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증예(症例) : 만성신부전 악화와 동반된 후천성혈우병 1예
정금모 ( Gum Mo Jung ),전성희 ( Sung Hee John ),김남돈 ( Nam Don Kim ),박용진 ( Yong Jin Park ),박요숙 ( Hyo Sook Park ) 전북대학교 의과학연구소 2003 全北醫大論文集 Vol.27 No.2
후천성혈우병은 매우 드문 질환으로 중증의 출혈이 흔하게 나타나고 이로 인한 사망률이 높기 때문에 조기에 정확히 진단하여 적절한 치료를 즉각적으로 시행하여야 한다. 저자들은 만성신부전증으로 치료중 지속적인 출혈로 인해 발견된 후천성혈우병 환자를 면역억제제를 사용하여 성공적으로 치료하고 이에 증례보고 하는 바이다. Acquired hemophilia due to factor Ⅷ inhibitor is a rare disease that occurs in about one per million people each year. In about 50% of patients the disorder is associated with other conditions, mainly the postpartum period, underlying malignancies, drug administration, or autoimmune disease, such as rheumatoid arthritis or systemic lupus erythematosus. It is associated with bleeding complications that can be life-threatening. However, these bleeding episodes can be controlled when the correct diagnosis is made quickly and appropriate therapy applied. We had a patient with acquired hemophilia who was presented with sustained bleeding during managing uremia. At first, the diagnosis was incorrect because of delayed inhibitor reactivity. But, by retestifying after 2 hour incubation of diluted plasma and assaying inhibitor titer, we could have correct diagnosis. And we successfully treated it with oral immunosuppressive agents.
장결핵 치료 중 Rifampin으로 유도된 심한 혈소판 감소증 및 백혈구 감소증 1예
김지웅 ( Ji Woong Kim ),정금모 ( Gum Mo Jung ),조은영 ( Eun Young Cho ),최창수 ( Chang Soo Choi ),서검석 ( Geom Seog Seo ),조진웅 ( Jin Woong Cho ),최석채 ( Suck Chei Choi ),나용호 ( Yong Ho Nah ) 대한장연구학회 2006 Intestinal Research Vol.4 No.1
Drug induced thrombocytopenia is a relatively not uncommon and potentially serious side effect of therapy. It`s characterized by thrombocytopenia, petechia, purpuric lesions and occasionally serious bleeding such as intracranial hemorrhage. The patient was 24 year-old female who was given rifampin 600mg daily for treatment of intestinal tuberculosis. Rifampin-induced immune thrombocytopenia was occurred 25 days after initiating therapy. Platelet and leukocyte count were 23,000/mm3, 2,850/mm3, respectively. Two week after discontinuation of antituberculous medication, platelet count was recovered. We report this case with a review of literature. (Intestinal Research 2006;4:64-68)
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)
총담관결석증 환자에서 침형절개도 누공형성술 후 유도선을 이용한 담도 삽관 과정 중 발생한 간문맥 내 삽관 1예
이원동 ( Won Dong Lee ),송재선 ( Jae Sun Song ),김병선 ( Byung Sun Kim ),양민아 ( Min A Yang ),이영재 ( Young Jae Lee ),정금모 ( Gum Mo Jung ),조용근 ( Yong Keun Cho ),조진웅 ( Jin Woong Cho ),김지웅 ( Ji Woong Kim ) 대한소화기학회 2021 대한소화기학회지 Vol.77 No.5
Cannulation of the portal vein is a rare complication of ERCP. This paper reports a case of portal vein catheterization during ERCP in a patient with choledocholithiasis. A 62-year-old man was admitted to the Presbyterian Medical Center with right upper quadrant pain and jaundice. ERCP was performed under the suspicion of obstructive jaundice caused by a radiolucent stone. Bile duct cannulation using a pull-type papillotome was attempted, but it failed. After needle-knife fistulotomy, wire-guided cannulation was performed successfully, and 10 mL contrast was injected. On the other hand, the fluoroscopy image showed that the contrast medium disappeared very quickly. Pure blood was collected when the catheter was aspirated to identify the bile reflux, indicating possible cannulation of the portal vein. The procedure was terminated immediately and abdominal computed tomography showed air in the portal vein. One day after, a follow-up CT scan showed no air in the portal vein. The patient underwent repeated ERCP, and the common bile duct was cannulated. In most cases, isolated portal vein cannulation does not result in severe morbidity. However, it is important to aware of this rare complication so that no further invasive procedure is performed on the patient. (Korean J Gastroenterol 2021;77:253-257)
박민규 ( Min Gyu Park ),조용근 ( Yong Keun Cho ),고성준 ( Sung Jun Goh ),서용우 ( Yong Woo Seo ),이동엽 ( Dong Yup Lee ),장미영 ( Mi Young Jang ),정금모 ( Gum Mo Jung ) 전북대학교 의과학연구소 2011 全北醫大論文集 Vol.35 No.2
사구종양은 진피나 피하조직에서 흔하게 발생하지만 위에서는 드물에 발생하는 종양으로 현재까지 국내에서 약 15예 정도가 보고되었다. 52세 여자환자가 우연히 위에서 점막하 종양이 발견되었다. 내시경 초음파상 위벽 3번째 그리고 4번째 층에서 1.8 ×1.7cm 의 경계가 명확하고 균질한 저에코 종양으로 관찰되었다. 복부 CT에서 종양은 동맥기의 간문맥과 동일한 정도로 강한 조영 증강 소견을 보였으며, 이러한 조영 증강이 문맥기까지 지속되었다. 조직학적 확진 및 치료를 위해 내시경적 점막하 박리절제술을 시도하였으나 주위 조직과의 유착으로 실패하였고 복강경을 이용한 쐐기절제술을 시행하였다. 면역조직화학염색에서 사구종양으로 진단되었다. 이에 본 저자들은 비교적드문 질환인 위에 발생한 사구종양을 진단하고 치료하였기에 보고하는 바이다. Glomus tumors are commonly observed in the dermis or subcutis but are only rarely found in the stomach, A 52-year-old woman presented with an incidental finding of a submucosal tumor in the stomach. Endoscopic ultrasonography (EUS) showed a 1.8 × 1.7 sized well-circumscribed homogemous hypoechoic tumor in the 3rd and 4th layer of the gastric wall. Contrast-enhanced abdominal computerized tomography (CT) demonstrated high enhancement of the tumor with the same level of enhancement as the portal vein for the arterial phase, with persistence of enhancement in the portal phase. For histologic confirmation and treatment, endoscopic enucleation was attempted but failed due to fibrotic adhesion with the surronding tissue. So laparoscopic wedge resections were performed. Histological and immunochemical analysis of the tumor cells were compatible with glomus tumors. Up to recently, about 15 cases of glomus tomor in the stomach was reported in Korea. We report here a case of glomus tumor in the stomach, which was experience for diagnosis and treatment in our hospital.
내시경적 배액술로 치료한 간위루가 합병된 아메바성 간농양1예
고성준 ( Sung Jun Goh ),조용근 ( Yong Keun Cho ),박민규 ( Min Gyu Park ),이동엽 ( Dong Yup Lee ),서용우 ( Yong Woo Seo ),장미영 ( Mi Young Jang ),정금모 ( Gum Mo Jung ),조진웅 ( Jin Woong Cho ) 전북대학교 의과학연구소 2011 全北醫大論文集 Vol.35 No.2
Amebiasis is caused by the protozoan Entamoeba histolytica. Worldwide, approximately 40 to 50 milion people are infected annually. Most infections are asymptomatic, but amebic dysentery, amebic liver abscess, and rarely pulmonary, cardiac or brain involvement can occur4. amebic liver abscess (ALA) is the most common extraintestinal manifestation of amebiasis. The most common complication of ALA is rupture into adjacent structures; the frequent sites of ALA rupture are pleuropulmonary (72%), subphrenic space (4%), and peritoneal cavity (10%). The rupture into stomach is extremely rare. To date, there have been only six case reports. the management of ALA rupture is controversial. In general, surgical treatment is recommended. We report here a case of ALA with hepatogastric fistula, which was successfully managed by endoscopic drainage and antibiotics.