포스터 발표 : 포스터 연제 ; 재발성 CAPD 복막염과 도관 생체막 형성과의 관계

박병헌 ( Park Byeong Heon ),김희진 ( Kim Hui Jin ),이태원 ( Lee Tae Won ),임천규 ( Im Cheon Gyu ),김명재 ( Kim Myeong Jae ) 대한신장학회 2000 춘계학술대회 초록집 Vol.19 No.2

고콜레스테롤혈증 성인환자에서 무증상 갑상선 기능저하증의 빈도와 혈청 콜레스테롤 치에 대한 혈청 TSH 의 영향

정원제(Won Jea Jeong),박병헌(Byeong Heon Park),박철영(Cheol Young Park),류미숙(Mee Sook Ryu),오승준(Seung Joon Oh),우정택(Jeong Tack Woo),김성운(Sung Woon Kim),양인명(In Myoung Yang),김진우(Jin Woo Kim),최영길(Young Kil Choi),팽정령( 대한내과학회 2002 대한내과학회지 Vol.62 No.2

N/A Background: Subclinical hypothyroidism is frequently discovered from hypercholesterolemic adults. It is defined as an asymptomatic state which characterized by normal free thyroxine (FT4) and elevated thyroid stimulating hormone (TSH) level. Hypercholesterolemia is a major risk factor for coronary heart disease, however hypercholesterolemia caused by hypothyroidism can be easily managed by thyroid hormone replacement. The screening of thyroid disease in hypercholesterolemia patient must be emphasized in order to find out correctable hypothyroidism. So we screened the prevalence of overt and subclinical hypothyroidism at different hypercholesterol levels in middle-aged men and women and also analyzed the correlation between TSH and total cholesterol level. Methods: We measured serum TSH levels and FT4 by radioimmunoassay from 491 patients with hypercholesterolemia. The subjects were divided into two groups according to serum cholesterol level. Group I was serum cholesterol ≥240 -〈300 mg/dL and group II was ≥300 mg/dL. Subclinical hypothyroidism was defined as TSH levels higher than 4 mU/L, in the presence of normal FT4 concentration. Results: The overall prevalence of subclinical and overt hypothyroidism was 3.4% and 2.5% in men and 4.7% and 3.5% in women of middle age. In men the prevalence of overt and subclinical hypothyroidism increased from 2.3% of group I to 16.1% in the group II (p<0.05). In women that increased from 5.2 % to 12.9 % (p<0.05). After age correction, an increase of 1 mU/L TSH in men was associated with an increase of 3.2 mg/dL total cholesterol (p<0.01). A similar trend was also found in women (2.1 mg/dL p=0.052). Conclusion: In this population, the prevalence of hypothyroidism is up to 16.1% in middle-aged men, 12.9% in middle-aged women with high total cholesterol and it may justify screening of thyroid disease in hypercholesterolemic patients especially in clinical practice.(Korean J Med 62:187-193, 2002)

Klebsiella 균혈증에 대한 임상적 고찰

이병욱,박병헌,오혜림,이호종,김수영,민선기,황유철,김경진,서환조 대한화학요법학회 2000 대한화학요법학회지 Vol.18 No.4

1988년 1월부터 1997년 12월까지 10년간 경희의료원에 입원했던 환자 중, 세균학적 검사로 확진된 157예의 Klebsiella 균혈증에 대한 임상적 관찰을 하여 다음과 같은 결과을 얻었다. 1) Klebsiella 균혈증의 발생빈도는 입원환자 1000명 3당, 0.79건이었다. 2) 성별로는 남자가 88(56%)명이었고, 여자가 69(44%)명이었으며, 연령별로는 신생아가 19명, 1세에서 39세 사이가 28명, 40세에서 59세 사이가 53명, 60세 이상은 57명이었고 평균 나이는 47.6세였다. 3) 분리빈도는 K. pneumoniae(146명 ; 94%), K. oxytoca(10명 ; 6.4%), K. ozaenae(1명 ; 0.6%)순이었고, 다균주가 배양된 경우는 8예(5.1%)에서 있었다. 4) 원외감염은 87명(55.4%)이었고, 원외감염은 70명(44.6%)이었다. 5) 원발병소는 비뇨기계(35명;22.3%), 간담도계(33명;21%), 호흡기계(27명;17.2%), 복막(6명;3.8%), 정막카데터(5명;3.2%), 기타(3명;1.9%) 순이었고, 원발병소가 밝혀지지 않은 경우는 48명(30.6%)이었다. 6) 기저질환으로는 당뇨병, 고형암, 뇌혈관질환, 담석증, 간경변, 미숙아, 혈액암, 알콜중독증, 만성신부전 등의 순으로 많았다. 7) 가장 흔한 임상양상은 발열(129명;82.2%)이었고, 백혈구 증다증은 117(74.5%)명에서 나타났으며, 범발성혈관내응고증, 패혈성쇽, 급성신부전은 각각 18.5%, 17.8%, 14.6%에서 나타났다. 8) 항균제 감수성 검사에서 β-lactam계열의 ampicillin, carbenicillin, cephlothin에는 각각 87.9%, 91.7%, 27.6%의 내성률을 나타냈고, aminoglycoside계통의 getamicin, tobramycin, kanamycin, amikacin에는 각각 22.3%, 22.9%, 17.4%, 1.3%의 내성률을 나타낸 반면, quinolone 계통의 ciprofloxacin과 ofloxacin에는 각각 3.6%, 0.9%의 내성을 보였으며 imipenem에 대해서는 모든 균주가 감수성을 보였다. 9) Klebsiella 균혈증의 사망률은 22.3%이었다. 10) 원발병소가 호흡기계와 복막인 경우, 부적절한 항균제 치료를 한 경우, 치료 도중 범발성혈관내응고증, 패혈성쇽, 급성신부전이 발생한 경우는 높은 사망률을 보였다. 11) 본 연구기간의 후반기에는 전반기보다 중증감염의 빈도가 많았다. 결론 : 이상의 결과에서 Klebsiella 균혈증은 신생아와 여러 가지 기저질환이 있는 성인환자에서 주로 발생하였고, 최근 들어 다약제 내성 균주의 급속한 출현에 의한 중증 감염이 증가하는 양상을 보이고 있으므로, 감수성 검사에 의한 적절한 항균제 선택이 환자의 치료 및 예후에 중요할 뿐만 아니라 내성 균주의 출현을 줄이는데 기여할 것이다. A clinical review on 158 patients with Klebsiella bacteremia among the patients who admitted to Kyunghee University Hospital from January 1988 to December 1997 was done. The incidence of Klebsiella bacteremia was 0.79 cases per 1000 admitted patients. The disease was community acquired in 55.4%. nosocomically acquired in 44.6%. 146 cases were caused by Klebsiella pneumoniae, 10 cases by Klebsiella oxytoca, one case by Klebsiella ozaenae, and 8 episodes were a part of a polymicrobial bacteremia. Portals of entry were urinary tract (22.3%), hepatobiliary tract (21%), pulmonary tract (17.2%), peritoneum (3.8%), intravenous tract (3.2%), and others (1.9%) in decreasing order of frequency. In 30.6% of patients, site of origin of the bacteremia could not be identified. Underlying diseases frequently encountered were diabetes, solid cancers, cerebrovascular accident and cholelithiasis. The most frequent clinical finding was fever (15 patients) , and the second was leukocytosis (117 patients). Disseminated intravascular coagulation septic shock and acute renal failure occurred in 18.5%. 17.8%. and 14.6% respectively. The isolated strains were resistant to ampicillin in 87.9% and to gentamicin in 22.3%, and all the isolates were sensitive imipenem. The overall mortality was 22.3%. THe higher mortality was shown in cases that patients received inappropriate antibiotic treatment, and disseminated intravascular coagulation, septic shock, and acute renal failure occurred during the disease courses, and portals of entry were pulmonary tract and peritoneum. In conclusion, Klebsiella bacteremia commonly occurred in neonates and adult patients with underlying diseases. Recently, the incidence of severe infections caused by multi-drug resistant strains is increasing. Appropriate antibiotic therapy is important in the prognosis and may reduce the appearance of resistant strains.

대장중첩증을 유발한 가족성 선종성 용종증 1예

김병호,김효종,김경진,장린,동석호,장영운,박병헌,이정일 대한소화기내시경학회 2000 Clinical Endoscopy Vol.20 No.6

A 26-year-old man with intermittent lower, abdominal, cramping pain, nausea, vomiting, and diarrhea was found to have intussusception by computed tomography. Whole emergency laparotomy was performed, intus-susception reduced spontaneously. Postoperately, familial adenomatous polyposis (FAP) was diagnosed by colonoscopy and barium enema. Innumerous polyps were found in the entire colon and one of these was presumed to have caused sigmoid invagination. If is believed that FAP is quite a rare cause of colonic intus-susception. This case of a 26-year-old man with an intussusception of the colon due to FAP is herein reported. It is important that surgeons and internists are aware of this rare cause of intussusception due to FAP because of the therapeutic implications.

면역성 혈소판 감소성 자반증을 동반한 궤양성 대장염 1 예

김병호,이동근,김효종,장린,이정일,동석호,장영운,박병헌,민선기,최천웅 대한소화기내시경학회 2001 Clinical Endoscopy Vol.24 No.1

가족성 선종성 용종증 수술 후 발생한 유건종과 십이지장 선종 1 예

김병호,이동근,김효종,김경진,장린,이정일,동석호,장영운,박병헌 대한소화기내시경학회 2001 Clinical Endoscopy Vol.23 No.1

Familial adenomatous polyposis (FAP) is an autosomal dominantly inherited disorder due to germline mutation of the tumor suppressor adenomatous polyposis coli (APC) gene, Multiple large bowel polyps usually develop in adolescenoe or early adulthood with inevitable progression to colorectal carcinoma. It is well known that patients with FAP are at considerable risk of developing extracolonic manisfestations of the disease. Particularly, desmoid tunors of the abdominal cavity, and duodenal adenomas and carcinomas are the most serious ones. Desmoid tumors and duodenal carcinomas are major muses of death in those patients in whom a prophylactic (procto) colectomy has been performed. We report the case of a 38-year-old man with desmoid tumor and duodenal adenoma developing after total colectomy with ileostomy due fo FAP, and liferafures were reviewed.