한국인 크론병의 Infliximab 유지치료 시 Infliximab 단독 투여와 Infliximab과 Azathioprine 병합 투여 비교

원현선 ( Hyun Sun Won ),박동일 ( Dong Il Park ),전창욱 ( Chang Uk Chon ),석효선 ( Hyo Sun Seok ),김태완 ( Tae Wan Kim ),허운제 ( Woon Je Heo ),이창균 ( Chang Kyun Lee ),은창수 ( Chang Soo Eun ),한동수 ( Dong Soo Han ),이석호 ( Suc 대한장연구학회 2011 Intestinal Research Vol.9 No.3

Background/Aims: The benefits and risks of concomitant immunomodulators with infliximab maintenance therapy in patients with luminal Crohn`s disease (CD) have not been adequately evaluated. We studied the influence of immunomodulator discontinuation in patients in remission with infliximab therapy through a restrospective case- control study. Methods: Medical records of 37 patients with luminal CD who received infliximab at four medical centers were retrospectively analyzed. We compared clinical and follow-up data of patients who were treated with infliximab alone with that of patients with combination therapy. Results: Among 37 patients, 31 (83.7%) were treated with infliximab plus azathioprine and six (16.2%) were treated with infliximab alone. Of the 31 patients receiving combination maintenance therapy, 26 (83.9%) were in complete remission after 12 months, as compared with five of six patients (83.3%) receiving infliximab alone. No significant difference was observed in remission rate between two groups (P=0.735). In total, 16.1% of patients in combination therapy and 16.7% in infliximab alone group reported side effects (P=1.000), but serious adverse events such as reactivation of tuberculosis were noted in only one patient in combination therapy group. Conclusions: Concomitant immunomodulators did not improve efficacy in patients with luminal CD who received scheduled infliximab maintenance. (Intest Res 2011;9:189-195)

목이 있는 폴립형 위장관 기질종양에 의해 유발된 위십이지장 중첩증

석효선 ( Hyo Sun Seok ),손정일 ( Chong Il Shon ),서현일 ( Hyun Il Seo ),최영길 ( Young Ghil Choi ),정원길 ( Won Gil Chung ),원현선 ( Hyun Sun Won ) 대한소화기학회 2012 대한소화기학회지 Vol.59 No.5

The gastrointestinal stromal tumor (GIST) is a mesenchymal tumor of the digestive tract showing differentiation along the line of interstitial cell of Cajal. The most GISTs in the stomach generally show the appearance of submucosal tumors. It is rare for GISTs to appear as a pedunculated polypoid lesion on endoscopy. We experienced a case of a 51-year-old man who had a pedunculated polypoid GIST. He was admitted to our hospital for nausea, vomiting, melena and severe anemia (hemoglobin 3.4 g/dL, hematocrit 10.8%). An upper endoscopy showed gastroduodenal intussusception due to a pedunculated polypoid mass. This report presents a rare case of endoscopically proven gastroduodenal intussusceptions due to pedunculated polypoid GIST in the stomach. (Korean J Gastroenterol 2012;59:372-376)

한국 여성에서의 동맥 맥파 속도와 심혈관 질환 위험인자들과의 상관관계

김태선 ( Tae Sun Kim ),서윤용 ( Yun Yong Seo ),이수희 ( Su Hee Lee ),홍영호 ( Young Ho Hong ),김도이 ( Do Yi Kim ),원현선 ( Hyun Sun Won ),양문석 ( Moon Seok Yang ),신현호 ( Hyun Ho Shin ) 한국지질동맥경화학회(구 한국지질학회) 2008 韓國脂質學會誌 Vol.18 No.2

증례 : 내분비-대사 ; 임신 3분기 중 발현된 요붕증

이수희 ( Su Hee Lee ),원현선 ( Hyun Sun Won ),류현미 ( Hyun Mee Ryu ),박소영 ( So Young Park ),김성훈 ( Sung Hoon Kim ),한기옥 ( Ki Ok Han ),윤현구 ( Hyun Koo Yoon ) 대한내과학회 2009 대한내과학회지 Vol.77 No.4

임신성 요붕증은 임신 후반부에 다뇨, 다음 및 갈증이 발생하는 드문 질환으로 태아 및 모체에게 신경학적 손상을 초래할 수 있으며, 임신 여성 100,000명 중 약 4명에서 발생한다. 특이 질환이 없는 경우 임신 후반부에 태반에서 유래되는 바조프레시나제의 활동증가로 혈중 바조프레신이 분해되어 임신성 요붕증을 일으킬 수 있다. 드물게 발생하는 질환이지만 이차적 손상의 위험을 감소시키기 위하여 빠른 진단과 치료가 필요하다. 저자들은 임신 3분기에 다뇨, 다음 등이 발생하여 요붕증으로 진단된 34세 산모에서 바조프레신의 아미노 말단부를 처리하여 바조프레시나제에 의해 분해되지 않는 데스모프레신의 비강흡입으로 요농축과 임상적 호전이 관찰되고 출산 후 치료없이 회복된 임신성 요붕증을 경험하여 문헌고찰과 함께 보고하는 바이다. Gestational diabetes insipidus, which occurs rarely during late pregnancy, may injure the mother and fetus neurologically. It takes place in about 4 of every 100,000 pregnancies. Increased placental-derived vasopressinase in late pregnancy markedly degrades vasopressin. The decreased vasopressin activity causes hypotonic polyuria, polydipsia, and dehydration. We report a woman with gestational diabetes insipidus who had no abnormal laboratory tests before developing symptoms. The diabetes insipidus was controlled well by administering nasal desmopressin (1-desamino-8-D-arginine vasopressin, DDAVP) followed by resolution of the signs and symptoms after delivery. Although gestational diabetes insipidus is rare, a prompt diagnosis and appropriate treatment to reduce the risks of maternal and fetal injury are important. (Korean J Med 77:512-516, 2009)

전기적 심율동전환술 후 심방세동의 재발에서 혈장 BNP의 역할

이수희 ( Su Hee Lee ),홍영호 ( Young Ho Hong ),김도이 ( Do Yi Kim ),원현선 ( Hyun Sun Won ),양문석 ( Moon Seok Yang ),김태선 ( Tae Sun Kim ),서윤용 ( Yun Yong Seo ),박정배 ( Jeong Bae Park ) 대한내과학회 2009 대한내과학회지 Vol.76 No.3

Background/Aims: No studies have conclusively determined whether the B-type natriuretic peptide (BNP) level measured before electrical cardioversion for atrial fibrillation (AF) is associated with the maintenance of sinus rhythm after the procedure. Therefore, we investigated whether the plasma BNP can predict AF recurrence in the short-term. Methods: We prospectively recruited 20 consecutive patients with persistent AF, without symptomatic congestive heart failure. The plasma BNP was measured before and after electrical cardioversion. Results: In all patients, AF was converted to normal sinus rhythm (NSR) after the procedure. NSR was maintained in 70.0% of the patients at 1 week and in 52.6% of the patients at 4 weeks. Of the patients with NSR at 1 week, five patients had relapsed by 4 weeks (4-week relapse group, 4WRG). The log BNP levels after cardioversion decreased significantly in all patients, except for the failed group at 1 week and the 4WRG. Multivariate analysis revealed that the maintenance of sinus rhythm was associated with body mass index at 1 week, and left atrial diameter (LAD) and left ventricular mass index (LVMI) at 4 weeks. 4WRG had a significantly higher baseline BNP. The baseline BNP was associated with the LVMI (R2=0.241, p=0.028) and tissue Doppler imaging (TDI) E` (R2=0.432, p=0.002). Conclusion: A higher plasma BNP at baseline in AF patients may help to predict the failure to maintain sinus rhythm 4 weeks after electrical cardioversion, but not the early recurrence at 1 week. (Korean J Med 76:311-320, 2009)

임신 또는 분만 시 혈전색전증에 대한 임상적 고찰

서윤용 ( Yun Yong Seo ),양문석 ( Moon Seok Yang ),김도이 ( Do Yi Kim ),원현선 ( Hyun Sun Won ),이수희 ( Su Hee Lee ),홍영호 ( Young Ho Hong ),김태선 ( Tae Sun Kim ),신현호 ( Hyun Ho Shin ),박정배 ( Jeong Bae Park ) 대한내과학회 2008 대한내과학회지 Vol.75 No.6

목적: 임신 또는 분만 시 혈전색전증은 높은 사망률을 보이는 치명적인 질환이다. 하지만 임신 중 과 산욕기의 위험도에 대해 그 위험성이 잘 알려져 있지 않다. 본 연구는 임신과 연관된 심부정맥혈전증과 폐색전증의 발생률, 위험인자 및 임상적 특징을 알아보고자 하였다. 방법: 2003년 2월부터 2008년 1월까지 5년간 관동의대제일병원에서 분만한 40,989명의 환자 중 심부정맥혈전증 및 폐색전증 진단을 받은 환자들의 빈도, 증상 및 이학적소견, 검사결과, 위험인자, 치료 및 예후 등을 후향적 조사하였다. 결과: 혈전색전증은 총 17예에서 보고되어 평균 발생 빈도는 0.042%(평균나이 32.4±2.5세)였으며, 이 중 심부정맥혈전증 환자는 4예(0.01%), 폐색전증 환자는 13예(0.032%) 발생하였다. 분만 전(2예)에 비해 분만 후(15예)의 발생률이 7배 이상 높게 나타났다. 진단 시 임상증상은 호흡곤란 8예(62%), 흉통 4예(31%), 기침 2예(15%), 실신 1예(8%) 등의 빈도였다. 혈전색전증의 위험인자로는 제왕절개술(OR=7.4, 95% CI; 0.002, p=0.002), 전자간증(OR=12.0; 95% CI: 4.2-34.2, p<0.000) 등 이었고, 35세 이상 고령의 산모와 다태임신 등은 발생빈도는 높았으나 통계학적으로 유의하지 않았다. 17예 모두에서 보존적 치료 및 항응고치료를 시행하였으며, 태아나 모성사망은 없었다. 결론: 임신과 관련된 혈전색전증의 발생률 및 위험인자로 제왕절개술, 전자간증 등을 알 수 있었으며, 위험인자를 가지고 있는 환자에서는 혈전색전증에 대한 가능성을 고려하여 임상적으로 의심이 될 경우 신속한 진단과 치료가 요구된다. Background/Aims: Venous thromboembolism (VTE) during pregnancy or postpartum is a major cause of maternal complications and death; however, the risk is uncertain. In this study, we sought to estimate the incidence of VTE during pregnancy and to identify risk factors for pregnancy-related VTE. Methods: We retrospectively evaluated the incidence, risk factors, treatment, and prognosis for VTE based on 40,989 deliveries at Cheil General Hospital, Kwandong University College of Medicine, over a five-year period from February 2003 to January 2008. The risk factors were analyzed by χ2-analysis and forward stepwise logistic regression, and are presented as crude and adjusted odds ratios (ORs) with a 95% confidence interval (CI). Results: The incidence of VTE was 0.042% (17 patients, mean age 32.4±2.5 years), with deep venous thrombosis (DVT) in 0.01% of the patients (4 patients, mean age 31.5±2.9 years), and pulmonary embolism (PE) in 0.032% of the patients (13 patients, mean age 32.6±2.5 years). The postnatal incidence of VTE was higher than the antenatal incidence (2 vs. 15). The main manifestations at the time of diagnosis, in order of frequency, were: dyspnea in 8 patients (62%), chest pain in 4 patients (31%), cough in 2 patients (15%), and syncope in 1 patient (8%). The risk factors for VTE were Cesarean section (OR=7.4; 95% CI: 2.1-25.7, p=0.002) and preeclampsia (OR=12.0; 95% CI: 4.2-34.2, p<0.000). All cases showed clinical improvement spontaneously, or with anticoagulation and surgical thrombectomy, and caused no fetal or maternal mortality. Conclusions: The incidence of VTE during pregnancy was 0.042%; the independent risk factors were Cesarean section and preeclampsia. (Korean J Med 75:658-664, 2008)