• Tuberculosis and Respiratory Diseases
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• 제79권1호
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• pp.22-30
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• 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
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• 제45권1호
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• pp.107-115
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• 1998

연구배경: 만성 호산구성 폐렴은 주로 중년 여성에서 호발하며, 발열, 야간발한, 체중감소, 식욕부진 등의 전신 증상과 기침, 천명, 가래 등의 호흡기 증상을 특징으로 하고, 대부분 말초 혈액 호산구증다증을 동반하고 흉부 방사선 소견상 폐 주변부 침윤을 보이며 스테로이드 치료에 즉각적인 반응을 나타낸다. 저자들은 드문 질환으로 국내에서 발생된 만성 호산구성 폐렴 환자의 특성을 조사하고자 하였다. 방 법: 1980년 1월에서 1996년 7월까지 대한 내과학회지, 결핵 및 호흡기질환자, 알레르기지에 보고되었던 만성 호산구성 폐렴 환자 8명과 최근 본원에서 경험하였던 환자 3명을 포함한 11명의 환자를 대상으로 환자의 병력, 검사소견 및 방사선 소견 등을 분석하였다. 결 과: 1) 환자의 남녀비는 3:8이었고, 40대에 46%로 가장 높은 빈도를 보였다. 과거력상 아토피 질환이 있었던 환자가 6명이었고 이중 기관지 천식이 5예로 가장 흔하였다. 2) 임상증상은 기침 10명, 호흡곤란 9명, 객담 8명, 체중감소 5명, 전신쇠약감 3명, 발열 2명, 야간 발한 2명, 피부발진 2명 등이었다. 3) 말초혈액 백혈구중 호산구가 차지하는 비율은 평균 38.4% (6~72%)였고, 총 IgE는 평균 880IU/ml(323~1,662IU/ml)였다. 흉부 방사선 소견상 전형적인 '사진상 반전'형태의 말초성 침윤을 보인 경우가 6예(55%)였다. 폐기능검사는 7예에서 시행되었으며 l명은 정상소견, 폐쇄성 감소가 2예, 혼합형 감소가 4예였다. 조직검사로 확진된 예는 7예(경기관지 폐생검 6예, 개흉 폐생검 1예)이며 기관지 폐포 세척액 검사를 시행한 5예에서 평균 호산구 55.2%(26~93%)의 소견을 보였다. 4) 11명 모두에서 스테로이드를 투여하여 임상증상 및 흉부 방사선 소견의 호전을 보였다. 결 론: 만성 호산구성 폐렴은 발열, 야간발한, 체중감소 등의 특징적인 임상중상과 방사선학적 소견상 전형적인 폐 주변부의 간상폐침윤을 보이며 말초혈액 호산구증다증을 보이는 경우에 진단할 수 있으며, 폐생검이나 기관지 폐포세척액 검사로 확진할 수 있다. 스태로이드 투여에 즉각적인 반응을 나타내어 진단 및 치료에 이용되며 스테로이드의 감량이나 중단으로 빈번한 재발을 가져오므로 재발을 방지하기 위하여는 최소한 6개월 이상의 스테로이드 투여가 필요하다.

• Molecules and Cells
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• 제24권3호
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• pp.388-393
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• 2007

Osteonecrosis of the femoral head (ONFH) is a multifactorial disease to which certain individuals are more at risk. Altered lipid metabolism is one of the major risk factors for osteonecrosis, especially corticosteroid therapy and alcoholism. Peroxisome Proliferator-Activated Receptor-${\gamma}$ ($PPAR{\gamma}$) plays a crucial role in differentiation of mesenchymal cells to adipocytes, lipid homeostasis, and bone metabolism. To investigate the possible association between $PPAR{\gamma}$ gene variants and susceptibility to ONFH, we genotyped three common polymorphisms (-796A > G, +34C > G[Pro12Ala], and +82466C > T[His477His]) in 448 ONFH patients and 336 control subjects. Genotypes, allele frequencies, and haplotypes of the polymorphisms in the complete set of patients as well as in subgroups by sex or etiology were not significantly different from those in the control group. This suggests that the examined polymorphisms and haplotypes of the $PPAR{\gamma}$ gene are unlikely to be associated with susceptibility to ONFH.

• Tuberculosis and Respiratory Diseases
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• 제64권2호
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• pp.138-143
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• 2008

특징적인 피부병변, 근력약화 등 분명한 피부근염의 임상소견을 보이지 않는 환자에서 동반된 NSIP 치료경과 중 자발성 종격동기종, 피하기종 및 대장기종이 발생한 증례를 경험하였고 스테로이드와 cyclosporin을 사용하여 좋은 치료반응을 경험하였다. 간질성폐렴을 동반한 피부근염에서 자발성 종격동기종, 피하기종 또는 대장기종 등이 드물게 보고되었고 이 경우 나쁜 예후를 보이므로 주의할 필요가 있다. 비교적 드물지만 NSIP에서 종격동기종, 대장기종이 발생하는 경우 임상경과 중 피부근염이 동반 또는 이환되었는지 세심한 관찰이 필요하겠다. 또 NSIP에서 기종이 발견되는 경우 스테로이드와 cyclosporin 또는 다른 면역억제제의 병용투여 등 적극적인 치료가 치료반응과 예후에 좋은 영향을 주리라 사료되어 본 증례를 보고하는 바이다.

• Clinical and Experimental Pediatrics
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• 제49권6호
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• pp.581-588
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• 2006

Asthma is a chronic inflammation of the airway associated with increased bronchial hyperresponsiveness that leads to recurrent episodes of cough, wheezing, breathless, chest tightness. According the recent studies, repeated airway inflammation leads to structural changes so called 'airway remodeling' and associated with decreased pulmonary function. Airway remodeling begins form the early stage of asthma and the early diagnosis and management is very important to prevent airway remodeling. Medication for asthma can be classified into acute symptom reliever and chronic controller. Short acting beta2 agonist is a well-known reliever that reduced asthma symptoms within minutes. Controllers should be taken daily as a long-term basis to control airway inflammation. Inhaled corticosteroid(ICS) is the most effective controller in current use. However, in some patients ICS monotherapy is not sufficient to control asthma. In those cases, other medications such as long acting beta2 agonist, leukotriene modifier or sustained-release theophylline should be added to ICS, which called Add-on-Therapy. Combination inhaler devices are easy to use. Oral leukotriene modifier has a good compliance especially in children. Finally, as asthma is a chronic disease, the development of on-going partnership among health care professionals, the patients, and the patients' family is necessary for the effective management of asthma.

• Clinical and Experimental Pediatrics
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• 제56권1호
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• pp.37-41
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• 2013

Idiopathic acute eosinophilic pneumonia (IAEP), characterized by acute febrile respiratory failure associated with diffuse radiographic infiltrates and pulmonary eosinophilia, is rarely reported in children. Diagnosis is based on an association of characteristic features including acute respiratory failure with fever, bilateral infiltrates on the chest X-ray, severe hypoxemia and bronchoalveolar lavage fluid >25% eosinophils or a predominant eosinophilic infiltrate in lung biopsies in the absence of any identifiable etiology. We present a 14-month-old girl who was admitted to our pediatric intensive care unit because of acute respiratory distress. She had a fever, dry cough, and progressive dyspnea for 1 day. Chest X-ray showed multifocal consolidations, increased interstitial markings, parenchymal emphysema and pneumothorax. IAEP was confirmed by marked pulmonary infiltrates of eosinophils in the lung biopsy specimen. Most known causes of acute eosinophilic pneumonia, such as exposure to causative drugs, toxins, second-hand smoking and infections were excluded. Her symptoms were resolved quickly after corticosteroid therapy.

• The Korean Journal of Pain
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• 제19권1호
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• pp.104-106
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• 2006

Tolosa-Hunt syndrome is a rare self-limiting disease that's characterized by painful ophthalmoplegia. It has a relapsing and remitting course, and the pain responds promptly to systemic corticosteroid therapy. Yet it is diagnosed by the exclusion of other major causes involving the superior orbital fissure or cavernous sinus, including trauma, neoplasm, aneurysm and inflammation. Further, the associated ophthalmoplegia may follow days to weeks after the onset of orbital or hemifacial pain. Hence, this condition is often misdiagnosed as atypical facial pain, and so improper management could result in unnecessary suffering of the patient. The following case describes a patient suffering with hemifacial pain associated with ipsilateral abducens nerve palsy, which was evident 2 weeks after the onset of pain, and this was misdiagnosed as trigeminal neuralgia and atypical facial pain.

• Childhood Kidney Diseases
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• 제18권2호
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• pp.123-127
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• 2014

다형 홍반은 피부, 구강, 입술 및 생식기 등을 침범하는 급성 피부점막 질환으로 점막 침범 여부에 따라 다형 홍반 minor와 다형 홍반 major로 분류된다. 스티븐스-존슨 증후군과 독성표피괴사용해는 다형 홍반 major에 속하는데, 이들은 증상이 심하고 진행성이며 높은 사망률을 보인다. 코르티코스테로이드는 현재 다형 홍반의 치료제로 사용되고 있다. 저자들은 신증후군을 가진 소아 환자에서 경구 코르티코스테로이드인 데플라자코트를 사용하던 중 발생된 3개의 다형 홍반 증례를 보고하는 바이다.

• 대한수의학회지
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• 제46권4호
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• pp.399-403
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• 2006

Caudal occipital malformation syndrome (COMS) is relatively common disease which occurs at craniocervical junction. It has been known that this syndrome was developed mainly in Cavalier King Charles spaniels, but these days there are a lot of case reports about COMS in other small breed dogs. In this report, COMS was diagnosed in ten dogs presented to Haemaru Referral Animal Hospital using MRI examination from January 2005 to April 2006. These cases were also investigated about concurrent diseases and syringomyelia was the most common type of complication, but clinical signs were nonspecific. COMS could be controlled by medical therapy with corticosteroid except cases with concurrent meningitis. It is considered that the present report could provide information regarding imaging and clinical features of COMS such as concurrent diseases, clinical signs, and prognosis in small animal practice despite of limited case numbers.

• Archives of Plastic Surgery
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• 제39권1호
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• pp.59-62
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• 2012

Sweet's syndrome is characterized by clinical symptoms, physical features, and pathologic findings which include fever, neutrophilia, tender erythematous skin lesions, and a diffuse infiltrate of mature neutrophils. This is a report of our experience of Sweet's syndrome with parotitis. A 57-year-old man initially presented with tender swelling on the right cheek similar to parotitis. His symptoms relapsed despite the use of an oral antibiotic agent for 3 weeks. He additionally presented with erythematous papules and plaques on the periocular area and dorsum of both hands. Histiopathologic findings on punch biopsy of the right dorsum of the hand showed superficial perivenular histiocytic infiltration without vasculitis. We confirmed this as histiocytoid Sweet's syndrome and used systemic corticosteroid. After initiation of treatment with systemic corticosteroids, there was a prompt recovery from both the dermatosis-releated symptoms and skin lesions. Sweet's syndrome should be considered in patients with therapy-refractory parotitis and unclear infiltrated nodules. We present a confusing case who initially appeared to have parotitis but turned out to have histiocytoid Sweet's syndrome.