Tacotsubo Cardiomyopathy Secondary to Pyogenic Liver Abscess

( Jeong Ill Suh ) 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1

Background: Takotsubo cardiomyopathy, also known as stress cardiomyopathy, is a type of non-ischemic cardiomyopathy in which myocardium suddenly weaken temporarily and is caused by emotional or physical stress such as sepsis, bleeding, asthma, or pheochromocytoma. Several infections have also been shown to precipitate Takotsubo cardiomyopathy. However, few cases have demonstrated the association with liver abscess. Reported herein is a rare case of Takotsubo cardiomyopathy precipitated by the liver abscess. Case: A 73-year-old female was admitted due to fever. She has been without any illness. She was acute ill looking appearance. Initial vital signs were: BP 110/60 mmHg, HR 101 beats/min, RR 20 breaths/min, temperature 38.0℃. Laboratory studies revealed WBC 21,550/㎣, hemoglobin 14.7 g/dL, platelet 101,000/㎣, prothrombin time was 15.8 sec (INR of 1.44). AST/ALT 94/87 IU/L, total bilirubin 0.89 mg/dL, albumin 2.9 g/dL, r-GTP 66 U/L, ALP 139 U/L. Viral markers were HBsAg(-), anti-HBs(+), anti-HBc IgM(-), anti-HAV IgM(-), anti-HCV(-). Initial EKG showed sinus tachycardia. Abdominal CT showed about 5x6cm sized cystic mass like lesion with air bubbles in the liver S8. Percutanenous catheter drainage was performed and antibiotic treatment was started. On 2^nd day after admission, she developed suddenly worsening of dyspnea followed by blood pressure drop. Follow up EKG revealed myocardial ischemic change of lateral wall. CK 602 U/L, CK-MB 105.4 ng/ml, LDH 613 U/L, Troponin-I 18.8 ng/ml. Transthorasic echocardiography showed diffuse myocardial hyokinesia (ejection fraction 26%). But, coronorary angiogram showed completely normal findings. The cultured pus and blood samples were positive for K. pneumoniae. On the 11th day of hospitalization, her cardiac function was restored and EKG showed normal sinus rhythm. Her liver function recovered completely to normal and follow up abdominal CT showed marked decreased size of liver abscess on 38th day of hospitalization. Conclusions: Tacotsubo cardiomyopathy caused by pyogenic liver abscess is rare. The presentation is vary from asymptomatic to chest pain, shortness of breath, nausea, vomiting, palpitations or fainting. It may also show an EKG change and troponin elevation similar to myocardial infarction. Although stress cardiomyopathy is a reversible condition, but it can be serious and fatal.

Passive Sampler를 이용한 진주시 NO_2 농도 분포

박정호,전기일,서정민 진주산업대학교 농업기술연구소 2000 農業技術硏究所報 Vol.13 No.-

In 1996, about 80 % of total emission in Chinju was emitted from mobile source, with about 26.9 % of nitrogen dioxide (NO_2) coming from mobile source. In this study, the distributions of NO_2 concentrations were investigated with Passive Sampler in Chinju. Passive Sampler can be a useful method to evaluate distribution of a detailed concentration in large area. The concentrations of NO_2 in downtown Chinju were appeared in the rage of 0.0046∼0.0285 ppm. And the concentrations of NO_2 in rural areas were appeared in the rage of 0.0018∼0.0176 ppm at the road side and 0.0014∼0.0064 ppm at the green zone. The mean concentration of NO_2 was appeared to be about 0.0043(±0.0020) ppm in Chinju. The NO_2 concentrations at the downtown site were about 21∼98 times higher than in rural areas.

우리나라 重要産業製品 流通構造의 近代化方案

李相道,金正子,宋瑞日,李相玩 동아대학교 공과대학 부설 한국자원개발연구소 1980 硏究報告 Vol.5 No.1

It needs the distributive facilities to perform efficiently the construction of distribution center for the improvement plan of physical distribution structure. In view of promoting distributive modernization and physical distribution cost reduction, the establishment of optimum scale by intensity and concerning of transportation is persued. These efficient arrangements of distribution center which can be organic combining facilities of a supplier and a demander are the urgent challenges. With a view to such distribution problems, the purpose of this paper is to concentrate the presentation of algorithm in selecting the optimal location of distribution center to build model for systematization and to obtain basic data on the design of distribution system in the future.

기종성 신우신염 1례

이재욱,구정태,서정일,양창헌,이정호,이동철,이영현,이활,이경섭 동국대학교 경주대학 1997 東國論集 Vol.16 No.1

기종성 신우신염은 주로 당뇨병환자나 폐쇄성 요로질환을 가진 환자에 발생하며 특징적으로 신실질 및 그 주위조직에 가스를 형성하면서 심한 조직괴사를 일으키는 매우 드문 급성 화농성 신감염으로 사망률이 높은 질환이다. 이 질환은 1989년 Kelly와 MacCallum에 의해 처음 보고된 이래 외국문헌에 약 90례 정도가 보고되어 있으며 국내에는 28례가 보고되어 있다. 수액 및 전해질 보충, 인슐린 투여를 통한 적절한 혈당조절 및 항생제 투여등의 내과적 치료와 절개배농 및 신적출술등의 수술적 치료 방법이 있다. 내과적 치료로 가스의 감소가 없는 경우에는 즉각적인 수술적 치료를 시행하여야하므로 이 가스변화에 대한 추적관찰이 중요하다 하겠다. 본 저자들은 당뇨병환자에서 발생한 기종성 신우신염 1례를 내과적 요법을 치험하였기에 문헌고찰과 함께 보고하고자 한다. Emphysematous pyelonephritis is rare, life-threatening infection of the renal parenchyma and perirenal tisseue. This disease is characterized by the production of intrarenal and perirenal gas and is frequently encountered in patients with diabetes mellitus or urinary obstruction. We experienced a case of emphysematouse pyelonephritis in a 62 years old women with poorly controlled diabetes mellitus who had been managed with medical theraphy. So we report this case with a review of the referenced literatures.

위의 유암종과 선종의 병발 1례

장재식,강혁주,이중현,서영범,윤병구,김용섭,이구,서정일,양창헌,이창우,김정란,윤환중 東國大學校醫學硏究所 2000 東國醫學 Vol.7 No.-

유암종은 전신에 퍼져 잇는 장크롬친화성 세포에서 기원하는데 위의 유암종은 비교적 드문 질환으로 모든 유암종의 1.9~2.2%에 해당하며 위에 발생하는 종양의 1% 미만에서 보고되고 있다. 유암종은 일반적으로 증상이 비특이적이고 면역조직화학검사에 의해서 진단되기 때문에 과거에는 드물게 발견되었으나 최근 내시경 기기 및 술기의 발전과 검사 빈도의 증가 및 면역조직화학검사의 발달로 진단율이 증가 추세에 있으며, 드물지만 유암종에서 선암과 공존하는 예들이 보고되고 있다. 저자들은 심와부 동통을 주소로 내원한 70세 남자 환자의 상부위장관내시경 검사에서 위체상부의 대만곡에서 0.4×0.4 cm 크기의 중간 함몰을 가진 Yamada 1형의 용종과 함께 전정부의 전벽에서 0.8×0.5 cm 크기의 융기된 점막 소견을 보여 조직학적으로 각각 위유암종 및 위선종임을 확진한 후 내시경적 용종 절제술로 치료한 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Carcinoid tumors are arisen from enterochromaffin cells, which are scattered throughout the body. These tumors are composed of variable numbers of cells that contain endocrine granules in their cytoplasm, which can be identified by immunohistochemistry and electron microscopy. Gastric carcinoid tumors are relatively rare tumor, the reported incidence being 1.9~2.2% of all carcinoid tumors and less than 1% of all gastric tumors. Sometimes, composite carcinoid tumors and adenocarcinoma is reported. We experienced a case of the coincidence of carcinoid tumor and adenoma at the other site of the stomach in a 70 year old male patient. Gastrofiberscope showed 0.4×0.4 cm sized Yamada type I polyp with central depression on the greater curvature of the proximal body and 0.8×0.5 cm sized focal slightly elevated mucosa on the anterior wall of the antrum. The endoscopic biopsy specimens revealed carcinoid tumor and tubular adenoma with moderate atypism, respectively. The carcinoid tumor and adenoma were removed by endoscopic polypectomy. According to the follow-up gastrofiberoscopy after 7 month later, both lesions were nearly normal mucosa except whitish atrophic change after polypectomy.

정상 면역 환자에서 발생한 거대세포바이러스 대장염 1예

이창우,김남일,이구,서정일,양창헌,구정태 대한소화기학회 2000 대한소화기학회지 Vol.35 No.5

Cytomegalovirus (CMV) infection is common in immunocompetent individuals, causing a mild flu- like illness. Up to 81% of normal healthy individuals aged over 35 have raised CMV antibody titers. However, CMV infection causing colitis is rare but usually fatal. On the contrary, CMV colitis is common in immunosuppressed individuals, especially in those who are Human immunodeficiency virus (HIV) seropositive. We experienced a case of colitis caused by CMV, which was not related with immunosuppression. It remains unclear why the patients developed CMV colitis. Here, we report a case of CMV colitis in an immunocompetent adult, which was confirmed by histopathologic findings through colonoscopic biopsy.

Empyema Comlicated by Pyogenic Liver Abscess

( Jeong Ill Suh ) 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1

Background: Empyema complicated by transdiaphragmatic extension of pyogenic liver abscess is a very rare complication of liver abscess. Effective drainage with proper antibiotic use is essential for treatment. Reported herein is a rare case of empyema complicated by pyogenic liver abscess. Case: A 58-year-old male was admitted due to fever with RUQ pain. He has been inactive HBV carrier state since 20 years ago. He was acute ill looking appearance. Initial vital signs were: BP 150/90 mmHg, HR 116 beats/min, RR 20 breaths/min, temperature 38.0oC. Laboratory studies revealed WBC 12,590/㎣, hemoglobin 13.5 g/dL, platelet 128,000/㎣, prothrombin time was 17.0 sec (INR of 1.55). CRP 25.6 mg/dl, AST/ALT 84/113 IU/L, total bilirubin 1.85 mg/dL, albumin 2.6 g/dL, r-GTP 53 U/L, ALP 102 U/L. Viral markers were HBsAg(+), anti-HBs(-), anti-HCV(-). Abdominal CT showed about 7x9cm sized septated cystic and low attenuation mass with mild rim enhancement in right heatic lobe posteror aspect. Percutanenous catheter drainage was performed and antibiotic treatment was started. On 6th day of hospitalization, he developed dyspnea. Follow up CT showed newly developed empyema of right lower lung. Chest tube drainage was performed. The cultured pus in liver abacess, empyema and blood samples were positive for K. pneumoniae. On the 20th day of hospitalization, liver function recovered completely to normal and follow up abdominal CT showed marked improved state of liver abscess and disappearance of empyema. Conclusions: It is very rare for pyogenic liver abscesses to expand into the diaphragm and cause empyema. Effective drainage with appropriate antibiotics is essential for successful treatment.

Drug-induced liver injury

( Jeong Ill Suh ) 영남대학교 의과대학 2020 Yeungnam University Journal of Medicine Vol.37 No.1

Drug-induced liver injury (DILI), including herbal and dietary supplement hepatotoxicity, is often passed lightly; however, it can lead to the requirement of a liver transplant or may even cause death because of liver failure. Recently, the American College of Gastroenterology, Chinese Society of Hepatology and European Association for the Study of the Liver guidelines for the diagnosis and treatment of DILI have been established, and they will be helpful for guiding clinical treatment decisions. Roussel Uclaf Causality Assessment Method scoring is the most commonly used method to diagnose DILI; however, it has some limitations, such as poor validity and reproducibility. Recently, studies on new biomarkers have been actively carried out, which will help diagnose DILI and predict the prognosis of DILI. It is expected that the development of new therapies such as autophagy inducers and various other technologies of the fourth industrial revolution will be applicable to DILI research.

Bee Sting Induced Hepatotoxicity

( Jeong Ill Suh ) 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1

Background: Bee sting is known to cause hepatotoxicity, renal damage, hemolysis and myocardial infarction. Hepatotoxicity can appear immediately or weeks after exposure of bee sting. Herein report is a case of hepatotoxicity in a 79-year-old woman after bee sting. Case: A 79-year-old woman accidentally touched the beehive and had multiple bee sting injury in various parts of her head, waist, and arms and then came to emergency room because of general weakness and urticaria. She denied drinking, smoking and taking any drugs or herbs. On emergency room, BP was 70/40 mmHg, HR 98 beats/min, RR 20 breaths/min, and BT 36.8℃. Under the suspicion of anaphylactic shock, epinephrine was administered immediately and blood pressure returned to normal. She was diagnosed with fatty liver 2 years ago. Her height was 156 cm, weight 52 kg, BMI 21.37. Laboratory findings revealed WBC 8,640/㎣, Hb 14.9 g/dL, PLT 240,000/㎣, PT 14.0 sec, PT (INR) 1.28, AST 645 IU/L, ALT 526 IU/L, total bilirubin 0.84 mg/dL, albumin 3.5 g/dL, sodium 141 mEq/L, potassium 3.1 mEq/L, chloride 103 mEq/L, BUN 14 mg/dL, creatinine 1.2 mg/dL, CK/LDH 172/988 U/L, amylase 40 U/L, Lipase 179 U/L. Viral markers (HBsAg, IgM HBV, IgM HAV, Anti HCV, HSV, EBV and CMV) were all negative. Abdominal ultrasonography showed moderate fatty liver and gallbladder distension with wall edema. Abdomen CT showed no defined focal mass lesion in the abdominal solid organs. Liver biopsy revealed fatty change (50~75%) with mild neutrophilic infiltration. On 12^th admission day after conservative treatment, her liver function was improved and she was discharged. Conclusions: The spectrum of bee sting induced totoxicity varies. Most of hepatotoxicity show a temporary increase in liver enzymes. The mechanism of hepatotoxicity is presumed to be a reversible pre-thrombotic condition and temporary autoimmune phenomena caused by bee sting, but additional evidence is needed.

IgG4-Related Autoimmune Pancreatitis Presented in Pre-Existing Retroperitoneal Fibrosis

( Jeong Ill Suh ) 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1

Background: Autoimmune pancreatitis is a rare systemic autoimmune disease that is difficult to diagnose. The features are diffuse enlarged and fibrous pancreas with lymphocyte infiltration, occasionally accompanied by retroperitoneal fibrosis. Reported herein is a case of IgG4-related autoimmune pancreatitis developed in pre-existing idiopathic retroperitoneal fibrosis. Case: A 76-year-old man was hospitalized due to epigastric pain with jaundice. On admission, BP was 150/90 mmHg, HR 60 beats/min, RR 20 breaths/min, and BT 36.5℃. He was diagnosed with retroperitoneal fibrosis and bilateral hydronephrosis 3 years ago. He did not take any health food or herbal medicine. Laboratory findings revealed WBC 6,980/mm3, Hb 11.3 g/ dL, PLT 252,000/mm3, PT 10.7 sec, PT (INR) 0.98, AST 299 IU/L, ALT 316 IU/L, total bilirubin 5.34 mg/dL, r-GTP 714 U/L, albumin 3.3 g/dL, BUN 19 mg/dL, creatinine 1.4 mg/dL. HBsAg(-), anti-HCV(-). AFP 2.4 ng/ml, CA 19-9 5.47 U/mL. Abdomen CT showed mild progression of retroperitoneal soft tissue infiltration, bilateral hydronephrosis and diffuse swelling of pancreas. Abdominal MRI revealed diffuse swelling of pancreas with subtle hypointense rim. On the 13th day of hospitalization, jaundice worsened (total bilirubin 13.4 mg/dL). An autoimmune pancreatitis was suspected and an IgG4 test was performed. The level of IgG4 increased to 15,900. Abdominal pain and jaundice improved after starting steroid treatment. Pancreatic size was significantly reduced on follow-up CT 5 months after administration of steroid and the IgG4 level was also reduced to 2,300. The patient is undergoing follow-up from an outpatient basis. Conclusions: IgG4-related autoimmune pancreatitis is difficult to diagnose, but it is important to suspect and actively detect when accompanied by abdominal pain and jaundice of unknown cause. IgG4-related autoimmune pancreatitis can be metachronously associated with retroperitoneal fibrosis.