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Levofloxacin과 Torsades de Pointes
권세아 ( Se Ah Kwon ),김철홍 ( Cheol Hong Kim ),송원준 ( Won Jun Song ),구자경 ( Ja Kyung Koo ),이순재 ( Soon Jae Lee ),박지영 ( Ji Young Park ),현인규 ( In Gyu Hyun ),고장휴 ( Jang Hyu Ko ),김현수 ( Hyun Soo Kim ) 대한결핵 및 호흡기학회 2010 Tuberculosis and Respiratory Diseases Vol.69 No.6
Torsades de pointes associated with a prolonged QT interval is a life-threatening arrhythmia, which may be induced by any of the following: drugs, electrolyte imbalances, severe bradycardia and intracranial hemorrhage. Torsades de pointes is characterized by beat-to-beat variations in the QRS complexes in any ECG leads with rates of 200~250 per minute. Fluoroquinolones are widely used and well tolerated antibacterial agents. However, prolongation of the QT interval leads rarely to Torsades de pointes as a significant adverse effect. So, it should be used with caution in high-risk patients for developing Torsades de pointes. We report one case of 67-year old man with contact burns who experienced Torsades de pointes, which probably resulted from the use of levofloxacin, and no further episode occurred after its withdrawal.
담관 스텐트 삽입으로 치료한 췌장암에 의한 담즙종 1예
박지영,이진,이순재,권세아,고동희,최민호,장현주,계세협 대한소화기내시경학회 2011 Clinical Endoscopy Vol.42 No.3
Biloma is a rare disorder, and is defined as an abnormal extrahepatic or intrahepatic collection of bile within a defined capsular space. The common causes of biloma are iatrogenic and trauma. Spontaneous biloma, especially caused by pancreatic cancer, is very rare. An 86-year-old man was admitted with abdominal pain and fever. The patient denied a history of abdominal surgery, endoscopic retrograde cholangiography, or trauma. Abdominal computed tomography demonstrated a huge collection of fluid in the left lobe of the liver, dilatation of the intra and proximal common bile duct, and a heterogeneous enhancing mass in the pancreatic head portion. Percutaneous drainage under ultrasound guidance was performed, and the fluid analysis was compatible with biloma. A plastic stent was endoscopically inserted into the common bile duct to treat continuous drainage of the fluid despite percutaneous drainage. We report a case of biloma developed spontaneously in a patient with pancreatic cancer and successfully treated by endoscopic biliary stenting. 담즙종은 담즙이 담도 외로 누출되어 간내 또는 간외에 축척된 것으로 주로 수술이나 경피적 담관 조영술 등에 의한 의인성 담도 손상이나 외상에 의한 경우가 많지만 자발적으로 발생하는 경우는 매우 드물며, 특히 췌암암이 원인인 경우는 더욱 그러하다. 이전에 복부 수술이나 시술 또는 외상의 병력이 없었던 86세 남자 환자가 복통과 열감을 주소로 내원하였다. 복부CT에서 담즙종과 췌장 두부의 종괴가 발견되었고 경피 배액술을 시행하였다. 이후에도 다량의 담즙성 배액이 지속되어 ERCP를 하여 총담관에 스텐트를 삽입한 후 환자는 안정되었다. 저자들은 췌장암 환자에서 자발적으로 발생한 담즙종을 경피배액술과 내시경적 담관 스텐트 삽입을 통해 치료한 증례를 경험하여 문헌고찰과 함께 보고한다.
구자경,김철홍,박지영,현인규,유제현,임아름,권세아,이순재 대한중환자의학회 2009 Acute and Critical Care Vol.24 No.2
Malignant hyperthermia is a rare, fatal pharmacogenetic disorder that occurs during general anesthesia following exposure to a depolarizing muscle relaxant, such as succinylcholine, or volatile anesthetics. Clinical findings in malignant hyperthermia include muscle rigidity, sinus tachycardia, increased CO2 production, skin cyanosis with mottling, and marked hyperthermia. For treatment, cooling techniques must be accompanied by discontinuation of the provocative medication. Furthermore, dantrolene administration is the mainstay of treatment for malignant hyperthermia, and should be initiated as soon as the diagnosis is suspected. We recently experienced a case with post-operative fever of 41.0℃ refractory to conventional anti-pyretic measures and finally resolved with dantrolene administration, in a patient with methicillin-sensitive Staphylococcus aureus monoarthritis of the knee and rapid progression of diffuse septic pneumonia requiring mechanical ventilation.
이순재 ( Soon Jae Lee ),박지영 ( Ji Young Park ),권세아 ( Se Ah Kwon ),고동희 ( Dong Hee Koh ),최민호 ( Min Ho Choi ),장현주 ( Hyun Ju Jang ),계세협 ( Sea Hyub Kae ),이진 ( Jin Lee ) 대한소화기학회 2011 대한소화기학회지 Vol.57 No.4
Pneumatosis cystoides intestinalis (PCI), characterized by presence of intramural gas cyst in the intestinal wall is associated with various medical condition. Polymyosistis, however, is rarely associated with PCI. Few cases are reported in the world, and none has not been reported previously in Korea. A 67-year-old woman with polymyositis developed mild abdominal pain and abdominal distension during treatment with steroid and azathioprine. Radiographic findings including CT scan showed intraperitoneal free gas and intramural air, compatible with PCI. The patient`s symptom and clinical findings improved after the treatment with antibiotics and high-dose oxygen therapy. (Korean J Gastroenterol 2011;57:249-252)