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고정희 ( Jung Hee Koh ),엄중섭 ( Jung Seop Eom ),김정섭 ( Jung Sub Kim ),송상헌 ( Sang Heon Song ),곽임수 ( Im Soo Kwak ),성은영 ( Eun Young Seong ) 대한신장학회 2011 Kidney Research and Clinical Practice Vol.30 No.1
Emphysematous pyelonephritis is an unusual, severe gas-forming infection of renal parenchyma and its surrounding areas. It is a rare cause of septic pulmonary embolism. We report on a case of emphysematous pyelonephritis complicated with renal vein thrombosis and septic pulmonary embolism with review of the literature. A 51-year-old diabetic woman was admitted to our hospital with symptoms of fever, diffuse abdominal pain and nausea. Her initial laboratory findings showed pyuria and leukocytosis. She was diagnosed with acute pyelonephritis with abscess formation on contrast enhanced abdominal CT. She was treated with antibiotics and percutaneous abscess aspiration, but progressed to emphysematous pyelonephritis complicated with renal vein thrombosis and septic pulmonary embolism. Finally she underwent the left total nephrectomy.
만성 콩팥병 환자에서 추정 사구체 여과율에 따른 25-Hydroxyvitamin D의 특성
고정희 ( Jung Hee Koh ),곽임수 ( Ihm Soo Kwak ),송상헌 ( Sang Heon Song ),이수봉 ( Soo Bong Lee ),이하린 ( Harin Rhee ),성은영 ( Eun Young Seong ),박창준 ( Chang Jun Park ),김태균 ( Tae Kyun Kim ),오상보 ( Sang Bo Oh ) 대한내과학회 2012 대한내과학회지 Vol.83 No.6
Background/Aims: Accumulating data suggest that vitamin D deficiency is prevalent in patients with chronic kidney disease (CKD). However, comprehensive data are lacking for Koreans. The aim of this study was to survey vitamin D deficiency among patients with CKD in Korea and to identify the relationships among various factors. Methods: We conducted a retrospective cohort study of 444 patients who were divided into four subgroups by estimated glomerular filtration rate (eGFR) for comparisons of mean 25-hydroxyvitamin D [25(OH)D] level and other parameters. In addition, non-dialyzed patients were categorized into four groups based on 25(OH)D levels (<10, 10-19, 20-29, and ≥ 30 ng/mL), and risk factors for severe vitamin D deficiency (<10 ng/mL) were investigated. Results: Of patients with an eGFR ≥ 60 mL/min/1.73 m2, 43% (34/79) showed severe 25(OH)D deficiency, and the mean 25(OH)D level was 11.7±5.3 ng/mL. In CKD3 group, 53.2% (41/77) showed severe 25(OH)D deficiency, with a mean level of 11.3±7.2 ng/mL. In CKD4 group, 53.3% (49/92) had severe 25(OH)D deficiency, with a mean level of 11.0±6.2 ng/mL. Approximately 71% (139/196) of patients in CKD5 group showed severe deficiency, and the mean level was 9.2±5.9 ng/mL. Severe 25(OH)D deficiency was affected by winter season, renal function, diabetes, and low-density lipoprotein cholesterol. The serum parathyroid hormone level was inversely correlated with the 25(OH)D level, such that 25(OH)D < 20 ng/mL were associated with a steep increase in parathyroid hormone. Conclusions: Vitamin D deficiency is highly prevalent in the Korean population. Few patients met a sufficient 25(OH)D concentration, even in the early stages of CKD. Our data suggest that 25(OH)D level of 20 ng/mL is a threshold for a rapid increase in parathyroid hormone levels. (Korean J Med 2012;83:740-751)
Hemobilia의 원인, 임상소견, 치료에 대한 분석
김태균 ( Tae Kyun Kim ),김동욱 ( Dong Uk Kim ),송근암 ( Geun Am Song ),김광하 ( Gwang Ha Kim ),허정 ( Jeong Heo ),서주완 ( Joo Wan Seo ),오상보 ( Sang Bo Oh ),고정희 ( Jung Hee Koh ) 대한췌담도학회 2013 대한췌담도학회지 Vol.18 No.1
배경/목적: 혈액담즙증은 발생률이 높지 않아 쉽게 인지되지는 않지만, 위장관 출혈의 감별 진단에 중요하다. 혈액 담즙증의 원인으로는 담석, 염증, 혈관 기형, 악성 종양, 담도 외상 및 의인성 등이 보고되어 왔으며, 시간의 흐름에 따라 혈액담즙증의 호발 원인에 변화가 관찰되었다. 본 연구에서는 최근 증가하고 있는 의인성 혈액담즙증의 발생률에 대해 살펴보고, 또한 국내의 혈액담즙증의 원인과 임상양상, 치료에 대해 알아보고자 하였다. 방법: 본원에서 혈액담즙증으로 진단된 53명의 환자를 대상으로 원인, 임상양상 및 치료에 대해 조사하였다. 또한 의인성 혈액 담즙증의 발생률을 확인하였고 위험인자인 항혈소판제제 복용 여부도 확인하였다. 결과: 혈액담즙증의 원인으로 의인성이 가장 흔했고, 다음으로 간세포암과 같은 악성종양이 뒤를 이었다. 임상양상에서 Quinke의 세 징후가 모두 나타난 것은 19% 정도였으며, 치료는 경도 혈액담즙증의 경우 보존적 치료만으로 호전되었으며, 중증의 경우 혈관조영술 및 색전술을 시행하였다. 결론: 의인성 혈액담즙증이 증가함에 따라 향후 시술시혈액담즙증에 대한 빠른 인지와 주의 및 신속한 대응이 필요할 것으로 생각된다. Backgrounds/Aims: Hemobilia is a rare condition that may be difficult to recognized. However, it is none the less important to include in the differential diagnosis of gastrointestinal bleeding. With the increasing use of percutaneous liver procedures, there has been increased in the incidence of iatrogenic hemobilia. The purpose of this study was to illustrate the present incidence of iatrogenic hemobilia and to identify the etiology, clinical manifestations and therapy of Korean patients with hemobilia. Methods : In this study, we reviewed 53 patients with hemobilia diagnosed definitely, for analyzing recent causes, presentations and treatment. In addition, we investigated prevalence of iatrogenic causes and frequency of taking antiplatelet agents. Results : In result, we found out that the most common cause was iatrogenic hemobilia and malignancy including hepatocellular carcinoma was followed. All symptoms of Quinke`s triad were presented in up to 19 %. In the case of minor bleeding, conservative therapy was enough to recover and severe cases needed angioembolization or surgery. Conclusions: Further investigation should be studied about how to prevent iatrogenic cause, because hemobilia due to percutaneous procedure continues to increase.
전이성 간암환자에서 간동맥 화학색전술 후 발생한 간농양에 합병된 척수경막외농양
이용재 ( Yong Jae Lee ),김광하 ( Gwang Ha Kim ),박도윤 ( Do Youn Park ),김석 ( Suk Kim ),박창준 ( Chang Jun Park ),김태균 ( Tae Kyun Kim ),고정희 ( Jung Hee Koh ) 대한소화기학회 2013 대한소화기학회지 Vol.61 No.4
Transarterial chemoembolization (TACE) is one of the most effective therapies for unresectable hepatocelluar carcinoma or metastatic hypervascular tumors. Abscess occurring in the other organs beside the liver after TACE is a complication that often occurs, sometimes potentially fatal. We report a case of spinal epidural abscess occurred after liver abscess complicated by TACE in a patient with metastatic neuroendocrine tumors to the liver. A 67-year-old female underwent TACE first for the metastatic lesions to liver, with a history of pancreatoduodenectomy for the primary pancreatic neuroendocrine tumor. Four days after TACE, sudden high fever occurred, and liver abscess was found on abdominal CT. Two days later, back pain and radiating pain to the right leg occurred, and lumbar spine MRI showed spinal epidural abscess. After intravenous antibiotics for 8 weeks and partial laminectomy, the patient recovered and was discharged without complications. (Korean J Gastroenterol 2013;61:225-229)