다발성 경화 소견으로 발현된 림프구성 간질성 폐렴

황규식 ( Kyu Sig Hwang ),노영욱 ( Young Wook Roh ),송성헌 ( Sung Heon Song ),김상헌 ( Sang Heon Kim ),손장원 ( Jang Won Sohn ),윤호주 ( Ho Joo Yoon ),신동호 ( Dong Ho Shin ),박성수 ( Sung Soo Park ),오영하 ( Young Ha Oh ),김태형 ( 대한결핵 및 호흡기학회 2009 Tuberculosis and Respiratory Diseases Vol.67 No.1

Lymphocytic interstitial pneumonia (LIP) is a rare disorder characterized by a diffuse infiltration of the alveolar space, interstitium by lymphocytes, plasma cells, and reticuloendothelial cells. Although its etiology is unknown, LIP has been associated with autoimmune disorders and with viral infections. Because it`s clinical and radiographic features are nonspecific, a confirmatory diagnosis is performed by open lung biopsy. A 59-year-old female presented dry cough, which had been present for 1 month. On initial findings of multifocal consolidation at the right middle lobe on both lower lobes in chest radiography, the first diagnosis of cryptogenic organizing pneumonia was suggested. On open lung biopsy, LIP was diagnosed. The patient had no autoimmune disease, viral infection or monoclonal gammopathy. After 3 months of corticosteroid treatment, the patient experienced improved symptoms, reduced abnormalities on chest radiography, and improved pulmonary function testing.

신장 ; 폐암 환자에서 항암요법 중 발생하는 시스플라틴신병증

황규식 ( Kyu Sig Hwang ),노영욱 ( Young Wook Rho ),정명호 ( Myung Ho Jung ),구태연 ( Tai Yeon Koo ),박준성 ( Joon Sung Park ),이창화 ( Chang Hwa Lee ),강종명 ( Chong Myung Kang ),윤호주 ( Ho Joo Yoon ),신동호 ( Dong Ho Shin ),박 대한내과학회 2010 대한내과학회지 Vol.78 No.3

목적: 시스플라틴(cisplatin)은 여러 고형암 치료에 효과적이지만 신독성이 중요한 제한점이다. 이 연구는 폐암으로 일련의 항암치료를 받는 환자에서 발생하는 시스플라틴신병증의 빈도, 경과 및 임상적 특징을 조사하고자 시행되었다. 방법: 시스플라틴+paclitaxel 병합요법을 시행받은 폐암 환자 124명의 자료를 후향적으로 검토하였다. 시스플라틴은 체표면적 m2당 70 mg을 1회 투여하였고, 3주 간격으로 6회까지 반복하였다. 예방적 수액요법으로 0.45% 식염수 3 L를 투여하였다. 시스플라틴을 투여하고 그 다음 투여 직전인 3주 후 추적한 혈청 크레아티닌이 기저치에 비해 30% 이상 상승한 경우를 급성 시스플라틴신병증으로 정의하였고, 6회 항암치료를 모두 종료하고 측정한 혈청 크레아티닌 농도가 최초 기저치에 비하여 50% 이상 상승한 경우를 만성 시스플라틴신병증으로 정의하였다. 결과: 급성 시스플라틴신병증은 1차부터 6차 항암치료까지 124명 중 23명(18.5%), 110명 중 8명(7.2%), 92명 중 6명(6.5%), 69명 중 10명(14.7%), 59명 중 7명(11.9%), 45명 중 7명(15.6%)에서 각각 발생하였다. 결국, 전체 환자 중 모두 51명(41.1%)에서 급성 시스플라틴신병증을 경험하였다. 만성 시스플라틴신병증은 총 6회 항암요법을 마친 45명 중 25명(55.5%)에서 발생하였다. 만성 시스플라틴신병증의 발생과 급성 시스플라틴신병증의 발생은 유의한 상관관계가 있었다(p<0.01). 만성 시스플라틴신병증 환자군에서 혈청 크레아티닌은 기저치 0.82±0.11 mg/dL에서 1.82±1.18 mg/dL으로 증가하였으나, 112±90일 지나서 검사한 혈청 크레아티닌은 1.60±1.05 mg/dL로 안정적이었다. 결론: 예방적 수액요법에도 불구하고 폐암 환자에서 시스플라틴신병증의 발생 빈도는 여전히 높아 보인다. 급성 시스플라틴신병증을 경험한 환자에서 다시 시스플라틴에 노출되었을 때 만성 시스플라틴신병증 발생이 증가하였으나, 만성시스플라틴신병증은 대부분 진행하지 않았다. Background/Aims: This study characterized the cisplatin nephrotoxicity occurring in patients treated with chemotherapy for lung cancer. Methods: In all, 124 patients with lung cancer received cisplatin 70 mg/m2 on day 1 every three weeks for up to six cycles with preventive hydration using 3 L of 0.45% saline. Acute and chronic cisplatin nephropathy were defined as an increase in serum creatinine ≥30% at 3 weeks after each cisplatin administration and an increase in serum creatinine ≥ 50% after the six cycles of chemotherapy, respectively. Results: Acute cisplatin nephropathy occurred in 23 of 124, 8 of 110, 6 of 92, 10 of 68, 7 of 59, and 7 of 45 patients after the 1st to 6th cycle of chemotherapy, respectively. In all, 51 patients (51.5%) experienced acute cisplatin nephropathy. Chronic cisplatin nephropathy occurred in 25 out of 45 patients (55.5%). The occurrence of chronic cisplatin nephropathy was significantly associated with that of acute cisplatin nephropathy (p<0.01). In chronic cisplatin nephropathy, the serum creatinine increased to 1.82±1.18 mg/dL from the basal 0.82±0.11 mg/dL (p<0.01). It was 1.60±1.05 mg/dL at the end of the follow-up period (112±90 days). Conclusions: Despite prophylactic hydration, the incidence of cisplatin nephropathy in patients with lung cancer is still high. Acute cisplatin nephropathy may predispose patients to chronic cisplatin nephropathy, but the latter does not seem to be progressive. (Korean J Med 78:341-347, 2010)

신이식 환자에서 발생한 재발성 유방외 파제트병 1예

노영욱 ( Young Wook Roh ),황규식 ( Kyu Sig Hwang ),정명호 ( Myung Ho Jeong ),박준성 ( Joon Sung Park ),이창화 ( Chang Hwa Lee ),김근호 ( Gheun Ho Kim ),백승삼 ( Seung Sam Paik ),김정태 ( Jeong Tae Kim ),강종명 ( Chong Myung Kan 대한신장학회 2009 Kidney Research and Clinical Practice Vol.28 No.6

The incidence of malignant disease increases in kidney transplant recipients taking immunosuppressive therapy. Extramammary Paget`s disease, a very rare dermatologic malignancy, is characterized by frequent recurrences and coexistence with other malignancies. Although skin cancer is the most common malignancy occurring after kidney transplantation, extramammary Paget`s disease has not been reported in Korea. In this paper, we report a case of recurrent extramammary Paget`s disease after renal transplantation. A 66-year old man, who underwent renal transplantation from a living unrelated donor 15 years ago, was diagnosed to have extramammary Paget`s disease 7 years ago. At this admission he was troubled with a pruritic skin lesion in his suprapubic area which previously occurred twice. The recurring Paget`s disease was treated with radical resection and coverage. No further recurrences have been developed during the following 12 months until now.

혈액투석 환자에서 적혈구생성자극제 사용과 헤모글로빈 변이성

박수경 ( Su Kyoung Park ),황규식 ( Kyu Sig Hwang ),박준성 ( Joon Sung Park ),이창화 ( Chang Hwa Lee ),강종명 ( Chong Myung Kang ),김근호 ( Gheun Ho Kim ) 대한신장학회 2011 Kidney Research and Clinical Practice Vol.30 No.1

Purpose: This study was undertaken to examine whether differences exist in the hemoglobin variability according to the types of erythropoiesis stimulating agent (ESA) in hemodialysis (HD) patients. Methods: Clinical data were retrospectively analyzed from 72 patients on maintenance hemodialysis who were using darbepoetin alfa (n=27), epoetin beta (n=27), and epoetin alpha (n=18). As parameters of hemoglobin variability, hemoglobin cycling, the variance of hemoglobin and the SD/mean of hemoglobin were analyzed. Hemoglobin cycling was defined as the presence of cycles with an amplitude >1.5 g/dL and lasting more than 2 months. Results: Hemoglobin cycling was present in 53 (73.6%) out of 72 HD patients. Hemoglobin cycling in patients receiving darbepoetin alfa had greater frequency (1.63±0.93 vs. 1.00±0.88 times/year, p<0.05), amplitude (2.88±1.48 vs. 1.88±1.60 g/dL, p<0.05), and velocity (1.21±0.74 vs. 0.73±0.66 g/dL/month, p<0.05) than that in patients receiving epoetin beta. The variance of hemoglobin in patients receiving epoetin beta (0.79±0.53 g/dL) was smaller than that in patients receiving darbepoetin alfa (1.29±0.70 g/dL, p<0.05) and epoetin alfa (1.08±0.52 g/dL, p<0.05). Also, the ratio of SD/mean of hemoglobin in patients receiving epoetin beta (8.20±2.59%) was lower than that in patients receiving darbepoetin alfa (10.81±2.10%, p<0.05) and epoetin alfa (10.30±2.10%, p<0.05). Conclusion: Hemoglobin variability is differential according to various ESAs, and it may be less with epoetin beta compared with darbepoetin alpha and epoetin alpha.

지속외래복막투석 환자에서 발생한 methicillin내성 Staphylococcus auricularis 복막염

최종욱 ( Jong Wook Choi ),김배근 ( Bae Keun Kim ),황규식 ( Kyu Sig Hwang ),박준성 ( Joon Sung Park ),이창화 ( Chang Hwa Lee ),강종명 ( Chong Myung Kang ),김근호 ( Gheun Ho Kim ) 대한신장학회 2010 Kidney Research and Clinical Practice Vol.29 No.5

Although coagulase-negative staphyloccus is the most common organism causing peritonitis in perito-neal dialysis (PD) patients, only one case of PD peritonitis due to Staphylococcus auricularis, the normal flora of external auditory meatus, has been reported over the world. Here we add a case of PD peritonitis caused by methicillin-resistant Staphylococcus auricularis, which was successfully treated with vancomycin. A 79-year-old male PD patient was admitted because of abdominal pain and cloudy peritoneal fluid. At admission, the exit site was clear, and no rebound tenderness was noted although the abdominal wall was diffusely tender. Gram stain of the peritoneal fluid did not reveal any organism, but white blood cell count was 1,210/mm3, with 80% polymorphonuclear cells and 10% lymphocytes. Empirical antibiotic therapy was started with intraperitoneal cefazolin and ceftazidime. Over the next few days, however, the peritoneal fluid was still turbid and showed an elevated cell count. Then, the result of peritoneal fluid culture identified that the organism was oxacillin-resistant Staphylococcus auricularis. Thus the antibiotics were switched into vancomycin, and intraperitoneal vancomycin 1 gm was administered three times at 5 days` intervals to achieve completely clear peritoneal fluid. Staphylococcus auricularisshould be considered as a new potential skin organism causing PD peritonitis.

Tacrolimus로 효과적으로 치료된 저항성 다발근육염

안용우 ( Yong Woo Ahn ),송성헌 ( Sung Heon Song ),황규식 ( Kyu Sig Hwang ),유대현 ( Dae Hyun Yoo ),김나래 ( Na Rae Kim ),김태환 ( Tae Hwan Kim ) 대한류마티스학회 2009 대한류마티스학회지 Vol.16 No.4

Polymyositis is one form of inflammatory myopathy. In some patients, this disease does not entirely respond to conventional initial therapy with glucocorticoid, methotrexate and azathioprine. Multiple options exist for treating these patients, but only intravenous immune globulin has been subjected to a randomized clinical trial. We report here on a case of polymyositis that did not respond to multiple drug therapy, but it did respond to tacrolimus. After treatment with tacrolimus, the patient`s disease has been well controlled for many years.