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갑상선 기능 항진증에 동반된 자가 면역성 용혈성 빈혈 1예
민현조,박석영,홍임작,이경생,이인생,서상렬,송창섭,마경란 대한내과학회 1992 대한내과학회지 Vol.42 No.1
저자들은 자가면역질환의 일부인 갑상선기능항진증이 있는 19세의 여자환자에서 갑상선중독발증과 자가면역성용혈성 빈혈이 동시에 발병하였다가 갑상선기능의 호전과 더불어 용혈성빈혈도 회복된 예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Autoimmune hemolytic anemia(AIHA) is a disease characterized by shortened red cell surivival and evidence of immune response directed toward autologous red cells, most frequently demonstrated by a positive direct antiglobulin reaction. The etiology of AIHA, as with other autoimmune disease, is unknown, In many patients with idiopathic AIHA, erythrocyte autoantibodies are the only recognizable evidence of immunologic aberration. AIHA may be classified by idiopathic and secondary on the basis of presence of underlying disorder, and on the other hand, classified by warm induced and cold induced AIHA on the basis of serologic characteristics of involved autoimmune process. Whereas the majority of AIHA are mediated by warm-induced autoantibodies, a smaller portion by cold-induced autoantibodies. Warm-induced AIHA is developed usually by IgG, and cold-induced by IgM. AIHA associated with hyperthyroidism are very rare, but a few cases have reported in the world. We experienced one case of AIHA associated simultaneously with hyperthyroidism in a 19 year-old female patient. The direct and indirect Coombs' test and thyroglobulin antibody were positive. It was demonstrated that hemolysis was induced by IgG antibody. The patient was resolved by antithyroidal drug and prednisone. But hemolytic anemia and hyperthyroidism recurred a few month after discontinuing the drugs. After thyroidectomy, hemolytic anemia was not recurred.
민현조(Hyun Jo Min) 대한내과학회 1998 대한내과학회지 Vol.55 No.2
N/A Background: In the present-day life, it is the conspicuous trend toward nuclear families and women have engaged in occupation. Therefore the patients have a load with taking care of children and living socially from inpatient therapy of acute pyelonephritis(APN). As a result of these, author intended to set up criteria of inpatient therapy, and reported the clinical study and status of resistance to antibiotics in APN. Method: I analyzed 316 patients with APN retrospectively. I analyzed their clinical features, resistance to antibiotics, result of treatment, and the cost of inpatient and outpatient therapy. And to set up the criteria about inpatient therapy, multiple factors which may influence prognosis were evaluated by univariate analysis and linear regression analysis. Result: Of the 316 cases, 19 were male and 297 were female. The averege count of clinical state was 5.2±1.7. The patients with underlying ca were 113(32.6%). The 16 of 21 cases with hydronephrosis or hydroureter on sonography carried out intravenous pyelography, 13(8.12%) cases had abnormal finding. 1lm most common pathogen is E.coli. The resistance to ampicillin, Trime5xyrim/sulfamethoxazole, and cephalothin increased progressively. The usually used antibiotics were 2nd-generation cephalosporin, aminoglycoside, and oral cephalosporin or quinolone. Considering the univariate analysis, 1) on the group with underlying causes, they were older age, had longer duration of admission and treatment. On the group with UTI history, they had more underlying causes and had higher clinical state, On the group with abnormal finding on sonography, they were older age and higher clinical state, had more WBC count and longer duration of admission and therapy. 2) On the group without underlying causes, the group above 38 years-old had longer duration of admission, but there was no difference in other variances. On both groups of 38.5°C in body temperature and on both gmups of the mild or moderate and severe clinical state, there was no difference in all variances. The group above 12,000/ml on WBC count had higher body temperature only. The group with renal swelling on sonography had higher WBC counts, higher clinical status, and longer duration of admission and treatment, but had no difference in age and body temperature, 3) In linear regression analysis on the group with normal renal size on sonography and without underlying causes, the age vs the duration of admission and WBC count, the hxly temperature vs the duration of admission, the clinical state vs the duration of admission had positive correlation, but low r-value, and there was no correlation in other relations. Conclusion: The resistance to antibiotics had increasing trend in Korea. The criteria far inpatient therapy of acute pyelonephritis on visit are following; severe clinical state and 1) underlying causes in history taking, or 2) recurrent urinary tract infection on past history, or 3) abnormal finding or enlarged kidney finding on sonography. We think that they should be admitted and had parenteral antibiotics to be relieved the severe generalized symptoms and confirmed the underlying cause, and in other cases, they can be treated by oral antibiotics in outpatient department.
뇌 전산화 단층촬영과 뇌 단일광자방출 전산화 단층촬영에서 다발성 저음영 또는 관류장애를 보인 열사병 2 예
이승우,민현조 대한내과학회 1994 대한내과학회지 Vol.47 No.2
Heat stroke is the life-threatening emergency recognized by three cardinal signs: severe central nervous disturbance; hyperpyrexia; and hot, dry skin, which is pink or ashen, depending on the circulatory state. It is subdivided into two forms, classic and exertional. Exertional heat stroke is a state of extreme hyperthermia that occurs when excess heat generated by muscular exercise exceeds the body's ability to dissipate it. It has been reported in military personnel, marathon runners, miners who perform strenous jobs in a hot environment, and among Muslim pilgrims in Mekkah, It is an important cause of death and morbidity in military activities such as long marches or field training exercise and annually several patients are admitted to our hospital. It commonly involves several organs including the brain, liver, kidney, heart, and the coagulation system. Immediate elimination of hyperpyrexia and support of vital organ systems are the two principal therapeutic objectives. Disturbances of the central nervous system are present in all cases as the brain is extremely sensitive to hyperthermia. Loss of consciousness often occurs with little waming. Coma, stupor, and combative delirium are often accompanied by plantar response, pupillary abnormalities, or generalized convulsions. The CNS manifestations are caused by the hyperthermia, hemorrhages, congestion, edema, and metabolic disturbances. There had been few reports on the brain CT and SPECT findings of seizure in heat stroke patients. We reported two cases of exertional heat stroke with central nervous system manifiestations, which were manifested by loss of consciousness and generalized convulsion associated with multifocal low density on computed tomography or multifocal perfusion defect on brain SPECT (single photon emission computed tomography).
정복섭(Bok Seup Chung),민현조(Hyeon Jo Min),홍연식(Yeon Sik Hong),이재수(Jae Soo Lee),김승원(Seoung Woon Kim),송창섭(Chang Seup Song) 대한내과학회 1990 대한내과학회지 Vol.39 No.1
N/A Thirty-three cases of diabetic ketoacidosis, experienced in Seoul Red Cross Hospital from Jan. 1, 1981 to Dec. 31, 1988, were analyzed retrospectively. The following results were obtained: 1) The incidence was 1.83Zo of total diabetic admissions. 2) The mean age of the patients was 40.5 years old, the peak outbreak was in the third decade, and the male-to-female ratio was 1:2.3. 3) The mean diabetic period of patients was 3.5 years. 4) The most frequent precipitating factor was infection, pneumonia being peredominant, 5) The average amount of fluid and electrolyte ad- ministered within the first 24 hours was 4.7L of water and 42 mEq of K. The average dose of insulin administered within 24 hours was 122.7 units. 6) Fom cases expired and the mortality rate was 12.1%, Factors contributing to death were dehydration, pulmonary edema, and brain edema. 7) On discharge, we recomened KPH insulin in 19 cases, oral hypoglycemic agent in 19 cases, and exercise and diet control in seven cases.