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1.
Article in English | WPRIM | ID: wpr-919478

ABSTRACT

Background@#Although respiratory tract infection is one of the most important factors triggering acute exacerbation of chronic obstructive pulmonary disease (AE-COPD), limited data are available to suggest an epidemiologic pattern of microbiology in South Korea. @*Methods@#A multicenter observational study was conducted between January 2015 and December 2018 across 28 hospitals in South Korea. Adult patients with moderate-to-severe acute exacerbations of COPD were eligible to participate in the present study. The participants underwent all conventional tests to identify etiology of microbial pathogenesis. The primary outcome was the percentage of different microbiological pathogens causing AE-COPD. A comparative microbiological analysis of the patients with overlapping asthma–COPD (ACO) and pure COPD was performed. @*Results@#We included 1,186 patients with AE-COPD. Patients with pure COPD constituted 87.9% and those with ACO accounted for 12.1%. Nearly half of the patients used an inhaled corticosteroid-containing regimen and one-fifth used systemic corticosteroids. Respiratory pathogens were found in 55.3% of all such patients. Bacteria and viruses were detected in 33% and 33.2%, respectively. Bacterial and viral coinfections were found in 10.9%. The most frequently detected bacteria were Pseudomonas aeruginosa (9.8%), and the most frequently detected virus was influenza A (10.4%). Multiple bacterial infections were more likely to appear in ACO than in pure COPD (8.3% vs. 3.6%, p=0.016). @*Conclusion@#Distinct microbiological patterns were identified in patients with moderate-to-severe AE-COPD in South Korea. These findings may improve evidence-based management of patients with AE-COPD and represent the basis for further studies investigating infectious pathogens in patients with COPD.

2.
Article in English | WPRIM | ID: wpr-875519

ABSTRACT

Background/Aims@#Pleuroparenchymal fibroelastosis (PPFE) is a type of rare idiopathic interstitial pneumonia that is characterized by predominantly upper lobe involvement with pleural fibrosis and subjacent parenchymal fibrosis. This study aimed to determine the clinico-radiologic-pathologic features and prognosis of Korean patients with PPFE. @*Methods@#A total of 26 patients who were confirmed to have PPFE by lung biopsy, were included, and their clinico-radiologic-pathologic findings were retrospectively analyzed. @*Results@#The mean follow-up period was 23.8 months, and the mean age of the patients was 62.5 years; 61.5% were men and 50% were smokers. Cough and dyspnea were the most frequent presenting symptoms, and restrictive pattern was the most common observation in lung function. In 84.6% of the subjects, lower lobe involvement was found on chest computed tomography, and the usual interstitial pneumonia (UIP) pattern was the most common (59.1%). Among patients whose lower lobe was biopsied (n = 13), the UIP pattern was the most common (46.2%). Patients with lower lobe involvement were older and walked a shorter distance during the 6-minute walk test, compared to those without. Spontaneous pneumothorax was a common complication (26.9%), and 15.4% of the patients died mostly due to pneumonia (100%). The 1- and 3-year survival rates were 90.2% and 84.5%, respectively. @*Conclusions@#Clinical features of Korean patients with PPFE were similar to those reported previously; however, lower lobe involvement was more frequent. During follow-up, one-fourth of the patients experienced pneumothorax and one-fifth died from pneumonia.

3.
Article in Korean | WPRIM | ID: wpr-900839

ABSTRACT

Autoimmune-associated interstitial lung disease (ILD) is a widespread and clinically significant form of autoimmune diseases. ILD can be present in most type of autoimmune diseases. Scleroderma, Sjogren syndrome, rheumatoid arthritis, inflammatory myositis, systemic lupus erythematosus, and mixed connective tissue disease are all examples of autoimmune disorders that can cause ILD. Treatment and prognosis vary from that of other forms of ILD depending on the etiology and pathogenesis of the autoimmune disease. As a result, glucocorticoids and immunosuppressive agents are the mainstays of treatment for autoimmune-associated ILD, despite the fact that there is little high-level evidence to guide the treatment owing to limited data from randomized controlled trials. Immunosuppressive agents including cyclophosphamide, tacrolimus, azathioprine, and mycophenolate mofetil can be used to reduce the dose of glucocorticoids and the inflammatory cascade and inhibit various pro-inflammatory cytokines. Studies have also started alternative therapeutic approaches, such as biological and antifibrotic agents, and traditional immunosuppressive agents. In this review, we summarize available treatment options and recent advances in therapeutic strategies for patients with autoimmune-associated ILD.

4.
Article in Korean | WPRIM | ID: wpr-893135

ABSTRACT

Autoimmune-associated interstitial lung disease (ILD) is a widespread and clinically significant form of autoimmune diseases. ILD can be present in most type of autoimmune diseases. Scleroderma, Sjogren syndrome, rheumatoid arthritis, inflammatory myositis, systemic lupus erythematosus, and mixed connective tissue disease are all examples of autoimmune disorders that can cause ILD. Treatment and prognosis vary from that of other forms of ILD depending on the etiology and pathogenesis of the autoimmune disease. As a result, glucocorticoids and immunosuppressive agents are the mainstays of treatment for autoimmune-associated ILD, despite the fact that there is little high-level evidence to guide the treatment owing to limited data from randomized controlled trials. Immunosuppressive agents including cyclophosphamide, tacrolimus, azathioprine, and mycophenolate mofetil can be used to reduce the dose of glucocorticoids and the inflammatory cascade and inhibit various pro-inflammatory cytokines. Studies have also started alternative therapeutic approaches, such as biological and antifibrotic agents, and traditional immunosuppressive agents. In this review, we summarize available treatment options and recent advances in therapeutic strategies for patients with autoimmune-associated ILD.

5.
Article | WPRIM | ID: wpr-837351

ABSTRACT

Background@#The Bronchiectasis Health Questionnaire (BHQ) is a simple and repeatable, self-reporting health status questionnaire for bronchiectasis. We have translated the original version of the BHQ into Korean using a standardized methodology. The purpose of this study was to assess the validity of the Korean version of the BHQ (K-BHQ) with Korean patients. @*Methods@#Stable state patients with bronchiectasis from two academic hospitals were enrolled in this study. The validity was assessed by investigating the relationship between the K-BHQ scores and the Korean version of the Chronic Obstructive Pulmonary Disease Assessment Test (K-CAT) scores. We also investigated the relationship between the K-BHQ scores and other variables of the modified Medical Research Council’s (mMRC) dyspnea scale, lung function, and exacerbations. @*Results@#A total of 126 patients with bronchiectasis were enrolled. The mean age was 64.3 (standard deviation [SD], 9.7). Women comprised 53.2% of the patients. The mean forced expiratory volume in one second (FEV1) was 60% of the predicted value (SD, 18.9%); the mean K-CAT score was 17.6 (SD, 9.1). The K-BHQ scores correlated strongly with the K-CAT scores (r=–0.656, p<0.001). There was significant correlation between the K-BHQ scores and the mMRC dyspnea scale (ρ=–0.409, p<0.001), FEV1 (r=0.406, p<0.001), and number of exacerbations requiring hospitalization (ρ=–0.303, p=0.001). @*Conclusion@#The K-BHQ is valid for assessing the health-related quality of life or health status of Korean bronchiectasis patients.

6.
Article in Korean | WPRIM | ID: wpr-739510

ABSTRACT

Rituximab is a monoclonal antibody used for the treatment of B-cell malignancies, including diffuse large B-cell lymphoma. Infusion-related hypersensitivity reactions to rituximab is well known, and delayed hypersensitivity reactions to rituximab are also reported. Desensitization is commonly used to prevent immediate hypersensitivity reactions, but recently there have been cases of successful desensitization therapy for delayed hypersensitivity reactions. A 66-year-old patient who underwent rituximab treatment for diffuse large B-cell lymphoma showed repeated rituximab-induced delayed hypersensitivity reactions with whole body rashes. Intravenous rapid desensitization was performed by using a 1-bottle, 11-step protocol for 6 cycles and thereafter hypersensitivity reaction did not recur. We herein reported a case of delayed hypersensitivity reaction caused by rituximab, which was successfully desensitized using our 11-step protocol.


Subject(s)
Aged , B-Lymphocytes , Desensitization, Immunologic , Exanthema , Humans , Hypersensitivity , Hypersensitivity, Delayed , Hypersensitivity, Immediate , Lymphoma, B-Cell , Rituximab
7.
Infection and Chemotherapy ; : 268-273, 2018.
Article in English | WPRIM | ID: wpr-722321

ABSTRACT

Emphysematous osteomyelitis, characterized by intraosseous gas, is a rare but potentially fatal condition that requires prompt diagnosis and aggressive therapy. Causative organisms are members of the bacterial family Enterobacteriaceae or anaerobes in most cases and significant comorbidities such as diabetes mellitus and malignancy, may predispose an individual to the development of emphysematous osteomyelitis. We report a case of extensive emphysematous osteomyelitis via hematogenous spread from Klebsiella pneumoniae liver abscess, complicated by gas-containing abscesses in adjacent soft tissues and epidural space, and multiple systemic septic emboli in a diabetic patient.


Subject(s)
Abscess , Comorbidity , Diabetes Mellitus , Diagnosis , Enterobacteriaceae , Epidural Space , Humans , Klebsiella pneumoniae , Klebsiella , Liver Abscess , Liver , Osteomyelitis
8.
Infection and Chemotherapy ; : 268-273, 2018.
Article in English | WPRIM | ID: wpr-721816

ABSTRACT

Emphysematous osteomyelitis, characterized by intraosseous gas, is a rare but potentially fatal condition that requires prompt diagnosis and aggressive therapy. Causative organisms are members of the bacterial family Enterobacteriaceae or anaerobes in most cases and significant comorbidities such as diabetes mellitus and malignancy, may predispose an individual to the development of emphysematous osteomyelitis. We report a case of extensive emphysematous osteomyelitis via hematogenous spread from Klebsiella pneumoniae liver abscess, complicated by gas-containing abscesses in adjacent soft tissues and epidural space, and multiple systemic septic emboli in a diabetic patient.


Subject(s)
Abscess , Comorbidity , Diabetes Mellitus , Diagnosis , Enterobacteriaceae , Epidural Space , Humans , Klebsiella pneumoniae , Klebsiella , Liver Abscess , Liver , Osteomyelitis
9.
Article in English | WPRIM | ID: wpr-715739

ABSTRACT

BACKGROUND: Chronic bronchitis (CB) is an important phenotype in chronic obstructive pulmonary disease (COPD). The purpose of this study is to evaluate different pattern of COPD assessment test (CAT) score between CB and non-CB patients. METHODS: Patients were recruited from 45 centers in Korea, as part of the Korean COPD Subgroup Study cohort. CB was defined when sputum continued for at least 3 months. RESULTS: Total 958 patients with COPD were eligible for analysis. Among enrolled patients, 328 (34.2%) were compatible with CB. The CAT score was significantly higher in patients with CB than non-CB, and each component of CAT score showed a similar result. CB was significantly associated with CAT score when adjusted with age, sex, modified Medical Research Council, and post-bronchodilator forced expiratory volume in 1 second. Each component of CAT score between patients with CB and non-CB showed different pattern according to Global Initiative for Chronic Obstructive Lung Disease grade. CONCLUSION: CAT score is significantly higher in patients with CB than non-CB. Each component of CAT score was significantly different between two groups.


Subject(s)
Animals , Bronchitis , Bronchitis, Chronic , Cats , Cohort Studies , Forced Expiratory Volume , Humans , Korea , Phenotype , Pulmonary Disease, Chronic Obstructive , Quality of Life , Sputum
10.
Article in English | WPRIM | ID: wpr-717911

ABSTRACT

BACKGROUND: Roflumilast is the only approved oral phosphodiesterase-4 inhibitor for the treatment of severe chronic obstructive pulmonary disease (COPD) in patients with chronic bronchitis and a history of frequent exacerbations. The purpose of this study was to examine the incidence of adverse effects associated with roflumilast treatment in a real-world setting. Further, we compared the incidence of adverse effects and the discontinuation rate among patients receiving different doses. METHODS: We identified all outpatients diagnosed with COPD at Seoul St. Mary's Hospital between May 2011 and September 2016 and retrospectively reviewed their medical records. Roflumilast was prescribed to patients in doses of 500 µg and 250 µg. RESULTS: A total of 269 COPD patients were prescribed roflumilast in our hospital during the study period. Among them, 178 patients were treated with 500 µg and 91 patients were treated with 250 µg. The incidence of adverse effects was 38.2% in the 500 µg group and 25.3% in the 250 µg group (p=0.034). The discontinuation rate of roflumilast was 41.6% (n=74) in the 500 µg group and 23.1% (n=21) in the 250 µg group (p=0.003). When adjusted by age, sex, smoking status, and lung function, 500 µg dose was significantly associated with the discontinuation of roflumilast (odds ratio, 2.87; p < 0.001). CONCLUSION: There was a lower incidence of adverse effects and discontinuation among patients treated with 250 µg compared with 500 µg dose. Further studies regarding the optimal dose of roflumilast are required.


Subject(s)
Bronchitis, Chronic , Cyclic Nucleotide Phosphodiesterases, Type 4 , Humans , Incidence , Lung , Medical Records , Outpatients , Pulmonary Disease, Chronic Obstructive , Retrospective Studies , Seoul , Smoke , Smoking
11.
Article in English | WPRIM | ID: wpr-770944

ABSTRACT

Amniotic fluid embolism is rare but is one of the most catastrophic complications in the peripartum period. This syndrome is caused by a maternal anaphylactic reaction to the introduction of fetal material into the pulmonary circulation. When amniotic fluid embolism is suspected, the immediate application of extracorporeal mechanical circulatory support such as veno-arterial extracorporeal membrane oxygenation (ECMO) or cardiopulmonary bypass should be considered. Without the application of extracorporeal mechanical circulatory support, medical supportive care might not be sufficient to maintain cardiopulmonary stabilization in severe cases of amniotic fluid embolism. In this report, we present the case of a 36-year-old pregnant woman who developed an amniotic fluid embolism immediately after a cesarean section. Her catastrophic event started with the sudden onset of severe hypoxia, followed by circulatory collapse within 8 minutes. The veno-arterial mode of extracorporeal membrane oxygenation was initiated immediately. She was successfully resuscitated but with impaired cognitive function. Thus, urgent ECMO should be considered when amniotic fluid embolism syndrome is suspected in patients presenting acute cardiopulmonary collapse.


Subject(s)
Adult , Amniotic Fluid , Anaphylaxis , Hypoxia , Cardiopulmonary Bypass , Cesarean Section , Cognition , Embolism, Amniotic Fluid , Extracorporeal Membrane Oxygenation , Female , Humans , Peripartum Period , Pregnancy , Pregnant Women , Pulmonary Circulation , Shock
12.
Article in English | WPRIM | ID: wpr-67123

ABSTRACT

Amniotic fluid embolism is rare but is one of the most catastrophic complications in the peripartum period. This syndrome is caused by a maternal anaphylactic reaction to the introduction of fetal material into the pulmonary circulation. When amniotic fluid embolism is suspected, the immediate application of extracorporeal mechanical circulatory support such as veno-arterial extracorporeal membrane oxygenation (ECMO) or cardiopulmonary bypass should be considered. Without the application of extracorporeal mechanical circulatory support, medical supportive care might not be sufficient to maintain cardiopulmonary stabilization in severe cases of amniotic fluid embolism. In this report, we present the case of a 36-year-old pregnant woman who developed an amniotic fluid embolism immediately after a cesarean section. Her catastrophic event started with the sudden onset of severe hypoxia, followed by circulatory collapse within 8 minutes. The veno-arterial mode of extracorporeal membrane oxygenation was initiated immediately. She was successfully resuscitated but with impaired cognitive function. Thus, urgent ECMO should be considered when amniotic fluid embolism syndrome is suspected in patients presenting acute cardiopulmonary collapse.


Subject(s)
Adult , Amniotic Fluid , Anaphylaxis , Hypoxia , Cardiopulmonary Bypass , Cesarean Section , Cognition , Embolism, Amniotic Fluid , Extracorporeal Membrane Oxygenation , Female , Humans , Peripartum Period , Pregnancy , Pregnant Women , Pulmonary Circulation , Shock
13.
Article in Korean | WPRIM | ID: wpr-15306

ABSTRACT

We developed security function modules based DICOM standard, including Secure Connection of TLS, Digital Signature, and Media Security of CMS. Using DICOM standard security functions, medical equipment, modality, and PACS software are able to communicate and exchange information safely without sacrifice for the compatibility. TLS enables secure connection between modality. Digital Signature guarantees data integrity and authentication based on PKI technology. Lastly, CMS algorithm provides how to encrypt DICOM File based on Media Storage Security. Signed and encrypted images are only to be decrypted by patient or who has authority, and it is to be proved that those images are not changed.


Subject(s)
Humans
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