급성 췌장염 및 간염이 병발된 장티푸스 환자에서 발생한 칸디다 혈증 1예

곽임수(Im Soo Kwak),이수봉(Soo Bong Lee),정주섭(Joo Seop Chung),조군제(Goon Jae Cho),나하연(Ha Yeon Rha) 대한내과학회 2000 대한내과학회지 Vol.58 No.4

Typhoid fever is a bacteremic disease and many organs, including intestine, liver, bone, lung, thyroid, kidney, spleen, heart and pancreas may be invaded by the organism. Acute pancreatitis associated with typhoid fever sometimes needs prolonged total parenteral hyperalimentation and antibiotic treatment. Systemic Candida infections are usually encountered as opportunistic infections in a setting of immunologic depression. The authors report a case of Candida parapsilosis fungemia associated parenteral nutrition in acute pancreatitis associated with typhoid fever. A 17 year-old man was transfered to Pusan national university hospital on May 4th, 1998 under diagnosis of salmonella sepsis. High fever, nausea, vomiting and diarrhea developed 10 days before entery. On admission, serum amylase, lipase and transaminase showed elevation. The patient was treated with antibiotics(ceftriaxon) and total parenteral hyperalimentation was done under diagnosis of acute pancreatitis and hepatitis associated with typhoid fever. On 3rd hospital day, body temperature returned to normal but abdominal pain, nausea and vomiting continued. On 18th hospital day, high fever recurred and ceftriaxon was re-administered. Three days later, body temperature returned to normal. On 25th hospital days, culture of blood and catheter tip was positive for C. parapsilosis. On 27th hospital days, sudden onset high fever, pnumonic infiltration, confusion, hypotension, oliguria and azotemia developed. On 34th hospital day, sudden onset ventricular fibillation developed. On 35th hospital day, the patients died. We report a case of candida fungemia in acute pancreatitis and hepatitis associated with typhoid fever. (Korean J Med 58:462-465, 2000)

초기 류마티스 관절염 환자에서 폐 질환 발생의 빈도와 연관인자

김성일 ( Sung Il Kim ),곽임수 ( Im Soo Kwak ),박순규 ( Soon Kew Park ),나하연 ( Ha Yeon Rha ) 대한류마티스학회 2000 대한류마티스학회지 Vol.7 No.1

Objective: To determine the frequency and associated factors of physiologic abnormalities indicative of lung disease in early rheumatoid arthritis (RA). Methods: Thirty-six early RA patients(mean age 43±12 years, 30 females, disease durations less than 12 months, mean duration 5±3 months), who had not been treated with disease modifying antirheumatic drugs (DMARDs), were studied. Clinical, laboratoy and radiologic variables such as age, sex, smoking history, past lung disease history, drug medication history, rheumatoid factor positivity, erythrocyte sedimentation rate (ESR), CRP and chest radiography, were undertaken. Pulmonary function tests (PFTs) were performed in all patients and results for PFTs were expressed as percentage of predicted values for each individual adjusted for age, sex, and height. Lung disease was defined as one or more of the followings should be present, 1) forced vital capacity (FVC) <80% for predicted, 2) diffusing capacity of carbon monoxide (DL(CO)) <80% for predicted, 3) forced expiratory flow from 25% and 75% of vital capacity (FEF 25-75%) <80% for predicted. Statistical comparisons were made using Student`s t test or chi-square test as appropriate. Results: All patients had normal chest radiography. Rheumatoid factor was positive in 21 patients (58%), smokers were 5 patients (14%), ESR and CRP were increased in 16 (44%) and 17 patients (47%). Ten patients (28%) had lung disease and included FVC<80% in 4, DL(CO)<80% in 4 and FEF 25-75%<80% in 6 patients. There was no significant predictor of lung disease. Conclusion: The frequency of lung disease in early RA by PFTs was 28% and there was no significant predictor of lung disease.

항인지질증후군의 임상적 고찰

이우철(Woo Chul Lee),이수봉(Soo Bong Lee),김영민(Young Min Kim),홍진희(Jin Hee Hong),성은영(Eun Young Seong),박성민(Sung Min Park),곽임수(Im Soo Kwak),나하연(Ha Youn Rha) 대한내과학회 1998 대한내과학회지 Vol.55 No.3

Objectives: Antiphospholipid syndrome(APS) is characterized by arterial or venous thrombosis, recurrent fetal loss, many neurological deficits, and presence of anticardiolipin antibody(ACA) or lupus anticoagulant(LA). This study was done to know the clinical and serological characteristics of antiphospholipid syndrome. Methods: Clinical and laboratory features of 18 patients with APS who had antiphopholipid antibodies and histories of obstetric events and thrombosis were studied. Results: Of the 18 patients, 4 were male, and 14 were female, and the ages ranged from 19 to 64 years. 11 patients were primary APS. 17 patients had ACAs: ll had IgG ACA; 2 had IgM ACA; 3 had both IgG and IgM; 1 had both IgG and IgA; 1 patient had LA. Antinuclear antibodies were positive(>1:40) in 15 patients, and antis-DNA(>l:10) were present in S patients. Hemolytic anemia was noted in 4 patients with positive in only direct Coomb`s test, and all were secondary APS. Thrombocytopenia(<150,000/mm3) was observed in 14 patients, 9 patients raged between 100,000/mm³ and 150,000/mm³. Initial presentation were vein thrombosis in 7 patients, pulmonary embolism in 3, arterial occlusion in 3, leg ulcer in 1, spontaneous abortion in 2, preeclampsia in 1, preterm labor in 1. Combined diseases were SLE, Sjogren syndrome, idiopathic thrombocytopenic purpura, hypertension. In 7 patients associated with cardiac abnormalities, 3 were mitral regurgitation, 4 were pericardial effusion, l was dilated cardiomyopathy. Venous thrombosis were present in 11 patients, 6 had deep vein thrombosis only, 3 had both deep vein thrombosis and pulmonary embolism Arterial occlusion were present in 4 patients, 3 had small multiple cerebral infarction, 1 had right common femoral ar4mal occlusion. Obstetric complications were present 5 patients of 14 female patients1` 3 had spontaneous abortion, preeclampsia was present in 1 and present labor was present in 1. Conclusions: The clinical and serological features of APS in this study were similar to those of previous reports (Oeffinger et al,1994: Edelman et al., 1995). Treatment with prednisolone, anticoagulants and antiplatelet agents was used. Of the 10 follow-up patients, none had recurrence of thrombotic events.

후천성면역결핍증 환자에서 기회감염으로 발생한 크립토코쿠스 뇌막염 1 예

황병욱(Byung Uk Hwang),김무영(Moo Young Kim),김상현(Sang Hyun Kim),김영수(Young Soo Kim),김성일(Sung Il Kim),윤영권(Young Kwan Yun),곽임수(Im Soo Kwak),나하연(Ha Youn Rha),조군제(Goon Jae Cho) 대한내과학회 1992 대한내과학회지 Vol.43 No.5

N/A

기종성 신우신염에 합병된 감염성 폐색전증 예 1

고정희 ( Jung Hee Koh ),엄중섭 ( Jung Seop Eom ),김정섭 ( Jung Sub Kim ),송상헌 ( Sang Heon Song ),곽임수 ( Im Soo Kwak ),성은영 ( Eun Young Seong ) 대한신장학회 2011 Kidney Research and Clinical Practice Vol.30 No.1

Emphysematous pyelonephritis is an unusual, severe gas-forming infection of renal parenchyma and its surrounding areas. It is a rare cause of septic pulmonary embolism. We report on a case of emphysematous pyelonephritis complicated with renal vein thrombosis and septic pulmonary embolism with review of the literature. A 51-year-old diabetic woman was admitted to our hospital with symptoms of fever, diffuse abdominal pain and nausea. Her initial laboratory findings showed pyuria and leukocytosis. She was diagnosed with acute pyelonephritis with abscess formation on contrast enhanced abdominal CT. She was treated with antibiotics and percutaneous abscess aspiration, but progressed to emphysematous pyelonephritis complicated with renal vein thrombosis and septic pulmonary embolism. Finally she underwent the left total nephrectomy.

痲醉된 고양이에서 痛症 誘發藥物에 의한 Reno-Renal Feflex의 發生과 이의腎機能에 대한 役割

곽임수 대한신장학회 1988 대한신장학회잡지 Vol.7 No.1

Role of Hydroxyl Radicals and Lipid Peroxidation in Cisplatin-induced Acute Renal Failure in Rabbits

Yang, Yong Suk,Kwak, Im Soo,Nah, Ha Yun,Kim, Yong Keun 대한신장학회 2002 Kidney Research and Clinical Practice Vol.21 No.2

목 적 : Cisplatin은 여러 종류의 고형성 암의 치료제로 널리 사용되는 약물이지만, 동시에 심각한 신장독성을 나타내는 것으로 잘 알려져 있다. 게다가 cisplatin이 어떤 기전으로 신장독성을 나타내는지도 명확히 밝혀져 있지 않다. 따라서 본 연구에서는 hydroxyl radical들과 지질의 과산화가 cisplatin에 의한 급성신부전에 중요한 역할을 하는지를 조사하였다. 방 법 : 토끼를 실험동물로 사용하여 cisplatin 5mg/kg 용량을 복강내 주사하여 급성신부전을 유발시키고 cisplatin을 주사한 48시간 동안 신장기능의 변화를 조사하였다. 결 과 : Cisplatin 주사 후에 혈청내 creatinine농도증가와 사구체여과율의 감소가 나타났으며, Na^(+), 포도당 및 무기인산의 배설분율의 증가가 나타났다. Cisplatin처치는 신피질절편에서 PAH 축적과 microsomalfraction에서 Na^(+)-K^(+) ATPase 활성을 감소시켰다. Cisplatin을 주사한 동물의 신장조직에서는 지질의 과산화가 증가하였다. Cisplatin을 주사하기 전에 항산화제인 N,N-diphenyl-p-phenylenediamine(DPPD), 철착염제인 deferoxamine, hydroxyl radical scavenger들인 dimethylthiourea와 sodium benzoate을 처치한 결과 cisplatin에 의한 급성신부전이 유의하게 방지되었으며, 지질의 과산화도 억제되었다. 시험관내에서 정상 신장의 피질절편을 cisplatin에 노출시켰을 때 lactate dehydrogenase(LDH) 유출과 지질의 과산화가 증가하였으며, 이러한 변화는 DPPD와 deferoxamine에 의해 방지되었다. 그러나 hydroxyl radical scavenger들인 dimethylthiourea와 thiourea는 cisplatin에 의한 지질의 과산화는 방지하였으나 LDH 유출에는 영향을 미치지 못하였다. 결 론 : 이러한 연구 결과는 cisplatin이 급성신부전을 유발하는데는 hydroxyl radical의 생성과 이로 인한 지질의 과산화가 중요한 역할을 한다는 것을 가리킨다. 그러나 hydroxyl radical들은 cisplatin에 의한 신장독성의 초기 단계에는 관여하지 않는 것으로 생각된다. Purpose : This study was undertaken to determine whether lipid peroxidation induced by hydroxyl radicals play a critical role in cisplatin(cis-diamminedichloroplatinum II)-induced acute renal failure. Methods : Animals received cisplatin at a single i.p. dose of 5 mg/kg, and changes in renal function were measured at 48 hr after cisplatin injection. Results : Cisplatin caused an increase in serum creatinine level, which was accompanied by reduction in GFR. The fractional excretion of Na^(+), glucose, and inorganic phosphate was increased in animals treated with cisplatin alone. Cisplatin treatment in vivo inhibited PAH uptake by renal cortical slices and Na^(+)-K^(+)-ATPase activity in microsomal fraction. Lipid peroxidation was increased in cisplatin-treated kidneys. When animals received the antioxidant N,N'-diphenyl-p-phenylenediamine(DPPD), the iron chelator deferoxamine, and hydroxyl radical scavengers dimethylthiourea and sodium benzoate before cisplatin injection, alterations in renal function and lipid peroxidation induced by cisplatin were significantly prevented. Exposure of renal cortical slices to cisplatin in vitro caused an increase in LDH release and lipid peroxidation, which were completely prevented by DPPD and deferoxamine. By contrast, hydroxyl radical scavengers(dimethylthiourea and thiourea) did not prevent cisplatin-induced LDH release despite they inhibited cisplatin-induced lipid peroxidation. Conclusion : These results suggest that the lipid peroxidation resulting from generation of hydroxyl radicals may play a role in cisplatin-induced acute renal failure. In addition, the protective effects of hydroxyl radical scavengers in vivo studies are different from the results obtained from in vitro studies using renal cortical slices. (Korean J Nep h rol 2 00 2;2 1( 2):2 13 -22 1)

대유행인플루엔자 대비를 위한 의료기관-바탕 탁상훈련 : 고안 및 평가

설희윤,김지량,권보란,목정하,이선희,곽임수,정진우,김정수,고옥배,조은희,김성순,신상숙,이상원 대한감염학회 2008 감염과 화학요법 Vol.40 No.2

목적 : 의료기관의 범유행 인플루엔자에 대한 효과적인 대비를 위한 훈련방법으로서 의료기관-바탕 탁상훈련 (hospital based tabletop exercise)의 유용성과 순응도를 평가하기 위해서 시행되었다. 재료 및 방법 : 탁상 훈련은 부산대학교 병원에서 시행되었으며 병원의 주요의사결정권자 및 주요부서 대표자, 실무자 42명이 지휘부, 진료부, 지원부 3그룹으로 나뉘어 훈련에 참가하였다 탁상훈련의 시나리오는 의료기관의 자체 훈련을 위해서 고안하였으며 현재 동남아에서 유행하고 있는 H5N1 인플루엔자가 국내에 처음으로 유입되어 확산되는 과정에서 의료기관에서 발생할 수 있는 상황을 3가지 모듈로 구성하였다. 훈련 평가는 훈련 전후에 각각 익명의 설문조사를 시행하였다. 결과 : 훈련에 초청된 참여자 42명 중 37명(88%)이 실제 당일 훈련에 참여하였다. 훈련에 참여한 37명의 직원 중에서 훈련 전 시행한 설문에 27명(73%)이 응답하였다. 훈련 전 정가에서는 훈련을 통해 획득하고 싶은 지식이나 기술의 우선 순위를 물었으며, 참여자들이 가장 중요하다고 생각하는 항목은 대유행인플루엔자 바이러스에 대한 지식 향상 22%, 병원 각 부서가 취해야 할 계획 및 의사소통과 관련된 지식 향상 19%, 지역사회 병원들 간의 상호협력을 향상시킬 전략 계발이 19%이었다. 그룹토의 동안에는 환자의 조기 발견 이후 대응에 대한 토론이 많았지만, 구체적인 부분이 미흡하였고, 대유행 인플루엔자에 대한 기본적인 이해가 부족하였다. 훈련에 참여한 37명의 직원 중에서 훈련 후 시행한 설문에 21명(57%)이 응답하였다. 훈련 후 평가에서 탁상훈련의 전반적인 만족도에 대한 질문에서 81%가 만족하였다고 답변을 하였고, 새로운 것을 배우는데 유용했는가 대한 질문에도 86%가 유용했다고 답변하였다. 결론 : 탁상훈련은 의료기관의 대유행인플루엔자 대비에 효과적인 훈련방법이라고 생각되며 훈련을 통해 의료기관 내의 여러 부서들이 각 의료기관의 특성에 맞는 현실적이고 실제적인 대비 계획을 수립하는데 도움을 줄 것으로 기대된다. 그러나 향후 토른 촉진, 구체적인 결과에 도달을 유도할 수 있는 질문, 끼워넣기 개발, 적절한 시간 등에 대한 연구가 필요할 것으로 생각된다. Background : To evaluate the usefulness and compliance of a hospital-based tabletop exercise in setting of pandemic influenza in hospitals. Materials and Methods : Tabletop exercise was held in Pusan National University Hospital and forty two hospital employees were invited to participate in the exercise. The scenario for hospital-based tabletop exercise was designed. It consisted of three modules, which simulated the influx and outbreak of H5N1 influenza that was epidemic in Southeast Asia. Pre-, post-exercise surveys were completed by anonymous questions. Results : Thirty-seven (88%) of 42 invited participants attended exercise. AII members of the administration group and the ancillary services group participated. But, only 77% members of the clinical services group participated. In pre-exercise survey, priorities of eight goals regarding skills and knowledge during exercise were inquired., The highest priorities pointed out by the respondents were "Increase the knowledge of pandemic influenza" (22%), "Development of strategies for optimal communication among employees within specific department" (19%) and "Development of strategies for improved coordination between facilities within the health system" (19%). Twenty-one (57%) of participants completed the post-exercise surveys. At post-exercise surveys, 81% of the participants stated that the tabletop exercise was extremely or very useful, 86% of the participants also stated that it increased their knowledge of pandemic influenza. Conclusion : Tabletop exercise is an effective modality for increasing pandemic influenza preparedness in hospitals, and this method is useful for guiding preparedness activities within the hospital environment. Further studies to determine the appropriate method of discussion, questionnaire, duration of exercise and injection are needed.