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성길명,이재천,이종후,김정홍,김미옥 대한결핵및호흡기학회 2014 Tuberculosis and Respiratory Diseases Vol.76 No.4
Background: Mycobacterial identification in active pulmonary tuberculosis (APTB) is confirmative, even though successful rates using self-expectorated sputum are limited. Sputum specimens collected by hypertonic saline nebulization showed higher bacteriologic diagnostic sensitivities over those of self-expectoration, mostly studied in smear-negative or sputum-scarce patients. The efficacy of induced sputum was rarely assessed in real clinical settings. Methods: A prospective randomized case-control study was performed in one hospital. The subjects highly suspicious of APTB were asked to provide 3 pairs of sputum specimens in 3 consecutive days. The first pairs of the specimens were obtained either by self-expectoration (ES) from the next day of the visit or sputum induction with 7% saline nebulization in clinic (SI), and the other specimens were collected in the same way. The samples were tested in microscopy, culture, and polymerase chain reaction (PCR). The outcomes of the bacteriological diagnosis were compared. Results: Seventy six patients were assigned to either ES (38 subjects, median age of 51, 65.8% male) or SI (38 subjects, median age of 55, 52.6% male). APTB was clinically confirmed in 51 patients (70.8%), 27 in ES and 24 in SI. Among the APTB, more adequate specimens were collected from SI (41/65, 63.1%) than ES (34/80, 42.5%) (p=0.01). Bacteriological confirmation was achieved in 14 (58.3%) patients in SI, and 13 (48.1%) in ES (p=0.46). In the same-day bacteriological diagnosis with microscopy and PCR, there were positive results for 9 patients (37.5%) in SI and 7 patients (25.9%) in ES (p=0.37). Conclusion: Sputum induction improves sputum specimen adequacy. It may be useful for the same-day bacteriological diagnosis with microscopic examination and PCR.
성길명,김미옥 대한 소아알레르기 호흡기학회 2019 Allergy Asthma & Respiratory Disease Vol.7 No.1
Exogenous lipoid pneumonia is an uncommon medical condition resulting from aspiration or inhalation of oily material. Generally, lipoid pneumonia has nonspecific clinical and radiological presentations, and may be misdiagnosed as bacterial pneumonia or lung cancer. We describe an unusual case of exogenous lipoid pneumonia accompanied by peripheral blood and pulmonary eosinophilia. A 63-year-old man was admitted with progressively worsening exertional dyspnea and productive cough for 5 days. A chest radiograph showed abnormalities in the lower lobe of the right lung, and a diagnosis of community-acquired pneumonia was made; intravenous antibiotics were administered. However, dyspnea and hypoxia gradually worsened and peripheral blood eosinophilia developed. A bronchoscopy was performed and bronchoalveolar lavage fluid analysis showed markedly increased numbers of eosinophils (40%). Subsequently, a comprehensive review of history revealed that he fell asleep with camellia oil in his mouth for 2 weeks to relieve foreign body sensation of the throat. Sputum and bronchoalveolar lavage fluid cytology showed the presence of lipid-laden macrophages. He was diagnosed with lipoid pneumonia and acute eosinophilic pneumonia. Chest radiograph and symptom were rapidly improved after treatment with intravenous methylprednisolone.
성길명,김송이,주승재 대한응급의학회 2011 대한응급의학회지 Vol.22 No.3
Digoxin, also known as digitalis, is a purified cardiac glycoside extracted from the foxglove plant, Digitalis purpurea. Digoxin-mediated cardiac glycoside toxicity due to accidental plant ingestion can occur. Presently, a 69-year-old woman visited our emergency department with epigastric pain, nausea and vomiting after ingestion of a plant. Physical examination and initial laboratory blood test results were within normal limits. An electrocardiogram (ECG)showed sinus bradycardia with first degree AV block and diffuse ST-segment depressions in a “scooping” pattern. The plant was identified as D. purpurea, and the patient’s serum digoxin level was 2.89 ng/mL. The patient was treated conservatively in the absence of any life-threatening event. Recovery was uneventful.
비전형적인 요통과 아급성 신부전으로 발현한 살모넬라요근 농양 1예
이재근,성길명,김현우,장은희 대한내과학회 2011 대한내과학회지 Vol.81 No.5
Salmonella is a rare cause of psoas abscess and infectious spondylitis. We report a case of a 62-year-old male patient with Salmonella group D psoas abscess and infectious spondylitis as low back pain and subacute renal failure. The patient who had a previous operation history of abdominal aortic aneurysm rupture was admitted to evaluate low back pain and abnormal renal function. Bilateral psoas abscess and infectious spondylitis of lumbar vertebrae was detected by spine MRI and Salmonella group D was isolated in aspirated fluid of psoas abscess. After long term antibiotics treatment (ceftriazxone and ciprofloxacin), psoas abscess and spondylitis was markedly improved, however, his renal function was not recovered to progress to end stage renal disease. (Korean J Med 2011;81:657-662) 저자들은 복부 대동맥류 파열 병력이 있는 환자에서 Salmonella group D로 인한 요근 농양 및 아급성 신부전증이 발생하여 신대체 요법을 시행하게 된 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다.
급성심근경색 환자에게 적용된 정맥-정맥 체외막산화기의 임상 효과
김수완,성길명,이재근,Kim, Su Wan,Seong, Gil Myeong,Lee, Jae-Geun 제주대학교 의과학연구소 2018 The Journal of Medicine and Life Science Vol.15 No.2
Extra-corporeal membrane oxygenation (ECMO) has the potential to rescue patients in cardiac arrest or respiratory failure. ECMO has two systems such as veno-arterial and veno-venous circulation. In cardiac arrest resulting from acute myocardial infarction, veno-arterial ECMO is mandatory for systemic circulation and oxygenation. A 75-year old female patient underwent primary coronary intervention for acute myocardial infarction. Despite successful revascularization, recurrent ventricular tachycardia and heart failure were progressing. We performed a veno-arterial ECMO through the femoral artery and vein, then the patient seemed to be stable clinically. However, laboratory studies, echocardiography, and vital signs indicated multi-organ failure and decreasing cardiac function. We found out an error that we performed veno-venous ECMO instead of veno-arterial ECMO. We added a femoral artery cannula and exchange the circuit system to veno-arterial ECMO. While the systemic circulation seemed to be recovered, the left ventricular function was decreased persistently. A hypovolemia resulting from pulmonary hemorrhage was occurred, which lead to ECMO failure. The patient died of cardiac arrest and multi-organ failure 23 hours after ECMO. Because the color of arterial and venous circuits represent the position and efficacy of ECMO, if unexpected or abnormal circuit colors are detected, prompt and aggressive evaluation for ECMO function is mandatory.