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이창석 ( Chang Seok Lee ),신동훈 ( Dong Hoon Shin ),최철웅 ( Cheol Woong Cho ),김형욱 ( Hyung Wook Kim ),강대환 ( Dae Hwan Kang ),고경원 ( Kyung Won Koh ),지병훈 ( Byoung Hoon Ji ),박수범 ( Su Bum Park ) 대한소화기학회 2014 대한소화기학회지 Vol.64 No.4
Primary colorectal lymphoma is a very rare disease entity that accounts for less than 0.2-0.65% of all colon cancers. It is as an extranodal lymphoma of the colon that mainly arises from B cells and primary colorectal lymphoma that arises from T cells is very rare both in Western countries and in Korea. Colonic lymphoma can be classified endoscopically into 5 categories as follows: fungating, ulcerative, infiltrative, ulcerofungating, and ulceroinfiltrative type. The endoscopic features of primary colorectal lymphoma differ according to their cellular origin; about half of B cell lymphomas are fungating type whereas most of T cell lymphomas are of ulcerative or ulceroinfiltrative type. Mass forming primary T cell lymphoma of the colon is extremely rare. Herein, we present a case of primary natural killer like T cell lymphoma of the colon presenting as fungating type with review of literature. (Korean J Gastroenterol 2014;64:229-233)
ABO 부적합 신장 이식 후 발생한 가역적 후백질 뇌병증 증후군 1예
김종인 ( Jong In Kim ),최안숙 ( An Sook Choi ),김수진 ( Su Jin Kim ),지병훈 ( Byoung Hoon Ji ),오준석 ( Joon Seok Oh ),손영기 ( Young Ki Son ),신용훈 ( Yong Hun Shin ),김중경 ( Joong Kyung Kim ) 대한신장학회 2010 Kidney Research and Clinical Practice Vol.29 No.2
Reversible posterior leukoencepalopathy syndrome (RPLS) was noted by a reversible syndrome of headache, altered mental status, seizure, and visual loss associated with findings indicating predominantly posterior leukoencephalopathy on imaging studies. We report a successful treatment of RPLS after secondary ABO incompatibility kidney transplantation with blood pressure control. A 41-year-old female whose primary kidney disease was chronic glomerulonephritis had graft failure developed after living donor kidney transplantation (1st kidney transplantation). She was admitted to our hospital for 2nd ABO incompatibility kidney transplantation. She had undergone 6 times of plasmapheresis and received additional two doses of rituximab (375mg/m2) and intravenous immunoglobulin (0.5g/kg) before kidney transplantation. She received basiliximab induction therapy, tacrolimus, steroid and mycophenolate mofetile after transplantation. The ABO antibody titer had been low (below 1:1) and evidences of rejection were not detected. Generalized tonic clonic type seizure, eyeball deviation, facial cyanotic change and loss of consciousness occurred at post operation 7th day. Several minutes later, she recovered her consciousness without disability and neurologic deficit. She did not represent attacks any more after we controlled blood pressure without withdrawal of immunosuppressants or dose reduction.
신장 이식 후 재발한 국소성 분절성 사구체 경화증 치료로 사용한 Rituximab과 혈장교환술 plasmapheresis 1예
남주연 ( Ju Yeon Nam ),최안숙 ( An Sook Choi ),김수진 ( Su Jin Kim ),지병훈 ( Byoung Hoon Ji ),오준석 ( Joon Suk Oh ),손영기 ( Young Ki Son ),신용훈 ( Yong Hun Sin ),김중경 ( Joong Kyung Kim ),김용진 ( Yong Jin Kim ) 대한신장학회 2010 Kidney Research and Clinical Practice Vol.29 No.2
Focal segmental glomerular sclerosis (FSGS) is known to recur in 20-40% of the renal allografts with graft loss in about half of these cases. We report a successful treatment of a recurrent FSGS after kidney transplantation with rituximab and plasmapheresis. An 16-year-old patient whose primary kidney disease was FSGS developed recurrence of proteinuria after living donor kidney transplantation despite preemptive plasmapheresis and one dose of rituximab (375mg/m2). After kidney transplantation, nephrotic range proteinuria was detected. Kidney biopsy was done and showed recurrent FSGS. She undergone 11 times of plasmapheresis in the first 4 week post transplantation. In addition, she received additional one dose of rituximab (375mg/m2) on day 14. Proteinuria was decreased below nephrotic range at 37 day. Ten months later, proteinuria was at 30mg/day with excellent graft function. No significant adverse events related to rituximab or plasmapheresis were observed. Rituximab with plasmapheresis may be another option for recurrent FSGS after kidney transplantation.
증례 : 신장 ; 지속성 외래 복막 투석 환자의 반코마이신 내성 장구균 복막염 치료 1예
정정임 ( Jung Im Jung ),김수진 ( Su Jin Kim ),지병훈 ( Byoung Hoon Ji ),오준석 ( Joon Seok Oh ),김성민 ( Sung Min Kim ),신용훈 ( Yong Hun Sin ),김중경 ( Joong Kyung Kim ) 대한내과학회 2011 대한내과학회지 Vol.80 No.2S
본 증례를 통하여 VRE에 의한 복막투석 복막염에 대해 quinupristin-dalfopristin를 사용하여 치료한 효과는 확인하였다. 하지만 치료 방법에 대한 명확한 기준은 아직 미흡한 실정이다. VRE 감염이 확인된 후 2주간의 quinupristin-dalfopristin를 사용하여 치료에 성공한 경우로 다른 항생제의 투여가 병용된 점은 quinupristin-dalfopristin만의 단독 효과로 생각하기에는 제한점을 가진다. 하지만 균주가 동정된 후 항생제내성 결과에 따라 투여된 약제가 효과를 나타냄에 따라VRE 감염증을 도관제거 없이 quinupristin-dalfopristin를 정맥 투여하여 감염증을 치료하였다. 도관을 제거하지 않고 지속적인 관류함으로 감염된 상처를 열어 놓으면서 균주의 박멸을 시도하는 것도 한 가지 방법이 될 수 있음을 이번 증례를 통해 경험하여 보고하는 바이다[17]. 최근 반코마이신 내성균주의 증가추세로 볼 때 향후 본 증례와 같은 VRE 복막염의 예가 증가할 것으로 예측되며 먼저 이를 줄이기 위해VRE의 전파 방지를 위한 노력이 필요하다. 또한, VRE로 인한 복막염이 진단된 경우에는 quinupristin-dalfopristin의 사용이 효과적일 것으로 생각되나 향후 지속적 연구를 통해 적절한 용량 및 투여기간에 대한 연구 및 보고가 있어야 할 것이다. Peritonitis is one of the major complications of continuous ambulatory peritoneal dialysis (CAPD). Multidrug-resistant organisms, including vancomycin-resistant enterococci (VRE), have been reported as pathogens of CAPD-associated peritonitis. The incidence of hospital-associated infections caused by VRE has recently increased. Some drugs, such as linezolid and quinupristin/dalfopristin, have been introduced as treatments of VRE infection. However, there is limited information about the effects of VRE-associated CAPD peritonitis. We present a case of successful treatment of CAPD peritonitis caused by VRE with quinupristin/dalfopristin and include a review of the literature. (Korean J Med 2011;80:S245-S248)