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극소 저출생 체중아의 정맥영양에서 칼슘과 인의 농도에 따른 효과 비교
피수영,박성종,김애란,문웅영,이영아,김기수 울산대학교 의과대학 1996 울산의대학술지 Vol.5 No.1
Hypothesis If calcium and phosphorus were administered to very low birth weight infants in amounts more than those currently used in the standard parenteral nutrition solution, the apparent retention of calcium and phosphorus will be increased and the bone mineralization will be improved in these very low birth weight infants. Patients Fifteen very low birth weight infants (<1,500gm) who were admitted to NICU at Asan Medical Center from February 1994 to August 1994 were recruited for the study. All of these infants required more than 2 weeks of parenteral nutrition therapy. Methods Those infants who received parenteral nutrition were divided into 2 groups : The standard supplement group (n=7, mean gestational age 28.6±2.1 weeks, mean birth weight 1,195±258gm), and high supplement group (n=8, mean gestational age 30.3±1.3 weeks, mean birth weight 1,129±197gm). The amount of elemental calcium supplied in the standard supplement group and high supplement group were 45mg/kg/day and 90mg/kg/day, respectively and the radio of calcium to phosphorus in parenteral nutrition solution was 1.7: 1 in both groups. The level of serum calcium, phosphorus, and alkiline phophatase was measured on 3rd and 14th day of the parenteral nutrition along with the urinary excretion of 24 hour calcium and phosphorus to estimate the retention of calcium and phosphorus in the body. The x-ray of the wrist was taken on 4th week of parenteral nutrition to see the mineralization of the bone and the changes for rickets. The sacral bone density was measured in both groups prior to discharge by using DPA(double-photon absorptiometry) when infants reached 1,800-2,000gm. Results 1) There were no differences in the serum concentration of calcium, phosphorus and alkaline phosphatase on 3rd and 14th day of parenteral nutrition between the standard and high supplement group. Both groups had similar values of the urinary excretion of calcium, phosphorus and the tubular reabsorption of phosphorus on 3rd and 14th day of parenteral nutrition. 2) The retentions of calcium and phosphorus which were checked on 3rd and 14th day of parenteral nutrition were significantly higher in the high supplement group than the standard group and this finding was statistically significant at p<0.05. 3) The radiographic findings of the rickets and osteopenia were more frequently observed in the standard supplement group than the high supplement group. Both bone mineral content (BMC) and bone mineral density(BMD) as measured by DPA were significantly higher in the high supplement group than the standard group(p<0.05). Conclusion The parenteral nutrition supply of high concentration of calcium and phosphorus in very low birth weight infant increased the retention of these minerals in the body, hence increasing the bone mineral contents. However, this study has its limitation due to small number of patients enrolled, therefore, further study is required to observe the effect of parenteral supply of calcium and phosphorus therapy on mineral retention and bone mineral content in very low birth weight infants.
임상 ; 당뇨병 산모에서 출생한 신생아의 선천성 기형 진단에서의 산전 정밀 초음파 검사의 역할
김영아 ( Young A Kim ),임진아 ( Gin A Lim ),이병섭 ( Byong Sop Lee ),심재윤 ( Jae Yoon Shim ),원혜성 ( Hye Sung Won ),김애란 ( Ai Rhan Kim ),김기수 ( Ki Soo Kim ),이필량 ( Pil Ryang Lee ),김암 ( Ahm Kim ),피수영 ( Soo Young Pi ) 대한주산의학회 2010 Perinatology Vol.21 No.3
목적: 당뇨병 산모아는 비당뇨병 산모아에 비해 선천성 기형의 빈도가 높다. 연구자들은 당뇨병 산모에서 산전정밀 초음파의 태아 기형 선별 검사로서의 유용성을 확인하고 신생아에 대한 출생 후 진단적 검사의 필요성에 대하여 조사하였다. 방법: 2004년 1월부터 2009년 2월까지 서울아산병원에서 임신성 또는 임신전성 당뇨로 진단받고 태아 기형의 검사 목적으로 정밀 초음파가 시행 된 218명과 이들에서 출생한 226명의 신생아를 대상으로 하여 의무기록을 후향적으로 검토하였다. 산전 진단 소견과 출생 후 진찰 및 초음파 검사 결과와의 차이점을 비교하였다. 결과: 산전 정밀초음파 검사 및 산후 진찰 및 초음파 검사 상 각각 32명(14.2%) 및 35명(15.5%)에서 이상소견이 발견되었다. 산전 진단에서 정상이었던 194명의 신생아 중 7례(3.6%)에서만 산후에 선천성 기형이 발견되었으며 이들은 모두 신생아기 진찰로 진단되거나 의심할 수 있었다. 임신 24-28주경 공복 혈당이 120 mg/dL이상인 경우와 인슐린 치료를 받은 경우 선천성 기형의 발생이 의미 있게 증가하였다. 결론: 숙련된 산과의사에 의하여 시행된 산전의 정밀 초음파 검사는 당뇨병 산모아의 선천성 기형의 발견 및 신생아기 치료방침 결정에 유용하였다. 당뇨 산모아에서 산전 정밀 초음파 상 이상이 없었던 경우 신생아기의 추가적인 진단적 초음파 검사는 필요하지 않을 것으로 생각된다. Objective: Infants of diabetic mothers have higher incidence of congenital malformations compared with those of non-diabetic mothers. We investigated the usefulness of prenatal level II or “targeted” ultrasonography (TUS) as a diagnostic tool to identify congenital abnormalities in infants of diabetic mothers. Methods: We retrospectively reviewed the medical records of 218 mothers diagnosed as pregestational or gestational diabetes in whom prenatal TUS was performed in Asan Medical Center between 2004 and 2009. The prenatal TUS findings were compared with the congenital abnormalities found in the infants (n=226) of the diabetic mothers by physical examination and ultrasonography (including echocardiography). Maternal risk factors associated with congenital anomalies were also investigated. Results: The incidence of congenital anomalies was 14.2% (n=32) in prenatal TUS and 15.5% (n=35) postnatally, respectively. Only 7 cases (3.6%) out of the 194 infants with normal prenatal TUS findings were found to have congenital abnormalities diagnosed postnatally. All of the abnormalities in these 7 infants could be detected or suspected by physical examination after birth. Maternal fasting glucose level >120 mg/dL and insulin therapy were significant risk factors for predicting congenital abnormalities in infants of diabetic mothers. Conclusion: Prenatal TUS performed by experienced obstetricians had a good reliability in the diagnosis of congenital anomalies in infants of diabetic mothers. Need for universal screening of ultrasound or echocardiography in these infants should be questioned especially in the cases in which prenatal TUS was performed.
A case of Riedel’s thyroiditis
Gyu Young Pi,Yong Sang Lee,Soon Won Hong,Hang-Seok Chang,Cheong Soo Park 대한외과학회 2012 Annals of Surgical Treatment and Research(ASRT) Vol.82 No.5
Riedel’s thyroiditis is an extremely rare disease that is difficult to diagnose correctly using preoperative diagnostic tools because it can mimic malignant neoplasm or the fibrous variant of Hashimoto thyroiditis during preoperative physical, radiologic, and pathologic examination. We describe here a rare case of Riedel’s thyroiditis in an elderly patient and its radiologic characteristics.