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- 저자 : 임승길(S. G. Lim) (검색결과 2 건)
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중증 부갑상선 기능항진중에서 부갑상선 결절내 Calcitriol 직접 주입술 및 충격요법 병용치료의 장기간 연구결과
신석균(S. K. Shin),황재하(J. H. Hwang),송현용(H. Y. Song),노현진(H. J. Noh),최규헌(K. H. Choi),임승길(S. G. Lim),이호영(H. Y. Lee) 대한신장학회 2000 Kidney Research and Clinical Practice Vol.19 No.1
N/A Severe hyperparathyroidism(i-PTH>1,000pg/ml, dia-meter of nodules>1.0cm, and hypercalcemia) in dialysis patients may be resistant to conventional calcitriol- pulse therapy. To assess the usefulness of direct calcitriol injections in restoring the responsiveness to calcitriol, we performed a prospective study in 23 dialysis patients(mean age 42.3 years, M: F 0.9: 1, CGN 14, hypertension 4, lupus nephritis 2 & others 3, mean duration of dialysis 9.5 years, HD: CAPD 9: 14) who had severe hyperparathyroidism resistant to calcitriol pulse therapy for more than 2 months and had no ectopic gland in Sestamibi parathyroid scan. We three repeatedly injected calcitriol of dose(μg) equal to 3-D nodule volume(cm(3)) under U.S.(Acuson Computa Sono, California, USA, 7MHz probe) for 1 week and concurrently began calcitriol-pulse therapy(0.75-1.0μg/day, t.i.w.) after 3rd injection. All patients were followed up by serum i-FI H(Allegro Intact FPH kits, Nichols Ins.), calcium, phosphate, and U.S. after 7 days, 1 month, 6 months, and 1 year of 3rd calcitriol injection. These combination therapy could significantly decrease i-PTH level and gland volume in patients with resistant secondary hyperparathyroidism on conventional calcitriol therapy and the response were main-tained for one year after start of these therapy. The complete response group was the patients with lower baseline i-FFH levels compared to those with partial and non-response(1001.7±150.2 vs. 1521.8±328.3, 1569.2 ±344.3pg/ml, p<0.05, respectively). The patients with baseline i-PTH of less than l,200pg/ml or gland volume of less than 1.5cm were well responded to the three consecutive direct calcitriol injection and pulse combination therapy(i-PTH; PPV 77.8%, NPV 92.8%, gland volume', PPV 87.5%, NPU 93.3%). No severe adverse effect was observed during this study. In conclusion, direct calcitriol injections into the parathyroid nodules and pulse combination therapy could be useful in secondary resistant hyperparathyroidism patients with conventional calcitriol therapy especially in those with i-PTH of less than 1,200pg/ml or gland volume of less than 1.5cm. However, sugical management may be indicated in patients with higher i-PTEI levels or larger gland volume than these.
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전근재(G . J . Jeon),임승길(S . K . Lim),이현철(H . C . Lee),김경래(K . R . Kim),허갑범(K . B . Huh) 대한내과학회 1988 대한내과학회지 Vol.35 No.6
N/A We studied 59 patients who had received a diagnosis of graves' disease or myxedema by dual photon absorptiometry from August 1986 to July 1987 at the Department of Internal Medicine, Yonsei University Severance Hospital. The results were summarized as follows: 1) Patients with Graves' disease of a mean duration of 19.2 weeks demonstrated an average of 9.37 mg/dl Ca and 4.29 mg/dl P in their blood samples while the 24 hr urine specimen showed 194.26 mg/dl 24 hr of Ca and the P revealed 520.36 mg/24 hr, which is higher than those of myxedema. 2) The patients with Graves' disease revealed a prevalance of osteoporosis in the following, Ward's triangle 18,8%, femora) neck 20.8%, trochanter 25%, but the spine, while observed at 22.9% in hyperthyroidism, also was detected at 18.2% in myxedema. 3) In females with Graves' disease, the values of BMD were relatively lower than those of the control group but showed a greater at traction to osteoporosis than the males. 4) Most womon in their postmonopaunal poriod showed a strong tondency to develop osteoporosis in the femoral neek but they demonstrated a greater relationship to the spine. 5) Even after treatment, the BMD revealed a tendency to continue increasing, however, there was still a possibility for incomplete recovery. Excess thyroid hormones lead to negative bone mineral balance. The revealed bone loss was clinically significant in postmenopausal women despite its short dyratuib abd ut aooeared ti be at keast oartuakkt reversubke after treatment.
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