척추 전이성 종양의 수술적 치료 : 삶의 질에 대한 평가를 중심으로 focused in evaluation of life quality

양준영,이준규,홍의표,안성환,이정범 충남대학교 의학연구소 2003 충남의대잡지 Vol.30 No.2

목적 : 척추에 발생한 전이성 종양 환자들을 대상으로, 수술적 치료를 시행한 환자에 있어서, 술후 생존 기간과 생존 기간 내 동통, 신경학적 증상, 일상 생활 능력 등의 평가를 통한 수술적 치료의 결과에 대하여 보고하고자 한다 . 연구대상 및 방법 : 1996년부터 1999년까지 본원에서 전이성 종양으로 수술적 치료를 받았던 환자중 추시가 가능했던 13례의 환자를 대상으로 하였으며 술 후 생존 기간 및 술 전 및 술 후 추시 중의 동통 양상 및 신경학적 증상의 호전여부, 일상 생활 수행 능력을 분석하였다 . 결과 : 전례에서 술 전 동통을 호소하였으며, 1례에서만 단독 보행이 가능하였고, 1례에서는 앉는 것만 가능하였으며, 11례에서는 앉지도 못하였다. 술 후 평가에서는 전례에서 동통이 감소하였으며, 술전에 신경학적 증상이 보였던 환자 중 75%에서 신경학적 증상이 호전이 나타났으며, 대상환자 중 92%에서 자가 보행이 가능하거나, 앉는 것이 가능하게 되었다. 사망한 환자의 술후 생존기간은 평균 11.2 개월이었다. 결론 : 수술적 치료를 받은 척추의 전이성 골종양 환자에서 술 후 신경학적 증상의 호전, 동통의 감소 및 보행 능력의 호전을 볼 수가 있었다. 따라서 척추의 전이성 종양 환자에 있어, 수술의 적응증이 된다면 수술적 치료를 적극적으로 시행하는 것이 환자의 삶의 질을 향상시킬 수 있다고 사료된다. To evaluate the clinical results of surgical treatment in metastatic spinal tumor patients. Thirteen patients of spinal metastatic tumor, treated by surgical methods, in this hospital from 1996 to 1999, were included in this study. We analysed pre and post operative pain, neurologic symptom and life quality. Preoperatively, all patients complained of pain and one case do could self walking, one case could do self sitting, and eleven patients were bed-ridden states. Postoperatively, pain was subsided in all cases. Neurologic symptom recovered in 75% of patients who had had preoperative neurologic symptoms. Postoperatively, patients walk or sit without assistance in 92% of cases. Mean postoperative span of survival was 11.2 months. Surgical treatment of spinal metastatic tumor improved the neurologic status and reduced pain. So, we conclude that if indicated, surgical treatment seems to achieve better results than conservative treatment in spinal metastatic tumor patient.

순비기나무 (Vitex rotundifolia L. f.) 삽수 종류 및 생장조정제 처리에 따른 발근율

Jeong Yeob Kim,Yoon Ki Hong,Song Hee Ahn,Jung Seob Moon,Eun Seok Park,Hee June Kim 한국약용작물학회 2016 한국약용작물학술대회 발표집 Vol.2016 No.05

Background : This study was conducted to developed the propagation method by cutting for mass cultivation of Vitex roundifolia. We were pitched the cutting two times and treated plant growth regulators to enhance the rooting percentage. Vitex roundifolia is live in beach sandy soil south of Hwanghae-Do and Gangwon-Do. Vitex roundifolia have been used to bath foam. It is good for aromatic plant. It has 0.8% essential oil content in leaf and flower. Major components of essential oil were alpha-Pinene, Sabinene, beta-Pinen, 1,8-cineole, d-Limone. Despite the superior usability, it had not yet been made by the artificial cultivation Methods and Results : We were pitched the cutting of a first-year branch on June 5, which was greenwood cutting and July 17, which was semi-hardwood cutting at Kwangseung-ri beach, Gochanggun, Jeonbuk. The length of cutting was 10cm. It had 3~4 nodes, we stuck a cutting remain 2 nodes above ground on ordinary raise seedling soil. Rooting percentage was measured at 60 days after stuck a cutting. Rooting percentage was higher greenwoody cutting(95%) than semi-hardwood cutting(57.6%). In green wood cutting, there was no significance with plant growth, but chemical injury was occurred in IBA 5,000ppm. In semi-hardwood cutting, there was significance with plant growth regulators. The rooting percentages of all the treat were higher than control(no treatment). Rooting percentage was the highest in NAA 5,000ppm treated. Conclusion : Greenwood cutting method was more proper to propagation for Vitex roundifolia than semi-hardwood cutting. The optimum time to cutting for Vitex roundifolia propagation was the early in June. If miss a time to propagation Rooting percent was elevated by plant growth regulator.

Evaluating inhaler device handling technique and risk factors for critical inhaler errors in Korean chronic obstructive pulmonary disease patients: single center study of 261 patients

( June Hong Ahn ),( Kwan Ho Lee ),( Jin Hong Chung ),( Kyeong-cheol Shin ),( Eun Young Choi ),( Hyun Jung Jin ),( Jong Geol Jang ),( Kyung Soo Hong ),( Young Seok Lee ),( Euna Lee ),( Mi Jeong Nam ) 대한결핵 및 호흡기학회 2019 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.127 No.-

Background: The objective of this study was to evaluate inhaler device handling techniques and risk factors associated with critical inhaler errors among patients with chronic obstructive pulmonary disease (COPD) in Korea. Methods: We assessed the handling of 308 devices used for continuous treatment of COPD in 261 patients. We enrolled 143 subjects who used dry power inhaler (DPI), 145 who used soft mist inhaler (SMI) and 20 who used pressured metered-dose inhaler (pMDI) for COPD treatment at Yeungnam University Hospital and visually tested inhaler device handling technique. Results: A total of 308 devices were evaluated. At least one errors were observed in 267 (86.7%). At least one critical inhaler errors were observed in 39.2% (56/143), 45.5% (66/145) and 55.0% (11/20) of inhalation assessment test with DPI, SMI and pMDI. Among DPI, critical errors were respectively observed in 60.0%, 41.0%, 27.8%, 12.5% and 44.4% of inhalation assessment test with Turbuhaler (n=20), Breezhaler (n=61), Ellipta (n=36), Diskus (n=8), and Genuair (n=18). In multivariate analysis, female sex (odds ratio [OR], 10.75; 95% confidence interval [CI], 2.30-50.30; p=0.003), higher inhaler puff burden (OR, 1.58, 95% CI, 1.24-2.02; p<0.001), higher mMRC (OR, 1.46, 95% CI, 1.05-2.03; p=0.025), lower feeling of satisfaction with inhaler (OR, 0.94, 95% CI, 0.88-0.99; p=0.032), and frequent exacerbation in previous one year (OR, 1.94, 95% CI, 1.03-3.66; p=0.040) were associated with critical inhaler errors.Conclusions: Among Korean COPD patients in tertiary hospital settings, inhaler device handling errors are common problem. Careful monitoring and training in inhaler use devices, especially in female, higher inhaler puff burden, higher mMRC, lower feeling of satisfaction with inhaler and frequent exacerbation COPD patients are important part of COPD management.

Critical inhaler handling error is an independent risk factor of frequent exacerbation of chronic obstructive pulmonary disease

( June Hong Ahn ),( Kwan Ho Lee ),( Jin Hong Chung ),( Kyeong-cheol Shin ),( Eun Young Choi ),( Hyun Jung Jin ),( Jong Geol Jang ),( Kyung Soo Hong ),( Young Seok Lee ),( Euna Lee ),( Mi Jeong Nam ) 대한결핵 및 호흡기학회 2019 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.127 No.-

Background: Acute exacerbations are significant event of morbidity and mortality in chronic obstructive pulmonary disease (COPD) patients. “Frequent exacerbator” phenotypes are considered as a distinct subgroup. The objective of this study was to evaluate risk factors associated with frequent exacerbations of COPD in Korean tertiary university hospital patients. Methods: The study was designed as a cross sectional, case-control study. We prospectively enrolled 261 COPD patients at Yeungnam University Hospital from January 2018 to November 2018. Subjects were tested their inhaler technique at study entry. Frequency of moderate to severe COPD exacerbations were reviewed retrospectively via electronic medical records during 12 months prior to study entry. “Frequent exacerbations” were defined as ≥2 moderate to severe exacerbations in the last 12 months. Multivariate logistic regression was performed to identify the risk factors of frequent exacerbations. Results: Among 261 COPD patients enrolled, 65 (24.9%) patients were “frequent exacerbator”. Frequent exacerbators had lower forced expiratory volume in 1 s (FEV1), lower forced vital capacity (FVC), higher mMRC, longer duration of inhaler usage, lower body mass index (BMI), higher critical inhaler handling error (<0.05). In multivariate analysis, longer duration of inhaler usage (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.00-1.19; p=0.041), lower BMI (OR, 0.91, 95% CI, 0.83-0.99; p=0.032), critical inhaler handling error (OR, 1.92, 95% CI, 1.06-3.48; p=0.032), low FVC (OR, 0.97, 95% CI, 0.95-0.99; p=0.005) were associated with frequent exacerbations. Conclusions: Our data revealed that longer duration of inhaler usage, lower BMI, critical inhaler handling error and low FVC are independent risk factors of frequent exacerbations in COPD patients. Careful monitoring and education in inhaler use devices, especially in “frequent exacerbators” are important part of COPD treatment.

Diagnostic yield and clinical characteristics of endobronchial ultrasound with a guide-sheath without fluoroscopy

( June Hong Ahn ),( Kyung Soo Hong ),( Jong Geol Jang ),( Jin Hong Chung ),( Kyeong Cheol Shin ),( Hyun Jung Jin ),( Eun Young Choi ) 대한결핵 및 호흡기학회 2019 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.127 No.-

Purpose: For tissue diagnosis of lung lesions, Radial probe endobronchial ultrasound (RP-EBUS) is useful. We analyzed the diagnostic yield and complications of RP-EBUS with a Guide-Sheath (GS) without fluoroscopy. And then, we identified factors associated with successful diagnosis. Reliability of molecular testing, using small specimens obtained by RP-EBUS, was also investigated. Method: A retrospective study of 102 patients who underwent RP-EBUS at Yeungnam University Hospital between January 2019 and July 2019 was conducted. RPEBUS was performed with GS without fluoroscopy. Then diagnostic yield and safety were assessed. Multivariate logistic regression analysis was used to identify factors associated with successful diagnosis. Result: The overall diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value for the diagnosis by RP-EBUS were 88.2% (90/102), 84.6% (66/78), 100% (24/24), 100% (66/66) and 66.7% (24/36), respectively. And the overall complication rate was 2.0% (2/102). Pneumothorax developed in two patients (2%) and one patient (1%) required chest tube insertion. In multivariate analysis, within the lesion of the probe (odds ratio, 14.6; p=0.001) was associated with diagnostic success. Molecular study including epidermal growth factor receptor and anaplastic lymphoma kinase for adenocarcinoma revealed 97.5% (39/40) and 82.5% (33/40), respectively. Conclusion: RP-EBUS with GS and without fluoroscopy showed a high diagnostic yield and a low complication rate. Even in molecular studies, small samples obtained by RP-EBUS have sufficient diagnostic value.

A Case of primary tracheal small cell carcinoma treated with concurrent chemoradiotherapy

( June Hong Ahn ),( Jin Hong Chung ),( Hyun Jung Jin ) 대한내과학회 2015 대한내과학회 추계학술발표논문집 Vol.2015 No.1

Introduction: Extrapulmonary small cell carcinoma (EPSCC) can arise in multiple organs and form a rare clinical entity of high-grade neuroendocrine tumors. EPSCC is often confused with metastatic SCLC. But, primary tracheal small cell carcinoma (SCC) is different from primary SCLC with metastatic disease. We report a case with primary tracheal SCC that was successfully treated with concurrent chemoradiotherapy. Case: A 73-year-old male patient with dyspnea lasting for 10-day visited our hospital. The patient had old tuberculosis and was a current smoker. There was inspiratory stridor and chest X-ray revealed narrowing of tracheal air column at T2-3 level. Chest computed tomography (CT) revealed a lobulated mass at proximal trachea. Bronchoscopy showed a 4.2 × 3.1 cm sized mass 5 cm above the carina. Biopsy was performed and SCC was revealed. Positron emission tomography revealed no nodal or distant metastasis. The patient received 6 cycles of systemic chemotherapy with etoposide and cisplatin. Concurrent radiotherapy to the tracheal mass was also performed. After therapy, bronchoscopy revealed only tracheal mucosa ulceration without tumor. Chest CT showed complete remission. 5 years after treatment, the patient is well being and no evidence of recurrence. Conclusions: We have diagnosed this patient as primary tracheal SCC. This is a very rare disease and it can be confused with metastatic SCLC. In a patient with primary tracheal SCC, it is possible to cure and to achieve long term survival with chemoradiotherapy.

Effects of repeated education of inhaler device handling by advanced practice nurse in teaching Korean chronic obstructive pulmonary disease patients

( June Hong Ahn ),( Kwan Ho Lee ),( Jin Hong Chung ),( Kyeong-cheol Shin ),( Eun Young Choi ),( Hyun Jung Jin ),( Jong Geol Jang ),( Kyung Soo Hong ),( Young Seok Lee ),( Euna Lee ),( Mi Jeong Nam ) 대한결핵 및 호흡기학회 2019 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.127 No.0

Objectives: The effects of inhaler education in chronic obstructive pulmonary disease (COPD) patients remain unclear. The objective of this study was to evaluate techniques and adherence in using inhaler devices and to investigate the effects of repeated education using inhaler device handling in COPD patients. Methods: We prospectively enrolled COPD patients who used their particular inhaler device for more than 1 month and evaluated the efficacy of repeated education for COPD. The educational intervention was 6-month education program of three visits, during which subjects were tested their inhaler technique and adherence, taught about inhaler technique face-to-face by advanced practice nurse. Inhaler technique, adherence, mMRC, COPD assessment tests (CAT), EuroQol-5D (EQ-5D), patient health questionnaire (PHQ-9), and feeling of satisfaction with inhaler questionnaire (FSI-10) were compared before and after education. Results: A total of 261 COPD patients performing a total of 308 inhaler devices were included in the study. 244 (93.5%) were men and the mean age was 69.8 ± 7.7. At least one errors were observed in 267 (86.7%) and at least one critical inhaler errors were observed in 43.2% (133/308). Education significantly decreased in percentage of incorrect techniques, incorrect critical techniques and poor adherence (86.7% vs 39.3%, p<0.001; 43.2% vs 8.8%, p<0.001; 2.3% vs 0.4%, p=0.009, respectively). FSI-10 for inhaler was significantly improved after education (44.4 ± 4.7 vs 47.7 ± 4.1, p<0.001). mMRC, CAT, EQ-5D and PHQ-9 were not significantly improved after education. Conclusions: Repeated face-to-face inhaler device handling education by advanced practice nurse significantly improved the inhaler technique, adherence and feeling of satisfaction with inhaler.

Assessment of Satisfaction with the Inhaler and Determinants of High Satisfaction in COPD Patients

( June Hong Ahn ),( Kwan Ho Lee ),( Jin Hong Chung ),( Kyeong-cheol Shin ),( Eun Young Choi ),( Hyun Jung Jin ),( Jong Geol Jang ),( Kyung Soo Hong ) 대한결핵 및 호흡기학회 2021 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.129 No.-

Background (Global Initiative for Chronic Obstructive Lung Disease) GOLD guidelines for chronic obstructive pulmonary disease (COPD) recommends considering patient’s preference in choosing inhaler device. However, few studies assessed inhaler satisfaction and factors associated with high inhaler satisfaction. We assessed satisfaction with the inhaler and determinants of high satisfaction in COPD patients. Methods COPD patients were prospectively enrolled from January 2018 to November 2019. The 308 inhalers used by the 261 participants in this study included dry powder inhalers (DPIs; Turbuhaler, Breezhaler, Ellipta, Diskus, Genuair), a soft mist inhaler (SMI; Respimat), and pressurized metered dose inhalers (pMDIs). Satisfaction with the inhaler were assessed by feeling of satisfaction with the inhaler questionnaire (FSI-10). High satisfaction with the inhaler was defined as FSI-10≥43. Results Among 261 COPD patients, 163 (62.5%) were highly satisfied with the inhaler device. The percentage of high satisfaction of inhaler for Turbuhaler, Breezhaler, Ellipta, Diskus, Genuair, Respimat, and pMDI usage were 40.0%, 67.2%, 66.7%, 50.0%, 55.6%, 63.4%, and 45.0%, respectively (p=0.973). Based on univariate analyses, higher body mass index, never or ex-smoker, good inhaler adherence, forced expiratory volume in 1 s (FEV1)≥50%, and mMRC<2 were potential factors for high satisfaction with inhaler. In the multivariate analyses, good inhaler adherence [OR], 1.99; 95% confidence interval [CI], 1.04-3.82; P=0.038) and mMRC<2 (OR 2.06; 95% CI, 1.21-3.49; P=0.007) were independent factors for high satisfaction with inhaler. Conclusions High satisfaction with inhaler was associated with good inhaler adherence and symptomatic control in COPD patients. Effective strategies are needed to improved satisfaction with inhaler, including proper inhaler device selection considering patient’s preference and repeated inhaler education to improve the understanding of inhalers.

P-97 Clinical characteristics of healthcare-associated pneumonia among hospitalized patients in a Korean tertiary teaching hospital

( June Hong Ahn ),( Hyun Jung Kim ),( Eun Young Choi ) 대한결핵 및 호흡기학회 2016 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.121 No.-

Background: Previous studies have shown that healthcare-associated pneumonia (HCAP) revealed worse clinical outcomes than community acquired pneumonia (CAP). We investigated clinical features of patients with HCAP and identified the risk factors for HCAP mortality. Methods: We conducted a retrospective, observational study of pneumonia patients who were hospitalized at a tertiary hospital. Identified pathogens that were not susceptible to β-lactams (ceftriaxone or ampicillin-sulbactam), macrolides, and respiratory fluoroquinolones were defined as CAP drug-resistant pathogens (CAP-DRPs). Primary outcome was 28-day mortality. Results: Of the 1046 patients, 399 were classified as HCAP and 647 as CAP. HCAP patients were older and had more frequency of comorbidities than CAP patients. Initial pneumonia severity index (PSI) was higher in patients with HCAP than with CAP. HCAP was associated with not only an increased rate of CAP-DRPs (HCAP, 57.5%; CAP, 22.6%; P<0.001), but also an increased rate of inappropriate initial antibiotic therapy (IIAT) (HCAP, 43.8%; CAP, 17.2%; P<0.001). HCAP was also associated with an increased 28-day mortality rate (HCAP, 14.5%; CAP, 6.3%; P<0.001). In multivariate analysis, PSI was an independent risk factor of 28-day mortality in patients with HCAP (OR 1.02, 95% CI 1.01-1.04). CAP-DRPs and IIAT were not associated with mortality. Conclusions: 28-day mortality was higher in patients with HCAP who are older and severely ill than with CAP. PSI, rather than CAP-DRPs or IIAT was an independent factor in predicting mortality in patients with HCAP.

Optimizing Radial Probe EBUS Techniques for TBLB

( June Hong Ahn ) 대한결핵 및 호흡기학회 2023 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.136 No.0