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Non-cirrhotic portal hypertension in an ankylosing spondylitis patient
박석기,이지현,최준설,김현우,심범진,최원규,김상현 영남대학교 의과대학 2018 Yeungnam University Journal of Medicine Vol.35 No.1
Idiopathic non-cirrhotic portal hypertension (INCPH) is a disease with an uncertain etiology consisting of non-cirrhotic portal hypertension and portal pressure increase in the absence of liver cirrhosis. In INCPH, patients exhibit normal liver functions and structures. The factors associated with INCPH include the following: Umbilical/portal pyremia, bacterial diseases, prothrombic states, chronic exposure to arsenic, vinyl chloride monomers, genetic disorders, and autoimmune diseases. Approximately 70% of patients present a history of major variceal bleeding, and treatment relies on the prevention of complications related to portal hypertension. Autoimmune disorders associated with INCPH are mainly systemic sclerosis, systemic lupus erythematosus and rheumatoid arthritis. To the best of our knowledge, a case of ankylosing spondylitis (AS) associated with INCPH has not been reported thus far. Therfore, we report our experience of a patient with AS accompanied by INCPH, who showed perisplenic varices with patent spleno-portal axis and hepatic veins along with no evidence of cirrhosis on liver biopsy, and provide a brief literature review.
증례 : 류마티스 ; 루푸스 환자에서 타크로리무스 사용 후 발생한 원위신세관산증 1예
김해구 ( Hae Koo Kim ),이지현 ( Ji Hyun Lee ),구인혜 ( In Hye Ku ),강성민 ( Sung Min Kang ),최준설 ( Joon Sul Choi ),김성준 ( Sung Jun Kim ) 대한내과학회 2015 대한내과학회지 Vol.89 No.4
신세관산증은 정상 음이온차 대사산증 및 혈중 칼륨농도이상, 신경학적 증상이 특징인 질환으로 드물게 약제나 자가면역질환과 관련되어 발생한다. 저자들은 신경정신루푸스 환자에서 반복적이며 일시적인 근력 저하 및 하지 감각이상 등의 증상을 보여 발작장애의 악화로 생각하여 신경과적 약제를 조절하다 타크로리무스(tacrolimus)에 의한 신세관산증으로 진단한 예를 경험하고 이를 문헌고찰과 함께 보고하는 바이다. Renal tubular acidosis (RTA) refers to a group of disorders involving transport defects in bicarbonate reabsorption or hydrogen excretion. Features like metabolic acidosis with a normal anion gap, neurological symptoms, and electrolyte imbalances indicate RTA. Kidney transplantation, cirrhosis, sickle cell anemia, medications, and autoimmune diseases, particularly Sjogren’s syndrome and rheumatoid arthritis, are related to RTA. We encountered a rare case of a patient with systemic lupus erythematosus accompanied by RTA secondary to tacrolimus administration, who had muscle weakness and paralysis. Her symptoms improved after discontinuing tacrolimus and correcting the acidosis and potassium levels. Here, we report on this case and review the relevant literature. (Korean J Med 2015;89:478-481)
Fracture Risk Assessment와 Framingham Risk Score를 중심으로 한 골절 위험도와 심혈관 질환 위험도와의 상관관계
구인혜 ( In Hye Ku ),이지현 ( Ji Hyun Lee ),김성만 ( Seong Man Kim ),강성민 ( Sung Min Kang ),김해구 ( Hae Koo Kim ),김동규 ( Dong Kyu Kim ),최준설 ( Joon Sul Choi ),박석기 ( Suk Ki Park ) 대한내과학회 2015 대한내과학회지 Vol.88 No.5
Background/Aims: Although trials have suggested an association between osteoporosis and cardiovascular disease (CVD), the relationship between fracture risk and cardiovascular disease is not well defined. Here, we examined whether subjects with a higher risk of fracture also share an increased likelihood of developing CVD. Methods: This study included 477 subjects; patients with a history of diabetes, chronic hepatopathy, nephritic syndrome, or any cardiovascular diseases were excluded. We used dual energy X-ray absorptiometry to assess the bone mineral density (BMD) of the lumbar spine and femur, and calculated fracture risk based on the Fracture Risk Assessment (FRAX) score. The Framingham risk score (FRS) was used to estimate cardiovascular risk. Results: Of the 477 subjects, 222 had osteopenia and 150 had osteoporosis; the remaining 105 had a normal BMD. In men, no significant differences were observed in systolic blood pressure (SBP), diastolic blood pressure, low-density lipoprotein, high-density lipoprotein (HDL), and triglyceride (TG) between groups. Men with osteoporosis were generally older, and had significantly higher total cholesterol (TC). In women, age and FRS were significantly higher in the osteoporosis group. In the multivariate analysis, age, SBP, TC, HDL, TG, and FRAX were all significantly associated with FRS. Conclusions: These data suggest that patients with a higher risk of fracture are also at greater risk of developing CVD, indicating a possible mechanistic link between CVD and osteoporosis. (Korean J Med 2015;88:547-554)
류마티스관절염 활성도와 호중구-림프구 비, 혈소판-림프구 비의 상관관계
김성준 ( Sung Jun Kim ),이지현 ( Ji Hyun Lee ),김성만 ( Seong Man Kim ),박민기 ( Min Gi Park ),박수호 ( Su Ho Park ),김동규 ( Dong Kyu Kim ),황지연 ( Ji Yeon Hwang ),최준설 ( Joon Sul Choi ),박석기 ( Suk Ki Park ) 대한류마티스학회 2016 대한류마티스학회지 Vol.23 No.2
Objective. Although previous trials suggested a relationship between neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and systemic inflammatory response, clinical utility of NLR and PLR in rheumatoid arthritis (RA) is not well defined. This study was conducted to assess the efficiency of NLR and PLR as an inflammatory index in patients with RA. Methods. A total of 107 patients with newly diagnosed RA who had never used steroid and a control group of 50 age- and gender-matched healthy subjects whose high sensitive C-reactive protein (hsCRP) was within normal range were included. Those with cerebrovascular diseases, diabetes, malignancies, or any cardiovascular diseases were excluded from both groups. The patients were divided into two groups according to the Disease Activity Score of 28 joints (DAS28). Group 1 included patients with a DAS28 score of 3.2 and lower (low disease activity) and group 2 included patients with a score higher than 3.2 (moderate to high disease activity). Results. NLR and PLR in the patient group were 2.99±2.04, 170.90±86.49, significantly higher than that of the control group. NLR and PLR in group 2 were 4.16±2.50, 225.23±93.21, significantly higher than those of group 1 patients (2.26±1.22, 137.15±61.92). NLR and PLR both showed correlation with rheumatoid factor, hsCRP, serum albumin, Korean Heath Assesment Questionnaire, and DAS28. Conclusion. These data showed a positive correlation between NLR or PLR level and RA disease activity, suggesting that NLR or PLR can be used as an additional inflammatory marker in patients with RA. (J Rheum Dis 2016;23:96-100)
박민기 ( Min Gi Park ),이지현 ( Ji Hyun Lee ),김성준 ( Sung Jun Kim ),박수호 ( Su Ho Park ),박석기 ( Suk Ki Park ),최준설 ( Joon Sul Choi ),황지연 ( Ji Yeon Hwang ) 영남대학교 의과대학 2017 Yeungnam University Journal of Medicine Vol.34 No.1
Gitelman syndrome is a condition caused by a mutation of the thiazide sensitive Na-Cl cotransporter gene on the distal convoluted tubule. It results in a variety of clinical features, including hypokalemia, hypomagne-semia, hypocalciuria, and metabolic alkalosis. It is often diagnosed in asymptomatic adults presented with unexplained hypokalemia; however, it is sometimes associated with muscular cramps, numbness, fatigue, weakness, or paralysis. We experienced a case of rheumatoid arthritis accompanied by Gitelman syndrome, presented with hand tremor. We diagnosed her using renal clearance study and genetic analysis. Here, we report our experiences regarding this case along with a literature review.