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증례 : 순환기 ; 전신 마취 후에 동시에 발생한 음압성 폐부종과 심막기종
황철구 ( Cheol Gu Hwang ),최재훈 ( Jae Hoon Choi ),김홍제 ( Hong Jae Kim ),장성필 ( Seong Pil Jang ),신재규 ( Jae Gyu Shin ),한동훈 ( Dong Hoon Han ),양미진 ( Mi Jin Yang ) 대한내과학회 2014 대한내과학회지 Vol.86 No.5
음압성 폐부종은 전신 마취 후에 발생하는 드문 합병증으로 대개는 탈관 후 짧은 시간 안에 일어나지만 수 시간 이후에도 발생할 수 있다. 내과 의사들은 종종 수술 후 급성호흡 곤란을 호소하는 환자들을 의뢰받게 되는데 수술실에서 나온 지 얼마되지 않은 환자들이라면 드물지만 음압성 폐부종을 감별 질환에 두고 평가를 해야겠다. 심막기종은 드문 병태로 유심히 살피지 않는다면 놓치기 쉬우므로 흉부 X-선을 확인할 때 심막 주위도 잘 살펴보는 것이 필요하다. 저자들은 상반된 기전의 두 병태인 음압성 폐부종과 심막기종이 동반되었다고 사료되는 한 증례를 문헌고찰과 함께 보고하는 바이다. Negative pressure pulmonary edema is an uncommon complication related to general anesthesia. Its main pathophysiology is excessive negative intrathoracic pressure that is caused by an acute upper airway obstruction. Pneumopericardium, the presence of air within the pericardial sac, is another rare condition. The common pathophysiology of pneumopericardium, except for that caused by blunt or penetrating trauma, is barotrauma-induced alveolar rupture caused by positive intrathoracic pressure. Here, we report the case of a 61-year old female patient with negative pulmonary edema and pneumopericardium after general anesthesia. She recovered after conservative management. (Korean J Med 2014;86:612-617)
김홍제,이상호,장성필,황철구,김지하,이재남 대한상부위장관ㆍ헬리코박터학회 2014 Korean Journal of Helicobacter Upper Gastrointesti Vol.14 No.1
Background/Aims: Percutaneous endoscopic gastrostomy (PEG) is a widely used method for providing nutritional support for patients who require prolonged tubal feeding. As survival times of PEG inserted patients increase, PEG related complications are also increasing. For this reason, we decided to review complications related to PEG. Materials and Methods: A retrospective review of medical records was conducted for patients who received PEG placement between January 2004 and March 2013 in our hospital. Of the total 331 cases of PEG placement, 131 cases of PEG exchanges were excluded and a total of 200 cases were included in our review. We reviewed the baseline characteristics of all PEG inserted patients and complications related to PEG insertion. Results: Complications related to PEG developed in 45 of 200 patients (22.5%). Peristomal infection occurred in 22 patients (11.0%) and buried bumper syndrome occurred in 10 patients (5.0%). Other complications that occurred in 13 patients were hemorrhage (3.0%), leakage (1.0%), aspiration pneumonia (1.0%), ileus (0.5%), necrotizing fasciitis (0.5%) and gastro-colo-cutaneous fistula (0.5%). The characteristics according to age, gender, procedure place and underlying disease were not different between the complication group and non complication group. The onset time to complication was significantly different between the buried bumper syndrome group and the other complication groups (P=0.035). Conclusions: Peristomal infection was the most common complication of PEG in our hospital. Late peristomal infection and buried bumper syndrome occurred more often than previous studies. Buried bumper syndrome was more likely to occur in later time compared with the other complications.
이현정 ( Hyun Jeong Lee ),김홍제 ( Hong Jae Kim ),황철구 ( Chul Gu Hwang ),최재훈 ( Jae Hoon Choi ),강은진 ( Eun Jin Kang ) 대한류마티스학회 2013 대한류마티스학회지 Vol.20 No.4
일차성 비후성 골관절증은 원인이 될만한 기저 질환이 없이 곤봉지, 피부와 두피가 두꺼워지는 연조직의 변화와 골막 반응을 특징으로 하는 드문 유전 질환으로, 저자들은 말단골용해 소견을 동반한 일차성 비후성 골관절증을 진단하고 약물치료를 시행하였던 증례를 경험하여 이를 보고하는 바이다. Primary hypertrophic osteoarthropathy or pachydermoperiostosis is a rare hereditary disorder characterized by digital clubbing, pachydermia and periostosis. Its precise incidence and prevalence is still unknown due to the lack of controlled data. It occurs without any underlying causes and usually has a chronic course. Life expectancy may be of normal standards, but many patients develop multiple functional and cosmetic complications. So, it is important to diagnose this disease at an early stage and to treat the symptomat for the quality of life. We report a case of primary hypertrophic osteoarthropathy in a 68-year-old male with clinical features such as digital clubbing and pachydermia, radiographic findings of acroosteolysis and periosteal new bone formation.
자연판막 심내막염에 동반된 급성 상지 허혈을 치료한 1예
장성필 ( Seong Pil Jang ),최재훈 ( Jae Hoon Choi ),양미진 ( Mi Jin Yang ),김홍제 ( Hong Je Kim ),황철구 ( Cheol Gu Hwang ),김지하 ( Ji Ha Kim ),한동훈 ( Dong Hun Han ) 대한내과학회 2014 대한내과학회지 Vol.87 No.1
급성 상지 허혈과 감염성 심내막염은 각각 자연경과가 치명적으로 나타날 수 있기 때문에 초기에 빠르게 진단을 내리고 치료하는 것이 환자의 예후를 개선할 수 있지만 쉽지 않다. 전신 색전증은 감염성 심내막염 환자의 진단기준에 포함되어 있을 만큼 비교적 흔한 증상이지만 자연판막 심내막염에서 메티실린 내성 표피포도상구균이 배양되는 경우에서 발생한 증례는 드물다. 저자들은 자연판막 심내막염에 따른 전신 색전증으로 인해 발생한 급성 상지 허혈 환자에서 흡인 혈전색전제거술와 선택적 동맥 내 혈전용해술의 중재적 시술을 통해 성공적으로 혈관 재개통과 사지구제를 하였다. 대동맥 판막을 침범한 크고 잘 움직이는 증식물에 대해서도 수술 없이 적절한 항균제 치료만으로 경식도 초음파에서 증식물의 크기 감소와 소멸을 확인하였으며 이후 11개월 동안 별다른 합병증 없이 추적관찰 중이다. We report a case of acute upper limb ischemia suspected to have originated from methicillin resistant Staphylococcus epidermidis native valve endocarditis in a 57-year-old man who had complained of sudden-onset fever and pain in the right hand. 3D computed tomography of the right upper extremity detected a thrombus occluding the brachial artery. Echocardiography showed a large vegetation on the aortic valve. Thus, we suspected, clinically, brachial artery occlusion by septic emboli originating from a large vegetation of the aortic valve. The patient was treated with intravenous antibiotics for the suspected methicillin-resistant Staphylococcus epidermidis-native valve endocarditis with a combination of percutaneous aspiration thromboembolectomy and selective intra-arterial thrombolysis for acute thromboembolic occlusion in the right upper limb. The large vegetation of the aortic valve resolved without surgery and aortic regurgitation improved. The patient recovered uneventfully with no complications, including septic embolism, over the following 11 months. (Korean J Med 2014;87:81-86)