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김부기,이동욱,조남천,유인천.Bu Ki Kim. MD. Dong Wook Lee. MD. Nam Chun Cho. MD. In Cheon You. MD 대한안과학회 2011 대한안과학회지 Vol.52 No.1
Purpose: To investigate the predisposing factors, clinical manifestations, treatment results and risk factors for treatment failure in Staphylococcus epidermidis keratitis. Methods: Sixty-one eyes of 61 patients who were diagnosed with Staphylococcus epidermidis keratitis were included in the present study. The past history, location and size of ulceration, hypopyon, treatment results, and antibiotic susceptibility were reviewed retrospectively. A logistic regression analysis was performed to identify the main prognostic risk factors for treatment failure. Results: Twenty-six eyes (42.6%) had previous histories of corneal traumas. Polymicrobial infections were observed in 31 cases (50.8%), including 11 cases (35.5%) combined with the Fusarium species. Twenty-five eyes (41.0%) had lesions located at the corneal center. The average size of ulceration was 7.3 ± 7.2 mm2. Thirteen eyes (21.3%) with lesions that progressed or occurred in the corneal perforation underwent evisceration, penetrating keratoplasty or scleral graft. Risk factors for treatment failure were a history of previous keratitis (P = 0.003) and an ulcer exceeding 5.0 mm2 in size (P = 0.018). Conclusions: Staphylococcus epidermidis keratitis usually has a good prognosis, although a history of previous keratitis and a large ulcer size are risk factors for treatment failure. J Korean Ophthalmol Soc 2011;52(1):14-22
진균각막염의 임상양상 및 예후 : 20년간의 변화 분석
조상일(Sang Il Cho),박영명(Young Myoung Park),안민(Min Ahn)조남천(Nam Chun Cho),유인천(In Cheon You) 대한안과학회 2021 대한안과학회지 Vol.62 No.7
목적: 최근 20년간 국내에서 발생된 진균각막염 환자의 임상양상, 원인균, 치료, 예후 등의 변화에 대해 알아보고자 하였다. 대상과 방법: 본원에서 각막염으로 진단받고 시행한 각막찰과 및 배양검사에서 진균이 검출된 177안의 의무기록을 후향적으로 조사하였다. 성별, 연령, 선행 요인, 원인균, 임상양상, 치료 방법, 예후 등을 분석하였다. 또한 배양과 KOH염색 여부에 따라 KOH양성그룹, 배양양성그룹, KOH-배양동시양성그룹으로 나누어 조사하였다. 불량한 임상결과와 관련 있는 위험인자를 로지스틱 회귀분석으로 조사하였다. 결과: 대상 환자의 평균연령은 67.4 ± 11.3세였고, 남자가 107명(60.5%)이었다. 진균각막염 발생의 위험인자는 안외상(57.6%), 특히 식물에 의한 외상(29.4%)이 많았다. 가장 흔한 사상진균은 푸사륨 49균주(31.6%)였고 효모균은 칸디다 17균주(11.0%)였다. 진균과 세균이 함께 배양된 41안 중 사상진균과 그람양성균이 29안(70.7%)으로 많았다. 치료 후 시력이 호전된 경우는 KOH양성그룹이 19명(79.2%), 악화된 경우는 배양양성그룹이 36명(40.4%)으로 흔하였다. 다변량분석에서 불량한 임상결과의 위험인자는 이전의 안질환(odds ratio [OR]: 3.744, p=0.010), 전방축농(OR: 2.941, p=0.030), 수술적 치료를 받은 경우(OR: 24.482, p<0.001)였다. 결론: 진균각막염은 KOH만 양성이면 임상양상이 양호하였고, 배양에서 균이 확인되면 심하였다. 진균이 의심되면 초기에 KOH염색과배양검사를 해야 하고, 불량한 임상결과의 위험인자가 있을 경우 조기에 최대한 약물치료를 시행해야 한다. Purpose: To describe the clinical manifestations, causative organisms, treatment, and prognostic factors of fungal keratitis based on analysis of patients over the past 20 years. Methods: A total of 177 patients (177 eyes) with fungal keratitis, who were diagnosed by smears and cultures, were reviewed retrospectively. Sex, age, predisposing factors, causative organisms, clinical manifestations, treatment, and prognosis were evaluated. The patients were divided into three groups: only potassium hydroxide (KOH)-positive, only culture-positive, and KOH- and culture-positive. Logistic regression was performed to identify the factors associated with a poor clinical outcome. Results: The mean age of the patients was 67.4 ± 11.3 years; 107 (60.5%) patients were men. The most common predisposing factor was ocular trauma (57.6%), especially by plants (29.4%). The most prevalent filamentous fungi were Fusarium species (31.6%, 49 isolates), and the most prevalent yeasts were Candida species (11.0%, 17 isolates). In cases of bacterial and fungal keratitis, filamentous fungus with Gram-positive bacterial infection (70.7%, 29/41) was the most common presentation. Visual improvement after treatment was common in the KOH-positive group (79.2%, 19/24), while visual deterioration after treatment was common in the culture-positive group (40.4%, 36/89). Previous ocular disease (odds ratio [OR]: 3.744, p = 0.010), hypopyon (OR: 2.941, p = 0.030), and surgical treatment (OR: 24.482, p < 0.001) were risk factors for a poor clinical outcome in the multivariate logistic regression model. Conclusions: Clinical prognosis was good in the KOH-positive only group, but poor in the culture-positive group. If fungal keratitis is suspected, diagnostic KOH staining and culture tests should be performed initially. Early intensive antifungal medical treatments are necessary for patients with risk factors for poor clinical outcomes.
김상규(Sang Gyu Kim),조남천(Nam Cheon Cho),윤광수(Kwang Soo Yoon),김대성(Dae Sung Kim),노병선(Byoung Seon Rhoe) 대한소화기학회 1995 대한소화기학회지 Vol.27 No.2
N/A Background/Aims: The mnjority of the patients with carcinoma of the gallbladder have anextremely poor prognosis because ot' its highly malignant nature characterized by early metastasis and rapid progression. The objective of this study is to evaluate the effect of an early diagnosis and treatment to gallbladder carcinoma on the patients' 1ong-term survival. Methods: A retrospec- tive study was conducted on reports of 32 gallbladder carcinoma patients who underwent surgical procedure from January 1982 to December l993. Results: Patients' ages ranged in their fifties and sixties, and the and sex ratio was l to 3 with female predominance. Among the clinical symptoms, right upper quadrant abdominal pain was the most common, followed by weight loss and jaundice. Right upper quadrant tenderness was the most frequent physical finding followed by jaundice and palpable mass. As for the duration of the symptoms, 18 cases(56.3%) showed less than one month, 12 cases(37.S%) showed less than six months, and 2 cases(6.2k) showed less thanone year before diagnosis. The correct preoperative diagnosis of carcinoma of the gallbladder was made only in 12 cases(43.7%). Other diagnosis include cholecystitis, common bile duct cancer, hepatoma and pancreatic head cancer. All of the 32 cases underwent laparotomy and among them, cholecystec- lomy was impossible in l4 cases(43.7%) because of their advanced stage of V by Nevin classification. Radical or plliative cholecystectomy was performed in the remaining l8 cases (S6,3/r). The most common metastatic site was liver(68.8%), followed by regional lymph nodes (56.2/), common bile duct(34.4%), and grcater omentum(21.9%). The histologic examination of tumor revealed adenocarcinoma(93.8/c), squamous carcinoma(3.I%), and adenosquamous carcino- ma(3.1%). Follow-up reports of patients ufter surgery were ovailable for 30 patients. Among them l8 cases(60.0%) survived for less than one year and rnost of their stage was V. Only 6 patients survivcd heyond two years. Among them, 4 cases(l3.3%) survived beyond 3 years. Conclusion: The poor survival of' primary gallbladder cancer patients could he altered by earlier diagnosis or more aggressive surgical procedures. (Korean J Gastroenterol 1995;27:228 - 236)
조상일(Sang Il Cho),유인천(In Cheon You),조남천(Nam Chun Cho),안 민(Min Ahn) 대한안과학회 2021 대한안과학회지 Vol.62 No.2
목적: 7세 여자아이에서 발생한 긴속눈썹증 1예를 보고하고자 한다. 증례요약: 7세 여자아이가 영유아 검진시 발견된 시력저하를 주소로 내원하였다. 내원 당시 나안시력 우안 0.2, 좌안 0.3이었으며, 양안 상, 하안검 속눈썹의 길이와 수의 증가를 보였다. 양안 속눈썹의 길이는 주변부에서 10 mm, 중심부에서 15 mm였다. 경도의 속눈썹의 각막찌름과 경도의 안검하수가 관찰되었으며 추가로 시행한 안저검사 및 시유발전위검사에서 특이 소견은 발견되지 않았다. 긴속눈썹증의 가족력은 없었으며 긴속눈썹증을 일으킬 만한 특이 소견은 발견되지 않았다. 혈액검사상 이상 소견은 없었으며 특이 약물 복용력 또한 없었다. 현재 긴속눈썹증 진단하에 경도의 시력저하 및 안검하수로 경과 관찰 중이다. 결론: 긴속눈썹증은 가족력 및 다양한 선천성 질환, 후천적 요인에 의하여 발생하는 것으로 알려져 있으나 특별한 원인 없이 선천적으로 발생하는 경우도 있으므로 이에 대하여 주지할 필요가 있다. Purpose: To report a case of congenital trichomegaly. Case summary: A 7-year-old girl visited our clinic with decreased visual acuity. The uncorrected visual acuity was 0.2 in the right eye and 0.3 in the left eye. The length and number of upper and lower eyelashes were increased. The eyelash length was 10 mm on the peripheral edge and 15 mm in the central area. Trichiasis and ptosis were also noted. There were no abnormal findings in the additional fundus examination or visual evoked potential test. There was no family history of trichomegaly, no abnormalities in blood test results, and no medication history. The patient is currently undergoing follow-up treatment for low visual acuity and mild ptosis under the diagnosis of trichomegaly. Conclusions: Trichomegaly is associated with family history, various congenital diseases, and acquired diseases. However, it may occur congenitally, without specific causes.