1.Treatment of connective tissue disease-associated interstitial lung disease: the pulmonologist's point of view.
The Korean Journal of Internal Medicine 2017;32(4):600-610
Interstitial lung disease (ILD) occurs in 15% of patients with collagen vascular disease (CVD), referred to as connective tissue disease (CTD). Despite advances in management strategies, ILD continues to be a significant cause of mortality in patients with CVD-associated ILD (CTD-ILD). There is a lack of randomized, clinical trials assessing pharmacological agents for CTD-ILD, except in cases of ILD-associated systemic sclerosis (SSc). This may be due to the lack of CTD cases available, the difficulty of histological confirmation of ILD, and the various types of CTD and ILD. As a result, evidence-based pharmacological treatment of CTD-ILD is not yet well established. CTD-ILD presents with varying degrees of histology, from inflammation to fibrosis, and a wide spectrum of clinical manifestations, from minimal symptoms to respiratory failure. This renders it difficult for clinicians to make decisions regarding treatment options, observational strategies, optimal timing for interventions, and the appropriateness of pharmacological agents for treatment. There is no specific treatment for reversing fibrosis-like idiopathic pulmonary fibrosis in a clinical setting. This review describes pharmacological interventions for SSc-ILD described in randomized control trials, and presents an overview of recent advances of CTD-ILD-dependent treatments based on the types of CTD.
Autoimmune Diseases
;
Collagen
;
Connective Tissue Diseases
;
Connective Tissue*
;
Fibrosis
;
Humans
;
Idiopathic Pulmonary Fibrosis
;
Immunosuppressive Agents
;
Inflammation
;
Lung Diseases, Interstitial*
;
Mortality
;
Respiratory Insufficiency
;
Scleroderma, Systemic
;
Vascular Diseases
2.The Perioperative Management of Antithrombotic Therapies Using Enoxaparin.
Hun Gyu HWANG ; So My KOO ; Soo Taek UH ; Yang Ki KIM
Journal of Korean Medical Science 2017;32(6):942-947
Oral anticoagulant therapy is frequently and increasingly prescribed for patients at risk of arterial or venous thromboembolism (VTE). Although elective surgical or invasive procedures have necessitated temporary interruption of anticoagulants, managing these patients has been performed empirically and been poorly investigated. This study was designed to evaluate the adequacy of perioperative anticoagulation using enoxaparin. This was a retrospective, single-center study that evaluated the efficacy and safety of therapeutic-dose enoxaparin for bridging therapy in patients on long-term warfarin at Soonchunhyang University Hospital in Korea between August 2009 and July 2011. Warfarin was discontinued 5 days before surgery, and enoxaparin was administered twice daily by subcutaneous injection at a dose of 1 mg per kg from 3 days before the procedure to the last dose 24 hours before the procedure. Anticoagulation was restarted if proper hemostasis had been confirmed. There were 49 patients, of whom 25 (51%) were men, and the mean age was 63 years. Thirty-four (69%) received warfarin therapy for VTE, and 9 (18%) for atrial fibrillation. Twenty-nine patients (59%) underwent major surgery and 20 (41%) minor surgery. The mean postoperative duration of enoxaparin was 4 days. No patients had thromboembolic complications through 30 days after the procedure. The overall 30-day mortality rate was 0%. In conclusion, our findings demonstrate that bridging therapy with therapeutic-dose enoxaparin is feasible and associated with a low incidence of major bleeding and no thromboembolic complications. However, the optimal approach to managing patients perioperatively is uncertain and requires further evaluation.
Anticoagulants
;
Atrial Fibrillation
;
Enoxaparin*
;
Hemorrhage
;
Hemostasis
;
Heparin, Low-Molecular-Weight
;
Humans
;
Incidence
;
Injections, Subcutaneous
;
Korea
;
Male
;
Minor Surgical Procedures
;
Mortality
;
Retrospective Studies
;
Thromboembolism
;
Venous Thromboembolism
;
Warfarin
3.De Novo Submucosal Colorectal Cancer in a 3 mm Sessile Polyp.
So My KOO ; Jin Oh KIM ; Hyun Gun KIM ; Tae Hee LEE ; Seong Ran JEON ; So Young JIN ; Joon Seong LEE
Korean Journal of Gastrointestinal Endoscopy 2011;42(2):109-112
The majority of colorectal carcinomas (95~100%) are thought to arise from adenomas. Yet colorectal carcinomas may rarely arise de novo. The popular definition of de novo carcinoma is that the lesion should consist exclusively of a carcinoma histologically and contain no adenomatous elements. Without an adenoma-carcinoma sequence, de novo carcinomas have a much higher rate of submucosal invasion, despite their small size. Their speed of growth is thought to be rapid. Some studies have shown that de novo carcinomas might arise as a macroscopically flat or depressed lesion, rather than a protruded one. However, the typical macroscopic findings of de novo carcinomas have not been established. They might be variable macroscopically and include a protruded type. We report a case of de novo colorectal carcinoma that invaded the submucosal layer involving a minute sessile polyp only 3 mm in diameter, which was removed by endoscopic mucosal resection.
Adenoma
;
Colorectal Neoplasms
;
Polyps
4.Acute Pulmonary Coccidioidomycosis and Review of Published Cases with Lung Involvement in Korea.
Ji Hyun OH ; Hyo Shik KIM ; Kyu Tae YOON ; Yena KANG ; Changwook MIN ; So My KOO ; Jung Hwa HWANG ; Ki Up KIM
Soonchunhyang Medical Science 2015;21(2):159-163
Coccidioidomycosis is a fungal infection caused by Coccidioides immitis. The endemic area is mostly south-western United States. As increasing in overseas travel to endemic areas, the incidence rate has been recently increased in non-endemic areas. The diagnosis may be delayed in non-endemic area. It is important to elicit traveling histories and to differentiate lung consolidation with eosinophilia, for timely diagnosis of coccidioidomycosis. Recently, we experienced a case with pulmonary coccidioidomycosis in a Korean American who visited Korea showed consolidation in right lower lobe on chest X-ray and prolonged eosinophilia. In the case, a confirmatory diagnostic method was percutaneous transthoracic needle biopsy of lung. We report acute pulomonary coccidioidomycosis case and review previous published reports with pulmonary manifestation in Korea.
Asian Americans
;
Biopsy, Needle
;
Coccidioides
;
Coccidioidomycosis*
;
Diagnosis
;
Endemic Diseases
;
Eosinophilia
;
Humans
;
Incidence
;
Korea*
;
Lung Diseases, Fungal
;
Lung*
;
Thorax
;
United States
5.Cytomegalovirus Infectious Mononucleosis in a Patient with a Gastric Ulcer.
Se Yoon PARK ; Eun Jung LEE ; Tae Hee LEE ; So My KOO ; Jin Nyoung KIM ; Min Huok JEON ; Eun Ju CHOO ; Tae Hyong KIM
Korean Journal of Gastrointestinal Endoscopy 2011;42(6):392-396
Cytomegalovirus (CMV) is a prevalent pathogen, with 98~100% of Korean adults showing prior exposure by serology. A primary infection, such as CMV infectious mononucleosis, is very rare. CMV infectious mononucleosis often presents an initial diagnostic problem. Patients are often hospitalized with a wide variety of clinical diagnoses including fever of unknown origin without pharyngitis and lymphadenopathy. CMV gastrointestinal infections are rare in previously immunocompetent individuals. The most common sites involved are the colon and rectum, although lesions of the stomach have also been described. It is unusual to see CMV infectious mononucleosis and CMV gastrointestinal infection in the same patient. Our patient received symptomatic treatment and fully recovered. We present a case of CMV infectious mononucleosis with gastric ulcers in a previously healthy adult.
Adult
;
Colon
;
Cytomegalovirus
;
Fever of Unknown Origin
;
Humans
;
Infectious Mononucleosis
;
Lymphatic Diseases
;
Pharyngitis
;
Rectum
;
Stomach
;
Stomach Ulcer
6.The activation of NLRP3-inflammsome by stimulation of diesel exhaust particles in lung tissues from emphysema model and RAW 264.7 cell line.
Soo Taek UH ; So My KOO ; Yangki KIM ; Kiup KIM ; Sungwoo PARK ; An Soo JANG ; Dojin KIM ; Yong Hoon KIM ; Choon Sik PARK
The Korean Journal of Internal Medicine 2017;32(5):865-874
BACKGROUND/AIMS: Diesel exhaust particles (DEPs) lead to elevation of reactive oxygen species, which can activate the nucleotide-binding oligomerization domain-like receptor (NLR) family members containing the pyrin domain 3 (NLRP3)-inf lammasome. In this study, we elucidated whether NLRP3 -inf lammasome is activated by DEPs and whether antioxidants (N-acetylcysteine [NAC]) could inhibit such activation. METHODS: RAW 264.7 cells and ex vivo lung tissues explants obtained from elastase-induced emphysema animal models were stimulated with cigarette smoking extract (CSE), DEPs, and lipopolysaccharide, and levels of interleukin-1β (IL-1β), caspase-1 and nucleotide-binding oligomerization domain-like receptor (NLR) family members containing the pyrin domain (NLRP3)-inflammasome were assessed by Western blotting and immunohistochemistry. RESULTS: NAC and caspase-1 inhibitor suppressed CSE- and DEP-induced secretion of IL-1β in RAW 264.7 cells. The expression levels of the NLRP3-inflammasome and caspase-1 were upregulated in RAW 264.7 cells by stimulation with CSE and DEPs and were inhibited by NAC. CSE and DEPs increased the secretion of IL-1β in lung tissues from both the normal and elastase-induced emphysema groups. The secretion of IL-1β by CSE and DEPs was increased in the elastin-induced emphysema group more than that in the normal group (CSE: 309 ± 19 pg/mL vs. 151 ± 13 pg/mL, respectively, p < 0.05; DEP: 350 ± 24 pg/mL vs. 281 ± 15 pg/mL, respectively, p < 0.05). NAC inhibited CSE- and DEP-induced IL-1β secretion in both the normal and elastase-induced emphysema groups. NLRP3-inflammasome expression as determined by immunohistochemistry was increased by CSE and DEPs in both the normal and elastin-induced emphysema groups, and was suppressed by NAC. CONCLUSIONS: The NLRP3-inf lammasome is activated by DEPs in ex vivo tissue explants from elastase-induced emphysema animal model, and this activation is inhibited by NAC.
Antioxidants
;
Blotting, Western
;
Emphysema*
;
Humans
;
Immunohistochemistry
;
Lung*
;
Models, Animal
;
Pancreatic Elastase
;
Pulmonary Disease, Chronic Obstructive
;
RAW 264.7 Cells*
;
Reactive Oxygen Species
;
Smoking
;
Vehicle Emissions*
7.Different Responses to Clarithromycin in Patients with Cryptogenic Organizing Pneumonia.
Ji Hyun OH ; Dong Jun OH ; So My KOO ; Yang Ki KIM ; Ki Up KIM ; Hyun Jo KIM ; Dong Won KIM ; Soo Taek UH
Tuberculosis and Respiratory Diseases 2015;78(4):401-407
Cryptogenic organizing pneumonia (COP) is an idiopathic interstitial pneumonia characterized by a subacute course and favorable prognosis with corticosteroids. However, some patients show resistance to steroids. Macrolides have been used with success in those patients showing resistance to steroids. A few reports showed treatment failure with macrolides in patients with COP who were resistant to steroids. In this report, we described two cases of COP who showed different responses to clarithromycin. One recovered completely, but the other gradually showed lung fibrosis with clarithromycin.
Adrenal Cortex Hormones
;
Clarithromycin*
;
Cryptogenic Organizing Pneumonia*
;
Fibrosis
;
Humans
;
Idiopathic Interstitial Pneumonias
;
Lung
;
Macrolides
;
Prognosis
;
Steroids
;
Treatment Failure
8.p53 Expression in a Malignant Mesothelioma Patient during Seven-Year Follow-up.
So My KOO ; Soo Taek UH ; Dong Won KIM ; Ki Up KIM ; Yang Ki KIM
Tuberculosis and Respiratory Diseases 2014;76(6):284-288
Malignant mesothelioma (MM) is the aggressive tumor of serosal surfaces. There are crude pathogenetic results regarding the biology of MM. Coordinated upregulations of p53 gene expression are shown in malignancies. We believed that there are changes in the p53 expression with transformation from reactive hyperplasia to MM. A 65-year-old male was admitted the hospital because of left pleuritic chest pains in 2004. Chest computed tomography (CT) results showed left pleural effusions with loculation and pleural thickening. Pathologic findings revealed reactive mesothelial hyperplasia. In 2008, the patient again felt left pleuritic chest pains. Chest CT showed progressive thickening of the left pleura. Pathologic diagnosis was atypical mesothelial hyperplasia. In 2011, chest CT showed progressive thickening of his left pleura. He was diagnosed with well-differentiated papillary mesothelioma. Serial change was analyzed by immunohistochemical staining for p53 of pleural tissues. There were no remarkable changes in p53 expressions during the transformation to MM.
Aged
;
Biology
;
Chest Pain
;
Diagnosis
;
Follow-Up Studies*
;
Genes, p53
;
Humans
;
Hyperplasia
;
Male
;
Mesothelioma*
;
Pleura
;
Pleural Effusion
;
Thorax
;
Tomography, X-Ray Computed
;
Tumor Suppressor Protein p53
9.Proteomic differences with and without ozone-exposure in a smoking-induced emphysema lung model.
Soo Taek UH ; So My KOO ; An Soo JANG ; Sung Woo PARK ; Jae Sung CHOI ; Yong Hoon KIM ; Choon Sik PARK
The Korean Journal of Internal Medicine 2015;30(1):62-72
BACKGROUND/AIMS: Acute exacerbations in chronic obstructive pulmonary disease may be related to air pollution, of which ozone is an important constituent. In this study, we investigated the protein profiles associated with ozone-induced exacerbations in a smoking-induced emphysema model. METHODS: Mice were divided into the following groups: group I, no smoking and no ozone (NS + NO); group II, no smoking and ozone (NS + O); group III, smoking and no ozone (S + NO); and group IV, smoking and ozone (S + O). Bronchoalveolar lavage, the mean linear intercept (MLI) on hematoxylin and eosin staining, nano-liquid chromatography-tandem mass spectrometry (LC-MS/MS), and Western blotting analyses were performed. RESULTS: The MLIs of groups III (S + NO) and IV (S + O) (45 +/- 2 and 44 +/- 3 microm, respectively) were significantly higher than those of groups I (NS + NO) and II (NS + O) (26 +/- 2 and 23 +/- 2 microm, respectively; p < 0.05). Fourteen spots that showed significantly different intensities on image analyses of two-dimensional (2D) protein electrophoresis in group I (NS + NO) were identified by LC-MS/MS. The levels of six proteins were higher in group IV (S + O). The levels of vimentin, lactate dehydrogenase A, and triose phosphate isomerase were decreased by both smoking and ozone treatment in Western blotting and proteomic analyses. In contrast, TBC1 domain family 5 (TBC1D5) and lamin A were increased by both smoking and ozone treatment. CONCLUSIONS: TBC1D5 could be a biomarker of ozone-induced lung injury in emphysema.
Animals
;
Biological Markers/metabolism
;
Blotting, Western
;
Bronchoalveolar Lavage Fluid/chemistry/cytology
;
Chromatography, Liquid
;
Disease Models, Animal
;
Electrophoresis, Gel, Two-Dimensional
;
Lung/*metabolism/pathology
;
Male
;
Mice, Inbred C57BL
;
*Ozone
;
Proteins/*metabolism
;
*Proteomics/methods
;
Pulmonary Disease, Chronic Obstructive/etiology/*metabolism/pathology
;
Pulmonary Emphysema/etiology/*metabolism/pathology
;
Smoking/*adverse effects
;
Tandem Mass Spectrometry
10.A Case of Pulmonary Siderosis Mimicking Metastatic Lung Cancer.
So My KOO ; Sung Woo PARK ; Jong Sook PARK ; June Hyuk LEE ; An Soo JANG ; Do Jin KIM ; Choon Sik PARK ; Sang Hyun PAIK ; Eun Suk KOH
Tuberculosis and Respiratory Diseases 2011;70(1):58-62
Pulmonary siderosis is a pneumoconiosis caused by chronic iron inhalation. A diagnosis of pulmonary siderosis is based on a patient history of iron inhalation, on chest radiographic findings, and on accumulation of iron oxide in macrophages within the lung. A typical radiographic finding of pulmonary siderosis includes ill-defined micronodules that are diffusely distributed in the lung. We experienced a 52-year-woman with a 1.3x1.5-cm mass in the left upper lobe with multiple nodules in both lungs. Because the radiographic findings were atypical, we conducted a video-assisted thorascopic lung biopsy procedure to exclude the diagnosis of metastatic lung cancer. After confirming iron deposition in the lung tissue and knowing the patient's occupational history of welding iron, we concluded that this was a case of pulmonary siderosis.
Biopsy
;
Ferric Compounds
;
Hemosiderosis
;
Humans
;
Inhalation
;
Iron
;
Lung
;
Lung Diseases
;
Lung Neoplasms
;
Macrophages
;
Multiple Pulmonary Nodules
;
Neoplasm Metastasis
;
Pneumoconiosis
;
Siderosis
;
Thorax
;
Welding