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소설 ( Seol So ),이상영 ( Sangyoung Yi ),박한빛 ( Han-bit Park ),조윤경 ( Yun Kyung Cho ),정지원 ( Jiwon Jung ),김성한 ( Sung-han Kim ),이상암 ( Sang-ahm Lee ) 대한내과학회 2016 대한내과학회지 Vol.91 No.3
경막외농양은 폐렴알균수막염 치료 중 발생하는 매우 드문 합병증으로써 빠른 진단과 항생제 사용 및 수술적 조치가 필요하다. 본 증례에서는 폐렴알균수막염 치료 중 경막외농양의 합병증이 생긴 환자에서 합병증이 발견되기 전에 뇌척수액세포증가증을 관찰하였다. 이 현상은 임상적 악화의 전조 징후일 수 있어 임상의의 면밀한 관찰이 필요하다고 생각한다. There have been a few reports of pneumococcal meningitis complicated by spinal epidural abscess. A 58-year-old female with Streptococcus pneumoniae meningitis underwent a recurrent pleocytosis without apparent clinical deterioration after appropriate antibiotic treatment. Subsequently, she developed a spinal epidural abscess. Spinal epidural abscess is a rare complication of pneumococcal meningitis, and subclinical deterioration of neutrophil-dominant pleocytosis may precede development of a spinal epidural abscess in individuals with bacterial meningitis. (Korean J Med 2016;91:330-333)
간문부 담관암과 유사한 원발 담관 점막 연관 림프조직 림프종 1예
황승하 ( Seungha Hwang ),송태준 ( Tae Jun Song ),소설 ( Seol So ),전민경 ( Min Kyung Jeon ),오은혜 ( Eun Hye Oh ),권병수 ( Byoung Soo Kwon ),안수종 ( Sujong An ),김명환 ( Myung Hwan Kim ) 대한소화기학회 2016 대한소화기학회지 Vol.68 No.2
Primary biliary mucosa-associated lymphoid tissue (MALT) lymphoma is extremely rare. We report a case of primary biliary MALT lymphoma with obstructive jaundice diagnosed by endoscopic biopsy, without surgical intervention. Obstructive jaundice was relieved by endoscopic drainage and endoscopic biopsy was done simultaneously during endoscopic retrograde cholangiopancreatography. Unnecessary surgical intervention can be avoided after pathological confirmation of lymphoma. The patient received radiotherapy, and is alive without any evidence of recurrence or biliary obstruction. Diagnosis of primary biliary lymphoma is very difficult because of its low prevalence. However, it should always be considered as a differential diagnosis, since when an accurate diagnosis is made, unnecessary surgical intervention can be avoided. (Korean J Gastroenterol 2016,68:114-118)
공장 정맥류 출혈에 대한 색전술 후 이동된 코일의 수술적 제거 1예
김준환 ( Junhwan Kim ),이단비 ( Danbi Lee ),오경환 ( Kyunghwan Oh ),이민기 ( Mingee Lee ),소설 ( Seol So ),양동훈 ( Dong-hoon Yang ),김찬욱 ( Chan-wook Kim ),권동일 ( Dong Il Gwon ),정영화 ( Young-hwa Chung ) 대한소화기학회 2017 대한소화기학회지 Vol.69 No.1
Jejunal variceal bleeding is less common compared with esophagogastric varices in patients with portal hypertension. However, jejunal variceal bleeding can be fatal without treatment. Treatments include surgery, transjugular intrahepatic porto-systemic shunt (TIPS), endoscopic sclerotherapy, percutaneous coil embolization, and balloon-occluded retrograde transvenous obliteration (BRTO). Percutaneous coil embolization can be considered as an alternative treatment option for those where endoscopic sclerotherapy, surgery, TIPS or BRTO are not possible. Complications of percutaneous coil embolization have been reported, including coil migration. Herein, we report a case of migration of the coil into the jejunal lumen after percutaneous coil embolization for jejunal variceal bleeding. The migrated coil was successfully removed using surgery. (Korean J Gastroenterol 2017;69:74-78)
화농성 간농양과 대량 용혈성 빈혈로 나타난 Clostridium perfringens에 의한 중증 패혈쇼크 1예
강선명 ( Sun-myoung Kang ),윤정아 ( Jung A Yoon ),김시찬 ( Si Chan Kim ),소설 ( Seol So ),이훈희 ( Hoon Hee Lee ),조석정 ( Seok Jung Jo ),허진원 ( Jin-won Huh ) 대한내과학회 2016 대한내과학회지 Vol.91 No.1
임상적으로 간농양의 원인균은 폐렴간균과 같은 그람음성간균에 의한 것이 대부분으로 건강한 사람에서 클로스트리듐퍼프린젠스에 의한 간농양 및 패혈증은 매우 드물다. 하지만 클로스트리듐퍼프린젠스에 의한 패혈증은 매우 중독한 경과를 보이며, 드물지만 특징적인 합병증인 대량 혈관내 용혈이 동반된 경우 사망률은 70%에서 100%에 이른다. 이에주의 깊은 병력 청취 및 특징적인 임상 관찰을 통해 클로스트리듐퍼프린젠스 감염을 조기 진단하는 것이 가장 중요하며 이후 신속한 경험적 항생제 투약 및 원인 조직의 수술적제거가 사망률을 낮추는데 필수적이다. A 65-year-old female visited the emergency room for severe back pain radiating to the neck. Aortic dissection computed tomography revealed a ruptured liver abscess and large pneumoperitoneum. Although emergent percutaneous drainage of the liver abscess and aggressive resuscitation were performed, massive hemolytic anemia and disseminated intravascular hemolysis developed and she subsequently died, 11 hours after her visit to the emergency room. Clostridium perfringens was identified in a blood culture obtained at the emergency room. We report this case because refractory septic shock due to a liver abscess and massive intravascular hemolytic anemia caused by Clostridium perfringens in a healthy female is rare. (Korean J Med 2016;91:57-61)