이달의 X-선 : 위치에 따라 이동하는 종괴를 포함한 공동으로 진행된 비소세포폐암에 동반된 폐렴

엄태찬 ( Tae Chan Um ),문귀애 ( Kwie Ae Moon ),김필호 ( Phil Ho Kim ),김상현 ( Sang Hyun Kim ),정병오 ( Byung Oh Jeoung ),이혁표 ( Hyuk Pyo Lee ),김주인 ( Joo In Kim ),염호기 ( Ho Kee Yum ),최수전 ( Soo Jeon Choi ),김성준 ( Sung J 대한결핵 및 호흡기학회 1999 Tuberculosis and Respiratory Diseases Vol.46 No.4

다운증후군과 동반된 부갑상선 기능저하증 1예

김필호,박연호,남궁준,문귀애,김상현,엄태찬,김성준,고경수,이병두,박미정 인제대학교 1998 仁濟醫學 Vol.19 No.2

다운증후군은 특이한 외모, 지능 발달 저하 등의 임상상으로 나타나는 가장 흔한 상염색체 수 이상 증후군이다. 저자들은 전신 경련을 주소로 내원한 환자에서 염색체 검사를 실시하여 Robertsonian translocation에 의한 부분 삼체성의 다운증후군 및 특발성 부갑상선 기능저하증이 동반된 증례를 경험하였기에 문헌 고찰과 함께 보고하는 바이다. Down syndrome is perhaps the oldest condition associated with mental retardation and the most common genetic cause of developmental disability. It is presumed that the additional gene products of the triplicated chromosome 21 cause alterations in the normal processes regulating embryogenesis. Ninety-five percent of cases are caused by trisomy 21, whereas the remainder are translocations. Mainly, the chromosomal translocation is made of Robertsonian translocation. Clinically it consists of cranio-facial abnormality, such as microcephaly, with flattening both of the occiput and face, an upward slant to the eyes with epicanthal folds, and the ears are small. Congenital heart disease, musculoskeletal abnormalities, gastrointestinal disorders, hematologic abnormalities and associated developmental disabilities. And thyroid dysfunction and infertility are the most significant endocrinologic disorders in individuals with Down syndrome. But we could not find any reported case of hypoparathyroidism associated with Down syndrome in worldwide search of literatures. Even though some cases of hereditary hypoparathyroidism, which is not associated with Down syndrome were reported. We experienced a rare case of 15-year-old male diagnosed as hypoparathyroidism associated with Down syndrome, which is diagnosed by cytogenetic chromosomal study and by radioimmunoassay for PTH wish symptoms of seizure disorder due to hypocalcemid and typical cranio-facial abnormalities.

대퇴동맥을 통한 경피적 관동맥 중재시술 환자의 천자부위 지혈을 위한 Angioseal^(�) 사용과 고식적 용수 압박법의 비교 : 전향적 연구

김용훈,권현철,김필호,안석진,유철웅,최진호,이상철,김준수,김덕경,전은석,이상훈,홍경표,박정의,서정돈 대한내과학회 2004 대한내과학회지 Vol.66 No.5

목적 : 경피적 관동맥 중재술은 최근 양적 및 질적으로 급격한 발전을 보였지만 시술 시 천자부위의 혈관 합병증은 아직 해결해야 할 문제점이다. 저자들은 대퇴동맥을 통한 경피적 관동맥 중재술을 환자에게 천자부위 지혈을 위한 혈관폐쇄기구인 안지오실의 안전성과 유용성을 고식적인 용수 압박법과 비교 연구하고자 하였다. 방법 : 2002년 4월부터 2003년 5월 사이에 삼성서울병원 심장혈관센터에서 대퇴동맥을 통한 경피적 관동맥 중재술을 성공적으로 시행한 200명의 환자(안지오실 사용군: A군, 100명, 고식적 용수압박법 사용군 B군, 100명)를 대상으로 시술 후 주요 합병증 및 경한 합병증, 지혈 후 환자가 자리에 앉기까지의 시간, 보행개시 가능시간, 총 재원 기간과 시술 1주 후의 합병증을 전향적으로 조사하여 비교 연구하였다. 결론 : 두 군에서 연령, 성별, 기저질환, 심혈관 질환의 위험요소, 시술의 종류, 시술 중 사용한 헤파린의 양, clopidogrel의 양, ticlopidine의 양, 지혈 시 수축기와 확장기혈압, ACT (activated clotting time)는 차이가 없었다. A군이 B군에 비해 시술 후 자리에 앉기까지의 시간 (A군: 4.3±0.3시간, B군: 13.7±0.8시간, p=0.004) 및 보행개시까지의 시간(A군: 6.8±0.5시간, B군: 18.8±2.1시간, p=0.013)이 유의하게 짧았다. 시술 후 주요 합병증은 두군 모두에서 관찰되지 않았으며, 경한 합병증의 전체발생은 A군에서 유의하게 적었다(A군: 28명, B군: 19명, p=0.003). 반상출혈의 경우는 A군에서 유의하게 낮았지만(A군: 3명, B군: 12명, p=0.01), 혈종, 출혈의 발생은 두군간에 차이가 없었다. 총 재원기간에는 두 군간에 차이가 없었다(p=0.239). 시술 1주 후 경과관찰에서 주요합병증은 역시 두 군 모두에서 관찰되지 않았으며, 경한 합병증의 전체발생은 두 군에서 차이가 없었다(A군: 15명, B군: 13명 p=0.418), 반상출혈의 빈도는 차이가 없었지만 혈종의 발생은 A군에서 더 낮았다(A군: 2명, B군:6명, p=0.004). 두 군 모두에서 출혈은 발생하지 않았다. 결론 : 대퇴동맥을 통한 경피적 관동맥 중재술을 시행한 환자에서 안지오실의 사용은 고식적 용수 압박법에 비해 환자의 침상 안정시간을 줄여 조기 활동개시가 가능하게 하였으며 국소합병증의 위험도를 일부 낮추어, 시술에 따른 환자의 불편을 현저하게 감소시킬 수 있다고 할 수 있을 것으로 기대된다. Background : Although the number and the quality of percutaneous coronary intervention have been recently increased dramatically, the vascular complication at puncture site is still the major cause of patients' morbidity. We evaluated the safety and efficacy of newly of newly-developed collagen-based arterial closure device, Angioseal after transfemoral percuatenous coronary intervention. Methods : This study was designed as a prospective single center non-randomized comparative study. A total 200 patients undergoing transfemoral percutaneous coronary intervention were enrolled between April 2002 and May 2003. They were divided into two groups; Angioseal group (group A, n=100) and manual compression group (group B, n=100). The baseline clinical and angiographic characteristics were reviewed. The time to sit up, the time to ambulation, the duration of hospital stay, major and minor vascular puncture site complications were monitored. The patients were followed-up for 1 week after procedure by telephone. Results : The baseline clinical characteriwtics, clinical diagnosis, cardiocascular risk factors, typesof procedure, doses and numbers of anticoagulants were similar between two groups. The blood pressure and activated clotting time were also similar. The time to sit up (group A: 4.3±0.3 hours, group B: 13.7±0.8 hours, p=0.004) and the time to ambulation (group A: 6.8±0.5 hours, group B: 18.8±2.1 hours, p=0.013) were shorter in group A. No major vascular complications were noted. The incidence of hematoma and bleeding were not significantly different between two groups. The incidence of ecchymosis, however, was significantly lower in group A (group A:12%, group B: 3%, p=0.001) The duration of gospital stay was similar between groups. During 7 days of follow-up period incidence of hematoma was significantly lower in group A (p=0.004). Although the incidence of ecchymosis was not significantly different between two groups. Conclusion : The angioseal may be associated with earlier ambulation and less patients' morbidity with low incidence of local complication rate compared to manual compression after transfemoral percutaneous coronary intervention.

중추성 요봉증과 단독성 성선자극 호르몬 결핍증을 동반한 공허안증후군 1예

김성준,조남국,엄태찬,문귀애,김필호,김상현,고경수,이병두,박재홍 인제대학교 1998 仁濟醫學 Vol.19 No.2

공허안증후군은 뇌하수체와 내로 거미막하 공간이 내려와 뇌하수체가 편평해지는 질환이다. 공허안증후군 환자의 대부분은 뇌하수체 기능 장애 없이 우연히 발견되는 경우가 많다. 저자들은 이차 성징 발현 소실을 주소로 내원한 30세 남자에서 원발성 공허안증후군과 중추성 요붕증, 단독성 성선자극호르몬 결핍증이 동반되었음을 경험하였기에 문헌 고찰과 함께 보고하는 바이다. Primary empty sella syndrome(PESS) associated wish trophic hormone deficiency is rare. Furthermore, PESS with central type of diabetes insipidus(DI) and isolated anterior pituitary hormone deficiency is extremely rare. We experienced a case of PESS associated with central type of DI and isolated gonadotropin deficiency in a 30-year-old man who had complained of sexual infantilism and polyuria. MRI of pituitary gland showed posteriorly displaced pituitary stalk and CSF-like signal intensity in the sella turcica. We report this case wish review of the relevant literatures.

단독성 부신피질 자극호르몬 결핍증 1예

김영일,박재홍,고경수,김명식,신상민,이병두,김필호,정병오,최홍집 대한내분비학회 1996 Endocrinology and metabolism Vol.11 No.4

Isolated ACTH deficiency is a rare cause of secondary adrenocortical insufficiency. Adrenal crisis in isolated ACTH deficiency is less common compared to primary adrenal insufficiency, but isolated ACTH deficiency is an important cause of hypoglycemia. Recently we experienced a 41-year-old man admitted because of mental confusion. On admission, plasma glucose and sodium concentration were 1.7, 132 mmol/L, respectively. Basal plasma ACTH and cortisol levels were low and other pituitary hormone showed normal response to combined pituitary stimulation test except growth hormone. Plasma ACTH concentration remained low even after intravenous injection of ovine corticotropin releasing factor. It suggest that the defect of ACTH secretion was apparently due to intrinsic pituitary rather than hypothalamic disease. The sellar CT showed the fossa to be filled by cerebrospinal fluid. After treatment with glucocorticoid, he had no further evidence of hypoglycemia and hyponatremia. In conclusion, we report a case of isolated ACTH deficiency with empty sella. (J Kor Soc Endocrinol 11:538 543, 1996)

만성간질환에 병발한 다발성근염 3예

이진호,이성홍,이현경,최태영,신원창,최대식,김필호,김관엽,엄태찬 대한내과학회 1999 대한내과학회지 Vol.56 No.3

Polymyositis is characterized by symmetrical proximal muscle weakness, nonsuppurative inflammation of striated skeletal muscle, elevation of muscle enzyme, and abnormality of electromyographical change, but its pathogenesis is not clear. The incidence of polymyositis is low, and that associated with chronic liver disease is rare. Clinical importance of polymyositis associated with chronic liver disease is that it is a reversible disease which can be treated with glucocorticoid. We experienced three cases of polymyositis associated with chronic liver disease which was treated with prednisolone. And we report these cases with a brief review of literature. So, the further study about the influence of chronic liver disease on the polymyositis is warranted.