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S-354 Grave`s disease 환자에서 반복적인 스테로이드 치료 후 생긴 thyrotoxic periodic paralysis 1예
함효주,이상민 대한내과학회 2013 대한내과학회 추계학술대회 Vol.2013 No.1
서론: thyrotoxic hypokalemic periodic paralysis (TPP)는 흔하지 않으나 저칼륨혈증과 관련되어 근육쇠약을 반복적으로 일으키는 양상으로 나타나 심각한 상태까지 진행될 수 있으며 고탄수화물식이나 과도한 운동후 발생할 수 있는 것으로 알려져 있다. 드물게 외국에서는 스테로이드 치료 이후 발생했다는 보고가 있었으나 국내에는 아직 보고되지 않았던 스테로이드 치료 후 발생한 thyrotoxic periodic paralysis 증례에 대해서 보고하는 바이다. 증례: 38세 남자가 하지 근육 저림과 쇠약을 주소로 내원하였고 환자는 한 달 전 그레이브스병으로 진단받고 methimazole 5 mg를 경구로 매일 복용하던 환자로 내원 전주에 감기로 prednisolone 15 mg를 3일간 복용한 적이 있었고, 고탄수화물식이를 한적 없고 운동은 따로 하지 않았다고 하며 직업은 사무직이었다. 내원 당시 말초혈액검사에서 potassium 2.0mmol/L, calcium 8.4 mg/dL phosphorus 1.3 mg/dL, aldosterone 5.2 ng/dL로 정상이었으나, freeT4 1.82ng/L, TSH <0.005 uIU/L이었고, cortisol 0.298, ACTH 3.3 pg/mL로 감소되어 있었다. 심전도 검사상 normal sinus rhythm 보였고 특이소견 없었다. 환자는 입원하여 cardiac monitoring하며 24시간동안 kcl 80 mEq 공급받았고 다음날 potassium 3.7 mmol/L로 정상화되었고 근육 쇠약 및 저린 증상 소실되었으며 다음날에도 potassium 4.1로 증가되어 퇴원하였다. 환자는 다시 한달 뒤 내원 3일전까지 이전과 같은 양의 prednisolone 15 mg를 이틀 복용하고 나서 하지 근육 저림과 쇠약을 주소로 응급실 내원하였고 potassium 2.3 mmol/L이었고 응급실에서 24시간동안 kcl 80 meq 공급받고 k 3.7 mmol/L로 정상화되고 증상소실되어 퇴원하였다.
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이정은,함효주,이관용,노지웅,유진석,정우백 이화여자대학교 의과학연구소 2014 EMJ (Ewha medical journal) Vol.37 No.2
Early repolarization is a common electrocardiographic (ECG) feature found in young adults, men and athletes, and has been considered to be a benign feature for the last several decades. But recent studies suggest that early repolarization may be related to idiopathic ventricular fibrillation and sudden cardiac death. We report a young man, 35 years old, who had life threatening ventricular fibrillation and sudden cardiac arrest. He was evaluated for cardiac causes of ventricular fibrillation. There was no explanation other than that his ECG showed an early repolarization pattern so we treated him with implantable cardioverter defibrillator. Thus, we suggest that early repolarization may be related with life threatening ventricular arrhythmia.
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S-9 : Long term follow-up data of patients who deferred cholecystectomy after successful EST
최영,주연호,장인애,함효주 대한내과학회 2013 대한내과학회 추계학술대회 Vol.2013 No.1
Background: The cholecystectomy is generally recommended after CBD stone removal by EST in cases with gall bladder stone. But there are debates if the cholecystectomy is necessary for all of the patiens, and lots of patients defer cholecystectomy for various reasons. We studied the natural courses of patients with gall bladder stone who defered cholecystectomy after EST in our clinic. Methods: There were 727 patients with gall bladder stone who received EST for CBD stone from 2004 to 2012 in Changwon Fatima Hospital. 605 patients received cholecystectomy soon after EST, and the other 122 patients who defered operation were analyzed retrospectivley by chart review and phone calls. 43 patients were lost to follow up and 79 patients were finally enrolled. Result: The mean age was 72.88 years and the mean follow up duration was 39.73 months. 28 patiens had biliary recurrence (35.4%) and 12 (15.1%) patients received emergent cholecystectomy later. All-cause death was occurred in 9 (11.3%) patients. The mean interval to 1st biliary recurrence was 17.9 (months) and the types of recurrence were mostly cholangitis (16 pts) followed by cholecystitis (15 pts) and uncomplicated biliary pain (3 pts). 34 patiens (43%) defered cholecystectomy for old age, 29 patients (36.7%) defered for personal reasons and 16 patients (20.2%) were high risk for operation. In 9 cases of death, cause of death was cancer in 4 patients and 3 patients were died of pneumonia. There were no biliary complication related death. Conclusion: There was significant biliary recurrence who had gall bladder stone but defered cholecystectomy after receiving EST for CBD stone. Many patients defer operation because of old age and personal reasons. They should be warned enough about high incidence of biliary recurrence despite rare mortality of biliary complication.
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