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궤양성 대장염 환자에서 메살라진 좌약으로 인하여 재발한 호산구성 폐렴
박명린,이정의,강상범,박연희 대한소화기학회 2019 대한소화기학회지 Vol.73 No.4
Mesalazine suppositories are widely used to treat ulcerative colitis and have a guaranteed safety profile, but although rare, they can cause pulmonary toxicity. A 35-year-old woman with ulcerative colitis was diagnosed to have acute eosinophilic pneumonia after 29 days of oral mesalazine use and improved after mesalazine and corticosteroid were withdrawn. Reintroduction of mesalazine suppositories resulted in acute eosinophilic pneumonia recurrence after 28 days. Mesalazine re-administration (even via a different route) in patients with a history of mesalazine-induced eosinophilic pneumonia should be undertaken cautiously, because eosinophilic pneumonia may recurrence.
박명린,박연희,박동일,정재욱,이정은,박희선,정성수,김주옥,문재영 대한결핵 및 호흡기학회 2016 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.121 No.-
Objectives: The serum total cholesterol (TC) level is known to be associated with survival of critically illness, especially in sepsis and surgical patients. However, there are only a few studies evaluating TC as a prognostic factor in medical patients. The aim of this study was to determine relationship between TC level and survival in medical patients admitted in intensive care unit (ICU). Methods: From September 2013 to February 2014, the data was acquired at the nine intensive care units in the four provincial academic medical centers retrospectively. Statistical analysis was conducted to confirm risk factors with using correlation analysis and logistic regression. Results: In this study, a total of 503 patients were enrolled. The hospital mortality which is based on 28 days after admission was 28.2%. TC levels derived at specific point of time showed negative correlation with APACHE IV score (initial TC, r=-0.231, p<0.001; second week TC, r=-0.361, p<0.001; third week TC, r=-0.327, p<0.001). TC level of second week, C-reactive protein level and status of ARDS were independent risk factor for mortality in multivariate analysis (hazard ratio (HR) =0.98, p<0.001; HR=1.05, p=0.02, HR=8.24, p=0.001, respectively). Conclusion: Lower TC level is a prognostic indicator of hospital mortality in medical patients admitted in ICU. Following up TC level regularly has advantage of managing critically ill patients.
고형암에서 발생한 Stenotrophomonas Maltophilia Pneumonia의 임상양상
박명린,박연희,최재우,박보미,박동일,정성수,김주옥,이정은 대한결핵 및 호흡기학회 2012 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.114 No.-
Background: Stenotrophomonas maltophilia에 의한 폐렴은 악성 종양환자에서는 항암화학치료 후 또는 호중구감소증과 같이 면역력이 저하된 상태에서 호발하며, 혈액암 환자에서 발생하였을 때 빠르게 악화하는 임상양상을 띄는 것으로 알려져 있다. 그러나 고형암 환자에서 발생한 S. maltophilia에 의한 폐렴의 임상양상은 아직 정확히 알려진 바가 없어서 그에 대한 분석을 실시하였다. Method: 2001년 1월부터 2011년 12월까지 충남대학교병원에 입원했던 고형암 환자들 중에서 S. maltophilia에 의한 폐렴으로 치료받았던 54명을 대상으로 후향적 분석을 실시하였다.Result: 임상증상은 기침이 53.7%, 객담이 57.4%, 발열이 42.5%에서 관찰되었고, 발열이 없으면서 기침과 객담이 동시에 나타나는 경우가 25.9%로 가장 많았다. 발열이 있을 때에는 38.5도 미만으로 체온이 측정된 경우가 60.9%이었다. 흉부 X-선 사진에서는 일측성 병변이 59.4%로 가장 많았으며 폐렴의 방사선학적 형태는 Lobar consolidation (42.6%), Lobular consolidation (31.5%), Inhomogenous in-filtration (22.2%), Diffuse interstitial infiltrates (18.5%) 순이었다. 폐쇄성 폐병변은 24.1%에서 관찰되었고, 흉수는 38.9%에서 발견되었다. 기저 암의 형태로는 폐암이 63%로 가장 많았으며, 위암과 식도암이 각각 7.4%씩 차지하였다. S. maltophilia에 대한 항생제 감수성 검사에서는 Levofloxacin에 대해 감수성이 있을 확률이 97.4%로 가장 높았으며, Cotrimoxazole 90.4%, Ciprofloxacin 64.2% 순으로 높았다. S. maltophilia 폐렴으로 인한 사망률은 40.7%였다. Conclusion: 고형암에서 발생하는 S.maltophilia 폐렴은 처음에는 경한 증상과 함께 일측성 병변을 보이지만, 사망률이 높은 질환으로 의심이 될 경우에는 감수성이 있는 항생제를 빨리 투여하는 것이 필요하다.
박명린,박연희,박동일,정재욱,문재영,박희선,정성수,김주옥,이정은 대한결핵 및 호흡기학회 2016 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.121 No.-
Objectives: The number of available regimens which can be used in relapsed small-cell lung cancer (SCLC) is small and the data of the regimens is lack than those of non-small cell lung cancer. The goal of the present study is to evaluate the clinical outcome of ifosfamide and carboplatin (IC) regimen for third- or further-line chemotherapy in SCLC patients. Methods: A retrospective analysis was conducted of all patients who received combination chemotherapy with IC regimen between 2011 and 2015 for relapsed SCLC. The data included baseline demographics, chemotherapy-related toxicities, therapeutic regimens that used and survival period. Results: A total of 12 patients were administered IC regimen. All of the IC regimens were used in third- or further-line chemotherapy and 9 (75%) of cases were fourth-line therapy. Of the 37 chemotherapy-related toxicity events, 27 (73%) were hematologic toxicities and thrombocytopenia (n=10 (27%)) was reported most frequently. The median overall survival (OS) after IC administration was 3.5 months. Patients with positive change of body mass index (BMI) before IC administration (p=0.071), without multiple metastases at start of IC regimen (p=0.001), refractory relapse after first line treatment (p=0.082), partial response or stable disease to the IC treatment (p=0.007) showed longer duration of OS. Conclusion: The IC regimen is a reasonable therapeutic arm for relapsed SCLC.
박명린,이정은,박연희,최재우,박동일,정재욱,문재영,박희선,정성수,김주옥,김선영 대한결핵및호흡기학회 2014 Tuberculosis and Respiratory Diseases Vol.76 No.5
Background: Small cell lung cancer (SCLC) is an extremely aggressive tumor with a poor clinical course. Although many efforts have been made to improve patients' survival rates, patients who survive longer than 2 years after chemotherapy are still very rare. We examined the baseline characteristics of patients with long-term survival rates in order to identify the prognostic factors for overall survivals. Methods: A total of 242 patients with cytologically or histologically diagnosed SCLC were enrolled into this study. The patients were categorized into long- and short-term survival groups by using a survival cut-off of 2 years after diagnosis. Cox’s analyses were performed to identify the independent factors. Results: The mean patient age was 65.66 years, and 85.5% were males; among the patients, 61 of them (25.2%) survived longer than 2 years. In the multivariate analyses, CRP (hazard ratio [HR], 2.75; 95% confidence interval [CI], 1.25−6.06; p=0.012), TNM staging (HR, 3.29; 95% CI, 1.59−6.80; p=0.001), and progression-free survival (PFS) (HR, 11.14; 95% CI, 2.98−41.73; p<0.001) were independent prognostic markers for poor survival rates. Conclusion: In addition to other well-known prognostic factors, this study discovered relationships between the long-term survival rates and serum CRP levels, TNM staging, and PFS. In situations with unfavorable conditions, the PFS would be particularly helpful for managing SCLC patients.
Streptococcus parasanguinis에 의한 폐렴과 부폐렴성 흉수
박명린 ( Myoung Rin Park ),박동일 ( Dong Il Park ),유수진 ( Su Jin Yoo ),정선영 ( Sun Young Jung ),은혁수 ( Hyuk Soo Eun ),김민정 ( Min Jung Kim ),박지원 ( Ji Won Park ),박희선 ( Hee Sun Park ),정성수 ( Sung Soo Jung ),김주옥 ( Ju 대한결핵 및 호흡기학회 2011 Tuberculosis and Respiratory Diseases Vol.71 No.5
Streptococcus parasanguinis is a Viridans group bacteria that is most often discovered in the oral cavity and causes dental plaque and endocarditis in a rat model. It has low virulence but an unknown relationship to human respiratory infections. We report on a 61-year-old woman who developed hemoptysis followed by pleuritic chest pain after conscious sedation during a gastroscopic polypectomy and was diagnosed with pneumonia and parapneumonic effusion from Streptococcus parasanguinis isolated in pleural fluid. Microaspiration during the procedure was presumed to play a role in the pathogenesis.