• Tuberculosis and Respiratory Diseases
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• 제66권5호
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• pp.370-373
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• 2009

폐동맥 색전증은 적절한 치료를 하지 않으면 사망률이 30%에 이르는 치명적인 질환이다. 장기간의 부동 상태, 수술, 악성 종양 등이 흔한 위험 인자이나, 크론병과 같은 염증성 장질환 또한 드물지만 폐동맥 혈전증을 일으킨다고 알려져 있다. 저자들은 3년 전 혈변과 설사로 크론병을 진단받고 재발 및 관해를 반복하던 25세 남자에서 폐동맥 색전증이 병발한 드문 예를 경험하였기에 증례 보고를 하는 바이다.

• Tuberculosis and Respiratory Diseases
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• 제69권4호
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• pp.243-249
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• 2010

Background: Chronic obstructive pulmonary disease (COPD) is one of the leading causes of disability and mortality worldwide. The aim of this study was to evaluate the risk factors associated with recurrent hospital admissions for exacerbation of COPD in Korea. Methods: A retrospective study of 77 consecutive patients hospitalized for exacerbation of COPD at Pusan National University Hospital during the time period January 2005 to May 2008 was performed. The information was collected from the hospitalization period: clinical information, spirometric measures, and laboratory variables. In addition, socioeconomic characteristics, co-morbidity, anxiety, and depression were reviewed. Frequent readmission was defined as 2 or more hospitalizations in the year following discharge. Results: During the 1-year period after discharge, 42 patients (54.6%) reported one hospital admission and 35 patients (45.4%) reported 2 or more hospital readmissions. Among the 35 frequent readmission patients, 4 had more than 10 readmissions. Univariate analysis showed that a body mass index (BMI) <$18.5kg/m^2$, duration >36 months, forced expiratory volume in 1 second ($FEV_1$) <50% predicted, arterial $CO_2$ partial pressure ($PaCO_2$) >40 mm Hg, and arterial oxygen saturation ($SaO_2$) <95% at discharge were associated significantly with frequent readmissions. The multivariate analysis revealed that BMI <$18.5kg/m^2$, $PaCO_2$ >40 mm Hg at discharge were independently associated with frequent readmissions for exacerbation of COPD. Conclusion: Frequent readmissions for exacerbation of COPD were associated with low BMI and hypercapnia at discharge.

• Tuberculosis and Respiratory Diseases
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• 제66권6호
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• pp.463-466
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• 2009

S. constellatus는 Streptococcus milleri group을 이루는 균이며 상부호흡기계, 비뇨기계 등에 정상 상재균으로 존재하다 면역저하 상태에서 기회감염을 일으키며 주로 농을 형성하는 것으로 알려져 있다. 저자들은 혈액투석을 받는 환자에게 발생한 S. constellatus에 의한 농흉 1예를 경험하였기에 문헌고찰과 함께 보고한다. 본 증례를 통해 면역이 저하된 환자에게 농흉이 형성된 경우 S. constellatus에 의한 감염을 생각해볼 수 있으며 이와 같은 경우 세균학적 검사 결과에 따른 항생제 치료와 함께 수술적 배농을 고려해야 한다는 것을 경험하였다.

• Tuberculosis and Respiratory Diseases
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• 제53권3호
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• pp.344-348
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• 2002

저자 등은 자리돔 가시를 먹고 흉부통증과 호흡곤란을 호소하여 내원한 환자에서 흉부전산화단층촬영에서 종격동염을 진단하고 보존적 치료에 의해 호전된 급성종격동염 1예를 경험 하였기에 문헌 고찰과 함께 보고하는 바이다.

• Tuberculosis and Respiratory Diseases
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• 제82권1호
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• pp.53-61
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• 2019

Background: Antiphospholipid antibody syndrome (APS), an important cause of acquired thrombophilia, is diagnosed when vascular thrombosis or pregnancy morbidity occurs with persistently positive antiphospholipid antibodies (aPL). APS is a risk factor for unprovoked recurrence of pulmonary embolism (PE). Performing laboratory testing for aPL after a first unprovoked acute PE is controversial. We investigated if a specific phenotype existed in patients with unprovoked with acute PE, suggesting the need to evaluate them for APS. Methods: We retrospectively reviewed patients with PE and APS (n=24) and those with unprovoked PE with aPL negative (n=44), evaluated 2006-2016 at the Asan Medical Center. We compared patient demographics, clinical manifestations, laboratory findings, and radiological findings between the groups. Results: On multivariate logistic regression analysis, two models of independent risk factors for APS-PE were suggested. Model I included hemoptysis (odds ratio [OR], 12.897; 95% confidence interval [CI], 1.025-162.343), low PE severity index (OR, 0.948; 95% CI, 0.917-0.979), and activated partial thromboplastin time (aPTT; OR, 1.166; 95% CI, 1.040-1.307). Model II included age (OR, 0.930; 95% CI, 0.893-0.969) and aPTT (OR, 1.104; 95% CI, 1.000-1.217). Conclusion: We conclude that patients with first unprovoked PE with hemoptysis and are age <40; have a low pulmonary embolism severity index, especially in risk class I-II; and/or prolonged aPTT (above 75th percentile of the reference interval), should be suspected of having APS, and undergo laboratory testing for aPL.

• Tuberculosis and Respiratory Diseases
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• 제46권4호
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• pp.586-590
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• 1999

비관통성 흉부손상에 의한 기관-기관지 파열의 높은 사망률과 이환율은 조기 진단과 수술로 이를 낮출 수 있으므로 초기 임상증상과 단순흉부방사선상 기관-기관지 파열이 의심되는 소견이 있으면 바로 기관지경검사로 기관-기관지 파열을 진단하고 적절한 치료를 해야한다. 저자들은 교통사고후 비관통성 흉부손상을 받고 호흡곤란을 주소로 내원한 환자에서 기관지경검사로 기관 파열을 조기 진단하여 수술적 치료로 회복시킨 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

• Tuberculosis and Respiratory Diseases
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• 제68권3호
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• pp.140-145
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• 2010

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.

• Tuberculosis and Respiratory Diseases
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• 제66권2호
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• pp.122-126
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• 2009

조혈모세포이식 후 1년 이내에 발생하는 폐 합병증의 진단 및 분류는 확립되어 있으나, 수 년 이상 장기간 생존자에게서 발생하는 폐 합병증에 대해서는 잘 알려져 있지 않다. 저자들은 8년 전 동종 조혈모세포이식을 시행받고, 호흡곤란을 주소로 내원한 18세 여자 환자에서, 폐조직 생검을 통해 비분류성 간질성 폐렴을 진단하였으나, 스테로이드 치료에도 불구하고 급격한 악화를 보여 호흡부전으로 사망한 1예를 경험하였기에 문헌 고찰과 함께 보고하는 바이다.

• Tuberculosis and Respiratory Diseases
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• 제80권3호
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• pp.296-303
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• 2017

Background: Acute respiratory distress syndrome (ARDS) is related to high mortality and morbidity. There are no proven therapeutic measures however, to improve the clinical course of ARDS, except using low tidal volume ventilation. Metformin is known to have pleiotropic effects including anti-inflammatory activity. We hypothesized that pre-admission metformin might alter the progress of ARDS among intensive care unit (ICU) patients with diabetes mellitus (DM). Methods: We performed a retrospective cohort study from January 1, 2005, to April 30, 2005 of patients who were admitted to the medical ICU at Seoul National University Hospital because of ARDS, and reviewed ARDS patients with DM. Metformin use was defined as prescribed within 3-month pre-admission. Results: Of 558 patients diagnosed with ARDS, 128 (23.3%) patients had diabetes and 33 patients were treated with metformin monotherapy or in combination with other antidiabetic medications. Demographic characteristics, cause of ARDS, and comorbid conditions (except chronic kidney disease) were not different between metformin users and nonusers. Several severity indexes of ARDS were similar in both groups. The 30-day mortality was 42.42% in metformin users and 55.32% in metformin nonusers. On multivariable regression analysis, use of metformin was not significantly related to a reduced 30-day mortality (adjusted ${\beta}-coefficient$, -0.19; 95% confidence interval, -1.76 to 1.39; p=0.816). Propensity score-matched analyses showed similar results. Conclusion: Pre-admission metformin use was not associated with reduced 30-day mortality among ARDS patients with DM in our medical ICU.

• Tuberculosis and Respiratory Diseases
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• 제71권5호
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• pp.335-340
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• 2011

Background: Community-acquired pneumonia (CAP) is an important cause of morbidity and mortality throughout the world in all age groups. Viral causes of CAP are less well characterized than bacterial causes. We analyzed the characteristics of hospitalized patients with CAP who had a viral pathogen detected by multiplex polymerase chain reaction (PCR). Methods: Multiplex real-time PCR was performed for respiratory viruses in samples collected from 520 adults who developed CAP at Chungnam National University Hospital. Clinical, laboratory, and radiological features at presentation as well as other epidemiological data were analyzed. Results: Of 520 patients with CAP, a viral pathogen was detected in 60 (11.5%), and influenza A was the most common. The virus detection rate in patients with CAP was highest in November. Two or more pathogens were detected in 13 (21.7%) patients. Seven patients had severe disease and were administered in the intensive care unit. Most patients (49/60, 81.7%) had comorbidities. However, nine (15%) patients had no comorbidities, and their age was <60 years. The ground glass opacity pattern was the most common radiological feature. Seven (11.7%) patients died from CAP. Conclusion: Viral pathogens are commonly detected in patients with CAP, and a respiratory virus may be associated with the severity and outcome of pneumonia. Careful attention should be paid to the viral etiology in adult patients with CAP.