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한 대학병원 내과계중환자실에서 장기간 기계 환기를 받은 환자들의 3년 예후
전규락 ( Gyu Rak Chon ),최익수 ( Ik Su Choi ),임채만 ( Chae Man Lim ),고윤석 ( Youn Suck Koh ),오연목 ( Yeon Mok Oh ),심태선 ( Tae Sun Shim ),이상도 ( Sang Do Lee ),김우성 ( Woo Sung Kim ),김동순 ( Dong Soon Kim ),김원동 ( Won Don 대한결핵 및 호흡기학회 2007 Tuberculosis and Respiratory Diseases Vol.62 No.5
연구배경: 내과계중환자실에서 72시간 이상 장기간 기계 환기를 받은 환자들의 자료가 부족하여 기저질환별, 기계 환기가 필요했던 원인질환별로 장기 예후를 관찰하며, 또한 1년째에는 삶의 질 평가를 같이 수행하여 이 환자들의 삶의 질 상태를 평가 하고자 하였다. 방법: 2003년 3월부터 2003년 7월까지 서울아산병원 내과계중환자실에서 72시간 이상 기계 환기치료를 받은 환자 73명을 대상으로 1, 3, 6, 12, 24, 36개월 생존율을 전향적으로 관찰하고 1년 생존자를 대상으로 Short Form 36(SF-36)을 이용하여 삶의 질을 측정하였다. 결과: 대상 환자들의 1개월 생존율은 54.8%(40/73), 3개월 생존율은 39.7%(29/73), 6개월 생존율은 30.1% (22/73), 12개월 생존율은 20.5%(15/73), 24개월 생존율은 18.3%(13/71), 그리고 36개월 생존율은 16.9% (12/71)이었다. 3년간 생존율은 기계 환기가 필요했던 원인질환별로는 차이가 없었고, 기저질환별로는 신생물 또는 만성간질환이 만성폐질환이나 만성신장질환에 비해 예후가 불량하였다(p<0.05). SF-36을 이용한 삶의 질 평가에서 정상 대조군과 비교 시 정신적 건강영역에서 Role limiting due to emotional problem을 제외하고 모두 낮은 값을 보였다. 결론: 한 대학병원 내과계중환자실에서 72시간 이상 장기간 기계 환기를 받은 환자들의 3년간 생존율은 낮았으며, 12개월까지 지속적으로 낮아지나 12개월부터 36개월까지는 유지되었다. 1년 시점에서 삶의 질 평가 시 이 환자들의 삶의 질 상태가 낮음을 보여주었다. Background: There is little data on the 3 year prognosis and quality of life of patients on long-term (>72 hour) mechanical ventilation in a medical intensive care unit (MICU). Methods: Patients with long-term mechanical ventilation from May 2003 through July 2003 in MICU of Asan Medical Center, Seoul were enrolled in this studay. The survival rates were observed prospectively at 1, 3, 6, 12, 24, 36 months, and the quality of life of survivor was measured at 12 months by using Short Form 36 (SF-36). Results: The survival rate at 1, 3, 6, 12, 24 and 36 months was 54.8% (40/73), 39.7% (29/73), 30.1% (22/73), 20.5% (15/73), 18.3% (13/71) and 16.9% (12/71), respectively. There was a similar survival rate regardless of the diseases that required mechanical ventilation. A neoplasm or chronic liver disease had a worse survival rate than chronic lung or kidney disease (p<0.05). Each SF-36 domain except for the Role-emotional was inferior to the general population. Conclusions: The survival rate of patients with mechanical ventilation more than 72 hours is decreases continuously until 12 months but is relatively constant from 12 to 36 months. In these patients quality of life is also decrased. (Tuberc Respir Dis 2007; 62: 398-405)
심폐소생술과 제세동 후에 발생한 횡문근융해증 환자에서 지속적 신대체요법 중 발생한 고칼슘혈증의 성공적인 치료
박지민 ( Jee Min Park ),전규락 ( Gyu Rak Chon ),왕준호 ( Jun Ho Wang ),이태의 ( Tae Ui Lee ),이우성 ( Woo Sung Lee ) 대한신장학회 2009 Kidney Research and Clinical Practice Vol.28 No.5
Rhabdomyolysis is a common clinical and laboratory syndrome resulting from reversible skeletal muscle injury, with release of muscle cell contents into the plasma. Cardioversion, and cardiopulmonary resuscitation may produce rhabdomyolysis and myoglobinuria. We report a 5-year-old boy surviving after cardiopulmonary resuscitation and repeated 5 times of cardioversion. He showed elevated serum BUN and creatinine levels, requiring hemodialysis treatment. We had tried 5 times of intermittent hemodialysis, but oliguria was continued and there was no change of serum BUN and creatinine. His urine output was less than 100 cc per day and he showed severe edema and weight gain of 7 kg, and so we started the continuous renal replacement therapy (Prismaflex(R), gambro). After 12 days of continuous venovenous hemodiafiltration (CVVHDF), his urine output recovered and his BUN, creatinine, liver enzyme, creatine kinase, and lactate dehydrogenase levels returned to normal. During the treatment of CVVHDF, he had shown persistent hypercalcemia, and so we changed dialysate and replacement solution from hemosol B0 to calcium free solution. The hypercalcemia was controlled successfully using this calcium free pharmacy-made bicarbonate solution.
각종 간질환에서 혈청 Antithrombin 3 활성도 측정의 임상적 의의
신요식(Yo Sig Shin),백운희(Won Hee Baek),임수진(Su Jin Im),전규락(Gyu Rak Chon),김영욱(Young Wook Kim),김준형(Jun Hyoung Kim),박상준(Sang Joon Park),김윤권(Yun Kwon Kim),김소연(So Yon Kim),김영중(Young Jung Kim),조민구(Min Koo Cho),이 대한내과학회 2002 대한내과학회지 Vol.63 No.4
Background : Antithrombin III (AT-III) produced from hepatocytes and endothelial cells is a coagulation inhibitor. The authors investigated the activity levels of AT-III in patients with liver disease and attempt to elucidate the clinical significance of activity levels of AT-III in relation to various liver disease. Methods : This study includes 158 patients with liver disease, who visited the National Police Hospital between October 1997 and March 2002. We performed laboratory tests such as LFT, AFP and either abdominal sonography or abdominal CT. At the same time, AT-III activity levels was measured by chromogenic method using ACL 3000 (IL, Lexington, USA). AT-III activity level of 70∼120% was regarded as normal. Results : AT-III activity level of liver cirrhosis patients was decreased along with severity of the disease evaluated by Child-Pugh Classification. AT-III activity level of liver cirrhosis patients and hepatocellular carcinoma patients with liver cirrhosis, whose serum AFP were within normal limits, were 50.11±2.86% and 75.58±6.61%, respectively. The difference between the two groups was statistically significant (p<0.001). Conclusion : Considering the results of the decrease of AT-III activity level in liver cirrhosis patients and the increase in hepatocellular carcinoma patients with liver cirrhosis, further evaluation for the possibility of hepatocellular carcinoma in liver cirrhosis patients without decrease of AT-III level or increase of AFP, may be in need.(Korean J Med 63:379-385, 2002)
김경곤 ( Kyong Gon Kim ),김준형 ( Jun Hyung Kim ),김성민 ( Song Min Kim ),전규락 ( Gyu Rak Chon ),김영욱 ( Young Wook Kim ),이호학 ( Ho Hak Lee ),박상준 ( Sang Joon Park ),김윤권 ( Yun Kwon Kim ),김소연 ( So Yon Kim ),김영중 ( You 대한내과학회 2002 대한내과학회지 Vol.63 No.6
Background: It is important to recognize rhabdomyolysis in clinical settings, because 10∼30% of rhabdomyolysis patients develop acute renal failure as a complication and patients with such complication have risk of high mortality. Recently, there have bee
폐종괴와 기관지 탄분섬유화로 발현한 Mycobacterium kansasii 감염
나승원 ( Seung Won Ra ),이광하 ( Kwang Ha Lee ),정주영 ( Ju Young Jung ),강호석 ( Ho Suk Kang ),박이내 ( I Nae Park ),최혜숙 ( Hye Sook Choi ),정훈 ( Hoon Jung ),전규락 ( Gyu Rak Chon ),심태선 ( Tae Sun Shim ) 대한결핵 및 호흡기학회 2006 Tuberculosis and Respiratory Diseases Vol.60 No.4
The incidence of Mycobacterium kansasii pulmonary diseases are on the increase in Korea with the higher probability of occurrence in middle-aged and older men with underlying lung diseases Among nontuberculosus mycobacterial (NTM) infections, the clinical features of M. kansasii pulmonary infection are most similar to those of tuberculosis (TB). The chest radiographic findings of M. kansasii infection are almost indistinguishable from those of M. tuberculosis (predthin-walled and have less surrounding infiltration than those of typical TB lesions. Although there are reports on the rare manifestations of M. kansasii infections, such as endobronchial ulcer, arthritis, empyema, cutaneous and mediastinal lymphadenitis, cellulites and osteomyelitis, the association with bronchial anthracofibrosis has not yet been reported. This report describes the first case of M. kansasii infection presenting as a lung mass in the right lower lobe with accompanying bronchial anthracofibrosis.(Tuberc Respir Dis 2006; 60: 464-468)
천식환자 및 만성 폐쇄성 폐질환환자군에서 연간 최대 호기유속의 변화량
홍성철 ( Sung Chul Hong ),이초이 ( Choi Lee ),한장수 ( Jang Soo Han ),김원동 ( Won Dong Kim ),이계영 ( Kye Young Lee ),김순종 ( Sun Jong Kim ),김희정 ( Hee Joung Kim ),하경원 ( Kyoung Won Ha ),전규락 ( Gyu Rak Chon ),유광하 ( Kwan 대한결핵 및 호흡기학회 2012 Tuberculosis and Respiratory Diseases Vol.72 No.1
Measurement of peak expiratory flow rate (PEFR) in a follow-up examination for a chronic airway disease is useful because it has the advantages of being a simple measurement and can be repeated during examination. The aim of this study was to examine the annual decrease of PEFR in asthma and chronic obstructive pulmonary disease (COPD) patients and to confirm the factors which influence this decrease. From May, 2003 to September, 2010, the annual decrease of PEFR was obtained from asthma and COPD patients attending an outpatient pulmonary clinic. PEFR was measured using a Mini-Wright peak flow meter (Clement Clarke International Ltd. UK), and we conducted an analysis of factors that influence the change of PEFR and its average values. The results showed an annual decrease of 1.70±12.86 L/min the asthmatic patients and an annual decrease of 10.3±7.32 L/min in the COPD patients. Age and FEV1 were the predictive factors influencing change in asthma, and FEV1 and smoking were the predictive factors influencing change in COPD. Conclusion: We confirmed the annual decreasing PEFR in patients with chronic airway disease and identified factors that work in conjunction with FEV1 to influence the change.
박유진 ( Eu Gene Park ),박중희 ( Jung Hee Park ),홍미진 ( Mi Jin Hong ),김원동 ( Won Dong Kim ),이계영 ( Kye Young Lee ),김순종 ( Sun Jong Kim ),김희정 ( Hee Joung Kim ),하경원 ( Kyoung Won Ha ),전규락 ( Gyu Rak Chon ),김현애 ( Hy 대한결핵 및 호흡기학회 2011 Tuberculosis and Respiratory Diseases Vol.71 No.1
Background: Pneumonia is commonly seen in outpatient clinics. it is widely known as the most common cause of death from infectious disease. Pneumonia has been diagnosed by its typical symptoms, chest X-ray and blood tests. However, both chest X-rays and blood tests have limitations in diagnosis. Thus primary care clinicians usually have been constrained due to a lack of adequate diagnostic tools. Vibration response imaging (VRI) is a newly emerging diagnostic modality, and its procedure is non-invasive, radiation-free, and easy to handle. This study was designed to evaluate the diagnostic usefulness of the VRI test among pneumonia patients and to consider its correlation with other conventional tests such as Chest X-ray, laboratory tests and clinical symptoms. Methods: VRI was performed in 46 patients diagnosed with pneumonia in Konkuk University Medical Center. VRI was assessed in a private and quiet room twice: before and after the treatment. Sensors for VRI were placed on a patient`s back at regular intervals; they detected pulmonary vibration energy produced when respiration occurred and presented as specific images. Any modifications either in chest X-ray, C-reactive protein (CRP), white blood cell count (WBC) or body temperature were compared with changes in VRI image during a given time course. Results: VRI, chest X-ray and CRP scores were significantly improved after treatment. Correlation between VRI and other tests was not clearly indicated among all patients. But relatively severe pneumonia patients showed correlations between VRI and chest X-ray, as well as between VRI and CRP. Conclusion: This study demonstrates that VRI can be safely applied to patients with pneumonia.