급성신부전을 동반한 급성신우신염의 임상상의 특징

송승찬(Seung Chan Song),이재웅(Jae Woong Lee),이오영(Oh Young Lee),양석철(Suk Chol Yang),한동수(Dong Soo Han),손주현(Ju Hyun Son),김순길(Soon Kil Kim),김호중(Ho Jung Kim) 대한내과학회 1997 대한내과학회지 Vol.53 No.3

N/A Background: Acute renal failure (ARF) due to acute pyelonephritis (APN) in patients in the absence of obstructive uropathy, diabetes, or chronic renal failure was reported rarely (12 cases in the last 25 yrs in Clin Inf Dis, 1992; 243-6 by SR Jones)2). Acute renal failure is a rare complication of acute pyelonephritis in patients who do not have urinary obstruction. Although urinary tract infections are common in adults, pyelonephritis is rarely considered in the differential diagnosis of acute renal failure, and when clinicians weigh the possible consequences of bacteriuria, renal failure is not considered to be a reasonable possibility. Methods : We observed 6 patients of acute pyelonephritis associated with acute renal failure as an initial manifestation on admission in the past 6 months. The analysis of clinical features of these 6 patients (APN+) compared to 7 patients of APN without ARF (APN-) revealed following data. Results: All were female in both groups. The mean age was 331.7 years in APN+ and 48+6 years in APN-, respectively (p, ns). All in both APN- and APN+ were caused by E. coli. But, none in both groups except 1 in APN- had bacteremia. The previous history of UTI was present in 5 in APN-, but none in APN+. Duration of clinical symptoms before admission (8.4±0.5 vs. 4.4±1.0 days, P<0.05) and admission days (24.2±1.8 vs. 11.1±1.5 days, p=0.000) were significantly longer in APN+. On admission, HUN and serum creatinine was 45±2.7mg/dL and 3.5±0.2mg/dL in APN+, respectively. No one in APN+ required dialysis, and subsequently recovered renal function with prompt antibiotic therapy resulting in no significant difference compared to that of APN on discharge (serum creatinine, 1.0±0.1 vs. 0.9±0.1mg/dL). No differences in leukocytosis and serum electrolyte levels on admission were present. However, significant anemia was noted in APN+ (hemoglobin, 9.0±0.7 vs. 11.9±0.2gm/dL). The days of fever and leukocytosis before disappearance were not different in both groups, but those of flank pain (12.8±1.5 vs. 5.7±0.7 days, P=0.001) and pyuria (16±1.9 vs. 6.4±0.6 days, P=0.000) significantly longer in APN+. Upon ultrasonography, all in APN+ showed enhanced echogenicity, but I in APN . (P=P value, NS=not significant) Conclusion: Upon these data, we concluded that ARF associated with APN as an initial manifestation was accompanied by several distinct clinical characteristics, which could be used for the early recognition of its unusual occurrence and subsequent appropriate management including antibiotics leading to a favorable outcome.

복어중독에 의한 가사 상태에서 소생한 1예

송승찬,신진호,강석우,박경남,최호순,박근태,문희식,기춘석,이성희,윤병철,노우균,조균석,이민호 大韓應急醫學會 1998 대한응급의학회지 Vol.9 No.3

Tetrodotoxin is a neurotoxin produced by about 90 species of puffer fish and causes paralysis of central nervous system and peripheral nerves by blocking the movement of all monovalent cation. Ingestion of tetrodotoxin produces clinical manifestations such as paresthesias(within 10-45 min), vomiting, lightheadedness, salivation, muscle twitching, dysphagia, difficulty in speaking, convulsion and death that expressed by cardiopulmonary arrest with loss of brain stem reflex sometimes. Tetrodotoxin prevents or delays ischemia induced neuronal death by way of following 3 mechanisms. Firstly, it reduces the energy demand of the brain tissues. Secondly, it delays or even prevents anoxic depolarization. Finally, it deminishes ischemia induced cell swelling and cerebral edema. We report a case of puffer fish poisoning which presented with cardiopulmonary arrest and loss of brain stem reflex, but completely recovered by aggressive cardiopulmonary resuscitation.

궤양성 대장염과 동반된 상장간막정맥 및 간문맥 혈전증 1예

김병훈,한동수,조윤주,송승찬,전용철,손주현,안명주,박경남 大韓消化器病學會 1998 大韓消化器病學會誌 Vol.32 No.3

궤양성 대장염과 동반된 상장간막정맥 및 간문맥 혈전증 1예

전용철,박경남,한동수,김병훈,손주현,안명주,조윤주,송승찬 대한소화기학회 1998 대한소화기학회지 Vol.32 No.3

Thromboembolism is a infrequent extraintestinal complication of inflammatory bowel disease. Especially, portal vein and superier mesenteric vein thrombosis are rare complications of ulcerative colitis and its mortality is invariably fatal. The mechanism of thrombolic complications in inflammatory bowel disease remains enigmatic. Moreover, the clarification of the hypercoagulable state remains elusive. This report describes the case of 27-year-old-female with active ulcerative colitis. The patient revealed portal vein and superior mesenteric vein thrombosis with ascites detected by abdominal ultrasound exammation and computed tomography and successfully treated with combined anticoaulation therapy.

풍선 확장술로 치유된 선천성 총담관 막양구조 (Web)

박경남,한동수,이민호,최호순,조용현,함준수,이성희,전용철,송승찬,문광호,기춘석,윤병철,손주현 대한소화기내시경학회 1998 Clinical Endoscopy Vol.18 No.3

The web of the common bile duct is an extremely rare anomaly and the cause of the obstructive jaundice. We experienced a case of the congenital web of common bile duct in a 42 years old male who complained of jaundice for 10 days prior to admission without choledocholithiasis and cholangitis. An endoscopic retrograde cholangiopancreatography revealed a common bile duct web (transverse, diaphragmatic type) and the diagnosis was confirmed by an endoscopic forcep biopsy. We reported a case of the congenita1 web of the common bile duct which was treated with a stent insertion and balloon dilatation.

대장내시경검사의 전처치로서 항콜린제 사용에 관한 연구 : 전향적, 이중맹검법으로

박경남,한동수,이민호,최호순,박준용,손주현,이오영,함준수,전용철,송승찬,기춘석,윤병철,이종희 대한소화기내시경학회 1997 Clinical Endoscopy Vol.17 No.3

Background: Use of antispasmodic medication prior to colonoscopy is controversial but someone believes antispasmodic may improve visualization of colonic mucosa and ease colonoscope insertion. So, we designed a study to assess the effect of premedication with the antispasmodic, hyoscine-N-butyl bromide(Buscopan') on the performance of colonoscopy. Methods: This study was prospective, double blinded, randomized, controlled study, One hundred three consecutive patients were randomized to receive intravenous buscopan lml(n=52) or placebo(n=51) combined with our standard initial medication(me- peridine 50 mg and midazolam 2 mg). Insertion of colonoscopy was timed, and 100 mm visual analogue scales (VAS) were used for asscssing difficulty of procedure, colonic motility, frequency of positional change, frequency of external compression, difficulty of assistance and degree of discomfort experienced by the patients. Results: There were no significant differences of intubation time between buscopan group(mean time, 7.23 min., range 2~15) and placebo group(7.07 min., range 3-25), (p=0.83) and withdrawal time between buscopan group (6.46 min., range 2-22) and placebo group(6.76 min., range 2 25), (p=0.69). Also, there was no significant differences in intubation time between males and females(buscopan; males 7.00 min., females 7.60 min., p=0.34, placebo; males 7.0~5 min., females 7.08 min., p 0.44). The VAS scores checked by endoscopist(p=0.29), assistant(p=0.32) and patient (p=0.15) were not significantly different in both groups. There were no significant differences in intubation time, VAS scores nf endoscopist, assistant, and patients. Conclusion: Premedication with intravenous bu.opan has no advantage on colonoscopy procedure. Use of antispasmodic medication prior to colonoscopy was not considered as recommendable agent.

유두부 괄약근 절개술로 치유한 Choledochocele

박경남,한동수,이민호,조균석,최호순,윤병철,손주현,이오영,기춘석,함준수,전용철,송승찬,임현철,문광호 대한소화기내시경학회 1998 Clinical Endoscopy Vol.18 No.5

A choledochocele is a cyst like herniation of the intramural segment of the distal common bile duct protruding into the duodenal lumen. It is controversial whether this disease entity represents a type III variation of a choledochal cyst or an acquired lesion due to a calculus, papillitis or sphincter of Oddi dysfunction. The choledochocele is the rarest form of choledochal cysts and represents only 1.4-5.0% of all choledochal cysts. The diagnosis of choledochocele can be confirmed with certainly using a cholangiography. During a side viewing duodenoscopy followed by retrograde cholangiopancreatography, the mucosa appears normal but the papilla may be larger than usual. When probing the choledochocele with a cannulating catheter, its surface may be appear to be soft and compressible, similar to the pillow sign. After contrast dye is instilled into the bile duct, a round, cyst-like contrast filled structure can be identified adjacent to the terminatian of the common bile duct and an air halo sign may be visible around it. The established treatment of choledochocele is surgical resection of the cyst with anastomosis of the common bile duct to the small intestine, but transduodenal sphincteroplasty or endoscopic sphincterotomy has been advocated as an alternative to excision because of the very low risk of malignant degeneration, operative complications and morbidity. The choice of therapy for the patients with symptomatic choledochchocele is to establish effective drainage of the common bile duct and pancreatic duct. The objective can be achieved using an endoscopic sphincterotomy or transduodenal sphinateroplasy. It has been determined in recent years that endoscopic sphincterotomy is v effective and often followed by a positive prognosis. We report two patients with reicurrent pancreatitis and the common bile duct dilatation secondary to a choledochoce]e, who were treated effectively by endoscopic sphincterotomy.

위절제술 후 담낭운동의 변화 및 우르소데옥시콜산의 효과

이용욱,이민호,류광현,최호순,윤병철,권성준,이오영,기춘석,함준수,은창수,송승찬,박경남 대한소화기학회 1999 대한소화기학회지 Vol.33 No.4

Background/Aims: The aims of this study were to evaluate the change of gallbladder motility in gastrectomized patients and to investigate the change of gallbladder motility after administration of ursodeoxycholic acid (UDCA). Methods: Prospective serial ultrasonographic study was performed in forty-six gastrectomized patients and thirty-seven healthy controls. Twenty-four patients who had low ejection fraction were studied after administration of ursodeoxycholic acid (1000 mg, daily). Results: The mean fasting (FV) and postprandial (PV) gallbladder volume were significantly increased in gas trectomized patients (FV 30.2 ±13.9 mL, PV 12.6 ±6.4 mL), compared with controls (FV 17.2 ±5.8 mL, PV 4.3 ±3.3 mL). The ejection fraction of gallbladder in gastrectomized patients (56.9 ±13.0%) was significantly lower than that in controls (75.5 ±16.1%). The ejection fraction was recovered slowly after gastrectomy. However, there was no significant difference between UDCA-treated group (71.5 ±11.9%) and non-treaup (71.4 ±13.9%). Conclusions: Gastrectomy may increase the risk of gallbladder stones or sludges by inducing gallbladder dysmotility. Ursodeoxycholic acid does no seem to affect gallbladder motility.

특발성 문맥압 항진증에 동반된 십이지장 정맥류 출혈 1예

박경남,한동수,이민호,최호순,윤병철,손주현,이오영,기춘석,함준수,노우균,전용철,송승찬,문광호,손동현,문희식 대한소화기내시경학회 1998 Clinical Endoscopy Vol.18 No.2

Bleeding duodenal varices are a rare complication in patients with portal hypertension. Cirrhosis followed by portal vein obstruction and splenic vein obstruction are the most common causes. Although the prognosis of bleeding duodenal varices is usually poor, an awareness of its characteristic presentation may enable diagnostic and therapeutic proce- dures to be performed rapidly with an increased likelihood of a reaching successful out- come. In this study, we report a case of bleeding duodenal varices in a 23-year-old woman with idiopathic portal hypertension who was also suffering with recurrent melena. Panendoscopy identified prominant tortuous varices with central erosion in the 3rd portion of the duodenum and no esophageal and gastric varices. The varices were successfully treated by distal splenorenal shunt.