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유지 혈액투석 환자에서 호산구증다증과 혈중 사이토카인 농도와의 상관관계
박은미 ( Eun Mi Park ),김향 ( Hyang Kim ),정수석 ( Soo Suk Jung ),윤중원 ( Jung Won Yun ),구은실 ( Eun Sil Koo ),이규백 ( Kyu Beck Lee ),금동극 ( Dong Keuk Keum ) 대한내과학회 2003 대한내과학회지 Vol.64 No.5
목적 : 혈액투석 환자에서 호산구 증다는 투석막에 대한 알러지나 혈액투석 동안 보체의 활성화와 연관되며 이러한 보체의 활성화는 사이토카인 생성을 증가시키고 증가된 사이토카인이 투석의 예후 및 생존율과 연관된다고 알려져 있다. 이에 유지 혈액투석 중인 말기 신부전 환자에서 호산구 증다증을 보이는 환자군과 그렇지 않은 환자군 간에 투석 후 사이토카인 농도에 차이가 있는지 알아보고 혈액투석 환자에서 호산구 증다가 투석으로 인한 사이토카인 생성을 간접적으로 반 Background : Eosinophilia in hemodialysis (HD) patients has been associated with allergic reactions to dialyzers and exaggerated activation of complement during HD. Complement activation can lead to cytokine production. The cause of the eosinophilia is co
담도협착의 감별진단에 대한 내시경적 쇄자 세포진 검사와 흡인 담즙 세포진 검사의 전향적 비교연구 - 담도협착에 대한 쇄자 세포진 검사의 전향적 비교연구
최호순(Ho Soon Choi),이성구(Sung Koo Lee),김명환(Myung Hwan Kim),서동진(Dong Jin Suh),민영일(Young Il Min),유은실(Eun Sil Yu) 대한소화기학회 1996 대한소화기학회지 Vol.28 No.6
N/A Background/Aims: Tissue biopsy from the biliary tree is difficult because of the focal and sclerotic or small annular nature, lower cellularity and well differentiated tumor. Biliary cytology is an effective tnethod of obtaining a tissue diagnosis for bile duct stricture, and thie diagnostic sensitivity of endoscopic brush cytology (EBC) is reported as between 40% and 70% for malignant bile duct strictures. In this study, we prospectively analyzed the diagnostic value of endoscopic brush cytology and aspiration bile cytology in patients with extrahepatic bile duct strictures. Methods: 30 patients with extrahepatic bile duct strictures diagnosed at endoscopic retrograde cholangiopancreatography underwent endoscopic brush cytology and aspiration bi]e cytology. 25 patients had malignant strictures and 5 patients had benign strictures, brushings were taken using a cytology brush(6Fr) or double lumen brush(8Fr) passed with a guide wire through the stricture. Results: The sensitivity and accuracy of brush cytology (60%; 15/25, 67%; 20/30) were significantly greater than bile cytology (20%; 5/25, 33%; 10/30). No false positive results were reported in brush cytology (specificity; 100%), but negative predictive value (33%; 5/15) was relatively low. There were no procedure related complications and the average sampling time was about five minutes. Conclusions: Endoscopic brush cytology is an effective, safe method of obtaining a tissue diagnosis for bile duct strictures, therefore EBC should be done routinely in bile duct strictures, but further prospective studies will be required to evaluate other new techniques such as endobiliary forceps biopsy or endoscopic fine needle aspiration or EBC with DNA flow cytometry because negative results do not exclude malignancy.(Korean J Gastroenterol 1996; 28: 832-844)
만성 간질환 환자에서 혈소판감소증과 혈청 Thrombopoietin 의 관계
조용균(Yong Kyun Cho),김병익(Byung Ik Kim),구은실(Eun Sil Koo),김시영(Si Young Kim),김창섭(Chang Seop Kim),박창영(Chang Young Park),손정일(Chong Il Sohn),전우규(Woo Kyu Jeon),정을순(Eul Soon Jung),이숭환(Soong Hwan Lee),이동후(Dong H 대한소화기학회 2002 대한소화기학회지 Vol.39 No.2
Background/Aims: The major origin of thrombocytopenia in liver cirrhosis is attributed to enlarged spleen. In order to determine the influence of thromboprotein (TPO) on the origin of thrombocytopenia in liver disease, we measured serum TPO levels in patients with chronic liver diseases. Methods: The study included 18 controls, 26 patients with chronic viral hepatitis, 35 patients with viral liver cirrhosis, and 28 patients with alcoholic liver cirrhosis. We determined their serum thrombopoietin levels by ELISA. Results: The TPO levels of patients with chronic viral hepatitis (147.9 ± 40.9 pg/mL) was significantly higher than those in patients with viral cirrhosis (95.9 ± 50.0 pg/mL), alcoholic cirrhosis (100.8 ± 43.5 pg/mL) or controls (108.1 ± 41.7 pg/mL). In the patients with viral and alcoholic liver cirrhosis, TPO showed a significant positive relationship with prothrombin time (ρ=0.4315, p=0.011 vs ρ=0.4171, p=0.030) and albumin (ρ=0.4939, p=0.003 vs ρ=0.4852, p=0.010). However, TPO levels had a significant inverse relationship with Child-Pugh score (ρ=-0.6151, p=0.000 vs ρ=-0.4658, p=0.014). Conclusion: Serum TPO levels were elevated in patients with chronic viral hepatitis by compensatory mechanism. Along with hypersplenism, low TPO production may play a role in the development of thrombocytopenia in patients with liver cirrhosis, but further studies are needed. (Korean J Gastroenterol 2002;39:108-113)
자궁경부암 환자에서 방사선 치료가 골무기물 함량에 미치는 영향
윤선민(Seon Min Youn),최태진(Tae Jin Choi),구은실(Eun Sil Koo),김옥배(Ok Bae Kim),이성문(Seung Moon Lee),서수지(Soo Jhi Suh) 대한방사선종양학회 1997 Radiation Oncology Journal Vol.15 No.2
목 적 : 자궁경부암 환자에서 방사선치료시 방사선조사면내의 골무기물 함량변화를 정상대조군과 환자군의 골무기물 함량을 비교하여 방사선이 골무기물에 미치는 영향을 조사하였다. 재료 및 방법 : 120kVp와 80kVp X선을 이용하는 이중에너지 전산화단층 촬영을 이용하여 환자군과 정상대조군에서 제 3, 4 및 제 5 요추의 해면골무기물 함량을 정량적으로 측정하였다. 총 인원수는 정상대조군 43명과 환자군 43명으로서 86명이며 각 연령별로는 정상대조군 40대 22명, 50대 10명, 60대 11명이었고, 환자군에서는 40대 14명, 50대 14명, 60대 15명이었다. 방사선조사부위는 골반과 제 5 요추를 포함하여 치료하였으며 외부방사선량은 45-54Gy였으며, 강내치료는 고선량률로 30Gy를 조사하였다. 결 과 : 정상대조군과 환자군의 여성에서 골무기물 함량은 나이가 증가함에 따라 감소함을 보였으며, 환자군은 정상군에 비해 약 13%에서 최대 40%의 감소를 보였다. 환자군에서 방사선 조사부위에 포함되지 않은 제 3, 4 요추의 각각 골무기물 함량은 40대 119.5±30.6, 117.0±31.7, 50대 83.3±37.8, 88.3±46.8, 60대 61.5±18.3, 56.2±26.6mg/cc로 나타났으며, 반면에 정상군은 각각 40대 148±19.9, 153.2±23.2, 50대 96.1±30.2, 105.6±26.5 및 60대 73.9±27.9, 77.2±27.2mg/cc를 각각 보였다. 정상군의 요추골의 골무기물함량은 제 5요추가 각연령층에서 가장 높았으며, 제 3, 4 요추는 제 5 요추에 가까울수록 높은 값에 비해 환자군에서는 방사선조사면에 가까울수록 골무기물함량의 감소하는 경향을 보였다. 특히 방사선조사부위인 환자군의 제 5 요추는 전연령층에서 제 3 요추나 제 4 요추에 비해 낮은 골무기물함량을 보였으며, 정상군에 비해서 40대 33%, 50대 31%와 60대 40%의 골무기물함량의 감소를 보여 방사선의 영향에 의한 감소가 현저하였다. 결 론 : 환자군의 요추골의 골무기물함량은 정상군에 비해 현저한 감소를 보였으며, 정상대조군의 제 5 요추가 제 3, 4 요추에 비해 높은 골무기물 함량수치를 보인 반면, 환자군에서는 방사선조사범위에 있는 제 5 요추의 골무기물 함량이 훨씬 낮게 나타나 방사선조사가 요추의 골무기물 함량의 감소에 상당한 영향을 끼침을 알 수 있다. Purpose : To evaluate the loss of bone mineral contents(BMC) in lumbar spine within the radiation field for cervical cancer treatment, BMC in the irradiated patient group was compared with that of a normal control group. Method and materials : Measurements of BMC in the trabecular bone in lumbar spines(L3-L5) were performed in the both patient and normal control groups. Investigators used dual-energy quantitative computerized tomography(DEQCT) using photon energy of 120 and 80kVp. The numbers of patient and control groups were 43 in each with age distribution of fifth to seventh decade of women. The numbers of control group were 22 in fifth, 10 in sixth, and 11 in seventh decade, those of patient group were 14 in fifth, 14 in sixth, and 15 in seventh decade of women. The radiation field was extended to L5 spine for pelvic irrdiation with 45- 54Gy of external radiation dose and 30Gy of high dose rate brachytherapy in cervical cancer. Results : The BMC is decreased as increasing age in both control and patient groups. BMC in lumbar spine of patient group was decreased by about 13% to 40% maximally. The BMC of L3 and L4 a region that is out of a radiation field for the patient group demonstrated 119.5±30.6, 117.0±31.7 for fifth, 83.3±37.8, 88.3±46.8 for sixth and 61.5±18.3, 56.2±26.6mg/cc for seventh. Contrasted by the normal control group has shown 148.0 ±19.9, 153.2±23.2 for fifth, 96.1±30.2, 105.6±26.5 for sixth and 73.9±27.9, 77.2±27.2mg/cc for seventh decade, respectively. The BMC of patient group was decreased as near the radiation field, while the lower lumbar spine has shown more large amounts of BMC in the normal control group. In particular, the BMC of L5 within the radiation field was significantly decresed to 33%, 31%, 40% compared with the control group of the fifth, sixth and seventh decades, respectively. Conclusion : The pelvic irradiation in cervical cancer has much effected on the loss of bone mineral content of lumbar spine within the radiation field, as the lower lumbar spine has shown a smaller BMC in patient group with pelvic irradiation in contrast to that of the normal control groups.
배변 자세에 따른 배변조영술에서의 항문직장각 및 회음하수의 변화
조용균 ( Yong Kyun Cho ),김창섭 ( Chang Seop Kim ),구은실 ( Eun Sil Koo ),윤중원 ( Jung Won Yun ),김정욱 ( Jeong Wook Kim ),이준행 ( Jun Haeng Lee ),박창영 ( Chang Young Park ),손정일 ( Chong Il Sohn ),전우규 ( Woo Kyu Jeon ),김 대한소화기학회 2003 대한소화기학회지 Vol.41 No.3
Background/Aims: Pelvic floor location and mobility vary according to the defecation posture. Authors investigated possible effects of the change of defecation posture on the patients with pelvic outlet obstructive constipation among patients with chronic idiopathic constipation. Methods: Subjects included in the study were 32 patients with pelvic outlet obstructive constipation (24 spastic pelvic floor syndrome, 8 perineal descent syndrome). From all the subjects, defecographies of both resting and straining phases were obtained for three different postures (sitting, leg elevating and squatting). Results: In the patients with spastic pelvic floor syndrome, the anorectal angles of straining phase in squatting position were 117.93±3.58캻nd 118.2±4.94?respectively. These values were significantly greater than those measured in sitting position (resting 93.75±6.74?straining 95.17±7.77?and leg elevating position (resting 99.42±4.79?straining 98.67±5.76?(p<0.01, p<0.01, respectively). In addition, in the patients with perineal descent syndrome, perineal descent in squatting position revealed no significant differences compared with sitting and leg elevating positions. Conclusions: In patients with spastic pelvic floor syndrome, squatting position increases the anorectal angle. Although further studies are needed to support our ideas, this study demonstrates that patients with spastic pelvic floor syndrome can have benefit from the Korean traditional defecation posture by increasing the anorectal angle. (Korean J Gastroenterol 2003;41:190-195)
특발성 원섬유성 사구체신염 (Fibrillary Glomerulonephritis)
김지훈(Ji Hoon Kim),정해혁(Hae Hyuk Jung),박정식(Jung Sik Park),이상구(Sang Koo Lee),유은실(Eun Sil Yu),장상필(Sang Pil Chang),이준승(Joon Seung Lee),정재걸(Jae Gul Chung) 대한신장학회 2000 Kidney Research and Clinical Practice Vol.19 No.3
A 17-year-old girl was admitted to our hospital due to mild generalized edema. Laboratory tests revealed a serum creatinine was 0.7mg/dL, protein/ albumin 6.7/3.5g/dL, cholesterol 190mg/dL, hemoglobin 10.0g/dL, and 24 hour urinary protein 4,40mg/day. Chest X-ray and renal ultrasound were normal. There were no clinical or serologic evidences of para-proteinemia, cryoglobulinemia, light chain disease or systemic lupus erythematosus. Renal biopsy showed membranoproliferative glomerulonephritis-like pattern with lobular accentuation, hypercellularity and diffuse GBM thickening by light microscope. Congo red stain-ing was negative. Granular IgG and C3 deposits were found along the glomerular capillary wall and mesangium by immunofluorescence microscope. Ultrastruc-turally, abundant subendothelial and mesangial fibril- lary deposits were found associated with thickening and wrinkling of GBM. These fibrils, measured about 20-30nm in diameter, were nonbranching and ran- domly arranged without either periodicity or an organized structure. These findings were compatible with those of fibrillary glomerulonephritis. Thus we report a case of idiopathic fibrillary glomerulonephritis, which is a rare cause of nephrotic syndrome.
Benzoyl Peroxide의 반복투여 독성과 생식 및 발생독성
송상환(Sanghwan Song),김수현(Su-Hyon Kim),배희경(Heekyung Bae),김미경(Mikyung Kim),구현주(Hyun Ju Koo),박광식(Kwangsik Park),이상균(Sangkyun Lee),박중훈(Joonghoon Park),최은실(Eun-Sil Choi),이문순(Moon-Soon Lee) 한국독성학회 2003 Toxicological Research Vol.19 No.2
This study was carried out to assess the combined repeated dose, reproduction and developmental toxicities of benzoyl peroxide for OECD SIDS (Screening Information Data Set) program. Male and female Sprague-Dawley rats were exposed to benzoyl peroxide at dose levels of 0, 250, 500 and 1,000 mg/kg/day for 29 days for males and for 41~51 days for females. No deaths were found in all animals including control group during exposure period. No hematological effects attributable to benzoyl peroxide were observed in all treated groups. Significant decrease in the weight of testes and epididymis were observed in males at 1,000 mg/kg/day. In females at 1,000 mg/kg/day, slight histopathological effects in uterus such as epithelial vacuolation or hyperplasia were observed. No treatment-related changes in precoital time and rate of copulation, fertility and gestation period were noted in all treated groups. There was no evidence of teratogenic effect of benzoyl peroxide, but body weight of pups at 1,000 mg/kg/day was significantly decreased. NOAEL for combined repeated dose and reproduction/developmental toxicity was 500 mg/kg/day.
안만수(Man Su Ahn),송문희(Moon Hee Song),박영환(Young Hwan Park),박주상(Ju Sang Park),이상수(Sang Soo Lee),김기락(Ki Rhack Kim),유은실(Eun Sil Yu),서동완(Dong Wan Seo),이성구(Sung Koo Lee),김명환(Myung Hwan Kim),민영일(Young Il Min) 대한소화기학회 2001 대한소화기학회지 Vol.38 No.5
Bile duct hamartomas are rare benign malformations of the biliary tract. It is usually discovered as occasional findings at autopsy. It may be confused with metastatic lesions of the liver or may rarely be found in association with cholangiocarcinoma. We report a case of 64-year-old woman who showed multiple small low attenuated lesions in both lobes of the liver on CT scan. Clinically, it was hard to differentiate them from metastatic lesions in the liver. Multiple bile duct hamartomas were histologically confirmed with liver needle biopsy. We report this case with a review of literature. (Korean J Gastroenterol 2001;38:385-388)