순간접착제 복용으로 인한 상부 위장관 이물 1예

왕길상,김명환,우명렬,최자성,조현근,문영명 대한소화기내시경학회 2008 Clinical Endoscopy Vol.36 No.4

상부 소화관 이물은 모든 연령층에서 의도적 또는 우연히 생길 수 있다. 소아에서 자주 발생할 수 있으며, 성인에서도 식도 질환, 의치, 정신 박약, 이차적 이득을 원하는 경우나 알콜 중독자들에서 종종 생길 수 있다. 이물의 종류는 사회적, 문화적 상황에 따라 달라질 수 있는데, 주로 동전, 코르크 마개, 장난감, 칫솔, 바늘, 볼펜, 생선가시 등이 있다. 상부 소화관 이물은 대부분 증상 없이 장관을 통과해서 배출되지만, 일부는 내시경적 제거술이나 개복 수술이 필요할 수 있다. 순간접착제가 식도와 위에 걸쳐 이물로 존재하여, 식도에서는 내시경적 제거를 시행하고 위에서는 개복술을 동시에 시행한 증례는 보고되지 않았다. 저자 들은 우울증과 자살 시도의 과거력을 가진 80세 남자에서 식도와 위의 순간접착제 이물을 내시경적 적출과 수술적 제거를 동시에 시행하여 치료한 1예를 경험하여 보고한다.

증례 : 소화기 ; 대장폐색을 동반한 Morgagni 탈장 1예

왕길상 ( Kil Sang Wang ),조현근 ( Hyeon Geun Cho ),김정훈 ( Jeong Hun Kim ),김명환 ( Myoung Hwan Kim ),박인서 ( In Suh Park ),박재균 ( Jea Kun Park ),김미성 ( Mi Sung Kim ) 대한내과학회 2009 대한내과학회지 Vol.76 No.4

Morgagni 탈장은 주로 중년 이후에 외상, 임신, 비만 등의 복강 내압 증가에 의해 복강 내 장기들이 결손 부위로 진입하여 발생된다. 임상 증상은 상복부 불편감, 상복부팽만감, 구역 및 구토 등이 발생되는데, 본 증례는 88세 고령의 여자환자로서 MDCT에 의해 Morgagni 탈장이 진단되었다. 그에 따라 대장 폐색이 영상으로 나타나 즉각적인 수술로 완쾌되었음을 경험하였기에 문헌고찰과 함께 보고하는 바이다. Although Morgagni hernias are rarely symptomatic, an 88-year-old woman presented with severe abdominal pain and distension due to large bowel obstruction. The transverse colon and omentum were herniated through an anterior medial diaphragmatic defect in the right thorax. The plain abdominal X-rays indicated intestinal obstruction and the plain chest X-ray showed hazy mass-like densities. The multi-detector row computed tomography (MDCT) findings were compatible with a Morgagni hernia. This diagnosis of a Morgagni hernia was confirmed at immediate surgery. (Korean J Med 76:481- 484, 2009)

항결핵제를 유지하면서 치료한 항결핵제 유발 위막성 대장염 치험 1예

우명렬,김정훈,김명환,권혁진,왕길상,이상엽,조현근,조재희 대한소화기내시경학회 2009 Clinical Endoscopy Vol.38 No.1

Tuberculosis is one of the main infectious health problems in Korea, and a combination of antibiotics is required to treat this illness. The combination therapy with rifampicin, isoniazid, ethambutol and pyrazinamide has many adverse reactions and there have been several case reports about pseudomembranous colitis (PMC) after anti- tuberculosis treatment. Rifampicin is regarded as a main cause of anti-tuberculosis induced PMC because of its bacteriocidal effect, and interruption of the offending drug, such as rifampicin, is usually necessary to treat the PMC. However, in patents with uncompensated tuberculosis, the discontinuance of anti-tuberculosis medication accentuates the disease severity, and continuance of the anti-tuberculosis medication is necessary to overcome the tuberculosis. We report here on a case in which the anti- tuberculosis agents induced PMC in 32 year old female who was diagnosed with active pulmonary tuberculosis. She was treated with maintenance of the anti-tuberculosis medication and also the addition of both oral metronidazole and probiotics. 항결핵제에 의한 위막성 대장염은 항결핵제에 내성을 획득한 C. difficile에 의해 유발될 수 있다. 일반적으로 위막성 대장염은 대증적 치료 외에 원인 약물을 중단하고 경구metronidazole이나 vancomycin 등을 사용하여 치료한다. 하지만 항결핵제 유발 위막성 대장염에서 항결핵제를 유지하면서 경구 metronidazole을 사용하여 위막성 대장염을 치료한 사례는 보고되지 않아, 저자들은 항결핵제를 유지하면서 치료한 위막성 대장염 1예를 보고하는 바이다.

포스터 전시 발표 : 소화기 ; 항결핵제를 유지하면서 치료한 항결핵제 유발 위막성 대장염 1예

우명렬,김명환,권혁진,왕길상,조재희,조현근,이상엽 대한내과학회 2008 대한내과학회지 Vol.75 No.1S

수신증에 의해 고칼륨혈증과 고알도스테론증을 보인 1예

김영훈,이성배,김응진,왕길상,이근만,한경아,한설혜,민경완,엄중호 대한내과학회 1999 대한내과학회지 Vol.56 No.2

Renal tubular dysfunctions have been observed in hydronephrosis, resulting in metabolic acidosis, hyperkalemia and excessive free water diuresis. These findings are occasionally found in infant and children. Batle et al. first reported distal tubular acidosis associated with low potassium excretion resulting from aldosterone resistance in adults with obstructive uropathy. We have experienced a case of transient hyperkalemia and hyperaldosteronism secondary to hydronephrosis in 63-year-old female patient. The causes of hyperkalemia were examined under the impression of secondary adrenal insufficiency due to corticosteroid abuse or hyporeninemic hypoaldosteronism due to diabetic nephropathy. But it proved to be resulted from hyperaldosteronism due to hydronephrosis. The hyperkalemia resulting from hyperaldosteronism is rare in adults. It may result from aldosterone resistance at distal nephron due to obstructive uropathy or the defect of distal nephron in hydrogen and potassium secretion in the distal nephron rather than from aldosterone deficiency. After she underwent percutaneous nephrostomy, serum potassium was maintained within normal range. She performed total cystectomy with ureterocutaneostomy in purpose for treatment of bladder cancer. So we report this case with a review of literature.

식사요법과 운동으로만 혈당을 조절하는 당뇨병 환자의 임상적 특징

이성배,김응진,이현석,전재석,왕길상,한경아,민경완 대한당뇨병학회 1999 Diabetes and Metabolism Journal Vol.23 No.1

대장 내시경 검사시 전처치제로서 Midazolam 단독 사용에 관한 연구

박영숙,문영수,김혜랑,왕길상,황의경,황인후,문찬희,이근만 대한소화기내시경학회 1999 Clinical Endoscopy Vol.19 No.1

Background: As the frequency of colonoscopic approaches increases, we need a less painful premedication for colonoscopy. We used midazolam as a premedication agent. It has more rapid onset of action than that of diazepam and its duration is shorter. The purpose of this study was to examine the clinical application of midazolam. Methods: Fifty patients underwent colonoscopies. An average dose of midazolam, 0.07 mg/kg, was given to patients intravenously as premedication. We measured systolic and diastolic blood pressures, pulse rates, respiratory rates, and oxygen saturation (SaO2) using pulse oxymetry before and after the injection. A Trieger test was accomplished before and after the procedures. We examined the levels of consciousness with verbal and physical stimulation during the colonoscopy. The examiners noted the degree of amnesia and pain after colono-scopy. We examined the patients' satisfaction and endoscopists' assessments. Results: 1) Systolic, diastolic blood pressures and respiratory rates showed no significant changes. But, pulse rates increased meaningfully at 15 minutes after the injection of midazolam (p <0.05). 2) The Trieger test showed meaningfully increased numbers of missed dots after the injection of midazolam. 3) The levels of consciousness during the test showed alertness in 22 patients (44%), drowsy mentality in 22 patients (44%) and stuporous mentality in 6 patient (12%). 4) The degree of amnesia after examination showed recall in 26 patients (52%), partial recall in 10 patients (20%) and total amnesia in 14 patients (28%). 5) Forty-five patients (90%) acknowledged this procedures to be more comfortable than previous procedures. Conclusions: Midazolam stabilized vital signs and oxygen saturation, therefore midazolam can be used safely as premedication for colonoscopy. Thirty-six patients (72%) recalled the procedures totally or partially. But, the relief of pain compared favorably to the degree of amnesia. We concluded that mida-zolam (0.07 mg/kg) was the safe and effective premedicatin for colonoscopy.

다발성 신경근신경병증과 뇌출혈을 동반한 과호산구성 증후군 1 예

김영훈,이상무,이성배,이현석,송창섭,김혜랑,왕길상,이근만 대한내과학회 1998 대한내과학회지 Vol.55 No.6

Clinical criteria have established for idiopathic hypereosinophilic syndrome(HES): persistent eosinophilia of 1500 eosinophils/㎣ for at least 6 months or death even within 6 months with signs and symptoms of HES; no evidence for parasitic, allergic, or other recognized causes of eosinophilia despite careful evaluation; and signs and symptoms of organ system involvement or dysfunction, such as congestive heart failure, hepatosplenomegaly, central nerveous system disease. Because cerebral hemorrhage in HES has not been reported yet in Korea, we report a case of hypereosinophilic syndrome with peripheral blood eosinophilia, with biopsies of skin and duodenum showing diffuse eosinophilic infiltration, and multiple organ dysfunction in a 49 year old man died of cerebral hemorrhage three months after the occurrence of the disease.