늑막조직생검으로 진단한 Pleural Paragonimiasis 1 예

김기영,이승환,박진현,이재갑,용석중,신계철,홍욱균,김향인,진춘조 대한내과학회 1991 대한내과학회지 Vol.40 No.5

We report a 28-year old female patient with pleural paragonimiasis who did not have the usual diagnostic triad for this parasitic disease. She did not have chronic hemoptysis, there were no pulmonary infiltrations, and stool, sputum and pleural fluid examinations did not yield paragonimus ova. The diagnosis was made on the basis of ova found in the pleural biopsy. Paragonimus pleural effusion was resolved with frequent thoracentesis and oral praziquantel therapy.

급성췌장염에 의한 췌장가성남종에서 내시경적 배액술후 발생한 췌장가성남종과 십이지장 및 대장에 발생한 내부 췌장루 1예

김연수,이문성,김진오,조영덕,이영홍,봉형근,조주영,이준성,심찬섭,황성규,전기원,변재호,장재영 대한소화기학회 1996 대한소화기학회지 Vol.28 No.1

운동후 측복통과 함께 발생한 급성 신부전 1 예

김종순,박영주,조종태,이정임,신민호,구천희,박태용,한승수,강진화 대한내과학회 1996 대한내과학회지 Vol.50 No.6

We report a case of acute renal failure with severe loin pain and patchy renal vasoconstriction after exercise. An immediate postcontrast computed tomogram of this case shows multiple patchy areas of poor contrast enhancement in the cortex of the both kidneys. A 24-hours delayed scan without further injection of contrast dye shows multiple wedge-shaped contrast enhancement in the coincident areas of poor enhancement in the immediate scan. The 2 and 5 days delayed scans show that wedge-shaped contrast enhancement becomes disappeared gradually to the renal cortex, and the 8 days delayed scan shows complete disappearance of contrast enhancement. The renal scintigrams with technetium-99m-methylene diphosphonate and dimercaptosuccinic acid show diffuse increased uptakes and multiple patchy photon deficient areas in the both kidneys respectively. The follow-up renal scintigrams show nearly normal findings, This patient had an uneventful hospital course and recovered completely without dialysis.

가성 장폐쇄로 발현한 부신경절종 1 예

김용태,이기업,박건춘,송영기,이문호,유은실,이준호,진태선 대한내과학회 1991 대한내과학회지 Vol.40 No.5

Phenochromocytoma is a catecholamine-secreting tumor, most of which grow at the adrenal gland. About 109p Of pheochromocytomas are detected at the extra-adrenal chromaffine tissues and are called paraganglioma. The main symptoms of pheochromacytoma include hypertension, headache, palpitation, and sweating. Gastrointestinal symptoms such as abdominal pain, constipation, and vomiting are found in 20∼40% of patients with pheochromocytoma, but these are usually overlooked because of the severe, prominant cardiovascular symptoms. Intestinal pseudo-obstruction without hypertension in pheochromocytoma is very rarely found. It is caused by the decreased motility of the intestine and the over-contraction of the intestinal sphincter, which are caused by the unbalanced activation of α-and β-adrenal receptors. It can be hypothesized that catecholamine receptors in the cardiovascular system are down-regulated or desensitized, but those in the intestine remain intact. We report herein a case of pheochromocytoma in which intestinal pseudo-obstruction was the main presenting clinical manifestation. Symptoms of intestinal pseudo-obstruction were completely relieved by administration of phenoxybenzamine, an α-receptor blocker, and excisional surgery.

B 형 간염 Virus-Associated Hemophagocytic Syndrome 1 예

김진우,임경수,최영미,정인석,박두복,김호균,정영기 대한내과학회 1991 대한내과학회지 Vol.40 No.6

Virus-associated hemophagocytic syndrome (VAHS) is a nonneoplastic generalized histiocytic proliferation with marked hemophagocytosis associated with systemic viral infections such as Epstein-Barr virus, cytomegalovirus, adenovirus, herpes virus. etc. High fever, liver dysfunction, coagulation abnormality, and peripheral blood cytopenias are characteristic findings. Hepatosplenomegaly, lymphadenopathy, bilateral pulmonary infiltrations, and skin rash are often present. We report a case of Hepatitis B virus-associated hemophagocytic syndrome with a brief review of literature.

기관지내 전이암

김현수,이상수,오미희,이재갑,원구태,홍희승,용석중,신계철 대한내과학회 1991 대한내과학회지 Vol.40 No.4

The lung is the most common site of metastasis of extrapulmonary malignant tumor. According to past reports, metastatic cancer of the lung has been found in about 2% of all patients at autopsy. But these days, a diagnosis of endobronchial metastatic cancer utilizing bronchoscopy only is not easy. Thus we need other means of gathering more informaction, such as past history, discovery of other metastatic sites, and pathologic findings with special staining and electronmicroscope, especially in cases of poorly differentiated adenocarcinoma and epidermoid cancer, which are common types of primary lung cancer. We present 5 cases of endobronchial metastatic cancer. We found endobronchial metastatic cancer 2 cases of cervix cancer (epidermoid, adenocarcinoma), 1 case of colon cancer (adenocarcinoma), hypernephroma (renal cell carcinoma), and bladder cancer (transitional cell carcinoma). Since it was impossiole to diagnose the metastatic adenocarcinoma from the cervix only with lightmicroscopic findings, we could use past history and unusual radiologic and bronchoscopic findings which was thought to be the specific endoscopic finding of metastic endobronchial cancer. The interval between the diagnosis of the primary cancer and endobronchial metastatic cancer was 25.7 months. In the future, development of immunohistochemistry, monoclonal antibody, and molecular biologic techniques will give us diagnostic clue for differential diagnosis of metastatic endobronchial cancer from primary bronchogenic lung cancer.

가토에서 CCNU 로 유발된 골수 저형성증의 혈액학적 소견과 골수스캔의 변화에 관한 연구

김승택,이명철,최두혁,고창순,김병국,이문호,박선양,최성재,김노경,최영희 대한내과학회 1986 대한내과학회지 Vol.30 No.1

To understand systematically the hematological changes including the bone marrow changes in chemotherapeutic agent-induced bone marrow hypoplasia and to define the relationship between hematological and bone marrow scan findings and prognosis of the hypoplasia, CCNU (lomustine) was given orally to 44 rabbits to induce hypoplasia of the bone marrow. And serial changes of peripheral blood and bone marrow findings and (111)In Cl(3)((111)In scan)/(99m)Tc tin colloid bone marrow scan((99m)Tc scan) were checked before and after induction of hypoplasia. With assessment of 28 evaluable rabbits, the following results were obtained: 1) Significant hypoplasia of the bone marrow developed around day 4 of CCNU administration and recovered around day 14(cellularity 51,4±13.5% and 24. 5±14.97o before and after CCNU respectively, p<005). Megakaryocyte count was significantly depressed from 95.67,26% to 36.7$gt;31.82%(P$lt;0.005). M: E ratio was decreased from 162±1.19 to 0, 0.5$lt;0. 43(p±0.005). Shift to left(475), maturation a(40%), naked nucleus and degenerated cells(20%), increase of lymphocytes(47%), monocytes and reticulum cells were also found. 2) The uptake ratio of the 99(m)Tc tin colloid bone marrow scan was markedly increased in contrast to the depression of the bone marrow(4.4±2.12 and 14.1±7.06 before and 4 days after CCNU, respectively, p40. 005). Tc scan uptake ratio was inversely related to the cellularity(r=-0.442, p$lt;0.05) and megakaryocyte number of the bone marrow(r= 0.89, p< 0.01) and peripheral blood granulocyte (r = 0. 54. Pg0.01) and platelet count(r=0.40, p$lt;0.05). There was not significant correlation between (111)In scan uptake ratio and hematologic parameters. 3) The amplitude of the change of the (99m)Tc scan uptake ratio was significantly related to the prognosis of the rabbits with experimentally induced hypoplasia of the bone marrow(dead 5.1±2,67, survivors 2,5±0.96, P<0.01). The change of the (111)In scan uptake ratio was not related to the prognosis of these rabbits. In experimentally induced rrow hypoplasia, morphologic changes in addition to the numerical changes of the bone marrow elements were observed. And serial (99)Tc scan of the bone marrow appears to be helpful assessing the severity and predicting the outcome of bone marrow hypoplasia.

소장내용물의 위내역류 및 위내용물 배출시간에 관한 연구

김진호,박승철,이형호,안일민,박영태,김열흥,이창흥 대한내과학회 1986 대한내과학회지 Vol.30 No.2

Radionuclide enterogastric scintigraphy was done with (99m)Tc-DISIDA and (111)In-DTPA in 35cases; control group 5, gastric ulcer group 6, subtotal gastrectomy with Billroth g group 5, and functional gastrointestinal disorder group with or without grossly mixed bile in the gastric juice 19 cases. The results were: 1) Enterogastric reflux was very significantly increased in the subtotal gastrectomy with Billroth II group (p$lt;0, 001), 2) Gastric emptying was significantly delayed in the functional gastrointestinal disorder groups with or without grossly mixed bile (p$lt;0.05, p$lt;0. 001). 3) Enterogastric reflux was not significantly increased in the gastric ulcer group. 4) Enterogastric reflux was not significantly different between the functional gastrointestinal groups with or without grossly mixed bile in the gastric juice. 5) Inverse correlation between the gastric emptying indices and the enterogastric reflux indices was not proved (r=-0.37).

Castleman 씨 병에 동반된 신유전분증

김연수,한진석,이정상,김병국,이중건,정윤철,이진학,최영진,안규리,김성권,이현순 대한내과학회 1994 대한내과학회지 Vol.46 No.2

Castlemam's disease is an asymptomatic and benign lymph node hyperplasia which is frequently manifested as mediastinal mass in over 70% of cases. Amyloidosis is rarely associated with Castleman's disease. Recently we experienced a patient with nephrotic syndrome due to renal amyloidosis who had been previously diagnosed as Castleman's disease of retroperitoneal lymph node enlargement. A 47-year old woman was admitted because of generalized edema and chest tightness. Five months ago she diagnosed as Castlman's disease-plasma cell type, of retroperitoneal lymph node enlargement. The patient was followed up through outpatient department without any specific medication. Physical examination showed pale conjunctivae, palpable mass on epigastric area and pretibial pitting edema. The hemoglobin, leukocyte count and erythrocyte sedimentation rate were 96 g/L, 5.9×109/L and 127 mm/hour, respectively. The blood urea nitogen was 3.6 mmol/L and creatinine was 88 umol/L. The urinalysis showed 3 positive for albumin. Twentyfour hour urine contained 16.6 grams of protein. A computerized tomographic (CT) scan of the abdomen disclosed multiple lymph node enlargement at mesentery. Percutaneous needle biopsy of kidney showed massive infiltration of pale pinkish amorphous material in the glomerular tuft forming large nodules. Ultrastructural examination exhibited heavy deposition of amyloid fibrils in the mesangium and perpendicular to glomerular basement membrane. Polarizing microscopy with Congo-red stain revealed prominent yellow green birefringence in glomeruli, tubules and interstitium.

경막외마취 확산의 비교관찰 제 1 보 Bupivacaine-Lidocaine

김영석,김완식,김인규,김흥대,안기량,김교상 대한마취과학회 1980 Korean Journal of Anesthesiology Vol.13 No.1

Epidural anesthesia is widely practiced for lower abdominal operation and delivery in many hospital and its complication in minimal compared with spinal anesthesia. Lidocaine has been used extensively for epidural anesthesia with very satisfactory results. It has a very rapid onset of action, producing complete analgesia and has a reasonable duration of action(about 1-1½hr). A concentration of 1. 5% lidocaine causes effective sensory and autonomic blockade but it is unlikely to produce motor paralysis. More recently, bupivacaine(0.5%) has tended to supplement lidocaine as the drug of choice of epidural anesthesia. Firstly, the duration of action is longer. Secondly, it has better affinity for the tissue so that less will be absorbed into the circulation, thus reducing the risk of a toxic reaction. Thirdly, when used with a continuous technique, there is much chance of tachyphylaxis. Using a standardized anesthesia technic, we compared level of sensory anesthesia with a 0. 5% bupivacaine and 1. 5% lidocaine uder elective and emergency surgery. When equal volume of local anesthetic solution were injected(20 ml of 0.5% bupivacaine and l. 5% lidocaine) there were no statistically significant differences in sensory level in bupivacaine and lidocaine, but the duration of anesthesia in bupivacaine from 2 to 3 times longer than lidocaine.