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증례 : 알레르기 ; 서혜부에 재발한 기무라씨 병 1예
한성환 ( Sung Hwahn Hahn ),한진형 ( Jin Hyung Han ),김경묵 ( Kyung Mook Kim ),김도형 ( Do Hyung Kim ),김윤섭 ( Youn Seup Kim ),박재석 ( Jae Seuk Park ),지영구 ( Young Koo Jee ) 대한내과학회 2011 대한내과학회지 Vol.80 No.6
기무라씨 병은 주로 젊은 동양인 남자에게서 다양한 부위에 무통성 종괴로 나타나지만 두경부 영역에 호발하며 양성경과를 띠는 것으로 알려져 있어 국내에서 장기적인 경과관찰이 이루어진 예가 드물다. 이에 병변의 발생이 드문 서혜부에 재발하여 수술적 절제 후 전신적으로 스테로이드를 투여하며 5년간 경과관찰 중인 여성 환자의 1예를 보고하는 바이다. Kimura disease is a rare chronic inflammatory disorder of unknown etiology, suggestive of an allergic or autoimmune mechanism, which presents mainly as soft tissue masses in the head and neck area in young Asian males. Blood tests show eosinophilia and an elevated immunoglobulin E; the typical pathologic findings are lymphoid follicular hyperplasia, interfollicular eosinophilic infiltration, and vascular hyperplasia. There is no standard treatment; surgical resection is preferred and systemic steroid or radiotherapy is used to treat disease relapses. Kimura disease in unusual sites has been reported, but there are few cases with long-term observations because of its benign nature. Here, we present the case of a female with recurrent Kimura disease; we follow her progress for about 5 years after surgical resection of masses in the right groin area, an unusual site, with a brief review of the literature. (Korean J Med 2011;80:745-750)
( Yo Han Kim ),( Kyoung Hwang Shin ),( Sung Hwahn Hahn ),( Jae Hwan Kong ),( Joon Ho Choi ),( Seoung Min Jeon ),( Hyun Deok Shin ),( Suk Bae Kim ),( Jung Eun Shin ),( Hong Ja Kim ),( Il Han Song ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: Sarcomatoid carcinoma arising from intrahepatic cholangiocyte, an extremely rare primary liver cancer, has highly invasive and metastatic potential. The pathogenesis of this tumor is unclear, although histogenetic mechanisms such as ‘transformation’, ‘combination’ and ‘collision’ might be suggested to explain the simultaneous co-existence of carcinoma and sarcoma components in the same tumor. Case: A 58 year-old male presented with a hepatic mass that was found during regular health examination. Liver computed tomography (CT) scan revealed 2. 0 cm-sized heterogeneous low density mass without enhancement located on the segment 6. Magnetic resonance imaging showed the tumor of segment 6 with a low-signal intensity in T1-weighted image and a high-signal intensity in T2-weighted image. Positron emission tomography-CT showed a focal hypermetabolic lesion in the same area, with no evidence of distant metastasis. This mass was suspected to be intrahepatic cholangiocarcinoma by ultrasonography-guided needle biopsy, so right posterior sectionectomy was performed. The resected liver showed a well-defi ned whitish or yellowish gray solid mass with a central hemorrhage and necrosis at a subcapsular area of segment 6. Microscopically, the tumor tissue consists of multiple polygonal and pleomorphic cells. The tumor cells were immunohistochemically positive for cytokeratin 19 and vimentin, but negative for Hep-par 1. The patient was confi rmed a defi nitive diagnosis of intrahepatic sarcomatoid carcinoma. After 2 months, the patient developed extensive abdominal metastases and received systemic chemoradiotherapy, resulting in no response visible radiologically. Conclusions: We report an unusual case of sarcomatoid carcinoma of the liver arising from intrahepatic cholangiocyte, confi rmed by immunohistochemical analysis following surgical resection.
( Hyun Don Joo ),( Kyoung Hwang Shin ),( Sung Hwahn Hahn ),( Jae Hwan Kong ),( Suk Bae Kim ),( Il Han Song ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: Cardiac cirrhosis, an uncommon disease entity of chronic liver injury, usually results from long-standing right-sided heart failure in which an elevated venous pressure was transmitted via inferior vena cava (IVC) and hepatic vein to sinusoids of the liver. Long-term hepatic congestion with relative ischemia can induce centrilobular necrosis, leading to pericentral fi brosis. Case: A 67 year-old male with liver cirrhosis of unknown origin was admitted with pretibial pitting edema, ascites and progressive dyspnea on exertion for 1 month. Four years ago, He received transcatheter arterial chemoembolization for hepatocellular carcinoma. At that time on admission, electrocardiography showed typical atrial fi utter with 2:1 or 3:1 conduction and serum cardiac enzymes were within normal limit. A chest radiograph showed a remarkable cardiomegaly with bilateral pleural effusion, being ascertained as transudate. Chest computed tomography (CT) scan showed the anterior pericardial calcifi cation with wall thickening. Dynamic liver CT scan showed a nodular hepatic contour with a small amount of ascites, especially, accompanying with the regurgitation of contrast materials to intrahepatic veins via IVC from right-sided heart chamber. Transthoracic echocardiography demonstrated moderate tricuspid regurgitation and left ventricular ejection fraction of 40%. Liver histology by ultrasound-guided needle biopsy revealed macrovesicular steatosis and bridging fi brosis with a minimal hepatic necroinfi ammation. Cardiac cirrhosis was confi rmed by histological and radiological fi ndings. After symptomatic improvement following conservative managements including diuretics, the patient is being followed up regularly. Conclusions: Based on the histological and radiological features, we report an uncommon case of cardiac cirrhosis caused by constrictive pericarditis accompanying with pericardial calcifi cation.
( Sun Young Ann ),( Kyoung Hwang Shin ),( Sung Hwahn Hahn ),( Jae Hwan Kong ),( Suk Bae Kim ),( Il Han Song ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: Echinococcosis, so called hydatid disease, is a representative zoonosis. Human cystic echinococcosis usually occurs as a result of infection by the larval stage of species Echinococcus granulosus, genus Echinococcus, via the ingestion of food and water fecally contaminated with eggs from the primary hosts such as dogs and wolves. Case: A 58 year-old male was admitted for further evaluation of liver cystic mass detected on routine examination of liver ultrasound. He was an immigrant worker from North-East China 4 year ago. At the time on admission, past medical history, physical examination, and laboratory findings including tumor markers showed no specific. Computed tomography and magnetic resonance imaging showed three cystic nodular lesions with calcifi cation in the liver: one 9 cm-sized exophytic cyst with daughther cysts (cysts in cyst) on left lateral segment; another 3. 5 cm-sized cyst with a focal wall calcifi cation on segment 8; and the other 2. 3 cm-sized dense calcifi ed nodule on segment 4. Surgical resection was performed for diagnostic confirmation and complete removal. Grossly, the left liver mass showed a lobulated cyst with a well-demarcated, reddish yellow-colored, and smoothy round nature, measuring 9. 5x9,5x8. 5 cm. The cut-surface of this cystic mass showed a yellow-colored unilobular cystic wall containing variable-sized membranes with a thin, transparent, and fi abby appearance. Microscopically, Brood capsules containing protoscolices of E. granulosus were scattered on the laminated cystic walls with germinal layers. Two other cystic masses revealed calcifi ed degenerations. After successful recovery without any complication following surgery, the patient was discharged with the medication of antihelminthic albendazol 400 mg twice daily, with a fat-rich meal for 4 weeks. Conclusions: We report a case of cystic echinococcosis of liver with typical fi ndings of radiological and histological features in immigrant worker from China.
페그-인터페론과 리바비린 병합치료 중 발생한 간질성 페렴 및 범혈구 감소증
서지현 ( Ji Hyun Suh ),한성환 ( Sung Hwahn Hahn ),이지은 ( Ji Eun Lee ),한진형 ( Jin Hyung Han ),김경묵 ( Kyung Mook Kim ),김도형 ( Doh Hyung Kim ),김윤섭 ( Yon Seop Kim ),박재석 ( Jae Suk Park ),지영구 ( Young Koo Jee ) 대한결핵 및 호흡기학회 2011 Tuberculosis and Respiratory Diseases Vol.70 No.1
The combination therapy of pegylated interferon and ribavirin is the mainstay of treatment for chronic hepatitis C patients. Anti-viral therapy is commonly associated with side effects such as headache, fever, myalgia, and arthralgia. However, anti-viral therapy can continue because these side effects are mostly mild and can be improved with supportive management. Anti-viral therapy should be stopped promptly if serious side effects, such as interstitial pneumonitis or hemolytic anemia occur, although those serious side effects are rare. There were a few case reports of interferon-related interstitial pneumonitis worldwide. In Korea, one atypical case report of interstitial pneumonitis has been reported, which followed the combination therapy of interferon-alpha and ribavirin in a patient with chronic hepatitis C. We present a case of interstitial pneumonitis and pancytopenia following the combination therapy of pegylated interferon and ribavirin in a patient with chronic hepatitis C.
A549 기도상피세포에서 IL-8 전사와 분비에 미치는 Dexamethasone과 Troglitazone의 병합투여효과
김남희 ( Nam Hee Kim ),이호연 ( Ho Youn Lee ),서지현 ( Ji Hyun Suh ),한성환 ( Sung Hwahn Hahn ),김도형 ( Doh Hyung Kim ),김윤섭 ( Youn Seop Kim ),박재석 ( Jae Seuk Park ),지영구 ( Young Koo Jee ) 대한천식알레르기학회 2008 천식 및 알레르기 Vol.28 No.4
Background: Glucocorticoid is a widely used anti-inflammatory agent in a variety of diseases. Recently, peroxisome proliferator activated receptor γ (PPARγ) ligand has been shown to exert a potential anti-inflammatory activity, mainly through their ability to down- regulate pro-inflammatory gene expressions. Objective This study was designed to evaluate the effects of co-treatment with dexamethasone and troglitazone (a ligand of PPARγ) on IL-8 transcription and secretion. Method: Steroid and troglitazone-induced transactivation was measured by using pGRE luciferase reporter gene in the A549 cell line. Steroid-induced transrepression was measured by using stable A549 IgG-NFκB luciferase cell line, which contained the minimal IL-8 promoter region. Result: Co-treatment with dexamethasone and troglitazone showed no additional increase of transactivation activity compared to dexamethasone single treatment. Suppressions of the transcriptional activity in the IL-8 promotor and IL-8 secretion showed no difference in the co-treatment with dexamethasone and troglitazone compared to those in dexamethasone single treatment. Conclusion: Our results suggest that co-treatment with PPARγ ligand and steroid may not have an additive anti-inflammatory activity at least in the airway epithelial cell. (Korean J Asthma Allergy Clin Immunol 2008;28:292-297)
기도상피세포에서 식물 에센셜 오일의 인터루킨-8 분비억제 효과
현경희 ( Kyung Hee Hyun ),김윤섭 ( Youn Seup Kim ),서정근 ( Jeung Keun Suh ),한성환 ( Sung Hwahn Hahn ),김도형 ( Do Hyung Kim ),박재석 ( Jae Suk Park ),지영구 ( Young Koo Jee ) 대한천식알레르기학회 2011 천식 및 알레르기 Vol.31 No.4
Background: Neutrophil is an important inflammatory cell in severe asthma and associated with steroid-resistance in asthma therapy. In addition, interleukin (IL)-8 is a key chemokines recruiting and activating neutrophils. Methods: The aim of this study was to explore the therapeutic potential of aromatherapy using essential oils derived from plant extracts in asthma treatment. Essential oils from citron, pine tree, Chamaecyparis pisifera, and Chamaecyparis obtusa were extracted by water-steam distillation. The promoter activity and secretion of IL-8 were measured by using luciferase assay and enzyme-linked immunosorbent assay after pretreatment in tumor necrosis factor-α stimulated A549 and human bronchial epithelial cells (BEAS-2B) cell lines with diluted essential oils. Results: IL-8 transcription was suppressed with 1 : 500 concentration of each essential oil (P<0.05). IL-8 secretion in A549 cell was suppressed with 1 : 1,000 or higher concentrations of oils except from citron (P<0.05). IL-8 secretion in BEAS-2B cells was decreased after exposure to 1 : 500 concentration of pine tree, Chamaecyparis pisifera and 1 : 2,000 or higher concentrations of Chamaecyparis obtusa (P <0.05). Conclusion: Essential oils from pine tree and Chamaecyparis obtusa may have a therapeutic potential for asthma by regulating neutrophil-mediated inflammation. (Korean J Asthma Allergy Clin Immunol 2011;31:272-280)