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김광하(Gwang Ha Kim),배용목(Yong Mock Bae),정을조(Eul Jo Jeong),문재현(Jae Hyeon Moon),안진광(Jin Kwang An),김진선(Jin Seon Kim),허정(Jeong Heo),강대환(Dae Hwan Kang),송근암(Geun Am Song),조몽(Mong Cho),양웅석(Ung Suk Yang) 대한내과학회 2002 대한내과학회지 Vol.63 No.4
목적 : 저진폭 수축파와 연동운동 단절은 식도 내용물의 부적절한 배출과 역류와 연관성이 있어 기능적·임상적 중요성을 가진다. 이런 이유로 비특이성 식도운동장애(NEMD)에서 구분하여 비효율적 식도운동(IEM) 이라는 새로운 진단명이 제시되고 있다. 이에 저자들은 산역류가 있는 IEM 환자에서 식도 산청소능을 조사하고자 하였다. 방법 : 2001년 6월부터 2002년 5월까지 쉰 목소리, 인후 이물감, 흉통 등으로 식도운동검사와 보행성 식도산도검사를 시행 받은 252예 중에서 산역류를 보이는 정상식도운동군 51명(남:여 18:33, 평균 48.0세)과 IEM군 40명(남;여, 16:24, 평균 48.6세)을 대상으로 하여 식도운동검사와 보행성 식도산도검사 결과를 비교분석하였다. 적어도 wet swallow의 30% 이상에서 원위부 식도의 저수축 소견이 관찰되는 경우를 IEM으로 진단하였으며. 식도 산청소능은 원위부 식도 pH가 4 미만인 전체 시간(분)을 총 역류 횟수로 나눈 값으로 정의하여 양군 간에 결과를 비교분석하였다. 결과 : 1) IEM군에서 근위부 식도와 원위부 식도 수축파의 진폭, 하부식도괄약근압은 각각 47.3±21.9 mmHg, 60.0±27.5 mmHg, 18.0±6.7 mmHg로, 정상식도운동군(66.5±22.6 mmHg, 100.3±31.8 mmHg, 29.5±8.4 mmHg)보다 유의하게 낮았다(p<0.05). 2) IEM군에서 전체 검사시간 중, 기립시, 앙와위시 pH 4 미만인 전체 측정시간 백분율은 0.78±1.08%, 1.05±1.55%, 0.42±1.16%로, 정상식도운동군(각각 0.55±0.85%, 0.85±1.31%, 0.14±0.41%)과 유의한 차이는 없었다(p>0.05). 또한, 전체 측정시간 중 pH 4 미만의 역류가 일어난 횟수, 전체 측정시간 중 pH 4 미만의 역류가 5분 이상 일어난 횟수, Demeester 종합점수, 최장역류시간도 양군간에 유의한 차이는 없었다(p>0.05). 3) IEM군에서 앙와위시 식도 산청소능은 0.73±0.64분/회로, 정상식도운동군 0.31±0.29분/회보다 유의하게 증가되어 있었다(p=0.021). 하지만 기립시 식도 산청소능은 IEM군 0.51±0.42분/회, 정상식도운동군 0.41±0.40분/회으로 양군간에 유의한 차이는 없었다(p=0.096). 결론 : IEM군에서 정상식도운동군보다 앙와위시 유의한 식도 산청소능 증가가 관찰되었다. IEM이 위식도역류질환(GERD)에서 흔히 관찰되는 것을 고려한다면, IEM시 보다 더 적극적인 항역류 치료가 필요하며, 차후 GERD의 장기합병증과의 관련성에 대한 연구도 필요할 것으로 보인다. 이러한 상황을 고려해 볼 때 IEM은 NEMD에서 분리하여 독립된 운동질환으로 분류하는 것이 바람직하리라 사료된다. Background : Failed or hypotensive peristalsis, two of the diagnostic criteria for NEMD, correlates with impaired anterograde propulsion and retrograde escape of esophageal contents. The aim of this study was to evaluate esophageal acid clearance (EAC) in patients with ineffective esophageal motility (IEM). Methods : Of 252 patients performing esophageal manometry and ambulatory esophageal pH monitoring, 51 patients with normal motility and acid reflux and 40 patients with IEM and acid reflux were included. Results : The amplitude of peristaltic waves in the proximal and distal esophagus and lower esophageal sphincter pressure was lower significantly in patients with IEM than those with normal motility. Percentage of time of pH<4 in total, upright, and supine period and number of reflux episodes was not different in both. Supine EAC was significantly increased in patients with IEM when compared to those with normal motility. Upright EAC was not different in both. Conclusion : We concluded supine EAC is increased in patients with IEM. Since IEM is frequently associated with gastroesophageal reflux disease (GERD), a more intensive therapy must be needed. We propose IEM can be as a specific entity of primary esophageal motility disorder, especially in patients with GERD.(Korean J Med 63:386-393, 2002)
상용량의 아세트아미노펜 복용 후 발생한 횡문근융해에 의한 급성신부전
김형진(Heung Jin Kim),김일두(Il Doo Kim),황영훈(Yeoung Hoon Whang),배용목(Yong Mock Bae),서길동(Gil Dong Seo),김명준(Myong June Kim),김수형(Soo Heung Kim),이인상(In Sang Lee) 대한신장학회 2000 Kidney Research and Clinical Practice Vol.19 No.1
A 21-year-young man had an episode of myalgia and chilling 3 days prior to hospital admission. He had consumed common doses of acetaminophen for one day, and was presented in the sauna room for an hour. On the next morning, he complained of dyspnea and was admitted. He presented in rhabdo-myolysis and acute renal failure with increased up-take in the proximal muscles by (99m)Tc-MPD bone scan. He was treated by hemodialysis and discharged on the twenty-eighth hospital day. Rhabdomyolysis has the variable causes. The causes of this case are two, the first cause is common doses of acetaminophen. But, there is no reports for rhabdomyolysis by common doses of acetaminophen only. However, we should consider that acetaminophen is a contributing factor in this case. The second cause is viral infection. Our patient had myalgia and chilling prior to hospital admission. Heat- stroke is well known cause of rhabdomyolysis. The mechnisms for rhabdomyolysis in this disease are hypovolemia, total body potassium deficit, and increased variable cytokines. Sauna, the last cause of our rhabdomyolysis case may have the same mechanisms with heatstroke. Our case had two causative factors, common doses of acetaminophen and sauna. These factors might be cooperated in our case of rhabdomyolysis and acute renal failure.
아르곤 플라스마 응고소작술 (argon plasma coagulation)로 치료한 위전정부 혈관확장증 (gastric antral vascular ectasia) 1예
배용목,정을조,허정,김광하,주형준,강대환,조몽,양웅석,이창훈 대한내과학회 2002 대한내과학회지 Vol.63 No.1
Gastric antral vascular ectasia (GAVE) is a rare but important cause of chronic gastrointestinal bleeding. Endoscopically, it has characteristic thickened red vascular folds radiating from the pylorus to the antrum. Diagnosis is made primarily by endoscopy. Histologic examination of the endoscopic mucosal biopsies may confirm the endoscopic diagnosis. Many treatment modalities of the gastric antral vascular ectasia exist. One of them, the argon plasma coagulation (APC) is an excellent therapeutic tool. Inactive argon gas is converted to ionized form by means of electrical energy. Ionized argon plasma conducts high frequency electrical energy to tissues and leads coagulation necrosis of tissues. We experienced a case of gastric antral vascular ectasia presenting melena for about one month in a 72-year-old man treated endoscopically in four sessions with argon plasma coagulation.
재발성 복부 통증을 호소한 환자에서 복벽에 발생한 자궁내막증 1예
홍현진,박성한,이준식,배용목,김지연,안광순,박선자 고신대학교의과대학 2008 고신대학교 의과대학 학술지 Vol.23 No.1
Endometriosis is the abnormal growth of endometrial tissue outside the uterine cavity. Endometriosis in the abdominal scar following cesarean section is very rare condition among the extrapelvic endometriosis. The frequency of abdominal wall endometriosis secondary to cesarean section is from 0.03% to 0.8% in some reports. It is difficult to diagnosed in spite of the typical symptoms. The typical symptom is aching swelling in the area of the surgical scar, which is influenced by the phases of menstruation. The definitive diagnosis is established by pathologic analysis. Surgical excision remains the treatment of choice. The majority of patients presented from 1 to 2 years after the precipitating operation. We experienced an unusual case of abdominal wall endometriosis presented over 10 years after cesarean section, who was admitted to our hospital complaining of recurrent left lower abdominal pain. So, we report this case with a brief review of the concerned literatures.
이숙영,김형진,배용목,서길동,황영훈,여동승,임성엽 대한알레르기학회 1999 천식 및 알레르기 Vol.19 No.3
Acute eosinophilic pneumonia(AEP) was first described in 1989 and represents a clinical entity distinct from chronic eosinophilic pneumonia. AEP is characterized by acute respiratory insufficiency, hypoxemia, fever, diffuse radiographic infiltrates, and eosinophilia in bronchoalveolar lavage fluid or lung biopsies in the absence of infection, atopy, or asthma. Rapid response to corticosteroids is characteristic. We experienced a 47-year-old metal driller presenting typical clinical and radiological characteristics of AEP. We confirmed eosinophilic pneumonia with brochoalveolar lavage analysis and transbronchial lung biopsy. We report a case of AEP diagnosed by clinical, radiographic, and histologic findings with a brief review of the literature.
김상현,김일두,장미화,배용목,서길동,임성엽,황영훈,김형진,김명준,김수형,조성락 대한소화기내시경학회 2000 Clinical Endoscopy Vol.20 No.6
Two cases are herein reported involving patients with ectopic gallstones which were discharged into the stomach and duodenum through a cholecystoduodenal fistula and successfully removed by endoscopic therapy. In the first case, a 75-year-old man was admitted with epigastric pain. Simple abdomen film demonstrated a round laminated calcification and air biliarygram in the RUQ. Endoscopic examination revealed a fistula on the posterior wall of the duodenal bulb and a brown stone (about 5 cm in diameter) was found in the second portion of the duodenum, It was demolished through endoscopic electrohydraulic lithotripsy (EEH1) and discharged with the stool. In the second case, a 55-year-old man was admitted with epigastric pain. A CT scan revealed an ovoid laminated calcification in the dependent portion of the stomach. Endoscopic examination revealed a fistula on the anterior wa11 of' the duodenal bulb and a black pigmented stone (about 2.5 cm in diameter) was found in the stomach. This stone was removed orally by an endoscopic snare. These patients were discharged and remained asymptomatic.