종설 : 스타틴 치료 후에도 남아있는 심혈관계 질환의 위험성: HDL-C의 중요성

박예민 ( Yae Min Park ),고광곤 ( Kwang Kon Koh ) 대한내과학회 2011 대한내과학회지 Vol.80 No.4

Lowering low-density lipoprotein-cholesterol (LDL-C) is the primary target to prevent cardiovascular events in patients with dyslipidemia at high risk for cardiovascular disease. Many patients on statin therapy have initial or recurrent coronary heart disease events despite reductions in LDL-C. Indeed, 2/3 of patients on statin therapy suffer from residual risk. Low high-density lipoprotein- cholesterol (HDL-C) and high triglycerides levels are modifiable and important factors to resolve a residual risk. Especially, low serum levels of HDL-C (< 40 mg/dL for men, < 50 mg/dL for women) are highly prevalent and are recognized as an independent risk factor for cardiovascular morbidity (myocardial infarction, stroke, peripheral arterial disease, and restenosis after coronary stenting) and mortality. Thus, therapy focusing on raising HDL-C may be an important paradigm for treating and slowing progression of atherosclerosis, coronary heart disease, and co-morbid metabolic disorders. In this review, we discuss the importance of HDL-C based on experimental and large scaled clinical trials. (Korean J Med 2011;80:397-401)

2018 대한부정맥학회 NOAC 사용 지침: 특별한 상황에서의 약물 복용(관상동맥질환, 용량 혼동시, 심율동 전환, 뇌졸중 발생, 악성종양) 및 기타

박예민 ( Yae Min Park ),박형욱 ( Hyung Wook Park ),이정명 ( Jung Myung Lee ),박진규 ( Jin-kyu Park ),이기홍 ( Ki Hong Lee ),김진배 ( Jin-bae Kim ),이영수 ( Young Soo Lee ),정보영 ( Boyoung Joung ) 대한내과학회 2019 대한내과학회지 Vol.94 No.1

Non-vitamin K antagonist oral anticoagulants (NOACs) are an alternative to vitamin K antagonists (VKAs) and have emerged as the treatment of choice in Korea. However, several questions remain regarding the optimal use of these agents in specific clinical situations. In this paper we discuss 1) patients with atrial fibrillation (AF) and coronary artery disease, 2) avoiding confusion with NOAC dosing across indications, 3) cardioversion in a patient treated with a NOAC, 4) AF patients who present with acute stroke while on NOACs, 5) NOACs in special situations, 6) anticoagulation in AF patients with a malignancy, and 7) optimizing VKA dose adjustments. (Korean J Med 2019;94:57-82)

2018 대한부정맥학회 심방세동 환자의 통합적 관리 지침

박준범 ( Junbeom Park ),정보영 ( Boyoung Joung ),김준 ( Jun Kim ),김진배 ( Jin-bae Kim ),박형욱 ( Hyung Wook Park ),박예민 ( Yae Min Park ),엄재선 ( Jae-sun Uhm ),안진희 ( Jinhee Ahn ),이대인 ( Dae In Lee ),김준수 ( June Soo Kim 대한내과학회 2018 대한내과학회지 Vol.93 No.4

Atrial fibrillation (AF) is the most common form of sustained arrhythmia in elderly patients. However, AF is often detected during health screening, or accidentally during testing for other diseases; some patients lack clinical symptoms. Nevertheless, AF increases the incidence of ischemic stroke and other thrombotic events, and compromises cardiovascular prognosis in terms of heart failure, dementia, and hospitalization. Therefore, initial AF management should be performed at the point of primary care, not only in specialized medical centers. We wish to propose a five-step management protocol for AF. We review the evidence supporting integrated management by primary care physicians new to AF, and by specialized physicians who often diagnose and manage AF. Further, we also outline a structured goal-based follow-up protocol; this is an important part of integrated management. (Korean J Med 2018;93:336-343)

가천의대 길병원에서 진단된 폐암 환자의 임상적 특성

신동복 ( Dong Bok Shin ),조은경 ( Eun Kyung Cho ),이재훈 ( Jae Hoon Lee ),박예민 ( Yae Min Park ),김명건 ( Myeong Gun Kim ),원인식 ( In Sik Won ),김유진 ( Yu Jin Kim ),경선영 ( Sun Young Kyung ),이상표 ( Sang Pyo Lee ),이재익 ( Ja 대한내과학회 2010 대한내과학회지 Vol.78 No.2

Background/Aims: This study examined the clinical characteristics of patients with lung cancer who were diagnosed at the Gachon University of Medicine and Science Gil Hospital from January 2006 to December 2008. Methods: The lung cancer data were downloaded from the hospital medical information system using cancer registration information. The patient clinical characteristics were analyzed retrospectively. Results: A total of 713 patients were diagnosed with lung cancer. Their median age was 69 years, 78.1% were over 60 years old, and 73.1% and 58.2% were men and smokers, respectively. Adenocarcinoma (32.7%) was the most common histologic type, followed by squamous carcinoma (25.9%), unclassifiable non-small-cell lung cancer (NSCLC) (17.3%), and small-cell carcinoma (SCLC) (15.0%). In the NSCLC group, the stage at diagnosis was IA (1.5%), IB (5.6%), ⅡA (1.3%), ⅡB (4.3%), IIIA (5.4%), ⅢB (23.1%), Ⅳ (47.7%), and unknown (11.1%). In the SCLC group, 20.6% of the patients were in the limited stage, 76.6% were in the extensive stage, and 2.8% were unknown. The patients were treated by surgery (9.8%), concurrent chemoradiotherapy (6.7%), radiotherapy only (5.9%), chemotherapy (32.4%), or best supportive care only (29.7%). The median overall survival was 15.3 months (95% CI, 11.5~19.1). The median survival based on histology was adenocarcinoma (35.0 months), squamous (13.5 months), NSCLC (14.2 months), and SCLC (11.8 months) (p=0.0445). Conclusions: Adenocarcinoma was the most common histologic type at our institute. Most patients were over 60 years of age (78.1%) and had stage Ⅲ/Ⅳ (76.3%) cancer. The survival of patients with adenocarcinoma was longer than that for the other histological types. (Korean J Med 78:215-221, 2010)

2021 대한부정맥학회 심방세동 환자의 특수 임상 상황 환자군에서 ABC Pathway 치료 지침

황유미 ( You Mi Hwang ),임홍의 ( Hong Euy Lim ),이대인 ( Dae In Lee ),유희태 ( Hee Tae Yu ),박예민 ( Yae Min Park ),정보영 ( Boyoung Joung ) 대한내과학회 2021 대한내과학회지 Vol.96 No.4

Optimized management of atrial fibrillation requires patient-oriented decision making with a multidisciplinary approach. This report incorporates recent authoritative studies to provide detailed recommendations for managing atrial fibrillation in specific clinical settings. The principles of the Atrial fibrillation Better Care (ABC) pathway apply in these clinical settings. In addition, specific considerations are discussed for each of these conditions and populations. (Korean J Med 2021;96:264-295)

뇌농양으로 나타난 중추신경계 방선균증 1예

박예민,원인식,김주일,조현정,서종구,김진용,김은영,박상희,박윤수,서일혜,조용균 대한감염학회 2009 감염과 화학요법 Vol.41 No.4

Actinomyces normally colonizes the mouth, colon, and vagina. Although disruption of mucosa may lead to infection at virtually any site, central nervous system actinomycosis is rare. A 45-year-old man presented with seizure and magnetic resonance imaging showed brain abscess. He was diagnosed with actinomycotic and streptococcal infection of brain by histologic and microbiologic examination. After stereotactic aspiration and biopsy, he was treated successfully by prolonged antibiotic therapy using intravenous penicillin-G and oral amoxicillin.

淪落女性들의 性病 管理 實態

박정한,예민해,도숙희,송선우 慶北大學校 醫科大學 1984 慶北醫大誌 Vol.25 No.2

1982년 8월초부터 1983년 9월말까지 대구시내 모 보건소에 등록된 윤락여성 192명과 1983년 1월초부터 9월말까지 보건증 발급 및 경신을 위해 등록한 유흥업소 종업원(다방, 술집, 전문음식점)에 대한 정기검진 실태와 임질과 매독의 감염상태를 분석한 결과 다음과 같은 성적을 얻었다. 윤락여성들의 연령분포는 20세에서 38세로 20세-24가 59.5%로 가장 많았다. 정기검진 수진율은 78.1%였으며, 평균 관찰기간은 10개월이었고 한사람이 평균 관찰기간 동안에 일어난 감염횟수는 6.3회였다. 임균성 및 비임균성 질 감염율은 평균 13.5%였고, 이 중 65%가 임균에 의한 감염이었으며 연령의 증가에 따라 감염율은 감소했다. 감염과 감염간의 간격은 평균 8.7주였다. 월별 감염율은 10월에서 2월 사이가 14.2%∼16.7%로 3월에서 9월사이의 10.6%∼14.0%보다 높은 감염율을 보였다. 보건소의 일차치료에 불응한 자는 11.2%였고 2주이상 지속적으로 낫지 않는 경우는 치료받은 자의 30.4%였다. 감염율이 낮은 집단과 높은 집단의 특성을 비교하면 저 감염균은 고 감염군보다 나이가 많고, 고객수가 적었으며 종사기간도 길었다. 자가예방법은 고감염군이 76%, 그리고 저 감염군이 78% 실시하고 있었으며, 항생제 복용 또는 주사를 가장 많이 사용하고 있었다. 업종별 질 감염율은 윤락여성이 13.5%, 다방종업원 6.2%, 술집종업원 5.2%, 그리고 전문음식점 종업원 5.0%로 윤락여성이 타업종 종사자에 비해 높았다(P<0.01). VDRL 양성율에서도 윤락여성이 9.8%로 타업종 종사자의 1.9%와 1.7%에 비해 높았다(P<0.01). 처음 등록하는 사람들이 임균성감염율이 17.7%로 등록되어 정기검진을 받는 윤락여성들의 8.8%보다 높은 감염율을 보여 미등록 상태에서 매음행위를 하는 사람들에 대한 대책이 요구되고 있으며 또한 이와같은 차이는 정기적인 성병검진의 효과일 것으로 생각된다. To assess the impact of V.D. control program of prostitutes on the prevalence of gonococcal and non-gonococcal infections and syphilis, the health records of 192 prostitutes registered at a health center of Taegu City and followed at the V.D. clinic of the center for more than six months between August 1982 and September 1983 were reviewed. The compliance rate of the prostitutes to the weekly routine vaginal culture and smear was 79.8%. The average infection rate for the study period was 13.5% and 65% of the these i.e., 8.8%, were gonococcal infections and the rest were non-gonococcal infections. The vaginal infection rate decreased with the age from 15.0% in 20-24 years group to 6.9% in 35-39 years group. The vaginal infection rate of the registered prostitutes was significantly higher (P<0.01) than that of the the waitresses of tea room (6.2%), bar (5.2%) and restaurant (5.0%). However, the infection rate was much lower compared with the non-registered prostitutes in the same area whose gonococcal infection rate was 17.7% at the first routine test for registration. VDRL positive rate of the registered prostitutes was higher(9.8%) than non-registered prostitutes (3.1%) and waitresses of tea room (1.9%) and bar (1.7%). The study results suggested that V.D. control program of the prostitutes significantly curtailed the gonococcal infection rate. To reduce the infection rate of the prostitutes and their contacts further an administrative measure to keep the non-registered prostitutes and infected registered prostitutes out of business should be established and sensitivity of the cultured organism to antibiotics should be periodically tested, if not routinely, to monitor the surge of resistant organism to the primary regimen of the health center.

정상면역환자에서 발생한 매독성 포도막염 1예

원인식,박예민,조현정,김형수,서종구,김진용,남동흔,박윤수,서일혜,조용균 대한감염학회 2009 감염과 화학요법 Vol.41 No.4

Syphilis is re-emerging worldwide due to the HIV epidemic. Prior to the introduction of penicillin, syphilis was the second most common primary cause of all cases of uveitis. Today, ocular syphilis is a rare disease, especially in an immunocompetent patient. Variable manifestation without pathognomonic signs of ocular syphilis often lead to delayed diagnosis, resulted in irreversibile loss of vision. In Korea, syphilitic uveitis has not been reported in an immunocompetent patient since 1984. We experienced a case of syphilitic uveitis in an immunocompetent man with visual deterioration. As the incidence of syphilis is increasing in these days, a high degree of clinical suspicion should be considered in patients with unexplained ocular inflammation and visual disturbances.