• 제목/요약/키워드: Asymptomatic disease

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체외 순환 없이 시행한 선천성 좌심방 부속지류 절제술 (Resection of a Congenital Left Atrial Appendage Aneurysm without Extracorporeal Circulation)

  • 김용호;유재현;이석기;강신광;임승평;이영
    • Journal of Chest Surgery
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    • 제42권2호
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    • pp.244-247
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    • 2009
  • 좌심방 부속지류는 매우 드문 질환으로 염증반응이나 퇴행성 변화로 발생할 수 있지만, 동반된 다른 기형이 없을 경우 선천성으로 생각할 수 있다. 선천성 좌심방 부속지류는 대부분 증상이 없어 우연히 발견되지만, 심방 세동, 상심실성 빈맥, 전신 색전증상, 심정지 등 합병증이 발생할 수 있어 진단되면 증상이 없어도 수술을 권장하고 있다. 개흉술을 통해 접근이 가능하지만, 기저부가 넓은 경우나 좌심방 부속지내에 혈전이 있는 경우에는 체외순환이 필요해 정중흉골 절개술이 필요할 수 있다. 저자들은 부분 심낭 결손증으로 오인되었던 선천성 좌심방 부속지류를 좌측 개흉술을 통해 체외순환 없이 성공적으로 수술하였기에 증례 보고를 하는 바이다.

광주지역 도축 돼지 및 가공품 E형 간염 실태 조사 (Screening of slaughter pig and pork products for hepatitis E virus in Gwangju and nearby areas)

  • 정하진;김지연;최인수;성창민;박자윤;박지영;안아진;곽진주;장미선;서계원;김용환
    • 한국동물위생학회지
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    • 제43권1호
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    • pp.23-29
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    • 2020
  • Hepatitis E Virus (HEV) infection is a worldwide disease and the primary cause of acute viral hepatitis in the world. It can be isolated from many different species including pigs. HEV is a zoonotic pathogen and foodborne disease. The main animal reservoir is domestic pigs. It is usually asymptomatic in pig but it is a public health concern, causing acute hepatitis in humans of varying severity. This study focused on the presence of HEV in pig and pork product. One hundred feces and one hundred fifty serum samples were randomly collected from pigs in slaughterhouses in Gwangju from November in 2018 to February in 2020. In addtion, seventy-five pork products were collected from markets in Gwangju. Feces and pork product samples were examined for the presence of HEV RNA using an reverse-transcription realtime PCR (RT-qPCR) assay. Serum samples were tested for the presence of HEV-specific IgG antibodies using Enzyme-linked immunosorbent assay (ELISA). HEV antigen and antibody positive rates were 3.0% (3/100) and 19.3% (29/150), respectively, in Gwangju and nearby areas such as Jeonnam and Jeonbuk. However, HEV antigen was not detected from any of pork product in this study. In conclusion, the prevalence of HEV should be continuously monitored because HEV was sporadically detected in Gwangju and nearby areas.

Incidence and Clinical Characteristic of Venous Thromboembolism in Gynecologic Oncology Patients attending King Chulalongkorn Memorial Hospital over a 10 Year Period

  • Oranratanaphan, S;Termrungruanglert, W;Khemapech, N
    • Asian Pacific Journal of Cancer Prevention
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    • 제16권15호
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    • pp.6705-6709
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    • 2015
  • Background: Venous thromboembolisms (VTEs) constitute a group of diseases including deep vein thrombosis (DVT) and pulmonary embolism (PE). They regarded as the second leading cause of death in cancer patients and several studies have confirmed that VTEs have a negative impact on survival and recurrent rate in both ovarian and endometrial cancer cases. The incidence of VTEs differs worldwide and depends on several risk factors including race, underlying disease, lifestyle, body weight, BMI and genetic risk factors. There is heterogeneity of DVT rates between Asian and Western countries. This study was conducted in order to evaluate the character and incidence of VTEs in gynecologic oncology patients in King Chulalongkorn Memorial Hospital over a 10 year period. Materials and Methods: A retrospective chart review was performed with VTEs defined as objective diagnosis of acute DVT or PE with typical symptoms and signs. Diagnoses were approved byan internist and/or confirmed with imaging studies. Data from both outpatient and inpatient sessions of the affected cases from January 2004 to December 2013 were extracted. General characteristics of the patients were collected with details of the diseases, types of cancer, stage, date of diagnosis of cancer, operative data, treatment outcome, progression free survival and overall survival. Results: Thirty cases of VTEs were identified in a total 2,316 gynecologic oncology cases. The incidence of symptomatic VTEs in total gynecologic oncology patients in our institution is 1.295%. The incidence of VTEs in ovarian cancer patients in our institution was 5.9%. Duration for VTE detection ranged from 13 months before diagnosis of cancer to 33 months after diagnosis of cancer. Most of the VTE cases were detected in ovarian cancer patients (60%). The most common cell type was adenocarcinoma (moderately to poorly differentiated) which accounted for 26.7% of the cases. The second most common cell type was clear cell carcinoma with 23.3% of the cases. Thirty percent of VTE cases developed before cancer was diagnosed, 20% were diagnosed at the same time as cancer detection and fifty percent developed after cancer was diagnosed. Median disease free survival of the gynecologic oncology patients with VTE was 7.5 months. Median overall survival (OS) was 12 months. Median progession free survivals of DVT and PE groups were 11.5 and 5.5 months, respectively. OS of DVT and PE was 12.0 and 11.5 months respectively. Conclusions: The incidence of VTE in Asian countries is believed to be lower than in European or Western countries. From our retrospective review, the incidence of VTEs in all types of gynecologic oncology was 1.295%, much lower than reported in the West. The reason for the lower incidence may genetic differences. Another factor is that VTE in this review was symptomatic, which is less than asymptomatic VTE. More than half of VTEs in this study developed in ovarian cancer patients. The results are compatible with earlier reports that among gynecologic malignancies, the incidence of VTE is highest in ovarian cancer.

Hepatitis C Virus - Proteins, Diagnosis, Treatment and New Approaches for Vaccine Development

  • Keyvani, Hossein;Fazlalipour, Mehdi;Monavari, Seyed Hamid Reza;Mollaie, Hamid Reza
    • Asian Pacific Journal of Cancer Prevention
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    • 제13권12호
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    • pp.5917-5935
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    • 2012
  • Background: Hepatitis C virus (HCV) causes acute and chronic human hepatitis infection and as such is an important global health problem. The virus was discovered in the USA in 1989 and it is now known that three to four million people are infected every year, WHO estimating that 3 percent of the 7 billion people worldwide being chronically infected. Humans are the natural hosts of HCV and this virus can eventually lead to permanent liver damage and carcinoma. HCV is a member of the Flaviviridae family and Hepacivirus genus. The diameter of the virus is about 50-60 nm and the virion contains a single-stranded positive RNA approximately 10,000 nucleotides in length and consisting of one ORF which is encapsulated by an external lipid envelope and icosahedral capsid. HCV is a heterogeneous virus, classified into 6 genotypes and more than 50 subtypes. Because of the genome variability, nucleotide sequences of genotypes differ by approximately 31-34%, and by 20-23% among subtypes. Quasi-species of mixed virus populations provide a survival advantage for the virus to create multiple variant genomes and a high rate of generation of variants to allow rapid selection of mutants for new environmental conditions. Direct contact with infected blood and blood products, sexual relationships and availability of injectable drugs have had remarkable effects on HCV epidemiology. Hundreds of thousands of people die each year from hepatitis and liver cancer caused by HCV virus infection. Approximately 80% of patients with acute hepatitis C progress into a chronic disease state leading to serious hepatic disorders, 10-20% of which develop chronic liver cirrhosis and hepatocellular carcinoma. The incubation period of HCV is 6-8 weeks and the infection is often asymptomatic so it is very hard to detect at early stages, making early treatment very difficult. Therefore, hepatitis C is called a "silent disease". Neutralizing antibodies are produced against several HCV proteins during infection but the virus mutates to escape from antibodies. Some patients with chronic hepatitis C may have some symptoms such as fatigue, muscle aches, nausea and pain. Autoimmune and immunecomplex-mediated diseases have also been reported with chronic HCV infection.

A Case of Short-chain Acyl-CoA Dehydrogenase Deficiency Detected by Newborn Screening

  • Park, Kyungwon;Ko, Jung Min;Jung, Goun;Lee, Hee Chul;Yoon, So Young;Ko, Sun Young;Lee, Yeon Kyung;Shin, Son Moon;Park, Sung Won
    • 대한유전성대사질환학회지
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    • 제15권1호
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    • pp.40-43
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    • 2015
  • Short-chain acyl-CoA dehydrogenase (SCAD) deficiency is an autosomal recessive mitochondrial disorder of fatty acid oxidation associated with mutations in the ACADS gene. While patients diagnosed clinically have a variable clinical presentation, patients diagnosed by newborn screening are largely asymptomatic. We describe here the case of a 1-year-old male patient who was detected by newborn screening and diagnosed as SCAD deficiency. Spectrometric screening for inborn errors of metabolism at 72hrs after birth showed elevated butyrylcarnitine (C4) level of 1.69 mol/L (normal, <0.83 mol/L), C4/C2 ration of 0.26 (normal, <0.09), C5DC+C60H level of 39 mol/L (normal, <0.28 mol/L), and C5DC/C8 ration of 7.36 (normal, <4.45). The follow-up testing at 18 days of age were performed: liquid chromatography tandem mass spectrometry (LC-MS/MS), urine organic acids, and quantitative acylcarnitine profile. C4 carnitine was elevated as 0.91; urine organic acid analysis showed elevated ethylmalonic acid as 62.87 nmol/molCr (normal, <6.5), methylsuccinate 6.81 nmol/molCr (normal, not detected). Sequence analysis of ACADS revealed a homozygous missense mutation, c.164C>T (p.Pro55Leu). He is growing well and no episodes of seizures or growth retardation had occurred.

이산화탄소 레이저를 이용한 모설의 치료 ($CO_2$ Laser Application for Treatment of the Hairy Tongue)

  • 정다운;조은애;안형준
    • Journal of Oral Medicine and Pain
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    • 제38권2호
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    • pp.97-101
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    • 2013
  • 모설(hairy tongue)은 혀의 사상유두(filiform papillae)가 과도하게 신장되어 발생하는 질환이다. 임상적으로 혀의 배면후방 1/3 부위에 주로 발생하며, 혀의 측면과 첨부에 생기는 경우는 드물다. 섭취하는 음식물과 색소유발 박테리아 등에 따라 백색에서 갈색, 검은색까지 다양한 색의 착색을 보인다. 대부분 증상이 없지만, 환자들은 주로 심미적인 문제로 병원을 찾으며, 드물게 오심, 구취, 미각이상, 불쾌한 느낌 등을 유발할 수 있다. 정확한 병인은 알려져 있지 않지만, 구강위생 관리 소홀, 구강 내 세균총의 변화, 감염, 방사선치료, 항생제, 면역 억제제 등의 사용, 과도한 음주, 흡연, 타액분비 감소 등이 소인으로 작용할 수 있다. 임상 소견이 매우 전형적이므로 육안으로도 진단이 충분히 가능하며, 생검은 필요하지 않다. 모설의 치료는 기본적인 유발요인들을 찾아서 제거해 주며, tongue cleaner 등을 이용해 혀를 부드럽게 닦아주도록 교육하고, 일부 경우에 있어서는 keratolytic agent를 사용하기도 한다. 모설 치료에 외과적 술식을 사용하는 경우는 드물지만, 유발 요인 제거 등의 다양한 치료법을 적용하였음에도 불구하고 장기간 호전이 없는 모설 환자에서, 이산화탄소 레이저(Carbondioxide laser, $CO_2$ laser)를 적용하여 효과적으로 치료한 증례를 보고하고자 한다.

결핵 치료 중 나타나는 관절 증상 (Joint Symptoms During Antituberculous Chemotherapy)

  • 김상철;백재중;이태훈;정연태
    • Tuberculosis and Respiratory Diseases
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    • 제49권2호
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    • pp.162-168
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    • 2000
  • 배경 : 항결핵제 투여시 나타나는 관절 증상은 경우에 따라서는 증상의 정도가 심해 일상 생활에 영향을 미치기도 하며 약물 순응도를 저하시키기도 하므로 항결핵제 투여시 발생하는 관절 증상에 대한 이해가 필요한데 이에 대해 체계적으로 기술되어 있는 자료가 부족한 실정이다. 방법 : 6개월이상 항결핵제 33명의 환자를 대상으로 하여 치료 경과 중 특별한 다른 원인이 없이 나타나는 관절 증상에 대해 조사 하였으며 증상을 호소하지 않는 비증상군과 비교함으로써 관절 증상 발생 및 이와 관련한 위험 인자를 확인하였다. 결과 : 관절 증상을 호소하는 환자가 33명중 19명으로 증상 유병률이 58% 에 달하였으며, 증상은 약물 투여 시작 후 1.9$\pm$1.4개월에 나타나서 3.6$\pm$2.5개월 지속되었다. 한 명을 제외하고는 모두 여러 관절을 침범하며 어깨관절과 무릎 관절이 각각 10명(53%), 손가락 관절 6명(32%)으로 흔하였다. 대부분의 환자가 항결핵제의 중단 또는 변경 없이 증상이 자연 소실되었으나, 14명(74%)의 환자는 치료 중 관절 증상에 대해 진통제를 복용하였다. 원안을 확인하기는 쉽지 않았으며 PZA 이외의 약물도 증상 발현에 관여 할 것으로 보인다. 비증상군과의 비교에서 연령, 성별, 기저질환, 치료 전 및 치료 중간의 혈중 요산 농도 등에서 유의한 차이를 확인할 수 없었다. 결론 : 항결핵제 투여 중 관절 증상의 발생은 혈중 요산 농도와 관련이 없으며, 이런 증상은 PZA 이외의 다른 약제에 의해서도 유발될 수 있으므로 증상이 심해 약을 중단하거나 대체해야 할 경우 이를 고려 하여야 한다.

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국소진행된 하인두암에서 선행 항암화학요법과 방사선치료의 효과 (Effect of Induction Chemotherapy Followed by Radiation Therapy of Locally Advanced Hypopharyngeal Carcinoma)

  • 김재원;손희영;전시영;박정제;안성기;강기문;김진평
    • 대한두경부종양학회지
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    • 제24권1호
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    • pp.26-32
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    • 2008
  • Purpose:Hypopharyngeal carcinoma is usually diagnosed as an advanced disease after an asymptomatic beginning, and it is related to a high frequency of lymph node metastases. An eventual negative outcome may occur not only because of possible locoregional failures but also for frequent distant metastases. Thus, the efficacy of induction chemotherapy followed by radiation therapy, with regards to the response, survival rate and complications for locally advanced hypopharyngeal carcinoma patients, was examined. Methods and Materials:Since July 1998 to February 2001, 18 patients having locally advanced hypopharyngeal carcinoma were treated with induction chemotherapy followed by radiation therapy, and the results were retrospectively analyzed. The regimen of the induction chemotherapy was the 5-flurouracil(5-FU, 1,000mg/$m^2$ daily for 5 consecutive days) and cisplatin(100mg/$m^2$ on day 1) combination at 3-week intervals for 2 cycles. The total radiation dose for the primary tumor and metastatic lymph nodes was 68.4-72.0Gy(median:70.2Gy) Results:The 3-year overall survival rate and disease free survival rate were 31.3% and 22.2%, respectively. In 6 patients(33.3%), preservation of the larynx for over 3 years was possible. After the induction chemotherapy and radiotherapy, a complete response was noted in 14 patients(77.8%), and a partial response in 4 patients (22.2%), with an overall response rate of 100%. Conclusion:Induction chemotherapy followed by radiation therapy is an effective treatment and larynx preservation rate was 33% in patients with locally advanced hypopharyngeal carcinoma in our report.

혈장 호모시스테인 농도가 상완-발목 맥파 속도에 미치는 영향 (The Effects of Plasma Homocysteine Concentration on Upper Arm-Ankle Pulse Wave Velocity)

  • 강지훈;신상열
    • 한국산학기술학회논문지
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    • 제20권2호
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    • pp.673-680
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    • 2019
  • 본 연구는 2016년 4월 1일부터 2016년 10월 31일까지 종합병원 건강검진센터에 내원한 435명을 대상으로 혈장 호모시스테인 농도가 정상 호모시스테인 군과 무증상 고호모시스테인 군 간에 발목-상완 pulse wave velocity에 유의한 차이가 있는지를 비교해 심혈관 질환 발생의 향후 예측인자로서 호모시스테인 검사와 동맥의 경직도를 간접적으로 반영하는 상완-발목 pulse wave velocity의 직접적인 상호 연관성을 비교해보고자 시도되었다. 연구결과 고 호모시스테인혈증 군에서 정상 호모시스테인 군에 비해 연령, 허리둘레, BUN, 혈장 크레아티닌이 유의하게 높았고, HDL은 유의하게 낮았다. 또한, 고 호모시스테인혈증은 흡연 및 음주 여부와 관련이 있었으며, 남성에서 유의하게 많았다. 관련 변수를 보정하기 전에는 고 호모시스테인 군에서 우측 및 좌측 상완-발목 맥파 속도가 유의하게 높았으나 관련 변수를 보정한 후에는 두 군의 상완-발목 맥파 속도는 유의한 차이를 보이지 않았다. 따라서, 향후 국내 수검자를 대상으로 호모시스테인 농도를 낮추는 중재적 치료 후 심혈관질환 예방에 대한 독립적 연관성 및 호모시스테인과 신장 기능의 관련성에 대한 추가 연구가 필요하겠다.

코로나 바이러스 대유행에 따른 치과 의료 관리 가이드라인 (Guidelines for dental clinic infection prevention during COVID-19 pandemic)

  • 김진
    • 대한치과의료관리학회지
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    • 제8권1호
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    • pp.1-7
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    • 2020
  • Dental settings have unique characteristics that warrant specific infection control considerations, including (1) prioritizing the most critical dental services and provide care in a way that minimizes harm to patients due to delayed care, or harm to personnel from potential exposure to persons infected with the COVID-19 disease, and (2) proactively communicate to both personnel and patients the need for them to stay at home if sick. For health care, an interim infection prevention and control recommendation (COVID-19) is recommended for patients suspected of having coronavirus or those whose status has been confirmed. SARS-CoV-2, which is the virus that causes COVID-19, is thought to be spread primarily between people who are in close contact with one another (within 6 feet) through respiratory droplets that are produced when an infected person coughs, sneezes, or talks. Airborne transmission from person-to-person over long distances is unlikely. However, COVID-19 is a new disease, and there remain uncertainties about its mode of spreads and the severity of illness it causes. The virus has been shown to persist in aerosols for several hours, and on some surfaces for days under laboratory conditions. COVID-19 may also be spread by people who are asymptomatic. The practice of dentistry involves the use of rotary dental and surgical instruments, such as handpieces or ultrasonic scalers, and air-water syringes. These instruments create a visible spray that can contain particle droplets of water, saliva, blood, microorganisms, and other debris. While KF 94 masks protect the mucous membranes of the mouth and nose from droplet spatter, they do not provide complete protection against the inhalation of airborne infectious agents. If the patient is afebrile (temperature <100.4°F)* and otherwise without symptoms consistent with COVID-19, then dental care may be provided using appropriate engineering and administrative controls, work practices, and infection control considerations. It is necessary to provide supplies for respiratory hygiene and cough etiquette, including alcohol-based hand rub (ABHR) with 60%~95% alcohol, tissues, and no-touch receptacles for disposal, at healthcare facility entrances, waiting rooms, and patient check-ins. There is also the need to install physical barriers (e.g., glass or plastic windows) in reception areas to limit close contact between triage personnel and potentially infectious patients. Ideally, dental treatment should be provided in individual rooms whenever possible, with a spacing of at least 6 feet between the patient chairs. Further, the use of easy-to-clean floor-to-ceiling barriers will enhance the effectiveness of portable HEPA air filtration systems. Before and after all patient contact, contact with potentially infectious material, and before putting on and after removing personal protective equipment, including gloves, hand hygiene after removal is particularly important to remove any pathogens that may have been transferred to the bare hands during the removal process. ABHR with 60~95% alcohol is to be used, or hands should be washed with soap and water for at least 20 s.