배뇨 후 벼락 두통을 동반한 방광 갈색세포종 1예

이신준,신호식,정연순,임학 대한내과학회 2011 대한내과학회 추계학술대회 Vol.2011 No.-

A case of peritoneal dialysis related hydrothorax in Liver cirrhotic patient

이신준,신호식,정연순,임학 대한내과학회 2011 대한내과학회 추계학술대회 Vol.2011 No.-

A case of peritoneal dialysis related hydrothorax in liver cirrhotic patient

이신준,신호식,정연순,임학 대한내과학회 2011 대한내과학회 추계학술대회 Vol.2011 No.1

The cirrhotic patient with ascites presents unique challenges to the renal caregiver. Many such patients have renal disease that progress to end stage renal disease, necessitation renal replacement therapy. In peritoneal dialysis (PD), tense ascites can increase the risk of early catheter leak and complicate the initial instillation of dialysate. These patients are at increased risk of spontaneous bacterial peritonitis and would be suspected to have peritonitis rates different from those in non-cirrhotic patients. Hydrothorax occurs as a complication of peritoneal dialysis in 2% of cases. Hydrothorax in a cirrhotic patient treated with PD poses a diagnostic dilemma. Proposed mechanisms for the development of a pleuro-peritoneal communication include congenital diaphragmatic defects, acquired weakening of diaphragmatic fibers caused by high intra-abdominal pressures during peritoneal dialysis, and impairments in lymphatic drainage. Since treatment modalities differ widely from that of other causes of pleural effusion seen in CAPD patients such as uremia, volume overload, congestive heart failure, infection and malignancy, pleuroperitoneal leak should be kept in mind in the differential diagnosis and should be excluded urgently. Pleural fluid analysis and diagnostic imaging assist in differentiation from other causes of pleural effusion. We report a case of hydrothorax in a cirrhotic patient after recent introduction to peritoneal dialysis.

배뇨 후 벼락 두통을 동반한 방광 갈색세포종 1예

이신준,신호식,정연순,임학 대한내과학회 2011 대한내과학회 추계학술대회 Vol.2011 No.1

서론: 갈색세포종은 카테콜라민을 분비하는 이차성 고혈압의 원인이 되는 종양 중 하나로 교감신경계의 크롬친화세포가 있는 곳은 어디서나 발생할 수 있다. 성인의 90%는 부신 수질에서 발생하며, 약10%에서는 방광, 두경부, 복부 대동맥 주위 등의 부신 수질 이외 장소에서 발생하는데, 방광에 발생한 원발성 갈색세포종은 매우 희귀한 질환으로 방광종양의 0.06%미만이며, 갈색세포종의 1%미만을 차지한다. 방광에 일차 적으로 발생한 원발성 갈색세포종의 술전 진단은 대개 임상병력으로 의심하며, 24시간뇨에서 에피네프린과 노르에피네프린 또는 그것들의 대사부산물을 측정하여 확진한다. 임상적 특징으로 육안적 혈뇨, 발작성 또는 지속적 고혈압, 심계항진, 과다한 발한, 창백, 배뇨 시 발작성 두통 등이 있는데, 배뇨 시 발작성 두통이 약 50%정도에서 나타난다. 저자들은 배뇨 후 반복적으로 발생하는 혈압상승을 동반한 두통을 주소로 내원한 환자에서 방광 갈색세포종 1예를 진단하였다. 증례: 61세 여자가 배뇨 후 반복적으로 발생하는 두통을 주소로 내원하였다. 환자는 7년 전부터 배뇨 직후 또는 배뇨 중에 혈압이 오르고, 심한 두통이 발작적으로 발생하였고, 대증적인 치료를 받아왔으나 호전이 없어 내원하였다. 과거력, 가족력상 특이소견은 없었다. 안저검사를 포함한 신체 검사와 신경학적 검진에서도 특이 소견은 없었다. 내원 당시 혈압은 120/90 mmHg이었으나, 배뇨 후 두통 발생 당시 혈압은 230/110 mmHg까지 측정되었다. 환자 병력과 증상을 바탕으로 배뇨와 관련된 두통을 의심하여 측정한 24시간 요검사에서 vanillylmandelic acid (VMA) 5.93 mg/day(정상치:2-8 mg/day), metanephrine 473 μg/day(정상치:0~300 μ g/day), normetanephrine 1508 μg/day(정상치:0~600 μg/day), epinephrine 10.4 μg/day(정상치:0~20 μg/day), norepinephrine 171.3 μg/day(정상 치:15-80 μg/day)으로 증가되어 있었다. 혈액검사에서 Dopamine 0.042 ng/mL(정상치:0~0.2 ng/mL), epinephrine 0.153 ng/mL(정상치:0~0.3 ng/mL), norepinephrine 0.5 ng/mL(정상치:0~0.8 ng/mL)였다. 복부 전산화단층촬영에서 방광의 좌측벽에 3x3.2cm의 종물이 관찰되었다. MIBG 스캔검사에서 방광 좌측 벽에만 이상 흡수 증가 소견을 보였다. 방광 갈색세포종으로 진단하고 수술을 준비하였다. 수술 2주전부터 알파차단 제(Doxazocin)를 경구로 투여하였고, 부분 방광절제술을 시행하였다. 병리조직검사에서는 CD56, chromogranin, synaptophysin염색에서 양성 반응을 보였다. 술후 추적한 방광경 검사에서 잔존 종양은 없었으며, 배뇨 후에도 혈압은 상승 없이 안정 시와 같이 유지 되었고, 두통도 호전 되었다.

경로탐색을 위한 GIS 네트워크 분석 시스템의 구현

이신준,양성봉,최윤철 연세대학교 산업기술연구소 1999 논문집 Vol.31 No.2

Path finding is one of the basic functions provided in the network analysis system of a geographic information system(GIS). A GIS network analysis system analyzes and models geographic networks, and enables user to solve a variety of problems concerning geographic networks such as finding a most efficient travel route. In path finding there are two types of routing problems. One is to find a shortest route between two nodes. The other is to find an optimum route among many points, which is known as the traveling salesman problem. We have implemented our GIS network analysis system for path finding on the Gothic GIS system. The implemented system consists of the optimal path finder and the multiple path finder. And the system in this paper also solves routing problems efficiently in GIS networks.

GIS에서의 효율적인 최단경로탐색 알고리즘

이신준,양성봉 연세대학교 산업기술연구소 1999 논문집 Vol.31 No.2

Finding a shortest route from a point to another is one of the basic functions provided in the network analysis of a geographic information system(GIS). A network in GIS consists of the set of nodes and the set of links. There are many examples for geographical networks such as streets, highways, railways, communication lines, electric lines, pipelines, rivers, etc. In this paper, we present four efficient algorithms for finding a shortest path in a network. Each algorithm utilizes the coordinates of nodes to reduce the search space and keeps a tree-like data structure, called a path tree, to find a better route than the path found in the previous step of the algorithm. Our algorithms can be classified into two types depending on the search directions used in the algorithms: one-way search and two-way search methods. Each search method can be further divided into two methods depending on whether the depth-first search(DFS) or the breadth-first search(BFS) is used. Overall, we have four methods: one-way DFS-DFS, one-way DFS-BFS, tow-way DFS-DFS, and two way DFS-BFS Each method has been compared with each other along with Dijkstra's algorithm. The experimental results have shown that two-way DFS-BFS outperformed others in almost all cases.

Tiropramide에 의해 발생한 전신두드러기

이신준 ( Shin Jun Lee ),한유진 ( You Jin Han ),이혜원 ( Hae Won Lee ),김희규 ( Hee Kyoo Kim ),최길순 ( Gil Soon Choi ) 대한천식알레르기학회 2011 천식 및 알레르기 Vol.31 No.4

Background: Tiropramide (Tiropa(R)), a widely prescribed drug, has rarely shown adverse reactions. We report the first case of drug adverse reactions with tiropramide. Case History: A 45 year old female patient complained of hives on the whole body with perioral and periorbital angioedema 2 hours after taking a drug containing tiropramide. Results: The intradermal skin test with tiropramide showed a weakly positive reaction. The oral challenge test was performed with tiropramide and resulted in urticaria and angioedema after 3 hours. The patient was confirmatively diagnosed with drug adverse reactions by tiropramide. Conclusion: Although the incidence of drug adverse reactions induced by tiropramide is rare, clinicians should be aware of this adverse reaction in clinical practice. (Korean J Asthma Allergy Clin Immunol 2011;31:300-303)

나선형 깊이 우선 탐색 방법을 사용한 3차원 데이터 압축 방법

이신준(Shin-Jun Lee),박우찬(Woo-Chan Park),이현석(Hyun-Suk Lee),양성봉(Sung-Bong Yang) 한국멀티미디어학회 2000 한국멀티미디어학회 학술발표논문집 Vol.2000 No.2

신장 이식 후 발생한 침습성 아스페르길루스 부비동염을 수술과 Voriconazole로 치료한 1예

신호식,이신준,정연순,임 학 고신대학교 의과대학 2011 고신대학교 의과대학 학술지 Vol.26 No.2

Invasive fungal sinusitis is a rare, severe disease, most commonly presenting in immunocompromised patients who have impaired neutrophil function or who have received long term immunosuppressive therapy. The gold standard for treatment has been wide surgical debridement, intravenous administration of antifungal agents such as amphotericin B (AMB), and correction of the underlying immunocompromised state. A 51-year-old female was admitted to our hospital with fever and headache who had received renal transplantation 14 years ago in the other hospital. Paranasal sinus CT scan revealed hyperplasia and soft tissue density of the left maxillary sinus. Histological examination of the fungus ball and edematous mucosa of the left maxillary sinus revealed suspicious invasion of Aspergillus in the mucosa. Clinical improvement occurred after a combination of surgery and post-operative systemic antifungal therapy with voriconazole. We think that voriconazole as initial treatment may be initiated for invasive sinonasal aspergillosis, if the infection is known to be due to Aspergillus species.

기관지내시경 초음파 조직검사로 진단된 종격동 이소성 갑상선조직 1예

박세진,이신준,심인경,장태원,천봉권 고신대학교 의과대학 2011 고신대학교 의과대학 학술지 Vol.26 No.1

A 77-year old woman was referred to hospital with dyspnea and chest dull pain for 5 months. The chest radiograph showed a mass located in the mediastinum. Trachea was deviated to right side. Chest computed tomography showed an enhancing large mass at the middle mediastinum. Endobronchial ultrasonography showed hyperechoic mediastinal mass. We performed endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA). Histologic finding was thyroid tissue with a benign looking papilla. Ectopic thyroid is an uncommon embryological aberration characterized by the presence of thyroid tissue in a site other than in its usual pretracheal region. It occurs along the path of descent of the developing thyroid primodium from the foramen cecum. It is extremely rare for mediastinal ectopic thyroid tissue diagnosised by EBUS-TBNA, so we report here on a case of mediastinal ectopic thyroid and we review the relevant medical literature.