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변승운 ( Seung Woon Byun ),최성호 ( Seong Ho Choi ),박현구 ( Hyun Gu Park ),김범준 ( Beom Jun Kim ),김의영 ( Eui Young Kim ),이규형 ( Kyoo Hyung Lee ),양원석 ( Won Seok Yang ) 대한내과학회 2007 대한내과학회지 Vol.73 No.4
저자들은 비타민의 공급 없이 총정맥영양법을 시행 중에 발생한 젖산산증에서 티아민 공급 후 수시간 이내로 산증이 교정된 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이며, 티아민을 공급하지 않는 총정맥영양법을 장기적으로 시행 중 발생한 젖산산증에는 티아민 결핍에 의한 젖산산증의 가능성을 반드시 염두에 두어야 할 것으로 사료된다. Lactic acidosis commonly occurs in association with shock. We encountered lactic acidosis in a patient with normal blood pressure. The patient was a 17 year-old man with acute lymphocytic leukemia. He was admitted for bone marrow transplantation. During hospitalization, he relied on total parenteral nutrition due to his poor oral intake. On the 37th day after admission, he developed lactic acidosis without an episode of hypotension or any causative medication. Because vitamins were not included in the parenteral nutrition, we prescribed thiamine replacement, and this corrected the acidosis within a few hours. Thiamine (in its active derivative) is a coenzyme for pyruvate dehydrogenase; thus, its deficiency causes accumulation of pyruvate and lactate. This case suggests that thiamine deficiency should be included in a differential diagnosis of lactic acidosis in patients who are on total parenteral nutrition without vitamin supplementation.(Korean J Med 73:443-447, 2007)
만성 항체 매개성 거부 반응에서 경정맥 면역 글로불린으로 치료한 1예
변승운 ( Seung Woon Byun ),여영선 ( Young Sun Yeo ),박정식 ( Jung Sik Park ),조영미 ( Yong Mee Cho ),박수길 ( Su Kil Park ) 대한신장학회 2009 Kidney Research and Clinical Practice Vol.28 No.4
A 66-year-old male was admitted for increasing azotemia. He was diagnosed with chronic antibody-mediated rejection and had received a livingdonor renal transplant from his 32-year-old son prior to his admission. The peritubular capillaries of his kidney were diffusely positive on C4d immunostaining. It is known that there is an agreement between C4d staining and serological and histopathological data during rejection that is thought to have a humoral component. The role of alloantibodies in chronic renal allograft deterioration and the corresponding morphologic changes have been increasingly recognized during the recent years. However the treatment guidelines for chronic antibody-mediated rejection have not yet been established. Intravenous immunoglobulin (IVIG) has been shown to decrease the titers of anti-HLA antibodies in highly sensitized patients awaiting transplant. There are also numerous proposed mechanisms regarding how IVIG exerts its immunomodulatory action. As we have experienced chronic antibody-mediated rejection and how IVIG treatment improves renal function, we recognize that IVIG has the potential to be used for treating certain subgroups of chronic allograft nephropathy patients with positive C4d staining and anti-HLA antibodies.
변승운 ( Seung Woon Byun ),이지영 ( Ji Young Lee ),박정식 ( Jung Sik Park ),박수길 ( Su Kil Park ) 대한신장학회 2009 Kidney Research and Clinical Practice Vol.28 No.5
A 41-year-old female was admitted for a subcapsular hematoma of her graft kidney six weeks after she underwent a kidney transplant. No report on subcapsular hematomas of graft kidneys has been published in Korea. Subcapsular hematoma of graft kidneys is one of a few very rare causes of bleeding. The clinical manifestations of subcapsular hematoma are the abrupt onset of flank pain or upper abdominal pain, nausea, anorexia, dizziness, and decrease in hemoglobin. If it is diagnosed late, it can result in renal insufficiency, hypovolemic shock, and even death. During the authors` management of a subcapsular hematoma of a renal graft, pure red cell aplasia induced by the parvovirus B19 was found to coexist. Bone marrow suppression, immunosuppressants and other drugs, bleeding, iron deficiency, and renal graft function insufficiency can result in anemia after a kidney transplant. Even though pure red cell aplasia is a rare cause of anemia, it should not be forgotten that pure red cell aplasia induced by parvovirus B19 infection can cause anemia after a kidney transplant.
신이식 후 발생한 Posttransplant Lymphoproliferative Disease
변승운 ( Seung Woon Byun ),박혜원 ( Hye Won Park ),송주형 ( Ju Hyung Song ),오지선 ( Ji Seon Oh ),김은희 ( Eun Hee Kim ),허주령 ( Joo Ryung Huh ),서철원 ( Cheol Won Suh ),박수길 ( Su Kil Park ) 대한신장학회 2006 Kidney Research and Clinical Practice Vol.25 No.5
Posttransplant lymphoproliferative disorders (PTLD) is an infrequent but serious complication of transplantation. Previous studies have suggested the terms of reference, early PTLD (referring to PTLD that occurs within 1 year of transplantation) and late PTLD (PTLD that occurs after 1 year). Early PTLD generally involves a single organ or nodal region and often responds favorably to a decrease in immunosuppression. Late PTLD tends to be disseminated, responds less frequently to a decrease in immunosuppression, and has a dismal prognosis. We encountered a diffuse large B-cell lymphoma in a 44-year-old man who underwent kidney transplantation over 10 years ago, in 1995. In situ hybridization for Epstein-Barr virus showed positive results in tumor cell. With decreased immunosuppressants and chemotheraphy, he is currently in complete remission. Korean J Nephrol 2006;25(5): 871-876)
급성 세포성 이식거부반응을 동반한 이식신의 면역 관련 단백의 발현 양상
박종하,변승운,유은실,박수길,한덕종,조영미 대한병리학회 2007 Journal of Pathology and Translational Medicine Vol.41 No.1
Background : We wanted to find an adjunctive marker(s) in renal allograft biopsies for predicting acute cellular rejection (ACR), and so the expression patterns of immune-related molecules were compared between ACR, borderline ACR and non-ACR cases. Methods : The expression patterns of Fas ligand (FasL), HLA-DR, granzyme B, caspase-3, CD56, interferon stimulated growth factor-3 (ISGF-3), and CD53 were assessed via immunohistochemical study in 75 allograft biopsies from patients with ACR (n=19), borderline ACR (n=22), and non-ACR (n=34). Results : Compared to those of the non-ACR group, the ACR group revealed an elevated number of FasL positive interstitial inflammatory cells, HLA-DR positive tubular inflammatory cells, cytoplasmic caspase-3 positive tubular epithelial cells, granzyme B positive interstitial mononuclear inflammatory cells and CD53 positive interstitial inflammatory cells. The expression patterns of the borderline ACR group were similar to those of non-ACR group, except for the intensity of FasL in the tubular epithelial cells. Conclusions : Immunohistochemical investigations of the adjunctive markers FasL, HLA-DR, granzyme B, caspase-3 and CD56 can be useful for making the diagnosis of ACR.
Staphylococcus lugdunensis에 의한 감염성 심내막염 1예
최성호,박현구,변승운,구동회,강호석,장항제,김양수,우준희,김영휘,최상호 대한감염학회 2006 Infection and Chemotherapy Vol.38 No.5
Staphylococcus lugdunensis is a coagulase-negative staphylococcus (CNS) that is commonly found on the human perineal skin. Contrary to other CNS, S. lugdunensis is a rare contaminant in cultures and has the potential to cause clinically significant infections, including infective endocarditis. Infective endocarditis due to S. lugdunensis have been known to resemble endocarditis due to S. aureus because of its aggressive clinical course and high mortality. We report a case of infective endocarditis caused by S. lugdunensis in a 21-year-old woman. She was cured of the infection with surgical and antibiotic therapy. S. lugdunensis에 의한 감염성 심내막염은 국내에서 보고가 없었던 매우 드물지만 다양한 합병증과 높은 사망률을 보이는 감염증이다. 저자들은 S. lugdunensis가 수술적 치료와 항생제 치료로 완치된 감염성 심내막염 1 예를 경험하였기에 문헌고찰과 함께 보고하는 바이다.
Staphylococcus lugdunensis에 의한 감염성 심내막염 1예
최성호,박현구,변승운,구동회,강호석,장항제,김양수,우준희,김영휘,최상호 대한감염학회 2006 감염과 화학요법 Vol.38 No.5
Staphylococcus lugdunensis is a coagulase-negative staphylococcus (CNS) that is commonly found on the human perineal skin. Contrary to other CNS, S. lugdunensis is a rare contaminant in cultures and has the potential to cause clinically significant infections, including infective endocarditis. Infective endocarditis due to S. lugdunensis have been known to resemble endocarditis due to S. aureus because of its aggressive clinical course and high mortality. We report a case of infective endocarditis caused by S. lugdunensis in a 21-year-old woman. She was cured of the infection with surgical and antibiotic therapy. S. lugdunensis에 의한 감염성 심내막염은 국내에서보고가 없었던 매우 드물지만 다양한 합병증과 높은 사망률을 보이는 감염증이다. 저자들은 S. lugdunensis가 수술적 치료와 항생제 치료로 완치된 감염성 심내막염 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다.
혈액 투석 환자에서 epoetin alfa와 darbepoetin alfa의 조혈 효과 비교: 무작위 교차 연구
이지영 ( Ji Young Lee ),변승운 ( Seung Woon Byun ),여영선 ( Young Sun Yeo ),양원석 ( Won Seok Yang ),박수길 ( Su Kil Park ),박정식 ( Jung Sik Park ),장재원 ( Jai Won Chang ) 대한신장학회 2009 Kidney Research and Clinical Practice Vol.28 No.5
Purpose: We aim to compare the erythropoietic effects of epoetin-α (EA, 4000 IU SC thrice a week) with those of darbepoetin-α (DA, 60ug IV weekly, conversion rate to EA=200:1). Methods: Forty one stable hemodialysis patients were enrolled in this randomized crossover study. After a washout period of erythropoietin stimulating agents (ESA), the patients with hemoglobin (Hb) level of ≤11.0 g/dL were randomly assigned to DA or EA and we measured Hb and reticulocyte levels. When Hb reached >11.0 g/dL, we stopped ESA. When Hb level decreased to ≤11.0 g/dL again, we switched to alternative ESA and repeated the rest of the steps. Results: Thirty six patients (M:F=20:16, age 62±11 years, Kt/V 1.65, nPCR 1.13 g/kg/day) completed the study. No significant differences were observed in baseline parameters between DA and EA during the period of the clinical trial. The rate of Hb level increase (EA 0.29 g/dL/week, DA 0.30 g/dL/week, p=0.76) and decrease (EA 0.45 g/dL/week, DA 0.38 g/dL/week, p=0.14) were not different between two periods. After ESA stopped, the duration of decreased Hb level of ≤11.0 g/dL was not significantly different (4 weeks in EA vs. 3.9 weeks in DA, p=0.86). Erythropoietin resistance index was 10.59 in the EA period. It was not significantly different from 10.97 in DA period (p=0.49). Nine patients (25%) showed a >30% change in EA efficiency relative to DA efficiency. Conclusion: There was no significant difference in erythropoietic parameters for both EA and DA.