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기관지 천식 환자에서 단기간의 부신피질호르몬제 투여가 뇌하수체 및 부신피질 기능에 미치는 영향
김옥란(Ok Lan Kim),서승천(Seung Cheon Seo),허성호(Sung Ho Hue),최병휘(Byung Hue Choi),배혜상(Hae Sang Bae),성천모(Cheon Mo Seong),이재용(Jae Yong Lee),최민석(Min Seok Choi),이원돈(Won Don Lee) 대한내과학회 1989 대한내과학회지 Vol.36 No.1
N/A Short-term, high dose corticosteroid therapy is often required for control of acute asthma episodes. To evaluate possible Hypothalamic-Pituitary-Adrenal (HPA)-axis suppression and recovery after such therapy, we studied 7 patients with adult acute asthma before and at 1, 3 and 7 days after completion of a 12 day course of corticosteroid. Corticosteroid was administered as a loading dose (methylprednisolone which was equivalent to 4 mg of hydrocortisone/kg body weight) and maintenance dose (equivalent to 3mg of hydrrcortisone/kg body weight/6 hours) for 3 days, followed by prednisolone (usual start dose was prednisolone 60 mg as a single daily morning dose). The dose was then reduced in half every 3 days. The function and reserve of the HPA-axis were evaluated with basal plasma cortisol, ACTH and short corticotropin stimulation tests. The results obtained were as follows: 1. Baseline plasma cortisol, ACTH, and cortisol responses to corticotropin before corticosteroid treatment were 10.3±5.6 ㎍/dl, 25.4±8.4 /㎍/ml, and 17.7±6.2 ㎍/dl, respectively. 2. One day after corticosteroid therapy, plasma cortisol and ACTH levels (3.9±2.4 ㎍/dl, 9.2±9.0 pg/ml) were significantly reduced compared to pretreatment levels (p<0.01. p<0.01), but the cortisol responses to corticotropin were preserved. 3. Three days after concluding the corticosteroid therapy, plasma cortisol and ACTH levels had returned to 68.9% and 71.7% of the pretreatment levels respectively, and were restored to near pretreatment baseline levels 7 days after treatment. These data suggest that a brief course of high dose corticosteroid treatment may limit the adrenal component of HPA responses for up to 7 days and patients may be at risk if they encounter major surgery or infection during this time.
늑막액에서 Cholesterol 측정의 진단적 의의에 관한 연구
이원돈(Won Don Lee),김옥란(Ok Ran Kim),이재용(Jae Young Lee),성천모(Chun Mo Sung),배혜상(Hae Sang Bae),서승천(Seung Cheon Seo),최병휘(Byung Hue Choi),허성호(Sung Ho Hue) 대한내과학회 1989 대한내과학회지 Vol.36 No.1
N/A The cholesterol of pleural fluids was measured in 30 patients various diseases with pleural effusion to investigate the utility of differential diagnosis of exudates from transudates. Six cases were pleural transudates and 24 cases were pleural exudates as by classified predefined criteria. The results were as follows: 1) Mean protein level in group 1 (transudates) was l.9±0.8 g/dl and 4.8±0.9 g/dl in group 2 (exudates). Mean pleural fluid to serum ratio in group 1 was 0.30±0.11 and 0.80±0.48 in group 2. 2) Mean LDH level was 40X29 IU in group 1 and 325+271 IU in group 2. Mean pleural fluid to serum ratio was 0.20±0.11 in group 1 and 2.01±1.90 in group 2. 3) Mean cholesterol level was 37±14 mg/dl in group 1 and 97±42 mg/dl in group 2. Mean pleural fluid to serum ratio was 0.18±0.06 in group 1 and 0.71±0.32 in group 2. 4) A protein level of 3.0 g/dl, LDH level of 200 IU, cholesterol level of 60 mg/dl and their pleural fluid to serum ratios of 0.5, 0.6 and 0.3 respectively were used as dividing lines separating transudates from exudates, and 0% was misclassified in group 1. Misclassified effusions in group 2 for each single parameter were: protein 0%, protein ratio 4%, LDH 29%, LDH ratio 20%, cholesterol 20%, cholesterol ratio 0%, and Light criteria 4%. We found the use of cholesterol level to be superior to the measurement of LDH level and inferior to protein level. The ratio of pleural fluid to serum cholesterol markedly improved the result. On the basis of the above results, it is suggested that pleural fluid cholesterol is a useful index in differentiating exudative from transudative pleural effusions.