Acute Exacerbation of Interstitial Pneumonia Other Than Idiopathic Pulmonary Fibrosis

Park, I-Nae,Kim, Dong Soon,Shim, Tae Sun,Lim, Chae-Man,Lee, Sang Do,Koh, Younsuck,Kim, Woo Sung,Kim, Won Dong,Jang, Se Jin,Colby, Thomas V. American College of Chest Physicians 2007 Chest Vol.132 No.1

<P>BACKGROUNDS: Acute exacerbation (AE) in idiopathic pulmonary fibrosis (IPF) is increasingly recognized as a relatively common and highly morbid clinical event. However, clinical data on AE in non-IPF interstitial pneumonia are sparse. This study was performed to find the frequency, clinical features, and outcome of AE in non-IPF interstitial pneumonia. METHODS: Retrospective analysis of 10 patients who satisfied the modified Akira criteria for AE during follow-up of 74 patients with surgical lung biopsy-confirmed idiopathic nonspecific interstitial pneumonia (I-NSIP) and 93 patients with biopsy-confirmed interstitial pneumonia associated with collagen vascular disease (CVD-IP). RESULTS: AE occurred in six patients with I-NSIP (1-year frequency, 4.2%) and in four patients with CVD-IP (rheumatoid arthritis [RA], n = 3; scleroderma, n = 1), with 1-year frequency of 3.3%. Median age was 58 years (range, 47 to 75); six patients were female. AE occurred in two patients immediately after surgical biopsy. Median duration of acute symptom before hospital admission was 10 days (range, 1 to 30). Median ratio of Pao(2) to the fraction of inspired oxygen (Fio(2)) was 172 (range, 107 to 273), and Pao(2)/Fio(2) ratio was < 200 in six patients. Surgical lung biopsy performed at the time of AE in two patients revealed diffuse alveolar damage superimposed on nonspecific interstitial pneumonia pattern. Four patients with I-NSIP survived to discharge and were followed up for 24 months (range, 6 to 121). CONCLUSION: AE occurred in the patients with I-NSIP with apparently better prognosis. In patients with CVD-IP, AE occurred mostly with RA-usual interstitial pneumonia in our small series with poor outcome.</P>

Poster Session : PS 1618 ; Mycobacterial Diseases : Buffalo Chest: A Case of Single Pleural Cavity as Sequela of Tuberculosis

( I Nae Park ),( Ho Kee Yum ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

In humans, both pleural cavities are completely separated by the mediastinum without anatomical communication in between. A single pleural space, resulting in pleuropleural communication between two normally separated pleural cavities, is very rare in humans and is often a corollary of heart-lung transplantation, major thoracic surgery, or a congenital anomaly. We present the case of a woman with a single pleural cavity who had never undergone thoracic surgery but who had a history of incompletely treated endobronchial tuberculosis. To our knowledge, this is the fi rst reported case of a single pleural cavity not associated with congenital anomaly or thoracic surgery.

A Case of Delayed Anaphylaxis with Severe but Temporary Muscle Weakness in All Four Limbs Following Influenza Vaccination

( I-nae Park ) 대한결핵 및 호흡기학회 2021 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.129 No.-

Post-vaccination acute-onset hypersensitivity reactions include self-limited localized adverse events and, rarely, systemic reactions ranging from urticaria to angioedema to anaphylaxis. We report a case of delayed anaphylaxis with severe but temporary muscle weakness in all four limbs 5 hours after influenza vaccination. A 37-year-old woman complained of sudden stabbing chest pain and breathing difficulty at home. When the 119-rescue team arrived, the patient was in drowsy mentality, making grunting sounds without a verbal response. On arrival at the emergency department, the patient had facial angioedema and upper airway swelling, but generalized hives were not observed. The motor powers of both limbs were measured as grade 1 by Medical Research Council scale. After acute management of anaphylaxis, she recovered gradually and was able to be discharged on the 7th day of hospitalization. This case is a reminder of the risk of vaccine-related anaphylaxis, which can occur several hours or more after vaccination.

Qualitative and quantitative results of interferon-γ release assays for monitoring the response to anti-tuberculosis treatment

( I-nae Park ),( Tae Sun Shim ) 대한내과학회 2017 The Korean Journal of Internal Medicine Vol.32 No.2

Background/Aims: The usefulness of interferon-γ release assays (IGRAs) in monitoring to responses to anti-tuberculosis (TB) treatment is controversial. We compared the results of two IGRAs before and after anti-TB treatment in same patients with active TB. Methods: From a retrospective review, we selected patients with active TB who underwent repeated QuantiFERON-TB Gold (QFN-Gold, Cellestis Limited) and T-SPOT.TB (Oxford Immunotec) assays before and after anti-TB treatment with first-line drugs. Both tests were performed prior to the start of anti-TB treatment or within 1 week after the start of anti-TB treatment and after completion of treatment. Results: A total of 33 active TB patients were included in the study. On the QFN-Gold test, at baseline, 23 cases (70%) were early secreted antigenic target 6-kDa protein 6 (ESAT-6) or culture filtrate protein 10 (CFP-10) positive. On the T-SPOT. TB test, at baseline, 31 cases (94%) were ESAT-6 or CFP-10 positive. Most of patients remained both test-positive after anti-TB treatment. Although changes in interferon-γ release responses over time were highly variable in both tests, there was a mean decline of 27 and 24 spot-forming counts for ESAT-6 and CFP-10, respectively on the T-SPOT.TB test (p < 0.05 for all). Conclusions: Although limited by the small number of patients and a short-term follow-up, there was significant decline in the quantitative result of the T-SPOT. TB test with treatment. However, both commercial IGRAs may not provide evidence regarding the cure of disease in Korea, a country where the prevalence of TB is within the intermediate range.

Thematic Poster : TP-78 ; Buffalo Chest: A Case of Single Pleural Cavity as Sequela of Tuberculosis

( I Nae Park ),( Ho Kee Yum ) 대한결핵 및 호흡기학회 2014 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.118 No.-

In humans, both pleural cavities are completely separated by the mediastinum without anatomical communication in between. A single pleural space, resulting in pleuropleural communication between two normally separated pleural cavities, is very rare in humans and is often a corollary of heart-lung transplantation, major thoracic surgery, or a congenital anomaly. We present the case of a woman with a single pleural cavity who had never undergone thoracic surgery but who had a history of incompletely treated endobronchial tuberculosis. To our knowledge, this is the first reported case of a single pleural cavity not associated with congenital anomaly or thoracic surgery.

A Single Hospital Closure and Quarantine record for 2 Weeks Due to One Case of COVID-19 Diagnosed during Hospitalization

( I-nae Park ),( Ho Kee Yum ) 대한결핵 및 호흡기학회 2020 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.128 No.0

After the mass outbreak in Daegu, residents or recent visitors to the Daegu-Gyeongbuk region were included in the COVID-19 epidemiological risk checklist. Our hospital also used checklist according to clinical and epidemiological criteria to evaluate the risk of COVID-19. Despite such efforts, a patient from the Daegu-Gyeongbuk region was hospitalized after filling out the questionnaire falsely at screening desk. The following is a record of the hospital's temporary closure due to one COVID-19 patient diagnosed during hospitalization. A patient in her late 70s was hospitalized in a 4-person hospital room on 6th floor for three weeks of nausea, vomiting, loss of appetite, and generalized weakness. In the CXR taken on the first day of hospitalization, lesions were not apparent except for suspicious subtle infiltration, but on the 4th day of hospitalization, although the patient herself said that she had a chronic cough caused by postnasal drip, other patients in the same room were concerned about her persistent cough, therefore a chest CT was taken in the evening. CT finding showed multifocal patchy GGO and consolidation of subpleural and peribronchial distribution in both lungs. On the morning of the 5th day of hospitalization, nasopharyngeal & oropharyngeal swabs and sputum test for COVID-19 were performed, and the result were both positive. The following is a flow diagram of the isolation and quarantine process at our hospital after in-hospital COVID-19 diagnosis (Figure 1). Although closing and isolating the hospital seemed to have played a useful role in preventing the spread of COVID-19 in-hospital and to the local community, it is questionable whether the hospital closure and the quarantine period continued unconditionally for two weeks was appropriate. It is important to prevent in-hospital infection, but it is also important that existing patients and non-COVID-19 patients can receive timely treatment without long-term entire hospital closure.

Regression of Primary Lung Carcinoma Following Novalis Radiosurgery for Brain Metastasis: A Case Report

( I-nae Park ) 대한결핵 및 호흡기학회 2021 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.129 No.-

Background The abscopal effect is a phenomenon which is probably associated with enhanced immune effect triggered by radiotherapy. Although abscopal effect has been documented in several types of cancer, it is a very rare phenomenon in non-small cell lung carcinoma (NSCLC). We present a 76-year-old male with brain metastasis from NSCLC who went into remission following Novalis radiosurgery treatment to a brain lesion, in the absence of systemic treatment. Case presentation A 76-year old man complained of cough, sputum and progressive dyspnea. Chest computed tomography (CT) scan revealed two well-defined 29mm and 12mm sized enhancing nodules in right lower lobe (RLL) and multiple enlarged nodes with internal dense calcifications in mediastinum. Lung biopsy revealed a moderately to poorly differentiated squamous cell carcinoma with positive for Programmed Death Ligand 1 (PDL1). .Positron emission tomography scan showed two hypermetabolic lung nodules in RLL and multiple lymph node enlargements with increased FDG uptake in mediastinum and cervical areas. Subsequently, a magnetic resonance imaging (MRI) of the brain was done for evaluation of metastasis. 2.3X2.1cm enhancing mass was noted at right parietal lobe with surrounding edema and another small metastasis at left occipital lobe was suggested. Due to poor performance and old age, the patient received Novalis radiosurgery to metastatic brain lesions without any form of systemic therapy. A follow-up outpatient chest CT scan was performed 3 and 6 months later, CT scans revealed the regression of lung nodules in RLL and marked decrease in the size of the multiple metastatic lymph nodes. Now he has survived more than two years since his initial diagnosis without recurrence of NSCLC. Conclusion Our case report confirms the existence of NSCLC. Also positivity for PDL1 might have contributed to remission in this patient.

True Understanding of Old Chosŏn

YOON NAE-HYUN(YUN NAE-HY?N),Yi H?i-chang(번역자) The Academy of Korean Studies 1987 Korea Journal Vol.27 No.12

Effect of Inhaled Tiotropium on Spirometric Parameters in Patients with Tuberculous Destroyed Lung

( Ho Kee Yum ),( I Nae Park ) 대한결핵 및 호흡기학회 2014 Tuberculosis and Respiratory Diseases Vol.77 No.4

Background: In Korea, patients with destroyed lung due to tuberculosis (TB) account for a significant portion of those affected by chronic pulmonary function impairment. The objective of our research was to evaluate the efficacy of inhaled tiotropium bromide in TB destroyed lung. Methods: We compared the effectiveness of inhaled tiotropium bromide for 2 months between pre- and post-treatment pulmonary function tests performed on 29 patients with destroyed lung due to TB. Results: The mean age of the total number of patients was 63±9 years, where 15 patients were male. The pre-treatment mean forced expiratory volume in 1 second (FEV1) was 1.02±0.31 L (44.1±16.0% predicted). The pre-treatment mean forced vital capacity (FVC) was 1.70±0.54 L (52.2±15.8% predicted). Overall, the change in FEV1% predicted over baseline with tiotropium was 19.5±19.1% (p<0.001). Twenty patients (72%) got better than a 10% increase in FEV1 over baseline with tiotropium, but one patient showed more than a 10% decrease in FEV1. Overall, the change in FVC% predicted over baseline with tiotropium was 18.5±19.9% (p<0.001). Seventeen patients (59%) experienced greater than a 10% increase in FVC over baseline with tiotropium; 12 (41%) patients had stable lung function. Conclusion: The inhaled tiotropium bromide therapy may lead to improve lung functions in patients with TB destroyed lung. However, the long-term effectiveness of this treatment still needs to be further assessed.

Effect of Inhaled Tiotropium on Spirometric Parameters in Patients with Tuberculous Destroyed Lung

Yum, Ho-Kee,Park, I-Nae The Korean Academy of Tuberculosis and Respiratory 2014 Tuberculosis and Respiratory Diseases Vol.77 No.4

Background: In Korea, patients with destroyed lung due to tuberculosis (TB) account for a significant portion of those affected by chronic pulmonary function impairment. The objective of our research was to evaluate the efficacy of inhaled tiotropium bromide in TB destroyed lung. Methods: We compared the effectiveness of inhaled tiotropium bromide for 2 months between pre- and post-treatment pulmonary function tests performed on 29 patients with destroyed lung due to TB. Results: The mean age of the total number of patients was $63{\pm}9$ years, where 15 patients were male. The pre-treatment mean forced expiratory volume in 1 second ($FEV_1$) was $1.02{\pm}0.31L$ ($44.1{\pm}16.0%$ predicted). The pre-treatment mean forced vital capacity (FVC) was $1.70{\pm}0.54L$ ($52.2{\pm}15.8%$ predicted). Overall, the change in $FEV_1%$ predicted over baseline with tiotropium was $19.5{\pm}19.1%$ (p<0.001). Twenty patients (72%) got better than a 10% increase in $FEV_1$ over baseline with tiotropium, but one patient showed more than a 10% decrease in $FEV_1$. Overall, the change in FVC% predicted over baseline with tiotropium was $18.5{\pm}19.9%$ (p<0.001). Seventeen patients (59%) experienced greater than a 10% increase in FVC over baseline with tiotropium; 12 (41%) patients had stable lung function. Conclusion: The inhaled tiotropium bromide therapy may lead to improve lung functions in patients with TB destroyed lung. However, the long-term effectiveness of this treatment still needs to be further assessed.