Azathioprine을 장기 복용한 신이식 환자에서 발생한 자발성 마미증후군 1예

형복진,전연주,이희연,유지한,노은숙,김수현,양철우,김용수,방병기 大韓移植學會 2007 Korean Journal of Transplantation Vol.21 No.1

혈액 투석 환자에서 발생한 자발성 간피막하 혈종 1예

형복진,김은숙,이희연,유지한,윤혜은,양철우,김용수,방병기 대한신장학회 2007 Kidney Research and Clinical Practice Vol.26 No.5

Spontaneous bleeding in various parts of the body has been reported in patients receiving maintenance hemodialysis, but reports on spontaneous subcapsular hematoma of the liver are scarce. We present a case of spontaneous subcapsular hematoma of the liver which developed in a 53-year-old man with maintenance hemodialysis. He was admitted to our hospital with epigastric pain and abnormal liver function test. On abdominal computed tomographic (CT) scan, a large, well-defined subcapsular mass of the liver with a density consistent with blood was observed. We performed embolization of the bleeding vessel and percutaneous drainage of the hematoma. Five months later, follow up abdominal CT scan revealed a moderate reduction of the subcapsular hematoma. In conclusion, the possibility of spontaneous hematoma of the liver should be considered in hemodialysis patients with epigastric pain, unexplained anemia and abnormal liver function.

Successful Renal Transplantation with Desensitization in Highly Sensitized Patients: A Single Center Experience

윤혜은,형복진,황현석,이소영,전연주,송준창,오은지,박순철,최범순,문인성,김용수,양철우 대한의학회 2009 Journal of Korean medical science Vol.24 No.-

Intravenous immunoglobulin (IVIG) and/or plasmapheresis (PP) are effective in preventing antibody-mediated rejection (AMR) of kidney allografts, but AMR is still a problem. This study reports our experience in living donor renal transplantation in highly sensitized patients. Ten patients with positive crossmatch tests or high levels of panel-reactive antibody (PRA) were included. Eight patients were desensitized with pretransplant PP and low dose IVIG, and two were additionally treated with rituximab. Allograft function, number of acute rejection (AR) episodes, protocol biopsy findings, and the presence of donor-specific antibody (DSA) were evaluated. With PP/IVIG, six out of eight patients showed good graft function without AR episodes. Protocol biopsies revealed no evidence of tissue injury or C4d deposits. Of two patients with AR, one was successfully treated with PP/IVIG, but the other lost graft function due to de novo production of DSA. Thereafter, rituximab was added to PP/IVIG in two cases. Rituximab gradually decreased PRA levels and the percentage of peripheral CD20+ cells. DSA was undetectable and protocol biopsy showed no C4d deposits. The graft function was stable and there were no AR episodes. Conclusively, desensitization using PP/IVIG with or without rituximab increases the likelihood of successful living donor renal transplantation in sensitized recipients.

Improved Gastrointestinal Symptoms and Quality of Life after Conversion from Mycophenolate Mofetil to Enteric-Coated Mycophenolate Sodium in Renal Transplant Patients Receiving Tacrolimus

황현석,형복진,김솔,오하영,김연수,김중경,김영훈,김용림,김찬덕,신규태,양철우 대한의학회 2010 Journal of Korean medical science Vol.25 No.12

It is reported that a conversion from mycophenolate mofetil (MMF) to enteric-coated mycophenolate sodium (EC-MPS) relieves gastrointestinal (GI) symptom burden and improves health-related quality of life (HRQoL). However, it is unclear whether renal transplant recipients using tacrolimus receive the same benefit from the conversion. In this prospective, multi-center, open-label trial, patients were categorized into two groups by their GI symptom screening. Equimolar EC-MPS (n=175) was prescribed for patients with GI burdens; those with no complaints remained on MMF (n=83). Gastrointestinal Symptom Rating Scale (GSRS) and Gastrointestinal Quality of Life Index (GIQLI) were evaluated at baseline and after one month. Patients and physicians completed Overall Treatment Effect (OTE) at one month. EC-MPS-converted patients had worse GSRS and GIQLI scores at baseline than MMF-continued patients (all P<0.001). Significant improvements in GSRS and GIQLI scores were observed for EC-MPS-converted patients at one month, but MMF-continued patients showed worsened GSRS scores (all P<0.05). OTE scale indicated that EC-MPS patients improved in overall GI symptoms and HRQoL more than MMF patients did (P<0.001). In tacrolimus-treated renal transplant recipients with GI burdens, a conversion from MMF to EC-MPS improves GI-related symptoms and HRQoL.

포스타 전시 발표 : 내분비-대사,신장 ; 혈당 조절이 불량한 제 1형 당뇨병 환자에서 동반된 당뇨병성 당원축적증 1예

홍은정,형복진,김미경,이혜정,권혁상,최윤희,윤건호,차봉연,이광우,강성구,손호영 대한내과학회 2004 대한내과학회 추계학술발표논문집 Vol.2004 No.1

신이식 후 발현된 일차 알도스테론증 1예

송준창,황현석,형복진,이소영,전연주,장세나,윤혜은,최범순,김용수,양철우 대한신장학회 2009 Kidney Research and Clinical Practice Vol.28 No.1

After renal transplantation, we are more likely to encounter hyperkalemia rather than hypokalemia. We report a case of kidney transplantation recipient with hypokalemia and hypertension secondary to primary aldosteronism. A 48 year-old woman was presented with fatigue and weight loss that had lasted for 3 months. She was diagnosed as autosomal dominant polycystic kidney disease that ultimately progressed to end-stage renal disease. She was operated for renal transplantation before 6 months. She had hypokalemia and hypertension at that time. The ratio of plasma aldosterone over plasma renin activity was 851.7. The computed tomography (CT) revealed 2.4×1.7 cm sized adrenal mass on the right side. The pre-transplantation CT also showed that there had been adrenal mass in the same location even before the transplantation. Right adrenalectomy was performed. After she got discharged, she was again presented with nausea and vomiting. She developed hyperkalemia and was diagnosed as hyporeninemic hypoaldosteronism. She was prescribed with fludrocortisones and recovered from the disease, and resumed the state of normokalemia and normotension.

포스터 전시 발표 순서 : 신장 ; 단일기관에서 복막투석 환자의 생존율 분석 (초)

이소영,윤혜은,형복진,전연주,황현석,송준창,최범순,양철우,김용수,김석영,최의진,장윤식,방병기 대한내과학회 2008 대한내과학회지 Vol.75 No.1S

만성 신부전 환자에서 발생한 Verapamil 독성 4예

박진아,신미정,형복진,박훈석,윤정민,최범순,양철우,김용수,김석영,방병기 대한신장학회 2005 Kidney Research and Clinical Practice Vol.24 No.3

Four hypertensive patients with chronic renal insufficiency who were treated with sustained release verapamil hydrochloride subsequently developed acute toxic effects. All four patients developed marked bradycardia, hypotension, hyperkalemia and metabolic aciodosis and were treated with atropine, fluid therapy, potasium lowing measure, dialysis, and temporary pacemaker, and were restored to the renal function and sinus rhythm after 12-24 hr. Patients with renal impairement who are treated with sustained release verapamil may accumulate verapamil or its metabolites and develop toxic side effects. We conclude that sustained release verapamil should be used with caution in chronic renal failure and that patients should be closely monitored for adverse cardiovascular, metaboic, and hepatic side effects. (Korean J Nephrol 2005;24(3):501-509) Verapamil은 주로 심근과 혈관의 평활근에 작용하여 세포막에 있는 칼슘 통로 (calcium channel)를 차단하여 심근의 부하를 줄이고 말초동맥과 관상동맥을 확장시키는 작용을 가지고 있어서 협심증, 상심실성 빈맥, 고혈압 등 심혈관계 질환과 편두통 질환의 치료에 이용되고 있다1). 또한 만성 신부전 환자에서 단백뇨 감소 및 신기능 보호효과가 있어 널리 쓰이고 있다2). Verapamil의 독성은 완전 방실 전도 차단을 비롯한 심부정맥과 말초 혈관 저항의 감소 및 심근 수축력의 저하로 인한 저혈압이 대표적이고, 간독성과 고혈당, 고칼륨혈증과 경련, 오심, 구토 및 폐부종이 알려져 있다4). 지금까지 Verapmil의 독성에 대한 보고는 거의 없으며, 대부분은 과량 복용에 의한 것이었다3). 외국에는 만성 신부전 환자에서 치료 용량의 verapamil 사용 후 발생한 독성을 보고한 예가 있으나2,5), 국내에서는 자살 목적으로 과량 복용한 verapamil 중독을 보고한 증례 이외에1) 치료 용량의 verapamil을 사용하고 발생한 부작용을 발표한 증례는 없었다. 저자들은 고혈압과 단백뇨를 보이는 만성 신부전 환자에서 서방정 verapamil을 치료용량으로 사용 후 혈압 강하, 대사성산증, 고칼륨혈증과 부정맥이 발생하였으며 투약중지 후 증세가 호전된 4예를 경험하였기에 문헌 고찰과 함께 보고하는 바이다.

포스터 전시 : 신장, 혈액종양 ; 수술이 불가능한 간내담도암과 동시에 발병한 대장암에서 Epirubicin cisplatin, UFT-E의 선행 항암화학요법 후 수술적 절제를 시행한 1예

손덕승,강석휘,형복진,고윤호,이명아,강진형,홍영선,이경식 대한내과학회 2005 대한내과학회 추계학술발표논문집 Vol.2005 No.1

폐암과 병발한 류마티스 관절염 환자에서항암요법에 따른 임상경과

최선욱,정재규,형복진,박상미,정현정,박보형,심병용,김완욱,김훈교 대한류마티스학회 2006 대한류마티스학회지 Vol.13 No.4

A 54-year-old male was admitted due to lung cancer and polyarthralgia involving wrist, hand, shoulder, and ankle joints. Five months ago, he had been diagnosed as adenocarcinoma of the lung, and treated with three cycles of chemotherapy using gemcitabine and cisplatin. In the course of chemotherapy, he had complained symmetrical polyarthralgia of hand and shoulder joints, resembling rheumatoid arthritis (RA). After treatment with chemotherapeutic agents, he still had severe polyarthritis refractory to anti-rheumatic drugs, including prednisolone, hydroxychloroquine, and methotrexate, and thus referred to our hospital. We changed the previous anti-cancer regimens to cisplatin plus docetaxel, a semisyntheic taxane molecule, which is known to suppress experimental polyarthritis. With additional three cycles of cisplatin plus docetaxel, RA disease activity as well as polyarthralgia was nearly completely resolved, and the extent of lung cancer was not aggravated. Although RA patients have an increased risk of malignancy, the outbreak of RA was very rare in lung cancer patients. Here we report a case of coincident lung cancer and rheumatoid arthritis, which was successfully treated by docetaxel plus cisplatin chemotherapy.