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Rhabdomyolysis and Acute Kidney Injury Associated with Hypothyroidism and Statin Therapy
안평,민현준,박상현,이병무,최명진,윤종우,구자룡 대한내분비학회 2013 Endocrinology and metabolism Vol.28 No.4
Rhabdomyolysis is a syndrome involving the breakdown of skeletal muscle that causes myoglobin and other intracellular proteins to leak into the circulatory system, resulting in organ injury including acute kidney injury. We report a case of statin-induced rhabdomyolysis and acute kidney injury that developed in a 63-year-old woman with previously undiagnosed hypothyroidism. Untreated hypothyroidism may have caused her hypercholesterolemia requiring statin treatment, and it is postulated that statininduced muscle injury was aggravated by hypothyroidism resulting in her full-blown rhabdomyolysis. Although this patient was successfully treated with continuous venovenous hemofiltration and L-thyroxin replacement, rhabdomyolysis with acute kidney injury is a potentially life-threatening disorder. Physicians must pay special attention to the possible presence of subclinical hypothyroidism when administering statins in patients with hypercholesterolemia.
고원진,안평,고광현,함기백,홍성표,조주영 대한소화기내시경학회 2015 Clinical Endoscopy Vol.48 No.5
Arising from human curiosity in terms of the desire to look within the human body, endoscopy has undergone significant advances in modern medicine. Direct visualization of the gastrointestinal (GI) tract by traditional endoscopy was first introduced over 50 years ago, after which fairly rapid advancement from rigid esophagogastric scopes to flexible scopes and high definition videoscopes has occurred. In an effort towards early detection of precancerous lesions in the GI tract, several high-technology imaging scopes have been developed, including narrow band imaging, autofocus imaging, magnified endoscopy, and confocal microendoscopy. However, these modern developments have resulted in fundamental imaging technology being skewed towards red-green-blue and this technology has obscured the advantages of other endoscope techniques. In this review article, we have described the importance of image quality analysis using a survey to consider the diversity of endoscope system selection in order to better achieve diagnostic and therapeutic goals. The ultimate aims can be achieved through the adoption of modern endoscopy systems that obtain high image quality.
김대용,박상현,안평,김연수,윤재훈,석기태,김진봉,최영희 대한췌담도학회 2011 대한췌담도학회지 Vol.16 No.2
Biliary intraepithelial neoplasia (BilIN) and intraductal papillary neoplasm of the biliary tract (IPN-B) were suggested the premalignant conditions of cholangiocarcinoma. BilIN microscopically manifests as flat, pseudopapillary or micropapillary lesions. In contrast, IPN-B is grossly visible, and is characterized by prominent papillary proliferation with distinct fibrovascular cores. A 65 years old woman was diagnosed the recurrent acute pancreatitis of uncertain etiology, 4 times, during the past 5 years. At the last admission, abdominal computed tomography revealed a tiny stone in the distal common bile duct. We performed an endoscopic retrograde cholangiopancreatography, and studies revealed a filling defect on distal CBD without evidence of CBD stone and a suspicious of soft tissue mass in the ampulla. We obtained biopsy specimens at the ampulla and distal CBD by biopsy forceps under the fluoroscopic guidance. The pathological report demonstrated BilIN. Therefore, we report a case of BilIN presented with recurrent acute pancreatitis with brief review. 담도상피내암종과 담관내유두모양종양은 담관암종의 전구병변으로 여겨지고 있으며 dysplasia- carcinoma sequence를 거쳐 담관암으로 진행한다고 알려져 있다. 담관상피내암종은 조직 학적 으로 편평(flat), 가성유두모양(pesudopapillary), 또는 미세유두모양(micropapillary)의 병 변 을 보이며, 담관내유두모양종양은 육안적으로 구분이 되는 조직학적으로 뚜렷한 관다발의 핵 (fibrovascular cores)을 보이는 담도 내피세포의 돌출된 유두모양의 과증식으로 진단된다. 저자 들은 지난 5년 동안 4차례의 급성 췌장염을 보인 65세 여자에서, 복부 전산화 단층촬영에서 담 도 말단부에 미세담석이 의심되었으나 내시경역행담췌관조영술에서 담석 없이 담도 말단부 의 미 세 충만결손을 보였고, 바터 팽대부와 담도 말단부의 내시경적 생검조직에서 제 1형과 2형 담관 상피내암종으로 진단된 예를 경험하였기에 문헌고찰과 함께 보고하는 바이다.
전이성 췌장암에서 젬시타빈 단독 요법 후 완전관해 유사 반응을 보인 1예
이병무,민현준,안평,박상현,한상완,김대용,윤재훈,김진봉 대한췌담도학회 2013 대한췌담도학회지 Vol.18 No.1
Pancreatic cancer is well known to have a very poor prognosis that is under 5% of five years survival rate. Especially, metastatic pancreatic cancer has poor responses to both of chemotherapy and radiation therapy. There are many clinical trials of variable chemo-regimens, but there is no proved regimen better than gemcitabine based therapy. A 71 years old male patient was diagnosed with 2.8 × 1.9cm sized advanced pancreatic body cancer with liver, mediastinal and both supraclavicular lymph nodes, right ischial bone metastasis in July, 2011. He was taken chemotherapy of gemcitabine single regimen, and his radiological findings after 10th cycles of chemotherapy revealed a near complete response. The authors report this rare case of near complete response with gemcitabine single chemotherapy in advanced pancreatic cancer with multiple metastasis.
증례 : 순환기 ; 건강한 성인에서 마라톤 경기 중 발생한 급성 심근경색증 2예
이병무 ( Byoung Moo Lee ),안평 ( Pyoung Ahn ),민현준 ( Hyun Joon Min ),박상현 ( Sang Hyun Park ),최현희 ( Hyun Hee Choi ),윤덕형 ( Duck Hyoung Yoon ),홍경순 ( Kyung Soon Hong ) 대한내과학회 2013 대한내과학회지 Vol.85 No.4
기존에 심혈관계 구조적인 이상을 가지고 있던 환자에서 격렬한 운동 중 급성 관상동맥 질환의 발생률이 높은 것으로 알려져 있다. 저자들이 경험한 두 증례는 특이 기왕력도 없었고 마라톤과 같은 격렬한 운동을 하면서 건강하다고 생각해 왔던 환자들이 단일 마라톤 경기 중 의식 저하 및 심정지가 발생한 경우였다. 두 환자 모두 현장에서 심폐소생술을 바로 시행하였고 첫 환자에서는 ST 분절의 상승을 동반한 급성 심근경색증, 두 번째 환자에서는 ST 분절의 상승을 동반하지 않은 급성 심근경색증으로 진단하고 응급으로 경피적 관동맥 중재술을 시행하여 치료하였다. 마라톤 경기 도중급성심근경색이 발생하였던 환자를 빠르고 정확한 심폐소생술 및 적절한 치료로 후유증 없이 회복시켰던 두 증례를 경험하여 문헌고찰과 함께 보고하고자 한다. It is generally accepted that vigorous exercise may trigger cardiovascular accidents if underlying cardiovascular disease is present. Coronary artery disease is the most frequent cause of sudden cardiac arrest, especially in older individuals (≥ 35 years of age). We describe two patients who presented with cardiac arrest followed by loss of consciousness. Both had been participating in a marathon race. After acute myocardial infarction was diagnosed by electrocardiography and laboratory findings, urgent percutaneous coronary intervention was performed on both patients. (Korean J Med 2013;85:411-415)
Clinical Features of Drug-induced Liver Injury According to Etiology
이병무,이웅철,장재영,안평,김진녕,정승원,박의주,이세환,김상균,차상우,김영석,조영덕,김홍수,김부성 대한의학회 2015 Journal of Korean medical science Vol.30 No.12
Drug-induced liver injury (DILI) is an increasingly common cause of acute hepatitis. We examined clinical features and types of liver injury of 65 affected patients who underwent liver biopsy according DILI etiology. The major causes of DILI were the use of herbal medications (43.2%), prescribed medications (21.6%), and traditional therapeutic preparations and dietary supplements (35%). DILI from herbal medications, traditional therapeutic preparations, and dietary supplements was associated with higher elevations in aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels than was DILI from prescription medications. The types of liver injury based on the R ratio were hepatocellular (67.7%), mixed (10.8%), and cholestatic (21.5%). Herbal medications and traditional therapeutic preparations were more commonly associated with hepatocellular liver injury than were prescription medications (P = 0.002). Herbal medications and traditional therapeutic preparations induce more hepatocellular DILI and increased elevations in AST and ALT than prescribed medications.