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증례 : 순환기 ; 인공 심박동기 시술로 치료한 Atrial standstill 1예
조정현 ( Jung Hyun Cho ),안연정 ( Yeon Jeong Ahn ),윤성은 ( Seong Eun Yun ),정영훈 ( Young Hoon Jeong ),최봉룡 ( Bong Ryong Choi ),황진용 ( Jin Yong Hwang ),곽충환 ( Choong Hwan Kwak ) 대한내과학회 2010 대한내과학회지 Vol.78 No.1
본 증례는 가족력 및 다른 특이 질환이 없는 환자에서 발생한 지속성 atrial standstill을 영구적 인공 심박동기를 시술하여 치료하였기에 이제까지 국내에서는 증례보고가 없는 바 문헌고찰과 더불어 보고하는 바이다. Persistent atrial standstill is an extremely rare arrhythmia that was first described by Chavez et al. Electrocardiographically, atrial standstill is characterized by bradycardia, the absence of a P wave, and a junctional narrow complex escape rhythm. Atrial standstill is usually classified into two types. The transient type is observed in drug intoxication, such as with digitalis or quinidine, and hyperkalemia. The persistent type is uncommon, often accompanied by syncopal attacks or brain embolism. We report a case of persistent atrial standstill in an 83-year-old man who was treated with implantation of a permanent pacemaker. (Korean J Med 78:109-112, 2010)
증례 : 순환기 ; 글루코코르티코이드 투여 후 반복적으로 유발된 갈색세포종 위기 1예
안지영 ( Jee Young An ),김동률 ( Dong Ryul Kim ),오종열 ( Jong Yeol Oh ),한양천 ( Yang Chun Han ),이일수 ( Il Soo Lee ),권태정 ( Tae Jung Kown ),최봉룡 ( Bong Ryong Choi ) 대한내과학회 2015 대한내과학회지 Vol.88 No.5
본 증례에서는 두드러기 치료를 위해 글루코코르티코이드 투여 이후에 혈압의 변동, 어지럼증 그리고 발작의 증상을 일으킨 환자에서 갈색세포종을 진단하게 되었고, 글루코 코르티코이드가 갈색세포종 위기를 일으키는 요인으로 작용한 1예를 경험하였다. 글루코코르티코이드가 갈색세포종 위기를 일으킨다는 것은 매우 드물게 알려져 있으며, 갈색세포종 환자에서 스테로이드 투여가 생명을 위협하는 갈색세포종 위기를 일으킬 수 있다는 것을 주지하여 스테로이드 투여시 신중을 기해야 할 것으로 보인다. 본 저자들은 두드러기 치료를 위해 글루코코르티코이드 투여 이후 발생한 혈압의 변동, 어지러움, 그리고 두근거림 증상으로 내원한 환자를 신속하게 갈색세포종으로 진단했으며, 글루코코르티코이드가 갈색세포종 위기를 일으키는 드문 증례를 경험했고 수술적 제거를 통해 성공적으로 치료하였기에 보고하는 바이다. Pheochromocytoma crisis is a life-threatening endocrine emergency. Stimuli that can elicit a pheochromocytoma crisis include anesthesia, tumor manipulation, and several drugs. Rarely, glucocorticoids can induce a pheochromocytoma crisis. Here, we describe the case of a 65-year-old female who developed an adrenergic crisis with blood pressure fluctuations, dizziness, and seizures after receiving glucocorticoids for the treatment of urticaria. The symptoms led us to speculate that a pheochromocytoma was present. We confirmed the diagnosis based on abdominal imaging and biochemical studies. The patient’s symptoms improved after surgical removal of the pheochromocytoma. (Korean J Med 2015;88:564-569)
64열 다중검출 CT를 이용한 관상동맥 스텐트재협착의 평가
서명기 ( Myung Ki Seo ),고진신 ( Jin Shin Kho ),박소라 ( So Ra Park ),강영란 ( Young Ran Kwang ),강민경 ( Min Kyeng Kang ),조정현 ( Jung Hyun Cho ),안연정 ( Youn Jung An ),최봉룡 ( Bong Ryong Choi ),정영훈 ( Young Hoon Jeong ) 대한내과학회 2009 대한내과학회지 Vol.76 No.4
Background/Aims: Multidetector computed tomography (MDCT) is considered to be a noninvasive, alternative method for evaluating stent restenosis. However, the diagnostic accuracy of 16-channel MDCT for stent stenosis is reported to have severe limitations because of high-attenuation stent-related artifacts. 64-channel MDCT, which recently became available in clinical practice, has better spatial and temporal resolution than 16-channel MDCT. The diagnostic accuracy of 64-channel MDCT for stent restenosis (in-segment and in-stent) was assessed by comparing it with conventional coronary angiography. Methods: In-segment and in-stent restenosis (≥50% in diameter) were evaluated in 96 stent segments in 68 patients [61±12 years, 51 (75%) male] using both 64-channel MDCT and conventional coronary angiography. The in-stent analysis was confined to the portion of the artery covered by the stent and the in-segment analysis included the stent and 5 mm proximal or distal to the stent edges. Results: The 64-channel MDCT could evaluate stent restenosis in 93 of 96 (97%) stent segments. Quantitative conventional coronary angiography found in-segment restenosis (≥50% in diameter) in 16 of 68 (23%) patients and 16 of 96 (17%) segments. For the patients with interpretable stent segments, the sensitivity, specificity, positive predictive value, and negative predictive value of 64-channel MDCT for in-segment restenosis per patient were 63, 96, 83, and 89%, respectively; per segment they were 63, 97, 83, and 93%, respectively; and for in-stent restenosis per stent they were 82, 98, 82, and 98%, respectively. Conclusions: The diagnostic accuracy of 64-channel MDCT for assessing stent restenosis had high specificity and negative predictive value in the clinical setting. The 64-channel MDCT may be a promising, less-invasive imaging tool for stent restenosis, especially for the purpose of excluding stent restenosis. (Korean J Med 76:434-442, 2009)