정상 개에서 Cesium Chloride에 의하여 유발된 QT간격 연장 증후군의 심전도 특징

전두수,김재형 가톨릭대학 (가톨릭신학대학) 대학원 1994 가톨릭大學醫學部 論文集 Vol.47 No.1

Treatment Outcome and Mortality among Patients with Multidrug-resistant Tuberculosis in Tuberculosis Hospitals of the Public Sector

전두수,신동옥,박승규,서정은,서해숙,조영수,이준영,김대연,공석준,김윤성,심태선 대한의학회 2011 Journal of Korean medical science Vol.26 No.1

This study was conducted to evaluate treatment outcome, mortality, and predictors of both in patients with multidrug-resistant tuberculosis (MDR-TB) at 3 TB referral hospitals in the public sector of Korea. We included MDR-TB patients treated at 3 TB referral hospitals in 2004 and reviewed retrospectively their medical records and mortality data. Of 202MDR-TB patients, 75 (37.1%) had treatment success and 127 (62.9%) poor outcomes. Default rate was high (37.1%, 75/202), comprising 59.1% of poor outcomes. Male sex (adjusted odds ratio [aOR], 2.91; 95% confidence interval [CI], 1.13-7.49), positive smear at treatment initiation (aOR, 5.50; 95% CI, 1.22-24.90), and extensively drug-resistant TB (aOR, 10.72; 95% CI, 1.23-93.64) were independent predictors of poor outcome. The allcause mortality rate was 31.2% (63/202) during the 3-4 yr after treatment initiation. In conclusion, the treatment outcomes of patients with MDR-TB at the 3 TB hospitals are poor, which may reflect the current status of MDR-TB in the public sector of Korea. A more comprehensive program against MDR-TB needs to be integrated into the National Tuberculosis Program of Korea.

Medical Management of Drug-Resistant Tuberculosis

전두수 대한결핵및호흡기학회 2015 Tuberculosis and Respiratory Diseases Vol.78 No.3

Drug-resistant tuberculosis (TB) is still a major threat worldwide. However, recent scientific advances in diagnostic and therapeutic tools have improved the management of drug-resistant TB. The development of rapid molecular testing methods allows for the early detection of drug resistance and prompt initiation of an appropriate treatment. In addition, there has been growing supportive evidence for shorter treatment regimens in multidrug-resistant TB; and for the first time in over 50 years, new anti-TB drugs have been developed. The World Health Organization has recently revised their guidelines, primarily based on evidence from a meta-analysis of individual patient data (n=9,153) derived from 32 observational studies, and outlined the recommended combination and correct use of available anti-TB drugs. This review summarizes the updated guidelines with a focus on the medical management of drug-resistant TB.

Role of Brain Natriuretic Peptide as a Prognostic Marker in Non-Cardiac Surgery

전두수 대한심장학회 2011 Korean Circulation Journal Vol.41 No.1

The Effect of Cilostazol on Stent Thrombosis After Drug-Eluting Stent Implantation

전두수,유기동,박찬석,신동일,허성호,박훈준,최윤석,김동빈,이종민,박철수,김범준,문건웅,장기육,김희열,정욱성,승기배,김재형,최규보 대한심장학회 2010 Korean Circulation Journal Vol.40 No.1

Background and Objectives: Placement of drug-eluting stents (DES) can be complicated by stent thrombosis; prophylactic antiplatelet therapy has been used to prevent such events. We evaluated the efficacy of cilostazol with regard to stent thrombosis as adjunctive antiplatelet therapy. Subjects and Methods: A total of 1,315 patients (846 males, 469 females) were prospectively enrolled and analyzed for the frequency of stent thrombosis. Patients with known risk factors for stent thrombosis, except diabetes and acute coronary syndrome, were excluded from the study. All patients maintained antiplatelet therapy for at least six months. To evaluate the effects of cilostazol as another option for antiplatelet therapy, triple antiplatelet therapy (aspirin+clopidogrel+cilostazol, n=502) was compared to dual antiplatelet therapy (aspirin+clopidogrel, n=813). Six months after stent placement, all patients received only two antiplatelet drugs: treatment either with cilostazol+aspirin (cilostazol group) or clopidogrel+aspirin (clopidogrel group). There were 1,033 patients (396 in cilostazol group and 637 in clopidogrel group) that maintained antiplatelet therapy for at least 12 months and were included in this study. Stent thrombosis was defined and classified according to the definition reported by the Academic Research Consortium (ARC). Results: During follow-up (561.7±251.4 days), 15 patients (1.14%) developed stent thrombosis between day 1 to day 657. Stent thrombosis occurred in seven patients (1.39%) on triple antiplatelet therapy and four patients (0.49%) on dual antiplatelet therapy (p=NS) within the first six months after stenting. Six months and later, after stent implantation, one patient (0.25%) developed stent thrombosis in the cilostazol group, and three (0.47%) in the clopidogrel group (p=NS). Conclusion: During the first six months after DES triple antiplatelet therapy may be more effective than dual antiplatelet therapy for the prevention of stent thrombosis. However, after the first six months, dual antiplatelet treatment, with aspirin and cilostazol, may have a better cost benefit ratio for the prevention of stent thrombosis.

Potential Role of Immunodiagnosis for Pulmonary Tuberculosis Using Induced Sputum Cells

전두수,엄석용,이승은,조우현,이병희,김윤성,이지은,손은순,이예진,홍민선 연세대학교의과대학 2015 Yonsei medical journal Vol.56 No.2

Purpose: To evaluate the diagnostic utility and predictors for determinate results of an enzyme-linked immunospot assay using induced sputum cells (IS ELISPOT) for a rapid diagnosis of pulmonary tuberculosis (TB). Materials and Methods: Subjects suspected of pulmonary TB who had either sputum acid fast bacilli smear-negative or not producing sputum spontaneously were prospectively enrolled. ELISPOT assay was performed using cells from induced sputum. Results: A total of 43 subjects, including 25 with TB (TB group) and 18 with non-TB disease(non-TB group) were enrolled. Results of IS ELISPOT were determinate in only 17/43 (39%) subjects, but all of determinate results were consistent with the final diagnosis. Of the 43 sputum samples, 11 (26%) were inadequate to perform IS ELISPOT. Of 32 adequate sputum samples, the proportion of determinate resultswas significantly higher in the TB group (75%, 15/20) than in the non-TB group (17%, 2/12) (p=0.002). The status of active TB was a unique predictor but smear positivity was not a significant predictor for determinate results. In addition, sensitivity of IS ELISPOT (75%, 9/12) in smear negative TB was higher than that of TB-polymerase chain reaction (25%, 3/12). Conclusion: IS ELISPOT showed relatively high diagnostic value and accuracy in the TB group, independent of smear positivity. IS ELISPOT may provide additional diagnostic yield for microbiologicaltools in the rapid diagnosis of smear-negative TB.

승모판 혈류의 E파와 폐정맥혈류의 D파의 최대속도 간의 시간 간격과 승모판 도플러 지수들과의 관계

전두수,이만영,박지원,김용주,임효영,강동헌,이길환,김종진,채장성,김재형,홍순조,최규보 대한순환기학회 1999 Korean Circulation Journal Vol.29 No.9

WHO Treatment Guidelines for Drug-Resistant Tuberculosis, 2016 Update: Applicability in South Korea

전두수 대한결핵및호흡기학회 2017 Tuberculosis and Respiratory Diseases Vol.80 No.4

Despite progress made in tuberculosis control worldwide, the disease burden and treatment outcome of multidrugresistant tuberculosis (MDR-TB) patients have remained virtually unchanged. In 2016, the World Health Organization released new guidelines for the management of MDR-TB. The guidelines are intended to improve detection rate and treatment outcome for MDR-TB through novel, rapid molecular testing and shorter treatment regimens. Key changes include the introduction of a new, shorter MDR-TB treatment regimen, a new classification of medicines and updated recommendations for the conventional MDR-TB regimen. This paper will review these key changes and discuss the potential issues with regard to the implementation of these guidelines in South Korea.

결핵성 흉수에서 IL-10, IL-12, IFN-$\gamma$, ADA 측정의 의의

전두수,윤상명,박삼석,이효진,김윤성,이민기,박순규,Jeon, Doo-Soo,Yun, Sang-Myung,Park, Sam-Seok,Lee, Hyo-Jin,Kim, Yun-Seong,Lee, Min-Ki,Park, Soon-Kew 대한결핵및호흡기학회 1998 Tuberculosis and Respiratory Diseases Vol.45 No.2

Background: Cell mediated immune response mediated by interaction between CD4+ T lymphocytes and macrophagies is thought to play an important role in tuberculous pleurisy. This interaction is dependent on the interplay of various cytokines. The immunologic response of tuberculous pleurisy is thought to depend on the balance between helper T cell(Th1) cytokine Interleukin-12, Interferon gamma and Th2 cytokine IL-4, IL-10. To understand immunologic mechanism in tuberculous pleurisy and evaluate diagnostic value of these cytokines, the concentrations of Th1 cytokine IL-12, IFN -$\gamma$ and Th2 cytokine IL-10 were measured in tuberculous pleurisy and malignant pleural effusion group. Material and Methods: The concentrations of IL-10, IL-12 and IFN-$\gamma$ were measured by ELISA method in pleural fluids and serums of 20 patients with tuberculous pleurisy and 20 patients with malignant pleural effusion ADA activities were measured by spetrophotomery in pleural fluids of both groups. Results: In tuberculous pleurisy, the mean concentrations of IL-10, IL-12 and IFN-$\gamma$ of pleural fluids showed $121.3{\pm}83.7$ pg/mL, $571.4{\pm}472.7$ pg/mL and $420.4{\pm}285.9$ pg/mL. These were significantly higher than that of serum, $21.2{\pm}60.9$ pg/mL, 194.5 pg/mL, $30.1{\pm}18.3$ pg/mL respectively(p< 0.01). In malignant pleural effusion, the mean concentrations of IL-10, IL-12 and IFN-$\gamma$ of pleural fluids showed $88.4{\pm}40.4$ pg/mL, $306.5{\pm}271.1$ pg/mL and $30.5{\pm}54.8$ pg/mL respectively. Compared with that of serum ($43.4{\pm}67.2$ pg/mL, $206.8{\pm}160.6$ pg/mL, $14.6{\pm}3.3$ pg/mL), only IL-10 was significantly higher (p<0.001), but IL-12, IFN-$\gamma$ were not significant. In tuberculous pleural effusion compared with malignant pleural effusion, the concentration of IL-12, IFN-$\gamma$, ADA were significantly higher (p=value 0.046, <0.001, <0.001), but IL-10 was not significant. For differential diagnosis of tuberculous pleurisy from malignant pleural effusion, using cut-off value of IL-12, IFN-$\gamma$, ADA as 300 pg/mL. 100 pg/mL, 45 U/L, the sensitivity/specificity were 60%/70%, 90%/87.5%, 85%/90% respectively. Conclusion: In tuberculous pleurisy, IL-10, IL-12 and IFN-$\gamma$ were selectively concentrated highly in pleural space than serum. Compared with malignant pleural effusion, IL-12 and IFN-$\gamma$ were significantly higher, but IL-10 were not in tuberculous pleural effusion. The results suggest that Th1 pathway contributes to immune resistant mechanism in tuberculous pleurisy. IFN-$\gamma$ and ADA revealed useful methods of differential diagnosis in tuberculous pleurisy from malignant pleural effusion. 연구배경: 결핵성 흉막염은 면학적으로 흉강내에 국소적으로 활성화된 CD4+ T림프구와 대식세포가 관여하는 세포매개면역이 중요한 역할을 하며 이들의 상호작용은 다양한 사이토카인에 의해 좌우된다고 알려져 있다. 특히 helper T cell type 1 (Th1) 사이토카인인 IL-12 및 IFN-$\gamma$와 Th2 사이토카인인 IL-4 및 IL-10간의 균형이 세포매개반응의 정도를 결정한다고 생각되고 있다. 본 연구는 세포매개면역반응의 지표로서 Th1 사이토카인인 IL-12, IFN-$\gamma$와 이들과 길항적으로 작용한다고 알려져있는 Th2 사이토카인 중 IL-10이 결핵성 흉수내에 어떻게 표현되는지를 검사하여 대조군인 악성 흉수와 비교함으로써 결핵성 흉막염의 변역학적 기전을 이해하는데 도움이 되고자 하였으며 아울러 사이토카인의 진단적 유용성을 알아보고자 하였다. 방 법: 각 20명의 결핵성 흉막염과 악성 흉막염 환자를 대상으로 흉수와 혈장에서 IL-10, IL-12, IFN-$\gamma$를 측정하고 흉수에서의 ADA를 측정하여 비교하였다. 사이토카인은 대상환자의 혈액과 흉수를 원심분리하여 얻은 상층액을 ELISA 방법으로 측정하였고 ADA 활성도는 비색법으로 측정하였다. 결 과: 결핵성 흉막염 환자에서 흉수의 IL-10, IL-12, IFN-$\gamma$의 농도는 $121.3{\pm}83.7$ pg/mL, $571.4{\pm}472.7$ pg/mL, $420.4{\pm}285.9$ pg/mL로 혈장의 $21.2{\pm}60.9$ pg/mL, $194.5{\pm}67.6$ pg/mL, $30.1{\pm}18.3$ pg/mL 보다 모두 유의하게 높았다 (p<0.01). 악성 흉막염 환자에서 흉수의 IL-10, IL-12, IFN-$\gamma$의 농도는 $88.4{\pm}40.4$ pg/mL, $306.5{\pm}271.1$ pg/mL, $30.5{\pm}54.8$ pg/mL로 혈장의 $43.4 {\pm}67.2$ pg/mL, $206.8{\pm}160.6$ pg/mL, $14.6{\pm}3.3$ pg/mL와 비교하였을때 IL-10 만이 유의하게 높았고 (p<0.001) IL12, IFN-$\gamma$에선 유의한 차이가 없었다. 결핵성 흉막염과 악성 흉막염 환자의 흉수에서의 농도를 비교하였을 때 IL-12, IFN-$\gamma$, ADA는 결핵성 흉막염에서 유의하게 높았으나 (p=0.046, <0.001, <0.001) IL-10은 유의한 차이가 없었다. 결핵성 흉수염을 악성 흉수염과 감별하는데 있어 IL-12, IFN-$\gamma$, ADA의 기준을 각각 300 pg/mL, 100 pg/mL, 45 U/L으로 하였을때 민감도/특이도는 IL-12에서 60%/70%, IFN-$\gamma$에서 90%/85%, ADA 에서 85%/90%였다. 결 론: 결핵성 흉수에서 흉강내에 Th1 사이토카인인 IL-12, IFN-$\gamma$와 함께 IL-10이 증가되어 있었고 악성흉수와 비교했을때 IL-12, IFN-$\gamma$는 유의하게 증가되어 있었으나 IL-10은 의의가 없었다. 따라서 결핵성 흉막염의 면역기전에 Th1 경로의 세포매개변역반응이 주로 관여함을 확인할 수 있었고 국소적인 IL-10 증가의 임상적 의의는 추후의 연구가 필요할 것으로 생각된다. 또한 IFN-$\gamma$와 ADA는 결핵성 흉수와 악성 흉수와의 감별에 유용한 진단법으로 생각된다.

신경학적으로 증상이 없는 환자에서 대동맥판막경화증의위중도와 목동맥 내막 중막 두께 및 죽상경화반과의 관계

전두수,이만영,김종진,윤호중,조은주,조진만,문건웅,김재형,홍순조,최규보 대한심장학회 2004 Korean Circulation Journal Vol.34 No.11

Background and Objectives:This study was designed to formulate a method for the qualitative and quantitative measurements of aortic valve sclerosis (AVS) and to assess the relationship between this method and the degree of the carotid intima-media thickness (IMT) in neurologically asymptomatic patients. Subjects and Methods:One hundred and seventeen patients (Male 43%, 57.9±13.1 years of age) were retrospectively studied. Only the right- and non-coronary cusps were analyzed. AVS (cusp thickness of ≥2.0 mm) severities were classified into two groups according to the thickness and presence of the restricted motion of the cusp:mild AVS:AVS of <3.0 mm in one cusp, without restricted motion;severe AVS:AVS (+) in both cusps, AVS (+) and restricted motion in the same cusp, or a thickness ≥3.0 mm. The far wall IMT was measured at its thickest part in the distal 10.0 mm section of the common carotid artery. A protruding lesion with a far wall IMT ≥1.2 mm in the carotid bulb was defined as a plaque. Results:According to the severity of AVS, there was a significant difference in the prevalence of an IMT ≥0.8 mm (38.7 vs. 50.0 vs. 75.8%, p<0.005 for trend) and ≥1.0 mm (14.5 vs. 13.6 vs. 42.4%, p<0.005 for trend), and a plaque (19.4 vs. 36.4 vs. 54.5%, p<0.0005 for trend). The severity of AVS was independently correlated with an IMT ≥0.8 mm and IMT ≥1.0 mm, and with the presence of a plaque from a multiple logistic regression model. Conclusion:There was a significant association between AVS and the carotid IMT/plaque in relation to both in the presence and severity. 배경 및 목적: 대동맥판막경화증은 죽상경화증의 위험인자를 흔히 동반하면서, 심혈관계 합병증의 발생도 높은 것으로 알려져 있으나 대동맥판막경화증의 정의는 연구자들마다 차이가 있다. 이 연구의 목적은 경흉부 초음파에서 대동맥판막경화증의 유무 및 정도를 평가하는 방법을 만들고 이 방법이 객관성이 있는지 알아보기 신경학적으로 증상이 없는 환자를 대상으로 목동맥의 내막-중막 두께 및 죽상 경화반의 유무와 비교하였다. 방 법: 경흉부 초음파와 목동맥 초음파를 동시에 검사 받은 117명(남자 43%, 평균 나이 57.9±13.1세)을 대상으로 하였다. 대상자는 대동맥판막의 연속파형 도플러심장초음파 검사에서 최고 속도가 1.8 m/sec 이하이고, 좌심실 박출계수가 55%이상이면서, 뇌중풍의 과거력이 없는 환자들이었다. 대동맥 첨판의 가장 두꺼운 부분이 2.0 mm 이상인 경우를 대동맥판막경화증으로 정의하였다. 경증 대동맥판막경화증은 첨판의 두께가 3.0 mm 미만이면서 운동의 제한이 없는 경우로 정의하였고, 중증 대동맥판막경화증은 두개의 첨판 모두에서 첨판의 두께가 2.0 mm 이상이거나, 한 첨판에서 3.0 mm 이상이거나, 3.0 mm 미만이더라도 그 첨판 운동이 제한되어 있는 경우로 정의하였다. 목동맥 초음파를 이용하여 총목동맥 원위부 10 mm에서 가장 두꺼운 내막-중막 두께를 측정하였고, 목동맥 팽대부에서 죽상 경화반의 유무를 알아보았는데, 죽상경화반의 정의는 내막-중막 두께가 1.2 mm이상이고 혈관의 일부분에서만 두꺼워져 있는 경우로 하였다. 결 과: 내막-중막 두께가0.8 mm 이상 되는 경우의 유병율(38.7% vs 50.0% vs 75.8%, p<0.005), 1.0 mm 이상 되는 경우의 유병율(14.5% vs 13.6% vs 42.4%, p<0.005), 평균 내막-중막 두께(0.68±0.22 mm vs 0.72±0.30 mm vs 0.84±0.17 mm, p<0.005) 및 죽상경화반의 유병율(19.4% vs 36.4% vs 54.5%, p<0.0005) 모두 대동맥판막경화증의 정도가 심해질수록 유의하게 증가하는 양상을 보였다. 죽상경화증 위험인자를 함께 고려한 다변량 로지스틱 회귀분석에서는 대동맥판막경화증 위중도는 내막-중막 두께가 0.8 mm이상(Odds Ratio(OR)=1.899, 95% confidence interval (CI)=1.153~3.127, p<0.05) 및 1.0 mm 이상(OR=1.863, 95% CI=1.026~3.383, p<0.05) 두꺼워지는 것 뿐만 아니라 죽상경화반(OR=2.819, 95% CI=1.552~5.119, p<0.005)의 존재와도 유의한 관계가 있었다. 결 론: 신경학적으로 증상이 없는 환자에서 경흉부 초음파상의 중증 대동맥판막경화증의 위중도는 목동맥의 내막-중막 두께의 증가 및 죽상경화반의 존재와 관계가 있었다.