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HBsAg 양성 급성 간염에서 간조직내 B 형 간염 바이러스 항원 검색의 임상적 의의
서상렬(Sang Yeol Suh),서동진(Dong Jin Suh) 대한내과학회 1989 대한내과학회지 Vol.37 No.2
N/A To evaluate the clinical significance of hepatitis B virus antigens in liver in HBsAg positive acute viral hepatitis, HBsAg end HBcAg were detected by the ABC immunoperoxidase method in 39 paraffin embedded liver tissues with histologic findings of acute viral hepatitis, and their correlation with serologic markers of HBV was studied. The results were as follows; 1) Among 39 patients with HBsAg positive acute viral hepatitis, hepatitis B virus antigens in liver tissue were demonstrated in 22 patients (56.4%). Of the 22 patients, both HBsAg and HBcAg were demonstrated in 7 patients, HBsAg only in 11 patients and HBcAg in 4 patients. 2) IgM anti-HBc was positive in 15 (38.4%)of the 39 patients. While IgM anti-HBc was positive in 2 (9%) among 22 tissue antigen positive patients, 13 (76.5%)of the 17 patients without tissue antigen had IgM anti- HBc. 3) Serum HBV-DNA was positive in 69.2%. While HBV-DNA was positive in 86.7% of tissue antigen positive patients, 54.5% of patients without tissue antigen did not have HBV-DNA. The level of serum HBV-DNA was significantly higher in tissue antigen positive patients (30.1±38.9pg/ml) than in negative patients (5.2±3.4pg/ml). 4) Twenty-seven patients were followed over 6 months. Although HBsAg was seroconverted in S (88.9%) among 9 patients without tissue antigen, all patients who had hepatitis B virus antigens in the liver had persistent hepatitis B surface antigenemia over 6 months. The presence of HBV antigens in the liver in acute HBsAg positive hepatitis appears to correspond with acute exacerbation of chronic HBV infection or superinfection with non-B hepatitis virus in HBU carriers rather than acute HBV infection, since most of them have no IgM anti-HBc and have chronic antigenemia. Such conditions may occur frequently in Korea where the HBsAg carrier rate is high.
혈전성 혈소판 감소성 자반증의 임상상을 보인 항사구체 기저막 항체질환 1 예
천정현(Jeong Hyun Chun),서상렬(Sang Yeol Suh),조상경(Sang Kyung Jo),김형규(Hyoung Kyu Kim),조원용(Won Yonpg Cho) 대한신장학회 2001 Kidney Research and Clinical Practice Vol.20 No.2
Thrombotic thrombocytopenic purpura(TTP) was first described in 1925, however, the definite cause of TTP remained unknown. Further study revealed that the pathogenesis of thrombotic thrombocytopenia was related to autoimmune disease. Autoantibodies generated by vessel injury and other causes result in excessive platelet aggregation and consumption. Recently, many autoimmune diseases and conditions associated with vascular injury have been reported to be accompanied by TTP-like feature, such as microangiopathic hemolytic anemia and thrombocytopenia. Anti-glomerular basement membrane(GBM) mediated glomerulonephritis is also related to autoantibody against collagen IV fiber in GBM, and cha- racterizded by diffuse glomerular capillary injury. Although the relationship of these two diseases is not clearly defined, here we report a case of anti- GBM antibody disease accompanied by TTP-like feature in a 40-year old man admitted for dyspnea. The patient had hemolytic anemia, thrombocytopenia, and acute renal failure. Anti-GBM antibody was positive and crescent formation and linear deposition of IgG along glomerular basement membrane was seen in renal biopsy. Disease progressed with no clinical response despite of prompt treatment by steroid and cyclophosphamide pulse therapy and plasmapheresis.
고삼투압성 비케톤성 당뇨병 혼수 환자에서 횡문근 융해증에 의한 급성신부전을 보인 1 예
박정근(Jeong Ken Park),김경석(Gyung Suk Kim),서상렬(Sang Yeol Suh),고흥석(Heung Suk Ko),조진수(Jin Su Jo) 대한내과학회 1997 대한내과학회지 Vol.52 No.5
Rhabdomyolysis is defined as skeletal muscle injury with release of muscle cell constituents into the plasma and may lead to acute renal failure secondary to myoglobinuria. The most sensitive marker of muscle cell damage is serum creatine kinase concentration. It was first described by Bywaters and Beall in association with crush injuries during the second world war, and since then it has been recognized as the cause of about 5 % of all cases of acute renal failure. But acute renal failure is extremely rare in diabetic patient with hyperosmolarity irrespective of the frequency of rhabdomyolysis. Since osmotic diuresis, which is provoked by a high renal glucose load, prevents the development of acute tubular necrosis; there have been a few case reports connecting diabetic hyperosmolar state with acute renal failure, secondary to rhabdomyolysis. We reported a case with diabetic hyperosmolar nonketotic coma who developed acute renal failure secondary to rhabdomyolysis and myoglobinuria in a 60 year old patient with review of the literatures.
김윤석(Yun Seog Kim),한병철(Byeong Cheol Han),김방수(Bang Soo Kim),조진수(Jin Soo Joh),서상렬(Sang Yeol Suh) 대한내과학회 1996 대한내과학회지 Vol.50 No.4
Two cases of vitamin B12 deficiency megaloblastic anemia are presented and literature for the cases are briefly reviewed. The first case is a 54-year-old man who was diagnosed as gastric ulcer perforation, and subtotal gastrectomy with gastrojejunostamy were performed 10years ago. The second case is a 78-year-old man complicated with intrinsic factor deficiendcy and atrophic gastritis. Both cases were admitted to our hospital because of anemic symptoms such as dizziness, headache, tinnitus, general weakness, and appetite loss. Peripheral blood revealed thrombocytopenia, macrocytic anemia with anisocytosis and hypersegmented neutrophil, and bone marrow findings were decreased M:E ratio and increased cellularity. Schilling test revealed the excretion of 0.51% and 1.7% in 24hr urine collection (control 7%) respectly, and serum vitamin B12 level was decreased markedly, After treatment of parenteral vitamin B12, their clinical symptoms and hematologic findings improved progressively and they have been followed up on outpatient basis with maintenance therapy of vitamin B12.
빈혈을 동반한 만성신부전에서 Recombinant Human Erythropoietin 의 효과
이경생(Kyoung Saeng Lee),이인생(In Saeng Lee),한수용(Su Yong Han),추장식(Jang Sik Choo),서상렬(Sang Yeol Suh),송창섭(Chang Sup Song) 대한내과학회 1993 대한내과학회지 Vol.45 No.1
Background: Anemia is a major complication of chronic renal failure. Recombinant human erythropoietin (rhuEPO) has proven to be a highly effective treatment for the anemia of end-stage renal disease. Methods: We administered rhuEPO to 15 anemic patients of end-stage renal disease who were undergoing hemodialysis. Recombinant human erythropoietin was given intravenously twice a week after dialysis. Transfusion requirements, hemoglobin, hematocrit, reticulocyte, ferrokinetics, BUN, creatinine, electrolytes and adverse reactions were monitored. Results: 1) In 15 patients treated for 8 weeks, hemoglobin level increased from initial mean (±SD) 6.4±0.64 g/dl to 8.6±0.69g/df (p<0.01). Hematocrit level increased from initial mean 18.9±1.79% to 25.2±3.36% (p<0.01). Reticulocyte level increased from initial mean 1.2±0.93% to 2.1±1.02% (p<0.01). 2) Serum iron level decreased from initial mean 128.3±98.54 ㎍/dl to 95.4±75.41 ㎍/dl (p<0.01) and ferritin level decreased from initial 1454.3±732.52±52 ng/dl to 1213.5±534.43 ng/dl (p<0.05). 3) There were no significant differences in the serum levels of BUN, creatinine, Na K and phosphorus before and after the treatment. 4) Adverse reactions of rhuEPO were observed in 2 patients. One was occlusion of arteriovenous fistula and the other was severe itching sensation. 5) The patients were transfused 1.6 pints of packed red cell per month before the treatment, but they no longer needed transfusion after the treatment. Conclusion: These results suggest that recombinant human erythropoietin is safe and may eliminate the need for transfusion in anemic patients of end-stage renal disease.
비당뇨성 말기신부전환자에서 복막투석 중 발생한 고혈당증 및 고삼투압증후군 1 예
추장식(Jang Sik Choo),김중근(Jung Gyn Kim),이양규(Yang Kyu Lee),김윤석(Yoon Suk Kim),서상렬(Sang Yeol Suh) 대한내과학회 1995 대한내과학회지 Vol.48 No.1
In non-diabetic end-stage renal disease patients, blood glucose concentrations have not significantly changed over time on CAPD. But hypergycemia and hyperosmolality may develop with the use of hypertonic dextrose solutions for peritoneal dialysis. Hyperglycemia without ketosis can cause coma, convulsions, shock, or death. Severe disturbances in brain function are a consequence of the high collection of glucose in the extracellular fluids resulting in intracellular dehydration. A 54-year-old male, non-diabetic end-stage renal disease patient, who had been taken CAPD for 16 months, was hospitalized because of drowsy mental state. He used 4.25% glucose solution for peritoneal dialysis 3 times in a day because of edema. He revealed hyperglycemia and hyperosmolality. Serum glucose level and osmolality returned to normal after injection of normal saline and insulin.
역설적 반응에 의하여 동시에 결핵성 뇌농양 및 결핵성 복막염이 발생한 증례 1예
안태홍 ( Tae Hong Ahn ),박민범 ( Min Bum Park ),이기조 ( Key Jo Lee ),정은호 ( Eun Ho Jung ),김진우 ( Jin Woo Kim ),서상렬 ( Sang Yeol Suh ),강석우 ( Seok Woo Kang ),김은나 ( Eun Na Kim ),한윤주 ( Yoon Ju Han ),조삼권 ( Sam Kwon C 대한결핵 및 호흡기학회 2009 Tuberculosis and Respiratory Diseases Vol.66 No.6
역설적 반응은 감수성 있는 항결핵제를 복용중인 결핵환자에서 치료시작 당시의 병변이 악화되거나 새로운 병변이 생기는 현상이고 이는 치료실패와 감별을 요한다. 일반적으로 역설적 반응은 기존 항결핵 치료로 좋은 결과를 보이므로, 이러한 임상 경과를 잘 이해함으로써 불필요한 검사나 치료약제 변경 등을 하지 않고 적절히 치료할 수 있게 될 것이다. 저자들은 적절한 항결핵제 치료 중에도 역설적 반응으로 결핵성 뇌농양, 결핵성 복막염이 연속적으로 병발한 환자 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. While receiving appropriate treatment, patients with tuberculosis occasionally have unusual, paradoxical reactions, with transient worsening of lesions or the development of new lesions. This report is a case of tuberculosis brain abscess and tuberculosis peritonitis with intra-abdominal abscess that developed during appropriate anti-tuberculosis chemotherapy. A 45-year-old male patient had been diagnosed as with all-drug susceptible pulmonary tuberculosis with pleurisy. Subsequently, the patient underwent standard treatment with anti-tuberculosis therapy; the pulmonary lesions improved. Three months after initial treatment, the patient developed brain abscesses and peritonitis. With the addition of corticosteroid treatment, the patient`s neurologic symptoms were relieved. Exploratory laparotomy with surgical drainage was performed and a diagnosis of tuberculosis peritonitis was confirmed on biopsy. Anti-tuberculosis therapy was continued for 19 months, the patient improved eventually without further complications, although the therapeutic regimen had not been altered. In this case, the paradoxical response to treatment may have been involved in the pathogenesis of disease.
혈액투석 환자에서 경요도방광종양절제술 후 발생한 경요도절제후 증후군 2예
정은호 ( Eun Ho Jeong ),김은나 ( Eun Na Kim ),왕희배 ( Hee Bae Wang ),김태호 ( Tae Ho Kim ),박정석 ( Jeong Suk Park ),김태형 ( Tae Hyung Kim ),김진우 ( Jin Ou Kim ),서상렬 ( Sang Yeol Suh ),성원섭 ( Won Sub Seong ) 대한신장학회 2011 Kidney Research and Clinical Practice Vol.30 No.4
Transurethral resection syndrome (TURS) is one of the complications of endoscopic transurethral operation with irrigation fluid. TURS comprehensively refer to several clinical symptoms and signs caused by intravascular absorbtion of irrigation fluid, hypertension, bradycardia, arrhythmia, respiratory distress, hypotension, confusion, blindness, seizure, coma, hyponatremia, and hypoosmolarity. TURS is mainly known as the complication of the transurethral resection of prostate (TURP), and rarely found in the procedures such as transurethral resection of bladder tumor (TUR-BT), hysteroscopy, cystoscopy, and arthroscopy. Only a few cases of TURS after TUR-BT have been reported. The patients on maintenance hemodialysis were restricted in the amount of water intake for volume control. They were susceptible to the absorption of irrigation fluid during TUR-BT since they had anuria. We hereby report the 2 cases maintenance hemodialysis patients who were led to TURS after TUR-BT.
박민범 ( Min Bom Park ),김은나 ( Eun Na Kim ),정은호 ( Eun Ho Jeong ),김진우 ( Jin Ou Kim ),왕희배 ( Hee Bae Wang ),김태호 ( Tae Ho Kim ),이기조 ( Key Jo Lee ),서상렬 ( Sang Yeol Suh ),진소영 ( So Young Jin ) 대한신장학회 2010 Kidney Research and Clinical Practice Vol.29 No.5
The definition of C1q nephropathy has been categorized since 1985. However, the clinical correlation and pathophysiology has not yet been fully revealed. Therefore, the treatment of C1q nephropathy has not been established. Our subject was a 23 year-old female patient with both leg edema and oliguria, who was presented with weight gain. Renal biopsy confirmed C1q nephropathy. Prednisolone and cyclosporine therapy was selected for treatment. After 2 weeks of treatment, the patient lost 8 kg of body weight and all laboratory examination results were normalized. Both leg edema and oliguria were resolved. After 21 weeks of regular follow-up, she stopped the medicine by herself. Eight weeks later, the patient came to the Emergency room because both leg edema recurred. Same regimen was administered for 3 weeks, and complete remission was achieved again.