기관지 방선균증의 임상 1례

이은영,장태원,정만홍,옥철호,이규원,손창배,이지숙,신은경,서정아,백종현,김영옥 고신대학교의과대학 2007 고신대학교 의과대학 학술지 Vol.22 No.2

Actinomycosis is a chronic suppurative infection, whitch infiltrates mucosa-associated tissues. Thoracic, pelvic and cervicofacial infections of actinomyces are not uncommon, but endobronchial actinomycosis is rarely reported. We report a case of a 29 year old man who presented with a recurrent pneumonia and chronic cough. Fiberoptic bronchoscopy revealed occlusion of the right. lower medio-basal segment bronchus with exophytic endobronchial mass. The diagnosis was confirmed histologically by demonstration of sulfur granules in the bronchoscopic biopsy of the mass. Intravenous administration of amoxacillin and clindamycin followed by oral amoxacillin and clindamycin therapy resulted in complete recovery.

기관지 탄분 섬유화증 환자의 임상 경과와 고감도 C-반응 단백(high sensitivity C-reactive protein, hsCRP)과의 상관 관계 비교

이규원,옥철호,장태원,정만홍 고신대학교의과대학 2008 고신대학교 의과대학 학술지 Vol.23 No.4

Background: To investigate the association between bronchial anthracofibrosis(AF) and tuberculosis(TB). and the clinical utility of high sensitivity C-reactive protein(hsCRP) for diagnosis of active pulmonary TB in patients with bronchial AF. Method: Eighty three patients(62 women and 21 men ranging in age from 55 to 87), who were diagnosed with bronchial AF by a bronchoscopy, were enrolled in this study. The hsCRP was measured in patient's blood. The hsCRP results were compared with the bacteriological, and clinical finding. Results: The common respiratory symptoms were cough(70%), sputum(35%), dyspnea(20%), and hemoptysis(10%). The sputum AFB smear, culture were positive in 20(22.8%) and 37(44.5%) patients, respectively. The level of hsCRP in patients with postive culture was significantly higher than that of patients with negative culture.(4.67±7.5, 0.90±1.59, p=0.005). Of 63 patients with negative smear, the level of hsCRP in patients(n=18) with positive culture was higher than that of patients(n=45) with negative culture.(3.39±5.78, 0.92±1.50, p=0.013). Of 20 patients with negative smear and positive culture who were empirically treated with anti-TB medication, 11 patients showed radiologic response. and their level of hsCRP was higher than that of 9 patients who showed no radiologic response.(1.56±1.89, 0.81±0.10,p=0.03) Conclusion: hsCRP appears to be useful diagnostic tool for predicting active pulmonary tuberculosis. in patients with bronchial AF.

OVA로 유도된 생쥐 모델에서 EGCG의 천식 예방 효과

박성남,이찬우,이창민,정만홍,황순철,박영민 고신대학교의과대학 2007 고신대학교 의과대학 학술지 Vol.22 No.2

Epigallocatechin-3-gallate (EGCG), a major form of tea epicatechin, has a variety of biological activities. It has recently been studied intensively as an antiallergic and anti-inflammatory agent. Thus we elucidated the anti-allergic effect of EGCG in the ovalbumin (OVA)-induced asthma model mice by examining the expression of matrix metalloproteinase (MMP)-9. Also airway reactivity to methacholine challenge and reactive oxygen species (ROS) generation in BAL fluid. mesured by the expression of iNOS mRNA in lung tissue and tumor necrosis factor (TNF) in BAL fluids. The OVA challenged mice showed allergic airway reactions, such as inflammatory chemokine (CCL5,CXCL10) in the airway and lung tissues. However mice administrated with EGCG had significantly reduced CCL5 and MMP-9 expression in lung tissues as well as TNF-α and IL-5 production in BAL fluid. these results suggest that EGCG regulate

경부임파선 전이가 동반된 폐암환자에서 초음파 유도 하 알코올 주입술의 효과

박진희,옥철호,장태원,전만홍 고신대학교의과대학 2008 고신대학교 의과대학 학술지 Vol.23 No.4

Background: Percutaneous ethanol injection therapy(PEIT) has been infrequently tried to treat hepatic tumors, thyroid tumors, renal tumors. We adopted this technique for treating locally recurrent lung cancer. The object of this study is to evaluate the local therapeutic efficacy, side effects of ethanol injection for treating locally neck node metastasis of lung cancer. Materials and Methods: Between May 2006 and october 2006, 20 lung cancer patients(17 males and 3 females) with 35 histologically proven symptomatic neck node metastatic lesions underwent sonography guided PEIT(US-PEIT) under local anesthesia . We analyzed relation between PEIT and size, the amount of pain. The amount of pain that patients feel was evaluated by VAS(Visual Analogue Scale). Result: A significant decrease of tumor size was observed in 19 lesions. The mean pre-injection diameter of the lesions was 24.2 mm, and this was decreased to 16.8 mm(p=0.001). The VAS score before injecting ethanol into the lesions was 5±3, this was decreased to 2.5±1.5(p=0.001). Conclusion: US-PEI is a valuable treatment option for patients with symptomatic cervical nodal metastases from advanced lung cancer who are not amenable to further therapy.

Fogarty Catheter를 이용한 소아 기도 이물의 제거 1례 : 증례 보고

김예나,옥철호,장태원,정만홍 고신대학교의과대학 2008 고신대학교 의과대학 학술지 Vol.23 No.4

Foreign body aspiration is a common problem in children necessitating prompt recognition and early treatment to minimize the potentially serious and sometimes even fatal conseqeunce. We report the case of a 7-year-old boy with a button lodged in his right main bronchus. Under general anesthesia, ultrathin bronchoscopy identified the foreign body which was then removed by the combined use of a Fogarty catheter and extraction forcep. This case differs from previous reports, in that the forcep extraction through working channel of ultrathin scope was used simultaneously with Fogarty catheter even in relately small airway of children.

폐허탈 및 농흉을 유발한 기관지 지방종 1예

이규진,이송주,옥철호,장태원,정만홍,김영옥,박성달 고신대학교의과대학 2008 고신대학교 의과대학 학술지 Vol.23 No.4

저자들은 객혈을 주소로 내원한 75세 남자 환자에서 기관지내시경 육안 소견상 양성 종양이 의심 되었으나 조직 검사상 지방종을 확진하지 못하였고 악성종양을 배제할 수 없는 상황에서 종괴에 의한 왼쪽 폐의 허탈과 농흉 때문에 수술적 치료를 시행 하였으며, 수술 결과 기관지 지방종에 의한 폐허탈, 농흉 및 기관지 확장증, 이로 인한 객혈이 발생한 예가 있어 보고하는 바이다. Lipoma is a common neoplasm on soft tissues. However, bronchial lipoma is rare benign tumor. Patients with bronchial lipoma might have a malignant potential, and there were case reports of lung cancer accompanied with lipoma. Therefore, it should initially be treated by fibrotic bronchoscopy or surgery. We encountered a 75 year-old male patients with bronchial lipoma, causing hemoptysis.

폐주변부 병변 진단 시 기관지솔질에 의한 출혈이 병소확인에 주는 유용성 연구

김예나,정수현,김혜수,옥철호,장태원,정만홍,천봉권 고신대학교 의과대학 2009 고신대학교 의과대학 학술지 Vol.24 No.2

Background : Diagnosis of peripheral pulmonary lesion by conventional bronchoscopy is still challenging. The sheathed bronchial brush has been used to collect samples from the visible endobronchial lesion. Recently developed endobronchial ultrsonography (EBUS). can obtain image of peripheral pulmonary lesion at bronchus suspected by bleeding sign of sheathed brush. This study evaluated availibility of detected lesions by bleeding after bronchial brushing in pheripehal pulmonary lesions before transbronchial lung biopsy Methods : Between August 2006 and November 2008, 50 patients(38 men and 12 women, median age, 65 yrs) whose peripheral pulmonary lesions could not be detected with flexible bronchoscopy were included in this study. Among 50 patients, 40 cases were malignant lesion(non-small cell carcinoma 35, small cell carcinoma 5), and 10 cases were benign lesions(inflammatory disease 7, others 3) Results : Of the 50 patients, lesions detected bleeding after bronchial brushing was 34 cases(68%) and lesions detected by EBUS was 33 cases(66%). Sensitivity was 90.0-95.4%, Specificity was 83.3-80%, Positive predictive value(PPV) was 83.3-95.4% and Negative predictive value(NPV) was 80-90.9%. Diagnostic rates in visualized lesion by EBUS and otal peripheral lesions were 75%(25/33), 58%(29/50) respectively. There was no significant complication related with bronchial brushing. Conclusions : Bleeding sign by bronchial brushing was safe and effective method to predict location of peripheral pulmonary lesion with sufficient diagnostic yield

상어 간유 흡인에 의한 급성 지방성 폐렴 1예 : 증례보고

임성경,옥철호,김희규,장태원,정만홍 고신대학교의과대학 2008 고신대학교 의과대학 학술지 Vol.23 No.4

저자들은 상어 간유를 과량 복용하고 기침, 호흡곤란을 주소로 내원한 48세 여자 환자에서 방사선 소견과 기관지 폐포 세척액 검사를 통해 급성 지방성 폐렴으로 진단하고 스테로이드에 불응하는 경과를 취하자 우측 전폐 기관지 폐포 세척술을 시행하여 폐 병변과 증상의 호전을 보인 1례를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Acute lipoid pneumonia is uncommon condition of the lungs that results from the aspiration of vegetable, animal, or mineral oils. Shark liver oil (so called Squalene) is taken as a traditional remedy in some Asian countries, and is used widely also in cosmetics. It results in foreign body type inflammatory reaction of the lung and can show various clinical presentations from asymptomatic incidental finding to severe pneumonia leading to acute respiratory failure. Although many cases have been reported, severe lipoid pneumonia requiring steroid or whole lung lavage for treatment is rare. We experienced a case of acute lipoid pneumonia of 48 year old female with dyspnea and cough caused by regular ingestion of large amount Shark liver oil, treated by whole lung lavage. We reported this case with a brief review of related literatures.

폐암환자의 경기관지 생검조직에서 MAGE 및 GAGE 발현

정만홍(Maan Hong Jung),김지호(Ji Ho Kim),김지혜(Ji Hae Kim),박기룡(Ki Ryong Park),옥철호(Chul Ho Oak),조현명(Hyun Myung Cho),장태원(Tae Won Jang) 대한내과학회 2002 대한내과학회지 Vol.62 No.1

N/A Background: There has been significant pr ogress in the identification of tumor associated antigens. Among the tumor associated antigens, MAGE (melanoma antigen), BAGE, GAGE, PRAME, NY-ESO were named as cancer/testis specific antigens since they are only expressed in the testis or cancer cells. Because of their relative specificity, they have been considered as the appropriate targets for the specific immunotherapy, or the early diagnosis of several cancers. In bronchogenic cancer, these antigens would be useful as a promising candidate in the screening test or immunotherapy. This study was to investigate the expression of MAGE and GAGE genes in the bronchogenic cancer tissues obtained by bronchoscopy. Methods: In five normal bronchial and 26 cancer tissues obtained by bronchoscopic biopsy from 26 bronchogenic cancer patients, total cellular mRNA was extracted. Then RT PCR was run in 35 cycles, with two different kinds of primers designed to detect the several subtypes of MAGE DNA simultaneously and the similar process to detect GAGE DNA was also done. Concurrently, DNA sequencing of the isolates was done in portion to prove the isolates are cloned MAGE and GAGE DNA. With probes confirmed by DNA sequencing, the isolates were reevaluated by Southern blotting. Then the expression of MAGE or GAGE in the bronchogenic cancer tissues was evaluated by the tissue types and clinical staging. Results: In the five controls, MAGE or GAGE was not detected in any specimen and beta actin was not expressed in 4 cases, suggesting the specimen might be too small to detect beta actin by 35 cycles of PCR. In the 26 cancer tissues, the expression rate of MAGE and GAGE was 42.3% (11/26) and 42.3% (11/26) respectively and MAGE or GAGE were expressed in 17 cases (65.3%). Neither clinical staging nor tissue types were associated with the expression of MAGE or GAGE. Bet a actin was not detected in 11 cases of cancer specimen, but MAGE or GAGE were expressed in 10 cases of them. Conclusion: Using these primers in detection of MAGE or GAGE genes in the bronchoscopic cancer tissues obtained by bronchoscopy biopsy tissues seems to be effective or complimentary method in screening of bronchogenic cancer patients, who would be the candidate for the possible immunotherapy.(Korean J Med 62:58-68, 2002)

증례 : 동시 항암화학 방사선요법으로 치료한 기관내 선양 낭포성 암종 1예

유홍준 ( Hong Jun You ),최평락 ( Pyoung Rak Choi ),양성우 ( Seung Wu Yang ),옥철호 ( Chul Ho Oak ),장태원 ( Tae Won Jang ),정만홍 ( Maan Hong Jung ),장희경 ( Hee Kyoung Jang ) 대한내과학회 2006 대한내과학회지 Vol.71 No.1S