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바터 팽대부에 비외상성 십이지장 벽내 혈종으로 인한 폐쇄성 황달과 급성 담낭염
안대선 ( Dae Seon Ahn ),김성훈 ( Seong Hun Kim ),윤지영 ( Ji Young Yoon ),장진원 ( Jin Won Jang ),전형구 ( Hyung Ku Chon ),김인희 ( In Hee Kim ),김상욱 ( Sang Wook Kim ),이승옥 ( Seung Ok Lee ) 대한췌장담도학회 2016 대한췌담도학회지 Vol.21 No.1
Nontraumatic spontaneous intramural hematoma is an infrequent complication of the use of oral anticoagulants. The most commonly affected site is the jejunum followed by ileum and duodenum. The symptoms can vary depending on the location and size of hematoma. Patients with intramural hematoma usually present with abdominal pain, nausea and vomiting, but rarely present with hematuria, pancreatitis, cholangitis. An obstructive jaundice and acute cholecystitis has not been reported as a secondary cause of duodenal intramural hematoma in Korea so far. Here, we report spontaneous duodenal intramural hematoma caused by anticoagulant therapy that associated with transient obstructive jaundice and acute cholecystitis in a 79-year-old man, which was successfully managed conservative management. In addition, we reviewed reports of intramural hematoma with literature review.
증예(症例) : 선택적 동맥 색전술로 치료한 파열된 신장 혈관근육지방종 1예
안대선 ( Dae Seon Ahn ),백영하 ( Young Ha Baek ),권대헌 ( Dae Hun Kwon ),유혜민 ( Hae Min Yu ),윤해은 ( Hae Eun Yun ),박경택 ( Kyung Taek Park ),전형구 ( Hyung Ku Chon ),홍영민 ( Young Min Hong ),이식 ( Sik Lee ) 전북대학교 의과학연구소 2010 全北醫大論文集 Vol.34 No.1
선택적 동맥색전술은 크기가 중등도 이상인 증상을 동반한 혈관근육지방종 환자에게 일차치료이다. 또한 본 증례에서처럼 혈관근육지방종이 파열된 경우와 같은 혈역동학적으로 불안정한 응급 상황에서도 동맥색전술은 효과적이며 시술 이후 응급 신장절제술과 같은 추가적인 치료가 필요한 경우는 흔치 않다. 동맥색전술 시행 이후에도 출혈이 조절되지 않거나 증상이 지속되는 경우 동맥색전술 실패로 간주하고 이러한 경우에 수술적 치료가 시행되어야 한다. Renal angoimyolipoma (AML) is a benign neoplasm that is composed of adipocyte clusters, smooth muscle and vascular tissue component. In most cases, renal AMLs are asymptomatic and incidental findings. When intra-tumoral hemorrhage occurs from ruptured tumor, it might lead to hypovolemic shock. In such cases, it is major medical emergency and urgent management is indicated. Selective arterial embolization of ruptured renal AMLs has been reported in small series with elective conditions and case reports in life-threatening conditions. However, questions remain with respect to the role and outcomes of emergent selective arterial embolization in urgent case involving ruptured renal AMLs. We report a case of ruptued renal angiomyolipoma in 45-year-old female successfully treated and fortunately the tumor regressed markedly in size by selective arterial embolization without any complication.
증예(症例) : Amphotericin B 및 Voriconazole로 치료한 객혈을 동반한 폐 아스페르길루스종 1예
권대헌 ( Dae Hun Kwon ),손지연 ( Ji Youn Sohn ),소재승 ( Jae Seung Soh ),정종환 ( Jong Whan Chong ),안대선 ( Dae Seon Ahn ),홍영민 ( Young Min Hong ),백영하 ( Young Ha Baek ),이양근 ( Yang Keun Rhee ) 전북대학교 의과학연구소 2009 全北醫大論文集 Vol.33 No.1
아스페르길루스 감염은 여러 형태로 나타나며 그 중 아스페르길루스종은 결핵 등의 공동성 병변을 가지는 환자에서 호발 한다. 객혈 등의 증상이 나타나면 치료의 적응증이 되며 수술을 시행하거나 객혈에 대해 기관지동맥색전술을 시행할 수 있다. 항진균 요법은 체계적으로 정립되지는 않았으나 치료 성공률 및 생존률 및 약물의 부작용, 내약성(tolerability) 등을 고려할 때 voriconazole이 선택적인 치료약제가 될 수 있다. 본 증례는 50세 남자 환자로 과거 결핵 치료를 받았으며 재발한 객혈을 주소로 내원하여 임상 증상 및 흉부방사선, 흉부컴퓨터단층촬영, 기관지내시경 상에서 아스페르길루스종으로 진단 받고 입원 기간 중 amphotericin B 5주간 정맥 주사 후 외래에서 14주간 voriconazole 경구제제 복용 후 임상 증상, 흉부방사선 소견 모두 호전을 보인 증례를 문헌고찰과 함께 보고하는 바이다. Aspergilloma is the most common and best recognized form of pulmonary involvement due to aspergillus. Pulmonary aspergillosis usually develops in a pre-existing cavity in the lung. Most patients with aspergilloma are asymptomatic. When symptoms are present, most patients would experience mild hemoptysis, but severe hemoptysis may occur, particularly in patients with underlying tuberculosis. A 50-year-old male patient who had COPD with previous pulmonary tuberculosis lesion complained hemoptysis. Chest X-ray and Chest CT revealed an huge cavitary lesion with air-fluid level. The bronchoscopic finding revealed large bullous change with multiple scattered fungal balls on left anterior segment of left upper lobe. Improvement of symptoms and chest X-ray occurred after systemic antifungal therapy with intravenous amphotericin B for 5 weeks and voriconazole medication for 14 weeks, subsequently. We suggest that voriconazole treatment after amphotericin B treatment show effective results for pulmonary aspergilloma patient who experienced recurrent hemoptysis.
증예(症例) : 불량예후에 대한 여러 고 위험인자를 가지로 있는 양측성 기종성 신우신염 치료 1에
백영하 ( Young Ha Baek ),권대헌 ( Dae Hun Kwon ),안대선 ( Dae Seon Ahn ),유혜민 ( Hae Min Yu ),윤해은 ( Hae Eun Yun ),정범수 ( Bum Su Joung ),홍영민 ( Young Min Hong ),박경택 ( Kyung Taek Park ),정종환 ( Jong Hwan Chong ),한영민 ( 전북대학교 의과학연구소 2010 全北醫大論文集 Vol.34 No.1
Patient outcomes with emphysematous pyelonephritis vary with the classification type and other factors. This is a case of bilateral emphysematous pyelonephritis with several risk factors for adverse outcomes. A 71-year-old diabetic woman was referred to us in stuporous state with fever. The patient`s temperature was 38.7 ℃ and blood pressure was 90/60 mmHg. The abdomen was distended with severe flank knocking tenderness. The laboratory findings showed white blood cell count of 26,400/mm3, hemoglobin level of 10.5 g/dl, platelet count of 46,000/mm3, glucose level of 422 mg/dl, BUN of 163 mg/dl, and creatinine level of 5.5 mg/dl. Urinalysis showed 1+ proteinuria, 1+ glycosuria, 25-30 WBCs/HPF, and 25-30 RBCs/HPF. Unenhanced computed tomography demonstrated multiple gas pockets in renal parenchyma, pelvis, ureter, and bladder. Patient was immediately treated with percutaneous catheter for drainage of gas and purulent material, and parenteral antibiotics. E.coli was isolated from both blood and urine cultures. This patient had several concomitant risk factors for adverse outcomes, such as thrombocytopenia, acute renal failure, impaired consciousness, shock and involvement of both kidneys, which are usually associated with significantly increased risk of mortality. However, the patient was successfully treated without undergoing nephrectomy.
증예(症例) : 이전 소변 검사상 이상 소견이 없었던 환자에서 신장 주위 혈종으로 발견된 전이성 융모상피암
윤해은 ( Hae Eun Yun ),유혜민 ( Hae Min Yu ),안대선 ( Dae Seon Ahn ),백영하 ( Young Ha Baek ),홍영민 ( Young Min Hong ),권대헌 ( Dae Hun Kwon ),전형구 ( Hyung Ku Chon ),박경택 ( Kyung Taek Park ),정종환 ( Jong Hwan Chong ),이식 ( 전북대학교 의과학연구소 2010 全北醫大論文集 Vol.34 No.1
융모 상피암은 임신성 융모성 질환의 악성 변화를 가지는 것으로 전신적인 전이가 흔하게 동반되므로 전이성 병변에 대한 검사가 필요하며, 특히 본 증례와 같이 소변 검사상 이상이 없더라도, 신장 전이가 있을 거능성이 있으므로 전신적인 전이에 대한 검사가 반드시 필요할 것으로 생각된다. Gestational trophoblastic diseases originate from placental tissues and include a spectrum from complete and partial hydatidiform mole, placental site trophoblastic tumor, and choriocarcinoma, which vary in their propensity for local invasion and spreading. The most frequent sites of metastases are lung, vagina, pelvis, liver, and brain. The tumors are highly vascular and prone to severe hemorrhage either spontaneously or during invasive procedure such as biopsy. Herein, spontaneous perirenal hemorrhage from tumor was present in this case, which was diagnosed metastasis to the kidney.
증예(症例) : 부신 출혈과 유사하여 진단이 늦어진 원발성 부신의 비강형 자연살해/T-세포 림프종 1예
백경택 ( Kyung Taek Park ),백영하 ( Young Ha Baek ),권대헌 ( Dae Hun Kwon ),안대선 ( Dae Seon Ahn ),유혜민 ( Hae Min Yu ),윤해은 ( Hae Eun Yun ),정범수 ( Bum Su Joung ),홍영민 ( Young Min Hong ),정종환 ( Jong Hwan Chong ),전형구 ( 전북대학교 의과학연구소 2010 全北醫大論文集 Vol.34 No.1
Primary adrenal lymphoma (PAL) is a rare disease. The vast majority of cases that have been reported were of B-cell origin. Here, we report a case of primary adrenal natural killer (NK)/T-cell nasal type lymphoma diagnosed with delay due to mimicking adrenal hemorrhage. A 29-year-old man, presented with abdominal pain and fever, had an initial computed tomography (CT) scan revealing low attenuation of both adrenal glands. Therefore, the initial concern was for tuberculous adrenalitis or autoimmune adrenalitis combined with adrenal hemorrhage. The patient was started on empirical anti-tuberculous medication, but there was no improvement. Enlargement of cervical lymph nodes were developed after that and excisional biopsy of cervical lymph nodes was performed. Pathologic finding of excised lymph nodes was compatible to NK/T-cell lymphoma. The patient died due to the progression of the disease even after undergoing therapeutic trials including chemotherapy and conservative management.
당뇨병성 신장병증을 가진 환자에서 급성 진피 내 모세혈관 파열
유혜민 ( Hea Min Yu ),윤해은 ( Hae Eun Yun ),백영하 ( Young Ha Baek ),전형구 ( Hyung Ku Chon ),박경택 ( Kyung Taek Park ),안대선 ( Dae Seon Ahn ),강경표 ( Kyung Pyo Kang ),김원 ( Won Kim ),박성광 ( Sung Kwang Park ),이식 ( Sik L 대한신장학회 2010 Kidney Research and Clinical Practice Vol.29 No.4
A 46-year-old diabetic woman visited our hospital with generalized edema and high blood pressure. An appropriately sized noninvasive blood pressure cuff was placed on her right arm above the elbow to measure blood pressure. While we were checking her blood pressure, we noticed small red petechial spots distal to the cuff involving her entire right forearm. Her blood pressure was 170/96 mmHg. The laboratory findings showed no abnormality of anticoagulation. The rest of the patient`s extremities were not affected. The petechiae on the right arm resolved spontaneously after ten days. The most likely explanation for these petechiae is acute dermal capillaryrupture, which is called the Rumpel-Leede phenomenon. Acute dermal capillary rupture appears as petechiae in an area following application of vascular constriction such as application of tourniquet to draw blood specimen or use of blood pressure cuff due to capillary fragility or abnormal platelets in numbers or in function. This situation has been reported previously in the literature as the Rumpel-Leede phenomenon in association with prolonged noninvasive BP monitoring. In the patient described herein, increased venous pressure from blood pressure measurement and capillary fragility associated with diabetes mellitus may have increased the risk of acute dermal capillary rupture.