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증례 : 신장 ; 시프로플록사신 정맥 주사 후 발생한 급성 요세관 괴사와 청력 소실 1예
김준재 ( Jun Jae Kim ),김현정 ( Hyun Jung Kim ),김상현 ( Sang Hyun Kim ),박원도 ( Won Do Park ) 대한내과학회 2014 대한내과학회지 Vol.87 No.4
Ciprofloxacin is a broad-spectrum antibiotic used to treat a variety of infections. However, acute kidney injury is a rarely reported side effect. Ciprofloxacin-related nephrotoxicity typically manifests as acute tubulointerstitial nephritis. To the best of our knowledge, few cases of acute tubular necrosis as a complication of ciprofloxacin have been reported to date. We herein describe a case involving a 41-year-old woman treated with intravenous ciprofloxacin at 200 mg twice daily for gastroenteritis. One day after initiation of treatment, her serum creatinine level increased from 0.95 to 3.83 mg/dL and she experienced impaired hearing. Five days later, renal biopsy demonstrated acute tubular necrosis. The acute tubular necrosis encountered in this patient resolved; however, short-term hemodialysis was required. This is the first reported case of acute kidney injury associated with ciprofloxacin use in Korea. (Korean J Med 2014;87:491-495)
증례 : 소화기 ; 2개의 내시경을 이용한 금속 스텐트 삽입술을 통해 치료한 들창자 증후군
김준재 ( Jun Jae Kim ),천영국 ( Young Koog Cheon ),이태윤 ( Tae Yoon Lee ),심찬섭 ( Chan Sup Shim ) 대한내과학회 2015 대한내과학회지 Vol.89 No.4
들창자 증후군의 비수술적 치료 방법은 다양하지만 언제나 모든 방법이 다 적용 가능한 것은 아니다. 특히 내시경적치료 방법은 해부학적 변형으로 인해 병변으로의 접근에 제한점이 있다. 이에 저자들은 악성 종양으로 인한 들창자 증후군 환자에서 2개의 내시경을 이용하여 성공적으로 금속스텐트를 삽입한 사례를 문헌 고찰과 함께 보고하는 바이다. Afferent loop syndrome is a rare complication of pancreaticoduodenectomy, and the endoscopic approach is difficult due to the surgically altered anatomy. Herein, we report a case of afferent loop obstruction treated by endoscopic metal stent insertion using two endoscopes. A 57-year-old male who had undergone the Whipple operation 7 months prior for pancreatic head cancer presented with abdominal pain and jaundice. Abdominal computed tomography showed afferent loop obstruction due to recurrent metastatic pancreatic cancer. First, we attempted to insert the stent using percutaneous transhepatic approaches following percutaneous transhepatic biliary drainage, but these failed. We therefore accessed the obstruction site using a relatively thin endoscope and then exchanged this endoscope for another with a large working channel, through which the self-expandable metal stent was passed. The stent was inserted successfully. This method will increase the success rate of endoscopic treatment. (Korean J Med 2015;89:428-432)
보중익기탕(補中益氣湯) 복용 후 재발생한 미만성 간질성 폐렴
김승구 ( Seung Gu Kim ),강건희 ( Gun Hi Kang ),김준재 ( Jun Jae Kim ),박현 ( Hyun Park ),백나나 ( Na Na Baek ),이현경 ( Hyun Kyung Lee ),신은아 ( Eun Ah Shin ),이영민 ( Young Min Lee ),이혁표 ( Hyuk Pyo Lee ),정훈 ( Hoon Jeung ) 대한결핵 및 호흡기학회 2008 Tuberculosis and Respiratory Diseases Vol.65 No.5
Many classes of drug, such as antineoplastic drugs and antiarrhythmic drugs, have potential to induce interstitial lung disease. Herbal medicines are also believed to have the potential to induce pneumonitis. However, to our knowledge, there are no reports of pneumonitis caused by herbal medications in the Korean medical database. We report a case of recurrent pneumonitis caused by a self rechallenge of the Herbal medicine Bojungikgitang (Bu-Zhong-Yi-Qi-Tang : Hochu-ekki-to). (Tuberc Respir Dis 2008;65:416-420)
전신성 홍반성 루프스 환자에서 발생한 자가 면역성 간염 1례
김준재,백나나,김현정,전태주,서동대,오태훈,최원충 인제대학교 2008 仁濟醫學 Vol.29 No.-
SLE 환자에서 간 효소 수치의 상승은 여러 가지 원인에 의하여 드물지 않게 관찰될 수 있다. 이 중 자가 면역 기전에 의해 발생되는 질환으로 자가 면역성 간염과 SLE에 동반된 간염이 있으며, 두 가지 질환의 감별은 환자의 예후 및 치료에 중요하다. 따라서 간 조직 검사를 포함한 정확한 진단 기준으로 조기에 진단하여야 하며, 이에 따른 적절한 치료를 통해서 간 부전 및 비가역적 간경변증으로 진행을 방지할 수 있을 것으로 사료된다. Patients with systemic lupus erythematosus (SLE) have a 25-50% chance of developing abnormal liver tests in their lifetime and various causes are related to elevation of liver enzyme, such as hepatic involvement of lupus, hepatotoxic drug, viral infection, autoimmune hepatitis and so on. Discrimination of autoimmune hepatitis from SLE-associated hepatitis is important because complications and therapy are quite different, although both are autoimmune syndromes. Here we are presenting a case of SLE patient with type I autoimmune hepatitis proved with liver biopsy.
엄흥식,김준재,김현수,박영정,최상봉,박원도,김상현 인제대학교 2006 仁濟醫學 Vol.27 No.-
Spinal epidural abscess is an uncommon but readily diagnosable and treatable potential cause of paralysis and death. The incidence of spinal epidural abscess is approximately one to two cases per 10,000 hospital admissions in the United States. The symptoms of spinal epidural abscess are varied but include lower back pain, fever, local tenderness and neurological deficit, especially in such high risk groups as patients with diabetes, intravenous drug abuse, chronic renal failure, alcoholism, liver disease and immunocompromization. Infections of the epidural space originate from contiguous spread or via hematogenous routes from a distant source. Cutaneous sites of infection are the most common remote sources, especially in intravenous drug users. S. aureus accounts for most spinal epidural abscess infections, followed by streptococci and gram-negative anaerobes. We here report a case of spinal epidural abscess in renal abscess patient complaining of fever and back pain. A 71-year old female patient was admitted to epigastric pain and oliguria. She had been diagnosed as acute renal failure and treated with hydration. After third hospital days, she shows a persistent fever and drowsy mentality. Abdominal computed tomography demonstrated renal abscess. She was treated with intravenous antibiotics, third cephalosporin. Blood cultures and urinary culture revealed Escherichia, coli. After fourteenth hospital days, she developed back pain, muscle weakness and decreased sensation of lower extremities. Spine MRI demonstrated spinal epidural abscess with spinal cord compression. Surgical drainage with laminectomy was performed. After treatment of intravenous antibiotics and surgical drainage, she discharged with improved back pain and neurological symptom.