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결절성 위염 환자의 임상적 특징과 헬리코박터 제균 치료
김성배 ( Sung Bae Kim ),이승헌 ( Seunghun Lee ),심재겸 ( Jae Kyeom Sim ),최연근 ( Yeonkun Choe ),조동호 ( Dong Ho Jo ),김준환 ( Joonhwan Kim ) 국군의무사령부 2019 대한군진의학학술지 Vol.50 No.1
Objective; Nodular gastritis (NG) is well-known endoscopic findings caused by Helicobacter pylori infected patients and related with diffuse-type gastric cancer. The aim of this study was to identify clinical characteristics of patients with NG in the armed forces and result of H.pylori eradication. Method; We reviewed 1062 patients who underwent upper gastroendoscopy between July 2016 and August 2018. We analyzed the clinical findings and H.pylori eradication results. Results; Total 39 (3.7%) patients diagnosed NG by endoscopy. Patients with age under 40 were associated with NG. Of the 39 patients with NG, H.pylori infection confirmed in 36 (92.3%). H.pylori eradication therapy including triple and sequential therapy successful in 83.3% patients. Conclusion; In patients with NG, h.pylori confirm test and eradication therapy is effective to improve patients symptom and prevent gastric cancer. To achieve this result, an integrated and effective patients tracking system is needed in miliary medicine.
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외래에서 철 결핍 빈혈로 진단된 남자 환자의 악성 종양 유병률과 연관인자
이병현 ( Byung Hyun Lee ),이재중 ( Jae Joong Lee ),심재겸 ( Jae Kyeom Sim ),김정선 ( Jung Sun Kim ),김대식 ( Dae Sik Kim ),박세종 ( Seh Jong Park ),이세련 ( Se Ryeon Lee ),박용 ( Yong Park ),최철원 ( Chul Won Choi ),김병수 ( Byun 대한내과학회 2014 대한내과학회지 Vol.87 No.1
목적: 빈혈은 전 세계적으로 가장 흔한 질환 중 하나이며 악성 종양의 중요한 표지자이다. 빈혈과 악성 종양에 관한 다양한 연구가 있으나 IDA 진단된 남자 환자를 대상으로 한 자료는 충분하지 않다. 이에 저자들은 남자 IDA 환자의 발생원인과 악성 종양의 유병률, 철분제 치료반응에 대해 조사하였고 악성 종양에 의한 IDA 환자의 특성과 악성 종양에 대한 선별 검사로 대변 잠혈 검사의 유용성에 대해 연구하였다. 방법: 2008년 3월부터 2013년 6월까지 고려대학교 구로 병원, 안암병원 혈액내과 외래에 내원하여 IDA로 진단된 남자 환자 202명을 대상으로 하여 임상적 특성과 빈혈의 원인에 대해 조사하였고, 원인에 따라 악성 종양군(Cancer, n = 24)과 악성 종양 이외의 다른 원인군(Non-cancer, n = 178)으로 분류하여 임상적 특성 및 치료반응을 후향적으로 분석하였다. 또한 대변 잠혈 검사의 악성 종양에 대한 민감도, 특이도, 양성 예측도에 대해 분석하였다. 결과: IDA의 원인 중에서 출혈이 86명(42.6%)으로 가장 많았다. 악성 종양 유병률은 11.9% (24명)였고 악성 종양의 상대 빈도는 대장직장암 14명(58.3%), 위암 7명(29.2%) 순이 었다. 연령군별로는 50세 미만 8.3% (2명), 50세 이상 91.7% (22명)였다. 악성 종양과 관련된 요인으로는 다변량 분석에서 고령(OR, 1.05; p = 0.026)과 대변 잠별 검사 양성(OR, 7.48; p = 0.001)이 확인되었다. 치료반응은 경구 철분제 투약 후 Hb 수치가 13이상 상승한 비율은 Cancer군에서 더 낮았지만 (OR, 0.49; 95% CI, 0.146-1.668; p = 0.31) 통계적으로 유의하지 않았고 경구 철분제 투약 후 평균 Hb 수치는 Cancer군에서 12.6 ± 2.2 g/dL, Non-cancer군에서 13.8 ± 1.6 g/dL로 Cancer 군에서 더 낮았고 통계적으로 유의하였다(p = 0.016). 대변 잠혈 검사의 악성 종양에 대한 민감도는 56.3%, 특이도는 81.2%, 양성 예측도는 32.1%였다. 결론: 외래에서 진단된 남자 IDA 환자에서 악성 종양의 유병률은 11.9%로 적지 않았고 이 중에서 91.7%가 50세 이상에서 진단되었으며, 악성 종양에 의한 IDA 환자들은 다른 원인에 의한 IDA에 의한 환자들에 비해 경구 철분제 치료에 대한 반응이 좋지 못하였다. 고령(50세 이상)에 대변 잠혈 검사 양성인 남자 IDA 환자에서는 악성 종양이 진단될 확률이 높으며 특히 대장암의 가능성이 높으므로 기저 질환에 대한 철저한 검사가 필요하다. Background/Aims: Despite several reports on clinical aspects of anemia and malignancy, little is known of male patients with iron-deficiency anemia (IDA) and malignancy in Korea. We examined the cause of anemia, prevalence of and factors associated with malignancy, and treatment response to iron therapy in male IDA patients. Methods: The results of 202 males with IDA seen from March 2008 to June 2013 were analyzed retrospectively. The patients were divided into two groups based on the causes of anemia: the cancer group included patients with anemia caused by malignancy and the non-cancer group included patients with anemia due to other causes. We compared the clinical characteristics and response to iron therapy between the two groups. Results: The most common cause of IDA was bleeding (42.6%). The prevalence of malignancy was 11.9%, with colorectal cancer (58.3%) being the most common. Among the cancer patients (n = 24), 22 patients (91.7%) were age 50 or older. Independent factors associated with malignancy were old age (OR, 1.05; p = 0.026) and a positive stool occult blood test (OR, 7.48; p = 0.001). The treatment response to iron therapy based on a normalized hemoglobin level was lower in the cancer group (OR, 0.49; p = 0.31), but the difference did not reach statistical significance. The treatment response based on the mean hemoglobin level was significantly lower in the cancer group (12.6 ± 2.2 vs. 13.8 ± 1.6 g/dL, p = 0.016). Conclusions: Old age and a positive stool occult blood test were independent risk factors for malignancy in male IDA patients. We recommend screening for malignancy in patients older than 50 years or with a positive stool occult blood test. (Korean J Med 2014;87:53-60)
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톡소카라증에 의한 호산구증으로 발생한 말초혈관혈전증 1예
표정의 ( Jeung Hui Pyo ),민병주 ( Byoung Ju Min ),박민선 ( Min Seon Park ),구대회 ( Dae Hoe Ku ),정창호 ( Chang Ho Jung ),심재겸 ( Jae Kyeom Sim ),민혜숙 ( Hye Sook Min ) 대한내과학회 2014 대한내과학회지 Vol.86 No.6
Hypereosinophilia is often associated with eosinphilic infiltration of tissue, which can lead to severe and irreversible organ damage. One of the most characteristic and critical complications is development of thrombosis in cardiac ventricles, and occasionally in deep veins. We report a rare case of hypereosinophilia, with peripheral vascular thrombosis, caused by Toxocara canis infection. (Korean J Med 2014;86:781-784)
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김현범 ( Hyun Beom Kim ),이승헌 ( Seung Hun Lee ),김준환 ( Joonhwan Kim ),조동호 ( Dong Ho Jo ),김성배 ( Sung Bae Kim ),최연근 ( Yeonkun Choe ),심재겸 ( Jae Kyeom Sim ) 국군의무사령부 2019 대한군진의학학술지 Vol.50 No.1
Objective; Adenoviral pneumonia has been common among infectious diseases which developed in the military. The clinical characteristics and outcomes of the patients with adenoviral pneumonia and accompanying complications are not clear. This study aims to evaluate the complications associated with adenoviral pneumonia. Method; All adults(age >18 years) who initially diagnosed as pneumonia by a combination of clinical symptoms, laboratory, and imaging findings in the Armed Forces Daejeon Hospital were prospectively enrolled in the current study from February to September 2018. This research was supported by a grant from the Korean Military Medical Association. Results; During the study period, a total of 126 patients(60 patients via the out-patient department, and 66 patients via emergency department) were finally enrolled. All patients were male, and the mean age was 21.1±3.4 years. Among all patients, 78.6% of patients(99/126) were confirmed as viral pneumonia by respiratory multiplex polymerase chain reaction test. Among 99 patients with viral pneumonia, 69.7%(69/99) patients were diagnosed as adenoviral pneumonia. The most frequent complications were tonsillitis(62.5%), and the others were as follows: hematologic abnormalities(36.2%), gastroenteritis(36.2%), hepatitis(37.7%), hematuria or proteinuria(34.8%), and pericardial effusion(5.8%). Conclusion; The patients with adenoviral pneumonia are sometimes complicated into other systemic organs. The most of systemic complications are improved by conservative management. When patients with severe or fatal adenoviral pneumonia, the physicians should pay attention and monitoring the onset of other systemic organ involvements.
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