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( Hark Rim ),( Sun Min Kim ),( Gyoung Hoon Kang ),( Ye Na Kim ),( Ho Sik Shin ),( Yeon Soon Jung ),( Hyun Yul Rhew ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: We report a rare case of CAPD peritonitis caused by Ochrobacterium anthropi. Introductions: Among the continuous ambulatory peritoneal dialysis(CAPD) patients, peritonitis is one of the most commonly taken complications, and also the general cause of dialytic modality exchange to hemodialysis. Usual pathogens of CAPD peritonitis may be bacteria, fungi, mycobacteria. Coagulase negative staphylococci, S. aureus, campylobacter, pseudomonas are common reported pathogens among the bacteria, of CAPD peritonitis cases, meanwhile candida is among fungi. Ochrobacterium anthropi is one species of Brucellaceae, which is rare pathogen of human disease. Case (Methods and results): 73 years old female, who was on CAPD due to diabetic end stage renal disease visited Kyung-Hee University hospital with intermittent abdominal pain. Body fi uid analysis showed increased white blood cell(WBC) count of 26,750/mm3 with her peritoneal fi uid. Culture study with peritoneal fi uid suggested O. anthropi, and DNA sequencing with PCR was consistent with O. anthropi. Intraperitoneal ceftazidime and cefazolin were administrated as empirical antibiotics. Ceftazidime resistance was noted with the result of antibiotics sensitivity test at 7th day of hospitalization, and antibiotics were changed into intraperitoneal gentamicin, which showed sensitivity to the pathogen. CAPD catheter removal and antibiotics re-exchange into imipenem and cefazolin, which were other sensitive antibiotics by the sensitivity test, were done since clinical manifestation and peritoneal fi uid WBC count was repeatedly improved and aggravated. The patient discharged with improved lab test results and resolving clinical symptoms afterward. Conclusions: We presentators report rare case of CAPD peritonitis with pathogen of O. anthropi. The pathogen of the case confi rmed by classical microbiologic, and molecular biologic Methods: The patient was unable to treat only with antibiotics, thus CAPD catheter, which might be act as colonizing source, was removed, and the disease resolved.
임학 고신대학교의과대학 2007 고신대학교 의과대학 학술지 Vol.22 No.1
The most of mushroom poisoning manifests self-limited features including gastrointestinal symptoms. However some kinds of mushrooms including Amanita phalloides can be seriously toxic and even be fatal. Although some cases in terms of mushroom poisoning have been reported in Korea, the most of them makes reports on the other types of mushrooms especially Amanita virosa. A case report of acute renal failure complicated by Amanita phalloides poisoning may not be found in Korea so far. A 55 year-old man admitted hospital because of oliguria and nausea. He ingested wild mushroom 5 days before admission. Identification of ingested mushroom was made by a pictorial directory. Laboratory findings showed an elevation of BUN and serum creatinine suggesting acute renal failure. Emergency hemodialysis was performed and maintained for a period of three weeks. Kidney biopsy made on 12th hospital day showed detachments of epithelial cells and inflammatory cells infiltrations with edema in interstitium suggesting acute interstitial nephritis and acute tubular necrosis. From 25th hospital day, no more hemodialysis was offered with a recovery of renal function. Patient discharged on 35th hospital day with a nearly stable renal function. I hereby report a case of acute renal failure complicated by Amanita phalloides poisoning with review of literature.
면역억제제투여중 발생한 Listeria monocytogences에 의한 뇌막염 2예
임학,안수열,유경무 고신대학교 의학부 1994 高神大學校 醫學部 論文集 Vol.10 No.1
It is well known that Listeria monocytogenes may cause meningitis in the immunocompromised host. We experienced 2 cases of L. monocytogenes meningitis in patients with renal transplant and with systemic lupus erythematosus. The confirmation of diagnosis was made by CSF culture and identification of pathogen. In both cases, third-generation cephalosporins were given before the identification of pathogen but no clinical improvement was found. Following the substitution cephalosporin by ampicillin, one patient died and the other recovered without any CNS complication.
이정림,유병철,임학,이용환 고신대학교 의과대학 2010 고신대학교 의과대학 학술지 Vol.25 No.2
Background: To access the related factors of depression and to provide the basic data for psychologic problems in patients with peritoneal dialysis. Method: We conducted questionnaire survey using Hamilton depression scale from July to August, 2008. Data were collected from 67 peritoneal dialysis patients who diagnosed end-stage renal disease. Depression was defined over 17 points by Hamilton depression scale. Data analysis were performed with t-test, ANOVA and multiple regression analysis using SAS (ver 9.1). Result: Hamilton depression scale score of patients with peritoneal dialysis was 10.4 ± 5.95 and the prevalence of depression was 28.3%(19/67). The related factors of depression scale in patients with peritoneal dialysis were level of education and health status after peritoneal dialysis. Conclusion: More than quadrant of patients with peritoneal dialysis were suspected depression. In order to prevent depression in patients with peritoneal dialysis, education programs considering their intellectual status and health promotion programs of peritoneal dialysis patients are needed.
임학 고신대학교의과대학 2007 고신대학교 의과대학 학술지 Vol.22 No.1
Although pleural effusion is indicative of an intrathoracic problem, it can also result from a number of extrathoracic cause, such as hypoproteinemia, Meig's syndrome, pancreatitis, urinothorax. Urinothorax is a rare cause of pleural effusion secondary to obstructive uropathy or a leakage from the urinary tract. Urinoma, retroperitoneal inflammatory or malignant diseases, renal biopsy, blunt trauma, percutaneous renal and endoscopic ureteral intervention are the reported causes of urinothorax. It is believed that the urine moves retroperitoneally into the pleural space, and the effusion resolves quickly with removal of the obstruction. Pleural fluid smells like urine, pleural fluid's biochemical characteristics, and renal scan can aid the diagnosis of urinothorax. Most cases are diagnosed retrospectively, that is when pleural effusion resolves following urinary diversion. I report a case of urinothorax due to a leakage from the urinary tract in a cervical cancer patient. She had right sided pleural effusion which demonstrated as urinothorax. The effusion disappeared within a few days after urinary drainage had been established.
Striatopallidodentate 석회화증과 의도 진전이 동반된 원발성 부갑상선 기능 저하증 1례
강성진,김민정,임학 고신대학교의과대학 2008 고신대학교 의과대학 학술지 Vol.23 No.2
We present a 65-year-old man with ataxic gait and both hands tremor. Laboratory findings were consistent with idiopathic hypoparathyroidism, and brain magnetic resonance images showed extensive bilateral calcification of the basal ganglia, dentate nuclei of cerebellum. These results suggested that striopallidodentate calcification developed by hypoparathyroidism. Administration of calcium and calcitriol returned serum calcium and phosphorus level to normal, with considerable clinical benefit.
저용량 Cyclosporine-A와 Diltiazem 병합요법에 의한 신증후군의 관해
김성은,정연순,임학 고신대학교의과대학 2008 고신대학교 의과대학 학술지 Vol.23 No.3
Background : Cyclosporine-A (CsA) has been widely used as a treatment of nephrotic syndrome especially in patients with steroid-resistance or steroid-dependence. However, it can be nephrotoxic and its cost might also be a point to be considered. Diltiazem (DZ), one of calcium channel blockers, may have a potential benefit of renoprotection, which decreases acute tubular necrosis of renal transplants. DZ can also be used for reducing CsA dose because it slows down the metabolism of CsA by inhibition of cytochrome P-450 hepatic enzyme. In these points of view, low-dose CsA with DZ combination could be considered as an alternative to nephrotic syndrome treatment. However, such a kind of trial was hardly found so far. The purpose of this study was to evaluate the therapeutic effect of low-dose CsA with DZ in patients with steroid-resistant or steroid-dependent nephrotic syndrome. Methods : Low-dose of CsA (mean 1.7±0.5 mg/kg) and 90 mg of DZ were administered simultaneously to 15 patients of steroid-resistant or steroid-dependent nephrotic syndrome for 6 months with no alteration of dose. Blood pressure, body weight and random urine protein, 24-hour urine protein, serum creatinine, albumin, total cholesterol, and trough level of CsA were analyzed. Results : The random urine protein tended to decrease by CsA treatment. Twenty-four hour urine protein excretion decreased significantly at 6th months of treatment (from 7,211±5,374 mg to 1,094±1,688 mg, n=7, p=0.018). Complete remission was achieved in 10 patients and partial remission in 5 patients. Changes in serum albumin, total cholesterol, hemoglobin, body weight and blood pressure were statistically not significant. Conclusion : Low-dose CsA combined with DZ may be an effective in patients with steroid-resistant or steroid-dependent nephrotic syndrome.