치명적 기관지천식 환자의 임상상

이종명(Jong Myung Lee),황윤근(Youn Keun Hwang),윤종수(Jong Soo Yun),강천일(Cheon Il Kang),서영익(Young Ik Seo),김능수(Nung Soo Kim),구성모(Seong Mo Koo),조봉기(Bong Kee Cho),강영모(Young Mo Kang),이중기(Choong Ki Lee) 대한내과학회 1997 대한내과학회지 Vol.52 No.1

N/A The number of persons with HIV infection in Korea have increased steadily, total number of HIV infection in Korea were 478 on August, 1995. To investigate the clinicoimmunologic manifestation of AIDS in Korea, we reviewed complete blood counts (CBC), CD4 counts, serum β2-microglobulin level, opportunistic infections and cause of death for 19 AIDS patients who had been admitted or visited at Pusan national university hospital during the period of January, 1990 to August, 1995. 1) The predominant mode of HIV transmission was heterosexual contact(18), other modes of transmission were homosexual contact(1). Clues of diagnosis of HIV infection were routine occupational health examination(14), and opportunistic infection symptoms such as fever, coughing(4). 2) Mean CD4 cell counts(/mm3) were 53±72 totally, 22±27 for 8 dead patients at mean 2 month before, 91±87 for 7 living patients. There were not significant difference(p>0.05). 3) Serum β2-microglobulin(MG;ug/ml) was measured at 12 patients, mean serum β2-MG level was4.8±7.3 totally, 7.1±10.3 for 6 dead patients at mean 1.3 month before, 2.5±0.4 for 6 living patients. There were not significant(p>0.05). 4) At CBC examination, WBC(/mm3) was 5,932±2,899 totally, 5,452±3,436 for 10 dead patients, 6,500 ±2,221 for 9 living patients(p>0.05). Hb(g/dl) was 11,4±2.8 totally, 9.4±1.8 for dead patients, 13.6±1.8 for living patients(p<0.05). Lymphocyte count(/mm) was 1,255±800 totally, 731±424 for dead patients, 1,838716 for living patients(p<0.05). ESR(mm/h) was 72±47 totally, 97±33 for dead patients, 47±47 for living patients(p<0.05). 5) Opportunistic infections had developed at 14 patients, candidiasis 7, pneumocystis carinii pneumonia 5, tuberculosis 3, cytomegalovirus infection 2, herpes zoster 3, toxoplasmosis 1, cryptococcal infection 2, bacterial pneumonia 5, and herpes simplex l. Malignant lymphoma had developed in 1 patient. 6) Mean survival interval from diagnosis of HIV infection to death was 32.8±19.1 months, and the most common cause of death was pneumocystis carinii pneumonia, and other causes of death were meningitis, bacterial pneumonia and AIDS-wasting syndrome. Based on these results, We concluded that CD4 counts, serum β2-microglobulin level, Hb, total lymphocyte count and ESR in AIDS patients are specific laboratory markers of progression and prognosis of AIDS, the most common opportunistic infection was candidiasis, and the most common cause of death in AIDS patients was pneumocystis carinii pneumonia.

한전계통에서의 80MVA UPFC 적용연구(I) : 기대효과 분석

추진부(Jin-Boo Choo),임성주(Sung-Ju Im),장병훈(Byung-Hoon Chang),전영수(Young-Soo Jeon),윤종수(Jong-Su Yun),오관일(Kwan-Il Oh) 대한전기학회 2001 대한전기학회 학술대회 논문집 Vol.2001 No.5

기관지 천식, 알레르기성 비염 및 만성기침 환자에서 메타콜린 유발검사 성적

윤종수,현상훈,남언정,김건우,강천일,서영익,이종명,김능수 慶北大學校 醫科大學 1996 慶北醫大誌 Vol.37 No.3

목적 : 비특이적 기관지과민증은 기관지천식 환자외에도 알레르기성 비염과 만성기침 환자의 일부에서 양성반응을 보이는 것으로 알려져 있다. 저자들은 기관지천식, 알레르기성 비염 및 만성기침 환자에서 기관지과민증의 정도 및 이에 영향을 미치는 인자를 조사하였다. 대상 및 방법 : 기관지천식 환자 135명, 알레르기성 비염 환자 56명, 만성기침 환자 54명을 대상으로 하여 폐기능 검사, 메타콜린 유발검사, 각종 알레르기 검사 등의 성적을 후향적으로 분석하였다. 결과 : 기관지천식 환자의 87.4%, 알레르기성 비염 환자의 19.6%, 만성기침 환자의 20.4%에서 기관지과민증이 관찰되었다. 기관지과민증은 천식 환자의 경우 기저 FEV_1 및 질병 이환기간과 각각양의 유의성 및 음의 유의성을 보였으며 중증인 천식 환자군에서 과민증이 더 현저하였다. 만성기침환자의 경우 메타콜린 양성인 군에서 질병 이환기간이 다소 짧았지만, 알레르기성 비염과 만성기침 환자군 모두에서 유의한 차이를 보이는 다른 변수는 없었다. 결론 : 기관지과민증은 기관지천식 환자의 대다수에서 관찰되며 이는 기저 폐기능, 천식 이환기간 및 천식의 증상 정도와 관련이 있었다. 또한 알레르기성 비염 및 만성기침 환자의 약 20%에서 기관지과민증이 동반되었으나 이를 예측할 수 있는 의미 있는 지표는 발견할 수 없었다. One of the characteristic features of bronchial asthma (BA) is the presence of bronchial hyperresponsiveness to physical, chemical, and pharmacological stimuli. But nonspecific bronchial hyperresponsiveness is also noted in some patients with allergic rhinitis (AR) and chronic cough (CC) who have experienced no dyspnea or wheeze. In order to find the prevalence of bronchial hyperresponsiveness and factors predicting its presence, we analyzed retrospectively the clinical and laboratory data of 135 patients with BA, 56 patients with AR and 54 patients with CC. The following results were obtained : 1) Response to methacholine bronchial provocation test (MBPT) was positive (PC_20≤25㎎/㎖) in 118 out of 135 BA (87.4%). 11 out of 56 AR (19.6%) and 11 out of 54 CC (20.4%). 2) Baseline FEV_1 and FEV_1/FVC(%) were significantly lower in MBPT positive BA group than those of negative group, but there was no significant difference in other variables. 3) Positive correlation between the baseline FEV_1 and methacholine logPC_20 (P=0.003) and negative correlation between the disease duration and methacholine logPC_20 (P=0.01) were noted in MBPT positive BA. And severe asthma group had lower logPC_20 values than mild and moderate asthma group (P=0.017). 4) Though MBPT positive CC group had shorter disease duration, there were no other significant variables predicting the presence of bronchial hyperresponsiveness in AR and CC. In conclusion, bronchial hyperresponsiveness existed in most BA patients and in about 20% of patients with AR or CC. It was related to pulmonary function and disease duration in BA, but there were no significant variables predicting its presense in AR and CC.

용혈성 요독 증후군이 합병된 출혈성 장염 1예

김능수,이원길,김기연,이종명,윤종수,김성한,전정훈 대한감염학회 1997 감염 Vol.29 No.3

저자들은 쇠고기에 의해 매개된 것으로 추정되는 출혈성 장염 및 이에 합병된 용혈성 요독 증후군 환자 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. We report case of hemolytic uremic syndrome(HUS) associated with hemorrhagic colitis. A 35-year0old man was admitted to a local hospital because of abdominal pain and watery diarrhea which had developed about 6 hours after taking roast beef. He was treated with intravenous fluids and antibiotics, but watery diarrhea changed to bloody in nature from the next day. He was transferred to our hospital due to progressive ascites and jaundice on his 8th day of illness. Examinations revealed ascites, jaundice, microangiopathic hemolytic anemia, thrombocytopenia and uremia. Sorbitol-negative Escherichia coli was isolated from his stool, which proved as Shiga-like toxin-negative E. coli, serotype O25. His conditions improved markedly after three times of plasmapheresis and intravenous fluids therapy, and the organism was not isolated from the follow-up stool culture.

기관지천식 환자에서 Furosemide, Disodium cromoglycate 및 Heparin 흡입이 고장액 식염수 기관지유발검사에 미치는 영향

강천일,현상훈,남언정,김건우,윤종수,서영익,이종명,김능수 慶北大學校 醫科大學 1996 慶北醫大誌 Vol.37 No.3

목적 : 기관지천식 환자에서 고장액 식염수의 흡입은 기도수축을 유발할 수 있으며 이는 운동유발성 천식반응과 밀접한 관계가 있는 것으로 알려져 있다. 저자들은 알레르겐 흡입이나 운동에 의해 유발되는 천식에 예방효과가 있는 것으로 알려진 disodium cromoglycate(DSCG), furosemide 및 heparin 흡입이 4.5% NaCl 기관지유발검사(BPT)에 미치는 영향을 조사하였다. 대상 및 방법 : 4.5% NaCl BPT에서 양성반응을 보이는 기관지천식 환자 13명을 대상으로 하였으며 사용된 약물은 furosemide 40㎎, DSCG 40㎎ 및 heparin 1,000μ/㎏이었다. 먼저baseline 4.5% NaCl BPT를 시행한 다음 이들 약물로 전처치후 다시 4.5% NaCl BPT를 시행하여 약물의 효과를 관찰하였다. 결과 : Furosemide 40㎎, DSCG 40㎎및 heparin 1,000μ/㎏의 흡입 전처치는 고장액 식염수에 의한 기도수축 반응에 뚜렷한 예방효과를 보였다. Furosemide와 DSCG로 전처치한 군(n=6)에서 이들의 기도수축 방어율은 각각 100.6±6.6%, 91.1±17.2%였으며 furosemide와 heparin으로 전처치한 군(n=7)에서는 각각 58.7±29.2%, 59.0±51.1%로서 각 군에서 이들 약제간의 방어율에는 유의한 차이가 없었다. 결론 : Furosemide(40㎎), DSCG(40㎎) 및 heparin(1000μ/㎏)의 흡입 전처치는 고장액 식염수에 의한 기도수축 반응에 뚜렷한 예방효과를 보였으며, 적어도 이 용량에서 기도수축 예방 정도에는 유의한 차이가 없음을 알 수 있었다. Background: Hypertonic saline (4.5% NaCl) inhalation is known to induce broncho-constriction by affecting mast cell, epithelial cell and vagal afferent pathway in some asthmatics. Disodium cromoglycate (DSCG) is known to have a preventive effect on allergic asthma and exercise induced asthma, and recently it was reported that furosemide and heparin had similar effect. The purpose of this study was to evaluate the effects of furosemide, DSCG and heparin on hypertonic saline provocation test in asthmatics. Methods: Thirteen asthmatics with a positive response to hypertonic saline challenge were enrolled. Hypertonic saline and test drugs were generated by ultrasonic nebulizer. After taking baseline 4.5% NaCl challenge, subjects were rechallenged with 4.5% NaCl after inhalation of furosemide 40㎎, DSCG 40㎎ or heparin 1,000μ/㎏. Results: 1. There was a significant positive relationship between PC_20-methacholine and PTM-4.5% NaCl(r=0.5575, p = 0.024). 2. Furosemide, DSCG and heparin had no direct bronchodilating effects. 3. Premedication of furosemide and DSCG(n=6) showed significant protective effects on 4.5% NaCl induced broncho-constriction. The average protection rate were 100.6±6.6% and 91.1±17.2%, respectively. 4. Premedication of furosemide and heparin(n=7) showed significant protective effects on 4.5% NaCl induced broncho-constriction. The average protection rate were 58.7±29.2% and 59.0±51.1%. respectively. Conclusions: Furosemide(40㎎), DSCG(40㎎) and heparin(1.000μ/㎏) had significant protective effects on hypertonic saline induced broncho-constriction in asthmatics, and there were no significant differences in their potency of protection rate.

전신성 홍반성 낭창환자에서 혈청 면역글로불린치의 변화

황윤근,윤종수,강천일,서영익,이종명,김능수 慶北大學校 醫科大學 1995 慶北醫大誌 Vol.36 No.3

목적 : SLE환자에서 혈청 면역글로불린치와 연령별, 질병 이환기간, 임상적 활동도 및 신증후군 유무와 혈청 면역글로불린치에 대한 상관관계를 알아보기 위하여 본 연구를 시행하였다. 재료 및 방법 : SLE로 진단된 54례(남자 3례, 여자 51례)의 환자를 대상으로 이들의 병력, 이학적 검사, 및 검사실 소견 등을 조사하였다. 혈청 IgG, IgA, IgM치는 RID(radial immunodiffusion)법으로, IgE치는 EIA(enzyme immuoassay)법을 이용하여 측정하였다. 결과 : 54명의 환자중 남녀비는 1:17이었고 환자의 평균연령은 29.1±11.6세, 평균 질병이환 기간은 3.0±2.7년이었다. 혈청 면역글로불린의 평균치는 IgG, IgA, IgM의 경우 정상범위내에 있었고 IgE치는 정상보다 높았다. 연령 또는 질병 이환기간과 혈청 면역글로불린 IgG, IgM, IgE치 사이에는 유의한 상관 관계가 없었으나 연령과 이환기간 사이에는 유의한 상관관계가 있었다. 임상적 활동도와 혈청 면역글로불린치 사이에는 IgG와 IgM의 평균치의 경우 활동군 및 비활동군사이에 유의한 차이가 없었으나 IgE치는 활동군에서 유의하게 높았다. 신증후군 유무와 혈청 면역글로불린치 사이에는 유의한 관계가 없었다. 결론 : SLE환자에서 혈청 면역 글로불린 중 IgE의 평균치가 정상범위보다 높았으며 임상적으로 활동군인 경우가 비활동군보다 IgE치가 유의하게 높았다. SLE환자에서 IgE의 증가와 기전 및 역할에 대해서는 추가적인 연구가 필요할 것으로 생각된다. To determine the factors influencing serum immunoglobulin levels, the effects of age, duration of disease, clinical activity and the presence of nephrotic syndrome on serum immunoglobulin level were investigated in 54 patients with SLE. Of 54 cases with SLE, 51 cases were females and 3 cases were males. The mean age of parients was 29.1 ± 11.6 years(range: 11-64) and the mean duration of disease was 3.0 ± 2.7 years with a range of 1-12 years. The mean IgG concentration was 16.54 ± 7.32 g/L, the mean IgA was 2.81 ± 1.13 g/L, the mean IgM was 1.56 ± 0.86 g/L and the mean IgE was 246.46 ± 286.04 IU/mL. The mean values of IgG, IgA and IgM was within the normal ranges but the mean IgE concentrations was higher than normal reference values. In view of relationships among age, disease duration and serum immunoglobuline concentrations, IgG, IgM and IgE levels were not correlated with age or disease duration. But age and disease duration were significantly correlated(r=0.457, p < 0.01). With regard to the effect of clinical activity on serum immunoglobulin levels, there was no significant difference in mean IgG and IgM levels between active and inactive group. But patients with active group had significantly higher mean IgE levels than inactive group(p < 0.05). In the study of determining the relationship between nephrotic syndrome and serum immunoglobulin levels, the mean values of IgG, IgM and IgE levels revealed no significant difference between the SLE patients with nephrotic syndrome and those without nephrotic syndrome. Further prospective studies are needed to evaluate the relationships among age, disease duration, clinical activity, nephrotic syndrome and serum immunoglobulin levels. And additional studies to clarify the clinical significance of altered immunoglobulin levels in patients with SLE might be needed

전신성 홍반성 낭창의 임상적 고찰

황윤근,윤종수,강천일,서영익,이종명,김능수 慶北大學校 醫科大學 1995 慶北醫大誌 Vol.36 No.3

목적 : 전신성 홍반성 낭창(systemic lupus erythematosus; 이하 SLE라 함)은 전신 주요장기의 결체조직을 침범하여 다양한 증상을 일으키는 자가면역질환으로 알려져 있다. 저자들은 최근 10년간 경북대학교 병원에서 경험한 SLE 환자를 대상으로 그 임상 증상과 검사 소견을 알아보기 위하여 본 연구를 시행하였다. 재료 및 방법 : SLE로 진단된 58례의 환자를 대상으로 이들의 병력, 이학적 검사 및 검사실 소견 등을 후향적으로 분석 조사하였다. 결과 및 결론 : 1) SLE의 호발 연령은 20대로 37.9%의 빈도를 나타내었고 이중 10∼39세사이의 환자가 전체의 93.0%를 차지하였으며 평균 연령은 26.2세 였다. 남녀비는 1:13.5로 여자에게서 월등히 많았다. 2) 1982년 미국 류마티즘 학회가 규정한 각 항목의 양성율은 항핵항체 양성 반응이 91.4%로 가장 높았으며 그 다음으로 관절통 혹은 관절염(84.5%), 신장 이상소견(82.8%), 혈액 이상소견(75.9%), 피부발진(72.4%), 면역학적 이상소견(67.2%), 장막염(41.4%), 광과민성(39.7%), 구강궤양(27.6%) 그리고 신경학적 이상소견(13.8%)의 순서를 보였다. 3) 환자들이 호소하는 첫 증상으로 관절통 흑은 관절염이 47.3%로 가장 많았고 주요 임상상으로서 가장 흔히 관찰된 증상은 전신증상으로 96.6%를 차지하였다. 4) 피부점막 병변중에서는 피부발진(72.4%)이 가장 많았고, 근골격계 증상에서는 관절통 혹은 관절염(85.2%)이, 심폐계 증상 중에서는 늑막염(32.8%)이, 신경정신학적 증상 중에서는 psychosis(10.3%)가 가장 않았다. 5) 신장 병변 중에서는 혈뇨 및 casts(75.9%)가 가장 많았고 신장 조직검사를 시행한 21례 중에서는 미만성 증식성 신염(38.1%)이 가장 많았다. 6) 일반 혈액정사상의 이상 소견으로 빈혈이 74.1%로 가장 많았으며 백혈구 감소증과 혈소판감소증이 각각 62.1%, 48.3%의 순이었다. 7) 면역학적 검사 소견에서는 항핵항체가 91.4%로 가장 많았으며 C_3 감소 및 C_4감소가 각각 77.2%, 75.0%였고, 항 ds DNA 항체 양성이 57.9%등의 순이었다. 8) SLE와 동반된 질환으로 결핵 6례, 갑상선 질환 5례(갑상선 기능 저하증 3례, 갑상선 기능항진증 2례), 혈액계 질환 4례(Evans' syndrome 3례, 특발성 혈소판 자반증 1례), 교원 질환 3례(류마치스성 관절염 2례, Sjo¨gren's syndrome 1례), 대상 포진 3례 등이 관찰되었다. 9) SLE의 사망원인으로 뇌출혈 3례, 중추신경계 루푸스 1례 및 폐렴이 합병된 신부전 1례 등이 있었고 원인 미상의 경우가 1례 있었다. Systemic lupus erythematosus(SLE) is an autoimmune disease characterized by multisystem involvement and various clinical and laboratory findings. During a 11-year period from Feb. 1983 to Feb. 1994, 58 cases of SLE were observed retrospectively at the department of Internal Medicine, Kyungpook National University Hospital The results were as follows: 1) In 58 patients with SLE, 22 cases(37.9%) were diagnosed to have SLE in the 3rd decade. The male to female ratio was 1:13.5 and the mean age was 26.2 years(range 11-59) 2) The sensitivities of 1982 revised ARA criteria for SLE showed that positive antinuclear antibody(ANA) was 91.4%, arthralgia or arthritis 84.5%, renal disorder 82.8%, hematologic disorder 75.9%, mucocutaneous disorder 72.4%, immunologic disorder 67.2%, serositis 41.4%, photosensitivity 39.7%, oral ulcer 27.6% and neuropsychiatric disorder 13.8%. 3) The most common major clinical manifestation was constitutional symptom such as fever, weight loss or fatigue sense. 4) The initial manifestation and their incidences of 55 patients with SLE revealed that arthralgia or arthritis was 47.3%, mucocutaneous disorder 41.8%, fever 20.0%, renal disorder 14.5%, myalgia or myositis 5.5%, pericarditis, pleritis, gum bleeding, headache and generalized weakness 1.8% each other. 5) The facial rash was the most common feature in mucocutaneous disorder, arthralgia or arthritis in musculoskeletal disorder, pleuritis and pericarditis in cardiopulmonary disorder and psychosis in neuropsychiatric disorder. 6) Abnormal urinary sediments was the most common finding in renal discorder. In 21 cases performed renal biopsy, the most common histologic type was diffuse proliferative glomerulonephritis (38.1%) 7) In hematologic abnormalities, anemia(74.1%) was the most common manifestation. 8) The most common immunologic disorder was positive ANA(91.4%), then hypocomplementemia, positive anti-dsDNA antibody in order. 9) The diseases associated with the patients with SLE were tuberculosis(6 cases), thyroid diseases (hypothyroidism 3 cases, hyperthyroidism 2 cases), hematologic disease (Evans' syndrome 3 cases, Idiopathic thrombocytopenic purpura 1 case), connective tissue diseases(Rheumatoid Arthritis 2 cases, Sjo¨gren's syndrome 1 case), herpes zoster(3 cases). 10) Number of death confirmed was 6 cases. Causes of death included 3 of intracerebral hemorrhage associated with thrombocytopenia, 1 of renal faiure complicated by pneumonia and 1 of CNS lupus. In another 1, the cause of death was not defined.

米糠배지에서 酵母에 의한 에탄올 발효액의 평가

손경현,윤종수,성용분,이강표,김재철,이재흥 한국산업미생물학회 1992 한국미생물·생명공학회지 Vol.20 No.1

Saccharomyces속 효모를 사용하여 미강을 배지로 하여 에탄을 발효특성을 조사하였다. 액화효소와 당화효소로 전처리한 미강에서 여러 Saccharomyces속 효모들을 배양한 결과 Saccharomyces cerevisiae IFO 2346이 높은 에탄을 생성 및 유리아미노산 함량을 나타내었다. 균체성장은 발효 24시간에 3×10^8 cells/㎖로 증가하였으며, 발효 72시간후 4.7%의 에탄올을 생성하였다. 유리아미노산 총량은 발효과정중 1,099㎎/ℓ에서 829 ㎎/ℓ로 감소하였으나, glutamic acid, histidine 및 isoleucine은 오히려 각각 218%, 315% 및 148%로 증가하였다. 배양 초기에 미강당화액에 5%의 포도당을 첨가하였을 때, 발효완료액은 포도당 무첨가시보다 에탄올 함량은 134%, 유리아미노산 함량은 264%의 대폭적인 증가를 보였으며, 이 때 발효완료액에는 glutamic acid, leucine, alanine, phenylalanine, valine 등의 유리아미노산이 높은 함량을 보였다. Rice bran was employed as a main medium component for ethanol fermentation by Saccharomyces species. Among the several strains of Saccharomyces yeasts, S. cerevisiae IFO 2346 was selected as the best strain in view of the interest in the production of ethanol and amino acids. It was found that S. cerevisiae IFO 2346 showed 3×10^8 cells/㎖ and 4.7% (v/v) ethanol production after 72 hr cultivation. Although total amount of free amino acids was decreased from 1,099 ㎎/ℓ to 829 ㎎/ℓ during the fermentation, glutamic acid, histidine, and isoleucine were increased considerably. With the supplement of 5% glucose to the fermentation medium, both ethanol and amino acid production were increased up to 134% and 264%, respectively, compared to the control case. Glutamic acid, leucine, alanine, phenylalanine, and valine were the major amino acids in the fermentation broth.

에반스 증후군 환자에서 발생한 대뇌정맥 혈전증 1예

남언정,현상훈,김건우,윤종수,강천일,이종명,김능수,김용선 한국지혈혈전학회 1996 한국지혈혈전학회지 Vol.3 No.1