일개 대학병원에서 경험한 방선균증의 임상상

정숙인,김연숙,기현균,김춘관,김신우,이혁,김성민,백경란,송재훈 대한화학요법학회 1999 대한화학요법학회지 Vol.17 No.3

배경 : 방선균증은 혐기성의 그람양성 간균에 의한 만성 화농성 감염으로, 경안면부, 흉부, 복부, 골반부 등을 주로 침범한다. 최근 구강 위생의 향상과 항생제의 사용으로 인해 방선균증의 빈도의 감소와 함께 그 임상양상 또한 크게 변화하였다. 저자들은 국내에서의 방선균증의 임상상을 분석하기 위해 본 연구를 시행하였다. 방법 : 1995년 5월부터 1998년 9월까지 삼성서울병원에서 방선균증으로 진단받은 환자를 대상으로 임상기록지를 토대로 감염병소와 임상경과 등을 후향적으로 조사하였다. 결과 : 방선균증 환자는 모두 12명으로 경안면부 1례, 흉부 3례, 복부 3례, 골반부 5례였다. 임상양상은 주로 종괴의 형태로 나타나 진단을 내리기까지 종양과의 감별에 어려웠으며 진단은 모두 조직검사나 흡인액에서 유황과립을 확인함으로써 이루어졌다. 방선균증으로 진단된 환자는 모두 호전소견을 보였다. 결론 : 국내에서도 방선균증이 드물지 않게 발생하고 있으며 임상양상이 다양하여 가장 많이 오진되는 질환 중의 하나이다. 방선균증은 조직검사나 균배양검사를 통해 진단하고 항생제를 통해 완치될 수 있는 질환이므로 환자 진단에 관심을 가지면 불필요한 수술을 피할 수 있을 것으로 생각된다. Background: Actinomycosis is an indolent, slowly progressive bacterial infection, caused by Actinomyces. a gram-positive, non-spore-forming anaerobic or microaerophilic rod. Actinomycosis affects nearly every organ and body site. The disease is classically divided into four types, depending on the anatomic sites involved: cervicofacial, thoracic, abdominal, and pelvic. It has been considered as a rare disease, and only several cases have been reported in Korea. We performed this study to analyse the clinical manifestations of actinomycosis in Korea. Method: We retrospectively reviewed the medical records of patients with actinomycosis at the Samsung Medical Center from May 1995 to December 1998. Results: During the study period, actinomycosis was diagnosed in 12 patients: 1 patient had cervicofacial lesion, 3 thoracic, 3 abdominal, and 5 pelvic. The male and female ratio was 1 : 2 and the mean age was 47.2 years. Sulfur granule was observed in the pathologic specimens from all cases, but organism did not grow at all. It was very difficult to differentiate actinomycosis from tumorous conditions without pathologic diagnosis. All patients were clinically improved with antibiotics or surgical procedures. Conclusion: Actinomycosis is not a rare disease nowadays and has various clinical manifestations. It can be diagnosed by pathologic examination or culture and cured by antibiotics without surgical management.

항암화학요법 중 호중구감소증이 발생한 저위험군 발열 환자들을 대상으로 한 경구 항균제 요법의 임상적 유용성 및 안정성에 대한 연구

김연숙,이혁,기현균,김춘관,김신우,김성민,백경란,김원석,윤성수,이홍기,강원기,박찬형,박근칠,송재훈 대한화학요법학회 2000 대한화학요법학회지 Vol.18 No.1

목적 : 항암화학요법 중 호중구감소증을 동반한 발열이 발생하는 암환자들을 치료하기 위한 다양한 항균제와 여러 가지 방법들이 시도되고 있는 가운데, 합병증과 사망률의 발생가능성이 적은 저위험군 환자들을 대상으로 초기 72시간동안 정주 항균제를 투여한 이후 경구 항균제로 전환하는 요법의 유용성과 안정성을 평가해보고자 본 연구를 시행하였다. 방법 : 1998년 2월부터 1999년 9월까지 본원에서 항암화학요법 중 호중구감소증과 발열이 발생한 환자들 가운데 기저 암질환이 고형암이거나 림프종이고, 입원당시 패혈증의 증후가 없으며 입원 72시간이내에 해열되고 백혈구수치가 증가 추세인 환자들을 대상으로 하여 72시간 동안 정주 항균제를 투여한 이후 경우 ciprofloxacin 750㎎을 하루 2회씩 투여하여 총 4일간 투여하였다. 모든 환자들은 열이 떨어지고 호중구감소증이 회복될 때까지 입원하도록 하였다. 결과 : 총 38명 환자의 40예가 등록이 되었고, 환자들의 기저암 질환은 고형함이 72.5%, 림프종이 27.5%였다. 입원당시 평균 호중구치수는 156/㎕였고, 호중구수치가 100/㎕미만인 경우는 65%였으며, 호중구감소증이 지속된 기간의 평균은 2.4일이었다. 40예 중 39예가 항균제의 변형이나 추가 없이 호중구감소증과 발열로부터 회복이 되어 97.5%의 성공율(95% 신뢰구간: 86.8-99.9%)을 보였다. 부작용으로 피부발진이 있었던 경우가 한 예 있었는데, 증상이 경하여 경구 항균제를 지속할 수 있었다. 심와부의 동통으로 복용을 지속할 수 없어서 대상에서 제외된 예가 또 한 예 있었다. 결론 : 항암요법 중 호중구감소증과 발열을 동반한 환자들 가운데 저위험군 환자들에서 항균제 72시간정주 이후 경구 항균제로의 전환요법은 효과적이고도 안전한 치료방법이라고 할 수 있다. Background : Oral antibiotic therapy following empirical intravenous antibiotics may be effective and safe for febrile neutropenic patients with lowrisk for complications. Methods : We conducted a prospective clinical trial of oral antibiotic therapy in the patients with neutropenia and fever during chemotherapy for cancer. Underlying malignancies were solid tumor or lymphoma with short duration of neurtropenia and the patients had no evidence of clinically or microbiologically documented infections. Oral ciprofloxacin was given to the patients who lacked signs of sepsis on admission, had a rising tendency of neutrophil count (ANC >100 /㎕ ) at 72 hours, and were afebrile at 72 hours. All patients were hospitalized until neutropenia and fever resolved. Results : A total of 40 episodes of 38 patients were enrolled from February 1998 to September 1999. The mean neutrophil counts on admission were 156/㎕ and the mean duration of neutropenia was 2.4 days. The episodes which had neutrophil count below 100 /㎕ were 26 (65%). Treatment was successful in 39 of 40 episodes (97.5% : 95 % confidence interval, 86.8% to 99.9%). Adverse reactions of oral ciprofloxacin were skin rash and epigastric soreness in two cases, respectively. There were no deaths during the study. Conclusions : For low-risk febrile patients with neutropenia during cancer chemotherapy, switch therapy to oral ciprofloxacin at 72 hours following intravenous broad-spectrum antibiotics is effective and safe,

조직학적 진단된 chronic necrotizing pulmonary aspergillosis 2예

김연숙,정숙인,기현균,김춘관,김신우,한정호,김성민,백경란,송재훈 대한화학요법학회 2000 대한화학요법학회지 Vol.18 No.1

CNPA는 기존의 폐질환 및 폐절제술로 인해 국소방어기전에 저하가 있거나 비특이적 전신면역상태저하를 갖고 있는 환자들에게서 주로 발생하는 만성적인 공동성 폐질환이다. 현재까지 우리나라에서는 CNPA의 보고가 없는 상태이고, 저자들은 최근 조직학적으로 진단된 CNPA 2예를 경험하였기에 보고하는 바이다. 저자들이 경험한 CNPA 환자들은 만성알코올 중독 및 기관지확장증과 같은 기저질환과 폐절제술을 받은 병력이 있었다. Aspergillus가 폐실질을 침윤하고 있는 조직소견과 조직배양에서 Aspergillus가 검출되어 조직학적 진단이 가능하였고, amphotericin B의 정주요법 및 경구 itraconazole 투여와 폐절제술 등으로 성공적으로 치료되었다. 아직 많은 임상의들에게는 낯선 질환인 CNPA의 치료성적은 환자의 동반질환 및 CNPA 자체의 중증도, 진단과 치료 시작의 지연 등에 의해 크게 좌우되므로 만성적으로 진행하는 공동성 폐병변을 갖고 있는 환자에게서 CNPA를 감별하는 것이 중요하다. Chronic necrotizing pulmonary aspergillosis (CNPA) is a chronic cavitary form of pulmonary aspergillosis. Dozens of CNPA cases have been reported in patients with systemic immunologic dysfunction or altered local defense mechanism from preexisting pulmonary disease. Review of literatures revealed that no CNPA cases have been reported in Korea yet. We experienced two cases of CNPA proven by lung biopsy. A 53-year-old alcoholic male in poor nutritional state was admitted with generalized weakness and weight loss. Chest CT revealed a cavitary nodule surrounded with ground-glass attenuation. CT-guided fine needle aspiration and biopsy was done. The biopsy specimen demonstrated dichotomously branching septated hyphae consistent with those of Aspergillus sp. Another case was a 39-year-old man with bronchiectasis who was admitted with persistent hemoptysis. He had a past history of pulmonary tuberculosis. A parahilar lesion with intracavitary soft tissue mass was incidentally detected in high-resolution GT. Left lingular segmentectomy was done due to uncontrolled hemoptysis and CNPA was histologically diagnosed. Both patients were successfully treated with intravenous amphotericin B followed by oral itraconazole. Even though CNPA is unfamiliar to most clinicians, it should be included in differential diagnoses of chronic progressive cavitary pulmonary lesion, especially in patients with immunologic dysfunction.

Pichia ohmeri에 의한 악성외이도염 1예

손준성,신상엽,민태훈,장현하,정숙인,오원섭,김성민,백경란,송재훈 대한감염학회 2002 감염 Vol.34 No.5

Perception of Long-Term Oxygen Therapy for Chronic Lung Diseases May Affect Poor Adherence in Korea

Hyun-Kyung Lee, M.D., Ph.D.,Hyo Jin Kim, M.D.,Hongyeul Lee, M.D.,Ji Young Yang, M.D.,Jae Ha Lee, M.D.,Seung Won Ra, M.D., Ph.D.,SungMin Hong, M.D.,Ho Young Lee, M.D.,Sung Hyun Kim, M.D.,Mi-Yeong Kim, 대한결핵및호흡기학회 2024 Tuberculosis and Respiratory Diseases Vol.87 No.1

Background: Long-term oxygen therapy (LTOT) improves the survival of patients withhypoxemia due to chronic respiratory diseases. The clinical outcomes of LTOT arestrongly associated with patient adherence. To improve the adherence of patients,physicians have focused on the efficacy of LTOT. However, poor adherence may stemfrom patients’ perceptions of LTOT. Herein we evaluated patients’ perceptions of LTOTaffecting adherence. Methods: We conducted a cross-sectional survey study using descriptive, open, andclosed-ended questionnaire. Patients using oxygen therapy (OT) or requiring it butavoiding OT responded to the questionnaires at three university hospitals. Results: Seventy-nine patients responded to the questionnaires. The number of patientsusing home and portable OT was 69 (93%) and 37 (46.3%), respectively. Patientswith good adherence were 22 (30.1%). Among patients with good adherence, 90.9%used oxygen according to physicians’ prescriptions whereas only 37.3% of those withpoor adherence followed physicians’ prescriptions (p<0.01). The reasons for avoidingusing home OT were fear of permanent use (50%), unwanted attention (40%), and lackof symptoms (40%). They avoided portable OT because of unwanted attention (39%),heaviness (31.7%), and lack of symptoms (21.6%). Conclusion: Patients on LTOT had the perception of the misunderstanding the effectsof OT and of psychosocial barriers to initiate or use LTOT. Considering these findings,health professionals need to provide effective education on the purpose of LTOT toimprove patient adherence to OT and provide sufficient support for the management ofpsychosocial barriers in patients using LTOT.

Production of bio-based cadaverine by engineered strains of C. glutamicum expressing heterologous lysine decarboxylases

Sungmin HYUN,Taeuk KANG,Kyounghee KANG,Mijeong GWON,Solhee JUNG,Younghoon OH,Heetaek KIM,Bongkeun SONG,Sijae PARK,Kyoungmun PARK,Jeongchan JOO 한국생물공학회 2016 한국생물공학회 학술대회 Vol.2016 No.4

Production of 5-Aminovaleric Acid by Metabolically Engineered Corynebacterium Glutamicum From Lignocellulosic Feedstock

Sungmin HYUN,Young Hoon OH,Tae Uk KANG,Kyoung-Hee KANG,Hee Taek KIM,Bong Keun SonG,Kyungmoon PARK,Ju-Hyun YU,Si Jae PARK,Jeong Chan JOO 한국생물공학회 2017 한국생물공학회 학술대회 Vol.2017 No.4

우주감시레이다에 대한 지구 대기권 영향 분석 연구

문현욱(Hyun-Wook Moon),최은정(Eun-Jung Choi),이종현(Jonghyun Lee),염재명(Jaemeung Yeum),권세웅(Sewoong Kwon),홍성민(Sungmin Hong),조성기(Sungki Cho),박장현(Jang-Hyun Park),조중현(Jung Hyun Jo) 한국전자파학회 2018 한국전자파학회논문지 Vol.29 No.8

본 논문에서는 우주감시레이다에 대한 지구 대기권 영향을 분석하기 위해 대기 굴절에 의한 고도 오차 및 주파수별 전리층 시간 지연에 의한 거리 오차를 레이다 고각에 따라 도출하였다. 이를 위해 국내 기상관측소 측정 데이터를 이용하여 지역별/계절별 특성을 고려한 전파 굴절도 프로파일을 모델링하고, 광선추적법을 이용하여 전파 굴절에 의한 고도오차를 도출했으며, 주파수에 따른 전리층 거리 오차를 도출하였다. 또한, 해외 우주감시레이다 및 국내 제안된 우주감시레이다를 토대로 레이다 오차 특성에 따른 레이다 설계 고려사항에 대해 알아보았다. 따라서 이러한 지구 대기권에 의한 우주감시레이다 오차 특성 분석은 향후 우주감시레이다 설계 시 레이다 위치, 레이다 조향 범위 및 주파수 선정에 활용될 수 있을 것으로 기대된다. In this study, both the altitude error due to the refraction and the range error due to the delay in the ionosphere with respect to the frequency are extracted according to the radar elevation to analyze the effect of atmosphere on the space surveillance radar. To achieve this, the radio refractivity profile is modeled using the measured data from domestic weather stations. Then, the altitude-error due to the refraction is extracted using the ray tracing method, and the range error in the ionosphere is extracted according to the frequency. Further, considerations for radar design with respect to the radar error characteristics are discussed based on the abroad space surveillance radar and proposed domestic space surveillance radar. This analysis of the error characteristics is expected to be utilized for the determination of radar location, range of steering, and frequency in the space surveillance radar design.

Histamine H1 receptor induces cytosolic calcium increase and aquaporin translocation in human salivary gland cells.

Kim, Ji-Hyun,Park, Seong-Hae,Moon, Young Wha,Hwang, Sungmin,Kim, Donghoon,Jo, Su-Hyun,Oh, Seog Bae,Kim, Joong Soo,Jahng, Jeong Won,Lee, Jong-Ho,Lee, Sung Joong,Choi, Se-Young,Park, Kyungpyo Williams Wilkins 2009 The Journal of pharmacology and experimental thera Vol.330 No.2

<P>One of the common side effects of antihistamine medicines is xerostomia (dry mouth). The current consensus is that antihistamine-induced xerostomia comes from an antimuscarinic effect. Although the effect of antihistamines on salivary secretion is both obvious and significant, the cellular mechanism whereby this happens is still unclear because of the lack of knowledge of histamine signaling in human salivary glands. Here, we have studied histamine receptors and the effect of antihistamines on human submandibular acinar cells. In primary cultured human submandibular gland and a HSG cell line, histamine increased the intracellular Ca(2+) concentration. The histamine-induced cytosolic free Ca(2+) concentration ([Ca(2+)](i)) increase was inhibited by histamine H1 receptor-specific antagonists, and the expression of the functional histamine H1 receptor was confirmed by reverse transcription-polymerase chain reaction. Interestingly, histamine pretreatment did not inhibit a subsequent carbachol-induced [Ca(2+)](i) rise without 'heterologous desensitization.' Chlorpheniramine inhibited a carbachol-induced [Ca(2+)](i) increase at a 100-fold greater concentration than histamine receptor antagonism, whereas astemizole and cetrizine showed more than 1000-fold difference, which in part explains the xerostomia-inducing potency among the antihistamines. Notably, histamine resulted in translocation of aquaporin-5 to the plasma membrane in human submandibular gland cells and green fluorescent protein-tagged aquaporin-5 expressing HSG cells. We found that histidine decarboxylase and the histamine H1 receptor are broadly distributed in submandibular gland cells, whereas choline acetyltransferase is localized only at the parasympathetic terminals. Our results suggest that human salivary gland cells express histamine H1 receptors and histamine-synthesizing enzymes, revealing the cellular mechanism of antihistamine-induced xerostomia.</P>

Clinical Characteristics and Risk Factors for Mortality in Critical Coronavirus Disease 2019 Patients 50 Years of Age or Younger During the Delta Wave: Comparison With Patients > 50 Years in Korea

Shi Hye Jin,Nham Eliel,Kim Bomi,Joo Eun-Jeong,Cheong Hae Suk,Hong Shin Hee,Hyun Miri,Kim Hyun ah,Jang Sukbin,Rhee Ji-Young,Kim Jungok,Kim Sungmin,Cho Hyun Kyu,Wi Yu Mi,Cheon Shinhye,Kim Yeon-Sook,Lim 대한의학회 2022 Journal of Korean medical science Vol.37 No.22

Background: Numerous patients around the globe are dying from coronavirus disease 2019 (COVID-19). While age is a known risk factor, risk analysis in the young generation is lacking. The present study aimed to evaluate the clinical features and mortality risk factors in younger patients (≤ 50 years) with a critical case of COVID-19 in comparison with those among older patients (> 50 years) in Korea. Methods: We analyzed the data of adult patients only in critical condition (requiring high flow nasal cannula oxygen therapy or higher respiratory support) hospitalized with PCR confirmed COVID-19 at 11 hospitals in Korea from July 1, 2021 to November 30, 2021 when the delta variant was a dominant strain. Patients’ electronic medical records were reviewed to identify clinical characteristics. Results: During the study period, 448 patients were enrolled. One hundred and forty-two were aged 50 years or younger (the younger group), while 306 were above 50 years of age (the older group). The most common pre-existing conditions in the younger group were diabetes mellitus and hypertension, and 69.7% of the patients had a body mass index (BMI) > 25 kg/m2 . Of 142 younger patients, 31 of 142 patients (21.8%, 19 women) did not have these pre-existing conditions. The overall case fatality rate among severity cases was 21.0%, and it differed according to age: 5.6% (n = 8/142) in the younger group, 28.1% in the older group, and 38% in the ≥ 65 years group. Age (odds ratio [OR], 7.902; 95% confidence interval [CI], 2.754–18.181), mechanical ventilation therapy (OR, 17.233; 95% CI, 8.439–35.192), highest creatinine > 1.5 mg/dL (OR, 17.631; 95% CI, 8.321–37.357), and combined blood stream infection (OR, 7.092; 95% CI, 1.061–18.181) were identified as independent predictors of mortality in total patients. Similar patterns were observed in age-specific analyses, but most results were statistically insignificant in multivariate analysis due to the low number of deaths in the younger group. The full vaccination rate was very low among study population (13.6%), and only three patients were fully vaccinated, with none of the patients who died having been fully vaccinated in the younger group. Seven of eight patients who died had a pre-existing condition or were obese (BMI > 25 kg/m2 ), and the one remaining patient died from a secondary infection. Conclusion: About 22% of the patients in the young critical group did not have an underlying disease or obesity, but the rate of obesity (BMI > 25 kg/m2 ) was high, with a fatality rate of 5.6%. The full vaccination rate was extremely low compared to the general population of the same age group, showing that non-vaccination has a grave impact on the progression of COVID-19 to a critical condition. The findings of this study highlight the need for measures to prevent critical progression of COVID-19, such as vaccinations and targeting young adults especially having risk factors.