급성 비특이성 장간막 림프절염의 임상 소견과 급성 충수돌기염과의 감별 인자

신경화,김갑철,이정권,이영환,감신,황진복,Shin, Kyung Hwa,Kim, Gab Cheol,Lee, Jung Kwon,Lee, Young Hwan,Kam, Sin,Hwang, Jin Bok 대한소아소화기영양학회 2004 Pediatric gastroenterology, hepatology & nutrition Vol.7 No.1

Purpose: Although acute nonspecific mesenteric lymphadenitis (ANML) is probably common cause of abdominal pain in children, which can be severe enough to be an abdominal emergency, the clinical features of mesenteric lymphadenitis are not clear. Also, a differential diagnosis with acute appendicitis (APPE) is indispensable to avoid serious complications. The clinical features of ANML were determined, and the risk factors for differential diagnosis with APPE were analyzed. Methods: Between November 2000 and May 2001, data from 26 patients (aged 1 to 11 years) with ANML and 21 patients (aged 2 to 13 years) with APPE were reviewed. ANML was defined as a cluster of five or more lymph nodes measuring 10 mm or greater in their longitudinal diameter in the right lower quadrant (RLQ) without an identifiable specific inflammatory process on the ultrasonographic examination. There were risk factors on patient's history, physical examination, and laboratory examination; the location of abdominal pain, abdominal rigidity, rebound tenderness, fever, nocturnal pain, the vomiting intensity, the diarrhea intensity, the symptom duration, and the peripheral blood leukocytes count. Results: Of the 26 ANML patients and 21 APPE patients, abdominal pain was noted on periumbilical (76.9% vs 14.2%), on RLQ (11.5% vs 71.4%), with abdomen rigidity (7.6% vs 80.9%), with rebound tenderness (0.0% vs 76.1%)(p<0.05), in the lower abdomen (11.5% vs 14.2%), and at night (80.8% vs 100.0%) (p>0.05). The clinical symptoms were vomiting (38.4% vs 90.4%), the vomiting intensity ($1.5{\pm}0.7$ [1~3]/day vs $4.5{\pm}2.9$ [1~10]/day), diarrhea (65.3% vs 28.5%) (p<0.05), and fever (61.5% vs 76.2%)(p>0.05). The period to the subsidence of abdominal pain in the ANMA patients was $2.5{\pm}0.5$ (2~3) days. The laboratory data showed a significant difference in the peripheral blood leukocytes count ($8,403{\pm}1,737[5,900{\sim}12,300]/mm^3\;vs\;15,471{\pm}3,749[5,400{\sim}20,800]/mm^3$)(p<0.05). Discriminant analysis between ANML and APPE showed that the independent discriminant factors were a vomiting intensity and the peripheral blood leukocytes count and the discriminant power was 95.7%. Conclusion: The clinical characteristics of ANML were abrupt onset of periumbilical pain without rigidity or rebound tenderness, a mild vomiting intensity, normal peripheral leukocytes count, and relatively short clinical course. If the abdominal pain persist for more than 3 days, and/or the vomiting intensity is more than 3 times/day, and/or the peripheral leukocytes count is over $13,500/mm^3$, abdominal ultrasonography is recommended to rule out APPE. 목 적: 급성 비특이성 장간막 림프절염(acute nonspecific mesenteric lymphadenitis, ANML)은 타 질환이 적절히 배제되었을 때 임상적 추정으로 진단하는 경우가 많아 그 실체에 대하여는 잘 알려져 있지 않다. 특히 급성 충수 돌기염(acute appendicitis, APPE)과의 감별에 혼란을 주어 복막염 등으로 이행되는 경우가 드물지 않다. ANML의 임상 소견을 보고하고, 특히 APPE와의 감별시 도움을 줄 수 있는 접근 방식을 연구하고자 한다. 방 법: 2000년 11월부터 2001년 5월까지 대구시 한영한마음연합소아과의원으로 급성 복통을 주소로 내원하여 ANML로 진단된 26명(남녀비 13:13)을, APPE 환자는 같은 기간 대구가톨릭대학병원을 방문하여 수술받은 21명(남녀비 12:9)을 대상으로 하였다. ANML 환자들은 복부 초음파 검사상 10 mm 이상, 5개 이상의 장간막 림프절이 관찰되면서 회장, 대장의 장벽 비후 소견이 5 mm를 넘지 않고 염증성 충수돌기가 관찰되지 않으며, 말초 혈액 검사, 소변 검사, 대변 검사상 타 질환을 의심할 소견이 없는 등을 진단기준으로 설정하였다. 결 과: 1) ANML군의 진단 당시 연령은 1~11세, $5.2{\pm}2.3$세였다. 2) ANML군의 복통 양상은 21례(80%)에서 야간 복통이 있었고, 위치는 배꼽 주위부 20례(76%), 우하복부 3례(11%), 하복부 3례(11%)였다. 2례(7%)에서 복부 강직이 있었고, 반발 압통은 전례에서 없었다. APPE군에서는 전례에서 야간 복통이 있었고, 17례(80%)에서 복부 강직이, 16례(76%)에서 반발 압통이 관찰되어 ANML군과 각각 유의한 차이를 보였다(p<0.05). 3) ANML군에서 복통의 회복까지 걸린 시간은 2~4일, $2.5{\pm}0.5$일이었다. 4) ANML군 10례(38%)에서 구토를 보였고 1~3회/일, $1.5{\pm}0.7$회/일이었다. 설사는 17례(65%)에서 있었고 1~4회/일, $1.6{\pm}0.8$회였다. APPE군 19례(90%)에서 구토가 있었으며 1~10회/일, $4.5{\pm}2.9$회로 ANML군과 유의한 차이를 보였다(p<0.05). APPE군의 설사는 6례(28%)에서 있었으며 1~5회/일, $2.1{\pm}1.6$회이었다. 5) ANML군에서 열은 19례(73%)에서 있었고, 말초혈액 백혈구 수는 $5,900{\sim}12,300/mm^3$이었으며 평균 $8,403{\pm}1,737/mm^3$이었다. APPE군에서는 열은 16례(76%)에서 관찰되었으며 백혈구 수는 $5,400{\sim}20,800/mm^3$으로 평균 $15,471{\pm}3,749/mm^3$이었으며 ANML군과는 유의한 차이를 보였다(p<0.05). 6) 판별분석을 이용하여 하루 구토의 강도와 백혈구 수를 독립변수로 하였을 때 ANML과 APPE는 95.7% 수준으로 분류되었다. 결 론: ANML과 APPE의 감별 시 복부강직, 반동압통 등 급성복증의 소견이 의심될 때 뿐만 아니라, 복통이 3일을 초과하여 지속되거나, 하루 구토가 3회를 초과하는 경우, 말초혈액검사상 백혈구 수가 $13,500/mm^3$ 이상을 보일 때에도 반드시 복부초음파 검사를 이용하여 APPE를 확인하여야 한다.

수박 억제재배 줄기유인에 따른 과 품질과 수량

이기권(Ki-Kwon Lee),김갑철(Gab-Cheol Kim),김웅(Woong Kim),노재종(Jae-Jong Noh),고복래(Bok-Rai Ko),최정식(Joung-Sik Choi),최영근(Young-Geun Choi) 한국원예학회 2004 한국원예학회 학술발표요지 Vol.2004 No.10

수박 소비자 만족도 및 구매의욕에 관한 연구

이기권(Ki-Kwon Lee),김갑철(Gab-Cheol Kim),김웅(Woong Kim),노재종(Jae-Jong Noh),고복래(Bok-Rai Ko),김대향(Dae Hyang Kim),최정식(Joung-Sik Choi),최영근(Young-Geun Choi) 한국원예학회 2004 한국원예학회 학술발표요지 Vol.2004 No.10

위장관 간질종양의 임상 및 병리학적 고찰

김영호,장우영,이순진,손희정,최규완,도재혁,백승운,이준행,이풍렬,이종철,박철근,임윤정,김갑철,김재준,임효근 대한소화기학회 2001 대한소화기학회지 Vol.37 No.3

Background & Aims: Gastrointestinal stromal tumor (GIST) constitutes primary nonepithelial neoplasms of the gastrointestinal tract and includes most tumors previously designated as leiomyomas/leiomyosarcomas. GIST is pathologically divided into benign, borderline and malignanct tumor. This study was carried out to delineate the clinical and pathologic features of GIST and to establish the features predicting malignancy. Methods: Clinicopathologic data of 84 patients who had GIST from 1995 to 1999 were reviewed. Results: The subjects were 42 men and 42 women, and their mean age was 59.3±13.2 years. We located fifty-two tumors in the stomach, 28 tumors in the small intestine and 4 tumors in the colorectum years. Histopathology revealed benign tumors in 23 of the 84 patients, borderline tumors in 22, malignant tumors in 39. The average size of tumors was 6.23 cm in diameter (range, 0.6-26 cm). Metastasis was noted in 15.5% of the patients at diagnosis. On endoscopy, ulceration was more common in malignancy. Endsonographic findings except size were not significant statistically. On contrast enhanced computed tomography, malignancy showed more irregular shape and variable attenuation than benign lesions, which seemed to be valuable factor. Conclusions: The variables predicting malignancy were large tumor size (≥5 cm), location of the colorectum, palpable abdominal mass, ulceration on endoscopy, and less uniformity in shape and variable attenuation on computed tomography.

허혈성 대장염의 임상 양상과 예후 인자

이미숙,손희정,강태욱,최규완,박동일,백승운,이준행,고광철,이종철,임윤정,이풍렬,김갑철,김재준 대한소화기내시경학회 2001 Clinical Endoscopy Vol.22 No.2

Background/Aims: Colonic ischemia is recognized as the most common vascular disorder of the intestines in the elderly. The severity of the disease may vary considerably with the prevalent benign transient forms, being amenable to conservative treatments and the severe gangrenous forms, requiring surgery. Correct diagnosis is usually made after the ischemic episode is over and colonic ischemia is frequently misdiagnosed. The aim of this study is to identify the clinical patterns and prognostic factors of ischemic colitis. Methods: We found 60 patients with nonoccusive ischemia of the large intestine, We analyzed age, sex, symptoms, signs, associated disease, location, endoscopy, hematologic, histologic, radiologic finding and treatment, retrospectively. Results: The mean age was 60.2±6.3 years. The most common symtoms were abdominal pain or bloody diarrhea. The most common sign was diffuse abdominal tenderness. The most common hematologic findings were anemia and leukocytosis. Associated medical illnesses wer diabetes, rhematoid arthritis and cerebrovascular accident, et al. Both computed tomography (CT) and endoscopy were useful diagnostic tools. The most common involved site was sigmoid colon. 46 patients were treated conservatively and 14 patients were managed surgically. Conclusions: Male gender, those with rebound tenderness, severe anemia, right or total colon involvement as well as rheumatoid arthritis had a poor prognosis. Both CT and endoscopy were useful in predicting prognosis.