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성승준,홍기웅,김은령,김일수,조병수,Sung, Seung-Joon,Hong, Ki-Woong,Kim, Eun-Ryoung,Kim, Il-Soo,Cho, Byung-Soo 대한소아신장학회 2001 Childhood kidney diseases Vol.5 No.2
목 적 : 신증후군 환자에서 신정맥 혈전증, 폐동맥 혈전증 등의 합병증은 아직도 치명율이 높은 합병증으로 되어 있다. 본 연구는 소아 미세변화 신증후군 환아에서 폐관류스캔을 이용하여 폐색전증의 빈도와 위험요인에 대해 조사함으로 합병증의 조기발견 및 예방으로 신증후군의 치명률을 줄이는데 도움을 얻고자 시행하였다. 대상 및 방법 : 폐관류스캔을 관해기 초기에 Technetium 99-microaggregated albumin (99mTC- MAA)을 사용하여 시행하였으며 폐색전증이 발생한 환아 5명을 A군, 폐색전증이 발생하지 않은 환아 9명을 B군으로 나누고 두 군 간에 혈소판. 적혈구용적률, 알부민, 콜레스테롤, 중성기방, 24시간 뇨 단백분비양에 유의한 차이가 있는지 비교 관찰하였다. 결 과 : 폐색전증을 동반한 A군에서 혈소판 수치가 유의하게 높았으며, 적혈구용적률은 유의한 차이가 없었다. 혈청 알부민도 유의한 차이는 없었으나, 입원시 24시간 뇨 단백은 A군에서 더 심한 단백뇨를 보여 주었으며 통계적으로 유의한 결과를 보여주었다. 혈청 콜레스테롤과 중성지방도 두 군 간에 유의한 차이는 없었다. 결 론 : 폐색전증은 소아미세변화 신증후군에서의 중요 합병증중의 하나이다. 폐색전증의 발생빈도는 치료전의 단백뇨의 정도와 스테로이드 치료 후 초기 관해기에 지속적인 혈소판증가와 연관이 있을 것이다. 그러므로 심한 단백뇨와 혈소판의 증가를 보이는 위험군은 증상이 경미하거나 없더라도 반드시 조기에 폐관류스캔을 시행하여 조기 진단 및 예방적 처치가 필요하리라 생각된다. Purpose : We investigated the incidence and predisposing factors of pulmonary embolism in minimal change nephrotic syndrome(MCNS). Methods : Lung perfusion scan using 99mTC-MAA were done on 14 patients who were diagnosed to minimal change nephrotic syndrome. Group h: Five patients who had perfusion defects on scan, Group B; Nine patients who had no perfusion defect on scan. Between the two groups, the differences of platelet number, hematocrits, albumin, cholesterol, triglyceride, proteinuria were evaluated. Results : Five patients were found to have perfusion defect consistent with pulmonary embolism($35.7\%$). However, there were minimal or no respiratory symptoms and signs. In our laboratory studies, the mean proteinuria on admissions was $676{\pm}31\;mg/m2/hr$ in the group with pulmonary embolism, and $313{\pm}28\;mg/m2/hr$ in the group without pulmonary embolism. There were more severe proteinuria in group with pulmonary embolism(P<0.05). The mean platelet count at early stage of remission after steroid treatment was $746,600{\pm}280,000/mm3$ in the group with pulmonary embolism, $511,890{\pm}90,000/mm3$ in the group without pulmonary embolism. There were significant difference of platelet count between the two groups(P<0.01). In patients with pulmonary embolism, there were more higher and sustained increasement of platelet count. All cases of pulmonary embolism were treated with dipyridamole(5 mg/kg). In 4 cases the perfusion defects were improved in two weeks, however, one case showed persistent perfusion defect after 1 month. Conclusion : Our study suggested that pulmonry embolism might be one of tile major complications in childhood MCNS The occurrence rate was correlated with severity of proteinuria before treatment and sustained increasement of platelet counts in early remission state after steroid treatment. Therefore, the scintigraphic pulmonary perfusion study is mandatory in childhood MCNS, especially in the high risk patients, such as the patients with severe proteinuria and sustained increasement of platelet count. (J Korean Soc Pediatr Nephrol 2001;5 : 100-8)
요로감염에서 99mTc-DMSA Pinhole 영상의 유용성
이태원,성승준,안병문,유이령,김일수,김은령,김성훈,박용휘 대한소아청소년과학회 2002 Clinical and Experimental Pediatrics (CEP) Vol.45 No.1
Purpose : The aim of this study was to assess the diagnostic value of the 99mTc-DMSA pinhole imaging by comparing the detection rate of cortical defects identified from planar and pinhole imaging. Methods : 99mTc-DMSA planar and pinhole imaging, voiding cystoureth-rogram(VCUG), renal ultrasonography were performed in 67 patients diagnosed with urinary tract infection at the Department of Pediatrics, Sung-Ae General Hospital, from September, 1999 to Feburary, 2001. The follow-up of 99mTc-DMSA pinhole imaging was performed on 25 patients. Results : Overall detection rate of 99mTc-DMSA planar imaging was 41.8%(28 patients/67 patients), but 99mTc-DMSA pinhole imaging showed cortical defects in 62.7%(42 patients/67 patients) and the patients with renal cortical defects in planar imaging showed all definite or more additional cortical defects in pinhole imaging. The detection rate of cortical defect by 99mTc- DMSA pinhole imaging in patients with vesicoureteral reflux(VUR) was 80%(24 kidneys/30 kidneys). Those without VUR, however, also presented high detection rate as 25.9%(27 kidneys/ 104 kidneys). Out of 25 patients, improvement of cortical defect was presented in 19, no change in 4, and aggravation in 2 from the follow-up studies by 99mTc-DMSA pinhole imaging. Conclusion : This study indicates that 99mTc-DMSA pinhole imaging is superior to planar imaging and, hence, that pinhole imaging is a useful initial diagnostic tool for children suspected of urinary tract infection, irrespective of VUR, and to identify patients who need more extensive radiological studies and early treatment. 목 적 : 소아 요로감염증시 수반되는 신피질 섭취결손 유무를 검사하는 의의는 조기 진단과 조기 치료로 심한 신 손상을 예방할 수 있다는 점에서 매우 중요하다. 신손상의 정도를 판정하는데 있어서 99mTc- DMSA 신스캔이 신피질 섭취결손 검출에 예민도가 높은 유용한 검사 방법으로 알려져 왔으나, 최근에는 3차원적 입체 영상인 SPECT를 실시하기도 한다. 그러나 기존의 99mTc-DMSA 신스캔에 pinhole 조준기를 적용시킨 99mTc-DMSA pinhole 영상은 해상력이 높아 진단적 가치가 있는 것으로 보고되고 있다. 저자들은 99mTc-DMSA 신스캔의 평면영상 및 pinhole 영상에 의한 신피질 섭취결손 검출 결과를 비교하고, 방광요로조영술 결과와의 상관관계를 분석하여 그 진단적 유용성을 평가하고자 본 연구를 시행하였다.방 법 : 1999년 9월부터 2001년 2월까지 18개월 동안 성애병원과 광명성애병원 소아과에서 요로감염증으로 진단받고, 99mTc-DMSA planar imaging, 99mTc- DMSA pinhole imaging, 배뇨 중 방광요로조영술, 신초음파를 모두 시행하였던 67명을 대상으로 하였다. 99mTc-DMSA를 주사하여 먼저 후면상 평면영상을 얻고 이어서 pinhole을 사용하여 99mTc-DMSA pinhole 영상을 얻었다. 신피질 섭취결손의 회복여부를 알아보기 위하여 추적조사가 가능했던 25명의 환아에서 3개월에서 6개월 사이에 99mTc-DMSA 신스캔을 다시 시행하였다.
건강증진센터를 방문하는 여성의 인유두종바이러스의 유병률 및 유전형의 분포와 자궁이형성증과의 관계
정소이,신수,윤종현,노은연,성승준,김경평,김의종 대한임상미생물학회 2013 Annals of clinical microbiology Vol.16 No.2
Background: The persistence of infection by high-risk human papillomavirus (HPV) may lead to cervical cancer. Recently, the American Society for Colposcopy and Cervical Pathology (ASCCP) announced that oncogenic HPV screening and the PAP smear are the main methods of screening for cervical cancer. The goal of this study was to investigate the prevalence and genotyping of HPV, as well as the risk of cervical dysplasia. Methods: HPV genotyping was conducted by a commercial chip assay. Cervical dysplasia was retrospectively reviewed using electronic medical records. The study participants were grouped together according to cervical dysplasia status: ‘no dysplasia,’ ‘atypical squamous cells of undetermined significance (ASCUS),’ ‘low-grade squamous intraepithelial lesion (LSIL),’ and ‘high-grade squamous intraepithelial lesion (HSIL).’ The HPV prevalence and genotyping were analyzed according to the cervical dysplasia group. Results: The overall prevalence of HPV was 17.6% (91 out of 518 patients). HPV-18 (2.3%), HPV-16 (2.1%), and HPV-58 (1.2%) were the three most frequent genotypes. The prevalence of HPV infection and the high-risk HPV positive rate was higher in the ASCUS, LSIL, and HSIL groups than in the no dysplasia group (P<0.05). Conclusion: In this study, basic data regarding the prevalence and distribution of HPV genotypes were obtained. Since HPV vaccination has been actively encouraged among Korean women, a change in the prevalence of HPV and cervical dysplasia is expected in the future. This study provided basic data describing the prevalence of HPV and its genotypes in the pre-HPV vaccination era.