• Journal of Preventive Medicine and Public Health
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• 제29권1호
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• pp.43-50
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• 1996

We experienced a case of nephropathy in chronic lead poisoning. The patient was 43-year-old male who has been working in secondary lead smelting plant for 14 years. On admission, blood pressure was 160/90 mmHg and the others were non-specific. In past history, he received chelating agent administration for lead poisoning irregularly and medicated for gout, and the blood lead concentration was $180.0{\mu}g/dl$ on 2 months before admission. Smoking habit has been 1 pack per day for 15 years and drinking habit has been 1 bottle of Soju per day but less flow. In liver function test, AST/ALT were 27/28 IU/l and $\gamma-GT$ was 456 IU/l. In blood test, Hb : 11.5 g/dl, Hct : 34.0% and basophilic stipplings were found in peripheral blood smear. Chest PA was normal and abdominal ultrasonographic finding was non-specific except fatty liver. In the test of lead exposure indices, $PbB:83.0{\mu}g/dl,\;PbU:28.3{\mu}g/l$, and blood ZPP was $300.0{\mu}g/dl$. And in renal function test, BUN : 31.4 mg/dl, blood creatinine : 2.7mg/dl, blood uric acid. 9.1 mg/dl, urinary albumin : 100.0 mg/g creatinine, urinary $\alpha_1-microglobulin$ : 120.5 mg/g creatinine, urinary $\beta_2-microglobulin$ : $183.8{\mu}g/g$ creatinine, and 24 hours urinary creatinine clearance was 31.9 ml/min. The ultrasonoguided renal biopsy showed the global sclerosis of glomerulus, moderate atrophy and loss of tubule, and interstitial fibrosis in light microscopy. There were diffuse losses of brush border of proximal tubule in electronmicroscopy.

• The Korean journal of internal medicine
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• 제33권6호
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• pp.1129-1136
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• 2018

Background/Aims: Vitamin D modulates innate and adaptive immune responses, and vitamin D deficiency is associated with increased mortality in hospitalized patients with pneumonia. We evaluated the prevalence of vitamin D deficiency in Korean patients with acute respiratory distress syndrome (ARDS) and its effect on the clinical outcomes of ARDS. Methods: We retrospectively analyzed the data of 108 patients who had a measured serum level of 25-hydroxy vitamin D3 ($25(OH)D_3$) at the time of diagnosis with ARDS. The clinical outcomes were evaluated based on $25(OH)D_3$ levels of 20 ng/mL and stratified by quartiles of $25(OH)D_3$ levels. Results: The mean age of patients was 59.4 years old; 77 (71.3%) were male. Vitamin D deficiency was found in 103 patients (95.4%). The mean $25(OH)D_3$ level was $8.3{\pm}7.0ng/mL$. Neither in-hospital mortality (40.0% vs. 68.0%) nor 6-month mortality (40.0% vs. 71.8%) significantly differed between groups. There were no significant differences in $25(OH)D_3$ level between survivors ($8.1{\pm}7.6ng/mL$) and non-survivors ($8.5{\pm}6.8ng/mL$, p = 0.765). There were no trends toward a difference in mortality among quartiles of $25(OH)D_3$ levels. However, $25(OH)D_3$ levels were inversely related with length of hospital stay and intensive care unit stay among in-hospital survivors. Conclusions: Vitamin D deficiency was prevalent in Korean patients with ARDS. However, levels of vitamin D were not associated with mortality. A large, prospective study is needed to evaluate the effects of vitamin D deficiency on clinical outcomes of ARDS.

• 역사민속학
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• 제52호
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• pp.7-46
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• 2017

조선시대 노인은 육체적 변화와 더불어 10년을 단위로 하는 연령별로 사회적 처우가 달랐다. 우선 유교 이념에서 노인은 군자로서의 완성된 성품을 지닌 자로서 여전히 수신해야 하는 존재였다. 군자로서의 성품을 지녔기에 존로와 경로는 신분과 관품을 초월해서 이루어졌다. 노인은 육체적 쇠약이 시작되는 50세부터로 보았지만 이는 장년과 노인의 변곡점을 언급한 것일 뿐 노인을 규정한 것은 아니다. 노인은 국역이라는 사회적 의무가 해제되는 60세는 모든 사회적 존재에게 해당되는 명실상부한 노인의 하한 연령이다. 그러나 60세는 사회적 의무가 해제될 뿐 여전히 노인은 일반 사회구성원으로 간주되었기에 특별한 혜택이 부여되지는 않았다. 신분제와 관료제 사회에서 노인의 우대는 연령별로 다르게 시행되었다. 70세는 고관에게만 다양한 혜택이 주어졌는데, 복호와 시정을 처음으로 제공했다. 또한 관료의 정년은 특별히 정해지지 않고 스스로 물러나는 치사(致仕)에 의해 존로를 예우하는 방식으로 거행되었다. 고관과 대신에게 주어진 최상의 예우라 하겠다. 80세는 양천 모두에게 노인을 우대하는 조치로 양로연을 베풀었다. 더불어 노인직을 수여함으로써 사회적 가치가 부여된 관품(官品)을 허용했다. 서인과 천인에게조차 허용된 관품은 최상의 존로(尊老)정책이었다고 하겠다. 그러나 노인 관련 존로정책은 신분과 관품에 따라 왕은 60세부터, 정2품 고관, 종친 등은 70세, 일반 서인은 80세, 노비는 90세에 사회적 예우의 대상이 되었다. 노인 봉양은 개인적으로 실시하면 되지만 국가가 이를 주관했기에 사회적 가치를 부여한 것이다. 신분과 관품에 따라 복호와 시정을 배정하고, 사물의 종류를 달리함으로써 당시 사회적 한계가 분명히 드러났다. 존로 사상이라는 이념보다는 신분과 관품이라는 사회적 질서가 우선시 된 것이다. 그러나 연령별, 신분별 존로 행위는 개인적 차원에 그치지 않고 국가가 사회의 구성원인 노인을 존로사상에 입각해 다양한 방법으로 양로했다. 육체적 쇠약으로 인해 활동이 여의치 않은 이들을 사회가 양로코자 했다. 경제적으로는 의자, 쌀, 고기, 얼음 등의 사물(賜物)을 통해, 법적으로는 면죄(免罪)와 감경과 속죄금 등으로, 사회적으로는 가자(加資)라는 노인직 수여를 통해 관료제 사회의 구성원으로 치환함으로써 그 존재 가치를 높였다. 신분과 관품을 초월하여 모든 계층을 대상으로 실시된 양로연과 가자는 80세 이상이 사회적 존로의 대상임을 분명히 한다. 즉 80세에 이르면 노인은 신분을 초월하여 사회적으로 존경받는 노인으로서 경로의 대상이 되었다.

• Tuberculosis and Respiratory Diseases
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• 제68권3호
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• pp.162-167
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• 2010

Background: To date, there are few data on the risk factors for severe cases and deaths associated with the 2009 pandemic H1N1 influenza A. Here, we describe the clinical and epidemiologic characteristics of patients hospitalized for pneumonia and identify those factors associated with the development of major complications (MC). Methods: We reviewed the medical records of 41 cases of pneumonia admitted to a university-affiliated tertiary hospital between Aug 26 and Dec 10, 2009, and who had confirmed H1N1 influenza A based on real-time reverse transcriptase-polymerase-chain-reaction assay. There were 7,962 patients that fit these criteria. We compared the clinical features and demographic characteristics of patients who developed MC to with those who did not develop MC. Results: During the study period, 10 patients developed MC (required admission to the intensive care unit, n=10; required ventilator therapy, n=6; death, n=4). Patients with MC were significantly older than those without MC and more frequently had underlying medical conditions (90.0% vs 41.9%, p-value <0.01). In the patients with developed MC, the median $PaO_2/FiO_2$ ratio of 230.0 (145.0~347.3) at admission and pneumonia severity index (PSI) score of 141.5 (88.3~158.5) were higher than patients without MC. However, no differences were observed in laboratory findings or in viral shedding between the 2 groups. Conclusion: In hospitalized pneumonia patients of 2009 H1N1 influenza, old age, a history of malignancy, initial hypoxemia, $PaO_2/FiO_2$ ratio, and PSI score appear to be risk factor significantly related to developing MC. These findings might be the basis to influence strategies for admitting patients to an intensive or intermediate care unit and for pre-emptive antiviral therapy.

• Journal of Chest Surgery
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• 제50권5호
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• pp.382-385
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• 2017

A 47-year-old man with myasthenia gravis (MG) was admitted for a lung transplant. He had bronchiolitis obliterans after allogeneic hematopoietic stem cell transplantation due to acute myeloid leukemia. MG developed after stem cell transplantation. Bilateral sequential lung transplantations and a total thymectomy were performed. The patient underwent right diaphragmatic plication simultaneously due to preoperatively diagnosed right diaphragmatic paralysis. A tracheostomy was performed and bilevel positive airway pressure (BiPAP) was applied on postoperative days 8 and 9, respectively. The patient was transferred to the general ward on postoperative day 12, successfully weaned off BiPAP on postoperative day 18, and finally discharged on postoperative day 62.

• Tuberculosis and Respiratory Diseases
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• 제64권2호
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• pp.138-143
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• 2008

특징적인 피부병변, 근력약화 등 분명한 피부근염의 임상소견을 보이지 않는 환자에서 동반된 NSIP 치료경과 중 자발성 종격동기종, 피하기종 및 대장기종이 발생한 증례를 경험하였고 스테로이드와 cyclosporin을 사용하여 좋은 치료반응을 경험하였다. 간질성폐렴을 동반한 피부근염에서 자발성 종격동기종, 피하기종 또는 대장기종 등이 드물게 보고되었고 이 경우 나쁜 예후를 보이므로 주의할 필요가 있다. 비교적 드물지만 NSIP에서 종격동기종, 대장기종이 발생하는 경우 임상경과 중 피부근염이 동반 또는 이환되었는지 세심한 관찰이 필요하겠다. 또 NSIP에서 기종이 발견되는 경우 스테로이드와 cyclosporin 또는 다른 면역억제제의 병용투여 등 적극적인 치료가 치료반응과 예후에 좋은 영향을 주리라 사료되어 본 증례를 보고하는 바이다.

• Journal of Dental Anesthesia and Pain Medicine
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• 제15권3호
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• pp.173-179
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• 2015

Issues related to the control of seizures and bleeding, as well as behavioral management due to mental retardation, render dental treatment less accessible or impossible for patients with Sturge-Weber syndrome (SWS). A 41-year-old man with SWS visited a dental clinic for rehabilitation of missing dentition. A bilateral port-wine facial nevus and intraoral hemangiomatous swollen lesion of the left maxillary and mandibular gingivae, mucosa, and lips were noted. The patient exhibited extreme anxiety immediately after injection of a local anesthetic and required various dental treatments to be performed over multiple visits. Therefore, full-mouth rehabilitation over two visits with general anesthesia and two visits with target-controlled intravenous infusion of a sedative anesthesia were planned. Despite concerns regarding seizure control, bleeding control, and airway management, no specific complications occurred during the treatments, and the patient was satisfied with the results.

• Journal of Chest Surgery
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• 제37권9호
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• pp.805-808
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• 2004

피가래를 주소로 69세 남자 환자가 내원하였다. 환자는 술 전 검사상 좌상엽에 5${\times}$2.8 cm의 종괴를 가지고 있었다. 좌상엽 절제술 및 림프 곽청술을 시행하였고 종괴는 원발성 폐 융모막 암종으로 진단되었다. 적절한 치료에도 불구하고 술 후 환자는 폐렴의 악화로 인해 항암 화학요법이 지연되었으며 암종은 급격한 진행을 보였다. 환자는 58병일째 폐렴으로 사망하였다. 원발성 폐 융모막 암종은 매우 드문 질환이며 치료 원칙도 정립되지 않았다. 이에 저자들은 수술 후에 진단된 원발성 폐 융모막 암종 1예를 치험하였기에 보고하는 바이다.

• 대한임상독성학회지
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• 제2권2호
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• pp.147-150
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• 2004

Hydrogen sulfide is a colorless, and malodorous 'rotten eggs' gas that results from the decay of organic material. It is a byproduct of industry and agriculture. The mechanism of its toxicity is primarily related to inhibition of oxidative phosphorylation, which causes a decrease in available cellular energy. Because there is no rapid method of detection that is of clinical diagnostic use, management decisions must be made based on history, clinical presentation, and diagnostic tests that imply hydrogen sulfide's presence. Although there is some anecdotal evidence to suggest that the early use of hyperbaric oxygen is beneficial, supportive care remains the mainstay of therapy. We describe an occupational exposure to hydrogen sulfide gas in 51-year-old man. While cleaning the sewage of pigs. he became unconscious. When he arrived in the emergency department, he had irritability and confused mentality. The typical smell of rotten eggs on clothing and exhaled air were enough to be considered to be exposed to hydrogen sulfide. Hyperbaric oxygen therapy was performed. He had a recovery to normal function.

• 대한장애인치과학회지
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• 제4권1호
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• pp.26-31
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• 2008

Cerebrovascular Accident(stroke) is that a sudden, nonconvulsive loss of neurologic function due to an ischemic or hemorrhagic intracranial vascular event. If stroke happens at the portion of trigeminal motor nucleus or its control part of cerebral cortex, masticatory muscles will be atrophy or paralyzed. So it is possible that dental occlusion changes after stroke. A 74-aged woman recurred mild stroke 2 month ago, who had experienced severe stroke 2 years ago. After recurrence, suddenly her upper full denture was dropped when lower denture contacted upper one. According to the her occlusion exam, her lower jaw moved back slightly compared with the occlusion of old denture. And her face had asymmetry and lower jaw dislocated to paralyzed side. A 50-aged man was treated because many cervical caries, which would occur because of an aftereffect of stroke, long-herm hospitalization and limits of self oral-care. 6 years ago he had cerebral hemorrhage and he claimed that he cannot bite exactly. Just two pairs of teeth was contact on biting, his lower jaw was located back, too. This two case suggests that dental occlusion can change after stroke.