이리 및 인접 지역에서 발생한 쭈쭈가무시병 40 예에 대한 임상적 고찰

유웅선(Woong Sun Yu),노인환(In Whan Ro),허종(Jeong Huh),김경중(Kyeong Joong Kim),안태규(Tae Gyoo Ahn),이용구(Yong Goo Lee) 대한내과학회 1989 대한내과학회지 Vol.37 No.4

N/A We reviewed 20cases of tsutsugamushi disease who were admitted to WonKwang University Hospital from October to November 1988 and the following clinical results were obtained: 1) Seasonally, the 40cases mainly occurred from Odctober to November. 2) Most of the cases resided in rural areas or were associated with farm work and the age distribution was mainly in the forties. fifties, and sixties. The number of female cases was twice that of male cases. 3) On physical examination, rash, lymphadenopathy and eschar were observed in 38 cases (95%), 28cases (70%) and 17cases (42.5%) respectively. 4) On laboratory findings, leukocytosis (15%) and leukopenia (10%) were observed but anemia was not observed. The degree of elevation of AST and ALT was 2 or 3 times the normal values and elevation of LDH was observed in all cases. 5) On EKG, sinus tachycardia was observed in 6cases (15%). On simple chest X-ray, abnormal X-ray findings (20%) were observed. 6) One case was positive to Weil-Felix reaction. Indirect immunofluorescent antibody test was performed in 26cases of which 3cases (84.6%) were positive. Thirteen cases were positive to indirect immunofluorescent antibody test among 14cases with eschar. 7) Thirty-nine cases were treated with T-C and doxycycline and one case was treated with chloramphenicol. Thirty-eight cases recovered, one case died 3 days after early discharge and the clinical course of one case was not known after early discharge.

원발성 종격동 정상피종

유웅선 ( Woong Sun Yu ),김안명 ( An Myung Kim ),정은택 ( Eun Taik Jeong ),최순호 ( Soon Ho Choi ),최찬 ( Chan Choi ) 대한결핵 및 호흡기학회 1990 Tuberculosis and Respiratory Diseases Vol.37 No.3

삼출성 황반변성에서 이중 망막색소상피파열 및 출혈성 망막박리 후 발생한 급성폐쇄각발작

최유진(Yu-Jin Choi),최영제(Young Je Choi),조용운(Yong Wun Cho),김병선(Byoung Seon Kim),유웅선(Woong-Sun Yoo),정인영(In Young Chung) 대한안과학회 2021 대한안과학회지 Vol.62 No.4

목적: 거대망막색소상피박리가 동반된 삼출성 황반변성에서 유리체강내 주사 후 이중 망막색소상피파열이 발생하였고 출혈성 망막박리와 급성폐쇄각발작을 치료하였기에 이를 보고하고자 한다. 증례요약: 66세 여자가 1달 전부터 시작된 좌안의 시력저하를 주소로 내원하였다. 빛간섭단층촬영과 인도시아닌그린혈관조영술에서 거대망막색소상피박리를 동반한 삼출성 황반변성으로 진단하고 유리체강내 애플리버셉트주입술을 1차 시행하였다. 주사 2주 후 망막색소상피파열이 발생, 이후 2차 주사 4주 후 망막색소상피파열의 범위가 황반부를 포함하여 확대되었다. 3차 주입술 3개월 후 대량의 황반하출혈이 발생하여 4차 주사 시행, 3일 후 안압 60 mmHg 상승과 전방각 폐쇄, 수정체 후면에 접촉되는 출혈성 장액망막박리가 발생하였다. 공막절개술을 이용한 망막하출혈과 망막하액의 배액을 시행하였고, 이후 안압하강과 망막박리의 감소 소견이 보여 경과 관찰 중이다. 결론: 삼출성 황반변성에서 유리체강내 주사 후 이중 망막색소상피파열로 진행되는 경우는 매우 드물다. 이중 망막색소상피파열에서 출혈성 망막박리로 발생한 급성폐쇄각발작으로 안압상승을 경험하고 이를 치료하였기에 보고하고자 한다. Purpose: To report a case of acute angle-closure attack resulting from hemorrhagic retinal detachment after a double retinal pigment epithelium (RPE) tear in exudative age-related macular degeneration (AMD) with large pigment epithelial detachment (PED). Case summary: A 66-year-old female visited with a complaint of poor vision in left eye, which began 1 month prior. She was diagnosed with exudative AMD with a large PED using optical coherence tomography and indocyanine green angiography. Intravitreal aflibercept injection was performed. The RPE tear occurred at 2 weeks after the intravitreal anti-vascular endothelial growth factor injection for AMD, after which the range of the RPE tear expanded and included the macular area at 4 weeks after the second injection. At 3 months after the third injection, massive submacular hemorrhage occurred; aflibercept injection was repeated. At 3 days after the fourth injection, the patient’s intraocular pressure (IOP) was 60 mmHg, and massive hemorrhagic serous retinal detachment and anterior movement of the lens with total angle closure were observed. Therefore, we performed a sclerotomy; a large amount of dark blood and subretinal fluid was drained. The IOP decreased, and the retinal detachment improved somewhat. The patient was kept under observation for careful monitoring of her condition. Conclusions: It is very rare to experience a double RPE rupture after intravitreal anti-vascular endothelial growth factor injection in AMD. We report on our experience and treatment of acute angle-closure attack. The IOP increased due to hemorrhagic retinal detachment after a double RPE tear over the treatment course.

망막분지정맥폐쇄에 동반된 황반부종에서 베바시주맙치료 결과

최유진(Yu-Jin Choi),최영제(Young Je Choi),조용운(Yong Wun Cho),유웅선(Woong-Sun Yoo),정인영(In Young Chung) 대한안과학회 2021 대한안과학회지 Vol.62 No.9

목적: 망막분지정맥폐쇄에 동반된 황반부종에서 유리체내 베바시주맙주입술 방법에 따른 치료 결과를 알아보고자 한다. 대상과 방법: 망막분지정맥폐쇄에서 첫 치료로 유리체내 베바시주맙을 주입한 62명 62안에 관하여 후향적으로 분석하였다. 초기 한 달 간격으로 3회 로딩 치료에 성공한 21안과 그렇지 않은 그룹 41안을 대상으로 주사 전과 주사 후 시기별 최대교정시력 및 빛간섭단층촬영의 소견 변화와 예후 관련인자를 분석하였다. 결과: 최대교정시력은 초기 3회 주입군에서 3회 로딩으로 치료하지 않은 군보다 3개월, 6개월, 12개월째 더 큰 호전을 보였다(p=0.025, p=0.019, p=0.008). 중심황반두께는 6개월째 초기 3회 주입군에서 3회 로딩으로 치료하지 않은 군보다 더 큰 호전을 보였다(p=0.034). 다변량 회귀분석 결과 증상 발현 기간, 3회 로딩, 최대교정시력, 망막내층손상, 맥락막두께가 시력호전 정도와 관련된 예측인자였으며(p=0.044, p=0.047, p=0.004, p=0.045, p=0.034), 연령, 3회 로딩, 최대교정시력, 망막내층손상이 최종 시력과 관련된 예측인자로 나타났다(p=0.045, p=0.046, p=0.002, p=0.034). 증상 발현 기간, 중심황반두께, 맥락막두께가 중심황반두께 호전에 관련된 예측인자로 나타났다(p=0.042, p=0.009, p=0.015). 결론: 망막분지정맥폐쇄의 황반부종에서 유리체내 베바시주맙 초기 3회 주입은 3회 로딩으로 치료하지 않은 방법에 비하여 단기적인 기능적 및 해부학적 호전과 장기적인 기능적 호전에 치료 우위적 효과를 보였다. Purpose: To evaluate the results of treatment according to the method of intravitreal injection of bevacizumab for macular edema due to branch retinal vein occlusion (BRVO). Methods: The clinical records of macular edema patients were analyzed retrospectively for a total of 62 eyes of 62 patients who were injected with bevacizumab into the vitreous as the first treatment for BRVO. Best-corrected visual acuity (BCVA), the findings of spectral-domain optical coherence tomography before and after injection, and prognosis-related factors were evaluated for 21 eyes that received the initial three monthly loading treatments and the 41 eyes that did not. Results: Significant improvement in BCVA was observed in the group having received the initial three injections compared with the group who did not receive the injections at 3, 6, and 12 months (p = 0.025, p = 0.019, and p = 0.008, respectively). The central macular thickness (CMT) showed greater improvement in the initial three injections group than the group without at 6 months (p = 0.034). Multivariate regression showed that the duration from the onset, the three loadings, BCVA, disorganization of the retinal inner layer (DRIL), and choroidal thickness were predictors related to visual gain (p = 0.044, p = 0.047, p = 0.004, p = 0.045, and p = 0.034, respectively). Age, three loadings, BCVA, and DRIL were predictors related to final visual acuity (p = 0.045, p = 0.046, p = 0.002, and p = 0.034, respectively). Duration from the onset, CMT, and choroidal thickness were predictors related to CMT improvement (p = 0.042, p = 0.009, and p = 0.015, respectively). Conclusions: In macular edema of BRVO, the initial three monthly intravitreal injections of bevacizumab provided superior treatment outcomes regarding short-term functional and anatomical improvements and long-term functional improvement, compared with methods that did not treat with the initial three monthly injections.

처음 진단된 습성 나이관련황반변성에서 라니비주맙 치료 및 연장 방법의 1년 결과 : 후향적 연구

최영제(Young-Je Choi),유웅선(Woong-Sun Yoo),조용운(Yong-Wun Cho),최유진(Yu-Jin Choi),정인영(In Young Chung) 대한안과학회 2021 대한안과학회지 Vol.62 No.7

목적: 습성 나이관련황반변성에서 라니비주맙 치료 및 연장 방법의 1년 결과와 같은 기간 내 약제를 변경하여 치료한 경우 임상결과를 알아보고자 하였다. 대상과 방법: 습성 나이관련황반변성으로 처음 진단되고 라니비주맙 치료 및 연장 방법으로 1년 이상 치료한 32안과 같은 기간 내에 약제를 변경하여 치료한 24안을 대상으로 주사 횟수, 중심망막두께 변화, 최대교정시력 변화를 후향적으로 분석하였다. 결과: 라니비주맙 치료 및 연장 방법으로 치료한 32안은 초기 최대교정시력은 평균 59.46 ± 15.13글자에서 12개월에 68.00 ± 12.48글자로 향상되었다. 초기 중심망막두께는 평균 409 ± 141 μm였고, 12개월에 273 ± 89 μm로 감소하였다. 1년간 평균 주사 회수는 7.2 ± 0.85회였다. 12개월간 주사와 관련된 합병증은 망막색소상피 찢겨짐이 1건 관찰되었으며, 전신적인 합병증은 관찰되지 않았다. 약제를 변경한 24안 중 애플리버셉트 3회 주사를 시행한 12안에서 초기 시력이 호전되거나 보존할 수 있었던 비율은 83% (10안)였으며, 중심망막두께는 초기 371.58 ± 109.96에서 290.33 ± 58.66으로 호전을 보였다. 결론: 1년간의 관찰에서 습성 나이관련황반변성에서 라니비주맙 치료 및 연장 방법은 효과적이고, 애플리버셉트로 변경한 경우 단기간의 결과 시력을 유지하는 경우가 많고, 해부학적 호전을 보일 수 있음을 알 수 있었다. Purpose: This study investigated the 1-year outcomes of a treat-and-extend regimen of ranibizumab for exudative age-related macular degeneration and examined the clinical results when drug treatment was changed within the same period. Methods: This retrospective analysis included 32 eyes first diagnosed with wet age-related macular degeneration and treated for more than 1 year with a treat-and-extend regimen of ranibizumab, as well as 24 eyes treated by changing from ranibizumab to aflibercept within the same period. The injection number, maximum injection interval, change in central retinal thickness, and best-corrected visual acuity were assessed in all eyes. Results: In 32 eyes that received a treat-and-extend regimen of ranibizumab, the mean best-corrected visual acuity improved from 59.46 ± 15.13 to 68.00 ± 12.48 at 12 months (p < 0.0001). The mean central retinal thickness decreased from 409 ± 141 μm to 273 ± 89 μm at 12 months (p < 0.0001). The average number of injections per year was 7.2 ± 0.85. One complication related to the 12 months of injections was a tear in the retinal pigment epithelium; no systemic complications were observed. Of 24 eyes that underwent a change in medication, the rate of maintenance or improvement in initial visual acuity was 83% (10 eyes). The central retinal thickness was initially 371.58 ± 109.96 μm, but improved to 290.33 ± 58.66 μm in 12 eyes that received three injections of aflibercept. Conclusions: At 1 year, good outcomes were obtained using treat-and-extend ranibizumab for exudative age-related macular degeneration. When the treatment was changed to aflibercept within the same period, vision was often maintained and short-term anatomical improvement was evident.

증례 : 류마티스 ; 루푸스와 연관된 혈구포식 림프조직구증에서 Etoposide 병합치료 1예

한승완 ( Sung Wan Han ),강규근 ( Kyu Keun Kang ),박소현 ( So Hyun Park ),송지영 ( Ji Young Song ),유웅선 ( Woong Sun Yu ),최정란 ( Jung Ran Choi ),김춘관 ( Choon Kwan Kim ) 대한내과학회 2013 대한내과학회지 Vol.84 No.4

50세 여자 환자를 SLE 연관 HLH로 진단하고, 면역억제치료에도 호전되지 않아 etoposide를 주사 후 호전된 증례 1예를 보고하는 바이다. Hemophagocytic lymphohistiocytosis (HLH) can develop following strong activation of the immune system and the cardinal symptoms are a prolonged fever, hematological abnormalities, hepatosplenomegaly, and hemophagocytosis. HLH can be classified as primary or secondary HLH, associated with infections, malignancy and autoimmune disease. There is no consensus on the primary treatment regimen in systemic lupus erythematosus (SLE)-associated HLH. We experienced a case of SLE-associated HLH in a previously healthy adult. She was initially treated with intravenous immunoglobulin, cyclosporine, and high-dose steroid, but had a poor clinical response. After intravenous etoposide, the patient stabilized and has been followed for 1 year without reactivation of the HLH or SLE. (Korean J Med 2013;84:613-618).

서부 경남 지역 감염안내염의 원인균과 임상양상

김병선(Byoung Seon Kim),홍채민(Chae Min Hong),최영제(Young Je Choi),최유진(Yu-Jin Choi),조용운(Yong Wun Cho),유웅선(Woong-Sun Yoo),김성재(Seong-Jae Kim),정인영(In Young Chung) 대한안과학회 2020 대한안과학회지 Vol.61 No.12

목적: 서부 경남 지역 3차 의료기관에서 진단한 감염안내염 환자들의 원인균, 임상양상 및 시력예후를 알아보고자 하였다. 대상과 방법: 2010년 1월부터 2019년 6월까지 경상대학교병원에서 감염안내염으로 진단된 93명(98안)을 대상으로 후향적으로 의무기록을 분석하였으며 모든 환자에서 전방과 유리체 검체의 배양검사를 시행하였고 배양된 균의 종류, 치료 방법, 시력예후 등을 분석하였다. 결과: 대상 환자 98안에서 균이 배양된 경우는 67안(68.4%)이었으며 가장 흔한 감염안내염의 원인은 백내장수술 후 발생한 안내염이었고. 가장 흔한 원인균은 그람양성균인 Staphylococcus epidermidis (16.3%)이었다. 최종 최대교정시력을 1.0 logMAR을 기준으로분석한 결과 초진 최대교정시력이 안전수지 이상인 경우, 유리체절제술을 시행한 경우가 통계적으로 의미있는 예후를 보였다(p<0.001, p=0.021). 결론: 감염안내염 중 외인안내염은 백내장수술 후 많은 발생 빈도를 보이며 그람양성균인 Staphylococcus epidermidis가 가장 흔하며 좋은 시력예후를 보여주었다. 내인안내염은 간농양이 가장 흔한 감염병소이고 그람음성균인 Klebsiella pneumoniae가 흔하고 나쁜 시력예후를 보여주었다. Purpose: To investigate the bacterial culture, clinical characteristics, and prognosis associated with infectious endophthalmitis in western Gyeongsangnam-do. Methods: This study was a retrospective review of the medical records of 98 eyes that presented with infectious endophthalmitis from 2010 to 2019. All patients were analyzed for the type of causative bacteria, treatment method, and the visual prognosis. Results: The bacterial cultures (n = 98 eyes) revealed bacterial growth in 67 eyes (68.4%). The most commonly isolated causative microorganism was Gram-positive Staphylococcus epidermidis (14.3%). As a result of analyzing the best corrected visual acuity (VA) based on 1.0 (logMAR), baseline VA was worse than counting fingers, and whether pars plana vitrectomy was undertaken showed a difference in the final visual acuity (p < 0.001, p = 0.021). Conclusions: Exogenous endophthalmitis occurs frequently after cataract surgery, and S. epidermidis is the most common causative agent, but a good visual prognosis resulted. Liver abscess was a common extraocular source of endogenous endophthalmitis and Klebsiella pneumonia was the most common causative agent for a poor visual prognosis.