• Clinical and Experimental Pediatrics
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• 제59권sup1호
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• pp.99-102
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• 2016

Tubulointerstitial nephritis and uveitis (TINU) syndrome is a rare disease, often underdiagnosed or misdiagnosed in children. We describe the case of a 12-year-old boy who presented to Severance Hospital with a 1-month history of bilateral conjunctival injection. He was first evaluated by an Ophthalmologist in another hospital and diagnosed with panuveitis. Laboratory tests indicated renal failure, and a renal biopsy confirmed the diagnosis of acute tubulointerstitial nephritis. An extensive exclusion of all possible causes allowed a diagnosis of TINU syndrome. The patient was treated with a systemic corticosteroid (initially prednisolone, 2 mg/kg and later deflazacort 1 mg/kg) and topical steroid drops for 1 month. Azathioprine was later added to the treatment regimen and the systemic steroid was slowly tapered. The final outcome of renal-ocular disease was favorable in the patient. However, long-term follow-up is necessary to properly manage frequent relapses and incomplete renal recovery. TINU should be considered as a differential diagnosis in children with uveitis or acute renal failure.

• 한국수정란이식학회지
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• 제28권2호
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• pp.157-162
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• 2013

Methoxychlor (MXC) was developed to be a replacement for the banned pesticide DDT. HPTE [2,2-bis (p-hydroxyphenyl)-1,1,1-trichloroethane], which is an in vivo metabolite of MXC, has strong oestrogenic and anti-androgenic effects. MXC and HPTE are thought to produce potentially adverse effects by acting through oestrogen and androgen receptors. Of the two, HPTE binds to sex-steroid receptors with greater affinity, and it inhibits testosterone biosynthesis in Leydig cells by inhibiting cholesterol side-chain cleavage enzyme activity and cholesterol utilisation. In a previous study, MXC was shown to induce Leydig cell apoptosis by decreasing testosterone concentrations. I focused on the effects of MXC on male mice that resulted from interactions with sex-steroid hormone receptors. Sex-steroid hormones affect other organs including the kidney and liver. Accordingly, I hypothesised that MXC can act through sex-steroid receptors to produce adverse effects on the testis, kidney and liver, and I designed our experiments to confirm the different effects of MXC exposure on the male reproductive system, kidney and liver. In these experiments, I used pre-pubescent ICR mice; the puberty period in ICR mice is from postnatal day (PND) 45 to PND60. I treated the experimental group with 0, 100, 200, 400 mg MXC/kg b.w. delivered by an intra-peritoneal injection with sesame oil used as vehicle for 4 weeks. At the end of the experiment, the mice were sacrificed under anaesthesia. The testes and accessory reproductive organs were collected, weighed and prepared for histological investigation. I performed a chemiluminescence immune assay to observe the serum levels of testosterone, LH and FSH. Blood biochemical determination was also performed to check for other effects. There were no significant differences in our histological observations or relative organ weights. Serum testosterone levels were decreased in a dose-dependent manner; a greater dose resulted in the production of less testosterone. Compared to the control group, testosterone concentrations differed in the 200 and 400 mg/kg dosage groups. In conclusion, I observed markedly negative effects of MXC exposure on testosterone concentrations in pre-pubescent male mice. From our biochemical determinations, I observed some changes that indicate renal and hepatic failure. Together, these data suggest that MXC produces adverse effects on the reproductive system, kidney and liver.

• 대한후두음성언어의학회지
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• 제14권1호
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• pp.40-46
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• 2003

Background and Objectives : The vocal fold granuloma has been associated with vocal abuse, gastroesophageal reflux, endotracheal intubation and habitual throat clearing etc.. Granuloma is benign growth of hypertrophic granulation tissue. It is usually located on the posterior third of vocal fold, in one or both vocal process of the arytenoid cartilage In spite of the voice therapy, steroid therapy, anti-reflex therapy and surgical procedure. The distinct advantage and uniform success rate of each methods have not been generally shown. Authors report that localized injection of botulinum toxin type A (BOTOX$^{\circledR}$) is the promising method both as an initial treatment and as an alternative treatment in patients who do not respond to standard therapy or who are poor surgical candidates. Materials and Method : We carried out a retrospective study of 9 patients with the diagnosis of vocal fold granuloma on the videostroboscopic examination from Jan 2000 to Mar 2003. The botulinum toxin type A was injected into one or both thyroarytenoid muscle or lateral cricoarytenoid muscle under the electromyography. The average dosage ranges from 6U to 8U per injection. Results : Unilateral vocal fold granuloma in 7 patients had been resolved completely within 2-3 months after first injection : 5 patients received th\ulcorner GER medical therapy in addition to the Botulinum toxin injections, 2 patients was resolved completely who had shown recurrence after $CO_2$ laser vaporization. 2 patients who had shown recurrence after $1^st$ injection were also completely resolved within 6 months after further injections. Conclusion : We expect that localized injection of Botulinum toxin type A can provide an alternative treatment for the refractory cases to the traditional forms of therapy and avoid the recurrence in conjunction with proper medical and voice therapy against GER and vocal abuse.

• Clinical and Experimental Reproductive Medicine
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• 제21권3호
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• pp.305-314
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• 1994

19-norandrostenedione(19-NORA) is known as an intermediate in the metabolic pathway from androstenedione to estrone. Administration of esterified 19-nortestosterone, anabolic steroid, reduces serum gonadotropin and testosterone concentration, and results in reversible azoospermia in men. 19-NORA have been isolated from testis, but its function in testis is not clear yet. Therefore, this study was designed to determine the effect of 19-NORA on steroidogenesis and on spermatogenesis. 19-NORA was administrated by single intratesticular injection to adult male rats weighing 350-400 g in dose of 1 mg/50${\mu}l$. The serum and testis were collected on 1, 3, 7, 12, 48 hr after injection. The histological differences in testis were observed by routine paraffin method. The concentrations of testosterone and estradiol in serum and in left testis were determined by the conventional radioimmunoassays. One hour after 19-NORA treatment, serum concentrations of testosterone and estradiol increased significantly, compared to those of pre-treated(0 hr) group, and reduced gradually to the control level on 7 hour after injection. The concentration of testosterone in left testis increased slightly 1 hour after injection, and estradiol level increased significantly(p<0.05). Also, testosterone and estradiol level of control group revealed no difference with pre-treated (0 hr) group. Gonad index, structure of seminiferous tubules, and the number of step 7 th spermatid were simillar to control group. The present study suggests that the elevation of testosterone level results from increment of estradiol followed by the rapid metabolism of 19-NORA at 7 hour after injection, and then testosterone concentration may be recovered to control level by feedback mechanism of hypothalamus-hypothysis-testis axis.

• 대한두개안면성형외과학회지
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• 제23권4호
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• pp.183-186
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• 2022

Plastic surgery around the eyes is usually performed under local anesthesia, using a mixture of lidocaine and epinephrine. Blindness is a rare but devastating complication after the injection of local anesthesia in this region. Most cases reported to date have been caused by occlusion of the ophthalmic artery or central retinal artery. In this case report, however, we present a highly unusual case of blindness caused by corneal edema after a local anesthetic injection. A patient visited the emergency room with a laceration on the eyebrow, and local anesthesia was injected before suturing. Immediately after the injection, severe corneal edema developed, making it impossible to observe the structures in the anterior chamber in detail or check the light reflex and visual acuity of the naked eye. An antibiotic (moxifloxacin hydrochloride) and high-concentration steroid eyedrops were promptly applied. High-concentration steroids were also administered orally. On day 13 post-injury, the visual acuity of the naked eye improved to 1.0, and no recurrence of corneal lesions was observed. Although the cause of corneal edema after the local injection could not be conclusively identified, we hope that this report will help raise clinicians' awareness of this complication and appropriate treatment methods.

• 대한정형외과 초음파학회지
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• 제5권1호
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• pp.9-14
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• 2012

목적: 유착성 관절낭염 환자에서 초음파를 이용한 관절와 상완 관절강 내 스테로이드 주사를 시행한 후 주사요법의 정확성이 임상적 결과에 미치는 영향을 평가하고자 하였다. 대상 및 방법: 임상적으로 유착성 관절낭염으로 진단받은 환자들 중 외상이 없고, 약물 치료 및 물리 치료를 받았으나 만족할 만한 호전을 보이지 않은 환자를 대상으로 하였다. 환자들은 총 33명으로 남자 15명, 여자 18명으로 평균 연령은 55.1세(42~72세)였다. 이를 대상으로 견봉 쇄골 접근법을 통해 스테로이드 칵테일 10 ml(triamcinolone 1 ml(40 mg/ml), lidocaine 4 ml(2%), normal saline 5 ml)와 조영제 5 ml ($Telebrix^{(R)}$, Guerbet, France)를 주입하였으며, 이후 바로 방사선 촬영을 시행하여 주사의 견관절 관절강 내 주입 여부를 확인하였다. 또한 조영제가 관절강내로 정확히 들어간 경우, 부분적으로 들어간 경우 그리고 조영제가 관절강 바깥으로 들어간 경우로 3군으로 분류하여 각각의 군에서 주사요법 전, 후 수동적 운동범위 및 VAS score를 이용한 통증 완화 정도를 분석하였다. 결과: 총 33례 중 25례(76%)에서 조영제가 정확히 관절강 내로 주입되었음을 확인하였다. 6례(18%)에서는 관절강에 부분적으로 조영제가 관찰되었고, 2례(6%)에서는 조영제가 관절강 바깥에서 관찰되었다. 조영제가 관절강내로 정확히 들어간 군은 시행 전 굴곡은 평균 111도(80~140도), 외회전은 48도(0~90도)였고, 시술 후 굴곡은 평균 134도(90~150도), 외회전은 70도(30~90도)로 호전되었다(p<0.01). 그리고 조영제가 관절강내로 부분적으로 들어간 군은 시행 전 굴곡은 평균 120도(90~150도), 외회전은 70도(10~90도)였고, 시술 후 굴곡은 평균 139(135~140도)도, 외회전은 78도(50~90도)로 호전된 결과가 관찰되었다(p<0.01). 조영제가 관절강 바깥으로 들어간 군은 환자수의 부족으로 통계적으로 의미를 갖지 않았다. 시술 전, 후 VAS 점수의 변화는 조영제가 관절강 내로 정확히 들어간 군은 7.1점(3~9점)에서 2.6점(0~5점)으로 호전되었고(p<0.01), 부분적으로 들어간 군은 7.5점(7~9점)에서 3.3점(2~4점)으로 호전되었고(p<0.01), 관절강 바깥으로 들어간 군은 7.5점에서 2점으로 호전되었다. 또한 당뇨 환자군과 비 당뇨 환자군을 비교한 결과 임상적 결과에 통계적으로 유의한 차이가 없이 모두 호전되었다. 결론: 유착성 관절낭염 환자에서 초음파 하에 견봉 쇄골 접근법을 통한 견관절 관절강 내 스테로이드 주사는 기존의 방법들보다 좋은 정확도(94%)를 보고하였으며, 이 중 관절강 바깥으로 새어나간 군과 새어나가지 않은 군 간에는 임상적으로 유의한 차이가 발견되지 않았다.

• The Korean Journal of Pain
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• 제18권1호
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• pp.15-18
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• 2005

Background: Epidural steroid injections (ESI) have been used widely for the treatment of back and radiating extremity pain. Although its effects on the metabolic and endocrine system have been studied, the effects following repeated injections remain to be determined. We studied the effects of three repeated caudal epidural injections of low dose triamcinolone. Methods: the subject were 10 elderly women with spinal stenosis. Caudal epidural injections were performed biweekly. Triamcinolone (20 mg), mixed with 15 ml of 0.25% lidocaine, was used as the ESI injectate. The procedures were performed with the patient in the prone position. Blood sampling was performed just before the first injection, and used as the baseline, and then just before each injection on the same day of the 2nd and 4th weeks, with the last samples taken 2 weeks after the third injection. Results: The blood glucose concentrations showed no significant changes. The blood cortisol and ACTH concentrations were significantly decreased after the first injection, but there were no further decreases after each of the subsequent injections. The cortisol concentrations were maintained within the normal range. Conclusion: Caudal epidural injections, with low dose triamcinolone, suppressed the hypothalamus-pituitary-adrenal (HPA) axis, but no further suppression followed the subsequent repeated injections. Three consecutive caudal injections at 2 week intervals seems to be a safe procedure.

• 한국발생생물학회지:발생과생식
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• 제12권3호
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• pp.261-266
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• 2008

연어과 어류인 열목어 재조합 생식선자극호르몬(r-mtFSH 또는 r-mtLH) 투여에 따른 암컷 뱀장어(Anguilla japonica)의 성성숙 유도 효과를 조사하였다. 양식산 암컷 뱀장어를 해수에 적응시킨 후 매주 복강에 재조합 호르몬을 농도별(0.1, 1, 10 ${\mu}g/m{\ell}$/fish)로 10주 반복 주사하였다. 매주 증체중을 측정하였고, 생식소중량지수 [GSI;(생식소중량/체중량$\times$100]와 혈중 성호르몬 농도 변화를 조사하였다. 그 결과, 모든 실험군에서 GSI는 서서히 감소하는 경향을 나타내었다. 또한, 대조구에서 혈중 testosterone (T)과 estradiol-17$\beta$(E2)는 유의적인 증가를 보이지 않았지만, 재조합 호르몬을 투여한 실험군에서 투여2주와 4주 후에 T와 E2 농도가 증가하였다. 또한, mt-rFSH(1, 10 ${\mu}g/m{\ell}$/fish) 또는 mt-rLH(0.1, 1, 10 ${\mu}g/m{\ell}$/fish)을 투여한 실험군에서는 난경이 대조구에 비해 유의하게 증가하였다. 이러한 결과는 열목어 재조합 생식선자극호르몬이 암컷 뱀장어의 초기 난성숙 발달을 유도함을 시사한다.

• The Korean Journal of Pain
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• 제27권4호
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• pp.353-359
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• 2014

Background: Epidural steroid injections are an accepted procedure for the conservative management of chronic backache caused by lumbar disc pathology. The purpose of this study was to evaluate the epidurographic findings for the midline, transforaminal and parasagittal approaches in lumbar epidural steroid injections, and correlating them with the clinical improvement. Methods: Sixty chronic lower back pain patients with unilateral radiculitis from a herniated/degenerated disc were enrolled. After screening the patients according to the exclusion criteria and randomly allocating them to 3 groups of 20 patients, fluoroscopic contrast enhanced epidural steroids were injected via midline (group 1), transforaminal (group 2) and parasagittal interlaminar (group 3) approaches at the level of the pathology. The fluoroscopic patterns of the three groups were studied and correlated with the clinical improvement measured by the VAS over the next 3 months; any incidences of complications were recorded. Results: The transforaminal group presented better results in terms of VAS reduction than the midline and parasagittal approach groups (P < 0.05). The epidurography showed a better ventral spread for both the transforaminal (P < 0.001) and the paramedian approaches (P < 0.05), as compared to the midline approach. The nerve root filling was greater in the transforaminal group (P < 0.001) than in the other two groups. The ventral spread of the contrast agent was associated with improvement in the VAS score and this difference was statistically significant in group 1 (P < 0.05), and highly significant in groups 2 and 3 (P < 0.001). In all the groups, any complications observed were transient and minor. Conclusions: The midline and paramedian approaches are technically easier and statistically comparable, but clinically less efficacious than the transforaminal approach. The incidence of ventral spread and nerve root delineation show a definite correlation with clinical improvement. However, an longer follow-up period is advisable for a better evaluation of the actual outcom.

• Journal of Korean Neurosurgical Society
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• 제30권5호
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• pp.638-641
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• 2001

Carboplatin intra-arterial chemotherapy(IAC) has an advantage of increased uptake during the first passage of the drugs through tumor capillaries. Although not common, this type of therapy is known to cause neurological complications, myelosuppression, and ototoxicity. However, the incidence of ocular toxicity is reported to be rare. Eleven of our patients with glioma(Grade II Astrocytoma : 3, Grade III Astrocytoma : 1, Grade IV Astrocytoma : 5, Gliofibroma : 1, Oligodendroglioma : 1) underwent IAC regimen with carboplatin($300mg/m^2$) which were administrated after blood-brain barrier disruption. Of there, 3 patients had ocular complications after supra-ophthalmic IAC injection of carboplatin but fully recovered following steroid therapy. Although our results from IAC seem to be favorable for these patients, we suggest that its complications, such as ocular toxicity, need to be carefully considered prior to treatment.