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중심성 뇌교 및 뇌교외 수초용해에 병발된 정신증적 장애
박시성,유봉구,임학,Park, Si-Sung,Yoo, Bong-Goo,Rim, Hark 한국정신신체의학회 2002 정신신체의학 Vol.10 No.1
중심성 뇌교 수초용해 (CPM) 및 뇌교의 수초용해(EPM) 은 대사 이상을 수반하는 여러 질환에서 뇌 세포 내외의 삼투질농도의 급속한 변화와 관련하여 발생하는 신경학적 질환이다. 저자들은 당뇨병성 신중에 의한 만성 신부전으로 신장이식을 받은 43세 남자 환자에서 발현한 CPM과 EPM 증례를 보고하였다. 환자는 망상, 연상이완, 환각, 부적절한 정동, 공격성, 기억장애 등을 수반한 정산병적 증상과 언어실조를 특징적으로 보인 경우로서, CPM과 EPM에서 비교적 드물게 발생하는 정신증상, 특히 정신병적 증상을 보인 증례이기에, 정선과적으로 중요한 임상적 의의를 가진다고 판단하여 문헌고찰과 함께 보고하는 바이다. Central pontine myelinolysis(CPM) and Extrapontine myelinolysis(EPM) are uncommon neurologic disorders associated with osmotic inequality between the extracellular fluid compartment and intracellular fluid compartment in the brain. Myelinolysis can occur in hyponatremia and after rapid correction of hyponatremia. It may be caused by various metabolic disturbances such as chronic alcoholism, malnourishment, cancer, chronic renal failure and organ transplantation. The authors reported a 43-year-old male patient who have received a kidney transplantation because of chronic renal failure due to diabetic nephropathy. The patient manifested psychotic symptoms such as delusion, loosened association, hallucination, inappropriate affect and aggressiveness as a sequele of CPM and EPM. He also showed neurocognitive impairment such as disorientation, memory impairment, decresed intelligence and aphasia. These manifestations are rare in CPM and EPM. We discuss the clinical features, diagnosis, course and management of the patient which may be clinically significant in the neuropsychiatric aspect especially at the consultation-liaison field.
염하용(Ha Yong Yum),배상균(Sang Kyun Bae),임학(Hark Rim) 대한핵의학회 1994 핵의학 분자영상 Vol.28 No.1
Massive hydrothorax complicating continuous ambulatory peritoneal dialysis (CAPD) is relatively rare. A 67-year-old male and a 23-year-old female patients during CAPD presented massive pleural effusion, They have been performing peritoneal dialysis due to end-stage renal disease for 8 months and 2 weeks respectively. We injected 99mTc-labelled radiopharmaceutical (phytate and MAA, respec- tively) into peritoneal cavity witb the dialysate. The anterior, posterior and right lateral images were obtained. The studies reveal visible radioactivity in the right chest indicating the communication between the peritoneal and the pleural space. After sclerotherapy with tetracycline, the same studies reveal no radioactivity in the right chest suggesting successful therapy. We think nuclear imaging is a simple and noninvasive method for the differential diagnosis of pteural effusion in patients during CAPD and the evaluation of therapy.
김종진(Jong Jin Kim),문미경(Mi Kyoung Moon),임학(Hark Rim),김진규(Jin Kyoou Kim),박선자(Seon Ja Park),양상호(Sang Ho Yang),박상은(Sang Eun Park),이시래(Si Rhae Lee) 대한내과학회 1991 대한내과학회지 Vol.41 No.2
The immune response to HB vaccination in ESRD patients has thus far been poor, but a better immune response is seen in patients who have been given reinforced vaccination. We measured anti-HBs seroconversion rates in a total of 100 ESRD patients (HD 60, CAPD 37, and transplantation 3 patients) who were vaccinated with Hepavax®. The results were as follows: 1) The anti-HBs seroconversion rate of 54 anti-HBc positive patients was 44.6%, and that of 46 anti-HBc negative patients 34.8%. 2) Anti-HBs seroconversion rates were 38.3% in the HD group, 43.2% in the CAPD group, and 33.3% in the renal transplantation group. 3) There was a lower anti-HBs seroconversion rate in the group under going a longer of dialysis: 44.4% in the group of less than 1 month period of dialysis and 9.1% in the group who had been on dialysis for 13 to 36 months. 4) Anti-HBs seroconversion rates were 39.1% in 40 ㎍, 3 times vaccination group, 45.6% in 20 ㎍, 3 times vaccination group, and 39.3% in 40 ㎍, 1 or 2 times vaccination group. The seroconverted patients in 40 ㎍, 3 times vaccination group revealed a higher titer and longer sustained anti-HBs in serum. However, anti-HBs seroconversion rates were not different in the 3 groups of various dosages. 5) An anti-HBc negative patient who had revealed low titer of anti-HBs after 3 doses of 20 ㎍, received a kindey transplantation from an HBsAg negative donor and developed acute viral hepatitis B in 10 months. Another anti-HBc positive patient, who had revealed a low titer of anti-HBs after 2 doses of 40 ㎍ but converted into anti-HBs negative in 5 months, showed a high titer of anti-HBs after receiving a renal transplantation from an HBsAg positive donor. These results show that reinforced doses of HB vaccine in ESRD patients were effective in developing a higher titer and longer duration of anti-HBs.