돌막창자 병변에 대한 추가 검사와 돌막창자판막 병변과의 상관관계

남지형 ( Ji Hyung Nam ),김재학 ( Jae Hak Kim ),이종호 ( Jong Ho Lee ),최종순 ( Jong Sun Choi ),박정배 ( Jeong Bae Park ),이준규 ( Jun Kyu Lee ),임윤정 ( Yun Jeong Lim ),고문수 ( Moon Soo Koh ),이진호 ( Jin Ho Lee ) 대한장연구학회 2008 Intestinal Research Vol.6 No.2

Background/Aims: The diagnostic value of terminal ileum (TI) biopsies during colonoscopy remains controversial. This study assessed the clinical characteristics of terminal ileal lesions during colonoscopy to find the affecting factors for the specific investigations in addition to TI biopsies. Methods: Thirty-seven patients (male to female ratio of 1.6, mean age 42.2±12.2 years, range 20-68 years) who had undergone colonoscopy with biopsies of TI at Dongguk University International Hospital from September 2005 to December 2007 were retrospectively studied. We analyzed the characteristics of patients, endoscopic and histopathologic findings, followed by multivariate analysis of those significant variables. Results: Ulcerative lesions were most frequently found in 17 cases (45.9%) and multiple lesions were observed in eight cases (21.6%). Aphthoid shape was evident in 19 cases (51.4%). Eight cases (21.6%) were combined with ileocecal valve (ICV) lesion. On histopathologic examination, nonspecific inflammation was evident in 19 cases (51.4%). The diagnostic yield of TI biopsies was 5.4%. Presence of ICV lesion (p=0.004) and multiple lesions (p=0.027) were associated with clinically significant TI lesion. By multivariate analysis, only ICV lesion was statistically significant (Odds ratio 8.3: 95% confidence interval 1.3-54.1, p=0.026). Conclusions: Not all patients who undergo colonoscopy require intubation of TI. However, a careful examination of ICV could be useful to determine whether intubation of TI would be necessary or not. (Intest Res 2008;6:121-127)

경주,포항 지역에서의 대장용종의 임상특성과 위험인자

남지형 ( Ji Hyung Nam ),양창헌 ( Chang Hun Yang ) 대한소화기학회 2008 대한소화기학회지 Vol.52 No.3

Background/Aims: The purposes of this study were to investigate various environmental factors for colon polyps and to analyze locoregional clinical characteristics of colon polyps in Gyeongju and Pohang area. Methods: From October 2005 to September 2006, patients who underwent colonoscopy were analyzed based on their ages, genders, body mass indices (BMI), dietary habits, smoking behaviors, accompaying diseases, and medications as risk factors for the occurrence of colon polyps. Then clinical manifestations, gross appearances and pathologic findings of polyps were investigated. Results: Among 253 patients enrolled, a total of 296 colon polyps were found in 108 patients. The incidence of colon polyps in more than 50-year old patients was 3.2-fold greater compared to less than 50-year old patients. Smoking habits were also significantly associated with the occurence of colon polyps. Among adenomatous polyps, tubulovillous type and moderate to severe dysplasia were frequently observed as the size increased, yet the location of polyps was not significantly associated. Conclusions: Older age and smoking habit increase the risk of colon polyps. Rectal polyps have less chance to be adenomatous type. The larger the polyp grows, the more likely it to be tubulovillous and dysplastic. (Korean J Gastroenterol 2008;52: 142-149)

증례 : 소화기 ; Fitz-Hugh-Curtis 증후군: 드물지 않은 질환

남지형 ( Ji Hyung Nam ),박정배 ( Jeong Bae Park ),김순애 ( Soon Ae Kim ),김말영 ( Mal Young Kim ),강봉균 ( Bong Kyun Kang ),이진호 ( Jin Ho Lee ),고문수 ( Moon Soo Koh ) 대한내과학회 2009 대한내과학회지 Vol.77 No.1

Fitz-Hugh-Curtis (FHC) 증후군은 골반내감염과 연관되어 발생하는 심한 우상복부 통증을 특징으로 하는 간주위염으로 국내의 골반내감염 환자의 증가에 따라 드물지 않게 발생하지만 급성 담낭염 등의 급성 복증과 감별이 어려울 수 있다. 저자들은 복통을 주소로 내원하여 FHC 증후군으로 진단된 8명의 환자를 경험하였다. 젊은 여성에서 우상복부 통증이 있을 경우 감별진단의 하나로 FHC 증후군을 고려하여야 하며, 나선식 전산화단층촬영이 진단에 유용하겠다. Fitz-Hugh-Curtis (FHC) syndrome is hepatitis characterized by severe right upper abdominal pain associated with pelvic inflammatory disease (PID), mimicking the symptoms of acute abdomen, such as in acute cholecystitis. FHC syndrome is becoming more common with the increasing incidence of PID in Korea. We treated eight patients with FHC syndrome, who visited our hospital with right upper quadrant abdominal pain. We emphasize the importance of spiral computed tomography (CT) in the diagnosis of right upper quadrant abdominal pain in sexually active young women. (Korean J Med 77:91-94, 2009)

우하복부 통증을 주소로 내원한 복막수염(Epiploic Appendagitis) 1예

강효철,남지형,전세윤,유경희,김영통,Kang, Hyo Cheol,Nam, Ji Hyung,Jeon, Se Yun,Yoo, Gyeong Hee,Kim, Young Tong 대한소아소화기영양학회 2006 Pediatric gastroenterology, hepatology & nutrition Vol.9 No.1

저자들은 우하복부 통증을 주소로 내원한 11세 남아에서 복부 초음파와 복부 컴퓨터 단층 촬영으로 복막수염을 진단하고, 대증 요법만으로 회복된 증례를 경험하였기에 문헌 고찰과 함께 보고하는 바이다. An inflammation of an epiploic appendage is a relatively rare cause of acute abdominal pain. It can be clinically misdiagnosed as either acute appendicitis or diverticulitis. Judicious interpretation of imaging with ultrasound or computed tomography may lead to an early diagnosis and prevent unnecessary surgical or medical treatment. Conservative treatment of symptoms is usually sufficient. We have experienced a case of epiploic appendagitis treated by conservative management and report this case with the review of the literature.

고용량 면역글로불린 정맥주사로 치료한 2세 남아의 독성표피괴사용해 1례

전세윤 ( Se Yun Jeon ),남지형 ( Ji Hyung Nam ),한상명 ( Sang Myung Han ),유경희 ( Kyung Hee Rhue ),이성열 ( Seong Yul Lee ),박준수 ( Joon Soo Park ) 대한소아알레르기호흡기학회 2006 소아알레르기 및 호흡기학회지 Vol.16 No.2

Toxic epidermal necrolysis(TEN) is a severe drug induced life-threatening disease and an acute illness. This disease is characterized by rapid onset of widespread necrosis resulting in sloughing of epidermis. The incidence of TEN is very rare, with approximately 0.5 to 1.4 cases per million per year. but TEN has a high mortality rate of 25-40 percent. Therapy for TEN is primarily aimed at supportive care. Treatment with systemic corticosteroid, immunosuppresive agent such as cyclosporine, cyclophosphamide, pentoxifyllin or plasmapheresis have not been shown to improve outcome. Recently, administration of high dose intravenous immunoglobulin(IVIG) has been shown to result in rapid improvement in patients with TEN. There have been several reports of the benefit of IVIG in adult patients with TEN. However we could not find using IVIG in pediatric patient with TEN in Korea. We have experienced improvement in a 2 years old boy with TEN after using high dose IVIG. [Pediatr Allergy Respir Dis(Korea) 2006;16:171-176]

기침에 의해 유발된 복부피하혈종 1예

김강 ( Kang Kim ),송준화 ( Jun Hwa Song ),김준섭 ( Jun Sub Kim ),하원철 ( Won Chul Ha ),남지형 ( Ji Hyung Nam ),김성자 ( Sung Ja Kim ),이영현 ( Young Hyun Lee ) 대한내과학회 2008 대한내과학회지 Vol.75 No.1S

Paclitaxel 단일 요법에 완전 관해를 보인 저항성 임신성 융모막암 1 예

조윤현(Yun Hyun Cho),김미경(Mi Kyung Kim),정상인(Sang In Jung),황종윤(Jong Yun Whang),조지형(Ji Hyung Cho),김영탁(Young Tak Kim),남주현(Joo Hyun Nam) 대한산부인과학회 2002 Obstetrics & Gynecology Science Vol.45 No.6

High-risk gestational choriocarcinoma in patients who have failed primary chemotherapy is known to have a very poor prognosis. About 25% of high-risk metastatic choriocarcinoma become refractory to EMACO (etoposide, methotrexate, actinomycin D, cyclophosphamide and vincristine) and fail to achieve a complete remission. Currently, there is no standard salvage chemotherapeutic regimen for EMACO refractory choriocarcinoma. Paclitaxel, a taxane analog extracted from the bark of the western yew, has shown antitumor activity in a variety of cancers. However, there has been few case reports that described the effectiveness of paclitaxel to choriocarcinoma. We describe a 41-year old woman with refractory choriocarcinoma, who demonstrated dramatic response to paclitaxel treatment with a brief review of literature.

메티실린내성 황색포도알균에 의한 지역사회획득 폐렴 2예

남지형,송준화,하원철,이정우,원기범,김성자,이영현 東國大學校醫學硏究所 2007 東國醫學 Vol.14 No.1

지역사회획득 폐렴은 병원이 아닌 지역사회에서 발생한 폐렴으로 비교적 흔하게 발병하며 감염성 질환에 의한 사망의 중요한 원인이다. 병원내 감염 폐렴의 대표적인 원인균으로 알려져 있는 메티실린내성 황색포도알균에 의한 지역사회획득 폐렴이 점차 증가추세에 있으며 기존의 vancomycin 계통의 항생제 외에 여러 항생제에 감수성을 보이는 경향이 있어 치료의 폭이 넓다. 지역사회획득 페렴에 대한 적절한 치료와 항생제 남용이나 vancomycin 내성 획득 환자를 줄이기 위해서 메티실린내성 황색포토알균에 의한 원내 폐렴과 지역사회획득 폐렴을 구별하는 것이 중요하다. Community acquired pneumonia (CAP) is a common infectious disease acquired from community and an important cause of death in infectious diseases. Methicillin-resistant Staphylococcus aureus (MRSA) is the most common cause of hospital-acquired pneumonia (HAP), but there are increasing cases of community-acquired pneumonia caused by MRSA which is susceptible to several antibiotics including vancomycin. It is important to differentiate HAP from CAP for more effective treatments to reduce the overuse of antibiotics and the development of vancomycin resistance.

소장내 위석에 의한 장폐쇄증으로 발생한 급성신부전 1례

김승민,남지형,김준섭,이용국,최재혁,강혁주,탁우택,이정호,정호근 東國大學校醫學硏究所 2007 東國醫學 Vol.14 No.1

Gastric bezoars are concretions or hard masses of foreign matter found in the gastrointestinal tract. It may induce many complications including intestinal obstruction. No report has been proposed on a case of prerenal ARF induced by intestinal obstruction by small-bowel bezoar. Therefore, we report a case of the patient with ARF associated with small-bowel bezoar, who initially visited with the symptoms of nausea and frequent vomiting. 위석(bezoar)은 여러 가지 이물 및 내재성물질이 위장관내에서 혼합되어 응고물을 형성한 것을 말하며, 가장 흔한 형태의 합병증으로 장폐쇄증이 올 수 있으나, 그로 인하여 신부전의 양상으로 나타나는 경우는 흔하지 않다. 이에 저자들은 내원 당시의 병력 및 이학적 검사만으로 장폐색의 원인이 위석임을 의심할 수 없었던 비전형적인 소견을 보인 소장내의 위석에 의한 장폐쇄증과 이로 인해 발생한 급성신부전의 예를 경험하였기에 이에 보고하는 바이다.

급성 하벽 심근경색증의 임상양상을 보인 복부 대동맥류 파열 1예

이준엽,남지형,김승민,김준섭,김강,성낙일,박정배,천우정,배준호,나득영 동국대학교 의학연구소 2006 東國醫學 Vol.13 No.2

대부분의 복부 대동맥류 파열은 저혈압, 복통을 동반하거나, 복부의 박동성 종괴가 촉지된다. 하지만 급성 심근경색의 임상양상을 나타낸 증례는 세계적으로 1예만이 보고되어 드문 것으로 알려져 있다. 그러나 수술적 치료가 요구되는 복부 대동맥류 파열과 혈전 용해제, 관상동맥성형술 등의 내과적 치료가 우선시 되는 급성 심근경색은 질환의 특성상 증상발현과 동시에 치명적인 결과를 초래할 수 있어, 신속하고 정확한 진단과 동시에 적절한 치료가 요구된다. 특히 복부 대동맥류를 가진 환자 중 22%에서 심혈관질환을 동반한 경우가 있고, 복부 대동맥류 파열로 인한 저혈압은 관상동맥의 혈류량을 감소시켜 급성 심근경색의 임상양상을 나타낼 수 있다. 따라서 급성 심근경색의 전형적인 흉통을 호소하는 환자도 이전의 병력이 없더라도 급성 대동맥 증후군의 위험인자를 가지고 있을 경우 급성 대동맥 증후군을 염두에 두어, 좀 더 세심한 이학적 검사, 전산화단층촬영 등의 대동맥에 대한 검사를 고려 해야 한다. 이에 저자들은 전형적인 급성 하벽 경색의 증상과 심전도 소견을 나타내었으나, 대동맥 조영술과 복부전산화단층촬영을 통해 복부 대동맥류 파열을 진단하였던 예를 문헌고찰과 함께 보고하는 바이다. The majority of acute aortic aneurysmal rupture presents the symptoms of hypotension, abdominal pain, and/or palpable pulsating abdominal mass. Acute aortic aneurysmal rupture with symptoms of acute myocardial infarction was rarely reported. The treatment of ruptured abdominal aortic aneurysm needs surgery, but acute myocardial infarction needs thrombolytc agents and/or coronary interventions. Hence these diseases need prompt and accurate differential diagnosis. Especially, the 22% of patients with aortic aneurysm have coronary heart disease, and the hypotension due to aortic aneurysmal rupture decreases the flow of coronary artery and causes mimic symptoms of acute myocardial infarction. Therefore, the patients with typical symptoms of acute myocardial infarction without pervious history of aortic aneurysm need more careful examination such as chest/abdominal CT for differential diagnosis of aortic aneurysmal rupture. We reported a 74-year-old female developed typical symptoms of acute myocardial infarction, but was diagnosed as ruptured abdominal aortic aneurysm by aortogram and computed tomography.