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박철연,권정석,정진욱,이충기,현대성,최정윤 영남대학교 의과대학 2008 Yeungnam University Journal of Medicine Vol.25 No.2
Dermatomyositis is characterized by progressive, symmetric, Proximal muscle weakness and a nonsuppurative inflammatory myopathy of unknown etiology involving predominantly skeletal muscles. It is also characterized by typical skin lesions. Interstitial lung disease has a poor prognosis when it is associated with dermatomyositis. Organizing pneumonia is a disease in which granulation tissue fills the lumina of terminal and respiratory bronchioles and extends into the distal airspaces. The cryptogenic nature of the process is appreciated in that organizing pneumonia patterns of injury can be seen in secondary forms of the disease (secondary organizing pneumonia). Organizin pneumonia has been reported to occur in 5~10% in dermatomyositis-polymyositis patients Anti-histidyl tRNA synthetase antibody (anti-Jo-1) is a Predictive disease marker that is reported to occur in up to 70% of patients. We describe a 49-year-old male dermatomyosits patient who presented with organizing pneumonia and was found to have negative anti-Jo-1 antibody.
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혈액투석 환자에서 쇄골하정맥 도관 삽입 후 쇄골에 발생한 골수염 1예
박철연 ( Chul Yun Park ),배경륜 ( Kyung Ryun Bae ),전승운 ( Seung Woon Jun ),곽진호 ( Jin Ho Kwak ),이인희 ( In Hee Lee ),안기성 ( Ki Sung Ahn ) 대한신장학회 2008 Kidney Research and Clinical Practice Vol.27 No.5
Osteomyelitis (OM) of the clavicle is a rare complication of the central venous catheterization and has been reported infrequently in the literature. We report here a case of OM of the left clavicle complicating right subclavian vein catheterization performed for hemodialysis (HD). A 41-year-old male patient on HD for 3 months complained of pain and mass over the left sternoclavicular joint. Computerized tomography showed a demarcated soft tissue mass. Bone scan demonstrated increased tracer uptake in the left clavicle compatible with OM. The patient underwent surgical exploration with removal of the necrotic bone and he was treated with antibiotics including vancomycin. Afterward he remained well on HD. In conclusion, OM should be considered in any dialysis patient who develops pain and signs of inflammation in the sternoclavicular area after central venous catheterization for HD.
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A Calcitonin-Negative Neuroendocrine Tumor Derived from Follicular Lesions of the Thyroid
김가영,박철연,조창호,박준식,정의달,전언주 대한내분비학회 2015 Endocrinology and metabolism Vol.30 No.2
Neuroendocrine lesions of the thyroid are rare. The most common types are medullary thyroid carcinomas (MTCs) and C-cell hyperplasia. MTCs originate from thyroid parafollicular cells that secrete calcitonin which serves as a serum marker of MTCs. Here, the rare case of a calcitonin-negative neuroendocrine tumor (NET) derived from follicular lesions of the thyroid is described. A 34-year-old man presented at our hospital for the surgical management of an incidental thyroid nodule that was observed on an ultrasound sonography (USG) of the neck. Initially, USG-guided aspiration cytology was performed, and a MTC was suspected. The expressions of thyroglobulin and thyroid transcription factor-1, which are thyroid follicular cell markers, and synaptophysin and chromogranin A, which are neuroendocrine markers, was confirmed following surgical pathology. However, the staining of calcitonin, a marker of MTCs, was not observed. A nonmedullary NET of the thyroid is uncommon, and the distinction between calcitonin-negative NETs and MTCs of the thyroid may be important due to differences in their clinical courses and management.
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골관절염 환자에서 piroxicam 함유 패취제의 유효성 및 안전성
박성훈 ( Sung Hoon Park ),박철연 ( Chul Yeon Park ),김성규 ( Seong Kyu Kim ),김채기 ( Chae Gi Kim ),최정윤 ( Jung Yoon Choe ),신임희 ( Im Hee Shin ) 대한내과학회 2008 대한내과학회지 Vol.74 No.5
골관절염 환자에서 경구용 소염진통제의 장기사용에 따른 전신 부작용의 위험을 줄이기 위한 필요성으로 국소형 진통소염제가 개발되었으며, 그 중 piroxicam을 주성분으로 하면서 기타 보조성분들을 이용하여 경피흡수율을 높이고, 통증부위에서의 지속적인 약물농도를 유지하도록 하는 트라스트 패취가 기존에 유용하게 사용되어왔다. 무르페는 트라스트와 동일한 주성분을 사용하되 새로운 흡수제와 용해제 등을 사용하여 임상효과의 향진을 시도한 새로운 패취로, 본 연구에서는 무르페와 트라스트를 사용하여 골관절염 환자에서 임상효과를 평가하기 위한 비교 연구를 시행하였다. 무르페는 1, 2차 유효성 평가 변수에서 모두 일관되게 트라스트에 비하여 우수한 통증감소 효과가 있으면서, 국소 및 전신 이상반응은 더 높지 않은 결과를 보여주었다. 무르페와 같은 패취형 NSAID의 사용이 무릎 골관절염 환자의 유용한 치료가 될 수 있을 것으로 생각되며, 패취제의 개발 시 적절한 보조제의 사용은 NSAID 국소 요법의 효능과 안전성을 높일 수 있을 것으로 판단된다. Background/Aims: We wanted to compare the efficacy and safety of a Murupe(R) patch, which is a newly-developed piroxicam patch, with the Trast(R) patch for the treatment of knee osteoarthritis. Methods: Two hundred ten patients with radiologically confirmed symptomatic osteoarthritis of the knee were included in a randomized, open-labeled controlled trial and they were treated with a 48 mg piroxicam patch once every 48 hours for 4 weeks. The main outcome measures were the pain intensity on movement and the spontaneous pain intensity during rest, and these were measured using the 10 cm Visual Analogue Scale (VAS) categorical pain scores, as measured by the patient and the investigator. Results: One hundred sixty-seven of the 210 enrolled patients completed the 4 week study. The pain intensity on movement was significantly reduced in both the Trast(R) and Murupe(R) groups (p<0.001) after 4 weeks of treatment; the improvement on the VAS was significantly higher in the Murupe(R) group (n=82) than that in the Trast(R) group (n=85) (4.5 cm versus 2.2 cm, respectively, p<0.001). Both treatment groups also showed reductions in all the other parameters of pain intensity, including spontaneous pain intensity during rest, the categorical pain scores and the 15 meter-walking time. There was no difference in adverse events between both groups. Conclusions: The superior analgesic activity of Murupe(R) patch indicates that the topical route of non-steroidal anti-inflammatory drug (NSAID) administration may be a safe, effective alternative to the oral route for the treatment of knee OA, and that the newly developed NSAID patch with its improved transdermal drug delivery may increase the efficacy of topical NSAIDs.(Korean J Med 74:537-545, 2008)
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중추신경계 침범을 보인 Sweet 증후군 1예: Neuro-Sweet disease
정현영 ( Hyun Young Jung ),김수경 ( Soo Kyoung Kim ),박근우 ( Keun Woo Park ),박철연 ( Cheol Yeon Park ),정승혜 ( Seung Hie Chung ),박성훈 ( Sung Hoon Park ),최정윤 ( Jung Yoon Choe ) 대한내과학회 2008 대한내과학회지 Vol.75 No.4
Sweet 증후군은 급성 발열, 백혈구 증가, 발적을 동반한 압통성 피부 병변을 특징으로 하며, 피부병변의 진피 조직에서 중성구의 피하침윤이 관찰된다. Sweet 증후군의 피부 외 발현으로 근골격계 증상이 흔하게 나타나지만 중추 신경계의 침범은 매우 드물어 국내에서는 보고된 바가 없다. 이에 저자들은 의식 혼탁으로 내원하여 중추 신경계를 침범한 Sweet 증후군으로 진단한 환자를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Sweet syndrome is an unusual disease characterized by the sudden onset of fever, leukocytosis, and painful erythematous plaques, and the dermal infiltration of neutrophils at the site of skin lesions. Although Sweet syndrome can also present with extra-cutaneous manifestations, involvement of the central nervous system (CNS) is rarely reported. We describe a case of Sweet syndrome involving the CNS in a 46-year-old male with a disturbance of consciousness following fever and erythematous skin plaques in the extremities. Cerebrospinal fluid examination disclosed neutrophilic pleocytosis without decreased glucose and protein levels. HLA typing showed B54, which is frequently seen in Sweet syndrome. Brain magnetic resonance imaging showed abnormal signal intensity lesions in the left temporal lobe. Skin biopsy revealed a dense dermal infiltration of neutrophils, which is compatible with Sweet syndrome. The confused mentality, fever, and erythematous skin plaques resolved after the administration of systemic corticosteroids. (Korean J Med 75:463-466, 2008)
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