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- 저자 : 박병석 ( Byong Seok Park ) (검색결과 2 건)
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지속성 외래 복막투석 환자에서 발생한 당뇨병성 근육 경색증
정택균 ( Taek Kyun Jeong ),이연경 ( Youn Kyoung Lee ),정균호 ( Gyun Ho Jeong ),박병석 ( Byong Seok Park ),마성권 ( Seong Kwon Ma ),김수완 ( Soo Wan Kim ),김남호 ( Nam Ho Kim ),최기철 ( Ki Chul Choi ) 대한신장학회 2003 Kidney Research and Clinical Practice Vol.22 No.1
Diabetic muscle infarction (DMI) is a rare condition occurring in subjects with long-standing complicated diabetes mellitus. We report DMI in a 65-vear-old man with type 2 diabetes mellitus undergoing continous ambulatory peritoneal dialysis (CAPD) with review of this condition in the literature. He had been suffered from type 2 diabetes mellitus for 21 years. In 1997, he reached end-stage renal disease and had received on renal replacement therapy with CAPD since then. In June 2002, he presented with sudden and spontaneous onset of severe pain in the right thigh region. He was afebrile, and the right thigh was swollen and tender but not erythematous. Laboratory data on admission included white blood cell count of 15,800/㎣, hemoglobin 9.0g/dL, platelet count 264,000/㎣, BUN 102.3mg/dL, serum creatinine 9.9 mg/dL, fasting blood glucose 85 mg/dL, postprandial 2 hours blood glucose 162 mg/dL, hemoglobin AIC 5.84%, ESR 125 mm/h (it was 52 mm/h one month earilier), CRP 18.9 mg/dL, and normal levels of creatinine kinase. Magnetic resonance imaging (MRI) showed asymmetry of the muscle in T1-weighted images and increased signal intensity involving the medial portion of right thigh (adductor longus, adductor magnus, vastus intermedius muscle, etc) in T2-weighted images with no contrast enhancement. Radioistope venography of the ileo-femoral veins was was normal, excluding deep venous thrombosis as a cause. The right thigh was explored surgically and a biopsy taken from the vastus intermedius muscle was consistent with chronically inflammed scar tissue with no evidence of malignancy. A biopsy taken from the vastus intermedius muscle showed hemorrhagic necrosis of skeletal muscle, with lymphcytic infiltration. Most of the blood vessels appeared normal. The swelling resolved spontaneously following a few weeks of bedrest and analgesia. To our knowledge, this is the first reported case of DMI in patients undergoing renal replacement therapy in Korea.
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당뇨병성 신증 환자에서 저분자량 헤파린 Dalteparin Sodium 사용 중 발생한 후복막강 혈종 1예
정택균,정균호,박병석,마성권,김수완,김남호,최기철 대한내과학회 2003 대한내과학회지 Vol.64 No.3
신대체 요법의 유무에 관계없이 신기능 장애가 있는 환자에서 항응고 치료로 저분자량 헤파린 (dateparin, enoxaparin 등)을 사용할 경우에는 제제에 관계없이 심한 출혈의 위험성이 높아질 수 있기 때문에 세심한 주의를 요한다. 6~8일 이상 투여하는 것은 삼가고 심각한 출혈을 일으킬 수 있음을 항상 주지하여야 하며 , 특히 항응고 치료 과정 중에 치료 전 없었던 옆구리, 서혜부, 하요부 및 하지의 통증 , 빈혈, 저혈압 등이발생하였을 때 후복막강 혈종의 가능성을 항상 고려하여야 할 것이다. Retroperitoneal Hematoma is a rare intraabdominal bleeding occurring in patients with low-molecular weight heparin anti-coagulant therapy. we report a case of dalteparin sodium-associated retroperitoneal hematoma in a 70-year-old man with diabetic nephropathy with review of this condition in the literature. He had been suffered from type 2 diabetes mellitus and hypertension for 15 years. In July 2002, he was admitted to our hospital because of unstable angina and left pleural effusion. He was treated with dalteparin sodium and aspirin for unstable angina. On the second hospital day, he was referred to division of nephrology for diabetic nephropathy. Laboratory data on admission included white blood cell count of 4,500/㎣, hemoglobin 9.6 g/dL, platelet count 294,000/㎣, BUN 58.1 mg/dL, serum creatinine 4.1 mg/dL, blood glucose 178 mg/dL, hemoglobin A1c5.9T, PT 13.9 sec (INR: 1.09), and aPTT 50 sec, On days 6 through 8, he had lower back pain, lower extremity pain and neuropathy, anemia and hypotension. Abdominal ultrasound showed 6×6 cm-sized well marginated mixed echogenic lesion in psoas muscle and fluid collection in retroperitoneal cavity. Magnetic resonance imaging (MRI) showed increased signal intensity and thickening of the right psoas muscle including 4.7×2.3×21 cm-sized cytic lesion and 6.2×5.3×3.7 cm-sized cystic lesion on the lateral portion of right psoas muscle in T2-weighted images. Percutaneous drainage of cystic lesion was performed by right lateral approach. Hemodialysis was begun without heparinization. Abdominal CT showed 5.5×5 cm-sized high attenuated lesion in right psoas muscle and 5×3 cm, 3×2 cm, 4.5×2.5 cm, 4×2.5 cm-sized heterogeneous, slightly high attenuated lesions in the right lower abdomen and cul-de-sac in the scans with no enhancement. He was treated by conservative therapy. He recovered gradually. Patients with kidney diseases receiving low molecular weight heparin (dalteparin, enoxaparin, etc) should be closely monitored to prevent serious bleeding complications. The possibility of retroperitoneal hematoma should be considered, whenever symptoms including lower back pain, inguinal pain, leg pain, anemia, or hypotension occurred during the lower molecular weight heparin anticoagulant therapy. To our knowledge, this is the first reported case of retroperitoneal hematoma in a patient during dalteparin sodium (Fragmin^??) anticoagulant therapy. (Korean J Med 64:322-327, 2003)
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