췌담관 폐쇄를 유발한 췌장 결핵과 대장암을 동반한 대장결핵 1예

황래석,남승우,이성은,권낙현,강효성,김성훈,남기석,홍경득,함세운,전영웅,박세혁,진성찬,안혜선 대한소화기내시경학회 2007 Clinical Endoscopy Vol.35 No.4

Systemic manifestation of tuberculosis is common, but tuberculous biliary obstruction of the pancreas and a colon adenocarcinoma with combined colonic tuberculosis is an uncommon disorder. We encountered a case of the above condition in 63-year-old male that was admitted to our hospital because of fever, diffuse abdominal pain and rigidity. Abdominal computed tomography showed biliary and pancreatic duct dilatation with left colonic wall thickening and surrounding peritoneal infiltration. Emergency segmental resection of the descending colon with intraoperative T-tube choledochostomy was performed due to the colon mass and biliary obstruction. A colonofiberoscopy was performed for low abdominal pain and hematochezia at 12 days after surgery. It showed multiple colonic ulcerations with a partial stricture. A colonic biopsy showed granulomatous inflammation with acid-fast bacilli. The cause of the biliary obstruction was also revealed as pancreatic tuberculosis by an intraoperative pancreatic and mesenteric biopsy. The patient improved after antituberculous treatment and the patient has been in good health until the last outpatient follow-up visit. (Korean J Gastrointest Endosc 2007;35:267-271) 췌장 실질 내 결핵은 결핵 유병률이 높은 우리나라에서도 복강 내 다른 장기의 결핵과는 달리 드문 질환이며 췌장 결핵이 췌담관 폐쇄를 유발하는 경우는 특히 드문 경우이다. 이와 함께 동시에 같은 환자에서 대장암과 장출혈을 동반한 대장 결핵의 예는 국내에 보고된 바가 없다. 저자들은 담췌관 폐쇄로 췌장암이 의심되는 환자에서 췌장 및 대장 결핵과 함께 대장암이 동반된 1예를 경험하였기에 보고하는 바이다.

3차 의료기관에 입원한 노숙자환자에서 감염질환의 유병율

함세운,남기석,노혜진,홍경득,황래석,방지환,신형식 대한감염학회 2007 Infection and Chemotherapy Vol.39 No.4

Background : Despite the expected high prevalence of several infectious diseases among the homeless, a majority of them have not received screening test and early treatment. Materials and Methods : The subjects of this study were 269 homeless patients who had been hospitalized in the National Medical Center (Korea) between January 2002 and August 2004. Their medical histories and records were reviewed to analyze the prevalence and clinical characteristics of hepatitis B and C, syphilis, tuberculosis and HIV infection among them. Results : The entire 269 homeless patients being hospitalized during the period of this study consist of 249 male patients and 19 female patients. For the prevalence of infectious diseases, HBV was seen in 15 of 228 patients (6.6%); HCV in 8 of 113 patients (7.1%); VDRL positive in 25 of 234 patients (10.7 %); HIV antibody positive in 2 of 130 (1.5%); and tuberculosis in 19 of 269 (7.1%). The number of patients who had the antibody to hepatitis B was 118 (51.7%). Of 28 patients hospitalized with the chief complaints of liver diseases and/or their complications, the number of cases infected with hepatitis B and C viruses was only 5 (17.9%). On the other hand, for patients with tuberculosis, 13 of 19 cases (68.4%) were hospitalized with the chief complaints associated with symptoms of pulmonary tuberculosis or enlarged lymph nodes. The number of patients with multiple infectious diseases was 9 in total. Conclusion : As expected, the prevalence of some infectious diseases were higher among the homeless inpatients, than non-homeless population. Proper screening tests in order to determine the presence of any infectious diseases among the patients and protect involved medical staff are necessary. Further, the government should take proactive measures to prevent the spread of infectious diseases in the aspect of public health. 목 적 : 3차 의료기관에서 입원치료를 받았던 노숙자를 대상으로 감염성 질환의 유병율을 알아보고자 하였다. 재료 및 방법 : 2002년 1월부터 2004년 8월 사이에 국립의료원에서 입원 치료를 받았던 269명의 노숙자 환자들을 대상으로 의무기록을 조사하였다. 결 과 : 연구 기간동안 입원치료를 받은 총 269명의 노숙자 환자 중 남자가 249명(92.9%), 여자가 19명(7.1%)이었다. 감염질환의 유병율은 B형 간염이 228명 중 15명(6.6 %), C형 간염 113명 중 8명(7.1%), 결핵은 269명중 19명(7.1%), VDRL 양성인 경우는 234명 중 25명(10.7%), 항 사람면역결핍바이러스항체 양성은 130명중 2명(1.5%)이었다. B형 간염표면항원에 대한 항체 형성자는 118명(51.7 %), 항체 미형성자는 95명(41.7%)이었다. 결핵으로 진단된 19명 중 객담도말 및 배양검사와 조직검사로 확인된 경우가 14명, 균음성이나 임상적으로 의심되는 경우가 5명이었다. 간질환 및 관련된 합병증으로 입원한 환자 28명 중 B형 및 C형 간염바이러스에 관련된 경우는 5명(17.9%)에 불과하였고 결핵은 19명중 13명(68.4%)이 폐결핵 및 림프절종대의 증상으로 입원치료를 받았다. 복합 감염의 경우는 총 9명이었는데 후천면역결핍증후군 환자였던 2명중 1명이 결핵에 이환되어 있으면서 VDRL 양성소견을 보였고 다른 1명이 HIV와 결핵의 동시감염이었다. 결 론 : 노숙자 입원환자에서 결핵, C형 간염 및 매독의 유병율이 일반 인구에 비해 높았다. 노숙자환자를 담당하는 의료인력를 보호하고 환자의 감염질환 유무를 파악하기 위해 적절한 선별검사가 필요하며 감염질환의 확산을 방지하기 위한 정부의 적극적인 대책이 필요하다.

해외여행자의 Atovaquone-proguanil 순응도

권낙현,강효성,박태수,김성훈,황래석,노혜진,방지환,김재윤,신형식 대한감염학회 2008 Infection and Chemotherapy Vol.40 No.5

Background : Recently, many Korean people travel abroad where malaria is prevalent. However, in Korea, relatively little is known about compliance of chemoprophylaxis against malaria. This study was performed to determine the factors influencing compliance of chemoprophylaxis against malaria in Korean travelers. Materials and Methods : Face to face interview, telephone interview and e-mail correspondence were performed to 241 people who were prescribed with atovaquone-proguanil at the international travelers' clinic of National Medical Center between February 2007 and October 2007. Results : Total of 55 people out of 235 reported one or more events of adverse reactions after chemoprophylaxis (total 76 events). However, in 38 adverse events the link between chemoprophylaxis and adverse events were very weak. Compliance of malaria chemoprophylaxis with atovaquone-proguanil was 53.9% in the study group. The predictive factors for non-compliance were package tour, travel of business affair and young age group. Conclusions : Compliance of malaria chemoprophylaxis in Korea travelers was low compared with Dutch and French studies. More efforts to increase compliance are needed, especially in travelers on package tour, business travel and people under age 40. Background : Recently, many Korean people travel abroad where malaria is prevalent. However, in Korea, relatively little is known about compliance of chemoprophylaxis against malaria. This study was performed to determine the factors influencing compliance of chemoprophylaxis against malaria in Korean travelers. Materials and Methods : Face to face interview, telephone interview and e-mail correspondence were performed to 241 people who were prescribed with atovaquone-proguanil at the international travelers' clinic of National Medical Center between February 2007 and October 2007. Results : Total of 55 people out of 235 reported one or more events of adverse reactions after chemoprophylaxis (total 76 events). However, in 38 adverse events the link between chemoprophylaxis and adverse events were very weak. Compliance of malaria chemoprophylaxis with atovaquone-proguanil was 53.9% in the study group. The predictive factors for non-compliance were package tour, travel of business affair and young age group. Conclusions : Compliance of malaria chemoprophylaxis in Korea travelers was low compared with Dutch and French studies. More efforts to increase compliance are needed, especially in travelers on package tour, business travel and people under age 40.

60세 이후에 처음 시작한 혈액 투석 환자의 임상적 특징과 예후

김성훈,전용덕,권낙현,황래석,강효성,남기석 대한노인병학회 2008 Annals of geriatric medicine and research Vol.12 No.2

Background: Observation on the hemodialysis treatment; whether there are any different effects on mortality rate, side effects, or effectiveness of the treatment depending on patients‘ age. Methods: Chronic renal failure patients who started hemodialysis treatment between 2002 and 2003 were separated in two groups, 33 patients of 60 and older and 76 patients under 60. We investigated mortality rate difference, A-V shunt re-operation, and total protein and albumin level. Also, comparing and analyzing the urea reduction ratio, we examined whether effectiveness is different depending on the patients’ age. Results: The 3 year survivor rate of patients who initially started hemodialysis treatment over 60 was 66.7%, and that of the patients under 60 resulted as 73.1%. The average total protein lefel for over 60 was 6.48 g/dL and for under 60 was 6.80 g/dL, and albumin for over 60 was 3.15 g/dL and under 60 was 3.46 g/dL. We identified that the patients who repeated shunt operation in over 60 group was 4 (12%) and in under 60 group was 4 (5.2%). Effectiveness of the treatment, Urea Reduction Ratio (URR), for both groups was 71%. Conclusion: The 3 year survivor rate of patients who initially started hemodialysis treatment over 60 was lower than the control group, but considering the remaining life expectancy, it seems to be no significant difference between the groups; and the treatment effectiveness was same in both groups.

포스터 전시 : 기타 ; Cyanoacrylate 및 Lipiodol에 의한 위정맥류 경화요법 후 발생한 폐색전증 1예

남기석,홍경득,함세운,노혜진,황래석,남승우,남궁은경,진성찬 대한소화기학회 2006 대한소화기학회 추계학술대회 Vol.2006 No.-

해외여행자의 Atovaquone-proguanil 순응도

권낙현,박태수,강효성,김성훈,황래석,노혜진,방지환,김재윤,신형식 대한감염학회 2008 감염과 화학요법 Vol.40 No.5

Background : Recently many Korean people travel abroad where malaria is prevalent. However, in Korea relatively little is known about compliance of chemoprophylaxis against malaria. This study was performed to determine the factors influencing compliance of chemoprophylaxis against malaria in Korean travelers. Materials and Methods : Face to face interview, telephone interview and e-mail correspondence were performed to 241 people who were prescribed with atovaquone-proguanil at the international travelers' clinic of National Medical Center between February 2007 and October 2007. Results : Total of 55 people out of 235 reported one or more events of adverse reactions after chemoprophylaxis (total 76 events). However, in 38 adverse events the link between chemoprophylaxis and adverse events were very weak. Compliance of malaria chemoprophylaxis with atovaquone-proguanil was 53.9% in the study group. The predictive factors for non-compliance were package tour, travel of business affair and young age group. Conclusions : Compliance of malaria chemoprophylaxis in Korea travelers was low compared with Dutch and French studies. More efforts to increase compliance are needed, especially in travelers on package tour, business travel and people under age 40.

3차 의료기관에 입원한 노숙환자에서 감염질환의 유병율

함세운,남기석,노혜진,홍경득,황래석,방지환,신형식 대한감염학회 2007 감염과 화학요법 Vol.39 No.4

목적 : 3차 의료기관에서 입원치료를 받았던 노숙자를 대상으로 감염성 질환의 유병율을 알아보고자 하였다. 재료 및 방법 : 2002년 1월부터 2004년 8월 사이에 국립의료원에서 입원 치료를 받았던 269명의 노숙자 환자들을 대상으로 의무기록을 조사하였다. 결과 : 연구 기간동안 입원치료를 받은 총 269명의 노숙자 환자 중 남자가 249명(92.9%), 여자가 19명(7.1%)이었다. 감염질환의 유병율은 B형 간염이 228명 중 15명(6.6%), C형 간염 113명 중 8명(7.1%), 결핵은 269명중 19명(7.1%), VDRL 양성인 경우는 234명 중 25명(10.7%), 항사람면역결핍바이러스항체 양성은 130명중 2명(1.5%)이었다. B형 간염표면항원에 대한 항체 형성자는 118명(51.7%), 항체 미형성자는 95명(41.7%)이었다. 결핵으로 진단된 19명 중 객담도말 및 배양검사와 조직검사로 확인된 경우가 14명, 균음성이나 임상적으로 의심되는 경우가 5명이었다. 간질환 및 관련된 합병증으로 입원한 환자 28명 중 B형 및 C형 간염바이러스에 관련된 경우는 5명(17.9%)에불과하였고 결핵은 19명중 13명(68.4%)이 폐결핵 및 림프절종대의 증상으로 입원치료를 받았다. 복합 감염의 경우는 총 9명이었는데 후천면역결핍증후군 환자였던 2명중 1명이 결핵에 이환되어 있으면서 VDRL 양성소견을 보였고 다른 1명이 HIV와 결핵의 동시감염이었다. 결론 : 노숙자 입원환자에서 결핵, C형 간염 및 매독의 유병율이 일반 인구에 비해 높았다. 노숙자환자를 담당하는 의료인력를 보호하고 환자의 감염질환 유무를 파악하기 위해 적절한 선별검사가 필요하며 감염질환의 확산을 방지하기 위한 정부의 적극적인 대책이 필요하다. Background : Despite the expected high prevalence of several infectious diseases among the homeless, a majority of them have not received screening test and early treatment. Materials and Methods : The subjects of this study were 269 homeless patients who had been hospitalized in the National Medical Center (Korea) between January 2002 and August 2004. Their medical histories and records were reviewed to analyze the prevalence and clinical characteristics of hepatitis B and C, syphilis, tuberculosis and HIV infection among them. Results : The entire 269 homeless patients being hospitalized during the period of this study consist of 249 male patients and 19 female patients. For the prevalence of infectious diseases, HBV was seen in 15 of 228 patients (6.6%); HCV in 8 of 113 patients (7.1%); VDRL positive in 25 of 234 patients (10.7 %); HIV antibody positive in 2 of 130 (1.5%); and tuberculosis in 19 of 269 (7.1%). The number of patients who had the antibody to hepatitis B was 118 (51.7%). Of 28 patients hospitalized with the chief complaints of liver diseases and/or their complications, the number of cases infected with hepatitis B and C viruses was only 5 (17.9%). On the other hand, for patients with tuberculosis, 13 of 19 cases (68.4%) were hospitalized with the chief complaints associated with symptoms of pulmonary tuberculosis or enlarged lymph nodes. The number of patients with multiple infectious diseases was 9 in total. Conclusion : As expected, the prevalence of some infectious diseases were higher among the homeless inpatients, than non-homeless population. Proper screening tests in order to determine the presence of any infectious diseases among the patients and protect involved medical staff are necessary. Further, the government should take proactive measures to prevent the spread of infectious diseases in the aspect of public health.