폐쇄성 수면 무호흡이 전신성 혈압, 심조율 및 요 Catecholamines 농도 변화에 미치는 영향

노대근 ( Dae Keun Lo ),최영미 ( Young Mee Choi ),송정섭 ( Jeong Sup Song ),박성학 ( Sung Hak Park ),문화식 ( Hwa Sik Moon ) 대한결핵 및 호흡기학회 1998 Tuberculosis and Respiratory Diseases Vol.45 No.1

장막간 혈관염에 의한 소장 경색을 동반한 전신성 홍반성 루푸스

노대근 ( Dae Keun Lo ),박윤희 ( Yoon Hee Park ),양형인 ( Hyung In Yang ),박성환 ( Sung Hwan Park ),이상헌 ( Sang Heon Lee ),조철수 ( Chul Soo Cho ),김호연 ( Ho Youn Kim ),김병기 ( Byung Kee Kim ),고응복 ( Yong Bok Koh ) 대한류마티스학회 1996 대한류마티스학회지 Vol.3 No.1

Systemic lupus erythematosus (SLE) is an autoimmune disease involving many organs. Mesenteric vasculitis is one of the serious organ involvement in this disease. Mesenteric vasculitis may produce mucosal ulceration. bowel edema with paralytic ileus, hemorrhagic ileitis, intussusception, perforation and mesenteric infarction. Because of high mortality rate, early diagnosis and treatment of this manifestation is very important. We experienced a case of SLE with extensive smell bowel infarction due to mesenteric vasculitis. She was 29 years old. She was suffered frem severe abdominal pain for three days. Abdominal computed tomography showed diffusse wall thickening of the small intestinal wall. After high dose intravenous steroid, her abdominal symptoms were improved. She was discharged with low dose oral steroid(15mg/day) treatment. Seven months later, she presented with sudden abdominal pain. Intravenous methyl-prednisolon (2mg/Kg) was started. Three days later. her abdominal symptoms were not subsided. On the plain radiograph of the abdomen, marked ileus was demonstrated. Mesenteric angiography showed diffuse decreased small bowel vascularity. A provisional diagnosis of small bowel infarction and obstruction, we performed exploratory laparotomy. She undergone small bowel segmental resection. The diagnosis was small bowel infaction due to mesenteric vasculitis.

만성적인 후두증상을 주소로한 환자에서의 식도내압검사 및 24 시간 보행성 pH 검사소견

방춘상(Choon Sang Bhang),노대근(Dae Keun Lo),박수헌(Soo Heon Park),최명규(Myung Gyu Choi),한준열(Jun Yeul Han),정인식(In Sik Chung),정규원(Kyu Won Chung),선희식(Hee Sik Sun),박두호(Doo Ho Park),김부성(Boo Sung Kim),조승호(Seung Ho Ch 대한내과학회 1996 대한내과학회지 Vol.51 No.6

Objectives: The exact causes of nonspecific chronic laryngitis or laryngeal symptoms are unknown, but many cases of this disease are associated with gastroesophageal reflux or motility disorders of esophagus. We suppose that because Korean people have less gastroesaphageal reflux diseases and the life style including food is different from those of western people, the causes of chronic laryngeal symptoms nre different, So we studied the patients who complained the chronic laryngeal symptoms for evaluation of the role of esophageal motility disorders and gastroesophageal reflux. Methods: 19 patients(male 3, female 16, mean age 40(26-66)) with hoarseness, globus sensation, sorethroat of chronic nature(greater than 3-month duration), not response to conventional therapy of otolaryngologist in St. Mary's Hospital were referred to department of internal medicine. A group of normal, 15 healthy subjects(male 7, female 8, mean age39(24-57)) who had no esophageal or laryngeal symptoms was studied as a control group. All patients and normal controls had manometric studies and 24 hour ambulatory pH monitoring. abnormal findings required pathologic reflux or results greater than the mean plus 2 SDs of normal controls. Results: 1) The chronic laryngeal symptoms were hoarseness in 15 patients(79%), globus sensation in 14 patients(74%), sorethroat in 6 patients(32%), pulmonary symptoms in 3 patients(16%), dysphagia in 2 patients(11%) and heartburn in 1 patient(5%). 2) The lower esophageal sphincter pressure by the rapid pull through tecnique(mean±SD, 27,9± 6.9mmHg) in patients was not different compared with normal controls(31,1±11.0nmHg), 3 patients (16%) had esophageal body dysmotility and all of these were non specific motility disorder. 3) The upper esophageal sphincter pressure(mean±SD, 53.2±23.8mmHg) in patients was not different compared with normal controls(40.9±20.8mmHg), but 2 patients(10.5%) had high upper esophageal sphincter pressures(>82,5mmHg), The postrelaxation pressure of upper esophageal sphincter(mean±SD,98.3±32.1mmHg) was not different compared with normal controls(79,8±30.6mmHg), but 2 patients(10.5%) had high postrelaxation pressures of upper esophageal sphincter(>141mmHg). 4) The time(mean±SD, 321±193msec) between lowest point of upper esophageal sphincter relaxation and onset of pharyngeal contraction was not different compared with normal controls(273.5±179,8msec). 5) The percentage of time of pH less than 4 was 2.4±4.7% in total periods, 2.5±2.3% in upright position and 2.4±9.7% in supine position. Two patients (10.5%) had pathologic reflux(more than 4% of percentage of time pH less than 4 in total periods) and one patient with 2.5% of persentage of time pH less than 4 had high symptom index(66.7%(4/6)). 6) According to above results either of abnormal esophageal pressure or dysmotility was seen in 6 patients(32%) and either of more than 4% of persentage time pH less than 4 in total periods or positive symptom index was seen in 3 patients(16%), Positive results in either of two tests were seen in 7 patients(37%). Conclusion We suggest that some patients who complain the chronic laryngeal symptoms in Korean may have abnormal esophageal motility or gastroesophageal reflux.

경막외로 전이된 원발성 간암

정규원(Kyu Won Chung),선희식(Hee Sik Sun),심상인(Sang In Shim),강창석(Chang Suck Kang),박수헌(Soo Heon Park),한혁준(Hyeok Jun Han),노대근(Dae Keun Lo),박진노(Jin No Park),방춘상(Chun Sang Bang),최명규(Myong Gyu Choi) 대한소화기학회 1997 대한소화기학회지 Vol.30 No.1

Hepatocellular carcinoma is one of the most common malignancies reported in ost of the Africa and South-east Asia. As hepatocellular carcinoma metastases well to distant site, half of the cases metastases to distant site at diagnosis. Hepatocellular carcinoma usually spread to regional lymph nodes around porta hepatis via lyphatics and venous metastasis can occur via intrahepatic vein. The usual sites of extrahepatic metastasis are lung, local lymph nodes, adrenal glands and bones, but epidural metastasis is very rare. Although the prognosis of the hepatocellular carcinoma was very poor in the past, the survival time seemed to be prolonged by early diagnosis and improvement of medical therapy. Therefore the importance of metastatic lesion of the hepatocellular carcinoma might be reemphasized. Recently we experienced a case of the hepatocellular carcinoma who developed paraplegia suddenly. MRI revealed ovoid epidural rnass at 6th and 7th dorsal vertebra level posteriorly. After emergency operation, the resected mass was confirmed metaststic hepatocellular carcinoma. (Korean J Gastroenterol 1997;30:119-125)

항 Ro/SS-A 항체 : 전신성 홍반성 루푸스환자에서의 임상적 의의와 그 주된 항원 결정인자 Its Clinical Significance and Major Antigenic Determinant in Patients with Systemic Lupus Erythematosus

민도준,노대근,민준기,홍연식,이상헌,박성환,조철수,김호연 大韓免疫學會 1996 大韓免疫學會誌 Vol.18 No.3

Objectives: Anti-Ro antibody is one of the prominent anti-nuclear antibodies in patients with systemic lupus erythematosus(SLE). This study was designed to determine whether this antibody reacts with certain antigenic determinants and to evaluate the frequency and clinical associations of anti-Ro antibody in patients with SLE. Method: Double immunodiffusion(DID) were used to detect anti-Ro antibody with sera from 151 patients with SLE. Western .blot analysis was done in 57 patients who were positive for anti-Ro antibody in DID to find out the major antigenic determinant of Ro antigen. We evaluated the presence of anti-Ro antibody and associations with clinical features in SLE. Result: 1) Anti-Ro by DID were positive in 56% (84 of 151 cases) of patients with SLE. 2) Photosensitivity(59% versus 27%, P=0.0001), cutaneous lesion of all types (80% versus 58%, P=0.004), malar rash (67% versus 49%, P=0.025), leukopenia (38% versus 22%, P=0.036) were closely associated with anti-Ro positivity. But there was no significant difference between anti-Ro positive and negative patients in other clinical findings such as sicca complex, thrombocytopenia and nephritis 3) In Western blot analysis, 38 of 57 Ro positive sera had antibodies to the 60-kD and the 52-kD peptide, 8 cases of them revealed antibody to the 60-kD peptide without concomitant antibody to the 52-kD, and only one had isolated presence of antibody to 52-kD peptide. Ten of immunodiffusion defined anti-Ro sera were not reactive with the Ro proteins by Western blot analysis. Conclusions: In patients with SLE, the presence of anti-Ro antibody is closely associated with photosensitive cutaneous lesion and leukopenia, and the major antigenic determinant of anti-Ro sera in SLE is 60-kD peptide.

인두로 전이된 식도암 1예

박수헌,정규원,최명규,선희식,박두호,노대근,방춘상 대한소화기내시경학회 1996 Clinical Endoscopy Vol.16 No.1

Generally, esophageal cancer metaetasizes to lymph node, lung, liver but metastasis to another digestive organ is very rare. A 51 year old man who had experienced dysphagia for 1 month was diagnosed as an esophageal cancer. After combined radiation therapy and chematherapy(5-FU, cisplatinum), he still had dysphagia. After implanta tion of self-expandable metallic esophageal stent, he could swallow solid food. Recently, he experienced pharyngeal pain for 1 month. Endoscopy showed multiple nodules in right pyriform sinus. Biopsy specimen revealed squamous cell carcinoma. Because the distance between esophageal cancer and pharyngeal nodule is more than 10 cm and computed tomography of the neck shows normal esophageal wall no cervical lymphadenopathy, we concluded that this case was an esophageal cancer with metastasis to the pharynx. Hence, we reported a case of esophageal cancer with pharyngeal metastasis with a review of literatures.