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허진욱 ( Jin Wuk Hur ),김태환 ( Tae Hwan Kim ) 대한류마티스학회 2005 대한류마티스학회지 Vol.12 No.3
The hallmark of ankylosing spondylitis (AS) is acute and chronic spinal inflammation initiating in the sacroiliac joints, often coupled with enthesitis, presenting as chronic inflammation at the sites of ligamentous and tendinous insertions into bone. Peripheral joint synovitis can be a prominent feature as well. Reactive arthritis (ReA) is a sterile synovitis arising after enteric or urogential tract infections. A great progression has been recently achieved in revealing the causes, and making plans for the treatments for AS and other types of spondyloarthropathy. The human leukocyte antigen (HLA)-B27 has been well known to be associated with disease susceptibility in AS and ReA. But the pathogenesis of AS and ReA is still not well defined. Although the clinical manifestations of AS and ReA may differ, in this review we discuss the two diseases together and focus on recent developments on the pathogenesis of both diseases.
류마티스 관절염 환자에서 hydroxychloroquine에 의한 급성 전신성 발진성 농포증 증례
임혜진 ( Hye Jin Lim ),정지혜 ( Ji Hye Jung ),김민정 ( Min Jeoung Kim ),김정민 ( Jeoung Min Kim ),강혜란 ( Hye Ran Kang ),송윤경 ( Yoon Kyung Song ),허진욱 ( Jin Wuk Hur ),김상훈 ( Sang Hoon Kim ),김은경 ( Eun Kyung Kim ) 대한천식알레르기학회 2013 Allergy Asthma & Respiratory Disease Vol.1 No.2
Acute generalized exanthematous pustulosis (AGEP) is characterized by acute nonfollicular sterile pustules on a background of edematous erythema. Hydroxychloroquine (HCQ), an antimalarial drug, widely used to treat rheumatic and dermatologic diseases. HCQ has been reported to be an uncommon cause of AGEP. We report a 60-year-old woman with rheumatoid arthritis requiring the use of HCQ presented fever and erythematous eruption on the trunk with sterile pustules. Leukocytosis and elevated erythrocyte sedimention rate noted on laboratory examination. On the histopathological examination of the skin biopsy specimen showed neutrophilic infiltration and scattered eosinohpils. The lesions were resolved with removal of HCQ. The clinical course was consistent with the diagnosis of AGEP associated with HCQ. We reported a case of typical AGEP associated with HCQ in a patient with Rheumatoid arthritis. The patient presented resolution from cutaneous lesions with withdrawal of culprit drug, without the need of systemic steroid. (Allergy Asthma Respir Dis 2013;1:176-178)Allergy Asthma Respir Dis 2013;1:176-178)
류마티스 관절염 환자에서 hydroxychloroquine에 의한 급성 전신성 발진성 농포증 증례 1예
임혜진 ( Hye Jin Lim ),정지혜 ( Ji Hye Jung ),김민정 ( Min Jeoung Kim ),김정민 ( Jeoung Min Kim ),강혜란 ( Hye Ran Kang ),송윤경 ( Yoon Kyung Song ),허진욱 ( Jin Wuk Hur ),김상훈 ( Sang Hoon Kim ),김은경 ( Eun Kyung Kim ) 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 1991 소아알레르기 및 호흡기학회지 Vol.1 No.2
Acute generalized exanthematous pustulosis (AGEP) is characterized by acute nonfollicular sterile pustules on a background of edematous erythema. Hydroxychloroquine (HCQ), an antimalarial drug, widely used to treat rheumatic and dermatologic diseases. HCQ has been reported to be an uncommon cause of AGEP. We report a 60-year-old woman with rheumatoid arthritis requiring the use of HCQ presented fever and erythematous eruption on the trunk with sterile pustules. Leukocytosis and elevated erythrocyte sedimention rate noted on laboratory examination. On the histopathological examination of the skin biopsy specimen showed neutrophilic infiltration and scattered eosinohpils. The lesions were resolved with removal of HCQ. The clinical course was consistent with the diagnosis of AGEP associated with HCQ. We reported a case of typical AGEP associated with HCQ in a patient with Rheumatoid arthritis. The patient presented resolution from cutaneous lesions with withdrawal of culprit drug, without the need of systemic steroid. (Allergy Asthma Respir Dis 2013;1:176-178)
김혜원 ( Hye Won Kim ),허진욱 ( Jin Wuk Hur ) 대한내과학회 2014 대한내과학회지 Vol.87 No.4
The systemic vasculitides are a group of diverse diseases characterized by blood vessel inflammation. The existing classification criteria are intended to create homogeneous patient groups for research and not to diagnose individual patients. However, they have been misused as diagnostic criteria, in both practice and research. The existing classification systems for vasculitis are limited by the overlapping features of disease entities and unrecognized pathogenic mechanisms. This review discusses the benefits and limitations of the widely used American College of Rheumatology criteria and Chapel Hill Consensus Conference nomenclature, updated in 2012. Improved diagnostics, including antineutrophil cytoplasmic antibody (ANCA) testing and imaging, argue for updating the established classification criteria. International efforts are underway to build a more effective classification and diagnostic criteria that reflect a better understanding of the pathophysiology of vasculitis and recent discoveries of genetics and biomarkers. (Korean J Med 2014;87:401-414)
고령의 무릎 골관절염 환자에서 Tramadol/Acetaminophen 복합제와 비스테로이드성 소염제의 유효성 및 안전성 비교
김세영 ( Se Young Kim ),류지원 ( Ji Won Ryou ),허진욱 ( Jin Wuk Hur ) 대한류마티스학회 2012 대한류마티스학회지 Vol.19 No.1
Objective. To compare the analgesic effectiveness and safety of tramadol 37.5 mg/acetaminophen 325 mg combination tablets (tramadol/acetaminophen) with non-steroidal anti-inflammatory drugs (NSAIDs) for the treatment of osteoarthrits in elderly patients. Methods. This randomized controlled study enrolled 48 patients with chronic knee osteoarthritis where the diagnostic period was over 3 months. Patients with at least moderate pain [visual analog scale (VAS) with scores ≥40/100 mm] after the washout period were randomized to tramadol/ acetaminophen or NSAID. All patients received tramadol/ acetaminophen 1 tablet TID or NSAID (naproxen 500 mg) BID. The primary outcome measures were the final pain VAS scores. Secondary measures included pain relief (5 point Likert scale), adverse events, and overall medication assessments. Results. In total, 43 intent-to-treat (ITT) patients received tramadol/acetaminophen (n=21) or NSAID (n=22). Mean baseline pain VAS scores showed no difference between two groups. ITT analysis showed significantly better mean final VAS scores (38.45 vs 31.24, p=0.004) and mean final pain relief scores (2.18 vs 2.95; p=0.007) for tramadol/acetaminophen rather than for NSAID. The most common treatment related adverse events with tramadol/acetaminophen were nausea/vomiting (47.6%) and constipation (33.3%). Epigastric soreness and heartburn was more frequent in NSAID treatment. Conclusion. Tramadol/acetaminophen combination showed better effectiveness in pain reduction compared with NSAIDs when used for the treatment of osteoarthritis in elderly patients.
강직성 척추염 환자에서 대동맥 박리를 동반한 마르팡 증후군 1예
류지원 ( Ji Won Ryou ),박지영 ( Ji Young Park ),송은주 ( Eun Ju Song ),허진욱 ( Jin Wuk Hur ) 대한내과학회 2013 대한내과학회지 Vol.84 No.6
A 33-year-old male presented with an acute onset of back pain and abdominal pain. He was 189.9 cm tall and had an arm span of 194 cm, and had mild pectus carinatum as well as arachnodactyly. Plain radiographs showed kyphoscoliosis of the lumbar spine, bamboo spine of the thoracic spine, and sacroiliitis of the pelvis. Abdominal computed tomography revealed debakey type 3 aortic dissection. We prescribed beta blockers to control his blood pressure. According to the modified New York criteria, we diagnosed him with HLA negative ankylosing spondylitis and initiated therapy with nabumetone and sulfasalazine. We later diagnosed Marfan syndrome based on the Ghent criteria and mutation screening at the fibrillin-1. After treatment, he has been followed up without symptoms or complications. (Korean J Med 2013;84:873-877)
혈액투석 중인 류마티스관절염 환자에서 Etanercept (Enbrel(R))로 치료한
백대현 ( Dae Hyun Baek ),송은주 ( Eun Ju Song ),이명하 ( Myoung Ha Lee ),이상렬 ( Sang Ryul Lee ),성수아 ( Su Ah Sung ),황영환 ( Young Hwan Hwang ),허진욱 ( Jin Wuk Hur ) 대한류마티스학회 2008 대한류마티스학회지 Vol.15 No.4
Disease-modifying antirheumatic drugs (DMARDs) have been used for rheumatoid arthritis (RA) with the aim of controlling synovitis and reducing radiologic progression. Although methotrexate (MTX) is one of the most effective DMARDs, it may cause severe adverse effects. Especially, hematologic toxicity including leukopenia, thrombocytopenia, and fatal pancytopenia is reported in patients with impaired renal function, since renal excretion constitutes the major route of MTX elimination. Tumor necrosis factor-α (TNFα) inhibitors are well-established biologic agents for the treatment of RA and their clinical efficacy and safety are already demonstrated. But there were few reports on the efficacy and safety in dialysis patients. We described a case of hemodialysis patient with refractory RA that was successfully treated with etanercept, and discussed with literature review.
간세포암 환자의 발생원인에 따른 말초혈액의 T 세포 아형과 자연살해세포능의 비교
허진욱,최바울,임현정,김수홍,김은석,윤병철,한병훈,이상욱 고신대학교 의학부 2003 高神大學校 醫學部 論文集 Vol.18 No.1
Backgrounds : Many cancer patients, such as Hepatocellular carcinoma(HCC), have a compromised cellular immune system. Several lympocytes subpopulations are involved in immunosurveillance against tumors. We try to evaluate on alteration of peripheral T cell subsets, NK cell and NK cell activity in patients with HCC. Materials and Method : Our study contain 257 patients with chronic liver disease. Of the 257 patients, 147 patients were chronic hepatitis, 44 patients were liver cirrhosis, 66 patients were Hepatocellular carcinoma. We distributed these patients to 3 groups due to cause, chronic hepatitis B (1st group, n=183), chronic hepatitis C (2nd group, n=52), alcoholic liver disease(3rd group, n=22). This study analysis ratio of CD3+, CD4+ CD8+, CD56+ T cell and NK cell activity. Results : The percentage of CD3+ and CD8+ cells were significantly decreased in LC and HCC groups. The activity of NK cells was significantly decreased in HCC than hepatitis group in HBV group. But not different in HCV and alcohol groups. NK cell and NK cell activity were significant decreased in HCC of younger patients (below 40 years) than older patients (above 60 years). Conclusions : Our study showed HCC was altered cellular immune system and decreased activity of NK cells. On the basis of this results, it can be suggested that decreased activity of NK cells according to age may be related to differnce of common age, prognosis and response of immune therapy.
박정필,허진욱,김신,김유리,박찬복,임현정,이지영,박무인,박선자,천봉권,안병권,구자영 고신대학교 의학부 2004 高神大學校 醫學部 論文集 Vol.19 No.1
저자들은 좌하복부 동통을 주소로 내원한 환자에서 대장 조영술, 대장 내시경, 하복부 전산화 촬영을 통해 S자 결장 게실염으로 진단하고 약물적 치료를 통해 호전되었으나, 지난 3년간 수회에 걸쳐서 게실염의 재발로 내과적 치료를 받은 병력과 최근 시행한 대장 조영술상 S상 결장의 누공이 관찰되어 재발성 게실염의 근치적 치료 목적으로 수술을 시행하여 합병증 없이 좋은 경과를 보였기에 이에 보고하는 바이다. Diverticular disease of the colon is quite common in developed countries, and its prevalence increases with age. The large majority of patients will remain entirely asymptomatic. Nonetheless, an estimated 20% of those affected may manifest clinical illness, mainly diverticulitis, with its potential complications of abscesses, fistulas, and obstruction as well as lower intestinal hemorrhage. A case was experienced involving of diverticulitis operated due to recurrent left lower abdominal pain in 51-year-old female. We present this case with brief review of the related literature.