TP-28 : 기관내 튜브 발관 후 후두 부종의 예방을 위한 Corticosteroids 투여의 유용성에 대한 연구

구소미,어수택,김기업,김양기 대한결핵 및 호흡기학회 2013 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.116 No.-

서론: 기관내 튜브 발관 후 발생하는 후두 부종은 22%까지 보고되는 흔한 부작용으로 기계환기 기간과 사망률을 증가시킨다. 기관내 튜브 발관 12-24시간 전 corticosteroids 투여로 성인에서의 후두 부종 발생을 줄일 수 있음이 보고되었으나 국내에는 임상적 결과에 대한 보고가 없었다. 대상 및 방법: 2012년 9월 1일부터 2013년 8월 31일 까지 12개월 동안 순천향대학교 서울 병원에서 기관내삽관 후 기계환기를 하였던 환자를 대상으로 하여 후향적 챠트 분석을 하였다. 36시간 이상 기계호흡을 유지 후 계획적으로 기관내 튜브 발관을 시행하였던 성인을 대상으로 하였다.일차 결과는 기관내 튜브 발관 후 24시간 동안의 후두 부종의 발생으로 하였다. 후두 부종은 호흡곤란을 동반한 고음조의 흡기시 천명(stridor)의 발생과, 이로 인한 재기관내삽관이 필요한 호흡부전을 포함하여 정의하였다. 결과: 연구기간 동안 성인 환자에서 482건의 기관내삽관이 있었으며, 36시간 이상 기계환기 유지 후 계획적인 기관내 튜브 발관은 91건이 있었다. 기관내 튜브 발관 전 24시간 이내에 후두 부종 예방 목적의 corticosteroids 투여는 29건(32%)에서 이루어졌고, 62건에서는 corticosteroids 투여 없이 기관내 튜브를 제거하였다. 기관내 튜브 발관 후 24시간 동안의 후두 부종의 발생은 총 5건으로 corticosteroids 투여 여부에 따른 집단 간 차이는 없었다(2 of 29, 6.9% vs 3 of 62, 4.8%, p=0.6521). 후두 부종으로 인한 호흡부전으로 재기관내삽관을 시행한 건수는 총 4건으로 corticosteroids 투여 여부에 따른 집단 간 차이는 없었다(1 of 29, 3.4% vs 3 of 62, 4.8%, p=1.000). 총 재기관내삽관 시행도 corticosteroids 투여 여부에 따른 집단 간 차이가 없었다(7 of 29, 24% vs 15 of 62, 24%, p=1.000). 결론: 기관내 튜브 발관 전 예방 목적의 corticosteroids 투여가 낮은 비율로 시행되고 있으나, 기관내 튜브 발관 후 24시간 동안의 후두 부종의 발생은 corticosteroids 투여 여부에 따른 집단 간의 차이가 없었다.

P-82 Afatinib, erlotinib, gefitinib in patients with non-small cell lung cancer and EGFR mutation positive and brain metastasis: network meta-analysis

구소미,김기업,김양기,어수택 대한결핵 및 호흡기학회 2016 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.121 No.-

Background: Tyrosine kinase inhibitors (TKIs) targeting the epidermal growth factor receptor (EGFR) have been the standard first-line therapy in patients with metastatic non-small cell lung cancer (NSCLC). Considerable number of patients have asymptomatic brain metastasis at initial diagnosis of NSCLC. The presence of brain metastasis is the important factor influenced survival. There is no head to head trials between TKIs in the population. We aimed to assess the relative efficacy between afatinib, erlotinib, and gefitinib using network meta-analysis. Method: A systematic literature review with electronic databases was conducted. Outcomes were variables on objective response rate (ORR), progression free survival (PFS), overall survival (OS). Results were analyzed using Bayesian method. Results: The literature search identified 3,487 articles. We found 664 full text articles. Eligible randomized controlled trials were included in the network meta-analysis. Conclusions: The current study indicated that EGFR-TKIs have therapeutic role for brain metastasis in patients with non-small cell lung cancer and EGFR mutation positive. The choice of regimen is needed to be fully discussed with patients in terms of risks and benefits.

Jejunal Variceal Bleeding Successfully Treated with Percutaneous Coil Embolization

구소미,정승원,장재영,이태희,전성란,김현건,김진오,김용재 대한의학회 2012 Journal of Korean medical science Vol.27 No.3

A 52-yr-old male with alcoholic liver cirrhosis was hospitalized for hematochezia. He had undergone small-bowel resection due to trauma 15 yr previously. Esophagogastroduodenoscopy showed grade 1 esophageal varices without bleeding. No bleeding lesion was seen on colonoscopy, but capsule endoscopy showed suspicious bleeding from angiodysplasia in the small bowel. After 2 weeks of conservative treatment,the hematochezia stopped. However, 1 week later, the patient was re-admitted with hematochezia and a hemoglobin level of 5.5 g/dL. Capsule endoscopy was performed again and showed active bleeding in the mid-jejunum. Abdominal computed tomography revealed a varix in the jejunal branch of the superior mesenteric vein. A direct portogram performed via the transhepatic route showed portosystemic collaterals at the distal jejunum. The patient underwent coil embolization of the superior mesenteric vein just above the portosystemic collaterals and was subsequently discharged without re-bleeding. At 8 months after discharge, his condition has remained stable, without further bleeding episodes.

Positive Conversion of P53 Expression in a Patient with Malignant Mesothelioma during Seven-year Follow Up

구소미,어수택,김기업,김양기,김동원 대한결핵 및 호흡기학회 2012 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.114 No.-

Introduction: Malignant mesothelioma(MM) is an aggressive tumor of serosal surfaces. There is a dilemma for diagnosis of MM because of the many morphologic similarities between neoplastic cells and their benign counterparts. We assumed that there is a change in p53 expression with transformation from reactive hyperplasia to MM. Case Report: In 2004, a 65 year old male presented with left pleuritic chest pain. He had been worked as a supervisor of factory of asbestos-containing products in past 20 years. Chest computed tomography(CT) showed moderate amount of left pleural effusion with some loculation and also, combined mild pleural thickening and subtle enhancing area. Pathologic diagnosis was reactive mesothelial hyperplasia. In 2008, he felt left pleuritic chest pain. Chest CT showed progressive thickening of the left pleura with nodularity. Pathologic diagnosis was atypical mesothelial hyperplasia. In 2011, chest CT showed progressive thickening of the left pleura. Pathologic diagnosis was well differentiated papillary mesothelioma. We analyzed the serial change as immunohistochemistry staining for p53 of pleural tissues obtained by VATS in this patient. The result revealed negative p53 stain with diagnosis of reactive mesothelial hyperplasia in 2004 and 2011. Positive conversion of p53 staining was showed with atypical mesothelial hyperplasia in 2008. Conclusion: P53 expression can changes during transformation from reactive hyperplasia to atypical hyperplasia and malignant mesothelioma. P53 staining may be helpful for early diagnosis of malignant mesothelioma.

Korean Guidelines for Diagnosis and Management of Interstitial Lung Diseases: Part 5. Connective Tissue Disease Associated Interstitial Lung Disease

구소미,김송이,최선미,이현경,on behalf of Korean Interstitial Lung Diseases Study Group 대한결핵및호흡기학회 2019 Tuberculosis and Respiratory Diseases Vol.82 No.4

Connective tissue disease (CTD) is a collection of disorders characterized by various signs and symptoms such as circulation of autoantibodies in the entire system causing damage to internal organs. Interstitial lung disease (ILD) which is associated with CTD is referred to as CTD-ILD. Patients diagnosed with ILD should be thoroughly examined for the co-occurrence of CTD, since the treatment procedures and prognosis of CTD-ILD are vary from those of idiopathic interstitial pneumonia. The representative types of CTD which may accompany ILD include rheumatoid arthritis, systemic sclerosis (SSc), Sjögren’s syndrome, mixed CTD, idiopathic inflammatory myopathies, and systemic lupus erythematous. Of these, ILD most frequently co-exists with SSc. If an ILD is observed in the chest, high resolution computed tomography and specific diagnostic criteria for any type of CTD are met, then a diagnosis of CTD-ILD is made. It is challenging to conduct a properly designed randomized study on CTD-ILD, due to low incidence. Therefore, CTD-ILD treatment approach is yet to been established in absence of randomized controlled clinical trials, with the exception of SSc-ILD. When a patient is presented with acute CTD-ILD or if symptoms occur due to progression of the disease, steroid and immunosuppressive therapy are generally considered.

Feasibility of using venous total carbon dioxide for detection of obesity-related hypoventilation

구소미,어수택,김기업,김양기,김용진 대한결핵 및 호흡기학회 2015 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.120 No.-

Purpose: Raised plasma bicarbonate level regarded as having early obesity-related hypoventilation for in normocapnic obese patients. It is known that the level of venous total carbon dioxide (total CO2) is well correlated with arterial bicarbonate. Detecting increased level of total CO2 may be a safe and early identifier for subclinical status with decreased ventilatory function. Methods: We reviewed records of the obese patients with bariatric surgery. We analyzed venous total CO2 levels both before and 1 year after bariatric surgery. Results: There were 821 obese patients with bariatric surgery. After excluding cases with missing values and duplicates, we analyzed the data of 378 patients [preoperative body mass index (BMI,kg/m2), 38.7; SD, 6.7; postoperative BMI, 27.7; SD, 5.1; age, 34.9 years; SD, 11.6 years]. Preoperative and postoperative mean values of total CO2 were 25.9 and 26.3 mmol/L, respectively (p<0.001). There was no linear relationship between the preoperative level of total CO2 and preoperative BMI. In severe obesity group (BMI>40 kg/m2), there was no significant difference in preoperative total CO2 level compared to that of mild to moderate obesity group [25.9 vs 25.8 mmol/L, respectively (p=0.686)]. There was no difference in preoperative level of total CO2 between two groups according to the clinical history for obstructive sleep apnea [26.3 vs 25.7 mmol/L, respectively (p=0.073)]. There was a positive linear relationship between preoperative and postoperative values of total CO2 (r=0.263, p<0.001). There was no correlation between BMI difference and the postoperative total CO2 level (p=0.666). Conclusion: There was a significant linear correlation between preoperative and postoperative values of venous total carbon dioxide in obese patients with bariatric surgery.

De Novo 점막하 침윤 대장암으로 진단된 3 mm 크기의 무경성 미소 용종

구소미,김진오,김현건,이태희,전성란,진소영,이준성 대한소화기내시경학회 2011 Clinical Endoscopy Vol.42 No.2

The majority of colorectal carcinomas (95∼100%) are thought to arise from adenomas. Yet colorectal carcinomas may rarely arise de novo. The popular definition of de novo carcinoma is that the lesion should consist exclusively of a carcinoma histologically and contain no adenomatous elements. Without an adenoma-carcinoma sequence, de novo carcinomas have a much higher rate of submucosal invasion, despite their small size. Their speed of growth is thought to be rapid. Some studies have shown that de novo carcinomas might arise as a macroscopically flat or depressed lesion, rather than a protruded one. However, the typical macroscopic findings of de novo carcinomas have not been established. They might be variable macroscopically and include a protruded type. We report a case of de novo colorectal carcinoma that invaded the submucosal layer involving a minute sessile polyp only 3 mm in diameter, which was removed by endoscopic mucosal resection. 대장암의 95∼100%는 샘종-샘암종 과정을 거치며, 직접 발생 과정을 거친 de novo 대장암은 비교적 드물다. 일반적으로 de novo 대장암은 암조직 주변에 샘종이 동반되지 않는 경우로 정의되며, 샘종-샘암종의 단계가 생략되면서 샘종에서 기원한 암보다 상대적으로 더 빠르게 성장하며 침윤 정도도 더 깊을 수 있다. De novo 대장암은 평탄형이나 함몰형 육안 소견으로 보고되지만 아직까지 그 육안 소견이 정립되어 있지 않으며 융기형을 포함하여 다양한 형태로 관찰될 수 있다. 저자들은 내시경 점막절제술로 제거한 3 mm 크기의 무경성 미소 대장 용종의 병리 조직 검사에서 점막하층을 침범한 de novo 대장암을 진단하여서 이를 보고한다.

Relationship between Survival and Age in Patients with IPF

구소미,어수택,김동순,박춘식 대한결핵 및 호흡기학회 2012 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.114 No.-

Purpose: There is a controversy that the older patients with idiopathic pulmonary fibrosis (IPF) have worse prognosis. We evaluated whether age and other factors can affect survival in patients with IPF.Methods: This retrospective observational study consisted of 1,685 patients with IPF by clinical (1,027 patients) or surgical (658 patients) diagnosis defined by the 2000 ATS/ERS consensus statement. Patients were enrolled from 54 hospitals in Korea from January 1, 2003 to December 31, 2007. They were stratified by four age groups (younger than 50 years, n=65; 50-60 years, n=252; 60-70 years, n=623; older than 70 years, n=748). We estimate the overall survival time. Results: The median survival time was 57.3 months in 1,685 patients. The median survival time of the group of older than 70 years was significantly shorter than that of other groups: [<50 years, 63.0 months; 50-60 years, 63.0 months; 60-70 years, 65.0 months; >70 years, 38.8 months (p=0.001)]. There was a significant difference in smoking status, presence of exertional dyspnea, forced vital capacity (FVC), forced expired volume in one second, total lung capacity, diffusion capacity of carbon monoxide, and arterial oxygen pressure at initial diagnosis between age groups. Age, presence of lung cancer, and FVC were significantly correlated with survival rate on the multivariate analysis. Conclusions: The overall survival time of the group of older than 70 years was significantly shorter than that of other groups. And age, presence of lung cancer, and FVC were the independent factors that were significantly correlated with survival.

흡연 추출물(Cigarette Smoking Extracts)에 의한 Vitamin D Receptor Translocation의 억제

구소미,박성우,김양기,장안수,김도진,김기업,김용훈,박춘식 대한결핵 및 호흡기학회 2011 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.112 No.-

p53 Expression in a Malignant Mesothelioma Patient during Seven-Year Follow-up

구소미,어수택,김동원,김기업,김양기 대한결핵및호흡기학회 2014 Tuberculosis and Respiratory Diseases Vol.76 No.6

Malignant mesothelioma (MM) is the aggressive tumor of serosal surfaces. There are crude pathogenetic results regarding the biology of MM. Coordinated upregulations of p53 gene expression are shown in malignancies. We believed that there are changes in the p53 expression with transformation from reactive hyperplasia to MM. A 65-year-old male was admitted the hospital because of left pleuritic chest pains in 2004. Chest computed tomography (CT) results showed left pleural effusions with loculation and pleural thickening. Pathologic findings revealed reactive mesothelial hyperplasia. In 2008, the patient again felt left pleuritic chest pains. Chest CT showed progressive thickening of the left pleura. Pathologic diagnosis was atypical mesothelial hyperplasia. In 2011, chest CT showed progressive thickening of his left pleura. He was diagnosed with well-differentiated papillary mesothelioma. Serial change was analyzed by immunohistochemical staining for p53 of pleural tissues. There were no remarkable changes in p53 expressions during the transformation to MM.