미만성 간질성 폐질환의 경과에 따른 운동생리학적 지표의 변화

현인규(In Gyu Hyun),이재호(Jae Ho Lee),최동철(Dong Chul Choi),송재훈(Jae Hoon Song),정기석(Ki Suck Jung),김영환(Young Whan Kim),한성구(Sung Koo Han),심영수(Young Soo Shim),김건열(Keun Youl Kim),한용철(Yong Chol Han) 대한내과학회 1991 대한내과학회지 Vol.40 No.3

N/A To evaluate the physiologic derangement in patient's with diffuse interstitial lung disease, chest X-ray, spirometry including forced vital capacity and diffusing capacity and arterial blood gas analysis are used generally. But it is known that these parameters do not correlate well with the degree of pulmonary fibrosis or changes of clinical course. Although the diffusing capacity is most widely used in evaluating the changes of physiologic derangement as the disease progresses, the changes of physiologic parameters during exercise and the availability of these parameters in clinical follow-up are not well known, Chest X-ray, spirometry with forced vital capacity and diffusing capacity and incremental exercise test with arterial blood gas analysis at rest and maximal exercise were performed in 13 clinically improved patients with diffuse interstitial lung disease before and 3 months after treatment with corticosteroid. The changes of resting and exercise physiologic parameters were evaluated and the correlation of mean percent changes between each parameters was analyzed. 1) Radiologic score manifesting pulmonary involvement in chest X-ray after 3 months' treatment showed significant improvement in comparison with that of pre-treatment(p < 0. 01). 2) Among the parameters in resting state, FVC, FEV f and DLco/VA, showed significant increase (p<0.01), and DLco/VA, showed largest change. 3) In incremental exercise test, work duration, maximal minute ventilation, maximal oxygen uptake and the difference in oxygen uptake between rest and maximal exercise showed significant increase (p<0.05), but maximal work load, maximal breathing frequency, breathing reserve and heart rate reserve showed no significant difference. 4) PaO₂at rest and maximal exercise were increased significantly (p<0.05), but PaCO₂, at rest and maximal exercise showed no significant change. 5) VD/VT,, P(A-a), O₂and P(a.ET) CO₂at rest and maximal exercise were decreased, but there was no significant difference (p>0.05). The changes of PaO₂/ changes of oxygen uptake and the changes of P(A-a)O₂/ changes of oxygen uptake between rest and maximal exercise also showed no significant difference. 6) The changes of DLco/VA, correlated with that of resting PaO₂, and exercise PaO₂(p<0.01), and that of maximal oxygen uptake correlated with that of exercise PaO₂and exercise P(A-a)O₂(p<0,01). From the above findings, it seems that DLco/VA, is a most useful parameter at rest in evaluating the changes of physiologic derangement in patients with diffuse interstitial lung disease after treatment, and reflects the changes of PaO₂, at rest and maximal exercise, and the changes of exercise parameters failed to show any superiority to resting parameters in this study.

만성폐색성폐질환 환자의 임상적 분류에 따른 운동생리의 차이

정만표(Man Pyo Jeong),현인규(In Gyu Hyun),송재훈(Jae Hun Song),정기석(Ki Suk Chung),한성구(Sung Koo Han),심영수(Young Soo Shim),김건열,한용철(Yong Chol Han) 대한내과학회 1991 대한내과학회지 Vol.40 No.4

N/A While patients with chronic obstructive pulmonary disease can be divided into two clinical groups as Pink Puffers (PP) and Blue Bloaters (BB), and whether or not knowledge on the physiologic changes during exercise in PP or BB and their differences might be useful to document the pathophysiology of PP and BB has been in debate. To evaluate the differences in exercise performance and physiologic changes during exercise between the two groups, pulmonary function test at rest, arterial blood gas analysis before and after exercise and incremental exercise test with bicycle ergometer on 16 PP and 9 BB patients with the same degree of airway obstruction in the resting state were conducted. The results were as follows. 1) There was no differences in sex, age, smoking history, forced vital capacity (FVC), forced expiratory volume in one second (FEV₁) and FEV₁/FVC between the two groups. 2) The anaerobic threshold (AT) was significantly lower in the PP group (p<0.05), while FEV₁, was not different. 3) There were no differences in the resting ventilatory response to O₂consupmption (VE/Vo₂) and to CO₂production (VE/Vco₂) between the two groups, but VE/ Vo₂and VE/Vco₂at maximal exercise were significant- ly nigher in the PP group (p<0.01). The increase in minute ventilation according to work load increment (△VE/△work 1oad), △VE/△Vo₂VE/Vco₂, were all significantly higher in the PP group (p<0.05, p<0.01, p<0.001, respectively). 4) There was a good correlation between △VE/△Vo₂, and △VE/△Vco₂(r = 0.782, p<0.001) in all patients. From the above findings. it was suggested that the PP were not only more sensitive in ventilatory response to the changes in the work load, O₂, or CO₂than BB, but that they also had lower exercise performance, and the ventilatory sensitivities to O₂, and CO₂were closely correlated with each other in all patients. However further study would be necessary for the identification of the pathophysiologic mechanisms of chronic obstructive pulmonary disease.

만성 특발성 기침에 대한 흡입 스테로이드의 치료 효과

한보람 ( Bo Ram Han ),장승훈 ( Seung Hun Jang ),김유진 ( Yu Jin Kim ),박성훈 ( Sung Hoon Park ),황용일 ( Yong Il Hwang ),김동규 ( Dong Gyu Kim ),김철홍 ( Cheol Hong Kim ),현인규 ( In Gyu Hyun ),정기석 ( Ki Suck Jung ) 대한결핵 및 호흡기학회 2009 Tuberculosis and Respiratory Diseases Vol.67 No.5

Background: The discomfort caused by chronic cough, that is persistent for more than 3 weeks, causes a number of patients to seek medical attention. However, the underlying disorder often remains undetermined despite thorough examinations, and is considered to be idiopathic. This study compared the efficacy of inhaled corticosteroid with conventional cough suppressants on chronic idiopathic cough. Methods: Eligible patients with chronic idiopathic cough were randomly assigned to either the inhaled fluticasone group or the codeine plus levodropropizine oral administration group. The subjects in each group took their planned medication for 2 weeks. After the trial, comparative analyses of outcomes were performed in terms of the remnant cough (%) at the end of treatment, drug compliance, and adverse drug events. Results: Seventy-seven patients were enrolled in this randomized trial; 38 to the inhaled fluticasone group and 39 to the codeine plus levodropropizine group. The remnant cough was 41.0±35.8% in the inhaled fluticasone group, and 32.4±32.0% in the codeine+levodropropizine group (p=0.288). Drug compliance was 95.4±7.4% and 81.8±18.6% in the inhaled fluticasone and the codeine+levodropropizine group, respectively (p<0.001). Nine patients had adverse drug events in the codeine+levodropropizine group compared to one in the inhaled fluticasone group (p<0.001). Conclusion: Short-term inhaled corticosteroid is not inferior to conventional antitussive agents in controlling chronic idiopathic cough without significant adverse events.

흡입화상 치료과정에서 생긴 공동성 폐 병변

신현원 ( Hyun Won Shin ),김철홍 ( Cheol Hong Kim ),엄광석 ( Kwang Seok Eom ),박용범 ( Yong Bum Park ),장승훈 ( Seung Hun Jang ),김동규 ( Dong Gyu Kim ),이명구 ( Myung Goo Lee ),현인규 ( In Gyu Hyun ),정기석 ( Ki Suck Jung ),이일성 대한결핵 및 호흡기학회 2006 Tuberculosis and Respiratory Diseases Vol.60 No.5

Toxic gases and soot deposition as a consequence of smoke inhalation can cause direct injury to the upper and lower airways and even to the lung parenchyma. A delay in proper and prompt therapy can be detrimental to critically ill burn patients with an inhalation injury. Therefore, serial chest radiography is an important diagnostic tool for pulmonary complications during treatment. The radiographic findings of the chest include normal, consolidation, interstitial and alveolar infiltrates, peribronchial thickening, atelectasis, cardiogenic and non-cardiogenic pulmonary edema, and a pneumothorax as acute complications of smoke inhalation. In addition, bronchiectasis, bronchiolitis obliterans and pulmonary fibrosis can occur as late complications. We encountered a case of 44-year-old male who presented with acute lung injury after an inhalation injury. He required endotracheal intubation and mechanical ventilation due to respiratory failure. He was managed successfully with conservative treatment. Later, a cavitary lesion of the left upper lobe was observed on the chest radiography and computed tomography, which was complicated by massive hemoptysis during the follow-up. However, the cavitary lesion disappeared spontaneously without any clinical consequences. (Tuberc Respir Dis 2006; 60: 564-570)

방사선 폐렴의 임상적 특징

이재호(Jae Ho Lee),현인규(In Gyu Hyun),최동철(Dong Chul Choi),유철규(Chul Gyu Yu),송재훈(Jae Hoon Song),정기석(Ki Suck Jung),김영환(Young Whan Kim),한성구(Sung Ku Han),심영수(Young Soo Shim),김건열(Keun Yeol Kim),한용철(Yong Chul Han 대한내과학회 1991 대한내과학회지 Vol.40 No.3

N/A Radiation pneumonitis is one of the most important early complication of radiation therapy. In order to examine whether or not the increasing in patients suffering from concurrent COPD and Lung Ca, and to study clinical features of radiation pneumonitis, the writers conducted a retrospective study on 60 patients with proven lung cancer who underwent radiation therapy during the period from 1985 to 1988 and had their PFT performed before the radiation and obtained the following results; 1) Non productive cough was the most frequent clinical symptom of radiation pneumonitis and dyspnea, whitish sputum, chest tightness, mild fever was also present. The clinical symptom was not related to radiation dose, initial time of pneumonitis, PFT, age but was more serious in the patients with FEV1/FVC more than 70%. 2) Radiation pneumonitis occurred most frequently between the period of 4 weeks and 12 weeks and onset time of radiation pneumonitis was not related to the radiation dose, PFT, age, 3) Chest X-ray showed alveolar, alveolar-interstitial mixed, interstitial pattern, fibrosis confined to radiation field and changed with time. 4) There was no significant difference between FEV1, FVC, FEV1/FVC and incidence of radiation pneumonitis but in patents with FEV1/FVC more then 70%, there was significantly higher incidence of radiation pneumonitis. 5) The incidence of radiation pneumonitis was increased as radiation dose was increased.

십이지장과 공장으로 전이된 원발성 편평성 폐암종

이문희(Moon Hee Lee),홍성표(Sung Pyo Hong),현인규(In Gyu Hyun),이진(Jin Lee),손주현(Joo Hyun Sohn),곽상택(Sang Taek Kwak),주상언(Sang Aun Joo),김이수(Lee Su Kim),최원진(Won Jin Choi),최철순(Choi Chul Soon) 대한소화기학회 1994 대한소화기학회지 Vol.26 No.1

Benign and malignant tumors are rarely encountered in the small intestine. Moreover small bowel metastases arising from the lung carcinoma are very unusual. Previous studies reported that the most common metastatic site of lung carcinoma was the esophagus and the most common histologic type was the squarnous cell carcinoma type. This case was duodenal and jejunal metastases from squamous cell carcinoma of the lung. The patient in this case com- plained of hematemesis and presence of movable mass in the lower left abdomen. N odular ul- cerative mass on the duodenal bulb was found by duodenoscopy, and an endoscopic biopsy re- vealed squamous cell carcinoma. A bronchoscopic biopsy determined squamous cell carcinoma of the lung. Abdominal exploration confirmed multiple metastases on duodenum, two sites of jejunum and Douglas pouch. So we report the case of multiple small bowel metastases from primary squamous lung carcinoma. (Korean J Gastronterol 1994; 26: 191 196)

원발성 쇼그렌 증후군(Primary Sj$\ddot{o}$gren's Syndrome) 환자에서 발생한 Bronchus-Associated Lymphoid Tissue(BALT) 림프종 1례

강민종,이재명,이승준,손지웅,김동규,이명구,현인규,정기석,Kang, Min-Jong,Lee, Jae-Myung,Lee, Seung-Joon,Son, Jee-Woong,Kim, Dong-Gyu,Lee, Myung-Goo,Hyun, In-Gyu,Jung, Ki-Suck 대한결핵및호흡기학회 2002 Tuberculosis and Respiratory Diseases Vol.52 No.2

원발성 쇼그렌 증후군 (Primary Sj$\ddot{o}$gren's syndrome) 환자에서 폐에 발생하는 Bronchus-associated lymphoid tissue(BALT) 림프종은 드문 질환이다. 본 환자는 49세 여자 환자로 5년 전부터 안구 건조증 및 구강 건조증이 점차 진행하였으나 그냥 지내던 중 2년 전부터 운동시 호흡곤란 및 전신 무력감이 계속 진행하여 본원에 입원하였다. 흉부청진상 호흡음이 거칠게 들렸으며 양측 폐야 전체에 걸쳐 흡기시 악 설음이 관찰되었다. 형광항핵항체시험 (FANA)이 양성으로 "speckled pattern"을 보였으며 anti-SSA(Ro) Ab 및 anti-SSB(La) Ab는 강양성 소견을 보였다. 단순 흉부 방사선 사진 상 양측 폐에서 미만성의 망상 결절성 음영 증가가 관찰되었으며 고해상도 흉부 컴퓨터 단층촬영상에서 양측 폐에 걸쳐 미만성 분포를 보이는 모자이크 양상의 비균질성 감쇠 (mosaic pattern of inhomogeneous attenuation) 소견이 관찰되었다. 경기관지 폐 조직 생검상 림프구의 침윤이 관찰되었고 개흉 폐 생검술을 이용하여 얻은 폐조직의 병리 소견에서 'low grade marginal zone B cell lymphoma of BALT(bronchus associated lymphoid tissue) type'에 합당한 소견을 얻어 원발성 쇼그렌 증후군 (Primary Sj$\ddot{o}$gren's syndrome) 환자에서 폐에 발생한 Bronchus-associated lymphaid tissue(BALT) 림프종으로 확진되었다. A bronchus-associated lymphoid tissue(BALT) lymphoma of the lung is a rare disorder of patients with Sj$\ddot{o}$gren's syndrome. A 49-year-old woman was admitted for an evaluation of exertional dyspnea and general weakness which had persisted for two years. The patient had suffered from dry mouth and dry eyes for five years. The physical examinations showed a coarse breath sound with inspiratory crackles on the whole lung field, particularly on the both basal lungs. The laboratory data disclosed high titers of anti-nuclear antibodies, and anti-SSA (Ro), and anti-SSB (La) antibodies. Chest radiographs demonstrated the presence of bilateral, diffuse, reticulonodular densities in both lungs. Thin-section CT scans showed diffusely distributed mosaic pattern of an inhomogeneous attenuation extending over the entire lung zone. The histological findings from an open-lung biopsy specimen revealed an accumulation of lymphoid cells around the bronchioles and an extension of malignant lymphoma cells from the bronchiolar epithelium toward the alveolar space. Immunohistochemically, the neoplastic cells reacted positively to the CD 20 antigen and were focally positive for the UCHL 1 antigen. The histological diagnosis was consistent with a low grade marginal zone B-cell lymphoma originating in the BALT. Here, we present a case of a histologically proven BALT lymphoma of the lung in a patient with primary Sj$\ddot{o}$gren's Syndrome.

폐결핵에서 객담 결핵균 중합효소 연쇄반응 검사의 누적 양성율

경태영(Tae Young Kyong),이준호(Jun Ho Lee),채경수(Gyeong Soo Chae),김동규(Dong Kyu Kim),모은경(Eun Kyung Mo),박명재(Myung Jae Park),이명구(Myung Goo Lee),현인규(In Gyu Hyun),남기형(Ki Hyung Nam),이경화(Kyung Wha Lee),정기석(Ki Suck J 대한내과학회 1998 대한내과학회지 Vol.55 No.6

N/A Objectives: The conventional methods such as smear or culture of Mycobacteria have been proved either low sensitivity and specificity or time-consuming. Polymerase chain reaction(PCR) is a rapid and sensitive alternative method to diagnose mycobacterial infection. We investigated the positive rate of sputum PCR for Mycobacterium tuberculosis by consecutive tests for its application in clinical practice. Methods: Sputum AFB smear, culture and serial AFR PCR test were performed in all patients who were suspected of pulmonary tuberculosis, Among them, 128 patients with positive sputum PCR test were enrolled from January 1996 through March 1997. The diagnostic criteria of pulmonary tuberculosis were sputum AFB smear positive, culture positive or pathologically proven granuloma. TB-CR TM kit (Bioneer, seoul, Korea), which amplifies insertion sequence(IS6110) of Mycobacterium tuberculosis complex, was used for sputum AFB PCR. Results: Of 128 patients, active pulmonary tuberculosis were 107 (male:74, female:33, mean age:48.9 year). Cumulative positive rate of sputum AFR PCR test was 89% at 1st test, 95% at 2nd test, 98% at 3rd test and 100% at 4th test. The sensitivity of sputum PCR, smear and culture was 98.0%(105/107), 85.0%(91/107) and 82.8%(77/107), respectively. The positive predictive value of sputum PCR was 83.6%(107/128). There were 21 patients who showed positive PCR test did not meet the diagnostic criteria of active tuberculosis. They had old tuberculosis with destroyed lung, history of anti-tuberculous medication(9/21), extrapulmonary tuberculosis (6/21) and other diseases(6/21). Conclusion: Sputum PCR test is a sensitive diagnostic tool in early diagnosis of pulmonary tuberculosis when it has been performed serially, we recommend at least 2 consecutive PCR test to achieve the sensitivity of 95%.

의과대학생의 청진 교육에 있어서 멀티미디어 이용의 효과

박명재(Myung Jae Park),이명구(Myung Goo Lee),김동규(Dong Kyu Kim),모은경(Eun Kyung Mo),현인규(In Gyu Hyun),정기석(Ki Suck Jung) 대한내과학회 1998 대한내과학회지 Vol.54 No.6

N/A Background: Auscultation of lung sound is a fundamental component of physical examination of respiratory disease. It is difficult to teach lung sound to the medical student because of the observer variability and the lack of objective recording in auscultation. Multimedia education has became available in many fields due to rapid development of computer and its software. So we made multimedia program to teach the lung sound and evaluated the effect of this program on the self study of the lung sound hy medical students. Method: We developed the multimedia title Auscultation of lung sound by integrating lung sounds, wave form display, radiographic findings and some explanations about various lung sounds including normal and abnormal lung sounds. Thirty students attending in the 2nd year of Medical school at the Hallym University was randomly divided into two groups. Each group studied on their own using either tape or multimedia title for one week. After the study, they were tested to describe the lung sound of real patients who were admitted to the Chun Cheon Sacred Heart Hospital. Multimedia group was asked to answer the questionnaire on multimedia title. Results: 1) Test score of auscultation on real patients The mean score of tape group and multimedia group was 1.20±1.08 and 1.54±0.74 respectively. But there was no significant difference between two groups (P=0.34). 2) Summary of questionnaire Twelve out of 15(80%) students answered that multimedia title helped them to understand the lung sound and three students (20%) answered that this program was very helpful. For the visual display of wave form, eight out of 15 (34%) students answered that it was helpful and three out of 15 (34%) students answered that it was very helpful. Eighty seven percent of the students answered that visual display of sound wave form helped them to understand the lung sound. Fourteen out of 15 students answered that multimedia program was interesting and provocative, All student answered that they will recommend this title to other colleagues. Conclusion: Even though there was no stastical significant difference between two self study methods but student of multimedia group showed narrow range of score than tape group. Answer to the questionnaire sup- ported the usefulness of multimedia for the self study of lung sound. Therefore we conclude that this program is helpful in the self-learninig of lung sound for medical students.

과호산구증가증을 동반한 Sézary 증후군

이윤찬 ( Yoonchan Lee ),심경아 ( Gyeongah Sim ),김병수 ( Byung-su Kim ),현정원 ( Jungwon Hyun ),김현철 ( Hyunchul Kim ),백문성 ( Moon Seong Baek ),김철홍 ( Cheol-hong Kim ),현인규 ( In-gyu Hyun ),최정희 ( Jeong-hee Choi ) 대한천식알레르기학회(구 대한알레르기학회) 2021 Allergy Asthma & Respiratory Disease Vol.9 No.2

The Sézary syndrome is a leukemic form of cutaneous T-cell lymphoma characterized by the presence of erythroderma covering at least 80% of the body-surface area, lymphadenopathy, and the presence of clonally related neoplastic T cells with cerebriform nuclei (Sézary cells) in the blood, skin, and lymph nodes. Hypereosinophilia can be caused by hematologic malignancy with clonal abnormality, which is often associated with Sézary syndrome. Sézary syndrome has rarely been reported in Korea. However, hypereosinophilia in the Sézary syndrome has not been reported in Korea. Here, we report a case of 75-year-old man with hypereosinophila, erythroderma, and cutaneous T-cell lymphoma which was finally diagnosed as Sézary syndrome. (Allergy Asthma Respir Dis 2021;9:93-98)