• Title/Summary/Keyword: 류마티스성 질환

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A Clinical Study on the Surgical Treatment of the Rheumatic Cardiac Valve Disease (류마티스성 심장판막질환의 외과적 치료에 대한 임상적 연구)

  • 김종원;정황규;이성광;김병준;신영우
    • Journal of Chest Surgery
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    • v.31 no.4
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    • pp.346-352
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    • 1998
  • Rheumatic valvulitis produces at least three distinct pathologic changes, the degree varying widely among the patients: fusion of the valve leaflets at the commissures; fusion and shortening of chordae tendinae: and fibrosis of the leaflets with subsequent stiffening, contraction and calcification. The most extensive changes usually are seen in patients with recurrent attacks of rheumatic fever. We studied on outcome of the surgical treatments of rheumatic valvular diseases that have been experienced for 12 years since 1982 at Pusan National University Hospital. The diagnoses were made by rheumatic fever history, echocardiographic findings, gross operative findings and microscopic findings. Total 502 patients were performed surgery for valvular heart diseases and 440 patients of rheumatic origin have bene analysed. There were more female than male patients as 1.3:1, and the mean age was 37.8 years old. 96.3% of them affected to the mitral valve, 19.8% to aortic valve, 16.3% affected to the tricuspid valve. Most of them underwent valve replacement, and valve repair was done in 3.9% of patients. There were 36 hospital deaths(8.2%) mainly from low cardiac output syndrome, and 15 late deaths equally due to embolism and hemorrhage. Follow up was 90.1% completed(2890 patient- year). Linealized rates of late complication events are follows : thromboembolism 1.3% per patient year; anticoagulant related hemorrhage 0.8% per patient year. Overall actuarial survival including hospital mortality was 92.7+/-2.9% in 1 year, 88.0+/-4.5% in 5 year, 82.3+/-7.7% in 10 year. We conclude that the rheumatic disease is still the most frequent and the most important cause of heart valve disease. So more intensive study is needed in spite of the abrupt decreasing rate of rheumatic fever in U.S.A. and other industrial country.

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Multimodal Diagnostic Approach for Synovitis of the Wrist (수근관절 활액막염 원인 질환 진단을 위한 다중적 접근법)

  • Bae, Kee Jeong;Kim, Jihyeung;Yoon, Chan;Hong, Seong Hwa;Gong, Hyun Sik;Baek, Goo Hyun
    • Journal of the Korean Orthopaedic Association
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    • v.53 no.6
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    • pp.540-546
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    • 2018
  • Purpose: The purpose of this study was to suggest a multimodal diagnostic approach to determine the cause of the disease in patients diagnosed with synovitis of the wrist and who underwent synovectomy. Materials and Methods: Twenty-nine patients, who underwent contrast magnetic resonance imaging (MRI) preoperatively and synovectomy from January 2000 to December 2013, were reviewed retrospectively. Among them, 17 patients underwent a $Tc^{99m}$ white blood cell (WBC) scan preoperatively. In patients who met the diagnostic criteria of rheumatoid arthritis (RA), the diagnosis was confirmed as RA if the MRI finding or histology was compatible with RA. If the MRI finding and histology were disparate, the final diagnosis was made based on the histologic finding. Results: Of the nine patients who met the diagnostic criteria of RA, seven patients were finally diagnosed as RA and two patients as tuberculous arthritis. Of the 20 patients who did not meet the diagnostic criteria of RA, the MRI findings and histology were consistent with the same disease in 12 patients. In the remaining eight patients, five were diagnosed with nonspecific chronic synovitis, one with RA, and two with tuberculous arthritis based on the clinical findings, MRI, and histology findings. Conclusion: MRI and a WBC scan are very useful imaging modalities for diagnosing the causative condition of the wrist synovitis. A histology evaluation after synovectomy can also be useful in cases with a difficult diagnosis or are refractory to medications.

Heart Failure by a Calcific Pericardial Ring -A case report - (식회화된 심낭 고리에 의한 심부전즙 - 1예 보고)

  • Hong Seong-Beom;Ahn Byung-Hee;Ryu Sang-Wan;Jung In-Suk;Kim Sang-Hyung
    • Journal of Chest Surgery
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    • v.38 no.9 s.254
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    • pp.648-651
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    • 2005
  • Calcific constrictive pericarditis is considered to be a nonspecific response to chronic inflammation. This disease has become rare, because the cause of it is usually tuberculosis, which has the tendency to decrease. Other possible causes of it include radiation, rheumatoid disorders, sarcoidosis, and trauma. Whatever the etiology, it can lead to cardiac tamponade by reducing cardiac diastolic filling. We report, herein, the case of a patient with heart failure by a calcific pericardial ring.

Improvement Effect of the Eucommia ulmoides Extracts on CIA-induced Rheumatoid Arthritis Animal Models (두충 추출물의 류마티스관절염 동물모델에 대한 개선 효과)

  • Ji, Joong-Gu
    • Journal of the Korean Applied Science and Technology
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    • v.39 no.1
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    • pp.18-26
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    • 2022
  • The present study aimed to evaluate the effect of Eucommia ulmoides extracts on rheumatoid arthritis biomarker in a CIA-induced DBA/1 mice. For evaluation, Eucommia ulmoides extracts was administered orally at dose of 100 mg/kg/day for 4 weeks after production of an animal model of rheumatoid arthritis and we confirmed the treatments' effects based on serum biomarker, radiological, structural parameter analysis. Compared to the negative control group, the Eucommia ulmoides extracts treatments significantly reduced the serum level of inflammation and immunoglobulin markers (i.e., TNF-α, IgG, and hs-CRP), and significantly decreased the monocyte count of white blood cells. Furthermore, the Eucommia ulmoides extracts treatments effectively preserved the joint destruction, and little the joint deformation. Moreover, compared to the negative control group, the Eucommia ulmoides extracts treatments increased the bone volume, and significantly decreased bone inflammation. The results indicate that the Eucommia ulmoides extracts improved rhrumatoid arthritis symptoms. Thus, the Eucommia ulmoides extracts may be a novel therapeutic option for the management of rheumatoid arthritis.

Inhibitory Effect of Deer Antler Aqua-acupunture (DAA) on Cathepsin S Activity and Rheumatoid Arthritis in Rats (생쥐에서 녹용약침액이 자가항원제시형 Cathepsin S 활성의 저해와 류마티스 관절염 억제에 미치는 효과)

  • Abn, Hyung-jun;Kim, Kap-sung
    • Journal of Acupuncture Research
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    • v.20 no.3
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    • pp.104-116
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    • 2003
  • 목적 : 시스테인 단백분해 효소인 cathepsin는 인간과 생쥐의 항원제시세포에서 II형 주적합항원 불변사슬(MHC class II invariant chain)의 분해에 관여한다. 본 연구는 녹용 약침액이 류마티스 관절염 생쥐 모델의 골조직(연골과 활액) 유래 cathepsin 활성에 미치는 영향을 검정하였다. 방법 : 관절염 동물모델은 BALb/c계 생쥐를 생후 3일에 흉선 적출(3d-Tx)을 하여 만들었다. 동물모델의 골조직, 임파절세포, 비장 등을 녹용처치군과 대조군으로 나누어 cathepsin의 활성도 및 자가항원 특이(C-II-specific) T-세포의 활성도를 비교 분석하였다. 결과 : 각 장기에서 cathepsin S의 활성은 녹용약침 처치군에서 농도 의존적으로 유의성 있게 억제되었고, T-세포 특이 자가항원반응은 녹용약침 처치군의 임파절 세포에서 유의성있게 억제되었다. 그리고 T-세포 특이 자가항원 반응의 불활성화에는 녹용 10~20ug/ml의 용량으로 충분하였다. 결론 : 이러한 실험결과는 녹용 약침액이 cathepsin S를 선택적으로 억제시켜 류마티스 관절염과 같은 자가면역 질환에 유효한 치료약물로 사용될 수 있음을 시사한다.

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Case Report : Temporomandibular Joint Involvement in Rheumatoid Arthritis (증례보고: 류마티스 관절염 환자에서 측두하악관절의 이환)

  • Lim, Hyun-Dae;Lee, You-Mee
    • Journal of Oral Medicine and Pain
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    • v.31 no.3
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    • pp.231-236
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    • 2006
  • Rheumatoid arthritis(RA) is an of autoimmune inflammatory systemic disease. It is characterized by uncontrolled proliferation of synovial tissue and a wide array multisystem comorbidities. The disease may involve any joint of the body, but often statrs in the peripheral joints. It was reported that more than 50% of RA patients exhibit clinical involvement of TMJ. This report is a case report of dental management and progression for 16 months in patients who had severe bony change in TMJ involved rheumatoid arthritis Dental management was included palliative treatment such as interocclusal splints, physical therapy, mouth opening exercise. Although it was progressed rapidly osteolytic bone change during follow-up, no more advanced occulsal change and improved symptom and jaw motion. Further investigations about rule of dentistry in TMJ involvement in RA maybe needed.

Mid-term Result of Operations for Atrial Fibrillation (심방세동 수술의 중기적 결과)

  • 최종범;고광표;한재오
    • Journal of Chest Surgery
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    • v.33 no.11
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    • pp.876-880
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    • 2000
  • 배경: Maze수술은 승모판 질환에 동반되는 심방세동의 효과적인 치료방법으로 알려져있다. 이 연구는 승모판 수술과 심방세동 수술을 동시에 시행한 환자에서 심방세동 수술 후 중기적인 결과와 그 재발 여부를 조사하였다. 대상 및 방법: 심방세동 수술과 승모판 수술을 받은 11예의 환자(10예는 류마티스성 승모판 질환)를 대상으로 하였다. Maze II 수술 및 그 변형수술을 6예에서 시행했고, Maze III 수술 및 그 변형수술을 5예에서 시행하였다. 심방세동 수술 후 좌심방의 수축정도를 심방세동 수술 없이 승모판 수술만으로 동율동을 얻은 경우와 비교하였다. 결과: Maze II 수술을 받은 환자 6예 중 5예(83.3%)에서, maze III 수술을 받은 환자 5예 모두에서 동율동을 회복하였다(전체적으로 90.9%). 전자의 1예(20%)와 후자의 2예(40%)에서 수술 후 각각 23, 2, 13개월만에 심방세동이 재발하였다. 그 후 다시 2예는 동율동으로 전환되었으나, 1예는 재발된 심방세동을 그대로 유지하고 있다. 변형술을 받은 3예에서는 심방세동의 재발이 없었다. Maze 수술 후 4예(40%)에서만 좌심방의 수축기능을 보였으며, maze 수술 후 좌심방 수축 정도(승모판의 A파의 속도)도 maze 수술 없이 승모판 수술과 항부정맥제 투여로 동율동을 회복한 경우보다 낮았다. 결론: 심방세동을 동반한 승모판 수술 환자에서 maze 수술로써 심방세동으로부터 동율동을 회복할 수 있으나 중기적으로 재발할 수 있으며, maze 수술 후 좌심방 수축정도는 상당히 떨어질 수 있다고 생각된다.

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A Case of ANCA-associated Pauci-immune Crescentic Glomerulonephritis in Juvenile Rheumatoid Arthritis (소아기 류마티스 관절염에서 발견된 ANCA 연관 극소면역성 반월상 사구체신염 1례)

  • Hwang You Sik;Rhie Young Jun;Ahn Sun Young;Kim Dong Soo;Lee Jae Seung;Jeong Hyun Joo
    • Childhood Kidney Diseases
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    • v.9 no.2
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    • pp.231-236
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    • 2005
  • Juvenile rheumatoid arthritis(JRA) is the most common major connective tissue disease in children. Renal involvement in JRA is rare. Among the renal lesions that have been reported in JRA, amyloidosis and drug-induced nephropathy are the most common. Crescentic glomerulonephritis in JRA has rarely been reported. We report a case of ANCA-associated pauci-immune crescentic glomerulonephritis in JRA. The patient was a 15-year old boy with a 3-year history of JRA. He presented with gross hematuria, proteinuria, positive p-ANCA and elevation of BUN and creatinine. Pathologic findings revealed focal necrotizing and crescentic glomerulonephritis. There were no significant immunoglobulin or complement deposits. His renal function recovered after intravenous methylprednisolone pulse therapy and oral steroid use. In Korea, this is the first reported case of pauci-immune crescentic glomerulonephritis in JRA. (J Korean Soc Pediatr Nephrol 2005;9:231-236)

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Occlusion of the Right Coronary Artery Ostium due to Rheumatic Aortic Valve Stenosis (류마티스성 대동맥 판막협착증에 의한 우관상동맥 개구부 폐쇄)

  • Seo, Hong-Joo;Oh, Sam-Se;Kim, Jae-Hyun;Kim, Soo-Cheol;Na, Chan-Young
    • Journal of Chest Surgery
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    • v.40 no.6 s.275
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    • pp.445-447
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    • 2007
  • Occlusion of a coronary artery ostium and especially occlusion of the right by an aortic cusp is a rare condition. We experienced an adult patient with occlusion of the right coronary ostium that was due to fusion of the right coronary cusp to the aortic wall along with underlying rheumatic aortic valve stenosis. During the operation, the adherent right coronary cusp was excised. After confirming that the right coronary ostium was patent, the other cusps were removed, and this followed by replacement of the aortic valve with a mechanical valve. The postoperative course was uneventful.

A case of mixed connective tissue disease presenting initially with Raynaud's phenomenon (레이노드 증후군으로 초기 발현된 복합 교원성 질환 1예)

  • Kim, Soo Young;Choi, Young Seok;Kim, Young Ok;Woo, Young Jong
    • Clinical and Experimental Pediatrics
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    • v.51 no.8
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    • pp.886-891
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    • 2008
  • Mixed connective tissue disease (MCTD) is characterized by diverse symptoms including rheumatoid arthritis, scleroderma, systemic lupus erythematosus, and dermatomyositis, associated with high titers of antibodies to extractable nuclear antigen (ENA), especially anti-ribonucleoprotein (anti-RNP) antibody. Since the first report of 25 cases with MCTD in adults, there have been only a few cases of MCTD reported in children. Here, we report a rare childhood case of MCTD in a 7-year-old girl presenting initially with Raynaud's phenomenon, swollen hands, and ulceration of the right index finger tip followed by alopecia and arthritis during follow-up.