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고용량의 면역 글로불린 주사 치료로 호전된 Salmonella 그룹 D 균혈증과 골수섬유증을 동반한 전신성 홍반성 루푸스
이혜순 ( Hye Soon Lee ),배상철 ( Sang Cheol Bae ),윤형란 ( Hyung Ran Yun ),이지현 ( Ji Hyun Lee ),정유성 ( Yu Seong Jeong ),배윤상 ( Yun Sang Bae ),김태환 ( Tae Hwan Kim ),전재범 ( Jae Bum Jun ),정성수 ( Sung Soo Jung ),이인홍 ( I 대한류마티스학회 2000 대한류마티스학회지 Vol.7 No.1
A 22-year-old woman presented with fever and pancytopenia. One year ago, she was diagnosed as Salmonella group D bacteremia and myelofibrosis associated with SLE at another hospital. She was placed on high dose steroid, however, there was no improvement. Two months ago, she was diagnosed as recurrent Salmonella group D bacteremia. After admission to our hospital, she was placed on intravenous antibiotics and high dose intravenous immunoglobulin. A significant improvement in laboratory and clinical condition occurred and bone marrow biopsy showed complete resolution of fibrosis. We report a case of SLE with myelofibrosis and recurrent Salmonella group D bacteremia.
HBsAg 양성인 류마티스 관절염 환자와 HBsAg 음성인 류마티스 관절염 환자의 methotrexate에 대한 간독성의 비교
박용욱 ( Yong Wook Park ),박재홍 ( Jae Hong Park ),배윤상 ( Yun Sang Bae ),김태환 ( Tae Hwan Kim ),전재범 ( Jae Bum Jun ),정성수 ( Sung Soo Jung ),배상철 ( Sang Cheol Bae ),김성윤 ( Seong Yoon Kim ),유대현 ( Dae Hyun Yoo ) 대한류마티스학회 2001 대한류마티스학회지 Vol.8 No.4
Objective: To investigate the hepatic safety of methotrexate (MTX) and useful parameters to assess the risk of hepatotoxicity in rheumatoid arthritis (RA) patients with hepatitis B surface antigen (HBsAg). Methods: 19 HBsAg positive (B group) and 54 HBsAg negative (non-B group) RA patients taking MTX were prospectively followed up for 2 years. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were checked at 2-month interval. In B group, HBeAg, HBeAb and levels of hepatitis B virus DNA (HBV DNA) were additionally checked, and liver biopsy was performed in seventeen of 19 patients. Change of AST or ALT to more than 1.5 times the upper limit of normal were considered as a hepatic event. The data were analyzed by stepwise linear and logistic regression method. Results: The findings of liver biopsy in B group were classified as grade I (n=8), II (n=6), and IIIA (n=3) according to the Roenigk Classification Scale. Mean cumulative dose of MTX in B group was 2054mg in cases with hepatic event and 1780mg in cases who stopped taking MTX. The frequency of hepatic event (47.4% vs 7.4%, p=0.0001) and MTX withdrawal (26.3% vs 1.9%, p=0.0008) was higher in B group than in non-B group. HBV DNA (+) group (n=9) showed the increased tendency of hepatic event and MTX withdrawal compared with HBV DNA (-) group (n=10). Baseline HBV DNA was negative in all HBeAg (-) patients (n=14), but HBV DNA was positive during MTX therapy in 7 of 14 HBeAg (-) patients. Serum levels of AST and ALT returned to normal range within 2 months after MTX withdrawal in twelve of 13 patients with hepatic event. Conclusion: The use of MTX in HBsAg positive RA patients requires close monitoring of AST and ALT. HBV DNA seems to be a useful marker to predict hepatic event and viral replication, especially in HBeAg (-) patients.
이상호,이성주,이은아,문원주,정찬형,양윤식,배윤상,이지혁 대한내과학회 1998 대한내과학회지 Vol.54 No.3
Acute uric acid nephropathy is a kind of acute renal failure and results from uric acid crystal deposition within the collecting ducts and the distal tubules due to rapid increase of serum uric acid concentration. Hyperuricemia can be, in the relation to the underlying physiology, classified into the three categories. i.e., increased urate production, decreased uric acid excretion, or a combination of the two. It is most commonly presented in the lymphoproliferative or myeloproliferative disorders after effective cytolytic chemotherapy in the form of tumor 1ysis syndrome. But we have recently experienced a case of a 73 year-old female patient with acute lymphoblastic leukemia whose first presentation was acute uric acid nephropathy, spontaneously developed without chemotherapy and so report it with review of related literatures.
이상호,배윤상,이지혁,심재광,양윤식,윤중근,설상영 인제대학교 1998 仁濟醫學 Vol.19 No.2
저자는 좌측 고관절 전치환술을 시행받은 후 다발성 피부결절이 나타나, 피부조직 검사 결과 전이성 선암이 있었다. 원발암을 추적 검사한 바, 진행된 위선암을 보인 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Multiple cutaneous metastases from gastric adenocarcinoma are rare and usually notified after diagnosis of primary cancer. Recently, we experienced a case of gastric adenocarcinoma presenting as multiple cutaneous metastases which developed after total hip replacement arthroplasty and transfusion. So, we report this case with a brief review of literatures.
항 벽세포 항체 및 항 내인자 항체 양성을 보인 악성 빈형 1예
이지혁,이은아,배윤상,김병준,정찬형,문원주,양윤식,손창학 인제대학교 1998 仁濟醫學 Vol.19 No.2
저자는 위 수술의 병력이 없으며 오심 및 구토, 소화불량의 증상으로 입원한 환자에서 A형 만성 위축성 위염과 함께 항 벽세포 항체(anti-parietal cell antibody) 및 항 내인자 항체(anti-intrinsic factor antibody) 양성을 보인 악성빈혈 1예를 경험하였기에 문헌 고찰과 함께 보고하는 바이다. We present a case of pernicious anemia without history of gastric operation in 77 year old male. The patient suffered from nausea, vomiting, and dyspepsia. He had dysesthesia and hypoesthesia on the distal area of both arm and foot by neurologic examination. Laboratory findings were as follows: serum cobalamin 10pg/ml(normal range: 200∼1000 pg/ml), serum folate 4.64ng/ml(normal range : 3 ∼15ng/ml), anti-intrinsic factor antibody (strong positive), antiparietal cell antibody(positive), first stage of Schilling test(1.4%). The findings of peripheral blood and bone marrow were compatible with megaloblastic anemia. He was treated with intramuscular injection of hydroxocobalamin, and clinical course appeared improving process. We report this case(pernicious anemia with positive antiparietal cell antibody and anti-in-trinsic factor antibody) with a brief review of the literature.