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증례 : 감염 ; 장티푸스와 렙토스피라병의 동시 감염 1예
송은훈 ( Eun Hoon Song ),김민정 ( Min Jeong Kim ),전해리 ( Hae Ri Chon ),고봉진 ( Bong Jin Ko ),서정연 ( Jung Yeon Seo ),정은수 ( Eun Soo Jeong ),최석훈 ( Seok Hoon Choi ) 대한내과학회 2010 대한내과학회지 Vol.79 No.3
열성 질환의 동시감염은 각 질환의 유사한 임상양상으로 인하여 진단 및 치료에 있어 혼란을 가져온다. 국내 및 해외 학회에서는 동시감염으로 인해 진단 및 치료에 있어서 어려움이 있었던 예들이 보고되어지고 있으나 장티푸스와 렙토스피라병의 동시감염은 아직 보고된 바가 없었다. 저자들은 초기 항생제 치료에 반응을 보이지 않았던 장티푸스에서 렙토스피라병의 동시감염을 진단하였고, 항생제 병용으로 치료한 1예를 경험하였기에 보고하는 바이다. A 37-year-old male patient presented with a fever, chills, and abdominal pain. The patient was diagnosed with Typhoid fever based on blood culture, but did not clinically respond to standard antibiotic (Ceftriaxone) therapy. On day 9, leptospira serology was positive and doxycycline was added to the treatment strategy. With combination therapy, the patient recovered from the infection. In most cases, similar clinical presentations make the diagnosis of concurrent infections of febrile diseases difficult, and serious complications can develop as a consequence of delayed treatment. As with this case, if the patient initially has serious a medical condition caused by complications, and does not clinically respond to initial standard antibiotics therapy or has an unusual course of disease, concurrent infection must be considered. (Korean J Med 79:331-334, 2010)
증례 : 소화기 ; 코카콜라 내시경적 주입법과 아르곤 플라스마 빔을 이용한 위석의 치료 1예
신혜영 ( Hye Young Shin ),김민정 ( Min Jeong Kim ),송은훈 ( Eun Hoon Song ),태재웅 ( Jae Woong Tae ),고봉진 ( Bong Jin Ko ),박장원 ( Jang Won Park ),장우진 ( Woo Jin Jang ) 대한내과학회 2010 대한내과학회지 Vol.79 No.1
크기가 크고 단단한 위석(10×8×6 cm)에 내시경적인 방법으로 주입기를 통해 코카콜라 30 mL를 여러 군데 주입하였고, 한 시간 후 아르곤 플라스마 빔을 조사하여 위석을 절개 및 파쇄하였다. 이 절단면에 다시 코카콜라를 주입하였고, 아르곤 플라스마 소작기, 용종절제술 올가미, 쇄석기 바스켓을 이용하여 위석을 반복적으로 분쇄하였다. 이와 같은 병합 요법으로 기존에 수일에 걸쳐 제거되었던 위석이 90분 내에 안전하게 제거되어 증례를 보고하는 바이다. Bezoars are persistent concretions of indigestible materials found in the stomach. They can cause mucosal ulceration or wall perforation, gastritis, gastric outlet obstruction, or gastrointestinal bleeding. With the significant development of endoscopic techniques, many authors have reported the removal of bezoars using methods such as endoscopic mechanical lithotomy and chemical dissolution however, the outcomes differ according to the treatment method. We report a case treated successfully with an endoscopic Coca-cola injection and an argon plasma beam for 90 minutes. A 61-year-old man was admitted with a 4-day history of upper abdominal pain. A bezoar was detected by upper gastrointestinal endoscopy. The bezoar (10×8×6 cm) was dark brown in color and extremely hard. Attemptat endoscopic removal using a polypectomy snare failed. We then injected Coca-cola directly into the bezoar mass and sprayed it with an Argon plasma beam. Ninety minutes later, the bezoar was broken into pieces and removed. The bezoar was absent at the follow up endoscopy 2 weeks later. (Korean J Med 79:48-52, 2010)
내시경적 역행성 췌담관조영술중 췌선방 조영 후 발생한 중증 췌장염 1예
장세중,기승석,김훈일,신혜영,박장원,송은훈,태재웅 朝鮮大學校 附設 醫學硏究所 2008 The Medical Journal of Chosun University Vol.33 No.2
내시경적 역행성 담췌관조영술 후 발생한 급성췌장염의 발생인자로 여러 가지 인자들이 관여하지만 특히 담췌관조영술 시행 후 과도한 췌선방 조영화에 의한 중증의 췌장염 증례를 경험하였기에 보고하는 바이다 Endoscopic retrograde cholangiopancreatography (ERCP) has been considered as a valuable tool for the diagnosis and management of disease of the pancreas and biliary tree. Post-ERCP pancreatitis is the most frequent and clinically significant complication following ERCP. But a few complication associated with this procedure are unforeseeable. Specially, acinarization as a result of a careless cooperation between operator and assistant may be influenced in complications of ERCP. Severe post-ERCP pancreatitis is rare complication, and its prognosis will be poor. Therefore, careful process and good relationship between operator and assistant in ERCP may be prevented this complication, but is not clear. Neglect of acinarization may be resulted in more aggravation of pancreatitis. We have cared for one patient with severe post-ERCP pancreatitis with pseudocyst after water-soluble contrast media spreading into the acini (acinarization) via ERCP in resolving phase idiopathic pancreatitis.