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당뇨병 환자의 족부 진균 질환 유병률과 당뇨병성 족부 질환과의 상관성 조사
이광훈 ( Kwang Hoon Lee ),이주희 ( Ju Hee Lee ),이정덕 ( Jeong Deuk Lee ),조백기 ( Baik Kee Cho ),김형옥 ( Hyung Ok Kim ),김계정 ( Kea Jeung Kim ),김낙인 ( Nack In Kim ),송해준 ( Hae Jun Song ),손숙자 ( Sook Ja Son ),김상원 ( Sang 대한피부과학회 2003 대한피부과학회지 Vol.41 No.7
Object : The purpose of this study was to determine the prevalence of fungal infection and ulcer on the feet of diabetic patients and the existence of correlation between ulcer and fungal infection. Methods : A total 21,693 outpatients diagnosed as diabetes mellitus at the department of endocrinology of 32 hospitals were examined. The diabetic patients with foot problems were consulted to the department of dermatology. Physical examination and KOH preparation were performed. Results : 13,271 patients had certain kinds of foot problem, accounting for 61.2% of 21,693 diabetics examined. Of these, fungal foot disease were found in 10,403 that constituted 78.4% (48.0% of the entire diabetic population). Tinea pedis was the diagnosis in 6,496 (29.9%), onychomycosis in 7,783 (35.9%), and coexistence was in 3,883 (17.9%). Foot deformity was in 1,346 (6.2% of diabetics; 10.1% of foot disease), non-palpable pulse in 1,051 (4.8% ; 7.9%), and foot ulcer was in 425 (2.0% ; 3.2%), following in a descending order of frequency. Odds ratios for diabetic foot ulcer were 2.5 in patients with the foot deformity, 1.6 with fungal foot disease and 2.2 with non-palpable pulse. Conversely, Odds ratios for fungal foot disease were 2.5 with foot deformity, and 1.6 with foot ulcer. A total of 5,486 patients paid a visit to the department of dermatology. Of these, 4,519 patients were diagnosed with fungal infection through physical examination and KOH smear by dermatologists. The population comprised of 2,272 males and 2,247 females, showing similar prevalence between sexes. However, age did have positive correlation regarding prevalence of fungal foot disease. The number of diabetic patients with toenail problems was 3,847 patients (70%) and onychomycosis was proven mycologically in 3,276. Onychomycosis of distal subungal type was the most common clinical finding, most frequently involving the great toenails. Abnormal skin findings of the foot were seen in 3,885(70.8%) and tinea pedis was found in 3,209 (58.5%), most commonly involving the soles. Conclusion : This study showed that fungal infection might be regarded as a risk factor of foot ulcer. Treatment of fungal infection in diabetic patients might prevent diabetic foot disease such as ulcer and reduce the disability, morbidity and mortality in diabetic patients. (Korean J Dermatol 2003;41(7) : 908~915)
유희태 ( Hee Tae Yu ),하유정 ( You Jung Ha ),정상윤 ( Sang Youn Jung ),이광훈 ( Kwang Hoon Lee ),김현민 ( Hyun Min Kim ),이수곤 ( Soo Kon Lee ),박용범 ( Yong Beom Park ) 대한류마티스학회 2010 대한류마티스학회지 Vol.17 No.2
Septic arthritis of the sternoclavicular joint is a rare condition. The predisposing risk factors include intravenous drug abuse, subclavian vein catheter placement, diabetes mellitus and trauma. Delayed or inadequate management can lead to irreversible joint damage with subsequent disability, even death. We report a 48-year-old female patient who presented with right sternoclavicular joint swelling and right shoulder pain. Magnetic resonance imaging of the sternum showed swelling of the right sternoclavicular joint with gadolinium enhancement. Synovial fluid and bone tissue culture revealed Escherichia coli (E.coli), and confirmed the diagnosis of sternoclavicular septic arthritis. She was successfully treated with surgical debridement and ciprofloxacin without recurrence. This is the first case report of E.coli sternoclavicular septic arthritis in Korea.
베체트병 환자의 말초혈액에서 T 림프구의 아형과 T 림프구의 혈관 내피세포에 대한 유착
김희성,방동식,이광훈 ( Hee Sung Kim,Dong Sik Bang,Kwang Hoon Lee ) 대한피부과학회 1997 대한피부과학회지 Vol.35 No.5
Background: Behcets disease represents a polysymptomatic, recurrent vasculitis' with a chronic course. Its etiology and pathogenesis still remains unclear. Several immunological abnormalities have been described in this disease and altered cell mediated immunity especially has been suggested to play an important role in the pathogenesis. Recently, suppressor-inducer (naive, CD4-CD45RA+ ) and helper-inducer (memory, CD4-CD45RO+) human T cell subsets have been identified by their relevant monoclonal antibodies. It has heen suspected that human dermal microvascular endothelial cells(HDMEC) are an important part in the pathogenesis of Behcets disease. However, there was no report for HDMEC-T lymphocyte adhesion in Behcets disease, Objective : We have investigated the subpopulation differences in CD4- T lymphocytes and the adhesiveness of T lymphocytes to cultured HDMEC in the presence of IL-1a, or TNF-a using T lymphocytes isolated from normal human subjects and Behcets disease patients respectively. Methods : T lymphocyte subsets were evaluated by the two-color immuno-fluorescence flow cytometric analysis using anti CD4-, CD8-, CD45RA- and CD45RO monoclonal antibodies. The binding assay of T lymphocytes to HDMEC was performed before and after stimulating HDMEC with IL-la or TNF-a. Results : 1. The number of CD4- T cells and the CD4+ to CD8+ ratio decreased in patients with Behcets disease compared to normal controls. 2. In the CD4+ T cell subpopulation, there was a significant decrease in the CD4+CD45RA+cell number with a slight increase in the CD4+ CD45RO+ cell number. 3. After stimulating HDMEC with IL-la and TNF-a, the degree of T lymphocyte-HDMEC adhesion generally increased in an E:T ratio dependent, manner in patients with Behcets disease compared to normal controls. 4. Increased binding of CD4+ CD45RA+ naive T lymphocytes and CD4+CD45RO+ memory T lymphocytes to HDMEC was induced after stimulation with IL-1a and TNF-a in both patients and normal controls. The increasing rate was higher in Behcets disease patients than in normal controls. There was no difference in T lymphocyte-HDMEC adhesion between memory and naive T lymphocytes. Conclusion : From these findings it can be postulated that the decrease in the CD4+CD45RA+ count may lead to the inactivation of CD8 suppressor cells resulting in abnormal immune suppression shown in Behcets disease. Proinflammatory cytokines may also play an integral role in the pathogenesis of Behcet's disease by activating endothelial cells increasing the interaction between T lymphocytes and endothelial cells. Increasing the interaction between T lymphocytes and HDMEC may be indirect evidence of activation of cell-mediated immunity. (Korean J Dermatol 1997;35(5): 883-892)
김태승(Tai Seung Kim),권상옥(Sang Ok Kwon),이광훈(Kwang Hoon Lee),배선우(Seon Woo Bae),노병선(Byoung Seon Rhoe),정순희(soon Hee Jung) 대한소화기학회 1987 대한소화기학회지 Vol.19 No.1
Familial Polyposis Coli is a rare inherited disease and has been considered a disease in which polyps are confined to the colon and rectum. Systemic studies have recently been conducted on the polyps of the extracolonic gastrointestinal tract in Familial Polyposis Coli, which suggest that the incidence of polyps may be higher than previously suspected. So it seems that Familial Polyposis Coli affects the whole gastrointestinal tract, not only the colon and rectum as believed earlier. In Korea, several cases of Familial Polyposis Coli have been reported, but in all of them, the polyps were confined to the colon and rectum. Here we are reporting one case of Familial Polyposis Coli of the entire gastrointestinal tract.
진균학적 검사 및 random amplified polymorphic DNA analysis 에 의한 피부사상균의 동정과 미동정 원인에 대한 분석
이광훈,권태은,문상은,조백기,윤종현,유희준,안규중,김정애 대한피부과학회 2001 大韓皮膚科學會誌 Vol.39 No.2
Background: Dermatophytes are usually identified based on their characteristic morphologies and physiological tests. However, identification is often delayed and problematic for atypical isolates. Recently, random amplified polymorphic DNA (RAPD) analysis was successfully performed for the identification of dermatophyes. Objective: This study was performed to identify clinical isolates which eould not be identified previously. The causes of unidentification were analysed and the merits and demerits of RAPD analysis were evaluated. Methods: Thirty-six clinical isolates and 14 standard strains were included in this study. Seven mycological studies were performed and RAPD analysis was done by using primer OPAO-15(5'GAAGGCTCCC-3') Results: Based on the results of 7 mycological tests, 28 strains were contirmed as follows: 24, T. rubrum; 2, T. mentagrophytes; 2, T. raubitschekii. Four were considered as atypical strains of T. rubrum, and another 4 as non-dermatophytic moulds. This results were confirmed by RAPD analysis. Conclusion: RAPD analysis was useful for the identification of dermatophytes, especially the atypical strains. However, non-dermatophytic mould could not be identified by RAPD analysis. RAPD analysis was considered as a supplementary method to the conventional mycological studies for the identification of dermatophytes.
이광훈,최승옥,원영준,김승률,여경구,홍희승,정인배 대한내과학회 1993 대한내과학회지 Vol.45 No.5
Advances medical cares for end-stage renal disease(ESRD), CAPD and renal transplatation have led to an extended life span for patients with ESRD. Despite these advanced, patients with ESRD have an exceeding- ly poor reprductive capacity. There are high incidence of infertilities, spontaneous abortions and still births. CAPD has been increasingly popular management tool for patient with ESRD and has advantages over hemodialysis in the management of pregnant patient. The fetus faces a more constant uterine environment without rapid shifts in fluids, solutes and electrolytes. The patients as a population have higher hematocrits and hypotensive episodes are less frequent. Recently we had experienced a case of successful pregnancy in patient with ESRD undergoing CAPD. This is the first case in Korea. A 25-year-old woman had been undergoing CAPD for 5 months became pregnant. Her blood pressure was controlled in the 144±11mmHg systolic and 97±8 mmHg diastolic range with 40 mg/day of hydralazine and 500 mg/day of methyldopa. Her mean serum BUN and creatinine during pregnancy were 31±10 mg/dl and 3.7±1.1 mg/dl, respectively. A female infant was delivered by normal spontaneous vaginal delivery at 37 weeks gestation with APGAR score of 7 and 9 at 1 and 5 minutes, respetively and birth weight was 2.1 Kg. There was no obstetric or neonatal complication. At the 3 months fallow-up the baby's growth and development are normal.
Kim, Tae-Woon,Choi, Chang-Young,Kim, Seong Won,Lee, Gwang-Hoon,Baek, Kwang Jin,Kwon, Nyoun Soo,Lee, Hee Sung,Yun, Hye-Young 중앙대학교 의과대학 의과학연구소 2000 中央醫大誌 Vol.25 No.1
신경 활성이 발생 및 세포 생존 유지에 중요한 조절인자라는 사실은 신경계의 활성 의존성 현상에 대한 그 동안의 연구결과를 통해 밝혀졌다. 특히, 염화칼륨(KCI)의 처리에 의한 세포막의 탈분극은 여러 종류의 일차배양 신경세포 및 세포주에서 혈청 존재시 생존을 증가시키고, 혈청 제거 시 유발되는 세포사멸을 현저히 저해시킨다. 그러나, 막 탈분극이 세포 생존 유지에 어떻게 관여하는지에 대해서는 아직까지 분명히 밝혀져 있지 않다. 본 연구에서는 막 탈분극에 의해 유입된 칼슘 이온이 어떻게 신경성장인자(NGF)가 제거된 PC12 신경세포주의 생존을 증가시키는지는 이해하기 위해 생존유지에 관련이 있을 것으로 추정되는 세포 내부 신호 전달 물질을 조사였다. L-type voltage-sensitive calium channels(VSCCs), 외부 칼슘의 유입, ras, extracellular single-regulated kinase(Erk),phosphatidylinositol-3 kinase(PI3K)의 활성 억제제를 각각 분화된 지 10일이 된PC12 신경 세포주에 투여하여 세포 생존유지에 미치는 효과를 측정한 결과 모두 세포막 탈분극에 의해 촉진되는 세포 생존을 억제했다. 또한, 전사 억제제와 단백질 합성 억제제를 전처리한 경우에서도 같은 효과가 나타났다. 이 결과는 L-type VSCCs를 통한 외부 칼슘의 세포내 유입, ras와Erk,PI3K같은 ras의 하위 효과자들, 그리고 새로운 유전자 전사 및 단백질의 합성이 PC12 세포의 생존유지에 매우 중요한 역할을 수행함을 암시한다. 따라서, 칼슘,ras,Erk,PI3K가 관여하는 신호 전달 경로가 세포핵으로 신호를 전달하여 아직 알려지지 않은 유전자의 전사활성 및 단백질 발현을 유도하여 세포막 탈분극에 의해 촉진되는 세포 생존유지를 조절하는 것으로 추정된다.