크론병의 드문 합병증으로 발생한 패혈성 문맥염

신아리 ( A Ri Shin ),이창균 ( Chang Kyun Lee ),김효종 ( Hyo Jong Kim ),심재준 ( Jae Jun Shim ),장재영 ( Jae Young Jang ),동석호 ( Seok Ho Dong ),김병호 ( Byung Ho Kim ),장영운 ( Young Woon Chang ) 대한소화기학회 2013 대한소화기학회지 Vol.61 No.4

Thrombophlebitis of the portal venous system (PVS) with superimposed bacterial infection (septic pylephlebitis) is an extremely rare complication of Crohn`s disease (CD), and therefore diagnosis of septic pylephlebitis is difficult without high clinical suspicion. A 16-year old male patient who was diagnosed with CD 3 months earlier was admitted with recurrent fever and abdominal pain. CD activity had been well controlled with conventional medical treatment during a follow-up period. Abdominal contrast- enhanced computed tomography showed massive thrombosis in the PVS without evidence of intra-abdominal infection, and blood cultures were positive for Streptococcus viridians. There was no evidence of deep vein thrombosis or pulmonary thromboembolism, and all laboratory tests for thrombophilia were normal. Based on these findings, the patient was diagnosed with septic pylephlebitis complicated with CD, and was successfully treated with intravenous antibiotic therapy combined with anticoagulation. This case suggests that early comprehensive evaluation is crucial for immediate diagnosis and proper treatment of septic pylephlebitis in patients with CD who present with fever and abdominal pain of unknown origin, even with stable disease activity and absence of other intra-abdominal infections. (Korean J Gastroenterol 2013;61:219-224)

면역기능이 정상인 환자에서 저용량 스테로이드를 복용 후 발생한 폐 효모균증 1례

장나은 ( Na Eun Jang ),신아리 ( A Ri Shin ),김혁 ( Hyuck Kim ),이정훈 ( Jung Hoon Lee ),조주희 ( Joo Hee Cho ),고원진 ( Weon Jin Ko ),김태영 ( Tae Young Kim ),김이형 ( Ee Hyung Kim ),유지홍 ( Jee Hong Yoo ),박명재 ( Myung Jae Par 전북대학교 의과학연구소 2012 全北醫大論文集 Vol.36 No.2

Cryptococcus neoformans is an organism that mainly causes opportunistic infection in immunocompromised patients. It can also cause various infections in immunocompetent patients including pulmonary cryptococcosis, but it is rare. Steroids are used in clinical practice for treatment of a wide array of disease, because of their anti-inflammatory or immunosuppressive action. But, steroids use predisposes patients to a variety of infection by interfering with host defense mechanism. Infections associated with steroids are dependent on the route of administration, dose, and duration of therapy. Generally, the rate of infection is not increased in patients receiving low dose and limiting periods administration. We presented a case of pulmonary cryptococcosis obscured by cryptogenic organizing pneumonia (COP) in 68-year old female with an immunocompetent patient after low dose and short duration of steroid therapy and review all published casese.

본태성 진전에 대한 중의학 연구동향

신아리 ( A-ri Shin ),배영롱 ( Yeong-long Bae ),임재유 ( Jae-yu Lim ),이승환 ( Seung-hwan Lee ),김상호 ( Sang-ho Kim ),임정화 ( Jung-hwa Lim ) 대한한방신경정신과학회 2017 동의신경정신과학회지 Vol.28 No.2

Objectives: This study was performed to review studies on Essential Tremor (ET) in Traditional Chinese medicine (TCM). Methods: We reviewed papers in the China National Knowledge Infrastructure (CNKI) from 2007∼ 2016. Search keywords were 原發性震?, 特發性震?, essential tremor and idiopathic tremor, and excluded non-clinical studies, non-related to ET or TCM studies, theses for degrees and non-Randomized Controlled Trial (RCT). The quality of the articles was assessed by Jadad scale and the Risk of Bias (RoB). Results: Thirteen studies were selected. `Criteria for the diagnosis of ET` was most frequently used as diagnostic criteria. `Tremor rating scale` was primarily used for outcome measurement. Meta-analysis of nine trials revealed the effective rate of acupuncture and Western medicine (WM+Acu) groups was significantly higher compared to the WM group (RR: 1.48, 95 percent CI: 1.20 to 1.82, p=0.0002, I²=0 percent) and tremor rating scale was also significantly decreased in the treatment group (MD: -1.35, 95 percent CI: -2.17 to -0.54, p=0.001, I²=0 percent). Also, effective rates of Electro-acupuncture (EA) and Chinese herbal medicine (CHM) groups were significantly higher than that of the WM group {(RR: 1.53, 95 percent CI: 1.22 to 1.92, p=0.0003, I2=0 percent) in EA vs. WM and (RR: 1.35, 95 percent CI: 1.16 to 1.57, p<0.0001, I²=0 percent) in CHM vs. WM}. However, the quality of selected clinical studies was poor. Conclusions: Treatment of ET in TCM may be more effective and safe than in Western medicine. Therefore, we hope this study will lead to further clinical research on treatment of ET in Korean medicine. Key Words: Essential Tremor, Idiopathic Tremor, Traditional Chinese Medicine.

연령에 따른 쉬리 Coreoleuciscus splendidus의 성적이형과 생식소 숙도 분석

송하윤,김경무,신아리,이진석,박희원,이완옥,Song, Ha-Yoon,Kim, Kyeong-Mu,Shin, A-Ri,Lee, Jin-Seok,Park, Hee-Won,Lee, Wan-Ok 한국어류학회 2017 韓國魚類學會誌 Vol.29 No.3

경기도 가평군의 가평천 일대에서 2016년 9월과 2017년 2, 4월에 쉬리 245개체를 채집하여 이석과 전장빈도분포법을 이용한 연령추정과 23가지의 계측형질을 이용하여 연령에 따른 성적이형을 조사하였다. 연령추정 결과 만 2년생부터 만 4년생의 비율이 높았고 만 5년생이 최대연령이었다. 23개의 계측형질 중 9개의 형질에서 성별 간에 유의한 차이가 있었다. 이중 뒷지느러미에서 나타나는 성적이형은 수컷의 뒷지느러미 연조가 길게 신장되어 뒷지느러미 폭과 길이가 암컷에 비해 넓고 긴 특징을 보이는 주요한 성적이형으로 나타났다. 또한 산란기에 수컷개체는 뒷지느러미의 연조에 추성이 발달하는 성적이형을 나타내었으나 뒷지느러미를 제외한 다른 계측형질과 외부형질에서 성별에 따른 성적이형이 나타나지 않았다. 성적으로 성숙하는 만 2년생 개체부터 성적이형이 나타났으며, 당년생 치어와 만 1년생 개체에서는 성적이형이 나타나지 않았다. 산란기는 4월에서 5월이었으며, 만 2세부터 산란에 참여하였다. 주요 산란 연령은 만 3세부터였으며, 최대 생식소 도지수(GSI)는 만 5세에서 암컷 14.91, 수컷 8.96으로 나타났다. Age estimation and sexual dimorphism of Coreoleuciscus splendidus were estimated using otolith, length-frequency distribution and 23 morphological measurements, from 245 individuals collected from September 2016, February and April 2017 in the Gapyeong stream, Han River, Korea. Result of age estimation of C. splendidus, we most examined were 2, 3 and 4-age, and the maximum observed ages were 5-age. Nine out of twenty-three morphometric measurements were significantly different between the genders. Anal fin have showing major sexual dimorphism in particular between adult individuals. This sexual dimorphism was based on extension of anal fin soft rays of male individuals. Therefore anal fin of males is always longer and wider than females. During spawning season male individuals possess nuptial tubercles on anal fin rays. However, another measurements and morphological characters does not exhibit sexual dimorphism in the between male and female individuals. The sexual dimorphism was observed to only over 2-years old individuals with sexual maturity. But juvenile and 1-years old individuals do not have sexual dimorphism with sexual maturity. Peak season of spawning was April to May and they start first spawning at 2-age. The ages at major spawning groups were most 3-age, and they maximum GSI index was 14.91 (female), 8.96 (male) at 5-age, respectively.

가다랑어 (Katsuwonus pelamis) 자어의 국내 출현

윤상철 ( Sang Chul Yoon ),정연규 ( Yeon Kyu Jeong ),지환성 ( Hwan Sung Ji ),신아리 ( A Ri Shin ),김장근 ( Zang Geun Kim ),최광호 ( Kwang Ho Choi ) 한국수산해양기술학회 2015 수산해양기술연구 Vol.51 No.1

Three specimens of larvae (5.2∼7.8 mm in standard length (SL)), of the family Scombridae, were collected from the southeastern waters off Jeju Island in August, 2014. These specimens were identified to Katsuwonus pelamis have melanophores distributed on the 1st dorsal-fin spines and post ventral margin on caudal peduncle. An analysis of the cytochrome oxidase submit I (COI) sequences (652 base pairs) of mitochondrial DNA showed that our specimens must be K. pelamis, because their sequences were concordant with those of the adult K. pelamis (genetic distance= 0.000∼0.002), followed by Auxis rochei (genetic distance= 0.061∼0.063) and Euthynnus affinis (genetic distance= 0.077∼0.079). During the larval stage, K. pelamis differed from Thunnus spp. species in melanophores distribution period of 1st dorsal-fin spines, lower jaws and ventral margin on caudal peduncle. In conclusion, occurrence of K. pelamis larvae means Korean waters are potential spawning ground of K. pelamis.

침과 이완요법 병행치료에 대한 중의학 연구동향

이승환 ( Seung-hwan Lee ),배영롱 ( Yeong-long Bae ),신아리 ( A-ri Shin ),김상호 ( Sang-ho Kim ),임정화 ( Jung-hwa Lim ) 대한한방신경정신과학회 2017 동의신경정신과학회지 Vol.28 No.2

Objectives: The purpose of this study was to investigate clinical trends of Traditional Chinese Medicine (TCM) on combined treatment of acupuncture and relaxation therapy. Methods: Clinical trials based on acupuncture and relaxation therapy searched and were selected from China National Knowledge Infrastructure (CNKI). In this study we selected clinical research articles using acupuncture and relaxation therapy as intervention. Studies were assessed by Risk of Bias (RoB) tool, and Jadad scale. Results: Eleven randomized controlled trials on combined treatment of acupuncture and relaxation therapy were selected, and these studies were published in China. Most studies have targeted psychiatric disorders such as insomnia and anxiety. Manual Acupuncture (MA) was the most used acupuncture treatment, and in five studies two or more relaxation therapies were used in parallel. Although the treatment result using acupuncture and relaxation therapy was superior, heterogeneity of the control group was high and it was difficult to estimate additional effects of relaxation therapy. Conclusions: Qualitative analysis revealed that the combination of acupuncture and relaxation was more effective than control in most studies. However, quality of most studies was low. Therefore, higher quality clinical research on combined treatment of acupuncture and relaxation therapy is required.

중증 궤양성 대장염 입원환자의 스테로이드 치료실패에 대한 예측 인자 및 모델 검증

김정욱 ( Jung Wook Kim ),김효종 ( Hyo Jong Kim ),이창균 ( Chang Kyun Lee ),김혁 ( Hyuck Kim ),신아리 ( A Ri Shin ),강경환 ( Kyung Hwan Kang ),김민경 ( Min Kyoung Kim ),박현진 ( Hyun Jin Park ),정회훈 ( Hoe Hoon Chung ),황은정 ( E 대한장연구학회 2012 Intestinal Research Vol.10 No.3

Background/Aims: Some clinical and laboratory parameter are predictors to determine steroid treatment failure in patients acute severe ulcerative colitis. We aimed to validate previous models in the Korean patients. Methods: This study was conducted retrospectively with 70 patients who were diagnosed with severe ulcerative colitis (UC) between January 2001 and June 2011. The rate of treatment failure was investigated using predictors or numerical scoring systems from prior studies. Results: Twelve (17.2%) patients failed to respond to steroid therapy. The logistic regression analysis revealed that stool frequency on the fifth day and colonic dilatation were the only independent predictive factors related to treatment failure. Formulated numerical risk scores based on mean stool frequency, colonic dilatation, and hypoalbuminemia were significantly higher in the non-responding group than those in the responding group (P<0.001). Using another scoring system (stool frequency on the third day+1.4×C-reactive protein [CRP]), treatment failure rate was significantly higher in the group in which the score was >8 than in the group with a score <8 (30.8% vs. 8.6%, P=0.042). Lastly, treatment failure rate was higher in the group (stool frequency >8 plus CRP >4.5 mg/dL or bloody stool plus CRP >4.3 mg/dL) than those of the other group at the third day (40% vs. 7.3%, P=0.004; 33.3% vs. 5.2%, P=0.014, respectively). Conclusions: Stool frequency and CRP level were the meaningful parameters among the predictors for steroid treatment response. Furthermore, several predictive models for steroid treatment failure in western countries seem to be of value for use in the Korean population. (Intest Res 2012;10:251-264)

증례 : 소화기 ; 내시경 점막하 박리술 시행 후 발생한 급성 봉소염성 위염을 항생제로 치료한 1예

박유민 ( Yoo Min Park ),장재영 ( Jae Young Jang ),하효정 ( Hyo Jung Ha ),김다래 ( Da Rae Kim ),박선희 ( Sun Hee Park ),신아리 ( A Ri Shin ),구자원 ( Ja Won Koo ) 대한내과학회 2016 대한내과학회지 Vol.90 No.2

급성 봉소염성 위염은 과도한 음주, 면역 저하 상태 혹은 위 점막의 광범위한 손상이 있는 경우에 발생하는 화농성 세균 감염질환으로 빈도는 매우 드물지만 사망률이 높은 질환이다. 저자들은 위선종 치료를 위해 시행한 내시경 점막하 박리술 후에 발생한 급성 봉소염성 위염을 수술 없이 항생제만으로 치료에 성공한 증례를 경험하여 이를 보고한다. Endoscopic submucosal dissection (ESD) is widely used to treat a variety of gastric lesions including early gastric cancer and gastric adenoma. Bleeding and perforation are the most common complications of ESD. However, a rare and fatal bacterial stomach infection, termed acute phlegmonous gastritis, can also develop after ESD. We treated a patient with a high fever who complained of severe abdominal pain after ESD. Abdominal computed tomography (CT) revealed a diffuse, submucosal, minimally attenuated lesion and mucosal irregularity. The clincial presentation and the CT findings were compatible with acute phlegmonous gastritis and the patient was successfully treated with antibiotics alone. The case is worth reporting because acute phlegmonous gastritis is a very rare complication of ESD. (Korean J Med 2016;90:127-131)