소아의 급성 천식발작에서 아미노필린의 효능과 안전성에 대한 재조명

윤운기,최준기,고지연,김문섭,김효빈,Takao Fujisawa,김창근 대한 소아알레르기 호흡기학회 2007 Allergy Asthma & Respiratory Disease Vol.17 No.3

Purpose : Although methylxanthines (aminophylline or theophylline) have an equivalent bronchodilator effect on inhaled β2-agonists, the GINA guidelines recommend methylxanthines as an alternative to methylxanthines becamse of their side effects. The Japanese Pediatric Guidelines for the Treatment and Management of Asthma (JPGTMA 2005), however, recommends methylxanthines for the treatment of asthma attack along with systemic corticosteroids. We aimed to determine whether the addition of intravenous (IV) aminophylline with both IV corticosteroids and inhaled β2-agonists would improve asthma symptoms better and earlier without serious adverse effects. Methods : Thirty-seven children with acute asthma exacerbation were studied. Twenty patients were treated with a combination of IV corticosteroids, inhaled β2 agonists and IV aminophyllines (Group A), and 17 patients were treated with IV corticosteroids and inhaled β2 agonists only (Group B). We evaluated the changes of symptom scores, including degrees of wheezing, retraction, orthopnea, cyanosis and SpO2, before and after treatment in both groups. Results : Group A patients showed faster improvement in asthma symptom score (P<0.05) and significantly faster resolution of wheezing (P<0.05) than Group B patients. In Group B, patients with prolonged wheezing (>72 hours) resulted in need for larger dose of systemic steroids (P<0.05). Although adverse effects occurred in 20% of Group A patients, all of which them were not serious without the need for drug withdrawal. Conclusion : IV aminophylline may be a therapeutic option for children with acute asthma exacerbation. Further evidence is needed to substantiate the conclusion. 목 적 : 메틸잔틴은 흡입된 β2-항진제처럼 기관지 확장 효과가 있으나, 부작용에 대한 염려 때문에 GINA에 따르면 메틸잔틴은 대체치료로만 사용할 것을 권장한다. 하지만 이와는 다르게 일본 소아천식 치료 및 관리 가이드라인(JPGTMA 2005)에 의하면 전신적 부신피질호르몬과 함께 사용하는 것을 권장하고 있다. 본 연구는 부신피질호르몬과 흡입성 β2-항진제에 아미노필린의 추가 투여가 큰 부작용이 없이 천식증상을 더 빠르고 더 잘 완화시키는지를 알아보고자 하였다. 방 법 : 37명의 급성 천식발작을 보인 환아들을 대상으로 하였고, 20명의 환자들(A군)은 전신적 부신피질호르몬과 흡입성 β2-항진제에 아미노필린을 추가로 정주하였고, 나머지 17명(B군)은 전신적 부신피질호르몬과 흡입성 β2-항진제만으로 치료받았다. 치료 전후의 천명의 정도, 흉부함몰, 기좌호흡, 그리고 SpO2를 포함하는 증상점수를 평가하였다. 결 과 : A군 환아들은 B군에 비해서 천식 증상점수가 빠른 호전을 보였으며,(P<0.05) 천명이 의미있게 감소하는 것을 알 수 있었다.(Logrank test P<0.05) B군에서 72시간 이상 천명을 보이는 환자들은 72시간 이내로 천명을 보인 환아들에 비해 더 많은 전신적 부신피질호르몬을 투여받았다.(P<0.05) 아미노필린의 부작용은 A군의 20%에서 나타났지만, 모두 심각한 경우가 아니었고, 약의 투여를 중단할 정도도 아니었다. 결 론 : 아미노필린은 급성 천식발작이 있는 우리나라 천식소아에게 좋은 치료선택이 되겠다. 이러한 결론을 뒷받침하기 위해서는 더 많은 연구가 지속되어야 하겠다.

소아의 급성 천식발작에서 아미노필린의 효능과 안전성에 대한 재조명

윤운기 ( Un Ki Youn ),최준기 ( Jun Gi Choi ),고지연 ( Ji Yeon Koh ),김문섭 ( Mun Seop Kim ),김효빈 ( Hyo Bin Kim ),김창근 ( Chang Keun Kim ) 대한소아알레르기 및 호흡기학회 2007 소아알레르기 및 호흡기학회지 Vol.17 No.3

우리나라에 서식하고있는 바퀴벌레의 분포에 관한 연구

전희경,윤운기,김성원,이용석,김광호,김명진,김정근,김대식,김효신,유인석,이수영,정병주,김동수,이기영,이한일 대한천식알레르기학회 1992 추계학술대회 초록집 Vol.1992 No.-

The Difference of Each Angiographic Finding After Multiple Stent According to Stent Type in Bilateral Vertebral Artery Dissection

이동훈,윤운기,백민우,김훈 대한뇌혈관외과학회 2013 Journal of Cerebrovascular and Endovascular Neuros Vol.15 No.3

We report a case of spontaneous bilateral intracranial vertebral artery dissecting aneurysms with subarachnoid hemorrhage. One dissecting lesion was treated with a coronary balloon-mounted stent (BMS) technique; however, due to differences in access route tortuosity, the other lesion was treated with a self-expandable stent (SES) technique. After 2 months, the angiographic outcome showed complete healing of the dissected segment on the side that was treated with BMS; in contrast, the dissection lesion appeared to be re-growing on the side that was treated with SES. Complete treatment of the aggravated lesion was achieved by additional deployment of BMSs. Therefore, we have provided a discussion of the possible reasons for this difference in outcome according to the stent type.

아토피 피부염에서 감마 인터페론의 치료효과

정선희,오수경,윤운기,오지섭 대한 소아알레르기 및 호흡기학회 1999 소아알레르기 및 호흡기학회지 Vol.9 No.2

목 적 : 아토피 피부염은 소아의 약 10%에서 발생하는 유병율이 높은 질환으로서 만성적 경과를 취하며 극심한 소양증과 알레르기 질환에서 보이는 면역학적인 이상을 특징으로 한다 최근에는 아로피 피부염의 치료로 여러 가지 부작용을 보이는 스테로이드 등의 기존 치료제 보다 면역학적 이상을 교정해주는 치료 방법들이 시도되고 있으며 이중 하나가 감마 인터페론의 사용이다. 아토피 피부염은 Th2 세포에서 생성되는 IL-4와 IL-5가 증가되어 있으므로, Th1 세포에서 생성되는 감마 인터페론이 IL-4와 IL-5 mRNA 발현을 억제하여, 아토피 피부염을 호전시키리라 생각되어진다. 본 연구에서는 아토피 피부염 환아에게서 감마 인터페론의 치료 효과와 치료 후의 재발율을 조사하여, 감마 인터페론의 치료율 및 치료 지속효과를 보았다. 또한 치료 전후에 혈중 총 백혈구 수, 혈중 총 호산구 수, 백혈구에서 호산구가 차지하늘 비율 및 IgE 농도를 측정하여 치료 및 재발에 영향을 미치는 객관적인 지표를 관찰하였다. 방 법 : 최소 일년 이상의 만성적인 경과를 보이며, 6개월 이상 항히스타민제재 및 스테로이드로 간헐적인 치료를 하였으나 증상 호전이 없었던 12명의 환아를 대상으로 하였다. 각 환아는 치료 전, 치료 2주, 치료 12주, 치료종료 12주 후에 일반 혈액검사와 IgE농도를 측정하였다. 감마 인터페론은 총 12주 동안 체표면적당 200만 단위로 총 25회 피하주사하였으며, 첫째 주는 5일간 매일 주사하였으나, 그후 투여간격을 점차 늘여 마지막 4주는 주 1회 투여하였다. 결 과 : 대상 환아 12명 모두에게서 치료 효과가 있었으며 치료 기간 중 투여간격을 늘리는 동안에도 임상증상의 악화는 관찰되지 않았다. 치료 종료 4주 후에도 재발 환아는 관찰되지 않았으며, 치료 종료 12주 후의 추적검사 상 총 5명의 환아에게서 임상증상의 악화가 관찰되었다. 혈액학적 검사상 혈색소, 헤마토크리트, 백혈구 수, 혈소판 수 백혈구에서 호중구의 구성비율 및 IgE는 치료 전후에 변화를 보이지 않았다. 혈중 총 호산구의 수 및 백혈구에서 호산구가 차지하는 구성 비율은 치료 시작 후 감소되었으며, 치료 종료 12주 후의 추적검사 상, 재발군에서 총 호산구의 수 및 백혈구에서 호산구가 차지하는 비율은 다시 의미있게 중가하였다. 그러나 계발유무를 치료 시작 전에 미리 예측할 수 있는 임상 및 혈액학적 지표는 없었다. 결 론 : 감마 인터페론은 기존의 치료에 반응하지 않는 아토피 피부염 환아에게서는 좋은 치료 결과를 보였으며, 특별한 부작용도 관찰되지 않았다. 그러나 치료 종료 12주에 총 5명의 환아가 재발하여 약 40%의 높은 재발율을 보였다. 혈중 호산구 수 및 백혈구에서 호산구가 차지하는 비율은 감마 인터페론 치료 후 의미 있게 감소하였으며, 계발 환아에게서 다시 의미 있게 증가하여 치료 효과 및 재발을 알 수 있는 의미 있는 지표로 생각되어진다. 만성적인 계발 환아를 위한 치료로는 장기간의 감마 인터페론 사용을 생각해 볼 수 있으며, 장기간 치료 시 투여 간격 및 부작용에 대한 더 않은 연구가 필요하다. Purpose : Atopic dermatitis is a chronic, inflammatory skin disease characterized by intense pruritus and an immunologic profile consistent with allergic disease. It is associated with increased eosinophil and IgE level and decreased INF-γ production. We describe the result of a treatment with INF-γ and assess the clinical, immunologic, and laboratory data of 12 patients with atopic dermatitis. Methods : Twelve patients were treated for 12 weeks with 2×10 exp (6) units/㎡ INF-γ by subcutaneous injection. General hematologic tests were done, and total eosinophil counts, eosinophil fractions, neutrophil fractions, and IgE levels were measured before the treatment, 2 weeks after the treatment, 12 weeks after the treatment serially. We also followed up the patients for 12 weeks after discontinuing INF-γ therapy. Results : All patients showed clinically significant improvement after 12 weeks of the systemic INF-γ therapy. There was no clinical aggravation during the therapy period and the follow-up 4 weeks without the therapy. But the recurrence rate in the 12 weeks after discontinuing the therapy was about 40%. Eosinophil counts and eosinophil fractions were significantly decreased after the therapy. And, eosinophil counts and eosinophil fractions were increased in clinically aggravated patients during the 12 weeks of off-therapy. Conclusion : We conclude that INF-γ is an effective therapy in atopic dermatitis without significant side effects. The eosinophil counts and eosinophil fractions were decreased during the INF-γ therapy, and increased in clinically aggravated patients after the off-therapy. There was no aggravation during the therapy. But 5 patients were clinically aggravated during the 12 weeks of off-therapy. Further studies for a long-term maintenance therapy and its side effect might be needed in chronic atopic dermatitis.

경련을 동반한 색소 실조증 예

서영옥,이균우,윤운기,오지섭,서기석,김상태 임상약학사 1993 臨床藥學 Vol.13 No.2

소아 알레르기 자반증에 대한 임상적 고찰

정선희,정종원,윤운기,오지섭 대한알레르기학회 1998 천식 및 알레르기 Vol.18 No.4

Background and objective: The clinical manifestation of Henoch-Schonlein purpura and existance of renal involvement may influence on its course and prognosis. To verify prevention with early administration of steroid, we studied the efficacy of corticosteroid treatment. Material and method: We analysed 65 children under 15 years of age with Henoch-Scho nlein purpura according to their age, sex, and seasonal incidence. Forty children showed typical skin lesions, arthralgia and abdominal pain. We have divided them two groups. Group A consisted of 20 children who received 1 mg/kg of prednisolone/perday for 2 weeks and group B did not. We carried out their physical examination and urinalysis monthly for a year. Result: The main clinical manifestations were skin rash(100% ), abdominal symptoms(41.5 %), joint symptoms (49.2%), and renal involvement(34%). As for gastrointestinal symptoms, abdominal pain(66.7% ) was most commonly observed one and others were nausea or vomiting (44.7%) and melena(25.9%). The joint involvement was observed mostly in knee(56.3%) and ankle joint(31.3% ), Hematuria was observed in all cases with renal involvement and proteinuria, in 28% of them. The improvement of renal manifestations were noted in 84.2% of them within 4 months. Mild elevation of IgA was more frequently observed in renal involvement group than non-involved group (p$lt; 0.01). There were no significant differences in immonologic parameters such as IgG, IgM, IgE, duration of the acute phase and severity of cutaneous symptoms between two growps. None of steroid treated growp showed progression of nephropathy. Of the 20 non-steroid treated growp, 2(10%) developed nephropathy. Conclusion We may suggest that existance of renal involvement in Henoch-Schonlein purpura influences its course and prognosis.

우리나라에서 서식하고 있는 바퀴벌레의 분포에 관한 연구

권순완,오신근,윤운기,김성원,이용석,김광호,김명진,김정근,김대식,김효신,유인석,이수영,정병주,김규언,김동수,이기영,이한일 대한천식알레르기학회 1993 천식 및 알레르기 Vol.13 No.3

Studies on the infestation rate and population density of cockroaches have been investigated in Seoul, Pusan and Junbuk district for one month in May 1992. The sampling of the cockroaches in the study were conducted in the kitchens, bed- rooms, floors, and toilets in huses of 73 Allergic patients. Allergic patients who lived in Seoul, Pusan, and Junbuk district were selected. A sticky trap were used to attract cockroaches. The results are summerized as follows ' 1) The cockroaches were collected in 58 houses out of a total of 73 houses. This corresponds to a 78.1 percent infestation rate of cockroaches. The average number of cockroaches collected per house was 22.8. B. germanica was the most Common species, showing 81.2 percent of the collected cockroaches, followed by P.japonica(9.1%), P.fuligionsa(4.8% ), and P americana(4.5%). 2) P. japonica were collected almost uniformly in those three districts, but P. fuliginosa and P. americana were mainly collected in the Pusan district. 3) Houses in poor sanitation and those with an installed central heating system showed higher infestation rates. 4) The average number of cockroaches collected in patients houses whose residents sho- wed positive results to allergy skin test were 32.4. This number was significantly higher than that of cockroaches collected in the houses negative allergy skin test patients, where. 18.2 was the average number of cockroaches.

소아 기관지천식에서 면역요법 효과판정

신효경,최은진,윤운기,오지섭 대한천식알레르기학회 1991 천식 및 알레르기 Vol.11 No.4

This study was performed to know which parameters are clinically useful to evaluate the effect of immnotherapy We selected sixteen asthmatic children who showed strong reactivity to Dermatophagoides pteronyssinus(Dp) on skin test and RAST and showed clinical improvement after 1 year of imunotherapy. We measured the changes of skinreactivity, serum levels of Dp-IgE, Dp-IgG, and pulmonary function test before and after immunotherapy and tried to evaluate the relationship between the immunologic and pulmonary function changes and clinical improvement The results are as follows '. 1. Dp-spcific IgE level was decreased significantly, (P<0. 01) 2. Dp-spcific IgG, level was increased, 3. Index of skin reactiVities was decreased, 4. At, Pulmonary function test FEVand PEFR was significantly improved. (P<0.01)

소아 기관지천식 환자에서 혈액과 타액중의 Theophylline농도의 연관성에 관한 연구

오신근,권순한,윤운기,류한선,손기호,Charles D.Sands 대한천식알레르기학회 1993 천식 및 알레르기 Vol.13 No.1

Theophylline is widely used in Korean Pediatric patients in the treatment of asthma and neonatal apnea. To achieve adequate bronchodilation and avoid side effects, It is generally accepted that the serum theophylline concentration should be maintained between 10 and 20 mcg/ml. The measurement of this serum concentration usually requires a 3-5cc blood sample which on many occasions is repeated several times. In the pediatric population, especially, this exposes the children to multiple venipuncture with its potential associated trauma. To evaluate the reliability of salivary theophylline levels as a guide to serum theophylline levels, we studied the twenty of asthmatic children, who were admitted to our hospital and received intravenous aminophylline and oral sustained release theophylline. The mean theophylline concentration of Group I were 10.11+- 4.89mcg/ml in serum and 6.09+- 3.24mcg/ml in saliva. A strong correlation between the serum and saliva theophvlline levels, r=0.87, was noted and it is statistically significant. Regression Equation was se- rum conc. = 1.3050 X saliva conc. 2.1624. Also there was a good correlation between the predicted and actual theophylline concen trations, r=0.78, and no significant diR'erence between two values in Group II. These suggest that the determination of salivary theophylline concentration may be a convenient, noninvasive method for routine monitoring of serum theophylline concentration.