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S-337 완전절제술 받은 비소세포폐암환자의 생존율 예측인자
황재준,최천웅,김대현 대한내과학회 2016 대한내과학회 추계학술발표논문집 Vol.2016 No.1
배경: 염증은 종양발생에 있어 중요한 인자이며 이에 대한 연구가 지속되고 있다. 저자는 수술을 통해 완전 절제된 비소세포폐암(Non-small cell lung cancer) 환자에 있어서 수술 전 백혈구(white blood cell), 호중구(neutrophil), 림프구(lymphocyte) 수 및 호중구 대비 림프구 비율(neutrophil/lymphocyte ratio)과 환자 생존율과의 관련성에 대한 연구를 진행하였다. 방법:2009년 1월부터 2014년 12월까지 강동경희대학교병원에서 비소세포폐암 진단 후 수술을 통해 완전 절제술을 시행 받은 환자가 대상이 되었고 수술 전 항생제(antibiotics), 면역억제제(immunosuppressants), 보조요법(neoadjuvant treatments) 사용자 등은 제외되었다. 생존율 분석을 위해 SPSS 18.0을 사용하였으며 p value 0.05 이하일 경우 통계학적으로 의미가 있다고 보았다. 결과:총 101명의 환자가 연구대상이 되었고 73명은 남자, 28명은 여자였으며 이들의 평균 나이는 64.1세였다. 병리학적 분류에 따라 선암(adenocarcinoma) 환자는 56명, 편평세포암종(squamous cell carcinoma) 환자는 39명 그 외 6명이 있었다. 병기(7th edition of TNM staging)에 따른 분류로는 1기 53명, 2기 22명, 3기 26명이 있었다. 생존율에 있어서 단변량분석 (univariate analysis)에 따르면 나이, 호중구 수 및 비율, 림프구 비율, 호중구 대비 림프구 비율, 백혈구수, 병기가 통계학적으로 의미 있었으나 다변량분석(multivariate analysis) 에서는 오직 호중구 대비 림프구 비율만이 의미가 있었다. 결론: 비록 본 연구가 단일 병원에서 소수의 환자를 대상으로 시행되었다는 제한점이 있으나, 수술을 통해 완전 절제된 비소세포 폐암(Non-small cell lung cancer) 환자에 있어 수술 전 호중구 수 및 비율 증가, 림프구 비율 증가 및 호중구 대비 림프구 비율 증가가 생존율 예측인자로서 의미가 있음을 확인할 수 있었다.
황재준,이송암,김준석,이태훈,임소덕,황은구,김요한 대한흉부외과학회 2006 Journal of Chest Surgery (J Chest Surg) Vol.39 No.3
폐실질 내 과오종은 흔히 볼 수 있는 양성 폐종양이나, 기관지 내 과오종은 드문 종양 중 하나이다. 치료로는 기관지내시경을 이용한 제거나 기관절개 또는 정상적인 폐실질을 보존하기 위해 소매절제를 통한 종양의 제거가 보편적이다. 그러나 만성적인 기관지 폐쇄로 인해 폐실질이 파괴되어 보존이 어려운 경우에는 폐절제술이 필요할 수 있다. 저자는 기관지 내 과오종에 의해 좌상엽의 경화가 진행되어 좌상엽절제술이 필요했던 환자를 보고하는 바이다. 42세 여자가 3주일 전부터 발생한 기침과 좌측 흉통을 주소로 내원하였다. 기관지내시경 소견상 좌상엽기관지의 입구를 완전히 막고 있는 엽성 종괴가 관찰되었고, 생검을 시도하였으나 출혈로 실패하였다. 수술 소견상 만성적인 기관지 폐쇄에 의해 좌상엽의 경화가 심하여 좌상엽절제술을 시행하였다. 환자는 술 후 14일째 퇴원하였다.
S-716 근육을 침범한 Henoch-Schonlein 자반증
황재준,이상훈 대한내과학회 2016 대한내과학회 추계학술발표논문집 Vol.2016 No.1
Introduction: Henoch-Schonlein 자반증(이하 HSP)는 IgA 면역 복합체와 관련되어 혈관염을 일으키는 질환으로 다양한 장기를 침범할 수 있다. 성인에 있어 HSP는 드물게 발생하며 다양한 임상 양상을 나타내나 근육침범은 보고된바 없다. 소아에 있어서는 외국에서 4례가 보고된 바 있으며 발생기전으로 출혈(bleeding)과 근육허혈(muscle ischemia)에 의한 가능성이 제시되었다. 저자는 성인 HSP환자에 있어 근육이 침범된 최초의 사례를 보고한다. Case Report: 본 증례에서 환자는 자반증 없이 발생한 양하지 통증을 주소로 2차 의료기관 내원하여 봉와직염(cellulitis) 의증 하에 항생제 치료 받았으나 증상호전 없어 양하지 자기공명영상(magnetic resonance imaging, MRI) 검사 시행 후 근육염(myositis) 의증 하에 본원으로 전원 되었다. MRI 상에서 혈관을 따라 발생한 괴사성 염증에 의한 근육허혈이 확인되었으며, 본원 입원하여 추가 검사 진행 중 양하지에 자반증 발생하여 병변에서 피부조직검사 시행하였다. H&E staining에서 백혈구 파괴성 혈관염(leukocytoclastic vasculitis) 확인되었으며 면역형광염색(immunofluorescence staining)에서 혈관을 따라 IgA 침착 있어 환자는 HSP로 진단되었다. Conclusions: 성인 HSP 환자에 있어 근육침범의 최초 사례를 보고하며 그 기전으로 이전 연구에서 시행된 CT 검사상에서 출혈의 증거가 없었고 본 증례의 MRI 및 조직검사 결과에 비추어 출혈보다 혈관을 따라 발생한 괴사성 염증으로 인한 근육허혈 가능성이 더 높음을 확인할 수 있었다.
황재준 대한흉부심장혈관외과학회 1992 Journal of Chest Surgery (J Chest Surg) Vol.25 No.7
In pulmonary arteriovenous fistula, there are abnormal communications between the pulmonary arteries and the pulmonary veins; the capillary networks that normally separate arteries from veins is absent. The only available treatment of this uncommon variety is an excision. We report a case of pulmonary arteriovenous fistula cured by segmentectomy with a review of literatures.
개심술 환자에서의 면역기능의 변화;T lymphocyte subset의 변화에 대한 고찰
황재준 대한흉부심장혈관외과학회 1992 Journal of Chest Surgery (J Chest Surg) Vol.25 No.11
Cell mediated immunity is depressed following surgical procedure and the degree of immunosuppression is directly related to the magintude of the procedure, blood transfusion, and length of operation. So we would expect cardiac operations to be highly immunosuppressive, although little is konwn about their immunosuppressive effect. The nearly complete consumption of complement factors and decreased levels of IgM and IgG resulting in an impaired opsonizing capacity. Additionally, peripheral blood mononuclear cell counts including T-and B-lymphocytes and T-cell subsets are reduced. Depression of cell-mediated immunity following open-heart surgery is potentially detrimental because it could increase the susceptability of patients to viral and bacterial infection. We reviewed 20 patients after cardiac operation to search for changes in peripheral blood lymphocyte subsets. Lymphocyte subsets were measured by flow cytometer and the preoperative values of lymphocyte subsets were compared with those from the first, fourth, and seventh days after operation. After cardiac operation, total mumbers of T lymphocyte was severely depressed on the first postoperative day and returned to the preoperative level by the seventh day after operation. CD3, CD4, and CD8 lymphocytes were decreased on the first postoperative day and returned to the preoperative level by the seventh day also. There was four cases of wound infection and these patients had increased CD4 lympocyte and more decreased CD19 lymphocyte compared with the non-infected group. It is concluded from these data that cell-mediated immunity is significantly depressed for at least one week following open-heart surgery and this result was closely related to the postoperative infection.
결핵성 늑막염의 진단시 늑막액의 Tb PCR 및 ADA활성도에 관한 연구
황재준,최영호,김욱진,신재승,손영상,김학제 대한흉부심장혈관외과학회 2000 Journal of Chest Surgery (J Chest Surg) Vol.33 No.8
Background: Tuberculous pleurisy is the leading cause of pleural effusion in Korea. And differential diagnosis of tuberculous pleurisy with other cause is clinically very important. Traditional diagnostic methods such as routine analysis of pleural fluid, staining for acid-fast bacilli or pleural biopsy have major inherent limitaion. This study was designed to evaluate the significance of pleural fluid polymerase chain reaction(PCR) and adenosine deaminase (ADA) activity in early diagnosis of tuberculous pleurisy. Material and Method: Between March 1996 and July 1997, 198 patients with pleural effusion reviewed retrospectively. The study group included 112 cases with tuberculous effusion and 86 cases with non-tuberculous effusions, whose diagnoses were confirmed by pleural biopsy, microbiological methods, or cytology. We compared the results of PCR and pleural fluid levels of ADA between tuberculous and non-tuberculous effusions. Result: Mean age was 47.54$\pm$19.52 years(range 2 to 85 years). The positive rate of PCR was significantly higher in tuberculous group than non-tuberculous group(p<0.05). The sensitivty, specificity, positive predictive value(PPV), and negative predictive value(NPV) for PCR were 31.7, 90.9, 83.0, and 48.8%, respectively. Mean ADA activity was significantly higher in tuberculous group than non-tuberculous group(83.2 U/L vs 49.8 U/L)(p<0.05). With diagnostic thresholds of 40 U/L, the sensitivity, specificity, PPV, and NPV of ADA for tuberculosis were 75.9, 70.9, 77.3, and 69.3% respectively. At a level of 70 U/L, the sensitivity, specificity, PPV, and NPV of ADA for tuberculosis were 70.1, 75.9, 82.9, and 60.3% respectively. Conclusion: PCR is very highly specific, but less sensitive methods in diagnosis of tuberculous pleurisy. But ADA level of pleural fluid has acceptable sensitivity and specificity in diagnosis of tuberculous pleurisy. ADA activity is more useful test in the evaluation of pleural effusions.
황재준 대한흉부심장혈관외과학회 1992 Journal of Chest Surgery (J Chest Surg) Vol.25 No.6
The pulmonary carcinosarcoma is a rare malignant tumor, which composed of an admixture of histologically malignant epithelial and mesenchymal tissues. Carcinosarcomas comprise 0.2% of all pulmonary neoplasms and are most often found in a proximal bronchus. We report two cases of the pulmonary carcinosarcoma with a rewiew of the literatures.
황재준,고일규,진준장,황락경,김상훈,전정원,백승숙,장복순,최천웅 대한배뇨장애요실금학회 2020 International Neurourology Journal Vol.24 No.S1
Purpose: Acute respiratory distress syndrome (ARDS) is characterized by its acute onset of symptoms such as bilateral pulmonary infiltrates, severe hypoxemia, and pulmonary edema. Many patients with ARDS survive in the acute phase, but then die from significant lung fibrosis.Methods: The effect of combination therapy with polydeoxyribonucleotide (PDRN) and pirfenidone on ARDS was investigated using human lung epithelial A549 cells. ARDS environment was induced by treatment with lipopolysaccharide and transforming growth factor (TGF)-β. Enzyme-linked immunoassay for connective tissue growth factor (CTGF) and hydroxyproline were conducted. Western blot for collagen type I, fibroblast growth factor (FGF), tumor necrosis factor (TNF)-α, and interleukin (IL)-6 was performed.Results: In this study, 8-μg/mL PDRN enhanced cell viability. Combination therapy with PDRN and pirfenidone and pirfenidone monotherapy suppressed expressions of CTGF and hydroxyproline and inhibited expressions of collagen type I and FGF. Combination therapy with PDRN and pirfenidone and PDRN monotherapy suppressed expression of TNF-α and IL-1β.Conclusions: The combination therapy with PDRN and pirfenidone exerted stronger therapeutic effect against lipopolysaccharide and TGF-β-induced ARDS environment compared to the PDRN monotherapy or pirfenidone monotherapy. The excellent therapeutic effect of combination therapy with PDRN and pirfenidone on ARDS was shown by promoting the rapid anti-inflammatory effect and inhibiting the fibrotic processes.
황재준,오연목,Chin Kook Rhee,유광하,박용범,Ho Il Yoon,임성용,Ji-Hyun Lee,김은경,Tae Hyung Kim,Sei Won Lee,Sang Do Lee,이재승,KOLD Group 대한의학회 2020 Journal of Korean medical science Vol.35 No.8
Background: Although the association of hyperuricemia with an increased risk of mortality has been demonstrated in the context of acute exacerbation of chronic obstructive pulmonary disease (COPD), the long-term outcomes of hyperuricemia have not been studied in the case of stable COPD. Methods: We retrospectively analyzed baseline data of 240 men with stable COPD enrolled in the Korea Obstructive Lung Disease cohort. We evaluated associations between serum uric acid levels and clinical parameters, risk factors for all-cause mortality, and acute exacerbation of COPD. Results: The mean age of subjects was 66.4 ± 7.7 years, and the median follow-up time was 5.9 years. We identified no significant difference in terms of lung function or laboratory findings between patients with hyperuricemia and those without. Serum uric acid level was negatively associated with systemic inflammation indicated by neutrophil–lymphocyte ratio (r = −0.211, P = 0.001). Univariate Cox regression analysis revealed hyperuricemia to not be associated with an increased risk of all-cause mortality in men with stable COPD (hazard ratio [HR], 0.580; 95% confidence interval [CI], 0.250–1.370; P = 0.213). In the multivariate Cox regression model, hyperuricemia was not an independent predictor of acute exacerbation (HR, 1.383; 95% CI, 0.977–1.959; P = 0.068). Conclusion: Among men with stable COPD, hyperuricemia is not an independent predictor of all-cause mortality or future acute exacerbation of COPD. These results differ from those of previous studies on patients with acute exacerbation of COPD.