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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.
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)