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성인에서 발생한 다발성 기관 유두종증에 대한 경직성 기관지경을 이용한 치험 1 예
정복현,임재민,김미혜,Jung, Bock-Hyun,Lim, Jae-Min,Kim, Mi-Hye 대한기관식도과학회 2009 大韓氣管食道科學會誌 Vol.15 No.2
A 57 year old human immune virus(HIV)-positive male presented with a progressive dyspnea for 6 months. Chest CT showed multiple polypoid masses arising from upper tracheal wall. Bronchoscopic examination revealed that multiple large cauliflower-like polypoid tumors was obstructing tracheal lumen. They were diagnosed as multiple squamous papillomas and were removed by Nd:YAG laser photocoagulation and rigid bronchoscopic treatment. The tumors were histologically diagnosed as squamous papilloma infected with human papilloma virus(HPV) type 6 and 11 in in-situ hybridization. Rigid bronchoscopy might be safer and more efficient than flexible bronchoscopy for the treatment of multiple tracheal papillomatosis obstructing tracheal lumen because of easy establishment of airway patency and direct use of rigid bronchoscope itself for tumor resection.
내과적 치료에 반응하지 않은 Lemierre 증후군 1예
허태윤 ( Tae Yun Heo ),정복현 ( Bock Hyun Jung ),유내선 ( Nae Sun Ryou ),정형주 ( Hyoung Chu Joung ),조민형 ( Min Hyung Cho ),김미혜 ( Mi Hye Kim ),류대식 ( Dae Sik Ryu ) 대한내과학회 2008 대한내과학회지 Vol.74 No.2
Lemierre 증후군은 구 인두염 후에 내경정맥의 혈전 정맥염이 발생하고 이로 인한 이차적 전이성 감염이 초래되는 드물지만 치명적 질환으로 특징적인 임상양상을 통하여 조기에 진단하고 적절한 항생제를 사용한다면 사망률을 현저히 낮출 수 있다. 그러나 antiphospholipid 증후군과 같이 혈전 형성의 고 위험 질환이 동반된 경우 내과적치료에 반응이 없을 수 있으므로 항 응고제 및 외과적 치료가 필요할 수 있다. 최근 비교적 전형적인 Lemierre 증후군의 임상양상을 보였고, antiphospholipid 증후군을 동반한 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Lemierre syndrome is a rare clinical condition that is characterized by anaerobic oropharyngeal infections leading to septic thrombophlebitis of the internal jugular vein and frequent secondary metastatic infections. The accurate diagnosis and treatment, for early stage disease, is important because it may be associated with a high mortality rate if untreated. We present the case of a 34-year-old man who presented with a history of typical for the diagnosis of Lemierre syndrome. Supportive care with antibiotics did not improve the clinical condition. The clinical course improved after treatment with IV anticoagulant and surgical thrombectomy. In addition, he had the antiphospholipid syndrome, which is known to be a common cause of acquired arterial or venous thrombosis. Therefore, in this patient the associated antiphospholipid syndrome might precipitate an internal jugular venous thrombophlebitis after an oropharyngeal infection or might account for the poor response to medical treatment. (Korean J Med 74:203-207, 2008)
고령에서 일차 항결핵 화학요법에 의한 약물 이상반응이 치료에 미치는 영향
정정임 ( Jeong Ihm Jeong ),정복현 ( Bock Hyun Jung ),김미혜 ( Mi Hye Kim ),임재민 ( Jae Min Lim ),하동천 ( Dong Cheon Ha ),조성원 ( Sung Won Cho ),류대식 ( Dae Sik Rhui ) 대한결핵 및 호흡기학회 2009 Tuberculosis and Respiratory Diseases Vol.67 No.4
Background: Pulmonary tuberculosis (TB) is still common disease among the elderly patients in Korea where the overall incidence of TB is decreasing. Adverse drug reactions (ADR) associated with anti-TB drugs occurs frequently. Especially the aged tends to have more frequent ADRs than younger ones. These ADRs can cause significant morbidity, compromise therapeutic effects of drugs and even induce drug resistance. Therefore we evaluated the effect of ADRs on the first-line anti-TB drugs in elderly patients with active pulmonary TB. Methods: We retrospectively reviewed the charts and radiological findings of the patients with 65 and older who were bacteriologically confirmed as active TB and treated with standard anti-TB drugs for at least 6 months. Major ADR was defined with temporary or continuous stop of any first-line drugs intake. Results: An ADR was noted in 54% of all patients. The incidence of major ADR was 32% in all elderly patients. Dermatologic ADR (9%) was the most common among the major ADRs. GI trouble (8%), arthralgia (6%), visual change (6%), hepatotoxicity (4%), and fever (1%) were also noted. The drugs responsible for major ADR were ethambutol (62%), pyrazinamide (35%), rifampin (18%) and isoniazid (9%). Major ADRs were associated with higher ESR level at the initiation of anti-TB drugs. Conclusion: First-line anti-TB drugs in elderly patients frequently caused the major ADRs. Therefore the elderly patients receiving anti-TB drugs should be closely monitored and better tolerable therapy should be considered as part of a TB research agenda.
정정임 ( Jeong Ihm Jeong ),정복현 ( Bock Hyun Jung ),김미혜 ( Mi Hye Kim ),박용진 ( Yong Jin Park ),허태윤 ( Tae Yun Hea ),류대식 ( Dae Sik Rhui ),강길현 ( Gil Hyun Kang ) 대한내과학회 2008 대한내과학회지 Vol.75 No.5
Rifampicin is a powerful agent for the treatment of pulmonary tuberculosis. However, it may induce several adverse effects, including rare cases of lung toxicity. Here, we report a case of rifampicin-induced interstitial pneumonitis. A 57-year-old woman diagnosed with cerebellar tuberculoma developed progressive dyspnea after the 5th day of anti-tuberculosis medication. Chest X-ray revealed newly developed ground glass opacities on both lower lung fields. Drug-induced pneumonitis was suspected and all anti-tuberculosis medications were halted. Transbronchial lung biopsy was consistent with desquamative interstitial pneumonitis. After clinical improvement, a rechallenge test with each anti-tuberculosis medication was attempted. No primary anti-tuberculosis drug except rifampicin triggered recurrence of symptoms, supporting a diagnosis of rifampicin-induced interstitial pneumonitis. Clinicians should be aware of this rare, but serious, side effect of rifampicin treatment. (Korean J Med 75:592-596, 2008)