하행 대장의 장간막에 발생한 악성 신경초종

김문범(Moon Beom Kim),한상영(Sang Young Han),강도영(Do Young Kang),김선택(Sun Tac Kim),박일(Il Park),배상문(Sang Moon Bae),김재석(Jae Seok Kim),노명환(Myung Hwan Noh),최석렬(Seok Reyol Choi),신우원(Woo Won Shin) 대한소화기학회 1996 대한소화기학회지 Vol.28 No.3

Malignant schwannoma(peripheral nerve sheath tumor) is relatively rare tumor. The extremity, trunk, head and neck are most frequently affected. We experienced a case of malignant schwan- noma in descending mesocolon which is very rare site. The patient was a 45-year-old ma]e who complained of abdominal distension. Abdominal CT scan showed a huge lobulated heterogeneous mass on abdominal and pelvic cavity. Abdominal exploration revealed a yellowish gray, friable, nodular and huge mass infiltrating sma]l bowel, large bowel and peritoneum partially. The tumor was resected with left hemicolectomy and partial resection of peritoneum and small bowel. Both histological and immuno-histochemical stain with S-100 protein revealed that it was a malignant schwannoma. The patient has received two courses of systemic chemotherapy and visited regulary at out-patient department. (Korean J Gastroenterol 1996; 28:439-444)

아토피피부염에서의 피부관리

김문범 ( Moon Bum Kim ),김범준 ( Beom Joon Kim ),서영준 ( Young Joon Seo ),이양원 ( Yang Won Lee ),이애영 ( Ai Young Lee ),김규한 ( Kyu Han Kim ),김명남 ( Myeung Nam Kim ),김진우 ( Jin Woo Kim ),노영석 ( Young Suck Ro ),박영민 ( Y 대한피부과학회 2009 대한피부과학회지 Vol.47 No.5

Background: Interplay of numerous constitutional and precipitating factors are involved in the development of atopic dermatitis (AD). Most of these etiologic factors are not controllable, but barrier dysfunction can be managed. Correction of barrier abnormalities has been accepted as a first-line therapy with effective anti-inflammatory therapy. Objective: We wished to establish standardized skin care guidelines for Korean patients who suffer from atopic dermatitis. Methods: The skin care guidelines were proposed by the Korean Atopic Dermatitis Association (KADA), with a particular emphasis for barrier dysfunction in AD from a review of more than 100 published studies and related documents in the clinical literature by a task force team (TFT) of the KADA. The TFT also evaluated the reliability of the studies based on scientific evidence and the size of the study populations. The TFT disregarded controversial findings and summarized all of the collected studies. Results: Skin care guidelines were proposed by the KADA, particularly for barrier dysfunction in AD. A warm bath for approximately 20 minutes was recommended once daily. Soap can be used two or three times per week and aggressive skin scrubbing should be avoided. A topical moisturizer should be applied at least twice a day. Immediate application of emollient is required after bathing. The donning of clothing made of cotton is recommended. Nails should be cut short to reduce skin damage caused by a skin scratch. Conclusion: Application of moisturizer immediately after appropriate bathing may be the most important treatment for skin care. A topical steroid should be used whenever AD develops. Nail care and proper clothing are also be helpful for the prevention of dermatitis aggravation. Proper ways to bathe, use of moisturizer and topical steroids and nail care and appropriate clothing were considered. (Korean J Dermatol 2009;47(5):531~538)

보습제와 피부장벽

김문범 ( Moon Beom Kim ) 한국피부장벽학회 2009 한국피부장벽학회지 Vol.11 No.1

보습제(補 or 保濕劑, moisturizer)라는 용어는 보습 크림이나 로션을 피부에 바르면 이 제제에 포함된 물 성분이 직접적으로 피부를 촉촉하게 만든다는 오해를 종종 야기한다. 보습제를 건조한 피부에 도포했을 때 기대할 수 있는 효과는 수분 보충과 경표피수분소실(transepidermal water loss, TEWL)의 감소 등인데 이러한 보습제의 작용은 보습제가 밀폐제(occlusives), 습윤제(humectants), 연화제(emollients)의 기능을 가지고 있기 때문이다. 과거 보습제의 개념은 단순한 피부의 수분 보충으로 이해되어 왔으나, 최근에는 단순한 수분보충 보다는 피부의 가장 중요한 기능인 장벽 기능의 회복에 보다 관심이 집중되고 있다. 이상적인 보습제는 이런 기능적인 측면 외에도 미용적으로 우수하고 접촉성 피부염과 여드름의 악화 등과 같은 부작용이 없으며 가격이 적정하고 기능이 오래 지속되는 제제인데, 현재까지 이런 이상적인 보습제에 가장 근접한 것이 생리적 지질혼합물(physiologic lipid mixture)라고 할 수 있다. 특정 질환이 없는 건강인이 보습제를 선택하는 기준은 skin type(dry skin oily skin, normal skin, combination skin), consistency, 향이나 보존제, 자외선 차단제, 특정한 유효성분 등의 첨가 유무 등이다. 하지만, 특정 피부질환의 경우에는 보습제가 치료제의 개념을 내포할 수 있고, 예로 어린선에서는 비정상적인 각질박리 과정을 호전시킬 수 있는 alpha-hydroxy acid(glycolic acid, lactic acid, ammonium lactate)가 포함된 제제가 유용하고 노인성 건조증에는 자연보습인자가 포함된 보습제가 유용하며 아토피피부염의 경우에는 ceramide, unsaturated fatty acid를 전달해주는 보습제가 유용하다. 보습제로 인한 심각한 부작용은 없으나, 다양한 자극반응과 접촉성 피부염이 야기될 수도 있다.

지역사회 거주 노인의 자살경향성 유병률과 위험요인

김문범(Moon Beom Kim),이광헌(Kwang-Hun Lee),이관(Kwan Lee),곽경필(Kyung-Phil Kwak) 대한생물치료정신의학회 2018 생물치료정신의학 Vol.24 No.3

Objectives:The purpose of this study was to investigate the prevalence and risk factors of suicidality among community-dwelling elderly. Methods:The participants were 2,201 elderly people whose ages were over 65. The participants were asked to complete questionnaires, including Mini International Neuropsychiatric Interview(MINI), module C, Short Geriatric Depression Scale of Korean version(SGDS-K), Korean Geriatric Anxiety Inventory(K-GAI), The Korean Health Status Measure for Elderly V 1.0, Korean version of Mini-Mental Status Examination for Dementia Screening(MMSE-DS). Their sociodemographic factors were investigated. The data were analyzed using the chi-square test and the logistic regression test to examine the relationship between suicidality and participants’ risk factors. Results:The prevalence rate of suicidality was 23.3%. In multiple logistic regression, depressive symptoms (OR=3.301, 95% CI : 2.453-4.440), anxiety symptoms(OR=3.289, 95% CI : 2.515-4.303), low physical function (OR=1.606, 95% CI : 1.229-2.098), no spouse(OR=1.571, 95% CI : 1.037-1.690), elderly aged 80 years or older (OR=1.506, 95% CI : 1.094-1.740) were independently associated with suicidality. Conclusion:Suicidality in community-dwelling elderly was quite high, particularly related to depressive symptoms. The results of this study can be useful for development of community-based prevention and management programs for suicidality.

신생검증례에 의한 사구체신질환의 분석

김기현(Ki Hyun Kim),권혁찬(Hyuk Chan Kwon),김문범(Moon Beom Kim),안원석(Won Suk An),감동호(Dong Ho Gam),김상곤(Sang Gon Kim),김성은(Seong Eun Kim),김종성(Jong Seong Kim) 대한내과학회 1995 대한내과학회지 Vol.49 No.5

N/A Objectives: We intended to evaluate the incidence and clinical characteristics of various glomerular diseases (GD) in adults including the patients with asymptomatic urinary abnormalities. Methods: We conducted retrospective study with review of histologic findings and clinical records of the 4% cases diagnosed as GD during 9years since 1985. The diagnoses of all cases were confirmed by renal biopsies. The laboratory studies to differentiate secondary diseases were also performed. Results: 1) There were 382 (78.6%) cases of primary GD and 104 (21.4%) of secondary GD. Among primary GD, IgA nephropathy (IgAN) was the most common as 151 (39.5%) cases followed by 123(32.2%) of minimal change nephrotic syndrome (MCNS), 34 (8.9%) of membrananous glomerulonephritis (MGN), 23 (6.0%) of membranoproliferative GN type I (MPGNI), and 21 of focal glomerulo- sclerosis (FGS) in the order of frequency. 2) In the secondary GD group, HBsAg positive cases were 49 (47.1%), and the rest was 35 (33.7%) of lupus nephritis (LN), 7(6,7%) of diabetic nephropathy, and 3 (2.9%) of HenochShoenlein purpura. 3) Out of 162 IgAN, 151(93.2%) cases were idiopathic- focal GN in 70(48.6%), diffuse mesangial proliferative (DMsPGN) in 40(27.8%), minor glomerular abnormality in 29(20.1%), and sclerosing GN in 5 (3.5%) cases. In 11cases of systemic disease-associated IgAN, there were 7 HBV surface antigenemia, 2liver cirrhosis, 1alcoholic liver disease, 1thin glomerular basement membrane disease. The frequent events causing medical attention in patients with IgAN were gross hematuria (36.6%), urinary abnormality on routine check (26.7%), and edema (21.4%), but only 11% of patients had true edema and hypoalbuminemia. 4) In idiopathic nephrotic syndrome group (INS, total 230cases), the prevalence of each disease and the incidence of clinically overt NS on admission were 60.6%, 16.7%, 11.3%, and 10.3% and 94%, 71%, 65%, and 81% in MCNS, MGN, MPGNI, and FGS, respectively. 5) Serum HBsAg was positive in 40% of MPGNI, 27.3% of MGN, and 5.7% of IgAN. 6) According to WHO classification, the histologic findings of LN (35 of 106cases, 33.0%) were type IV 48.6%, V in 28.6%, and each of II and III in Conclusion. 1) IgAK was the most common primary GD. Thus, gross hematuria or abnormal urine findings on routine examination should be considered as highly suggestive of IgAN. 2) MCNS was the most common cause of INS in this study. 3) HRV infection seems to have a significant role in the pathogenesis of MPGNI and MGN, but not in IgAN. 4) In secondary GD, SLE is an important systemic disease requiring renal biopsy.

관동맥 조영술로서의 상완 접근법

손지원(Ji Won Son),김무현(Moo Hyun Kim),이주일(Ju Il Lee),김문범(Moon Beom Kim),성명식(Myung Sik Sung),도현국(Hyun Kuk Do),김종성(Jong Seoung Kim) 대한내과학회 1995 대한내과학회지 Vol.48 No.5

N/A Objectives: There are two approach methods in the coronary angiography, which are femoral and brachial approaches. In Korea, femoral approach has been used routinely, but brachial approach is not used widely compared to America, Europe and Japan, where the brachial approach is used more than 30% among the diagnostic coronary angiography. Recently, we had experienced coronary angiography by brachial artery puncture, so we will discuss about its usefulness. Methods: Coronary angiography was done in 149 cases by femoral approach, and 39 cases by brachial approach, from Nov. 1992 to Oct. 1993. Unpaired t-test, x2-test and ANOVA were used for comparison of each method about the duration of procedure time, the total dose of the contrast media, numbers of the used catheter and the learning effect. Results: 1) In brachial approach group, mean procedure time was 25±12 min, and the mean dose of contrast media was 147±37ml, which were not statistically significant compared with femoral approach group, 22±9 min and 138±37ml respectively. Mean numbers of the used catheter were 1.6 in brachial group and 3.6 in femoral group(p<0.05). 6 cases of brachial approach(6/39) were done by outpatient basis. 2) The percentage of incomplete engagement was 7.8(3/39) in brachial group and 2.7% (4/149) in femoral group, which was significantly higher in brachial group(p<0.05). By the way, all 3 cases of in- complete engagement were left coronary artery in brachial group, but there was same incidence between left and right coronary artery in femoral group. 3) Complications occurred 10.2%(4/39) in brachial group, 3.3%(5/149) in femoral group(p<0.01), but most of them were minor. 4) We compared the total dose of contrast media and procedure time by 3 month, 6 month interval. The duration of procedure time was relatively constant in femoral group, but decreased in brachial group with time course(p<0.05). By 6 month interval, it was significantly shorter in femoral group compared with brachial group in the first half(p<0.05), but there were no statistical significance between 2 groups in the 2nd half. Also there were no significant differences in the total dose of contrast media between two groups. Conclusion: Coronary angiography via brachial artery puncture has similar result in the duration of procedure time, the total dose of contrast media, compared with femoral approach. Brachial approach is useful method especially in the patient with obstructive vascular lesions and outpatient basis. We think it requires experience and discipline.

유방외 파젯트병 환자에서 진단된 위암

이시학(See Hak Lee),김현열(Hyun Yul Kim),전태용(Tae Yong Jeon),김동헌(Dong Heon Kim),심문섭(Mun Sup Sim),김문범(Moon Beom Kim) 대한외과학회 2004 Annals of Surgical Treatment and Research(ASRT) Vol.67 No.4

Rotor 증후군

서영조(Young Zo Suh),양창호(Chang Ho Yang),김문범(Moon Beom Kim),최석렬(Seok Reyol Choi),김덕규(Duk Kyu Kim) 대한소화기학회 1994 대한소화기학회지 Vol.26 No.3

Rotors syndrome is a rare hereditary disorder characterized by chronic, nonhemolytic and predominantly conjugated hyprbilirubinemia with normal hepatic histology. It resembles the Dubin-Johnson syndrome, the main difference being the absence of brown pigment in the liver cell. Recent studies dernonstrated that these two syndromes are distinct pathophysiologic entities. Authors traced a 19 year-old male patient who had shown persistent and predominant,ly con- jugated hyperbilirubinemia from birth. Urinary excretion of total coproporphyrin was marked- ly increased. Oral cholecystography visualized the gallbladder, but Tc-DISIDA scan showed markedly decreased hepatic uptake and poor visualization of the gallbladder and biliary tree. Histology of the liver was normal. So we confirmed the diagnosis of Rotors syndrome. (Kore- an J Gastroenterol 1994; 26: 592 595)