A Case of Nonthrombotic Pulmonary Embolism after Facial Injection of Hyaluronic Acid in an Illegal Cosmetic Procedure

장종걸,최은영,홍경수 대한결핵및호흡기학회 2014 Tuberculosis and Respiratory Diseases Vol.77 No.2

Hyaluronic acid is widely used in medical procedures, particularly in cosmetic procedures administered by physicians or nonmedical personnel. The materials used for cosmetic procedures by physicians as well as illegally by non-medical personnel can cause nonthrombotic pulmonary embolism (NTPE). We report the case of a woman with acute respiratory failure, neurologic symptoms and petechiae after an illegal procedure of hyaluronic acid dermal filler performed by an unlicensed medical practitioner 3 days before symptom onset. Although a few cases of NTPE after injection of hyaluronic acid have been reported yet, this is the first typical case showing a NTPE manifestation after the facial injection of hyaluronic acid.

Prognostic Factors for Severe Coronavirus Disease 2019 in Daegu, Korea

장종걸,허지안,최은영,홍경수,이원화,안준홍 대한의학회 2020 Journal of Korean medical science Vol.35 No.23

Background: Since its first detection in December 2019, coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 infection has spread rapidly around the world. Although there have been several studies investigating prognostic factors for severe COVID-19, there have been no such studies in Korea. Methods: We performed a retrospective observational study of 110 patients with confirmed COVID-19 hospitalized at a tertiary hospital in Daegu, Korea. Demographic, clinical, laboratory, and outcome data were collected and analyzed. Severe disease was defined as a composite outcome of acute respiratory distress syndrome, intensive care unit care, or death. Results: Diabetes mellitus (odds ratio [OR], 19.15; 95% confidence interval [CI], 1.90– 193.42; P = 0.012), body temperature ≥ 37.8°C (OR, 10.91; 95% CI, 1.35–88.36; P = 0.025), peripheral oxygen saturation < 92% (OR, 33.31; 95% CI, 2.45–452.22; P = 0.008), and creatine kinase-MB (CK-MB) > 6.3 (OR, 56.84; 95% CI, 2.64–1,223.78, P = 0.010) at admission were associated with higher risk of severe COVID-19. The likelihood of development of severe COVID-19 increased with an increasing number of prognostic factors. Conclusion: In conclusion, we found that diabetes mellitus, body temperature ≥ 37.8°C, peripheral oxygen saturation < 92%, and CK-MB > 6.3 are independent predictors of severe disease in hospitalized COVID-19 patients. Appropriate assessment of prognostic factors and close monitoring to provide the necessary interventions at the appropriate time in high-risk patients may reduce the case fatality rate of COVID-19.

Diagnosis and treatment of multidrug-resistant tuberculosis

장종걸,정진홍 영남대학교 의과대학 2020 Yeungnam University Journal of Medicine Vol.37 No.4

Tuberculosis (TB) is still a major health problem worldwide. Especially, multidrug-resistant TB (MDR-TB), which is defined as TB that shows resistance to both isoniazid and rifampicin, is a barrier in the treatment of TB. Globally, approximately 3.4% of new TB patients and 20% of the patients with a history of previous treatment for TB were diagnosed with MDR-TB. The treatment of MDR-TB requires medications for a long duration (up to 20–24 months) with less effective and toxic second-line drugs and has unfavorable outcomes. However, treatment outcomes are expected to improve due to the introduction of a new agent (bedaquiline), repurposed drugs (linezolid, clofazimine, and cycloserine), and technological advancement in rapid drug sensitivity testing. The World Health Organization (WHO) released a rapid communication in 2018, followed by consolidated guidelines for the treatment of MDR-TB in 2019 based on clinical trials and an individual patient data meta-analysis. In these guidelines, the WHO suggested reclassification of second-line anti-TB drugs and recommended oral treatment regimens that included the new and repurposed agents. The aims of this article are to review the treatment strategies of MDR-TB based on the 2019 WHO guidelines regarding the management of MDR-TB and the diagnostic techniques for detecting resistance, including phenotypic and molecular drug sensitivity tests.

Effects of programmed education for chronic obstructive pulmonary disease on tertiary teaching hospital

장종걸,정진홍,신경철,최은영,진현정,안준홍,김지선,이미숙,방소희,박다영,남미정,김계순,이관호 대한결핵 및 호흡기학회 2018 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.126 No.-

Background: Despite its increasing prevalence of chronic obstructive pulmonary disease (COPD), the knowledge and awareness of the disease is still low in general population. This prospective study was aimed to demonstrate the effectiveness of organized educational intervention of COPD in tertiary teaching hospital. Method: The subjects included COPD patients on inhaler treatment. In this study, the patients make three visits to the hospital overall (baseline, 1, 3 month) On their first and second visit, systematic education about COPD including inhaler technique was performed. The COPD assessment score, modified Bristol COPD Knowledge Questionnaire (mBCKQ), Hospital Anxiety and Depression Scale and Rosenberg self-esteem scale was estimated on first and third hospital visit. Result: 55 subjects were enrolled. The mBCKQ after the education was significantly increased. (62.5±16% vs 89.3±7.1% p <0.001) The inhaler technique was also significantly improved after the education. (5.4±1.5 vs 5.8±0.4 p=0.038) In subgroup analysis, we made comparison between the group whose mBCKQ were increased more than 20% and those who were not. In group whose mBCKQ were increased more than 20%, their CAT score was significantly improved (2.6±6.7 vs -3.7±6.5, p=0.001) and the duration of their COPD treatment before enrollment was significantly shorter (1.6±2.4 vs 4.4±4.7 years, p=0.021) compared to those whose mBCKQ were increased less than 20%. Conclusion: In COPD patients, sequential systematic education of the disease right after the diagnosis may be helpful in symptom cotrol.

A Case of Solitary Fibrous Pleura Tumor Associated with Severe Hypoglycemia: Doege-Potter Syndrome

장종걸,정진홍,홍경수,안준홍,이재영,조재호,이동원,신경철,이관호,김미진,이정철,이장훈,이재교 대한결핵및호흡기학회 2015 Tuberculosis and Respiratory Diseases Vol.78 No.2

Solitary fibrous tumor of the pleura (SFTP) is a rare primary intrathoracic tumor that arises from mesenchymal tissue underlying the mesothelial layer of the pleura. It usually has an indolent clinical course. The hypoglycemia that accompanies SFTP was first described by Doege and Potter independently in 1930, hence the eponym Doege-Potter syndrome (DPS). The incidence of DPS is reported to be ~4%. In this report, we present a typical case of DPS that was cured through complete surgical resection.

S-289 : 코일색전술을 이용하여 재발없이 치료된 다발성 폐동정맥기형 1예

이동원,장종걸,홍경수,이관호,정진홍,신경철 대한내과학회 2013 대한내과학회 추계학술대회 Vol.2013 No.1

서론: 폐동정맥기형(pulmonary arteriovenous malformation, PAVM)은 모세혈관의 연결없이 폐동맥과 폐정맥이 비정상적으로 직접 연결되어 있는 드문 질환으로 최근에는 중재적 시술의 발달로 여러 색전 물질을 이용한 경피적색전술(transcatheterembolotherapy)이 우선적으로 고려되고 있는 질환이다. 객혈을 주소로 내원한 다발성 폐동정맥 기형환자에서 코일(coil)을 이용하여 재발없이 성공적으로 경피적색전술을 시행한 1예를 보고한다. 증례: 특이병력이 없던 18세 여자 환자가 내원 3개월 전부터 시작된 기침과 객담, 간헐적인 객혈이 있었으나 그냥 지내다3일 전부터 객혈과 왼쪽 흉벽통증이 있어 내원하였다. 이학적 검사 및 혈액 검사상 특이사항 없었다. 흉부X-선 검사상 좌하엽에 결절성 음영을 보여 시행한 흉부 전산화 단층 촬영상 좌, 우하엽에 다발성 폐동정맥 기형이 관찰되었다. 입원 2일째 기관지 내시경 및 심초음파를 시행하였으나 특이소견 관찰 되지 않았다. 입원 3일째 코일을 이용하여 병변부위에 경피적색전술을 시행하였다. 시행 후 좌측 흉벽통증과 객혈은 점차 호전되었으며 입원 6일째 퇴원하였다. 퇴원 한달 후 확인한 흉부 전산화 단층 촬영상 코일색전술을 시행한 부위 주변으로 폐경색이 관찰되었으며 18개월이 지난 현재까지 증상의 재발없이 외래 경과관찰중이다. 고찰: 다발성 폐동정맥 기형의 치료에 있어서 수술적 접근은 어려움이 있을 수 있다. 수술적 접근이 힘든 경우 경피적색전술이 완치를 목적으로 하는 치료의 다른 방법이 될 수 있다. 색전물질로 코일을 이용할 경우 불완전 폐색 및 장치 색전증등의 합병증이 있을 수 있으나 본 증례와 같이 적절한 시술 후에는 장기간 효과적이므로 완치를 목적으로 하는 치료로써 수술을 대체할 수 있으며 적극적인 시행이 고려되어야 한다.

An overlap syndrome of Churg-Strauss syndrome and rheumatoid arthritis

배승일,장종걸,김훈태,안희윤,김민정,김현제,이충기,홍영훈 영남대학교 의과대학 2015 Yeungnam University Journal of Medicine Vol.32 No.2

Churg-Strauss syndrome (CSS) is a necrotizing vasculitis with extra-, peri-vascular eosinophilic infiltration. Chronic symmetric polyarthritis with the presence of rheumatoid factor (RF) and anti-cyclic citrullinated peptide antibody are the mainstay of rheumatoid arthritis (RA) diagnosis. Mononeuritis multiplex is a peripheral neuropathy involving more than 2 separate nerve areas. A 62-year-old male patient was referred for left foot drop and polyarthritis of both hands and feet for 4 months. During evaluation, mononeuritis multiplex was detected on nerve conduction study and electromyography tests: vasculitis with neutrophil, eosinophil, and lymphocyte infiltration on peroneal nerve biopsy. A positive response to methacholin and bronchodilator was observed on the pulmonary function test. Radiologic tests showed peri-articular soft tissue swelling and osteopenia on both hand and foot. Marked peripheral eosinophilia, high RF, and positive perinuclear anti-neutrophil cytoplasmic antibody were detected on blood tests. Here, we report on a patient with overlap syndrome of CSS and RA with review of the relevant literature, from which a few references to overlap syndrome of CSS and RA were available.

Risk factors of peripheral neuropathy in drug-resistant tuberculosis patients on linezolid regimens

서민지,권용식,장종걸,최금주,이재희,박지은 대한내과학회 2022 대한내과학회 추계학술대회 Vol.2022 No.2

Two cases of radial EBUS with GS without fluoroscopy for diagnosis of ground glass opacity

정영상,안준홍,장종걸,홍경수 대한내과학회 2020 대한내과학회 추계학술대회 Vol.2020 No.1

S-292 : 진행된 폐선암환자의 1차 치료로 paclitaxel/cisplatin 병합요법과 pemetrexed/cisplatin 병합요법의 비교

이동원,우대형,장종걸,홍경수,정진홍,이관호,신경철 대한내과학회 2013 대한내과학회 추계학술대회 Vol.2013 No.1

목적: 진행된 비소세포 폐암의 1차 치료로는 최근까지 백금유도체인 cisplatin이나 carboplatin을 기본으로 vinorelbine, gemcitabine 또는 paclitaxel이나 docetaxel같은 taxanes을 병합하는 요법이 기준치료로 되어 왔으며, Scargliotti 등의 연구 이후 pemetrexed/cisplatin 병합요법이 진행된 폐선암의 1차 치료제로 사용되고 있다. 진행된(IIIb-IV) 병기의 폐선암으로 진단된 환자들 중 1차 항암치료로 paclitaxel/cisplatin 병합요법을 사용한 환자들과 pemetrexed/cisplatin 병합요법을 사용한 환자들의 치료효과와 부작용빈도에 대한 차이를 알아보고자 하였다. 방법: 2008년 1월부터 2011년 9월까지 진행된(IIIb-IV) 병기의 폐선암으로 진단된 환자 중 1차 항암치료로 paclitaxel/cisplatin 병합요법을 사용한 47명의 환자와 pemetrexed/cisplatin 병합요법을 사용한 43명의 환자들을 대상으로 후향적 분석을 시행하였다. 결과: pemetrexed/cisplatin 병합요법으로 치료받은 환자군의 경우가 paclitaxel/cisplatin 병합요법으로 치료받은 환자군보다 무진행생존기간의 평균이 35.1일(231.9일 Vs. 196.8일) 긴 것으로 나타났으나 통계적 유의성은 없었다. 각 연령대와 성별 모두에서 pemetrexed/cisplatin 병합요법의 무진행 생존기간의 평균이 긴 것으로 나타났다. 선택된 치료방법에 따른 부작용 발생여부를 비교하였으며 그 중 말초신경병증의 경우 pemetrexed/cisplatin 병합요법으로 치료받은 환자군에서 paclitaxel/cisplatin 병합요법으로 치료받은 환자군보다 통계적으로 유의하게 발생빈도가 낮았으나(4.7% vs 44.7%) 백혈구 감소증과 빈혈은 유의한 차이가 없었다. 결론: 진행된 폐선암환자에서 1차 항암치료로 pemetrexed/cisplatin 병합요법이 paclitaxel/cisplatin 병합요법에 비해 통계적으로 유의하지 않았지만 각 연령대와 성별 모두에서 치료효과는 좋은 경향을 확인할 수 있었으며 말초신경증의 발생빈도가 유의하게 낮았다.