노인 감염성 질환 ; 노인성 폐렴

장현하 ( Hyun Ha Chang ) 대한내과학회 2010 대한내과학회지 Vol.79 No.4

Pneumonia is the one of the 10 leading causes of overall mortality and the most common cause of infection-related death in Korea, especially in elderly patients. Streptococcus pneumoniae is the most common pathogen causing community-acquired pneumonia (CAP) in elderly patients, and gram-negative bacilli have also been reported as an important pathogen in Korea. Treatment guidelines for community-acquired pneumonia, which were published by the Joint Committee of the Korean Society for Chemotherapy, the Korean Society of Infectious Diseases, and the Korean Academy of Tuberculosis and Respiratory Diseases, are briefly presented in this article. A special consideration should be given to active preventive measures for CAP in elderly patients, especially vaccination using a seasonal influenza and pneumococcal 23-valent polysaccharide vaccine. (Korean J Med 79:346-355, 2010)

증례 : 내시경 경비 담관 배액술로 진단된 간질증 1예

하상우 ( Sang Woo Ha ),장현하 ( Hyun Ha Chang ),김신우 ( Shin Woo Kim ),이종명 ( Jong Myung Lee ),조창민 ( Chang Min Cho ),공현희 ( Hyun Hee Kong ),정동일 ( Dong Il Chung ) 대한내과학회 2007 대한내과학회지 Vol.72 No.6

저자들은 상복부 동통과 심한 호산구증다증을 보이는 환자에게서 컴퓨터 단층 촬영과 조직 생검, 그리고 내시경 역행성 담췌관 조영술을 통한 경비 담관 배액술을 시행하여 얻은 담즙에서 충란을 발견하여 간질증으로 진단하고 triclabendazole로 치료한 예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Fascioliasis is a zoonotic parasitic disease caused by Fasciola hepatica, the sheep liver fluke. Humans are accidental hosts in the life cycle of this parasite. Radiographic studies such as computerized tomography (CT) and ultrasonography are used widely for diagnosis. The abnormalities seen most commonly on a CT scan of the abdomen are multiple, small (less than 10 mm), indiscrete, hypodense lesions and microabscesses with tunnel-like branches, with frequent subcapsular locations of the lesions. A rare case of fascioliasis presenting with multi-septated hepatic cystic lesion like biliary cyst adenoma is reported. We experienced a 28-year-old woman who had epigastric pain for 5 months with severe eosinophilia and multi-septated 3.6 cm-sized hepatic cysts. We finally diagnosed the condition by identifying eggs of Fasciola hepatica from endoscopic nasobiliary drainage (ENBD) fluid. (Korean J Med 72:658-662, 2007)

증례 : 감염 ; 에이즈 환자에서 발생한 위장 카포시 육종 1예

정덕원 ( Duk Won Chung ),장현하 ( Hyun Ha Chang ),황희영 ( Hee Young Hwang ),김혜인 ( Hye In Kim ),박가영 ( Ga Young Park ),김신우 ( Shin Woo Kim ),이종명 ( Jong Myung Lee ) 대한내과학회 2009 대한내과학회지 Vol.77 No.3

AIDS 관련 카포시 육종은 AIDS 및 면역억제 장기이식 환자의 증가와 함께 이전에 비해 드물지 않게 볼 수 있는 질환으로 병기 및 환자의 임상경과에 따라 치료를 선택하게 된다. 저자들은 AIDS 환자에서 발생한 위장 카포시 육종 환자에서 항레트로바이러스 치료 및 인터페론 알파로 치료한 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Kaposi sarcoma in acquired immunodeficiency syndrome (AIDS) is rarely seen in Korea and the incidence has declined in the era of highly active antiretroviral therapy (HAART). Visceral involvement in patients having AIDS with Kaposi sarcoma is more common than in patients infected with non-human immunodeficiency virus. Visceral involvement may be asymptomatic and usually does not require specific therapy. Chemotherapy is usually used in symptomatic or rapidly progressive disease, and interferon-alpha can be applied as an alternative treatment option. Compared to cutaneous Kaposi sarcoma in AIDS, only three cases of gastrointestinal Kaposi sarcoma in patients with AIDS have been reported in Korea, and no experience with interferon therapy for AIDS-associated visceral Kaposi sarcoma has been reported. We report a case of gastrointestinal Kaposi sarcoma in a patient with AIDS who had combined treatment with interferon-alpha and HAART. (Korean J Med 77:371-376, 2009)

후천성면역결핍환자의 삶의 질 측정을 위한 한국판 WHOQOL-HIV BREF 개발

이원기,김신우,김혜인,장현하,이종명,김윤주,이미영,Lee, Won Kee,Kim, Shin-Woo,Kim, Hye-In,Chang, Hyun-Ha,Lee, Jong-Myung,Kim, Yoon-Joo,Lee, Mi-Young 한국데이터정보과학회 2014 한국데이터정보과학회지 Vol.25 No.2

세계보건협회에서 인간후천성면역결핍환자 (human immunodeficiency virus; HIV)의 삶의 질을 측정하기 위해 개발한 WHOQOL-HIV BREF (World Health Organization's quality of life - human immunodeficiency virus, brief scale)를 한국판으로 번역 개발하였다. 설문 문항은 전반적 삶의 질과 건강상태를 묻는 두 문항과 6개의 도메인을 포함한 29문항을 합하여 총 31문항으로 구성되어 있다. 자료수집은 국내 14개 병원에 내원한 220명의 인간면역결핍바이러스 양성환자를 대상으로 전문조사원이 무기명 자가 기입식으로 조사하였다. 대상자 중 남성이 202명 (91.8%), 평균 나이는 40.6세, 평균 CD4+ T 세포수는 1ml당 414.9개였다. 삶의 질은 평균 53.2점이었고 도구의 크론바흐 ${\alpha}$ 신뢰계수는 0.942였다. 동일 도구로 측정한 포르투칼의 경우 54.8점으로 유사하였으며 전반적인 삶의 질과 건강상태와의 상관관계는 각각 0.747 (p <0.01)과 0.651 (p <0.01)이었다. 한국판 도구의 내적신뢰도와 구성타당도도 만족스러웠다. 후천성면역결핍증후군과 인간면역결핍바이러스 환자의 지속적인 관찰은 필요하며 이러한 도구의 개발은 이들의 삶 삶의 질 향상에 기여할 뿐만 아니라 다른 나라 환자들과의 비교를 가능하게 해 줄 것이다. There is no known publication about assessment of quality of life (QOL) in Korean HIV patients. We aimed to assess the QOL of HIV patients. We developed Korean version of the WHOQOL-HIV BREF (short forms of WHOQOL-HIV, 31 questions with 6 domains). Survey data from 220 HIV-positive adults were obtained in 14 centers in South Korea. Male were dominant (202/220, 91.8%). Mean age was $40.6{\pm}12.1$. Mean CD4+ T-cell count was $414.9{\pm}226.6/ml$. Overall of WHOQOL-HIV BREF were $53.2{\pm}14.9$ (perfect score=100) (Cronbach's ${\alpha}$ = 0.942). It is similar score comparing to another country (Portugal: 54.75/100, measured by WHOQOL-HIV). Correlations of WHOQOL-HIV BREF score with patients' subjective QOL and with subjective satisfaction were 0.747 (p <0.01) and 0.651 (p <0.01), respectively. WHOQOL-HIV BREF have internal reliability. There is in need of monitoring for QOL of HIV patients in the clinical practice and trials. This survey tool could be used to assess the effect of intervention. Additionally, comparison across countries would be possible and promising.

감염 : 위험인자가 없는 성인에서 발생한 삼첨판 심내막염

박가영 ( Ga Young Park ),장현하 ( Hyun Ha Chang ),김신우 ( Shin Woo Kim ),김혜인 ( Hye In Kim ),권유진 ( Eu Gene Kwon ),김효훈 ( Hyo Hoon Kim ),정주영 ( Ju Young Jeong ) 대한내과학회 2012 대한내과학회지 Vol.82 No.6

우측 심내막염은 대개 정맥주사 약물 남용이나 심장 질환과 관련되어 발생하는 것으로 알려져 있으며 기저질환 없이 발생하는 경우는 매우 드물다. 저자들은 이러한 기저 질환이 없는 평소 건강하였던 25세 남자에서 발생한 양측 폐의 패혈성 색전폐렴과 우측 주 폐동맥 색전을 합병한 methicillin-sensitive Staphylococus aureus (MSSA)에 의한 삼첨판 심내막염을 진단하여 항생제 치료와 함께 삼첨판 치환술과 폐동맥 색전 제거술을 시행하여 치료한 증례를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Staphylococcus aureus is a well-known pathogen involved inright-sided endocarditis with predisposing factors, and the clinical course may be acute and rapidly progressive. Intravenous drug abuse, pacemakers or central vascular catheters, and congenital heart diseases are well-known predisposing factors. However, right-sided endocarditis as a result of S. aureus infection is very rare in patients without these predisposing factors. Here, we report the case of a previously healthy 25-year-old male with native tricuspid valve infective endocarditis by methicillin-sensitive Staphylococcus aureus, complicating multiple septic pneumonia and septic pulmonary artery thrombosis. The patient was treated with antibiotics and surgical thromboembolectomy with tricuspid valve repair.

증례 : 감염 ; 거대세포바이러스 망막염으로 발현된 Good증후군 2예

김혜인 ( Hye In Kim ),장현하 ( Hyun Ha Chang ),박가영 ( Ga Young Park ),권유진 ( Eu Gene Kwon ),김효훈 ( Hyo Hoon Kim ),김신우 ( Shin Woo Kim ),이종명 ( Jong Myung Lee ) 대한내과학회 2011 대한내과학회지 Vol.81 No.2

Good증후군은 흉선종과 면역결핍을 나타내는 질환이다. 주로 체액성 면역결핍에 의한 세균감염이 발생하며 또한 세포성 면역결핍에 의하여 바이러스나 진균, 결핵 감염을 나타내기도 한다. Good증후군의 치료는 면역글로불린 정맥 주사이다. 시력저하를 주소로 내원한 두 환자에서 공통적으로 세포성 면역결핍에 의한 거대세포바이러스 망막염으로 발현한 Good증후군을 진단하였으며 증례 1의 환자는 폐 및 연부 조직 결핵을 동반하였고, 증례 2의 경우 거대세포바이러스 폐렴을 동반하였다. 두 환자 모두 ganciclovir 정맥주사 및 면역글로불린 치료로 호전된 바 이에 저자들은 문헌고찰과 함께 보고하는 바이다. Good`s syndrome (GS) is a rare cause of acquired combined B- and T-cell immunodeficiency in adults. GS is also known as a rare form of paraneoplastic syndrome of thymoma that may persist after thymectomy. Some reported GS cases have been related to various diseases as a result of humoral immunodeficiency, but no report to date has related GS to cytomegalovirus (CMV) retinitis in Korea. We report two cases of CMV retinitis as a manifestation of GS with severe cellular immunodeficiency. In the first case, a 61-year-old woman was diagnosed with GS manifesting as CMV retinitis combined with coincident pulmonary tuberculosis and soft-tissue tuberculosis. In the second case, a 56-year-old man had CMV retinitis and CMV pneumonia. Both patients had a history of thymoma and had received total thymectomies, and were diagnosed with GS a few years thereafter. (Korean J Med2011;81:266-272)

감염 ; 감염질환 진료시 희귀의약품 사용의 현황과 개선할 점

김민정 ( Min Jung Kim ),장현하 ( Hyun Ha Chang ),진선 ( Sun Jin ),박정화 ( Jung Hwa Park ),정혜진 ( Hyejin Jung ),이혜진 ( Hye Jin Lee ),최상호 ( Sang Ho Choi ),김신우 ( Shin Woo Kim ) 대한내과학회 2015 대한내과학회지 Vol.89 No.6

Background/Aims: The aim of this study was to investigate the inconveniences and potential improvements in the use of orphan drugs for the treatment of infectious diseases, as determined by a survey of medical professionals. Methods: An email was sent twice to the members of the Korean Society for Chemotherapy, and an online survey was conducted. The data collected were analyzed in terms of the frequency of drug use and associated difficulties as well as the scope for improvement. Results: A total of 77 medical professionals participated in this survey. Rabies vaccine (n = 52), rabies immunoglobulin (n = 47), and foscarnet injection (n = 43) were supplied mainly through the Korea Orphan Drug Center (KODC), while artesunate (n = 29), quinine sulfate capsule (n = 24), quinine dihydrochloride injection (n = 23), and quinidine gluconate injection (n = 21) were supplied mainly through the National Medical Center (NMC). Difficulties in obtaining orphan drugs through the KODC were related to the KODC drug retrieval system (n = 67, 95.7% of respondents), lack of supplies on holidays (n = 66, 94.3%), complicated application procedures and documents (n = 61, 87.1%), and shipping inconveniences (n = 61, 87.1%). With regard to the use of orphan drugs supplied through the NMC, 52 participants (98.1%) responded that a staff visit should be mandatory for obtaining the drugs. Conclusions: Antivirals and antimalarial drugs are major orphan drugs used for the treatment of rare infections. It is necessary to establish a more efficient system to ensure a stable supply of orphan drugs, including on holidays, to enhance the smart drug searching system, and to simplify related administrative procedures. (Korean J Med 2015;89:675-680)

신성 저뇨산형증 환자에서 운동 후 발생한 급성 신부전증 1 예

김명재(Myung Jae Kim),장현하(Hyun Ha Chang),김희진(Hee Jin Kim),이재진(Jae Jin Lee),김진혁(Jin Hyuk Kim),이태원(Tae Won Lee),임천규(Chun Gyoo Ihm) 대한신장학회 2001 Kidney Research and Clinical Practice Vol.20 No.4

We report a case of exercise-induced acute renal failure associated with renal hypouricemia in a 35- year-old man who complained of oliguria and back pain after swimming. Laboratory tests revealed that serum blood urea nitrogen and creatinine level were elevated, the serum uric acid concentration was sub- normal(2.1 mg/dL). After conservative treatment, renal function was recovered. But, uric acid level decreased to 0.4 mg/dL. In addition, there was no supression of urate clearance to creatinine clearnace ratio(CUA/Ccr) following the administration of pyrazinamide, and no increase of CUA/Ccr, after benzbromarone. Therefore, we think the cause of renal hypouricemia in this patient may be the subtotal defect in the urate transport.

다발성 색전 폐렴을 동반한 Candida tropicalis 폐동맥 혈전증 1예

권유진 ( Eu Gene Kwon ),장현하 ( Hyun Ha Chang ),김신우 ( Shin Woo Kim ),김혜인 ( Hye In Kim ),긴효훈 ( Hyo Hoon Kim ),정주영 ( Ju Young Jeong ),정희연 ( Hee Yeon Jung ) 대한내과학회 2013 대한내과학회지 Vol.84 No.5

패혈성 폐 혈전색전증은 드문 질환으로 약물 중독자들에 흔하였으나 점차 감소하는 추세이며 중심 정맥 카테터의 사용, 인공 혈관 장치, 면역억제자와 관련성이 나타나고 있다. 저자들은 기저질환이 없는 건강한 젊은 환자에서 그라목손 음독으로 인하여 스테로이드와 cyclophosphamide 치료 후, 장기간 중심정맥 카테터를 통한 완전 정맥 영양을 시행하는 상태에서 발생한 진균혈증이 심내막염과 내안구염을 동반한 심한 다발성 색전 폐렴과 칸디다 폐동맥 혈전증을 유발하여 항진균제 치료 후 호전된 1예를 경험하여 문헌고찰과 함께 보고하는 바이다. Septic pulmonary thromboembolism resulting from fungal infection is rare. A 32-year-old woman with acute paraquat intoxication was treated with high-dose intravenous steroid and cyclophosphamide pulse therapy. She presented with a prolonged fever, dyspnea, and multiple pneumonic infiltrations. Central venous catheterization was necessary for total parenteral nutrition. The response to antibiotic therapy was disappointing and Candida tropicalis was cultured in the blood repeatedly. Vegetations were found in the superior vena cava on echocardiography and both pulmonary arteries had massive thromboembolism on computed tomography (CT). Intravenous amphotericin B and anticoagulation therapy showed improvement. When patients with central venous catheters and recurrent fungemia present with dyspnea and fever, septic pulmonary thromboembolism and other disseminated infections, such as infective endocarditis or endophthalmitis, should be kept in mind. (Korean J Med 2013; 84:759-763)

일개 상급종합병원 의료인의 감염관리 지침 준수 의도 영향요인: 계획된 행위이론을 중심으로

최영신(Choi, Young Sin),김수현(Kim, Su Hyun),장현하(Chang, Hyun Ha) 기본간호학회 2021 기본간호학회지 Vol.28 No.4

Purpose: This study aimed to identify factors affecting physicians and nurses’ intention to comply with healthcare-associated infection control guidelines, based on the theory of planned behavior. Methods: This study was a cross-sectional, descriptive survey. Data were collected using self-report questionnaires from 169 doctors and nurses at a tertiary hospital. Pearson correlation analysis and multiple regression analysis were used to analyze the factors influencing intention to comply with healthcare-associated infection control guidelines. Results: The mean score of intention to comply with infection control guidelines was 17.17±2.60 points (possible range 3-21 points). The intention to comply with infection control guidelines was positively associated with subjective norms and perceived behavioral control over compliance with healthcare-associated infection control guidelines. In the multiple regression analysis, perceived behavioral control was the only significant predictor of intention to comply with healthcare-associated infection control guidelines. Conclusion: In order to encourage doctors and nurses to comply with infection control guidelines, it is necessary to provide resources, enhance the work environment, and utilize strategies to increase perceived behavioral control over compliance with infection control guidelines.