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즐례 : 심방 세동 환자에게 propafenone 투여 후 발현된 Brugada 심전도 패턴 1예
심형훈 ( Hyoung Hun Sim ),권낙현 ( Nak Hyun Kwon ),백주영 ( Joo Yeong Baeg ),윤창용 ( Chang Yong Yun ),안수민 ( Soo Min Ahn ),오유미 ( Yu Mi Oh ),김영중 ( Young Jung Kim ) 대한내과학회 2014 대한내과학회지 Vol.86 No.1
Brugada 증후군은 구조적 심질환이 없는 환자에게서 발생 하는 심실성 부정맥과 연관된 돌연사를 특징으로 한다. 저자 등은 실신을 주소로 내원한 환자의 심방 세동 치료를 위해 propafenone 투약 후 숨겨져 있던 Brugada 심전도 패턴이 드러난 증례를 경험하였다. 실신을 경험한 34세의 남자 환자가 급성 심방 세동으로 응급실로 내원하였으며 propafenone 300 mg 투여 후 Brugada type 1 심전도 패턴이 발현되어 이를 보 고하는 바이다. Brugada syndrome is characterized by sudden cardiac death associated with ventricular tachyarrhythmia in patients without structural heart disease. We recently observed a case of concealed Brugada ECG pattern, which appeared after oral propafenone administration for atrial fibrillation. A 34-year-old male patient who experienced syncope was admitted to the emergency department with acute atrial fibrillation (AF). Three hundred milligrams of propafenone that were administered to convert AF to sinus rhythm unmasked the Brugada ECG pattern that had remained concealed. The patient showed a type 1 Brugada ECG pattern after taking propafenone. (Korean J Med 2014;86:70-73)
항결핵 치료 전 발견된 폐결핵과 동반된 폐동맥 혈전색전증 1예
윤창용 ( Chang Yong Yun ),유창민 ( Chang Min Yu ),오유미 ( Yu Mi Oh ),안수민 ( Soo Min Ahn ),심형훈 ( Hyoung Hun Sim ),김은실 ( Eun Sil Kim ),유지원 ( Ji Won Yu ) 전북대학교 의과학연구소 2013 全北醫大論文集 Vol.37 No.1
Venous thrombosis and pulmonary thromboembolism results from a distortion in Virchow`s triad by venostasis, hypercoagulability, or vessel wall inflammation. There have been reported very low prevalence of venous thrombosis combined with mycobacterium tuberculosis infection. The pathogenesis may be associated with rifampin and the hypercoagulable state induced by acute infection. We report a case of pulmonary thromboembolism associated with pulmonary tuberculosis before antituberculosis treatment. A 21-year old young man who presented with cough and dyspnea didn`t have any risk factors for venous thrombosis but contrast-enhanced chest computed tomography and perfusion scan showed pulmonary thromboembolism. Even before antituberculosis treatment, pulmonary thromboembolism can be combined with pulmonary tuberculosis.
혈소판 감소증으로 발견된 사람면역결핍 바이러스 감염증 1예
오유미 ( Yu Mi Oh ),조재현 ( Jae Hyun Cho ),안수민 ( Soo Min Ahn ),윤창용 ( Chang Yong Yun ),심형훈 ( Hyoung Hun Sim ),김소연 ( Soyon Kim ),김윤권 ( Youn Kwon Kim ),유창민 ( Chang Min Yu ),이세한 ( Se Han Lee ) 전북대학교 의과학연구소 2013 全北醫大論文集 Vol.37 No.1
Although hematologic abnormalities are common in patients with HIV infection, there are few reports of HIV infected patients who first presented with severe thrombocytopenia (<25,000 / μL). We experienced a case of HIV-infected patient presenting only severe thrombocytopenia. There was no other cause that can cause thrombocytopenia. He was treated with antiretroviral therapy. And thrombocytopenia improved after 7 months..
크론병 환자에서 Azathioprine 치료 중 발생한 다형성 지방육종
안수민 ( Soo Min Ahn ),서승오 ( Seong O Suh ),오유미 ( Yu Mi Oh ),윤창용 ( Chang Yong Yun ),심형훈 ( Hyoung Hun Sim ),박채아 ( Chae A Park ),송철민 ( Cheol Min Song ),배지윤 ( Ji Yoon Bae ) 대한소화기학회 2013 대한소화기학회지 Vol.62 No.4
Azathioprine is frequently used for the treatment of inflammatory bowel diseases (IBD) such as Crohn`s disease and ulcerative colitis. Lymphomas, squamous cell carcinomas, and undifferentiated pleomorphic sarcomas have been reported among patients receiving azathioprine therapy. Herein, we report a case of pleomorphic liposarcoma of chest wall which occurred in a 44-year-old man with Crohn`s disease taking azathioprine. He was diagnosed with Crohn`s disease 3 years ago after suffering from abdominal pain and hematochezia for 12 years. He had been taking 50 mg of azathioprine per day for 23 months when he visited the thoracic and cardiovascular surgery clinic due to right chest palpable mass that had rapidly grown during the past 2 months. Excisional biopsy was performed and the mass was diagnosed as pleomorphic liposarcoma. Therefore, he underwent radical excision of the right chest wall mass, which measured 11.0×6.5 cm in size. He is scheduled to receive radiation therapy and chemotherapy. (Korean J Gastroenterol 2013;62:248-252)
혈액투석 환자에서 발생한 신장 혈종과 자발성 비장 파열의 1예
허소정 ( So Chong Hur ),김윤권 ( Youn Kwon Kim ),정준오 ( Jun Oh Jung ),이세한 ( Se Han Lee ),유서희 ( Seo Hee Ryu ),심형훈 ( Hyoung Hun Sim ),윤창용 ( Chang Yong Yun ) 전북대학교 의과학연구소 2012 全北醫大論文集 Vol.36 No.2
혈액 투석 중인 환자에서의 자발성 비장출혈은 요독성 출혈 경향과 항혈소판제, 투석중 헤파린 사용 등과 연관되어 발생할 수 있으며 매우 드물게 보고되고 있다. 저자들은 혈액 투석 중인 환자에서 최근 외상병력 없이 새로이 발생한 자발성 비장 출혈을 경험하였다. 말기 신부전으로 혈액 투석중인43세 남자가 투석 후 복부 전반의 찌르는듯한 통증을 주소로 내원하였다. 3개월전 발생한 자발성 우측 신장 혈종으로 보존적 치료 중이었으며 항응고제를 복용하고 있지 않았다. 혈압은 152/88 mmHg, 맥박 78 회/분이었고 결막은 창백하고 복부 전반에 걸친 압통과 반발통이 있었다. 복부 전산화 단층 촬영에서 비장 혈종과 다량의 복강 내출혈을 보여, 비장 절제술을 시행 받고 현재혈액투석하며 경과 관찰 중이다. Spontaneous splenic rupture is a rare disease. Dialysis patients with chronic renal failure can undergo spontaneous splenic hemorrhage caused by uremic coagulopathy, heparin used in hemodialysis, infection, amyloidosis. We report spontaneous splenic rupture in a 43year-old man undergoing hemodialysis for end-stage renal disease (ESRD). After hemodialysis he was admitted with complaints of pricking whole abdominal pain and anorexia. He had undergone renal hematoma 3months ago without recent trauma history and had been managed conservatively without using anticoagulant and anti platelet agents during hemodialysis. Blood pressure was 152/88 mmHg, heart rate was 78 bmp. White blood cell count was 8,600/μL, hemoglobin was 6.6 g/dL, platelet was 121,000/μL, PT INR was 1.37 and aPTT was 30.4sec. Abdominal CT scan showed splenic hematoma and large amount of hemoperitoneum. An emergent splenectomy was performed without immediate complications related to the surgical procedures. Pathology report demonstrated that spleen had normal tissue with hematoma. The postoperative course was uneventful. The patient has been undergoing hemodialysis till now. Spontaneous spleen rupture, a rare disease can cause life threatening situation and we should make early diagnosis and management of spontaneous spleen rupture when evaluating patients undergoing hemodialysis who present with abdominal pain and acute onset of anemia.