종괴성 병변을 보인 여포성 기관지염/세기관지염 1예 보고

김명성,임성철,김윤현,나국주,김경수,권건영,김영철,박경옥,Kim, Myeong-Seong,Lim, Sung-Chul,Kim, Yun-Hyeon,Na, Kook-Joo,Kim, Kyung-Soo,Kwon, Kun-Young,Kim, Young-Chul,Park, Kyung-Ok 대한결핵및호흡기학회 1998 Tuberculosis and Respiratory Diseases Vol.45 No.1

Follicular bronchitis/bronchiolitis is pathologically characterized by peribronchiolar lymphoid follicles, which is one of reactive pulmonary lymphoid disorders. It is associated with 1) the result of infections such as mycoplasma, chlamydia etc., 2) immunodeficiency syndromes, 3) connective tissue diseases such as rheumatoid arthritis and Sjogren's syndrome and 4) local or systemic hypersensitivity reaction. And it can be also developed without obvious causes and associated diseases(idiopathic). Radiologically it represents as bilateral interstitial patterns of pulmonary infiltrates. In this case, a 49 year-old woman was presented with intermittent cough and sputum. On chest X-ray and CT, $5\times4$ cm sized mass in right upper lobe and paratracheal lymphadenopathies were detected, by which lung malignancy was suspected. Bronchoscopy, trans bronchial lung biopsy and transthoracic needle aspiration showed non-specific findings only. After right upper lobectomy, we could confirm a case of follicular bronchiolitis which presented as an unusual mass-like radiologic finding.

IgA 신병증에서 혈청 면역글로불린 A 의 유용성

김명성(Myeong Sung Kim),신규태(Gyu Tae Shin),임현이(Hyun Ee Yim),김승정(Seung Jung Kim),신승수(Seung Soo Sheen),마경애(Kyoung Ai Ma),조남한(Nam Han Cho),최영일(Young Il Choi),김흥수(Heung Soo Kim),김도헌(Do Hun Kim) 대한신장학회 2002 Kidney Research and Clinical Practice Vol.21 No.1

배 경 : 면역글로불린 A (Immunoglobulin A, 이하 IgA) 신병증은 가장 흔한 사구체신염으로 알려져 있다. IgA 환자의 30- 50%에서 혈청 IgA 농도가 증가하지만 혈청 IgA 측정이 갖는 IgA 신병증 진단의 유용성에 대해서는 잘 밝혀져 있지 않다. 방 법 : 1994년 6월부터 1998년 12월까지 아주대학교병원에 내원하여 신조직 검사를 시행한 전체환자 333명 중 혈청 IgA 농도를 측정한 270명을 후향적으로 조사하였다. 결 과 : 혈청 IgA 농도의 정상치의 상한 값인 365 ㎎/dL를 초과하는 환자 수는 IgA 신병증 환자들에서는 80명 중에 32.5%인 26명이었으며, 나머지 환자들에서는 190명 중에 8.9%인 17명이 혈청 IgA치가 365 ㎎/dL를 초과하였다(p<0.001). 혈청 IgA 농도 증가에 따라 IgA 신병증 진단에 대한 민감도는 감소하며, 특이도는 증가하는 관계를 나타내었다. 혈청 IgA농도 1 ㎎/dL에 대해 IgA 신병증으로 진단 받을 위험도(Risk ratio)는 1.0025였다(p- value 0.0043). 또한 혈청 보체치가 저하되지 않은 환자만을 대상으로 하였을 경우 이러한 위험도는 1.0079로 더욱 상승하였다. 그러나 혈청 IgA 농도와 신조직 면역형광 소견과는 상관관계가 없는 것으로 나타났다. 결 론 : 혈청 IgA 농도 측정이 IgA 신병증 진단 추정에 유용함을 보여 주었고, 이러한 결과는 특히 신 조직 검사가 적합하지 않은 환자에서, 혈청 IgA 농도, 보체 등을 이용하여 IgA 신병증 진단을 추정하는데 임상적으로 도움을 줄 수 있다. Background : Immunoglogulin A (IgA) nephropathy is the most common primary glomerular disease throughout the world. 30-50% of patients with IgA nephropathy (IgAN) have high serum IgA concentrations. However, we do not know if the degree of elevation in IgA level increases the likelihood of having IgAN. Neither do we know if the IgA level has any association with pathological findings of IgAN. Methods : We analyzed the relationships between IgAN and the levels of serum IgA which has been a routine part of the study in all patients with glomerulonephritis in our institution for the last 4 years. We reviewed 270 patients in whom the pathological diagnosis and the results of their IgA levels were both available. Results : Of 80 patients who were IgA nephropathy, 26 patients (32.5%) had higher than normal cutoff value of serum IgA (385 ㎎/dL). In contrast, 8.9% of patients with other types of glomerulonephropathies showed the values above normal(p<0.0001). The risk ratio for an increase of one unit of the IgA level was 1.0025(logistic regression, p=0.0043), which was increased to 1.0079 when patients with low complement levels were excluded from the analysis. The data were also analyzed according to the immunofluorescence microscopic findings of IgAN, which were found to have no significant correlation with IgA concentrations. Conclusion : The IgA level is a risk factor for IgAN throughout the whole range. However, it does not correlate with the IgA deposition in the renal tissue. We believe that this study will help understanding the interpretation of IgA levels in patients with IgAN.

전남 농촌 지역의 anti - HCV 양성률에 대한 연구 - 제 2 세대 효소면역측정법 ( anti - HCV EIA Imx(R) ) 으로 -

김명성(Myeong Seong Kim),서강석(Kang Seok Seo),김남진(Nam Jin Kim),최성규(Sung Kyu Choi),서순팔(Soon Pal Suh),최진수(Jin Su Choi),김세종(Sei Jong Kim) 대한내과학회 1997 대한내과학회지 Vol.53 No.6

N/A Backgroud: Hepatitis C virus(HCV) is well known major cause of posttransfusion hepatitis. There were a lot of studies about the prevalence of anti-HCV. But, most of these focused on healthy blood donors or patients with liver diseases in urban areas. So they may not represent the prevalence of anti-HCV in the entire Korean population. This study focused on people of a rural area which consisted of six towns near Reservoir Juam in the Chonnam province in Korea, Methods: Nine hundred and sixty three persons were selected by multi-stage cluster sampling method from January to February in 19%, Anti-HCV and HBsAg were examined by microparticle enzyme immunoassy(MELA; Abbott Co., USA). Alanine aminotransferase(ALT) was examined by enzyme kinetic method. Results: 1) The positivity of anti-HCV in all subjects was 0.9%. 2) The positivity of anti-HCV in male(1.1%) was not significantly higher than in female(0.9%). 3) The positivity of anti-HCV was 0% below the 5th decade, 0.7% in the 6th decade, 1.4% in the 7th decade, 1.7% in 8th decade, 0% above the 9th decade. There was no significant relationship between the positivity of anti-HCV and age. 4) The positivity of anti-HCV was 0.8% in normal ALT( 435U/L) subjects, and 1.6% in elevated ALT(>35U/L) subjects. There was no statistical relationship between the positivity of anti-HCV and ALT level. 5) HBsAg was serologically negative in all of nine anti-HCV positive subjects. Conclusion : The positivity of anti-HCV was 0.9% in rural area of Korea and was similar to the prevalence of anti-HCV in urban areas.

CT조영제의 요오드 농도와 양에 따른 조영효과 비교

김윤기(Yun Ki Kim),김명성(Myeong Sung Kim),이수연(Su Yeon Lee),이지만(Ji Man Lee),이형선(Hyeong Sun Lee),정종성(Jong Sung Jeong),김명구(Myeong Gu Kim) 대한CT영상기술학회 2014 대한CT영상기술학회지 Vol.16 No.2

목적 : 컴퓨터단층촬영 조영제는 요오드 농도에 따라서 상품명에 표기를 달리 한다. 조영제를 이용한 검사는 그 검사의 특성 또는 조영제 부작용의 위험성이 있는 환자 등의 상황에 따라 조영제를 선택적으로 사용하고 있다. 이에 조영제의 요오드 농도와 양에 따라 어느 정도의 조영증강효과 차이가 생기는지 비교 실험해 보았다. 대상 및 방법 : 64slice MDCT(GE Healthcare, Discovery 750HD, USA)를 이용하여 팬텀과 사람을 대상으로 다음과 같은 방법으로 측정하였다. 1) 팬텀(Alderson Rando Phantom)에 순수조영제와 희석조영제(생리식염수1:1조영제)를 요오드 농도 별로 넣고 각각 획득한 영상의 관심 영역을 설정하여 감약계수(HU)를 측정 하였다. 2) 요오드 농도가 다른 조영제를 사용하여 몸무게 74kg인 동일 대상자의 역동적 간 검사를 시행 하였으며 조영제 주입 후 40초 영상을 획득하였다. 3) 요오드 농도 300의 조영제로 몸무게가 47~73kg인 환자 18명의 역동적 간 검사를 시행하였으며 조영제 주입 후 40초 영상을 획득하였다. 감약계수(HU) 측정은 PACS 장비(M-view 5.4 Infinitt Healthcare PACS, Korea)로 복부 대동맥과 상장간막 동맥에 관심영역을 정하여 측정하였다. 자료 처리는 윈도우 환경의 SPSS 12한글버전을 사용하여 선형회귀분석을 하였다. 결과 : 팬텀을 이용한 순수조영제와 희석조영제의 영상에서 요오드 농도별 감약계수(HU) 차이는 유의한 차이가 없었다(p=0.343, p=0.287). 동일인의 요오드 농도의 차에 따른 감약계수(HU) 차이는 복부 대동맥과 상장간막 동맥 모두 유의한 차이가 없었다(p=0.988, p=0.443). 요오드 농도300 조영제의 조영제 양에 따른 감약계수(HU) 차이는 복부 대동맥에서 유의한 차이를 보였으며(P=0.045), 상장간막 동맥에선 유의한 차이가 없었다(P=0.133). 결론 : 요오드 농도별 감약계수(HU)는 유의한 차이가 없었지만 몸무게에 따른 감약계수(HU)는 반비례적으로 유의한 차이를 보였다. 이는 조영제의 양이 감약계수(HU)에 영향을 주는것을 반증한다. 따라서 높은 요오드 농도의 조영제보다 낮은 농도의 조영제로도 적정량을 사용하면 보다 큰 조영증강 효과를 볼 수 있을 것으로 사료된다. Purpose : Computed tomography contrast agent differs in the product name in accordance with the concentration of iodine. Examinations using contrast agent are selectively taken according to the situation such as a patient with high risk of contrast agent side effects and characteristics of the test. I tried to compare the difference of contrast enhancing effect depending on the amount and the iodine concentration of contrast agent. Material and Methods : Using 64slice MDCT (GE Healthcare, Discovery 750HD, USA), I measured the Hounsfield Unit(HU) for people and phantom by the following method. 1) I injected the pure contrast and the diluted contrast(one-to-one mixture of saline and contrast media) separately by iodine concentration to the phantom(Alderson Rando Phantom). And I selected the specific resions to measur the HU of the image. 2) Using the contrast agents with different iodine concentration, I tested a man whose weight is 74kg for dynamic liver CT. And I obtained the images of 40 seconds after contrast agent injection. 3) Using the contrast agents with 300 iodine concentration, I tested 18 patients whose weight is ranging 47kg to 73kg for dynamic liver CT. And I obtained the images of 40 seconds after contrast agent injection. HU is measured by PACS equipment(M-view5.4 Infinitt Healthcare PACS, Korea). I measured the region of interest in the superior mesenteric artery and abdominal aorta. I analysed the data by using SPSS12 Korean version of Windows environment, and made linear regression analysis. Result : There is no significant difference of Iodine-concentration HU in image between the pure contrast and diluted contrast using a phantom(p = 0.343, p = 0.287). There is no significant difference of HU in image using different Iodine-concentration for same person in both the superior mesenteric artery and abdominal aorta(p = 0.988, p = 0.443). There is a significant difference in abdominal aorta using the contrast agents with 300 iodine concentration(P = 0.045). But there is no significant difference in the superior mesenteric artery(P = 0.133). Conclusion : There is no significant difference in Iodine-concentration but is significant difference corresponding to the weight inversely. This disproves the amount of contrast agent affects HU. Therefore, it is believed that the appropriate usage of lower concentration contrast agents than higher iodine concentration will be able to gain a greater contrast enhancement effect.

재생 불량성 빈혈 환자에서 B 형 및 C 형 간염 바이러스 간염에 대한 분석 평가

김남진(Nam Jin Kim),임우현(Woo Hyun Lim),유상두(Sang Doo You),김명성(Myeong Seong Kim),서순팔(Soon Pal Suh),이현철(Hyun Chul Lee),황태주(Tae Joo Hwang),김세종(Sei Jong Kim) 대한내과학회 1998 대한내과학회지 Vol.55 No.3

N/A Objective: Aplastic anemia is a rare but serious complication of viral hepatitis. Both aplastic anemia and viral hepatitis are more common in Korea than in the Western countries. It is necessary to study about the relationship between them. Methods: Twenty-three patients with aplastic anemia visiting Chonnam University Hospital from 1995 to 1996 were studied for positivity of hepatitis B virus (HBV) and hepatitis C virus (HCV) to investigate the association of hepatitis virus infection with aplastic anemia. The surface antigen of HBV (HBsAg) and anti-HCV in sera were tested by EIA(enzyme immunoassay), and the presence of HBV-DNA and HCV-RNA in both sera and bone marrow cells was examined by the polymerase chain reaction (PCR). Results: The positivities of HBsAg and anti-HCV in 23 patients with aplastic anemia were 4.3% (1 patient) and 8.7% (2 patients), respectively. The positivity of HBsAg is similar to that of HBsAg in general population of Korea. The positivity of anti-HCV is higher than that of anti-HCV in general population of Korea. One patient had HBV DNA and 3 patients had HCV HNA in their sera. All of the 3 hepatitis C viremic patients received 11 to 15 units of blood products in the past. None of the patients showed the evidence of recent viral hepatitis infection. HBV DNA and HCV RNA were not detected by the PCR in bone marrow cells in any of the patients. Conclusion: This study suggests that the HBV or HCV might not be a causative agent of aplastic anemia. The higher positivity of anti-HCV in the patients might be due to passive transmission of EICV after transfusion of blood products.

복막염이 동반되지 않으면서 복막투석 도관에 증식한 진균 (Alternaria species)

신도현 ( Sin Do Hyeon ),안상미 ( An Sang Mi ),임선교 ( Im Seon Gyo ),정희선 ( Jeong Hui Seon ),김명성 ( Kim Myeong Seong ),신규태 ( Sin Gyu Tae ),이위교 ( Lee Wi Gyo ),임현이 ( Im Hyeon I ),길혜련 ( Gil Hye Lyeon ),김흥수 ( Kim He 대한신장학회 2004 Kidney Research and Clinical Practice Vol.23 No.3

Visible fungal colonization on peritoneal dialysis catheter is a rare complication and it was not reported yet in Korea. We here report a case of Alternaria spp. colonization on peritoneal dialysis catheter without peritonitis. A 58-year-old man on continuous ambulatory peritoneal dialysis for 2 years, noticed 3..4 mm sized two black-brown immobile fungal colonization plaque on peritoneal catheter lumen (15 cm distal from catheter exit site). The dialysate effluent was clear and culture for fungus and bacteria was negative. Peritoneal catheter was removed and culture from the plaque revealed saprophytic fungus, Alternaria species. The catheter removal alone was sufficient for the treatment. He is on hemodialysis thereafter. (Korean J Nephrol 2004;23(3):523-527)

대동정맥루가 병발한 비외상성 복부 대동맥류 1예

김명성,신준한,윤명호,김영준,김한수,탁승제,조윤경,최병일 대한내과학회 1997 대한내과학회지 Vol.53 No.3S

저자 등은 3년 전 매독을 앓고 치유된 매독환자에서 대동정맥루(Aotro-Caval fistula)를 동반한 복부 대동맥류(Abdominal aneurysm) 1예를 경험하였기에 이를 보고하는 바이다. Aorto-caval fistula(ACF) is a rare complication of abdominal aortic aneurysm(AAA). The incidence of ACF has been estimated about one per cent of all patients with AAA and four per cent in patients with ruptured aneurysm. Approximately 100 cases of ACF has been reported, since Syme reported the first case of ACF in 1831. ACF is divided into three types : the spontaneous(80%), the traumatic(15%), and the iatrogenic(5%). Even though most of the spontaneous fistulas are arteriosclerotic in origin, syphilis, connective tissue disease such as Marfan's disease and Ehlers-Danlos syndrome have been reported as causes of ACF. Surgery is the choice of treatment. Without surgical intervention, the condition is always fatal, even though operative mortality has ranged from 25 to 50%. Causes of death are high-output heart failure, venous hypertension and multi-organ circulatory failure. We report a case of 52 year old male patient with aorto-caval fistula, who had been treated for syphilis 3 years ago and had been complaining lower back pain for 3 months. Physical examination revealed 10×10㎝ sized pulsatile mass in periumbilical area. Blood pressures were 95/60㎜Hg on right arm, 130/50㎜Hg on left arm, l00/60㎜Hg on right leg, and not palpable on left leg. With the clinical suspicion of a aortic aneurysm, abdominal computed tomography was performed and showed 5cm sized aortic aneurysm just below renal arteries and extending to the aortic bifurcation. On abdominal aortography, contast media could be seen in inferior vena cava indicating aortocaval fistula. On operation, abdominal aneurysm was repaired by using Y-graft and 0.3㎝ sized fistula located above aortic bifurcation was closed by ligation. Patient recoverd without a significant complication after operation. Histopathology of the specimen showed medial necrosis associated with calcification, which appeared to be necrotizing vasculitis, often seen in syphilitic arteritis.

백혈병으로 전환된 림프종 환자에서 발생한 유산산증(Lactic Acidosis)

김현수,김도헌,마경애,신규태,서유진,김승정,김명성,안성균,정혁준,현봉학 대한신장학회 1999 Kidney Research and Clinical Practice Vol.18 No.3

Occurence of lactic acidosis with adequate tissue oxygenation(type B lactic acidosis) has been described in association with leukemia, lymphoma, small cell carcinoma and breast cancer. However, no such case has been reported in Korea. Therefore, we report a case of type B lactic acidosis in a man with rapidly progressing acute lymphoblastic leukemia which had been transformed from lymphoma.

동종 골수이식 후 만성 이식편대숙주질환과 동반되어 신증후군으로 발현된 IgA 신병증 1예

정철권,김현수,박준성,정성현,조도연,최진혁,남동기,임호영,김명성,신규태,임현이,김효철 대한조혈모세포이식학회 1999 대한조혈모세포이식학회지 Vol.4 No.2

동종 골수이식 후 발생하는 신기능부전은 원인이 다양하여 감별에 어려움이 있다. 만성 GVHD는 흉선의 기능저하에 따른 면역관용의 실패로 발생되는 자가면역현상에 의해 발생되는 것으로 알려져 있으며 드물게 신장을 침범하여 신증후군을 일으키기도 한다. CaA의 용량을 줄이거나 투약중지 후 발생한 만성 GVHD에 동반된 신증후군의 경우 조기에 신조직검사를 시행하여 감별진단하고 CsA의 용량을 증량하거나 재투약하여 좋은 치료 결과를 보일 것으로 기대된다. 저자들은 문헌고찰을 통해 동종 골수이식 후 발생된 신증후군이 유사한 임상양상을 보이며 발생기전에 만성 GVHD와 자가면역현상이 연관되어 있음을 확인하였으며 동종 골수이식 후 신증후군의 임상양상을 보이는 환자에서 병리조직학적으로 lgA 신병증을 진단하고 이러한 lgA 신병증이 발생기전에 만성 GVHD와 자가 면역현상이 연관되어 있을 가능성을 최초로 확인하였으며 CsA를 이용하여 성공적으로 치료한 경험을 하였기에 보고하는 바이다. Renal insufficiency is occasionally encountered in allogeneic bone marrow transplantation and its cause is difficult to ascertain. Chronic graft-versus-host disease (GVHD) related to thymic dysfunction is immune-mediated and involves autoreactivity of T-lymphocytes derived from donor marrow to recipient's major histocompatibility complex(MHC) minor antigens. The clinical mainifestations of chronic GVHD are similar to those of autoimmune disease but kidney involvement is rare. Few cases of nephrotic syndrome with membranous nephropathy or minimal change nephrotic syndrome have been reported to be associated with chronic GVHD in allogeneic bone marrow transplant recipient especially after cyclosporine A(CsA) withdrawal, and these cases have responded well to CsA. Therefore, it is prudent to differentiate the cause of post-transplant renal insufficiency using renal biopsy and to start CsA in a case of nephrotic syndrome associated with chronic GVHD as early as possible. We report a case who had a massive proteinuria during the post-allogeneic marrow transplantation period. The cause of nephrotic syndrome was diagnosed as IgA nephropathy by renal biopsy. The patient was successfully treated with reintroduction of CsA.