Acute Myocardial Infarction after Radiofrequency Catheter Ablation of Typical Atrial Flutter

윤세효,이우주,황지원,김은,하정민,김준수 대한의학회 2014 Journal of Korean medical science Vol.29 No.2

A 53-yr-old man underwent radiofrequency ablation to treat persistent atrial flutter. After the procedure, the chest pain was getting worse, and the electrocardiogram showed ST-segment elevation in inferior leads with reciprocal changes. Immediate coronary angiography showed total occlusion with thrombi at the distal portion of the right coronary artery, which was very close to the ablation site. Intervention with thrombus aspiration and balloon dilatation was successful, and the patient recovered without any kind of sequelae. Although the exact mechanism is obscure, the most likely explanation is a thermal injury to the vascular wall that ruptured into the lumen and formed thrombus. Vasospasm and thromboembolism can also be other possibilities. This case raise the alarm to cardiologists who perform radiofrequency ablation to treat various kinds of cardiac arrhythmias, in that myocardial infarction has been rarely considered one of the complications.

Fractional Exhaled Nitric Oxide: Comparison Between Portable Devices and Correlation With Sputum Eosinophils

윤세효,이진영,최동철,이병재 대한천식알레르기학회 2015 Allergy, Asthma & Immunology Research Vol.7 No.4

This study was performed to compare the 2 different portable devices measuring fractional exhaled nitric oxide (FeNO) and to see the correlation between FeNO and induced sputum eosinophil count (ISE). Forty consecutive subjects clinically suspected to have asthma underwent FeNO measurement by NIOX-MINO® and NObreath® concurrently. All also had induced sputum analysis, methacholine provocation test or bronchodilator response test, and spin prick test. Agreement between the 2 devices was evaluated. The correlation between FeNO and ISE was assessed, as well as the cut-off level of FeNO to identify ISE ≥ 3%. The intraclass correlation coefficient (ICC) between FeNO levels measured by NIOX-MINO® (Fe- NONIOX-MINO) and NObreath® (FeNONObreath) was 0.972 with 95% confidence interval of 0.948-0.985. The 95% limits of agreement were -28.9 to 19.9 ppb. The correlation coefficient between ISE and FeNONIOX-MINO was 0.733 (P<0.001), and 0.751 between ISE and FeNONObreath (P<0.001). The ROC curve found that the FeNONIOXMINO of 37.5 ppb and the FeNONObreath of 36.5 ppb identified ISE ≥ 3% with 90% sensitivity and 81% specificity. Age, sex, body mass index, smoking history, atopy, and the presence of asthma did not affect the FeNO level and its correlation with ISE. The NIOX-MINO ® and NObreath® agree with each other to a high degree. Both devices showed close correlation with ISE with similar cut-off value in identifying ISE ≥ 3%.

Clinical Characteristics and Treatment Response of Peripheral Neuropathy in the Presence of Eosinophilic Granulomatosis with Polyangiitis (Churg-Strauss Syndrome): Experience at a Single Tertiary Center

조혜진,윤세효,석진명,조은빈,민주홍,서연림,이병재,김병준,최동철 대한신경과학회 2017 Journal of Clinical Neurology Vol.13 No.1

Background and Purpose Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare systemic small-vessel vasculitis accompanied by asthma, eosinophilia, and eosinophilic inflammation of various tissues including the peripheral nerves. This study investigated the clinical course and long-term outcomes of peripheral neuropathy in patients with EGPA. Methods Seventy-one patients with physician-diagnosed EGPA were identified at Samsung Medical Center between January 1995 and April 2014. Sixty-one of these patients were followed-up for more than 1 year and received corticosteroid therapy with or without intravenous cyclophosphamide pulse therapy for 6 to 18 months. Medical records of the 61 patients including demographic data, clinical features, laboratory and pathological findings, treatments, and outcomes were reviewed. Results Peripheral neuropathy as a manifestation of EGPA was present in 46 (75%) of the 61 patients. The mean follow-up duration of the patients with neuropathy was 6.4 years (range 1.2–18.8 years). The scores on the neurological functional disability scale before and after the combination treatment with corticosteroid and cyclophosphamide were 2.43±0.86 and 0.54±0.95 (mean±SD; p<0.001), respectively. The peripheral neuropathy relapsed in one patient. Conclusions The long-term clinical outcome of peripheral neuropathy in patients with EGPA receiving initial corticosteroid and cyclophosphamide combination therapy was favorable with a very low relapse rate.

위장관 ; 장폐쇄를 동반한 크론병 환자에서 내과적 치료에 대한 반응 예측 인자

김은 ( Eun Kim ),윤세효 ( She Yo Yune ),하정민 ( Jung Min Ha ),이우주 ( Woo Joo Lee ),황지원 ( Ji Won Hwang ),민신영 ( Sin Young Min ),홍성노 ( Sung Noh Hong ),장동경 ( Dong Kyung Chang ),이풍렬 ( Poong Lyul Rhee ),김재준 ( Jae J 대한소화기학회 2013 대한소화기학회지 Vol.62 No.4

Background/Aims: Crohn`s disease is a chronic inflammatory bowel disease. Stricture is a very important indication for surgical intervention as strictures can lead to intestinal obstruction. Strictures can be divided into inflammatory and fibrous strictures. Intestinal obstruction due to inflammatory stricture is expected to be resolved with medical treatment. However, factors that can predict the response to medical treatments are unknown. In the present study, we aimed to identify the factors that can predict the response to medical treatments in Crohn`s disease patients with intestinal obstruction. Methods: Data were collected by retrospectively reviewing the medical records of patients with Crohn`s disease who visited the emergency department at Samsung Medical Center in Seoul from January 1, 2000 to December 31, 2010 because of intestinal obstruction. Based on the response to medical treatments, we classified the patients as responders and non-responders and compared the clinical, biochemical, and radiological findings of the two groups. Results: A total of 39 patients were enrolled. Twenty-nine patients responded to medical treatments whereas 10 patients did not. Significant differences were observed between the two groups in terms of vomiting and duration of disease before the development of obstruction. Conclusions: Patients who responded to the medical treatments exhibited a higher incidence of vomiting and longer duration of disease before the development of obstruction. However, further prospective studies are needed to identify the factors that can predict the response to medical treatments. (Korean J Gastroenterol 2013;62:213-218)

Unusual Manifestation of Intravascular Large B-Cell Lymphoma: Severe Hypercalcemia with Parathyroid Hormone-Related Protein

하정민,김은,이우주,황지원,윤세효,고영혜,최준영,김석진,김원석 대한암학회 2014 Cancer Research and Treatment Vol.46 No.3

Intravascular large B-cell lymphoma (IVLBCL) is a rare subtype of non-Hodgkinlymphoma. It usually presents with nonspecific symptoms, such as fever, rather thanwith overt lymphadenopathy. Reports of hypercalcemia, as the initial presentation ofIVLBCL, are limited in the literature, despite it being a well-known complication of varioussolid cancers. We present a 68-year-old male with severe hypercalcemia andincreased levels of serum parathyroid hormone-related protein. He was diagnosedwith IVLBCL, involving the bone marrow and spleen, and was successfully treated withrituximab-containing chemotherapy. A few previous case reports have shown hypercalcemiain patients with IVLBCL. Much like our case, previous cases with hypercalcemiahad advanced diseases, including bone marrow invasion. Although it was anextremely rare manifestation of IVLBCL, we suggest that IVLBCL should be a part ofthe differential diagnosis in patients with unexplained hypercalcemia. Therefore, anactive work-up might be recommended, including positron emission tomography/computed tomography scan and bone marrow examination, which may be useful forearly diagnosis.

Immunoglobulin G4 Non-Related Sclerosing Disease with Intracardiac Mass Mimicking Mitral Stenosis: Case Report

황지원,박성지,곽혜빈,하정민,이우주,김은,윤세효,김정선,박양진,김덕경 대한의학회 2013 Journal of Korean medical science Vol.28 No.12

The cardiovascular system may be one of the target organs of both immunoglobulin G4 related and non-related systemic multifocal fibrosclerosis. We present a case of IgG4 non-related systemic multifocal fibrosclerosis mimicking mitral stenosis on echocardiography. For a more detailed differential diagnosis, we used multimodal imaging techniques. After surgical biopsy around the abdominal aortic area in the retroperitoneum, histological examination revealed IgG4 non-related systemic multifocal fibrosclerosis. We describe the multimodal imaging used to diagnose IgG4 non-related systemic multifocal fibrosclerosis and a positive response to steroid treatment. There have been no previous case reports of IgG4 non-related systemic multifocal fibrosclerosis with intracardiac involvement. Here, we report a case of IgG4 non-related systemic multifocal fibrosclerosis mimicking mitral stenosis.

The Hidden Culprit: A Case of Repeated Anaphylaxis to Cremophor

김영남,김준영,김지원,김진해,김혜인,윤세효,최동철,이병재 대한천식알레르기학회 2016 Allergy, Asthma & Immunology Research Vol.8 No.2

Drug-induced anaphylaxis is a big pitfall in patients receiving antineoplastic chemotherapy. We report a case of lung cancer patient who experienced two near-fatal anaphylactic reactions that resulted from paclitaxel and multivitamin, seperately. Recurrent severe reactions to different agents led to further investigation to which material the patient was hypersensitive. The skin prick test revealed sensitization to cremophor, which is a commonly used emulsifying agent. This case emphasizes the importance of correctly identifying the culprit drug of anaphylaxis to avoid potentially fatal reaction.

The Prevalence of Toxocariasis and Diagnostic Value of Serologic Tests in Asymptomatic Korean Adults

이진영,양문희,황정해,강미라,팽재원,이병재,최동철,윤세효 대한천식알레르기학회 2015 Allergy, Asthma & Immunology Research Vol.7 No.5

Purpose: Toxocariasis is the most common cause of peripheral blood eosinophilia in Korea and produces eosinophilic infiltration in various organs, including the lung. However, the prevalence of toxocariasis in the general population is rarely reported. Methods: We investigated the seroprevalence of Toxocara larval antibody among asymptomatic people who attended Samsung Medical Center for a health checkup, including low-dose chest computed tomography (CT) between March 2012 and December 2013. A total of 633 people (400 men and 233 women) were prospectively recruited. Results: The Toxocara-seropositive rate was 51.2% using the current cutoff value based on Toxocara enzyme-linked immunosorbent assay (ELISA) (67.0% for men and 24.0% for women). In the multivariate-adjusted model, age (odds ratio [OR], 1.08; 95% confidence intervals [CI], 1.04- 1.11), male sex (OR, 3.47; 95% CI, 2.26-5.33), rural residence (OR, 1.55; 95% CI, 1.05-2.30), and history of raw liver intake (OR, 8.52; 95% CI, 3.61- 20.11) were significantly associated with Toxocara seropositivity. When subjects were divided into 3 groups using cutoff values base on weak positive and strong positive control optical densities (ODs), the ORs for peripheral blood eosinophilia and serum hyperIgEaemia were 0.31 (95% CI, 0.02- 2.89) in the weakpositive group and 36.64 (95% CI, 11.73-111.42) in the strong positive group compared to the seronegative group. Similarly, ORs for the solid nodule with surrounding halo were 2.54 (95% CI, 0.60-10.84) in the weak positive group and 15.08 (95 CI 4.09-55.56) in the strong positive group compared to the seronegative group. Conclusions: The study indicated that the Toxocara-seropositive rate obtained by using the current cutoff value based on ELISA was high in the asymptomatic population in Korea. The results of this study suggest that active toxocariasis may be more frequently seen in the Toxocara-strong positive group than in the Toxocara-weak positive group.

급성 담낭염으로 발현한 Churg-Strauss 증후군 1예

이우주 ( Woo Joo Lee ),황지원 ( Ji Won Hwang ),김은 ( Eun Kim ),윤세효 ( Se Hyo Yune ),하정민 ( Jung Min Ha ),윤나라 ( Na Ra Yoon ),이병재 ( Byung Jae Lee ),최동철 ( Dong Chull Choi ) 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 1991 소아알레르기 및 호흡기학회지 Vol.1 No.4

Churg-Strauss syndrome (CSS) is a rare systemic vasculitis. It is characterized by peripheral eosinophilia, asthma, neuropathy, skin manifestation, and less frequently gastrointestinal tract symptoms. Here we report a case of CSS which is initially manifested as acute acalculous cholecystitis. A 67-year-old asthmatic woman visited Emergency Room because of acute abdominal pain. Computed tomography showed acalculous cholecystitis and laparoscopic cholecystectomy was done. Pathology of gallbladder showed marked eosinophilic infiltration with necrotizing vasculitis and granuloma. On the basis of asthma, sinusitis, lung infiltration, combined peripheral eosinophilia and neuropathy, the patient was diagnosed as CSS. To our knowledge, this is the first case of pathologically proven eosinophilic cholecystitis in Korea. (Allergy Asthma Respir Dis 2013;1:388-390)

급성 담낭염으로 발현한 Churg-Strauss 증후군 1예

이우주 ( Woo Joo Lee ),황지원 ( Ji Won Hwang ),김은 ( Eun Kim ),윤세효 ( Se Hyo Yune ),하정민 ( Jung Min Ha ),윤나라 ( Na Ra Yoon ),이병재 ( Byung Jae Lee ),최동철 ( Dong Chull Choi ) 대한천식알레르기학회(구 대한알레르기학회) 2013 Allergy Asthma & Respiratory Disease Vol.1 No.4

Churg-Strauss syndrome (CSS) is a rare systemic vasculitis. It is characterized by peripheral eosinophilia, asthma, neuropathy, skin manifestation, and less frequently gastrointestinal tract symptoms. Here we report a case of CSS which is initially manifested as acute acalculous cholecystitis. A 67-year-old asthmatic woman visited Emergency Room because of acute abdominal pain. Computed tomography showed acalculous cholecystitis and laparoscopic cholecystectomy was done. Pathology of gallbladder showed marked eosinophilic infiltration with necrotizing vasculitis and granuloma. On the basis of asthma, sinusitis, lung infiltration, combined peripheral eosinophilia and neuropathy, the patient was diagnosed as CSS. To our knowledge, this is the first case of pathologically proven eosinophilic cholecystitis in Korea.