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Somatostatin 투여로 임상적 호전을 보인 악성인슐린종 1 예
정창호,권용준,한승수,김종호,이병두,김광희,문병천,전배완 대한내과학회 1991 대한내과학회지 Vol.41 No.2
A 61 year-old woman with symptomatic, malignant insulinoma was hospitalized with random blood glucose levels of 16-48 mg/dl and corresponding serum insulin levels of 35~54 μIU/ml. Physical examination showed a slightly enlarged liver, which was palpable 1 finger breadth below the right costal margin. Abdominal CT and selective celiac angiogram revealed hypervascular pancreatic mass with metastases to the liver and spleen. Ultrasono-guided aspiration biopsy cytology of the pancreas and excisional biopsy of tumor thrombus on the gastrocolic omentum revealed islet cell adenoma. Treatment was begun with subcutaneous injection of 50㎍ of SMS 201-995 every 8 hours. The hypoglycemic symptom was well controlled by doses of 200~250㎍ t.i.d and blood glucose levels also improved, There were no significant side effects except for diarrhea which was easily controlled by conservative treatment. The potential value of this new drug in management of malignant insulinoma was illustrated by this case over a short period, but the long-term effects on the serum glucose and insulin levels in our patient remain to be determined.
문정미,전병조,이병국,염경인,허탁,민용일,서정진 대한응급의학회 2002 대한응급의학회지 Vol.13 No.4
Locked in syndrome (LIS) is a state of tetraplegia and lower cranial nerve palsies in which vertical eye movement and blinking are the only means of communication, but consciousness is preserved. LIS is most frequently a sequelae of a basilar artery thrombosis lesion and may be caused by trauma, hemorrhage, a tumor, infection, etc., which results in a ventral pontine lesion or bilateral midbrain lesion. Early diagnosis and treatment must be a priority because the recovery of patients with locked in syndrome caused by a basilar artery occlusion is exceptional, with a 65∼75% mortality. Although an improved clinical outcome can be achieved in patients with a basilar artery occlusion by early recanalization after the use of thrombolytic therapy or angioplasty, early diagnosis and treatment of this state is difficult, for the neurologic deficits develope gradually. The diagnosis of LIS in patients who present with hypoxia, metabolic disorder, endocrine disorder, central nerve system disorder, acute alcohol intoxication, acute drug intoxication, etc may be missed. At the emergency department, closer attention and frequent neurologic examinations must be given to patients who complain of altered mental state. We report a case of LIS which was misdiagnosised as hypoglycemic encephalopathy and review the literature.