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증례 : 감염 ; 귀밑샘 양성 림프상피낭으로 발현한 사람면역결핍바이러스 감염 1예
천신혜 ( Shin Hye Cheon ),나선희 ( Sun Hee Na ),남은영 ( Eun Young Nam ),이명진 ( Myoung Jin Lee ),정영희 ( Young Hee Jung ),김문석 ( Moon Suk Kim ),김남중 ( Nam Joong Kim ) 대한내과학회 2015 대한내과학회지 Vol.88 No.1
저자들은 귀밑샘의 양성 림프상피낭이 단서가 되어 HIV 감염을 확정 진단한 환자를 경험하여 이를 보고한다. Benign lymphoepithelial cysts are rare, and are associated with swelling of the salivary glands (usually the parotid gland). The cytopathological features include lymphoid hyperplasia with an epithelial component, exhibiting cystic and proliferative changes. Development of a benign lymphoepithelial cyst commonly precedes acquisition of acquired immunodeficiency syndrome, but may also be the initial clinical manifestation of human immunodeficiency virus (HIV) infection. A 43 year-old male presented with a slowly growing multilocular cystic mass in his right cheek. Computed tomography of the neck revealed a well-circumscribed cystic lesion in the bilateral parotid glands. A provisional diagnosis of a benign lymphoepithelial cyst associated with HIV infection was made, and Western blotting confirmed the HIV infection. Three months after initiation of antiretroviral therapy, the parotid swelling was completely resolved. We report this case to suggest that clinicians should consider the possibility of HIV infection when patients present with benign lymphoepithelial cysts of the parotid gland. (Korean J Med 2015;88:106-109)
증례 : 위험인자가 없는 환자에서 발생한 Serratia grimesii에 의한 감염성 척추염 1예
천신혜 ( Shin Hye Cheon ),손경목 ( Kyung Mok Sohn ),김연숙 ( Yeon Sook Kim ),정현 ( Hyeon Jung ),은혁수 ( Hyuk Soo Eun ),최승원 ( Seung Won Choi ),구선회 ( Sun Hoe Koo ) 대한내과학회 2012 대한내과학회지 Vol.83 No.1
Serratia에 의한 감염은 대부분 병원 시술이나 수술 혹은 면역 저하와 관련되어 있다. 인간 감염을 일으키는 것으로 S. marcescens가 가장 흔하고 S. liquefaciens도 종종 문제가 된다. 그러나 S. gimesii에 의한 감염 혹은 지역사회 획득 Serratia 척추염은 보고된 적이 없다. 저자들은 고혈압 외에는 건강하게 지내던 환자에서 발생한 경막외 고름을 동반한 S. grimesii에 의한 척추 골수염을 경험하였다. 고름 제거 후 항생제 치료로 호전되어 문헌고찰과 함께 보고하는 바이다. Vertebral osteomyelitis or paraspinal abscess caused by Serratia species is rare and has been reported only in certain groups of people, such as intravenous drug users, immunocompromised hosts, and patients who have undergone invasive procedures. However, we report here that Serratia was recovered from a patient with vertebral osteomyelitis and epidural abscess without predisposing factors. The organism was initially identified as Serratia liquefaciens by a Vitek II-based assessment. It was finally identified as Serratia grimesii by 16S rRNA gene sequence analysis. We present the first case of vertebral osteomyelitis caused by S. grimesii in a patient without risk factors and who was managed successfully.
당뇨병 환자에서 건강 문해력, 당뇨병 지식과 혈당조절의 상관관계
천신혜 ( Shin Hye Cheon ),나상규 ( Sang Kyu Na ),김하윤 ( Ha Yoon Kim ),임희경 ( Hee Kyung Lim ),최민규 ( Min Kyu Choi ),노용균 ( Yong Kyun Roh ) 대한의료커뮤니케이션학회 2015 의료커뮤니케이션 Vol.10 No.2
Purpose: Patients with limited health literacy usually have less disease-related knowledge, and consequently have poor health status. On the other hand, diabetes care requires complex course of strict medication and lifestyle changes to maintain appropriate glycemic levels and to prevent diabetic complications. We evaluated the association between health literacy, diabetes knowledge and glycemic control among diabetic patients. Methods: A cross-sectional study of 84 enrollees who were older than 30 years and had type 2 diabetes was conducted in a university hospital. Health literacy was measured using the short form of Newest Vital Sign (NVS), and diabetes knowledge measured using one of the two parallel diabetes knowledge tests. Participants were interviewed to determine participants’ characteristics, and HbA1c levels were identified from the clinical database of Hallym University Kang Nam Sacred Heart Hospital to assess glycemic control. Results: The mean score of health literacy was 1.8 (±1.9) and mean score of diabetes knowledge was 12.0 (±4.1). Only 23.8% of participants had adequate literacy. After adjusting sociodemographic characteristics, duration of diabetes, and treatment regimen, diabetes knowledge and health literacy were not independently associated with HbA1c levels. Only significant factor of glycemic control was duration of diabetes (r=0.489, p<0.001). Conclusion: Among patients with type 2 diabetes, health literacy and diabetes knowldege were not independently associated with glycemic control. Better strategies are needed to improve glycemic control.
중증 또는 비전형적 지역사회획득 폐렴으로 입원한 환자에서 호흡기 바이러스 의 검출 빈도
박지원 ( Ji Won Park ),정선영 ( Sun Young Jung ),은혁수 ( Hyuk Soo Eun ),천신혜 ( Shin Hye Cheon ),성석우 ( Seok Woo Seong ),박동일 ( Dong Il Park ),박명린 ( Myung Rin Park ),박희선 ( Hee Sun Park ),정성수 ( Sung Soo Jung ),김주옥 대한결핵 및 호흡기학회 2011 Tuberculosis and Respiratory Diseases Vol.71 No.5
Background: Community-acquired pneumonia (CAP) is an important cause of morbidity and mortality throughout the world in all age groups. Viral causes of CAP are less well characterized than bacterial causes. We analyzed the characteristics of hospitalized patients with CAP who had a viral pathogen detected by multiplex polymerase chain reaction (PCR). Methods: Multiplex real-time PCR was performed for respiratory viruses in samples collected from 520 adults who developed CAP at Chungnam National University Hospital. Clinical, laboratory, and radiological features at presentation as well as other epidemiological data were analyzed. Results: Of 520 patients with CAP, a viral pathogen was detected in 60 (11.5%), and influenza A was the most common. The virus detection rate in patients with CAP was highest in November. Two or more pathogens were detected in 13 (21.7%) patients. Seven patients had severe disease and were administered in the intensive care unit. Most patients (49/60, 81.7%) had comorbidities. However, nine (15%) patients had no comorbidities, and their age was <60 years. The ground glass opacity pattern was the most common radiological feature. Seven (11.7%) patients died from CAP. Conclusion: Viral pathogens are commonly detected in patients with CAP, and a respiratory virus may be associated with the severity and outcome of pneumonia. Careful attention should be paid to the viral etiology in adult patients with CAP.
경막하 혈종제거술 후 발생한 비장티푸스성 살모넬라에 의한 경막하 축농 1예
송창헌 ( Chang Hun Song ),김민성 ( Min Seong Kim ),천신혜 ( Shin Hye Cheon ),손경목 ( Kyung Mok Sohn ),김선환 ( Seon Hwan Kim ),김연숙 ( Yeon- Sook Kim ) 대한내과학회 2016 대한내과학회지 Vol.91 No.1
저자들은 국내에서 보고된 바 없었던 비장티푸스성 살모넬라가 일으킨 경막하 축농 환자 1예를 경험하고 치료하였기에 보고하는 바이다. Nontyphoidal Salmonella infection often results in acute gastroenteritis, but extraintestinal infection presenting as a subdural empyema is unusual. We report a case of a 67-year-old man diagnosed with a subdural empyema caused by Salmonella group B that developed after evacuation of a subdural hematoma. To our knowledge, this is the first such case report in Korea. (Korean J Med 2016;91:84-86)
순환기 : 심한 좌심방 석회화와 반복적인 좌심방 혈전 및 액와부 혈종
성석우 ( Seok Woo Seong ),안계택 ( Kye Taek Ahn ),김혜진 ( Hye Jin Kim ),천신혜 ( Shin Hye Cheon ),진선아 ( Seon Ah Jin ),신성균 ( Sung Kyun Sin ),정진옥 ( Jin Ok Jeong ) 대한내과학회 2012 대한내과학회지 Vol.82 No.6
저자들은 23년 전에 류마티스성 승모판 협착증, 좌심방 혈전이 동반되어 기계 판막을 이용한 승모판 치환술 및 좌심방 혈전 제거술을 시행한 뒤에 진행하는 좌심방의 심한 심내막 석회화와 좌심방 혈전 및 액와부의 혈종이 발생한 1예를 경험하였다. Left atrial wall calcification is frequently observed in patients with rheumatic valvular heart disease. However, massive left atrial wall calcification, so called porcelain or coconut atrium, with left atrium thrombi is very rare. Here, we describe the case of a 67-year-old male patient with porcelain atrium, recurrent left atrial thrombi, and a spontaneous axillary hematoma after mitral valve replacement and surgical thrombectomy due to rheumatic valvular heart disease. The patient underwent two valvular surgeries 20 years prior; therefore, we determined not to perform additional surgeries because of a high risk of morbidity, mortality, and the recurrence of atrial thrombi. The patient has been maintained on daily warfarin as an anti-thrombic therapy for more than 5 years without major embolic complications.