증례 : 닭 골편에 의해 발생한 간농양 1예

장재현 ( Jae Hyun Jang ),원경준 ( Kyung Jun Won ),이준 ( Jun Lee ),변유미 ( Yu Mi Byeon ),박찬국 ( Chan Guk Park ),김만우 ( Man Woo Kim ) 대한내과학회 2007 대한내과학회지 Vol.73 No.1S

제 1형 신경섬유종증 환자에서 발생한 위장관 간질종양 1예

원경준,이준,변유미,조민근,한경택,김원,홍란,임성철,김경종,김영대,박찬국,김만우 朝鮮大學校 附設 醫學硏究所 2007 The Medical Journal of Chosun University Vol.32 No.2

Gastrointestinal stromal tumor (GIST) is the most common non-epithelial neoplasm arising in the gastrointestinal tract, but this tumor is rarely seen in association with type l neurofibromatosis (NFl) Generally, the majority of GISTs are isolated neoplasm and they are sporadically found in the stomach, but the GISTs in NFl patients are usually multiple and usually found in the small intestine. We report a case of multiple GISTs in the jejunum of a 63-year-old woman diagnosed as NFl accompanied by complication of gastrointestinal bleeding, In this case, Patient had multiple cafe-au lait spots and neurofibroma on skin and had freckling on axilla and groin, and then, we made a diagnosis of NFl. Gastrointestinal bleeding is controlled by resection of multiple GISTs. Generally, only 3-5% of all gastrointestinal bleeding comes from the small bowel. Causes of small intestinal bleeding are angiodysplasia, neoplasm, NSAIDs induced ulcer etc. but, If patients have NFl accompanied by complication of gastrointestinal bleeding, GISTs on small bowel must be considered.

간경변 환자에서 Oro-cecal Transit Time의 측정

원경준,이준,변유미,조민근,조주연,서정균,김영대,박찬국,김만우 朝鮮大學校 附設 醫學硏究所 2008 The Medical Journal of Chosun University Vol.33 No.2

Background: Neurotransmitter like substances in the gut have been proposed to contribute to the overall portal systemic encephalopathy (PSE). The source of the ammonia in patients with PSE is mainly the small bowel, as a result of the conversion of glutamine in the diet to glutamate and ammonia. PSE is highly responsive to changes in diet, to antibiotic therapy and to ingestion of nondigestible disaccharides such as lactulose. This study was performed to evaluate the relationship between PSE and oro-cecal transit time. In addition, performed to evaluate the effect of severity, cause, complications of liver cirrhosis on oro-cecal transit time. Methods: Between August 2006 and February 2007, 48 cirrhotic patients consecutively was enrolled in study their oro-cecal transit time after informed consent was obtained. A non-invasive hydrogen breath test was used to study oro-cecal transit time (OCTT). Result: The OCTT were delayed in cirrhotic patients with PSE compared without PSE (123.3 ± 42.7 min vs 170.0 ± 58.3 min, p<0.05). OCTT tended to prolongate further as the damage in the liver got worse, nevertheless the result was statistically meaningless (p<0.111). Neither presence of ascites or cause of PSE had any influence on gastrointestinal transit. Conclusions: Cirrhotic patients with PSE have more delayed OCTT than without PSE. Further research is needed to find out the relationship between OCTT and severity of liver cirrhosis.

아메바성 대장염과 연관된 Henoch-Scho¨nlein Purpura 1예

장재현,원경준,이준,변유미,이재광,김영훈,박찬국,김만우 朝鮮大學校 附設 醫學硏究所 2006 The Medical Journal of Chosun University Vol.31 No.3

Henoch-SchonIein purpura is a common form of vasculitis primarily involving the skin, the gastrointestinal tract, the joints, the kidneys, and the nervous system. The etiological investigations are essential, because triggering factors are found in approximately half the patients such as viral, bacterial and parasitic infections, drugs, toxins, systemic diseases and cancer. But it's the correlation between Henoch-SchonIein purpura and Entamoeba histolytica has been rarely reported. We report a 29-years-old woman with Henoch-SchoIein purpura complicated by the lower gastrointestinal bleeding caused by the amoebic colitis. She complained of cramping abdominal pain, lower extremity purpura and hematochezia. Cysts and trophozoites of Entamoeba histolytica were detected in her stool. Skin biopsy demonstrated the leukocytoclastic vasculitis. She was administered metronidazole 1,500㎎ a day for the treatment of amebic colitis. Her hematochezia was improved, but the abdominal pain and purpura were not. The subsequent corticosteroid therapy improved her symptoms.

좌측흉수로 발현된 Boerhaave 증후군 1예

이준,변유미,조민근,조주연,원경준,김영대,박찬국,김만우,유재근,서홍주,이석기 朝鮮大學校 附設 醫學硏究所 2008 The Medical Journal of Chosun University Vol.33 No.2

구토 후 발생한 토혈을 주소로 내원한 환자에서 좌측 늑막 삼출 동반 시 식도 파열의 가능성을 고려하여 흉수 천자 및 지속적인 흉부 단순 촬영의 추적관찰이 필요하며 식도 파열이 배제된 후 환자의 생체 징후 및 토혈 양을 파악하여 내시경 검사 시기를 신중히 결정하는 것이 좋을 것으로 생각된다. 본 증례는 토혈을 주소로 내원하여 Mallory-Weiss 증후군 의심 하에 내시경을 통한 치료 시행 후 추적 관찰에 의해 진단된 Boerhaave 증후군을 경험하였기에 보고하는 바이다. Boerhaave's syndrome is a spontaneous perforation of the esophagus most commonly resulting from a sudden increase in intraesophageal pressure combined with negative intrathoracic pressure caused by straining or vomiting. Surgery should generally be performed within 24 hours because mortality approached 30 to 50 percent in which surgery was delayed. Therefore, early diagnosis and prompt surgical repair are critical for survival. We have experienced a case of Boerhaave's syndrome in a patient presenting with hematemesis with left pleural effusion without any signs or symptoms of pneumomediastinum or pneumothorax.

염산증기 흡입에 의해 발생한 화학성 폐렴 1예

장재혁,원경준,권세훈,하성일,권용은,이승일,윤성호 朝鮮大學校 附設 醫學硏究所 2007 The Medical Journal of Chosun University Vol.32 No.2

A 38-year-old man with dyspnea admitted to the emergency department after exposure to hydrochloric acid in pharmaceutical product manufacturer. Crackle was auscultated in both lung fields in initial physical examination. Chest radiograph showed consolidation and diffuse parenchymal infiltration in both lung fields. Arterial blood gas analysis showed severe hypoxia. This patient was treated by mechanical ventilation, corticosteroid, antibiotics and bronchodilators and was improved completely in a week after the admission. The authors report a rare case of chemical pneumonitis caused by hydrochloric acid.

비장경색이 동반된 쯔쯔가무시병 1예

오종찬,이범주,장재현,원경준,박경희,김동민,박치영,정춘해 朝鮮大學校 附設 醫學硏究所 2005 The Medical Journal of Chosun University Vol.30 No.1

Tsutsugamushi disease is an acute febrile illness caused by Orientie. tsutsugsmushi. It is characterized by fever, myalgia, lymphadenopathy, and rash. And it can be easily diagnosed by characteristic eschar and serologic testing. Nearly all of the patients with tsutsugamushi disease improve with antibiotics such as doxycycline. However, the fatality rate of untreated cases is seven to ten percent. Splenic infarction is not common disease which is caused by occlusion of the main splenic artery or any of its branches. It is mainly caused by emboli that arise from cardiovascular disease, but sometimes by regional thrombosis associated with leukemia, myeloproliferative disorder, sickle cell anemia, pancreatitis, splenic torsion and septicemia. We experienced one case of tsutsugamushi disease with splenic infarction, which was improved after doxycycline treatment finished.

신경섬유종증 환자에게서 발생한 특발성 혈소판 감소증 1예

권세훈,김형호,강지인,장재혁,원경준,장재현,김상용,배학연 朝鮮大學校 附設 醫學硏究所 2006 The Medical Journal of Chosun University Vol.31 No.3

Idiopathic thrombocytopenic purpura is a disease characterized by thrombocytopenia in peripheral blood with positive anti-platelet antibody titer, no splenomegaly, the presence of megakarocyte. The causes of idiopathic thrombocytopenic purpura were usually related to autoimmune disease, infection and drugs. A 46-years-old man was admitted for evaluation of abdominal mass. He has many cafe-au-lait spots and nodules in almost skin for 30 years. Several years ago, he palpated mass in Lt. inguinal area. hIe has known the abdominal mass after checking abdomen CT in local clinic and visited our hospital for evaluation of abdominal mass. At admission, laboratory tests showed hemoglobin 12.5 g/dL, hematocrit 38.4 %, WBC 5,460 /㎣ (neutrophil 64.5%, lymphocyte 21.7%, monocyte 4.1%, eosinophil 5.4%), reticulocyte 0.7%, Platelet 52,000 /㎣, total protein 6.51 g/dL, albumin 3.80 g/dL, alkaline pohsphatase 161 IU/L, AST 110.7 IU/L, ALT 64.9 IU/L, total bilirubin 0.44 ㎎/dL, BUN 18.4 ㎎/dL, creatinine 0.79 ㎎/dL. Peripheral blood smear showed normocytic normochromic anemia, thrombocytopenia. Bone marrow aspiration smear showed normoplastic myeloid and erythroid precursor. The bone marrow biopsy section shows normocellular marrow (35%) for his age and mildly increasing myeloid cell lineage. We have experienced a case of idiopathic thrombocytopenic purpura in a patient being in neurofibromatosis and therefore reporting it with documentary records. 저자들은 신경섬유종증 환자에서 특별한 원인을 발견할 수 없었음에도 특발성 혈소판 감소증이 발생한 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다.