208
￭ S-329 ￭
Prognosis of Pneumocystis pneumonia in patients with hematologic malignancies
1가톨릭대학교 의과대학 내과학교실, 2가톨릭대학교 의과대학 내과학교실 호흡기내과, 3가톨릭대학교 의과대학 내과학교실 혈액내과,
4가톨릭대학교 의과대학 내과학교실 호흡기내과
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김영기
1, 이화영
2, 이종욱
3, 이진국
4Background: Pneumocystis jirovecii is one of common pathogen causing pneumonia in patients with hematologic malignancies. However, studies which describe clinical characteristics and prognosis of pneumocystis pneumonia (PCP) in those patients are lacking. Methods: We retrospectively an- alyzed baseline clinical characteristics and treatment outcome among the patients diagnosed Pneumocystis pneumonia from Feb 2010 to July 2015.
Results: Total 101 possible patients were identified with positive polymerase chain reaction (PCR) results in bronchoscopic washing fluid. Among them, 81 were clinically diagnosed PCP with positive PCR result and relevant chest computed tomography findings. Thirty-seven (45.7%) patients were diagnosed lymphoid malignancies, 54 (66.7%) had active disease and 36 (44.4%) were post-bone marrow transplantation (BMT) status. The most com- mon combined infection was viral (24.7%) infection and 6 (7.4%) had bacterial infections. All of the patients received Trimethoprim-sulfamethoxazole (TMP-SMX) and/or pentamidine, disease related mortality was 32.1%. Forty-one (50.6%) patients were transferred to intensive care unit, 30 (37%) were mechanically ventilated and 9 (11.1%) were under high-flow nasal cannula (HFNC) supplement. Univariate analysis showed that lymphoid malig- nancies, post-BMT status, application of mechanical ventilator or HFNC were associated with disease-related mortality. Additional variables such as combined bacterial infection (p＝0.02) and use of pentamidine (p＝0.007) were associated with mechanical ventilation in addition to lymphoid malig- nancies (p＝0.003) and post-BMT status (p＝0.01). Conclusion: In patients with hematologic malignancies, post-BMT status and combined bacterial infections elevated the risk of mechanical ventilation which were associated with high disease related mortality.
￭ S-330 ￭
A case of removal of metallic endobronchial stent in patient with benign airway obstruction
가톨릭대학교 내과학교실
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허정원, 이상학, 김신범, 강현희
Complications of metallic airway stents include granulation tissue formation, migration and mucous plugging. When these complications result in air- way injury or obstruction, it may become necessary to remove the stents. We report a patients with relapsing polychondritis and complications caused by removal of stents. A 49-year-old woman visited the outpatient clinic with chief complaint of dyspnea for 3 months. She was diagnosed relapsing pol- ychondritis 5 years ago, and managed with metallic stent 3 years ago in Japan because of pulmonary involvement of relapsing polychondritis.
Auscultation was coarse with wheezing breath sounds. X-ray shown collapse of right middle and lower lobe. Chest CT shown stent applied state in the trachea, both main bronchi and obstructed lumen due to granulation tissue formation. Metallic stents was fragmented and removed by rigid bronchoscopy. It took 17 hours for 3 days. And She experienced a postoperative pneumothorax and required chest tube. And She had mucosal injury and respiratory distress during or following stent removal. She received ventilator care in intensive care unit. Slicone stents were placed in the both main bronchus for bronchomalacia that allowed liberation from mechanical ventilation. Metallic stent removal can be associated with life-threatening complication. Metallic stents should not considered the first line of therapy for patients with benign airway obstruction. In patients with non malignant airway obstruction, a metallic stent should probably be used only if all else fails.
