• 제목/요약/키워드: lower abdominal pain

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Meckel 게실의 임상양상 (A Clinical Manifestation of Meckel's Diverticulum)

  • 이진범;이용순;유은선;김혜순;손세정;박은애;이승주;성순희;서정완
    • Clinical and Experimental Pediatrics
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    • 제45권4호
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    • pp.466-472
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    • 2002
  • 목 적 : Meckel 게실은 장출혈, 장폐색, 감염, 천공등의 합병증에 의한 증상이 나타날 수 있으며 급성 복증을 일으키는 다른 질환과 감별진단이 어렵고 진단이 지연되기 쉽다. 저자들은 Meckel 게실 환자에서 임상증상과 조직학적 소견을 비교하여 신속히 진단하고 치료하는데 도움이 되고자 하였다. 방 법 : 1993년 10월부터 2001년 8월까지 이화의료원에서 진단한 Meckel 게실 10례의 의무기록을 후향적으로 조사하여 임상증상과 조직학적 소견 등을 분석하였다. 결 과 : 1) 환자의 연령은 7일-14세의 분포를 보였고, 6세 이전(60%)이 많았다. 남녀비는 2.3 : 1로 남아에서 많았다. 2) 주요증상은 무통성 하부 장출혈, 복통, 복부 팽만, 구토 순이었고 나이가 많을수록 증상이 심하였다. 3) 수술 전에 Meckel 게실로 진단되거나 의심되어 수술 한 경우 5례, 초음파 유도하 수압으로 정복되지 않은 장중첩증(3례)과 장폐색(2례)으로 수술하여 발견된 경우 5례이었다. 4) Meckel 스캔($^{99m}Tc-pertechnetate$)은 cimetidine을 투여한 후 6례에서 시행되었으며, 이소성 위점막이 있었던 5례 중 4례에서 양성, 1례 위음성, 이소성 위점막이 없었던 1례에서 음성이었다. 5) Meckel 게실은 회맹판으로부터 35-70 cm 상부에 있었고, 길이는 4-12 cm이었으며 이중 80%가 5cm 미만이었다. 6) 하부 장출혈이 있었던 5례 모두에서 이소성 위점막이 발견되었고, 그 외의 조직학적 소견은 염증 3례, 궤양 3례, 천공 1례, 출혈 3례, 경색 1례이었다. 결 론 : Meckel 게실은 출혈량이 적거나 증상이 경미한 환자에서 신속히 진단하게 되면 출혈이나 수혈의 빈도를 줄일 수 있으며 회복도 빠르므로, Meckel 게실을 염두에 두고 조영술이나 내시경에 우선하여 Meckel 스캔을 시행하는 것이 좋다. 이소성 위점막이 없는 Meckel 게실에서는 Meckel 스캔이 음성이므로 임상적으로 의심될 때에는 복강경, 컴퓨터 단층촬영, 고해상도 초음파촬영 등의 다양한 진단법이 시도되어야 할 것이다.

경기지역 여고생과 여대생의 배변양상에 영향을 미치는 생활습관 요인 조사 (A Study on the Defecation Pattern and Lifestyle Factors of Female High School and College Students in Gyeonggi Province)

  • 이종현;오주환
    • 대한지역사회영양학회지
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    • 제10권1호
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    • pp.36-45
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    • 2005
  • The aim of this study was to investigate the dietary and lifestyle factors related to bowel pattern of female high school and college students in Gyeonggi Province. The total of 202 self-administered questionnaires (high school students 77 ; college students 125) were analyzed. All respondents were devided into four groups based on their self-reported pattern of defecation: 18 subjects ($9.0\%$) comprised the normal group, 73 ($36.1\%$) the constipation group, 73 ($36.1\%$) the constipation/diarrhea group, and 38 ($18.8\%$) the diarrhea group. Regularity of exercise was significantly higher in the college students than high school students, and times spending on a chair were longer in the high school students than college students. Most students ($72.7\%$) reported that they had stress. Fourty point six percent of the subjects reported that they had 3 meals per day, which tended to be higher in the normal and diarrhea group than constipation and constipation/ diarrhea group. Most students (69.7) skipped breakfast which was lower in the normal group than the other groups. The most preferred dietary fiber food was korean cabbage kimchi. Fifty-eight point four percent of the subjects reported that they had irregular bowel movement. Bowel movement was more irregular in the high school students than college students, and in the constipation group than the other groups. Of the subjects, $77.7\%$ had defecation frequency between three per week and three per day. Those who spent within 10 minutes for defecation were $79.6\%$, and those had difficulty in evacuating were $76.0\%$. High school students and those with constipation and constipation/diarrhea had a significantly lower defecation frequency, longer time spent at the toilet, and greater difficulty in evacuating than college students and normal and diarrhea group. The percentage of those who had feelings of residue in the intestine after defecation was $92.5\%$, and it was greater in the constipation or diarrhea group than in the normal group. Most students ($93.5\%$) reported that they had abdominal pain or discomfort. These results suggest that decreasing times spending on a chair, decreasing stress, keeping 3 meal per day at regular hours, and increasing dietary fiber intake are associated with desirable bowel pattern.

요추궁절제술 후에 발생한 총장골동맥의 동정맥루에 대한 수술 (Surgical Treatment for Common Iliac Arteriovenous Fistula after Lumbar Laminectomy)

  • 류경민;유재욱;박성식;김석곤;서필원
    • Journal of Chest Surgery
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    • 제40권6호
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    • pp.455-458
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    • 2007
  • 4개월 전 요추 4, 5번 추궁절제술을 시행받은 40세 남자환자가 호흡곤란과 하지부종을 주소로 내원하였다. 우측하복부에서 박동성 종괴가 촉진되었고 기계잡음이 청진되었다. 흉부단순촬영에서 심비대소견이 관찰되었고, 복부 전산화 단층촬영에서 제5요추 위치의 총장골동맥과 정맥간에 가성동맥류를 동반한 동정맥루가 존재하였다. 복부정중절개를 하여 동맥류를 통한 동정맥 누공의 일차봉합을 시도하여 상,하부 대동맥과 대정맥 감자결찰 후 동맥류를 절개하였으나 대량출혈이 발생하여 누공봉합에 실패한 후 동맥류를 봉합하였다. 동맥치환술로 수술계획을 변경한 후 동맥류에 연해있는 대동맥과 양측 총장골동맥을 절단봉합한 후, 인공도관을 이용하여 동맥을 재건하였고, 동맥류는 총장골정맥에 붙어있는 상태에서 축소성형술을 시행하였다. 환자는 수술 후 별다른 합병증 없이 8일째 퇴원하였고, 이후 별다른 문제없이 24개월간 추적관찰 중이다. 일반적으로 요추궁절제술 후 발생한 동정맥루에서는 누공봉합술을 시행하나 본 증례에서는 동맥치환술과 동맥류 축소성형술을 시행하였기에 문헌고찰과 함께 보고하는 바이다.

소아 충수돌기염 진단에서 Alvarado Scoring System의 유용성 (Usefulness of a Alvarado Scoring System for the Diagnosis of Acute Appendicitis in Children)

  • 양은석;윤성관;김은영;노영일;박상기;박영봉;문경래
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • 제7권1호
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    • pp.1-7
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    • 2004
  • 목 적: Alvarado score는 성인에서 급성 충수돌기염 환자의 조기 진단에 용이하고 오진율을 줄이는 유용한 진단법으로 알려져 있다. 저자들은 급성 복통이 주소인 소아 환아에서 급성충수돌기염 진단에 alvarado score의 유용성에 대하여 알아보고 진단의 정확성에 대하여 평가하고자 연구를 하였다. 방 법: 2002년 6월부터 2003년 5월까지 조선대학교 부속 병원 응급실을 방문한 복통을 호소하는 소아 170명 중 충수돌기염의 강하게 의심되는 122명을 대상으로 전향적으로 조사하였다. 복통을 주소로 방문한 환아의 나이, 임상증상, 임상징후, 혈액학적 검사결과를 분석하여 Alvarado score를 산출하고 진단을 위해 복부초음파 검사나 전산화 단층 촬영을 시행하고 수술을 시행한 경우 조직학적 진단을 하여 확진하였으며 수술하지 않은 군은 12시간의 추적 관찰로 확진하였다. 방사선학적 진단과 수술 결과 등을 비교하여 확진군과 오진군의 Alvarado score를 비교 분석하였다. 결 과: 응급실에 복통이 주소인 환아 중 충수돌기염이 강하게 의심되었던 환아는 122명이었다. 122명의 환아 중 남아는 67명(54.9%), 여아는 55명(45.1%)이었다. 조직검사를 통해 충수돌기염으로 진단 받은 환자는 수술한 105명 중 92명으로 87.6%에 해당하였고 충수돌기염으로 수술한 환자들의 오진율은 12.4%였다. 평균 Alvarado score는 충수돌기염 군은 $5.40{\pm}1.24$, 충수돌기염이 아닌 군은 $3.73{\pm}1.82$이었다(p<0.05). Alvarado score 6점 이상인 경우 소아 충수돌기염을 진단하는데 민감도가 86.4%, 특이도는 80.0%였다. 소아 충수돌기염을 진단하는데 복부 초음파검사나 전산화단층촬영의 진단의 민감도는 92.5%였다. 결 론: 복부초음파검사나 전산화 단층 촬영 등과 함께 Alvarado score는 소아 충수돌기염의 진단에 유용하게 이용될 수 있을 것으로 생각된다.

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"동의보감(東醫寶鑑)" "내경편(內景篇)"의 포(胞), 소변(小便), 대편(大便)에 나타난 질병(疾病)의 변증화(辨證化) 연구 (Study on Mechanistic Pattern Identification of Disease for Uterine, Urine and Excrements Parts of DongEuiBoGam NaeGyungPyen)

  • 김영목
    • 동의생리병리학회지
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    • 제24권5호
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    • pp.727-736
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    • 2010
  • This study is about researching mechanistic pattern identification of disease for DongEuiBoGam NaeGyungPyen by analysing with pattern identification of modern Traditional Korean medical patholgy as more logical, systematic and standardized theory. Disease pattern mechanisms of uterine, urine and excrements parts of DongEuiBoGam NaeGyun gPyen in NaeGyungPyen of DongEuiBoGam are these. Menstrual irregularities in DongEuiBoGam can be classified flui d-humor depletion, blood deficiency, qi deficiency, qi stagnation, qi stagnation complicated by heat, blood stasis, blood deficiency complicated by heat, syndrome of heat entering blood chamber, syndrome of cold entering blood chamber. The disease pattern of abdominal pain after menstruation in DongEuiBoGam is blood deficiency complicated by heat, and a dysmenorrhea represents blood stasis with heat, fluid-humor deficiency. Advanced menstruation represent dual heat of the qi and blood, delayed menstruation is blood deficiency. The disease pattern of inhibited urination in DongEuiBoGam can be classified deficiency heat pattern of kidney yin deficiency(yin deficiency with effulgent fire), kidney qi deficiency, yin deficiency with yang hyperactivity, fluid-humor depletion, spleen-stomach dual deficiency, and excess he at pattern of bladder excess heat. The disease pattern of urinary incontinence in DongEuiBoGam can be classified deficiency pattern of kidney-bladder qi deficiency, consumptive disease, lung qi deficiency, kidney yin deficiency(yin deficiency with effulgent fire), kidney yang deficiency and excess pattern of lower energizer blood amassment, bladder excess heat. And most of them are deficiency from deficiency-excess Pattern Identification. The disease pattern of diarrhea in DongEuiBoGam can be classified deficiency pattern of qi deficiency, qi fall, spleen yang deficiency, kidney yang deficiency and so on and excess pattern of wind-cold-summerheat-dampness-fire, phlegm-fluid retention, dietary irregularities, qi movement stagnation. And most of them are deficiency from deficiency-excess Pattern Identification. Like these, this study identify pattern of disease in DongEuiBoGam by mechanism of disease theory.

일부 도시지역에 있어서 중, 고교생의 월경에 관한 조사연구 (Survey on Menstruation of Middle & High School Girls in an Urban Area)

  • 김명엽;강현숙
    • 대한간호학회지
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    • 제2권1호
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    • pp.63-72
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    • 1971
  • The conclusions were obtained from the detailed survey of 1,285 students experiencing menstruation, who were chosen among 1,717 students in middle & high school girls in Seoul. The survey was conducted during July 20-July 24, 1971. 1. Age of Menarche An average age of menarche was 13.3$\pm$1.07. The earliest age of menarche was 9 and the latest age 18. Ages of menarche were between 12 and 14 in 84.3 percent of the students surveyed. a. By present age distribution, the aged students were lower, than younger students in the average age of menarche. b. By father′s educational levels, among the students whose fathers were graduated from high schools, college & ever the earliest average age of menarche was found with 13.2, and among the students whose fathers were graduated from primary schools that wag latest with 13.6. c. By father′s occupations, among the students whose fathom engaged in "workers not classifiable"the earliest age of menarche was found with 12.5$\pm$0.27, among the students whose fathers were in "service business"the second was 12.9$\pm$1.07, and among the students whose fathers were in "miners, quarrymen and related workers"that was latest with 13.8$\pm$1.14. d. By economic status, among the students of "wealthy"families the age of menarche was 13.1$\pm$0.25, the among the students of "ordinary"families the lags of menarche 13.3$\pm$1.06. and the among the students of "poor" families that was 13.8$\pm$0.31. e. By home discipline, among the students being treated "rigid" the age of menarche was 13.5$\pm$1.13, among the students being treated "moderate"the age of menarche was 13.3$\pm$0.22, and those being treated "indifferent" that was 13.0$\pm$0.26. f. By students physical condition, among the students of "good" condition the average of menarche was 13.3$\pm$0.16, and among the students "poor" that was 13.5$\pm$0.31. 2. Menstruation a. For the six months after the average of menarche 39.0 percent of the students had normal menstruations, and 61.3 percent of them had abnormal ones. Of the students with abnormal menstruation 21.7 percent had abnormal menstruation from time to time, 25.4 percent had no menstruation for one month to three months, 7.2 percent had menstruation for four to six months and 6.7 per cent had no menstruation for more than sin months. Most students became to have normal menstruations a few months later the age of menarche. b. At the time interviewed, the percentile of cycle of menstruation as following: 23 days types: 46.8 percent 30 days types: 40.6 percent others : 12.6 percent The average cycle of menstruation was every 28.9 days. c. The average duration of menstruation is 4.69 days. d. The subjective symptoms during menstruation period: Out of the total 89.7 per cent had some pains, while 10.3 percent had no symptom. Among the symptoms, abdominal pain occupied 29.9 percent, neurotic symptoms 19.0 percent and lumbago 15.1 percent. e. By attitude or Action at first physical change, "Treated it by own experience" : 30.0 percent "Don′t know what to do because of ignorance" : 20.1 percent "Asked others about it" : 43.0 percent

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Presentation and Outcomes of Gastric Cancer at a University Teaching Hospital in Nepal

  • Sah, Jayant Kumar;Singh, Yogendra P;Ghimire, Bikal
    • Asian Pacific Journal of Cancer Prevention
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    • 제16권13호
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    • pp.5385-5388
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    • 2015
  • Background: Gastric cancer is the most common gastrointestinal cancer and a leading cause of cancer mortality in Nepal. Survival of gastric cancer patients depends on the stage at which diagnosis is made. The aim of this study was to analyze the presentation and outcomes of gastric cancer patients treated at a tertiary care hospital in Nepal. Materials and Methods: A retrospective analysis of 140 consecutive histologically proven gastric adenocarcinoma cases managed at the Department of Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal for the period of January 2009 to December 2013 was carried out. Results: One hundred forty out of the total 186 patients with histologically proven gastric adenocarcinoma, were admitted for surgery. The mean age was $59.6{\pm}12.4yrs$ (range 29 to 78 yrs) and the male: female ratio was 2:1. Sixty three (45%) patients featured Tibeto-Burman descent though this ethnic group accounts for only 18% of the Nepalese population. Two-thirds or more patients presented with abdominal pain, anorexia, weight loss and/or vomiting. In 86 (61.5%) of the patients the tumor was located in the lower $3^{rd}$ of the stomach and in only 15% of the patients the tumor was located at the upper $3^{rd}$. Early gastric cancer was diagnosed postoperatively in only 4%. In 54%, the disease was locally advanced and metastatic lesions were found in 14% of the patients. Subtotal (73) or total (11) curative gastrectomies (D1, D1+ or D2) were performed in 84 (60%) patients with average lymph node retrieval of $16.6{\pm}8.2$. Palliative gastrectomies or procedures were performed in 23% of the patients and no intervention (open & close/biopsy) was employed in 15% of the patients. Perioperative morbidity was seen in 10% and mortality in 4%. Three, four and five year survival rates up to the recent follow-up were 17.9%, 11.9% and 8.3%, respectively. Conclusions: Gastric cancer in Nepal is usually diagnosed at an advanced stage and has a poor prognosis. Thus, early detection is the key to improve the survival of gastric cancer patients.

A Case of Ischemic Colitis Associated with Paclitaxel Loaded Polymeric Micelle ($Genexol-PM^{(R)}$) Chemotherapy

  • Park, Choel-Kyu;Kang, Hyun-Wook;Kim, Tae-Ok;Ki, Ho-Seok;Kim, Eun-Young;Ban, Hee-Jung;Yoon, Byeong-Kab;Oh, In-Jae;Choi, Yoo-Deok;Kwon, Yong-Soo;Kim, Yoo-Il;Lim, Sung-Chul;Kim, Young-Chul;Kim, Kyu-Sik
    • Tuberculosis and Respiratory Diseases
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    • 제69권2호
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    • pp.115-118
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    • 2010
  • Paclitaxel has been widely used for treating many solid tumors. Although colonic toxicity is an unusual complication of paclitaxel-based chemotherapy, the reported toxicities include pseudomembranous colitis, neutropenic enterocolitis and on rare occasions ischemic colitis. $Genexol-PM^{(R)}$, which is a recently developed cremophor-free, polymeric micelle-formulated paclitaxel, has shown a more potent antitumor effect because it can increase the usual dose of paclitaxel due to that $Genexol-PM^{(R)}$ does not include the toxic cremophor compound. We report here on a case of a 57-year-old man with advanced non-small cell lung cancer and who developed ischemic colitis after chemotherapy with $Genexol-PM^{(R)}$ and cisplatin. He complained of hematochezia with abdominal pain on the left lower quadrant. Colonoscopy revealed diffuse mucosal hemorrhage and edema from the sigmoid colon to the splenic flexure. After bowel rest, he recovered from his symptoms and the follow-up colonoscopic findings showed that the mucosa was healing. Since then, he was treated with pemetrexed monotherapy instead of a paclitaxel compound and platinum.

인진쑥 methanol 추출물의 투여가 암이 유발된 마우스에서 보인 혈액생화학적 및 종양 무게에 미치는 영향 (Effects of Blood Biochemistry and Tumors' Weights of Artemisia capillaris Methanol Extract in Mice Bearing Cancer Cells)

  • 김홍태;김주완;진태원;김지은;임미경;여상건;장광호;오태호;이근우
    • 한국임상수의학회지
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    • 제24권3호
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    • pp.372-378
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    • 2007
  • The Artemisia capillaris THUNB is a perennial herb that belongs to the family Compositae spp and probably the most common plant among the various herbal folk remedies being used in the treatment of abdominal pain hepatitis chronic liver disease, jaundice and coughing in Korea. Recently the biological and pharmacological actions of herb have been studied well such as antibacterial, antidiabetic and antitumor activities. This experiment was conducted to investigate antitumor and immunomodulatory effects of Artemisia capillarix extracts against Hepa-1c1c7 and Sarcoma 180 cancer cells on in vivo experimental tests. On in vivo experimental tests using 280 ICR mice the gain of body weight in the control-group mice bearing Sarcoma 180 ascites tumor was 1.5 times more than that of the normal-group mice after 33 days. However, the gain of body weight in all experimental groups administered with Artemisia capillaris extracts was significantly lower than that of the control-group mice (P<0.05). The mean survival times of mice administered with Artemisia capillaris extracts of 25 and 100 mg/kg for 28 days were shown to be 25.39% and 15.39% longer than that of the control-group mice injected with saline (P<0.05). Artemisia capillaris extracts showed the highest tumor inhibition effects, which were 42.4% and 27.2% when intraperitoneally injected with doses of 25 and 100 mg/kg once a day for 28 days in inoculated ICR mice with Sarcoma 180 solid tumor cells (P<0.05). The results suggest that Artemisia capillaris methanol extracts have prominent antitumor effects on the cancer cell lines Hepa-1c1c7 and Sarcoma 180.

1988년 가을 대구.경북 및 그 인접지역에서 발생한 쯔쯔가무시(Tsutsugamushi)병 26례에 대한 임상적고찰 (An Outbreak of Tsutsugamushi Disease in Vicinity of Taegu City and Kyungpook Province in 1988)

  • 권영수;김종호;손명원;이관호;현명수;정문관;이현우
    • Journal of Yeungnam Medical Science
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    • 제6권1호
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    • pp.31-41
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    • 1989
  • 1988년 가을 대구, 경북 및 그 인접지역에서 발생한 쯔쯔가무시병 26례를 경험하여 다음과 같은 결과를 얻었다. 1) 발병시기는, 9월말에서 11월말 까지였으며, 11월에 집중적으로 발생하였다. 2) 연령 분포는 18세에서 69세 까지였고, 50대에서 가장 발병률이 높았다. 주증상은 고열과 오한(88%), 근육통(65%), 두통(54%), 오심, 구토(31%) 순이었고 이학적 소견으로는 피부발진이 26례중 18례로 (69%) 가장 많았다. 가피는 26례중 18례에서 (69%) 관찰되었고, 여자에서 다소 빈도가 더 높았고, 50세이상이 14례로 85%를 차지하였다. 3) 검사소견상 백혈구 증가 4례(15%), 혈소판 감소 2례(8%)였고, SGOT 14례(54%), SGPT 15례(58%), LDH가 7례(27%)에서 증가하였다. 4) 치료는 tetracycline 또는 chloramphenicol을 투여하였고, 투약후 해열기간은 tetracycline 사용시 2.1일, chloramphenicol 사용시 2.5일로 큰 차이는 없었다. 합병증은 뇌막염이 2례, 쇽이 1례 관찰되었으나 항생제 및 강압제 투여후 회복되었고, 사망한예는 없었다. 이상의 결과와 같이 대구, 경북지역에서도 쯔쯔가무시병이 발병할 수 있으며, 지금까지의 국내 타보고자와 유사한 양상을 나타내었다.

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