Acute Exacerbation of Interstitial Pneumonia Other Than Idiopathic Pulmonary Fibrosis

Park, I-Nae,Kim, Dong Soon,Shim, Tae Sun,Lim, Chae-Man,Lee, Sang Do,Koh, Younsuck,Kim, Woo Sung,Kim, Won Dong,Jang, Se Jin,Colby, Thomas V. American College of Chest Physicians 2007 Chest Vol.132 No.1

<P>BACKGROUNDS: Acute exacerbation (AE) in idiopathic pulmonary fibrosis (IPF) is increasingly recognized as a relatively common and highly morbid clinical event. However, clinical data on AE in non-IPF interstitial pneumonia are sparse. This study was performed to find the frequency, clinical features, and outcome of AE in non-IPF interstitial pneumonia. METHODS: Retrospective analysis of 10 patients who satisfied the modified Akira criteria for AE during follow-up of 74 patients with surgical lung biopsy-confirmed idiopathic nonspecific interstitial pneumonia (I-NSIP) and 93 patients with biopsy-confirmed interstitial pneumonia associated with collagen vascular disease (CVD-IP). RESULTS: AE occurred in six patients with I-NSIP (1-year frequency, 4.2%) and in four patients with CVD-IP (rheumatoid arthritis [RA], n = 3; scleroderma, n = 1), with 1-year frequency of 3.3%. Median age was 58 years (range, 47 to 75); six patients were female. AE occurred in two patients immediately after surgical biopsy. Median duration of acute symptom before hospital admission was 10 days (range, 1 to 30). Median ratio of Pao(2) to the fraction of inspired oxygen (Fio(2)) was 172 (range, 107 to 273), and Pao(2)/Fio(2) ratio was < 200 in six patients. Surgical lung biopsy performed at the time of AE in two patients revealed diffuse alveolar damage superimposed on nonspecific interstitial pneumonia pattern. Four patients with I-NSIP survived to discharge and were followed up for 24 months (range, 6 to 121). CONCLUSION: AE occurred in the patients with I-NSIP with apparently better prognosis. In patients with CVD-IP, AE occurred mostly with RA-usual interstitial pneumonia in our small series with poor outcome.</P>

Thematic Poster : TP-78 ; Buffalo Chest: A Case of Single Pleural Cavity as Sequela of Tuberculosis

( I Nae Park ),( Ho Kee Yum ) 대한결핵 및 호흡기학회 2014 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.118 No.-

In humans, both pleural cavities are completely separated by the mediastinum without anatomical communication in between. A single pleural space, resulting in pleuropleural communication between two normally separated pleural cavities, is very rare in humans and is often a corollary of heart-lung transplantation, major thoracic surgery, or a congenital anomaly. We present the case of a woman with a single pleural cavity who had never undergone thoracic surgery but who had a history of incompletely treated endobronchial tuberculosis. To our knowledge, this is the first reported case of a single pleural cavity not associated with congenital anomaly or thoracic surgery.

Poster Session : PS 1618 ; Mycobacterial Diseases : Buffalo Chest: A Case of Single Pleural Cavity as Sequela of Tuberculosis

( I Nae Park ),( Ho Kee Yum ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

In humans, both pleural cavities are completely separated by the mediastinum without anatomical communication in between. A single pleural space, resulting in pleuropleural communication between two normally separated pleural cavities, is very rare in humans and is often a corollary of heart-lung transplantation, major thoracic surgery, or a congenital anomaly. We present the case of a woman with a single pleural cavity who had never undergone thoracic surgery but who had a history of incompletely treated endobronchial tuberculosis. To our knowledge, this is the fi rst reported case of a single pleural cavity not associated with congenital anomaly or thoracic surgery.

Qualitative and quantitative results of interferon-γ release assays for monitoring the response to anti-tuberculosis treatment

( I-nae Park ),( Tae Sun Shim ) 대한내과학회 2017 The Korean Journal of Internal Medicine Vol.32 No.2

Background/Aims: The usefulness of interferon-γ release assays (IGRAs) in monitoring to responses to anti-tuberculosis (TB) treatment is controversial. We compared the results of two IGRAs before and after anti-TB treatment in same patients with active TB. Methods: From a retrospective review, we selected patients with active TB who underwent repeated QuantiFERON-TB Gold (QFN-Gold, Cellestis Limited) and T-SPOT.TB (Oxford Immunotec) assays before and after anti-TB treatment with first-line drugs. Both tests were performed prior to the start of anti-TB treatment or within 1 week after the start of anti-TB treatment and after completion of treatment. Results: A total of 33 active TB patients were included in the study. On the QFN-Gold test, at baseline, 23 cases (70%) were early secreted antigenic target 6-kDa protein 6 (ESAT-6) or culture filtrate protein 10 (CFP-10) positive. On the T-SPOT. TB test, at baseline, 31 cases (94%) were ESAT-6 or CFP-10 positive. Most of patients remained both test-positive after anti-TB treatment. Although changes in interferon-γ release responses over time were highly variable in both tests, there was a mean decline of 27 and 24 spot-forming counts for ESAT-6 and CFP-10, respectively on the T-SPOT.TB test (p < 0.05 for all). Conclusions: Although limited by the small number of patients and a short-term follow-up, there was significant decline in the quantitative result of the T-SPOT. TB test with treatment. However, both commercial IGRAs may not provide evidence regarding the cure of disease in Korea, a country where the prevalence of TB is within the intermediate range.

A Case of Delayed Anaphylaxis with Severe but Temporary Muscle Weakness in All Four Limbs Following Influenza Vaccination

( I-nae Park ) 대한결핵 및 호흡기학회 2021 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.129 No.-

Post-vaccination acute-onset hypersensitivity reactions include self-limited localized adverse events and, rarely, systemic reactions ranging from urticaria to angioedema to anaphylaxis. We report a case of delayed anaphylaxis with severe but temporary muscle weakness in all four limbs 5 hours after influenza vaccination. A 37-year-old woman complained of sudden stabbing chest pain and breathing difficulty at home. When the 119-rescue team arrived, the patient was in drowsy mentality, making grunting sounds without a verbal response. On arrival at the emergency department, the patient had facial angioedema and upper airway swelling, but generalized hives were not observed. The motor powers of both limbs were measured as grade 1 by Medical Research Council scale. After acute management of anaphylaxis, she recovered gradually and was able to be discharged on the 7th day of hospitalization. This case is a reminder of the risk of vaccine-related anaphylaxis, which can occur several hours or more after vaccination.

A Single Hospital Closure and Quarantine record for 2 Weeks Due to One Case of COVID-19 Diagnosed during Hospitalization

( I-nae Park ),( Ho Kee Yum ) 대한결핵 및 호흡기학회 2020 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.128 No.0

After the mass outbreak in Daegu, residents or recent visitors to the Daegu-Gyeongbuk region were included in the COVID-19 epidemiological risk checklist. Our hospital also used checklist according to clinical and epidemiological criteria to evaluate the risk of COVID-19. Despite such efforts, a patient from the Daegu-Gyeongbuk region was hospitalized after filling out the questionnaire falsely at screening desk. The following is a record of the hospital's temporary closure due to one COVID-19 patient diagnosed during hospitalization. A patient in her late 70s was hospitalized in a 4-person hospital room on 6th floor for three weeks of nausea, vomiting, loss of appetite, and generalized weakness. In the CXR taken on the first day of hospitalization, lesions were not apparent except for suspicious subtle infiltration, but on the 4th day of hospitalization, although the patient herself said that she had a chronic cough caused by postnasal drip, other patients in the same room were concerned about her persistent cough, therefore a chest CT was taken in the evening. CT finding showed multifocal patchy GGO and consolidation of subpleural and peribronchial distribution in both lungs. On the morning of the 5th day of hospitalization, nasopharyngeal & oropharyngeal swabs and sputum test for COVID-19 were performed, and the result were both positive. The following is a flow diagram of the isolation and quarantine process at our hospital after in-hospital COVID-19 diagnosis (Figure 1). Although closing and isolating the hospital seemed to have played a useful role in preventing the spread of COVID-19 in-hospital and to the local community, it is questionable whether the hospital closure and the quarantine period continued unconditionally for two weeks was appropriate. It is important to prevent in-hospital infection, but it is also important that existing patients and non-COVID-19 patients can receive timely treatment without long-term entire hospital closure.

Regression of Primary Lung Carcinoma Following Novalis Radiosurgery for Brain Metastasis: A Case Report

( I-nae Park ) 대한결핵 및 호흡기학회 2021 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.129 No.-

Background The abscopal effect is a phenomenon which is probably associated with enhanced immune effect triggered by radiotherapy. Although abscopal effect has been documented in several types of cancer, it is a very rare phenomenon in non-small cell lung carcinoma (NSCLC). We present a 76-year-old male with brain metastasis from NSCLC who went into remission following Novalis radiosurgery treatment to a brain lesion, in the absence of systemic treatment. Case presentation A 76-year old man complained of cough, sputum and progressive dyspnea. Chest computed tomography (CT) scan revealed two well-defined 29mm and 12mm sized enhancing nodules in right lower lobe (RLL) and multiple enlarged nodes with internal dense calcifications in mediastinum. Lung biopsy revealed a moderately to poorly differentiated squamous cell carcinoma with positive for Programmed Death Ligand 1 (PDL1). .Positron emission tomography scan showed two hypermetabolic lung nodules in RLL and multiple lymph node enlargements with increased FDG uptake in mediastinum and cervical areas. Subsequently, a magnetic resonance imaging (MRI) of the brain was done for evaluation of metastasis. 2.3X2.1cm enhancing mass was noted at right parietal lobe with surrounding edema and another small metastasis at left occipital lobe was suggested. Due to poor performance and old age, the patient received Novalis radiosurgery to metastatic brain lesions without any form of systemic therapy. A follow-up outpatient chest CT scan was performed 3 and 6 months later, CT scans revealed the regression of lung nodules in RLL and marked decrease in the size of the multiple metastatic lymph nodes. Now he has survived more than two years since his initial diagnosis without recurrence of NSCLC. Conclusion Our case report confirms the existence of NSCLC. Also positivity for PDL1 might have contributed to remission in this patient.

부갑상선암의 고칼슘혈증에 의한 만성 췌장염 1 예

박상현(Sang Hyun Park),김인(In Kim),박이내(I Nae Park),김태협(Tae Hyup Kim),조영환(Young Whan Cho),박덕우(Duk Woo Park),강혜진(Hye Jin Kang),심선진(Sun Jin Sym),신상효(Sang Hyo Shin),조창래(Chang Lae Jo),이상수(Sang Soo Lee),이성구(Sun 대한소화기학회 2002 대한소화기학회지 Vol.39 No.6

N/A

성인에서 진단된 선천성 낭포성 유선종 폐기형 6예

박영진 ( Young Jin Park ),정훈 ( Hoon Jung ),박이내 ( I Nae Park ),최상봉 ( Sang Bong Choi ),허진원 ( Jin Won Hur ),이혁표 ( Hyuk Pyo Lee ),염호기 ( Ho Kee Yum ),최수전 ( Soo Jeon Choi ),구호석 ( Ho Seok Koo ),이양행 ( Yang Haeng 대한결핵 및 호흡기학회 2008 Tuberculosis and Respiratory Diseases Vol.65 No.2

연구배경: CCAM은 드문 하부 호흡기의 선천성 발달 기형으로 대부분은 생후 2년 내에 진단되는 것으로 보고되고 있다. 그리고 매우 드물게 성인이 되어서 호흡기 합병증이 생기거나 무증상인 채로 우연히 진단된 증례들이 보고되었다. 우리는 본원에서 수술을 통해 조직학적 소견으로 확진된 6명의 성인 CCAM 환자들을 기술하였고 이들의 임상적, 방사선학적 및 조직학적 특성을 분석하고자 하였다. 방법: 2001년 8월부터 2007년 2월까지 본원에서 성인기에 수술을 통한 조직학적 소견으로 확진된 6명의 CCAM 환자를 확인하였다. 의무기록 검토를 통해 그들의 인구학적 및 임상적 특성, 흉부 방사선 자료 그리고 조직학적 특성을 후향적으로 분석하였다. 결과: 6명의 CCAM 환자 중 4명이 여자였고 진단 당시의 평균 나이는 23.5세(범위 18∼39세)였다. 내원 당시 주요 임상 양상은 하부 호흡기 감염, 객혈, 그리고 기흉이었다. 흉부 전산화 단층촬영을 보면 5명의 환자는 공기 액체층을 동반한 다발성 격막을 가진 낭종성 병변을 가지고 있었고 나머지 1명에서는 우상엽에 공기 액체층을 동반한 다발성 공동성 병변과 주위에 다발성 침윤성 병변을 가지고 있었다. 모든 환자는 폐엽 절제 수술을 받았는데 5명은 개흉술을 통한 폐엽 절제술을 그리고 1명은 흉강경을 이용한 폐엽 절제술을 시행 받았다. 조직학적 검사결과 Stocker씨 분류법에 따라 3명의 환자는 1형 그리고 나머지 3명은 2형으로 분류되었다. 모든 환자의 검체에서 동반된 악성 종양의 증거는 없었다. 결론: CCAM이 하부 호흡기 감염, 기흉, 객혈 등의 다양한 호흡기 합병증과 악성화를 일으킬 가능성이 있고 수술적 치료와 연관된 합병증이 거의 없기 때문에 CCAM으로 의심되거나 확실치 않은 폐의 낭종성 혹은 공동성 병변이 있을 때 정확한 진단과 적절한 치료를 위해서 반드시 수술적 치료가 필요하다. Background: Congenital cystic adenomatoid malformation of the lung (CCAM) is a rare congenital developmental anomaly of the lower respiratory tract. Most cases are diagnosed within the first 2 years of life, so adult presentation of CCAM is rare. We describe here six adult cases of CCAM and the patients underwent surgical resection, and all these patients were seen during a five and a half year period. The purpose of this study was to analyze the clinical, radiological and histological characteristics of adult patients with CCAM. Methods: Through medical records analysis, we retrospectively reviewed the clinical characteristics, the chest pictures (X-ray and CT) and the histological characteristics. Results: Four patients were women and the mean age at diagnosis was 23.5 years (range: 18∼39 years). The major clinical presentations were lower respiratory tract infection, hemoptysis and pneumothorax. According to the chest CT scan, 5 patients had multiseptated cystic lesions with air fluid levels and one patient had multiple cavitary lesions with air fluid levels, and these lesions were surrounded by poorly defined opacities at the right upper lobe. All the patients were treated with surgical resection. 5 patients underwent open lobectomy and one patient underwent VATS lobectomy. On the pathological examination, 3 were found to be CCAM type I and 3 patients were CCAM type II, according to Stocker`s classification. There was no associated malignancy on the histological studies of the surgical specimens. Conclusion: As CCAM can cause various respiratory complications and malignant changes, and the risks associated with surgery are extremely low, those patients who are suspected of having or who are diagnosed with CCAM should go through surgical treatment for making the correct diagnosis and administering appropriate treatment. (Tuberc Respir Dis 2008;65:110-115)

Poster Session : PS 1264 ; Pulmonology : Spontaneous Pneumomediastinum: A Case of Anorexia Nervosa Complication

( Kyung Jin Lee ),( I Nae Park ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Introduction: Spontaneous pneumomediastinum is an uncommon condition in which de. ned as the presence of free air in the mediastinum, usually results from spontaneous alveolar wall rupture. It occurs in situation of sudden intra-alveolar pressure increasing, such as severe coughing, vomiting, violent exercise. We report a case of anorexia nervosa complicated spontaneous pneumomediastinum Case: A 14 year-old girl, who had anorexia nervosa for 4 months. She complained of abdominal discomfort and unusual crackling sensation in her neck and both axillary area. Chest x-ray revealed subcutaneous emphysema in the neck and both axillary, pneumomediastinum. She didn`t have vomiting, nausea and trauma history. Physical examination showed blood pressure 97/71mmHg, cardiac rate 54/minute. Temperature 36.5°C. Height was 165cm, weight 29kg, body mass index(BMI) 10.7kg/m2. (6month ago, patient weight was 50kg) she had 6 months amenorrhea and lanugo on whole body. Laboratory test revealed a Hb 11.3g/dl, WBC 6130/mm3, platelet 186,000/mm3, BUN/Cr 23/0.74, serum protein 6.2g/dl, albumin 4.1g/dl, AST 34IU/L, ALT 50IU/L. CT scan revealed subcutaneous emphysema in the neck and both axillary, pneumomediastinum, retropneumoperitoneum in left kidney area. Upper gastrointestinal series with gastrografin didn`t reveal perforation. We ordered the patient to undergo short fast and inhaled oxygen 5L/minute. Within a week, the subcutaneous emphysema disappeared. after 2week, pneumomediastinum disappeared and patient had good tolerance of diet. Discussion: Anorexia nervosa is a psychiatric disorder, as well as multi-systemic disease. It causes many medical problems, including irregular menstruation, hypotension, bradycardia and lanugo on whole body. Sometime, this disorder also cause rare complication, including abnormal air collections, such as pneumomediastinum, retropneumoperitoneum, subcutaneous emphysema. Prolonged starvation can cause weakness of alveolar wall, decreasing alveolar compliance and thinning of the connective tissue. Therefore, minimal increase of intra-alveolar pressure during usual daily activities (coughing, yawning, sneezing) can become the cause of pneumomediastinum.