혈액투석을 위한 쇄골하정맥 도관삽입술 162예의 임상적 경험

송승렬,김형언,장명규,김태현,송주흥 圓光大學校 醫科學硏究所 1993 圓光醫科學 Vol.9 No.1-2

162 subclavian dual lumen catheters were placed in 162 patients as a temporary vascular access for hemodialysis at Wonkwang University Hospital during the last 8 years. Subclavian catheters were used in the treatment of 132 chronic renal failure patients waiting for the maturation of AV fistulas, 20 acute renal failure patients who required emergency hemodialysis, and 10 other patients. Catheters were inserted in the right subclavian vein and were left in place for an average of 25.4 days(3-118 days) and the number of hemodialysis per catheter were 10 times(3-56 times). The overall complication rate was 18.5%. Catheter related infections were 14 cases, there were 5 cases of bacteremia in 9 patients with suspected sepsis. Catheter malfunction were 8 cases, and inadvertent withdrawal of the catheter were 3 cases. Immediate traumatic complications were 3 pneumothoraxes. 1 hemopneumothorax and one exit site bleeding. We suggested that subclavian dual lumen catheters for hemodialysis could provide an excellent temporay vascular access with little serious complications.

십이지장 팽대부의 융모성선종 1예

송승렬,임동석,조규혜,최석채,유재규,김학철 大韓消化器病學會 1993 大韓消化器病學會誌 Vol.25 No.4

위식도 역류질환에서 식도염의 발현율

나용호,송승렬,유재규,장명규 대한소화기내시경학회 1994 Clinical Endoscopy Vol.14 No.2

The exact incidence of esophagitis in gastroesophageal reflux disease (GERD) remains poorly understood in Korea. To determine incidence of esophagitis in GERD, from August 1988 to July 1993, endoscopy, esophageal manometry with Bernstein test, and ambulatory 24 hour esophageal pH monitoring were carried out in a group of 349 patients with symptoms of heartburn or noncardiac chest pain. Based on these studies, 151(40%) patients had some degree of GERD and pstients were categorized as having: pathologic reflux, 98 patients; symptomatic reflux, 42 patients; and sensitive mucosal reflux, 11 patients. Among 151 patients with GERD, 27 patients(18%) had some degree of esophagitis. In conclusion, 40% of patients with symptoms suggestive of GERD have GERD. GERD is divided into subgroups; pathologic reflux, symptomatic reflux, and mucosal sensitive reflux. Less than 20% of GERD have esophagitis or esophageal mucosal injury and these low incidence of mucosal injury in Korean may be due to increased esophageal mucosal resistance.

불완전 세관형의 식도 중복증 1 예

김학철,송승렬,장명규,강정성,원수연,전일문 대한내과학회 1994 대한내과학회지 Vol.46 No.2

Esophageal duplication is rare congenital malformation of the gastrointestinal tract, and it may occur at any level in the esophagus, but more frequently in the lower third. There are 2 types of it, cystic and tubular, the former is more common than the latter, and some- times its also classified as communicating type or non-communicating type whether the accessory lumen has opening to the esophagus or the adjacent structure or not. The clinical symptoms are variable according to the location, the type of esophageal dulication. We experienced an asymtomatic case considered as partial tubular duplication of esophagus that had two longitudinal folds those were not changed during the degluttination and connected the two orifices in the lower esophagus. So we report one case of partial tubular duplication of esophagus with review of the literatures.

피부 병변 및 전신임파선증을 동반한 급성 골수성 백혈병 환자 1 예

이용구,송승렬,박명선,유재규,강정성,원수연,전일문,장명규 대한내과학회 1993 대한내과학회지 Vol.45 No.6

We describe a patient with acute myelogenous leukemia who demonstrated striking leukemia infiltration in back and large cervical, axillary and inguinal 1ymphadenopathy, A 62-year-old man had visited to our hospital with complaints of sore throat, cervical lymphadenopathy and multiple nodules on the skin. Skin biopsy specimen showed diffuse dermal, subcutaneous and fat infiltration of abnormal cells that appeared to be leukemic cell in nature. Bone marrow biopsy and aspiration specimen showed findings of acute monocytic leukemia. Treatment was initiated with combination chemotherapy (Thioguanine, Daunorubicin and Cytarabine) and radiation therapy. We report one case of acute monocytic leukemia patient who had multiple leukemia infiltration on the skin and generalzed lymphadenopathy.

만성신부전증 환자에서 좌심실 비대에 관한 연구

김태현,최석채,송승렬,박옥규,송주흥 대한신장학회 1992 Kidney Research and Clinical Practice Vol.11 No.4

Cardiovascular disease is the commonest cause of death in patients treated with end stage renal disease (ESRD). Left ventricular hypertophy (LVH) may occur frequently in patients with ESRD. Some factors such as increased preload, hypertension, hyperparathyroidism, anemia, hemodialysis duration could be associated with LVH in ESRD. To determine the most important risk factors that independently relate to LVH among them, 24 ESRD patients on hemodialysis, 13 normal subjects, 11 essential hypertension patients had echocardiography and clinical review. The LVMI of ESRD patients was significantly higher than that of control group (168.04 g/m vs 123.46 g,m', P $lt;0.05) and higher than that of hypertensive group (168. 04 vs 147.15 g/m). Among factors that may independently relate to LVH in ESRD patients, only systolic and diastolic blood pressure were correlate significantly to LVMI (r=0.6, r=0.59, P$lt;0.05 respectively). If ESRD patients were devided into 4 subgroups dependent upon systolic and diastolic pressure, the LVMI of each subgroup (systolic blood pressure$gt;150 mmHg or diastolic blood pressure$gt;90 mmHg) was significantly higher than that of each subgroup (systolic pressure $lt; 150 mmHg or diastolic pressure$lt;90 mmHg) (P$lt;0.05). Using multiple regression, systolic and diastolic blood pressure were most important factors which independently related to LVH, followed by anemia. Level of parathyroid hormone, the amount of ultrafiltration, hemodialysis duration were not related to LVH. It is concluded that the most important factors associated with LVH in ESRD are hypertension, anemia.

과립구 집락촉진인자 ( G - CSF )에 의한 항갑상선제 유도 무과립세포증 치험 1 예

이용구,조정구,유광현,손성식,송승렬,박명선 대한내분비학회 1993 Endocrinology and metabolism Vol.8 No.3

Agranulocytosis represents a life-threatening complication of antithyroid therapy, occurring in 0. 1% to 1% of patients. Course and duration of agranulocytosis may be highly variable. Recently, recombinant human granulocyte-macrophage colony stimulating factor (rhGM-CSF) and granulocyte colony stimulating factor (fhG-CSF) have proved useful in the treatment of idiopathic aplastic anemia, idiopathic neuropenia, and chemotherapy-associated agranulocytosis. That G-CSR might also be useful in drug-induced allergic-toxic agranulocytosis. We experienced successful rhG-CSF treatment of a 25-year-old woman who had propylthiouracil induced agrnulocytosis. The availability of G-CSF may help to shorten the course of agranulocytosis and to reduce its fatality rate (J Kor Soc Endocrinol 8:347~350, 1993).

CMV 감염의 재활성화에 의한 간염의 역학적 조사

김학철,최석채,임동석,송승렬,유재규 대한소화기학회 1992 대한소화기학회지 Vol.24 No.6

십이지장 팽대부의 융모성선종

최석채(Suck Chei Choi),송승렬(Seung Ryel Song),임동석(Dong Suk Lim),조규혜(Kyoo Hye Cho),유재규(Jae Kyu Ryu),김학철(Hak Chel Kim) 대한소화기학회 1993 대한소화기학회지 Vol.25 No.4

Villous adenoma of the ampulla of Vater Which is sometimes the cause of extrahepatic obstructive jaudice is uncommon disease. But they are important in spite of their rarity, because of frequent malignant change in the tumor as a focal or all occult tumor. Recently, the early diagnosis of ampullary tumors has become possible due to the ide application of fiberoptic endoscopy and increasing knowledge about the ampullary tumors. Although the biopsies were taken during the endoscopy, sometimes one might miss the area of malignant degeneration. But, it could increase the diagnostic accuracy by performing a hiopsy at the highly suspected site ofl malignancy, like our case in which fixed and discolorecl areas in the lesion were biopsied. So we recommed an affn.ssive endoscopic study and hypotonic duodenogram. Even thought it is diagnosed as benign, and can be treated with endoscopic pelypectorny, but we recommend the complete resection of the tumor because of high incidence of recurrence and malign ant transformati on.

영양실조성 당뇨병 2 예

조정구,박명선,유광현,장명규,손성식,송승렬 대한내과학회 1994 대한내과학회지 Vol.46 No.2

Malnutrition-related diabetes mellitus is a form of diabetes peculiar to developing countries within the tropical belt, which comprises two subgroups, fibrocalculous pancreatic diabetes (FCPD) and protein-deficient pancreatic diabetes (PDPD). FCPD is a form of diabetes secondary to chronic calcific pancreatitis, which is not due to alcohol consumption and tend to affect younger people and characterized by insulin-requiring but ketosis-resistant and coexisting malnutrition or pancreatic duct stone. FCPD is diagnosed by demonstrating calculi and signs of chronic pancreatitis by radiographic or ultra-sound imaging, together with evidence of pancreatic exocrine insufficiency. We recently experienced the two cases of fibrocalculous pancreatic diabetes. MRDM deserves further study not only because it is now recognized as a major form of the disease but also because it may improve our understanding of other forms of diabetes.