미만성 기관지 유전분증 1 예

권성운(Sung Woon Kwon),김용균(Yong Kyun Kim),정광호(Kwang Ho Jung),김동순(Dong Soon Kim),전우기(Woo Ki Jeon),서연림(Yeon Lim Suh) 대한내과학회 1993 대한내과학회지 Vol.45 No.5

Primary pulmonary amyloidosis is a rare disorder. It can be classified into tracheo-bronchial, diffuse alveolar septal and nodular parenchymal form. Tracheo-bronchial amyloidosis can be further subdivided into diffuse and focal varieties. We report a case of diffuse tracheo-bronchial amyloidosis in a 49-year old man comfirmed by broncos-copic biopsy. He has suffered from cough and exertional dyspnea over 20 years and recently atelectasis of fright middle and lower lobe was found on chest X-ray with aggravation of symptom. The chest CT showed irregular thickening of tracheo-bronchial wall with calcification in addition to collapse of right middle and lower lobe. The bronchoscopy showed multiple variable sized submucosal nodules in lower trachea and both sides of bronchi, and biopsy revealed amyloid deposition at the subepithelial layer. We discussed this case with review of literature.

Angiotensin Converting Enzyme Inhibitor 가 Capsaicin 유발 기침반사에 미치는 영향

김동순(Dong Soon Kim),권성운(Seong Woon Kwon),김용복(Yong Bok Kim),임창영(Chang Young Lim),유원상(Won Sang Yoo),최석구(Suck Koo Choi) 대한내과학회 1993 대한내과학회지 Vol.45 No.5

Background: Angiotensin converting enzyme(ACE) inhibitors are widely used for the treatment of hypertension and heart failure without serious side effects, but in some patients, they induce intractable cough. The mee-hanism of this cough is not known, but ACE and kininase II are the same enzyme, the derangement in the metabolism of kinines and Substance-P by ACE inhibitors has been proposed as one possibility. So we performed a placebo-controlled, double-blind, randomized crossover study, to find out whether the enalrpril can change the sensitivity to capsaicin which released Substance-P from the nerve ending and its relation to the development of cough after the enalarpril. Method: The subjects were 21 patients (9 men and 12 wemen) with mild to moderate hypertension. Eleven patients developed cough with the Enalarpril (cougher), and 10 pateints didn't have cough (non-cougher) and served as a control group. Baseline PFT, serum IgE level, and blood eosinophil count were done. The patients received either enalarpril 10 mg per day or placebo for one week, and after the washout period of at least one week, another drug(placebo if the patient had enalapril previously and vice versa) was given for a week. Blood pressure, pulmonary function test, and capsaicin challenge test were performed at the end of each period. Capsaicin challenge test was done by inhalation of different concentration of capsaicin via DeVil-bis 646 nebulizer with dosimeter (SCM Co., U.S.A.) and the lowest concentration which induced 2 or more coughs (Th-w) and 5 or more coughs (Th-5) were deter- mined. Result: The age of the two groups were similar (55.5 vs 52 years), but females were predominant in cougher (8 female and 4 male) compared to non-cougher (4 female and 6 male). There was no Significant difference in serum IgE level, eosinophil counts, and pulmonary function between two groups. Cough developed immediately after the inhalation of capsaicin, and the dose-response relationship was fonud between the number of coughs and the concentration of capsaicin. In all patients, Th-2 was 19.7±16.1uM and Th-5 was 78.8±48.6uM. But there was no significant difference in both Th-2 and Th-5 between coughers (21,3 uM and 72.2 uM) and non-coughers (18.0 uM and 81.6 uM). also, no significant change in Th-2 and Th-5 was found during the therapy of enarlapril compared to the placebo period in both groups. Among 11 coughers, 2 patients developed more coughs with capsaicin inhalation after the enarlapril compared to placebo period (responder), and in non-cougher, 3 among 10 patients were responders. Blood pressure was significantly decreased after the Enarlapril, but no significant change in pulmonary function was noted. Conclusion: Our data suggest that Enarlapril does not increase the sensitivity to capsaicin and the cough after the Enarlapril seems to have different mechanism.

甘草가 흰쥐肝의 cytochrome P_450 관여 藥物代謝酵素活性에 미치는 影響

최성운,권창호 慶熙大學校 1990 論文集 Vol.19 No.-

Drug metabolizing enzymes containing Cytochrome P-450 of liver microsomes of rat were induced by phenobarbital sodium injection and extractum Glycyrrhizae then they were purified partially. Then these enzymes were tested on activities catalizing the hydroxylation of anisole of aromatic ethers. The results are summarized as follow : 1. As a result of injection phenobarbital sodium and p.o. extractum Glycyrrhizae into rat, protein content was most highest between 38∼40 fraction of the enzymes containing Cytochrome P-450 eluted with Emalgen 913. And the group pretreated wit Extractum Glycyrrhizae has been increased by 6.5% and with phenobarbital sodium injection by 64% in comparison with the control group. 2. From the reaction of anisole and the reconstituted enzyme containing Cytochrome P-450, guaiacol has been obtained 5∼6% in the control group and 6∼7% in the group pretreated with Extractum Glycyrrhizae and 7∼10% in the group pretreated with phenobarbital sodium. 3. Based on all above results, it is concluded that the Drug Metabolizing Enzyme containing Cytochrome P-450 was induced slightly by Extractum Glycyrrhizae and induced strongly by phenobarbital sodium.

본태성 고혈압에 대한 Felodipine의 강압효과 및 안전성에 관한 검토

권성운,김용복,임창영,박상현,최석구,유원상 인제대학교 1991 仁濟醫學 Vol.12 No.4

본태성 고혈압 환자를 대상으로 칼슘 길항제인 Felodipine의 강압효과 및 안정성을 검토한 결과 경증 및 중등증 고혈압 환자에게 안전하고도 유효한 강압제라고 생각되기에 이를 보고하는 바이다. Twelve patients with essential hypertension were administered Felodipine, a new calcium antagonist. 5-10mg once daily to evaluate the hypotensive efficay and safety of the drug for 8 weeks The results were as follows: 1.The patients consisted of 7 males and 5 females, aged 54 on average and were classified as mild in 10 patients and moderate in 2 patients. 2.The optimal initial dose was 5mg a day and the 3 patients were taking 10mg a day at the end of the study. 3.The blood pressure dropped 20/19mmHg on average after 8 weeks, normalized in 83% of patients. 4.The most frequent sloe reaction was facial flushing in 3 patients. followed by palpitation and leg swelling. All of side reactions did not make the medication discontinued. 5.Most of routine laboratory parameters were normal and unchanged between before and after the trial. 6.Overall rating of usefulness was 75%. In conclusion, Felodipine 5 to 10mg once daily regimen is effective and well tolerated in the treatment of mild to moderate essential hypertension.

Advanced Aggressive Non Hodgkin's Lymphima Treated with CHOP(Cyclophosphamide, Doxorubicin, Vincrstine and Prednisone) or CHOP plus Bleomycin with or without Focal Irradiation

Kim, Chul Soo,Kwon, Sung Woon,Kim, Yong Kyun,Sung, Young Joo,Lim, Chang Young,Kim, Yong Bok,Kim, Joon Hee,Suh, Hyun Suk,Kim, Sung Rok,Lee, Young Soo,Kim, Re Hwe 인제대학교 1993 仁濟醫學 Vol.14 No.4

예후불량 조직형 비호치킨 림프종으로 진단받은 1명의 제 3병기 환자 및 17명의 제 4병기 환자에게 Oncovin 1.5mg을 제 1일에, Adriamycin 50mg을 제 2일에, Cytoxan 400mg을 제 3, 4, 5일에 정맥주사하고, Prednisone 60mg을 제 1일에서 5일까지 경구 투여하는 동시에 경우에 따라 Bleomycin 15mg을 제 6,7일에 정맥주사하거나 대형의 종괴, 화학요법에 저항을 보이는 종괴, 골절의 위험이 있는 골침윤 부위 및 중추신경계의 종양침윤에 대하여 국소적인 방사선 요법을 시행하였다. 조직학적으로 11명은 미만성 대세포, 3명은 미만성 분절 소세포, 2명은 림프아구, 1명은 면역아구, 1명은 여포성 대세포형 림프종을 가지고 있었으며, 남녀의 비율은 16대 2, 연령은 15세에서 74세(중앙치 44)였으며 7명은 B증상을 가지고 있었다. 항암화학요법은 2차례에서 14차례까지 시행가능하였으며(중앙치 4) 5명에서는 Bleomycin을 추가하였고 8명에서는 국소적 방사선 조사를 시행하였다. 판정이 가능하였던 17명중 6명(35%)은 완전관해, 6명(35%)은 부분관해, 5명(30%)은 무반응을 보였고 완전관해의 지속기간은 6개월에서 27개월(중앙치 12.5)이었으며 완전관해군의 생존기간은 14개월에서 64개월(중앙치 29), 부분관해군의 생존기간 중앙치는 7개월, 무반응군의 생존기간 중앙치는 6개월로서 전체환자의 생존기간 중앙치는 10개월이였고 전체환자의 5년 생존율은 6%였다. 치료로 인한 독성은 경미하였고 치료로 인한 사망례는 없었다. 완전관해율및 생존율의 부진함은 의학적 권고를 제대로 따르지 못한 상당수 환자의 불충분한 치료및 대다수 환자의 불량한 예후인자에서 기인하였다. 항암화학요법에 민감한 환자군에서는 충분한 횟수의 항암화학요법이 요구되며 항암화학요법에 저항을 보이거나 재발한 환자에서는 고식적인 항암화학요법보다 더욱 혁신적인 치료가 필요할것으로 사료된다. Eighteen patients histologically proven as disseminated aggressive non Hodgkin's lymphoma were treated wish CHOP(vincristine 1.5mg IV on day 1, doxorubicin 50mg IV on day 2, cyclophosphamide 400mg IV on days 3∼5, prednisone 60mg PO on days 1∼5) or CHOP plus bleomycin(15mg IV on days 6∼7) with or without focal irradiation. There were 16 male and 2 female patients with their ages ranging 15∼74( median 44). The histological subtypes consisted of diffuse large cell in 11, diffuse small cleaved cell in 3, lymphoblastic in 2, immunoblastic in 1, and follicular large cell in 1. One patient was in stage IIIA, 10 in stave IVA, and 7 in stage IVB. The number of courses of chemotherapy ranged 2∼14(median 4). Focal irradiation was given to 8 patients. Therapy related morbidity was minimal with no case of mortality. Among 17 evaluable patients, six(35%) attained CR(complete remission) with a median remission duration of 12.5 months(range 6∼27). Six(35%) responded partially and five(30%) did not respond. The median survival durations were 29 months(range 14∼64) in patients who entered CR, 7 months in who achieved PR(partial remission), and 6 months in non responders. The overall median survival duration was 10 months and 5 year survival rate 6% (1 in 17). The poor CR and long term survival rate seemed to be resulted from poor compliance of the patients on one hand rather than the defect of our regimen and from poor prognostic factors of our patient group on the other hand. A strict application of the treatment schedule is needed for the chemosensitive group and an innovative treatment is required for the relapsed or chemoresistant group.

Allopurinol로 치료된 경련중적상태(status epilepticus) 1례

김용복,김용균,권성운,오세익,김철수,김예희 인제대학교 1993 仁濟醫學 Vol.14 No.2

저자들은 정신혼미를 주소로 입원한 경련중적상태 환자에게 고전적인 약제, 즉 phenitoin, carbamazephine, phenobarbital 치료 및 barbiturate anesthesia 시행 후 위의 약제 사용에도 불구하고 발작을 치료할 수 없어 Allopurinol을 보조적으로 투여한 바 좋은 효과를 경험하였기에 보고하는 바이다. Status epilepticus is a medical emergency needing immediate treatment to prevent organic brain damage. We experienced a refractory case of status epilepticus to conventional phenytoin administration which mandated barbiturate general anesthesia and carbamazepine trial. On recovery from the anesthesia, repeated seizures reappeared with the elevation of liver enzymes probably caused by phenytoin. Switching of phenytoin to phenobarbital up to a therapeutic level also failed to control the seizure. Allopurinol was added as an adjunctive agent to phenobarbital and the seizure subsided. Though the exact pharmacologic mechanism of allopurinol has been unknown, the agent deserves a trial in the refractory case of status epilepticus to conventional treatment.