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Easy Diagnosis of Asthma: Computer-Assisted, Symptom-Based Diagnosis
Choi, Byoung Whui,Yoo, Kwang-Ha,Jeong, Jae-Won,Yoon, Ho Joo,Kim, Sang-Heon,Park, Yong-Mean,Kim, Wo-Kyung,Oh, Jae-Won,Rha, Yeong-Ho,Pyun, Bok-Yang,Chang, Suk-Il,Moon, Hee-Bom,Kim, You-Young,Cho, Sang-H KOREAN ACADEMY OF MEDICAL SCIENCE 2007 JOURNAL OF KOREAN MEDICAL SCIENCE Vol.22 No.5
<P>Diagnosis of asthma is often challenging in primary-care physicians due to lack of tools measuring airway obstruction and variability. Symptom-based diagnosis of asthma utilizing objective diagnostic parameters and appropriate software would be useful in clinical practice. A total of 302 adult patients with respiratory symptoms responded to a questionnaire regarding asthma symptoms and provoking factors. Questions were asked and recorded by physicians into a computer program. A definite diagnosis of asthma was made based on a positive response to methacholine bronchial provocation or bronchodilator response (BDR) testing. Multivariate logistic regression analysis was used to evaluate the significance of questionnaire responses in terms of discriminating asthmatics. Asthmatic patients showed higher total symptom scores than non-asthmatics (mean 5.93 vs. 4.93; <I>p</I><0.01). Multivariate logistic regression analysis identified that response to questions concerning the following significantly discriminated asthmatics; wheezing with dyspnea, which is aggravated at night, and by exercise, cold air, and upper respiratory infection. Moreover, the presence of these symptoms was found to agree significantly with definite diagnosis of asthma (by kappa statistics). Receiver-operating characteristic curve analysis revealed that the diagnostic accuracy of symptom-based diagnosis was high with an area under the curve of 0.647±0.033. Using a computer-assisted symptom-based diagnosis program, it is possible to increase the accuracy of diagnosing asthma in general practice, when the facilities required to evaluate airway hyperresponsiveness or BDR are unavailable.</P>
연구보고 : 기관지천식환자에 있어서 고해상도 전산화단층촬영술을 이용한 기관지유발에 대한 기도의 반응
최병휘 ( Byoung Whui Choi ),강윤정 ( Yoon Jeong Kang ),고형기 ( Hyung Ki Ko ),박인원 ( In Won Park ),허성호 ( Sung Ho Hue ),김양수 ( Yang Soo Kim ),김영구 ( Young Goo Kim ),김건상 ( Kun Sang Kim ),김종효 ( Jong Hyo Kim ) 대한결핵 및 호흡기학회 1995 Tuberculosis and Respiratory Diseases Vol.42 No.6
S-280 : A case of paragonimiasis presented with pseudochylothorax
( Young Hwan Choi ),( Cheol Won Hyeon ),( Jae Woo Jung ),( Jae Chol Choi ),( Jong Wook Shin ),( Jae Yeol Kim ),( In Won Park ),( Byoung Whui Choi ) 대한내과학회 2013 대한내과학회 추계학술대회 Vol.2013 No.1
A pseudochylothorax, also known as cholesterol pleurisy or chyliform effusion that contains cholesterol crystals or high lipid content, is a rare lung disease. Although there have been several reported cases of pseudochylothorax associated with paragonimiasis, paragonimiasis is still a rare cause of pseudochylothorax. Moreover, no case of pleural paragonimiasis presented with pseudochylothroax has been reported in Korea. We report a case of Paragonimus westermani with unilateral pseudochylothorax A 93-year-old man was admitted to our hospital for progressive dyspnea with one week history of cough and sputum. He had a history of paragonimiasis 30years previously which had been successfully treated with mebendazol. He denied a recent history of ingestion of raw freshwater crab. Laboratory tests revealed a white blood cell count (WBC) was 8390 cells/mm3 (67% neutrophils, 16% lymphocytes, 1% eosinophils), hemoglobin 14.9 g/dL, platelet count 148,000/mm3 and the C-reactive protein was 10.97 mg/L. His chest radiographs showed right pleural effusion, thickening and calcification and chest CT scan detected no apparent abnormal pulmonary infiltrations or mediastinal lymph node swelling. Ultra-sound-guided percutaneous catheter drainage (PCD) was performed for diagnostic and therapeutic reasons. Pleural effusions from both pleural cavities were turbid and milky yellow. On biochemical examination this fluid was found to have a specific gravity of 1.035, pH 7.16, triglyceride 14 mg/dL, cholesterol 178 mg/dL, glucose 8 mg/dL, LDH 3195 IU/L, protein 7.0 g/dL and adenosine deaminase 43.4 IU/L. The cell cont was 50 cells/mm3 (neutrophils 71%, lymphocytes 28% and eosinophils 1%). Characteristic operculated eggs consistent with P. westermani and typical rhomboidal cholesterol crystals were noted on microscopic examination. The patient was treated with praziquantel (1,500 mg t.i.d. for 2 days). This case suggests that paragonimiasis should be included in the differential diagnosis of pseudochylothorax even if blood and pleural fluid eosinophilia are not detected.
비용, 인공환기관련폐렴 발생 빈도에 있어서의 개방 기관내 흡인술에 대한 폐쇄 흡인술의 비교
정재우 ( Jae Woo Jung ),최은희 ( Eun Hee Choi ),김진희 ( Jin Hee Kim ),서효경 ( Hyo Kyung Seo ),최지연 ( Ji Yeon Choi ),최재철 ( Jae Cheol Choi ),신종욱 ( Jong Wook Shin ),박인원 ( In Won Park ),최병휘 ( Byoung Whui Choi ),김재열 대한결핵 및 호흡기학회 2008 Tuberculosis and Respiratory Diseases Vol.65 No.3
연구배경: 폐쇄관을 이용한 기관내 흡인은 임상적으로 중한 환자에게 생리적인 이점이 있지만, 병원성 균주에 의한 기관지 내의 집락화가 증가될 수 있다는 보고가 있다. 비용증가는 폐쇄흡인의 또 다른 제한점이다. 본 연구는 폐쇄흡인 및 개방흡인에 따른 병원균주의 집락화와 인공환기관련폐렴의 빈도와 가격효율성을 비교해보고자 시행되었다. 방법: 각각 한 달의 간격을 사이에 두고 내과계 중환자실에 입원한 환자들을 대상으로 다중사용 개방흡인, 단일사용 개방흡인, 다중사용 폐쇄흡인을 순차적으로 시행하였다. 비용, MRSA의 기관지내 집락화, 인공환기폐렴의 발생률을 분석하였다. 결과: 106명의 환자가 연구 대상으로 포함이 되었고, 이 중 20명의 환자가 다중사용 개방흡인을, 42명이 단일사용 개방흡인을, 44명이 다중사용 폐쇄흡인술을 시행받았다. MRSA의 집락화와 인공환기관련폐렴의 빈도는 세 군간에 의미있는 차이를 보이지 않았다. 입원 일당 소모되는 비용은 다중사용 개방흡인이 $10.58, 단일사용 개방흡인이 $28.27, 다중사용 폐쇄흡인의 경우 $23.76인 것으로 나타났다. 결론: 다중사용 폐쇄흡인을 매 48시간마다 교환하는 경우 MRSA 집락화와 인공환기폐렴 발생 빈도는 비슷하였고, 기관내 흡인술에 있어서 비용면에서도 효율적인 방법임을 알 수 있었다. Background: Tracheobronchial suctioning using the closed suctioning system has physiological benefits for critically ill patients. Despite these benefits, there are concerns about increased colonization of tracheobronchial tree by pathogenic organisms. The cost is another hinder to the introduction of closed suction system. The aim of this study was to evaluate the incidence of colonization and ventilator associated pneumonia and the cost-effectiveness of closed suction compared with open suction. Methods: During separated one month period, patients admitted MICU were cared by multiple-use, open suction, single-use, open suction and multiple-use, closed suction method, consecutively. Costs, colonization of tracheobronchial tree by MRSA and the incidence of ventilator-associated pneumonia (VAP) were analyzed. Results: One-hundred and six patients were enrolled. Twenty patients were treated with multiple-use, open suction, while 42 and 44 patients were cared with single-use, open catheter and multiple-use, closed catheter, respectively. Colonization by MRSA and the incidence of VAP were not different among three ways of suctioning. The overall costs per patient per day for suctioning were $10.58 for multiple-use, open suction, $28.27 for single-use, open suction and $23.76 for multiple-use, closed suction. Conclusion: Multiple-use, closed suctioning, when suction catheters were changed every 48 hrs, has the similar incidence of colonization of MRSA and occurrence of VAP and is a cost-efficient way of endotracheal suction.