Raynaud씨 증상이 식도 운동에 미치는 영향

이오영 ( Oh Young Lee ),김태환 ( Tae Hwan Kim ),고희관 ( Hee Kwan Koh ),이제경 ( Je Kyung Lee ),유태석 ( Tae Seok Yoo ),장대국 ( Dae Kook Chang ),심승철 ( Seung Cheol Shim ),전재범 ( Jae Bum Jun ),정성수 ( Sung Soo Jung ),이인홍 ( 대한류마티스학회 1998 대한류마티스학회지 Vol.5 No.1

Objectives: In the connective tissue disease patients, esophageal dysfunction is often closely associated with the presence of Raynaud`s phenomenon. But there are no previous reports concerning the values of esophageal manometry in the connective tissue disease with Raynaud`s phenomenon in Korea. Therefore, we performed this study to evaluate esophageal function in connective tissue disease with Raynaud`s phenomenon. Methods: Total 86 subjects were employed in this study including 30 normal control group, 14 mixed connective tissue disease(MCTD), 21 systemic sclerosis, 16 systemic lupus erythematosus(SLE), and 5 Raynaud`s phenomenon only. In each subject, esophageal manometric study was performed with lower compliance capillary infusion system. Results: The mean age(±SD) of patients and controls were as follows: MCTD 34.1(±8.9), systemic sclerosis 44.9(±9.3), SLE 32.1(±7.9), and normal controls 31.9(±5.3). All patients with MCTD and systemic sclerosis had Raynaud`s phenomenon. Twelve out of 14 patients with MCTD, 17 out of 21 patients with systemic sclerosis, were abnormal in esophageal manometry. Nine out of 16 SLE had Raynaud`s phenomenon. Among 9 SLE with Raynaud`s phenomenon, 5 patients(55.5%) were abnormal in esophageal manometry, and among 7 SLE without Raynaud`s phenomenon, 2 patients(28.6%) were abnormal in esophageal manometry. Among 5 patients with Raynaud`s phenomenon, 3 patients were abnormal in esophageal manometry. Abnormal esophageal manometry finding is more common in the connective tissue disease patients with Raynaud`s phenomenon compared with the patients without Raynaud`s phenomenon (P=0.0219). Conclusions: Abnormal esophageal manometry finding is more common in the connective tissue disease patients with Raynaud`s phenomenon compared with the patients without Raynaud`s phenomenon.

레이노 현상의 한의학적 치료에 대한 연구 동향 - 국내 논문을 중심으로 -

이창욱 ( Chang Wook Lee ),김상찬 ( Sang Chan Kim ),박정아 ( Chung A Park ) 대구한의대학교 제한동의학술원 2019 제한동의학술원논문집 Vol.17 No.1

Objective : The purpose of this study is to review herbal treatment for Raynaud's phenomenon by summarizing Korean clinical research studies. Method : The study was based on 6 papers published in Korea. The papers were searched on Koreantk, NDSL, RISS and KISS. Results : 1. The average age of the subjects was 47.3 years. In sexual proportion, male is 71.4% and female is 28.6%. The average duration of Raynaud's phenomenon was 23.7 months. 2. The most frequent Pattern of Raynaud's phenomenon was Gi-hyul stagnation syndrome (氣血鬱滯) and Deficiency Syndrome (虛證). 3. The most frequent herbal medicinal treatment was Chiljehyangbuhwan (七製香附丸). 4. The most frequent herb was Angelicae Gigantis Radix (當歸) and the next was Glycyrrhizae Radix et Rhizoma (甘草), Astragalus membranaceus Bunge (黃民), Rehmanniae Radix Preparata (熟地黃) and Paeoniae Radix (苟藥). 5. The average period of treatment was 45.5 days and the most frequent rating scale was VAS or NRS score. 6. The effects of treatment were evaluated based on VAS, NRS score, DITI, CST, CRR and other evaluation indexes. Most of all studies, VAS or NRS score decreased to 1-4, and DITI, CST, CRR and other outcome measurement were significantly better than before treatment. Conclusion : Chiljehyangbuhwan (七製香附丸) as a herbal formula and Angelicae Gigantis Radix (當歸)as a herb were frequently used in Raynaud's phenomenon, respectively. To confirm the herbal treatment method for Raynaud's phenomenon, extensive research will be required.

레이노 현상을 진단받은 환자에서 발생한 단안의 망막 반점 출혈 1예

박찬금,이수정,박정민 대한안과학회 2015 대한안과학회지 Vol.56 No.4

목적: 우안 시력저하를 주소로 내원하여 우안에 국한된 망막 반점 출혈 소견으로 경과관찰 중 레이노 현상을 진단받은 1예를 경험하였기에 이를 보고하고자 한다. 증례요약: 65세 여자 환자가 하루 전부터 발생한 우안 시력장애를 주소로 내원하였다. 기왕력으로 고혈압을 2년 전에 진단받고 경구약 복용 중이었다. 최대 교정시력 우안 0.8 좌안 1.0이었고 안압은 우안 15 mmHg, 좌안 21 mmHg로 측정되었으며 안저 검사상 우안4 사분면에 걸친 망막 반점출혈과 망막 혈관 비틀림(tortuosity)이 증가된 소견이 관찰되었다. 시야검사 및 경 흉부 심장초음파, 목동맥 도플러 초음파 검사상 이상소견은 관찰되지 않았다. 혈액검사상 항핵항체 강 양성 및 항중심절항체 양성소견을 보여 류마티스내과와 협진하였고 전신성 피부 경화증, 전신성 홍반성 루푸스 등의 다른 류마티스 질환과의 연관성은 발견되지 않아 일차성 레이노현상으로 진단받게 되었다. 이후 혈액순환 개선제를 복용하며 경과관찰하였고 5개월 후 양안 교정시력은 각각 1.0이고 안저 촬영에서우안의 망막 반점출혈 소견은 소실되었다. 결론: 다른 안과적 원인이 배제된 비정형적 망막 반점출혈 소견을 보인 환자에게서 레이노 현상이 동반된 경우 레이노 현상 발현과연관된 망막 혈관의 자동 조절 기전의 변화가 망막 반점출혈의 기전과 관련이 있을 수도 있으므로 정밀검사 및 자세한 병력청취를 통해 레이노 현상 유무를 감별할 필요가 있다. Purpose: To report a case of retinal blot hemorrhage localized to 1 eye accompanied by Raynaud’s phenomenon. Case summary: A 65-year-old female was referred for vision disorder in the right eye. She had been taking an antihypertensive drug since diagnosed with systemic hypertension 2 years previously. On initial examination, her best corrected visual acuity was 20/25 in the right eye and 20/20 in the left eye and intraocular pressure was 15 mm Hg in the right eye and 21 mm Hg in the left eye. Fundus examination showed retinal blot hemorrhage across the entire retina and increased retinal vascular tortuosity. No specific finding was found on visual field examination, transthoracic ultrasonography and carotid Doppler ultrasound. The blood test was positive for antinuclear and anticentromere antibodies, thus she was referred to the rheumatologic department. The patient was diagnosed with primary Raynaud’s phenomenon because no correlation with other rheumatologic diseases was found. Subsequently, she was scheduled for regular follow-ups with a prescription of circulatory stimulant. Five months later, her best corrected visual acuity was 20/20 in the both eyes and retinal blot hemorrhage in the right eye was significantly decreased based on fundus examination. Conclusions: In the case of atypical retinal blot hemorrhage without other ophthalmic causes except Raynaud’s phenomenon,the change in retinal circulatory autoregulation associated with the mechanism of retinal blot hemorrhage can be presumed.Therefore, a close examination and history taking should be conducted so that Raynaud’s phenomenon as a pathological factor is not overlooked.

Fluoxetine, the Next niche in the Treatment of Raynaud's Phenomenon

O, Chinyoung 한국병원약사회 2002 병원약사회지 Vol.19 No.3

Abstract : To evaluate the use of fluoxetine in patients with Raynaud's phenomenon. Data sources : Literature was accessed through Medline searches. Data Synthesis : Literatures published to assess and report the use of fluoxetine to treat Raynaud's phenomenon was analyzed. Conclusions : Reports of fluoxetie treating the Raynaud's have been published; however, the opposite events fluoxetine caused the Raynaud's have been reported. Fluoxetine benefits to the primary and female Raynaud's phenomenon from the randomized controlled study; however, due to the limitations of these reports, insufficient evidence establishes the benefits of fluoxetine. Further clinical study needed.

Risperidone Related Raynaud’s Phenomenon: An Adolescent Case

Serkan Güneş,Özalp Ekinci,Halenur Teke,Veli Yıldırım 대한정신약물학회 2018 CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE Vol.16 No.1

Raynaud’s phenomenon is a recurrent vasospastic condition with reducing in peripheral blood flow due to cold, or emotional stress. White, blue and red discolorations occur during the attacks. Serotonin reuptake inhibitors, psychostimulants, and aripiprazole are reported to be related with Raynaud’s phenomenon. Risperidone is an atypical antipsychotic drug with dopaminergic and serotonergic effects. In children and adolescents, risperidone is used for bipolar disorder, tic disorders, conduct disorder, schizophrenia, symptoms of irritability and self-mutilation. Here we report a case of Raynaud’s phenomenon associated with risperidone in a 12-year-old boy. Raynaud’s phenomenon occurred two weeks after starting risperidone and disappeared after stopping risperidone.

봉약침과 홍화약침으로 치료한 레이노 현상을 동반한 수근관증후군 환자 1례

최석우,박평범,오성종,Choi, Seok-Woo,Park, Pyeong-Beom,Oh, Sung-Jong 대한약침학회 2009 Journal of pharmacopuncture Vol.12 No.1

Objectives : This study is to report the effect of Pharmacopuncture therapy on a patient suffering from the pain and cold intolerance of hand caused by Carpal tunnel syndrome with Raynaud's phenomenon. Methods : We had treated the patient diagnosed as Carpal tunnel syndrome with Raynaud's phenomenon by Sweet BV and CF pharmacopuncture. We injected Sweet BV and CF into acupuncture points on both hands - Sweet BV into Baxie (EX-UE9), CF into Naegwan ($PC_6$) and Daereung ($PC_7$). And then we evaluated her symptoms by VAS (Visual Analog Scale). Results : Clinical symptoms about Carpal tunnel syndrome with Raynaud's phenomenon were remarkably improved by Sweet BV and CF Pharmacopuncture. Conclusion : Therefore, we concluded that pharmacopuncture therapy - Sweet BV, CF etc. - may be useful to treat Carpal tunnel syndrome with Raynaud's phenomenon.

레이노 환자의 한랭 부하 후 손가락 끝 온도 측정을 통한 진단 보조지표의 가능성 연구

장호석(Ho-Suk Chang),허영철(Yeong-Cheol Heo) 한국방사선학회 2019 한국방사선학회 논문지 Vol.13 No.2

본 연구의 목적은 레이노 현상 의심 환자의 정량적 판독 보조 지표의 가능성을 확인하고자 하는 것이다. 레이노 현상 의심 환자 99명에서 가능성 낮음 48명, 중간 16명, 높음 35명을 대상으로 하였다. 검사는 15.2± 0.8°C 얼음물에 10분 간 양 손을 한랭 부하 후 99m Tc 370 MBq(10 mCi)를 정맥 주사하였다. 이 후 5분, 10분, 20분 양측 열 손가락의 온도 변화를 측정하였고, 핵의학 판독의의 판독 결과와 온도 변화를 비교하였다. 판독 결과 레이노 현상의 가능성이 낮은 군은 손가락 온도가 32.6±4.9°C로 높게 측정되었고, 가능성이 높은 군은 22.7±6.0°C로 낮게 측정되었다(p<0.05). 결론적으로 레이노 현상 의심 증상에 따라 손가락 온도의 차이가 났음을 확인하였고 이를 통해 손가락 온도의 측정이 레이노 진단의 정량적 보조 지표로서의 가능성이 있음을 확인하였다. The purpose of this study is to suggest a quantitative supplementary index for patients with suspected Raynaud phenomenon. The subjects were 99 patients with suspected Raynaud phenomenon, 48 patients with low likelihood, 16 patients with middle range and 35 patients with high range. The test was instilled in ice water at 15.2 ±0.8°C for 10 minutes of both hands and then venous injected of 99m-Tc 370 Mbq(10 mCi). After 5, 10 and 20 minutes, temperature changes of both fingers were measured. As a result, the temperature of the fingers was 32.6±4.9°C in patients with a low diagnostic probability of Raynaud syndromes and 22.7±6.0°C for those with a high diagnostic probability(p<0.05). In conclusion, we could confirm the difference of Raynaud phenomenon and finger temperature, and confirmed the possibility of secondary diagnosis as a quantitative index of Raynaud’s diagnosis.

말초 동맥 교감 신경 절제술을 이용한 레이노드 현상의 치료(증례 보고)

이광석,박종웅,서동훈,Lee, Kwang-Suk,Park, Jong-Woong,Suh, Dong-Hoon 대한미세수술학회 1997 Archives of reconstructive microsurgery Vol.6 No.1

The treatment of chronic digital pain and cold intolerance due to Raynaud's phenomenon is quite difficult especially it is combined with scleroderma. Several surgical trial such as cervicothoracic sympathectomy have been attempted for the medically unresponsible Raynaud's phenomenon, but their results were unsatisfactory. We have tried peripheral periarterial sympathectomy for the 44 years old female patient who had medically unresponsible severe Raynaud's phenomenon with scleroderma. Periarterial adventitial stripping was performed at the level of wrist, superficial palmar arch, common digital artery and proper digital artery about 1.5-2 cm in length. Preoperative angiography and radioactive angiography were done and preoperatively and postoperatively the blood flow was measured by the desk top computer-aided histogram. Both hands digital pain were markedly reduced after operation and blood flow increased as compaired with the preoperative measure.

결체조직질환 환자에서 조갑 융기부 (Nailfold) 모세혈관 소견의 임상적 유용성에 관하여

송광선 ( Kwang Seon Song ),이수곤 ( Soo Kon Lee ),홍천수 ( Chein Soo Hong ) 대한류마티스학회 1994 대한류마티스학회지 Vol.1 No.1

Objective: Raynaud`s phenomenon is a vascular disorder characterized by reversible spasm of arteries of fingers. It is the first symptom in 70% of partients with systemic sclerosis. The more systemic involvment the worse prognosis is expected in patients with systemic sclerosis. A more reliable indication of systemic sclerosis is the microvascular involvement by the disease (characteristic patterns of capillary abnormality in the nailfold). Our puroses were to evaluate the significance of the degree of nailfold capillary abnormlitry in making the diagnosis fo systemic sclerosis, and in determining organ involvement in patients with systemic sclerosis. Methods: Twenty-six patients with Raynaud`s phenomenon whose diagnosis were systemic sclerosis (10 patients), SLE (10 patient), Raynaud`s disease (6 patients) were observed for nailfold capillary abnormalities by widefield microscopy. Results: Capillary abnormalities were seen in 100% of the systemic sclerosis (10 patients), 30% of the SLE (3 patients) and 50% of the Raynaud`s disease (3 patients). A significant correlation between degree of finger lesions (r=0.718) or organ involvement (X2=20.4, p=0.015) and capillary abnormality class was found although a significant correlation was not found between the duration of the disease and the degree of capillary abnormality in patients with systemic sclerosis (r=0.32). Conclusions: Nailfold capillary abnormality can easily be observed and could be used as an assistive tools for the diagnosis and prediction of prognosis and extent of organ involvement in patients with Raynaud`s phenomenon especially in patients with systemic sclerosis.

수완진동 증후군 환자에서 발생한 족부의 레이노현상 1예

최나리,심창선,윤재국,김석환,박형욱,이지호,유철인 大韓産業醫學會 2008 대한직업환경의학회지 Vol.20 No.2

배경: 지난 세기 동안 수완진동 증후군에 대한 연구는 많이 이루어졌으며 스톡홀름 분류는 유용한 진단도구로 인정되고 있다. 아직 표준 검사법은 없지만 수지 냉각부하검사와 혈류검사는 수완진동 중후군을 확진 및 평가하기 위한 객관적인 검사방법으로 주로 쓰이고 있다. 그러나 아직 족지의 레이노현상에 대한 보고는 전 세계적으로 많지 않으며 국내에서는 아직 보고 된 경우가 없어 본 증례를 통해 수완진동 증후군으로 진단 받은 환자에서 발생한 족지의 레이노현상을 국내에서는 처음으로 보고하고자 한다. 증례: 약 30년간 공기압력식 착암기를 사용한 48세 남자로 양측 수완진동 증후군으로 진단받고 진동공구 사용을 중단하였으나 여름에 냉수에서 족지에도 창백지가 발생하는 것을 발견하게 되었고 본원에서 검사를 받게 되었다. 수지 냉각부하검사,광혈류검사,족지혈압측정,신경 전도검사,혈액검사 및 기타검사를 시행하여 레이노현상을 일으킬만한 2차 원인들을 배제하였다. 스톡홀름 분류를 족지에 적용한다면 stage 2에 해당한다. 결론: 진동공구 사용 근로자에서 족부의 레이노현상에 대한 객관적인 검사들과 다른 원인들을 배제한 상태에서 국내 최초의 진동에 의한 직업성 족부 창백지로 진단을 하여 보고하는 바이다. Background: There have been many studies on hand-arm vibration syndrome (HAVS) for almost a century. The Stockholm Workshop scale has been accepted as a useful tool in diagnosing HAVS. Although they are not standard tests for diagnosis, cold provocation test and plethysmography of the fingers are commonly used as objective measurements to confirm the vascular component of HAVS. However, there are only a handful of case reports and studies worldwide on Raynaud's phenomenon in the toes. We report the case of a patient with HAVS who developed Raynaud's phenomenon in the toes after the vibration exposure had ceased. To our knowledge, this is the first report ofthis entity in Korea. Case Report: A 58-year-o1d male, who had been diagnosed with HAVS in 2003, first noticed white toes in the summer of 2006 after immersing his feet in cold water. He had been working as a rock drill operator since 1976 for almost 30 years and had symptoms on his fingers since 1992. He underwent the cold provocation test, photoplethysmography, Nerve conduction velocity, and basic laboratory tests to rule out other causes of secondary Raynaud's phenomenon. To describe the severity of his feet, it could be classified as vascular stage 2 and sensorineural stage 1 if we were to apply the Stockholm Workshop scale. Conclusions: The patient showed vibration-induced white toes, and we would like to share the results of objective findings related to his condition. When diagnosing HAVS, symptoms of the feet should be assessed by the occupational and environmental medicine physicians. Further studies are needed to standardize test methods to diagnose "vibration-induced white toes."