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

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

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.

결핵성 흉막염에서 Soluble Interleukin-2R, Interleukin-6 및 Adenosine Deaminase의 변화에 관한 연구

김종혁 ( Kim Jong Hyeog ),정복현 ( Jeong Bog Hyeon ),문승환 ( Mun Seung Hwan ),조호준 ( Jo Ho Jun ),이명구 ( Lee Myeong Gu ),현인규 ( Hyeon In Gyu ),정기석 ( Jeong Gi Seog ),남송현 ( Nam Song Hyeon ),류지소 ( Lyu Ji So ),조현찬 ( 대한내과학회 1993 대한내과학회지 Vol.44 No.2

Background: The aim of this study is to evaluate the value of interleukin-6 (IL-6), Soluble interleukin-2 receptor (sIL-2R) and adenosine deaminase in diagnosing tuberculos pleurisy and in differentiating it from malignant pleural effusion, and to find out mutual relationships between the three parameters. Methods: We investigated the level of IL-6, sIL-2R and ADA in various pleural diseases. Included were 77 subjects with pleural effusion (57 bopsy proven tuberculous pleurisy, 9 malignant pleural effusion, 5 empyema, 4 parapneumonic effusion, 1 paragonimiasis and 1 pancreatitis). IL-6 was measured by Quantikine human IL-6 (R&D systems), sIL-2R by h-interleukin-2-receotor ELISA (Boehringer Manheim biochemica) and ADA by Giusti`s colorimetric method. Results: The level of IL-6 was significantly higher in tuberculous effusion (25,593±17,352 pg/ml) than that of malignant effusion (5,800±3,485 pg/ml, p < 0.001). IL-6 was also increased in empyema fluids (74,080±48, 569 pg/ml). The level of sIL-2R was significantly higher in tuberculous effuson (877±430 pmol/l) than that of 20 nontuberculous effusion (259±230 pmol/L, p<0.001). The level of ADA was also higher in tuberculous effusion (82.4±26.9 U/L) than that of nontuberculous effusion (18.8±11.6 U/L, p<0.001). Levels of both ADA and sIL-2R were lower in malignant effusion (16.4±9.66 U/L, 229+171 pmol/L) than those of tuberculous effusion. The sensitivity and specificity of IL-6 in discriminating tuberculosis from malignancy were 84% and 100% respectively (cut-off value: 10000 pg/ml). Those of sIL-2R were 87% and 77% (cut-off value: 350 pmol/L). ADA was most valuable in differentiating tuberculosis from malignancy, sensitivity and specificity of which were 100% (cut-off value: 40 U/L). The correlation coefficient of sIL-2R and IL-6 was 0.3822 (p=0.001). Conclusion: It was suggested that assay of IL-6, sIL-2R and ADA could play an implemental role in differential diagnosis of tuberculous pleural effusion. Increased level of the three parameters and significant correlations between them were suggestive of the involvement of activated T cells in tuberculous pleural effusion.

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.

Rifampin 아나필락시 1 예

이자영(Ja Young Lee),장명국(Myoung Kuk Jang),김동규(Dong Kyu Kim),모은경(Eun Kyung Mo),최정은(Jeong Eun Choi),박명재(Myung Jae Park),이명구(Myung Goo Lee),현인규(In Gyu Hyun),정기석(Ki Suck Jung) 대한내과학회 1998 대한내과학회지 Vol.55 No.2

Rifampin, when given in usual doses, is well tolerated with less than 4% of patients having significant adverse reactions. The patient had did not have any adverse reaction to rifampin in the first place. After 10 years, however, the patient was presented with hypotension, shortness of breath, wheezing and deterioration of consciousness in 10 minutes after taking rifampin. All abnormal symptoms and signs of anaphylaxis were normalized in 24 hours after administration of normal saline, glucocorticosteroid, and antihistamine. Skin prick test with rifampin showed positive reaction to gradual concentration of rifampin in dose dependent manner. The wheals by rifampin developed in 30 minutes and maximized in 2 hours, while normal saline and histamine controls showed expected negative and positive response in 10 minutes, respectively. Recently we expererienced a rare case of anaphylaxis after single oral administration of rifampin(450mg), who had been treated with antituberculous drug including rifampin, ca 10 years ago.

폐렴의 진단에서 정량적 기관지폐포 세척액 배양의 유용성

한태호(Tae Ho Hahn),장명국(Myoung Kuk Jang),김성균(Seong Gyun Kim),이자영(Ja Young Lee),이재명(Jae Myung Lee),김동규(Dong Kyu Kim),최정은(Jeong Eun Choi),모은경(Eun Kyung Mo),박명재(Myung Jae Park),이명구(Myung Goo Lee),현인규(In Gyu 대한내과학회 1998 대한내과학회지 Vol.54 No.6

Background: The aim of this study is to evaluate the usefulness of quantitative culture of bronchoalveolar lavage (BAL) fluid for the diagnosis of bacterial pneumonia and identification of causative agents. Methods: Study group consisted of 30 epiaodes in 28 patients, enrolled from January 1995 through June 1996. Inclusion criteria were 1) presence of respiratory symptoms such as cough, sputum or dyspnea 2) increased peripheral blood leukocyte count (≥11,000/mm³) 3) Fever (≥38.3ºC) 4) purulent sputum 5) new or progressive infiltrate on chest radiography. For the diagnosis of pneumonia and its causative agents, sputum smear and culture, blood culture and BAL fluid studies were performed. BAL fluid studies included differential count of white blood cell, BAL fluid smear and culture, detection of elastin fibers and presence of intracellular organisms (ICO). Quantitative culture of BAL fluid was considered positive if colony forming units was more than 1.0×10(4)/ml. Positive criteria for ICO was presence of microorganism in more than five per 100 of phagocytes, Result: Recruited were 22 males and 6 females. The mean age was 57.5±13.5 years (range 25-84), Of 30 episodes underwent BAL fluid studies, 19 cases were diagnosed to be bacterial pneumonia, S. aureus (7 cases) was the most common causative agent and was followed by P. aeruginosa (4), E. cloacae (2), A baumanii (1), H. influenzae (1) and a-hemolytic Streptococcus (1). Sensitivity of quantitative culture of BAL fluid for the diagnosis of bacterial pneumonia was 68.4% and its specificity was 63.6%. Elastin fibers were detected in 5 cases (31%) and ICO over 5% in 3 cases (15.7%). When criteria of quantitative culture of BAL fluid, detection of ICO and elastin fibers were applied together, diagnostic rate of pneumonia was 84.2% (16/19). Conclusion: Quantitative culture of BAL fluid was sensive and specific compared to sputum and b1ood culture for the diagnosis of bacterial pneumonia, It was suggested that detection of ICO and elastic fibers in BAL fluid could raise the diagnostic rate of bacterial pneumonia.

증례 / 경기관지 폐생검으로 진단된 폐 효모균중 1예

김정한(Jung Han Kim),장현주(Hyun Joo Jang),김성진(Sung Jin Kim),김철홍(Cheol Hong Kim),김동규(Dong Gyu Kim),모은경(Eun Kyung Mo),박명재(Myoung Jae Park),이명구(Myung Gu Lee),현인규(In Gyu Hyun),정기석(Ki Suck Jung) 대한내과학회 1999 대한내과학회지 Vol.56 No.1

Cryptococcosis has been considered as an opportunistic mycosis associated with depressed immune function of the host. However, it may develop in healthy individuals without any underlying disease. Recently, we experienced a case of pulmonary cryptococcosis in healthy person. The patient had experienced hemoptysis and dry cough persisted for a month. The chest X-ray and CT showed multifocal pneumonic consolidation containing small cavities in RLL, LUL and LLL. Fiberoptic bronchoscopy didn't revealed endobronchial lesion in both lungs. Transbronchial lung biopsy(TBLB) was done, and we could diagnose pulmonary cryptococcosis by means of histopathologic examination. Clinical evaluations did not reveal immune deficiency or evidence of other specific disease. The patient was treated with fluconazole and resulted in clinical and radiological improvement. Cryptococcosis has well known for its meningeal involvement. Although primary pulmonary cryptococcosis is rare, we must think of it when meet mass or nodular lesion on the chest radiology.

가을철 유행하는 급성열성질환의 폐침범과 CRP와의 연관관계

김고운 ( Go Woon Kim ),이우진 ( Woo Jin Lee ),홍원기 ( Won Ki Hong ),이성화 ( Sung Hoa Lee ),이창률 ( Chang Youl Lee ),이명구 ( Myung Goo Lee ),현인규 ( In Gyu Hyun ),정기석 ( Ki Suck Jung ) 대한결핵 및 호흡기학회 2009 Tuberculosis and Respiratory Diseases Vol.66 No.2

연구배경: 쯔쯔가무시병, 렙토스피라병, 신증후출혈열은 우리나라에서 흔한 급성열성질환으로 최근 발병과 유행성의 보고가 있음에도 불구하고 열성질환에 있어서 폐 침범에 대한 연구는 부족한 상태이다. 열성질환에 있어서 폐합병증이 있을 때 임상적으로 더 심한 경과를 보이고 CRP 수치도 더 높게 측정되는 경우가 있어 입원 시 측정한 CRP값이 조기에 적극적인 치료 대상에 대한 예측인자가 될 수 있는지 알아보고자 하였다. 방법: 2002년 1월부터 2008년 5월까지 한림대학교 춘천성심병원에서 혈청학적 검사에서 양성이거나 임상적으로 진단을 받았던 환자를 대상으로 후향적 연구를 하였다. 결과: 총 105명의 환자가 대상이 되었고 쯔쯔가무시병 63명(63%), 신증후출혈열 32명(30.5%), 렙토스피라병 10명(9.5%)이었고 폐침범은 42명(40%)에서 관찰되었으며 폐부종 20명(19%), 가슴막삼출 20명(19%), 간질폐렴 2명(2%)이었다. CRP는 평균 8.87±7.29 mg/dl였고 20 mg/dl 이상의 높은 값을 보였던 환자도 8명 있었고 폐침범 중 간질폐렴 형태에서 가장 높은 평균값을 보였다(p=0.027). 폐합병증을 보였던 환자군에서 임상적으로 심한 경과를 보였으며 중환자실 입원치료와 인공호흡기 치료를 동반하고 있었고 더 높은 CRP값을 보였다(p=0.0073). 결론: 급성열성질환에 있어서 폐합병증을 보인 군에서 더 높은 CPR 수치가 측정되었으며 입원 시 CRP측정을 통해 조기에 더 적극적인 치료가 필요한 환자군을 선택할 수 있고 폐침범에 의한 사망률과 치명률의 감소에도 도움이 될 것으로 추정된다. Background: Tsutsugamushi, leptospirosis and hemorrhagic fever with renal syndrome (HFRS) are the prevalent diseases among the acute febrile illnesses in Korea. Pulmonary involvement in the patients with these diseases remains poorly recognized in endemic regions, and this is despite reports of recent outbreaks and epidemic episodes. Pulmonary involvement and a higher CRP level as clinical manifestations show a more severe form of infection. The aim of this study is to analyze the correlation of pulmonary involvement and the CRP level in patients with acute febrile illnesses. Methods: We retrospectively reviewed the clinical records of 105 patients who were diagnosed with tsutsugamushi, HFRS and leptospirosis from January 2002 to May 2008 in Chuncheon Sacred Heart Hospital. The radiographic images were retrospectively analyzed by two radiologists. We analyzed the pulmonary complications of the patients with these febrile diseases and we checked the CRP level at admission. Results: The study included 105 patients who were diagnosed with febrile diseases. Of these patients, 32 patients had hantaan, 10 patients had leptospirosis and 63 patients had tsutsugamushi disease. 42 (40%) patients had pulmonary complications, 20 patients had pulmonary edema, 20 patients had pleural effusion and 2 patients had interstitial pneumonitis. The patients with pulmonary involvement showed a more severe form of infection and a higher CRP level than that of those patients without pulmonary involvement (p=0.0073). Conclusion: Pulmonary involvement in patients with acute febrile diseases might be correlated with a higher CRP level. Identification of this factor on admission might provide useful selection criteria for the patients who need early intensive care.

의학강좌-개원의를 우한 모범 처방전 : 폐렴의 외래 치료

현인규 ( In Gyu Hyun ) 대한내과학회 2003 대한내과학회지 Vol.64 No.1

결핵 환자에서 말초혈액 결핵균 중합효소 연쇄반응 양성의 임상적 의의

김규원 ( Kim Gyu Won ),이재명 ( Lee Jae Myeong ),강민종 ( Kang Min Jong ),손지웅 ( Son Ji Ung ),이승준 ( Lee Seung Jun ),김동규 ( Kim Dong Gyu ),이명구 ( Lee Myeong Gu ),현인규 ( Hyeon In Gyu ),정기석 ( Jeong Gi Seog ),이영경 ( Le 대한결핵 및 호흡기학회 2001 Tuberculosis and Respiratory Diseases Vol.50 No.5