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S-102 : 자발적으로 발생한 다발성 우측 2, 3, 4번 허리동맥 출혈 1예
홍종삼,신사영,한군희,김영돈,이상진,박종규,서현일,천갑진,정우진 대한내과학회 2013 대한내과학회 추계학술대회 Vol.2013 No.1
서론: 간경화환자에서 출혈은 정상인보다 흔하다. 이들에게 가장 주요한 출혈은 간문맥고혈압에 의한 혈액손실이다. 이들에서 위장관출혈의 70%가 식도정맥류의 파열이고 그 외에 울혈성 위병증, 위 정맥류, 소화성 궤양 질환 그리고 위염이있다. 이들의 생명을 위협하는 출혈은 주로 위식도정맥출혈이다. 최근 국내에서 간경화환자의 가슴동맥의 자발성 파열 증례가 보고 되었다. 저자들은 알콜성간경화 환자에서 우측2, 3, 4번 허리동맥의 자발성파열로 진단된 환자를 경험하여 이를 문헌고찰과 함께 보고한다. 증례: 55세 알콜성간경화 있는 여환이 외래에서 우측 상완 채혈 후 채혈부위 혈종이 생겼고 통증과 붓기악화되어 내원하였다. 내원 당시 WBC 9,200/uL, Hb 7.4/dL, Plt 125,000/uL PT 57% (INR 1.61), aPTT 37.1 sec, Abumin 3.0 g/dL, AST/ALT 105/36IU/L, Bilirubin (Total/direct) 8.4/2.7 mg/dL였다. 입원 후 혈종에 대해 외부압박하며 수혈하였으나 지혈되지 않아 경피적동맥색전술 시행하였으나 증상 지속되었고 20일째 외부충격 없이 우측 옆구리로 멍과 통증이 발생되었다. 27일째 팔 부위의 외과적절개배액술 및 혈관결찰 시행했고 30일째 복부역동CT에서 우측후복막 공간의 침윤, 허리근육의 엉덩뼈오목부위의 액체저류가 관찰되었다. 34일째 옆구리통증, 부종, 멍이 심해지며 BP 80/50 mmHg, HR 80회, RR 20회, BT 36.6, WBC 15,500/uL, Hb 4.9 g/dL, Plt 54,000, PT 29% (INR 2.60), CT에서 혈종의 크기증가와 조영제 혈관외유출소견이 보였다. 이후 적혈구, 혈소판, 동결혈장수혈했고 우측 2, 3, 4번째 허리동맥 색전술 시행후 중환자실로 전동되었다. 36일째 호흡곤란, 통증 심해지고 Hb감소하며 생명징후 불안정하여 시행한 복부혈관조영 CT에서 혈종은 약간 증가되었지만 혈관외유출소견은 보이지 않았다. 보호자는 ICU전동 이후 보전적 치료만 원하던 상태였고 43일째 대량수혈로 인한 급성폐손상으로 의심되는 흉수 동반한 호흡부전과 저혈량성쇼크로 사망하였다. 요약: 간경화 환자에서의 출혈은 광범위한 측부 순환과 관련된 위식도 정맥류, 간문맥 고혈압 위병증, 말로리-바이즈 열상과 소화성 궤양이 주원인지만 자발성 동맥출혈은 드물다. 최근 알콜성간경화가 있는 55세 여환에서 우측 2, 3, 4 허리동맥의 현성출혈이 있으며 반복되는 수혈과 동맥 색전술(최상의 보존적 치료, 전체 수혈량-적혈구 37u, 신선동결혈장 66u, 혈소판 108u)에도 불구하고 사망한 케이스가 있었다 . 이전에도 간경화가 있는 환자에서 자발성 동맥출혈에 대한 보고는 있었지만 드문 실정이다.
방사선 투시 위루술 후 4개월만에 발견된 횡행결장 관통 및 위루관의 이탈 1예
홍종삼,한군희,이홍렬,박종규,이상진,김영돈,정우진,천갑진 대한소화기내시경학회 2011 Clinical Endoscopy Vol.42 No.1
Percutaneous radiologic gastrostomy (PRG) is an enteral nutritional method that can be applied to a patient with dysphagia due to cerebrovascular accident, Parkinsonism, dementia, or head and neck cancer. PRG is a safe and cost-effective method with low morbidity and mortality rates compared with surgical gastrostomy, because it require less sedation and less invasive placement technique. PRG complications include wound infections, peritonitis, tube malfunctions, peristomal leakage, bleeding, ileus, pneumoperitoneum, aspiration pneumonia, and bowel perforation. But, bowel perforation after PRG is rare. We recently experienced a case of transverse colon penetration and tube displacement, which occurred as a PRG complication in a 60-year-old male with a cerebrovascular accident. 방사선 투시 위루술은 연하곤란, 뇌혈관 사고, 파킨슨병, 치매, 두경부 종양으로 인해 장기간 영양공급이 필요한 환자에게 시술하는 경장영양 방법 중 하나이다. 방사선 투시 위루술은 경피적 내시경하 위루술과 함께 수술적 위루술에 비해 전신 마취가 필요 없어 상대적으로 효과적이며 안전한 시술법이다. PRG의 합병증으로 창상감염, 위액 누출, 기복증, 출혈, 장마비, 영양관 기능이상, 흡인 폐렴 등이 있다. 저자들은 뇌경색과 모야모야병으로 인한 실어증, 연하곤란, 기관흡인 증상으로 PRG를 시행한 60세 남자에서 시술 4개월 후 빈번한 설사 증상으로 시행한 대장내시경검사로 횡행결장을 관통하여 시술된 위루관 및 위루관의 이탈을 진단한 증례를 경험하여서 문헌고찰과 함께 보고한다.
간경변증 환자에서 자발적으로 발생한 다발성 우측 허리동맥 출혈
홍종삼 ( Jong Sam Hong ),정우진 ( Woo Jin Jeong ),한양희 ( Yang Hee Han ),신사영 ( Sa Young Shin ),전제혁 ( Jae Hyuck Jun ),우영민 ( Yeong Min Woo ),윤정호 ( Jung Ho Yun ),천갑진 ( Gab Jin Cheon ) 대한소화기학회 2015 대한소화기학회지 Vol.65 No.3
Esophageal and gastric varix, portal hypertensive gastropathy, Mallory-Weiss tear and gastric ulcer are common causes of bleeding in patients with liver cirrhosis. However, spontaneous arterial bleeding without a history of trauma is a rare cause of bleeding which can be fatal. We report a case of a 55-year-old woman with alcoholic liver cirrhosis who developed spontaneous bleeding of multiple right lumbar arteries and died in spite of repetitive transfusion and embolization. (Korean J Gastroenterol 2015;65:186-189)
2009 대유행 인플루엔자 A/H1N1과 포도알균의 동시 감염에 합병된 위막성 기관기관지염 1예
남기호,홍종삼,홍만용,임재민,김미혜,정복현,송은희,류대식 대한감염학회 2011 Infection and Chemotherapy Vol.43 No.5
An influenza pandemic due to a novel influenza A/H1N1 virus occurred after April 2009. This virus has some characteristics that differentiate it from the seasonal influenza virus. The 2009 pandemic influenza A/H1N1 virus can frequently infect the lower respiratory tract, and it might cause acute tracheobronchitis as well as pneumonia. Viral-bacterial interaction is well known as an important mechanism of the pathogenesis of respiratory complications of influenza. Herein, we report on a case that presented with pseudomembranous tracheobronchitis complicated by coinfection with 2009 pandemic influenza A/H1N1 and Staphylococcus aureus. We also review the relevent literature.
이성우,조남훈,홍종삼 국민대학교 생산기술연구소 2002 공학기술논문집 Vol.25 No.-
Structural characteristics of concrete filled glass fiber reinforced composite pile was studied. Confinement model of composite pile was derived from experimental data, and numerical method to find P-M diagram of composite pile was developed. The flexure-compression test results were compared with analytical P-M diagram and it is demonstrated that they agree well each other. Utilizing these results, pilot composite pile was designed, fabricated, and flexural test were conducted.
후천성면역결핍증 환자에서 발생한 다발성 폐결절 양상의 폐포자 충 폐렴 1예
김은정,유승진,강경훈,홍만용,홍종삼,류대식,엄대운,정복현,송은희 대한감염학회 2012 Infection and Chemotherapy Vol.44 No.1
Pneumocystis jirovecii pneumonia (PCP) is a frequent manifestation of Acquired Immune Deficiency Syndrome (AIDS). The classic chest radiographic finding is perihilar ground glass opacities that may progress to more diffuse lung involvement. Atypical radiographic appearances include a normal chest film, lobar or segmental consolidation, cystic lesions, cavitation, pneumothorax, pleural effusion, and solitary or multiple pulmonary nodules. Although PCP is common in AIDS,presenting with nodular pulmonary densities is rare. We encountered the case of a 33-year-old man with AIDS whose chest radiography showed multiple bilateral nodular patterns suggestive of malignancy. We performed a transcutaneous lung biopsy and diagnosed him with PCP by Gomori methenamine-silver staining. Along with fungal and mycobacterial infections, intrathoracic Kaposi’s sarcoma,and lymphoma, PCP should be considered in the differential diagnosis of nodular pulmonary disease in AIDS patients.
강종원 ( Jong Won Kang ),김영돈 ( Young Don Kim ),홍종삼 ( Jong Sam Hong ),권장훈 ( Jang Hoon Kwon ),서현웅 ( Hyun Woong Seo ),김성훈 ( Sung Hoon Kim ),이종혁 ( Jong Hyuk Lee ),천갑진 ( Gab Jin Cheon ) 대한소화기학회 2012 대한소화기학회지 Vol.59 No.2
Paracentesis is a diagnostic, therapeutic procedure performed in patients with ascites. It is generally thought to be a safe procedure and transfusion of platelet concentrate or fresh frozen plasma is not recommended before the procedure, because the incidence of clinically significant bleeding is very low. We report a case of lateral abdominal wall hematoma due to the injury of the deep circumflex iliac artery after paracentesis in patient with alcoholic liver cirrhosis who was treated with transcatheter arterial embolization.
단일 기관에서 경험한 원발성 간세포암의 10년간의 변화 양상
김영돈 ( Young Don Kim ),장우성 ( Woo Sung Jang ),권장훈 ( Jang Hoon Kwon ),홍종삼 ( Jong Sam Hong ),천갑진 ( Gab Jin Cheon ) 대한간암학회 2013 대한간암학회지 Vol.13 No.2
Background/Aims: Hepatocellular carcinoma (HCC) is common cause of liver related death in Korea, and the importance of alcohol as an etiology of chronic liver disease including cirrhosis is emphasized recently. We investigated the epidemiologic changes of HCC during last 10 years in single tertiary center in Gangneung, Korea. Methods: We retrospectively reviewed the medical records of admitted patients diagnosed as HCC in year 2002 and 2012 respectively, and their clinical characteristics were compared. Results: A total of 214 patients were enrolled. Mean age was 60.1 years and 179 (83.6%) was male. Number of patient with cirrhosis was 160 (74.8%) and with viral hepatitis was 164 (74.8%). Chronic hepatitis B (CHB) was the most common cause of HCC patients with liver cirrhosis (61.9%), and alcohol was 14.4%. The possible curative group (by BCLC stage 0 or A) was only 36.4% (n=78), and had not decreased during the study periods (36.3 % vs. 36.6%, P=0.144), and other clinical variables also had no statistical differences. Conclusions: The clinical characteristics of HCC including clinical stage at the time of diagnosis were not changed over the last 10 year period, and CHB was still the most common etiology of HCC in Gangneung, Korea.
장우성 ( Woo Sung Chang ),정우진 ( Woo Jin Jeong ),강경훈 ( Kyung Hoon Kang ),권장훈 ( Jang Hoon Kwon ),홍종삼 ( Jong Sam Hong ),엄대운 ( Dae Woon Eom ),천갑진 ( Gab Jin Cheon ) 대한내과학회 2012 대한내과학회지 Vol.83 No.6
Anaplastic large-cell lymphoma (ALCL) is a rare subgroup of non-Hodgkin`s lymphoma. Primary gastric ALCL is extremely rare. Patients with anaplastic lymphoma kinase (ALK)-positive primary systemic ALCL are known to have better overall survival than those with ALK-negative ALCL. We herein report a case of primary gastric ALK-positive anaplastic large-cell lymphoma. A 37-year-old woman presented with postprandial epigastric pain for 2 months. Endoscopic examination of the upper gastrointestinal tract showed multiple variably sized, round, elevated lesions with friable crater-erosion on the body and fundus. Pathologic examination revealed atypical large lymphoid cell infiltration in the lamina propria; the cells were positive for CD3, CD30, and ALK. We diagnosed the patient with ALCL. She underwent a cycle of chemotherapy with cyclophosphamide, adriamycin, vincristine, and prednisolone. However, she developed brain metastases. Despite two cycles of palliative chemotherapy with high-dose methotrexate for brain metastases, she died due to ALCL progression. (Korean J Med 2012;83:752-756)