상악골 전방견인 후 경조직과 연조직의 재발에 관한 연구

양준호,박수병,손우성 대한치과교정학회 1997 대한치과교정학회지 Vol.27 No.3

본 연구는 성장기 아동 중 골격성 III급 부정교합 환자에서 구외력을 이용한 상악골 전방견인시에 발생하는 경조직과 연조직의 변화와 상악골 전방견인 장치의 제거 후 관찰되는 경조직과 연조직의 재발 양상 및 이들의 상관성을 알아보곡자 하였다. 부산대학교병원 치과교정과에 내원하여 상악골 열성장을 동반하는 골격성 III급 부정교합으로 진단받은 아동 중 안면 비대칭과 순구개열이 없고 상악골 전반견인 치료 전이나 후에 상하악에서 고정성 또는 가철성 장치를 사용하지 않은 29명(남자 10명, 여자19명)을 대상으로 상악골 전방견인 전, 후와 장치제거 후 1-3개월 때 채득한 측모두부 방사선 규격사진을 계측, 분석하여 다음과 같은 결과를 얻었다. 1. 상악골 전방견인에 의하여 상순부 연조직은 그 하방 경조직과 함께 전하방 이동되었고 하순부 연조직은 경조직의 변화에도 불구하고 수평적으로는 비교적 안정적이었다. 2. 상악골 전방견인 장치제거 후 상하 전치의 재발양상에도 불구하고 상하순 모두 수평방향으로는 비교적 안정적이었으며 수직방향으로는 전방견인 후보다 더 하방이동 하였다. 3. 상악골 전방견인에 의하여 상악골과 상악치열이 전방 이동되었고 구개평면은 전상방 회전되었으며 하악골과 하악치열은 하후방 회전되었다. 4. 상악골 전방견인 장치제거 후 악골의 위치는 비교적 안정적이었으나 상하 전치의 치축과 전상방 회전되었던 구개평면이 치료 전 위치로 재발되었다. 5. 경조직과 연조직의 상관성 검정에서 입술의 위치는 그 하방 경조직과 밀접한 상관성을 보였다. The purpose of this study was to evaluate the effect of maxillary protraction and the relapse of hard and soft tissue after maxillary protraction. For this study 29 patients who were treated with maxillary protractor and labiolingual archwire were selected. Their mean age was 9 years 4 months and mean treatment period was 8.5 months. Lateral cephalograms were taken at pretreatment, immediately after treatment and one to three months after removal of the maxillary protractor. They were traced on skeletodental and soft tissue structures based on Burstone`s analysis and analyzed by Quick-Ceph Image Digitizing System(ORTHODONTIC PROCESSING). The mean and standard deviation between pretreatment and posttreatment and between posttreatment and retention period for each cephalometric variable were calculated. Student t-test was used to determine the statistical significance of the changes in each variable. Correlation coefficients between hard tissue and soft tissue were used to determine interrelationship. The results were as follows : 1. After maxillary protraction, the maxilla and maxillary dentition moved antero-inferiorly, the mandibld and mandibular dentition moved postero-inferiorly and palatal plane rotated antero-superiorly by 0.59°. 2. After maxillary protraction, the soft tissue of upper lip moved antero-inferiorly with the movement of hard tissue but the antero-posterior position of lower lip was stable in spite of the change of hard tissue. The thickness of upper lip was decreased and that of lower lip was increased after maxillary protraction. 3. During the retention period, the position of jaws was relatively stable but upper and lower anterior teeth and antero-superiorly rotated palatal plane relapsed to original position. 4. During the retention period, the soft tissue of lips was stable antero-posteriorly and moved more inferiorly than posttreatment. 5. The correlation coefficients between the position of upper and lower incisal edge and that position of lips were high, especially in horizontal change.

소아 급성 림프구성 백혈병 재발환아에 대한 임상적 고찰

박미정,오승환,유철주,양창현,김길영 大韓血液學會 1994 大韓血液學會誌 Vol.29 No.1

폐결핵 재발 환자의 약제 감수성과 재발 간격에 관한 단면 연구 - 서울시 일부 보건소 등록 환자를 중심으로

박혜숙,하은희,위자형,강지용,Park, Hye-Sook,Ha, Eun-Hee,Wie, Cha-Hyung,Kang, Ji-Yong 대한예방의학회 1996 Journal of Preventive Medicine and Public Health Vol.29 No.1

The purpose of this study was examine the general characteristics of relapsed pulmonary tuberculous patients (i.e. age, sex, weight, occupation, previous forms of treatment, drug sensitivity, and the frequency of relapse) in order to improve future treatments of tuberculosis as well as to perpetuate health education. The data was obtained from the medical records of 186 relapsed pulmonary tuberculosis patients who were registered for treatment at various public health offices in Seoul during the year of 1994. The major findings obtained from the study were as follows; 1) The male to female ratio of relapsed pulmonary tuberculous patients was about 7:3, more specifically 23.7% of the men and 30.9% of the women were between 20 and 29 years of age. 2) Comparing initial less aggravated states to relapsed states, patients with minimal X-ray findings later proved moderately advanced X-ray findings. Furthermore, patients with negative sputum AFB findings later proved positive sputum AFB findings. 3) Of the 186 patients studied, 91.9% suffered, relapse and 8.1% suffered 2 or more relapses. Of the patients who suffered at least 1 relapse, 54.8% received short-term treatment, 26.9% received long-term treatment, and 18.3% received treatment of an unknown during their initial tuberculosis treatment periods. 4) fifty five point four percent of the patients had no reaction to the drug treatment(not available), 25.9% of the patients had sensitive reaction to the drug treatment, 18.7% of the patients had resistant reaction to the- drug treatment. Drug resistance was higher in patients that exhibited positive X-ray findings as well as in patients that exhibited positive sputum AFB findings. furthermore, patients receiving treatment of an unknown nature(35.5%) exhibited higher drug resistance than those receiving short-term treatment(13.6%) and long-term treatment(17.0%). 5) Of the 160 patients who suffered relapses, 8.8% suffered a relapse within 1 year after treatment and 91.2% suffered a relapse at least 1 year after treatment. Furthermore, our study showed that women, under 30, who received short-term treatment and encounterd complications during their primary treatment suffered relapses faster than any other groups studied. In addition, minimal X-ray findings and sputum AFB findings were not correlated to the time relapse occured. Therefore, the seater efforts are needed to prevent relapsed pulmonary tuberculosis.

Benign Epilepsy of Childhood with Centro-temporal Spikes(BECT)의 항경련제 치료 후 재발인자에 관한 연구

임시홍(Si Hong Lim),구윤아(Yun Ah Gu),방준석(Jun Suck Bang),이경화(Kyung Hwa Lee),배은주(Eun Joo Bae),이홍진(Hong Jin Lee),박원일(Won Il Park) 대한소아신경학회 2005 대한소아신경학회지 Vol.13 No.2

목 적 : BECT의 항경련제 치료 후 재발과 재발을 예측할 수 있는 임상적 위험인자를 알아보고자 본 연구를 시행하였다. 방 법 : 1990년 1월부터 2004년 12월까지 15년 동안 한림대학교 춘천성심병원 소아과에 내원하여 BECT로 진단받았던 환아 중 24개월 이상 추적 관찰이 가능하였던 총 57명을 대상으로 발작시작 연령, 성별 및 횟수, 항경련제 치료 후의 반응, 뇌파 소견 등이 재발에 미치는 영향을 분석했다. 결 과 : 1) 57명의 환아들 중 7례(12.2%)에서 항경련제의 치료 종료 후 재발되었으며, 7례의 환아 중 남아 5례(8.7%), 여아 2례(3.5%)로 남아에서 여아보다 재발률이 높았으나 유의성은 없었다. 2) 재발된 환아의 발작 시작 연령은 7.85세로 재발을 보이지 않은 환아들의 7.18세보다 높았으나 유의성은 없었다. 3) 항경련제 치료 후 발작 지속기간과 횟수에 따른 재발률의 차이는 없었다. 4) 항경련제의 복용 기간은 36개월 미만인 경우는 31례 중 7례(22.5%), 36개월 이상인 경우 26례에서는 재발한 경우가 없어 항경련제의 치료기간이 짧을수록 재발률이 높았다. 5) 항경련제 치료 종료 시까지 30개월 미만 발작이 없었던 47례 중 7례(14.8%)에서 재발되어 발작이 없었던 기간이 짧을수록 재발이 높았다. 6) 치료 종료 시 뇌파검사에서 이상 발작파를 보였던 경우 9례 중 3례(33.3%)에서 재발되어 뇌파의 이상을 보인 환아에서 재발률이 높았으나 유의성은 없었다. 결 론 : BECT의 항경련제 치료 후 발작기간이 짧을수록, 항경련제 복용 기간이 짧을수록 재발의 예측인자로 생각되어지고, 치료를 종료할 때 고려되어야 할 것으로 생각되며 향후 더 많은 수의 환아를 대상으로 재발인자에 대한 임상연구가 필요할 것으로 생각된다. Purpose : This study was undertaken to recognize the relapse rate and risk factors of relapse after discontinuation of antiepileptic drugs in patients with benign epilepsy of childhood with centro-temporal spikes(BECT). Methods : The subjects were 57 patients with BECT, who visited our hospital from January 1990 to December 2004. They were followed up for more than 24 months after discontinuation of antiepileptic drugs. And they were analysed on the relapse rate and the factors that were presumed to influence the relapse. Results : Seizures were relapsed in 7 of 57 patients(12.2%) after discontinuation of antiepileptic drugs. Relapses were more frequent in patients who took antiepileptic drugs for seizure control more than 12 months(15.0%) than those who didn’t(10.8%). Moreover, more relapses occurred to those who were at higher age at onset and who took antiepileptic drugs less than 36 months(100%). Furthermore, those who had abnormalities in EEG experienced more relapses(33.3%) than others. The relapse rate was not significantly different in the aspect of and sex seizure frequency after discontinuation of medication between relapsed and non-relapsed patients. Conclusion : It is concluded that we should consider the risk factors of relapse in patients with BECT in order to avoid relapse when discontinuing antiepileptic drugs. Moreover, further studies are needed to clarify the risk factors of relapse.

알코올의존의 재발 모형 개발: 심리적 위험요소 중심으로

채숙희 한국심리학회 2006 한국심리학회지 일반 Vol.25 No.2

본 연구는 한국의 알코올의존 환자들을 대상으로 알코올의존의 재발 모형을 개발하고자 하였다. 알코올의존의 재발가능성을 예측하는 심리적 요인을 이론적으로 음주관련 신념, 부정적 정서, 대처 방식 그리고 금주효능감으로 규정하였다. 먼저 이들 변인들과 재발가능성의 상관관계를 알아보았다. 또한 이러한 심리적 변인들이 어떤 심리적 기제로 재발가능성에 작용하는지 살펴보기 위해, 재발가능성에 대한 심리적 변인들의 인과적 관계성과 매개 경로를 가정한 가설적 모형을 개발하고 모형의 부합도를 검증하였다. 연구 대상은 입원 또는 외래 치료중인 알코올의존 환자 213명이었다. 연구 결과, 연구자가 설정한 부분 매개 모형이 좋은 모형이지만, 음주관련 신념이 재발가능성을 직접 예측하는 경로를 제외한 완전 매개 모형이 최종적으로는 가장 좋은 모형인 것으로 밝혀졌다. 그리고 음주관련 신념과 재발가능성의 관계에서 부정적 정서, 정서중심적 대처, 문제중심적 대처, 그리고 금주 효능감이 매개 역할을 한다는 것이 확인되었다. The purposes of this study are to model relapse of alcohol dependence in korea. The predictive psychological factors for relapse possibility of the patients with alcohol dependence were identified theoretically as alcohol-related belief, negative affect, coping strategy and abstinence self-efficacy. First, the correlation between these variables and relapse possibility were studied. Also, to identify how these psychological variables function on relapse possibility, we developed the hypothetical model presupposing a causal relationship and a mediating path among psychological factors for relapse possibility and tested it. The subjects were 213 inpatients or outpatients with alcohol dependence. The results of the structural equation analysis showed the partial mediating model suggested in this study was valid, but a fully mediated model, except the path of alcohol-related belief directly predicting relapse possibility was the best one. It was also revealed that negative affect, emotion-focused coping, problem-focused coping and abstinence self-efficacy played a mediating role in the relation between alcohol-related belief and relapse.

Predictors of renal relapse in Koreans with lupus nephritis after achieving complete response: a 35-years of experience at a single center

( Howook Jeon ),( Jennifer Lee ),( Su-jin Moon ),( Seung-ki Kwok ),( Ji Hyeon Ju ),( Wan-uk Kim ),( Sung-hwan Park ) 대한내과학회 2024 The Korean Journal of Internal Medicine Vol.39 No.2

Background/Aims: Renal relapse has known to be a poor prognostic factor in patients with lupus nephritis (LN), but there were few studies that identified the risk factors of renal relapse in real world. We conducted this study based on 35-years of experience at a single center to find out predictors of renal relapse in Korean patients with LN after achieving complete response (CR). Methods: We retrospectively analyzed the clinical, laboratory, pathologic and therapeutic parameters in 296 patients of LN who reached CR. The cumulative risk and the independent risk factors for renal relapse were examined by Kaplan-Meier methods and Cox proportional hazards regression analyses, respectively. Results: The median follow-up period from CR was 123 months. Renal relapse had occurred in 157 patients. Renal relapse occurred in 38.2%, 57.6% and 67.9% of patients within 5-, 10-, and 20-year, respectively. The age at diagnosis of SLE and LN were significantly younger, and the proportions of severe proteinuria and serum hypoalbuminemia were higher in patients with renal relapse. Interestingly, the proportion of receiving cytotoxic maintenance treatment was higher in patients with renal relapse. In Cox proportional hazards regression analyses, only young-age onset of LN (by 10 years, HR = 0.779, p = 0.007) was identified to independent predictor of renal relapse. Conclusions: Young-age onset of LN was only independent predictor and the patients with severe proteinuria and serum hypoalbuminemia also tended to relapse more, despite of sufficient maintenance treatment. Studies on more effective maintenance treatment regimens and duration are needed to reduce renal relapse.

Prognostic significance of the FLT3 ITD mutation in patients with normal-karyotype acute myeloid leukemia in relapse

박상혁,지현숙,민숙경,조영욱,장성수,박찬정,이정희,이제환,이규형,임호준,서종진 대한혈액학회 2011 Blood Research Vol.46 No.2

Background :Fms-like tyrosine kinase 3 internal tandem duplication (FLT3 ITD) mutation is related to poor prognosis in normal-karyotype acute myeloid leukemia (AML). However, the prognostic significance of the mutation at relapse has not been adequately investigated. We investigated the prognostic significance of the FLT3 ITD mutation at relapse in normal-karyotype AML patients. Methods :We analyzed 69 normal-karyotype AML patients, in whom paired bone marrow samples taken at initial diagnosis and subsequent relapse were analyzed for the FLT3 ITD mutation at the Asan Medical Center between 1995 and 2009. Results :Forty patients showed a persistent wild-type genotype, 11 showed the FLT3 ITD mutation at diagnosis and relapse, and 9 lost and another 9 acquired the mutation at relapse. The mutation status at relapse affected the overall survival (OS), with the mutation group showing shorter OS and survival after relapse than the wild-type group did (P<0.001 and P<0.001, respectively), despite having received more frequent stem cell transplantation after relapse than the wild-type group did. However, no difference was detected in the OS and survival after relapse with regard to the mutation status at diagnosis. Conclusion :The patients with FLT3 ITD mutation at relapse showed poorer prognoses than those without the mutation. However, mutation status at diagnosis did not affect the outcome. These results suggest that, in normal-karyotype AML patients with relapse, the prognostic significance of FLT3 ITD mutation at relapse is greater than that of the mutation status at diagnosis.

Outcome of Intensive Therapy for Children with Relapsed Acute Myeloid Leukemia: A Single Institution Korean Study

이재욱,유재원,김성구,장필상,정낙균,조빈 대한암학회 2022 Cancer Research and Treatment Vol.54 No.4

Purpose Approximately 30%-40% of pediatric acute myeloid leukemia (AML) patients relapse. In this study, we analyzed the outcome and prognostic factors of relapsed AML patients who had previously received first-line therapy at our institution. Materials and Methods The study group consisted of 50 patients who had been diagnosed with AML from April 2009 to December 2018, and then showed first relapse. Thirty-two of the patients (64%) had previously received allogeneic hematopoietic stem cell transplantation (HSCT) in first complete remission (CR). Results Forty-five of the patients (90%) received intensive chemotherapy upon diagnosis of relapse, and 76% (34/45) of these patients achieved a second CR. Estimated 5-year overall survival for these 45 patients was 44.9%±7.6%. Time from diagnosis to relapse, extramedullary involvement (EMI) at diagnosis, core binding factor AML, and complex karyotype were significant prognostic factors; in multivariate study, both time from diagnosis to relapse and EMI at diagnosis proved significant. There was no difference in 5-year disease-free survival between patients previously treated with chemotherapy only and those who received HSCT in first CR (52.4%±14.9% vs. 52.6%±11.5%). Of the 19 patients who achieved second CR after previous allogeneic HSCT in first CR and subsequent relapse, 11 were treated with chemotherapy only, and seven survive disease-free. Conclusion Intensive therapy allowed for long-term survival in 40%-50% of patients, and 50% of patients who achieved second CR, regardless of prior treatment modalities in first CR. Intensive treatment may allow for salvage of a significant portion of patients with relapsed pediatric AML. Purpose Approximately 30%-40% of pediatric acute myeloid leukemia (AML) patients relapse. In this study, we analyzed the outcome and prognostic factors of relapsed AML patients who had previously received first-line therapy at our institution.Materials and Methods The study group consisted of 50 patients who had been diagnosed with AML from April 2009 to December 2018, and then showed first relapse. Thirty-two of the patients (64%) had previously received allogeneic hematopoietic stem cell transplantation (HSCT) in first complete remission (CR).Results Forty-five of the patients (90%) received intensive chemotherapy upon diagnosis of relapse, and 76% (34/45) of these patients achieved a second CR. Estimated 5-year overall survival for these 45 patients was 44.9%±7.6%. Time from diagnosis to relapse, extramedullary involvement (EMI) at diagnosis, core binding factor AML, and complex karyotype were significant prognostic factors; in multivariate study, both time from diagnosis to relapse and EMI at diagnosis proved significant. There was no difference in 5-year disease-free survival between patients previously treated with chemotherapy only and those who received HSCT in first CR (52.4%±14.9% vs. 52.6%±11.5%). Of the 19 patients who achieved second CR after previous allogeneic HSCT in first CR and subsequent relapse, 11 were treated with chemotherapy only, and seven survive disease-free.Conclusion Intensive therapy allowed for long-term survival in 40%-50% of patients, and 50% of patients who achieved second CR, regardless of prior treatment modalities in first CR. Intensive treatment may allow for salvage of a significant portion of patients with relapsed pediatric AML.

Allogeneic hematopoietic cell transplantation for acute leukemia in first relapse or second remission

이제환,정철원,이정희,김대영,Young-Shin Lee,윤성철,Inho Kim,박선양,김병국,김기현,안진석,이규형,윤성수 대한혈액학회 2010 Blood Research Vol.45 No.2

Background The role of pre-transplant salvage chemotherapy has been controversial in relapsed acute leukemia. Methods We investigated post-transplant outcomes in 65 patients with acute leukemia treated with allogeneic hematopoietic cell transplantation (HCT) during first relapse or second remission. Results The 5-year cumulative incidence of relapse (CIR) was 52.3%. Multivariate analysis for CIR revealed that patients with unfavorable cytogenetics and those not in remission at the time of HCT had a significantly high CIR (P=0.031 and P=0.031, respectively). Allogeneic HCT was performed in 14 patients after first relapse without salvage chemotherapy (“untreated relapse” group), 15 patients failed chemotherapy for reinduction of remission before HCT (“refractory relapse” group), and 36 patients attained second remission with salvage chemotherapy before HCT (“second remission” group). The 5-year CIR for patients in the untreated relapse group (57.1%) was higher than that for those in the second remission group (42.3%), but it was lower than that for patients in the refractory relapse group (66.7%). Among patients who underwent allogeneic HCT in relapse, those with bone marrow (BM) blasts ≤30% had a lower 5-year CIR than those in florid relapse (BM blasts >30%) (57.7% vs. 70.6%). Conclusion Our results do not support the role of salvage chemotherapy aimed at re-induction of remission before allogeneic HCT in patients with acute leukemia after first relapse. Patients with early relapse do not appear to benefit from salvage chemotherapy before HCT.

소아 일차성 신증후군의 치료반응과 재발빈도에 관련된 인자

전학수,안병훈,하태선,Jeon, Hak-Su,Ahn, Byung-Hoon,Ha, Tae-Sun 대한소아신장학회 2006 Childhood kidney diseases Vol.10 No.2

Purpose : This study was aimed to determine the predictive risk factors for the treatment response and relapse rate in children diagnosed with idiopathic nephrotic syndrome. Methods : We analyzed the medical records of children who were diagnosed and treated for childhood idiopathic nephrotic syndrome from November 1991 to May 2005. Variables selected in this study were age at onset, sex, laboratory data, concomitant bacterial infections, days to remission, and interval to first relapse. Results : There were 46 males and 11 females, giving a male:female ratio of 4.2:1. The age($mean{\pm}SD$) of patients was $5.8{\pm}4.1$ years old. Of all patients who were initially given corticosteroids, complete remission(CR) was observed in 54(94.7%). Of the 54 patients who showed CR with initial treatment, 40(70.2%) showed CR within 2 weeks and 14(24.6%) showed CR after 2 weeks. The levels of serum IgG were lower in the latter group who showed CR after 2 weeks(P=0.036). Of the 54 patients who showed CR with initial treatment, 47(82.5%) relapsed. Of these patients, 35.1% were frequent relapsers and 43.9% were infrequent relapsers. There was no significant correlation between the frequency of relapse and the following variables : sex, days to remission, and laboratory data. However, age at onset and interval to first relapse had a negative correlation with the frequency of relapse(Pearson's coefficient=-0.337, -0.433, P<0.012, P<0.01). Conclusion : The age at onset and the interval to first relapse were found to be predictive clinical parameters for the relapse rate, while the levels of serum IgG at initial presentation were a predictive laboratory factor for treatment response in childhood idiopathic nephrotic syndrome.