성인에서 간혈관종에 의해 발생한 카사바-메리트 증후군

옥찬영 ( Chan Young Oak ),전충환 ( Chung Hwan Jun ),조은애 ( Eun Ae Cho ),이두현 ( Du Hyun Lee ),조성범 ( Sung Bum Cho ),박창환 ( Chang Hwan Park ),주영은 ( Young Eun Joo ),김현수 ( Hyun Soo Kim ),류종선 ( Jong Sun Rew ),최성규 ( 대한소화기학회 2016 대한소화기학회지 Vol.67 No.4

Hemangiomas are the most common benign tumors of the liver. They are generally asymptomatic, but giant hemangiomas can lead to abdominal discomfort, bleeding, or obstructive symptoms. Kasabach-Merritt syndrome is a rare but life-threatening complication of hemangioma, characterized by consumptive coagulopathy with large vascular tumors. More than 80% of Kasabach-Merritt syndrome cases occur within the first year of life. However, there are few reports of Kasabach-Merritt syndrome with giant hepatic hemangioma in adults and, as far as we know, no reports of Kasabach-Merritt syndrome with hepatic hemangioma treated with first line medical treatment only. The most important treatment for this syndrome is removal of the large vascular tumor. However, surgical treatment entails risk of bleeding, and the patient’s condition can mitigate against surgery. We herein present a case of unresectable giant hepatic hemangioma with disseminated intravascular coagulopathy. The patient was a 60-year-old woman who complained of hematochezia, ecchymosis, and abdominal distension. She refused all surgical management and was therefore treated with systemic glucocorticoids and beta-blockers. After two weeks of steroid therapy, she responded partially to the treatment. Her laboratory findings and hematochezia improved. She was discharged on hospital day 33 and observed without signs of bleeding for three months. (Korean J Gastroenterol 2016;67:220-223)

증례 : 신장 ; 간신증후군으로 오인하였던 메포르민에 의한 유산산증 1예

김옥기 ( Ok Ki Kim ),옥찬영 ( Chan Young Oak ),정지민 ( Ji Min Jeong ),이정원 ( Jeong Won Lee ),신민호 ( Min Ho Shin ),김남호 ( Nam Ho Kim ) 대한내과학회 2012 대한내과학회지 Vol.82 No.2

저자들은 간경화 환자에서 메포르민에 의해 발생한 유산산증 및 급성 신손상 환자를 약물 복용력이 확인되지 않아간신증후군으로 오진하였던 증례를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Metformin is a well-established drug for the treatment of type 2 diabetes mellitus. The incidence of metformin-induced lactic acidosis is low, but the estimated mortality rate is approximately 50% in cases with lactic acidosis in combination with metformin therapy. Lactic acidosis occurs most often in patients with compromised cardiac, pulmonary, hepatic, and/or renal function. Acute kidney injury is a relatively frequent problem in cirrhosis patients. Hepatorenal syndrome is a diagnosis of exclusion, making its diagnosis difficult in the clinical field. We report a case of metformin-induced lactic acidosis with acute kidney injury that was misdiagnosed as hepatorenal syndrome in a cirrhosis patient. (Korean J Med 2012;82:241-246)

위장관 ; 위장관기질종양과 구별되는 위 신경초종의 초음파 내시경 특징

박형철 ( Hyung Chul Park ),손동준 ( Dong Jun Son ),오형훈 ( Hyung Hoon Oh ),옥찬영 ( Chan Young Oak ),김미영 ( Mi Young Kim ),정조윤 ( Cho Yun Chung ),명대성 ( Dae Seong Myung,),김종선 ( Jong Sun Kim ),조성범 ( Sung Bum Cho ),이 대한소화기학회 2015 대한소화기학회지 Vol.65 No.1

Background/Aims: Gastric schwannoma (GS), a rare neurogenic mesenchymal tumor, is usually benign, slow-growing, and asymptomatic. However, GS is often misdiagnosed as gastrointestinal stromal tumors (GIST) on endoscopic and radiological examinations. The purpose of this study was to evaluate EUS characteristics of GS distinguished from GIST. Methods: A total of 119 gastric subepithelial lesions, including 31 GSs and 88 GISTs, who were histologically identified and underwent EUS, were enrolled in this study. We evaluated the EUS characteristics, including location, size, gross morphology, mucosal lesion, layer of origin, border, echogenic pattern, marginal halo, and presence of an internal echoic lesion by retrospective review of the medical records. Results: GS patients comprised nine males and 22 females, indicating female predominance. In the gross morphology according to Yamada`s classification, type I was predominant in GS and type III was predominant in GIST. In location, GSs were predominantly located in the gastric body and GISTs were predominantly located in the cardia or fundus. The frequency of 4th layer origin and isoechogenicity as compared to the echogenicity of proper muscle layer was significantly more common in GS than GIST. Although not statistically significant, marginal halo was more frequent in GS than GIST. The presence of an internal echoic lesion was significantly more common in GIST than GS. Conclusions: The EUS characteristics, including tumor location, gross morphology, layer of origin, echogenicity in comparison with the normal muscle layer, and presence of an internal echoic lesion may be useful in distinguishing between GS and GIST.

만성 신장 질환이 급성 허혈성 뇌졸중의 예후에 미치는 영향

최준석 ( Joon Seok Choi ),김하연 ( Ha Yeon Kim ),옥찬영 ( Chan Young Oak ),김민지 ( Min Jee Kim ),김창성 ( Chang Sung Kim ),오슬현 ( Seul Hyun Oh ),이형철 ( Hyung Chul Lee ),박정우 ( Jeong Woo Park ),배은희 ( Eun Hui Bae ),마성권 대한내과학회 2010 대한내과학회지 Vol.78 No.5

목적: 만성 신장 질환은 관상동맥 질환의 독립적인 위험인자로 알려져 있다. 하지만 심혈관 질환의 다른 형태인 급성 허혈성 뇌졸중과 만성 신장 질환과의 연관관계에 대해서는 아직 잘 알려져 있지 않다. 이에 저자들은 급성 허혈성 뇌졸중 환자에서 만성 신장 질환의 진행 정도에 따라 예후에 미치는 영향을 알아보고자 하였다. 방법: 급성 허혈성 뇌졸중으로 내원한 환자 282예를 대상으로 후향적 연구를 통해 만성 신장 질환의 진행 정도에 따른 예후와의 상관관계를 연구하였다. 사구체 여과율은 Cockcroft-Gault 공식과 Modification of Diet in Renal Disease (MDRD) 공식을 이용하여 측정하였다. 사구체 여과율에 따라 세 군으로 분류하여 분석을 시행하였다(I 군: ≥60 mL/min/1.73 m2, II 군: 45~59 mL/min/1.73 m2, III 군: 15~44 mL/min/1.73 m2). 급성 허혈성 뇌졸중 발생 1개월과 12개월 후에 추적관찰을 통하여 사구체 여과율 감소에 따른 사망률 및 요양기관 재원률의 차이를 비교 분석하였다. 결과: Cockcroft-Gault 공식을 사용한 군의 1년 사망률은 군에서 6.0%, II 군에서 20.3%, III 군에서 21.1%였으며 상대적으로 MDRD 공식을 사용한 군의 1년 사망률은 9.1%, 12.5%, 37.5%로 관찰되었다. Cockcrfot-Gault 공식을 사용한 군의 1년 사망률에 대한 odds ratio는 II 군에서 3.97 (1.7~9.2, 95% CI), III 군에서 4.16 (1.2~14.5, 95% CI)이며 사구체 여과율의 감소에 따라 odds ratio가 증가하였다. MDRD 공식을 사용한 군에서 1년 사망률에 대한 odds ratio는 1.43 (0.5~4.4, 95% CI), 6.00 (1.3~26.8, 95% CI)으로 관찰되었다. Adjusted odds ratio는 양 공식을 사용한 군 모두에서 사구체 여과율의 감소에 따라 odds ratio의 증가가 관찰되었다. 결론: 급성 허혈성 뇌졸중 환자에서 사구체 여과율의 감소 및 만성 신장 질환의 중등도는 사망률 증가 및 불량한 예후와 관계가 있었다. Background/Aims: Chronic kidney disease is recognized as an independent risk factor for coronary artery disease. It is unknown whether renal function predicts clinical outcomes of acute ischemic stroke. The present study was aimed at examining the correlation between the degree of renal dysfunction and stroke outcome. Methods: Our retrospective study included 282 consecutive patients hospitalized due to acute ischemic stroke. Renal function was assessed by the estimated Glomerular filtration rate (GFR), using two methods: Cockcroft-Gault equation and Modification of Diet in Renal Disease (MDRD) equation. Each of the estimated GFRs were categorized into three groups (Group I: ≥60 mL/min/1.73 m2, Group II: 45~59 mL/min/1.73 m2, Group III: 15~44 mL/min/1.73 m2). From collected patient databases, we compared mortality and rate of hospitalization to GFR at 1 month and 12 months follow up. Results: Our study found that, based on the GFR, the 1 year mortality, using the Cockcroft-Gault equation, was 6.0% in group I, 20.3% in group II and 21.1% in group III and, using the MDRD equation, 9.1%, 12.5% and 37.5%, respectively. Patients with lower GFRs exhibited an increased odds ratio for 1 year mortality when estimated by the Cockcroft-Gault equation: 3.97 (1.7~9.2, 95% CI) in group II and 4.16 (1.2~14.5, 95% CI) in group III. Based on the MDRD equation, patients with lower GFRs also exhibited an increased odds ratio for 1-year mortality: 1.43 (0.5~4.4, 95% CI) in group II and 6.00 (1.3~26.8, 95% CI) in group III. The adjusted odds ratio for 1-year mortality also increased based on our analysis using either equation. Conclusions: Decline of GFR and severity of chronic kidney disease are associated with poor clinical outcomes of acute ischemic stroke. (Korean J Med 78:602-609, 2010)

쇄석위로 자궁근종절제술 후 발생한 장딴지 부위 횡문근융해증 1예

이정원 ( Jeong Won Lee ),김남호 ( Nam Ho Kim ),최원영 ( Won Young Choi ),김옥기 ( Ok Ki Kim ),정지민 ( Ji Min Jeong ),옥찬영 ( Chan Young Oak ) 대한내과학회 2012 대한내과학회지 Vol.83 No.6

Rhabdomyolysis is a syndrome characterized by muscle necrosis and release of intracellular muscle constituents into the circulation. It can occur in various diseases and conditions involving destruction of muscle membranes, including muscle strain, persistent coma, drug or alcohol abuse, connective tissue disease, excessive exercise, and surgery. Many factors have been implicated in the development of rhabdomyolysis during surgery; these include patient positioning with obstructed blood flow of either a femoral vessel at the hip or a popliteal vessel at the knee. Rhabdomyolysis can also be caused by muscle compression due to operative positioning during prolonged surgery. Surgery performed in the lithotomy position sometimes results in serious complications of rhabdomyolysis and acute renal failure. We report a case of rhabdomyolysis of both calves associated with the lithotomy position for laparoscopic myomectomy. (Korean J Med 2012;83:802-806)