變化樣相을 比較 分析하여 다음과 같은 結果를 얻었다. EOH 群에서 心博數는 ethanol 投與後 20分에는 有意하게 增加하다가 次次 減少하여 180分에는 安靜狀態로 恢復하였고, 血壓은 ethanol 投與後 20分부터 減少하다가 40分 以後부터는 有意하게 減少하였으며, 呼吸數도 多少 낮은 傾向을 보였다. 運動負荷後 心博數의 恢復은 EOH+運動群이 運動群보다 더 늦었다. 恢復 1分에 EOH+運動群에서 安靜時 71.4±0.88회에서 114.7±2.85회로서 運動群의 118.0±2.81회보다 더 낮았으나, 運動群이 急速히 恢復되므로 恢復 5, 10 및 20分에서는 EOH+運動群이 有意하게 높았다. 그리고 兩群 모두 恢復 20分까지 安靜狀態보다 有意하게 높았다. 運動負荷後 血壓은 兩群 모두 대개 恢復 1分에서 5分까지 安靜狀態보다 有意하게 높다가 10分에는 安靜狀態로 恢復되었으나, 이 中 EOH+運動群의 收縮期 血壓은 恢復 20分에 112.9±2.50㎜Hg로 安靜時 119.0±0.71㎜Hg에 比해 有意하게 낮았으며, 擴張期 血壓은 恢復期에 安靜時와 비슷하거나 오히려 낮았다. EOH+運動群의 收縮期 血壓은 運動群보다 낮은 값으로 恢復되었고, 特히 擴張期 血壓과 平均 動脈壓은 恢復 20分까지 繼續 有意하게 낮은 값으로 恢復되었으며, 脈壓은 높은 값으로 恢復되었다. 運動負荷後 呼吸數는 EOH+運動群이 運動群보다 恢復 1 및 3分에서 繼續 有意하게 낮았으나, 運動群이 恢復이 빨라서 恢復 20分에는 兩群이 비슷하였다. 血中乳酸濃度는 安靜狀態에 12.81±0.87㎎/㎗에서 運動直後 EOH+運動群과 運動群은 各各 65.95±6.37㎎/㎗ 및 76.50±6.93㎎/㎗로 增加되었으며, 兩群 모두 急速히 恢復되다가 運動群은 60分에서 EOH+運動群은 120分에서 各各 安靜狀態로 恢復되었다. 血中 ethanol 濃度는 EOH+運動群 및 EOH群에 모두 60分에 63.67±3.84㎎/㎗ 및 63.43±5.09㎎/㎗로 거의 같은 값으로 增加하였다가, EOH+運動群은 120分에 37.40±2.56㎎/㎗로 急速히 恢復되는데 反해 EOH群은 63.0±5.33㎎/㎗로 恢復이 緩慢하였다. 以上의 結果를 綜合하면 ethanol의 影響으로 心博數가 增加되어 運動後 그 恢復이 늦어지고 血壓이 繼續 낮은 값으로 恢復되는 점과 血中乳酸濃度가 ethanol의 影響으로 增加되어 運動後 恢復도 늦어지고 運動負荷後 血中 ethanol 濃度가 急速히 減少한 점 等은 意義있는 結果인 것으로 注目되는 바이다. 이번 硏究에 對象으로서 積極 參與해 준 慶北大學校 醫科大學 一學年 學生一同(1981학년도)에게 깊이 感謝한다. Effect of ethanol(EOH) on cardiovascular system and blood lactate levels following exercise was studied in 100 male college students (Age:20-22yr) who were divided into 3 groups: Ethanol group, Exercise group and Ethanol+Exercise group. Ethanol was administered as 25% Korean liquor (Kumbokju) in a dose of 2ml per Kg body weight. Exercise was performed on a minitrampoline(rebounder) with repeated rhythmic bouncing at a rate of 80 per min for 3 min. During 3 hrs of recovery after the exercise, the heart rate, blood pressure, respiratory rate and blood levels of ethanol and lactate were measured. The following results were obtained. The heart rate following ethanol ingestion increased significantly at 20 min, and decreased gradually thereafter and returned to the resting level at 180min. Blood pressure following ethanol ingestion decreased significantly at 40 min and remained at a low value during the 3 hr experimental period. Ethanol produced a non-significant decrease in respriatory rate. Recovery of heart rate following exercise was retarded in EOH+Exercise group. Heart rate at 20min after exercise was significantly higher than the resting level in both Exercise and EOH+Exercise groups. Blood pressure of both exercise and EOH+Exercise groups was significantly highter at 1 and 5min after exercise and returned to the resting level at 10 min. However, EOH+Exercise group showed significantly lower systolic, diastolic and mean arterial pressure but higher pulse pressure than the Exercise group during the recovery period. The EOH+Exercise group showed a significantly lower respiratory rate at 1 and 3 min after exericse but showed no difference at 20 min. Blood lactate level was 12.81±0.87 mg/dl at rest but increased signifcantly to 76.50±6.93 mg/dl and 65.95±6.36 mg/dl immediately after exercise both in Exercise and EOH+Exercise group, respectively. Blood lactate level decreased markedly thereafter and returned to the resting level at 60min in Exercise group and at 120min in EOH+Exercise group. Blood ethanol concentrations in EOH+Exercise and Ethanol groups were 63.67±3.84 mg/dl and 63.43±5.09 mg/dl at 60 min, respectively and 37.40±2.56 mg/dl and 63.0±5.38 mg/dl at 120min, respectively. The above results indicate that ethanol produces an elevation of heart rate and blood lactate level and retards the recovery rate of heart rate and blood lactate after exercise. Because of ethanol's depressor effect, blood pressure follwing exercise returned to the resting level faster. Exercise seems to facilitate the metabolic rate of ethanol.

미세수술에 의한 난관채성형수술 후의 임신율에 관한 연구

임화석,이두룡 啓明大學校 醫科大學 1985 계명의대학술지 Vol.4 No.1

1983년 8월부터 1984년 12월까지 만 1년 5개월간 계명대학교 의과대학 동산의료원 산부인과를 찾아 온 불임환자 가운데 infertility work-up을 완전하게 시행하여 불임의 원인이 난관 및 복막인자로 판명되어, 미세수술을 이용한 난관채부성형수술을 받은 38예 가운데 1985년 5월말 현재 최장으로는 22개월 최단으로는 5개월간 추적조사가 가능했던 26예를 대상으로 다음과 같은 결과를 얻었다. 난관채부성형술을 받았던 26예중 11예에서 임신이 이루어져 임신율은 43%이었다. 전체임신예중 수술 후 첫 3개월내에 27%, 6개월내에 54%, 12개월내에 72%, 22개월내에 100%에서 임신이 이루어 졌다. 미세수술에 의한 난관채부수술 후 임신된 11예는 만삭분만 및 분만예정이 6예, 난관임신이 3예, 자연유산이 2예 이었다. 만삭임신율은 분만예정자(임신후반기)를 포함하여 23%이었다. A micorsurgical technique of fimbrioplasty has been utilized in 26 patients operated on by the authors from August 1983 through December 1984, and they have been followed up for 5 to 22 months postoperatively in the Department of Obstetrics and Gynecology, School of Medicine, Keimyung University. Forty-three percent of 26 patients who had a pure microsurgical fimbrioplasty conceived postoperatively. Three of these 11 pregncies was ectopic. Utering pregnancy was achieved in 31% and ectopic pregnancy in 12% of this series. It is of interest that 54% (6/11) of t6hose patients achieving a pregnancy did so within first 6 months of surgery.

쌍태임신과 단태임신에서의 모체 혈청내 Uric Acid치의 비교

김왕식,김종인,박성규,김경희,김판조,배정만 啓明大學校 醫科大學 1998 계명의대학술지 Vol.17 No.1

1997년 1월부터 1997년 12월까지 계명대학교의과대학 산부인과 교실에 분만 및 치료를 위해 입원한 임신 28주 이상의 쌍태 임신 (24례), 단태 임신 (79례), 전자간증이 동반된 쌍태 임신 (18례), 전자간증이 동반된 단태 임신 (35례)을 대상으로 정맥혈을 이용하여 혈청내 뇨산 (uric acid)을 측정하여, 쌍태 임산부에서의 혈청내 정상 뇨산 값의 측정과 단태 임산부에서의 뇨산의 측정 및 쌍태 임신과의 비교, 전자간증의 유무에 EK른 뇨산값을 비교하고자 본 연구를 시도하였다. 전자간증이 없는 24례의 쌍태 임신 군과 79례의 단태 임신 군에서는 쌍태 임신 군에서의 혈청내 뇨산(uric acid)의 값이 유의하게 높게 나타났다. (4.94±1.5 versus 4.04±1.4mg/dL, P=0.001). 또한 전자간증이 동반된 18례의 쌍태 임신 군에서의 혈정내 뇨산의 값이 (6.125±1.6 mg/dL) 전자간증이 동반된 35례의 단태 임신 군에서의 값(5.98±1.2 mg/dL)보다 유의하게 높았다(P=.001). 쌍태 임신에서는 모성 혈정내 뇨산의 값이 5.8 mg/dL 이상인 경우 전자간증의 예측 cutoff 값으로 측정되어, 이 값을 cutoff level 값으로 이용하여 18례의 전자간중이 동반된 쌍태아임신부에서 17례 (94%)에서 진단예측이 가능하였고, 35례의 전자간증이 동반된 단태 임신에서는 7례 (20%)에서 진단이 가능하였다. 모성 혈청내 뇨산 5.8 mg/dL의 값을 이용한 쌍태 임신에서의 전자간중의 진단예측에 대한 민감도는 94%, 특이도는 78%를 나타내었다. 본 연구에서 쌍태 임신에 동반되는 전자간중의 진단 예견에 도움이 되는 모성 혈정내 뇨산의 cutoff 값이 제한된 수에서 얻은 결과로 확실한 진단 예견에 어려움이 있으나, 임상 진단에서의 정확한 진단이 어려운 경우 진단의 보조 수단으로서 이용이 가능하며, 특히 쌍태 임신에서의 전자간증의 진단 예견에는 많은 도움이 되리라 사료된다. This study was undertaken to establish normative values of serum uric acid levels in women with twin pregnancy and to compare maternal serum uric acid levels of twins and singletons, stratified by the presence or absence of preeclampsia. With or without preeclampsia, women carrying twins have significantly higher serum uric acid levels than their singleton counterparts, which suggests a need for separate normative values for twin gestations. We proposed that a serum uric acid level of 5.8 mg/dL or greater be used to identify those women with twin gestaions who are at higher for preeclampsia by a receiver operating characteristics (ROC) curve.

나환자의 혈청 과산화 지질

노용지,송준영,박의수 啓明大學校 醫科大學 1992 계명의대학술지 Vol.11 No.1

Lipid peroxide is metabolic products of unsaturated fatty acid which functions, in vivo, are detoxification, drug metabolism, production of prostaglandins and microcidal action. If lipid peroxide increase in serum which causes variable metabolic disorders by impairement of organ cell membranes. But several enzymatic systems prevent high accumulations of lipid peroxide in serum. In this study, we have examined serum lipid peroxide conentration by using Yagi's method in 31 lepromatous leprosy patients and 11 tuberculoid leprosy patients. As normal controls, 22 healthy persons have been selected. As the results, Values of lipid perxide in leprosy patients superior to normal controls statistically(The values are significant only in lepromatous leprosy, not significant in tuberculoid leprosy patients.) We also found that sex, age, duration of disease had not affected the lipid peroxide levels. These results suggested that the type and severity of leprosy may be related the level of lipid peroxide. Now we present a paper, serum lipid peroxide in leprosy patients, with references.