• 제목/요약/키워드: Chronic Patients

검색결과 5,210건 처리시간 0.034초

중증 근무력증 진단에 있어서 제반 검사법들의 유용도 비교 (Comparison of Usefulness of Laboratory Tests in Diagnosis of Myasthenia Gravis)

  • 박승권;도현철;김민정;이승엽;박미영;하정상;김욱년;이준
    • Journal of Yeungnam Medical Science
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    • 제15권1호
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    • pp.125-134
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    • 1998
  • 1993년 1월 1일부터 1995년 6월 30일 까지 영남대학교 의과대학 부속병원 신경과에 중증 근무력증 증상을 주소로 내원한 환자 중 21명에게 텐실론검사, 반복신경자극검사, 단일근섬유 근전도 검사 및 아세틸콜린 수용체에 대한 항체 측정 검사 모두를 시행하여 각 검사의 양성률을 구하여 비교하였다. 텐실론검사에서는 양성률이 95%였고, 반복신경자극검사상 최초 한 근육이상에서 양성률을 보인 경우가 67%였고 근육별로는 안윤근에서 67%, 척측수근굴근에서 38%, 소지외전근에서 43%로 원위근육에 비해 안윤근에서 더 높은 양성률을 보였으나 통계학적인 유의성은 없었다. 한편 단일근 섬유 근전도검사, 아세틸콜린 수용체에 대한 항체 측정 양성률은 각각 87%, 76%로 텐실론검사에서 양성률이 가장 높았고, 안형에서 시행한 반복신경자극검사에서는 양성률이 45%로 가장 낮았다. 또 각각의 검사들을 안형군과 전신형으로 나누어 양성률을 비교하였을 때 모두 안형에 비해 전신형에서 양성률이 증가된 소견을 보였으나 반복 신경자극검사에서만 유의성있게 양성률이 증가하였고(p<0.05) 나머지 검사들에서는 통계학적 유의성이 없었다. 이상의 결과로 볼 때 중증 근무력중 증상이 보이는 환자에게서 우선적으로 양성률이 가장 높은 텐실론검사를 먼저 실시한 후, 반복신경자극검사와 함께 특이성을 높일 수 있도록 아세틸콜린 수용체에 대한 항체를 측정하고, 비교적 양성률이 낮은 안형에서는 단일근섬유 근전도검사를 같이 시행하면 중증 근무력증에 대한 확진률을 높일 수 있으리라고 사료된다.

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저염식으로 유도한 Cyclosporine 신독성 백서에서의 치은 변화 (Comparative Study of Gingival Changes in Cyclosporine-Induced Nephrotoxicity with Normal and Low Salt Diet)

  • 임재계;김용진;박용훈
    • Journal of Periodontal and Implant Science
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    • 제30권2호
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    • pp.359-374
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    • 2000
  • Cyclosporine A(CsA) is a widely used immunosuppressant for transplant patients and is also used for the treatment of a wide variety of systemic diseases with immunologic disorders. However, its use is frequently limited because of complications such as nephrotoxicity or gingival hyperplasia. Although several hypotheses have been postulated for CsA-induced gingival hyperplasia, i.e. various cytokine effects of inflammatory cells, existence of plaque or CsA itself, but its pathogenesis is still unclear. For experimental chronic CsA toxicity, salt depletion has been shown to increased susceptibility of rodents to the effects of CsA, and this maneuver facilitates production of arteriolopathy and interstitial fibrosis in kidney that mimic the changes found in human. The purpose of this study was to evaluate pathogenesis of CsA-induced gingival hyperplasia by comparing changes between CsA administration groups of normal standard diet and those of low salt diet group. Specific pathogen-free, 20 to 25 days old(120 to 150 g), male Fisher-344 rats(KIST, Korea), 120 to 150g of body weight, were assigned to four groups of six animals each after one week of adaptation period for powder food. Group 1 received olive oil($300{\mu}l/g\;of\;diet$) with normal standard diet(0.4% of sodium)(NSD). Group 2 received CsA(Cypol-N, Jonggundang, Korea; $300{\mu}g/g\;of\;diet$) with normal standard diet(NSD+CsA). Group 3 received same amount of olive oil with low salt diet(0.05 % of sodium, Teklad Premier, U.S.A.)(LSD). Group 4 received same dose of CsA with low salt diet(LSD+CsA). Rats were pair fed and were sacrificed after six weeks. Renal histologic lesions associated with CsA, consisted of cortical interstitial fibrosis, tubular atrophy and hyalinization of arterioles and the impairment of renal function including increase of serum creatinine and decrease of glomerular filtration rate was more severe in low salt diet group. These were proved as the results of activated of renin-angiotensin system in the kidney by low salt condition. Meanwhile the degree of gingival hyperplasia at incisor and molar tooth was less severe in low salt diet group compared with normal sodium diet group. Hyperplastic gingiva showed mild epithelial hyperplasia and expanded underlyng stroma which consisted of matrix increasement, capillary proliferation and dilatation. While the number and the activation of fibroblasts were increased, inflammatory cells were rare in the stroma. The immunohistochemistry for TGF-${\beta}_1$ in the kidney and gingiva revealed stronger positive in LSD+CsA in kidney but in gingiva of NSD+CsA. These results suggested followings; Gingival hyperplasia can be developed without inflammatory cells infiltration and seemed not induced by CsA by itself. The major role for gingival hyperplasia by CsA would be the secondary effect of TGF-${\beta}$, which maybe upregulated by CsA administration. Low salt diet can attenuate this hyperplasia perhaps by decreasing the activation of $TGF-{\beta}$.

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치근활택술과 치은박리소파술 후 치아동요도 변화에 관한 연구 (Clinical Evaluation of Tooth Mobility Following Root Planing and Flap Operation)

  • 방은경;채중규;김종관;조규성
    • Journal of Periodontal and Implant Science
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    • 제29권4호
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    • pp.893-914
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    • 1999
  • Tooth mobility may be the decisive factor that determines whether dental treatment of any kind is undertaken. Although tooth mobility in isolation says little in itself, the finding of increased tooth mobility is of both diagnostic and prognostic importance. Only the detection of an increase or decrease in mobility makes an evaluation possible. Thus prior to treatment, we must understand the pathologic process causing the observed the tooth mobility and decide whether the pattern and degree of observed tooth mobility is reversible or irreversible. And then it must be decided whether retention and treatment or extraction and replacement. The purpose of this study was to compare tooth mobility at different time period during root planing and flap operation and to relate changes in mobility to each treatment method. Twenty-one patients (287 teeth) with chronic adult periodontitis were treated with root planing(control group) and flap operation(experimental group), and each group was divided 3 subgroups based upon initial probing pocket depth (1-3mm, 4-6mm, 7mm and more). Tooth mobility was measured with $Periotest^{(R)}$ at the day of operation, 4 days, 1 week, 2 weeks, 3 weeks, 4 weeks, 8 weeks, 12 weeks after each treatment. Tooth mobility, attachment loss, radiographic bone loss, and bleeding on probing were measured at the day of operation, 4 weeks, 8 weeks and 12 weeks after treatment. 1. In group initial probing depth was 1-3mm, tooth mobility had no significant difference after root planing and flap operation. 2 . In group initial probing depth was 4-6mm, 7mm and more, tooth mobility had decreased in 12 weeks after root planing(p<0.01). And the mobility had increased after flap operation(p<0.01) and was at peak in 1 week, and decreased at initial level in 4 weeks, below the initial level in 12 weeks(p<0.01). 3. In 1 week, significant difference in tooth mobility between control and experimental group was found(p<0.01) but, in 12 weeks no difference between two groups was found. 4. Change of immediate tooth mobility after treatment was more larger in deep pocket than in shallow one. In group with the same probing pocket depth, the change of tooth mobility in molar group was greater than that of premolar group. 5. Tooth mobility before treatment was more strongly correlated with radiographic bone loss (r=0.5325) than probing depth, attachment loss and bleeding on probing, in 12 weeks after treatment, was more strongly correlated with attachment loss($r^2$=0.4761) than probing depth and bleeding on probing. Evaluation of the treatment effect and the prognosis after root planing and flap operation were meaningful on tooth initial probing depth 4mm and more. After flap operation, evaluation of the prognosis should be performed at least in 4 weeks and in 12 weeks after treatment, no difference in tooth mobility between two groups was observed. Radiographic bone loss and attachment loss were good clinical indicators to evaluate tooth mobility.

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수질(水蛭)의 제법(制法)에 따른 BEAS-2B 인간(人間) 기관지상피세포(氣管支上皮細胞)의 염증유발성(炎症誘發性) Cytokines 발현(發顯)에 미치는 영향(影響) (A Study the Effects of Three Preparations of Hirudo on the Expression of Pro-inflammatory Cytokines in Human Bronchial Epithelial Cells Line BEAS-2B)

  • 정희재;정승기;이형구;한동하
    • 대한한방내과학회지
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    • 제25권4호
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    • pp.260-273
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    • 2004
  • Backgrounds : In recent years, asthma has become recognized as a chronic inflammatory disease associated pathologically with airway epithelial inflammation and airway remodeling. Objectives : To evaluate the different effects of Hirudo depending upon pharmaceutical manufactures on the expression and the activities of IL-6 and GM-CSF in airway epithelial cells, samples of Hirudo(水蛭), Hirudo toasted with Talcum(水蛭滑石炒) and Hirudo toasted with Ephedrae Herba(水蛭麻黃炒) were tested. Methods : After inducing enhanced messenger RNA(mRNA) expression and secretion of each cytokine by tumor necrosis factor-alpha(10 ng/ml) treatment, cultured human bronchial epithelial cell line BEAS-2B was added to each sample$(l,\;10,\;100\;&\;1000\;{\mu}g/ml)$. Subsequently, DNA activities were analyzed. Specifically mRNA expression and culture supernatants(protein levels) of IL-6 and GM-CSF from BEAS-2B cells, were analyzed using luciferase reporter gene assay, reverse transcription-polymerase chain reaction(RT-PCR) analysis and enzyme-linked immunosorbent assay. Results : Hirudo toasted with Ephedrae Herba(水蛭麻黃炒) and Hirudo(水蛭) inhibited IL-6 activities in BEAS-2B cells remarkably, and inhibited mRNA expression levels and protein levels in supernatant of IL-6 and GM-CSF at various concentrations, significantly(p<0.05). However, Hirudo toasted with Talcum(水蛭滑石炒) had no effect on mRNA expression levels and showed a slight inhibitory effect on GM-CSF protein levels in supernatant of culture medium. Conclusions : These results strongly suggest that Hirudo toasted with Ephedrae Herba(水蛭麻黃炒) and Hirudo(水蛭) would be serve as effective medicaments in the treatment of airway inflammation and remodeling of asthmatic patients.

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궁부문합 선행법에 의한 대동맥 전궁치환술의 단기 임상 성적 (The Short Term Results of the Total Aortic Arch Replacement with Arch First Technique)

  • 우종수;김시호;방정희;이길수;최필조;조광조
    • Journal of Chest Surgery
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    • 제37권11호
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    • pp.903-910
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    • 2004
  • 배경: 대동맥궁부치환술은 경우에 따라 필요한 수기이지만 사망률이 높은 어려운 수술 중 하나이다. 쇄골하동맥관류를 통한 저체온 순환정지하에 궁부문합선행법이 안전한 방법으로 제시되고 있어 이에 대한 단기 성적을 알아보고자 하였다. 대상 및 방법: 2003년 2월부터 2004년 7월까지 급성대동맥 박리증 11명, 만성박리성대동맥궁류 3명, 및 동맥경화성 대동맥궁류 4명을 궁부문합선행법에 의한 전궁치환술을 시행하였다. 이들의 성비는 남자 10명, 여자 8명이었고 평균연령은 59.3$\pm$12.9세이었다. 결과L 평균 입원일은 20.2$\pm$7.4일이었고 저심박출증으로 조기사망이 한 명, 수술과 무관한 뇌출혈로 술 후 24일째 한 명이 사망하였다. 나머지는 평균 180$\pm$156.3일째 특별한 문제없이 외래 경과 추적 중이다. 결론: 쇄골하동맥관류법에 의한 궁부치환선행법은 대동맥궁치환에 우수한 방법으로 수술 사망률을 낮추는데 기여할 것이며 이를 적극적으로 활용하여 궁부와 원위하행대동맥 병변을 확실하게 교정하여 이차 수술로 인한 위험을 감소시키는 것이 바람직하다고 생각된다.

Helicobacter pylori 감염 환자에서 Western blot 법에 의한 혈청내 세포독성 유전자의 발현에 관한 연구 (Diagnostic Significance of Cytotoxic Genes Expression by Western blotting of Serum in Helicobacter pylori Infection)

  • 김대인;이구;서정일;이창우;김정란;하경임;이규춘;남경수;양창헌
    • 생명과학회지
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    • 제10권6호
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    • pp.630-639
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    • 2000
  • The gastric pathogen Helicobacter pylori(H. pylori) establishes long-term chronic infection that can lead to atrophic gastritis, intestinal metaplasia, and gastric cancer. H. pylori, which express cytotoxic genes is now recohnized as a cause of peptic ulcer and is also a major risk factor for the development of gastric adenocarcinoma. We performed this study 1) to assess the detection rate of H. pylori according to direct investigation of bacteria of gastric biopsy specimen and two serologic tests of GAP test and Helico blot 2.0 system in the symptomatic and non-symptomatic group 2) to evaluate and compare the efficacy of two serologic tests of GAP test and Helico blot 2.0 system for the diagnosis of H. pylori infection. Forty-nine patients were positive for H pylori infection based on direct investigation of bacteria by histology. The detection rates of H. pylori infection based on direct investigation of bacteria by histology. The detection rates of H. phlori were significantly lower in gastric cancer than in other gastroduodenal disease(p<0.05). The concordance of two serologic tests of GAP test and Helico blot 2.0 system is poor. There was no statistically significant difference between the expression rate of CagA and VacA in the symptomatic and non-symptomatic group. Although Helico blot 2.0 system may not displace GAP test, it was a very sensitive serologic test for the diagnosis of H. pylori infection and it was used to detect IgG antibodies to H. pylori-specific antigens, including CagA, VacA and the various urease subunit. Our data suggest that further investigation is needed to determine whether or not the serologic expression of cytotoxic gene may be clinical usefulness of diagnostic methods in the gastroduodenal disease.

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부인과 암 생존자와 정상 대조군의 영양소 섭취와 식사의 질(Diet Quality Index-International) 비교 - 2013~2016년 국민건강영양조사 자료이용 - (A Comparisons of Nutritional Intake and Diet Quality Index-International in Gynecological Cancer Survivors and Normal Women - Using the Korea National Health and Nutrition Examination Survey 2013~2016 -)

  • 서보영;허은실
    • 대한지역사회영양학회지
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    • 제25권5호
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    • pp.406-415
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    • 2020
  • Objectives: The aim of this study was to compare the nutritional intake and Diet Quality Index-International (DQI-I) of gynecological cancer survivors and normal women. Methods: This study compared the anthropometric indices, dietary behavior, nutritional intake, and DQI-I in women with previous history of breast or uterine cancer [Gynecological cancer survivors group (GCSG, n=126)] and normal women [Normal control group (NCG, n=7,011)] using the 2013~2016 Korea National Health and Nutrition Examination Survey data. Results: Body mass index and waist circumference were lower in the GCSG compared the NCG. The frequency of skipping breakfast and eating out was higher in the NCG compared to GCSG. Energy and fat intake were significantly higher in the NCG than in the GCSG, whereas intake of all minerals and vitamins (excluding thiamine), and dietary fiber intake were higher in GCSG. It was observed that the fatty acid intake of the GCSG was significantly lower than that of the NCG. The diet quality evaluation using DQI-I results showed that GCSG was higher in the "within-group" diet variety and adequacy of vegetable group than the NCG, whereas the intake level of the fruit group was higher in NCG. Besides, protein, calcium, and vitamin C intake were higher in the GCSG than in the NCG. The GCSG showed higher levels of total fat and saturated fat moderation than the NCG, whereas cholesterol moderation showed the opposite results. The results of DQI-I comparison according to the cancer survival years showed that the overall score and scores related to diet adequacy and balance were higher in the below 5-year group, whereas the over 5-year group scored higher in terms of moderation of diet. Conclusions: The results of this study suggest that a chronic disease based management approach is needed in cancer survivors. The study provides important data which can help in the preparation of guidelines for long-term lifestyle and diet management, in these patients.

우리나라 가정간호제도화 방안에 관한 고찰 (A Consideration on the Instituting Home Health Care in Korea)

  • 윤순녕;황나미;현혜진;최정명;권미경
    • 가정∙방문간호학회지
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    • 제2권
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    • pp.5-18
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    • 1995
  • While the socioeonomic status of Koreas has been dramatically increasing in recent years, chronic and geriatric diseases have also been on the rise, bringing about many changes in our health care system. The basic goals of the home health care are to reduce health care costs, to increase the attrition rate in general hospitals, and to care for patients effectively and conveniontly at home. The purpose of this paper is to review and examine the current status of the home health care in Korea throughout the reports, surveys, other informations and education system of home health nurse. We identified the various types of home health care services programs, such as hospital-based home health care operated in public sector(demonstration project) and community-based home health care in health centers or in private sector, that is, Korean Nurse Association. Hospital based home heatlh care model was established as an alternative to traditional in-patiet services. Quality assurance and client satisfaction is an important measure of care received and establishment of payment and reimbursement for home health care services is important in promotng the home health care. We found out a fee-per-visit system composed of three kinds of fees : a basic service fee(16,000 Won), a travel fee(5,000 Won), and per-service fees (variables). Like fees paid for in-patient care, insureds pay 20% and insurers pay 80% of the basic and per-service fee. The travel fee is borne totally by the insured. Home health care continues to be viewed as not only the most preferred way to provide care to clients, but also the most cost effective. Home health care is that component of a continuum of comprehensive health care whereby health services are provided to individuals and families in their places of residence for the purpose of promoting, maintaining, or restoring health, or of maximizing the level of independence, while minimizing illness. Services appropriate to the needs of the individual patient and family should be planned and provided, nursing is to be a force for positive change and enhanced the nursing professionalism. Whatever type of involvement of home health care, it is essential to remember that home health care is highly service-oriented and highly touch health car deilvery system.

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에탄올 및 사염화탄소의 긴 손상에 미치는 흰점박이꽃무지 추출물의 영향 (Influence of Protaetia brevitarsis Extract on Liver Damage Induced by Carbon Tetrachloride and Ethanol in Rats)

  • 이형철;황상구;강영국;손영옥;문자영
    • 생명과학회지
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    • 제11권5호
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    • pp.405-414
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    • 2001
  • 흰점박이꽃무지(Protaetia brevitarsis)는 간 질환의 치료를 위해 민간요법 뿐만 아니라 한방에서는 이용하는 전통약물로 알려져 있다. 본 연구는 사염화탄소와 에탄올로 간 손산을 유도한 흰쥐에서 흰점박이꽃무지 추출물(PBE)의 영향을 조사하였다. 사염화탄소는 이물질대사효소(cytochrome P_450, cytochrome b$_{5}$, cytochrome b$_{5}$ reductase), TBARS, 혈청 AST와 ALT, 간 무게비에서 유의한 변화가 확인되는 간독성이 유발하였으며, 에탄올은 혈청 AST와 TBARS의 변화는 유도하지 않았으나 이물질대사효소, ALT, 체중 당 무게비가 유의한 변화를 나타내었다. PBE로 전 처리한 실험군은 이물질대사효소(cytochrome P_450, cytochrome b$_{5}$, cytochrome b$_{5}$, reductase), 혈청 TBARS, AST와 ALT, 간무게비에서 어떠한 유의적인 변화도 관찰되지 않았다. 이러한결과는 적어도 이 실험조건에서는 PBE가 사염호탄소 혹은 에탄올로 유도한 간 독성에 대하여 보호 또는 회복효과가 없다고 판단된다.

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9세 소아에서 발생한 하악과두의 골수염 (Osteomyelitis of Mandibular Condyle : A Case Report in 9-year-old Child)

  • 이경은;최순정;서봉직
    • Journal of Oral Medicine and Pain
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    • 제34권3호
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    • pp.333-340
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    • 2009
  • 골수염은 골수의 염증을 의미하며 임상적으로는 골을 구성하고 있는 조직등의 염증을 포함한다. 일반적으로 골수에서 시작되어 수질내로 확장되며 피질골, 골막등에 이환되어 골 전반에 걸친 골괴사를 야기시킨다. 원인은 일반적으로 세균에 의한 감염으로 여겨지며 항생제의 발달로 그 유병율이 감소하였으나 여전히 외상, 매독, 만성 신질환, 알코올 중독, 영양결핍, 방사선 조사나 화학적 항암요법은 골의 감염을 위험하는 인자로 알려져 있다. 골수염의 치료는 비교적 까다로우며 난치성으로 진행될 가능성이 있다. 특히 소아에서는 하악구조가 성숙이 덜되어 있어 염증이 쉽고 빠르게 퍼진다. 따라서 소아에서는 골수염을 조기에 발견하고 치료하는 것이 중요하다. 또한 소아는 성장중이므로 악골의 성장 또한 고려해야 하므로 조기발견이 더욱 중요하다고 볼 수 있다. 특히 하악골중에서 하악과두는 하악골 성장의 중요한 곳으로 하악과두의 질환발생시 하악성장율감소, 안면비대칭과 같은 큰 문제를 야기할 수 있어 주의가 요구된다. 하악과두의 골수염은 대부분 치성감염이나 하악골절후의 감염으로 발생한다. 단, 소아의 경우에는 특별한 감염원인 없이 하악의 골수염이 발생했다는 보고도 있다. 이에 저자는 9세의 소아에서 뚜렷한 원인을 찾기 어려운 하악과두의 골수염을 경험하였기에 증례보고와 함께 문헌고찰을 하고자 한다.