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증례 : 류마티스 관절염 환자에서 infliximab 치료 후 발생한 간질성 폐렴 1예
유인설 ( In Seol Yoo ),송주경 ( Ju Kyoung Song ) 대한내과학회 2010 대한내과학회지 Vol.79 No.2
종양괴사인자 억제제는 류마티스 관절염에서 효과 및 안정성이 입증되어 현재 보편화된 치료이다. 부작용으로는 결핵 및 감염에 의한 폐렴, 급성 주사 반응, 루프스 유사 증후군, 악성 종양, 울혈성 심부전의 악화 등이 있으며 드물게 비감염성 간질성 폐렴이 외국에서 보고되었다. 비감염성 간질성 폐렴은 주로 methotrexate와 병용할 때 호발하며 국내에서는 아직 보고된 바가 없다. 저자들은 종양괴사인자 억제제인 infliximab을 사용한 류마티스 관절염 환자에서 발생한 비감염성 간질성 폐렴으로 고용량의 스테로이드를 사용한 후 호전된 증례를 경험하여 보고하는 바이다. Tumor necrosis factor (TNF)-α inhibitors are well-established biological agents for the treatment of a wide variety of chronic autoimmune diseases and inflammatory conditions, including rheumatoid arthritis (RA), ankylosing spondylitis, and psoriatic arthritis. Although these drugs have been noted to have good safety profiles, some important side effects, including infection, injection site reactions, lupus-like syndrome, congestive heart failure, and malignancies have been reported. Therefore, utilization of TNF-α inhibitors demands caution. Interstitial pneumonitis is a very rare complication of TNF-α inhibitors. We report here a 71-year-old man with RA who developed interstitial pneumonitis after the third infusion of infliximab. (Korean J Med 79:215-218, 2010)
귀밑샘 점액표피양암종의 폐 전이에 연관된 비후성 골관절증의
송승택 ( Seung Taek Song ),유인설 ( In Seol Yoo ),김영 ( Young Kim ),박찬걸 ( Chan Keol Park ),윤환중 ( Hwan Jung Yun ),강성욱 ( Seong Wook Kang ),김진현 ( Jin Hyun Kim ) 대한류마티스학회 2014 대한류마티스학회지 Vol.21 No.5
Hypertrophic osteoarthropathy is a syndrome characterized by periosteal new bone formation, arthritis, and clubbing of the fingers and toes. The majority of cases occur secondarily to the conditions associated with pulmonary, cardiac, gastrointestinal disorders or other systemic diseases. There are many cases with malignancy worldwide. We report the first patient who had hypertrophic osteoarthropathy due to metastatic cancer after surgical removal for mucoepidermoid carcinoma of the parotid gland.
박찬걸 ( Chan Keol Park ),유수진 ( Su-jin Yoo ),유인설 ( In Seol Yoo ),김진현 ( Jinhyun Kim ),심승철 ( Seung Cheol Shim ),여민경 ( Min-kyung Yeo ),강성욱 ( Seong Wook Kang ) 대한내과학회 2018 대한내과학회지 Vol.93 No.6
저자들은 최초 복부 CT 소견상 후복막강섬유화증으로 오인되었으나 적극적인 조직 검사를 통하여 후복막강에만 국한된 원발 부위 불명 전이암으로 진단된 증례를 경험하였다. 최근 후복막강섬유화증의 진단에 있어서 PET-CT 등 영상 검사가 기술적으로 많은 발전을 이루었지만 후복막강섬유화증의 진단시 악성종양의 배제는 필수적이기 때문에 후복막강섬유화증의 확진은 반드시 조직학적인 검사에 기초하여 이루어져야 함을 강조하는 바이다. Retroperitoneal fibrosis (RPF) is a rare disease characterized by marked fibro-inflammatory tissue in the retroperitoneum. Approximately 70% of cases of RPF are idiopathic, while the rest can be secondary to several other causes. The diagnosis is mainly obtained by imaging modalities such as computed tomography (CT). However, histological examination should be considered when the clinical manifestations and imaging studies suggest malignancy. In particular, in malignant diseases with retroperitoneal metastases, abnormal collagen plaques are formed from an exuberant desmoplastic response, which may not be distinguishable from RPF on CT scans. Therefore, even if CT suggests RPF, biopsy is essential to identify malignant disease because it typically results in a fatal prognosis. Here, we report a case of metastatic adenocarcinoma of unknown primary site that developed only in the retroperitoneum and was initially diagnosed as RPF based on CT findings. (Korean J Med 2018;93:575-581)
동종 조혈모세포 이식 후 발생한 호산구 근막염(Eosinophilic Fasciitis)
김진만 ( Jin Man Kim ),김진현 ( Jin Hyun Kim ),김민경 ( Min Kyung Kim ),강성욱 ( Seong Wook Kang ),조덕연 ( Deog Yeon Jo ),유인설 ( In Seol Yoo ),송승택 ( Seung Tak Song ) 대한류마티스학회 2011 대한류마티스학회지 Vol.18 No.1
Eosinophilic fasciitis (EF) is a relatively rare disorder characterized by eosinophilia of the peripheral blood and inflammation of fascia and skin. The etiology of EF is unknown but it can precede or occur concomitantly with hematologic disorders including malignancy. EF can rarely occur after bone marrow transplantation and is a feature of chronic graft-versus-host disease (cGVHD). We report a 49-year-old man who developed EF as the first manifestation of cGVHD after allogeneic hematopoietic stem cell transplantation (AlloHSCT).
류마티스 : 전신홍반루푸스로 오인된 혈관내B대세포림프종 1예
박찬걸 ( Chan Keol Park ),이정찬 ( Jeong Chan Lee ),강성욱 ( Seong Wook Kang ),심승철 ( Seung Cheol Shim ),윤환중 ( Hwan Jung Yun ),김진만 ( Jin Man Kim ),유인설 ( In Seol Yoo ) 대한내과학회 2015 대한내과학회지 Vol.89 No.6
Intravascular large B-cell lymphoma (IVLBCL) is a rare subtype of non-Hodgkin’s lymphoma (NHL) and that progresses rapidly and is usually fatal. Because it usually presents with nonspecific symptoms, such as fever, the early diagnosis of IVLBCL is very difficult and it is often misdiagnosed as another disease. Systemic lupus erythematosus (SLE) is an autoimmune disease that affects various organs. The clinical manifestation of SLE ranges from rash and arthritis through anemia and thrombocytopenia to serositis, nephritis, seizures, and psychosis. Thus, it can be easily confused with many other disorders. We report a case of IVLBCL mimicking SLE in the initial diagnosis. (Korean J Med 2015;89:746-751)