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( Joong-yub Kim ),( Sun Mi Choi ),( Jayeun Kim ),( Jaeyoung Cho ),( Nakwon Kwak ),( Young Sik Park ),( Chang-hoon Lee ),( Sang-min Lee ) 대한결핵 및 호흡기학회 2020 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.128 No.-
Background Acute exacerbation (AE) of idiopathic pulmonary fibrosis (IPF) is the leading cause of death in IPF patients. While AE-IPF in-hospital mortality reaches near 50%, what distinguishes non-survivors from survivors is less known. Here, we present an easy-to-use scoring system predicting mortality of AE-IPF patients with six clinical markers that can be quickly acquired at patient’s initial presentation. Methods A retrospective derivation cohort of 769 IPF patients between January 2001 to December 2019 was constructed. Following the latest 2016 AE-IPF diagnostic criteria, we focused on 134 patients who experienced AE for the first-time. Medical history, vital signs, and laboratory Results from emergency department visits or hospital admissions were collected via medical record review. We used beta-coefficients of statistically and/or clinically significant factors from multiple logistic binary regression analysis (Primary outcome: 30-day mortality) to design a scoring system. Its performance was assessed with receiver operating characteristic (ROC) curve analysis. Results Patients with diabetes [adjusted odds ratio (aOR) 2.728, p=0.042], current cigarette use [aOR 4.085, p=0.023], PaO2/FiO2 (PF) ratio above 100 and less than or equal to 200 mmHg [aOR 3.108, p=0.016], and bilirubinemia over 1.2 mg/dL [aOR 2.767, p=0.040] were associated with higher 30-day mortality. Admission within previous 6 months [aOR 2.147, p=0.082], initial systolic blood pressure over 140 mmHg [aOR 2.432, p=0.061], and PF ratio below 100 mmHg [aOR 2.746, p=0.215] were also included in the modeling due to clinical significance. Area under the ROC curve of the scoring system was 0.770 (95% CI 0.679- 0.862, p<0.0001). Derivation cohort patients were divided into quartiles according to their score. Interquartile mortality differed (Q1: 7.69%, Q2: 17.74%, Q3: 54.35%, Q4: 100%) with statistical significance. Conclusion We report a quantitative scoring system predicting 30-day mortality of AE-IPF patients. After validation, this easy-to-use scoring system will serve as a useful aid for clinical decision making.
2세대 약물 용출 관상동맥 스텐트 삽입 후 급성 심근 경색으로 병발한 관상동맥 연축 1예
김중근 ( Joong Keun Kim ),이신은 ( Shin Eun Lee ),박문식 ( Moon Sik Park ),윤소희 ( So Hee Yun ),이나은 ( Na Eun Lee ),이재운 ( Jae Un Lee ),이동엽 ( Dong Yub Lee ),박종필 ( Jong Pil Park ),전성희 ( Sung Hee John ),임지현 ( Ji Hyu 전북대학교 의과학연구소 2012 全北醫大論文集 Vol.36 No.1
Although several investigators have reported the coronary artery spasm after coronary artery stenting, all previous reports, coronary spasm after drug-eluting stent (DES) placement was occurred in first generation DES, such as sirolimus-eluting (Cypher®) and paclitaxel-eluting stents (Taxus®). Clinical relevance is unknown, the underlying mechanism may be delayed vascular healing due to toxic effects of the sirolimus and paclitaxel to endothelial cells (EC). The second-generation DES, such as everolimus-eluting (Xience V®) and zotarolimus-eluting stents (Endeavor®), are proving to be significantly more effective and safer than the first-generation DES.1)2) We report a patient with severe coronary artery spasm lead to myocardial infarction after second generation DES implantation at the site of detectable atherosclerotic lesion.
Pre-Sepsis Length of Hospital Stay and Mortality: A Nationwide Multicenter Cohort Study
Kim Joong-Yub,Lee Hong Yeul,Lee Jinwoo,Oh Dong Kyu,Lee Su Yeon,Park Mi Hyeon,Lim Chae-Man,Lee Sang-Min 대한의학회 2024 Journal of Korean medical science Vol.39 No.9
Background: Prolonged length of hospital stay (LOS) is associated with an increased risk of hospital-acquired conditions and worse outcomes. We conducted a nationwide, multicenter, retrospective cohort study to determine whether prolonged hospitalization before developing sepsis has a negative impact on its prognosis. Methods: We analyzed data from 19 tertiary referral or university-affiliated hospitals between September 2019 and December 2020. Adult patients with confirmed sepsis during hospitalization were included. In-hospital mortality was the primary outcome. The patients were divided into two groups according to their LOS before the diagnosis of sepsis: early- (< 5 days) and late-onset groups (≥ 5 days). Conditional multivariable logistic regression for propensity score matched-pair analysis was employed to assess the association between lateonset sepsis and the primary outcome. Results: A total of 1,395 patients were included (median age, 68.0 years; women, 36.3%). The early- and late-onset sepsis groups comprised 668 (47.9%) and 727 (52.1%) patients. Propensity score-matched analysis showed an increased risk of in-hospital mortality in the late-onset group (adjusted odds ratio [aOR], 3.00; 95% confidence interval [CI], 1.69–5.34). The same trend was observed in the entire study population (aOR, 1.85; 95% CI, 1.37–2.50). When patients were divided into LOS quartile groups, an increasing trend of mortality risk was observed in the higher quartiles (P for trend < 0.001). Conclusion: Extended LOS before developing sepsis is associated with higher in-hospital mortality. More careful management is required when sepsis occurs in patients hospitalized for ≥ 5 days.
이준호 ( Joon Ho Lee ),진상윤 ( Sang Yun Jin ),최윤석 ( Yun Seok Choi ),권혁부 ( Hyok Bu Kwon ),이승호 ( Seung Ho Lee ),이중엽 ( Joong Yub Lee ),박병주 ( Byung Joo Park ),이애영 ( Ai Young Lee ) 대한천식알레르기학회 2011 천식 및 알레르기 Vol.31 No.2
Background: Spa has been applied for the alleviation of atopic dermatitis (AD), but there have been few studies on the efficacy and safety of hot spring sea water therapy. Objective: This study aimed to clarify the conditions which have adequate efficacy and safety of hot spring sea water therapy for the treatment of AD. Method: Twenty-eight patients with AD who had mild to moderate symptoms were enrolled and divided into 14 groups according to bathing frequencies, temperatures, durations, and kinds of water. Bathing frequency was 2, 3 or 7 times a week. Temperature was 37˚C or 40˚C, and duration was 15 or 30 minutes. Twelve groups took a bath in hot spring sea water obtained from an island in Korea, 1 group took a bath in salt water and 1 took a bath in tap water. We assessed o-SCORAD index at baseline and every week for 4 weeks. In addition, colony counts of S. aureus were evaluated at baseline and at the last visit. Result: The 3 times-a-week/37˚C/15 minute and twice-a-week/37˚C/30 minute groups showed the largest and continuous decline in o-SCORAD index. The index was also slightly decreased in the salt and tap water groups. The colony counts of S. aureus did not show significant changes after bathing. Conclusion: This pilot study shows the possibility that hot spring sea water therapy might be an efficacious and safe treatment option for treating AD. However, the precise mechanism should be elucidated through further studies. (Korean J Asthma Allergy Clin Immunol 2011;31:124-130)
전신마취 수술 후 폐합병증 발생 예측 인자에 대한 재평가
도윤정 ( Yun Joung Doh ),허인경 ( In Kyong Hur ),이준엽 ( Jun Yub Lee ),박정배 ( Jung Bae Park ),성낙일 ( Nak Il Sung ),이용국 ( Yong Guk Lee ),이중현 ( Joong Hyun Lee ),이영현 ( Young Hyun Lee ) 대한내과학회 2007 대한내과학회지 Vol.72 No.5
목적: 최근 고령 환자의 수술 빈도가 증가하고 있고, 이에 따라 PPC의 위험 또한 커지고 있다. PPC를 줄이기 위해 이를 예측할 수 있는 독립적인 인자들에 대한 여러 연구가 이루어져 왔으나 합의된 지침은 아직 정해지지 않은 상태이다. 본 연구에서는 상대적으로 고령 인구로 구성된 경주지역 환자를 대상으로 PPC 발생에 관여되는 인자는 어떤 것이 있는지 재분석하였다. 방법: 2004년 2월부터 2004년 12월까지 본원에서 전신마취 하에 흉부, 복부, 두경부, 사지 수술을 받았던 84명의 환자를 대상으로 하였다. 수술 전 예측인자의 선정에 있어서는 성별, 연령, 신장, 체중, 비만도, 흡연력, 기저질환, 호흡기질환 동반여부, 악성종양의 병력, 수술 전 흉부 진찰 소견, 입원시 혈액검사소견(혈색소, 알부민, 동맥혈 가스분석) 및 폐기능검사(1초간 강제 날숨량, 강제 폐활량), 마취시간, 수술부위에 관하여 후향적으로 조사하였다. 중증 PPC는 급성호흡부전, 폐혈전증이 새로 발생한 경우로 정의하였고, 경증의 PPC는 수술 후 기침, 객담 또는 비정상 호흡음이 새로 발생한 경우, 정상 체온을 보이던 환자가 다른 부위의 발열의 원인이 없이 38℃이 상의 체온 상승을 보인 경우, 흉부 단순 촬영 소견상 술 전에 비하여 새로운 폐허탈이나 폐침윤이 발생한 경우 중 한 가지 이상 포함하고 있을 때로 정의하였다. 결과: 평균 연령은 65.5세였다. 전신마취 수술 후 발생할 수 있는 PPC의 예측인자들을 분석한 결과, 기저질환의 동반 여부, 저알부민치(<3.5 g/dL), 수술부위(흉복부)가 통계적으로 유의한 독립변수였다. 기저질환의 여부 및 수술 부위는 기존의 연구에서도 예측인자로 밝혀져 있어 동일한 결과를 보였으나, 저알부민 수치는 기존 3.0 g/dL 이하보다 높은 기준을 적용하였음에도 불구하고 유의한 결과를 보였다. 이는 향후 고령 환자를 대상으로 하는 수술에서는 알부민 수치가 3.0~3.5 g/dL 사이인 경우도 고위험군으로 분류되어야 할 가능성을 시사하는 것이다. 또한 본 연구에서는 %FEV1.0은 통계적 유의성을 보이지 않아, 고령인 환자에게 있어서도 PPC 예측인자로서 폐기능의 가치에 대하여는 재고가 필요함을 시사하였다. 결론: PPC 발생의 예측인자는 연령에 따라 다른 기준을 적용하여야 할 필요가 있다. 최근 늘어나고 있는 고령의 수술 환자에 대하여, 이러한 예측인자의 차이점을 인지하고 고위험군 선별에 적용해야 한다. 고위험군 환자에 대하여는 수술 전 영양상태의 개선, 기저질환의 교정 등을 통하여 PPC 발생을 줄이고자 하는 노력이 필요하다. Background: As our population in Korea ages, more postoperative pulmonary complications (PPCs) have recently developed. There have been several studies about the predictive factors for PPC, but any consensus has not been established. In this study, we reappraised the predictive factors for PPC after general anesthesia in a population from Gyeong-ju, which was composed of elderly people. Methods: We retrospectively investigated the incidence and predictive factors for PPC in 84 patients who underwent general anesthesia. We investigated gender, age, height, weight, BMI, smoking, underlying disease, underlying respiratory disease, malignancy, the laboratory findings (hemoglobin, albumin, arterial O2 saturation) and the pulmonary function tests of the patients. Results: 84 patients were initially enrolled into the study, and PPC developed in 31 (36%) patients. The mean age of the enrolled patients was 66.515.1 years old, so it shows the trend of an aging society. Three predictive factors were revealed that are independently associated with the PPC: site of operation (OR, 8.3), underlying disease (OR, 9.9) and serum albumin (OR, 4.0). Conclusions: Among the statistically meaningful predictive factors, underlying disease and operation site are well known from previous studies, but the albumin level < 3.5 g/dL is also meaningful, which is higher than the previous reference level. It implies that the patient with a albumin level 3.0~3.5 g/dL can be classified into the high risk group. Therefore, we should recognize that it is necessary to apply more strict reference levels in an aging population to reduce the incidence of PPC. (Korean J Med 72:501 510, 2007)
하시모토갑상선염에 동반된 골수를 침범한 ( 병기 4E 기 ) 원발성 갑상선 림프종 1 예
이기업,송영기,박중열,김기수,김상희,공경엽,조재근,추윤호,엄완식,지현숙 대한내분비학회 1994 Endocrinology and metabolism Vol.9 No.4
Primary lymphoma of the thyroid is a relatively rare malignant tumor of the thyroid. It is known to be frequently associated with Hashimoto's thyroiditis. In Korea, a few cases of primary lymphoma of the thyroid have been reported and most of these cases were in the stage I E or II E. Recently, we experienced a case of the primary thyroid lymphoma, stage IV E associated with Hashimoto's thyroiditis in a 70-year-old woman who presented with dysphagia and dyspnea due to rapidly enlarging neck mass. She was treated with combination chemotherapy(cyclophosphamide, adriamycin, vincristine and methylprednisolone) and local radiotherapy and achieved partial response with resolution of dysphagia and dyspnea(J Kor Soc Endocrinol 9: 390-394, 1994).