두개강내 출혈을 동반한 불응성 특발성 혈소판감소성 자반증의 CYCLOPHOSPHAMIDE 치험 1예

서정철,양태영,최연수,박유환,김완중,허경,정원영,정춘해 朝鮮大學校 附設 醫學硏究所 1993 The Medical Journal of Chosun University Vol.18 No.1

Idiopathic thrombocytopenic purpura(ITP) is an autoimmune bleeding disorder characterized by the development of antibodies to one's own platelets, which are then destroyed by phagocytosis in the spleen and liver. Its clinical manifestations are characterized by bleeding and the most serious complication is hemorrhage into the central nervous system, but which is rarely seen below 1%. In treating IPT, the therapy of first chice is administration of adrenocorticosteroid and r-globuline. If satisfactory results are not obtained, then splenectomy is recommended. If this also proves inadequate, then administration of immunosuppressants is carried out. 16-year-old male was admitted with complaints of left hemiplegia and nasal bleeding. This case may be developed spontaneous intracerebral hemorrhage causing thrombocytopenia and was treated by steroid, r-globuline and splenectomy, but satisfactory results are not obtained. After all, the paient was successfully treated with cyclophosphamide.

편마비 환자의 총대퇴동맥에서 초음파를 이용한 혈류 동태 분석

김완호,고명환,서정환,김연희 大韓再活醫學會 1998 Annals of Rehabilitation Medicine Vol.22 No.3

이행성 협심증 환자에서 운동부하 심전도 검사

이정우,박형서,박용규,노상필,이유선,정승현,김보영,이재환,최시완,정진옥,성인환 충남대학교 의과대학 의학연구소 2003 충남의대잡지 Vol.30 No.1

목적 : 관상동맥의 경련에 의한 이형성 협심증환자에 있어서 운동부하 심전도 검사의 결과는 매우 다양하다. 이에 저자들은 충남대학교병원 순환기내과에서 관상동맥조영술상 이형성 협심증으로 확진된 환자를 대상으로 운동부하 심전도 검사를 시행하여 이에 대한 결과를 연구하였다. 방법 : 1995년 1월부터 2002년 3월까지 흉통을 주소로 충남대학교병원 순환기 내과에 입원하여 관상동맥조영술을 시행하여 관상동맥의 내경이 50% 미만의 협착이 있고, 에르고노빈(ergonovine) 유발검사도 이형성 협심증으로 진단을 받은 233명중 운동부하 심전도 검사를 시행 받은 183명의 환자를 연구 대상으로 하였다. 운동부하 심전도 검사 결과의 판독시 발생할 수 있는 오류를 줄이기 위해서 운동부하 심전도 검사를 시행하기전 심전도상 ST분절의 상승(5예)이나 하강(8예)이 있는 경우 EH한 T파의 역위(19예)가 있는 32명의 환자를 제외한 총 151명의 환자를 대상으로 하였다. 운동부하는 Marquette사의 case 15 답차를 이용하였고, Bruce protocol에 따라 증상이 나타날 때까지 최대로 실시하였으며 각 stage 및 운동후의 혈압을 측정하고 12 유도 심전도를 기록하였다. 결과 : 1) 임상적 특성 - 내원시 임상 상은 안정형 협심증이 39예(25.8%), 불안정형 협심증이 103예(68.2%), 심근경색증이 9예(6.0%)이었다. 운동부하 심전도 검사 결과 양성 군과 음성군간에 있어서 당뇨병, 고혈압, 비만도, 총 혈청콜레스테롤치, 현재의 흡연 여부, 병력상 운동시 흉통의 유무, 내원시 임상적 진단, 협착의 정도, 연축의 수 등을 조사하였는 바 어떠한 인자들도 유의한 차이를 발견할 수 없었다. 2) 운동부하 심전도 검사 - 운동부하 심전도 검사를 시행 받은 151명의 환자중 음성인 경우는 134예(88.8%)이었고, 양성인 경우는 17예(11.2%)이었다. 양성 소견을 보인 환자들중 ST 분절의 상승이 4예(2.6%), ST 분절의 하강이 13예(8.6%)이었다. 3) 관상동맥조영술 - 관상동맥조영술상에서 혈관 경력 위치는 우관상동맥이 70예(46.1%), 좌전하동맥이 44예(28.9%), 좌회선동맥이 17예(11.2%)의 순으로 나타났다. 운동부하 심전도 검사상 ST 분절의 상승이 있었던 예중 Ⅱ, Ⅲ, aVF에서 ST 분절의 상승이 있었던 1예는 관상 동맥조영술상 우관상동맥에서 경련이 발생하였고, V2-V4에서 ST 분절의 상승이 있었던 2예중 관상동맥조영술상에도 좌전하행동맥에서 경련이 나타난 예는 1예이었으며 다른 1예는 좌회선동맥에서 경련이 나타났고, V5-V6에서 ST 분절의 상승이 있었던 1예는 관상동맥조영술상에도 좌회선동맥에서 경련이 나타났다. 운동부하 심전도 검사상 V5 또는 V6에서 ST 분절의 하강이 있엇던 13예중 6예(46.1%)는 관상동맥조영술상 우관상동맥에서 경련이 발생하였고, 3예(23.1%)는 좌전하행동맥에서, 1예(7.7%)는 좌회선동맥에서, 나머지 3예(23.1%)는 2개의 혈관이나 기타 분지에서 경련이 발생하였다. 결론 : 1) 이형성 협심증 환자는 운동부하 심전도 검사에서 11.2%의 양성소견을 보였다. 이중 ST 분절의 상승은 2.6%이었고, ST 분절의 하강은 8.6%이었다. 2) 이형성 환자중 운동부하 심전도 검사를 실시하여 음성을 보이는 경우 다혈관 관상동맥질환이기 보다는 이형성 협심증일 가능성이 더 높다고 예측할 수 있을 것으로 생각된다. 3) 이형성 협심증 환자중 운동부하 심전도 검사를 실시하여 ST 분절의 상승을 보이는 경우 다혈관 관상동맥질환이기 보다는 이형성 협심증일 가능성이 더 높다고 예측할 수 있을 것으로 생각된다. 4) 운동부하 심전도 검사 결과에 대한 당뇨병, 고혈압, 비만도, 총 혈청콜레스테롤치, 현재의 흡연여부, 병력상 운동시 흉통의 유무, 내원시 임상적 진단, 협착의 정도 등 어떠한 인자들도 3그룹(ST 분절의 상승, ST 분절의 하강, 음성)간에 유의한 차이를 발견할 수 없었다. 5) ST 분절의 상승 부위와 관상동맥조영술상 관상동맥의 연축이 일어나는 혈관과의 상관관계는 매우 높았다. No reports in the literature describe the results of exercise testings in a large number of patients with pure variant angina(coronary stenosis <50%) in Korea. In this report, We present the results of treadmil exercise testing in 151 patients with variant angina. 151 patients with angiographically proven coronary artery spasm underwent a treadmil exercise test. The clinical characteristics of variant angina patients classified according to ST-segment response to exercise were analyzed. Of 151 patients underwent a treadmil exercise test, negative result was seen in 134 patients(88.8%) and positive result was in 17 patients(11.2%). Of 17 patients saw positive result, exercise-induced ST segment elevation was present in 4 patients(2.6%) and ST segment depression was seen in 13 patients(8.6%). There was not a significant relationship between the ST segment response to exercise and the clinical variables(diabetes, hypertension, obesity, total cholesterol, current smoking, effort angina, clinical diagnosis, and degree of stenosis) assessed. Of 4 patients with ST segment elevation in treadmil exercise test, 1 patient with ST segment elevation in Ⅰ,Ⅲ,aVF had spasm in right coronary artery(100%) on coronary angiography, of 2 patients in V2-V4 had spasm in left anterior descending coronary artery in 1 patient(50%) and 1 patient in V5-V6 had spasm in left circumflex artery(100%). Positive treadmil exercise test was present in 11.2% of variant angina patient. If we have negative treadmil exercise result in patients with clinical manifestation of unstable angina at admission, we may have a suspicion of variant angina rather than multi-vessel disease. If we have exercise-induced ST segment elevation in patients with clinical manifestation of unstable angina at admission, we have a suspicion of variant angina rather than multi-vessel disease. Our result suggests that the correlation between the site of the ST segment elevation and the artery involved is quite good.

척수손상 환자에서 골 대사의 생화학적 변화

김상수,서정환,김완호,김연희 大韓再活醫學會 1997 Annals of Rehabilitation Medicine Vol.21 No.6

관상동맥 질환에서 SDF-1α의 농도

김보영,박용규,박형서,노상필,정승현,이유선,이정우,이재환,최시완,정진옥,성인환 충남대학교 의과대학 의학연구소 2003 충남의대잡지 Vol.30 No.1

Atherosclerosis is now viewed as an inflammatory disease of the vascular system. Expression of several chemokines, including monocyte chemoattractant protein(MCP)-1, MCP-4, RANTES(regulated on activation normal T-cell expressed and secreted), and interleukin-8(IL-8) are increased in human atherosclerotic plaques compared with normal vessels. They are involved in the pathogenesis of atherosclerosis and plaque rupture by activating and directing leukocytes into the atherosclerotic lesions. However, some are involved in homeostatic functions such as normal leukocyte traffic and growth regulation. SDF-la is a multi-functional cytokine that is involved in myelogenesis, hematopoiesis, angiogenesis and injured gastric mucosal regeneration in the gastric ulcer patient. SDF-la is recently shown to be highly expressed in atherosclerotic plaques and a potent platelet agonist. At least in high concentrations, SDF-la may mediate antiinflammatory and matrix stabilizing effects in unstable angina. Many studies are going on to know the function of SDF-la in coronary artery diseases. I investigated the difference of the plasma level of SDF-la between control group and coronary artery disease group. Total 75 subjects were enrolled. The diagnosis of coronary artery disease was confirmed in all patients by coronary angiography. Control subjects in this study were confirmed normal by coronary angiography. Clinical profile and risk factors were also reviewed. Control subjects in this study were 27 (M=10, F=17). Plasma for the study was collected before the angiography and centrifuged. SDF-la analysis was performed by ELISA. Plasma level of SDF-la is significantly increased in patients with stable angina(n=20) and unstable angina group(n=28) compared with healthy control group(n=27). the risk factors do not influence the plasma level of SDF-la in coronary artery diseases. In this study, plasma level of SDF-la is increased in patients with stable angina and unstable angina groups compared with healthy control group(P<0.05). the risk factors do not influence the plasma level of SDF-la in coronary artery diseases.

유명산의 식물상 및 산림군락분류에 관한 연구

김흥식,김인수,홍금희,김남영,박광서,김정유,박완근 江原大學校 森林科學硏究所 2003 Journal of Forest Science Vol.19 No.-

2002년 3월부터 2003년 10월까지 유명산 자연휴양림을 대상으로 식물상과 산림군락구조를 조사한 결과, 관속식물이 98과 331속 570종 1아종 81변종 4품종 2교잡종으로 총 658종류로 나타났으며, 한국특산식물은 10과 14속 13종 2변종 1교잡종 총 16종류. 희귀 및 멸종위기식물은 9과 10속 11종 총 11종류, 귀화식물은 12과 22속 28종 총 28종류로 나타났다. 산림군락은 신갈나무-철쭉군목, 신갈나무-생강나무군단, 소나무-산거울군락, 잣나무-주름조개풀군락, 물푸레나무-신갈나무군락, 층층나무-신갈나무군락, 굴참나무-신갈나무군락, 싸리-신갈나무군락으로 전체 1군목, 1군단, 6군락이 분포하는 것으로 나타났다. The study was carried out to investigate the flora and community classification of forest vegetation in Mt. Yumyeong from March, 2002 to October, 2003. As a result of that, the vascular plants were 98 families, 331 genera, 570 species. 1 subspecies, 81 varieties, 4 formae, 2 hybrid, 658 taxa in all. Korean endemic plants were 10 families, 14 genera, 13 species, 2 variaties, 1 hybrid. 16 taxa in all ;, rare and endangered plants were 9 families, 10 genera. 11 species, 11 taxa in all ; naturalized plants were 12 families, 22 genera, 28 species, 28 taxa in all. The forest vegetation was classified into 1 order, 1 alliance. 6 communities : Rhododendro - Quercetalia mongolicae (Kim, 1990) Lindero - Quercion mongolicae (Kim, 1990) A. Carex humilis var. nana - Pinus densiflora Community B. Oplismenus undulatifolius - Pinus koraiensis Community C. Fraxinius rhynchophylla - Quercus mongolica Community D. Cornus controversa - Quercus mongolica Community E. Quercus variabilis - Quercus mongolica Community F. Lespedeza bicolor - Quercus mongolica Community

소아에서의 급성 파종성 뇌척수염의 임상적 고찰

조수진,박은애,유은선,김혜순,손세정,서정완,이승주,한후재 이화여자대학교 의과대학 2003 EMJ (Ewha medical journal) Vol.26 No.2

목적: 급성 파종성 뇌척수염은 감염이나 예방 접종 후 발생하는 중추 신경계의 급성 자가 면역 염증성 질환으로 탈수초를 일으킨다. 신경학적인 증상으로 발현되고 대부분 환전히 회복되지만 신경학적 후유증을 남기거나 사망 할 수도 있다. 이에 저자들은 본원에서 발생 한 14명을 분석하여 조기 진단과 치료에 도움을 주고자 하였다. 대상과 방법: 1998년 3월부터 2003년 8월까지 이대목동병원에서 급성 파종성 뇌척수염으로 진단 받은 14명의 의무기록을 후향적으로 조사하였다. 결과: 환자들의 평균 발생 연령은 5±7.8개월이였고, 특정계절이나 연도에 집중되어서 나타나지는 않았다. 선행질환은 주로 비특이적인 상기도 감염이 가장 많았고, 초기증상으로는 경련이 가장 많았다. 그 외에 의식저하나 운동장애도 있었다. 뇌척수액 검사에서 백혈구 증가증이 발견된 경우는 있었으나 단백이 증가된 경우는 없었다. 뇌 자기공명 촬영에서 T2 증강시 뇌백질과 기저핵에 고음영의 다발성 병소가 발견되었고 추적 촬영에서 대부분에서 소실되었다. 뇌파 검사가 시행되었던 경우 전반적인 서파가 가장 많았고 국소적인 극파가 나온 경우도 한 명 있었다. 환자들은 정맥 면역 글로블린과 메틸프레드니졸론으로 치료하였고 치료 시작 후 3~7일내 증상이 호전되었다. 모든 환자를 2달 이상 추적 관찰하였고 항경련제가 지속적으로 필요한 정도의 경련성 질환이 두 명, 신경아교증이 남아잇는 경우가 한 명, 외래에서 다발성 경화증이 의심되는 경우가 한 명 있었다. 결론: 급성 파종성 뇌척수염은 침범 부위에 따라서 다양한 임상 상으로 나타나며 면역 글로블린과 메틸프레드니졸론이 치료에 효과적이였다. 본 연구에서는 대상 환자수가 적어 신경학적 후유증의 위험요소는 밝힐 수는 없으나, 예후는 검사소견과 연관되어 있지는 않았고, 대부분에서 양호하여 완전히 회복되었으나, 신경학적 후유증이 남은 경우도 있었다. Objective:Acute disseminated encephalomyelitis(ADEM) is an acute demyelinating autoimmune inflammatory disease of the central nervous system which develops after infection of vaccination. It may be fatal, and produce a permanent residual static disability or fully recover. We retrospec-tively studied 14 cases to investigate the clinical findings and outcome of ADEM. Methods : 14cases of ADEM diagnosed at Ewha Womans University Mokdong Hospital from 1998 to 2003 were retrospectively reviewed. Results : The age of onset was 5years±7.8 months and no seasonal clustering was found. The time of onset of symptoms was between 3 to 30 days. The preceding events were nonspecific upper respiratory infections in 9 cases, aseptic meningitis in 4 cases, and gastroenteritis in one case..The initial symptoms were seizure, altered consciousness, hemiparesis, fever, headache, and vomiting. Brain MRI showed multifocal high signal intensity lesions on T2 weighted image mainly in the cerebral whith matter, basal ganglia and periventricular white matter. EEG was performed in some cases and showed generalized or focal slow waves and only one case showed focal spikes. Patients were treated with IV globulin and methylprednisolone and the symptoms improved within 3-7 days after treatment. All patients were followed up for more than 2 months and most of them fully recovered except two. Conclusion : ADEM presents in various clinical manifestations depending on its involvement of the brain lesions. Most cases recovered fully but in some cases, residual permanent neurologic sequelae remained.

[P330] A case of primary cutaneous cd30+ anaplastic large cell lymphoma

( Jeong-wan Seo ),( Ho-jin Kim ),( Tae-hoon Kim ),( Ki-hoon Song ),( Ki-ho Kim ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.1

Epithelial Membrane Antigen(EMA) and Anaplastic Lymphoma Kinase (ALK) expressions are uncommon in primary cutaneous T-cell-lymphomas (CTCL). We report a patient who was initially clinically diagnosed with squamous cell carcinoma, and eventually developed an unusual manifestation of CTCL. His disease was presented as aggressively ulcerating plaques and tumors of the entire skin. Histopathologic examination revealed monoclonal proliferation of atypical T-lymphocytes with positivities for CD30, EMA, but, negative for ALK. Extensive staging work-ups confirmed the primary cutaneous of the anaplastic large cell lymphoma(C-ALCL). Because distinguishing C-ALCL from systemic ALCL is important to provide adequate treatments for systemic lymphoma patients without overtreatment, the differential diagnosis is often made with the aid of immunohistochemistry and molecular genetics. Despite the positive findings for ALK and EMA favor systemic ALCL, the clinical course and histopathologic findings clearly indicates C-ALCL in this patients. Such studies should be useful for improving the diagnosis and predicting the prognosis of C-ALCL, and may identify a subset of this disease and it would be amenable to therapies targeted against ALK.

[P120] Treatment of refractory discoid lupus erythematosus with 5% imiquimod cream

( Jeong-wan Seo ),( Ho-jin Kim ),( Tae-hoon Kim ),( Ki-hoon Song ),( Ki-ho Kim ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.1

Discoid lupus erythematosus (DLE) is most common form of lupus erythematosus (LE)-specific skin diseases, localized on the face and scalp in 80% of patients. Antimalarials and topical, intralesional steroids are the first-line standard therapies. As second-line therapies, systemic steroids, azathioprine and dapsone are used. However, discoid lupus erythematosus (DLE) with disfiguring skin lesions is a therapeutic challenging problem. A 41-years-old Korean male presented with multiple well demarcated erythematous patches on cheeks and forehead for 5 years. He was already diagnosed as DLE and applied antimalarials and various steroids. However, disease control cannot be achieved so adequately. We started to treat skin lesions with 5% Imiquimod cream(Aldara^®) and applied once a day 3 times a week. Despite an initial development of erythema as a sign of drug-induced inflammation, entire lesions regressed in a remarkable manner after 15 applications. So, we propose topical imiquimod may be an alternative treatment for generalized DLE.

[P030] A case of epitheloid hemangioma on back

( Jeong-wan Seo ),( Ho-jin Kim ),( Tae-hoon Kim ),( Ki-hoon Song ),( Ki-ho Kim ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.1

Epitheloid hemangioma is an uncommon subcutaneous angioproliferating tumor. It presents as an increase in immature, primarily lymphatic vessels with plump endothelial cells lining vascular spaces, often with an associated medium-sized vessel. Surrounding the vascular component is a mixed infiltrate composed of lymphocytes that may form lymphoid follicles as well as histiocytes, plasma cells, and eosinophils. Epitheloid hemangioma can occur in all races, but it is reported more frequently in young to middle-aged Asians. Epitheloid hemangioma presents with persistent, recurrent dermal or subcutaneous nodules primarily typically in the head and neck area with pruritus and pain. Epitheloid hemangioma can have a spontaneous remission over the course of months or years. A 56-year-old woman presented with 6-month history of asymptomatic two erythematous slight elevated plaques of 2.5 x 3.5cm size on upper back. Her disease showed a repetition of improvement and deterioration. Histopathologic findings showed vascular dilation with lymphocyte. histiocyte and eosinophil infiltration with granulomatous changes in the dermis. Additionally, prominent endothelial cells were lined along vascular channel as cobblestone appearance. Herein, we report on uncommon case of an epitheloid hemangioma on back.