폐흡충에 의한 무균성 노흉에 대한 돼지꼬리형 도관(pig-tail catheter)을 이용한 치료의 효과

한경택,권세훈,김형호,하재화,선길홍,권용은,윤성호,이승일 朝鮮大學校 附設 醫學硏究所 2006 The Medical Journal of Chosun University Vol.31 No.3

Background: Pulmonary paragonimiasis is caused by consumption of raw or improperlycooked crustacea infected with the laval stage (metacercaria) of Paragonimus westermani. The most characteristic symptoms were rust-colored sputum and cough. Paragonimiasis causes pleural thickening or effusion in 48% of the patients. Pleuro-pulmonary paragonimiasis can be easily overlooked by physicians who do not suspect this disease in the differential diagnosis. Method: We compared the outcomes of 11 patients with paragonimus empyema managed either through thoracotomy or pig-tail catheter drain. These patients were confirmed by food history, clinical and radiological findings, and laboratory data. Results: The male and female ratio was 1.75 : 1, and mean age was 40.0 ± 13.5 years. AII patients had pulmonary symptoms such as cough or chest pain. Serum-ELISA for paragonimiasis were all positive (mean titer was 0.57). AII patients had pleural effusion in radiological findings( 2 patients had bilateral pleural effusion). All patients received praziquantel (75 ㎎/㎏/day for 3days). Two patients were treated with thoracotomy and nine patients were treated with pig-tail drain. Hospital stay were 14.5 days in thoracotomy group and 5.6 days in pig-tail group respectively, Conclusion: Compared to the conventional thoracotomy grouP, the patients with paragonimus empyema who received pig-tail catheters had a significantly-decreased period of drain in situ, were clinically improved earlier, and were discharged earlier.

흉막삼출의 유무에 따른 쯔쯔가무시증 환자간의 비교

권세훈,김형호,강지인,하재하,한경택,이재록,김동민,권용은,윤성호,이승일 朝鮮大學校 附設 醫學硏究所 2007 The Medical Journal of Chosun University Vol.32 No.1

Scrub typhus is a potentially fatal infectious disease caused by the organism Orientia tsutsugamushi. Clinical manifestations are fever, skin rash, eschar and varying degree of respiratory distress. The pleural effusion in scrub typhus is rare and secondary to the destruction of vascular endothelium. Because the respiratory symptoms are generally mild and the pleural effusion in scmb typhus is rare than in interstitial pneumonia, there are few comments about the characteristics of scmb typhus with pleural effusion. So we made the comparative study of scmb typhus patients between with pleural effusion and without pleural effusion. 연구배경 치명적일 수 있는 감염질환 중 하나인 쯔쯔가무시중(Scrub typhus)에서 드문 흉막삼출을 동반한 환자에 대한 고찰은 다른 문헌에서도 자주 언급되지 않았다. 따라서 본 저자들은 흉막삼출이 있는 경우와 없는 경우에 따른 쯔쯔가무시중 환자들을 비교하고자 하였다. 방법 2003년에서 2006년까지 조선대학교 병원 내과에 입원중인 환자 중 쯔쯔가무시중 진단을 받은 총 109명의 환자를 대상으로 하여 흉부 X선 검사 및 혈청학적 검사(CPK, LDH, ESR, CRP, AST, ALT, ADA), 혈액학적 검사(WBC, PLT) 및 백분율 검사등을 실시하였다. 결과 흉막삼출이 있는 환자들의 경우 흉막 삼출이 없는 환자들에 비해 ESR 수치가 통계학적으로 의의있게 높았다(p-vaule < 0.05). 결론 흉막삼출 유무에 따른 쯔쯔가무시중 환자간의 비교에 있어 ESR 수치가 통계학적인 의의를 가졌다.

췌장암 환자에서 알코올 내장신경 신경파괴블럭 후 발생한 간염

이상은,최석환,김영환,임세훈,이정한,이근무,정순호,최영균,김영재,신치만 인제대학교 2008 仁濟醫學 Vol.29 No.-

Splanchnic neurolytic block(SNB) with alcohol improves the management of pancreatic cancer pain. Adverse effects of alcohol SNB which include regional pain, hypotension, diarrhea, and acute alcohol intoxication are common, but acute hepatitis caused by alcohol neurolytic block is rare. A 63-year-old patient with pancreatic head cancer and liver metastasis had complete pain relief after both retrocrural tansdiscal SNB with 100% alcohol 10 ml. But, 1 day later, liver function test showed a high elevation in the aspartate aminotransferase (AST, 2182 IU/L) and alanine aminotransferase (ALT, 1807 IU/L). The patient had slight jaundice, general weakness, chilling, nausea and vomiting after SNB. Both AST and ALT decreased to 46 and 119 IU/L within 10 days with only supportive therapy. But, 19 days later, the patient died due to pneumonia. Our case illustrates the importance of clinical surveillance especially in patient with hepatic disease after alcohol SNB.

악교정 수술 환자에서 수술부 술전소독에 사용되는 소독제의 항균성에 대한 임상적인 비교 : POVIDONE-IODINE AND CHLORHEXIDINE

엄기훈,한세우,유준영,양병은,김용관 大韓顎顔面成形再建外科學會 2003 Maxillofacial Plastic Reconstructive Surgery Vol.25 No.2

For prevention of bacteremia and surgical field contamination, various concentration are used in preoperative skin preparation. Of these, povidone(PVP)-iodine has been known as one having believable effect. But, application of PVP-Ⅰon pral and maxillofacial field has some problems-skin discoloration, hypersensitivity, corneal irritation,etc. Therefore chlorhexidine has been tried to replace PVP-Ⅰ. More recent studies of antibacterial effect of chlorhexidine and PVP-Ⅰ has been achieved on the other field. The purpose of this study was to compare the antibactreial effect of two kinds of skin disinfectants used in oral and maxillofacial surgical field.-chlorhexidine and PVP-Ⅰ. We studied the 40 patients who have taken operation of orthognathic surgery in Dept. of oral & Maxillofacial Surgery, Kangnam General Hospital Public Corp..Results of bacterial culture taken from facial skin and intraoral mucosa after application 10% PVP-Ⅰ and 0.5% chlorhexidine were compared.

전기경련요법에서 remifentanil이 혈역학에 미치는 효과

정순호,이상은,임세훈,이정한,이근무,최영균,김영재,신치만 白中央醫療院 2005 仁濟醫學 Vol.26 No.1

Objective: Electroconvulsive therapy (ECT) is often associated with transient hypertension and tachycardia. Acute hemodynamic change may produce serious complications. Remifentanil is a potent ultra short acting opioid and has been found to reduce blood pressure and heart rate. The goal of this study was to evaluate effects of remifentanil on seizure duration, recovery parameters and hemodynamic changes during ECT. Methods: Ten ASA Ⅰ, Ⅱ patients enrolled in this prospective, randomized trial, each receiving more than four electroconvulsive therapy. Patients were randomized to receive placebo, group P (propofol 1mg/kg+0.9% normal saline 1ml, n=10), and propofol with remifentanil, group R (propofol 1mg/kg+remifentanil 1ug/Kg n=10). Supplemental dose of propofol was given as required to achieve loss of consciousness. We recorded hemodynamic parameters, seizure duration, and recovery parameters. Results: Seizure duration and recovery parameters were similar in group R and group P. Blood pressure and Hear rate after ECT were significantly lower in group R. Conclusions: Remifentanil(1ug/kg) attenuated the acute hemodynamic response to ECT under propofol anesthesia without adversely affecting the duration of seizure activity and recovery profile. Adjunctive use of remifentanil may be good alternative regimens for ECT.

소아에서의 급성 파종성 뇌척수염의 임상적 고찰

조수진,박은애,유은선,김혜순,손세정,서정완,이승주,한후재 이화여자대학교 의과대학 2003 EMJ (Ewha medical journal) Vol.26 No.2

목적: 급성 파종성 뇌척수염은 감염이나 예방 접종 후 발생하는 중추 신경계의 급성 자가 면역 염증성 질환으로 탈수초를 일으킨다. 신경학적인 증상으로 발현되고 대부분 환전히 회복되지만 신경학적 후유증을 남기거나 사망 할 수도 있다. 이에 저자들은 본원에서 발생 한 14명을 분석하여 조기 진단과 치료에 도움을 주고자 하였다. 대상과 방법: 1998년 3월부터 2003년 8월까지 이대목동병원에서 급성 파종성 뇌척수염으로 진단 받은 14명의 의무기록을 후향적으로 조사하였다. 결과: 환자들의 평균 발생 연령은 5±7.8개월이였고, 특정계절이나 연도에 집중되어서 나타나지는 않았다. 선행질환은 주로 비특이적인 상기도 감염이 가장 많았고, 초기증상으로는 경련이 가장 많았다. 그 외에 의식저하나 운동장애도 있었다. 뇌척수액 검사에서 백혈구 증가증이 발견된 경우는 있었으나 단백이 증가된 경우는 없었다. 뇌 자기공명 촬영에서 T2 증강시 뇌백질과 기저핵에 고음영의 다발성 병소가 발견되었고 추적 촬영에서 대부분에서 소실되었다. 뇌파 검사가 시행되었던 경우 전반적인 서파가 가장 많았고 국소적인 극파가 나온 경우도 한 명 있었다. 환자들은 정맥 면역 글로블린과 메틸프레드니졸론으로 치료하였고 치료 시작 후 3~7일내 증상이 호전되었다. 모든 환자를 2달 이상 추적 관찰하였고 항경련제가 지속적으로 필요한 정도의 경련성 질환이 두 명, 신경아교증이 남아잇는 경우가 한 명, 외래에서 다발성 경화증이 의심되는 경우가 한 명 있었다. 결론: 급성 파종성 뇌척수염은 침범 부위에 따라서 다양한 임상 상으로 나타나며 면역 글로블린과 메틸프레드니졸론이 치료에 효과적이였다. 본 연구에서는 대상 환자수가 적어 신경학적 후유증의 위험요소는 밝힐 수는 없으나, 예후는 검사소견과 연관되어 있지는 않았고, 대부분에서 양호하여 완전히 회복되었으나, 신경학적 후유증이 남은 경우도 있었다. Objective:Acute disseminated encephalomyelitis(ADEM) is an acute demyelinating autoimmune inflammatory disease of the central nervous system which develops after infection of vaccination. It may be fatal, and produce a permanent residual static disability or fully recover. We retrospec-tively studied 14 cases to investigate the clinical findings and outcome of ADEM. Methods : 14cases of ADEM diagnosed at Ewha Womans University Mokdong Hospital from 1998 to 2003 were retrospectively reviewed. Results : The age of onset was 5years±7.8 months and no seasonal clustering was found. The time of onset of symptoms was between 3 to 30 days. The preceding events were nonspecific upper respiratory infections in 9 cases, aseptic meningitis in 4 cases, and gastroenteritis in one case..The initial symptoms were seizure, altered consciousness, hemiparesis, fever, headache, and vomiting. Brain MRI showed multifocal high signal intensity lesions on T2 weighted image mainly in the cerebral whith matter, basal ganglia and periventricular white matter. EEG was performed in some cases and showed generalized or focal slow waves and only one case showed focal spikes. Patients were treated with IV globulin and methylprednisolone and the symptoms improved within 3-7 days after treatment. All patients were followed up for more than 2 months and most of them fully recovered except two. Conclusion : ADEM presents in various clinical manifestations depending on its involvement of the brain lesions. Most cases recovered fully but in some cases, residual permanent neurologic sequelae remained.

극단 저체중 신생아에서의 동맥관 개존증 결찰술을 위한 진정맥 마취 경험 2례

최영균,고명진,이상은,조광래,김영환,임세훈,이정한,이근무,정순호,김영재,신치만 仁濟大學校 白病院 2010 仁濟醫學 Vol.31 No.-

Running title: Cases of anesthesia for extremely low birth weight infant. Extremely low birth weight infants (birth weight < 1000 g) are prone to various morbidities such as respiratory distress syndrome, intraventricular hemorrhage, periventricular leukomalacia, patent ductus arteriosus, necrotizing enterocolitis and retinopathy. To accomplish successful anesthetic management, many precautions must be continuously taken during the operation. First, inspired oxygen concentration should be adjusted to avoid oxygen toxicity. Second, body temperature must be maintained adequately. Third, hemodynamic parameters should be kept stable. We report 2 cases of successful anesthetic management for extremely low birth weight infant who underwent ligation of patent ductus arteriosus at the neonatal intensive care unit.

Lactobacillus plantarum HY7712 Ameliorates Cyclophosphamide-Induced Immunosuppression in Mice

( Se Eun Jang ),( Eun Ha Joh ),( Ho Yong Lee ),( Young Tae Ahn ),( Jung Hee Lee ),( Chul Sung Huh ),( Myung Joo Han ),( Dong Hyun Kim ) 한국미생물 · 생명공학회 2013 Journal of microbiology and biotechnology Vol.23 No.3

Lactic acid bacteria (LAB) in fermented foods have attracted considerable attention recently as treatment options for immune diseases, the incidence of which has been increasing worldwide. The ability of 500 strains of LAB, isolated from kimchi, to induce TNF-α production in peritoneal macrophages was investigated. Lactobacillus plantarum HY7712 most strongly induced TNF-α production as well as NF-κB activation. However, HY7712 inhibited NF-κB activation in LPS-stimulated peritoneal macrophages. When HY7712 was orally treated in cyclophosphamide (CP)-immunosuppressed mice for 5 or 15 days, it reversed the body and spleen weights, blood RBC and WBC levels, and splenocyte and bone marrow cells that were reduced by CP. Orally administered HY7712 increased concanavalin A-induced T cell proliferation to 84.5% of the normal group on day 15, although treatment with CP alone markedly reduced it to 53.7% of the normal group. Furthermore, orally administered HY7712 significantly induced the expressions of IL-2 and IFN-γ in ConA-induced splenic cytotoxic T cells of CP-treated mice. Orally administered HY7712 restored the CP-impaired phagocytosis of macrophages in mice. Orally administered HY7712 also restored the cytotoxicity of NK and cytotoxic T cells derived from spleen and bone marrow against YAC-1 in CP-immunosuppressed mice. Based on these findings, orally administered HY7712 may accelerate the recovery of cyclophosphamide-caused immunosuppression, without evident side effects, by immunopotentiating NK and Tc cells, and may provide a mechanistic basis for using HY7712 as an alternative means in lessening chemotherapyinduced immunosuppression in cancer patients.

Porcine Epidemic Diarrhea Virus Variant Strain with a Large Genomic Deletion, Vietnam

Se Eun Choe,Kee Hwan Park,Seong In Lim,Phan Le Van,Ba Hien Nguyen,Ngoc Thach Pham,Hai Quynh Do,Song Hee Han,Seok Ho Han,In Soo Cho,Dong Jun An 대한수의학회 2015 대한수의학회 학술대회발표집 Vol.2015 No.-

Poster Session : PS 1317 ; Endocrinology : Adrenal Pseudocyst Presenting with Retroperitoneal Hemorrhage and Hormonal Abnormalities

( Se Eun Han ),( Myung Kwan Ko ),( Yang Won Nah ),( Jae Hee Suh ),( So Hyun Park ),( Eun Sook Kim ),( Young Il Kim ),( Il Seong Nam Goong ),( Gyeong Min Jeong ),( Chui Yong Pak ),( Kyung Hye Park ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Adrenal pseudocysts are rare cystic lesions and most of them are usually nonfunctional and asymptomatic, discovered incidentally during diagnostic imaging such as ultrasonography and computed tomography. However, large pseudocyst may cause compressive effects on adjacent organs, abdominal symptoms, and sometimes complications by rupture and hemorrhage or infection of pseudocyst. We report a case of a 28-year old woman with spontaneously ruptured right adrenal pseudocyst with retroperitoneal hemorrhage and hormonal abnormalities treated with delayed laparoscopic surgery. She was visited to our hospital due to sudden onset of right upper quadrant pain. A computed tomography revealed a 14cm sized retroperitoneal hematoma around the right adrenal gland due to unknown origin. She showed elevated blood pressure and increased levels of 24 hours urine catecholamines and its metabolites. After admission at intensive care unit, hemoglobin level was reduced to 7.6 g/dl and hypotension was developed. She received blood transfusion and underwent renal artery angiography, but active bleeding site was not observed. After transfusion, she became stable and surgical treatment was delayed after further absorption of retroperitoneal hematoma. After discharge, size of the retroperitoneal hematoma decreased slowly on serial computed tomography and levels of catecholamines and its metabolites remained to normal range. Laparoscopic right adrenalectomy was done after two years of initial event. And histopathologic findings diagnosed adrenal pseudocyst with fibrosis and dystrophic calcification. Our case shows that adrenal pseudocyst with retroperitoneal hemorrhage can be accompanied by catecholamine excess. In case of huge retroperitoneal hemorrhage from adrenal lesion, the delayed laparoscopic adrenalectomy may be an appropriate management strategy after stabilization of patient`s status with initial careful monitoring rather than prompt surgical exploration.