급성 골수성 백혈병에 동반된 심낭삼출 1례

구대식,옥승철,김양욱,김동수,손창학 인제대학교 1993 仁濟醫學 Vol.14 No.4

급성 백혈병에서의 심낭침윤은 국내에서는 비교적 드문질환으로, 급성 골수성 백혈병에서 심낭천자를 통해 백혈병세포 침윤성 심낭삼출을 확인한 1례를 경험하였기에 이에 보고하고자 한다. Leukemic infiltration of heart and its investing membrances were not uncommon among the patients with acute leukemia. But, clinically early detection of such abnormlities is difficult since it would be obscured by symptomatology. So, most studies of leukemic pericardial involvement have been from postmortem period. In addition, the information for adequate management and prognosis is limited. We experienced a case of acute myeloid leukemia with pericardial effusion in 39 years old female patient complaining exertional dyspnea, general weakness and fatigue for one month. Examination showed her to be acutely ill with both engorged neck veins. The chest x-ray and echocardiography showed the pleural effusion and large amount of pericardial effusion. The pericardiocentesis was performed and aspiration cytology of pericardial fluid showed abundant leukemic blast cells. The two cycles of induction chemotherapy with Ara-C, daunorubicin, VP-16 brought out complete remission. But, leukemia and pericardial effusion were relapsed after four months and died due to sepsis despite of aggressive treatment.

Infection-Associated Hemophagocytic Syndrome 1예

구대식,류홍옥,김규환,전종휘 대한감염학회 1993 감염 Vol.25 No.1

IAHS is a rare clinicopathologic entity characterized by fever, pancytopenia, liver dysfunction and the reactive proliferation of histiocytes actively phagocytosing hemopoietic cells, simulating the malignant histiocytosis, but distinct in that the phagocytosing histiocytes are morphologically mature and benign. This syndrome occurs in patients who develop infections in the setting of preexisting immunological abnormalities or neoplasm, and usually runs a self-limited course, although in a minority of cases fatal outcomes ensue. Recently, the author experienced a case of IAHS developed during immunosuppressive therapy in uveitis patient. So we report this case with brief review of literatures.

동맥관개존증에 병발된 심내막염 1례

김환태,구대식,류홍옥,김동수,이경순 인제대학교 1992 仁濟醫學 Vol.13 No.4

선천성 심장병인 동맥관개존증에 병발된 감염성 심내막염으로 인해 승모판과 주폐동맥에 발생한 증식성 병변을 항생제와 고식적 치료에 의해 증식성 병변은 소실되고 동맥관개존증은 ligation에 의해 호전된 1례를 경험하였기에 보고하는 바이다. Infective endocarditis is an infection which produces vegetations on the endocardium. A heart valve is usually involved, but infection may be on a septal defect or mural endocardium. Infection of arteriovenous shunt or coarctation of the aorta is more properly called endarteritis. The association between congenital heart disease(CHD) and endocarditis was firmly established. Ventricular septal defect, patent ductus arteriosus(PDA), and tetralogy of Fallot have been the most common underlying lesions. We experienced a case of infective endocarditis on PDA with multiple vegetations of mitral valve and mall pulmonary antery. The vegetations were detected by echocardiography and gradually reduced in size after antibiotics were given. PDA was corrected by surgical ligation after medical treatment.

성인 급성 림프구성 백혈병의 화학요법 효과

손창학,구대식,조기정,이성근 大韓血液學會 1993 大韓血液學會誌 Vol.28 No.1

식도 정맥류 출혈에 대한 내시경적 경화요법의 장기관찰 결과

정정명,박정현,구대식,김규환,이상혁,최하진 인제대학교 1992 仁濟醫學 Vol.13 No.4

In 1939, Crafoord and Frenckner originally reported the sucessful use of endoscopic sclerotherapy by paravasal injection of quinine as a sclerosant to control acute variceal bleeding of a 16-year-old girl. After the introduction of shunt operation as a treatment of acute variceal bleeding, the endoscopic sclerotherapy became less adoptable for a while. But since 1970, with the development of the technique, equipments and newer sclerosants, endoscopic sclerotherapy became favorable as a treatment of acute variceal bleeding. Since 1980 in Korea, endoscopic sclerotherapy as a treatment of acute variceal bleeding has been practiced in many clinics. However, there are few reports of the prognosis and survival rates of the patients who received endoscopic sclerotherapy, and there are many differences among those reports. Now we report the results of the clinical observation and the survival rates of 125 patients who have been followed for several years(from June 1985 to June 1991) by the Department of Internal Medicine, Paik Hospital, Inje University, Pusan. The results are as follows. 1.125 patients(103 male and 22 female) with bleeding esophageal varices were treated by endoscopic sclerotherapy and followed over a period ranging 3∼6 years. Among them, 24 patients were Child class A, 43 Child class B and 58 Child class C. In the degrees of varices, 65 patients showed grade III and 56 patients grade IV respectively, accounting for 97% of all patients. 2.The most prevalent underlying disease was post-necrotic liver cirrhosis in 84 patients, alcoholic liver cirrhosis in 12 patients, chronic active hepatitls in 4, idiopathic portal hypertension in 4 and unknown in 10 patients. 3.Variceal rebleeding after sclerotherapy occorred in 51 patients(40.8%) ; rebleeding occurred within 6 months in 20 patients(16.0%), and after 6 months in 31 patients(24.8%). 4.Complications after slcerotherapy occurred in 16 patients(12.8%) ; pneumonia 6 patients, esophageal ulcer 4, esophageal stricture 3, and mediastinitis 3 patients. 5.Fifty-four patients(43.2%) were dead during the clinical observation period : 24 patients(19.2%) were died within 1 month after sclerotherapy, and 30 patients(24.0%) after 1 month. The most prevalent cause of death was hepatic failure accounting for half of all deaths. 6.The survival rate of the patients who were treated with sclerotherapy was calculated by Kaplan-Meier method. One year survival rate was 75%, 5 year survival rate was 40%. Patients in he Child grade A and B showed much higher survival rate than the patients in the Child grade C. With our experience, one third of the patients died within 2 years after sclerotherapy and another one third died 2-5 years after sclerotherapy, but the rest one third survived mostly over 5 years after sclerotherapy. In conclusion, endoscopic sclerotherapy of the aucte variceal bleeding shows still higher frequency of variceal rebleeding and does not affect the overall mortality rate, but endoscopic sclerotherapy is estimated to be an excellent method of choice in treatment of acute variceal bleeding with its excellent hemostatic effect and less side effects.

혈장교환술로 치험한 급성감각 신경장애 1 예

박정현,김환태,허경,구대식,강창일,강호규,이태윤,조효근 대한내과학회 1992 대한내과학회지 Vol.43 No.6

We report a 36-year-old woman of acute sensory neuropathy whose chief complaint was dysesthesia and hyperesthesia that has had 3 weeks course of progression and ascension from left hand to four extremities. On past history, she had not suffered from upper respiratory infection, G-I upset, and not experienced the exposure of special drugs and toxins. No evidence was not found that she had connective tissue disease and malignancy. On neurologic examination, the functions of all sensory modalities were impaired moderately. There was the weakness of muscle power. The CSF study showed that acellular high protein level was found. In that, increased gamma fraction was seen. The electrophysiologic study demonstrated that on SNCT, sensory potential was decreased or not checked at distal portion of 4 extremities, and on motor NCT, abnormal finding was not shown in NCV or CMAP. But mild degree of denervation was observed in EMG. This patient has taken plasma exchange as therapeutic regimen, and then her symptoms were improved immediately. But her trivial residual neurologic deficits yet remained 6 months after that time.

내시경적 " O "-ring 결찰술을 이용한 용종절제술 5예

오경석,이상혁,정정명,설상영,구대식,장현정,김찬환 대한소화기내시경학회 1994 Clinical Endoscopy Vol.14 No.4

Endoscopic polypectomy was firstly introduced by Tsuneoka in 1969, and till now this method has been widely used for the treatment of benign and malignant polyps with the advent of technical improvement. This method is a very important modality as secondary prevention of malignancy because polyps in gastraintestinal tract are now being considered as precancerous lesion. Polypectomy with snare and electrocautery is mainly used for pedunclated polyps (eg. Yamada Class III, IV), but sessile polyps pose technical difficulty and occasionally cause serious gastrointestinal hemorrhage when resection margin adjacent polyp base. We performed polypectomy with $quot;O$quot;-ring used in endocopic variceal ligation (EVL) to make sessile polyp as semipedunclated form, and also to control bleeding, and then successfully remove it with conventional snare polypectomy. We report these 5 cases with the review of the literature.

본태성 고혈압에서 좌심실 비대와 심실 수축기능에 대한 혈역학적 부하와의 상관관계

서정철,이명수,채창식,조기정,김환태,구대식,김동수,이경순 대한순환기학회 1993 Korean Circulation Journal Vol.23 No.3

십이지장의 Brunner`s Gland 선종 4예

오경석,이상혁,김환태,정정명,설상영,옥승철,구대식,조현대 대한소화기내시경학회 1994 Clinical Endoscopy Vol.14 No.1

Brunners gland adenoma is a benign epithelial tumor of the duodenum originating from submucosal Brunners gland. This is an extremely rare entity that account for only 10.6% of benign duodenal tumor, which are themselves relatively rare, representing 0.008% of all surgical and autopsy specimens. The clinical manifestation are nonspecific gastrointestinal complaints, such as bloating or epigastric pain, and the tumor gives rise to melena or anemia, due to the ulceration or erosion of the tumor. The diagnosis is usually made by radiologic studies and gastroduodenal endoscopy which can also provide definitive treatment. The aim of treatment is complete removal of the lesion and exclude malignancy. We report on 4 cases of Brunners gland adenoma which was confirmed by operation or endoscopic polypectomy.