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ERRATUM : Outcome of Inhaler Withdrawal in Patients Receiving Triple Therapy for COPD
Kim, Sae Ahm,Lee, Ji-Hyun,Kim, Eun-Kyung,Kim, Tae-Hyung,Kim, Woo Jin,Lee, Jin Hwa,Yoon, Ho Il,Baek, Seunghee,Lee, Jae Seung,Oh, Yeon-Mok,Lee, Sang-Do The Korean Academy of Tuberculosis and Respiratory 2016 Tuberculosis and Respiratory Diseases Vol.79 No.3
Outcome of Inhaler Withdrawal in Patients Receiving Triple Therapy for COPD
Kim, Sae Ahm,Lee, Ji-Hyun,Kim, Eun-Kyung,Kim, Tae-Hyung,Kim, Woo Jin,Lee, Jin Hwa,Yoon, Ho Il,Baek, Seunghee,Lee, Jae Seung,Oh, Yeon-Mok,Lee, Sang-Do The Korean Academy of Tuberculosis and Respiratory 2016 Tuberculosis and Respiratory Diseases Vol.79 No.1
Background: The purpose of this study was to document outcomes following withdrawal of a single inhaler (step-down) in chronic obstructive pulmonary disease (COPD) patients on triple therapy (long-acting muscarinic antagonist and a combination of long-acting ${\beta}2$-agonists and inhaled corticosteroid), which a common treatment strategy in clinical practice. Methods: Through a retrospective observational study, COPD patients receiving triple therapy over 2 years (triple group; n=109) were compared with those who had undergone triple therapy for at least 1 year and subsequently, over 9 months, initiated inhaler withdrawal (step-down group, n=39). The index time was defined as the time of withdrawal in the step-down group and as 1 year after the start of triple therapy in the triple group. Results: Lung function at the index time was superior and the previous exacerbation frequency was lower in the step-down group than in the triple group. Step-down resulted in aggravating disease symptoms, a reduced overall quality of life, decreasing exercise performance, and accelerated forced expiratory volume in 1 second ($FEV_1$) decline ($54.7{\pm}15.7mL/yr$ vs. $10.7{\pm}7.1mL/yr$, p=0.007), but there was no observed increase in the frequency of exacerbations. Conclusion: Withdrawal of a single inhaler during triple therapy in COPD patients should be conducted with caution as it may impair the exercise capacity and quality of life while accelerating $FEV_1$ decline.
Endobronchial ALK-Positive Anaplastic Large Cell Lymphoma Presenting Massive Hemoptysis
Kim, Hee Kyung,Kim, Bo Hye,Kim, Sae Ahm,Shin, Jae Kyoung,Song, Ji-Hyun,Kwon, Ah-Young,Kim, Jung-Hyun,Kim, Eun-Kyung,Lee, Ji-Hyun,Kim, Gwaung-Il,Jeong, Hye Cheol The Korean Academy of Tuberculosis and Respiratory 2015 Tuberculosis and Respiratory Diseases Vol.78 No.4
Primary anaplastic large cell lymphoma (ALCL) of the lung is highly aggressive and quite rare. We report here a case of anaplastic lymphoma kinase-positive endobronchial ALCL, that was initially thought to be primary lung cancer. A 68-year-old woman presented with hemoptysis, dyspnea, and upper respiratory symptoms persisting since 1 month. The hemoptysis and and bronchial obstruction lead to respiratory failure, prompting emergency radiotherapy and steroid treatment based on the probable diagnosis of lung cancer, although a biopsy did not confirm malignancy. Following treatment, her symptoms resolved completely. Chest computed tomography scan performed 8 months later showed increased and enlarged intra-abdominal lymph nodes, suggesting lymphoma. At that time, a lymph node biopsy was recommended, but the patient refused and was lost to follow up. Sixteen months later, the patient revisited the emergency department, complaining of persistent abdominal pain since several months. A laparoscopic intra-abdominal lymph node biopsy confirmed a diagnosis of ALCL.
Outcome of Inhaler Withdrawal in Patients Receiving Triple Therapy for COPD
( Sae Ahm Kim ),( Ji Hyun Lee ),( Eun Kyung Kim ),( Tae Hyung Kim ),( Woo Jin Kim ),( Jin Hwa Lee ),( Ho Il Yoon ),( Seunghee Baek ),( Jae Seung Lee ),( Yeon Mok Oh ),( Sang Do Lee ) 대한결핵 및 호흡기학회 2016 Tuberculosis and Respiratory Diseases Vol.79 No.1
Background: The purpose of this study was to document outcomes following withdrawal of a single inhaler (step-down) in chronic obstructive pulmonary disease (COPD) patients on triple therapy (long-acting muscarinic antagonist and a combination of long-acting β2-agonists and inhaled corticosteroid), which a common treatment strategy in clinical practice. Methods: Through a retrospective observational study, COPD patients receiving triple therapy over 2 years (triple group; n=109) were compared with those who had undergone triple therapy for at least 1 year and subsequently, over 9 months, initiated inhaler withdrawal (step-down group, n=39). The index time was defined as the time of withdrawal in the stepdown group and as 1 year after the start of triple therapy in the triple group. Results: Lung function at the index time was superior and the previous exacerbation frequency was lower in the stepdown group than in the triple group. Step-down resulted in aggravating disease symptoms, a reduced overall quality of life, decreasing exercise performance, and accelerated forced expiratory volume in 1 second (FEV1) decline (54.7±15.7 mL/yr vs. 10.7±7.1 mL/yr, p=0.007), but there was no observed increase in the frequency of exacerbations. Conclusion: Withdrawal of a single inhaler during triple therapy in COPD patients should be conducted with caution as it may impair the exercise capacity and quality of life while accelerating FEV1 decline.
Outcome of Inhaler Withdrawal in Patients Receiving Triple Therapy for COPD
( Sae Ahm Kim ),( Ji Hyun Lee ),( Eun Kyung Kim ),( Tae Hyung Kim ),( Woo Jin Kim ),( Jin Hwa Lee ),( Ho Il Yoon ),( Seunghee Baek ),( Jae Seung Lee ),( Yeon Mok Oh ),( Sang Do Lee ) 대한결핵 및 호흡기학회 2016 Tuberculosis and Respiratory Diseases Vol.79 No.3
( Hee Kyung Kim ),( Bo Hye Kim ),( Sae Ahm Kim ),( Jae Kyoung Shin ),( Ji Hyun Song ),( Ah Young Kwon ),( Jung Hyun Kim ),( Eun Kyung Kim ),( Ji Hyun Lee ),( Gwaung Il Kim ),( Hye Cheol Jeong ) 대한결핵 및 호흡기학회 2015 Tuberculosis and Respiratory Diseases Vol.78 No.4
Primary anaplastic large cell lymphoma (ALCL) of the lung is highly aggressive and quite rare. We report here a case of anaplastic lymphoma kinase-positive endobronchial ALCL, that was initially thought to be primary lung cancer. A 68-year-old woman presented with hemoptysis, dyspnea, and upper respiratory symptoms persisting since 1 month. The hemoptysis and and bronchial obstruction lead to respiratory failure, prompting emergency radiotherapy and steroid treatment based on the probable diagnosis of lung cancer, although a biopsy did not confirm malignancy. Following treatment, her symptoms resolved completely. Chest computed tomography scan performed 8 months later showed increased and enlarged intra-abdominal lymph nodes, suggesting lymphoma. At that time, a lymph node biopsy was recommended, but the patient refused and was lost to follow up. Sixteen months later, the patient revisited the emergency department, complaining of persistent abdominal pain since several months. A laparoscopic intra-abdominal lymph node biopsy confirmed a diagnosis of ALCL.
( Sae Ahm Kim ),( Hak Su Kim ),( Hui Kyong Kim ),( Hye Jeong Cho ),( So Dam Hong ),( Jae Kyoung Shin ),( Hee Jin Hong ),( Kwang Hyun Ko ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
We report unusual case of arising two cancers, pancreatic head cancer and cholangiocarcinoma in intrahepatic duct (IHD), in 43-year-old woman who have undergone excision of choledochal cyst and Roux-en-Y hepaticojejunostomy. Patient fi rst visited hospital in 2002, diagnosed by CT as choledochal cyst (Todani-type IVa) and multiple stones in common bile duct, IHD, and gall bladder. After surgery, IHD stones were repeatedly detected on CT and treated by percutaneous transhepatic cholangioscopy (PTCS) in 2003, 2004, 2007, and there were no fi ndings suggesting malignancies. In 2008, abdomen CT and positron emission tomography (PET) scan for evaluation of elevated total bilirubin (4. 89 mg/dL) showed 25 mm sized mass in pancreas head suggesting malignancy. Pathologic report about tissue from pylorus-preserving pancreaticoduodenectomy, July 3, 2008, was moderately differentiated adenocarcinoma with extension of tumor to distal common bile duct and duodenal serosa. With diagnosis of stage III (T4 N1 M0) pancreatic head cancer, concurrent chemoradiotherapy from October 31, 2008 to October 23, 2009 was done, and her disease was cured. 2011, during removal of right IHD stone (detected on CT) by PTCS, papillary-growing mucosal lesion was showed in IHD near hepaticojejunostomy site. Biopsy resulted adenocarcinoma, it diagnosed as cholangiocarcinoma limited in mucosa. 2 times of photodynamic therapy, more than 10 times of argon plasma coagulation and following 3 times of brachytherapy via PTBD were failed eradication cholangiocarcinoma. 2013, abdomen CT and PET scan showed progression of cholangiocarcinoma with 6 cm infi ltrative lesion in central portion of IHD. Systemic chemotherapy with gemcitabine and cisplatin was started with recent application of radiofrequency ablasion (RFA) therapy. In conclusion, close and long term follow-up for pancreatic cancer and bile duct cancer in patients who have undergone excisional surgery for choledochal cyst should be mandatory.
Kim, Donghee,Kim, Won,Joo, Sae Kyung,Bae, Jeong Mo,Kim, Jung Ho,Ahmed, Aijaz Elsevier 2018 Clinical gastroenterology and hepatology Vol.16 No.1
<P><B>Background & Aims</B></P> <P>Variations in level of thyroid-stimulating hormone (TSH) within the reference range of thyroid hormone could have negative health effects. We evaluated the effect of plasma TSH levels within the euthyroid range on the severity of histological damage associated with nonalcoholic fatty liver disease (NAFLD).</P> <P><B>Methods</B></P> <P>We performed a cross-sectional study of 425 subjects with biopsy-proven NAFLD (mean age, 53 years; 52% male) who participated in the Boramae NAFLD study from January 2013 to January 2017. Each subject underwent an anthropometric assessment and laboratory and clinical evaluations. Of the subjects, 282 were assigned to a strict-normal thyroid function group (plasma level of TSH, 0.4 to 2.5 mIU/L). Patients with low thyroid function were assigned to groups of subclinical hypothyroidism (plasma level of TSH above 4.5 mIU/L with a normal thyroid hormone level; n = 59) or low-normal thyroid function (higher plasma TSH level [2.5 to 4.5 mIU/L] with a normal thyroid hormone level; n = 84). Multivariate logistic regression analysis was used to identify factors independently associated with nonalcoholic steatohepatitis (NASH) and advanced fibrosis.</P> <P><B>Results</B></P> <P>NASH and advanced fibrosis were found in higher percentages of subjects with low thyroid function vs strict-normal thyroid function (52.4% vs 37.2% for NASH and 21.0% vs 10.6% for advanced fibrosis; <I>P</I> < .01). Among subjects with low thyroid function, a higher proportion of patients with subclinical hypothyroidism had NASH and associated advanced fibrosis vs patients with low-normal thyroid function (57.6% vs 48.8% for NASH and 25.4% vs 17.9% for advanced fibrosis; <I>P</I> < .01). Subjects with low thyroid function had more extensive hepatic steatosis with greater severity of balloon degeneration and fibrosis. In multivariate analyses, low thyroid function was significantly associated with NASH (odds ratio, 1.61; 95% CI, 1.04–2.50; <I>P</I> = .035) and advanced fibrosis (odds ratio, 2.23; 95% CI, 1.18–4.23; <I>P</I> = .014). Risks of NASH and advanced fibrosis increased significantly with plasma concentration of TSH (<I>P</I>trend <.05 for each).</P> <P><B>Conclusions</B></P> <P>Subclinical hypothyroidism and low-normal thyroid function are independent predictors of NASH and advanced fibrosis, confirming the relationship between these diseases. ClinicalTrials.gov, Number: NCT02206841.</P>
Uncommon Manifestation of an Everolimus-induced Lung Complication, Pleural Effusion
( Sae Ahm Kim ),( Hye Cheol Jeong ) 대한내과학회 2015 대한내과학회 추계학술대회 Vol.2015 No.1
Everolimus is an inhibitor of the mammalian target of rapamycin (mTOR), which is used for the clear cell type of advanced renal cell carcinoma (RCC). There are several cases reported for adverse events of everolimus, especially pneumonitis. However, empyema like feature or necrotizing pneumonia with pleural effusion has not been reported yet. A 60-year-old male diagnosed with advanced RCC and treated by everolimus for 8 months visited us due to cough, dyspnea, and a chilling sensation. At first, on Chest CT and Chest x-ray, his lesion was thought to be a necrotizing pneumonia with empyema, so anti-biotic treatment was started and percutaneous drainage was performed. In fluid analysis, it was categorized as exudates and LDH, ADA was high. 3 days later, there were not any symptoms which was related with infection, so methylprednisoln was admited as 1 mg/kg once daily. After steroid treatment, the patient’s lesion was rapidly improved and he discharged at 14th day of admission. Thouhg ADA was high, the result of Tb culture and PCR was negative. Considering with clinical manifestations (no fever and pain), fluid analysis results (no abnormal findings of cytology and culture) and improvement after taking steroid and stopping everolimus, therefore, we finally diagnosed that his empyema like lesion was induced by everolimus.
( Bo Hye Kim ),( Hee Kyung Kim ),( Hye Jeong Cho ),( So Dam Hong ),( Jae Kyoung Shin ),( Hee Jin Hong ),( Sae Ahm Kim ),( Hak Su Kim ),( Suk Pyo Shin ),( Ha Na Park ),( Seong Gyu Hwang ),( Kyu Sung Ri 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: Pyogenic liver abscess is the most common type of visceral abscess with a mortality rate of 10% to 25%. The mortality of liver abscess markedly decreased due to the improvement of diagnostic methods, antibiotics and other treatment modalities. We describe the clinical feature, changing trends of etiology and poor prognostic factors of pyogenic liver abscess during the recent 2 decades. Methods: We retrospectively reviewed the medical records of patients with pyogenic liver abscess who were treated in CHA Bundang Medical Center between 1996 and 2014. The period was divided into period 1 (1996-2004) and period 2 (2005-2014). We compare these two groups in age, etiology, etc. Results: 148 patients were indentifi ed. 60 patients were included period 1 and 86 patients were included period 2. There were no signifi cant interval changes in symptom, sign, number and size of abscess and laboratory fi nding between the two periods. The average age increased in period 2 (aged 62. 7) relative to period 1 (aged 57. 2) (P=0. 001). Klebsiella pneumoniae was the most common pathogen both two periods. The most common infection route was biliary tract (45. 5%) in period 1 and cyptogenic cause (53. 8%) in period 2 (P=0. 042). Interestingly, the percentage of hepatobiliary malignacy in etiology increased from 4. 5% in Period 1 to 10. 2% in period 2. (P= 0. 03) Liver abscess originated from hepatobiliary problem showed a higher recurrent rate (P=0. 018). Conclusions:The average age of patients with pyogenic liver abscess has increased substantially and the predominant pathogen originates from the biliary tract because biliary procedures has increased. Hepatobiliary malignancy is the major risk factor and poor prognostic factor for pyogenic liver abscess. Therefore early diagnosis and close observation is important for patients with biliary problem or hepatobiliary malignancy.