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A Case of Providencia rettgeri Sepsis in a Patient with Cervical Cord Injury
조현정,임승진,천승연,박권오,이상호,박종원,이진서,엄중식 대한감염학회 2010 Infection and Chemotherapy Vol.42 No.6
Providencia rettgeri is a member of Enterobacteriacea that is known to cause urinary tract infection (UTI), septicemia, and wound infections, especially in immunocompromised patients and in those with indwelling urinary catheters. We experienced a case of UTI sepsis by Providencia rettgeri in a patient with spinal cord injury. The patient had only high fever without urinary symptoms or signs after high dose intravenous methylprednisolone. The laboratory results showed leukocytosis (21,900/μL, segmented neutrophils 91.1%) and pyuria. Cefepime was given empirically and it was switched to oral trimethoprim-sulfamethoxazole because P. rettgeri was identified from blood and urine culture which was susceptible to TMP-SMX. The patient was improved clinically but P. rettgeri was not eradicated microbiologically. To the best of our knowledge, this is the first case report on sepsis caused by Providencia rettgeri in Korea.
내시경 풍선확장술로 호전된 거대세포바이러스 대장염 관련 직장협착 1예
박권오,김경호,박종원,이상호,조현정,천승연,박혜원,김학양 대한소화기내시경학회 2010 Clinical Endoscopy Vol.41 No.4
Cytomegalovirus (CMV) colitis is a common opportunistic infection in immunocompromised patients. Affected individuals present with abdominal pain, diarrhea, or hematochezia. Complications of CMV colitis can include massive bleeding, toxic megacolon, bowel perforation and, rarely, colon stricture. A 69-year-old woman who had no specific past history was admitted to the orthopedic department for pelvic bone fracture with right iliac artery rupture caused by a traffic accident. She was successfully managed with emergency transarterial coil embolization. After 2 weeks, she developed hematochezia and recurrent abdominal pain. Colonoscopy showed a huge, deep ulcer in the rectosigmoid colon. Biopsy and immunohistochemical staining revealed giant cells with intracellular inclusion bodies that were positive for CMV antigen. She received antiviral treatment after which her symptoms improved. On follow-up colonoscopy 3 months later, we found a tight luminal narrowing in the rectum. We did a repeat endoscopic balloon dilation in this patient and she experienced improvement. 거대세포바이러스 대장염은 면역기능이 저하된 환자에서 흔히 발생하는 기회 감염이다. 그러나 드물게 면역기능이 정상인 사람에서도 발병한다. 복통, 설사 및 출혈 등의 임상증상을 보이며, 합병증은 대량 출혈, 독성 거대 결장, 장천공 등이 있으나 대장의 협착은 드물다. 69세 여자가 교통사고로 우측 엉덩동맥 파열과 엉덩뼈 골절로 정형외과에 입원하였다. 환자는 응급 혈관조영술 및 코일색전술을 시행받고 호전되었으나, 사고 2주째부터 혈변과 반복적인 복통을 호소하였다. 대장내시경검사에서 직장 주변에 커다란 깊은 궤양을 확인하였고 조직검사와 면역조직염색으로 거대세포바이러스 대장염을 진단하였다. 항바이러스제 치료 후 환자의 증상은 호전되었으나, 3개월 뒤 시행한 대장내시경검사에서 직장 협착이 발견되었다. 환자는 복통과 변비 증상을 호소하여 내시경 풍선확장술을 3회 시행하였고, 이후 증상은 호전되었다.
캡슐내시경으로 진단된 공장의 다발성 위장관 간질종양 1예
김소연 ( So Yeon Kim ),박철희 ( Cheol Hee Park ),천승연 ( Seung Yeon Chun ),김수진 ( Su Jin Kim ),김종혁 ( Jong Hyeok Kim ),박충기 ( Choong Kee Park ),임만섭 ( Man Sup Lim ),서진원 ( Jin Won Seo ) 대한소화기학회 2012 대한소화기학회지 Vol.59 No.3
More than 90% cases of chronic gastrointestinal bleeding can be diagnosed by upper endoscopy and/or colonoscopy, and therefore, obscure gastrointestinal bleeding has been defined as bleeding of unknown origin that persists after these conventional endoscopic evaluation, Gastrointestinal stromal tumors (GISTs) are rare tumors, but the most common form of mesenchymal tumors of the gastrointestinal tract. Small bowel is the second most common primary site for GISTs, and accounts for 2-10% of chronic bleeding sites, GISTs usually present as a sporadic and solitary tumor, and a minority of the cases of multiple GISTs are discovered as forms of hereditary or idiopathic tumor syndromes, Small bowel tumor has been difficult to diagnose because of absence of accurate and proper diagnostic tools. Recently developed wireless capsule endoscopy helps in the diagnostic work-up of small bowel diseases. We report a case of multiple jejunal GISTs presenting melena in a 39-year-old male, which was diagnosed with wireless capsule endoscopy.
김수진 ( Su Jin Kim ),박철희 ( Cheol Hee Park ),김용민 ( Yong Min Kim ),김성열 ( Seong Yeol Kim ),천승연 ( Seung Yeon Chun ),권진우 ( Chin Woo Kwon ),박지원 ( Ji Won Park ),김경오 ( Kyoung Oh Kim ),백일현 ( Il Hyun Baek ),유교상 ( 대한장연구학회 2012 Intestinal Research Vol.10 No.2
Background/Aims: Intussusception is uncommon in adults compared with children. The present study aimed to review our experience of adult intussusceptions and discuss the preoperative diagnosis and management. Methods: A retrospective review was performed for 25 patients, at least 18 years old. These patients were diagnosed as intestinal intussusceptions at Hallym University Sacred Heart Hospital from January 1999 to October 2010. Results: There were 14 male and 11 female with a mean age of 55 years. The most common symptom was abdominal pain. The preoperative diagnostic rate was 92% because of the use of an abdominal computed tomography (CT) and an ultrasound. A total of 9 (36%) patients had enteroenteric intussusception, 8 had ileocolic, 1 had ileocecal and 7 patients had colocolic intussusception. A discrete pathologic process was present in 22 (88%) patients and the remaining 3 (12%) patients were idiopathic. There were 12 small bowel lesions and 10 colonic lesions. Neoplasms were the most common etiology of intussusceptions. Of the cases with a defined colonic cause, 8 (80%) were malignant. Overall, 12 (48%) patients underwent primary resection of the intussusception without prior reduction, 11 (44%) patients had reduction of their intussusception followed by resection. Conclusions: Adult colonic intussusception is usually associated with malignancy. All patients with obstruction of unknown cause or lead point on CT should consider surgical exploration. (Intest Res 2012;10:183-188)