소아 중환자실에 입원한 혈액-종양 환아에서 발생한 폐 합병증의 원인과 예후에 대한 분석

정진영,홍수종,안영준,김자형,서종진,문형남,김태형,Jung, Jin Young,Hong, Soo-Jong,An, Young Jun,Kim, Ja Hyung,Seo, Jong Jin,Moon, Hyung Nam,Ghim, Thad 대한소아청소년과학회 2002 Clinical and Experimental Pediatrics (CEP) Vol.45 No.8

Purpose : In the course of treatment, patients with hematological or oncological disorders often develop pulmonary complication. The patients who develop a severe pulmonary complication have a poor outlook. The causes of pulmonary complication are either infectious or non-infectious in origin. We have analyzed the etiology and outcome of these patients admitted to the pediatric intensive care unit of Asan Medical Center. Methods : Medical records of 95 patients on Pediatric oncology service who were admitted to pediatric intensive care unit(PICU) of Asan Medical Center from Jan 1997 to May 2000 were retrospectively reviewed. Results : The mean age of the patients was 8.5 years(2 months-18 years). The underlying malignancies of these 95 patients were as following; acute lymphoblastic leukemia(31 cases), lymphoma (11 cases), acute myeloid leukemia(nine cases), brain tumor(eight cases) and other solid tumors(25 cases). Pulmonary complications included pneumonia, acute respiratory failure, pneumothorax and pleural effusion. The most common cause of pulmonary complication was infection(88%) in etiology. The overall mortality rate was 56.8%. Pulmonary complications in these patients carried high rates of mortality regardless of whether they were immune compromised(76%) or not(69%). Even without pulmonary complications, the hematological or oncological patients admitted to PICU had high mortality rates of 43%. Conclusion : Pulmonary complications are frequent finding in the hematological or oncological patients admitted to Intensive Care Unit. The main etiology of these pulmonary complications was infection, which carried a high mortality rate regardless of their immune status at the time when they were admitted to PICU. 목 적 : 혈액-종양 환자에서 항암화학요법으로 치료하는 과정 중에서 중증 폐 질환 합병증이 발생할 수 있다. 그 원인으로는 감염성 또는 비 감염성의 원인들이 있고 특히 이들 환자에서 폐 질환 합병증 또는 호흡부전으로 인한 인공환기 치료시에는 예후가 나쁘다고 알려져 있다. 저자들은 본원 소아 중환자실에 입원한 혈액-종양 환아에서 면역 저하상태(절대 호중구수 < $1,000/mm^3$)의 지표의 하나인 호중구 감소증과 폐합병증의 유무에 따른 원인과 예후를 분석하였다. 방 법: 1997년 1월부터 2001년 5월까지 서울중앙병원 소아 중환자실에 입원한 혈액-종양 환아 95명의 의무기록을 후향적으로 분석하여 폐 합병증의 원인과 진단 방법, 호중구 감소상태와 폐 합병증의 유무에 따른 사망률을 분석하였다. 결 과 : 연령 분포는 생후 2개월에서 18세까지 평균 8.5세였고, 원인 혈액-종양 질환으로는 급성 림프성 백혈병 31명, 급성 골수성 백혈병 9명, 림프선 종양 11명, 뇌종양 8명, 고형종양 25명, 그 외 혈액질환이 11명이었다. 95명의 환아 중 중환자실 입원당시의 원인으로는 패혈증 23명(24%), 패혈증을 동반한 폐렴 22명(23%), 급성 호흡부전 12명(12.5%), 의식소실 16명(17%), 급성 신부전, 심부전의 기타 질환이 15명(16%)이었다. 이들 중에서 폐 합병증을 동반한 환아는 42명(44%), 동반하지 않은 환아는 53명(56%)이었다. 폐 합병증으로는 폐렴, 늑막삼출, 급성호흡부전, 기흉이 있었다. 폐 합병증이 있는 환아 중 호중구 감소상태의 환아는 29명(69%), 호중구 감소상태가 아닌 환아는 13명(31%)이었다. 원인으로는 감염성인 경우가 37명(88%), 비 감염성인 경우가 2명(5%)이었고, 구분이 어려운 경우가 3명(7%)이었다. 시행된 각각의 검체에서 균이 검출된 빈도를 비교하면 혈액배양검사는 42명중 15명(36%), 객담검사는 42명 중 7명(16%), 소변 배양검사는 42명 중 3명(7%), 인공환기요법 중인 환아에서 시행한 기도내 분비물 배양검사는 28명 중 5명(18%)이었다. 주요 원인균으로는 Candida species 12명(33%), MRSA 6명(17%), Pseudomonas aeruginosa 4명(11%), Klebsiella pneumoniae 4명(11%)이었다. 골수이식술을 받은 환자는 모두 10명으로 이중 7명에서 폐 합병증이 있었고, 원인균이 동정된 경우는 모두 3명으로 각각 S.maltophilia, K.pneumoniae, Parainfluenza virus이었다. 10명의 환아 중 8명이 사망하였고 사망 원인으로는 폐혈증이 5명, 급성호흡부전 증후군이 2명, 뇌출혈이 1명이었다. 전체 사망률은 56.8%였고, 사망률을 보면 이중 폐 합병증이 있고 호중구 감소상태의 환아는 76%(22명), 폐 합병증이 있으나 호중구 감소상태가 아닌 환아는 69% (9명), 폐 합병증이 없으나 호중구 감소상태의 환아는 46%(7명), 폐 합병증이 없으며 호중구 감소상태가 아닌 환아는 43%(16명)이었다. 결 론 : 중환자실에 입원한 혈액-종양 환아에서 폐 합병증의 원인으로 감염성인 경우가 많았다. 사망률은 폐 합병증이 있는 경우가 없는 경우에 비해 높았으며, 특히 폐 합병증이 있는 환아 중 호중구 감소상태의 환아에서 사망률이 높았다. 이 결과로 미루어 폐 합병증이 있는 혈액-종양 환자에서 더 적극적인 원인 규명과 치료를 시도해야 할 것으로 생각된다.

The Vasodilating Mechanism of Atrial Natriuretic Peptide in 2-kidney 1 Clip Renovascular Hypertensive Rats

정진영,안영철,김헌식,고규영,안희열,김명석,Jung, Jin-Young,Ahn, Young-Chul,Kim, Hun-Sik,Koh, Gou-Young,Ahn, Hee-Yul,Kim, Myung-Suk The Korean Society of Pharmacology 1996 대한약리학잡지 Vol.32 No.1

본 연구의 목적은 2-kidney 1 clip (2K-1C) 신혈관성 고혈압흰쥐에서 심방이뇨펩이드의 혈관 이완작용의 기전을 규명하고 정상혈압흰쥐에서의 혈관이완작용과 비교하는 것이다. 2K-1C 신혈관성 고혈압흰쥐는 정상혈압흰쥐에 비하여 평균동맥압의 유의한 상승과 혈장레닌활성의 증가가 관찰되었다. 2K-1C 신혈관성 고혈압흰쥐의 대동맥에서 norepinephrine (NE)의 수축력의 감수성 및 최대 수축력이 정상혈압흰쥐의 대동맥보다 증가하였다. 심방이뇨펩타이드는 NE에 의한 수축을 농도-의존적으로 각각의 혈압군에서 억제하였다. 그러나, 2K-1C 신혈관성 고혈압흰쥐에서 심방이뇨펩타이드의 NE 억제 작용은 전체적으로 정상혈압흰쥐에서 보다 감소되었다. 그러나 최대 용량의 심방이뇨펩타이드의 NE 이완작용은 양 고혈압군에서 차이가 없었다. 2K-1C 신혈관성 고혈압흰쥐에서 NE에 의하여 $Ca^{2+}$의 유입이 유의하게 증가하였고, 심방이뇨펩타이드는 이 증가를 억제하였다. 정상혈압흰쥐에서도 심방이뇨펩타이드는 NE에 의하여 유의하게 증가된 $Ca^{2+}$의 유입을 억제하였다. 이상과 같은 결과로 볼 때 정상혈압흰쥐와 2K-1C 신혈관성 고혈압흰쥐의 심방이뇨펩타이드의 이완작용의 기전에는 $Ca^{2+}$의 유입 차단이 관여할 것으로 추측되며, 이때 심방이뇨펩타이드의 NE 수축억제에 대한 potency는 2K-1C 신혈관성 고혈압 흰쥐에서 감소하였으나 efficacy는 정상혈압흰쥐와 비교하여 변함이 없음이 관찰되었다. The objectives of this study is to find out mechanism of vasodilating effects of ANP in 2K-1C renovascular hypertensive rat aorta and to compare with those of normotensive rat aorta. In 2K-1C renovascular hypertensive rat, average arterial blood pressure and plasma renin activity were higher than in normotensive rat. In 2K-1C renovascular hypertensive rat aorta, NE sensitivity was more increased and maximal contraction of aorta by NE was higher than those of normotensive rat aorta. ANP inhibited NE-induced contraction in both 2K-1C renovascular hypertensive and normotensive rat aorta, concentration-dependently. However, ANP was less effective for relaxing NE-induced contraction in 2K-1C renovascular hypertensive rat aorta than in normotensive rat aorta. ANP inhibited $^{45}Ca^{2+}$ uptake induced by NE in both 2K-1C renovascular hypertensive and normotensive rat aorta. From these results. inhibition of $Ca^{2+}$ influx may be one of the vasodilating mechanism of ANP in 2K-1C renovascular hypertensive rat aorta. Although the potency of ANP in relaxing NE-induced contractions was attenuated, the efficacy of ANP was not changed in 2K-1C renovascular hypertensive rat aorta compared with that of ANP in normotensive rat aorta. Abbreviations: ANP, Atrial natriuretic peptide; 2K-1C, 2-kidney 1 clip; NE, norepinephrine; SHR, Spontaneously hypertensive rat; DOC, Deoxycorticosterone; EDTA, Ethylenediaminetetra-acetic acid; PSS, Physiological salt solution; TRIS, tris(hydroxymethyl) aminomethane

식도 평활근종증이 동반된 Alport 증후군 1례

정진영,김철민,임연정,김자형,유종우,최보화,홍수종,박영서,Jung, Jin Young,Kim, Cheol-Min,Lim, Yean Jung,Kim, Ja Hyung,You, Chong Woo,Choi, Bo-Hwa,Hong, Soo-Joung,Park, Young Seo 대한소아청소년과학회 2002 Clinical and Experimental Pediatrics (CEP) Vol.45 No.9

저자들은 반복적인 천명과 폐렴을 주소로 내원한 환아에서 식도 평활근종이 동반된 Alport 증후군 1례를 경험하였기에 보고하는 바이다. We report a case of Alport syndrome associated with esophageal leiomyomatosis, presenting as recurrent pneumonia. A 5-year old girl who had a history of cataract visited the out patient clinic with a complaint of recurrent wheezing and respiratory difficulty which had started five months previously. Chest magnetic resonance image(MRI) and esophagography, checked on the suspicion of achalasia, revealed esophageal leiomyomatosis and renal biopsy revealed Alport syndrome. In the pediatric population, this tumor is a rare cause of dysphagia and is often misdiagnosed as an esophageal motility disorder. Although a number of Alport syndrome associated with leiomyomatosis were reported in the literature, this is a second case report presented with recurrent pneumonia in Korea.

통규탕(通竅湯)이 알레르기 비염 모델 횐 쥐에 미치는 영향

정진영,김윤범,Jung, Jin-Young,Kim, Yoon-Bum 대한한방안이비인후피부과학회 2005 한방안이비인후피부과학회지 Vol.18 No.2

Background and Objectives: Allergic rhinitis is an allergic reaction characterized by sneezingm itchy nose, mouth and throat, congestion and/or nasal discharge. The offending allergenes are usually pollens, molds, dust mites and animal allergen. Recently, the incidence of infectious nasal diseases tend to decrease. However, allergic rhinitis has increased and treatment in most cases has only deat with the symptom. Tongkyu-tang was composed of sixteen crude drugs. The Oriental Medical References mention therapeutic effects of Tongkyu-tang on nasal obstruction, watery nasal discharg. And Tongkyu-tang has clinically been used for the treatment of common cold, headache, sternutation, rhinitis etc. Speacially Tongkyu-tang is one of the most frequently used medical treatment for the allergic rhinitis. Experimental studies were conducted to investigate for the effect of Tongkyu-tang on the changes of neutrophil segment, lymphocyte, total IgE and nassal tissue in allergic rhinitis of ovalbumin-inhalation rat. Meterial and Methods: Fifteen Sprague-Dawley rats were divided into three group: normal group, control group, experimental group. To induce the allergic rhinitis in control group and experimental group, rats were sentitized intraperitoneally with 0.1 % ovalbumin solution 3 times at intervals of I week. Then intranasal sensitization was performed by diffusing 0.1 % ovalbumin solution 3 times at intervals of 2 days. After that time, rat in the experimental group were oral administration treated by Tongkyu-tang for 28 days. We observed changes in nasal tissue; changes in the number of white blood cell, red blood cell and total Ig E; also changes in the segment of neutrophil and lymphocyte in blood. And we observed the changes of AST, ALT of three group. We used anova test statistically. Result: The number of leucocyte remained unchanged between three group. The number of erythrocyte was increased in experimental group and control group when compared with the normal group. The segment of neutrophil, in blood was decreased in experimental group when compared with the control group but, that was not significant statistically(p<0.05). The promotion of lymphocyte in blood was significantly decreased in experimental group when compared with the Control group(p<0.05). Total IgE was decreased in experimental group when compared with the control group but, that was not significant statistically(p<0.05). The cilium be well preserved in experimental group: the nasal tissue in experimental group was similar to in the normal group. Congestion and expantion of grandular cell in nasal submucosa, hypertropy of epithelium in nasal mucosa, acid mucus in epithelium and neutral mucus in subepithelium were decreased in experimental group when compared with the control group. Effect of Tongkyu-tang on the liver function were also studies in rats. Treatment of Tongkyu-lang did not affected on AST and ALT. Conclusion: Considering the above experimental results, it is suggested that oral administration treatment using Tongkyu-lang, without worry about liver function injury, decreased response on an Animal model with Allergic Rhinitis.

난치성 암성 통증 제어를 위한 뇌정위적 대상회 절개술

정진영,장종희,장진우,박용구,정상섭,Jung, Jin Young,Chang, Jong Hee,Chang, Jin Woo,Park, Yong Gou,Chung, Sang Sup 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.4

Objective : Although cingulotomy has been applied to patients with affective disorders more frequently, there are numerous reports of its use for the control of severe pain. The goal of this study was to investigate the role of stereotactic bilateral anterior cingulotomy for intractable cancer pain. Method : Between January and June, 2000, we underwent stereotactic bilateral anterior cingulotomy in 6 patients for intractable cancer pain with poor response to opioids. The patients were suffering from widespread musculoskeletal or visceral pain. We made four lesions along the two tracks on either side of the cingulate cortex. Result : In all patients, pain reliefs after cingulotomy were dramatic and immediate. Five out of six patients did not require any opioids and one patient could reduce dose of opioids. There were no deaths or serious complications related to the procedure. Conclusion : These results suggested that a bilateral anterior cingulotomy might be useful method to control intractable cancer pain associated with the widespread metastatic disease. To provide rationale of bilateral anterior cingulotomy in intractable cancer pain, the theoretical mechanisms and role of bilateral anterior cingulotomy are discussed, along with our surgical techniques and the course of our patients.

유기성폐기물의 바이오에너지화 현황과 전망

정진영,Jung, Jin-Young 대한환경공학회 2008 대한환경공학회지 Vol.30 No.9

3차원 면진장치의 수직면진을 위한 강댐퍼 개발

정진영(Jung, Jin-Young),구경회(Koo, Gyeong-Hoi),이민석(Lee, Min Seok) 한국강구조학회 2022 한국강구조학회 학술대회 발표집 Vol.33 No.1

손 제스쳐를 이용한 조이스틱 방식의 마우스제어 방법

정진영(Jin-Young Jung),김정인(Jung-In Kim) 한국멀티미디어학회 2016 멀티미디어학회논문지 Vol.19 No.1

다중센서를 이용한 비행체식별에서 공중표적 데이타의 연계

정진영(Jin Young Jung),고봉홍(Bong Hong Go),우영운(Young Woon Woo),김재희(Jaihie Kim),홍인표(In Pyo Hong),조동래(Dong Lae Cho) 대한전자공학회 1994 대한전자공학회 학술대회 Vol.1994 No.11

海寄翁 金欞, 19세기 한 향촌 지식인의 삶

정진영(Jung, Jin-young) 한국인물사연구회 2015 한국인물사연구 Vol.24 No.-

Haeghiong Kim Ryeong(金?, 1577-1641) was a practical intellectual who lived in Hyangchon (meaning a country village in the Joseon Dynasty) in the early and mid-19<SUP>th</SUP> century. In spite of being from an influential family in Danseong-hyeon, Gyeongsang province, he was financially ruined in the 19<SUP>th</SUP> century. Despite under such a situation, Kim Ryeong built friendship with Jeongjae Ryu Chi-myeong(柳致明, 1777∼1861), who was then the master of Namin Party in Yeongnam area and Seongjae Heo Jeon(許傳, 1797~1886), a great scholar in the Namin party in the capital area. His son Kim In-seop even passed the liberal arts state examination called Mungwa(文科) and became Jeongeon, an official working at Saganwon(司諫院, Office of Censors). However, he couldn’t avoid the financial difficulties. Kim Ryeong and his son, who were rusticated in 1858, actively involved in agricultural management. However, exploitation of taxation by the government officials centered on Hwangok(還穀), the grain repayment system was threatening the survival of peasants as well as noble men. In 1862, the residents in Danseong resisted against the exploitation by the public officials. Kim Ryeong, who led the resistance, was exiled to Imjado Island in Jeolla province for two years. He wrote Gangjeongilrok(艱貞日錄), the exile journal and Thousand-Character Classic of All Time(歷代千字文) for teaching the grandchildren. Thousand- Character Classic of All Time also described Korean history. His life was aggressive and intense but not away from the typical life of Confucian scholars. For Kim Ryeong, the resistance in Imsul Year was not different from the forthright advice to the King by the loyalists in a turbulent age. He tried to realize the people-oriented idea of Confucianism by punishing the officials who do not obey King’s order. There were not a few practical intellectuals in the 19<SUP>th</SUP> century who did not give up on such Confucian ideals like Kim Ryeong.