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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)
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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.
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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.
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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.
KCI
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