증례 : 폐에 발생한 원발성 반지세포암 1예

손준광 ( Jun Gwang Son ),김성호 ( Seong Ho Kim ),선제형 ( Jae Hyung Sun ),박진석 ( Jin Seok Park ),김유일 ( Yu Il Kim ),이숭 ( Soong Lee ),신정현 ( Jung Hyun Shin ) 대한내과학회 2005 대한내과학회지 Vol.69 No.-

반지세포암은 과거에 여러 장기에서 보고되어졌으며 위에서 가장 많이 발생하는 것으로 알려져 있다. 특히 폐 조직에서 반지세포가 나올 경우 일반적으로 전이에 의해 발생한 것으로 생각되어 왔다. 하지만 드물게 폐에서 원발성으로 반지세포암이 발생될 수 있음이 보고되었고, 과거에는 부검이나 다른 장기의 병변이 없는 경우 진단하였으나, 최근 보고들에 따르면 종양 세포들의 형태학적 특징과 면역조직화학염색을 통해 폐의 원발성 반지세포암을 진단하는 예가 증가하고 있다. 저자들의 경우도 기관지 내시경을 통한 조직 검사와 면역조직화학염색으로 반지세포암을 진단하였으며 다른 여러 장기를 검사한 결과 전이 가능한 장기들에서 이상 소견을 발견할 수 없어 폐에 발생한 원발성 반지세포암으로 확진하였고, cisplatin과 paclitaxel의 복합 항암화학요법을 시행하였다. Signet ring cell carcinoma (SRCC) is a unique subtype of adenocarcinoma that is characterized by abundant intracellular mucin accumulation. SRCC can arise in various organs, including stomach, colon, breast, bladder, and prostate. SRCC can also arise as a primary lung tumor, but its incidence is low, ranging from 0.14% to 1.9% in the reported series. Therefore, SRCC in the lung is generally believed to be metastatic. But, recent several immunohistochemical studies have demonstrated that thyroid transcription factor-1 (TTF-1), cytokeratins 7 and 20 are specific markers for SRCC arising in the lung. We report a case of pulmonary SRCC with immunohistochemical characterization in a 54-year-old male. Chest X-ray and chest computed tomography (CT) scan showed a homogeneous mass, approximately 3 cm in diameter and subcarinal lymphadenopathy of left perihilar region. The tumor cells were mainly composed of signet-ring cells and strongly demonstrated cytokeratins (7+/20-). The investigations of whole body failed to reveal any other tumor. On the basis of immunohistochemical studies, we concluded that the tumor was SRCC arising in the lung. (Korean J Med 69:S830-S834, 2005)

심한 간 및 췌장 손상을 동반한 신경 식욕부진증

박정호 ( Jung Ho Park ),이태희 ( Tae Hee Lee ),천상렬 ( Sang Lyeol Cheon ),선제형 ( Jae Hyung Sun ),최인기 ( In Key Choi ),김용석 ( Yong Seok Kim ),최용우 ( Young Woo Choi ),강영우 ( Young Woo Kang ) 대한소화기학회 2009 대한소화기학회지 Vol.54 No.4

Anorexia nervosa, a syndrome most commonly affecting young women, is characterized by weight less than 85% of weight that is considered normal for that person`s age and height, distorted body image, and fear of becoming obese, and its mortality is up to 9%. We present a case of a 33-year-old woman with a 9-year history of anorexia nervosa. She admitted to our institution with decreased mentality, and her body mass index was 11.5 kg/m2 of the time admission. Initial aminotransferase level was severely elevated, but it was normalized solely with improved nutrition and weight gain. Five and sixteen days after the admission urinary tract infection and elevation of pancreatic enzymes occurred. They were successfully treated with antibiotics and nutritional support. Fifty seven days after the admission, she discharged. We report a case of acute hepatitis and pancreatitis treated with nutritional rehabilitation in a patient with severe anorexia nervosa for the first time in Korea. (Korean J Gastroenterol 2009;54:257-260)

증례 : 소화기 ; 급성 A형 간염 산모에서의 신부전, 췌장염 및 태아의 사산 1예

강민규 ( Min Gyu Kang ),이태희 ( Tae Hee Lee ),박정호 ( Jung Ho Park ),최인기 ( In Kee Choi ),선제형 ( Jae Hyung Sun ),천상열 ( Sang Lyeol Cheon ),강영우 ( Young Woo Kang ) 대한내과학회 2010 대한내과학회지 Vol.78 No.5

급성 A형 간염은 간외 합병증이 적고 저절로 좋아지는 질환으로 일반적으로 인식하고 있다. 그러나 최근 관절염, 혈관염 급성 신부전, 전격성 간부전, 췌장염 등의 전신 합병증이 많이 보고되고 있다8). 비전격 A형 간염에서 본 증례와 같이 급성 췌장염, 신부전 및 사산 등 여러 합병증이 병발하는 경우가 드물어 이를 문헌고찰과 함께 보고하고자 한다. The incidence of hepatitis A has increased sharply in Korea, and cases have been associated with many complications. We report a pregnant woman who developed acute renal failure, acute pancreatitis, and stillbirth associated with hepatitis A. She had no relevant medical history. She was admitted to hospital with vaginal bleeding, fever, and myalgia. The initial laboratory data and clinical findings were compatible with acute hepatitis, renal failure, and pancreatitis. To the best of our knowledge, this is the first case report of non?fulminant hepatitis with multiple complications in Korea. (Korean J Med 78:620-623, 2010)

악성 점막하 종양과의 구별이 어려웠던 Gastritis Cystica Profunda 1예

선제형,박진석,한민석,김수항,김우진,박인형,이숭,유종선,박찬국 朝鮮大學校 附設 醫學硏究所 2006 The Medical Journal of Chosun University Vol.31 No.3

Gastritis cystica profunda (GCP) is a rare disease characterized by gastric foveolae elongation along with hyperplasia and cystic dilatation of the gastric glands extending into the tissue beneath the submucosa. GCP mainly develops at the gastroenterostomy stoma but can arise in a stomach that has not undergone surgery. The proposed pathogenesis is related to chronic inflammation, ischemia and the presence of a foreign body. GCP may present as a submucosal tumor, Polyp or a giant gastric mucosal fold. Endoscopic ultrasonography (EUS) is an effective diagnostic method for differentiating GCP from protruding and elevated gastric lesions. We report a case of GCP along with the endoscopic and EUS findings that were indistinguishable from a malignant submucosal tumor.

진행성 위암에 동반된 위 칸디다증 1예

이두영,김성호,선제형,박진석,손존광,선홍주,이승,박찬국 朝鮮大學校 附設 醫學硏究所 2004 The Medical Journal of Chosun University Vol.29 No.2

Gastric candidiasis is an uncommon disorder. It is an opportunistic pathogen in immune compromised individuals, alcoholics, persons treated with broad-spectrum antibiotics, immunosuppressive and chemotherapeutic agents. Besides, the use of drugs that reduce the gastric acid production may be a cause of gastric candidiasis. We experienced a case of gastric candidiasis following advanced gastric adenocarcinoma. A 85-year-old woman was admitted to our hospital because of epigastric soreness. Endoscopic findings revealed a large ulcero-infiltrating mass with yellow exudate at cardia of the stomach, which suggested an advanced gastric cancer. Endoscopic biopsy revealed spores and pseudohyphae infiltrating through the ulcerated stomach wall, diffuse infiltration of tumor cells and abortive tumor glands. After treatment with fluconazole 100 mg daily for 21 days, no evidence of the gastric candidiasis was seen on endoscopic biopsy and pathologic findings. The case is herein reported of gastric candidiasis following advanced gastric adenocarcinoma along with a review of corresponding literature.

곰쓸개 복용 후 발생한 육안적 혈뇨와 신유두부 괴사증 1예

김우진,한민석,김수항,박인형,박진석,선제형,홍세인,박옥영,신정현,이숭,신병철 朝鮮大學校 附設 醫學硏究所 2006 The Medical Journal of Chosun University Vol.31 No.3

Renal papillary necrosis occurs most commonly in association with urinary tract infection, diabetes mellitus, sickle cell disease, vascular disease, and analgesic nephropathy. Clinical presentation may be related to symptoms of pyelonephritis such as flank pain, renal colic, hematuria, Proteinuria, recurrent fever. The necrotic tissue may be sloughed off, and the diagnosis can sometimes be made by finding piece of renal medullary tissue in the urine. Pyelography may demonstrate cavities and sinuses in the resion of papillae. Anuria & oliguria can lead to the acute renal failure, and especially prognosis and progress may be affect influenced by urinary infection. We report a case of renal papillary necrosis with ingestion of bear gallbladder. On pyelography, Persistent contrast is diagnostic clue of renal papillary necrosis. This case is not be related to urinary tract infection, but occurred acute renal failure. Expectant treatment was gone.

전해질 불균형과 동반된 신경이완제 금단 악성 증후군 1예

선홍주,김성호,이두영,선제형,박진석,박옥영,신정현,김현리,이승 朝鮮大學校 附設 醫學硏究所 2004 The Medical Journal of Chosun University Vol.29 No.1

Electrolytcs disturbance is one of the common medical problems encountered in chronic schizophrenic patients. Recently, we experienced a case of a 50-year-o1d man schizophrenic patient with severe hypokalemia (K:1.62 mEq/L) and hyponatremia (Na:100.8 mEq/L), which developed after psychogcnic polydipsia, followed by projectile vomiting. Aftcr admission, patient presented dysphagia, rigidity, tremor and mental change. We first considered that those symptoms were caused bv electrolyte disturbance. Thcretbrc, we corrected hypokalemia and hyponatremia. However despite of appropriate fluid therapy with electrolytes correction, these symptoms not resolved. But, after administration of antrpsychotic drug, symptoms were alleviated. Wc concluded patient's symptoms may be attributed to withdrawal ncuroleptic malignant syndrome (WNMS). In chronic schizophrenic patient, patient's symptoms were not sufficient to differentiate between hypokalemic psychosis and an exacerbation of schizophrenia. We report a case with brief literature review. 저자들은 과다 수분 섭취와 사출성 구토로 인한 전해질 불균형 소견을 보인 만성 정신분열병 환자에서 수일간 투여 중단 하였던 항정신병 약물의 투여로 사지 마비와 경직, 연하곤란, 구음장애 등이 호전되었음을 관찰하고, 정신 분열병 환자의 급격한 임상 양상의 변화가 약물의 금단에 의한 정신 질환의 악화임을 임상적으로 경험하였기에 문헌 고찰과 함께 보고하는 바이다.