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( Jae Huk Choi ),( Jong Sung Park ) 대한내과학회 2013 대한내과학회 추계학술대회 Vol.2013 No.1
Acute myocardial infarction (AMI) secondary to dissection of the ascending aorta remains a relatively rare complication. Aortic dissection frequently confused with AMI, leading to delayed diagnosis and inappropriate treatment with antiplatelet, antithrombin, and percutaneous coronary intervention (PCI). We report a case of a 57 years old female who presented with signs and symptoms of AMI and was later found to have aortic dissection. A 57-year old woman with a history of hypertension and diabetes mellitus visited emergency room with effort chest pain accompanied by sweating and headache. She underwent aortic valve replacement 3 years ago. There was no significant ST-segment change or pathologic Q-wave on initial standard 12-lead electrocardiogram (ECG). Transthoracic echocardiography revealed ischemic insult of LAD territory, mild left ventricular dysfunction and normal prosthetic aortic valve state. Anticoagulation and antiplatelet therapy started and chest pain was relieved. After 4 hours, she complained re-onset chest pain and follow-up ECG and troponin- I level showed severe T-inversion in V1-6 and 20.7 ng/mL. Emergency coronary angiography (CAG) showed diffuse stenosis from proximal left anterior descending (LAD) artery to distal LAD artery. After repeated intra-arterial nitrate therapy, diffuse stenosis of LAD artery was resolved. We diagnosed non ST-segment myocardial infarction induced by severe LAD artery spasm and prescribed calcium channel blocker. 2 days later, she complained recurrent chest pain and follow-up troponin- I showed 50 ng/mL. Repeated CAG demonstrated diffuse stenosis of LAD artery. But, although repeated intra-arterial nitrate therapy, LAD artery was not resolved. Cardiac computed tomography (CT) performed and revealed ascending aortic dissection of from aortic root to distal aortic arch and extension to mid LAD territory. Emergency ascending aorta replacement with Bentall`s operation was performed. The patient recovered completely and discharged. This case illustrates how myocardial infarction can mask an aortic dissection. Careful evaluation of clinical features and use of various modalities such as ECG, echocardiography, and cardiac CT is necessary for accurate diagnosis.
10년간 크기가 서서히 증가한 고립성 폐결절이 선암으로 진단된 1예
권기두 ( Ki Du Kwon ),김지형 ( Ji Hyeong Kim ),김대용 ( Dae Yong Kim ),최문한 ( Moon Han Choi ),최재혁 ( Jae Huk Choi ),신동원 ( Dong Won Shin ),최종효 ( Jong Hyo Choi ),이설희 ( Sul Hee Yi ),윤진아 ( Jin A Yun ),최재성 ( Jae Sung 대한결핵 및 호흡기학회 2008 Tuberculosis and Respiratory Diseases Vol.64 No.4
치주질환치료에서 국소약물 송달제재의 임상 및 세균학적 효과
최성재,이만섭,권영혁,Choi, Sung-Jae,Lee, Man-Sup,Kwon, Young-Huk 대한치주과학회 1993 Journal of Periodontal & Implant Science Vol.23 No.1
The purpose of this study was to evaluate the clinical and microbiological effects of minocycline-loaded polycaprolactone strip on periodontal disease. Ten patients with probing depth (deeper than 5mm) were tested. Of the two periodontal pockets selected from each patient, one randomly selected pocket was treated by the insertion of 30% minocycline-loaded polycaprolactone sttip as the experimental group and the other with a minocycline-free polycaprolactone strip as the control group. All groups were examined by clinical and microbiological methods. 1. Plaque index scores, gingival index scores and sulcular bleeding index scores in both group were significantly reduced from the baseline to 2 weeks. Plaque index scores of experimental group and sulcular bleeding index scores of control group tended to be progressively reduced in all experimental periods. 2. Probing depth amounts in both group were significantly reduced from 4 weeks to 8 weeks. 3. Attachment loss amounts in both group shows no singnificant differences in time. Attachment loss amounts in experimental group tended to be less than those in control group. 4. The number of cocci in both groups were significantly increased in all experimental periods, but that of the non-motile rods were significantly reduced from 2 weeks in experimental group, and from 4 weeks in control group, that of the motile rods were reduced from 4 weeks in experimental group and from 1 week in control group. The number of spirochetes were reduced from I week during all experimental period in experimental group, but there was no changes in control group.
에이즈 환자에서 발생한 파종성 조류형 결핵균 감염 1예
이설희,최재혁,최문한,신동원,최종효,김태형,전민혁,고은석,추은주 대한감염학회 2008 감염과 화학요법 Vol.40 No.5
Nontuberculous Mycobacteria, especially Mycobacterium avium complex (MAC) infection is a common opportunistic infection in patients with acquired immunodeficiency syndrome (AIDS). In patients with AIDS, MAC infection more frequently presents as disseminated form rather than localized infection. Disseminated MAC infection is associated with a high mortality rate in patient with AIDS. We report a case of disseminated MAC infection in an AIDS patient involving bone marrow, mediastinal lymph node and lung.
정태연,손석만,이창화,이원재,백승덕,최우혁,정희철,정소연,김남일,서정일,양창헌,이창우,정기훈,김정란 東國大學校醫學硏究所 2002 東國醫學 Vol.9 No.2
위장관은 악성 림프종이 가장 흔히 침범하는 림프절 외 장기이지만, 원발성 소장 악성림프종이 비교적 드물게 발생한다. 장중첩증은 장 림프종의 드문 징후이며, 다양한 영상 검사에 의하여 진단된다. 저자들은 회장 장중첩증에 의해 우연히 발견된 림프종의 예를 보고하는 바이다. 조직학적 소견은 미만성 대 B 세포의 악성 림프종이였고, 중증도의 미만성 대비분열성세포이였다. 환자는 수술적인 절제술과 항암요법을 시행하였고 15개월간 재발이 없는 상태로 추적 관찰 중이다. Although the gastrointestinal tract is one of the most frequent sites of extranodal malignant lymphoma, the occurrence of primary small intestinal lymphoma is relatively uncommon. The intussusception is a rare presenting sign of intestinal lymphoma, and diagnosed by various imaging studies. We report on a case of the lymphoma on ileum manifested by ileo-ileal intussusception. Pathologic type was malignant lymphoma with diffuse large B cell (REAL classification), intermediate grade, diffuse large noncleaved cell (Working formulation). The patient received surgical resection and combined chemotherapy and doing well for 15 months.
소화성 궤양 출혈에서 내시경적 클립 시술의 기술적 완성도 결정인자
황순오,이석호,김종화,김수지,서성우,이용관,전웅,조영신,최문한,최재혁 순천향의학연구소 2007 Journal of Soonchunhyang Medical Science Vol.13 No.2
Background/Aims: Although endoscopic hemoclip therapy for bleeding peptic ulcer has widely been used, there are few reports that assess its technical completeness. We retrospectively evaluated the related factors for the completeness of endoscopic hemoclip placement with bleeding peptic ulcer. Methods: 50 patients were enrolled. They received emergency endoscopy and received hemoclip application for bleeding peptic ulcer, then follow up endosconv was performed after 48 hours. We analyzed endoscopic feature, clinical factors and operator's experience retrospectively. Results: Initial hemostasis was achieved in 100%. The rebleeding rate was 10%. In cases larger and peripherally located vessel on the ulcer, difficult site of ulcer to access and insufficiently experienced endoscopist, the rate of completeness of endoscopic hemoclip placement were significantly lower with statistical difference(p<0.05). Conclusions: Endoscopic hemoclip application provides effective hemostasis in the treatment of bleeding peptic ulcer. But in difficult cases, we have to attend various technical re-adjustment or may consider other hemostatic procedures instead of doing hemoclip therapy.