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증례 : 호흡기 ; 양성 전이성 폐 평활근종의 자연 경과
박재만 ( Jae Man Park ),최재성 ( Jae Sung Choi ),나주옥 ( Ju Ock Na ),김용훈 ( Yong Hoon Kim ),서기현 ( Ki Hyun Seo ),오미혜 ( Mi Hye Oh ),조성식 ( Sung Shick Jou ) 대한내과학회 2011 대한내과학회지 Vol.81 No.3
폐에 발생하는 양성 전이성 근종은 과거 자궁 절제술이나 근종 절제술을 시행 받은 가임기 여성에게 호발하는 드문 질환으로 악성의 임상 특징을 가진다. 대부분 무증상이나 일부에서는 마른 기침이나 흉통, 호흡곤란 및 심한 경우 호흡 부전까지 발생하는 등 여러 가지 임상양상을 가진다. 치료는 본 질환이 여성 호르몬과 관련 있어 여성 호르몬을 소실시키는 방법을 주로 사용하고 있다. 저자들은 자궁 절제술과 근종절제술을 시행받은 기왕력이 있는 여성에서 발생한 양성 전이성 폐평활근종 각각 1예를 경험하여 문헌고찰과 함께 보고하는 바이다. Benign metastasizing pulmonary leiomyoma is a rare disease that is usually detected several years after hysterectomy or myomectomy. Recently, we experienced two cases, one with monthly chest pain and the other without symptoms, which were diagnosed with benign metastasizing leiomyoma in the lung. A 48-year-old woman who underwent hysterectomy 12 years earlier was referred to us because of multiple pulmonary nodules on chest radiography, and chest pain for 6 months. Thoracoscopic tumor excision was performed. Pathologically, she was diagnosed with benign metastasizing leiomyoma in the lung. After that, chest computed tomography showed tumors with a progressive reduction in size. The other 48-year-old woman, who had undergone myomectomy for uterine leiomyoma 8 years before, visited our hospital for evaluation of incidentally revealed bilateral multiple nodules on chest radiography. The microscopic finding of percutaneous transthoracic needle biopsy revealed a benign pulmonary metastasizing leiomyoma originating from uterine leiomyoma. Multiple nodules on chest radiography were more increased than those performed 1 year and 3 months prior to admission. However, chest X-ray showed tumors that had progressively decreased in size at 6 months after diagnosis of menopause. (Korean J Med 2011;81:387-392)
성인에서 발견된 비정형 샘 증식증과 동반된 폐의 선천성 낭성 선종양 기형
이호성 ( Ho Sung Lee ),최재성 ( Jae Sung Choi ),서기현 ( Ki Hyun Seo ),나주옥 ( Ju Ock Na ),김용훈 ( Yong Hoon Kim ),오미혜 ( Mi Hye Oh ),조성식 ( Sung Shick Jou ) 대한결핵 및 호흡기학회 2009 Tuberculosis and Respiratory Diseases Vol.66 No.5
Congenital cystic adenomatoid malformation (CCAM), which is classified into five types according to size and bronchial invasion, is a rare type of developmental anomaly of the lung. CCAM is occasionally accompanied by malignancy, such as bronchioloalveolar carcinoma (BAC) or rhabdomyosarcoma. As defined by the WHO, atypical adenomatous hyperplasia (AAH) is a non-invasive spread of atypical epithelial cells in single rows along the alveolar wall, within a lesion that is usually less than 5 mm in diameter. AAH was also regarded as a pre-invasive neoplasia, especially associated with BAC and adenocarcinoma. We report a case of type II CCAM with AAH in adults, with a review of the references.
하대정맥 필터 삽입 후 합병증으로 발생한 Phlegmasia Cerulea Dolens
조영신 ( Young Sin Cho ),김종화 ( Jong Hwa Kim ),이호성 ( Ho Sung Lee ),최재성 ( Jae Sung Choi ),나주옥 ( Ju Ock Na ),서기현 ( Ki Hyun Seo ),김용훈 ( Yong Hoon Kim ) 대한결핵 및 호흡기학회 2008 Tuberculosis and Respiratory Diseases Vol.65 No.3
Inferior vena cava filters are increasingly being used as an alternative to anticoagulation therapy for the prevention of pulmonary embolism. However, using an Inferior vena cava filter may result in clinically significant complications. Phlegmasia cerulea dolens is a rare disease that presents with acute complete venous occlusion due to extensive thrombosis in the lower extremity. It is characterized by intense pain, edema, decreased pulses and a cyanotic extremity. We report here on a case of phlegmasia cerulea dolens that was accompanied with disseminated intravascular coagulation (DIC) as a complication of the placement of an inferior vena cava filter in a patient who had been previously diagnosed with pulmonary embolism, and the patient had recently developed a cerebral hemorrhage due to a traffic accident. (Tuberc Respir Dis 2008;65:225-229)
증례 : 호흡기 ; 골수형성이상증후군에서 폐 침윤과 흉수를 동반한 스위트 증후군 1예
고규봉 ( Gyu Bong Ko ),이혁규 ( Hyeok Gyu Lee ),이호성 ( Ho Sung Lee ),최재성 ( Jae Sung Choi ),서기현 ( Ki Hyun Seo ),나주옥 ( Ju Ock Na ),김용훈 ( Yong Hoon Kim ) 대한내과학회 2011 대한내과학회지 Vol.80 No.2
저자들은 75세 골수형성이상증후군 환자에서 폐 침윤과 동반된 양측 흉수가 발생한 스위트 증후군 1예를 경험하였기에 이를 보고한다. Sweet`s syndrome is characterized by a constellation of clinical symptoms, physical features, and pathologic findings, which include fever, leukocytosis, tender erythematous skin lesions, and a diffuse infiltrate consisting predominantly of mature neutrophils in the upper dermis. Pulmonary involvement in Sweet`s syndrome is rare. In addition, a pleural effusion has been rarely reported in the pulmonary involvement of Sweet`s syndrome. We report a case of Sweet`s syndrome presenting with pulmonary involvement and a bilateral pleural effusion in a patient with myelodysplastic syndrome. (Korean J Med 2011;80:216-220)
김지연 ( Ji Yon Kim ),황현규 ( Hyun Gyu Hwang ),최재성 ( Jae Sung Choi ),서기현 ( Ki Hyun Seo ),김용훈 ( Yong Hoon Kim ),오미혜 ( Mee Hye Oh ),나주옥 ( Ju Ock Na ) 대한결핵 및 호흡기학회 2008 Tuberculosis and Respiratory Diseases Vol.64 No.3
쇼그렌 증후군은 림프구 침윤과 관련된 만성적인 염증성 자가면역 질환으로 아직 정확한 병태생리학적 기전은 밝혀지지 않았다. 45세 여자 환자가 내원 2년 전 전신 쇠약 및 피로감으로 입원하여 혈청 검사에서 anti-Ro/La antibody 양성, 흉부 단순방사선 및 컴퓨터 촬영에서 양 폐야의 다낭성 병변이 관찰되어 비디오 흉강경을 이용한 폐 생검 시행 결과 세기관지 주위에 림프구 침윤 및 다양한 크기의 폐낭종들이 관찰되어 쇼그렌 증후군의 폐 침범 의심하에 추가 검사 시행하려 하였으나 추적 관찰 되지 않았다. 2년 후 폐렴으로 입원하였으며, 다시 시행한 흉부 컴퓨터 단층촬영에서 다발성 낭성 변화는 큰 차이를 보이지 않았다. 쇼그렌 증후군의 폐 침범은 다양한 형태로 나타나는데, 단순히 세기관지 주위에 림프구 침윤에 의한 다낭성 폐 질환에 대한 보고는 극히 드물다. 따라서 본 저자들은 일차성 쇼그렌 증후군 환자에서 비디오 흉강경을 이용한 폐 생검으로 진단된 세기관지 주위에 림프구 침윤을 동반한 다낭성 폐 질환 1예를 경험하였기에 보고하는 바이다. (Tuberc Respir Dis 2008;64:230-235)
증례 : 호흡기; 쯔쯔가무시병에서 발생된 급성 전격성 심근염 1예
한동재 ( Dong Jae Han ),박희순 ( Hee Soon Park ),김대연 ( Dae Yeon Kim ),강효철 ( Hyo Chul Kang ),이호성 ( Ho Sung Rhee ),이세환 ( Se Whan Lee ),나주옥 ( Ju Ock Na ) 대한내과학회 2013 대한내과학회지 Vol.85 No.6
쯔쯔가무시병은 국내에서 대표적인 가을철 열성 질환의 하나이며 이로 인한 호흡부전이나 신부전은 널리 알려져 있지만 심근염은 질병의 위중함에 미루어 잘 알려져 있지 않은 합병증이다. 저자들은 85세 고령의 여성에서 쯔쯔가무시병을 적절하게 빠른 시일에 진단하였으며 그 후 항균제 투약 등 적절한처치를 시행하였음에도 불구하고 급성 심근염 및 급성 신부전으로 사망한 예를 보고하였다. Scrub typhus is an acute febrile illness caused by Orientia tsutsugamushi that is characterized by focal or disseminated vasculitis and perivasculitis. Scrub typhus can have fatal complications, such as acute respiratory distress syndrome, septic shock, and acute kidney injury. However, there are few reports of fatal myocarditis caused by scrub typhus. We present a case of acute fatal myocarditis combined with acute kidney injury complicating scrub typhus. (Korean J Med 2013;85:623-628)
수술 및 단기간의 항생제 투여로 완치된 기관지 방선균증 2예
이용관 ( Yong Kwan Lee ),이호성 ( Ho Sung Lee ),오미혜 ( Mee Hye Oh ),최재성 ( Jae Sung Choi ),서기현 ( Ki Hyun Seo ),김용훈 ( Yong Hoon Kim ),나주옥 ( Ju Ock Na ),황헌규 ( Hun Gyu Hwang ) 대한결핵 및 호흡기학회 2008 Tuberculosis and Respiratory Diseases Vol.65 No.2
Endobronchial actinomycosis is a rare chronic suppurative granulomatous infection of the bronchus, and this is sometimes related with a foreign body or a broncholith. The traditional treatment of endobroncial actinomycosis is intravenous antibiotics for 2 to 6 weeks and then oral antibiotics therapy for 6 to 12 months. We report here on 2 cases of endobronchial actinomycosis that were associated with a broncholith and a foreign body, respectively. Surgery followed by short term antibiotics therapy for only 20 days and 34 days, respectively, was effective as treatment for the endobronchial actinomycosis in our cases. After treatment, there were no complications or recurrence during the following period. We suggest that short term antibiotics therapy combined with a surgical operation might be effective as treatment for primary endobronchial actinomycosis, and especially when this illness is combined with a foreign body or a broncholith, as compared with traditional long term antibiotic therapy. (Tuberc Respir Dis 2008;65:125-130)
근치적 수술 후 소장으로 단독 전이된 폐의 다형성 암종
김기원 ( Ki Won Kim ),이호성 ( Ho Sung Lee ),최재성 ( Jae Sung Choi ),서기현 ( Ki Hyun Seo ),오미혜 ( Mee Hye Oh ),조성식 ( Sung Shick Jou ),김용훈 ( Yong Hoon Kim ),나주옥 ( Ju Ock Na ) 대한결핵 및 호흡기학회 2011 Tuberculosis and Respiratory Diseases Vol.71 No.2
Small bowel metastasis of pleomorphic carcinoma of the lung is very rare. A 58-year-old man was admitted to our hospital with abdominal palpable mass in the right upper quadrant area. He underwent right middle and lower lobectomy for early stage pleomorphic carcinoma of the lung approximately 3 months ago. USG-guided biopsy was performed for abdominal mass. Pathologic examination revealed a metastatic pleomorphic carcinoma from the lung. He received chemotherapy followed by radiation therapy but died due to septic shock caused by intestinal stenosis and adhesion. We report the first case of small bowel metastasis by pleomorphic carcinoma of the lung after curative surgery.