유기인제 급성폭로후에 발생한 지연형 신경장애 1례

김탁관,이동철,김상범 동국대학교 경주대학 1993 東國論集 Vol.12 No.-

A relatively healthy 64-year-old man who ingested organophosphorous insecticide in an attempt to commit suicide was brought to the emergency room by his family members showing mental change and respiratory arrest. He suffered from delayed onset of generalized muscle weakness, body balance loss and respiratory difficulty that developed on 3 days after admission, and then he was supported by mechanical ventilation. We concluded that his final diagnosis is delayed neurotoxicity after carefully examining his neurologic status and electromyography. We have no data from nerve and muscle biopsy but we think delayed neurotoxicity in present due to compatible findings of clinical features and electrodiagnosis report.

약년자에서 급성 심근경색증 후에 발생한 심인성 급사 1례

이상구,최성민,권삼,김탁관,신현종,이동철,강승완,정민영 東國大學校醫學硏究所 1994 東國醫學 Vol.2 No.-

평소에 건강하며 심장 혈관계의 가족력이 없는 33세의 남자 환자가 이른 아침에 갑자기 발생한 흉통, 식은땀, 오심으로 인하여 응급실로 실려 왔다. 병력청취와 심전도 검사후에 약년자에게 발생한 급성 심근경색증을 의심하여 대증요법후에 혈전용해제 치료를 준비하던 중 환자는 극심한 흉통과 어지러움을 호소하면서 의식을 잃었으며 이때 심전도 감시장치에서 심실성 빈맥의 소견을 보였다. 즉시 심율동전환(D.C.shock)과 함께 심폐소생술을 실시하였으나 환자의 의식과 심장 기능은 돌아오지 않았다. 젊은 환자가 허혈성 심질환으로 인한 심실성 부정맥을 일으킨 후에 사망한 증례로 문헌고찰후에 심전도 기록과 함께 보고한다. Acute myocardial infraction in young people is rare, but once it occurred, the prognosis is better compared to old ages. Primary ventricular arrhythmia associated with acute ischemia is an important problem and can be treatable. But below case was not. A young male patient without any past history and family history visited emergency room due to sudden anterior chest pain with cold sweating, diaphoresis and nausea. He was a healthy 33-year-old heavy smoker. After getting history and electrocardiography, we diagnosed as acute myocardial infarction(anteroseptal wall), while we were preparing thrombolytic therapy at emergency room, sudden ventricular arrhythmia was appeared. We performed electroconversion and cardiopulmonary resuscitation, but failed.

과인슐린혈증을 보인 Nesidioblastosis 1 예

박성진,이정호,정민영,김정란,이예봉,김성숙,윤형진,구정완,김종목,김탁관,서정욱 대한내과학회 1994 대한내과학회지 Vol.47 No.5

Nesidioblastosis, a condition characterized by diffuse islet cell hyperplasia arising from the ductal epithelium, is often associated with hyperinsulinemic hypoglycemia. This is the most common cause of persistent neonatal hypoglycemia and is extremely rare in adults. A 38-year-old man had suffered from intermittent hypolycemic symptoms for 5 years, and had been relieved by carbohydrate ingestion. Plasma immunoreactive insulin levels and I/G ratio were inappropriately high during prolonged fast. Abdominal CT scan, angiography, and frozen section provided no evidence of a tumor. Pathologic examination of the resected pancreas revealed irregularly sized islets and scattering of small endocrine cell clusters throughout the acinar tissue and ductuloinsular complex and distinct islet cell hypertrophy are present.

중증 위장관형 탄저병 3 예

이창우,이영현,김정란,전창호,김성자,정병욱,양창헌,하경임,윤형진,권삼,김종목,김탁관,이승석,강승완 대한내과학회 1995 대한내과학회지 Vol.49 No.4

Anthrax, a zoonotic disease of herbivorous animals transmissible from animals to man, occurs primarily in three forms: cutaneous, inhalation (or pulmonary), and gastro-intestinal. It is caused by Bacillus anthracis, a gram-positive, aerobic, spore-forming bacillus, The complications of anthrax shuch as meningitis and septicemia usually occur secondary to one of the primary form. Among three forms, gastrointestinal anthrax caused by the ingestion of Racillus anthracis-contaminated food is rare and is associated with high mortality. There are two clinical presentations of gastrointestinal antrax: abdominal (or intestinal) and oropharyngeal. We present three patients who have a rare clinical form of severe gastrointestinal anthrax caused by ingestion of meat or products of cattle which died from anthrax, Case one had fever, nausea, vomiting, abdominal pain and massive ascites recovered completely with surgery and antibiotic therapy. The other two patients died of possible complications due to gastrointestinal anthrax (sepsis in the second case and hemorrhagic meningitis in the third case)within several hours in the hospital. Bacillus anthracis was isolated from the blood culture of all three patients.

IgM, Lambda 형 단일클론 감마병증이 동반된 만성 림프구성 백혈병 1 예

이동철,이정호,이영현,이승석,김정란,양창헌,하경임,이상구,윤형진,김종목,김탁관 대한내과학회 1996 대한내과학회지 Vol.50 No.3

It appears that chronic lymphocytic leukemia (CLL) has a world wide distribution, but the incidence of CLL has known to be low in Korea. Hypogammaglobulinemia is common in chronic lymphocytic leukemia, but monoclonal gammopathy is rare. So we present a case of B-cell chronic lymphocytic leukemia associated with monoclonal gammopathy (IgM, λ type). A 60-year-old male patient visited Dongguk University Hospital due to blood-tinged sputum, cough and dyspnea for 3 to 4 weeks. Physical examination revealed inspiratory rales on the right lower lung field, non-tender 5 finger breaths sized splenomegaly and both inguinal lymphadenopathy. Radiologic study showed a single lung abscess accompanied by acute bacterial pneumonia on the right lower lobe. The peripheral blood smear and bone marrow examination presented many mature appearing small sized lymphocytes. The bone marrow biopsy revealed nodular lymphocyte infiltrates. On the immunohistochemical stain, these cells exhibited anti-CD19 phenotype. The lymph node was largely flooded by small monotonous mature lymphocytes. Serum protein electrophoresis and immunoelectrophoresis showed monoclonal gammopathy(lgkl, λtype, 3.7g/dL). The immunophenotyping study of lymphocytes demonstrated CD19 (+), CD20 (+), HLA-DR (+) but CD5 We concluded that this patient's diagnosis is B-cell chronic lymphocytic leukemia with monoclonal gammopathy.

Na+ - K+ pump 억제가 토끼 도관동맥과 저항동맥의 수축과 이완에 미치는 영향

이동철(Dong Chul Lee),김성자(Sung Ja Kim),이승석(Seong Seok Lee),정민영(Min Yung Chung),김탁관(Tak Gwan Kim),강승완(Seung Wan Kang),서석효(Seok Hyo Seo),유원상(Won Sang Yoo) 대한내과학회 1995 대한내과학회지 Vol.48 No.6

N/A Objectives: Recently endogenous digitalits-like substances were found in the blood of various cardiovascular diseases and they have been considered as one of the causes developing hypertension. Whereas the pathophysiology of the hypertension developed by endogeous digitalis-like substances has not been clarified yet. The purpose of this study is to investigate the effects of Na+-K+ pump blocking on the contractility of blood vessel(conduit and resistant artery) of rabbit. Methods: We used the rings of abdominal aorta and branches of sup. mesenteric artery of rabbits as conduit arteries and resistant arteries respectively. Na+-K+ pump blocking was obtained by treatment with [K+]o solution or ouabain 10μM solution for 30 minutes. The vascular responses to vasoconstrictors or vasodilators were measured by organ bath study and cyclic GMP measurement. Results: Basal tension was elevated by blocking of Na+-K+ pump with [K+]o solution. The increase of basal tension in the aortic rings without endothelium was significantly greater than that in the rings with endothelium. The magnitudes of contractions of aortic rings by norepinephrine, serotonin and acetylcholine were significantly increased by the blocking of Na+-K+ pump. The magnitudes of endothelium-dependent relaxation and relaxation induced by sodium nitroprusside and isoproterenol in aortic rings were decreased by the blocking of Na+-K+ pump. The endothelium-dependent increase of cyclic GMP level in smooth muscle was attenuated by the blocking of Na+-K+ pump. In branches of sup. mesenteric arteries, the increase of norepinephrine induced contraction by ouabain was greater than that of in aortic rings and endothelium-dependent relaxation was completely blocked by the treatment with ouabain. Conclusion: It could be suggested that the contractility of vascular smooth muscle with the blocking of Na+-K+ pump was increased and the responsivenesses of vascular smooth muscle to vasorelaxing agents were decreased. These findings suggest that endogenous digitalis-like substances may play an important role in pathogenesis of essential hypertension. Also these findings make an offer how to develop the functional changes in smooth muscle and ednothelium of blood vessels in hypertension.