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증례 : 감염: 신병훈련소의 군인에서 발생한 아데노바이러스 55형 폐렴
윤진구 ( Jin Gu Yoon ),이샘나 ( Saem Na Lee ),이정민 ( Jung Min Lee ),노지윤 ( Ji Yun Noh ),송준영 ( Joon Young Song ),정희진 ( Hee Jin Cheong ),김우주 ( Woo Joo Kim ) 대한내과학회 2016 대한내과학회지 Vol.90 No.4
Adenoviral pneumonia is rare in healthy adults. However, several cases were recently reported in a military training center in South Korea. Adenovirus genotype 3, 6, and 7 are predominant in South Korea. More recently, genotype 55, which emerged sporadically in China, has been reported in South Korea. In this study, we present a case of adenoviral pneumonia caused by genotype 55 in a healthy soldier from an army recruit training center in South Korea. (Korean J Med 2016;90:365-368)
B형 인플루엔자와 관련되어 발생한 혈구포식 림프조직구증식증
이샘나 ( Saem Na Lee ),윤진구 ( Jin Gu Yoon ),조치현 ( Chi Hyun Cho ),최철원 ( Chul Won Choi ),최정윤 ( Jung Yoon Choi ),정희진 ( Hee Jin Cheong ),김우주 ( Woo Joo Kim ) 대한내과학회 2016 대한내과학회지 Vol.91 No.1
혈구포식 림프조직구증식증(HLH)은 대식세포와 림프구의 증식과 활성화가 조절되지 않아 발생하게 되는 드문 과염증 증후군으로, 치명적인 예후를 초래하는 경우가 많다. 저자들은 기저 질환이 없는 환자에서 B형 인플루엔자 감염과 연관되어 발생한 혈구포식 림프조직구증식증으로 인하여 사망한 증례를 경험하여 이를 보고하는 바이다. Influenza infection may be complicated by various infectious or non-infectious diseases. Among them, hemophagocytic lymphohistiocytosis (HLH) is an uncommon hyperinflammatory syndrome caused by uncontrolled proliferation and activation of macrophages and lymphocytes, and it is often life threatening. A previously healthy male patient was suspected to have HLH after influenza B infection. The diagnosis was established based on clinical diagnostic criteria suggested in the HLH-2004 trial. Despite prompt antiviral therapy, the patient expired on day 19 of hospitalization. Influenza can thus be complicated by HLH. Due to the non-specific manifestations of HLH, clinical suspicion and early diagnosis are important. (Korean J Med 2016;91:88-91)
증 례 : 위에서 발견된 함몰증식성 폴립 1예 보고 및 문헌고찰
이연호 ( Yeon Ho Lee ),주문경 ( Moon Kyung Joo ),이범재 ( Beom Jae Lee ),이지애 ( Ji Ae Lee ),김태현 ( Taehyun Kim ),윤진구 ( Jin Gu Yoon ),이정민 ( Jung Min Lee ),박종재 ( Jong Jae Park ) 대한소화기학회 2016 대한소화기학회지 Vol.67 No.2
An inverted hyperplastic polyp (IHP) found in stomach is rare and characterized by downward growth of hyperplastic mucosal component into the submucosa. Because of such characteristic, IHP can be misdiagnosed as subepithelial tumor or malignant tumor. In fact, adenocarcinoma was reported to have coexisted with gastric IHP in several previous reports. Because only 18 cases on gastric IHP have been reported in English and Korean literature until now, pathogenesis and clinical features of gastric IHP and correlation with adenocarcinoma have not been clearly established. Herein, we report a case of gastric IHP which was initially misdiagnosed as gastrointestinal stromal tumor and resected using endoscopic submucosal dissection. Literature review of previously published case reports on gastric IHP is also presented.
증례 : 혈액종양: 남성호르몬 박탈 치료에 좋은 반응을 보인 타액선관상피암 1예
이정민 ( Jung Min Lee ),이지애 ( Ji Ae Lee ),임상윤 ( Sang Youn Lim ),김성민 ( Seong Min Kim ),이연호 ( Yeon Ho Lee ),윤진구 ( Jin Gu Yoon ),강은주 ( Eun Joo Kang ) 대한내과학회 2016 대한내과학회지 Vol.90 No.4
타액선관상피암은 진행이 빨라 다른 타액선암에 비해 예후가 불량한 종양이다. 본 증례의 경우 수술과 수술 후 동시 화학방사선 치료 및 항암화학 치료에도 반응이 없던 매우 공격적인 남성호르몬 양성 타액선관상피암이 남성호르몬 박탈 치료에 좋은 반응을 얻었다는 점에서 남성호르몬 박탈 치료가 하나의 표준요법이 될 수 있는 가능성을 확인하였기에 증례를 보고하는 바이다. Salivary duct carcinoma (SDC) is a rare, aggressive tumor. Androgen deprivation therapy (ADT) has been shown to have beneficial effects on SDC-expressing androgen receptors (ARs). A 69-year-old male with a right neck mass presented to our clinic. Computed tomography (CT) of the neck revealed a mass (6 cm diameter) on the right parotid gland, and enlarged lymph nodes. Examination of a needle biopsy sample identified SDC-expressing ARs. We performed total parotidectomy with bilateral neck dissection and concurrent postoperative chemoradiotherapy (total 66 Gy) with cisplatin (35 mg/m2), followed by another two cycles of chemotherapy (cisplatin 60 mg/m2, 5 FU 750 mg/m2). Post-treatment neck CT indicated that no residual tumor tissue remained; however, chest CT indicated recurrence in the right axilla. We initiated ADT with bicalutamide and leuprolide. Five months later, the axillar tumor tissue had almost disappeared. Our case demonstrates that ADT is effective for SDC of ARs. Therefore, clinicians should consider ADT in recurrent or metastatic SDC of ARs. (Korean J Med 2016;90:357-360)
3차병원 중환자실 내 전향적 감사와 피드백을 통한 항생제 사용 중재 효과
윤진구,최하늘,김성란,조민희,최유정,남엘리엘,성혜,노지윤,정희진,김우주,송준영 건강보험심사평가원 2023 HIRA RESEARCH Vol.3 No.2
Background: The implementation of antibiotic stewardship program (ASP) has been encouraged in developed countries in response to increasing antibiotic resistance. However, the implementation of ASP has been limited owing to a lack of manpower and awareness. We aimed to analyze the effectiveness of prospective audit and feedback (PAF), one of the core strategies in ASP, by applying it to the intensive care units (ICUs). Methods: In this study, we applied PAF to the neurological/surgical ICUs of a tertiary hospital starting from March 1, 2023, we compared the data of 6 months before (from September 2022 to February 2023) and after (from March 2023 to August 2023) the implementation to assess the difference in antimicrobial use density (AUD) and the acquisition rates of antibiotic-resistant bacteria. Furthermore, we surveyed the satisfaction of PAF using a questionnaire. PAF was conducted twice a week during rounds by the ASP team, which consisted of an infectious disease specialist and one assistant. Results: Before and after the implementation of PAF, AUD showed a tendency to decrease in the classes of beta-lactam/beta-lactamase inhibitors, cephalosporins and glycopeptides, although the changes were not statistically significant. The acquisition rate of carbapenem-resistant Acinetobacter baumannii decreased slightly in the surgical ICU. Most participating interns and residents reported that PAF was clinically and educationally helpful in the survey. Conclusion: Implementing PAF twice a week in the neurological/surgical ICUs could reduce antibiotic usage and the acquisition rates of some resistant bacteria.