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백운희 ( Baeg Un Hui ),김영욱 ( Kim Yeong Ug ),홍순창 ( Hong Sun Chang ),박상준 ( Park Sang Jun ),김윤권 ( Kim Yun Gwon ),김소연 ( Kim So Yeon ),김영중 ( Kim Yeong Jung ),조민구 ( Jo Min Gu ),이권전 ( Lee Gwon Jeon ) 대한신장학회 2003 Kidney Research and Clinical Practice Vol.22 No.4
Liddle`s syndrome is a rare inferited disease with characteristic clinical manifestations of hytertension an hypokalemic metabolic alkalosis. Markedly suppressed serum aldosterone and renin levels are important laboratory findings to differentiate this disorder from primary hyperaldosterionism. When Liddle et al. reported the disorder in 1963, they proposed aggressive Na+ absorption and increased excretion of K+ as the pathogenesis of the syndrome. Since then, specific mutaion in the epithelial Na+ channel located in the collecting duct of the kidney has been dlucidated as a disease mechanism. Liddle`s syndrome is inherited by an autosomal dominant trait and generally the onset of the syndrome is before the age of 20 with increased risk of premature death due to stroke or heart failure. Recently, however, a few cases of late onset and genetically proven non-familial cases with de novo mutation of β or γ Na+ channel have been reported. We report a case of seventy-one year old woman who had hypertension with hypokalemic metabolic alkalosis and was diagnosed as Liddle`s syndrome. Further evaluation revealed low renin and aldosterone levels. Primary aldosteronism, Cushing`s syndrome, glucocorticoid remediable aldosteronism and deficiency of 11 β-OHase and 17α-OHase were ruled out based on her laboratory data and history. Her hypertension and hypokalemia responded to amiloride treatment but not to spironolactone. (Korean J Nephrol 2003;22(4):464-468)
흉부 X-선상 활동성 미정으로 판독된 경증 폐결핵 환자에서 활동성 판정에 대한 67Ga 평면영상과 SPECT의 비교분석
안민 ( An Min ),장원규 ( Jang Won Gyu ),김경곤 ( Kim Gyeong Gon ),김성민 ( Kim Seong Min ),김윤권 ( Kim Yun Gwon ),김소연 ( Kim So Yeon ),김영중 ( Kim Yeong Jung ),박병익 ( Park Byeong Ig ),조민구 ( Jo Min Gu ),이권전 ( Lee Gwon 대한결핵 및 호흡기학회 2000 Tuberculosis and Respiratory Diseases Vol.48 No.6
정상범위의 간기능검사치를 갖는 만성 B 형간염 보유자에서 간조직검사와 혈청 4 형 콜라겐치의 비교
송명준(Myung Jun Song),김경곤(Kyoung Gon Kim),신요식(Yo Sig Shin),황남철(Nam Cheol Hwang),박상준(Sang Joon Park),김윤권(Yun Kwon Kim),김소연(So Yon Kim),김영중(Young Jung Kim),조민구(Min Koo Cho),이권전(Gwon Jun Lee) 대한내과학회 2002 대한내과학회지 Vol.63 No.1
목적 : 정상범위의 간기능검사치를 갖는 만성 B형간염 보유자에서 조직학적인 판단을 할 때 경피적인 간생검이 주로 사용되고 있다. 그러나 간생검은 침습적이며 검체 채취상의 오차 및 환자의 거부감에 따른 반복시행의 어려움이 있다. 최근 간 섬유화의 정도와 혈청 Ⅳ형 콜라겐치의 연관성이 있음이 알려짐에 따라 저자들은 간생검의 결과와 혈청 Ⅳ형 콜라겐치의 관계를 연구함으로써 조직소견을 예측하고 감별함에 있어 임상적으로 유용한지 알아보고자 하였다. 대상 및 방법: 임상적인 증상이 없는 정상범위의 간기능검사치를 갖는 만성 B형간염 보유자 31명의 전투경찰을 대상으로 간생검을 시행하여 병리조직학적 소견에 따라 3개의 군으로 분류하였고 각각은 병리학회에서 제안한 기준에 의거하였다. 간생검 당일 아침에 혈액을 채취한 후 Ⅳ형 콜라겐치 (정상치:5 ng/mL 이하)를 측정하여 조직소견과의 관계를 분석하였다. 결과: 총 31예의 대상환자 중 조직소견이 정상인 A군 13명 (41.9%), 섬유화는 없으면서 조직학적 이상이 있는 B군 11명 (35.5%), 섬유화가 있는 C군 7명 (22.6%)이었다. 혈청 Ⅳ형 콜라겐치는 A군에서 3.53±0.57 ng/mL, B군에서 3.56±1.17 ng/mL, C군에서 3.99±0.88 ng/mL이었고, 각 군간에 수치의 상승이 있었으나 유의하게 높지는 않았다 (p>0.05). 조직학적 이상이 보인 경우는 18명 (Group B and C)으로 평균 collagen수치는 3.73±1.06 ng/mL이었고, 섬유화가 없는 경우는 24명 (Group A and B)으로 평균 collagen수치는 3.55±0.88 ng/mL이었고, 각각 A군과 C군과 비교하여 유의성이 없었다 (p>0.05). 결론: 정상범위의 간기능검사치를 갖는 만성 B형간염 보유자의 경우 조직학적 변화를 알고자 할 때 조직학적인 변화에 따라 Ⅳ형 콜라겐치의 상승은 있으나 유의성이 없어 조직소견을 대변할 수는 없으며 간생검이 가장 유용한 검사라고 생각된다. Background: We compared the results of liver biopsy and the levels of serum type Ⅳ collagen of the hepatitis B carriers with normal liver function test (LFT) to evaluate the clinical usefulness of serum type Ⅳ collagen in predicting the progression of histopathological findings. Methods: Thirty one chronic hepatitis B carriers with normal LFT and no significant clinical symptoms, who were Korean combat police, were classified into three groups according to their histologic results of the liver biopsies. The classification followed the standard proposed by Korean Society of Pathology. Blood samplings for serum type Ⅳcollagen (reference : less than 5 ng/mL) were done in the morning of the same day of the liver biopsy. Results: Of thirty one patients, thirteen patients showed normal histologic findings (41.9%, Group A), eleven patients revealed histologic abnormalities without fibrosis (35.5%, Group B) and seven patients were with fibrosis on liver biopsy (22.6%, Group C). Serum type Ⅳ collagen levels of Group A, B and C were 3.53±0.57 ng/mL, 3.56±1.17 ng/mL and 3.97±0.88 ng/mL, respectively. The average of serum type Ⅳ collagen levels of Group C was higher than of Group B and the average of Group B higher than that of Group A without any statistical significance (p>0.05). The averages of serum type Ⅳ collagen of eighteen patients with histologic abnormalities (Group B and C) and twenty four patients without fibrosis (Group A and B) were 3.73±1.06 ng/mL and 3.55±0.88 ng/mL respectively. Upon comparison of these averages with the those of Group A and C, no statistical significance was established (p>0.05). Conclusion: In chronic hepatitis B carriers with normal LFT findings, levels of serum type Ⅳ collagen were elevated along with histologic severities without statistical significance, therefore can not represent the changing degree of the histologic findings. Liver biopsy is considered to be one of the most accurate tool to assess the histologic status of the liver.(Korean J Med 63:29-35, 2002)
활동성폐결핵 환자의 치료에 따른 67Gallium 폐주사의 음전시기의 의의 ( 제 2 보 )
이숭구(Sung Ku Lee),이윤하(Yoon Ha Lee),김진곤(Jin Gon Kim),서대원(Dae Won Soe),장태종(Tae Jong Jang),김윤권(Yun Kwon Kim),김소연(So Yon Kim),박병익(Byong Yik Park),이권전(Gwon Jun Lee) 대한내과학회 1995 대한내과학회지 Vol.49 No.2
N/A Objectives: In the treatment of active pulmonary tuberculosis, it is difficult to determine when the active tuberculosis has became inactive. (67)Gallium lung scan is known to be useful in the diagnosis of active pulmonary tuberculosis. The grade of Galliumuptake, the time of loss of uptake and the relation to the stability of tuberculous lesion in the chest radiograph were followed to define the possibility of making early decision when active pulmonary tuberculosis became inactive Metheds: In 31 patients with active pulmonary tuberculosis, (67)Galliurn lung scan and chest radiograph were followed serially from June 1991 to October 1993. (67)Gallium lung scan and chest radiograph were followed serially from June 1991 to October 1993, (67)Gallium lung scan was performed 48 hours after intravenous injection of 3mCi of (67)Gallium citrate and classified into 4 grades according to the degree of up- take. Results: 1) In patients with active pulmonary tuberculosis, the grade of Gallium uptake in lung scan was proportional to the severity of lesion in chest radiograph. 2) The degree of (67)Gallium uptake in serial lung scan waned progressively while antituberculous chemotherapy was continued, and showed in loss of uptake in 83% of patients within 6 months of therapy 3) The loss of (67)Gallium uptake was observed simultaneously in most patients as the lesion in chest radiograph became stable. In 81% of patients, the interval between the time of loss of (67)Gallium uptake and Radiologic stabilization was less than one month. Conclusion : While antituberculous chemotherapy was given, the serial (67)Gallium lung scan might be useful in determining the activity of tuberculous lung lesion and in making earlier decision than chest radiograph. Conclusively, we consider Gallium lung scan as a valuable measure in assessing the effectiveness of antituberculous treatment.
전투 경찰에서 발생한 렙토스피라병 12 예에 대한 역학 및 임상적 고찰
장원규(Won Gyu Chang),송명준(Myung Jun Song),차영학(Young Hak Cha),김경곤(Kyoung Gon Kim),백운희(Un Hee Paik),김윤권(Yun Kwon Kim),김소연(So Yon Kim),김영중(Young Jung Kim),조민구(Min Koo Cho),이권전(Gwon Jun Lee) 대한내과학회 2001 대한내과학회지 Vol.61 No.5
N/A Background: There were two occurrences of typhoon and the floods in Korea from early to late September, 2000. The Korean Combat Police and policemen participated in cleaning activities at the flooded area. Leptospirosis broke out among these participants . This study describes the epidemiological and clinical characteristics of leptospirosis patients among policemen. Methods: Of 16,750 individuals involved, 3,752 subjected to passive hemagglutination antibody (PHA) test at the Regional Health Care Units or the National Police Hospital. With 1 case of dead plus 12 cases which were turned out to be seropositive by PHA test and confirmed by microagglutination (MA) test, epidemiological and clinical characteristics were studied by questionnaire survey, laboratory test, and history of treatment while being hospitalized. Results: The seropositive rate of leptospira antibody was 0.3% (12/ 3,752). All 12 serpositives were bare-footed while working at the flooded area and of these, 8 patients (67%) were noticed abrasions either on hand or feet. However, no statistically significant correlation was found between the duration of outdoor activity and the seropositive rate (r=-0.46, p =0.36). There were clinical difference among patients who has the same serotype of leptospirosis, physical conditions, circumstance and the same work area. Two abnormal EKG results are present, the one who complained of chest pain is myocardial ischemia and the other who didn`t complain of any symptoms is sinus pause. Correlation between the febrile period before and the duration of fever after the use of antibiotics was estimated as ; febrile period after antibiotics use = 0.102804+0.995327×febrile period before antibiotics use (p =0.058). Conclusion: When leptospirosis is related to group activities, it is possible to educate in advance and to manage systematically afterwards, it may prevent the occurrence of leptospirosis or the related complications.(Korean J Med 61:553-561, 2001)
횡문근융해증으로 인한 급성신부전증의 핍뇨기에서 발생한 중증 고칼슘혈증
임수진 ( Im Su Jin ),이승희 ( Lee Seung Hui ),문창기 ( Mun Chang Gi ),정준오 ( Jeong Jun O ),박상준 ( Park Sang Jun ),김윤권 ( Kim Yun Gwon ),김소연 ( Kim So Yeon ),김영중 ( Kim Yeong Jung ),조민구 ( Jo Min Gu ),이권전 ( Lee Gwon 대한신장학회 2003 Kidney Research and Clinical Practice Vol.22 No.6
Hypercalcemia rarely develops in patients with acute renal failure associated with rhabdomyolysis. If hypercalcemia occurs, it happens mostly in diuretic phase and rarely in oliguric phase. Secondary hyperparathyroidism, abnormal metabolism of Vitamin D, immobilization of patient, and release of calcium from injured muscle are considered as possible pathogenetic mechanisms of hypercalcemia in acute renal failure associated with rhabdomyolysis. Among them, dissoultion of calcium from injured muscle into extracellular fluid is accepted as the major mechanism of pathogenesis of hypercalcemia. A twenty year old male patient, combat policeman, developed syncope in the course of regular physical training. He was diagnosed of acute renal failure associated with rhabdomyolysis at the hospital he initially visited. After being subjected to three sessions of acute hemodialysis, he was transferred to our hospital. During the treatment, laboratory test was performed upon his continuous complaints of lower extremity weakness. It showed severe hypercalcemia with plasma calcium level of 17.3 mg/dL. He was in oliguric phase at the time of this severe hypercalcemia. Patient`s lower extremity weakness was gradually improved by hemodialysis using low calcium dialysate. He was discharged after his renal function became normal. He has been followed on regular basis. (Korean J Nephrol 2003;22(6):731-735)
만성 간질환에서 Propranolol의 문맥압 감소 효과 : 경직장 문맥 신티그라피를 이용한 평가 Evaluation by Perrectal Portal Scintigraphy
김영중,김학수,윤수진,박병익,한신,노영호,조민구,김소연,이권전,김윤권 대한핵의학회 1999 핵의학 분자영상 Vol.33 No.4
Purpose: Propranolol is known to decrease portal pressure by reducing blood flow of portal vein. Per-rectal portal scintigraphy with Tc-99m pertechnetate has been introduced to evaluate the portal circulation and early diagnosis of liver cirrhosis. We evaluated the effects of propranolol on portal circulation by using per-rectal portal scintigraphy. Materials and Methods: We analyzed the portal hemodynamics by per-rectal portal scintigraphy in 51 patients with liver cirrhosis, 10 chronic hepatitis and 10 normal subjects. 38 patients with cirrhosis underwent per-rectal portal scintigraphy before and after propranolol medication. Per-rectal portal scintigraphy was performed after per-rectal administration of 370 MBq of Tc-99m pertechnetate. The shunt index was calculated as the ratio, expressed as a percentage of heart radioactivity to the sum of heart and liver radioactivity during the first 30 seconds. Results: The shunt index in 40 patients with cirrhosis (59.8±27.2%) was significantly higher than that of nrmal control (5.0±1.2%, p<0.01) and chronic hepatitis (11.4±3.5%, p<0.01). Shunt index was significantly different according to Child's classification and the degree of esophageal varix (p<0.01). After propranolol medication, shunt index was significantly decreased from 59.9±27.3% to 51.3±15.3% (p<0.01) in 38 patients with liver cirrhosis. There was no significant difference of the amount of shunt index reduction after propranolol according to Childs' classification and the degree of esophgageal varix. Conclusion: The effect of propranolol on portal circulation was demonstrated as decreasing shunt index on per-rectal portal scintigraphy in patients with liver cirrhosis. Per-rectal portal scintigraphy may be useful to evaluate the portal circulation and to predict the effect of propranolol in patients with liver cirrhosis. (Korean J Nucl Med 1999;33:388-97)
삼배체 염색체 이상을 보인 급성 림프구성 백혈병 1 예
이은희,김영중,차주영,이경인,박병익,김윤권,조민구,김소연,이권전,오형모,전종구,신요식 대한내과학회 2001 대한내과학회지 Vol.61 No.2
$quot;In addition to age, white cell count and immunophenotype, karyotype has been reported to be one of the important prognostic factors in acute lymphocytic leukemias. Furthermore 70 percent of patients with acute B lymphocytic leukemia presented chromosomal abnormalities, which is known to have a close relationship with the prognosis. Among the abnormalities, triploid is rare and known to have the worse prognosis. Structural chromosomal abnormality of the 11q23 band is more common in childhood acute lymphocytic leukemia and has been rarely reported in adult lymphocytic leukemia. We present a case of a 29 year - old male patient with acute lymphocytic leukemia, who had triploid and chromosomal translocation including 11q23 band along with the review of related literature.(Korean J Med 61:190-194, 2001)$quot;
부동액 섭취 후 급성 신부전 및 후기 신경병증이 발생한 1 예
장원규,김영중,송명준,윤수진,박병익,김윤권,조민구,김소연,이권전,황남철,백운희,임수진 대한내과학회 2001 대한내과학회지 Vol.61 No.1
Antifreeze contains ethylene glycol up to ninty five percent. Ethylene glycol is colorless, odorless, sweet-tasting and water-soluble compound and has been widely used as a chemical solvent. Ethylene glycol has been reported as a common cause of incidental poisoning all over the world because of its easy access. However, in Korea, it is not easy to find statistical references on incidences of ethylene glycol intoxication, except two reported cases. Ethylene glycol itself is not toxic substance. But, many other daughter metabolites are very toxic and lethal. Acid metabolites among them can cause metabolic acidosis. Oxalate, end-product of ethylene glycol, is quickly transformed to calrium oxalate crystals, which precipitate in body tissues such as brain, kidney, heart, liver, and pancreas. We report a case of acute renal failure and neuropathy due to ethylene glycol intoxication along with a review of toxic effects of ethylene glycol. (Korean J Med 61:64-70, 2001)