호산구성 폐렴은 혈중 호산구가 1,000/mm3 이상이거나 폐포 내 호산구 분획이 25% 이상으로 나타나는 다양한 폐 질환을 총괄하여 부르는 용어이다. 혈중 호산구증가증은 특발성 급성 호산구 폐렴의 초기나 이미 부신피질호르몬 제제를 투여받은 환자에서는 나타나지 않을 수 있다. 호산구성 폐렴은 무증상의 폐 침윤에서 기계 환기가 필요한 급성 호흡 부전 증후군까지 증상의 중증도도 다양하다. 호산구성 폐렴의 원인으로 약제나 기생충이 있지만 많은 경우 원인을 찾을 수 없다. 폐 외 증상이 동반될 경우 Churg-Strauss 증후군이나 과다호산구증가 증후군의 가능성을 생가해야 되며 이런 경우 심장을 침범하였는지 여부에 따라 예후가 결정된다. 가능한 원인에 대한 노출을 피하는 것 외에는, 부신피질호르몬 제제 투여가 가장 중요하며 대부분 극적인 호전을 보인다. 하지만 약제의 감량 중이나 치료 종결 후 재발하는 경우가 자주 있다. HES의 골수 증식성 변이형 치료에 imatinib의 효과가 최근 입증되었다.
연구배경: 다제내성결핵과 광범위내성결핵은 전세계적으로 결핵 치료에 큰 위협으로 등장하고 있지만 이에 대한 국내의 정확한 실태 및 추이는 잘 알려져 있지 않다. 일개 결핵병원에서 다제내성결핵과 광범위내성결핵의 빈도 및 추이를 살펴봄으로써 국내 실태를 간접적으로 파악하고자 하였다. 방 법: 2001년부터 2005년 사이에 국립마산병원에 입원하여 배양양성 결핵으로 진단된 환자를 대상으로 약제감수성검사 결과와 의무기록을 후향적으로 분석하였다. 결 과: 2001년부터 2005년 사이에, 다제내성결핵은 신환자에서 9.2%, 13.8%, 16.9%, 23%, 27.0%로 의미있게 증가하였고(p＜0.001 for trend) 재치료환자에서 9.1%, 15.7%, 17.3%, 19.9%, 19.1%로 의미있게 증가하였다(p=0.002 for trend). 광범위내성결핵은 신환자에서 0%, 2.3%, 3.1%, 2.5%, 6.3%로 의미있게 증가하였고(p=0.005 for trend) 재치료환자에서 9.1%, 15.7%, 17.3%, 19.9%, 19.1%로 의미있게 증가하였다(p＜0.001 for trend). 결 론: 다제내성결핵과 광범위내성결핵은 신환자와 재치료환자 모두에서 증가하는 추이를 보였다. 국내의 정확한 실태 파악을 위하여 공공 및 민간의료기관을 포괄하는 통합적인 약제내성실태 조사가 필요할 것으로 사료된다.
Background: Multidrug-resistant tuberculosis (MDR-TB) and extensively drug resistant tuberculosis (XDR-TB) are serious threats to worldwide tuberculosis control, but the national burden and the trends of infectious spread are largely unknown. Methods: We retrospectively reviewed the results of drug sensitivity tests and medical records of patients that were diagnosed with culture-confirmed pulmonary tuberculosis and were admitted to the National Masan Tuberculosis Hospital between 2001 and 2005. Results: From 2001 to 2005, the proportion of MDR-TB among new cases was 9.2%, 13.8%, 16.9%, 23% and 27.0% in 2001, 2002, 2003, 2004 and 2005, respectively, and the proportion of MDR-TB among previously treated cases was 58.5%, 60.2%, 62.7%, 61.7% and 71.3% in 2001, 2002, 2003, 2004 and 2005, respectively. A significant increasing trend could be discerned for MDR-TB among both new and previously treated cases (p＜0.001, p=0.002 for trend, respectively). The proportion of XDR-TB among new cases was 0%, 2.3%, 3.1%, 2.5% and 6.3% in 2001, 2002, 2003, 2004 and 2005, respectively, and the proportion of XDR-TB among previously treated cases was 9.1%, 15.7%, 17.3%, 19.9% and 19.1% in 2001, 2002, 2003, 2004 and 2005, respectively. A significant increasing trend could be discerned for XDR-TB among both new and previously treated cases (p=0.005, p＜0.001 for trend, respectively). Conclusion: Both MDR-B and XDR-TB were gradually increased among both new and previously treated cases. Integrated national surveillance, including the public and private sectors, will be needed to estimate the exact status of antituberculous drug resistance.
Background: Early identification of pathogens can improve the prognosis of patients with ventilator associated pneumonia (VAP). In the present study, we evaluated the feasibility of performing multiplex PCR for endotracheal aspirates to detect three important pathogens (P. aeruginosa, K. pneumoniae and MRSA) in patients with VAP. Methods: The endotracheal aspirates of 24 patients were collected within 24 hours of the diagnosis of VAP for performing multiplex PCR. Forward and reverse primers were designed to target the specific site of each pathogen (the oprL gene for P. aeruginosa, 16S rRNA for K. pneumoniae and the mec gene for MRSA). We analyzed the clinical data of the VAP patients, including the culture reports for the endotracheal aspirates. Results: Twenty-four patients (M:F=18:6, mean age=70±11) with VAP were enrolled. Pathogens were isolated from 11 patients (P. aeruginosa in 2, K. pneumoniae in 1, MRSA in 2, other enteric Gram negative bacilli in 3, S.pneumoniae in 2 and mixed infection in 1). Multiplex PCR detected three cases of P.aeruginosa (2 cases coincided with the culture reports) and four cases of K. pneumoniae (1 matched with the culture report). PCR detected two MRSA cases, which did not coincide with the culture reports. Conclusion: Multiplex PCR of the endotracheal aspirate showed some ability to detect Gram negative bacilli, although caution is required when interpreting the results.
Background: Tumor angiogenesis plays an important role in tumor growth, maintenance and metastatic potential. Tumor tissue produces many types of angiogenic growth factors. Vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) have both been implicated to have roles in tumor angiogenesis. In this study, the expression of tissue VEGF and bFGF from non-small cell lung cancer (NSCLC) patients were analyzed. Methods: We retrospectively investigated 35 patients with a histologically confirmed adenocarcinoma or squamous cell carcinoma of the lung, where the primary curative approach was surgery. An ELISA was employed to determine the expression of VEGF and bFGF in extracts prepared from 35 frozen tissue samples taken from the cancer patients. Results: VEGF and bFGF concentrations were significantly increased in lung cancer tissue as compared with control(non-cancerous) tissue. The VEGF concentration was significantly increased in T2 and T3 cancers as compared with T1 cancer. Expression of VEGF was increased in node-positive lung cancer tissue as compared with node-negative lung cancer tissue (p=0.06). VEGF and bFGF expression were not directly related to the stage of lung cancer and patient survival. Conclusion: Expression of VEGF and bFGF were increased in lung cancer tissue, and the expression of VEGF concentration in lung cancer tissue was more likely related with tumor size and the presence of a lymph node metastasis than the expression of bFGF. However, in this study, expression of both VEGF and bFGF in tissue were not associated with patient prognosis.
기관지결핵에 의한 기도폐쇄, 협착은 기관지결핵 치료 초기보다는 치료 도중 또는 치료 후기에 주로 발생하는 합병증이다. 23세 여자환자가 기관결핵을 진단받고 항결핵제 치료 시작 2주 후 급성으로 악화된 심한 기침, 호흡곤란으로 병원에 왔다. 시행한 기관지내시경에서 용종과 같은 기관종괴가 기관 내에서 호흡에 따라 상, 하 운동을 하면서 호기 시에 기도폐쇄를 일으켰고 이 종괴는 기관지 내시경을 통해 성공적으로 제거되었다. 기관결핵의 치료경과 중 발생한 드물게 보이는 형태의 급성 기도폐쇄로 사료되어 문헌고찰과 함께 보고한다.
화학성 폐렴은 유독한 화학물질의 흡입 혹은 흡인으로 발생한다. 황화수소는 자연적으로 발생하기도 하지만, 석유 정제, 약품 제조 과정 등에서 발생하여, 고농도로 노출될 경우 화학성 폐렴을 일으킨다. 두 명의 근로자가 제약회사의 폐수처리장에서 작업하던 중 황화수소가 포함된 혼합가스에 노출된 후 의식을 잃었다가, 구조된 이후에 의식은 회복되었으나, 호흡곤란과 기침을 호소하며 내원하였다. 단순 흉부 방사선 검사 및 고해상도 전산화 단층촬영에서 폐침윤이 관찰되어, 화학성 폐렴으로 진단하였고, 동맥혈 가스 분석에서 저산소혈증을 보여 산소공급 및 보존적 치료 후 임상 및 방사선학적으로 회복되었다.
Chemical pneumonitis is an occupational lung disease that's caused by the inhalation of chemical substances. Its severity depends on the characteristics of the substances, the exposure time and the susceptibility of the patients. Hydrogen sulfide is not only emitted naturally, but it also frequently found in industrial settings where it is either used as a reactant or it is a by-product of manufacturing or industrial processes. Inhalation of hydrogen sulfide causes various respiratory reactions from cough to acute respiratory failure, depending on the severity. Two pharmaceutical factory workers were admitted after being rescued from a waste water disposal site that contained hydrogen sulfide. In spite that they recovered their consciousness, they had excessive cough and mild dyspnea. The simple chest radiographs and high resolution computed tomography showed diffuse interstitial infiltrates, and hypoxemia was present. They were diagnosed as suffering from chemical pneumonitis caused by hydrogen sulfide. After conservative management that included oxygen therapy, their symptoms, hypoxemia and radiographic abnormalities were improved.
고형암에서의 종양용해증후군은 드물지만 발생하면 높은 사망률을 보이는 치명적인 합병증으로 외국에서는 지금까지 약 50여명의 증례가 보고되어 왔다. 우리 나라에서도 종 발생한다고 알려져 있지만 실제로 뒷받침 할만한 증례를 찾아 보기가 힘든 실정이었다. 이에 저자들은 소세포폐암에서 항암화학요법 도중 발생한 치명적 종양용해증후군 1예를 경험하였기에 문헌 고찰과 함께 이를 보고하는 바이다.
Tumor lysis syndrome is a life-threatening complication of anti-cancer therapy that typically occurs in patients with large, rapidly growing and treatment-sensitive tumors such as high-grade lymphomas and acute leukemias. However, its incidence in solid tumors has been known to be very low. Tumor lysis syndrome in solid tumors has a high mortality rate owing to the lack of prophylactic therapy to prevent this complication. We report a case of fatal tumor lysis syndrome developed during chemotherapy in extensive-stage small cell lung cancer, along with a brief review of the relevant literature considering the rarity of this manifestation in solid tumor.
저자들은 대량 객혈로 내원한 환자에서 폐 출혈과 함께 반복적인 심인성 폐부종, 카테콜라민 유도성 심부전이 합병된 드문 형태의 갈색세포종을 경험하여 이러한 임상 증상시 폐나 심장 질환 외에 갈색세포종에 대한 고려가 필요할 것으로 생각되어 문헌고찰과 함께 보고하는 바이다.
Pheochromocytoma is derived from the chromaffin tissue. The typical finding of pheochromocytoma is paroxysmal hypertension accompanied with various signs and symptoms that are due to the excess of catecholamines or other bioactive substances. Yet the diagnosis is sometimes difficult to make because its clinical presentation is quite variable. Especially, hemoptysis is a very rare symptom, so the diagnosis is often missed or delayed. Without making the correct diagnosis and then subsequently administering treatment, the condition may be fatal. We herein report on a 68 year-old woman who was admitted because of abdominal pain and hemoptysis. The initial radiologic findings suggested pulmonary edema with alveolar hemorrhage. The urine catecholamine levels were elevated and she developed catecholamine-induced cardiomyopathy. We performed bronchial arterial embolization and we administered alpha blocker medication for controlling the hemoptysis and hypertension. After the temporary symptomatic improvement, her clinical course was aggravated by pneumonia and pulmonary edema. In spite of performing definitive surgery for pheochromocytoma, she died of postoperative hemodynamic instability.
ECD는 포말 대식세포의 전신 침범으로 염증 반응을 일으키는 드문 질환으로 다양한 임상양상과 불량한 예후를 보이는 질환이다. 본 증례는 골 동통과 폐막 침범이 된 자에서 흉막 생검을 통한 확진으로 ECD가 진단된 경우이며 기저질환으로 진성 적혈구 증다증이 있는 자에서 발현한 예를 경험하였기에 이를 문헌고찰과 함께 보고하는 바이다.
Erdheim-Chester disease (ECD) is a rare disease that is characterized by multi-organ involvement of foamy histiocytes. It causes systemic inflammation, and also demonstrates various clinical manifestations and has a poor prognosis. We encountered a case of ECD in a patient that had been treated for underlying polycythemia vera. As far as we know, this is the first reported case worldwide where ECD developed in association with polycythemia vera. A 59-year-old man visited our hospital due to pleuric pain at the right side of the chest. Pleural tissue that was obtained following a thoracoscopic biopsy showed non-Langerhan's cell histiocytosis, suggesting the presence of ECD. The histiocytes stained positively for CD68, but were negative for S-100 and CD1a. The patient also complained of pain at both hips and the right shoulder area. An X-ray and magnetic resonance image demonstrated that the lesion showed sclerosis and osteolysis in both the proximal femur and right humerus. Treatment was started with predinisolone, and subsequently cyclophosphamide was added. ECD is a very rare multi-systemic disease, and its cause and therapeutic options have not yet been defined. ECD has a poor prognosis. Therefore, we believe that additional case studies are needed prior to the determination of a novel therapy for ECD.
쇼그렌 증후군은 림프구 침윤과 관련된 만성적인 염증성 자가면역 질환으로 아직 정확한 병태생리학적 기전은 밝혀지지 않았다. 45세 여자 환자가 내원 2년 전 전신 쇠약 및 피로감으로 입원하여 혈청 검사에서 anti- Ro/La antibody 양성,흉부 단순방사선 및 컴퓨터 촬영에서 양 폐야의 다낭성 병변이 관찰되어 비디오 흉강경을 이용한 폐 생검 시행 결과 세기관지 주위에 림프구 침윤 및 다양한 크기의 폐낭종들이 관찰되어 쇼그렌 증후군의 폐 침범 의심하에 추가 검사 시행하려 하였으나 추적 관찰 되지 않았다. 2년 후 폐렴으로 입원하였으며, 다시 시행한 흉부 컴퓨터 단층촬영에서 다발성 낭성 변화는 큰 차이를 보이지 않았다. 쇼그렌 증후군의 폐 침범은 다양한 형태로 나타나는데, 단순히 세기관지주위에 림프구 침윤에 의한 다낭성 폐 질환에 대한 보고는 극히 드물다. 따라서 본 저자들은 일차성 쇼그렌 증후군 환자에서 비디오 흉강경을 이용한 폐 생검으로 진단된 세기관지 주위에 림프구 침윤을 동반한 다낭성 폐 질환 1예를 경험하였기에 보고하는 바이다.
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A unique case of atypical pulmonary sarcoidosis in a 62-year-old man complaining of dyspnea is presented. Chest CT scan showed an unusual pattern and distribution of pulmonary sarcoidosis manifesting mainly as reticular densities, interlobular septal thickening, and ground-glass opacities, in the subpleural and lower lung predominancy. However, a surgical lung biopsy revealed classical findings of sarcoidosis. Knowledge of this atypical pulmonary involvement may improve understanding sarcoidosis as the great masquerader.