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말기신질환자에서 호모시스테인농도에 따른 엽산의 치료효과 및 Pulse wave velocity(PWV)의 변화
고재기 ( Jae Ki Koh ),김수현 ( Su Hyun Kim ),신석호 ( Suk Ho Shin ),전관선 ( Kwan Sun Chun ),최준혁 ( Jun Hyouck Choi ),임지환 ( Ji Hwan Lim ),윤수진 ( Su Jin Yoon ) 대한내과학회 2007 대한내과학회지 Vol.72 No.6
Background: In end-stage renal disease (ESRD) patients, cardiovascular disease (CVD) is a major cause of morbidity and mortality. These patients frequently have hyperhomocysteinemia, a putative risk factor for cardiovascular disease. Several studies suggest that lowering plasma homocysteine may improve endothelial dysfunction, a marker of atherothrombotic risk. Pulse wave velocity (PWV) is a useful diagnostic tool to access endothelial dysfunction, and is widely used screening test for atherosclerosis. Methods: We measured fasting total plasma homocysteine (tHcy) in 84 hemodialysis patients and 21 peritoneal dialysis patients. Subjects were assigned to two groups. Group I (tHcy<20 umol/L) consisted of 74 ESRD patients who have taken continual usual dose folate (1 mg/day). Group II (tHcy≥20 umol/L) consisted of 26 ESRD patients who have taken high dose folate (5 mg/day). For 15 Group I patients and 5 Group II patients, pulse wave doppler velocity (PWV) measurements were taken before and after 3 months of folate treatment. Results: The mean tHcy concentration was higher in the ESRD patients (82 HD: 16.9±6.4 mol/L, 20 PD: 18.0±16.7 mol/L). The pulse wave velocity (PWV) was faster in ESRD patients-19 HD: Aorta (Ao)-PWV 8.98±1.4, lower extremities (LE)-PWV 10.15±1.3, upper extremities (UE)-PWV 8.80±0.8 (m/s); 8 PD: Ao-PWV 9.32±1.8, LE-PWV 10.64±1.4, UE-PWV 9.24±0.7 (m/s). The PWV increased in ESRD patients with coronary heart disease and who had a history of angioplasty because of thrombosis or stenosis of vascular access. There was a significant reduction in hyperhomocysteinemia after 3 months in the high dose folate supplement group as compared to the usual dose folate supplement group with a significant statistical difference between the two groups. (15 Group I patients: 13.9±4.9 mol/L→13.5±6.1 for 5 Group II patients: 34.3±27.5 mol/L→23.0±5.9 mol/L (p<0.05, paired t-test). No difference in the PWV was found before and after folic acid supplementation for the two groups (p>0.05, paired t-test). Conclusions: We assume that PWV and homocysteine concentration have some correlation and both studies are available as part of screening tests for atherosclerosis in ESRD. Although no significant interval change was detected for the PWV, this finding suggests that high-dose folate supplementation was helpful to minimize the risk of cardiovascular disease associated with hyperhomocysteinemia in ESRD patients. (Korean J Med 72:607-615, 2007)
긴장성 동공으로 발현한 류마티스 관절염과 동반된 쇼그렌 증후군
고재기 ( Jae Ki Koh ),김진현 ( Jin Hyun Kim ),류희정 ( Hee Jeong Ryu ),이은영 ( Eun Young Lee ),이윤종 ( Yoon Jong Lee ),이은봉 ( Eun Bong Lee ),송영욱 ( Yeong Wook Song ) 대한내과학회 2009 대한내과학회지 Vol.77 No.2
Sjogren`s syndrome is an autoimmune disease that presents mainly as dry eyes and mouth, and occasionally with extra-glandular symptoms. A peripheral neuropathy is present in 10~30% of the cases with extra-glandular symptoms, although a tonic pupil caused by destruction of the ciliary ganglion is rare. We report a case of rheumatoid arthritis with Sjogren`s syndrome presenting as a tonic pupil. A 29-year-old woman was admitted for evaluation of polyarthralgia and a tonic pupil. On physical examination, she had poly-arthritis involving the jaws, shoulders, wrists, and hands. Her pupils were anisocoric and did not react to light, but constricted promptly to pilocarpine. Biopsy of the minor salivary gland showed lymphocyte infiltration. Rose-Bengal stain was positive. She was diagnosed with rheumatoid arthritis with Sjogren`s syndrome and treated with prednisolone and hydroxychloroquine. Three months later, her polyarthritis had improved markedly, but she still had a tonic pupil. (Korean J Med 77:261-264 2009)
전신홍반루푸스에서 발생한 만성 염증성 수초탈락성 다발성 신경병증
문기원 ( Ki Won Moon ),송영욱 ( Yeong Wook Song ),송란 ( Ran Song ),윤찬영 ( Chan Young Yun ),고재기 ( Jae Ki Koh ),김진현 ( Jin Hyun Kim ),이은영 ( Eun Young Lee ),이은봉 ( Eun Bong Lee ) 대한류마티스학회 2009 대한류마티스학회지 Vol.16 No.3
Chronic inflammatory demyelinating polyneuropathy (CIDP) is characterized by symmetrical weakness, impaired sensation, absent or diminished tendon reflexes, an elevated cerebrospinal fluid protein level and nerve-conduction studies that show demyelination. The occurrence of CIDP in patients with systemic lupus erythematosus (SLE) has been rarely reported. We experienced a case of a 33 year-old woman with SLE and she presented with fever, abdominal pain, a tingling sensation of both of her hands and feet, and symmetrical weakness in both the proximal and distal extremities. Her symptoms had persisted for over 1 months before she visited our department. The CSF examination showed an elevated protein level and the nerve conduction studies revealed demyelination. Her symptoms showed minimal improvement with high dose steroid and immunoglobulin therapy, but she responded to cyclophosphamide therapy.
전관선 ( Kwan Sun Chun ),신석호 ( Suk Ho Shin ),김수현 ( Su Hyun Kim ),고재기 ( Jae Ki Koh ),김인영 ( In Yung Kim ),황환식 ( Hwan Sik Hwang ),박훈기 ( Hoon Ki Park ) 대한내과학회 2007 대한내과학회지 Vol.73 No.4
Background: Atherosclerotic cardiovascular disease and metabolic syndrome are both rapidly increasing in Koreans due to the new westernized eating habits and the aging of the population. The pulse wave velocity (PWV) reflects arterial stiffness and it may be used as an indicator of atherosclerosis. This study was conducted to investigate the association of the PWV with metabolic syndrome. Methods: Among 1438 persons who visited the Internal Medicine Clinic or Health Center of a general hospital in Seoul, Korea, 384 adults (age range: 30-69 years old) were selected as study subjects. Those patients with cardiovascular disease or other systemic disease were excluded, but the patients with hypertension and diabetes mellitus were included. Ninety four (25.4%) subjects were classified as patients with metabolic syndrome when jointly applying the WHO Asia-Pacific criteria and NCEP ATPIII criteria. Results: The PWV was higher in the older aged group and in the men compared to the other group. The greater the number of diagnostic criteria of the metabolic syndrome subjects had, the higher was their PWV. After adjustment for age, gender, blood pressure, BMI and fasting blood glucose, a PWV change of 1.0 m/sec increased the risk of metabolic syndrome by 1.31 times (95% CI: 0.81-2.09). The risk of metabolic syndrome was 7.62 times higher among the subjects with a PWV greater than 7.5 m/sec (95% CI: 1.07-54.42), as compared with that of subjects with a PWV less than 7.5 m/sec. Conclusions: The PWV may independently increase the risk of metabolic syndrome as a non-linear pattern. A prospective study needs to be conducted to confirm the meaning of PWV as a risk factor for metabolic syndrome, and especially to determine the cut off point.(Korean J Med 73:384-392, 2007)
안와내로 침범한 술후성 상악동 낭종의 비내시경적 치료 1예
고재기,고재웅 朝鮮大學校 附設 醫學硏究所 2006 The Medical Journal of Chosun University Vol.31 No.2
Purpose: The postoperative maxillary cyst (POMC) develops as a delayed complication of many years after surgical intervention in maxillary sinus. We report a case of postoperative maxillary cyst invaded into the orbit causing displacement of the globe, which was successfully treated with drainage under nasal endoscopy. Subject and Method: A 38-year-old man visited the hospital complaining of palpable mass on his right lower eyelid area for -10days. He had had CaIdweII-Luc operation for maxillary sinusitis for 10 years ago. Examination revealed hard and painless palpable mass on his right lower eyelid area. Computed tomographic (CT) scan of head and orbits revealed a low density, cystic mass in the right maxillary sinus invaded into the orbit, displacing the globe superiorly. We found a bulging cystic mass supero-posterior to the middle turbinate, and we performed incision and drainage under nasal endoscopy. Result: At third postoperative day, successful treatment of cystic mass was confirmed by nasal endoscopy, with disappearing of palpable mass on right lower eyelid area. Conclusion: We suggest that nasal endoscopic surgery in treatment of postoperative maxillary cyst invaded; into the orbit maybe effective method.