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함현석 ( Hyun Seok Ham ),이승준 ( Seung Jun Lee ),조유지 ( Yu Ji Cho ),정이영 ( Yi Yeong Jeong ),전경녀 ( Kyoung Nyeo Jeon ),김호철 ( Ho Cheol Kim ),이종덕 ( Jong Deok Lee ),황영실 ( Young Sil Hwang ) 대한결핵 및 호흡기학회 2006 Tuberculosis and Respiratory Diseases Vol.61 No.2
A 70-year-old man was referred to the department of pulmonology due to blood tinged sputum and an abnormal chest X-ray. The chest X-ray and CT scans revealed a lobulated contour mass-like lesion in the left upper lung field. The bronchoscopic examination showed a whitish and polypoid mass occluding the left upper lobe bronchus. A biopsy specimen from the lesion revealed many aspergillus hyphae. Intravenous and oral itraconozole were administered over a 4 weeks period. Several months later, the size of the mass on chest X-ray increased and a percutaneous lung biopsy revealed a sarcomatoid carcinoma. We reported a case of lung cancer that was obscured by an endobronchial aspergilloma with a review of the relevant literature. (Tuberc Respir Dis 2006; 61: 157-161)
우중엽증후군의 원인 -최근 수년간 지역 3차 병원의 경험-
김현옥 ( Hyun Ok Kim ),마정은 ( Jeong Eun Ma ),이승준 ( Seung Jun Lee ),조유지 ( Yu Ji Cho ),정이영 ( Yi Yeong Jeong ),전경녀 ( Kyoung Nyeo Jeon ),김호철 ( Ho Cheol Kim ),이종덕 ( Jong Deok Lee ),황영실 ( Young Sil Hwang ) 대한결핵 및 호흡기학회 2007 Tuberculosis and Respiratory Diseases Vol.62 No.3
배경: 우중엽증후군은 반복적이고 만성적인 우중엽의 허탈을 나타내는 질환으로 그 원인은 매우 다양하다. 최근 국내에서 우중엽증후군의 원인에 대한 발표는 부족한 실정이어서 저자들은 최근 수년간 지역 3차 병원에서 경험한 우중엽증후군의 원인과 임상적 특징을 알아보고자 하였다. 방법: 2003년 1월부터 2006년 7월까지 경상대학교 병원에 내원하여 흉부 단순촬영 또는 전산화 단층촬영에서 우중엽증후군이 의심되어 기관지내시경 검사를 시행한 88명의 환자(남:여=22:64, 평균연령: 67.2±10.3)를 대상으로 그 원인과 임상적 특징을 후향적으로 조사하였다. 결과: 1) 여자가 64예(72.7%)로 남자보다 많았고 연령별 빈도에서 65세 이상의 고령환자가 58예로 65.9%를 차지하였다. 2) 임상 증상은 기침이 30예(34.1%)로 가장 흔하게 나타났고, 호흡곤란 21예(23.9%), 객담 15예(17.0%), 객혈 11예(12.5%), 흉부통증과 전신 쇠약감이 각각 5예(5.7%)에서 나타났으며, 증상이 없이 우연히 발견된 경우가 8예(9.1%)였다. 3) 흉부 방사선 촬영에서는 무기폐 49예(55.7%), 폐경화 43예(48.9%), 종괴 4예(4.5%) 소견을 보였다. 4) 기관지내시경 검사 소견에서 충혈을 동반한 점막 부종 38예(43.2%), 탄분증을 동반한 점막 부종 16예(18.2%), 점액 매복(mucus impaction) 13예(14.8%), 섬유성 협착 10예(11.4%), 종괴 8예(9.1%), 삼출성 조직 괴사 4예(4.5%), 외인성 압박에 의한 협착 2예(2.3%), 정상 12예(13.6%)로 나타났다. 5) 원인 질환은 결핵이 23예(26.1%, 기관지 결핵 22예, 폐결핵 1예)로 가장 많았고, 염증성 변화에 의한 양성 협착 22예(25%), 탄분섬유화증 13예(14.8%), 폐렴 11예(12.5%), 폐암 10예(11.4%), 점액 매복 3예(3.4%), 기관지 확장증 2예(2.3%), 특별한 이상이 발견되지 않은 경우가 7예(8.0%)이었다. 결론: 본 연구에서 우중엽증후군은 65세 이상의 환자에서 흔하게 관찰되었으며, 원인은 대부분 양성 질환이었고, 그 중 기관지 결핵이 가장 흔한 원인이었다. Background: Right middle lobe syndrome (RMLS) is defined as transient or chronic and recurrent atelectasis of the right middle lobe. Although numerous conditions are associated with RMLS, there are very few recent reports in Korea. This study evaluated the causes of RMLS in a local tertiary hospitalover a period of 42 months. Method: Eighty-eight patients (M:F=64:22, mean age: 67.2±10.3 years), who had consistent chest radiography findings and underwent bronchoscopy in Gyeongsang University Hospital from January 2003 to July 2006, were enrolled in this study. The clinical characteristics and causes of RMLS in these patients were retrospectively reviewed. Results: The most common symptoms fo RMLS were cough, dyspnea and sputum. Tuberculosis was the most common cause (endobronchial tuberculosis in 22 and pulmonary tuberculosis in 1) The other causes were bronchial stenosis by benign fibrotic changes in 22 cases (25%), anthracofibrosis in 13 cases (14.8%), pneumonia in 11 cases (12.5%), lung cancer in 10 cases (11.4%), mucus impaction in 3 cases (3.4%), bronchiectasis in 2 cases (2.3%) and no demonstrable causes in 7 cases (8%). The bronchoscopy findings were mucosal edema with hyperemic changes in 38 cases (43.2%), mucosal edema with anthracotic pigmentation in 16 cases (18.2%), mucus impaction in 13 cases (14.8%), fibrotic stenosis in 13 cases (14.8%), a mass like lesion in 8 cases (9.1%), exudative necrotic material in 4 cases (4.5%), narrowing as a result of extrinsic compression in 2 cases (2.3%) and no demonstrable abnormalities in 12 cases (13.6%). Conclusion: Right middle lobe syndrome was observed more frequently in patients over the age of 65. The causes were mainly benign diseases with endobronchial tuberculosis being the most common. (Tuberc Respir Dis 2007; 62: 192-196)
조유지 ( Yu Ji Cho ),강명희 ( Myoung Hee Kang ),김현식 ( Hyeon Sik Kim ),정이영 ( Yi Yeong Jeong ),장인석 ( In Seok Jang ),김호철 ( Ho Cheol Kim ),황영실 ( Young Sil Hwang ),이종덕 ( Jong Deog Lee ) 대한결핵 및 호흡기학회 2008 Tuberculosis and Respiratory Diseases Vol.64 No.6
Pulmonary mucormycosis is an uncommon, serious opportunistic infection caused by fungi belonging to the order Mucorales and it occurs exclusively in debilitated or immuno-compromised hosts. It is known that the fungi can invade the blood vessels and cause serious ischemic necrosis and bleeding5. We experienced a fatal case of pulmonary mucormycosis in a diabetic 75-year-old man who developed a progressive necrotizing lesion despite administering proper and prompt medical and surgical treatment. We report here on this case along with a review of the relevant medical literature.
기계환기가 요구된 중증 지역사회획득 폐렴에서 전신 스테로이드의 투여가 예후와 합병증의 발생에 미치는 영향
이승준 ( Seung Jun Lee ),이승훈 ( Seung Hun Lee ),김유은 ( You Eun Kim ),조유지 ( Yu Ji Cho ),정이영 ( Yi Yeong Jeong ),김호철 ( Ho Cheol Kim ),이종덕 ( Jong Deog Lee ),김장락 ( Jang Rak Kim ),황영실 ( Young Sil Hwang ) 대한결핵 및 호흡기학회 2012 Tuberculosis and Respiratory Diseases Vol.72 No.2
Background: This study is to evaluate the effect of systemic corticosteroid on the clinical outcomes and the occurrence of complications in mechanical ventilated patients with severe community-acquired pneumonia (CAP). Methods: We retrospectively assessed the clinical outcomes and complications in patients with severe CAP admitted to ICU between March 1, 2003 and July 28, 2009. Outcomes were measured by hospital mortality after ICU admission, duration of mechanical ventilation (MV), ICU, and hospital stay. Complications such as ventilator associated pneumonia (VAP), catheter related-blood stream infection (CR-BSI), and upper gastrointestinal (UGI) bleeding during ICU stay were assessed. Results: Of the 93 patients, 36 patients received corticosteroids over 7 days while 57 patients did not receive corticosteroids. Age, underlying disease, APACHE II, PSI score, and use of vasopressor were not different between two groups. In-hospital mortality was 30.5% in the steroid group and 36.8% in the non-steroid group (p>0.05). The major complications such as VAP, CR-BSI and UGI bleeding was significantly higher in the steroid group than in the non-steroid group (19.4% vs. 7%, p<0.05). The use of steroids and the duration of ICU stay were significantly associated with the development of major complications during ones ICU stay (p<0.05). Conclusion: Systemic corticosteroid in patients with severe CAP requiring mechanical ventilation may have no beneficial effect on clinical outcomes like duration of ICU stay and in-hospital mortality but may contribute to the development of ICU acquired complications.
기계 환기가 요구된 중증 지역사회 획득 폐렴에서 저용량 하이드로코르티손 주입의 효과
김호철 ( Ho Cheol Kim ),이승준 ( Seung Jun Lee ),함현석 ( Hyoun Seok Ham ),조유지 ( Yu Ji Cho ),정이영 ( Yi Yeong Jeong ),이종덕 ( Jong Deok Lee ),황영실 ( Young Sil Hwang ) 대한결핵 및 호흡기학회 2006 Tuberculosis and Respiratory Diseases Vol.60 No.4
배경 : 중증 지역사회 획득 폐렴은 항생제의 발달과 보조요법의 발전에도 불구하고 사망률이 높은 질환으로 호흡부전으로 진행되어 기계환기가 필요한 경우 사망률은 더욱 증가하게 된다. 최근 중증 지역사회 획득 폐렴에서 저용량 하이드로코르티손 주입이 사망률을 감소시킨다고 보고되었다. 본 연구는 기계환기가 요구된 중증 지역사회 획득 폐렴 환자에서 하이드로코르티손 정주의 효과를 알아보기 위하여 시행하였다. 방법 : 2005년 2월부터 7월까지 중증 지역사회 획득 폐렴으로 기계환기를 유지한 13명의 환자(남:여=10:3, 평균 연령: 68.6±14.1)를 대상으로 하이드로코르티손을 240mg을 부하로 정주하고 시간당 10mg을 지속적으로 7일간 주입하였다. 대조군은 연구 기간 이전 중증 지역사회 획득 폐렴으로 기계환기를 유지하고 스테로이드 치료를 하지 않았던 13명의 환자를 대상으로 하였다. 하이드로코르티손 주입 전과 주입 8일째 두 군 간의 임상적, 생리적 지표의 차이와 최종결과를 비교하였다. 결과 : 1) 하이드로코르티손 주입 전 주입군과 대조군의 나이, 성별, 내원 당시의 SAPS II, SOFA 점수, 체온, 백혈구 수, PaO2/FiO2(P/F) 비, P/F 200이 하인 환자수, 흉부방사선 사진 점수, 폐손상 점수, 카테콜라민 의존성 패혈성 쇽의 빈도 등은 유의한 차이가 없었다. 2) 하이드로코르티손 주입 8일 후 대조군에 비해 주입군이 P/F비가 100이상 호전된 환자의 비율과 흉부 방사선 점수가 호전된 환자의 비율이 유의하게 높았다(61.5% vs. 15.4% p=0.016, 76.9%vs. 23.1% p<0.05). 이외 다른 임상적 및 생리적 지표들은 주입군과 대조군 사이에 유의한 차이는 없었다. 3) 두 군 간에 기계환기 유지기간, 중환자실 재원기간, 병원내 재원기간, 재원 10일째와 30일째의 사망률은 유의한 차이가 없었다. 결론 : 기계환기가 요구되는 중증 지역사회 획득 폐렴에서 하이드로코르티손 정주는 산소화와 흉부 방사선 점수의 빠른 호전을 보이지만 최종 치료 성적에 대해서는 많은 환자를 대상으로 한 전향적 무작위 대조 연구가 필요할 것으로 사료된다. Background : Severe community-acquired pneumonia (CAP) can develop into respiratory failure that requires mechanical ventilation (MV), which is associated with a higher rate of mortality. It was recently reported that a hydrocortisone infusion in severe CAP patients was associated with a significant reduction in the length of the hospital stay and mortality. This study evaluated efficacy of a hydrocortisone infusion for patients with severe CAP requiring MV. Methods : From February 2005 to July 2005, 13 patients (M:F=10:3, mean age: 68.6±14.1 years), who were diagnosed with severe CAP and required MV, were enrolled in this study. Hydrocortisone was administered as an intravenous 200mg loading bolus, which was followed by an infusion at a rate of 10mg/hour for 7 days. The control group was comprised of patients with severe CAP requiring MV but in whom corticosteroid was not used before study period. The clinical and physiologic parameters on or by day 8 and the outcome in the hydrocortisone infusion group were compared with those in the control group. Results : 1) There was no significant difference in age, gender ratio, SAPS II, SOFA score, temperature, leukocyte count, PaO2/FiO2 (P/F) ratio, the number of patients with P/F ratio < 200, chest radiograph score, lung injury score and catecholamine-dependent septic shock between the hydrocortisone infusion group and control group at day 1. 2) At day 8, the proportion of patients with an improvement in the P/F ratio ≥ 100 and the chest radiograph score was significantly higher in the hydrocortisone infusion group than in the control group (61.5% vs. 15.4%, 76.9% vs. 23.1%, p<0.05). However, there was no significant difference in the other clinical and physiologic parameters. 3). There was no significant difference in the duration of the MV, ICU stay, hospital stay and 10th and 30th day mortality between the two groups. Conclusion : Hydrocortisone infusion for patients with severe CAP requiring invasive mechanical ventilation may be effective in improving the level of oxygenation and the chest radiograph score. (Tuberc Respir Dis 2006; 60: 419-425)