http://chineseinput.net/에서 pinyin(병음)방식으로 중국어를 변환할 수 있습니다.
변환된 중국어를 복사하여 사용하시면 됩니다.
우측 대장에 국한된 허혈성 대장염은 불향한 예후의 예측인자 인가?
전형구 ( Hyung Ku Chon ),박경택 ( Kyung Taek Park ),정종환 ( Jong Hwan Chong ),정범수 ( Beon Su Jeong ),유혜민 ( Hye Min Yu ),안대선 ( Dea Sun An ),윤해은 ( Hae Eun Youn ),김선민 ( Sun Min Kim ),양희찬 ( Hee Chan Yang ),이수택 전북대학교 의과학연구소 2010 全北醫大論文集 Vol.34 No.1
Background/Aims: Ischemic colitis is a medical condition in which inflammation and injury of the large intestine result from inadequate blood supply. In general, the patients with ischemic colitis have a wide spectrum of severity; most of them are treated supportively and then recovered fully, while a minority of them in critical condition may develop sepsis and become severely ill. But, there have been few studies analyzing the factors associated with poor prognosis in ischemic colitis. As the blood supply of colon, we suppose that when ischemia affects the right side of the colon in an isolated fashion, the prognosis may not be so favorable. After comparison between isolated right colon ischemia and the others, we would recognize the clinical meaning of that and doubt whether significant factor related to the prediction of poor prognosis. Methods and Materials: Patients with ischemic colitis were enrolled in a retrospective study at Chonbuk National University Hospital during interval January 2003 to June 2009. They were identified using computerized searches of ICD-9 codes for colon ischemia, that were diagnosed by colonoscopy( or sigmoidoscopy), MDCT (multidirectional computed tomography). And then, divided into two groups, one with isolated right colon ischemia (IRCI) and the other with colon ischemia not involving the right colon in an isolated fashion (non-IRCI). We analyzed age, gender, underlying diseases [e.g diabetis mellitus, hypertension, chronic kidney disease, arrhythmia(atrial fibrillation or atrial flutter), cerebral vascular disease, ischemic heart disease, previous cancer history, abdominal operation history], clinical symptoms and signs, blood test (hemoglobin, white blood cell count and basic biochemical profile) , CT findings, treatment and mortality. Results: A total 89 patients were identified colon ischemia. IRCI group was composed of 18 patients (11 females and 7 males, average age of 66.83±2.81). The mortality of patients with IRCI was 27.8% compared with a mortality of 1.4% in patients with non-IRCL(p=0.001) Moreover, they had a more underlying DM (44.4% vs 31.0%. p=0.281), hypertension (61.1% vs 36.6 %, p=0.060), vascular disorder(IHD or CVA) (27.8% vs 15.5%, p=0.225), previous cancer history (27.8% vs 18.3%, p=0.372), previous abdomen operation history (50.5% vs 11.3%, p=0.003) than non-IRCI group. Arrival at hospital, IRCI group had more abdominal pain (94.4% vs 81.7%, p=0.184) and tenderness (88.9% vs 63.4%, p=0.037), more frequency of fever, chills(33.3% vs 14.1 %, p=0.057), and higher heart rate (93.77±5.63 vs 83.07 ±1.81, p=0.021) but less diarrhea (27.8% vs. 29.6%, P =0.881), hematochezia (44.4% vs. 52.1%, P =0.561) and lower hemoglobin level (11.28±0.52 vs 12.63 ±0.21, p=0.008) compared with non IRCI group. Among CT findings, wall thickening (80.0% vs. 20.0% p =0.012), attenuation (27.8% vs. 5.0% p=0.005), enhancement (27.8% vs 5.0%, p=0.005) and thrombosis/porto-mesenteric gas (44.4% vs. 3.3% p =.001) were significantly different between two groups. Hospital duration of IRCI group was longer (17.94±6.08 vs 13.93± 1.92, p=0.413) and more recurrence(22.2% vs 9.9% p=0.155) than non IRCI group. During admission, 4 patients(22.2%) of IRCI group suffered from abdomen operation for their appropriate treatment; but 2 patients(2.8%) of non IRCI group did.(p=0.014) Odds ratio for mortality and surgery with IRCI compared With Non-IRCI is 26.9 (95% CI=2.9~249.7,p=0.001), 9.857 (95% CI= 9.6~59.2,p=0.014), respectively Conclusions: Patients with IRCI significantly undergone more surgery and had a higher mortality. Although statistically meaningless, they had a higher recurrence rate and longer hospital stay.
증예(症例) : 부신 출혈과 유사하여 진단이 늦어진 원발성 부신의 비강형 자연살해/T-세포 림프종 1예
백경택 ( Kyung Taek Park ),백영하 ( Young Ha Baek ),권대헌 ( Dae Hun Kwon ),안대선 ( Dae Seon Ahn ),유혜민 ( Hae Min Yu ),윤해은 ( Hae Eun Yun ),정범수 ( Bum Su Joung ),홍영민 ( Young Min Hong ),정종환 ( Jong Hwan Chong ),전형구 ( 전북대학교 의과학연구소 2010 全北醫大論文集 Vol.34 No.1
Primary adrenal lymphoma (PAL) is a rare disease. The vast majority of cases that have been reported were of B-cell origin. Here, we report a case of primary adrenal natural killer (NK)/T-cell nasal type lymphoma diagnosed with delay due to mimicking adrenal hemorrhage. A 29-year-old man, presented with abdominal pain and fever, had an initial computed tomography (CT) scan revealing low attenuation of both adrenal glands. Therefore, the initial concern was for tuberculous adrenalitis or autoimmune adrenalitis combined with adrenal hemorrhage. The patient was started on empirical anti-tuberculous medication, but there was no improvement. Enlargement of cervical lymph nodes were developed after that and excisional biopsy of cervical lymph nodes was performed. Pathologic finding of excised lymph nodes was compatible to NK/T-cell lymphoma. The patient died due to the progression of the disease even after undergoing therapeutic trials including chemotherapy and conservative management.
증예(症例) : 불량예후에 대한 여러 고 위험인자를 가지로 있는 양측성 기종성 신우신염 치료 1에
백영하 ( Young Ha Baek ),권대헌 ( Dae Hun Kwon ),안대선 ( Dae Seon Ahn ),유혜민 ( Hae Min Yu ),윤해은 ( Hae Eun Yun ),정범수 ( Bum Su Joung ),홍영민 ( Young Min Hong ),박경택 ( Kyung Taek Park ),정종환 ( Jong Hwan Chong ),한영민 ( 전북대학교 의과학연구소 2010 全北醫大論文集 Vol.34 No.1
Patient outcomes with emphysematous pyelonephritis vary with the classification type and other factors. This is a case of bilateral emphysematous pyelonephritis with several risk factors for adverse outcomes. A 71-year-old diabetic woman was referred to us in stuporous state with fever. The patient`s temperature was 38.7 ℃ and blood pressure was 90/60 mmHg. The abdomen was distended with severe flank knocking tenderness. The laboratory findings showed white blood cell count of 26,400/mm3, hemoglobin level of 10.5 g/dl, platelet count of 46,000/mm3, glucose level of 422 mg/dl, BUN of 163 mg/dl, and creatinine level of 5.5 mg/dl. Urinalysis showed 1+ proteinuria, 1+ glycosuria, 25-30 WBCs/HPF, and 25-30 RBCs/HPF. Unenhanced computed tomography demonstrated multiple gas pockets in renal parenchyma, pelvis, ureter, and bladder. Patient was immediately treated with percutaneous catheter for drainage of gas and purulent material, and parenteral antibiotics. E.coli was isolated from both blood and urine cultures. This patient had several concomitant risk factors for adverse outcomes, such as thrombocytopenia, acute renal failure, impaired consciousness, shock and involvement of both kidneys, which are usually associated with significantly increased risk of mortality. However, the patient was successfully treated without undergoing nephrectomy.
증예(症例) : 이전 소변 검사상 이상 소견이 없었던 환자에서 신장 주위 혈종으로 발견된 전이성 융모상피암
윤해은 ( Hae Eun Yun ),유혜민 ( Hae Min Yu ),안대선 ( Dae Seon Ahn ),백영하 ( Young Ha Baek ),홍영민 ( Young Min Hong ),권대헌 ( Dae Hun Kwon ),전형구 ( Hyung Ku Chon ),박경택 ( Kyung Taek Park ),정종환 ( Jong Hwan Chong ),이식 ( 전북대학교 의과학연구소 2010 全北醫大論文集 Vol.34 No.1
융모 상피암은 임신성 융모성 질환의 악성 변화를 가지는 것으로 전신적인 전이가 흔하게 동반되므로 전이성 병변에 대한 검사가 필요하며, 특히 본 증례와 같이 소변 검사상 이상이 없더라도, 신장 전이가 있을 거능성이 있으므로 전신적인 전이에 대한 검사가 반드시 필요할 것으로 생각된다. Gestational trophoblastic diseases originate from placental tissues and include a spectrum from complete and partial hydatidiform mole, placental site trophoblastic tumor, and choriocarcinoma, which vary in their propensity for local invasion and spreading. The most frequent sites of metastases are lung, vagina, pelvis, liver, and brain. The tumors are highly vascular and prone to severe hemorrhage either spontaneously or during invasive procedure such as biopsy. Herein, spontaneous perirenal hemorrhage from tumor was present in this case, which was diagnosed metastasis to the kidney.