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Antineutrophil Cytoplasmic Autoantibody 양성인 결절성 다발동맥염 1 예
조원경(Won Kyoung Cho),제수정(Soo Jung Je),최정은(Jeong Eun Choi),정해혁(Hae Hyuk Jung),이미화(Me Hwa Lee),홍진선(Jin Surn Hong),박흥동(Heung Dong Park),박정식(Jung Sik Park),김대원(Dae Won Kim),유은실(Eun Sil Yoo) 대한내과학회 1993 대한내과학회지 Vol.45 No.5
Anti-neutrophil cytoplasmic autoantibodies are serologic marker for various disease, ranging from multi system vasculitis, such as Wegner's granulomatosis and polyarteritis nodosa, to renal-limited disease (that is, idiopathic crescentic glomerulonephritis) These ANCA-associated diseases share the pathologic feature of necrotizing vascular inflammation with scant immune deposition. In vitro studies suggest that these diseases also have a common immunopathogenesis mediated by ANCA-induced neutrophil activation. We experienced a case of ANCA positive polyarteritis nodosa. The physical exammination of abdomen showed mild direct tenderness on the right upper quadrant. Laboratory studies on admission revealed leukocytosis, elevated ESR, proteinuria, hematuria, and elevated alkaline phosphatase. Liver bipsy and renal biopsy revaled characteristic findings of Polyarteritis Nodosa. Serologic test for ANCA showed central type with 1:1280 of titer. The patients was treated with prednisolone and oral cyclophosphamide but the disease progressed to end-stage renal disease.
관동맥연축에서 서방형 칼슘길항제인 Diltiazem 과 Verapamil 의 치료효과 : Ergonovine Echocardiography 를 이용한 무작위 비교 연구
송재관(Jae Kwan Song),박성욱(Seong Wook Park),제수정(Soo Jung Je),김재중(Jae Joong Kim),두영철(Young Cheoul Doo),김원호(Won Ho Kim),진재용(Jae Yong Chin),김형호(Hyeong Ho Kim),정상식(Sang Sig Cheong),박승정(Seung Jung Park),이종구(Jo 대한내과학회 1994 대한내과학회지 Vol.46 No.3
Background: Detection of left ventricular regional wall motion abnormality with two dimensional echocardiography during ergonovine injection (Ergonovine Echocardiography: Erg Echo) is a useful noninvasive diagnostic method of coronary vasospasm, and as it can be used repeatedly, comparison of the therapeutic efficacy of the prescribed drugs for the patients with variant angina may be possible with this method. The purpose of this study were to compare the antispasmotic action of short-term medication of two currently available sustained-releasing (SR) calcium antagonists (Diltiazem vs Verapamil) with Erg Echo, to investigate the factors determining the drug efficacy and to determine if the results of repeated tests of Erg Echo after shortterm medication correlate with the clinical response. Methods: Forty patients with angiographicallyproven coronary vasospam and positive Erg Echo without medication were randomly assigned into group I and II. Diltiazem SR 90mg b.i,d. was prescribed in the patients of group l and Verapamil SR 120 mg b.i.d. in group II. Isosorbide-5-mononitrate (ISMN, Elantan 20 mg b.i.d.) was commonly given in both groups. After medication of 4 days Erg Echo was repeated, and if follow up results were positive doubling of the dosage of prescribed calcium channel antagonists (i.e. Diltiazem SR 180 mg or Verapamil SR 240 mg b.i.d.) was done and the second follow up test of Erg Echo was performed after another 4 days. Clinical follow-up was done with the dosage of negative Erg Echo, and during 9 (±3) month follow-up period one patient of group I and two of group II were lost and final analysis was done with total 37 patients (19 in group I and 18 in group II). Results: Among 37 patients with variant angina, 32 were male and the mean age was 53 (±8). Sex ratio, mean age, body weight, clinical activity of variant angina assessed by the frquency of chest pain attack, number of spasm-documented coronary vessels, dosage of ergonovine for positive response in baseline Erg Echo and number of the patients with concomitant fixed coronary stenosis were not significantly different between both groups. After 4 day medication coronary vasospasm was not provoked with ergonovine injection in 13 patients of group I, and the positive rate of Erg Echo after medication was 32% (6/19) in group I, which was not significantly different from that (50%, 9/18) of group II (p=0.66). In 15 patients coronary vasospasm was provoked with ergonovine injection despite the medication, and ergonovine dose for positive response rose from 146±84 microgram (mcg) to 218±75 mcg with medication. Patients with 'mixed disease' (coronary vasospasm and concomitant fixed disease) showed higher positive result of Erg Echo after medication than the patients with pure spasm (p=0.001). During open label follow-up of 9±3 months, there was neither case of acute myocardial infarction nor that of sudden cardiac death. Recurrent chest pain with medication was observed in 6 patients of group I and 7 of group II (p=0.90), and recurrent chest pain during follow-up was more frequently observed in patients with positive Erg Echo after 4 day medication than those with negative test (p=0.01). In group II medication was modified to control the high activity of variant angina (chest pain attacks more than 5 per week) in 3 patients and verapamil SR was withdrawned in 4 patients due to side effects (2 cases of impotence, each case of constipation and peripheral edema), while there was no case of drug modification or withdrawl of diltiazem SR (p<0.05) in group I. Conclusion: Although there was no significant difference of short term medication on prevention of coronary vasospasm provoked by ergonovine injection, during long term follow-up of variant angina, diltizem SR with ISMN was superior to verapamil SR with ISMN in control of chest pain and absence of side effects. Erg Echo after short term medication was useful in comparison of drug efficacy, investication of the fact
인슐린 비의존형 당뇨병환자에서 중식성 망막증 발생에 관한 종적연구
조구영(Goo Yeong Cho),김상욱(Sang Wook Kim),이미화(Mee Wha Lee),박중열(Joong Yeol Park),제수정(Soo Jung Je),이기업(Ki Up Lee),김기수(Ghi Su Kim) 대한내과학회 1994 대한내과학회지 Vol.47 No.4
Background: Proliferative diabetic retinopathy (PDR), a late stage of diabetic retinopathy, is the com- monest cause of acquired blindness in adults. Despite many previous studies, the risk factors for the development of PDR in Korean NIDDM patients have not been precisely defined yet. The aims of the present study were to evaluate the incidence and the risk factors of PDR. Method: From April to June 1993, we retrospectively studied 243 NIDDM outpatients (duration of diabetes 7.9±7.1, age 54.5±10.8, male 110 and fema1e 133) who had undertaken fundoscopic examination for diabetic retinopathy before April 1991. At the time of the examination, 70 patients had nonproliferative diabetic retinopathy (NPDR). Of those, 12 patients progressed to PDR and 58 patients did not. Clinical characteristics and laboratory findings of progressed group were compared with non-progressed group. Results: Of the 162 patients who were free of diabetic retinopathy at the initial examination, 18 patients progressed to diabetic retinopathy; the incidence rate of diabetic retinopathy was 34.9/1,000 person-yr. Of these, 1 patients had PDR (1.9/1,000 person-yr). After 2.6 years of mean follow-up, 12 out of 70 patients with initial NPDR progressed to PDR. The incidence rate of PDR in the patients with NPDR was 63.2/1,000 person-yr. Microalbuminuria, more severe weight loss, lower level of C-peptide and insulin therapy were associated with an increased 2.6-year risk of developing PDR. However, sex, smoking, use of antihypertensive drugs or aspirin, age, duration of diabetes and the mean fasting serum glucose, hemoglobin Al, cholesterol, systolic or diastolic blood pressure levels during the follow-up period were not associated with the progression to PDR. Forward stepwise multiple logistic regression analysis revealed that initial microalbuminuria and delta BMI are significant independent predictor for the progression to PDR. Conclusion: Microalbuminuria can be used as a predictor for progression to PDR. Lower level of C-peptide, more severe weight loss and current insulin use may be also the risk factors for progression to PDR in Korean NIDDM patients with nonproliferative retinopathy. However, long-term prospective study is warranted to answer the question more properly.