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정두련 ( Doo Ryeon Chung ) 대한내과학회 2018 대한내과학회지 Vol.93 No.4
To prevent the transmission of pathogens in hospitals, implementation of transmission-based precautions is essential, such as precautions to prevent airborne, droplet, and contact transmissions. However, it is impossible to identify all hidden asymptomatic carriers. Emphasis has therefore been placed on the use of standard precautions, including hand hygiene and cough etiquette. Recently, the possibility of the spread of imported emerging infectious diseases in medical institutions has also become an area of focus. Prevention of the spread of infections in hospitals should be a top priority to ensure the highest quality of care. (Korean J Med 2018;93:317-323)
정두련 ( Doo Ryeon Chung ) 대한간학회 2011 Clinical and Molecular Hepatology(대한간학회지) Vol.17 No.2(S)
Liver abscess usually develops from infectious foci caused by enteric bacteria entering through hepatic portal vein or biliary tract. Abscess formation is the result of the interaction between the host defense mechanism and microbial virulence factors. Classically etiologic microorganisms causing liver abscess have been aerobic enteric bacteria including Escherichia coli and anaerobic bacteria such as Bacteroides fragilis, however recently, Klebsiella pneumoniae has become the predominant cause of liver abscess in Korea. Successful treatment requires appropriate antimicrobial therapy for long duration and adequate therapeutic drainage of abscess.
Clostridium difficile 관련 설사의 진단
정두련 ( Doo Ryeon Chung ) 대한내과학회 2010 대한내과학회지 Vol.78 No.3
Clostridium difficile-associated diarrhea (CDAD) has been one of common nosocomial infections associated with previous antibiotic use. Early diagnosis and adequate management of CDAD is necessary especially for severe cases, however, diagnosis has not been satisfactory. Cytotoxicity assay or toxigenic culture can be considered as a golden standard for diagnosis of CDAD, however, they are labor intensive and require a long time. Instead, a rapid enzyme immunoassay for toxin A and B has been widely utilized in most clinical laboratories. However, its low sensitivity has also been a limitation. Sigmoidoscopy can be helpful in a rapid diagnosis of CDAD for some cases which show negative results in enzyme immunoassay. (Korean J Med 78:316-317, 2010)
한국인의 Epstein-Barr Virus 항체 양성률 변화양상에 대한 분석: 단일기관 연구
김수경,최준식,김동섭,강철인,정두련,백경란,강은숙,김예진,Kim, Su Kyung,Choi, Joon-Sik,Kim, Dongsub,Kang, Cheol-In,Chung, Doo Ryeon,Peck, Kyong Ran,Kang, Eun-Suk,Kim, Yae-Jean 대한소아감염학회 2020 Pediatric Infection and Vaccine Vol.27 No.2
Purpose: Epstein-Barr virus (EBV) infection is related to infectious mononucleosis or nasopharyngeal cancer, and its epidemiology may change according to the socioeconomic development of communities. This study aimed to evaluate the recent epidemiology of EBV seropositive rate in Korea. Methods: We retrospectively reviewed EBV serology test results obtained from a part of clinical care at Samsung Medical Center, Seoul, South Korea, from January 2000 to December 2017. Results: The EBV seropositive rate in 26,527 subjects during the study period was 81.0% (21,485/26,527): 44.4% (2,716/6,122) in subjects aged 0-9 years, 75.8% (2,077/2,739) in those aged 10-19 years, and 94.5% (16,692/17,666) in those aged ≥20 years. The EBV seropositive rate decreased from 89.4% (8,592/9,616) in 2000-2008 to 76.2% (12,893/16,911) in 2009-2017 (P<0.001). Especially, the EBV seropositive rate in subjects aged 0-19 years significantly decreased from 2000-2008 to 2009-2017 (0-9 years, 62.8% [1,172/1,866] in 2000-2008 and 36.3% [1,544/4,256] in 2009-2017; 10-19 years, 83.8% [745/858] in 2000-2008 and 70.8% (1,332/1,881) in 2009-2017) (P<0.001). Conclusions: The EBV seropositive rate in children has decreased in the last 20 years. As the age of patients with primary EBV infection increased, there is a need for interest in clinical manifestation, such as infectious mononucleosis, in adolescents and young adults.
증례 : 감염 ; rpoB 유전자 RFLP에 의한 Mycobacterium Marinum 힘줄윤활막염 진단 1예
정호중 ( Ho Jung Chung ),이미래 ( Mi Rae Lee ),배선윤 ( Sun Youn Bae ),김미연 ( Mi Yeon Kim ),정두련 ( Doo Ryeon Chung ) 대한내과학회 2012 대한내과학회지 Vol.82 No.3
Mycobacterium marinum is an uncommon cause of skin and soft-tissue infection. The diagnosis of M. marinum infection is often delayed when only a conventional tissue culture method is used. PCR-restriction fragment length polymorphism (RFLP) analysis using the novel region of the rpoB gene is now available for the rapid identification of Mycobacteria. We report a case of hand infection caused by M. marinum that was identified by PCR-RFLP analysis. The PCR-RFLP assay is a specific and rapid method for the identification of Mycobacteria that facilitates the early diagnosis of non-tuberculous Mycobacterium infection. (Korean J Med 2012;82:378-381)
건강검진자의 혈청 Rheumatoid Factor 양성률과 간염바이러스 감염의 관계에 대한 연구
엄완식(Wan Sik Uhm),조재근(Jae Kun Cho),정두련(Doo Ryeon Chung),최승원(Seung Won Choi),이무송(Moo Song Lee),유빈(Bin Yoo),문희범(Hee Bom Moon) 대한내과학회 1996 대한내과학회지 Vol.50 No.4
N/A Objectives: To estimate the prevalence of rheumatoid factor(BF) positivity in adult Korean population and to investigate the association between viral hepatitis infection and rheumatoid factor positivity. Methods: The database from 21,907 subjects who visited general health screening center of Asan Medical Center during 1 year's period were surveyed. RF was tested using a commercial latex test kit(RapiTex® RF Test; Behringwerke). Results : 1) The prevalence of I4F was 2.9%(male 3.1%, female 2.7%) and increased along with the higher age groups. 2) The prevalence of HF in HBsAg(+) subjects was higher(13.3%) than that of RF in HBsAg(-) subjects(2.2%). 3) The prevalence of RF in anti-HCV(+) subjects was higher(6.1%) than that of BF in anti-HCV(-) subjects(2.8%). 4) HBsAg positivity was highly associated the presence of RF than age, anti-HCV, or abnormnl AST/ALT. Conclusion : The prevalence of RF in healthy Korean adults can be estimated as 3% and shows high association with hepatitis B and C virus infection.
증례 : 비장티푸스성 살모넬라 감염으로 인한 감염성 거짓동맥류와 합병증 1예
서윤 ( Yun Seo ),하영은 ( Young Eun Ha ),성기익 ( Ki Ick Sung ),강철인 ( Cheol In Kang ),백경란 ( Kyong Ran Peck ),송재훈 ( Jae Hoon Song ),정두련 ( Doo Ryeon Chung ) 대한내과학회 2012 대한내과학회지 Vol.83 No.2
저자들은 대동맥활에 발생하고 종격동, 흉강, 심장막에 광범위한 화농성 합병증을 동반한 비장티푸스성 살모넬라 감염에 의한 감염성 거짓 동맥류 1예를 경험하고 치료하였기에 보고하는 바이다. Non-typhoidal Salmonella infections, which rarely present with multiple complications, are predominantly seen in immunocompromised patients, In particular, non-typhoidal Salmonella infections presenting with more than two complications are extremely rare, Here, we report a case of an infected pseudoaneurysm in the aortic arch caused by a non-typhoidal Salmonella species complicated by pleural empyema, pericarditis, pericardial empyema, and mediastinitis, To our knowledge, this is the first such case report in Korea.
비장절제 환자에서 전격자색반이 동반된 폐렴사슬알균 패혈증 1예
유지연 ( Ji Youn Yoo ),송혜근 ( Hae Geun Song ),이정화 ( Jung Hwa Lee ),김기성 ( Ki Seong Kim ),이승순 ( Seung Soon Lee ),김효정 ( Hyo Jung Kim ),정두련 ( Doo Ryeon Chung ) 대한내과학회 2006 대한내과학회지 Vol.70 No.6
비장절제술을 시행 받은 환자에서는 피막성 세균에 의한 치명적 감염이 발생할 위험이 증가한다. 이 중 가장 흔한 감염은 폐렴사슬알균에 의한 패혈증으로서 그 사망률이 매우 높다. 또 다른 흔한 감염으로서 수막알균 패혈증을 들 수 있는데 이에는 전격자색반이 흔히 동반되는 것이 특징적이다. 폐렴사슬알균 감염에서도 드물게 전격자색반이 동반될 수 있는데 국내에서는 아직까지 비장절제 환자에서 폐렴사슬알균 감염에 의해 전격자색반이 발생한 증례는 보고된 바가 없었다. 저 The most serious problem after splenectomy is the increased risk of life-threatening infections caused by encapsulated bacteria such as Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis. Purpura fulminans, which is commonly assoc
정동식 ( Dong Sik Jung ),오유정 ( You Jeong Oh ),권기태 ( Ki Tae Kwon ),이지영 ( Ji Young Rhee ),신상엽 ( Sang Yop Shin ),정혜숙 ( Hae Suk Cheong ),이남용 ( Nam Yong Lee ),이혁 ( Hyuck Lee ),정두련 ( Doo Ryeon Chung ),백경란 ( Ky 대한내과학회 2008 대한내과학회지 Vol.75 No.3
목적: 결핵성 수막염은 중추신경계 감염 중 가장 흔한 질환 중의 하나이며 조기 진단과 치료가 되지 않을 경우 20~50%의 사망률과 높은 신경학적 합병증을 초래한다. 본 연구는 간단한 임상양상과 검사실 소견만으로 결핵성 수막염을 조기 진단하는데 도움을 주는 것으로 알려진 Thwaites 등이 제안한 진단지표를 국내에서도 유용하게 활용할 수 있는지를 평가하고자 하였다. 방법: 1995년 3월부터 2005년 12월까지 10년 동안 삼성서울병원 응급실에 수막염을 시사하는 임상소견을 가지고 내원한 환자 중 뇌척수액에서 결핵균이 나오거나 결핵균 중합효소연쇄반응 양성이 나온 결핵성 수막염 환자와 뇌척수액에 세균이 나오거나 혈액배양에서 세균이 동정되었으나 수막염 외에는 다른 감염 병소가 없는 급성 세균성 수막염 환자를 대상으로 진단지표의 타당성을 후향적으로 조사하였다. 결과: 총 77명의 환자가 본 연구에 포함되었으며 이 중 47명이 결핵성 수막염, 30명이 급성 세균성 수막염이었다. 결핵성 수막염 47예 중 이 진단지표(Thwaites등이 제안한 최적 결정치 4이하)를 통해 47명 모두(100%)가 진단이 가능했고, 세균성 수막염 30예 중 27예(90%)가 진단이 가능했다. 본 연구에서는 Area under ROC curve는 0.993 (95% CI, 0.979-1.0)으로 진단적 정확도가 높게 나왔으며 최적 결정치는 지표의 총합이 3이하인 경우 민감도와 특이도의 합이 최대로 나왔다. 그에 따른 민감도 100%, 특이도 93.3%, 양성예측도 95.9%, 음성예측도 100%이었다. 결론: 임상양상과 검사실 소견으로 결핵성 수막염과 급성 세균성 수막염을 감별진단 하는 Thwaites의 진단지표는 국내에서도 진단적 타당도가 높아 유용하게 활용 가능할 것으로 기대된다. 또한 최적 결정치는 지표의 총합이 3이하인 경우가 진단적 타당도가 더 높은 결과를 보였다. Background/Aims: Tuberculous meningitis is a common, occasionally fatal infectious disease of the central nervous system. We evaluated the diagnostic validity of weighted diagnostic index scores (WDIS), which have been suggested to aid in the diagnosis of adult patients with tuberculous meningitis, on the basis of simple clinical and laboratory findings. Methods: The microbiological and clinical data of adult patients with either tuberculous or bacterial meningitis were reviewed retrospectively. Diagnostic validity and WDIS cut-off values were evaluated by receiver operating characteristic (ROC) curve analysis. Results: A total of 77 cases were included: 47 with tuberculous meningitis and 30 with bacterial meningitis. For the diagnosis of tuberculous meningitis, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of WDIS suggested by Thwaites (cut-off value of ≤4) were 100, 90, 94 and 100%, respectively. Based on ROC curve analysis (area under ROC curve=0.993), a cut-off value of ≤3 was most appropriate for the diagnosis of tuberculous meningitis. The sensitivity and specificity of WDIS with a cut-off value of ≤3 were 100 and 93.3%, respectively. Conclusions: Our study demonstrated that WDIS are highly predictable and acceptable for the early diagnosis of tuberculous meningitis in Korea, based on our analysis of clinical and laboratory findings. A cut-off value of ≤3 showed the best diagnostic validity. (Korean J Med 75:316-321, 2008)