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가토슬관절내 Osmic Acid주입에 따른 관절연골변화에 대한 연구
김헌국,전재명,이은우,송계용 중앙대학교 의과대학 의과학연구소 1990 中央醫大誌 Vol.15 No.1
Radiochemical synovectomy appears to be a@ effective means of decreasing inflammation, effusion, and pain in patients with rheumatoid arthritis. There has been much effort to find out a special material which can be used with the intraarticular injection for similar effect to operative synovectomy. Since von Reis and Swensson reported that osmic acid could be used for the chemical synovectomy at 1951, it has been used clinically. But the articular cartilagenous change has not been clearly clarified. Author injected 1% osmic acid to 50 rabbit knees, then the change of the articular cartilage was observed grossly, radiologically, light microscopically and transmission electron microscopically. The following results were obtained. 1. Grossly, the colour of the cartilage was dark brown at the first day after injection. The degenerative change appeared at the twelfth week, and spread widely at the sixteenth week. 2. Radiologically, the degenerative change appeared at the sixteenth week. 3. Light microscopically, there was boundary between the superficial and deep layers at the second week. After then, the degenerative change progressed at the superficial layer through the eighth week. At the twelfth week, the surface layer of the articular cartilage was necrotic. 4. Transmission electron microscopically, there was destruction of the chondrocytes of the superfcial layer at the first day after injection. At the sixteenth week, the intracellular organells of the chondrocytes dispersed extracellularly. Above findings suggest that intraarticular osmic acid treatment seems not suitable for rheumatoid arthritis because osmic acid destructs articular cartilage.
다발성 누공과 십이지장 궤양 출혈로 내원한 췌관 내 점액성 유두 종양 1예
김헌국,김재우,김현수,백순구,조미연,차승환,채명훈,이진형 대한소화기내시경학회 2009 Clinical Endoscopy Vol.38 No.4
An intraductal papillary mucinous neoplasm (IPMN) of the pancreas is an uncommon tumor characterized by the production of mucin in the pancreatic duct that occasionally involves the formation of fistulas with surrounding organs, including the stomach, duodenum and common bile duct. The mechanism underlying the formation of such fistulas is direct invasion by a tumor or a combination of high pressure in the main pancreatic duct and inflammatory stimulation. A 73-year-old man was referred to our hospital due to the presence of a gastric ulcer detected on screening gastroscopy. Endoscopic findings showed the presence of a whitish thick mucin coated ulcerative lesion that appeared as a perforation or fistula opening. Abdominal computed tomography and magnetic resonance cholangiopancreatography demonstrated the presence of an IPMN of the pancreas and multiple fistula formation with the neighboring organs. An endoscopic biopsy was carried out to obtain pancreatic tumor tissue through the pancreatogastric fistula and the mass was confirmed as a mucinous adenocarcinoma. To the best of our knowledge, this is the first case of an IPMN associated with a pancreatojejunal fistula and duodenal ulcer bleeding due to fistula formation. 췌관 내 점액성 유두 종양은 췌관 내에서 점액을 생성하는 췌장암으로 드물기는 하지만 인접한 주변 장기와 누공을 형성할 수 있다. 위, 십이지장, 총담관 등과 누공을 형성하여 여러 증상을 나타내기도 하는데 2개 이상의 장기와 누공을 형성하는 경우는 드물다. 주변 장기와 누공을 형성하는 기전은 정확하게 알려진 바가 없으나 누공이 생성되는 위치를 볼 때 직접적인 암성 침윤 내지 점액에 의한 주췌관 내 압력의 증가와 염증성 자극에 의한 것이 그 원인으로 생각되고 있다. 본 증례는 기존의 증례와는 다르게 4개의 주변 장기인 위, 공장, 총담관, 십이지장과 다발성 누공을 형성하고 십이지장 궤양성 출혈을 일으킨 경우로 현재까지 공장과 누공을 형성하였다는 증례 보고는 없어 문헌 고찰과 함께 보고한다.
간만곡부 거대 종괴로 발현된 충수돌기 점액낭종에 의한 장중첩증
김헌국,김현수,석기태,차승환,정요셉,조미연,김혜정,박경원 대한소화기내시경학회 2009 Clinical Endoscopy Vol.38 No.3
Appendiceal intussusception is a rare disease entity and appendiceal mucocele is one of the causes of this disease. Although computed tomography, ultrasonography, barium enema and colonoscopy can be performed to make a preoperative diagnosis, only a few cases of appendiceal mucocele-induced intussusception have been precisely diagnosed by these diaggnostic tools. Most of all, few such cases have been confirmed by colonoscopic examination. Colonoscopic examination has a supplementary role for the differential diagnosis of acute or chronic appendicitis, tumor or abscess in the ascending colon and cecum that is caused by appendiceal intussusception. We report here on a case of intussusception that was caused by an appendiceal mucocele, and this showed a target appearing structure in the hepatic flexure and a cystic mass inside the intussusceptive lumen on abdominal CT, and a huge mass was discovered on the colonoscopic examination. 충수돌기 장중첩증은 드문 질환으로 충수돌기 점액낭종이 직접적인 원인 중의 하나이다. 복부 단층 촬영, 복부 초음파, 바륨 조영술 및 대장내시경을 통하여 수술 전 진단을 시도하려는 노력이 있어 왔으나 명확히 진단된 증례가 많지 않고 현재까지 대장내시경을 통하여 병변 부위를 직접 확인한 예는 매우 드물다. 급만성 충수염, 오름 결장이나 맹장 부위의 종양 또는 농양과의 감별 진단에 복부 영상 진단과 더불어 대장내시경 검사가 도움이 될 수 있다. 저자들은 우하복부 동통과 혈변을 주소로 내원한 환자에서 복부 단층 촬영에서 간만곡부에 과녁 모양의 구조물과 중첩된 장 내강으로 낭성 종괴를 나타내고, 대장내시경으로는 거대 종괴 형태로 발현된 충수돌기 점액낭종에 의한 장중첩증 1예를 경험하여 문헌 고찰과 함께 보고한다.