만성 C 형 간염 환자에서 인터페론치료에 의한 갑상선질환의 발생

김민대(Min Dae Kim),전익수(Ik Soo jeon),강승수(Seung Su Kang),엄재섭(Jae Sup Eum),손호성(Ho Seung Son),박현용(Hyung Lyong Park),윤병철(Byung Cheol Yun),이상욱(Sang Uk Lee),한병훈(Byung Hoon Han) 대한소화기학회 2001 대한소화기학회지 Vol.37 No.6

Background/Aims: It has been suggested that hepatitis C virus is associated with the autoimmune disease and interferon also induces hepatic and non-hepatic autoimmune reaction. We conducted this study to assess the effect of interferon-alpha (INF-α) on the induction of thyroid autoantibodies and clinical thyroid disease and to know whether the thyroid autoantibodies affect the IFN-α efficacy in patients with chronic hepatitis C. Methods: Twenty-nine patients with chronic hepatitis C were enrolled. Anti-thyroglobulin antibody (ATA), anti-microsomal antibody (AMsA), thyroid stimulating hormone and free thyroxine were measured before, during, and after IFN-α therapy. Results: Two of the 29 patients (6.5%) were positive for ATA and AMsA before IFN-α therapy. Of these two patients, one patient was a woman, who showed hyperthyroidism druing IFN-α therapy. Of the 27 patients who had been negative for ATA and AMsA, one female patient became ATA positive with the development of hyperthyroidism, and 3 male patients became AMsA positive during IFN-α therapy. There was no difference in the efficacy of INF-α therapy between the thyroid autoantibody positive and negative groups. Conclusions: IFN-α therapy induced thyroid disease with high prevalence in the patients with chronic hepatis C. Thus, thyroid status should be checked even in patients without thyroid autoantibodies, especially in woman. Antithyroid autoantibodies seem unlikely to affect the efficacy of IFN-α therapy. (Korean J Gastroenterol 2001;37:436-442)

IV형 담관 낭종에서 발생한 간내담관암

김석훈 ( Suk Hun Kim ),김형욱 ( Hyung Wook Kim ),강대환 ( Dae Hwan Kang ),김민대 ( Min Dae Kim ),이진호 ( Jin Ho Lee ),이재형 ( Jae Hyung Lee ),김봉갑 ( Bong Gap Kim ),박종환 ( Jong Hwan Park ) 대한소화기학회 2012 대한소화기학회지 Vol.60 No.2

Anomalous union of the pancreaticobiliary duct (AUPBD) is a congenital anomaly that is defined as a junction of the bile duct and pancreatic duct outside the duodenal wall. This anomaly results in a loss of normal sphincteric mechanisms at the pancreaticobiliary junction. As a result, regurgitation of pancreatic juice into the biliary system develops and causes choledochal cysts, choledocholithiasis, cholangitis, pancreatitis and malignancy of the biliary tract. Gallbladder cancer or common bile duct cancer associated with AUPBD and choledochal cysts have been frequently reported. But, intrahepatic cholangiocarcinoma associated with this condition has been only rarely reported. Here, we report a case of intrahepatic cholangiocarcinoma associated with AUPBD and choledochal cyst. (Korean J Gastroenterol 2012;60:123-127)

소화기 ; Churg-Strauss 증후군 환자에서 발생한 무결석 담낭염

박종환 ( Jong Hwan Park ),강대환 ( Dae Hwan Kang ),이진호 ( Jin Ho Lee ),김민대 ( Min Dae Kim ),최철웅 ( Cheol Woong Choi ),김형욱 ( Hyung Wook Kim ) 대한내과학회 2010 대한내과학회지 Vol.79 No.4

저자들은 급성 무결석성 담낭염으로 발현한 Churg-Strauss 증후군 환자를 조직 소견을 포함한 ACR 기준에 따라 진단하여 치료하였고, 증상 호전 후 담낭절제술을 시행하였는데 담낭조직에서는 호산구 침윤이나 혈관염을 찾을 수 없었던 증례를 경험하여 관련 문헌 및 최근 문헌보고와 함께 보고하는 바이다. Churg-Strauss syndrome is an uncommon disorder characterized by asthma, hypereosinophilia, and systemic vasculitis. Gastrointestinal involvement is commonly encountered in Churg-Strauss syndrome; however, acute cholecystitis is rare, and few cases have been documented in the literature. A 22-year-old female with a history of asthma was admitted with a complaint of steady pain in the right upper abdominal quadrant. Laboratory test results showed leukocytosis with hypereosinophilia. Abdominal ultrasonography and computed tomography revealed acute cholecystitis. Her symptoms did not improve with conservative treatment, so she underwent percutaneous transhepatic gallbladder drainage. Subsequently, peripheral neuropathy, erythematous papules on the skin, and dyspnea developed. A chest computed tomography scan showed bilateral pulmonary infiltrates. A pathological examination of the skin lesion indicated necrotizing vasculitis with eosinophilic infiltrates. She was diagnosed with Churg-Strauss syndrome. She was treated with corticosteroids, and her condition improved dramatically. After the drainage catheter was removed, complications including a bile leak occurred. Consequently, a cholecystectomy was performed. (Korean J Med 79:412-416, 2010)

좌각차단을 동반한 심부전증 환자에 실시한 양심실 심박조율기 치료 : 증례 보고

김찬욱,차태준,김성만,김민대,권성일,서수홍,최병주,주승재,이재우 고신대학교 의학부 2002 高神大學校 醫學部 論文集 Vol.17 No.1

Epidemiological studies suggest that 30-50% of patients diagnosed with symptomatic congestive heart failure(CHF) have electrocardiographic evidence of a major intraventricular conduction delay, which may worsen left ventricular systolic and diastolic dysfunction through asynchronous ventricular contraction and paradoxical interventricular septal wall motion. Biventricular pacing is an emerging therapy allowing simultaneous electrical stimulation of the both ventricles with an implantable pacing system and it improves hemodynamics and well-being of patient by reducing ventricular asynchrony. Recently, we underwent biventricular DDD pacemaker implantation in a patient with CHF and Left bundle branch block and was significantly improved exercise tolerance and quality of life in that patient.

다제약제내성 결핵의 유병율

김길수,전익수,신성훈,김민대,강승수,권성일,옥철호,조현명,장태원,정만홍 고신대학교 의학부 2001 高神大學校 醫學部 論文集 Vol.16 No.1

Background Multidrug-resistant tuberculosis (MDRTB) is defined as the reduction in susceptibility of Mycobacterium tuberculosis to Isoniazid and Rifampicin with or without resistance to additional drugs. The development of MDRTB is a big problem not only to the patients but also to the society given with its lower cure rate. The purpose of this study is to investigate the prevalence and the clinical features of MDRTB at university hospital and to establish the proper therapeutic plan. Method The incidence of MDRTB among 161 patients diagnosed as pulmonary tuberculosis by the AFB culture between January 1997 and June 2000, and the relationship of MDRTB with the history of previous therapy, associated diseases, bronchial involvement, and the consequence of treatment were studied retrospectively. Results Fortyeight (29.8%) patients were resistant to at least one drug and 27 (16.8%) patients suffered from MDRTB. Among the MDRTB patients, 22 had the previous history of therapy. More than 30 percent of all the patients had associated diseases, such diabetes mellitus, malignancy, chronic liver disease, systemic erythematous lupus or psychosis. Endobronchial lesions suggesting bronchial involvement of tuberculosis were found in 37 (35%) patients. Out of the 16 patients eligible for the efficacy of treatment among 27 MDRTB patients, nine (56.3%) patients were treated successfully but seven (43.8%) were failed. Conclusion Prevalence of MDRTB was high especially in patients with previous therapy history and the results of treatment was modest in this study. It is imperative to prevent the emergence of drug resistance by the proper delivery of chemotherapy and the development of new drugs.

Cerivastatin과 Cyclosporine을 병용 투약한 신이식 환자에서의 횡문근융해증 1예

신성훈,김민대,강승수,김찬욱,이지영,엄재섭,권성일,김길수,정연순,임학 고신대학교 의학부 2002 高神大學校 醫學部 論文集 Vol.17 No.1

Cerivastatin, a kind of statins, is a recently used lipid-lowering drug. which inhibits of hydroxymethylglutarate coenzyme A (HMG-CoA) reductase. The serum concentrations of statins in healthy volunteers are increased by the simultaneous administration of cyclosporine, itraconazole, as well as erythromycin and verapamil and increased risk of myalgia and rhabdomyolysis has been reported after concomitant use of HMG-CoA reductase inhibitors with these drugs. A 57-year-old female kidney transplant recipient admitted because of a dark urine, myalgia and weakness of extremities. Six weeks before admission, the patient has taken cerivastatin 0.3mg daily. Cyclosporine, prednisolone and mycophenolate mofetil were maintained for recent two years. Initial laboratory data showed serum creatinine 1.1mg/dl, AST 235 IU/L, LDH 2,465 IU/L, CPK 1600 IU/L, myoglobin >3,000 ng/ml and cyclosporine 288ng/ml (TDX). Medication of cerivastatin was discontinued, and the patient recovered rapidly with supportive therapy. After eighteen weeks of cerivastatin withdrawal. the drug was represcribed to control the increased lipid levels. The patient showed the same clinical manifestations suggesting rhabdomyolysis following eight weeks of cerivastatin administration. We report a case of rhabdomyolysis associated with cerivastatin and cyclosporine combination therapy in a kidney transplant recipient.

기능부전 혈액투석동정맥루 치료법으로서 경피경관혈관성형술의 임상적 의의 및 효과

정연순,김민대,신호식,정규식,유창현,김홍기,황일용,임학 대한신장학회 2002 Kidney Research and Clinical Practice Vol.21 No.2

목 적 : 기능부전 혈액투석동정맥루의 치료로서의 경피경관혈관성형술의 임상적 의의와 장기개통률에 영향을 미치는 요소에 대하여 알아보고자 본 연구를 시행하였다. 방 법 : 기능부전 혈액투석동정맥루로 정맥조영술을 시행한 53명의 환자(총 61예) 중 동정맥루의 협착 및 폐쇄로 경피경관혈관성형술이 시도된 환자는 49명(총 57예)이었으며 이들의 정맥조영술 적응증을 알아보았다. 이 중 경피경관혈관성형술을 성공적으로 시행받은 38명의 환자(총 46예)를 대상으로 하여 임상적 특성과 6, 12, 24개월의 개통률을 분석하였다. 환자의 연령, 당뇨병의 유무, 만성신부전의 병력기간, 동정맥루의 종류와 사용기간, 혈액투석동정맥루의 위치와 협착의 길이, 잔여협착의 정도 등이 장기개통률에 미치는 영향을 Kaplan-Meier method에 의한 log-rank test를 이용하여 평가하였고, multivariate analysis로 Cox Regression Model을 사용하여 평가하였다. 통계적 유의성 검정은 p값이 0.05 미만인 경우로 하였다. 경피경관혈관성형술을 실패한 경우의 정맥조영술 소견과 시술 전후의 합병증을 조사하였다. 결 과 : 시술의 성공률은 80.7%(46/57)였으며 성공한 예의 추적 검사에서 개통률(postintervention primary patency)은 6, 12, 24개월 각각 68, 38, 5%였다. 재협착으로 인해 2번의PTA를 시행받은 환자가 8명 있었으며, 이들 경우를 포함했을 때의 개통률(postintervention assisted primary patency)은 6, 12, 24개월 각각 69, 40, 10%였다. 환자의 연령, 당뇨병의 유무, 만성신부전의 병력기간, 동정맥루의 종류와 사용기간, 혈액투석동정맥루의 위치와 협착의 길이, 잔여협착의 정도 등이 장기 개통률에 미치는 영향은 통계학적으로 유의한 경우는 없었다(p>0.05). 혈관성형술을 실패한 경우는 총 11예로 대량혈전으로 인한 완전폐쇄가 6예, 광범위한 과도한 혈관협착이 5예였다. 시술과 연관된 합병증은 없었다. 결 론 : 이상의 결과로 동정맥루 협착이 동반된 혈액투석 환자에서 경피적경관혈관성형술은 안전하고 비교적 효과적인 치료법으로 사료되며, 장기 개통률에 영향을 미치는 요소는 없었다. Purpose : The purpose of this study was to evaluate the effect of percutaneous transluminal angioplasty( PTA) and to determine patency rates and the factors affecting the long-term patency rates in the management of insufficient arteriovenous fistulae. Methods : Sixty-one cases of insufficient dialysis shunts in 53 patients underwent venography of the fistula. These patients' indications of venographys were reviewed. Forty-six cases of insufficient dialysis shunts in 38 patients were treated by PTA. These patients' clinical characteristics and patency rates were evaluated. According to the patient's age, history of diabetes mellitus, duration of renal failure, type and age of the arteriovenous fistula, the site of AVF and length of the stenosis, and to the degree of residual stenosis, patency rates were compared within each subgroup using the Kaplan-Meier logrank test. To estimate reasons for the incidence of vascular access failure, Cox regression model was used. Venographic findings of failed PTAs and PTA related complications were evaluated. Results : The success rate was 80.7%. In cases in which initial success was obtained, postintervention primary patency rate at 6, 12 and 24 months were 68%, 38% and 5% respectively. With repeatitive PTAs, postintervention assisted primary patency rate at 6, 12 and 24 months were 69%, 40% and 10% respectively. The effect of the above mentioned factors(age, DM, duration of CRF etc.) on long-term patency was not statistically significant(p>0.05). Among 11 cases of failed PTA, there were 6 cases of total obstruction due to massive thrombosis and 5 cases of extensive vascular stenosis(>5 cm of length, >4 sites of stenosis and >75% of stenosis in all cases). There were no PTA related complications. Conclusion : PTA is considered to be an effective and safe treatment modality for shunt stenosis. No factors affected long-term patency rates in our study. (Korean J Nephrol 2002;21(2):276-284)