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Mycobacterium Tuberculosis에 의한 각막염 1예
하효신,김재찬 대한안과학회 2004 대한안과학회지 Vol.45 No.2
목적 : Mycobacterium tuberculosis는 일반적으로 폐를 침범하지만, 드물게는 안구를 침범하여 심각한 감염증을 일으키기도 한다. 1예의 남자 환자에서 결핵균에 의한 각막염을 경험하였기에 이를 보고하고자 한다. 대상과 방법 : 20여 년 전부터 경부의 결핵성 임파선염으로 치료 받고 있는 48세 남자 환자가 약 9개월 전부터 시작된 우안의 각막 혼탁을 주소로 내원하였다. 세극등 현미경 검사상 주변부 각막 간질의 다발성 혼탁과 신생 혈관을 볼 수 있었으며, 자각 증상은 보이지 않았다. 수술 전에는 fortified tobramycin 점안액과 경구용 항결핵약제를 사용하였다. 국소마취 하에 병변을 제거하고 lyophilized cornea를 이용하여 lamellar keratoplasty를 시행한 뒤 양막으로 병변을 덮어주었다. 수술 후에는 amikacin 점안액을 추가로 사용하였다. 그 결과 수술 후 15일째부터 각막 혼탁이 서서히 감소하였다. 결론 : 본 예에서 알 수 있듯이 결핵의 원발성 병소를 가진 환자에게서 무통성 각막 혼탁이 나타날 경우, 결핵균에 대한 과민반응으로 나타난 간질성 각막염의 가능성을 일차적으로 생각해보아야 하며, 항결핵제를 포함한 적절한 치료가 필요할 것이다. Purpose: Mycobacterium tuberculosis usually affects the lungs, although it may involve various segments of the eye and cause severe visual loss if not treated properly. We report the case of Mycobacterium tuberculosis keratitis treated successfully with antituberculous medication and amniotic membrane transplantation. Methods: A 48-year-old male patient diagnosed as cervical tuberculous lymphadenitis about 20 years ago was referred from other hospital. He complained about painless corneal opacity on right eye. And other systemic evaluation other than cervical lymphadenitis was not remarkable. On biomicrosopy, peripheral multiple corneal opacity and neovascularization were observed. Fortified tobramycin eyedrops and oral antituberculous medication were used preoperatively. Under local anesthesia, the lesion was removed, and lamellar keratoplasty with lyophilized cornea and amniotic membrane transplantation was performed. Amikacin eyedrops was used postoperatively. Results: From postoperative day 15, corneal opacity was decreased gradually. Conclusions: Mycobacterium tuberculosis should be considered as one of the causes of keratitis manifesting painless corneal opacity concomitant with cervical tuberculous lymphadenitis. Proper examination and management are necessary.
하효신,김재찬,Hyo Shin Ha,Jae Chan Kim,Ph,D 대한안과학회 2006 대한안과학회지 Vol.47 No.2
Purpose: Ultraviolet rays, dust, and the human papilloma virus are well known as extrinsic risk factors in pterygium pathogenesis, but the intrinsic factors and nasal predominance related to the development of pterygium have not been fully ulucidated. Herein, we sought to determine whether the relative ischemic state of nasal bulbar conjunctiva affects the development of nasal predominance in pterygium pathogenesis. Methods: Anterior segment fluorescein angiography was performed and the anterior bulbar conjunctival temperature was obtained to identify the presence of nasal ischemia. Tear samples were collected from both a normal and a patient group. The difference in SDF-1 (stromal cell-derived factor-1) was determined through ELISA and Western blot anyalyses. The excised pterygium tissues were immunohistochemically stained by antibodies for HIF-1 (hypoxia-inducible factor-1), SDF-1, and CXCR4. Results: Results of the anterior segment fluorescein angiography showed that, the vascularity of the nasal limbus was lowest among each groups and the nasal filling time was significantly delayed in the patient group. The temperature of the nasal bulbar conjunctiva was lower than that of the temporal bulbar conjunctiva. The concentration of SDF-1 in tears was significantly higher in the patient group. In the immunohistochemical stain, HIF-1, SDF-1, and CXCR4 were revealed at epithelial basal cells or vascular endothelia in the stroma and the stained areas corresponded to each other. Conclusions: From the above results, we assumed that low nasal vascularity and temperature resulted in relative ischemic state and this hypoxic injury may be a major risk factor in pterygium development through the mobilization of endothelial progenitor cells by HIF-1 induced SDF-1 overexpression.
하효길(Hyo-geel Hah) 한국무속학회 2001 한국무속학 Vol.0 No.3
한국의 무속의례에서는 의식구(儀式具)로써 띠배(茅-船)와 용배(龍船)가 등장한다. 띠배는 무속의례의 마지막 절차로 바다에 띄워보내는 의식구이고, 용배는 무속의례의 제단에 장식해 놓는 의식구이다. 띠배는 다년초인 띠풀로 만들기에 붙여진 이름이고, 용배는 종이로 만든 배로서 굿청의 제단 쪽에 걸어 놓는 장식이 된다. 띠배는 현세에서의 인간의 삶을 위해 액과 질병신, 바람신 등을 태워 보내어 인간에게 불행을 막아주는 역할의 상징성을 지닌다. 반면 용배는 내세의 삶을 위해 인간 영혼을 저승에, 특히 극락세계에 편안하게 태워 가는 역할의 상징성을 지닌다. 이들 상징성으로부터 한국무속의 현세와 내세에 대한 의미를 엿볼 수 있다. The purpose of this paper is to understand the function of ships in Korean shamanistic rites, Kut. Concretely speaking, Teebae and/or Yongbae are usually used in Kut. Tee means the material of Teebae, but Yong does dragon. So, the functions are very different between them. Teebae is related with diminishing current unhappy, while Yongbae is connected with going into Lotus paradise. From this, we can understand the standpoint of life and death in Korean Shamanism.