위의 평활근아세포종

김선주(Sun Joo Kim),황성규(Seong Gyu Hwang),이문호(Moon Ho Lee),김순길(Soon Kil Kim),오도연(Do Yeun Oh),김창진(Chang Jin Kim) 대한소화기학회 1990 대한소화기학회지 Vol.22 No.3

Leiomyoblastoma is an uncommon intrarnural tumor of the stomach. It was first described in 1960 by Martin et al.. Stout reported a series of 69 simiIar cases and propoaed the term leiomyoblastoma in 1962. A 65 year old female patient presented with epigastric pain for two years. She took several episodes of transfusion for recent 2 years. UGI, gastrofiberscopy and abodinal CT showed a submucosal mass, located at anterior wall. Subtotal gastrectomy was perfomed under the impression of leiomyosarcoma, The final hiatologic diagnosis was leiomyoblastoma. The smooth muscle origin of this tumor was conffrmed positive staining for MaaSons trichrome and by intracellular myofibrils on electron microscopic studly. Cytoplaamic clear zonee, previously thought to be typical of the light microscopic moryhology of leiomyoblastoma, was not observed by electron microscopy, suggesting that they may be an artifact of fixation. The pragnosie of leiomyoblastoma may be related to tumor size, the numbers of mitotic figures and most impurtantly cellular characteristics.

농촌 지역에서 발생한 치명적 약물 중독에 관한 임상적 관찰

김명환(Myung Hwan Kim),박명재(Myung Jae Park),김순길(Soon Kil Kim),박인석(In Seok Park),오도연(Do Yun Oh),표석주(Sok Joo Pio),김선주(Sun Joo Kim),홍세용(Sae Yong Hong) 대한내과학회 1988 대한내과학회지 Vol.35 No.6

N/A We analysed 255 cases of acute drug intoxication in patients who were admitted to the Department of Internal Medicine, Chun An Soon Chun Hyang University Hospital from January 1983 to December 1987. The following results were obtained: 1) The most common drugs were agricultural chemicals in 197 cases (77%), the remainder were hypnotics in 21 cases (8%), rodenticides and chemicals in 13 cases (5%), each, and unknown drugs in 9 cases (4%), in order of frequency. 2) The overall sex incidence ratio was 1.63 male to 1 female with a male preponderance and patients were most commonlyaffected in the 3rd decade (30%). Monthly incidence was highest in July and there was an increasing tendency in the number of cases admitted annually. 3) The causes of intoxication were suicidal attempts in 137 cases (54%), unknown in 97 cases (38%), accidental intoxication in 18 cases (1%), in order of frequency. 4) The highest mortality was observed in patients of organophosphorous and paraquat intoxicalion. The mortality rate was 95% in paraguat intoxication and 79% in organophosphorous intoxication. 5) In cases of organophosphorous intoxications, the mortality rate was 78% in 3 days after acute intoxication and 73% for paraguat intoxication in the same period. 6) The most common cause of death was respiratory failure (76%) in organophosphorous intoxication and respiratory failure (48%) and renal failure (45%) in paraquat intoxication.

급성심근경색증에서의 심장자기공명영상술의 진단 정확도와 심근 생존력 평가: TI-201 심근관류 SPECT와의 비교

김혜선,박동우,김용수,김영선,최요원,전석철,서흥석,함창곡,김순길,안유헌,최윤영,박충기,Kim Hye-seon,Park Dong Woo,Kim Yongsoo,Kim Young-sun,Choi Yo Won,Jeon Seok Chul,Seo Heung Suk,Hahm Chang Kok,Kim Soon Kil,Ahn You hern,Choi Yoon Young,P 대한자기공명의과학회 2003 Investigative Magnetic Resonance Imaging Vol.7 No.2

목적 : 급성심근경색을 진단하는데 있어 심장자기공명영상의 유용성을 알아보고, 생존심근을 평가하는데 있어 Tl-201 심근관류 SPECT와 비교하고자 하였다. 대상 및 방법 : 흉통 및 호흡곤란이 있는 환자 중 심장자기공명영상과 Tl-201 SPECT를 시행한 17명을 후향적으로 조사하였다. 심장자기공명영상에서는 T2강조영상에서 심벽의 고신호 강도 유무, 영화영상에서 심벽 운동, Gd-DTPA 조영 증강 후 좌심실 벽의 관류 결손 및 주입 15분 후의 지연조영증강 유무를 평가하였다. T1-201 SPECT에서는 아데노신 부하 영상과 휴식기 영상을 얻어 관류 결손 유무와 관류 결손시 가역성 여부를 평가하였다. 결과 심장자기공명영상과 T1-201 SPECT 모두 급성심근경색을 진단하는데 통계적으로 의미가 있었고, T2강조영상, T1-201 SPECT, 지연조영증강 및 심벽운동 순으로 연관성이 있는 것으로 나타났고, 관류 결손은 통계적 유의성이 없었다. 생존심근 평가에 있어서는 두 검사간 유의한 차이가 없었으며, T2강조영상과 관류영상에서 T1-201 SPECT와 높은 일치율, 지연조영증강 및 심벽운동은 낮은 일치율을 보였다. 결론 : 심장자기공명영상은 급성심근경색을 진단하는데 매우 유의한 진단율을 보였고, 생존 심근여부의 판단에 있어 SPECT와 높은 일치율을 보였다. 그러나 각 검사별 판독 기준과 방법에서 많은 연구가 필요할 것으로 생각된다. Purpose : To assess the usefulness of cardiac MR imaging (MRI) in the diagnosis of acute myocardial infarction and in the assessment of myocardial viability in comparision with T1-201 SPECT. Materials and Methods : We retrospectively studied 17 patients who complained of chest pain and dyspnea with cardiac MRI . The patients were evaluated for the presence or absence of high signal intensity on T2-weighted image (T2wI), abnormal wall motion on 2D-FIESTA, perfusion defect on Gd-DTPA enhanced T1WI, and delayed myocardial enhancement on 15-minutes delay Gd-DTPA enhanced T1WI. The results were correlated with the images on T1-201 SPECT, taken at rest and stress, through which reversibility of perfusion defect was assessed. Results : Both cardiac MRI and T1-201 SPECT proved to be useful methods for diagnosing acute myocardial infarction. In order of decreasing correspondence, T2WI, T1-201 SPECT, delayed enhancement study, and wall motion images all showed significant statistical correlation with the clinical diagnosis of myocardial infarction. Perfusion MRI, on the other hand, showed no significant statistical difference was found between T1-201 SPECT and cardiac MRI. The results on T2WI showed high accordance with those on Tl-201 SPECT, while delayed myocardial enhancement and wall motion studies showed no agreement with Tl-201 SPECT. Conclusion : Cardiac MRI is useful method for diagnosis of acute myocardiac infarction. With respect to the assessment of myocardial viability, the results obtained on cardiac MRI showed high agreement with those on Tl-201 SPECT. However, further study is necessary at this point for standardization and establishment of the methods for assessing myocardial viability on cardiac MRI.

신경차단이 정맥압박에 의한 t - PA 분비에 미치는 영향

홍세용(Sae Yong Hong),양동호(Dong Ho Yang),신현길(Hyun Kil Shin),김순길(Sun Kil Kim),김난숙(Nam Suk Kim),김형미(Hyung Mi Kim),신정순(Jung Sunn Shin) 대한내과학회 1992 대한내과학회지 Vol.43 No.2

Background: Fibrinoiytic response to venous occlusion of the limbs had been regarded as a sensitive and reliable method for assessing the individual fibrinolytic capacity, but the exact mechanism of the increased fibrinolytic activity after venous occlusion is not clear. Methods: In order to investigate the influence of neurotransmitter on t-PA release by venous occlusion, we compared the increase in t-PA and fibrinolytic activity in the euglobulin fraction initiated by cubital venous occlusion (100mmHg for 10mins), in pre-neural block and post-neural block states, in seven cases. In all patients, the supra-clavicular approach was used to obtain a brachial plexus block and venous occlusion was achieved at the cubital levels on the ipsilateral arm. Results: The euglobulin fibrinolytic activity before venous occlusion was 100.9±27,5 BAU in the pre nerve block state and 102.7±29.4 BAU in the post nerve block state (p>0.5). The t-FA antigen level before venous occlusion was 3.5±1.2ng/ml in the pre nerve block state and 4.0±1.0ng/ml in the post nerve block state (p>0.5). The increase in the euglobulin fibrinolytic activity after venous occlusion was 18.0±16.7 BAU in the pre nerve block state, and 18.3±15.6 BAU in the post nerve block state (p>0.5). The increase in the t-PA antigen levels after venous occlusion was 3.0±2.0ng/ ml in the pre nerve block state and 3.0±2.1ng/ml in the post nerve block state (p>0.5). Conelwion: These findings suggest that the peripheral nervous system does not exert any influence on t-PA release during venous occlusion.

활차 운동이 인체의 섬유소 용해능에 미치는 영향

김순길,신승호,양동호,김선주,홍세용 대한내과학회 1992 대한내과학회지 Vol.42 No.2

저자들은 섬유소 용해능 자극 검사로서 활차운동의 유용성을 조사하기 위하여 일차적으로 활차운동 후 혈액의 섬유소 용해능의 변화를 조사하였다. 15세에서 68세 사이의 건강한 남자 16명의 활차운동 전후의 euglobulin 섬유소 용해능 및 tissue-type plasminogen activator 와 urokinase-type plasminogen activator의 antigen 농도를 측정하여 다음과 같은 결과를 얻었기에 보고하는 바이다. 1) Euglobulin 섬유소 용해능은 활차운동 전 98.4±9.5 BAU (Blood Activator Unit)에서 운동 후 116.4±17.4 BAU로 증가하였다(p<0.0005). 2) t-PA antigen 농도는 활차운동전 3.2±2.3ng/㎖에서 운동후 4.9±2.6ng/㎖로 증가하였다(p<0.0001). 3) u-PA antigen 농도는 활차운동전 1.7±0.3ng/㎖에서 운동후 1.7±0.4ng/㎖로 의미있는 변화는 없었다. 결론적으로 활차운동 후 혈장 섬유소 용해능과 t-PA antigen 농도는 현저히 증가하였으며, 전신적인 섬유소 용해능을 자극하는 임상적인 방법으로서 활차운동은 비교적 안전하고 유용한 검사하고 사료된다. The systemic fibrinolytic potential could not be deter-mined by simple measurement of plasma fibrinolytic activity or plasma plasminogen activators, and stimulation test is essential to determine systemic fibrinolytic potential. In general plasma fibrinolytic activity is increased by emotional stress, physical exercise, venous occlusion, and DDAVP (desamino-d-arginine vasopressin) infusion. But until recently standardized test to stimulate systemic fibrinolysis is not established in clinical field. The treadmill exercise is one of the method to stimulate systemic fibrinolysis and is relatively safe in every clinical situations> Moreover standardization of exercise test as clinical standardized stimulation test of systemic fibrinolysis. On the first step, we measured plasma fibrinolytic activities before and after standardized treadmill exdrcise in normal individuals to testify its reliability. Sixteen healthy men (age from 15 to 68) performed more than 85% of maximal exercise determined by heart rate for their age group on treadmill. Before and after exercise we measured euglobulin fibrin lysis area, and antigen levels of t-PA and u-PA by ELISA method. After exercise euglobulin fibrin plate lysis area was increased from 98.4±9.5 BAU (Blood Activator Unit) to 116.4±17.4 (p<0.0005) (Normal pooled plasma: 100 BAU). And t-PA antigen level was also increased from 3.2±2.3ng/㎖ (before exercise) to 4.9±2.6ng/㎖ (after exercise) (p<0.0001). The antigen level of u-PA was not changed after exercise: from 1.7±0.3ng/㎖ pre-exercise to 1.7±0.4ng/㎖ post-exercise. In conclusion we found that systemic fibrinolytic activity and antigen level of t-PA were enhanced after exercise. And we consider that standardized treadmill exercise is safe and reliable method to stimulate systemic fibrinolysis.

구리 지역에서 조사한 고혈압의 인지도, 치료률 및 관리률

홍철호,김순길,홍택원,이제,신진호,이재웅,김경수,김정현,임헌길,이방헌 대한간질학회 2003 대한간질학회지 Vol.9 No.1

항응고제 사용 중 발병된 소장의 체강벽내 혈종

김종표,김순길,오승일,박준성,김동욱,이재형,이 상,이재웅,김경수,이철범,김정현,임헌길,이방헌 한양대학교 의과대학 2002 한양의대 학술지 Vol.22 No.2

Hemorrhages are the main complications associated with oral anticoagulant therapy. Spontaneous intramural small bowel hemorrhage is considered to be a rare but clinically serious problem. The exact pathogenesis of these complications is unknown. Neither the clinical nor the laboratory and radiologic features are in themselves diagnostic of intramural hematoma, but if a patient receiving anticoagulant therapy is suspicious to have hemorrhagic complications, then radiological workup of the patient including abdominal ultrasound and a CT scan should be considered. The management of patients with proved or suspected anticoagulation associated intramural hemorrhage of the small intestine is conservative, but surgery should be contemplated if the patient's condition does not improve when the anticoagulant is withdrawn. A 75-year-old female patient who received anticoagulant therapy with warfarin due to atrial fibrillation, mitral stenosis and aortic regurgitation was admitted to our hospital because of abdominal pain. A pre-contrast abdominal CT scan revealed intramural hematoma of small intestine. After immidiate cessation of the anticoagulant and conservative treatment with transfusion, the patient was improved. Therefore, we report the clinical course of the patient and review literatures.

Anti-HBs항체 정량적 분석의 임상적 의의

김순길,김기원,이문호,황성규,양동호,홍세용,김선주 순천향대학교 1992 논문집 Vol.15 No.4

To evaluate the advantage of quantitative analysis of anti-HBs, we attempted to measure the anti-HBs quantitatively using the CPM value during radioimmunoassay of anti-HBs. Anti-HBs was higher in abnormal LFT group(SGPT>40 unit) than normal LFT group(SGPT<40). Anti-HBs was higher in chonic hepatitis group than healthy control group, but there was no difference among acute hepatitis group, liver cirrhosis group, and control group. These findings suggest that humoral immunity is accelerated in chronic hepatitis. Quantitive analysis of anti-HBs will be the more useful predictor to under stand pathophysiology of viral hepatitis B and /or quantitive immune response to HBsAg than qualitive analysis.

Zircaloy-4 핵연료 피복관의 온도에 따른 연성변화

김규태,김형섭,홍순익,김순길,최창범 대한금속재료학회(대한금속학회) 1999 대한금속·재료학회지 Vol.37 No.12

Temperature and strain rate dependence of elongation and flow stress in Zircaloy-4 CANDU nuclear fuel claddings were studied. The elongation minimum and strain rate sensitivity minimum ocurred at each strain rate and the minima were shifted to higher temperature with increaging strain rate. The loss of ductility associated with dynamic strain aging was observed between 250∼400℃. SEM observation revealed that the fracture surface of Zircaloy-4 nuclear fuel claddings was ductile irrespective of strain rate and temperature. The predicted strain rate sensitivity and elongation are in reasonably good agreement with experimental data in the temperature region of the dynamic strain aging. In the temperature region of the flow stress plateau, the decreases in the strain rate sensitivity due to dynamic strain aging result in a low ductility. Above the temperature range of the flow stress plateau, the high strain rate sensitivity due to dynamic strain aging causes high ductility.

자발성 관동맥 박리증에 의한 급성 심근경색증

홍택원,김순길,김태엽,정재면,고동희,이재웅,김경수,김정현,임헌길,이방헌,이철범 한양대학교 의과대학 2002 한양의대 학술지 Vol.22 No.2

Spontaneous coronary artery dissection is a rare cause of myocardial infarction. It occurs in relatively young people with a striking predilection for women, mainly during or after prognancy. The optimal management of spontaneous coronary artery dissection has not been established yet and may vary, depending upon the presence of intimal versus extramural compromise. Coronary artery bypass, stenting, and thrombolysis may have been successful and also may have failed, owing to extension of dissection. We describe a case of acute myocardial infarction caused by spontaneous coronary artery dissection which occurs in a 51-year old man. The coronary angiography showed a spiral dissection of right coronary artery, from the origin of conus branch to the distal portion of right coronary artery. An intimal plaque with 35% obstruction and normal (TIMI 3) flow was demonstrated. The patient was functionally recovered after conventional midical treatment including heparin, beta blockers and long acting nitrates. Four months later, follow up coronary angiography showed stabilization of coronary lesion and improvement of stenosis.