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소아 급성 천식의 치료에서 베타 자극제와 스테로이드제에 추가된 정맥 투여 아미노필린의 효능
나영호(Young Ho Rah),배종우(Chong Woo Bae),정사준(Sa Jun Chung),최용묵(Yong Mook Choi) 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 1998 소아알레르기 및 호흡기학회지 Vol.8 No.1
목 적 : Methylxanthine제의 기관지 확장제인 아미노필린 정맥주사는 그 효능에 대한 근거가 적고 유효 치료 범위가 매우 즘은 단점에도 불구하고 오래 전부터 홉입 베타 자극제와 함께 천식의 급성 악화 환자에서 광범위하게 사용되고 있다. 최근에 급성 천식 상태에서 적절한 베타 자극제에 추가된 아미노필린의 유용성을 검증하고자 하는 연구들이 시행되었으며 여러 연구 결과에 의해서 정맥용 아미노필린의 추가 투여가 아무런 유용한 역할을 하지 못한다는 사실이 제시되었다. 이에 본 저자들은 흡입용 베타 자극제와 부신피질 스테로이드의 정맥 투여에 추가된 정맥용 아미노필린의 효능을 알아보고자 본 연구를 시행하였다. 방 법 : 대상은 1996년 3월부터 1997년 9월까지 18계월동안 경회의대 부속병원 소아과에 급성 기관지천식 발작으로 입원한 만 5세부터 15세까지의 환아 30명을 선정하여 아미노필린을 투여받는 군(아미노필린군, n=15)과 투여받지 않는 군(대조군, n=15)으로 나누었다. 두군 모두 전 입원기간을 통해서 흡입용 albuterol과 정맥으로 methylprednisolone을 투여받았으며 아미노필린군은 정맥용 아미노필린을 추가로 투여받았다. 치료에 따른 효능의 평가는 입원기간, 최대호기속도(PEFR), 천식 증상점수 등을 근거로 하였으며 각 변수에 대해서 Student t-test와 chi-square 분석을 통해서 통계 처리하였다. 결 과 : 아미노필린군과 대조군의 연령, 성비, 치료 전에 측정한 PEFR의 정상추정치에 대한 백분을, 천식 중상점수(asthma symptom score) 및 심박수에서는 두군 간에 유의한 차이가 없었다. 두군의 치료에 따른 결과 변수 비교에서 아미노괼린군과 대조군의 입원기 간은 각각 5.1±1.0일과 5.3±1.2일로 유의한 차이가 없었으며 아미노필린군과 대조군에서 치료 전과 치료 후 24시간의 중상점수 차이는 각각 2.0±1.1점과 1.9±0.9점으로 두군 모두에서 치료후 24시간에 치료전 비해서 증상점수의 유의한 감소를 나타냈으나 두군 사이 에는 유의한 차이가 없었다. PEFR의 정상 추정치에 대한 백분을의 평균치는 아미노필린군과 대조군에서 각각 치료후 12시간에 54그雲4%와 53±19%, 24시간에 58±15%와 60±20%, 48시간에 64±25%와 66±23%, 최종 측정치는 78±30%과 82±28%로 24시간 이후부터는 기저치에 비해 유의하게 증가되었다. 그러나 연구 기간의 어떤 시점에서도 두 군간에 PEFR의 정상 추정치에 대한 백분율의 유의한 차이는 없었다. Albuterol 분무 치료 24시간 동안의 albuterol 투여 횟수는 아미노필련군과 대조군에서 각각 4.5±0.8회와 4.4±0.6회로 유의한 차이가 없었다. 아미노필린군의 평균 혈중 theophylline 농도는 10.2±1.7㎍/mL이었다. 부작용은 아미노필린군에서 더 흔하였으나 유의한 차이가 없었으며 구역(nausea) 및 구토 중상이 아미노필린군에서 가장 흔하였다. 결 론 : 이상의 결과로 급성 천식 발작으로 입원한 경증 및 중둥중 환아의 치료에서의 베타 자극제의 흡입과 전신 스테로이드 투여에 정맥내 아미노필린을 추가로 투여했을 때 대조군에 비해 효과의 차이를 관찰할 수 없었으며 중종의 급성 천식환자에서 아미노필린의 정맥내 투여로 이점을 기대할 수 있을 지에 대한 결정을 위해서 향후 연구가 필요할 것으로 사료된다. Purpose : To determine if intravenous aminophylline adds any efficacy to nebulized albuterol and intravenously administered corticosteroid in children who hospitalized with mild to moderate asthma. Method : Subjects were children between the ages of 5 and 15 years admitted of acute asthma attack to Department of Pediatrics, Kyung Hee University Hospital. All patient received therapy with albuterol delivered with nebulization at 4-6 hour interval and intravenously adminstered methylprednisolone in standardized doses. Thirty patients were recruited to receive either an intravenous aminophylline(n=15) or not(n=15). The outcome variables were:duration of hospitalization, percent of predicted peak expiratory flow rates recorded at 12-hour intervals and side effects. When intravenously administered medications were discontinued, therapy continued with oral administration of theophylline. Twice daily assessments of clinical asthma symptoms were made by using a scoring system consisting of respiratory rate, wheeze and accessory muscle use. Results : 1) There were no significant differences at study entry in age, sex, race, number of previous hospital admission, clinical symptom scores, or initial peak flow rates ` for the two groups. 2) Fifteen patients in the aminophylline group were hospitalized for an mean duration of 5.1 1.0 days, whereas 15 patients in the control group required 5.3 1.2 days. There were no significant differences between the two groups. 3) There was no differences in the absolute changes in their scores two scoring intervals(at 24 hours) between the two groups. 4) The two groups showed no differences in measurements of peak expiratory flow rates at any time interval and at the end of treatment. 5) The mean theophylline level for aminophylline group was 10.2 1.7 ㎍/mL. 6) In the aminophylline group, 6 of 15 patients who entered the study experienced adverse effects consisting of nausea/vomiting, abdominal pain, and irritability. Five of 15 patients in the control group had an adverse effects. There were no significant differences between the two groups for incidence of adverse effects 7) There were no significant differences between the two groups for amount of albuterol therapy required. Conclusion : When the combination of systemically administered corticosteroid and inhaled albuterol is used in hospitalized asthmatic children with mild to moderate asthma, addition of theophylline provided no additional benefit. Further study will be needed to evaluate if patients with more severe asthma exacerbation benefit for the use of intraveously administered aminophylline.
초등학생의 베타용혈성 연쇄구균 보균자 검출에 있어서 인두부 중복배양(duplicate throat culture)의 유용성
차성호,한미영,최용묵,길영철,서진태,Cha, Sung-Ho,Han, Mi-Young,Choi, Yong-Mook,Kil, Young-Chul,Suh, Jin-Tae 대한소아감염학회 1996 Pediatric Infection and Vaccine Vol.3 No.2
Purpose : The most patients with acute streptococcal pharyngitis lack of classic clinical manifestations, therefore diagnostic laboratory test such as the throat culture or a rapid antigen detection test are frequently employed in primary practices of developed countries. We'd like to know the accuracy of the throat swab culture as gold standard for diagnosis of streptococcal infection with studying the discordant and concordant rate of duplicate culture. Methods : The study included 89 normal school children (boys:50, girls:39) who were attending Uljin primary school in Uljin, Kyong Sang Buk Do on March 1996. We obtained simultaneous 2 times of throat swab from each subject, and plating and streaking on 5-7% of sheep blood agar separately. We counted the characteristic beta-hemolytic colonies after overnight incubation. Results : 1) The carrier rate of beta-hemolytic streptococci at first culture is 25.1% and second one is 29.2%. 2) Ten out of 89(11.2%) is discordant in duplicate culture. 3) Culture containing less than 50 colonies of beta-hemolytic streptococci (+2) in first culture is 70.4%, second one is 85.7%. 4) Number of colonies is less than 50 in all ten discordant children. Conclusions : The discordant rate of duplicate throat swab cullture for beta-hemolytic streptococci is 11.2%, even if the subjects are normal school children. About 5% of individuals harboring beta-hemolytic streptococci in the pharynx may be missed by a single throat culture. If we are trying to examine the patients with pharyngitis, the discordant rate will be much lower than this results.
Anti-Kidd(Jk<sup>b</sup>) 항체 부적합증에 의한 신생아 용혈성 질환 1례
박동균,김영민,배종우,최용묵,이우인,Park, Dong-Kyun,Kim, Young-Min,Bae, Chong-Woo,Choi, Yong-Mook,Lee, Woo-In 대한소아청소년과학회 2003 Clinical and Experimental Pediatrics (CEP) Vol.46 No.7
저자들은 신생아 용혈성 질환을 일으킨 아기를 분만한 산모와 신생아에서 $anti-Jk^b$를 동정하여 진단하였으며, 이에 대해 그 임상경과를 문헌고찰과 함께 보고하는 바이다. 따라서, 생후 24시간이내 신생아 황달이 있는 경우 군소 혈액형 부적합증에 의한 신생아 용혈성 질환을 감별하여야 하며, 불규칙항체 선별 검사나 불규칙항체 동정 검사를 통하여 항체를 규명하고, 광선요법이나 교환수혈 등을 실시하여 핵황달 예방에 주의함과 동시에 지연성 빈혈이 없는지 지속적인 관찰이 필요할 것으로 사료된다. The isoimmune hemolytic disease of newborn due to the incompatibility of minor blood groups is characterized by progressive neonatal hyperbilirubinemia and anemia caused by the IgG antibody transmitted from the mother to the fetus. Recently we had a case of hemolytic disease in a newborn due to $anti-Jk^b$. There were no ABO and Rh(D) incompatibilities between mother and baby. The infant's direct and indirect antiglobulin tests were strongly positive. From the mother and baby, an irregular antibody was found and identified as $anti-Jk^b$. Generally, hemolytic disease of the newborn resulting from $anti-Jk^b$ incompatibility has a benign clinical course and a good prognosis. This patient completely recovered without exchange transfusion. We report this case with a brief review of relevant literature.
근이완제 및 인공 환기요법으로 치료한 신생아 파상풍 1례
이현주,정지영,정사준,최용묵,배종우,Lee, Hyeon Joo,Jeong, Ji Young,Jung, Sa Jun,Choi, Yong Mook,Bae, Chong Woo 대한소아청소년과학회 2003 Clinical and Experimental Pediatrics (CEP) Vol.46 No.2
가정분만으로 태어난 후 생후 6일된 신생아에서 전신성 강직-간대 경련이 발생하여 내원한 환아에서, 병력과 진찰 소견상 신생아 파상풍으로 진단하여 근이완제 및 인공환기요법으로 치료한 1례를 경험하였기에 보고하는 바이다. A neonate born at 38 gestational weeks was admitted due to generalized tonic-clonic seizure and cyanosis. The neonate was born six days previously at home through normal delivery and the umbilical cord was cut using scissors sterilized in boiling water. The neonate weighed 3,180 g at admission. Physical examination revealed cyanosis, opisthotonus, trismus and reactive muscle spasms. Laboratory exam, brain sonogram and EEG showed no significant abnormal findings. Based on her history and physical examination, the neonate was diagnosed with tetanus and put in an incubator isolated in a quiet, dark room. Treatment with tetanus human immunoglobulin along with antibiotics (penicillin G) were started immediately, and mechanical ventilation, administration of neuromuscular blocking agent and muscle relaxant were also started off. The frequency of seizure episode decreased gradually, and on the 32nd hospital day, mechanical ventilatory support was stopped along with extubation two days later. Thereafter, the neonate was in continuous generalized hypertonic state and showed feeding difficulty, but there was gradual improvement. She was dismissed on the 49th hospital day and is currently under OPD follow-up, doing well with no special problems. Respiratory management is critical to neonatal tetanus. We report here a case of tetanus treated with inhibition of self-respiration, neuromuscular blocker and application of ventilator, and present this method as a useful direction for future treatment of neonatal tetanus.
윤영호,최용묵 도립 강원전문대학 1999 道立 江原專門大學 論文集 Vol.2 No.-
Recently, the environment of earth was harmed of Global warming. It is very interest that sea level rise. The impacts of sea level are destruction of natural ecosystem. Besides it cause the damage of construction to a typhoon by wave force. Thought a warning and regulation in environment Pollution is strengthen, it is increasing. We must estimate a degree of sea level rise, for it will be do. Not only other nation but also our nation not escape the effects of sea level rise the height of construction is economical method. In this paper, the construction of sea level rise and the effect of nearshore zone by sea level rise are discussed. The relationship between sea level and crest height of a existing coastal strucyures are observed. In result, through the simulation of hydraulic modelling the control of overtopping without increasing crest height is illustrated.