東醫壽世保元 臟腑論에 대한 考察

李敬愛,朴性植,李源哲 동국대학교 한의학연구소 1995 東國韓醫學硏究所論文集 Vol.4 No.-

The purpose of this study is to understand a term of 'Jangbu theory 臟腑論' in 'Dong-Eui-Su-Se-Bo-Won 東醫壽世保元' . The conclusion would be summerized as follows. 1.'Jangbu theory 臟腑論' of 'Sa-Sang medicine 四象醫學' is based on 'Sa-Sang structure 四象構造' . 2.'Mind 心' of 'Sa-Sang medicine 四象醫學' is recognised as the Lord of body. 3.'four-Jang 四臟' and 'four-Bu 四腑' constitute 'Sa-Sang structure 四象構造' which is based on the deviation of 'vital energy 氣', and 'four-Jang 四贓' plays a loading role. 4.'Sacho 四焦' explaine the whole function of human body including one's heart's desire, physical constitution and the visceral physiology. 5.'ear-eye-nose-mouth 耳 目 鼻 口' is connected with 'the profound secrets of nature 天機' and also has a close relation with creation of 'spirit-vital energy-blood-essence 神氣血精' and spiritual function. 6.'SaHae theory 四海論' of 'Dong Mu 東武' is philosophical concept set on the basis of 'nature 天性' and 'life 入命'. 7.'spirit-vital energy-blood-essence 神氣血精' doesn't have the relation of mutual transformation. It's creation and consumption lies on 'the power of ear-eye-nose-mouth 耳目鼻口之力'. 8.'Sa-Sang medicine 四象醫學' expands its theory centering on the deviation of 'vital energry 氣'and the transversaa circulation of 'SaHae 四海'. According to the above result, 'Jangbu theory 臟腑論' in 'Dong-Hui-Su-Se-Bo-Won 東醫壽世保元' should be understood on the basis of' Sacho 四焦' and 'SaHae 四海' according to 'Sa-Sang structure 四象構造' , accompanying philosophical thinking focused on human and society, the centural concept of 'Jangbu theory 臟腑論' could be said as' Mind 心' to be the Lord of body.

신부전이 동반된 당뇨병 환자에서 발생된 침습성 모균증 : 수술과 Liposomal amphotericin B 및 GM-CSF 병합 요법에 의한 성공적인 치험 1예

이원영,오기원,임국희,장재혁,이동건,최정현,강무일,신완식,차봉연,이광우,손호영,강성구 대한화학요법학회 1999 대한화학요법학회지 Vol.17 No.4

저자들은 신부전이 동반된 당뇨병 환자에서 발생된 부비동형 모균증에 대하여 수술과 함께 liposomal amphotericin B 및 GM-CSF의 복합치료를 하여 성공적으로 치료한 1예를 경험하였기에 문헌 고찰과 함께 보고하는 바이다. Mucormycosis (zygomycosis) primarily affects diabetic or immunocompromised patients and typically progresses rapidly, necessitating surgical excision and antifungal therapy with amphotericin B. Large doses of amphotericin B are needed for cure, but it has the risk of causing significant renal toxicity. The recent development of liposomal amphotericin B allows antifungal therapy to be administered with potentially improved efficacy and reduced nephrotoxicity. We have experienced a case of paranasal mucormycosis successfully treated with surgery, liposomal amphotericin B and GM-CSF. A 59-year-old male suffering from diabetes mellitus for 6 years was admitted with pain at left maxillary area. He was diagnosed as mucormycosis after cytologic exam on the necrotic nasal mucosa, which showed typical hyphae. He have had diabetic nephropathy with macroproteinuria and had rapidly rising serum creatinine levels with the amphotericin B treatment: creatinine levels reverted to basal level with the use of liposomal amphotericin B. Despite surgical excision and continued antifungal therapy, his infection was not effectively controlled. Therefore, GM-CSF was administered additionally to improve phagocytic activity of leukocytes. He was finally cured after receiving a combination of aggressive surgery, liposomal amphotericin B and GM-CSF. To our knowledge, this is the first detailed clinical description of the treatment of mucormycosis with liposomal amphotericin B in Korea.

췌장 선방세포암 1예

이화정,지준호,박승찬,박정철,최은정,서혜진,이원식,이정림,배병조,손경락,이경희 영남대학교 의과대학 2008 Yeungnam University Journal of Medicine Vol.25 No.2

Acinar cell carcinoma is a rare tumor that represents 1~2% of al1 pancreatic cancers. Clinical and radiologic findings are inconclusive in this disease Acinar cell carcinoma is characterized by rapid progression and early metastasis, which lead to its poor prognosis. A 41-year-o1d man was admitted to our hospital for abdominal pain. Abdominal computed tomography (CT) and positron emission tomography-computed tomography (PET-CT) showed a splenic mass, which was being invaded by a pancreatic tail mass and which had increased ^(18)F-fluorodeoxyglucose (FDG) uptake Primary radical distal pancreatectomy and splenectomy were performed. Pathologic findings revealed an acinar cell carcinoma of the Pancreas The patient underwent a total gastrectomy three months later because of gastric recurrence Four months later, multiple hepatic metastases were discovered, and the patient underwent a left hepatectomy During treatment with capecitabine, there was no evidence of tumor progression for 14 months. We report a case of metastatic pancreatic acinar cell carcinoma, which did not progress for an extended period while the patient was being treated with capecitabme.

한국에서의 간질의 사회적 낙인

이상암,유희정,허경,박형국,신동진,송홍기,정원영,권오영,이성수,김요식,김성은,이병인 대한간질학회 2002 대한간질학회지 Vol.6 No.2

흉선종 제거후에 발생한 재생 불량성 빈혈 : 증례보고

전원선,이상철,김현정,배상병,김찬규,이남수,박노진,이규택,박성규,홍대식,박희숙,원종호 순천향의학연구소 2007 Journal of Soonchunhyang Medical Science Vol.13 No.2

Thymoma is associated with myasthenia gravis, Pure red cell aplasia, and autoimmune diseases such as autoimmune hemolytic anemia, aplastic anemia, and hypogammaglobulinemia. It's association with aplastic anemia is rare and aplastic anemia appearing after surgical removal of thymoma is especially rare. The authors hereby report a case of aplastic anemia occuring in a patient who was diagnosed with thymoma and myasthenia gravis and had the tumor surgically removed. The patient was treated with anti-thymocyte globulin, cyclosporin, and prednisolone, and showed partial remission with hematologic improvements after 12 months.

원발성 후복막 점액낭샘암종 1예

지준호,이화정,박승찬,박정철,최은정,서혜진,이원식,이정림,배병조,손경락,이경희 영남대학교 의과대학 2008 Yeungnam University Journal of Medicine Vol.25 No.2

Primary retroperitoneal mucinous cystadenocarcinoma is a very rare malignancy, and little is known concerning its Pathogenesis, optimal treatment, and prognosis. A 29-year-o1d pregnant woman (21 weeks) Presented with abdominal discomfort CA 19-9, CA 125, and CEA were normal Abdominal CT scanning revealed a 19x15x13 cm retropentoneal tumor Exploratory laparotomy and tumor excision were performed. Mucinous retropentoneal implants were removed as completely as possible Histologically, the tumor showed focal areas of capsular invasion, but free resection margins The uterus and both ovaries were normal in appearance No adjuvant therapy was pursued. Six months later, Peritoneal and bilateral ovarian metastases were discovered. Hence, we report the details of this case of primary retroperitoneal mucinous Cystadeno-carcinoma and present a review of the literature.

당뇨병과 동반된 화농성 간농양의 임상상 및 예후인자

오은숙,강무일,이원영,오기원,임동준,이소영,이정민,고승현,김성래,안유배,손현식,윤건호,차봉연,이광우,손호영,강성구 대한당뇨병학회 2000 임상당뇨병 Vol.1 No.1

연구배경: 감염질환은 혈관질환과 함께 당뇨병의 중요한 사망원인의 하나이며, 혈당조절이 불량할수록 감염 빈도가 증가됨은 잘 알려져 있다. 간농양의 발생이 있어서도 당뇨병은 중요한 기저질환 중의 하나이다. 일반적으로 간농양의 가장 흔한 원인균은 Escherichi coli라고 알려져 있으나, 최근 당뇨병을 가진 간농양 환자에서 Klesiella pneumoniae의 검출이 증가되고 있다. 또 최근 연구에 의하면 K.pneumonie가 간농양의 가장 흔한 원인균이며, K. pneumoniae에 의한 간농양은 K.pneumoniae 이외의 균주에 의한 간농양보다 당뇨병과 밀접히 관련되어 있다고 보고된 바 있다. 이에 저자들은 간농양 환자를 대상으로 당뇨병환자의 빈도를 알아보고, 그 원인균 및 특징을 비당뇨병 환자들의 경우와 비교해 보고자 하였다. 방법: 1992년 1월부터 1999년 6월까지 방사선학적 검사 혹은 수술에 의해 간농양이 확인되거나, 경피적 천자나 수술을 통한 배농액 배양, 혹은 혈액 검사에서 원인균이 증명된 182명의 환자를 대상으로 후향적 임상고찰을 실시하였다. 결과: 화농성 농양을 가진 167명의 환자(남:94명, 여:73명)중 당뇨병을 가진 환자는 54명 (남:30명, 여:24명)으로 32.3%를 차지하였다. 환자의 평균나이는 당뇨군에서 62.1 ± 13.4세, 비당뇨군에서는 55.1 ±15.5세로 당뇨군에서 높았으며(p=0.0021), 남녀간의 평균나이 비교 시 두 군 모두 여성의 나이가 의미있게 높았다. 비당뇨군에 비하여 당뇨군의 경우 저알부민혈증의 빈도와 aspartate transaminase가 증가되어있었다. 원인균주는 K. pneumoniae (당뇨군54%, 비당뇨군 39.1%), E. coli(당뇨군 17.5%, 비당뇨군 18.8%), Pseudomonas aeruginosa, Streptococcus viridans, Enterococcus 순이었으며 두 군간의 의미는 차이는 없었으나 K. pneumoniae의 경우 다른 균종에 비해 단독감염의 빈도가 높았다(82.8%). 사망률은 당뇨군에서 16.7%, 비당뇨군에서 7.1%로 당뇨군에서 의미있게 높았으며(p=0.019), 당뇨군에서의 사망환자는 모두 패혈증이 동반되어 있었다. 당뇨환자의 사망군은 생존군에 비해 당뇨병 이환기간이 길고 혼합감염의 빈도가 높았다(p=0.046). 검사실 소견에서는 총 빌리루빈 및 알카리성 포스파타제의 증가가 관찰되어 있었다. 결론: E. coli가 간농양의 주된 원인균이라는 기존 보고와는 달리 당뇨군과 비당뇨군 모두 K. pneumoniae가 간농양의 주된 원인균이었다. 또한 당뇨 유병기간이 길고 당뇨조절이 불량한 환자에서 혼합감염이며 총 빌리루빈 및 알카리성 포스파타제의 증가등과 같은 위험인자가 존재할 경우 사망률이 증가될 수 있으므로 이들 군에서는 적극적인 치료가 필요할 것으로 사료된다. Background: Liver abscesses are commonly associated with underlying disease, particularly diabete mellitus. The number of the liver abscesses caused by Klebslella pneumoniae in diabetic patient has been increased in Korea nowadays. This study was conducted to clarify the clinical presentation and prognostic factors of pyogenic liver abscesses, especially in diabetic patients and to determine the proportion of K. pneunomiae as a pathogen in liver abscess in Korea. Methods: Medical records of 167 patients treated for pyogenic liver abscess from January, 1992 through June, 1999 were reviewed retrospectively in detail. Major Pathogenic organism, clinical manifestations, prognostic factors, the importance of diabetes mellilus as an underlying disease and its effect on clinical features and prognosis were analyzed. Results: Among 167 cases of pyogenic liver abscess, underlying diabetes mellitus was present in 32.3%. The mean age of patients was 62.7 13.4 years in diabetic liver abscess group and 55.1 15.5 years in non-diabetic liver abscess group. Most liver abscesses were cryptogenic in origin or secondary to the billary tree diseases. The clinical presentations among the two groups were not significantly different. When compared to patients without diabetes, patients with diabetes had significantly higher proportions of hypoalbuminemia and elevated aspartate transaminase level. The most common organism of the pyogenic abscess was K. pneumoniae in both groups. Percutaneous drainage of the abscess with appropriate antibiotics was the most commonly used therapeutic modality in liver abscess. The mortality rate of diabetic liver abscess is 16.1 % and 7.1% in nondiabetic liver abscess. Complications, especially septicemla, were found more frequently in patients with diabetes than in patients without diabetes (64.8% vs 28.3%, septicemia : 31.5% vs 9.7%). The factors influencing mortality in the diabetic liver abscess were disease duration, mixed infection, presence of septicemia, elevated bilirubin and alkaline phosphatase. Conclusions: In contrast to prior report that the E. coli was the most common pathogen in liver abscess, we found that K. pneumoniae was the most common organism cultured in liver abscess. Diabetic patients have more complications and higher mortality than patients without diabetes. Early detection and proper treatment are needed to improve the outcome for diabetic patient with liver abscess.

야뇨증 환아들의 심리사회적 특성에 대한 다기관 연구 : 행동 및 정서 문제를 중심으로

조수철,김재원,신민섭,황준원,한상원,박관현,이상돈,김경도,김건석,서홍진,이유식,정재용,김영균,문두건,남궁미경,한창희,조원열,김영식,배기수,이종국,정우영,신의진 大韓神經精神醫學會 2005 신경정신의학 Vol.44 No.6

Objectives : The aim of this study was to examine the behavioral and emotional problems associated with nocturnal enuresis in Korean children. Methods : Three hundred eighteen children with nocturnal enuresis, together with their parents, completed the Child Behavior Checklist (CBCL), Disruptive Behavior Disorder Scale according to DSM-IV (DBDS), Children's Depression Inventory (CDI), State-Trait Anxiety Inventory for Children (STAIC), and Piers-Harris Children's Self-Concept Scale (PHCSC). Ninety-three normal students were selected as the control group. Results : Compared to the normal control group, the mean scores with regard to the withdrawn, social problems, attention problems, delinquent behavior, aggressive behavior, externalizing problems and total problems profiles were significantly higher in the nocturnal enuresis group according to the CBCL results. The nocturnal enuresis group also scored significantly higher in the ADHD and ODD profiles of the DBDS. The nocturnal enuresis group was more depressed and anxious than the control group according to the results of the CDI and STAI. The mean score of the PHCSC was significantly lower in the nocturnal enuresis group when compared to the normal control group. Conclusion : The results of this study suggest that children with nocturnal enuresis in Korea have clinically relevant behavioral and emotional problems. The findings support the link between nocturnal enuresis and psychopathology in Korean children.

간세포암과 하대정맥 막성폐쇄의 치료 후 호전된 백혈구파괴혈관염 1예

이준엽 ( Jun Yeob Lee1 ),이주원 ( Ju Won Lee1 ),이진욱 ( Jin Wook Lee ),박현준 ( Hyun Joon Park ),장국환 ( Gook Hwan Jang ),김다정 ( Da Jung Kim ),김선민 ( Sun Min Kim ),한병훈 ( Byung Hoon Han ),정규식 ( Gyoo Sik Jung ),김근태 ( 대한류마티스학회 2015 대한류마티스학회지 Vol.22 No.5

저자들은 하지 자색반과 고환 통증으로 내원한 알코올성 간경화증 환자에서 LCV의 원인 감별하는 과정에서 HCC와 하대정맥 막성폐쇄를 진단하고 이에 대한 치료 후 LCV의 호전된 증례를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Vasculitis is a heterogeneous group of diseases that destroy blood vessel walls by inflammation. Approximately half of vasculitis cases are idiopathic, but sometimes associated with genetic factors, medicines, chronic infection, autoimmune diseases, and malignancies. Although the mechanism remains unclear, vasculitis secondary to malignancy, also known as paraneoplastic vasculitis, has been reported. It is generally associated with hematologic malignancies rather than solid malignancies and commonly presents as leukocytoclastic vasculitis or polyarteritis nodosa. We experienced a case of leukocytoclastic vasculitis in a patient with hepatocellular carcinoma and membranous obstruction of the inferior vena cava. Here, we report this case with a brief review of literature. (J Rheum Dis 2015;22:322-326)

최근 病院可檢物에서 분리되는 중요 細菌의 抗生劑感受性

李源吉,金在崇,金重明,金在植 慶北大學校 醫科大學 1982 慶北醫大誌 Vol.23 No.2

1981년 본 대학 부속병원 임상병리 細菌檢査室에 의뢰된 검체에서 분리된 35種의 총 菌株수는 891株이었으며 소변에서 분리된 것이 301株(33.8%)로 가장 많았고 다음은 喀痰, 膿 및 咽喉순이었다. 100株 이상씩 분리된 菌種은 S. epidermidis, Micrococcus, S. aureus와 E. coli 순이었고 S. epidermidis는 小便과 喀痰, Micrococcus는 喀痰에서 S.aureus는 膿과 小便에서 E. coli는 小便에서 분리된 것이 대부분이었다. Streptococcus는 α-hemolyticus가 99株로서 喀痰에서 주로 분리되었고 50株 내외로 분리된 K. pneumoniae, Ent.cloacae, Ps. fluorescens, Citrobacter freundii와 Acinetobacter calcoaceticus는 각각 小便과 喀痰, 小便과 膿, 膿과 小便, 小便 및 小便에서 대부분 분리되었고 기타 菌種은 소수에서 분리되었다. 7種의 중요 菌種으로 부터 각각 무작위로 선택한 총 258株를 대상으로 하여 9種의 抗生劑에 대하여 disk diffusion(DD)와 agar dilution(AD)법으로 感受性을 조사하였다. E. coli 는 amikacin(AMK)에 매우 높은 感受性을 gentamycin(GAM)과 tobramycin(TOB)에 비교적 높은 感受性을 보였고 ampicillin(AMP), chloramphenicol(CAM) 및 tetracyaline(TET)에 비교적 높은 耐性을 나타내었고 K. pneumoniae는 AMK에 높은 感受性을 CEP, GAM 및 TOB에 비교적 높은 感受性을 보였고 AMP에 고도의 耐性, CAM과 TET에는 비교적 높은 感受性을 CAM과 GAM에는 중등도의 感受性을 penicillin과 TET에 고도의 耐性을 보였다. Ser. marces-cens 는 AMK에 중등도의 感受性을 GAM에 낮은 感受性을 보이나 나머지 抗生劑에 고도의 耐性을 보였다. Ps. aeruginosa는 AMK에 비교적 높은 感受性을 GAM, TOB 및 carbenicillin에 비교적 낮은 感受性을 보였고 Salmonella group A는 AMK, GAM, AMP, CEP, CAM 및 TOB에 매우 높은 感受性의 경향을 나타내었고 TET에도 비교적 높은 感受性의 경향을 나타내었다. Shigella group B는 AMK CEP, GAM 및 TOB에 매우 높은 感受性의 경향을 그리고 AMP, CAM 및 TET에 매우 높은 耐性의 경향을 보였다. Amikacin이 모든 供試菌들에 대하여 가장 强한 抗菌力을 보였고 Serratia 菌種과 Pseudomonas菌種은 다른 供試菌種에 비하여 확실히 耐性의 傾向을 나타내었다. Agar dilution 法과 disk diffusion 法에서 이 두방법은 서로 잘 일치하는 경향이나 DD법이 AD법에 비하여 안정성을 보이는 것 같았다. 검체에 의한 각 菌種사이에 있어서 感受性의 차이는 볼 수 없었다. Total numbers of isolated bacteria were 35 species and were 891 strains. The highest isolates were 301 strains (33.8%) which were from urine specimens and followed by sputum, pus and throat. S. epidermidis, Micrococcus, S. aureus and E. coli in order were over 100 strains. S.epidermidis strains were isolated mainly from urine and sputum, Micrococcus strains from sputum, S. aureus strains from pus, and urine and E. coli from urine, and Streptococcus (α-hemolyticus) were 99 strains which were isolated from mainly sputum. K. Preumoniae, Ent. cloacae, Ps. fluorescens, Citrobacter freundii and Acinetobacter calcoaceticus were more or less 50 strains and isolated mainly from urine and sputum, urine and pus, and urine, urine and urine respectively. Others were in small numbers. Totally 258 strains selected at random from 7 important bacteriae which were selected recently and antibiotic susceptibility testings to these orgamisms were performed. E. coli was very sensitive to amikacin (AMK), moderately sensitive to gentamycin (GAM) tobramycin (TOB) and moderately risistant to ampicillin (AMP), chloramphenicol (CAM) and tetraciclin (TET). K. pneumoniae was highly sensitive to AMK, moderately sensitive to cephalothin (CEP), gentamycin (GAM) and TOB, very highly resistantce to ampicillin (AMP) and highly resistant to CAM and TET. S. aureus was very sensitive to AMK, and CEP, moderately sensitive to CAM and GAM, and very highly resistant to penicillin and TET. Ser. marcescens revealed low sensitivity to AMK and GAM but resistances to the other antibiotics. Salmonella group A showed very high sensitivity to AMK, GAM, AMP, CEP, CAM and TOB and high sensitivity even in TET. Shigella group B were very highly sensitive to AMK, CEP, GAM and TOB, but very highly resistant to AMP, CAM and TET. AMK showed the highest sensititity to the most organism but Serratia and Pseudomonas revealed distinctively high resistances to antibiotics even in the new potent antibiotics of broad spectrum. The disk diffusion and agar dilution method were generally corresponding but the former appeared to be more reliable. There were no remarkable difference in susceptibility from specimen to specimen.