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( Yeun Seoung Choi ),( Hyun Sung Pack ),( Shin Young Hyun ),( Kwang Yong Shim ),( Chong In Lee ),( Jee Hyun Kong ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: Age is an adverse prognostic factor in lymphoma. In general, elderly patients` medical conditionis poor and they receive subsequently reduced dosages of chemotherapy agents. Therefore, we evaluated the treatment patterns and clinical outcomes in elderly patients with lymphoma in Wonju Severance Christian Hospital (WCH). Methods: We retrospectively reviewed the medical records of elderly patients (=65 years ) who were diagnosed with lymphoma at WCH from January 2010 to December 2013. For this study, we checked the treatment medication, dosage, frequency, response and survival. Results: A total of 55 patients were identified and were followed up for a median of 7(0-43) months. The median age was 71(65-89) years and there were 27 male and 28 female. fifty three patients presented with Non-Hodgkin`s lymphoma (94.6%) and 32 of them were diffuse large B cell lymphoma. Chemotherapy was performed in 46 (83.6%) patients. Eighteen patients went through full cycles and 6 patients received the full dose of chemotherapy. However, neither the cycle nor the mean dosage of chemotherapy made significant differences on responses. The median survival of patients with chemotherapy seemed to be longer than that of those with conservative care only, but it was not statistically significant (8 (0-43) months vs. 1.5 months (0- 40 months), p=0.281). Neither chemotherapy cycle, dosages, stage, LDH nor a bulky disease made any difference regarding survival, but a poor performance, the presence of an extranodal disease and T cell histology showed poor survival. Conclusion: Chemotherapy seemed to improve the survival in elderly lymphoma patients, but without clinical significance. However, this study included only 55 patients with heterogenous histology. Therefore, further prospectivetrials with a larger number of patients and a longer monitoring period are warranted to determine the best treatment strategy in elderly lymphoma patients.
Choi, Yeun Seoung,Lim, Jung Soo,Kwon, Woocheol,Jung, Soon-Hee,Park, Il Hwan,Lee, Myoung Kyu,Lee, Won Yeon,Yong, Suk Joong,Lee, Seok Jeong,Jung, Ye-Ryung,Choi, Jiwon,Choi, Ji Sun,Jeong, Joon Taek,Yoo, The Korean Academy of Tuberculosis and Respiratory 2015 Tuberculosis and Respiratory Diseases Vol.78 No.4
Pulmonary Langerhans cell histiocytosis is an uncommon diffuse cystic lung disease in adults. In rare cases, it can involve extrapulmonary organs and lead to endocrine abnormalities such as central diabetes insipidus. A 42-year-old man presented with polyphagia and polydipsia, as well as a dry cough and dyspnea on exertion. Magnetic resonance imaging of the hypothalamic-pituitary system failed to show the posterior pituitary, which is a typical finding in patients with central diabetes insipidus. This condition was confirmed by a water deprivation test, and the patient was also found to have type 2 diabetes mellitus. Computed tomographic scanning of the lungs revealed multiple, irregularly shaped cystic lesions and small nodules bilaterally, with sparing of the costophrenic angles. Lung biopsy through video-assisted thoracoscopic surgery revealed pulmonary Langerhans cell histiocytosis. On a follow-up visit, only 1 year after the patient had quit smoking, clinical and radiological improvement was significant. Here, we report an uncommon case of pulmonary Langerhans cell histiocytosis that simultaneously presented with diabetes insipidus and diabetes mellitus.
( Yeun Seoung Choi ),( Jung Soo Lim ),( Woocheol Kwon ),( Soon Hee Jung ),( Il Hwan Park ),( Myoung Kyu Lee ),( Won Yeon Lee ),( Suk Joong Yong ),( Seok Jeong Lee ),( Ye Ryung Jung ),( Jiwon Choi ),( 대한결핵 및 호흡기학회 2015 Tuberculosis and Respiratory Diseases Vol.78 No.4
Pulmonary Langerhans cell histiocytosis is an uncommon diffuse cystic lung disease in adults. In rare cases, it can involve extrapulmonary organs and lead to endocrine abnormalities such as central diabetes insipidus. A 42-year-old man presented with polyphagia and polydipsia, as well as a dry cough and dyspnea on exertion. Magnetic resonance imaging of the hypothalamic-pituitary system failed to show the posterior pituitary, which is a typical finding in patients with central diabetes insipidus. This condition was confirmed by a water deprivation test, and the patient was also found to have type 2 diabetes mellitus. Computed tomographic scanning of the lungs revealed multiple, irregularly shaped cystic lesions and small nodules bilaterally, with sparing of the costophrenic angles. Lung biopsy through video-assisted thoracoscopic surgery revealed pulmonary Langerhans cell histiocytosis. On a follow-up visit, only 1 year after the patient had quit smoking, clinical and radiological improvement was significant. Here, we report an uncommon case of pulmonary Langerhans cell histiocytosis that simultaneously presented with diabetes insipidus and diabetes mellitus.
( Ji Sun Choi ),( Myoung Kyu Lee ),( Sang Ha Kim ),( Won Yeon Lee ),( Suk Joong Yong ),( Kye Chul Shin ),( Jiwon Choi ),( Yeun Seoung Choi ),( Jae Ho Seong ),( Ye Ryung Jung ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: Limited studies have been identifi ed about nursing and healthcare-associated pneumonia (NHCAP) requiring intensive care unit (ICU) admission. We evaluated the clinical and microbiological characteristics of NHCAP patients admitted to the ICU. Methods: NHCAP was categorized as four groups. Reviewed database included age, gender, comorbid diseases, laboratory data and microbiological Results: The severity of pneumonia was assessed by using the pneumonia severity index (PSI) and CURB-65. The 30-day mortality and duration of ICU stay were evaluated as endpoints Results: Total 428 patients (men, 67.1%) were reviewed. The mean age was 71.2 ± 11.9 year-old. Thirty-day mortality was 25.5%, and duration of ICU stay was 13.8 ± 13.3 days. Mortality (P = 0.349) had no signifi cant difference among four groups although duration of ICU stay (P = 0.008) was signifi cantly longer in group C and D. When we performed multivariate logistic analysis using signifi cant variables, PSI score (OR 1.015 95% CI 1.004-1.026, P = 0.009), serum HCO3- level (OR 0.954 95% CI 0.918-0.993, P = 0.020), duration of ICU stay (OR 0.971 95% CI 0.950-0.993, P = 0.010), multidrug-resistant (MDR) pathogens including ESBL-producing K. pneumoniae (OR 2.688 95% CI 1.237-5.840, P = 0.013) and MDR A. baumannii (OR 3.081 95% CI 1.504-6.311, P = 0.002) were signifi cantly associated with 30-day mortality. Conclusions: ESBL-producing K. pneumoniae and MDR A. baumannii were more often isolated and associated with mortality in NHCAP in ICU patients, therefore these MDR pathogens as well as PSI score should be considered as prognostic factors in NHCAP.
Lee, Nakwon,Kim, Sang-Ha,Kwon, Woocheol,Lee, Myoung Kyu,Yong, Suk Joong,Shin, Kye Chul,Jung, Ye-Ryung,Choi, Yeun Seoung,Choi, Jiwon,Choi, Ji Sun,Lee, Won Yeon The Korean Academy of Tuberculosis and Respiratory 2014 Tuberculosis and Respiratory Diseases Vol.77 No.6
Background: Transbronchial lung biopsy (TBLB) is a valuable diagnostic tool for peripheral pulmonary lesions. The diagnostic yield of TBLB reportedly ranges from 41%-60%. Many studies demonstrated the various factors that influence the yield of TBLB, including size, location, and distance from the carina or pleura. However, no study has evaluated the effects of the bronchoscope diameter. We evaluated whether the bronchoscope diameter affected the diagnostic yield of TBLB. Methods: We reviewed records from 178 patients who underwent TBLB using bronchoscopes of two different diameters (5.7 mm, thick outer diameter, Olympus BF-200; 4.9 mm, thin, BF-260). The fluoroscopic guidance rates, yield of TBLB and flexible bronchoscopy (FB) were compared between the two groups. Additionally, we compared the results of the procedures with respect to diagnosis, distance from the pleura, and size of the lesion. Results: The results of fluoroscopic guidance, TBLB, and FB yield using thin diameter bronchoscope were significantly better than those obtained with a thick diameter bronchoscope (p=0.021, p=0.036, and p=0.010, respectively). Particularly, when the distance from the pleura was ${\leq}10mm$, success rates for fluoroscopic guidance and FB with thin bronchoscope were higher (p=0.013 and p=0.033, respectively), as compared to with thick bronchoscope. Conclusion: A thinner diameter bronchoscope increased the yield of bronchoscopy, and bronchial washing in conjunction with TBLB was useful in the diagnosis of peripheral pulmonary nodules.
( Myoung Kyu Lee ),( Sang Ha Kim ),( Suk Joong Yong ),( Kye Chul Shin ),( Ye Ryung Jung ),( Jae Ho Seong ),( Yeun Seoung Choi ),( Ji Won Choi ),( Won Yeon Lee ) 대한결핵 및 호흡기학회 2014 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.118 No.-
Background: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are important causes of hospital admission and mortality. We investigated the clinical features of hospitalized patients with severe AECOPD and evaluated prognostic factors associated the readmission or mortality due to re-exacerbation of COPD within 6 months. Methods: The prospective study was enrolled 314 patients who hospitalized with severe AECOPD. And we collected demographic, clinical and laboratory findings at admission. Lung function was evaluated using the COPD assessment test (CAT) questionnaire, the modified Medical Research Council (mMRC) dyspnea scale, and spirometry in the stable state. Results: The mean age was 72.2 ± 9.4 years (76.4% of male), and the rate of readmission within 6 months was 45.2% and mortality rate was 16.6%. When multivariate analysis was performed by using the significant variables, age (P < 0.001), CAT score (P < 0.001), old pulmonary tuberculosis (P = 0.003), initial PaO2 (P = 0.026), hemoglobin (P = 0.009), albumin (P = 0.005) and CRP at discharge (P < 0.001) were significantly associated with mortality. And also CAT score (P < 0.001), diabetes mellitus (P = 0.030) and CRP at discharge (P = 0.004) were significantly associated with readmission. In receiver operating characteristic curves, CRP at discharge than CAT score showed a good accuracy to predict the mortality. But CAT score showed good accuracy to predict readmission due to severe AECOPD. Conclusions: CRP at discharge as well as CAT score was significantly associated with both mortality and readmission due to AECOPD.
( Myoung Kyu Lee ),( Sang Ha Kim ),( Suk Joong Yong ),( Kye Chul Shin ),( Ye Ryung Jung ),( Jae Ho Seong ),( Yeun Seoung Choi ),( Jiwon Choi ),( Won Yeon Lee ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are important causes of hospital admission and mortality. We investigated the clinical features of hospitalized patients with severe AECOPD and evaluated prognostic factors associated the readmission or mortality due to re-exacerbation of COPD within 6 months. Methods: The prospective study was enrolled 314 patients who hospitalized with severe AECOPD. And we collected demographic, clinical and laboratory findings at admission. Lung function was evaluated using the COPD assessment test (CAT) questionnaire, the modified Medical Research Council (mMRC) dyspnea scale, and spirometry in the stable state. Results: The mean age was 72.2 ± 9.4 years (76.4% of male), and the rate of readmission within 6 months was 45.2% and mortality rate was 16.6%. When multivariate analysis was performed by using the significant variables, age (P < 0.001), CAT score (P < 0.001), old pulmonary tuberculosis (P = 0.003), initial PaO2 (P = 0.026), hemoglobin (P = 0.009), albumin (P = 0.005) and CRP at discharge (P < 0.001) were significantly associated with mortality. And also CAT score (P < 0.001), diabetes mellitus (P = 0.030) and CRP at discharge (P = 0.004) were significantly associated with readmission. In receiver operating characteristic curves, CRP at discharge than CAT score showed a good accuracy to predict the mortality. But CAT score showed good accuracy to predict readmission due to severe AECOPD. Conclusions: CRP at discharge as well as CAT score was significantly associated with both mortality and readmission due to AECOPD.
( Na Kwon Lee ),( Sang Ha Kim ),( Woo Cheol Kwon ),( Myoung Kyu Lee ),( Suk Joong Yong ),( Kye Chul Shin ),( Ye Ryung Jung ),( Yeun Seoung Choi ),( Ji Won Choi ),( Ji Sun Choi ),( Won Yeon Lee ) 대한결핵 및 호흡기학회 2014 Tuberculosis and Respiratory Diseases Vol.77 No.6
Background: Transbronchial lung biopsy (TBLB) is a valuable diagnostic tool for peripheral pulmonary lesions. Thediagnostic yield of TBLB reportedly ranges from 41%-60%. Many studies demonstrated the various factors that influencethe yield of TBLB, including size, location, and distance from the carina or pleura. However, no study has evaluated theeffects of the bronchoscope diameter. We evaluated whether the bronchoscope diameter affected the diagnostic yield ofTBLB. Methods: We reviewed records from 178 patients who underwent TBLB using bronchoscopes of two different diameters(5.7 mm, thick outer diameter, Olympus BF-200; 4.9 mm, thin, BF-260). The fluoroscopic guidance rates, yield of TBLBand flexible bronchoscopy (FB) were compared between the two groups. Additionally, we compared the results of theprocedures with respect to diagnosis, distance from the pleura, and size of the lesion. Results: The results of fluoroscopic guidance, TBLB, and FB yield using thin diameter bronchoscope were significantlybetter than those obtained with a thick diameter bronchoscope (p=0.021, p=0.036, and p=0.010, respectively). Particularly,when the distance from the pleura was ≤ 10 mm, success rates for fluoroscopic guidance and FB with thin bronchoscopewere higher (p=0.013 and p=0.033, respectively), as compared to with thick bronchoscope. Conclusion: A thinner diameter bronchoscope increased the yield of bronchoscopy, and bronchial washing inconjunction with TBLB was useful in the diagnosis of peripheral pulmonary nodules.