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다발내분비샘종양1형에서 췌장 신경내분비종양의 내시경초음파에탄올 주입술 1예
안수종 ( Sujong An ),이재용 ( Jae Yong Lee ),황승하 ( Sung-ha Hwang ),박도현 ( Do Hyun Park ),이성구 ( Sung-koo Lee ) 대한췌담도학회 2016 대한췌담도학회지 Vol.21 No.4
MEN1 환자에서 췌장 NET는 30-80% 동반된다. 증상 및악성 가능성이 있는 경우 수술적 절제가 예후에 중요한 영향을 미친다. 수술이 불가능한 췌장 NET에 대해 EUS-EI를 고려할 때는 합병증과 불완전 치료 및 재발 가능성에 대한 주의 깊은 고려가 필요하다. Multiple endocrine neoplasia type 1 (MEN1) is a rare inherited disorder caused by mutations in the MEN1 gene on chromosome 1. Clinical diagnostic criteria for MEN1 include the presence of two or more endocrine tumors such as pituitary, parathyroid, and pancreatic islet tumors. Treatment is needed for tumors accompanied by symptoms or having malignant potential. Malignant neuroendocrine tumors (NETs) are the major cause of MEN1-related death, and pancreatic NETs account for 30-80% of MEN1 cases. Surgery is the mainstay curative treatment, and endoscopic intervention is a treatment option when patients are poor candidates for surgery. A 33-year old female patient with MEN1 was treated via endoscopic ultrasonographyguided ethanol injection for a pancreatic NET.
Primaquine 복용 후 발생한 메트헤모글로빈혈증 1예
이재용 ( Jae Yong Lee ),김성한 ( Sung-han Kim ),안수종 ( Sujong An ),오혜선 ( Hye-seon Oh ),이상영 ( Sang Young Yi ),이훈희 ( Hoon Hee Lee ),한덕종 ( Duck Jong Han ) 대한내과학회 2017 대한내과학회지 Vol.92 No.1
Primaquine은 말라리아 치료제로써 널리 사용되고 있으며, 주폐포자충 폐렴 치료제로써 clindamycin과 병합하여 사용되고 있다. Primaquine의 다양한 부작용은 많은 보고를 통해 알려져 있으며, 메트헤모글로빈혈증은 primaquine의 드문 부작용 중 하나이다. 메트헤모글로빈혈증은 임상 증상 및 검사소견으로 의심할 수 있으며, 이를 확진하기 위해서는 특별한 진단적 접근이 이뤄져야 한다. 저자들은 주폐포자충 폐렴을 치료하기 위해 표준용량의 primaquine을 복용한 후 청색증을 동반한 메트헤모글로빈혈증이 발생한 증례를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Primaquine is often administered for the hypnozoite stage of Plasmodium vivax and Plasmodium ovale. Primaquine (with clindamycin) is also an alternative drug for treatment of pneumocystis pneumonia when trimethoprim/sulfamethoxazole cannot be used. Primaquine may cause methemoglobinemia, an altered state of hemoglobin in which the ferrous state of heme is oxidized to the ferric state. We report a case of methemoglobinemia caused by a standard dose of primaquine plus clindamycin in a 27-year-old female recipient of a kidney transplant who was diagnosed with pneumocystis pneumonia. (Korean J Med 2017;92:94-98)
알도스테론 분비 부신 선종에 의한 고알도스테론증으로 오인된 17알파 수산화효소 결핍증 1예
조윤경 ( Yun Kyung Cho ),오혜선 ( Hyeseon Oh ),강선명 ( Sun-myoung Kang ),안수종 ( Sujong An ),허진영 ( Jin-young Huh ),이지향 ( Ji-hyang Lee ),이우제 ( Woo Je Lee ) 대한내과학회 2016 대한내과학회지 Vol.91 No.2
17알파 수산화효소 결핍증은 고혈압, 남성 환자에서의 가성남녀한몸증 및 여성 환자에서의 성적 유치증 및 일차무월경을 유발하는 드문 질환이다. 염류 코르티코이드에 의한 고혈압과 감별하여야 하며, 특히 알도스테론 수치가 높은 17알파 수산화효소 결핍증 환자에서는 성호르몬과 11-디옥시코르티코스테론, 코르티코스테론을 포함한 부신호르몬에 대한검사를 통해 진단에 도움을 받을 수 있다. 저자들은 혈압이 조절되지 않아 내원한 32세 여자에서 부신 선종 절제술 이후에도 고혈압이 지속되어, 남성 남녀한몸증의 병력을 고려하여 추가적인 호르몬 검사를 시행한 결과 17알파 수산화효소결핍증이 진단된 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. 17α-hydroxylase deficiency is a rare cause of congenital adrenal hyperplasia and is characterized by primary amenorrhea, delayed puberty and hypertension. Although 17α-hydroxylase deficiency mimics mineralocorticoid-induced hypertension, impaired sexual development can aid in the differential diagnosis of this disease. A 32-year-old woman, who had a history of testicular feminization syndrome, presented with hypertension. Her aldosterone level was elevated whereas plasma renin activity was reduced, and her computed tomography scan showed a left adrenal adenoma, which was thought to be an aldosterone producing adenoma. A left adrenalectomy was performed to treat hypertension; however, the condition did not improve. The hormonal tests revealed high levels of plasma progesterone, mineralocorticoid and adrenocorticotropic hormone, and low levels of 17a hydroxyprogesterone, cortisol and sex hormones. The patient was diagnosed with 17α-hydroxylase deficiency and commenced on prednisolone, which controlled hypertension. Here, we report a case of 17α-hydroxylase deficiency mimicking hyperaldosteronism via aldosterone-producing adrenal adenoma. (Korean J Med 2016;91:191-196)
Ceftizoxime 투약 후 면역용혈빈혈 및 다발장기부전
허진영 ( Jin-young Huh ),안아리 ( Ari Ahn ),김형석 ( Hyungsuk Kim ),권석운 ( Seog-woon Kwon ),안수종 ( Sujong An ),이재용 ( Jae Yong Lee ),권병수 ( Byoung Soo Kwon ),오은혜 ( Eun Hye Oh ),박도현 ( Do Hyun Park ),허진원 ( Jin Won H 영남대학교 의과대학 2017 Yeungnam University Journal of Medicine Vol.34 No.1
Drug-induced immune hemolytic anemia (DIIHA) is a rare side effect of drugs. DIIHA may cause a systemic inflammatory response that results in acute multi-organ failure and death. Ceftizoxime belongs to the class of third generation cephalosporins, which are the most common drugs associated with DIIHA. Herein, we present a case of a 66-year-old man who developed fatal DIIHA after receiving a second dose of ceftizoxime. He was admitted to receive photodynamic therapy. He had a history of a single parenteral dose of ceftizoxime 3 months prior to admission. On the day of the procedure ― shortly after the infusion of ceftizoxime ― the patient`s mental status was altered. The blood test results revealed hemolysis. Oliguric acute kidney injury developed, and continuous renal replacement therapy had to be applied. On the suspicion of DIIHA, the patient underwent plasmapheresis. Diagnosis was confirmed by a detection of drug-dependent antibody with immune complex formation. Although his hemolysis improved, his liver failure did not improve. He was eventually discharged to palliative care, and subsequently died.
간문부 담관암과 유사한 원발 담관 점막 연관 림프조직 림프종 1예
황승하 ( Seungha Hwang ),송태준 ( Tae Jun Song ),소설 ( Seol So ),전민경 ( Min Kyung Jeon ),오은혜 ( Eun Hye Oh ),권병수 ( Byoung Soo Kwon ),안수종 ( Sujong An ),김명환 ( Myung Hwan Kim ) 대한소화기학회 2016 대한소화기학회지 Vol.68 No.2
Primary biliary mucosa-associated lymphoid tissue (MALT) lymphoma is extremely rare. We report a case of primary biliary MALT lymphoma with obstructive jaundice diagnosed by endoscopic biopsy, without surgical intervention. Obstructive jaundice was relieved by endoscopic drainage and endoscopic biopsy was done simultaneously during endoscopic retrograde cholangiopancreatography. Unnecessary surgical intervention can be avoided after pathological confirmation of lymphoma. The patient received radiotherapy, and is alive without any evidence of recurrence or biliary obstruction. Diagnosis of primary biliary lymphoma is very difficult because of its low prevalence. However, it should always be considered as a differential diagnosis, since when an accurate diagnosis is made, unnecessary surgical intervention can be avoided. (Korean J Gastroenterol 2016,68:114-118)