A Case of Pleural Paragonimiasis Confused with Tuberculous Pleurisy

송준휘,고원중,홍구현,송재욱,김우열,한서구,고유상,장복순,정병호,엄중섭,이지현,전병우,전경만,김홍관 대한결핵및호흡기학회 2014 Tuberculosis and Respiratory Diseases Vol.76 No.4

Here, we report a case of pleural paragonimiasis that was confused with tuberculous pleurisy. A 38-year-old man complained of a mild febrile sensation and pleuritic chest pain. Radiologic findings showed right pleural effusion with pleural thickening and subpleural consolidation. Adenosine deaminase (ADA) activity in the pleural effusion was elevated (85.3 IU/L), whereas other examinations for tuberculosis were negative. At this time, the patient started empirical anti-tuberculous treatment. Despite 2 months of treatment, the pleural effusion persisted, and video-assisted thoracoscopic surgery was performed. Finally, the patient was diagnosed with pleural paragonimiasis based on the pathologic findings of chronic granulomatous inflammation containing Paragonimus eggs. This case suggested that pleural paragonimiasis should be considered when pleural effusion and elevated ADA levels are observed.

Peanut Sprout Extracts Cultivated with Fermented Sawdust Medium Inhibits Benign Prostatic Hyperplasia In Vitro and In Vivo

송준휘,황병두,정현주,문보경,김진욱,고기성,김배환,김원룡,김운재,명순철,문성권 대한남성과학회 2020 The World Journal of Men's Health Vol.38 No.3

Purpose: In this study, we tested whether the resveratrol-enriched peanut sprout extracts cultivated with fermented sawdust medium (PSEFS) could suppress benign prostatic hyperplasia (BPH) in vitro and in vivo. Materials and Methods: The mode of action of PSEFS was estimated by employing high-performance liquid chromatography analysis, MTT assay, cell counting, cell cycle analysis, immunoblots, and immunoprecipitation and electrophoretic mobility shift assay. In vivo efficacy of PSEFS was analyzed in BPH animal model via immunostaining and enzyme-linked immunosorbent assay. Results: We selected the Yesan peanut sprout variety, which contains the highest level of resveratrol. The resveratrol levels in PSEFS were higher than those obtained with hydroponic technology. PSEFS treatment induced cell cycle arrest at the G1- phase by downregulating CDK4 and cyclin D1 via p21WAF1 induction in the RWPE-1 and WPMY prostate cells, thereby decreasing their proliferation. Treatment with PSEFS decreased ERK1/2 phosphorylation and increased JNK phosphorylation. The levels of DNA-bound transcription factors associated with proliferation (nuclear factor-κB, Sp-1, and AP-1) decreased upon PSEFS treatment in both prostate cells. Additionally, the levels of the molecular markers of BPH development (5α-reductase, androgen receptor, fibroblast growth factor, Bcl-2, and Bax) also changed by the addition of PSEFS. Finally, in a testosterone propionate-induced BPH model in rats, PSEFS administration attenuated the size, weight, and thickness of prostate tissues with no signs of death. Conclusions: These results showed that PSEFS inhibited BPH both in vitro and in vivo and might be useful in the development of a potential BPH therapy.

전폐 세척술로 부분 관해 후 GM-CSF 투여로 치료된 특발성 폐포단백증

송준휘 ( Jun Whi Song ),박순효 ( Sun Hyo Park ),강경우 ( Kyung Woo Kang ) 대한결핵 및 호흡기학회 2009 Tuberculosis and Respiratory Diseases Vol.67 No.6

Idiopathic pulmonary alveolar proteinosis (PAP) is a rare disorder characterized by surfactant component accumulation in the alveolar space. Idiopathic PAP has recently been recognized as a autoimmune disease of impaired alveolar macrophage function caused by autoantibodies against granulocyte-macrophage colony-stimulating factor (GM-CSF). While whole lung lavage has been the standard treatment, not every patient shows a complete response. Subcutaneous injection or inhalation of GM-CSF is another promising treatment option for PAP. A 45-year-old patient visited our hospital for dyspnea, he was diagnosed as PAP and underwent whole lung lavage. Eighteen months later, the patient had not achieved complete remission in despite of initial response. After then he was administered with GM-CSF (5 μg/kg/day, subcutaneous injection) for fivetimes a week during 2 months. Nine months later, the abnormal shadows in high-resolution computed tomography (HRCT) decreased and the patient fully recovered in forced vital capacity. After 60 months, the HRCT scan showed complete remission of PAP.

Are There Any Additional Benefits to Performing Positron Emission Tomography/Computed Tomography Scans and Brain Magnetic Resonance Imaging on Patients with Ground-Glass Nodules Prior to Surgery?

송재욱,송준휘,이경종,김호중,권오정,최준영,김진국,한정호,엄상원 대한결핵및호흡기학회 2017 Tuberculosis and Respiratory Diseases Vol.80 No.4

Background: A ground-glass nodule (GGN) represents early-stage lung adenocarcinoma. However, there is still no consensus for preoperative staging of GGNs. Therefore, we evaluated the need for the routine use of positron emission tomography/computed tomography (PET)/computed tomography (CT) scans and brain magnetic resonance imaging (MRI) during staging. Methods: A retrospective analysis was undertaken in 72 patients with 74 GGNs of less than 3 cm in diameter, which were confirmed via surgery as malignancy, at the Samsung Medical Center between May 2010 and December 2011. Results: The median age of the patients was 59 years. The median GGN diameter was 18 mm. Pure and part-solid GGNs were identified in 35 (47.3%) and 39 (52.7%) cases, respectively. No mediastinal or distant metastasis was observed in these patients. In preoperative staging, all of the 74 GGNs were categorized as stage IA via chest CT scans. Additional PET/CT scans and brain MRIs classified 71 GGNs as stage IA, one as stage IIIA, and two as stage IV. However, surgery and additional diagnostic work-ups for abnormal findings from PET/CT scans classified 70 GGNs as stage IA, three as stage IB, and one as stage IIA. The chest CT scans did not differ from the combined modality of PET/CT scans and brain MRIs for the determination of the overall stage (94.6% vs. 90.5%; kappa value, 0.712). Conclusion: PET/CT scans in combination with brain MRIs have no additional benefit for the staging of patients with GGN lung adenocarcinoma before surgery.

Bronchogenic Cyst Rupture and Pneumonia after Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration: A Case Report

홍구현,송준휘,이경종,전경만,고원중,서지영,정만표,김호중,권오정,엄상원 대한결핵및호흡기학회 2013 Tuberculosis and Respiratory Diseases Vol.74 No.4

We report a 54-year-old woman who presented with a well-defined, homogeneous, and non-enhancing mass in the retrobronchial region of the bronchus intermedius. The patient underwent endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for histological confirmation. Serous fluid was aspirated by EBUS-TBNA. Cytological examination identified an acellular smear with negative microbiological cultures. The patient was finally diagnosed with bronchogenic cysts by chest computed tomography (CT) and EBUS-TBNA findings. However, 1 week after EBUS-TBNA, the patient developed bronchogenic cyst rupture and pneumonia. Empirical antibiotics were administered, and pneumonia from the bronchogenic cyst rupture had resolved on follow-up chest CT. To our knowledge, this is the first reported case of pneumonia from bronchogenic cyst rupture after EBUS-TBNA.

Clinical Significance of the Isolation of Mycobacterium Szulgai from Respiratory Specimens

유홍석,전경만,고유상,송준휘,장복순,정병호,홍구현,김우열,한서구,박혜윤,기창석,이남용,고원중 대한결핵 및 호흡기학회 2012 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.114 No.-

Objectives: The isolation of Mycobacterium szulgai from respiratory specimens were traditionally considered to be highly indicative of disease. However, the high clinical relevance is not consistent through the literature. The aim of this study is to determine the clinical significance of M. szulgai isolates from respiratory specimens and to identify the clinical features and outcomes of M. szulgai lung disease. Methods: We reviewed the medical records for 30 patients with M. szulgai isolates between 2001 and 2010 at the Samsung Medical Center. Results: Of the 30 patients, 13 (43%) met the American Thoracic Society diagnostic criteria and were thus likely to have true M. szulgai lung disease. Approximately 57% (17/30) of M. szulgai isolates were recovered only once from patients with other pulmonary diseases, such as pulmonary tuberculosis, and bacterial pneumonia. The 13 patients with M. szulgai lung disease included 12 men (92%), with a median age of 63 years. Seven (54%) were current smokers and 7 (54%) had a history of previous tuberculosis treatment. Eight (62%) patients had the fibrocavitary form of M. szulgai lung disease. Nine (69%) patients received antimycobacterial treatment for a median duration of 8 months. Negative culture-conversion was documented in all patients. There was no recurrence or disease-related mortality. Conclusions: Because the isolated M. szulgai from respiratory specimens could be regarded as pathogenic in less than 50% cases, it is important to evaluate patients` risk factors and adhere to the recommended diagnostic criteria.

Multidrug-Resistant Tuberculosis Presenting as Miliary Tuberculosis without Immune Suppression: A Case Diagnosed Rapidly with the Genotypic Line Probe Assay Method

고유상,이영민,이호영,이영석,송준휘,김미영,이현경,신정환,최석진 대한결핵및호흡기학회 2014 Tuberculosis and Respiratory Diseases Vol.76 No.5

Miliary tuberculosis (TB) is a rare extrapulmonary form of TB, and there have been only two reports of miliary TB associated with infection with multidrug-resistant (MDR)-TB pathogen in an immunocompetent host. A 32-year-old woman was referred to our hospital because of abnormal findings on chest X-ray. The patient was diagnosed with MDR-TB by a line probe assay and was administered proper antituberculous drugs. After eight weeks, a solid-media drug sensitivity test revealed that the pathogen was resistant to ethambutol and streptomycin in addition to isoniazid and rifampicin. The patient was then treated with effective antituberculous drugs without delay after diagnosis of MDR-TB. To the best of our knowledge, this is the first case of miliary TB caused by MDR-TB pathogen in Korea.

Risk Factors for Death during Pulmonary Tuberculosis Treatment in Korea: A Multicenter Retrospective Cohort Study

권용수,김이형,송재욱,전경만,송준휘,류연주,최재철,김호철,고원중 대한의학회 2014 Journal of Korean medical science Vol.29 No.9

The data regarding risk factors for death during tuberculosis (TB) treatment areinconsistent, and few studies examined this issue in Korea. The purpose of this study wasto evaluate baseline prognostic factors for death during treatment of adult patients withpulmonary TB in Korea. A multicenter retrospective cohort study of 2,481 patients whoreceived TB treatment at eight hospitals from January 2009 to December 2010 wasperformed. Successful treatment included cure (1,129, 45.5%) and treatment completion(1,204, 48.5%) in 2,333 patients (94.0%). Unsuccessful treatment included death (85,3.4%) and treatment failure (63, 2.5%) occurred in 148 patients (6.0%). In multivariateanalysis, male sex, anemia, dyspnea, chronic heart disease, malignancy, and intensive careunit (ICU) admission were significant risk factors for death during TB treatment. Therefore,male sex, anemia, dyspnea, chronic heart disease, malignancy, and ICU admission couldbe baseline prognostic factors for death during treatment of adult patients with pulmonaryTB in Korea.

결핵 치료 중 발생한 부작용으로 약제 변경한 환자들에 대한 임상적 고찰

김호철,김호철,김이형,송재욱,고원중,전경만,송준휘,류연주,김우열,권용수,최재철,박소영 대한결핵 및 호흡기학회 2012 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.114 No.-

목적: 일차 항결핵제 치료 중 부작용으로 약제변경을 한 환자들의 임상적 특성과 치료 경과에 대하여 알아보고자 하였다. 방법: 2009년 1월부터 12월까지 국내 10개 병원에서 일차 항결핵제 치료를 시작한 환자들 중에서 부작용으로 인해 약제를 변경한 환자들을 대상으로 변경 원인과 임상적 특성, 치료경과에 대하여 후향적으로 조사하였다. 결과: 일차 항결핵제치료를 시작한 환자는 총 2,601명이었고, 남자는 1438명(55.3%), 평균나이는 49.8±19.1세였다. 이 환자들 중 부작용으로 약제 변경한 환자는 230명(8.8%)이었고 남자는 116명(50.4%)이었고, 평균나이는 50.9±19.6세였다. 발생한 부작용으로는 간독성이 99명(43.0%)으로 가장 많았고 피부 이상반응은 63명(27.4%), 위장관 증상 46명(20.0%), 시력장애 31명(13.5%), 발열 23명(10.0%%), 백혈구 또는 혈소판감소증 15명(6.5%) 신기능장애 8명(3.5%), 손발저림 5명(2.2%) 순이었다. 나이, 체질량지수는 관련이 없었고, 당뇨(19%, p=0.02), 만성간질환(9%, p=<0.001) 및 폐외결핵(40%, p=0.047)이 약제부작용 발생과 관련이 있었다. 치료기간은 평균 294.5±189.7일로 더 길었으나 최종 치료성적과 재발여부에는 차이가 없었다. 결론: 일차 항결핵제 치료를 받는 환자들 중에서 기저질환으로 당뇨, 만성간질환이 있거나, 폐외결핵의 환자들에서 약제 부작용이 더 많았고 이로 인해 약제변경이 필요하였다. 그러나 약제를 변경한 경우에도 치료 성적에는 큰 차이가 없었다.

Baseline Predictors of Unfavorable Outcome in Pulmonary Tuberculosis: a Multi-institutional Retrospective Study of 1,973 Patients

권용수,김이형,송재욱,김호철,고원중,전경만,송준휘,류연주,김우열,최재철,박소영 대한결핵 및 호흡기학회 2012 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.114 No.-

Objective; To evaluate the baseline predictors of treatment outcome in patients with pulmonary tuberculosis (TB). Methods: We retrospectively reviewed the cohort of 2713 patients who were suspected of having active TB and received anti-TB therapy in 10 teaching hospitals from Jan. 2009 to Dec. 2009. Results: Of all patients, we excluded 740 patients with extrapulmonary TB (n=504), changing their final diagnosis (n=156), known multi-drug resistant TB who received 2nd-line anti-TB drugs at the start of treatment (n=18), insufficient data for treatment outcomes (n=59) and others (n=3). Finally 1973 patients were enrolled (age=50±19, male=57%). The favorable outcome including cured or completed therapy was achieved for 78% of all patients. Male, elderly (≥65), ever smoking, bilateral lung involvement, positive sputum AFB stain at the start of treatment, previous TB treatment, and co-morbid conditions: diabetes, neurologic disease, lung cancer, and other solid organ tumors except lung cancer were associated with unfavorable outcome in univariate analysis. However, elderly (odd ratio [OR]=2.5, 95% confidence interval [CI] 1.8-3.3), ever smoking (OR=2.5, 95% CI 1.7-3.6), bilateral lung involvement (OR=1.5, 95% CI 1.1-2.1), previous TB treatment (OR=1.8, 95% CI 1.3-2.5), and combined neurologic disease (OR=2.4, 95% CI 1.2-4.8) were independent predictors of unfavorable outcome in multivariate analysis. Conclusion: Elderly, ever smoking, bilateral lung involvement, previous TB treatment, and combined neurologic disease could be baseline prognostic factors for pulmonary TB.