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윤수아 ( Su A Yun ),구현철 ( Hyun Cheol Koo ),장지웅 ( Ji Woong Jang ),김안나 ( An Na Kim ),김용식 ( Yong Sik Kim ),정성희 ( Sung Hee Jung ),김새희 ( Sae Hee Kim ),성우경 ( Woo Kyung Sung ) 대한췌장담도학회 2014 대한췌담도학회지 Vol.19 No.2
Renal cell carcinoma (RCC) is the second most common urological malignancy and it has diverse range of clinical manifestation. One third of the patients show the metastasis at the time of the diagnosis. The common sites of metastasis are the lung, bone, lymph nodes and metastasis to the pancreas is rare. In case of pancreatic metastasis, more than half of the patients are asymptomatic. Patients with symptoms visit hospital complaining of abdominal pain, weight loss, steatorrhea and rarely biliary obstruction. Although about 40% of all patients visit hospital with hemorrhage, cholangitis caused by spontaneous pancreatic hemorrhage is rare. We report an interesting case of 61-year-old woman with cholangitis caused by bleeding due to pancreatic metastasis from renal cell carcinoma.
증례 : 바소프레신 의존성 거대결절성 부신피질 증식증 1예
한재필 ( Jae Pil Han ),구현철 ( Hyun Cheol Koo ),김익근 ( Ick Keun Kim ),박인일 ( In Il Park ),최현희 ( Hyun Hee Choi ),이성진 ( Seong Jin Lee ),최문기 ( Moon Gi Choi ) 대한내과학회 2005 대한내과학회지 Vol.69 No.-
저자들은 전신쇠약감과 체중 증가를 호소하여 시행 받은 신체검사, 호르몬검사, 호르몬 자극검사 및 방사선검사에서 바소프레신 의존성 거대결절성 부신피질 증식증으로 진단되어 케토코나졸 투여 후 호전된 증례를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Macronodular adrernal hyperplasia (MAH) is an extremely rare cause of ACTH-independent Cushing syndrome, in which cortisol secretion is autonomous and plasma ACTH level is persistently suppressed. The pathogenesis of MAH is not clear but recent studies suggest that cortisol secretion may be mediated by expression of ectopic or aberrant receptors for gastric inhibitory polypeptide, vasopressin, β-adrenergic agonist or serotonin. The conventional treatment is bilateral adrenalec-tomy followed by concomittent glucocorticoid and mineralocorticoid replacement therapy. We report a fifty-seven year-old man presenting with generalized weakness, weight gain and hematochezia. The endocrinological and radiological findings revealed ACTH-independent MAH, in which plasma cortisol level was abruptly elevated by administration of vasopressin 10 IU. Because he had severe dilated cardiomyopathy, we only prescribed high dose ketoconazole (1,200 mg/day) which suppresses biosynthesis and secretion of cortisol, and thereafter twenty-four hours urinary free cortisol level was dramatically decreased. In summary, these results strongly suggest that aberrant expression of vasopressin receptor may be associated with the pathophysiology of MAH. (Korean J Med 69:S867-S872, 2005)
Acinetobacter 병원내 폐렴에서 다제 내성군과 약제 감수성군 간의 임상적 특징과 예후
박인일 ( In Il Park ),김익근 ( Ick Keun Kim ),구현철 ( Hyun Cheol Koo ),한재필 ( Jae Pil Han ),김영묵 ( Young Mook Kim ),이명구 ( Myung Goo Lee ),정기석 ( Ki Suck Jung ) 대한결핵 및 호흡기학회 2006 Tuberculosis and Respiratory Diseases Vol.61 No.1
연구 배경: A. baumannii는 전 세계적으로 중요한 병원 내 병원균으로 부각되고 있고 이들 균에 의한 감염 또한 빠르게 증가하고 있다. 이들 감염에 연관된 사망률(균혈증:52%, 폐렴:23-73%)은 매우 높고 다제 내성은 비교적 흔하게 발생하고 있는 실정이다. 그러므로 다제 내성 A. baumannii 감염에 대한 효과적인 치료를 위해서 이들의 임상 특징과 결과를 분석하고 이해하는 것이 필요하다. 이에 본 연구는 A. baumannii 병원내 폐렴 중 다제 내성군과 약제 감수성군간의 임상적 특징, 사망률, 이환율을 비교하였다. 방법: 2002년 1월 1일부터 2004년 11월 1일까지 춘천성심병원에 입원했던 환자 중 Acinetobacter 병원 내 폐렴으로 판단되는 47명의 환자를 연구 대상으로 하였고 이들의 의무기록을 후향적으로 분석하였다. 본 연구에서는 다제 내성 A. baumannii를 실험 환경에서 A. baumannii에 효과적이며 상업적으로 이용할 수 있는 모든 항생제에 내성을 보이는 것으로 정의하였다. 결과: 47명의 A. baumannii 병원내 폐렴 환자 중 17명이 다제 내성군, 30명이 약제 감수성군으로 분류되었다. 이들의 평균 연령은 다제 내성군은 69±11세, 약제 감수성군 70±13세이었고 APACHE II 점수, 중환자실 입원기간, 사망률에 있어서 두 군간에 유의한 차이는 없었다(16.1±5.4 vs 14.9±4.8, P=0.43, 25.1±13.6 vs 39.1±31.0, P=0.2, 58.8% vs 40%, P=0.21). 결론: Acinetobacter baumannii 다제 내성군과 약제 감수성군 간의 사망률과 임상적 특징 사이에서 유의한 차이는 보이지 않았다. 그러나 양군 모두 사망률과 이환율은 높게 나타나 A. baumannii 감염의 효과적인 감시 및 조절이 지속적으로 필요하겠다. Background: Acinetobacter baumannii has emerged as an important nosocomial pathogen worldwide. The incidence of these infections has recently begun to increase. The mortality rate associated with these infections is high (bacteremia; 52%, pneumonia: 23%~73%) and multidrug resistance has been reported. For the effective control of multidrug-resistant Acinetobacter baumannii(MDR-AB), the impact of these organisms in clinical practice should be determined. This study compared the clinical characteristics, mortality and morbidity of Acinetobacter nosocomial pneumonia between MDR strain and non-MDR strain. Methods: From Jan. 1, 2002 to Nov. 1. 2004, 47 adult patients with Acinetobacter nosocomial pneumonia in Chuncheon Sacred Heart Hospital were recruited and analyzed retrospectively. MDR-AB was defined as showing in vitro resistance to all commercially available antibiotics against A. baumannii. Results: There were 47 patients with Acinetobacter nosocomial pneumonia. MDR-AB and non MDR-AB was the cause of the pneumonia in 17 and 30 patients, respectively. Mean age of the former was 69±11 years old and the latter was 70±13 years old. The mean APCHE II score, ICU days and mortality were not different between the two groups(16.1±5.4 vs. 14.9±4.8, P=0.43, 25.1±13.6 vs. 39.1±31.0, P=0.2, 58.8% vs. 40%, P=0.21). Conclusion: There are no significant differences in mortality and morbidity between MDR and non-MDR Acinetobacter baumannii. The mortality of the two groups is surprisingly high, therefore proper infection control practices are essential. (Tuberc Respir Dis 2006; 61: 13-19)
정상 비장과 다른 조영 양상을 보여 췌장 종괴로 오인된 췌장 내부비장
박준석 ( Jun Seok Park ),김완중 ( Wan Jung Kim ),정영규 ( Yeong Gyu Jeong ),박윤선 ( Youn Sun Park ),구현철 ( Hyun Cheol Koo ),이태일 ( Tae Il Lee ),최교창 ( Gyo Chang Choi ),김숙 ( Sook Kim ) 대한소화기학회 2011 대한소화기학회지 Vol.58 No.6
Most cases of accessory spleen show similar features as normal spleen in imaging studies. However, some accessory spleen has unusual scan feature which can be misdiagnosed. We present a case of intrapancreatic accessory spleen that was discovered incidentally during a workup for abdominal pain in a 47-year-old woman. CT and MRI revealed a different enhancing pattern from that of the spleen. Further evaluation with endoscopic ultrasonography failed to identify the pancreatic mass. Therefore, it was surgically removed and diagnosed pathologically as an accessory spleen. (Korean J Gastroenterol 2011;58:357-360)