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혈액투석 환자에서 발생한 속립성 폐결핵과 동반된 결핵성 간농양 1 예 및 투석환자의 결핵에 대한 문헌고찰
문계혁(Gae Hyuk Moon),송준호(Joon Ho Song),이승우(Seoung Woo Lee),이경주(Kyong Ju Lee),박현신(Hyun Sin Park),김문재(Moon Jae Kim) 대한신장학회 2001 Kidney Research and Clinical Practice Vol.20 No.2
The impairment of host defense mechanisms, particularly of cellular immunity, causes high incidence of mycobacterial infections in the patients with ESRD. Extrapulmonary mycobacterial infections are more frequent in ESRD patients compared to general population. However, there has been rarely reported on the occurrence of hepatic tuberculous abscess as an extrapulmonary mycobacterial infection in ESRD patients. We present a case of ESRD patient manifesting miliary tuberculosis and hepatic tuberculous abscess, which have successfully resolved after antituberculous medications. A 44 years old male admit- ted with fever, general weakness, night sweating, and cough. Chest X-ray and abdominal CT revealed pulmonary miliary tuberculosis and a solitary tuberculous abscess at S7 of right hepatic lobe with multiple periportal and celiac lymphadenopathy. After the administration of anti-tuberculous medications(isoniazid, rifampicin, ethambutol - eight month, pyrazinamide - two month), miliary tubuculosis disappeared. The size of hepatic tuberculous abscess and lymphadenopathy were reduced in abdominal CT six month later. The patient is followed in outpatient without noticeable symptoms after eight month treatment.
간암 절제술 후 후기 합병증으로 발생한 기관지담관루의 치료 1 예
김영수,이진우,박현신,김인한,이돈행,김범수,김형길,문계혁,김승연,조진경 대한소화기내시경학회 2001 Clinical Endoscopy Vol.23 No.2
A bronchobiliary fistula (BBF), which is defined by an abnormal communication between the biliary system and the bronchial tree, is an uncommon complication after hemihe-patectomy, trauma, hydatid disease, choledocholithiasis, and other causes of biliary obstruction, BBF are rare complication of hepatic resection that can present from days to years after operation. Management of fistula is often very difficult and can be associated with high morbidity and mortality rates. Early recognition and proper management are essential to avoid a fatal outcome. Endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous trans-hepatic cholangiography (PTC) are the diagnostic studies of choice and offer the possibility of therapeutic intervention. Although large series in the literature emphasize the surgical management of BBF, the reoperative procedures tend to be complicated, with a significant morbidity and mortality. Nonsurgical intervention via ERCP or PTC are more recently notably successful when resolution of a distal biliary obstruction is accomplished. Only after aggressive attempts at nonoperative, interventional techniques have failed should operative approaches be entertained. We are reporting a case of BBF secondary to hepatic resection of hepatocellular carcinoma which was managed by surgical operation.
전압 장애성 원위부 신세뇨관성 산증과 신성 요붕증으로 발현한 Sjogren 증후군 1예
김태숙,김문재,송준호,이경주,이승우,최원식,문계혁 대한내과학회 2001 대한내과학회지 Vol.60 No.5
Distal renal tubular acidosis is a condition characterized by an inability of the distal nephron to acidify urine, causing hyperchloremic metabolic acidosis. Distal renal tubular acidosis is classified as proton secretory defect, permeability defect and voltage defect based on its pathophysiology. In the former two, serum level of potassium decreases due to increased excretion of potassium. But in the latter (voltage defect), hyperkalemia is characteristic by impaired the generation of an optimal electrical gradient for hydrogen ion and potassium secretion. We experienced a case of Sjogren`s syndrome associated with both voltage defect distal renal tubular acidosis and nephrogenic diabetes insipidus. The patient was a 58- year-old woman who complained of general weakness, nausea and xerostomia. Laboratory analysis showed metabolic acidosis with alkaline urine and hyperkalemia. Anti-nuclear antibody and anti-ds DNA antibody were positive. She presented with polyuria, low urine osmolarity and inadequate response to DDAVP. The response to Shirmer test was decreased. Salivary scintigraphy showed decrease of uptake in the parotid and submandibular salivary glands. We believe this is the first case report in which Sjogren`s syndrome is associated with both voltage defect distal renal tubular acidosis and nephrogenic diabetes insipidus.(Korean J Med 60:485-489, 2001)