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ST분절 상승 심근경색증 환자에서 시간 지연이 사망률에 미치는 영향
박용규 ( Yong Kyu Park ),정진옥 ( Jin Ok Jeong ),박재호 ( Jae Ho Park ),이현석 ( Hyeon Seok Lee ),이영달 ( Young Dal Lee ),최웅림 ( Ung Lim Choi ),진선아 ( Sun Ah Jin ),신성균 ( Sung Kyun Sin ),김준형 ( Jun Hyung Kim ),박재형 ( Ja 대한내과학회 2011 대한내과학회지 Vol.81 No.2
Background/Aims: The delay between the onset of myocardial infarction symptoms and primary percutaneous coronary intervention (PCI) is an important prognostic factor in patients with ST-segment elevation acute myocardial infarction (STEMI).We reviewed this delay in patients with STEMI and analyzed clinical outcomes. Methods: The study enrolled 3,399 patients (age, 61.4±12.8 years; 25.6% women) with STEMI who underwent primary PCIwithin 12 hours of symptom onset between October 2005 and February 2008 from the Korea Acute Myocardial Infarction Registry.The patients were divided into two groups according to the symptom-to-balloon time: group I (≤ 3 hours, n=955) and group II (>3 hours, n=2444). The in-hospital mortality rates and 1-year mortality and major adverse cardiac event (MACE) rates werecompared between the two groups. Results: The mean time interval from the onset of symptoms to arrival at the emergency room (ER) was 188.0±133.6 minutes(median, 152 minutes). The mean time interval from the ER to reperfusion (door-to-balloon time) was 97.8±67.9 minutes (median,80 minutes). The mean time interval from the onset of symptoms to reperfusion (symptom-to-balloon time) was 285.8±146.2minutes (median 250 minutes). The in-hospital mortality rate was significantly lower in group I as compared with group II (3.6%versus 5.2%, p=0.044). The 1-year mortality rate was also significantly lower in group I (4.7% versus 7.2%, p=0.012), while the1-year MACE rate was not significantly different between groups (17.9% versus 20.4%, p=0.179). Conclusions: This study demonstrates that there is a significant pre-hospital time delay in patients with STEMI in Korea and this time delay is associated with increased 1-year mortality. (Korean J Med 2011;81:199-207)
게실 내 유두에서 두 개의 카테타를 이용한 췌담관 삽관술
김명환,김진영,이성구,서동완,김홍자,민영일,정세라,박재형,장진석,김기락 대한소화기내시경학회 2001 Clinical Endoscopy Vol.23 No.1
cAn ampulla within a diverticulum is not rare especially in elderly patients with duct stones, but may pose a problem in identifying the papilla and properly orienting this structure for cannulation during endoscopic retrograde cholangiopancreatography. We therefore have used a new technique using the application of an additional catheter to keep the ampulla outside the diverticulum. When we pushed the duodenal fold downward and laterally with the first catheter, the ampulla was everted from the diverticulum and the hidden papilla was brought into view. Once the papilla was visible, the second catheter which was identical to the first, was advanced alongside it and inserted into the papillary orifice without difficulty. Bventually a successful Cholangiogram was obtained. With the insertion of a guidewire through the second catheter, sphincterotomy and insertion of endoscopic nasobiliary drainage tube were also performed successfully.
다제내성 그람양성균에 대한 Linezolid(Zyvox^(�))의 시험관내 항균력 비교
박대원,정희진,엄중식,황병연,김성범,이재갑,이연주,정혜원,정성주,박재형,이진수,손장욱,김우주,김민자,박승철 대한감염학회 2003 감염과 화학요법 Vol.35 No.5
배경 : MRSA, VRE, VRSA같은 다제 내성 그람 양성균의 등장에 따라 glycopeptide를 대체할 새로운 항생제의 개발이 필요하게 되었고 결과적으로 새로운 항생제인 linezolid라는 항생제가 개발되었다. Linezolid는 이전의 항생제와는 다른 새로운 계열의 oxazolidinone으로 경구 이용률이 우수하다. 원내 및 원외감염의 중요한 원인균이 되고 있는 MRSA, VRE에 대한 적절한 경구용 항균제가 없는 국내에서 폐렴 및 피부 연조직 감염에서 경구용으로 사용해 볼 수 있는 약제이다. 본 연구에서는 고대 구로 병원에서 분리된 MRSA, VRE 등을 대상으로 다른 여러 항균제와 비교한 linezolid의 시험관내 항균력을 조사하고자 하였다. 재료 및 방법 : 연구대상은 1998년 1월부터 2000년 12월까지 본원에서 입원 및 외래를 통하여 피부 연조직 감염증 및 호흡기 감염증, 요로감염증으로 진단된 환자들의 가검물로부터 분리된 MRSA 60균주, VRE 43균주, PRSP 25균주를 액체배지 또는 한천배지 희석법을 통하여 linezolid 및 기타 항균제에 대한 최소발육억제농도를 구하였다. 결과 : 실험에 사용한 S. aureus는 모두 MRSA였고 이들은 linezolid에 대해 MIC_(90) 2㎍/㎖(MIC 범위 1-2㎍/㎖), Enterococcus spp는 모두 VRE로 linezolid의 MIC_(90)은 2㎍/㎖로 MIC 범위는 1-4㎍/㎖였다. 한 개의 균주에서 MIC 4㎍/㎖로 중등도 감수성을 보였으나 MIC breakpoint가 (8㎍/㎖인 내성균주는 없고 모두 감수성을 보였다. S. pneumoniae의 경우 penicillin 내성이었고, linezolid MIC_(90) 1㎍/㎖ (MIC 범위 0.5-1㎍/㎖)로 전부 감수성을 보였다. 결론 : Linezolid는 MRSA를 위시한 VRE, PRSP 등의 다제 내성 그람 양성균에 대하여 우수한 시험관내 항균력을 보임을 알 수 있었다. Background : The emergence of multi-drug resistant Gram-positive cocci, such as MRSA, VRE, and VRSA, necessitated to develop new antibiotics, which could replace the glycopeptide. As a result, a new antibiotics named linezolid was developed. Linezolid is different line of oxazolidinones with a good oral bioavailability, compared to other antibiotics. Since appropriate oral antibiotics are not presently available for MRSA, which is a major cause of nosocomial and community acquired infections, the introduction of linezolid will have favorable effect on treatment of infections such as pneumonia or skin infections. In this study, we investigated the antibiotic effect of linezolid on MRSA and VRE isolated from patients who were treated in Korea University Guro Hospital. Material and Methods : By using broth microdilution and agar dilution method we measured minimum inhibitory concentration (MIC) with sixty S. aureus, forty three Enterococcus spp., and twenty five S. pneumoniae isolates from patients who were diagnosed as skin, soft tissue, respiratory, and urinary infections in Korea University Guro Hospital from January, 1998 to December, 2002. Results : All of S. aureus used in this study were MRSA, and MIG_(90) of linezolid was below 2 ㎍/㎖ (MIC ranged between 1-2 ㎍/㎖). All of Enterococcus spp. were VRE, and had MIG_(90) of 2 ㎍/㎖ (MIC ranged between 1 to 4 ㎍/㎖). One of the VRE showed intermediate susceptibility with MIC of 4 ㎍/㎖. However, none was resistant with MIC breakpoint above 8 ㎍/㎖. All of S. pneumoniae were resistant to penicillin, but they were susceptible to linezolid with MICao of 1 ㎍/㎖(MIC range 0.5-1㎍/㎖). Conclusion : In conclusions, linezolid has an excellent in vitro antibiotic effect on multi-drug resistant Gram-positive cocci, such as MRSA, PRSP, and VRE.