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Child-Pugh 분류 A군 간경화에 수반된 간폐증후군
김정선 ( Jung Sun Kim ),김창환 ( Chang Hwan Kim ),김계수 ( Gye Su Kim ),임달수 ( Dal Soo Lim ),황흥곤 ( Hweung Kon Hwang ),노영무 ( Young Moo Ro ) 대한결핵 및 호흡기학회 2009 Tuberculosis and Respiratory Diseases Vol.66 No.1
Hepatopulmonary syndrome (HPS) is characterized by a defect in arterial oxygenation that`s induced by pulmonary vascular dilatation in the setting of liver disease. Some studies have shown the relationship between the presence of the HPS and the severity of liver disease, but there are only rare cases of HPS inpatient with Child-Pugh class A liver cirrhosis. We report here on a case of a 58 years-old male who suffered from progressive dyspnea for the previous few years. He was diagnosed with alcoholic liver cirrhosis 5 years previously. There was no significant abnormality on the chest radiograph and transthoracic echocardiography, but the arterial blood gas analysis revealed severe hypoxemia. Contrast-enhanced transesophageal echocardiograpy with agitated saline demonstrated a delayed appearance of microbubbles in the left cardiac chambers. Thus, he was finally diagnosed with HPS. This case suggests that we should consider HPS when a patient with compensated liver cirrhosis has unexplained dyspnea.
김미영,홍석근,임달수,황흥곤,전성희,김우규,김정경 대한내과학회 2000 대한내과학회지 Vol.58 No.4
Fungal prosthetic valve endocarditis is a rare, poo-prognostic disease. The risk factors for fungal valve endocardits are open heart surgery, hyperalimentation, antibiotic therapy, IV drug abuse, concomitant bacterial endocarditis and immunosuppression. We report a case of aspergillus endocarditis in the aortic valve, which extended to ascending aorta after Redo-aortic valve replacement surgery. A 22-year-old male patient underwent Redo-aortic valve replacement surgery with 23mm-sized Sorin valve(bi-leaflet tilting disc valve) due to prosthetic valve failure. He was readmitted because of development of cough, anorexia, fatigue and fever after operation. The results of repeated blood culture were negative, and the symptoms continued in spite of 2 week treatment with broad spectrum antibiotics. Echocardiography and spiral computed tomographic angiography revealed multiple, huge masses in the aortic valve extending to ascending aorta. Emergent surgery was performed. Infected valve and surrounding areas were widely excised and aortic homograft was inserted. Resected aorta and prosthetic valve showed multiple mass-forming vegetations, measuring up to 4㎝×3㎝×3㎝. Microscopically, they revealed fungal organisms, showing sharp-angle branching and septate hyphae. Aspergillus flavus was isolated in culture of resected tissue. The patient suddenly died of ventricular fibrillation 3 weeks after surgery in spite of treatement with intravenous amphotericin B.(Korean J Med 58:466-471, 2000)