• 제목/요약/키워드: clinical case

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Anterior Communicating Artery Aneurysm Related to Visual Symptoms

  • Park, Jung-Hyun;Park, Sang-Keun;Kim, Tae-Hong;Shin, Jun-Jae;Shin, Hyung-Shik;Hwang, Yong-Soon
    • Journal of Korean Neurosurgical Society
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    • 제46권3호
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    • pp.232-238
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    • 2009
  • Objective : Intracranial aneurysms are sometimes presented with visual symptoms by their rupture or direct compression of the optic nerve. It is because their prevalent sites are anatomically located close to the optic pathway. Anterior communicating artery is especially located in close proximity to optic nerve. Aneurysm arising in this area can produce visual symptoms according to their direction while the size is small. Clinical importance of visual symptoms presented by aneurysmal optic nerve compression is stressed in this study. Methods : Retrospective analysis of ruptured anterior communicating artery aneurysms compressing optic apparatus were carried out. Total 33 cases were enrolled in this study. Optic nerve compression of the aneurysms was confirmed by the surgical fields. Results : In 33 cases among 351 cases of ruptured anterior communicating artery aneurysms treated surgically, from 1991 to 2000, the dome of aneurysm was compressed in optic pathway. In some cases, aneurysm impacted into the optic nerve that deep hollowness was found when the aneurysm sac was removed during operation. Among 33 cases, 10 cases presented with preoperative visual symptoms, such as visual dimness (5), unilateral visual field defect (2) or unilateral visual loss (3), 20 cases had no visual symptoms. Visual symptoms could not be checked in 3 cases due to the poor mental state. In 6 cases among 20 cases having no visual symptoms, optic nerve was deeply compressed by the dome of aneurysm which was seen in the surgical field. Of 10 patients who had visual symptoms, 8 showed improvement in visual symptoms within 6 months after clipping of aneurysms. In 2 cases, the visual symptoms did not recover. Conclusion : Anterior communicating artery aneurysm can cause visual symptoms by compressing the optic nerve or direct rupture to the optic nerve with focal hematoma formation. We emphasize that cerebral vascular study is highly recommended to detect intracranial aneurysm before its rupture in the case of normal CT findings with visual symptoms and frequent headache.

"의종금감(醫宗金鑑).정정중경전서상한론주(訂正仲景全書傷寒論註)" "변태음병맥증병치전편(辨太陰病脈證幷治全篇)"에 대한 번역연구 (Translational Study on a Chapter of Taeeum-Disease[太陰病篇] in "The Golden Mirror of Medicine.The Notes of Treatise on Cold-Induced Diseases(醫宗金鑑.傷寒論注)")

  • 이용범
    • 대한한의학원전학회지
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    • 제23권2호
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    • pp.33-62
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    • 2010
  • "The Golden Mirror of Medicine(醫宗金鑑)" was compiled by the medical officers of the Cheong(淸) government headed by Ogyeom(吳謙: 1736-1795) in 1742, and was adopted as a textbook by the Institute of Imperial Physicians(太醫院) in 1749. This book provides a good summary of academic contents and clinical experiences from before the Cheong(淸) dynasty, and serves as a convenient and practical guide book. "The Notes of Treatise on Cold-Induced Diseases(傷寒論注)" is one part of "The Golden Mirror of Medicine(醫宗金鑑)", and this is placed at the beginning of the book, indicating its importance. The chapter on taeeum-disease[太陰病篇], which is the third part of "The Notes of the Treatise on Cold-Induced Diseases(傷寒論注)", has not yet been translated into Korean. Therefore, in this study, the characteristics of Ogyeom's(吳謙) notes are inspected through a comparative study of the chapter of taeeum-disease[太陰病篇] based on translation and the notes of famous scholars. The texts first provide an outline of taeeum-disease[太陰病], which is followed by diarrhea, vomiting and therapeutic methods of syndrome involving both the exterior and interior[表裏兼證], as well as abdominal distension and pain. The prognoses are then explained in succession. The eight texts that have been shown in the chapter of taeeum-disease[太陰病篇] of original text were relocated and the seven texts that existed in the chapters of taeyang(太陽), yangmyeong(陽明) and gwol-eum(厥陰) were moved to this chapter. Furthermore, Ogyeom(吳謙) moved the cold-dysphagia[寒格] text from a chapter of gwol-eum-disease[厥陰病] to a chapter of taeeum-disease[太陰病] and explained vomiting due to pathogenic cold. The origins of taeeum-disease[太陰病] are purported to occur through the yang-channel[陽經] to the eum-channel[陰經], and taeeum-disease[太陰病] was reported to include both interior-deficiency-cold-syndrome[裏虛寒證] and interior-excess-heat-syndrome[裏實熱證]. In the case of diarrhea-more-severe-symptoms[自利益甚], he thought it induced by faultpurgation[誤下], and in indication for decoction of cinnamon with peony[桂枝加芍藥湯] and decoction of cinnamon with rhubarb[桂枝加大黃湯], he thought it included the exterior syndrome of taeyang-disease[太陽表證], and rhubarb was used in purgation of taeeum-excess[太陰實].

개에 있어서 전신성 홍반성 낭창 일례 (A Case of Systemic Lupus Erythematosus in a Dog)

  • 김주향;김기홍;고인경;이금종;나기정;양만표
    • 한국임상수의학회지
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    • 제17권2호
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    • pp.443-449
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    • 2000
  • A three-year-old male jindo with generalized skin lesions (including seborrhea, hyperk- eratosis, alopecia, papules, and ecchymoses), pruritus lymph node enlargement, and fever was brought to Veterinary Teaching Hospital, College of Veterinary Medicine, Chungbuk National Uni- versity. There were no laboratory findings for parasites and fungi in the hair and skin But, the com- plete blood counts (CBC) showed leukocytosis and severe cosinophilia, It was suspected to be an inflammatory and allergic dermatitis. Thus, prednisoIone (0.5 mg/kg PO, BID for 1 week) and ampi- cillin (10 mg/kg PO, BID for 1 week given. One week later, pruritus and ecchymoses were reduced. These treatments were repeated for 7 day again. Three months later, the dog was presented again due to the relapse and exacerbation of the clinical signs. The signs were as follows; severe pru- ritus, vesicobullous skin lesions, anorexia, emaciation, lameness, and welling of carpal joints that showed inflammatory skin lesion and draining of synovia-like fluid. The values of WBC counts were returned to normal ranges. In contrast, eosinophilia was still observed. Coombs test for patient RBC and serum were negative. Hypoalbuminemia (2.5g/dl) was shown by serum chemistry. The uri- nalysis revealed and presence of leukocytes. Luxation finding of right radial carpal joint by polyarthritis was shown in radiography of affected joints.Lupus eryhematosus(LE) cells also appeared in peripheral blood and synovial fluid of affected joints. Definitely, antinuclear antibody (ANA) of patient serum using feline peripheral blood mononuclear cells was detected by all immu- nofluorescence. Based on these findings such as sedum ANA-Positive. major signs (skin disease, non- erosive polyarthritis with soft tissue swelling. and proteinuria), minor signs (fever), and LE cell-pos- itive, a diagnosis of systemic lupus crythematosus (SLE) was mad\ulcorner in this dog. The dog with SLE was administered with Pre(2.0 mg/kg PO, BID for first 4 week and then QOD) to inhibit the production of autoantibodies and with ampicillin (10 mg/kg PO, BID for first 4 weeks and then QOD) to prevent the secondary infection. The condition of this dog was monitored every 2 weeks by physical examinations, radiography, CBC, serum chemistry and urinalyais. At 8th week of treat- ment, the state of SLE evaluated by physical examinations and laboratory findings was markedly improved except for proteinura.

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개에서 발생한 상공막염 12례 (Episcleritis in dogs: 12 cases)

  • 박신애;정만복;김원태;김세은;박영우;지향;김대용;서강문
    • 한국임상수의학회지
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    • 제25권5호
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    • pp.415-419
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    • 2008
  • The purpose of this study was to determine clinical features of canine episcleritis and outcomes of therapy in Korea. The medical records of dogs with episcleritis presented at the Veterinary Medical Teaching Hospital of Seoul National University from January 2006 to December 2007 were reviewed. Episcleritis was diagnosed in 17 eyes of 12 dogs. The most frequently affected breed was Shih Tzu (n = 6). The median affected age was 5 years with a range from 3 years to 12 years. Simple episcleritis was identified in 8 dogs, nodular granulomatous episcleritis (NGE) in 3 dogs, and secondary episcleritis caused by panophthalmitis in a dog. The combination immunosuppressive therapy of topical corticosteroids, topical cyclosporine A, and intralesional injection of triamcinolone (4 mg) and gentamicin (4 mg) was performed. Most of the patients with episcleritis were resolved within 30 days following the therapy. Surgical excision was performed in 1 NGE case which was not responded to the medical therapy. Recurrence was observed in 4 dogs between 5 and 8 months after the first visit. It is considered that strong immunosuppressive therapy and periodic ocular examination are needed to control episcleritis.

개에서 탈출된 경추디스크에 대한 디스크내 오존가스 주입 치료 (A Case of Intradiscal Oxygen-ozone Injection Therapy for Cervical Herniated Intervertebral Disc in a Dog)

  • 장하영;이준섭;이보라;김경희;정순욱
    • 한국임상수의학회지
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    • 제26권3호
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    • pp.273-275
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    • 2009
  • 사지마비를 보이는 6년령 시쮸 숫컷이 내원하였다. 신경검사소견 및 영상진단소견에서 경추 4번과 5번 사이, 경추 5번과 6번 사이 및 경추 6번과 7번 사이의 디스크가 탈출되어 척수를 압박하고 있는 것으로 나타났다. 오존가스를 경추 4번과 5번 사이 디스크 및 경추 6번과 7번 사이 디스크에 주입하고 경추 5번과 6번 사이는 복측 감압술로 탈출된 디스크를 제거하였다. 환축은 수술후 목 통증이 사라지고 수술후 3주경 정상보행을 나타냈다. 수술후 2개월째 자기공명영상에서 경추 5번과 6번 사이 디스크와 경추 6번과 7번 사이 디스크의 탈출된 소견이 사라졌고 경추 4번과 5번 사이의 디스크는 탈출된 정도가 현저히 줄어든 소견을 보였다.

불완전 방사선치료 환자의 분석 (Why Do Patients Drop Out During Radiation Therapy? - Analyses of Incompletely Treated Patients -)

  • 허승재;우홍균;안용찬;김대용;신경환;이규찬;정원아;김현주
    • Radiation Oncology Journal
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    • 제16권3호
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    • pp.347-350
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    • 1998
  • 목적 : 본 연구는 계획된 방사선치료의 과정 도중에 방사선치료를 완료하지 못하는 환자들의 빈도를 조사하고 그 이유를 분석하고자 하였다. 대상 및 방법 :삼성서울병원 치료방사선과에서 방사선치료를 받은 환자 중에서 1996년 4월부터 1997년 5월까지 방사선치료를 시행 받은 1,100명의 환자들을 대상으로 하였다. 대상 환자들 중에서 최초 계획 방사선량의 95$\%$ 이하를 받은 경우를 불완전 방사선치료로 정의하여 그 빈도와 이유를 조사하였다. 결과 : 불완전 방사선치료의 빈도는 1,100명 중 128명으로 12$\%$였다. 불완전 방사선치료 환자들의 운동수행능력은 전체 환자들에 비하여 불량하였으며, 방사선치료의 목적은 고식적 목적이 많았다. 불완전 방사선치료의 가장 흔한 이유는 환자의 거부였으며 이는 주로 환자의 방사선치료에 대한 불신과 경제적 부담 때문이었다. 결론 : 불완전 방사선치료의 빈도를 줄이기 위해서는 방사선치료의 임상적 적응 여부는 물론 환자의 사회 경제적인 여건을 잘 고려하여 방사선치료의 대상 환자를 선정하는 것이 요망되며 이는 특히 고식적 방사선치료의 경우에 더욱 중요하다고 할 수 있겠다.

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청소년기에 발생한 ADAMTS-13 활성도 저하와 항체 양성을 보인 혈전저혈소판혈증자색반병 1례 (Thrombotic thrombocytopenic purpura with decreased level of ADAMTS-13 activity and increased level of ADAMTS-13 inhibitor in an adolescent)

  • 양은미;한동균;백희조;신명근;김영옥;국훈;황태주
    • Clinical and Experimental Pediatrics
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    • 제53권3호
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    • pp.428-431
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    • 2010
  • 혈전저혈소판혈증자색반병은 혈관 내피 세포 손상에 의한 혈전미세혈관병증으로 미세혈관병용혈빈혈, 혈소판감소증과 미세혈관 혈전에 의한 다양한 정도의 신경 및 신장 침범을 보인다. 이는 소아에서는 드물게 발생하며 종종 치명적인 경과를 보일 수 있다. 혈전저혈소판혈증자색반병은 ADAMTS-13 유전자 변이에 의한 결핍을 보인 선천성 그리고 ADAMTS-13 항체들에 의해 발생하는 후천성인 경우로 분류할 수 있다. ADAMTS-13 활성도 및 순환 항체검사, 그리고 항 ADAMTS-13 IgG와 ADAMTS-13 염기서열분석은 이 질환의 진단에 중요하다. 후천성 환자에게는 혈장교환술이 주된 치료이며, 스테로이드제나 면역억제제도 사용된다. 저자들은 청소년기에 발생한 ADAMTS-13 활성도 저하와 항체 양성을 보인 후천성 혈전저혈소판혈증자색반병을 진단 후 혈장교환술로 효과적으로 치료하였던 1례를 보고하는 바이다.

메틸화 특이 PCR로 진단된 거설증을 동반한 일과성 신생아 당뇨병 (Transient neonatal diabetes mellitus with macroglossia diagnosed by methylation specific PCR (MS-PCR))

  • 진혜영;최진호;김구환;유한욱
    • Clinical and Experimental Pediatrics
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    • 제53권3호
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    • pp.432-436
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    • 2010
  • 일과성 신생아 당뇨병은 6번 염색체의 부친 이체성, 부친으로부터 유래한 염색체 6q24의 중복, ZAC 또는 HYMAI 유전자의 CpG 섬의 메틸화 결함에 의해 야기된다. 저자들은 고혈당, 거설증, 자궁내성장지연으로 발현되어 부친으로부터 유래된 HYMA1 유전자만을 보인 일과성 신생아 당뇨병 1례를 경험하였다. 생후 18일된 여아가 거설증과 반복되는 고혈당으로 입원하였다. 거설증과 함께 큰 대천문, 작은 턱, 두드러진 눈을 보였으며 혈중 포도당 농도는 200-300 mg/dL로 유지되다가 입원 2일 후부터 인슐린 투여 없이도 정상 범위로 유지되었다. 모체로부터 유래된 메틸화된 대립유전자 유무를 확인하기 위하여 말초 혈액으로부터 genomic DNA를 추출하여 bisulfite를 처리한 후, 메틸화 특이 중합 효소 연쇄 반응으로 HYMAI 유전자의 일부분을 증폭시키고, 제한 효소 BssHII를 이용한 제한 효소 절편 길이 다형성 (restriction fragment length polymorphism, RFLP) 분석을 이용하여 HYMAI 유전자의 메틸화 여부를 확인한 결과, HYMAI 유전자의 메틸화 결함을 보여 부친에서 유래된 HYMAI 유전자만을 갖고 있음을 확인하였다. HYMAI 유전자의 메틸화 검사를 통해 6번 염색체의 각인된 유전자가 증명되었으며 메틸화 결함으로 인해 일과성 신생아 당뇨병이 발생하였다.

Subclinical left ventricular dysfunction in children after hematopoietic stem cell transplantation for severe aplastic anemia: a case control study using speckle tracking echocardiography

  • Kim, Beom Joon;Moon, Kyung Pil;Yoon, Ji-Hong;Lee, Eun-Jung;Lee, Jae Young;Kim, Seong Koo;Lee, Jae Wook;Chung, Nack Gyun;Cho, Bin;Kim, Hack Ki
    • Clinical and Experimental Pediatrics
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    • 제59권4호
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    • pp.190-195
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    • 2016
  • Purpose: Severe aplastic anemia (SAA), a fatal disease, requires multiple transfusion, immunosuppressive therapy, and finally, hematopoietic stem cell transplantation (HSCT) as the definitive treatment. We hypothesized that iron overloading associated with multiple transfusions and HSCT-related complications may adversely affect cardiac function. Left ventricular (LV) function was assessed in children after HSCT for SAA. Methods: Forty-six consecutive patients with a median age of 9.8 years (range, 1.5-18 years), who received HSCT for SAA and who underwent comprehensive echocardiography before and after HSCT, were included in this study. The data of LV functional parameters obtained using conventional echocardiography, tissue Doppler imaging (TDI), and speckle-tracking echocardiography (STE) were collected from pre- and post-HSCT echocardiography. These data were compared to those of 40 age-matched normal controls. Results: In patients, the LV ejection fraction, shortening fraction, end-diastolic dimension, mitral early diastolic E velocity, TDI mitral septal E' velocity, and STE LV longitudinal systolic strain rate (SSR) decreased significantly after HSCT. Compared to normal controls, patients had significantly lower post-HSCT early diastolic E velocity and E/A ratio. On STE, patients had significantly decreased LV deformational parameters including LV longitudinal systolic strain (SS), SSR, and diastolic SR (DSR), and circumferential SS and DSR. Serum ferritin levels showed weak but significant correlations (P<0.05) with LV longitudinal SS and SSR and circumferential SS and DSR. Conclusion: Subclinical LV dysfunction is evident in patients after HSCT for SAA, and was associated with increased iron load. Serial monitoring of cardiac function is mandatory in this population.

Bronchial compression in an infant with isolated secundum atrial septal defect associated with severe pulmonary arterial hypertension

  • Park, Sung-Hee;Park, So-Young;Kim, Nam-Kyun;Park, Su-Jin;Park, Han-Ki;Park, Young-Hwan;Choi, Jae-Young
    • Clinical and Experimental Pediatrics
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    • 제55권8호
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    • pp.297-300
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    • 2012
  • Symptomatic pulmonary arterial hypertension (PAH) in patients with isolated atrial septal defect (ASD) is rare during infancy. We report a case of isolated ASD with severe PAH in an infant who developed airway obstruction as cardiomegaly progressed. The patient presented with recurrent severe respiratory insufficiency and failure to thrive before the repair of the ASD. Echocardiography confirmed volume overload on the right side of heart and severe PAH (tricuspid regurgitation [TR] with a peak pressure gradient of 55 to 60 mmHg). The chest radiographs demonstrated severe collapse of both lung fields, and a computed tomography scan showed narrowing of the main bronchus because of an intrinsic cause, as well as a dilated pulmonary artery compressing the main bronchus on the left and the intermediate bronchus on the right. ASD patch closure was performed when the infant was 8 months old. After the repair of the ASD, echocardiography showed improvement of PAH (TR with a peak pressure gradient of 22 to 26 mmHg), and the patient has not developed recurrent respiratory infections while showing successful catch-up growth. In infants with symptomatic isolated ASD, especially in those with respiratory insufficiency associated with severe PAH, extrinsic airway compression should be considered. Correcting any congenital heart diseases in these patients may improve their symptoms.