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내독소에 의해 유도된 급성 폐 손상에서 PAF Remodelling 및 Adhesion Molecule의 억제가 폐장내 Oxidative Stress에 미치는 영향
신태림 ( Tae Rim Shin ),나보경 ( Bo Kyung Na ),이영만 ( Young Man Lee ) 대한결핵 및 호흡기학회 2005 Tuberculosis and Respiratory Diseases Vol.58 No.3
연구배경 : 호중구는 급성 폐손상에서 폐장내 염증반응에 중추적인 역할을 하는 것으로 알려져 있다. 호중구가 조직 손상을 유발하기 위해서 폐모세혈관내로 격리(sequestration), 유착(adhesion) 및 화학주성 (chemotaxis)에 의한 폐장내의 간질 (interstitium)쪽으로의 이동 (migration)등의 과정을 거치며, 유착분자는 이 과정에서 호중구의 혈관내피세포에의 결합을 매개한다. 한편 폐손상에서 remodeling 경로를 통 Backgraound : There have been many reports on the pathogenesis of sepsis-induced acute respiratory distress syndrome(ARDS) but, the precise mechanism has not been elucidated. This study examined the protective effect of an inhibition of platelet activatin
내과계 중환자실 폐혈증 환자의 예후 예측인자 비교 분석
신태림(Tae Rim Shin),천선희(Seon Hee Cheon),장중현(Jung Hyun Chang) 대한내과학회 1998 대한내과학회지 Vol.55 No.1
Objectives: Despite the advances in medical practice and technology, a steady increase in the incidence of sepsis has been reported and the mortality has been persistently high ranging from 20 to 50%, especially in medical intensive care unit. Therefore, objective assessment of severity of illness based on risk estimates derived from severity of illness score has been important. Thus this study was designed for identification of risk factors and comparison of severity of illness scores' Acute physiology and chronic health evaluation II(APACHE II), Acute physiology and chronic health evaluation III (APACHE III), Multiorgan failure scaring system(MOF), Simplified acute physiology score(SAPS), Septic severity score(SSS). Methods : A retrospective clinical study was done on 97 patients with sepsis treated in medical intensive care unit, who had been admitted to Ewha Womans University Mokdong Hospital from September 1994 to May 1997, Multiple factors which may influence mortality and severity of illness score were evaluated by univariate and logistic regression analysis. Results : 1) Of the 97 patients, 52 were male and 45 were female. The mean age was 62 years and the overall mortality was 59.8%. 2) On severity of illness, sepsis was 21cases, severe sepsis 36 and septic shock 40. On primary source of infection, pulmonary origin was 39cases, gastrointestinal origin 23 and urinary tract origin 13. The infection caused by documented organism was 53cases. 3) Based on the univariate analysis, age, sex, respiratory rate, number of organ failure, admission source, ventilatory support, hematocrit, WBC, prothrombin time, Na and K, pH, PaO2/FiO2, D(A-a)C2 and the following severity of illness scores: APACHE II, APACHE JII, MOF, SAPS, and SSS for predicting mortality risk were all significant factors discriminating between survivors and nonsurvivors. 4) In distribution curve of APACHE II, APACHE III, MOF, SAPS, and SSS, the cut-off values in predictive risk of 50% were 21, 88, 4, 15, and 29. By logistic regression analysis after substituting their cut off value, APACHE II and APACHE III were significant independent predictors influencing survival with odd ratio 3.82 in APACHE II and 4.62 in APACHE IIL 1n predictive risk of 50%, sensitivity was 55%, specificity 85%, accuracy 85%. and relative risk 6.77 in APACHE II. And sensitivity was 47%, specificity 97%, accuracy 88% and relative risk 7.62 in APACHE III. Conclusion: APACHE II and APACHE III were significant predictor influencing mortality in sepsis patients treated in medical intensive care unit and APACHE III was superior to that of its predecessor. In near future, prospective and multicentral studies are required to confirm these results.
Thiazide 계 이뇨제에 의한 호중구 침윤이 현저한 급성 간질성 신염 1 예
신태림(Tae Rim Shin),홍은순(Eun Soon Hong),김미선(Mi Sun Kim),이은영(Eun Young Lee),강덕희(Duk Hee Kang),최규복(Gyu Bock Choi),윤견일(Kyun Il Yoon),성순희(Soon Hee Sung) 대한내과학회 1998 대한내과학회지 Vol.54 No.2
Drug-induced acute interstitial nephritis, induced by unknown immunologic mechanisms, is inflammatory lesions of the tub3ointerstitial area due to several kinds of drugs as hapten and a rare, but increasingly recognized cause of acute renal failure. Drugs implicated include not only methicillin and other penicillins but also diuretics and nonsteroidal anti-imflammatory agents. Diagnosis of acute interstitial nephritis is important, because withdrawal of the offending agent will usually result in rapid improvement in renal function, and steroid therapy may reduce residual chronic renal damage. We are reporting a case of diuretic-induced acute interstitial nephritis in a 49 year-old female patient, who was given hydrochlomthiazide to treat hypertension. A percutaneous biopsy showed tubulointerstitial nephritis accopanying prominent neutrophil infiltration without glomerulitis. Withdrawal of the drug and use of corticosteroid led to remarkable improvement with renal function returning to normal.
성인 천식 환자에서 체질량지수와 기도과민성 및 폐기능의 연관성
최정은 ( Jung Eun Choi ),신태림 ( Tae Rim Shin ),박상면 ( Sang Myeon Park ),김주희 ( Joo Hee Kim ),신성호 ( Sung Ho Shin ),이현영 ( Hyun Young Lee ),장주아 ( Juah Jang ),이훈구 ( Hun Gu Lee ),김철홍 ( Cheol Hong Kim ),현인규 ( In 대한천식알레르기학회 2014 Allergy Asthma & Respiratory Disease Vol.2 No.1
Purpose: Obesity is commonly regarded as a risk factor for asthma development, poor asthma control, and poor response to asthma therapy. However, its relationships are not always consistent. Gender difference has been reported to influence asthma severity and asthma control. We investigated the contribution of obesity to airway hyperresponsiveness (AHR) and lung function before and after treatment in adult asthmatics. Methods: The medical records of a total of 323 adult asthmatics were analyzed retrospectively. Asthma was diagnosed based on the positive result of methacholine bronchial provocation test (PC20≤25 mg/mL) or bronchodilator test (≥12% and 200-mL improvement in forced expiratory volume in 1 second after inhalation of a bronchodilator). Follow-up spirometry was performed in 113 patients after at least 3 months of asthma treatment with controller medication. Percent change between spirometry before and after treatment was defined as {[(value after treatment.value before treatment)/value before treatment]×100}. Body mass index (BMI, weight [kg]/height [m2]) was categorized into underweight (<18.5), normal weight (18.5.24.9), overweight (25.0.29.9), and obese (>30) according to the world health organization classification. Results: BMI did not show any significant correlation with PC20 value of methacholine provocation test and each lung function parameter before and after treatment. When we divided the study subjects according to gender and age, BMI was negatively correlated with PC20 value only in female adult asthmatics under 65 years old (r=.0.024, P=0.036). Conclusion: Obesity is positively correlated with the intensity of AHR in female adult asthmatics. Gender seems to differentially contribute to the relationship between BMI and AHR. (Allergy Asthma Respir Dis 2014;2:16-22)
신미승(Mi Seung Shin),이진화(Jin Wha Lee),신태림(Tae Rim Shin),우가은(Ka Eun Woo),이현경(Hyun Kyung Lee),김영선(Young Sun Kim),조영주(Young Joo Cho) 대한내과학회 1998 대한내과학회지 Vol.54 No.3
Systemic lupus erythematosus and myasthenia gravis are autoimmune disorders in which genetic, environmental and hormonal as well as immunological factors have been implicated. We experienced a case of 24 year-old female patient developed SLE(anemia, leukopenia, facial malar rash, high titers of anti-DNA and anti-nuclear antibody) 3 years following successful therapeutic thymectomy for myasthenia gravis. A review of the warld-wide literature revealed 8.3% to 24.3% association between myasthenia gravis and SLE However there has been no controlled epidemiological study to prove a real association between them two disease. The differential diagnosis of fatigue and fever in patient with SLE should always include the possibility of myasthenia gravis.
급성 천식발작시 혈장 및 요중 Endothelin 농도 변동
장중현 ( Jung Hyun Chang ),신태림 ( Tae Rim Shin ),우가은 ( Ga Eun Woo ),김종선 ( Jong Seon Kim ),홍은순 ( Eun Soon Hong ),서기열 ( Gi Yeoul Seo ),차주현 ( Joo Hyun Cha ),김미선 ( Mi Seon Kim ),김영선 ( Yeung Seon Kim ),조영주 ( Y 대한결핵 및 호흡기학회 1997 Tuberculosis and Respiratory Diseases Vol.44 No.4
성인 재발성 폐렴에 대한 임상적 고찰 -한림대학교 의료원 내원 환자를 대상으로-
엄광석 ( Kwang Seok Eom ),전강 ( Gang Jeon ),신태림 ( Tae Rim Shin ),장승훈 ( Seung Hun Jang ),반준우 ( Joon Woo Bahn ),이재영 ( Jae Young Lee ),박용범 ( Yong Bum Park ),김철홍 ( Cheol Hong Kim ),전만조 ( Man Jo Jeon ),박상면 ( S 대한결핵 및 호흡기학회 2004 Tuberculosis and Respiratory Diseases Vol.57 No.1
김종엽 ( Jong Yeop Kim ),김철홍 ( Cheol Hong Kim ),신현원 ( Hyun Won Shin ),채영제 ( Young Je Chae ),최철영 ( Chul Young Choi ),신태림 ( Tae Rim Shin ),박용범 ( Yong Bum Park ),이재영 ( Jae Young Lee ),반준우 ( Joon Woo Bahn ) 대한결핵 및 호흡기학회 2006 Tuberculosis and Respiratory Diseases Vol.60 No.6
연구배경: 흡입화상은 폐렴, 호흡부전 등의 폐합병증으로 인해 이환율 및 사망률 증가에 기인하는 것으로 알려져 있다. 화기 흡입에 의한 기도 손상이 폐기능에 영향을 줄 것으로 예상되나 이에 대한 연구는 빈약한 실정이다. 흡입화상으로 인한 폐기능 검사소견의 변화를 알아보고자 하였다. 방법: 2002년 8월부터 2005년 8월까지 기관지내시경검사에 의해 흡입 폐 손상이 확인된 환자들을 대상으로 급성기 및 회복기에 폐기능 검사를 시행하여 비교 및 분석하였다. 초기 폐기능 검사에서 FVC, FEV1, FEV25-75% 및 PEF의 정상 추정치는 흡입화상에 대한 내시경적 중증도와의 상관성을 알아보았다. 사망환자, 연기 흡입으로 뇌손상을 입은 환자 및 선행 만성 호흡기질환자는 제외하였다. 결과: 화상체표면적이 0-18%의 범위에 있는 총 37명(남 28, 여 9)의 환자를 대상으로 하였다. 내원 당시의 PaO2/FiO2 비는 286.4±129.6 ㎜Hg, COHb은 7.8±6.6%였으며, 기관내 삽관은 9예(24.3%), 기계호흡은 3예(8.1%)에서 이루어졌다. 초기 방사선 소견에서 이상 소견을 보인 18예(48.6%) 중 15예(83.3%)는 정상화되었으나 3예(16.7%)는 잔흔을 남기고 치유되었다. 초기 폐기능 검사에서 19예(51.4%)가 정상 소견이었다. 폐쇄성 장애가 9예(24.3%) 있었으며 이 중 4예(44.4%)는 기관지 확장제에 양성반응을 보였다. 제한성 장애도 9예(24.3%) 관찰되었다. DLco를 시행한 23예 중 4예(17.4%)만이 감소된 소견을 보여 주었다. 추적 폐기능 검사에서 초기에 이상 폐기능 소견을 보인 대부분이 정상으로 회복되었으며, 폐쇄성 및 제한성 장애가 각각 1예(2.7%)씩 관찰되었다. DLco는 전부 정상화 되었다. 결론: 흡입화상 이후 생존한 환자를 대상으로 급성 호흡기 증상이 안정된 상태에서 시행한 초기 폐기능 검사상 정상, 폐쇄성 및 제한성 장애로 나타나 특이적인 환기장애 양상은 관찰되지 않았다. 또한 초기에 이상소견을 보여주었다 하더라도 추적검사에서 대부분 정상으로 회복되는 것을 관찰할 수 있었다. 그리고, 기관지확장제 양성을 보이는 일부 환자는 기관지 확장제 치료를 적극적으로 시도해 볼 수 있을 것으로 사료된다. Background: The changes in the pulmonary function observed in burn patients with an inhalation injury are probably the result of a combination of airway inflammation, chest wall and muscular abnormalities, and scar formation. In addition, it appears that prolonged ventilatory support and an episode of pneumonia contribute to the findings. This study investigated the changes in the pulmonary function in patients with inhalation injury at the early and late post-burn periods. Methods: From August 1, 2002, to August 30, 2005, surviving burn patients who had an inhalation injury were enrolled prospectively. An inhalation injury was identified by bronchoscopy within 48hours after admission. Spirometry was performed at the early phase during admission and the recovery phase after discharge, and the changes in the pulmonary function were compared. Results: 37 patients (M=28, F=9) with a total burn surface area (% TBSA), ranging from 0 to 18%, were included. The initial PaO2/FiO2ratio and COHb were 286.4±129.6㎜Hg and 7.8±6.6%. Nine cases (24.3%) underwent endotracheal intubation and 3 cases (8.1%) underwent mechanical ventilation. The initial X-ray findings revealed abnormalities in, 18 cases (48.6%) with 15 (83.3%) of these being completely resolved. However, 3 (16.7%) of these had residual sequela. The initial pulmonary function test, showed an obstructive pattern in 9 (24.3%) with 4 (44.4%) of these showing a positive bronchodilator response, A restrictive pattern was also observed in 9 (24.3%) patients. A lower DLco was observed in only 4 (17.4%) patients of which 23 had undergone DLco. In the follow-up study, an obstructive and restrictive pattern was observed in only one (2.7%) case each. All the decreased DLco returned to mormal. Conclusions: Most surviving burn patients with an inhalation injury but with a small burn size showed initial derangements in the pulmonary function test that was restored to a normal lung function during the follow up period. (Tuberc Respir Dis 2006; 60: 653-662)