결핵성 및 암성 흉수의 감별진단에서 흉수내 SC5b - 9 농도 측정의 진단적 의의

서동완(Dong Wan Seo),곽승민(Seung Min Kwak),김우성(Woo Sung Kim),김동순(Dong Soon Kim),서을주(Eul Ju Seo),민원기(Won Ki Min),김원동(Won Dong Kim),고윤석(Youn Suk Koh) 대한내과학회 1994 대한내과학회지 Vol.47 No.6

N/A To evaluate the diagnotic value of pleural SCSb-9 in the differential diagnosis of tuberculous and malignant pleural effusion, we measured pleural ADA activity and SCSb-9 concentration in 71 cases of pleural effusions due to tuberculosis (n=35) and malignancy (n=36). And we also measured pleural C4d fragment and Bb fragment concentration to determine by which pathway the complement activation occurs in pleural space. The results were as follows: 1) The median value of pleural SC5b-9 concentration of tuberculous effusion was 6.4 ug/ml (interquartile range 2.6~11.7) and was significantly higher than that of malignant effusion (p<0.005). 2) The median values of pleural C4d fragment concentration were 15.5 mg/ml (9.9~18.9) in tuberculous effusion and 12.8 mg/ml (7.3~19.6) in malignant effusion. There were no significant difference between two groups. The median value of pleural Bb fragment concentration of tuberculous effusion was 7.8 mg/ml (5.5~12.8) and was significantly higher than that of malignant effusion (p<0.01). 3) The SC5b-9 concentration showed no significant correlation with C4d fragment concentration both in tuberculous effusion and malignant effusion. But the SC5b-9 concentration showed significant correlation with Bb fragment concentration both in tuberculous effusion (r=0.48, p<0.005) and malignant effusion (r=0.72, p<0.001). 4) The median value of pleural ADA activity of tuberculous effusion was 64.3 U/L (40.9~103.5) and significantly higher than that of malignant effusion (p<0.001). 5) Pleural ADA activity showed significant correlation with pleural SC5b-9 concentration in tuberculous effusion (r=0.53, p<0.005). 6) According to the receiver-operating characteristic curve analysis, the measurement of pleural ADA activity is superior to that of pleural SC5b-9 concentration in the differential diagnosis of tuberculous and malignant effusion. In conclusion, the measurement of pleural SC5b-9 concentration can be used as an adjunctive test in the differential diagnosis of tuberculous and malignant effusion but pleural ADA activity measurement was superior to pleural SC5b-9 concentration measurement. And pleural SC5b-9 concentration of tuberculous effusion was higher than that of malignant effusion and it seems to be due to the difference in activation of alternative pathway activation of complement in two groups.

진행성 비소세포폐암에서 Navelbine , Ifosfamide , Cisplatin 복합항암화학요법

김태원(Tae Won Kim),김상희(Sang Hee Kim),최성준(Sung Jun Choi),최종수(Jong Soo Choi),김상위(Sang We Kim),최은경(Eun Kyung Choi),서철원(Cheol Won Suh),이정신(Jung Shin Lee),김우성(Woo Sung Kim),김동순(Dong Soon Kim),김원동(Won Dong Ki 대한내과학회 2001 대한내과학회지 Vol.60 No.5

N/A Background : We performed a phase 2 study to determine the activity and toxicity of Navelbine, Ifosfamide, and Cisplatin (NIP) combination in patients with stage IIIB-4 non-small cell lung cancer (NSCLC). Methods : Thirty-two chemotherapy naive patients were enrolled from 2 centers between February 1997 and December 1997. The median age was 57 years (range, 29-71) ; stage IIIB/IV 6/26; male/female 23/9. The regimen consisted of navelbine (25 mg/m2 day 1 and 5), ifosfamide (3 g/m2 day 5 with uroprotective mesna), and cisplatin (80 mg/m2 day 5) every 3 weeks. Results : Twenty-six were evaluable for response and 31 for toxicity. One patient was lost to follow up, one patient refused to continue, and 4 patients could not continue due to poor performance. Total of 120 cycles have been given, with median of 4 cycles per patient (range ; 1-6). Sixteen patients achieved partial response (response rate on an intention-to-treat basis, 50%; 95% C.I:32-68% ). Neutropenia was the most common toxicity. Grade 3-4 neutropenia was observed in 39% of courses ; thrombocytopenia 4% of courses ; anemia 14% of courses. Three patients developed febrile neutropenia; there was no treatment-related death. The median time to progression was 6.9 months and the median overall survival 8.0 months. The probability for 1-year survival was 25%.

Rifampicin 단독내성 폐결핵

심태선 ( Tae Sun Shim ),이기만 ( Ki Man Lee ),임채만 ( Chee Man Lim ),이상도 ( Sang Do Lee ),고윤석 ( Youn Suck Koh ),김우성 ( Woo Sung Kim ),김동순 ( Dong Soon Kim ),김원동 ( Won Dong Kim ) 대한결핵 및 호흡기학회 1999 Tuberculosis and Respiratory Diseases Vol.46 No.5

직장암의 방사선치료에 대한 Patterns of Care Study : 1998~1999년도 수술 후 방사선치료 환자들의 특성 및 치료내용에 대한 분석결과

김종훈(Jong Hoon Kim),오도훈(Do Hoon Oh),강기문(Ki Moon Kang),김우철(Woo Cheol Kim),김원동(Won Dong Kim),김정수(Jung Soo Kim),김준상(June Sang Kim),김진희(Jin Hee Kim),길학재(Hak Jae Kil),서창옥(Chang Ok Suh),손승창(Seung Chang Sohn) 대한방사선종양학회 2005 Radiation Oncology Journal Vol.23 No.1

목 적: 전국의 각 병원 방사선종양학과에서 1998년과 1999년도의 2년간 직장암 진단 하에 수술 후 방사선치료를 시행한 환자들의 자료를 분석하여 한국인 직장암 환자의 전체적인 구성과 특성을 파악하고 치료 내용에 대한 현황 을 조사하여 국가적인 자료로 활용하고자 하였다. 대상 및 방법: 대상 환자의 기준은 1998년부터 1999년 사이에 직장 선암의 수술 후 방사선치료를 시작한 환자로서 육안적 잔여 병소 없이 근치적으로 수술이 이루어진 환자를 대상으로 했으며 직장암이외의 다른 암의 병력이 있거나 과거에 골반에 방사선치료를 받은 병력이 있는 환자는 제외하였다. 각 병원별 치료환자 수에 비례하여 해당 병원의 입력 환자수를 정한 후 PCS 본부의 무작위 추출 과정을 통하여 입력할 환자를 선정하였다. 선정된 환자는 웹 기반 PCS시스템을 이용하여 각 병원에서 직접 자료를 입력하였다. 결 과: 전국의 19개 병원에서 총 309명의 환자 자료가 입력되었다. 남녀 성비는 59:41이었으며 하단연 기준 종양의 위치는 항문연 6 cm 이내가 46%로 가장 많았다. 수술 전 CEA검사는 79%에서 시행되었으며 이 중 43%에서 6 ng/ml 이상인 것으로 나타났다. 수술 전 직장내초음파검사는 50명(16%)에서만 시행되었으며 CT 등을 이용한 임상적 병기판정은 274명에서 가능하였으며 stage II가 32%, III가 48%를 차지하였다. 수술 후 조직소견에 의한 병리학적 병기는 stage II가 34%, III 가 63%였다. 수술의 방법은 복회음부절제수술이 38%, 저위전방절제술이 59%였으며, 5명의 환자에서는 원격전이가 있었으나 원발병소와 함께 절제되었다. 절제연에서 종양세포가 발견된 경우가 13예였으며, 수술 후 항암화학치료를 받은 환자는 전체의 91%였고 80%의 환자는 정맥주사, 9%의 환자는 경구항암제를 투여한 것으로 나타났다. 항암제는 5FU와 leucovorine의 조합이 212명(69%)으로 가장 많았고 시행횟수는 6회가 140예(45%)로 가장 많았다. 환자의 치료자세는 복와위자세가 251예(81.2%)로 나타났고, 치료 조사야 수는 박스형 4문조사가 75예(24.3%)로 가장 많았으며 3문조사(후방-양측방)가 201예(65.0%)로 그 뒤를 이었다. 치료 시 소장을 조사야 외부로 이동시키기 위한 장치나 소변을 참는 등의 조치는 40.1%의 환자에서 시행되었다. 선량의 처방점은 회전중심점이 140예(45.3%), 등선량곡선이 123예로 비슷하게 나타났다. 실제 치료된 조사선량은 180∼7,740 cGy의 분포를 보였으며 목표선량의 90%이상이 투여된 경우가 287예(92.9%)였다. 결 론: 전국 각 병원들의 환자를 종합하여 관찰된 내용은 문헌상 권장되는 것과 비슷한 결과를 보였으며 수술의 범위와 항암화학치료의 방법은 병원에 따라 비교적 다양한 형태로 시행되고 있는 것으로 나타났다. 각 병원의 방사선치료 내용은 환자의 상태에 따라 결정되는 탓에 방사선량과 조사야의 선택에 있어 차이가 관찰되었으며 처방된 치료에 대한 환자의 순응도는 90% 이상으로 높게 나타났다. Purpose: To conduct a nationwide survey on the principles in radiotherapy for rectal cancer, and produce a database of Korean Patterns of Care Study. Materials and Methods: We developed web-based Patterns of Care Study system and a national survey was conducted using random sampling based on power allocation methods. Eligible patients were who had postoperative radiotherapy for rectal cancer without gross residual tumor after surgical resection and without previous history of other cancer and radiotherapy to pelvis. Data of patients were inputted to the web based PCS system by each investigators in 19 institutions. Results: Informations on 309 patients with rectal cancer who received radiotherapy between 1998 and 1999 were collected. Male to female ratio was 59:41, and the most common location of tumor was lower rectum (46%). Preoperative CEA was checked in 79% of cases and its value was higher than 6 ng/ml in 32%. Pathologic stage were I in 1.6%, II in 32%, III in 63%, and IV in 1.6%. Low anterior resection was the most common type of surgery and complete resection was performed in 95% of cases. Distal resection margin was less than 2 cm in 30%, and number of lymph node dissected was less than 12 in 31%. Chemotherapy was performed in 91% and most common regimen was 5-FU and leucovorine (69%). The most common type of field arrangement used for the initial pelvic field was the four field box (Posterior-Right-Left) technique (65.0%), and there was no AP-PA parallel opposing field used. Patient position was prone in 81.2%, and the boost field was used in 61.8%. To displace bowel outward, pressure modulating devices or bladder filling was used in 40.1%. Radiation dose was prescribed to isocenter in 45.3% and to isodose line in 123 cases (39.8%). Percent delivered dose over 90% was achieved in 92.9%. Conclusion: We could find the Patterns of Care for the radiotherapy in Korean rectal cancer patients was similar to that of US national survey. The type of surgery and the regimen of chemotherapy were variable according to institutions and the variations of radiation dose and field arrangement were within acceptable range.

급성호흡곤란증후군 환자에서 복와위(prone position)와 산화질소흡입(nitric oxide inhalation) 병용 치료의 효과

고윤석 ( Youn Suck Koh ),임채만 ( Chae Man Lim ),이기만 ( Ki Man Lee ),진재용 ( Jae Yong Chin ),심태선 ( Tae Sun Shim ),이상도 ( Sang Do Lee ),김우성 ( Woo Sung Kim ),김동순 ( Dong Soon Kim ),김원동 ( Won Dong Kim ) 대한결핵 및 호흡기학회 1998 Tuberculosis and Respiratory Diseases Vol.45 No.6

기관내 관 제거 후 발생한 급성 호흡부전에서 비침습적 양압 환기법의 유용성

나주옥 ( Joo Ock Na ),임채만 ( Chae Man Lim ),심태선 ( Tae Sun Shim ),박주헌 ( Joo Hun Park ),이기만 ( Ki Man Lee ),이상도 ( Sang Do Lee ),김우성 ( Woo Sung Kim ),김동순 ( Dong Soon Kim ),김원동 ( Won Dong Kim ),고윤석 ( Youn Suck 대한결핵 및 호흡기학회 1999 Tuberculosis and Respiratory Diseases Vol.46 No.3

폐결핵 환자의 말초 혈액에서 중합효소연쇄반응을 이용한 결핵균 DNA의 검출

성흥섭 ( Heung Sup Sung ),오연목 ( Yeon Mok Oh ),이상도 ( Sang Do Lee ),김우성 ( Woo Sung Kim ),김동순 ( Dong Soon Kim ),김원동 ( Won Dong Kim ),심태선 ( Tae Sun Shim ),홍윤기 ( Yoon Ki Hong ),조경욱 ( Kyung Uk Jo ),이혜영 ( Hye Y 대한결핵 및 호흡기학회 2007 Tuberculosis and Respiratory Diseases Vol.63 No.4

연구배경: 결핵은 호흡기를 통한 전염성 질환이지만 말초혈액에서 결핵균 PCR이 양성이거나 결핵균이 배양된 보고가 일부 있었다. 이는 결핵의 진단에 있어서의 유용성과 헌혈을 통한 결핵의 전염 가능성의 두 가지 문제를 제기하게 되었고, 저자들은 상기 문제들에 대한 향후 연구방향의 기초자료로 사용하고자 연구를 시행하여 보았다. 방법: 속립성 결핵이 아닌 폐결핵, 비결핵항산균 폐질환, 폐암 및 폐렴 환자 69명을 대상으로 말초혈액에서 결핵균 PCR을 시행하였고, 결핵균이 많을 것으로 추정되는 10명의 폐결핵 환자의 말초혈액을 대상으로 결핵균 배양을 시행하였다. 결핵균 PCR은 nested PCR을 이용한 TB-taq (M&D, Korea)을 이용하였고 혈액배양에는 BACTEC Myco/F Lytic 혈액배양병(Becton Dickinson, Sparks, Md)을 사용하였다. 결과: 결핵균 PCR을 시행한 환자는 69명으로 각각 폐결핵 35명, 비결핵항산균 폐질환 6명, 폐암 20명, 폐렴 8명이었다. 폐렴이나 폐암 환자 28명 모두에서 PCR은 음성이었고, 비결핵항산균 폐질환 6명 중 1명(16.7%), 폐결핵 35명 중 8명(22.8%)에서 양성이었다. 혈액 배양은 폐결핵 10명 모두에서 음성이었다. 결론: 미만성 결핵이 동반되지 않은 폐결핵 환자의 말초혈액에서 결핵균의 DNA가 검출됨을 확인할 수 있었으나 균배양이 되지 않는 것으로 보아 살아있는 균이 존재하기 보다는 균의 일부 성분만 존재할 가능성을 제시하였다. Background: Although pulmonary tuberculosis (TB) is a respiratory disease, the presence of Mycobacterium tuberculosis (Mtb) DNA or Mtb itself has been reported in the peripheral blood (PB) of several patients with pulmonary TB. Additionally, it was recently announced that active pulmonary TB patients donated PB, and that this blood was then transfused to other individuals in Korea. Methods: Sixty-nine patients with bacteriologically-confirmed pulmonary TB (35), non-tuberculous mycobacterial (NTM) lung disease (6), and other lung diseases (28) were enrolled in this study, which was conducted to determine if Mtb DNA could be detected in the PB by PCR. In addition, 10 pulmonary TB patients with high-burden bacilli were also enrolled in this study for the culture of Mtb in PB. Results: PCR detected the presence of Mtb in 22.8% (8/35) of the pulmonary TB patients, in 16.7% (1/6) of the patients with NTM lung disease, and in none of the patients with other diseases (0%). In addition, no Mtb was cultured from the PB of the 10 pulmonary TB patients. Conclusion: Although Mtb DNA was detected in the PB of some patients with pulmonary TB, viable Mtb was not isolated from the PB of those patients, which indicates that patients that viable Mth may not be transmitted via trasfusion of blood of pulmonary TB patients. (Tuberc Respir Dis 2007; 63: 331-336)

심한 전신질환 환자에서의 혈중 Cortisol과 DHEA-S의 변동

이문호,고윤석,이기업,송재훈,김우성,김원동,최종무,송영기,이명혜,황재현 대한내분비학회 1990 Endocrinology and metabolism Vol.5 No.4

Dehydroepiandrosterone sulfate (DEHA-S) is the most abundant adrenal androgen in human, but physiological role of DHEA-S is not well known. In the present study, we measured serum cortisol and DHEA-S levels in 19 critically ill patients. The results are follows: 1) Basal serum cortisol concentrations were elevated in the patients group (p$lt;0.005). 2) Basal serum DHEA-S concentrations were decreased in the patients group (p$lt;0.005). 3) There was no significant difference between basal and ACTH-stimulated serum cortisol concentrations in the patients group (p$gt;0.05). 4) Basal serum DHEA-S concentrations in patient group were significantly lower on second day of admission compared to those of day 1 (p$lt;0.05). With above results, we speculate that there is a shift in the metabolism of adrenal pregnenolone in serous illness, away from adrenal androgen and toward glucocorticoid (J Kor Soc Endocrinol 5:288~293, 1990).