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김성권 ( Suhng Gwon Kim ),박재윤 ( Jae Yoon Park ),이성우 ( Seong Woo Lee ),안신영 ( Shin Young Ahn ),정종철 ( Jong Cheol Jeong ),( Sung Hae Chang ),이태원 ( Tae Woo Lee ),오국환 ( Kook Hwan Oh ),진호준 ( Ho Jun Chin ),주권욱 ( 대한신장학회 2010 Kidney Research and Clinical Practice Vol.29 No.6
Purpose: This report examines a patient with pulmonary adenocarcinoma that developed on a previous lesion from microscopic polyangiitis. A 59-year-old woman had been diagnosed with microscopic polyangiitis in October of 1988 based on her clinical symptoms and serological tests, which were positive for anti- neutrophil cytoplasmic antibodies. Her glomerulonephritis had been well controlled with low-dose prednisolone. She presented in October of 2005 with vague chest discomfort and dyspnea on exertion. Physical examination was unremarkable. A non-contrast computed tomography (CT) scan of the chest showed patch ground-glass opacity at the right lower lobe of the lung. Because we did not believe the lesion to be a definite malignancy, we decided to follow up with chest images over a short interval. During the 18 months following the images, the lesion did not change. However, the opacity of the lesion increased slightly over the last two months, and a non-contrast CT scan of the chest was therefore performed. A CT scan showed persistent ground-glass opacity with a slightly solid portion. To diagnose the previous finding and possibly to provide treatment, a right lower lobectomy of the lung via video-assisted thoracoscopic surgery was performed. The pathologic review of the resected lung revealed an adenocarcinoma, stage pT1N0. After one year, fluorodeoxyglucose positron emission tomography was performed, and no evidence of a recurrent malignancy was found.
신혈관성 고혈압의 진단에 있어서 캅토프릴 신스캔의 의의
김성권(Suhng Gwon Kim),이정상(Jung Sang Lee),고창순(Chang Soon Koh),이명철(Myung Chul Lee),정준기(June Key Chung),이동수(Dong Soo Lee),최창운(Chang Woon Choi),배상균(Sang Kyun Bae),양형인(Hyung In Yang),김승철(Sung Chul Kim) 대한핵의학회 1992 핵의학 분자영상 Vol.26 No.2
N/A To evaluate the sensitivity and specificity of captopril renal scan for renovascular hypertension, we employed the captopril renal scan in conjunction with renal angiography in 81 patients, 159 kidneys, who were referred to evaluate the cause of hypertension. We defined the renovascular hypertension by the criteria of demonstration of renal artery stenosis by angiography, and improvement or cure of hypertension by revascularization. Visual and quantitative evaluation of Tc-99m-DTPA renal scan was performed pre and post captopril administration. The prevalence rate of renovascular hypertension was 40% in comparing with renal angiography, and 70% in confirmed cases. The causes of renovascular hypertension in 81 patients were Takayasu's arteritis, fibromuscular dysplasia, atherosclerosis, essential hypertension, chronic pyelonephritis etc. The sensitivity and specificity of captopril renal scan in comparing with renal angiography were 80%, 86.5%, respectively and also 84.2%, 72.6% in confirmed cases of renovascular hypertension, respectively. The causes of false negative cases were nonfunctioning kidney due to complete obstruction or long duration of disease in basal scan, segmental branch artery stenosis, unknown causes, and suspicious true negative cases without confirmation. The false positive cases were abdominal aortic stenosis or aneurysm, dehydration, unknown causes, and suspicious true positive cases. We conclude that captopril renal scintigraphy is highly sensitive, reasonably specific diagnostic method and comparable to other techniques very favorably.
전신성 홍반성 낭창 환자에서 Natural Killer 세포와 Natural Killer T 세포의 분포와 기능에 관한 연구
김현리 ( Hyun Lee Kim ),김성균 ( Seong Gyun Kim ),김연수 ( Yon Su Kim ),이동섭 ( Dong Sup Lee ),정경천 ( Kyeong Cheon Jung ),정종훈 ( Jong Hoon Chung ),안규리 ( Curie Ahn ),한진석 ( Jin Suk Han ),김성권 ( Suhng Gwon Kim ),이정상 ( 대한신장학회 2003 Kidney Research and Clinical Practice Vol.22 No.2
목적 : T 세포 중 표지자인 NK1.1 단백을 표현하는 T 세포를 NKT 세포라고 한다. 이 NKT 세포의 기능에 대하여 정확하게 밝혀지지는 않았지만 최근 들어서 생체 내에서 면역학적 반응을 조절하는 기능을 지니고 있다고 알려지고, 이에 대한 연구가 진행되고 있다. 저자들은 전신성 홍반성 낭창 (SLE)의 발병에 관여하는 NKT 세포의 면역조절기능을 알아보기 위해 말초 혈액 내 NK, NKT 세포의 분포와 외부자극에 대한 NKT 세포들의 기능을 평가하고자 본 연구를 수행하였다. 방법 : SLE 환자 22명과 정상 대조군 18명을 대상으로 NK 표지자 (CD56, CD94)와 T 세포 표지자 (CD3)를 이용한 유세포 분석을 통해 NK와 NKT 세포의 말초혈액 내 분포를 확인하고 이를 질환의 임상지표와 비교하였다. SLE 환자와 정상 대조군의 NKT 세포 기능은 PMA와 ionomycin 자극에 대한 NKT 세포 내의 cytokine (IL-4, IFN-γ)의 발현으로 비교하였다. 결과 : SLE 환자와 정상 대조군을 대상으로 말초혈액 내 NK 세포와 NKT 세포의 수적변화를 비교하였을 때 SLE 환자의 말초혈액 내 NK 세포 (CD3-/CD56+ 4.93±1.30%; CD3-/CD94+ 4.03±1.00%)는 정상 대조군 (CD3-/CD56+ 11.28±1.77%; CD3-/CD94+; 8.15±1.40%)에 비해 감소되어 있었으며 p<0.01), NKT 세포 또한 SLE군이 대조군에 비해 유의하게 감소되어 있었다 (CD3+/CD56+; 1.79±0.42 vs 5.04±0.44%: CD3+/CD94+; 1.21±0.27 vs 4.39±0.45%, p<0.01). NK 세포의 수적변화와 SLE 환자의 임상상과의 연관성을 분석하였을 때 항 ds-DNA 항체가의 증가, ESR의 증가와 C4의 감소와 유의한 연관성을 보였으나 (p<0.05), 신질환의 활동성과는 상관관계를 보이지 않았다. 말초 혈액을 분리, 자극한 후 NK 및 NKT 세포 내 IL-4, IFN-γ를 측정하였을 때, 발현정도는 SLE 환자(n=6)와 정상 대조군(n=6) 사이에 유의한 차이가 없었다. 결론 : SLE 환자에서 면역조절 세포의 일부인 NKT 세포의 수적인 감소는 NKT 세포가 SLE 병인에 밀접한 관계가 있음을 시사한다. 하지만 감소된 NKT 세포의 기능은 정상으로 유지되고 있는 점으로 보아 SLE 환자에서 NKT 세포의 기능적 결함보다는 NKT 세포의 단순한 수의 감소에 의한 면역조절능의 감소가 SLE의 병의 발병및 경과에 영향을 미칠 것으로 판단된다. Background : Systemic lupus erythematosus (SLE) is one of chronic autoimmune diseases of which the central pathophysiologic derangement has not been yet established. Recently, it has been suggested that immune-regulatory cells might affect the development of autoimmune diseases such as SLE and RA. NKT cells were reported to be strong candidate for regulatory cells to regulate immune responses in vivo. To elucidate the roles of immune regulatory cells in the pathogenesis of SLE, we investigated the fractional distribution and functional status of NK and NKT cells in peripheral blood mononuclear cells (PBMC) of SLE patients and healthy volunteers. Methods : Twenty-two SLE patients and 18 agematched healthy volunteers were included in this study. The analysis for NK and NKT cells fraction in PBMCs of patients and normal controls were performed by flow cytometric analysis. In addition, to explore the functional status of these cells in SLE patients, we stimulated PBMCs using phorbol ester and ionomycin and measured cytoplasmic IL-4 and IFN-γ by flow cytometry. Results : The number (percentage) of NK cells was lower in SLE patients (CD3- CD56+ :4.93±1.30%, CD3-CD94+:4.03±1.00%) than in controls (11.28±1.77%, 8.15±1.40%; p<0.01, respectively). Peripheral NK cell numbers negatively correlated with antidsDNA Ab levels (r=0.431, p<0.05) and ESR (r=-0.475, p,0.05). However, the percentage of these cells was not correlated with renal activity or corticosteroid doses. SLE patients showed, compared with controls, significantly decreased numbers of NKT cells (CD3+CD56+ :1.79±0.42% vs 5.04±0.44%, CD3+CD94+ :1.21±0.27% vs 4.39±0.45%; p<0.01, respectively). The cytoplasmic expression of IL-4 and IFN-γ in NK and NKT cells of SLE patients stimulated using phorbol ester and ionomycin were almost sililar to those of normal controls, suggesting the NKT cells from SLE patients are functionally intact. Conclusion : Our results suggested that the decreased numbers of immune regulatory cells were associated with the immune dysregulation of SLE patients. The cellular replacement of NKT cells may be one of useful therapeutic approaches for autoimmune diseases such as SLE.
증례 : 말기 신부전 환자에서 발생한 원발성 신장 혈관육종 1예
김선문 ( Sun Moon Kim ),노한 ( Han Ro ),김치원 ( Chi Weon Kim ),차란희 ( Ran Hui Cha ),김연수 ( Yon Su Kim ),김성권 ( Suhng Gwon Kim ),문경철 ( Kyung Chul Moon ) 대한내과학회 2007 대한내과학회지 Vol.72 No.3
원발성 신장 혈관육종은 매우 드문 악성 종양으로, 그 예후가 불량하다. 외국에서는 20예 정도가 보고되어 왔으나, 아직까지 우리나라에서는 보고된 바가 없다. 저자들은 신장출혈로 발현한 원발성 신장 혈관육종 1예를 경험하였기에 이를 보고한다. 특히 본 증례의 경우, 자발성 신장출혈로 발현하였고, 말기 신부전증으로 투석 치료를 받는 중에 발생하였던 점이 이전의 보고와 다르며, 증상 발현부터 사망까지 3개월여 동안의 방사선학적 검사와 두 차례의 수술 등으로 임상경과를 상세하게 알 수 있었다. 신장출혈을 동반한 환자에서 드물지만, 신장 혈관육종 등이 가능함을 알고 향후 감별진단에 고려해야 하겠다. Primary renal angiosarcoma is a rare and fatal malignant tumor. About 20 cases have been reported in the literature, but there has been no report of renal angiosarcoma in Korea. A 67-year old man with end-stage renal disease was admitted to the hospital for left flank pain. A computed tomography examination revealed a subcapsular hemorrhage in the left kidney. The patient was discharged after 2 weeks of observation. However, at 6 weeks after the discharge, the patient revisited the outpatient clinic due to aggravating pain, and a left nephrectomy was performed. The histopathological diagnosis was angiosarcoma. Three weeks after the nephrectomy, a re-operation was performed because of uncontrolled intra-abdominal bleeding. The surgical findings revealed massive metastasis. The patient died of an uncontrolled hemorrhage about 1 week after the second surgery. To our knowledge, this is the first report of a renal angiosarcoma in a patient with end-stage renal disease. It should be noted that a renal angiosarcoma may be a cause of a retroperitoneal hematoma. (Korean J Med 72:322-325, 2007)