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      • 동종 골수이식 후 만성 이식편대숙주질환과 동반되어 신증후군으로 발현된 IgA 신병증 1예

        정철권,김현수,박준성,정성현,조도연,최진혁,남동기,임호영,김명성,신규태,임현이,김효철 대한조혈모세포이식학회 1999 대한조혈모세포이식학회지 Vol.4 No.2

        동종 골수이식 후 발생하는 신기능부전은 원인이 다양하여 감별에 어려움이 있다. 만성 GVHD는 흉선의 기능저하에 따른 면역관용의 실패로 발생되는 자가면역현상에 의해 발생되는 것으로 알려져 있으며 드물게 신장을 침범하여 신증후군을 일으키기도 한다. CaA의 용량을 줄이거나 투약중지 후 발생한 만성 GVHD에 동반된 신증후군의 경우 조기에 신조직검사를 시행하여 감별진단하고 CsA의 용량을 증량하거나 재투약하여 좋은 치료 결과를 보일 것으로 기대된다. 저자들은 문헌고찰을 통해 동종 골수이식 후 발생된 신증후군이 유사한 임상양상을 보이며 발생기전에 만성 GVHD와 자가면역현상이 연관되어 있음을 확인하였으며 동종 골수이식 후 신증후군의 임상양상을 보이는 환자에서 병리조직학적으로 lgA 신병증을 진단하고 이러한 lgA 신병증이 발생기전에 만성 GVHD와 자가 면역현상이 연관되어 있을 가능성을 최초로 확인하였으며 CsA를 이용하여 성공적으로 치료한 경험을 하였기에 보고하는 바이다. Renal insufficiency is occasionally encountered in allogeneic bone marrow transplantation and its cause is difficult to ascertain. Chronic graft-versus-host disease (GVHD) related to thymic dysfunction is immune-mediated and involves autoreactivity of T-lymphocytes derived from donor marrow to recipient's major histocompatibility complex(MHC) minor antigens. The clinical mainifestations of chronic GVHD are similar to those of autoimmune disease but kidney involvement is rare. Few cases of nephrotic syndrome with membranous nephropathy or minimal change nephrotic syndrome have been reported to be associated with chronic GVHD in allogeneic bone marrow transplant recipient especially after cyclosporine A(CsA) withdrawal, and these cases have responded well to CsA. Therefore, it is prudent to differentiate the cause of post-transplant renal insufficiency using renal biopsy and to start CsA in a case of nephrotic syndrome associated with chronic GVHD as early as possible. We report a case who had a massive proteinuria during the post-allogeneic marrow transplantation period. The cause of nephrotic syndrome was diagnosed as IgA nephropathy by renal biopsy. The patient was successfully treated with reintroduction of CsA.

      • 果采類 殘留性 農藥의 突然變異 誘發性

        오명철,오창경,김성홍,고용구,김수현 濟州大學校工科大學産業技術硏究所 1995 尖端技術硏究所論文集 Vol.6 No.-

        Salmonella typhimurium TA 균주를 이용하여 과채류 재배에 많이 사용되는 12종의 잔류성 농약에 대한 돌연변이 유발성을 검정하였다. 본 연구에 사용된 12종의 농약 중 Tedion, Monopho, Danoton, Ometon 및 Captan에 대한 돌연변이 유발성은 강하였고, Thalonil, Prosing, EPN, Phentoate, Dicopol 및 Captan에 대한 돌연변이 유발성은 중간 정도였으나, Dicopol은 돌연변이 유발성이 없었다. TA98에서, Monopho와 Danoton은 강한 돌연변이 유발성을 나타내었고, Thalonil, Prosing, EPN, Phentoate, Parathion 및 Sappiran은 중간정도의 돌연변이 유발성, Danoton은 약한 돌연변이 유발성을 나타낸 반면, Dicopol과 Sappiran은 돌연변이 유발성을 나타내지 않았다. 한편, TA100에서는 Tedion, Danoton, Ometon 및 Captan이 강한 돌연변이 유발성을, Thalonil과 Monopho는 중간 정도의 돌연변이 유발성, Prosing, Phentoate, Parathion 및 Sappiran은 약한 돌연변이 유발성을 보인 반면, EPN과 Dicopol은 돌연변이 유발성이 없었다. 따라서, EPN은 구조이동성 돌연변이를, Sappiran은 염기치환성 돌연변이를, 그리고 이들과 Dicopol을 제외한 나머지 9종의 농약은 구조이동성 및 염기치환성 돌연변이를 일으키는 돌연변이원임을 확인하였다. Twelve residual pesticides which applied on the fruits and vegetables cultivation were tested for mutagenic activity using Salmonella typhimurium TA strain. Mutagenic activities against Tedion, Monopho, Danoton, Ometon and Captan of twelve pesticides tested were strong, Thalonil, Prosing, EPN, Phentoate, Dicopol and Captan were medium, and Dicopol were no. Tedion, Monopho and Danoton showed strong mutagenic activities on TA98, Thalonil, Prosing, EPN, Phentoate, Parathion and Sappiran showed medium, and Danoton showed weak, while Dicopol and Sappiran showed no. At the other hand, Tedion, Danoton, Ometon and Captan showed strong mutagenic activities on TA100, Thalonil and Monopho showed medium and Prosing, Phentoate, Parathion and Sappiran showed weak, while EPN and Dicopol showed no. Therefore, EPN identified mutagen which induced only frameshift mutation, Sappiran was only base-substitution, and nine except these and Dicopol of twelve pesticides tested were mutagens which induced both frameshift and base-substitution mutation.

      • 개에 있어서 耳根部의 Lidocaine 水針에 의한 全身 無痛覺의 誘發

        권현주,유건주,이상은,이정연,송근호,김명철,정성목,박성준,김덕환 충남대학교 수의과대학 동물의과학연구소 2004 動物醫科學硏究誌 Vol.12 No.-

        Twelve clinically healthy mongrel dogs were used to clarify the possibility of general analgesia induction by lidocaine aquapuncture to auricular root area in the present study. The experimental animals were devided into control (6 heads) and experimental groups (6 heads), respectively. Physiological salines (3 ml/kg) were injected into both auricular root areas in control group. Lidocaine hydrochlorides (3 ml/kg) were injected into both auricular root areas in experimental group. Superficial pain, the changes of vital signs and blood leukocytes, and PCV were examined on pre, 5 min., 15 min., 30 min, and 60 min. after injection in control and experimental groups, respectively. Analgesia was not detected at all in control group, however, all experimental animals were recumbent and analgesia was generally detected in the auricles, noses, dorsal parts, ventral areas, limbs and tails from 5 to 30 minutes after injection with lidocaine hydrochloride into auricular root areas in experimental group. As for the change of vital signs, body temperature showed decreasing tendency from 5 minutes after lidocaine injection in experimental group. Heart rates and respiration rates were increased on 5 minutes after lidocaine injection and then they showed decreasing tendency in experimental group. No significant difference were found among groups. As for the changes of hematological findings, the numbers of blood leukocytes were increased till 15 minutes after lidocaine injection and then they showed decreasing tendency. PCV values were increased on 5 minutes after lidocaine injection, and then they showed decreasing tendency. However, no significant differences were observed among groups. Considering the above findings, it was thought that general analgesia was possible by aquapuncture with lidocaine hydrochloride into auricular root areas and lidocaine aquapuncture didn’t affect so much to the changes of vital signs and blood.

      • 회맹장 및 대장을 침범한 장 결핵에 있어서 바륨을 이용한 방사선 이중조영촬영 소견에 대한 연구

        진용현,전혜정,이용근,강철호,조성범,김윤환,박철민,차상훈,김일영,이혜경 건국대학교 의과학연구소 2002 건국의과학학술지 Vol.12 No.-

        To determine the characteristic double contrast barium enema findings of ileo-cecal and colonic tuberculosis and to make differential diagnosis from other bowel inflammatory disease. Sixty-seven patients confirmed as ileo-cecal and/or colonic-tuberculosis in six hospitals were evaluated retrospectively. The diagnosis was proven by endoscopic biopsy, surgery, and clinical follow up. Nine of 67 patients were excluded because radiologic findings were normal though endocopic biopsy examinations resulted in tuberculosis. Histopathological diagnosis were madein 58 cases as follows: endoscopic biopsy(n=29), operation(n=12), follow up examination(n=14), tissue culture(n=1), laparoscopic biopsy(n=2). There were 30 men and 28 females. The mean age were 36 yrs(range:16-67), 34 patients were in the second and third decade. The distribution of lesions, morphological characteristics, mucosal changes, ulcer shape and depth, associated with other tuberculous lesion, multiplicity were retrospectively analyzed in the findngs of double contrast barim enema. The commonest clinical symptoms were abdominal pain(n=35, 60%) and diarrhea(n=18, 31%). The chest radiography revealed association of pulmonary tuberculosis in 39 cases. Tuberculous lesions of other organs except chest were present in five cases. Double contrast barium enema findings showed a thickening and irregularity of intestinal mucosal fold(n=29, 50%), bowel contraction and/or shortening(n=26, 45%). There were small, nodular, superficial ulcers in the case of ulcer depth less than 2 mm in the depth. As many as 39 cases(67%) in this series had two or more lesions in the intestinal tuberculosis. The involved segment revealed symmetrical feature(n=21, 36%). Inflammatory pseudopolypoid lesions were noted in 30 cases(52%). The ileo-cecal region was involved in 38 cases(66%). The ascending colon(n=25, 43%) was the second commonest site with or without contiguous cecal involvement. Lesions in terminal ileum, ileo-cecal valve, transverse colon, descending colon and appendix were seen in 19, 18, 18, 12 and seven cases, respectively. Among 18 cases of ileo-cecal valve lesions, there were incompetency in nine cases(16%) and wide gapping in four cases(7%). In 14 cases, tuberculous enterocolitis was diagnosed by clinical follow-up and double contrast barium enema study. 12 out of 14 cases, the findings of double contrast barium enema of tuberculous enterocolitis were normalized after anti-tuberculous medication. However, two cases showed more aggravated state than before due to inappropriate treatment. Double contrast barium enema plays an important role in the diagnosis of tuberculous enterocolitis, determines the type, site and extent of the involvement and helps in treatment guide by using sequential studies.

      • 양성갑상선종물 환자에서 갑사선 호르몬 억제요법과 갑상선 호르몬과 항갑상선제 병합요법의 치료효과 비교

        최성남,공병호,배현철,오연상,신순현 중앙대학교 의과대학 의과학연구소 1998 中央醫大誌 Vol.23 No.1

        Traditionally, patients with nontoxic benign thyroid nodule has been treated with levothyroxine. The successful treatment of T4 suppressive therapy, however, has been observed in 50 % of patients with thyroid nodules oven though the treatment were continued more than 1 year. The side effects such as osteoporosis, left ventricular hypertrophy has been observed. Therefore, we performed this study to evaluate the efficacy of the new treatment modality (levothyroxine and methimazole combination) in the treatment of thyroid nodule. Study population was 67 patients having nontoxic benign thyroid nodule. Serum TSH, fT4, T3 and thyroid nodular volume were measured at pretreatment and post-treatment periods. The benign thyroid lesion was confirmed by FNAC (fine needle aspiration cytology). The factors can be influenced on therapeutic response were also studied. The patients were divided into two groups. One group had been treated with levothyroxine only and the other with levothyroxine and anthithyroid drug combination. 47 patients had been treated with levothyroxine only. The other 20 patients had received combination therapy with levothyroxine and methimazole. The mean age and sex ratio, pretreatment nodular volume, TSH, fT4 and total T3 level measured at pretreatment and post-treatment had no stastistical difference between two groups. The combination therapy group had been treated for 8.4 ± 2.6 months and T4 suppressive therapy group for 11.1 ± 4.8 months (P=0.03). Pretreatment TSH concentration was 0.99 ± 0.60 μIU/ml in T4 suppressive therapy group, 1.43 ± 1.21 μIU/ml in combination therapy group. (P=0.023) But the value of serum TSH in both groups was in normal range. The responder group was 17 patients and the response rate was 85 % in combination therapy group and 25 and 53 % in T4 suppressive group. In the combination therapy group, the volume reduction was more greater. (71.5% in combination group, 18.1 % in T4 group) In conclusion, combination therapy can reduce treatment duration, enhance therapeutic response rate for the treatment of benign thyroid nodule. The exact mechanism of methimazole on thyroid nodule wan not not clearly known. Perhapse, the influence of methimazole on the transcription factor may be involved Further study in this regard is needed in the future.

      • KCI등재
      • SCIESCOPUSKCI등재
      • Lutembacher 증후군 환자 증례 보고

        김성범,서정주,곽철훈,김상민,이보라,민선경,황은구,김용인,조욱현,최석구 인제대학교 2008 仁濟醫學 Vol.29 No.-

        Lutembacher's syndrome is rare combination of mitral stenosis (MS) and atrial septal defect (ASD). The hemodynamic interplay between the MS and ASD leads to wide variation of clinical presentation. Here we describe a 43-year-old female with Lutembacher's syndrome and tricuspid regurgitation with pulmonary hypertension, who underwent direct closure of ASD and tricuspid valvuloplasty successfully. We also reviewed other literatures in an effort to increase awareness of this condition.

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