선천성 우측 폐동맥 형성부전증

라성수 ( Sung Soo La ),김소미 ( So Mi Kim ),김도형 ( Doh Hyung Kim ) 대한결핵 및 호흡기학회 2008 Tuberculosis and Respiratory Diseases Vol.65 No.5

Unilateral absence of the pulmonary artery (UAPA) is a rare congenital anomaly that occurs in association with other cardiovascular anomalies, such as tetralogy of Fallot or ventricular septal defects. On the other hand, it is less commonly found as an isolated finding without accompanying diseases. Isolated UAPA is a rare cause of hemoptysis, and massive hemoptysis has been reported to occur in approximately 18∼20% of UAPA patients during their clinical course. Even if a lung resection is considered a treatment option to control life-threatening hemoptysis, the procedure is more difficult than an ordinary lung resection because of the excessive collateral vessels from the systemic circulation. We encountered an isolated UAPA occurring in a young male patient suffering from intermittent blood tinged sputum. To our knowledge, only a few cases of isolated UAPA have been reported in Korea. This case is expected to be a good example to help clinicians better understand isolated UAPA as an unusual cause of hemoptysis. (Tuberc Respir Dis 2008;65:430-434)

건강한 젊은 남성에서 발생한 폐트리코모나스증

라성수 ( Sung Soo La ),공재환 ( Jae Hwan Kong ),방창석 ( Chang Seok Bang ),한성환 ( Sung Hwhan Hahn ),명나혜 ( Na Hye Myong ),김도형 ( Doh Hyung Kim ) 대한결핵 및 호흡기학회 2008 Tuberculosis and Respiratory Diseases Vol.64 No.5

Bronchopulmonary infections caused by trichomonads have been reported principally in patients with pre-existing pulmonary diseases, such as bronchial carcinoma, lung abscess, or bronchiectasis. Pulmonary trichomoniasis is most often caused by Trichomonas tenax, which is usually regarded as a harmless commensal organism of the human mouth. However, pulmonary infection may rarely be caused by other trichomonas species, including Trichomonas vaginalis from the genitourinary tract and Trichomonas hominis from the intestines. Because of the rarity of trichomonas pulmonary infection, and because of its close association with underlying lung and systemic disease, pulmonary trichomoniasis is considered an opportunistic infection. We recently treated a case of pulmonary trichomoniasis occurring in a young, healthy male without obvious underlying pulmonary or systemic illness. To our knowledge, there has been only one reported case of pulmonary trichomoniasis in Korea, and there have been only two reported cases of pulmonary trichomoniasis occurring in normal lung worldwide. (Tuberc Respir Dis 2008;64:387-391)

한국 밀리치료사들의 근무 현황 조사

오영택,배성수,전제균,라기용,문향미 대한물리치료학회 1998 대한물리치료학회지 Vol.10 No.1

The purpose of this article is to identify real problems and to have a view of the future an Korean physical therapy of it through the survey. Moreover we make a statement for the justification acquiring the rights of practing physical therapiests with this fundamental data. The survey was conducted on 368 employed physical therapiests males 164, female 190 in Korea from April 1 to 30 in 1998 with self-administered questionnaire. The following results were obtained: 1. Of the 323 cases, 121(37.46%) work in local clinics, 55(17.02%) in hospitals, 103(31.89%) in general hospital and 21(9.60%) in rehabilitation centers or public welfare facilities. 2. In investigation of annual salary, the most common annual salary was more than 20million won in male(22.67%) and 12-14million won in female(35.36%). 3. The age group of 27-29 years accounted far 32.32% in male and 24-26 years accounted for 46.77% in female of the total physical therapiests are the highest. 4. In job satisfaction, 44.5% of physical therapiests who work in general hospital are generally satisfied and 25% are unsatisfied. 5. The periods of clinical practice for which physical therapicsts expect to devote are 1.64(44.81%) consider less than 10years, and 67(18.31%) expect 20years, 6. The problems of physical therapy system in korea are deviated administration of a cantral executive committee(39.94%) and excessive production of resistered physical therapiests.

직장 유암종에 대한 내시경적 절제술 시행 후 12일째 발생한 대량 지연 출혈 1예

김소미,윤세영,최훈수,라성수,공재환 대한소화기내시경학회 2009 Clinical Endoscopy Vol.38 No.2

Endoscopic resection is currently accepted as a standard therapy for colon polyp because of its safety and efficiency. The indications for endoscopic resection have been expanded to treat mucosal colon cancer and submucosal tumor. The major complications of endoscopic resection are hemorrhage, perforation and post- polypectomy coagulation syndrome. Hemorrhage is the most common complication, and this can occur immediately following colonoscopic polypectomy or it can be delayed after completion of the procedure. Delayed hemorrhage usually occurs within 7 days and this can stop by itself or the hemorrhage can be controlled endoscopically in the majority of patients, with only the unusual and serious cases requiring transfusion, angiography and surgery. We experienced a case of delayed massive hemorrhage with hypotension that required transfusion 12 days after performing endoscopic resection for rectal carcinoid tumor. We report here on this case to provide a good example and to place emphasis on delayed massive hemorrhage after endoscopic resection. 내시경적 용종 절제술은 대장 용종의 표준 치료로 인정받고 있으며, 내시경 술기 및 기기의 발달로 내시경적 점막절제술 및 내시경적 점막하 박리술을 이용하여 점막에 국한된 조기 대장암 및 일부 점막하 종양의 치료로 발전하고 있다. 이와 같은 내시경적 절제술은 비교적 안전하며 삶의 질을 높일 수 있어 수술적 치료를 대체하고 있으나 출혈, 천공 및 용종 절제술 후 응고 증후군 등의 합병증이 발생할 수 있다. 내시경적 용종 절제술과 관련된 가장 흔한 합병증은 출혈로서 약 0.3∼6.1%에서 발생하며 시술 중에 발생하는 즉시 출혈과 시술 이후에 발생하는 지연 출혈로 나눌 수 있다. 지연 출혈의 경우 대부분 일주일 내에 소출혈의 양상을 보이게 된다. 저자들은 1.2 cm 크기의 직장 유암종을 내시경적 절제술로 제거한 후 조기 출혈 없이 퇴원하였으나, 시술 12일째 불안정한 활력 징후를 보이며 수혈 치료가 필요했던 대량 지연 출혈 1예를 경험하여 문헌 고찰과 함께 보고한다.

흡인성 폐렴 환자에서 발생한 베르니케 뇌병증 1예

김소미,서지현,노란,추영광,라성수,박재석,김도형 대한중환자의학회 2008 Acute and Critical Care Vol.23 No.2

Wernicke`s encephalopathy is a neurologic complication of thiamine deficiency, presenting with acute confusion, oculomotor dysfunction, and gait ataxia. While most often associated with chronic alcoholism, Wernicke`s encephalopathy occasionally occurs in the setting of poor nutritional status, such as malabsorption, increased metabolic requirements, or increased loss of the water-soluble vitamins. Patients with critical illnesses can present with excessive catabolic status because of activation of the sympathetic nervous system and the pituitary-adrenal axis. In addition, inappropriate nutritional evaluation and lack of concerns for adequate nutrient support can increase the morbidity and mortality in such patients. However, the importance of adequate nutritional support is often disregarded during treatment of the patient`s primary illness. We have recently managed a patient with Wernicke`s encephalopathy and pneumonia who did not receive adequate nutritional support during hospitalization. We report this case to call attention to the importance of nutritional support in critically ill patients.

국내에서 보고된 간내 국소결절과형성에 대한 임상 분석

강하얀 ( Ha Yan Kang ),라성수 ( Sung Soo La ),공재환 ( Jae Hwan Kong ),이상석 ( Sang Seok Lee ),백두산 ( Doo San Baek ),임상수 ( Sang Soo Lim ),신기철 ( Ki Chul Shin ),신현덕 ( Hyun Duk Shin ),윤세영 ( Se Young Yun ),김석배 ( Suk 대한소화기학회 2008 대한소화기학회지 Vol.52 No.6

목적: 간의 국소결절과형성(FNH)은 간세포암종이나 간선종과 같은 수술 치료를 요하는 간내 종괴와 감별을 요하는 양성 종양 중 하나이다. 저자들은 국내에서 보고된 증례들을 통해 FNH의 임상, 영상의학 및 병리 특성을 알아보고자 하였다. 대상 및 방법: 인터넷 사이트 "http://koreamed.org"에서 "focal nodular hyperplasia"와 "liver"를 검색용어로 하여 간내 FNH을 검색하였다. 1997년부터 최근까지 검색된 17편의 논문에 발표된 증례 37예와 본원에서 경험한 1예 등 총 38예를 대상으로 하였다. 결과: 국내에서 보고된 FNH 총 38예의 발생 연령은 평균 34세(재태 36주-67세)였으며 남녀 성비는 1.2:1 (21예:17예)이었고 17명의 여성은 모두 경구 피임제를 복용한 병력이 없었다. 18예(47.4%)에서 무증상으로 우연히 발견되었으며, 증상이 있어 검사를 시행한 경우는 20예(52.6%)였으며 동반된 증상으로는 심와부 통증이 제일 많았고, 복부 종괴, 전신 쇠약, 오심 및 구토, 식욕부진 및 황달 등의 순이었다. 결절의 평균크기는 3.9 cm (0.5-16 cm)였으며 32예(84.2%)에서 단일결절을 보였다. 초음파검사에서는 55% (11/20)에서 저에코 결절로 보였다. 컴퓨터단층촬영에서는 85% (34/40)에서 동맥기에 조영증강되는 소견을 보였으나 지연영상에서는 다양하게 나타났다. 자기공명영상의 T1 강조영상에서 저신호 강도를 보인 경우는 60% (18/30), T2 강조영상에서 고신호 강도를 보인 경우는 73.3% (22/30)였다. 간동맥 조영술은 10예에서 시행되었으며 6예에서 고혈관 종괴를 나타냈다. 외과 절제를 시행한 20예 중 육안 소견이 확인된 13예에서 피막 형성을 동반하지 않은 경계가 명확한 결절이 관찰되었으며, 이 중 8예에서 중심부별모양 반흔이 확인되었다. 병리 소견에서는 비정상적인 결절과 섬유 격막이 관찰되었고 섬유 격막에는 혈관 및 쓸개세관 증식을 포함하는 전형적인 형태가 대부분이었다. 결론: 국내에서 보고된 간내 FNH은 기존의 역학 및 임상양상에 대한 보고와 비교하여 성비, 임상 증상, 경구용 피임약 복용 여부 등에서 차이를 보이고 있다. 하지만 국내에서 보고된 증례가 많지 않고 그 임상정보가 한정되어 있으며 비전형적인 임상상을 보이는 예가 많이 포함되어 있어 추후 전국적 임상 조사를 통한 전향 분석이 필요하리라 생각한다. Background/Aims: Focal nodular hyperplasia (FNH) is mandatory to be differentiated from other hepatic tumorous conditions such as hepatocellular carcinoma and adenoma. The purpose of this study was to explore the clinical, radiological and pathological features of FNH cases reported in Korea. Methods: We have searched the journals from the web site "http://koreamed.org" using keywords "focal nodular hyperplasia" and "liver"-total of 38 cases of FNH, 37 cases from 17 published articles and one case from our experience confirmed histologically, were reviewed and analyzed. Results: Thirty eight cases were diagnosed between gestational age of 36 weeks and 67 years. Seventeen female patients (45%) had no history of taking oral contraceptives. Twenty cases (52.6%) experienced clinical symptoms such as abdominal pain and palpable mass. Computed tomography revealed contrast-enhancement in 34 nodules (85%) and typical central stellate scar in 9 (22.5%) of 40 nodules. Magnetic resonance imaging showed T1 weighted low signal in 18 (60%) and T2 weighted high signal in 22 (73.3%) of 30 nodules. Six (60%) of 10 cases showed hypervascular staining on hepatic angiography. Among 38 cases, 32 (84.2%) cases had single nodule and their mean size was 3.9 cm (0.5-16 cm). Pathologically, fibrous septa, proliferation of bile ductules and arterial wall thickening were seen in most cases. Conclusions: Of all the FNH cases reported in Korea, there were some differences in clinical aspects of sex ratio, accompanying clinical symptoms, and relationship with oral contraceptives, compared with previous reports. Further prospective studies are needed by means of nation-wide clinical survey and analysis.

증례 : 뇌하수체 거대선종 수술 후 발생한 뇌성염분소실

송탁호 ( Tak Ho Song ),라성수 ( Sung Soo La ),방창석 ( Chang Seok Bang ),이상석 ( Sang Seok Lee ),강하얀 ( Ha Yan Kang ),김희진 ( Hee Jin Kim ),이상구 ( Sang Koo Lee ) 대한내과학회 2007 대한내과학회지 Vol.73 No.4

저자들은 뇌하수체 거대선종의 경접형동 선종절제술 후 뇌성염분소실의 발생으로 다뇨와 저나트륨혈증을 보인 환자에서 충분한 수액과 나트륨의 공급으로 저나트륨혈증이 교정되고 다뇨가 호전된 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. The central nervous system (CNS) has important roles in the regulation of sodium and water homeostasis, so the risk of hyponatremia is increased for patients with neurological disorders. Cerebral salt wasting (CSW) is a syndrome that is characterized by hyponatremia and extracellular volume contraction, and these problems are caused by natriuresis and the concomitant polyuria in patient with intracranial disease. It is critical to differentiate CSW from syndrome of inappropriate secretion of antidiuretic hormone (SIADH) for patients with hyponatremia and after they experience cerebral insults. This is because fluid restriction is the treatment of choice for SIADH and administration of isotonic or hypertonic saline is important for treating CSW. We report here on a case of CSW following trassphenoidal surgery for pituitary tumor in a 67-year-old man with nonfunctioning pituitary macroadenoma. Hyposmotic hyponatremia, increased urine output and signs of dehydration developed postoperatively, and the patient was managed by water and salt supplementation.(Korean J Med 73:432-437, 2007)

증례 : 소화기 ; 내시경적 Urokinase 주입으로 치료한 위석 1예

김동우 ( Dong Woo Kim ),윤승욱 ( Seung Wook Yun ),김지환 ( Ji Hwan Kim ),김배환 ( Bae Hwan Kim ),라성수 ( Sung Soo La ),백두산 ( Du San Baik ),김석배 ( Suk Bae Kim ) 대한내과학회 2009 대한내과학회지 Vol.76 No.1

단단한 위석을 제거하는 방법으로 코카콜라를 위석 내로 직접 주입하는 것이 기존의 방법보다 비용이나 효과 면에서 우수하다. 하지만 보고자마다 시술 시간의 차이가 크고 본 증례에서도 1개의 위석을 제거하는데 1시간 정도가 걸렸기 때문에 위석이 여러개인 경우에는 다른 주입 물질을 고려해 볼 만하다. Urokinase는 섬유소를 제거하는 역할을 하기 때문에 식물위석의 경우 코카콜라보다 효과적인 물질이라고 여겨진다. 저자들은 3개의 단단한 위석으로 인해 위궤양 및 상복부 통증이 발생하였던 환자에게 첫날 코카콜라 주입 후 위석을 제거하기까지 걸린 시간을 단축시키기 위해서 다음날 urokinase를 주입해 위석 제거시간을 단축시킨 증례를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Bezoars are collections or concretions of indigestible foreign material that accumulate and coalesce in the gastrointestinal tract. Treatment options include dissolution with enzymes, endoscopic removal or aspiration, and surgery. The outcome differs according to the treatment method. A 57-year-old man was admitted with a 1-month history of epigastric pain. On gastrofiberscopy, an approximately 2-cm deep ulcer was seen on the lesser curvature of the antrum and three huge bezoars were found. In order to remove the first one, we injected Coca-Cola into it directly. It took 20 minutes to cut up and 1 hour to remove completely. To decrease the procedure time, we changed the injection fluid to urokinase for the remaining two bezoars. It took 9 and 10 minutes to cut up the second and third bezoars, respectively, and 1 hour to remove them completely. We report a case of phytobezoars treated successfully by endoscopic injections of Coca-Cola and urokinase. (Korean J Med 76:64-69, 2009)

증례 : 혈액종양 ; 대장암 환자에서 복막 전이에 의한 상장간막 동맥 증후군 1예

방창석 ( Chang Seok Bang ),이순일 ( Soon Il Lee ),박건우 ( Geun Woo Park ),강하얀 ( Ha Yan Kang ),라성수 ( Sung Soo La ),공재환 ( Jae Hwan Kong ),강진모 ( Jin Mo Kang ) 대한내과학회 2009 대한내과학회지 Vol.76 No.3

저자들은 고식적 항암화학요법 치료 중인 대장암 환자에서 오심, 구토 등의 소장 폐색 증상을 호소하여 영상 의학적 검사들을 시행하여 상장간막 동맥 증후군을 진단하였으며, 수술적 치료를 통해 대장암의 복막전이에 의한 전이성 결절이 상장간막 동맥을 외부에서 직접 압박하여 발생한 상장간막 동맥 증후군으로 밝혀진 증례를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Small bowel obstruction can develop from adhesions, hernias, and less frequently from tumors. Superior mesenteric artery (SMA) syndrome is an uncommon cause of small bowel obstruction. We experienced a case of SMA syndrome caused by peritoneal seeding from colon cancer. A 57-year-old woman presented with nausea, post-prandial vomiting, and weight loss. She had been receiving palliative chemotherapy for 12 months to treat colon cancer with peritoneal seeding. Abdominal computed tomography and a small bowel series revealed typical findings of SMA syndrome. As conservative treatment including nutritional support and positional change was ineffective, she was treated surgically. An adhesive mass compressing the SMA and duodenum was found at the third portion of the duodenum. The pathologic diagnosis was metastatic adenocarcinoma of colorectal origin. Adhesiolysis and duodenojejunostomy relieved her symptoms. This case shows that SMA syndrome can develop via peritoneal seeding in cancer patients. (Korean J Med 76:380-384, 2009)

전신적 림프절 종대와 골 용해성 병변을 동반한 전립선암 1예

김지환 ( Ji Hwan Kim ),이순일 ( Soon Il Lee ),박건우 ( Keon Woo Park ),김윤섭 ( Youn Seup Kim ),이호연 ( Ho Youn Lee ),공재환 ( Jae Hwan Kong ),라성수 ( Sung Soo La ) 대한내과학회 2008 대한내과학회지 Vol.74 No.1S