특발성 혈색소증에 동반된 치명적인 Aeromonas hydrophila 감염

이진호(Jin Ho Lee),조병렬(Byung Ryul Cho),김관엽(Kwan Yop Kim),전수영(Soo Young Jeon),손영돈(Young Don Son) 대한소화기학회 1991 대한소화기학회지 Vol.23 No.2

A 57 year-old male with underlying idiopathic hemochromatosis with liver cirrhosis and diabetes mellitus died of the seps s due to Aeromonas hydrophila infection accompanying bullous skin eruptions, simulating sepsis of Vivrio vulnificus infection frequently found in the liver cirrhosis patients.

동의나물 섭취 후 발생한 서맥을 동반한 쇼크 2례

박찬우,옥택근,조준휘,최동욱,허애영,이희영,김용훈,조병렬,김성은,최기훈,배지훈,서정열,정재봉,Park,, Chan-Woo,Ok, Taek-Gun,Cho, Jun-Hwi,Choi, Dong-Wook,Her, Ae-Young,Lee, Hee-Young,Kim,, Yong-Hoon,Cho, Byung-Ryul,Kim,, Sung-Eun,Choi, Ki-Hoon 대한임상독성학회 2004 대한임상독성학회지 Vol.2 No.1

With a recent well-being boom, our interest in chemical-free vegetables is also increasing. So, some people are trying to take in wild plants chosen by themselves. However, others often come to their rescue in an emergency department after eating them, caused by their misunderstanding poisonous herbs as edible vegetables. We have ever seen two persons carried into the emergency department with bradycardia and shock incurred by his intake by confusion between Caltha palustris and Ligularia fischeri lately. There were symptoms such as epigastric pain, nausea, vomiting and so on in their cases, and the symptoms of bradycardia and hypotension continued. Owing to sustained bradycardia and hypotension states, we applied a dopamine to a patient, and then the in-patient left the hospital two days later. We presumed the cause of the two symptoms appeared in two cases to be a saponin in Caltha palustris. For that reason, if someone has the bradycardia and hypotension symptoms from an unknown cause after taking in wild plants, they have to consider a toxication by the Caltha palustris. Therefore, this paper focused on the issue that unexpected poisoning would have to be prevented by studying about wild plants much more and informing the toxic risk from the plants.

Cell Surface Tissue Transglutaminase-induced Activation of Phosphoinositol 3-Kinase/Akt Pathway

Seung-Oh Kim(김승오),Min-kyung Kim(김민경),Seung-Su Lee(이승수),Byung-Ryul Cho(조병렬),Dae-joong Kim(김대중) 대한체질인류학회 2009 대한체질인류학회지 Vol.22 No.3

Tissue transglutaminase (tTGase)는 lysine과 glutamine residue를 서로 연결하여 Ca²?의 조절 하에 Nε-(γ-L-glutamyl)-L-lysine (GGEL) isopeptide 결합을 형성한다. tTGase는 세포 안과 밖의 단백질들을 서로 결합하는 작용을 하므로 이와 같은 기능을 통해 상피조직의 기능성 방벽 또는 apoptosis와 같은 여러 가지 생명 현상에 관여하는 것으로 알려져 있다. tTGase는 주로 세포질 내에 존재하지만 세포에 따라서는 상당한 양의 tTGase가 핵에서 발견되기도 하며, 세포표면과 세포외기질(extracellular matrix)에서 관찰된다. 본 연구는 세포표면부착 tTGase가 세포의 밖에서 세포막을 통과하여 세포질 내로 전달되는 과정에서 어떤 역할을 하는지 관찰하고자 하였다. 사람의 tTGase 단백질을 과발현 시킨 H9c2 세포주(H9c2/tTGase)를 이용하여 세포면역형광염색, western blot 분석 방법을 이용하여 세포표면의 tTGase 단백질의 증가를 확인한 후 항 tTGase 항체를 처리하여 세포 외부로부터 내부로 전달되는 신호를 증폭하는 방법을 이용하여 세포표면의 tTGase가 관여하는 신호전달체계를 조사하였다. 과발현된 tTGase 단백질은 세포내부뿐만 아니라 세포표면에서도 증가하였으며, 세포배양액으로의 분비량 역시 증가하였다. H9c2/tTGase 세포의 세포표면에 부착된 tTGase 단백질을 통해 증폭된 신호를 세포내부로 전달한 결과 세포질 내부의 tTGase 발현이 감소하였다. 이와 같은 tTGase 단백질의 감소는 phosphoinositol 3-kinase/Akt (PI-3K/Akt) 신호전달계를 통해 mitogen-activated protein kinase (MAP kinase)에 전달된 신호에 의해 일어나는 것으로 사료된다. 본 연구의 결과들은 활성화된 세포로부터 유리된 tTGase가 세포표면에 부착됨으로써 세포내부의 신호전달체계에 영향을 미치는 것으로 사료되며, 이와 같은 결과는 암 발생과 전이 등의 세포부착과 관련된 질병현상의 이해를 돕기 위한 기초자료가 될 것이다. Multifunctional tissue transglutaminase (tTGase) is found in the cytoplasm and cell surface, as well as in the extracellular matrix. However, it is difficult to determine the exact function of tTGase in each cell compartment. This study focused on the potential role of cell surface tTGase in the process of “outside-in” signal transduction. Immunofluorescence study and western blotting was performed to localize the overexpression of tTGase. tTGase-overexpressed H9c2/tTGase cells were treated with anti-tTGase antibody to evaluate the potential functions of tTGase on the outside-in signal process. The tTGase level markedly increased in each cell compartment and the culture media of H9c2/tTGase cells that show overexpression of tTGases. Anti-tTGase monoclonal antibody reduced tTGase levels in the whole lysate of H9c2/tTGase cells, and concomitantly increased the activity of the Akt. The results suggest that the cell surface expression of tTGase may be associated with an intracellular signaling pathway via the phosphoinositol-3 kinase/Akt. Phosphorylation of mitogen activated protein kinase family, ERK1/2, and Jun N-terminal Kinase (JNK), was also inhibited in the anti-tTGase antibody-treated H9c2/tTGase cells. These results suggest that cell surface tTGase may regulate intracellular signaling pathways in an autocrine or paracrine manner.

고혈압 환자에서 발행할 수 있는 수술중 및 수술후의 심혈관계 변화에 대한 고찰

이성봉(Sung Bong Lee),손영돈(Young Don Son),조병렬(Byung Ryul Cho),최석구(Suck Koo Choi),유원상(Won Sang Yoo),이동철(Dong Chul Lee) 대한내과학회 1991 대한내과학회지 Vol.41 No.5

N/A Hypetension is the most common cause of heart failure and left ventricular hypertrophy. Recently, with advances in operating techniques, equipment and anaesthesiology, elderly patients have had more chances to undergo operation. Therefore, chances for patients with hypertension that comprise 15%-20% of the adult population in Korea to undergo operation has become more frequent. To evaluate the frequency and pragnosis of the cardiovascular changes in patients with hypertension during operation and the perioperative period, the blood pressures of 100 patients who underwent operation at Seoul Paik Hospital from September 1988 to October 1990 were measured proeoperatively, during operation, and postoperatively and analyzed in relevance to cardiovascular complications. The cardiovascular complications were divided into 4 categories: 1) Increase in systolic blood pressure 2) Decrease in systolic blood pressure 3) Marked changes in systolic blood pressure 4) Others (arrythmias, heart failure, chest pain) The results were as follows: 1) Episodes of an increase in the systolic blood pressure more than 50 mmHg compared to the systolic blood pressure at the time of consultation were found in 7 cases (7%) 2) Episodes of a decrease in systolic blood pressure below 100 mmHg were detected in 8 cases (8%) and in most cases, the blood pressure was corrected to normal level simply by the rapid infusion of fluid, except for 1 case that required the use of ephedrine or clacium gluconates. 3) Episodes of changes in systolic blood pressure more than 50 mmHg were found in 42 cases (42%). 4) There were 5 episodes of ventricular premature beat or atrial premature beat, but they were corrected to normal sinus rhythm by intravenous lidocain injection, and there were no more problems postoperatively. 5) There were no coronary events or heart failures clinically. 6) It seemed that there was no correlation between the level of preoperative blood pressure and frequency of cardiovascular complications, In conclusion, most of the patients with hypertension corrected preoperatively or not underwent operation successfully without any cardiovascular complications if the anaesthesiologist monitored the blood pressure and took appropriate therapeutic measures predperatively.

Glyphosate 근주 후 발생한 봉와직염 1례

김윤성,옥택근,신명철,최현영,문중범,김성은,서정열,안무업,조병렬,김용훈,이봉기,김명,조준휘,Kim, Yoon-Sung,Ohk, Taek-Gun,Shin, Myeung-Cheol,Choi, Hyun-Young,Moon, Joong-Bum,Kim, Sung-Eun,Seo, Jeong-Yeul,Ahn, Moo-Eob,Cho, Byung-Ryul,Kim, Yang 대한임상독성학회 2007 대한임상독성학회지 Vol.5 No.1

Glyphosate is the active ingredient in widely used herbicides. It acts through inhibition of the shikimate metabolic pathway in plants. This pathway does not exist in mammals, however, so glyphosate is presumably less toxic to humans. Nevertheless, fatal cases of glyphosate poisoning in humans have still occurred. Cases of glyphosate poisoning reported in the previous literature were almost always caused by intentional ingestion. Therefore, intramuscular injection of glyphosate with suicidal intent has not been reported. We report a case of 43-year-old man with poisoning due to intramuscular injection of glyphosate herbicide. He was admitted to the emergency department with a chilling sensation, local hotness, swelling, and tenderness at the site of glyphosate injection. He was treated with intravenous antibiotics and analgesics for 10 days and was discharged without any other complication.

간경변증환자에서 병발한 비장농양

이진호(Jin Ho Lee),함희용(Hee Yong Hahm),전수영(Soo Young chun),조병렬(Byung Ryul Cho),김관엽(Kwan Yop Kim) 대한소화기학회 1990 대한소화기학회지 Vol.22 No.4

A 38 year-old female was diagnosed as the splenic abscesses due to Aeromo sobria infection of the enlarged spleen which complicated to portal hypertension because of postnecrotic liver cirrhoeis by hepatitic B virus and cured by canventional combination therapy of broad spectrum antibiotics with ultraeonographic follow-up for 2 mont,hs.

증례 보고 : 저분자량 헤파린 사용 중 발생한 급성 구획증후군을 동반한 자발성 근육내 혈종 - 2예 보고 -

김근우 ( Keun Woo Kim ),남우동 ( Woo Dong Nam ),유기형 ( Kee Hyung Rhyu ),조병렬 ( Byung Ryul Cho ),김용훈 ( Yong Hoon Kim ),어수익 ( Soo Ik Awe ) 대한골절학회 2006 대한골절학회지 Vol.19 No.1

저분자량 헤파린은 일반 헤파린에 비해 항응고작용이 떨어지지 않으면서 출혈 부작용이 거의 없는 항응고제로 알려져 있어 심장내과 영역에서 혈전발생성 심장질환환자들에게 경구 항응고제로의 전환 전에 중간 치료제로 널리 쓰이고 있다. 저분자량 헤파린의 치료 중 발생 된 근육내 혈종 과 동반된 구획증후군은 거의 보고되어 있지 않은 드문 합병증으로, 저자들은 저분자량 헤파린 치료 중인 2명의 환자에서 평균 3일경에 각각 대퇴부와 하퇴부에 생긴 통증성 팽윤 부종을 동반한 다발성 근육 내 혈종과 구획증후군을 경험하였으며, 추가 출혈성 합병증 없이 근막절개술 및 혈종제거술로 성공적으로 치료하였기에 이를 증례보고하고자 한다. Low-molecular-weight heparin (LMWH) has been considered superior to unfractionated heparin in several facets such as more effective anticoagulant, more predictable bioavailability, and less bleeding complications. We report two cases of LMWH, enoxaparin-induced spontaneous intramuscular hematoma with compartment syndrome of the lower extremity in patients with cardiac problems. The patients were treated with enoxaparin (LMWH) as bridging anticoagulation before use of warfarin due to cardiac problems. At the average 3 days of enoxaparin treatment, large and painful swelling was noticed in the lower extremities without intramuscular injection or trauma. The patients were diagnosed as having compartment syndrome with large intramuscular hematoma by CT. The patients underwent immediate fasciotomy and hematoma evacuation, and recovered without any complications.

심장혈관 조영술과 심장혈관 인터벤션의 환자 선량 평가

김정수(Jung Su Kim),이종혁(Joun Hyuk Lee),정혜경(Hae Kyoung Jung),김정민(Jung Min Kim),조병렬(Byung Ryul Cho) 대한방사선과학회(구 대한방사선기술학회) 2016 방사선기술과학 Vol.39 No.1

심장혈관 조영술과 인터벤션은 현대 성인병의 증가로 급격히 증가하고 있다. 심장혈관 인터벤션은 장시간 동일 부위에 방사선을 조사하는 검사로 방사선으로 인한 피부상해를 일으킬 수 있다. 본 연구에서는 의료기관의 심장혈관 인터벤션의 진단참조준위를 조사하여 환자의 피폭선량을 감소시키는 도구로 사용하고자 한다. 본 연구는 147명의 환자에서 심장혈관 조영술과 인터벤션을 대상으로 누적 투시시간, 누적 투시면적선량, 영상촬영을 위한 면적선량, 누적 면적선량, 공기커마, 동영상 수, 총 영상 수에 대한 정보를 획득하여 진단참조준위를 설정하였다. 심장혈관 조영술의 진단참조준위와 인터벤션의 진단참조준위에 해당하는 면적선량 값은 각각 44.4 Gy·cm2와 298.6 Gy·cm2로 나타났고 투시시간에 대한 진단참조준위는 각각 191.5 sec와 1935.3sec로 나타났다. 진단참조준위는 반드시 넘으면 안 되는 값은 아니다. 하지만 진단참조준위를 제정하여 의료기관에서 사용하고 있는 선량의 참조 값을 설정하고 이를 검토하는 과정은 환자의 불필요한 피폭선량을 감소시키는데 기여할 것이다. The use of cardiac angiography (CA) and the interventional procedures is rapidly increasing due to the increase in modern adult diseases. Cardiovascular intervention (CI) is an examination method where radiation is applied to the same area for a long period, and thus may cause skin injury. In this study, we investigate the diagnostic reference level (DRL) of the cardiovascular intervention (CI) carried out by medical institutions and use it as a tool to reduce patient exposure dose. In this study, the DRL was set by acquiring information about the cumulative fluoroscopy time, cumulative fluoroscopy dose-area product (DAP), radiography DAP, cumulative DAP, air kerma, number of video clips, and the total number of images from the cardiac angiography and interventional procedures performed on 147 patients. The DAPs corresponding to the DRL of cardiac angiography(CA) and that of the interventional procedures were shown to be 44.4Gy·cm2 and 298.6Gy·cm2, respectively; the corresponding DRLs of fluoroscopy time were shown to be 191.5s and 1935.3s, respectively. A DRL is not a strict upper bound for radiation exposure. However, the process of setting, enacting, and reviewing the DRLs for the dose by medical institutions will contribute to a reduction in the unnecessary exposure dose of patients.

증례 : 저분자량 헤파린 사용 중 구획증후군을 동반하며 발생한 근육내 혈종 1예

최대희 ( Dae Hee Choi ),최동욱 ( Dong Wook Choi ),어수익 ( Soo Ik Awe ),유기형 ( Kee Hyung Rhyu ),김우진 ( Wook Jin Kim ),김용훈 ( Yong Hoon Kim ),조병렬 ( Byung Ryul Cho ) 대한내과학회 2005 대한내과학회지 Vol.69 No.-

본 예는 신기능이 정상인 환자에서 외상 등의 위험이 없었으나 자발적으로 구획증후군을 동반한 근육내 혈종이 발생한 1예로 뚜렷한 위험인자가 없이 구획증후군을 동반한 경우는 국내에서 보고가 없었기에 문헌고찰과 함께 보고하는 바이다. Low-molecular-weight heparin (LMWH) has been considered theoretically superior to unfractionated heparin in several facts such as more effective anticoagulant, more predictable bioavailability, and less bleeding complications. In rare cases, LMWH is associated with spontaneous major bleeding complications. We report a case of LMWH, enoxaparin-induced spontaneous intramuscular hematoma with compartment syndrome in the left lower leg in a 79-year-old woman with atrial fibrillation. We used enoxaparin (1 mg/kg per 12 hours) as bridging anticoagulation before use of warfarin in patient with atrial fibrillation. At 3 days of used for enoxaparin, large and painful subcutaneous mass was noticed in the mid portion of left thigh in condition that had not intrmuscular injection or trauma. It was associated with pulseless in the left dorsalis pedis artery and pale and tingling sense in the left lower leg. We diagnosed large intramuscular hematoma by computer tomography and immediately and successfully treated patient with surgical removal of hematoma. (Korean J Med 69:S948-S951, 2005)

증례 : 순환기; 감염성 심내막염이 발생한 젊은 여성에서 동반된 스트레스성 심근병증

허정원 ( Jeong Won Heo ),정철민 ( Chul Min Jung ),박현선 ( Hyun Sun Park ),최장원 ( Jang Won Choi ),오원섭 ( Won Sub Oh ),조병렬 ( Byung Ryul Cho ),류동열 ( Dong Ryeol Ryu ) 대한내과학회 2014 대한내과학회지 Vol.86 No.3

Takotsubo cardiomyopathy is a clinical syndrome characterized by chest pain, transient left ventricular dysfunction, and specific electrocardiographic changes induced by physical or emotional stress. We describe a rare case of this syndrome associated with acute mitral valve bacterial endocarditis in a young female.