가와사끼병에서 감마글로불린 재투여가 필요했던 경우의 임상적 특징

김덕수,한윤수,한헌석,Kim, Deok-Soo,Hahn, Yoon-Soo,Han, Heon-Seok 대한소아청소년과학회 2002 Clinical and Experimental Pediatrics (CEP) Vol.45 No.11

목 적 : 저자들은 IVGG의 재투여가 필요했던 환아들의 검사소견 및 임상적 특징을 알아보고, 재투여가 필요 없었던 환아들과 비교하여 재투여가 필요한 환아를 예측할 수 있는지 알아보고자 하였다. 방 법: 1997년 10월부터 2001년 2월까지 적어도 6개월 이상의 추적관찰이 가능하였던 117명의 환자를 대상으로 통상적인 혈액검사, 심전도, 신호평준화 심전도, 심초음파도를 후향적으로 검토하였다. IVGG 한번 투여 후 recurrent fever 혹은 recrudescence fever를 보이는 6명(5.1%)에게는 IVGG를 한번 더 투여하였으며, 그래도 발열이 지속되는 경우는 methylprednisolone를 한번 내지 두번을 pulse로 주었다. 결 과: 전체 117명의 환아 중 23명(19.7%)에서 6개월 이상의 추적 기간중 심장의 합병증이 생겼으며, 초기 심장의 합병증이 23명에서, 후기 합병증은 4명에서 관찰되었다. IVGG의 재투여가 필요했던 환자는 6명(5.1%)이었으며, 초기의 심장합병증은 IVGG을 재투여한 군에서 1회 투여한 군에 비하여 높으며(P<0.0001), 장기적인 심장 합병증도 재투여군이 높았다(P<0.0001). IVGG 재투여군 중 m-PD까지 사용했던 군도 초기 합병증 및 후기 합병증이 1회 투여군에 비하여 현저히 높았다. 전체적인 합병증 유무에 따른 여러 가지 검사 소견 중 CRP만이 합병증이 있는 군에서 유의하게 증가되어 있었으며($11.94{\pm}7.43$ vs $6.97{\pm}6.41$ P<0.01), IVGG 재투여군이 1회 투여군보다 CRP가 현저히 증가되어 있었다($15.68{\pm}8.67$ vs $7.44{\pm}6.50$ P<0.05). 결 론: 초기 검사에서 CRP가 현저히 높은 군이 합병증의 발생빈도도 높고 IVGG을 재 투여할 가능성도 높다. 그러나, IVGG의 재투여가 관상동맥 합병증의 발생을 감소시키지는 못하였다. 이는 IVGG의 재투여가 필요했던 군에서는 CRP의 결과에서 보듯이 많은 양의 IVGG가 필요할 정도로 심한 염증반응이 있었거나 IVGG 자체로는 효과적으로 심장 후유증을 예방할 수 없기 때문이라고 생각된다. Purpose : Although the use of intravenous gamma-globulin(IVGG) in Kawasaki disease(KD) is effective in reducing clinical symptoms and coronary artery complications, 20-30% of patients have persistent or recrudescent fever and ongoing clinical symptoms. In these patients, the additional infusion of IVGG is considered. The authors studied the characteristics of patients who received IVGG retreatment, and compared them with the patients who did not need IVGG retreatment, for determination of IVGG retreatment. Methods : We reviewed the medical records of 117 KD patients who could be followed up at least six months. We studied the conventional laboratory findings, electrocardiogram(EKG), signal averaged ECG(SAECG) and echocardiogram. Results : Twenty three patients had early cardiac complications during the six months of follow-up. Four patients had late cardiac complications after six months. The early cardiac complication rate was higher in the IVGG retreatment group than the single infusion group(P<0.0001). The late complication rate was also higher in the retreatment group(P<0.0001). The patients who received methyl-prednisolone(m-PD) pulse therapy had much higher rates of early and late cardiac complications than those who received a single IVGG infusion. Among the clinical data and laboratory findings, only CRP increased significantly in patients who have had the cardiac complications. The IVGG retreatment group had increased CRP than the single infusion group. Conclusion : The patients with increased initial CRP may have an increased incidence of complications and an increased possibility of IVGG retreatment. We thought that retreated KD patients might have inflammations severe enough to need high dose IVGG as shown by high CRP levels, and IVGG retreatment could not prevent coronary artery lesions sufficiently.

소아 아토피천식 환자에서 메타콜린 PC20와 천식 조절 상태 사이의 연관성

윤신애 ( Shin Ae Yoon ),윤지용 ( Ji Yong Yoon ),김헌 ( Heon Kim ),한윤수 ( Youn Soo Hahn ) 대한소아알레르기호흡기학회 2013 Allergy Asthma & Respiratory Disease Vol.1 No.1

Purpose: Although methacholine PC20 helps clinicians to identify asthma, there are practical limitations in using methacholine PC20 to assess asthma control. We assessed the relationship between methacholine PC20 levels and asthma control status in child patients with atopic asthma. Methods: We enrolled 153 children of 8 to 15 years of age with atopic asthma and measured methacholine PC20 of these children when their asthma was controlled. We followed up these patients for more than 2 years with measurements of asthma control score, lung function, bronchodilator response (BDR), and fractional exhaled nitric oxide (FeNO). Results: The geometric mean of methacholine PC20 in the study population was 2.81 mg/mL. Lower methacholine PC20 was found to be associated with lower lung function, higher rate of BDR greater than 12%, higher level of BDR, higher rate of FeNO levels greater than 23 ppb, higher FeNO, higher numbers of asthma aggravation per year, and higher rate of asthma control test scores of 19 or less. Conclusion: These data provide evidences that the degree of methacholine PC20 is linked to disease severity in children with atopic asthma. Thus, regular and close monitoring of asthma control should be required for patients with lower levels of methacholine PC20. (Allergy Asthma Respir Dis 1(1):35-40, 2013)

폴리실리콘용 유동층 반응기에서 탄화규소의 내구성과 적합성 연구

최균(Kyoon Choi),서진원(Jin Won Seo),한윤수(Yoon Soo Hahn),손민수(Min Soo Son) 한국표면공학회 2014 한국표면공학회지 Vol.47 No.6

In order to utilize silicon carbide (SiC) as an inner part of fluidized bed reactor (FBR) for manufacturing poly-silicon, we have carried out the thermodynamic calculation on the overall reactions including poly-silicon synthesis and compatibility of SiC with FBR process. The resources of silicon included SiH₄(MS), SiHCl₃(TCS) and SiCl₄(STC) and the thermodynamic yield of the FBR with MS, TCS and STC were compared each other with variable range of temperature, pressure and hydrogen to silicon ratio. The silicon yield of MS, TCS and STC were 100%, 28% and 4%, respectively, throughout the conventional FBR conditions. Silicon carbide having high hardness and strength showed strong resistance to granule collisions during the FBR process using a lab-scale reactor. And it also showed quite good compatibility with the typical FBR processes of MS and TCS resources.

연소성 류마티스 관절염에 대한 임상적 고찰 (1.전신형)

김중곤 ( Joong Gon Kim ),정주영 ( Ju Young Jeong ),윤보영 ( Bo Young Yoon ),한윤수 ( Yoon Soo Hahn ) 대한류마티스학회 1994 대한류마티스학회지 Vol.1 No.2

Objective: To investigate the clinical manifestations and laboratory findings observed from the patients with systemic juvenile rheumatoid arthritis. Methods: Twenty three patients with systemic JRA who were diagnosed and treated at the Department of Pediatrics, Seoul National University Children`s Hospital from 1988 to 1993 were investigated for their clinical manifestations and laboratory findings. Results: 1) Boys were affected more prevalently than girls, as a ratio of 2: 1. 2) Sixty seven percent of patients were 3 to 6 years old at onset. 3) The clinical manifestations observed were high fever (100%), rash (78%), arthritis (96%), lymphadenopathy (45%), hepatomegaly (41 %), splenomegaly (30%), pericarditis (22%), pleuritis (22%), peritonitis (13%) and myalgia (100%), Arthritis occurred with the onset of systemic manifestations in 82% of patients and occurred 8 month later 3 cases in but in one case arthritis proceeded the systemic manifestations for 5 months. The arthritis mainly involved the large joints, knees (68%), ankles (59%), wrists (50%), elbows (32%) and shoulders (23%) and also involved small joints, fingers (27%) and toes (5%). The number of joints involved was four or fewer in 50% of patients and 5 or more in 50% of patients. The patterns of joint involvement were symmetric (77%) or asymmetric (23%). 4) The main laboratory findings observed were anemia (61%), leukocytosis (91%), thrombocytosis (65%), increased ESR (l00%), positive CRP(l00%), positive RF(13%) and positive ANA (9%), homogenous or speckled type. One patients gave the transient proteinuria. The histology of lymph nodes showed the follicular hyperplasia of interfollicular plasmocytosis, indicating the nonspecific reactive hyperplasia. The bone marrow showed granulocytosis, monocytosis or toxic granules. Conclusion: These data showed the clinical manifestations and laboratory findings of systemic juvenile rheumatoid arthritis in the Korean patients.

전신에 물집성 병변으로 나타난 과호산구 증후군

이혜영 ( Hye Young Lee ),김준기 ( Jun Ki Kim ),이지연 ( Ji Yeoun Lee ),김미경 ( Mi Kyeong Kim ),한윤수 ( Youn Soo Hahn ),윤태영 ( Tae Young Yoon ) 대한피부과학회 2014 대한피부과학회지 Vol.52 No.7

Hypereosinophilic syndrome is a multisystem disorder with unexplained persistent eosinophilia and marked preference for systemic organ involvement. More than half of all patients have cutaneous involvement, usually presenting as angioedema, urticarial lesions, and eczematous, pruriginous papules. Hypereosinophilic syndrome presenting with generalized cutaneous blisters is rare, and we report the findings of a patient who was successfully treated with interferon-α. (Korean J Dermatol 2014;52(7):486∼489)

소아에서 IL-10 유전자 단일염기유전자다형과 아토피 사이의 연관성

민소정 ( So Jung Min ),최성식 ( Sung Sik Choi ),허은희 ( Yin Ji Xu ),이근혜 ( Keun Hye Lee ),김헌 ( Heon Kim ),강종원 ( Jong Won Kang ),윤형진 ( Hyung Jin Yoon ),한윤수 ( Youn Soo Hahn ) 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 2005 소아알레르기 및 호흡기학회지 Vol.15 No.4

건강검진에서 발견된 폐결절에 대한 임상경과

최강현,박진우,한윤수 충북대학교 의과대학 충북대학교 의학연구소 2010 忠北醫大學術誌 Vol.20 No.1

연구목적 : 최근 건강검진에서 흉부 전상화단층촬영을 흔히 시행하면서 비석회화 폐결절의 발견이 증가하고 있다. 그러나 이들 폐결절이 여러 번의 추적검사에서 악성으로 밝혀지는 경우는 많지 않다. 따라서 이러한 폐결절에 대해 추적검사를 반드시 필요한 경우를 알아보고자 하였다. 대상 및 방법 : 2007년부터 건강검진을 받은 후 흉부 전산화단층촬영에서 비석회화 폐결절이 발견된 환자를 대상으로 폐결절의 위치, 크기 및 성상을 조사하였다. 추적 전산화단층촬영은 3,6,9,12 및 24개월 후로 계획하였고 폐결정의 변화를 알아보았다. 결과 : 대상환자는 모두 122명으로 남자 107명(87.7%), 여자 15명(12.3%), 이들의 평균연령은 53±10세이었고, 흡연자는 71명(85.2%)이었다. 폐결절이 1개인 경우는 62명(50.8%)으로 가장 많았고, 2개인 경우가 29명(23.8%), 3개인 경우가 12명(9.8%), 4개 이상인 경우가 19명(15.6%)이었다. 결절의 내무가 견고(solid)하며 경계가 분명(distinct)한 경우가 89례, 내부가 견고하지만 경계가 불분명(fuzzy)한 경우가 10례, 내부가 간유리형(ground-glass)이며 경계가 분명한 경우는 7례, 내부가 간유리형이며 경계가 불분명한 경우가 16례로, 내부가 견고하면서 경계가 분명한 경우가 가장 많았다. 흉부 전산화단층촬영상 비특이적이거나 양성으로 여겨지는 경우는 108(88.5%)이었고, 14명(11.54%)에서는 악성 또는 양성으로 구분할 수 없는 상태였다. 추적관찰은 116명(95.1%)에서 한번 이상의 추적 흉부 전산화단층촬영이 시행되었다. 추적관찰은 116명(95.1%)에서 한번 이상의 추적 흉부 전산화단층촬영이 시행되었다. 추적관찰의 기간은 평균 10.8±7.3개월이었다. 추적관찰 중에 5명(4.1%)에서는 결절이 완전히 소실되었고, 8명(6.6%)에서는 일부 호전되었고, 95명(77.9%)에서는 결절의 변화가 없었다. 2명(1.6%)에서는 한 개의 결절이 있었는데, 그 크기가 증가하였다. 3명(2.5%)에서는 결절수가 증가하였다가 다시 감소하였고, 또 다른 3명(2.5%)에서는 결절 수가 감소하였다가 다시 증가하였다. 크기가 증가한 결정 환자 3명 중 1명은 선암으로 판명되었고, 다른 한명은 폐결핵으로 진단되었다. 1년 이상 추적관찰을 한 48명의 환자 중, 처음 추정진단이 '비특이적 결절' 이거나 '양성 결절'인 경우에는 악성으로 진단된 환자는 없었다. 결론 : 건강검진시 발견된 폐결절 환자 중, 처음 추정진단이 '비특이적 결절' 또는 '양성 결절' 일 경우에는 반드시 추적검사가 필요하지 않을 수 있으나 더 대규모의 장기간 연구가 필요하다. Purpose : The number of patients with pulmonary nodules detected by computed tomography in general health evaluation has recently been increased. A very little portion of these patients, however, turned to have malignant nodule, and the rest of the patients had to be checked follow-up computed tomography repeatedly. This study was performed to evaluate any condition that avoid repeated tomography in these patients. Materials and Methods : Patients with noncalcified pulmonary nodules detected in general health evaluation were enrolled. Their symptoms, smoking history, location, size and nature of the pulmonary nodules were evaluated. Follow-up chest computed tomoraphy was checked after 3, 6, 9, 12 and 24 months later. Results : One hundred twenty-two patients (male:female, 107:15) were enrolled and their mean age was 53 ± 10 years. Seventy-one (85.2%) patients were smoker. Sixty-two (50.8%) patients had one nodule, 29 (23.8%) patients had 2 nodules, 12 (9.8%) patients had 3 nodules, and 19 (15.6%) patients had 4 or more nodules. The mean size of the biggest nodule in each patients is 5.7 ± 3.0mm. Solid nodules with distinct margin were most frequent. There was a tendency that solid nodules had distinct margin, whereas ground-glass nodules had fuzzy margin (p < 0.001). One hundred sixteen (95.1%) patients were followed-up at least once. In two patients, their nodules increased in size within 3 and 6 months. One was adenocarcinoma and the other was pulmonary tuberculosis. Among the patients who was followed-up over one year, no patients had malignant nodules. The patients with initial presumptive diagnosis as 'nonspecific' or 'benign' nodule, had no malignancy after one year. Conclusion : In 1.6% of patients, the pulmonary nodule increased in size within 6 months, one was adenocarcinoma, and the other was tuberculosis. In the patients with initial presumptive diagnosis as 'nonspecific' or 'benign' nodule on computed tomography, no nodule turned to be malignant. A longer and larger-scale study is needed.