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정을식,최병호,최현석,김병훈,하민수,신동수,박진선,이종록,서일혜,박윤수 대한감염학회 2012 Infection and Chemotherapy Vol.44 No.3
Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a disorder which can be caused by treatment with a diverse collection of drugs, and it is characterized by fever, rash, lymphadenopathy, and internal organ involvement with eosinophilia. Although ethambutol and rifampin are popularly used to treat tuberculosis, there has been only one reported case of DRESS syndrome associated with ethambutol. DRESS syndrome associated with administration of rifampin have not been reported. In this report and discussion, we present the case of a patient suffering from DRESS syndrome induced by both ethambutol and rifampin.
정을식,정우경,김애진,노한,장제현,이현희,정지용 대한의학회 2017 Journal of Korean medical science Vol.32 No.1
Hemodialysis (HD) patients experience vascular calcification, ultimately leading to high mortality rates. Previously, we reported associations between soluble receptor for advanced glycation end products (sRAGEs) and extracellular newly identified RAGE-binding protein S100A12 (EN-RAGE) and vascular calcification. Here, we extended our observations, investigating whether these biomarkers may be useful for predicting cardiovascular morbidity and mortality in these subjects. Thus, we evaluated the relationship between sRAGE and S100A12 and mortality in long-term HD patients. This was a prospective observational cohort study in 199 HD patients from an extended analysis of our previous study. Plasma sRAGE, S100A12, comorbidities, and other traditional risk factors were investigated. The cumulative incidences for death using Cox proportional hazards regression were evaluated in multivariable analyses. The observation period was 44 months. During the observation period, 27 (13.6%) patients died. Univariate analysis demonstrated that S100A12 was correlated with diabetes (P = 0.040) and high-sensitivity C-reactive protein (hsCRP) (P = 0.006). In multivariable analyses, plasma sRAGE (hazard ratio [HR] = 1.155; 95% confidence interval [CI] = 0.612–2.183; P = 0.656) and S100A12 (HR = 0.960; 95% CI = 0.566–1.630; P = 0.881) were not associated with mortality in HD patients, although traditional predictors of mortality, including age, history of cardiovascular diseases (CVDs), and serum levels of albumin and hsCRP were related to mortality. Powerful predictors of mortality were age, CVD, and albumin levels. Plasma sRAGE and S100A12 may be weak surrogate markers for predicting all-cause mortality in patients undergoing HD, although S100A12 was partly related to diabetes and inflammation.
Acute Severe Symptomatic Hyponatremia Following Coronary Angiography
정을식,강웅철,장영록,김세중,양지원,이경훈,안태훈 대한심장학회 2011 Korean Circulation Journal Vol.41 No.9
Hyponatremia is a relatively common electrolyte disorder. Although severe acute hyponatremia following coronary angiography is rare, potentially lethal neurologic manifestations may result. We describe a patient with severe, symptomatic hyponatremia, an unusual complication of coronary angiography. Lack of familiarity with contrast media-related hyponatremia caused a delay in diagnosis and therapy in our case. The diagnosis of acute hyponatremia should be considered in any patient who develops behavioral or neurologic manifestations following coronary angiography. Prompt diagnosis and treatment is essential to avoid permanent neurologic damage or death.
X 연관 부신백질이영양증의 분류, 진단 및 치료의 최신 지견
정을식(Eul Sik Jung),고아라(Ara Ko),강훈철(Hoon Chul Kang) 대한소아신경학회 2016 대한소아신경학회지 Vol.24 No.3
X-linked adrenoleukodystrophy (X-ALD) is caused by mutations in the ATP binding cassette subfamily D member 1 (ABCD1), a gene that encodes peroxisomal membrane located on ABC half-transporter named adrenoleukodystrophy protein (ALDP). X-ALD is characterized by a highly variable clinical spectrum, including progressive cerebral type, adrenomyeloneuropathy, and addison-only phenotype. No genotype/phenotype correlation has been established. Thus, unidentified modifier genes and other co-factors are speculated to modulate the phenotypic variation and disease severity. Recent advanced sequencing methods and reprogramming technologies not only offer an affordable and applicable approach to investigate the pathophysiological mechanisms of adrenoleukodystrophy, but also provide means to develop therapy. A causal therapy of X-ALD is lacking. Lorenzo’s oil therapy is recommended for asymptomatic boys, but the longest study found that the oil was not beneficial at all to symptomatic X-ALD patients. Hematopoietic stem cell therapy has a relevant chance of success when performed during this early stage of cerebral type X-ALD. Recently, it has been insisted that lentiviral-mediated gene therapy of hematopoietic stem cells can provide clinical benefits in X-ALD. This review describes current knowledge on the clinical presentation, pathogenesis, diagnosis and management of X- ALD.
Low Resistin Level is Associated with Poor Hospitalization-Free Survival in Hemodialysis Patients
정우경,정을식,신동수,최성한,정지용,장재현,이현희,김동기,김세중 대한의학회 2012 Journal of Korean medical science Vol.27 No.4
전남대학교Malnutrition and inflammation are related to high rates of morbidity and mortality in hemodialysis patients. Resistin is associated with nutrition and inflammation. We attempted to determine whether resistin levels may predict clinical outcomes in hemodialysis patients. We conducted a prospective evaluation of 100 outpatients on hemodialysis in a single dialysis center (male, 46%; mean age, 53.7 ± 16.4 yr). We stratified the patients into 4 groups according to quartiles of serum resistin levels. During the 18-month observational period, patients with the lowest quartile of serum resistin levels had poor hospitalization-free survival (log rank test, P = 0.016). After adjustment of all co-variables, patients with the lowest quartile of serum resistin levels had poor hospitalization-free survival, compared with reference resistin levels. Higher levels of interleukin-6 were an independent predictor of poor hospitalization-free survival. In contrast, serum resistin levels were not correlated with interleukin-6 levels. The current data showed that low resistin levels may independently predict poor hospitalization free survival in hemodialysis patients.
증례 : 신장 ; 트라넥사민산에 의해 유발된 급성 신피질 괴사 1예
성지윤 ( Ji Yoon Sung ),정을식 ( Eul Sik Jung ),최성한 ( Shung Han Choi ),신동수 ( Dong Su Shin ),이현희 ( Hyun Hee Lee ),정우경 ( Woo Kyung Chung ),장제현 ( Jae Hyun Chang ) 대한내과학회 2012 대한내과학회지 Vol.82 No.4
Kidney cortex necrosis is a relatively rare cause of acute kidney injury and is characterized by complete or partial destruction of the renal cortex, but sparing of the medulla. Tranexamic acid has antifibrinolytic activity and is used to reduce bleeding. We report a rare case of kidney cortex necrosis caused by tranexamic acid. A 49-year-old woman complained of coughing up blood-tinged sputum. She had a history of bronchiectasis and was treated with tranexamic acid for 3 days. Four days after admission, she developed anuria and azotemia. Computerized tomography showed enhancement of the renal medulla, but not the bilateral renal cortex. The patient was treated with hemodialysis, and has since been maintained on hemodialysis for 6 months. Due to the development of kidney cortex necrosis in patients treated with tranexamic acid, all its potential complications should be considered. (Korean J Med 2012;82:503-506)
A Comparison of Two Brands of Clopidogrel in Patients With Drug-Eluting Stent Implantation
박예민,안태훈,이경훈,Kwen-Chul Shin,정을식,Dong Su Shin,Myeong Gun Kim,강웅철,한승환,최인석,신익균 대한심장학회 2012 Korean Circulation Journal Vol.42 No.7
Background and Objectives: Although generic clopidogrel is widely used, clinical efficacy and safety between generic and original clopi-dogrel had not been well evaluated. The aim of this study was to evaluate the clinical outcomes of 2 oral formulations of clopidogrel 75 mg tablets in patients with coronary artery disease (CAD) undergoing drug-eluting stent (DES) implantation. Subjects and Methods: Between July 2006 and February 2009, 428 patients that underwent implantation with DES for CAD and com-pleted >1 year of clinical follow-up were enrolled in this study. Patients were divided into the following 2 groups based on treatment for-mulation, Platless® (test formulation, n=211) or Plavix® (reference formulation, n=217). The incidence of 1-year major adverse cardiovas-cular and cerebrovascular event (MACCE) and stent thrombosis (ST) were retrospectively reviewed. Results: The baseline demographic and procedural characteristics were not significantly different between two treatment groups. The in -cidence of 1-year MACCEs was 8.5% {19/211, 2 deaths, 4 myocardial infarctions (MIs), 2 strokes, and 11 target vessel revascularizations (TVRs)} in Platless® group vs. 7.4% (16/217, 4 deaths, 1 MI, 2 strokes, and 9 TVRs) in Plavix® group (p=0.66). The incidence of 1-year ST was 0.5% (1 definite and subacute ST) in Platless® group vs. 0% in Plavix® group (p=0.49). Conclusion: In this study, the 2 tablet preparations of clopidogrel showed similar rates of MACCEs, but additional prospective random-ized studies with pharmacodynamics and platelet reactivity are needed to conclude whether generic clopidgrel may replace original clopi-dogrel.
증례 : 감염 ; 수술 후 발생한 Corynebacterium Striatum 복강 내 감염
최현석 ( Hyun Seok Choi ),김주승 ( Ju Seung Kim ),정을식 ( Eul Sik Jung ),김애진 ( Ae Jin Kim ),정한 ( Han Jung ),박윤수 ( Yoon Soo Park ),서일혜 ( Yiel Hea Seo ) 대한내과학회 2012 대한내과학회지 Vol.82 No.4
Corynebacterium striatum is an aerobic, Gram-positive bacillus that is part of the resident flora of skin and mucosal membranes. C. striatum is usually considered a non-pathogenic contaminant, although infective endocarditis and respiratory infection, and less frequently arthritis and meningitis, due to C. striatum have been reported. C. striatum has been particularly associated with catheter-related infections and infections following conditions that resulted in disruption of the skin barrier in both immunocompromised and immunocompetent hosts. We describe a case of post-operative intra-abdominal infection caused by the rare pathogen, C. striatum. (Korean J Med 2012;82:516-519)
정석후 ( Seok Hu Jeong ),오경용 ( Kyong Yong Oh ),신동수 ( Dong Su Shin ),최성한 ( Shung Han Choi ),정을식 ( Eul Sik Jung ),박진선 ( Jin Sun Park ),나선영 ( Sun Young Na ),성지윤 ( Ji Yoon Sung ),정지용 ( Ji Yong Jung ),김세중 ( S 대한신장학회 2010 Kidney Research and Clinical Practice Vol.29 No.4
Kaposi`s sarcoma (KS) is an unusual multifocal neoplasm of vascular endothelial cell origin. The trunk, arms, head, and neck are the most common sites. It is common in men and has four distinct variants: classic, Africa-endemic, immunosuppressive drug-associated, and acquired immunodeficiency syndromeassociated KS. KS appears to develop immunosuppressed patients, but is uncommon in patients on dialysis. A 79-year-old man on hemodialysis for 2 months presented with pruritus over the entire body and multiple, discrete, variable-sized, dark blue papulonodules (papuloplaques, maculopapules) on the left arm and shoulder. A biopsy specimen form the left arm showed spindle cells with slit-like spaces and extravasated red blood cells. The specimen was positive for CD 34 antigen, and human herpesvirus 8 was detected. We report a case of KS that occurred in a 79-year-old patient on hemodialysis.