폐렴의 진단에서 정량적 기관지폐포 세척액 배양의 유용성

한태호(Tae Ho Hahn),장명국(Myoung Kuk Jang),김성균(Seong Gyun Kim),이자영(Ja Young Lee),이재명(Jae Myung Lee),김동규(Dong Kyu Kim),최정은(Jeong Eun Choi),모은경(Eun Kyung Mo),박명재(Myung Jae Park),이명구(Myung Goo Lee),현인규(In Gyu 대한내과학회 1998 대한내과학회지 Vol.54 No.6

Background: The aim of this study is to evaluate the usefulness of quantitative culture of bronchoalveolar lavage (BAL) fluid for the diagnosis of bacterial pneumonia and identification of causative agents. Methods: Study group consisted of 30 epiaodes in 28 patients, enrolled from January 1995 through June 1996. Inclusion criteria were 1) presence of respiratory symptoms such as cough, sputum or dyspnea 2) increased peripheral blood leukocyte count (≥11,000/mm³) 3) Fever (≥38.3ºC) 4) purulent sputum 5) new or progressive infiltrate on chest radiography. For the diagnosis of pneumonia and its causative agents, sputum smear and culture, blood culture and BAL fluid studies were performed. BAL fluid studies included differential count of white blood cell, BAL fluid smear and culture, detection of elastin fibers and presence of intracellular organisms (ICO). Quantitative culture of BAL fluid was considered positive if colony forming units was more than 1.0×10(4)/ml. Positive criteria for ICO was presence of microorganism in more than five per 100 of phagocytes, Result: Recruited were 22 males and 6 females. The mean age was 57.5±13.5 years (range 25-84), Of 30 episodes underwent BAL fluid studies, 19 cases were diagnosed to be bacterial pneumonia, S. aureus (7 cases) was the most common causative agent and was followed by P. aeruginosa (4), E. cloacae (2), A baumanii (1), H. influenzae (1) and a-hemolytic Streptococcus (1). Sensitivity of quantitative culture of BAL fluid for the diagnosis of bacterial pneumonia was 68.4% and its specificity was 63.6%. Elastin fibers were detected in 5 cases (31%) and ICO over 5% in 3 cases (15.7%). When criteria of quantitative culture of BAL fluid, detection of ICO and elastin fibers were applied together, diagnostic rate of pneumonia was 84.2% (16/19). Conclusion: Quantitative culture of BAL fluid was sensive and specific compared to sputum and b1ood culture for the diagnosis of bacterial pneumonia, It was suggested that detection of ICO and elastic fibers in BAL fluid could raise the diagnostic rate of bacterial pneumonia.

Rifampin 아나필락시 1 예

이자영(Ja Young Lee),장명국(Myoung Kuk Jang),김동규(Dong Kyu Kim),모은경(Eun Kyung Mo),최정은(Jeong Eun Choi),박명재(Myung Jae Park),이명구(Myung Goo Lee),현인규(In Gyu Hyun),정기석(Ki Suck Jung) 대한내과학회 1998 대한내과학회지 Vol.55 No.2

Rifampin, when given in usual doses, is well tolerated with less than 4% of patients having significant adverse reactions. The patient had did not have any adverse reaction to rifampin in the first place. After 10 years, however, the patient was presented with hypotension, shortness of breath, wheezing and deterioration of consciousness in 10 minutes after taking rifampin. All abnormal symptoms and signs of anaphylaxis were normalized in 24 hours after administration of normal saline, glucocorticosteroid, and antihistamine. Skin prick test with rifampin showed positive reaction to gradual concentration of rifampin in dose dependent manner. The wheals by rifampin developed in 30 minutes and maximized in 2 hours, while normal saline and histamine controls showed expected negative and positive response in 10 minutes, respectively. Recently we expererienced a rare case of anaphylaxis after single oral administration of rifampin(450mg), who had been treated with antituberculous drug including rifampin, ca 10 years ago.

췌장의 비기능성 도세포종양의 임상적 특징 및 악성 예측인자

김현준 ( Kim Hyun Jun ),김명환 ( Kim Myung Hwan ),이성구 ( Lee Sung Koo ),이상수 ( Lee Sang Soo ),배종석 ( Bae Jong Seok ),장명국 ( Jang Myoung Kuk ),변정식 ( Byeon Jeong Sik ),민영일 ( Min Young Il ),황신 ( Hwang Shin ),박광민 ( 대한소화기학회 2003 대한소화기학회지 Vol.42 No.1

Background/Aims: It is difficult to determine preoperatively whether nonfunctioning islet cell tumors (NFICTs) are malignant or benign. The purposes of this study were to evaluate clinical characteristics and to differentiate benign from malignant behavior of NFICTs. Methods: We retrospectively analyzed 21 patients with NFICTs between 1990 and 2002. Results: Mean age was 51.4±13.2 years and female was predominant. Tumor size ranged from 0.5 to 13 cm (average 3.3±1.8 cm). Thirteen patients had variable symptoms. Histologically, 14 tumors were malignant and 7 were benign. In 9 out of 13 patients, pancreatogram showed narrowing of the main pancreatic duct, which was more frequently detected in patients with malignant NFICTs than in patients with benign ones (p<0.01). Surgical resection was performed in 20 patients. All patients with benign NFICTs are still alive after surgery, while 3 out of 14 patients with malignant NFICTs died 11, 22, 30 months after operation or diagnosis, respectively. The follow up time ranged from 1 to 111 months (mean 32.6 months) Conclusions: The presenting symptoms of patients with NFICTs were non-specific. The malignancy rate of NFICTs was high. Narrowing of the main pancreatic duct on pancreatogram suggested the malignancy. (Korean J Gastroenterol 2003;42:57-62)

관동맥 질환 환자에서 Lipoprotein ( a ) 농도와 당내인성과 관련성

두영철(Young Cheoul Doo),최조영(Jo Young Choi),장명국(Myung Kuk Jang),홍성훈(Sung Hun Hong),장명준(Myeong Jun Chang),고순희(Soon Hee Koh),한규록(Kyoo Rok Han),오동진(Dong Jin Oh),유규형(Kyu Hyung Ryu),고영박(Young Bahk Koh),이영(You 대한내과학회 1996 대한내과학회지 Vol.51 No.4

Objectives: A raised Lp (a) lipoprotein concentration is associated with coronary artery disease and impaired glucose intolerance has also been shown to be predictive of coronary artery clisease in some studies. It has been suggested that there is a significant association between impaired glucose tolerance and increased circulating Lp (a) lipoprotein concentration. The object of this study is to determine whether glucose intolerance and raised Lp (a) concentration are associated in subjects with coronary artery disease. Methods: The study group comprised 60 patients with coronary artery disease (M:20, mean age 56+/-13 year) and 70 control subjects without coronary artery disease (M:15, mean age 58+/-10 year). We compared the clinical variables, lipid profile including Lp (a), fasting glucose, and fasting insulin in subjects with coronary artery disease with impaired glucose tolerance and normal glucose tolerance, and in controls. Results: 1) Nine of 60 patients (15%) with coronary artery disease had glucose intolerance. There were no significant difference in the incidence of cardiovascular risk factors, body mass index, left ventricular mass index, the levels of lipid including Lp (a), and the levels of fasting glucose, insulin, and C-peptide except in the incidence of smoking (48% in patients with coronary artery disease vs 24% in normal control, p<0.05) between patients with coronary artery disease and normal controls. 2) Between coronary artery disease patients group with and without glucose intolerance, and normal controls, there were no difference in the level of Lp (a) concentration. Conclusion: The level of fasting glucose and concentration of Lp (a) were no difference in between patients with coronary artery disease and normal controls. There was no difference in concentration of Lp (a) in patients of coronary artery disease with and without glucose intolerance, and so suggest that raised Lp (a) lipoprotein concentration are not responsible for the association between impaired glucose tolerance and coronary artery disease.

약제 내성 만성 B형 간염 환자에서 S202, M250 엔테카비어 내성이 테노포비어 근간 구제 요법의 바이러스 반응에 미치는 영향

김성은 ( Sung Eun Kim ),박지원 ( Ji Won Park ),김형수 ( Hyoung Su Kim ),석기태 ( Ki Tae Suk ),장명국 ( Myoung Kuk Jang ),박상훈 ( Sang Hoon Park ),이명석 ( Myung Seok Lee ),김동준 ( Dong Joon Kim ),박충기 ( Choong Kee Park ) 대한내과학회 2015 대한내과학회지 Vol.89 No.5

Background/Aims: Long-term use of nucleos(t)ide analogues (NA) may lead to genotypic and/or phenotypic resistance of the hepatitis B virus (HBV). We investigated the efficacy of tenofovir-based rescue therapy in chronic hepatitis B (CHB) patients with newly developed genotypic resistance to prior NAs or partial virologic response to sequential rescue therapies. Methods: Fifty-four CHB patients were included retrospectively. The patients were treated with tenofovir alone or combined with lamivudine or entecavir. Results: There were 26 forms of genotypic resistance at enrollment. The median amount of serum HBV-DNA was 18,438 IU/mL and 83% of samples were positive for hepatitis B e antigen (HBeAg). Serum HBV-DNA was undetectable in 50%, 61%, and 76% of the patients at 3, 6, and 12 months, respectively. In multivariate analysis, HBV-DNA < 20,000 IU/mL and negative HBeAg at baseline were independent predictors of negativity for serum HBV-DNA. Interestingly, the rtS202 mutation tended to be associated with an unfavorable response. Other clinical variables and viral resistance genotypes showed non-significant viral response. Conclusions: Lower serum HBV-DNA, negative HBeAg and lack of rtS202G mutations at baseline may predict a favorable response to tenofovir-based rescue therapies in CHB patients with newly developed genotypic resistance to prior NAs or a partial virologic response to sequential rescue therapies. (Korean J Med 2015,89:527-536)

건선 환자에 동방된 염증성 장질환에 관한 임상적 고찰

김광중,김재왕,이종주,신형식,석사미,장명국 대한피부과학회 1999 大韓皮膚科學會誌 Vol.37 No.1

Background : Inflammatory bowel disease(IBD) such as ulcerative colitis or Croln's disease is often related with varied diseases including pyoderma gangrenosum, erythema nodosum, ankylosing arthritis and psoriasis. To date, however, a cIinical observation of IBD accompanied by psoriasis has been sparcely accomplished although an immunogenetic mechanism explaining a coexistence of IBD and psoriasis has been proposed. Objective: We estimated the prevalence of IBD in patients with psoriasis in Korea and investigated the clinical characteristics of IBD accompanied by psoriasis. Methods : 92 psoriatic patients and 389 non-psoriatic control subjects were enrolled in this study. Colonoscopic biopsy and barium series were performed in 47 psoriatic patients and 110 control subjects showing irritative intestinal symptoms. Results: 1. The prevalence of IBD in psoriatic patients(14.1%) was significantly greater than in the control group(1.0%). 2. In the temporal relationship, psoriasis developed several years prior to the onset of IBD in 84.6% of psoriatic patients. 3. The frequency of arthropathies in the psoriatic patients possessing IBD(84.6%) was significantly higher than that of non-psariatic counterparts with IBD(25.0%) or that of psoriatics without lBD(2.5%). 4. The psoriatir patients with IBD demonstrated much more frequently diffuse colonal extension than in non-psoriatic subjects with IBD. Conclusion: Our findings of an increased prevalence of IBD in the psoriatic population present further evidence of an association between IBD and psoriasis. In the psoriatic patients showing acute or chronic gastrointestinal symptoms, colonoseopic evaluation might be mandatory for the evaluation of IBD.