간세포암종 환자에서 경동맥화학색전술 이후 발생한 척수원추증후군

유선홍 ( Sun Hong Yoo ),배시현 ( Si Hyun Bae ),성필수 ( Pil Soo Sung ),김희언 ( Hee Yeon Kim ),송도선 ( Do Seon Song ),송명준 ( Myeong Jun Song ),최종영 ( Jong Young Choi ),윤승규 ( Seung Kew Yoon ),천호종 ( Ho Jong Chun ) 대한간암학회 2011 대한간암학회지 Vol.11 No.2

Hepatocellular carcinoma (HCC) is the fourth most common cancer in Korea and a common cause of cancer death. Transcatheter arterial chemoembolization (TACE) is used as palliative therapy for patients with inoperable HCC. TACE is an effective treatments for inoperable HCC, but variable complications due to using embolic agents can occur after TACE. Complications due to embolic agents include pulmonary lipiodol embolism, splenic infarction, cerebral lipiodol infarction, and spinal cord injury. This is a rare case of spinal cord injury after a sixth TACE via right T9 intercostal artery.

간세포암종 환자에서 간동맥화학색전술의 합병증

유선홍 ( Sun Hong Yoo ),배시현 ( Si Hyun Bae ) 대한간암학회 2011 대한간암학회지 Vol.11 No.2

Transcatheter arterial chemoembolization (TACE) is one of the most effective treatments for patients with inoperable hepatocellular carcinoma (HCC). However, variable complications can occur after TACE. Complications resulting from TACE contain postembolization syndrome, liver abscess, bile duct injury, ruptured HCC, acute hepatic failure, variceal bleeding, acute kidney injury, pulmonary lipiodol embolization, femoral artery pseudoaneurysm, femoral arteriovenous fistula, abdominal aortic dissection, spinal cord injury, and others. Complications after TACE are occasionally fatal. Therefore, it is important that we are well acquainted ourselves with these complications, and need care promptly the patient who develop symptoms of complication.

임상 연구 : 복막투석환자에서 복강 내 칼시트리올 충격요법의 부갑상선 호르몬 억제효과

송호철 ( Ho Cheol Song ),유선홍 ( Sun Hong Yoo ),정현화 ( Hyun Wha Jeong ),김용균 ( Yong Gyun Kim ),신석준 ( Seok Joon Shin ),김병수 ( Byung Soo Kim ),김영옥 ( Young Ok Kim ),김용수 ( Yong Soo Kim ),최의진 ( Euy Jin Choi ) 대한신장학회 2008 Kidney Research and Clinical Practice Vol.27 No.6

목적: 투석중인 말기신부전 환자에서 신성 골이양증은 중요 합병중에 하나이며 이의 치료를 위해 칼시트리올이 주로 사용되고 있다. 혈액투석의 경우 칼시트리올 정주요법이 많이 연구되고 임상에서 사용되고 있으나 복막투석 환자의 경우 정주요법의 한계로 인하여 정주요법 보다는 경구요법과 복강 내 주입이 임상에서 시도 되고 있다. 특히 복강 내 주사의 경우 경구요법의 대안으로 제시되고 있으나 아직 이에 대한 치료방법이 확립되지 않은 실정이다. 이에 본 연구에서는 복막투석중인 환자를 대상으로 하여 복강 내 칼시트리올 충격요법의 효과와 부작용의 발생빈도를 알아보고자 이 연구를 시행하였다. 방법: 2006년 1월부터 2007년 1월까지 가톨릭대학교 성가병원에서 6개월 이상 안정적으로 복막투석중이며 연구에 동의한 자를 대상으로 하였고, iPTH의 측정치가 300 pg/mL 이상의 환자를 대상으로 연구를 진행하였다. 대상환자는 한번에 2 ㎍씩 주 2회 복강내로 칼시트리올을 투여하였다. 연구기간 중 고칼슘혈증 (>10.5 mg/dL)과 고인산혈증 (>6.5 mg/dL)의 발생시 연구에서 제외하였다. 결과: 대상환자 18명중, 복막염과 고인산혈증으로 각각 1명이 연구에서 제외되었다. 대상환자의 원인질환은 당뇨병성 신증, 사구체신염, 고혈압증 신증이었다. 3개월간의 복강내 칼시트리올주입 후 iPTH측정치가 투여 전 (490±234 pg/mL)에 비해 3개월 투여 후 (318±315 pg/mL) 의미 있게 감소하였다 (p<0.05). 3개월 동안의 복강 내 투여기간 중 고칼슘혈증은 발생은 없었으며, 1명에서 고인산혈증의 발생으로 연구에서 제외되었다. 투여 후 30% 미만으로 iPTH가 감소한 군이 30% 이상 감소한 군에 (반응군에) 비해 투여 전 iPTH가 유의하게 높았다 (p<0.05). 결론: 복막투석 환자에서 발생한 이차성 부갑상선의 치료에 복강 내 칼시트리올 충격요법은 비교적 낮은 부작용의 빈도로 치료할 수 있는 수단이며 확립된 치료방법을 위해 보다 많은 전향적 연구가 필요하리라 사료된다. Purpose: In hemodialysis patients with secondary hyperparathyroidism, intravenous administration of calcitriol became widely utilized. In CAPD patients, however, the intravenous administration of calcitriol is not practical. The purpose of the present study was to determine the effect and safety of intraperitoneal (IP) calcitriol pulse therapy in CAPD patients. Methods: All patients undergoing CAPD between January 2006 and January 2007 and willing to give informed consent were eligible. Inclusion criteria were age greater 18 years, on CAPD for at least 6 months, and secondary hyperparathyroidism (intact PTH >300 pg/mL). Intraperitoneal calcitriol was given by direct infusion into the dialysate (2.0 ㎍) twice per week. If hypercalcemia (>10.5 mg/dL) and hyperphosphatemia (>6.5 mg/dL) developed, the patients were excluded from study. Results: Eighteen patients were enrolled into the study. Among them, 16 patients completed the study period. After IP calcitriol for 3 months, there was a significant drop of iPTH level from the pretreatment level of 490±234 pg/mL to the level of 318±315 pg/mL (p<0.05). There were no definite hypercalcemia during the study period, and only 1 patient was excluded from study due to hyperphosphatemia. Conclusion: In CAPD patients, IP calcitriol pulse therapy is effective in treating secondary hyperparathyroidism, and that IP calcitriol pulse therapy is associated with a low incidence of hypercalcemia and hyperphosphatemia.

증례 : 혈액종양 ; c-kit 돌연변이가 동반된 RUNX1/RUNX1T1 양성 급성골수성백혈병에서의 골수육종

윤유선 ( Yu Seon Yun ),최승화 ( Seung Hwa Choi ),유선홍 ( Sun Hong Yoo ),유진석 ( Jin Sok Yu ),이지은 ( Ji Eun Lee ),김희제 ( Hee Je Kim ),민우성 ( Woo Sung Min ) 대한내과학회 2011 대한내과학회지 Vol.81 No.4

RUNX1-RUNX1T1 양성 AML에서 c-kit 돌연변이와 골수외 백혈병의 발생은 밀접한 상관관계가 있으며 고식적 치료법에 저항성을 나타내고 궁극적으로 매우 나쁜 예후를 보인다. 그러므로 임상적으로 골수외 백혈병이 동반된 AML 환자에서 c-kit 돌연변이 여부를 확인하고 고위험군으로 분류하여 더욱 적극적인 치료를 시행해야겠다. 저자들은 최근 t (8;21) (q22;q22);RUNX1-RUNX1T1 양성 AML 환자에서 c-kit 유전자 돌연변이와 골수외 백혈병이 동반된 3예를 임상 경험하여 문헌고찰와 함께 보고하는 바이다. t (8;21)(q22;q22) is the most frequently detected cytogenetic abnormality in patients with acute myeloid leukemia (AML) and accounts for 8-21% of de novo AML. The translocation involves two genes, RUNX1 (formerly AML1) on 21q22 and RUNX1T1 (ETO) on 8q22. RUNX1/RUNX1T1 translocation confers a favorable prognosis, but a subset of patients has a precipitous course with a high incidence of relapse. This patient subset is associated with the presence of a c-kit mutation. c-kit is a proto-oncogene, which encodes a type III transmembrane tyrosine kinase, which elicits a variety of cellular responses essential for the development of bone marrow stem cells. The expression of the c-kit mutation in AML is < 2%, whereas AML with RUNX1/RUNX1T1 shows higher rates of c-kit mutation and is associated with extramedullary leukemia and poor clinical outcome. We report cases of myeloid sarcoma in patients with RUNX1/RUNX1T1-positive AML and a c-kit mutation. (Korean J Med 2011;81:517-525)

복강경하 근치적 신절제술 후에 발생한 급성 신부전을 동반한 횡문근 융해증

옥주현 ( Ju Hyun Oak ),정미향 ( Mi Hyang Jung ),황병희 ( Byung Hee Hwang ),유선홍 ( Sun Hong Yoo ),박기훈 ( Ki Hoon Park ),김지훈 ( Ji Hun Kim ),안서희 ( Seo Hee Ann ),김용균 ( Yong Kyun Kim ),송호철 ( Ho Cheol Song ),최의진 ( Eui 대한신장학회 2009 Kidney Research and Clinical Practice Vol.28 No.1

Postoperative rhabdomyolysis with acute renal failure (ARF) is a rare complication of laparoscopic urologic surgery. It is associated with lateral decubitus surgical position, long operative time, and increased body mass. We report a case of a 49-year-old-man with right renal cell carcinoma who underwent a laparoscopic right radical nephrectomy for 7 hours in left decubitus position and was complicated by ARF due to postoperative rhabdomyolysis. Laparoscopic renal surgery is performed in many surgical renal diseases and heightened suspicion may help early recognition of postoperative rhabdomyolysis. Vigorous hydration and hemodialysis are also helpful in treating ARF secondary to rhabdomyolysis.

장기간 담즙 외부 배액 유지 후 발생한 야맹증

이승민,최진영,강호준,성지희,박상종,유선홍,박영민 이화여자대학교 의과학연구소 2015 EMJ (Ewha medical journal) Vol.38 No.1

Vitamin A deficiency can occur as a result of malnutrition, malabsorption, or poor vitamin metabolism due to liver disease and night blindness might develop as the first symptom. Although there have been foreign reports about night blindness due to vitamin A deficiency which was derived from liver cirrhosis, primary biliary cirrhosis, intestinal bypass surgery or bariatric operation, it is hard to find reports about night blindness after percutaneous transhepatic biliary drainage for external bile drainage. We report a case of night blindness derived from fat-soluble vitamin A deficiency developed after long-term (18 months) external bile drainage for benign biliary stricture occurred after left hepatic lobectomy and hepaticojejunostomy due to the Klatskin tumor (IIIb). Her night blindness and low serum retinol level (0.02 mg/L) was dramatically improved after vitamin A supplementation. We recommend lipid-soluble vitamin supplementation on the case of long-term external bile drainage.