사용 전 베타락탐 항생제 피부시험의 유용성에 대한 전문가 의견

김성렬 ( Sung-ryeol Kim ),김수정 ( Sujeong Kim ),김세훈 ( Sae-hoon Kim ),박종숙 ( Jong-sook Park ),박혜정 ( Hye Jung Park ),서동인 ( Dong In Suh ),심다운 ( Da Woon Sim ),양민석 ( Min Suk Yang ),이재현 ( Jae-hyun Lee ),이화영 ( Hwa 대한천식알레르기학회 2022 Allergy Asthma & Respiratory Disease Vol.10 No.1

An allergy skin test is used to diagnose certain allergies by identifying sensitized allergens. In other words, it is a test for patients who are already sensitized to certain allergens. Because of the prevailing perception that beta-lactam allergy can be dangerous and potentially lethal, the intradermal test has long been routinely performed before use to screen beta-lactam allergy in Korea. The prevalence of penicillin allergy is estimated to be 1% to 2%. However, only 14% of the subjects with perceived penicillin allergy is considered to have true penicillin allergy. Moreover, it is difficult to justify performing a skin test on subjects who are very unlikely to be sensitized to beta-lactam, such as those who never used beta-lactam or never experienced allergy after previous use of beta-lactam. Therefore, allergists recommend beta-lactam skin testing in those who have allergy after the use of beta-lactam. Nevertheless, many hospitals in Korea are conducting routine skin tests on patients regardless of a history of beta-lactam allergy, which are not clinically validated but consume considerable human and material resources. False-positive results can consequently result in inappropriate labeling of beta-lactam allergy, leading to the unnecessary restriction of medication prescriptions and the increase in medical expenses. Herein, the drug allergy working group affiliated with the Korean Academy of Asthma, Allergy, and Clinical Immunology announces an expert opinion on the preuse beta-lactam skin test for subjects without a history of beta-lactam allergy based on the objective evidence from the literature and clinical relevance. (Allergy Asthma Respir Dis 2022;10:3-8)

중운 ( 1,2등 ) 핵모의 음가구명 - 중고음과 상고음의 운모대응을 중심으로 -

김성렬 ( Sung Ryeol Kim ) 한국어교육학회 1982 국어교육 Vol.- No.42

베체트병 환자에서 아자티오프린 사용 중 나타난 와파린 저항성 1예

김성렬 ( Sung Ryeol Kim ),임동우 ( Dong Woo Leem ),문일주 ( Il Joo Moon ),고범석 ( Beom Seok Koh ),장명희 ( Myung Hee Chang ),유종하 ( Jongha Yoo ),양희철 ( Hee Chul Yang ),이찬희 ( Chan Hee Lee ) 대한류마티스학회 2015 대한류마티스학회지 Vol.22 No.4

본 증례는 베체트병 환자에서 심부정맥혈전증이 생겨 와파린으로 항응고치료를 하던 중 질병이 활성화되어 아자티오프린을 추가로 투여하였고 이후 심부정맥혈전증이 악화된 경우이다. 와파린을 증량하였으나 INR 증가가 뚜렷하지 않았으며, 아자티오프린을 중단한 뒤 INR이 적절하게 유지되었고 와파린도 감량할 수 있었으며 심부정맥혈 전증도 호전되는 추세를 보였다. 함께 투여하였던 다른 약제와 와파린과의 약물 상호작용은 확실하지 않았으며 과응고 상태와 관련된 검사에서 특이 소견이 명확하지 않았기에, 아자티오프린에 의해 와파린의 효과가 저하되어 환자의 심부정맥혈전이 재발 및 악화된 것으로 보인다. 따라서 와파린 저항성이 아자티오프린에 의해 나타날 수 있는 것을 추정해 볼 수 있었으며, 임상의사가 이 두 약을 처방할 때에는 이에 대한 주의가 필요할 것으로 보인다. Behcet’s disease is characterized by recurrent oral aphthous ulcers, genital ulcers, uveitis, and skin lesions. Thrombosis associated with vascular inflammation in patients with Behcet’s disease presents various clinical symptoms. Warfarin is usually administered for treatment of thrombosis. However, warfarin can interact with many medications that cause various problems. A 43-year-old woman with Behcet’s disease presented with a swollen right leg. Deep vein thrombosis (DVT) was confirmed, and treated with warfarin. Due to exacerbation of Behcet’s disease, she received azathioprine along with warfarin. Subsequently, the international normalized ratio (INR) decreased and DVT was exacerbated. Despite an increase in the warfarin dose, the patient did not reach the target INR. After discontinuation of azathioprine, DVT improved and the warfarin dose was decreased. There were no specific findings associated with a hypercoagulable status. This finding suggests the interaction of azathioprine and warfarin. Therefore, clinicians should be cautious regarding the possibility of drug interactions between azathioprine and warfarin. (J Rheum Dis 2015;22:242-245)

Fault History에 기반한 페이지 선반입 시스템의 구현

김성렬(Seong Ryeol Kim),송인식(In Shik Song),민상렬(Sang Lyul Min),조유근(Yoo Kun Cho) 한국정보과학회 1993 한국정보과학회 학술발표논문집 Vol.20 No.2

현재의 컴퓨터 시스템들은 가상 메모리를 구현하기 위하여 요구 페이징(Demand-Paging) 기법을 사용한다. 이 방법은 페이지 부재가 발생하였을때 반입 지연을 유발하는 단점이 있다. 본 논문에서는 메모리 참조 특성이 반복적이라는 가정을 하고, 반입 지연을 해결하기 위한 방법으로서 실행 시간의 Fault History에 기반한 선반입(미시적 선반입) 방법을 제안하고, 이를 i486 / Mach 시스템과 i486DX2 / SVR4/MP 시스템 상에 구현하고 성능 분석한 결과를 보인다. 또한, 실행 시간의 Fault History에 기초한 선반입만으로는 초기 시작 페이지 부재(Cold-Start Miss)에 대해서는 선반입이 불가능하므로, 자주 사용되는 프로그램들에 대하여 과거 실행의 Trace에 기초한 Fault History를 관리하고, 이에 의한 선반입(거시적 선반입)을 행할 수 있는 방법을 제안하고, 그 설계를 보인다.

지역관성 안정도 추정을 위한 고장상태 관성 측정기술에 관한 연구

김한영(Han-Yeong Kim),정영민(Jung-Young Min),김성렬(Kim-Sung Ryeol) 대한전기학회 2023 대한전기학회 학술대회 논문집 Vol.2023 No.11

노면전차시스템 도입에 대한 역할 증대방안

이재봉(Jae-Bong Lee),김성렬(Sung-Ryeol Kim),안성진(Sung-Gin An) 한국철도학회 2011 한국철도학회 학술발표대회논문집 Vol.2011 No.10

With the development of the technology the usage of the car has been increased to the allowed limit of the road and has caused global warming and air pollution. Subway is good transit system with punctuality safety and eco-friendliness but it needs relatively much money for construction considering the needs of transit. So it is hard to balance the finance. Many developed countries have adopted advanced transit system including tram for the linking small and medium sized cities after 1980s due to the relatively low construction cost. This paper reviews the way to increase the role of tram which is planed to be introduced to the local governments as a kind of Advanced transit system.

성인 여성에서 신체조성, 최대산소섭취량과 안정시 대사량간의 상관성

배영현 ( Young Hyeon Bae ),김열 ( Yeol Kim ),정승현 ( Seung Hyeon Jeong ),이재갑 ( Jae Gap Lee ),김성렬 ( Sung Ryeol Kim ),이석민 ( Suk Min Lee ) 대한스포츠의학회 2008 대한스포츠의학회지 Vol.26 No.2

The purpose of this study was to analyze the correlation between the body composition, maximum oxygen uptake (VO2max) and resting metabolic rate (RMR) of 53 adult females. The RMR and RMR/body weight (BW) were significantly increased in subjects with higher VO2max/BW (p<0.05). It was found that the higher was the body mass index (BMI), the lower was the RMR/BW (p<0.05). The age, BW, BMI, body fat mass, and body fat percentage showed negative correlation with the RMR/BW, while the height and VO2max/BW showed positive one. In conclusion, it seems that, during an evaluation of RMR, the positive effect of lean body mass, muscle mass, VO2max on RMR could be shown more easily by measuring RMR/BW when a subject has higher level of VO2max; the negative effect of BMI, BFM, and BFP on RMR could be excluded more efficiently when the subject has lower level of it.

알레르기 ; 단일 3차 의료 기관의 약물 유발 아나필락시스 발생 현황

문일주 ( Il Joo Moon ),박혜정 ( Hye Jung Park ),김성렬 ( Sung Ryeol Kim ),고범석 ( Beom Seok Koh ),임동우 ( Dong Woo Leem ),박경희 ( Kyung Hee Park ),이재현 ( Jae Hyun Lee ),박중원 ( Jung Won Park ) 대한내과학회 2015 대한내과학회지 Vol.88 No.3

목적: 약물은 성인 아나필락시스의 가장 흔한 원인이며 약물 유발 아나필락시스는 생명을 위협할 수 있는 심각한 약물 부작용이다. 하지만 한국에서의 약물 유발 아나필락시스에 대한 연구는 매우 부족한 상태이기 때문에 약물 유발 아나필락시스 환자들을 대상으로 임상양상, 원인 약물, 치료방법 등을 알아보고자 하였다. 방법: 2006년 1월 1일부터 2013년 10월 30일까지 세브란스병원에 입원하거나 외래 또는 응급실을 방문한 환자들 중 전자 의무 기록 검색을 통해 약물 유발 아나필락시스를 진단 받은 환자를 선별했다. 이 환자들을 대상으로 의무 기록확인을 통해 환자의 나이, 성별, 과거력 및 동반 질환, 아나 필락시스 발생 당시의 임상증상, 병원 내원 경로, 응급실 내원 환자에서의 거취 결정, 아나필락시스의 원인 물질 등을 후향적으로 조사하였다. 결과: 총 605명의 아나필락시스 환자 중 167명이 약물에 의한 아나필락시스 환자였다. 원인 약제로는 조영제(43건, 25.7%), 항생제(38건, 22.8%), 비스테로이드성 항염증제 및 아스피린(35건, 21.0%), 항암제(22건, 13.2%), 주사용 비타민제(9건, 5.4%), 라니티딘(6건, 3.6%) 순이었으며 흔한 임상증상으로는 심혈관계 증상(74.3%), 피부 증상(71.3%), 호흡기계 증상(55.7%), 소화기계 증상(19.2%) 순이었다. 치료로는 항히스타민(77.2%), 부신피질 호르몬제(76.5%), 에피네프린(35.3%)이 사용되었다. 결론: 약물 유발 아나필락시스의 원인 약제 중 조영제가 가장 흔한 원인 약물이었으며 치료를 위한 에피네프린의 사용률이 저조한 것으로 나타나 향후 아나필락시스를 진료하는 의료진에 대한 교육이 필요할 것으로 생각된다. Background/Aims: Drug-induced anaphylaxis (DIA) is a severe, acute, and potentially life-threatening condition. In Korea, only a few well-documented cases of DIA have been described. Therefore, the aim of this study was to investigate the clinical characteristics, causes, and management of DIA in a single Korean medical institute. Methods: This was a retrospective medical record review of all DIA patients who visited the in-patient, out-patient, and emergency departments of our hospital from January 1 2006 to October 30 2013. Results: Among 605 cases of anaphylaxis, 167 were drug-induced. The culprit drugs were contrast agents (43 cases, 25.7%), antibiotics (38, 22.8%), non-steroidal anti-inflammatory drugs (35, 21.0%), anti-cancer drugs (22, 13.2%), parenteral vitamins (9, 5.4%), ranitidine (6, 3.6%), and neuromuscular blockers (3, 1.8%). The most common organ-specific symptoms/signs were cardiovascular (74.3%), cutaneous (71.3%), respiratory (55.7%), and gastrointestinal manifestations (19.2%). In most cases, DIA was treated with antihistamines (77.2%) and systemic corticosteroids (76.5%); the use of epinephrine was considerably less frequent (35.3%). Conclusions: In our institution, contrast agents were the leading cause of DIA. Although epinephrine is the drug of choice in the treatment of acute anaphylaxis, fewer than 50% of the study patients received epinephrine to treat DIA. (Korean J Med 2015;88: 281-287)

급성 천식 발작 환자를 위한 표준치료지침의 운용 경험: 효율성과 임상 경과

임동우 ( Dong Woo Leem ),박경희 ( Kyung Hee Park ),문일주 ( Il Joo Moon ),김성렬 ( Sung Ryeol Kim ),고범석 ( Beom Seok Koh ),박혜정 ( Hye Jung Park ),이재현 ( Jae Hyun Lee ),박중원 ( Jung Won Park ) 대한천식알레르기학회 2015 Allergy Asthma & Respiratory Disease Vol.3 No.1

Purpose: Early recognition and management of asthma attack is critical before it becomes worse. We developed critical pathway (CP) of asthma attack at Emergency Center (EC) for making undelayed decision and management of asthma attack. Methods: Acute asthma attack assessment and treatment (4AT) CP began on April 1st 2012 and recruited the patients for 18 months. This study enrolled the patients who were older than 15 years and visited EC for dyspnea and wheezing. Initial assessment was done measuring peak expiratory flow rate (PEFR), oxygen saturation (SaO2). Once CP is activated, oxygen, inhalation of short acting β2 agonist, and injection of corticosteroid were administered to the patients. Every hour after CP activated, we reassess the patients’ response and make decisions whether to admit or discharge. Results: Until January 10th 2014, 62 patients enrolled in this study. Seven patients hospitalized for asthma and 40 patients discharged. The other 15 patients were deactivated as they were diagnosed of heart failure, myocardial infarction, aortic dissection, anaphylaxis, chronic obstructive pulmonary disease and pneumonia for the causes of dyspnea. Mean Interval from EC arrival to 4AT activation was 32.6±29.1 minutes and the mean interval from 4AT activation to position decision was 254.5±302.0 minutes. Among 47 patients who were diagnosed with asthma attack, 13 patients were not aware of asthma before this attack. Forty patients were discharged at EC after management of CP. Among them, 34 patients revisited clinic, but 6 patients did not. We called back to the lost 6 patients but only 3 patients were connected. Even they visited EC due to asthma attack, 2 patients had no insight of importance of regular management and the other one promised to revisit. Conclusion: CP was successful for early management of asthma attack. However, 15% of discharged patients never show up again. So, education program about the importance of ongoing management of asthma for prevention of asthma attack is needed. (Allergy Asthma Respir

꾸지뽕(Cudrania tricuspidata) 민간요법에 의한 약물유해반응 2예: 전격성 간염 및 급성 전신성 발진성 농포증

고범석 ( Beom Seok Koh ),박혜정 ( Hye Jung Park ),김성렬 ( Sung Ryeol Kim ),문일주 ( Il Joo Moon ),임동우 ( Dong Woo Leem ),박경희 ( Kyung Hee Park ),이재현 ( Jae Hyun Lee ),박중원 ( Jung Won Park ) 대한천식알레르기학회 2014 Allergy Asthma & Respiratory Disease Vol.2 No.5

Cudrania tricuspidata is a deciduous tree belonging to the Moraceae plant, which has been widely used as a folk remedy or health supplements in the Asian countries including Korea. As far as we know, side effects from taking the extract of C. tricuspidata has not yet been reported. We reviewed the electronic medical records of 2 patients who had adverse drug reactions to C. tricuspidata. The first case was a 30-year-old woman without a specific medical history. She was admitted with a 2-week history of jaundice and dyspepsia after taking extract of C. tricuspidata for 3 days. Initial laboratory findings were as follows: aspartate aminotransferase, 364 IU/L; alanine aminotransferase, 574 IU/L; total bilirubin, 36.3 mg/dL; and direct bilirubin, 18.3 mg/dL. She was conservatively treated for liver and renal failure while awaiting liver transplantation. However, she was expired due to combined pneumonia and progressed hepatic and renal failure. The second case was a 42-year-old woman who has chronic urticaria without other medical history. She was admitted with a 3-month history of whole body rash with small pustular vesicle after taking extract of C. tricuspidata. She was treated with intravenous steroids and antihistamines. Skin lesions were improved after 1 week. Here, we report 2 cases of adverse drug reaction to C. tricuspidata. It should be considered that C. tricuspidata ingestion could cause severe adverse drug reactions such as liver failure and acute generalized exanthematous pustulosis.(Allergy Asthma Respir Dis 2014;2:387-390)