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신수린 ( Su Rin Shin ),이명석 ( Myung Seok Lee ),박상훈 ( Sang Hoon Park ),최종수 ( Jong Soo Choi ),이경민 ( Kyung Min Lee ),김진배 ( Jin Bae Kim ),김형수 ( Hyeong Su Kim ),김정원 ( Jeong Won Kim ) 대한소화기학회 2012 대한소화기학회지 Vol.60 No.3
Breast cancer is a rare disease in men. We report a case of 53-year-old obese male, with known cryptogenic cirrhosis and hepatocellular carcinoma, presenting a tender mass on left breast. He was diagnosed with invasive intraductal carcinoma, which was consistent with a sporadic lesion. On the basis of previous literatures, obesity can be regarded as a cause for breast cancer even in men. However, there has been inconsistent data about link between liver cirrhosis and male breast cancer, which can be due to heterogenity in the etiology of cirrhosis. Through this case, it can be postulated that the risk for male breast cancer may vary according to the etiology of cirrhosis. (Korean J Gastroenterol 2012;60:182-185)
신수린 ( Su Rin Shin ),김창환 ( Chang Hwan Kim ),김성은 ( Sung Eun Kim ),박용범 ( Yong Bum Park ),이재영 ( Jae Young Lee ),모은경 ( Eun Kyung Mo ),김철홍 ( Cheol Hong Kim ),엄광석 ( Kwang Seok Eom ),장승훈 ( Seung Hun Jang ),김동 대한결핵 및 호흡기학회 2006 Tuberculosis and Respiratory Diseases Vol.61 No.3
배경: 근치적 항결핵제의 유용에도 불구하고, 결핵으로 사망하는 환자는 증가하고 있다. 다제내성결핵과 HIV 감염이 높은 사망률과 관련되어 있지만, HIV 감염률이 낮은 지역에서는 다른 요소들이 사망과 관련되어 있을 가능성이 있다. 이에 결핵으로 입원한 환자에서 병원내 사망과 관련된 인자들을 알아보고자 하였다. 방법: 2003년 1월 1일부터 2004년 12월 31일까지 한림대학교 병원에 결핵으로 확진되어 치료한 신환에서 사망한 환자 27명과 호전되어 퇴원한 환자 중 나이와 성별을 짝지은 54명을 대조군으로 비교분석하였다. 결과: 사망군의 평균 나이는 60±16세이며, 남자가 70%였다. 대조군에 비해 사망군에서 혈색소, 알부민과 콜레스테롤이 유의하게 낮았으며(p<0.05), 혈액요소질소, AST, C-reactive protein는 유의하게 높았다(p<0.05). 사망군에서 대조군에 대해 결핵의 기왕력은 차이가 없었으며, 방사선학적 중증도, 동반질환, 내원시 호흡곤란, 응급실을 통한 입원과 초기 중환자실 치료가 유의하게 높았다(p<0.05). 다중회귀분석을 통해 알부민과 초기 중환자실 치료가 독립적으로 사망에 영향을 미치는 인자로 밝혀졌다(p<0.05). 결론: 심한 영양결핍을 동반한 중증 결핵 환자는 사망에 고위험군으로 결핵 환자의 조기 발견 및 치료에 개선이 필요하며, 효율적인 공공 보건 교육, 검진정책과 환자관리가 중요할 것으로 사료된다. Study objectives: To determine the factors associated with mortality after an in-hospital diagnosis of tuberculosis in a region with low levels of HIV coinfection. Methods: From January 2003 to December 2004, all subjects who were > 15 years of age and had received a diagnosis of tuberculosis were registered. The clinical, radiological and laboratory aspects of the patients who died (n=27) were compared with those of an age and gender matched control population(n=54). Logistic regression analyses were carried out, which included age, gender, hospital admission source, initial site of admission, dyspnea, general weakness and initial laboratory data. Results: The mean age of the patients was 60±16 years and male patients outnumbered female patients. Univariate analysis identified hemoglobin, blood urea nitrogen, albumin, cholesterol, aspartate aminotransferase (AST), C-reactive protein and the risk factors for tuberculosis to be significantly associated with mortality. Among the characteristics of disease presentation and treatment, emergency department admission, intensive care unit, disease severity, general weakness and dyspnea at the time of admission were associated with mortality. Multiple regression analysis revealed the initial management in the intensive care unit and lower serum albumin to be independently associated with mortality. Conclusion: The markers of disease chronicity and severity appear to be associated with in-hospital mortality. Identifying potentially reversible factors such as malnutrition and respiratory failure suggests specific intervention that might lead to an improvement in the patients` outcomes. (Tuberc Respir Dis 2006; 61: 233-238)
대장 점막-점막하 유경성 용종에서 발생한 비용종성 암 1예
신윤호 ( Yun Ho Shin ),김진배 ( Jin Bae Kim ),최종수 ( Jong Soo Choi ),이경민 ( Kyung Min Lee ),신수린 ( Su Rin Shin ),박상훈 ( Sang Hoon Park ),김정원 ( Jeong Won Kim ),이명석 ( Myung Seok Lee ) 대한소화기학회 2012 대한소화기학회지 Vol.59 No.3
A colonic muco-submucosal elongated polyp (CMSEP) was identified at colonoscopy in a 53-year-old male patient with lower gastrointestinal bleeding. Non-polypoid depressed type of early cancer was noted at the tip of the colonic polyp. The CMSEP is very rare and incidentally found in most cases. Moreover, its association with colonic neoplasia is extremely rare. To our knowledge, this is the second case report of CMSEP associated with a cancerous transformation.
복강 내 발생한 Immunoglobulin G4 연관 염증성 가성종양
모인호 ( In Ho Moh ),김진배 ( Jin Bae Kim ),신수린 ( Su Rin Shin ),정성원 ( Sung Won Jung ),박상훈 ( Sang Hoon Park ),김정원 ( Jeong Won Kim ),신미경 ( Mi Kyung Shin ),이명석 ( Myung Seok Lee ) 대한소화기학회 2012 대한소화기학회지 Vol.60 No.4
The term inflammatory pseudotumor (IPT) has been used to describe inflammatory and fibrosing tumoral processes of an undetermined cause that may involve a variety of organ system. IgG4-related disease is a newly recognized fibroinflammatory condition characterized by IgG4-producing plasma cell expansion in affected organs and, often but not always, elevated serum IgG4 concentrations. IgG4-related IPTs, a subtype of IPT, are characterized by dense infiltration of IgG4-positive plasma cells and stromal fibrosis. The association between inflammatory pseudotumor and IgG4 was first reported with a regard to sclerosing pancreatitis. Despite there are many reports on intraperitoneal IPTs including both cellular and lymphoplasmacytic type, only a few cases have been confirmed to be IgG4-related. We experienced a case of intraperitoneal IgG4-related inflammatory pseudotumor in an 83-year-old woman presenting with epigastric pain and malaise. Surgical specimens revealed an IgG4-related inflammatory pseudotumor.
김성은 ( Sung Eun Kim ),김수진 ( Soo Jin Kim ),김형수 ( Hyoung Su Kim ),김희선 ( Hee Sun Kim ),남은숙 ( Eun Sook Nam ),이상규 ( Sang Kyu Lee ),신수린 ( Su Rin Shin ),김학양 ( Hak Yang Kim ) 대한소화기학회 2006 대한소화기학회지 Vol.48 No.6
Hepatitis A is generally regarded as a mild, self-limiting disease of the liver. Acute renal failure has rarely been reported in association with non-fulminant acute hepatitis A. Acute tubular necrosis is the most common form of renal injury in such patients. We recently experienced two cases of hepatitis A in which acute renal failure occurred early in the course of the illness and had a clinical course suggestive of acute tubular necrosis. In both patients, the clinical course of renal dysfunction was almost parallel to that of hepatic dysfunction. Hemodialysis was performed in patient 1 because of severe uremia despite maintaining urine output more than 2,000 mL per day. On the other hand, hemodialysis was not performed in patient 2 who showed a rapid recovery of renal dysfunction. The renal biopsy of patient 1 demonstrated typical findings of acute tubular necrosis on microscopy. (Korean J Gastroenterol 2006;48:421-426)
증례 : 역설적 반응에 의하여 발생한 결핵성 간농양 1예
정성웅 ( Sung Woong Jung ),김진배 ( Jin Bae Kim ),최종수 ( Jong Soo Choi ),이경민 ( Kyung Min Lee ),신수린 ( Su Rin Shin ),박상훈 ( Sang Hoon Park ),이명석 ( Myung Seok Lee ) 대한내과학회 2012 대한내과학회지 Vol.83 No.1
역설적 반응은 적절한 항결핵제로 치료하여 임상적 호전을 보이는 결핵 환자에서 치료 당시의 결핵병변이 악화되거나 또는 새로운 병변이 발생하는 경우를 말한다. 이는 약제 내성이나 치료 실패와의 감별이 필요하다. 저자들은 장 및 복강 결핵에 대한 항결핵제 치료로 임상적 호전을 보이며 원발부위의 영상검사 소견도 호전되는 상황에서 치료 2개월째 역설적 반응으로 간농양이 발생하여 지속적인 약물치료에도 호전되지 않아 수술을 시행한 증례를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Tuberculous liver abscesses are rare. We report here a case of tuberculous liver abscess that developed in a paradoxical response during appropriate anti-tuberculosis chemotherapy in a 50-year-old male. In this case, a paradoxical response to the treatment of intestinal tuberculosis may have been involved in the pathogenesis of the liver abscess.