전신성 홍반성 루푸스 환자에서 발병된 크립토코쿠스 뇌막염

이창원 ( Chang Won Lee ),송상헌 ( Sang Heun Song ),배우형 ( Woo Hyung Bae ),안준협 ( Jun Hyup An ),김성일 ( Sung Il Kim ),김명규 ( Myeong Kyu Kim ),이신석 ( Shin Seok Lee ),정대수 ( Dae Soo Jung ),곽임수 ( Ihm Soo Kwak ),나하연 ( 대한류마티스학회 1999 대한류마티스학회지 Vol.6 No.4

Cryptococcal meningitis is rare but, often fatal complication of systemic lupus erythematosus(SLE). It is difficult to differentiate cryptococcal meningitis from neuropsychiatric lupus due to similarity of clinical symptoms and laboratory findings of cerebrospinal fluid(CSF). Earlier diagnosis and effective antifungal therapy improve the prognosis of cryptococcal meningitis in SLE patients. We report a case of cryptococcal meningitis in a patient with SLE who had been medicated with low dose steroid.

류마티스 관절염 환자에서 이차적으로 발생한 유전분증 1예

이창훈 ( Chang Hoon Lee ),김성일 ( Sung Il Kim ),박순규 ( Soon Kew Park ),곽임수 ( Ihm Soo Kwak ),나하연 ( Ha Yeon Rha ),송상헌 ( Sang Heun Song ) 대한내과학회 1999 대한내과학회지 Vol.57 No.6

we report a case of a 47 years old woman who secondary reanal amyloidosis due to rhrunatoid arthritis. She admitted our hospital due to generalized eddma. weakness and polyarthralgia, and had been diagnosed as having rheumatoid atritis and treated irregularly with anti-rheumatic drug for 3years. She had nephrotic range proteinuria (24 hour urine protein was 3.8 was deposited in renal glomerular, tubule and vessel walls. We diagnosed secondary renal amyloidosis.(Korena J Med 57:1061-1065,1999)

피부 지방층염을 동반한 재발성 다발성 연골염 1례

정현철 ( Hyun Chul Jung ),안준협 ( Jun Hyeop An ),송상헌 ( Sang Heun Song ),김성일 ( Sung Il Kim ),곽임수 ( Ihm Soo Kwak ),나하연 ( Ha Yeon Rha ),설미영 ( Mee Young Sol ) 대한류마티스학회 1999 대한류마티스학회지 Vol.6 No.3

Relapsing polychondritis is a rare disease characterized by widespread destructive inflammatory lesions, involving cartilaginous tissue throughout the body. Commonly involved organs include the external ear, nose, joints, eyes, tracheo-bronchial tree, cardiovascular system and cutaneous tissues. Erythema nodosum or mesenteric panniculitis have sometimes been described in association with relapsing polychondritis, but cutaneous panniculitis is rarely reported in relapsing polychondritis. We report here a relapsing polychondritis patient who developed cutaneous panniculitis, which was resolved by corticosteroid therapy.

사구체 신염 환자에서 Gallium-67 신티그램의 임상적 유용성

이수봉(Soo Bong Lee),이우철(Woo Chul Lee),정현철(Hyun Chul Jung),송상헌(Sang Heun Song),곽임수(Ihm Soo Kwak),나하연(Ha Yeon Rha) 대한내과학회 1999 대한내과학회지 Vol.56 No.4

N/A Objectives : Gallium 67(Ga-67) scintigraphy has been used to diagnose inflammatory and neoplastic diseases. We undertook a study to determine the clinical value of Ga- 67 renal scan in patients with various glomerular diseases. Methods : Ga-67 scintigraphy was performed in 48 patients with various biopsy proven forms of renal diseases. Renal uptake in 48 patients images was graded as follow: Grade 0 = not visualization at 48 hours : 1 = faintly visualize : 2 = equal to uptake in spine : 3 = greater than over the spine : 4 = greater than activity over the liver. Results : 1) Of the 48 patients, 31 were male, and mean age was 32 years. 11 patients had hypertension and 29 patients had hematuria. 2) Positive scintigram were seen in 40 of 48(83%) cases. In results of renal biopsy, IgA nephropathy(IgAN) was 15 patients, minimal change disease(MCD) was 14, focal segmental glomerulosclerosis (FSGS) was 8, membranoproliferative glomerulonephritis (MPGN) was 3, lupus nephritis(LN) was 3, poststreptococcal glomerulo- nephritis(PSGN) was 3 and membranous glomerulonephritis(MGN) was 2. 3) In 26 patients (54%) with nephrotic-range proteinuria, Grade 2 or higher renal uptake was observed in 9 (75%) of MCD, 5(100%) of FSGS, 2(100%) of LN and 3(75%) of IgAN. 4) In comparision nephrotics with non-nephrotics at biopsy, renal Ga-67 uptake in who patients had nephrotic- range proteinuria was correlated with clinical severity determined by serum albumin, serum total cholesterol and 24 hours urine protein excretion. Conclusions : Renal Ga-67 scintigraphy may be able to be a predictor in the assessment for severity of nephrotic syndrome.

균혈증 및 패혈증의 임상 양상 및 예후 인자에 대한 고찰

이수봉(Soo Bong Lee),이우철(Woo Chul Lee),정현철(Hyun Chul Jung),송상헌(Sang Heun Song),이동원(Dong Won Lee),김용범(Yong Bum Kim),정주섭(Joo Seop Chung),곽임수(Ihm Soo Kwak),조군제(Goon Jae Cho),나하연(Ha Youn Rha),장철훈(Chul Hun Ch 대한내과학회 1999 대한내과학회지 Vol.56 No.3

N/A Objectives : In spite of the improvement in therapeutic strategy, the mortality rate from sepsis is still high. The purpose of this study was to examine the clinical characteristics and prognostic factors of sepsis to get help in treatment and estimation of prognosis of sepsis. Methods : We analyzed the clinical and bacteriologic data of 313 admitted patients with bacteremia at Pusan National University Hospital from Jan., 1996 to Dec., 1997 retrospectively and all patients were categorized into 4 groups (bacteremia, sepsis, severe sepsis, septic shock) by the definition from American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference, 1992. Results : 1) Male to female ratio was 1.22 : 1 and mean age was 52 years. 2) The overall mortality rate was 32.3% and the mortality rates of bacteremia, sepsis, severe sepsis and septic shock were 14.9%, 22.8%, 52.0%, and 95.2%, respectively. 3) Underlying diseases predisposing to bacteremia were diabetes mellitus(14.4%), solid cancer (13.1%), hematologic malignancy(10.2%) and liver cirrhosis(9.9%), but the most common was no underlying disease. 4) Among the total 80 species of isolated microorganisms, gram-positive organisms were responsible in 169 cases, gram-negative organisms in 218 cases. E. coli was isolated most frequently, followed by S. aureus, S. epidermidis, K. pneumoniae, Enterococcus spp., Enterobacter spp., Str. viridans group, CNS, P. aeruginosa and S. typhi. 5) Although the source of bacteremia could not be identified in 28.8% of the patients, the others had the primary site of infections ; skin(17.9%), gastrointestinal tract(16.9%), respiratory tract(12.5%), urinary tract(9.9%) and biliary tract(7.3%). 6) The mortality rate in patients with gram-positive bacteremia was 39.4%, with gram-negative bacteremia was 20.9% and with polymicrobial bacteremia was 33.3%. MRSA sepsis showed the highest mortality rate(58.8%), followed by Enterococcus spp.(50.0%), K. pneumoniae (35.0%), P. aeruginosa(27.3%) and E. coli(18.8%). 7) There was significant relation between etiologic organisms of bacteremia and the primary site of infections. 8) Using logistic regression analysis, mortality was predicted by disseminated intravascular coagulation, severity of sepsis and severity of underlying diseases. Conclusion : Sepsis occurred in 16 patients among 1,000 adult admitted patients and overall mortality rate was 32.3%, still high. The mortality rate had positive correlation with the severity of sepsis. Among 16 evaluated risk factors of mortality, mortality was predicted by disseminated intravascular coagulation, severity of sepsis and severity of underlying disease.

독우산광대버섯 중독에 의한 급성 신부전 2예

정현철(Hyun Chul Jung),김보석(Bo Suk Kim),송상헌(Sang Heun Song),김용범(Yong Bum Kim),신호진(Ho Jin Sin),이동원(Dong Won Lee),이우철(Woo Chul Lee),이수봉(Soo Bong Lee),곽임수(Ihm Soo Kwak),나하연(Ha Yeon Rha) 대한내과학회 1999 대한내과학회지 Vol.57 No.6

N/A Although the most of mushroom poisoning have a clinical menifestation of mild to moderate gastroenteritis, some mushroom may cause a serious illness; acute renal failure, hepatic necrosis. We experienced two cases of acute renal failure complicated by the poisoning of amanita virosa. Amanita virosa have a amatoxin. Amatoxin deteriorate hepatocytes, renal tubular cells, intestinal mucosal cells, and pancreas. They were transferred from local hospital for renal failure management. On admission, blood urea nitrogen and serum creatinine were highly elevated. We diagnosed acute renal failure complicated by poisoning of amanita virosa. In one case, renal function was further deteriorated compared with initial laboratory findings after creatinine was normalized at fifth day. Thus, we did a kidney biopsy. Light microscopy and EM showed interstitial inflammation and moderate tubular atrophy. They were recovered with the supportive management. We report two cases of mushroom poisoning-induced acute renal failure with review of literature. (Korean J Med 57:1053-1056, 1999)

패혈증에 의한 급성 신부전의 예견인자로서의 APACHE III prognostic system과 Liano system의 유용성

신호진(Ho Jin Shin),이수봉(Soo Bong Lee),곽임수(Ihm Soo Kwak),나하연(Ha Yeon Rha),송상헌(Sang Heun Song),정현철(Hyun Chul Jung),배우형(Woo Hyung Bae),안승재(Seung Jae Ahn) 대한신장학회 2000 Kidney Research and Clinical Practice Vol.19 No.2

N/A Uncontrolled infection quite often 1eads to systemic inflammatory response syndrome and multi-organ dysfunction syndrome. Despite advances in medical knowledge and technology, the mortality of patient with sepsis is still 35-60%, and even reach up to 50-90% in septic patients having acute renal failure. The purpose of this study was to examine the characteristics and predictive factors of progression to acute renal failure(ARF) in sepsis. We analyzed the bacteriologic and laboratory data of 54 admitted patients with SIRS(systemic inflam-matory response syndrome) at Pusan National University Hospital from July 1997 to July 1999(ARF 23 vs non-ARF 31). Multiple factor which may influence mortality and progression to AEK in sepsis, were evaluated and measured on admission day. The following of results, 1) Of the 54 patients, 23 were ARF group and 31 were non-ARF group. Mean age were,52 years and 51 years. The mortality of ARF group and non-ARF group were 78% and 23%, Urine output, albumin, cholesterol, mean arterial blood pressure and evidence of underlying disease were not statistically different in each group. 2) Although the sources of sepsis could not identified in 9%(ARF), 23%(non-ARF), the others had the primary site of infections ' gastrointestinal tract(35% vs 29%), lung(30% vs 19%), genitourinary tract(9% vs 13%), skin(17% vs 16%). 3) Although statistically not different, gram-posi-tive bacterial infection was more common in ARF group(mainly staphylococcus aureus). Culture negative results were 4 patients(ARF), 1 patient(non- ARF). 4) APACHE III score in ARF group was higher than non-ARF group(48.1±16.5 vs 30.2±15.6). Liafio score in ARF group was higher than non-ARF group(39.1±13.0 vs 28.9±8.3). 5) APACHE III score and Liailo score in non- survivors were higher than survivors(APACHE III score:48.6±15.3 vs 28.1±14.0, Liaho score:37.9±12.0 vs 29.4±9.2) 6) APACHE lII system was positively correlated with Liaho system(r=0.512, p=0.001). In conclusion, APACHE III system and Liaho system were significant predictors of progression to ARF and mortality in sepsis. In the future, prospec-tive and multicenter studies are required to improve the method of treatment and the prognosis in sepsis.

만성 신부전 환자의 영양평가 지표로서의 DEXA의 유용성

박성민,곽임수,나하연,송상헌,성은영,이수봉,이우철,정현철 대한신장학회 1999 Kidney Research and Clinical Practice Vol.18 No.2

It has been considered that the nutrition affects the mortality of chronic renal failure patients. Thus, several studies reported the method of examination about nutritional status in chronic renal failure patients. The purpose of the present study was to evaluate the nutritional status of 32 chronic renal failure patients, and recommend DEXA as a objective method. Thirty two chronic renal failure patients and 24 disease-free persons on kidney(control group) were included in this syudy. There were no difference in mean age, sex, weight, height, body mass index between two groups. We measured % total body fat, fat-free mass, limb fat, trunl fat, limb fat/trunk fat ratio with Hologic QDR 4500. The results were as follows. 1)% Total body fat of chronic renal failure patients was 20.7±7.9%. That was lower than 26.3±7.9% of control group(P$lt;0.05). 2)Fat-free mass of chronic renal failure patients revealed lower result compared with control group. Each result was 40.2±12.2kg, 46.2±9.1kg(P$lt;0.05). 3)Despite ofsignificant difference between two groups in ratio of limb fat and trunk fat, limb fat and trunk fat were statistically different(Limb fat:CRF-5.6±2.4kg, Control-7.1±1.9kg, Trunk fat:CRF- 5.2±3.0kg, Control-7.7±2.7kg)(P$lt;0.05). 4)Triceps skinfold thockness was positively correlated with % total body fat, limb fat, trunk fat, and negatively correlated with fat-free mass. Mid- arm muscle area circumference had inverse relationship above(P$lt;0.05). 6)Severe malnurished patients(SGA-C group) had lower result compared to mild-moderate malnurished patients(SGA-B group) about %TBF, LF,TF, total lymphocyte count. In addition to DEXA, we examined triceps skinfold thickness and mid-arm muscle area circumference. The result showed significant comparison between two groups, too. But albumin, cholesterol, potassium level was no statistical significant difference, except lymphcyte count. In conclusion, as suggested by above results, chronic renal failure patients has protein-calorie malnutrition. This nutritional staaffects long-term survival of chronic renal failure patients. DEXA can give objective data accompanied with simple anthropometric measurement in nutriti onal status. Thus, we recommend DEXA as objective method of nutritional examination. In future, more precise method will be discovered, and that contribute more long-term survival of chronic renal failure patients.

급성 신우신염에 합병된 급성 신부전증 2예

정현철,이우철,이수봉,김도훈,곽임수,나하연,송상헌,배우형,박삼석 대한내과학회 2001 대한내과학회지 Vol.60 No.3

Acute renal failure secondary to acute pyelonephritis is developed rarely. But acute pyelonephritis is considered in differential diagnosis of acute renal failure, particularly in elderly patient. Elderly patient showed subtle symptoms or signs of infections and can be missed easily. We experienced two cases of acute renal failure secondary to acute pyelonephritis. In first case, one patient complained fever, chilling and right flank pain for 10 days. Three repeated blood and urine cultures showed E. coli, respectively. At admission serum creatinine showed 2.4 mg/dL and thereafter increased to 4.5 mg/dL, and then decreased to 1.7 mg/dL with antibiotic therapy and hydration at 14 days of admission. In second case, patient complained right flank pain, costovertebral tenderness and urinary difficulty at admission. Two repeated blood culture showed no growth, two repeated urine culture showed $gt; 105 ml/dL of E. coli. At admission serum creatinine level was 2.69 mg/dL and then decreased to 1.7 mg/dL with antibiotic therapy and hydration at 14 days of admission. Acute pyelonephritis should be considered in differential diagnosis of acute renal failure in the elder ages, although this developed rarely. Early recognition and appropriate antibiotic treatment helps recover acute renal failure secondary to acute pyelonephritis.(Korean J Med 60:254-259, 2001)

미세변화형 신증후군에서 병발된 급성심근경색 1 예

이동원,정현철,이우철,박성민,이수봉,송상헌,나하연,성은영,안준협,곽임수 대한내과학회 1998 대한내과학회지 Vol.55 No.5

The authors report the case of a 25 year old woman with a chronic corticosteroid-refractory nephrotic syndrome complicated by myocardial infarction. The thromboembolism, especially acute myocardial infarction, is the most serious complication of nephrotic syndrome. Until now many mechanisms have been studied about thromboembolism including coronary artery disease in nephrotic syndrome, but not clear. Hypercoagulability and prolonged hyperlipidemia are known as the principal contributing factors in this complication. In addition, use of steroid as therapeutic trial and hypovolemic state induced by vigorous diuretics will affect the thromboembolism, too. In this case, several coagulation abnormality and prolonged hyperlipidemia are observed. On admission day, this patient had deep vein thrombosis and then was complicated by pulmonary thromboembolism. Despite of anticoagulant and thrombolytic therapy, she experienced acute myocardial infarction on fourth day after admission. After onset of myocardial infarction, by thrombolytics and prolonged anticoagulant therapy, this nephrotic patient was relieved and discharged without other serious complication. We recommend anticoagulant and antiplatelet agent therpy in risky patient of nephrotic syndrome. We present this case with review of literature.