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김세희 ( Sai Hui Kim ),양석균 ( Suk Kyun Yang ),김경조 ( Kyung Jo Kim ),김은희 ( Eun Hee Kim ),윤순만 ( Soon Man Yoon ),예병덕 ( Byong Duk Ye ),변정식 ( Jeong Sik Byeon ),명승재 ( Seung Jae Myung ),김진호 ( Jin Ho Kim ) 대한소화기학회 2009 대한소화기학회지 Vol.54 No.2
Background/Aims: Infliximab has been proven to be effective for refractory luminal and fistulizing Crohn`s disease (CD). We performed this study to demonstrate the efficacy of infliximab in Korean CD patients. Methods: Medical records of 40 CD patients who had been treated with infliximab were reviewed retrospectively. Results: Among 40 patients, 11 (27.5%) patients were treated for refractory luminal disease, 14 (35%) for fistulizing disease, and 15 (37.5%) for both types. Clinical response rate was higher in 26 patients with refractory luminal disease (Complete response (CR), 73.1%; Partial response (PR), 23.1%) than in 29 patients with fistulizing disease (CR, 41.4%; PR, 31%) (p=0.024). The clinical response rate tended to be higher in 28 patients with external fistulas (CR, 46.4%; PR, 32.2%) than 4 patients with internal fistulas (PR, 25%; NR, 75%) (p=0.064). Among patients with external fistulas, the response rate of 8 patients with enterocutaneous fistulas (CR, 50%; PR, 12.5%) was not different from 20 patients with perianal fistulas (CR, 45%; PR, 40%). Among 20 patients with perianal fistulas, the response rate of 6 patients with perianal fistulas without a history of operation (CR, 83.3%; PR, 0%) was higher than 14 patients with perianal fistulas resistant to previous surgical treatment (CR, 28.6%; PR, 57.1%) (p=0.044). As for adverse reaction, 7 patients experienced mild infusion reaction, and 2 patients developed serious infection. Conclusions: Infliximab is more effective for refractory luminal disease than for fistulizing disease. In addition, clinical responses to infliximab are different according to subtypes of fistulas. These findings should be considered for the proper use of infliximab. (Korean J Gastroenterol 2009;54:108-116)
한국인 궤양성 대장염 환자의 임상적 특징과 장기적 예후
김영민 ( Young Min Kim ),박상형 ( Sang Hyoung Park ),양석균 ( Suk Kyun Yang ),최재원 ( Jae Won Choe ),김세희 ( Sai Hui Kim ),변정식 ( Jeong Sik Byeon ),명승재 ( Seung Jae Myung ),조윤경 ( Yun Kyung Cho ),유창식 ( Chang Sik Yu ) 대한장연구학회 2006 Intestinal Research Vol.4 No.1
목적: 한국인 궤양성 대장염 환자의 진단 시 임상적 특징과 장기적 예후를 평가하기 위하여 연구를 시행하였다. 대상 및 방법: 1989년 6월부터 2005년 8월 사이에 서울아산병원에서 처음으로 진단받은 304명의 궤양성 대장염 환자를 대상으로 후향적 연구를 시행하였다. 결과: 진단 시 환자들의 중간 연령은 40.0세(12-72세)였고, 남녀비는 0.94:1이었다. 병변의 범위는 직장염 134예(44.1%), 좌측 결장염 69예(22.7%) 및 광범위 결장염 101예(33.2%)였고, 질병의 활성도는 경증 149예(49.0%), 중등증 125예(41.1%) 및 중증 26예(8.6%)였으며, 증상이 없이 선별 대장 내시경 검사에 의해 진단된 경우가 4예(1.3%) 있었다. 전체 환자의 치료 개시 후 관해율은 97.4%였고 누적 재발률은 각각 1년 30.2%, 5년 72.0%, 10년 88.4%였다. 진단 시 병변의 범위가 직장염 혹은 좌측 결장염인 환자에서 병변의 누적 확장률은 5년에 33.0%, 10년에 44.5%였다. 누적 수술률은 각각 1년 2.0%, 3년 2.8%, 5년 3.3%, 10년 3.3%였다. 누적 생존률은 각각 1년 100%, 5년 99.4%, 10년 97.4%, 15년 89.9%였다. 결론: 한국인 궤양성 대장염 환자의 진단시 임상적 특징은 서양과 유사하였다. 그러나 경과 중 낮은 수술률을 보임으로써 서양의 환자보다 양호한 임상 경과를 보일 가능성을 시사하였다. Background/Aims: Clinical characteristics of ulcerative colitis (UC) in Asian populations are not well recognized. We therefore investigated the clinical features and natural history of UC in Korea. Methods: We retrospectively analyzed 304 Korean UC patients first diagnosed at Asan Medical Center between June 1989 and August 2005. Results: The male to female ratio was 0.94:1 and the median age at diagnosis was 40.0 years (range, 12-72 years). At diagnosis, proctitis was noted in 134 patients (44.1%), left-sided colitis in 69 (22.7%), and extensive colitis in 101 (33.2%). Disease activity at diagnosis was mild in 149 patients (49.0%), moderate in 125 (41.1%), and severe in 26 (8.6%). In addition, 4 (1.3%) asymptomatic patients were detected as a result of a screening colonoscopy. Clinical remission after the first attack was documented in 97.4% of patients. The cumulative relapse rates at 1, 5, 10 years were 30.2%, 72.0%, and 88.4%, respectively. The cumulative risk of proximal extension in patients with proctitis or left-sided colitis was 33.0% at 5 years and 44.5% at 10 years. The cumulative probability of colectomy was 2.0% at 1 year, 2.8% at 3 years, and 3.3% at 5-15 years. The cumulative survival rates at 1, 5, and 10 years were 100%, 99.4%, and 97.4%, respectively. Conclusions: Clinical features of Korean UC patients at diagnosis are similar to those of Westerners. However, UC in Koreans may have a milder course than in Westerners, since Koreans have a lower rate of colectomy. (Intestinal Research 2006;4:12-21)
이경훈 ( Kyoung Hoon Rhee ),정창희 ( Chang Hee Jung ),배정호 ( Jung Ho Bae ),소민욱 ( Min Wook So ),오지선 ( Ji Seon Oh ),김세희 ( Sai Hui Kim ),나성수 ( Seong Su Nah ),이창근 ( Chang Keun Lee ),유빈 ( Bin Yoo ),문희범 ( Hee Bom 대한류마티스학회 2006 대한류마티스학회지 Vol.13 No.2
Dermatomyositis (DM) is an inflammatory myopathy of unknown etiology, which involves predominantly the muscles and skin, but also produces pulmonary manifestations in approximately 10% of the patients. Increasing attention has been paid to progressive interstitial pneumonitis as an important pulmonary manifestation of DM that can sometimes have a serious influence on the prognosis. Pneumomediastinum has been reported as a rare complication of DM. In this report, we present a case of 40-year-old woman with DM and interstitial lung disease who developed spontaneuous pneumomediastinum and was successfully treated with cyclosporin A.