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남형석 ( Hyung Seok Nam ),김광하 ( Gwang Ha Kim ),김동욱 ( Dong Uk Kim ),최문기 ( Mun Ki Choi ),이양선 ( Yang Seon Yi ),황종민 ( Jong Min Hwang ),김석 ( Suk Kim ) 대한소화기학회 2011 대한소화기학회지 Vol.57 No.2
Endoscopic retrograde biliary drainage (ERBD) is useful for the palliative decompression of biliary obstruction. However, the complications of ERBD include cholangitis, hemorrhage, acute pancreatitis, obstruction of the stent, and duodenal perforation. Pressure necrosis on the duodenal mucosa by the stent may contribute to perforation. Although duodenal perforation following ERBD is very rare compared to other complications, it can result in a fatal outcome. Recent reports describe nonsurgical treatment for small gastrointestinal perforation with localized peritonitis and suggest that endoclipping may be appropriate in the management of a well selected group of patients with iatrogenic perforation. We describe a case of duodenal perforation secondary to ERBD that was successfully treated with approximating using endoclip and detachable snare. (Korean J Gastroenterol 2011;57:129-133)
증례 : 신장 ; Nutcracker Syndrome과 함께 진단된 특발성 막증식성 사구체 신염 제1형 1예
신민지 ( Min Ji Shin ),이희선 ( Hee Sun Lee ),안강희 ( Kang Hee An ),황종민 ( Jong Min Hwang ),남형석 ( Hyung Suk Nam ),김정섭 ( Jung Sup Kim ),곽임수 ( Ihm Soo Kwak ) 대한내과학회 2011 대한내과학회지 Vol.81 No.1
Nutcracker 증후군이란 좌측 신정맥이 대동맥과 상장간막동맥 사이에서 압박을 받아 발생하는 임상적인 증후군으로 무증상의 혈뇨, 좌측 요통이나 복통의 형태로 나타나고 심한 단백뇨는 드물다고 알려져 있다. 저자들은 신증후군과 현미경적 혈뇨로 내원하여 Nutcracker syndrome과 함께 특발성 막증식성 사구체신염 제1형으로 확진된 1예를 경험하였다.Nutcracker 증후군으로 진단되더라도 심한 단백뇨를 보일 때는 사구체신염의 동반 가능성도 배제해야 하므로 신생검을 고려해야 하겠다. The Nutcracker syndrome refers to compression of the left renal vein between the aorta and superior mesenteric artery, which results in renal vein and left gonadal vein varices, hematuria, and left flank pain. Here, we report a case of biopsy-proven membranoproliferative glomerulonephritis with radiologically documented Nutcracker syndrome. The patient presented with generalized edema for several months. In order to evaluate isomorphic hematuria, we performed computed tomography (CT), which showed Nutcracker syndrome. A renal biopsy revealedmembranoproliferative glomerulonephritis, Type I. In conclusion, inadults with Nutcracker syndrome that involves severe proteinuria, the possibility of combined glomerulonephritis must be considered. (Korean J Med 2011;81:111-115)