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홍천수,강진경,문영명,최흥재,윤진우 대한소화기학회 1977 대한소화기학회지 Vol.9 No.2
We have presented a clinical study of 711 cases with primary carcinoma of the liver during the period between January 1965 and May 1975. The results are as follows: 1. The highest incidence was seen in the 6th decade and 65.9% of total cases belonged to the age group of 5th and 6th decades. There was a significant difference between the sexes; males were 83.3% and females were 16.7%. 2. Major symptoms consist of abdominal pain (48.9%), anorexia/indigestion (34.3%), abdominal distension (25.6%) and palpable abdominal mass (25.2%). 3. The most frequent physical finding was hepatomegaly (81.4%) and jaundice (54.0%), abdominal tenderness (51.6%), ascites (40.1%) were also frequent. The splenomegaly (10.7%) was not rare. 4. The common associated abnormal liver function tests were BSP retention (87.8%), elevated alkaline phosphatase (79.0%) and elevated SGOT (76.3%). 5. The serum AFP was positive in 57.5% of the patients, Those patients with high serum cholesterol level had much higher AFP positive rate than those with low serum cholesterol level. Seventy percent of the patients withmore than 300㎎% of serum total cholesterol were AFP positive and there were no AFP negative patients with more than 500㎎% of serum total cholesterol level. 6. Hepatocellular carcinoma was predominant (93.4%), while cholangiocarcinoma was rare (6.2%), Liver cirrhosis was associated with primary carcinoma of the liver in 73.6% and the most frequent form of these was postnecrotic cirrhosis. 7. Various kinds of liver diseases were observed in 30.5% of the patients before onset of primary carcinoma of the liver. Clonorchiasis was the most frequent of these (11.1%). 8. Remote matastasis was observed in 17.0% and pulmonary matastasis was the most frequent of these (12.1%). 9. There was usually rapidly fatal course in the patients and 91.1% of the patients had less than 6 months of symptoms before diagnosis. Hepatic coma was the most frequent cause of death and 71.2% of the patients died within 3 months from onset of symptoms.
김준명,박형천,김 응,홍천수 대한감염학회 1994 감염 Vol.26 No.4
목적: 모균증은 치명적인 진균감염증으로 생체의 면역학적 방어력이 감소되었을때 잘 합병되는 기회감염이다. 모균은 자연계 도처에 존재하나 정상인에서는 잘 감염되지 않으며, 당뇨병, 백혈병, 임파종, 장기이식등과 같은 면역저하 상태에서 잘 발생한다. 국내에는 지금까지 약 13예가 산발적으로 보고되었으며 최근 각종 항생제의 사용증가, 스테로이드제제의 과용, 항암제의 사용 등으로 감염에 대한 환자의 저항력이 약화됨에 따라 모균증이 증가하는 추세를 보이고 있다. 방법: 저자들은 1986년 3월부터 1993년 6월까지 연세대학교 의과대학 세브란스병원에서 모균증으로 진단받은 15명의 환자의 임상적 특성을 관찰하여 다음과 같은 결과를 얻었다. 결과: 1) 모균증의 남녀의 비는 1:1.1로 남녀 성별 차이는 없었고, 연령분포상 50대에서 가장 많이 발생하였다. 2) 임상형태에 따른 분류상 총 15예 중 비대뇌형 모균증이 13예였고, 위장관형모균증이 2예 있었다. 3) 대부분 선행질환을 동반하였고, 비대뇌형모균증의 경우 당뇨병이 5예로 가장 많았고 위장관형모균증은 모두 급성백혈병에서 발생하였다. 4) 초기증상은 비대뇌형모균증의 경우 두통과 안와부동통이 가장 많았고 위장관형모균증의 경우 복부동통이 초기에 나타났다. 5) 치료는 근치적 절제술과 항진균제의 병합요법이 총 15예 중 10예에서 사용되었고, 4예에서는 외과적 수술만 시행하였고 1예에서는 스테로이드제제만 사용하였다. 6) 예후는 일반적으로 불량하여 전체 생존률이 64%였고, 비교적 전형적인 모균증의 증상과 증후를 나타낸 경우 모두 사망하였다. 결론: 모균증은 생체의 면역학적 방어력이 감소되었을때 호발하는 치명적인 진균감염증으로 조기진단과 초기치료가 중요하다. 치료는 대개 외과적 절제술과 항진균제의 병합요법이 사용되며 적극적인 치료에도 불구하고 상당히 불량한 예후를 보인다. Background: Mucormycosis is a highly virulent and rapidly progressive disease with a grave prognosis. It encompasses a distinctive group of infections caused by fungi belonging to order Mucorales. These fungi are widespread in nature, subsisting on decaying vegetation and diverse organic materials. The infection occurs almost exclusively in immunocompromised hosts and poses difficult diagnostic challenge to physicians. The aim of the study was to investigate the clinical characteristics of patients with mucormycosis. Methods: Clinical characteristics of mucormycosis was examined by retrospective review of 15 patients diagnosed as mucormycosis at Severance hospital from March 1986 to June 1993. Results: 1) Mucormycosis occured most frequently in the 6th decade. 2) Underlying diseases, frequently diabetes mellitus, were usually present. 3) Headache and ocular pain were the most common initial symptoms in rhinocerebral mucormycosis. 4) Ethmoid and maxillary sinuses were the most frequently involved sites. 5) Radical surgery combined with Amphotericin B was the treatment of choice. 6) Mortality rate was 36%(5/14) among those who were followed. Most patients with high mortality rate had underlying disease, especially diabetes and liver cirrhosis. Conclusion: Mucormycosis is a fatal fungal infection usually arising in immunocompromised patients. Early diagnosis and timely institution of aggressive treatment is sine qua non for patients with mucormycosis.