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손지연 ( Ji Youn Sohn ),김소리 ( So Ri Kim ),박성주 ( Seoung Ju Park ),이흥범 ( Heung Bum Lee ),이용철 ( Yong Chul Lee ),이양근 ( Yang Keun Rhee ) 대한결핵 및 호흡기학회 2009 Tuberculosis and Respiratory Diseases Vol.67 No.6
Background: A combination of salmeterol and fluticasone propionate (SFC) and tiotropium bromide (TIO) is commonly prescribed for COPD patients but there is little data on their effectiveness, particularly in COPD patients with bronchial hyperresponsiveness. This study compared the spirometric improvement based on the change in FEV1, FEV1/FVC, and IC as well as the clinical outcomes of the therapeutic strategies with SFC and TIO versus the individual components in patients with severe COPD and bronchial hyperresponsiveness. Methods: This study examined the spirometric data and clinical outcomes of 214 patients with COPD and hyperresponsiveness, who were divided into three groups according to the therapeutic regimen (TIO only, SFC only, and a triple therapy regimen). Results: All regimen groups showed early improvement in the FEV1 and IC (at 3- and 6 months after treatment). However, long-term beneficial effects were observed only in the SFC group (at 24 months after treatment). However, these beneficial effects decreased after a 36-month follow up. In all spirometric results, the 12-, 24-, and 36-months data showed a similar degree of improvement in the three groups. The triple therapy group showed higher St. George`s Respiratory Questionnaire scores and lower acute exacerbations and hospitalization. Conclusion: SFC can be a more important component in the pharmacological treatment of severe COPD patients with hyperresponsiveness than TIO, particularly in the spirometric and clinical outcomes.
손지연 ( Ji Youn Sohn ),이경애 ( Kyung Ae Lee ),홍윤경 ( Yun Kyung Hong ),류완희 ( Wan Hee Yoo ) 대한류마티스학회 2009 대한류마티스학회지 Vol.16 No.4
Thromobotic thrombocytopenic purpura (TTP) is a multisystem disorder that`s characterized by consumptive thrombocytopenia, microangiopathic hemolytic anemia, and neurologic symptoms. TTP is associated with many diseases and several therapeutic drugs. We report here on the first Korean case of a patient with rheumatoid arthritis (RA) and who developed TTP that was associated with trimethoprim-sulfamethoxazole (TMP-SMX) in Korea. She recovered from the TTP following daily sessions of therapeutic plasma exchange (TPE) with fresh plasma replacement and glucocorticoid therapy. Awareness of the possible development of TTP in patient with RA and who is being treated with TMP-SMX is important for making the early diagnosis and administering proper treatment.
증예(症例) : Amphotericin B 및 Voriconazole로 치료한 객혈을 동반한 폐 아스페르길루스종 1예
권대헌 ( Dae Hun Kwon ),손지연 ( Ji Youn Sohn ),소재승 ( Jae Seung Soh ),정종환 ( Jong Whan Chong ),안대선 ( Dae Seon Ahn ),홍영민 ( Young Min Hong ),백영하 ( Young Ha Baek ),이양근 ( Yang Keun Rhee ) 전북대학교 의과학연구소 2009 全北醫大論文集 Vol.33 No.1
아스페르길루스 감염은 여러 형태로 나타나며 그 중 아스페르길루스종은 결핵 등의 공동성 병변을 가지는 환자에서 호발 한다. 객혈 등의 증상이 나타나면 치료의 적응증이 되며 수술을 시행하거나 객혈에 대해 기관지동맥색전술을 시행할 수 있다. 항진균 요법은 체계적으로 정립되지는 않았으나 치료 성공률 및 생존률 및 약물의 부작용, 내약성(tolerability) 등을 고려할 때 voriconazole이 선택적인 치료약제가 될 수 있다. 본 증례는 50세 남자 환자로 과거 결핵 치료를 받았으며 재발한 객혈을 주소로 내원하여 임상 증상 및 흉부방사선, 흉부컴퓨터단층촬영, 기관지내시경 상에서 아스페르길루스종으로 진단 받고 입원 기간 중 amphotericin B 5주간 정맥 주사 후 외래에서 14주간 voriconazole 경구제제 복용 후 임상 증상, 흉부방사선 소견 모두 호전을 보인 증례를 문헌고찰과 함께 보고하는 바이다. Aspergilloma is the most common and best recognized form of pulmonary involvement due to aspergillus. Pulmonary aspergillosis usually develops in a pre-existing cavity in the lung. Most patients with aspergilloma are asymptomatic. When symptoms are present, most patients would experience mild hemoptysis, but severe hemoptysis may occur, particularly in patients with underlying tuberculosis. A 50-year-old male patient who had COPD with previous pulmonary tuberculosis lesion complained hemoptysis. Chest X-ray and Chest CT revealed an huge cavitary lesion with air-fluid level. The bronchoscopic finding revealed large bullous change with multiple scattered fungal balls on left anterior segment of left upper lobe. Improvement of symptoms and chest X-ray occurred after systemic antifungal therapy with intravenous amphotericin B for 5 weeks and voriconazole medication for 14 weeks, subsequently. We suggest that voriconazole treatment after amphotericin B treatment show effective results for pulmonary aspergilloma patient who experienced recurrent hemoptysis.
증례(症例) : 배액술 및 항결핵제 병합 치료로 성공한 흉벽내 걸핵 1례
김재문 ( Jae Moon Kim ),최경화 ( Kyoung Hwa Choi ),손지연 ( Ji Youn Sohn ),이원석 ( Won Seok Lee ),김형일 ( Hyung Il Kim ),고강석 ( Kang Suk Ko ),한효진 ( Hyo Jin Han ),김이식 ( I Sik Kim ),최정환 ( Chung Hwan Choi ),박성주 ( Seou 전북대학교 의과학연구소 2007 全北醫大論文集 Vol.31 No.1
흉벽내 결핵 (tuberculosis of the chest wall)은 흔하지 않은 질환으로 근골격계를 침범하는 결핵의 1~5%정도를 차지하는 질환이다. 흉벽내 결핵은 주로 CT 및 임상증상 및 조직검사를 통하여 진단되는 경우가 많으며 AFB microscopy로 진단되는 경우도 있었으나 흔하지 않다. 흉벽농약에서 검사한 AFB microscopy를 통해 진단하였으며 관을 통해 배액술 및 항생제 병합 치료 후 호전된 1예가 있어 보고한다. Primary tuberculosis of the chest wall is rare and clinical features resemble pyogenic abscess or tumor. Thus, the distinction of them can be difficult. Although it has been known that chest wall tuberculosis is usually presented with a painful mass that is frequently cystic, doughy, or soft and may fluctuate on physical examination, cold abscess, meaning swelling without inflammation, is one of the characteristics of the chest wall tuberculosis. Tuberculous cold abscesses of the chest wall are infrequently encountered and reportedly represent less than 10% of all skeletal tuberculosis cases. The presentation of cold abscesses is a progressively enlarging mass with or without destruction of the underlying bone or cartilage, and the consistency of the mass may be soft or firm. Some reports have demonstrated that chest wall tuberculosis occurs by one of three mechanisms of spread: (1) direct extension from the underlying pleural or pulmonary parenchymal disease, (2) hematogenous dissemination that is associated with the activation of a dormant tuberculous focus, and (3) direct extension from lymphadenitis of the chest wall. The diagnosis of chest wall tuberculosis is made by bacteriologic examinations for detecting acid-fast bacilli, polymerase chain reaction, or culture of aspiration specimens or postoperative specimens. Although recent trend of treatment of chest wall tuberculosis is combination therapy, surgical excision, and postoperative antituberculous chemotherapy, but there has no general consensus about the treatment of chest wall tuberculosis. Here, we report a case of chest wall tuberculosis treated successfully with abscess drainage and antituberculous chemotherapy.
症例(증례) : 류마티스 곤절염과 동반된 IgA 신병증 1례
고강석 ( Kang Suk Ko ),조양동 ( Yang Tong Cho ),김희정 ( Hui Jung Kim ),이원석 ( Won Seok Lee ),김형일 ( Hyoung Il Kim ),송민주 ( Min Ju Song ),손지연 ( Ji Youn Sohn ),류완희 ( Wan Hee Yoo ),강경표 ( Kyung Pyo Kang ),강명재 ( Myun 전북대학교 의과학연구소 2007 全北醫大論文集 Vol.31 No.2
IgA nephropathy is a common primary glomerulonephritis characterized by the deposition of IgA in glomerular mesangium. At clinical presentation the disorder may be macroscopic hematuria, often recurring in association with viral upper respiratory illness or with microscopic hematuria or proteinuria. Although the cause of primary IgA nephropathy is unknown, IgA nephropathy can be associated with systemic diseases, such as ankylosing spondylitis, Reiters`s syndrome, liver disease, and Sicca syndrome. We report a case of IgA nephropathy associated with rheumatoid arthritis. A 49-year-old woman, who has complaint of multiple joint swelling and pain, was presented with microscopic hematuria and proteinuria. Light microscopy showed mesangial and segmental endocapillary proliferative glomerulonephritis and immunofluorescence microscopy demonstrated segmental positive mesangial stainings for IgA and C3, consistent with IgA nephropathy. Treatment with anti-rheumatic medications and angiotensin converting enzyme inhibitor resulted in gradual disappearance of microscopic hematuria and proteinuria. Therefore, we suggest that IgA nephropathy may be associated with rheumatoid arthritis.