성인의 재발성 호흡기계 유두종증 환자에서 장기간 인터페론 치료의 유효성

남해성 ( Hae Seong Nam ),고원중 ( Won Jung Koh ),서지영 ( Gee Young Suh ),정만표 ( Man Pyo Chung ),권오정 ( O Jung Kwon ),김호중 ( Ho Joong Kim ) 대한결핵 및 호흡기학회 2008 Tuberculosis and Respiratory Diseases Vol.65 No.5

연구배경: 재발성 호흡기계 유두종증은 기관을 따라 다발성 유두종이 반복적으로 재발하는 매우 드문 질환이다. 1980년대 이후, 소아의 재발성 유두종증에 보조적 치료로 인터페론이 사용되어 왔다. 그러나, 성인 환자에서의 유효성 등에 대하여는 많은 연구 등이 필요하다. 2002년 이후, 삼성서울병원에서는 성인의 재발성 호흡기계 유두종증 환자들에서 재발을 예방하기 위해, 인터페론을 사용하여 왔다. 이에 본 저자들은 재발성 호흡기계 유두종증 성인 환자에서 인터페론의 장기간 사용 효과를 알아보고자 하였다. 방법: 기관지내시경과 조직학적으로 확인된 5명의 재발성 호흡기계 유두종증 환자에서 타 병원에서 치료한 기록 등을 포함한 의무기록 등을 조사하였다. 레이저 소작술을 포함한 치료적 기관지내시경 시술 후, 모든 환자는 2개월 간격으로 인터페론-알파 600만 단위를 피하주사 하였다. 추가적인 치료적 기관지내시경 시술은 추적 검사 중 환자의 증상 등을 확인하여 필요 시 시행하였으며, 기관지 내시경 또는 컴퓨터 단층 촬영 등을 추적 조사하였다. 결과: 모든 환자들의 연령의 중앙값은 44세(범위 13∼68세), 남녀비는 3:2, 유두종증 기간의 중앙값은 31년(범위 1∼45년)이었다. 소아형과 성인형 유두종증은 각각 3명과 2명이었으며, 2명의 환자는 진단 당시 기관절개술을 시행 받았던 과거력이 있었다. 인터페론 치료기간의 중앙값은 56개월(범위 12∼66개월)이었다. 인터페론 치료 후 2명의 환자는 12개월과 36개월에 각각 완전완화를 보였으며, 나머지 3명의 환자는 부분완화를 보여 레이저치료의 횟수가 중요하게 감소하였다. 결론: 재발성 호흡기계 유두종증 환자에서 인터페론의 보조적 치료의 적정 용량과 기간 등은 향후 더 많은 연구 등을 필요로 하며, 오랜 기간 지속된 성인의 재발성 호흡기계 유두종증 환자에서 2개월 간격의 인터페론의 치료는 안정적이며 효과적이다. (Tuberc Respir Dis 2008;65:390-395) Background: Since the early 1980s, interferon-alpha (IFN-α) has been used as adjuvant therapy in pediatric patients with recurrent respiratory papillomatosis (RRP). However, its efficacy in adults needs to be validated. Since 2002, Samsung Medical Center`s guidelines have mandated regular injection of IFN-α in patients with RRP to prevent recurrence. To evaluate these guidelines, patient data were investigated. Methods: Five patients diagnosed as having RRP by bronchoscopy and histopathology were included. After initial bronchoscopic intervention, including laser cauterization, all patients received subcutaneous injection of 6 million units of IFN-α every 2 months. Further bronchoscopic intervention was carried out as needed. Patients were regularly evaluated using bronchoscopy or computed tomography. Results: The median age of the patients was 44 years (range 13∼68), and the median duration of papillomatosis was 31 years (range 1∼45). Three and two patients had juvenile-onset and adult-onset disease, respectively. Two patients had a history of tracheostomy at the time of diagnosis. The median duration of IFN-α therapy was 56 months (range 12∼66). Two patients showed complete remission at 12 and 36 months after IFN-α injection, respectively. The other three patients showed partial remission, and the number of laser therapy sessions was significantly reduced. Conclusion: Intermittent IFN-α injection is effective in patients with long-standing RRP and can reduce the number of laser therapy sessions required in their treatment.

악성흉수의 진단과 치료

남해성 ( Hae Seong Nam ),류정선 ( Jeong Seon Ryu ) 대한내과학회 2011 대한내과학회지 Vol.81 No.2

Malignant pleural effusions (MPEs) are an important clinical problem in patients with neoplastic disease. They can occur as the initial presentation of cancer, a delayed complication in patients with previously diagnosed malignancies, or the first manifestation of cancer recurrence after therapy. Common cancer types causing MPEs include lymphomas, mesotheliomas, and carcinomas of the breast, lung, and ovaries. However, almost all tumor types have been reported to cause MPEs. Regardless of the etiology, the median survival from clinical recognition is 4 months. New imaging modalities assist the evaluation of patients with a suspected MPE. However cytologic or tissue confirmation of malignant cells is necessary to establish a diagnosis. Management of an MPE remains palliative. Managements are directed toward removing pleural fluids and when appropriate, performing pleurodesis or initiating long-term drainage to prevent fluid reaccumulation. Talc pleurodesis is still the choice of treatment although concerns about its safety remain. Several factors such as performance status, expected survival, lung re-expansion following pleural fluid drainage and co-morbidities should be considered before the treatment. (Korean J Med 2011;81:167-173)

서서히 자라는 폐암의 임상적 특성 6증례 평가

남해성 ( Hae Seong Nam ),양동혁 ( Dong Hyuk Yang ),김정수 ( Jeong Soo Kim ),김현정 ( Hyun Jung Kim ),이현규 ( Hyeon Gyu Yi ),이경희 ( Kyung Hee Lee ),조재화 ( Jae Hwa Cho ),윤용한 ( Yong Han Yoon ),곽승민 ( Seung Min Kwak ),이홍렬 대한결핵 및 호흡기학회 2010 Tuberculosis and Respiratory Diseases Vol.68 No.3

Slowly growing lung cancers are quite rare and the leading cause of length time bias and over-diagnosis bias in lung cancer screening. We report 6 cases of slowly growing lung cancer in a tertiary hospital between January 1999 and December 2008. The clinical characteristics of these 6 cases with slowly growing lung cancer were examined. The median age at diagnosis was 68 years (range, 49∼72), and 5 patients (83%) were female. The most common histology type was adenocarcinoma (83%). After excluding two patients who showed no change in the tumor size, the median tumor doubling time was 189 months (range, 86∼387). The proportion of patients with slowly growing lung cancer appears to be particularly large in women, especially among patients with adenocarcinoma. Our experience shows that slowly growly lung cancers are more heterogeneous and diverse.

Isoniazid에 의해 유발된 급성 췌장염

정병하 ( Byung Ha Chung ),남해성 ( Hae Seong Nam ),권정현 ( Jung Hyun Kwon ),임소희 ( So Hi Im ),박선희 ( Sun Hee Park ),김진우 ( Jin Woo Kim ),김승준 ( Seung Joon Kim ),이숙영 ( Sook Young Lee ),김영균 ( Young Kyoon Kim ),박성학 대한결핵 및 호흡기학회 2004 Tuberculosis and Respiratory Diseases Vol.56 No.4

공복혈당과 당화혈색소에 의한 당뇨병 진단 비교

윤우준,신민호,권순석,박경수,이영훈,남해성,정슬기,윤용운,최진수,Yun, Woo-Jun,Shin, Min-Ho,Kweon, Sun-Seong,Park, Kyeong-Soo,Lee, Young-Hoon,Nam, Hae-Sung,Jeong, Seul-Ki,Yun, Yong-Woon,Choi, Jin-Su 대한예방의학회 2010 Journal of Preventive Medicine and Public Health Vol.43 No.5

Objectives: The American Diabetes Association (ADA) has recently recommended the HbA1c assay as one of four options for making the diagnosis of diabetes mellitus, with a cut-point of $\geq$ 6.5%. We compared the HbA1c assay and the fasting plasma glucose level for making the diagnosis of diabetes among Korean adults. Methods: We analyzed 8710 adults (age 45-74 years), who were not diagnosed as having diabetes mellitus, from the Namwon study population. A fasting plasma glucose level of $\geq$126 mg/dL and an A1c of $\geq$ 6.5% were used for the diagnosis of diabetes. The kappa index of agreement was calculated to measure the agreement between the diagnosis based on the fasting plasma glucose level and the HbA1c. Results: The kappa index of agreement between the fasting plasma glucose level and HbA1c was 0.50. Conclusions: The agreement between the fasting plasma glucose and HbA1c for the diagnosis of diabetes was moderate for Korean adults.

증례 : 호흡기 ; 유방 성형 목적으로 폴리아크릴아마이드 주입 후에 발생한 폐포 출혈 1예

임준혁 ( Jun Hyeok Lim ),이정민 ( Jeong Min Lee ),최성환 ( Seong Huan Choi ),남해성 ( Hae Seong Nam ),조재화 ( Jae Hwa Cho ),류정선 ( Jeong Seon Ryu ),곽승민 ( Seung Min Kwak ) 대한내과학회 2015 대한내과학회지 Vol.88 No.4

Polyacrylamide는 최근 주사용 필러로서의 사용이 증가되고 있는 물질로 본 증례에서와 같이 무자격 시술자에 의한 주입되는 경우가 있다. Polyacrylamide에 의한 국소적인 부작용에 대하여는 여러 차례 보고된 바가 있으나 전신적 부작용에 대하여는 보고된 바가 없다. 저자들은 유방 성형 목적으로 polyacrylamide를 양측 유방에 주입 받았던 환자에서 폐포 출혈이 발생한 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Polyacrylamide hydrogel is used widely in plastic surgery due to its nontoxic, nonabsorbent nature. There have been reports of silicone leading to pulmonary embolism and acute respiratory distress syndrome with systemic adverse effects. However, there have been case reports only of local reactions involving polyacrylamide; systemic reactions appear to be rare. Furthermore, there has been no report of alveolar hemorrhage after polyacrylamide injection for breast augmentation. We treated a 53-year-old female with an alveolar hemorrhage that occurred 2 days after a polyacrylamide injection. On the day of admission, the patient had a fever with chills and dyspnea. The chest X-ray showed multiple infiltrations and chest computed tomography showed consolidation and a ground-glass appearance in both lung fields. The alveolar hemorrhage was confirmed at fiber-optic bronchoscopy and bronchoalveolar lavage. The symptoms and radiology findings improved after corticosteroid administration and conservative treatment. We report the first case of alveolar hemorrhage after a polyacrylamide injection for breast augmentation.

증례 : 관해 유도 후 글리벡과 동종 조혈모세포 이식으로 치료한 필라델피아 염색체 양성 급성 골수성백혈병 3예

윤재호 ( Jae Ho Yoon ),김희제 ( Hee Je Kim ),남해성 ( Hae Seong Nam ),박윤정 ( Yun Jung Park ),엄기성 ( Ki Seong Eom ),민우성 ( Woo Sung Min ),김춘추 ( Chun Choo Kim ) 대한내과학회 2007 대한내과학회지 Vol.72 No.3

필라델피아 염색체 양성 일차성 급성 골수성백혈병은 보편적으로 치료에 반응을 잘 하지 않아 예후가 나쁘지만, 글리벡을 항암화학요법과 병용할 경우, 관해를 유도하고 유지하는데에 도움이 될 것이라고 소개되었다. 장기적인 관해 유지를 위해서는 궁극적으로 동종 조혈모세포 이식을 고려해야 하나, 국내외적으로 증례가 드물고 예후가 나쁘기 때문에 필라델피아 양성 일차성 급성 골수성백혈병에 대한 표준적인 치료법을 제시할만한 근거가 부족하다. 글리벡을 병용하는 것에 대한 몇몇 국외 증례가 있으나, 근거 확립을 위해 더 많은 증례 보고가 필요하리라 생각되며, 저자들이 제시한 것처럼 항암 화학요법과 글리벡의 중간 요법으로 안정된 관해 상태를 유지하고 동종 조혈모세포 이식을 시행하여 효과적인 치료 결과를 기대할 수 있을 것이다. The Ph-chromosome is the hallmark of chronic myelogenous leukemia (CML), but it has also been reported infrequently for de novo AML. This cytogenetic variant of AML is characterized by a poor prognosis associated with extraordinary drug resistance. Experience with the use of imatinib mesylate for Ph-chromosome-positive de novo AML is limited because of the rarity of the disorder. Thus, allogeneic hematopoietic stem cell transplantation (HSCT), as a post-remission therapy, should be considered. In three patients with Ph-chromosome-positive AML, we achieved complete remission with induction chemotherapy and the use of an imatinib cycle as an interim therapy. Subsequently, all patients received consolidation chemotherapy followed by imatinib cycles, bridging the time to allogeneic HSCT. All patients were successfully transplanted, and have been in excellent condition, with a median follow-up duration of 15 months (range, 2-25 months). We report on these cases and present the treatment strategy of induction chemotherapy, maintenance with imatinib mesylate, and final allogeneic HSCT as a representative paradigm for the treatment of Ph-chromosome-positive de novo AML. (Korean J Med 72:326-330, 2007)

증례 : 호흡기 ; 급성 흉수처럼 보인 횡격막 탈장 1예

박지선 ( Ji Seon Park ),이경희 ( Kyung Hee Lee ),김영삼 ( Young Sam Kim ),조재화 ( Jae Hwa Cho ),곽승민 ( Seung Min Kwak ),류정선 ( Jeong Seon Ryu ),남해성 ( Hae Seong Nam ) 대한내과학회 2014 대한내과학회지 Vol.87 No.3

Diaphragmatic hernia may be either congenital or acquired. Acquired cases may be secondary to trauma, infection, pregnancy, or surgery. In adults, diaphragmatic hernia causes chronic and variable symptoms such as abdominal discomfort, dyspepsia, and chronic dyspnea; in infants, however, it frequently causes acute respiratory failure. We report herein a case of diaphragmatic hernia in an adult patient who presented with left chest pain. Left pleural effusion was revealed on a plain chest radiograph. Computed tomography confirmed the presence of a diaphragmatic defect and a shift of the omentum to the thoracic cavity. The patient underwent omental resection and primary repair of the diaphragmatic muscle defect via exploratory thoracotomy. (Korean J Med 2014;87:343-346)

말초 비소세포폐암 환자에서 기관지 세척액 MAGE 유전자 진단의 유용성

김수현 ( Su Hyun Kim ),김호중 ( Ho Joong Kim ),권오정 ( O Jung Kwon ),정만표 ( Man Pyo Chung ),서지영 ( Gee Young Suh ),고원중 ( Won Jung Koh ),함초롬 ( Cho Rom Ham ),남해성 ( Hae Seong Nam ),엄상원 ( Sang Won Um ),권용수 ( Yong S 대한결핵 및 호흡기학회 2008 Tuberculosis and Respiratory Diseases Vol.64 No.1

연구배경: 기관지 내시경으로 조직 검사가 불가능한 고립성 폐결절 환자에서 경피적 폐생검이 중요한 진단 방법으로 사용되고 있으나, 기흉 및 출혈 등의 합병증 및 접근성 등이 문제가 된다. 흑색종항원유전자(Melanoma Antigen Gene, MAGE)는 악성 흑색종에서 처음 발견된 20 종양 항원 및 유전자로서, 비소세포폐암을 비롯한 다양한 암종에서 발현되며 정상 조직에서는 남성의 생식기 세포 및 태반에서만 발현된다. 본 연구는 기관지내시경으로 보이지 않았던 비소세포폐암 환자에서 기관지 세척액을 이용한 MAGE 양성 여부를 검사하여 폐암의 진단에 어느정도 도움이 되는지 알아보고자 하였다. 방 법: 2007년 1월부터 2개월간 삼성서울병원 호흡기 내과에서 기관지 내시경을 시행한 환자 중에서 내시경적 조직 검사가 불가능한 고립성 폐결절 환자 37명을 대상으로 하였다. 기관지 세척을 시행하여 MAGE A1-6 RT-nested PCR (iC&G Co, Daegu, Korea)검사와 세포진 검사를 시행하였고, 경피적 폐생검 및 수술을 통한 병리학적인 진단과 비교하였다. 결 과: 37명 중에서 비소세포폐암 환자는 21명(56.8%) 이었고(선암종 13/21, 편평상피세포암 8/21), 나머지 16명 (43.2%)은 폐결핵(5), 진균 감염(3), 기질화 폐렴(2) 및 유육종증, 비결핵 항산균 폐질환과 선천성 낭종 등으로 진단 되었다. 비소세포폐암 환자에서 세포학적인 검사의 양성률은 9.5% (2/21)에 불과하였으나, MAGE mRNA는 47.6% (10/21)에서 양성을 보여 양성 예측률이 71.4%였다. MAGE 양성률은 편평상피세포암에서 더 높게 나타났다 (선암종 30.8%, 편평상피세포암 75.0%, p>0.05). 양성 병변으로 진단된 16명의 MAGE 발현율은 25.0% (4/16)였다. 결 론: 기관지 세척액을 이용한 MAGE 검사는 기관지 내시경을 통한 조직검사가 불가능한 고립성 폐결절에서 기존의 세포진검사에 비해 우수한 양성 예측률을 나타내어 폐암의 진단에 도움이 될 것으로 보인다. Background: The melanoma antigen-encoding ( MAGE) genes are known to be expressed in various cancer cells, including non-small cell lung cancer (NSCLC), and are silent in all normal tissues except for the testis. In patients with peripheral NSCLC, bronchial washing fluid can be used to detect the MAGE genes, suggesting a diagnosis of lung cancer. In order to evaluate the diagnostic utility of the MAGE test in patients with peripheral NSCLC, bronchial washing fluid was investigated in patients with peripheral pulmonary nodules, which were invisible as detected by bronchoscopy. Methods: Bronchial washing fluid from 37 patients was used for cytological examinations and MAGE gene detection, using RT-nested-PCR of common A1-A6 mRNA. Results were compared to a final diagnosis of patients as confirmed by pathology. Results: Among the 37 subjects, NSCLC was diagnosed in 21 patients, and benign pulmonary diseases were diagnosed in 16 patients. MAGE mRNA was detected in 10 of 21 (47.6%) NSCLC patients, while conventional cytology examinations were positive for MAGE expression in 2 of 21 (9.5%) cases. MAGE expression was observed in 4 of 16 (25%) benign pulmonary disease patients. Conclusion: The MAGE test of bronchial washing fluid can be used as a sensitive predictor of peripheral NSCLC patients. (Tuberc Respir Dis 2008;64:15-21)

Escherichia coli 패혈증 환자에 합병된 대칭적 하지 말단 괴사증 1예

남해성,유진홍,권순석,민준기,조현선,박민경,심병주,남유정,이지인,김진수,길욱현,조근종,신완식 대한감염학회 2005 감염과 화학요법 Vol.37 No.6

We have encountered a rare case of symmetrical peripheral gangrene complicating Escherichia coli sepsis in a 47-years-old male. He was successfully treated with antibiotics, anticoagulants, and vasodilator. To our knowledge, this is the first report on symmetrical peripheral gangrene complicating E. coli sepsis in Korea.