Catheter-Related Trichosporon asahii Bloodstream Infection in a Neutropenic Patient with Myelodysplastic Syndrome

고세은,이경진,김예니,최재기,김유진,이동건 대한감염학회 2018 Infection and Chemotherapy Vol.50 No.2

Because primary antifungal prophylaxis is widely used for immunocompromised hosts, the incidences of unusual fungal infections have increased. Trichosporon asahii has emerged as an important life-threatening opportunistic systemic pathogen because of the increased use of cytotoxic or immunosuppressant agents, along with high mortality rates. Here, we describe a case of catheter-related T. asahii bloodstream infection with multiple septic skin nodules in both the arms and legs of the patient who was in the neutropenic period after allogeneic stem cell transplantation for myelodysplastic syndrome treated with prophylactic ciprofloxacin and itraconazole. We successfully treated her with intravenous voriconazole for more than a month without any complications. Clinicians should consider breakthrough Trichosporon infections when clinical progress in an immunocompromised patient with unexplained infection signs and symptoms does not improve despite proper treatment with antibiotics or various antifungal agents. In addition, voriconazole can be a good treatment choice for achieving better treatment results and prognosis.

AHP를 통한 온라인 유통 통합 관리플랫폼의 확산 중요 요인 우선순위 평가

방선호,고세은,조유진,이강현,신광섭 한국생산관리학회 2023 한국생산관리학회지 Vol.34 No.-

최근 공공 디지털 플랫폼은 공익과 사회적 가치 창출을 위한 기회로 활용되고 있으며, 우리 정부 역시 공공 데이터 플랫폼을 운영 중에 있다. 특히, 온라인 유통 물류 산업 내 공공 주도 디지털 플랫폼을 도입하기 위한 사업이 추진 중이나추진 중에 있으나 실제 플랫폼에 참여하는 다양한 이해관계자의 관점이 반영되기 어려운 상황이다. 이에 본 연구에서는 디지털 플랫폼의 개발과 원활한 확산을 위해 다수의 이해관계자를 플랫폼 개발자와 사용자 측면으로 구분하고, 각 이해관계자가 플랫폼의 성공적인 운영과 확산을 위한 주요 요인에 대한 상대적 중요도 평가를 진행하였다. 플랫폼의 도입과 확산과 관련된 요인을 도출하기 위해 기술 수용 모형 기반으로 요인을 도출하였으며, 사용자 그룹 간그룹간 중요도 평가 결과가 상이한 것으로 분석되었다. 이를 기반으로 향후 성공적인 디지털 플랫폼 구성과 운영, 유통물류 산업 전방위 확산을 위한 방향성을 수립할 수 있을 것이다. The public digital platform is currently utilized as the opportunity to create public profit and social value, our government also operates the public data platform. Especially, it is ongoing to introduce the public digital platform in the online retail and logistics industry. But, it seems very difficult to consider all the viewpoints of various stakeholders who participate in the digital platform. In this research, we have categorized the stakeholders into two groups, platform developers and users. Then, we have evaluated the relative importance of factors that are very important to successfully design, operate, and proliferate the digital platform. To identify the critical factors related to implementing and proliferating the digital platform by revising the Technology Acceptance Model (TAM), and the result shows a very different rank among groups. With the result of this research, it seems possible to build a more reasonable and stable direction to design, operate, and proliferate the digital platform in the online retail and logistics industry.

Patient’s Factors at Entering Hospice Affecting Length of Survival in a Hospice Center

이국진,안혜신,고세은,김지현,서민우,강승헌,양여리,이미영,이구옥,전상훈,진종률 대한암학회 2015 Cancer Research and Treatment Vol.47 No.1

Purpose In order to provide effective hospice care, adequate length of survival (LOS) in hospice isnecessary. However the reported average LOS is much shorter. Analysis of LOS in hospicehas not been reported from Korea. We evaluated the duration of LOS and the factorsassociated with LOS at our hospice center. Materials and MethodsWe retrospectively examined 446 patients who were admitted to our hospice unit betweenJanuary 2010 and December 2012. We performed univariate and multivariate analysis foranalysis of factors associated with LOS. ResultsThe median LOS was 9.5 days (range, 1 to 186 days). The LOS of 389 patients (86.8%)was< 1 month. At the time of admission to hospice, 112 patients (25.2%) were completelybedridden, 110 patients (24.8%) had mouth care only without intake, and 134 patients(30.1%) had decreased consciousness, from confusion to coma. The median time intervalbetween the day of the last anticancer treatment and the day of hospice admission was 75days. By analysis of the results of multivariate analysis, decreased intake and laboratoryresults showing increased total white blood cell (WBC), decreased platelet count, increasedserum creatinine, increased aspartate aminotransferase (AST), alanine aminotransferase(ALT), and lactate dehydrogenase (LDH) level were poor prognostic factors for survival inhospice. ConclusionBefore hospice admission, careful evaluation of the patient’s performance, particularly theoral intake, and total WBC, platelet, creatinine, AST, ALT, and LDH level is essential, becausethese were strong predictors of shorter LOS. In the future, conduct of prospective controlledstudies is warranted in order to confirm the relationship between potential prognostic factorsand LOS in hospice.

척추후측만증 환자에서 급속히 진행된 비만성 저환기 증후군 1례

김민영,정지선,장유나,고세은,이상학,문화식,강현희,Kim, Min Young,Jeong, Jee Sun,Jang, Yu Na,Go, Se-eun,Lee, Sang Haak,Moon, Hwa Sik,Kang, Hyeon Hui 대한수면의학회 2015 수면·정신생리 Vol.22 No.1

비만성 저환기 증후군은 체질량지수 $30kg/m^2$ 이상의 비만 환자에서 낮 동안의 저산소혈증 및 고탄산혈증($PaCO_2$ 45 mmHg 이상, $PaO_2$ 70 mmHg 미만) 소견을 보이는 질환으로 90% 이상에서 무호흡-저호흡 지수가 시간 당 5회 이상인 폐쇄성 수면 무호흡이 동반되어 나타난다. 특히 고탄산혈증을 유발할 수 있는 심한 폐쇄성 환기장애나, 간질성 폐질환 혹은 심한 흉벽질환 및 신경근육질환을 배제하는 것이 진단에 필수적이나, 임상적으로 비만성저환기 증후군의 양상을 보인다면 조기에 질환을 의심하는 것이 예후에 매우 중요한 영향을 끼친다. 비만성 저환기 증후군 치료의 목표는 체중감소 및 폐쇄성 수면무호흡의 치료, 고탄산혈증과 저산소혈증의 개선으로 산소치료, 경비적 지속적 상기도 양압술, 비침습적 양압 환기요법 등으로 치료 효과를 얻은 증례들이 보고되어 있다. 특히 만성 호흡 부전의 급성 악화가 동반 환자이거나, 지속적 상기도 양압술로 치료가 실패한 환자, 폐쇄성수면무호흡을 동반하지 않은 비만성저환기 환자의 경우에는 이단 상기도 양압술을 적용하여 더 효과적인 치료 결과를 기대할 수 있다. 저자들은 폐포저환기를 유발할만한 다른 질병이나 상태를 가진 환자의 경우에도 중증 비만, 코골이 및 수면 중 무호흡, 낮 동안의 저산소혈증 및 고탄산혈증 등 비만성저환기증후군의 특징적 임상 양상에 근거하여 조기에 비만성저환기 증후군을 의심하였고 이에 대한 평가를 진행하여 이단 상기도 양압 치료를 통해 치료 효과를 거두고 환자의 예후에 매우 큰 영향을 끼치는 것을 경험하였기에 보고하는 바이다. Obesity hypoventilation syndrome (OHS) is characterized by severe obesity, excessive daytime sleepiness, hypoxemia and hypercapnea. Because OHS mimics pulmonary hypertension or cor pulmonale, clinicians should recognize and treat this syndrome appropriately. A 58-year-old female visited the emergency room because of dyspnea. She was obese and had kyphoscoliosis. The patient also experienced snoring, recurrent choking during sleep and daytime hypersomnolence which worsened after gaining weight in the recent year. The arterial blood gas analysis showed she experienced hypoxemia and hypercapnea not only during nighttime but also daytime. We suspected OHS and the patient underwent polysomnography to confirm whether obstructive sleep apnea was present. During the polysomnography test, sleep obstructive apnea was observed and apnea-hypopnea index was 9.2/hr. The patient was treated with bilevel positive airway pressure therapy (BiPAP). After BiPAP for 4 days, hypoxemia and hypercapnia were resolved and she is currently well without BiPAP. We report a case successfully treated with clinical improvement by presuming OHS early in a patient who had typical OHS symptoms, even while having other conditions which could cause hypoventilation.

Efficacy of Peracetic Acid (EndoPA®) for Disinfection of Endoscopes

이지민,이강문,김대범,고세은,고성우,강윤구,홍소림 대한소화기학회 2018 대한소화기학회지 Vol.71 No.6

Background/Aims: We aimed to investigate the efficacy of peracetic acid (EndoPA®; Firson Co., Ltd., Cheonan, Korea) in disinfecting endoscopes. Methods: We prospectively investigated the gastroscopes (Part I) utilized in 100 gastroscopic examinations and colonoscopes (Part II) utilized in 30 colonoscopic examinations after disinfecting them with 0.2% peracetic acid (EndoPA®; Firson Co., Ltd.). These instruments had been collected consecutively throughout the study period. We reprocessed and disinfected the endoscopes according to the guidelines for cleaning and disinfecting gastrointestinal endoscopes laid down by the Korean Society of Gastrointestinal Endoscopy in 2017. Three culture samples were obtained from each examination, based on different sampling methods. The primary outcome was a positive culture rate. Results: In Part I of our study, two of 300 samples were positive. The culture positive rate after disinfection was 0.7% (2/300). The culture positive rate was not significantly different based on the exposure time to EndoPA® or the age of the scopes (p=0.7 or 0.2, respectively). In Part II of our study, all samples (n=90) were negative. Conclusions: We conclude that 0.2% peracetic acid (EndoPA®) appears to be a good disinfectant for both gastroscopes and colonoscopes.

내시경기기 소독에 있어 과초산계 소독제(엔도파^Ⓡ)의 효과

이지민 ( Ji Min Lee ),이강문 ( Kang-moon Lee ),김대범 ( Dae Bum Kim ),고세은 ( Se Eun Go ),고성우 ( Sungwoo Ko ),강윤구 ( Yoongoo Kang ),홍소림 ( Solim Hong ) 대한소화기학회 2018 대한소화기학회지 Vol.71 No.6

Background/Aims: We aimed to investigate the efficacy of peracetic acid (EndoPA^®; Firson Co., Ltd., Cheonan, Korea) in disinfecting endoscopes. Methods: We prospectively investigated the gastroscopes (Part I) utilized in 100 gastroscopic examinations and colonoscopes (Part II) utilized in 30 colonoscopic examinations after disinfecting them with 0.2% peracetic acid (EndoPA^®; Firson Co., Ltd.). These instruments had been collected consecutively throughout the study period. We reprocessed and disinfected the endoscopes according to the guidelines for cleaning and disinfecting gastrointestinal endoscopes laid down by the Korean Society of Gastrointestinal Endoscopy in 2017. Three culture samples were obtained from each examination, based on different sampling methods. The primary outcome was a positive culture rate. Results: In Part I of our study, two of 300 samples were positive. The culture positive rate after disinfection was 0.7% (2/300). The culture positive rate was not significantly different based on the exposure time to EndoPA^® or the age of the scopes (p=0.7 or 0.2, respectively). In Part II of our study, all samples (n=90) were negative. Conclusions: We conclude that 0.2% peracetic acid (EndoPA^®) appears to be a good disinfectant for both gastroscopes and colonoscopes. (Korean J Gastroenterol 2018;71:319-323)

증례 : 신장 ; 우연히 발견된 무증상 기종성 신우신염 1예

이현정 ( Hyeon Jung Lee ),신새봄 ( Sae Bom Shin ),고세은 ( Se Eun Go ),서주현 ( Ju Hyun Seo ),한덕재 ( Deok Jae Han ),조형준 ( Hyeong Jun Cho ),김영옥 ( Young Ok Kim ) 대한내과학회 2015 대한내과학회지 Vol.89 No.5

기종성 신우신염은 주로 당뇨병 환자에서 발생하는 심한 괴사성 감염으로 발생빈도는 낮지만 임상경과가 매우 빠르고 예후가 나쁠 수 있기에 즉각적인 처치가 필요한 것으로 알려져 있다. 대개 급성 신우신염과 유사한 증상을 보이나 요로감염을 시사하는 증상 없이 우연히 영상검사 중에 진단된 증례가 국외에서 1예[7] 보고된 바 있다. 저자들은 진단 시점부터 치료 시작 전까지 무증상이었으나 연속적으로 시행한 영상검사상 악화 소견을 보여 항생제 치료를 시작하였고 영상검사상에서 호전을 확인한 증례를 경험하였기에 유사한 증례의 고찰과 함께 보고하는 바이다. Emphysematous pyelonephritis (EPN) is a severe gas-forming infection of the renal parenchyma and surrounding tissues. Patients with EPN commonly present with high fever, chills, and flank pain. These symptoms mimic a simple urinary tract infection, such that diagnosis is often delayed. Because of its life-threatening fulminant course, the early detection of EPN and its prompt treatment with intravenous antibiotics with or without percutaneous drainage are critical. Here we describe a case of a 63-year-old Korean female with diabetes mellitus who had no specific symptoms or signs of EPN. A chest computed tomography (CT) scan to assess a right pleural effusion incidentally detected an abnormal gas shadow in the renal parenchyma. An abdominal CT scan performed 5 days later showed increased gas within the kidney parenchyma, but the patient still had no symptoms of EPN. She was treated with intravenous antibiotics alone. A follow-up abdominal CT scan revealed the complete disappearance of the features of EPN. (Korean J Med 2015,89:567-570)