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알레르기 진단에 있어서 morphine 피부단자시험의 임상적 가치
박석채,강광원,최인선 대한알레르기학회 1999 천식 및 알레르기 Vol.19 No.3
Background: Few studies have demonstrated an enhanced skin responsiveness to opiates in atopic subjects. Objective: To determine whether the skin response to morphine is increased in atopics and to assess the clinical usefulness of morphine skin prick test in diagnosis of allergic diseases. Method: Allergy skin prick tests were performed using 55 common allergens, histamine, and morphine in 158 patients with allergic diseases. Results: Wheal and flare sizes for morphine (1mg/mL) were significantly related to and smaller than those for histamine (1mg/mL). Although the proportion of subjects with allergic rhinitis and the level of serum total IgE were not different between responders (wheal >- 2mm) and nonresponders to morphine, the positive response rate to allergens was significantly lower in nonresponders. The flare sizes for morphine were significantly higher in positive allergen test group (A/H ratio >- 0.5). Among positive allergen test group, the subjects with atopy score >- 5 showed a larger flare size for morphine than those with atopy score < 5 while the sizes for histamine were not different. Conclusion: Morphine skin prick test is helpful for detecting false negative responses to allergens, and morphine skin test responses are increased in highly atopic patients probably due to enhanced mast cell releasability.
비이온성 방사선 조영제 iopromide (Ultravist (R)) 에 의한 아나필락시양 반응을 보인 1 례
조상희,박석채,최인선,박창민,명보현 대한알레르기학회 2001 천식 및 알레르기 Vol.21 No.4
Because the risk of adverse reactions is lower with nonionic radiocontrast media than with conventional ionic agent, it is recommended that high-risk patients receive lower osmolality, a nonionic radiocontrast for their examination. However, the occurrence of a severe, life-threatening anaphylactoid reaction to even a small dose of nonionic radiocontrast has been reported. We report the first case in Korea of near-fatal anaphylactoid reaction to a nonionic contrast media. A 21-year-old lady with an abdominal mass due to benign mucinous cystadenoma received an injection of iopromide (UltravistR) for abdominal computerized tomogram. Two minutes after the injection, perioral swelling and erythema, vomiting, seizure, and cardiopulmonary arrests deve- loped. Immediate cardiopulmonary resuscitation and administrations of antihistamine, steroid, and sympathomimetics were performed with successful recovery. She had a history of allergic rhinitis and showed mild airway hyperresponsiveness on histamine bronchoprovocation test. Since a pretreatment with corticosteroid & antihistamine regimen in addition to use of nonionic agent helped to reduce the further occurrence of anaphylactoid reactions in previous contrast reactors, this near-fatal anaphylactoid reaction in an atopic individual suggests that a use of pretreatment plus nonionic agent is desirable in all patients with atopy or asthma.
결핵성 및 비결핵성 흉막삼출액에서 TNF-$\alpha$ 농도의 진단적 의의
나현주,박석채,강광원,박형관,김영철,최인선,박경옥,Na, Hyun-Joo,Park, Seog-Chea,Kang, Kwang-Won,Park, Hyeong-Kwan,Kim, Young-Chul,Choi, In-Seon,Park, Kyung-Ok 대한결핵및호흡기학회 1997 Tuberculosis and Respiratory Diseases Vol.44 No.3
연구배경 : 결핵성 흉막염의 감별 진단 목적으로 널리 이용되고 있는 검사는 adenosine deaminase와 INF-$\gamma$를 세포성 면역에 또다른 중요한 매개체로 알려진 TNF-$\alpha$의 진단적 의의를 조사하고, 현재 임상에서 유용한 지표로 사용되고 있는 adenosine deaminase와의 감별력을 비교하고자 본 연구를 시행하였다. 방 법 : 삼출성 흉막염 80예(결핵성 : 39예, 암성 : 31예, 부폐렴흉막염 : 10예)를 대상으로 흉수의 기본적인 세포조성, 화학 검사와 더불어 ADA와 TNF-$\alpha$(Medgenix IRMA kit)를 측정하였다. 결 과 : 흉수내 ADA농도는 결핵성 흉막염에서 $48.7{\pm}32.7U/L$로 비결핵성 흉막염 $26.0{\pm}41.3U/L$에 비해 유의한 차이로 높았고(p < 0.05), TNF-$\alpha$치 또한 결핵성 흉막염에서 $184.1{\pm}214.2pg/mL$로 비결핵성 흉막삼출액 $44.1{\pm}114.2pg/mL$에 비해 유의하게 높았다(p < 0.01). ROC 곡선을 이용하여 ADA와 TNF-$\alpha$의 감별력을 가장 높일 수 있는 기준치를 정하였을 때, ADA는 30U/ml, TNF-$\alpha$는 15pg/ml로 측정되었고, 각각의 기준치를 이용하여 감수성과 특이도를 구하였을때, ADA는 감수성 66.7%, 특이도 85.0%, TNF-$\alpha$는 감수성 69.2% 특이도 87.1%를 보였다. 두 검사의 민감도와 특이도를 비교하기 위한 ROC 곡선에서, ROC 곡선아래의 면적(area under curve)은 ADA와 TNF-$\alpha$사이에 유의한 차이가 없었다(ADA 0.83, TNF-$\alpha$ 0.82). 다중회귀분석(multiple stepwise regression)에서 ADA가 가장 유용한 지표로 계산되었으나 TNF-$\alpha$의 추가가 분별력에 더 이상의 기여함은 없었다. 결 론 : 결핵성 흉막염과 비결핵성 흉막염을 감별 진단하는데 ADA와 함께 TNF-$\alpha$도 유용한 지표로 이용될 수 있으나 두가지 검사를 함께 시행함에 따른 진단에 있어서의 잇점은 없었다. Objectives : The differentiation of tuberculous effusion from the other causes of exudative pleural effusion remained difficult even with aids of biochemical analyses and pleural biopsy. As the pathophysiology of tuberculous pleural effusion is an enhanced cell mediated immunity, Adenosine deaminase(ADA) and various eytokines including Inteferon-$\gamma$, tumor necrosis factor alpha(TNF-$\alpha$) are considered as useful diagnostic tools in differentiating exudative pleural effusion. The author would like to demonstrate the diagnostic usefulness of TNF-$\alpha$ in the differentiation of exudative pleural effusion, and compared the discriminating ability of TNF-$\alpha$ with ADA. Methods : Pleural fluids obtained from 80 patients (tuberculous : 39, malignant : 31, parapneumonic : 10) with exudate pleural effusions were processed for cell counts and biochemical analysis including ADA and TNF-$\alpha$. Results : Tuberculous pleural fluid showed higher levels of ADA and TNF-$\alpha$, $48.7{\pm}32.7U/L$ and $184.1{\pm}214.2pg/mL$ than that of non-tuberculous effusion $26.0{\pm}41.3U/L$ and $44.1{\pm}114.2pg/mL$, respectively (ADA, TNF-$\alpha$, p < 0.05, p < 0.01). Receiver operating characteristics(ROC) curves were generated for ADA and TNF-$\alpha$ and the best cut-off value for adenosine deaminase and TNF-$\alpha$were considered as 30U/L and 15pg/ml, respectively. Comparing the area under the ROC curves, there was no significant difference between ADA and TNF-$\alpha$. Conclusion : For the differential diagnosis of tuberculous pleural effusion from the other causes of exudative pleural effusions, TNF-$\alpha$ as well as ADA was considered as useful diagnostic method. However adding TNF-$\alpha$ to ADA has no further diagnotic benefit than ADA alone.
폐쇄성 환기장애 질환에서 노력성 폐활량 수기에 의한 천명의 의의
장안수,최인선,박석채,양주열 대한알레르기학회 1999 천식 및 알레르기 Vol.19 No.2
Background: Wheezing which is defined as a continuous sound with a musical quality is commonly auscultated in patients with chronic obstructive airway diseases. The correlation between wheezing and airway obstruction is unclear. Objective: This study was designed to evaluate the relationships among wheezing, severity of airway obstruction, and pulmonary function tests. Methods: Forty-one subjects were examined by the same observer. Wheezing during normal breathing and maximal forced exhalation, was auscultated respectively. Posterior lung bases were auscultated bilaterally with the seated patient taking repeated inspiratory capacity breaths through an open mouth. To quantify wheezing intensity, a regional score was assigned for each area after a minimum of 3 breaths, according to the following scale: zero, no wheezing heard: one, faint or intermittent wheezes: two, moderate wheezing during every expiration: three, loud wheezing during every expiration. The lung function tests by standard pneumotachograph were performed by skilled technicians. Results: Wheezing was auscultated more in forced exhalation than in normal breathing in patients with asthma and COPD [8/9(88%) vs 1/9(11%), p$lt;0.01 ll/15(73%) vs 1/15(6%), p$lt;0.05)]. Forced expiratory wheezes group (n=25) compared to no wheezes group (n=16) had significantly lower FEV₁(75 ±5.8% vs 95.6 ±6.6%, p$lt;0.05). Compared to no wheezes group, the group with forced expiratory wheezes had lower FEV₁and FEV₁/FVC (50.4 ±21.3% vs 81.15 ±7.7%, 70.4 ±22.4% vs 92.5 ±19.3%, respectively, p$lt;0.05). Bronchial asthma compared with COPD tended to have higher wheezing scores (Wheeze scores Bronchial asthma 3.5 vs COPD 2.4, p=0.08). Wheezing scores were correlated to FEV₁(normal breathing: r=-0.35, p$lt;0.05: forced exhalation: r=-0.45, p$lt;0.05), but no differences were found in wheezing incidence according to severity of airway obstruction. Conclusion: These findings suggest that wheezing on maximal forced exhalation may be a useful physical indicator for evaluating the severity of airway obstruction.