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조영제 사용 전 피부반응검사 후 발생한 조영제 과민반응의 발생 빈도와 임상 양상
박보배 ( Bo Bae Park ),박창한 ( Chang Han Park ),노인영 ( In Young Nho ),김해성 ( Hae Sung Kim ),강남규 ( Nam Kyu Kang ),장석일 ( Suk Il Chang ),김장민 ( Jang Min Kim ) 대한천식알레르기학회(구 대한알레르기학회) 2016 Allergy Asthma & Respiratory Disease Vol.4 No.6
Purpose: Hypersensitivity reactions to contrast media (CM) are one of the most common causes of drug adverse reactions. The overall prevalence of immediate hypersensitivity reaction (IHR) was 0.16%-7.7% to nonionic CM. Although IHR to CM has been traditionally considered nonallergic, there is growing evidence that the mechanism of IHR to CM is mediated by IgE. It can be severe, even fatal, and a legal problem. To reduce IHR, the prescreening skin test is on the rise. Methods: We reviewed cases of IHR to CM during enhanced computed tomography (CT) from 2008 to 2015 at a secondary hospital in South Korea. Patients who underwent enhanced CT were performed the 2-step prescreening skin test before nonionic CM-enhanced CT. If patients had adverse reactions to CM, the reactions were reported. IHR to CM was defined as an immediate reaction within 1 hour after CM administration. The Ring and Messmer system was used to classify the severity of reactions by grades I to IV, and we defined grades III and IV as severe reactions. Results: A total of 30,105 CM-enhanced CT cases were recruited from 2008 to 2015. A total 46 patients with CM adverse reactions were reported. The IHR were noted in 30 of the total patients (0.1%), of which 6 had severe reaction. Conclusion: The prevalences of IHR and severe IHR to CM were 0.1% and 0.02%, respectively. Further studies are needed to evaluate the usefulness of prescreening skin tests to prevent IHR to CM. (Allergy Asthma Respir Dis 2016:4:442-448)
증 례 : 경피적 승모판 풍선성형술을 시행한 환자에 나타난 감염성 심내막염 1예
강남규 ( Nam Kyu Kang ),김배근 ( Bae Keun Kim ),김해성 ( Hae Sung Kim ),박보배 ( Bo Bae Park ),노인영 ( In Young Nho ),이우진 ( Woo Jin Yi ),정혜선 ( Hye Seon Jung ) 대한내과학회 2016 대한내과학회지 Vol.90 No.1
경피적 승모판 풍선성형술은 적응증에 해당할 경우 수술을 대신할 수 있는 승모판 협착의 치료로 시행되고 있다. 경피적 승모판 풍선성형술 이후 합병증으로 감염성 심내막염이 보고된 사례는 국내에 없다. 저자들은 경피적 승모판 성형술을 시행한 승모판 협착증 환자에서 시술 1년 후에 나타난 감염성 심내막염을 경험하였기에 문헌고찰과 함께 보고하는 바이다. 경피적 승모판 성형술시 발생하는 승모판 파열과 이완 작용이 감염성 심내막염의 병태생리에 미칠 수 있는 영향과, 이를 반영하여 고위험 시술시 예방적 항생제 투여 대상 선정에 대한 고찰이 필요할 것이다. Percutaneous mitral balloon valvuloplasty (PMBV) is the treatment of choice for mitral stenosis. Only a few reported cases have been reported in PMBV patients worldwide. In this study, a case of a 34 year-old female with infective endocarditis a year after PMBV is presented. The patient presented with fever, and peripheral vascular symptoms. Transthoracic echocardiography showed vegetation on the anterior mitral leaflets and Staphylococcus Viridans was isolated from blood cultures. The patient was successfully treated with Amoxicillin + Clavulate and Gentamicin. Further studies on the correlation between PMBV and infective endocarditis are needed. (Korean J Med 2016;90:37-40)