A Case of Mycobacterium avium pulmonary disease with Massive Pleural Effusion in an HIV-negative, nonimmunosuppressed patient: Using PCR-Restriction Fragment Length Polymorphism Assay

( Kkot Sil Lee ),( Eun Jae Rhie ),( Geun Jun Ko ),( Hyung Seob Choi ),( Sang Soo Kim ),( Seo Goo Han ),( Jeong Eun Choi ),( June Myung Kim ) 대한내과학회 2003 대한내과학회 추계학술발표논문집 Vol.2003 No.1

Infective endocarditis caused by Gemella sanguinis in a hemodialysis patient (초)

Sang Heun Lee,Deok Kyu Cho,Hyu Kmin Lee,Sang Choel Lee,In Tae Kim,Hyung Bok Park,Yuk Yung Hyun,Yoon Ji Kim,Kkot Sil Lee 대한내과학회 2009 대한내과학회지 Vol.77 No.4S

Infective endocarditis caused by Gemella sanguinis in a hemodialysis patient

( Sang Heun Lee ),( Deok Kyu Cho ),( Hyuk Min Lee ),( Sang Choel Lee ),( In Tae Kim ),( Hyung Bok Park ),( Yuk Yung Hyun ),( Yoon Ji Kim ),( Kkot Sil Lee ) 대한내과학회 2009 대한내과학회 추계학술발표논문집 Vol.2009 No.-

Aspergillus fumigatus에 대한 Apolactoferrin의 성장억제 효과

이꽃실,장경희,김명수,김영근,김자경,최성희,허애정,염준섭,송영구,김준명 대한감염학회 2001 감염 Vol.33 No.5

Background : The incidence of aspergillosis is rising with the increased use of antimicrobial agents and immunosuppressive drugs for the treatment of malignant diseases, acquired immunodeficiency syndrome, or organ transplant recipients. However, treatment failures are also increasing which brings up the need for the development of new and more effective agents and/or compounds which support the activity of common antifungal agents. Apolactoferrin is one of the nonspecific host defence factors present in saliva that exhibit antifungal activity. We studied the in vitro antifungal effect of apolactoferrin in combination with amphotericin-B against Aspergillus fumigatus. Methods : Preparation of the inoculum and the growth conditions used were those recommended by the National Committee for Clinical Laboratory Standards M38-P (Conidium-forming filamentous fungi : proposed standard). Aspergillus fumigatus test inoculum was prepared to a concentration of 0.4×104~5×104 cells/mL. Appropriate concentrations of the antifungal agents were added to the wells (50 □L) and after inoculation, plates were incubated for 48 h at 35℃. Turbidity measurement was performed at 48 h at 630 nm and the MIC was defined as the lowest concentration of antifungal agents that inhibited growth of the organism as detected visually. Results : In the combination of experiments, we observed a pronounced cooperative activity against growth of Aspergillus fumigatus by using apolactoferrin and amphotericin-B. The MIC of amphotericin-B was reduced by 1/10 in the presence of apolactoferrin. Conclusion : The combined use of apolactoferrin and amphotericin-B against severe infections with Aspergillus fumigatus is an attractive therapeutic option. Clinical studies to further elucidate the potential utility of this combination therapy have been initiated. (Korean J Infect Dis 33:325~330, 2001)

후천성 면역 결핍증 환자에서 조직생검으로 확진된 진행성 다발성 백질뇌병증 1예

이중민,박윤선,최석훈,한상훈,진범식,신소연,최준용,이꽃실,박윤수,조정호,장경희,송영구,김준명 대한감염학회 2004 감염과 화학요법 Vol.36 No.1

세포면역결핍 상황에서 병발하는 진행성 다발성 백질뇌병증은 후천성 면역결핍증의 유병률이 감소하면서 그 발생률 또한 같이 증가하고 있다. 진단을 위해서는 임상양상과 방사선 검사에 추가해서 뇌척수액의 분자생물학적 검사 또는 뇌조직 검사를 시행하여야 한다. 본 예는 뇌생검을 통해 진행성 다발성 백질뇌병증이 확진되었으며 항레트로바이러스 치료 후 양호한 경과를 보였기에 문헌고찰과 함께 보고하는 바이다. In Korea, as the prevalence of acquired immune deficiency syndrome (AIDS) increases, various opportunistic infections are becoming a problem. Progressive multifocal leukoencephalopathy (PML) is postulated to be associated with impaired cellular immunity and can be more frequently encountered these days primarily due to increasing incidence of AIDS. Neurologic deficits and brain imaging study together strongly suggest PML, but confirmatory diagnosis can be made only by cerebrospinal fluid study or tissue biopsy. In Korea few cases of confirmed PML in AIDS patients have been reported, and herein we offer our experience of a case of PML who underwent brain biopsy for confirmative diagnosis.

국내 HIV 감염자에 있어서 항레트로바이러스 치료제의 부작용

이꽃실,장경희,최준용,박윤선,한상훈,진범식,최석훈,송영구,김준명 대한감염학회 2003 감염과 화학요법 Vol.35 No.2

목적 : 최근 HIV 감염의 치료는 역전사 효소억제제와 단백분해 효소억제제의 병용요법으로 괄목할 만한 치료 효과가 관찰되었으나, 국내에서 이들 약제에 대한 부작용의 보고는 미미한 실정이다. 이에 국내에 항레트로바이러스 치료제가 도입된 1990년대 초부터 최근 병용요법 투여까지 국내 감염자에서 발생한 부작용을 조사하고, 기존에 보고된 외국 감염자에서의 부작용과의 차이에 대하여 문헌고찰을 통하여 비교하여 인종에 따른 차이가 있는지 알아보고자 하였다. 방법 : 연세대학교 의과대학 세브란스 병원에서 1992년부터 2002년까지 항레트로바이러스 치료제를 투여받은 126예의 HIV 감염자를 대상으로 약제 부작용, 종류와 빈도, 그에 따른 약제 중단 유무 등을 후향적으로 조사하였다. 결과 : HIV 감염자의 치료 시작시 평균 연령은 34.4±8.3세였고, 남자가 112예이고 여자가 14예이었다. Zidovudine에 따른 부작용은 120예 중 40예(33.3%)에서 나타났으며, 골수 억제가 16예(13.3%), 위장관계 증상 14예(11.7%), 두통 5예(4.2%) 그리고 간기능 이상 3예(2.5%) 등이 있었다. Lamivudine에 따른 부작용은 119예 중 2예(1.7%)에서 나타났는데 모두 위장관계 증상이었고, didanosine에 의한 부작용은 29예 중 14예(48.3%)로 위장관계 증상이 7예(24.1%), 설사가 4예(13.8%), 발진 1예(3.4%), 그 외 말초신경병증, 간기능 이상, 췌장염, 치아시림, 비전형적인 흉통 등이 있었다. Indinavir에 의한 부작용은 114예 중 66예(57.9%)에서 나타났는데 고빌리루빈 혈증 43예(37.7%), 측배통이 24예(21.1%), 지방이형성증 6예(5.3%)에서 있었다. Nelfinavir에 의한 부작용은 21예 중 각각 1예(4.8%)에서 설사와 발진이 있었고 efavirenz에 따른 부작용은 11예 중 3예(27.3%)로 중추신경계 장애가 있었다. 항레트로 바이러스 약제 투여 중 64.3%에서 부작용을 경험하였으며, 36예(28.6%)에서 약제를 교체하였다. zidovudine이 17예 였으며 그 중 위장관 불편감이 7예, 두통이 5예, 골수억제가 4예로 나타났다. Indinavir로 총 8예에서 약제를 교체하였는데 측배통과 위장관 불편감이 각각 5예와 3예를 차지하였다. 대부분의 부작용은 보존적인 치료와 일시적인 투여 중단으로 회복되어 약제를 유지할 수 있었고, 부작용으로 인해 사망한 경우는 없었다. 결론 : HIV의 감염 치료를 위해 국내에 다양한 항레트로바이러스 치료제가 도입되어 약제에 따른 다양한 부작용이 발생되고 있으며, 이에 대해 주의 및 경각심이 필요하리라 생각한다. Purpose : Antiretroviral toxicity is an increasingly important issue in the management of HIV-infected individuals. However, adverse effects and long term safety in Koreans are hardly known. We evaluated the incidence of adverse effects of various antiretroviral drugs in Koreans, and difference among races was also studied. Methods: One hundred and twenty six Koreans with HIV infection and AIDS treated with antiretroviral drugs at Yonsei University College of Medicine from 1992 to 2002 were investigated. We analyzed the prevalence of adverse effects of various drugs. Results: The mean age of subjects at initial treatment was 34.4?.3 years. One hundred and twelve subjects were male, and 14 subjects were female. Adverse effects were found in 40 subjects (33.3%) out of 120 subjects who received zidovudine. The prevalence of adverse effects of didanosine and indinavir were 48.3% (14 out of 29 subjects) and 57.9% (66 of 114 subjects), respectively. Frequent toxicities of the subjects who received zidovudine were bone marrow suppression (13.3%), followed by gastrointestinal intolerance (11.7%), headache (4.2%), and hepatic dysfunction (2.5%). Frequent toxicities of the subjects who received didanosine were gastrointestinal intolerance (24.1%), followed by diarrhea (13.8%), rash (3.4%), peripheral neuropathy (3.4%), and pancreatitis (3.4%). Adverse effects of indinavir were as follows: hyperbilirubinemia (37.7%), flank pain (21.1%), gastrointestinal intolerance (6.1%), and lipodystrophy (5.3%). The main adverse effect of efavirenz was impaired concentration (27.3%). The overall incidence of adverse effects from antiretroviral drugs was 64.3% (81 out of 126 subjects) in HIV-infected Koreans. Change of antiretroviral regimens was inevitable in 36 subjects (28.6%). In most cases, the subjects recovered from adverse effects by conservative management. Conclusion: Clinicians should be aware of toxicity profiles in various races in the management of long term treatment with antiretroviral drugs, since the toxicity hazards of these drugs may easily outshadow the success of antiretroviral therapy.

Helicobater pylori에 의한 위암세포주 사멸

김원호,이경원,박인서,이용찬,여말희,이꽃실 대한소화기학회 1999 대한소화기학회지 Vol.34 No.1

Background/Aims: Helicobacter pylori (H. pylori) is associated with active gastritis and peptic ulcer disease. Mechanism for H. pylori-induced gastric epithelial damage is still incompletely understood. However, the increase of apoptotic cells in H. pylori-infected mucosa suggested that apoptosis could be a major mechanism for cellular damage. As an effort to clarify the mechanism, we investigated whether H. pylori directly induce apoptosis in gastric cancer cells in vitro. Methods: Cultured H. pylori (ATCC 43504) were suspended as 109/mL. IL (interleukin)-8 was measured by enzyme linked immunosorbent assay. Cell survival was assessed by MTT [3-(4,5-dimethyl-thiazol-2-yl)-2,5-diphenyltetrazolium bromide] assay. Apoptosis was detected and confirmed by demonstration of DNA fragmentation and morphologic changes. Results: H. pylori induced IL-8 production as well as decrease of cell survival in gastric cancer cell lines in a time- and concentration-dependen way. Addition of H. pylori to gastric cancer cells induced apoptosis. Such induction was not organ specific. Heat or formalin treatment of H. pylori almost completely inhibited IL-8 production but only partially blocked apoptosis. H. pylori- induced apoptosis was potentiated by interferon-γ pretreatment in HT-29 but not in AGS and KATO III. Conclusions: These results suggest that H. pylori affects on gastric epithelial cell growth by direct induction of apoptosis.

Septicemia due to Pasteurella pneumotropica in a patient with cerebral hemorrhage (초)

In Tae Kim,Hyu Kmin Lee,Won Joon Go,Kkot Sil Lee 대한내과학회 2009 대한내과학회지 Vol.77 No.4S

Septicemia due to Pasteurella pneumotropica in a patient with cerebral hemorrhage

( In Tae Kim ),( Hyuk Min Lee ),( Won Joon Go ),( Kkot Sil Lee ) 대한내과학회 2009 대한내과학회 추계학술발표논문집 Vol.2009 No.-

An Unusual Case of Tubo-ovarian Abscess by Gemella morbillorum

Jang, Hyoungsun,Kim, Seryun,Ryu, Kiyoung,Lee, Kkot Sil,Kim, Jaewook,Kim, Jongwook 대한감염학회 2009 감염과 화학요법 Vol.41 No.5

Gemellae is a gram positive cocci that forms part of the oropharyngeal microflora in humans and is anaerobic to aerotolerant. Unlike the other members of the same genus, G. morbillorum rarely causes human infections. Recently, we experienced a case of tubo-ovarian abscess caused by G. morbillorum which was initially suspected to be actinomycosis associated with intrauterine device. This is the first case in the world on tubo-ovarian abscess with G. morbillorum as the culprit.