The Correlation of Carotid Artery Stiffness with Heart Function in Hypertensive Patients

명유식,서혜선,정인현,이내희,서존,최재혁,조윤행 한국심초음파학회 2012 Journal of Cardiovascular Imaging (J Cardiovasc Im Vol.20 No.3

Background: The strength of each heart beat and the stiffness of large arteries contribute to blood pressure (BP). When the large arteries are stiff and their resistance greater, the afterload increases and this may change the function of the heart. However,the relation between common carotid artery stiffness and heart function in hypertensive patients has not been clarified. Methods: Two hundred and twenty hypertensive patients underwent transthoracic and carotid echocardiography. Measurements of local arterial stiffness were taken at the right common carotid artery level and stiffness parameter (β), pressure-strain elasticity modulus and intima-media thickness were calculated. Brachial cuff BP was measured just before starting the carotid study. The patients with any cardiovascular disease, diabetes mellitus, stroke, transient ischemic attack, or carotid stenosis were excluded. Results: Carotid artery stiffness parameter (β) was correlated with age and left ventricular mass index (p < 0.005). Even though β was not correlated with LV systolic function, it was inversely correlated with diastolic function as measured by early mitral annular velocity. When the artery was stiffer, early mitral annular velocity (e’) decreased (p < 0.001) and the index of left atrial (LA) pressure (early diastolic mitral inflow E velocity/e’) increased (p = 0.001). In logistic regression, diastolic dysfunction was affected by age (beta -0.385, p = 0.001), LA volume index (beta 0.175, p = 0.013) and β (beta -0.273, p = 0.019). Conclusion: In hypertensive patients, changes in carotid artery stiffness can affect the diastolic function, independent of age and LA volume index. Therefore, measurements and control of carotid stiffness can play an important role in the prevention of diastolic heart failure.

간세포양 위샘암종 증례

명유식,한재필,홍수진,김혜수,박정환,김희경,정귀애,조규석 대한상부위장관ㆍ헬리코박터학회 2015 Korean Journal of Helicobacter Upper Gastrointesti Vol.15 No.1

Hepatoid adenocarcinoma of the stomach (HAS) is a rare form of gastric cancer that histologically resembles hepatocellular carcinoma and is characterized by large amounts of alpha fetoprotein in the serum. The prognosis of HAS is poor compared to that of primary gastric cancer with five-year survival rates of 9% and 44%, respectively. Here, we report five patients diagnosed with HAS. Our experience suggests that an advanced stage of HAS has an extremely poor prognosis, but early detection and radical surgery can help improve the prognosis of the disease.

개회충증에 의한 심낭 삼출액을 동반한 급성 담낭염 1예

명유식,문종호,최현종,한승효,윤형근,이태훈,조영덕,박상흠,김선주 대한내과학회 2011 대한내과학회 추계학술발표논문집 Vol.2011 No.1

서론: 내장유충이행증(visceral larva migrans)은 기생충의 유충이 장벽을 뚫고 간문맥이나 간조직에 침투하여 발생하는데 괴사, 간질성 부종,출혈, 육아종성 반응을 일으키며, 간 조직을 벗어나 눈, 중추 신경계, 심근, 폐 등을 침투하여 임상증상을 나타낼 수 있다. 이러한 내장유충이행증의 가장 일반적인 기생충은 개회충증(Toxocariasis)으로 알려져 있으며, 현재까지 국내문헌에 눈과 폐를 침범한 증례가 드물게 보고되었지만, 아직까지 개회충중에 의한 담낭이나 심낭의 침범은 보고된 바가 없다. 저자 등은 개회충증에 의한 현저한 호산구 증가 소견과 함께 심낭 삼출액을 동반한 급성 담낭염 1예를 경험하였기에 보고하는 바이다. 증례: 39세 여자 환자로 내원 4일전부터 발생한 발열을 동반한 우상복부 통증을 주소로 응급실에 내원하였다. 신체 검사에서 우상복부 압통, Murphy`s sign 양성 소견을 보였다. 검사실 소견에서 WBC11850/uL(호산구 l 7.2%), AST/ALT 44/39 IU/L, total bilirubin 0.76 mg/dL, ALP 67 IU/L r-GT 49 IU/L, ESR 6 mm/hr CRP 1.34 mg/dL보였으며 심전도에서는 정상 동성 리듬을 보였다. 복부 초음파 검사에서 담낭종대 및 담낭벽의 비후가 관찰되었고, 복부 전산화 단층촬영에서 낭종대 및 담낭벽의 비후 외에 중등도의 심낭 삼출액 소견이 관찰되었다. 급성 담낭염 진단하에 금식 및 항생제 치료 유지하였고 심낭 삼출액에 대해 심낭천자술 및 배액술을 시행하였다. 심낭 삼출액 분석에서 WBC 2640/mm3(호산구 47%) 소견보였고, 추적 말초혈액검사에서 WBC10160/uL(호산구 58%)로 호산구증가증이 관찰되었다. 호산구증가증에 대한 원인 감별을 위해 시행한 Toxocariasis canis ELISA 항체 검사에서 0.515 (양성판정기준;0.250)으로 양성소견을 보였다. 개회충증 진단 하에 albendazole 400 mg 하루 2회 7일간 복용하였고 환자의 우상복부통증 및 심낭 삼출 배액량이 현저히 호전되었다. 추적 혈액검사에서 호산구증가증 호전된 상태로 특이 증상없이 외래에서 경과 관찰 중이다. 결론: 저자들은 우상복부 통증을 주소로 내원한 환자에서 개회충증에 의한 급성 담낭염 및 심낭 삼출액 발생을 경험하였기에 보고하는 바이다.

수은 증기 흡입에 의한 급성 폐손상 및 급성 전신성 발진성 농포증

서현정 ( Hyun Jung Seo ),명유식 ( Yu Sik Myung ),정희재 ( Hee Jae Jung ),김민진 ( Min Jin Kim ),서유리 ( Yu Ri Seo ),박경아 ( Kyong Ah Park ),박춘식 ( Choon Sik Park ),박재성 ( Jai Soung Park ),박종숙 ( Jong Sook Park ) 대한천식알레르기학회 2012 천식 및 알레르기 Vol.32 No.4

Background: Inhalation of mercury vapor is very rare, but if it occurs, fatal damage, such as acute lung injury or death, may ensure. In addition, acute generalized exanthematous pustulosis due to mercury hypersensitivity has rarely been reported in the literature. We experienced a 49-year-old male patient who had been exposed to mercury vapor following burning of mercury-containing materials. Case History: The patient complained of dyspnea, fever, and systemic erythema. Physical examination revealed that he had macular erythema with tiny pustules. His body temperature was 38.3oC and a complete blood count revealed elevated leucocytes. Chest radiographs revealed diffuse airspace opacification in both lungs. Results: He was admitted to the intensive care unit and treated with oxygen, intravenous methylprednisolone 125 mg per day, and oral antihistamines. His symptoms improved and his skin lesions resolved completely with desquamation 5 days. On the eighth hospital day, intravenous methylprednisolve was tapered to 62.5 mg methyprednisolone, followed by oral methyprednisolone. He was discharged from the hospital on the 20th hospital day and is currently being followed-up with no aggravation of symptoms or relapse. Conclusion: We report a case of acute lung injury and acute generalized exanthematous pustulosis induced by inhalation of mercury vapor that was successfully treated with early avoidance and steroid therapy.

Salmonella Enteritidis에 의한 감염성 슬관절염 1예

김민진,허순미,조윤희,정희재,명유식,이은정,전민혁,김태형,신희봉,추은주 대한감염학회 2012 Infection and Chemotherapy Vol.44 No.6

Salmonella septic arthritis in a healthy, immunocompetent patient is extremely rare. We experienced a case of septic arthritis of the knee caused by Salmonella Group D in a patient with Non-small cell lung cancer. A 43-year-old female receiving steroid therapy for treatment of Non-small cell lung cancer with metastasis to the spinal cord complained of painful swelling of the right knee joint. Culture of synovial fluid obtained by aspiration yielded growth of Salmonella Group D. The patient was treated with ceftriaxone; however, she expired on the ninth day after treatment.

후천성면역결핍증 환자에서 발생한 위장관과 경부 림프절을 침범한 카포시육종 1예

조윤희,한재필,허순미,김민진,정희재,명유식,김희경,이은정,전민혁,김태형,추은주 순천향대학교 순천향의학연구소 2012 Journal of Soonchunhyang Medical Science Vol.18 No.1

Kaposi’s sarcoma was the first malignancy to be recognized as a cancer defining acquired immunodeficiency syndrome (AIDS). Kaposi’s sarcoma, a rare tumor, usually presents itself with skin lesions but it may be widely disseminated internally such as digestive,respiratory organ, spleen, or lymph node. The incidence of Kaposi’s sarcoma in patients with AIDS has declined in the era of effective antiretroviral therapy (ART), and cases of disseminated Kaposi’s sarcomas have rarely been reported in Korea. Chemotherapy is usually used in symptomatic or rapidly progressive disease, and interferon-α can be applied as a treatment option. We report a successfully treated case of gastrointestinal and cervical lymph nodal Kaposi’s sarcoma in a patient with AIDS who had combined treatment with ART, interferon-α, and paclitaxel.

이식 후 신기능 상실로 혈액투석을 시작한 환자에서 뇌경색을 동반한 감염성 심내막염 1예

정희재 ( Hee Jae Jung ),유병철 ( Byung Chul You ),명유식 ( Yu Sik Myung ),김은정 ( Eun Jung Kim ),박무용 ( Moo Yong Park ),최수정 ( Soo Jeong Choi ),김진국 ( Jin Kuk Kim ),황승덕 ( Seung Duk Hwang ),고은석 ( Eun Suk Koh ),허균 ( 대한신장학회 2011 Kidney Research and Clinical Practice Vol.30 No.5

Infective endocarditis is a dreaded complication in dialysis or kidney transplantation patients, with high morbidity and mortality. Despite the improved early survival of the transplanted kidney with new immunosuppressive agents, the number of patients returning to dialysis after a failed renal allograft is increasing. There is no consensus on the optimal management of immunosuppression in patients with a failed allograft. Continued immunosuppression is associated with infection, and the rapid discontinuation of immunosuppression may lead to acute rejection. Therefore, it is important to taper the immunosuppression properly in patients with a failed renal allograft. We report on a hemodialysis patient with a failed renal allograft who had a cerebral infarction following infective endocarditis. The patient was treated successfully with antibiotics and valve replacement.

개회충증에 의하여 유발된 호산구성 심장막염을 동반한 급성 담낭염 1예

추진우 ( Jin Woo Choo ),최현종 ( Hyun Jong Choi ),문종호 ( Jong Ho Moon ),정종호 ( Jong Ho Chung ),박진석 ( Jin Seok Park ),명유식 ( Yu Sik Myung ),서혜선 ( Hye Sun Seo ) 대한내과학회 2013 대한내과학회지 Vol.84 No.6

Toxocariasis is a parasite infection of a human host caused by Toxocara canis. Most human infections occur in persons who eat contaminated food containing embryonated eggs or larvae. Toxocariasis can produce various symptoms associated with eosinophilic infiltration into various internal organs such as the liver, lungs, eyes, or central nervous system. However, a simultaneous onset of cholecystitis and pericarditis has not yet been reported in the literature. A 39-year-old female patient complained of right upper abdominal pain. Several imaging studies revealed acute cholecystitis and pericarditis with pericardial effusion. Marked eosinophilia was observed in her peripheral blood and pericardial fluid. A high titer of antibodies against T. canis was discovered during the search for the cause of the eosinophilia. All clinical features and the eosinophilia improved dramatically after treatment with albendazole. We report a case of simultaneous onset of acute cholecystitis and pericarditis associated with marked eosinophilia caused by T. canis. (Korean J Med 2013;84:836-841)