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A Case of Cardiac Amyloidosis With Diuretic-Refractory Pleural Effusions Treated With Bevacizumab
배숙향,황진연,김우재,윤현화,김정민,남영희,백희경,조용락,박선이,김정환,김성현,박태호,이기남,나서희,김영대 대한심장학회 2010 Korean Circulation Journal Vol.40 No.12
Cardiac amyloidosis describes a clinical disorder caused by infiltration of abnormal insoluble fibrils in the heart, characterized by progressive heart failure and a grave prognosis. Pleural effusion in cardiac amyloidosis may represent a sign of heart failure,but it can also result from pleural infiltration of amyloid, manifested by recurrent large fluid accumulations. Recently,the role of vascular endothelial growth factor (VEGF) has been implicated in the pathogenesis of refractory pleural effusion. We report a case of a 53 year-old female patient with cardiac amyloidosis who presented with recurrent accumulation of large pleural effusions. She was initially treated with high dose loop diuretics, but the pleural effusion persisted, with the daily amount of drainage averaging 1 L/day. Accumulation of pleural fluid did not subside after 3 cycles of melphalan/prednisolone therapy. After the introduction of bevacizumab, an anti-VEGF antibody, the amount of pleural effusion decreased significantly. Efficacy of anti-VEGF therapy for refractory pleural effusions needs to be defined through further studies.
장경색을 동반한 상장간막정맥 혈전증 환자에서 요골동맥을 통한 혈전 용해제 주입술과 경피적 혈전제거술로 치험 1예
배숙향,김경한,황진연,이정민,김정민,구정모,이종훈 대한내과학회 2018 대한내과학회지 Vol.93 No.1
Mesenteric venous thrombosis has a low prevalence and nonspecific clinical symptoms, and it may cause bowel infarction and death. Early diagnosis and prompt surgical intervention with anticoagulants are important to patients. We examined a 27-year-old woman complaining of diffuse abdominal pain and hematochezia, and diagnosed extensive mesenteric venous thrombosis with intestinal infarction and pulmonary thromboembolism. In light of the patient’s symptoms, an operation seemed necessary. However, because of the high risk of mortality, we decided to look for another option. The patient was successfully treated with intensive medical care and a radiological procedure in spite of intestinal infarction. 간문맥 및 상장간막정맥의 광범위한 혈전증으로 인해 복막염 및 장경색의 징후를 보이는 환자에서 요골동맥을 통한카테터를 이용하여 상장간막동맥으로 혈전 용해제를 주입하고 경피경간 문맥조영술을 이용하여 간문맥 및 상장간막정맥의 혈전제거술을 시행하여 광범위한 간문맥 및 상장간막정맥 혈전증을 성공적으로 치료한 1예를 경험하였다. 경색및 복막염이 동반되어 수술 위험도가 클 경우 나이, 전신상태, 진단 시기, 혈전증의 원인 등을 고려해서 방사선 중재법및 내과적 보존적 치료를 시도해 볼 수 있겠다.
경요골동맥 혈전용해제 주입과 경피적 혈전제거술로 치료한 장경색을 동반한 상장간막정맥혈전증
배숙향,이종훈,한상영,노명환,최석렬,장진석,이성욱,백양현,박병호 대한내과학회 2011 대한내과학회 추계학술대회 Vol.2011 No.1
서론: 장간막정맥혈전증은 수액과 항생제 및 항응고제 등의 비수술적인 치료로 예후가 좋은 경우도 있지만 복막염이나 장경색의 징후가 있는 경우는 즉각적인 수술적 치료의 적응증이 된다. 저자들은 장경색의 징후를 보이는 장간막정맥혈전증 환자에서 비수술적인 방법으로서 경요골(transradial) 동맥을 통한 지속적인 혈전용해제 주입과 경피경간(percutaneous transhepatic) 카테터를 이용한 혈전제거술(thrombectomy)을 시행하여 치료에 성공한 1예를 경험하였다. 증례: 27세 여자 환자로 자궁내막증으로 소파술 시행후 경구 피임약을 2년째 복용중이었으며 흡연가였다. 내원 1주전부터 시작된 복통으로 지역병원에서 복부컴퓨터단층촬영상 간문맥에서 상장간막에 이르는 혈전증을 보여 항응고 요법을 시작한 지 2일째 소변량감소와 다량의 혈변을 보여 본원으로 전원되었다. 입원 당시 활력징후는 38.1도의 발열이외는 정상이었으며 복부 진찰상 장음은 들리지 않고 복부팽만, 복부전반에 걸친 압통 및 반발압통을 호소하였다. 말초혈액검사상 백혈구 42,170/mm3, 혈색소 14.0g/dL, 혈소판 176,000 /mm3, 혈액응고검사상 프로트롬빈시간 37.7%, 활성화부분트롬보플라스틴시간 35.4초, FDP 76.5 ug/mL, D-dimer 31.44ug/mL였다. 생화학검사상 BUN 36 mg/dL, creatinine 4.4 mg/dL, albumin 2.9 g/dL, C-reactive protein 8.56 mg/dL이었다. 복부컴퓨터단층촬영상 간문맥에서 상장간막에 광범위한 혈전증과 이로 인한 소장의 허혈 및 경색, 우측대장의 울혈성 장병증, 다량의 복수소견을 보였다. 수술위험도가 높아 헤파린 정주와 함께 경요골(transradial) 동맥에서 상장간막동맥을 연결하는 카테터를 통해 urokinase를 7일간 지속적으로 주입한 뒤, 경피경간(percutaneous transhepatic) 카테터를 통해 간문맥과 상장간막정맥내 혈전제거술(thrombectomy)을 시행하였다. 추적검사한 복부컴퓨터단층촬영에서 혈전은 관찰되지 않았으나 소장과 우측대장의 호전은 보이지 않았다. 그러나 금식, 헤파린 정주, 항생제 및 수액의 보존적 치료로 입원 16일 째 환자는 정상배변을 보였고 이후 식이를 진행하였다. 결론: 간문맥 및 상장간막정맥의 혈전증으로 인해 장경색의 징후를 보이는 환자에서 비수술적인 방법으로 혈전을 제거하고 보존적 치료를 시도해 볼 수 있다.
HBeAg 양성 만성 B형 간염환자에서 Clevudine, Entecavir 및 Lamivudine의 초치료 효과
배숙향 ( Suk Hyang Bae ),백양현 ( Yang Hyun Baek ),이성욱 ( Sung Wook Lee ),한상영 ( Sang Young Han ) 대한소화기학회 2010 대한소화기학회지 Vol.56 No.6
Background/Aims: Clevudine is a potent antiviral agent that has demonstrated efficacy in patients with chronic hepatitis B. This study compared the efficacy of clevudine (C), entecavir (E) and lamivudine (L) in treatment-naive patient with HBeAg-positive chronic hepatitis B. Methods: A total of 146 treatment-naive patients with HBeAg-positive chronic hepatitis B received clevudine, entecavir or lamivudine. C group (n=39) received 30 mg of clevudine, E group (n=39) received 0.5 mg of entecavir and L group (n=68) received 100 mg of lamivudine once a day for more than 48 weeks. The efficacy analysis estimated the mean changes of the HBV DNA levels as a virologic response, the normalization of the ALT levels (less than 35 IU/L) as a biochemical response and loss of HBeAg or seroconversion as a serologic response. The serum HBV DNA level was quantified by hybrid capture and real-time PCR assay. Results: Before the administration of clevudine, entecavir and lamivudine, the mean HBV DNA and ALT levels and the gender and age were well balanced among the three groups (p>0.05). For the virologic response at 48 weeks, the mean changes of the HBV DNA levels from baseline of the C, E and L groups were -3.8±2.2, -4.5±1.9 and -2.5±2.1 log copies/mL. C and E group showed superior antiviral activity compared to that of L group (p<0.0001), but no significant differences in antiviral response were noted between C and E groups. For the biochemical response at 48 weeks, the normalization of the ALT levels (less than 35 IU/L) among the C, E and L groups was 82%, 74% and 71%, respectively (p=0.46). The rates of undetectable serum HBV DNA (less than 300 copies/mL) of the C, E and L groups were 39%, 69% and 27%, respectively (p<0.0001). For the serologic response at 48 weeks, the loss of HBeAg was 13%, 31% and 24% and the seroconversion was 10%, 23% and 17%, respectively. There was no difference of efficacy among the three groups regarding ALT normalization or serologic response (p>0.05). Viral breakthrough in C group was noted at 24 weeks (5%) and 48 weeks (21%), but no biochemical breakthrough was noted. The elevation of the serum CK level was noted in only 1 patient of group C at 48 weeks (2.56%) after therapy. For the patients without or with liver cirrhosis (LC), C and E group showed superior antiviral activity compared to that of the L group, but the antiviral activity was more effective in non-LC group than LC group (p<0.0001 vs p=0.036). Conclusions: Clevudine therapy compared with lamivudine for 48 weeks showed significantly potent antiviral efficacy in treatment-naive patients with HBeAg-positive chronic hepatitis B, and especially in the non-LC patients. However, the antiviral efficacy of clevudine was similar to that of entecavir even though taking into account relatively short follow up period and retrospective study. (Korean J Gastroenterol 2010;56:365-372)
증례 : 혈액종양 ; 불응성 급성전구B림프모세포백혈병 환자에서 발생한 장기종 1예
배숙향 ( Suk Hyang Bae ),황진연 ( Jin Yeon Hwang ),김동균 ( Dong Kyun Kim ),김민식 ( Min Sik Kim ),권희진 ( Hee Jin Kwon ),한진영 ( Jin Yeong Han ),김성현 ( Sung Hyun Kim ) 대한내과학회 2011 대한내과학회지 Vol.80 No.4
장기종은 소화기 장벽내 공기가 축적되는 방사선학적 소견이다. 장기종의 원인은 매우 다양하여 그 원인이 아직 명확하지 않다. 백혈병 환자에서 장기종은 약물치료 및 수술적 치료가 필요한 드문 합병증이다. 대부분의 장기종은 경과 및 예후가 좋은 편이지만 응급수술이 필요한 경우도 있으므로 치료 결정이 어려울 때가 많다. 저자들은 불응성 급성전구B 림프모세포백혈병 환자에서 백혈병의 진행과정으로서 장기종이 발생하여 결국 패혈증으로 사망한 증례를 경험하여 보고하는 바이다. Pneumatosis intestinalis (PI) is an imaging phenomenon that represents air in the bowel wall. The cause of PI is variable, although specific etiologic factors remain unknown. It is an infrequent complication in leukemia patients and is associated with several medical and surgical conditions. PI often represents a benign condition, but it can also require surgery. Therefore, the assessment of PI with or without complications can be difficult. Herein, we report on an unusual case of a 63 year-old woman with refractory acute precursor B-cell lymphoblastic leukemia-lymphoma who presented with PI resulting from the leukemic process, and finally expired due to sepsis. (Korean J Med 2011;80:482-485)
황진연,배숙향,이정민,김동균,안지혜,김민식,김영대,백희경,조용락,박태호 대한심장학회 2010 Korean Circulation Journal Vol.40 No.11
Cardiovascular manifestations in hyperthyroidism occur frequently with various phenotypes. An association between hyperthyroidism and pulmonary arterial hypertension has been reported. In previously reported cases, the hemodynamic and symptomatic recovery of pulmonary arterial hypertension is usually concomitant with achievement of euthyroidism. We report a patient who had pulmonary arterial hypertension associated with Graves’ disease, which persisted after euthyroidism was obtained.