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고동희,김종혁,이진,최호순 대한췌담도학회 2013 대한췌담도학회지 Vol.18 No.2
급성 췌장염의 진단에 대해서는 최근 생화학 검사의 발 달과 영상의학의 발달로 조금씩 변화하고 있다. 일반적으 로 인정받는 기준은 1)상복부의 급성 복통과 압통, 2)혈액 췌장 효소 수치의 상승(아밀라아제 그리고/또는 리파아제 ≥ 정상상한치의 3배), 3)복부 초음파나 복부 CT, 복부 MRI에서 급성 췌장염의 소견 위의 세가지 중에 2가지 이 상이면서 다른 췌장 질환이나 급성 복통을 질환을 감별된 다면 급성 췌장염으로 진단 할 수 있다. 급성 췌장염을 진 단하는데 있어 현재 많이 사용되고 있는 생화학적 검사는 혈청 아밀라아제이지만, 혈청 리파아제검사가 혈청 아밀라 아제검사보다 특이도와 민감도가 높아 더 급성췌장염의 진 단에 유용하다. 복부 CT는 급성 췌장염을 확진 하는데 있 어 가장 좋은 검사로 다른 복부 질환들을 감별할 수 있고, 췌장염의 중증도를 결정하고, 합병증을 확인 할 수 있는 영상 검사이다. 급성 췌장염으로 진단되면 앞으로 치료 계 획의 수립과 재발 방지를 위해 가능한 빨리 원인에 대한 평가를 시작하여야 한다. 일차적으로 환자의 과거력과 가 족력을 확인하고 간기능검사, 칼슘, 중성지방 등의 혈액검 사와 복부 초음파검사를 시행하여야 한다. 담석성 췌장염 이 강력히 의심되는 환자에서 담도염이 있거나, 담도폐쇄 가 지속되는 경우 조기에 ERCP를 시행한다. 경증의 담석 성 췌장염환자에서 증상이 호전되기 시작하면 같은 입원기 간 내에 복강경 담낭절제술을 시행하고, 중증의 췌장염의 경우에는 염증반응이 충분히 해소되고 임상적으로 호전된 후 시행하는 것을 권장한다. There is general acceptance that a diagnosis of acute pancreatitis requires two of the following three features: 1) abdominal pain characteristic of acute pancreatitis, 2) serum amylase and/or lipase ≥3 times the upper limit of normal, and 3) characteristic findings of acute pancreatitis on ultrasonography, CT or MRI. Other pancreatic diseases and acute abdomen have been ruled out are diagnosed. In pancreatic enzymes, serum lipase may be preferable because it is thought to be more sensitive and specific than serum amylase in the diagnosis of acute pancreatitis. Contrast-enhanced CT scan is the best imaging technique to exclude conditions that masquerade as acute pancreatitis, to diagnose the severity of acute pancreatitis, and to identify complications of pancreatitis. After the diagnosis of acute pancreatitis has been made, its etiology should be made clear to decide treatment policy of acute pancreatitis or to prevent the recurrence of pancreatitis. The etiology of acute pancreatitis in an emergency situation should be assessed by clinical history, laboratory tests such as serum liver function tests, measurement of serum calcium and serum triglycerides and ultrasonography. A differentiation of gallstone-induced acute pancreatitis should be given top priority in its etiologic diagnosis because it is related to the decision of treatment policy. Early ERCP should be performed in patients with gallstone pancreatitis if a complication of cholangitis and a prolonged passage disorder of the biliary tract are suspected. Cholecystectomy should be considered after recovery from an attack of gallstone pancreatitis during the same hospital stay. In severe gallstone-induced acute pancreatitis, cholecystectomy should be delayed until there is sufficient resolution of the inflammatory response and clinical recovery.
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고동희,정재면,홍택원,김동욱,전재범,김태환 한양대학교 의과대학 2002 한양의대 학술지 Vol.22 No.2
Myositis ossificans progressiva is rare heritable disorder of connective tissue characterized by congenital malformation of the great toes and by progressive ossification of striated muscle and connective tissue associated with pain and disability. Myositis ossificans progressiva occurs sporadically and is transmitted as a dominant trait with variable expression and complete penetrance. The disease progress from axial to appendicular, cranial to caudal, and proximal to distal sites. We present an 21-year-old man with typical muscle ossification, skeletal malformation and spondylopathy and a review of the pathogenesis, clinical manifestations and treatment options of the rare disease.
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고동희,김세중,안현수 대한비뇨의학회 2004 Investigative and Clinical Urology Vol.45 No.1
Purpose: Spontaneous renal rupture with perirenal hemorrhage is a relatively uncommon, but often diagnostically challenging, condition. Accurate diagnosis requires a combination of clinical information and radiological imaging. The etiology and clinical aspects of spontaneous renal rupture with perirenal hemorrhage were studied. Materials and Methods: Twelve cases(7 women and 5 men, mean age 44.5 years) of spontaneous renal rupture with perirenal hemorrhage in our hospital were retrospectively analyzed for symptoms, imaging studies, etiology, and treatment modalities. Twenty-five cases(15 women and 10 men, mean age 43.4 years) reported in Korea were also reviewed. Results: In our 12 cases, the etiology was neoplasm in 8(6 angiomyolipoma, 1 renal cell carcinoma, and 1 metastatic cancer), renal vascular disease in 3(2 arteriovenous malformation and 1 polyarteritis nodosa), and unidentified in 1. Radiologic studies(computed tomography and/or renal angiography) were done in all cases and 10(83.3%) were accurately diagnosed. Nephrectomy was performed in 5 cases, arterial embolization in 6, and conservative management in 1. In all 37 cases reported in Korea, including our own, neoplasm(26 cases, 70.3%) was the most common cause and angiomyolipoma(18 cases) was the leading cause. Computed tomography was performed in 33 cases, and 26 cases(78.8%) were correctly diagnosed. Nephrectomy was performed in 21 cases(56.8%). Conclusions: The most common cause of spontaneous renal rupture with perirenal hemorrhage is angiomyolipoma. Computed tomography is the method of choice for the evaluation of spontaneous renal rupture with perirenal hemorrhage. (Korean J Urol 2004;45:64-68)
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