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( Byung Woo Jhun ),( Kyung Jong Lee ),( Gee Young Suh ),( Man Pyo Chung ),( Hojoong Kim ),( O Jung Kwon ),( Kyung Soo Lee ),( Joung Ho Han ),( Sang Won Um ) 대한결핵 및 호흡기학회 2014 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.118 No.-
Background: There are no accurate data on the diagnostic value of preoperative flexible bronchoscopy (FB) for persistent ground glass opacity (GGO) nodules. Methods: We retrospectively searched a database for subjects who had ‘GGO,’ ‘non-solid nodule,’ ‘part-solid nodule,’ or ‘sub-solid nodule’ in radiological reports of chest computed tomography between February 2004 and March 2012. Patients who had infiltrative GGO, focal GGO larger than 3 cm, or were lost to follow-up were excluded. We assessed the diagnostic value of preoperative FB in patients with persistent GGO nodules who underwent planned surgical resection. Results: In total, 296 GGO nodules were evaluated by FB in 264 patients with persistent GGO nodules who underwent preoperative FB and planned surgical resection. The median size of the GGO nodules was 18 mm, and 135 (46%) were pure GGO and 161 (54%) were mixed GGO. No visible tumor or unsuspected endobronchial metastasis was identified by preoperative FB. Only 3 (1%, 3/208) GGO nodules were identified preoperatively as malignant by bronchial washing cytology, which were all mixed GGO; no other accompanying etiology was identified by FB. Of all GGO nodules, 271 (91%) were subsequently confirmed as malignant and 25 (9%) were confirmed as benign by surgical resection. Consequently, the overall diagnostic sensitivity and negative predictive value of preoperative FB on a per-nodule basis were 1% (3/271) and 8% (25/293), respectively. The preoperative FB did not change the planned surgical strategy. Conclusions: Preoperative FB should not be routinely recommended in surgical candidates with persistent GGO nodules, especially pure GGO nodules.
( Byung Woo Jhun ),( Kyung Jong Lee ),( Gee Young Suh ),( Man Pyo Chung ),( Ho Joong Kim ),( O Jung Kwon ),( Kyung Soo Lee ),( Joung Ho Han ),( Sang Won Um ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: There are no accurate data on the diagnostic value of preoperative exible bronchoscopy (FB) for persistent ground glass opacity (GGO) nodules. Methods: We retrospectively searched a database for subjects who had ‘GGO,’ ‘non-solid nodule,’ ‘part-solid nodule,’ or ‘sub-solid nodule’ in radiological reports of chest computed tomography between February 2004 and March 2012. Patients who had infi ltrative GGO, focal GGO larger than 3 cm, or were lost to follow-up were excluded.We assessed the diagnostic value of preoperative FB in patients with persistent GGO nodules who underwent planned surgical resection. Results: In total, 296 GGO nodules were evaluated by FB in 264 patients with persistent GGO nodules who underwent preoperative FB and planned surgical resection. The median size of the GGO nodules was 18 mm, and 135 (46%) were pure GGO and 161 (54%) were mixed GGO. No visible tumor or unsuspected endobronchial metastasiswas identifi ed by preoperative FB. Only 3 (1%, 3/208) GGO nodules were identifi ed preoperatively as malignant by bronchial washing cytology, which were all mixed GGO; no other accompanying etiology was identifi ed by FB. Of all GGO nodules, 271 (91%) were subsequently confi rmed as malignant and 25 (9%) were confi rmed as benign by surgical resection. Consequently, the overall diagnostic sensitivity and negative predictivevalue of preoperative FB on a per-nodule basis were 1% (3/271) and 8% (25/293), respectively. The preoperative FB did not change the planned surgical strategy.Conclusions: Preoperative FB should not be routinely recommended in surgical candidates with persistent GGO nodules, especially pure GGO nodules.
Amikacin Inhalation as Salvage Therapy for Refractory Nontuberculous Mycobacterial Lung Disease
Jhun, Byung Woo,Yang, Bumhee,Moon, Seong Mi,Lee, Hyun,Park, Hye Yun,Jeon, Kyeongman,Kwon, O Jung,Ahn, Jungmin,Moon, Il Joon,Shin, Sung Jae,Daley, Charles L.,Koh, Won-Jung American Society for Microbiology 2018 Antimicrobial Agents and Chemotherapy Vol.62 No.7
<P>Although guidelines recommend amikacin (AMK) inhalation therapy for difficult-to-treat nontuberculous mycobacterial lung disease (NTM-LD), data are limited regarding the safety and clinical efficacy of this salvage therapy. We retrospectively evaluated the treatment outcomes of 77 patients with refractory NTM-LD caused by Mycobacterium abscessus complex (MABC) or M. avium complex (MAC) who initiated AMK inhalation therapy between February 2015 and June 2016. MABC was the most common etiology (n = 48, 62%), followed by MAC (n = 20, 26%) and mixed infections (n = 9, 12%). Isolates with macrolide resistance and baseline AMK resistance were identified in 63 (82%) patients and 5 (6%) patients, respectively. At 12 months after AMK inhalation therapy, 49% of patients had symptomatic improvement, whereas 42% had radiological improvement. Conversion to a negative sputum culture occurred in 14 (18%) patients, and the culture conversion rate was higher in patients infected with macrolide-susceptible isolates (7/14, 50%) than in those infected with macrolide-resistant isolates (7/63, 11%) (P = 0.003). Significant decreases in sputum semiquantitative culture positivity occurred after AMK inhalation therapy (P < 0.001). On multivariate analysis, conversion to a negative sputum culture was associated with mixed infections (P = 0.009), a forced expiratory volume in 1 s of greater than 60% (P = 0.008), and the absence of macrolide resistance (P = 0.003). Thirty-eight percent of patients experienced adverse effects, with ototoxicity (n = 15) being the most common. AMK inhalation salvage therapy may improve the treatment responses in some patients with refractory NTM-LD. However, considering the common adverse effects, further evaluation of the optimal dosage and intervals for AMK inhalation therapy is needed.</P>
Treatment of Isoniazid-Resistant Pulmonary Tuberculosis
( Byung Woo Jhun ),( Won-jung Koh ) 대한결핵 및 호흡기학회 2020 Tuberculosis and Respiratory Diseases Vol.83 No.1
Tuberculosis (TB) remains a threat to public health and is the leading cause of death globally. Isoniazid (INH) is an important first-line agent for the treatment of TB considering its early bactericidal activity. Resistance to INH is now the most common type of resistance. Resistance to INH reduces the probability of treatment success and increases the risk of acquiring resistance to other first-line drugs such as rifampicin (RIF), thereby increasing the risk of multidrug-resistant-TB. Studies in the 1970s and 1980s showed high success rates for INH-resistant TB cases receiving regimens comprised of first-line drugs. However, recent data have indicated that INH-resistant TB patients treated with only first-line drugs have poor outcomes. Fortunately, based on recent systematic meta-analyses, the World Health Organization published consolidated guidelines on drug-resistant TB in 2019. Their key recommendations are treatment with RIF-ethambutol (EMB)-pyrazinamide (PZA)-levofloxacin (LFX) for 6 months and no addition of injectable agents to the treatment regimen. The guidelines also emphasize the importance of excluding resistance to RIF before starting RIF-EMB-PZA-LFX regimen. Additionally, when the diagnosis of INH-resistant TB is confirmed long after starting the first-line TB treatment, the clinician must decide whether to start a 6-month course of RIF-EMB-PZA-LFX based on the patient’s condition. However, these recommendations are based on observational studies, not randomized controlled trials, and are thus conditional and based on low certainty of the effect estimates. Therefore, further work is needed to optimize the treatment of INH-resistant TB.
Vitamin D Status in South Korean Military Personnel with Acute Eosinophilic Pneumonia: A Pilot Study
Jhun, Byung Woo,Kim, Se Jin,Kim, Kang,Lee, Ji Eun,Hong, Duck Jin The Korean Academy of Tuberculosis and Respiratory 2015 Tuberculosis and Respiratory Diseases Vol.78 No.3
Background: A relationship between low vitamin D levels and the development or outcomes of respiratory diseases has been identified. However, there is no data on the vitamin D status in patients with acute eosinophilic pneumonia (AEP). We evaluated the vitamin D status in patients with AEP among South Korean military personnel. Methods: We prospectively compared the serum levels of total 25-hydroxyvitamin D [25(OH)D], 25(OH)D3, and 25(OH)D2 among patients with AEP, pulmonary tuberculosis (PTB), and community-acquired pneumonia (CAP). Results: In total, 65 patients with respiratory diseases, including AEP (n=24), PTB (n=19), and CAP (n=22), were identified. Of the 24 patients with AEP, 2 (8%) had deficient total 25(OH)D levels (<10 ng/mL), 17 (71%) had insufficient total 25(OH)D levels (${\geq}10$ to <30 ng/mL), and only 5 (21%) had sufficient total 25(OH)D levels (${\geq}30$ to <100 ng/mL). The difference in the total 25(OH)D levels among patients with AEP, PTB, and CAP was not statistically significant (p=0.230). The median levels of total 25(OH)D, 25(OH)D3, and 25(OH)D2 were 22.84, 22.84, and 0.00 ng/mL, respectively, and no differences in the 25(OH)D level were present among patients with AEP, PTB, and CAP with the exception of the total 25(OH)D level between patients with AEP and PTB (p=0.042). Conclusion: We have shown that low vitamin D levels are frequently found in patients with AEP and are comparable with those in patients with PTB and CAP.
( Byung Woo Jhun ),( Kyeong Man Jeon ),( Jung Seop Eom ),( Ji Hyun Lee,),( Gee Young Suh ),( Man Pyo Chung ),( O Jung Kwon ),( Won Jung Koh ) 대한결핵 및 호흡기학회 2012 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.114 No.-
Backgroud: Chronic pulmonary aspergillosis (CPA) is uncommon and there are few data on the clinical characteristics, optimal therapeutic strategies, and outcomes. Methods: We retrospectively reviewed the records of patients with newly diagnosed CPA and assessed the clinical, radiologic, and laboratory responses, and outcomes between January 2008 and January 2012. Results: A total of 70 CPA patients were included. Median age was 55 years and 51 patients (72.9% ) were men. Fifty-seven patients (81.4%) had a history of pulmonary tuberculosis and 32 patients (45.7%) had non-tuberculosis mycobacterium (NTM) lung disease, 17 of whom had a history of NTM treatment and 15 was under NTM treatment. Sixty-nine patients (98.6%) received oral itraconazole, except one with oral voriconazole for a median duration of 6.2 months. Symptomatic improvement occurred in 52 patients (74.3%), radiologic improvement occurred in 29 (41.4%), and laboratory tests improved more than 60% of all patients. Thirty-six patients (51.4%) achieved treatment success, defined as symptomatic improvement after at least 6 months of therapy regardless of radiological improvement, and 4 of whom needed retreatment after a median of 8.4 months. There was no difference in clinical characteristics and outcomes according to NTM status and 10 (14.3%) discontinued therapy due to adverse reactions. Death occurred in 10 (14.3%) and median follow-up duration was 11.2 months. Conclusion: Antifungal therapy for about 6 months and reassessment of disease might be feasible treatment strategy in managing patients with CPA.
Vitamin D Status in South Korean Military Personnel with Acute Eosinophilic Pneumonia: A Pilot Study
( Byung Woo Jhun ),( Se Jin Kim ),( Kang Kim ),( Ji Eun Lee ),( Duck Jin Hong ) 대한결핵 및 호흡기학회 2015 Tuberculosis and Respiratory Diseases Vol.78 No.3
Background: A relationship between low vitamin D levels and the development or outcomes of respiratory diseases has been identified. However, there is no data on the vitamin D status in patients with acute eosinophilic pneumonia (AEP). We evaluated the vitamin D status in patients with AEP among South Korean military personnel. Methods: We prospectively compared the serum levels of total 25-hydroxyvitamin D [25(OH)D], 25(OH)D3, and 25(OH)D2 among patients with AEP, pulmonary tuberculosis (PTB), and community-acquired pneumonia (CAP). Results: In total, 65 patients with respiratory diseases, including AEP (n=24), PTB (n=19), and CAP (n=22), were identified. Of the 24 patients with AEP, 2 (8%) had deficient total 25(OH)D levels (<10 ng/mL), 17 (71%) had insufficient total 25(OH)D levels (≥10 to <30 ng/mL), and only 5 (21%) had sufficient total 25(OH)D levels (≥30 to <100 ng/mL). The difference in the total 25(OH)D levels among patients with AEP, PTB, and CAP was not statistically significant (p=0.230). The median levels of total 25(OH)D, 25(OH)D3, and 25(OH)D2 were 22.84, 22.84, and 0.00 ng/mL, respectively, and no differences in the 25(OH)D level were present among patients with AEP, PTB, and CAP with the exception of the total 25(OH)D level between patients with AEP and PTB (p=0.042). Conclusion: We have shown that low vitamin D levels are frequently found in patients with AEP and are comparable with those in patients with PTB and CAP.
Jhun, Byung Woo,Moon, Seong Mi,Kim, Su-Young,Park, Hye Yun,Jeon, Kyeongman,Kwon, O Jung,Huh, Hee Jae,Ki, Chang-Seok,Lee, Nam Yong,Chung, Myung Jin,Lee, Kyung Soo,Shin, Sung Jae,Daley, Charles L.,Koh, American Society for Microbiology 2018 Antimicrobial agents and chemotherapy Vol.62 No.2
<P>Intermittent, three-times-weekly oral antibiotic therapy is recommended for the initial treatment of noncavitary nodular bronchiectatic (NB) Mycobacterium avium complex (MAC) lung disease. However, intermittent therapy is not recommended for patients who have been previously treated. We evaluated 53 patients with recurrent noncavitary NB MAC lung disease who underwent antibiotic treatment for >= 12 months with daily therapy (n = 26) or intermittent therapy (n = 27) between January 2008 and December 2015. Baseline characteristics were comparable between daily therapy and intermittent therapy groups. Sputum culture conversion rates did not differ between daily therapy (21/26, 81%) and intermittent therapy (22/27, 82%) groups. Compared to the etiologic organism at the time of previous treatment, recurrent MAC lung disease was caused by the same MAC species in 38 patients (72%) and by a different MAC species in 15 patients (28%). Genotype analysis in patients with sequenced paired isolates revealed that 86% (12/14) of cases with same species recurrence were due to reinfection with a new MAC genotype. In conclusion, most recurrent noncavitary NB MAC lung disease cases were caused by reinfection rather than relapse. Intermittent antibiotic therapy is a reasonable treatment strategy for recurrent noncavitary NB MAC lung disease.</P>