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임선교 ( Sun Gyo Lim ),김정은 ( Jeong Eun Kim ),이종우 ( Jong Woo Lee ),이동훈 ( Dong Hun Lee ),임승관 ( Seung Kwan Lim ),박인휘 ( In Whee Park ),조현경 ( Hyeon Kyeong Cho ),김흥수 ( Heung Soo Kim ),신규택 ( Gyu Tae Shin ),임현이 대한신장학회 2003 Kidney Research and Clinical Practice Vol.22 No.1
Anti-glomerular basement membrane antibody mediated rapidly progressiv glomerulonephritis is a rare autoimmune disease. It is characterized by acute renal failure and crescentic glomeruli with linear immune deposits along glomerular basement membrane mediated by anti-GBM antibodies. We report a case of a sixty-years-old man with generalized edema and hematuria. On admission, BUN/Creatinine was 118/19.6 ng/dL, Hb was 10.2 g/bL. On urinalysis, protein was 3+, and many RBCs were found. Renal biopsy specimen which contained 8 glomeruli showed active cellular crescent formation in all glomeruli. On immunofluorescent staining specimen, there were 4 glomeruli which showed strong IgG linear staining along the glomerular basement membrane and mild C3 & Ciq deposit along the capillary walls. The titer of anti-GBM antibody was 123 EU by ELISA (normal : <10 EU). We treated with high dose of corticosteroid and plasmapheresis, but renal function was not recovered even after 3 months of hemodialysis.
황선혁 ( Sun Hyuk Hwang ),박선영 ( Sun Young Park ),김기찬 ( Ki Chan Kim ),박주한 ( Joo Han Park ),김시연 ( Si Yeon Kim ),송가원 ( Ga Won Song ),정숙희 ( Jun Goo Kang ),임선교 ( Sook Hee Chung ),이기명 ( Sun Gyo Lim ),이광재 ( Kwa 전북대학교 의과학연구소 2013 全北醫大論文集 Vol.37 No.2
Cavernous hemangioma of the colon is a rare disease. It mostly affects young patients with recurrent painless rectal bleeding. Complete surgical excision with a sphincter saving procedure is the best therapeutic option. A 25-year-old man referred to our hospital because of a chronic anemia and recurrent painless rectal bleeding. In esophagogastroduodenoscopy, there was gastric erosion. In colonoscopy, there were multiple submucosal vessel dilatations on whole colon. Prominent submucosal vessel was noted on cecum and rectum suspicious for cavernous hemangioma. Biopsy was not performed because of the risk of bleeding. Abdomen computer tomography (CT) showed bowel wall thickening in rectum and colon. Multiple small aggregated cystic lesions in omentum and mesentery were seen. Multiple calcifications in the rectum were noted, a finding compatible with phleboliths. We recommended surgery but patient refused and now he is followed up in our outpainet clinic without complication. Cavernous hemangioma is a rare disease but clinicians should be cautious about the occurrence of this malformation in young patients with recurrent rectal bleeding. Suspicion and knowledge of this disease would reduce the misdiagnosis and mismanagement.
총담관 결석의 내시경적 제거술 후 내시경적 경비담관 배액술의 유용성
김순선 ( Soon Sun Kim ),황재철 ( Jae Chul Hwang ),임선교 ( Sun Gyo Lim ),이다미 ( Da Mi Lee ),최재명 ( Jae Myoung Choi ),류경호 ( Kyoung Ho Ryu ),유병무 ( Byung Moo Yoo ),김진홍 ( Jin Hong Kim ) 대한췌담도학회 2012 대한췌담도학회지 Vol.17 No.1
배경 및 목적: 총담관 결석의 내시경적 제거 후 일상적인 내시경적 경비담관 배액술 (ENBD)의 유용성은 논란이 있다. 이에 저자들은 총담관 결석의 내시경적 제거술을 받은 환자를 대상으로 ENBD를 시행한 군과 시행하지 않은 군의 임상 치료성적 및 담도염과 잔류 결석의 발생률을 분석하고자 하였다. 방법: 2003년 3월부터 2008년 8월까지 총담관 결석 진단 하에 경구적 내시경적 담석 제거술을 받은 환자 중, 경피적 담관배액술 또는 경피적 담낭배액술을 먼저 시행한 환자, 간내 결석을 동반한 환자, 내시경적 역행성 담도배액술을 시행한 환자를 제외한 532명의 환자를 후향적으로 분석하였다. 결과: 총 532명(남자 282명, 평균나이 62.4세) 중 경구적 내시경적 담석 제거술에 의하여 담석이 완전 제거된 환자는 523명으로 98.3%의 성공률을 보였으며, 이들 523명의 초회 성공률은 96.9%였다. 적응증에 관계 없이 ENBD를 삽입한 군(ENBD-1군, n=28)과 삽입하지 않은 군(Non-ENBD-1군, n=504)을 비교하였을 때 담도염의 발생률(3.6% vs. 2.2%, P=0.48)과, 잔류 총담관 결석 발생률(3.6% vs. 0.6%, P=0.08)은 유의한 차이가 없었다. 총담관 결석의 내시경적 완전 제거 후 일상적인 ENBD삽입이 담도염 및 잔류 총담관 결석의 발생률에 미치는 영향을 알아보기 위하여 ENBD를 삽입한 군(ENBD-2군, n=9)과 삽입하지 않은 군(Non-ENBD-2군, n=500)을 비교하였을 때, 담도염발생률(0.0% vs. 2.2%, P=1.00)과 잔류 총담관 결석 발생률 (0.0% vs. 0.8%, P=1.00) 역시 유의한 차이가 없었다. 결론: 총담관 결석의 내시경적 제거술후 담도염 및 잔류 결석 발생률은 낮고, ENBD를 시행한 군과 시행하지 않은 군에서 차이가 없었다. 따라서 총담관 결석의 내시경적 제거 후 ENBD의 일상적인 시행은 신중하여야 하며, 향후 이에 대한 전향적 연구가 필요하다. Background/Aims: We aimed to compare the clinical outcomes between endoscopic nasobiliary drainage (ENBD) group and non-ENBD group after endoscopic common bile duct (CBD) stone extraction. Methods: From March 2003 to August 2008, a total of 532 patients (282 men; mean age 62.4 years) underwent endoscopic retrograde cholangiopancreatography (ERCP) for CBD stone extraction. Results: Among 532 patients, CBD stones were completely extracted in 523 patients (98.3%). Among 523 patients, CBD stone were completely extracted by 1st ERCP attempt in 507 patients (96.9%). ENBD-1 group comprised of 28 patients who received ENBD with any indication. ENBD-2 group comprised of 9 patients who received ENBD routinely after complete CBD stone removal. There was no significant difference in occurrence of post ERCP cholangitis or residual CBD stone between ENBD-1 group (n=28) and Non-ENBD-1 group (n=504) (3.6% vs. 2.2%, 3.6% vs. 0.6%, P=0.48 and P =0.08, respectively), and between ENBD-2 group (n=9) and Non-ENBD-2 group (n=500) (0.0% vs. 2.2%, 0.0% vs. 0.8%, P =1.00 and P =1.00, respectively). Conclusions: Post ERCP cholangitis and residual CBD stone occurred rarely after CBD stone extraction. Therefore routine insertion of ENBD for biliary decompression after CBD stone extraction should be considered prudently.
연구논문 : 초치료 만성 B형간염 환자에서 엔테카비어 치료반응 및 관련 인자
이명희 ( Myoung Hee Lee ),임선교 ( Sun Gyo Lim ),전수진 ( Su Jin Jeon ),강창준 ( Chang Joon Kang ),조영주 ( Young Ju Cho ),김순선 ( Soon Sun Kim ),이다미 ( Da Mi Lee ),정재연 ( Jae Youn Cheong ),조성원 ( Sung Won Cho ) 대한간학회 2009 Clinical and Molecular Hepatology(대한간학회지) Vol.15 No.4
목적: 엔테카비어는 만성 B형간염의 초치료 환자에서 강력한 항바이러스 효과 및 낮은 내성률이 보고되고 있다. 본 연구에서는 단일 기관에서 경험한 엔테카비어의 혈청, 생화학, 바이러스반응을 관찰하고 엔테카비어의 치료반응과 연관된 인자를 규명하고자 하였다. 대상과 방법: 12개월 이상 1일 1회 0.5 mg의 엔테카비어를 경구 투여받은 114명의 만성 B형간염 환자를 대상으로 하였다. 초기바이러스반응은 치료 3개월 후 혈청 HBV DNA가 2,000 copies/mL 미만으로 감소한 경우로 정의하였다. 결과: 엔테카비어 투여 후 혈청 ALT값의 정상화는 치료 6개월, 12개월, 24개월에 각각 76명(68.5%), 85명(74.6%), 62명(81.6%)에서, HBV DNA PCR 음전은 각각 50명(43.9%), 81명(71.1%), 65명(85.5%)에서 관찰되었다. HBeAg 혈청소실은 6개월에 17명(36.2%), 12개월에 27명(43.5%), 24개월에 22명(56.4%), 혈청전환은 각각 8명(12.9%), 9명(14.5%), 6명(15.4%)에서 관찰되었다. HBV DNA PCR 음전을 예측할 수 인자는 단변량 분석에서 HBeAg 유무, 치료 전 혈청 AST치, 혈청 HBV DNA치, 초기바이러스반응 유무였고, 다변량 분석에서 초기바이러스반응이 독립적인 인자였다[P<0.001, OR=7.286(2.663~19.932)]. HBeAg의 혈청소실은 혈청 알부민치와 혈소판 수치가 낮은 경우, 혈청 AST치가 높은 경우, 간경변을 동반한 경우와 초기바이러스반응이 있는 경우에 빈번하게 발생하였고, 혈청 알부민[P=0.041, OR=0.232(0.057~0.945)]치와 초기바이러스반응[P=0.005, OR=7.017(1.799~27.378)]이 독립적인 예측인자였다. 결론: 엔테카비어는 만성 B형간염의 초치료 환자에서 우수한 치료반응을 보였으며, 치료 3개월째 초기바이러스반응은 HBV DNA 음전 및 HBeAg 소실의 독립적 예측인자였다. Background/Aims: Entecavir is a potent and selective guanosine analogue that has demonstrated a significant antiviral efficacy against hepatitis B virus (HBV). The aim of this study was to characterize the response to entecavir and to examine the factors affecting that response. Methods: We administered 0.5 mg of entecavir once daily for more than 12 months to 114 naive chronic hepatitis B (CHB) patients. We measured the levels of liver enzymes, serological markers, and serum HBV DNA at 3-month interval. Results: Normalization of serum alanine aminotransferase levels was observed in 68.5% (76/114), 74.6% (85/114), and 81.6% (62/76) of patients after 6, 12, and 24 months of therapy, respectively. HBV DNA levels of <50 copies/mL (as evaluated by polymerase chain reaction) were observed in 43.9% (50/114), 71.1% (81/114), and 85.5% (65/76) of patients after 6, 12, and 24 months, respectively. Viral breakthrough was not observed. The rates of HBeAg loss and seroconversion were 43.5% (27/62) and 14.5% (9/62), respectively, after 12 months of therapy, and 56.4% (22/39) and 15.4% (6/39) after 24 months. The independent factor associated with PCR negativity was early virologic response (EVR; HBV DNA <2,000 copies/mL after 3 months of therapy, P<0.001). The independent factors predicting HBeAg loss were found to be serum albumin levels (P=0.041) and EVR (P=0.005). Conclusions: Entecavir induced excellent biochemical and virologic responses in naive CHB patients. EVR was an independent factor for predicting HBV PCR negativity and HBeAg loss. (Korean J Hepatol 2009;15:446-453)
대장내시경에서 궤양의 특성에 따른 베체트 장염의 임상경과
김민철 ( Min Cheul Kim ),신성재 ( Sung Jae Shin ),임선교 ( Sun Gyo Lim ),이경록 ( Kyung Rok Lee ),우학 ( Hak Woo ),최상조 ( Sang Jo Choi ),조정수 ( Jung Soo Jo ),엄중호 ( Jung Ho Eum ),차동엽 ( Dong Youb Cha ),황재철 ( Jae Chul H 대한장연구학회 2010 Intestinal Research Vol.8 No.1
Background/Aims: Intestinal involvement with bleeding and perforation is one of the main causes of morbidity and mortality in patients with Behcet’s disease (BD); however, the clinical course of intestinal BD has not been defined. The aim of this study was to determine the clinical course of intestinal BD based on the characteristics of ulcers visualized during colonoscopy. Methods: We retrospectively reviewed the medical records and colonoscopic findings of 41 patients with intestinal BD. All patients were classified into subgroups according to ulcer depth, size, and number, and we analyzed the clinical manifestations, subset type of BD, medications, surgical procedures, and relapse rate among the subgroups. Results: The median age at the time of diagnosis was 38 years (range, 18-74 years); 25 patients were females (M:F=1:1.56). Abdominal pain (n=40), diarrhea (n=27), and RLQ tenderness (n=21) were common symptoms. The number of complete, incomplete, and suspected types was 3, 17, and 21, respectively. In an analysis according to ulcer depth, the rate of steroid use and intestinal surgeries was more frequent in the deep ulcer group compared with the aphthous and shallow ulcer groups (50.0% vs. 0% vs. 17.6%; P=0.012; 42.9% vs. 0% vs. 23.5%: P=0.013) The rate of steroid use and relapse tended to be higher as the size of the ulcer increased; however, there was no difference in the rates of steroid use, surgeries, and relapse based on the number of intestinal ulcers. Conclusions: The prognosis was worse in patients with intestinal BD who have deeper and larger ulcers. Therefore, we suggest that such patients need to be treated aggressively. (Intest Res 2010;8:40-47)
만성 B형 간염 환자에서 중증 간 섬유화 및 간경변의 예측 지표로써 AST/혈소판 비의 유용성
심성준 ( Sung Jun Sim ),정재연 ( Jae Youn Cheong ),조성원 ( Sung Won Cho ),김종수 ( Jong Su Kim ),임태영 ( Tae Young Lim ),신도현 ( Do Hyun Shin ),임선교 ( Sun Gyo Lim ),김영배 ( Young Bae Kim ),이기명 ( Kee Myung Lee ),유병무 ( B 대한소화기학회 2005 대한소화기학회지 Vol.45 No.5
Background/Aims: An ideal noninvasive diagnostic test for hepatic fibrosis should be simple, inexpensive, and accurate. We aimed to find the simple marker for predicting hepatic fibrosis and to compare the accuracy of AST, platelet, AST/ALT ratio and AST
증례 : 소화기 ; 무증상의 빈혈로 발현된 상장간막동맥 거짓동맥류 파열 1예
김주성 ( Joo Sung Kim ),진우람 ( U Ram Jin ),이길호 ( Gil Ho Lee ),황수현 ( Su Hyun Hwang ),이연경 ( Yeon Kyung Lee ),임기현 ( Ki Hyun Lim ),임선교 ( Sun Gyo Lim ) 대한내과학회 2015 대한내과학회지 Vol.88 No.5
Anemia is a common cause of referrals to gastroenterologists. Only a small number of anemia cases result from vascular abnormalities. Visceral artery aneurysms and pseudoaneurysms are rare forms of vascular disease that have significant potential for rupture, resulting in potentially life-threatening hemorrhaging. We present the case of a 70-year-old female patient with a pseudoaneurysm of the superior mesenteric artery complicated with rupture, who had no abdominal pain and only anemia. (Korean J Med 2015;88:560-563)
라미부딘 내성 만성 B형간염 환자에서 아데포비어 단독요법 후 라미부딘 추가투여의 효과
조영주 ( Young Ju Cho ),정재연 ( Jae Youn Cheong ),이명희 ( Myoung Hee Lee ),전수진 ( Su Jin Jeon ),이윤철 ( Yoon Chul Lee ),임선교 ( Sun Gyo Lim ),강창준 ( Chang Joon Kang ),조성원 ( Sung Won Cho ) 대한소화기학회 2010 대한소화기학회지 Vol.56 No.2
Background/Aims: Add on adefovir (ADV) to ongoing lamivudine (LAM) has been recommended as a standard therapy for the treatment of LAM resistance. In the past, switch to ADV monotherapy was suggested as an option for the treatment of LAM resistance, leading to frequent development of ADV resistance. However, ADV monotherapy has been still used in LAM-resistant patients because of low cost in Korea. The aims of this study were to evaluate the virologic response and virologic breakthrough during adding on LAM in LAM-resistant patients receiving ADV monotherapy. Methods: The study population comprised 99 patients with LAM-resistance. We divided them into 3 groups (Group 1: switch to ADV monotherapy, N=58, Group 2: add on ADV to ongoing LAM, N=25, Group 3: add on LAM to ADV monotherapy, N=16). HBV DNA levels were assessed at baseline and every 3 months during therapy. Serum HBV DNA levels were measured by bDNA assay or the COBAS TaqMan(TM) HBV test. Results: The median treatment duration for group 1, group 2, and group 3 was 42.0, 20.6, and 31.8 (18.7 mon. of ADV+13.1 mon. of LAM) months, respectively. Cumulative rate of virologic breakthrough in group 1 was 5.2%, 19.0%, and 25.9% at 12, 24, and 36 months of treatment, respectively. Virologic breakthrough was not detected in group 2 and group 3 (p=0.016, group 1 vs. group 2 or 3). In group 3, median serum HBV DNA levels were 4.22 log(10) copies/mL prior to LAM administration. Median serum HBV DNA changes from baseline (log10 copies/mL) were ?0.91, ?1.93, ?1.87 and ?1.74 at week 12, 24, 36 and 48, respectively. Conclusions: Later add on LAM to ADV monotherapy prevented the development of ADV resistance in patients with LAM resistance effectively, comparable to ADV add on to continuing LAM therapy. (Korean J Gastroenterol 2010;56:83-89)
운동유발성 아나필락시스 환자에서 혈 중 tryptase 측정 1례
예영민,임선교,서유진,최정희,서창희,남동호,박해심 대한천식 및 알레르기학회 2004 천식 및 알레르기 Vol.24 No.1
Exercise-induced anaphylaxis(EIA) is a medical emergency in that it derives from a physical allergy. We reported a case of food-independent EIA based on history and laboratory data. A 40-year-old male patient was presented with generalized urticaria, angioedema, and syncope after jogging. He had suffered from allergic rhinitis for 25 years. Increased level of serum tryptase was noted. Mast cell activation might be suggested in the pathophysiologic mechanism of EIA. (J Asthma Allergy Clin Immunol 24 : 152-5, 2004)