급성 담낭염에 대한 내과적 치료의 역할

강성원,조한래,한설해,박현주,정인성,홍선미,김성걸,이헌영 충남대학교 의과대학 지역사회의학연구소 1993 충남의대잡지 Vol.20 No.2

In 58 patients who were admitted to department of internal medicine, ChungNam national university hospital from January 1989 to March, 1993. We evaluated for medical treatments and the following results were obtained. 1) The ratio of male and female was 1 : 1 and mean age of the patients was 57.4 years. 2) At arrival on hospital, the most common clinical symptom was pain in right upper quadrant and epigastrium(93.1%), the remainders were fever and chill(79.3%), nausea(51.7%) and vomiting(36.2 %) in order of frequency. 3) The most common physical findings was tenderness on the right upper quadrant and epaigastrium(98%), the remainders were jaundice(50%) and palpable gall bladder(13.8%) in order of freguency. 4) In laboratory examination, elevated levels of ESR(82.8%), leukocytosis(67.2%), elevated levels of AST(62.0%), ALT(50.0%), serum total bilirubin(51.7%) and alkaline phosphatase (43.1%) were noted. 5) The mean period of NPO was 3.9 days and the mean hospital period was 13.5 days. 6) The rates of combined complications in patients with acute cholecystitis were 17.2%; these are gall bladder empyema(5.2%), hydrops(5.2%), perforation(3.4%), sepsis(3.4%) and intestinal obstruction (1.7%). 7) In 96.6 percent of 58 cases, the symptoms of acute cholecystitis were improved by conservative management. 8) The mean follow-up period was 25.5 months and the recurrence rate was 10% during this period.

Propylthiouracil에 의한 간염 1예

박현주,정인성,강성원,조한래,한설혜,한경아,김주형,임양희,오경식 大韓消化器病學會 1994 大韓消化器病學會誌 Vol.26 No.2

간질환 없이 고암모니아혈증을 보인 선천성 하부 장간막-신정맥 단락 1 예

이옥재,박현주,김영채,조한래,손미정,김정렬,원용한 대한내과학회 1995 대한내과학회지 Vol.49 No.6

An inferior mesenteric-caval shunt through the left renal vein is very rare and cause hyperammonemia. Although the accurate cause of this shunt remains unknown, it is considerd as a congenital malformation or seguellae of abdominal surgery. Accordingly, congenital inferior mesenteric-caval shunt needs to be considered in the differential diagnosis of hyperammonemia, particularly when liver disease or portal hypertension are excluded. Recently, we experienced a case of congenital inferior mesenteric-caval shunt through the left renal vein presenting symptomatic hyperammonemia without liver disease in a 61 years old woman. The onset of symptoms has been correlated with a sharp rise in the levels of ammonia in the peripheral blood.

Propylthiouracil에 의한 간염

박현주(Hyun Joo Park),정인성(In Sung Chung),강성원(Sung Won Kang),조한래(Han Rse Cho),한설혜(Sul Hae Han),한경아(Kyung Ah Han),김주형(Ju Hyung Kim),임양희(Yang Hee Lim),오경식(Kyung Shik Oh) 대한소화기학회 1994 대한소화기학회지 Vol.26 No.2

Propylthiouracil(PTU) is widely used to treat patients with hyperthyroidism. In rare case, this drug has been found to have toxic effects on the liver. W e experienced a case of PTU in- duced hepatitis in a 45 year old woman treated for Graves' disease with PTU. The biochemi- cal pattern of injury was predominantly hepatocellular with moderately elevated transminase values and histologic findings revealed marked micro and macrovesicular fatty changes and focal necrosis of hepatocytes without any zonal difference. Discontinuation of drug leads to complete recovery in this case. Although overt hepatitis due to PTU is probably a rare compli- cation, there is a potential danger of permanent liver damage. Thus it might be advisable to monitor transaminase levels on regular base in patients receiving PTU.(Korean J Gastroenterol 1994; 26: 369 372)

만성 폐 질환 환자에서 조직으로의 산소 전도와 2.3 - DPG 동 정맥간 산소 분압 차에 대한 연구

이동수(Dong Soo Lee),김민수(Min Soo Kim),유근배(Geun Bai Yu),조한래(Han Rae Cho),한설혜(Sul Hai Han),오경식(Kung Sik Oh),임양희(Yang Hee Lim),김주형(Ju Hyung Kim) 대한내과학회 1997 대한내과학회지 Vol.52 No.4

N/A Objectives: The presence of chronic low oxygen delivery to the tissues (blood flow×Hb concentration×arterovenous oxygen content difference) in patients with chronic lung disease (CLD) leads to a aggravated dyspnea. Therefore, total oxygen delivery to the tissues is a reverse correlation with severity of dyspnea. So far, the treatment of patients with CLD has been limited to only the increase of ventilation and perfusion capacity. However, this study focused on the capacity of oxygen delivery to the tissues in patients with CLD. We measured blood oxygen parameters as one of the extended approaches. Method: Simultaneous arterial and venous blood samples from 15 patients with CLD at rest were evaluated for 2.3-DPG, CO-Hb (Carboxy-monohe-moglobin), Met-Hb (methomoglobin), ABGA (Arterial blood gas analysis), VBGA (Venous blood gas analysis) and Hb (Hemoglobin). Smokers and patients with other disease were excluded from the study in order to avoid the factors (2.3-DPG, CO-Hb etc.) which can shift the oxygen dissociation curve. There were 12 men and 3 women, ranging in age from 40 to 75 years. The disease onset varied from 3 years to more than 30 years. Results: 1) As total oxygen delivery to the tissues decreased, Ao2(Arterial oxygen partial pressure) and A-VCb (Arteriovenous oxygen content difference) decreased, while 2.3-DPG increased. Total oxygen delivary to the tissues showed a significant correlation with more A-V and 2.3-DPG than AO2. 2) AO2 had a correlation with A-VO2 but AO2 did not clearly reflect A-VO2. 3) 2.3-DPG activity depended on more A-VO2 than AO2. 4) As A-VO2 decreased, there was more significant relationship among 2.3-DPG, A-VO2 and tissue oxygen delivery. 5) A-VO2 showed a significant reverse correlation with 2.3-DPG as well as Met-Hb % + CO-Hb %. 6) ACO2 (arterial carbon dioxide partial pressure) showed a correlation with 2.3-DPG as well as A-VO2. 7) Arterial PH did not correlate with 2.3-DPG as well as A-V. Conclusion: 1) AO2 in patient with CLD correlated with A-VO2 but AO2 did not clearly reflect A-V. 2) Total oxygen delivery (severity of dyspnea) showed a significant correlation with more A-VO2 and 2.3-DPG than AO2. 3) 2.3-DPG activity depended on more A-VO2 than AO2. 4) 2.3-DPG activity had a reverse correlation with A-V in spite that 2.3-DPG shifts the oxygen dissociation curve to the right, because 2.3-DPG shift is secondary change associated with the low oxygen delivery to the tissues, More extensive k prospective investigations are needed to clearly define correlation among A-VO2, 2.3-DPG and prognosis of patients with CLD.

심초음파도와 영상화 심혈관 조영술을 이용한 심 박출계수간의 상관 관계에 대한 연구

오지영(Jee Young Oh),신길자(Gil Ja Shin),박시훈(Si Hoon Park),이우형(Woo Hyung Lee),조한래(Han Rae Cho) 대한내과학회 1997 대한내과학회지 Vol.52 No.5

N/A Objective: Left ventricular ejection fraction is an important clinical variable with respect to diagnosis, treatment and prognosis in various cardiovascular diseases. Measurement of left ventricular ejection fraction is performed by three commonly used methods, M-mode and two dimensional echocardiography, radionuclide angiography and contrast cineangiography. We compared echocardiographic and contrast cinean-giographic ejection fraction by correlation coefficiency to determine the accuracy of echocardiography determined ejection fraction at our institution and to assess the agreement of left ventricular ejection fraction between two methods. Methods: We measured left ventricular ejection fraction by M-mode, two-dimensional echocardiography and contrast cineangiography in 144 cases of normal and cardiovascular heart disease patients from September 1993 to April 1995 in the cardiology division of Ewha Womans University hospital. The echocar-diography and contraat cineangiography were performed within 7 days of each other. Results: M-mode echocardiographic ejection fraction correlated with contrast cineangiographic ejection fraction (r=0.7841). M-mode echocardiographic ejection fraction corrected with two-dimensional echocardiography in the presence of regional wall motion abnormality correlated with contrast cineangiographic ejection fraction (r=0.8149). By agreement analysis, the difference of mean of ejection fraction measured by M-mode echocardiography and contrast cineangiography was within 95% confidence limits. The mean was 4.08% and the standard deviation was 8.29%. The difference of mean of ejection fraction corrected by two-dimensional echocardiography and contrast cineangiography was within 95% confidence limits. The mean was -3.19% and the standard deviation was 7.74% Conclusion: The values of left ventricular ejection fraction by echocardiography showed good correlation with those of contrast cineangiographic ejection fraction, Therefore, echocardiography would be a useful tool as contrast cineangiography in evaluating the left ventricular function.