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결핵성 흉막염에서 초감염 결핵과 재발성 결핵의 임상 양상
홍구현 ( Koo Hyun Hong ),임상수 ( Sang Soo Lim ),신재민 ( Jae Min Shin ),박재석 ( Jae Seuk Park ) 대한결핵 및 호흡기학회 2006 Tuberculosis and Respiratory Diseases Vol.61 No.6
연구배경: 결핵성 흉막염은 대부분 초감염 결핵의 형태로 발생하는 것으로 알려져 왔다. 그러나 최근 결핵환자가 감소함에 따라 초감염 결핵보다 재발성 결핵으로 결핵성 흉막염이 발생하는 경향이 늘고 있다. 대상 및 방법: 2003년 1월부터 2006년 2월까지 단국대학교병원에서 결핵성 흉막염으로 진단받은 환자들의 과거력과 방사선 소견에 따라 초감염 결핵과 재발성 결핵으로 분류하고 두 군 사이에 임상 소견, 방사선 소견, 그리고 6 개월 동안 항결핵 약물치료 후 잔여 흉막비후에 있어서 차이가 있는지 알아보았다. 결과: 1. 결핵성 흉막염 환자 141명 중에서 135명에서 초감염 결핵과 재발성 결핵의 구분이 가능하였는데 초감염 결핵의 소견을 보인 환자는 38명(28%), 재발성 결핵의 소견을 보인 환자는 97명(72%)으로 재발성 결핵의 소견을 보이는 환자가 더 많았다. 2. 초감염과 재발성 결핵 환자 사이에서 성별, 나이, 증상의 발현 시작부터 흉수검사까지의 기간, 진단 시의 흉수의 양, 흉수 총백혈구수, 림프구수, LDH, ADA 수치에 있어서 유의한 차이가 없었다. 3. 6개월 이상 추적관찰이 가능하였던 124명의 환자들의 잔여 흉막비후의 정도에 있어서 초감염 결핵과 재발성 결핵 사이에 차이가 없었다. 결론: 결핵성 흉막염 환자 중에서 초감염 결핵보다 재발성 결핵의 소견을 보이는 환자가 더 많았으며 두 군 사이에 임상 소견, 방사선 소견, 흉수 소견에서 유의한 차이가 없었으며, 6개월 치료 후의 잔여 흉막비후의 정도에 있어서도 유의한 차이가 없었다. Backgroud: Traditionally, tuberculous pleurisy has been known to largely develop as primary tuberculosis. However, as the incidence of tuberculosis decrease, recent studies have shown reactivation tuberculosis has become the main cause of tuberculous pleurisy. Methods: 141 cases of tuberculous pleurisy, between January 2003 and February 2006, at the Dankook university hospital, were retrospectively studied. The patients were divided into primary and reactivation tuberculosis, based on the history and radiological characteristics, and the clinical, radiological characteristics at the time of diagnosis and residual pleural thickening after 6 month of chemotherapy were compared between the two groups. Results: 1. Of the 141 tuberculous pleurisy cases, in 135 it was possible to differentiate between primary and reactivation tuberculosis. 2. Of the 135 tuberculous pleurisy cases, 38 (28%) showed a primary tuberculosis pattern, and 98 (72%) showed a reactivation tuberculosis pattern. 3. There were no significant differences between primary and reactivation tuberculosis in relation to age, sex, duration of symptom, amount of pleural effusion, pleural fluid WBC, lymphocyte count, and level of protein, LDH and ADA at the time of diagnosis 4. 124 patients were followed for 6 months after diagnosis of tuberculous pleurisy, and there was no significant difference in the residual pleural thickening between primary and reactivation tuberculosis. Conclusion: In South Korea, a reactivation disease is currently a more common cause of tuberculous pleurisy than a primary disease. There was no difference in the clinical characteristics between primary and reactivation tuberculosis. (Tuberc Respir Dis 2006; 61: 526-532)
림프구활성화시험으로 확인된 methazolamide에 의한 독성표피괴사융해 1예
한규형 ( Kyu-hyung Han ),홍구현 ( Ku-hyun Hong ),김도형 ( Doh Hyung Kim ),김윤섭 ( Youn Seup Kim ),박재석 ( Jae-suk Park ),김승현 ( Seung-heon Kim ),지영구 ( Young-koo Jee ) 대한천식알레르기학회(구 대한알레르기학회) 2016 Allergy Asthma & Respiratory Disease Vol.4 No.4
Among various dermatological entities, toxic epidermal necrolysis (TEN) is a rare but potentially fatal delayed hypersensitivity reaction to numerous medications. A 38-year-old male presented with systemic hypersensitivity reaction, such as high fever, pain in the eyes, and diffuse pruritic erythematous maculopapular eruptions with multiple targetoid plaques that became vesicular and bullous. Oral mucosa and conjunctivae were involved. The first sign appeared about 1 week after taking methazolamide (50 mg twice a day) for the management of glaucomatous eyes. Although methazolamide was discontinued, blistering and skin denudation progressed to affect up to 80% of the body surface area and a positive Nikolsky sign was noted. High fever also persisted. Skin lesions started to improve after 2 weeks of management and fever subsided. Cutaneous lesions improved with minimal permanent sequele 2 months later. HLA-B*5901 was found by high-resolution genotyping. The lymphocyte activation test performed 6 months after r mission showed a positive response to methazolamide challenge. This is the first case of methazolamide-induced TEN in which methazolamide was confirmed as a culprit drug by the lymphocyte activation test. (Allergy Asthma Respir Dis 2016:4:301-304)
PET/CT로 혈전증과 감별된 원발성 폐동맥 육종 1례
임상수 ( Sang Soo Lim ),홍구현 ( Koo Hyun Hong ),신재민 ( Jae Min Shin ),김윤섭 ( Youn Seup Kim ),지영구 ( Young Koo Jee ),명나혜 ( Na Hye Myoung ),박석건 ( Seok Gun Park ),박재석 ( Jae Seuk Park ) 대한결핵 및 호흡기학회 2007 Tuberculosis and Respiratory Diseases Vol.62 No.3
Primary pulmonary artery sarcoma is a rare malignant tumor arising from the pulmonary artery. Diagnosis of primary pulmonary artery sarcoma is quite difficult and the conditon is often misdiagnosed as a more common disease, such as a pulmonary embolism. PET can help in diagnosing a pulmonary artery sarcoma due to the increased uptake of 18F-FDG in the area of the tumor. However, the poor anatomic resolution of PET has limited its clinical applications in pulmonary vascular disease. The recently developed PET/CT is the fusion of PET and CT that improves the anatomical resolution of PET. We report a case of a primary pulmonary artery sarcoma mimicking a pulmonary embolism that was diagnosed with PET/CT and confirmed with a surgical resection. (Tuberc Respir Dis 2007; 62: 232-236)
말초혈액단핵구에서 아토피에 따른 GATA-3, c-maf, T-bet의 발현차이
신재민 ( Jae Min Shin ),임상수 ( Sang Su Lim ),홍구현 ( Gu Hyun Hong ),이호연 ( Ho Yeon Lee ),김남의 ( Nam Eui Kim ),지영구 ( Young Koo Jee ) 대한천식알레르기학회 2007 천식 및 알레르기 Vol.27 No.2
Background & Objective: GATA-3 and T-bet are now considered as master transcriptional factors involving Th cell differentiation, but the roles of these factors are still uncertain in vivo. The study was to investigate the expression of these transcription factors in the peripheral blood mononuclear cells (PBMC) according to atopic status. Method: PBMCs were obtained from non-atopic controls, atopic controls, allergic rhinitis patients, atopic asthmatics, and non-atopic asthmatics. PBMCs were cultured for 48 hours, and then 12-o-tetracanoylphorbol-13-acetate (PMA) and calcium ionophore (ionomycin) were added. Expressions of mRNA of cytokines, GATA-3, c-maf and T-bet were measured by RT-PCR. Result: T-bet was expressed higher in the non-atopic controls that in the other groups. GATA-3 was expressed higher in the atopic controls, allergic rhinitis patients and atopic asthmatics, but lower in the non-atopic controls. Non-atopic asthmatics showed similar levels of expression of T-bet with atopic asthmatics, but significantly lower level of expression of GATA-3 than atopic groups. Conclusion: This study suggest that transcription factors, especially GATA-3, reflect or may be related to atopic status. (Korean J Asthma Allergy Clin Immunol 2007;27:90-97)
자동차 천정 성형 공장에서 발생한 Methylenediphenyl Isocyanate에 의한 직업성 천식 2예
양주연 ( Ju Yeon Yang ),정인국 ( In Kook Jeong ),임상수 ( Sang Su Lim ),홍구현 ( Gu Hyun Hong ),신재민 ( Jae Min Shin ),노상철 ( Sang Chul Rho ),김윤섭 ( Youn Seup Kim ),박재석 ( Jae Seuk Park ),지영구 ( Young Koo Jee ) 대한천식알레르기학회 2006 천식 및 알레르기 Vol.26 No.4
Since isocyanate-induced occupational asthma (OA) was first reported about 50 years ago, the first case of methylenediphenyl isocyanate (MDI)-induced OA was reported in 1973. Although toluene diisocyanate (TDI)-induced OA is the most common OA, MDI-induced asthma has been very rarely reported in Korea. Here we report two cases of MDI-induced OA developed in the molding lining of automobile industry. Two patients who had worked at the molding lining using MDI for several years presented with cough and dyspnea. The metacholine bronchial provocation tests of two patients were positive (PC20 : 1.51 mg/mL and PC20 : 1.28 mg/mL, respectively). The bronchial provocation tests with MDI showed early response. MDI aerosol was generated by heating MDI to 100℃ with heat block. Skin prick tests were all negative to common inhalent allergens and MDI. The level of serum total IgE was within the normal range. They are now well-controlled state with persistent medication and changes of working place in the same company. (Korean J Asthma Allergy Clin Immunol 2006;26:314-317)