최근 9 년간 ( 1987 - 1995 ) Salmonella 감염증의 변화양상과 항균제 감수성의 변화

장상필(Sang Pil Chang),이상호(Sang Ho Lee),김구엽(Koo Yeop Kim),서환조(Hwan Jo Suh) 대한내과학회 1998 대한내과학회지 Vol.54 No.1

N/A Objectives: Salmonellosis is one of the most common bacterial infections in the Korea. The incidence of salmonellosis has changed dramatically. The incidence of typhoid fever tends to decrease as environmental & personal sanitations improve, whereas that of nontyphoid salmonellae have markedly increased. Antimicrobial resistance is increasing in Salmonella strains. Increasing emergence in multiple-drug resistant. Sallmonella strains has important clinical & public implications for populations at risk and the treatment of invasive salmonellosis is complicated by the increasing resistance among Sallmonella strains to commonly used antimicrobial agents. This study is performed to fine out the pattern and the antimicrobial susceptibility of isolated Sallmonella strains and the clinical charateristics of Salmonella infection. Methods : We reviewed medical records of all patients with culture-confirmed Salmonella infection in Kyung Hee University Hospital for the period January 1987 through December 1995. Results: 1) The mean age of the patients was 31.0 years and the ratio of male to female was 1.03: 1 2) The frequency of isolation of specific serogroups is ordered as followings : serogroup B(47.9%), serogroup D(23.3%), S. typhi(16.2%), serogroup C (9.6%), serogroup E(l.8%), serogroup A(1.2%), 3) The sites of isolation were as follows: stool (68.6%), blood(24.0%), pus(3.5%), urine(2.2%), bone marrow(2.2%), bile juice(0.4%), ascites(0.4%), CSF (0.2%), sputum(0.2%). 4) The isolation rate of resistant strains of specific serogroups was as follows in order : serogroup B(52.4%), serogroup C(33.3%), serogroup E (25%), serogroup D(9.8%), S. typhi(4.2%). serogoup A(0%). 5) The frequency of animicrobial resistance in Salmonella strains to tested 8 antimicrobial agents was as follows: ampicillin(28.8%), carbenicillin(28.1%), chloramphenicol(16.4%), kanamycin(5.9%), trimethoprim-sulfamethoxazole(5.3%), cephalothin(2.3%), gentamicin(0.9%), amikacin(0.5%). 6) The most of antimicrobial-resistant Salmonella (95.0% of resistant strains) has multiple drug resistance. 7) The frequency of clinical manifestations of nontyphoid sa1monellosis was as follows: enterocolitis(80.1%), bacteremia without focal infection (13.1%), focal infection(6.8%). 8) The clinical variables statistically significant between resistant and sensitive Salmonella infection are frequency of bacteremia and duration of admission. Conclusion: Different serogroups of Sallmonella isolates reveal the different frequency & pattern in antimicrobial resistance. The frequency of antimicrobial resistance for Salmonella isolates is markely increased during recent 9 years. In preparation for the future outbreaks of multiresistant sallmonellosis, nationwide studies should be carried out periodically to monitor effectively trends in the antimicrobial resistance of Salmonella and the development of effective and practical alternative therapy for resistant salmonellosis is clearly needed.

사람의 혈관간세포에서 고농도의 당에 의한 Monocyte Chemoattractant Protein-1(MCP-1) 의 발현 및 신호 전달 체계에 관한 연구

장상필(Sang Pil Chang),김청수(Choung Soo Kim),김명재(Myung Jae Kim),김순배(Soon Bae Kim),이상구(Sang Koo Lee),박정식(Jung Sik Park) 대한신장학회 2001 Kidney Research and Clinical Practice Vol.20 No.4

Infiltration of circulating monocytes into glomeruli has been implicated in the pathogenesis of glomerular injury in many human and experimental forms of glomerulonephritis. Monocyte chemoattractant pro- tein-l(MCP-l), a potent chemokine with considerable specificity for monocytes, can be up-regulated by various cytokines and growth factors in mesangial cells. Glomerular infiltration of monocytes has been reported in diabetic nephropathy as well. However, effect of high glucose on MCP-1 expression in hu- man mesangial cells has not been known well. We investigated the effect of high glucose on MCP-1 expression and its signal transduction pathway. Human mesangial cells were conditioned with glucose(5-60 mM) or mannitol chronically for up to 5 days. Expression of MCP-1 mRNA and protein was measured by Northern blot analysis and ELISA respectively. To examine the role of transcription factor AP- 1 or NF-κB, electrophoretic mobility shift assay(EMSA) was performed. Glucose induced MCP-1 mRNA expression in a time and dose dependent manner. MCP-1 protein in cell culture supemant was also increased. Equivalent concentrations of mannitol had no significant effect. EMSA revealed that glucose increased the AP-1 binding activity in a time and dose dependent manner but not NF-B. Inhibitor of AP-1, curcumin(7.5- 15 pM) dose dependently suppressed the induction of MCP-1 mRNA by high glucose. Tyrosine kinase inhibitors such as genistein(12.5-50 μM) and herbimycin A(0.1-1 μM) inhibited the high glucose-induced IvlCP-1 mRNA expression in a dose dependent manner and also suppressed the high glucose-induced AP-1 binding activity. In summary, high glucose induces mesangial MCP-1 expression partly via tyrosine kinase-AP-1 pathway.

신장이식 후 나타난 Parvovirus B19 감염에 의한 순수적혈구형성부전증 1 예

최상호(Sang Ho Choi),장상필(Sang Pil Chang),원종철(Jong Chul Won),이준승(Jun Seung Lee),양원석(Won Seok Yang),지현숙(Hyun Sook Chi),박수길(Su Kil Park) 대한신장학회 2001 Kidney Research and Clinical Practice Vol.20 No.4

We report an unexplained anemia that persisted for 4 months in a renal transplant patient who was receiving immunosuppression therapy that included prednisolone, tacrolimus, and azathioprine. A bone marrow biopsy demonstrated pure erythroid hypoplasia and occasional giant pronormoblasts with intranuclear inclusions, characteristic of a parvovirus B19 infection. Both the serum and bone marrow cells were positive for a parvovirus B19 DNA polymerase chain reaction. The anemia resolved 6 weeks after the administration of IV immunoglobuln. But, 4 months later, refractory anemia developed and persisted despite treatment with IV immunoglobulin. However, the patient showed rapid improvement after tacrolimus was switched to cyclosporin A. A parvovirus B19 infection should be included in the differential diagnosis of renal transplant recipients who present with an anemia associated with low reticulocytes, and clinicians should be awared that tacrolimus m;iy impair the clearance of a parvovirus B19 infection.

허혈성 심장질환을 동반한 말기신부전 환자에서 관상동맥 스텐트 시술과 우회로 이식술의 임상성적

이준승(Joon Seung Lee),장재원(Jai Weon Chang),이미숙(Mee Sook Lee),장상필(Sang Pil Chang),박성욱(Seong Wook Park),이철환(Cheol Whan Lee),송현(Hyun Song),박정식(Jung Sik Park) 대한신장학회 2001 Kidney Research and Clinical Practice Vol.20 No.2

N/A The purpose of this study was firstly, to evaluate the efficacy of coronary stenting in ESRD patients compared with non uremic patients and secondly, to compare the perioperative mortality of coronary artery bypass grafting(CABG) in ESRD patients with that in non-uremic patients exhibiting a similar degree of left ventricular function. We examined the clinical restenosis of coronary stenting and 30 day mortality rate after CABG in this retrospective, casecontrolled study. The case histories of twenty-five ESRD patients with ischemic heart disease(IHD) and twenty-five non-uremic IHD patients matched for age, sex, ejection fraction and number of implanted stents, who had undergone first, elective, primarily successful coronary stenting were reviewed. The case of histories of another sixteen ESRD patients with IHD and sixteen non-uremic IHD patients matched for age, sex, ejection fraction and number of grafted vessels, who had undergone first elective CABG were also reviewed. Clinical restenosis developed in nine of the twenty-five ESRD patients and in eight of the twenty-five non-uremic patients after coronary stenting within follow up periods of 16.9±14.5 months and 17.6±14.6 months, respectively. There was no significant difference in the cumulative clinical restenosis free curves between the two groups(p=0.79). Three out of sixteen for the ESRD patients and one out of sixteen for the non-uremic patients died in 30 days after CABG, follow up periods being 11.3±9.6 months and 11.1±8.9 months, respectively. The perioperative mortality did not differ between the two groups(p=0.28). We conclude that coronary stenting in ESRD patients is as effective as in non-uremic patients regarding initial coronary revascularization and perioperative mortality rate of CABG in ESRD patients is not significantly higher compared with non-uremic patients when Left ventricular function is matched.

만성신부전과 B 형 간염에 의한 간경화가 동반되었던 혼자에서의 간 - 신장 동시 이식 2 예

김유미(Yu Mi Kim),이윤정(Yun Jeong Lee),이준승(Joon Seung Lee),장상필(Sang Pil Chang),박종하(Jong Ha Park),김은경(Eun Kyung Kim),정성희(Sung Hee Jung),이영상(Yung Sang Lee),박수길(Su Kil Park),한덕종(Duck Jong Han),이승규(Seung Gyu L 대한신장학회 2001 Kidney Research and Clinical Practice Vol.20 No.1

We here report two cases of combined liver-kidney transplantation in patients with both end stage renal disease and hepatitis B related liver cirrhosis. The first case was a 55-year-old man with hepatitis B related liver cirrhosis and chronic renal failure, who received cadaveric liver and kidney transplantation. Immunosuppressants were cyclosporine, prednisolone, and mycophenolate mofetil. Clinical course was uneventful except for hemolytic anemia due to alloimmunization that occurs after ABO- mismatched solid organ transplantation. Hemoglobin level became stable after plasmapheresis. His renal and hepatic function is maintained up to the present time. The second case was a 42-year-old rnan with nephrotic syndrome and liver cirrhosis. The patient underwent living related-combined liver-kidney tran- splantation. Donors were his son and brother. Blood type of the patient and donors were identical and the result of HLA crossmatch was negative. On the 14th postoperative day, stenosis at anastomotic site of hepatic artery was detected. After balloon angioplasty hepatic function was normalized. At 8 months after the transplantation, the patient is stable without adverse events.

특발성 원섬유성 사구체신염 (Fibrillary Glomerulonephritis)

김지훈(Ji Hoon Kim),정해혁(Hae Hyuk Jung),박정식(Jung Sik Park),이상구(Sang Koo Lee),유은실(Eun Sil Yu),장상필(Sang Pil Chang),이준승(Joon Seung Lee),정재걸(Jae Gul Chung) 대한신장학회 2000 Kidney Research and Clinical Practice Vol.19 No.3

A 17-year-old girl was admitted to our hospital due to mild generalized edema. Laboratory tests revealed a serum creatinine was 0.7mg/dL, protein/ albumin 6.7/3.5g/dL, cholesterol 190mg/dL, hemoglobin 10.0g/dL, and 24 hour urinary protein 4,40mg/day. Chest X-ray and renal ultrasound were normal. There were no clinical or serologic evidences of para-proteinemia, cryoglobulinemia, light chain disease or systemic lupus erythematosus. Renal biopsy showed membranoproliferative glomerulonephritis-like pattern with lobular accentuation, hypercellularity and diffuse GBM thickening by light microscope. Congo red stain-ing was negative. Granular IgG and C3 deposits were found along the glomerular capillary wall and mesangium by immunofluorescence microscope. Ultrastruc-turally, abundant subendothelial and mesangial fibril- lary deposits were found associated with thickening and wrinkling of GBM. These fibrils, measured about 20-30nm in diameter, were nonbranching and ran- domly arranged without either periodicity or an organized structure. These findings were compatible with those of fibrillary glomerulonephritis. Thus we report a case of idiopathic fibrillary glomerulonephritis, which is a rare cause of nephrotic syndrome.

이식신에서 발견된 IgA신병증의 임상적 중요성과 예후인자

김지훈(Ji Hoon Kim),정해혁(Hae Hyuk Jung),박정식(Jung Sik Park),유은실(Eun Sil Yu),김순배(Soon Bae Kim),박수길(Su Kil Park),박종하(Jong Ha Park),장상필(Sang Pil Chang),이미숙(Mee Sook Lee),정재걸(Jae Gul Chung) 대한신장학회 2000 Kidney Research and Clinical Practice Vol.19 No.2

N/A Recently IgA nephropathy(IgAN) in transplanted kidney have been reported a more grave prognosis of the disease, which account for progressive allograft loss as 12-16%. But, the studies for the clinical significance and the prognostic factors of IgAN developed in transplanted kidney were not sufficient. We analyzed the frequency and the prognostic factors of IgAN developed in patients who underwent Kidney transplantation(KT) between January 1990 and Octo-ber 1998. Total 231 renal biopsies was done. IgAN was diagnosed in 31 cases, and it was 13.4% of total cases and 24.4% of cases that acute rejection(AR) were excluded. After the 3 patients of IgAN was excluded due to combined AR, 28 patients were followed. The allograft dysfunction, which defined as serum creatinine at last follow-up was above 2.0 mg/dL, was observed in 10 patients(35.7%) and 4 patients(14.3%) of them had graft failure and restarted hemodialysis. The serum crcatinine and creatinine clearance at renal biopsy were significantly correlated with allograft dysfunction, also interstitial fibrosis, tubular atrophy and vascular fibrous intima1 thickening showed similar correlation with prognosis. In conclusion, when allograft dysfunction was developed, IgAN in transplanted kidney should be considered and if the evidences of elevated serurn creatinine and decresed creatinine clearence at biopsy, severe interstitial fibrosis and tubular atrophy, severe vascular fibrous intimal thickening were present, more closer follow-up and careful treatment should be taken.

지속성 외래 복막 투석 환자에서 C반응단백과 관상동맥 질환과 사망률

장상필,박정식,김유미,박종하,김순배,정세라,이준승,유지숙,홍창기 대한신장학회 2000 Kidney Research and Clinical Practice Vol.19 No.6

Background: Atherosclerotic vascular disease is major cause of morbidity and mortality in dialysis patients. C-reactive protein(CRP) as a marker of inflammation appears to be clinically useful in prediction of coronary heart disease and mortality. This study is designed to test whether plasma concentration of CRP correlates with coronary heart disease and mortality in CAPD patients. Methods: A total of l37 end-stage-renal disease patients undergoing CAPD were included. The measurement of baseline CRP and stress thallium SPECT were performed in all patients. Patients were followed prospectively from initiation of dialysis to June 1999 for analysis of survival rate and cause of death. Coronary angiography performed in 16 of 32 patients showed all positive results. Results: 32 patients showed positive results in thallium SPECT. The baseline CRP concentration were higher among patients with positive results in thallium SPECT than those with negative results(1.05g/L vs 1.30mg/dL, p$lt;0.001). The survival rate was significantly lower in lower CRP group than higher CRP group (44months vs 26 months, p$lt;0.001). However, There was no difference in cause of death according to serum CRP level. Death from cardiac cause is significantly higher among patients with positive thallium SPECT than negative results. The most common cause of death are, in descending order of frequency, cardiac disease including acute MI, sepsis, cerebrovascular disease. Conclusion: The baseline level of inflammation as assessed by the plasma concentration of CRP independently predicts the risk of coronary heart disease and survival in CAPD patients.

골다공증 진단을 위한 Osteosone을 이용한 정상인의 피부 두께 측정

이동근,장상필,김덕윤,김영설,최영길 최신의학사 1997 最新醫學 Vol.40 No.7

부적절한 예방화학요법 후 지연 발현된 Plasmodium vivax 말라리아 1 예

최수철,장상필,김상화,서환조,서진태,김구엽 대한내과학회 1998 대한내과학회지 Vol.54 No.3

Malaria is the world's most important parasitic infection. Although it has been erw5cated from temperate zones including Korea, increasing numbers of travellers visit tropical malarious countries and imported malaria becomes important medical problem in the developed countries. In Korea with increasing travellers to malaria-endemic area, the incidence of imported malaria shows rising tendency same as the developed countries. It becomes important to personal general personal protective measures and chemoprophylaxis to trevellers, when employed in appropriate manner, that can be highly effective in preventing malaria. We recently experienced a case of in Plasmodium vivax malaria with delayed manifestations due to inadequate chemoprophylaxis. A 53-year-old woman with history of trevel to East Africa 4 months ago and chief complaint of fever was diagnosed as tertian malaria. She had irregularly taken prophylatic antimalarial during travel and had not taken it after return but should have taken it at least 4 weeks after return.