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결핵성 파괴폐의 흉부 전산화단층촬영 소견 및 폐기능과의 상관관계
채진녕 ( Jin Nyeong Chae ),정치영 ( Chi Young Jung ),심상우 ( Sang Woo Shim ),노병학 ( Byung Hak Rho ),전영준 ( Young June Jeon ) 대한결핵 및 호흡기학회 2011 Tuberculosis and Respiratory Diseases Vol.71 No.3
Background: A tuberculous destroyed lung is sequelae of pulmonary tuberculosis and causes various respiratory symptoms and pulmonary dysfunction. The patients with a tuberculous destroyed lung account for a significant portion of those with chronic lung disease in Korea. However, few reports can be found in the literature. We investigated the computed tomography (CT) findings in a tuberculous destroyed lung and the correlation with lung function. Methods: A retrospective analysis was carried out for 44 patients who were diagnosed with a tuberculous destroyed lung at the Keimyung University Dongsan Hospital between January 2004 and December 2009. Results: A chest CT scan showed various thoracic sequelae of tuberculosis. In lung parenchymal lesions, there were cicatrization atelectasis in 37 cases (84.1%) and emphysema in 13 cases. Bronchiectasis (n=39, 88.6%) was most commonly found in airway lesions. The mean number of destroyed bronchopulmonary segments was 7.7 (range, 4~14). The most common injured segment was the apicoposterior segment of the left upper lobe (n=36, 81.8%). In the pulmonary function test, obstructive ventilatory defects were observed in 31 cases (70.5%), followed by a mixed (n=7) and restrictive ventilatory defect (n=5). The number of destroyed bronchopulmonary segments showed a significant negative correlation with forced vital capacity (FVC), % predicted (r=?0.379, p=0.001) and forced expiratory volume in one second (FEV1), % predicted (r= ?0.349, p=0.020). After adjustment for age and smoking status (pack-years), the number of destroyed segments also showed a significant negative correlation with FVC, % predicted (B=?0.070, p=0.014) and FEV1, % predicted (B=?0.050, p=0.022). Conclusion: Tuberculous destroyed lungs commonly showed obstructive ventilatory defects, possibly due to bronchiectasis and emphysema. There was negative correlation between the extent of destruction and lung function.
한 대학병원에서 급성 폐색전증으로 진단된 환자들의 임상적 특성 및 예후
채진녕 ( Jin Nyeong Chae ),최원일 ( Won Il Choi ),박지혜 ( Jie Hae Park ),조병학 ( Byung Hak Rho ),김재범 ( Jae Bum Kim ) 대한결핵 및 호흡기학회 2010 Tuberculosis and Respiratory Diseases Vol.68 No.3
Background: Pulmonary embolism (PE) is a common clinical problem in the West that is associated with substantial morbidity and mortality. The diagnostic modality has been changed since 2001. This study retrospectively reviewed the PE mortality with the aim of identifying the risk factors associated with mortality since the multidetector computed tomography (MDCT) was introduced. Methods: We analyzed 105 patients with acute PE proven by multidetector CT or ventilation perfusion scan. The primary outcome measure was the all-cause mortality at 3 months. The prognostic effect of the baseline factors on survival was assessed by multivariate analysis. Results: The main risk factors were prolonged immobilization, stroke, cancer and obesity. Forty nine percent of patients had 3 or more risk factors. The overall mortality at 3 months was 18.1%. Multivariate analysis revealed low diastolic blood pressure and the existence of cancer to be independent factors significantly associated with mortality. Forty two PE patients were examined for the coagulation inhibitors. Four of these patients had a protein C deficiency (9.5%), and 11 had a protein S deficiency (26%). Conclusion: PE is an important clinical problem with a high mortality rate. Close monitoring may be necessary in patients with the risk factors.
폐색전증 환자에서 발견된 Factor VII 유전자의 프로모터 -401G/A 다형성 1예
민보람,김신,박지혜,채진녕,최원일,Min, Bo Ram,Kim, Shin,Park, Ji Hae,Chae, Jin Nyeong,Choi, Won Il 대한결핵및호흡기학회 2008 Tuberculosis and Respiratory Diseases Vol.64 No.6
저자들은 저자들은 폐색전증이 발생한 환자에서 기저질환을 조사하던 중 Factor VII 활성도 저하를 관찰하였고, 이 환자에게서 Factor VII 유전자의 프로모터 -401의 단염기 치환($G{\rightarrow}A$)을 발견하여 보고하며, 국내에도 Factor VII 유전자 다형성이 존재함을 밝히며, Factor VII 활성도 감소와 폐색전증이 동반된 환자를 보고하는 바이다. A factor VII gene -401 G/A polymorphism was identified in a patient with a pulmonary embolism. The patient was a 71-year-old woman who presented with acute-onset dyspnea. A chest CT scan revealed a pulmonary embolism. Despite the administration of low-dose warfarin as anticoagulation therapy, there was an excessively prolonged prothrombin time (PT). The blood tests revealed lower factor VII activity than normal. Full factor VII gene sequencing revealed a G to A substitution at -401 in the promoter region. There were no other gene sequence anomalies. PCR-based analysis indicated lower factor VII gene expression in the patient than in a control subject. The data suggested the promoter polymorphism to be responsible for the lower transcription level. In conclusion, we encountered a case of Factor VII DNA polymorphism in a patient with a pulmonary embolism showing significantly reduced Factor VII activity.
호흡기내과 의사를 위한 Respiratory Review of 2010
박지혜 ( Jie Hae Park ),채진녕 ( Jin Nyeong Chae ),최원일 ( Won Il Choi ) 대한결핵 및 호흡기학회 2010 Tuberculosis and Respiratory Diseases Vol.69 No.2
The year of 2009~2010 brought a number of concepts and new ideas were evaluated with promising results. However, some studies that challenged many beliefs. In acute respiratory distress syndrome (ARDS), recent clinical studies took into consideration of pathophysiologic changes of respiratory system compliance. Meta-analysis of positive end-expiratory pressure trials showed survival benefit of high positive end-expiratory pressure in ARDS. Until now, prone positioning did not show survival benefit in patients with ARDS. Extracorporeal membrane oxygenation (ECMO) based management improved survival in patients with severe ARDS. ECMO can be a management option in severe ARDS. Sedation is a standard practice in critically ill patients needing mechanical ventilation. However, Danish group reported less sedation of critically ill patients receiving mechanical ventilation was associated with an increase in days without ventilation. Although this single center study has some limitations, the overall results are promising. Use of maximal sterile barrier precautions (mask, sterile gown, sterile gloves, and large sterile drapes) with chlorhexidine-impregnated dressing reduced central venous catheter related infection. Selective oropharyngeal decontamination (application of topical antibiotics in the oropharynx) reduced the mortality rate of an intensive care unit (ICU) population. Normoglycemia in Intensive Care Evaluation and Survival Using Glucose Algorithm Regulation (NICE-SUGAR) trial reported intensive glucose control increased mortality among adults in the ICU. Some of the results of above papers are promising. However, some ideas may need for more frequent individual assessment and increase the workload of ICU staffs. Before implementation of new practice in ICU, we should take into consideration of individual hospital situation including human and material resources.
가로방향척수염으로 발현된 Churg-Strauss 증후군
조용원 ( Yong Won Cho ),장혁원 ( Hyuk Won Chang ),채진녕 ( Jin Nyeong Chae ),김상현 ( Sang Hyon Kim ) 대한류마티스학회 2009 대한류마티스학회지 Vol.16 No.4
Churg-Strauss syndrome (CSS), also known as allergic granulomatous angiitis, is a rare disorder characterized by the presence of asthma, eosinophilia and small-to-medium-sized vessels vasculitis. The peripheral nervous system is frequently involved in CSS, but central nervous system (CNS) involvement is rare. Furthermore, transverse myelitis (TM) as a presenting symptom in patients with CSS is extremely rare. We report here on a 60-year-old female who presented peripheral eosinophilia, lung eosinophilic infiltration, lung vasculitis, and TM. She was diagnosed as CSS based on clinical manifestation, pathologic findings, and the use of magnetic resonance imaging (MRI).
폐색전증 환자에서 발견된 Factor 7 유전자의 프로모터 -401G/A 다형성
민보람 ( Bo Ram Min ),김신 ( Shin Kim ),박지혜 ( Ji Hae Park ),채진녕 ( Jin Nyeong Chae ),최원일 ( Won Il Choi ) 대한결핵 및 호흡기학회 2008 Tuberculosis and Respiratory Diseases Vol.64 No.6
A factor VII gene -401 G/A polymorphism was identified in a patient with a pulmonary embolism. The patient was a 71-year-old woman who presented with acute-onset dyspnea. A chest CT scan revealed a pulmonary embolism. Despite the administration of low-dose warfarin as anticoagulation therapy, there was an excessively prolonged prothrombin time (PT). The blood tests revealed lower factor VII activity than normal. Full factor VII gene sequencing revealed a G to A substitution at -401 in the promoter region. There were no other gene sequence anomalies. PCR-based analysis indicated lower factor VII gene expression in the patient than in a control subject. The data suggested the promoter polymorphism to be responsible for the lower transcription level. In conclusion, we encountered a case of Factor VII DNA polymorphism in a patient with a pulmonary embolism showing significantly reduced Factor VII activity.
만성 폐쇄성 폐질환(COPD) 환자에서 운동 시 발생하는 산소 불포화 반응과 관련된 인자
심상우 ( Sang Woo Shim ),조준연 ( Jun Yeon Jo ),권용식 ( Yong Sik Kwon ),채진녕 ( Jin Nyeong Chae ),박지혜 ( Jie Hae Park ),이미영 ( Mi Young Lee ),노병학 ( Byung Hak Rho ),최원일 ( Won Il Choi ) 대한결핵 및 호흡기학회 2011 Tuberculosis and Respiratory Diseases Vol.70 No.6
Background: The causes of exertional desaturation in patients with COPD can be multifactorial. We aimed to investigate factors predict exertional desaturation in patients with moderate to severe COPD. Methods: We tested 51 consecutive patients with stable COPD (FEV1/FVC, 40±13% predicted). Patients performed a six minute walk test (6MWT). Pulse oxymetric saturation (SpO2) and pulse rate were recorded. Results: Oxygen desaturation was found in 15 subjects after 6MWT, while 36 subjects were not desaturated. Lung diffusing capacity was significantly lower in desaturation (DS) group (62±18% predicted) compared with not desaturated (ND) group (84±20, p<0.01). However there was no statistical difference of FEV1/FVC ratio or residual volume between two groups. The pulse rate change was significantly higher in the desaturated compared with the not desaturated group. Six minute walking distance, subjective dyspnea scale, airflow obstruction, and residual volume did not predict exertional oxygen desaturation. Independent factors assessed by multiple logistic regression revealed that a pulse rate increment (odd ratio [OR], 1.19; 95% confidence interval [CI], 1.01~1.40; p=0.02), a decrease in baseline PaO2 (OR, 1.105; 95% CI, 1.003~1.218; p=0.04) and a decrease in lung diffusing capacity (OR, 1.10; 95% CI, 1.01~1.19; p=0.01) were significantly associated with oxygen desaturation. Receiver operator characteristic (ROC) analysis showed that an absolute increment in pulse rate of 16/min gave optimal discrimination between desaturated and not desaturated patients after 6MWT. Conclusion: Pulse rate increment and diffusion capacity can predict exertional oxygen desaturation in stable COPD patients with moderate to severe airflow obstruction.
조철현 ( Chul Hyun Cho ),김범수 ( Beom Soo Kim ),배기철 ( Ki Cheor Bae ),채진녕 ( Jin Nyeong Chae ),김상현 ( Sang Hyon Kim ) 대한류마티스학회 2012 대한류마티스학회지 Vol.19 No.6
Ulnar neuropathy around the elbow in patients with rheumatoid arthritis can occur by synovial invasion, flexion contracture or valgus deformity of the elbow. However, attritional rupture of the ulnar nerve by medial osteophyte with synovial invasion of the rheumatoid elbow is extremely rare. We reported a case of attritional rupture of the ulnar nerve by medial osteophyte in 62 years-old male with rheumatoid arthritis. Exact diagnosis and proper treatment are required if symptoms of ulnar neuropathy present in rheumatoid arthritis with contracture and valgus deformity of the elbow.
폐색전증이 의심된 환자에서 두 가지 폐색전증 진단 예측 모형의 평가
박재석 ( Jae Seok Park ),최원일 ( Won Il Choi ),민보람 ( Bo Ram Min ),박지혜 ( Jie Hae Park ),채진녕 ( Jin Nyeong Chae ),전영준 ( Young June Jeon ),유호정 ( Ho Jung Yu ),김지영 ( Ji Young Kim ),김경주 ( Gyoung Ju Kim ),고성민 ( Su 대한결핵 및 호흡기학회 2008 Tuberculosis and Respiratory Diseases Vol.64 No.4