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Takotsubo Cardiomyopathy Caused by Pulmonary Tuberculosis: A Case Report
하직환,이상학,이혜원,박영재,강현희,문화식 대한결핵및호흡기학회 2014 Tuberculosis and Respiratory Diseases Vol.77 No.1
Takotsubo cardiomyopathy (TTC) is defined as a reversible, acute ventricular dysfunction without any evidence of coronary artery obstruction. There have been reports of TTC caused by emotional or physical stress, drug use, hormone imbalance, or medical conditions such as pulmonary disease, sepsis, and trauma, but a relationship between TTC and pulmonary tuberculosis has not previously been reported. From our knowledge, this is the first report of TTC caused by pulmonary tuberculosis.
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Effects of acute hyperoxia exposure in lipopolysaccharide (LPS) lung injury mouse model
하직환,김인경,김경훈,김신범,이종민,김세원,강현희,김석찬,이상학 대한결핵 및 호흡기학회 2018 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.126 No.-
Introduction: Hyperoxia can cause injury to normal lung tissue. However, patients with acute respiratory distress syndrome frequently be exposed to very high FiO2 (FiO2≥0.9). Objectives: The purpose of this study is to evaluate the effect of hyperoxia exposure in acute lung injury state. Methods: Lipopolysaccharide (LPS, 055:B5, 0.5 mg/kg) or PBS was administered intratracheally in male C57BL/6J mice (7-8 weeks old). After 2h, mice were divided into two groups, and then exposed to normoxia or hyperoxia condition for 48h. Hyperoxia groups were placed within their cages in a Plexiglass chamber, in which an atmosphere of 95% O2 was constantly monitored using an oxygen analyzer. Results: From BAL fluid, numbers of total cells and neutrophils significantly increased in LPS + normoxia and LPS + hyperoxia group compared with the control normoxia group (**p<0.01). Lung wet/dry ratio was also significantly increased in LPS + normoxia and LPS + hyperoxia group compared with the control normoxia group (**p<0.01). However, there were no significant differences in numbers of total cells, neutrophils and lung wet/dry ratio between LPS + normoxia and LPS + hyperoxia group. By histological evaluation of H&E stained lung tissue sections, edema, interstitial thickening, and inflammatory cell influx showed no significant difference between LPS + normoxia and LPS + hyperoxia group. Conclusion: No significant differences were seen in lung inflammation and lung injury between LPS + normoxia and LPS + hyperoxia group. From our results, hyperoxia did not augment LPS-induced lung injury.
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하직환,이혜연,이진국,강지영,김승준,이숙영,김석찬,김영균 대한결핵 및 호흡기학회 2012 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.114 No.-
Background: The clinical significance of respiratory NTM isolations in allo-HSCT patients is still not clear. We aimed to investigate the characteristics of HSCT recipients with NTM isolations from respiratory specimens and the clinical course. Methods: Medical records were reviewed among patients who underwent allo-HSCT at Catholic HSCT center from 2004 to 2012. Results: Twenty one patients had a positive culture for NTM. Their mean age at NTM isolation was 41.13 and 16 were male. The mean duration of NTM isolation from HSCT was 1194 days after HSCT. The common NTM species were M. avium (n=5), M. intracelluare (n=6), and M. abscessus (n=4). Patients with isolated NTM were mostly taken immunosuppressants due to GvHD (n=15) and had combined infection (n=14) such as aspergillous species. As for radiologic findings, there was no specific typical NTM lung disease such as bronchiectasis, centrilobular nodules when NTM was detected from respiratory specimens. However, there were nine cases ocases of bronchiolitis obliterans syndrome. Eight of twenty one patients were treated due to the possibility of NTM infection. During the follow up of 3 years, only one patient expired due to an association with an aggravation of NTM lung disease.Conclusion: NTM isolation in respiratory specimens has a higher tendency in allo-HSCT patients with mmunosuppressants treatments, combined infection, and lung GvHD. In addition, the decision for treatment of NTM had better observe thoroughly rather than prompt therapy, even in case of severe immunocompromised patients such as HSCT, like in our study.
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하직환,여창동,이진국,박찬권,김승준 대한결핵 및 호흡기학회 2012 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.114 No.-
Background: Peptide nucleic acid (PNA)-mediated real-time PCR clamping method is recently introduced to increase the diagnostic sensitivity detecting mutations in various cancers because the diagnostic accuracy of direct sequencing method is not satisfactory in clinical setting. Pleural effusion and serum samples could be easily obtained compared with tumor tissue to examine the mutational status of lung cancer. Methods: 37 NSCLC patients with malignant effusion were enrolled. By using both PNA-mediated real-time PCR clamping method and direct DNA sequencing method, the concordance and diagnostic accuracy of samples from tumor tissue, cell block, pleural effusion and serum were investigated. Results: Ten out of 37 patients (27.0%) and 1 out of 36 patients (2.8%) showed EGFR mutations in pleural effusions and serums, respectively by both PNA-mediated real-time PCR clamping method and direct sequencing method. The overall agree-ment between the two methods were 86% (ĸ coefficient=0.68), 95% (ĸ coefficient=0.91) and 89% (ĸ coefficient=0.75) in tissues, cell blocks and effusions, respectively. The diagnostic accuracy by PNA-mediated real-time PCR clamping method in pleural effusion (sensitivity 0.89, specificity 1.00, positive predictive value 1.00, negative predictive value 0.95) was superior to that of direct sequencing. Conclusion: Although serum samples were not useful to detect EGFR mutational status in lung cancer, pleural effusion samples were comparable with tumor and cell block samples. PNA-mediated real-time PCR clamping method is more sensitive than direct sequencing method to detect EGFR mutation in malignant pleural effusion of lung cancer.
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하직환,이진국,조병식,이혜연,김석찬,이숙영,김영균,송정섭,윤형규 대한결핵 및 호흡기학회 2012 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.114 No.-
Background: In the past, bronchiolitis obliterans syndrome (BOS) was thought to be a relatively rare disease. However, a recent report shows that the prevalence rate is actually higher than that of previous reports. BOS also deteriorates the quality of life after transplantation and its mortality rate is high. Nevertheless, owing to scarcity of data of patient group based on a coherent standard, grasping of clinical manifestations and finding effective treatment methods are limited. Methods: This retrospective study included patients who survived for one-hundred days or longer after transplantation among those patients who had undergone allogenic hematopoietic stem cell transplantation at the Catholic Hematopoietic Stem Cell Transplantation Center from January 2002 to December 2008. This investigation, commencing in January 2012, utilized the modified NIH criteria proposed in 2009 and reviewed patient charts. Results: Of those eight-hundred sixty-three patients who survived for one-hundred days or longer, thirty-sixty (4.2%) met the diagnostic criteria. The risk factors for BOS were peripheral blood stem cell transplantation (PBSCT) and low pre-transplant forced vital capacity (FVC; <80% predicted). Pulmonary function test findings at the time of diagnosis showed significant decrease in functional vital capacity (FVC), forced expiratory volume in 1 sec (FEV1), maximal mid expiratory flow rate, FEV1/FVC and carbon monoxide diffusion in the lung, as opposed to that before transplantation (P<0.001). Both residual volume (RV) and RV/total lung capacity, the variables associated with the lung volume, showed significant increase (P<0.001) The prognostic factor associated with the three year mortality rate of BOS patients, in cases of having diagnosis within the period of five-hundred days after transplantation, was pre-transplant FEV1 value of 3 Liters. Conclusion: Being the first investigation that reports on prevalence rate, risk factor and clinical manifestations of BOS using modified NIH criteria, the study results may assist in early discovery and treatment of BOS.
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F-44 : Free Paper Presentation ; Clinical Features of Rigid Bronchoscopy in Single Center
하직환,반우호,강혜선,이화영,이혜연,강현희,강지영,김승준,문화식,이상학 대한결핵 및 호흡기학회 2013 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.116 No.-
Background: To evaluate the usefulness of rigid bronchoscopy with argon plasma coagulation (APC) for the management of central airway obstruction due to central airway tumors. Methods: We retrospectively evaluated patients with central airway obstructions due to benign or malignant tumors from February 2008 to February 2013 at Chonnam National University Hospital were retrospectively reviewed. All patients were received a rigid bronchoscopic tumor removal under general anesthesia and APC was applied before and after tumor removal. Results: The median age of all patients were 58 (interquartile [IQR] range, 53-67) and 60% were female. The causes of airway obstruction include malignancy (n=8) and benign (n=12). According to types of airway tumors, intra-luminal lesions were 7 (55%) and mixed lesions were 9 (45%). The median size of tumor was 15 mm (IQR 10-18) and median degree of airway obstruction was 90% (IQR 85-95). All patients except 3 who had no dyspnea before procedure showed improvement in dyspnea and 10 of 11 who performed pulmonary function tests before and after bronchoscopy showed improvement in FEV1 (46 [IQR 30-74] vs 91 [IQR 80-107], % predicted, p=0.003). There were no procedure related acute complications and mortality. Conclusions: Rigid bronchoscopy with argon plasma coagulation (APC) for the management of central airway obstruction was an effective and safe procedure to alleviate central airway tumors.Background: To evaluate the usefulness of rigid bronchoscopy with argon plasma coagulation (APC) for the management of central airway obstruction due to central airway tumors. Methods: We retrospectively evaluated patients with central airway obstructions due to benign or malignant tumors from February 2008 to February 2013 at Chonnam National University Hospital were retrospectively reviewed. All patients were received a rigid bronchoscopic tumor removal under general anesthesia and APC was applied before and after tumor removal. Results: The median age of all patients were 58 (interquartile [IQR] range, 53-67) and 60% were female. The causes of airway obstruction include malignancy (n=8) and benign (n=12). According to types of airway tumors, intra-luminal lesions were 7 (55%) and mixed lesions were 9 (45%). The median size of tumor was 15 mm (IQR 10-18) and median degree of airway obstruction was 90% (IQR 85-95). All patients except 3 who had no dyspnea before procedure showed improvement in dyspnea and 10 of 11 who performed pulmonary function tests before and after bronchoscopy showed improvement in FEV1 (46 [IQR 30-74] vs 91 [IQR 80-107], % predicted, p=0.003). There were no procedure related acute complications and mortality. Conclusions: Rigid bronchoscopy with argon plasma coagulation (APC) for the management of central airway obstruction was an effective and safe procedure to alleviate central airway tumors.Background: To evaluate the usefulness of rigid bronchoscopy with argon plasma coagulation (APC) for the management of central airway obstruction due to central airway tumors. Methods: We retrospectively evaluated patients with central airway obstructions due to benign or malignant tumors from February 2008 to February 2013 at Chonnam National University Hospital were retrospectively reviewed. All patients were received a rigid bronchoscopic tumor removal under general anesthesia and APC was applied before and after tumor removal. Results: The median age of all patients were 58 (interquartile [IQR] range, 53-67) and 60% were female. The causes of airway obstruction include malignancy (n=8) and benign (n=12). According to types of airway tumors, intra-luminal lesions were 7 (55%) and mixed lesions were 9 (45%). The median size of tumor was 15 mm (IQR 10-18) and median degree of airway obstruction was 90% (IQR 85-95). All patients except 3 who had no dyspnea before procedure showed improvement in dyspnea and 10 of 11 who performed pulmonary function tests before and after bronchoscopy showed improvement in FEV1 (46 [IQR 30-74] vs 91 [IQR 80-107], % predicted, p=0.003). There were no procedure related acute complications and mortality. Conclusions: Rigid bronchoscopy with argon plasma coagulation (APC) for the management of central airway obstruction was an effective and safe procedure to alleviate central airway tumors.Background: To evaluate the usefulness of rigid bronchoscopy with argon plasma coagulation (APC) for the management of central airway obstruction due to central airway tumors. Methods: We retrospectively evaluated patients with central airway obstructions due to benign or malignant tumors from February 2008 to February 2013 at Chonnam National University Hospital were retrospectively reviewed. All patients were received a rigid bronchoscopic tumor removal under general anesthesia and APC was applied before and after tumor removal. Results: The median age of all patients were 58 (interquartile [IQR] range, 53-67) and 60% were female. The causes of airway obstruction include malignancy (n=8) and benign (n=12). According to types of airway tumors, intra-luminal lesions were 7 (55%) and mixed lesions were 9 (45%). The median size of tumor was 15 mm (IQR 10-18) and median degree of airway obstruction was 90% (IQR 85-95). All patients except 3 who had no dyspnea before procedure showed improvement in dyspnea and 10 of 11 who performed pulmonary function tests before and after bronchoscopy showed improvement in FEV1 (46 [IQR 30-74] vs 91 [IQR 80-107], % predicted, p=0.003). There were no procedure related acute complications and mortality. Conclusions: Rigid bronchoscopy with argon plasma coagulation (APC) for the management of central airway obstruction was an effective and safe procedure to alleviate central airway tumors.
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하직환,여창동,이혜연,이진국,강지영,강현희,김성경,김승준,문화식,이상학 대한결핵 및 호흡기학회 2013 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.116 No.-
Background: Limited information is available regarding baseline pulmonary function and changes in pulmonary function following chemotherapy in patients with non-small cell lung cancer (NSCLC). Methods: We retrospectively reviewed a prospective database of patients with NSCLC who underwent PFTs both before and after two or three cycles of platinum-based doublet chemotherapy. Results: Sixty-four patients with stage III and IV NSCLC were included for analysis. Out of these 64 patients, 39 had SCC. With respect to the baseline pulmonary functions, the SCC group showed significantly lower spirometric values of forced vital capacity (p=0,031), forced expiratory volume in 1 sec. (p=0.002), FEV1/FVC (p<0.001) and maximum mid-expiratory flow rate (p=0.002). Residual volume (p=0.012) and RV/TLC (p=0.009) were significantly higher in the SCC group. The baseline values of DLCO were significantly lower in the SCC group (p=0.013) than the ADC group. After chemotherapy, spirometric parameters were significantly improved in the SCC group, while DLCO reduction was significant (p=0.021) in the ADC group. Conclusion: Our results demonstrate that differences exist between the two distinct types of NSCLC, SCC and ADC, both in baseline values and changing patterns of PFT values following chemotherapy. These differences in PFT results might reflect the different biology between these two histologic types.Background: Limited information is available regarding baseline pulmonary function and changes in pulmonary function following chemotherapy in patients with non-small cell lung cancer (NSCLC). Methods: We retrospectively reviewed a prospective database of patients with NSCLC who underwent PFTs both before and after two or three cycles of platinum-based doublet chemotherapy. Results: Sixty-four patients with stage III and IV NSCLC were included for analysis. Out of these 64 patients, 39 had SCC. With respect to the baseline pulmonary functions, the SCC group showed significantly lower spirometric values of forced vital capacity (p=0,031), forced expiratory volume in 1 sec. (p=0.002), FEV1/FVC (p<0.001) and maximum mid-expiratory flow rate (p=0.002). Residual volume (p=0.012) and RV/TLC (p=0.009) were significantly higher in the SCC group. The baseline values of DLCO were significantly lower in the SCC group (p=0.013) than the ADC group. After chemotherapy, spirometric parameters were significantly improved in the SCC group, while DLCO reduction was significant (p=0.021) in the ADC group. Conclusion: Our results demonstrate that differences exist between the two distinct types of NSCLC, SCC and ADC, both in baseline values and changing patterns of PFT values following chemotherapy. These differences in PFT results might reflect the different biology between these two histologic types.
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Obstructive Fibrinous Tracheal Pseudomembrane Presented with Atelectasis
하직환,이혜원,박영재,강현희,문화식,이상학 대한중환자의학회 2014 Acute and Critical Care Vol.29 No.2
Obstructive fibrinous tracheal pseudomembrane (OFTP) is a rare condition usually associated with endotracheal intubation. Airway obstruction caused by OFTP may occur after endotracheal tube extubation and can lead to severe respiratory distress. It is a rare but potentially fatal complication. In this report, we present a case of OFTP presented with atelectasis that caused dyspnea after extubation and was successfully treated by mechanical removal using a rigid bronchoscope.
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