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대퇴골 골절 환자에서 발생한 급성신손상의 위험인자와 임상경과
윤유선 ( Yu-seon Yun ),유지한 ( Ji Han Yu ),김지희 ( Ji Hee Kim ),권기욱 ( Ki Wook Kwon ),이홍석 ( Hong Seok Lee ),이영복 ( Yeong Bok Lee ),박원종 ( Won Jong Bahk ),김영옥 ( Young Ok Kim ) 대한내과학회 2013 대한내과학회지 Vol.84 No.6
Background/Aims: Femoral fracture occurs most often in elderly patients and is highly associated with medical problems such as acute kidney injury (AKI); however no reports of AKI in femoral fracture patients have been published. This study was performed to identify risk factors and the clinical course of AKI in patients with femoral fracture. Methods: We retrospectively evaluated the medical records of 110 patients with femoral fracture between November 2006 and December 2011 at Uijeongbu St. Mary`s Hospital. We investigated the incidence and clinical course of AKI in femoral fracture patients and compared the clinical findings between AKI and normal kidney function (NKF) groups. Results: Of the 110 femoral fracture patients, AKI was observed in 19 (17.3%). The peak serum creatinine level in patients with AKI was 2.59 ± 1.57 mg/dL. Two of 19 patients with AKI died and two progressed to chronic kidney disease. When compared to the NKF group, the AKI group had a higher incidence of elevated lactate dehydrogenase (LDH) (63.2% vs. 34.1%, p = 0.020), erythrocyte sedimentation rate (ESR) (31.6% vs. 6.6%, p = 0.008), and C-reactive protein (57.9% vs. 46.2%, p = 0.042). The AKI group also had a longer hospitalization duration, and more patients were prescribed an angiotensin-converting-enzyme (ACE) inhibitor than in the NKF group. Multivariate analysis demonstrated elevated LDH, ESR and ACE inhibitor prescriptions as independent risk factors for AKI in patients with a femoral fracture. Conclusions: The incidence of AKI in patients with a femoral fracture was 17.3%, and AKI was associated with a longer clinical course. We recommend monitoring of laboratory findings
증례 : 내분비-대사 ; 무균성 뇌수막염으로 오인된 뇌하수체졸증 1예
윤유선 ( Yu Seon Yun ),김은숙 ( Eun Sook Kim ),신정아 ( Jung Ah Shin ),강무일 ( Moo Il Kang ),윤건호 ( Kun Ho Yoon ),차봉연 ( Bong Yun Cha ),손호영 ( Ho Young Son ) 대한내과학회 2011 대한내과학회지 Vol.80 No.1
본 저자들은 뇌수막염 증상으로 오인되어 치료가 지연, 부신 위기 동반으로 악화된 후 진단된 뇌하수체 선종의 뇌하수체졸증 1예를 경험하여, 무균성 뇌수막염이 호전되지 않을 경우에는 드물지만 치명적인 경과를 보일 수 있는 뇌하수체졸증일 가능성을 상기하고자 이를 보고하는 바이다. Pituitary apoplexy is a clinical syndrome caused by an acute ischemic or hemorrhagic vascular accident. Although pituitary apoplexy is an emergency, it is often overlooked because it is rare and presents with various signs and symptoms, including those of neurologic and endocrine disorders. We describe a case of pituitary apoplexy misdiagnosed as aseptic meningitis accompanied by acute-onset headache and nausea, followed by fever. Subsequently, it was revealed as pituitary apoplexy by brain magnetic resonance imaging (MRI) performed when the clinical course worsened and ophthalmoplegia developed. We suggest that pituitary apoplexy be included in the differential diagnosis of patients presenting with headache or signs of meningeal irritation; when there is no clinical improvement, prompt steroid treatment should be started, while considering neurological decompression to prevent neurological sequelae. (Korean J Med 2011;80:102-107)
증례 : 혈액종양 ; c-kit 돌연변이가 동반된 RUNX1/RUNX1T1 양성 급성골수성백혈병에서의 골수육종
윤유선 ( Yu Seon Yun ),최승화 ( Seung Hwa Choi ),유선홍 ( Sun Hong Yoo ),유진석 ( Jin Sok Yu ),이지은 ( Ji Eun Lee ),김희제 ( Hee Je Kim ),민우성 ( Woo Sung Min ) 대한내과학회 2011 대한내과학회지 Vol.81 No.4
RUNX1-RUNX1T1 양성 AML에서 c-kit 돌연변이와 골수외 백혈병의 발생은 밀접한 상관관계가 있으며 고식적 치료법에 저항성을 나타내고 궁극적으로 매우 나쁜 예후를 보인다. 그러므로 임상적으로 골수외 백혈병이 동반된 AML 환자에서 c-kit 돌연변이 여부를 확인하고 고위험군으로 분류하여 더욱 적극적인 치료를 시행해야겠다. 저자들은 최근 t (8;21) (q22;q22);RUNX1-RUNX1T1 양성 AML 환자에서 c-kit 유전자 돌연변이와 골수외 백혈병이 동반된 3예를 임상 경험하여 문헌고찰와 함께 보고하는 바이다. t (8;21)(q22;q22) is the most frequently detected cytogenetic abnormality in patients with acute myeloid leukemia (AML) and accounts for 8-21% of de novo AML. The translocation involves two genes, RUNX1 (formerly AML1) on 21q22 and RUNX1T1 (ETO) on 8q22. RUNX1/RUNX1T1 translocation confers a favorable prognosis, but a subset of patients has a precipitous course with a high incidence of relapse. This patient subset is associated with the presence of a c-kit mutation. c-kit is a proto-oncogene, which encodes a type III transmembrane tyrosine kinase, which elicits a variety of cellular responses essential for the development of bone marrow stem cells. The expression of the c-kit mutation in AML is < 2%, whereas AML with RUNX1/RUNX1T1 shows higher rates of c-kit mutation and is associated with extramedullary leukemia and poor clinical outcome. We report cases of myeloid sarcoma in patients with RUNX1/RUNX1T1-positive AML and a c-kit mutation. (Korean J Med 2011;81:517-525)
유지한 ( Ji Han Yu ),신영신 ( Yeong Sin Shin ),정현주 ( Hyun Ju Jung ),윤유선 ( Yu Seon Yun ),김현경 ( Hyun Gyung Kim ),김영수 ( Yooung Soo Kim ),윤선애 ( Sun Ae Yoon ),김용수 ( Yong Soo Kim ),김영옥 ( Young Ok Kim ) 대한신장학회 2011 Kidney Research and Clinical Practice Vol.30 No.1
Purpose: Acute alcohol intoxication (AAI) causes various complications such as electrolyte imbalance, alcoholic ketoacidosis (AKA), rhabdomyolysis, and acute kidney injury (AKI). Although there have been some reports about AKA and rhabdomyolysis, AKI due to acute alcohol intoxication is rarely reported. Methods: We retrospectively evaluated the medical records of 371 patients with AAI between January 2004 and May 2010 in Uijeongbu St. Mary`s Hospital. We compared the clinical findings, morbidity and mortality rate between AKI and normal kidney function (NKF) groups. Results: Of the total 371 patients with AAI, AKI occurred in 107 patients (28.8%). The peak serum creatinine level in AKI patients was 2.9±1.9 mg/dL. Thirteen of the 107 patients (12.1%) received renal replacement therapy. AKI group had higher incidence of decreased mentality (29.0% vs 16.3%, p= 0.006), dyspnea (11.2% vs 4.9%, p=0.029) and hypotension (66.0% vs 41.7%, p<0.001), and lower incidence of gastrointestinal bleeding (22.4% vs 34.8%, p=0.019), compared to NKF group. The AKI group also had higher incidence of ketoacidosis (78.5% vs 28.8%, p<0.001), rhabdomyolysis (19.6% vs 4.2%, p<0.001), and pneumonia (22.4% vs 8.0%, p<0.001), compared to NKF group. The length of ICU stay was longer (7.4±10.8 vs 4.1±6.1 days, p=0.003) and the mortality rate was higher (17.8% vs 2.3%, p<0.001) in AKI group. Conclusion: This study demonstrated that incidence of AKI in patients with AAI was 28.8% and AKI was associated with high morbidity and mortality. And multivariate analysis demonstrated that independent risk factors of AKI were ketoacidosis and increased serum osmolality.
증례 : 신장 ; 중심정맥 도관 제거 후 발생한 일측성 공기머리증 1예
김대원 ( Dae Won Kim ),윤유선 ( Yu Seon Yun ),이혜연 ( Hye Yeon Lee ),최현호 ( Hyun Ho Choi ),최승화 ( Seung Hwa Choi ),이관현 ( Kwan Hyun Lee ),황대연 ( Dae Yeon Hwang ) 대한내과학회 2011 대한내과학회지 Vol.80 No.2S
저자들은 중심정맥 도관 제거 후 일측성으로 발생한 공기 머리증 환자 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. The presence of pneumocephalus associated with insertion, maintenance, and removal of intravenous catheters is a rare radiographic finding, but may be clinically relevant. Various pathways have been proposed to explain the development of pneumocephalus, but none are well understood. We present a patient with hemicranial pneumocephalus secondary to removal of a central venous catheter as determined by computed tomography, and we propose a possible mechanism of the pneumocephalus. (Korean J Med 2011;80:S249-S252)
김현경 ( Hyun Gyung Kim ),김형우 ( Hyong Woo Kim ),김석환 ( Seok Hwan Kim ),윤유선 ( Yu Seon Yun ),이보희 ( Bo Hee Lee ),윤성로 ( Seong Ro Yoon ),김영수 ( Young Soo Kim ),윤선애 ( Sun Ae Yoon ),김영옥 ( Young Ok Kim ),원유동 ( Yoo 대한신장학회 2010 Kidney Research and Clinical Practice Vol.29 No.6
Purpose: Central venous stenosis or occlusion is commonly associated with placement of central venous catheters or devices. Although rare, central venous stenosis or occlusion may also develop without a history of previous central venous catheter placement. Here we report a case of central venous stenosis without a previous central catheter placement. A 76-year-old woman with hypertensive nephropathy was admitted due to deterioration of renal function. Tunneled cuffed catheter for hemodialysis was inserted in the right external jugular vein, and we intended to insert central venous catheter because of poorly functioning peripheral vein. But, left internal jugular vein was not cannulated. The patients had a history of pulmonary tuberculosis and chest x-ray revealed extensive calcified lesions mainly in left upper lung. Venography and CT angiogram showed complete occlusion at the confluent point of the left subclavian vein and left internal jugular vein, and left brachiocephalic vein by calcified lesion. The anterior cervical vein and jugular venous arch forming an anastomosis between the neck vein were marked dilated. The patient did not show any clinical symptoms and signs associated with central venous stenosis, and the central venous catheter functioned well, correction of central vein stenosis was not necessary. After the supportive care including temporary hemodialysis, the patient improved from renal dysfunction.
김연지 ( Yeon Ji Kim ),강승훈 ( Seung Hun Kang ),최수진 ( Su Jin Choi ),권아미 ( A Mi Kwon ),윤유선 ( Yu Seon Yun ),윤선애 ( Sun Ae Yoon ),김영옥 ( Young Ok Kim ) 대한내과학회 2013 대한내과학회지 Vol.84 No.2
본 증례와 같이 다운증후군 환자에서는 림프관의 선천적 취약성 및 해부학적 특징으로 인해 일반인에 비해 유미흉이 발생할 가능성이 높다. 따라서 기관 삽관 등의 시술 시 흉벽에 물리적 압박이 최소한으로 가해지도록 주의해야 하며 이러한 선천적 질환을 가진 환자에서 흉수가 발생하면 유미흉의 가능성을 고려하여 진단 검사를 시행하고 조기에 적절한 치료를 시행해야 하겠다. 저자들은 성인 다운증후군 환자에서 흉부의 둔상으로 인해 유미흉이 발생한 드문 예를 진단하고 보존적 요법을 통해 성공적으로 치료한 경험이 있어 이를 보고하는 바이다. Chylothorax is the accumulation of chyle-containing lymphatic fluid within the pleural space. It is mainly caused by injury or obstruction of the thoracic duct due to neoplasm or trauma. There have been several reports of chylothorax associated with chromosomal anomaly such as Down syndrome. Most cases are congenital, and development of chylothorax in an adult with Down syndrome is rare. Here, we report a case of chylothorax in an adult with Down syndrome who had been treated with mechanical ventilation. A 31-year-old woman with Down syndrome was admitted with urosepsis. She was treated with mechanical ventilation due to severe respiratory acidosis. Four days after mechanical ventilation, she developed unilateral pleural effusion, and analysis indicated chylothorax. After conservative treatment, including fasting and total parenteral nutritional support, the chylous formation completely disappeared. (Korean J Med 2013;84:279-283)