• Childhood Kidney Diseases
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• 제18권2호
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• pp.92-97
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• 2014

목적: 비스포스포네이트는 스테로이드 유발성 골다공증을 앓고 있는 환자의 치료에 널리 사용되어 왔다. 비스포스포네이트의 사용이 증가되면서 성장 중인 뼈에서 보이는 방사선학적 이상 소견에 대한 몇몇 보고가 있었다. 그래서 소아 환자에서 비스포스포네이트를 사용하는 것에 대해서는 논란의 여지가 있다. 이번 연구는 신병증을 가진 소아 환자에서 파미드로네이트 치료를 했을 때 발생한 방사선학적 이상 소견, 특히 골간단 경화성 선을 장기간 추적 관찰한 결과를 알기 위한 것이다. 방법: 경구로 칼슘제와 파미드로네이트(용량: 매일 100 mg)를 복용한 24명의 신병증 환아(평균 복용 기간: 9개월)를 후향적으로 연구하였다. 모든 대상 환아는 신병증에 대한 치료로 장기간 스테로이드 치료를 받았기 때문에 스테로이드 유발성 골다공증을 앓고 있었다. 파미드로네이트 치료 전에 장골의 방사선 사진을 촬영하였으며 수년간 추적 관찰 하였다. 뼈의 성장 속도는 검사를 시행한 시간 간격에 따라 방사선 사진 상에서 경화성 선이 이동한 거리를 측정하여 계산하였다. 결과: 평균 추적 관찰 기간은 138개월이었다. 장골의 방사선 사진 상, 모든 환자에서 골간단의 끝부분에서 뚜렷한 경화성 선이 관찰 되었으며 이 경화성 선은 성장판에서 골간쪽으로 점점 이동하였다 경화성 선의 평균 이동 속도는 6.21 mm/년이었다. 24명 중 12명의 환자에서는 경화성선이 완전히 사라졌다. 그리고 평균 키의 성장 속도는 7.33 cm/년이었다. 결론: 이번 연구에서 장기간 동안 추적 관찰한 결과 파미드로네이트 치료와 연관된 골간단부의 경화성 선은 뼈 성장에 영향을 주지 않았으며 점점 없어지는 경향을 보였다. 그러므로 신병증을 가진 소아 환자에서 스테로이드 유발성 골다공증을 비스포스포네이트로 치료하는 것은 안전한 것으로 생각된다. 그러나 좀 더 많은 수의 환자를 대상으로 하는 추가적인 연구가 필요하다.

• Journal of Chest Surgery
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• 제8권1호
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• pp.19-28
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• 1975

The thoracoscopic study was reported on 21 cases of spontaneous pneumothorax requiring surgical management, and clinical values of thoracoscopic examination on spontaneous pneumothorax were also discussed. patients were treated in the Department of .Thoracic Surgery, Hanyang University Hospital for the period of two Years from May 1972 to April 1974. For exact detection of etiologic factors on spontaneous pneumothorax, the thoracoscopic examination in the intrapleural space was performed in parallel with X-ray study. this study, the difference of diagnostic and therapeutic significance between radiological and thoracoscopic findings were observed and compared simultaneously. The results are summerized as follows: Patients age was distributed between 3 and 70 years old with highest incidence in the age group of sixty decade [33. 3%], and sex ratio of male to female was 5:2. The tuberculous processes which developed superficial subpleural layer in the lung parenchyme, on the pulmonary surface could be observed by thoracoscopic examination in a characteristic picture. detection ratio of pulmonary tuberculosis by the radiologic study to that by thoracoscopy was 8:2. The adhesion between the visceral and the parietal pleura which could possibly make a rupture of the alveola and the visceral pleura was found to be localized in a small area of the lung surface. The other part of the lung surface was free of the adhesion and, therefore, the movement of the lung took place completely without any difficulty. The ruptured orifice of the pleura and pathological changes surrounding the orifice can be detected by thoracoscopy, but not by other means such as radiologic examination. A single tuberculous bleb and multiple emphysematous blebs were found on 6 cases out of 21 cases of spontaneous pneumothorax. Among these cases, radiologic Study revealed the bleb only in one patient. On the other hand, the blebs were found in all the six patients by means of thoracoscopic examination. It gives the detection ratio of bleb by radiologic study to that by thoracoscopy was 1:6. By thoracoscopy, the rupture on the lung surface were visualized on the 10 patients out of a total of 21 patients [10 patients of visual rupture]. However, the rupture of the pleura was not observed on the rest of 11 patients even by thoracoscopic examination [11 patients of non visual rupture]. Five patients [50%] out of ten who had the visual rupture on the lung surface was required a surgical operation to remove pneumothorax. For the patients who were detected to have the visual rupture of the pleura by thoracoscopy, be considered in the early stage of closed thoracostomy. of 21 patients, 16 patients [11 patients of non visual rupture of the pleura and 5 patients of visual rupture of the pleura] who received no surgical management, were treated with closed thoracostomy with continuous suction, and the` pneumothorax was healed completely up in each cases. Therapeutic measures for the remaining 5 patients of visual rupture of the pleura who were subjected to surgical approach for radical treatment of spontaneous pneumothorax were accordingly complicated, and the following different procedures were properly indicated case by case, that is, rib resection thoracostomy, simple closure of ruptured visceral pleura, wedged resection of the lung, and lobectomy.

• 대한유전성대사질환학회지
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• 제15권1호
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• pp.49-54
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• 2015

다발성 골단이형성증은 비교적 흔한 골이형성증으로 소아기에 관절통과 관절 강직, 뒤뚱거리면 걸어가는 보행 및 일부에서 경한 저신장을 특징으로 하며 영상의학적 검사에서는 여러 관절에서 골단의 불규칙한 소견과 골화 지연을 보인다. 본 증례 환자는 임상적, 영상의학적으로 다발성 골단이형성증을 진단 할 수 있었으며 환자의 넓적다리 관절 영상 검사는 MATN3 유전자 변이를, 무릎 관절 영상 검사는 COMP 유전자 변이를 시사하였기에 MATN3과 COMP 유전자 변이에 대해 시퀀싱(sequencing)을 하였으나, 변이는 발견되지 않았다. 이후 엑솜시퀀싱(exomesequencing)을 시행하였으나, 기존에 다발성 골단이형성증과 관련이 있는 것으로 알려진 유전자에 대한 변이가 발견되지 않았다. 본 증례와 같이 임상적, 영상의학적으로 다발성 골단이형성증으로 진단가능 하였으나 분자유전학적으로 기존에 알려진 변이 유전자가 발견되지 않은 환자들을 위해 추가적인 연구가 필요할 것으로 보인다.

• Tuberculosis and Respiratory Diseases
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• 제59권5호
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• pp.566-570
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• 2005

폐에 발생하는 원발성 비호지킨 림프종은 아주 드문 질환으로 대개 폐문이나 중격동의 림프절 비대로 나타난다. 조직학적으로 대개 low grade B-cell 형태로 주로 발생하고 말초 T세포 형태로 폐에 원발성으로 발생하는 림프종은 드문 것으로 알려져 있다. 저자들은 발열과 전신 홍반이 있으면서, 흉부 X-선 사진상 급속히 진행하는 미만성 폐침윤 및 흉수 소견을 보여 초기에는 감염성 질환을 의심하였으나 피부병변과 림프절 및 골수 검사상 말초 T세포 림프종으로 진단된 예를 경험하였기에 문헌 고찰과 함께 보고하는 바이다.

• The Korean Journal of Pain
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• 제8권2호
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• pp.298-303
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• 1995

We have inserted epidural catheter for single or continuous injection of a drug for epidural analgesia. It is important to localize the tip of epidural catheter in appropriate site to acquire the most effective analgesia. In epidural block, we observed course and location of the tip of epidural catheter. Subject: 70 patients were divided into group I(non-injection of saline group during catheter insertion) and group II(injection group during catheter insertion). Group I included cervical(n=20), thoracic(n=10), and lumbar(n=20) epidural group. Group II, cervical(n=10), and lumbar(n=10) epidural group. Method: 19G FlexTip $Plus^{TM}$ Epidural Catheter ($Arrow^{(R)}$) was inserted 10cm cephaladly in epidural space with(group II) or without(group I) saline flushing. We observed course and location of the tip of epidural catheter by C-arm image intensifier during injection of contrast media ($Omnipaque^{(R)}$). Result: In group I, the number of tips of epidural catheters located within 2 cm from inserted site were: cervical 14/20(70%), thoracic 2/10(20%). lumbar 16/20(80%). In thoracic epidural blocks, tips of epidural catheters were more cephaladly located than with cervical and lumbar epidural blocks. With cervical epidural blocks, the number of tips of epidural catheters located within 2 cm from insertion site were less in group II than group I (20% vs. 70%). But no significant differences were noted between group I and group II with lumbar epidural block(90% vs. 80%). The number of tips of epidural catheters located around a predicted site were: cervical 2/20(10%), thoracic 4/10(40%), lumbar 0/20(0%) in group I, and cervical 2/10(20%), lumbar 1/10(10%) in group II. Conclusion: It was impossible to predict the exact location of tips of epidural catheters by measuring the inserted length without epidurogram. With many cases, tips of epidural catheters were located around the insertion site in lumbar epidural blocks, and in some cases around the predicted site in thoracic epidural blocks. The results suggests that epidural block should be done at a point near the required band of analgesia.

• Journal of Acupuncture Research
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• 제35권4호
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• pp.158-168
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• 2018

The purpose of this study was to review clinical studies of lumbar herniated intervertebral disc (LHIVD) treatment using acupuncture. Online database (PubMed, COCHRANE Library, EMBASE, CNKI, KISS, NDSL, KoreaMed, KMbase, OASIS, and KISTI) searches were conducted in May 2018. Studies that used acupuncture, electroacupuncture or warm needle acupuncture were included, along with participants who had lower back pain and radiating pain of their lower limbs consistent with radiological findings. Animal studies and nonclinical data were excluded. Data on treatment methods, site, time, frequency, period, and scales used were analyzed. There were 69 studies including 38 randomized controlled trials, 14 retrospective observational studies, and 17 clinical case studies. There were 51 acupoints selected for acupuncture treatment of LHIVD. The most frequently treated acupoints were BL23, BL25, BL24, and BL40. The mean treatment time, frequency, and duration were $26.06{\pm}6.70$ mins, $6.29{\pm}1.70$ times/week, and $20.57{\pm}11.04$ days, respectively, in randomized controlled trials (RCT), and $18.62{\pm}4.60$ mins, $11.58{\pm}3.99$ times/week, and $34.43{\pm}17.62$ days, respectively, in case/retrospective studies ($mean{\pm}SD$). This review collates information about acupuncture treatment methods for LHIVD.

• 한국전문물리치료학회지
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• 제18권1호
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• pp.83-92
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• 2011

Osteoarthritis is a degenerative joint disease and is led to physical disability. Yet the development of effective disease-modifying treatments has lagged. In this study, I examined the effect of physical therapeutic intervention through microcurrent stimulation and attempt to find which degree of intensity, either 25 ${\mu}A$ or 500 ${\mu}A$ with a regular 5 pps pulse, is more effective in the osteoarthritis. Osteoarthritis was induced with a mixture of 2% carrageenan and 2% kaolin in 26 male Sprague-Dawley rats. The mixture (0.1 $m{\ell}$) was injected into the intra-articular capsule of knee joint once a week for three weeks. Five animals did not show degenerative changes by radiological findings and excluded in the following experiment. Osteoarthritic animals were randomly divided into 3 groups ($n_1$, $n_2$, $n_3$=7/each): untreated, treated with 25 ${\mu}A$, treated with 500 ${\mu}A$. All experimental groups received microcurrent stimulation for four weeks (15 min/day, 5 days/week). The ethological inspection of foot print analysis on the walking corridor was accomplished every week. Histological preparations and immunohistochemical staining with insulin-like growth factor-1 were also done in the articular cartilages. All of these parameters were compared with those of osteoarthritic control group (n=7). The ethological inspection of foot print analysis revealed that changes of walking track (paw width) and stride length was significantly increased in both experimental groups. The better results were observed in experimental group treated with 25 ${\mu}A$ intensity without significance than group treated with 500 ${\mu}A$. Histological preparations disclosed that routine hyaline cartilage of articular surface were altered to fibrous cartilage in untreated group and experimental group treated with 500 ${\mu}A$ intensity. But a little changes were seen in experimental group treated with 25 ${\mu}A$ intensity. Immunolocalization of insulin-like growth factor-1 was simultaneously decreased according to the duration of osteoarthritis, and did not show significant difference among the groups. In this study discovered that the microcurrent stimulation, especially 25 ${\mu}A$ intensity, had a positive effect by the ethological inspection, histological and immunohistochemical stainings. These results suggest that microcurrent stimulation with low-intensity might be effective in the promotion of healing process for the osteoarthritis.

• Journal of Gastric Cancer
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• 제1권2호
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• pp.106-112
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• 2001

Purpose: Even with excellent surgical outcome, recurrence of early gastric cancer (EGC) after a curative resection is not declining because the incidence of EGC is increasing. The aim of this study was to propose an appropriate treatment strategy by assessing the risk factors for recurrence of curatively resected early gastric cancer. Materials and Methods: Of 3662 patients who had undergone gastric resections for gastric cancer from 1987 to 1996, the cases of 1050 curatively resected EGC patients were reviewed retrospectively. Among those 1050 patients, 50 patients ($4.8\%$) were diagnosed as having recurrent cancer, which was confirmed by clinico-radiological examination or re-operation. The risk factors that determined the recurrence patterns were investigated by using univariate and multivariate analyses. Results: The mean time to recurrence was 30.9 months, and hematogenous recurrence was the most frequent type ($32.0\%$). Among the 50 recurred patients, peritoneal recurrence showed the shortest mean time to recurrence ($18.5\pm17.7$months). Between the recurred and the non-recurred patients, there was no statistically significant difference with respect to age, sex, operation type, tumor size, tumor location, gross appearance, or histological differentiation. However, depth of invasion (submucosal invasion) and nodal involvement were significantly different (P<0.001) between the two groups. Using logistic regression analyses, nodal involvement was the only significant risk factor for recurrence in early gastric cancer (P<0.001). The median survival after the recurrence had been diagnosed was 4 months. Conclusion: Although the prognosis for EGC patients is excellent and recurrence of EGC after a curative resection is rare, the time to recurrence and the patterns of recurrence in EGC patients were diverse and unpredictable, and the result after recurrence is dismal. Considering the impact of lymph node metastasis on recurrence of EGC, a systematic lymphadenectomy, rather than limited surgery, should be performed if lymph node involvement is confirmed pre- or intraoperatively. Also if the postoperative pathologic findings reveal lymph node involvement, adjuvant chemotherapy is recommended.

• Tuberculosis and Respiratory Diseases
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• 제61권5호
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• pp.479-483
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• 2006

급성 섬유소성 기질화 폐렴 (AFOP)은 임상적으로 급성 간질성 폐렴과 유사하지만 세기관지내 섬유소 축적을 보이며 유리질막이 존재하지 않는 조직학적 특성을 갖는 간질성 폐렴의 한 형태이다. 일부 보고나 본 증례에 따르면 임상경과는 급성 간질성 폐렴보다 비교적 양호한 것으로 기대된다. 그러므로 급격히 진행하는 호흡곤란을 호소하는 환자에게 거친 호흡음과 함께 수포음이 들리고, 방사선 검사상 양측 폐 전반에 걸쳐 현저한 간유리 음영이 있을 경우 조직소견을 바탕으로 급성 간질성 폐렴이나 다른 간질성 폐질환을 감별진단하고 치료방법을 결정하고 병의 경과 및 예후를 예측할 수 있다.

• Tuberculosis and Respiratory Diseases
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• 제61권5호
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• pp.473-478
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• 2006

저자들은 폐암 및 항암치료에 의한 만성 질환으로 유발된 중등도의 빈혈이 있어 농축적혈구의 수혈치료 후 발생한 호흡곤란 및 발열 호소하여 다른 원인 감별 후 수혈에 의해 유발된 급성 폐 손상 진단하에 대증치료후 환자의 증상은 호전되었다. 이러한 수혈에 의해 유발된 급성 폐 손상은 그간 국내에서 보고 된 적이 없었던 증례로 이를 문헌 고찰과 함께 보고하는 바이다.