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내과적 질환에 병발된 반사성 교감신경계 위축 증후군 20 예의 분석
송소향(So Hyang Song),이정득(Jeong Deuk Lee),이상헌(Sang Heon Lee),홍연식(Yeon Sik Hong),조철수(Chul Su Cho),박동준(Dong Joon Park),정수교(Soo Kyo Chung),김호연(Ho Yun Kim) 대한내과학회 1993 대한내과학회지 Vol.45 No.5
N/A Reflex sympathetic dystrophy syndrome (RSDS) is an distinct symptom complex characterized by diffuse distal-limb pain, edema, vasomotor skin change and dystrophic skin change. It has been associated with limb-trauma, acute stoke, myocardial ischemia, peripheral neuropathy, phamacological agents such as phenobarbital and antituberculosis agents and malignancy. We report the clinical and radiological features of 20 patients who were diagnosed of RSDS at Kangnam Saint Mary's Hospital between January 198S and May 1991. The results were as fo1lows: 1)According to Kozin's criteria, seven (35%) are diagnosed of definite RSDS, eight (40%) of probable RSDS, and five (25%) of doubtful RSDS. 2) Disorders associated with RSDS were cerebrovascular disease (7 patients), malignancy (4 patients), myocardial ischemia (4 patients) and antituberculosis drug (2 patients). The remaining 6 padtients (30%) had no specific precipitating events. 3) Review of the Three phase bone scitigraphy (TPBS) for 20 patients indicated that nineteen of twenty patients (95%) has asymmetric and abnormal blood flow in TPBS. 4) Most patients were diagnosed early, therefore, had symptomatic relief without sequele such as flexion contracture of skin or subcutaneous atrophy by analgesics, steroid, calcitonin and physical therapy. In summary, the TPBS is a potentially sensitive and specific test to corroborate the diagnosis of RSDS and we can expect to have symptomatic relief without sequence if this disorder could be diagnased and treated, early.
특발성 과호산구성 증후군에 병발한 Immunotactoid Glomerulopathy 1예
이정득,우제영,윤영석,강성구,방병기,양기화,지영희,심상인 대한내과학회 1992 대한내과학회지 Vol.42 No.5
저자들은 수술 전 시행한 말초혈액검사에서 우연히 호산구증다증이 발견되어 여러 검사를 거쳐 과호산구성 증후군으로 진단된 환자가 중증 단백뇨의 소견을 보여 신장 조직검사를 실시하였다. 조직검사 결과 광학현미경 소견상 신사구체 모세관 기저막의 비후와 부종성 변화를 보이는 세포 및 섬유성 물질에 의하여 모세관 내강이 막혀있는 소견과 면역형광현미경 검사상 IgG, C3가 모세관 벽을 따라 침착된 소견을 보였고 전자현미경 검사상 내피세포 하부의 기저막에 직경 20nm의 섬유성 물질의 침착을 보였고 유전분증의 진단적 가치를 가지는 염색법인 Congo red에 음성을 보였다. 이상과 같은 소견은 immunotactoid glomerulopathy에 합당하다고 생각되어 문헌고찰과 함께 보고하는 바이다. The immunotactoid glomerulopathy is a recently described entity characterized histologically by highly organized ultrastructural deposits that appears to be composed of immunoglobulin and complement and are negative for amyloid by Congo red stain. The idiopathic hypereosinophilic syndrome is a disease characterized by idiopathic eosinophilia in blood and eosinophilic infiltration of multiple organs. Although all organ systems can be virtually involved, renal involvement is rare. The authors have experienced a case of idiopathic hypereosinophilic syndrome in a 18-year-old male who showed asymptomatic proteinuria of nephrotic range. Renal biopsy revealed the findings of thickening of the glomerular capillary basement membranes and deposits within the capillary lumen by light microscopy. Immunofluoresence microscopy disclosed IgG and C3 in mesangial regions and capillary walls. Electron microscopy showed highly organized, fibrillary structures measuring about 20 nm in the mesangial matrix and basement membrane. Congo red staining for amyloid was negative. This case was thought to represent an instance of immunotactoid glomerulopathy.
항 C(rh`) 항체에 의한 지연 용혈성 수혈 반응 1 예
서정민,박동준,김판규,이혜경,조철수,심규식,박석준,이정득 대한내과학회 1993 대한내과학회지 Vol.45 No.1
A delayed hemolytic transfusion reaction precipitated by anti-C (rh') is described in a previously transfused 40-year-old man. Seven days after the transfusion of the 7 pints of red cells for anemia due to Mallory-Weiss syndrome, he experienced a fall in hematocrit and hemoglobinuria accompanied by a positive direct and indirect antiglobulin test. Anti-C (rh') was identified in the patients serum by Panel cell screening test.
신조직검사로 진단된 급성백혈병 세포의 침윤에 의한 신부전
박석영,김판규,김석영,한지연,서광선,박지원,임응훈,방병기,양철우,김종률,이정득 대한내과학회 1993 대한내과학회지 Vol.45 No.5
Infitration of the kidneys in acute 1ymphocytic leukemia is thought to cause rarely functional imparment or lead to renal failure. When renal failure occurs in acute lymphocytic leukemia(ALL), it is secondary to complications such as tumor lysis syndrome, uric acid nephropathy, obstruction, haemolysis and glomerulone-phritis. We report a 56 year-old female patient with ALL who presented with renal failure and was found to have extensive infitration of the kidney with leukemic infiltrates. The absence of other causes of renal failure and the presence of large kidneys with extensive infiltration of the interstitum with tumor cells makes it highly likely that renal failure was caused by leukemic infiltration.