주요우울장애와 병발한 중증 당뇨병성 위마비 1예

구상건,박무인,김철수 대한내과학회 2011 대한내과학회 추계학술대회 Vol.2011 No.-

주요우울장애와 병발한 중증 당뇨병성 위마비 1예

구상건,박무인,김철수 대한내과학회 2011 대한내과학회 추계학술대회 Vol.2011 No.1

당뇨병성 위마비는 당뇨에 이환된 기간이 길고, 다른 당뇨병성 합병증이 발생한 환자에서 흔히 조기 포만감, 상 복부 통증, 오심 및 구토, 식욕 저하를 호소하며 내원하는 질환이다. 보통 위배출 검사의 지연 정도에 따라 중증도를 구분하며, 4시간 이후 위 저류 정도가 35% 이상인 경우 중증으로 판정하게 되는데 최근 저자 등은 반감기(T1/2)가 추산값 371분으로 위의 운동성이 현저하게 떨어진 중증의 환자를 경험하였으며, 환자의 기저에 주요우울장애가 병발되어있어 그 치료에 어려움을 겪었던 바 이에 보고하고자 한다. 10년 전 당뇨로 진단받고 인슐린과 경구제제로 혈당 조절을 하던 42세 여자환자가 3개월 전부터 지속된 상 복부 통증을 동반한 메스꺼움, 반복되는 심한 구토 증세를 호소하며 본원 응급실로 방문하였다. 환자 내원 2년 전 부터 발생한 유사 증상으로 인근 의원에서 지지적 치료 시행하였으나 호전과 악화를 반복하며 차도가 없어 본원을 방문하였다. 환자는 안과 협진하 이루어진 안저검사 상에서 당뇨성 막막병증 소견이 관찰되었으며, 신경과 협진 하에서 당뇨성 신경병증이 동반되었음을 확인하였다. 상부 위장관 내시경 상에서 LA classification B의 역류성 식도염소견 관찰되었고 기질적 폐쇄를 의심할만한 병변은 없었다. 위 배출 검사에서 반감기가 추산치 371분으로, 심한 위 배출 지연 소견이 관찰되었다. 환자 내원 이후 경정맥 영양 공급과 함께 인슐린을 이용한 혈당 조절, Metoclopramide, Domperidone, Mosapride 등의 위운동조절제, PPI 등을 처방하여 부분적 호전관찰 되었으나 환자 의식적으로 목구멍을 자극하여 구토하는 등의 양상 관찰되었다. 신경정신과 협진 하에 주요우울삽화로 진단 하에 항우울제를 병용 처방하였으며, 중증의 구역, 구토에 대하여 5-HT3-receptor antagonist patch를 처방한 이후 유의한 증상 호전이 관찰되었다.

제3형 자가면역성 다선 증후군 1 예

구상건,최영식,김부경,박요한,김근태,이준섭 고신대학교(의대) 고신대학교 의과대학 학술지 2013 고신대학교 의과대학 학술지 Vol.28 No.2

The autoimmune polyglandular syndromes (APS) are groups of syndromes comprising a combination of endocrine and nonendocrine autoimmune diseases. Among of those four types of APS, the main characteristics of the 3 APS are autoimmune thyroid diseases associated to other autoimmune diseases, excluding Addison's disease. Type 3 APS are also subdivided into 3A, 3B, 3C, and 3D. Recently, we experience a case of APS manifesting 3A, 3C, and 3D subtype. A 28-year-old woman developed type I diabetes. According to her medical history, she had Graves' disease, vitiligo, auimmune hemolytic anemia and systemic lupus erythematosus (SLE). The antoantibodies associated with Graves' disease, SLE, and type I diabetes showed positive findings. We report this case with literatures review.

A Case of Endobronchial Actinomycosis with a Broncholith cured by Cryotherapy through a Flexible Bronchoscope

유진석,조은주,구상건,권혜정,임성경,장태원,옥철호 고신대학교(의대) 고신대학교 의과대학 학술지 2013 고신대학교 의과대학 학술지 Vol.28 No.2

We report the case of a 53-year-old man who presented with obstructive pneumonitis and broncholithiasis. We attempted to remove the broncholith with forceps through a flexible endoscope, but the potential for bleeding due to partial synechia did not allow this. We succeeded in removing it with cryotherapy. The histopathological diagnosis was thoracic actinomycosis associated with broncholithiasis. Endobronchial actinomycosis with a broncholith is very rare. We successfully treated a patient with endobronchial actinomycosis with a broncholith by administering short-term antibiotics after broncholithectomy via cryotherapy through a flexible bronchoscope.

여포성 종양에서 CXC Chemokine Receptor 4와 Galectin-3의 면역조직화학적 발현

박지은,김부경,구상건,박요한,최영식,김영옥 대한갑상선학회 2012 International Journal of Thyroidology Vol.5 No.1

Background and Objectives: Follicular tumors can present a difficult diagnostic challenge for cytological evaluation and ultrasound findings. Therefore, new methods which could help distinguish follicular adenoma from follicular carcinoma simply and accurately are greatly desired. This study investigated the usefulness of immnunohistochemical expression of CXC chemokine receptor 4 (CXCR4) and galectin-3 as marker of differentiated thyroid carcinomas. Materials and Methods: Expression of CXCR4 and galectin-3 were examined immunohistochemically in the 60 paraffin embedded tissues which were already diagnosed as follicular adenoma (n=20), follicullar carcinoma (n=20), and papillary carcinoma (n=20) of thyroid. Results: Galatin-3 was expressed significantly high in follicular carcinoma than follicular adenoma (p=0.022). CXCR4 was also expressed significantly high in follicular carcinoma than follicular adenoma (p=0.027). The sensitivity of CXCR4 and galectin-3 was 70% and 80% and specificity, 65% and 60% for differential diagnosis of follicular tumors. Conclusion: An immunohistochemical panel, including galatin-3 and CXCR4, could be useful in the differential diagnosis between follicular adenoma from follicular carcinoma.

주기성 구토 양상을 보인 당뇨병성 위마비

남용진,김성은,박무인,박선자,문원,김재현,정경원,구상건 대한상부위장관ㆍ헬리코박터학회 2017 Korean Journal of Helicobacter Upper Gastrointesti Vol.17 No.3

Gastroparesis is a syndrome characterized by delayed gastric emptying in the absence of mechanical obstruction of the stomach. Approximately 20∼40% of patients with a long course of diabetes mellitus and/or other complications, especially neurologic dysfunction, develop diabetic gastroparesis. Diabetic gastroparesis has been thoroughly investigated; however, few reports have considered an associated episodic cyclic vomiting pattern. We present a literature review and report the case of our recent experience with a 29-year-old male patient who presented with a cyclic vomiting pattern associated with diabetic gastroparesis.

초음파 기관지 내시경으로 진단한 기관기관지 골연골형성증 1예

이천우,옥철호,정만홍,장태원,임성경,조은주,이신준,이혜원,구상건,천봉권 고신대학교 의과대학 2011 고신대학교 의과대학 학술지 Vol.26 No.2

Tracheobronchopathia osteochondroplastica (TO) is a rare benign disease of unknown etiology characterized by accumulation of calcium phosphate in the submucosa of large airways and benign proliferation of bone and cartilage resulting in nodular formation. We report a case of tracheobronchopathia osteochondroplastica diagnosed by Endobronchial ultrasonography in a 56-year-old man. Chest Computed Tomography revealed thickening of tracheal and bronchial wall, and multiple nodules through whole trachea. Endobronchial ultrasonography showed numerous submucosal nodules with hetero-echogenecity in the third and fourth layers. Histopathological examination revealed nonspecific bronchitis with squamous metaplasia and metaplastic ossification. We confirmed tracheobronchopathia osteochondroplastica. The patient's symptoms were successfully treated with antibiotics and oxygen supplyment. endobronchial ultrasonography can helpful diagnosis in tracheobronchopathia osteochondroplastica.

위장관 ; 절제 불가능한 Stage IV 진행성 식도암의 치료방법에 따른 효과 비교

이규진 ( Gyu Jin Lee ),박무인 ( Moo In Park ),구상건 ( Sangeon Gwoo ),정현주 ( Hyun Joo Jung ),김주훈 ( Joo Hoon Kim ),박선자 ( Seun Ja Park ),문원 ( Won Moon ),김형훈 ( Hyung Hun Kim ),김양수 ( Yang Soo Kim ),박성달 ( Sung Dal P 대한소화기학회 2012 대한소화기학회지 Vol.59 No.4

Background/Aims: The aim of this study was to compare palliative treatments such as chemotherapy, chemoradiotherapy or radiotherapy with best supportive care in patients with inoperable advanced esophageal cancer. Methods: A total of 67 patients with inoperable advanced esophageal cancer visiting Kosin University Gospel Hospital between January 2000 and July 2010 were included in a retrospective analysis. Patients were categorized as having palliative treatment or best supportive care to compare their prognosis. Results: The median survival was 6.4 months in 67 patients. There was significant difference in median survival between the palliative and best supportive treatment (9.8 months vs. 4.5 months, p=0.01). The patients who underwent palliative treatment had superior 1-year and 3-year overall survival rate than those with best supportive treatment (27%, 10% vs. 5%, 5%, respectively). The 1-year and 3-year overall survival rate of palliative treatment was 18% (1-year overall survival rate) in chemotherapy, 33% (1-year overall survival rate) in radiotherapy, 45% and 9% in concurrent chemoradiotherapy, and 20% and 20% in sequential chemoradiotherapy, respectively. Conclusions: These results may suggest that palliative treatments are more effective than best supportive care. Further prospective studies are still needed to elucidate beneficial effect of palliative treatments on inoperable advanced esophageal cancer. (Korean J Gastroenterol 2012;59:282-288)