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폐 침윤을 동반한 급성 중증 환자의 기관지 폐포 세척액에서 측정한 Pre-B-Cell Colony-Enhancing Factor의 임상적 유용성
이광하 ( Kwang Ha Lee ),홍상범 ( Sang Bum Hong ) 대한결핵 및 호흡기학회 2009 Tuberculosis and Respiratory Diseases Vol.67 No.5
Background: Pre-B-cell colony enhancing factor (PBEF) has been suggested as a novel biomarker in sepsis and acute lung injury. We measured the PBEF in bronchoalveolar lavage (BAL) fluid of acute critically ill patients with lung infiltrates in order to evaluate the clinical utility of measuring PBEF in BAL fluid. Methods: BAL fluid was collected by bronchoscope from 185 adult patients with lung infiltrates. An enzyme-linked immunosorbent assay was then performed on the collected fluids to measure the PBEF. Results: Mean patient age was 59.9±14.5 years and 63.8% of patients were males. The mean concentration of PBEF in BAL fluid was 17.5±88.3 ng/mL, and patients with more than 9 ng/mL of PBEF concentration (n=26, 14.1%) had higher Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) scores on the BAL exam day. However, there were no significant differences in clinical characteristics between survivors and non-survivors. In patients with leukocytosis (n=93) seen on the BAL exam day, the linear regression analysis revealed a significant, positive relationship between PBEF and APACHE II (r2=0.06), SOFA score (r2=0.08), Clinical Pulmonary Infection Score (r2=0.05), and plateau pressure in patients on ventilators (r2=0.07) (p<0.05, respectively). In addition, multivariate regression analysis with PBEF as a dependent variable showed that the plateau pressure (r2=0.177, p<0.05) was correlated positively with PBEF. Conclusion: The PBEF level in the BAL fluid may be a useful, new biomarker for predicting the severity of illness and ventilator-induced lung injury in critically ill patients with lung infiltates and leukocytosis.
한 내과계 중환자실에서 치료하였던 중증 알코올성 케톤산증 환자들의 임상적 특성
이광하 ( Kwang Ha Lee ),이세환 ( Sae Hwan Lee ),오연목 ( Yeon Mok Oh ),심태선 ( Tae Sun Shim ),임채만 ( Chae Man Lim ),이상도 ( Sang Do Lee ),고윤석 ( Yoon Suck Koh ),김우성 ( Woo Sung Kim ),김동순 ( Dong Soon Kim ),김원동 ( Won D 대한결핵 및 호흡기학회 2006 Tuberculosis and Respiratory Diseases Vol.60 No.5
연구배경 : 알코올성 케톤산증은 대부분 예후가 양호하나 여러 장기부전을 동반한 경우 중환자실 치료가 필요하다. 이런 중증환자에 대한 보고가 부족하여 저자들은 중증 알코올성 케톤산증의 증례를 분석하였다. 방법 : 2000년 1월 1일부터 2005년 6월 30일까지 서울아산병원 중환자실에서 입원하여 치료받았던 합병증을 가진 알코올성 케톤산증 10례를 선정하여 분석하였다. 결과 : 모두 남자환자였고, 평균 나이는 52.7±12.4 세, 평균 20±13년의 음주력이 있었다. 내원시 주증상은 복통,구토등의 소화기증상이 50%로 가장 많았다. 주요 검사실 소견상 Lactic acid (mmol/L) 57.89±55.35, 동맥혈 pH 6.828±0.139, Osmolar Gap (mOsm/L) 37.28±24.55, Anion Gap (mOsm/L) 31.43±11.61이었다. 동반된 주된 합병증으로 횡문근 융해증(80%), 패혈증(20%), 췌장염(10%) 순이었다. 70% 환자에서 투석이 80% 환자에서 기계환기가 실시되었다. 사망자 (60%) 들은 모두 3일이내에 쇼크로 인해서 사망하였다. 생존자들은 12시간안에 동맥혈 pH 7.15 이상으로 회복되었다. 결론 : 중증 알코올성 케톤산증은 횡문근 융해증 및 급성 신부전이 주된 합병증으로 동반되며 사망률이 높다. Background : Alcoholic ketoacidosis(AKA) is a metabolic disturbance that is caused by prolonged and excessive alcohol consumption. Though the prognosis is reportedly good, its outcome is unclear in some cases that are combined with multi-organ failure. There are few reports of an analysis of cases admitted to an intensive care unit(ICU). Method: Cases of AKA admitted to the ICU over the last 5 years were retrospectively analyzed. Severe AKA was characterized by multi-organ failure that required treatment in an ICU. Results : All patients were males with a history of excessive alcohol consumption. Five of them (50%) mainly complained of gastrointestinal symptoms (nausea, vomiting, diarrhea), showing metabolic acidosis with an increased asmolar and anion gap. Rhabdomyolysis with acute renal failure was the most common combined organ failure. Mechanical ventilation was performed in 80%. Six patients died and 4 patients survived. In the surviving patients, the arterial blood gas analysis(ABGA) was normalized within 12 hours after admission. Conclusion : In severe AKA patients, rhabdomyolysis with acute renal failure was the most common complication. The mortality rate was high and death from shock occurred within 3 days. (Tuberc Respir Dis 2006; 60: 548-553)
기관과 기관지내 다발성 점막 병변을 동반한 Churg-Strauss 증후군
부선진 ( Sun Jin Boo ),이광하 ( Kwang Ha Lee ),나승원 ( Seung Won Ra ),진영주 ( Young Joo Jin ),박경민 ( Gyung Min Park ),홍상범 ( Sang Bum Hong ) 대한결핵 및 호흡기학회 2008 Tuberculosis and Respiratory Diseases Vol.65 No.5
Churg-Strauss syndrome is a rare form of systemic necrotizing vasculitis that occurs exclusively in patients with asthma, and is associated with blood and tissue eosinophilia. The classic pathology findings in the lung include a combination of eosinophilic pneumonia, granulomatous inflammation and necrotizing vasculitis. However, there are few reports of tracheobronchial mucosal lesions in Churg-Strauss syndrome. We report a case of Churg-Strauss syndrome with multiple tracheobronchial mucosal lesions in a 33-year-old man with a history of bronchial asthma and allergic rhinitis. He had been diagnosed with community acquired pneumonia at another hospital and was treated with antibiotics. However, the chest radiographic findings were aggravated and showed multifocal consolidations in the whole lung fields. He was transferred to the Asan Medical Center. Fiberoptic bronchoscopy revealed multiple nodular mucosal lesions of the trachea and bronchi. The histopathology of the mucosal lesions revealed necrotizing bronchial inflammation with eosinophilic infiltration. Video Assisted Thoracic Surgery was performed. The wedge resected lung tissue revealed chronic eosinophilic pneumonia that was consistent with Churg-Strauss syndrome. Methylprednisolone (1 mg/kg q 8 hr) was prescribed and his symptoms resolved gradually. The chest radiographic findings improved significantly, and a follow-up fiberoptic bronchoscopy performed eight days later showed that the tracheobronchial mucosal lesions had resolved. The patient was prescribed oral prednisolone for 20 months after discharge. Currently, the patient is not taking steroids and is being followed up. (Tuberc Respir Dis 2008;65:405-409)
이상희 ( Sang Hee Lee ),조은정 ( Eun Jung Jo ),목정하 ( Jeong Ha Mok ),김미현 ( Mi Hyun Kim ),김계형 ( Kye Hyung Kim ),조우현 ( Woo Hyun Cho ),이광하 ( Kwang Ha Lee ),김기욱 ( Ki Uk Kim ),전두수 ( Doo Soo Jeon ),박혜경 ( Hye Kyung 대한천식알레르기학회 2013 Allergy Asthma & Respiratory Disease Vol.1 No.2
Vancomycin frequently induces hypersensitivity reactions including red man syndrome (RMS) and anaphylaxis. Lowering infusion rate with antihistamine premedication is usually effective to reduce RMS, however, desensitization should be considered for severe reactions not responding to usual measures. Here, we report a case of a patient with pyogenic spondylitis who had developed hypersensitivity reaction to vancomycin, got a full recovery with vancomycin desensitization. A 63-year-old man was transferred to our hospital for back pain, proved to pyogenic spondylitis. As methicillin-resistant Staphylococci aureus infection was suspected, vancomycin was administrated. But, he showed hypersensitivity reactions such as hypotension, dyspnea and severe flushing after vancomycin administration at previous hospital. Readministration of vancomycin at a lower infusion rate with premedication was tried. Three hours after vancomycin infusion, he developed fever, chills, rash and hypotension. Thrombocytopenia was occurred after administration of other antibiotics including cefazolin and teicoplanin. Vancomycin administration was attempted according to a rapid desensitization protocol. The infusion rate of vancomycin was increased to the standard rate. After the desensitization, he successfully completed the full course of treatment with vancomycin. Vancomycin desensitization could be the option for the vancomycin hypersensitivity when other antibiotics are not feasible. (Allergy Asthma Respir Dis 2013;1:168-171)Allergy Asthma Respir Dis 2013;1:168-171)
폐종괴와 기관지 탄분섬유화로 발현한 Mycobacterium kansasii 감염
나승원 ( Seung Won Ra ),이광하 ( Kwang Ha Lee ),정주영 ( Ju Young Jung ),강호석 ( Ho Suk Kang ),박이내 ( I Nae Park ),최혜숙 ( Hye Sook Choi ),정훈 ( Hoon Jung ),전규락 ( Gyu Rak Chon ),심태선 ( Tae Sun Shim ) 대한결핵 및 호흡기학회 2006 Tuberculosis and Respiratory Diseases Vol.60 No.4
The incidence of Mycobacterium kansasii pulmonary diseases are on the increase in Korea with the higher probability of occurrence in middle-aged and older men with underlying lung diseases Among nontuberculosus mycobacterial (NTM) infections, the clinical features of M. kansasii pulmonary infection are most similar to those of tuberculosis (TB). The chest radiographic findings of M. kansasii infection are almost indistinguishable from those of M. tuberculosis (predthin-walled and have less surrounding infiltration than those of typical TB lesions. Although there are reports on the rare manifestations of M. kansasii infections, such as endobronchial ulcer, arthritis, empyema, cutaneous and mediastinal lymphadenitis, cellulites and osteomyelitis, the association with bronchial anthracofibrosis has not yet been reported. This report describes the first case of M. kansasii infection presenting as a lung mass in the right lower lobe with accompanying bronchial anthracofibrosis.(Tuberc Respir Dis 2006; 60: 464-468)
이상희 ( Sang Hee Lee ),조은정 ( Eun Jung Jo ),목정하 ( Jeong Ha Mok ),김미현 ( Mi Hyun Kim ),김계형 ( Kye Hyung Kim ),조우현 ( Woo Hyun Cho ),이광하 ( Kwang Ha Lee ),김기욱 ( Ki Uk Kim ),전두수 ( Doo Soo Jeon ),박혜경 ( Hye Kyung 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 1991 소아알레르기 및 호흡기학회지 Vol.1 No.2
Vancomycin frequently induces hypersensitivity reactions including red man syndrome (RMS) and anaphylaxis. Lowering infusion rate with antihistamine premedication is usually effective to reduce RMS, however, desensitization should be considered for severe reactions not responding to usual measures. Here, we report a case of a patient with pyogenic spondylitis who had developed hypersensitivity reaction to vancomycin, got a full recovery with vancomycin desensitization. A 63-year-old man was transferred to our hospital for back pain, proved to pyogenic spondylitis. As methicillin-resistant Staphylococci aureus infection was suspected, vancomycin was administrated. But, he showed hypersensitivity reactions such as hypotension, dyspnea and severe flushing after vancomycin administration at previous hospital. Readministration of vancomycin at a lower infusion rate with premedication was tried. Three hours after vancomycin infusion, he developed fever, chills, rash and hypotension. Thrombocytopenia was occurred after administration of other antibiotics including cefazolin and teicoplanin. Vancomycin administration was attempted according to a rapid desensitization protocol. The infusion rate of vancomycin was increased to the standard rate. After the desensitization, he successfully completed the full course of treatment with vancomycin. Vancomycin desensitization could be the option for the vancomycin hypersensitivity when other antibiotics are not feasible. (Allergy Asthma Respir Dis 2013;1:168-171)