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( Jae Kyeom Sim ),( Seok Joo Moon ),( Juwhan Choi ),( Jee Youn Oh ),( Young Seok Lee ),( Kyung Hoon Min ),( Gyu Young Hur ),( Sung Yong Lee ),( Jae Jeong Shim ) 대한내과학회 2024 The Korean Journal of Internal Medicine Vol.39 No.2
Background/Aims: The prognosis of patients with idiopathic pulmonary fibrosis (IPF) and respiratory failure requiring mechanical ventilation is poor. Therefore, mechanical ventilation is not recommended. Recently, outcomes of mechanical ventilation, including those for patients with IPF, have improved. The aim of this study was to investigate changes in the use of mechanical ventilation in patients with IPF and their outcomes over time. Methods: This retrospective, observational cohort study used data from the National Health Insurance Service database. Patients diagnosed with IPF between January 2011 and December 2019 who were placed on mechanical ventilation were included. We analyzed changes in the use of mechanical ventilation in patients with IPF and their mortality using the Cochran- Armitage trend test. Results: Between 2011 and 2019, 1,227 patients with IPF were placed on mechanical ventilation. The annual number of patients with IPF with and without mechanical ventilation increased over time. However, the ratio was relatively stable at approximately 3.5%. The overall hospital mortality rate was 69.4%. There was no improvement in annual hospital mortality rate. The overall 30-day mortality rate was 68.7%, which did not change significantly. The overall 90-day mortality rate was 85.3%. The annual 90-day mortality rate was decreased from 90.9% in 2011 to 83.1% in 2019 (p = 0.028). Conclusions: Despite improvements in intensive care and ventilator management, the prognosis of patients with IPF receiving mechanical ventilation has not improved significantly.
( Jae Hoon Kim ),( Jae Kyeom Shim ),( Young Ho Seo ),( Sung Jae Choi ),( Young Ho Lee ),( Jong Dae Ji ),( Kyung Ho Kang ),( Gwan Gyu Song ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Introduction: Adalimumab is a full human monoclonal antibody that inhibits tumor necrosis factor-alpha (TNF-a). It has recently been shown to be effective in the treatment of rheumatoid arthritis, ankylosing spondylitis (AS). As the pulmonary complication of TNF-a antagonist, infection, interstitial pneumonitis, sarcoidosis and pulmonary vasculitis has been reported. Sarcoidosis is a rare complication among them. Here, we report a patient who has developed sarcoid like granuloma confi rmed by lung biopsy following adalimumab therapy for AS. Case Description: The patient is a 26-year-old man with a history of ankylosing spondylits evolving over the previous 9 years, who had received treatment with non-steroid anti-infi ammatory drugs and sulfasalazin. Adalimumab was injected at a dose of 40 mg twice a month for 9 months with a very positive clinical response. He is admitted due to the patch opacity showed on the right upper and middle lobe at chest radiograph in annual medical checkup. Computed tomography (CT) of the chest revealed various sized multiple nodules on the right upper and middle lobe and lymph node enlargement in both hilum and right paratracheal area. The blood analysis determined ESR 19 mm/hr, CRP 2. 16 mg/L with normal renal and hepatic function. The levels of the angiotensin-converting enzyme were 95. 7 U/L (normal value 9. 0~47. 0). The tuberculosis skin test and the interferon gamma releasing assay were negative. Blood cultures and sputum analysis were negative. The microbiological analysis of the bronchoalveolar lavage were negative. CT guided lung biopsy was carried out and demonstrated the presence of granulomas with histiocytic cells and giant multinucleatedcells, with neither necrosis nor caseum. Conclusion: Sarcoid-like granulomatosis is rare but not exceptional in patients treated with TNF antagonist. It is important for clinicians to be aware of this potential and uncommon complication of TNF antagonist.
Clinical and molecular characteristics of pulmo-nary sarcomatoid carcinoma
( Jae Kyeom Sim ),( Sang Mi Chung ),( Jong Hyun Choi ),( Jee Youn Oh ),( Seung Heon Lee ),( Je Hyeong Kim ),( Kyung Hoon Min ),( Gyu Young Hur ),( Jae Jeong Shim ),( Kyung Ho Kang ),( Bong Kyung Shin 대한내과학회 2018 The Korean Journal of Internal Medicine Vol.33 No.4
Background/Aims: Pulmonary sarcomatoid carcinoma (PSC) is a poorly differentiated non-small cell lung cancer (NSCLC) that contains components of spindle or giant cells. Owing to its low prevalence, there are insufficient data regarding its clinical features, therapeutic strategies and prognosis. Methods: The medical records of 26 patients diagnosed with PSC from January 2009 to June 2015 were reviewed and analyzed for clinicopathological characteristics, treatment modality, and outcomes. Results: The median age was 69.5 years. Twenty-three patients (88%) were male. Twenty-four patients (92%) were smokers. The median time from symptom onset to diagnosis was one month. Eighteen patients (69%) were diagnosed at an advanced stage. Pleomorphic carcinoma was the most common subtype, and epidermal growth factor receptor (EGFR) mutation was positive in two of 11 patients. Among 13 patients tested for programmed death ligand 1 (PD-L1) immunohistochemistry assay, eight showed high expression of PD-L1. The median overall survival (OS) of all patients was 9.5 months. In total, 12 patients were treated with chemotherapy: nine with platinum-based doublet therapy, two with tyrosine kinase inhibitor, and one with docetaxel. Seven patients showed partial response or stable disease. The median OS and progression-free survival of patients who received chemotherapy were 8.7 and 2.8 months, respectively. Conclusions: PSC was more common in males, smokers, and the elderly, with worse prognosis than ordinary NSCLC; chemotherapy response was favorable, and EGFR mutation status and PD-L1 expression may offer more therapeutic options.
( Jae Kyeom Sim ),( Jong Hyun Choi ),( Jee Youn Oh ),( Jae Young Cho ),( Eul Sun Moon ),( Hye Sook Min ),( Byung Hyun Lee ),( Min Seon Park ),( Gyu Young Hur ),( Sung Yong Lee ),( Jae Jeong Shim ),( K 대한결핵 및 호흡기학회 2014 Tuberculosis and Respiratory Diseases Vol.76 No.3
Although endobronchial hamartoma is a rare benign tumor, most patients with endobronchial hamartoma have respiratory symptoms such as obstructive pneumonia, hemoptysis, cough, or dyspnea due to bronchial obstruction. It can cause irreversible post-obstructive pulmonary destruction, thus early diagnosis and treatment is very important. Recently, there have been cases of neodymium-doped yttrium aluminum garnet (Nd:YAG) laser and electrocautery procedures for bronchoscopic treatment of malignant or benign central airway obstruction with comparable therapeutic efficacy and few complications. Bronchoscopic cryotherapy is a newly developed technique for management of central airway obstruction. Moreover, it provides diagnostic methods with improving diagnostic yield and safety. We report two cases of endobronchial hamartoma, each diagnosed and definitively treated with bronchoscopic techniques. Endobronchial biopsy and removal was successfully performed by cryotherapy via flexible bronchoscopy without notable complications. Follow-up bronchoscopic examinations excluded residual or recurrent disease.
Sim, Jae Kyeom,Oh, Jee Youn,Lee, Eun Joo,Hur, Gyu Young,Lee, Seung Heon,Lee, Sung Yong,Lee, Sang Yeub,Kim, Je Hyeong,Shin, Chol,Shim, Jae Jeong,In, Kwang Ho,Kang, Kyung Ho,Min, Kyung Hoon Elsevier 2016 The American journal of the medical sciences Vol.351 No.5
<P>Background: Acute exacerbation and bacterial pneumonia are major life-threatening conditions in patients with interstitial lung disease (ILD). The rapid recognition of these 2 different conditions is important for their proper treatment. An elevated procalcitonin (PCT) level is commonly detected in patients with bacterial infections. This study assessed the usefulness of the serum PCT level as a biomarker for the differential diagnosis of acute exacerbation and bacterial pneumonia in patients with ILD. Materials and Methods: In this prospective observational study, we enrolled patients with ILD who had experienced recently progressive dyspnea and exhibited new infiltrations on chest radiographs. We classified these patients into an acute exacerbation group and a bacterial pneumonia group and compared their baseline characteristics and laboratory parameters, including the PCT level. Results: Of 21 patients with ILD, 9 patients had bacterial pneumonia. Both the groups showed similar baseline characteristics. The bacterial pneumonia group demonstrated a high PCT level. The PCT level in the acute exacerbation group was significantly lower than that in the bacterial pneumonia group (0.05 versus 0.91ng/mL, respectively; P < 0.001). Other parameters, such as the C-reactive protein level, leukocyte count and body temperature, were also lower in the acute exacerbation group. At a cutoff value of 0.1ng/mL, the sensitivity, specificity and negative predictive values of the serum PCT level were 88.9%, 100.0% and 92.3%, respectively. Conclusions: These findings suggest that the serum PCT level is useful in the differential diagnosis of acute exacerbation and bacterial pneumonia in patients with ILD.</P>
Sim, Jae Kyeom,Choi, Jong Hyun,Oh, Jee Youn,Cho, Jae Young,Moon, Eul Sun,Min, Hye Sook,Lee, Byung Hyun,Park, Min Seon,Hur, Gyu Young,Lee, Sung Yong,Shim, Jae Jeong,Kang, Kyung Ho,Min, Kyung Hoon The Korean Academy of Tuberculosis and Respiratory 2014 Tuberculosis and Respiratory Diseases Vol.76 No.3
Although endobronchial hamartoma is a rare benign tumor, most patients with endobronchial hamartoma have respiratory symptoms such as obstructive pneumonia, hemoptysis, cough, or dyspnea due to bronchial obstruction. It can cause irreversible post-obstructive pulmonary destruction, thus early diagnosis and treatment is very important. Recently, there have been cases of neodymium-doped yttrium aluminum garnet (Nd:YAG) laser and electrocautery procedures for bronchoscopic treatment of malignant or benign central airway obstruction with comparable therapeutic efficacy and few complications. Bronchoscopic cryotherapy is a newly developed technique for management of central airway obstruction. Moreover, it provides diagnostic methods with improving diagnostic yield and safety. We report two cases of endobronchial hamartoma, each diagnosed and definitively treated with bronchoscopic techniques. Endobronchial biopsy and removal was successfully performed by cryotherapy via flexible bronchoscopy without notable complications. Follow-up bronchoscopic examinations excluded residual or recurrent disease.
고형암에 대한 항암화학요법 치료 중 병발한 결핵의 특성
김덕겸 ( Deog Kyeom Kim ),이세원 ( Sei Won Lee ),강영애 ( Young Ae Kang ),윤영순 ( Young Soon Yoon ),유철규 ( Chul Gyoo Yoo ),김영환 ( Young Whan Kim ),한성구 ( Sung Koo Han ),심영수 ( Young Soo Shim ),임재준 ( Jae Joon Yim ) 대한결핵 및 호흡기학회 2005 Tuberculosis and Respiratory Diseases Vol.58 No.3
연구 배경 : 면역 기능 저하를 초래하여 결핵의 재활성화에 관여할 것으로 생각되는 주기적인 항암화학요법치료 중인 고형암 환자에서 발생한 결핵의 임상적 특징과 치료 반응을 파악하고자 하였다. 대상 및 방법 : 2000년 1월부터 2004년 7월까지 국내 일개 3차 병원에서 항암화학요법 치료 중에 세균학적으로, 병리학적으로 또는 임상적으로 진단된 결핵 환자 중 기존에 알려진 결핵 재활성화의 위험 요인이 없는 22명을 대상으로 후향적 연구를 시행하였다. 결과 Background : Some malignancies including lymphoma, head and neck cancer, and lung cancer are believed to be associated with the reactivation of tuberculosis (TB) because cyclic anti-cancer chemotherapy can induce the leukopenia or immunological deteriorat
( Jee Youn Oh ),( Jae Kyeom Sim ),( Kyung Hoon Min ),( Gyu Young Hur ),( Jae Jeong Shim ),( Kyung Ho Kang ),( Sung Yong Lee ) 대한결핵 및 호흡기학회 2015 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.120 No.-
The programmed death-1 (PD-1) mediates tumor-induced immune suppression. Expression of mutant EGFR in bronchial epithelial cells induces PD-1 ligand (PD-L1) and PD-L1 expression is reduced by EGFR inhibitors in lung cancer cell lines with activated EGFR. Thus, we compared the levels of PD-1 in peripheral blood according to stage and tyrosine kinase inhibitor(TKI) treatment response in lung cancer patients. Blood samples of lung cancer were obtained from Korea university guro hospital, and additional samples were done for patients with EGFR mutant adenocarcinoma after EGFR TKI treatment. Flow cytometry was used to detect PD-1 expression. Total 40 patients were enrolled for relationship of stage and PD-1, and among them 7 patients were EGFR mutant and treated with EGFR TKI. The expression levels of CD8+PD-1+ cells in Stage I/II patients tended to be lower than stage III/IV (0.18±0.19% vs. 0.90±1.18%, P=0.09). For patients treated with EGFR TKI, expression levels of CD8+PD-1+ cells significantly decreased after TKI treatment (1.85±1.56% vs. 0.77±0.83%, P=0.02). Post/pre TKI treatment ratio of CD8+PD-1+ cells expression was lower in partial response (n=3) than stable disease (n=4) (0.15±0.10 vs. 0.67±0.25, P=0.04). We confirmed the role of PD-1 of immune escape and tumor development by comparing levels of peripheral blood according to stage. We also verified that EGFR mutant lung tumor inhibited antitumor immunity by activating PD-1 and PD-1 expression was reduced by EGFR TKI, which was proportional to treatment response. Further large studies should be followed.
Park, Sun-Young,Shim, Jae-Ho,Kim, Mi-Na,Sun, Yih Hsiu,Kwak, Hyun-Soo,Yan, Xiangmei,Choi, Byung-Chul,Im, Chae-Uk,Sim, Sang-Soo,Jeong, Ji-Hoon,Kim, In-Kyeom,Min, Young-Sil,Sohn, Uy-Dong The Korean Society of Pharmacology 2010 The Korean Journal of Physiology & Pharmacology Vol.14 No.1
We have shown that myosin light chain kinase (MLCK) was required for the off-contraction in response to the electrical field stimulation (EFS) of feline esophageal smooth muscle. In this study, we investigated whether protein kinase C (PKC) may require the on-contraction in response to EFS using feline esophageal smooth muscle. The contractions were recorded using an isometric force transducer. On-contraction occurred in the presence of $N^G$-nitro-L-arginine methyl ester (L-NAME), suggesting that nitric oxide acts as an inhibitory mediator in smooth muscle. The excitatory composition of both contractions was cholinergic dependent which was blocked by tetrodotoxin or atropine. The on-contraction was abolished in $Ca^{2+}$-free buffer but reappeared in normal $Ca^{2+}$-containing buffer indicating that the contraction was $Ca^{2+}$ dependent. 4-aminopyridine (4-AP), voltage-dependent $K^+$ channel blocker, significantly enhanced on-contraction. Aluminum fluoride (a G-protein activator) increased on-contraction. Pertussis toxin (a $G_i$ inactivator) and C3 exoenzyme (a rhoA inactivator) significantly decreased on-contraction suggesting that Gi or rhoA protein may be related with $Ca^{2+}$ and $K^+$ channel. ML-9, a MLCK inhibitor, significantly inhibited on-contraction, and chelerythrine (PKC inhibitor) affected on the contraction. These results suggest that endogenous cholinergic contractions activated directly by low-frequency EFS may be mediated by $Ca^{2+}$, and G proteins, such as Gi and rhoA, which resulted in the activation of MLCK, and PKC to produce the contraction in feline distal esophageal smooth muscle.
A Case of IgG4-Related Disease Presenting as Massive Pleural Effusion and Thrombophlebitis
( Jong Hyun Choi ),( Jae Kyeom Sim ),( Jee Youn Oh ),( Eun Joo Lee ),( Gyu Young Hur ),( Seung Heon Lee ),( Sung Yong Lee ),( Je Hyeong Kim ),( Sang Yeub Lee ),( Chol Shin ),( Jae Jeong Shim ),( Kwang 대한결핵 및 호흡기학회 2014 Tuberculosis and Respiratory Diseases Vol.76 No.4
Immunoglobulin (Ig) G4-related disease is a recently recognized systemic fibroinflammatory condition characterized by a lymphoplasmacytic infiltrate rich in IgG4-positive plasma cells with elevated circulating levels of IgG4. The disease can either be localized to one or two organs, or present as diffuse multi-organ disease. Furthermore, lesions in different organs can present simultaneously or metachronously. In the pulmonary manefestations, lesions associated with IgG4-related disease have been described in the lung parenchyma, airways and pleura, as well as the mediastinum. We report a case of IgG4-related disease presenting as massive pleural effusion and thrombophlebitis.