• Journal of Chest Surgery
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• v.33 no.8
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• pp.688-692
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• 2000

Descending Necrotizing Mediastinitis(DNM) is a complication of oropharyngeal infections that can spread to the mediastinum. It is difficult to diagnose early because clinical and radiologic findings appear in the late stage of the infection. late diagnosis is the principal reason for the high mortality in DNM. An 18-year-old female admitted with Ludwig's angina from dental caries. Despite of combined antibiotics, dental extraction and drainge of submental abscess, infection spread to the cervical area. Chest computed tomogram revealed extension of the abscess to the pretracheal and periaortic space and development of bilateral pleural empyema. We performed bilateral cervical mediastinotomy and thoracotomy for drainage and debridement. Tracheostomy to secure the airway and postoperative pleural irrigation were performed. Postoperative course was uneventful and patient was discharged on the 40th postoperative day. It is important to perform chest CT scanning for early diagnosis of DNM when oropharyngeal infection spreads to the cervical area. Improved survival of patients with DNM implies early and radical surgical drainage and debridement via a cervical mediastinomy and thoracotomy.

• The Monthly Diabetes
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• s.216
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• pp.39-41
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• 2007

당뇨병환자에서의 감염증은 인슐린과 항균제의 사용으로 그 이환율과 사망률이 현저히 감소하였으나, 현재까지 당뇨병환자의 진료에 있어서 해결해야 할 중요한 문제로 남아있다. 당뇨병환자에서 감염증의 발생빈도는 대부분 일반인과 차이가 없다고 보고되고 있으나 일부 특정 감염증의 빈도는 현저하게 증가하고 감염증의 정도가 훨씬 심하며, 임상양상도 정상인과 다른 것으로 알려져 있다. 특히 인플루엔자, 세균뇨, 악성 외이도염, 비뇌모균증, 기종성 담낭염, 기종성 신우신염 또는 방광염, 급성 신유두괴사, 신주위 농양, 진균성 요로 감염증, 그람 음성균에 의한 폐렴, 괴사성 연조직 감염과 족부 궤양 관련 감염증 등은 당뇨병과의 관련성이 이미 입증된 감염질환들이다. 당뇨병 환자에서 감염증의 발생빈도는 약 14.4%에서 39.5%까지 보고되고 있으며, 국내에서는 폐결핵 20%, 요로 감염 20%, 폐렴 16%, 진균감염 7.6%, 균혈증 6.2%, 족부 궤양 관련 감염증 5.5%의 순으로 보고되고 있다. 당뇨병환자가 감염증에 대한 원인에 대해서는 확실히 밝혀지지는 않았지만 탈수, 영양실조, 다형 백혈구의 기능 장애, 혈액 순환장애 및 신경병증 등으로 설명되고 있다. 특히 당뇨병환자에서는 미세 혈관병증과 죽상경화증이 흔히 발생하기 때문에 각 조직으로의 혈액 공급이 감소되어 각 장기 조직에서는 정상적인 영양 및 산소 공급과 적절한 면역 반응을 유지하는 것이 어려워 결과적으로 감염증에 걸리기 쉽다. 이 글에서는 여러 가지 감염증 중 족부 궤양 감염증, 기종성 신우신염, 비대뇌모균증, 간농양에 대해 사례를 중심으로 알아보겠다.

• Clinical and Experimental Pediatrics
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• v.45 no.2
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• pp.261-266
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• 2002

Vascular ring, originating from abnormal regression of the aortic arch during fetal life, can cause prolonged and recurrent respiratory symptoms and dysphagia when the diagnosis is delayed. We report a 4 month old girl with vascular ring, who had been treated for persistent respiratory symptoms including stridor, wheezing, and dyspnea soon after birth. Initially her respiratory symptoms were thought to be due to bronchiolitis, for which respiratory syncytial virus was confirmed by immunofluorescent staining. Her clinical course was again complicated with tracheitis and pneumonia due to Haemophilus influenzae type b. The possibility of anatomical anomaly was investigated when it was felt to be difficult to insert a suction catheter deep down through a endotracheal tube which was placed for adequate ventilatory management. A three-dimensional chest CT revealed a vascular ring consisting of a double aortic arch. For 5 months following surgery, her respiratory symptoms have slowly been improving. She developed another episode of pneumonia which was milder than the one which occurred before the surgery.

• Journal of The Korean Society of Inherited Metabolic disease
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• v.14 no.2
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• pp.168-173
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• 2014

Vascular Ehlers-Danlos syndrome (vEDS) is an autosomal dominant disorder caused by a mutation of the type III collagen (COL3A1). The manifestation of vEDS can be seen in skin, joints, blood vessels, and internal organs. The diagnosis of vEDS often is missed until the patient presents with a life-threatening complication such as spontaneous arterial rupture or bowel perforation. We report a 16-year-old male who had recurrent right thigh hematoma after simple exercise and minor trauma, respectively. He had a history of surgery due to spontaneous colon perforation at his age of 11 years. Gene test of COL3A1 revealed a novel mutation c.2931+dupT.

• Tuberculosis and Respiratory Diseases
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• v.51 no.6
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• pp.603-608
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• 2001

Intracranial vasculitis is a rare and disastrous complication of tuberculous meningitis if not treated properly. Focal neurologic deficits according to the vessels involved are common manifestation. Here, we report a 29-year-old man who suffered abrupt, bizarre behavioral changes caused by vasculitis complicating tuberculous meningoencephalitis. The diagnosis of tuberculous meningitis is based upon both the CSF findings and a chest X-ray. His systemic symptoms disappeared by after being administered antituberculous medication but various psychotic features such as hypersomnia, hyperphagia and aggressive behavior continued. A brain MRI showed multiple small parenchymal tuberculous nodules, and the brain MR angiography revealed a narrowing of the proximal middle cerebral arteries and a reduced visualization of the cerebral vessels, suggesting widespread vasculitis. Intravenous dexamethasone successfully ameliorated his behavioral changes. In addition both the follow up brain MRI and angiography showed a normalization of the previous findings.

• Childhood Kidney Diseases
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• v.10 no.1
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• pp.40-44
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• 2006

[ $Henoch-Sch{\"{o}}nlein$ ] purpura(HSP) is a systemic small vessel vasculitis characterized by cutaneous purpura, arthritis, abdominal pain and nephritis. The characteristic rash of HSP consists of palpable purpura on the buttocks and lower extremities. Bullous lesions often appear in adults with HSP, whereas they are very rare in children with HSP. In this case report, the patient presented with arthralgia and abdominal pain and had hemorrhagic bullae as a prominent manifestation of the disease. The skin biopsy of the patient revealed typical leukocytoclastic vasculitis of dermal vessels and prominent IgA and fibrinogen deposits on capillary walls by direct immunofluorescence. We confirmed the diagnosis of HSP and observed improvement of clinical symptoms and signs within a few days after corticosteroid treatment. We therefore report a case with a review of the literature.

• The Korean Journal of Nuclear Medicine
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• v.38 no.6
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• pp.498-505
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• 2004

Purpose: We compared captopril renal scintigraphic criteria for the diagnosis of renovascular hypertension by unilateral renal artery stenosis. Materials and Methods: The study group consisted of 24 patients (m/f : 16/8, age: $39{\pm}18$ years) with unilateral renal artery stenosis who underwent renal artery revascularization and captopril renal scintigraphy with $^{99m}Tc$-diethylenetriaminepentaacetic acid between May 1995 and April 2004. The blood pressure response was classified as cure/improvement or failure. We evaluated captopril-induced changes in relative function (BCfun) and renogram grade (0 to 5: 0=normal, and 5=renal failure pattern without measurable uptake) (CBren) and the difference of renograms between the normal and stenotic kidney on captopril scan (CNren). Results: light of 24 patients were cured and 11 improved and 5 patients were classified as failed revascularization. Significant predictors of a cure or improvement of blood pressure were younger age, stenosis by fibromuscular dysplasia or arteritis, BCfun, CBren and CNren. Areas under the receiver operating characteristic curve of age, BCfun, CBren and CNren were not significantly different. Positive and negative predictive values of predictors were 100% and 42% (age ${\leq}38$): 92% and 50% (BCfun ${\geq}1%$): 92% and 75% (CBren ${\geq}1$), and 90% and 60% (CNren ${\geq}1$), respectively. Conclusion: Captopril induced changes in renal function and renogram can reliably predict hypertension response to revascularization. Renogram pattern on captopril scan can diagnose renovascular hypertension without baseline data in patients with unilateral renal artery stenosis.

• Journal of the Korea Convergence Society
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• v.2 no.4
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• pp.47-52
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• 2011

Periodontal disease is a common inflammatory disorder that is being considered as a risk factor for atherosclerotic complication. Recent epidemiological evidence also supports that its potential association with increased blood pressure levels and hypertensive prevalence. Data from cross-sectional studies suggest that in hypertensive patients periodontal disease may enhance the risk and degree of target organ damage. So dental infections have been associated with cardiovascular diseases. There are potential pathophysiologic links between hypertension and periodontits. The role of the inflammatory pathway include C-reactive protein(CRP). CRP is an inflammatory mediator that has been shown to predict the development of hypertension independently of baseline BP and traditional risk factors, has been consistently reported as at least mildly elevated in patients with periodontal disease. Reactive oxygen species produced by locally infiltrating neutrophils participate in periodontal tissue destruction. Periodontits can lead to inflammatory responses in the atrial myocardium, which disturbs the structural and electrophysiologic properties of the atrium and facilitates atrial fibrillation in the animal experiment.

• Tuberculosis and Respiratory Diseases
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• v.52 no.3
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• pp.278-282
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• 2002

A 68-year-old woman was admitted after suffering facial edema with neck vein engorgement for approximately 2 months. A chest X-ray showed a mild widening of the superior mediastinum and a luminal obliteration of the superior vena cava(SVC) was noted on a computed tomograph. Venography showed that both subclavian veins were obstructed at the level of the proximal clavicle with a nonvisualization of the SVC. The SVC, both the innominate and the left internal jugular veins were completely obstructed with extensive cord-like fibrotic changes despite the absence of mediastinal involvement. The microscopic features showed a chronic granulomatous inflammation with a fibrosis minimally invading the mediastinal fat, which is consistent with fibrosing mediastinitis.

• Journal of Chest Surgery
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• v.35 no.11
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• pp.831-834
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• 2002

When any part of the pacemaker system is infected, all pacemaker hardware should be removed, because reinfection rates of 51% to 77% have been noted in patients whose infected pacemaker system has been only partially explanted. The removal of infected leads during cardiopulmonary bypass prevents mechanical injury as well as the spread of infection and vegetation. We report one case of endocarditis by staphylococcus aureus with infected transvenous pacing lead which was migrated into the heart from the left subclavian vein. We removed the migrated pacing lead and vegetation under cardiopulmonary bypass.