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김준명(June Myeong Kim),김영기(Young Ki Kim),김응(Eung Kim),김영준(Young Joon Kim),강신욱(Shin Wook Kang),홍천수(Chein Soo Hong) 대한내과학회 1989 대한내과학회지 Vol.36 No.5
N/A Since 1986, when tsutsugamushi disease was first reported in Korea, there have been numerous reports about the disease and the prevalent season was from late fall to early winter. In Japan, there have been reports of its occurrence in the spring, so it is possible that it may also occur in the spring in Korea. We experienced a case of tsutsugamushi disease which occurred in May of 1988. The patient was a 72-year-old female living in Kyungki-Do who visited Severance Hospital because of fever, abdominal pain and vomiting of 12 days duration. The diagnosis was confirmed as tsutsugamushi disease by clinical findings such as eschar and high antibody titers on indirect immunoperoxidase assay. She showed clinical features of adult respiratory distress syndrome and disseminated intravascular coagulopathy, but completely recovered with chloramphenicol and other supportive management.
장티푸스 이환시 Salmonella typhi Vi 항원에 대한 IgG , IgM IgA 항체가의 시간에 따른 변화
김준명(June Myeong Kim),안광진(Kwang Jin Ahn),김응(Eung Kim),홍천수(Chein Soo Hong) 대한내과학회 1989 대한내과학회지 Vol.37 No.3
N/A The varied antigenicity of salmonella species is determined by O, H and Vi antigens whose chemical components and roles are recognized partiallty and are still under study. The Vi antigen of Salmonella typhi is known to have a specific role in the pathogenesis of typhoid fever by exerting a protective action upon the serum complement system and thus resisting phagocytosis. Lately, Vi antigen was introduced for the diagnosis of typhoid fever, and sequential changes of polyvalent immunoglobulin antibody titers against Vi antigen in typhoid fever were reported. So we studied immunological responses against Vi antigen in twelve patients with typhoid fever, and sequentially measured immunoglobulin G, M and A titers by indirect fluorescent antibody test using Vi antigen (Vi-IFAT). The IgG antibody titers were already increased 1 week after fever onset, reached a peak level at 3 to 4 weeks, and then showed some period of plateau followed by a gradual decrease after 2 to 3 months. The IgM antibody titers showed no definite increase in the early phase of the disease in most of the patients, but a slight increase was noted 2 to 3 weeks after fever onset followed by a rapid decrease thereafter. The IgA antibody titers were already highly increased 1 week after fever onset, and then showed some period of plateau followed by a rapid decrease after 6 to 8 weeks. Compared with previous studies regarding O antibody production in Korea, the pattern of antibody responses against Vi antigen was very similar. Based on these results, we found that IgG antibody production was predominant and IgM antibody production was relatively suppressed even in the acute phase of typhoid fever. Considering that Korea is one of the endemic areas of typhoid fever, a previously acquired immunity against typhoid fever or exhaustion of IgM antibody-forming cells may lead to the relatively low IgM antibody titers.
장티푸스 진단에 있어서 Vi - 간접형광항체법의 유용성
김준명(June Myeong Kim),김응(Eung Kim),홍천수(Chein Soo Hong),정윤섭(Yun Sop Chong),박기일(Ki Il Park) 대한내과학회 1987 대한내과학회지 Vol.33 No.6
N/A Although the confirmative diagnosis of typhoid fever is by culture of the causative organism usually from body fluids, serological test can be helpful in providing a more rapid method of diagnosis. The indirect fluorescent antibody test using a Salmonella typhi Vi-antigen and a FITC-conjugated rabbit anti-human polyvalent immunoglobulins has been evaluated for the diagnosis of typhoid fever. The results obtained were as follows: 1) Only two of 61 sera from culture proved typhoid fever patients were falsely negative. Of 79 sera from patients with febrile diseases other than typhoid fever only one had falsely positive titer. Forty sera from normal subjects were all negative. The sensitivity and specificity were 96.7% and 99.2% respectively. 2) The positive rate of the test was 71.4% within the 1st week, 90.0% from the 1st week to 2nd week, and 100% since the 2nd week after fever onset. 3) The antibody titer to Vi-antigen was already increased within the 1st week after fever onset. And the titer showed its maximum response in the 2nd and 3rd week and was gradually decreased to near normal level throughout this study. In conclusion, the Vi-indirect fluorescent antibody test (Vi-IFAT) could serve as an useful serologic test for the diagnosis of typhoid fever.
Methicillin 내성 황색 포도상구균 감염증의 임상적 고찰
홍명기(Myeong Ki Hong),김준명(June Myeong Kim),김응(Eung Kim),박성삼(Sung Sam Park),홍천수(Chein Soo Hong),정윤섭(Yun Sop Chong) 대한내과학회 1988 대한내과학회지 Vol.35 No.4
N/A The methicillin resistant Staphylococcus aureus (MRSA) strains can produce clinically serious infections. Recently, MRSA infections have had very important clinical significance because of the increasing incidence of MRSA infections and the resistance of MRSA to various antimicrobial agents. The purpose of this study was to evaluate the clinical aspects of MRSA infections treated at Yonsei University Severance Hospital from Jan. lst, 1986 to Dec, 31st, 1987. The results are as follows: 1) The incidence of MRSA isolated was 27.8% of the total Staphylococcus aureus isolated. It was found to be present at frequent of 38.6% in sputum, 23.9% in pus, 38.6% in urine and 18.2% in blood. 2) The sites of MRSA infections were wouod infection (51.2%), pneumonia (25.2%), sepsis (8.1%) and urinary tract infection (8.1%). 3) The risk factors associated with MRSA infection were previous use of antimicrobial agents (80.9%), previous operation (69.7%) and previous care in an intersive care unit (50%). The diagnoses at admission in patients with MRSA infection were trauma (30.3%), neurologic disease (12.3%), disease of the reapiratory system (11.5 %), oncologic disease (5.7%) and burn (4.9%). 4) The treatment failure rate of MRSA infections was 35%, the mortality rate of MRSA infections was 12%. 5) According to in vitro susceptibility tests, sensitivity to MRSA was 100% for vancomycin,99% for fusidic acid, 88% for sulfamethoxazole-trimethoprim,27 % for clindamycin,25% for amikacin,3% for tobramycin and 3% for gentamicin. This study suggests that MRSA infection can be decreased by early recognition of the risk factors associated with MRSA infections, administration of adquate antimicrobial agents and detailed epidemiologic surveillance.
알레르기 질환에서 피부단자시험과 RAST 성적에 관한 연구
이은직(Eun Jig Lee),김준명(June Myeong Kim),이수곤(Soo Gon Lee),박해심(Hae Sim Park),오승헌(Seung Heon Oh),홍천수(Chein Soo Hong) 대한내과학회 1987 대한내과학회지 Vol.32 No.4
N/A The prick skin test and RAST were used commonly in demonstrating the presence of skin sensitizing antibody in the diagnosis of allergic diseases. The agreement rate and correlation between skin test and RAST were studied by using Phadebas RAST kits and Bencard allergen extracts of 37 common allergens. The following results were obtained; 1) Total agreement rate of 37 allergens between skin test and RAST was 62.3% in 1840 samples. 2) The positive rate of RAST was 20,3% in the + positive group of skin test in all allergens 34.4% in %, and 83.19o in %. 3) Correlation coefficient between skin test and RAST was 0.79 in D. pteronyssinus, 0.67 in D. farinae, and 0.55 in house dust. 4) RAST positive rate of positive skin test and RAST negatvie rate of negative skin test were 68.7%, 94.4% in D. pteronyssinus, 57.8%, 91.3% in D. farinae 47.5%, 96.1 % in Artemisia, 42.4%, 84.3% in Ambrosia, and 32.8%, 97.9% in house dust. 5) RAST positive rate of D. pteronyssinus, D. Farinae, house dust, cat epithelium, cockroach, Ambrosia, Artemisia, mold were 31.0%, 35.1%, 16.4%, 21.7%, 53.8 %, 10.0%, 13.3%, 47,1% in patients with asthma, 59.6%, 55.8%, 30.0%, 18.2%, 22.2%, 48.0%, 39.4%, 34.1% in allergic rhinitis, 60.2%, 56.9%, 37.4%, 34.1%, 40.0%, 21.2 %, 23.2%, 20.0% in asthma associated with allergic rhinitis, 6) The positive RAST rate of D. pteronyssinus was 88.1% when RAS1 of D. Farinae was positive, and positive RAST rate of D. farinae 88.8% when RAST of D. pteronyssinus positive.
악성고형종양 환자에 있어서 Neoplastic Fever 와 Infectious Fever 의 감별을 위한 Naproxen 의 투여
송시영(Si Young Song),김준명(June Myeong Kim),김주항(Joo Hang Kim),김웅(Eung Kim),홍천수(Chein Soo Hong) 대한내과학회 1989 대한내과학회지 Vol.37 No.4
N/A Recurrent unexplained fever as a manifestion of certain malignancies is a well described phenomenon and is usually attributed to infection related to the immunocompromised state, from either the cancer itself or chemotherapy. However, fever might originate from the tumor per se, namely neoplastic fever, and the differential diagnosis of the infectious fever and the neoplastic fever becnmes a true challenge to the clinician due to its urgency and necessity for appropriate treatment. Thus, we evaluated the antipyretic effect of naproxen in 18 febrile patients who were diagnosed with a malignant solid tumor for the purpose of differentiation of the neoplastic fever and the infectious fever. All 10 patients with neoplastic fever showed complete lysis and an afebrile stafe was sustained while the patients were maintained on naproxen. Among 8 patients with infectious fever, 4 patients showed no lysis, 3 patients partial response, and 1 patient complete lysis. Even though the naproxen dosage was increased to a dose of 250 mg every 6 or H hours in the patients who showed no response, partial response was noticed only in two patients and the remaining two patients continued to show no response. Naproxen is well known to cause gastrointestinal side effects and functional platelet defects. However, in our experience, the side effects have been minimal because most of the patients have received a relatively short course of therapy. In conclusion, naproxen appears to be a very effective tool in assisting in the differential diagnosis of infectious fever and neoplastic fever in patients with a malignant solid tumor.
백승(Seung Paik),김준명(June Myeong Kim),정재복(Jae Bock Chung),박준용(Jun Yong Park),김응(Eung Kim),홍천수(Chein Soo Hong),최흥재(Heung Jai Choi) 대한내과학회 1988 대한내과학회지 Vol.35 No.5
N/A In a nine-year retrospective study, there were S5 episodes (2.24%) of bacteremia among 3789 patients with liver cirrhosis. The total number of causative microorganisms was 87 strains. The mean patient age was 49.6±10.5 years. Of 85 patients, 69 were male and 16 were female giving a ratio of approximately 4.3 to 1. The peak of highest age incidence was the fourth and fifth decades. Community acquired bacteremia numbered 59 episodes and hospital acquired, 26 episodes. In hospital acquired bacteremia, twenty patients (76.9%) underwent one or more major procedures such as gastroscopy, endoscopic sclerotherapy, balloon tamponade, paracentesis, or intraabdominal surgery just before the onset of bacteremia. The causative microorganisms were 72 strains of gram-negative bacteria (82.8%) and 15 strains of gram-positive bacteria (17.2%). Of the more common microorganisms, E. coli accounted for 37.9 percent, Klebsiella 16.1 percent and Staphylococcus 14.9 percent. The incidence of Staphylococcus was relatively high in community acquired bacteremia, and Klebsiella was high in hospital acquired bacteremia. In community acquired bacteremia, E, coli were highly susceptible to aminoglycoside, cefamandole and third generation cephalosporin. Klebsiella were susceptible to aminoglycoside and second and third generation cephalosporin. Staphylococcus were highly susceptible to cephalothin, methicillin and clindamycin. In hospital acquired bacteremia, E. coli were highly susceptible to aminoglycoside and third generation cephalosporin, Klebsiella to aminoglycoside, cephalosporin and chloramphenicol, and Staphylococcus were susceptible to cephalothin, but 50% were susceptible to methicillin, clindamycin, erythromycin and chloramphenicol. Of 85 bacteremic patients with liver cirrhosis, 31 patients (36.5%) died; in community acquired bacteremia, 23 patients (37.7%) died and in hospital acquired bacteremia, 8 patients (30.8%) died. The causes of death were sepsis and/or septic shock, bleeding, hepatic coma, etc. The severity of the cirrhosis was assessed according to Child's grading; 2 patients were found to be in claw A (2.4/c ), 12 in class B (14,1%), and 71 in class C (83.5%), Seventy-three patients suffered from one or more of the following complications: ascites, encephalopathy, hematemesis, and spontaneous bacterial peritonitis. Two or more (mean 2.2) complications were associated with mortality eases, whereas approximately one (mean 1.3) complication was seen in improved patients. In conclusion, patients suffering from liver cirrhosis were highly susceptible to infection because of various defects in the defence system, and when bacteremia developed, the prognosis was very poor. Therefore, bacteremia should be considered a serious complication in liver cirrhosis.