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대장용종의 겸자생겸과 내시경적 절제 후의 병리 조직 소견의 비교
강구흠 ( Gu Hyum Kang ),허규찬 ( Kyu Chan Huh ),김선문 ( Sun Moon Kim ),이태희 ( Tae Hee Lee ),임의혁 ( Euyi Hyeong Im ),최용우 ( Young Woo Choi ),김범경 ( Beom Kyoung Kim ),강영우 ( Young Woo Kang ),강구현 ( Gu Hyun Kang ) 대한내과학회 2008 대한내과학회지 Vol.74 No.3
목적: 대장암의 발생기전으로 생각되는 adenoma-carcinoma sequence 가설이 직접 증명된 경우는 없지만, 정상점막에서 양성선종, 대장암으로 진행되는 것에 대해서는 여러 가지 간접 증거들이 보고되고 있어 대장용종의 조직학적 진단이 매우 중요하다. 겸자 생검은 용종 전체 부분을 조직검사를 하는 것이 아니므로 전체 용종 절제를 통한 조직검사와는 다를 수 있으나, 처음 내원하여 내시경검사 시 언제나 즉시 대장용종 절제가 가능한 것은 아니다. 이에 저자들은 겸자 생검과 내시경 절제 후의 병리 조직 검사 결과를 비교하여 겸자 생검의 조직학적 유용성을 알아보고자 한다. 방법: 2003년 3월부터 2005년 12월까지 건양대학교 소화기내과를 방문하여 시행한 대장 내시경검사 시 시행한 조직검사에서 양성 용종으로 진단받은 환자 중에서 2주 이내에 전체 병변 절제를 시행한 환자 중 조직소견의 비교가 가능한 221명의 환자(평균나이 59.0, 남자: 152, 여자: 69)를 대상으로 겸자 생검 조직검사와 용종절제술 후 조직 검사 결과를 비교하여 보았다. 결과: 겸자 생검 결과 관상선종은 217예(71.8%), 관상융모상선종 20예(6.6%), 융모상선종 2예(0.6%), 증식성용종 29예(9.6%), 염증성용종 29예(9.6%), 그리고 암성변화는 5예(1.65%)였다. 용종절제술 후 조직검사 결과 관상선종은 186예, 관상융모선종 22예, 그리고 암종성 변화는 12예(4.0%)였다. 겸자 생검과 용종절제술 후 조직 소견은 302예 중 215예(71.2%)에서 일치하였다. 겸자 생검 결과에서 악성변화를 보이는 암종성 용종과 융모상 용종으로 진단된 경우, 용종절제술 후 조직검사에서도 모두 같은 소견을 보였다. 용종절제술 후 조직학적 진단에 비해 내시경적 겸자 생검의 악성도가 과소 진단된 경우 임상적 중요성을 가지며, 전체 용종 중 악성변화가 12예 중 겸자 생검에서 악성변화를 확인할 수 없었으나 용종절제술 후 조직검사에서 악성변화를 보인 경우는 7예로 모두 관상선종이었다. 7예 중 4예는 심한 이형성을 동반하였으며, 이형성이 없는 나머지 3예는 크기가 1 cm 이상인 경우였다. 결론: 대장용종 중 특히 선종은 대장암의 전구 병변으로 인식되고 있어, 선종성 용종의 진단은 매우 중요하며 조직학적 진단 시 겸자 생검 만으로 충분치 않다고 생각한다. 대장용종이 겸자 생검에서 선종으로 판명되었을 경우에는 정확한 진단 및 치료 목적으로 용종절제술이 필요하며 특히 크기가 1 cm 이상, 심한 이형성이 동반한 경우에는 용종절제술이 필요할 것으로 생각한다. Background/Aims: Adenomatous polyps of the colon are believed to be precursor of colon cancer. Total polyp resection is indicated when they are identified. However, resection of the polyp is not always attainable at the initial colonoscopy. The aim of this study was to assess the validity of cold biopsy findings as representative of the whole polypectomy specimen, with regard to the histopathological features. Methods: We analyzed 221 patients with colon polyps that were biopsied at their initial colonoscopy and had their adenomas subsequently removed by polypectomy within 2 weeks from the initial procedure. We analyzed the histopathological discrepancies between the cold biopsy and the polypectomy specimens. Results: We analyzed 302 cases from 221 patients. There was 71.2% agreement between the forceps biopsy and the polypectomy. When colon polyps were diagnosed as carcinoma and villous adenomas, the diagnosis was the same in the polypectomy. Discrepancy between in forceps biopsy with polypectomy was found in the tubular adenomas obtained by forceps biopsy. Fifty tubular adenoma samples obtained by forceps biopsy had a deferent diagnosis than did the polypectomy. Fourteen of 50 tubular adenomas were underestimated by the forceps biopsy samples and seven of the 50 tubular adenomas were finally diagnosed as carcinoma from the polypectomy specimens. Seven villous adenomas were diagnosed as carcinoma and had severe dysplasia (n=4) or 1>=(n=1) size. Conclusions: Accurate tissue sampling of colorectal adenomas is crucial for their management. However, forceps biopsy does not accurately reflect the histology of colon polyps. Total resection of colon polyps is needed for an accurate diagnosis. (Korean J Med 74:258-263, 2008)
증례 잉어 담즙 생식 후 병발된 무뇨성 급성신부전과 급성간염 및 횡문근융해증
강구현 ( Gu Hyun Kang ),박건태 ( Geon Tae Park ),송준휘 ( Jun Whee Song ),이지은 ( Ji En Lee ),우재곤 ( Jae Gon Woo ),조성 ( Sung Cho ),김성록 ( Sung Rok Kim ) 대한신장학회 2008 Kidney Research and Clinical Practice Vol.27 No.3
Gall bladder of a common carp is taken in some areas of Asia as a traditional medicine for improvement of their general health problems like hypertension, poor visual acuity, and impotence. Many cases have been reported on acute hepatitis, acute renal failure, gastrointestinal problems and neurological symptoms following ingestion of raw carp bile juice. We experienced a case of anuric ARF, acute hepatitis, and rhabdomyolysis that developed after indigestion of raw carp bile juice, not yet seen in previous studies. In this case, anuric state of patient was resolved after 4 days with continuous renal replacement therapy. Thus we report this case with review of literature.
김태영,김석영,강구현,Kim, Tae-young,Kim, Seok-young,Kang, Gu-hyun 대한상한금궤의학회 2012 대한상한금궤의학회지 Vol.4 No.1
Objective : to increase understanding of readers of Idan with translating in compliance with and restraining spoken language Method : referred to Chinese ancient language grammar and Korean standard language grammar Results & Conclusions : 1. spaced the original text by adequate syntax 2. corrected typo in typed text under the original text 3. translated in compliance with and restraining spoken language 4. footnoted in reference to fables and phrases.
Nicotine 패치에 의한 Nicotine 중독 증례
손유동,이재성,강구현,최정태,안무업,서정열,안희철,Sohn, You-Dong,Lee, Jae-Sung,Kang, Gu-Hyun,Choi, Jung-Tae,Ahn, Moo-Eob,Seo, Jeong-Youl,Ahn, Hee-Cheol 대한임상독성학회 2007 대한임상독성학회지 Vol.5 No.1
Nicotine poisoning arising from the use of nicotine patches is rare. However, because nicotine patches are classified as an OTC drug, the risk of misuse or abuse is increasing. Nicotine poisoning using nicotine patches shows an unusual clinical presentation compared to that from oral ingestion of multiple doses of nicotine. We present a case of misused nicotine patches that cause a nicotine poisoning. A thirty-nine year-old healthy man visited the ER with complaints of an intermittent cramping abdominal pain with nausea and vomiting. Upon physical examination, there were no specific findings except increased bowel sounds, and the patient's initial laboratory findings were also unremarkable except for an increased bilirubin level. CT revealed a mild degree of fatty liver. The patient's symptoms did not improve any further with conservative management. During his ED stay, we meticulously took his history again, and we discovered that he had used nicotine patches for three days, six days before admission, and had misused the nicotine patches as NSAID patches. The patient's diagnosis of nicotine poisoning was confirmed by a urine cotinine level ten times the normal value. After a 12-hour stay in the ED, his symptoms disappeared without any specific management.
김우열 ( Woo Youl Kim ),강구현 ( Gu Hyun Kang ),이진호 ( Jin Ho Lee ),박순효 ( Sun Hyo Park ),강경우 ( Kyung Woo Kang ) 대한결핵 및 호흡기학회 2006 Tuberculosis and Respiratory Diseases Vol.61 No.5
A primary pulmonary leiomyosarcoma is a very rare pulmonary malignancy that arises from smooth muscle of either the bronchial or arterial walls. Common symptoms of the tumor are cough, dyspnea, chest pain and hemoptysis. The diagnosis of a primary pulmonary sarcoma can be established only after extensive clinical and radiologic examinations have failed to identify an alternative primary source. The only effective treatment for the tumor is a complete surgical resection when feasible. The type of resection is dictated by the local anatomic extent of the tumor. We report a case of a 21-year-old male with a primary endobronchial leiomyosarcoma who presented with massive hemoptysis. A necrotic ulcerative endobronchial lesion was observed in the orifice of left lower lobe bronchus on a bronchoscopic examination. He was treated with a complete sleeve resection of the left lower lobe. Three months later, local recurrence of the tumor was noticed on the follow up bronchoscopy and a then left pneumonectomy was then performed. Fifteen months later, the patient died from empyema with a bronchopleural fistula that was associated with tumor recurrence at the stump of the pneumonectomy. (Tuberc Respir Dis 2006; 61: 484-489)
관통상으로 응급실을 내원한 내국인과 외국인 환자의 진료의 차이
김용관 ( Yong Kwan Kim ),장용수 ( Yong Soo Jang ),강구현 ( Gu Hyun Kang ),최정태 ( Jung Tae Choi ),전후 ( Hoo Jeon ),김진호 ( Jin Ho Kim ) 대한외상학회 2010 大韓外傷學會誌 Vol.23 No.2
Purpose: With the increasing numbers of foreign residents in Korea, the need for an emergency medical care system for foreign patients seems to be growing. Sometimes, a foreigner admitted to an emergency room is not treated sufficiently due to the absence of insurance, facility in the Korean language, and a guardian. The management of a foreigner with trauma in the ER is difficult due to various problems such as social and economic status. The purpose of this study was to investigate the current management status of foreigners with penetrating wounds in the emergency room. Methods: This study is an analysis of 580 patients that were diagnosed with penetrating wounds in one teaching Hospital from Jan. 1, 2008 to Dec. 31, 2008. We analyzed results according to nationality, alcohol ingestion, intentional or accidental trauma, trauma mechanism, injury severity, management time in the ER, and outcome in the ER. Results: Of the total 580 patients, 486 patients (83.8%) were native Koreans and 94 patients (16.2%) were foreigners. According to the Revised Trauma Score, the average score of native Korean patients was 7.808, and the average score of foreign patients was 7.638. Of native Korean patients, 22.6% had knife wounds while 38.3% of foreign patients did. Of native Korean patients, 17.3% experienced intentional trauma while 33.0% of the foreign patients did. Of native Korean patients, 22.5% had ingested alcohol while 49.4% of the foreigners had. Of native Korean patients, 10.5% were admitted while 7.6% of the foreign patients were. Of native Korean patients, 14.2% were discharged against medical advice (DAMA), while 18.5% of foreign patients were. Of native Korean patients, 1.2% ran away while 8.7% of the foreign patients did. Conclusion: Stabbing was the most common cause of penetrating wounds in foreigner patients in this study. Intentional trauma was more common in foreigners with penetrating wounds than in native Koreans. The severity was higher in foreigners with penetrating wounds than it was in native Koreans, and patients who ran away or were discharged against medical advice were more commonly foreigners with penetrating wounds. Social insurance or policy is needed for the management of foreigners with penetrating wounds. (J Korean Soc Traumatol 2010;23:102-106)