당뇨병과 위장질환

선우인철 사단법인 한국당뇨협회 2003 당뇨 Vol.160 No.-

결핵을 동반한 후천성 면연결핍증 1예

김신응,이광섭,선우인철,김종만 대한감염학회 1994 감염 Vol.26 No.3

AIDS란 HIV감염증의 최종단계로서, 심한 면역결핍으로 인한 각종 기회감염 및 종양을 초래하고 결국 사망에 이른다. 결핵은 다른 기회감염의 병원균보다도 virulent하기 때문에, HIV감염 초기에 잘 발생하고 면역결핍이 심할수록 비전형적인 임상소견을 나타내며 예후가 불량하다. 저자들은 비특이증상으로 입원한 환자의 늑막삼출액에서 결핵균이 확인된 35세 남자 AIDS환자 1례를 경험하였기에 보고하는 바이다. HIV infection usually requires several years to progress to AIDS, the final stage of disease. Since Mycobacterium tuberculosis is more virulent than non-tuberculous mycobacterium and other opportunistic pathogens, tuberculosis tends to occur relatively early in the course of HIV immunosuppression as a reactivation of latent infection with increased frequency, especially more prevalent in endemic areas, and has been characterized by atypical clinical and radiograpgic presentation. A case of 35 year-old-man with shoulder pain, weakness and mild fever was experienced. Initial X-ray of the chest showing partial collapse on the left upper lobe which was taken one month earlier turned out to have pulmonary infiltrations, hilar lymphadenopathy and pleural effusion on admission. Culture for mycobacterium with pleural fluid resulted in the growth of Mycobacterium tuberculosis and anti-HIV antibody positivity with ELISA was confirmed by Western blot method.

인슐린요구형 당뇨병 환자에서 인슐린 주사에 대한 입원교육이 당뇨병관리에 미치는 영향

강신주,김승용,한덕희,류형준,선우인철 대한당뇨병학회 1991 Diabetes and Metabolism Journal Vol.15 No.1

심초음파로 진단된 성인의 총포정맥환류이상 1례

이광섭,최광섭,김신응,선우인철,김종만,장미영,이철범 대한순환기학회 1992 Korean Circulation Journal Vol.22 No.5

Cytopagic Histiocytic Panniculitis 1 예

김용태,박원,한창순,송태의,선우인철 대한내과학회 1991 대한내과학회지 Vol.41 No.3

Cytophagic histiocytic panniculitis is a histiocytic proliferative disorder characterized by the presence of fever, pancytopenia, and subcutaneous nodule resulting from the infiltration of fat and dermis by inflammatory cells and histiocytes that contain phagocytized RBC, lymphocyfes, and platelets. A 39 year-old male was admitted to the hospital because of painful subcutanenous nodules on both cheeks and abdominal wall, which had spread to both lower extremities. On the physical exam, the body temperature was 38.5℃ and the pulse was 98/min. There were tender subcutaneous nodules on both cheeks and abdomen and relatively well-defined tender erythematous subcutaneous nodules on both lower extremities. Laboratory findings revealed pancytopenia, prolongation of prothrombin time, and elevation of liver enzymes. Abdominal CT showed increased density and irregular thickening of the subcutaneous fat layer in the entire abdominal trunk. Full thickness skin biopsy of the abdominal wall revealed dense mononuclear cell infiltrate and fat necrosis, These histiocytes showed phagocytic activity including RBC, WBC, and nuclear debris with typical bean bag$quot; appearance. With 6cycles of CHOP$quot; chemotherapy, on improvement of the skin lesions and laboratory and biopsy findings was observed.

3 남매에서 발생한 Pendred 증후군

한형수,유형준,박원,한경아,선우인철,한덕희 대한내과학회 1991 대한내과학회지 Vol.41 No.1

Pendred syndrome is a autosomal recessively transmitted rare disease (about 1/14, 300 births), characterized by goiter, congenital sensory-neural hearing loss and various degrees of hypothyroidism. This 32-year-old female patient was admitted with a growing anterior neck mass first detected when she was 4 years old. She has been a deaf-mute since childhood had no complaints except intermittent headache. Two of the patients 3 brothers are alive, and show the same symptoms as that of patient. But other relatives, including siblings and parents, do not show such symptoms. The patient's goiter was 5×10 cm in size, rubbery and nodular in nature, Laboratory findings were as follows: thyroid function test: nearly euthyroid; thyroid scan: diffuse goiter; thyroid aspiration cytology: adenomatous goiter with moderate hyperplasia. A perchlorate discharge test were performed in the patient and her 2 brothers, showing all positive findings. Antimicrosomal antibody and antithyroglobulin antibody were negative in for all of them.

전기감전으로 인한 뇌경색증 1 예

김종만,홍선미,장미영,이광섭,김신응,조준길,선우인철 대한내과학회 1992 대한내과학회지 Vol.43 No.6

The tissue damage associated with an electrical injury occurs when electric energy is converted to thermal energy or heat according to Joule's law, and it occurs not only cutaneous contact site but may also involve underlying tissue and organs along the route taken by the current between the entrance and exit sites. Among multiple interacting variables, inc1uding voltage, amperage, tissue resistance, type of current and current pathway, amperage is most important factor which relates closely to deep tissue injury and mortality. A case of 33 year old laborer with left hemiplegia after electric current of AC 380 voltage, 60 Hz was experienced. Normal initial brain CT scan turned out to have right hemorrhagic infarct 5 days later, and decreased infarct size 2 months later, with neurological sequelae of left hemiplegia.

전신성 홍반성 낭창에 병발한 급성 심근경색증 1 예

이홍순,이학중,박원,한창순,유수웅,주신배,선우인철 대한내과학회 1991 대한내과학회지 Vol.41 No.6

Acute myocardial infarction (AMI) rarely occurs in systemic lupus erythematosus (SLE), but mortality is as high as 50%. Also, AMI is a possible cause of inexplained heart failure in SLE patients. We experienced a case of AMI resulting from coronary vasculitis which was manifested by diffuse sclerotic narrowing of the coronary arteries in coronary angio-graphy in a 36-year-old male lupus patient. Management by prednisolone and post-centrifugal plasma-pheresis decreased systemic symptoms, chest pain, and cardiac enzymes. Follow up coronary angiography also revealed improved sclerotic lesions in the coronary arteries, The patient iss cunently under follow-up tsectment as an out-patient for 20 months with only skin manifestation without heart symtoms.

전자 현미경상 Epinephrine 과립이 관찰된 Zuckerkandl 기관에 발생한 Norepinephrine 분비성 갈색세포종 1예

이원석,김의숙,이강룡,이정아,장지정,선우인철,김대하,이광섭,백영주 대한내분비학회 1996 Endocrinology and metabolism Vol.11 No.2

Extraadrenal pheochromocytomas developed from the paraganglia other than adrenal medulla are uncommon tumors. Such lesions have been reported that as much as 10% of retroperitoneal paragliomas arise outside the adrenal gland. But their incidence and prognosis are changing partly as a result of progression in developmental mechanism, diagnostic tools and concepts including ultrastructure, immunohistochemistry. The ultrastructure of chromaffine neoplasm from adrenal and extraadrenal tissues has been studied with chrornaffine granule specificity and type of catecholamine content. With rare exceptions, extraadrenal chrornaffine tumor mainly has high concentration of norepinephrine which is suggested as dict relationship to numoruos electrone dense granular bodies in the cell cytoplasrm. High or intermediate level of epinephrine in tissue is associated with cytoplasmic granular bodies of much less density. Recently we experienced the exception, a case of norepinephrine secreting pheochrom-ocytoma in the organ of Zuckerkandl with epinephrine granules in cytoplasm and this discrepancy probably due to the plasticity - the differences in developmental process and local factors between adrenal medulla and extraadrenal tissues(J Kor Soc Endocrinol 11:233 ~239, 1996).

폐렴을 동반한 15 세 남자 환자에서 발견된 선천성 낭포성 유선종 폐기형 1 예

한영숙,김의숙,이원석,이정아,장지정,선우인철,김대하,이광섭,백영주,이강룡,김신응,지미경 대한내과학회 1997 대한내과학회지 Vol.52 No.1

Congenital cystic adenomatoid malformation(C.C. A.M.) is a rare variant of congenital pulmonary cystic diseases. C.C.A.M. was first distinguished from other pulmonary cystic lesions by Ch'in and Tang in 1949. It is characterized by cessation of bronchiolar maturation with an overgrowth of mesenchymal elements and proliferation of polypoid glandular tissue in the absence of normal alveolar differentiation. In 80% to 95% of cases, C.C.A.M. of the lung is confinded to a single lobe and there is no lobe predilection and right and left predominance. The clinical presentation may be widely variable, ranging from intrauterine fetal death secondary to nonimmune hydrops fetalis to discovery in childhood after recurrent pulmonary infections. Definitive treatment is removal of affected lobe. In rare instances, there is cases of myxosarcoma, embryonal rhabdomyosarcoma. Bronchoalveolar carcinoma arising in C.C.A.M.. So, resection is recommended even if they are asymtomatic. We have experienced a case of congenital cystic adenomatoid malformation (type II) of the lung in 15 year old man with pneumonia. After the improvement of pneumonia, surgical operation was performed. A brief review of the related literature is presented.