궤양성 대장염에 병발된 비특이적 간질성 폐렴

노영욱 ( Young Wook Noh ),백은경 ( Eun Kyung Baik ),류연주 ( Yon Ju Ryu ),김성은 ( Seong Eun Kim ),이진화 ( Jin Hwa Lee ),심성신 ( Sung Shin Sim ),이신애 ( Shi Nae Lee ),천은미 ( Eun Mi Chun ) 대한결핵 및 호흡기학회 2007 Tuberculosis and Respiratory Diseases Vol.62 No.1

Pulmonary complications of ulcerative colitis are relatively uncommon and may present as a variety of disorders. Ulcerative colitis-related interstitial lung disease is extremely rare. There are a few case reports of nonspecific interstitial pneumonia in ulcerative colitis worldwide but none in Korea. We report a patient with ulcerative colitis related biopsy-proven nonspecific interstitial pneumonia, who responded to prednisolone (1mg/kg) and mesalazine therapy. (Tuberc Respir Dis 2007; 62: 56-61)

국내 염증성 장질환 환자에서의 임신과 출산

노영욱 ( Young Wook Noh ),정성애 ( Sung Ae Jung ),강민정 ( Min Jung Kang ),정지민 ( Ji Min Jung ),김성은 ( Seong Eun Kim ),심기남 ( Ki Nam Shim ),김태헌 ( Tae Hun Kim ),유권 ( Kwon Yoo ) 대한장연구학회 2010 Intestinal Research Vol.8 No.1

Background/Aims: It is unknown what effect inflammatory bowel disease (IBD) has on pregnancy in Korean patients. We aimed to determine the effect of IBD and its treatment on pregnancy outcomes using web-based survey. Methods: A web-based survey was conducted in three Korean internet communities for IBD patients between May and September 2008. Pregnancy and birth outcomes were examined, and the influence of IBD activity and drug therapy were analyzed. Results: Of 56 pregnancies in 36 female IBD patients, live births occurred in 60.7%, miscarriages in 10.7%, and artificial abortions in 17.8%. These results were similar to those expected for pregnant women in the general Korean population. All artificial abortions occurred in unplanned pregnancies, and 80% of those cases were due to a misunderstanding of IBD and medications. IBD was aggravated in 11.1% of the patients in remission or with mild activity and in 85.7% of patients with moderate or severe activity at the time of early pregnancy. Of 57 pregnancies in the spouses of 39 male patients, live births occurred in 78.9%, miscarriages in 8.8%, and artificial abortions in 3.5%. There was no significant influence of therapeutic medications on the natural course of pregnancies. Conclusions: Pregnancy outcomes in IBD patients appear to be similar to those of the general Korean population. A properly planned pregnancy and a comprehensive treatment course before and during pregnancy are important considerations for increasing the likelihood of a normal pregnancy in those with IBD. (Intest Res 2010;8:30-39)

폐색전증을 동반한 원발성 항인지질증후군

이재범 ( Jae Beom Lee ),심윤수 ( Yun Su Sim ),노영욱 ( Young Wook Noh ),박혜성 ( Hye Sung Park ),태정현 ( Chung Hyun Tae ),임소연 ( So Yeon Lim ),전윤희 ( Yoon Hee Jun ),류연주 ( Yon Ju Ryu ),천은미 ( Eun Mi Chun ),이진화 ( Jin Hw 대한결핵 및 호흡기학회 2007 Tuberculosis and Respiratory Diseases Vol.63 No.1

Antiphospholipid syndrome (APS) causes recurrent thromboses and morbidity during pregnancy, including fetal loss. This malady is associated with the persistent presence of anticardiolipin antibody or lupus anticoagulant. The pulmonary manifestations of antiphospholipid syndrome include pulmonary thromboembolism, pulmonary hypertension, acute respiratory distress syndrome, etc. Pulmonary thromboembolism is often the initial manifestation of antiphospholipid syndrome and a timely diagnosis is critical due to the high mortality rate. We herein report on a 19-year-old man with pulmonary thromboembolism that was caused by primary antiphospholipid syndrome. He presented with blood-tinged sputum, fever and epigastric pain, and his chest computerized tomography showed pulmonary thromboembolism. The other possible causes of pulmonary thromboembolism were excluded and the diagnosis of primary antiphospholipid syndrome was confirmed by the lupus anticoagulant that was present on two occasions six weeks apart. We also discuss the nature and management of antiphospholipid syndrome, along with a brief review of the relevant literatures. (Tuberc Respir Dis 2007; 63: 72-77)

염증성 장질환 환자에서의 골밀도 저하의 위험인자 분석

박재정 ( Jae Jung Park ),정성애 ( Sung Ae Jung ),노영욱 ( Young Wook Noh ),강민정 ( Min Jung Kang ),정지민 ( Ji Min Jung ),김성은 ( Seong Eun Kim ),정혜경 ( Hye Kyung Jung ),심기남 ( Ki Nam Shim ),김태헌 ( Tae Hun Kim ),유권 ( Kw 대한소화기학회 2010 대한소화기학회지 Vol.55 No.4

목적: 염증성 장질환에서 골밀도 감소는 비교적 흔한 합병증이며 이와 연관된 위험인자들이 보고되고 있으나, 한국의 염증성 장질환 환자에서의 연구는 미미하다. 본 연구는 염증성 장질환 환자에서의 골밀도 감소의 유병률 및 위험인자를 알아보고자 하였다. 대상 및 방법: 30명의 염증성 장질환 환자를 대상으로 X-선 골밀도 측정기에 의해 골밀도를 측정하였다. 혈청 인, 칼슘, 오스테오칼신과 데옥시피리디놀린을 포함한 인자들을 측정하였다. 의무기록을 후향적으로 검토하여 질병의 유병기간, 활성도, 약물력, 체질량지수 등을 조사하고 골감소와의 연관성을 분석하였다. 결과: 전체 환자의 63.3%에서 골밀도 감소가 있었으며 크론병과 궤양성 대장염에서의 유의한 차이는 없었다. 골밀도 감소와 임상적 지표들 간의 유의한 연관성이 없었고, 골대사의 지표들과 골밀도 사이에 유의한 상관관계가 없었다. 골밀도검사 전 글루코코르티코이드를 사용하지 않았던 염증성 장질환 환자의 50.0%에서 골밀도 감소를 보였다. 결론: 한국의 염증성 장질환 환자에서도 서구와 마찬가지로 골밀도 감소가 빈번하며, 이러한 골감소의 원인은 명확하지는 않지만 다양한 인자들이 복합적으로 관여할 것으로 여겨진다. 따라서, 글루코코르티코이드 사용 여부와 상관없이 염증성 장질환 환자에서 골밀도 측정이 필요하다. Background/Aims: Several clinical risk factors for low bone mineral density (BMD) in the patients with inflammatory bowel disease (IBD) have been suggested. However, its prevalence and pathophysiology in Korean population have not been fully studied. The aim of this study was to investigate the prevalence and risk factors for low BMD in Korean IBD patient. Methods: BMD of the lumbar spine and femur was evaluated using dual-energy X-ray absorptiometry in 30 patients with IBD. Biochemical parameters of bone metabolism, such as serum calcium, phosphorus, osteocalcin, and deoxypyridinoline were measured. The associations between low BMD and clinical parameters such as disease duration, disease activity, drug history, body mass index (BMI), and others were evaluated retrospectively using medical records. Results: Low BMD at the lumbar spine or femur was observed in 63.3% of the patients, and there was no significant difference between the patients with Crohn`s disease and ulcerative colitis. Clinical and biochemical parameters were irrelevant to BMD. In the patients without glucocorticoid treatment prior to BMD measurement, already 50.0% of patients had low BMD. Conclusions: Low BMD is a common feature in Korean IBD patients, even those who do not use glucocorticoid. The multiple factors may be involved in the pathogenesis of low BMD. Therefore, BMD should be examined in all IBD patients, irrespective of glucocorticoid treatment. (Korean J Gastroenterol 2010;55:237-244)

원발성 복막수염의 임상양상

박재정 ( Jae Jung Park ),정성애 ( Sung Ae Jung ),노영욱 ( Young Wook Noh ),김고흔 ( Go Heun Kim ),허현미 ( Hyun Mi Heo ),배서은 ( Suh Eun Bae ),최윤정 ( Yun Jung Choi ),김소이 ( So I Kim ),이명원 ( Myung Won Lee ),강민정 ( Min Jun 대한장연구학회 2009 Intestinal Research Vol.7 No.1

Background/Aims: Primary epiploic appendagitis (PEA) is a rare cause of focal abdominal pain in otherwise healthy patients. Patients with acute abdominal pain are often misdiagnosed clinically as acute appendicitis or diverticulitis. The purpose of this study was to describe the clinical presentation and characteristic computed tomography (CT) findings of PEA. Methods: We reviewed the clinical records and CT images of 23 consecutive patients in Korea who presented with acute abdominal pain between January 2005 and February 2009 and had radiologic signs of PEA. Results: Twenty-three patients (7 females and 16 males; average age, 42±14 years) were diagnosed with symptomatic PEA. Abdominal pain localized to the left (8 patients [44.5%]) and right (10 patients [55.5%]) lower quadrants as the leading symptom. CT findings specific for PEA were present in all patients except one. The symptoms resolved within 1 week (mean, 3.5 days) with or without antibiotic treatment. Conclusions: In patients with localized, sharp, acute abdominal pain not associated with other symptoms, such as nausea, vomiting, fever or atypical laboratory values, the diagnosis of PEA should be considered and the diagnosis confirmed by CT scan. (Intest Res 2009;7:47-51)

소세포폐암 환자에서 토포테칸 투약 후 발생한 급성호흡곤란증후군

태정현 ( Jung Hyun Tae ),이진화 ( Jin Hwa Lee ),김윤경 ( Yoon Kyung Kim ),심윤수 ( Yun Su Sim ),이경종 ( Kyung Jong Lee ),노영욱 ( Young Wook Noh ),박재정 ( Jae Jung Park ),류연주 ( Yon Ju Ryu ),천은미 ( Eun Mi Chun ),장중현 ( Jun 대한결핵 및 호흡기학회 2008 Tuberculosis and Respiratory Diseases Vol.65 No.2

Small cell lung cancer is characterized by an aggressive clinical course and a high tendency for early dissemination in spite of a good chemotherapy response. Topotecan is a topoisomerase I inhibitor, and it is used as second-line treatment for small cell lung cancer. The reported dose-limiting adverse reactions to topotecan are mainly hematologic. Yet pulmonary toxicity associated with topotecan is known to be rare. We report here on a case that showed the development of acute respiratory distress syndrome during the 3rd cycle of topotecan chemotherapy in a patient with small cell lung cancer. He developed dyspnea and respiratory failure, and the chest CT scan revealed diffuse ground-glass opacity that was probably due to chemotherapy-related pulmonary toxicity. He finally died of acute respiratory distress syndrome. (Tuberc Respir Dis 2008;65:142-146)

십이지장 조직 검사 후 발생한 미세 천공 1예

노영욱,정성애,송현주,박재정,이경종,백은경,민석기 이화여자대학교 의과학연구소 2008 EMJ (Ewha medical journal) Vol.31 No.2

최근들어 상부위장관 내시경의 술기가 발달함에 따라 식도, 위, 십이지장에 발생하는 질환을 진단하고 치료하기 위해 상부위장관 내시경이 전세계적으로 널리 사용되고 있다. 상부위장관 내시경 검사의 합병증은 정의와 조사된 통계 등에 따라 차이가 있으나 발생율은 0.13~0.24%이고, 이 중 천공의 발생률은 0.03~0.1%이지만 조직 생검으로 발생하는 천공은 매우 드문 것으로 보고되고 있다1-3). 따라서 상부위장관 내시경 검사 중 천공의 발생이 드물기 때문에 간과하고 지나치기 쉬우나, 천공이 발생하였을 경우 환자에게 복통 및 복막염 등의 합병증을 유발할 수 있으므로, 내시경 시술의는 천공이 발생할 수 있는 상황에 주의하고 천공이 발생시 이에 대한 적절한 대처를 숙지하여야 한다. 저자들은 상부위장관 내시경 검사 중 십이지장 점막하 종양의 조직 검사 후에 발생한 천공 1예를 문헌 고찰과 함께 보고한다. Nowadays, upper gastrointestinal endoscopy is very commonly performed procedure as a diagnostic tool or therapeutic purpose. Although perforation rate during diagnostic evaluation has been reported as low about 0.03%, gastrointestinal perforation is a critical problem to the patients owing to significant morbidity and hospital stay. Therefore, all endoscopists should know the risk factors for the perforation and pay attention to avoid this complication. We experienced a case of 66 yearold-male with duodenal microperforation after endoscopic biopsy. During endoscopic examination, a submucosal mass was detected at duodenal second portion and endoscopic biopsy was performed. After this, he complained of severe abdominal pain during colonoscopy. Emergent simple abdomen and abdominal computed tomography revealed multiple free air in retroperitoneal space and duodenal perforation was suspicious. He was treated with primary closure and then recovered completely. Therefore, we report a case with microperforation after endoscopic duodenal biopsy.

다클론성 감마글로불린병증을 동반한 C-ANCA 양성 급속진행성 사구체신염 1예

백은경,노선희,박진경,조정연,권성신,심은진,권경주,노영욱,이경종,윤정윤,김인선,김소이,류동열,성순희,홍기숙 이화여자대학교 의과학연구소 2008 EMJ (Ewha medical journal) Vol.31 No.1

저자들은 육안적 혈뇨, 체중 감소를 주소로 입원하여 특별한 원인을 찾을 수 없는 심한 빈혈과 고감마글로불린병증을 보이고 신조직 검사에서 C-ANCA 양성 급속 진행성 사구체신염으로 진단된 예를 경험하였기에 보고 하는 바이다. Rapidly progressive glomerulonephritis(RPGN) is one of the most calamitous renal disease which is clinically characterized by sudden and relentless deterioration in renal function within weeks to months and associated with the pathologic finding of extensive extracapillary proliferation. Pauci-immune RPGN is mostly associated with anti neutrophil cytoplasmic antibody (ANCA) positive systemic vasculitis, but renal-limited RPGN may be found in part. We experienced a case of ANCA positive RPGN associated with polyclonal gammopathy without systemic symptoms. A 64-year-old woman was admitted with gross hematuria and azotemia. Laboratory findings revealed polyclonal gammopathy and severe anemia without definite cause, and she was diagnosed as C-ANCA positive crescentic glomerulonephritis without systemic vasculitis. She was treated with steroid pulse therapy and her renal function and anemia were progressively improved. We report herein a rare case of C-ANCA positive crescentic glomerulonephritis associated with polyclonal gammopathy and severe anemia with the review of literature.