• Tuberculosis and Respiratory Diseases
• /
• 제46권5호
• /
• pp.709-717
• /
• 1999

연구배경 및 방법 : BOOP는 미만성 간질성 폐질환의 일종으로 기질화폐렴의 특별한 한 형태로도 구분되는 아주 특별한 임상병리 소견을 가진 질환이다. 임상적으로는 내원 수주전부터 감기 유사증상을 앓다가 점차 악화되는 호흡곤란 증세로 내원하여 마치 폐렴양 소견을 보이며, 병리학적으로 폴립형의 육아 조직이 세기관지내에 충전되어 관강내 용종양 조직을 형성하고 폐포관에까지 침범된 기질화된 폐렴의 소견을 보인다. 최근, 저자등은 본원에서 경험한 다섯 증례와 국내의 학술지상에 증례 보고된 19예를 합하여 그 임상적 특성에 대해 분석해 보고 국외의 문헌보고 결과들과 비교분석하고자 하였다. 결 과 : 국내 환자들의 평균연령은 54세이었으며 여성에서 약간 더 많이 발생하였다. 병원에 내원한 주증상은 호흡 곤란 및 기침이었으며 그 지속기간은 평균 41일이었다. 흉부진찰에서 흡기시 악설음이 흔히 관찰되었고 여러 혈액학적 검사소견은 저산소혈증외에는 비특이적이었으며 이들 소견만으로는 폐렴과 구분하기 어려웠다. 폐활량검사에서는 제한성 혹은 폐쇄성과의 혼재형 환기장애가 주소견이었으며 방사선학적으로는 양측성, 반상의 비엽성 폐포침윤을 보였고 고해상 컴퓨터단층촬영에서 잘 확인되었다. 다른 간질성폐질환과는 달리 부신피질호르몬의 치료에 잘 반응하여 양호한 예후 및 경과를 보였다. 상기 국내의 결과는 국외 문헌보고에서 얻은 결과와 비교시에 대체적으로 유사 소견을 보였으나 국내는 여자에서 더 흔히 발생한 차이가 있었으며 엑스선 소견 및 임상경과 등에 대해서는 좀더 추적조사를 하여 비교해야 할 것으로 판단된다. 결 론 : 폐렴양 소견을 보이는 환자에서 적절한 치료에도 불구하고 임상양상이 비전형적이고 진행시에는 임상소견 및 방사선학적 소견 등을 BOOP의 관점에서 재점검해야 할 것이다. 이 질환은 부신피질호르몬제에 비교적 빠른 반응을 보이며 조기 진단으로 완치가 가능하지만 성급한 치료종결시 재발이 잘 되며 급격한 호흡부전으로 사망할 수도 있는 질환이므로 BOOP가 의심되고 치료에도 병이 진행성일 때 적기에 조직검사를 통해 확진함이 중요하다.

• Tuberculosis and Respiratory Diseases
• /
• 제79권1호
• /
• pp.22-30
• /
• 2016

Background: The purpose of this study was to document outcomes following withdrawal of a single inhaler (step-down) in chronic obstructive pulmonary disease (COPD) patients on triple therapy (long-acting muscarinic antagonist and a combination of long-acting ${\beta}2$-agonists and inhaled corticosteroid), which a common treatment strategy in clinical practice. Methods: Through a retrospective observational study, COPD patients receiving triple therapy over 2 years (triple group; n=109) were compared with those who had undergone triple therapy for at least 1 year and subsequently, over 9 months, initiated inhaler withdrawal (step-down group, n=39). The index time was defined as the time of withdrawal in the step-down group and as 1 year after the start of triple therapy in the triple group. Results: Lung function at the index time was superior and the previous exacerbation frequency was lower in the step-down group than in the triple group. Step-down resulted in aggravating disease symptoms, a reduced overall quality of life, decreasing exercise performance, and accelerated forced expiratory volume in 1 second ($FEV_1$) decline ($54.7{\pm}15.7mL/yr$ vs. $10.7{\pm}7.1mL/yr$, p=0.007), but there was no observed increase in the frequency of exacerbations. Conclusion: Withdrawal of a single inhaler during triple therapy in COPD patients should be conducted with caution as it may impair the exercise capacity and quality of life while accelerating $FEV_1$ decline.

• Tuberculosis and Respiratory Diseases
• /
• 제66권6호
• /
• pp.457-462
• /
• 2009

역설적 반응은 감수성 있는 항결핵제를 복용중인 결핵 환자에서 치료시작 당시의 병변이 악화되거나 새로운 병변이 생기는 현상이고 이는 치료실패와 감별을 요한다. 일반적으로 역설적 반응은 기존 항결핵 치료로 좋은 결과를 보이므로, 이러한 임상 경과를 잘 이해함으로써 불필요한 검사나 치료약제 변경 등을 하지 않고 적절히 치료할 수 있게 될 것이다. 저자들은 적절한 항결핵제 치료 중에도 역설적 반응으로 결핵성 뇌농양, 결핵성 복막염이 연속적으로 병발한 환자 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

• 한방안이비인후피부과학회지
• /
• 제29권3호
• /
• pp.27-41
• /
• 2016

Objectives : The purpose of this research is to understand melanin with both Korean and Western medicine.Methods : We investigated the comprehension of melanin in both western and Korean medicine through literature review and studied relationships between melanin and five viscera(五臟), especially liver(肝), spleen(脾), kidney(腎). We Also studied representative pigmentary disorders(melasma, vitiligo) in western and Korean medicine to figure out how to understand pigmentary disorders in oriental medicine.Results : The results are as follows. 1. Melanin is associate with liver, because free coursing(疎泄) function of liver is the origin of transport melanin to keratinocyte from melanocyte. Also, melanogenesis factors like MITF and CREB are closely associated with liver and pigmentary disorders occur frequently after stress conditions or women. 2. Melanin is absorbed and scattered in keratinocytes by the function of spleen. Pigmentary disorders result from failure of spleen and formation of phlegm-retained fluid(痰飮). 3. Kidney essence(腎精) is the origin of melanin formation. In addition, corticosteroid, the major hormone of melanogenesis is secreted by adrenalin and adrenalin belongs to kidney(腎) in Korean medicine. 4. Melasma is created by disorder of melanin transport and absorbtion, so melasma is associated liver (肝) and spleen(脾). Therefore the treatment for melasma may focus on improvement function of liver and spleen. 5. The destruction of melanocyte or abnormal melanogenesis by disorder of the immune system, metabolic and affective disorders can make vitiligo, so vitiligo is associated with liver and kidney which are major part of melanin formation. Therefore the treatment of vitiligo can focus on improvement function of liver(肝) and kidney(腎).Conclusion : We compared Korean and western medicine to understand melanin. We also interpreted the mechanism of melanin and pigmantary disorders in western medicine and considered the relationship with visceral manifestation theory(臟象論) in traditional Korean medicine. Further studies are needed to apply comprehension of melanin to clinical stage.

• Clinics in Shoulder and Elbow
• /
• 제18권3호
• /
• pp.120-127
• /
• 2015

Background: We prospectively compared the response to blind and ultrasound-guided glenohumeral injection of corticosteroids for treatment of shoulder stiffness. Methods: A total of 77 patients with shoulder stiffness between April 2008 and March 2012 were recruited. Patients were randomized to receive either a blind (group 1, n=39) or ultrasound-guided (group 2, n=38) glenohumeral injection of 40 mg triamcinolone. The clinical outcomes and shoulder range of motion (ROM) before injection, at 3, 6, and 12 months after injection and at the last follow-up were assessed. The same rehabilitation program was applied in both groups during the follow-up period. Results: There was no significant difference in demographic data on age, sex, ROM, and symptom duration before injection between groups (p>0.05). There were no significant differences in ROM including forward flexion, external rotation at the side, external rotation at $90^{\circ}$ abduction, and internal rotation, visual analogue scale for pain and functional outcomes including American Shoulder and Elbow Surgeons score, Simple Shoulder test between the two groups at any time point (p>0.05). Conclusions: Based on the current data, the result of ultrasound-guided glenohumeral injection was not superior to that of blind injection in the treatment of shoulder stiffness. We suggest that ultrasound-guided glenohumeral injection could be performed according to the patient's compliance and the surgeon's preference. Once familiar with the non-imaging-guided glenohumeral injection, it is an efficient and reliable method for the experienced surgeon. Ultrasound could be performed according to the surgeon's preference.

• Childhood Kidney Diseases
• /
• 제1권1호
• /
• pp.13-16
• /
• 1997

스테로이드에 의한 골다공증은 특히 성장하는 소아 신증후군에서 심각한 문제이다. 이러한 경우에 활성형 비타민 D원알파, 일성신약)를 1년간 투여하고 그 효과를 보기 위하여 여러가지 골대사 지표를 치료 전후에 검사하여 보았다. 대상 환자는 40명의 빈회재발형 신증후군 환아이며, 본 연구를 시작하기전까지 환자의 스테로이드 치료기간은 $50{\pm}29$ 개월 이었다. 성인에서 골형성지표로서 잘알려진 혈청 osteocalcin(ng/ml)은 치료전 $7.75{\pm}3.34$, 치료후 $9.38{\pm}5.06$으로 증가 되었고, 골 흡수 지표로 장 알려진 소변 pyridinoline(nmol/mmol Cr)은 치료전 $417.26{\pm}250.98$, 치료후 $462.59{\pm}265.15$로 증가되어 소아 에서 골대사 지표로서 유의하지 않았다. 그러나 골밀도는 $0.71{\pm}0.016$에서 $0.73{\pm}0.015$로 의미 있게 증가하였다(p<0.05). 스테로이드에 의한 골다공증때 활성형 비타민의 투여로 골다공증을 예방할 수 있을것으로 사료되며, 골 형성 및 골 흡수의 지표로서 성인에서 많이 쓰이는 검사법은 소아의 경우는 예민하지 않았으며, 골밀도 검사만이 유의한 것으로 나타났다.

• Tuberculosis and Respiratory Diseases
• /
• 제71권5호
• /
• pp.368-372
• /
• 2011

Acute fibrinous and organizing pneumonia is a newly recognized pattern of acute lung injury. A 49-year-old female presented with a cough and worsening dyspnea on exertion. She had no history of smoking and no specific past medical history except exposure of home humidifier containing sterilizer. A chest computed tomography scan showed patchy consolidation with fibrosis in the right lower lobe and ill-defined centrilobular ground glass opacity in both lungs. The pathological findings were patchy areas of lung parenchyma with fibrin deposits in the alveolar ducts and alveoli, and fibrin balls with hemosiderin deposition in the alveolar spaces. The histological pattern of our case is differentiated from diffuse alveolar damage by the absence of hyaline membranes, and from eosinophilic pneumonia by the lack of eosinophils. In our case, the patient was treated with corticosteroid pulse therapy. However, the clinical course became aggravated and she died within two weeks.

• Tuberculosis and Respiratory Diseases
• /
• 제68권3호
• /
• pp.175-179
• /
• 2010

The ulcerative colitis is a chronic inflammatory bowel disease with an unknown etiology. The major symptoms of ulcerative colitis are diarrhea, abdominal pain and hematochezia. However, arthritis, skin disorders, hepatobiliary inflammation and uveitis are occasionally recognized as systemic complications. Although there are few reports of coexistent pulmonary and inflammatory bowel disease, the lung is not generally considered to be a target organ in ulcerative colitis. We report a patient with ulcerative colitis-related bronchilolitis obliterans organizing pneumonia confirmed by video-assisted thoracoscopic surgery, who responded to corticosteroid therapy.

• Clinical and Experimental Pediatrics
• /
• 제51권11호
• /
• pp.1211-1216
• /
• 2008

목 적: DBA는 적혈구 저형성증, 선천성 기형, 그리고 암으로 진행할 수 있는 가능성을 지닌 드문 유전성 질환이다. Corticosteroid와 수혈이 주된 치료이다. 본 연구에서는 16년 동안 경험했던 6명의 환아의 임상양상, 혈액학적 특징, 치료 및 경과에 대해 기술하고자 한다. 방 법: 1992년부터 2008년까지 전남대학교병원에서 DBA로 진단 받은 6명의 환아의 의무기록을 후향적으로 고찰하였다. 결 과: 6명 중 3명의 환자는 남아였고, 진단 당시 나이는 2개월에서 18개월(중앙값, 5.5개월)사이였다. 4명의 환자에서 선천성 심장기형이 동반되었고, 그 외 기형으로 다지증이 2명, 사시가 1명에서 발견되었다. 수혈은 2회에서 8회까지 시행되었으며, 진단 후 모든 환자는 스테로이드로 치료를 시작하였다. 치료 시작 후 혈색소 수치가 9 g/dL 이상으로 반응을 보인 시기의 중앙값 12.5일(범위, 7-22일)이었다. 치료 시작 후 3명의 환자는 스테로이드 투약을 점감한 후 투약을 중지하였고, 3명의 환자에서 최소량의 prednisolone (${\leq}5mg$/일)로 투약을 지속하고 있다. 환자들의 추적 관찰기간의 중앙값은 14년이며 추적 관찰 중 저신장을 제외하고 스테로이드와 관련된 부작용이나 암의 발생은 발견되지 않았다. 결 론: DBA 환자의 대부분 스테로이드 치료에 반응을 보이며 저용량으로 혈색소 수치를 유지할 수 있다. 하지만 스테로이드의 장기복용으로 인한 부작용 및 심장기능, 암의 발병 등에 대한 보다 적극적인 추적관찰이 요구되고, 국내 DBA 환자들에 대한 대단위 연구도 병행되어야 할 것으로 생각된다.

• 대한한방내과학회지
• /
• 제24권1호
• /
• pp.1-10
• /
• 2003

Background : In recent years, the glucocorticoid hormone has become a fundamental medication for asthma. However, a long period of hormone administration will result. in general. side effects on many body parts as well as hormone dependence, which has become a serious problem for western physicians. Objectives : We aimed to identify the clinical effects of Cheongsanghoha-tang and the steroid sparing effects of Cheongsanghoha-tang on. Materials and Methods : A subject group consists of 36 asthmatics who had been treated with Cheongsanghoha-tang for four weeks. Cheongsanghoha-tang is a herbal decoction, which has been used of the traditional therapeutic agent of asthma. PFT, QLQAKA, blood eosinophil, serum IgE, Serum IL-4. IL-5, IFN-${\gamma}$ were checked before and 4weeks after the treatment. Results : The only FVC% in ICSG among asthmatic patients was increased significantly compared to NICSG. Treatment of Cheongsanghoha-tang for four weeks resulted in significant increase in QLQAKA. The NICSG treated with Cheongsangboha-tang for four weeks were no significant difference in the blood eosinophil, serum IgE, IL-4 and IL-5. The PFT and QLQAKA in NICSG were increased significantly after 4 weeks treatment. But the serum IFN-${\gamma}$ in NICSG was decreased significantly after 4 weeks treatment. Discontinuation of treatment with inhaled corticosteroid in ICSG resulted in insignificant changes in PFT, the blood eosinophil, the serum IgE, IL-4, IL-5 and IFN-${\gamma}$ and significant increase in QLQAKA. As a result. 8 of 13 cases were cured with hormones completely and the rest of ICSG reduced the dose of ICS. Conclusions : This study shows that Cheongsanghoha-tang has the effects on the improvement of pulmonary function and cures asthmatic patients. These findings demonstrate that Cheongsanghoha-tang has the steroid sparing effect. Some satisfactory therapeutic results have been obtained in treating hormone-dependent asthma by Cheongsanghoha-tang. However. the concept and mechanism of hormone-dependent asthma have not been fully defined yet, and the standard for judging therapeutic effects have not been established. Obviously further researches concerning all these are still necessary.