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소아천식 환자에서 충격진동법과 폐활량기로 측정한 소기도 장애와 호기산화질소와의 관계
서보선 ( Bo Seon Seo ),이정민 ( Jeong Min Lee ),조은혜 ( Eunhae Cho ),백지현 ( Ji Hyeon Baek ),이경석 ( Geong Suk Lee ),신윤호 ( Youn Ho Shin ),지혜미 ( Hye Mi Jee ),정영호 ( Yong Ho Jung ),한만용 ( Man Yong Han ) 대한천식알레르기학회 2015 Allergy Asthma & Respiratory Disease Vol.3 No.4
Purpose: Fractional exhaled nitric oxide (FeNO) is a maker of airway inflammation, and impedance of low frequency in the impulse oscillometry system (IOS) reflects small-airway obstruction. We investigated the association of the FeNO level with IOS parameters and spirometry results in asthma patients. Methods: Fifty-eight children with asthma (60.3%, male), mean age 8.3 years (range, 4.5.16.0 years), were enrolled in the study. Reactance and resistance at 5 Hz with IOS, forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and forced expiratory flow 25%.75% of the vital capacity (FEF25%-75%) with spirometry and FeNO were measured in all patients. The Z-score of spirometry and IOS parameters and the mean level of FeNO were used for correlation and regression analysis. Results: FeNO was not significantly associated with height, age, or other demographic parameters. There was a statistically significant correlation between spirometry results and IOS measurements. The FeNO level was not significantly correlated with IOS variables. After adjusting for height, sex, atopic status, and the use of inhaled corticosteroid, the FeNO level showed significant correlations with Z-score of FEV1/FVC (P=0.037, adjusted R2=0.234). Conclusion: FeNO was significantly correlated with Z-scores of FEV1/FVC, but not with IOS variables. Therefore, FeNO may be used to detect whole airway obstruction, but not small-airway obstruction. (Allergy Asthma Respir Dis 2015;3:267-271)
임신성 당뇨 선별검사에서 양성이었으나 확진되지 않은 산모에서 태어난 후기 미숙아들의 예후
이정민 ( Jeong Min Lee ),서보선 ( Bo Seon Seo ),김은선 ( Eun Sun Kim ) 대한주산의학회 2015 Perinatology Vol.26 No.3
Purpose: The aim of the study is to determine whether late preterm infants from normal oral GTT (glucose tolerance test) but positive GCT (glucose challenge test) mothers are associated with adverse postnatal outcome. Methods: A retrospective study was performed from singleton infants who were born at 34+0-36+6 weeks between January 2008 and December 2012 and prenatally checked at CHA Gangnam Medical Center. Infants were categorized into three groups according to the results of 50 g oral GCT and 100 g oral GTT; NG group (normal glucose tolerance group, n=603) vs. GIG group (gestational impaired glucose tolerance group; infants of normal oral GTT but positive GCT mothers, n=77) vs. GDM group (gestational diabetes group, n=52). Neonatal outcomes were compared among the three groups. Results: GIG group showed significantly increased incidence of jaundice compared to NG group (9.6% vs. 19.5%, P=0.031). The number of old mothers (≥35 years at delivery) was significantly higher in GIG group compared to NG group (27.5% vs. 33.8%, P=0.006). After stratification by maternal age, GIG group showed significantly increased respiratory diseases compared to NG group (44% vs. 65.4%, P=0.04). Hypocalcemia and feeding problem increased across the groups (NG vs. GIG vs. GDM; 13.3% vs. 26.9% vs. 32.0%, P= 0.024; 6.0% vs. 11.5% vs. 20.0%, P=0.05, respectively). Conclusion: Late preterm infants of normal oral GTT but positive GCT mothers, especially in older mother, have increased risk of postnatal morbidities such as respiratory distress, jaundice, hypocalcemia or feeding intolerance. Thus, careful follow up may be needed in this group since antepartum period.
신생아기에 비특이적 증상으로 발현된 선천성 횡격막 탈장 2례
이정민 ( Jeong Min Lee ),서보선 ( Bo Seon Seo ),조희승 ( Heui Seung Jo ),정수민 ( Soo Min Jung ),조기현 ( Kee Hyun Cho ),이규형 ( Kyu Hyung Lee ) 대한주산의학회 2015 Perinatology Vol.26 No.3
Most of the congenital diaphragmatic hernia (CDH) cases are diagnosed at prenatal period or immediately after birth with severe respiratory symptom. The classic triad, which is respiratory distress, apparent dextrocardia and a scaphoid abdomen, is usually seen in this period. Several case reports have described older infants and children with a wide spectrum of symptoms of CDH, whereas extremely few cases were reported in neonatal period except classic triad such as straungulation of the bowel. These atypical manifestations can lead physician to delayed diagnosis. We report two cases of CDH newborns. First case was diagnosed with pneumoperitoneum following tension pneumothorax, transient diaphragm eventration on 5 days after birth. The other case was diagnosed with failure to thrive and mediastinal mass on 30 days after birth. These cases suggest physicians to consider CDH in late newborn period with pneumoperitoneum following tension pneumothorax, transient diaphragm eventration, failure to thrive, and mediastinal mass.
기관지확장제 반응 검사에서 속효성 기관지확장제 투여 용량의 차이가 소기도 반응도에 영향을 줄까?
백지현 ( Ji Hyeon Baek ),장호민 ( Homin Jang ),전유훈 ( You Hoon Jeon ),서보선 ( Bo Seon Seo ),이승진 ( Seung Jin Lee ),지혜미 ( Hye Mi Jee ),이경석 ( Kyung Suk Lee ),정영호 ( Young-ho Jung ),신윤호 ( Youn Ho Sheen ),한만용 ( Man 대한천식알레르기학회(구 대한알레르기학회) 2016 Allergy Asthma & Respiratory Disease Vol.4 No.4
Purpose: It is recommended to use 200 (2 puffs) or 400 (4 puffs) μg of salbutamol in the bronchodilator response (BDR) test. We aimed to compare the difference between these 2 doses with regard to small airway dysfunction.Methods: One hundred sixteen subjects who visited the hospital for diagnosis or follow-up of asthma were consecutively enrolled between June 1 and November 31, 2013. The subjects were randomly assigned to the BDR test at the 2 doses (200 or 400 μg of salbutamol), with physicians blinded to the group each subject was assigned to and undertook the BDR test using the spirometry and impulse oscillometry system (IOS).Results: A total of 116 subjects participated in this study; the mean age was 7.8±3.6 years. The number of participants who were assigned to 2 and 4 puffs groups was 59 and 57, respectively. The mean age was older in the 4 puffs group than in the 2 puffs group (P=0.008). There were no significant difference in spirometric and oscillometric parameters between the 2 and 4 puffs groups. However, in subgroup analysis of asthmatic patients on maintenance therapy (n=21), there was a significant difference in relative changes in Rrs5 between the 2 and 4 puffs groups (16.4%±9.6% vs. 28.7%±8.8%, P=0.035). The forced expiratory volume of 1 second showed a significant correlation with resistance in the 2 puffs group and with reactance in the 4 puffs group.Conclusion: There was a significant relationship between the amounts of bronchodilators administered and the small airway dysfunction in children with asthma on maintenance therapy. Further research is warranted to delineate changes in spirometric and IOS measures in accordance with the different amounts of bronchodilators administered. (Allergy Asthma Respir Dis 2016:4:284-289)