정상면역을 가진 성인에서 발생한 식도 방선균증

김현수 ( Hyun Soo Kim ),천종운 ( Jong Woon Cheon ),김민수 ( Min Su Kim ),정창길 ( Chang Kil Jung ),김경록 ( Kyung Rok Kim ),최재원 ( Jae Won Choi ),강동우 ( Dong Woo Kang ),김선영 ( Sun Young Kim ) 대한소화기학회 2013 대한소화기학회지 Vol.61 No.2

Hyun Soo Kim, Jong Woon Cheon, Min Su Kim, Chang Kil Jung, Kyung Rok Kim, Jae Won Choi, Dong Woo Kang and Sun Young Kim1 Departments of Internal Medicine and Pathology1, DongKang Medical Center, Ulsan, Korea Actinomycosis is a chronic suppurative disease and caused by Actinomycosis species, principally Actinomyces israelii, which are part of the normal inhabitant on the mucous membrane of the oropharynx, gastrointestinal tract, and urogenital tract. It usually affects cervicofacial, thoracic and abdominal tissue. Cervicofacial type has the highest percentage of occurrence with 50%. Actinomycosis frequently occurs following dental extraction, jaw surgery, chronic infection or poor oral hygiene. It may also be considered as an opportunistic infection in immunocompromised patients such as malignancy, human immunodeficiency virus infection, diabetes mellitus, steroid usage or alcoholism. But, actinomycosis rarely occurs in adults with normal immunity and rare in the esophagus. We report an unusual case of esophageal actinomycosis which was developed in a patient with normal immunity and improved by therapy with intravenous penicillin G followed oral amoxicillin, and we also reviewed the associated literature.

당뇨병 환자에서 혈장 Thrombin-Antithrombin Ⅲ 및 Plasmin-α_2-Plasmin Inhibitor 복합체의 임상적 의의

김경욱,김은숙,정상수,윤수지,박우일,이준희,남수연,안철우,문병수,김경래,차봉수,송영득,임승길,이현철,허갑범 대한당뇨병학회 2002 Diabetes and Metabolism Journal Vol.25 No.5

연구배경:당뇨병 환자에서 혈액응고 및 섬유소용해 체계의 이상경향이 있어 그 결과로 여러 혈관합병증의 발생위험이 높다는 사실은 널리 알려져 있다. 그 기전은 아직 확실히 밝혀지지 않았으나, 고혈당으로 인한 혈장 단백질들의 비효소성 당화작용이나 산화성 스트레스로 인한 유리 라티칼 작용으로 응고항진이나 섬유소용해 활성의 저하를 유발하는 것으로 생각되고 있다. 최근 응고 및 용해인자와 그 억제자의 복합체들의 증가가 이 상태를 비교적 예민하게 반영한다고 알려져 있다. 방법:본 연구에서는 당뇨병 환자 101명과 정상 대조군 20명에서 혈장내 thrombin­antithrombin complex(TAT)와 plasmin­α₂­plasmin inhibitor complex(PIC)를 측정하여 비교하고, 당뇨병 환자에서 미세혈관 합병증과 대혈관합병증의 유무에 따른 차이와, 이미 혈관 질환의 위험인자로 알려져 있는 인자들간의 상관성을 알아보고자 하였다. 결과:1. 환자의 분포를 살펴보면 혈관합병증이 있는 군은 85명, 혈관합병증이 없는 군은 16명이었고, 평균연령은 각각 57.9±14.1세, 49.9±16.6세로 혈관 합병증이 있는 군에서 더 나이가 많았고, 체질량지수는 23.2±3.4㎏/㎡, 24.1±3.4㎏/㎡로 두 군간 유의한 차이는 없었다. 또 두 군간의 혈압 및 HbA1c, 공복혈당 및 인슐린과 C­peptide, 총 콜레스테롤, 중성지방, HDL­콜레스테롤, Lp⒜는 유의한 차이가 없었고, 미세혈관합병증이 있는 군에서 당뇨병의 유병기간이 길었다. 2. TAT 및 PIC의 농도는 정상 대조군에서는 2.8±1.2 ng/mL, 240.4±69.7 ng/mL이었고, 당뇨병 환자군에서는 9.5±22.6 ng/mL, 472.2±258.7 ng/mL이었다. TAT와 PIC 모두 당뇨병 환자군에서 정상 대조군에 비해 유의하게 증가되어 있었고(p<0.001), TAT/PIC ratio는 두 군간 차이가 없었다. 3. 당뇨병 환자의 혈관합병증에 따른 TAT 및 PIC, fibrinogen 농도는 합병증이 없는 군은 각각 4.1±2.4ng/mL, 362.2±272.0ng/mL, 322.7±102.4mg/mL으로 PIC와 fibrinogen의 증가를 보였으나, 연령을 보정한 후에는 통계학적 유의성은 없었다. 또 대혈관 합병증군에서는 각각 6.0±4.9 ng/mL, 507.4±321.6 ng/mL, 427.1±194.7 mg/dL이었으며 미세·대혈관 합병증군에서는 10.4±6.4 ng/mL, 484.8±269.7 ng/mL, 388.4±132.4 mg/dL으로 TAT의 증가를 보였으나 역시 연령을 보정한 후에는 통계학적 유의성은 없었다. 4. 미세혈관합병증군에서 HbA1c(>8%)가 높은 군의 PIC 농도가 유의하게 높았고(p=0.049), 대혈관합병증군에서 HbA1c(>8%)가 높은 군의 총 콜레스테롤 농도가 유의하게 높았다(p=0.042). 5. 총 당뇨병 환자군에서 PIC는 fibrinogen과 HbA1c와 양의 상관관계를, BMI와 음의 상관관계를 보였으며(r=0.47, 0.31,-0.25), 혈관 합병증이 없는 당뇨병 환자군에서만 TAT는 HbA1c와 양의 상관관계를 보였다(r=0.67). 결론:이상의 결과에서 혈장 TAT 및 PIC 농도는 당뇨병 환자에서 정상 대조군에 비해 의미있게 증가되어 있었고, 당뇨병 환자군에서는 연령의 증가와 유병기간이 혈액응고항진 및 용해의 장애에 큰 역할을 함을 알 수 있었으며, 총 당뇨병 환자군에 PIC와 HbA1c와 양의 상관관계를, BMI와 음의 상관관계를 보였으며 혈관 합병증이 없는 당뇨병 환자군에서만 TAT는 HbA1c와 양의 상관관계를 보였다. 따라서 당뇨병 환자에서 혈액응고 및 용해의 장애가 동반되어 있다고 볼 수 있으며, 혈장 TAT 및 PIC는 혈관합병증으로의 진행을 예측하는 지표로서 유용하리라 생각된다. 또 혈당조절정도와 상관성이 있으므로 혈당조절후에 추적검사를 시행하여 합병증의 예방이 가능한지 추후 연구가 필요하리라 생각된다. Background : Abnormality of coagulation and fibrinolystic system is known as a predisposing factor of vascular complication in diabetes. Although the pathogenesis is not well known, non-enzymatic glycation reaction and the increase in production of free radicals due to an increased oxidative stress may be linked to the hypercoagulibility and hypofibrinolytic activity. As indices of abnormality in coagulation and firinolysis in peripheral blood, plasma thrombin-antithrombin Ⅲ complex (TAT) and plasmin-α_2-plasmin inhibitor complex (PIC) were measured. The purpose of this study was to clarify whether hypercoagulability exists in diabetic patients with or without vascular complication. Methods : In our study, we measured plasma thrombin-antithrombin Ⅲ compelx (TAT) and plasmin-α_2-plasmin inhibit or complex (PIC) in 101 diabetic subjects and 20 controls. Comparing TAT and PIC levels in diabetic microvascular complication group, diabetic macrovascular complication group and controls, we examined correlation between risk factors associated with diabetic vascular complication. Results : 1. The group with diabetic vascular complication was older than group without complication. There was no significant difference in BMI, blood pressure, HbA_ic, blood sugar level, insulin, C-peptide, serum creatinine, total cholesterol, triglyceride, HDL-cholesterol, Lp (a) between two groups. The group with diabetic microvascular complication had longer duration of diabetes. 2. Concentration of TAT and PIC were 2.8±1.2 ng/ mL, 240.4±69.7 ng/ mL in controls and 9.5±22.6 ng/ mL, 472.2±258.7 ng/ mL in diabetic patients, respectively. TAT and PIC were significantly higher in diabetic patients than in control (p<0.001). But TAT/PIC ratio was no significant difference between two groups. 3. In diabetic patients, concentration of TAT and PIC and fibrinogen were respectively 4.1±2.4 ng/ mL, 362.2±272.0 ng/ mL, 322.7±102.4 mg/ dL in group without vascular complication and 5.3±4.1 ng/ mL, 529.5±258.7 ng/ mL, 374.9±106.2 mg/ dL in group with microvascular complication, which group had increase in PIC and Fibrinogen but no significance after correction of age. Concentration of TAT and PIC and Fibrinogen were 60.±4.9 ng/ mL, 507.4±321.6 ng/ mL, 427.1±194.7 mg/ dL in macrovascular complication, and 10.4±6.7 mg/ mL, 484.8±269.7 ng/ mL, 388.4±132.4 mg/ dL in combined vascular complication which group showed increase of TAT but also had no significant increase after correction of age. 4. In diabetic microvascular complication patients, group of high HbA_1c (>8%) (p=0.049) had significant high PIC concentration. In diabetic macrovascular complication patients, group of high HbA_1c (>8%) (p=0.042) had significant high total cholesterol concentration. 5. In all diabetic patients, PIC was positively correlated with fibrinogen and HbA_1c and negatively correlated BMI (r=0.47, 0.31, -0.25). Only in daibetic patients without angiopathy, TAT was positively correlated with HbA_1c (r=0.67). Conclusion : In this study, plasma TAT and PIC concentration significantly increased in diabetic patients compared with controls, and PIC was increased in group with microvascular complication, TAT were increased in group with combined micro macrovascular complication. However, there was no significance relationship existed when correctinf for age. PIC was correlated with HbA_1c. TAT was correlated with HbA_1c only in the group without angiopathy. Abnormality of coagulation and fibrinolysis were combined in diabetes, plasma TAT and PIC can be used as an index of vascular complication. Also we found the correlation with the degree of the blood glucose control. Therefore we need follow up study for the possibility of prevention of vascular complication after controlling the blood glucose to age-matched patients (J Kor Diaabetes Asso 25:354~363, 2001).

신장이식 환자에서 HCMV 항원혈증 검사의 임상적 유용성

김탁,성흥섭,박관태,김송철,김성한,최상호,김양수,우준희,박수길,한덕종,이상오 대한감염학회 2009 감염과 화학요법 Vol.41 No.2

Background : This study was performed to determine the cut-off value and the predictability of symptomatic human cytomegalovirus (HCMV) infection according to the peak value of HCMV antigenemia assay in kidney transplant recipients. Materials and Methods : We reviewed the results of HCMV antigenemia assay (Chemicon, CA, USA) in patients who received kidney transplantation at our institution from May 2003 through May 2008, and investigated the existence and the type of HCMV infection by the medical record review. Patients who underwent the test only once during the episode or those who received ganciclovir for more than 48hrs before the test were excluded. The receiver-operator characteristic curve was drawn and the point showing maximum likelihood ratio (LR) was chosen as the cut-off value of symptomatic HCMV infection. Results : A total of 689 episodes were screened and 134 episodes were enrolled. Thirty-three (24.6%) episodes were symptomatic HCMV infection, 23 (17.2%) episodes were associated with HCMV syndrome, and 10 (7.5%) episodes were tissue-invasive diseases. The maximum LR was 7.5 (95% confidence interval, 4.014.2) and the cut-off value was 29.5 cells/200,000 WBC. The sensitivity, specificity, Positive predictive value, and negative predictive value were 66.7%, 91.1%, 71.0%, and 89.3%, respectively. Conclusions : The cut-off value of symptomatic HCMV infection by the peak value of HCMV antigenemia assay in our study was similar with previous results, although the sensitivity was relatively low.

위절제술 환자의 표준진료지침 개발 및 적용 효과

김은희,김철규,이순교,김순덕,이혜옥,권정순,이경미,이민미,심순미,유용만,신종식,강은희,이상일,김병식,오성태,육정환,박수길 한국의료QA학회 2003 한국의료질향상학회지 Vol.10 No.2

Background : Gastric cancer is the most common malignant tumor in Korea. surgical operation is one of the major treatment modalities for gastric cancer patients. Therefore, gastrectomy is one of the most common procedures in General Surgery. There were variation in length of hospital stay and medical treatment for gastrectomy between three surgeons at Asan Medical Center. Clinical pathways have received considerable attention as a tool for recucing the medical practice variation, increasing the efficiency of care process, and improving the quality of care. The aim of this study was to evaluate the effect of a clinical pathway for gastrectomy in gastric cancer patients. Methods : The clinical pathway for gastrectomy was developed and implemented by a multidisciplinary group in Asan Medical Center. A computerized clinical pathway program was developed and revised after a pilot test. A total of 145 patients underwent gastrectomy by three surgeons at Asan Medical Center. We compared the length of hospital stay, patient satisfaction, and unplanned readmission rate between the pre-pathway group(n=67) and the post-pathway group(n=78). We also investigated the degree of satisfaction among the physicians and nurses who were main end-users of the clinical pathway. Results : The clinical pathway was applied to all target patients. The average length of hospital stay was shortened from 12.7days to 10.6days(p<0.01). The degree of patient satisfaction with the care process changed from 90.3% to 89.2% after the implementation of the clinical pathway, but the difference was of satistically significant(p=0.761). Unplanned readmission rate was 2.9% in the pre-pathway group. More than 90% of physicians and nurses answered that the clinical pathway had been a useful tool in their medical practice. Conclusions : The findings of the study demonstrated that implementation of the clinical pathway for gastrectomy produced substantial reduction in the length of hospital stay while improving the quality of patient outcomes. The computerized clinical pathway program can be used as one of the powerful patient management tools for reducing the practice variations and increasing the efficiency of care process in Korea hospital settings.

鬱血性心不全症에 對한 臨床的 觀察

徐明洙,金吉洙,金佑泰,張錫源,金承源,宋昌燮 대한적십자사 1983 적십자병원지 Vol.10 No.2

장기간의 Cyclosporine 유지 요법으로 신기능을 유지 중인 FSGS 2예

권순길,김상현,김수희,박은주,이은경,박수길 대한신장학회 2004 대한신장학회잡지 Vol.23 No.1

비음주 수진자들에서 지방간과 대사증후군과의 연관성

김길수,최영식,,박요한 KOSIN UNIVERSITY COLLEGE OF MEDICINE 2006 高神大學校 醫學部 論文集 Vol.21 No.1

Background: Nonalcoholic fatty liver disease (NAFLD) is liver disease characterized by diffuse fatty infilteration and inflammation. NAFLD is closely related with metabolic syndrome such as diabetes, obesity, hyperlipidemia, and hypertension. Definitive diagnosis of NAFLD still requires a liver biopsy. So, it is difficult to diagnosis of NAFLD in the health screen examinees. The aim of this was to assess the association fatty liver diagnosed by ultrasonography and components and parameters of metabolic syndrome in the non-alcoholic health screen examinees. Methods: A total of 3,829 health screen examinees (1,985 men, 1,844 women) who participated in health screening at health promotion center in Kosin Medical Center from March, 1997 to December, 2003 were enrolled in this study. All participants was no evidence of viral hepatitis and alcohol abuse. The examinees were divided two group, fatty liver and nonfatty liver group and the clinical, biochemical and metabolic parameters analyzed by multiple regression and logistic methods. Results: Almost of all variables (age, weight, blood pressure, body mass index (BMI), waist circumference (WC), total cholesterol, triglyceride, fasting blood glucose, gamma glutamyltransferase (γGTP) except high density lipoprotein (HDL) cholesterol were significantly high in the fatty liver group than nonfatty liver group (p,0.05). There was a significant positive correlation between WC and weight, blood pressure, BMI, total cholesterol, triglyceride (p<0.01). The age adjusted odds ratio between WC and fatty liver was 1.614 in men and 2.906 in women (p<0.01). As subjects were grouped according to their number of components metabolic syndrome, the development of fatty liver was increased according to the numbers of components of metabolic syndrome (p<0.05). γGTP was a significant positive correlation with WC, weight, blood pressure, BMI, total cholesterol, triglyceride (p<0.01). When subjects were grouped according to the γGTP level, group Ⅰ (≤20 U/L) and group Ⅱ (20 U/L~40 U/L) and group Ⅲ (>40 U/L). Significant differences was notice in almost of all variables (weight, blood pressure, BMI, WC, total cholesterol, triglyceride, fasting blood glucose) among each group (p<0.000). Conclusion: These results suggested that fatty liver in non alcoholic health examinees is closely associated with metabolic syndrome and number of components of metabolic syndrome. Among the metabolic parameters, the author noticed that γGTP is not a marker of alcohol induced liver disease but may also a independent and reliable marker of metabolic syndrome.

용융 AI-10Si 합금의 산화피막강도 및 표면 미세조직에 미치는 Mg첨가의 효과에 관한 연구

김길수,양중식,김기주,백영남 慶熙大學校 材料科學技術硏究所 1992 材料科學技術硏究論集 Vol.5 No.-

This study was carried out to determine the strength of oxide skins of Al-10Si alloy melts and the effect of Mg addition on the morphology of oxide skins as the practical alloy for automobile piston. This has been observed by Rotational Die Movement Equipment for the temperature range from 600℃ to 720℃, the oxidation time range from 2 min. to 60 min. and the Mg weight percent(wt %) range from 1% to 5%. As the surface temperature and the surface oxide time of alloy melts increased, the crystalization of oxide layer and the creation of oxides were verified.

명령어 수준 병렬 프로세서의 쓰레드 활용도 분석

김지선,김석일 충북대학교 컴퓨터정보통신 연구소 2003 컴퓨터정보통신연구 Vol.11 No.2

명령어 수준 병렬(ILP: Instruction Level Parallel) 프로세서 구조에서 명령어를 실행할 때, 실제로 그 프로세서가 갖고 있는 자원을 충분히 활용하지 못한다. 이 논문에서는 여러 개의 연산처리기로 구성된 ILP 프로세서에서 여러 개의 쓰레드를 동시에 실행할 수 있는 지를 확인하기 위하여 프로세서를 구성하는 연산처리기의 자원활용도를 분석하였다. 실험을 위해 자원활용도 분석기를 구현하였으며, 6개의 벤치마크 프로그램에 대해 SimpleScalar 시뮬레이터에서 제공되는 명령어 파이프라인 트레이스 파일을 분석하였다. 실험 결과 벤치마크의 평균 IPC(Instructions Per Cycle)는 1.007이며, EX단계의 평균 자원활용도가 26.9%로 낮아 2개 이상의 연산처리기로 구성된 ILP 프로세서는 충분한 쓰레드 병렬성이 존재함을 확인할 수 있었다. Instruction Level Parallel (ILP) processors can not fully utilize their resources, while they execute instruction streams. In this paper, we analyze the resource utilization of functional units composing an ILP processor, so as to confirm whether multiple threads can be executed in it. For experimentation, we implemented a resource utilization analyzer, that reads instruction pipeline traces of six benchmarks produced by the SimpleScalar simulator. The test results show that average IPC (instruction per cycle) is 1.7 for benchmarks, while average resource utilization of the EX stage is 28.9%. This result concludes that ILP processors with more than two functional units have enough thread parallelism in them.

전자선 증착장치 및 ITO 박막의 제작과 그 특성에 관한 연구

김수길,최범식,우정주,고년규,황정남,정원모,이철주 연세대학교 자연과학연구소 1982 學術論文集 Vol.9 No.-

태양 전지의 제작시 투명 전극막으로 쓰이는 ITO 박막을 제조하기 위하여 cathode 접지 방식의 전자총을 가진 정전 편향 집속형의 전자선 증착 장치를 제작하였다. 가속전압이 0∼15kV, 필라멘트 전류가 0∼28A, 두 전극판 사이의 간격이 11mm, anode와 deflector 사이의 간격이 30mm인 최적 실험조건하에서 생성된 전자선 spot의 크기는 길이가 20mm 폭이 1mm였으며, 전자선의 출력은 약 400W였다. 이 전자선 증착 장치를 이용하여 1600℃까지의 증발 온도를 가진 도체와 절연체 등을 쉽게 증착시킬 수 있었으며, 만드어진 ITO 박막은 약 5000Å의 두께에서 10^-1∼10^-2Ω·㎝의 비저항과 95%의 광투과율을 갖는다. An electron beam evaporator with a cathode grounded type electron gun was designed and constructed in order to deposit ITO thin films for photovoltaic applications. The optimum condition was observed with electode spacing of 11mm, 30mm between anode and deflector, a cathode inner diameter of 3mm and an anode inner diameter of 5mm. As the accelerating voltage varies from 0 to 15kV and ghe filament current from 0 to 28 A, the minimum electron beam spot has a 20mm length, and 1mm width and the output power ranges from 0 to 400W under the above optimum conditions. We can deposit materials whose evaporation temperature is over 1600℃ using this evaporator. And as a result ITO thin film showed a low resistivity of 10^-1∼10^-2Ω·㎝ and the transmittance of 95%.