기관지내 전이암

김현수,이상수,오미희,이재갑,원구태,홍희승,용석중,신계철 대한내과학회 1991 대한내과학회지 Vol.40 No.4

The lung is the most common site of metastasis of extrapulmonary malignant tumor. According to past reports, metastatic cancer of the lung has been found in about 2% of all patients at autopsy. But these days, a diagnosis of endobronchial metastatic cancer utilizing bronchoscopy only is not easy. Thus we need other means of gathering more informaction, such as past history, discovery of other metastatic sites, and pathologic findings with special staining and electronmicroscope, especially in cases of poorly differentiated adenocarcinoma and epidermoid cancer, which are common types of primary lung cancer. We present 5 cases of endobronchial metastatic cancer. We found endobronchial metastatic cancer 2 cases of cervix cancer (epidermoid, adenocarcinoma), 1 case of colon cancer (adenocarcinoma), hypernephroma (renal cell carcinoma), and bladder cancer (transitional cell carcinoma). Since it was impossiole to diagnose the metastatic adenocarcinoma from the cervix only with lightmicroscopic findings, we could use past history and unusual radiologic and bronchoscopic findings which was thought to be the specific endoscopic finding of metastic endobronchial cancer. The interval between the diagnosis of the primary cancer and endobronchial metastatic cancer was 25.7 months. In the future, development of immunohistochemistry, monoclonal antibody, and molecular biologic techniques will give us diagnostic clue for differential diagnosis of metastatic endobronchial cancer from primary bronchogenic lung cancer.

한국산 날치과(Beloniformes , Exocoetidae)어류 5 종의 분류학적 재검토

김종만,김진구,유정화,조선형,명정구,강충배,김용억 한국어류학회 2001 韓國魚類學會誌 Vol.13 No.2

Taxonomic review of the five flyingfishes, Parexocoetus mento (Valenciennes), Cheilopogon agoo (Temminck et Schlegel), Cheilopogon heterurus doederleini (Steindachner), Cheilopogon cyanopterus (Valenciennes), Hirundichthys oxycephalus (Bleeker) were carried out based on samples collected from the South sea and around sea of Jeju Island of Korea from 1996 to 1998. Parexocoetus mento (Valenciennes) and Cheilopogon cyanopterus (Valenciennes) were revealed as the unrecorded species in Korea, which were named as "Men-to-hwang-nal-chi" and "Ki-geom-nal-chi" respectively. Parexocoetus mento is differed from P. barchypterus in having no chin barbels in juveniles, and Cheilopogon cyanopterus is distinguished from C. agoo in the branched form of pectoral fin rays and from C. heterurus doederleini in the numbers of the dorsal fin ray and the color of pectoral fins.

가성 장폐쇄로 발현한 부신경절종 1 예

김용태,이기업,박건춘,송영기,이문호,유은실,이준호,진태선 대한내과학회 1991 대한내과학회지 Vol.40 No.5

Phenochromocytoma is a catecholamine-secreting tumor, most of which grow at the adrenal gland. About 109p Of pheochromocytomas are detected at the extra-adrenal chromaffine tissues and are called paraganglioma. The main symptoms of pheochromacytoma include hypertension, headache, palpitation, and sweating. Gastrointestinal symptoms such as abdominal pain, constipation, and vomiting are found in 20∼40% of patients with pheochromocytoma, but these are usually overlooked because of the severe, prominant cardiovascular symptoms. Intestinal pseudo-obstruction without hypertension in pheochromocytoma is very rarely found. It is caused by the decreased motility of the intestine and the over-contraction of the intestinal sphincter, which are caused by the unbalanced activation of α-and β-adrenal receptors. It can be hypothesized that catecholamine receptors in the cardiovascular system are down-regulated or desensitized, but those in the intestine remain intact. We report herein a case of pheochromocytoma in which intestinal pseudo-obstruction was the main presenting clinical manifestation. Symptoms of intestinal pseudo-obstruction were completely relieved by administration of phenoxybenzamine, an α-receptor blocker, and excisional surgery.

중등도 및 중증고혈압에서 Nifedipine 설하투여의 강압효과에 관한 연구

김영훈,서순규,최인석,김열홍,안희권,심완주,노영무 대한내과학회 1986 대한내과학회지 Vol.31 No.5

In order to assess the efficacy of sublingual nifedipine in the acute treatment of moderate to severe hypertension, a single blind test was done in 30 patients, 10 males and 20 females, aged 40 to 76 years, with moderate to severe hypertension. The patients with mean sitting blood pressure(BP) of more than J40 mmHg received sublingual placebo, and BP and pulse rate(PR) were measured in sitting position 10,20 and 30 minutes after the sublingual placebo was given. The patients with post-placebo 30 minutes sitting mean BP of less than 13pmmHg were excluded from the study. The placebo treatment period was followed by the administration of 10mg of sublingual nifedipine, and BP and PR were measured 10,20,30 and 45 minutes after nifedipine was given. BP decreased with placebo treatment(p$lt;0. 01 by paired t-test, preplacebo vs. post-placebo 30 minutes). With sublingual nifedipine BP started to fall in 10 minutes and reached the lowest levels in 30 or 45 minu1es. The systolic BP decreased from 198.0±21.4mmHg to 159±20.4mmHg, diastolic BP from 122.5±13.0 mmHg to 103.2±14.4 mmHg and mean from 147.7±13.4 mmHg to 121.7±14.8 mmHg 45minutes after nifedipine(p$lt;0.01 by paired t-test). The average fall in systolic BP/diastolic BP/mean BP 45 minutes after nifedipine was 39/19/26 mmHg(p$lt;0. 001, by paired t-test). The maximal fall in systolic BP correlated better with pretreatment value(r=0.42) than the maximal fall in diastolic pressure(r=0.21), PR increased from 79±12 to 87±11/minute with nifedipine(p$lt;0.001, by paired t-test). Side effects were mild facial flushing(16.7%) and palpitation (3.3%). The findings suggest that a dose of 10mg of sublingual nifedipine is a simple, effective and safe method for the acute treatment of moderate to severe hypertension and can be used as a non-injecting alternative agent for the treatment of hypertensive emergency.

사료의 pH 및 단백질 수준이 자돈의 성장 및 영양소 소화율에 미치는 영향

김지훈,한인규,김진동,조원탁,현충남,이지훈 한국영양사료학회 1999 韓國營養飼料學會誌 Vol.23 No.4

자돈사료내 pH와 단백질 수준의 효과를 알아보기 위하여 2개의 시험을 수행하였다. 시험 1에서는 pH 수준이 자돈의 성장과 영양소 소화율에 미치는 영향을 총 150두의 자돈(L×D×LW ; 8.82㎏ BW 30 ± 2일령)을 이용하여 1) pH 4.7, 2) pH 5.2, 3) pH 5.7 (basal diet), 4) pH 6.2, 5) pH 6.7의 다섯처리를 두었고, 시험 2에서는 pH와 단백질 수준의 효과를 알아보기 위하여 150두의 자돈을 (L×D×LW ; 5.46㎏ BW) 2×3 요인법으로 배치하였다. (조단백질 = 21.5, 24.5%, 사료 pH = 4.5, 5.5, 6.5). 또한 소화율의 측정을 위하여 시험 1에는 25두, 시험 2에는 24두의 자돈에 T-cannular를 설치하였다. 시험 1에서 pH는 자돈의 성장에 아무런 영향이 없는 것으로 나타났다. 낮은 pH사료를 급이한 구에서 사료효율이 약간 좋은 경향이 있었으나, 유의적인 차이는 발견되지 않았다. 회장 및 분소화율도 처리에 의한 효과가 발견되지 않았다. 시험 2에서는 낮은 pH 사료를 급이한 구에서 성장 및 사료효율이 개선되는 경향이 있었다 (P = 0.16). 사료효율은 단백질 수준에 의한 영향이 있었으며 (P<0.05), pH와 단백질 수준간의 상호작용이나 다른 효과는 발견되지 않았다. 회장 소화율도 단백질 수준에 의한 영향은 있었으나, pH의 효과는 methionine의 소화율에만 영향이 있는 것으로 나타났다. 전체적으로 소화율은 pH에 의한 일정한 경향이 발견되지 않았다. 본 시험의 결과는 사료의 pH 조절효과는 자돈의 나이나 사료의 종류에 따라 영향을 받는다는 것을 암시하며, 일반적으로 통용되고 있는 자돈사료는 특별한 산성화 처리가 필요하지 않은 것으로 나타났다. Two experiments were conducted to investigate the effect of diet pH and protein levels on the growth performance and nutrients digestibility in young piglets. In Exp. 1, a total of 150 piglets (Landrace × Duroc × Large White ; 8.82㎏ B W, 30 ± 2 days of age) were allotted into 5 treatments. Treatments were 1) pH 4.7, 2) pH 5.2, 3) pH 5.7 (basal diet), 4) pH 6.2 and 5) pH 6.7. In Exp. 2, the effect of dietary protein and diet pH levels on the growth performance and nutrient digestibility was examined with 150 crossbreds Landrace × Duroc × Large White ; 5.46㎏ BW) piglets in 2 × 3 factorial arrangement. (21.5 and 24.5% CP and diet pH (4.5, 5.5 and 6.5)). Each treatment has 5 replications, 5 heads per replicate. For the digestibility determination, 25 pigs for Exp 1. and 24 pigs for Exp. 2. were fitted with simple T-cannula and individually fed the experimental diet. In Exp. 1, no significant difference was found in any of the criteria measured. Pigs fed low pH diets showed slightly better feed efficiency, but the difference was not significant. Both ileal and fecal nutrient digestibility were not different. A small difference was found in major amino acids digestibility, but there was no constant trend detected. In Exp. 2, pigs fed low pH diet showed a trend (P = 0.16) to grow faster than those fed high pH diet. Feed efficiency was affected by protein level (P<0.05). No other main effect was detected. Protein level affected the ileal digestibility of energy, dry matter, crude fat, methionine and threonine. The effect of pH was found only in methionine digestibility. No other main effect was found in ileal digestibility. It appeared that age of pigs and type of diet could greatly influence the effect of diet pH manipulation. Acidification of commercially available diets might have minimal effect when diet contained high portion of high quality feed ingredients.

소장내용물의 위내역류 및 위내용물 배출시간에 관한 연구

김진호,박승철,이형호,안일민,박영태,김열흥,이창흥 대한내과학회 1986 대한내과학회지 Vol.30 No.2

Radionuclide enterogastric scintigraphy was done with (99m)Tc-DISIDA and (111)In-DTPA in 35cases; control group 5, gastric ulcer group 6, subtotal gastrectomy with Billroth g group 5, and functional gastrointestinal disorder group with or without grossly mixed bile in the gastric juice 19 cases. The results were: 1) Enterogastric reflux was very significantly increased in the subtotal gastrectomy with Billroth II group (p$lt;0, 001), 2) Gastric emptying was significantly delayed in the functional gastrointestinal disorder groups with or without grossly mixed bile (p$lt;0.05, p$lt;0. 001). 3) Enterogastric reflux was not significantly increased in the gastric ulcer group. 4) Enterogastric reflux was not significantly different between the functional gastrointestinal groups with or without grossly mixed bile in the gastric juice. 5) Inverse correlation between the gastric emptying indices and the enterogastric reflux indices was not proved (r=-0.37).

가토에서 CCNU 로 유발된 골수 저형성증의 혈액학적 소견과 골수스캔의 변화에 관한 연구

김승택,이명철,최두혁,고창순,김병국,이문호,박선양,최성재,김노경,최영희 대한내과학회 1986 대한내과학회지 Vol.30 No.1

To understand systematically the hematological changes including the bone marrow changes in chemotherapeutic agent-induced bone marrow hypoplasia and to define the relationship between hematological and bone marrow scan findings and prognosis of the hypoplasia, CCNU (lomustine) was given orally to 44 rabbits to induce hypoplasia of the bone marrow. And serial changes of peripheral blood and bone marrow findings and (111)In Cl(3)((111)In scan)/(99m)Tc tin colloid bone marrow scan((99m)Tc scan) were checked before and after induction of hypoplasia. With assessment of 28 evaluable rabbits, the following results were obtained: 1) Significant hypoplasia of the bone marrow developed around day 4 of CCNU administration and recovered around day 14(cellularity 51,4±13.5% and 24. 5±14.97o before and after CCNU respectively, p<005). Megakaryocyte count was significantly depressed from 95.67,26% to 36.7$gt;31.82%(P$lt;0.005). M: E ratio was decreased from 162±1.19 to 0, 0.5$lt;0. 43(p±0.005). Shift to left(475), maturation a(40%), naked nucleus and degenerated cells(20%), increase of lymphocytes(47%), monocytes and reticulum cells were also found. 2) The uptake ratio of the 99(m)Tc tin colloid bone marrow scan was markedly increased in contrast to the depression of the bone marrow(4.4±2.12 and 14.1±7.06 before and 4 days after CCNU, respectively, p40. 005). Tc scan uptake ratio was inversely related to the cellularity(r=-0.442, p$lt;0.05) and megakaryocyte number of the bone marrow(r= 0.89, p< 0.01) and peripheral blood granulocyte (r = 0. 54. Pg0.01) and platelet count(r=0.40, p$lt;0.05). There was not significant correlation between (111)In scan uptake ratio and hematologic parameters. 3) The amplitude of the change of the (99m)Tc scan uptake ratio was significantly related to the prognosis of the rabbits with experimentally induced hypoplasia of the bone marrow(dead 5.1±2,67, survivors 2,5±0.96, P<0.01). The change of the (111)In scan uptake ratio was not related to the prognosis of these rabbits. In experimentally induced rrow hypoplasia, morphologic changes in addition to the numerical changes of the bone marrow elements were observed. And serial (99)Tc scan of the bone marrow appears to be helpful assessing the severity and predicting the outcome of bone marrow hypoplasia.

보행마취(步行麻醉)

김영석,김완식,황호성,이진근,유희구,김흥대 대한마취과학회 1977 Korean Journal of Anesthesiology Vol.10 No.2

An imaginative innovation to shorten hospital stays as a means to reduce patient charges, is out-patient surgery. This procedure also minimized the inconvenience and disruption of the family unit, reduced the opportunities for cross-infection, and freed hospifal beds for the more serriously ill patienta Since the concept of out-patient surgical service was organized, managed, and performed in the Hanyang Medieal Center, we had experience of 132 ambulatory anesthetics during the last two years (from Jan. 1974. to Dec. 1975 ). The results are summarized as follower 1. Preanesthetic examination should be routinely cheeked with Hb., Hct., urinalysis and chest x-ray. 2. Premedication should be administered preanesthetically, atropine sulfate intravenously. 3. ASA class 1 patients should be rhnsen fnr short (less than 1 hour) procedures. 4. Anesthesia is induced with Epontol+S.C.C. and maintained with Halothane+N2O+O2. 5. We suggest that ambulatory anesthesia should be more carefully planned, organized, and managed.

운동후 측복통과 함께 발생한 급성 신부전 1 예

김종순,박영주,조종태,이정임,신민호,구천희,박태용,한승수,강진화 대한내과학회 1996 대한내과학회지 Vol.50 No.6

We report a case of acute renal failure with severe loin pain and patchy renal vasoconstriction after exercise. An immediate postcontrast computed tomogram of this case shows multiple patchy areas of poor contrast enhancement in the cortex of the both kidneys. A 24-hours delayed scan without further injection of contrast dye shows multiple wedge-shaped contrast enhancement in the coincident areas of poor enhancement in the immediate scan. The 2 and 5 days delayed scans show that wedge-shaped contrast enhancement becomes disappeared gradually to the renal cortex, and the 8 days delayed scan shows complete disappearance of contrast enhancement. The renal scintigrams with technetium-99m-methylene diphosphonate and dimercaptosuccinic acid show diffuse increased uptakes and multiple patchy photon deficient areas in the both kidneys respectively. The follow-up renal scintigrams show nearly normal findings, This patient had an uneventful hospital course and recovered completely without dialysis.

늑막조직생검으로 진단한 Pleural Paragonimiasis 1 예

김기영,이승환,박진현,이재갑,용석중,신계철,홍욱균,김향인,진춘조 대한내과학회 1991 대한내과학회지 Vol.40 No.5

We report a 28-year old female patient with pleural paragonimiasis who did not have the usual diagnostic triad for this parasitic disease. She did not have chronic hemoptysis, there were no pulmonary infiltrations, and stool, sputum and pleural fluid examinations did not yield paragonimus ova. The diagnosis was made on the basis of ova found in the pleural biopsy. Paragonimus pleural effusion was resolved with frequent thoracentesis and oral praziquantel therapy.