흡입 알레르겐에 대한 피부단자시험과 혈청 특이 IgE (ImmunoCAP system)의 비교

남영희 ( Young Hee Nam ),전동섭 ( Dong Sub Jeon ),이수걸 ( Soo Keol Lee ) 대한천식알레르기학회 2015 Allergy Asthma & Respiratory Disease Vol.3 No.1

Purpose: It appears that much of the discordance between skin prick test (SPT) and ImmunoCAP in clinical practice. We investigated the comparison and correlation between SPT and ImmunoCAP for inhalant allergens. Methods: A total of 1,400 patients who were tested SPT and ImmunoCAP were recruited from June 2011 to May 2014 in Dong-A University Hospital, and the results of two assays were compared for 17 inhalant allergens. For SPT, mean wheal size≥3 mm or allergen/ histamine≥1 at 15 minutes, and the result of ImmunoCAP of ≥0.35 kU/L was considered positive, respectively. Results: Of the study subjects, bronchial asthma was 29.3%, rhinitis 36.8%, atopic dermatitis 0.6%, and chronic urticaria 4.3%. The agreement rate of between two assays was 77.4%. When ImmunoCAP was compared with SPT as the reference, the sensitivity, specificity was 75.5% and 80.0%, respectively. Significant correlation was observed (r=0.59), and birch, mugwort, Japanese hop, house dust mites, and cockroach showed very strong correlation (r>0.7). Conclusion: The agreement, sensitivity, and specificity between SPT and ImmunoCAP was various according to allergens. We should determine the clinical relevance of the allergen sensitization using both SPT and ImmunoCAP not alone with combination of clinical symptoms.

Linezolid 사용 후 발생한 세로토닌 증후군 1예

전동섭 ( Dong Sub Jeon ),남영희 ( Young Hee Nam ),김석현 ( Suk Hyun Kim ),최원종 ( Won Jong Choi ),김은빈 ( Eun Bin Kim ),이혜원 ( Hye Won Lee ),남희주 ( Hee Joo Nam ),송정은 ( Jeong Eun Song ),이수걸 ( Soo Keol Lee ) 대한천식알레르기학회 2014 Allergy Asthma & Respiratory Disease Vol.2 No.4

Serotonin syndrome (SS) is a potentially life-threatening drug reaction characterized by mental status change, increased neuromuscular tone, and autonomic instability. Linezolid, an oxazolidinone antibacterial agent, is widely used in general hospitals; however, it interacts with some serotonin agonists and may cause SS. We report a case of SS caused by linezolid, without the concomitant use of serotonin agonist. A 72-year-old patient was admitted due to recurrent wound infection of his left ankle. He developed fever, skin rash, and renal function deterioration, and blood eosinophils and liver enzymes increased after administration of vancomycin. The antibiotic was changed to linezolid against methicillin-resistant Staphylococcus aureus. Four days later, he developed agitation, fever, increased blood pressure, and tachycardia. There were no abnormal findings in laboratory and image tests, including brain and chest computed tomography suggesting the cause of his symptoms. He had not taken any serotonin agonists, including serotonin uptake inhibitors and monoamineoxidase-inhibiting antidepressants. When administration of linezolid was stopped, his symptoms improved within 24 hours and fully recovered within 2 days without additional treatments.

소라페닙 치료 간세포암 환자에서 발생한 드레스 증후군 1예

김동균 ( Dong Kyun Kim ),이성우 ( Sung Woo Lee ),남화성 ( Hwa Seong Nam ),전동섭 ( Dong Sub Jeon ),박나래 ( Na Rae Park ),남영희 ( Young Hee Nam ),이수걸 ( Soo Keol Lee ),백양현 ( Yang Hyun Baek ),한상영 ( Sang Young Han ),이성욱 대한소화기학회 2016 대한소화기학회지 Vol.67 No.6

Sorafenib is currently the only targeted therapy available for advanced stage hepatocellular carcinoma (HCC). Cutaneous adverse events associated with sorafenib treatment include hand-foot skin reaction, but there has been no report of drug reaction (or rash) with eosinophilia and systemic symptoms (DRESS) syndrome. Here, we report a case of 72-year-old man with HCC and alcoholic liver cirrhosis who developed skin eruptions, fever, eosinophilia, and deteriorated hepatic and renal function under sorafenib treatment. He has since successfully recovered with conservative care. (Korean J Gastroenterol 2016;67:337-340)

신부전이 없는 환자에서 발생한 Cefepime에 의한 뇌병증 1예

김석현 ( Suk Hyun Kim ),남영희 ( Young Hee Nam ),전동섭 ( Dong Sub Jeon ),이혜원 ( Hye Won Lee ),남희주 ( Hee Joo Nam ),이수걸 ( Soo Keol Lee ) 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 1992 소아알레르기 및 호흡기학회지 Vol.2 No.3

Cefepime is an extended-spectrum, fourth-generation cephalosporin that has been widely used for approved indications such as febrile neutropenia. Common adverse events of cefepime include headache, skin rash, gastrointestinal problems, and fever. However, encephalopathathy caused by cefepime has been sporadically reported worldwide over the last decade. We experienced a rare case of cefepime-induced encephalopathy. A 75-year-old man with a 30-year history of chronic obstructive pulmonary disease was admitted to the medical intensive care unit under a diagnosis of pneumonia. Initial antibiotic therapy was started with piperacillin/ sulbactam and ciprofloxacin. His condition was improved with this treatment. About 2 months later, his condition was aggravated again, with mild fever and purulent sputum. Intravenous cefepime was selected on the basis of antibiotic susceptibility to Pseudomonas aeruginosa isolated from his sputum. However, his mentality became drowsy 48 hours after cefepime adminstration. He showed tremors and right facial paralysis. Neurologic examination for motor power and sensory function revealed normal findings. Laboratory tests, including serum electrolytes, glucose, osmolality, and ammonia, gave normal results. Brain magnetic resonance imaging showed chronic ischemic and atropic changes, and an electroencephalography revealed triphasic waves. The administration of cefepime was stopped, and his symptoms started to improve within 48 hours. Electroencephalography results became normalized, and he completely recovered within 48 hours after discontinuation of cefepime. (Allergy Asthma Respir Dis 2014;2:213-217)

신부전이 없는 환자에서 발생한 Cefepime에 의한 뇌병증 1예

김석현 ( Suk Hyun Kim ),남영희 ( Young Hee Nam ),전동섭 ( Dong Sub Jeon ),이혜원 ( Hye Won Lee ),남희주 ( Hee Joo Nam ),이수걸 ( Soo Keol Lee ) 대한천식알레르기학회 2014 Allergy Asthma & Respiratory Disease Vol.2 No.3

Cefepime is an extended-spectrum, fourth-generation cephalosporin that has been widely used for approved indications such as febrile neutropenia. Common adverse events of cefepime include headache, skin rash, gastrointestinal problems, and fever. However, encephalopathathy caused by cefepime has been sporadically reported worldwide over the last decade. We experienced a rare case of cefepime-induced encephalopathy. A 75-year-old man with a 30-year history of chronic obstructive pulmonary disease was admitted to the medical intensive care unit under a diagnosis of pneumonia. Initial antibiotic therapy was started with piperacillin/sulbactam and ciprofloxacin. His condition was improved with this treatment. About 2 months later, his condition was aggravated again, with mild fever and purulent sputum. Intravenous cefepime was selected on the basis of antibiotic susceptibility to Pseudomonas aeruginosa isolated from his sputum. However, his mentality became drowsy 48 hours after cefepime adminstration. He showed tremors and right facial paralysis. Neurologic examination for motor power and sensory function revealed normal findings. Laboratory tests, including serum electrolytes, glucose, osmolality, and ammonia, gave normal results. Brain magnetic resonance imaging showed chronic ischemic and atropic changes, and an electroencephalography revealed triphasic waves. The administration of cefepime was stopped, and his symptoms started to improve within 48 hours. Electroencephalography results became normalized, and he completely recovered within 48 hours after discontinuation of cefepime.

거대 관상동맥류를 동반한 우관상동맥-좌심실 누공

김은영 ( Eun Young Kim ),박종성 ( Jong Sung Park ),전동섭 ( Dong Sub Jeon ),정상석 ( Sang Seok Jeong ),박권재 ( Kwon-jae Park ),우종수 ( Jong Soo Woo ),강은주 ( Eun-ju Kang ) 대한내과학회 2016 대한내과학회지 Vol.90 No.6

35세 남자가 피로감 및 호흡곤란으로 병원에 왔다. 청진상확장기 심장잡음이 들리고 심전도 및 흉부 X선 검사에서 좌심실비대 소견이 보였다. 가슴 경유 심초음파 검사에서 좌심실 기저부의 하벽에 지름 11 mm 크기의 심근 결손 부위가보였고 우관상동맥으로 보이는 확장된 혈관구조물로부터 심근 결손 부위를 통해 좌심실 내로 유입되는 확장기 혈류가보였다. 식도 경유 심초음파 검사에서 최대 지름 17 mm의 확장된 우관상동맥이 보였다. 관상동맥 컴퓨터단층촬영 조영검사에서 거대 관상동맥류를 동반한 우관상동맥이 좌심실기저부의 좌심실 벽 결손부를 통해 좌심실과 연결되어 있음을 확인한 후 거대 관상동맥류를 동반한 우관상동맥-좌심실누공으로 진단하였다. 관상동맥류를 동반한 우관상동맥-좌심실 누공은 드물게 보고되는데, 좌심실의 용적 과부하로 인한 울혈성 심부전 발생의 위험성과 거대 관상동맥류의 자연적 파열 위험성을 고려하여 수술적으로 우관상동맥을 폐쇄하기로 하였다. 개흉술을 시행하여 우관상동맥의 입구와 우관상동맥-좌심실 누공 부위를 소심장막패치를 덧대어 봉합하고 우관상동맥을 결찰하였다. 우관상동맥에서 갈라져 나오는 지름이 큰 동맥가지들이 없어 심근경색을 예방하기 위한 관상동맥 우회로조성술을 시행하지 않기로 하였다. 환자는 수술 관련 합병증 없이 퇴원하였고 증상의 재발 없이 추적관찰 중이다. 저자들은 임상에서 접하기 힘든 증상을 동반한 우관상동맥-좌심실 누공의 영상 진단 및 수술적 치료 과정을 문헌고찰과 함께 보고하는 바이다. A 35-year-old male with exertional dyspnea was transferred to our hospital for evaluation of a diastolic murmur and cardiomegaly discovered by chest X-ray. Two-dimensional and Doppler echocardiographic studies revealed an aneurysmal dilation of the right coronary artery (RCA) and diastolic inflow from the RCA to the left ventricle (LV) through a myocardial defect 11 mm in diameter in the basal inferior LV wall. Coronary computed tomography angiography (CCTA) confirmed the presence of a giant RCA to LV fistula. Due to the risks for developing overt left heart failure and spontaneous rupture of the giant RCA, the RCA was obliterated surgically. Coronary-cameral fistulas are a rare congenital coronary artery anomaly. A fistula between the coronary artery and LV, especially when combined with coronary artery aneurysm, is a rare occurrence in the literature. Here, we report a case of a giant RCA to LV fistula detected by echocardiography and CCTA. (Korean J Med 2016;90:518-523)