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이선녕 ( Shun Nyung Lee ),이석정 ( Seok Jeong Lee ),노진규 ( Jin Kyu Noh ),이민수 ( Min Su Lee ),이남석 ( Nam Seok Lee ),이부길 ( Bu Ghil Lee ),리원연 ( Won Yeon Lee ),용석중 ( Suk Joong Yong ),신계철 ( Kye Chul Shin ),김상하 ( Sa 대한천식알레르기학회 2008 천식 및 알레르기 Vol.28 No.4
Occupational allergic rhinitis caused by rabbit fur has been reported in Korea. However, occupational asthma due to rabbit fur has not yet reported in Korea. We report a suspected case of allergic asthma caused by rabbit fur on occupational exposure. A 35-year-old male developed dyspnea, chest discomfort related to rabbit fur. He has been worked for a spinning factory. He presented with a history of allergic rhinitis and asthma. Peripheral blood eosinophil count was 690/mm3. Bronchodilator response was positive, the results of skin prick test were positive for house dust mite, cockroach and rabbit fur. The level of specific IgE for rabbit fur was 8.39 KU/L. The methacholine challenge test was positive (PC20 1.96 mg/mL). These findings suggest that the rabbit fur could induce occupational asthma. We could not perform bronchoprovacation test with rabbit fur due to patient`s refusal. He is in a well controlled state with the use of a combination of inhaled corticosteroid and long acting β2 agonist after the avoidance of rabbit fur. (Korean J Asthma Allergy Clin Immunol 2008;28:309-312)
이석정 ( Seok Jeong Lee ),리원연 ( Won Yeon Lee ),정순희 ( Soon Hee Jung ),권우철 ( Woo Cheol Kwon ),이선녕 ( Shun Nyung Lee ),이남석 ( Nam Seok Lee ),김상하 ( Sang Ha Kim ),신계철 ( Kye Chul Shin ),용석중 ( Seok Joong Yong ) 대한결핵 및 호흡기학회 2008 Tuberculosis and Respiratory Diseases Vol.65 No.6
We report on a case of a patient with laryngo-tracheobronchial amyloidosis who complained of cough, sputum, and hoarseness. A chest X-ray showed consolidation in the right middle lobe. A chest CT scan showed diffuse, irregular narrowing of the tracheobronchial tree and atelectasis of the right middle lobe, with calcification of bronchial wall. Bronchoscopic findings were multinodular submucosal thickening of the right vocal cord, and yellowish multinodular submucosal thickening from the lower trachea through both main bronchi, as well as the lingular division of the left upper lobe, the right middle lobe, and the right lower lobe. The right middle lobe bronchus was nearly obstructed. The diagnosis of amyloidosis was made by multiple bronchoscopic biopsies on the right vocal cord and both bronchi. Pathologic findings were characteristic apple-green birefringence under polarized microscopy with Congo-red stain. The patient had no evidence of systemic amyloidosis. The patient is under conservative symptomatic treatment. (Tuberc Respir Dis 2008;65:532-536)
성인 비아토피 호흡기알레르기 환자에서 혈청 총 IgE와 신체질량지수의 관계
이지호 ( Ji Ho Lee ),리원연 ( Won Yeon Lee ),용석중 ( Suk Joong Yong ),신계철 ( Kye Chul Shin ),이선녕 ( Shun Nyung Lee ),이석정 ( Seok Jeong Lee ),김종환 ( Chong Whan Kim ),정세현 ( Sae Hyun Jung ),정예령 ( Ye Ryung Jung ),김상하 대한천식알레르기학회 2011 천식 및 알레르기 Vol.31 No.4
Background: Serum total IgE levels are increased in some obese patients with nonatopic respiratory allergy. It has not yet been fully determined a significant relationship between total IgE and body mass index (BMI) in nonatopic patients. We sought to examine the relationship between total IgE and BMI in patients with nonatopic respiratory allergy. Methods: We retrospectively reviewed 468 patietns with nonatopic asthma or allergic rhinitis without sensitization to 33 aeroallerens out of the 1,596 patients wirh respiratory allergic diseases who visitied Wonju Christian Hospital between June 2005 and July 2007. Nonatopy was determined by negative skin prick test results for all of the aeroallergens. Patients with were excluded from the study total IgE levels of >500 IU/mL because such levels were more frequently associated with other causes. Results: There were 468 patients with nonatopy and total IgE levels of <500 IU/mL (169 males and 299 females). The mean total IgE levels were 41.0 IU/mL in female patients with underweight (BMI<18.5 kg/m2), 64.6 IU/mL in those with normal weight (18.5≤BMI<23 kg/m2), 78.9 IU/mL in those with overweight (23≤BMI<25 kg/m2), and 85.5 IU/mL in those with obesity (BMI≥25 kg/m2). The mean total IgE levels were significantly higher in female patients with obesity or overweight than in those without (83.4 versus 61.8 IU/mL, P=0.036). There were no significant difference in serum total IgE levels according to BMI in male patients. Conclusion: Obesity may be a contributor to increased total IgE levels in female patients with nonatopic respiratory allergy. (Korean J Asthma Allergy Clin Immunol 2011; 31:288-294)
호흡기 알레르기증상으로 강원도의 한 대학병원을 방문한 환자에서 흡입 알레르겐에 대한 감작률
이명규 ( Myoung Kyu Lee ),리원연 ( Won Yeon Lee ),용석중 ( Suk Joong Yong ),신계철 ( Kye Chul Shin ),이선녕 ( Shun Nyung Lee ),이석정 ( Seok Jeong Lee ),이지호 ( Ji Ho Lee ),정세현 ( Sae Hyun Jung ),정예령 ( Ye Ryung Jung ),김상하 대한천식알레르기학회 2011 천식 및 알레르기 Vol.31 No.1
Background: There are some differences in common inhalant allergens among regions in Korea. Gangwon region, including Wonju City, which has a lot of mountains is relatively less urbanized and industrialized. It is necessary to determine which inhalant allergens are common in this region. Objective: This study was conducted to observe the prevalence of sensitization to inhalant allergens in patients visiting a university hospital in Gangwon region and to evaluate the difference in sensitization rates to allergens from other regions in Korea. Method: Skin prick tests were performed with 33 common inhalant allergens on 1,596 patients with respiratory allergic symptoms from June 2005 through July 2007 at a university hospital. Result: The number of positive responders to more than 1 allergen was 609 (38.2%) of the 1,596 patients. The most common offending allergen was Dermatophagoides pteronyssinus (19.5%), followed by Dermatophagoides farinae (17.2%), Tyrophagus putrescentiae (10.1%), Trichophyton (9.5%), rabbit fur (7.8%), mugwort (7.4%), cockroach (6.5%) and orchard grass (4.9%). Conclusion: The most common offending allergen was found to be the house dust mite in Gangwon region. The sensitization rate to mugwort pollen is the highest among pollen allergens, followed by orchard grass pollen. (Korean J Asthma Allergy Clin Immunol 2011;31:27-32)
김신태 ( Shin Tae Kim ),이선녕 ( Shun Nyung Lee ),이석정 ( Seok Jeong Lee ),정필문 ( Pil Moon Jung ),박홍준 ( Hong Jun Park ),신명상 ( Myung Sang Shin ),김종환 ( Chong Whan Kim ),이부길 ( Bu Ghil Lee ),김상하 ( Sang Ha Kim ),리원 대한결핵 및 호흡기학회 2007 Tuberculosis and Respiratory Diseases Vol.63 No.6
Mycoplasma pneumoniae (M. pneumoniae) is the leading cause of pneumonia in older children and young adults. Normally, it does not progress to a condition requiring hospitalization but improves spontaneously or has a mild clinical course. We report two cases of M. pneumoniae pneumonia with different clinical manifestations from the normal course. The patients were young healthy individuals. The diagnoses were made by serology. However, it could not be determined beforehand that they had M. pneumoniae pneumonia. Based on the empirical treatment strategy of severe community acquired pneumonia, the patients were treated with broad-spectrum antibiotics including cephalosporin, quinolone and macrolide. After administering the antibiotics, they showed a gradually favorable clinical course and recovered without residual complications. A M. pneumoniae infection should be considered as a cause of severe community acquired pneumonia, and empirical treatment targeting this organism might be helpful in treating patients with the severe manifestation. (Tuberc Respir Dis 2007;63:515-520)
흉수의 감별에 있어서 procalcitonin과 C-반응성단백의 유용성
김상하 ( Sang Ha Kim ),박주영 ( Joo Young Park ),박현숙 ( Hyun Sook Park ),서희석 ( Hee Seok Seo ),김신태 ( Shin Tae Kim ),김종환 ( Chong Whan Kim ),이부길 ( Bu Ghil Lee ),이석정 ( Seok Jeong Lee ),이선녕 ( Shun Nyung Lee ),노진규 대한결핵 및 호흡기학회 2007 Tuberculosis and Respiratory Diseases Vol.63 No.4
연구 배경: 흉수의 감별을 위해 염증지표로 알려진 procalcitonin과 CRP를 흉수와 혈청에서 각각 측정하여, 삼출액과 여출액의 감별과 삼출성 흉수의 다양한 원인들에 대한 감별에 유용한지 확인하고자 하였다. 대상 및 방법: 2005년 10월 1일부터 2006년 9월 30일까지 흉수로 입원하였거나 입원 중에 흉수가 발생하였던 총 198명을 전향적으로 연구하였으며, 원인 질환으로 한 가지의 정확한 진단이 가능하였던 178명을 분석하였다. 악성 흉수 57명, 결핵성 흉수 51명, 부폐렴성 흉수 31명, 농흉 5명, 기타 원인의 양성 흉수 7명과 여출성 흉수 27명이었으며, 대상 환자의 혈청과 흉수에서 procalcitonin과 CRP를 포함한 측정값을 비교 분석하였다. 결과: 흉수 procalcitonin과 CRP는 여출액과 비교하여 삼출액에서 유의한 증가를 보였고, 흉수 CRP가 2.06 mg/dL 이상일 때 특이도 96.3%, 민감도 45.0%로 삼출액을 감별할 수 있었다. 악성 흉수와 비교하였을 때에도 흉수 procalcitonin과 CRP는 양성 흉수에서 유의한 증가를 보였고, 흉수 CRP가 2.28 mg/dL 이상일 때 특이도 86.0%, 민감도 53.2%로, 흉수 procalcitonin이 0.11 ng/mL 이상일 때 특이도 84.2%, 민감도 40.4%로 양성 흉수를 감별할 수 있었다. 또한 흉수 procalcitonin은 비결핵성 흉수에서 유의한 증가를 보였다. 결론: 흉수에서 CRP와 procalcitonin을 측정하는 것은 삼출액과 여출액의 감별뿐 아니라 삼출성 흉수의 다양한 원인들 감별 등에 보조적으로 사용하기에 유용하다. Background: Malignancies are a common and important causes of exudative pleural effusions. Several tumor markers have been studied because the pleural fluid cytology and pleural biopsy specimens do not provide a diagnosis in a high percentage of malignant effusions. In an attempt to overcome this limitation, procalcitonin and C-reactive protein (CRP) in pleural effusions and serum, which are known to be inflammation markers, were measured to determine if they can differentiate an exudate from trasndate as well as the diverse causes of exudative pleural effusion. Methods: 178 consecutive patients with pleural effusion (malignant 57, tuberculous 51, parapneumonic 31, empyema 5, miscellaneous benign 7, transudative 27)were studied prospectively. The standard parameters of pleural effusion and measured serum and pleural procalcitonin were examined using in immunoluminometric assay. The level of CRP in serum and pleural fluid was determined by turbidimetric immunoassay. Results: The pleural procalcitonin levels in the exudate were significantly higher than those in the transudate, 0.81±3.09 ng/mL and 0.12±0.12 ng/mL, respectively (p=0.007). The pleural CRP levels were significantly higher in the exudate than the transudate, 2.83±3.31 mg/dL and 0.74±0.67 mg/dL, respectively (p<0.001). The pleural procalcitonin levels in the benign effusion were significantly higher than those in the malignant effusion, 1.15±3.82 ng/mL and 0.25±0.92 ng/mL, respectively (p=0.032). The pleural CRP levels were significantly higher in the benign effusion than in the malignant effusion, 3.68±3.78 mg/dL and 1.42±1.54 mg/dL, respectively (p<0.001). The pleural procalcitonin levels in the non-tuberculous effusion were significantly higher than those in the tuberculous effusion, 1.16±3.75 ng/mL and 0.13±0.37 ng/mL, respectively (p=0.008). Conclusion: Measuring the level of procalcitonin and CRP in the pleural fluid is helpful for differentiating between transudates and exudates. In addition, it is useful for differentiating between benign and malignant pleural effusions. (Tuberc Respir Dis 2007; 63: 353-361)
김종환 ( Chong Whan Kim ),박일환 ( Il Hwna Park ),권우철 ( Woo Xheol Kwon ),김영주 ( Young Joo Kim ),정순희 ( Soon Hee Jung ),이선녕 ( Shun Nyung Lee ),이석정 ( Seok Jeong Lee ),이지호 ( Ji Ho Lee ),정세현 ( Sae Hyun Jung ),전예령 대한결핵 및 호흡기학회 2012 Tuberculosis and Respiratory Diseases Vol.72 No.1
Hereditary hemorrhagic telangiectasia (HHT, Osler-Weber-Rendu disease) is a rare autosomal dominant disease characterized by heterogenous multisystemic dysplasia of the vascular tissue. Prevalence of HHT is 1 in 5,000∼8,000. HHT commonly presents with recurrent epistaxis, but may have more serious consequences if visceral vascular beds are involved. Approximately 30∼50% of HHT cases also present with pulmonary arteriovenous malformation (PAVM). Spontaneous hemothorax is less common, and PAVM is one of the causes leading to hemothorax. Our case involved an 18-year-old female who had suddenly developed right chest pain. The reason for chest pain was due to right spontaneous hemothorax accompanied by PAVM in the right middle lobe. The patient was additionally diagnosed with HHT upon examination of her family history, specifically through her mother`s symptom that included recurrent epistaxis and mucosal telangiectasia.