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증례 : 순환기 ; 벌독 아나필락시스쇼크 후 병발한 신부전과 스트레스성 심근병증 1예
천미주 ( Mi Ju Cheon ),윤병우 ( Byung Woo Yoon ),송용건 ( Yong Geon Song ),이창균 ( Chang Kyun Lee ),이태연 ( Tae Yeon Lee ),조인수 ( In Soo Cho ),홍지연 ( Ji Yeon Hong ) 대한내과학회 2016 대한내과학회지 Vol.90 No.5
벌독 유발 아나필락시스쇼크 후 횡문근융해증에 의한 급성 신부전이 발생하는 것은 국내에서도 2예만 보고될 정도로 매우 드문 경우에 속한다. 본 증례에서 환자는 벌자상 후횡문근융해증으로 인한 급성 신부전과 스트레스성 심근병증이 병발하여 기관내 삽관 및 기계호흡이 불가피할 정도로 심한 심부전이 동반되었다. 그러나 보존적 치료 후 빠른 증상호전과 함께 증상 발생 30일 이내에 모든 검사에서 정상 소견을 보였기에 이를 문헌고찰과 함께 보고하는 바이다. Bee venom-induced anaphylaxis usually causes urticaria, angioedema, respiratory distress, nausea, and vomiting. Occasionally, it leads to unusual complications such as acute myocardial infarction, takotsubo cardiomyopathy, arrhythmia, rhabdomyolysis, intravascular hemolysis, and acute kidney injury. Renal complications are rare, and there are only two cases of acute kidney injury associated with rhabdomyolysis due to multiple bee stings reported in Korea. We report a 67-year-old woman who presented at our emergency department with confusion, respiratory distress, and dizziness after multiple bee stings. She was diagnosed with anaphylactic shock. There was acute kidney injury associated with rhabdomyolysis and heart failure related to takotsubo cardiomyopathy, all of which indicated unusual and fatal complications. Her condition worsened, almost requiring intubation and mechanical ventilation. However, the patient recovered without cardiac or renal complications within 30 days of therapy with hydration and diuretics. (Korean J Med 2016;90:427-432)
양영순,천미주,곽용태 대한치매학회 2016 Dementia and Neurocognitive Disorders Vol.15 No.3
Background and Purpose During Vietnam War, many Korean soldiers were dispatched to fight in the war where they were exposed toAgent Orange. Until now, there exist only limited evidence on existence of association between exposure to Agent Orange and Parkinson’sdisease (PD). To elucidate the effects of Agent Orange exposure on PD, we compared the clinical characteristics and radiolabeled 18F-FP-CITPET uptake between patients with Agent Orange exposure and patients with Agent Orange no-exposure. Methods We retrospectively evaluated 143 patients exposed to Agent Orange and 500 patients with no exposure to Agent Orange from ourmovement clinics database. The differences between clinical characteristics and pattern of 18F-FP-CIT PET uptake were investigated. Results Among Unified Parkinson’s Disease Rating Scale III motor subscales, tremor at rest, rigidity, finger taps, and rapid alternatingmovement was significantly higher in patients exposed to Agent Orange as compared to patients with no exposure to Agent Orange. The facialexpression score was significantly lower in patients exposed to Agent Orange as compared to patients with no exposure to Agent Orange. Compared to patients not exposed to Agent Orange, all basal ganglia areas (contra- and ipsilateral caudate nucleus, anterior putamen, andposterior putamen) showed a lower18F-FP-CIT uptake and higher asymmetry index of anterior and posterior putamen was found in patientsexposed to Agent Orange. The caudate/putamen ratio was significantly lower in patients exposed to Agent Orange as compared to patientswith no exposure to Agent Orange. Conclusions This study showed a different clinical profile and FP-CIT PET findings between patients exposed to Agent Orange as comparedto patients with no exposure to Agent Orange. This finding suggests the possibility of different pathophysiology of PD in patients exposedto Agent Orange from idiopathic PD.
양영순,천미주,곽용태 대한치매학회 2017 Dementia and Neurocognitive Disorders Vol.16 No.3
Background and Purpose The aim of this paper was to investigate the utility of 18F-N-(3-fluoropropyl)-2β-carboxymethoxy-3β-(4iodophenyl) nortropane (FP-CIT) positron emission tomography (PET) for evaluating the severity of Parkinson’s disease (PD) according to various clinical stages, and to identify the relationship between the striatal substructure and the Unified Parkinson’s Disease Rating Scale (UPDRS) motor score, cognitive symptoms through 18F-FP-CIT PET. Methods We retrospectively identified 542 patients with various clinical stages of PD who underwent an 18F-FP-CIT PET at our clinics. The difference between the 18F-FP-CIT PET according to the Hoehn-Yahr stage, correlation between 18F-FP-CIT PET and the UPDRS III grouped motor items, and the Korean Mini-Mental State Examination (K-MMSE) were investigated. Results As disease progressed, the right caudate and both the anterior putamen and caudate/putamen ratios exhibited a significantly lower uptake. The uptake of all striatal substructures was significantly correlated with the UPDRS total motor score. The right caudate nucleus was significantly related to both the UPDRS tremor items and the right UPDRS akinesia-rigidity items. The left caudate nucleus was related to both the UPDRS tremor items and UPDRS akinesia-rigidity items. The right anterior putamen was related to the axial items, right tremor and akinesia-rigidity items; while the left anterior putamen was related to the right tremor and right akinesia-rigidity items. Both of the posterior putamens were related to the axil items, left tremor and left akinesia rigidity items. K-MMSE was not significantly related to any striatal substructures. Conclusions The UPDRS total motor score was significantly correlated with the uptake of all striatal substructures. However, the 18F-FPCIT uptake in specific striatal substructures was rather complexly correlated with the UPDRS motor grouped items and was not significantly related to K-MMSE. These results suggest the possibility of the complex pathophysiology of motor symptoms of PD and limitation of 18F-FPCIT PET for the evaluation of the severity of PD motor and cognitive symptoms.
이원구,이은주,천미주,이준수,김현진,이미란,신승목,임효정 대한내과학회 2016 대한내과학회 추계학술대회 Vol.2016 No.1
서론: 흉강 비장증은 비장절제술을 시행받은 환자에서 비장 조직 내에서 유출된 세포가 생착되어 발생하는 드문 질환이다. 악성 종양의 폐전이, 흉막 중피종 또는 종격동 질환과 감별이 필요하여 진단을 위해 침습적 검사를 시행하는 경우도 있다. 저자들은 방사성 동위원소를 이용한 비장 스캔으로 비침습적으로 흉강 비장증을 진단하여 보고하는 바이다. 증례: 72세 남환 타병원에서 시행한 복부 초음파에서 췌관 확장 소견이 관찰되어 내원하였다. 본원에서 복부조영증강단층촬영 시행하여 영상에 포함된 폐의 좌하엽부위에 다발성 폐결절이 관찰되었다. 복강내 비장이 관찰되지 않았으며 과거력상 내원 30년 전 교통사고로 개복술을 시행 받았고 당시 비장을 절제하였다고 하였다. 추가로 시행한 흉부조영증강단층촬영에서 주로 좌측 흉막 주변에 위치한 조영증강이 잘 되는 다발성 폐결절이 관찰되었다. 외상으로 인한 비장절제술 이외 다른 질환의 과거력이 없고, 폐결절이 주로 좌측 흉강에 국한되어 있으며, 조영증강이 잘되는 다발성 폐결절의 형태인 점을 고려하여 흉강 비장증 가능성이 높을것으로 판단하여 진단을 위해 99m테크네슘을 이용한 비장 스캔을 시행하였다. 검사 결과 폐결절이 위치한 부위와 동일한 부위에서 방사선 원소의 섭취증가가 나타났다. 이에 흉강 비장증으로 확진하고 외래에서 추적관찰 중이다. 결론: 흉강 비장증은 무증상이며 진단 이후 특별한 치료를 필요로 하지 않지만 조영증강이 되는 다발성 폐결절로 나타나기 때문에 악성 종양, 흉막 중피종과의 감별이 필요하며 진단을 위해 개흉술을 시행하는 경우도 있다. 본 증례는 좌측에 국한된 다발성 폐결절 환자에서 흉복강 외상 및 비장절제술 여부를 확인하고 합당한 과거력이 있는 환자에서 비장증을 의심할 수 있다면 침습적 개흉술 없이 핵의학 검사만으로 흉강 비장증을 확진할 수 있음을 보여준다.
18F-FDG PET/CT in Primary AL Hepatic Amyloidosis Associated with Multiple Myeloma
손윤미,최준영,박철희,천미주,김용은,이경한,김병태 대한영상의학회 2011 Korean Journal of Radiology Vol.12 No.5
We report here on a rare case of primary AL hepatic amyloidosis associated with multiple myeloma in a 64-year-old woman. The patient was referred for evaluating her progressive jaundice and right upper quadrant pain. 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) showed diffusely and markedly increased 18F-FDG uptake in the liver. Although there have been several case studies showing positive 18F-FDG uptake in pulmonary amyloidosis, to the best of our knowledge, the 18F-FDG PET/CT findings of hepatic amyloidosis or primary hepatic amyloidosis associated with multiple myeloma have not been reported previously.