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이수윤 ( Soo Youn Lee ),김난희 ( Nan Hee Kim ),정사라 ( Sa Rah Jeong ),장동석 ( Dong Seok Jang ),이영모 ( Young Mo Lee ),나기량 ( Ki Ryang Na ),이강욱 ( Kang Wook Lee ),신영태 ( Young Tai Shin ) 대한내과학회 2007 대한내과학회지 Vol.73 No.2
목적: 연구자는 1995년 1월부터 2005년 6월까지 충남대학교병원 신장내과에서 치료적 혈장교환술을 시행 받은 신장질환 환자들을 대상으로 질환명과 이에 따른 임상양상 및 치료 결과를 알아보고자 하였다. 방법: 1995년 1월부터 2005년 6월까지 충남대학교병원 신장내과에 입원하여 혈장교환술을 시행한 23명의 환자를 대상으로 환자들의 의무기록을 후향적으로 검토하여 내원 시 주소, 기저질환, 임상경과, 병용치료 내용, 치료 결과를 조사하였다. 결과: 환자의 성별은 남자가 8예, 여자가 15예가 있었다. 질환별로는 혈전성 혈소판감소성 자반증 11예, 현미경적 다발성혈관염 7예, 루프스 신염 2예, 신이식후 급성체액성거부반응 2예, 세균성 심내막염에 병발된 급속진행성 사구체신염 1예. 11명의 혈전성 혈소판감소성 자반증 환자중 6명이 호전되었으며, 3명은 사망하였고, 2명은 ESRD로 진행하였다. 현미경적 다발성혈관염 7예 및 루프스 신염 2예 에서는 치료적 혈장교환술을 시행할 당시 폐출혈이 있었으며 혈장교환술을 시행후에 1예를 제외하고 모두 폐출혈의 호전이 있었다. 신이식후 급성 체액성거부반응 2명 중 1명은 혈장교환술 후에 호전되었고, 1명은 반응이 없어서 이식신을 제거하였다. 세균성 심내막염에 병발된 급속 진행성 사구체신염환자는 치료 후에 호전되었다. 부작용으로는 저혈압 3예, 소양증 2예, 오한 1예가 있었다. 결론: 혈장교환술은 혈전성 혈소판감소성 자반증 뿐 만 아니라 폐출혈을 동반한 ANCA 양성 혈관염과 루프스 신염의 치료에 효과가 있으며, 신이식 후 발생한 초급성 체액성 거부반응 및 이차성 급속 진행성 사구체신염의 치료로 고려할 수 있다. Background: Therapeutic plasma exchange (TPE) is a procedure by which plasma is removed from whole blood and this can be used in the treatment of some renal diseases. Methods: We reviewed the medical records for the chief complaints, underlying diseases, clinical courses and treatment outcomes of 23 patients who had been treated with TPE at the Renal Division of Chungnam National University Hospital from January 1995 to June 2005. Results: Patients with thrombotic thrombocytopenic purpura (TTP), microcopic polyangitis, lupus nephritis, hyperacute humoral rejection after kidney trasnplantation and rapidly progressive glomerulonephritis (RPGN) secondary to subacute bacterial endocarditis were included in this study. Among the 11 patients with TTP, six patients improved and two patients progressed to end-stage renal disease (ESRD). Three patients with TTP died. Seven patients with microscopic polyangitis and two patients with lupus nephritis had pulmonary hemorrhage at the time of TPE. Eight of the 11 TTP patients showed improvement of their pulmonary hemorrhage after TPE. One of the two patients with hyperacute humoral rejection after kidney transplantation and one patient with secondary RPGN were improved after TPE. Hypotension (three cases) was the most common adverse effect of TPE, followed by two cases of itching sensation and one case of fever with chills. Conclusions: Therapeutic plasma exchange was an effective treatment for patients with TTP, microscopic polyangitis, lupus nephritis with pulmonary hemorrhage and hyperacute humoral rejection after kidney transplantation. (Korean J Med 73:176-182, 2007)
신이식 후 Trimethoprim-Sulfamethoxazole과 Omeprazole에 의한 급성간질성신염
장동석 ( Dong Seok Jang ),나소영 ( So Young Na ),이수윤 ( Soo Youn Lee ),권오경 ( O Kyong Kwon ),이한규 ( Han Kyu Lee ),이영모 ( Young Mo Lee ),나기량 ( Ki Ryang Na ),이강욱 ( Kang Wook Lee ),서광선 ( Kwang Sun Suh ),신영태 ( Youn 대한신장학회 2005 Kidney Research and Clinical Practice Vol.24 No.6
만성 C형 간염에서 페그인터페론과 리바비린의 병합치료시 치료 순응도의 중요성
이헌영 ( Heon Young Lee ),고평곤 ( Pyung Gohn Goh ),김민정 ( Min Jung Kim ),김혜진 ( Hye Jin Kim ),은혁수 ( Hyuk Soo Eun ),김의식 ( Eui Sik Kim ),김윤정 ( Yun Jeung Kim ),이수윤 ( Soo Youn Lee ),문희석 ( Hee Seok Moon ),이엄석 ( E 대한소화기학회 2011 대한소화기학회지 Vol.57 No.5
Background/Aims: The combination therapy with peginterferon and ribavirin is a standard treatment for patients with chronic hepatitis C. However, because of the long duration of the treatment and many complications, the reduction of adherence frequently occur. This study aimed to assess influences of reduced medication adherence in the combination therapy of chronic hepatitis C patients. Methods: We retrospectively reviewed the medical records of 82 patients with chronic hepatitis C who received a combination therapy with peginterferon and ribavirin. The patients were categorized into 3 subgroups on the basis of medication adherence. Group 1 comprised patients who received ≥80% of the recommended dosage of both peginterferon and ribavirin. Group 2 comprised those patients who received ≥80% of the recommended dosage of only 1 drug. The patients of Group 3 received <80% of the recommended dosage of both the drugs. Results: Sustained virologic response (SVR)s of patients in Group 1, 2 and 3 were 85.4% (41/48), 85.7% (18/21), and 38.5% (5/13), respectively (p=0.002). SVRs of genotype 1 patients in Group 1, 2 and 3 were 84.2% (16/19), 75% (9/12), and 14.3% (1/7), respectively (p=0.003). SVRs of genotype non-1 patients in Group 1, 2 and 3 were 86.2% (25/29), 100% (9/9), and 66.7% (4/6), respectively (p=0.196). Furthermore are SVRs significantly differed with the degree of medication adherence to either peginterferon or ribavirin (p=0.003 and 0.021, respectively). In multivariate analysis, the peginterferon dose was a significant independent factor associated with SVR. Conclusions: Medication adherence of chronic hepatitis C patients to the combination therapy with peginterferon and ribavirin is very important for achieving SVR. In particular, we think that genotype 1 patients should maintain higher adherence than genotype non-1 patients. (Korean J Gastroenterol 2011;57:294-301)
위 천공에 의한 복막염으로 나타난 위 림프상피종양 암종 1예
고평곤 ( Pyung Gohn Goh ),김의식 ( Eui Sik Kim ),김윤정 ( Yun Jeung Kim ),이수윤 ( Soo Youn Lee ),문희석 ( Hee Seok Moon ),김석현 ( Seok Hyun Kim ),이병석 ( Byung Seok Lee ),정현용 ( Hyun Yong Jeong ) 대한소화기학회 2011 대한소화기학회지 Vol.58 No.4
Gastric lymphoepithelioma-like carcinoma is a rare carcinoma among gastric malignant tumor but has a good prognosis. The carcinoma has histologic feature characterized by small nest of cancer cells mixed with lymphoid stroma. We report a case with lymphoepithelioma-like carcinoma of stomach initially presenting as panperitonitis because of spontaneous tumor perforation. A 56-year-old man visited our emergency room because of epigastric pain. A preoperative abdominal CT scan showed a massive pneumoperitoneum in the upper abdomen, and the presence of gastric cancer in the lesser curvature of the stomach. An emergent laparotomy was performed followed by radical subtotal gastrectomy. Pathologic examination revealed that the tumor was a lymphoepithelioma-like gastric carcinoma. (Korean J Gastroenterol 2011;58:208-211)
양성자 방출 단층 CT (PET-CT)에서 과대사 종괴로 발견된 후복강내 신경집종
고평곤 ( Pyung Gohn Goh ),고광훈 ( Kwang Hun Ko ),김의식 ( Eui Sik Kim ),김윤정 ( Yun Jeung Kim ),이수윤 ( Soo Youn Lee ),문희석 ( Hee Seok Moon ),정현용 ( Hyun Yong Jeong ) 대한소화기학회 2011 대한소화기학회지 Vol.57 No.5
Schwannoma is a benign neoplasm of the Schwann cells of the neural sheath. Most schwannomas occur in the head and neck, and extremities and rarely in the retroperitoneal space. The differentiation of a schwannoma from other malignant tumor or benign tumor is very difficult on a preoperative examination with ultrasonography, computed tomography or magnetic resonance imaging. Furthermore, the lesion with increased fluorodeoxyglucose uptake in PET-CT cannot exclude malignant tumor. Therefore, this lesion needs surgical excision and a histological examination with immunohistochemical staining. We report a case of schwannoma occuring in the retroperitoneal space that incidentally discovered by PET-CT for health-check up. Pathologic confirmation by laparoscopic excision was done. (Korean J Gastroenterol 2011;57:323-326)