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증례 : 순환기 ; 프로포폴 수면 마취 이후 발생한 스트레스 유발성 심근병증 1예
민승연 ( Seung Yeon Min ),이형탁 ( Hyung Tak Lee ),장기설 ( Ki Sul Chang ),이정훈 ( Junghoon Lee ),김경수 ( Kyung Soo Kim ),신진호 ( Jinho Shin ),임영효 ( Young Hyo Lim ) 대한내과학회 2015 대한내과학회지 Vol.89 No.2
Propofol is an intravenous hypnotic agent that is generally used for sedation in the intensive care unit and for induction of anesthesia during minimally invasive surgery, endoscopy, and plastic surgery in local clinics. Low blood pressure and transient apnea might occur under propofol sedation, whereas stress-induced cardiomyopathy is a very rare complication. We herein describe a case involving a 25-year-old woman without cardiovascular risk factors who developed stress-induced cardiomyopathy after propofol injection for anesthesia and was treated with conservative treatment. This case reminds us that clinicians should consider the possible occurrence of stress-induced cardiomyopathy after anesthesia using propofol, even in patients without cardiovascular risk factors. (Korean J Med 2015,89:206-209)
이지영 ( Ji Young Lee ),손주현 ( Joo Hyun Sohn ),김태엽 ( Tae Yeob Kim ),이정훈 ( Jung Hoon Lee ),장기설 ( Ki Sul Chang ),이혜영 ( Hye Young Lee ),이효영 ( Hyo Young Lee ) 대한간암학회 2013 대한간암학회지 Vol.13 No.2
Parasternal abscess is usually related to cardiac surgery, trauma or IV drug use and curable with antibiotics and surgical drainage. Sternal metastasis or primary parasternal abscess in a patient with hepatocellular carcinoma (HCC) is much rare and the differentiation between two diseases is occasionally difficult. Herein, we report a patient with HCC, diabetes mellitus and a spontaneously occurred parasternal abscess that is initially confused with a sternal metastasis. A-57-year-old man was admitted due to a slowly growing parasternal mass for 2 months. Two years prior to the admission, he had been diagnosed with small (1.6 cm) HCC in segment VII related to chronic hepatitis Band liver cirrhosis and treated with radiofrequency thermal ablation (RFTA). One year after RFTA, small (1.7 cm) HCC recurred in segment I and then he received TACE twiceat interval of 2 months. Eight months after that, multinodular HCCs newly developed in segment V and VIII (TNM stage IIIA) and two times of additional TACE were given. Thereafter he complained of gradually protruding mass with focal redness and mild tenderness on the sternum. But he denied any febrile and chilling sensation. Dynamic CT scans showed an enhanced parasternal lesion with bone destruction, while a bone scan displayed an increased uptake in the same site, resulting in an indistinguishable lesion between an abscess and a sternal metastasis of HCC. An excisional biopsy was performed on the lesion and revealed an abscess with sternal osteomyelitis rather than sternal metastasis. It was cured with surgical excision and antibiotics without complications.
간세포암종 환자에서 간동맥화학색전술 치료 직후 발생한 자발성 세균성 복막염 2예
이정훈 ( Jung Hoon Lee ),손주현 ( Joo Hyun Sohn ),김태엽 ( Tae Yeob Kim ),이지영 ( Ji Young Lee ),장기설 ( Ki Sul Chang ),이동훈 ( Dong Hoon Lee ),박은식 ( Eun Sik Park ) 대한간암학회 2013 대한간암학회지 Vol.13 No.2
Although acute hepatic failure (AHF) after transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) is not a rare complication, the development of spontaneous bacterial peritonitis (SBP) is uncommon. We describe two cases who suffered SBP and AHF right after TACE for HCCs. In the first case, 5 days after TACE ascites and jaundice newly developed and SBP was diagnosed at 9 days after TACE. After use of secondary antibiotics (imipenam) due to failure of primary therapy with 3rd cephalosporin, he discharged with resolution of SBP. In the second case, jaundice, abdominal pain and fever developed with increased ascites 3 days after TACE. After 8 days, SBP was diagnosed and treated with imipenam due to primary treatment failure, but clinical course was deteriorated. Eighteen days after discharge, she died of AHF. In patients with increased ascites and fever after TACE, clinician should be considered SBP with AHF among post-TACE complications, and prompt management is needed.