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혈액투석 환자에서 발생한 신장 혈종과 자발성 비장 파열의 1예
허소정 ( So Chong Hur ),김윤권 ( Youn Kwon Kim ),정준오 ( Jun Oh Jung ),이세한 ( Se Han Lee ),유서희 ( Seo Hee Ryu ),심형훈 ( Hyoung Hun Sim ),윤창용 ( Chang Yong Yun ) 전북대학교 의과학연구소 2012 全北醫大論文集 Vol.36 No.2
혈액 투석 중인 환자에서의 자발성 비장출혈은 요독성 출혈 경향과 항혈소판제, 투석중 헤파린 사용 등과 연관되어 발생할 수 있으며 매우 드물게 보고되고 있다. 저자들은 혈액 투석 중인 환자에서 최근 외상병력 없이 새로이 발생한 자발성 비장 출혈을 경험하였다. 말기 신부전으로 혈액 투석중인43세 남자가 투석 후 복부 전반의 찌르는듯한 통증을 주소로 내원하였다. 3개월전 발생한 자발성 우측 신장 혈종으로 보존적 치료 중이었으며 항응고제를 복용하고 있지 않았다. 혈압은 152/88 mmHg, 맥박 78 회/분이었고 결막은 창백하고 복부 전반에 걸친 압통과 반발통이 있었다. 복부 전산화 단층 촬영에서 비장 혈종과 다량의 복강 내출혈을 보여, 비장 절제술을 시행 받고 현재혈액투석하며 경과 관찰 중이다. Spontaneous splenic rupture is a rare disease. Dialysis patients with chronic renal failure can undergo spontaneous splenic hemorrhage caused by uremic coagulopathy, heparin used in hemodialysis, infection, amyloidosis. We report spontaneous splenic rupture in a 43year-old man undergoing hemodialysis for end-stage renal disease (ESRD). After hemodialysis he was admitted with complaints of pricking whole abdominal pain and anorexia. He had undergone renal hematoma 3months ago without recent trauma history and had been managed conservatively without using anticoagulant and anti platelet agents during hemodialysis. Blood pressure was 152/88 mmHg, heart rate was 78 bmp. White blood cell count was 8,600/μL, hemoglobin was 6.6 g/dL, platelet was 121,000/μL, PT INR was 1.37 and aPTT was 30.4sec. Abdominal CT scan showed splenic hematoma and large amount of hemoperitoneum. An emergent splenectomy was performed without immediate complications related to the surgical procedures. Pathology report demonstrated that spleen had normal tissue with hematoma. The postoperative course was uneventful. The patient has been undergoing hemodialysis till now. Spontaneous spleen rupture, a rare disease can cause life threatening situation and we should make early diagnosis and management of spontaneous spleen rupture when evaluating patients undergoing hemodialysis who present with abdominal pain and acute onset of anemia.
Seo, Han-Seok,Kim, Eun-Sil,Kim, So-Yon,Im, Su-Jin,Park, Yong-Hyun,Lee, Ju-Hyoung,Hur, So-Chong The Korea Society of Nuclear Medicine 2011 핵의학 분자영상 Vol.45 No.4
Urethral metastasis from colorectal cancer is rare and is known to have a poor prognosis. A 72-year-old man with a history of colectomy and colostomy due to sigmoid colon cancer was admitted to the emergency room with bowel distension, rectal bleeding and urinary symptoms. Computed tomography of the abdominopelvis showed sigmoid colon cancer with multiple metastases involving the liver. Positron emission tomography with F-18 fluorodeoxyglucose (FDG) showed multiple hypermetabolic foci in the liver, penis and pubic bone, which otherwise could not be diagnosed. The lesions revealed no improvement with chemotherapy and urological surgery on follow-up F-18 FDG PET/CT. We present a case of urethral metastasis of sigmoid colon cancer diagnostically and prognostically indicated by F-18 FDG PET/CT.
Tracheal Involvement in Crohn Disease: the First Case in Korea
Seunghyun Park,Jong Ha Park,김현국,Ji Yeon Kim,So Chong Hur,Ju Hyung Lee,Jae Won Jung,Juwon Lee 대한소화기내시경학회 2016 Clinical Endoscopy Vol.49 No.2
Respiratory involvement in Crohn disease (CD) is rare condition with only about a dozen reported cases. We report the first case of CD with tracheal involvement in Korea. An 18-year-old woman with CD was hospitalized because of coughing, dyspnea, and fever sustained for 3 weeks. Because she had stridor in her neck, we performed computed tomography of the neck, which showed circumferential wall thickening of the larynx and hypopharynx. Bronchoscopy revealed mucosal irregularity, ulceration, and exudates debris in the proximal trachea, and bronchial biopsy revealed chronic inflammation with granulation tissue. Based on these findings, we suspected CD with tracheal involvement and began administering intravenous methylprednisolone at 1 mg/kg per day, after which her symptoms and bronchoscopic findings improved.
Ju Hyoung Lee,Kyeong Min Jo,Tae Oh Kim,Jong Ha Park,Seung hyun Park,Jae Won Jung,So Chong Hur,양성연 대한소화기내시경학회 2016 Clinical Endoscopy Vol.49 No.6
Brunner’s gland hamartomas are small benign lesions that are most commonly found in the bulb of the duodenum. They are veryuncommon, and most are found incidentally during upper gastrointestinal series or esophagogastroduodenoscopy. The lesions tendto be asymptomatic, but patients may present with symptoms of duodenal obstruction or hemorrhage secondary to ulceration. Histologically, a Brunner's gland hamartoma consists of the components of Brunner's gland cells, as well as glandular, adipose andmuscle cells. In this study, we report the case of a 30-year-old man who presented with upper gastrointestinal bleeding and obstructivesymptoms due to a giant Brunner's gland hamartoma in the duodenal bulb. The hamartoma was successfully removed by endoscopicresection. No significant complications were observed. Microscopically, the lesion was found to be entirely composed of variableBrunner's glands and adipocytes.
Monitoring Therapeutic Response in a Case of Extrapulmonary Tuberculosis by Serial F-18 FDG PET/CT
Park, Yong-Hyun,Yu, Chang-Min,Kim, Eun-Sil,Jung, Jun-Oh,Seo, Han-Seok,Lee, Ju-Hyoung,Hur, So-Chong,Kim, So-Yeon,Lee, Hyon-Young The Korea Society of Nuclear Medicine 2012 핵의학 분자영상 Vol.46 No.1
Due to the low yield of AFB smear and culture in extrapulmonary tuberculosis, therapeutic responses of patients with extrapulmonary tuberculosis are usually monitored clinically and/or radiographically. Such monitoring techniques, however, are not enough to provide effective diagnosis if a remnant lesion exists after treatment. Tuberculosis presents hypermetabolic activity on F-18 fluorodeoxyglucose positron emission tomography/computed tomography (F-18 FDG PET/CT) scanning. Reported herein is a case of extrapulmonary tuberculosis where the therapeutic response was assessed via serial F-18 FDG PET/CT scanning, which was useful for detecting the extent of extrapulmonary tuberculosis and for estimating the patient's therapeutic response.
Jang, Moon Ju,Kim, Hye-Sun,Lee, Hye-Gyn,Kim, Gi Jin,Jeon, Hwang Gyun,Shin, Hyun-Soo,Chang, Sei-Kyung,Hur, Gin-Hyung,Chong, So Young,Oh, Doyeun,Chung, Hyung-Min S. Karger AG 2013 Acta haematologica Vol.129 No.4
<P>Abstract</P><P><B><I>Background and Aims:</I></B> Immunomodulatory properties of mesenchymal stem cells (MSCs) have been applied to reduce the incidence of graft-versus-host disease (GVHD) after hematopoietic stem cell transplantation (HSCT). Among the various sources of MSCs that have immunomodulatory effects in vitro, only placenta-derived MSCs (PD-MSCs) have not been evaluated in an in vivo model of GVHD. In this study, we investigated the immunomodulatory properties of PD-MSCs in vitro and evaluated their clinical potential for controlling GVHD in an animal model. <B><I>Methods:</I></B> A GVHD animal model was established by transplanting C57BL/6 donor bone marrow cells and spleen cells into lethally irradiated BALB/c recipient mice. To control GVHD, human PD-MSCs were transplanted into recipient mice (5 × 10<SUP>5</SUP> or 1 × 10<SUP>6</SUP> cells). <B><I>Results:</I></B> PD-MSCs suppressed mitogen-stimulated T cell proliferation in vitro in a dose-dependent manner. Moreover, PD-MSCs inhibited cytokine secretion (interleukin-12, tumor necrosis factor-α and interferon-γ) of activated T cells. In vivo, the survival rate in the PD-MSC group (transplanted with 1 × 10<SUP>6</SUP> cells) was higher than that in the control group and histological scores were low in the PD-MSC group. <B><I>Conclusion:</I></B> We present the first evidence that human PD-MSCs can efficiently control GVHD in an HSCT in vivo model.</P><P>Copyright © 2012 S. Karger AG, Basel</P>