성인 지역사회 폐렴의 원인 미생물에 대한 전향적 다기관 연구 : Legionella, Leptospira, Hantaan virus and Orientia tsutsugamushi

김민자,정희진,손장욱,심희선,박대원,박승철,우준희,강재명,김유겸,신완식,김양리,이환종,김지희 대한감염학회 2001 감염 Vol.33 No.1

Background : Despite rigorous investigations, the etiology of community-acquired pneumonia remains unknown in about 50% of hospitalized patients. The diagnosis of the etiological agent is becoming more challenging and more critical as number of newer pathogens have been recognized in recent years. In the 3-year period prospective study we investigated adult patients with community-acquired pneumonia for Legionella, Leptospira, Hantaan virus and Orientia tsutsugamushi as potential etiologic agents. Methods : A prospective multicenter study was performed from May 1997 to April 2000. A total of 431 patients with community-acquired pneumonia under the inclusion criteria were examined for specific microbial diagnosis; sputum culture and PCR, and serologic teats including indirect immunofluorescence antibody (IFA) test for Legionella, and hemagglutination tests for Leptosoira, Hantaan virus and O. tsutsugamushi. Etiologic diagnosis was determined on the basis of the review of case record forms and specific laboratory diagnostic criteria. Results : During the study period a total of 385 sputum and 283 serum samples were examined. Legionella pneumonia was diagnosed in 2.3% (10/431) of the cases examined : 1.4% cases with PCR-positive (5/367) and 2.1% with positive IFA test (6/283). Leptospirosis and scrub typhus were diagnosed in 0.4% (1/252) and 2.0% (5/252), respectively. All 5 cases with scrub typhus occurred in late fall, and rash or eschar was not found. None of cases was Hantaan virus infection. Conclusion : The results suggest that Legionella, Leptospira, and O. tsutsugamushi should be considered in the etiologic diagnosis and empirical antibiotic therapy of community-acquired pneumonia. (Korean J Infect Dis 32:24∼31, 2001)

정신분열증 환자에서 주관적 음성증상경험의 임상적 의의

김지웅,김찬형,구민성,손석한,박진철,최문종,이은철,윤도준,이홍식 대한신경정신의학회 1999 신경정신의학 Vol.38 No.1

연구목적 : 현재까지 정신분열증의 음성증상평가는 주로 객관적인 평가에만 의존해왔기 때문에, 환자들이 주관적으로 직접 경험하는 음성증상의 평가는 경시된 경향이 있었다. 그러나 실제 많은 정신분열증 환자들은 음성증상을 자가하고 있다. 특히, 개관적인 양성 및 음성증상이 관찰되지 않는 경우에도 환자 본인은 음성증상으로 괴로워한다는 이전의 연구보고들이 있었다. 따라서 저자들은 주관적인 음성증상경험과 개관적인 양성증상 및 음성 증상, 우울증상, 불안증상, 추세외로증상과의 상관성을 알아봄으로써 정신분열증의 정신병리에 있어 주관적 음성증상의 존재를 규명하고, 정신분열증 정신병리의 발생기전을 유추해보며 이차적 음성증상과의 관계를 규명하고자 하였으며. 이러한 연구가 정신분열증 정신병리를 이해하는데 도움을 줄 수 있을 뿐 아니라 환자를 공감적으로 이해하는데 도움을 줄 수 있을 것으로 생각되어 본 연구를 시행하였다. 방 법 : DSM-Ⅳ 진단기준의 정신분열증 진단기준에 해당하는 환자를 대상으로 하였다. 주관적인 음성증상의 평가를 위해서 Scale for the Subjective Experience of Negative Symptoms : Korean version(KSENS)을 이용하였고, 개관적인 정신분열증 정신병리의 평가는 Positive and Negative Syndrome Scale(PNASS)를 이용하였다. 우울증상, 불안증상, 추세외로증상의 평가를 위해서 각각 Hamilton Rating Scale for Depression(HAM-D), Hamilton Rating Scale for Anxiety(HAM-A), Extrapyramidal Symptoms Rating Scale(ESRS)을 이용하였다. 각 정신병리척도 점수간의 상관성은 Spearman 상관계수를 이용하여 분석하였다. 결 과 : K-SENS 24항목 중에서 환자가 이를 불편한 것으로 경험하고 있는 항목의 비율과 PANSS 양성척도점수 사이에는 유의한 상관점이 있었으며 (r=-0.40, p〈0.05), 양성증상 중에서도 특히 과대성(r=-0.46, p〈0.05), 의심/피해(r=-0.34, p〈0.05), 적개심(r=-0.52, p〈0.05) 등의 증상과 유의한 상관관계를 보였다. K-SENS 24 항목 중에서 환자가 이를 불편한 것으로 경험하고 있는 항목의 비율과 PANSS 전체점수(r=-0.25, p〉0.05), PANSS 음성척도점수(r=-0.20, p〉0.05), PANSS 일반정신병리척도(r=-0.08, p〉0.05),와는 각각 유의한 상관성이 없었다. K-SENS 24항목 중에서 환자가 이를 불편한 것으로 경험하고 있는 항목의 비율과 HAM-D 점수(r=-0.01, p〉0.05), HAM-A 점수(r=-0.11, p〉0.05), ESRS 총점(r=0.34, p〉0.05)은 각각 유의한 상관성이 없었다. 결 론 : 본 연구결과에서, 정신분열증 환자들이 불편한 것으로 경험하는 주관적 음성증상과 과대성, 의심/피해, 적개심 같은 양성증상은 역상관관계가 있었으며, 이러한 결과를 바탕으로 양성증상이 주관적으로 불편하게 느끼는 음성증상에 대한 가능성과, 혹은 양성증상이 심할 경우, 이에 압도되어 음성증상을 주관적으로 느끼지 못할 수 있다는 가능성이 시사되었으며, 향후 종적인 연구를 통해 이를 규명해 볼 필요성이 제시되었다. 주관적인 음성증상경험과 우울증상, 불안증상, 추세외로 증상과는 상관성이 없는 것으로 나타나서 이들 증상과는 독립적인 증상임을 시사한다. Objective : Since the evaluation of negative symptoms has depended on the clinician's objective observation, the patients subjective experience of negative symptoms has been neglected. However, in fact, a lot of patients are aware of their negative symptoms. There are several reported suggesting that patients suffer from the subjective experiences of their deficit symptoms, even though the objective positive and negative symptoms cannot be observed. Under these circumstances, we have attempted this study with the idea that it would be helpful in understanding the psychopathology of schizophrenia. Also it would help clarifying the relationship between subjective experience of negative symptoms and objectives positive and negative symptoms, depression anxiety symptoms, and extrapyramidal symptoms. Method : All the 37 patients satisfied the diagnostic criteria of DSM-Ⅵ for schizophrenia. The subjective experiences of negative symptoms were evaluated using Scale for the Subjective Experience of Negative Symptoms : Korean version(KSENS), and for the depression, anxiety, extrapyramidal symptoms, we used Hamilton Rating Scale for Depression(HAM-D), Hamilton Rating Scale for Anxiety(HAM-A), and Extrapyramidal Symptoms Rating Scale(ESRS). The correlation between each psychopathology was tested by calculating Spearman correlation coefficient. Results : There was a significant correlation between the ratio of items experienced as uncomfortable symptoms among 24 items of K-SENS, and the score of PANSS positive subscale(γ=-0.40, p〈0.05), Among the positive symptoms, grandiosity(γ=-0.46, p〈0.05), suspiciousnes/persecution(γ=-0.34, p〈0.05), and hostility(γ=-0.52, p〈0.05) showed a significant correlation with the ratio of items experienced as uncomfortable symptoms among 24 items of K-SENS. There was no significant correlation between the ratio of items experienced as uncomfortable symptoms among 24 items of K-SENS, and PANSS total score(γ=-0.25, p〉0.05), or negative subscale score(γ=-0.20, p〉0.05), or general psychology subscale score(γ=-0.08, p〉0.05), respectively. There was no significant correlation between ratio of items experienced as uncomfortable symptoms among 24 items of K-SENS, and HAM-D(γ=-0.01, p〉0.05), or HAM-A(γ=-0.11, p〉0.05), ESRS(γ=0.34, p〉0.05), respectively. Conclusion : These revealed that the negative correlation between the subjective negative symptoms experienced as an uncomfortable ones and the objective symptoms such as grandiosity, suspiciousness/persecution, and hostility. From these results, the possibility that positive symptoms are used as a defense to hide from the negative symptoms because they are overwhelmed by their positive symptoms, is suggested. These results also suggest that subjective experiences of negative symptoms are independent from depression, anxiety and extrapyramidal symptoms.

특발성 과호산구 증후군 환자의 치료 도중 발생한 간혈종 1례

이영태,김동기,박지훈,김윤정,김기향,박보민,권민정,김애란,이원식,주영돈,손창학 白中央醫療院 2005 仁濟醫學 Vol.26 No.1

Idiopathic hypereosinophilic syndrome is characterized by marked elevation of eosinophil count ( >1,500/㎣) in peripheral blood without explaining etiology. It shows tissue involvement in many organs such as liver, G-I tract, myocar dium, lung, skin, kidney and nerve. Some case of hypereosinophilic syndrome with hepatic involvement have been reported, but not much. We have recently experienced a case with idiopathic hypereosinophilic syndrome of a 40 year old man who presented with RUQ pain. By abdominal CT, ill- defined subcapsular hematoma was detected. Liver biopsy showed eosinophilic infiltration within the portal tract and sinusoid. Drain procedure and corticosteroid adminiiatbrought marked improvement of clinical manifestation, hematologic abnormality and radiologic abnormality.

Factors Influencing the Acrylamide Content of Fried Potato Products

Jin, Yong-Ik,Park, Kyeong-Hun,Chang, Dong-Chil,Cho, Ji-Hong,Cho, Kwang-Su,Im, Ju-Sung,Hong, Su-Young,Kim, Su-Jeong,Nam, Jung-Hwan,Sohn, Hwang-Bae,Yu, Hong-Seob,Chung, Ill-Min The Korean Society of Environmental Agriculture 2016 한국환경농학회지 Vol.35 No.4

BACKGROUND: Acrylamide (CAS No. 79-06-1) is known to be a carcinogenic compound, and is classified as a Group 2A compound by the International Agency for Research on Cancer (IARC, 1994). Acrylamide can be generated during the browning process via the non-enzymatic Maillard reaction of carbohydrates such as reducing sugars and of amino acids such as asparagine, both of which occur at a temperature above $120^{\circ}C$. Potato tubers contain reducing sugars, and thus, this will affect the safety of processed potato products such as potato chips and French fries. In order to reduce the level of acrylamide in potato processed products, it is therefore necessary to understand factors that affect the reducing sugar content of potatoes, such as environmental factors and potato storage conditions, as well as understanding factors affecting acrylamide formation during potato processing itself. METHODS AND RESULTS: Potatoes were cultivated in eight regions of Korea; For each of these different environments, soil physico-chemical characteristics such as pH, electrical conductivity, total nitrogen, available phosphate, and exchangeable cation content were measured and correlations with potato reducing sugar content and potato chip acrylamide levels were examined. The reducing sugar content in potato during storage for three months was determined and acrylamide level in potato chip was analyzed after processing. The storage temperature levels were $4^{\circ}C$, $8^{\circ}C$, or $10^{\circ}C$, respectively. The acrylamide content of chips prepared from potatoes stored at $10^{\circ}C$ or $20^{\circ}C$ for one month was analyzed and the different frying times were 2, 3, 5, and 7 min. CONCLUSION: This study showed that monitoring and controlling the phosphate content within a potato field should be sufficient to avoid producing brown or black potato chips. For potatoes stored at low temperatures, a reconditioning period ($20^{\circ}C$ for 20 days) is required in order to reduce the levels of reducing sugars in the potato and subsequently reduce the acrylamide and improve chip coloration and appearance.

한국 정상인에서 연령에 따른 뇌혈류분포와 혈류예비능의 변화 : Tc-99m HMPAO SPECT 에 의한 연구

문대혁,이희경,송호천,이재태,범희승,손혜경,정환정,민정준,김지열 대한핵의학회 1999 핵의학 분자영상 Vol.33 No.3

Purpose: The aim of this study was to evaluate the normal values of regional cerebral blood flow (rCBF) and cerebrovascular reserve (CVR) in normal children to aged volunteers using Tc-99m HMPAO. Materials and Methods: Thirty four right-handed normal volunteers (20 males, 14 females, mean age 40.3±24.9 years, range 4 to 82 years) were underwent rest/acetazolamide (ACZ) brain SPECT using Tc-99m HMPAO and the sequential injection and subtraction method. rCBF was estimated on the basis of a semiquantitative approach by means of right/left ratio, region/cerebellum and region to whole brain ratios in frontal, parietal, temporal, and occipital lobes, basal ganglia, thalami, and cerebellum. CVR was measured by means of % perfusion increase calculated as % mean count change compared to rest rCBF in each regions. Results: Mean values of right to left ratios range from 1.004 to 1.018. rCBF was highest in cerebellum and lowest in basal ganglia and thalami. Frontal and temporal rCBF decreased while occipital and thalami rCBF increased according to age. No sexual difference of rCBF was noted. Mean CVR was 29.9±12.9%. Mean CVR significantly increased to late teens, and declined thereafter. After 6th decade, CVR in both frontal lobes, left parietal lobe and right basal ganglia decreased significantly with advancing age. There was no sexual difference of CVR. Conclusion: Quantitative assessment of CVR was possible by ACZ Tc-99m HMPAO brain SPECT. It revealed that rCBF and CVR changed according to age in normal Korean volunteers. There was no sexual difference.

P-80 Successful erlotinib treatment after gefitinib-induced acute interstitial pneumonitis

( Ji-hee Min ),( Dong Won Park ),( Yeonkyung Park ),( Gun Woo Koo ),( Tai Sun Park ),( Ji-yong Moon ),( Sang-heon Kim ),( Tae-hyung Kim ),( Jang Won Sohn ),( Ho Joo Yoon ) 대한결핵 및 호흡기학회 2017 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.124 No.-

Gefitinib-induced ILD is the most serious adverse effect, with an incidence reported to be approximately 1.3% in worldwide and with about one third of the cases being fatal. A 56-year-old nonsmoker woman who suffered from anorexia during 2 weeks was found to have adenocarcinoma of left upper lung, with bone and multiple lung metastasis by bronchoscopic biopsy(T4N3M1). She received chemotherapy (pemetrexed) as a first-line treatment, before detection of EGFR mutation. After 20 days of pemetrexed, EGFR mutation (exon-19 deletion) was detected at outpatient department, interrupting gefitinib was served as a second- line treatment. After 3 days of gefitinib treatment, she experienced cough and dyspnea, and visited emergency department complaining fever and hypoxemia (PaO2 49.6mmHg, Saturation 87.5% on room air). A chest CT revealed partial remission of metastatic nodules and extensive bilateral ground-glass opacities on both lung fields. Gefitinib was discontinued immediately, and the treatment with high-dose methylprednisolone was initiated. There was improvement of symptoms and radiologic findings by the third day of steroid therapy. Three weeks after ILD, erlotinib 150mg/d was administered concurrently with tapering steroid. Chest radiography revealed no evidence of pulmonary toxicity and a reduction in the size of multiple metastatic nodules. Here, we report a case of gefitinib-induced acute interstitial pneumonitis with severe hypoxemia and impending respiratory failure, who showed good response with high-dose systemic steroids and successfully switched to erlotinib.

Scar sarcoidosis following blepharoplasty: a case report

Ji-Sang Min,Eun-Jung Sohn,Ji-Young Suh,Hee-Bae Ahn 대한미용의학회 2017 대한미용의학회지 Vol.1 No.1

Few cases have been previously reported regarding scar sarcoidosis following blepharoplasty. We report the case of a patient that developed sarcoidosis of a scar following a blepharoplasty procedure. A 41-year-old woman had a one-month history of beadshaped masses along her right upper eyelid. The patient underwent blepharoplasty 20 years ago. We performed excisional biopsy. Histopathological examination revealed a chronic non-caseating granuloma. Results of other tests were normal, including urinalysis, blood tests, and chest radiograph. Polymerase chain reaction (PCR) did not demonstrate evidence of tuberculosis, and a culture test for microbes showed no evidence of infection. She was diagnosed with sarcoidosis of the eyelid, and was prescribed an oral steroid. Once no evidence of recurrence was noted 3 months after the operation, the oral steroid dose was tapered off over an 8-week period. This case represents a rare occurrence of sarcoidosis that developed in the incisional scar after blepharoplasty. Sarcoidosis of the incisional scar should be considered as a differential diagnosis for an unusual mass that develops in a scar following blepharoplasty.

F-42 Plasma neutrophil gelatinase-associated lipocalin is effective in assessing severity and clinical outcomes in hospitalized patients with pneumonia

( Ji-hee Min ),( Yeonkyung Park ),( Gun Woo Koo ),( Tai Sun Park ),( Dong Won Park ),( Ji-yong Moon ),( Sang-heon Kim ),( Tae-hyung Kim ),( Jang Won Sohn ),( Ho Joo Yoon ) 대한결핵 및 호흡기학회 2017 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.124 No.-

Background: While neutrophil gelatinase-associated lipocalin (NGAL) is known as an early marker of acute kidney injury, little is known about the roles in the management of acute lung diseases, such as pneumonia. In this study, we investigated the role of plasma NGAL in assessing severity and clinical outcomes of hospitalized patients with pneumonia. Method: With a prospective observation design, we enrolled adult patients, who were admitted to a university hospital for the treatment of pneumonia. At the time of admission, we measured plasma level of NGAL in addition to serum concentrations of CRP and procalcitonin. Primary outcomes were Pneumonia Severity Index (PSI) score at admission and mortality due to pneumonia after hospitalization. Results: We enrolled a total of 136 hospitalized patients with pneumonia. NGAL was significantly correlated with PSI score (P <0.001), with 290.6 ng/ml in lowest PSI quartile and 373.9 ng/ml in highest PSI quartile. Concentrations of NGAL was much higher in non-survivors (n = 24) than survivors (n = 112) of pneumonia (679.2 vs. 308.5 ng/ml, P = 0.003). Receiver operating curve analysis showed that plasma NGAL is useful for predicting mortality (AUC 0.74, 95%CI 0.64-0.84, P <0.001). In a multivariate logistic regression analysis adjusting for age, gender, smoking and serum creatinine, NGAL was found to be an independently associated with mortality (P = 0.001). Conclusions: These findings suggest that plasma NGAL is a useful biomarker for assessment of severity of pneumonia and predicting mortality in hospitalized patients with pneumonia.

A Case of Peritoneal Tuberculosis Developed after Infliximab Therapy for Refractory RA

( Ji Yeon Min ),( So Young Bang ),( Seung Yeon Min ),( Dae Sung Lee ),( Bo Sang Kim ),( Jeong Eun Kim ),( Eun Sung Lee ),( Ju Yeon Pyo ),( Jang Won Sohn ),( Tae Hyung Kim ),( Hye Soon Lee ) 대한결핵 및 호흡기학회 2012 Tuberculosis and Respiratory Diseases Vol.73 No.4

Recently, interferon gamma releasing assay has been recommended to compensate the tuberculin skin test (TST) for screening for latent tuberculosis infection (LTBI). Although it improved the detection of LTBI before treatment with tumor necrosis factor blocker, its application to immune suppressed patients is limited. We report a case of peritoneal tuberculosis (TB) developed in a patient who tested positive for TST and QuantiFERON-TB Gold (QFT-G) before infliximab therapy, to emphasize the importance of monitoring during treatment. A 52-year-old woman presented with abdominal distension. She had been diagnosed with seropositive rheumatoid arthritis six years ago. She had started taking infliximab six months ago. All screening tests for TB were performed and the results of all were negative. At admission, the results of repeated TST and QFT-G tests were positive. Histopathological examination confirmed peritoneal TB. The patient started anti-TB therapy and the symptoms were relieved.

Gender-specific association between high sensitivity C-reactive protein and lung function in adults: Korean National Health and Nutrition Examination Survey analysis

( Ji-hee Min ),( Yeonkyung Park ),( Gun Woo Koo ),( Tai Sun Park ),( Dong Won Park ),( Ji-yong Moon ),( Sang-heon Kim ),( Tae-hyung Kim ),( Jang Won Sohn ),( Ho Joo Yoon ) 대한결핵 및 호흡기학회 2017 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.124 No.-

Background: C-reactive protein (CRP) is synthesized by the liver in response to various stimuli, thus frequently used as a biomarker for systemic inflammation. While CRP has been reported to be associated with lower lung function, it is not clear whether there is a gender-specific association. In this study, we aimed to examine the association of serum level of CRP with lung function both in male and female adults by analyzing data from Korean National Health and Nutrition Examination Survey (KNHANES) in Korean adults. Methods: We performed a cross-sectional study of adults aged ≥40 from KNHANES 2015. Lung functions were determined using spirometry and serum level of high sensitivity CRP (hs-CRP) was measured. A generalized linear model was used to evaluate the relationship between hs-CRP and lung function in consideration of weight for complex sample design. Results: In multivariate analysis, serum hs-CRP showed negative associations with both FVC and FEV1 respectively (P <0.05) after adjusting for age, gender, body mass index and smoking. In the highest CRP quartile, the average FVC% was 90.2% (95%CI 88.9-91.5), significantly lower than 94.5% (95%CI 93.2-95.9) in the lowest quartile (P <0.05). This negative association was more prominent in males, while there was no significant association in female gender in multivariate analysis. Conclusion: Serum hs-CRP is inversely related with lung function in terms of FVC and FEV1 in male adults, not in females. These findings suggest that the relationship between hs-CRP and lung function is gender specific.