내장동맥 진균성 동맥류를 동반한 감염성 심내막염 1예

류봉춘,천정학,오성용,최성철,이혁,김신우,김성민,백경란,홍경표 대한감염학회 1999 감염 Vol.31 No.2

기관지석으로 발현한 기관지성 방선균증 1예

정숙인,천정학,홍종락,고영민,정만표,권오정,이종헌,백경란,송재훈 대한화학요법학회 1999 대한화학요법학회지 Vol.17 No.2

기관지성 방선균증은 매우 예외적이고 드물며 임상양상이 다양하여 폐암과의 감별이 어렵기도 하지만 기관지내시경 검사를 통해 진단할 수 있고 항생제 투여로 완치될 수 있는 질환이다. 저자들은 기관지석과 함께 발현한 기관지성 방선균증을 장기간의 경구 항생제 요법으로 완치한 1례를 경험하였기에 보고하는 바이다. Endobronchial actmomycosis is considered as an exceptional event. We report a case of a 49-year-old woman who presented with cough and exertional dyspnea for 20 months. Her chest X-ray showed calcified lymph nodes in the right lower paratracheal and subcarinal area and consolidation in the right middle lobe. Bronchoscopic examination demonstrated whitish broncholithiasis with mucosal nodularity in the bronchus intermedius obstructing the lumen near-completely. The biopsy specimen revealed sulfur granules and calcified material which were consistent with actmomycosis. Prolonged oral antibiotic treatment resulted in complete recovery, without need for surgical resection.

조절된 만성천식 환자에서 스테로이드 흡입제 중단에 의한 실험적 천식 악화

임호,고영일,최인선,장안수,천정학 대한알레르기학회 2001 천식 및 알레르기 Vol.21 No.1

Background:It has been recognized that cessation of treatment with inhaled corticosteroids evokes a recurrence of symptoms in most asthmatics within a month. Objective: To examine whether a useful model of asthma for studies on effects of new antiasthmatic drugs can be induced by discontinuation of inhaled corticosteroids treatment. Method : Twenty five patients with controlled asthma on inhaled corticosteroids were enrolled in this study. Spirometric measurements were performed before and 2 weeks after cessation of treatment with inhaled budesonide. Peak expiratory flow rates(PEFR), asthma symptom scores, and short-acting inhaled β2 agonist requirements were checked during 2-week period before and during 2-week period after the cessation of inhaled budesonide. Results : Discontinuation of treatment with inhaled budesonide resulted in significant falls in FEV1, and morning and evening PEFRs, and significant increase in diurnal variability of PEFR (40% of patients showed diurnal variability of ≥ 20%). Theirmptom scores and the days required for salbutamol use were also significantly increased. However, the mean fall in FEV1 was 6.9% and the maximum fall 29%, and a significant fall (≥15%) occurred in only 29% of patients. Conclusion : These findings demonstrate that asthma exacerbation can be safely induced by discontinuation of treatment with inhaled corticosteroids in controlled asthmatics, suggesting that this experimental model of mild asthma exacerbation can be used for studying the effects of new antiasthmatic drugs.

다발성 뇌경색이 합병된 Pasteurella multocida 심내막염 1예

이남용,고재현,백경란,송재훈,천정학,김성민,이혁,김수정 대한감염학회 1997 감염 Vol.29 No.6

저자들은 평소 건강하였던 환자에서 동물과의 접촉없이 P.multocida에 의한 세균성 심내막염이 발생하여 임상 경과 중 다발성 뇌경색이 합병되었으나, 항균제 투여만으로 완치가 되었던 증례를 경험하였기에 문헌 고찰과 함께 이를 보고하는 바이다. In recent years, an increasing number of infections with Pasteurella multoida in human have been reported, causing a wide range of systemic illness. Infective endocarditis with P.multocida, however, is still quite rare. Recently we experienced a cases of P. multocida endocarditis in a 26-year old man who was admitted because of fever and headache. He denied any recent contact with animals. P. multocida was identified from blood cultures and echocardiography showed mitral regurgitation and vegetations on mitral valve area. He became stuporous on the fourth hospital day and the brain MRI showed acute cerebral infarction. He was treated with penicillin intravenously for six weeks, which successfully controlled clinical features of infections. To our knowledge, this is the first case of P. multocida endocarditis complicated with cerebral infarction in Korea.

혈변을 주소로 내원한 하부위장관출혈 환자에 대한 임상적 고찰

최윤호,손희정,김재준,최규완,백승운,고광철,이풍렬,이종철,천정학 대한소화기내시경학회 1999 Clinical Endoscopy Vol.19 No.6

Backgroud/Aims: The frequency of different etiologies of lower gastrointestinal bleeding varies by a number of factors including patient age, the severity of bleeding evaluated, the diagnostic method, and the institution. There were few reports on the clinical analysis of lower gastrointestinal bleeding in Korea. Therefore, this study was conducted to evaluate the frequency of various etiologies, diagnostic methods, and the management of patients with lower gastrointestinal bleeding. Methods: 474 patients with lower gastrointestinal bleeding who were admitted to Samsung Medical Center from September 1994 to April 1998 were reviewed. The inclusion criteria were as follows: 1) age at least 15 years, and 2) patients whose bleeding was attributed to a lesion distal to the ligament of Treitz. The age and sex distribution, etiology, diagnostic methods, treatment, and transfusion were checked. Results: 474 patients (261 males and 213 females) met the inclusion criteria. The average age of the patients was 51 years old. The etiologies of bleeding were as follows: colorectal cancer, 43%; anorectal disease, 32%; inflammatory bowel disease, 6.6%; ischemic colitis, 5%; miscellaneous, 6%; and unknown, 7.4%. Colonoscopy was the most commonly employed diagnostic modality and was used in 245 (52%) patients of the study group. Other tests included sigmoidoscopy in 136 (29%), barium enema in 90 (19%), small bowel radiography in 24, radionuclide bleeding scans in 8, and mesenteric angiography in 7. Patients who improved with conservative and medical treatment were 29%, and 71% required surgery. Patients who required a transfusion were 37%. 139 patients (68.8%) with diagnosed malignant neoplasm received a transfusion. Conclusions: The incidence of lower gastrointestinal bleeding was high in old age. Colorectal cancer was the most common cause and required surgery. Colonoscopy was a valuable diagnostic tool for the evaluation of lower gastrointestinal bleeding.

반대측 비기능성 흑색선종과 동반되 일측성 알도스테론분비선종 1예

이명식,양정현,오은영,김광원,민용기,정재훈,김병준,이문규,임영희,강수정,천정학 대한내분비학회 1999 Endocrinology and metabolism Vol.14 No.1

Primary aldosteronism due to unilateral adenoma is a rare cause of surgically curable hypertension. Bilateral adrenal mass has occasionally been reported in this syndrome, and bilateral aldosterone-producing adenoma (APA), or bilateral adrenal nodular hyperplasia have been demonstrated in some cases. However, another possibility is the coexistence of a unilateral APA with a contralateral benign or metastatic nonfunctioning mass, because adrenal tumors are frequently found at autopsy or incidentally detected during abdominal morphological evaluation in patients without adrenal dysfunction. A 39 year-old woman presented with hyperaldosteronism, suppressed renin levels, and bilateral adrenal mass on adrenal CT scanning. Selective adrenal venous sampling was unsuccessful in demonstrating concentration gradient of aldosterone. Postoperative measurement of hormone content in the tumor extract revealed unilateral aldosteron-producing adenoma with contralateral nonfunctioning black adenoma, Determination of hormone content in the tumor extract could be useful for the discrimination of functioning and nonfunctioning endocrine tumors, particularly in case of multiple tumors (J Kor Soc Endocrinol 14:177~182, 1999).

대장 선종성 용종의 악성화에 영향을 미치는 인자

김영호,이화영,김선우,박형석,손희정,김재준,배상수,최규완,백승운,고광철,이풍렬,이종철,박정호,박상종,천정학,심상군,김창섭 대한소화기학회 1999 대한소화기학회지 Vol.34 No.6

Background/Aims: The aim of this study was to investigate predictive factors for malignant transformation of colorectal adenomatous polyps in Korea. Methods: One thousand five hundred and eighty- nine sessions of colonoscopic polypectomy were performed from November 1994 to September 1998 for 1,375 patients with adenomatous polyps at Samsung Medical Center. We analyzed the 2,179 adenomatous polyps including 55 (2.5%) polyps with malignant transformation, retrospectively. Results: Six parameters showed significant differences in univariate (p$lt;0.01) and multivariate analysis. For each parameter, the proportions of malignant polyps were as follows: for number of polyps, 1.3% in cases of single polyp and 10.3% in cases of multiple polyps; for size, 1.4% of polyps less than 1 cm and 15.5% of polyps larger than 1 cm; for location, 4.6% of the polyps located in rectum or sigmoid colon and 1.1% of the polyps located in descending to ascending colon; for morphology, 0.9% in polyps of Yamada type I/II and 7.6% in polyps of Yamada type III/IV; for underlying histology, 1.4% in cases of tubular adenoma and 8.1% in cases of tubulovillous or villous adenoma; for degree of dysplasia, 1.2% in cases accompanied with low-grade dysplasia and 8.9% in cases accompanied with high-grade dysplasia. Conclusions: The malignant potential of colorectal adenomatous polyps in Korea is correlated with multiplicity, distal location, pedunculated shape as well as well-known factors like size, histologic type and degree of dysplasia.