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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.
Human immunodeficiency virus(HIV) 감염자에 있어서 3제 병용요법의 치료효과 및 안전성
홍성관(Sung Kwan Hong),박윤수(Yoon Soo Park),조정호(Jeong Ho Cho),노현정(Hyun Jung Roh),김효열(Hyo Yeol Kim),장경희(Kyung Hee Chang),송영구(Young Goo Song),김준명(June Myung Kim) 대한내과학회 2000 대한내과학회지 Vol.58 No.5
Background : Antiretroviral combination therapy with one protease inhibitor and two reverse transcriptase inhibitors is profoundly suppressive of HIV replication. To determine the efficacy and safety of the triple combination therapy in persons with HIV infection in Korea, we analyzed the response of therapy in terms of immunity and viral load. Methods : Ten persons with HIV infection, who were treated with triple combination therapy at least 12 months at Yonsei University College of Medicine from 1997 to 1999 were studied. The triple combination therapy regimen consisted of two reverse transcriptase inhibitors (zidovudine or didanosine, lamivudine) and one protease inhibitor (indinavir). We analyzed the levels of HIV RNA, CD4+ cell counts, β2MG, and p24Ag before and after treatment. Adverse drug reactions during therapy were described. Results : The mean age of patients at treatment was 38.7 years. Nine patients were male, and 1 patient was female. Six patients received triple combination therapy as initial treatment, while 4 patients received it as re-treatment. The mean level of HIV RNA was 129,222 copies/mm3 before treatment. RNA level decreased to less than 500 copies/mm3 (non-detectable range) at 1 month in 7 of 10 patients, at 12 months in 9 of 10 patients. The mean CD4+ cell counts was 206/mm3 before treatment, and 376/mm3 after 12 months treatment. The β2MG decreased to 2.7 mg/L from 2.8 mg/L after 12 months of treatment. The p24Ag was positive in 3 of 10 patients and negative in all of the patients at 3 months treatment. Mild hyperbilirubinemia (5 cases) was the most frequent adverse reaction followed by flank pain (3 cases), skin rash (2 cases), abdominal discomfort (2 cases), and mild elevation of AST/ALT (1 case). Conclusion : The triple combination therapy in HIV infection appeared to be generally well tolerated, and was able to profoundly sustain suppression of HIV replication.(Korean J Med 58:582-589, 2000)
홍석경,홍성관<SUP>1<.SUP>,홍석준,Suk Kyung Hong,M.D.,Sung Kwan Hong,M.D.<SUP>1<.SUP> and Suk Joon Hong,M.D. 대한갑상선-내분비외과학회 2003 The Koreran journal of Endocrine Surgery Vol.3 No.2
Purpose: A retroperitoneoscopic adrenalectomy is theoretically the ideal procedure for an adrenalectomy. However, it is not popular due to its technical difficulty. Herein, we report our experience with retroperitoneoscopic adrenalectomies and describe the difficulties encountered during the operations. Methods: From November 1996 to October 1999, a total of 41 retroperitoneoscopic adrenalectomies were performed. Forty (40) patients had a unilateral adrenal tumor (size: 1∼6 cm): 21 aldosteronomas, 12 Cushing adenomas, 3 neurogenic tumors, 2 nonfunctioning adenomas, 1 vascular cyst, and 1 angiomyolipoma of the kidney. One (1) had bilateral hyperplasia. The operations were carried out in prone position in all cases with 3 trochars. Results: Thirty five (35) operations were completed endoscopically. Five were converted to open procedures, and one was converted to a transperitoneal laparoscopic approach. The causes of conversion were 1 severe subcutaneous emphysema, 2 technical difficulties, 1 bleeding, 1 partial nephrectomy, and 1 missing tumor. The average operating time for the complete endoscopic adrenalectomies was 183 minutes in the first 14 cases and 142 minutes in the next 21 cases. There was no operative morbidity or mortality. The average hospital stay was 4.3 days in the first 14 cases and 2.8 days in the next 21 cases. Conclusion: A retroperitoneoscopic adrenalectomy is a less invasive procedure than any other adrenalectomy procedure, and its only disadvantage is technical difficulty. However, the technical difficulty can be overcome with increasing experience. (Korean J Endocrine Surg 2003;3:178-182)
일차성 슬관절 전치환술 환자에서 세균 비강 집락의 유병률
김희천 ( Hee Chun Kim ),홍성관 ( Sung Kwan Hong ),단진명 ( Jin Myoung Dan ),이돈석 ( Don Seok Lee ),조용석 ( Yong Suk Cho ) 대한슬관절학회 2010 대한슬관절학회지 Vol.22 No.4
Purpose: The objective of the current study was to investigate the prevalence of bacterial nasal colonization in patients who are undergoing primary total knee arthroplasty and to determine whether the prevalence affects the incidence of deep surgical site infections. Materials and Methods: Of the 488 consecutive patients (784 knees) who had been screened for bacterial nasal colonization using nasal swab cultures before elective total knee arthroplasties, 434 patients (88.9%) were available for review at one year postoperatively. We assessed the overall rate of deep surgical site infections in the patients with nasal carriage of bacteria (group I) and in those patients without any bacterial nasal colonization (group II), respectively. Results: Of the 434 patients, 69 (15.9%) had nasal carriage of bacteria. There was 1 infection (0.9%) among 113 knees of 69 patients in group I and 10 infections (1.7%) among 591 knees of 365 patients in group II. Those differences were not statistically significant. Conclusion: The prevalence of bacterial nasal colonization in patients undergoing primary total knee arthroplasty was 15.9% and the preoperative nasal carriage of bacteria did not affect the rate of deep surgical site infections.
조보연(Bo Youn Cho),이홍규(Hong Kyu Lee),고창순(Chang Soon Koh),민헌기(Hun Ki Min),이석인(Seok In Lee),고경수(Kyung Soo Ko),홍성관(Sung Kwan Hong),김성연(Seong Yeon Kim) 대한내과학회 1992 대한내과학회지 Vol.43 No.1
Isolated ACTH deficiency is a rare disorder, only 50 cases of which have been reported worldwide till now, and characterized by hypoglycemia, hypotension and hyponatremia. In 1989, we reported the first case of Isolated ACTH deficiency combined with autoimmune thyroiditis. Recently we experienced another case of Isolated ACTH deficiency without other combined autoimmune disease or other endocrine abnormalities. The patient, 31 year-old man, was admitted because of dyspnea, nausea and vomiting. On admission, serum sodium was 121mmol/L, pottasium 2.6mmol/L, serum osmolality 239mOsm/kg and urine osmolality 737mOsm/kg. Basal serum cortisol was 1.0 ↓ ug/ml, ACTH 13 pg/ml and glucose was 43 mg/dl. Although cortisol did not respond to rapid ACTH stimulation, it responded to standard ACTH stimulation test, On combined pituitary stimulation test, the cortisol did not respond and all anterior pituitary hormones showed normal responses except ACTH. There were no abnormalities in Sellar CT, and hyponatremia was corrected dramatically with prednisolone replacement.
김준수,김창진,하상수,김정훈,이정교,권병덕,홍성관,이기업,이봉재,김용재,최충곤,이호규,Kim, Joon Soo,Kim, Chang Jin,Ha, Sang Soo,Kim, Jung Hoon,Lee, Jung Gyo,Kwun, Byung Duk,Hong, Sung Kwan,Lee, Ki Up,Lee, Bong Jae,Kim, Yong Jae,Choi, Choo 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.5
Objective : We analyzed the clinical and endocrinological results of the transsphenoidal microsurgery for ACTH secreting pituitary adenomas. Marerials and Methods : From October 1995 to August 2000, 18 patients underwent transsphenoidal microsurgery for Cushing's disease. We analyzed the surgical results of 17 patients, one patient who was previously operated from other hospital was excluded. Age of the patients were 18 to 61 years old(mean 37.7), male to female ratio was 1 : 3.3, and follow-up period was 3 to 50 months(mean 20.3). The selection of candidates for transsphenoidal exploration was based on endocrinologic criteria. Magnetic resonance imaging was the preferred radiologic test. Selective inferior petrosal sinus sampling of adrenocorticotropic hormone futher refined the diagnosis when endocrinologic and radiologic procedures were not definitive. Results : Results of the preoperative endocrinological test were : level of serum ACTH 29.4 to $225{\mu}g/dL$(mean $93.88{\mu}g/dL$) ; serum cortisol 11.9 to $47.5{\mu}g/dL$(mean $27.49{\mu}g/dL$) ; 24-hour urine free cortisol 235 to $1019{\mu}g/day$(mean $571.0{\mu}g/day$). Inferior petrosal sinus sampling for ACTH was performed in 11 patients and all were confirmed by Cushing's disease and we could predict the laterality of the tumor in 9 of 11 patients. We performed transsphenoidal selective adenomectomy in 5 patients, adenomectomy and subtotal hypophysectomy in 2 patients, adenomectomy and partial hypophysectomy in 9 patients, and in the remaining one patient, hemihypophysectomy followed by total hypophysectomy due to remission failure. Fifteen of 17 patients(88.2%) showed endocrinological remission. Glucocorticoid replacement therapy was performed in all the patients who showed remission for 1 to 24 months(mean 5.9 months), and 6 patients received steroid over 6 months. Conclusion : We conclude that the direct demonstration of a tumor in the pituitary gland by MRI is the most important and definitive diagnostic tool and the location of a mass should be confirmed with increased level of ACTH by the inferior petrosal sinus sampling. Transsphenoidal microsurgery is effective treatment modality for Cushing's disease and the immediate postoperative evaluation of the surgical resection of the tumor is very important. The patients should show hypocortisolism, decreased, subnormal serum ACTH and cortisol levels and 24-hours urine free cortisol. We performed 18 transsphenoidal microsurgery for Cushing's disease in 17 patients and 15 patients(88.2%) showed endocrinological remission.
자가면역성 다선증후군 ( Polyglandular Autoimmune Syndrome ) 1 예
김성연(Seong Yeon Kim),이홍규(Hong Kyu Lee),고창순(Chang Soon Koh),민헌기(Hun Ki Min),이문규(Moon Kyu Lee),홍성관(Sung Kwan Hong),김원배(Won Bae Kim),이병두(Byoung Doo Rhee),조보연(Bo Youn Cho),이광우(Kwang Woo Lee) 대한내과학회 1989 대한내과학회지 Vol.36 No.6
N/A Polyglandular antoimmune (PGA) syndrome designates endocrine dysfunction involving two or more glands on the basis of autoimmune mechanisms. There are 3 types of PGA syndrome and their etiology or pathogenesis is still not completely understood. We report here a case of polyglandular autoimmune syndrome manifesting insulin-dependent diabetes mellitus, hyperthyroidism and myasthenia gravis, which met the criteria of type III PGA syndrome. HLA-DR4 & -DRw8 were positive and so was the thyroid antimicrosomal antibody. We think that upon further study, additional cases of this syndrome could be found.