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이달의 X-선 : 급성호흡부전 환자에서 기관절개술 시술 후에 발생한 양측성 긴장성 기흉 1예
윤현영 ( Hyeon Young Yoon ),오숙의 ( Suk Ui Oh ),박종규 ( Jong Gyu Park ),신태림 ( Tae Rim Sin ),박상면 ( Sang Myeon Park ) 대한결핵 및 호흡기학회 2007 Tuberculosis and Respiratory Diseases Vol.62 No.5
기관절개술은 가장 오래된 수술기술 중의 하나로 상기도 폐쇄의 경감, 장기간의 기계호흡유지, 보조적 기계호흡시에 기도 저항의 감소 등의 목적으로 시행할 수 있다. 기관절개술에 따른 초기합병증으로는 기흉, 피하조직기종, 절개부위 출혈, 종격동 기종, 흡인, 기관절개 관 전위 등을 들 수 있다. 수술에 따른 피하조직기종과 기흉은 0.9-5%에서 보고되었다. 본 증례에서는 기관절개술 직후에 피하조직기종과 양측 폐에서 발생한 긴장성 기흉을 경험하였기에 보고하는 바이다. Tracheostomy is one of the oldest surgical procedures in medical history. The indications for a tracheostomy include the relief of an upper airway obstruction, long-term mechanical ventilation, and decreased airway resistance to help wean the patient from mechanical ventilator support. Unfortunately, tracheostomy is also associated with a number of problems including, bleeding, infection, pneumothorax, and tracheal stenosis. A pneumothorax is an uncommon complication of a tracheostomy, and can result from direct injury to the pleura or positive pressure ventilation through a dislocation of the tracheostomy tube. We report an uncommon case of a tracheostomy-induced bilateral tension pneumothorax with a review of the literature. (Tuberc Respir Dis 2007; 62: 437-440)
윤현영 ( Hyeon Young Yoon ),오숙의 ( Suk Ui Oh ),박종규 ( Jong Gyu Park ),신태림 ( Tae Rim Sin ),박상면 ( Sang Myeon Park ) 대한결핵 및 호흡기학회 2007 Tuberculosis and Respiratory Diseases Vol.62 No.6
The patient is a 62-year-old man with known diabetes mellitus who presented with a two-weeks-history of dyspnea, cough, and fever. He was diagnosed with a lung abscess in the right upper lobe and was treated with intravenous antibiotics. The patient`s clinical and radiological findings improved within seven days after medical treatment. However, newly developed ground-glass opacity and infiltrations were observed in the right lower lung. Fourteen days after admission, the patient`s symptoms and imaging finding became aggravated despite trestment with susceptible antibiotics for lung abscess. Trans-bronchial lung biopsy (TBLB) was performed in the lateral basal segment of the right lower lobe of the lung. A histologic photomicrograph showed organizing pneumonia, also called bronchiolitis obliterans with organizing pneumonia(BOOP), that became more definite as the terminal bronchioles and alveoli became occluded with masses of inflammatory cells and fibrotic tissue. The clinical symptoms and radiograph findings resolved quickly with prednisone treatment. We report a case of secondary organizing pneumonia diagnosed after TBLB following lung abscess treatment and provide a review of the literature. (Tuberc Respir Dis 2007; 62: 540-544)
증례 : 폐쇄성 황달로 발현한 임프형질세포 경화성 췌장염 1예
박종규 ( Jong Kyu Park ),김진배 ( Jin Bae Kim ),윤현영 ( Hyeon Young Yoon ),백일현 ( Il Hyun Baek ),정성원 ( Sung Won Jung ),장윤정 ( Yun Jung Chang ),이명석 ( Myung Seok Lee ) 대한내과학회 2007 대한내과학회지 Vol.72 No.6
LPSP는 자가면역성 췌장염의 병리소견으로 악·양 성병변의 감별이 어려워 시행하는 Whipple씨 술식에서 양성병변 중 가장 흔하다. 본 증례는 폐쇄성 황달을 주소로 내원한 67세 남자에서 악·양성병변의 감별이 어려워 whipple씨 술식을 시행하고 LPSP를 진단한 예를 경험하여 보고하는 바이다. Lymphoplasmacytic sclerosing pancreatitis, also referred to as autoimmune pancreatitis, is a benign disease characterized by irregular narrowing of the pancreatic duct, swelling of the pancreatic parenchyma, lymphoplasmacytic infiltration and fibrosis. A few cases with locally affected lesions show features similar to cancer. Lymphoplasmacytic sclerosing pancreatitis is the most common benign disease in patients undergoing Whipple resection for a presumed pancreatic malignancy. We report a case of lymphoplasmacytic sclerosing pancreatitis diagnosed after surgery in a patient presenting with obstructive jaundice, with a review of the literature. (Korean J Med 72:663-667, 2007)
오숙의 ( Sook Eui Oh ),정재헌 ( Jae Hun Jung ),윤성보 ( Seong Bo Yoon ),윤현영 ( Hyeon Young Yoon ),박종규 ( Jong Kyu Park ),이동훈 ( Dong Hun Lee ),홍성호 ( Sung Ho Hong ),우경희 ( Kung Hee Woo ),최성훈 ( Seong Hoon Choi ),이상학 대한결핵 및 호흡기학회 2007 Tuberculosis and Respiratory Diseases Vol.62 No.3
Hyperhomocysteinemia is an independent risk factor for cardiovascular, cerebrovascular and peripheral vascular diseases that are complicated by atherosclerosis and a thromboembolism. An increased level of plasma homocysteine develops from a genetic defect in the of enzyme for the homocysteine metabolism or a vitamin deficiency. Hyperhomocysteinemia has direct toxic effect on the vascular endothelium and causes damages to the antithrombotic action of vascular endothelial cells. Most cases of hyperhomocysteinemia are asymptomatic, but cardiopulmonary or cerebrovascular incidents developin rare cases. In the case of a thromboembolism with an unknown cause, hyperhomocysteinemia should be considered in a differential diagnosis. The authors report a case of pulmonary thromboembolism in a patient with hyperhomocysteinemia with a review of the relevant literature. (Tuberc Respir Dis 2007; 62: 211-216)