간경변 환자에서 조영 심초음파검사를 이용한 폐내 단락의 빈도 및 임상적 의의

정석(Seok Jeong),배성권(Sung Kwon Bae),권계숙(Kye Sook Kwon),조성욱(Seong Wook Cho),고광근(Kwang Kon Koh),신용운(Yong Woon Shin),조상균(Sang Kyoon Cho),김순혜(Soon Hye Kim),김삼수(Sam Soo Kim) 대한내과학회 1998 대한내과학회지 Vol.54 No.5

N/A Objectives: Intrapulmonary vascular abnormalities resulting in right-to-left shunt have been described in patients with severe liver disease, especially advanced hepatic cirrhosis. They result in hypoxemia which is associated with liver cirrhosis without preexisting cardiac or pulmonary diseases. Since Rydell and Hoffbauer first described intrapulmonary shunt in a cirrhotic patient in 1956, it has been reported recently that 13 to 47 percent of the end-stage hepatic disease patients have these intrapulmonary vascular abnormalities. Contrast echocardiography (CE) has been proved useful in detecting intrapulmonary shunt, The aim of the study is to determine the prevalence of intrapulmonary shunt by CE in patients with hepatic cirrhosis, and to campare the clinical characteristics of those with and without evidence of intrapulmonary shunt. Methods: We performed CE studies in 24 stable cirrhotic patients without the evidence of severe complications such as massive ascites, upper GI bleeding, and hepatic coma. Clinical information including symptom and sign, results of liver and pulmonary function tests, and arterial blood gas values measured both at the supine and erect position, were analyzed in each group of patients with or without intrapulmonary shunt. Results: Positive CE suggesting intrapulmonary shunt was found in 8 of 2A patients (33.3%). However the degree of relative opacifications were one positive (1+) in all 8 patients, and hypoxemia and its related symptom and sign appeared to be rare. Any of the parameters of liver and pulmonary function test did not show the significant difference between CE-positive and CE-negative group. Conclusion: Only the presence of spider angioma was associated with intrapulmonary shunt among the several clinical signs, which suggests common pathogenesis of both vascular abnormalities.

내부 승저증(internal myiasis) 1례

정평림(Pyung-Rim CHUNG),정영현(Younghun JUNG),김기선(Ki-Sun KIM),조상균(Sang-Kyoon CHO),정석(Seok JEONG),이한일(Han-Il REE) 대한기생충학열대의학회 1996 The Korean Journal of Parasitology Vol.34 No.2

증례 : 성인에서 발견된 단독 심실 비치밀화증 1예

임연정 ( Yeun Jung Lim ),김정순 ( Jeong Soon Kim ),김인환 ( In Hwan Kim ),박상순 ( Sang Soon Park ),조성욱 ( Seong Wook Cho ),김동진 ( Dong Jin Kim ),조상균 ( Sang Kyoon Cho ) 대한내과학회 2007 대한내과학회지 Vol.73 No.1

단독 심실 비치밀화증은 태아기에 심근의 치밀화 과정이 정지됨으로서 과도한 육주(trabecula)가 형성되고 그 육주 사이에 깊은 함몰이 생기는 선천성 심근병증이다. 진단을 위해 심초음파는 가장 중요한 검사이며, 심초음파로 진단이 확실하지 않을 때에는 비침습적인 방법으로 다중단면 컴퓨터 단층촬영(MD CT), 자기공명단층촬영(MRI)을 통해 도움을 받을 수 있다. 임상양상은 매우 다양하여 무증상인 경우부터 심장이식이 필요하거나 사망할 수도 있는 전격성 심부전까지 나타날 수 있으며, 부정맥, 혈전 색전증이 발생할 수 있다. 저자들은 성인남자에서 심계항진 및 호흡곤란을 주소로 내원하여 단독 심실 비치밀화증으로 진단받고 심부전, 심방 세동 및 심첨부의 혈전에 대한 치료를 하였으나 결국 난치심부전 및 다발성 장기부전으로 사망한 1예를 경험하였기에 보고하는 바이다. Noncompaction of the ventricular myocardium is a rare congenital cardiomyopathy that is thought to be caused by arrest of normal endomyocardial embryogenesis. It is usually diagnosed via echocardiography. The three major clinical manifestations of noncompaction are heart failure, arrhythmia and embolic events. We report here on a case of isolated noncompaction of the ventricular myocardium, and the patient was admitted due to palpitation and dyspnea. Sadly, he died of intractable heart failure despite that we administered intensive medical treatment.(Korean J Med 73:96-102, 2007)

가족성 대동맥판 상부 협착증

권계숙,박태병,조철호,고광곤,조상균,김삼수,박찬섭,서창해 대한내과학회 1993 대한내과학회지 Vol.44 No.5

저자등은 대동맥판 상부 협착증을 가진 남매의 증례를 통해 가족성 대동맥판 상부 협착증을 경험하였기에 문헌 고찰과 함께 보고하는 바이다. Supravalvular aortic stenosis is a dongenital narrowing of the ascending aorta. The stenotic lesion may be localized or diffuse, originating at the superior margin of the sinuses of Valsalva just above the level of the coronary arteries. This disease is suggested to have familial tendency heredited by an autosomal dominant type of transmission. A 17-years-old male with intermittent exertional chest pain, whose elder sister being a patient with supravalvular aortic stenosis, was admitted for cardiologic evaluation. Diagnosis of supravalvualr aortic stenosis was made by echocardiography, angiocardiography and magnetic resonance imaging of heart. We reported a case of familial supravalvualr aortic stenosis with a review of literature.

관상동맥 경련이 의심되는 한국인에서 0.4㎎ Ergonovine Maleate 단일괴 사용법에 의한 유발 검사

고광곤,윤진,이기형,우재순,김치열,김영범,조철호,조상균,김삼수 대한내과학회 1992 대한내과학회지 Vol.42 No.2

관상동맥 경련은 허혈성 심질환의 다양한 임상상에 역할을 한다. 관상동맥조영검사가 경련을 진단 내리는데 유일한 직접적인 검사 방법이다. 경련을 유발시키기 위해서 여러 검사 방법들이 사용되었지만, ergometrine이 경련을 유발시키는데 가장 효과적 약물이라고 발표되었다. 여러 사람들이 다양한 용량과 다양한 방법으로 ergonovine을 사용해왔다. 하지만 ergonovine의 dose-response curve는 누적용량(0.1+0.2+0.3+0.4㎎)이 0.4㎎의 단일 용량과 똑같은 효과를 보였고, 용량 중강 방법이 시간 소비적이am로 0.4㎎ ergometrine 단일괴를 사용하여 검사한 결과, 위험성이 용량 중강 방법과 차이가 없다고 발표되었다. 방법 : 비전형적 흉통을 주소로 하는 6명과 급성 심근경색증 1명 모두 7명을 A군, 임상적으로 이형협심증이 강력히 의심되는 환자 6명을 B군으로 나누어 13명 환자들에게 단일괴 0.4㎎ ergonovine을 정주하여 검사하였다. 결과 : A군 환자들에게 관상동백조영검사상 30% 이하의 미만성 혈관수축을 관찰하였고, 흉통이나 심전도 변화는 없었다. B군 환자들에게 관상동맥조영검사상 2명에서 우측 관상동맥이 각각 100%, 95% 협착, 1명에서 좌전하행지 완전 협착, 1명에서 좌측 회선지 완전 협착, 2명에서 50에서 75%에 이르는 미만성 삼혈관상동맥 협착 소견을 관찰하였다. 6명 모두 전형적 협심증을 호소하였고, 6명중 2명에서 ST-T분절 변화 소견을 보였다. 저자들은 이형협심증이 의심되는 한국인에서 단일괴 0.4㎎ ergonovine 검사 방법을 치명적인 부정맥이나 심경색증, 사망 등의 합병증 없이 좋은 결과를 얻고 시행하였다. 결론 : 0.4㎎ 단일괴 ergonovine 유발 검사는 관상동맥 환자들은 진단내리는 데 예민하고 특이적이고 임상적으로 유용한 방법이며, 대상과 금기 사항을 잘 가기고 주의사항을 잘 알고 이행하며, 한국인에서도 안전하고 정확하게 시행될 수 있는 방법이라고 생각된다. Background. Many tests have been proposed for the provocation of coronary arterial spasm. But, ergonovine maleate has been known to be most effective for the provocation. Although ergonovine testing is usually safe, a number of complications have been described. Therefore, several investigators recommend the use of incremental doses starting with an intravenous injecion of 0.05~0.1㎎ followed by small incremdents of 0.1~0.15㎎ at 2~5 min intervals up to a maximum of 0.4㎎. By a dose-response curre of ergonovine, the cumulative doses (0.1+0.2+0.3+0.4㎎) have the same effects that a single dose of 0.4㎎ Methods. Because the technique with incremental doses is time-consuming, we performed using a single bolus of 0.4㎎ ergonovine intravenously without any increments in 13 patients who were divided clinically into 2 groups: group A: 7 patients with atypical chest pain (6) and acute myocardial infarction (1). group B: 6 patients with strongly suspected variant angina. Results. In group A patients coronary angiography demonstrated less than 30% diffuse vasoconstriction not accompanied by chest pain or electrocardiographic changes. In group B patients coronary angiography demonstrated right coronary artery 100%, 95% stenosis in 2 patient, total occlusion of left circumflex coronary artery in 1 patients and more than 50% to 75% stenosis of diffuse three vessel coronary in 2 patients. All six patients complained of typical angina and 2 of 6 patients showed ST-T segment changes. We performed using a single bolus of 0.4㎎ ergonovine to provoke coronary arterial spasm in Korean patients without major arrhythmia, myocardial infarction or sudden death. Conclusion. Provocative testing with a single bolus of 0.4㎎ ergonovine maleate in Korean is safe, time-saving and radiation exposure-reducing if precautions and contraindications are used.

간전이가 동반된 intraductal papillary mucinous tumor 1 예

김병수,김용태,김정룡,정윤철,윤용범,류지곤,장유현,조상균,최윤정 대한내과학회 2000 대한내과학회지 Vol.59 No.4

IPMT는 우리나라에서는 1992년에 처음 보고되었으며 점차 증례 수가 늘고 있다. 이 질환은 악성일 수 있고 전암성 병변일 수도 있으나 악성일지라도 절제가 가능하여 췌관암에 비해 예후가 양호한 경우가 있다. 본 증례의 환자는 63세의 남자로서 진단 당시 간전이가 동반되어 있었다. 환자는 3 개월 전에 시작된 반복적인 심와부 동통을 주소로 내원하였으며, 복부 전산화 단층 촬영에서 췌장 체부에 3 cm 크기의 종괴와 췌관의 확장, 다발성 간전이의 소견을 보였다. ERCP에서 팽대된 유두부 개구와 점액 분비, 미만성으로 확장된 췌관이 관찰되었으며, 동시에 시행한 세포진 검사에서 점액성 물질과 비전형적인 원주 상피세포가 보였다. 초음파 유도로 간 조직검사를 시행하여 전이성 선암으로 진단되었다. 환자는 보존적 치료 만을 받았으며 3개월 후 사망하였다. Intraductal papillary mucinous tumor has been reported with increasing frequency these days. It can be malignant (adenocarcinoma) or premalignant (adenoma). This tumor, even when malignant, is often resectable and has a favorable prognosis as compared with pancreatic ductal adenocarcinoma. We report a case of intraductal papillary mucinous tumor with liver metastasis in a 63-year-old male patient. He presented with recurrent epigastric pain, which had developed 3 months ago. Abdominal computed tomography showed the diffusely dilated pancreatic duct, 3 cm-sized low-attenuated mass in the body and multiple liver metastasis. During endoscopic retrograde pancreatography, patulous orifice of papilla, mucin secretion and diffusely dilated pancreatic duct were noted. Cytologic examination during ERCP revealed mucinous material with atypical columnar cells. Metastatic adenocarcinoma was confirmed by sono-guided liver biopsy. Only supportive care has been done and he died at 3 months after the diagnosis.(Korean J Med 59:472-477, 2000)

정상 관동맥을 가진 이형협심증 환자에서 발생한 급성 심근경색증의 혈전용해제 치험

김삼수,김응진,고광곤,문태훈,박태병,이명묵,조상균,방준경 대한내과학회 1994 대한내과학회지 Vol.47 No.6

Coronary vasospasm has been proposed as a mechanism of muocardial infarction, particularly in variant angina pectoris with normal coronary arteries. Plaque rupture or prolonged stasis facilitating thrombus formation has been postulated as the mechanisms of vasospasm induced myocardial infarction, Recently some reports decribed effects of thrombolytic therapy in patients with variant angina and chest pain with long duration to prevent or reduce the amount of myocardial infarction. We report two cases of patients with myocardial infarction in normal coronary artery, who were proved coronary artery spasm and were successfully managed by thrombolytic therapy.

상행대동맥류로 수술받은 Marfan 증후군 환자에서 발생한 박리성 하행대동맥류 1예

박태병,김응진,문태훈,조철호,고광곤,조상균,김삼수,김문환,진성훈,박찬섭,서창해 대한내과학회 1993 대한내과학회지 Vol.44 No.2

Marfan증후군 환자에서의 심혈관계 병변은 주로 상행동맥의 확장과 이에 동반된 합병증(대동맥박리, 대동맥판 폐쇄부전증)을 나타나는 경우가 많으며 이들 병변이 문제를 일으킬 정도가 되면 수술적 치료를 하는 경향이다. 그러나 Marfan증후군 환자에서의 혈관병변은 대동맥 중막의 약화로 인해 대동맥의 다른 부위에서도 쉽게 일어날 수가 있으며 주의깊은 관찰과 대비가 필요하다. 저자들은 Marfan증후군 환자에서 대동맥판 폐쇄부전증이 동반된 상행대동맥류로 modified Bentall수술을 시행받고 추적 관리중 하행대동맥에 박리성대동맥류가 발생하여 내과적으로 치료한 증례를 경험하였기에 보고하는 바이다. Most of the patients with Marfan's syndrome are affected by cardiovascular complications which is responsible for the patient's reduced life expectancy. So, to prevent catastrophic event, surgical correction of dilated aorta, dissecting aortic aneurysm or incompetent valve is often indicated. The cardiovascular complication can occur on any large vascular system and multiple lesions and recurrences are not rare. Case: 36-years-old female with Marfan's syndrome was admitted due to suddenly developed back pain. She was performed modified Bentall's operation 4 years earlier due to ascending aortic aneurysm and aortic regurgitation as complications of Marfan's syndrome. The aortography and abdominal ultrasonography revealed dissecting aneurysm at descending thoracic and abdominal aorta without compromised major branches. The patient was managed conservatively and was able to discharge without any serious problems.

폐동정맥 기형을 동반한 유전성 출혈경향 말초혈관 확장증 1 예

김삼수,백완기,이준희,김인한,고광곤,조철호,김여주,문태훈,김준미,박찬섭,민수기,조상균,조수신,정원모,주영채 대한내과학회 1996 대한내과학회지 Vol.50 No.4

Hereditay hemorrhagic telangiectasia (Osler-Weber-Rendu disease) is a familial disease that is characterized by delicate, ectatic vessels in the skin, mucous membrane and viscera. These patients have generalized vascular derangement. Pulmonary arteriovenous fistular is a rare congenital condition originated from malformation of capillary development. Direct communications between branches of the pulmonary artery and pulmonary vein cause right-to-left shunts, in which mixed venous blood cannot be oxygenated as it passes throuth the pulmonary circulation, Congenital arteriovenous malformation are associated with Osler-Weber-Rendu disease in 36-57% of cases. Recently, we experienced a rare case of hereditary hemorrhagic telangiectasia with pulmonary arteriovenous malformation.

전기손상으로 발생한 심실 세동과 간혈종을 동반한 Electric Shock 1 예

윤진,김삼수,김응진,조철호,고광곤,박찬섭,박태병,서창해,조상균,최민준,배창환 대한내과학회 1992 대한내과학회지 Vol.43 No.3

Nowadays electrical injuries are common. Electrical injuries result from conversion of electrical energy into heat energy as electrical current courses through tissue. The extent of injury is related to several factors such as voltage, tissue resistance, tissue susceptibility, type of current, current pathway, site, and duration of electrical contact, The heart, in particular, is liable to damage by electrical injury. Thus high voltage($gt;500 V, direct or alternating Current) can cause sudden death from cardiac arrest, but the low voltage(110∼380 V, alternating current 50∼60Hz) u in household electrical equipment aiso cause death, usually from ventricular fibrillation. Recently, we experienced a e of electric shock accompanied by ventricular fibrillation and hepatic hematoma. A 36-year-old ,man was adimitted to the hospital with complaints of apnea and comatose mentality ca by electric injury of 220 Volt. The patient had ventricular fibrillation on admission to the hospital, but reverted to normal sinus rhythm after cardioversion of 200J and cardiopulmonary resuscitation immediately. The history , electrocardiographic findings and cardiac enzymes showed no evidence of myocardial injury or infarction. On 12th and 17th hospital day, abdominal ultrasonography and computed tomography scan was done to evaluate liver damage, which showed 6×4cm-sized hepatic hematoma. The patient had no specific symptom and sign of hepatic hematoma and abnormal liver function test converted to normal range on the 15th hospital day. Abdominal ultrasonography was followed up 2 months after discharge and demonstrated complete resolution of hepatic hematoma.