피질하 혈관성 치매 환자에서 협착성 뇌혈관 병변의 의의 : 자기공명 혈관조영술과 양전자방출단층촬영을 이용한 연구 MR Angiography and ^(18)FDG-PET Study

유경호,이병철,마효일,김윤중,정지향,나덕렬,강연욱 대한치매학회 2004 Dementia and Neurocognitive Disorders Vol.3 No.1

Background and Objective:Subcortical vascular dementia (SVD) incorporates small vessel disease as the primary vascular etiology, represents in MRI by lacunar infarct and deep white matter lesions. In clinical practice, a number of SVD patients present with various vascular risk factors for large artery disease (LAD) i.e., old age, hypertension, and diabetes. However the current diagnostic criteria for SVD did not include angiographic findings as a key feature. Therefore we tried to find out the frequency of large artery disease in SVD and to elucidate whether the presence of LAD affects clinico-radiological manifestations of SVD. Methods:Thirty three patients fulfilling 'Research criteria for SVD' by Erkinjuntti from 17 study centers were recruited. Of these 33 patients, 21 who underwent comprehensive neuropsychological test battery, MRI ^(18)FDG-PET, and MR angiography were classified into two subgroups according to the patterns of MRI abnormality:white matter dominant (WM) type (n=5) and multiple lacunar (LC) type (n=16). Clinical and neuropsychological profile and ^(18)FDG-PET findings of 21 SVD patients with and without LAD were compared. Results: Twelve (57%) of 21 SVD patients had mild stenotic lesions in intracranial large arteries:4 in middle cerebral artery, 8 in posterior cerebral artery, and 4 in vertebrobasilarj artery. There were no differences in vascular risk factors, characteristics of cognitive dysfunctions, and ^(18)FDG-PET findings between SVD with and without LAD. Conclusions:Our results showed that the presence of mild degree of large artery stenosis did not affect the clinical., neuropsychological profile and cerebral metabolism in PET. Therefore, the current 'Research criteria for SVaD' by Erkinjuntti could be used to diagnose SVD as a homogenous clinical group regardless of angiographic abnormalities.

크론병에 대한 CoPPLX의 방어효과에 대한 연구

이호학,김유림,문창기,이재일,양병윤,김종수,이정민,정재혁,안석진,박상준,김윤권,김소연,김영중,조민구,최영자,장성조 圓光大學校 醫科學硏究所 2005 圓光醫科學 Vol.20 No.1

안면부, 유방 및 상완부에 발생한 홍반성 루푸스 지방층염 1예

송유근,손두식,명형준,이현정,임중규,김순호,김윤아 朝鮮大學校 附設 醫學硏究所 2004 The Medical Journal of Chosun University Vol.29 No.2

Lupus erythematous panniculitis is a chronic inflammatory disease of subcutaneous fat that occurs in 2-3% of patients with systemic lupus erythematosus. Lupus erythematous panniculitis typically presents with firm, indurated subcutaneous nodules or plaques commonly developed in proximal extremities, trunks, head and neck. Face, breast and upper extremities involvement with lupus erythematous panniculitis has been infrequently reported. We report a case of lupus erythematous panniculitis developed in a 27-year-old female confirmed by histologic features and laboratory findings.

충수돌기에 발생한 비호지킨 림프종 1예

정유경,이미숙,김윤식,이미자,전호종 조선의대 1995 The Medical Journal of Chosun University Vol.20 No.2

뇌졸중 위험인자를 가진 어지럼 환자에서의 확산강조 자기공명영상

강형구,윤유상,이진희,박인철,이경룡,정상원,구홍두,김승호 대한응급의학회 2001 대한응급의학회지 Vol.12 No.4

Background: The management of vertiginous patients is a great challenge to emergency physicians. We evaluated the diagnostic value of a diffusion-weighted image(DWI) in differentiating central vertigo from the peripheral vertigo in patients who presented no neurological symptoms other than risk factors for stroke. Methods: From March 2000 to February 2001, we retrospectively analyzed the cases of 68 patients who visited the emergency department with symptoms of isolated vertigo and who had risk factors for stroke. DWIs, computed tomograms(CT), and medical records were reviewed, and the final diagnose, the DWIs and the CT readings, the risk factors for stroke, and the time it took waiting for a DWI or CT scan were analyzed. Results: Of the 68 patients, 21(30.8%) had central vertigo: 15 vertebrobasilar transient ischemic attacks(VB-TIA), 4 brain stem infarctions, 1 cerebellar infarction, and 1 cerebellopeduncular infarction. The DWI showed a 28.6% sensitivity, a 97.9% specificity, and an 85.7% positive predictive value in diagnosing central vertigo. It also had a 100% sensitivity in detecting infarctions. Conclusion: A DWI had a comparable sensitivity to MRI in detecting central vertigo and small, but potentially, lethal infarctions in our patient population. We recommend clinical application of DWI in the emergency department evaluation of isolated vertigo patients with risk factors for stroke.

제2형 당뇨병 동물모델인 OLETF 쥐에서 장기간 라미프릴 투여가 내당능 및 췌도 베타세포에 미치는 효과

고승현,윤건호,김명미,안유배,송기호,유순집,손현식,차봉연,이광우,손호영,강성구 대한당뇨병학회 2002 Diabetes and Metabolism Journal Vol.25 No.6

연구배경:최근 소개된 HOPE(Heart Outcomes Prevention Evaluation)study의 결과에 의하면, 심혈관질환이나 이에 대한 위험인자가 1가지 이상인 9,541명을 대상으로 안지오텐신 전환효소 억제제의 일종인 라미프릴을 투여하여 사망율과 뇌졸증, 심부전, 당뇨병 합병증이 개선되었을 뿐 아니라 다른 항고혈압제에 비해 새롭게 당뇨병으로 진단되는 환자가 줄었음을 보고한바 있다. 이에 저자들은 라미프릴(ramipril)을 제2형 당뇨병 동물모델에 장기간 투여함으로써 당뇨병을 예방하거나 고혈당 상태 또는 인슐린 감수성을 개선시킬수 있는지를 알아보고자 하였다. 방법:생후 24주된 체중 400∼450g의 OLETF와 LETO 쥐를 대상으로 6개월간 라미프릴 경구투여 하였고 혈압, 24시간 단백뇨 및 인슐린 내성검사를 시행하였다. 6개월 이후로는 8주간 투여군과 대조군의 체중을 비슷하게 맞추어 내당능 상태를 평가하였고 이후 다시 8주간 고농도 포도당을 투여하였다. 경구당부하검사를 시행한 후 희생시켜 조직표본을 만들어 guinea pig anti­human insulin 항체로 염색후 DAB로 발색하여 point count 법으로 베타세포를 정량하였고, 면역염색으로 췌도의 변화와 섬유화의 정도를 관찰하였다. 결과:라미프릴을 6개월간 투여하였을 때 OLETF 쥐에서 1)체중 증가가 적었으며 2)경구 당부하검사시 포도당하 면적은 의미있게 감소하였고 3)인슐린 내성검사상 Kitt가 증가되는 경향을 보였으며 4)수축기, 이완기 혈압과 24시간 단백뇨양이 의미있게 감소하였고 5)체중을 맞추면 내당능 상태가 비슷해졌다가 고농도 포도당 주입시 다시 포도당하 면적이 대조군에서 더 증가되었다. 라미프릴 투여군에서 췌도변형 및 파괴와 탈과립, 췌도내 섬유화가 감소하였다. 결론:본 실험에서는 인슐린 비의존성 당뇨병 동물 모델인 OLETF 쥐에서 당뇨병 발생 이전 단계부터 장기간 라미프릴을 투여할 경우 체중증가가 적었고, 투여군과 대조군의 체중을 맞추었을 때는 내당능상태의 차이가 없아가 고혈당 투여시 다시 투여군과 대조군에서 의미있는 차이를 보였다. 라미프릴 투여가 베타세포의 기능면에서 이로운 효과를 보일 것으로 생각되었다. 따라서 비만한 환자에서 안지오텐신 전환효소 억제제의 장기투여는 단백뇨 감소, 혈압강하 효과 이외에 체중증가의 억제 및 당뇨병 발생을 억제할 가능성을 시사한다. Background : In a Heart Outcomes Prevention Evaluation HOPE study, ramipril, a long-acting angiotensin-converting enzyme (ACE) inhibitor, significantly reduced the death rates the number of myocardial infarctions, strokes, heart failure as well as the risk of complications related to diabetes and of diabetes itself. However, it is known that ACE inhibitors improve glucose tolerance or insulin sensitivity or reduce the incidence of diabetes. Methods : 24 week-old OLETF (Otsuka Long Evans Tokushima Fatty) rats weighing 400 ~ 450 g were used in this study. 4 groups of rats were examined in parallel for 40 weeks. The OLETF rats were randomized for treatment with an aqueous solution of ramipril (5 mg/Kg) daily [OL (RMP), n=10)] and with saline [OL (CON), n=10)]. The LETO rats were also randomized in the same was as the OLETF rats (LT(RMP), n=10, LT (CON), n=10). The blood glucose level, body weight, systolic and diastolic blood pressure was assessed every month. At 3 and 6 months, the 24hrs urinary protein concentration was measured, and as insulin tolerance test and oral glucose tolerance test were conducted in all experimental groups. After 6 months, the body·weight was matched for 2 months in each corresponding group. Subsequently, a 15% sucrose loading was done for 2 months. After the glucose tolerance test, the pancreas was excised and immuno histochemical staining was conducted for insulin to quantify the beta cell mass by a point-counting method. In addition, the islet morphology was evaluated in the pancreas. Results : Ramipril treatment for a period of 6 months improved the 2hr blood glucose level, the area under the glucose curve in the oral glucose tolerance test, insulin sensitivity in addition to lowering significantly systolic and diastolic blood pressure and 24hrs urinary protein level significantly in OLETF rats. Of note, a lower weight gain was observed in both the ramipril-treated animals at 6 months. After weight matching, the AUC g and 2hr blood glucose level values were similar between the corresponding groups, but a 15% sucrose loading worsened the AUC g value. Histologically, the islets were less disorganized and the extent of fibrosis was lower in the ramipril-treated OLETF rats in the trichrome stain. Conclusion : Long-term treatment of ramipril, a long acting angiotensin-converting enzyme inhibitor may be useful for suppressing weight gain and proteinuria in addition to having a protective effect on the islet to harmful stimuli such as hyperglycemia (J Kor Diabetes Asso 25:469~482, 2001).

콘택트렌즈 보존 용기 유래 Acanthamoeba lugdunensis KA/L5주의 내공생세균

정동일,공현희,김태호,황미열,유학선,윤호철,설성용 경북대학교 의학연구소 1999 경북대학교병원의학연구소논문집 Vol.3 No.1

콘택트렌즈 보존 용기 유래 가시아메바 KA/L5주의 세포질 내에 존재하는 bacterial endosymbiont(내공생세균)를 투과전자현미경으로 관찰하여 확인하였다. 숙주인 가시아메바 KA/L5주는 형태학적으로 제2군에 속하였고, rDNA PCR-RFLP 결과 A. lugdunensis로 동정되었다. 미토콘드리아 DNA RFLP와 동위효소 분석상 이 충주는 국내 콘택트렌즈 보존용기에서 가장흔히 분리되는 type인 KA/Ll주, 국내 임상 분리주 중 하나인 KA/E2주, 내공생세균을 가지는 것으로 보고된 병원 냉각수 유래 KA/W4주 및 L3a주와 동일하거나 매우 유사한 성적을 보였다. 내공생세균은 약 1.38× 0.507㎛의 크기였고, 아메바 세포질 내에 불규칙하게 분포하고 있었으며. 그 표면에 아메바의 ribosome이 부착되어 있었다. 내공생세균을 둘러싼 lacunae나 막과 같은 구조는 관찰되지 않았다. Legionella 특이 primer를 이용한 효소중합반응(PCR)에서 내공생세균의 염색체 DNA는 증폭되지 않았다. A. lugdunensis의 우리말 이름을 담수가시아메바로 제안한다. Transmission electron microscopy of an Acanthamieba isolate (KA/L5) from a contact lens case revealed bacterial endosymbionts within cytoplasm of the amoebae, The Acanthamoeba isolate belonged to the morphological group II. Based on the polymerase chain reaction (PCR) - restriction fragment length Polymorphism (RFLP) of 18S ribosomal RNA coding DNA (rDNA), the Isolate was identified as A. lugdunensis. Strain typing by isoenzyme analysis using isoelectric focusing (IEF) and mitochondrial (Mt) DNA RFLP revealed that the isolate was closely related with KA/Ll , the most predominant type of isolates from contact lens storage cases, KA/E2, a clinical isolate, KA/W4, preciously reported to host endosymbionts, and L3a strains of A. lugdunensis. The endosymbionts were similar to those of KA/W4 In aspects that they were randomly distributed in both trophozoites and cysts, and were rod-shaped bacteria measuring approximately 1.38x 0.50㎛. But the number of endosymbionts per amoeba was significantly lower than that of KA/W4. They were neither limited by phagosomal membranes nor included In lacunae- like structure.

S-331 : 18FDG-PET brain showing diffuse uptake in Cushing`s disease solved by total hypophysectomy

( Yu Jung Yun ),( Youn Jeong Choi ),( Beo Deul Kang ),( Mi Jin Yun ),( Se Hoon Kim ),( Sun Ho Kim ),( Yu Mie Rhee ) 대한내과학회 2013 대한내과학회 추계학술대회 Vol.2013 No.1

A 18-year-old boy was admitted with weight gain (15 kg per 6 months, 164 cm/64 kg, BMI 23.8) and Cushingoid feature. He was diagnosed with precursor T-cell lymphoblastic leukemia at the age of 10. He underwent chemotherapy for 3 years and prophylactic cranial irradiation (18 Gy), then achieved complete remission. During the chemotherapy treatment, 12,158 mg of dexamethasone was administered. Investigation for hormones showed high cortisol (38.3 ug/dL), ACTH (82.85 pg/mL) and 24 hr urine free cortisol (761.4 ug/day). MR images of the sellar region showed no abnormal findings. In PET brain scan, there was diffusely increased FDG uptake in the pituitary gland suggestive of hyperplasia. Adrenal CT scan showed no definite mass. Cortisol was not suppressed by low and high dose dexamethasone test. Subsequent intrapetrosal sinus sampling revealed central/peripheral ACTH ratio over 3 (right 4.09/ left 7.15) and left lateralization of 1.7 was identified. Thus left pituitary gland was removed via transsphenoidal approach. Pathological diagnosis of resected pituitary showed the possibility of corticotroph hyperplasia without any focus of adenoma. After the surgery cortisol and ACTH levels were still high. Therefore, 111indium octreosan and chest CT scan were performed in order to find any ectopic corticotroph releasing hormone secreting focus, but there were no significant findings. Then brain MRI, PET brain scan and IPSS were repeated again to evaluate the tumor recurrence or hidden microadenoma. In IPSS, the central/peripheral ACTH ratio was still over 3 (right 19.23/ left 3.74) and PET brain scan still showing diffuse uptake in the remnant right pituitary gland. Finally, to completely control cortisol excess, right pituitary gland was also surgically removed. After the surgery, the cortisol and ACTH levels were decreased. In the resected pituitary, Crooke hyalinization were presented significantly more without definite corticotroph hyperplasia or adenoma. This case was about the Cushing`s disease due to hyperfunctionig corticotroph cells. And we thought that the cause of hyperfunctionig corticotroph cells was the loss of cortisol negative feedback after the quit of high dose dexamathasone administration.

Plasma endocan level and prognosis of immunoglobulin A nephropathy

( Yu Ho Lee ),( Jin Sug Kim ),( Se Yun Kim ),( Yang Gyun Kim ),( Ju Young Moon ),( Kyung Hwan Jeong ),( Tae Won Lee ),( Chun Gyoo Ihm ),( Sang Ho Lee ) 대한신장학회 2016 Kidney Research and Clinical Practice Vol.35 No.3

Background: Endocan, previously called endothelial cellespecific molecule-1, is a soluble proteoglycan that is secreted from vascular endothelial cells. Elevated plasma endocan levels were shown to be associated with poor cardiovascular outcomes in patients with chronic kidney disease (CKD). We investigated the clinical relevance of plasma and urine endocan levels in patients with immunoglobulin A nephropathy (IgAN). Methods: Sixty-four patients with IgAN and 20 healthy controls were enrolled in this study. Plasma and urine endocan levels were measured. Clinical parameters, pathologic grades, and renal outcomes were compared among subgroups with different plasma and urine endocan levels. Results: Both plasma and urine endocan levels were significantly higher in patients with IgAN than in controls. Elevated serum phosphorus and C-reactive protein were independent determinants for plasma endocan, and elevated C-reactive protein was also an independent determinant for urine endocan levels in multivariate analysis. Plasma endocan level was not significantly different across CKD stages, but patients with higher plasma endocan levels showed adverse renal outcome. Urine endocan levels were also elevated in patients with poor renal function. Cox proportional hazard models showed that high plasma endocanwas an independent risk factor for CKD progression after adjusting for the well-known predictors of outcome in patients with IgAN. Conclusion: This study suggested that plasma endocan might be useful as a prognostic factor in patients with IgAN.

Equivalent Circuit Model of A Semiconductor Nanowire Field-Effect Transistor

Yun Seop Yu,Sung Ho Choi,Nam Ho Kim 한국정보통신학회 2007 2016 INTERNATIONAL CONFERENCE Vol.1 No.1