단백질-칼로리 영양 실조를 동반한 장결핵 1례

송준섭,박지혜,정소정,김교순,Song, Joon Sup,Park, Ji He,Chung, So Chung,Kim, Kyo Sun 대한소아감염학회 2001 Pediatric Infection and Vaccine Vol.8 No.2

The frequency and severity of intestinal tuberculosis are decreased due to socioeconomic development, pasteurization of milk and more effective anti-tuberculous chemotherapy. But in recent year, HIV-infected patients are known to be at high risk of developing tuberculosis. The pathogenesis of intestinal tuberculosis is dependent on a immune state and nutritional status of the patient, the tuberculosis amount of sputum and tuberculosis toxicity. The diagnosis of intestinal tuberculosis is usually difficult because of non-specific clinical features and radiological signs. Chronic diarrhea in intestinal tuberculosis is able to produce a malnutrition, marasmus, kwashiorkor or the combined form. The treatment is anti-tuberculous chemotherapy for 12~24 months, but operation should be considered to intestinal perforation, obstruction, fistula formation and massive bleeding. The study about kwashiorkor in intestinal tuberculosis is rare in recent years, we should remind that tuberculosis is still prevalent disease in Korea. We report a ten year-old boy with ileocecal tuberculosis who presented with kwashiorkor, severe malnutrition with review of literature. 아직도 우리나라에서는 미국과 같은 선진국과 비교해 폐결핵의 유병률이 높은 상태이다. 그리고 높은 폐결핵 발생과 함께 장결핵의 발생도 높을 것으로 예상되나 정확한 통계 및 연구는 미비한 실정이다. 또한, 발생 가능성이 높을 것으로 예상되는 장결핵에 의한 영양실조에 대한 관심도 부족한 실정이다. 저자 등은 결핵 발생이 현격하게 감소되지 않는 한 앞으로도 계속 발생할 수 있는 장결핵에 의한 영양실조의 가능성을 상기하고자 장결핵에 의한 영양실조 1례를 경험하였기에 문헌 고찰과 함께 보고하는 바이다.

로타바이러스 장염 환아의 대변 내 지방량에 관한 연구

송준섭,정소정,김교순,Song, Joon Sup,Chung, So Chung,Kim, Kyo Sun 대한소아청소년과학회 2003 Clinical and Experimental Pediatrics (CEP) Vol.46 No.12

목 적 : 로타바이러스 장염은 소아 위장관염의 주요 원인 중 하나로 수양성변을 특징으로 한다. 대변은 수양성일뿐 아니라 지방이 포함될 것으로 짐작되고 있으나 정량적 방법을 사용하여 대변 내 지방의 양을 측정한 연구는 없었다. 본 연구에서는 로타바이러스 장염 환아의 대변에서 지방량을 알아보고자 acid steatocrit 법을 사용하여 정량적으로 측정하였다. 방 법 : 2001년 6월부터 2002년 5월까지 건국대학교병원에 입원하였던 1개월에서 5세까지의 로타바이러스 장염 환아 72명 및 위장관 증상이 없는 대조군 환아 75명을 대상으로 하였다. 로타바이러스 장염 환아의 평균 연령은 $17{\pm}11$개월이었고 대조군 환아의 평균 연령은 $14{\pm}15$개월이었다(P>0.05). Acid steatocrit 법을 사용하여 대변 내 지방량을 측정하였다. 결 과 : 로타바이러스 장염 환아 및 대조군 환아의 acid steatocrit 치는 각각 $84.9{\pm}5.8%$와 $72.6{\pm}13.1%$로 두 군간의 유의한 차이를 보였다(P<0.05). 연령별로 구분하여 보면, 1-6개월의 로타바이러스 장염 환아의 acid steatocrit 치는 $83.9{\pm}4.8%$로 대조군 환아의 $82.7{\pm}9.2%$와 유의한 차이를 보이지 않았으며, 7-12개월의 로타바이러스 장염 환아의 acid steatocrit 치는 $85.9{\pm}5.9%$로 대조군 환아의 $70.0{\pm}11.6%$와 비교하여 유의한 차이를 보였다(P<0.05). 13-18개월 및 19개월-5세의 로타바이러스 장염 환아의 acid steatocrit 치는 각각 $83.4{\pm}7.2%$와 $86.1{\pm}3.9%$로 대조군 환아의 acid steatocrit 치 $65.0{\pm}12.8%$, $65.3{\pm}9.3%$에 비해 유의하게 증가되어 있었다(P<0.05). 로타바이러스 장염 환아에서 연령 군별 acid steatocrit 치는 유의한 차이를 보이지 않았다. 결 론 : 로타바이러스 장염 환아의 대변은 정상변과 비교하여 높은 acid steatocrit 치를 보여 로타바이러스 장염 환아에서 지방 흡수 장애가 동반됨을 확인하였고 그 원인은 소장 상피 세포의 기능 장애로 인한 흡수 장애에서 기인한다고 사료된다. Purpose : Rotavirus is a leading cause of severe gastroenteritis in infants and young children around the world. The aim of this study is to investigate the fat content in stools of patients with rotaviral enteritis compared to the stools of children who had no gastroenteritis. Methods : Seventy two patients who were admitted to Konkuk University Hospital, College of Medicine from Jun 2001 to May 2002 due to rotaviral enteritis and seventy five patients who were admitted at the same time with other diseases with no gastrointestinal problems as control, were enrolled in this study. The age of patients was from one month to five years. The average age of children with rotaviral enteritis was $17{\pm}11months$ and the average age of control patients was $14{\pm}15months$. Fat content of stools was investigated by acid steatocrit tests in both patients with rotaviral enteritis and control. Results : Acid steatocrit value of patients with rotaviral enteritis was higher than that of control patients. There was no difference in acid steatocrit value of children with rotaviral enteritis among the age groups. In one month- to six month-old infants, there was no difference in acid steatocrit values between the children with rotaviral enteritis and control patients. But, over the age of seven months, the acid steatocrit value of children with rotaviral enteritis was higher than that of control patients. Conclusion : We are of the opinion that fat malabsorption in patients with rotaviral enteritis and steatorrhea in rotaviral enteritis may result from decreased fat absorption in the small intestine.

내독소 투여로 유발된 흰쥐의 급성 폐 손상에서 표면활성제(surfactant) 투여가 Interleukin (IL)-1β와 IL-6에 미치는 효과

송준섭 ( Joon Sup Song ),노창수 ( Chang Soo Noh ),정헌종 ( Chung Hun Jong ),김민희 ( Min Hee Kim ),조승제 ( Seung Jei Cho ) 대한주산의학회 2004 Perinatology Vol.15 No.2

목적 : E. coli 내독소로 급성 폐 손상을 유발한 폐에 표면활성제를 투여한 후, IL-1β와 IL-6치를 측정하여 표면활성제 투여가 폐 손상을 완화시키는지 알아보고자 한다. 방법 : 흰쥐에 E. coli LPS 내독소 (40 mg/kg)를 기도 내로 주사하여 급성 폐 손상을 유발시켰다. 흰쥐를 표면활성제 투여군(실험군)과 비투여군(대조군)으로 나누어, 체중, LPS 내독소 투여 전과 후의 호흡수, 심박수를 측정하였다. 실험군은 100 mg/kg의 뉴팩탄(R) (유한양행, 서울)을 LPS 내독소와 동시에 기도내로 주사하였고 대조군(6마리)은 동량의 생리 식염수를 주입하였다. 12시간 후 흰쥐의 혈청에서 IL-1β, IL-6, 백혈구수를 측정하고 기관지 세척액에서 IL-1β, IL-6치, 백혈구 수, 총 단백치를 측정하였다. 결과 : 기관지 세척액의 백혈구 수는 시험군에서 4,855±690/mm3, 대조군에서 12,658±4,251/mm3로 유의한 차이가 있었다(p<0.05). 혈청 IL-1β치는 실험군에서 133.3±27.4 pg/mL, 대조군에서 188.2±39.4 pg/mL이었고 IL-6치는 각각 246.2±79.2 pg/mL와 923.2±300.3 pg/mL로 유의한 차이가 있었다(p<0.05). 기관지 세척액의 IL-1β치는 실험군에서 804.5±184.3 pg/mL, 대조군에서 1,280.2±804.5 pg/mL로 p<0.05), IL-6치는 각각 940.2±475.7 pg/mL와 2,260.2±377.6 pg/mL로 유의한 감소가 있었다(p<0.05). 결론 : LPS 내독소 유발된 흰쥐의 급성 폐 손상에서 표면활성제 투여는 혈청 IL-1β, IL-6의 감소와 기관지 세척액의 백혈구, IL-1β와 IL-6의 감소를 보였고, 이는 폐포 대식세포에서 IL-1β와 IL-6의 분비를 감소시키는 면역 조절 작용으로 폐 손상을 완화시키는 것으로 생각된다. Objective : We evaluated the effects of surfactant therapy in acute lung injury (ALI) induced by E. coli lipopolysaccharide (LPS) endotoxin. Methods : ALI was induced by intratracheal administration of E. coli LPS endotoxin in rats. The study group was treated with E. coli LPS endotoxin (40 mg/kg) and surfactant (100 mg/kg) intratracheally. The controls were intratracheally injected with LPS endotoxin and same dose of 0.9% normal saline instead of surfactant. Before and after endotoxin instillation, we estimated body weight, respiratory rate (RR) and heart rate (HR). The WBC counts had estimated in blood and bronchoalveolar lavage (BAL) fluid, and the total protein values were measured in BAL fluid. And also, we examined IL-1β, IL-6 values in BAL fluid and serum. Finally, the histopathologic changes were confirmed with light and electron microscopic study. Results : In the study group, the WBC counts had decreased in BAL fluid (p<0.05) and the IL-1β and IL-6 values had decreased in serum and BAL fluid (p<0.05). But, there were non-significant decrement in WBC counts of blood and the total protein values in BAL fluid (p>0.05). The RR and HR changes after instillation were also non-significant (p>0.05). Morphologically, the light microscopic examination denoted pathological findings such as infiltration of neutrophils and alveolar macrophages, vascular congestion. In electron microscopic study, there were various sized and shaped lamella bodies, and vacuolization of lamella bodies in alveolar type II cell. Conclusion : Surfactant protects effectively the ALI caused by LPS endotoxin in vivo and the protective effects of that may be related to anti-inflammatory action.

천식 소아에서 혈중 포스포리파제 A2: leptin과 운동유발 기관지과민성과의 상관성

유정섭 ( Jueng Sup You ),최원복 ( Won Bok Choi ),이윤영 ( Yoon Young Yi ),정수인 ( Soo In Jeong ),송준섭 ( Joon Sup Song ),양승 ( Seong Yang ),황일태 ( Il Tae Hwang ),이하백 ( Ha Baik Lee ),백혜성 ( Hey Sung Baek ) 대한천식알레르기학회 2015 Allergy Asthma & Respiratory Disease Vol.3 No.2

Purpose: Dysregulated cysteinyl leukotriene (CysLT) synthesis is prominent in exercise-induced bronchoconstriction (EIB). Secreted phospholipase A2 (sPLA2) plays a key regulatory role in the biosynthesis of CysLTs. We previously found that serum leptin levels cor￢relate with (EIB) in children with asthma. The aim of this study was to address the relationship between plasma sPLA2/leptin levels and EIB. Methods: Sixty-seven prepubertal children between the ages of 6 and 10 years were included in the study. They were asthmatics with EIB (n=25), asthmatics without EIB (n=21), and healthy subjects (n=21). We measured the plasma sPLA2 and leptin levels. We also performed pulmonary function tests at baseline, after bronchodilator inhalation, and after exercise. Results: The sPLA2 and leptin levels were significantly higher in asthmatics with EIB than in those without and control subjects. In addition, sPLA2 levels were significantly correlated with body mass index (Speraman correlation coefficient r=0.343, P=0.023) and leptin levels (partial correlation coefficient r=318, P=0.033). The maximum decrease in % forced expiratory volume in 1 second af￢ter exercise was significantly correlated with both PLA2 levels (r=0.301, P=0.041) and leptin levels (r=0.346, P=0.018). Conclusion: The sPLA2 and leptin levels were significantly higher in asthmatics with EIB than in asthmatics without EIB and control subjects. In addition, sPLA2 levels were significantly correlated with leptin levels and EIB in asthmatic children.(Allergy Asthma Respir Dis 2015;3:99-104)

자작나무에 감작된 소아에서 과일 알레르기를 진단하기 위한 microarray법에 의한 성분 항원검사

최원복 ( Won Bok Choi ),유정섭 ( Jueng Sup You ),이윤영 ( Yoon Young Yi ),정수인 ( Soo In Jeong ),송준섭 ( Joon Sup Song ),양승 ( Seong Yang ),황일태 ( Il Tae Hwang ),이하백 ( Ha Baik Lee ),백혜성 ( Hey Sung Baek ) 대한천식알레르기학회 2015 Allergy Asthma & Respiratory Disease Vol.3 No.3

Purpose: Recently, component-resolved diagnosis (CRD) using microarray technology has been introduced to the field of clinical allergy. This study was aimed to investigate the clinical usefulness of microarray-based IgE detection for diagnosing clinical raw fruit allergy in birch pollen-sensitized children. Methods: Thirty-one children with allergic disease who had been sensitized to pollen were studied. A pollen-sensitized patient was defined as having an allergen-specific history with concomitant positive skin-prick tests (SPTs) to natural allergen extracts or positive allergen-specific IgE. All subjects underwent SPTs for pollen and fruit. In all subjects, specific IgE to pollen and fruit were measured by ImmunoCAP. Specific IgE antibodies to allergen components were determined by a customized allergen microarray (ISAC). Results: Thirteen of the 31 patients (41.9%) had a history of fruit hypersensitivity with positive SPTs. Measuring IgE to allergen components by ISAC, all the 13 patients with fruit hypersensitivity were positive to at least one of Mal d 1, Pru p 1, Pru p 3, Act d 8, and Act d 2 compared to 12 of the 13 patients (92.3%) who had at least 1 positive IgE to fruits (apple, peach, and kiwi) using ImmunoCAP. The sensitivity of ISAC microarray was 100.0% for the diagnosis of fruit hypersensitivity, but its specificity was 27.7% (5/18). The sensitivity of ImmunoCAP was 92.3%, and its specificity was 83.3%. Conclusion: The sensitivity of allergen components tested using microarray for the diagnosis of clinical fruit hypersensitivity in children with pollen allergy was high; however, its specificity was low.(Allergy Asthma Respir Dis 2015;3:200-205)

선천성 낭선종성 기형이 의심되었던 환아에서 진단된 흉막폐모세포종 1례

우성일 ( Sung Il Woo ),김효빈 ( Hyo Bin Kim ),송준섭 ( Joon Sup Song ),구현령 ( Hyun Lyoung Koo ),임호준 ( Ho Jun Lim ),홍수종 ( Soo Jong Hong ) 대한소아알레르기호흡기학회 2006 소아알레르기 및 호흡기학회지 Vol.16 No.2

Congenital cystic adenomatoid malformation(CCAM) is one of the most common congenital lung lesions. Clinical manifestations that show are neonatal respiratory distress, recurrent respiratory infection, pneumothorax, and hemothorax. But, there are patients who are asymptomatic until mid-childhood. The treatment of asymptomatic CCAM is controversial. There is a possibility to resolve it spontaneously, but late complications such as recurrent pulmonary infection, pneumothorax, hemothorax, and cancer, which includes bronchoalveolar carcinoma and rhabdomyocarcinoma, pleuropulmonary blastoma still remain. Some investigators advocate routine surgery for all cases of CCAM that are apparent at birth. A previously healthy 16-months-old girl who had suffered from a cough for 2 weeks was transferred to Asan Medical Center with CCAM. Due to a chest CT and fever, we first thought that she had CCAM with infection. After we treated her with antibiotics for one week, we performed surgery to confirm the diagnosis and to prevent further complication. But by surgical wedge resection, a pleuropulmonary blastoma was found. There were no evidence of metastasis and adjacent involvement. She started her chemotherapy with vincristine, actinomycin D and cyclophosphamide, and is now continuing maintenance chemotherapy with etoposide, vincristine, and Ifosfamide. We report pleuropulmonary blastoma that presented as CCAM. So we recommend surgical resection in asymptomatic CCAM to confirm the diagnosis and to prevent its malignant transformation, even not accompanied by symptoms. [Pediatr Allergy Respir Dis(Korea) 2006;16:177-182]

천식 소아에서 혈청 렙틴과 만니톨 기관지 과민성과의 관계

유정경 ( Jung Kyung Yoo ),신재영 ( Jae Young Shin ),유정섭 ( Jueng Sup You ),정수인 ( Soo In Jeong ),송준섭 ( Joon Sup Song ),양승 ( Seong Yang ),황일태 ( Il Tae Hwang ),이하백 ( Ha Baik Lee ),백혜성 ( Hey Sung Ba다 ) 대한천식알레르기학회 2014 Allergy Asthma & Respiratory Disease Vol.2 No.1

Purpose: Epidemiological data indicate that obesity is a risk factor in asthma, however effects related to obesity and adipokines on airway inflammation and bronchial hyper-responsiveness (BHR) have not yet been demonstrated in the human airway. The aim of this study was to investigate the relationship between serum adipokine levels and BHR to mannitol in asthmatic children. Methods: Serum adipokine levels were measured and pulmonary function tests were perfomed: baseline, postbronchodilator inhalation, methacholine inhalation, and mannitol inhalation. The response to mannitol was expressed as the dose causing a 15% decrease in forced expiratory volume in one second (FEV1) (PD15), and as the response-dose ratio (RDR) (% fall in FEV1/cumulative dose). Results: Sixty-nine prepubertal children between the ages of 6 and 10 years were participated in the study. They comprised asthmatic children (n=40) and healthy (n=29). Twenty-two subjects (55.5%) with asthma had a positive mannitol bronchial provocation test (BPT) result. The body mass index (BMI) was higher in those asthmatics with positive mannitol BPTs than in asthmatics with negative mannitol BPTs and in the control group (19.30 kg/m2 vs. 17.60 kg/m2 vs. 17.93 kg/m2, P=0.035, P=0.046). Serum leptin levels were also significantly higher in asthmatics with positive mannitol BPTs than in asthmatics with negative mannitol BPTs and in the control group (10.58 ng/mL vs. 5.49 ng/mL vs. 6.75 ng/mL, P=0.002, P=0.016). Leptin values were significantly associated with a PD15 (r=.0.498, P=0.022) and RDR to mannitol (r=0.346, P=0.033) in asthmatic children after adjustment for BMI. Conclusion: Serum leptin levels were significantly associated with BHR to mannitol in asthmatic children. (Allergy Asthma Respir Dis 2014;2:30-37)