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한병근(Byoung Geun Han),최승옥(Seung Ok Choi),김효열(Hyo Youl Kim),강남규(Nam Kyu Kang),류정선(Jeong Seon Ryu),이광훈(Kwang Hoon Lee) 대한내과학회 1996 대한내과학회지 Vol.50 No.3
N/A Objectives : We analyzed the clinical characteristics and complications of poisonous snake bite in Korea. Also we evaluated the causes of acute renal failure associated with poisonous snake bite. Methods: Fifty-eight patients with poisonous snake bite were included in this study. We reviewed and compared the clinical symptoms, physical examinations, and laboratory data of the complications that could be expected, such as rhabdomyolysis, disseminated intravascular coagulopathy and acute renal failure. Results: 1) The epidemiologic feature showed that most of the cases occurred from June to September, and the peak incidence of age was fifties and sixties. The snake distributions we studied were 12 cases(41.4%) of Agkistrdon blomhoffi brevicandus, 10 cases(34.5%) of A. saxatilis and 7 cases(24.1%) of A. caliginosus. 2) The systemic symptoms and signs were various. The most common complaints were nausea and vomiting. Most of the patients complained of localized edema and pain around the snake bite wound. 3) Generally, patients showed a mild clinical course but 2 cases were discharged hopelessly due to its complication accompanying acute renal failure. The complications of poisonous snake bite were rhabdomyolysis (32.7%), disseminated intravascular coagulopathy (29.3%), acute renal failure (8.6%) and hemolysis (1.7%). 4) A caliginosus was found to be the most common cause of the rhabdomyolysis induced by snake bite(p<0.05). Disseminated intravascular coagulopathy was mostly associated with A. blomhoffi brevicandus(p<0.05). 5) We believe that the secondary effects of fluid sequestration into the third space, rhabodmyolysis, disseminated intravascular coagulopathy and hemolysis play significant roles in acute renal failure associated with poisonous snake bite.
국소 분절 사구체 경화증 환자에서 발생한 Nocardia farcinica 뇌 농양 1예
한승태 ( Seung Tae Han ),김영섭 ( Young Sub Kim ),송신한 ( Shin Han Song ),어영 ( Young Uh ),한병근 ( Byoung Geun Han ),최승옥 ( Seung Ok Choi ),양재원 ( Jae Won Yang ) 대한신장학회 2011 Kidney Research and Clinical Practice Vol.30 No.1
Nocardia is an opportunistic pathogen that can cause disseminated disease in serious immunosuppressive patients with organ transplantation, advanced HIV infection, malignancy or long-term corticosteroid use. Cerebral nocardiosis constitutes the most severe form of Nocardial infection. Early detection and treatment of cerebral abscess of Nocardia is important because the mortality is three times higher than that of other bacterial cerebral abscesses. We report a case of N. farcinica brain abscess in a focal segmental glomerulosclerosis (FSGS) patient after steroid treatment.
증례 : 내분비-대사 ; 그레이브스병 환자에서 발생한 막증식성 사구체신염 1예
김보라 ( Bo Ra Kim ),한병근 ( Byoung Geun Han ),이미영 ( Mi Young Lee ),김송이 ( Song Yi Kim ),김재현 ( Jae Hyun Kim ),정춘희 ( Choon Hee Chung ) 대한내과학회 2010 대한내과학회지 Vol.78 No.6
저자들은 그레이브스 병을 진단받은 환자에게서 병발한 막증식성 사구체신염 1예를 경험하였기에 보고하는 바이다. 이와 같이 자가면역 갑상선질환을 진단받은 환자는 갑상선 호르몬 및 자가면역 기전의 연관성으로 인하여 다양한 장기에 영향을 받을 수 있다는 것을 항상 염두에 두어야 하겠다. 특히 단백뇨나 혈뇨가 관찰되었을 때에는 신기능의 감소 유무를 확인하고 추적관찰이 필요하겠으며, 적응증이 될 경우에는 신조직 검사를 시행하여 사구체신염의 유무등 병리학적 소견을 확인하는 것이 환자의 예후를 판정하는 데에 중요할 것으로 사료된다. Patients with autoimmune thyroid disease commonly have accompanying forms of systemic autoimmune disease. Some reports have indicated an association between autoimmune thyroiditis and the glomerulonephropathies. The most commonly reported glomerulonephropathy related to autoimmune thyroiditis is membranous glomerulonephritis, but it has not been reported in a case of membranoproliferative glomerulonephritis. We report the case of a 35-year-old woman who had Graves` disease combined with membranoproliferative glomerulonephritis confirmed by a renal biopsy. (Korean J Med 78:756-760, 2010)
혈액투석 환자에서 혈청 부갑상선 호르몬 농도의 임상적의미
이은영(Eun Young Lee),한병근(Byoung Geun Han),정춘희(Choon Hee Chung),김진수(Jin Soo Kim),최승옥(Seung Ok Choi) 대한내과학회 2000 대한내과학회지 Vol.59 No.4
Background : Secondary hyperparathyroidism is a common complication of chronic renal failure. The only reliable method for distinguishing patients with high turnover from those with low turnover bone disease is bone histomorphometric study, but its clinical utility is restricted. Because of its invasive nature, efforts have been made to predict indirectly the type and severity of this metabolic bone disease by serologic assays. This study was undertaken to evaluate the determinants and clinical significance of intact parathyroid hormone(iPTH) in end-stage renal disease patients on regular hemodialysis. Methods : Ninety-eight patients on regular hemodialysis patients were included in this study. Laboratory data included blood urea nitrogen, serum creatinine, albumin, calcium, phosphate, alkaline phosphatase and iPTH. Serum iPTH was checked by immunoradiometric assay. We also evaluated age, sex and underlying renal diseases.Results : The mean age was 50.3±13.8 years, duration of dialysis 42.7±40.1 months, duration of follow-up 38.3±10.9 months. Thirty patients had an iPTH level more than three times of normal (≥195 pg/mL). Patients with iPTH level of ≥195 pg/mL had longer duration of dialysis, younger age, lower incidence of diabetes, higher serum creatinine, albumin, alkaline phosphatase, lower calcium and arterial HCO3- concentration. In patients with iPTH level of <195 pg/mL, there was significant correlation between serum iPTH and calcium level(r=-0.43, p<0.001), whereas there was no significant correlation in those with iPTH level of ≥195 pg/mL. Conclusion : In patients with iPTH level of ≥195 pg/mL (three times of normal level), normal calcium-parathyroid feedback mechanism are not maintained. Serum iPTH level seems to be affected by nourishment, age, acidosis and the presence of diabetes.(Korean J Med 59:404-412, 2000)
자상후 유발된 지연성 신동맥류 및 신동맥-하대정맥루에 의한 신성 고혈압
최승옥(Seung Ok Choi),한병근(Byoung Geun Han),김진수(Jin Soo Kim),이은영(Eun Young Lee),김재권(Jae Kwon Kim),김영주(Young Ju Kim),구철희(Chul Hoe Koo) 대한신장학회 2000 Kidney Research and Clinical Practice Vol.19 No.1
Renovascular hypertension is the most common cause of curable hypertension. The exact prevalence of renovascular hypertension is not known, and the diagnosis is probably missed in many patients. It is important to recognize this condition in clinical practice, first, because it is a correctable form of secondary hypertension, and second, it is a reversible cause of renal failure in some patients. The Basic lesion of renovascular hypertension is stenosis of the renal artery caused usually by either one of the two most common etiologies, atherosclerosis or fibromuscular dysplasia. Other known causes of renovascular hypertension include aneurysm, embolism, arterio venous fistula, neurofibromatosis, tumor, hematoma, foreign body induced compression, and trauma. Its treatment can be divided into surgical intervention, percutaneous transluminal balloon angioplasty, and medical therapy. Recently, selective embolization has been introduced as a useful alter native therapeutic modality in the management of arterio venous fistula and aneurysm. We report a case of delayed renovascular hyper-tension in stab injury induced renal artery-IVC fistula and its renal artery aneurysm in a 20 year-old man. Embolization of the renal arterio venous fistula was achieved by inserting a detachable balloon, and embolization of the renal aneurysm and lumbar artery pseudoaneurysm was performed using micro-eo-ils. Arteriogram immediately after embolization con- firmed complete occlusion of the ancurysm and closure of the arterio venous fistula. After the procedure, improvement of blood pressure was noted in the patient who is currently being followed-up on an out-patient basis.
간경변증 환자의 비정형 선종성 증식성 결절 ( Atypical Adenomatous Hyperplastic nodule ) 에서 발생한 소 간세포암
권상옥(Sang Ok Kwon),노병선(Byoung Seon Rhoe),장우익(Woo Ick Jang),이동기(Dong Ki Lee),이용규(Yong Gyu Lee),한병근(Byoung Geun Han),심영학(Young Hak Sim),조미연(Mi Yeon Cho) 대한소화기학회 1993 대한소화기학회지 Vol.25 No.4
Adenornatous hyperplasia (AH), defined as a sizable parenchymal nodules that may follow acute or chronic liver injury, has been reported as precursor lesion of hepatocellular carcinoma in the cirrhotic liver. These lesions often coexist with obvious rnalignant foci as small nodule-in-nodule. Morphologically AH can be divided into 'ordinary' and atypical (AAH)' types. The former consisted of hepatocytes similar to those of the surrounding liver. The latter type was composed of hepatocytes showing nuclear, cellular and structural atypia relative to the surrounding liver, and shoved irregular or sparse portal tracts. Cytological and structural pattens are characteristically heterogenous within a nodule. Now AAH are considered to be precancerous lesion evolving to early hepatocellular carcinoma. Authots report one case of hepatocellular carcinoma eithin an atypical adenomatous hyperplastic nodule in 55-years-old male with a review of literatures.
Cisplatin 항암요법 후 발생한 신성 염분소실 증후군 1예
황혜원 ( Hye Won Hwang ),송신한 ( Shin Han Song ),한승태 ( Seung Tae Han ),김재석 ( Jae Seok Kim ),한병근 ( Byoung Geun Han ),최승옥 ( Seung Ok Choi ),양재원 ( Jae Won Yang ) 대한신장학회 2011 Kidney Research and Clinical Practice Vol.30 No.1
Cisplatin is widely used for chemotherapy, but known to cause renal, auditory, hematologic, gastrointestinal, and neurologic toxicities. Hyponatremia after administration of cisplatin is related to renal tubular sodium excretion. A 71-year-old female was referred to our hospital for chemotherapy of laryngeal cancer. On admission, the patient`s laboratory data were normal. The patient received for 3 days chemotherapy without complication, but presented mental confusion on the 4th hospital day. The laboratory findings were as follows; serum sodium was 118 mmol/L, urine sodium 163 mmol/L, serum osmolality 248 mmol/kg, and urine osmolality 594 mmol/kg. On physical exam, volume status was hypovolemic, so we supplied hypertonic and isotonic salines. On the 9th hospital day, she showed normal sodium concentration and clear consciousness. After chemotherapy, we should make differential diagnosis between SIADH (syndrome of inappropriate antidiuretic hormone) and renal salt wasting syndrome according to the physical examination. We report a case of renal salt wasting syndrome with severe mental change after chemotherapy using cisplatin.