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증례 : 십이지장 우회술을 받은 신장이식환자에서 반복적 급성 거부반응으로 인한 이식 신소실 1예
김하늘 ( Ha Neul Kim ),조율희 ( Yul Hee Cho ),김영신 ( Young Shin Kim ),전현지 ( Hyun Ji Chun ),최수진 ( Su Jin Choi ),김은오 ( Eun Oh Kim ),양철우 ( Chul Woo Yang ) 대한내과학회 2012 대한내과학회지 Vol.83 No.3
Tacrlolumus는 calcineurin inhibitor의 한 종류로서 신이식 후 연역 억제위해 널리 사용되고 있다. Tacrolimu의 흡수는 전 장에서 일어나지만, 십이지장이 흡수와 대사에서 가장 많은 부분을 차지하는 것으로 알려져 있다. 따라서 신이식 환자에서 십이지장 우회술을 받은 경우 tacrolimus의 흡수과 대사저하가 발생할 수 있다. 저자들은 신이식을 받은 41세 여자환자가 십이지장 우회술을 받은 뒤 이식실패를 경험한 사례를 보고하고자 한다. 환자는 췌장염으로 입원, 십이지장천공으로 십이지장 우회 술 및 위공장연결술을 시행 받았고, 수술 이후 tacrolimus 용량 증가에도 불구하고 혈중 tacrolimus 농도가 치료 목표 수준을 유지하지 못하였으며, 반복적인 거부반응으로 우회술 3개월 만에 이식실패를 경험하였다. 이 증례는 신이식 환자가 십이지장 우회술을 받은 경우 약물 흡수의 중요성을 보여주는 사례로 생각된다. The calcineurin inhibitor-immunosuppressant tacrolimus is widely used in patients undergoing kidney transplantation. Although tacrolimus is absorbed from the entire gastrointestinal tract, the duodenum is the primary site of its absorption and metabolism. Therefore, duodenal bypass surgery in a renal transplant recipient can significantly disrupt tacrolimus absorption and metabolism, Here, we report a case of allograft failure that developed after duodenal bypass surgery, The patient was a 41-year-old woman who received a deceased donor kidney transplantation, She underwent a gastrojejunostomy due to a duodenal perforation and pancreatitis after endoscopic retrograde cholangiopancreatography, After the surgery, her blood tacrolimus level decreased gradually, and remained lower than therapeutic target levels, even after the tacrolimus dose was increased from 5 to 12 mg/day. Repetitive rejection developed and the patient suffered allograft failure 3 months after bypass surgery. This case raises the importance of drug absorption in renal transplant recipients undergoing duodenal bypass surgery.
Low GWP 냉매를 적용한 수열원 히트펌프 시스템의 난방성능 특성에 관한 실험적 연구
최연성(Youn Sung Choi),강희정(Hee Jeong Kang),김은오(Eun Oh Kim) 대한설비공학회 2018 대한설비공학회 학술발표대회논문집 Vol.2018 No.6
In this study, performance characteristics of a water source heat pumps system using R452B as a alternative refrigerant are experimentally investigated. The performance of the heat pump adopting R452B was also compared with the system applying R410A. Heating capacities and COP of the R452B system are analyzed for system performance variables such as refrigerant charge, load temperature conditions. Results show that optimum amount of refrigerant charge at maximum point of COP curve. The heating capacity of R452B heat pump system showed a slightly lower values within 1% comparing with R410A system. The R452B system’s coefficient of performance was enhanced by 5% at heating mode.
반우호 ( Woo Ho Ban ),강현희 ( Hyeon Hui Kang ),백명기 ( Myong Ki Baeg ),김재경 ( Jae Gyung Kim ),김현진 ( Hyun Jin Kim ),백인운 ( In Woon Baek ),김은오 ( Eun Oh Kim ),고선혜 ( Sun Hye Ko ),이상학 ( Sang Haak Lee ),문화식 ( Hwa Si 대한결핵 및 호흡기학회 2011 Tuberculosis and Respiratory Diseases Vol.70 No.4
Herein we report the case of a 71-year-old woman who complained of fatigue and enlarged right axillary lymph nodes for 18 months. At her first visit, her chest X-ray showed diffuse nodular opacities in both lung fields. Initial excisional biopsy of the axillary lymph nodes showed granulomatous lesions and acid fast bacilli were seen on Ziehl-Neelsen staining. However, even after 15 months of anti-tuberculosis (TB) medication, her right axillary lymph nodes were enlarged. We re-performed an excisional biopsy of the nodes, which showed Hodgkin`s lymphoma (HL). A retrograde review of the biopsy before anti-tuberculous medication, revealed HL coexisting with TB. HL and TB cause difficulties in differential diagnosis due to similarities in clinical course, imaging procedures and histopathological analysis of the involved tissue. Therefore, it is important to consider the possibility of concurrent HL and TB when patients who undergo treatment for TB or chemotherapy for lymphoma complain of persistent systemic symptoms or enlarged lymph nodes.