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症例(증례) : 류마티스 곤절염과 동반된 IgA 신병증 1례
고강석 ( Kang Suk Ko ),조양동 ( Yang Tong Cho ),김희정 ( Hui Jung Kim ),이원석 ( Won Seok Lee ),김형일 ( Hyoung Il Kim ),송민주 ( Min Ju Song ),손지연 ( Ji Youn Sohn ),류완희 ( Wan Hee Yoo ),강경표 ( Kyung Pyo Kang ),강명재 ( Myun 전북대학교 의과학연구소 2007 全北醫大論文集 Vol.31 No.2
IgA nephropathy is a common primary glomerulonephritis characterized by the deposition of IgA in glomerular mesangium. At clinical presentation the disorder may be macroscopic hematuria, often recurring in association with viral upper respiratory illness or with microscopic hematuria or proteinuria. Although the cause of primary IgA nephropathy is unknown, IgA nephropathy can be associated with systemic diseases, such as ankylosing spondylitis, Reiters`s syndrome, liver disease, and Sicca syndrome. We report a case of IgA nephropathy associated with rheumatoid arthritis. A 49-year-old woman, who has complaint of multiple joint swelling and pain, was presented with microscopic hematuria and proteinuria. Light microscopy showed mesangial and segmental endocapillary proliferative glomerulonephritis and immunofluorescence microscopy demonstrated segmental positive mesangial stainings for IgA and C3, consistent with IgA nephropathy. Treatment with anti-rheumatic medications and angiotensin converting enzyme inhibitor resulted in gradual disappearance of microscopic hematuria and proteinuria. Therefore, we suggest that IgA nephropathy may be associated with rheumatoid arthritis.
症例(증례) : 원발병소가 없느 폐암의 흉막전이를 PET-CT로 확인한 1예
김이식 ( Yi Shik Kim ),고강석 ( Kang Suk Ko ),조양동 ( Yang Tong Cho ),김웅지 ( Woong Ji Kim ),이가영 ( Ka Young Lee ),이흥범 ( Heung Bum Lee ),이용철 ( Yong Chul Lee ),이양근 ( Yang Keum Rhee ),박성주 ( Seoung Ju Park ) 전북대학교 의과학연구소 2008 全北醫大論文集 Vol.32 No.1
The discovery of malignant cells in pleural fluid and/or parietal pleura indicates a disseminated or advanced disease in the patients with various malignancies. For 5-10% of patients with these malignant pleural effusions, the site of origin cannot be identified even though extensive work-up. Recently, 18F fluorodeoxyglucose positron emission tomography (FDG PET) has been shown to be a highly reliable and accurate test for detection and staging of lung cancer. We report here a case of histopathologically diagnosed metastatic bronchogenic adenocarcinoma of pleura without detection of primary lung cancer which was evaluated by PET, and review the diagnostic work-up and the role of PET in the malignant pleural effusion.
증례(症例) : 기도협착으로 나타난 재발성 다발성 연골염 1예
최정환 ( Chung Hwan Choi ),고강석 ( Kang Suk Ko ),김재문 ( Jae Moon Kim ),훙윤경 ( Yun Kyung Hong ),류완희 ( Wan Hee Yoo ) 전북대학교 의과학연구소 2007 全北醫大論文集 Vol.31 No.1
재발성 다발성 연골염은 드문 자가면역질환으로서 첫 임상증상이 다양하게 나타날 수 있다. 이 질환은 이개 연골염이나 비연골염 등의 특징적인 증상이 나타날 경우 비교적 용이하게 진단할 수 있으나 다른 비특이 적인 증상들로 발현할 경우는 진단 및 적절한 치료가 지연될 가능성이 많다. 저자들은 이개 연골염 등의 전형적인 증상 없이 호흡곤란으로 내원하여 기도협착 등의 소견을 보인 다발성 연골염 1예를 경험하고 문헌고찰과 함께 보고하는 바이다. Relapsing polychondritis is a rare multisystem rheumatic disease, characterized by recurrent and potentially destructive inflammatory lesions of cartilaginous structures. All type of cartilage & other proteoglycan-rich structures may be involved, resulting in auricular chondritis, laryngotracheal chondritis, ocular symptoms, vasculitis, cardiac abnormalities, skin lesions and glomerulonephritis. Major airway involvement occurs rarely, it may be presented with only repiratory symtoms without typical clinical manifestation of relapsing polychondritis. We experienced a 50-year-old female patient who have been relapsing polychondritis involving airway tract without other characteristic clinical manifestation and present here with a review of literatures.
혈관내피세포에서 방사선 조영제에 의해서 유발된 아포프토시스에 대한 adrenomedullin의 세포보호 효과
강경표 ( Kyung Pyo Kang ),이애신 ( Ae Sin Lee ),정유진 ( Yu Jin Jung ),김덕훈 ( Duk Hoon Kim ),고강석 ( Kang Suk Ko ),최경화 ( Kyoung Hwa Choi ),정영욱 ( Young Wook Jeong ),김이식,이식 ( Sik Lee ),박성광 ( Sung Kwang Park ),성미정 ( 대한신장학회 2008 Kidney Research and Clinical Practice Vol.27 No.1
목적: 혈관내피 세포는 혈장과 혈장내 여러 가지 물질이 직접 접촉하게 되어 다양한 자극을 주는 물질을 통하여 병태생리에 관련된다. 최근, 아포프토시스가 세포손상의 새로운 병태생리 기전 중의 하나라는 것이 알려져서 혈관내피세포에 서 아포프토시스는 혈관세포손상의 기전이 될 수 있다. 또한, 아포프토시스를 줄일 수 있는 물질은 세포 손상을 줄이거나 억제함으로서 혈관손상을 예방 또는 치료제로서의 효과를 가질 수 있다. 따라서, 이 연구에서는 조영제인 iopromide를 사람의 제대정맥 내피세포에 투여하여 아포프토시스를 유발시키는지를 알아보고, adrenomedullin을 투여하여 아포프토시스 억제효과와 신호전달과정을 관찰하고자 하였다. 방법: 사람의 제대정맥내피세포을 이용하여 iopromide로 아포프토시스를 유발시켰으며, adrenomedullin을 투여하여 아포프토시스 억제 효과를 FACScan과 TUNEL 염색으로 관찰하였으며 신호전달과정은 phospho-Akt/Akt의 western blotting을 시행하였다. 결과: 제대정맥 내피세포에서 iopromide은 농도에 의존적으로 아포프토시스를 유발하였으며 adrenomedullin은 10-9 mol/L 이상의 농도에서부터 iopromide에 의해서 유도된 아포프토시스에 억제효과가 있었다. Iopromide에 의해서 유발된 아포프토시스에서 adrenomedullin의 억제효과는 농도에 의존적이었다. 결론 : 피세포에서 adrenomedullin은 iopromde에 의해서 유발된 apoptosis를 감소시켰며 이는 phosphatidylinositol 3`-kinase/Akt의존적인 신호전달 경로를 통하여 이루어졌다. Purpose: Because vascular endothelial cells play a pivotal role in the vascular diseases, damage of vascular endothelial cells lead to progression of vascular disease. Apoptotic damage of cells is an important mechanism in vascular disease. Therefore, several growth factors that have antiapoptotic effect may have a protective role in maintaining a cell function in apoptotic cell injury. In this study, we examined the effects of adrenomedullin on apoptosis in iopromide-induced endothelial cell injury. Methods: Human umbilical vein endothelial cells were incubated with nonionic radiocontrast agent, iopromide and/or adrenomedullin. Apoptosis was assessed quantitatively using FACScan after annexin V-FITC and propidium iodide staining, and by terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL) stain. Signaling pathway was evaluated by Western blot analysis of phospho-Akt and Akt. Results: Iopromide-induced apoptosis in human umbilical vein endothelial cells was increased in a dose-dependent manner. Adrenomedullin prevented iopromide-induced apoptosis in human umbilical vein endothelial cells in a dose dependent manner. Wortmannin, phosphatidylinositol 3-kinase inhibitor, decrease the adrenomedullin-induced antiapoptotic effect. Conclusion: These results suggest that adrenomedullin protects vascular endothelial cells from iopromide-induced apoptosis by regulating the activity of Akt.
이태환 ( Tae Hwan Lee ),강선미 ( Seon Mi Kang ),고강석 ( Kang Suk Ko ),한효진 ( Hyo Jin Han ),김희정 ( Hui Jung Kim ),김재문 ( Jae Moon Kim ),류완희 ( Wan Hee Yoo ) 대한류마티스학회 2006 대한류마티스학회지 Vol.13 No.4
Infectious sacroiliitis is an uncommon disease and the diagnosis is very difficult due to unawareness of the disease. The predisposing conditions to the disease are pelvic trauma, respiratory or genitourinary infection, skin infection, pregnancy, endocarditis, intravenous drug abuser and recent dental manipulation. The clinical characteristics of the disease are fever, leukocytosis, pain and tenderness of buttock, gait disturbance and positive result of blood culture and imaging study of sacroiliac joint. To our knowledge, the acupuncture induced infectious sacroiliitis with bacteremia is one of the rarely reported cases. We have recently experienced a case of infectious sacroiliitis as a very unusual complication of the acupuncture. In this case, increased signal intensity in the SI joint was found in the MRI. and focal hot uptake in SI joint was observed in bone scan. Staphyolococcus areus were cultured in the blood sample. Under the diagnosis of infectious sacroiliitis with bacteremia, the antibiotics was administered, and the clinical symptoms and laboratory findings were completely improved. This case report emphasizes that an acupuncture is a predisposing factor of the infectious sacroiliitis with bacteremia.
증예(症例) : 만성 폐쇄성 폐질환 환자에서 기관지유래암종으로 오인된 기관지 방선균증 1례
김소영 ( So Young Kim ),최영훈 ( Young Hun Choi ),김국민 ( Kuk Min Kim ),이태환 ( Tae Hwan Lee ),강선미 ( Seon Mi Kang ),이윤재 ( Yoon Jae Lee ),고강석 ( Kang Suk Ko ),김이식 ( Yi Shik Kim ),김재문 ( Jae Moon Kim ),김희정 ( Hui Ju 전북대학교 의과학연구소 2006 全北醫大論文集 Vol.30 No.1
방선균증은 혐기성 그람 양성균인 Actinomyces 속(genus)에 의해서 유발되는 만성 화농성 감염성 질환이다. 기관지 방선균증(endobronchial actinomycosis)은 국내의 적으로 그 빈도가 매우 드문 질환으로 기관지 결핵(endobronchial tuberculosis) 혹은 기관지 유래 암종(bronchogenic carcinoma)으로 잘못 의심되는 경우가 있다. 본 저자들은 50갑년의 흡연력과 만성 폐쇄성 폐질환의 폐암 위험 인자를 가진 65세 남자 환자가 객혈을 주소로 내원하여 흉부 전산화 단층촬영 소견과 기관지 내시경 소견상 기관지 유래 암종이 의증되었던 환자에서 조직 검사를 통해 방선균증으로 진단된 증례를 보고하는 바이다. Endobronchial actinomycosis is a rare disease that presents with endobronchial mass, Endobronchial actinomycosis can be misdiagnosed as endobronchial malignancy such as bronchogenic carcinoma, endobronchial tuberculosis, lipoma, or unresolving pneumonia. We report here a case of endobronchial actinomycosis mimicking bronchogenic carcinoma in patient with chronic obstructive lung disease (COPD). On admission, the patient presented with hemoptysis and had history of COPD. Chest CT finding was endobronchial mass with atelectasis, and fiberoptic bronchoscopy revealed near total obstruction of the left inferior lingular bronchus (LB5) of left upper lobe with an exophytic endobronchial mass. Contrary to fist impression, bronchoscopic biopsy revealed actinomycotic infection involving the bronchus. Intravenous administration of penicillin G followed by oral amoxicillin therapy was done and the mass was markedly decreased thereafter.
증례(症例) : 배액술 및 항결핵제 병합 치료로 성공한 흉벽내 걸핵 1례
김재문 ( Jae Moon Kim ),최경화 ( Kyoung Hwa Choi ),손지연 ( Ji Youn Sohn ),이원석 ( Won Seok Lee ),김형일 ( Hyung Il Kim ),고강석 ( Kang Suk Ko ),한효진 ( Hyo Jin Han ),김이식 ( I Sik Kim ),최정환 ( Chung Hwan Choi ),박성주 ( Seou 전북대학교 의과학연구소 2007 全北醫大論文集 Vol.31 No.1
흉벽내 결핵 (tuberculosis of the chest wall)은 흔하지 않은 질환으로 근골격계를 침범하는 결핵의 1~5%정도를 차지하는 질환이다. 흉벽내 결핵은 주로 CT 및 임상증상 및 조직검사를 통하여 진단되는 경우가 많으며 AFB microscopy로 진단되는 경우도 있었으나 흔하지 않다. 흉벽농약에서 검사한 AFB microscopy를 통해 진단하였으며 관을 통해 배액술 및 항생제 병합 치료 후 호전된 1예가 있어 보고한다. Primary tuberculosis of the chest wall is rare and clinical features resemble pyogenic abscess or tumor. Thus, the distinction of them can be difficult. Although it has been known that chest wall tuberculosis is usually presented with a painful mass that is frequently cystic, doughy, or soft and may fluctuate on physical examination, cold abscess, meaning swelling without inflammation, is one of the characteristics of the chest wall tuberculosis. Tuberculous cold abscesses of the chest wall are infrequently encountered and reportedly represent less than 10% of all skeletal tuberculosis cases. The presentation of cold abscesses is a progressively enlarging mass with or without destruction of the underlying bone or cartilage, and the consistency of the mass may be soft or firm. Some reports have demonstrated that chest wall tuberculosis occurs by one of three mechanisms of spread: (1) direct extension from the underlying pleural or pulmonary parenchymal disease, (2) hematogenous dissemination that is associated with the activation of a dormant tuberculous focus, and (3) direct extension from lymphadenitis of the chest wall. The diagnosis of chest wall tuberculosis is made by bacteriologic examinations for detecting acid-fast bacilli, polymerase chain reaction, or culture of aspiration specimens or postoperative specimens. Although recent trend of treatment of chest wall tuberculosis is combination therapy, surgical excision, and postoperative antituberculous chemotherapy, but there has no general consensus about the treatment of chest wall tuberculosis. Here, we report a case of chest wall tuberculosis treated successfully with abscess drainage and antituberculous chemotherapy.