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침술 및 근육 내 자극치료 (Intramuscular Stimulation)에 의한 콩팥주위 혈종
김설영 ( Seul Young Kim ),장원익 ( Won Ik Jang ),정사라 ( Sa Rah Chung ),최대은 ( Dae Eun Choi ),나기량 ( Ki Ryang Na ),이강욱 ( Kang Wook Lee ),신영태 ( Young Tai Shin ) 대한신장학회 2009 Kidney Research and Clinical Practice Vol.28 No.2
Acupuncture therapy has been widely performed by staffs of oriental medicine in Korea, and intramuscular stimulation (IMS) therapy has been introduced recently and used for controlling myofascial pain in the field of orthopedics, rehabilitation, and pain clinics. To penetrate human tissues, relatively long needles are used in both procedures and these these may have some risks to puncture blood vessels. However, there were few reports about sequelae or complications after such procedures in Korean literatures. Recently, we experienced two cases of perirenal hematoma in patients without blood coagulation abnormalities (one case induced by acupuncture in oriental medicine clinic, and the other case induced by IMS in orthopedic clinic and was also accompanied by perirenal abscess).
김규섭 ( Kyu Seop Kim ),문희석 ( Hee Seok Moon ),고광훈 ( Kwang Hun Ko ),정일순 ( Ii Soon Jung ),김설영 ( Seul Young Kim ),성재규 ( Jae Kyu Seong ),정현용 ( Hyun Yong Jeong ) 대한내과학회 2012 대한내과학회지 Vol.83 No.2
미분화 췌장암은 매우 드문 질환이나, 치료 방법이 제한적이고 그 진행 속도가 빠르다. 또한 진단 당시 십이지장, 위, 결장 간막 등 주위 조직을 침범하는 경우가 많고 간, 폐, 림프절 등으로 원격 전이가 많다. 그 중 위나 십이지장의 침범의 경우 종양 자체의 불량한 예후뿐만 아니라 종양의 급속한 성장에 의한 출혈과 천공의 위험성이 높기 때문에 조기에 정확한 진단이 중요하다. 하지만 임상 증상 및 방사선적, 내시경적 소견 등이 모호하고 비특이적이어서 그 진단이 어렵다. 그러나 앞서 기술한 몇 가지 소견, 즉, 상복부 동통, 황달, 만져지는 복부 종괴, 복부 전산화 단층 촬영상 췌장의 체부나 미부에서 주변 조직들을 침범하는 거대한 중심괴사성종괴, 특히 종양 주변부의 조영 증강 소견, 내시경상 점막하 종양의 형태나 외부에서의 압박 소견 등이 있을 때 이를 종합적으로 판단하여 미분화 췌장암을 의심해보는 것이 필요하리라 생각된다. 본 증례에서는 내시경적, 방사선적으로 위장관 기질종양으로 판단하였으나, 수술 후 조직 검사에서 최종적으로 미분화 췌장암으로 진단된 환자를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Anaplastic carcinoma of the pancreas is an extremely rare but aggressive, rapidly progressive tumor. It often presents with invasion of adjacent organs and distant metastases. Most cases are inoperable and confirmed by autopsy. A correct diagnosis of stomach invasion by anaplastic carcinoma of the pancreas is important due to the risk of bleeding, perforation by rapid tumor growth, and a poor prognosis. However, an accurate diagnosis is difficult as a result of the various clinical presentations, symptoms, and radiological findings. We herein report a case of anaplastic carcinoma of the pancreas in a 78-year-old woman who presented with stomach invasion mimicking a gastrointestinal stromal tumor.
복부동맥류 치료를 위하여 삽입한 혈관 내 스텐트로 인하여 유발된 대동맥 장관루의 혈관조영색전술 치료
고광훈 ( Kwang Hun Ko ),김설영 ( Seul Young Kim ),정일순 ( Il Soon Jung ),김규섭 ( Kyu Seop Kim ),문희석 ( Hee Seok Moon ),성재규 ( Jae Kyu Seong ),정현용 ( Hyun Yong Jeong ) 대한소화기학회 2013 대한소화기학회지 Vol.61 No.4
Aortoenteric fistula (AEF) developed after treatment for an abdominal aortic aneurysm (AAA) is a rare but usually fatal complication. We report a rare case of AEF bleeding after endovascular stent grafting for AAA which was managed angiographically. An 81-year-old man presented with hematochezia and acute abdominal pain for 1 day ago. Four years ago, an aortic stent was implanted in the infrarenal aorta for AAA. Endoscopies were performed to evaluate the hematochezia. Evidence of gastrointestinal bleeding was observed, but a clear bleeding point was not detected on upper endoscopy and colonoscopy. Contrast-enhanced computed tomography performed subsequently showed that the bleeding point was located in the fourth portion of the duodenum as an AEF caused by an inflammatory process in the stent-graft. Intra-arterial angiography showed a massive contrast leakage into the bowel via a small fistula from around the aortic stent graft site. Embolization was successfully performed by injecting a mixture of glue and lipiodol into the AEF tract. The patient was discharged with no evidence of gastrointestinal bleeding after the embolization. (Korean J Gastroenterol 2013;61:230-233)
증례 : 비기능성 뇌하수체 종양에 연관된 항이뇨호르몬 분비이상 증후군 1예
이준철 ( Jun Chul Lee ),권기현 ( Ki Hyun Kwon ),이인석 ( Ihn Suk Lee ),김윤정 ( Yun Jeung Kim ),정사라 ( Sa Rah Jeong ),김설영 ( Seul Young Kim ),구본정 ( Bon Jeong Ku ) 대한내과학회 2007 대한내과학회지 Vol.72 No.3
저자들은 저나트륨혈증을 주소로 내원하여 시행한 검사상 항이뇨호르몬 분비이상 증후군으로 진단을 받은 환자에서 일반화학 및 방사선학적 검사를 통해 비기능성 뇌하수체 종양을 진단한 예를 경험하였다. 항이뇨호르몬의 과도한 분비를 유발하는 기전은 아직 분명하지 않으나 본 증례에서와 같이 비기능성 종양에 의한 물리적 압박이 하나의 원인으로 작용할 수 있다고 생각되어 보고하는 바이다. We present a case of severe hyponatremia in a 64-year-old man who had a pituitary tumor. He had nausea and recurrent vomiting with a severe headache, and was admitted to Chungnam National University Hospital for further evaluation. On physical examination, he was alert, and had bitemporal hemianopsia. There was no indication of dehydration or edema. Laboratory data showed a serum sodium level of 126 mEq/L, plasma osmolality of 259 mOsm/kg, and urinary osmolality of 544 mOsm/kg. The plasma argipressin level was 2.88 pg/mL, despite marked hyposmolality. Otherwise, pituitary function was normal. Brain magnetic resonance imaging showed a pituitary macroadenoma measuring 25×16×13 mm and no visible normal pituitary stalk or gland in the sella turcica. After the adenomectomy, the serum sodium level maintained normal without treatment. Histology showed the presence of a pituitary adenoma. These findings indicate that a non-functioning pituitary tumor may cause the exaggerated secretion of argipressin, resulting in inappropriate antidiuretic hormone syndrome. (Korean J Med 72:315-321, 2007)