기존 혈관 확장술로 실패한 동정맥루 협착증의 Cutting Balloon을 이용한 성공적 치료

송하헌 ( Ha Hun Song ),김기태 ( Ki Tae Kim ),구영미 ( Young Mi Ku ),강유나 ( Yu Na Kang ),김영수 ( Young Soo Kim ),윤선애 ( Sun Ae Yoon ),장윤식 ( Yoon Sik Chang ),김영옥 ( Young Ok Kim ) 대한신장학회 2004 Kidney Research and Clinical Practice Vol.23 No.4

방광암의 공기충만법을 이용한 박편전산화단층촬영 : 표재성 방광암의 전산화단층촬영소견

김현,송하헌,김미혜,김영신,이은자,강시원,신경섭,Kim, Hyun,Song, Ha-Hun,Kim, Mi-Hye,Kim, Young-Sin,Lee, Eun-Ja,Kang, Si-Won,Shinn, Kyung-Sub 대한영상의학회 1994 대한영상의학회지 Vol.30 No.2

목 적: 방과내에 공기를 주입하고 나서 박편절단(thin-section) CT(공기충만법-CT)를 시행하여 방광벽에 국한된 저병기의 암종들을 보다 자세히 관찰하고 이들에 대한 정확한 병기결정에 도움을 주고자 하였으며, 저자들이 시행했던 방법과 경험된 표재성방광암종의 공기충만법-CT 소견을 기술하고 분석하고자 한다. 대상 및 방법: 공기충만법-CT를 시행하고 병기A(pT1)의 표재성방광암으로 확진된 19명, 24예(16명: 단일종괴, 3명: 다발성종괴)를 대상으로 하였다. 공기충만법-CT는 요도도관(Foley catheter)을 이용하여 약 200ml의 공기를 방광에 주입한 다음, 통상적인 골반부 스캔을 하고 나서 암종부위만을 1.5-5mm 두께와 간격으로 박편절단을 하였다.공기충만법-CT를 시행하고 병기 A로 판명된 24예의 암종에 대해 크기, 형태, 위치 등을 알아보았고 또한 암종부위 방광벽의 모습을 후향적으로 분석하였다. 성 적: 표재성방광암종이 방광내의 공기중에 노출되었을 \ulcorner\ulcorner의 형태는 결절형(5예, 20.8%), 유두형(15예, 62.5%), 피라미드형(2예, 8.3%), 반구형(2예, 8.3%)등으로 관찰 되었고, 이들은 목부위가 좁고 넓음에 따라 type I (pedunculated polypoid tumor : 4예, 16.6%), type II ( polypoid tumor with short neck : 13예, 54.2%), type III (sessile tumor :7예, 29.2%)의 3가지의 형태로 단순화 시킬 수 있엇다. 각각의 형태에 따른 평균암종의 크기는 type I : 22x25x6mm, type II : 23x22x18mm, type III : 18x15x18mm 이었다. Type I-II 암종의 목너비(width of tumoral neck)는 평균 15mm이었고, type I 암종의 목길이는 평균 2.5mm이었다. 또한 표재성방광암종이 방광에 집적된 조영제에 잠겨있을 때에는 해초양의 돌기들(papillary fronds)이 전체 24예 중 10예(41.7%)의 종괴 표면에서 관찰되었다. 암종이 발생한 부위 방광벽의 외연은 24예 모두에서 주위의 정상방광벽과 같이 평활 하였다. 결 론: 공기충만법-CT로 방광암종을 보다 세밀하게 관찰할 수 있었으며, 표재성방광암은 그 크기가 작고 대부분에 있어서 짧은 목을 갖는 용종양 종괴로 보이면서 침범된 방광벽의 외연이 평활한 특징을 가지고 있음을 알 수 있었다. Purpose: The staging of bladder carcinoma is a major determinant of operative management. CT of bladder carcinoma has been widely used to diagnose external extension (pT3b and over), but tumors confined to the bladder wall (from pTl to pT3a) are poorly delineated. The authors describe CT findings of the superficial bladder carcinoma (below 71, stage A) in thin -section CT with air insufflation technique (air insufflation-CT) to facilitate early detection and to aid correct staging of the superficial bladder carcinoma.Meterials and Methods: The materials consisted of proved 24 cases (19 patients, single tumor'16 patients, multiple tumors :3 patients) of stage A bladder carcinomas. Air insufflation-CT was performed by the infusion of approximately 200mL of air into the bladder via a Foley catheter. After the routine pelvic CT, bladder tumors were re-scanned with 1.5 to 5 mm thickness and intervals.Results: The superficial bladder carcinomas were detected as nodular(5 cases, 20.8'/, ), papillary(IS cases, 62.5'/, ), pyramidal(2 cases, 8.3%), and domed(2 cases, 8.3%) forms on air insufflation -CT. These tumors were classified into three types according to the size of the tumoral neck : type 1(pedundulated polypoid tumor : 4cases, 16.6%), type 11(polypid tumor with short neck:13 cases, 54.2'/, ), and type 111(sessile tumor .7 cases, 29.2%). The mean size(tumoral width x height x base c, neck/stalk) of the tumors was 22$\times$20$\times$16mm. The average tumoral sizes according to each type of the superficial tumors were type 1 :22$\times$25$\times$6mm, type 11'23$\times$22x18mm, and type 111 :18$\times$1Sx18mm. The mean width of the type 1-11 tumoral necks was 15mm. The mean length of the type 1 tumoral neck(pedicle) was 2.5mm. Papillary fronds of the tumors were seen in 10 cases(41.7%) of24 superficial tumors. Outer margin of the involved bladder wall was smooth in all cases.Conclusion : Thin-sectin CT with air insufflation technique for bladder carcinoma was useful in tumoral demonstration, and characteristics of the superficial bladder carcinomas were small polypoid tumors had a short neck mostly and smooth outer wall of the involved bladder wall.

수술 고위험 중증 환자에게서 발생한 급성 담낭염의 경피적 담낭배액술 단독 치료와 담낭절제술 비교; 단일 기관, 단면 연구

차병효 ( Byung Hyo Cha ),송하헌 ( Ha Hun Song ),김영남 ( Young Nam Kim ),전원중 ( Won Jung Jeon ),이상진 ( Sang Jin Lee ),김진동 ( Jin Dong Kim ),이학현 ( Hak Hyun Lee ),이반석 ( Ban Seok Lee ),이상협 ( Sang Hyub Lee ) 대한소화기학회 2014 대한소화기학회지 Vol.63 No.1

Background/Aims: Percutaneous cholecystostomy (PC) is an effective treatment for cholecystitis in high-risk surgical patients. However, there is no definitive agreement on the need for additional cholecystectomy in these patients. Methods: All patients who were admitted to Cheju Halla General Hospital (Jeju, Korea) for acute cholecystitis and who underwent ultrasonography-guided PC between 2007 and 2012 were consecutively enrolled in this study. Among 82 total patients enrolled, 35 underwent laparoscopic cholecystectomy after recovery and 47 received the best supportive care (BSC) without additional surgery. Results: The technical and clinical success rates for PC were 100% and 97.5%, respectively. The overall mean survival was 12.8 months. In the BSC group, mean survival was 5.4 months, and in the cholecystectomy group, mean survival was 22.4 months (p<0.01). However, there was no significant difference between these groups in multivariate analysis (relative risk [RR]=1.92; 95% CI, 0.77-4.77; p=0.16). However, advanced age (RR=1.05; 95% CI, 1.02-1.08; p=0.001) and higher class in the American Society of Anesthesiologists` physical status (RR=3.06; 95% CI, 1.37-6.83, p=0.006) were significantly associated with survival in the multivariate analysis. Among the 47 patients in the BSC group, the cholecystostomy tube was removed in 31 patients per protocol. Recurrent cholecystitis was not observed in either group of patients during the follow-up period. Conclusions: In high-risk surgical patients, PC without additional cholecystectomy might be the best definitive management. Furthermore, the cholecystostomy drainage catheter can be safely removed in certain patients. (Korean J Gastroenterol 2014;63:32-38)

섬유성 이형성증의 바늘구멍 골스캔 소견

백지희,이성용,김성훈,정용안,김범수,송하헌,정수교,강시원,박용휘,신경섭 ( Jee Hee Baek,Sung Yong Lee,Sung Hoon Kim,Yong An Chung,Bum Soo Kim,Ha Hun Song,Soo Kyo Chung,Si Won Kang,Yong Whee Bahk,Kyung Sub Shinn ) 대한핵의학회 1997 핵의학 분자영상 Vol.31 No.4

To evaluate the pinhole scintigraphic findings and its significance, authors retros- pectively compared the pinhole bone scintigrams and corresponding radiograms of 16 lesions in 14 patients with fibrous dysplasia. They were diagnosed pathologically in 10 lesions and radiologically in 6 lesions. The mean age of patients was 41.1 years. The mean interval between two studies was 1.1 days. Locations were ribs 7, pelvic bone 4, clavicle l, long bones 4(femur 2, titbia 1, humerus 1). The radiographic findings were as follows :the central portions were radiolucent(n=9), ground-glass opacities(n=5) or sclerotic(n=2) and the peripheral appearance were sclerotic rim(n-5), septation(n=7), cortical perforation (n=10) and invisible cortical thinning(n=9). Pinhc>le scintigraphic findings were as follows : Central portions showed normal 1+ uptake in 6 cases(radiolucent 5, ground-glass opacity 1), slightly increased 2+ uptake in cases(radiolucent 4, ground-glass opacity 3), and marked 3+ uptake in,3 cases(ground-glass opacity 1, sclerotic 2). The 15 of 16 lesions showed more intense uptake in the peripheral portion : slightly increased 2+ uptake corresponding to the sclerotic rim(5/5) and unvisible cortical thinning(1/9), and irregular foci of marked 3 + uptake corresponding to septation(7/7), cortical perforation(10/10) and invisible cortical thinning (8/9). One of 16 lesions showed homogeneous 2t uptake. In conclusion, pinhole scintigram provides information on regional activity of the fibrous dysplasia, which would be helpful in diagnosis, prediction of prognosis and determination of treatment plan.

동정맥루 폐쇄 환자에서 경피적 혈전제거술 후 발생한 요골동맥 색전증

김민수 ( Min Soo Kim ),정병하 ( Byung Ha Chung ),김정훈 ( Jeong Hoon Kim ),송하헌 ( Ha Hun Song ),구영미 ( Young Mi Ku ),김지일 ( Ji Il Kim ),김영수 ( Young Soo Kim ),윤선애 ( Sun Ae Yoon ),김영옥 ( Young Ok Kim ) 대한신장학회 2004 Kidney Research and Clinical Practice Vol.23 No.6

혈액 투석 환자에서 투석중 정맥압과 요소재순환율 측정에 의한 동정맥루 협착의 조기진단

김영옥(Young Ok Kim),전희경(Hui Kyung Jeon),박용근(Yong Kun Park),윤선애(Sun Ae Yoon),송하헌(Ha Hun Song),김남일(Nam Il Kim),김용수(Yong Soo Kim),김석영(Suk Young Kim),최의진(Euy Jin Choi),장윤식(Yoon Sik Chang),방병기(Byung Kee Bang 대한내과학회 1998 대한내과학회지 Vol.54 No.6

N/A Objectives: The most cammon cause of vascular access loss is thrombosis, usually caused by venous stasis associated with venous stenotic lesions. Therefore early detection of venous stenosis is very important. We studied the correlation of venous dialysis pressure and urea recirculation ratio to venous stenosis in chronic hemodialysis patients. Methods: Venous dialysis pressure and urea recirculation ratio were measured at extracoporeal blood flow of 200 ml/min thruugh 16 gauge needles within initial 30 minutes in 80 chronic hemodialysis patients. Venography was performed in patients with elevated venous dialysis pressure (>100 mmHg) or urea recirculation ratio (>15%), and if significant stenosis was found, venous dialysis pressure and urea recirculation ratio were reevaluated after percutaneous transluminal angioplasty (PTA). Results: Of the total 80 patients, 30 patients had elevated venous dialysis pressure or urea recirculation ratio. In patients with elevated urea recirculation ratio, venous dialysis pressure was high (102±21 mmHg vs 71±20 mmHg, P<0.001) and the past history of subclavian catheterization ipsilateral to fistula site was also high (39.1% vs 15.8%, P=0.02). There were no differences between two groups in terms of age, sex, diabetes mellitus, duration of hemodialysis, fistula site, and interneedle length. Of the total 27 patients undergone venography, 14 patients (51.9%) had venous stenosis. PTA was performed in 11 significant stenotic lesions in 5 patients and initial success rate of 91% was obtained, After PTA, urea recirculation ratios significantly decreased (16.7±5.9% vs 5.0±3.6%, P=0.01) and venous dialysis pressures slightly decreased without statistical significance (117.4±23.0 vs 99.0±8.9 mmHg, P=0.058). Conclusion: Venous dialysis and urea recirculation ratio seem to be active indicator of venous stenosis and outcome of subsequent percutaneous transluminal angioplasty in hamodialysis patients.

요통 환자에서 입원 전 치료 양상에 대한 분석

심대무,김태균,송하헌,송재용,이동훈,이명실 대한척추외과학회 1999 대한척추외과학회지 Vol.6 No.1

연구계획 : 요통으로 대학 병원에 입원하여 수술 치료전까지 질환의 만성화와 과대한 의료비 지출을 보이는 경향 이 있어 의무 기록 및 간호사 면담을 통하여 조사하였다. 연구목적 : 본 연구는 요통으로 입원한 환자의 입원 전까지 치료 내용을 간호사가 환자 상담을 통하여 얻은 내원 동기, 진료비, 치료 과정, 치료 결과 등에 대하여 분석하여 우리 의료 환경 특성을 이해하고자 하는데 있다. 대상 및 방법 : 1997년 10월부터 1998년 3월까지 5개월간 본교 정형외과에 요통을 주소로 입원치료한 100명을 대상으로 하였다. 입원 후 간호력 조사시 오차를 줄이기 위하여 한 명의 간호사가 병력 일지 및 면담 후 작성하고 치료 기간, 내원 동기, 진료비, 치료 과정, 치료 결과 등에 대하여 조사하였다. 결과 : 다음과 같이 요약 할수 있다. 1. 입원 전의 진료는 발병 후 입원까지 기간이 6개월 이상이 72 %로 만성화를 보였으며, 한방 진료를 거쳐 내원한 경우가 80 %이였다. 2. 입원 전 진료비 지출은 1인 평균 100만원 이상의 고가의 진료비 지출을 보였고, 한방 진료 기관의 경우 1인당 평균 130만원의 진료비 지출이 있었으며, 1회 방문 당 진료비는 한의원이 의원에 비하여 7배이상의 지출로 제일 높았다. 3. 입원을 선택한 동기는 주위의 권유에 의한 경우가 89 %로 주종을 이루었고, 수술적 치료를 시행한 환자는 62명중 탁월 12명, 우수 35명, 양호 13명과 불량 2명을 보였다. 결론 : 환자의 장기화 및 고가의 진료비 지출과 한방 진료의 선호들을 보이고 있으며, 위 3가지 요소가 서로 관련 이 있음을 보여 주고 있다. Object : The Authors compaired the treatment interval, the motive of admission and costs of episodes of back pain care between different provide type in a population representation of the Korea. Material & Method : We reviewed 100 different patients undergone back pain care from October 1997 to March 1998 in Wonkwang Medical Center. This study was a prospective, nurse community based and observational design. Male were 42 and female were 58, mean age was 51(18-81)years. Patients with back pain had been treated with 62 patients operation and 38 patients conservative treatment. Results : The results were as follows 1. The from preadmmision treatment to admission treatment time is consume over 6 months, that makes chronic phase of back pain until 72%, more than 80% of the patients were admitted after the herb medical treatment. 2. The cost of preadmission treatment is average 1,000,000 won. In the cases of herb medicine are average 1,300,000won. The medical fee in the herb medicine is seven times as much as in the medical clinics for a visit. 3. The motive of admission is recommended by neighbour that major to 89%, 62 patients were operated that showed 12 excellent, 35 good, 13 fair and 2 poor results. Conclusion : There were correlations of three factors, that is high cost, patients chronicity and preference of the herb medicine.

대장균에 의한 다발성 신농양 환자에서 발생한 가역성 단백 상실성 장병증 1례

김영옥,이창돈,송하헌,윤선애,오수혁,방병기,민준기,박재명 대한내과학회 1999 대한내과학회지 Vol.56 No.3

Protein-losing enteropathy is characterized by excessive protein loss into the intestinal tract in association with various disorders. We report a case of reversible protein-losing enteropathy as a cause of severe hypoalbuminemia in a patient with multiple renal abscesses. A 61-year-old woman presented with high fever and left flank pain. Abdominal computed tomography showed multiple abscesses in the left kidney. E. coli was cultured from her blood. Although hypoalbuminemia was severe (1.9 g/dL), the liver function tests including prothrombin time were normal and urine protein was negative. The results of 99mTc-human serum albumin scintigraphy were compatible with protein-losing enteropathy. Alpha-1 -antitrypsin clearence was 89 ml/24 hours (normal range <13 ml/24 hours). After the renal abscess was improved with antibiotic therapy, serum albumin increased to normal range and protein-losing enteropathy disappeared.

척추 수술후 C-반응 단백 및 적혈구 침강 속도의 정량분석

심대무,김태균,송하헌,심용석,이성호,송진호 대한척추외과학회 1998 대한척추외과학회지 Vol.5 No.1

Objectives : In order to standardize the CRP, ESR and WBC count after three types of spinal surgery and get clinical usefulness from these laboratory datas after spinal surgery and clinical usefulness of laboratory datas. Material and Methods : Three groups of patients(microdisectomy, anterior and posterior fusion) were chosen for the study. CRP, ESR and WBC levels were prospectively determined before surgery and at days 1-5, 10, 14, 21 and 42 after surgery Results : In all patients, preoperative normal CRP level(<10㎎/L) increased, reaching peak levels on the second day after anterior fusion(84.6㎎/L), and at the third day after microdiscectomy(54.5㎎/L) and posterolateral intercorporal fu sion(152.2㎎/L), with normalization in 5-10 days. Preoperative normal ESR `level increased to peak level on the forth day after microdiscectomy(33.0㎜/hr), and increased double peak levels after anterior(postoperative days 2&5) and posterolateral intercorporal fusion(postoperative days 3&5). ESR followed by a slow and irregular decrease, and at 42 days after surgery often remained elevated. WBC increased to variable peak level within normal limit in all patients. Conclusions : The rapid decline in CRP will probably be interrupted by a second rise or persisting elevation if infection occurs. CRP is presumably a better test than ESR for early detection of postoperative infection.

동맥조영술을 시행한 환자에서 조영제에 의한 신독성의 임상경과와 위험인자에 대한 연구

김영수,송선화,구영미,송하헌,윤선애,송호철,김영옥,김기태,장윤식,방병기 대한신장학회 2004 대한신장학회잡지 Vol.23 No.2