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반복적인 호흡기 감염과 천식 악화가 동반된 IgG3 아형 결핍증 성인 환자에서 intravenous immunoglobulin 사용 1예
이홍열 ( Hong Yeul Lee ),윤상원 ( Sang Won Yoon ),김영 ( Young Kim ),조환준 ( Hwan Jun Cho ),이주영 ( Joo Young Lee ),구강모 ( Kang Mo Gu ),박태연 ( Tae Yun Park ),최재철 ( Jae Chol Choi ),신종욱 ( Jong Wook Shin ),김재열 ( Jae Y 대한천식알레르기학회(구 대한알레르기학회) 2016 Allergy Asthma & Respiratory Disease Vol.4 No.3
The IgG subclass deficiency is defined as a significant decrease in the serum concentrations of one or more subclasses of IgG in a patient whose total IgG concentration is normal. IgG subclass deficiency can predispose to recurrent sinopulmonary infections. A 29-year-old female patient with a 4-year history of bronchial asthma presented with cough, sputum, dyspnea, and recurrent respiratory infections. She had frequently been treated with antibiotics and systemic steroids for recurrent respiratory infections and acute asthma exacerbations. Chest X-ray and computed tomography showed pectus excavatum and bronchial wall thickening without lung parenchymal abnormalities. On immunological evaluation, she was found to have a low serum IgG3, with normal total IgG concentration. Under diagnosis of selective IgG3 deficiency, she was started on monthly infusions of intravenous immunoglobulin (IVIG) therapy. The frequency and severity of respiratory infections and acute asthma exacerbations were markedly decreased during 3 years of IVIG therapy. Our case report suggests that a patient who has underlying selective IgG3 deficiency and asthma may benefit from IVIG therapy as this can significantly reduce the incidence and severity of recurrent respiratory infections and acute asthma exacerbations. (Allergy Asthma Respir Dis 2016;4:225-229)
호흡기 내과계 중환자실 전공의 수와 중환자실 사망률의 관련성
이병준 ( Byoung Jun Lee ),이창훈 ( Chang Hoon Lee ),김덕겸 ( Deog Kyeom Kim ),김경희 ( Kyoung Hee Kim ),김은선 ( Eun Sun Kim ),박태연 ( Tae Yun Park ),정근범 ( Keun Bum Chung ),강효재 ( Hyo Jae Kang ),정윤정 ( Yun Jeong Jeong ) 대한내과학회 2010 대한내과학회지 Vol.79 No.2
Background/Aims: The treatment outcome of patients hospitalized in intensive care units (ICUs) can be influenced by physician factors, including both intensivists and resident physicians. We evaluated the association between the number of residents who are exclusively responsible for the ICU and the mortality rate in a medical ICU. Methods: The data obtained from an open medical ICU in a teaching hospital from Jan. 2005 to Dec. 2009 were analyzed retrospectively. We evaluated the associations between the ICU mortality rate and both the number of resident physicians and the number of patient-days per resident physician using multivariate Poisson regression analysis adjusted for year and month. Results: The months with fewer than two residents tended to have a higher ICU mortality rate, although this difference was not significant in the univariate analyses. Multivariate Poisson regression analysis showed that months with fewer than two residents had a significantly higher ICU mortality rate compared with months with two residents (incidence risk ratio (IRR) 1.59, 95% confidence interval (CI) 1.05-2.41; p=0.029). The number of ICU patient-days per resident physician was not associated with the ICU mortality rate (IRR; 1.00, 95% CI, 0.99-1.01; p=0.649). Conclusions: The presence of fewer than two residents exclusively responsible for the medical ICU was an independent risk factor of a higher ICU mortality rate. However, no association was found between the number of ICU patient-days per resident physician and the ICU mortality rate. (Korean J Med 79:155-162, 2010)