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기관지 내시경적 냉동치료를 통한 중심성 기도폐쇄의 치료
류지원 ( Ji Won Lyu ),송진우 ( Jin Woo Song ),홍상범 ( Sang Bum Hong ),오연목 ( Yeon Mok Oh ),심태선 ( Tae Sun Shim ),임채만 ( Chae Man Lim ),이상도 ( Sang Do Lee ),고윤석 ( Youn Suck Koh ),김우성 ( Woo Sung Kim ),김동순 ( Dong So 대한결핵 및 호흡기학회 2010 Tuberculosis and Respiratory Diseases Vol.68 No.1
Background: The efficacious use of interventional bronchoscope for patients with central airway obstruction due to malignant or benign lesions has been proven. Among many therapeutic bronchoscopic procedures, endobronchial cryotherapy is an established recanalization method for the obstruction of the respiratory tract. Recently, the use of this procedure has been increasing in Korea. However, limited data are available in the literature regarding its efficacy in Korea. Methods: Thirty patients, who had been treated with a flexible cryoprobe for cryotherapy were enrolled; clinical characteristics and treatment outcomes were analyzed. The patients had been treated with the technique using nitrous oxide as a cryogen under local anesthesia. Objective outcomes were 3 different degrees of therapeutic success by use of follow-up bronchoscopic findings as follows: successful, partially successful, and unsuccessful response. Subjective outcomes were evaluated as an improvement in symptoms. Results: The mean age of enrolled patients was 59±11 years and there was a male (22/30) dominance. Twenty- three patients had malignant tumor and 7 patients had benign lesions with central airway obstruction. Successful recanalization was achieved in 11 (37%) patients, and partially successful response was achieved in 15 (50%) patients. Dyspnea was improved in 84.2% (16/19) of patients. At least one respiratory symptom was resolved in 91.3% (21/23) patients. Seven patients (23.3%) needed additional bronchoscopic electrocautery because of the bleeding as a complication of cryotherapy. Conclusion: Endobronchial cryotherapy is an effective and less expensive procedure for the management of central airway obstruction. However, the procedure should be performed under the preparing for an emergency situation, such as massive bleeding.
레지오넬라 폐렴과 폐렴구균 폐렴 환자의 임상 양상에 대한 비교
류지원 ( Ji Won Lyu ),송진우 ( Jin Woo Song ),최창민 ( Chang Min Choi ),오연목 ( Yeon Mok Oh ),이상도 ( Sang Do Lee ),김우성 ( Woo Sung Kim ),김동순 ( Dong Soon Kim ),김미나 ( Mi Na Kim ),심태선 ( Tae Sun Shim ) 대한결핵 및 호흡기학회 2010 Tuberculosis and Respiratory Diseases Vol.68 No.2
Background: Legionella pneumophila has been recognized as an important cause of pneumonia. However, limited data are available in the literature regarding legionella pneumonia in Korea. The objective of this study was to compare epidemiological data and clinical presentation of legionella pneumonia and pneumococcal pneumonia. Methods: We retrospectively compared clinical, radiological, and laboratory data, antimicrobial treatment, and treatment outcomes between 28 cases of legionella pneumonia and 56 cases of pneumococcal pneumonia. Diagnoses of both legionella and pneumococcal pneumonia were based on commercial urinary antigen tests. Results: Legionella pneumonia patients included 23 men and 5 women, with a mean age of 61.6 years (range 36∼88). Fifteen were smokers and 26 had some underlying diseases. Legionella pneumonia occurred more frequently in healthcare-associated settings than pneumococcal pneumonia (42.9% vs 21.4%, respectively, p=0.040). There were no significant differences in clinical signs and symptoms. Compared to patients with pneumococcal pneumonia, patients with legionella pneumonia presented more frequently with anemia (39.3% vs 8.9%, p=0.001), increased C-reactive protein (57.1% vs 30.4%, p=0.018) and increased alkaline phosphatase (46.4% vs 16.1%, p=0.003). Also, legionella pneumonia patients more often showed pleural effusion on simple chest X-rays (50.0% vs 12.5%, p<0.001). Conclusion: Legionella pneumonia and pneumococcal pneumonia can not be distinguished by clinical manifestations alone. However, legionella pneumonia occurred as a healthcare-associated pneumonia more frequently and was more often associated with anemia and increased CRP and alkaline phosphatase levels.
초음파 기관지 내시경 세침흡인을 이용하여 진단한 폐 사르코이드증
김원영 ( Won Young Kim ),장유진 ( You Jin Chang ),류지원 ( Ji Won Lyu ),박영수 ( Young Soo Park ),장세진 ( Se Jin Jang ),송진우 ( Jin Woo Song ),오연목 ( Yeon Mok Oh ),심태선 ( Tae Sun Shim ),이상도 ( Sang Do Lee ),김우성 ( Woo Su 대한결핵 및 호흡기학회 2010 Tuberculosis and Respiratory Diseases Vol.68 No.5
Background: Pulmonary sarcoidosis often involves mediastinal or hilar Lymph nodes in the Lung parenchyma. Mediastinoscopy is the gold standard for diagnosis, but it is invasive and expensive. Transbronchial needle aspiration using conventional bronchoscope is Less invasive than mediastinoscopy, but its diagnostic accuracy is in question due to the blind approach to targeting Lymph nodes. Transbronchial needle aspiration (TBNA) via endobronchial ultrasound (EBUS) has high diagnostic value due to direct visualization of Lymph nodes and to its relatively safeness. The purpose of this study was to assess the usefulness of EBUS-TBNA in the diagnosis of pulmonary sarcoidosis. Methods: Twenty-five patients with symptoms of sarcoidosis were enrolled into this study. Core tissue was obtained for a definitive diagnosis. Endobronchial biopsy, transbronchial Lung biopsy, and bronchoalveolar Lavage were performed to verify diagnosis. For patients without a confirmed diagnosis after the above procedures were performed, the additional procedures of mediastinoscopy or video-associated thoracoscopic surgery were performedto confirm a final diagnosis. Results: A total 25 EBUS procedures were done and 50 Lymph nodes were aspirated. Thirty-three (37) out of 50 Lymph nodes were consistent with non-caseating granuloma, confirming sarcoidosis as the final diagnosis. Sarcoidosis was the final diagnosis for all 25 patients, and 21 required EBUS-TBNA for a final diagnosis. There were no complications associated with the procedure. Conclusion: EBUS-TBNA is already a well-known procedure for diagnosing mediastinal or hilar Lymphadenopathy. We used EBUS-TBNA for the diagnosis of pulmonary sarcoidosis and our results showed 84% diagnostic accuracy and no complications related to the procedure. EBUS-TBNA is a reliable and practical diagnostic modality in the diagnosis of pulmonary sarcoidosis.
3차 의료기관 응급실에 내원한 아나필락시스 환자에 대한 임상적 및 통계적 고찰
홍규락 ( Kyu Rak Hong ),문형준 ( Hyung Jun Moon ),류지원 ( Ji Won Lyu ),이성열 ( Sung Yul Lee ),이종석 ( Jong Suk Lee ),이상훈 ( Sang Hoon Lee ),박영립 ( Young Lip Park ),김정은 ( Jung Eun Kim ) 대한피부과학회 2019 대한피부과학회지 Vol.57 No.3
Background: Understanding the epidemiology of anaphylaxis is imperative for appropriate diagnosis and treatment, but the prevalence reportedly varies and only a few studies have compared the clinical features of anaphylaxis with the underlying causes in Korea. Objective: This study aimed to investigate the etiology and clinical features of anaphylaxis. Methods: We retrospectively reviewed the medical records of 319 anaphylaxis patients who visited our emergency room and extracted information on the causes, clinical characteristics, and subsequent outpatient visits. Results: Food, drugs, and environmental factors were common causes of anaphylaxis. Statistically significant differences (p<0.001) were observed between children (<18 years of age) and adults (≥18 years of age), with food and drugs identified as the most common causes, respectively. Clinical characteristics of the patients were compared according to the common causes of anaphylaxis. Cutaneous symptoms were observed more frequently in food-induced cases (n=137, 95.1%) compared to drug-induced (n=73, 77.7%) and bee sting-induced (n=18, 78.3%) cases (p<0.001), whereas neurological symptoms were observed more frequently in drug-induced (n=37, 39.4%) and bee sting-induced (n=11, 47.8%) cases than in food-induced (n=18, 12.5%) cases (p<0.01). Drug-induced (n=44, 46.8%) and bee sting-induced (n=11, 47.8%) cases were more severe than food-induced cases (n=32, 22.2%). Out of the 319 assessed patients, only 25, 14, and 14 patients were referred to the pediatrics, allergy, and dermatology departments, respectively, after visiting the emergency room. Conclusion: Clinical characteristics of anaphylactic patients differed according to the underlying cause, but these findings are presumably influenced by factors determining the severity of anaphylaxis. We found that subsequent follow-up care in other departments to identify the cause of anaphylaxis was inadequate for most patients. (Korean J Dermatol 2019;57(3):126∼135)
건측 폐보호를 위해 Univent(R)튜브를 사용한 대량객혈환자의 증례
문재영 ( Jae Young Moon ),이영석 ( Young Seok Lee ),류지원 ( Ji Won Lyu ),허진원 ( Jin Won Huh ),홍상범 ( Sang Bum Hong ),김상위 ( Sang We Kim ),임채만 ( Chae Man Lim ),고윤석 ( Youn Suck Koh ) 대한결핵 및 호흡기학회 2012 Tuberculosis and Respiratory Diseases Vol.72 No.2
Massive hemoptysis is a life-threatening condition and sometimes leads to death due to airway obstruction rather than exsanguinations. In a critical hemoptysis, endotracheal intubation may be necessary to maintain adequate gas exchange and protect the unaffected side of the lung. Bronchial blockers (BBs), commonly used technique for one-lung ventilation in thoracic or cardiac surgeries, are valuable devices for protecting the airway in massive endobronchial bleeding. We report three cases intubated with BBs, Univent?, in massive hemoptysis. We suggest that BBs are one of the indispensable equipments for respiratory specialized wards and intensive care units.
홍성아 ( Seong Ah Hong ),하태훈 ( Tae Hoon Ha ),류지원 ( Ji Won Lyu ),김양기 ( Yang Ki Kim ),이영목 ( Young Mok Lee ),김기업 ( Ki Up Kim ),어수택 ( Soo Taek Uh ),노형준 ( Hyung Jun Noh ),김용재 ( Yong Jae Kim ),구동억 ( Dong Erk G 대한결핵 및 호흡기학회 2007 Tuberculosis and Respiratory Diseases Vol.62 No.1
A bronchial artery aneurysm is a rare condition, which needs optimal treatment due to the possibility of a life-threatening hemorrhage by rupture. The surgical removal of the aneurysm is the standard treatment. However, there are a few reports of coil embolization with a transcatheter. A 69 year-old man was referred for a further evaluation of a mass in the right hilum on chest radiography. He denied any respiratory symptoms. A chest CT scan showed a 3 × 3 × 4.5 cm sized vascular mass with strong contrast enhancement on the right hilar area that originated from the bronchial artery. On the angiogram, the bronchial artery originated from the descending thoracic aorta at the T8 level. A bronchial artery aneurysm was catheterized selectively. and embolized successfully with a coil. After coil embolization, the selective bronchial arteriography confirmed complete occlusion. We report this case of bronchial aneurysm that was treated successfully with coil embolization. (Tuberc Respir Dis 2007; 62: 62-66)
2개의 3축 관성센서를 이용한 입원환자 보행 모니터링 기반 낙상위험 평가방법 개발 사전연구
김중연(Jung-Yeon Kim),김초명(Chomyong Kim),전섭(Seob-Jeon),길효욱(Hyo-Wook Gil),유익동(Ik-Dong Yu),류지원(Ji-Won Lyu),정의현(Euy-Hyun Chung),남윤영(Yunyoung Nam) 한국정보기술학회 2022 Proceedings of KIIT Conference Vol.2022 No.12
각종 센서를 활용하여 건강과 관련된 정보를 수집하고 분석하여 웨어러블 센서의 효용성을 파악하려는 연구들이 많이 진행되고 있다. 본 연구에서 제안하는 시스템은 입원환자들의 보행 및 균형 기능을 단편적으로 평가하여 낙상위험을 가늠해 보는 기존 방법의 제한점을 보완하기 위한 시스템으로, 입원환자들이 병원에서 생활할 때 발생하는 행동데이터를 퇴원 시 까지 지속적으로 수집하여 보행이 발생된 관성센서 신호를 검출하고 낙상위험이 발생할 가능성을 평가하기 위한 특징적 지표를 계산하는 방법을 포함한다. There are increasing numbers of studies to identify efficacy of wearable sensors on collecting health-related data. This study proposes a machine-learning based method to detect gait pattern from long-term behavior monitoring data and compute gait parameters, which can be used to investigate patients’ gait and balance, to assess fall risk while they are staying at a hospital. The result of gait patterns detection and gait parameters computed from the part of long-term monitoring data.
간호간병통합병동 EMR 데이터를 활용한 낙상 위험 사정 도구 개발
김초명(Chomyong Kim),김중연(Jung-Yeon Kim),전섭(Seob Jeon),길효욱(Hyo-Wook Gil),유익동(Ik-Dong Yu),류지원(Ji-Won Lyu),정의현(Euy Hyun Chung),남윤영(Yunyoung Nam) 한국정보기술학회 2022 Proceedings of KIIT Conference Vol.2022 No.12
환자 낙상은 병원에서 쉽게 발생하는 일종의 사고로써 환자의 신체적, 정신적 부작용을 일으킬 뿐만 아니라 의료비 및 재원일 수 증가를 넘어 의료사고 및 법정소송을 발생시킬 수 있어 사전예방이 가장 우선시 되어야 한다. 낙상 위험군 환자를 분리하기 위해 Morse Fall Scale(MFS), Hendrick Ⅱ, STRATIFY 및 다양한 낙상 위험 사정 도구를 사용하지만 낮은 예측률을 보이며, 주로 빈번하게 사용되는 MFS의 경우 순천향대학교 부속병원을 기준으로 약 73%의 예측률을 보인다. 본 연구는 이미 사용하고 있는 MFS 사정 도구의 변수와 간호간병 통합병동에서 EMR로 관리하는 여러 도구의 변수를 모아 로지스틱 회귀분석(Logistic Regression)을 통해 분류모델을 개발함과 동시에 표준화된 가중치를 구해 새로운 점수를 산출한다. 본 연구의 예측률은 83%로 증가했으며, 가중치를 활용해 낙상 위험도를 재산출한 결과 낙상 중간위험군으로 분류된 환자가 낙상 고위험군으로 분류되면서 낙상 예방 교육 및 집중 간호를 받을 수 있게 한다. Patient falls are a type of accident that easily occurs in hospitals, and not only cause physical and mental side effects to the patient but also cause medical accidents and legal litigation beyond the increase in medical expenses and hospital stays. Morse Fall Scale (MFS), Hendrick II, STRATIFY, and various fall risk assessment tools are used to isolate patients at risk for falls, but with low predictive rates. MFS, which is mainly used frequently, shows a prediction rate of about 73% based on Soonchunhyang University Hospital. In this study, we developed a classification model through logistic regression by collecting the variables of the MFS assessment tool already used and the variables of various tools managed by EMR(Electric Medical Record) in the nursing care integrated ward, and at the same time obtaining standardized weights to obtain new Calculate the score. As a result of the study, the prediction rate for falls of this research model increased to 83%, and as a result of recalculating the fall risk using weights, patients classified as the intermediate risk for falls are classified as high risk for falls, allowing them to receive fall prevention education and intensive care.