Publications by authors named "Ho Kee Yum"

26 Publications

  • Page 1 of 1

Medicosocial Conflict and Crisis due to Illegal Physician Assistant System in Korea.

J Korean Med Sci 2021 Jul 12;36(27):e199. Epub 2021 Jul 12.

Department of Neurosurgery, Korea University Anam Hospital, Seoul, Korea.

The Korean Medical Association opposes the illegal attempt to implement the physician assistant (PA) system in Korea. The exact meaning of 'PA' in Korea at present time is 'Unlicensed Assistant (UA)' since it is not legally established in our healthcare system. Thus, PA in Korea refers to unlawful, unqualified, auxiliary personnel for medical practitioners. There have been several issues with the illegal PA system in Korea facing medicosocial conflicts and crisis. Patients want to be diagnosed and treated by medically-educated, licensed and professionally trained physicians not PAs. In clinical settings, PAs deprive the training and educational opportunities of trainees such as interns and residents. Recently, there have been several attempts, by CEO or directors of major hospitals in Korea, to adopt and legalize this system without general consensus from medical professional associations and societies. Without such consensus, this illegal implementation of PA system will create new and additional very serious medical crises due to unlawful medical, educational, professional conflicts and safety issues in medical practice. Before considering the implementation of the PA system, there needs to be a convincing justification by solving the fundamental problems beforehand, such as the collapsed medical delivery system, protection and provision of optimal education program and training environment of trainees, burnout from excessive workloads of physicians with very low compensational system and poor conditions for working and education, etc.
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http://dx.doi.org/10.3346/jkms.2021.36.e199DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8275465PMC
July 2021

Risk Factors of Outcomes of COVID-19 Patients in Korea: Focus on Early Symptoms.

J Korean Med Sci 2021 May 10;36(18):e132. Epub 2021 May 10.

Department of Urology, Kyung Hee University School of Medicine, Seoul, Korea.

Background: Coronavirus disease 2019 (COVID-19) has spread around the globe, and it is important to determine the risk factors of death in the general population. Our study aimed to determine the risk factors of death and severe illness requiring supplemental oxygen therapy based on the demographic and clinical characteristics of COVID-19 patients in Korea.

Methods: In this study, we used data provided by the Korea Disease Control and Prevention Agency (KDCA) and analyzed a total of 5,068 patients with COVID-19, excluding 19 pregnant women and 544 individuals with missing data. We performed logistic regression analysis to determine the impact of early symptoms on survival and severe disease. Logistic regression models included sex, age, number of comorbidities, symptoms on admission, blood pressure, heart rate, and body temperature as explanatory variables, and death and oxygen therapy as outcome variables.

Results: Logistic regression analyses revealed that the male sex, older age (≥ 60 years), higher number of comorbidities, presence of symptoms on admission, heart rate ≥ 120 bpm, and body temperature ≥ 37.5°C presented with higher risk of in-hospital death and oxygen therapy requirement. Conversely, rhinorrhea and headache were associated with a low risk of death and oxygen therapy requirement. The findings showed that cough, sputum, and fever were the most common symptoms on admission, while 25.3% of patients with COVID-19 were asymptomatic.

Conclusion: COVID-19 patients with high-risk early symptoms on admission, such as dyspnea and altered mental status, and those without low-risk symptoms of rhinorrhea and headache should be included in priority treatment groups.
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http://dx.doi.org/10.3346/jkms.2021.36.e132DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8111043PMC
May 2021

Diagnostic procedures and clinico-radiological findings of acute fibrinous and organizing pneumonia: a systematic review and pooled analysis.

Eur Radiol 2021 Mar 31. Epub 2021 Mar 31.

Department of Radiology, Seoul National University Hospital, Seoul National College of Medicine, Seoul, South Korea.

Objectives: To evaluate the clinico-radiological findings of acute fibrinous and organizing pneumonia (AFOP) in the literature according to whether a surgical or non-surgical biopsy was performed, as well as to identify prognostic predictors.

Methods: We searched the Embase and OVID-MEDLINE databases to identify studies that presented CT findings of AFOP and had extractable individual patient data. We compared the clinical and CT findings of the patients depending on whether a surgical or non-surgical biopsy was performed and identified survival predictors using a multivariate logistic regression analysis.

Results: Eighty-one patients (surgical biopsy, n = 52; non-surgical biopsy, n = 29) from 63 studies were included. The surgical biopsy group frequently experienced an acute fulminant presentation (p = .011) and dyspnea (p = .001) and less frequently had a fever (p = .006) than the non-surgical biopsy group. The surgical biopsy group had a worse prognosis than the non-surgical biopsy group in terms of mechanical ventilation and mortality (both, p = .023). For survival analysis, the patients with the predominant CT finding of patchy or mass-like air-space consolidation survived more frequently (p < .001) than those with other CT findings. For prognostic predictors, subacute indolent presentation (p = .001) and patchy or mass-like air-space consolidation on CT images (p = .002) were independently associated with good survival.

Conclusions: Approximately one-third of alleged AFOP cases in the literature were diagnosed via non-surgical biopsy, but those cases had different symptomatic presentations and prognosis from surgically proven AFOP. Subacute indolent presentation and patchy or mass-like air-space consolidation at the presentation on CT images indicated a good prognosis in patients with AFOP.

Key Points: • Acute fibrinous and organizing pneumonia (AFOP) cases diagnosed via non-surgical biopsy had different symptomatic presentations and prognosis from surgically proven AFOP. • Subacute indolent presentation and patchy or mass-like air-space consolidation on CT images indicated a good prognosis in patients with acute fibrinous and organizing pneumonia.
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http://dx.doi.org/10.1007/s00330-021-07868-zDOI Listing
March 2021

Guidelines for Surgery of Confirmed or Suspected COVID-19 Patients.

Infect Chemother 2020 Sep 27;52(3):453-459. Epub 2020 Aug 27.

Division of Infectious Diseases, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea.

Coronavirus disease 2019 (COVID-19) has spread widely across the world since January 2020. There are many challenges when caring for patients with COVID-19, one of which is infection prevention and control. In particular, in cases where surgery must absolutely be performed, special infection control may be required in order to perform surgery without spreading infection within the hospital. We aim to present potentially useful recommendations for non-deferrable surgery for COVID-19 patients based on and research and clinical experiences from many countries.
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http://dx.doi.org/10.3947/ic.2020.52.3.453DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7533204PMC
September 2020

Stepwise Strategy of Social Distancing in Korea.

J Korean Med Sci 2020 Jul 20;35(28):e264. Epub 2020 Jul 20.

Department of Respiratory and Critical Care Medicine, Inje University Seoul Paik Hospital, Seoul, Korea.

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http://dx.doi.org/10.3346/jkms.2020.35.e264DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7371458PMC
July 2020

Suggestions to Prepare for the Second Epidemic of COVID-19 in Korea.

Authors:
Ho Kee Yum

J Korean Med Sci 2020 May 18;35(19):e191. Epub 2020 May 18.

Department of Internal Medicine, Inje University College of Medicine, Busan, Korea.

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http://dx.doi.org/10.3346/jkms.2020.35.e191DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7234859PMC
May 2020

Short-term Evaluation of a Comprehensive Education Program Including Inhaler Training and Disease Management on Chronic Obstructive Pulmonary Disease.

Tuberc Respir Dis (Seoul) 2017 Oct 1;80(4):377-384. Epub 2017 Sep 1.

Department of Internal Medicine, Inje University Seoul Paik Hospital, Seoul, Korea.

Background: Proper education regarding inhaler usage and optimal management of chronic obstructive pulmonary disease (COPD) is essential for effectively treating patients with COPD. This study was conducted to evaluate the effects of a comprehensive education program including inhaler training and COPD management.

Methods: We enlisted 127 patients with COPD on an outpatient basis at 43 private clinics in Korea. The patients were educated on inhaler usage and disease management for three visits across 2 weeks. Physicians and patients were administered a COPD assessment test (CAT) and questionnaires about the correct usage of inhalers and management of COPD before commencement of this program and after their third visit.

Results: The outcomes of 127 COPD patients were analyzed. CAT scores (19.6±12.5 vs. 15.1±12.3) improved significantly after this program (p<0.05). Patients with improved CAT scores of 4 points or more had a better understanding of COPD management and the correct technique for using inhalers than those who did not have improved CAT scores (p<0.05).

Conclusion: A comprehensive education program including inhaler training and COPD management at a primary care setting improved CAT scores and led to patients' better understanding of COPD management.
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http://dx.doi.org/10.4046/trd.2017.0041DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5617854PMC
October 2017

Factors affecting satisfaction with education program for chronic airway disease in primary care settings.

J Thorac Dis 2017 Jul;9(7):1911-1918

Department of Internal Medicine, Seoul Paik Hospital, Inje University, Seoul, Korea.

Background: A well-organized education program improved the patients' knowledge about their disease, inhaler technique and quality of life in asthma and chronic obstructive pulmonary disease (COPD) patients. The effectiveness of the education program can be evaluated by assessing patients' satisfaction with the education program as well. In this study, we compared the patients' satisfaction with education program between COPD and asthma patients.

Methods: A total of 284 asthma and COPD patients were enrolled. Three educational visits were conducted at 2-week intervals. On the first visit, we taught the patients about their diseases and the proper inhaler technique. On the second visit, non-pharmacologic treatments and action plans for acute exacerbation were introduced. On the final appointment, we summarized the educational concepts covered in the two prior visits. After the education program, the patients were assessed for their quality of life, knowledge of chronic airways disease, and satisfaction with the education program, using a structured questionnaire.

Results: After the education program, 99.3% of the asthma patients knew much more about their disease and 96.8% agreed that education from the hospital is needed. For COPD patients, 94.8% felt more informed about their disease and 95.7% agreed that education from the hospital is needed. However, 17.1% of asthma patients and 13.5% of COPD patients disagreed to paying an additional fee for the education program. Finally, the knowledge improvement was linked to patient satisfaction with the education program.

Conclusions: The improvement in self-knowledge about their disease was linked to their satisfaction with the education program. However, costs associated with the program could limit its accessibility to the patients. The patient education program is a self-management intervention to improve the lives of patients with asthma and COPD. Thus, a policy to reduce the economic burden of the patients should be considered to disseminate the education program in primary care clinics.
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http://dx.doi.org/10.21037/jtd.2017.06.01DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5543003PMC
July 2017

The Need for a Well-Organized, Video-Assisted Asthma Education Program at Korean Primary Care Clinics.

Tuberc Respir Dis (Seoul) 2017 Apr 31;80(2):169-178. Epub 2017 Mar 31.

Department of Internal Medicine, Inje University Seoul Paik Hospital, Seoul, Korea.

Background: The purpose of this study was to assess the effect of our new video-assisted asthma education program on patients' knowledge regarding asthma and asthma control.

Methods: Adult asthmatics who were diagnosed by primary care physicians and followed for at least 1 year were educated via smart devices and pamphlets. The education sessions were carried out three times at 2-week intervals. Each education period lasted at most 5 minutes. The effectiveness was then evaluated using questionnaires and an asthma control test (ACT).

Results: The study enrolled 144 patients (mean age, 56.7±16.7 years). Half of the patients had not been taught how to use their inhalers. After participating in the education program, the participants' understanding of asthma improved significantly across all six items of a questionnaire assessing their general knowledge of asthma. The proportion of patients who made errors while manipulating their inhalers was reduced to less than 10%. The ACT score increased from 16.6±4.6 to 20.0±3.9 (p<0.001). The number of asthmatics whose ACT score was at least 20 increased from 45 (33.3%) to 93 (65.3%) (p<0.001). The magnitude of improvement in the ACT score did not differ between patients who received an education session at least three times within 1 year and those who had not. The majority of patients agreed to the need for an education program (95.8%) and showed a willingness to pay an additional cost for the education (81.9%).

Conclusion: This study indicated that our newly developed education program would become an effective component of asthma management in primary care clinics.
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http://dx.doi.org/10.4046/trd.2017.80.2.169DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5392488PMC
April 2017

Safety and Effectiveness of Indacaterol in Chronic Obstructive Pulmonary Disease Patients in South Korea.

Tuberc Respir Dis (Seoul) 2017 Jan 30;80(1):52-59. Epub 2016 Dec 30.

Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Background: Inhaled indacaterol (Onbrez Breezhaler), a long-acting β-agonist, is approved in over 100 countries, including South Korea, as a once-daily bronchodilator for maintenance and treatment of chronic obstructive pulmonary disease (COPD). Here, we present an interim analysis of a post-marketing surveillance study conducted to evaluate the real-world safety and effectiveness of indacaterol in the Korean population.

Methods: This was an open-label, observational, prospective study in which COPD patients, who were newly prescribed with indacaterol (150 or 300 µg), were evaluated for 12 or 24 weeks. Safety was assessed based on the incidence rates of adverse events (AEs) and serious adverse events (SAEs). Effectiveness was evaluated based on physician's assessment by considering changes in symptoms and lung function, if the values of forced expiratory volume in 1 second were available.

Results: Safety data were analyzed in 1,016 patients of the 1,043 enrolled COPD patients receiving indacaterol, and 784 patients were included for the effectiveness analysis. AEs were reported in 228 (22.44%) patients, while 98 (9.65%) patients reported SAEs. The COPD condition improved in 348 patients (44.4%), while the condition was maintained in 396 patients (50.5%), and only 40 patients (5.1%) exhibited worsening of ailment as compared with baseline. During the treatment period, 90 patients were hospitalized while nine patients died. All deaths were assessed to be not related to the study drug by the investigator.

Conclusion: In real-life clinical practice in South Korea, indacaterol was well tolerated in COPD patients, and can be regarded as an effective option for their maintenance treatment.
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http://dx.doi.org/10.4046/trd.2017.80.1.52DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5256353PMC
January 2017

Effects of Educational Interventions for Chronic Airway Disease on Primary Care.

J Korean Med Sci 2016 Jul 19;31(7):1069-74. Epub 2016 May 19.

Department of Internal Medicine, Seoul Paik Hospital, Inje University, Seoul, Korea .

Education has been known to essential for management of chronic airway diseases. However the real benefits remain unclear. We evaluated the effectiveness of an organized educational intervention for chronic airway diseases directed at primary care physicians and patients. The intervention was a 1-month education program of three visits, during which subjects were taught about their disease, an action plan in acute exacerbation and inhaler technique. Asthma control tests (ACT) for asthma and, chronic obstructive pulmonary disease (COPD) assessment tests (CAT) for COPD subjects were compared before and after education as an index of quality of life. Educational effectiveness was also measured associated with improvement of their knowledge for chronic airway disease itself, proper use of inhaler technique, and satisfaction of the subjects and clinicians before and after education. Among the 285 participants, 60.7% (n = 173) were men and the mean age was 62.2 ± 14.7. ACT for asthma and CAT in COPD patients were significantly improved by 49.7% (n = 79) and 51.2% (n = 65) more than MCID respectively after education (P < 0.05). In all individual items, knowledge about their disease, inhaler use and satisfaction of the patients and clinicians were also improved after education (P < 0.05). This study demonstrates the well-organized education program for primary care physicians and patients is a crucial process for management of chronic airway diseases.
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http://dx.doi.org/10.3346/jkms.2016.31.7.1069DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4900998PMC
July 2016

Spontaneous Pneumomediastinum: An Unusual Pulmonary Complication in Anorexia Nervosa.

Tuberc Respir Dis (Seoul) 2015 Oct 1;78(4):360-2. Epub 2015 Oct 1.

Department of Internal Medicine, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea.

Spontaneous pneumomediastinum (PM) is an uncommon condition in which free air enters the mediastinum. This usually occurs either through esophageal tears after vigorous vomiting, or after alveolar rupture subsequent to a rapid increase in intra-alveolar pressure. Spontaneous PM is a rare entity in anorexia nervosa (AN) and self-induced vomiting is often the cause of PM in patients with AN. We experienced a case of spontaneous PM in an anorexic adolescent, in whom vomiting was not the cause of PM.
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http://dx.doi.org/10.4046/trd.2015.78.4.360DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4620330PMC
October 2015

Prevention of venous thromboembolism in medical intensive care unit: a multicenter observational study in Korea.

J Korean Med Sci 2014 Nov 4;29(11):1572-6. Epub 2014 Nov 4.

Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.

Patients admitted to medical intensive care unit (MICU) are at increased risk for venous thromboembolism (VTE); and prophylaxis is recommended. However, the actual range and frequency of VTE prophylaxis administered to MICU patients are not well defined. Patients over 40 yr of age and expected MICU stay of more than 48 hr were eligible for this observational cohort study of 23 MICUs in Korea. Patients already on anticoagulation therapy or those requiring anticoagulation for reasons other than VTE were excluded. Among 830 patients, VTE prophylaxis was given to 560 (67.5%) patients. Among 560 patients, 323 (38.9%) received pharmacoprophylaxis, 318 (38.4%) received mechanical prophylaxis and 81 (9.8%) received both forms of prophylaxis. About 74% of patients in the pharmacoprophylaxis group received low molecular weight heparin and 53% of the patients in the mechanical prophylaxis group used intermittent pneumatic compression. Most of the patients (90%) had more than one risk factor for VTE and the most common risk factor was old age, followed by heart and respiratory failure. In this observational cohort study of 23 MICUs in Korea, 67.5% of patients received thromboprophylaxis. Further studies are needed to clarify the role and efficacy of VTE prophylaxis in Korean critically ill patients.
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http://dx.doi.org/10.3346/jkms.2014.29.11.1572DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4234927PMC
November 2014

Recurrent Pseudomonas aeruginosa Infection in Chronic Lung Diseases: Relapse or Reinfection?

Tuberc Respir Dis (Seoul) 2014 Oct 31;77(4):172-7. Epub 2014 Oct 31.

Department of Laboratory Medicine, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea.

Background: Pseudomonas aeruginosa infection is particularly associated with progressive and ultimately chronic recurrent respiratory infections in chronic obstructive pulmonary disease, bronchiectasis, chronic destroyed lung disease, and cystic fibrosis. Its treatment is also very complex because of drug resistance and recurrence.

Methods: Forty eight cultures from 18 patients with recurrent P. aeruginosa pneumonia from 1998 to 2002 were included in this study. Two or more pairs of sputum cultures were performed during 2 or more different periods of recurrences. The comparison of strains was made according to the phenotypic patterns of antibiotic resistance and chromosomal fingerprinting by pulsed field gel electrophoresis (PFGE) using the genomic DNA of P. aeruginosa from the sputum culture.

Results: Phenotypic patterns of antibiotic resistance of P. aeruginosa were not correlated with their prior antibiotic exposition. Fifteen of 18 patients (83.3%) had recurrent P. aeruginosa pneumonia caused by the strains with same PFGE pattern.

Conclusion: These data suggest that the most of the recurrent P. aeruginosa infections in chronic lung disease occurred due to the relapse of prior infections. Further investigations should be performed for assessing the molecular mechanisms of the persistent colonization and for determining how to eradicate clonal persistence of P. aeruginosa.
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http://dx.doi.org/10.4046/trd.2014.77.4.172DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4217033PMC
October 2014

Effect of inhaled tiotropium on spirometric parameters in patients with tuberculous destroyed lung.

Tuberc Respir Dis (Seoul) 2014 Oct 31;77(4):167-71. Epub 2014 Oct 31.

Department of Internal Medicine, Inje University Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea.

Background: In Korea, patients with destroyed lung due to tuberculosis (TB) account for a significant portion of those affected by chronic pulmonary function impairment. The objective of our research was to evaluate the efficacy of inhaled tiotropium bromide in TB destroyed lung.

Methods: We compared the effectiveness of inhaled tiotropium bromide for 2 months between pre- and post-treatment pulmonary function tests performed on 29 patients with destroyed lung due to TB.

Results: The mean age of the total number of patients was 63±9 years, where 15 patients were male. The pre-treatment mean forced expiratory volume in 1 second (FEV1) was 1.02±0.31 L (44.1±16.0% predicted). The pre-treatment mean forced vital capacity (FVC) was 1.70±0.54 L (52.2±15.8% predicted). Overall, the change in FEV1% predicted over baseline with tiotropium was 19.5±19.1% (p<0.001). Twenty patients (72%) got better than a 10% increase in FEV1 over baseline with tiotropium, but one patient showed more than a 10% decrease in FEV1. Overall, the change in FVC% predicted over baseline with tiotropium was 18.5±19.9% (p<0.001). Seventeen patients (59%) experienced greater than a 10% increase in FVC over baseline with tiotropium; 12 (41%) patients had stable lung function.

Conclusion: The inhaled tiotropium bromide therapy may lead to improve lung functions in patients with TB destroyed lung. However, the long-term effectiveness of this treatment still needs to be further assessed.
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http://dx.doi.org/10.4046/trd.2014.77.4.167DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4217032PMC
October 2014

Second to fourth digit ratio: a predictor of adult lung function.

Asian J Androl 2014 Jan-Feb;16(1):140-5

Department of Urology, Gachon University Gil Hospital, Incheon, Korea.

Sex and sex hormones play a major role in lung physiology. It has been proposed that the ratio of the second to fourth digits (digit ratio) is correlated with fetal sex hormones. We therefore hypothesized that digit ratio might help predict lung function. We investigated the relationship between digit ratio and pulmonary function test (PFT) findings. A total of 245 South Korean patients (162 male, 83 female) aged from 34 to 90 years who were hospitalized for urological surgery were prospectively enrolled. Before administering the PFTs, the lengths of the second and fourth digits of the right hand were measured by a single investigator using a digital Vernier caliper. In males (n = 162), univariate and multivariate analysis using linear regression models showed that digit ratio was a significant predictive factor of forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) (FVC: r = 0.156, P = 0.047; FEV1: r = 0.160, P = 0.042). In male ever-smokers (n = 69), lung functions (FVC and FEV1) were correlated with smoking exposure rather than digit ratio. In female never-smokers (n = 83), lung functions (FEV1 and FEV1/FVC ratio) were positively correlated with digit ratio on univariate analysis (FEV1: r = 0.242, P = 0.027; FEV1/FVC ratio: r = 0.245, P = 0.026). Patients with lower digit ratios tend to have decreased lung function. These results suggest that digit ratio is a predictor of airway function.
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http://dx.doi.org/10.4103/1008-682X.122195DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3901873PMC
September 2014

Inverted Tako-Tsubo cardiomyopathy associated with bronchoalveolar lavage.

Heart Lung Circ 2011 Jul 13;20(7):476-8. Epub 2011 May 13.

Division of Cardiology, Cardiac and Vascular Center, Department of Medicine, Inje University Seoul Paik Hospital, Inje University School of Medicine, #85 Jeo-dong 2-ga, Jung-gu, Seoul, Republic of Korea.

Tako-Tsubo cardiomyopathy (TTC), also known as transient left ventricular (LV) ballooning syndrome or stress-induced cardiomyopathy, is characterised by transient LV dysfunction in the absence of significant angiographic coronary stenoses, frequently provoked by an episode of emotional or physical stress. In TTC, typically transient akinesis or dyskinesis of the LV apical segments with normal or hypercontractile basal wall motions is observed. Recently, several cases of atypical or inverted transient TTC sparing the LV apex have been reported. We report a case of inverted TTC showing akinesis of the basal and mid-ventricular segments of the LV with apical hyperkinesia triggered by bronchoscopy with bronchoalveolar lavage.
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http://dx.doi.org/10.1016/j.hlc.2011.01.004DOI Listing
July 2011

A nationwide survey of lymphangioleiomyomatosis in Korea: recent increase in newly diagnosed patients.

J Korean Med Sci 2010 Aug 21;25(8):1182-6. Epub 2010 Jul 21.

Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

In 2007, the Korean Interstitial Lung Disease Society had collected clinical data of patients who have diagnosed as Lymphangioleiomyomatosis (LAM) since 1990 through nationwide survey, which showed that LAM patients had increased sharply after 2004. The present study was performed to show the clinical features of Korean patients with LAM, and to establish the reason for the recent increase in the diagnosis. All 63 patients were women and the mean age at diagnosis was 36 yr. The most common presenting symptom was dyspnea and 8 patients had tuberous sclerosis complex. The survival rate at 5 yr after diagnosis was 84%. Compared with patients diagnosed after 2004 (n=34), the patients diagnosed before 2004 (n=29) complained with dyspnea more (P=0.016) and had lower FEV(1)% predicted (P=0.003), and DLco% predicted (P=0.042). The higher proportion of patients diagnosed after 2004 showed the normal chest radiography, and they were detected by routine chest CT screening (P=0.016). This study showed that clinical features of Korean patients with LAM were not different from those reported elsewhere. It is concluded that the reason for the increase of newly diagnosed patients is the result of increase in detection of the early stage LAM by the widespread use of chest CT screening.
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http://dx.doi.org/10.3346/jkms.2010.25.8.1182DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2908788PMC
August 2010

Catamenial hemoptysis: a nationwide analysis in Korea.

Respiration 2010 14;79(4):296-301. Epub 2009 Jul 14.

Department of Internal Medicine, National Health Insurance Corporation, Ilsan Hospital, Koyang, South Korea.

Background: Hemoptysis is a potentially serious clinical problem. However, there is no consensus on the clinical characteristics, treatment and patient outcome of catamenial hemoptysis.

Objective: Clinical characteristics, treatments and outcome in patients of catamenial hemoptysis were evaluated.

Methods: We conducted a retrospective nationwide observational analysis of Korean patients with catamenial hemoptysis.

Results: Nineteen patients with catamenial hemoptysis were evaluated from 13 tertiary-care hospitals in Korea. The median age of the patients was 25 years; 8 (42%) were ever-smokers. Eight patients were pathologically diagnosed; 11 were diagnosed by clinical criteria. Sixteen (84%) patients had a history of obstetric or gynecological procedures before developing hemoptysis. The mean amount of hemoptysis (mean +/- SD) was 58.3 +/- 71.3 for surgery, 46.4 +/- 33.2 for hormonal and 29.1 +/- 26.3 for conservative treatment groups. Hemoptysis did not recur in 8 (89%) of 9 patients after surgery. None of the patients in the hormonal or conservative treatment groups had persistent hemoptysis. There was an excellent outcome (complete remission and partial responses) in all patients with conservative treatment, suggesting that endometrial cells implanted into the lung may have a benign course.

Conclusion: Patients without massive hemoptysis can be treated conservatively or with hormonal agents.
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http://dx.doi.org/10.1159/000228831DOI Listing
May 2010

Lung cancer patients who are asymptomatic at diagnosis show favorable prognosis: a korean Lung Cancer Registry Study.

Lung Cancer 2009 May 21;64(2):232-7. Epub 2008 Sep 21.

The Survey Committee of Korean Association for the Study of Lung Cancer, South Korea.

Purpose And Methods: The outcomes of lung cancer patients who were asymptomatic at diagnosis have never been reported as part of a large-scale study. A national survey of lung cancer in South Korea registered a total of 8788 patients diagnosed in 2005. We report the results herein, with an emphasis on the prognosis of the asymptomatic lung cancer patients.

Results: Adenocarcinoma was the most frequent (36.1%) histopathologic type, followed by squamous cell carcinoma (32.1%), large cell carcinoma (1.5%), and small cell carcinoma (13.5%). In most cases, lung cancer was detected with subjective symptoms, but 6.5% of cases had no symptoms indicative of lung cancer at the time of diagnosis. Compared to symptomatic patients, asymptomatic patients were younger, more often female, non-smokers, and more frequently presented with adenocarcinoma. Initial treatments were surgery (22.1%), radiation therapy (7.8%), chemo-radiation therapy (5.4%), and chemotherapy (38%), while 26.6% of patients were recorded to have supportive care only. Asymptomatic patients received surgery in 60.0% of cases, and they showed significantly longer survival times than symptomatic patients. Absence of symptoms at diagnosis significantly reduced the risk of death from non-small cell lung cancer, regardless of patient age, patient gender, stage at diagnosis, smoking history, or whether treatment was performed, but did not reduce the risk of death from small cell lung cancer.

Conclusions: Adenocarcinoma has grown to be the leading histopathologic type of lung cancer in South Korea. Absence of symptom at diagnosis is a favorable prognostic factor for patients with non-small cell lung cancer.
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http://dx.doi.org/10.1016/j.lungcan.2008.08.005DOI Listing
May 2009

Loffler's syndrome associated with Clonorchis sinensis infestation.

Korean J Intern Med 2003 Dec;18(4):255-9

Department of Internal Medicine, Inje University College of Medicine, Seoul, Korea.

In 1932, Loffler described a syndrome of self-limiting, transient pulmonary infiltrates associated with peripheral blood eosinophilia and mild pulmonary symptoms. A number of conditions are related to pulmonary eosinophilia or pulmonary infiltration with eosinophilia. Especially, parasitic infestations are often related to pulmonary eosinophilia, but only two cases associated with Clonorchis sinensis have been anecdotally reported in English literature. Here we report a case of migrating pulmonary eosniophilic infiltrations associated with Clonorchis sinensis that was successfully treated with praziquantel. Clonorchiasis should be considered in patients with marked eosinophilia and pulmonary infiltrations.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4531639PMC
http://dx.doi.org/10.3904/kjim.2003.18.4.255DOI Listing
December 2003

Detection of mycobacterial DNA using nested polymerase chain reaction of pleural biopsy specimens: compared to pathologic findings.

Korean J Intern Med 2003 Jun;18(2):89-93

Department of Internal Medicine, Inje University College of Medicine, Seoul, Korea.

Background: Although there are many methods including AFB smear and culture, and the analysis of pleural fluid in the etiological diagnosis of pleural effusion, it is sometimes difficult to confirm a diagnosis especially in cases of incomplete pleural biopsies. Moreover, the high incidence of tuberculous pleuritis in young people caused confusion in the differential diagnosis of pleural effusion in Korea. The pathognomonic finding of tuberculous pleuritis in pleural biopsy is chronic granulomatous pleuritis (CGP) with caseous necrosis. But a biopsy does not always provide a definitive diagnosis, which shows in only 60-70% of all biopsies, because of either limitations in blind biopsies or inadequate specimens. An adequate biopsy also gives only limited information, such as chronic or nonspecific pleuritis.

Methods: We compared the clinical diagnosis, pathologic findings and detection of mycobacterial DNA using nested PCR of pleural biopsy tissues. We carried out the nested PCR for IS6110 insertion sequence of Mycobacterium tuberculosis using outer primer IS-1/IS-2 (5'-AGGCGTTGGTTCGCGAGGG-3'/5'-TGATGACGCCCTCGTTGCC-3') and inner primer IS-3/IS-4 (5'-CCAACCCGCTCGGTCTCAA-3'/5'-ACCGATGGACTGGTCACCC-3') in 52 pleural biopsy tissues which were pathologically diagnosed as tuberculous pleuritis, malignant pleuritis or non-specific pleuritis.

Results: Five (71.4%) of 7 cases clinically and pathologically confirmed tuberculous pleuritis diagnosed as chronic granulomatous pleuritis (CGP) with caseous necrosis revealed positive in nested PCR for M. tuberculosis. Seven (36.8%) of 19 cases diagnosed as CGP without caseous necrosis were positive. However, only 3 (25%) of 12 cases diagnosed as non-specific chronic pleuritis were positive by PCR for M. tuberculosis. Neither congestive heart failure nor malignancies with pleurisy showed a positive reaction.

Conclusion: In this study, pathologic findings were significantly associated with the detection rate of mycobacterial DNA. And, even in patients with nonspecific or chronic inflammatory pleuritis, mycobacterial DNA could be detected by using nested PCR in pleural biopsy tissue with good specificity. Detection of mycobacterial DNA in pleural tissue might provide additional information for etiological diagnosis in patients with pleural effusion.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4531611PMC
http://dx.doi.org/10.3904/kjim.2003.18.2.89DOI Listing
June 2003

Activation of gene expression in human neutrophils by high mobility group box 1 protein.

Am J Physiol Cell Physiol 2003 Apr;284(4):C870-9

Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Health Sciences Center, Denver, Colorado 80262, USA.

High mobility group box 1 (HMGB1) protein, a DNA binding protein that stabilizes nucleosomes and facilitates transcription, was recently identified as a late mediator of endotoxin lethality. High serum HMGB1 levels in patients with sepsis are associated with increased mortality, and administration of HMGB1 produces acute inflammation in animal models of lung injury and endotoxemia. Neutrophils occupy a critical role in mediating the development of endotoxemia-associated acute lung injury, but previously it was not known whether HMGB1 could influence neutrophil activation. In the present experiments, we demonstrate that HMGB1 increases the nuclear translocation of NF-kappaB and enhances the expression of proinflammatory cytokines in human neutrophils. These proinflammatory effects of HMGB1 in neutrophils appear to involve the p38 MAPK, phosphatidylinositol 3-kinase/Akt, and ERK1/2 pathways. The mechanisms of HMGB1-induced neutrophil activation are distinct from endotoxin-induced signals, because HMGB1 leads to a different profile of gene expression, pattern of cytokine expression, and kinetics of p38 activation compared with LPS. These findings indicate that HMGB1 is an effective stimulus of neutrophil activation that can contribute to development of a proinflammatory phenotype in diseases characterized by excessively high levels of HMGB1.
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http://dx.doi.org/10.1152/ajpcell.00322.2002DOI Listing
April 2003

Lymphocytic interstitial pneumonitis associated with Epstein-Barr virus in Systemic Lupus Erythematosus and Sjögren's Syndrome. Complete remission with corticosteriod and cyclophosphamide.

Korean J Intern Med 2002 Sep;17(3):198-203

Department of Internal Medicine, Inje University College of Medicine, Seoul, Korea.

Lymphocytic interstitial pneumonitis (LIP) is characterized by diffuse bilateral pulmonary infiltrations in both lower lobes. Pleomorphic lymphohistiocytes including mature lymphocytes, variable admixture of plasma cells and other mononuclear cells infiltrate within the pulmonary interstitium, ranging from widened septa to confluent masses. We report a case of LIP associated with Epstein-Barr virus in a patient with SLE and Sjögren's syndrome. A 50-year-old woman was admitted with insidious onset of progressive dyspnea for 20 days. She suffered from arthritis 10 years earlier without specific diagnosis. A radiography of chest has showed bilateral consolidative infiltrations with pleural effusion in both lower lung fields. Open lung biopsy documented lymphocytic interstitial pneumonitis which expressed Epstein-Barr virus genome in situ hybridization study. Following corticosteroid and cyclophosphamide therapy, clinical symptoms and radiologic infiltrations gradually remitted.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4531674PMC
http://dx.doi.org/10.3904/kjim.2002.17.3.198DOI Listing
September 2002

Effects of catecholamines on kinase activation in lung neutrophils after hemorrhage or endotoxemia.

J Leukoc Biol 2002 Sep;72(3):571-9

Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Health Sciences Center, Denver 80262, USA.

Catecholamines are released in high levels after hemorrhage or endotoxemia and have been shown to modulate immune function, including cellular release of inflammatory mediators. In the present experiments, we examined the effects of endogenous and exogenous catecholamines on neutrophil accumulation and activation in the lungs using pretreatment with alpha- or beta-antagonists or alpha-adrenergic agonists before hemorrhage or endotoxemia. These studies showed that alpha-, but not beta-adrenergic stimuli, modulated the severity of acute lung injury after hemorrhage or endotoxemia, and alpha-adrenergic stimuli was proinflammatory after hemorrhage but anti-inflammatory after endotoxemia. The observed alpha-adrenergic effects on lung neutrophil activation appeared to involve primarily the extracellular signal-regulated kinase pathway at the upstream kinase Raf, but not Ras. Although p38 and protein kinase A were activated in lung neutrophils after hemorrhage or endotoxemia, these kinases were not affected by alpha- or beta-adrenergic modulation. These results demonstrate that catecholamines have important immunomodulatory effects in vivo that affect intracellular signaling pathways in neutrophils and neutrophil-driven, inflammatory processes such as the development of acute lung injury.
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September 2002

Lipopolysaccharide-induced neutrophil gene expression under in vivo or in vitro conditions.

Chest 2002 Mar;121(3 Suppl):76S

Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Health Science Center, Denver, CO 80262, USA.

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http://dx.doi.org/10.1378/chest.121.3_suppl.76sDOI Listing
March 2002