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클로피도그렐 저항성 환자에서 동시다발적 세혈관 조기스텐트 혈전증
성충실 ( Choong Sil Seong ),최혜미 ( Hye Mi Choi ),이웅기 ( Woong Ki Lee ),김병선 ( Byung Sun Kim ),이혁수 ( Hyeuk Soo Lee ),이동엽 ( Dong Yob Lee ),박종필 ( Jong Pil Park ) 전북대학교 의과학연구소 2014 全北醫大論文集 Vol.38 No.2
The incidence of early stent thrombosis is decreasing because of the development of new generation drug-eluting stents (DES) and dual antiplatelet therapy. However, early stent thromboses still occur with fatal complications. Nowadays, investigations are focusing on the hyporesponsiveness of clopidogrel and CYP2C19 genetic correlation to reveal the cause of early stent thrombosis. Herein, we report a case of simultaneous early triple stent thrombosis related with clopidogrel resistance and CYP2C19 genetic mutation.
Two Successfully Treated Cases of Pulmonary Fibrosis Due to Paraquat Poisoning
이웅기,성충실,김병선,최혜미,이혁수,윤현주,김정관,이미숙,이광영,선인오 대한응급의학회 2014 大韓應急醫學會誌 Vol.25 No.4
Paraquat poisoning can cause severe multiple organ failureinvolving the kidneys, liver, lungs, adrenals, and central nervoussystem. The toxic effect of paraquat on the lung manifestsas pulmonary edema, hypoxia, respiratory failure, andpulmonary fibrosis. However, optimal guidelines for treatmentof lung fibrosis following paraquat ingestion are not available. We experienced two cases, a 45-year-old Korean male and a66-year-old Korean male, who visited the emergency centerbecause of paraquat poisoning. They initially received methylprednisolonepulse therapy and cyclophosphamide. Thenthey experienced pulmonary fibrosis approximately 10 daysafter admission during renal recovery. Although steroid pulsetherapy with cyclophosphamide was reported to reduce mortalitydue to paraquat poisoning, the side effects of cyclophosphamidetreatment were concerning in our patients, who hadalready received cyclophosphamide. Therefore, we decidedto repeat steroid pulse therapy without cyclophosphamide. Fortunately, pulmonary fibrosis in these two patients resolvedafter repeated steroid pulse therapy. Thus, steroid pulse therapyalone could benefit patients with lung fibrosis, who havealready received steroid and cyclophosphamide treatment. Herein, we report on two cases of pulmonary fibrosis due toparaquat poisoning that were treated successfully with repeatedsteroid pulse therapy.
The Experience and Management of Two Cases of Metformin-associated Lactic Acidosis
이혁수,성충실,김병선,이웅기,최혜미,윤현주,김정관,선인오,이광영 대한응급의학회 2014 大韓應急醫學會誌 Vol.25 No.6
Metformin, a dimethylbiguanide, is an oral antihyperglycemicdrug used in treatment of type 2 diabetes mellitus. It has been reported that metformin may be associated withlactic acidosis in patients with clinical conditions such asrenal failure and heart failure. Metformin-associated lacticacidosis (MALA) is a rare, but serious complication with amortality rate of approximately 30~50%. Therefore, anaggressive treatment strategy including hemodialysis is recommendedfor these patients. Although continuous renalreplacement therapy (CRRT) has been administered inhemodynamically unstable patients with MALA, there arefew case reports describing the use of CRRT as a therapeuticmodality in Korea. Here, we describe the case historiesof two MALA patients who underwent treatment withCRRT.
간성 뇌증과 감별이 어려웠던 C형간염 간경변증 환자의 크립토코쿠스뇌수막염
최혜미 ( Hye Mi Choi ),정금모 ( Gum Mo Jung ),이웅기 ( Woong Ki Lee ),이혁수 ( Hyeuk Soo Lee ),김병선 ( Byung Sun Kim ),성충실 ( Choong Sil Seong ),윤소희 ( So Hee Yoon ),조용근 ( Yong Keun Cho ) 대한소화기학회 2014 대한소화기학회지 Vol.64 No.5
Cryptococcus neoformans, an encapsulated fungus, is an important opportunistic pathogen that can cause meningitis in immunocompromised patients. Since patients with cryptococcemia have high mortality, it is essential to make an early diagnosis and promptly initiate antifungal therapy. However, it is often very difficult to differentiate between cryptococcal meningitis and hepatic encephalopathy in patients with liver cirrhosis, and there is delay in making the diagnosis. Therefore, these patients have a particularly grave prognosis and consequently many patients die before culture results become available. In one study, starting antifungal therapy within 48 hours of the blood culture was associated with improved survival, but patients with liver cirrhosis were significantly less likely to receive antifungal therapy within 48 hours compared to those without liver cirrhosis. Recently, the authors experience a case of a 68-year-old woman with liver cirrhosis who presented with fever and a drowsy mental status. She had a previous history of having been admitted for infection-associated hepatic encephlopathy. Cryptococcal meningitis and cryptococcemia were diagnosed by spinal puncture and culture of cerebrospinal fluid. In spite of adequate treatment, the patient developed multi-system organ failure and eventually expired. Herein, we report a case of cryptococcal meningitis mimicking hepatic encephalopathy in a patient with liver cirrhosis. (Korean J Gastroenterol 2014,64:294-297)