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비당뇨병성 말기신부전증 환자에서 양측성 기저핵 병변과 소뇌 병변을 동반한 요독성 뇌병증
심성록 ( Soung Rok Sim ),이상훈 ( Sang Hun Lee ),장재훈 ( Jae Hoon Jahng ),임재윤 ( Jae Yun Lim ),최유경 ( You Kyoung Choi ),배기선 ( Ki Sun Bae ),박우일 ( Woo Il Park ),김기중 ( Ki Joong Kim ),이경열 ( Kyung Yul Lee ),박형천 ( Hy 대한신장학회 2006 Kidney Research and Clinical Practice Vol.25 No.6
Involvement of central nervous system is a well-known compication in uremic patients. However, development of acute extrapyramidal symptoms with bilateral basal ganglia involvement (acute basal ganglia syndrome), especially in non-diabetic hemodialysis patient is very rare. We report a case of acute basal ganglia syndrome in a non-diabetic hemodialysis patient. A 45-year-old man with autosomal dominant polycystic kidney disease (ADPKD) on chronic hemodialysis treatment for the last 4 years was admitted due to generalized myalgia. On admission, the patient was found to have rhabdomyolysis and intractable metabolic acidosis. Nine days after admission, he suddenly developed dysarthria, lateralizing ataxia, and bradykinesia. Brain MRI demonstrated low and high signals in bilateral basal ganglia and cerebellar vermis in T1-weighted and T2-weighted images, respectively. Intensified hemodialysis treatment combined with general supportive therapy resolved the severe metabolic acidosis and the neurologic manifestations gradually improved. Follow up brain CT scan taken 3 months later showed decreased size of initial low attenuation lesions in bilateral basal ganglia and cerebellar vermis. Although no definite pathophysiology is yet established, severe metabolic disorder is believed to play an important role in development of acute basal ganglia syndrome. Correction of metabolic acidosis and hypoglycemia in our patient lead to improvement in neurologic manifestations and organic brain lesions. Our case suggests that severe metabolic acidosis and hypoglycemia in uremic patient may act as risk factors for acute basal ganglia syndrome even in non-diabetic patient. (Korean J Nephrol 2006;25(6):1061-1066)
최유경,김혜진,임재윤,심성록,이상훈,윤희정,김명수,송영구,김준명 대한감염학회 2006 감염과 화학요법 Vol.38 No.5
2명의 간경변 환자에서 비브리오균혈증을 경험하였다. 1명은 구토와 설사 등의 장염 증세로 내원하여 혈액배양검사에서 비브리오균이 검출되었다. 다른 환자는 설사를 주소로 내원하였고 다리에 수포성 병변도 같이 발생하였고 혈액배양 검사에서 비브리오균이 검출되었다. 두 환자 모두 수액과 항생제 치료로 증세 호전되고 혈액배양검사 음전되어 퇴원하였다. We have experienced two cases of bacteremia in liver cirrhosis patients caused by Vibrio parahemolyticus. One presented with acute gastroenteritidis symptoms such as vomiting, diarrhea. Vibrio parahemolyticus was cultured in the blood. In the other patients showed vesicular rash in lower extremities with a positive blood culture. Both patients had been treated with intravenous fluid and antibiotics.