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울산 , 울주지역에 발생한 쯔쯔가무시병 27 예에 대한 임상적 고찰
박후근(Hoo Keun Park),정세주(Sae Joo Jung),이승표(Seung Pyo Lee),진성호(Sung Ho Jin),이관호(Kwan Ho Lee),박동철(Dong Chul Park),조준탁(Jun Tac Cho),이진관(Jin Kwan Lee),홍영애(Young Ae Hong) 대한내과학회 1988 대한내과학회지 Vol.35 No.3
N/A Since the first report of clinical tsutsugamushi disease in Chinhae by Lee in 1986, the disease is now known to be a not uncommon infectious disease in many districts of Korea. In 1987, many cases of the disease were found in Ulsan, Ulchu and other locations in this vicinity. 1) In Dong Kang Hospital, 27 patients with tsutsugamushi disease were treated in October and November of 1987. Of 27 patients, 20 were serologically confirmed and the remainder were clinically documented. Another approximately 20 cases, which had been treated in several local clinics in Ulsan city, were discovered during a survey conducted by the Ulsan branch of the Korean Association of Internal Medicine. Thus, we presume that more than 50 cases of tustusgamushi disease might have developed in Ulsan, Ulchu and the surrounding areas in 1987, 2) The age of the 27 patients ranged from 19 to 74 years with the peak incidence occurring in the sixth decade. Of the 27 patients, 14 were male and 13 were female, which indicates that there was no sexual preponderance. Also 16 patients had their residence in Ulsan city, 8 in Ulchu Gun and 3 in Woelsung Gun. 3) Fever with chills(100%), myalgia (89%) and headache (859o) were the most common prominent symptoms and were frequently accompanied by gastrointestinal symptoms such as nausea, vomiting, anorexia. Important physical findings included skin rash (81%), conjunctival injection (56%), eschar (48%), lymphadenopathy (26%) and hepatosplenomegaly (48%). 4) According to laboratory tests, anemia and leukoeytosis were found in 48% and 16% of the patients respectively. Albuminuria was found in 11% of patients, hematuria in 22% and pyruia in 41%, 1ncreased FDP and decreased fibrinogen were seen in 74% and 37% of the patients respectively. 5) The chloramphenicol and tetracycline regimens were very effective in radpidly producing an afebrile state in all patients. However, in spite of chemotherapy a 74 year old patient, who had moderately advanced pulmonary tuberculosis and chronic obstructive lung disease, died due to respiratory failure.
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적혈구 탐식소견을 보인 원발성 형질세포성 백혈병 1 예
박경현,이종명,박동철,이진관,이승표,정세주,홍영애,허충,박후군,조준탁 대한내과학회 1989 대한내과학회지 Vol.37 No.2
Primary plasma cell leukemia (PCL) is a very rare form of plasma cell dyscrasia. Phagocytosis of cellular elements by malignant cells is generally considered to be a feature of monocytic-histiocytic disorders, althogh it has been reported to occur rarely in other forms of neoplasia. The patient was an 18-year old male who presented weadness, fever, nasal bleeding and hepatosplenomegaly of 1.5 months duration. Peripheral blood examination revealed severe anemia, thrombocytopenia and a normal leukocyte count with 32% plasma cells. On serum and urine protein electrophoresis, monoclonal gammopathy was found. The analysis of the abnormal gamma-globulin showed IgA and kappa type on immunoelectrophoresis. A bone marrow smear from the right anterior superior iliac spine disclosed hypercellularity with 66.1% plasma cells (48.7% immature type), Some of the plasma cells showed erythrophagocytosis. The number of other cellular elements in marrow was decreased. A partial remission was obtained through the following treatment with a combination of vincristine, cyclophosphamide, Mephalan and prednisolone, But increased plasma cells in peripheral blood, anemia and development of extramedullary plasmacytoma appeared 6 months later. We thought that this case fulfilled the primary PCL criteria.
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박경현,이은경,박동철,김용림,이진관,허충,박후근,정세주,조준탁,이수기,김규란 대한내과학회 1991 대한내과학회지 Vol.39 No.6
Caroli's disease is a rare congenital disorder characterized by segmental saccular dilatation of the intrahepatic bile ducts, but the mode of it's inheritance is not clarified. It is commonly complicated with cholangitis, cholelithiasis, hepatic abscess, septicemia and is frequently associated with other congenital disorders, such as congenital hepatic fibrosis, choledochal cyst, medullary sponge kidney, etc. Some authors regard this disease as a premalignant condition because of the high incidence (7%) of the bile duct carcinoma. Recently, we experienced a case of Caroli's disease complicated with cholangitis, cholelithiasis, clonorchiasis, cholangiocarcinoma in the dilated intrahepatic duct and adenocarcinoma in the common hepatic duct. Diagnosis was made by abdominal ultrasonography, percutaneous transhepatic cholangiography, abdominal computed tomography and intraoperative wedge biopsy of the liver. Roux-en-Y hepaticojejunostomy after segmental resection of the common hepatic duct and cholecystectomy was performd. Our report describes Caroli's disease associated with bile duct carcinoma and reviews the literature on the disorder.
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