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증례 : 진성다혈구증에 병발된 사구체간질 증식성 사구체 신염 1예
박철희 ( Cheul Hee Park ),정낙소 ( Nak So Chung ),정우경 ( Woo Kyung Chung ),방수미 ( Soo Mee Bang ),이종호 ( Jong Ho Lee ),정재걸 ( Jae Gul Chung ),이준승 ( Joon Seung Lee ) 대한내과학회 2005 대한내과학회지 Vol.69 No.-
진성다혈구증과 동반한 사구체신염의 병발은 매우 드문 것으로 보고되어 있다. 진성다혈구증에 병발한 사구체간질 증식성 사구체신염의 보고가 있었으나 면역형광 현미경 검사가 없어서 IgA 신증을 배제하지 못하였다. 저자들은 단백뇨 및 비장비대를 주소로 내원한 환자에서 면역형광 현미경검사를 포함한 신생검으로 사구체간질 증식성 사구체신염과 세계보건기구 진단 기준에 따른 진성다혈구증으로 진단된 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. There are only a few reports of glomerulonephritis associated with polycythemia vera (PV). These cases include diffuse mesangial proliferative glomerulonephritis (mesPGN), Henoch-Schonlein purpura nephritis, focal segmental glomerulonephritis and IgA nephropathy. In 1983, Plomley et al. reported on 3 cases of mesPGN in patients with PV for the first time. However the possibility that these cases were IgA nephropathy could not be excluded since there was no data of electron microscopic or immnunofluorescent (IF) study. We report a case of idiopathic mesPGN combined with PV. A 46-year-old male was referred to our hospital because of proteinuria and splenomegaly on his routine medical examination. While undergoing investigation for the proteinuria, the patient was found to have a high hemoglobin (22.3 g/dL) and hematocrit (68.8%) levels. At that time, the urinary protein excretion was 3.0 g in 24 hour. We diagnosed the patient as a case of PV by World Health Organization criteria. The renal biopsy revealed focal mesangial proliferation with expansion of the matrix. On IF study, there was no deposition of IgA, IgG and C3 in the mesangium. (Korean J Med 69:S884-S889, 2005)
복부 둔상에 의한 장간막 손상 환자의 평가에서 복부단층촬영의 가치
노기철 ( Ki Cheul Noh ),김진주 ( Jin Joo Kim ),정진호 ( Jin Ho Jung ),임용수 ( Yong Su Lim ),양혁준 ( Hyuk Jun Yang ),이근 ( Keun Lee ),진욱 ( Uk Jin ),박철희 ( Cheul Hee Park ) 대한외상학회 2004 大韓外傷學會誌 Vol.17 No.2
Background: Contrast-enhanced Abdominopelvic Computed Tomography(CT) is widely used for diagnosing abdominal injuries after blunt trauma. The purpose of this retrospective study is to classify the contrast-enhanced Abdominopelvic CT finding of mesenteric injuries after blunt abdominal trauma and assess of CT finding on clinical management. Methods: Between January 2000 and December 2003, 607 consecutive spiral abdomonopelvic CT examinations were performed in the ER of Gil medical center after blunt abdominal trauma. CT represented mesenteric injuries : bowel wall thickening or hematoma, mesenteric haziness or fatty infiltration, confined fluid or hematoma within mesenteric folds. We classified patients into 5 Grade by the hematoma size on CT scans : Grade I(None, 0 mm), II(Minimal, ≤10 mm), III(Small, 11~30mm), IV(Moderate, 31~60 mm), V(Large, ≥61 mm). Results: On the basis of the CT findings, 42 of the 607 patients were selected. 18 (42.9%) of 42 patients were classified as having grade I, II, III (≤30 mm) and 24 (57.1%) of 42 patients as having grade IV, V(≥31 mm). Of the 18 patients with grade I, II, III, 16(88.9%) were managed conservatively, while 2(11.1%) underwent surgery. of the 24 patients with grade IV, V injuries, 20(83.3%) were treated surgically and 4(16.7%) patients were managed conservatively. Conclusions: It is sufficient to treat of grade I, II, III mesenteric injuries by conservative management. It should be considered emergency operation to treatment of grade IV, V mesenteric injuries. (p<0.001) There were no relations between grading and initial systolic blood pressure, initial blood pressure and operation.
양필선 ( Pil Seon Yang ),박철희 ( Cheul Hee Park ),정낙소 ( Nak So Chung ),김성용 ( Sung Yong Kim ),이미라 ( Mee Ra Lee ),백한주 ( Han Joo Baek ) 대한류마티스학회 2004 대한류마티스학회지 Vol.11 No.4
Systemic lupus erythematosus (SLE) is an autoimmune disease which may affect different organs and disclose various clinical manifestations. The clinical manifesations of central nervous system involvement in SLE are highly variable and range from mild cognitive dysfunction, movement disorder, headache, psychosis to life-threatening stroke and coma. Among neuropsychiaric disorders encountered in patients with SLE, cerebrovascular disease has relatively been rare complication. We experienced a case of subdural hematoma (SDH) occurring in a SLE patient which presented with headache. She was diagnosed as SDH by neuropsychiatric symptoms, brain CT, and brain MRI, and showed good response to medical treatment.
B형 간염바이러스, 음주, 그리고 B형 간염바이러스와 음주의 중복 원인에 의한 간경변증에서 간세포암종 발생에 관한 단면 비교연구
정낙소 ( Nak So Chung ),권오상 ( Oh Sang Kwon ),박철희 ( Cheul Hee Park ),김영남 ( Young Nam Kim ),조권현 ( Gwon Hyun Cho ),이종준 ( Jong Jun Lee ),김길현 ( Gil Hyun Kim ),김현옥 ( Hyun Ok Kim ),고광일 ( Kwang Il Ko ),유상균 ( San 대한소화기학회 2007 대한소화기학회지 Vol.49 No.6
목적: 만성 C형 간염 환자에서 음주는 간세포암종 발생을 증가시키는 것으로 알려져 있으나, 만성 B형 간염 환자에서 음주가 간세포암종 발생을 증가시키는지의 여부는 명확히 밝혀져 있지 않다. 이번 연구는 만성 B형 간염바이러스에 의한 간경변증 환자에서 음주가 간세포암종 발생을 증가시키는지에 대하여 알아보고자 하였다. 대상 및 방법: 2001년 3월부터 2005년 6월까지 B형 간염바이러스 또는 음주가 원인인 간경변증 또는 간세포암종 환자 342명을 대상으로 하여 단면 연구를 시행하였다. 간질환의 원인에 따라서 음주군(AL), B형 간염바이러스군(HBV), 그리고 B형 간염바이러스와 음주에 의한 중복 원인군(HBV+AL) 등 3개의 군으로 분류하였다. 환자들의 등록 당시 나이, 검사실 결과, 그리고 간경변 원인을 조사하여 간세포암종의 위험인자를 다변량 로지스틱 회귀분석을 이용하여 분석하였다. 결과: 전체 간경변증 환자(n=342)에서 원인에 따른 비는 AL군 44%, HBV군 39%, 그리고 HBV+AL군 17%로 음주가 원인인 경우가 가장 많았다. 각 원인별 간경변증에서 간세포 암종이 차지하는 비가 HBV+AL군(76%)이 AL군(17%)과 HBV군(55%)에 비해 높았다(p<0.01). 간세포암종 진단 시의 나이는 HBV+AL군(52±9세)이 AL군(60±11세)에 비해 젊었으나(p=0.036) HBV군(55±10세)과는 차이가 없었다. 간세포암 발생의 위험인자를 찾고자 시행한 다변량 로지스틱 회귀분석에서 독립적인 위험인자는 나이와 원인으로, 나이가 많을수록(odds ratio: 1.056, p<0.001) 그리고 AL군에 비해 HBV군(odds ratio: 8.449, p<0.001)이 HBV군에 비해 HBV+AL군(odds ratio: 2.614, p=0.007)이 간세포암종 발생이 높았다. 결론: B형 간염바이러스에 의한 간경변증에서 음주가 간세포암종 발생을 촉진시킬 수 있는 것으로 생각하나, 향후 이를 증명하기 위한 전향 연구가 필요하다. Background/Aims: Alcohol may be a cocarcinogen in patients with chronic viral hepatitis. We investigated the effect of alcohol on the development of hepatocellular carcinoma (HCC) in liver cirrhosis (LC) caused by hepatitis B virus (HBV). Methods: All patients with LC or HCC associated with HBV or alcohol, admitted between March 2001 and June 2005, were included. Patients were divided into three groups according to the etiology of LC: Alcohol (AL), HBV, or HBV+alcohol (HBV+AL). Age and laboratory data at the enrollment of study were analyzed. The logistic regression coefficiency for the prevalence of HCC was calculated by using variables such as age, gender, serologic markers, and etiology of LC. Results: In LC patients (n=342), the proportions of AL, HBV, and HBV+AL groups were 44%, 39%, and 17%, respectively. The proportions of HCC in AL, HBV and HBV+AL groups were 17%, 55%, and 76%, respectively. Age at the diagnosis of HCC was younger in HBV+AL than in AL group (p=0.036). In logistic regression analysis for the risk factor of HCC, odds ratio of age was 1.056 (p<0.001). Odds ratios of HBV and HBV+AL group comparing AL were 8.449 (p<0.001) and 17.609 (p<0.001), respectively. Therefore, old age and chronic alcohol intake in patients with HBsAg were the risk factors of HCC. Conclusions: Chronic alcohol intake may be an additive factor for the development of HCC in patient with LC caused by HBV. However, a prospective cohort study is needed to confirm these findings. (Korean J Gastroenterol 2007;49:369-375)
정낙소 ( Nak So Chung ),김연석 ( Yeon Suk Kim ),박철희 ( Cheul Hee Park ),김성용 ( Sung Yong Kim ),이미라 ( Mi Ra Lee ),권광안 ( Kwang An Kwon ),정문기 ( Moon Gi Chung ),박동균 ( Dong Kyun Park ),김선숙 ( Sun Suk Kim ),권소영 ( So 대한소화기학회 2005 대한소화기학회지 Vol.45 No.3
Complications of acute pancreatitis usually occur in pancreas and its contiguous organs. The prevalence of colonic invasion is rare, however, the consequence is fatal, with mortality above 50%. The initial symptoms and onset times are variable and major a