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폐암환자에서 발생한 피하매몰 중심정맥포트 골절 및 색전증 2예
주진영 ( Jin Yung Ju ),조재영 ( Jae Yeong Cho ),임정환 ( Jung Hwan Lim ),조계중 ( Gye Jung Cho ),채동렬 ( Dong Ryeol Chae ),오인재 ( In Jae Oh ),김규식 ( Kyu Sik Kim ),김유일 ( Yu Il Kim ),임성철 ( Sung Chul Lim ),김영철 ( Young C 대한결핵 및 호흡기학회 2007 Tuberculosis and Respiratory Diseases Vol.63 No.5
Totally implanted central venous access devices for chemotherapy (chemoport) are being used increasingly in lung cancer patients. Vascular catheters are associated with various complications including infection, thrombosis as well as spontaneous fractures and embolization of the catheter, which is known as ``pinch-off syndrome``. ``Pinch-off syndrome`` refers to the compression of a subclavian central venous catheter between the clavicle and first rib resulting in an intermittent or permanent obstruction, which can lead to tears, transection, or embolization. We report two cases of fractured and embolized implanted subclavian venous catheters in which the fragments were removed percutaneously. A 62-year-old man presented with back pain with a duration of a few weeks. The chest radiograph revealed complete transsection and embolization of the catheter into the right atrium. In addition, a 47-year-old woman with a chemoport had a grade 3 pinch-off sign in a chest radiograph demonstrating complete transsection and embolization of the catheter into the pulmonary artery. Both cases were managed by retrieving the embolized distal fragment percutaneously and removing the proximal section of the catheter. (Tuberc Respir Dis 2007;63:449-453)
재발된 소세포폐암환자에서 이차 약제로 사용되는 Belotecan (CKD-602)의 임상적 효용성
반희정 ( Hee Jung Ban ),오인재 ( In Jae Oh ),김규식 ( Kyu Sik Kim ),주진영 ( Jin Yung Ju ),권용수 ( Yong Soo Kwon ),김유일 ( Yu Il Kim ),임성철 ( Sung Chul Lim ),김영철 ( Young Chul Kim ) 대한결핵 및 호흡기학회 2009 Tuberculosis and Respiratory Diseases Vol.66 No.2
연구배경: Belotecan (Camtobell, CKD-602, Chongkundang Pharm., Korea)은 camptothecin의 치환체로 topoisomerase I 효소를 억제하여 항암효과를 나타내는 것으로 알려져 있다. 이에 2차 항암화학요법에 치료제로써 Belotecan의 효과, 생존율 및 부작용에 대해 연구하였다. 방법: 이에 소세포폐암에서 etoposide와 platinum을 사용한 1차 항암화학요법에서 실패한 49명의 환자들을 대상으로 2차 항암화학요법에 Belotecan을 투약하였다. 결과: 전체 반응률은 25%였으며, 11명의 환자에서 partial response를 보였다. 또한 1차 항암화학요법 이후 90일 이내에 재발한 군과 90일 이상 경과한 군간에 유의한 차이는 보이지 않았다. 전체 환자의 중심생존기간은 10.3개월(290일)이었고, 비반응군에서는 186일(95% CI; 67~305)로 반응군의 471일(95% CI; 234~568)에 비해 생존기간의 감소 유의하게 있음을 확인하였다(p=0.07). 결론: 2차 항암화학요법의 치료제로써 Belotecan의 효능과 부작용에 대해서는 향후 무작위 비교 연구가 필요할 것으로 사료된다. Background: Belotecan (Camtobell, CKD-602, Chong-kundang Pharm., Korea), a camptothecin derivative, has anticancer effects by inhibiting topoisomerase I such as topotecan. This study observed the response, survival and toxicity of belotecan monotherapy after the failure of etoposide and platinum (EP). Methods: Forty nine small cell lung cancer (SCLC) patients (M/F=41/8; age, 64.5±7.6 (mean±SD) years), who failed in their first line chemotherapy were enrolled in this study. Twenty one SCLC patients showed relapsed lung cancer more than 90 days after their prior EP chemotherapy (sensitive relapse group, SR) and 28 patients relapsed within 90 days (refractory relapse group, RR). Results: The response rate was 25%. Eleven patients showed partial responses and 5 patients could not be checked. The response rate of the SR and RR patients was similar. The relative dose intensity was lower in the responders (78±15%) than non-responders (83±13%, p=0.03). The median survival time (MST) was 10.3 months (290 days). The MST of the non-responders and responders was 186 days (95% CI; 67~305) and 401 days (95% CI; 234∼568, p=0.07), respectively. The median progression free survival (MPFS) was similar in the SR (79 days) and RR (67 days) patients. Grade 3~4 neutropenia, anemia, and thrombocytopenia were observed in 59.6%, 12.8% and 23.4% of patients, respectively. Conclusion: The efficacy and survival were demonstrated in the second-line setting. However, a randomized comparative trial with topotecan will be needed.
김영일 ( Young Il Kim ),지수영 ( Su Young Chi ),반희정 ( Hee Jung Ban ),주진영 ( Jin Yung Ju ),권용수 ( Yong Soo Kwon ),오인재 ( In Jae Oh ),김규식 ( Kyu Sik Kim ),김유일 ( Yu Il Kim ),김영철 ( Young Chul Kim ),임성철 ( Sung Chul 대한결핵 및 호흡기학회 2008 Tuberculosis and Respiratory Diseases Vol.65 No.5
Factitious hemoptysis is the bleeding type of Munchausen`s syndrome, and this describes a group of patients who intentionally produce symptoms. Because factitious hemoptysis is a very rare manifestation of hemoptysis, it generally passes unnoticed. We report here on a case of factitious hemoptysis in a 15-year-old boy who presented with hemoptysis. During his three hospitalizations, we conducted many diagnostic procedures, including chest CT, laryngoscopy, bronchoscopy and bronchial arteriography, yet we failed to find the definitive cause of the patient`s hemoptysis. He kept on complaining of repetitive hemoptysis and seizure-like activity. His father discovered that he had collected his blood into the specimen cup via an intravenous line. After we removed the intravenous line, he did not show blood to us again. We suggest that factitious hemoptysis should be considered in the differential diagnosis of hemoptysis of an unclear bleeding focus, and especially when the patient has a bizarre hospital course or unusual behavior. We also include a review of the relevant literature. (Tuberc Respir Dis 2008;65:396-399)
증례 : 호흡기 ; 전신마취하 경직성 기관지 내시경으로 치료한 과오종 1예
반희정 ( Hee Jung Ban ),지수영 ( Su Young Chi ),오인재 ( In Jae Oh ),김규식 ( Kyu Sik Kim ),주진영 ( Jin Yung Ju ),권용수 ( Yong Soo Kwon ),김유일 ( Yu Il Kim ) 대한내과학회 2009 대한내과학회지 Vol.77 No.3
기관지 내 과오종은 조직학적으로는 양성이나 기관지 폐쇄나 객혈 등을 야기하여 폐실질 조직 손상을 일으킬 수 있는 잠재적으로 위험한 종양이므로 비가역적인 손상이 발생하기 전에 적절한 치료가 필요한데, 숙련된 의료진에 의한 경직성 기관지 내시경적 종양절제술이 안전하고 효과적으로 이용될 수 있어 문헌고찰과 함께 보고하는 바이다. A 54-year-old man presented with a cough, sputum, and fever. His chest X-ray showed atelectasis in the right middle lobe. Computed tomography revealed obstruction of the bronchus intermedius by an endobronchial tumor. The first bronchoscopic biopsy specimens suggested lipoma. We resected the tumor via rigid bronchoscopy under general anesthesia and the final pathology report revealed a cartilaginous hamartoma. Subsequently, he has been followed for more than 1 year without recurrence. (Korean J Med 77:349-352, 2009)
채동렬 ( Dong Ryeol Chae ),임성욱 ( Seong Uk Lim ),조계중 ( Gye Jung Cho ),임정환 ( Jung Hwan Lim ),주진영 ( Jin Yung Ju ),권용수 ( Yong Soo Kwon ),오인재 ( In Jae Oh ),김규식 ( Kyu Sik Kim ),김유일 ( Yu Il Kim ),임성철 ( Sung Chu 대한결핵 및 호흡기학회 2008 Tuberculosis and Respiratory Diseases Vol.65 No.2
유육종증의 비강 침범은 드물게 발견되며 폐 침범 없이 비강만 단독으로 침범하는 경우는 더욱 드물게 보고되고 있다. 37세의 여자 환자가 콧물과 비강 폐색을 주소로 내원하였다. 비강 종괴의 조직 검사상 일부분에서 괴사를 동반한 비건락성 육아종으로 나와 폐외 결핵으로 생각하고 9개월간 항결핵제의 투약을 하였다. 그러나 항결핵제 투약 완료 후에 결막 종괴 및 많은 수의 흉곽 내 림프절 비대가 새로이 발견되었고, 결막 종괴에서 시행한 조직 검사상 비강 종괴와 동일한 양상의 비건락성 육아종이 발견되었다. 항결핵제 투약에도 불구하고 임상 증상의 호전이 없었고 비강과 결막 조직 검사에서 비건락성 육아종 소견이 동일하게 보여 최종적으로 유육종증으로 진단 할 수 있었다. 혈청 안지오텐신 전환효소 수치는 상승되어 있었다. 부신피질 호르몬 투여 이후 환자의 증상은 점차 개선되었다. (Tuberc Respir Dis 2008;65:121-124)
정종필 ( Jong Pil Jeong ),반희정 ( Hee Jung Ban ),김수옥 ( Soo Ock Kim ),손준광 ( Jun Gwang Son ),주진영 ( Jin Yung Ju ),권용수 ( Yong Soo Kwon ),오인재 ( In Jae Oh ),김규식 ( Kyu Sik Kim ),김유일 ( Yu Il Kim ),임성철 ( Sung Chul 대한결핵 및 호흡기학회 2008 Tuberculosis and Respiratory Diseases Vol.64 No.3
Pheochromocytoma is derived from the chromaffin tissue. The typical finding of pheochromocytoma is paroxysmal hypertension accompanied with various signs and symptoms that are due to the excess of catecholamines or other bioactive substances. Yet the diagnosis is sometimes difficult to make because its clinical presentation is quite variable. Especially, hemoptysis is a very rare symptom, so the diagnosis is often missed or delayed. Without making the correct diagnosis and then subsequently administering treatment, the condition may be fatal. We herein report on a 68 year-old woman who was admitted because of abdominal pain and hemoptysis. The initial radiologic findings suggested pulmonary edema with alveolar hemorrhage. The urine catecholamine levels were elevated and she developed catecholamine-induced cardiomyopathy. We performed bronchial arterial embolization and we administered alpha blocker medication for controlling the hemoptysis and hypertension. After the temporary symptomatic improvement, her clinical course was aggravated by pneumonia and pulmonary edema. In spite of performing definitive surgery for pheochromocytoma, she died of postoperative hemodynamic instability. (Tuberc Respir Dis 2008;64:219-223)
손준광 ( Jun Gwang Son ),오인재 ( In Jae Oh ),정종필 ( Jong Pil Jeong ),김수옥 ( Soo Ok Kim ),주진영 ( Jin Yung Ju ),임정환 ( Jung Hwan Lim ),조계중 ( Gye Jung Cho ),채동렬 ( Dong Ryeol Chae ),김규식 ( Kyu Sik Kim ),김유일 ( Yu Il 대한결핵 및 호흡기학회 2007 Tuberculosis and Respiratory Diseases Vol.63 No.5
Recently, intra-Muscular Stimulation (IMS) therapy is being increasingly used for musculoskeletal pain. This procedure is generally regarded as a safe procedure for the general public. Some cases of iatrogenic pneumothorax caused by acupuncture have been reported in the medical literature. However, a case of an IMS therapy associated pneumothorax has not reported. We experienced two cases of iatrogenic pneumothorax after IMS therapy. A 62 year-old man received IMS therapy on the right shoulder due to posterior neck pain. After IMS therapy, acute dyspnea and chest discomfort developed. The other patient was a 74 year-old woman who also received IMS therapy. This patient experienced a nonproductive cough and acute dyspnea after the treatment. As the popularity of this form of alternative medicine increases, we might expect to see more cases of iatrogenic pneumothorax. Physicians should be aware of the adverse events associated with IMS therapy. (Tuberc Respir Dis 2007;63:444-448)
김희경 ( Hee Kyung Kim ),반희정 ( Hee Jung Ban ),지수영 ( Su Young Chi ),채동렬 ( Dong Ryeol Chae ),조계중 ( Gye Jung Cho ),임정환 ( Jung Hwan Lim ),주진영 ( Jin Yung Ju ),권용수 ( Yong Soo Kwon ),오인재 ( In Jae Oh ),김규식 ( Kyu 대한결핵 및 호흡기학회 2008 Tuberculosis and Respiratory Diseases Vol.64 No.2
A sarcoidosis is a multisystemic granulomatous disorder that has a predilection for pulmonary involvement, and the common radiological findings for the disease are bilateral nodular or reticulonodular patterns. Pseudoalveolar sarcoidosis is a rare presentation of sarcoidosis. The radiological finding is an alveolar pattern that involves or compresses the alveoli by clustered interstitial granuloma. A 58-year-old man was admitted due to incidental findings of a unilateral consolidative lesion as seen on chest radiography. A chest computed tomography (CT) examination showed multiple bronchoalveolar consolidations that were suspicious of a malignancy. However, a percutaneous needle biopsy revealed non-caseating granuloma with an asteroid body that was compatible with sarcoidosis. After one month, the consolidative lesions improved without any treatment. (Tuberc Respir Dis 2008;64:149-152)