• 제목/요약/키워드: Combination syndrome

검색결과 230건 처리시간 0.028초

발열과 림프절 종대를 보인 환자에서 화농성 경부 림프절염과 가와사키병의 감별 진단 (Differential Diagnosis of Bacterial Cervical Lymphadenitis and Kawasaki Disease in Patients with Fever and Cervical Lymphadenopathy)

  • 장호민;하은교;김희진;이택진
    • Pediatric Infection and Vaccine
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    • 제23권3호
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    • pp.188-193
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    • 2016
  • 목적: 경부 림프절 종대를 먼저 보인 가와사키병(node-first presented Kawasaki disease [NFKD])에 대한 임상 연구를 통해 세균 경부 림프절염(bacterial cervical lymphadenitis [BCL]), 전형적인 가와사키병(Kawasaki disease [KD])과 구별되는 특징을 찾고자 하였다. 방법: 2007년부터 2015년까지 BCL, NFKD, 전형적인 KD로 입원한 환자들의 의무기록을 검토하여 인구학적 특성, 임상 양상, 혈액검사 및 영상의학적 검사 결과를 후향적으로 비교 분석하였다. 결과: 22명의 BCL, 37명의 NFKD, 132명의 전형적인 KD 환자가 연구에 포함되었다. BCL과 NFKD의 비교에서 BCL군의 입원 기간이 더 길었고 NFKD군은 양측, 다발형 림프절 비대를 보이면서 혈소판 수가 적고 호중구 백분율과 CRP 수치가 높았다. NFKD와 전형적인 KD의 비교에서 NFKD군의 나이가 더 많았고 백혈구 수, 호중구 백분율, 호중구 수, CRP 수치가 높고 혈소판 수와 ALT 수치가 낮았다. 결론: 발열과 경부 림프절 종대가 있는 환자에서 호중구 백분율과 CRP 수치가 높고 혈소판 수치가 높지 않으면서 양측, 다발형 경부 림프절 비대를 보인다면, KD의 진단 및 치료가 지연되지 않도록 NFKD 진단을 신속하게 고려하여야 한다.

Chronic inflammatory demyelinating polyneuropathy in children: a report of four patients with variable relapsing courses

  • Chang, Soo Jin;Lee, Ji Hyun;Kim, Shin Hye;Lee, Joon Soo;Kim, Heung Dong;Kang, Joon Won;Lee, Young Mock;Kang, Hoon-Chul
    • Clinical and Experimental Pediatrics
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    • 제58권5호
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    • pp.194-198
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    • 2015
  • Chronic inflammatory demyelinating polyneuropathy (CIDP) is a chronically progressive or relapsing symmetric sensorimotor disorder presumed to occur because of immunologic antibody-mediated reactions. To understand the clinical courses of CIDP, we report variable CIDP courses in children with respect to initial presentation, responsiveness to medical treatment, and recurrence interval. Four patients who were diagnosed with acute-onset and relapsing CIDP courses at Severance Children's Hospital, Seoul, Korea, were enrolled in this retrospective study. We diagnosed each patient on the basis of the CIDP diagnostic criteria developed in 2010 by the European Federation of Neurological Societies/Peripheral Nerve Society Guidelines. We present the cases of four pediatric patients diagnosed with CIDP to understand the variable clinical course of the disease in children. Our four patients were all between 8 and 12 years of age. Patients 1 and 2 were diagnosed with acute cerebellar ataxia or Guillain-$Barr{\acute{e}}$ syndrome as initial symptoms. While patients 1 and 4 were given only intravenous dexamethasone (0.3 mg/kg/day) for 5 days at the first episode, Patients 2 and 3 were given a combination of intravenous immunoglobulin (2 g/kg) and dexamethasone (0.3 mg/kg/day). All patients were maintained with oral prednisolone at 30 mg/day, but their clinical courses were variable in both relapse intervals and severity. We experienced variable clinical courses of CIDP in children with respect to initial presentation, responsiveness to medical treatment, and recurrence interval.

Subvalvular Septal Myectomy and Enlargement of the Narrow Aortic Root in Patients with Aortic Valve Replacement

  • Schulte, H.D.;Birchs, W;Horstkotte, D;Kim, Y.H.;Kerstholt, J;Preusse, C.J.;Winter, J
    • Journal of Chest Surgery
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    • 제22권2호
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    • pp.220-224
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    • 1989
  • In candidates for aortic valve replacement [AVR]it is our primary intention to implant the largest possible vale prosthesis of at least 23 mm in diameter in patients with severe valvular aortic stenosis. However, in many patients there is an additional subvalvular asymmetric septal hypertrophy which in some cases may cause an postextrasystolic increase of the LV-aortic gradient. Another component of the aortic stenosis syndrome is a narrow valvular ring, or a combination of both. After complete removal of the diseased valve and decalcification the narrow aortic ring [< 23 mm] can be widened firstly by transaortic subvalvular septal myectomy- [TSM] thus unfolding the left ventricular outflow tract[LVOT]and secondly by extending the oblique aortic incision into the aortic valve ring or further down into the anterior leaflet of the mitral valve. The sub-and supra-valvular defect will be closed by patch enlargement of the aortic root [PEAR] using autologous pericardium. These techniques allow a considerable enlargement of the valvular ring of about 4 to 10 mm in circumference. In a retrospective study using a computerized program, 847 patients with AVR [1980-1984]were reviewed to evaluate the intraoperative hemodynamic results mainly concerning relief of the transvalvular gradient. In 626 patients AVR was performed, 151 patients had double valve replacement [AVR+MVR], and 70 patients had AVR plus additional surgical procedures. Concentrating on the AVR-group [n=626] there were 103 patients with TSM, 24 patients with PEAR and 20 patients with TSM+PEAR which demonstrated that in a total, of 147 patients of this groups [23.5%] an additional procedure was necessary. The Statistical evaluation of the intraoperative pressure measurements before and after AVR in relation to the size of the implanted prostheses indicated the lowest preoperative mean gradient in patients with AVR alone, the highest in patients who afforded TSM plus PEAR. However, after AVR the mean gradients in all three groups were very low [mean 5 to 10 mmHg]. These data indicate that in patients with a narrow aortic ring and additional considerable ASH, TSM and PEAR are suitable techniques to enlarge the aortic root to enable the implantation of an adequate aortic valve prosthesis. Long-term controls have shown that autologous pericardium is a qualified graft material for the ascending aorta.

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Prediction of Colorectal Cancer Risk Using a Genetic Risk Score: The Korean Cancer Prevention Study-II (KCPS-II)

  • Jo, Jae-Seong;Nam, Chung-Mo;Sull, Jae-Woong;Yun, Ji-Eun;Kim, Sang-Yeun;Lee, Sun-Ju;Kim, Yoon-Nam;Park, Eun-Jung;Kimm, Hee-Jin;Jee, Sun-Ha
    • Genomics & Informatics
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    • 제10권3호
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    • pp.175-183
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    • 2012
  • Colorectal cancer (CRC) is among the leading causes of cancer deaths and can be caused by environmental factors as well as genetic factors. Therefore, we developed a prediction model of CRC using genetic risk scores (GRS) and evaluated the effects of conventional risk factors, including family history of CRC, in combination with GRS on the risk of CRC in Koreans. This study included 187 cases (men, 133; women, 54) and 976 controls (men, 554; women, 422). GRS were calculated with most significantly associated single-nucleotide polymorphism with CRC through a genomewide association study. The area under the curve (AUC) increased by 0.5% to 5.2% when either counted or weighted GRS was added to a prediction model consisting of age alone (AUC 0.687 for men, 0.598 for women) or age and family history of CRC (AUC 0.692 for men, 0.603 for women) for both men and women. Furthermore, the risk of CRC significantly increased for individuals with a family history of CRC in the highest quartile of GRS when compared to subjects without a family history of CRC in the lowest quartile of GRS (counted GRS odds ratio [OR], 47.9; 95% confidence interval [CI], 4.9 to 471.8 for men; OR, 22.3; 95% CI, 1.4 to 344.2 for women) (weighted GRS OR, 35.9; 95% CI, 5.9 to 218.2 for men; OR, 18.1, 95% CI, 3.7 to 88.1 for women). Our findings suggest that in Koreans, especially in Korean men, GRS improve the prediction of CRC when considered in conjunction with age and family history of CRC.

섬어(語語)와 정성(鄭聲)에 대한 동서의학적(東西醫學的) 고찰(考察) (The oriental-western literatural study of Delirious speech and Fading murmuring)

  • 최병만;이상용
    • 혜화의학회지
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    • 제9권1호
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    • pp.745-761
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    • 2000
  • Literatural study for Delirious speech and Fading murmuring, the results were as follows. 1. Delirious speech and Fading murmuring are given at the speech impediment. Derious speech to be out of language's order and slur the end of his words, and Fading murmuring is to repeat in losing conscious. 2. In constrast with Delirious speech and Fading murmuring, Maniac speech is induced by a general term for manic-depressive psychosis. Luoyan is to say in a feeble voice and mumble in a sleeping condition, and Paraphasia and Solioquy are appeared in a clear mental condition. The speech impediment is caused by damages of the nervous system and speech organ, and Yuyancuoluan is appeared in a feverless condition. 3. The symptoms of Delirious speech are to utter ravings and have a loud and heavy voice, and these resemble the delirium which specially has a speech impediment and muddle in the western medical world. The symptoms of Fading murmuring are to speak ambigously, repeatedly, and illogically and so are similar to the Wernicke dysphasia which is caused by a incomprehensible conversation. 4. The causes of Delirious speech are to spread a stomach heat and the lungs pathogenic qi into heart, not to sweat in cold damage, the Three Yang Combination of syndrome, stomach repletion, yang collapse due to excessive sweat, diarrhea, after diarrhea, heat to enter the blood chamer, feces to remain in the stomach, stasis blood to enter the viscera, to carry anger to extremity, and to be constipated. the cause of Fading murmuring is to despair vacuity desertion of vital essence and energy after a serious illness. 5. The causes of delirium are general infection, postoperative states, and metabolism disorders and those of Wernicke dysphasia are disorders of the blood vessel, brain tumors and traumas. 6. Delirious speech is cured with the discrimination of vacuity and repletion. Baitong Tang(白通湯), Chaihu Guizhi Tang(柴胡桂枝湯), Chaihu Jia Longgu Muli Tang(柴胡加龍骨牡蠣湯) are prescribed in case of vacuity, while Chengqi Tang(承氣湯), Baihu Tang(白虎湯), Liangge San(凉膈散) are in case of repletion. Fading murmuring is treated with Xiao Chaihu Tang(小柴胡湯), Fuzi Tang Jiawei(附子湯加味), Shengmai San(生脈散), and Renshen Sanbai Tang(人蔘三白湯). 7. To acupunture Qimen-Xue(期門穴) is required when it is late to prescribe a medical decoction or the hyperactive liver qi attacking the spleen.

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『상한론(傷寒論)·평맥법(平脈法)』에 관한 연구(1) (The study on ShanghanLun PingMaiFa (1))

  • 최진영;박광천;정한솔;하기태;신상우
    • 한국의사학회지
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    • 제25권2호
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    • pp.63-96
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    • 2012
  • The PingMaiFa chapter, which is the second chapter of SongBon ShangHanLun, is the scholarly description(專論) of the pulse and pathological mechanism but has not been studied and published yet. This study is about article 1-13 which is the first part of The PingMaiFa chapter. We compared the original texts within the editions, comparing and analyzing the annotations of successive dynastic medical group. The articles of The SongBon ShangHanLun PingMaiFa chapter 1-13 is consisted as is shown: article 1 states about the general features of normal pulse (平脈) and its physiological mechanism and the morbid pulses (病脈) caused by wind, cold, retained fluid, pain and heat vexation, article 1,10 state about the normal pulses of Five viscera (lung, heart, spleen, liver and kidney) and their manipulations in pulse taking, article 2 states about the differentiations of deficiency and excess syndrome according to pulse conditions, article 3, 4 state about the estimation of good prognoses and a factitious disorder by the combination of pulses and symptoms, article 6 states about Latent qi (伏氣) and its diagnostic features, article 5 states about inspection and listening examination as co-diagnostic methods of the pulse diagnosis, article 7, 8, 9 state that the emotions, such as fear and shame, and the dietary are important factors to consider for making diagnosis, article 11 states about the overwhelming pulse (相乘脈) which indicates the abnormal correlations between five phases and appears in four patterns as the dissolute(縱), the unrighteous(橫), the unfavorable(逆) and the favorable(順), article 12 states about 6 harmful pulses(殘賊脈), which are string-like pulse(弦脈), tight pulse(緊脈), floating pulse(浮脈), slippery pulse(滑脈), sunken pulse(沈脈), rough pulse(澁脈), article 13 states about "JaeGoe"(災怪) which is an unexpected response after treatment and it comes because of the formulas that had before. Throughout all these articles, The PingMaiFa chapter not only offers great value for Pulse-taking diagnosis, but also leads to a better understanding of clinical applications.

Comparison of Methods for Detection of Escherichia coli O157:H7 in Ground Beef and Radish Sprouts

  • Lee, Jae-Hoon;Hyeon, Ji-Yeon;Heo, Seok;Hwang, In-Gyun;Kwak, Hyo-Sun;Choi, In-Soo;Park, Chan-Kyu;Seo, Kun-Ho
    • 한국축산식품학회지
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    • 제30권2호
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    • pp.179-184
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    • 2010
  • Escherichia coli O157:H7 is a food-borne pathogen that causes bloody diarrhea, hemorrhagic colitis, and hemolytic uremic syndrome (HUS). We compared three selective media and evaluated the performance of immunomagnetic separation (IMS) for the detection of low levels of E. coli O157:H7 in ground beef and radish sprouts with different levels of background flora. Bulk food samples (500 g for each trial) were artificially inoculated with nalidixic acid-resistant E. coli O157:H7 at the lowest dose that would generate 20 partial-positive samples of 25 g each. All samples were homogenized in mTSB (225 mL) and incubated overnight at $37^{\circ}C$. IMS was performed using the enriched mTSB samples (1 mL) along with conventional spreads plated onto three different selective media: Sorbitol MacConkey agar (SMAC), Sorbitol MacConkey agar with cefixime and tellulite (CT-SMAC), and Sorbitol MacConkey agar with nalidixic acid (NAL-SMAC) as the gold standard. Two suspicious colonies from each medium were selected and confirmed usinga serological test after transfer to tryptic soy broth with yeast extract (TSAYE). CT-SMAC was better than SMAC for detecting E. coli O157:H7 in all food types. Although there was no statistical difference in the number of positive samples when using IMS vs. non-IMS techniques, more positive samples were detected when IMS was used in both ground beef and radish sprouts. It appears that the improvement was more significant in radish sprouts, which had a higher level of background flora than ground beef. The results also suggest that the combination of CT-SMAC and IMS is sufficient to recover low levels of E. coli O157:H7 in high background flora food samples.

Protein Intake Recommendation for Korean Older Adults to Prevent Sarcopenia: Expert Consensus by the Korean Geriatric Society and the Korean Nutrition Society

  • Jung, Hee-Won;Kim, Sun-Wook;Kim, Il-Young;Lim, Jae-Young;Park, Hyoung-Su;Song, Wook;Yoo, Hyung Joon;Jang, HakChul;Kim, Kirang;Park, Yongsoon;Park, Yoon Jung;Yang, Soo Jin;Lee, Hae-Jeung;Won, Chang Won
    • Annals of Geriatric Medicine and Research
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    • 제22권4호
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    • pp.167-175
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    • 2018
  • Sarcopenia, a common clinical syndrome in older adults, is defined as decreased muscle mass, strength, and physical performance. Since sarcopenia is associated with the incidence of functional decline, falls, and even mortality in older adults, researchers and health care providers have been keen to accumulate clinical evidence to advocate the screening and prevention of sarcopenia progression in older adults. The factors that may accelerate the loss of muscle mass and function include chronic diseases, inactivity, and deficiency in appropriate nutritional support. Among these, nutritional support is considered an initial step to delay the progression of muscle wasting and improve physical performance in community-dwelling older adults. However, a nationwide study suggested that most Korean older adults do not consume sufficient dietary protein to maintain their muscle mass. Furthermore, considering age-associated anabolic resistance to dietary protein, higher protein intake should be emphasized in older adults than in younger people. To develop a dietary protein recommendation for older adults in Korea, we reviewed the relevant literature, including interventional studies from Korea. From these, we recommend that older adults consume at least 1.2 g of protein per kg of body weight per day (g/kg/day) to delay the progression of muscle wasting. The amount we recommend (1.2 g/kg/day) is 31.4% higher than the previously suggested recommended daily allowance (i.e., 0.91 g/kg/day) for the general population of Korea. Also, evidence to date suggests that the combination of exercise and nutritional support may enhance the beneficial effects of protein intake in older adults in Korea. We found that the current studies are insufficient to build population-based guidelines for older adults, and we call for further researches in Korea.

섬유근통의 통증 및 우울증상에 대한 침치료의 효과성: 체계적 문헌고찰 및 메타분석 (Effectiveness of Acupuncture for Pain and Depressive Symptoms in Fibromyalgia: Systematic Review and Meta-Analysis)

  • 이현우;박찬;방태훈;지형민;김종우;정선용
    • 동의신경정신과학회지
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    • 제34권2호
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    • pp.95-113
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    • 2023
  • Objectives: To review studies evaluating effects of acupuncture on pain and depressive symptoms in fibromyalgia. Methods: Quantitative evidences (RCTs) were systematically reviewed. Literature were searched for a combination of fibromyalgia and depression (The Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, medline (via PubMed), Kmbase, KISS, ScienceON, OASIS, CiNii, CNKI). Quantitative research findings were critically appraised by Cochrane risk of bias (RoB) tool and pooled. Meta-analysis was then conducted using Review Manager (RevMan) 5.4. Results: Eighteen studies were selected. American College of Rheumatology (ACR) classification criteria for Fibromyalgia Syndrome was most frequently used as diagnostic criteria for fibromyalgia. As for outcome measurement, Hamilton Rating Scale for Depression (HAMD), Visual Analog Scale (VAS), and Total Effective Rate (TER) were used most commonly. Meta-analysis of ten studies revealed that both Depression and VAS scores of the Acupuncture+Western Medicine group were significantly lower than those of Western Medicine group (Depression: SMD, -0.94, 95% CI, -1.17 to -0.70; VAS: MD, -1.51, 95% CI, -1.83 to -1.19). Also, TERs of both Acupuncture group and Acupuncture+Western Acupuncture+Western Medicine group were significantly higher than those of the Western Medicine group (OR: 2.38, 95% CI: 1.29 to 4.41; and OR: 7.40, 95% CI: 3.41 to 16.07). There was no significant difference in Depression or VAS score between the Acupuncture Group and the Western Medicine Group. Conclusions: Acupuncture might be an effective option for pain and depressive symptoms of fibromyalgia when it is combined with Western Medicine treatment. For more accurate results, more types of Korean medicine treatment should be conducted.

Prediction of Patient Management in COVID-19 Using Deep Learning-Based Fully Automated Extraction of Cardiothoracic CT Metrics and Laboratory Findings

  • Thomas Weikert;Saikiran Rapaka;Sasa Grbic;Thomas Re;Shikha Chaganti;David J. Winkel;Constantin Anastasopoulos;Tilo Niemann;Benedikt J. Wiggli;Jens Bremerich;Raphael Twerenbold;Gregor Sommer;Dorin Comaniciu;Alexander W. Sauter
    • Korean Journal of Radiology
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    • 제22권6호
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    • pp.994-1004
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    • 2021
  • Objective: To extract pulmonary and cardiovascular metrics from chest CTs of patients with coronavirus disease 2019 (COVID-19) using a fully automated deep learning-based approach and assess their potential to predict patient management. Materials and Methods: All initial chest CTs of patients who tested positive for severe acute respiratory syndrome coronavirus 2 at our emergency department between March 25 and April 25, 2020, were identified (n = 120). Three patient management groups were defined: group 1 (outpatient), group 2 (general ward), and group 3 (intensive care unit [ICU]). Multiple pulmonary and cardiovascular metrics were extracted from the chest CT images using deep learning. Additionally, six laboratory findings indicating inflammation and cellular damage were considered. Differences in CT metrics, laboratory findings, and demographics between the patient management groups were assessed. The potential of these parameters to predict patients' needs for intensive care (yes/no) was analyzed using logistic regression and receiver operating characteristic curves. Internal and external validity were assessed using 109 independent chest CT scans. Results: While demographic parameters alone (sex and age) were not sufficient to predict ICU management status, both CT metrics alone (including both pulmonary and cardiovascular metrics; area under the curve [AUC] = 0.88; 95% confidence interval [CI] = 0.79-0.97) and laboratory findings alone (C-reactive protein, lactate dehydrogenase, white blood cell count, and albumin; AUC = 0.86; 95% CI = 0.77-0.94) were good classifiers. Excellent performance was achieved by a combination of demographic parameters, CT metrics, and laboratory findings (AUC = 0.91; 95% CI = 0.85-0.98). Application of a model that combined both pulmonary CT metrics and demographic parameters on a dataset from another hospital indicated its external validity (AUC = 0.77; 95% CI = 0.66-0.88). Conclusion: Chest CT of patients with COVID-19 contains valuable information that can be accessed using automated image analysis. These metrics are useful for the prediction of patient management.