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증례 : 순환기 ; 달맞이꽃 종자유로 인한 일시적인 가역적 완전방실차단 1예
민인선 ( In Sun Min ),이주영 ( Ju Young Lee ),정태섭 ( Tae Seob Jung ),강남규 ( Nam Kyu Kang ),박보배 ( Bo Bae Park ),김배근 ( Bae Keun Kim ) 대한내과학회 2016 대한내과학회지 Vol.90 No.5
완전방실차단의 원인은 약물 복용을 포함하여 다양하다. 달맞이꽃 종자유를 포함하여 다양한 약물이 완전방실차단을 유발함을 알 수 있다. 약물 중단에 의해 정상 조율로 회복되는 경우가 대부분이나, 합병증이 발생할 경우도 있으므로 안전하지 않은 약물 복용에 대한 주의가 필요하겠다. 달맞이꽃 종자유를 복용하여 발생한 일시적인 가역적 완전방실차단 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. A complete atrioventricular block is seen in patients due to a variety of causes, including drugs. The resolution of a drug-induced atrioventricular block is often accomplished by drug discontinuation. We report a case of a complete atrioventricular block in a 31-year-old woman following a month of treatment with evening primrose oils. After excluding all other likely causes of conduction disorders, an adverse effect of the evening primrose oils seemed to be the most likely diagnosis. After discontinuation of the oils, no associated symptoms or conduction disturbances were observed for 4 months after discharge. We stress the reconsideration of taking medicines and functional foods continuously as most patients are not aware of the hazards they pose. (Korean J Med 2016;90:440-443)
요로 결석에 대한 체외 충격파 쇄석술 이후 발생한 급성 췌장염 1예
홍정운 ( Jung Un Hong ),전병민 ( Byung Min John ),정태섭 ( Tae Seob Jung ),노인영 ( In Young Noh ),강남규 ( Nam Kyu Kang ),민인선 ( In Sun Min ),이주영 ( Ju Young Lee ),김해성 ( Hae Sung Kim ) 대한췌담도학회 2016 대한췌담도학회지 Vol.21 No.2
48세 여자가 좌측 옆구리 통증을 주소로 내원하여 좌측 요관 결석으로 진단되어 체외 충격파쇄석술을 시행받았으나, 12시간 후 갑작스런 복통을 호소하며 혈압저하, 폐부종을 보였다. 국소적인 합병증을 동반한 중등도의 급성 췌장염으로 진단하고 수액과 승압제, 항생제 등의 대증적 치료 시행 후 퇴원하였다. 체외 충격파쇄석술은 요로결석의 대표적인 치료법이다. 안전하고 효과적으로 알려져 있으나 시술받은 환자의 1%에서 급성 췌장염, 신장주위 혈종, 비뇨기계 패혈증, 정맥혈전, 담도 폐쇄, 장천공, 폐손상, 부정맥 등의 심각한 합병증이 보고되고 있다. 쇄석술 이후 발생한 급성 췌장염은 드물지만 임상의는 이러한 합병증에 대한 주의가 필요하다. 48-year-old woman was admitted to emergency room due to left flank pain. It was diagnosed with left ureteral stone and underwent extracorporeal shock wave lithotripsy (ESWL). However, 12 hours later, the patient complained acute upper abdominal pain with pulmonary edema and low blood pressure. A diagnosis of moderate acute pancreatitis with local complication was considered and we decided conservative therapy including fluid resuscitation, inotropics and antibiotics. It was suggested that ESWL was responsible for the acute pancreatitis. The patient gradually recovered and was discharged on 13th day of admission. ESWL is considered the standard treatment for urolithiasis. Although, it has proved to be safe and effective, serious complications have been reported in 1% of patients, including acute pancreatitis, perirenal hematoma, urosepsis, venous thrombosis, biliary obstruction, bowel perforation, lung injury, and cardiac arrhythmia. Although the possibility of post-ESWL acute pancreatitis is extremely low, physicians should take care of this complication.
정태섭 ( Tae Seob Jung ),홍정운 ( Jung Un Hong ),박신희 ( Shin Hee Park ),이희정 ( Hee Jeong Lee ),민인선 ( In Sun Min ),이주영 ( Ju Young Lee ),석창현 ( Chang Hyeon Seock ) 대한소화기학회 2016 대한소화기학회지 Vol.67 No.3
Pseudomyxoma peritonei is a very rare condition, and even rarer in patients with history of cancer. A 70-year old woman with a history of breast cancer was admitted with abdominal pain and distention. Abdominal computed tomography revealed ascites collection, diffuse engorgement and infiltration of the mesenteric vessel, suggesting peritonitis or peritoneal carcinomatosis. Diagnostic paracentesis was attempted several times, but a sufficient specimen could not be collected due to the thick and gelatinous nature of the ascites. Therefore, the patient underwent diagnostic laparoscopy for tissue biopsy of the peritoneum, which indicated pseudomyxoma peritonei. However, the origin of the pseudomyxoma peritonei could not be identified intraoperatively due to adhesions and large amount of mucoceles. Systemic chemotherapy was performed using Fluorouracil, producing some symptomatic relief. After discharge, abdominal pain and distention gradually worsened, so at 18 months after initial diagnosis the patient received palliative surgery based on massive mucinous ascites and palpable mass at the omentum. The patient expired after surgery due to massive bleeding. (Korean J Gastroenterol 2016;67:153-157)