증례 : 소화기 ; Oseltamivir에 의해 유발된 급성 출혈성 대장염 1예

정덕원 ( Duk Won Chung ),손혁수 ( Hyuk Su Son ),박재형 ( Jae Hyung Park ),정민규 ( Min Kyu Jung ),전성우 ( Seong Woo Jeon ),조창민 ( Chang Min Cho ),김성국 ( Sung Kook Kim ) 대한내과학회 2011 대한내과학회지 Vol.80 No.2S

신종 인플루엔자의 대유행과 함께 치료의 중요성이 인식 되었고 치료제로 널리 처방된 oseltamivir이 드물지만 급성출혈성 장염을 유발할 수 있다. 현재까지 국내 증례보고는 없는 상태로 저자들은 치료 및 화학적 예방요법으로 권장되는 oseltamivir (Tamiflu(R))를 복용한 환자에서 출혈성 장염의 증례를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Oseltamivir is a potent selective neuraminidase enzyme inhibitor and effective against nearly all strains of influenza A and B. The importance of treating influenza has been recognized, and oseltamivir has been prescribed frequently at the onset of the H1N1 influenza A pandemic this year. However, oseltamivir can cause hemorrhagic colitis as a rare adverse effect. Until now, only two cases of hemorrhagic colitis following the use of oseltamivir have been reported in Japan, and none have been reported in Korea. We report a case of acute hemorrhagic colitis in a 15-year-old boy after the oral administration of oseltamivir for swine originating influenza A. (Korean J Med 2011;80:S87-S90)

정상 위 분문부 점막에서 발견된 이소성 골 형성

엄석현 ( Seok Hyeon Eom ),박창환 ( Chang Hwan Park ),정덕원 ( Duk Won Chung ),이상혁 ( Sang Hyeok Lee ),서지영 ( Ji Young Seo ),김영성 ( Yeong Sung Kim ),곽동협 ( Dong Hyup Kwak ),김정희 ( Jung Hee Kim ) 영남대학교 의과대학 2016 Yeungnam University Journal of Medicine Vol.33 No.2

Heterotopic bone formation in the gastrointestinal tract is a rare phenomenon. Most reported cases were associated with benign and malignant neoplasms, except for a case in which heterotopic bone formation was found in a patient with Barrett`s esophagus. The exact pathogenesis of the disease has not yet been established. However, most heterotopic bones found in the gastrointestinal tract were associated with mucinproducing tumors of the appendix, colon, and rectum. Inflammation may also play a role in osseous metaplasia in a case with bone formation at the base of an ulcer in Barrett`s esophagus. Here, we report on a patient with heterotopic bone formation in normal gastric cardiac mucosa. A 50-year-old female visited our hospital for a routine health examination. She had no gastrointestinal symptoms, and her physical examination, blood test, X-ray, urine, and stool examination results were normal. A 0.3 cm sized polypoid lesion located just below the squamocolumnar junction was observed on upper gastrointestinal endoscopy. A piece of biopsy was taken. Histologically, a lamella bone trabecula and chronic inflammatory cells were observed in the gastric cardiac mucosa. The follow-up endoscopy performed one month later showed no residual lesion.

기관지천식 환자에서 Interleukin (IL)-13 유전자 다형성

김건우 ( Gun Woo Kim ),손자영 ( Ja Young Son ),최은정 ( Eun Jung Choi ),신재대 ( Jae Dae Shin ),이응갑 ( Eung Kab Lee ),정덕원 ( Duk Won Chung ),이종명 ( Jong Myung Lee ),김능수 ( Nung Soo Kim ) 대한천식알레르기학회 2006 천식 및 알레르기 Vol.26 No.4

Background: Asthma is characterized by airway hyperresponsiveness, eosinophilic inflammation, airway mucus hypersecretion, and elevated serum immunoglobulin E (IgE). IL-13 is an important cytokine in the pathogenesis of asthma through the production of IgE, stimulation of bronchial epithelial mucus production, and smooth muscle hyperreactivity. Previous studies have shown that the polymorphisms in IL-13 gene are associated with asthma, atopy, or total IgE. Objective: We investigate whether the polymorphism Arg 110Gln within the IL-13 gene is associated with asthma, atopy, serum total IgE, asthma severity and airway hyperresponsiveness in adult asthma. Method: One hundred fifty-five asthmatic adults and 147 non-asthmatic healthy adults were enrolled. Asthma phenotype and bronchial responsiveness to methacholine were determined by the same physician. IL-13 Arg110Gln polymorphism was genotyped using PCR-RFLP assay. Result: Genotype frequency of IL-13 Arg110Gln polymorphism was significantly different between asthmatic patients (P=0.021), especially between atopic asthma (P=0.024) and controls, and was associated with elevated levels of serum total IgE (P=0.009), asthma severity (P=0.026), pulmonary function (P=0.017), and airway hyperresponsiveness (P=0.025) in patients with asthma. Conclusion: IL-13 Gln110 variant may be an asthma susceptibility gene in Korean adults. In addition, IL-13 Gln110 variant is associated with elevated levels of serum total IgE and severity of asthma. (Korean J Asthma Allergy Clin Immunol 2006;26:302-309)

증례 : 소화기 ; Propofol을 사용한 수면내시경 후 발생한 아나필락시스 1예

김성국 ( Sung Kook Kim ),김성욱 ( Sung Uk Kim ),정인권 ( In Kwon Chung ),전성우 ( Seong Woo Jeon ),정민규 ( Min Kyu Jung ),손종원 ( Jong Won Sohn ),정덕원 ( Duk Won Jung ) 대한내과학회 2010 대한내과학회지 Vol.79 No.5

프로포폴은 수면내시경 검사 시행 시 진정유도를 위해 널리 쓰이는 약제로 이로 인한 호흡계 및 순환계 억제에 대해서는 잘 알려져 있으나 아나필락시스는 드물다. 저자들은 약제에 대한 알레르기의 병력이 없는 환자에서 프로포폴을 사용한 수면내시경 후 피부발진, 소양감, 호흡곤란 및 저혈압등의 증상이 발생한 1예를 경험하였다. 피부단자시험이나 혈청 특이 IgE 항체를 측정하지 못하였으나, 다른 약제나 라텍스 장갑의 사용 없이 프로포폴 단독 투여 후 발생하여 프로포폴 유발성 아나필락시스로 진단하였고, 이를 문헌고찰과 함께 보고하는 바이다. Propofol is widely used for sedation during endoscopy. Hemodynamic compromise and respiratory depression might occur under propofol sedation, whereas anaphylaxis is rare. We recently experienced this rare side effect. A 71-year-old woman suffering from substernal chest discomfort underwent endoscopic examination under propofol sedation. She denied any history of allergic reaction to drugs or foods such as beans and eggs. After completion of the endoscopic examination, she developed a whole-body rash with pruritus and edema of her face, including the eyelids and lips. Hypotension was seen on physical examination, and her oxygen saturation was decreased on pulse oximetry. She recovered completely after treatment with epinephrine, an antihistamine, and steroids, with supportive care. Anaphylaxis to propofol is a rare side effect, and prompt treatment is mandatory when it develops. (Korean J Med 79:549-552, 2010)

메티실린 내성 황색 포도알균에 의한 연조직 및 골 감염에 대한 전환요법으로서의 경구 Rifampin의 유용성

손종원,김신우,하상우,이응갑,정덕원,장현하,이종명,김능수 대한감염학회 2005 감염과 화학요법 Vol.37 No.6

목적 : 메티실린 내성 황색 포도알균에 의한 연조직및 골 감염의 치료 시 glycopeptide약물의 정주 요법에 이은 경구 항생제로의 처방 전환이 요구되는 경우가 많으나 마땅한 경구 약제의 선택이 어려운 실정이다. 이에 경구 rifampin을 메티실린 내성 황색 포도알균에 의한 연조직 및 골 감염에 사용하여 치료한 경우를 분석하여 그 유용성 정도와 실패한 경우 실패의 위험인자를 알아보고자 하였다. 재료 및 방법 : 2001년 1월부터 2004년 9월까지 메티실린 내성 황색 포도알균에 의한 연조직 및 골 감염 환자를 대상으로 rifampin을 그 치료 목적으로 사용한 44명의 환자를 의무 기록과 X선 사진을 통해 후향적으로 분석하였다. 기초 자료를 분석하였고 감염이 재발하여 치료 실패로 판정된 환자들에 대해 치료 실패의 원인이 될 만한 주요 변수에 대한 Chi-square 검증과 로지스틱 회귀분석을 시행하였다. 결과 : 치료 후 재발은 20.5% (8/39)였으며 재발 예와 사망에 대한 위험요소에 대한 단변량 분석에서 고관절 보형물이 있는 경우 흔하였으나 통계적 차이에는 미치지 못하였다(P=0.065). 고관절 보형물 외에 동반된 질환들, 쇼크의 동반, 균혈증의 동반, 경구 시 ciprofloxacin과 rifampin의 병합 복용 기간 등을 혼란 변수로 사용한 다변량 로지스틱 회귀분석에서는 고관절 보형물 만이 통계적으로 유의하였다(P=0.044). 결론 : 메티실린 내성 황색 포도알균에 의한 연조직및 골 감염에 rifampin과 다른 약제를 병합하여 치료하는 경우 재발은 적었다. 치료 실패의 경우는 고관절 부위 감염과 같이 보형물을 쉽게 제거하기 어려운 상황과 관계되는 것을 보여준다. Background : Rifampin is sometimes used in combination with other anti-staphylococcal agents to treat methicillin-resistant Staphylococcus aureus (MRSA) infections but few reports are available about the usefulness of rifampin against MRSA infections, especially in soft tissue and bone infections. Thus, we evaluated the efficacy of rifampin as switch therapy for soft tissue and bone infections caused by MRSA and assessed the risk factors for treatment failure. Materials and Methods : We retrospectively studied 44 patients who had soft tissue and bone infections caused by MRSA and were treated with rifampin in combination or as monotherapy as switch therapy from January 2001 to September 2004. Results : The mean age of the subjects was 50.2 years and the number of male and female were 34 and 10, respectively. Median duration of rifampin use was 32 days and 25% of the patients had artificial prostheses. Thirty one patients (79.5%, 31/39) were cured with parenteral glycopeptide followed by rifampin in combination or as monotherapy. Eight patients (8/39) recurred after the completion of treatment. The presence of hip prosthesis was the only significant risk factor (P= 0.027) in multivariate logistic regression test. Rifampin was tolerable in all cases. Conclusion : Rifampin as switch therapy for soft tissue and bone infection caused by MRSA was effective in 79.5% (31/39) of sujects. The treatment failure seems to be associated with unremovable infected prosthesis.