Actinomycosis 감염과 연관된 Henoch-Schonlein Purpura

엄은아,한병호,박남영,이은영,정연순,임학,이승현 대한내과학회 2008 대한내과학회 추계학술대회 Vol.2008 No.-

포스터 전시 발표 순서 : 신장 ; Actinomycosis 감염과 연관된 Henoch-Schonlein Purpura 1례 (초)

엄은아,한병호,박남영,이은영,정연순,임학,이승현 대한내과학회 2008 대한내과학회지 Vol.75 No.1S

The Management of Retained Rectal Foreign Body

김주훈,엄은해,정성민,신용찬,정성원,김재일,허태길,이명수,전흥만,최평화 대한대장항문학회 2020 Annals of Coloproctolgy Vol.36 No.5

Purpose: Because insertion of a foreign body (FB) into the anus is considered a taboo practice, patients with a retained rectal FB may hesitate to obtain medical care, and attending surgeons may lack experience with removing these FBs. We performed this study to evaluate the clinical characteristics of Korean patients with a retained rectal FB and propose management guideline for such cases based on our experience.Methods: We retrospectively investigated 14 patients between January 2006 and December 2018. We assessed demographic features, mechanism of FB insertion, clinical course between diagnosis and management, and outcomes.Results: All patients were male (mean age, 43 years) and presented with low abdominal pain (n = 2), anal bleeding (n = 2), or concern about a retained rectal FB without symptoms (n = 10). FB insertion was most commonly associated with sexual gratification or anal eroticism (n = 11, 78.6%). All patients underwent general anesthesia for anal sphincter relaxation with the exception of 2 who underwent FB removal in the emergency department. FBs were retrieved transanally using a clamp (n = 2), myoma screw (n = 1), clamp application following abdominal wall compression (n = 2), or laparotomy followed by rectosigmoid colon milking (n = 2). Colotomy and primary repair were performed in four patients, and Hartmann operation was performed in one patient with fecal peritonitis. No morbidity or mortality was reported. All patients refused postextraction anorectal functional and anatomical evaluation and psychological counseling.Conclusion: Retained rectal FB is rare; however, colorectal surgeons should be aware of the various methods that can be used for FB retrieval and the therapeutic algorithm applicable in such cases.

신조직검사 후 발생한 괴사성 근막염

한병호,엄은아,박남영,이은영,정연순,임학 대한내과학회 2008 대한내과학회 추계학술대회 Vol.2008 No.-

포스터 전시 발표 순서 : 신장 ; 신조직검사 후 발생한 괴사성 근막염 1예 (초)

한병호,엄은아,박남영,이은영,정연순,임학 대한내과학회 2008 대한내과학회지 Vol.75 No.1S

Anatomical Popliteal Artery Entrapment Syndrome Caused by an Aberrant Plantaris Muscle

권용재,권태원,엄은해,신성,조용필,김종민,이상훈,황승준 대한혈관외과학회 2015 Vascular Specialist International Vol.31 No.3

Purpose: We report on cases of anatomical popliteal artery entrapment syndrome (PAES) caused by an aberrant plantaris muscle and highlight the involvement of this muscle in PAES. Materials and Methods: Seven symptomatic PAES legs in six patients treated at The Division of Vascular Surgery, Asan Medical Center, Seoul, Korea, between 1995 and 2011 were included in this study. We retrospectively analyzed patient records, magnetic resonance imaging (MRI) and/or computed tomography (CT) scans of the knee joint, Doppler pressure studies, CT angiographies, and conventional femoral arteriographies. Results: Five males and one female patient with a median age of 32 (18-53) years old were enrolled in the study. All patients complained of intermittent claudication of the affected leg. All aberrant plantaris muscles were higher and more medially located than normal plantaris muscles, causing occlusion of the popliteal artery upon forced plantar flexion of the ankle. For arterial lesions, five occlusions of the popliteal artery and two patent popliteal arteries with positive provocation were noted. As for treatment, myotomy of the aberrant plantaris muscle was done for two non-occlusive PAES legs. For occlusive PAES legs, one thrombectomy, one saphenous vein graft interposition of the popliteal artery followed by myotomy, and two below-knee femoro-popliteal bypasses were performed. The median follow-up period was 88 (7-148) months. Conclusion: An aberrant plantaris muscle can cause anatomical PAES. Classification or diagnosis of PAES should be based on axial studies using CT scans or MRI using various reconstruction methods. Treatment, including myotomy of the plantaris muscle, should be individualized.

혈관 반응성에 대한 Cyclooxygenase 억제제 효과와 Cyclooxygenase 발현 변화

이기영,박진우,엄은아,강영진,이광윤,최형철 영남대학교 의과대학 2006 Yeungnam University Journal of Medicine Vol.23 No.1

진통과 해열작용을 가진 NSAIDs는 소화기계에 대한 부작용 때문에 COX-2 선택성 억제제로 대체되고 있다. 그러나 COX-2 선택적 억제제는 심혈관계에 대한 부작용이 보고되고 있어 혈관 평활근에 대한 직접적인 연구가 필요하다. 이에 본 연구에서는 혈관 반응성에 미치는 celecoxib와 aspirin, indomethacin의 영향을 비교 분석하였다. 또한 COX-1, COX-2 단백질 발현에 대한 indomethacin과 NO 공여제의 영향을 조사하였다. Phenylephrine 유발 수축반응에서 전처치 된 celecoxib, indometacin, aspirin 순서로 혈관 반응성을 증가시켜, cyclooxygenase를 억제하면 혈관 수축성물질에 대한 반응성이 커질 수 있음을 나타낸다. 이중 cyclooxygenase에 대해 비가역적으로 강한 억제를 나타내는 aspirin이 제일 강한 효과를 나타내어 여기에 대한 연구는 더 필요할 것으로 생각된다. 혈관평활근 세포의 COX-2 단백질 발현은 indomethacin과 SNP, NOR-3 처치에 의해 증가되었으며, LPS를 이용하여 혈관염증을 유발시키는 경우 혈관평활근 세포의 COX-2 단백질 발현이 증가되었고, 이 상태에서 SNP 100μM 전처치로 COX-2 단백질 발현을 감소되었으며, NOR-3 100 μM은 COX-2 단백질 발현을 증가시켰다. LPS 유도 nitrite 생성에서 NOR-3는 SNP 보다 더 많은 nitrite를 생성시켰다. 이는 혈관의 수축반응에서 aspirin은 강한 상승작용을 유발하고, 혈관평활근 세포의 COX-2 발현은 NO 공여제, 혈관염증 유무에 따라 차이가 있는 것을 나타낸다. Background: There is controversy regarding whether COX-2 specific inhibitors are associated with elevation of blood pressure. We compared the effects of aspirin, indomethacin, and celecoxib for vascular reactivity induced by phenylephrine. We also tested the effects of indomethacin and NO donor on COX-1 and COX-2 protein expression, as well as nitrite production in culture medium of vascular smooth muscle cells. Materials and Methods: In this experiment, we used the isometric tension study for vascular reactivity. After 45 minutes of pretreatment with aspirin, indomethacin, celecoxib, and phenylephrine induced contractions were tested. COX-1 and COX-2 protein expressions were analyzed by Western blot and nitrite production by the Griess reaction. Results: Although celecoxib pretreatment caused enhanced arterial contraction, aspirin pretreatment induced more potent arterial contraction than celecoxib in the isometric tension study of rabbit femoral artery. COX-1 protein expression was unchanged by indomethacin, SNP and NOR-3; COX-2 protein expression was increased by the addition of indomethacin, SNP, and NOR-3. Especially, NOR-3, a NO donor, significantly increased COX-2 protein expression with unstimulated conditions as well as LPS stimulation. Induction of nitrite production was higher with NOR-3 treatment than SNP treatment with LPS stimulation. Conclusion: These results suggest that aspirin caused more potent vascular contraction than celecoxib and indomethacin. COX-2 expression in VSMC depended on the types of NO donor and LPS stimulation.

증례 : 신장 ; 신조직 검사 후 발생한 괴사성 근막염 1예

한병호 ( Byoung Ho Han ),엄은아 ( Eun A Eum ),정연순 ( Yeon Soon Jung ),임학 ( Hark Rim ) 대한내과학회 2009 대한내과학회지 Vol.76 No.1S

A Case of Longitudinal Myelitis Associated with Systemic Lupus Erythematosus

Park, Jin Woo,Jung, Hyun Chul,Cho, Joon Hyun,Eom, Eun A,Lee, Ki Young,Woo, Soon Joo,Choi, Seung Won 동국대학교 의학연구소 2006 東國醫學 Vol.13 No.2

가로 척수염은 드물게 발생하는 전신성 홍반성 루프스의 신경계 합병증으로, 척수 신경의 손상을 일으켜 감각과 운동 신경 및 조임근 기능 부전을 일으키며 그 발생기전은 면역 연관성 혈관염으로 추정된다. 최근 가로 척수염이 연속하는 여러 범위의 척수를 침범하는 것을 세로 척수염(longitudinal myelitis)이라고 명명되었는데, 이는 더욱 드물게 발생하며 그 예후도 매우 불량하다. 가로 척수염의 특징적인 자기공명영상 소견은 T2 강조 영상에서 병변 부위의 신호강도가 증가하고 부종이 관찰된다. 최근 저자들은 전신성 홍반성 루프스로 치료 중이던 24세 여자 환자에서 갑작스런 사지마비와 조임근 기능부전이 발생하였으며 자기공명영상에서 흉추 5번에서 12번에 이르는 척수와, 안쪽 시상, 중간뇌, 교내 및 소뇌에서 신호강도 증가를 보여 세로 척수염으로 진단하였다. 이후 환자는 고용량 스테로이드, 사이클로포스파마이드 및 혈장분리반출술로 치료하였으며 부분적 호전을 보였으나, 치료 후 1년 이 경과한 시점에서 하지 이완마비, 제 10흉추 부위 이하의 감각감소와 신경탓 방광은 일부 남아있었다. Transverse myelitis (TM) is a clinical syndrome in which an immune-mediated process causes neural injury of the spinal cord, resulting in sensory or motor deficits and sphincter dysfunction. It is a rare and serious complication of systemic lupus erythematosus (SLE). TM may involve continuous levels of the spinal cord, recently named 'longitudinal myelitis' is more unusual and shows generally poor prognosis. Magnetic resonance imaging (MRI) typically reveals the increased signal intensity in T2 weighted images and edema of the spinal cord. We describe a 24-year-old woman with SLE who developed longitudinal myelitis with acute catastrophic onset, manifesting as quadriparesis, respiratory failure, and sphincter dysfunction. MRI showed extensive involvement of the spinal cord from T5 to T12, medial thalamus, mid brain, pons, and cerebellum. She responded partially to the treatment with high dose corticosteroid, plasmapheresis and cyclophosphamide. But the flaccid paralysis of the lower extremities, sensory loss below T10 levels, and neurogenic bladder persisted.

유지 혈액투석치료를 받는 만성신부전에 수반된 우울증에서 항우울제 치료에 따른 우울증상 및 영양지표의 변화

정연순 ( Yeon Soon Jung ),박시성 ( Si Sung Park ),민은정 ( Eun Jeong Min ),한병호 ( Byung Ho Han ),엄은아 ( Eun A Eum ),임학 ( Hark Rim ) 대한신장학회 2008 Kidney Research and Clinical Practice Vol.27 No.1

목적: 유지 혈액투석치료를 받고 있는 만성신부전 환자에서 수반되는 우울증과 우울증상의 특성 및 정도를 조사하고, 항우울제 치료 전후의 우울증상 및 영양지표의 변화를 측정하여, 우울증과 우울증상의 치료가 유지 혈액투석치료를 받고 있는 만성신부전 환자에게 미치는 임상적 영향을 살펴보고자 하였다. 방법: 고신대학교 복음병원 인공신장실에서 6개월 이상 동안 유지 혈액투석치료를 받고 있는 만성신부전 환자 64명을 대상으로 우울증 및 우울정도와 영양상태 지표들을 조사하였다. 주요우울증의 진단은 반구조화된 면담을 통하여 DSM-IV TR 기준을 사용하였다. 우울증상의 정도는 17문항의 Hamilton Rating Scale for Depression (HRSD)을 사용하여 측정하였다. Subjective global assessment (SGA), body mass index (BMI), triceps skin fold thickness (TSF), mid-arm muscle circimference (MAMC)와 handgrip strength를 측정하였으며 KT/V, normalized protein catabolic rate (nPCR), 혈청 알부민 농도 등과 같은 영양지표도 측정하였다. 우울증이 있는 경우 8주간의 항우울제 약물치료를 시행하였고, 치료 이후 우울증상과 영양상태의 항목들을 재평가하였다. 결과: 만성신부전으로 유지 혈액투석치료를 받고 있는 환자들 중 우울증으로 진단된 환자는 19명으로 42.2% (주요 우울장애 11명 24.4%, 기분부전장애 8명 17.8%)였다. 우울증이 있는 경우 우울한 기분, 죄책감, 자살사고, 수면장애, 일과 활동의 저하, 정신운동의 지연, 정신적 불안 및 신체 불안, 전반적인 신체증상 및 건강염려 등이 유의하게 높았다. 항우울제 약물치료 후 우울한 기분과 정신적 불안, 죄책감, 자살사고, 일과 활동, 수면장애 및 전반적인 신체증상 등이 유의하게 호전되었다. 치료 후 TSF (p<0.05), handgrip strength (p<0.01)와 hematocrit (p<0.05)이 개선되었다. 결론: 유지 혈액투석 중인 만성신부전 환자에서 우울증이 수반될 경우 우울증상에 대한 항우울제 치료는 수면과 신체증상 등을 포함하여 우울증상을 호전시킬 뿐만 아니라 삶의 질을 향상시킬 것으로 기대되므로 적극적인 항우울제 치료가 필요하다고 하겠다. Purpose: Depression is common in patients with chronic renal failure on maintenance hemodialysis, though success rate of treatment is low. This study aimed to investigate the features and severity of the depressive symptoms and nutritional indices, and significant changes after antidepressant treatment. Methods: The authors assessed 45 patients. Diagnosis of depression was made using DSM-IV-TR and the depressive symptoms were evaluated using Hamilton Rating Scale for Depression via semistructured interview. Subjective global assessment, anthropometric measurements and nutritional indices such as Kt/V, nPCR were examined. Depressive patients were treated for 8 weeks with SSRI (citalopram), and all the variables were examined again after the treatment. Results: 19 (42.2%) patients were diagnosed as depression. Nutritional status was not different between patients with depression and those without depression. Compared to non-depressed patients, depressed patients showed significantly higher depressed mood, guilty feeling, suicide idea, psychic and somatic anxiety, lower work and activities, psychomotor retardation, sleep disturbances, general somatic symptoms and hypochondriasis. After antidepressant treatment, depressed mood, guilty feeling, suicide idea, psychic anxiety, initial insomnia, middle insomnia, early awakening, work and activities and general somatic symptoms were improved significantly. TSF (p<0.05), handgrip strength (p<0.01) and hematocrit (p<0.05) were significantly increased. Conclusion: Antidepressant treatment is helpful not only for the improvement of depressive symptoms such as sleep and somatic symptoms but for the improvement of quality of life. Proper treatment should be more actively attempted for the hemodialytic patients with depression.