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증례 : 감염 ; 수막염을 합병한 폐렴알균 심내막염 1예
권종규 ( Jong Kyu Kwon ),권혁용 ( Hyuck Yong Kwon ),은동엽 ( Dong Yeub Eun ),이재광 ( Jae Gwang Lee ),이경숙 ( Kyoung Suk Lee ),최진우 ( Jin Woo Choi ),권기태 ( Ki Tae Kwon ) 대한내과학회 2010 대한내과학회지 Vol.78 No.1
페니실린이 개발된 이래로 폐렴알균에 의한 감염성 심내막염은 매우 드문 질환으로, 전형적으로는 알코올중독자에서 폐렴에 합병되어 발생하고 수막염을 일으키기도 한다. 현재까지 국내에는 성인에서 폐렴알균에 의한 감염성 심내막염 1예가 보고되어 있으며, Austrian 증후군이나 수막염이 동반된 증례는 보고가 없다. 감염성 색전 물질이 뇌혈관이나 수막혈관에 살포되어 수막염을 일으키기도 한다. 저자들은 아직까지 국내에 보고된 바 없는 색전뇌경색증과 수막염을 합병한 폐렴알균 심내막염 1예를 경험하였기에 보고하는 바이다. 심장 수술을 하지 않고 항균제 치료만 지속하다가 심장 합병증으로 사망하였으며, 폐렴알균 심내막염은 급속히 진행하고 국소적 전신적 합병증이 잘 발생하므로 심장 수술을 하지 않고는 치료가 어렵다는 것을 보여주는 증례이다. Streptococcus pneumoniae is an infrequent cause of infective endocarditis in the penicillin era. This infection typically follows pneumonia in the setting of chronic alcoholism and may be complicated by meningitis. Only one adult case of pneumococcal endocarditis (PE) has been reported in Korea. We report the case of a 73-year-old woman who suffered from PE complicated by embolic cerebral infarction and meningitis. This is the first Korean case of PE complicated with meningitis. The patient was treated medically and died from a cardiac complication. This case shows that PE is difficult to treat without surgery because its evolution is usually acute and very aggressive; it has a high rate of local and systemic complications despite the administration of appropriate antibiotics. (Korean J Med 78:138-143, 2010)
권종규(Jong Kyou Kwon),오철규(Cheol Kyu Oh) 대한비뇨기종양학회 2015 대한비뇨기종양학회지 Vol.13 No.1
Laparoscopic adrenalectomy has been the standard method for resecting adrenal gland tumors. Recently, laparoscopic retroperitoneal adrenalectomy (RA) has been more popular than conventional transperitoneal laparoscopic adrenalectomy (TLA) as an alternative method. Studies comparing laparoscopic RA and TLA showed that laparoscopic RA was superior or at least comparable to TLA in operation time, blood loss, pain score, hospital stay, and return to normal activity. Conversion rates and complication rates were similar. At present, laparoscopic RA has been int the limelight procedure for patients with benign adrenal disease. However, surgeons have been reluctant to offer this operation to patients because of the concerns over inadequate working space and overall perceived higher rate of complications, laparoscopic RA is not popular in urologic field up to now. This article summarizes the latest ideas and issues on laparoscopic RA in the expanding field of laparoscopy in urology.
박민규 ( Min Kyu Park ),정윤진 ( Yun Jin Chung ),백인엽 ( In Yub Baek ),김형석 ( Hyeong Seok Kim ),배상수 ( Sang Soo Bae ),이수옥 ( Su Ok Lee ),이경숙 ( Kyoung Suk Lee ),권종규 ( Jong Kyu Kwon ) 대한소화기학회 2013 대한소화기학회지 Vol.61 No.5
Biliary enteric fistula is an abnormal pathway often caused by biliary disease. It is difficult to diagnose the disease because patients have nonspecific symptoms. A 67-year-old woman presented with hematemesis and melena. She was diagnosed with Dieulafoy lesion on the gastric antrum and underwent endoscopic hemostasis using hemoclips. Follow-up upper gastrointestinal endoscopy revealed an abnormal opening on a previous treated site that was suggestive of biliary enteric fistula. Abdomen simple X-ray and abdominal dynamic CT scan showed pneumobilia and cholecysto-gastric fistula. The patient had cholecystectomy and wedge resection of the gastric antrum, followed by right extended hemicolectomy because of severe adhesive lesion between the gallbladder and colon. She was diagnosed with cholecysto-gastro-colic fistula postoperatively. We report on this case and give a brief review of the literatures.
강직척추염 환자에서 발생한 병적 골절을 동반한 다발성 골수종
권혁용 ( Hyuck Yong Kwon ),한승우 ( Seung Woo Han ),권종규 ( Jong Kyu Kwon ),최진우 ( Jin Woo Choi ),이경숙 ( Kyung Sook Lee ),권기태 ( Ki Tae Kwon ),김건우 ( Gun Woo Kim ) 대한류마티스학회 2009 대한류마티스학회지 Vol.16 No.2
Multiple myeloma (MM) is a malignant monoclonal proliferation of plasma cells that commonly causes pathologic fractures in the vertebrae, femur, humerus and rib. Although the association of MM and ankylosing spondylitis (AS) has rarely been reported, most of MM patients with AS share the characteristic of IgA type paraproteinemia, which suggests the presence of mechanisms that possibly connect the two conditions. In this report, we describe a 47-year-old man with a 25-year history of AS, and he was diagnosed as having IgA κ type MM with a pathologic fracture at the left clavicle. To the best of our knowledge, this is the first case of IgA myeloma presenting with a pathologic fracture in a patient with AS. We report here on this case along conducting a review of the relevant medical literature.
증례 : 류마티스 ; 무통성 항문출혈로 발현한 현미경적 다발혈관염 1예
한승우 ( Seung Woo Han ),권혁용 ( Hyuck Yong Kwon ),권종규 ( Jong Kyu Kwon ),최진우 ( Jin Woo Choi ),이경숙 ( Kyung Sook Lee ),손경락 ( Kyung Rak Sohn ),김건우 ( Gun Woo Kim ) 대한내과학회 2009 대한내과학회지 Vol.77 No.5S
현미경적 다발혈관염에서 위장관 출혈은 비교적 드물게 보고되며 특히 항문 출혈은 아직 전세계적으로 보고된 바 없다. 현미경적 다발혈관염에서 위장관 침범은 예후에 중요하며 혈관염이 진단된 경우 증상이 없어도 위장관 침범의 가능성을 고려해야 할 것이다. 저자들은 무통성의 항문 출혈로 내원한 환자에서 항문에 국한된 위장관 침범과 괴사성 사구체신염을 동반한 현미경적 다발혈관염 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Microscopic polyangiitis (MPA) is a systemic vasculitis that is characterized by small-vessel involvement histologically. Although MPA is primarily associated with necrotizing and crescentic glomerulonephritis and pulmonary capillaritis, it often has gastrointestinal (GI) involvement. The most frequent GI symptom in MPA is abdominal pain of an ischemic nature, while GI bleeding is rare. We report a case of MPA that presented with painless anal bleeding, which was initially misdiagnosed as an internal hemorrhoid. The surgical specimen of the anus showed vasculitis of small arteries with fibrinoid necrosis and the renal biopsy showed necrotizing glomerulonephritis with tubular atrophy. To our knowledge, this is the first reported case of anal involvement in MPA. (Korean J Med 77:S1337-S1341, 2009)
일개 2차 의료기관에서의 비결핵성 마이코박테리아 분리비율 및 폐질환의 임상 경과
이재광 ( Jae Kwang Lee ),권혁용 ( Hwuck Young Kwon ),권종규 ( Jong Kyu Kwon ),이화정 ( Hwa Jeong Lee ),이동욱 ( Dong Wook Lee ),이유진 ( Yu Jin Lee ),윤경화 ( Kyung Hwa Yoon ),송도영 ( Do Young Song ),이병기 ( Byung Ki Lee ),김연 대한결핵 및 호흡기학회 2009 Tuberculosis and Respiratory Diseases Vol.67 No.3
Background: To examine the recovery rate of nontuberculous mycobacteria (NTM) from respiratory specimens and the clinical course of NTM pulmonary disease at a 700-bed secondary hospital. Methods: This study analyzed the results of 843 acid-fast bacilli (AFB) culture-positive respiratory specimens from 650 subjects collected between May 2003 and April 2008. In addition, the clinical course of NTM pulmonary disease, diagnosed using criteria established by the American Thoracic Society, was examined. Results: There were 67 (7.9%) NTM isolates recovered from 52 (8.0%) subjects. Among the 535 AFB smear-positive specimens, 34 (6.3%) NTM isolates were recovered. There were 33 (10.7%) NTM isolates were recovered from 308 AFB smear-negative specimens. Of 52 subjects with isolated NTM, M. intracellulare was the most common species at 73.1% (n=33), followed by M. kansassi (n=7), M. abscessus (n=2), M. fortuitum (n=2), and M. avium (n=1). Sixteen (30.8%) patients had NTM pulmonary disease and the most common causative organism was M. intracellulare (n=14, 87.5%). Of these, 6 cases attained negative conversion in culture, 4 cases failed to attain negative conversion because of poor cooperation or expiration from complicated underlying lung disease, and 5 cases were transferred to a higher-grade hospital. Conclusion: The recovery rate of NTM from respiratory specimens was relatively low and the most common species was M. intracellulare. Patients with NTM pulmonary disease showed variable clinical outcomes.