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Alemtuzumab을 이용한 이차성 순적혈구 빈혈의 치료
박혜민 ( Hye Min Park ),임재욱 ( Jae Uk Im ),박주환 ( Ju Hwan Park ),김은혜 ( En Hye Kim ),전홍길 ( Hong Gil Jun ),박재후 ( Jae Hoo Park ),김혁 ( Hawk Kim ) 대한내과학회 2013 대한내과학회지 Vol.85 No.2
Pure red cell aplasia (PRCA) in adults is usually idiopathic, although some underlying conditions can cause PRCA. Immunosuppressive therapy (IST) is used to treat PRCA, but IST has side effects and may fail. The anti-CD52 monoclonal antibody alemtuzumab (ALM) was recently used to successfully treat therapy-resistant PRCA. We herein report successful treatment of secondary PRCA after erythropoietin therapy using ALM and cyclosporin A (CsA) in one patient. The total dose of ALM was 60 mg over 3 days (10, 20, and 30 mg, respectively) plus CsA for at least 6 months. The patient achieved a complete response 18 months after ALM-CsA treatment and his treatment could be changed to a different erythropoietin stimulating agent. (Korean J Med 2013;85:214-217)
울산지역에서 주폐경기 ( Perimenopause ) 여성의 골다공증 유병률과 연관인자
김영일(Young Il Kim),박재후(Jae Hoo Park),이종수(Jong Soo Lee),김진우(Jin Woo Kim),양승오(Seoung Oh Yang),전대준(Dae Joon Jeon),김문찬(Mun Chan Kim),정태흠(Tae Heum Jeong),이윤구(Yoon Gu Lee),이병두(Byoung Doo Rhee) 대한내과학회 2002 대한내과학회지 Vol.62 No.1
N/A Background: Osteoporotic fractures pose a major public problem, not only in Western populations but also of increasing significance in Asian populations. However, most previous studies for the prevalence of osteoporosis in Korea were carried out from the data of hospitalized or out-patient based subjects, hospital staff, healthy volunteers and so forth. The purpose of present study was to evaluate the normative data of bone mineral density (BMD) in Korean young and perimenopausal women and to determine the prevalence and risk factors of low bone mass, including osteoporosis and osteopenia in a community- based population. Methods: In 1999, a baseline survey was carried out in the Dong-gu of Ulsan city, a urban area but located in seashore of southeastern Korea. The selected community sample of 3,822 inhabit ants (all were women aged 49-54 years) were chosen. We studied 1,629 women among them and 127 healthy women aged 20-35 years. BMD of lumbar spine and femur was measured using dual-energy X-ray absorptiometry. For analysis of risk fact ors, those were excluded who was the current or recent user of estrogen and who had osteoporosis related disease or unknown menopause due to previous hysterectomy. Thus, 1,020 subjects were analysed for the association of low BMD and risk factors. Significant determinants of BMD were investigated using univariate and multiple regression analysis. Results: When our young normal data were used, 9.8% for the lumbar spine and 1.4% for the femoral neck of our study population (n=1,629) were classified as osteoporosis. Among them, the menopausal status of above 1,020 subjects had independent association with low BMD (T-score<-1.0) of both lumbar spine (odds ratio=4.71 in postmenopause, p <0.001) and femoral neck (odds ratio=2.86 in postmenopause, p <0.001). In premenopausal women (n=507), weight and age of menarche were associated independently with low bone mass, including osteoporosis and osteopenia of both lumbar spine and femoral neck. In postmenopausal women (n=513), weight and duration since menopause were associated independently with low bone mass of both lumbar spine and femoral neck. Also, daily amount of calcium intake had significant association (regression coefficient =0.047; p <0.05) independently with BMD of femoral neck. Conclusion: The result s of this population-based study suggest that it is import ant to prevent bone loss and screen the BMD in women aged 49-54 years with menopause, low body weight, late menarche, prolonged duration since menopause, low calcium intake.(Korean J Med 62:11- 24, 2002)
김도하(Do Ha Kim),박능화(Neung Wha Park),주광로(Kwang Ro Joo),이선호(Seon Ho Lee),김성률(Sung Ryul Kim),유철인(Cheol In Yoo),서재희(Jae Hee Suh),박재후(Jae Hoo Park) 대한소화기학회 2002 대한소화기학회지 Vol.39 No.4
Background/Aims: Enterogastric reflux of bile has been suspected as a risk factor of foregut cancer. Thus, we measured total intragastric bile acid to determine association between duodenogastric reflux and development of intestinal metaplasia known as premalignant gastric mucosal change. Methods: One hundred and three patients with a functional dyspepsia underwent endoscopy. Subsequently, samples of fasting gastric juice were taken from all patients for analysis of total bile acid. With the specimens from 5 sites of the antrum and body, the degree of intestinal metaplasia was evaluated by the update Sydney System and H. pylori infection was evaluated also by Warthin-Starry staining. Results: There was a significant correlation between the total bile acid level and the degree of intestinal metaplasia (r=0.278, p=0.005). Moreover, multiple linear regression test showed that the concentration of total bile acid was one of the independent risk factors for intestinal metaplasia regardless of age and H. pylori infection. Conclusions: These results suggest that intragastric bile acid may affect histologic premalignant changes of the gastric mucosa and thus, duodenogastric reflux may play a role in gastric carcinogenesis. (Korean J Gastroenterol 2002;39:248-253)
Cyclophosphamide 충격요법으로 호전된 전신성 홍반성 루푸스에 병발된 폐고혈압
최승원 ( Seung Won Choi ),정인두 ( In Du Jeong ),박종호 ( Jong Ho Park ),박재후 ( Jae Hoo Park ),이종수 ( Jong Soo Lee ),김진우 ( Jin Woo Kim ) 대한류마티스학회 2002 대한류마티스학회지 Vol.9 No.1
Pulmonary hypertension is an uncommon but serious complication of systemic lupus erythematosis (SLE). Usually its outcomes are ominous and may progress to heart failure and even sudden death. The pathophysiology is still unknown, but several mechanisms, such as pneumonitis, vasculitis, thromboembolism or thrombosis in situ have been proposed. There is no definitive therapy for this condition. Although supportive measures with vasodilators remain the mainstay of treatment, the responses are generally disappointing. We describe a case of improvement of pulmonary hypertension in SLE treated with cyclophosphamide pulse therapy as documented by hemodynamic data. Immunosuppressive treatment with cyclophosphamide was effective in this condition, suggested an immune mediated pathogenesis.
윤태권 ( Tae Guen Yun ),주광로 ( Kwang Ro Joo ),박지현 ( Ji Hyun Park ),김병철 ( Byung Chul Kim ),김대현 ( Dae Hyun Kim ),김도하 ( Do Ha Kim ),박능화 ( Neung Hwa Park ),박재후 ( Jae Hoo Park ) 대한소화기학회 2003 대한소화기학회지 Vol.41 No.5
Congenital anomalies of the pancreatic ductal system are very rare and result from abnormalities in embryological development of the pancreas from the ventral and dorsal buds. We encountered an interesting case of anomalous pancreatic duct in a patient with post-bulbar insertion of the common bile duct. It could be caused by defective rotation and fusion of the pancreatic anlagens during early gestation. To our best knowledge, this kind of anomaly has not been previously described. (Korean J Gastroenterol 2003;41:414-416)
혈액투석 중 채취한 검체를 이용한 Equilibrated Kt/V 를 예측하는 방법
이종수(Jong Soo Lee),김도하(Do Ha Kim),최승원(Seung Won Choi),김영일(Young Il Kim),박재후(Jae Hoo Park),박수길(Su Kil Park),이상구(Sang Koo Lee),이선호(Seon Ho Lee),김성률(Sung Ryul Kim),박정식(Jung Sik Park) 대한신장학회 2002 Kidney Research and Clinical Practice Vol.21 No.1
목 적 : 단일 구획 요소 역동학 모형에서 투석 직후 혈중 요소질소 농도의 반등(postdialysis urea ebound, PDUR)은 실제 Kt/ V를 과대 평가하게 된다. 본 연구는 투석 후 평형상태의 혈중 요소질소 농도를 가장 잘 반영하는 투석 중의 혈액 검체 채취 시점을 확인하고, 이 검체를 이용하여 계산된 Kt/ V가 요소질소 농도 반등 완료 후의 Kt/V와 일치하는 정도를 알아보고자 하였다. 방 법 : 유지혈액 투석을 받고 있는 21명의 말기 신부전증 환자에서 투석 전, 투석시작 후 80분, 120분, 190분, 200분, 210분, 220분, 투석종료 시점, 투석종료 45분 후 혈액을 채취하여 각각 BUN을 측정하였다. 저자들은 투석종료 45분 후 요소질소 농도 반등이 완료된 시점의 검체를 이용한 Kt/V(eKt/V PDUR)를 참고치로 하여 Smye method, double- pool Daugirdas 공식, Tattersall 공식, 투석 중에 채취한 검체 중 하나를 이용하여 계산한 Kt/V를 각각 비교하였다. 결 과 : 투석 후 평균 요소질소 농도의 반등은 17.2±6%였고 single poool (sp)Kt/ V와 eKt/V는 각각 1.300±0.24, 1.120±0.20으로 spKt/ V는 eKt/ V PDUR를 13.5±4% 과대평가 하였다. 투석 중에 채취한 검체 중 투석종료 40분 전에 채취한 검체가(27.9±9 ㎎/dL) 요소농도 반등후의 평형상태의 혈중요소 질소 농도(28.0±9 ㎎/dL)를 가장 잘 반영하였다. Double- pool Daugirdas 공식의 Kt/V(eKt/V Dau =1.135±0.21, r =0.972, p<0.001), Tattersall 공식의 Kt/V(eKt/ V T at =1.134±0.22, r =0.972, p<0.001), Smye공식의 Kt/ V(eKt/ V Smye=1.156±0.24, r =0.900, p<0.001)는 PDUR eKt/V과 유의한 상관관계를 보였으며, 투석종료 40분 전에 채취한 검체를 이용하여 계산한 Kt/ V(eKt/V T-40 min =1.120±0.20, r =0.984, p<0.001)가 가장 유의한 상관관계를 나타내는 경향을 보였다. Bland- Altman분석에서 Kt/V T - 40 min는 eKt/ V PDUR과 가장 좋은 일치 정도를 보였다. 결 론 : 일반 투석기를 이용한 4시간 동안의 혈액투석에 있어서 spKt/V는 실제 전달된 Kt/V를 평가하는데 부적절하며, 투석종료 40분 전에 채취한 검체를 이용하여 계산한 Kt/V는 요소질소 농도 반등 후의 평형상태의 Kt/ V를 예측하는데 있어서 임상적으로 간단하게 이용할 수 있는 좋은 방법으로 생각된다. Purpose : Postdialysis urea rebound(PDUR) causes the overestimation of actual amount of delivered dialysis in Kt/V from single pool urea kinetic. To correct PDUR and predict equilibrated Kt/V (eKt/V) some methods have suggested by Daugirdas, et al. Smye, et al. and Tattersall, et al. The purposes of this study were to determine the optimum intradialytic urea sample time that fits best with PDUR and to compare calculated Kt/V by this sample with the different other methods. Methods : The subjects were 21 patients who were dialyzed at three times 4 hours weekly, using bicarbonate and cellulosynthetic membranes. Blood samples to measure BUN were obtained at initiation of dialysis session and then at 80, 120, 180, 200, 210, 220 minutes, and the end of dialysis session times and then at 45 minutes of postdialysis . We compared four different methods of eKt/V with the equilibrated 45-minute PDUR Kt/V (eKt/V PDUR) as the reference method. Results : The mean PDUR was 17.2± 6%. spKt/V and eKt/V PDUR was 1.300±0.24 and 1.120±0.20 respectively, leading to overestimation of actual delivered Kt/V by 13.5±5%. The best time for intradialytic sampling to fit with PDUR BUN w as 40 minute before the end of session. eKt/V by Daugirdas formulae(eKt/V Dau=1.315± 0.21, r=0.972, p<0.001), Tattersal formulae(eKt/V T at=1.134± 0.22, r =0.972, p<0.972, p<0.001) and Smye formulae(eKt/V Smye=1.156± 0.24, r=0.900, p<0.001) showed good correlation with eKt/V PDUR. eKt/V calculated by the sample of 40 minute before end of session (eKt/V T-40=1.120±0.20, r=0.984) had tendency of the best correlation with eKt/V PDUR. Among these different methods, eKt/V T -40 had the best degree of agreement with eKt/V PDUR by Bland-Altman analysis. Conclusion : Our results suggest that the use of spKt/V is not adequate to estimate the amount of delivered hemodialysis dose because of the existence of significant postdialysis urea rebound even conventional 4 hour dialysis. Intradialytic sampling method is a simple and accurate method to predict eKt/V for use in clinical practice.