헬리코박터 파일로리(Helicobacter pylori) 감염 및 치료법 개요

송영구,Song, Young Goo 대한자원환경지질학회 2015 자원환경지질 Vol.48 No.3

Helicobacter pylori는 사람의 위점막에서 발견되는 전염성이 있는 중요한 병원균이다. 장기간 기생하면서 만성위염, 소화성궤양, 위 변연부 B세포 림프종, 그리고 위암을 일으키는 세균으로 알려져 있다. 국내에서는 프로톤펌프 억제제(proton pump inhibitor, PPI)와 두 가지 항생제(amoxicillin, clarithromycin)를 포함하는 표준 삼제 요법을 1차 치료로 사용하여 왔으나, 점점 증가하고 있는 항생제 내성으로 인해 제균율은 점차 감소하고 있다. 여기서는 H. pylori의 현재의 치료법들과 이들 치료법들의 문제점들을 검토하고, 표적치료의 필요성과 표적치료에 활용할 수 있는 약물전달체로서의 점토광물의 가능성에 대해 알아보고, 이들을 이용한 새로운 치료 방향에 대한 향후 연구계획 등에 대해서 논하고자 한다. Helicobacter pylori is an important transmissible human pathogen found on the luminal surface of the gastric epithelium. The organism can persist in the stomach indefinitely and causes gastroduodenal inflammation that may proceed to atrophic gastritis, peptic ulcer, gastric MALT lymphoma, and gastric cancer. Standard triple therapy which consists of proton pump inhibitor (PPI) plus two antibiotics (amoxicillin and clarithromycin) is now generally used in Korea, however, eradication rates of H. pylori has been decreasing due to increasing antibiotic resistance. In this review, current second-line treatment regimens, difficult problems on treatment, necessity of local target therapy, applicability of clay minerals as a drug delivery system (DDS), and a new therapeutic strategy and its study plans will be discussed.

1980 년대와 1990 년대의 불명열 원인의 비교분석

김영근(Young Keun Kim),김명수(Myoung Soo Kim),이꽃실(Kkot Sil Lee),허애정(Ae Jung Huh),염준섭(Joon Sup Yeom),홍성관(Sung Kwan Hong),장경희(Kyung Hee Chang),송영구(Young Goo Song),김준명(June Myung Kim) 대한내과학회 2001 대한내과학회지 Vol.61 No.5

N/A Background : Physicians find fever of unknown origin (FUO) a difficult problem to solve. Analysis of the causes of FUO may be useful in the diagnosis of FUO. We investigated the causes of FUO in the last two decades from 1980 to 1999 and compared the two decades to seek for a trend of changes of the causes of FUO. Methods : Among 854 patient s diagnosed as FUO on discharge, we retrospectively reviewed 278 patient s compatible with the Petersdorf`s criteria through inpatient and outpatient medical records . Results : There were 144 (51.5%) men and 134 (48.2%) women. Among the 98 patients in the 1980s, infectious disease was the cause in 37 (37.8%) patients, collagen vascular disease in 17 (17.3%), malignancy in 8 (8.2%), miscellaneous in 11 (11.2%), and unidentifiable cause in 25 (25.5%) patients. Among the 180 patients in the 1990s, infectious disease was the cause in 45 (25.0%) patients, collagen vascular disease in 37 (20.5%), malignancy in 34 (18.9%), miscellaneous in 45 (25.0%), and unidentifiable cause in 19 (10.6%) patients. According t o the order of frequency, the causes of infectious disease were pulmonary tuberculosis (19.4%), extrapulmonary tuberculosis (8.2%), liver abscess (4.1%) in the 1980s and extrapulmonary tuberculosis (17.2%), pulmonary tuberculosis (4.4%), liver abscess (1.1%) in the 1990s. The diagnostic methods for evaluation of FUO were culture (45.6%), radiology (17.6%), serology (16.2%), and biopsy (10.3%) in the 1980s and radiology (31.5%), biopsy (26.9%), culture (21.5%) and serology (20.0%) in the 1990s. Conclusion : Among the causes of FUO, infectious disease decreased and collagen disease and malignancy increased with time. The most common cause of infectious disease was pulmonary tuberculosis in the 1980s but extrapulmonary tuberculosis in the 1990s. Use of radiology and biopsy as diagnostic methods for FUO increased.(Korean J Med 61:546- 552, 2001)

항생제-스멕타이트 복합물 유도 및 소화기계 약물전달체로의 가능성

송윤구,정동훈,송영구,최우현,Song, Yungoo,Chung, Donghoon,Song, Young Goo,Choi, Woohyun 대한자원환경지질학회 2015 자원환경지질 Vol.48 No.3

본 연구에서는 흡수성 항생제인 Amoxicillin과 Clarithromycin, 그리고 아미노글루코사이드 (Aminoglucoside) 계열 비흡수성 항생제인 Gentamicin, Tobramycin 및 Netilmicin의 스멕타이트 층간 유도를 통해 항생제-스멕타이트 복합물을 합성하고, 이 중 Clarithromycin-스멕타이트 복합물 대상 예비 용출실험을 통해 소화기계 항생제 약물전달체로의 가능성을 확인하고자 하였다. 실험 결과, 5종의 항생제 모두 수용액 상태에서의 교환반을을 통해 스멕타이트 층간에 유도되었다. Clarithromycin에 대하여 스멕타이트 층간 최대 유도 량을 결정하기 위한 농도별 평형반응실험 결과 Langmuir isotherm을 따르며, 층간 최대유도 량은 1.811 mmole/g으로 계산되었다. Clarithromycin-스멕타이트 복합물 대상 pH=2, 3 및 4 용출용액을 이용한 예비 용출실험결과 모든 용출용액에서 지속적인 용출이 일어났으며, pH 증가에 따라 용출량은 감소하였다. In this study, we aimed to make antibiotic-intercalated smectite composites using amoxicillin and clarithromycin as hygroscopic antibiotics, and gentamicin, tobramycin and netilmicin as non-hygroscopic aminoglucosides, and to check their drug delivery potential in gastric system using preliminary in-situ column release test for clarithromycinsmectite composite. All antibiotics were successfully intercalated into the interlayer of smectite by cation-exchange reaction in the batch experiment. Equilibrium batch test showed that clarithromycin-intercalation followed Langmuir isotherm and the possible maximum amount was calculated as 1.811 mmole/g. Clarithromycin was continuously released by the solutions of pH=2, 3, and 4 and the amount was decreased with pH increase.

대장의 크립토콕쿠스증

송재천 ( Jae Chun Song ),김상겸 ( Sang Kyum Kim ),김익성 ( Eak Seong Kim ),정인수 ( In Su Jung ),송영구 ( Young Goo Song ),유정식 ( Jeong Sik Yu ),박효진 ( Hyo Jin Park ) 대한소화기학회 2008 대한소화기학회지 Vol.52 No.4

We experienced a rare case of colonic cryptococcosis in an apparently immunocompetent individual. A 27-year-old woman admitted our hospital for intermittent melena. Initial abdominal CT scan revealed a mass lesion obstructing most of the lumen in ascending colon. Colonoscopy showed huge ulcerofungating mass in proximal ascending colon. Colonoscopic biopsy was performed and pathologic diagnosis was made as colonic cryptococcosis with positive PAS stain. Laboratory test evaluating immune status and bone marrow examination was normal. The patient was treated with intravenous amphotericin B for four weeks and six months of oral fluconazole afterwards. Follow-up abdominal CT scan and colonoscopy were taken at four weeks and seven months after the beginning of treatment. On completion of intravenous amphotericin B treatment, the mass lesion was decreased in abdominal CT and colonoscopy. After seven months, abdominal CT and colonoscopy showed near-complete resolution of the colonic lesion so the treatment ended. Cryptococcosis in a healthy individual is a rare disease and there have been only several sporadic case reports on pulmonary or central nervous system involvement. Hence, we report a case of colonic cryptococcosis in an apparently immunocompetent individual. (Korean J Gastroenterol 2008;52:255-260)

기관지의 과립세포종

박태병 ( Tae Byung Park ),송영구 ( Young Goo Song ),구성현 ( Sung Hyun Ku ),고영윤 ( Young Yoon Ko ),황성철 ( Sung Chul Hwang ),이이형 ( Yi Hyeong Lee ),주희재 ( Hee Jae Joo ) 대한결핵 및 호흡기학회 1996 Tuberculosis and Respiratory Diseases Vol.43 No.2

증례 : 감염 ; 진균과 세균 복합 감염의 척추체-추간판염 1예

조미옥 ( Mi Ok Cho ),송영구 ( Young Goo Song ),이서희 ( Seo Hui Lee ),조세희 ( Se Hee Jo ),최아란 ( Ah Ran Choi ),은나래 ( Na Lae Eun ),진성준 ( Sung Joon Jin ) 대한내과학회 2015 대한내과학회지 Vol.88 No.4

내원 3개월 전 척추 수술을 시행 받았던 66세 여자 환자가 요통 및 하지 동통으로 내원하였다. Magnetic resonance image상 척추체-추간판염 소견이 보였으며 조직 검사를 통한 세균 배양 검사에서 Enterococcus faecium과 Candida parapsilosis가 동정되어 진균과 세균의 복합 감염으로 확인되었다. 저자는 적극적인 조직 배양 검사를 통해 진균과 세균의 복합 감염을 정확히 진단함으로써 이에 따른 적절한 치료를 시행하여 문헌고찰과 함께 보고하는 바이다. 또한 본 사례를 통해 진단율을 높이는 적극적인 조직 검사를 독려하고자 한다. A 66-year-old female who had undergone surgery for a herniated disc at the L5-S1 level at another hospital 3 months earlier was admitted with persistent back and leg pain. She was diagnosed with spondylodiscitis at the L5-S1 level by magnetic resonance imaging. A biopsy was performed, and Candida parapsilosis and Enterococcus faecium were isolated from the excised material. We report herein a case of successful treatment of polymicrobial spondylodiscitis in accordance with accurate microbiological diagnosis. Based on this case, we hope to encourage physicians to perform biopsies more aggressively or repeatedly to improve the diagnostic yield.

제49차 대한내과학회 추계학술대회초록집 : 심포지움 ; 비류마티스 질환의 근골격계 증상 : HIV 감염과 관련된 근골격근계 증상

김준명 ( June Myung Kim ),송영구 ( Young Goo Song ) 대한내과학회 1997 대한내과학회지 Vol.53 No.-

제49차 대한내과학회 추계학술대회초록집 : 심포지움 ; 비류마티스 질환의 근골격계 증상 : HIV 감염과 관련된 근골격근계 증상

김준명 ( June Myung Kim ),송영구 ( Young Goo Song ) 대한내과학회 1997 대한내과학회지 Vol.53 No.2S

브루셀라증의 개요

임현술(Hyun-Sul Lim),송영구(Young-Goo Song),유한상(Han-Sang Yoo),박미연(Mi-Yeoun Park),김종완(Jong-Wan Kim) 한국역학회 2005 Epidemiology and Health Vol.27 No.1

Brucellosis is zoonotic disease of worldwide distribution and still remains endemic in some developing countries. The main pathogenic species worldwide are B. abortus, responsible for bovine brucellosis, B. melitensis. The B. abortus is most common in Korea. Each Brncella spp. has a preferred natural host that serves as a reservoir of infection. The incubation period varies between 5 and 60 days, and Brucella infection may be asymptomatic or symptomatic. The majority of patients complained of fever (undulating fever), sweats, malaise, anorexia, and arthralgia. The diagnosis of brucellosis requires the isolation of Brucella from blood Of body tissues, or the combination of suggestive clinical presentation and positive serology. There were first patients in 2002, thereafter 16 patients in 2003, and 47 patients in 2004, the human brucellosis are increasing more gradually in Korea. Brucellosis is an occupational risk for farmers, veterinarians, and abattoir workers. The main sources of Brucella are infected animals or their products, such as milk, blood, carcasses, and abortion products. Routes of transmission of the infection to humans include direct contact with infected animals and their secretions through cuts and abrasions in the skin, by way of infected aerosols inhaled or via the ingestion of unpasteurized dairy products. A combination of doxycycline and streptomycin has been used widely in brucellosis. Prevention of brucellosis in human still depends on the eradication or control of the disease in animal hosts, the exercise of hygienic precautions to limit exposure to infection through occupational activities and the effective heating of dairy products, and other potentially contaminated foods. Also, physicians and veterinarians must be concerned about specific environments and clinical patterns of brucellosis.

증례 : 지역사회에서 획득된 Acinetobacter baumannii에 의한 감염성 심내막염 1예

김민형 ( Min Hyung Kim ),안진영 ( Jin Young Ahn ),구남수 ( Nam Su Ku ),한상훈 ( Sang Hoon Han ),최준용 ( Jun Yong Choi ),송영구 ( Young Goo Song ),김준명 ( June Myung Kim ) 대한내과학회 2013 대한내과학회지 Vol.84 No.2

기저 질환이 없는 젊은 여성이 급성 뇌경색이 발생하여 내원하였으며 A. baumannii 균혈증이 확인되었다. 경흉부 심초음파에서 우식증이 관찰되어 심내막염 진단과 함께 cefoperazon/sulbactam을 총 5주 동안 사용한 결과 추가적인 합병증이 발생하지 않고 심내막염이 완치되었다. 지역사회 획득 A. baumannii에 의하여 발생한 감염성 심내막염의 국내 첫 증례를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Acinetobacter baumannii has become an important pathogen that causes healthcare-associated infections, including pneumonia, bacteremia, and urinary tract infection. Only sporadic cases of infective endocarditis (IE) have been reported worldwide, and in particular, community-acquired IE caused by A. baumannii is very rare. To our knowledge, no case has ever been reported in Korea. We report a 30-year-old woman who recovered from native-valve community-acquired IE caused by A. baumannii. She did not have any underlying diseases and presented with left-sided weakness, dysarthria, and fever. On investigation of acute cerebral infarction, a vegetation on her anterior mitral leaflet was found in echocardiography, and A. baumannii was cultured from the blood. In this case, A. baumannii showed intermediate resistance to cefotaxime and was sensitive to all other antibiotics. She underwent antibiotic therapy with cefoperazone/sulbactam for 5 weeks, without surgery. Consequently, the vegetation was absent in follow-up echocardiography, and no complications related to IE developed. (Korean J Med 2013;84:313-317)