춘천 지역에서 발생한 쯔쯔가무시병의 임상적 특징

이호권 ( Ho Gwon Lee ),민슬기 ( Seul Ki Min ),공승진 ( Seung Jin Kong ),이수정 ( Su Jung Lee ),송헌호 ( Hun Ho Song ),윤종우 ( Jong Woo Yoon ),이명구 ( Myung Goo Lee ),신동훈 ( Dong Hoon Shin ),강성하 ( Sung Ha Kang ),이정열 ( Jeo 대한내과학회 2005 대한내과학회지 Vol.69 No.2

목적 : 쯔쯔가무시병 환자의 일부는 중증감염으로 중환자실 집중치료를 필요로 하며 이 중 사망하는 환자들도 있다. 본 연구는 춘천 및 인근 지역에서 발생한 쯔쯔가무시병 환자의 임상적인 특징과 이 중 중증환자들의 특징을 분석하여 지역사회의 쯔쯔가무시병의 진단과 치료 및 교육에 도움이 되고자 하였다. 방법 : 1997년 4월부터 2002년 12월까지 한림대학교 부속 춘천성심병원에서 쯔쯔가무시 병으로 진단되었던 81예의 환자들의 의무기록 열람을 통한 후향적 분석을 시행하였다. 81예 환자들의 내원시 임상소견을 분석하였고, 이 중 본 병원에서 치료 받았던 79예의 환자들의 치료결과를 분석하였으며, 내원시 일반병실로 입원한 환자와 중환자실로 입원하였던 환자의 임상소견을 비교하여 중증환자들의 특징을 비교하였다. 결과 : 73예의 환자가 가을에 발생하였으며, 70예에서 발열이 있었고, 가피가 발견된 경우는 58예(71.6%)였다. Doxycycline 치료 후 45예의 환자가 48시간내 열이 없어졌으나 13예에서는 5일이상 열이 지속되었다. 79예 중에서 중환자실로 입원한 경우가 25예 였으며 이 중 8예에서 기계환기 치료를 받았고, 3예가 다발성 장기부전으로 사망하였다. 중환자실에 입원한 중증환자들은 백혈구수가 많았고, BUN과 크레아티닌이 높았고, 알부민 수치가 낮았다. 결론 : 쯔쯔가무시병은 중증질환으로 이환될 수 있으며 특히 고령이거나 만성질환을 가지고 있는 환자에게서는 치명적인 결과를 초래할 수 있으므로 감염발생의 위험이 있는 지역사회에서 유행 시기에 발열 등의 증상이 있을 때 조기 진단이 필수적이며 이를 위한 교육이 필요하다. 그리고 중증환자에서 백혈구수, 혈청 알부민, BUN, 크레아틴 등에서 차이를 나타내어 쯔쯔가무시 병의 예후를 예측하는 요소로 사료된다. Background : Tsutsugamushi disease is an acute febrile disease in Korea. Some patients with tsutsugamushi disease have severe illness, which needs care in intensive care unit, and may die due to the disease. We analyzed the cases with tsutsugamushi disease who lived in Chuncheon and neighboring communities to find out clinical manifestations, laboratory findings especially in severe cases. Methods : We reviewed the clinical records of the 81 cases who were diagnosed as tsutsugamushi in Chuncheon Sacred Heart Hospital from April, 1997 to December, 2002. We analyzed the clinical and laboratory findings of the 81 cases, and the treatment results of 79 cases who recieved the treatment in this hospital. We also compared the characteristics of the patients between admission to general ward and intensive care unit (ICU). Results : Seventy three cases developed the disease in autumn. Seventy cases had fever. 58 cases had eschar in their bodies. With the doxycycline treatment, forty five cases subsided the fever within 48 hours, but in 13 cases, fever continued after 5 days of treatment. Twenty five cases were admitted to ICU, 8 cases among them were treated with ventilator, 3 cases died due to the multi-organ failure. When we compared the clinical characteristics of the patients admitted to ICU with those to general wards, leukocyte count, the level of BUN and creatinine were higher, the albumin level was lower in ICU patients than those of general ward patients. Conclusion : Tsutsugamushi disease can progress to severe disease, and be fatal to the patients. So it is necessary to diagnose early and treat carefully. We suggest that leukocyte count, BUN, creatinine, or albumin can be used to predict the prognosis.(Korean J Med 69:190-196, 2005)

위신단락이 있는 간경변 환자의 위정맥류 치료에 있어서 역행성경정맥위정맥류폐색술의 치료 효과

백광호 ( Baeg Gwang Ho ),김동준 ( Kim Dong Jun ),이호권 ( Lee Ho Gwon ),민슬기 ( Min Seul Gi ),공승진 ( Gong Seung Jin ),김진봉 ( Kim Jin Bong ),이자영 ( Lee Ja Yeong ),한태호 ( Han Tae Ho ),백일현 ( Baeg Il Hyeon ),김종혁 ( Kim J 대한소화기학회 2004 대한소화기학회지 Vol.43 No.3

Background/Aims: Rupture of gastric varices was one of the most dreadful complications of cirrhosis. Recently, a new interventional procedure, balloon-occluded retrograde transvenous obliteration (B-RTO) was introduced for the treatment of gastric variceal bleeding. This study was performed to evaluate the therapeutic efficacy of B-RTO in the treatment of gastric varices with gastro-renal shunts. Methods: From March 2000 to June 2003, we performed B-RTO in 17 patients with gastric varices and gastrorenal shunts. All patients had history or high risk factors of gastric variceal bleeding. For the evaluation of therapeutic efficacy, we performed esophago-gastroduodenoscopy (EGD) and computed tomography (CT) at 1, 6 and 12 months after B-RTO. Successful B-RTO was judged by combined CT findings and EGD findings (disappearance of gastric varices or markedly reduced gastric variceal size or bleeding risk) during follow-up periods (1-14 months, mean:6.18). We analyzed the clinical factors related to clinical success of B-RTO. Results: Technical success were achieved in all patients except one (94.1%). Gastric varices were disappeared or decreased after B-RTO in 13 patients (81.2%). Complications related to procedure included transient hematuria (n=5), puncture site oozing (n=1) and partial splenic infarction (n=1), and all were conservatively managed. During the follow up periods, neither significant hepatic nor renal functional damages occurred. Statistically, no significant factors related with B-RTO success. Conclusions: B-RTO is effective and safe in the management of gastric varices in cirrhotic patients with gastrorenal shunt. Korean J Gastroenterol 2004;43:196-203)

춘천지역에서 위암 발생률 추정에 관한 연구-지난 10년간의 변화

백광호 ( Baeg Gwang Ho ),김동준 ( Kim Dong Jun ),김진봉 ( Kim Jin Bong ),이호권 ( Lee Ho Gwon ),김경호 ( Kim Gyeong Ho ),은창수 ( Eun Chang Su ),백일현 ( Baeg Il Hyeon ),김종혁 ( Kim Jong Hyeog ),김학양 ( Kim Hag Yang ) 대한소화기학회 2003 대한소화기학회 추계학술대회 Vol.2003 No.-

<목적> 위암은 아직까지 국내 발생률 1위의 암으로 조기진단과 확진이 일선 의료기관에서 가능한 질환이다. 최근 H. pylori가 위암의 원인으로 알려지면서 위암의 역학에 대해서 관심이 고조되고 있다. 춘천에서는 1992년부터 2년간 춘전지역에서 위암발생률 추정에 관한 연구 가 수행된 바 있다. 따라서 10년이 지난 시점에서 위암발생률을 추정, 비교함으로써 조기위암을 발견하기위한 노력과 함께 암관리 사업의 기초자료를 만들고자한다. <방법> 2000년

증례 : 하시모토 갑상선중독증 및 휘트르레 선종과 동반된 본태성 혈소판증가증 1예

민슬기 ( Seul Ki Min ),공승진 ( Seung Jin Kong ),이호권 ( Ho Gwon Lee ),신동훈 ( Dong Hun Shin ),송헌호 ( Hun Ho Song ),이성진 ( Seong Jin Lee ),최문기 ( Moon Gi Choi ) 대한내과학회 2005 대한내과학회지 Vol.69 No.-

저자들은 심계항진과 전경부 종괴를 주소로 내원하여 시행 받은 갑상선기능검사, 갑상선 자가항체검사, 병리조직학적 검사 및 골수조직검사에서 하시모토 갑상선중독증 및 휘트르레 선종과 동반된 본태성 혈소판증가증으로 진단된 증례를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Hashitoxicosis, a rare cause of primary hyperthyroidism, is diagnosed by presence of thyrotropin receptor antibody, increased radioiodine uptake and histological finding of lymphoid follicle with lymphcytic infiltration. Thrombocytopenia associated with hyperthyroidism including hashitoxicosis is probably caused by increased destruction of platelets in reticuloendothelial phagocytic system although it is partially compensated by increased production of magakaryocytes in bone marrow. Because essential thrombocythemia in hyperthyroid state has not been reported, most cases of thrombocytosis developed in the treatment of hyperthyroidism are considered as secondary thrombocytosis without any further examination. We experienced fourty-seven year-old woman presenting with palpitation and anterior neck swelling. By endocrinological and histological examinations, she was diagnosed as hashitoxicosis and Hurthle cell adenoma. For evaluation of progressive thrombocytosis, bone marrow biopsy was performed, in which essential thrombocythemia was diagnosed. In summary, we report the first case of an essential thrombocythemia with hashitoxicosis and Hurthle cell adenoma. (Korean J Med 69:S856-S860, 2005)

부신피질 호산성 과립세포종 1예

이성진,이호권,박철영,정인경,홍은경,오기원,김현규,김두만,유재명,임성희,최문기,유형준,박성우 대한내분비학회 2004 Endocrinology and metabolism Vol.19 No.1

저자들은 건강검진에서 시행한 복부 초음파검사상 우연히 좌측 부신 종괴가 발견되어 복부 전산화 단층 촬영검사와 호르몬검사를 시행한 후 부신피질 악성종양과의 감별 진단을 위해 부신절제술과 전자현미경검사를 포함한 병리조직학적 검사를 시행하여 부신피질호산성 과립세포종으로 진단한 증례를 경험하였기에 문헌고찰과 함께 이를 보고하는 바이다. Oncocytomas are neoplasms, histologically are composed of epithelial cells, with abundant, acidophilic and granular cytoplasm. Electron microscopic studies of oncocytomas have shown that the cytoplasm of oncocytes is packed with mitochondria. The adrenal gland is a very rare anatomical site for oncocytomas, and to the best of our knowledge, only thirty-six cases of adrenal oncocytomas have been described. Herein, a case of a large adrenal mass in a forty-year-old man, which was incidentally detected by abdominal ultrasonography, is presented. This patient demonstrated no clinical manifestation associated with adrenal hyperfunction. Hormonal studies showed no abnormal findings, except for a mild elevation of the 24-hour urinary VMA level. Abdominal computed tomography with enhancement revealed a large, well-defined left adrenal mass, measuring 5.0×4.2 ×3.0 cm. The patient underwent a left adrenalectomy, and a light microscopic examination confirmed an adrenocortical oncocytoma, with characteristic oncocytes and polygonal, abundant, eosinophilic and granular cytoplasm. The tumor cells were positive for cytokeratin and vimentin as well as S-100, but negative for chromogranin on immunohistochemical staining. An electron microscopic examination demonstrated closely packed mitochondria, containing intramitochondrial inclusions. After surgery, there was no evidence of a recurrent or distant metastatic disease at the 5 month follow-up. In summary, an extremely rare case of a man with an adrenocortical oncocytoma is reported, which was confirmed by histological examinations, including electron microscopy (J Kor Soc Endocrinol 19:82∼89, 2004).