다낭성 신질환을 동반한 만성신부전으로 혈액투석 중인 결절성 경화증 환자에 발생한 신혈관근지방종 파열 치료 1예

김태우 ( Tae Woo Kim ),김숙 ( Sook Kim ),양승부 ( Seung Boo Yang ),이추희 ( Chu Hee Lee ),박종원 ( Jong Won Park ),도준영 ( Jun Young Do ) 대한신장학회 2007 Kidney Research and Clinical Practice Vol.26 No.6

사지마비로 장기 침상안정 환자에서 폐결핵 발생부위 변화

황헌규 ( Hun Gyu Hwang ),정은정 ( Eun Jung Jung ),임건일 ( Gune Il Lim ),양승부 ( Seung Boo Yang ),임한혁 ( Han Hyeok Im ) 대한결핵 및 호흡기학회 2010 Tuberculosis and Respiratory Diseases Vol.69 No.1

Pulmonary tuberculosis has intermediate prevalence in Korea. It is known that tuberculosis infection predominantly involves the upper lobes, based on the fact that multiplication of Mycobacterium tuberculosis is favored in areas with decreased pulmonary blood flow, impaired lymphatic drainage, and high oxygen tension. We report this case of a 40-year-old man who was brought to our hospital with hemoptysis and dyspnea. Prior to admission, the patient had been in a bedridden state for 15 years due to an injury of the cervical spine 4~5. A 3-Dimensional computed tomography showed predominantly longitudinal distribution of centrilobular nodules along the anterior chest wall, in the left lung. MTB-PCR and AFB culture of bronchial washing fluid revealed pulmonary tuberculosis. This case shows that long-standing supine posture and decreased motion of the anterior chest wall may change the distribution of preferential infection site of Mycobacterium tuberculosis in the lung, resulting in a ventral predominance of tuberculosis infection in the quadriplegic patient.

양측 자궁동맥 색전술을 이용한 자궁근종의 치료

최정범 ( Jeong Bum Choi ),유지훈 ( Ji Hoon Yoo ),김신혜 ( Shin Hye Kim ),박승준 ( Seung Jun Park ),조환성 ( Hwan Sung Joe ),한효상 ( Hyo Sang Han ),황인철 ( In Cheol Hwang ),최규연 ( Kyu Yeon Choi ),양승부 ( Seung Boo Yang ) 대한산부인과학회 2006 Obstetrics & Gynecology Science Vol.49 No.11

목적: 자궁근종 환자들을 대상으로 하여 수술을 피하고 싶은 환자, 가임 여성으로 자궁을 보존하고 싶은 환자들을 대상으로 양측 자궁동맥 색전술을 시행하여 양측 자궁동맥 색전술이 자궁근종 증상 및 근종의 크기를 얼마나 감소시킬 수 있는지를 평가하고자 하였다. 연구 방법: 2003년 1월부터 2005년 6월까지 2년 6개월 동안 본원 산부인과 외래에서 초음파로 자궁근종으로 진단 받은 환자들을 대상으로 하여 수술을 원치 않거나, 가임기 여성으로 임신을 위해 자궁을 보존하고 싶어하는 증상이 있는 환자들을 대상으로 하였다. 시술 전에 질식초음파와 MRI를 이용하여 자궁근종의 크기를 다시 정확히 측정하였으며, 시술 후 2, 6, 12주 후에 질식 초음파를 통하여 근종 크기의 감소 여부를 측정하였고, 증상의 호전 여부에 대하여 많이 호전, 약간 호전, 호전 없음, 약간 악화, 많이 악화로 구분하여 조사, 평가하였다. 결과: 환자군의 평균연령은 24세 에서 50세로 평균 36.3±7.9세였고, 근종의 평균 직경은 4.8±2.5 cm이었고, 평균 부피는 55.4 (46.3-67.4) cm3이었다. 근종의 형태는 간질 또는 근층내 근종이 9예, 점막하근종이 6예였고, 장막하 또는 복막하 근종 및 유경성 근종, 광간막 근종은 없었다. 평균자궁근종 용적감소는 시술 후 2주 후, 6주 후, 12주 후에 58.6±9.7%, 77.5±12.3%, 86.8±23.5%으로 자궁근종의 크기가 의미 있게 감소한 것을 확인할 수 있었다. 질출혈이나 하복부 통증의 증상은 시술 12주 후 많이 호전된 경우가 60%, 약간 호전된 경우가 40%였으며, 호전이 없거나 악화된 경우는 없었다. 대부분의 연구 대상자에 있어서 증상의 호전을 보였다. 자궁동맥 색전술 시행 후 전자궁 절제술이나, 자궁근종 절제술 등의 수술을 시행 받은 경우는 없었으며, 자궁근종 크기의 증가나, 증상의 악화를 보인 경우도 없었다. 시술 후 합병증으로는 시술 후 복부통증이 모든 환자에게서 발생하였으나, 감염, 자궁괴사, 난소기능저하, 재출혈, 혈종 등의 합병증은 없었다. 결론: 따라서, 자궁동맥 색전술을 이용한 자궁근종의 치료는 수술로 인한 출혈이나 감염, 요관손상 등의 부작용을 최대한 줄일 수 있으며, 덜 침습적인 치료방법으로, 무엇보다도 자궁내막 손상이 거의 없어 가임 여성에서 생식능력을 보존할 수 있다는 장점을 가진 유용하고 안전한 치료방법이 될 것이다. Objective: The purpose of this study is to evaluate the effectiveness and safety of uterine artery embolization for the treatment of symptomatic leiomyomas in the patients who want to preserve uterus, want fertility or feel fear for operation. Methods: From January 2003 to June 2005, among the patients with symptomatic uterine leiomyoma, fifteen women who wanted to preserve uterus or wanted fertility or had fear for operation were included in this retrospective study. Bilateral Uterine artery embolization (UAE) was performed. At the preprocedure and at 2, 6, and 12 weeks of postprocedure, transvaginal ultrasonography was performed for all patients. Clinical symptoms and follow-up information for each patient were evaluated. Results: 15 leimyomas were treated with UAE. The initial mean volume of leiomyomas was 55.4 (46.3-67.4) cm3. The mean volume decrease was 58.6±9.7%, 77.5±12.3%, 86.8±23.5% at 2, 6, 12 weeks. The outcome of clinical symptoms were as followed; `much improved` 20% (3/15), `somewhat improved` 60% (6/15), `no improvement` 20% (3/15), `somewhat worsen`s 0% (0/15), and `much worsen` was 0% (0/15). There was no case of hysterectomy or myomectomy after UAE. And also no case of increasement of volume nor worsening of clinical symptoms were found. Lower abdominal pain was the most common symptoms after UAE, but complications were not detected. Conclusion: In this study, UAE to treat patients with uterine leiomyoma is proved to be effective not only in volume reduction, but also in symptom improvement. And it is a relatively less-invasive procedure which decreases the risk of side effects of operation. Above all things, it preserves fecundity in young women. Therefore, UAE is very effective and safe procedure in the treatment of symptomatic uterine leiomyoma.

증례 : 호흡기 ; 결핵성 흉막염을 동반한 갑상선 유두암의 폐전이 1예

안병규 ( Byung Kyu Ahn ),박세윤 ( Se Yun Park ),황헌규 ( Hun Gyu Hwang ),임건일 ( Gun Il Lim ),김숙 ( Sook Kim ),양승부 ( Seung Boo Yang ),임한혁 ( Han Hyeok Im ) 대한내과학회 2010 대한내과학회지 Vol.79 No.3

저자들은 70세 여자 환자가 흉수소견으로 내원하여 흉수 천자 및 늑막 조직검사를 시행하여 결핵성 흉막염이 진단되었으나, 아데노신 탈아미노효소가 2.4 IU/L로 낮았고, 흉부 전산화단층촬영상 우하엽에 폐종괴 소견과 양측 미세결절이 관찰되었다. 경흉 세침흡입 세포검사에서 5년 전 전절제술을 받았던 갑상선 유두암의 폐전이가 진단되어, 결핵성 흉막염을 동반한 갑상선 유두암의 폐전이 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Papillary thyroid carcinoma is the most prevalent type of thyroid cancer. Metastasis of this carcinoma commonly occurs in the lung and has been reported to present 5 to 30 years after the initial diagnosis of thyroid cancer. Pleural effusion can mask this metastatic spread. In patients with pleural effusion, laboratory measurement of the adenosine deaminase (ADA) level in the pleural fluid can be effective in identifying and ranking pulmonary metastasis in the differential diagnosis. A 70-year-old female patient visited our hospital with dyspnea. She presented with a considerable amount of pleural effusion. A pleural biopsy was performed and the Ziehl-Neelsen stains revealed a few acid-fast bacilli, but the ADA level in the pleural fluid was 2.4 IU/L. After drainage of the pleural effusions, we discovered pulmonary nodules by computed tomography (CT), which were later diagnosed through histologic examination as pulmonary metastasis from papillary thyroid carcinoma. We report this case. (Korean J Med 79:311-315, 2010)

자궁선근증의 방사선학적 진단 : 경질초음파의 유용성과 유용한 소견 Usefulness of Transvaginal Sonogram and Useful findings

양승부,최진수 순천향의학연구소 2003 Journal of Soonchunhyang Medical Science Vol.9 No.1

Object : To evaluate the usefulness of transvaginal sonogram for radiologic diagnosis of adenomysis uteri and useful trasvaginal sonogram findings. Materials and Methods : Thirty five patients who were performed both ulㅅrasonography and hysterectomy proved as adenomyosis were analysed by sonographic finding of myometrial echo texture and also included 4 cases of combined myoma. Results : Four pattern of myometrial echo texture were analyzed. The most common type is ill defined heterogenous echo(19 case) but sensitivity is low(69%). And then ill defined heterogenous echo with multiple small cystic echoes(3 case), multiple alterating striation echo pattern(11 case), and single cystic echo(2 case) were followed. Ill defined heterogenous echo with multiple small cysts and multiple alterating striation echo pattern were most reliable findings(100% of sensitivity). Conclusion : Most reliable myometrial echo texture of adenomyosis are ill defined heterogenous echo with combined multiple small cyst or multiple alterating striation echo pattern. Multiple alteraing striation echo is the suggested charateristic finding of adenomyosis.

동맥색전술을 이용한 객혈의 치료

양승부,최진수 순천향의학연구소 2003 Journal of Soonchunhyang Medical Science Vol.9 No.1

Object : Our purpose of this study is to evaluate the effectiveness of the bronchial and non-bronchial systemic arterial embolization for control of hemoptysis. Materials and Methods : 20 cases of seventeen patients with massive or recurrent hemoptysis underwent percutaneous transcatheter embolization between January 1999 and September 2001. We reviewed 26 cases of bronchial artery embolization and 17 cases of nonbronchial systemic artery embolization. Results : Immediate control of hemoptysis underwent percutaneous transcatheter embolization between January 1999 and September 2001. We reviewed 26 cases of bronchial artery embolization and 17 cases of nonbronchial systemic artery embolization. Results : Immediate control of hemoptysis was achieved in 16 of 20(80%) cases. The cause of hemoptysis was tuberculosis, bronchiectasis, and chronic bronchitis. Conclusion : Bronchial artery embolization is an effective and life saving procedure in non-surgical and preoperative candidates. Recognition and occlusion of non-bronchial systemic arterial that feed to hypervascular pulmonary lesion is essential for successful embolotherapy of hemoptysis.

경도관 동맥색전술을 이용한 비정상 자궁출혈의 치료

양승부,최교창,이상진,정영진,임한혁,한효상,황인철,조환성 순천향의학연구소 2005 Journal of Soonchunhyang Medical Science Vol.11 No.1

Objective : Our purpose of this study is to evaluate the effectiveness of the transcatheter arterial embolization for the management of abnormal uterine bleeding. Materials and Methods : 14 patients with massive or recurrent uterine bleeding underwent percutaneous transcatheter arterial embolization between February 2003 and September 2004. We reviewed 14 cases of uterine artery or internal iliac artery embolization using gelfoam or PVA particles. Results : Good management of uterine bleeding was achieved in 13 of 14(93%) cases. The cause of abnormal uterine bleeding was myoma(5 case), post D & E bleeding(3), acquired vascular malformation(3), pseudoaneurysm(1), adenomyosis(1), and endometrial hyperplasia(1). Conclusion : Transcatheter artery embolization is an effective and life-saving procedure in massive or recurrent uterine bleeding. Early diagnosis and prompt transcatheter arterial embolization is a useful mangement of uterine bleeding.

골반 골절에 동반된 동맥 출혈에서의 경피적 동맥색전술의 유용성

양승부,임한혁,최교창 순천향의학연구소 2005 Journal of Soonchunhyang Medical Science Vol.11 No.1

Purpose : To determine the usefullness of transcatheter embolization of arterial bleeding in patients with pelvic bone fracture. Materials and Methods : Between March 2003 and December 2004, we evaluated 13 injuried arteries of eight patients with pelvic bone fracture, All patients underwent angiography, followed by transcatheter arterial embolization using gelfoam. We investigated the vital sign, survival rate and complication of transcatheter arterial embolization. Results : Angiography revealed extravasation of cantrast media in six patients; extravasation and abrupt cut-off of an artery in two. The injured arteries involved(n=13) were internal pudendal(n=4), obturator(n=3), inferior gluteal(n=3), iliolumbar(n=2) and superior gluteal artery(n=1). Transcather arterial embolization was technically successful and there was no complication in all cases. Old age patients(n=2, >60years) died due to hypovolemia and pulmonary complication. Conclusion : Transcatheter arterial embolization of arterial bleeding is a useful procedure in lowering the mortality and complication in pelvic bone fracture.