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Adenosine Deaminase 수치가 높은 골수종 흉수 1예
문한주 ( Han Ju Moon ),신동엽 ( Dong-yeop Shin ),김혜련 ( Hye Ryoun Kim ),박연원 ( Yeon Won Park ),우승민 ( Seung Min Woo ),차진훈 ( Jin Hoon Cha ),한강희 ( Kang Hee Han ) 대한내과학회 2016 대한내과학회지 Vol.91 No.3
다발성 골수종은 주로 골수와 골격계로 발생하는 질환이다. 다발성 골수종 환자에서 흉수의 발생은 6% 정도이며 주된 원인은 심부전, 결핵이나 폐렴, 폐색전증, 신부전, 저알부민혈증 등이고, 다발성 골수종이 직접적으로 흉수의 원인이 되는 경우는 1% 내로 매우 드문 것으로 알려져 있다. 흉수 검사에서 ADA 수치가 50 IU/L 이상일 경우 결핵성흉수 진단에 중요한 생체지표가 된다. 때문에 일반적으로 흉수로 인한 호흡곤란을 호소하여 내원한 환자의 흉수 검사에서 림프구성 삼출액으로 ADA 수치가 높을 경우 결핵성 흉수를 우선적으로 고려해야 한다. 저자들은 다발성 골수종으로 항암 치료를 받는 47세 여자가 2달 동안 좌측과 우측으로 독립적인 흉수 증가가 있었고 우측 흉수는 림프구성 삼출액으로 ADA 수치가 100 IU/L 이상 상승하여 결핵성 흉수에 대해 감별 검사를 해야 했으나 흉수의 AFB 염색 및 배양과 TB-PCR 결과가 음성으로 확인되었고 세포병리에서 형질세포종이 포함되어 최종적으로 골수종 흉수로 진단한 1예를 경험하였기에 ADA 수치가 상승된 골수종 흉수에 대한 문헌고찰과 함께 증례를 보고하는 바이다. Multiple myeloma is a plasma cell neoplasm mainly involving the bone marrow and skeletal system. Myelomatous pleural effusion is rare, accounting for less than 1%. In cases with high adenosine deaminase (ADA) activity, with lymphocytic exudate in the pleural fluid, tuberculous pleural effusion should be differentiated first. We report herein a rare case of a unilateral pleural effusion in a patient who was undergoing chemotherapy for multiple myeloma, with an ADA level of > 100 IU/L and lymphocytic exudate in the pleural fluid. An acid fast bacillus stain and polymerase chain reaction test for tuberculosis were negative. Consequently, the patient was diagnosed with myelomatous pleural effusion with elevated ADA activity. (Korean J Med 2016;91:316-320)
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황기와 행인(杏仁)이 면역세포(免疫細胞)의 Apoptosis 및 Nitric Oxide에 미치는 효과(效果)
정현우,문한주,Jeong Hyun-Woo,Moon Han-Ju 대한한의학방제학회 1998 大韓韓醫學方劑學會誌 Vol.6 No.1
The purpose of this research was to investigate effects of Astragali Radix(AR) and Armeniacae Semen(AS) on T-lymphocytes and peritoneal macrophages in mice. The proliferation of thymocytes and splenocytes were teated using macroplate-reader. The apoptosis and sub-population of T-lymphocytes were tested using a flow cytometer. Nitric oxide production was tested using a Griess reagents. The result were obtained as follow; 1. AR increased the proliferation of thymocytes and splenocytes. 2. AS decreased the proliferation of thymocytes and splenocytes. 3. AR and AS decreased No production fron peritoneal macrophages 4. AR and AS were accelerate T-lymphocytes apoptosis. 5. AR and AS increased $T_C$ cells population, but decreased $T_H$ cells population of T-lymphocyte.
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박연원 ( Yeon Won Park ),문한주 ( Han Ju Moon ),한정석 ( Jung Suk Han ),한지민 ( Ji Min Han ),박종욱 ( Jong Wook Park ),구윤희 ( Yun Hyi Ku ) 영남대학교 의과대학 2017 Yeungnam University Journal of Medicine Vol.34 No.2
Approximately 10-15% of pheochromocytomas are malignant. There are insufficient histologic criteria for the diagnosis of malignant pheochromocytoma. Thus, the term malignant pheochromocytoma is restricted to tumors with local invasion or distant metastases. We experienced a case of malignant pheochromocytoma recurred with spinal metastasis 4 years after the surgery for huge benign pheochromocytoma. A 68-year-old female was admitted for trunk and back pain. The patient had a history of surgery 4 years ago for a 10.0× 9.5×7.5 cm sized benign pheochromocytoma at the left adrenal gland. A thoracolumbar magnetic resonance imaging showed a tumor in the 7th thoracic vertebral body and a 24-hour urinary norepinephrine increased, suggesting metastatic recurrence of malignant pheochromocytoma. After metastasectomy in the 7th thoracic vertebral body, urine catecholamine was normalized and pain also disappeared. However, a metastatic lesion was found in the paraaortic area on a follow-up abdominal computed tomography scan and an additional metastasectomy was performed. The pathology confirmed the diagnosis of metastatic pheochromocytoma in the paraaortic lymph nodes. She is supposed to be treated with adjuvant iodine 131-meta-iodobenzylguanidine therapy. In our experience, a close follow-up should be considered in patients who had a huge benign pheochromocytoma due to the possibility of malignant metastases.
KCI
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