중독성 표피 괴사증(toxic epidermal necrolysis) 환자에서 발생한 파종성 칸디다증 1예

유철웅,김동림,박기호,정희진,김우주,김민자,박승철,김주원,오칠환 대한감염학회 1999 감염 Vol.31 No.4

The Feasibility of 5-French Transradial Coronary Intervention, as Compared with a 6-French Approach, for Treating Chronic Total Occlusion

유철웅,권현철,천우정,최유정,김용훈,최진호,이상철,이상훈,홍경표,박정의 대한심장학회 2007 Korean Circulation Journal Vol.37 No.7

Background and Objectives:Recent studies have shown that transradial coronary intervention (TRI) is feasible for percutaneous revascularization of chronic total occlusion (CTO). We investigated the feasibility and safety of using a 5-French catheter (5F) TRI for CTO and we compared it with that of using a 6F catheter TRI. Subjects and Methods:One hundred fifteen patients (117 lesions) who underwent TRI for CTO (TIMI 0 or 1 for more than 2 months) were prospectively registered in this study from April 2002 to July 2004 (54 patients for the 5F and 61 patients for the 6F). The clinical, angiographic and procedural characteristics were evaluated and compared between the 2 groups. Results:No major difference was noted for the clinical characteristics between the 2 groups. Coronary angiography showed a shorter occlusion length (5F: 8.8±7.6 mm, 6F: 14.7±12.7, p=0.008) and a higher incidence of the tapered type of entry morphology (5F: 74%, 6F: 56%, p=0.042) in the 5F group. A deep-seating technique was used more often in the 5F group (5F: 83%, 6F: 51%, p<0.001). The procedural success rate was similar between the 2 groups (5F: 82%, 6F: 86%, p<0.54). The most common cause of procedural failure for both groups was failure to pass the guidewire. The occlusion duration, lesion length and lesion angulation were the statistically significant predictors of procedural failure. No major procedural or local complication was noted. Minor hematoma occurred in 2 patients and no radial artery occlusion was noted. Conclusion:A 5F catheter TRI may be feasible and safe to use for a selected group of CTO lesions. (Korean Circulation J 2007;37:298-303)

Trends and Outcomes of Transcatheter Aortic Valve Implantation (TAVI) in Korea: The Results of the First Cohort of Korean TAVI registry

유철웅,김원장,안정민,국형돈,강세훈,한정규,고영국,최승혁,구본권,장기육,김효수 대한심장학회 2018 Korean Circulation Journal Vol.48 No.5

Background and Objectives There has been no nation-wide data on the outcomes of transcatheter aortic valve implantation (TAVI) after commercialization of TAVI in Korea. We report clinical features and outcomes of the first cohort of TAVI performed from Jun 2015 to Jun 2017 in Korea. Methods The first cohort of Korean-TAVI (K-TAVI) registry includes 576 consecutive patients with severe symptomatic aortic stenosis who underwent TAVI from 17 Korean hospitals for 2 years. Results Most of TAVI procedures were performed for septuagenarians and octogenarians (90.8%) through transfemoral approach (98.3%). The rate of device success was 92.5% and permanent pacemaker was implanted in 5.6%. In successive years, incidences of paravalvular leakage (PVL) and major bleeding declined. Society of Thoracic Surgeons (STS) score was 5.2 (3.0 to 9.0) and 34.7% of patients had high surgical risk (STS ≥8). One-year all-cause death occurred in 8.9% and was significantly lower in low to intermediate risk one than in high risk (5.4% vs. 15.5%, p<0.001). The independent predictors of 1-year mortality were age (hazard ratio [HR], 1.087; 95% confidence interval [CI], 1.036–1.141; p=0.001), moderate or severe PVL (HR, 4.631; 95% CI, 1.624–13.203; p=0.004) and end-stage renal disease (HR, 5.785; 95% CI, 2.717–12.316; p<0.001). Conclusions K-TAVI registry showed favorable 1-year outcomes with decreasing complication rate over time in real-world Korean patients. Two-thirds of patients were low to intermediate surgical risk and showed a significantly lower mortality than the high-risk patients, suggesting the promising future on the expanded indications of TAVI.

S-175 : Case of Pheochromocytoma Presenting with Combined Cardiovascular Manifestations

김유나,유철웅 대한내과학회 2013 대한내과학회 추계학술대회 Vol.2013 No.1

Excess level of catecholamine in pheochromocytoma can cause various clinical manifestations. Hypertension, palpitation, anxiety, headache and nausea are common manifestations of pheochromocytoma ever reported. There are few reports of pheochromocytoma presented with catecholamine-induced myopathy after mild stress and the case of the disease relating non-occlusive stroke is more uncommon.We report a case of pheochromocytoma manifestated repeated stress-induced cardiomyopathy after mild stress featuring fulminant myocarditis and combined non-occlusive stroke. A 56-year-old man admitted presenting with cardiac enzyme elevation, regional left ventricular (LV) wall motion abnormality and pulmonary edema. However, coronary angiography was normal. LV function was totally recovered at discharge, suggesting fulminant myocarditis. During the hospital stay, he also developed acute non-occlusive stroke but resulted in no neurologic sequelae. After 3 years, he readmitted because ventricular tachycardia and severe LV systolic dysfunction (EF=15%) were developed after mild stress. 3 days of applying percutaneous cardiopulmonary bypass system, the patient was completely recovered. Suspicious of pheochromocytoma, considering the repeated cardiomyopathy developed after stress, we checked 24 hour urine VMA and metanephrine and abdomen computed tomography, which revealed pheochromocytoma. After laparoscopic adrenalectomy, 24-hour urine catecholamine level were normalized and he was finally diagnosed with catecholamine-induced cardiomyopathy due to pheochromocytoma.

새만금지구의 퇴적과정에 관한 연구

신문섭,유철웅 한국수자원학회 1996 한국수자원학회 학술대회 Vol.1996 No.1

Transaortic Transcatheter Aortic Valve Replacement (TAVR) in Aortic Stenosis (AS)

최영광,유철웅,정재승,차정준 대한내과학회 2023 대한내과학회 추계학술대회 Vol.2023 No.2

중환자실 입원환자에서 Vancomycin 내성 장구균의 직장내 감시 배양 연구

김동림,유철웅,정희진,우흥정,최선주,김우주,박승철 대한화학요법학회 2001 대한화학요법학회지 Vol.19 No.2

목적: 1990년대 들어 미국에서 중요한 원내 병원균으로 부각되고 있는 VRE는 대부분 항생제에 내성을 보이며 적절한 치료약제가 없는 실정이다. 국내에서 VRE의 빈도는 임상분리 장구균중 약 1%, 대변 배양검사에서 2-8%로 보고된 바 있다. 그러나 VRE 출현의 위험이 높은 중환자실에서 VRE 보균율에 대한 연구 결과는 없었다. 저자들은 본원에서 VRE의 임상 감염예가 발생되었던 중환자실 환자들을 대상으로 직장내 감시 배양을 시행하여 VRE의 보균율을 조사하고 VRE 보균에 관여하는 위험인자를 규명하여 VRE 감영 관리에 기본 자료로 삼고자 본 연구를 시행하였다. 대상 및 방법 : 1998년 8월부터 10주간 고대 구로 병원 중환자실엣 입원한 환자들을 대상으로 매주 1회 직장내 감시 배양을 시행하여 VRE의 보균율을 조사하였다. 직장 도말을 vancomycin 6㎍/mL이 포함함 Enterococcosel agar에 접종하여 VRE를 일차 검색하였다. 한천 회석법으로 vancomycin과 teicoplanin의 MIC를 측정하여 표현형을 결정하였고 PCR을 이용하여 vanA, vanB, vanC1, vanC2에 대한 유전형을 결정하였다. VRE 직장내 보균자와 비보균자간 임상 자료를 비교하여 VRE 보균에의 위험 인자들을 조사하였다. 결과 : 대상환자 93명중 22명 환자에서 26주의 VRE가 분리되어 23.7%의 직장내 보균율을 보였으나 조사기간 중 임상 감영은 없었다. 분리주중 E. faecium, E. gallinarum, E. casseliflavus는 VanC형을 표현형으로 나타내어 유전형과 일치하였다. 3명의 환자에서는 2개 이상의 균종이 분리되어 복합 보균이 있음을 알 수 있었다. VanA형VREF가 분리된 2명은 모두 기저 질환을 가지고 있엇고, 각각 중환자실 입원 32, 16일째에 VRE가 분리 동정되었다. VRE 직장내 보균에의 위험 인자로는 당뇨병, 중심 정맥 도관 장착, 동맥 도관의 장착, vancomycin사용의 기왕력 등의 유의하게 관련되어 있음을 알 수 있었다. 결론 : 본원 중환자실에서 직장내 감시 배양 연구 결과 VRE의 직장내 보균율은 23.6%였으나, 임상적으로 유의한 VanA형 VREF의 보균율은 2.2%(2/93) 였다. 따라서 출현 초기인 현 시점에서 국내 대학병원 중환자실 환자에서 VRE의 감염을 예방하기 위해 HICPAC에서 제시한 수칙을 준수하며, 특히 vancomycin의 사용을 제한해야 될 것으로 사료된다. Background : VRE (vancomycin-resistant enterococci) have been an important nosocomial pathogen in the United States in the 1990s. VRE are usually multidrug-resistant, and pose a therapeutic problems and dilemmas. In late 1990s, VRE have become an emerging nosocomial pathogen in Korea, but there have been a few studies on the epidemiologic investigation on the infection or colonization of VRE among hospitalized patients with high risk factors. The purpose of this study was to determine the prevalence of rectal colonization of VRE among patients hospitalized in the intensive care unit (ICU), to study the risk factors for nosocomial acquisition of VRE, and to obtain the baseline data for controlling the spread of VRE infection within the hospital. Methods : Between August 1 and October 12 (10 weeks) 1998, a prospective surveillance study was conducted in the ICU at Korea University, Guro Hospital. Surveillance rectal swab cultures for detecting VRE were obtained at weekly intervals among 93 patients admitted to the ICU during the study period. To obtain the VRE, rectal swab cultures were performed on Enterococcosel agar (BBL Microbiology Systems, Cockeysville, Md, USA) containing 6 ㎍/mL of vancomycin. Minimal inhibitory concentrations (MICs) of vancomycin and teicoplanin were determined by agar dilution method. For the genotyping of isolated VRE, detection of vanA, vanB, vanC1 and vanC2 gene by polymerase chain reaction was done. Patients harboring VRE were compared to patients who were not colonized with this organism to identify the risk factors associated with rectal colonization. Results : The rectal colonization rate of VRE among ICU patients was 23.6%(22/93patients), but there were no patients with VRE infection during the study period. Twenty-six strains of VRE, which were isolated from 22 patients, incluede 2 vanA E.feacium, 18 vanC1 E. gallinarum and 6 van C2 E. casseliflavus isolates. Therefore the colonization rate of clinically significant vanA genotype vancomycin-rexixitant E.faecium(VREF) was 2.2% (2/93 patients). Risk factors for rectal colonization of VRE included diabetes, catheterization of arterial and central venous lines, and vancomycin usage. Conclusions : This study demonstrated the low rectal colonization rate of clinically significant VREF (2.2%) among patients admitted to the ICU. This study suggested that maintaining HICPAC guidelines, restricted vancomycin usage and periodic surveillance in patients with high risk factors are important in preventing the emergence and spread of VRE infection among ICU patients in a university-affiliated hospital.

새만금지구의 퇴적과정에 관한 연구

신문섭,유철웅,김익중 한국해안해양공학회 1997 학술강연회 발표논문초록집 Vol.1 No.1

The purpose of this study is to find sedimentation patterns variation in Saemangeum coastal sea region. Water circulations are calculated diagnostically from the observed water temperature and salinity data and wind data and tidal residual current. Three dimensional movements of injected particles due to currents, turbulence and sinking velocity are tracked by the Euler-lagrange methoed.Calculated sedimentation patterns of riverine material are highly similar to the observed ones.

quinolone 내성 Escherichia coli 균혈증의 임상 및 미생물학적 양상

정희진,유철웅,최종일,박정원,김우주,김민자,박승철 대한감염학회 2000 감염 Vol.32 No.4

Seasonal Variation of Kinetic and Potential Energy of Residual Flow Field in Suyoung Bay , Korea

Kim, Dong-Sun,Yanagi, Tetsuo 한국환경과학회 1997 한국환경과학회지 Vol.6 No.4

In order to study the seasonal variation of kinetic and potential energy of residual flow field in Suyoung Bay of Korea, we calculated its energy budget and compared it with the tidal energy there. The potential energy shows the large value in winter and spring and the small one in summer and early autumn when the density stratification is developed. The kinetic energy of residual flow varies seasonally and the seasonally averaged kinetic energy of residual flow per unit area is 6.4 × 10 exp (-4) ergs s^-1cm^-2. It is mainly governed by the density-driven current with the exception of that in November when the kinetic energy of tide-induced residual current is larger than those of density-driven current and winddriven current. An averaged fraction of the kinetic energy of tide-induced residual current, wind-driven current and density-driven current, which are the major components of residual flow, is 29.1%, 3.4%, 67.5%, respectively, to the kinetic energy of residual flow. The fraction of kinetic energy of residual flow, potential energy and tidal energy per unit area is 1.0 : 6.7 × 10 exp (3) : 8.2 × 10 exp (4), respectively.