연구배경: M. abscessus 폐질환은 최근 우리나라에서 유병률이 증가하는 질환이다. 국내 M. abscessus 폐감염증에 대한 치료성적 및 치료 후 장기결과에 대해서 알아보고자 의무기록을 후향적으로 분석하였다. 방 법: 1996년부터 2003년까지 서울아산병원에서 미국흉부학회진단기준에 부합하는 35명의 M. abscessus 폐질환 환자 중 치료를 받은 29명의 환자를 대상으로 임상적 특징과 치료, 치료 후 추적결과에 대해 분석하였다. 결 과: 29명의 평균 나이는 56.1세(± 13.6)였고 여성이 76% 이었으며(22/29), 20명(69%)에서 결절 기관지확장증형이었다. 29명 중 19명(65.5%)에서 치료성공하였고 9명(31%)은 치료실패하였다. 1명은 약물부작용으로 치료를 중단하였다. 치료성공군은 중앙값 543일(범위 176 1,160)동안 치료를 받았고, 균배양 음전까지의 기간은 중앙값 42일(범위 15-362)이었다. 수술은 5명에서 시행되었으며 한 엽에만 국한된 병변을 가진 두 환자에서 치료성공하였다. 치료 완료 후 중앙값 931일 (범위 230-2294일)동안 추적관찰이 이루어졌고, 19명 중 1명(5.3%)이 재발하였다.
Background: Although there is an increasing incidence of Mycobacterium abscessus pulmonary disease in Korea, the optimal therapeutic regimen has not yet been established and there are no reports of the long-term treatment outcomes. This study examined the long-term treatment outcomes of M. abscessus pulmonary disease. Methods: Twenty-nine patients diagnosed with M. abscessus pulmonary according to the American Thoracic Society criteria and treated from January 1996 to December 2003 were enrolled in ghis study. The clinical characteristics, radiological findings, treatment outcome, and follow up data were analyzed retrospectively. Results: The mean age of the 29 patients was 56.1 (± 13.6) years and there was a female (22/29) dominance. The chest radiography revealed the nodular bronchiectatic type to be dominant (69%, 20/29). Twenty-seven (93.1%) were prescribed clarithromycin-containing regimens, and injectable drugs, mainly aminoglycosides, were included in the regimen of nineteen patients. The most predominant regimen (48.3%) consisted of clarithromycin and amikacin. The treatment success, failure, and default were achieved in 19(65.5%), 9(31.0%), and 1(3.4%), respectively. The median duration to culture conversion was 42 days (range 15-362) and the median duration of treatment in the success group was 543 days (range 176-1,160). An adjunctive surgical resection was performed in five patients, which resulted in treatment success in two patients. After the completion of treatment, nineteen patients were followed up for a median duration of 931 days (range 230-2,294). Only one (5.3%) patient relapsed 45 days after completing treatment. Conclusion: Treatment with clarithromycin-containing regimens resulted in a successful treatment in approximately two thirds of patients with M. abscessus pulmonary disease. The long-term relapse rate was also quite low. (Tuberc Respir Dis 2007; 62: 98-104)
연구배경: 내독소로 유발된 급성폐손상의 발생기전에 산화스트레스가 중요한 역할은 한다. 본 실험은 LPS로 유발한 급성폐손상 모델에서 항산화제인 α-lipoic acid의 치료효과를 보고하였다.방 법: Sprague-Dawley 쥐를 대상으로 LPS (E.coli, 3mg/Kg)를 기도내 주입 후 α-lipoic acid를 복강 내 주입하였다. 2시간, 6시간 후에 폐포세척액에서 호중구수, CINC, 시토카인의 농도를 구하고 폐조직에서 MPO 를 측정하였다. 결 과: α-lipoic acid를 후처치한 군에서 LPS 단독군보다 2시간 뒤와 6시간 뒤에 총 세포수와 호중구의 수가 감소하였으나 단백질 농도는 차이가 없었다. 또한 염증성 인자인 TNF-α, IL-1ß, IL-6의 농도도 α-lipoic acid 처치군에서 유의한 감소를 보이지 못하였다.
Background: Oxidative stress may play an important role in the pathogenesis of endotoxin-induced acute lung injury (ALI). This study evaluated the therapeutic effect of α-lipoic acid, a nonenzymatic antioxidant, in a rat model of lipopolysaccharide (LPS) induced ALI. Materials and Methods: ALI was induced in Sprague-Dawley rats by instilling LPS (E.coli, 3mg/Kg) into the trachea. The rats were classified into the control, control+α-lipoic acid, LPS, and LPS+α-lipoic acid groups.The lung lavage neutrophil count, cytokine-induced neutrophil chemoattractant (CINC), lung myeloperoxidase (MPO), and cytokine concentrations (TNF-α, IL-1ß, IL-6 and IL-10) were measured at 2 h and 6 h after LPS administration. Results: The total cell and neutrophil counts of the LPS+α-lipoic acid groups were significantly lower than the LPS groups. The protein concentration in the BAL fluid was similar in the LPS groups and LPS+α-lipoic acid groups. The TNF-α, IL-1ß, and IL-6 concentrations in the BAL fluid were not decreased by the α-lipoic acid treatment in the LPS treated rats. Conclusions: Although α-lipoic acid decreased the level of LPS-induced neutrophil infiltration into the lung, it could not attenuate the LPS-induced ALI at the dose administered in this study. (Tuberc Respir Dis 2007; 62: 105-112)
연구배경: 파라쿼트 중독은 다발성 장기부전과 폐섬유화를 유발하여 높은 사망률을 초래한다. 폐섬유화의 약화를 위해 여러 종류의 면역억제제가 사용되었으나 그 치료효과는 다양하다. 철은 파라쿼트로 유발된 산화 스트레스에 의한 폐손상에 중요한 역할은 한다. 본 연구는 파라쿼트 중독의 치료시 철 킬레이트 제제인 deferoxamine의 효과를 보고자 시행되었다.방 법: 2001년 10월부터 2005년 4월까지 파라쿼트 중독으로 내과계중환자실에 입원한 37명 중 28명이 본 연구에 포함되었다. 환자들은 서울아산병원의 파라쿼트 치료 프로토콜에 따라서 치료되었다. 이 중 12명이 추가로 deferoxamine 투여군으로 무작위 분류되었다.결 과: 두 군간의 성별, 나이, 파라쿼트 중독의 정도, 섭취 후 병원까지의 도착 시간 등은 유의한 차이를 보이지 않았다. 파라쿼트 섭취 후 간기능과 신기능의 변화도 유의한 차이를 보이지 않았다. 전체 사망률은 두 군 간의 차이는 없었으나 deferoxamine 투여군에서 대조군과 비교시 호흡부전의 빈도가 높았다(4/7 versus 0/9, p=0.019).
Background: Paraquat is known to induce oxidant injury that results in multiorgan failure and lung fibrosis. Iron has been considered to play a key role in paraquat-induced oxidant lung injury. This study examined the effect of deferoxamine, an iron-chelating agent, in the treatment of paraquat poisoning. Methods: From September, 2001 to April, 2005, 28 patients with paraquat poisoning who were admitted at a medical intensive care unit of a University-affiliated hospital, were enrolled in this study. Sixteen patients were treated according to the paraquat poisoning treatment guidelines and 12 received an intravenous infusion of deferoxamine in addition to the treatment guidelines. Results: There were no differences between the two groups in terms of age, gender, severity of paraquat poisoning, and the time elapsed from ingestion to presentation at hospital. There was no difference in overall mortality between the two groups but the incidence of respiratory failure in the deferoxamine group was higher than in the conventional group(4/7 versus 0/9, p=0.019). Conclusion: Deferoxamine seems to have no clinical benefit compared with the conventional treatment. (Tuberc Respir Dis 2007; 62: 113--118)
Sarcoidosis is a multi-system granulomatous disorder of an unknown etiology and affects individuals worldwide. It is characterized pathologically by the presence of non-caseating granulomas in more than one involved organ. However, pleural involvement of sarcoidosis is rare and there are no reported cases in Korea. Traditionally, sarcoidosis has often been treated with systemic corticosteroids or cytotoxic agents. In particular, chylothorax with sarcoidosis is usually treated with corticosteroid for approximately 3~6 months, followed by repeated therapeutic thoracentesis, talc pleurodesis, dietary treatment, or thoracic duct ligation where needed. We encountered a 46 years old female patient presenting with cough, dyspnea and both hilar lymphadenopathy (stage I) on chest radiograph. The patient was diagnosed with a non-caseating granuloma, sarcoidosis by a mediastinoscopic biopsy. For one month, she had suffered from dyspnea due to right side pleural effusion, which was clearly identified as a chylothorax on thoracentesis. Corticosteroid therapy with dietary adjustment was ineffective. She was treated successfully with a subcutaneous injection of octreotide for 3 weeks and oral corticosteroid. We report a case of successful and rapid treatment of chylothorax associated with sarcoidosis using octreotide and oral corticosteroid. (Tuberc Respir Dis 2007; 62: 119-124)
Docetaxel 은 비소세포암에서 널리 사용되는 taxoid 계열의 항암제로, 조갑변화의 부작용은 한국에서 드물게 알려져 있다. 저자들은 비소세포암 4기인 62세 남환이 5차례 docetaxel 및 carboplatin 항암치료 시행 7일 후 발생한 조갑하 농양 및 조갑 박리의 진단과 치료 1예를 경험하여 문헌 고찰과 함께 보고하는 바이다.
Docetaxel is a taxoid antineoplastic drug, which is widely used to treat locally advanced or metastatic non-small cell lung cancer (NSCLC). Among the adverse dermatological reactions, nail disorders such as bending, onycholysis, hypo- or hyperpigmentation are rare. We report a case of a 62-year-old male with advanced NSCLC (cT4N3M1, stage IV), who developed purulent discharge and onycholysis in the nail of all his fingers and the left great toe after five courses of anti-neoplastic chemotherapy, which included docetaxel (cumulative dose: 370 mg/m2, 590 mg). Seven days after the final session of chemotherapy, the patient had become aware of discoloration and swelling of the nail beds with out pain. Three days later, greenish-yellow purulent discharge oozed out from the involved nails. Microbiologic studies revealed Pseudomonas aeruginosa. Intravenous and topical antibiotics (mupirocin) were applied. After 2 weeks, regrown nails were observed and the onycholysis had improved. (Tuberc Respir Dis 2007; 62: 125-128)
기관지내에 발생하는 신경집종은 매우 드물고 증상과 방사선학적 소견이 다양하게 나타난다. 진단을 위해서 기관지내시경을 통한 조직검사가 필요하지만 기관지내시경을 통한 조직검사에서도 확진이 되지 않을 수 있음을 고려해야 한다. 치료로는 기관지내시경을 통한 국소적 치료와 외과적 절제술이 있으며 환자의 상태, 종양의 위치 및 진행 정도 등을 고려하여 결정해야 할 것이다.
Neurilemmomas are benign tumors that originate from Schwann cells. These tumors rarely occur in the trachea or bronchus. Although small peripheral lesions cause no symptoms, they usually cause dyspnea, cough, wheeze, and atelectasis. We encountered two cases of endobronchial neurilemmoma, and reviewed 10 cases previously reported in Korea in order to clarify the characteristics of this disease, and to determine the appropriate treatment. The median age of the 12 patients reviewed were 36.5 (range 16-75). Cough and dyspnea were the most common initial symptoms (40%), and two cases had no symptoms. Regarding the diagnostic methods, bronchoscopic biopsy was found to be inadequate for diagnosis in two cases. A review of the cases revealed the following teatments: bronchoscopic removal in two cases, surgery in six cases, and combined bronchoscopic removal and surgery in one case. (Tuberc Respir Dis 2007; 62: 129-133)
Gefitinib은 진행성 비소세포성 폐암에 사용이 증가 되고 있는 새로운 표적 항암 치료제로써 대부분이 경미한 부작용을 보이나 심각한 약제 유발성 간질성 폐렴이 발생 할 수 있다. 발생 빈도가 높은 일본에서는 유병률이 3.5%까지도 보고 된 바 있으나 현재 우리 나라에서는 EAP에서 확인된 1건을 제외하고는 보고가 거의 없어 gefitinib로 인한 간질성 폐렴에 대한 낮은 인지도와 감별 진단의 어려움 등이 문제가 되는 것으로 판단된다. 저자들은 gefitinib에 의한 간질성 폐렴 2례를 경험하였기에 이를 보고하는 바이다.
Gefitinib is a novel drug used to treat advanced non-small cell lung cancer. However, drug-related interstitial pneumonia is a major life-threatening side effect, which has a worldwide prevalence of 0.3-0.4%. In Japan, the prevalence is high as 3-4% but the actual frequency in Korea has not been officially assessed. We report two cases of gefitinib-induced interstitial lung disease during the treatment of non-small cell lung cancer. High-resolution computerized tomography (HRCT) of one case showed nonspecific ground glass opacity and the chest x-ray of another case showed diffuse bilateral ground glass opacity. The former patient showed a rapid good response to corticosteroid treatment whereas the latter died despite receiving aggressive treatment with high dose corticosteroid and empirical antibiotics. (Tuberc Respir Dis 2007; 62: 134-139)
심한 암통증을 호소하는 폐암 환자에서 고용량 펜타닐 첩포(600g/hr)를 이용하여 통증의 완화를 경험하였기에 이를 문헌고찰과 함께 보고하는 바이다.
A 60-year-old man was diagnosed with locally advanced non-small cell lung cancer. He refused treatment with a curative aim and was treated conservatively. Pain had developed on his shoulder and chest wall, which became worse as the cancer progressed. Although his pain initially appeared to be relieved with weak opioids and analgesics, it became more severe Strong opioids (transdermal fentanly patch and oxycodone), antidepressant or epidural block were introduced, However, the background pain became more intense and reached up to 8~9/10 on the visual analog scale (VAS). The dose of the transdermal fentanl patch was gradually increased to 600µg/hr, which resulted in a dramatic improvement in his pain (9/10 of VAS) to 3/10 for most of the time. We described the successful experience with a high dose transdermal fentanyl patch for cancer pain relief, which might be an alternative option for cancer patients suffering from severe pain. (Tuberc Respir Dis 2007; 62: 140-143)
저자 등은 gefitinib 투약 중 발생한 급성호흡곤란으로 사망한 2 예를 경험하였기에 이를 보고하는 바이다.
Gefitinib is an oral selective inhibitor that targets the tyrosine kinase of the epidermal growth factor receptor. The prevalence of interstitial lung disease is 2% in Japan and 0.3% in the USA with a mortality rate of up to one third. We describe two non-small cell lung cancer patients who developed acute respiratory failure after gefitinib, and suggest that clinicians take extreme caution when deciding to treat patients with gefitinib. (Tuberc Respir Dis 2007; 62: 144-148)
폐모세포종은 폐종양으로 매우 드물게 나타나며 드물게 간, 흉외 림프절, 심장으로 전이된다고 보고되고 있다. 본 저자들은 복부의 팽만감과 통증 및 호흡곤란을 주소로 내원한 환자에서 간과 폐의 거대 종괴를 발견하였고, 조직 검사를 통하여 간, 횡격막, 심장 등 다발성 침범을 동반한 폐모세포종으로 진단받은 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다.
A pulmonary blastoma is a rare malignant tumor of the lung that is composed of epithelial and mesenchymal elements and resembles the structure of an embryonic lung. Pulmonary blastomas have a very poor prognosis and make up 0.25 to 0.5 percent of all primary malignant lung tumors. A pulmonary blastoma usually manifests as a solitary parenchymal mass or nodule and multiple subpleural mass with effusion on chest X-ray and computed tomography. We encountered a very rare case of pulmonary blastoma in a 52 years old male. He complained of abdominal pain, fullness, and dyspnea. The radiology examination revealed a huge lung mass invading the mediastinum, heart, diaphragm, and liver. The percutaneous needle biopsies were performed, and this tumor was diagnosed as a pulmonary blastoma. We report a biopsy confirmed case of a huge pulmonary blastoma invading multiple organs. (Tuberc Respir Dis 2007; 62: 149-153)