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증례 / Warfarin 사용 중에 발생한 급성 신부전증을 동반한 Purple Toe Syndrome 1예
홍성관(Sung Kwan Hong),류동렬(Dong Ryeol Ryu),이재훈(Jae Hoon Lee),박효경(Hyo Kyoung Park),조영준(Young Jun Cho),조정호(Jeong Ho Cho),강신욱(Shin Wook Kang),최규현(Kyu Hun Choi),조승연(Seung Yun Cho),한대석(Dae Suk Han),이호영(Ho Yun 대한내과학회 1999 대한내과학회지 Vol.56 No.2
Purple toe syndrome is an extremely rare complication of warfarin therapy. The occurrence of purple toe syndrome is characterized by a sudden appearance of purplish discoloration of toes and the sides of feet. The skin lesions usually develop 3-8 weeks after beginning anticoagulation. The pathogenesis was not clearly defined but the presence of atherosclerosis in most of patients led to suggest that the mechanism was related to cholesterol emboli from the atherosclerotic plaques and warfarin- induced bleeding into the plaques. These microemboli are commonly associated with irreversible organ dysfunction such as renal failure, distal gangrene, pancreatitis, and multifocal myocardial necrosis. Therefore purple toe syndrome may be considered as a sentinel of cholesterol crystal embolism. Once established, anticoagulation and thrombolysis are contraindicated. Necrosis and gangrenous changes may result in loss of limb and occasional mortality has been reported. We report a case of purple toe syndrome associated with acute renal failure after warfarin therapy with a review of literatures.
호산구증다증을 동반한 P-ANCA 양성 괴사성 사구체신염
신장열 ( Jang Yel Shin ),강이화 ( Ea Wha Kang ),류동렬 ( Dong Ryeol Ryu ),송정식 ( Jung Sik Song ),이원기 ( Won Ki Lee ),박용범 ( Yong Beom Park ),김루시아 ( Lucia Kim ),정현주 ( Heun Ju Jung ),이수곤 ( Soo Kon Lee ) 대한류마티스학회 2000 대한류마티스학회지 Vol.7 No.1
Antineutrophil cytoplasmic antibodies (ANCAs) are now regarded as a serologic marker for pauci-immune crescentic necrotizing glomerulonephritis either in renal-limited form or in association with systemic vasculitis, such as Wegener`s granulomatosis, microscopic polyarteritis, and Churg-Strauss syndrome. Two major ANCA antigens have been indentified: proteinase3, which produces a cytoplasmic staining pattern termed C-ANCA, and myeloperoxidase, which produces a perinuclear pattern termed P-ANCA on ethanol-fixed neutrophils by indirect immunofluorescence. In ANCA- associated diseases, eosinphilia in excess of 1.5×10(9)/L has been proposed to be characteristic of Churg-Strauss syndrome and is rare in other forms of ANCA-associated systemic vasculitis and crescentic necrotizing glomerulonephritis. Recently, there were two cases of P-ANCA positive crescentic necrotizing glomerulonephritis with peripheral blood eosinophilia and extrarenal microscopic vasculitis without asthma or granulomas. We experienced a patient with P-ANCA positive pauci-immune necrotizing glomerulonephritis with few eosinophilic infiltration and eosinophilia. He improved with oral prednisolone along with combination of intravenous cyclophosphamide. So we report this case with the review of literature.
폐색전 제거술 후 혈전에서 우연히 확인된 원발 미상 편평 상피 세포암
최창환 ( Chang Hwan Choi ),박영수 ( Young Soo Park ),류동렬 ( Dong Ryeol Ryu ),박성하 ( Sung Ha Park ),고원기 ( Won Ki Ko ),안강현 ( Kang Hyun Ahn ),박재민 ( Jae Min Park ),김세규 ( Se Kyu Kim ),장준 ( Joon Chang ),김성규 ( Sung 대한결핵 및 호흡기학회 1999 Tuberculosis and Respiratory Diseases Vol.47 No.1
복강내 농양과 연관되어 S자 결장으로 연결된 원발성 대동맥 장관루
이원호 ( Won Ho Lee ),정철민 ( Chul Min Jung ),조은희 ( Eun Hee Cho ),류동렬 ( Dong Ryeol Ryu ),최대희 ( Dae Hee Choi ),김재환 ( Jai Hwan Kim ) 대한소화기학회 2014 대한소화기학회지 Vol.63 No.4
Plummer-Vinson syndrome manifests as cervical dysphagia, iron deficiency anemia, an upper esophageal web, and atrophic glossitis. The cause of the esophageal web is thought to be iron deficiency anemia; however, the cause of Plummer-Vinson syndrome has not been established. Crohn`s disease is usually accompanied by malnutrition and iron deficiency anemia; however, no case of concomitant Crohn`s disease and Plummer-Vinson syndrome with aggravated malnutrition and anemia has been previously reported. Here, we report on a rare case of Plummer-Vinson syndrome in a Crohn`s disease patient, which caused malnutrition and constipation.
최규헌(Kyu Hun Choi),이호영(Ho Yung Lee),한대석(Dae Suk Han),하성규(Sung Kyu Ha),류동렬(Dong Ryeol Ryu),송현용(Hyun Yong Song),신석균(Suk Kyun Shin),황재하(Jae Ha Hwang),노현정(Hyun Jung Roh),유태현(Tae Hyun Yoo),김주성(Joo Seong Kim 대한신장학회 2000 Kidney Research and Clinical Practice Vol.19 No.1
N/A Lupus nephritis is a major cause of morbidity and mortality arising from systemic lupus erythematous. It is generally acknowledged that the presence of diffuse proliferative lupus nephritis(DPLN) is highly predictive of a poor prognosis in terms of renal and patient out- come on survival. The objective of this study was to evaluate the clinicopathologic characteristics, renal out- come according to therapeutic regimen, and prognostic factors of biopsy-proven diffuse proliferative lupus nephritis. Among the biopsy-proven lupus nephritis patients who were admitted to Yonsei University Medical Center from January 1986 to June 1997, 36 patents who were diagnosed DPLN by renal biopsy and treated for at least 6 months and regularly followed-up for at least 12 months were included. We retrospec-tively reviewed the medical recorders. Patients were treated with steroid regimen with or without cyclo-phosphamide. According to the therapeutic response, patients were divided into two groups : a therapeutic response group(n=24), and a therapeutic non-response group<n=12). The mean age of the patients was 27.4 years and the mean follow-up duration was 51 months. Lupus nephritis developed at a mean 9.7 months after SLE diagnosis and mean duration of nephritis was 39.2 months. Mean serum creatinine was 1.6mg/ dL, 24 hour proteinuria was 4,873mg, and anti-DNA antibody was positive in 8196 of patients at the time of renal biopsy. Activity index and chronicity index were 10.4 and 2.8, respectively. Overall 5 year renal survival rate was 7596 and no difference between steroid single therapy and cyclophosphamide combination therapy was observed. Factors affecting therapeutic response included delayed development of nephritis(3.1 vs 13.8 months, p<0.05) and elevated serum creatinine level(0.9 vs 1.9mg/dL, p<0.05), which were associated with poor therapeutic response. Other clinicopathologic, biochemical and immunologic parameters were not different between the therapeutic response group and the therapeutic non-response group. In conclusion, delayed development of lupus nephritis and elevated serum creatinine at nephritis presentation are poor prognostic factors of DPLN, but further randomized prospective study{including divided cytoxan intravenous pulse therapy and oral therapy, with long-term follow-up) is necessary.
이차성 부갑상선 기능 항진증이 있는 지속성 외래 복막투석(CAPD) 환자에서 칼시트리올(칼시오) 경구 충격요법과 저용량 매일요법의 비교 연구
강신욱(Shin Wook Kang),최규헌(Kyu Hun Choi),이호영(Ho Yung Lee),한대석(Dae Suk Han),유태현(Tae Hyeon Yoo),신석균(Sug Kyun Shin),하성규(Sung Kyu Ha),노현진(Hyun Jin Noh),류동렬(Dong Ryeol Ryu),송현용(Hyun Yong Song),황재하(Jae Ha Hwan 대한신장학회 2000 Kidney Research and Clinical Practice Vol.19 No.3
N/A The most widely used method for treatment of secondary hyperparathyroidism(SH) in CAPD patients has been the administration of calcitriol by oral route. In this study, we compared the efficacy and safety of daily low dose calcitriol therapy with those of intermittent high dose pulse therapy. The study group consisted of 38 patients undergoing CAPD with serum intact PTH level of more than 200pg/ mL. Twenty patients were randomly administered daily low dose calcitriol(0.25μg/day for 1 month followed by 0.5μg daily dose for the next 3 mon-ths) while 18 patients were given intermittent pulse therapy(0.5μg-0.5μg-0.75μg 3 times a week for 1 month, increased to 1.0μg-1.25μg-1.25μg 3 times a week for the next 3 months). Thirty five patients completed the study : 17 on daily oral calcitriol (M: F=0.7:1, mean age=47.3±10.6 years, mean duration of CAPD=48.9±41.1 months), and 18 on oral pulse calcitriol(M: F=1.6: 1, mean age=41.5±12.7 years, mean duration of CAPD=49.2±41.6 months). The baseline serum levels of calcium, phosphorus, i-PTH, alkaline phosphatase, and total CO₂were not different be- tween daily and pulse group(9.5±0.8 vs 9.3±0.9mg/ dL, 5.8±1.3 vs 5.1±1.2mg/dL, 443.1±162.5 vs 546±385.9pg/mL, 91.8±47.7 vs 108.9±66.5IU/L, 23.7±1.9 vs 25.5±2.0mEq/L, p>0.05, respectively). The i-PTH level decreased significantly in daily calcitriol group after 1 month(332.8±214.8pg/mL, p<0.01), and at final evaluation(180.4±254.8pg/mL, p<0.01). In pulse calcitriol group, i-PTH level also decreased signi-ficantly to 400,4±225.8pg/mL(p<0.05), 89.4±122.6 pg/mL(p<0.01), respectively. The rate of decline in i-PTH level from baseline were similar(daily=25.4±22.7 vs pulse=19.5±12.6%decline/month, p>0.05). The serum calcium increased similarly in both groups after treatment(daily=10.6±0.8 vs pulse=l0.1±1.0mg/ dL, p>0.05). Hypercalcemia(>11.0mg/dL) was rarely observed in all patients(daily=5, pulse=8 episodes). In conclusion, both daily and pulse calcitriol therapy were similarly effective and safe in control of SH.
감염관련 혈구탐식증후군 (Infection-Associated Hemophagocytic Syndrome)으로 추정되는 2예 보고 및 국내 증례 분석
류동렬,염준섭,장경희,홍성관,박윤수,최영화,송영구,양우익,유내춘,한지숙,김준명 대한감염학회 1998 감염 Vol.30 No.5
목적: 혈구탐식증후군은 골수, 간, 림프절 및 비장에 조직구 증식과 침윤이 있으면서 이들에 의한 혈구탐식의 소견을 보이며, 임상적으로는 고열, 전신쇠약, 간비종대 및 림프절종대를 보이고, 말초혈액에서 범혈구 감소증, 혈액응고 이상 및 간기능 이상을 보이는 질환이며, 악성 질환의 증거없이 감염증과 관련되어 나타나는 경우를 infection-associated hemophagocytic syndrome이라 한다. 저자 등은 평소 건강하던 환자에서 감염증과 관련된 것으로 추정되는 혈구탐식증후군 2예를 경험하고 보고하고 현재까지 국내에서 보고된 IAHS에 대한 역학, 임상증상, 검사 소견, 관련 감염 질환, 기저 질환의 유무에 대해 고찰하고자 하였다. 방법: 1985년부터 국내에서 보고된 IAHS에 대한 31예의 증례보고를 고찰하고, 본원에서 경험한 증례 2예의 임상증상, 말초혈액 소견, 골수 천자 소견을 조사하였다. 결과: 총 33예의 IAHS 중 평균 연령은 20.8세 였고 남녀의 비율은 2:1로 남자에서 흔하였으며, 발열(100%), 간종대 (84.8%) 비종대 (81.8%), 범혈구감소증(51.5%), 혈액응고장애(69.7%), 간기능이상 (75.8%) 소견이 흔하게 관찰되었고, 바이러스 감염과 동반된 경우가 10예였으며 그 중에서 헤르페스 바이러스가 가장 흔하였고, 세균감염이 7예에서 동반되었다. 스테로이드 치료, 발기신부전, 간경변, 급성 골수성 백혈병 및 골수 이형성 증후군으로 화학요법을 시행 받은 후 면역 억제 상태에서 발생한 경우도 있었으나, 기저 질환을 찾을 수 없는 경우도 25예가 있었다. 결론: 감염증과 관련된 혈구탐식증후군은 비교적 드문 질환이나 현재까지 그 치료방법에 대해 정립된 바가 없어 치명적일 수 있다. 향후 본 질환에 대한 정확한 진단과 관련 감염질환을 찾기 위한 노력이 좀더 적극적으로 이루어져야 할 것이며, 적절한 치료법의 정립이 필요할 것으로 사료된다. The hemophagocytic syndrome is a disorder caused by systemic proliferation of benign histiocytes with avid phagocytosis of blood cells. Although this is an established disease entity, early clinical diagnosis is often difficult. The disease is known to be rare. The clinical and laboratory characteristics of 33 patients with the infection-associated hemophagocytic syndrome were reviewed which included previously reported 31 cases from the literature, and 2 recent cases presented in this study. The patients were 22 males and 11 females with a mean age of 20.8 years(range 1 to 69 years). Ten patients were associated with viral infection and seven with bacterial infection. The infection usually occurs in patients with preexisting immunological abnormalities, but in this study underlying illness was found in only 8 out of the 33 cases. The overall mortality rate was 63.6%, which is a higher percentage than in other countries. Since the clinical course can be fulminant, accurate diagnosis and effective treatment are needed.