위 MALT 림프종에서 다발성 림프절 전이로 오인된 동시성 림프절 결핵 1예

김성은,김규종,김도현,송준영,문대성,장리라,유찬희,문원,박무인,박선자,김영옥 고신대학교의과대학 2008 고신대학교 의과대학 학술지 Vol.23 No.2

28세 남자가 내시경적 점막절제술을 통해 저등급 위MALT 림프종으로 진단되었다. 병기설정을 위해 18F-FDG PET 검사를 시행하였고 우측 쇄골상부, 우측상/하부 기관주위, AP window 부위에 강한 섭취가 관찰되어 전이성 림프절로 판단하였다. 그러나, 우측 쇄골상부 림프절에서 시행한 절제생검에서 만성육아종성염증소견이 관찰되었고 조직의 결핵 중합효소연쇄반응에서도 양성 반응을 보였다. 2개월간 항결핵제의 사용 후 시행한 추적 컴퓨터단층촬영 검사에서 림프절 크기의 감소를 보여 최종적으로 위 MALT 림프종에서 광범위 림프절 전이로 오인된 동시성 림프절 결핵으로 진단되었다. A 28-year-old man was diagnosed as gastric MALT lymphoma in diagnostic EMR (endoscopic mucosal resection). He subsequently underwent an 18F-FDG PET. 18F-FDG PET showed intense multifocal uptake in right supraclavicular, right upper and lower paratracheal, and AP window areas that was considered radiologically to represent widespread metastatic lymphadenopathy. Excisional biopsy of a supraclavicular lymph node, however, revealed chronic granulomatous lymphadenitis with a positive reaction of Tb-nested PCR. After antituberculosis treatment for 2 months, a follow-up CT scan showed complete resolution of the lesions. Intense 18F-FDG uptake could be due to an infectious process such as synchronous tuberculous lymphadenitis. Therefore, this could mimic a malignant condition such as lymphoma with extensive lymph node metastasis due to a false-positive finding, which may lead to a misdiagnosis.

상어 간유 흡인에 의한 급성 지방성 폐렴 1예 : 증례보고

임성경,옥철호,김희규,장태원,정만홍 고신대학교의과대학 2008 고신대학교 의과대학 학술지 Vol.23 No.4

저자들은 상어 간유를 과량 복용하고 기침, 호흡곤란을 주소로 내원한 48세 여자 환자에서 방사선 소견과 기관지 폐포 세척액 검사를 통해 급성 지방성 폐렴으로 진단하고 스테로이드에 불응하는 경과를 취하자 우측 전폐 기관지 폐포 세척술을 시행하여 폐 병변과 증상의 호전을 보인 1례를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Acute lipoid pneumonia is uncommon condition of the lungs that results from the aspiration of vegetable, animal, or mineral oils. Shark liver oil (so called Squalene) is taken as a traditional remedy in some Asian countries, and is used widely also in cosmetics. It results in foreign body type inflammatory reaction of the lung and can show various clinical presentations from asymptomatic incidental finding to severe pneumonia leading to acute respiratory failure. Although many cases have been reported, severe lipoid pneumonia requiring steroid or whole lung lavage for treatment is rare. We experienced a case of acute lipoid pneumonia of 48 year old female with dyspnea and cough caused by regular ingestion of large amount Shark liver oil, treated by whole lung lavage. We reported this case with a brief review of related literatures.

체외충격파 쇄석술 시행 후 5년 뒤 발생한 요관 협착 및 농신장 1예

이현승,권균홍,조용건,김봉진,임창섭,김자영,허동,임학 고신대학교의과대학 2008 고신대학교 의과대학 학술지 Vol.23 No.4

A 40-years-old woman was admitted to this hospital with flank pain and high grade fever for 2 weeks. As a matter of her past history, extracorporeal shock wave lithotripsy (ESWL) was performed for treatment of renal stones 5 years ago. Her abdominal CT findings were hydronephrosis with pyonephrosis and renal stones. Antibiotics administered for 5 days had no effects on her symptom improvement. A right ureteral stricture was noticed by ultrasonography follow up. We inserted double J stent and continued antibiotics therapy for 10 days, and then her fever was disappeared and flank pain was improved. ESWL is one of the most important treatment of renal and ureteral stone. However, its complications should not be negligible including bleeding, pain, ureteral obstruction, infection and so on. Complications of ESWL can be divided into acute and chronic courses. When we treat pyelonephritis patient with past history of ESWL, possibility of ureteral stricture must also be considered. In this study we report a case of pyelonephritis caused by ureteral stricture, possibly as a chronic complication of ESWL performed 5 years earlier

팔씨름 중 발생된 상완골의 나비형 골편을 동반한 분쇄형 나선 골절

이근우,손정환,김태훈 고신대학교의과대학 2012 고신대학교 의과대학 학술지 Vol.27 No.1

The fracture of the humerus during arm wrestling are uncommon, but may occur in the shaft or medial condyle. In the shaft of humerus, the fractures are usually spiral and between the middle and distal third, with or without neurological involvement. A case of a comminuted spiral fracture with butterfly fragment of the distal third of the humerus is reported which had occurred during arm wrestling and was treated by open reduction and internal fixation. The possible mechanism of injury and the question of treatment are discussed.

Doxylamine Succinate 과다복용 환자에서 발생한 횡문근융해증 1예

임호섭,최종순 고신대학교의과대학 2008 고신대학교 의과대학 학술지 Vol.23 No.4

Doxylamine succinate is an antihistamine, classified as hypnotics and sedatives by the Ministry of Health and Welfare, and it can be obtained easily as an over-the-counter medicine. After doxylamine overdose, the anticholinergic effects of this drug can also lead to nausea, vomiting, and ileus as well as urinary retention, and patients often have dry mouth, absence of sweating, flushing, fever, and dilated pupils. Although Rhabdomyolysis seems unusually common with doxylamine poisoning, it can lead to acute renal failure and serious complications. A careful observation is needed, because disseminated intravascular coagulation, metabolic acidosis, acute cardiomyopathy, respiratory distress, compartment syndrome and peripheral neuropathy can occur in doxylamine intoxication. We report a case of rhabdomyolysis after doxylamine overdose.

경부임파선 전이가 동반된 폐암환자에서 초음파 유도 하 알코올 주입술의 효과

박진희,옥철호,장태원,전만홍 고신대학교의과대학 2008 고신대학교 의과대학 학술지 Vol.23 No.4

Background: Percutaneous ethanol injection therapy(PEIT) has been infrequently tried to treat hepatic tumors, thyroid tumors, renal tumors. We adopted this technique for treating locally recurrent lung cancer. The object of this study is to evaluate the local therapeutic efficacy, side effects of ethanol injection for treating locally neck node metastasis of lung cancer. Materials and Methods: Between May 2006 and october 2006, 20 lung cancer patients(17 males and 3 females) with 35 histologically proven symptomatic neck node metastatic lesions underwent sonography guided PEIT(US-PEIT) under local anesthesia . We analyzed relation between PEIT and size, the amount of pain. The amount of pain that patients feel was evaluated by VAS(Visual Analogue Scale). Result: A significant decrease of tumor size was observed in 19 lesions. The mean pre-injection diameter of the lesions was 24.2 mm, and this was decreased to 16.8 mm(p=0.001). The VAS score before injecting ethanol into the lesions was 5±3, this was decreased to 2.5±1.5(p=0.001). Conclusion: US-PEI is a valuable treatment option for patients with symptomatic cervical nodal metastases from advanced lung cancer who are not amenable to further therapy.

혈중 아연농도와 위암환자의 임상 병리학적 상관성

서경원,윤기영 고신대학교의과대학 2008 고신대학교 의과대학 학술지 Vol.23 No.4

Objective: Until it was recently overtaken by stomach cancer was the most common cancer in the world. It is still a major cause of death in many countries. Previous most presentation is a discussion of the possible role of micronutrients in the etiology of common human cancers. The aim of this study is to explore the relationship between the Zinc trace elements and clinicopathologic nature in gastric carcinoma. Methods: Trace element Zn were measured in primary gastric carcinoma from 189 patients. It was compared with age, cancer stage, cancer location and pathological types with the contents of Zn. Results: There were no significant differences in the contents of Zn among primary gastric tumors, age (P=0.207 post hoc test), and no significant differences in the contents of Zn between gastric cancer stage (P=0.688 post hoc test). There were no significant differences in the contents of Zn among primary gastric tumors, location (P=0.99 post hoc test), and no significant differences in the contents of Zn between gastric cancer WHO pathological type (P=0.553 post hoc test). Conclusions: There were no significant differences in the contents of Zn among primary gastric tumors, age, cancer stage, cancer location and WHO pathological type.

척수신경결찰 흰쥐에서 척수강내로 투여한 Memantine의 기계적 항이질통 효과

김두식 고신대학교의과대학 2008 고신대학교 의과대학 학술지 Vol.23 No.4

Background : Peripheral nerve injury can cause neuropathic pain states in which patients report painful sensation to stimuli that are normally innocuous (allodynia), or enhanced pain mechanism underlying neuropathic pain states are poorly understood. Since spinal glutamate receptor activation is a critical step in central sensitization, leading to spinal hyperexcitability in pain processing. Methods : Letf L5/6 spinal nerves were tightly ligated (SNL) to induce neuropathic pain in Harlan Sprague Dawley rats as described by Kim et al (1992). Two weeks after SNL, memantine 2 mg/kg directly injected into L5/6 spinal region in 10 μl followed by 10 μl saline. Hind paw withdrawal thresholds (PWT) to von Frey filament stimulation were tested for mechanical hypersensitivity in SNL rats injected intrathecally with memantine, before and post intrathecal injections in a blinded manner as detailed in Chaplan et al (1994). Results : Intrathecal injection of N-methyl-D-aspartate (NMDA) receptor antagonist memantine significantly reversed the allodynia state in SNL rats. Conclusion : The evidence provided by the study shows a strong correlation between inhibition of NMDA receptors and tactile allodynia. Increased NMDA activation can lead to a tactile allodynia under innocuous stimuli. Memantine can block the facilitated state of NMDA receptors and tactile allodynia in the SNL rats.

ANA 선별 검사가 음성이면 ENA 자가항체 검사는 안해도 되는가? : IIFA에 의한 ANA선별 검사 결과와 LIA에 의한 Ro60과 Ro52 자가항체 검사 결과의 연관성 분석

황현용,김종국 고신대학교의과대학 2007 고신대학교 의과대학 학술지 Vol.22 No.2

Background: Differently from a theory, the test results of anti-extractable nuclear antigen antibody (ENA Ab) are sometimes positive when those of antinuclear antibody are negative in the same patient. We performed the association analysis between the result of ANA and that of R060 and Ro52 ENA Abs which are prevalently identified in the laboratory practice. Methods: From January 2006 to June 2007, a total of 133 patients’ test results of ANA by indirect immunofluorescence assay (IIFA) and 13 ENA Abs by line immunoassay (LIA) were analyzed. The patients were divided into 3 groups depending on the results of Ro antibodies: 1) Ro60 (+)-Ro52 (+), 2) Ro60 (+)-Ro52 (-), 3) Ro60 (-)-Ro52 (+). The associations between the results of IIFA and those of LIA in between the groups were analyzed. The associations between the results of IIFA and those of LIA and the prevalence of ENA Abs were analyzed in the ENA (+) group. The prevalence of ENA Abs in the IIFA (-)-LIA (+) group was analyzed. The distributions of ENA Abs identified in the same patient were analyzed in LIA (+), IIFA (+)-LIA (+), and IIFA (-)-LIA (+) groups. Results: There were no statistical differences between the results of ANA and those of ENA Abs in between the groups, but significant difference was suspected between the Ro60 (+)-Ro52 (+) and the Ro60 (-)-Ro52 (+) groups (p=0.052). The prevalence of Ro60 a d Ro52 were high among 13 ENA Abs identified (18.8% and 24% respectively). Statistically significant association between the results of ANAs and those of Ro60 was observed (p=0.005). The prevalence of Ro52 was highest in the IIFA (-)-LIA (+) group (28.6%). The numbers of ENA Abs identified in the same patient decreased in the IIFA (-)-LIA (+) group. Conclusion: When the autoimmune diseases associated with Ro52 autoantibody are suspected, an ENA profile test should be performed regardless of the ANA results.

요추 천자 후 발생한 뇌실내 공기뇌증

강성진,김종국,김민정,유봉구,김광수 고신대학교의과대학 2007 고신대학교 의과대학 학술지 Vol.22 No.2

Lumbar epidural injections are used to treat chronic and acute pain involving lower extremities. We report a case of intraventricular pneumocephlaus occurring after lumbar puncture. He complains severe bifrontal headache followed by nausea. Brain CT reveals air in the lateral ventricle anterior horn, temporal horn and basal cistern. CSF study shows normal findings.