악성 흉막삼출액에서 Bleomycin을 이용한 흉막유착설의 시술효과

박정현,김학렬,양세훈,정은택 圓光大學校 醫科學硏究所 2002 圓光醫科學 Vol.17 No.1

목적: 악성 흉막삼출액이 반복적이고 지속적으로 발생하는 경우, 호흡곤란, 흉통등의 증상을 유발시키므로 흉막경화제에 의한 흉막유착술을 시행할 수 있다. 흔히 사용되던 talc의 심각한 부작용이 보고되고 있고, doxycycline 주사제도 국내에서 발매되지 않고 있다. 이에 연자들은 항암제로 소개된 bleomycin을 이용한 흉막유착술의 단기와 중기효과, 부작용 및 생존율 등을 전향적으로 확인하였다. 방법: 2000년 1월부터 2001년 12열까지 원광대학교 부속병원에 내원하여 반복적이고 지속적인 악성 흉막삼출액으로 흉막유착술이 필요한 26명의 환자를 대상으로 특별한 전 처치 없이 bleomycin 60 unit를 식염수와 함께 흉강 내 주입 후, 1일 후의 흉관에 의한 배액량을 확인하고 부작용을 관찰하였으며, 1개월 후에 흉부 방사선상으로 재 저류 유무를 확인하였다. 또한 시술 반응군과 비반응군으로 나누어 중앙생존기간을 비교분석 하였다. 결과: 시술 1일 후 26예중 10예(38%)에서 배액이 없었고, 8예(31%)에서 배액량이 100ml이하였으며, 8예(31%)는 100ml이상이었으나 시술 전보다 감소하였으며 증가된 경우는 없었다. 유의할만한 부작용은 4예(고열 3예, 흉통 1예)에서 발생하였으나, 대증요업으로 조절되었다. 시술 1개월 후 흉부 방사선과 26예중 9예(35%)는 재 저류액이 없었고, 10예(38%)는 저류액이 있으나 시술 전보다 감소하였으며, 1예(4%)는 이전과 변화가 없었고, 6예(23%)는 시술 전보다 저류액이 증가하였다. 시술 후 단기 및 중기효과를 반응군과 비반응군으로 나누어 중앙생존기간으로 양군간을 비교하였을 때, 반응군에서 연장이 되었으나 통계적으로 유의한 차이는 없었다. 결론: 이상의 결과로서 bleomycin에 의한 흉막유착술은 다른 경화제보다 특별한 전 처치가 필요 없는 간편하고, 비교적 부작용이 적은 안전한 방법이며, 효과적인 치료성적을 보이는 시술로 사료된다. Background : Malignant pleural effusions are common and significant problems in patients with advanced malignancy. Repeated thoracentesis provides temporary symptomatic improvement, but most patients progressively cause dyspnea or pleuritic pain. So pleurodesis with sclerosing agent is effective as a palliative treatment. There are many drugs used as pleural sclerosing agents. But doxycycline hasn't been used in Korea since 1999. And recently talc has been reported serious side effects. In this study, pleurodesis with bleomycin was prospectively investigated for its short term and middle period effects and its side effects. Methods : Twenty-six patients with malignant pleural effusion were prospectively analyzed to estimate the effects of bleomycin pleurodesis. Without special management before the procedure, 60 units of bleomycin in 50-100ml of normal saline were instilled into the pleural space via a small bore catheter(8-10 F). Andthen repeated positional changes and rotations were done for 2 hours. We measured the drainage amount and evaluated the side effects after 24 hours and checked the existence of the effusion by chest radiography after 1 month. Results : After 24 hours, the drainage amount showed that the responder group(none or ≤ 100ml) was 69%, and that the nonresponder group(> 100ml) was 31%. Side effects (high fever in 3 cases and severe pleuritic pain in 1 case) were 15%(4/26), but patients recovered easily by symptomatic management. After 1 month, chest radiography showed that the response rate(complete or partial response) was 73%. Differences of survival times between responder and nonresponder group was not statistically significant. Conclusions : We are suggest that bleomycin as a pleural sclerosing agent is a relatively simple, safe and effective agent. But a prospective study with a larger number of patients must be warranted.

Wegener 씨 육아종 증례보고 1예 : A Case Report

정선관,임형근,정은택,노병석,김창근,원종진 圓光大學校 醫科學硏究所 1995 圓光醫科學 Vol.11 No.2

Wegener's granulomatosis is characterized by necrotizing and granulomatous disease which involves upper, lower respiratory tract and kidney. The basic pathophysiologic mechanism of Wegener's granulomatosis is still unknown. We report a case of Wegener's granulomatosis which involved lung and pleura and was diagnosed by clinical symptoms, radiologic findings and anti-neutrophilic cytoplasmic autoantibodies.

폐암으로 오인된 이물질에 의한 기관지 육아종증 1예

정종훈,김소영,김휘정,김학렬,양세훈,정은택 圓光大學校 醫科學硏究所 2005 圓光醫科學 Vol.20 No.1

흡연에 의한 급성 호산구성 폐렴 2예

박종빈,김학렬,주현준,유태양,신성남,신정현,송정섭,황기은,김소영,양세훈,정은택 圓光大學校 醫科學硏究所 2008 圓光醫科學 Vol.23 No.2

최근 흡연을 시작한 젊은 성언에서 급성 호산구성 폐렴의 발생에 대한 증례가 보고되고 있다. 급성 호산구성 폐렴은 대개 발열을 동반하기 때문에 초기에는 감염성 폐렴으로 잘못 진단, 치료되는 경우가 많다. 아직 정확한 병태 생리 및 조직학적 소견은 밝혀져 있지 않지만 병력 청취 및 임상 양상, 방사선 소견의 관찰을 통해 급성 호산구성 폐렴을 의심하고, 진단을 위해 기관지 폐포 세척액 검사를 시행한다면 좀 더 쉽게 진단 내릴 수 있을 것이다. 본 저자들은 최근 처음 시작한 흡연에 의해 발생한 급성 호산구성 폐렴을 진단하고, 스테로이드를 투여하여 성공적으로 치료한 환자 2예를 경험하였기에 이를 문헌 고찰과 함께 보고하는 바이다. Acute eosinophilic pneumonia(AEP) is characterized by acute febrile respiratory illness associated with diffuse pulmonary infiltration and pulmonary eosinophilia. The specific etiology for acute eosinophilic pneumonia is elusive. By some investigators, cigarette smoking is suggested as a causative substance which can cause AEP. In recent, the authors experienced two cases of AEP following cigarette smoking. Both cases had characteristic features including age around 20 years, new onset smoking before occurance of AEP, diffuse infiltration on chest radiography, pulmonary eosinophilia based on bronchoalveolar lavage and acute improvement after steroid therapy. These clinical features are resemble with previous smoking induced AEP case reports. Base on these clinical features, cigarette smoking associated AEP could be diagnosed more easily.

자발성 기흉을 동반한 폐림프관평활근종증 1예

안용환,정종훈,김소영,김휘정,김학렬,양세훈,최순호,문형배,조향정,정은택 圓光大學校 醫科學硏究所 2005 圓光醫科學 Vol.20 No.1

Case Reports : Case of Pseudomembranous Necrotizing Tracheobronchial Aspergillosis in an Immunocompetent Host

Hyo Jeong Oh,Hak Ryul Kim,Ki Eun Hwang,So Young Kim,Sun Ho Ahn,Sei Hoon Yang,Eun Taik Jeong 대한내과학회 2006 The Korean Journal of Internal Medicine Vol.21 No.4

A 44-year-old Korean male died of rapidly progressive respiratory failure and refractory hypoxemia in 8 days after being admitted with a fever and dyspnea. The patient was diagnosed with pseudomembranous necrotizing tracheobronchial aspergillosis by fibroptic bronchoscopy and it was not related to an invasion of the pulmonary parenchyma. To the best of our knowledge, this case represents a patient with pseudomembranous necrotizing tracheobronchial aspergillosis that developed in an immunocompetent host, rapidly resulting in airway obstruction with acute respiratory failure and refractory hypoxemia without an invasion of the pulmonary parenchyma.

Computed tomography morphologic features of pulmonary adenocarcinoma with brain/bone metastasis

( Ki-eun Hwang ),( Su-jin Oh ),( Chul Park ),( Se-jeong Jeon ),( Jeong-mi Lee ),( Byong-ki Cha ),( Kwon-ha Yoon ),( Eun-taik Jeong ),( Hak-ryul Kim ) 대한내과학회 2018 The Korean Journal of Internal Medicine Vol.33 No.2

Background/Aims: Brain and bone metastases are common in patients with lung cancer. The development of metastasis is associated with poor survival in lung cancer patients. Although tumor morphologic features on radiographs are routinely assessed for differentiation between benign and malignant lung nodules, they are not used to predict metastasis. We assessed morphologic features of pulmonary adenocarcinomas with brain/bone metastasis on computed tomography (CT) to identify related factors for metastasis. Methods: We performed a retrospective analysis of initial chest CT findings (size, type of contour, percentage of necrosis, enhancement, presence or absence of calcification, and air cavity) from 2009 to 2010 of patients with brain or bone metastasis and compared the findings with those of patients without metastases. Results: In total, 128 patients were included (78 men, 52 women; mean age 69 years; range, 36 to 87). Nineteen patients had brain metastases and 32 had bone metastases. Morphologic features associated with brain metastasis included size ≥ 50 mm (odds ratio [OR], 3.37; 95% confidence interval [CI], 1.24 to 9.17; p = 0.013), necrosis ≥ 30% (OR, 4.51; 95% CI, 1.62 to 12.55; p =0.002), and presence of calcification (OR, 3.97; 95% CI, 1.16 to 13.55; p = 0.035). Morphologic features associated with bone metastasis included necrosis ≥ 30% (OR, 4.639; 95% CI, 1.98 to 10.82; p < 0.001) and T 3 to 4 stage (OR, 2.53; 95% CI, 1.07 to 6.00; p = 0.031). Conclusions: We found that necrosis ≥ 30% was associated with pulmonary adenocarcinoma with brain and bone metastasis at initial chest CT morphologic feature. To validate these results, further research should be conducted.

제48차 대한내과학회 추계학술대회초록집 : 심포지움 ; 폐암 : 폐암에서의 예후추정인자

정은택 ( Eun Taik Jeong ) 대한내과학회 1996 대한내과학회지 Vol.51 No.-

CASE REPORT : Primary Malignant Fibrous Histiocytoma of the Chest Wall Misdiagnosed as Traumatic Hemothorax

( Ki Eun Hwang ),( June Seong Hwang ),( Kyung Min Kim ),( Jae Wan Jung ),( Su Jin Oh ),( Eun Kyoung Kim ),( Dae Woon Ryu ),( Keum Ha Choi ),( Eun Taik Jeong ),( Hak Ryul Kim ) 대한결핵 및 호흡기학회 2014 Tuberculosis and Respiratory Diseases Vol.76 No.6

Malignant fibrous histiocytoma (MFH), a type of sarcoma, is a malignant neoplasm with uncertain origins that arise from both the soft tissues and the bone. The occurrence of MFH on the chest wall is extremely rare. We hereby report a case of a 72-year-old woman who was incidentally detected with MFH after a traffic accident.

Flow Cytometer 를 이용한 , 결핵환자의 말초혈액 및 늑막저류액에서의 T - 임파구아형의 변화에 관한 연구

정은택(Eun Taik Jeong),정헌택(Hun Taeg Chung),박경옥(Kyung Ock Park) 대한내과학회 1989 대한내과학회지 Vol.37 No.1

N/A Recently, the development of monoclonal antibodies against human T lymphocytes subsets has allowed the classification of T cell subsets based on functional properties, namely helper/inducer and suppressor/ cytotoxic cells. The importance of a balance between helper and suppressor cells in maintaining immune homeostasis has recently been illustrated and abnormalities in these T cell subsets have been associated with tuberculous diseases. The flow cytometric study was performed to observe the change of the percentage of T-lymphocyte subsets in the peripheral blood of normal controls, pulmonary tuberculosis and tuberculous pleurisy patients, and in the pleural fluid of tuberculous pleurisy patients. The results obtained were as follows: 1) In normal controls, the percentage of T4+ and T8+ and T4+/T8+ ratio in peripheral blood were 43.66±7.91 %, 28.23±3.07% and 1.57±0.38, respectively. 2) In the peripheral blood of pulmonary tuberculosis and tuberculous pleurisy patients, the percentates of T4+ were 39.33±12.10 % and 40.24±8.01%, that of T8+ were 22.26±8.73% and 22.65±8.07% and the T4+/T8+ ratios were 2.06±0.55 and 2.06±0.99. T4 was decreased insignificantly. T8+ was decreased significantly and T4+/T8+ was increased insiginficantly in both groups compared with the normal controls. 3) The tuberculous pleurisy patients showed a significant increase in the percentage of T4+ cells (57.43±9.54 %) and in the T4+/T8+ ratio (3.07±1.27), but no change in the percentage of T8+ cells (20.73±6.00%) in the pleural fluid compared with peripheral blood.