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- 저자 : 권성신 ( Sung Shin Kwon ) (검색결과 4 건)
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중증 급성 천식 악화로 중환자실에 입원한 환자의 사망 위험 요인
권성신 ( Sung Shin Kwon ),김민혜 ( Min Hye Kim ),조영주 ( Young Joo Cho ) 대한천식알레르기학회 2015 Allergy Asthma & Respiratory Disease Vol.3 No.6
Purpose: Asthma is a global health concern involving 300 million people, and mortality due to asthma still accounts for a significant proportion of deaths. The purpose of this study was to define risk factors for the mortality of patients admitted to the intensive care unit because of asthma exacerbation. Methods: A retrospective analysis of 163 severe asthma patients, who were admitted to Ewha Womans University Mokdong Hospital from January 1997 to December 2011 with the need for intensive medical care, was performed. The medical history and laboratory workup at initial visit to hospital were collected by reviewing medical records. To identify risk factors for mortality, data was compared between the survivors (survivor group) and the dead (death group). Results: As a result, mortality rate was 30.7%. The number of patients 65 years or older was larger in the death group. The number of patients on mechanical ventilation was larger in the death group compared to the survivor group. In arterial blood gas analysis, the levels of pH and PaO2 were higher and the PCO2 levels were lower in the death group. In multivariate analysis, the risk of death was higher in patients on mechanical ventilation (odds ratio [OR], 5.327). PCO2 and O2 saturation were protective factors for mortality (OR, 0.90 and 0.915, respectively). Conclusion: Use of mechanical ventilator, low PCO2, and O2 saturation are the most important factors for mortality while admitted to the intensive care unit in severe asthma patients. We should pay attention to patients who are on mechanical ventilation and have low PCO2 and O2 saturation levels. (Allergy Asthma Respir Dis 2015;3:432-438)
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박혜성 ( Hye Sung Park ),심윤수 ( Yun Su Sim ),임소연 ( So Yeon Lim ),조정연 ( Jung Youn Jo ),권성신 ( Sung Shin Kwon ),노선희 ( Sun Hee Roh ),김유리 ( Yoo Ri Kim ),천은미 ( Eun Mi Chun ),이진화 ( Jin Hwa Lee ),류연주 ( Yon Ju Ryu 대한결핵 및 호흡기학회 2008 Tuberculosis and Respiratory Diseases Vol.64 No.1
A hiccup is caused by involuntary, intermittent, and spasmodic contractions of the diaphragm and intercostals muscles. It starts with a sudden inspiration and ends with an abrupt closure of the glottis. Even though a hiccup is thought to develop through the hiccup reflex arc, its exact pathophysiology is still unclear. The etiologies include gastrointestinal disorders, respiratory abnormalities, psychogenic factors, toxic-metabolic disorders, central nervous system dysfunctions and irritation of the vagus and phrenic nerves. Most benign hiccups can be controlled by traditional empirical therapy such as breath holding and swallowing water. However, though rare, a persistent hiccup longer than 48 hours can lead to significant adverse effects including malnutrition, dehydration, insomnia, electrolyte imbalance, and cardiac arrhythmia. An intractable hiccup can sometimes even cause death. We herein describe a patient with non-small cell lung cancer who was severely distressed by a persistent hiccup. (Tuberc Respir Dis 2008;64:39-43)
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Klebsiella Ornithinolytica 균혈증의 발생 양상과 임상적 특성
윤정윤,박진경,조정연,김인선,권성신,최희정,이미애 이화여자대학교 의과학연구소 2008 EMJ (Ewha medical journal) Vol.31 No.1
Objectives : Klebsiella ornithinolytica is a very rare type of Klebsiella species isolated from human and environment and is currently reported to be the cause of bacteremia. However, there have been no data on the clinical implication of K. ornithinolytica bacteremia. Materials and Methods : We have analyzed 9 cases of K.ornithinolytica bacteremia diagnosed at Ewha Womans Medical Center from 2003 to 2006. All available clinical and microbial data were analyzed. Results : All 9 cases were community acquired. The causes of bacteremia were hepatobiliary disease(66.7%), Primary bacteremia(22.2%) and spontaneous bacterial peritonitis(11.1%). Underlying diseases were colon cancer, type 2 diabetes, hypertension and hepatobiliary disease. In 44.4% patients, there were no underlying diseases. Acute renal failure and shock occurred in 33.3% patients. All of the isolated strain were resistant to ampicillin, and only 1 case was resistant to cephalothin, piperacillin/tazobactam. Conclusion : K. ornithinolytica bacteremia is commonly community acquired, especially in patients with hepatobiliary disease. Higher mortality was associated with acute renal failure and shock. 목적 Klebsiella 감염증의 대부분◎ K pneumonia에 의한 것이고 드물게 K. oxytoca에 의해서도 발병된다. 최근 Klebsiella 속내 여러 종들이 인간과 환경 추출물에서 분리되고 있으나 그 중 K. ornithinolytica 균혈증은 2002 국내에서 1예. 2008년 미국에서 1예만 보고되었다. 본 연구는 한 대학병원에서 최근 경험한 K. ornithinolytica 균혈증에 대하여 알아보고자 하였다. 방법 2000년 1월부터 2006년 8월까지 이대 목동 병원에서 시행한 혈액배양 검사에서 K. ornithinolytica가 동정되었던 환자들의 의무기록을 후향적으로 분석하였다. 결과 연구 기간 동안 K. ornithinolytica 균혈증으로 진단된 년도별 발생 건수는 2003년도에 1예, 2004년 3예 2005년 2예, 2006년 3예였다. 환자는 모두 9명이었고 남자 5명(55.6%), 여자 4명(44.4%)이며 평균 나이는 63.6±8.65세였다. 1명에서만 내원 2개월 전 1세대 Cephalosporin 경구 복용한 적이 있었고 나머지 예에서는 지역 획득 감염에 의한 균혈증이었다. K. ornithinolytica 단일 균주만 배양된 경우는 7예(77.8%)이었고 2예(22.2%)의 환자에서 다른 균주가 동반되었다. 침입 경로는 대부분 간담도계 감염이 6명(66.7%), 국소감염의 증거가 없는 일차적 균혈증이 2명(22.2%), 자발성 복막염이 1명(11.1%)이었다. 환자들의 기저 질환은 고형암 3예, 당뇨 2예, 담도 질환 2예, 기저 질환이 없는 경우가 4예 이었다. 합병증으로 쇽과 급성 신부전이 3명(33.3%)에서 나타났으며 쇽 환자 3명중 2명에서 급성 신부전이 동반되었다. 치료로 모두 적절한 항균제를 사용하였고 이용한 항균제의 수는 각각 1가지가 6예(66.7%), 2가지가 1예(11.1%), 3가지가 2예(22.2%)이었다. 항균제 감수성 결과에서 모두 ampicillin에 내성을 보였고 그 외 대부분 항생제에 감수성을 보였으나 1예에서 cephlothin 내성. piperacillin/tazobactam에 중증도 내성을 보였다. 균혈증과 관련된 사망률은 22.2%였으며, 치료 도중 쇽, 급성 신부전, 기저질환과 관련이 있었다. 결론 K. ornithinolytica 균혈증은 2003년부터 본원에서 관찰되었고 주로 지역획득 감염이 많고 간담도계 질환과 연관이 높았으며 심한 경우 쇽. 급성 신부전을 일으켜 이로 인해 사망할 수 있음을 보여줬다. 앞으로 K. ornithinolytica 감염의 임상적 특징과 이에 대한 역학적 연구가 필요할 것으로 보인다.
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다클론성 감마글로불린병증을 동반한 C-ANCA 양성 급속진행성 사구체신염 1예
백은경,노선희,박진경,조정연,권성신,심은진,권경주,노영욱,이경종,윤정윤,김인선,김소이,류동열,성순희,홍기숙 이화여자대학교 의과학연구소 2008 EMJ (Ewha medical journal) Vol.31 No.1
저자들은 육안적 혈뇨, 체중 감소를 주소로 입원하여 특별한 원인을 찾을 수 없는 심한 빈혈과 고감마글로불린병증을 보이고 신조직 검사에서 C-ANCA 양성 급속 진행성 사구체신염으로 진단된 예를 경험하였기에 보고 하는 바이다. Rapidly progressive glomerulonephritis(RPGN) is one of the most calamitous renal disease which is clinically characterized by sudden and relentless deterioration in renal function within weeks to months and associated with the pathologic finding of extensive extracapillary proliferation. Pauci-immune RPGN is mostly associated with anti neutrophil cytoplasmic antibody (ANCA) positive systemic vasculitis, but renal-limited RPGN may be found in part. We experienced a case of ANCA positive RPGN associated with polyclonal gammopathy without systemic symptoms. A 64-year-old woman was admitted with gross hematuria and azotemia. Laboratory findings revealed polyclonal gammopathy and severe anemia without definite cause, and she was diagnosed as C-ANCA positive crescentic glomerulonephritis without systemic vasculitis. She was treated with steroid pulse therapy and her renal function and anemia were progressively improved. We report herein a rare case of C-ANCA positive crescentic glomerulonephritis associated with polyclonal gammopathy and severe anemia with the review of literature.
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