신경 악성 증후군에 속발된 급성 신부전

허민영 ( Min Young Her ),서우선 ( Woo Seon Seo ),문치숙 ( Chi Sook Moon ),윤혁진 ( Hyuk Jin Yoon ),김양욱 ( Yang Wook Kim ),김영훈 ( Yeung Hoon Kim ) 대한신장학회 2003 Kidney Research and Clinical Practice Vol.22 No.2

Neuroletic malignant syndrome is a rare, idiosyncratic and potentially lethal side effect that occurs patients receiving neuroleptic drugs. Characteristic sings and symtoms include muscle rigidity, fever, altered consciousness, and autonomic dysfuction. The most common serious complication is rhabdomyolysis ,which produces acute myoglobiuric renal failure. We present a case of 32-year-old man in whom had NMS and acute renal failure after he had received a combination of chloropromazine and haloperiodol. The patients recovered after treatment by immediate hydration, diuretics and other conservative measure.

쯔쯔가무시병에서 가피의 위치와 복장과의 관계

김백남,곽이경,문치숙,김의석,박상원,이창섭 대한감염학회 2006 감염과 화학요법 Vol.38 No.6

목적 : 쯔쯔가무시병의 예방을 위하여 위험지역에서 긴소매 윗옷을 입고 바지 끝을 양말 속에 넣는 것이 권장되고 있다. 이러한 예방조치의 효용성을 알아보기 위하여 우리는 쯔쯔가무시병에서 가피의 위치와 신발과 복장과의 관계를 살펴보았다. 재료 및 방법 : 2005년 10-12월 사이 6개 병원에서 전형적인 임상양상, 가피의 존재, 혈청검사 결과로 쯔쯔가무시병이 의심되거나 확진된 159명의 성인을 대상으로 가피의 위치, 추정 감염일, 야외활동, 당시 착용한 신발과 복장 등 을 조사하였다. 결과 : 혈청검사는 5명에서 시행되지 않았고 99명이 양성이었으며, 가피는 142명에서 발견되었다. 몸의 두 군데에서 발견된 6명을 제외한 136명 중 82명(60.3%)에서 가피는 하반신(아랫배, 엉덩이, 서혜부, 생식기, 넓적다리, 종아리)에 있었다. 감염일이 추정가능하고 가피가 1개만 있는 44명을 대상으로 하였을 때, 가피가 하반신에서 발견된 17명에서 슬리퍼를 신거나 맨발인 경우는 5명이었으나 상반신에 있는 27명 중에는 아무도 없었다(P=0.006). 바지아랫단을 양말 속에 집어 넣은 4명 중 1명은 하반신에서 3명은 상반신에서 가피가 발견되었다. 42명이 긴 소매 윗옷을 입었는데, 이중 16명은 하반신에서 26명은 상반신에서 가피가 발견되었다(P=1.00). 결론 : 쯔쯔가무시병 환자에서 신발을 신지 않거나 발이 잘 보호되지 않았을 때 가피는 하반신에 더 잘 생겼다. 바지 아랫단의 처리방법이나 긴 소매 윗옷의 착용은 가피의 위치와 통계적으로 유의한 연관관계는 발견되지는 않았다. 그러나 표본수가 적고 유충의 침범경로에 영향을 줄수 있는 다른 요인이 있기 때문에 가피의 위치와 연관관계가 없다고 이 연구에서 단정할 수는 없다. 따라서 쯔쯔가무시병의 예방을 위한 실용적인 권고를 위해서는 더 많은 연구가 필요하다. Background:Wearing a long-sleeved shirt and tucking the pants legs into the socks is recommended to prevent scrub typhus. This study investigated associations between the location of eschar and the type of clothes and shoes to evaluate the efficacy of these protective measures. Materials and Methods:One-hundred and fifty nine patients in whom scrub typhus was confirmed or suspected based on the typical clinical manifestations, presence of eschar, or positive results of serologic tests at 6 Korean hospitals from October to December 2005 were included in this study. We collected the information on the location of eschar, presumed exposure date to chiggers, and the clothes and shoes which they had worn. Results:Serologic tests were positive in 99 patients. Eschars were observed in 142 patients and 6 of them exhibited more than 2 eschars. Eighty-two (60.3%) of 136 patients with a single eschar had an eschar on the lower half of the body. Of the 44 patients whose exposure date could be estimated, and who had only a single eschar, 5 of the 17 patients with eschars in the lower half of their bodies, and none of the 27 patients with eschars in the upper half of their bodies went barefoot or wore open footware (P=0.006). Only 4 patients tucked the pants into their socks, and an eschar was found in the lower half in one patient, and in the upper half of the body in the other 3 patients. Of 42 patients who wore long-sleeved shirts, eschars were found in their lower bodies in 16, and on their upper bodies in 26 (P=1.00). Conclusion:When the feet were not protected properly with shoes, eschars were found more frequently on the lower half of the body than on the upper half. Wearing a long-sleeved shirt or tucking the pants legs into the socks was not found to be significantly correlated to the location of eschars. Further studies involving larger samples are necessary for the development of practical guidelines of protective measures to prevent scrub typhus.

국내 Epstein-Barr 바이러스 일차감염의 임상적 특성

김백남,곽이경,문치숙,김의석,박상원,이창섭 대한감염학회 2007 감염과 화학요법 Vol.39 No.6

In this study, the clinical features of 264 patients of primary Epstein-Barr virus (EBV) infection between the years of 2002-2006 were evaluated retrospectively. The median age of the patients was 6 years old (0-69), and the hospitalization rate was 78.0%. Fever (83.3%) and sore throat (50.4%) were the most common symptoms. Cervical lymphadenopathy (71.2%), tonsillitis (51.1%), splenomegaly (26.1 %), hepatomegaly (25.8%), rash (10.2%) and jaundice (1.5%) were observed. Cervical lymphadenopathy was less frequent in older age groups. The annual number of primary EBV infections according to the age group during the study period did not change significantly in this study.

2009년 인플루엔자 대유행 중 인플루엔자 진료소 방문자의 연령 분포 변화

김백남,곽이경,문치숙,김연숙,김의석,배인규,염준섭,이창섭,허지안 대한감염학회 2010 감염과 화학요법 Vol.42 No.2

The pandemic influenza (H1N1 2009) virus, after being introduced in Korea in April, 2009, spread rapidly nationwide in mid-2009. This study was conducted to characterize trend in age distribution of visitors to Flu-clinics during the pandemic. Demographic, clinical and laboratory data of visitors to flu clinic from Week 36 to 52 (August 30 to December 26) of 2009 were retrieved and collected from electronic databases at 9 hospitals. Visitors 0-6, 7-12, 13-18, 19-29, 30-64, and 65 years or more of age were classified into group I to VI, respectively. A total of 107,467 visitors were seen at Flu-clinics for a 17-week study period. Of those, 32,485 were laboratory-confirmed. Antivirals were prescribed for 62,533 visitors. Numbers of visits, prescriptions of antivirals, and laboratory-confirmed cases of the pandemic influenza (H1N1 2009) peaked at Week 44. A large number of visits by group II and III were followed by those of group I and V, especially around the peak. Numbers of visits by group VI were lowest in all hospitals. In some hospitals, higher number of visits lasted longer in children than in adults while vice versa in other hospitals depending on the location. In summary, the pandemic influenza (H1N1 2009) was presumed to peak in late October and involved majorly children and students in Korea. Unique age distribution of visitors to flu clinic was observed in some hospitals.

급성심근경색후 발생한 심실중격결손 2례

김태희,이재호,김애란,허민영,문치숙,정수룡,김대경,김두일,김동수 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.4

Ventricular septal defect remains an infrequent but devastating complication of acute MI. Approximately 1∼3% of cases of acute myocardial infarction are complicated by ventricular septal rupture in the prethrombolytic era and the incidence has decreased to 0.2% with reperfusion therapy. This mechanical complication usually occurs within the first 10 to 14 days when necrotic tissue is most abundant and the collateral coronary circulation is not well developed. This lesion is generally associated with complete coronary obstruction rather than severe stenosis. Rupture of the ventricular septum is a severe mechanical complication of acute myocardial infarction, usually resulting in death unless surgical repair is performed. The bad prognosis of this event within the first 2 weeks indicates the need for early surgical rapair. This complication is more frequent after the first acute myocardial infarction in the elderly and secondary to a transmural myocardial infarction. We report two cases of ventricular septal rupture after acute myocardial infarction.

폐렴 구균(Streptococcus pneumoniae)에 의한 척수 경막외 농양 1예

이지영,위유미,손경목,기현균,문치숙,오원섭,백경란,송재훈 대한감염학회 2004 감염과 화학요법 Vol.36 No.6

폐렴구균은 보통 폐렴이나 뇌막염을 일으키는 균으로 척수 경막외 농양을 일으키는 경우는 매우 드물다. 본 저자들은 폐렴 구균에 의한 척수 경막 외 농양을 경험하여 보고하는 바이다. 과거 건강했던 36세 남자 환자로 사다리에서 낙상한 후 요통 및 고열, 신경학적 이상으로 내원하여 자기 공명 촬영 결과 척수 경막 외 농양으로 진단받고 항균제 투여와 함께 응급 수술을 시행하였다. 농 배양 결과 페니실린 감수성인 폐렴 구균이 분리 되었고, 수술 요법과 항생제 투여 후 농양은 치유되었으나 신경학적 이상은 호전 없는 상태로 타원으로 전원되었다. Pneumonia and meningitis are the most frequent manifestations of pneumococcal infections. Pneumococcal spinal epidural abscesses have been rarely reported. Spinal epidural abscess by Streptococcus pneumoniae has been diagnosed among the patients with diabetes mellitus, alcoholism, corticosteroid therapy, intravenous drug use, chronic renal failure, AIDS, and history of spinal surgery. Recently, we experienced a case of pneumococcal spinal epidural abscess after spinal trauma. A 36-year-old male patient was admitted with back pain, fever, and paraplegia which occurred 5 days after the trauma. Spine MRI revealed spinal epidural abscess at the level from T2 to T9. He was treated with antimicrobial agents and surgical exploration for spinal epidural abscess. Pus culture grew S. pneumoniae which was susceptible to penicillin. Despite early surgical treatment, neurologic sequelae remained. Considering the high mortality and morbidity of pneumococcal spinal epidural abscess, early diagnosis and aggressive treatment including surgical intervention and antibiotics therapy should be implemented immediately.

Bucillamine에 의해 유발된 폐 섬유화증 1례

이영민,문치숙,염호기,박성근,최석진,김주인 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.3

Interstitial lung disease is a frequent and important clinical manifestation of drug toxicity. Drug-induced lung disease has no pathognomonic signs, symptoms, laboratory tests, or pathologic findings. Thus, the diagnosis of drug-induced pulmonary toxicity always rests on the exclusion of such processes as neoplasm, infection, pulmonary thromboembolism, and congestive heart failure. In most cases, the mainstay of ther apy consists of drug withdrawal, and a trial of corticosterois is warranted if gas exchange abnormalities are severe. Bucillamine is a disease modifying antirheumatic drug(DMARD) which is used for the treatment of rheumatoid arthritis(RA) and shows clinical efficacy in RA. Since the chemical structure of bucillamine is similar to that of D-penicillamine, side effects of bucillamine may be similar to those of D-penicillamine. Various side effects have been associated with bucillamine, but to our knowledge, until recently there has been no report on an association between pulmonary fibrosis and bucillamine. We experienced a patient with RA who developed pulmonary fibrosis during the treatment of bucillamine and reported with review of the literature.

20대 후반에 발견된 단심방 환자 1례

김태희,문치숙,이상민,이현성,정수룡,이영민,조길현,김대경,김두일,김동수 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.3

This malformation of the heart entirely lacks atrial septum due to lack of formation of the septum primum and septum secundum. The main anatomical feature is the existence of a large, common cavity behaving as a single atrium. Hemodynamics are quite similar to the one of a large atrial septal defect. Treatment is no significant difference with ASD. A large prosthesis is usually necessary to obliterate the large defect. We report a case of patient with single atrium treated with patch closure.

관상동맥내 스텐트 삽입후 발생한 관상동맥류 2례

제인수,허민영,문치숙,이재호,정수룡,조길현,이영민,김대경,김두일,김동수 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.3

Coronary artery aneurysms are detected with increasing frequency because of the routine use of coronary angiography in the diagnosis and management of coronary artery disease. Although some coronary artery aneurysms are congenital or inflammatory, most are atherosclerotic. The prognosis of atherosclerotic coronary artery aneurysm may depend on the morphology of the aneurysm or the presence of coexisting obstructive disease. Coronary artery aneurysms have been also reported to occur after ballon angioplasty, directional athrectomy, laser angioplasty, and stent implantation with a frequency of 2% to 4%. The long-term outcome of post-intervention coronary artery aneurysm is unknown. We report two cases of the development of a coronary aneurysm 6 months after stent implantation as a treatment of severe obsructive coronary artery disease.

발열을 동반한 호중구감소증에서 Cefepime 단독투여와 Ceftazidime 및 Tobramycin 병합투여의 효능비교

정현욱,채제욱,강미라,양정채,문치숙,기현균,장현하,오원섭,김기현,백경란,이남용,송재훈 대한감염학회 2004 감염과 화학요법 Vol.36 No.6

목적 : 국내에서 발열을 동반한 호중구감소증이 있는 악성 종양환자에게 경험적 항생제로 베타락탐계 항생제와 아미노배당체의 병합요법의 사용이 일반적이다. Cefepime은 광범위 항균 작용을 가지고 있어, 그람 음성균 뿐만 아니라 그람 양성균에 대해서도 우수한 효과를 나타낸다. 재료 및 방법: 발열을 동반한 호중구감소증이 있는 악성 종양환자를 대상으로 무작위, 공개, 비교 연구를 시행하였다. 대상 환자를 무작위로 cefepime 단독요법군과 ceftazidime 및 tobramycin 병합요법군으로 나누어 투여하고 각각의 임상적 효능과 안전성을 비교하였다. 구강및 인후 점막염이 있는 환자에서 분리된 녹색 연쇄알 구균에 대한 항생제 내성 정도를 조사하였다. 결과 : 대상환자 89명 중 CA 투여군이 48예(53.9%), CT 투여군이 41예(46.1%)이었다. 발열의 유형별로 MDI는 18예(20.2%), CDI는 9예(10.1%), UF는 62예(69.7%)로 두 군 간에 차이가 없었다. CA 투여군과 CT 투여군의 임상적 호전률은 시험약 투여 후 2-4일째 각각 91.7%, 85.4% (P=0.31), 치료 종료 시 각각 91.7%, 100% (P=0.15)로 두 군간에 유의한 차이가 없었다. 치료 종료 시 CA 투여군과 CT 투여군의 세균학적 소실률은 모두 100%로 두 군간의 유의한 차이가 없었다(P=0.78). 점막염이 있는 환자로부터 녹색 연쇄알 구균이 분리된 경우는 25예(28.1%)이었으며, 분리된 녹색 연쇄알 구균은 penicillin, ceftriaxone, cefepime, vancomycin에 모두 감수성을 보였다. 약제 관련 이상 반응의 발생 빈도도 두 군간에 유의한 차이가 없었다. 결론 : 발열을 동반한 호중구감소증이 있는 악성 종양환자의 경험적 항생제로서 cefepime 단독요법은 ceftazidime 및 아미노배당체의 병합요법만큼 효과적이고 안전하였다. Background : Broad-spectrum antibiotic therapy has been recommended as an empirical regimen in cancer patients with febrile neutropenia. Cefepime is a fourth generation cephalosporin with good activity against both gram-positive cocci and gram-negative bacilli. Materials and Methods : To compare the efficacy and safety of cefepime alone with ceftazidime plus tobramycin as empirical regimen for adult cancer patients with febrile neutropenia, a randomized, open label, comparative trial was performed. If the patient showed clinical improvent 72 hours, antibiotic could be changed to oral ciprofloxacin. Clinical and microbiological responses were determined at 72 hours and at the end of therapy. To investigate the antimicrobial resistance of viridans streptococci, swab cultures were obtained from throat in all enrolled patients and antimicrobial susceptibility tests were performed by using microdilution method according to the NCCLS. Results : A total of 89 patients were enrolled. Forty-eight patients received cefepime alone (CA), and 41 patients received ceftazidime plus tobramycin (CT). Demographic and baseline clinical characteristics were similar in both groups (P>0.05). The initial clinical success rate at day 2-4 in group CA (91.7%) was similar with that in CT group (85.4%) (P=0.31). At the end of therapy, the final clinical success rate in CA group (91.7%) was similar to that in CT group (100%) (P=0.15). In 18 patients, with microbiologically defined infections, the eradication rate was 100% in both groups. Adverse events including liver dysfunction (21.3%) and renal dysfunction (2.2%), were similar in both groups (P=0.87). Viridans streptococci were isolated from the throat cultures in 25 cases, and all of these strains were susceptible to penicillin (MIC_(90) 0.12 ㎍/mL), cefepime (1 ㎍/mL), and vancomycin (0.12 ㎍/mL). Conclusion : Efficacy and safety of cefepime monotherapy was comparable to the combination of ceftazidime and tobramycin. It could be used as an alternative empirical regimen for treating cancer patients with febrile neutropenia.