운동후 측복통과 함께 발생한 급성 신부전 1 예

김종순,박영주,조종태,이정임,신민호,구천희,박태용,한승수,강진화 대한내과학회 1996 대한내과학회지 Vol.50 No.6

We report a case of acute renal failure with severe loin pain and patchy renal vasoconstriction after exercise. An immediate postcontrast computed tomogram of this case shows multiple patchy areas of poor contrast enhancement in the cortex of the both kidneys. A 24-hours delayed scan without further injection of contrast dye shows multiple wedge-shaped contrast enhancement in the coincident areas of poor enhancement in the immediate scan. The 2 and 5 days delayed scans show that wedge-shaped contrast enhancement becomes disappeared gradually to the renal cortex, and the 8 days delayed scan shows complete disappearance of contrast enhancement. The renal scintigrams with technetium-99m-methylene diphosphonate and dimercaptosuccinic acid show diffuse increased uptakes and multiple patchy photon deficient areas in the both kidneys respectively. The follow-up renal scintigrams show nearly normal findings, This patient had an uneventful hospital course and recovered completely without dialysis.

소장내용물의 위내역류 및 위내용물 배출시간에 관한 연구

김진호,박승철,이형호,안일민,박영태,김열흥,이창흥 대한내과학회 1986 대한내과학회지 Vol.30 No.2

Radionuclide enterogastric scintigraphy was done with (99m)Tc-DISIDA and (111)In-DTPA in 35cases; control group 5, gastric ulcer group 6, subtotal gastrectomy with Billroth g group 5, and functional gastrointestinal disorder group with or without grossly mixed bile in the gastric juice 19 cases. The results were: 1) Enterogastric reflux was very significantly increased in the subtotal gastrectomy with Billroth II group (p$lt;0, 001), 2) Gastric emptying was significantly delayed in the functional gastrointestinal disorder groups with or without grossly mixed bile (p$lt;0.05, p$lt;0. 001). 3) Enterogastric reflux was not significantly increased in the gastric ulcer group. 4) Enterogastric reflux was not significantly different between the functional gastrointestinal groups with or without grossly mixed bile in the gastric juice. 5) Inverse correlation between the gastric emptying indices and the enterogastric reflux indices was not proved (r=-0.37).

다른 광물질과 혼합된 크롬 피콜린산 급여가 비육돈의 성장 , 도체특성 , 혈액성상에 미치는 영향

김지훈,한인규,김진동,김대성,양종석,손현수,현영 한국영양사료학회 1999 韓國營養飼料學會誌 Vol.23 No.5

본 시험은 여러 가지 광물질과 혼합된 크롬 피콜린 산을 첨가한 사료의 급여가 비육돈의 성장, 도체특성, 혈액성상에 미치는 영향을 알아보기 위하여 수행되었다. 개시체중이 69㎏인 총 513두의 비육돈을 돈방당 16∼21두씩 수용하여 사양시험을 수행하였으며, 9마리가 대사시험에 사용되었다. 처리구는 2개의 단백질 수준별 대조구 (Con 12, Cen 14)와 외산 크롬 피콜린산 (CrP-CaCO₃ ; Prince사 제품). 크롬 제오라이트 (CrP-Zeolite 12, 14), 국산 크롬 피콜린산 1 (CrP-CaCO₃; KIST 개발), 크롬 피콜린산-산화아연 (CrP-CaCO₃-ZnO 12, 14) 그리고 국산 크롬 피콜린산 2 (CrP-CaCO₃ ; M. H. Lee 개발)이었다. 성장성적에 있어서는 일당중체량, 일당사료섭취량, 사료효율 등 모든 조사항목에서 처리구간의 차이가 발견되지 않았으나, 등지방 두께는 크롬 피콜린산 첨가에 의해 감소하는 경향이 발견되었고, 이러한 경향은 출하체중이 무거울수륵 뚜렷하게 나타났다. 도체등급은 크롬 제오라이트구와 크롬 피콜린산-산화아연처리구에서 높게 나타났으며, 혈액내 콜레스테를의 함량도 크롬 제오라이트구와 크롬 피콜린산-산화아연처리구에서 대조구에 비해 유의적으로 감소하였다 (p<0.05). 크롬 피콜린산-산화아연처리구와 크롬 피콜린산구에서 건물 및 단백질 소화율이 향상되었다 (p<0.05). This experiment was conducted to investigate the effects of chromium picolinate in different combinations with minerals on growth, carcass characteristics, serum traits and nutrient digestibility in finishing pigs. Five-hundred and thirteen pigs (69.0 ㎏ of initial weight) were assigned to 9 treatments, each containing three replicates of sixteen to twenty-one pigs each. Additional nine pigs were used in a digestion trial. Treatments were two controls (12% CP and 14% CP), foreign CrP-CaCO₃, two CrP-Zeolite (12% CP and 14% CP), domestic CrP-CaCO₃ 1, CrP-CaCO₃-ZnO (12% CP and 14% CP) and domestic CrP-CaCO₃ 2. ADG was not significantly different among the treatments. Tenth rib backfat thickness tended to be decreased by feeding diet with CrP. Carcass grade was improved by using zeolite and CaCO₃ + ZnO along with CrP in diets. Serum cholesterol level was significantly reduced by feeding diets containing CrP with CaCO₃ + ZnO or Zeolite compared with the control. Supplementation of Cr with CrP-CaCO₃ + ZnO or CrP-CaCO₃ in diets significantly improved the digestibility of crude protein and dry matter (p<0.05). The excretion of nitrogen was lower in pigs fed diets containing Cr regardless of the combinations with minerals. The excretion of phosphorus was lowest in the CrP-CaCO₃ + ZnO group which showed the highest phosphorus digestibility.

한국형 출혈열 후유증으로 발생된 만성 신우신염

김연수,한진석,이정상,김성권,진호준,안규리,오국환,오윤규 대한내과학회 1997 대한내과학회지 Vol.52 No.4

It has been known that most patients with Korean Hemorrhagic Fever (KHF) were recovered without any significant renal complication. But several cases of renal hypertension, chronic pyelonephritis, and chronic renal failure after KHF have been reported. Recently, we experienced one case of chronic pyelonephritis as a sequela of KHF, which has been diagnosed at the 78th month of illness. This case showed reduced thickness of renal parenchyme, small and irregular shaped kidney, focal loss of normal cupping of calyces, and accumulation of radiacontrast media at distal calyes by IVP. This case suggested that chronic pyelonephritis may develop as a sequela of KHF,

크롬 피콜린산 또는 카르니틴이 첨가된 사료급여가 비육돈의 성장 및 도체특성에 미치는 영향

김지훈,한인규,김대성,배극환,양종석,손현수,현영 한국영양사료학회 1999 韓國營養飼料學會誌 Vol.23 No.5

본 시험은 여러 가지 광물질과 혼합된 크롬 피콜린산이나 카르니틴을 첨가한 사료의 급여가 비육돈의 성장 및 도체특성에 미치는 영향을 조사하기 위하여 실시되었다. 평균체중 60.69±1.11 kg인 삼원교잡종 (Yorkshire×Landrace×Duroc) 비육돈 암수 180마리를 대조구, CFC{CrP + Fe₂O₃ + CaCO₃}, CFZC{CrP + Fe₂O₃ + ZnO + CaCO₃}, CZC-1 {CrP (1/300) + ZnO(9/300) + CaCO₃(290/300)}, CZC-2(CrP(1/300) + ZnO(14/300) + CaCO₃ (285/300)} 그리고 카르니틴구 등 6처리구에 성별로 배치하였다. 크롬 피콜린산이나 카르니틴에 의한 성장개선은 발견되지 않았다. 수퇘지에 있어서는 CFZC 처리구가 CZC-2 처리구보다 유의적으로 사료효율이 좋았다 (p<0.05). 도체특성에 있어서도 전체적으로 처리구간의 유의적인 차이는 발견되지 않았으나, 수퇘지에서는 CFZC 처리구가 대조구에 비해 등지방두께가 않았고 (p<0.05), 가장 좋은 도체등급은 CZC-2 처리구에서 나타났다. A study was conducted to investigate the effect of feeding diets containing chromium picolinate (CrP) or carnitine on growth and carcass characteristics in finishing pigs. A total of 180 cross bred pigs (Yorkshire x Landrace x Duroc; initial body weight of 60.7±1.1 kg) were assigned to 6 treatments : Control, CFC{CrP + Fe₂O₃ + CaCO₃}, CFZC{CrP + Fe₂O₃ + ZnO + CaCO₃}, CZC-1 {CrP (1/300) + ZnO(9/300) + CaCO₃(290/300)}, CZC-2(CrP(1/300) + ZnO(14/300) + CaCO₃ (285/300)} and camitine. No significant improvement was found in average daily gain (ADG), average daily feed intake (ADFI), and feed/gain ratio (F/G) by feeding diets containing chromium picolinate. The feed efficiency of male pigs fed with CFZC was better than pigs fed CZC-2 diet during the entire period (p<0.05). No differences were found in carcass characteristics between treatments expect that backfat thickness was reduced in male pigs fed the CFZC diet compared to the control (p<0.05). The best carcass grade was found in pigs fed CZC-2 the diet.

B 형 간염 Virus-Associated Hemophagocytic Syndrome 1 예

김진우,임경수,최영미,정인석,박두복,김호균,정영기 대한내과학회 1991 대한내과학회지 Vol.40 No.6

Virus-associated hemophagocytic syndrome (VAHS) is a nonneoplastic generalized histiocytic proliferation with marked hemophagocytosis associated with systemic viral infections such as Epstein-Barr virus, cytomegalovirus, adenovirus, herpes virus. etc. High fever, liver dysfunction, coagulation abnormality, and peripheral blood cytopenias are characteristic findings. Hepatosplenomegaly, lymphadenopathy, bilateral pulmonary infiltrations, and skin rash are often present. We report a case of Hepatitis B virus-associated hemophagocytic syndrome with a brief review of literature.

중등도 및 중증고혈압에서 Nifedipine 설하투여의 강압효과에 관한 연구

김영훈,서순규,최인석,김열홍,안희권,심완주,노영무 대한내과학회 1986 대한내과학회지 Vol.31 No.5

In order to assess the efficacy of sublingual nifedipine in the acute treatment of moderate to severe hypertension, a single blind test was done in 30 patients, 10 males and 20 females, aged 40 to 76 years, with moderate to severe hypertension. The patients with mean sitting blood pressure(BP) of more than J40 mmHg received sublingual placebo, and BP and pulse rate(PR) were measured in sitting position 10,20 and 30 minutes after the sublingual placebo was given. The patients with post-placebo 30 minutes sitting mean BP of less than 13pmmHg were excluded from the study. The placebo treatment period was followed by the administration of 10mg of sublingual nifedipine, and BP and PR were measured 10,20,30 and 45 minutes after nifedipine was given. BP decreased with placebo treatment(p$lt;0. 01 by paired t-test, preplacebo vs. post-placebo 30 minutes). With sublingual nifedipine BP started to fall in 10 minutes and reached the lowest levels in 30 or 45 minu1es. The systolic BP decreased from 198.0±21.4mmHg to 159±20.4mmHg, diastolic BP from 122.5±13.0 mmHg to 103.2±14.4 mmHg and mean from 147.7±13.4 mmHg to 121.7±14.8 mmHg 45minutes after nifedipine(p$lt;0.01 by paired t-test). The average fall in systolic BP/diastolic BP/mean BP 45 minutes after nifedipine was 39/19/26 mmHg(p$lt;0. 001, by paired t-test). The maximal fall in systolic BP correlated better with pretreatment value(r=0.42) than the maximal fall in diastolic pressure(r=0.21), PR increased from 79±12 to 87±11/minute with nifedipine(p$lt;0.001, by paired t-test). Side effects were mild facial flushing(16.7%) and palpitation (3.3%). The findings suggest that a dose of 10mg of sublingual nifedipine is a simple, effective and safe method for the acute treatment of moderate to severe hypertension and can be used as a non-injecting alternative agent for the treatment of hypertensive emergency.

보행마취(步行麻醉)

김영석,김완식,황호성,이진근,유희구,김흥대 대한마취과학회 1977 Korean Journal of Anesthesiology Vol.10 No.2

An imaginative innovation to shorten hospital stays as a means to reduce patient charges, is out-patient surgery. This procedure also minimized the inconvenience and disruption of the family unit, reduced the opportunities for cross-infection, and freed hospifal beds for the more serriously ill patienta Since the concept of out-patient surgical service was organized, managed, and performed in the Hanyang Medieal Center, we had experience of 132 ambulatory anesthetics during the last two years (from Jan. 1974. to Dec. 1975 ). The results are summarized as follower 1. Preanesthetic examination should be routinely cheeked with Hb., Hct., urinalysis and chest x-ray. 2. Premedication should be administered preanesthetically, atropine sulfate intravenously. 3. ASA class 1 patients should be rhnsen fnr short (less than 1 hour) procedures. 4. Anesthesia is induced with Epontol+S.C.C. and maintained with Halothane+N2O+O2. 5. We suggest that ambulatory anesthesia should be more carefully planned, organized, and managed.

가토에서 CCNU 로 유발된 골수 저형성증의 혈액학적 소견과 골수스캔의 변화에 관한 연구

김승택,이명철,최두혁,고창순,김병국,이문호,박선양,최성재,김노경,최영희 대한내과학회 1986 대한내과학회지 Vol.30 No.1

To understand systematically the hematological changes including the bone marrow changes in chemotherapeutic agent-induced bone marrow hypoplasia and to define the relationship between hematological and bone marrow scan findings and prognosis of the hypoplasia, CCNU (lomustine) was given orally to 44 rabbits to induce hypoplasia of the bone marrow. And serial changes of peripheral blood and bone marrow findings and (111)In Cl(3)((111)In scan)/(99m)Tc tin colloid bone marrow scan((99m)Tc scan) were checked before and after induction of hypoplasia. With assessment of 28 evaluable rabbits, the following results were obtained: 1) Significant hypoplasia of the bone marrow developed around day 4 of CCNU administration and recovered around day 14(cellularity 51,4±13.5% and 24. 5±14.97o before and after CCNU respectively, p<005). Megakaryocyte count was significantly depressed from 95.67,26% to 36.7$gt;31.82%(P$lt;0.005). M: E ratio was decreased from 162±1.19 to 0, 0.5$lt;0. 43(p±0.005). Shift to left(475), maturation a(40%), naked nucleus and degenerated cells(20%), increase of lymphocytes(47%), monocytes and reticulum cells were also found. 2) The uptake ratio of the 99(m)Tc tin colloid bone marrow scan was markedly increased in contrast to the depression of the bone marrow(4.4±2.12 and 14.1±7.06 before and 4 days after CCNU, respectively, p40. 005). Tc scan uptake ratio was inversely related to the cellularity(r=-0.442, p$lt;0.05) and megakaryocyte number of the bone marrow(r= 0.89, p< 0.01) and peripheral blood granulocyte (r = 0. 54. Pg0.01) and platelet count(r=0.40, p$lt;0.05). There was not significant correlation between (111)In scan uptake ratio and hematologic parameters. 3) The amplitude of the change of the (99m)Tc scan uptake ratio was significantly related to the prognosis of the rabbits with experimentally induced hypoplasia of the bone marrow(dead 5.1±2,67, survivors 2,5±0.96, P<0.01). The change of the (111)In scan uptake ratio was not related to the prognosis of these rabbits. In experimentally induced rrow hypoplasia, morphologic changes in addition to the numerical changes of the bone marrow elements were observed. And serial (99)Tc scan of the bone marrow appears to be helpful assessing the severity and predicting the outcome of bone marrow hypoplasia.

가성 장폐쇄로 발현한 부신경절종 1 예

김용태,이기업,박건춘,송영기,이문호,유은실,이준호,진태선 대한내과학회 1991 대한내과학회지 Vol.40 No.5

Phenochromocytoma is a catecholamine-secreting tumor, most of which grow at the adrenal gland. About 109p Of pheochromocytomas are detected at the extra-adrenal chromaffine tissues and are called paraganglioma. The main symptoms of pheochromacytoma include hypertension, headache, palpitation, and sweating. Gastrointestinal symptoms such as abdominal pain, constipation, and vomiting are found in 20∼40% of patients with pheochromocytoma, but these are usually overlooked because of the severe, prominant cardiovascular symptoms. Intestinal pseudo-obstruction without hypertension in pheochromocytoma is very rarely found. It is caused by the decreased motility of the intestine and the over-contraction of the intestinal sphincter, which are caused by the unbalanced activation of α-and β-adrenal receptors. It can be hypothesized that catecholamine receptors in the cardiovascular system are down-regulated or desensitized, but those in the intestine remain intact. We report herein a case of pheochromocytoma in which intestinal pseudo-obstruction was the main presenting clinical manifestation. Symptoms of intestinal pseudo-obstruction were completely relieved by administration of phenoxybenzamine, an α-receptor blocker, and excisional surgery.