Aeromonas 균혈증에 대한 임상적 고찰

원현상(Hyun Sang Won),안우석(U Seouk Ahn),이규춘(Ku Chun Lee),이원욱(Weon Uk Lee),김기중(Ki Jung Kim),성낙천(Nak Cheon Seong),김구엽(Koo Yup Kim),서환조(Hwan Jo Suh) 대한내과학회 1997 대한내과학회지 Vol.52 No.3

N/A Objectives: Aeromonas species is a gram-negative, facultative anaerobe of the family Vibrionaceae. The organism has been recognized as a pathogen associated with illness in human, such as acute gastroenteritis, cellulitis, septicemia, and other rare diseases. Methods: To evaluate the clinical significance of Aeromonas bacteremia in Korea and it's susceptibility of antibiotics, we evaluated the 17patients with Aeromonas bacteremia. Identification was done by use of API 20E system and antibiotic susceptibility was tested with disk diffusion method. Results: Male to female ratio was 11:6, and mean age was 54.1years(8-85years) old. Liver cirrhosis was the most common underlying disease(10cases of 17patients, 58.8%a). Other underlying diseases were as follows: gallstone in 2cases, cholangiocarcinoma in 2cases, and aplastic anemia in 1case, cerebral infarction in 1case. But one had no underlying disease. So Aeromonas bacteremia were occurred in 14immunocompromised patients(82.3%), and in 10patients with hepatobiliary diseases, A. hydrophila was most commonly isolated(13cases, 764%), and the A sobria(4cases, 23.5%) was infrequently isolated. The overall fatality was 47%, and there had no significant difference in fatality between A. hydrophila and A sobria All Aeromonas species had resistance to ampicillin and carbenicillin. Conclusion: Because Aeromonas bacteremia may occur through water-borne route, especially in immunocompromised host. We should pay attention to immunocompromised patients, espacially having hepatobiliary disease.

상행결장에 발생한 선암과 동반된 소세포암

권선희(S . H . Kwon),안우석(U Seouk Ahn),한민수(Min Soo Han),동석호(Seok Ho Dong),김효종(Hyo Jong Kim),김병호(Byoung Ho Kim),장영운(Young Woon Chang),이정일(Jung Il Lee),장린(Rin Chang) 대한소화기학회 1996 대한소화기학회지 Vol.28 No.3

Small cell carcinoma rarely occurs in the colon and rectum, and it is difficult to differentiaie it from colorectal adenocarcinoma clinically. We have recently experienced a 75-year-old man who had small cell carcinoma of the ascending colon with chief complaint of abdominal pain. The mechanical obstruction developed during admission period, so operation was done. The tumor directly invaded to the pericolic soft tissues, pericolic lymph nodes and right renal fasciia, but no distant metastasis. The tumor mainly consisted of small cell carcinoma and focally adenocarcinoma. This case was confirmed by pathologic permanent section after surgical resection. (Korean J Gastroenterol 1996; 28:433 - 438)

Stenotrophomonas maltophilia 감염의 임상 양상

이원욱(Won Uk Lee),김병준(Byoung Joon Kim),안우석(U . Seouk Ahn),원현상(Hyun Sang Won),김기중(Ki Joong Kim),성낙천(Nak Cheon Seong),김구엽(Gu Yeup Kim),서환조(Hwan Jo Suh) 대한내과학회 1997 대한내과학회지 Vol.53 No.3

N/A Objective: Stenotrophomonas maltophilia has been emerging as an important nosocomial pathogen in recent years in patients with impaired host- defense mechanism or who has been exposed to large amount of inocula. This organism is usually resistant to multiple (commonly used) antimicrobial agents, particularly to those of the beta-lactam class. To evaluate the clinical feature of Stenotrophomonas maltophilia infection and in vitro anti- microbial susceptibility, we performed a retrospective study. Methods: We analyzed the result of in vitro antimicrobial susceptibility test for 200 isolates of S. maltophilia and the annual isolation rate during the period between January 1990 and December 1994 in our institution, and performed a retrospective study for the available records of 165 cases among them. The data were obtained with only the first isolation of the organism for each patients. Results : Total of 165 initial isolates, the isolates were from wounds in 50(30.3%), urine in 47(28.5%), the respiratory tract in 37(22.4%), blood in 9(5.5%), bile in 6(3.6%), and miscellaneous sources in 16(9.7%). The 84.2% of isolates were hospital-acquired isolate and 58.3% of these patients had received antecedent antibiotic therapy: polymicrobial growth was demonstrated in 61.9% of the cases. In vitro antimicrobial susceptibiiity test, ofloxacin was active against the isolates in 89.2%, moxalactam in 85.9%, ciprofloxacin in 83.9%, TMP-SMX(trimethoprim-sulfamethoxazole) in 64.2%, As expected, S. maltophilia isolates were, in general, not susceptible to cephalosporins, penicillins. The annual isolation rate at Kyung Hee University hospital was not increased significantly from 1990 to 1994, 19.53 per 10,000 patients dismissals in 1990, 13.56 in 1994. The major underlying diseases of patients were malignancy(17.6%), cerebrovascular disorder(17%), diabetic mellitus(13.3%). Mortality rate is 10.3%. Conclusion: S. maltophilia has been emerging as an important nosocomial pathogen in immunocompromised patients, especially those receiving broad-spectrum antimicrobial therapy. And this organism is resistant to multiple antimicrobial agents, particularly to those of the beta-lactam class. When antimicrobial treatment is necessary, the clinician should be guided by results of in vitro susceptibility testing because of the notable in vitro resistance of S. maltophilia to commonly used antibiotics. And when S. maltophilia has been recovered from a patient, wound and contact isolation is warranted.

한국인에서 경동맥 경화와 관상 동맥 질환의 연관 관계에 관한 연구

이상억(Sang Eog Lee),김권삼(Kwon Sam Kim),김병준(Byoung Joon Kim),이효정(Hyo Jung Lee),안우석(U Seouk Ahn),강흥선(Heung Sun Kang),조정휘(Chung Whee Choue),김명식(Myung Shick Kim),송정상(Jung Sang Song),배종화(Jong Hwa Bae) 대한내과학회 1996 대한내과학회지 Vol.51 No.6

N/A Objectives: Along with the recent change in lifestyle in Korea, the incidence of coronary artery disease(CAD) and cerebrovascular disease due to atherosclerosis has increased. B-mode ultrasound of the extracranial carotid arteries offers a valid and repeatable noninvasive method for quantifying the extent of atherosclerosis. The extent of carotid artery atherosclerosis as measured by B-mode ultrasound has been shown to be strongly and independently correlated with the presence or absence of CAD. We investigated the relation between carotid atherosclerosis and the status of CAD in Korean population with a carotid B-mode ultrasound. Methods: One hundred twenty eight patients underwent. B-mode ultrasound of the carotid arteries with 10 MHZ linear array probe. The intima-media thickness(IMT) at two sites in far(posterior) wall of the both common carotid artery and bifurcation were quantified and evaluated for the incidence of softand hard plaques. Coronary angiography was performed by the percutaneous technique using Judkins catheter. The extent of CAD was counted as 0,1,2,3-vessel disease according to the number of major coronary vessels with an obstruction of 50% or greater. Results: The number of coronary artery involved was single-vessel disease in 41, two-vessel disease in 19, three-vessel disease in 25 and no corona atherosclerotic disease in 43. The incidence of plaques was no CAD group in 10(23%) at the bifurcation, whearas CAD group in 18(23%) at the common carotid artery and 68(80%) at the bifurcation. The incidence of plaques at the bifurcation increased progressively in each of 2- and 3-vessel disease group compare with the 1-vessel disease group(89%, 100% vs 64%). The sum of IMT at both common carotid artery and bifurcation was significantly different between no CAD and CAD group(3.17±0.08mm vs 4.26±1.37mm, p<0,05), and increased progressively in each of the groups with increasing numbers of stenosed vessels(2-vessel clisease:4.98±1.28mm, 3-vessel disease: 5.29±1.20mm Conclusion: The results suggest that increased IMT of carotid arteries is closely related to status and extent of CAD Also measurement of IMT may be useful screening method for assessment of CAD and systemic atherosclerosis.

임신여성을 제외한 성인에서의 B군 연쇄구균 감염에 관한 임상적 고찰

고경식,권선희,안우석,이원욱,김구엽,서환조 대한감염학회 1995 감염 Vol.27 No.4

목적:B군 연쇄구균은 최근 보고에 의하면 만성 기저질환(당뇨병, 악성종양등)이 있는 성인에서 감염빈도 및 사망률, 이환율이 증가하고 있는 추세이며 그 중요성이 대두되고 있다. 이에 저자들은 B군 연쇄구균 감염의 임상양상, 기저질환(위험인자)을 알아보고, B군 연쇄구균 항균제 감수성등을 규명하고자 하였다. 방법:1986년 1월부터 1993년 12월까지 경희대학교 부속병원에서 B군 연쇄구균이 배양된 274예를 대상으로 의무기록지를 검토하였다. 결과: 1) 전체 연구대상은 274예로 98예(35.8%)가 남자였고, 176예(64.2%)가 여자였다. 이들의 연령분포를 보면 신생아군에서 감염이 많이 발생하였다 이후 감소추세를 보이다가 20대 이상에서 다시 증가 하는 추세를 보였다. 2) 감염 양상은 274명중 명확한 감염이 156명(56.9%), 추정감염이 55명(20.1%), 비감염이 63명(23.0%)이었다. 임신을 제외한 18세 이상의 성인은 231명으로 남자가 83명, 여자가 148명이었고 남여 비율은 1:1.78이었다. 이중 133예(57.6%)에서 명확한 감염이었고, 46명(19.9%)에서 추정 감염, 52명(22.5%)에서 비감염이었다. 명확한 감염환자 133명중 31명(23.3%)이 병원내 감염이였다. 3) 18세 이상의 성인 231명에서 Group B Streptococcus가 분리 동정된 감염 부위는 자궁 경부 77예(33.3%), 요 73예(31.6%), 객담및 상기도 39예(16.9%), 농 24예(10.4%)등이었다. 4) 명확한 감염을 가지고 있었던 성인 133명의 임상양상은 요로 감염 37명(28%), 자궁 경부염 37명(28%), 피부, 연조직 감염 23명(17%), 폐렴 10명(8%), 패혈증 8명(6%)등이었다. 5) 명확한 감염을 가지고 있었던 성인 133명중 92명(69%)에서 한가지 이상의 만성 기저질환이 있었으며, 이중 당뇨병 32%, 뇌 혈관 질환 21%, 고혈압 19%, 신부전 12%, 악성종양 5%등을 차지하였다. 6) 항균제 감수성 검사(251예)에서 penicillin 98.4%, cephalothin 99.6%, cefamandol 98.8%, erythromycin 96.0%, clindamycin 89.4%, oxacillin 88.8%, lincomycin 87.8%, methicillin 86.8%, minocycline 49.4%, trimethoprim-sulfamethoxazole 15.5%의 감수성을 보였다. 7) 명확한 성인 감염 133명중 6명(4.5%)이 사망하였다. 결론:B군 연쇄구균은 만성 기저질환이 있는 성인에서 감염 빈도가 높고, 치명적인 결과를 초래할수 있으므로 감염 예방 및 조기 발견, 적절한 항균제 감수성 검사에 따라 조기 치료로 사망률을 줄여야 할것으로 생각된다. Background: Several reports have suggested that the incidence of diseases caused by Group B streptococcus is increasing in nonpregnant adults, particularly those with serious underlying diseases. The objectives of this study were to define the clinical manifestations, underlying conditions(risk factors) of definite group B streptococcal diseases in nonpregnant adults and to obtain antimicrobial sensitivity of these infections. Methods: We analyzed the records of 274 cases of the Group B streptococcus isolated in Kyung-Hee University hospital between 1986 and 1993. Results: 1) Total Group B streptococcal isolates were 274 cases : Of these cases, 7 percent were 1 month of age or younger, 3 percent were older than 1 month but younger than 18 years of age, and 91 percent were 18 or older. 2) Men and nonpregnant women accounted for 87 percent (n=231) : 133 cases (57.6%) with definite infection, 46 cases(19.9%) with possible infection, and 52 cases(22.5%) with no infection. 31 cases of 133 (23.3%) nonpregnant adult with definite infection apeared to have acquired the disease nosocomially. 3) In the 133 nonpregnant adult patients, the most common clinical diagnosis were urinary tract infection(28%), and cervicitis(28%). 4) In the 133 nonpregnant adult patients, the underlying diseases or conditions were diabetes mellitus(32%), cerebrovascular accident(21%), hypertension(19%), renal failure(12%), and malignant neoplasm(5%), Sixty-nine percent of the cases had one or more underlying diseases. 5) In the antimicrobial sensitivity tests, 98.4% of isolates were sensitive to penicillin, 99.6% to cephalothin, 98,8% to cefamandol, 96.0% to erythromycin, 89.4% to clindamycin, and 49.4% to minocycline. 6) The case mortality rate was 4.5%(6 of 133). Conclusion:We found group B streptococcal infection to be a significant and apparently increasing cause of definite diseases in nonprognant adults, particularly in those with serious underlying diseases. Recognizing these infections early in the groups with serious underlying diseases will be helpful in lowering mortality.

요관결석환자에서 발생된 Salmonella typhi 에 의한 Acute Focal Bacterial Nephritis

홍성표,김명재,이태원,김병준,김기중,안우석,이상억,원현상,현용준,성낙천,임천규 대한내과학회 1996 대한내과학회지 Vol.51 No.6

Acute focal bacterial nephritis(AFBN; Acute lobar nephronia) represents a acute, localized, non necrotizing suppurative inflammation of an entire lobule of kidney analogue to segmental involvement of the lung in lobar pneumonia. Renal Abscess, renalcyst and renal cell cancer, which also may appear as a mass, is distinguished radiologically from AFBN by abdominal ultrasonogram, abdominal CT scan, kidney MRI and renal scan. We have experienced a case of a 50-years-old male with acute focal bacterial nephritis by Salmonella typhi with ureteral stone. The patient was treated with chloramphenicol for 3 weeks and discharged, After 5 weeks later, the sonographic examination revealed reduced size of mass at affected kidney. We report this case with review of literatures.