폐결핵치료 중인 환자에서 Rifampicin에 의해 유발된 위막성 대장염 2예

김봉진,권균홍,임창섭,김자영,홍정범,옥미선,배용목,김지연 고신대학교의과대학 2008 고신대학교 의과대학 학술지 Vol.23 No.4

Pseudomembranous colitis (PMC) is a disease caused by Clostridium difficile proliferation. The causative drugs are clindamycin, third-generation cephalosporins, flouroquinolone and so on. Rifampicin has been reported as a cause of PMC in the 1980s, and the frequency of PMC is increasing because rifampicin is a first line drug for anti-tuberculosis therapy. Two patients were recently admitted to our hospital due to watery diarrhea for 1 month and they were diagnosed with PMC by sigmoidoscopy. Their onset age were 74, 72 years old and latent period of symptoms were 60, 129 days, respectively. In one case, the patient displayed coexisting hypertension and diabetes. The clinical symptoms improved after discontinuing the rifampicin and then administering oral metronidazole. We report here on two cases presumed to be rifampicin-induced PMC.

운동 유발성 횡문근 융해를 동반한 요로결석 2례

허진,최원혁,조진혁,함영희,홍정범,정성규,김현,허동 고신대학교 의과대학 2010 고신대학교 의과대학 학술지 Vol.25 No.2

Two men were admitted to hospital with flank pain, hematuria, which was diagnosised as ureteral stone. Elevation of aspartate aminotransferase (AST) without typical pattern of toxic hepatitis was observed. Careful history taking, several laboratory tests, abdominal and pelvis computered tomography was done. Findings from theses examinations supported the clinical diagnosis of ureteral stone complicated of exercised induced rabdomyolysis. Early recognization of rhabdomyolysis in clinical setting is important, because clinical manifestations have ranged from asymtomatic elevation of creatine kinase to acute renal failure which is a life threating medical emergency. Authors report two cases of exercised induced rhabdomyolysis initially admittied as ureteral stone managed with hydration

우관상동맥에서 자발적으로 이동하는 폐쇄성 연축을 보인 이형 협심증1예

홍정범,허 진,조진혁,박민규,함영희,정성규,김수형,최재영 고신대학교 의과대학 2011 고신대학교 의과대학 학술지 Vol.26 No.2

Variant angina is a syndrome of cyclical chest pain at rest caused by vasospasm and associated with ST-segment elevation. Most of these cases are induced by the provocation with ergonovine or acetylcholine, and mechanical irritation of coronary artery by catheter, but spontaneous migrating spasm in right coronary artery is very rare. We report a fifty one year old male patient presenting as a variant angina due to spontaneous migrating spasm in right coronary artery during diagnostic coronary angiogram. The spasm was relieved spontaneously or by the administration of intracoronary nitroglycerin. No chest pain was documented after medication with calcium-channel blocker and nitrates on 6 month clinical follow-up. This paper presents our experience with a patient presenting with migrating coronay vasospasm of right coronary artery.

Poster Session:PS 1096 ; Gastroenterology (Gastrointestinal Tract) : A Case Report: Rectal Tonsil

( Peel Jung ),( Joung Boom Hong ),( Yuyi Choi ),( Sook Kyoung Oh ),( Dong Ku Kang ),( Hyung Wook Kim ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

The rectal tonsil is a reactive proliferation of lymphoid tissue located in the rectum. This lesion is benign lymphoid hyperplasia, but must be prevent a misdiagnosis from the polypoid type of mucosa-associated lymphoid tissue (MALT) lymphomas. We report a case of rectal tonsil. Case Report : A 59-year-old woman admitted for suspicious tuberculous colitis. Tuberculin test was negative. Micobacterium tuberculosis interferon test on blood was positive. Colonoscopy showed ulcerous lesions in the ascending colon and cecum, and the ileocecal valve was totally destroyed with ulcer and pseudopolyp formation. Furthermore, a hard, solitary sessile mass (5 mm) was noted at 10 cm from the anal verge (fig 1); endoscopic ultrasound showed a 5 mm homogenous hypoechoic mass located in the submucosa and without defi nite lymph node enlargement (fig 2). We performed cap-endoscopic mucosal resection (C-EMR). Histopathologically, a dense lymphoid infi ltrate mainly located in the submucosa and extened to mucosa that was a disc of yellow white mucosal tissue, measuring 0. 8 x 0. 5 x 0. 5 cm in dimensions. The lesion was characterized by follicles with well-formed reactive germinal centers of different size; there were abundant macrophages inside the germinal follicles. Immunohistologic study demonstrated that typical lymphoid follicles and suggested follicular type of proliferation with B cells markers were positive for CD20+ (B cells), and intraepithelial lymphocytes were positive for CD3+ (T cells). These studies confi rmed a reactive lymphoid proliferation, and excluded lymphoma. The patient was a tuberculostatic therapy with isoniazid, rifampicin, pyrazinamid, and ethambutol for 6 month. After 3 month of tuberculostatic therapy and C-EMR, follow-up colonoscopy showed grossly normal healed mucosa in cecum, ascending colon and rectum.

S-82 : Efficacy of cap-assisted colonoscopy, compared to standard colonoscopy

( Dong Jun Kim ),( Hyung Wook Kim ),( Cheol Woong Choi ),( Dae Hwan Kang ),( Su Bum Park ),( Joung Boom Hong ),( Byoung Hoon Ji ),( Seung Jei Park ),( Kyung Won Koh ),( Chang Seok Lee ) 대한내과학회 2013 대한내과학회 추계학술대회 Vol.2013 No.1

Background & Aims: Colonoscopy is an effective procedure for the detection of colon polyps. Early detection and removal of colon adenomatous polyps is important to prevention of colorectal cancer. A few studies showed that cap-assisted colonoscopy (CAC) improved polyp detection rate (PDR) and adenoma detection rate (ADR), but other studies showed different results. We evaluated PDR, ADR, large ADR, small ADR, and ADR of Right sided colon in expert group and trainee group, compared to standard colonoscopy (SC). Methods: Patients who underwent the first screening colonoscopy in Pusan National University Yangsan Hospital (PNUYH) were enrolled. The patients with poor or inadequate Aronchick scale was excluded. In expert group, three expert colonoscopists (more than 2,000 procedures) have performed procedures. In trainee group, twelve trainees have performed procedures. We retrospectively compared PDR, ADR, large ADR (polyp size ≥6mm), small ADR (polyp size ≤5 mm), and ADR of Right sided colon between CAC and SC group. We evaluate same factors between two groups in subgroup (expert and trainee) respectively. Results: A total of 420 colonoscopies were retrospectively analyzed in this study. CAC group is consist of 202 colonoscopies, and SC group is consist of 218 colonoscopies. Although PDR was higher in CAC group, but not significant (93/202 vs. 83/218, p=0.098). ADR was not different between both CAC and SC group (68/202 vs. 60/218, p=0.172). Large ADR was similar (27/202 vs. 21/218, p=0.23). Small ADR was higher in CAC group, but not significant (53/202 vs. 41/218, p=0.068). The ADR of Right-sided colon was higher in CAC group than SC group (49/202 vs. 35/218, p=0.036). Especially, ADR of Right-sided colon of CAC group was significantly higher in trainee group (38/155 vs. 23/173, p<0.01), but it was similar in expert group (11/47 vs. 12/45, p=0.718). Conclusion: CAC did not improve PDR and ADR than SC. But CAC significantly increased ADR of Right sided colon, especially in trainee group.

증례 : 신장 ; 성인에서의 신우요관이행부폐색의 1예

임창섭 ( Chang Sup Lim ),김봉진 ( Bong Jin Kim ),김자영 ( Ja Young Kim ),허진 ( Jin Heo ),최원혁 ( Won Hyuk Choi ),홍정범 ( Joung Boom Hong ),허동 ( Dong Heo ) 대한내과학회 2009 대한내과학회지 Vol.77 No.5S

신우요관이행부폐색은 태아, 신생아, 소아에서 상부요로 폐색을 일으키는 가장 흔한 기형으로 약 30~50%가 출생 전에 이미 진단되나 성인에서도 드물게 발견되는 경우도 있다. 소아에서의 진단은 초음파를 통하여 우연히 수신증이 발견 되거나, 요로감염 및 발열, 복부 및 측복부 동통, 종물의 촉지등의 증상으로 인해 발견되지만, 성인에서는 장기적으로 무증상을 보이다가 측복부 동통, 혈뇨 등이 나타나면서 진단되며, 일생 동안 증상이 없는 경우도 있다. 장기간의 측복부 동통을 주소로 내원하여 신우요관이행부폐색으로 진단된 성인의 1예가 있어 문헌고찰과 함께 보고하는 바이다. Ureteropelvic junction obstruction is the most common congenital anomaly and causes upper urinary tract obstruction in fetuses, neonates, and children, of which 30~50% is diagnosed before birth and rarely diagnosed in adults. In childhood, a ureteropelvic junction obstruction is usually diagnosed by incidental hydronephrosis on ultrasonography, UTIs, fever, abdominal and flank pain, and a palpable abdominal mass. In adults, a ureteropelvic junction obstruction may be asymptomatic for life or may result in flank pain and/or hematuria. We report a case of chronic flank pain, which was finally diagnosed as a ureteropelvic junction obstruction. (Korean J Med 77:S1253-S1257, 2009)