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김계훈 Kye Hun Kim,Myung Ho Jeong,Ik Joo Chung,Jeong Gwan Cho,Tae Bok Song,Jong Chun Park,Jung Chaee Kang 대한내과학회 2005 The Korean Journal of Internal Medicine Vol.20 No.4
Maternal septic shock and disseminated intravascular coagulation (DIC) following amniocentesis is a relatively rare condition, and its incidence is only 0.03~0.19%. Acute myocardial infarction (AMI) associated with DIC is also rare. We report here on a 40
증례 : 순환기 ; 간농양 환자에서 발생된 가성동맥류 형성을 동반한 다발성 감염성 동맥염
이승헌 ( Seung Hun Lee ),김계훈 ( Kye Hun Kim ),조재영 ( Jae Yeong Cho ),안영근 ( Young Keun Ahn ),정명호 ( Myung Ho Jeong ),조정관 ( Jeong Gwan Cho ),박종춘 ( Jong Chun Park ) 대한내과학회 2015 대한내과학회지 Vol.88 No.5
감염성 동맥염과 가성동맥류는 매우 드물고 예후가 좋지 않으며 간농양의 합병증으로 발생할 수 있으나 아직까지 다발성으로 발생한 사례는 보고되지 않았다. 74세 남자 환자가 간농양으로 치료 받던 중 복부 통증과 경부 통증을 호소하여 시행한 전산화 단층촬영 혈관조영술상 간농양은 호전되 었으나 하행 흉부 대동맥과 좌측 내경동맥의 감염성 동맥염 및 하행 흉부 대동맥의 감염성 가성동맥류가 진단되었다. 4주간의 항생제 치료 후 추적 검사에서 내경동맥 동맥염과 농양은 호전되었으나 대동맥의 가성동맥류는 그 크기가 유의하게 증가하였다. 저자들은 가성동맥류의 파열을 예방하기 위하여 혈관 내 스텐트 이식편을 삽입했고 8주간의 추가 항생제 치료를 시행함으로써 성공적으로 이를 치료하였다. 본 증례를 통하여 간농양과 연관된 원격 감염의 형태로 동맥염 및 감염성 가성동맥류가 동시 다발적으로 다양한 혈관에 발생할 가능성이 있음을 확인할 수 있었다. 감염성 동맥염이나 가성동맥류가 진단된 환자에서 다른 부위의 증상을 호소한다면 원격 감염의 가능성을 염두에 두고 추가적인 검사를 고려해야 할 것이다. 가성동맥류의 파열이 일어나는 경우에는 높은 사망률과 나쁜 예후와 연관이 있기 때문에 감염성 가동맥류의 진단 시부터 수술 또는 혈관 내 스텐트삽입술을 고려해야만 한다. 과거에는 주로 수술을 통한 감염 병소의 조절이 이루어졌지만 본 환자에서처럼 적절한 항생제 치료와 함께 혈관 내 스텐트 삽입술을 시행한다면 장기추적 관찰에서 예후가 좋을 수 있다. 따라서 수술을 시행할수 없는 환자들에게 혈관 내 스텐트 삽입술은 좋은 치료 대안이 될 것으로 생각된다. Infectious arteritis is a rare complication of liver abscess, and infectious arteritis involving multiple arterial sites with pseudoaneurysm formation has not been described previously. A 74-year-old man treated for liver abscess complained of abdominal and neck pain. Abdominal computed tomographic angiography (CTA) revealed a decrease in the size of the liver abscess, but also disclosed a pseudoaneurysm in the distal descending thoracic aorta was newly noted. Neck CTA revealed arteritis with abscess formation in the left internal carotid artery (ICA). Follow-up CTA after antibiotic therapy showed a decrease in the size of the left ICA abscess and a significant increase in the size of the aortic pseudoaneurysm. To prevent the rupture of the pseudoaneurysm, an endovascular stent graft was used. The final CTA revealed the disappearance of the aortic pseudoaneurysm with good apposition of the grafted stent. The patient has been monitored for 3 years with no new clinical events. (Korean J Med 2015;88:570-575)
Tritium Concentrations in Surface Seawater around Korean Peninsula
김창규,조용우,김계훈,Kim, Chang-Kyu,Cho, Yong-Woo,Kim, Kye-Hun Korean Association for Radiation Protection 1996 방사선방어학회지 Vol.21 No.2
전해농축법을 이용하여 한국 주변 해역 해수중 저준위 삼중수소를 측정하였다. 동 서 남해안에서 채취된 표충해수중 삼중수소를 측정한 결과, 삼중수소 농도는 $0.12 BqL^{-1}$에서 $1.50 BqL^{-1}$ 범위내의 값을 나타내었으며 그 평균값은 $0.60{\pm}0.353qL^{-1}$였다. 해역별 평균 삼중수소 농도는 동해안에서 $0.54{\pm}0.30 BqL^{-1}$ 남해안에서 $0.48{\pm}0.35 BqL^{-1}$. 서해안에서 $0.77{\pm}0.32 BqL^{-1}$의 농도분포를 각각 나타내었으며, 해역별로 큰 차이를 나타내지 않았다. 또한, 시료채취지점이 매우 좁은 위도범위내에 한정되어 있어 위도에 따른 삼중수소 농도의 체계적인 변화는 관찰되지 않았다. 본 연구에서 얻어진 표층해수 중 삼중수소 농도 준위는 일본 근해에서 조사된 결과와 매우 유사하였으며, 태평양지역에서의 삼중수소 농도에 비해서는 약간 높은 값을 나타내었다. An electrolytic enrichment technique was used to measure low levels of tritium in seawater around the Korean peninsula. Tritium concentrations were determined for surface seawater samples collected from the East Sea, the South Sea, and the Yellow Sea. The tritium concentrations in surface seawater samples from the study area ranged from $0.12 BqL^{-1}\;to\;1.50BqL^{-1}$ with a mean value of $0.60{\pm}0.35 BqL^{-1}$. The means of the tritium concentration were $0.54{\pm}0.30 BqL^{-1}$ for the East Sea, $0.48{\pm}0.35 BqL^{-1}$ for the South Sea, and $0.77{\pm}0.32 BqL^{-1}$ for the Yellow Sea. The tritium concentrations in the sea areas did not show much difference no matter where the samples were taken. Due to the limited number and distribution of sampling points, no systematic change in tritium levels with latitude was observed. Measured tritium levels were similar to those observed in other data collected near Japan, but higher than mid-Pacific Ocean measurements.
영구형 심박동기 삽입 후 유의한 삼첨판 역류증 발생의 예측인자
이경진 ( Kyoung Jin Lee ),김계훈 ( Kye Hun Kim ),임이랑 ( Yi Rang Yim ),박혁진 ( Hyuk Jin Park ),이승헌 ( Seung Hun Lee ),김지은 ( Ji Eun Kim ),정형기 ( Hyung Ki Jeong ),윤현주 ( Hyun Ju Yoon ),윤남식 ( Nam Sik Yoon ),홍영준 ( You 대한내과학회 2014 대한내과학회지 Vol.86 No.5
Background/Aims: We sought to identify predictors of significant tricuspid regurgitation (TR) after successful permanent pacemaker (PPM) implantation in Korean patients. Methods: Of 404 patients who underwent PPM implantation, 187 patients who had both baseline and follow-up echocardiographic examinations were assigned to one of two groups: no development or change in TR (Group I, n = 172, 65.5 ± 13.7 years) versus the development of significant TR (Group II, n = 15, 72.1 ± 8.3 years). Clinical, laboratory, and echocardiographic variables were compared between the two groups. Results: Overall, the grade of TR was significantly aggravated from 0.46 ± 0.73 to 0.81 ± 0.84 (p < 0.001) during 3.1 ± 1.8 years of follow-up (0.49 ± 0.75 to 0.69 ± 0.74 in Group I, p < 0.001; 0.13 ± 0.35 to 2.27 ± 0.46 in Group II, p < 0.001). The de novo development or aggravation of TR was observed in 66 patients (35.3%), and significant TR developed in 15 patients (8.0%). The presence of atrial fibrillation (AF) was significantly higher (53.3 vs. 18.6%, p = 0.002), and the implantation of a ventricle pacing, ventricle sensing, inhibited by ventricular event (VVI) type pacemaker was more frequent in Group II than in Group I (46.7 vs. 15.1%, p = 0.002). Other variables were not different between the groups. Conclusions: The development or aggravation of TR was not rare after successful PPM implantation, even though the development of significant TR was uncommon. The presence of AF and the implantation of a VVI type pacemaker were predictors of the development of significant TR. Together, the results of this study suggest that the development or aggravation of TR should be monitored carefully after PPM implantation. (Korean J Med 2014;86:577-584)
신장기능이 저하된 급성 관상동맥 증후군 환자에서 조영제 유발 신증의 발생 예측인자
김주한 ( Ju Han Kim ),박종춘 ( Jong Chun Park ),조정관 ( Jeong Gwan Cho ),안영근 ( Young Keun Ahn ),홍영준 ( Young Joon Hong ),김계훈 ( Kye Hun Kim ),강정채 ( Jung Chaee Kang ),박수환 ( Soo Hwan Park ),정명호 ( Myung Ho Jeong ) 대한내과학회 2012 대한내과학회지 Vol.82 No.2
Background/Aims: Contrast-induced nephropathy (CIN) is an important complication of diagnostic coronary angiography (CAG) and percutaneous coronary intervention (PCI). We investigated the incidence and predictors of the development of CIN in acute coronary syndrome (ACS) patients with renal dysfunction undergoing PCI. Methods: From January 2005 to June 2010, we evaluated the clinical, laboratory, and angiographic data of 406 patients with ACS who had a serum creatinine ≥ 1.3 mg/dL and underwent CAG or PCI. The patients were divided into two groups according to the development of CIN (CIN, n=92; no CIN, n=314). Results: Of the 406 patients, 92 (22.7%) developed CIN. The development of CIN was associated with a lower baseline body mass index (p=0.001), decreased left ventricular ejection fraction (LVEF) (p<0.001), decreased creatinine clearance (CrCl) (p<0.001), lower albumin (p<0.001), lower hemoglobin (p=0.003), higher N-terminal pro B type natriuretic peptide (p=0.001), and greater contrast medium volume (CMV) (p=0.021). On multiple logistic regression analysis, LVEF<40% (OR, 4.080; 95% CI, 2.087-7.977; p<0.001), albumin<3.5 g/dL (OR, 2.042; 95% CI, 1.211-3.440; p=0.007), and CMV/CrCl ≥ 3.5 (OR, 1.964; 95% CI, 1.243-3.101; p=0.004) were independent predictors of CIN. The cut-off value for CMV/CrCl was 3.5, and that for albumin was 3.55 g/dL. Conclusions: CIN occurred in 22.7% of the patients with ACS and renal dysfunction who underwent CAG or PCI. Independent predictors of CIN were decreased LVEF, decreased albumin, and increased CMV/CrCl ratio. (Korean J Med 2012;82:185-193)
폐동맥에서 기시된 좌측 관상동맥 및 이중 우측 관상동맥과 관련된 심근경색
김지은 ( Ji Eun Kim ),김계훈 ( Kye Hun Kim ),조재영 ( Jae Yeong Cho ),안영근 ( Young Keun Ahn ),정명호 ( Myung Ho Jeong ),조정관 ( Jeong Gwan Cho ),박종춘 ( Jong Chun Park ) 대한내과학회 2019 대한내과학회지 Vol.94 No.2
Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare coronary artery anomaly and double right coronary artery (RCA) is a very rare coronary anomaly. Because patients with ALCAPA usually die within 1 year of being born due to myocardial infarction (MI) and heart failure, ALPACA is very rarely seen in adults. Here, we report an extremely rare asymptomatic case of MI, presumably caused by ALCAPA and double RCA, and provide a review of the literature. This is the first reported case of coronary artery anomaly that had both ALCAPA and double RCA. (Korean J Med 2019;94:215-220)
구요한 ( Yo Han Ku ),김계훈 ( Kye Hun Kim ),김형윤 ( Hyung Yoon Kim ),정인석 ( In Seok Jeong ),정명호 ( Myung Ho Jeong ),조정관 ( Jeong Gwan Cho ),박종춘 ( Jong Chun Park ) 대한내과학회 2020 대한내과학회지 Vol.95 No.4
Kommerell 게실은 근위부 하행대동맥의 확장이 특징인 대동맥 궁의 드문 선천성 이상으로 이상적으로 기시하는 쇄골하동맥이 동반된다. 무증상일 수 있으나 식도나 기도 등의 압박으로 인한 증상이 동반될 수 있으며, 대동맥 박리나 게실의 파열로 나타날 수 있다. 저자들은 우측 대동맥 궁에서 동반된 Kommerell 게실이 식도를 압박하여 심한 연하곤란으로 발현한 증례를 경험하였기에 보고하고자 한다. Kommerell diverticulum is a rare congenital anomaly of the aortic arch characterized by dilation at the proximal descending aorta, which gives rise to an aberrant subclavian artery. Kommerell diverticulum is usually asymptomatic, but can also be associated with symptoms due to compression of the esophagus or trachea, and can rarely be fatal due to dissection or rupture of the diverticulum. Here, we report a rare case of dysphagia caused by compression of the esophagus by Kommerell diverticulum originating from the right-sided aortic arch. (Korean J Med 2020;95:287-291)
정상 면역 환자에서 발생한 Enterococcus gallinarum 자연판막 심내막염
김옥기 ( Ok Ki Kim ),정숙인 ( Sook In Jung ),박경화 ( Kyung Hwa Park ),김계훈 ( Kye Hun Kim ),정명호 ( Myung Ho Jeong ),신종희 ( Jong Hee Shin ),안병희 ( Byung Hee Ahn ) 대한내과학회 2008 대한내과학회지 Vol.74 No.4
E. gallinarum 감염은 면역이 감소되어 있거나 기저질환을 가지고 있는 사람에서 드물게 발생하는 것으로 알려져 있다. 저자들은 면역기능이 정상인 환자에서 반코마이신에 저도 내성을 갖는 E. gallinarum에 의한 자연 판막 심내막염 1예를 경험하였기에 보고한다. Motile Enterococci, including Enterococcus gallinarum and Enterococcus casseliflavus/flavescens are rarely encountered in human clinical specimens. Enterococcus gallinarum is intrinsically resistant to low levels of vancomycin and causes bacteremia or infection among immunosuppressed or chronically ill patients, sometimes through nosocomial acquisition. We report a case of native valve endocarditis caused by Enterococcus gallinarum in an immunocompetent patient without any medical history.(Korean J Med 74:457-461, 2008)
증례 : 순환기 ; 드문 심비대의 원인으로서 거대 심낭 지방종
김우진 ( Woo Jin Kim ),김계훈 ( Kye Hun Kim ),조재영 ( Jae Yeong Cho ),안영근 ( Young Keun Ahn ),정명호 ( Myung Ho Jeong ),조정관 ( Jeong Gwan Cho ),박종춘 ( Jong Chun Park ) 대한내과학회 2014 대한내과학회지 Vol.87 No.3
Cardiomegaly is a commonly encountered clinical presentation on simple chest radiographs, and it usually indicates the enlargement of one or more cardiac chambers. However, cardiomegaly less commonly comes from abnormalities in the structures adjacent to the heart, including pericardial effusion, enlarged great vessels, or mediastinal tumors. Pericardial lipoma is a rare primary cardiac tumor that can grow to a large size by the time of diagnosis and result in huge cardiomegaly because of a lack of symptoms. Here, we report a rare case of giant pericardial lipoma that presented as huge cardiomegaly on simple chest radiographs. Multi-modality cardiovascular imaging, including echocardiography and cardiac magnetic resonance imaging, played a key role in the diagnosis and development of a therapeutic treatment plan for the present case. (Korean J Med 2014;87:338-342)