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호흡부전과 신경학적 이상을 동반한 Acute Intermittent Porphyria
전대원(Dae Won Jun),최춘식(Choon Shik Choi),최호순(Ho Soon Choi),전용철(Yong Chul Jung),손주현(Joo Hyun Sohn),한동수(Dong Soo Han),윤병철(Byung Chul Yoon),함준수(Joon Soo Hahm),이민호(Min Ho Lee),이동후(Dong Hoo Lee),기춘석(Choon Shu 대한소화기학회 2000 대한소화기학회지 Vol.36 No.3
The acute intermittent porphyria (AIP) is characterized biochemically by increased excretion of porphyrins and porphyrin precursors, S-aminolevulinic acid (ALA) and porphobilinogen (PBG). AIP presents with abdominal pain, mental disturbances and neurologic dysfunction. A 24-year-old woman with a medical history of AIP was admitted to our hospital because of abdominal pain and proximal muscle weakness. She was treated by carbohydrate loading with intravenous glucose. Twenty five days later, she developed tachycardia, fluctuation of blood pressure and syndrome of inappropriate secretion of antidiuretic hormore (SIADH). On 90th day, intubation was required to control her breathing. Complete flaccid paralysis developed, and the patient became comatose. The neurologic effects of acute porphyria are generally reversible, but the clinical course of severe case is complicated with respiratory failure, fluid electrolyte imbalance. AIP should be considered in differential diagnosis of patient with unexplained respiratory failure. (Kor J Gastroenterol 2000;36:413 - 418)
Choi, Choon Shik,Kim, In Soon,Choi, Il Young 한양대학교 의과대학 1999 한양의대 학술지 Vol.19 No.2
악성이나 비악성 종양에 대해 화학 요법과/또는 방사선 조사로 치료를 받은 환자들 가운데 백혈병이 이차적으로 발병된 환자들을 일컬어 "치료와 연관된 백혈병(therapy-related leukemia)" 환자라 한다. 급성 골수성 백혈병은 치료와 연관된 이차적인 악성 종양 중 그 빈도가 가장 많고 가장 심각한 종양이다. 이러한 이차성 급성 골수성 백혈병은 이전에 epipodophyllotoxins와 anthracyclines를 투여한 것과 연관이 있으며 M4와 M5가 현저한 반면 M2 아류형은 드물게 보고 되고 있고, 또한 최근에는 치료와 연관된 급성 전골수성 백혈병(M3)에 대한 보고도 나날이 늘어나고 있는 실정이다. 여기서 우리는 유방암에 대한 술후 보조 화학 요법과 국소 방사선 요법을 시행한 후 84개월 만에 급성 전골수성 백혈병으로 진단된 42세 여자 환자를 보고하고자 한다.
만성 간질환의 진행 정도 평가를 위한 비침습적 검사들의 상관관계와 임상적 의의
이재원,정진웅,이민호,박근태,김진배,전대원,함준수,유영조,박경남,윤병철,최호순,최춘식 대한소화기학회 1999 대한소화기학회지 Vol.33 No.6
Background/Aims: We aimed to figure out a correlation of non-invasive tests for the diagnosis o chronic active hepatitis (CAH) or liver cirrhosis (LC). Methods: We measured the levels of serum albumin, bilirubin, alanine aminotransferase (ALT), asparate aminotransferase (AST), cholesterol prothrombin time, ICG-Rmax and shunt index (heart/liver ratio) in 174 patients with CAH and 80 patients with LC (Child A, 73 patients; Child B, 7 patients). A correlation of these values to evaluat the progression to liver cirrhosis was figured out from the multiple regression analysis. Results: There were significant differences between CAH patients and LC patients in the ratio of ALT to AST (ALT/AST, 1.45 ±0.05 vs 0.99 ±0.05), prothrombin time (93.9 ±1.2% vs 77.1 ±2.4%), ICG-Rmax (2.11 ±0.15 vs 1.07 ±0.12) and shunt index (0.21 ±0.00 vs 0.60 ±0.03). The multiple regression analysis of non-invasive tests yielded a formula, Y=3.3431 -0.8160 ×ALT/AST -0.0343 ×prothrom-bin time +2.6963 ×shunt index & p=ey/(ey+1)timate the progression of chronic liver disease. The p value was less than 0.7 in 126 (96.2%) of 131 CAH patients, while 47 (68.1%) o69 LC patients showed p value over 0.7. Conclusions: When the p value mentioned above exceed 0.7, CAH is likely to develop into an early LC. These results suggest that the formula inferred from the multiple regression analysis of non-invasive tests may be used to evaluate the progression of chronic liver disease without the repeat of liver biopsy.
급성 복통과 상부위장관 출혈을 동반한 물개회충 감염 2예
박경남,이민호,강문수,최호순,변재원,이동후,기춘석,함준수,전대원,최춘식,윤병철,류재숙,안명희,민득영,윤창옥 대한소화기학회 2000 대한소화기학회지 Vol.35 No.4
Human Anisakiasis is caused by the accidental human infestation of larvae of marine mammals. The larvae are usually introduced into human body by the intake of saltwater fish and squid. The common clinical symptoms are colicky pain, diffuse abdominal tenderness, nausea, vomiting, fever, and leukocytosis. Sometimes, they are severe enough to need acute abdominal surgery. The larvae invade the gastrointestinal mucosa, and occasionally result in upper gastrointestinal bleeding. Infestation by Anisakis type I is observed more often than that by Peudoterranova decipiens in Korea. The characteristic intestinal cecum which protrudes towards the ventriculus can be seen in Peudoterranova decipiens. While the characteristics of Anisakis type I and Peudoterranova decipiens are a little different, the clinical manifestation and treatment seem to be the same. We report two cases of gastric Anisakiasis caused by Peudoterranova decipiens larvae, which present acute abdominal pain and upper gastrointestinal bleeding.