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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)
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.
Bronchiolitis Interstitial Pneumonitis
지수영 ( Su Young Chi ),유경호 ( Kyoung Ho Ryu ),임대훈 ( Dae Hun Lim ),신홍준 ( Hong Joon Shin ),반희정 ( Hee Jung Ban ),오인재 ( In Jae Oh ),권용수 ( Yong Soo Kwon ),김규식 ( Kyu Sik Kim ),임성철 ( Sung Chul Lim ),김영철 ( Young 대한결핵 및 호흡기학회 2009 Tuberculosis and Respiratory Diseases Vol.67 No.4
Bronchiolitis interstitial pneumonitis (BIP), an unclassified and newly described interstitial pneumonia, has a combined feature of prominent bronchiolitis, interstitial inflammation, and fibrosis. It is distinct from bronchiolitis obliterans or bronchiolitis obliterans organizing pneumonia (BOOP). BIP has a better prognosis than common cases of interstitial pneumonia. However, BIP has a poorer prognosis than BOOP. BIP`s response to corticosteroids is not as successful as BOOP`s response to this treatment. We encountered the case of a 31-year-old woman with BIP with an initial presentation of dyspnea and a cough that had lasted for 3 months. The patient`s chest CT scan demonstrated patchy ground glass opacities and multiple ill-defined centrilobular nodules in both lungs, suggesting military tuberculosis or nontuberculous mycobacterial infection. A video-assisted thoracoscopic lung biopsy resulted in the diagnosis of BIP. Clinical symptoms, pulmonary lesions, and pulmonary function tests were improved after oral glucocorticoid therapy.
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)
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.
김영일 ( Young Il Kim ),지수영 ( Su Young Chi ),반희정 ( Hee Jung Ban ),주진영 ( Jin Yung Ju ),권용수 ( Yong Soo Kwon ),오인재 ( In Jae Oh ),김규식 ( Kyu Sik Kim ),김유일 ( Yu Il Kim ),김영철 ( Young Chul Kim ),임성철 ( Sung Chul 대한결핵 및 호흡기학회 2008 Tuberculosis and Respiratory Diseases Vol.65 No.5
Factitious hemoptysis is the bleeding type of Munchausen`s syndrome, and this describes a group of patients who intentionally produce symptoms. Because factitious hemoptysis is a very rare manifestation of hemoptysis, it generally passes unnoticed. We report here on a case of factitious hemoptysis in a 15-year-old boy who presented with hemoptysis. During his three hospitalizations, we conducted many diagnostic procedures, including chest CT, laryngoscopy, bronchoscopy and bronchial arteriography, yet we failed to find the definitive cause of the patient`s hemoptysis. He kept on complaining of repetitive hemoptysis and seizure-like activity. His father discovered that he had collected his blood into the specimen cup via an intravenous line. After we removed the intravenous line, he did not show blood to us again. We suggest that factitious hemoptysis should be considered in the differential diagnosis of hemoptysis of an unclear bleeding focus, and especially when the patient has a bizarre hospital course or unusual behavior. We also include a review of the relevant literature. (Tuberc Respir Dis 2008;65:396-399)
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.
신홍준 ( Hong Joon Shin ),김윤희 ( Yoon Hee Kim ),지수영 ( Su Young Chi ),반희정 ( Hee Jung Ban ),권용수 ( Yong Soo Kwon ),오인재 ( In Jae Oh ),김규식 ( Kyu Sik Kim ),임성철 ( Sung Chul Lim ),김영철 ( Young Chul Kim ),김수옥 ( Soo 대한결핵 및 호흡기학회 2010 Tuberculosis and Respiratory Diseases Vol.69 No.6
Rectus sheath hematoma (RSH) is a rare condition caused by hemorrhage into the rectus sheath. It is usually associated with severe cough, abdominal surgery, coagulopathy, and anticoagulation treatment. RSH can be difficult to diagnose and can be misdiagnosed as acute appendicitis, as diverticulitis, or as an ovarian mass. Although RSH usually presents as a benign condition, it can be life threatening, especially in the critically-ill patient. Here, we report a case of fatal RSH due to hypovolemic shock in a critically-ill 73-year-old woman, who had received heparin treatment due to acute myocardial infarction in the intensive care unit and who had been successfully treated by conservative management.
결핵에 의한 급성호흡곤란증후군의 사망률 및 예후 예측인자
김태옥 ( Tae ok Kim ),강현욱 ( Hyun Wook Kang ),지수영 ( Su Young Chi ),반희정 ( Hee Jung Ban ),오인재 ( In Jae Oh ),김규식 ( Kyu Sik Kim ),김유일 ( Yu Il Kim ),임성철 ( Sung Chul Lim ),김영철 ( Young Chul Kim ),권용수 ( Yong Soo 대한내과학회 2011 대한내과학회지 Vol.81 No.4
Background/Aims: Acute respiratory distress syndrome (ARDS) due to tuberculosis (TB) is a rare disease, but its mortality is believed to be high. The aim of this study was to evaluate the mortality rate and prognostic factors of ARDS. Methods: We retrospectively reviewed the demographic, clinical, radiologic, and laboratory data of 19 patients with ARDS due to active pulmonary TB at Chonnam National University Hospital between January 2000 and December 2010. Results: The median age of patients was 71.1 (interquartile range [IQR] 51-74) years. None had a history of TB treatment. The most common symptoms were dyspnea (90%), fever (68%), and cough (53%). The overall in-hospital mortality was 73%. The median acute physiologic assessment and chronic health evaluation (APACHE) III score and pneumonia severity index (PSI) were 81.9 (IQR 59.0-92.0) and 111.0 (IQR 77.0-131.0), respectively. The PSI was significantly higher in non-survivors than in survivors (55.0 vs. 122.0; p=0.016). The rate of TB treatment before admission was significantly higher in survivors than in non-survivors (75% vs. 13%; p=0.037). The time from admission to treatment initiation was significantly longer in non-survivors than in survivors (3 vs. 0 days; p=0.049). The median duration of mechanical ventilation was 11 days (IQR 5-16 days). The most common cause of death was a refractory shock (53%). Conclusions: The overall mortality rate of ARDS due to pulmonary TB was high. A high PSI score and delay of TB treatment may be risk factors for a poor outcome of ARDS due to pulmonary TB. (Korean J Med 2011;81:458-463)