Etanercept 치료로 호전된 성인형 스틸병

우학 ( Hak Woo ),김옥기 ( Ok Ki Kim ),이기훈 ( Gi Hoon Lee ),박정진 ( Jeong Jin Park ),이신석 ( Shin Seok Lee ),박용욱 ( Yong Wook Park ) 대한류마티스학회 2006 대한류마티스학회지 Vol.13 No.4

Adult-onset Still`s disease (AOSD) is a rare systemic inflammatory disorder of unknown etiology. Non-steroidal anti-inflammatory drugs (NSAIDs), steroids, disease modifying anti-rheumatic drugs (DMARDs), immunosuppressives and intravenous immunoglobulin (IVIG) have been used to control the disease. It was suggested that several pro-inflammatory cytokines, such as interleukin (IL)-5, IL-8, IL-18, and tumor necrosis factor (TNF)-α, play an important role in its pathogenesis. Recent reports showed the clinical effectiveness of TNF-α blockers (infliximab and etanercept) in refractory AOSD. We report a case successfully treated with etanercept in the early AOSD refractory to the combination therapy of high-dose prednisolone and cyclosporine (CSA).

신기능과 혈색소의 관계

우학 ( Hak Woo ),신민호 ( Min Ho Shin ),김옥기 ( Ok Ki Kim ),배우균 ( Woo Kyun Bae ),조영욱 ( Young Wook Cho ),이연경 ( Youn Kyoung Lee ),마성권 ( Seong Kwon Ma ),김수완 ( Soo Wan Kim ),김남호 ( Nam Ho Kim ),최기철 ( Ki Chul Choi 대한내과학회 2007 대한내과학회지 Vol.72 No.2

목적: 빈혈은 만성신질환 환자들에서 좌심실비대 등 건강에 여러 가지 악영향을 미치는 중요한 합병증 중의 하나이다. 기저질환에 관계없이 신기능의 악화에 따른 빈혈의 발생빈도, 혈색소 농도와 적혈구용적률의 변화 및 성별에 따른 차이를 알아보기 위해 이 연구를 시행하였다. 방법: 전남대학교병원 내과에서 치료하고 있는 환자들 중 남성 157명, 여성 132명의 의무기록을 후향적으로 분석하였다. MDRD 등식에 따라 추정 사구체여과율을 측정하고, 사구체여과율(GFR)이 90 mL/min/1.73 m2 이상을 기준(정상)으로 하여, 추정 사구체여과율이 10 mL/min/1.73 m2씩 감소함에 따라 9개 군으로 분류하여 기준과 비교하여 평균 혈색소 농도와 적혈구용적률이 통계학적으로 유의하게 감소하는 신기능의 범위를 찾아서 남성과 여성을 각각 비교하였다. 결과: 모든 대상 환자들은 기준치(추정 사구체여과율≥90 mL/min/1.73 m2)에 비해 추정 사구체여과율 50≤GFR<60 mL/min/1.73 m2에서 평균 혈색소 농도는 0.8 g/dL(p=0.021), 적혈구용적률은 2.6%(p=0.011)가 감소하였고, 신기능이 감소함에 따라 평균 혈색소 농도와 적혈구용적률은 더욱 유의하게 감소하였다(Hgb.: r=0.635, Hct.: r=0.640, p<0.001). 남성은 기준치에 비해 추정 사구체여과율 40≤GFR<50 mL/min/1.73 m2에서 평균 혈색소 농도는 1.7 g/dL(p<0.01), 적혈구용적률은 4.4%(p<0.01)가 감소하였고, 신기능이 감소함에 따라 평균 혈색소 농도와 적혈구용적률은 더욱 유의하게 감소하였다(Hgb.: r=0.69 8, Hct.: r=0.689, p<0.001). 여성은 기준치에 비해 추정 사구체여과율 60≤GFR<70 mL/min/1.73 m2에서 평균 혈색소 농도는 0.9 g/dL(p<0.01), 적혈구용적률은 2.8%(p<0.01)가 감소하였고, 신기능이 감소함에 따라 평균 혈색소 농도와 적혈구용적률은 더욱 유의하게 감소하였다(Hgb.: r=0.672, Hct.: r=0.687, p<0.001). 결론: 만성신질환 환자들에서 혈색소 농도와 적혈구용적률은 신기능이 감소함에 따라 점차 감소하였고 이것은 경증 내지 중등도 신기능 감소부터 관찰되었다. Background: The goal of this study is to define the relationship between the decreased renal function and anemia, and also to determine whether this relationship is different in male and female patients. Methods: We conducted a retrospective study of 289 patients (male:female=157:132) who were followed at the department of internal medicine at Chonnam National University Hospital. General linear models were used to analyze the relationship between the hemoglobin concentration and Modification of Diet in the Renal Disease formula estimated Glomerular Filtration Rate (mL/min/1.73 m2). Results: Among all patients, the mean hemoglobin concentration and hematocrit of the men with a Glomerular Filtration Rate of 50~59 mL/min/1.73 m2 was an absolute change of 0.8 g/dL (p=0.021) and it was 2.6% (p=0.011) lower than those of the patients with a Glomerular Filtration Rate≥90 mL/min/1.73 m2 and continued to decrease further as the Glomerular Filtration Rate decreased, respectively (Hgb.: r=0.635, Hct.: r=0.640, all p<0.001). Among the male patients, the mean hemoglobin concentration and the hematocrit of men with a Glomerular Filtration Rate of 40~49 mL/min/1.73 m2 was an absolute change of 1.7 g/dL (p<0.01) and it was 4.4% (p<0.01) lower than those of the male patients with a Glomerular Filtration Rate≥90 mL/min/1.73 m2 and continued decrease as the Glomerular Filtration Rate decreased, respectively (Hgb.: r=0.698, Hct.: r=0.689, all p<0.001). Among the female patients, the mean hemoglobin concentration with a Glomerular Filtration Rate of 60~69 mL/min/1.73 m2 was an absolute change of 0.9 g/dL (p<0.01) and the mean hematocrit was 2.8% (p<0.01) lower than those of the female patients with a Glomerular Filtration Rate ≥90 mL/min/1.73 m2 and continued to decrease further as the Glomerular Filtration Rate decreased, respectively (Hgb.: r=0.672, Hct.: r=0.687, all p<0.001). Conclusions: A decrease in the hemoglobin concentration was statistically significant in the patients of both genders, along with a moderately decreased Glomerular Filtration Rate (≤60 mL/min/1.73 m2). (Korean J Med 72:191-199, 2007)

괴사 근막염이 합병된 류마티스 관절염

황준일 ( Jun Eul Hwang ),우학 ( Hak Woo ),김상호 ( Sang Ho Kim ),이우석 ( Woo Seok Lee ),황재하 ( Jae Ha Hwang ),김정철 ( Jung Chul Kim ),조덕 ( Duck Cho ),박정진 ( Jeong Jin Park ),이신석 ( Shin Seok Lee ),박용욱 ( Yong Wook Pa 대한류마티스학회 2006 대한류마티스학회지 Vol.13 No.2

Necrotizing fasciitis is a life-threatening soft tissue infection involving skin, subcutaneous tissue, and superficial fascia. We report a case of necrotizing fasciitis that developed in a 76-year-old female patient taking low-dose methotrexate and prednisolone for rheumatoid arthritis (RA). A computed tomography scan of the neck during the initial work-up showed soft tissue swelling, loss of fat planes, and mild heterogeneous enhancement in the right lateral neck, suggesting cellulitis. The lesions were associated with skin necrosis and multiple bullae rapidly expanded to the right anterior chest in spite of empirical antibiotic therapy. Surgical debridement was immediately performed, and soft tissue biopsy from the lesions showed the pathologic finding consistent with necrotizing fasciitis. The skin wound defect was reconstructed by a flap operation with split-thickness skin graft. This case shows the development of necrotizing fasciitis in a elderly patient taking methotrexate and low-dose steroid for RA and highlights early recognition and prompt surgical debridement for successful management.

지속성 외래 복막 투석 환자에서 복막 투석액 및 혈청 Cancer Antigen 125 (CA125)농도 변화의 임상적 의의

조영욱 ( Young Wook Cho ),우학 ( Hak Woo ),배우균 ( Woo Kyun Bae ),이윤철 ( Yoon Chul Lee ),이민구 ( Min Goo Lee ),이연경 ( Yun Kyung Lee ),조민석 ( Min Seok Cho ),마성권 ( Seong Kwon Ma ),김수완 ( Soo Wan Kim ),김남호 ( Nam Ho K 대한내과학회 2005 대한내과학회지 Vol.68 No.3

증례 : 양측성 수신증을 동반한 골반내 방선균증 1예

이연경 ( Youn Kyoung Lee ),우학 ( Hak Woo ),조민석 ( Min Seok Cho ),마성권 ( Seong Kwon Ma ),김수완 ( Soo Wan Kim ),김남호 ( Nam Ho Kim ),최기철 ( Ki Chul Choi ) 대한내과학회 2005 대한내과학회지 Vol.69 No.-

방선균증에 의해 투석을 요할 정도의 중증 양측성 수신증이 발생한 경우는 국내에서는 보고된 예가 없다. 저자들은 하복부 통증과 부종으로 내원한 자궁내 피임장치를 하고 있는 여자 환자에서 골반내 종괴를 발견하여 조직검사를 통해 방선균증을 확진하였고, 이 종괴에 의해 발생한 양측성 수신증과 이에 의한 급성 신부전증이 합병되었으나 항균제 치료로 종괴가 완전히 소실된 방선균증 1예를 경험하였기에 보고하는 바이다. Actinomycosis is a rare opportunistic infection caused by an anerobic gram positive organism. Actinomyces israelii may be localized to cervicofacial, thoracic and abdominopelvic areas. Pelvic actinomycosis is observed in patients who present with prolonged use of intrauterine devices. Ureteral obstruction and subsequent hydronephrosis are rare complications of pelvic inflammatory disease. We report a case of acute renal failure with bilateral hydronephrosis as complication of pelvic actinomycosis with prolonged use of intrauterine devices in a 42-year-old female patient. (Korean J Med 69:S999-S1002, 2005)

대장내시경에서 궤양의 특성에 따른 베체트 장염의 임상경과

김민철 ( Min Cheul Kim ),신성재 ( Sung Jae Shin ),임선교 ( Sun Gyo Lim ),이경록 ( Kyung Rok Lee ),우학 ( Hak Woo ),최상조 ( Sang Jo Choi ),조정수 ( Jung Soo Jo ),엄중호 ( Jung Ho Eum ),차동엽 ( Dong Youb Cha ),황재철 ( Jae Chul H 대한장연구학회 2010 Intestinal Research Vol.8 No.1

Background/Aims: Intestinal involvement with bleeding and perforation is one of the main causes of morbidity and mortality in patients with Behcet’s disease (BD); however, the clinical course of intestinal BD has not been defined. The aim of this study was to determine the clinical course of intestinal BD based on the characteristics of ulcers visualized during colonoscopy. Methods: We retrospectively reviewed the medical records and colonoscopic findings of 41 patients with intestinal BD. All patients were classified into subgroups according to ulcer depth, size, and number, and we analyzed the clinical manifestations, subset type of BD, medications, surgical procedures, and relapse rate among the subgroups. Results: The median age at the time of diagnosis was 38 years (range, 18-74 years); 25 patients were females (M:F=1:1.56). Abdominal pain (n=40), diarrhea (n=27), and RLQ tenderness (n=21) were common symptoms. The number of complete, incomplete, and suspected types was 3, 17, and 21, respectively. In an analysis according to ulcer depth, the rate of steroid use and intestinal surgeries was more frequent in the deep ulcer group compared with the aphthous and shallow ulcer groups (50.0% vs. 0% vs. 17.6%; P=0.012; 42.9% vs. 0% vs. 23.5%: P=0.013) The rate of steroid use and relapse tended to be higher as the size of the ulcer increased; however, there was no difference in the rates of steroid use, surgeries, and relapse based on the number of intestinal ulcers. Conclusions: The prognosis was worse in patients with intestinal BD who have deeper and larger ulcers. Therefore, we suggest that such patients need to be treated aggressively. (Intest Res 2010;8:40-47)

알레르기 ; 메타콜린과 운동 유발 기관지 수축반응의 상관관계에 대한 종단적 연구

김창성 ( Chang Seong Kim ),최인선 ( In Seon S. Choi ),김상훈 ( Sang Hoon Kim ),우학 ( Hak Woo ),심현정 ( Hyeon Jeong Sim ),한의령 ( Eui Ryoung Han ) 대한내과학회 2009 대한내과학회지 Vol.77 No.4

목적: 천식의 AHR에는 기도 염증과 관련된 가변성 AHR과 기도 재형성과 관련된 지속성 AHR이 있다. 가변성 AHR은 운동 등 간접 자극이 잘 반영하고, 지속성 AHR은 메타콜린 등 직접 자극이 반영한다고 알려졌으나 AHR 두 가지를 구별하여 추적검사한 논문은 없어서 이를 연구하였다. 방법: 2004년 12월~2008년 2월에 전남대학교병원에서 메타콜린 AHR 검사와 운동 유발시험을 함께 시행하고 나중에 반복 시행하였으며, 운동 유발성 천식이 1회 이상 증명된 젊은 남자환자 36명의 진료부 자료를 후향적으로 분석하였다. 각 자극에 대한 반응의 심한 정도를 0~ 3점으로 점수화하여 비교하였다. 결과: 처음과 추적검사 사이의 간격은 평균 9.8개월(5~58개월)이었다. 처음 검사에서는 차이가 없었으나 추적검사 때는 메타콜린 AHR 점수에 비해 운동 AHR 점수가 유의하게 낮았다(1.58±0.16 대 1.19±0.15, p<0.01). 처음 검사에 비해 추적 검사 때 메타콜린 AHR 점수는 유의한 차이가 없었으나 운동 AHR 점수는 유의하게 저하되었고(1.67±0.13 대 1.19±0.15, p<0.01), 두 점수의 차이는 유의하게 상승하였다(0.03±0.13 대 0.39±0.13, p<0.05). 메타콜린 PC20은 운동 후 FEV1의 최대 저하치와 유의한 상관관계가 있었고(r=-0.571, p<0.001), 처음과 추적검사 사이의 메타콜린 PC20와 운동 후 FEV1의 최대 저하치 변화도 유의한 상관관계가 있었다(r=-0.467, p<0.01). 결론: 운동 유발성 기관지수축과 메타콜린 AHR은 서로 상관관계가 있으나 메타콜린 AHR 변화는 운동 유발반응의 변화보다 작았다. 이것은 메타콜린 AHR이 운동 유발반응과 관련된 가변성 AHR 뿐 아니라 시간 경과에 따라 점차 심해진 지속성 AHR을 함께 반영하기 때문일 것이다. Background/Aims: The airway hyperresponsiveness (AHR) in asthma has variable and persistent components that are related to airway inflammation and remodeling, respectively. This longitudinal study examined the relationship of airway responses between exercise (reflecting variable AHR) and methacholine (reflecting persistent AHR). Methods: The charts were reviewed of 36 young adult males who underwent both methacholine and exercise challenges at different times and were diagnosed with exercise-induced asthma. The severity of the response to each stimulus was scored (0~3). Results: The mean interval between the baseline and follow-up tests was 9.8 (5~58) months. The AHR score was significantly lower with the exercise challenge than with methacholine at follow-up (1.58±0.16 vs 1.19±0.15, p<0.01), but not at baseline. Compared to baseline, the AHR score was significantly lower with exercise (1.67±0.13 vs 1.19±0.15, p<0.01), but not with methacholine, and the difference in the AHR scores between exercise and methacholine increased significantly from baseline to follow-up (0.03±0.13 vs 0.39±0.13, p<0.05). The maximum fall in the forced expiratory volume in 1 s following exercise was significantly related to methacholine AHR (r=-0.571, p<0.001). Conclusions: Exercise-induced bronchoconstriction was significantly related to methacholine AHR. However, the change in methacholine AHR in a follow-up test was significantly lower than that in the exercise response, which might have resulted from persistent worsening of the AHR with time because methacholine AHR reflects both variable and persistent AHR. (Korean J Med 77:472-479, 2009)