면역억제 환자의 급성 폐침윤에서 기관지폐포세척술의 진단적 유용성

박재석(Jae Seok Park),김재열(Jae Yeol Kim),강민종(Min Jong Kang),이계영(Kye Young Lee),유철규(Chul Gyu Yoo),김영환(Young Whan Kim),한성구(Sung Koo Han),심영수(Young Soo Shim),한용철(Yong Chol Han) 대한내과학회 1995 대한내과학회지 Vol.49 No.3

Objectives: Bronchoalveolar lavage(BAL) has been regarded as a valuable diagnostic tool in immunocompromised patients when they show acute pulmonary infiltration. The purpose of this study is to evaluate the diagnostic utility of BAL, in Korean immunocompromised patients with acute pulmonary infiltration. Methods: Twenty-nine BALs, performed on 29 immunocompromised patients with acute pulmonary infiltration, were evaluated. The types of immunoeompromise state, radiologic findings, diagnostic yield, complication of BAL, and clinical course were anlayzed. Results: 1) BAL could make etiologic diagnosis in 38%(11/29) of patients. Among them were 5 cases of Pneumocystis carinii pneumonia, 4 cases of pulmonary tuberculosis, 1 case of co-infection by Pneumocystis carinii and Cytomegalovirus, 1 case of pulmonary infiltration of malingnancy. 2) Sensitivity of BAL for diagnosing PCP and pulmonary tuberculosis were 60 % and 80 %, respectively. 3) However, the diagnosis of etiologic process by BAL did not improve the mortality of the patients. 4) Diagnostic yield of BAL was not significantly different according to the pattern of infiltration (bilateral diffuse vs localized) or severity of respiratory disease (with vs without ventilator care). 5) There were no clinically significant complications by the procedure of BAL. Conclusion: RAL is relatively safe procedure and useful for the diagnosis of immunocompromised patients who show acute pulmonary infiltration in their chest radiography.

Impact of Toxocariasis in Patients with Unexplained Patchy Pulmonary Infiltrate in Korea

윤영순,이창훈,강영애,Sung-Youn Kwon,윤호일,이재호,이춘택 대한의학회 2009 Journal of Korean medical science Vol.24 No.1

Toxocariasis is one of the causes of pulmonary eosinophilic infiltrate that is increasing in Korea. This study was designed to identify the prevalence of toxocara seropositivity in patients with unexplained pulmonary patchy infiltrate and to evaluate associated factors. We evaluated 102 patients with unexplained pulmonary patchy infiltrate on chest computed tomography (CT) scan. As a control set, 116 subjects with normal chest CT were also evaluated. History of allergic disease, drug use, parasitic disease and raw cow liver intake were taken. Blood eosinophil count and total IgE level were measured. Specific serum IgG antibody to Toxocara canis larval antigen and specific IgG antibodies to 4 other parasites were measured by enzymelinked immunosorbent assay (ELISA). In the infiltrate group, 66.7% subjects were toxocara seropositive whereas 22.4% of the control group were seropositive (p< 0.001). In the infiltrate group, patients with a history of eating raw cow liver (odds ratio [OR], 7.8) and patients with eosinophilia (OR, 5.2) had a higher incidence of toxocara seropositivity. Thirty-five percent of toxocara seropositive patients with infiltrate exhibited migrating infiltrate and 48% had decreased infiltrate on the follow- up CT. We recommend that toxocara ELISA should be performed in patients with unexplained pulmonary patchy infiltrate, and that the eating of raw cow liver should be actively discouraged.

동종 조혈모세포이식 후 폐합병증 : 미만성 폐침윤에서 기관지경의 유용성

민창기,엄기성,이동건,김동욱,이종욱,민우성,김춘추,정정임,김태연,송정섭 대한조혈모세포이식학회 2000 대한조혈모세포이식학회지 Vol.5 No.1

배경:동종 조혈모세포이식을 받고 백혈구수가 회복한 이후의 폐합병증은 대부분 국소적 폐렴이 아닌 미만성의 폐침윤(diffuse pulmonary infiltrate) 소견을 보이고 이식 후 불완전한 면역 재구성 또는 이식편대 숙주질환(graft-versus-host disease; GVHD) 등과 관련된다고 알려져 있다. 원인은 세균보다는 바이러스(주로 cytomegalovirus; CMV), Pneumocytis carinii (PC) 등이며 원인을 규명할 수 없는 특발성의 경우도 상당수를 차지하고 있으나 아직 국내에서는 자세히 보고된바 없다. 저자들은 본 센터에서 동종 조혈모세포이식 후 발생한 폐합병증의 진단 및 치료성적을 보고하고자한다. 방법:1997년 1월부터 1999년 8월까지 본 센터에서 동종 조혈모세포이식을 받은 321예의 환자 중에 방사선학적으로 미만성 폐침윤을 보여 기관지경 검사를 받은 환자 35예를 대상으로 하였으며 5예의 환자는 임상적인 경과의 변화로 기관지경 검사를 2회 실시 받았다. 환자들의 임상적 특성, 영상학적 검사 그리고 기관지경 검사로 기관지 폐포세척술을 실시하여 얻은 가검물에서 원인 미생물을 배양하거나 폐조직 생검을 통하여 진단하였다. 각 환자에서 진단에 따른 치료 및 반응을 관찰하였다. 결과:1) 환자연령의 중앙치는 31 (16~40)세, 이식 후 미만성 폐침윤이 발생하기까지 기간의 중앙치는 162 (55~965)일 이었다. 이식 당시 질환은 CML 16예, AML 10예, ALL 5예, NHL 2예, MDS 1예 그리고 CLL 1예 이었으며 35예 중 11예에서 2차 관해 이상의 진행된 질환을 갖고 있었다. 35예 중 비혈연간 또는 혈연간 HLA 부분일치 동종 조혈모세포이식 환자는 12예였고, 전처치에 전신 방사선조사를 받은 환자가 27예 항암제만 받은 환자는 8예 이었다. 2) GVHD 예방 약제로는 cyclosporin+methotrexate (n=26) 또는 tacrolimus+methotrexate (n=9) 조합을 사용하였다. 감염 예방으로 경구로 trimethoprim-sulfamethoxazole, acyclovir을 투여를 받은 환자는 9예(25.7%) 이었다. II도 이상의 급성 GVHD를 가진 환자가 12예(34.3%) 이었고, 27예(77.1%)에서 만성 GVHD를 갖고 있었다. 3) 기관지 폐포세척술의 가검물 배양 결과 미만성 폐침윤의 원인 미생물로는 CMV 8예, PC 6예, 두 미생물의 혼합감염 10예, 폐렴구균 1예, 그리고 Mycobacterium tuberculosis 1예 이었고, 나머지 14예(35%)에서는 원인균이 동정되지 않았다. 경기관지 폐조직생검은 19예 중 3예(15.8%)에서 진단적 가치가 있었다. 4) 기관지경을 시행한 40예 중 8예(20%)에서 폐포세척술 검체의 배양 및 경기관지 폐생검의 결과에 따라 치료를 하였음에도 불구하고 호전되지 않았다. 5) 35예 중 9예의 환자가 사망하였으며 이중 5예는 폐합병증으로 사망하였고 나머지 4예는 재발 또는 이식편대숙주질환에 의해 사망하였다. 폐합병증으로 사망한 환자의 원인으로는 CMV 1예, PC 1예, 혼합감염 1예, 그리고 원인 불명의 폐합병증이 2예 있었다. 결론:동종 조혈모세포이식 후 발생한 미만성의 폐침윤의 주된 원인은 CMV, PC 등이며 단독 감염보다는 혼합 감염의 형태를 보였다. 기관지경 검사 및 폐포세척술은 미만성 폐침윤의 진단에 유용하며 안전한 시술로 사료된다. 폐합병증은 주로 만성 GVHD 환자에서 출현하였으며 원인이 밝혀지지 않은 경우에 면역억제 치료가 효과적이었다. Background:Diffuse pulmonary infiltrates (DPI) after a neutropenic phase following allogeneic stem cell transplantation (allo-SCT) are common and include various causes. Multiple factors are thought to contribute to these pulmonary complications, including the graft-versus-host disease (GVHD), incomplete immune reconstruction and infections. This study was undertaken to determine the results of fiberoptic bronchoscopy (FOB) in patients with DPI after allo-SCT. Methods:Three hundreds twenty one patients underwent allo-SCT from January 1997 through August 1999 at Catholic Hemopoietic Stem Cell Transplantation Center. Out of 321 patients, 40 FOBs were performed in 35 patients who were aged 16 to 40 years (median age 31 years). In all cases, bronchoalveolar lavage (BAL) was achieved. Transbronchial forceps biopsy (TBFB) was also carried out in 47.5% (19/40). Clinical, radiologic, pulmonary function, microbiological and pathologic tests were reviewed. Results: 1)The underlying diseases were predominantly chronic myeloid leukemia and acute leukemia (31/35, 88.5%). Median time to FOB following SCT was 162 days (range, 55-965). The patients with acute GVHD more than grade II were 34.3% (12/35) and those with chronic GVHD were 77.1% (27/35). 3) An etiological diagnosis could be obtained in 26/40 (65%) of cases; mixed infection of cytomegalovirus (CMV) and Pneumocystis carinii (PC) was the most common finding (10/40, 25%), CMV and PC were isolated in BAL in 8/40 and 6/40 respectively, Pneumococci in one and Mycobacterium tuberculosis in one. In 14 procedures (35%), the results were negative. TBFB were valuable for diagnosis for only 3 out of 19 patients. There was one minor bleeding following FOB and TBFB. 4) Thirty two cases (80%) of FOB improved after treatment according to etiology. The patients with unknown etiology showed a good response to steroid (11/14, 78.6%). 5) Overall mortality in patients with DPI was 9/35 (25.7%). Five episodes of DPI were to refractory to treatment and were causes of death. Five causes consisted of 1 CMV, 1 PC, 1 mixed infection, and 2 unknown etiologies. Conclusion:FOB is a safe and valuable procedure for the evaluation of DPI after allo-SCT, which were commonly associated with GVHD, CMV and PC. The mixed infections were more predominant than those due to single isolated organism. Steroid was effective for patients with DPI in whom causative organisms were not able to be identified.

복강경하 자궁근종제거술 및 보조질식자궁절제술시 자궁과 자궁경관 주위조직으로 투여된 vasopressin에 의해 발생된 폐부종 -증례 보고-

김수연,이정향,방은치,이현숙,강용인,조경숙,권태희 대한마취통증의학회 2010 Anesthesia and pain medicine Vol.5 No.4

Vasopressin is often used locally to reduce blood loss in gynecologic surgery. The use of local infiltration of low concentration vasopressin (0.05−0.3 units/ml) has been considered to be safe. However, serious side effects such as bradycardia, hypertension, arrhythmia, pulmonary edema, coronary vasospasm, myocardial infarction and even cardiac arrest were reported during low-dose vasopressin. In 2 healthy women with myoma and multiple myoma combined with adenomyosis, we experienced pulmonary edema after intramyometrial injection and paracervical infiltration of vasopressin. After diuretics and oxygen therapy, the patients were recovered without any complications.

Roentgenological Findings on Pulmonary Paragonimiasis

Joo, Chong Yoon 계명대학교 의과학연구소 2000 계명의대학술지 Vol.19 No.2

In order to determine the roentgenological characteristics of pulmonary paragonimiasis, chest roentgenograms of 76 patients with positive Paragonimus intradermal tests were studied. The chest roentgenograms were of normal appearance in 50 cases or 65.5 per cent and abnormal in 26 cases or 35.5 per cent. Of the abnormal films, 19 cases had at least one cystic lesion and 7 cases were infiltrative appearance. The abnormal shadows were located more frequently in the right lung field than in the left, and involved in the all portions of the lungs except for rare apical involvement.

개회충증에 의한 호산구성 지방층염과 폐침범

조우성 ( Woo Sung Jo ),박혜경 ( Hye Kyung Park ),김지은 ( Ji En Kim ),김기욱 ( Ki Uk Kim ),김윤성 ( Yun Seong Kim ),이상표 ( Sang Pyo Lee ),이민기 ( Min Ki Lee ),박순규 ( Soon Kew Park ) 대한천식알레르기학회 2006 천식 및 알레르기 Vol.26 No.2

Eosinophilic panniculitis is characterized by prominent infiltration of eosinophils in the subcutaneous fat. It may be considered as a reactive process because most patients have an associated systemic condition. Once a diagnosis of eosinophilic panniculitis is established, appropriate evaluation for an associated clinical condition should be performed. Human toxocariasis is a helminthozoonosis due to migration of Toxocara species larvae and one of the major causes of peripheral eosinophilia. The larva can reach various organs such as the liver, lung, brain, and eye and cause visceral larva migrans. We report a case of toxocariasis manifested by erythematous pruritic nodules on left thigh and migrating pulmonary infiltration on CT scan in a 45- year-old man with eosinophilia. (Korean J Asthma Allergy Clin Immunol 2006;26:163-166)

Comparative toxicity of polyhexamethylene guanidine phosphate in three strains of rats

Woo Jong-Hwan,Kim Ki Cheon,Kim Hyeon-Young,Kim In-Hyeon,Kim Sung-Hwan,Lee Kyuhong 대한독성 유전단백체 학회 2022 Molecular & cellular toxicology Vol.18 No.1

Background Although polyhexamethylene guanidine phosphate (PHMG) is the main antibacterial ingredient in humidifi er disinfectants, inhalation of PHMG causes severe respiratory diseases, including pulmonary fibrosis and asthma. Many studies using animal models have been conducted to investigate the molecular mechanisms of PHMG-induced pulmonary diseases. However, there have been no comparative studies analyzing the differences in sensitivity according to different strains, especially in rats. Objective In this study, we investigated pulmonary toxicity by comparing the pathological features in various strains of PHMG-instilled rats including Fischer 344 (F344), Sprague Dawley (SD), and Wistar rats. Results During the experimental periods, mortality rates of 1 and 2 mg/kg PHMG-instilled F344 rats and 2 mg/kg PHMGinstilled SD rats were 16.7%, 33.3%, and 33% respectively. However, there were no deaths in PHMG-instilled Wistar rats. Body weight significantly decreased in all rat strains immediately after the first PHMG instillation, and gradually recovered again after Day 5. Absolute and relative lung weights in all rat strains significantly increased after dose-dependent PHMG instillation. Histopathological analysis of all PHMG-instilled rat strains showed clear granulomatous inflammation, interstitial inflammation, squamous cell metaplasia, and macrophage infiltration in the alveoli. Specifically, eosinophilic infiltration in the alveoli was only observed in PHMG-instilled SD and Wistar rats. In addition, immunohistochemistry assessment revealed the presence of TGF-β1-positive cells in the lung tissues of all PHMG-instilled rat strains, and IL-5-positive cells in the lung tissues of PHMG-instilled SD and Wistar rats. Conclusion These results could potentially provide baseline data on the selection of experimental species for inhalation toxicity studies.

폐 침윤을 동반한 특발성 과호산구 증후군 1례

류헌모,권영수,정진홍,이관호,이현우,김동석,이삼범 영남대학교의과대학 1994 Yeungnam University Journal of Medicine Vol.11 No.2

저자들은 말초 혈액에서 현저한 호산구 증가를 보이면서 간, 임파선, 골수 및 폐에 호산구 침윤을 보여 hydroxyurea로 치료한 특발성 과호산구 증후군 1례를 경험하였기에 문헌고찰과 함께 보고하는 바이다. The idiopathic hyperecoinophilic syndrome consists of peripheral blood eosinophilia of 1500/㎣ or more without a known cause, plus signs and symptoms of organ eosinophilia. The prognosis of HES without treatment is poor. However, about one third of the patients with this syndrome may respond to corticosteroid thrapy. Morever, the majority of the remainder may have a favorable response to hydroxyurea. We present here a case of hypereosinophilic syndrome without any identifiable causes, involving bone marrow, liver, lungs and cervical lymph node. We tried corticosteroid as a treatment but it showed on response. However the hydroxyurea showed good response.

A Case of Pulmonary Cysticercosis

Jin Hak Choi,Sun Il Chung,Young Sil Whang,Jong Deog Lee,Hyeon Ok Lim,Jin Hyun Choi,Se Ho Chang,Ki Mun Jung,Sang Ho Rhie 대한내과학회 1991 The Korean Journal of Internal Medicine Vol.6 No.1

백혈병 환자에서 발생한 폐침윤의 진단 및 치료에 있어 침습적 검사의 역할

강수정 ( Kang Su Jeong ),박상준 ( Park Sang Jun ),안창혁 ( An Chang Hyeog ),안종운 ( An Jong Un ),김호철 ( Kim Ho Cheol ),임시형 ( Im Si Hyeong ),서지영 ( Seo Ji Yeong ),김호중 ( Kim Ho Jung ),권오정 ( Kwon O Jeong ),이홍기 ( Lee 대한결핵 및 호흡기학회 2000 Tuberculosis and Respiratory Diseases Vol.48 No.4