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홍지택 ( Ji Taek Hong ),정석 ( Seok Jeong ),이돈행 ( Don Haeng Lee ),김성현 ( Seong Hyun Kim ),민상준 ( Sang Joon Min ),정현정 ( Hyun Jung Chung ),전용선 ( Yong Sun Jeon ) 대한내과학회 2012 대한내과학회지 Vol.83 No.4
Emphysematous infections of the abdomen are potentially life-threatening conditions that require aggressive medical and surgical management. Emphysematous pancreatitis is an uncommon disease that presents as acute pancreatitis with intra-parenchymal gas at the time of diagnosis. Traditionally, emphysematous pancreatitis is an indication for surgical intervention. However, a few cases of emphysematous pancreatitis, managed successfully without surgical debridement have been reported. We present a case of emphysematous pancreatitis managed medically without surgical debridement in a 56-year-old male. (Korean J Med 2012;83:485-489)
한 종합전문병원에서의 2009년 H1N1 대유행인플루엔자와 관련된 심폐질환 입원환자수의 변화-계절인플루엔자와의 비교
나소연,홍지택,임재형,이정환,김아름,김미정,이혜진,정문현,백지현,이진수,박신구 대한감염학회 2011 Infection and Chemotherapy Vol.43 No.5
Background: The world encountered the global outbreak of an H1N1 influenza pandemic in 2009. Influenza has accounted for grave outcomes, not only through infectious complications, but also through the exacerbation of underlying chronic diseases. A substantial number of confirmed or probable cases of influenza had been reported during the 2009 H1N1 pandemic in South Korea, but a review of the development of influenza-related complications or the exacerbation of underlying chronic diseases has been absent. This study aims to understand the influence of the 2009 pandemic on the exacerbation of existing cardiopulmonary diseases. Materials and Methods: We surveyed the number of hospitalized patients with a diagnosis of pneumonia, asthma, chronic obstructive pulmonary disease, acute myocardial infarctions, and heart failure during the period of the 2009 H1N1influenza pandemic in a 950-bed teaching hospital in Korea. Three influenza seasons from 2007 to 2009 were compared via a medical records review. Data collection included the number of hospitalizations, patient age, number of deaths from all causes, and underlying medical conditions of fatal patients. Results: The weekly number of cardiopulmonary hospitalizations showed no differences between the 2009 pandemic influenza period and seasonal influenza epidemics (53 and 56 on average, respectively), but the total number of hospitalized patients during the pandemic influenza period was 1481, whereas there were 625 on average for seasonal influenza. The hospitalization rate for patients under five years of age exceeded that of the patients sixty years of age or older in pandemic influenza, and the hospitalization rate of patients twentyfive to fifty-nine during pandemic influenza was significantly higher than that of seasonal influenza outbreaks (P=0.012). On the other hand, the hospitalization rate of the patients sixty years of age or older during the pandemic influenza period significantly fell short of that in past seasonal influenza periods (P<0.001). However, the patients sixty years of age or older had the highest case fatality rate during both periods. The total number of deaths among hospitalized patients with cardiopulmonary diseases in pandemic influenza and seasonal influenza epidemics was 87 and 46 on average, respectively. Weekly fatal cases were 3 and 4. Conclusions: The cardiopulmonary hospitalization rate during the pandemic period outnumbered that of preceding seasonal influenza epidemics by its extended length. But, the virulence or disease severity of the 2009 H1N1 and seasonal influenza seems to be little different. A larger-scale epidemiological investigation is necessary.
면역적격인에서 고립성 폐결절로 발현된 폐 효모균증: 증례보고 및 국내문헌 고찰
이정환,홍지택,신천호,김루시아,이경희,조재화,유정선,곽승민,이홍렬,남해성 순천향대학교 순천향의학연구소 2011 Journal of Soonchunhyang Medical Science Vol.17 No.2
In immunocompetent individuals, pulmonary cryptococcosis is a rarely diagnosed fungal infection. It’s common radiological findings are multiple pulmonary nodules. We report a case of pulmonary cryptococcosis in a 67-year-old woman who presented with solitary pulmonary nodule (SPN) on chest computed tomography (CT). She complained of intermittent blood tinged sputum for 10 days. She was a non-smoker and had no clinical evidence of immonosuppression. Pathological examination of the lung tissue core via percutaneous fine needle biopsy revealed chronic granulomatous inflammation compatible with cryptococcosis on the special stain. She received 6 months of antifungal therapy with fluconazole and the SPN was disappeared on the CT after antifungal therapy. We also reviewed that the features of pulmonary cryptococcosis presenting SPN in immnocompetent patients reported in the Korean literatures.
A rare case of spinal epidural abscess due to Streptococcus pneumoniae
나소연,정주홍,홍지택,백지현,이진수,정문현 대한내과학회 2011 대한내과학회 추계학술대회 Vol.2011 No.1
Common manifestations of pneumococcal infection are otitis media, sinusitis, pneumonia, meningitis, and infrequently,brain abscess, endocarditis, and bone and joint infection can develop. Spinal epidural abscess caused by S. pneumoniae are rarely described. We report a rare case of pneumococcal spinal epidural abscess in an immunecompetent person, in which causative pathogen was confirmed by positive blood culture in the context of relevant clinical setting. A previously healthy 75 year-old woman presented with febrile sense and lower back pain. Physical examination was unremarkable with the exception of tenderness in lower lumbar spine, bilateral costovertebral angles. No neurological abnormal finding was noted. Initial vital sign showed no fever, but the patient was taking NSAIDs. Laboratory test revealed leukocytosis and elevated ESR (102 mm/hr) and CRP (28.56 mg/dl). Chest x-ray finding was unremarkable. Magnetic resonance imaging of spine confirmed epidural abscess extending from spinal level L3 to S1. Meanwhile patient complained left shoulder pain and MRI was taken which revealed septic arthritis at glenohumeral joint. Blood cultures were positive for S. pneumoniae with intermediate antibiotic resistance to penicillin(MIC:0.25). On 22nd hospital day, decompressive surgery was performed. Intraoperative pus culture showed no growth. The patient was diagnosed S. pneumoniae epidural abscess and septic arthritis with bacteremia. On 8th hospital day, in regard to culture result, intravenous penicillin G 20milion IU was given and maintained for 7 days, then was changed to cefotaxime due to failure of defervescence with concern for drug fever. Because of persistent fever, cefotaxime was switched to levofloxacin considering cross-reactivity of cephalosporin with penicillin, and maintained afterwards. After near 2 months of antibiotic therapy, interval regression of epidural abscess was found in MRI. Patient was discharged with oral levofloxacin for outpatient follow-up. S. pneumoniae is a virulent and invasive eorganism, one should remind that S. pneumoniae can be implicated in potentially devastating invasive infections, such as epidural abscess.
증례 : 내분비-대사 ; 중추성 요붕증과 제2형 당뇨병이 동반된 고혈당성 고삼투압 증후군 1예
이정환 ( Jung Hwan Lee ),홍지택 ( Ji Taek Hong ),민상준 ( Sang Joon Min ),홍성빈 ( Seong Bin Hong ),남문석 ( Moonsuk Nam ),김용성 ( Yong Seong Kim ),김소헌 ( So Hun Kim ) 대한내과학회 2012 대한내과학회지 Vol.82 No.1
본 저자들은 제2형 당뇨병이 발생하였고, 특발성 중추성 으로 추정되는 요붕증에 의해 고혈당성 고삼투압성 증후군의 임상적 형태로 나타난 환자를 경험하였다. 수액치료와 슐린 치료 및 데스모프레신에 의해 호전된 증례를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Diabetes insipidus is a disorder caused by complete or partial deficiency or unresponsiveness to antidiuretic hormone. Both diabetes mellitus and diabetes insipidus are well-known causes of polyuria and polydipsia. Although Wolfram Syndrome, which is characterized by the concurrence of diabetes mellitus and diabetes insipidus along with optic atrophy and ataxia, is frequently reported, the concurrence of diabetes insipidus and type 2 diabetes mellitus without optic atrophy and deafness is rare. We report a 31-year-old woman presenting with hyperglycemic hyperosmolar syndrome caused by type 2 diabetes mellitus complicated with concurrent central diabetes insipidus. (Korean J Med 2012;82:90-94)