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- 저자 : 구승원 ( Seung Won Koo ) (검색결과 5 건)
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증례 : 신장 ; 급성 신부전과 흉수를 동반한 원발성 후복막강 섬유화증 1예
구승원 ( Seung Won Koo ),김미애 ( Mi Ae Kim ),김주환 ( Ju Hwan Kim ),유광호 ( Kwang Ho Yoo ),박현정 ( Hyun Jung Park ),김경호 ( Kyung Ho Kim ),김형종 ( Hyung Jong Kim ) 대한내과학회 2011 대한내과학회지 Vol.80 No.2S
저자들은 50세 남자 환자에서 요관 폐쇄에 의한 급성 신부전과 편측성 흉수를 동반한 원발성 후복막강 섬유화증을 진단하고, 요관내 카테터 삽입술을 시행받았으나 신부전 악화되어 경피적 신루술 및 steroid 투여 후에 급성 신부전 및 편측성 흉수의 호전을 보인 1예 경험하였기에 문헌고찰과 함께 보고하는 바이다. Idiopathic retroperitoneal fibrosis (IRF) is characterized by a fibrotic process and chronic inflammation of the retroperitoneal area and aorta. The development of retroperitoneal inflammation and fibrosis often results in periureteral encasement, ureteral obstruction, acute renal failure, and subsequent chronic renal failure and, rarely, mediastinal, pericardial, or pleural involvement. Our patient presented with left flank pain and abdominal computed tomography (CT) showed a retroperitoneal mass encompassing the aorta and both ureters. IRF was diagnosed after a biopsy of the retroperitoneal mass. A complicating left pleural effusion and acute renal failure developed and the patient underwent a percutaneous nephrostomy and was treated with prednisolone. After this, the patient`s symptoms, renal failure, and pleural effusion improved and the retroperitoneal mass decreased in size. We report a case of IRF with a pleural effusion and acute renal failure that improved with steroid treatment, with a literature review. (Korean J Med 2011;80:S263-S267)
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만성폐쇄성폐질환 급성 악화로 입원한 환자의 세균성 원인
주세경 ( Sae Kyung Joo ),구승원 ( Seung Won Koo ),김미애 ( Mi Ae Kim ),조양현 ( Yang Hyun Cho ),차성태 ( Sung Tae Cha ),홍기연 ( Gi Youn Hong ),김은경 ( Eun Kyung Kim ),이지현 ( Ji Hyun Lee ),홍성근 ( Seong Geun Hong ),정혜철 ( Hy 대한내과학회 2009 대한내과학회지 Vol.77 No.3
Background/Aims: Bacterial infections play an important role in acute exacerbations of chronic obstructive pulmonary disease (AECOPD). While critically ill patients requiring admission need proper antibiotic treatment for the causative pathogen, little is known about the bacterial etiology of AECOPD in Korea. We therefore studied the bacterial etiology of hospitalized patients with COPD in our institution. Methods: The study enrolled 149 patients who were admitted to the hospital in Sungnam with the diagnosis of AECOPD between July 1, 2004 and June 1, 2007. We retrospectively reviewed the clinical data and results of sputum cultures. Results: Of the 149 subjects with sputum collected, 51% (76 cases) had positive bacterial cultures [age 70.7±9.2 years (mean±SD); 116 males] of sputum. Pseudomonas aeruginosa (24 cases, 30.4%) was the organism cultured in sputum most commonly, followed by Streptococcus pneumonia (15 cases, 18.9%), Acinetobacter sp. (9 cases, 11.4%), and Klebsiella pneumonia (7 cases, 8.9%). Patients whose FEV1 was <50% of the predicted value had a greater chance of showing positive growth of P. aeruginosa than patients having a FEV1 >50% (17/96 vs. 4/53, respectively, p=0.002). Patients taking systemic steroids also had a higher rate of sputum culture of P. aeruginosa (85.7%). Conclusions: P. aeruginosa was the pathogen most commonly isolated in hospitalized patients with COPD. This species should be considered when physicians select empirical antibiotics to treat patients with AECOPD. (Korean J Med 77:309-314, 2009)
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증례 : 순환기 ; 감전 사고 후 발생한 발작성 심방세동 1예
유광호 ( Kwang Ho Yoo ),김지운 ( Ji Woon Kim ),김주환 ( Ju Hwan Kim ),구승원 ( Seung Won Koo ),박현정 ( Hyun Jung Park ),성정훈 ( Jung Hoon Sung ) 대한내과학회 2011 대한내과학회지 Vol.80 No.2S
감전사고 이후 발생하는 심방세동의 빈도는 매우 드문 것으로 알려져 있다. 이전에 보고된 감전 후 심방세동은 1000볼트 이상의 고전압에 의한 것이 대부분이었고, 본 증례의 경우는 약한 볼트의 가정용 전압에서 발생된 것으로 국내에서는 그 예가 보고된 바가 없다. 부정맥이 감전에 의해 유발되는 정확한 기전은 아직까지 명확하지 않다. 다만, 체내로 들어온 전류는 전기적 저항의 차이에 의해 주로 혈관과 신경을 타고 주행하게 되며 이로 인해 심장이 취약한 것으로 알려져 있다. 본 환자의 경우 약한 전압임에도 입을 통해 심장을 관통하여 왼손으로 주행하였기 때문에 일시적인 부정맥을 일으켰을 것으로 생각된다. 심방세동의 치료는 베타차단제, 칼슘차단제, 디곡신 등으로 심박동수를 조절하거나, 필요하다면 class I, III와 같은 심부정맥약물로 정상동율동을 회복하여야 하고, 혈역학적으로 불안정한 경우 DC cardioversion 등을 고려해야 한다. Electrical injuries can cause cardiac abnormalities, ranging from dysrhythmias to myocardial infarction. Atrial fibrillation after electrical injury is extremely rare. The mechanisms underlying electrical current-induced arrhythmias are unclear. However, due to differences in electrical resistance, current travels preferentially along blood vessels and nerves, making the heart the most susceptible organ to electrical injury. Cardiac arrhythmias may occur at the time of electrical injury or later, but most occur within the first day of injury. Almost all patients described in previous reports with atrial fibrillation developed the condition after high voltage injuries (> 1,000 V). In our case, however, atrial fibrillation developed after a low voltage injury (220 V). Atrial fibrillation was detected and the rate was controlled with intravenous digoxin infusion. A normal sinus rhythm was restored 21 h after the electrical injury. (Korean J Med 2011;80:S142-S145)
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증례 : 신장 ; 거대 단순 신낭종의 경화요법 치료를 받은 환자에서 발견된 신세포암 1예
선한경 ( Han Gyung Seon ),김주환 ( Ju Hwan Kim ),구승원 ( Seung Won Koo ),유광호 ( Kwang Ho Yoo ),박경미 ( Kyeong Mi Park ),김지운 ( Ji Woon Kim ),김형종 ( Hyung Jong Kim ) 대한내과학회 2010 대한내과학회지 Vol.79 No.2
본 증례는 단순 신낭종에서 악성 신세포암이 발생하였을 것으로 생각되어 병리 검사를 시행하였으나, 신절제술 소견에서 이전 단순 신낭종 치료 부위에 근접하여 신세포암이 발견되었으며 낭성 종괴에서 종양세포는 발견되지 않았다. 아마도 단순 신낭종의 경화요법으로 치료할 당시에도 신세포암이 있었는지는 알기 어려우나, 과거 보고를 참고하였을 때 단순 신낭종으로 진단된 경우에도 드물기는 하나 악성 종양으로의 변형에 대한 가능성 및 새로운 신세포암이 발생할 수 있음을 염두에 두어 단순 신낭종의 치료 후에도 정기적인 추적관찰이 필요할 것으로 생각된다. Simple renal cysts are a common cystic disease of the kidneys, which is not symptomatic in most cases and is diagnosed by radiological examination. However, if the cyst is huge or symptomatic, it must be treated. Renal cyst aspiration and alcohol sclerotherapy is a safe and effective treatment for symptomatic simple renal cysts. Simple renal cysts have benign clinical features in the main and transformation of a simple renal cyst into renal cell carcinoma has rarely been reported. However, one case of renal cell carcinoma during renal cyst follow-up has been reported. We report a case of renal cell carcinoma that developed in a patient who was being treated with huge simple renal cyst sclerotherapy. (Korean J Med 79:201-205, 2010)
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만성 신부전 환자에서 clopidogrel에 의해 유발된 호중구감소증 1예
홍기연 ( Gi Youn Hong ),선한경 ( Han Gyung Seon ),정준구 ( Joon Gu Cheong ),주세경 ( Sae Kyung Joo ),강민경 ( Min Kyoung Kang ),이지은 ( Ji Eun Lee ),김주환 ( Ju Hwan Kim ),구승원 ( Seung Won Koo ),박경미 ( Kyoung Mi Park ),이소영 대한신장학회 2010 Kidney Research and Clinical Practice Vol.29 No.1
Clopidogrel, a thienopyridine derivative, is an anti-platelet agent that acts as an antagonist of the platelet adenosine diphosphate receptor and considered for essential prophylaxis for intracoronary stent thrombosis in the treatment of ischemic heart disease. Clopidogrel is considered as safe as aspirin but a few cases of severe hematologic adverse reactions associated with clopidogrel had been reported such as neutropenia, aplastic anemia, thrombocytopenic purpura, and thrombocytopenia. We report a rare case of neutropenia induced by clopidogrel in chronic renal failure in a patient who underwent percutaneous coronary intervention.
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