천식 치료에서 순응도

정이영 ( Yi Yeong Jeong ) 대한천식알레르기학회 2013 Allergy Asthma & Respiratory Disease Vol.1 No.2

Adherence is defined as ‘the extent to which a patient`s behavior corresponds with recommendations from a health care provider’. In all chronic diseases, including asthma, patient nonadherence to medical recommendations is common. In asthma, low rates of adherence to preventive medication are associated with higher rates of hospitalization and death. Many patients choose not to take their medication because they perceive it to be unnecessary or because they are concerned about potential adverse effects. Approximately one third of asthma patients have strong concerns about adverse effects from inhaled corticosteroids (ICSs). Clinicians must be prepared to work in an ongoing partnership with patients to ensure that they are offered a clear rationale as to why ICS are necessary and to address their concerns about potential adverse effects. This approach, based on a detailed examination of patients` perspectives on asthma and its treatment, and an open, nonjudgmental manner on the part of the clinician, is consistent with the idea of concordance. Both the efficacy of a medication and patient adherence to the therapeutic regimen influence the effectiveness of a treatment. This article will review the underlying reasons for patient nonadherence and describe the role played by clinicians in promoting optimal medicine management. (Allergy Asthma Respir Dis 2013;1:105-110)Allergy Asthma Respir Dis 2013;1:105-110)

천식 치료에서 순응도

정이영 ( Yi Yeong Jeong ) 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 1991 소아알레르기 및 호흡기학회지 Vol.1 No.2

Adherence is defined as ‘the extent to which a patient``s behavior corresponds with recommendations from a health care provider’. In all chronic diseases, including asthma, patient nonadherence to medical recommendations is common. In asthma, low rates of adherence to preventive medication are associated with higher rates of hospitalization and death. Many patients choose not to take their medication because they perceive it to be unnecessary or because they are concerned about potential adverse effects. Approximately one third of asthma patients have strong concerns about adverse effects from inhaled corticosteroids (ICSs). Clinicians must be prepared to work in an ongoing partnership with patients to ensure that they are offered a clear rationale as to why ICS are necessary and to address their concerns about potential adverse effects. This approach, based on a detailed examination of patients’ perspectives on asthma and its treatment, and an open, nonjudgmental manner on the part of the clinician, is consistent with the idea of concordance. Both the efficacy of a medication and patient adherence to the therapeutic regimen influence the effectiveness of a treatment. This article will review the underlying reasons for patient nonadherence and describe the role played by clinicians in promoting optimal medicine management. (Allergy Asthma Respir Dis 2013;1:105-110)

불가사리 추출물의 복숭아혹진딧물(Myzus Persicae) 살충활성

장자영 ( Ja Yeong Jang ),이솔 ( Sol Yi ),정이영 ( Iee Young Jung ),최은현 ( Eun Hyun Choi ),조욱희 ( Uk Hee Jo ),양시영 ( Jung Mi Seo ),서정미 ( Si Young Yang ),김인선 ( In Seon Kim ) 한국환경농학회 2011 한국환경농학회지 Vol.30 No.2

BACKGROUND: Starfish is one of major sea invertebrates that have become a serious economic threat to aquacultural farms in Korea. Much effort has sacrificed to reduce the economic losses of the farms by predatory starfish, including developing and searching biological resources for medicinal and agricultural purposes. In the present study, we investigated aphicidal activity of the extracts from the starfish Asterina pectinifera against green peach aphid. METHODS AND RESULTS: Fresh starfishes were cut into small pieces, homogenized and soaked in methanol. The methanol extracts were centrifuged and the resulting supernatant was subjected to aphicidal activity assays and a series of silica gel column chromatography. More than 70% mortality of aphids were observed by the extracts at a concentration of 1,000 mg/L, exhibiting dose-dependent mortality. TOF-MS analyses detected polyhydroxysteroid as a main aphicidal compound from the starfish extracts. Transmission electronic microscopy could demonstrate that the extracts with polyhydroxysteroid caused aphids death by affecting their epicuticular membrane. CONCLUSION(s): This is the first report of aphicidal activity of the starfish Asterina pectinifera extracts against green peach aphid. Starfish biological resources may be used as a potential candidate for developing a new type natural insecticide.

Enflurane에 의한 약물 과민 반응

김경묵 ( Kyung Mook Kim ),김성환 ( Sung Hwan Kim ),권혁수 ( Hyouk Soo Kwon ),정이영 ( Yi Yeong Jeong ),권용은 ( Yong Eun Kwon ),박흥우 ( Heung Woo Park ),김상헌 ( Sang Heon Kim ),김태범 ( Tae Bum Kim ),박혜경 ( Hye Kyung Park ) 대한천식알레르기학회 2004 천식 및 알레르기 Vol.24 No.4

당뇨 환자에서 진단된 대량 객혈을 보인 폐 모균증

조유지 ( Yu Ji Cho ),강명희 ( Myoung Hee Kang ),김현식 ( Hyeon Sik Kim ),정이영 ( Yi Yeong Jeong ),장인석 ( In Seok Jang ),김호철 ( Ho Cheol Kim ),황영실 ( Young Sil Hwang ),이종덕 ( Jong Deog Lee ) 대한결핵 및 호흡기학회 2008 Tuberculosis and Respiratory Diseases Vol.64 No.6

Pulmonary mucormycosis is an uncommon, serious opportunistic infection caused by fungi belonging to the order Mucorales and it occurs exclusively in debilitated or immuno-compromised hosts. It is known that the fungi can invade the blood vessels and cause serious ischemic necrosis and bleeding5. We experienced a fatal case of pulmonary mucormycosis in a diabetic 75-year-old man who developed a progressive necrotizing lesion despite administering proper and prompt medical and surgical treatment. We report here on this case along with a review of the relevant medical literature.

기관지내 아스페르길루스종으로 오인된 폐암

함현석 ( Hyun Seok Ham ),이승준 ( Seung Jun Lee ),조유지 ( Yu Ji Cho ),정이영 ( Yi Yeong Jeong ),전경녀 ( Kyoung Nyeo Jeon ),김호철 ( Ho Cheol Kim ),이종덕 ( Jong Deok Lee ),황영실 ( Young Sil Hwang ) 대한결핵 및 호흡기학회 2006 Tuberculosis and Respiratory Diseases Vol.61 No.2

A 70-year-old man was referred to the department of pulmonology due to blood tinged sputum and an abnormal chest X-ray. The chest X-ray and CT scans revealed a lobulated contour mass-like lesion in the left upper lung field. The bronchoscopic examination showed a whitish and polypoid mass occluding the left upper lobe bronchus. A biopsy specimen from the lesion revealed many aspergillus hyphae. Intravenous and oral itraconozole were administered over a 4 weeks period. Several months later, the size of the mass on chest X-ray increased and a percutaneous lung biopsy revealed a sarcomatoid carcinoma. We reported a case of lung cancer that was obscured by an endobronchial aspergilloma with a review of the relevant literature. (Tuberc Respir Dis 2006; 61: 157-161)

결핵성 흉막삼출액에서 흉수 Adenosine Deaminase치와 림프구/호중구 비의 진단적 유용성

신민기 ( Min Khi Shin ),함현석 ( Hyun Seok Ham ),이동원 ( Dong Won Lee ),조유지 ( Yoo Ji Cho ),정이영 ( Yi Yeong Jeong ),김호철 ( Ho Cheol Kim ),이종덕 ( Jong Deok Lee ),황영실 ( Young Sil Hwang ) 대한결핵 및 호흡기학회 2004 Tuberculosis and Respiratory Diseases Vol.57 No.2

기계 환기가 요구된 중증 지역사회 획득 폐렴에서 저용량 하이드로코르티손 주입의 효과

김호철 ( Ho Cheol Kim ),이승준 ( Seung Jun Lee ),함현석 ( Hyoun Seok Ham ),조유지 ( Yu Ji Cho ),정이영 ( Yi Yeong Jeong ),이종덕 ( Jong Deok Lee ),황영실 ( Young Sil Hwang ) 대한결핵 및 호흡기학회 2006 Tuberculosis and Respiratory Diseases Vol.60 No.4

배경 : 중증 지역사회 획득 폐렴은 항생제의 발달과 보조요법의 발전에도 불구하고 사망률이 높은 질환으로 호흡부전으로 진행되어 기계환기가 필요한 경우 사망률은 더욱 증가하게 된다. 최근 중증 지역사회 획득 폐렴에서 저용량 하이드로코르티손 주입이 사망률을 감소시킨다고 보고되었다. 본 연구는 기계환기가 요구된 중증 지역사회 획득 폐렴 환자에서 하이드로코르티손 정주의 효과를 알아보기 위하여 시행하였다. 방법 : 2005년 2월부터 7월까지 중증 지역사회 획득 폐렴으로 기계환기를 유지한 13명의 환자(남:여=10:3, 평균 연령: 68.6±14.1)를 대상으로 하이드로코르티손을 240mg을 부하로 정주하고 시간당 10mg을 지속적으로 7일간 주입하였다. 대조군은 연구 기간 이전 중증 지역사회 획득 폐렴으로 기계환기를 유지하고 스테로이드 치료를 하지 않았던 13명의 환자를 대상으로 하였다. 하이드로코르티손 주입 전과 주입 8일째 두 군 간의 임상적, 생리적 지표의 차이와 최종결과를 비교하였다. 결과 : 1) 하이드로코르티손 주입 전 주입군과 대조군의 나이, 성별, 내원 당시의 SAPS II, SOFA 점수, 체온, 백혈구 수, PaO2/FiO2(P/F) 비, P/F 200이 하인 환자수, 흉부방사선 사진 점수, 폐손상 점수, 카테콜라민 의존성 패혈성 쇽의 빈도 등은 유의한 차이가 없었다. 2) 하이드로코르티손 주입 8일 후 대조군에 비해 주입군이 P/F비가 100이상 호전된 환자의 비율과 흉부 방사선 점수가 호전된 환자의 비율이 유의하게 높았다(61.5% vs. 15.4% p=0.016, 76.9%vs. 23.1% p<0.05). 이외 다른 임상적 및 생리적 지표들은 주입군과 대조군 사이에 유의한 차이는 없었다. 3) 두 군 간에 기계환기 유지기간, 중환자실 재원기간, 병원내 재원기간, 재원 10일째와 30일째의 사망률은 유의한 차이가 없었다. 결론 : 기계환기가 요구되는 중증 지역사회 획득 폐렴에서 하이드로코르티손 정주는 산소화와 흉부 방사선 점수의 빠른 호전을 보이지만 최종 치료 성적에 대해서는 많은 환자를 대상으로 한 전향적 무작위 대조 연구가 필요할 것으로 사료된다. Background : Severe community-acquired pneumonia (CAP) can develop into respiratory failure that requires mechanical ventilation (MV), which is associated with a higher rate of mortality. It was recently reported that a hydrocortisone infusion in severe CAP patients was associated with a significant reduction in the length of the hospital stay and mortality. This study evaluated efficacy of a hydrocortisone infusion for patients with severe CAP requiring MV. Methods : From February 2005 to July 2005, 13 patients (M:F=10:3, mean age: 68.6±14.1 years), who were diagnosed with severe CAP and required MV, were enrolled in this study. Hydrocortisone was administered as an intravenous 200mg loading bolus, which was followed by an infusion at a rate of 10mg/hour for 7 days. The control group was comprised of patients with severe CAP requiring MV but in whom corticosteroid was not used before study period. The clinical and physiologic parameters on or by day 8 and the outcome in the hydrocortisone infusion group were compared with those in the control group. Results : 1) There was no significant difference in age, gender ratio, SAPS II, SOFA score, temperature, leukocyte count, PaO2/FiO2 (P/F) ratio, the number of patients with P/F ratio < 200, chest radiograph score, lung injury score and catecholamine-dependent septic shock between the hydrocortisone infusion group and control group at day 1. 2) At day 8, the proportion of patients with an improvement in the P/F ratio ≥ 100 and the chest radiograph score was significantly higher in the hydrocortisone infusion group than in the control group (61.5% vs. 15.4%, 76.9% vs. 23.1%, p<0.05). However, there was no significant difference in the other clinical and physiologic parameters. 3). There was no significant difference in the duration of the MV, ICU stay, hospital stay and 10th and 30th day mortality between the two groups. Conclusion : Hydrocortisone infusion for patients with severe CAP requiring invasive mechanical ventilation may be effective in improving the level of oxygenation and the chest radiograph score. (Tuberc Respir Dis 2006; 60: 419-425)

기계환기가 요구된 중증 지역사회획득 폐렴에서 전신 스테로이드의 투여가 예후와 합병증의 발생에 미치는 영향

이승준 ( Seung Jun Lee ),이승훈 ( Seung Hun Lee ),김유은 ( You Eun Kim ),조유지 ( Yu Ji Cho ),정이영 ( Yi Yeong Jeong ),김호철 ( Ho Cheol Kim ),이종덕 ( Jong Deog Lee ),김장락 ( Jang Rak Kim ),황영실 ( Young Sil Hwang ) 대한결핵 및 호흡기학회 2012 Tuberculosis and Respiratory Diseases Vol.72 No.2

Background: This study is to evaluate the effect of systemic corticosteroid on the clinical outcomes and the occurrence of complications in mechanical ventilated patients with severe community-acquired pneumonia (CAP). Methods: We retrospectively assessed the clinical outcomes and complications in patients with severe CAP admitted to ICU between March 1, 2003 and July 28, 2009. Outcomes were measured by hospital mortality after ICU admission, duration of mechanical ventilation (MV), ICU, and hospital stay. Complications such as ventilator associated pneumonia (VAP), catheter related-blood stream infection (CR-BSI), and upper gastrointestinal (UGI) bleeding during ICU stay were assessed. Results: Of the 93 patients, 36 patients received corticosteroids over 7 days while 57 patients did not receive corticosteroids. Age, underlying disease, APACHE II, PSI score, and use of vasopressor were not different between two groups. In-hospital mortality was 30.5% in the steroid group and 36.8% in the non-steroid group (p>0.05). The major complications such as VAP, CR-BSI and UGI bleeding was significantly higher in the steroid group than in the non-steroid group (19.4% vs. 7%, p<0.05). The use of steroids and the duration of ICU stay were significantly associated with the development of major complications during ones ICU stay (p<0.05). Conclusion: Systemic corticosteroid in patients with severe CAP requiring mechanical ventilation may have no beneficial effect on clinical outcomes like duration of ICU stay and in-hospital mortality but may contribute to the development of ICU acquired complications.

안정된 만성폐쇄성폐질환 환자에서 신체질량지수와 전신 염증인자, 산화 스트레스와의 관련성

함현석 ( Hyun Seok Ham ),이해영 ( Hae Young Lee ),이승준 ( Seung Jun Lee ),조유지 ( Yu Ji Cho ),정이영 ( Yi Young Jung ),김호철 ( Ho Cheol Kim ),함종렬 ( Jong Ryeal Hahm ),박찬후 ( Chan Hoo Park ),이종덕 ( Jong Deok Lee ),손현준 ( 대한결핵 및 호흡기학회 2006 Tuberculosis and Respiratory Diseases Vol.61 No.4

연구배경: 만성폐쇄성폐질환은 기도염증으로 인한 기도폐쇄를 특징으로 하는 질환이지만, 질병의 경과 중에 체중감소나 근위축 같은 전신증상을 동반하게 된다. 만성 염증과 산화 스트레스가 만성폐쇄성폐질환의 병인에 중요한 역할을 하므로 신체질량지수의 감소와 관련이 있을 것으로 추측할 수 있다. 연구자 등은 안정된 만성폐쇄성폐질환 환자에서 신체질량지수와 관련된 인자를 알아보기 위해 다음과 같은 연구를 시행하였다. 방법: 안정된 만성폐쇄성폐질환 환자 53명(남: 여 =49:4, 평균나이 =68.25±6.32)과 정상 대조군 33명을 대상으로 폐기능 검사를 실시하고 전신염증인자로 혈청 IL-6, TNF-α를 측정하고 산화 스트레스 인자로 혈청 8-iso-prostaglandin F2α와 carbonyl protein을 측정하여 비교하였다. 또한 만성폐쇄성폐질환 환자를 신체질량지수에 따라 다시 3군(<18.5, 18.5-25,>25)으로 나누어 각각의 수치들을 비교하였고 만성폐쇄성 폐질환의 중증도에 따라 신체질량지수를 비교하였다. 결과: 만성폐쇄성폐질환 환자와 정상 대조군의 혈청에서 IL-6, TNF-α, carbonyl protein은 유의한 차이가 없었으며 8-iso-prostaglandin F2α은 각각 456.08±574.12 pg/㎖, 264.74±143.15 pg/㎖로 만성폐쇄성폐질환 환자에서 유의하게 높았다(p<0.05). 만성폐쇄성폐질환에서 신체질량지수의 차이에 따라 혈청IL-6, TNF-α, carbonyl protein 과 8-iso-prostaglan-din F2α 은 유의한 차이를 보이지 않았다. 신체질량지수에 따른 환자의 FEV1은 각각 0.93±0.25ℓ, 1.34±0.52ℓ, 1.72±0.41ℓ로 신체질량지수가 낮을수록 FEV1 값도 감소하는 경향을 보였고 (p=0.002, r=0.42), 최중증 만성폐쇄성폐질환 환자의 신체질량지수는 19.8±2.57로 중등증의 환자의 22.6±3.14에 비해 유의하게 낮았다(p<0.05). 결론: 본 연구에서 안정된 만성폐쇄성폐질환 환자의 신체질량지수는 전신염증인자와 산화 스트레스의 정도와는 관련을 보이지 않았으나 기도폐쇄의 정도와는 관련이 있을 것으로 사료된다. 만성폐쇄성폐질환 환자에서 신체질량지수의 감소와 관련된 인자에 대해서는 추가적인 연구가 필요할 것으로 사료된다. Background: The main factors associated with weight loss in patients with COPD are not well known. Since chronic inflammation and oxidative stress play a major pathogenic role in COPD, these factors may be responsible for the patients` weight loss. Therefore, this study measured the body mass index (BMI) in COPD patients and evaluated the variables, such as systemic inflammatory marker, oxidative stress and lung function, that correlate with the BMI. Method: The stable COPD patients (M:F=49:4, mean age=68.25±6.32) were divided into the lower (<18.5), normal (18.5-25) and higher (>25) BMI group. The severity of the airway obstruction was evaluated by measuring the FEV1. The serum IL-6 and TNF-α levels were measured to determine the degree of systemic inflammation, and the carbonyl protein and 8-iso-prostaglandin F2α level was measured to determine the level of oxidative stress. Each value in the COPD patients and normal control was compared with the BMI. Results: 1) Serum 8-iso-prostaglandin F2α in COPD patients was significantly higher (456.08±574.12 pg/㎖) than that in normal control (264.74±143.15 pg/㎖) (p<0.05). However, there were no significant differences in the serum IL-6, TNF-α, carbonyl protein between the COPD patients and normal controls. 2). In the COPD patients, the FEV1 of the lower BMI group was significantly lower (0.93±0.25ℓ) than that of the normal BMI (1.34±0.52ℓ) and higher BMI groups (1.72±0.41ℓ) (p<0.05). The lower FEV1 was significantly associated with a lower BMI in COPD patients (p=0.002, r=0.42). The BMI of very severe COPD patients was significantly lower (19.8±2.57) than that of the patients with moderate COPD (22.6±3.14) (p<0.05). 3). There were no significant differences in the serum IL-6, TNF-α, carbonyl protein and 8-iso-prostaglandin F2α according to the BMI in the COPD patients. Conclusion: The severity of the airway obstruction, not the systemic inflammatory markers and oxidative stress, might be associated with the BMI in stable COPD patients. Further study will be needed to determine the factors associated with the decrease in the BMI of COPD patients. (Tuberc Respir Dis 2006 61: 330-338)