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경피적 내시경적 괴사 제거술에서 완전 피복 식도 금속 스텐트의 유용성
이나겸 ( Nah Kyum Lee ),박도현 ( Do Hyun Park ),박신희 ( Shin Hee Park ),박수연 ( Su Yeon Park ),정수민 ( Soo Min Jeung ),오진선 ( Jin Sun Oh ),서보미 ( Bo Mi Seo ) 대한췌담도학회 2015 대한췌담도학회지 Vol.20 No.2
괴사성 췌장염은 사망률이 높고 괴사된 췌장 부위에 감염이 동반되어 있을 경우에 패혈증과 다발성 장기 부전이 발생하여 사망률이 더욱 증가하는 중대한 질환으로 과거에는 수술적 괴사 제거술이 많이 시행되었지만 최근에는 경피적 배액술 또는 내시경적 괴사 제거술과 같은 최소 침습 시술이 치료에 널리 이용되고 있다. 저자들은 경피적 배액술과 내시경적 배액술을 시행하였으나 치료 반응이 없고 임상적으로 악화 경과를 보이는 환자에서 직경이 넓은 식도 금속 스텐트를 사용하여 경피적 내시경적 괴사 제거술을 시행하여 대장주변(paracolic gutter)에 있는 막으로 둘러싸인 괴사를 성공적으로 치료한 사례들을 경험하였고 식도 금속 스텐트를 사용하여 경피적 내시경적 괴사 제거술이 시행된 증례는 국내에서 이전에 보고된 바가 없기에 이를 문헌 고찰과 함께 보고하는 바이다. Necrotizing pancreatitis is associated with high rates of morbidity and mortality. Managing necrotizing pancreatitis is challenging, and minimally invasive treatment modalities recently replaced traditional open necrosectomy. Percutaneous catheter drainage and endoscopic necrosectomy are now widely used because they are less invasive, safer, and can more effectively remove necrotic materials. Various methods and novel techniques have been introduced to manage walled-off necrosis. Herein, we report a case series of patients with necrotizing pancreatitis who were successfully treated using fully covered esophageal metal stent and endoscopic necrosectomy via the percutaneous approach. Percutaneous endoscopic necrosectomy using a fully covered esophageal stent is an effective endoscopic treatment for patients with walled-off necrosis that extends along both sides of the paracolic gutter, reduces the number of necrosectomy sessions, and improves disease status faster than conventional treatment. Korean J Pancreatobiliary 2015;20(2):88-93
Rapidly resolved IgG4-related retroperitoneal fibrosis after steroid pulse therapy
Jeung, Soomin,Kim, Hyosang,Seo, Yuri,Yoon, Hee-Young,Lee, Nah Kyum,Park, Shinhee,Seo, Bomi,Park, Su-Yeon,Park, Su-Kil Yeungnam University College of Medicine 2016 Yeungnam University Journal of Medicine Vol.33 No.1
Retroperitoneal fibrosis (RF) is a disorder characterized by the presence of a retroperitoneal mass and concurrent systemic inflammation. Some cases of RF are recognized as belonging to the spectrum of immunoglobulin G4-related disease (IgG4-RD). Glucocorticoids are highly effective for treatment of retroperitoneal fibrosis, although the optimal dose and duration of therapy have not been established. An initial dose of prednisone (40-60 mg) daily is usually administered with a tapering scheme. We report on a 55-year-old man diagnosed with IgG4-related RF and successfully treated with a 3-day course of daily 250 mg (4 mg/kg) intravenous methylprednisolone, which resulted in the prompt resolution of urinary obstruction and systemic symptoms.
전신홍반루푸스에 동반된 불응성 혈구포식 림프조직구증식증에서 Tocilizumab 치료 1예
유빈 ( Bin Yoo ),오진선 ( Jin Sun Oh ),박진오 ( Jinoh Park ),이나겸 ( Nah Kyum Lee ),배승현 ( Seung Hyeon Bae ),김용길 ( Yong Gil Kim ),이창근 ( Chang Keun Lee ) 대한내과학회 2015 대한내과학회지 Vol.89 No.3
Macrophage activation syndrome (MAS) is a secondary hemophagocytic lymphohistiocytosis caused by autoimmune diseases, such as systemic lupus erythematosus (SLE). It is characterized by fever, cytopenia, coagulopathy, hepatosplenomegaly, elevated liver enzyme, and high ferritin, typically combined with hemophagocytic histiocyte proliferation in the bone marrow. Here, we report a case of MAS in a patient with SLE treated successfully by tocilizumab. She was transferred to our hospital due to persistent fever of unknown origin. Initial blood tests revealed cytopenia, elevated liver enzyme, and high ferritin. Bone marrow histology revealed the presence of hemophagocytic histiocytes. The patient was initially treated with high dose corticosteroids; however, fever and cytopenia were not controlled. Additional treatments with cyclosporine, intravenous immunoglobulin, and rituximab were applied consecutively, but the fever and cytopenia persisted. Symptom resolution was finally achieved following treatment with tocilizumab, resulting in rapid improved of fever, and resolution of pancytopenia within 2 months. (Korean J Med 2015;89:372-376)
Rapidly resolved IgG4-related retroperitoneal fibrosis after steroid pulse therapy
( Soomin Jeung ),( Hyosang Kim ),( Yuri Seo ),( Hee-young Yoon ),( Nah Kyum Lee ),( Shinhee Park ),( Bomi Seo ),( Su-yeon Park ),( Su-kil Park ) 영남대학교 의과대학 2016 Yeungnam University Journal of Medicine Vol.33 No.1
Retroperitoneal fibrosis (RF) is a disorder characterized by the presence of a retroperitoneal mass and concurrent systemic inflammation. Some cases of RF are recognized as belonging to the spectrum of immunoglobulin G4-related disease (IgG4-RD). Glucocorticoids are highly effective for treatment of retroperitoneal fibrosis, although the optimal dose and duration of therapy have not been established. An initial dose of prednisone (40-60 mg) daily is usually administered with a tapering scheme. We report on a 55-year-old man diagnosed with IgG4-related RF and successfully treated with a 3-day course of daily 250 mg (4 mg/kg) intravenous methylprednisolone, which resulted in the prompt resolution of urinary obstruction and systemic symptoms.
Multiple System Atrophy Manifested by Bilateral Vocal Cord Palsy as an Initial Sign
Yuri Seo,Soomin Jeung,Heeyoung Yoon,Min-chul Kim,Nah Kyum Lee,Byeong Zu Ghang,Sun Ju Chung,고윤석 대한중환자의학회 2015 Acute and Critical Care Vol.30 No.2
A 71-year-old male initially presented with vocal cord palsy and underwent tracheostomy. After thorough examination, urogenital dysfunction, orthostatic hypotension, and Parkinsonism were found, which led to the diagnosis of multiple system atrophy (MSA). After the tracheostomy, bi-level positive airway pressure ventilation was required during the night due to nocturnal hypoxemia. Nighttime hypoxemia is related to central sleep apnea, which is one of the manifestations of MSA. This is the first case of MSA manifested by bilateral vocal cord palsy as an initial sign in Korea. This case supports the notion that MSA should be taken into consideration when vocal cord paralysis is observed.