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림프구활성화시험으로 확인된 methazolamide에 의한 독성표피괴사융해 1예
한규형 ( Kyu-hyung Han ),홍구현 ( Ku-hyun Hong ),김도형 ( Doh Hyung Kim ),김윤섭 ( Youn Seup Kim ),박재석 ( Jae-suk Park ),김승현 ( Seung-heon Kim ),지영구 ( Young-koo Jee ) 대한천식알레르기학회(구 대한알레르기학회) 2016 Allergy Asthma & Respiratory Disease Vol.4 No.4
Among various dermatological entities, toxic epidermal necrolysis (TEN) is a rare but potentially fatal delayed hypersensitivity reaction to numerous medications. A 38-year-old male presented with systemic hypersensitivity reaction, such as high fever, pain in the eyes, and diffuse pruritic erythematous maculopapular eruptions with multiple targetoid plaques that became vesicular and bullous. Oral mucosa and conjunctivae were involved. The first sign appeared about 1 week after taking methazolamide (50 mg twice a day) for the management of glaucomatous eyes. Although methazolamide was discontinued, blistering and skin denudation progressed to affect up to 80% of the body surface area and a positive Nikolsky sign was noted. High fever also persisted. Skin lesions started to improve after 2 weeks of management and fever subsided. Cutaneous lesions improved with minimal permanent sequele 2 months later. HLA-B*5901 was found by high-resolution genotyping. The lymphocyte activation test performed 6 months after r mission showed a positive response to methazolamide challenge. This is the first case of methazolamide-induced TEN in which methazolamide was confirmed as a culprit drug by the lymphocyte activation test. (Allergy Asthma Respir Dis 2016:4:301-304)
HRCT Emphysema Scoring과 운동부하 폐기능검사 지표들 간의 상관관계
최은경,최영희,김도형,김용호,윤세영,박재석,김건열,이계영,Choi, Eun-Kyoung,Choi, Young-Hee,Kim, Doh-Hyung,Kim, Yong-Ho,Yoon, Se-Young,Park, Jae-Seuk,Kim, Keun-Youl,Lee, Kye-Young 대한결핵및호흡기학회 2001 Tuberculosis and Respiratory Diseases Vol.50 No.4
배 경 : 폐기종의 중증도 판정에 있어서 병리학적 기준은 기강(air space)의 확장 정도에 있으며, 이는 고해상도 전산화 촬영 (high resolution computed tomography, HRCT)에 의해 결정되는 폐기종 점수(emphysema scoring)와 좋은 상관성을 보인다는 것은 주지의 사실이다. 한편 폐기종의 주증상은 운동성 호흡곤란이므로 폐기종에 대한 임상적 평가는 운동능력의 감소를 측정하는 것이 타당하다고 알려져 있다. 그러나 대개의 경우 폐기종의 중증도 판정은 안정시 폐기능 검사에 의존하는 경우가 흔하며, 병리학적 중증도 판정과 상관성이 높다고 알려져 있는 고해상도 전산화 촬영에 의한 폐기종 점수와 운동부하 폐기능검사 지표들과의 상관성 여부에 대한 연구는 드문 실정이다. 이에 본 연구에서는 폐기종의 중증도 판정에 있어서 HRCT와 안정시 폐기능 검사 및 운동부하 폐기능 검사간에 상호 관련성을 확인하여 보았다. 방 법 : 평균 연령 $60.6{\pm}10.3$세인 14명의 폐기종 환자들을 대상으로 HRCT, 안정시 폐기능 검사(forced expiratory flow volume curve, lung volumes by He dilution method, DLco, ABGA), 그리고 점진적운동부하폐 기능검사(incremental cycle ergometer)를 시행하였으며 HRCT는 GE highlight를 이용하여 조영증강 없이 최대흡기시에 1.5mm collimation, 10mm 간격으로 폐전체를 스캔하였고, 환자마다 모든 스캔에서 density mask를 이용하여 -400 HU를 기준으로 한 총폐면적과 -900 HU를 기준으로 한 폐기종 면적을 각각 구하여 백분율로 환산하여 폐기종 점수를 구하였다. 결 과 : 평균 폐기종 점수는 $37.4{\pm}14.9%$ 이었다. 폐기종 점수와 안정시 폐기능 검사의 DLco(r=-0.75)와 $PaO_2$(r=-0.66) 사이에서만 유의한(p<0.05) 상관성이 관찰되었다. 반면 폐기종 점수와 운동부하폐기능 지표들간의 상관성은 최대 산소섭취량(r=-0.68), 혐기성 역치(V-slope method, r=-0.690), 최대운동부하(r=-0.74), 최대운동시 $O_2$ pulse(r=-0.73), 최대운동시의 생리적 사강비율 (r=0.80) 등과 높은 유의성 (p<0.01)을 나타내었다. 그러나 호흡예비율과 심박수 예비율간에서는 유의한 상관성이 없었고, pulse oxymeter로 측정한 산소포화도와의 상관성도 유의하지 않았다. 결 론 : 이상의 결과에서 폐기종의 병리학적 중증도를 잘반영한다고 알려진 HRCT 폐기종 접수는 폐기종에 의한 생리학적 장애를 잘 반영하는 운동부하 폐기능 검사의 주요 지표들과 유의한 상관성이 있음을 확인할 수 있었다. Background : The correlation between the high resolution computed tomography(HRCT) emphysema score and the physiologic parameters including resting and exercise pulmonary function test was investigated in 14 patients($60.6{\pm}10.3$ years) with pulmonary emphysema. Methods : The patients underwent a HRCT, a resting pulmonary function test, and incremental exercise testing(cycle ergometer, 10 W/min). Computed tomography scans were obtained on a GE highlight at 10 mm intervals using 10 mm collimation, from the apex to the base after a full inspiration. The emphysema scores were determined by a CT program 'Density mask' outlining the areas with attenuation values less than -900 HU, indicating the emphysema areas, and providing an overall percentage of lung involvement by emphysema. Results : Among the resting PFT parameters, only the diffusing capacity(r=-0.75) and $PaO_2$ (r=-0.66) correlated with the emphysema score(p<0.05). Among the exercise test parameters, the emphysema score correlated significantly with the maximum power(r=-0.74), maximum oxygen consumption(r=-0.68), anaerobic threshold(V-slope method: r=-0.69), maximal $O_2$-pulse(r=-0.73), and the physiologic dead space ratio at the maximum workload(r=-0.80)(p<0.01). Conclusion: We could find that exercise testing parameters showed a much better correlation with the HRCT emphysema score, which is known to have a good correlation with the pathologic severity than the resting PIT parameters. Therefore it is suggested that exercise testing is superior to resting PIT for estimating in the estimation of the physiologic disturbance in emphysema patients.
김영민 ( Young Min Kim ),이소라 ( So Ra Lee ),정지연 ( Ji Yun Jung ),신경황 ( Kyoung Hwang Shin ),김도형 ( Doh Hyung Kim ),김지현 ( Jee Hyun Kim ),지영구 ( Young Koo Jee ) 대한내과학회 2013 대한내과학회지 Vol.84 No.6
Background/Aims: Zolpidem is a safe and effective drug for the treatment of insomnia. However, there are some reports of adverse effects, such as delirium, after administration of zolpidem. The aim of this study was to evaluate the incidence of and risk factors for zolpidem-induced delirium. Methods: This retrospective study enrolled 481 patients who were admitted to hospital and received zolpidem between January and May 2011. We analyzed the incidence and risk factors associated with zolpidem-induced delirium. Results: Zolpidem-induced delirium occurred in 19 of 481 (4.0%) patients. Zolpidem-induced delirium was significantly associated with old age (≥ 65 years; odds ratio [OR] = 4.35, 95% confidence interval [CI] = 1.52-12.44, p = 0.006) and co-administration of benzodiazepine (OR = 4.30, 95% CI = 1.52-12.12, p = 0.006). When males > 65 years-old took both benzodiazepine and zolpidem simultaneously, the incidence of delirium was notably elevated (OR = 6.04, 95% CI = 1.80-20.20, p = 0.003). Other factors, including dosage, did not influence the occurrence of delirium. Conclusions: Old age and co-administration of benzodiazepine were independent risk factors for zolpidem-induced delirium. Therefore, a detailed medical history should be taken before prescribing zolpidem to an older person, and zolpidem should be used cautiously, with careful monitoring, in these patients. (Korean J Med 2013;84:804-809)
A549 기도상피세포에서 IL-8 전사와 분비에 미치는 Dexamethasone과 Troglitazone의 병합투여효과
김남희 ( Nam Hee Kim ),이호연 ( Ho Youn Lee ),서지현 ( Ji Hyun Suh ),한성환 ( Sung Hwahn Hahn ),김도형 ( Doh Hyung Kim ),김윤섭 ( Youn Seop Kim ),박재석 ( Jae Seuk Park ),지영구 ( Young Koo Jee ) 대한천식알레르기학회 2008 천식 및 알레르기 Vol.28 No.4
Background: Glucocorticoid is a widely used anti-inflammatory agent in a variety of diseases. Recently, peroxisome proliferator activated receptor γ (PPARγ) ligand has been shown to exert a potential anti-inflammatory activity, mainly through their ability to down- regulate pro-inflammatory gene expressions. Objective This study was designed to evaluate the effects of co-treatment with dexamethasone and troglitazone (a ligand of PPARγ) on IL-8 transcription and secretion. Method: Steroid and troglitazone-induced transactivation was measured by using pGRE luciferase reporter gene in the A549 cell line. Steroid-induced transrepression was measured by using stable A549 IgG-NFκB luciferase cell line, which contained the minimal IL-8 promoter region. Result: Co-treatment with dexamethasone and troglitazone showed no additional increase of transactivation activity compared to dexamethasone single treatment. Suppressions of the transcriptional activity in the IL-8 promotor and IL-8 secretion showed no difference in the co-treatment with dexamethasone and troglitazone compared to those in dexamethasone single treatment. Conclusion: Our results suggest that co-treatment with PPARγ ligand and steroid may not have an additive anti-inflammatory activity at least in the airway epithelial cell. (Korean J Asthma Allergy Clin Immunol 2008;28:292-297)
라성수 ( Sung Soo La ),김소미 ( So Mi Kim ),김도형 ( Doh Hyung Kim ) 대한결핵 및 호흡기학회 2008 Tuberculosis and Respiratory Diseases Vol.65 No.5
Unilateral absence of the pulmonary artery (UAPA) is a rare congenital anomaly that occurs in association with other cardiovascular anomalies, such as tetralogy of Fallot or ventricular septal defects. On the other hand, it is less commonly found as an isolated finding without accompanying diseases. Isolated UAPA is a rare cause of hemoptysis, and massive hemoptysis has been reported to occur in approximately 18∼20% of UAPA patients during their clinical course. Even if a lung resection is considered a treatment option to control life-threatening hemoptysis, the procedure is more difficult than an ordinary lung resection because of the excessive collateral vessels from the systemic circulation. We encountered an isolated UAPA occurring in a young male patient suffering from intermittent blood tinged sputum. To our knowledge, only a few cases of isolated UAPA have been reported in Korea. This case is expected to be a good example to help clinicians better understand isolated UAPA as an unusual cause of hemoptysis. (Tuberc Respir Dis 2008;65:430-434)
증례 : 혈액종양 ; 전이성 신세포암에서 Everolimus 사용 후 유발된 간질성 폐렴 1예
이소라 ( So Ra Lee ),김영민 ( Young Min Kim ),정지연 ( Ji Yun Jung ),김형준 ( Hyung Joon Kim ),김도형 ( Doh Hyung Kim ),박건우 ( Keon Woo Park ),이순일 ( Soon Il Lee ) 대한내과학회 2012 대한내과학회지 Vol.83 No.4
Everolimus, an inhibitor of the mammalian target of rapamycin, is an active agent against metastatic renal cell carcinoma. Treatment with everolimus prolongs progression-free survival in patients with clear cell-type renal cell carcinoma that has progressed on vascular endothelial growth factor receptor tyrosine kinase inhibitors, such as sunitinib and/or sorafenib. Everolimus-induced interstitial pneumonitis is not rare and is sometimes fatal. Due to the potential for pulmonary toxicity due to everolimus, it is recommended that pulmonary complications be periodically evaluated. We report a case of everolimus-associated interstitial pneumonitis in a patient with metastatic renal cell carcinoma. (Korean J Med 2012;83:520-524)
A549 기도 상피세포에서 GRβ의 과발현이 스테로이드에 의한 전체 유전자 변화에 미치는 영향
이호연 ( Ho Youn Lee ),김남희 ( Nam Hee Kim ),김도형 ( Doh Hyung Kim ),김윤섭 ( Youn Seop Kim ),박재석 ( Jae Seuk Park ),김동훈 ( Dong Hoon Kim ),지영구 ( Young Koo Jee ) 대한천식알레르기학회 2008 천식 및 알레르기 Vol.28 No.3
Background: Glucocorticoid receptor β (GRβ) may not bind to ligands and is thought to affect gene transcription only by acting as a dominant negative inhibitor of Glucocorticoid receptor α (GRα). However, there have been few reports about the functional roles of GRβ in the steroid-induces changes of gene expression. Objective: To investigate the functional role of GRβ overexpression in the steroid-induced changes of gene expression. Method: The changes in gene expressions such as steroid-induced synthesis of genes, TNF-α-induced synthesis of inflammatory genes and steroid induced suppression of activated genes by TNF-α treatment were compared with and without pCMV GRβ expression. Result: The number of genes increased by dexamethasone treatment only in the GRβ transfected group were 54. Increased expressions of genes by dexamethasone treatment were not affected by GRβ overexpression. The number genes increased by TNF-α treatment only in the GRβ-transfected group were 69. Expressions of genes increased by TNF-α treatment in both the control and the GRβ-transfected group were decreased by further dexamethasone treatment in a similar manner. Conclusion: The results of this study suggest that GRβ may not be a dominant negative inhibitor in the steroid-induced changes of genes and that it may have some functional roles in the regulation of gene expressions. (Korean J Asthma Allergy Clin Immunol 2008;28: 220-225)
전이성 대장암에서 FOLFOX4 항암 화학요법 시행 중 발생한 간질성 폐질환 1예
윤정석(Jeung-seuk Yoon),박동국(Dong-Guk Park),남궁환(Hwan Namgung),김도형(Doh-hyung Kim) 대한종양외과학회 2012 Korean Journal of Clinical Oncology Vol.8 No.1
FOLFOX4 요법은 진행성 대장직장암에서 첫 번째 치료 요법 중 하나이다. 잘 알려진 부작용으로 신경학적, 혈액학적, 소화기 독성이 있다. 그러나 최근 들어 이 요법과 관련된 심각한 폐독성이 보고 되고 있다. 저자들은 FOLFOX4 요법 중 발생한 간질성 폐질환 1예를 보고하는 바이다. FOLFOX4 regimen is one of the first line treatments for advanced colorectal cancer. Well known adverse effects are neurological, hematologic, and gastro-intestinal toxicities. But recently, there were several case reports about severe form pulmonary toxicity of this regimen. We herein report the case of an additional patient with FOLFOX4 induced interstitial lung disease.