내과계 중환자들의 예후 판정에 었어서 제 7병일 APACHE III 점수의 임상적 유용성

김미옥,윤수미,박은주,손장원,양석철,윤호주,신동호,박성수,Kim, Mi-Ok,Yun, Soo-Mi,Park, Eun-Joo,Sohn, Jang-Won,Yang, Seok-Chul,Yoon, Ho-Joo,Shin, Dong-Ho,Park, Sung-Soo 대한결핵및호흡기학회 2001 Tuberculosis and Respiratory Diseases Vol.50 No.2

연구배경 : 중환자의 예후를 계량화 하려는 채점 체계 중 APACHE III 체계는 중환자실 제1병일 접수는 물론 일 갱선점수도 중환자의 예후를 예측할 수 있는 것으로 알려져 왔다. 평균 재원일이 외국과 비교하여 3-4배의 차이가 나는 점을 감안하면, 일 갱신점수는 예후를 판정하는 지표로서 경제적 효율성이 떨어진다. 이에 제7병일(평균 중간 재원일)의 APACHE III 점수의 임상적 유용성에 관해 알아 보고자 하였다. 방 법 : 1997년 6월부터 1998년 4월까지 한양대학교 구리병원 내파계 중환자실에 입원한 241명의 제1병일과 7병일 APACHE III 점수를 조사하여 생존군과 비생존군 간의 차이를 분석하였다. 결 과 : 전체 환자 수는 241명으로 이 중 사망자가 65명으로 26.6%의 사망률을 나타내었으며 평균 재원일 수는 $10.3{\pm}13.8$일이였다. 제1병일 APACHE III 점수는 $59.7{\pm}30.9$, 제7병일 APACHE III 점수는, $37.9{\pm}27.7$점이였다. 제1병일과 제7병일 APACHE III 점수는 생존군과 비생존군에서 $49.9{\pm}23.8$, $86.3{\pm}32.3$점, $30.1{\pm}18.5$, $81.1{\pm}30.4$점으로 유의한 차이를 보였다(P<0.0001, P<0.0001). APACHE III 점수가 사망률에 미치는 영향을 알아보기 위하여 로지스틱 회귀분석을 시행한 결과 제1병일과 제7병영일의 비차비(odds ratio)는 각각 1.0507, 1.0779로 유의한 결과를 나타내었다(P<0.0001). 결 론 : 이상의 결과로서 제1병일 APACHE III 점수 뿐 아니라 제7병일 점수 또한 사망률 예측과 입원 후 치료 경과에 의해 변화된 예후를 평가하기에 유용한 척도임을 알 수 있었다. 평균 중간 재원일인 제7병일 APACHE III 점수는 일 갱선점수가 경제적으로 물적, 인적 비용이 많이 드는 상황에서 비용효과면에서 임상의에게 도움을 줄 수 있다고 판단된다. Background : Most current research using prognostic scoring systems in critically ill patients have focused on prediction using the first intensive care unit (ICU) day data or daily updated data. Usually the mean ICU length of stay in Korea is longer than in the western world. Consequently, a more cost-effective and practical prognostic parameter is required. The principal aim of this study was to assess the prognostic value of the seventh day(7th day : the average mean ICU length of stay) APACHE III score in a medical intensive care unit. Methods : 241 medical ICU patients from July 1997 to April 1998 were enrolled. The 1st and 7th scores were measured by using the APACHE III scoring system and compared between survivors and non-survivors. Logistic regression analysis was performed to determine the relationship between the $1^{st}$ and $7^{th}$ APACHE III scores and the mortality risk. Results : 1 )The mean length of stay in the ICU was $10.3{\pm}13.8$ days. 2)The mean $1^{st}$ and $7^{th}$ day APACHE III scores were $59.7{\pm}30.9$ and $37.9{\pm}27.7$. 3) The mean $1^{st}$ day APACHE III score was significantly lower in survivors than in non- survivors($49.9{\pm}23.8$ vs $86.3{\pm}32.3$, P<0.0001). 4)The mean $7^{th}$ day APACHE III score was significantly lower in survivors than in non- survivors($30.1{\pm}18.5$ vs $80.1{\pm}30.4$, P<0.0001). 5)The odds ratios among the $1^{st}$ and $7^{th}$ day APACHE III scores and the mortality rate were 1.0507 and 1.0779 respectively. Conclusion : These results suggest that the seventh day APACHE III score is as useful in predicting the outcome as is such like the first day APACHE III score. Therefore, in comparison to the daily APACHE III score, measuring the $1^{st}$ and $7^{th}$ day APACHE III scores are also useful for predicting the prognosis of critically ill patients in terms of cost-effectiveness. It is suggested that the $7^{th}$ day APACHE III score is useful for predicting the clinical outcome.

증례 : 호흡기 ; 한랭글로불린혈증에서 동반된 기질화 폐렴 1예

김연재 ( Yeon Jae Kim ),김상헌 ( Sang Heon Kim ),김태형 ( Tae Hyung Kim ),윤호주 ( Ho Joo Yun ),신동호 ( Dong Ho Shin ),박성수 ( Sung Soo Park ),손장원 ( Jang Won Sohn ) 대한내과학회 2009 대한내과학회지 Vol.77 No.5S

OPC는 매우 드문 질환으로 저자 등은 혼합한랭글로불린 혈증을 진단받은 환자에게서 감염의 증거가 없고 항생제에 반응하지 않으며 호전과 악화를 반복하는 지속적인 폐침윤을 확인하고 조직 검사를 통해 OPC 진단하여 스테로이드치료 후 호전된 1예를 경험하였기에 보고하는 바이다. Cryoglobulinemia refers to the presence of serum polyclonal immunoglobulins that precipitate reversibly at cold temperature. Cryoglobulinemia can involve various organs, including the skin, liver, kidney, and lung. Although many diseases can lead to organizing pneumonia, reports of organizing pneumonia with cryoglobulinemia (OPC) are rare. We treated a case of prolonged migrating patchy lung infiltration combined with mixed cryoglobulinemia. A 75-year-old man was admitted with progressive dyspnea and cough. The serological, clinical, and pathological findings confirmed the presence of mixed cryoglobulinemia. A chest radiograph and computed tomography (CT) showed multiple patchy consolidations that did not resolve with empirical antibiotic treatment. Additionally, his symptoms did not respond to antibiotics. The transbronchial lung biopsy showed organizing pneumonia, so steroid treatment was started, and the clinical symptoms and radiological findings improved. (Korean J Med 77:S1183-S1187, 2009)

Respiratory Syncytial Virus 감염과 기관지천식

윤호주 대한 소아알레르기 및 호흡기학회 1999 소아알레르기 및 호흡기학회지 Vol.9 No.1

감초(licorice)에 의한 직업성 천식 1 예

김유영,박재경,민경업,김윤근,조상헌,윤호주,최동철 대한내과학회 1994 대한내과학회지 Vol.47 No.6

More than 200 kinds of occupational allergens are known to cause occupational asthma. But there has been no case report of occupational asthma caused by herb materials except one case reported by Moon et al in 1986 in Korea. Licorice is one of the oldest traditional chinese medicines and is used as a tonic, antiphlogistic, mucolytic, expectorant, and an analgesic for the treatment of gastrointestinal and respiratory disorders and also to alleviate the toxicity of some other drugs. We report a case of occupational asthma caused by licorice. A 34 year-old male patient came to the clinic because of cough, dyspnea and wheezing which had developed one month ago. He had worked at a herb drug store for 3 years. His symptoms used to be worsened during and shortly after his work and subsided several hours after rest. When he visited the clinic, he had no such symptoms and revealed no abnormality on physical examinations. At that time peripheral blood eosinophil count was 590/㎣, total IgE (PRIST) was 770 IU/ml. Radiologic findings of chest and paranasal sinus were normal. Skin prick test with common inhalant allergens revealed positivities to various allergens and licorice extract. He showed a bronchial hyperresponsiveness on methacholine bronchoprovocation test, which increased 24 hours after allergen bronchial provocation with licorice powder and extract. he showed early asthmatic responses to allergen bronchial provocations with licorice powder and extract. Licorice is constituted by triterpenoid, flavonoid and isoflavonoid derivatives. The structures of these constituents are almost low molecular chemicals. In this case the patient showed a positive bronchial provocation test to licorice powder and licorice extract and a positive skin prick test to licorice extract. Thus it is suggested that pathogenic mechanism of licorice induced asthma may be an IgE-mediated allergic reaction. But further studies will be necessory to evaluate exact pathogenesis of licorice induced asthma.

장결핵의 임상적 고찰

정성수,박경남,이민호,기춘석,함준수,이종철,손주현,심종걸,윤호주 대한소화기내시경학회 1988 Clinical Endoscopy Vol.8 No.1

Intestinal tuberculosis is an infectious disease which is still prevalent in the developing countries including Korea. It may occur insidously, have a vague clinical marofestation, and take a chronic course. We have analyzed 101 cases of intestinal tuberculosis. proven by clinical and histopathologic diagnosis for 10yrs since 1977. The results are as follows: 1) Intestinal tbc was prevalent in the age of 20-30 and the male to female ratio was 1:1.7. 2) Among clinical manifestations, abdominal pain, and tenderness, general malaise and abdominal mass were observed in order of frequency. 3) Active pulmonary lesion was associated in 73 cases (73.3%). 4) Ileocecal region was the most frequent site of involvement in barium study and in colonoscopy. 5) The most frequent colonoscopic finding was multiple ulceration and pseudopolyposis and chronic granulomatous inflammation was noted in 58% on hitopathology. 6) Ulcerative type was the most common type 45.4% by intestinal x-ray and colonofiberscopic examination