증례 : 류마티스 ; 파미드로네이트 불응성 다발 장기 전이성 석회화를 동반한 고칼슘혈증

배기범 ( Gi Bum Bae ),은정수 ( Jung Su Eun ),김나리 ( Na Ri Kim ),임철현 ( Churl Hyun Im ),남언정 ( Eon Jeong Nam ),강영모 ( Young Mo Kang ) 대한내과학회 2013 대한내과학회지 Vol.85 No.5

저자들은 외상으로 인한 골절 수술 이후 중증 고칼슘혈증과 다발 장기의 전이성 석회화가 동반된 파제트병이 의심되는 환자에서 고칼슘혈증, 다발 장기 전이성 석회화와 신부전이 파미드로네이트 치료에 부분적인 반응과 재발 소견이 반복되었으나 졸레드로닉산에 극적인 치료효과를 나타낸 증례를 보고하는 바이다. 중증 고칼슘혈증과 다발 장기 전이성 석회화가 동반된 파제트병은 현재까지 세계적으로 문헌보고가 없는 상태이다. 중증 고칼슘혈증과 다발 장기 전이성 석회화가 동반된 파제트병 환자에서 지속적인 임상적 호전을 위해서는 뼈 대사 억제 치료로서 졸레드로닉산 사용을 고려해 볼 수 있을 것으로 사료된다. Paget`s disease of bone (PDB) is a disorder featuring high-level bone turnover associated with the presence of disorganized and immature bone tissue with excessive levels of fibrosis. The risk of deformity is very high. The etiology of PDB is not well understood, but includes both genetic and environmental factors among which is bone trauma. Hypercalcemia can occur as a complication of PDB in patients who are immobilized and dehydrated. However, to date, no case of severe hypercalcemia with metastatic calcifications in multiple organs has been reported in any PDB patient. The drugs of choice for treatment of PDB are bisphosphonates. These drugs effectively suppress bone turnover. Patients with extensive PDB may require higher doses of bisphosphonates, and acquired resistance to a particular bisphosphonate may be overcome by use an alternative drug. Here, we report a case of suspicion of PDB. The patient presented with hypercalcemia and metastatic calcifications and his condition improved dramatically after treatment with zoledronic acid. (Korean J Med 2013;85:545-550)

임상화보 : 저절로 호전된 혈변주소의 소장 장중첩증

배기범 ( Gi Bum Bae ),최창훈 ( Chang Hoon Choi ),서광운 ( Kwang Woon Seo ) 대한내과학회 2010 대한내과학회지 Vol.79 No.4

류마티스관절염환자에서 동맥경화증의 독립적인 예측인자 규명: KARRA 코호트 연구 기반

김지훈 ( Ji Hun Kim ),강종완 ( Jong Wan Kang ),김나리 ( Na Ri Kim ),배기범 ( Gi Bum Bae ),이수곤 ( Soo Kon Lee ),임철현 ( Churl Hyun Im ),남언정 ( Eon Jeong Nam ),강영모 ( Young Mo Kang ) 대한류마티스학회 2012 대한류마티스학회지 Vol.19 No.1

Objective. This study sought to investigate independent predictive factors for subclinical atherosclerosis in Korean patients with rheumatoid arthritis (RA). Methods. We used high-resolution B-mode ultrasonography to measure the carotid artery intima-media thickness (IMT) and carotid plaque in 367 patients with RA. Detailed information on the demographic characteristics, cardiovascular (CV) risk factors, and RA disease characteristics were collected on all subjects. The relationship of the carotid artery IMT and carotid plaque to relevant clinical and laboratory variables were examined. Results. Old age and male sex had the most significant association with increased IMT and presence of plaque than other factors. Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and mKHAQ (Korean version of modified health assessment questionnaire) were significantly associated with both increased IMT and presence of plaque after univariate analysis adjusting for age and sex. A multivariable logistic regression analysis revealed that ESR and TJC68 were independent factors associated with the presence of plaque (p<0.001 and p=0.019, respectively). There was a significant linear correlation between the number of plaques and ESR (p<0.001 and R2=0.07). Conclusion. Our results indicated that markers of systemic inflammation contributed significantly to subclinical atherosclerosis in patients with RA. We emphasize the need for aggressive control of RA disease activity in patients who persistently demonstrate highly elevated ESR levels.

류마트스 : 항인지질 증후군을 동반한 전신홍반루푸스에서 진단된 May-Thurner 증후군

김지훈 ( Ji Hun Kim ),강종완 ( Jong Wan Kang ),배기범 ( Gi Bum Bae ),이종민 ( Jong Min Lee ),임철현 ( Churl Hyun Im ),남언정 ( Eon Jeong Nam ),강영모 ( Young Mo Kang ) 대한내과학회 2012 대한내과학회지 Vol.82 No.6

항인지질 증후군이 동반된 전신홍반루푸스 환자에서 May-Thurner 증후군이 진단된 예는 아직 세계적으로 보고가 없다. 본 증례와 같이 전신홍반루푸스를 가진 젊은 환자에서 좌측 하지에 심부정맥 혈전증이 발생한 경우 항인지질 증후군을 감별하여야 하며 동시에 May-Thurner 증후군도 감별진단에 포함시켜야 한다. 그리고 진단 이후의 적극적인 혈관중 재시술과 지속적인 항응고제 치료를 통해 재발을 방지하기 위한 전략이 필요할 것이다. May-Thurner syndrome, which refers to an iliofemoral venous thrombosis caused by chronic compression of the left common iliac vein by the right common iliac artery, usually manifests as left lower extremity pain and swelling. The syndrome is particularly evident in patients with health conditions including obesity, smoking, pregnancy, surgery, or prolonged immobility. Antiphospholipid syndrome consists of arterial or venous thrombosis and the association of lupus anticoagulant or anticardiolipin antibodies. Most common clinical manifestations include pregnancy loss and deep vein thrombosis. We experienced a rare case of May-Thurner syndrome concurrent with antiphospholipid syndrome, secondary to systemic lupus erythematosus. The patient was treated successfully by catheter-directed percutaneous thrombectomy, venous thrombolysis, and stent insertion, followed by oral anticoagulant therapy.

전신성 경화증 환자에서 99m Tc - DTPA 폐제거율의 의의

이명권(Myung Kwon Lee),강영모(Young Mo Kang),배기범(Gi Bum Bae),박지현(Jee Hyun Park),이종명(Jong Myung Lee),이재태(Jae Tae Lee),김능수(Nung Soo Kim) 대한내과학회 2001 대한내과학회지 Vol.61 No.1

N/A Background: We measured the clearance rate of inhaled 99mTc-diethyl triaminepentaacetic acid (DTPA) aerosol in patients with systemic sclerosis. We also investigated its correlation with respiratory function test and acute phase reactant proteins. Methods : Ten patients with systemic sclerosis, ten patients with rheumatoid arthritis, and ten healthy controls were included. Dynamic scintigrams (20 seconds/frame, up to 30 minutes) were obtained following inhalation of 99mTc-DTPA aerosol through a radioaerosol delivery system. The time to half clearance (T1/2) was calculated from the time-activity curves. High resolution computed tomography, pulmonary function test and laboratory tests such as ESR, CBP, and complement (C3/C4) were performed. Results : 1) Mean T1/2 values of 99mTc-DTPA clearance after inhalation were 28.1±3.8, 57.9±20.9, and 64.3±13.0 minutes in systemic sclerosis, rheumatoid arthritis and normal controls, respectively. Mean T1/2 value in systemic sclerosis was significantly reduced compared with those of rheumatoid arthritis group (ρ<0.001) and normal controls (ρ =0.001). 2) No significant correlations were found between mean T1/2 and FEV1/FVC, FVC or DLco in patients with systemic sclerosis. 3) There was no significant corre4tion between mean T1/2 and ESR or CRP in patients with systemic sclerosis. And in patients with rheumatoid arthritis, mean T1/2, value correlated significantly with ESR and CRP. Conclusion ' The clearance rate of inhaled 99mTc-DTPA was significantly increased in patients with systemic sclerosis and had no significant correlation with pulmonary function test and acute phase reactants, but was found to have significant correlations with ESR and CRP in patients with rheumatoid arthritis. (Korean J Med 61:33-40, 2001)

파라콰트 중독 환자에서 예후 예측인자 및 혈액관류술의 효과

배기범,김성욱,손종원,서재석,오종택,도병훈,한승우,신병철,김신우,강영모,이종명,김능수 대한응급의학회 2002 대한응급의학회지 Vol.13 No.3

Purpose: Paraquat is a nonselective contact herbicide that may induce damage to many organs poisoned with it. Due to the high mortality associated with paraquat poisoning, a prediction of the outcome is a prerequisite for determining the therapeutic modality. Methods: To identify prognostic factors for paraquat poisoning, the authors analyzed retrospectively the clinical features and outcomes of 45 patients (mean age: 45.9 years, male-to female ratio: 1.1 : 1) poisoned with paraquat herbicides; they had been admitted to the emergency room of Kyungpook National University Hospital between June 1992 and June 2001. Results: Most patients (91.1%) ingested liquid paraquat concentrate; twenty-six (62%) patients had intended to commit suicide. The overall mortality rate was 64.4% (29 patients); the mortality rate with ingestion of more than two mouthfuls was 93.3%. Seventy-six percent of the fatal cases expired within 2 days after intoxication. Azotemia, hypokalemia, hypoalbuminemia, leukocytosis, and decreased level of arterial PaCO₂and bicarbonate on the first hospital day were significantly related with mortality. Increased level of serum AST on the 4th hospital day was an additional marker of mortality. The survival rates according to the Yamaguchi index were significantly different (A: 60%, B: 12.5%, C: 17%). There was no significant difference in the mortality rate between patients treated with and without hemoperfusion. Conclusion: Acid-base and electrolyte imbalances, an abnormal renal function, a low Yamaguchi index, and a positive urine paraquat test might be useful as early markers of poor prognosis. The effect of hemoperfusion remains to be determined by a further larger prospective study.

PFAPA (Periodic Fever, Aphthous Stomatitis, Pharyngitis, and Cervical Adentis) 증후군 1예

강혜련,김신우,배기범,박지현,강영모,이종명,김능수 대한감염학회 2001 감염 Vol.33 No.3

PFAPA (Periodic Fever, Aphthous stomatitis, Pharyngitis, and cervical Adenitis) syndrome has characteristic features of an early onset, periodicity (interval <4 weeks), and a brisk rising high fever (>39℃) of 3 to 6 days' duration without signs of infection. An 18-year-old male was admitted for high fever, sore throat, headache, and abdominal pain. He had suffered from periodic fevers associated with pharyngitis and cervical adenitis for 14 years without any evidence of infection. The fever recurred approximately every 4 weeks lasting 4 to 7 days with intervening asymptomatic periods. Physical examination was unremarkable except for slightly injected tonsils. Most laboratory tests including CBC were normal except for elevation of Creactive protein level (3.47 mg/dL). Bacteriologic and radiologic studies were negative. The fever was spontaneously subsided in 6 days. To our knowledge, this is the first case report of PFAPA syndrome in Korea. (Korean J Infect Dis 33:219∼222, 2001)