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Background: There have been some uncontrolled studies on clinical efficacy of high-dose intravenous immunoglobulin (IVIG) in patients with Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN). Objective: This study was conducted to demonstrate the effectiveness of high-dose IVIG therapy in reducing mortality in Korean patients with SJS or TEN. Method: Retrospective data from 2 patients with SJS, 4 patients with SJS/TEN and 3 patients with TEN treated with high-dose IVIG were analyzed. Result: The total dose of IVIG administered was 1.0 gm/kg/day from 2 days to 1.0 gm/kg for 7 days. Of the 8 patients who showed good responses to IVIG, the mean time to objective responses was 2.0±1.4 days (range, 1 to 5 days). The length of stay in hospital was 22.8±9.2 days (range, 11 to 40 days). Two patients had poor outcomes. Based on the SCORTEN system, 3.2 patients (39.9%) were expected to die, but 2.0 patients (25.0%) died. However, there was no statistical significance (P>0.05). Conclusion: Therapy with high-dose IVIG showed a slightly improved mortality in patients with SJS, SJS/TEN overlap and TEN, but there was no statistical significance (P>0.05). Although dramatic clinical improvement was noted in most patients, further nationwide multicenter clinical trials are required to evaluate the effectiveness of high-dose IVIG in the treatment of patients with SJS or TEN. (Korean J Asthma Allergy Clin Immunol 2009;29:256-261)
김수진 ( Soo Jin Kim ),남영희 ( Young-hee Nam ),정지영 ( Ji Young Juong ),김은영 ( Eun Young Kim ),이수미 ( Su Mi Lee ),손영기 ( Young Ki Son ),남희주 ( Hee-joo Nam ),김기호 ( Ki-ho Kim ),이수걸 ( Soo-keol Lee ) 영남대학교 의과대학 2016 Yeungnam University Journal of Medicine Vol.33 No.1
Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare and severe drug-induced hypersensitivity syndrome characterized by hematological abnormalities and multiorgan involvement. Liver involvement is the most common visceral manifestation. However, renal failure has been rarely described. The common culprit drugs are anticonvulsants and allopurinol. We experienced a patient with DRESS syndrome with acute interstitial nephritis caused by concomitant administration of quinolone and non-steroidal anti-inflammatory drugs (NSAIDs). A 41-year-old man presented with a diffuse erythematous rash and fever which developed after administration of quinolone and NSAIDs for a month due to prostatitis. He was diagnosed with DRESS syndrome. Skin rash, fever, eosinophilia, and elevations of liver enzymes improved with conservative treatment and discontinuation of the causative drugs. However, deterioration of his renal function occurred on day 8 of admission. The levels of blood urea nitrogen and serum creatinine increased and oliguria, proteinuria and urinary eosinophils were observed. Ultrasonography showed diffuse renal enlargement. The clinical features were compatible with acute interstitial nephritis. Despite intravenous rehydration and diuretics, renal function did not improve. After hemodialysis, his renal function recovered completely within 2 weeks without administration of systemic corticosteroid.
엄수정 ( Soo Jung Um ),양두경 ( Doo Kyung Yang ),이수걸 ( Soo Keol Lee ),손춘희 ( Choon Hee Son ),노미숙 ( Mee Sook Roh ),김기남 ( Ki Nam Kim ),이기남 ( Ki Nam Lee ),최필조 ( Pil Jo Choi ),방정희 ( Jung Heui Bang ) 대한결핵 및 호흡기학회 2009 Tuberculosis and Respiratory Diseases Vol.66 No.2
Asthma is a chronic inflammatory disorder of the airways in which many cells and cellular elements play a role. Chronic inflammation is associated with airway hyper-responsiveness, which leads to various airway symptoms. Approaches to asthma treatment have been changing because our knowledge about the pathogenesis and treatment of asthma is continually evolving. Until recently, the stepwise approach to the treatment of asthma was based on a patient`s asthma severity. However, new international guidelines have recommended that treatment should be adjusted in a continuous cycle driven by the patient`s asthma-control status. If asthma is not controlled on the current treatment regimen, treatment should be stepped up until control is achieved. When control is maintained for at least 3 months, treatment can be stepped down. Ongoing monitoring is essential to maintain control and to establish the lowest step and dose of treatment to minimize cost and maximize safety. However, the stepwise approach and recommended treatments are meant to assist, not replace, the clinical decision making necessary to determine the most appropriate treatment to meet the individual patient`s needs and circumstances. This article is a review of the stepwise approach to the treatment of asthma recommended by the Global Initiative for Asthma 2009 and Expert Panel Report 3 of National Heart, Lung, and Blood Institute 2007. (Korean J Med 2011;80:145-151)
Most patients with asthma have mild to moderate disease and are well controlled by regular use of inhaled corticosteroids with or without long-acting β2-agonists. However, about 5-10% patients with severe asthma remain poorly controlled despite optimal treatment, and these patients have greater morbidity and mortality than mild to moderate asthmatics. Patients with severe refractory asthma (SRA) often require regular systemic corticosteroid use, which increase risk of steroid-related adverse events and require more health care support. A systematic approach is necessary to establish a correct diagnosis, identify coexisting disorders, and evaluate aggravating factors. The management of SRA remains extremely challenging, and many clinical studies are currently in progress. Anti-IgE antibody (omalizumab) and bronchial thermoplasty may be alternative treatment for SRA approved by US Food and Drug Administration. SRA is a heterogeneous disease, which is classified in to distinct clinical phenotypes. A better understanding of these subtypes may lead to improved treatment of SRA. (Korean J Med 2012;83:438-443)
양두경 ( Doo Kyung Yang ),이수걸 ( Soo Keol Lee ),서성환 ( Sung Wan Suh ),손유정 ( You Jeong Sohn ),김경태 ( Kyoung Tae Kim ),유정남 ( Jung Nam Yoo ),김종국 ( Jong Kuk Kim ),노미숙 ( Mee Sook Roh ),최필조 ( Pil Jo Choi ),김기남 ( 대한결핵 및 호흡기학회 2004 Tuberculosis and Respiratory Diseases Vol.57 No.5
Airway remodeling implies structural changes in the airways of patients with asthma. These changes are associated with poor long-term clinical outcomes and are attributed to chronic airway inflammation. However, some recent studies suggest that traditional anti-inflammatory therapies play a limited role in the modulation of airway remodeling. These findings have questioned the concept that persistent inflammation leads to airway remodeling. Growing evidence demonstrates that physical forces elicit a number of biologically relevant signals in the human body. The airway is exposed to a variety of mechanical stimuli, the most prominent of which is acute compressive stress caused by bronchoconstriction. A variety of in vitro studies have demonstrated that airway epithelial cells, as well as lung fibroblasts and smooth muscle cells, are responsive to mechanical stimuli. A recent in vivo study has shown that airway remodeling can be promoted simply by episodic administration of an inhaled bronchoconstrictor, methacholine. This result suggests another possibility of the association between airway remodeling and mechanical stimuli. However, further studies are required using well-designed, 3-dimensional in vitro experimental models as well as more patients with varying severities of asthma. These studies will help understand the interplay between mechanical and inflammatory contributions to airway remodeling.(Korean J Asthma Allergy Clin Immunol 2012;32:1-7)
Anaphylaxis is a life-threatening systemic hypersensitivity reaction with a rapid onset. All healthcare professionals should be familiar with its recognition and management. The clinical diagnosis is important. It involves the sudden onset of characteristic symptoms and signs within minutes to hours after exposure to a known or potential trigger, often followed by rapid progression over hours. Symptoms usually involve two or more body systems, including the skin and mucous membranes, and respiratory, gastrointestinal, cardiovascular, and central nervous systems. Prompt initial basic treatment with intramuscular epinephrine in the mid-anterolateral thigh can be life-saving. Simultaneously, it is important to place the patient in a supine position, call for help when indicated, provide supplemental oxygen, start intravenous fluid, and provide cardiopulmonary resuscitation as required, while monitoring the patient’s vital signs and oxygenation status. Antihistamines and glucocorticoids are not initial treatments of choice. For self-management, patients at risk of anaphylaxis should carry epinephrine auto-injectors, have personalized emergency action plans, and follow-up with a physician about preventing anaphylaxis recurrence. Patient and caregiver training and education are essential in the management of anaphylaxis. (Korean J Med 2015;89:413-417)
양두경 ( Doo Kyung Yang ),이수걸 ( Soo Keol Lee ),손춘희 ( Choon Hee Son ),노미숙 ( Mee Sook Roh ),최필조 ( Phil Jo Choi ),이진화 ( Jin Hwa Lee ),김기남 ( Ki Nam Kim ),이기남 ( Ki Nam Lee ),이영목 ( Young Mok Lee ),박해심 ( Hae Si 대한천식 및 알레르기학회 ( 구 대한알레르기학회 ) 2005 천식 및 알레르기 Vol.25 No.2
김동균 ( Dong Kyun Kim ),이성우 ( Sung Woo Lee ),남화성 ( Hwa Seong Nam ),전동섭 ( Dong Sub Jeon ),박나래 ( Na Rae Park ),남영희 ( Young Hee Nam ),이수걸 ( Soo Keol Lee ),백양현 ( Yang Hyun Baek ),한상영 ( Sang Young Han ),이성욱 대한소화기학회 2016 대한소화기학회지 Vol.67 No.6
Sorafenib is currently the only targeted therapy available for advanced stage hepatocellular carcinoma (HCC). Cutaneous adverse events associated with sorafenib treatment include hand-foot skin reaction, but there has been no report of drug reaction (or rash) with eosinophilia and systemic symptoms (DRESS) syndrome. Here, we report a case of 72-year-old man with HCC and alcoholic liver cirrhosis who developed skin eruptions, fever, eosinophilia, and deteriorated hepatic and renal function under sorafenib treatment. He has since successfully recovered with conservative care. (Korean J Gastroenterol 2016;67:337-340)