The Clinical Significance of Ventilator-Associated Event

심재겸,오지연,민경훈,허규영,이승룡,심재정,강경호 대한결핵 및 호흡기학회 2015 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.120 No.-

Introduction: The Centers for Disease Control and Prevention (CDC) proposed a new surveillance definition of ventilator-associated event (VAE). We investigated clinical characteristics of VAE. Method: We reviewed the medical records of patients who admitted to intensive care units (ICUs) from January 2013 to June 2014. Patients who were less than 18 or dependent on mechanical ventilation (MV) less than 2 calendar days were excluded. We checked the occurrence of VAE retrospectively and compared the groups with or without VAE. Result: Among 1031 episodes of MV, there were 92 ventilator-associated condition, 36 infection-related ventilator-associated complication, 11 possible ventilator associated pneumonia and 19 probable ventilator associated pneumonia. The median time to onset of VAE was 5 days. There was no significant difference in age, sex, Acute Physiology and Chronic Health Evaluation II score, and Charlson comorbidity index. We analyzed the primary causes of MV and classified them to 10 categories (central nervous system disorder, cardiovascular disorder, respiratory disease, severe sepsis or septic shock, gastrointestinal bleeding, renal disorder, trauma, post operative state, pulmonary edema and others). VAE was significantly higher in trauma and post operative patients. (p = 0.035 and p = 0.007). The VAE group was associated with longer MV day (5 days vs 12 days, p < 0.001), weaning failure (34.6% vs 75.0%, p < 0.001) and 30-day mortality (35.6% vs 74.2%, p < 0.001). Conclusion: The VAE was associated poor outcome.

Pulmonary Sarcoidosis Induced by Adalimumab: A Case Report and Literature Review

심재겸,강경호,이승룡,심재정 연세대학교의과대학 2016 Yonsei medical journal Vol.57 No.1

Not available

종격동 지방종증(Mediastinal Lipomatosis) 1예

심재겸,김세중,민병주,김제형,신철 대한내과학회 2011 대한내과학회 추계학술대회 Vol.2011 No.-

Two Cases of Diagnosis and Removal of Endobronchial Hamartoma by Cryotherapy via Flexible Bronchoscopy

심재겸,최종현,오지연,조재영,문을선,민혜숙,이병현,박민선,허규영,이승용,심재정,강경호,민경훈 대한결핵및호흡기학회 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.

Association between mechanical power and intensive care unit mortality in Korean patients under pressure-controlled ventilation

심재겸,이상민,강형구,김경찬,김영삼,김윤성,리원연,박성훈,박소영,박주희,Sim Yun Su,이광하,이연주,이진화,이흥범,임채만,최원일,홍지영,송원준,서지영 대한중환자의학회 2024 Acute and Critical Care Vol.39 No.1

Background: Mechanical power (MP), which integrates ventilator variables affecting ventilator-induced lung injury, has been reported to be associated with clinical outcomes. Because the original MP equation is derived from paralyzed patients under volume-controlled ventilation, its application in practice could be limited in patients receiving pressure-controlled ventilation (PCV). Recently, a simplified equation for patients under PCV was developed. We investigated the association between MP and intensive care unit (ICU) mortality.Methods: We conducted a retrospective analysis of Korean data from the Fourth International Study of Mechanical Ventilation. We extracted data of patients under PCV on day 1 and calculated MP using the following simplified equation: MPPCV=0.098 ∙ RR ∙ VT ∙ (ΔPinsp + PEEP). Patients were divided into survivors and non-survivors and then compared. Multivariable logistic regression was performed to determine association between MPPCV and ICU mortality. The interaction of MPPCV and use of neuromuscular blocking agent (NMBA) was also analyzed. Results: A total of 125 patients was eligible for final analysis, of whom 38 died in the ICU. MPPCV was higher in non-survivors (17.6 vs. 26.3 J/min, P<0.001). In logistic regression analysis, only MPPCV was significantly associated with ICU mortality (odds ratio, 1.090; 95% confidence interval, 1.029–1.155; P=0.003). There was no significant effect of the interaction between MPPCV and use of NMBA on ICU mortality (P=0.579).Conclusions: MPPCV is associated with ICU mortality in patients mechanically ventilated with PCV mode, regardless of NMBA use.

종격동 지방종증(Mediastinal lipomatosis) 1예

심재겸,김세중,민병주,김제형,신철 대한내과학회 2011 대한내과학회 추계학술발표논문집 Vol.2011 No.1

서론: 종격동 지방종증은 양성 질환으로 피막에 둘러싸이지 않은 지방 조직이 종격동 내에 축적되는 것으로 아직 국내 보고는 없다. 위험인 자로는 부신피질 스테로이드 복용, 쿠싱 증후군, 비만 등이 있다. 저자들은 흉부 불편감을 주소로 내원한 환자에서 종격동 지방종증 증례를 경험하였기에 보고하는 바이다. 증례: 30갑 년의 흡연력 있는 53세 남자가 내원 3주 전부터 발생한 흉부 불편감을 주소로 내원하였다. 신장 170 cm, 체중 70 kg, 체질량지수 24.2로 정상이었으며, 전립선비대증과 위궤양으로 약물 복용 중이었으나 스테로이드 복용력은 없었다. 이학 적 검진상 특이 소견 없었으며, 단순 흉부방사선과 흉부 전산화단층촬영에서 우측 전 종격동에 3.0 cm×1.9 cm 크기의 종양이 발견되었다. 종양은 불균질한 조영 증강을 보였고, 심장에 인접해있어 심막 침범이 의심되었다. 심전도 및 심장 초음파는 정상이었고, 복부 전산화단층촬 영 상 부신 등에 특이 소견 없었다. 림프암 등을 감별하기 위해 시행한 종양표지자 검사는 정상이었다. 진단 및 치료 목적으로 비디오 흉강경 하 절제술을 시행하였다. 수술 소견 상 늑강 내에 전반적인 유착이 있었고, 종양은 심장의 우심방에 유착되어 있었다. 비디오 흉강경 하 유착 박리술과 종양 절제술을 실시하였으며 수술 후 합병증은 없었다. 적출된 종양의 육안 소견상 피막에 싸이지 않은 노란색의 흐물흐물한 조직 이었으며 병리 소견 상 흉선 세포 없이 지방 세포와 소수의 혈관으로 이루어진 지방종증으로 최종 진단하였다. 고찰: 종격동 지방종증은 호흡곤란, 흉통을 일으키기도 하나 대부분 무증상이며 단순 흉부방사선 이상 소견으로 우연히 발견된다. 이 자체로는 악성화 가능성은 없지만 흉선종 및 림프암 등과 구별하기 위하여 조직 검사를 통한 정확한 진단을 내리는 것이 중요하다. 수술적 절제 후 재발은 드물어 예후는 양호하다. 종격동 종양이 발견되었을 때 흉선종, 림프종 등 흔한 질환들 이외에도, 감별 진단으로서 드물지만 지방종증에 대한 고려가 필요할 것으로 판단된다.

The Overlap Syndrome of Asthma and COPD: Its Prevalence and Clinical Characteristics

심재겸,민경훈,허규영,심재정,강경호 대한결핵 및 호흡기학회 2012 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.114 No.-

Background: Although asthma and COPD have been accepted as different diseases, many elderly patients show clinical features of both asthma and COPD, so called "overlap syndrome". The purpose of our study was to examine the prevalence and clinical characteristics of the overlap syndrome (OS). Methods: We conducted a retrospective survey of patients above 40 years who had visited our hospital from January 2005 to June 2009 because of obstructive lung disease. Patients with structural lung disease were excluded and patients with short follow-up duration were excluded. Based on lung function profile, we classified subjects into COPD and OS groups, and analyzed their prevalence, demographics and lung function. Results: 2,105 subjects were included. 240 (11.4%) and 630 (29.9%) were found to have OS and COPD, respectively. The mean age was similar in both group (66.40 years vs 67.67 years, P=0.553) but age of symptom onset was earlier in OS group than COPD group (38.42 years vs 58.17 years, P<0.001). OS group showed lower baseline postbronchodilator FEV1 than COPD group (50.88% vs 57.65%, P=0.04). After additional treatment with tiotropium, OS and COPD groups showed significant improvement of postbronchodilator FEV1 (5.50%, P=0.012; 7.68%, P=.0.000). Conclusion: Certain proportion of aged patients have overlap syndrome. Although their symptom develops earlier and baseline lung function is worse, intensive treatment can improve lung function.

A Case of IgG4-related Disease Presenting as Massive Pleural Effusion and Thrombophlebitis

심재겸,최종현,오지연,이은정,이승현,민경훈,이승헌,이은주,허규영,이승룡,이상엽,김제형,신철,심재정,인광호,강경호 대한결핵 및 호흡기학회 2012 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.114 No.-

IgG4-related disease is a newly recognized fibroinflammatory condition characterized by tumefactive lesions, a dense lym-phoplasmacytic infiltrate rich in IgG4-positive plasma cells, storiform fibrosis, and, often but not always, elevated serum IgG4 concentrations. The disease can either be localized to one or two organs, or be present with diffuse multi-organ disease. In the thorax, 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. A 48-year-old man was admitted to our hospital complaining of fever, chills, sweating, and dyspnea. He has a history of admission for evaluation and management of suggested deep neck infection with small amount of left pleural effusion. On physical examination, he showed generalized edematous appearance with venous engorgement of neck and upper chest. Chest X-ray and Chest CT showed thrombophlebitis at left innominate vein, subclavian vein and left internal jugular vein and enlarged lymph node at left neck and axillar area with both pleural effusion and ascites. Pleural fluid analysis showed lymphocyte predominant exudates nature. Pleural biopsy showed chronic inflammation with lymphoplasmacytic infiltration and fibrosis. The ratio of IgG4-positive to IgG-positive plasma cells in specimen was 23%. Serum IgG4 level was 248 mg/dL. He showed symptomatic and radiographic improvement after systemic steroid therapy with anticoagulation.

Clincial characteristics of pulmonary sarcomatoid carcinoma

심재겸,오지연,민경훈,허규영,이승헌,이승룡,김제형,심재정,강경호 대한결핵 및 호흡기학회 2015 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.120 No.-

Introduction: Pulmonary sarcomatoid carcinoma (PSC) is poorly differentiated non small cell lung cancer with spindle cell or giant cell. There is insufficient data regarding them. Method: We reviewed the medical records of patients diagnosed with PSC from January 2009 to February 2015. We analyzed the clinical features, treatment response and prognosis. Result: We investigated 23 patients with median age of 66 years. 20 patients were male. Initial presentation included respiratory symptom (11), cancer-related pain (5), constitutional symptom (2). 5 patients were presented with abnormal chest image. 14 patients were current or ex-smokers. 12 patients had primary lesion on right upper lobe, 5 on left upper lobe, 3 on right and left lower lobes. 18 patients were in stage IV at the time of diagnosis. Epidermal growth factor receptor (EGFR) mutation test was conducted in 11 patients and 2 were positive. The primary treatment was palliative chemotherapy (11), curative surgery (5), curative radiation therapy (1) and best supportive care (6). Platinum-based doublet regimen was selected as first line in 8 patients. 2 patients with EGFR mutation were treated with tyrosine kinase inhibitor. We assessed the best response of first line therapy and found that 2 and 3 patients showed partial response and stable disease. The overall survival of all patients were 508 days and the progression free survival of patients with first line chemotherapy was 53 days. Conclusion: PSC patients had fair prognsois.However, response to chemotherapy was unfavorable.

하얀 피부 검은 가면: 1960년대 미국 화이트팬더당과 ‘문화혁명’

심재겸(Shim, Jae Kyom) 한국대중음악학회 2012 대중음악 Vol.- No.10

아마도 1960년대는 미국 현대사에서 가장 소란스러웠던 시기로 기억될 것이다. 존 F. 케네디 암살의 충격과 함께 시작된 1960년대는 도저히 종잡을 수 없는 폭력과 좌절의 사건들로 가득 차 있는 것처럼 보인다. 하지만 미국의 1960년대는 단지 사건의 나열만으로는 이해할 수 없다. 보다 넓은 맥락에서 본다면, 1960년대 미국의 대중운동은 이미 1950년대에 완성된 현대 대중사회와 소비자본주의에 대한 반발이었다. 1960년대 운동의 지도자들은 사회를 변혁하기 위해 투쟁해야 할 대상이 바로 문화의 영역에 있다고 주장하였다. 그래서 그들은 자본주의적 인간형에 대항하여 새로운 인간형의 창출을 추구했다. 그것은 노먼 메일러가 ‘화이트니그로(The White Negro)’라 부른 백인성과 흑인성의 혼효였다. 1960년대의 청년들은 백인적인 것을 분리, 경쟁, 개인주의, 획일성을 표상하는 것으로 인식한 반면, 흑인적인 것은 백인의 서구문명이 잃어버린 자연성과 공동체 정신을 간직하는 것처럼 보았다. 흑인성에 대한 인종적 구축은 흑인적 퍼포먼스, 감정, 그리고 그 신체가 백인 중심의 사회에서 표상하는 부정, 불순, 자연을 형상화한다. 그것은 서구 지적 전통의 과학적 합리적 사고와 이항대립적으로 구성되는 ‘원시주의(primitivism)의 스펙터클’이었다. 그런 점에서 백인 로큰롤이 흑인성을 전유하는 것은 백인과 흑인, 그리고 우월과 열등의 위계를 전복하면서 독특한 반사회적 미학을 구축하는 것이었다. 백인 10대들은 흑인음악을 듣고, 흑인음악을 연주하면서 소외와 고립을 극복한 ‘화이트니그로’가 되고싶었다. 그들은 억압적인 기성사회로부터 이탈하여 자신만의 국가를 만들고자 하였다. 시어도어 로작이 이름 붙인 ‘대항문화(counterculture)’는 바로 그 ‘국가’의 문화였으며, 로큰롤은 문화혁명의 가장 강력한 첨병이 되었다. This article examines the White Panther Party (WPP) in Detroit in 1960s and their idea of “Cultural Revolution.” America in 1960s is the period of material prosperity and spiritual poverty. In wild waves of “Sixties” movement, counterculture, including John Sinclair and WPP, protested this contradiction of modern America society. Rock‘n’roll, including MC5, can be seen as an outgrowth of the moment in history when the significance of Fordism shifted from representing the American Dream to standing for the failure of it. For white youth, life under the Fordism meant not only the legacy of affluent society, but the hopeless future of it at once. Rock‘n’roll of MC5 did not simply reproduce the sensibility of white labor class, but rather stood as an attempt to turn the logic against itself. In politics of ‘Noise,’ WPP tried to liberate the life itself by rock‘n’roll which is conflicting mixture of “Whiteness” and “Blackness.” In high-decibel sound expanded by technology, there was only peaceful coexistence without separation and isolation. However, the change from “drop out” to “take over” should be considered as another eclecticism borrowing Marx-Leninist and Maoism revolutionary politics alike they adopted sources from diverse cultural style. It seems that this eclecticism brought only contradiction and rupture. On the one hand, WPP was attacked by FBI and police for their “radical militancy,” MC5 began to grow tired of WPP’s increasing political gestures and dropped out from WPP on the other hand. Finally, WPP was disorganized due to not only external oppression, but internal rupture.