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증례 : 호흡기 ; 전신마취하 경직성 기관지 내시경으로 치료한 과오종 1예
반희정 ( Hee Jung Ban ),지수영 ( Su Young Chi ),오인재 ( In Jae Oh ),김규식 ( Kyu Sik Kim ),주진영 ( Jin Yung Ju ),권용수 ( Yong Soo Kwon ),김유일 ( Yu Il Kim ) 대한내과학회 2009 대한내과학회지 Vol.77 No.3
기관지 내 과오종은 조직학적으로는 양성이나 기관지 폐쇄나 객혈 등을 야기하여 폐실질 조직 손상을 일으킬 수 있는 잠재적으로 위험한 종양이므로 비가역적인 손상이 발생하기 전에 적절한 치료가 필요한데, 숙련된 의료진에 의한 경직성 기관지 내시경적 종양절제술이 안전하고 효과적으로 이용될 수 있어 문헌고찰과 함께 보고하는 바이다. A 54-year-old man presented with a cough, sputum, and fever. His chest X-ray showed atelectasis in the right middle lobe. Computed tomography revealed obstruction of the bronchus intermedius by an endobronchial tumor. The first bronchoscopic biopsy specimens suggested lipoma. We resected the tumor via rigid bronchoscopy under general anesthesia and the final pathology report revealed a cartilaginous hamartoma. Subsequently, he has been followed for more than 1 year without recurrence. (Korean J Med 77:349-352, 2009)
재발된 소세포폐암환자에서 이차 약제로 사용되는 Belotecan (CKD-602)의 임상적 효용성
반희정 ( Hee Jung Ban ),오인재 ( In Jae Oh ),김규식 ( Kyu Sik Kim ),주진영 ( Jin Yung Ju ),권용수 ( Yong Soo Kwon ),김유일 ( Yu Il Kim ),임성철 ( Sung Chul Lim ),김영철 ( Young Chul Kim ) 대한결핵 및 호흡기학회 2009 Tuberculosis and Respiratory Diseases Vol.66 No.2
연구배경: Belotecan (Camtobell, CKD-602, Chongkundang Pharm., Korea)은 camptothecin의 치환체로 topoisomerase I 효소를 억제하여 항암효과를 나타내는 것으로 알려져 있다. 이에 2차 항암화학요법에 치료제로써 Belotecan의 효과, 생존율 및 부작용에 대해 연구하였다. 방법: 이에 소세포폐암에서 etoposide와 platinum을 사용한 1차 항암화학요법에서 실패한 49명의 환자들을 대상으로 2차 항암화학요법에 Belotecan을 투약하였다. 결과: 전체 반응률은 25%였으며, 11명의 환자에서 partial response를 보였다. 또한 1차 항암화학요법 이후 90일 이내에 재발한 군과 90일 이상 경과한 군간에 유의한 차이는 보이지 않았다. 전체 환자의 중심생존기간은 10.3개월(290일)이었고, 비반응군에서는 186일(95% CI; 67~305)로 반응군의 471일(95% CI; 234~568)에 비해 생존기간의 감소 유의하게 있음을 확인하였다(p=0.07). 결론: 2차 항암화학요법의 치료제로써 Belotecan의 효능과 부작용에 대해서는 향후 무작위 비교 연구가 필요할 것으로 사료된다. Background: Belotecan (Camtobell, CKD-602, Chong-kundang Pharm., Korea), a camptothecin derivative, has anticancer effects by inhibiting topoisomerase I such as topotecan. This study observed the response, survival and toxicity of belotecan monotherapy after the failure of etoposide and platinum (EP). Methods: Forty nine small cell lung cancer (SCLC) patients (M/F=41/8; age, 64.5±7.6 (mean±SD) years), who failed in their first line chemotherapy were enrolled in this study. Twenty one SCLC patients showed relapsed lung cancer more than 90 days after their prior EP chemotherapy (sensitive relapse group, SR) and 28 patients relapsed within 90 days (refractory relapse group, RR). Results: The response rate was 25%. Eleven patients showed partial responses and 5 patients could not be checked. The response rate of the SR and RR patients was similar. The relative dose intensity was lower in the responders (78±15%) than non-responders (83±13%, p=0.03). The median survival time (MST) was 10.3 months (290 days). The MST of the non-responders and responders was 186 days (95% CI; 67~305) and 401 days (95% CI; 234∼568, p=0.07), respectively. The median progression free survival (MPFS) was similar in the SR (79 days) and RR (67 days) patients. Grade 3~4 neutropenia, anemia, and thrombocytopenia were observed in 59.6%, 12.8% and 23.4% of patients, respectively. Conclusion: The efficacy and survival were demonstrated in the second-line setting. However, a randomized comparative trial with topotecan will be needed.
폐암 환자에서 항암화학치료 중 발생한 빈혈에 대한 Darbepoetin alfa의 효과
반희정 ( Hee Jung Ban ),지수영 ( Su Young Chi ),박철규 ( Cheol Kyu Park ),김은영 ( Eun Young Kim ),김윤희 ( Yoon Hee Kim ),김규식 ( Kyu Sik Kim ),주진영 ( Jin Young Ju ),권용수 ( Yong Soo Kwon ),오인재 ( In Jae Oh ),김유일 ( Yu Il 대한결핵 및 호흡기학회 2009 Tuberculosis and Respiratory Diseases Vol.66 No.2
연구배경: 빈혈은 폐암 환자의 항암 치료중 발생하여 삶의 질을 떨어뜨리는 원인이 된다. 최근 사용 되는 darbepoetin alfa는 적혈구 생성 촉진 인자로 사용되고 있어 이의 효과와 부작용을 알아보고자 하였다. 방법: 2004년 9월부터 2007년 3월까지 화순전남대학교 병원을 내원한 환자 중에서 소세포 혹은 비소 세포 폐암을 진단받고 항암 화학 치료를 적어도 1개월 이상 받은 환자들 중에서 혈색소 수치 10 g/dl 미만의 빈혈이 발생한 환자들 중 darbepoetin alfa를 투여 받은 환자를 대상으로 후향적으로 분석하였다. 결과: 항암 화학 치료 후 혈색소는 9.03±0.64 g/dl로 감소하였고, darbepoetin alfa를 처치 후 혈색소 1 g/dl 이상의 증가를 보였던 환자는 62.4%였으며 최고치 10.45±1.18 g/dl, 4주째 10.09±1.17 g/dl로 관찰되었다. 경증 부작용이 일부에서 관찰되었나 모두 호전되었다. 결론: darbepoetin alfa는 항암 치료와 연관된 빈혈의 치료에 효과적이며 부작용이 심하지 않아 보조 치료제로 사용될 수 있겠다. Background: Anemia is quite common in lung cancer patients and known to decrease the quality of life. Darbepoetin alfa is an erythropoiesis-stimulating protein approved for administration to cancer patients. This study examined the efficacy and safety of darbepoetin alfa in lung cancer patients with a hemoglobin concentration <10 g/dl during chemotherapy. Methods: Lung cancer patients (n=178) received darbepoetin alfa at doses of 1.91 μg/kg per week until the hemoglobin concentration increased to >10 g/dl. The efficacy and safety were measured by comparing the hemoglobin concentration and assessing the adverse events. Results: After chemotherapy, the hemoglobin concentration decreased to 9.03±0.64 g/dl. With the darbepoetin alfa treatment, the hemoglobin concentration increased to 10.09±1.17 g/dl after 4 weeks reaching a peak hemoglobin concentration of 10.45±1.18 g/dl. The changes in hemoglobin after 4 and 8 weeks with treatment were 1.08±1.24 g/dl and 1.38±1.59 g/dl (p<0.01). At least a 1 g/dl or more increase in hemoglobin was observed in 62.4% of patients. There were no serious adverse effects except for some mild reactions. Conclusion: Darbepoetin alfa administered to lung cancer patients appears to be an effective, well-tolerated treatment for chemotherapy induced anemia.
김희경 ( Hee Kyung Kim ),반희정 ( Hee Jung Ban ),지수영 ( Su Young Chi ),채동렬 ( Dong Ryeol Chae ),조계중 ( Gye Jung Cho ),임정환 ( Jung Hwan Lim ),주진영 ( Jin Yung Ju ),권용수 ( Yong Soo Kwon ),오인재 ( In Jae Oh ),김규식 ( Kyu 대한결핵 및 호흡기학회 2008 Tuberculosis and Respiratory Diseases Vol.64 No.2
A sarcoidosis is a multisystemic granulomatous disorder that has a predilection for pulmonary involvement, and the common radiological findings for the disease are bilateral nodular or reticulonodular patterns. Pseudoalveolar sarcoidosis is a rare presentation of sarcoidosis. The radiological finding is an alveolar pattern that involves or compresses the alveoli by clustered interstitial granuloma. A 58-year-old man was admitted due to incidental findings of a unilateral consolidative lesion as seen on chest radiography. A chest computed tomography (CT) examination showed multiple bronchoalveolar consolidations that were suspicious of a malignancy. However, a percutaneous needle biopsy revealed non-caseating granuloma with an asteroid body that was compatible with sarcoidosis. After one month, the consolidative lesions improved without any treatment. (Tuberc Respir Dis 2008;64:149-152)
전남대학교 병원에서 2000년 이후 진단된 폐암의 임상 특성
임정환 ( Jung Hwan Lim ),반희정 ( Hee Jung Ban ),오인재 ( In Jae Oh ),김수옥 ( Soo Ok Kim ),손준광 ( Jun Gwang Son ),정종필 ( Jong Pil Jeong ),김규식 ( Kyu Sik Kim ),김유일 ( Yu Il Kim ),임성철 ( Sung Chul Lim ),김영철 ( Young Chu 대한결핵 및 호흡기학회 2006 Tuberculosis and Respiratory Diseases Vol.61 No.5
Background: Lung cancer has been the leading cause of cancer death in South Korea since 2000. This study examined the clinical characteristics of lung cancer patients diagnosed in a community hospital from the year 2000 to 2005, and compared these results with previously reported statistical data. Method: The lung cancer data in a form of an electronic medical record was downloaded from the hospital medical information system. The clinical characteristics of the 1,509 patients with lung cancer were analyzed retrospectively. Result: The mean age of the patients was 63.7 years. 82.5% and 74.5% of the patients were men and smokers, respectively. Squamous cell carcinoma (41.6%) was the most common pathology type followed by adenocarcinoma(32.3%) and small cell carcinoma(13.9%). When 604 patients who were diagnosed from 2000 to 2003 were compared with 905 patients diagnosed from 2004 to 2005, the age of patients increased significantly (61.5 years vs. 65.1 years; p<0.001) and the proportion of adenocarcinomas was significantly higher(29.3% vs. 34.4%; p=0.046). Conclusion: Among the major histology types of lung cancer, the incidence of adenocarcinoma has been increasing recently. The age of the lung cancer patients at diagnosis is getting older. This is despite the fact that the distributions of the initial anatomic stages have not changed significantly. (Tuberc Respir Dis 2006; 61: 427-432)
조계중 ( Gye Jung Cho ),임정환 ( Jung Hwan Lim ),채동렬 ( Dong Ryeol Chae ),지수영 ( Su Young Chi ),반희정 ( Hee Jung Ban ),윤병갑 ( Byeong Kab Yoon ),권용수 ( Yong Soo Kwon ),오인재 ( In Jae Oh ),김규식 ( Kyu Sik Kim ),김유일 ( Y 대한결핵 및 호흡기학회 2009 Tuberculosis and Respiratory Diseases Vol.66 No.6
Paragonimiasis is a parasitic infection that occurs following the ingestion of infectious Paragonimus metacercariae, which occurs as a result of eating raw or undercooked freshwater crabs or crayfish. Pulmonary paragonimiasis is the most common clinical manifestation of this infection. Human paragonimiasis occurs sporadically. We experienced a case of pulmonary paragonimiasis in a 35-year-old woman with left lower chest pain. The patient had hypereosinophilia and a pleural effusion. The diagnosis was confirmed by positive ELISA (Enzyme-linked immunosorbent assay) that detected Paragonimiasis westermani antibody in the serum. We treated the patient with praziquantel for two days at a daily dosage of 75 mg/kg. Left pleuritic pain and pleural effusion improved after treatment. However, similar symptoms and pleural effusion developed recurrently for the first 3 courses of treatment with praziquantel. Upon the fourth round of treatment, the patient made a full recovery.
정종필 ( Jong Pil Jeong ),반희정 ( Hee Jung Ban ),김수옥 ( Soo Ock Kim ),손준광 ( Jun Gwang Son ),주진영 ( Jin Yung Ju ),권용수 ( Yong Soo Kwon ),오인재 ( In Jae Oh ),김규식 ( Kyu Sik Kim ),김유일 ( Yu Il Kim ),임성철 ( Sung Chul 대한결핵 및 호흡기학회 2008 Tuberculosis and Respiratory Diseases Vol.64 No.3
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. (Tuberc Respir Dis 2008;64:219-223)
리도카인 아나필락시스 환자에서 경직 기관지내시경술을 통해 기도 암종을 진단한
윤병갑 ( Byeong Kab Yoon ),반희정 ( Hee Jung Ban ),권용수 ( Yong Soo Kwon ),오인재 ( In Jae Oh ),김규식 ( Kyu Sik Kim ),김유일 ( Yu Il Kim ),임성철 ( Sung Chul Lim ),김영철 ( Young Chul Kim ),송상윤 ( Sang Yoon Song ) 대한결핵 및 호흡기학회 2009 Tuberculosis and Respiratory Diseases Vol.67 No.2
The majority of flexible bronchoscopies are performed under topical anesthesia with lidocaine being the most commonly used agent. Anaphylaxis rarely occurs after local administration of lidocaine, but can be a fatal complication. We experienced a case of unexpected anaphylaxis. A 66-year-old woman was scheduled for flexible bronchoscopy to evaluate a tracheal mass and stenosis. The oral and nasal mucosa were pretreated with lidocaine. About 2∼3 minutes later, the patient developed hypotension and we treated for anaphylaxis in the emergency room. Then, we decided to perform rigid bronchoscopy in this patient, under conditions of general anesthesia. A rigid bronchoscopy was performed in this patient, safely and successfully. The tracheal mass was determined to be squamous cell carcinoma.
정해영 ( Hae Young Jung ),최인선 ( In Seon Choi ),이우진 ( Woo Jin Lee ),반희정 ( Hee Jeong Ban ),이성지 ( Seong Ji Lee ) 대한천식알레르기학회 2009 천식 및 알레르기 Vol.29 No.1
Background: Approximately 10% of patients with near-fatal asthma (NFA) die within a year of an attack, and close follow-up is helpful to prevent fatal events. Objective: To investigate the clinical outcomes of acute severe asthma and whether close follow-up may help to improve clinical outcomes. Method: Asthma patients (N=225), who were hospitalized due to severe exacerbation during the period 1998∼2006, were followed up using questionnaires or phone interviews. The 146 patients, who had regularly visited our hospital until the examination, were assigned as regular hospital visitor. Result: Twenty-two (9.8%) of the total patients and 7 (15.9%) of 44 NFA patients died (mean follow-up period: 138.9 weeks). The mortality rate was significantly lower in regular hospital visitors than in the others (total: 6.2% vs. 16.5%, P<0.05; NFA: 3.4% vs. 40.0%, P<0.01). The regular hospital visitors controlled their asthma better (controlled/partly controlled/uncontrolled: 75/38/33 vs. 20/28/31; P<0.001), had better knowledge of asthma (9.7±0.2 vs. 8.5±0.3, P<0.01) and used inhaled steroid more frequently (74.7% vs. 55.7%, P<0.001) than the others. Conclusion: Not a few patients with acute severe asthma die after discharge from hospital. However, close follow-up and adequate asthma control seem to help in the reduction of asthma mortality. (Korean J Asthma Allergy Clin Immunol 2009;29:27-32)
김수옥 ( Soo Ok Kim ),김윤희 ( Yoon Hee Kim ),지수영 ( Su Young Chi ),반희정 ( Hee Jung Ban ),오인재 ( In Jae Oh ),권용수 ( Yong Soo Kwon ),김규식 ( Kyu Sik Kim ),김유일 ( Yu Il Kim ),임성철 ( Sung Chul Lim ),김영철 ( Young Chul K 대한결핵 및 호흡기학회 2010 Tuberculosis and Respiratory Diseases Vol.68 No.6
Background: The polymerase chain reaction (PCR) test is important for the confirmatory diagnosis of tuberculosis (TB) caused by Mycobacterium tuberculosis. The aim of this study was to analyze the yield of repeated PCR testing in patients with confirmed pulmonary TB. Methods: The medical records of 130 patients, who had more than two consecutive PCR tests and a M. tuberculosis- positive sputum culture from August, 2006 to December, 2007, were retrospectively reviewed for the purposes of this study. A positive TB-PCR test was defined as at least one positive test result. Results: The cumulative positive PCR test rate was 80% (104/130), with gradually increasing rates of positive findings upon the first, second and third TB-PCR tests with 52.3%, 68.5% and 75.4%, respectively. However, further testing did not increase the positive rate further. Conclusion: Repeated PCR testing at least three times for M. tuberculosis is helpful for diagnosis of pulmonary TB.