Clopidogrel 복용 중 발생한 혈전성 혈소판 감소성 자반증 1예

신성훈 고신대학교의과대학 2008 고신대학교 의과대학 학술지 Vol.23 No.3

Clopidogrel은 드물지만 혈전성 혈소판 감소성 자반증(TTP)를 유발할 수 있는 것으로 알려져 있다.1,2,4,6) 미국내 TTP의 발생 빈도는 매년 백만명 당 3.7명 정도로 보고되고 있고 경피적 관상동맥 중재술 시행 환자 중에는 0.02–0.06%에서 발생하는 것으로 보고되고 있다.1,2,4,6) 저자는 뇌혈관 폐쇄 질환으로 clopidogel을 복용해 오던 환자에서 미세 혈관병 용혈 빈혈 (microangiopathic hemolytic anemia) 급성 신부전, 혈소판 감소에 의한 출혈소견, 의식 장애 발생하여 혈전성 혈소판 감소성 자반증(TTP)으로 진단하고 혈장 교환술, 면역글로불린 치료 시행 후 호전된 증례 1예를 경험하였기에 보고한다. 호전 이후 다른 종류의 항 혈소판제 사용하였으나 특별한 부작용 관찰되지 않았다. thienopyridine에 의해 야기되는 TTP의 경우 약제별(ticlopidine, clopidogrel)로 발생 기전이 다른 것으로 보고되고 있어 반드시 thienopyridine계의 사용이 불가피한 경우는 다른 종류의 약제로의 변경도 고려해 볼 수 있으리라 생각된다.1,2,4,6) Thrombotic thrombocytopenic purpura (TTP) is an extremely rare and life-threatening condition, which is characterized by microangiopathic hemolytic anemia, acute renal failure, fever and changes in mental status. Pregnancy, toxins, malignancy, antineoplastic agents and thienopyridines (clopidogrel and ticlopidine) are known to precipitate it. Clopidogrel, a widely used antiplatelet agent, has been rarely reported to cause TTP. We report a case of clopidogrel-induced TTP. An 81 year old male patient suffered an acute ischemic stroke. Clopidogrel (75mg) was started daily and the platelet count was normal on the 2nd and the 22th day of its administration. On the 45th day, he showed thrombocytopenic purpura and stuporous mentality. Under the diagnosis of TTP, a plasma exchange was performed and his condition eventually returned to normal platelet count and normal mental status.

표준화 포럼 탐방 - 임베디드SW기술포럼

신성훈,Sin, Seong-Hun 한국정보통신기술협회 2014 TTA저널 Vol.154 No.-

Clinical Usefulness of Hydromorphone-OROS in Improving Sleep Disturbances in Korean Cancer Patients: A Multicenter, Prospective, Open-Label Study

신성훈,이호섭,김양수,최영진,김성현,권혁찬,오성용,강정훈,손창학,이상민,백진호,민영주,김충락,정주섭 대한암학회 2014 Cancer Research and Treatment Vol.46 No.4

PurposeTo evaluate the efficacy of hydromorphone-OROS (HM-OROS) in reducing sleep disturbanceand relieving cancer pain. Materials and MethodsOne hundred twenty cancer patients with pain (numeric rating scale [NRS] ≥ 4) and sleepdisturbance (NRS ≥ 4) were evaluated. The initial HM-OROS dosing was based on previousopioid dose (HM-OROS:oral morphine=1:5). Dose adjustment of the study drug waspermitted at the investigator’s discretion. Pain intensity, number of breakthrough painepisodes, and quality of sleep were evaluated. ResultsA total of 120 patients received at least one dose of HM-OROS; 74 of them completed thefinal assessment. Compared to the previous opioids, HM-OROS reduced the average painNRS from 5.3 to 4.1 (p < 0.01), worst pain NRS from 6.7 to 5.4 (p < 0.01), sleep disturbanceNRS from 5.9 to 4.1 (p < 0.01), incidence of breakthrough pain at night from 2.63 to 1.53times (p < 0.001), and immediate-release opioids use for the management of breakthroughpain from 0.83 to 0.39 times per night (p = 0.001). Of the 74 patients who completed thetreatment, 83.7% indicated that they preferred HM-OROS to the previous medication. Theadverse events (AEs) were somnolence, asthenia, constipation, dizziness, and nausea. ConclusionHM-OROS was efficacious in reducing cancer pain and associated sleep disturbances. TheAEs were manageable.

전해 플라즈마 공정에 의해 AZ61A 합금에 형성된 산화물층의 특성에 미치는 OH^- 이온 농도의 영향

신성훈,정영승,구본흔,Shin, Seong Hun,Jeong, Young Seung,Rehman, Zeeshan Ur,Koo, Bon Heun 한국재료학회 2016 한국재료학회지 Vol.26 No.10

The effect of NaOH concentration on the properties of electrolytic plasma processing (EPP) coating formed on AZ61A Mg alloy is studied. Various types of EPP were employed on magnesium alloy AZ61A in a silicate bath with different concentrations of NaOH additive. Analysis of the composition and structure of the coating layers was carried out using an X-ray diffractometer (XRD) and a scanning electron microscope (SEM). The results showed that the oxide coating layer mainly consisted of MgO and $Mg_2SiO_4$; its porosity and thickness were highly dependent on the NaOH concentration. The Vickers hardness was over 900 HV for all the coatings. The oxide layer with 3 g/l of NaOH concentration exhibited the highest hardness value (1220 HV) and the lowest wear rate. Potentiodynamic testing of the 3 g/l NaOH concentration showed that this concentration had the highest corrosion resistance value of $2.04{\times}10^5{\Omega}cm^2$; however, the corrosion current density value of $5.80{\times}10^{-7}A/cm^2$ was the lowest such value.

도로노면 온도측정 시스템을 이용한 사면구간의 도로노면 온도 특성

신성훈,성정곤 한국도로학회 2007 한국도로학회 학술대회 발표논문 초록집 Vol.2007 No.10

CM at Risk의 국내 건설시장 도입 및 활성화 방안 연구

신성훈,서용칠,구교진,현창택 대한건축학회 2003 대한건축학회 학술발표대회 논문집 - 계획계/구조계 Vol.23 No.1(구조계)

Nowadays, construction projects are increasing its complexities, risks and demands for greater' input and management skill. Also owners are gradually inclined to transfer their risks to other parties. In order to respond this situation, it is necessary that the different kinds of delivery systems suitable for the clients' needs be diversified and adapted to the Korean construction industry. In this background, the study is to present the approach to introduce CM at risk, one of the alternative delivery systems in Korea, by revising some regulations and proposing various types of this system.

[병영일기] 다섯 살 많은 친구

신성훈 샘터사 1999 월간 샘터 Vol.30 No.7

만성 골수성 백혈병의 뇌수막 괴립구육종 1예

신성훈 고신대학교의과대학 2008 고신대학교 의과대학 학술지 Vol.23 No.3

과립구 육종은 골수성 백혈병 세포의 국소적 증식으로 야기되는 골수 외 고형 종양으로 정의된다. 이 중 만성 골수성 백혈병 환자에서 발생하는 뇌수막 과립구육종은 극히 드문 것으로 알려져 있다. 몇몇 증례에서 수술이나 방사선 치료로 호전된 사례를 보고하고 있기는 하나 전반적인 예후가 극도로 나빠 대개 수개월 안에 사망한다. 글리벡 치료 도중 발생한 골수 외 과립구 육종 증례를 경험하였기에 보고한다. 만성 골수성 백혈병 글리벡 치료과정 중 발생한 과립구육종은 나쁜 예후를 시사하며 혈액학적 관해가 유지되고 있다 하더라도 발생 가능함을 경험하였다. 그리고 발생 부위가 생명 증후와 직접 연관되는 연수, 뇌간 인근일 경우 병의 진행으로 또는 방사선치료의 추가적인 부종으로 생명이 위험할 수 있으므로 조기 수술적 뇌압 감압술 시행 후 추가적인 방사선 치료와 항암치료를 시행할 것을 고려해야 한다. Granulocytic sarcoma is an extramedullary solid tumor which results from the localized proliferation of myelogenous leukemic cells. Leptomeningeal involvement of granulocytic sarcoma is very rare in chronic myelogenous leukemia (CML). Some patients improve after surgery and radiotherapy but the prognosis is so poor that most patients die within months. The author experienced a case of chronic myelogenous leukemia associated with a leptomeningeal granulocytic sarcoma. The patient was a 27 year-old female and she was admitted with acute visual disturbance. She was diagnosed as extramedullary progressive disease of CML 1 year after Imatinib therapy. Therefore, the author report this case with literature review.

Cerivastatin과 Cyclosporine을 병용 투약한 신이식 환자에서의 횡문근융해증 1예

신성훈,김민대,강승수,김찬욱,이지영,엄재섭,권성일,김길수,정연순,임학 고신대학교 의학부 2002 高神大學校 醫學部 論文集 Vol.17 No.1

Cerivastatin, a kind of statins, is a recently used lipid-lowering drug. which inhibits of hydroxymethylglutarate coenzyme A (HMG-CoA) reductase. The serum concentrations of statins in healthy volunteers are increased by the simultaneous administration of cyclosporine, itraconazole, as well as erythromycin and verapamil and increased risk of myalgia and rhabdomyolysis has been reported after concomitant use of HMG-CoA reductase inhibitors with these drugs. A 57-year-old female kidney transplant recipient admitted because of a dark urine, myalgia and weakness of extremities. Six weeks before admission, the patient has taken cerivastatin 0.3mg daily. Cyclosporine, prednisolone and mycophenolate mofetil were maintained for recent two years. Initial laboratory data showed serum creatinine 1.1mg/dl, AST 235 IU/L, LDH 2,465 IU/L, CPK 1600 IU/L, myoglobin >3,000 ng/ml and cyclosporine 288ng/ml (TDX). Medication of cerivastatin was discontinued, and the patient recovered rapidly with supportive therapy. After eighteen weeks of cerivastatin withdrawal. the drug was represcribed to control the increased lipid levels. The patient showed the same clinical manifestations suggesting rhabdomyolysis following eight weeks of cerivastatin administration. We report a case of rhabdomyolysis associated with cerivastatin and cyclosporine combination therapy in a kidney transplant recipient.

농흉 연관 흉막 T 세포 림프종 1예

신성훈 고신대학교의과대학 2008 고신대학교 의과대학 학술지 Vol.23 No.3

농흉 연관성 림프종(pyothorax-associated lymphoma)은 일반적으로 B 세포성 림프종이 대부분을 차지하며 T세포 림프종의 발생은 극히 드문 것으로 알려져 있다. 조기진단과 종양의 수술적 완전 절제 가능 여부가 예후에 중요하다. 방사선 치료의 좋은 성적을 보고한 소규모의 후향적 조사들이 있으나 명확한 표준 치료를 제시하기는 힘든 실정이다. 저자는 흉막에 발생한 농흉 연관성 T 세포 림프종 1예를 경험하였기에 참고 문헌 검토와 함께 증례 보고하는 바이다. The author report a case of primary malignant T cell lymphoma arising from the pleura. The patient suffered from pulmonary tuberculosis 20 years ago but he was sucessfully cured after 12 months-antituberculosis therapy. He was admitted with dyspnea on exertion. Chest CT demonstrated a mass along the right chest wall. PCNB (Percutaneous Transthoracic Biopsy) of the pleural tumor and bone marrow biopsy were performed. Results of immunohistochemical analysis were CD2(+), CD5(+), CD7(+), CD20(-), CD45RO(+) and HLA-DR(-). The author diagnosed this case as a peripheral T-cell lymphoma. The patient was progressively deteriorated and he died of sepsis 2 months after the completion of 2nd cycle CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) chemotherapy