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반전된 Takotsubo 형태를 보이는 스트레스성 심근병증 1예
임상우 ( Sang Woo Yim ),천우정 ( Woo Jung Chun ),오주현 ( Ju Hyun Oh ),박용휘 ( Yong Whi Park ),박용환 ( Yong Whan Park ),박건태 ( Geon Tae Park ),송준휘 ( Jun Hwi Song ) 대한내과학회 2009 대한내과학회지 Vol.76 No.6
스트레스성 심근병증은 다양한 육체적 또는 정신적 스트레스 후 발생하는 심장질환 증후군으로 초기 임상양상이 급성 관상동맥 증후군과 유사하지만 양호한 예후를 갖는다. 그러나 기존에 발표된 연구에서는 대부분의 환자에서 심첨부나 중간부 좌심실에서 무운동성을 관찰되었으나 저자들은 심실 기저부의 무운동성이 관찰되는 스트레스성 심근병증증례를 경험하였기에 보고한다. Stress-induced cardiomyopathy, known as Takotsubo cardiomyopathy, is a newly described clinical entity characterized by transient left ventricular apical ballooning and left ventricular apical dyskinesis, with no significant stenosis on the coronary angiogram. We describe a patient who had transient cardiomyopathy with akinesia of the basal portions of the left ventricle and hyperkinesia of the apex. This is the first case of stress-induced cardiomyopathy with an "inverted Takotsubo" contractile pattern triggered by emotional stress in Korea. The cause of stress-induced cardiomyopathy is unclear, but catecholamines probably play a role in this syndrome. This entity could provide clues to the pathophysiology underlying stress-induced cardiomyopathy. (Korean J Med 76:746-751, 2009)
고용량 스테로이드 치료 저항성 폐출혈 루푸스 환자에서 Rituximab 사용
임상우 ( Sang Woo Yim ),변창규 ( Chang Kyoo Byon ),박준용 ( Jun Yong Park ),이상엽 ( Sang Yeob Lee ),이성원 ( Sung Won Lee ),정원태 ( Won Tae Chung ) 대한류마티스학회 2014 대한류마티스학회지 Vol.21 No.4
Rituximab is a chimeric murine-human monoclonal antibody that is directed against the specific B-cell CD20 antigen, which has recently been successfully used in active or refractory systemic lupus erythematosus (SLE) manifestations, such as nephritis, thrombocytopenia, and vasculitis. We report a case of a 25-year-old woman diagnosed with diffuse alveolar hemorrhage of SLE refractory to steroid pulse therapy. The patient was treated successfully with rituximab as a part of the immunosuppressive regimen.
이상엽 ( Sang Yeob Lee ),임상우 ( Sang Woo Yim ),박준용 ( Jun Yong Park ),정원태 ( Won Tae Chung ),이성원 ( Sung Won Lee ) 대한류마티스학회 2015 대한류마티스학회지 Vol.22 No.1
Objective. This study was designed to assess sequential association between right ventricular systolic pressure and cardiothoracic (C/T) ratio of chest radiography in systemic sclerosis (SSc) patients and inferred pulmonary arterial hypertension by increased C/T ratio and right ventricular systolic pressure. Methods. Twenty-eight consecutive patients with confirmed SSc (22 females, 6 males; mean age 51.1±2.1 years), with a mean time of 91.0±6.7 months from SSc diagnosis, were prospectively included in the study. C/T ratio was obtained by chest radiography with an interval of two years. The first C/T ratio was taken at diagnosis and second C/T ratio was taken at the time of enrollment. The enrolled subjects were agree to undergo echocardiography and measurement of brain natriuretic peptide. Results. In 24 SSc patients with normal right ventricular systolic pressure, 10 SSc patients had increased C/T ratio, the other four SSc patients with increased right ventricular systolic pressure by echocardiography, had increased C/T ratio all together. In four SSc patients with increased right ventricular systolic pressure, one patient had resting dyspnea, taken cardiac catheterization and confirmed as pulmonary hypertension and the other three patients had no clinical symptoms. The increased right ventricular systolic pressure is related to the increase of C/T ratio (>0.55) in chest radiography (p<0.05) and increased brain natriuretic peptide in blood (p<0.05). Conclusion. The increase of C/T ratio (>0.55) in chest radiography was associated with increased right ventricular systolic pressure measured by echocardiography and inferred a role in early detection of asymptomatic pulmonary arterial hypertension in SSc patients. (J Rheum Dis 2015;22:19-24)
건강한 젊은 남자에서의 자발성 신동맥 및 복강동맥 박리 1예
허종훈 ( Jong Hun Heo ),박건태 ( Geon Tae Park ),송준휘 ( Jun Whee Song ),임상우 ( Sang Woo Yim ),김정훈,조성 ( Sung Cho ),김성록 ( Sung Rok Kim ) 대한신장학회 2008 Kidney Research and Clinical Practice Vol.27 No.5
Spontaneous dissection of peripheral arteries unrelated to the aorta is rare. Cases reported in the literature have involved the renal arteries, the coronary arteries, the cerebral arteries, and visceral arteries, in order of incidence. There is no consensus yet on indications for medical or surgical therapeutic modality. As a consequence of the rarity of spontaneous dissection of peripheral arteries, its natural history has been poorly described. A healthy 37-year-old male with normotension was admitted with an acute onset of left flank pain. Physical examination turned out an unremarkable result. Right renal infarction and splenic infarction was diagnosed by abdominal computed tomography. A spiral CT angiogram and angiography showed dissection of main right renal artery and celiac artery with involvement of branches. One year later, he has remained well and normotensive without treatment. To our knowledge, this is the first case of spontaneous renal and celiac artery dissection in normotensive patient in Korea.
한대희 ( Dae Hui Han ),조성 ( Seung Cho ),김성록 ( Sung Rok Kim ),김윤영 ( Yun Young Kim ),강구현 ( Gu Hyun Kang ),임상우 ( Sang Woo Yim ),김정훈 ( Jung Hun Kim ) 대한내과학회 2007 대한내과학회지 Vol.73 No.4
저자들은 진성다혈구증에 병발된 미세변화형 신증을 보이는 환자를 경험하였기에 문헌고찰과 함께 이를 보고하는 바이다. The cause of secondary polycythemia is known to be renal diseases such as renal tumors, renal cysts, hydronephrosis, renal artery stenosis, renal transplantation and Bartter`s syndrome. Yet this disease rarely reported in conjunction with nephrotic syndrome, nephrosclerosis, pyelonephritis or chronic glomerulonephritis. There are only rare reports of glomerulonephritis with polycythemia vera. We report here on a case of a minimal change nephrotic syndrome with polycythemia vera. A 60-year-old man visited our hospital due to his elevated hemoglobin level and proteinuria and his elevated neuron specific enolase. The blood hemoglobin level was 22.4 g/dL. The blood level of neuron specific enolase was 36.7 ng/mL. The bone marrow aspirate showed hypercellularity and panmyelosis. Electron microscopy showed diffuse effacement of the epithelial foot processes and microvillous transformation of the foot processes. Treatment was done by performing phlebotomy and administering hydroxyurea. There was decreased urinary protein and normalization of the hemoglobin level following treatment with phlebotomy and hydroxyurea.(Korean J Med 73:438-442, 2007)