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심한 임신과다구토에 의해 Wernicke 뇌증과 각기병이 동반되었던 급성 신부전
석현정 ( Hyun Jung Seok ),최정 ( Choi Jung ),김정욱 ( Jung Wook Kim ),김순배 ( Soon Bae Kim ),박수길 ( Su Kil Park ),박정식 ( Jung Sik Park ),이상구 ( Sang Koo Lee ) 대한신장학회 2007 Kidney Research and Clinical Practice Vol.26 No.2
Severe hyperemesis gravidarum (HG) is a rare but potentially devastating complication of pregnancy. It can cause dehydration, electrolyte imbalance, malnutrition (especially, thiamine deficiency), and compromised renal function. We report a case of acute renal failure (ARF) with Wernicke`s encephalopathy and beriberi due to severe HG. A 35-year-old woman at 16 weeks of gestation presented with confused mentality, quadriparesis, nystagmus, peripheral neuropathy, and tachycardia after prolonged nausea and vomiting. Her initial serum creatinine and blood urea were 2.6 mg/dL and 100 mg/dL, respectively. FLAIR image of the initial MR examination demonstrated bilateral symmetric high signal intensities in the medial and dorsal thalami. Echocardiography showed left ventricular dilatation and dysfunction. We thought that ARF, Wernicke`s encephalopathy and beriberi were resulted from dehydration and thiamine deficiency due to HG. She was managed with intravenous fluid and 100-200 mg of parenteral thiamine. ARF was improved within one week and echocardiographic findings were normalized within 1 month. MR examination at the 21st week of pregnancy showed a decreased size of the lesion. After 4 months, her neuroloic status was recovered.
급성 상기도 감염 후 발생한 전신성 모세혈관 누출 증후군
김유미 ( Yu Mi Kim ),석현정 ( Hyun Jung Seok ),김상현 ( Sang Hyun Kim ),권순길 ( Soon Kil Kwon ),이정익 ( Jeong Ik Lee ),서장원 ( Jang Won Seo ),박수길 ( Su Kil Park ) 대한신장학회 2003 Kidney Research and Clinical Practice Vol.22 No.2
Systemic capillary leak syndrome is a rare condition characterized by recurrent episodes of generalized edema and severe hypotension associated with paraproteinaemia. We experienced a case of recurrent systemic capillary leak syndrome. A 30-year-old woman hd flu-like syndrome with fever, chill, and sore throat. Two days later, she presented progressive generalized edema and weight gain of 4 kg. Biological examination showed hemoconcentration, leukocytosis, and hypoalbuminemia without proteinuria. A radiograph of the chest showed pleural effusion. She had no evidence of heart failuer, renal failure, or a protein losing enteropathy, and no abnormalities of liver function. Anti-neuclear antibody and antibodies to ds-DNA were negative. C3 and C4 were decreased. Serum protein electrophoresis showed oligoclonal banding consisting of IgG Λ bands. Bone marrow biopsy was normal and there was no Bence-Jones protein in urine. She experienced a progressive reduction in her weight and a resolution of the peripheral edema without specific treatment. Five months later, she was readmitted with severe episode of shock. After a total of 10 L of fluid was administered intravenously, pulmonary edema developed. Intravenous steroid and theophylline were given which resulted in clinical improvement, accompanied by diuresis. Oral theophylline has been administered for prevention of this crisis up to the present time.
Burkholderia pseudomallei에 의한 균혈증과 패혈 폐렴 1예
석현정,김재일,이장한,추은주,곽이경,장성수,김남중,김양수,우준희,류지소 대한감염학회 2004 감염과 화학요법 Vol.36 No.2
Meliodosis는 열대지방의 토양과 지표수에 광범위하게 존재하는 Burkholderia pseudomallei에 의한 감염증으로 감염의 선행요인인 당뇨병, 신질환, 간경화, 지중해빈혈증, 알코올중독, 질병이나 약물로 인한 면역 저하자 등에서 발생하는 것으로 알려져 있다. 열성 질환으로 발현하며 급성 전격성 균혈증에서 만성적인 국소적 질환까지 다양한 양상을 나타내며 가장 빈번히 침범되는 장기는 폐이다. 태국, 말레이시아, 싱가포르, 오스트리아 북구 등에서 발생하며 이러한 지역에 거주하거나 여행한 환자에서도 발생한 보고가 있지만 국내에서 환자가 보고된 적은 없다. 저자들은 melioidosis의 발생 지역인 말레이시아에 거주한 적이 있는 당뇨병 환자에서 3년의 잠복기 후 발생한 Burkholderia pseudomallei에 의한 균혈증과 패혈 폐렴을 경험하였기에 문헌 고찰과 함께 보고하는 바이다. Melioidosis is an infectious disease caused by a gram-negative saprophyte bacterium, Burkholderia pseudomallei. It is endemic to Southeast Asia and Northern Australia. It mostly infects adults with predisposing conditions, mainly diabetes mellitus. The lung is the most commonly affected organ. The spectrum of melioidois in human varies from subclinical to overwhelming protean manifestations resembling other acute and chronic bacterial infections. We report herein a case of septicemia and septic pneumonia due to Burkholderia pseudomallei in 47-year-old man with diabetes mellitus who has history of traveling to Malaysia. This is the first report of melioidosis in Korea.
CPPD 결정침착 질환에 의한 경부 측수증(cervical myelopathy) 1예
김재일,석현정,정선미,이은영,이창근,유빈,문희범 대한내과학회 2004 대한내과학회지 Vol.66 No.2
저자들은 우측 상지와 하지의 근력약화와 강직성 보행장애가 있어 내원한 57세 여자 환자에서 CPPD 결정침착질환에 의한 황색인대의 칼슘침착과 그에 수반된 경부측수증 1예를 경험하였기에 보고하는 바이다. Calcium pyrophosphate dihydrate (CPPD) deposition disease is an inflammatory arthropathy that is defined by the deposition of CPPD crystals in articular and periarticular structure. Spinal involvement in CPPD deposition disease is rare. We reported a rare case of CPPD deposition disease that caused compressive cervical myelopathy. A 57-year-old woman was admitted to the hospital with 1 week history of progressive paresis of the right upper and lower extremities. Computed tomography showed the round and nodular calcified ligamentum flavum. Magnetic resonance imaging showed a low intensity epidural mass pressing and distorting the cervical cord at C-4 and 5 levels on both T1 and T2- weighted images. Radiographic findings were consistent with calcification of the ligamentum flavum in the C-4 and 5 levels causing cord compression. The lesion was eventually removed by hemilaminectomy. The mass was composed of a very hard crystal like calcified deposition in the ligamentum flavum. The histopathological evaluation of the exicised ligamentum flavum revealed the characteristic crystals of CPPD.