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조덕신,이병재,민태훈,강보현,김형훈,이병완,최동철 대한내과학회 2002 대한내과학회지 Vol.63 No.4
The hemolytic uremic syndrome (HUS) is a clinical syndrome defined by the presence of thrombocytopenia, microangiopathic hemolytic anemia and acute renal failure with or without a clinically apparent etiology. The conventional treatment of choice is plasmapheresis as a first-line therapy. Most patients respond to plasmapheresis whereas some patients are refractory to the therapy. The second-line therapy is not well established although various therapies such as steroid, vincristine, intravenous immunoglobulin have been suggested. The intravenous immunoglobulin therapy in refractory hemolytic-uremic syndrome have rarely been successful in complete remission. We report a case of refractory HUS in a 48 year-old man who developed hemolytic anemia, thrombocytopenia, acute renal failure and ischemic retinopathy. The patient was refractory to plasmapheresis as a first-line therapy. The patient received intravenous immunoglobulin therapy as a second-line therapy after 8 days of plasmapheresis, which subsequently resulted in a complete remission of refractory HUS. The complete remission using immunoglobulin in HUS has not been previously reported in Korea.(Korean J Med 63:431-435, 2002) 저자들은 국내에는 드문 성인 용혈성 요독 증후군 환자에서 혈장 교환술에 반응이 없어 이차적 치료로 면역글로불린을 투여하여 완전 치유가 되었기에 이를 문헌 고찰과 함께 보고하는 바이다.
조덕신,이병재,민태훈,강보현,김형훈,이병완,최동철 대한내과학회 2002 대한내과학회지 Vol.63 No.4
The hemolytic uremic syndrome (HUS) is a clinical syndrome defined by the presence of thrombocytopenia, microangiopathic hemolytic anemia and acute renal failure with or without a clinically apparent etiology. The conventional treatment of choice is plasmapheresis as a first-line therapy. Most patients respond to plasmapheresis whereas some patients are refractory to the therapy. The second-line therapy is not well established although various therapies such as steroid, vincristine, intravenous immunoglobulin have been suggested. The intravenous immunoglobulin therapy in refractory hemolytic-uremic syndrome have rarely been successful in complete remission. We report a case of refractory HUS in a 48 year-old man who developed hemolytic anemia, thrombocytopenia, acute renal failure and ischemic retinopathy. The patient was refractory to plasmapheresis as a first-line therapy. The patient received intravenous immunoglobulin therapy as a second-line therapy after 8 days of plasmapheresis, which subsequently resulted in a complete remission of refractory HUS. The complete remission using immunoglobulin in HUS has not been previously reported in Korea.
Streptozotocin을 포함한 약물치료의 실패후 재수술로 완치된 Nesidioblastosis 1예
김형훈,정인경,강보현,강한욱,이병완,신상엽,조덕신,윤종욱,김범진,정재훈,민용기,이명식,이문규,오영륜,서연림,박미경,김광원 대한내분비학회 2002 Endocrinology and metabolism Vol.17 No.5
Nesidioblatosis is a term that describes small clusters of pancreatic islet cells budding off exocrine ducts, and is commonly reported in infants with intractable idiopathic hypoglucemia. The onset of nesidioblastosis in adults is an extremely rare entity associated with hypersecretion of insulin and the treatment of choice is pancreatic resection. Medical treatment, including somatostatin, propranolol, diazoxide, hydrochlorthiazide and streptozotocin have achieved limited success. We experienced a case of adult nesidioblastosis that underwent reoperation after the failure of medical treatment following an inappropriate first operation.A 54-year old man was admitted due to intermittent hypoglycemic symptoms, which had been relieved by carbohydrate ingestion. Hyperinsulinemic hypoglycemia was documented during a prolonged fast. Image studies found no localized lesion, so a distal pancreatectomy was performed. The pathological examination of the resected pancreas revealed irregularly sized islets and a scattering of small endocrine cell clusters throughout the acinar tissue and ductuloinsular complex.攀접수일자: 2002년 8월 2일통과일자: 2002년 10월 8일 공복시 반복되는 발한, 진전을 주소로 내원하였던 54세 남자 환자에서 고인슐린성 저혈당으로 판별되어 distal pancreatectomy를 시행후 nesidioblastosis를 진단 받은 환자에서 술후 저혈당이 재발하여 streptozotocin을 포함한 여러 약물의 내과적 치료를 시행하였으나 저혈당의 증상이 소실되지 않아 near total pancreatectomy를 시행 받은후 완치된 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다.
말단비대증 환자의 혈중 프롤락틴 수치와 면역조직화학염색과의 상관관계
강보현 ( Bo Hyun Kang ),정인경 ( In Kyung Jeong ),조덕신 ( Duck Shin Cho ),강한욱 ( Han Wook Kang ),김형훈 ( Hyung Hoon Kim ),김범진 ( Beom Jin Kim ),민태훈 ( Tae Hoon Min ),손준성 ( Jun Seong Son ),홍성노 ( Sung No Hong ),이춘영 대한내과학회 2003 대한내과학회지 Vol.64 No.2
목적: 말단비대증은 대부분 성장호르몬 분비 뇌하수체 선종에 의한 것으로 35%에서 고프롤락틴혈증이 동반된다고 알려져 있다. 저자들은 말단비대증 환자의 뇌하수체 조직의 면역조직화학염색 소견과 혈중 호르몬 수치를 비교하여 이들간에 어떠한 관계가 있는지 알아보고자 하였다. 방법: 1998년 8월부터 2001년 5월까지 말단비대증 진단 하에 뇌하수체 종양 제거수술을 받은 환자 28명(남자:여자=18:10, 평균연령: 41세)을 대상으로 하였다. 혈중 기저 성장 Background: Acromegaly occurs by excessive secretion of growth hormone and more than 99% of cases are caused by a growth hormone-secreting pituitary adenoma. Pituitary adenomas expressing multiple immunoreactivities are common. We assumed that the pituita