신이식 환자에서 발생한 재발성 유방외 파제트병 1예

노영욱 ( Young Wook Roh ),황규식 ( Kyu Sig Hwang ),정명호 ( Myung Ho Jeong ),박준성 ( Joon Sung Park ),이창화 ( Chang Hwa Lee ),김근호 ( Gheun Ho Kim ),백승삼 ( Seung Sam Paik ),김정태 ( Jeong Tae Kim ),강종명 ( Chong Myung Kan 대한신장학회 2009 Kidney Research and Clinical Practice Vol.28 No.6

The incidence of malignant disease increases in kidney transplant recipients taking immunosuppressive therapy. Extramammary Paget`s disease, a very rare dermatologic malignancy, is characterized by frequent recurrences and coexistence with other malignancies. Although skin cancer is the most common malignancy occurring after kidney transplantation, extramammary Paget`s disease has not been reported in Korea. In this paper, we report a case of recurrent extramammary Paget`s disease after renal transplantation. A 66-year old man, who underwent renal transplantation from a living unrelated donor 15 years ago, was diagnosed to have extramammary Paget`s disease 7 years ago. At this admission he was troubled with a pruritic skin lesion in his suprapubic area which previously occurred twice. The recurring Paget`s disease was treated with radical resection and coverage. No further recurrences have been developed during the following 12 months until now.

다발성 경화 소견으로 발현된 림프구성 간질성 폐렴

황규식 ( Kyu Sig Hwang ),노영욱 ( Young Wook Roh ),송성헌 ( Sung Heon Song ),김상헌 ( Sang Heon Kim ),손장원 ( Jang Won Sohn ),윤호주 ( Ho Joo Yoon ),신동호 ( Dong Ho Shin ),박성수 ( Sung Soo Park ),오영하 ( Young Ha Oh ),김태형 ( 대한결핵 및 호흡기학회 2009 Tuberculosis and Respiratory Diseases Vol.67 No.1

Lymphocytic interstitial pneumonia (LIP) is a rare disorder characterized by a diffuse infiltration of the alveolar space, interstitium by lymphocytes, plasma cells, and reticuloendothelial cells. Although its etiology is unknown, LIP has been associated with autoimmune disorders and with viral infections. Because it`s clinical and radiographic features are nonspecific, a confirmatory diagnosis is performed by open lung biopsy. A 59-year-old female presented dry cough, which had been present for 1 month. On initial findings of multifocal consolidation at the right middle lobe on both lower lobes in chest radiography, the first diagnosis of cryptogenic organizing pneumonia was suggested. On open lung biopsy, LIP was diagnosed. The patient had no autoimmune disease, viral infection or monoclonal gammopathy. After 3 months of corticosteroid treatment, the patient experienced improved symptoms, reduced abnormalities on chest radiography, and improved pulmonary function testing.

연구논문 : 만성 바이러스간질환에서 간섬유화의 다양한 비침습 혈청표지자검사의 비교

김선민 ( Sun Min Kim ),손주현 ( Joo Hyun Sohn ),김태엽 ( Tae Yeob Kim ),노영욱 ( Young Wook Roh ),은창수 ( Chang Soo Eun ),전용철 ( Yong Cheol Jeon ),한동수 ( Dong Soo Han ),오영하 ( Young Ha Oh ) 대한간학회 2009 Clinical and Molecular Hepatology(대한간학회지) Vol.15 No.4

목적: 만성 바이러스간질환에서 병의 경과와 예후를 평가하고 치료반응을 예측함에 있어 간섬유화의 진단은 중요하다. 최근 간섬유화 평가에 표준방법이지만 침습적 간생검을 대신하여 여러 가지 비침습적 진단법이 이용되고 있고, 또한 새로운 검사법들이 개발되고 있다. 저자들은 만성 B형 및 C형간염 환자를 대상으로 임상에서 광범위하게 흔히 시행하는 혈액검사와 임상 소견을 이용한 아래와 같은 진단법들만으로 간섬유화를 얼마나 정확하게 평가할 수 있는지 알아보고, 단일 검사로 간섬유화를 평가하는 데 유용하다고 알려져 있는 hyaluronic acid(HA)와 IV형 콜라겐 농도와 비교하여 그 임상적 유용성을 평가하였다. 대상과 방법: 2002년 3월부터 2007년 2월까지 만성 바이러스간 질환으로 간생검을 시행받은 225명의 환자(HBV 180명, HCV 43명, HBV+HCV 2명)를 대상으로 분석하였다. 간생검을 시행하는 날에 말초혈액검사, 혈액응고검사, 혈청생화학검사를 시행하고, 혈중 HA, IV형 콜라겐 농도를 측정하였다. 간섬유화의 정도는 F0(섬유화가 없음), F1(문맥역 섬유화), F2(문맥주변부 섬유화), F3(섬유성 격막) 및 F4(간경변증)의 4단계로 구분하였다. 대상 환자를 F0-1, F2-4 혹은 F0-2, F3-4의 두 집단으로 분류하여 두 집단을 구분하고자 할 때 AAR(AST/ALT ratio), API(age-platelet index), APRI(AST to platelet index), CDS(cirrhosis discriminant score), platelet count, HA, IV형 콜라겐의 예측능을 area under the receiver operating characteristic curve (AUROC)값을 이용하여 비교하였다. 결과: 대상환자의 섬유화의 단계는 F0 집단은 17명, F1 집단은 40명, F2 집단은 61명, F3 집단은 74명, F4 집단은 33명이었다. 의미 있는 간섬유화를 F2 이상으로 판단할 때, 의미 있는 섬유화의 예측에 대한 AUROC 값은 APRI=0.822, CDS=0.776, platelet count=0.773, API=0.756, HA=0.749, IV형 콜라겐=0.718, AAR=0.642 순이었고, F3 이상의 광범위한 섬유화 예측에 대한 AUROC값은 CDS=0.835, platelet count=0.795, API=0.794, HA=0.766, AAR=0.711, IV형 콜라겐=0.697, APRI=0.691 순으로 관찰되었다. 결론: 만성 바이러스간질환에서 간섬유화를 평가하는 데 임상 소견 및 혈액검사를 이용한 방법들이 비침습적 진단법 중 단독 검사로도 유용한 것으로 알려져 있는 혈중 HA와 IV형 콜라겐 농도와 비교하여 우월하거나 대등하였다. 특히 APRI는 다른 인자들에 비해 F2 이상의 의미 있는 섬유화를 예측하는 데 가장 유용하였고, CDS는 F3 이상의 광범위한 섬유화를 예측하는 데 가장 유용하였다. Background/Aims: The aim of this study was to determine the clinical performances of noninvasive serum markers for the prediction of liver fibrosis in chronic viral liver diseases. Methods: We analyzed a total of 225 patients with chronic viral liver diseases (180 with hepatitis B virus, 43 with hepatitis C virus, and 2 with hepatitis B+C virus) who underwent a liver biopsy procedure at the Hanyang University Guri Hospital between March 2002 and February 2007. Serum was also obtained at the time of liver biopsy. Liver fibrosis was staged according to the scoring system proposed by the Korean Study Group for the Pathology of Digestive Diseases. Various noninvasive serum markers were evaluated, including the aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio (AAR), age-platelet (AP) index, AST/platelet ratio index (APRI), cirrhosis discriminant score (CDS), platelet count, hyaluronic acid (HA), and type IV collagen. Results: There were 17, 40, 61, 74, and 33 patients at stages F0, F1, F2, F3, and F4, respectively. The overall diagnostic accuracies of each marker, as determined by the area under receiver operating characteristics curves, were APRI=0.822, CDS=0.776, platelet count=0.773, AP index=0.756, HA=0.749, type IV collagen=0.718, and AAR=0.642 for predicting significant fibrosis (≥F2); and CDS=0.835, platelet count=0.795, AP index=0.794, HA=0.766, AAR=0.711, type IV collagen=0.697, and APRI=0.691 for predicting extensive fibrosis (≥F3). Conclusions: Conclusions: All noninvasive serum markers evaluated in this study were useful for predicting significant or extensive liver fibrosis in chronic viral liver diseases. In particular, APRI was most useful for the prediction of significant fibrosis, and CDS was most useful for the prediction of extensive fibrosis. (Korean J Hepatol 2009;15:454-463)

다클론성 감마글로불린병증을 동반한 C-ANCA 양성 급속진행성 사구체신염 1예

백은경,노선희,박진경,조정연,권성신,심은진,권경주,노영욱,이경종,윤정윤,김인선,김소이,류동열,성순희,홍기숙 이화여자대학교 의과학연구소 2008 EMJ (Ewha medical journal) Vol.31 No.1

저자들은 육안적 혈뇨, 체중 감소를 주소로 입원하여 특별한 원인을 찾을 수 없는 심한 빈혈과 고감마글로불린병증을 보이고 신조직 검사에서 C-ANCA 양성 급속 진행성 사구체신염으로 진단된 예를 경험하였기에 보고 하는 바이다. Rapidly progressive glomerulonephritis(RPGN) is one of the most calamitous renal disease which is clinically characterized by sudden and relentless deterioration in renal function within weeks to months and associated with the pathologic finding of extensive extracapillary proliferation. Pauci-immune RPGN is mostly associated with anti neutrophil cytoplasmic antibody (ANCA) positive systemic vasculitis, but renal-limited RPGN may be found in part. We experienced a case of ANCA positive RPGN associated with polyclonal gammopathy without systemic symptoms. A 64-year-old woman was admitted with gross hematuria and azotemia. Laboratory findings revealed polyclonal gammopathy and severe anemia without definite cause, and she was diagnosed as C-ANCA positive crescentic glomerulonephritis without systemic vasculitis. She was treated with steroid pulse therapy and her renal function and anemia were progressively improved. We report herein a rare case of C-ANCA positive crescentic glomerulonephritis associated with polyclonal gammopathy and severe anemia with the review of literature.

간 및 경부 림프절 생검으로 진단된 혼합 간세포-담관상피암종

강혜원,박재정,문일환,김서우,김현경,오현정,김고흔,최윤정,허현미,노영욱,김태헌,유 권,배지윤,송동은 이화여자대학교 의과대학 2009 EMJ (Ewha medical journal) Vol.32 No.2

Mixed hepatocellular-cholangiocarcinoma accounts for about 1% of all hepatocellular carcinoma. In many cases, mixed hepatocellular-cholangiocarcinoma has been misdiagnosed as hepatocellular carcinoma or cholangiocarcinoma because of the indistinctive clinical course and radiologic findings. The clinical course and the pathologic characters are not known well, but it resembles the characteristics of hepatocellularcarcinoma rather than cholangiocarcinoma. So mixed hepatocellular-cholangiocarcinoma was classified as a kind of hepatocellular carcinoma. But the growth and dissemination rate is faster than that of hepatocellular carcinoma and the prognosis more poor. So the exact diagnosis is important. Authors experienced a patient who has the mixed hepatocellular-cholangiocarcinoma diagnosed by liver and neck node biopsy in patient who complain-ed abdominal discomfort and palpable mass, so we report the case.