북한 보건의료인력개발을 위한 제언

경쾌수,Kyung, Kwae Soo 연세대학교 의과대학 2016 의학교육논단 Vol.18 No.1

The government of South Korea and its medical personnel must make a way by which health professionals who have escaped from the Democratic People's Republic of Korea (DPRK) can play a positive and practical role in unification and south-north medical unification while south-north authority talks on DPRK public health and medicine manpower development are not going smoothly. Medical personnel escaped from the DPRK have to be recruited for the interviewer of the national examination, to improve the accuracy of national examination interviews. For those medical professionals who have escaped from the DPRK with 6 years' medical college education, but failed the interview on the national examination, we propose here a course of 3.6 months for them to have a right to apply the Korean Medical Licensing Examinations (KMLE). We also propose that medical professionals who have escaped from the DPRK who have graduated from a 6-year medical college in the DPRK and who are medical doctors over the fifth grade or with more than 6 years of experience can be qualified as unification medical doctors and be exempted from the KMLE, getting the right to go directly into an internship and residency. They should be permitted to work in manpower development projects for the health professions. They should also be given opportunities such as to become psychiatrists who treat the mental illness of persons escaped from the DPRK and people from North Korea after unification. Medical students in South Korea should earn college credits on the topic of medical unification and not only students, but all South Korean medical personnel, should prepare for north-south medical unification with an open mind. A way for each medical college to participate in DPRK manpower development for the health professions through a memorandum of understanding between the medical colleges of the south and north.

자궁경부암을 동반한 피부근염

경쾌수 ( Kwae Soo Kyung ),송영수 ( Young Soo Song ),한성훈 ( Seong Hun Han ),김정수 ( Jung Su Kim ),이혜경 ( Hye Kyung Lee ),이윤우 ( Yun Woo Lee ) 대한류마티스학회 1995 대한류마티스학회지 Vol.2 No.1

Dermatomyositis is a group of connective tissue disorders characterized by nonsuppurative inflammation of the skeletal muscle and skin lesions. It is associated with malignancy, especially of the stomach, lung, overy and breast. we report a case of dermatomyositis with uterine cervical concer. A 78 year old female patient was admitted because of progressive proximal muscle weakness, skin rashes, and vaginal spotting. She was bedridden because of severe proximal muscle weakness and atrophy, unable to elevate her head, and suffered from dysphagia. Gottron`s patches were found on the knuckles of the hands, scaly erythematous rashes on the extensor surfaces of bilateral elbows, wrists and knees. The serum concentrations of muscle enzymes were elevated, the biopsy of quadriceps muscle showed the features compatable with myositis, and the uterine cervical biopsy revealed squamous cell carcinoma, which was determined to be in stage IIb by pelvic CT. Radiotherapy(total 3240 cGy) was done for the cervical cancer and prednisolone (initially 60mg/day) was given for the dermatomyositis. The muscle power improved only a little although the concentrations of serum muscle enzmes returned to normal. She deceased of aspiration pneumonia 43 days after the admission.

흉막삼출을 동반한 맥관육종

경쾌수 ( Kwae Soo Kyung ),정성광 ( Sung Kwang Jung ),이혜경 ( Hye Kyung Lee ),전우기 ( Woo Ki Jeon ),염호기 ( Ho Kee Yum ),김동순 ( Dong Soon Kim ) 대한결핵 및 호흡기학회 1994 Tuberculosis and Respiratory Diseases Vol.41 No.1

자가면역성 만성 간염

임창영(Chang Young Lim),김대현(Dae Hyun Kim),박상현(Sang Hyun Park),경쾌수(Kwae Soo Kyung),전영빈(Young Bin Jeon),유권(Kwon Yoo),이윤우(Yun Woo Lee) 대한소화기학회 1995 대한소화기학회지 Vol.27 No.6

The autoimrnune chronic hepatitis is a rare cause of chronic liver disease in Korea. A case of autoimmune chronic hepatitis was diagnosed in a 24 year-old female. She was admitted to the hospital due to the pain and swelling of the right parotid gland. Her liver function test had been known to be abnormal also. The liver biopsy was performed for the further evaluation of abnormal liver function. It showed chronic active hepatitis without evidence of viral infection or injury by hepatotoxin. Laborotory test showed hypergammaglobulinemia and autoantibodies. We report this case as a autoimmune chronic hepatitis with literature review. (Korean J Gastroenterol 1995;739 - 743)

수산염(oxalate) 섭취에 의한 급성 신부전 1례

경쾌수,송영수,김현대,남경재,노승현,고행일 인제대학교 1994 仁濟醫學 Vol.15 No.4

수산염에 의한 신장애는 신장에서 수산칼슘 형태의 결정체가 세뇨관에 침착되어 신장애 및 대사성 산증 등을 드물게 일으킨다. 저자들은 우연히 수산염을 성취하여 질소혈증 및 단백뇨를 보여 신조직 검사상 옥살산증을 보인 예를 경험하여 보고한다. Acute renal failure caused by oxalate ingestion is very rare. The authors experienced a case of a 17 year old male patient who ingested oxalate incidently and developed acute renal failure. Crystalline deposition of oxalate within tubule and necrosis of tubular epithelium were seen on kidney biopsy. The insult was recovered uneventfully with conservative managent for renal failure.

경피적 신생검 579례에 대한 고찰

경쾌수,김현대,노승현,고행일 인제대학교 1996 仁濟醫學 Vol.17 No.1

경피적 신생검은 신장 질환의 진단 수단이며 병리조직학적 소견은 치료방침 결정이나 예후 판정에 중요한 지표가 된다. 연구 대상은 1978년 3월부터 1994년 12월까지 16년 9개월간 인제의과대학 서울백병원 내과에서 신질환을 의심하여 입원한 579명이며 모두에서 경피적 신생검을 실시하였다. 시행된 경피적 신생검의 안정성 및 합병증과 신질환의 빈도를 후향적으로 연구하였으며 연구 대상의 남녀비는 1.4:1 이었고 연령별 분포는 15세에서 83세까지로 평균 34세였다. 신조직은 98.9%(540/546)에서 얻었고 병리조직학적 진단이 가능했던 사구체 5개이상인 경우는 81.3%(471/546)이었다. 검색된 사구체 수는 최하 0에서 최고 106개였으며, 그 분포는 5-9개 군이 89례, 10-14개군이 99례, 15-19개군이 90례로 5-19개군이 50.9%이였다. 합병증으로는 심한통증이 2례로 0.3%, 육안적 혈뇨는 7례로 1.2%였으며 이들 중 2례에서 지속적인 심한 혈뇨가 있어 1례에서는 수혈로 조절되었고 1례에서는 결국 신절제술을 시행하였다. 1989년 6월이후 모든 환자에서 실시한 초음파상 10례에서 신주위 혈종이 있었다. 마비성 장폐색, 신장염증, 무뇨증이나 사망의 경우는 없었다. 병리조직학적 소견에서 가장 빈도가 높은 소견은 IgA 신증과 미세 변화 병변으로서 각각 28.0%, 22.1%였다. 원발성 신증후군에서의 조직소견은 미세 변화 병변이 61.6%, 막성 신증이 15.1%, 국소성 분절성 사구체 경화가 15.1%, 막증식성 사구체신염의 7.0% 순이었다. IgA 신증의 병리조직소견은 국소 분절성 사구체 변화가 54.8%, 국소성 사구체 변화가 21.8%, 미만성 메잔지움증식성 사구체 변화의 15.3% 순이었다. 임상적으로 무증상 뇨이상을 보인 161례에서는 IgA 신증이 100례, 작은 사구체이상 소견이 40례 등의 순으로 나타났으며, 낭창성 신염 27례에서 WHO 병리조직 분류는 미만성 증식형 신염이 16례, 막성 사구체신염이 7례, 메잔지움 증식성 신염2례, 국소성 증식성 신염 2례의 순이었다. 신생검한 환자 중 HBsAg을 검사한 총 315례 중 11.7%에서 HBsAg 양성을 보였으며 막증식성 사구체신염의 55%에서 HBsAg양성을 보였다. 신생검은 신질환 및 전신 질환의 신장 침범이 의심되는 환자의 정확한 진단과 치료 방침 및 예후를 아는데 필수적이고 비교적 안전한 진단 수기로 생각되며 이상의 성적으로 보아서 IgA 신증의 병인에 대한 전향적인 연구에 노력을 기울여야 하겠으며 HBsAg 양성과 막증식성 사구체신염의 병인에도 한국적인 특성을 고려한다면 더 많은 연구 노력이 필요할 것으로 생각된다. An analysis of pathologic results and complications on 579 percutaneous renal biopsies, examined during a period of 16 years and 9 months(March, 1978 to December, 1994) at Inje University Seoul Paik Hospital, was carried out in relation to biopsy procedure. Renal tissues were obtained in 98.9% of all the biopsies : these tissues containing glomeruli accounted for 97.3% and were adequate for pathologic diagnosis in 81.3% of the biopsies, and no renal tissues were in 1.1%. The number of glomeruli seen in sections from each piece of renal tissue taken in present series averaged 18.1 glomeruli. Definite symptoms or signs of complications were observed in 3.4% of 579 renal biopsies. 10 patients had perirenal hematoma and 7 patients developed gross hematuria, of which one patient required transfusion and another required nephrectomy, There were no deaths, paralytic ileus, renal infection nor anuria. The proportion of IgA nephropathy and minor glomerular abnormalities was 28.0%, 22.1% respectively. The causes of primary nephrotic syndrome were consisted of minimal change disease 61.6%, membranous glomerulonephropathy 15.1%, focal and segmental glomerulosclerosis 15.1%, and membranoproliferative glomerulonephritis 7.0% in order The histopathologic findings of IgA nephropathy were focal segmental glomerulonephritis 54.8% , focal glomerulonephritis 21.8%, diffuse mesangial proliferative glomerulonephrltis 15.3% and minor glomerular abnormalities 2.4% in order. In the cases of asymptomatic urinary abnormalities, IgA nephropathy was 62.1% by histopatholigical diagnosis. The distribution of WHO classification of 27 cases with lupus nephritis were diffuse proliferative nephritis 59.2%, membranous glomerulonephritls 25.9%, mesangial change 7.4%, and focal segmental proliferative nephritis 6.7%. The frequency of HBs antigenemia was 11.7% of all biopsied patients, which was not different from that in the general population of South Korea. The more than half of patients with membranoproliferative glomerulonephritis have HBs Ag, and 15% of membranous nephropathy showed HBs antigenemia. The percutaneous renal biopsy is relatively safe and accurate method to diagnose renal disease and evaluate renal lesion in patients with primary renal diseases and systemic disease involving the kidney. The more prospective studies on IgA nephropathy and hepatitis B virus associated nephropathy, especially membranoproliferative glomerulonephritis, will be needed in the future because we are living in endemic area.

Angiotensin 변환효소 억제제에 의한 좌심실 질량감소에 대한 연구

김형곤,김현대,최진우,강기혁,경쾌수,유호준,최석구,유원상 인제대학교 1995 仁濟醫學 Vol.16 No.3

고혈압에 의한 좌심실 비대는 환자의 예후와 밀접한 관계가 있으므로 좌심실 질량을 감소시키는 항 고혈압 제제에 대한 관심이 높아지고 있다. 본 저자들은 Angiotensin 변환효소 억제제의 좌심실 질량 감소에 대한 효과와 감압 효과를 평균 17개월 동안 다른 항 고혈압 제제들과 서로 비교 분석하였다. 그 결과 Angiotensin 변환효소 억제제를 사용한 군과 다른 항 고혈압 제제를 사용한 군에 있어 양군 모두에서 좌심실 질량 감소와 감압에 대한 효과는 의미가 있었지만 양군 사이에는 의미있는 차이가 없는 것으로 나타났다. 그러므로 Angiotensin 변환효소 억제제가 다른 항 고혈압 제제보다 좌심실 질량을 감소시키는 효과가 탁월한 지에 대한 것은 더 많은 연구가 필요하겠다. Background : Hypertensin is the major risk factor for cardiovascular disease. The increased left ventricular mass has been recognized as an independent predictor of morbidity and mortality in hypertensive patients. The assessment of the regression of left ventricular(LV)mass after antihypertensive therapy offers prognostic information. 2D echocardiography has proved a sensitive tool for the detection of the change of LV mass. Method : LV mass and LV mass index were measured by Penn's method of 2D echocardiography in 16 hypertensive patients to evaluate the effect of antihypertensive drugs include angiotensin converting enzyme(ACE) inhibitor(group I, n=7) and other hypertensive drugs(groupII, n = 9) on the regression of LV mass. Results : After 17 months treatment, LV mass significantly decreased in group I(342.7+79.29gm vs 287.4+102.6 gm) and group II (315.7+72.4gm vs 271.6+67.2gm). The blood pressure were significantly decreased in group I (160.7+25.9mmhg/101.4+13.5mmHg vs 141.4+15.7mmHg/90.0+6.8mmHg) and group II (181.1+29.3mmHg/108.3+12.7mmHg vs 136.7+11.2mmhg/88.9+7.8mmHg). There was no significant difference between group I and II in LV mass and systolic BP/diastolic BP Conclusion : The results showed that LV mass can be reduced in hypertensive patients who receive antihypertensive drugs. The effect of antihypertensive therapy on LV mass should be considered in treatment of the hypertensive patients who have hypertrophied LV.