중등도 및 중증고혈압에서 Nifedipine 설하투여의 강압효과에 관한 연구

김영훈,서순규,최인석,김열홍,안희권,심완주,노영무 대한내과학회 1986 대한내과학회지 Vol.31 No.5

In order to assess the efficacy of sublingual nifedipine in the acute treatment of moderate to severe hypertension, a single blind test was done in 30 patients, 10 males and 20 females, aged 40 to 76 years, with moderate to severe hypertension. The patients with mean sitting blood pressure(BP) of more than J40 mmHg received sublingual placebo, and BP and pulse rate(PR) were measured in sitting position 10,20 and 30 minutes after the sublingual placebo was given. The patients with post-placebo 30 minutes sitting mean BP of less than 13pmmHg were excluded from the study. The placebo treatment period was followed by the administration of 10mg of sublingual nifedipine, and BP and PR were measured 10,20,30 and 45 minutes after nifedipine was given. BP decreased with placebo treatment(p$lt;0. 01 by paired t-test, preplacebo vs. post-placebo 30 minutes). With sublingual nifedipine BP started to fall in 10 minutes and reached the lowest levels in 30 or 45 minu1es. The systolic BP decreased from 198.0±21.4mmHg to 159±20.4mmHg, diastolic BP from 122.5±13.0 mmHg to 103.2±14.4 mmHg and mean from 147.7±13.4 mmHg to 121.7±14.8 mmHg 45minutes after nifedipine(p$lt;0.01 by paired t-test). The average fall in systolic BP/diastolic BP/mean BP 45 minutes after nifedipine was 39/19/26 mmHg(p$lt;0. 001, by paired t-test). The maximal fall in systolic BP correlated better with pretreatment value(r=0.42) than the maximal fall in diastolic pressure(r=0.21), PR increased from 79±12 to 87±11/minute with nifedipine(p$lt;0.001, by paired t-test). Side effects were mild facial flushing(16.7%) and palpitation (3.3%). The findings suggest that a dose of 10mg of sublingual nifedipine is a simple, effective and safe method for the acute treatment of moderate to severe hypertension and can be used as a non-injecting alternative agent for the treatment of hypertensive emergency.

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

경막외마취 확산의 비교 관찰

김영석,김완식,황영희,김흥대,김교상,장경덕 대한마취과학회 1981 Korean Journal of Anesthesiology Vol.14 No.1

The segmental spread of epidural analgesia was measured in seventeen surgical patients aged between 17 and 52 years, and in fourteen patients between 60 and 77 years. The upper level in the young was 6.29(±1.56) thoracic vertebra level, but in the elderly was 4(±0.65) thoracic vertebra level at 20 minutes after epidural injection of 1.5% lidocaine 20㎖. A given volume of solution spreads to 0.9, 1.07, 1.54, 2.29 segments greater upper extent at 5, 10, 15, 20 minutes after epidural injection and 0.57, 1.07 segments greater lower extent at 5, 10 minutes in the elder than young. So with increasing age relatively small amounts of solution are required, to produce the same extent of anesthesia in the yonung.

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.

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.

다른 광물질과 혼합된 크롬 피콜린산 급여가 비육돈의 성장 , 도체특성 , 혈액성상에 미치는 영향

김지훈,한인규,김진동,김대성,양종석,손현수,현영 한국영양사료학회 1999 韓國營養飼料學會誌 Vol.23 No.5

본 시험은 여러 가지 광물질과 혼합된 크롬 피콜린 산을 첨가한 사료의 급여가 비육돈의 성장, 도체특성, 혈액성상에 미치는 영향을 알아보기 위하여 수행되었다. 개시체중이 69㎏인 총 513두의 비육돈을 돈방당 16∼21두씩 수용하여 사양시험을 수행하였으며, 9마리가 대사시험에 사용되었다. 처리구는 2개의 단백질 수준별 대조구 (Con 12, Cen 14)와 외산 크롬 피콜린산 (CrP-CaCO₃ ; Prince사 제품). 크롬 제오라이트 (CrP-Zeolite 12, 14), 국산 크롬 피콜린산 1 (CrP-CaCO₃; KIST 개발), 크롬 피콜린산-산화아연 (CrP-CaCO₃-ZnO 12, 14) 그리고 국산 크롬 피콜린산 2 (CrP-CaCO₃ ; M. H. Lee 개발)이었다. 성장성적에 있어서는 일당중체량, 일당사료섭취량, 사료효율 등 모든 조사항목에서 처리구간의 차이가 발견되지 않았으나, 등지방 두께는 크롬 피콜린산 첨가에 의해 감소하는 경향이 발견되었고, 이러한 경향은 출하체중이 무거울수륵 뚜렷하게 나타났다. 도체등급은 크롬 제오라이트구와 크롬 피콜린산-산화아연처리구에서 높게 나타났으며, 혈액내 콜레스테를의 함량도 크롬 제오라이트구와 크롬 피콜린산-산화아연처리구에서 대조구에 비해 유의적으로 감소하였다 (p<0.05). 크롬 피콜린산-산화아연처리구와 크롬 피콜린산구에서 건물 및 단백질 소화율이 향상되었다 (p<0.05). This experiment was conducted to investigate the effects of chromium picolinate in different combinations with minerals on growth, carcass characteristics, serum traits and nutrient digestibility in finishing pigs. Five-hundred and thirteen pigs (69.0 ㎏ of initial weight) were assigned to 9 treatments, each containing three replicates of sixteen to twenty-one pigs each. Additional nine pigs were used in a digestion trial. Treatments were two controls (12% CP and 14% CP), foreign CrP-CaCO₃, two CrP-Zeolite (12% CP and 14% CP), domestic CrP-CaCO₃ 1, CrP-CaCO₃-ZnO (12% CP and 14% CP) and domestic CrP-CaCO₃ 2. ADG was not significantly different among the treatments. Tenth rib backfat thickness tended to be decreased by feeding diet with CrP. Carcass grade was improved by using zeolite and CaCO₃ + ZnO along with CrP in diets. Serum cholesterol level was significantly reduced by feeding diets containing CrP with CaCO₃ + ZnO or Zeolite compared with the control. Supplementation of Cr with CrP-CaCO₃ + ZnO or CrP-CaCO₃ in diets significantly improved the digestibility of crude protein and dry matter (p<0.05). The excretion of nitrogen was lower in pigs fed diets containing Cr regardless of the combinations with minerals. The excretion of phosphorus was lowest in the CrP-CaCO₃ + ZnO group which showed the highest phosphorus digestibility.

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).

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.

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.