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결핵성 복막염과 감별이 어려운 클라미디아 트라코마티스 복막염
강화미 ( Hwa Mi Kang ),오태훈 ( Tae Hoon Oh ),강건희 ( Gun Hi Kang ),전태주 ( Tae Joo Joen ),서동대 ( Dong Dae Seo ),신원창 ( Won Chang Shin ),최원충 ( Won Choong Choi ),양근호 ( Keun Ho Yang ) 대한소화기학회 2011 대한소화기학회지 Vol.58 No.2
Lymphocytic ascites with low serum-ascites albumin gradient (SAAG) are observed mainly in tuberculous peritonitis, peritoneal carcinomatosis, and pancreatic disease. However, pelvic inflammatory disease (PID) induced generalized peritonitis causing diffuse ascites has been rarely described. We report a 26-year old female patient, who was diagnosed as generalized peritonitis with diffuse ascites due to Chlamydia trachomatis infection. Gynecologic examination did not show the clue of PID and in the analysis of ascites, low SAAG, predominant lymphocyte count and high level of adenosine deaminase were noted. Although the best impression was tuberculous peritonitis on the base of these findings, the laparoscopic finding was consistent with PID and the PCR for C. trachomatis infection in cervical swab was positive. This case suggests that C. trachomatis peritonitis should be considered as a rare cause of low SAAG and lymphocytic ascites in sexually active women and should be intensively evaluated including laparoscopic examination. (Korean J Gastroenterol 2011;58:111-116)
강화미 ( Hwa Mi Kang ),오태훈 ( Tae Hoon Oh ),서지영 ( Ji Young Seo ),전태주 ( Tae Joo Joen ),서동대 ( Dong Dae Seo ),신원창 ( Won Chang Shin ),최원충 ( Won Choong Choi ),김정연 ( Jung Yeon Kim ) 대한소화기학회 2011 대한소화기학회지 Vol.58 No.4
Background/Aims: Hyperplastic polyps (HPs) are the most common cause of all benign epithelial gastric polyps, constituting 30 to 93%. Although gastric HPs are usually considered as benign lesions compared with adenoma, neoplastic transformation has been known to occur rarely. We aimed to identify the clinical factors of gastric HPs predicting for neoplastic transformation. Methods: Between January 2002 to August 2010, a total of 274 gastric HPs, which had been removed by endoscopic polypectomy or surgical resection from 210 patients, were analyzed retrospectively. Results: Neoplastic transformation was found in 15 cases (5.5%) of 274 HPs including 10 cases of low grade dysplasia (3.7%), 2 cases of high grade dysplasia (0.7%) and 3 cases of adenocarcinoma (1.1%). Neoplastic transformations were significantly associated with >1 cm in size (n=10 [66.7%] vs. n=91 [35.1%], p=0.024), with pedunculated shape (n=9 [60.0%] vs. n=62 [23.9%], p=0.002), with previous history of gastrectomy (n=3 [20.0%] vs. n=3 [1.2%], p=0.002) and with synchronous neoplastic lesions occurring elsewhere in the gastric mucosa (n=5 [33.3%] vs. n=31 [12.0%], p=0.021). However, no significant difference was found between HPs with and without neoplastic transformation in terms of age, sex, number of polyps detected per patient, location, macroscopic appearance such as erosion, hyperemia. Conclusions: Neoplastic transformation of gastric HPs had significant relationships with >1 cm in size, pedunculated shape, postgastectomy state, and synchronous neoplastic lesion. Therefore, endoscopic polypectomy should be considered in these HPs to avoid the risk of missing HPs with neoplastic potential. (Korean J Gastroenterol 2011;58:184-189)
신장이식 환자에서의 ABO 부(副)-부적합에 의한 용혈성 빈혈
이동렬 ( Dong Ryeol Lee ),강화미 ( Hwa Mi Kang ),김민웅 ( Min Woong Kim ),김치훈 ( Chi Heun Kim ),박종환 ( Jong Hwan Park ),윤지훈 ( Ji Hoon Yoon ),공진민 ( Jin Min Kong ) 대한내과학회 2005 대한내과학회지 Vol.69 No.2
Background : Immune hemolysis secondary to ABO minor incompatibility is a rare graft versus host disease in renal recipients, secondary to anti-ABO antibody produced by lymphocytes of donor origin that reacts against recipient RBCs. Methods : To investigate the incidence and clinical features of immune hemolysis secondary to ABO minor incompatibility in renal allograft recipients, clinical records of 358 renal transplantation performed in Maryknoll Hospital since 1991 were analyzed retrospectively. Results : Fifty four (15%) of 358 renal transplants were ABO minor incompatible. Immune hemolysis secondary to anti-ABO antibody developed in 5 (9.2%) of 54 ABO minor incompatible renal transplant recipients. Immune hemolysis occurred in 3 (13.6%) patients among 22 allografts from blood type O donor to A recipients and 2 (10%) patients among 20 from blood type O donor to B recipients. All 5 patients received cyclosporin with prednisolone, and MMF was administered to one patient additionally. Immune hemolysis developed on 14±3 days after renal transplantation and lasted for about 10±3 days. The maximum reduction of hemoglobin was 3.3±1.0g/dL. All patients required donor type (blood type O) washed RBCs transfusion (5.0±2.6 units per patient) and plasmapheresis were performed in 3 patients (4.0±1.0 per patient). All patients recovered without deterioration of graft function. Age, number of HLA mismatch, creatinine at 1 year after transplantation, frequency of acute rejection and serum cyclosporin level during first 2 weeks were not significantly different between hemolysis group (N=5) and non-hemolysis group (N=49). Living unrelated transplantation is associated with increased incidence of immune hemolysis compared with living related transplantation (p<0.01). Conclusion : Although immune hemolysis secondary to ABO minor incompatibility is uncommon, we experienced cases with marked reduction of hemoglobin that required a large amount of transfusion. Therefore, this type of immune hemolysis needs to be considered as a differential diagnosis of posttransplant hemolysis. As our center routinely performs donor specific transfusion (DST), the incidence may be higher than that of other centers where DST is not usually given.(Korean J Med 69:177-182, 2005)
김민웅 ( Min Woong Kim ),윤지훈 ( Ji Hoon Yoon ),김치훈 ( Chi Hoon Kim ),강화미 ( Hwa Mi Kang ),박정호 ( Jung Ho Park ),조경임 ( Gyeong Im Jo ),김태익 ( Tae Ik Kim ) 대한내과학회 2006 대한내과학회지 Vol.71 No.4
Clopidogrel is an oral agent that blocks ADP receptor-mediated platelet aggregation. Clopidogrel along with aspirin was shown by the CURE trial to result in a 20% relative reduction of cardiovascular death, myocardial infarction or stroke. Ticlopidine has been shown to reduce the incidence of stent thrombosis compared with warfarin, but it may cause serious hematological side effects. However, the reported neutropenia has been similar to clopidogrel and aspirin treatment groups (0.01 vs 0.17%, respectively) with corresponding rates (0.05 vs 0.04%, respectively) of severe neutropenia. We treated a 72-year-old female patient with severe neutropenia who underwent percutaneous coronary intervention with drug-eluting stent placement and had no neutrophils in the peripheral blood at 11 days after clopidogrel use. Therefore, clinicians should be alerted to the possibility of severe neutropenia with clopidogrel treatment.(Korean J Med 71:426-430, 2006)