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포스터 발표 : 포스터 연제 ; 카드뮴 중독과 연관된 type 2 RTA를 동반한 성인형 Fanconi 증후군 1예
여미애 ( Yeo Mi Ae ),조진원 ( Jo Jin Won ),박규용 ( Park Gyu Yong ),구자룡 ( Gu Ja Lyong ),김근호 ( Kim Geun Ho ),전로원 ( Jeon Lo Won ),김형직 ( Kim Hyeong Jig ),채동완 ( Chae Dong Wan ),노정우 ( No Jeong U ),남은숙 ( Nam Eun Sug 대한신장학회 1999 춘계학술대회 초록집 Vol.18 No.2
박수현,이준상,김형건,여미애,김지수,이중서,오흥영,곽성재 대한간학회 2000 Clinical and Molecular Hepatology(대한간학회지) Vol.6 No.2
Fluoxetine (Prozac ) is a antidepressant that inhibits the reuptake of serotonin in central nervous system, and has lesser adverse effects than the tricyclic antidepressants. The adverse effects of this drug are various, and the most common side effects are headache and nausea. The hepatic injury caused by fluoxetine is reported but very rare and not well known. Literature review has shown only 3 cases of hepatotoxicity from fluoxetine. We regard our case as the first of the hepatotoxicity from fluoxetine in Korea. The patient that we experienced showed normal aspartate aminotransferase (AST) and alanine aminotransferase (ALT) values before fluoxetine administration. 15 days after she took fluoxetine, AST and ALT values were increased and gradually increased as she took fluoxetine daily. We studied about viral hepatitis, metabolic liver disease, and autoimmune liver disease, but the cause of hepatic injury was not established. After the patient stopped to take fluoxetine, AST and ALT values decreased. A liver biopsy showed a moderate infiltration within the portal tracts with lymphocytes and ballooning degeneration of hepatocytes. We concluded fluoxetine-induced acute toxic hepatitis had occured. We must keep in mind that fluoxetine may cause hepatitis without cholestasis and suggest taking liver function tests regularly.(Korean J Hepatol 2000;6:236-240)
특발성 문맥압항진증 환자에게 병발된 간문맥 및 상장간막정맥 혈전증 1 예
김지수,박수현,김형건,여미애,오흥영,곽성재,육청미,김삼 대한소화기학회 2000 대한소화기학회지 Vol.36 No.5
Idiopathic portal hypertension (IPH) presents with splenomegaly, pancytopenia, and variceal bleeding, but shows no hepatic dysfunction. Although the absence of extrahepatic portal vein obstruction is required for diagnosis of IPH, cases associated with extrahepatic portal vein thrombosis have been repeatedly reported. We recently experienced a case of IPH, which developed portal and superior mesenteric vein thrombosis (PMVT). A 27-year-old woman, who had presented with dizziness and received splenectomy after diagnosis of IPH at age 22, was admitted for melena. Esophageal and fundic varices were observed. Spiral abdominal computed tomography (CT) showed long segmental PMVT. After endoscopic variceal ligation, anticoagulation therapy was performed for PMVT. Follow-up CT showed almost complete resolution of PMVT. We report a case of IPH associated with extrahepatic portal vein thrombosis for the first time in Korea.
카드뮴 중독과 연관된 성인형 Fanconi 증후군 1 예
박수현,한진석,구자룡,남은숙,여미애,곽성재,채동완,김근호,박규용,노정우,김형직,전로원,김현태,전은실 대한내과학회 2001 대한내과학회지 Vol.61 No.3
Adult Fanconi syndrome is a very rare disease characterized by renal glycosuria, generalized aminoaciduria, hypophosphatemia, hypouricemia and proximal renal tubular acidosis. It is divided into inherited and acquired forms. Proximal tubular transport defect in acquired Fanconi syndrome has been known to be resulted from multiple myeloma, dysproteinemias, heavy metal poisoning and chemical intoxications. A 50-year-old woman was admitted because of nausea for 2 weeks and body weight loss for 4 months. Leukocyte count, hemoglobin level and platelet count were 7,870/mm3, 11.7 g/dL 404,000/mm3 each. The urinalysis showed pH of 7.0, 3 positive for glucose and 3 positive for protein. The serum calcium, phosphate, uric acid and potassium were low to 8.9 mg/dL, 1.0 mg/dL, and 1.7 mEq/L. Serum creatinine level was 1.3mg/dL. The arterial blood gas analysis showed that the pH was 7.292 and bicarbonate was 14.7 mmol/L. Determination of amino acids in 24 hour urine specimen revealed the generalized aminoaciduria. Renal biopsy showed degeneration and necrosis of proximal tubules with normal glomeruli. Some tubular epithelial cells had enlarged nuclei and prominant nucleoli with vacuolated large mitochondrias. Cadmium concentrations of blood and urine were definitely higher than normal. The concentration of β2-microglobulin in urine was also high. Bicarbonate loading tests showed increased fractional excretions of bicarbonate in urine (6.129% at blood pH 7.248 and plasma HCO3 18.8 mEq/L, 13.7% at blood pH 7.315 and plasma HCO3 21.8 mEq/L). 24 hour urine protein electrophoresis showed no monoclonal gammopathy. This case of adult Fanconi syndrome was regarded to be related with cadmium intoxication. But no case of adult Fanconi syndrome related with cadmium toxicity has been reported yet in Korea. So authors report this case with brief review of literatures. (Korean J Med 61:276-280, 2001)
김우중,이명석,김형건,오흥영,곽성재,권성희,여미애,이경원 대한소화기학회 2000 대한소화기학회지 Vol.35 No.6
Tuberculosis of the liver is uncommon. Subsequent development of jaundice during antituberculous chemotherapy is usually caused by the side effects of drugs. The case of obstruction of the extrahepatic biliary system by tuberculous lymphadenopathy causing obstructive jaundice is extremely rare. A 18- year-old man was admitted to the hospital due to jaundice. He had the medical history of tuberculous pleurisy treated by antituberculous chemotherapy for about 4 months. Abdominal ultrasonography and computed tomography revealed a 3.4 cm-sized soft tissue masses at periportal area. Endoscopic retrograde cholangiography showed nearly complete luminal obstruction of the distal common bile duct. Ultrasound-guided fine needle aspiration and biopsies showed epithelioid histiocytes and necrotic materials. Endoscopic nasobiliary drainage and successive antituberculous chemotherapy resolved obstructive jaundice and lymphadenopathy without surgical management. We report a case of obstructive jaundice due to tuberculous portal lymphadenitis.
Erythropoietin 투여중인 만성 신부전 환자에서 발병한 급성 골수성 백혈병 1예
박수현,김현태,구자룡,채동완,김근호,박규용,노정우,이준상,여미애,김형직,전로원,권성희 대한내과학회 2000 대한내과학회지 Vol.59 No.6
Recombinant human erythropoietin is a synthetic glycoprotein hormone and has the effect on bone marrow erythroid progenitor cells. Therefore, recombinant human erythropoietin has been frequently used as an agent treating anemia in chronic renal failure patients. However, Stockenhuber reported that recombinant human erythropoietin also affected other bone marrow progenitor cells (colony- forming unit-granulocyte-erythrocyte-macrophage, colony-forming-gra-nulocyte-macrophage). This reports may suggest a possible casual relationship between acute myeloid leukemia and erythropoietin. Acute myeloid leukemia is a rare disease in patients with chronic renal failure especially on erythropoietin treatment. By this time only a case of acute leukemia in chronic renal failure was reported by Campistrus in 1995. Campistrus's case was on the remission state of acute myeloid leukemia, and erythropoietin was administered to treat anemia of chronic renal failure. Also no previous case of acute myeloid leukemia developed in chronic renal failure patients on erythropoietin treatment was yet reported in Korea. So, we report a case of acute myeloid leukemia developed in a pre-dialysis chronic renal failure patient but on erythropoietin treatment.(Korean J Med 59:674-678, 2000)
말기신부전 환자의 혈액투석에 있어서 혈관 성숙기간이 동정맥루 생존율에 미치는 영향
박규용(Ky Yong Park),김근호(Guen Ho Kim),김형직(Hyung Jik Kim),채동완(Dong Wan Chae),노정우(Jung Woo Noh),구자룡(Ja Ryong Koo),조진원(Jin Won Cho),여미애(Mi Ae Yeo),양형원(Hyung Won Yang),김경희(Kyung Hee Kim),이기성(Ki Sung Lee),전로원 대한내과학회 1999 대한내과학회지 Vol.57 No.1
N/A Arteriovenous fistula(AVF) has been the most important, primary mode of achieving vascular access for chronic hemodialysis by this time. In general, maturation period over 4 to 8 weeks after operation for the formation of AVF has been recommended for the long-term survival of AVF, and so insertion of central venous catheter without using AVF being matured has been primarily recommended whenever hemodialysis is needed. But not infrequently, serious complications have been reported in association with the insertion and the use of central venous catheter. So earlier use of AVF is regarded as a good method of avoiding serious complications with regard to the insertion and the use of central venous catheter. But early use of AVF has not been generally recommended, for early use of AVF has been regarded to be associated with early failure of AVF. But few studies have reported the correlation between maturation period and AVF survival. And in practice, early use of AVF has already been performed frequently by not a few nephrologists or nurses of dialysis units. So authors tried to examine the correlation between maturation period and AVF survival rate, and to find the validity of early use of AVF if it is regarded usable for the hemodialysis by experienced hemodialysis nurses and nephrologists. Methods : A retrospective analysis using 88 AVF cases which had been created in 85 patients from Oct. 1986 through June 1996, and from which authors could get enough information for this study was done. Authors compared one year survival rates of AVF according to the maturation period, the presence of DM, and condition of AVF assessed clinically by doctors and experienced nurses in hemodialysis units. Also from the cases with AVF obstruction, authors examined the 1st, 2nd, and 3rd year survival rate of AVF according to the maturation period. Results : One year survival rate of AVF with maturation period less than 4 weeks was higher than that with maturation period more than 4 weeks, but there was no statistical significance. One year survival rate, irrespective of the length of maturation period for AVFs, of AVF regarded to be usable and good for hemodialysis was higher than that of AVF regarded to be usable but not good for hemodialysis. In the study with the AVF obstruction group only, one year survival rate of AVF with maturation period less than 4 weeks was higher than that of AVF with maturation period more than 4 weeks but there was no statistical significance. And one year AVF survival rate was higher in non DM group(94.1%) than DM group(60%) regardless of maturation period of AVF(P<0.05). Conclusion : On the contrary to the views that longer maturation period of more than 4 weeks will be necessary for the long-term survival of AVF, our results suggest that shorter maturation period for AVF less than 4 weeks does not necessarily mean early failure of AVF once AVF is regarded to be usable for hemodialysis. So it is suggested that early use of AVF instead of inserting central venous catheter is a reasonable approach for getting an adequate vascular access for hemodialysis in chronic renal failure patients who were subjected to receive hemodialysis on waiting peroid of AVF maturation.