Tacotsubo Cardiomyopathy Secondary to Pyogenic Liver Abscess

( Jeong Ill Suh ) 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1

Background: Takotsubo cardiomyopathy, also known as stress cardiomyopathy, is a type of non-ischemic cardiomyopathy in which myocardium suddenly weaken temporarily and is caused by emotional or physical stress such as sepsis, bleeding, asthma, or pheochromocytoma. Several infections have also been shown to precipitate Takotsubo cardiomyopathy. However, few cases have demonstrated the association with liver abscess. Reported herein is a rare case of Takotsubo cardiomyopathy precipitated by the liver abscess. Case: A 73-year-old female was admitted due to fever. She has been without any illness. She was acute ill looking appearance. Initial vital signs were: BP 110/60 mmHg, HR 101 beats/min, RR 20 breaths/min, temperature 38.0℃. Laboratory studies revealed WBC 21,550/㎣, hemoglobin 14.7 g/dL, platelet 101,000/㎣, prothrombin time was 15.8 sec (INR of 1.44). AST/ALT 94/87 IU/L, total bilirubin 0.89 mg/dL, albumin 2.9 g/dL, r-GTP 66 U/L, ALP 139 U/L. Viral markers were HBsAg(-), anti-HBs(+), anti-HBc IgM(-), anti-HAV IgM(-), anti-HCV(-). Initial EKG showed sinus tachycardia. Abdominal CT showed about 5x6cm sized cystic mass like lesion with air bubbles in the liver S8. Percutanenous catheter drainage was performed and antibiotic treatment was started. On 2^nd day after admission, she developed suddenly worsening of dyspnea followed by blood pressure drop. Follow up EKG revealed myocardial ischemic change of lateral wall. CK 602 U/L, CK-MB 105.4 ng/ml, LDH 613 U/L, Troponin-I 18.8 ng/ml. Transthorasic echocardiography showed diffuse myocardial hyokinesia (ejection fraction 26%). But, coronorary angiogram showed completely normal findings. The cultured pus and blood samples were positive for K. pneumoniae. On the 11th day of hospitalization, her cardiac function was restored and EKG showed normal sinus rhythm. Her liver function recovered completely to normal and follow up abdominal CT showed marked decreased size of liver abscess on 38th day of hospitalization. Conclusions: Tacotsubo cardiomyopathy caused by pyogenic liver abscess is rare. The presentation is vary from asymptomatic to chest pain, shortness of breath, nausea, vomiting, palpitations or fainting. It may also show an EKG change and troponin elevation similar to myocardial infarction. Although stress cardiomyopathy is a reversible condition, but it can be serious and fatal.

가성동맥류의 수술적 가료

김재홍,임만빈,이창영,김일만,Kim, Jae Hong,Yim, Man Bin,Lee, Chang Young,Kim, Ill Man 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.3

Objective : Surgical experiences of pseudoaneurysms such as traumatic, mycotic and ill-defined unknown causes of aneurysms are rare. The authors have studied the results of surgical management from such cases in our series. Patients and Method : In the last 17 years, 1320 patients with cerebrovascular aneurysms were managed surgically. Among these, 16 patients showed the pseudoaneurysms. The authors analyzed retrospectively the clinical characteristics, treatment methods, management outcomes and problems in the managements. Results : There were 6 patients with traumatic aneurysm, 4 mycotic aneurysms and 6 ill-defined unknown causes of aneurysm. The sites of traumatic aneurysms were cavernous portion of the internal carotid artery(n=3), distal portion of the anterior cerebral artery (n=2) and vertebral artery(VA : n=1). Good outcomes in 5 cases could be obtained by extracranial - intracranial bypass followed by parent vessel occlusion or resection of aneurysm followed by re-anastomosis of parent vessel. The sites of mycotic aneurysm were peripheral portions of middle cerebral artery(MCA : n=3) and posterior cerebral artery(PCA : n=1). The outcomes of the patients with a mycotic aneurysm were relatively poor. It was partially due to the development of new aneurysm after treatment in one. The sites of ill-defined unknown causes of aneurysm were extracranial carotid artery(n=3), V2 portion of the VA(n=1), peripheral portion of the PCA (n=1) and MCA(n=1). Good outcome in all cases could be obtained by resection of aneurysm with or without saphenous vein graft. Conclusion : For the treatments of cerebrovascular pseudoaneurysm, combinations of aggressive medical, endovascular and surgical managements seem mandatory. Insertion of stent for a extracranial carotid artery aneurysm and coiling for a peripheral mycotic aneurysm can be option in future.

現場作業者의 品質意識調査硏究

宋瑞日 동아대학교 공과대학 부설 한국자원개발연구소 1986 硏究報告 Vol.10 No.2

This paper analyzes the results of questionnaire-survey, which "What's the reason of the occurrence of defects in working?", to obtain informations to the worker's quality consciousness. The enque^te, which consists of 4 categories such as technical knowledge, work performance, working environment and human relations at home and office, is prepared and handed out 810 workers to get information. The results are summarized as follows: (1) Being worse hand at work and unconscious of the work's method bring unskillfullness at work. (2) Getting distracting thoughts at work and their instantaneous carelessness cause lackness of mental concentration. (3) Excessive noise around the work station, ill-ventilating condition and lackness of the number of workers interfere concentrating on all their energies to the work. (4) Their inconvenient human relations with coworkers, foreman, and officers decrease their working intention.

홍역 경과증 Tuberculin 반응의 관찰

金一秀 대한소아과학회 1971 小兒科 Vol.14 No.2

유태人의 迫害意識과 救濟 : Saul Bellow의 The Victim을 中心으로

金日周 釜山大學校 師範大學 1979 교사교육연구 Vol.6 No.1

All of Bellow's novels, with the possible exception of The Adventure of Augie March, deal with the sufferer who, confronted by a guilt-distorted correlative of himself, seeks to redeem himself throuh succumbing to the temptation of his devil. It is also ture of the Victim. The Victim is a superbly through examination of complexities of moral guilt in the course of the redemption from the heroe's distorted sense of persecution. This paper attempts to investigate the sense of infringement which the hero suffers from, and examine how he should free himself from it to survive, in the absurd world. As a jew, Asa Levethal is a sufferer who has his natural tendency、to feel percecuted. Allbee is Leventhal's antagonist, who is the anti-Semite, a suffering and insufferable creep. He appears from somewhere to accuse Leventhal of having contrived his ruin in revenge for an anti-Semitic remark Allbee once made at a party. He blames Leventhal for all his ills, haunts Levethal in parks and restaurants and moves into his appartment where he finally attempted suicide. Owing to his painful consciousness of anti-Semitism, Asa Leventhal is vulnerable to Allbee's blame. And he feels guilty because he believes that his suffering, like all suffering, is desevered. As he becomes correspondingly more guilt-ridden, he becomes more obsessed with being oppressed. In truth, The anti-Semite is a kind of objective correlative for Leventhal existence, and assails Leventhal's self-image and intensifies his repressed sense of inadquacy. At my frist reading, it seems that the horror of anti-semitism takes possession of his cons-ciousness. He sees the world from a Jewish distorted point of view, so that his tormenting throughts are imaginary. So he is a victim of himself instead of a victim of Allbee. Under the combined pressure of Allbee's persecution and Mickey's death, his rational monitor breaks down. Unable to distinguish the external world from his obsessive internal one, he loses almost all the sense of reality and his perception becomes in effect insane. His salvation from the obsessive internal world begins with accepting his responsibility for Allbee's comedown. His conscious acceptance of responsibility is a moral act that makes possible his ultimate redemption. But this legalism is not enough to bring about Asa's transformation. In this view point, Bellow maks Leventhal share Allbee's depravities and identify with him. In the begin- ning Asa will not acknowledge his affinity with Allbee, but, with the development of their relation, there is his growing sense of closeness and his sense of almost physical oneness. He feels this at their meeting at the zoo. Momentarily he sees himself from the point of the other. Late during Allbee's visit comes to Asa again a feeling of intimate nearness. He senses that the look of recognition Allbee bent on him duplicated the look in his own eyes and even feels tied to Allbee in a way that extents beyond duty and repayment. Their mutual repulsion and objectified self-repulsion, evolves, through their sense of likeness, into a grotesque attraction. As seen at the last scene Allbee carries on a sordid affair with a woman, it shows a moment of obscene identification between two. With the growing feeling of identification, Leventhal finally accept his responsibility for Allbee's degradation even though he did not inflict Allbee intentionally. At last he accept not only Allbee's suffering but also the hardship of all the people in the world, for he is convinced that everything takes place as if within a single soul. It is a sense of the unity of all persons, the essential affinity of all persons. The movement toward perception of others as real, toward identification with others and toward acceptance of self makes possible Leventhal's redemption from his own paranoiac version of the real world. This truth of unity in the Victim is Bellow's way of reconciling the individual and the community.

GIS기법으로 복원한 일산지역의 Holocene 古地理

황상일 慶北大學校 師範大學 地理敎育科 1995 地理敎育 Vol.8 No.-

In this research through the outcome of research about Ⅱ-San area Gyunggi Bay province, on the basis of sedimemtary facies, environmental change of sedimentation and holocene sea level change, I recovered the paleogeography of alluvial low land and alluvial plain since around 7,000 B.P. by using GIS method. And also in this research, I examined the efficiency of explaining paleogeography using GIS, by comparing and investigating three-dimensional outcome with another topographical map drawn by two-dimension. The chief contents are summarized as follows: 1. The alluvial low land plain in Ⅲ-San area, from around 7,000 B.P. to almost 5,000 B.P. was under the influence of salt water flowed upstream through the paleo-river channel, which is 4 or 5m different from the surface of the adjacent alluvial plain in height, became inner bay environment influenced greatly by open-water then changed into a sallow swampy land environment by 3,200 B.P. and then by 2,300 B.P. it changed into inner bay environment and finally replaced by overflowing environment. 2. Since 7,000B.P there had been two transgressions and two regressions in turn. During thig period, the alluvial low lands were formed. Up to now, except the last 1000 years, it had been under the influence of salt water. This kind of environmental change seemed to have a great influence on the way of living of the prehistoric inhabitants, That is, we could verify in the result of antiquarian investigations that human activities were prosperous around 2,300 B.P. period, influence of salt water decreased. 3. This recovered ancient geography with three-dimension method, the relationship between human and nature since 7,000 B.P. can be analyzed and explained in various ways, if it's combined with archeological discovery. 4. The research of geomorphology in Korea is mostly about geomorphological surface of gentle slope and alluvial plain. Considering this kind of stream three-dimensional map method of GIS has some defects of exaggerating near hilly districts, comparing a contour line map with two-dimension, it is easy to understand by sight.

열사병에 관한 임상적 고찰

이춘일,김정완,길현교,장연복,박정식,박성우,김병태,최문기,고영박,선덕재 대한내과학회 1990 대한내과학회지 Vol.38 No.3

Heat stroke is a medical emergency and the most important environmental heat illness. It is a disease of high fever, dry warm skin without sweating, and mental disturbances. It commonly involves several organs including the liver, kidney, heart, brain, and the coagulation system. Recently, we experienced 10 cases of heat stroke. The clinical findings of those were as follows: 1) At the time of admission, body temperature in all patients were higher than 39.4℃, and especially in 4 cases, higher than 41.4℃ : pulse rates in all patients were more than 140/min: and systolic blood pressure were less than 100 ㎜Hg except in one case. 2) The clinical manifestations were CNS symptoms including 6 cases of coma, variable skin lesions, G-I hemorrhage, muscle swelling with tenderness and oliguria. 3) On blood chemistry, there were markedly decreased levels of protein, albumin and calcium: markedly inceased level of SGOT, SGPT, CPK, LDH, BUN, and creatinine: one case of hypokalemia and two cases of hyperkalemia: and 4 cases of hyperbilirubinemia greater than 2㎎/㎗. 4) Two cases of myoglobinuria, 3 cases of proteinuria nd 1 cases of hematuria were observed. 5) Complications, such as uremia, ventricular tachycardia, D.I.C., pulmonary edema, pleural effusion, jaundice and acute pancreatitis were observed. 6) Four cases out of 10 were died. The causes of death were pulmonary edema, cerebral edema, D.I.C., hepatic failure and cardiac failure.

VATER Association 1예

최명재,박영일,김상우,고일향 인제대학교 1986 仁濟醫學 Vol.7 No.4

We have experienced a case of VATER association in a newborn infant who presented with typical anomalies. The diagnosis was made with physical and autopsy findings consisted of anal atresia, tracheoesophageal fistula with esophageal atresia, left radial dysplasia with limb anomalies, right renal agenesis, cardiac anomalies, vesicoperineal fistula, and vesicorectal fistula. Brief review of the related literatures is also presented.

정상 면역 환자에서 발생한 거대세포바이러스 대장염 1예

이창우,김남일,이구,서정일,양창헌,구정태 대한소화기학회 2000 대한소화기학회지 Vol.35 No.5

Cytomegalovirus (CMV) infection is common in immunocompetent individuals, causing a mild flu- like illness. Up to 81% of normal healthy individuals aged over 35 have raised CMV antibody titers. However, CMV infection causing colitis is rare but usually fatal. On the contrary, CMV colitis is common in immunosuppressed individuals, especially in those who are Human immunodeficiency virus (HIV) seropositive. We experienced a case of colitis caused by CMV, which was not related with immunosuppression. It remains unclear why the patients developed CMV colitis. Here, we report a case of CMV colitis in an immunocompetent adult, which was confirmed by histopathologic findings through colonoscopic biopsy.

1988 년 가을 강원도 영서지역에서 발생한 쭈쭈가무시병 24 예의 임상적 관찰

최동성(Dong Seong Choi),이광훈(Kwang Hoon Lee),박진현(Jin Hyun Park),신계철(Gae Chul Shin),조한선(Han Sun Jo),심영학(Young Hak Shim),윤갑준(Gap Jun Yun),백일기(Ill Ki Baek),임채선(Chae Sun Im),호휘남(Whi Nam Ho) 대한내과학회 1989 대한내과학회지 Vol.37 No.3

N/A We obserbed 24 cases of tsutsugamushi disease occur- ring in the Gang-Won-Do area from September to October 1988, which were confirmed by indirect immunofluorescent antibody test, and analysed their clinical findings. On physical examination eschars which can be a clinical clue to tsutsugamushi disease in the early stage of infection were recorded in 11 cases (45%). Common laboratory features included thrombocytopenia in 19 cases (95/o), and increased SGOT in 22 cases (92%), SGPT in 49 cases (79%), LDH in 19 out of 20 cases (95%) tested, CK in 7 out of 20 cases (35%) tested and serum ADA level in 12 of 13 cases (92%) tested. Serum fibrinogen was decreased in 5 of 13 cases (38%) tested, FDP was positive in 8 of 13 cases (62%) tested and prolonged prothrombin time was observed in 9 cases (38%). When IgM and IgG titers were measured separately, two distinct responses were seen. The IgM titers gradually declined during the period from 14-40 days. The IgG responses in the same patients developed more slowly. In our study, tsutsugamushi disease was a mild to severe febrile illness of 1 to 2 weeks duration. We think that more concern about tsutsugamushi disease is necessary because of possible mortality in poorly treated cases as well as a need for more precise differential diagnosis of acute febrile illness.