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다제내성 Acinetobacter baumannii에 의한 인공호흡기연관 페렴에서 Colistin 단독요법과 시험관 내 상승작용에 근거한 병합요법간의 효능 비교
장항제 ( Hang Jea Jang ),김미나 ( Mi Na Kim ),이광하 ( Kwang Ha Lee ),홍상범 ( Sang Bum Hong ),임채만 ( Chae Man Lim ),고윤석 ( Youn Suck Koh ) 대한결핵 및 호흡기학회 2009 Tuberculosis and Respiratory Diseases Vol.67 No.3
Background: Ventilator-associated pneumonia caused by multi-drug resistant Acinetobacter baumannii has been increasing and growing as a threat in intensive care units. Limited therapeutic options have forced clinicians to choose colistin with or without combination of other antibiotics. We tried to compare the effectiveness between colistin monotherapy and combination therapy based on in vitro synergistic tests. Methods: From January 2006 to December 2007 in medical ICU of a tertiary care hospital in Korea, We reviewed the medical records of patients treated with intravenous colistin due to ventilator-associated pneumonia caused by multi-drug resistant Acinetobacter baumannii. Results: A total of 41 patients were analyzed. 22 patients had been treated with colistin monotherapy and 19 patients with colistin and combination antibiotics that were found to have in vitro synergistic effects. Baseline characteristics were similar in both groups but the mean duration of colistin administration was significantly longer in the combination group (19.1±11.2 days vs. 12.3±6.8 days, p=0.042). There were no significant differences in outcome variables between the two groups. Conclusion: Combination treatment based on the in vitro antimicrobial synergy test did not show better outcomes compared with colistin monotherapy in VAP caused by multi-drug resistant A. baumannii.
( Sihyung Park ),( Hang Jea Jang ),( Yang Wook Kim ),( Bong Soo Park ),( Hyun Kuk Kim ),( Jong Woon Song ),( Yeon Mi Kim ),( Kyubok Jin ) 대한류마티스학회 2015 대한류마티스학회지 Vol.22 No.6
Cytomegalovirus (CMV), a member of the human herpesvirus group, causes severe disease in immunocompromised patients. In particular, CMV pneumonia can be a life-threatening disease to patients taking immunosuppressive drugs. The radiographic manifestations of CMV are variable and may consist of reticular or reticulonodular patterns, ground-glass opacities, air-space consolidations, or mixed patterns. A cavitary lesion in pneumonia associated with CMV infection is extremely rare. Herein we report on a case of CMV pneumonia which presented with a cavitary lesion and was treated successfully in a systemic lupus erythematosus patient who was taking immunosuppressive drugs. (J Rheum Dis 2015;22:387-390)
Lee Jae Ha,Jang Ji Hoon,Kim Hyun Kuk,Jang Hang-Jea,Lee Sunggun,Kim Seong-Ho,Kim Ji Yeon,Choi Hee Eun,Han Ji-yeon,Kim Da Som,Kang Min Kyun,Kang Eunsu,Kim Il Hwan,Jin Han Park 대한결핵및호흡기학회 2022 Tuberculosis and Respiratory Diseases Vol.85 No.4
Background: An accurate diagnosis in patients with interstitial lung diseases (ILDs) by multidisciplinary discussion (MDD) based on histopathologic information is essential for optimal treatment. Transbronchial lung cryobiopsy (TBLC) has increasingly been used as a diagnostic alternative to surgical lung biopsy. This study aimed to evaluate the appropriate methods of TBLC in patients with ILD in Korea.Methods: A total of 27 patients who underwent TBLC were included. TBLC procedure details and clinical MDD diagnosis using TBLC histopathologic information were retrospectively analyzed.Results: All procedures were performed under general anesthesia with the fluoroscopic guidance in the operation room using flexible bronchoscopy and endobronchial balloon blocker. The median procedure duration was less than 30 minutes, and the median number of biopsies per participant was 2. Most of the bleeding after TBLC was not severe, and the rate of pneumothorax was 25.9%. The most common histopathologic pattern was alternative (48.2%), followed by indeterminate (33.3%) and usual interstitial pneumonia (UIP)/probable UIP (18.5%). In the MDD after TBLC, the most common diagnosis was idiopathic pulmonary fibrosis (33.3%), followed by smoking-related ILD (25.9%), nonspecific interstitial pneumonia (18.6%), unclassifiable-ILD (14.8%), and others (7.4%).Conclusion: This first single-center experience showed that TBLC using a flexible bronchoscopy and endobronchial balloon blocker with the fluoroscopic guidance under general anesthesia may be a safe and adequate diagnostic method for ILD patients in Korea. The diagnostic yield of MDD was 85.2%. Further studies are needed to evaluate the diagnostic yield and confidence of TBLC.
Jae Ha Lee,Hang Jea Jang,Jin Han Park,Yong Kyun Kim,Ho Ki Min,Sun Young Kim,Hyun-kuk Kim 대한중환자의학회 2016 Acute and Critical Care Vol.31 No.3
Amniotic fluid embolism is rare but is one of the most catastrophic complications in the peripartum period. This syndrome is caused by a maternal anaphylactic reaction to the introduction of fetal material into the pulmonary circulation. When amniotic fluid embolism is suspected, the immediate application of extracorporeal mechanical circulatory support such as veno-arterial extracorporeal membrane oxygenation (ECMO) or cardiopulmonary bypass should be considered. Without the application of extracorporeal mechanical circulatory support, medical supportive care might not be sufficient to maintain cardiopulmonary stabilization in severe cases of amniotic fluid embolism. In this report, we present the case of a 36-year-old pregnant woman who developed an amniotic fluid embolism immediately after a cesarean section. Her catastrophic event started with the sudden onset of severe hypoxia, followed by circulatory collapse within 8 minutes. The veno-arterial mode of extracorporeal membrane oxygenation was initiated immediately. She was successfully resuscitated but with impaired cognitive function. Thus, urgent ECMO should be considered when amniotic fluid embolism syndrome is suspected in patients presenting acute cardiopulmonary collapse.
( Jin Han Park ),( Sun Young Kim ),( Hang Jea Jang ),( Hyun Kuk Kim ),( Chan Sun Park ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: The aim of this study was to evaluate whether impulse oscillometry (IOS) can represent bronchodilator response and to distinguish between subtypes of chronic obstructive airway disease (COAD), especially in elderly patients. Methods: We enrolled 66 elderly (mean age 74±11) patients with chronic obstructive airway disease, including 33 asthma and 33 COPD respectively. Pre- and post- bronchodilator IOS and forced spirometry was assessed. Correlation analysis was used to compare spirometry measurements and IOS parameters. In addition, we compared changes of the parameters and the measurements in COPD and asthma group. Results: In whole group analysis, the percent changes of IOS parameters, especially respiratory resistance at 5Hz (R5) and frequency dependency of resistance (R5 to 20) after bronchodilation were strongly correlated with the percent changes of forced expiratory volume at 1 second and forced expiratory fi ow at 25-75%. (p<0.05) But, percent changes of IOS parameters failed to reveal differences between asthma and COPD group. Conclusions: In elderly patients with CAOD, IOS may be useful for identifying bronchodilator response. But to discriminate between COPD and asthma by IOS, we need further study. Further investigation through classifying asthma-COPD overlap syndrome and COPD may be helpful.
( Jin Han Park ),( Sun Young Kim ),( Hang Jea Jang ),( Hyun Kuk Kim ),( Chan Sun Park ) 대한결핵 및 호흡기학회 2014 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.118 No.-
Background: The aim of this study was to evaluate whether impulse oscillometry (IOS) can represent bronchodilator response and to distinguish between subtypes of chronic obstructive airway disease (COAD), especially in elderly patients. Methods: We enrolled 66 elderly (mean age 74±11) patients with chronic obstructive airway disease, including 33 asthma and 33 COPD respectively. Pre- and post- bronchodilator IOS and forced spirometry was assessed. Correlation analysis was used to compare spirometry measurements and IOS parameters. In addition, we compared changes of the parameters and the measurements in COPD and asthma group. Results: In whole group analysis, the percent changes of IOS parameters, especially respiratory resistance at 5Hz (R5) and frequency dependency of resistance (R5 to 20) after bronchodilation were strongly correlated with the percent changes of forced expiratory volume at 1 second and forced expiratory flow at 25-75%. (p<0.05) But, percent changes of IOS parameters failed to reveal differences between asthma and COPD group. Conclusions: In elderly patients with CAOD, IOS may be useful for identifying bronchodilator response. But to discriminate between COPD and asthma by IOS, we need further study. Further investigation through classifying asthma-COPD overlap syndrome and COPD may be helpful.
( Mingyo Seo ),( Jae Ha Lee ),( Hang Jea Jang ),( Jin Han Park ) 대한결핵 및 호흡기학회 2019 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.127 No.-
Backgrounds: Acute exacerbation of interstitial lung disease (AE-ILD) was defined as an acute, clinically significant deterioration with high mortality. There are no currently proven effective management strategies. Recently some studies proposed the effectiveness of PMX-DHP in patients with AE-ILD as potential therapy. Methods: Clinical data were retrospectively analyzed in 12 patients with AE-ILD (13 episodes of AE), who were treated by PMX-DHP, enrolled from January 2018 to June 2019 at Haeundae-Paik hospital, Busan, Korea. We compared laboratory results, the ratio of arterial oxygen partial pressure to fractional inspired oxygen (PF ratio), C-reactive protein (CRP), Interleukin-6 (IL-6) before and after PMX-DHP. Results: Twelve patients with idiopathic pulmonary fibrosis (IPF) and one patient with fibrotic nonspecific interstitial pneumonia (fNSIP) were included. Most patients (92.3%) were treated with high dose steroid and five patients (38.5%) with immunosuppressant. Mean number of PMX-DHP cycle was 2.4 times and mean duration of each cycle was 6.8 hours. After PMX-DHP, PF ratio was significantly improved at the end of PMX-DHP (109.3 ± 66.2 vs. 182.7 ± 96.2, p = 0.041) and after 72 hours (109.3 ± 66.2 vs. 173.7 ± 81.9, p = 0.044) compare to before. IL-6 was also significantly decreased at the end of PMX-DHP (330.6±600.5 vs. 18.3±15.5, p=0.0049) and after 72 hours (330.6±600.5 vs. 17.9±15, p=0.0078). There was no difference in CRP. 28-days mortality was 76.9% and there was no adverse event of PMX-DHP. Conclusions: Considering PF ratio improvement and removal of cytokine (IL-6), PMX-DHP would be helpful in patients with AE-ILD. But the improvement of oxygenation and cytokine removal always might not lead improvement of survival rate in our study. A larger prospective well controlled trial is needed to determine usefulness of PMX-DHP in patient with AE-ILD.
Kim, Yong Kyun,Lee, Dong-Hwan,Jeon, Jaehyun,Jang, Hang-Jea,Kim, Hyeon-Kuk,Jin, Kyubok,Lim, Sung-Nam,Lee, Sung Sook,Park, Bong Soo,Kim, Yang Wook,Shin, Jae-Gook,Kiem, Sungmin Elsevier 2018 Clinical therapeutics Vol.40 No.8
<P><B>Abstract</B></P> <P><B>Purpose</B></P> <P>The aim of this study was to investigate the population pharmacokinetic (PK) profile of meropenem in Korean patients with acute infections.</P> <P><B>Methods</B></P> <P>The study included 37 patients with a creatinine clearance ≤50 or >50 mL/min who received a 500- or 1000-mg dose of meropenem, respectively, infused intravenously over 1 hour every 8 hours. Blood samples were collected before and at 1, 1.5, and 5 hours after the start of the fourth infusion. The population PK analysis was conducted by using nonlinear mixed effect modeling software (NONMEM). Monte-Carlo simulations were performed to identify optimal dosing regimens.</P> <P><B>Findings</B></P> <P>Thirty-seven subjects completed the study. Meropenem PK variables were well described by using a one-compartment model. The typical values (relative SE) for weight-normalized clearance (CL) and V<SUB>d</SUB> were 0.266 L/h/kg (12.29%) and 0.489 L/kg (11.01%), respectively. Meropenem CL was significantly influenced by the serum creatinine level, which explained 11% of the interindividual CK variability. The proposed equation to estimate meropenem CL in Korean patients was as follows: CL (L/h) = 0.266 × weight × [serum creatinine/0.74]<SUP>–1.017</SUP> <SUB>.</SUB> The simulation results indicate that the current meropenem dosing regimen may be suboptimal in patients infected with normal or augmented renal function.</P> <P><B>Implications</B></P> <P>Prolonged infusions of meropenem over at least 2 hours should be considered, especially in patients with augmented renal function and those infected with pathogens for which the minimum inhibitory meropenem concentration is >1 μg/mL. Our results suggest an individualized meropenem dosing regimen for patients with abnormal renal function and those infected with pathogens with decreased in vitro susceptibility.</P>