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홍수민;박경식;박일권;손형래;구호석;고행일 인제대학교 2011 仁濟醫學 Vol.32 No.-
Hepatitis A is a mild, self-limiting disease of the liver, critical complications of which, such as acute kidney injury, are rare. Two cases of patients with acute hepatitis A who had an acute renal failure complication are reported herein. The first case is that of a 30-year-old man who showed up at the author’s hospital complaining of fever and myalgia. His laboratory tests upon his admission showed 9,520 lU/L of aspartate transaminase, 5,600 lU/L of alanine transaminase, 31.9 mg/dL of blood urea nitrogen, and 5.5 mg/dL of creatinine, and he was positive for the Anti-HAV IgM antibody. Upon his admission, supportive treatment was started, which included fluid therapy. The laboratory tests on the next day showed 53 mg/dL of blood urea nitrogen, 9.9 mg/dL of creatinine, and lower urine output per day. Renal replacement therapy was performed only once. A renal biopsy was performed and the result was Acute Tubular Necrosis (ATN). The patient recovered from acute renal failure without sequela. In the second case, a 35-year-old man complained of fever and abdominal pain. His laboratory tests upon his admission showed 8,570 lU/L of aspartate transaminase, 4,510 lU/L of alanine transaminase, 16 mg/dL of blood urea nitrogen, and 1.19 mg/dL of creatinine, and he was positive for the Anti-HAV IgM antibody. He experienced acute renal failure and recovered after two-time renal replacement therapy. The result of the renal biopsy was Acute Tubular Necrosis and C1q nephropathy.
A rare case of extensive papillary muscle calcification in senile cardiac calcification syndrome
김은진;송봉근;강민호;손형래;홍수민;박동원;허승혜;김계연;최석구 인제대학교 2011 仁濟醫學 Vol.32 No.-
광범위 유두근 석회화는 흔하지 앉으며, 원인과 임상적 중요성에 관한 문헌만 드물게 찾아볼 수 있다. 반면에 작은 석회 침착은 노인에서 흔하며 심장 첨부에 주로 나타난다. 유두근 석회화는 관상동맥질환, 확장성 심근병증, 승모관 질환, 고칼슘혈증, 그리고 말기신부전에서 인산칼슘의 중가와 연관성이 있다. 저자는 심장초옴파와 MDCT를 통해 진단된 전외측 유두근의 광범위 석회화의 드문 사례가 있어 보고한다.
육안적 혈뇨로 내원한 환자에서 발견된 방광 유전분증 : 증례보고
김은진;성 현;홍수민;정성연;박경식;손형래;박일권;구호석;고행일 인제대학교 백병원 2011 仁濟醫學 Vol.32 No.-
Amyloidosis is a disease resulting in deposition of amyloid in the body. The disease can be either primary or secondary. The amyloidosis of urinary bladder is more usually affected by primary amyloidosis and also very rare. The patient with primary amyloidosis of the bladder usually presents with gross hematuria. The amyloidosis resembles bladder cancer in cystoscopy. It can be confirmed by biopsy. The treatment consists of medication (e.g., steroid, antitumor agent, cholchicine, DMSO) and/or transurethral resection. The standard treatment is mephalan and prednisolone. A 49-year-old man complained of recently developed gross hematuria without abdominal pain. We examined urinary bladder cystoscope for gross hematuria. It revealed small bulging mass on trigone are a of bladder. Therefore we did bladder biopsy. Finally, it revealed bladder amyloidosis. The patient was improved by medication (mephalan 2mg and prednisolone 1 mg/kg po daily). We report an unusual case of amyloidosis involving bladder.
( Hyung Rae Sohn ),( Soo Hyung Ryu ),( Seung Hye Heo ),( Sun Young Kim ),( Jin Nam Kim ),( You Sun Kim ),( Jeong Seop Moon ) 대한내과학회 2011 대한내과학회 추계학술대회 Vol.2011 No.1
Introduction: Dictamnus dasycarpus is one of the most common causes of drug-induced hepatitis in South Korea. Generally, most patients with drug-induced toxic hepatitis can fully recover after cessation of causative agents and supportive care. However, there has been some cases of Dictamnus dasycarpus-induced toxic hepatitis with progression to fulminant hepatitis and even death. We introduce a case of dramatic complete recovery from Dictamnus dasycarpus-induced severe toxic hepatitis after oral predinisolone treatment. Case: A 78-year-old woman was admitted with jaundice. She had consumed a decoction made by boiling down the root of Dictamnus dasycarpus, 1L per day for recent 3 months. Besides that, she did not have any medical and drug history. In-hospital laboratory test results are as follows: AST/ALT 1607/996 IU/L, total bilirubin 21.6 mg/dl, direct bilirubin 16.9 mg/dl, protein/albumin 5.8/3.5 g/dl, ALP 164 IU/L, r-GTP 47 IU/L, PT INR 1.03, and aPTT 39.6 seconds. All hepatic viral markers were negative. We diagnosed Dictamnus dasycarpus-induced toxic hepatitis as RUCAM scored 6. Even though interruption of taking Dictamnus dasycarpus for 10 days, total bilirubin increased up to 34 mg/dl. We decided to try oral prednisolone before consideration of liver transplantation. After start of oral prednisolone 40 mg per day, she showed a dramatic improvement in the clinical course and laboratory tests. Continued step-down prednisolone therapy for two months made her liver function test almost normal; total bilirubin was 2.2 mg/dl and AST/ALT was 27/28 IU/L. Discussion: Oral prednisolone treatment may be helpful and recommendable in clinically serious cases of Dictamnus dasycarpus-induced toxic hepatitis which are not respond to cessation of Dictamnus dasycarpus and best supportive care.
( Hyung Rae Sohn ),( Bo Young Min ),( Mun Hyuk Seong ),( Sang Soo Lee ),( Jin Wook Kim ),( Sook Hyang Jeong ) 대한간학회 2012 춘·추계 학술대회 (KASL) Vol.2012 No.1
Background: Current goals of antiviral therapy in chronic hepatitis B patients are ALT normalization, undetectable HBV DNA level and HBsAg loss. However, HBsAg loss rarely occurs during oral nucleos(t)ide analogue (NA) therapy, and it is not certain how long NA should be maintained in patients who obtain virologic response but still have HBsAg in the serum. Thus, the aim of this study was to determine the relapse rate and the predicting factors of sustained virologic response after withdrawal of oral NA therapy in chronic hepatitis B patients. Methods: CHB patients who were withdrawn from NA (entecavir, lamivudine, clevudine) after at least 6 months of undetectable HBV DNA were enrolled in this retrospective study. The clinical, biochemical and virologic data was obtained and compared in patients with or without viral relapse. The cummulative relapse rate was assessed by Kaplan-Meier method, and multivariate analysis with predictors of sustained viral response by logistic regression analysis. Results: Total 105 CHB patients discontinued NA therapy between April 2003 and March 2012. Among CHB patients, 75, 16, 14 were treated with entecavir, lamivudine and clevudine, respectively. Overall 3, 6, 12 month relapse rates after NA withdrawal were 25.9%, 61.7% and 75.3%, respectively. The 6 month relapse rate was 58.8% in entecavir group, 68.7% in lamivudine group, 69% in clevudine group (p=0.571). In multivariate analysis, duration of oral NA treatment after achievement of virologic response was the only significant predicting factor associated with sustained virologic response. (p=0.042,HR ; 0.001) Conclusions: Early withdrawal of oral NA therapy is associated with high relapse rate regardless of clinical characteristic, biochemical and virologic factors. Prolonged NA therapy may increase the chance for sustained virologic response after withdrawal of NA in CHB
( Hyung Rae Sohn ),( Bo Young Min ),( Mun Hyuk Seong ),( Sang Soo Lee ),( Jin Wook Kim ),( Sook Hyang Jeong ) 대한간학회 2012 춘·추계 학술대회 (KASL) Vol.2012 No.-
Background: Current goals of antiviral therapy in chronic hepatitis B patients are ALT normalization, undetectable HBV DNA level and HBsAg loss. However, HBsAg loss rarely occurs during oral nucleos(t)ide analogue (NA) therapy, and it is not certain how long NA should be maintained in patients who obtain virologic response but still have HBsAg in the serum. Thus, the aim of this study was to determine the relapse rate and the predicting factors of sustained virologic response after withdrawal of oral NA therapy in chronic hepatitis B patients. Methods: CHB patients who were withdrawn from NA (entecavir, lamivudine, clevudine) after at least 6 months of undetectable HBV DNA were enrolled in this retrospective study. The clinical, biochemical and virologic data was obtained and compared in patients with or without viral relapse. The cummulative relapse rate was assessed by Kaplan-Meier method, and multivariate analysis with predictors of sustained viral response by logistic regression analysis. Results: Total 105 CHB patients discontinued NA therapy between April 2003 and March 2012. Among CHB patients, 75, 16, 14 were treated with entecavir, lamivudine and clevudine, respectively. Overall 3, 6, 12 month relapse rates after NA withdrawal were 25.9%, 61.7% and 75.3%, respectively. The 6 month relapse rate was 58.8% in entecavir group, 68.7% in lamivudine group, 69% in clevudine group (p=0.571). In multivariate analysis, duration of oral NA treatment after achievement of virologic response was the only significant predicting factor associated with sustained virologic response. (p=0.042,HR ; 0.001) Conclusions: Early withdrawal of oral NA therapy is associated with high relapse rate regardless of clinical characteristic, biochemical and virologic factors. Prolonged NA therapy may increase the chance for sustained virologic response after withdrawal of NA in CHB.
Cardiac Amyloidosis with Progressive Heart Failure Managed by Heart Transplantation : A Case Report
Sohn, Hyung-Rae;Song, Bong-Gun;Kang, Min-Ho;Kim, Eun-Jin;Jeong, Seong-Yeon;Hong, Su-Min;Jung, Hyun-Gul;Choi, Suk-Koo 인제대학교 2011 仁濟醫學 Vol.32 No.-
아밀로이드의 심근 침윤은 심각한 예후를 초래할 수 있는 진행성 심근병증 뿐만 아니라 울혈성 심부전, 심장 판막 질환, 부정맥 등과 같은 다양한 심장질환을 일으킬 수 있다. 우리는 처음에 심근 아밀로이드증으로 내원하였으나 신드롬 X로 잘못 진단되었던 환자가 재발성 흉통 및 진행성 심부전으로 인해 심장 이식을 시행한 증례가 있어, 이를 보고하는 바이다.
Molecular characterization of a venom serine protease from the bumblebee Bombus terrestris
Yuling Qiu,Young Moo Choo,Mi Ri Sohn,Hyung Joo Yoon,Hung Dae Sohn,Byung Rae Jin 한국응용곤충학회 2010 한국응용곤충학회 학술대회논문집 Vol.2010 No.05
Bee venom contains a variety of peptides and enzymes, including serine proteases. Here we describe the molecular cloning and characterization of a serine protease (Bt-VSP) isolated from the venom of the bumblebee Bombus terrestris. The Bt-VSP gene consists of six exons encoding a 358-amino acid protein. The form of Bt-VSP detected in bee venom was the 34-kDa mature protein, which is created by cleavage of the catalytic domain of Bt-proVSP between Arg111 and Val112. Bt-VSP activates prothrombin and directly degrades fibrinogen into fibrin degradation products, defining roles for Bt-VSP as a prothrombin activator, a thrombin-like protease, and a plasmin-like protease. The finding that Bt-VSP acts as a fibrin(ogen)olytic enzyme is similar to a previous finding that Bi-VSP, a venom serine protease of B. ignitus, exhibits fibrin(ogen)olytic activity. We also compared major venom components in honeybee and bumblebee, and found that bumblebee venom contains a larger amount of serine protease. Furthermore, unlike bumblebee venom, which exhibits fibrin(ogen)olytic activity owing to the presence of a serine protease, it is likely that honeybee venom lacks fibrin(ogen)olytic activity.