Causes and Predictive Factors Associated with "Diagnosis Changed" Outcomes in Patients Notified as Tuberculosis Cases in a Private Tertiary Hospital

Kang, Byung Ju,Jo, Kyung-Wook,Park, Tai Sun,Yoo, Jung-Wan,Lee, Sei Won,Choi, Chang-Min,Oh, Yeon-Mok,Lee, Sang-Do,Kim, Woo Sung,Kim, Dong Soon,Shim, Tae Sun The Korean Academy of Tuberculosis and Respiratory 2013 Tuberculosis and Respiratory Diseases Vol.75 No.6

Background: The aim of our study was to evaluate the "diagnosis changed" rate in patients notified as tuberculosis (TB) on the Korean TB surveillance system (KTBS). Methods: A total of 1,273 patients notified as TB cases on the KTBS in one private tertiary hospital in 2011 were enrolled in the present study. Patients were classified into three groups: "diagnosis maintained", "diagnosis changed" (initially notified as TB, but ultimately diagnosed as non-TB), and "administrative error" (notified as TB due to administrative errors). Results: Excluding 17 patients in the "administrative error" group, the "diagnosis maintained" and "diagnosis changed" groups included 1,097 (87.3%) and 159 patients (12.7%), respectively. Common causes of "diagnosis changed" were nontuberculous mycobacterial (NTM) disease (51.7%, 61/118), and pneumonia (17.8%) in cases notified as pulmonary TB, and meningitis (19.5%, 8/41) and Crohn's disease (12.2%) in cases notified as extrapulmonary TB. Being older than 35 years of age (odds ratio [OR], 2.18) and a positive acid-fast bacilli stain (OR, 1.58) were positive predictors and a TB-related radiological finding (OR, 0.42) was a negative predictor for a "diagnosis changed" result via multivariate logistic regression analysis in pulmonary TB cases. Conclusion: Because of a high "diagnosis changed" rate in TB notifications to the KTBS, the TB incidence rate measured by the KTBS may be overestimated. Considering the worldwide trend toward increased NTM disease, the "diagnosis changed" rate may increase over time. Thus, when reporting the annual TB notification rate in Korea, the exclusion of "diagnosis changed" cases is desirable.

Causes and Predictive Factors Associated with “Diagnosis Changed” Outcomes in Patients Notified as Tuberculosis Cases in a Private Tertiary Hospital

( Byung Ju Kang ),( Kyung Wook Jo ),( Tai Sun Park ),( Jung Wan Yoo ),( Sei Won Lee ),( Chang Min Choi ),( Yeon Mok Oh ),( Sang Do Lee ),( Woo Sung Kim ),( Dong Soon Kim ),( Tae Sun Shim ) 대한결핵 및 호흡기학회 2013 Tuberculosis and Respiratory Diseases Vol.75 No.6

Background: The aim of our study was to evaluate the “diagnosis changed” rate in patients notified as tuberculosis (TB) on the Korean TB surveillance system (KTBS). Methods: A total of 1,273 patients notified as TB cases on the KTBS in one private tertiary hospital in 2011 were enrolled in the present study. Patients were classified into three groups: “diagnosis maintained”, “diagnosis changed” (initially notified as TB, but ultimately diagnosed as non-TB), and “administrative error” (notified as TB due to administrative errors). Results: Excluding 17 patients in the “administrative error” group, the “diagnosis maintained” and “diagnosis changed” groups included 1,097 (87.3%) and 159 patients (12.7%), respectively. Common causes of “diagnosis changed” were nontuberculous mycobacterial (NTM) disease (51.7%, 61/118), and pneumonia (17.8%) in cases notified as pulmonary TB, and meningitis (19.5%, 8/41) and Crohn`s disease (12.2%) in cases notified as extrapulmonary TB. Being older than 35 years of age (odds ratio [OR], 2.18) and a positive acid-fast bacilli stain (OR, 1.58) were positive predictors and a TB-related radiological finding (OR, 0.42) was a negative predictor for a “diagnosis changed” result via multivariate logistic regression analysis in pulmonary TB cases. Conclusion: Because of a high “diagnosis changed” rate in TB notifications to the KTBS, the TB incidence rate measured by the KTBS may be overestimated. Considering the worldwide trend toward increased NTM disease, the “diagnosis changed” rate may increase over time. Thus, when reporting the annual TB notification rate in Korea, the exclusion of “diagnosis changed” cases is desirable.

무증상 갑상선기능저하증 환자에서 Thyroxine 치료에 따른 혈청 지질 및 아포지단백의 변화

조보연,신찬수,김원배,고창순,김성연,박혜영,박건상,이홍규,박형규,김숙경 대한내분비학회 1996 Endocrinology and metabolism Vol.11 No.1

Background: Subclinical hypothyroidism(SCH) is a common biochemical abnormality which can be found in routine screening tests of thyroid function. We are increasingly faced with the question of whether its an indication for thyroxine replacement therapy. The effect of thyroxine replacement on lipid profile in SCH has aroused a great interest because of an association of overt hypothyroidism(OVH) with hyperlipidemia and increased risk of coronary artery disease. Method: We prospectively evaluated the changes in lipids and apoproteins before and after thyroxine replacement therapy in 23 patients with SCH and in 37 patients with OVH. We measured serum total cholesterol and triglyceride using autoanalyzer, high density lipoprotein(HDL) chole-sterol by dextran sulfate method, Apo A1 and Apo B by immunonephelometric assay. Results: Thyroxine replacement therapy significantly decreased total cholesterol, low density lipoprotein(LDL) cholesterol and apo B levels, but did not affect the level of triglyceride, HDL cholesterol or apo AI in patients with OVH. In SCH, thyroxine replacement therapy with the doses to normalize serum TSH concentrations also decreased significantly the level of cholesterol and LDL cholesterol albeit apo B levels did not change. Moreover, in most of patients with OVH (11 of 12) and in all of patients with SCH(5 of 5) who had had hyperchlesterolemia before treatment, thyroxine replament normalized their cholesterol and LDL cholesterol levels. Conclusion: In regard to the beneficial changes in blood lipid levels, patients with SCH should be treated, especially in cases who have other risk factors for the development of atherosclerosis. If thyroxine replacement only will reduce the incidence of coronary artery disease in SCH remains to be elucidated by long-term prospective studies(J Kor Soc Endocrinol 11:41-51, 1996).

정상인에서 도플러 초음파술을 이용하여 측정한 니트로글리세린 투여후 두개내 혈류속도의 변화

박일(Il Park),장경식(Kyoung Sig Chang),안기완(Gi Wan An),최연수(Yeon Soo Choi),국기용(Ki Yong Kook),홍순표(Soon Pyo Hong) 대한내과학회 1995 대한내과학회지 Vol.48 No.4

N/A Objectives: With advances in transcranial ultrasound technology, transcranial color-code Doppler ultrasonography provides the anatomical location of basal transcranial vessel and their blood flow. To study of changes of cerebral blood flow, we measured continuously the blood flow velocity of middle cerebral artery by transcranial Doppler(2.5MHz) before and after sublingual administration of 0.6mg. nitroglycerin in twenty healthy young persons. Methods: Pulse rate and systolic and diastolic blood pressure and velocity of percussion(P), tidal (T) and dicrotic(Dc) wave, and diastole(Ds), velocity time integral(VTI), mean velocity(V), pulsatility index(PI) were measured. Results: Heart rate was increased, and systolic blood pressure was decreased significantly two minutes after administration of nitroglycerin. Diameter of outer margin of color Doppler spectrum was increased, and P, T, Ds, VTI and V were decreased significantly after two minutes. PI was increased significantly after two minutes, but returned to baseline level soon. Conclusion: We concluded that dilatation and decreased blood flow velocity of middle cerebral artery were resulted by nitroglycerin.

만성 화농성 중이염의 세균학적 고찰

조남순,이영훈,강기훈,최제환,송태현,이병돈,장혁순,강주원,김연준 순천향의학연구소;Soonchunhyang Medical Research Institute 2000 Journal of Soonchunhyang Medical Science Vol.6 No.1

Background and Objectives : Chronic suppurative otitis media is one of the frequent diseases in otolaryngologic field. It is important to choose of antibiotics in the management of infectious disease. But the organisms in infections have been changed and resistance to antibiotics has been grown as the development of antibiotics has been achieved. And so it has been necessary to recognize the changes of organisms and resistance in antibiotics. Our study was performed to identify the pathogens isolated from discharges in chronic otitis media and evaluate the antibiotic agents, to recognize the change of to resistance to·antibiotic agents and to use the appropriate anitiotics. Materials and Methods : Retrospectively, authors reviewed the backeriologic study of 114 cases of chronic suppurative otitis media who visited the Department of Otolaryngology, Soonchunhyang University in Seoul from Nov. 1996 to Oct. 1999 and analyzed 101 strains and its sensitivity test to various antibiotics. Result : In 93 cases in which pathogenic organism was isolated, single infection was 85 cases(91.4%) and mixed infection was 8 cases(8.6%). The most frequent pathogenic organism was Staphylococcus aureus(59.4%), Pseudomonas aeruginosa(13.9%), Providencia(4.8%), Alcaligenes(3.0%) and Streptococcus pneumoniae(2.9%) were the next. Methicilline-Resistance Staphylococcus aureus was 34 cases(57.6%) of Staphylococcus aureus. Staphylococcus aureus was sensitive to Vancomycin(96.7%), Trimethoprim-Sulfamethoxazole (57.6%), Cefuroxime(42.4%) and Ciprofloxacin(40.7%) but resistant to Penicillin(94.9%). Pseudomonas aeruginosa was sentitive Amikacin(100%), Ciprofloxacin(100%) and Gentamicin(67%). Conclusion : As MRSA recently was wide spread in community accquired infection as well as nosocomial infection, we must consider strict control of MRSA.

기능부전 혈액투석동정맥루 치료법으로서 경피경관혈관성형술의 임상적 의의 및 효과

정연순,김민대,신호식,정규식,유창현,김홍기,황일용,임학 대한신장학회 2002 Kidney Research and Clinical Practice Vol.21 No.2

목 적 : 기능부전 혈액투석동정맥루의 치료로서의 경피경관혈관성형술의 임상적 의의와 장기개통률에 영향을 미치는 요소에 대하여 알아보고자 본 연구를 시행하였다. 방 법 : 기능부전 혈액투석동정맥루로 정맥조영술을 시행한 53명의 환자(총 61예) 중 동정맥루의 협착 및 폐쇄로 경피경관혈관성형술이 시도된 환자는 49명(총 57예)이었으며 이들의 정맥조영술 적응증을 알아보았다. 이 중 경피경관혈관성형술을 성공적으로 시행받은 38명의 환자(총 46예)를 대상으로 하여 임상적 특성과 6, 12, 24개월의 개통률을 분석하였다. 환자의 연령, 당뇨병의 유무, 만성신부전의 병력기간, 동정맥루의 종류와 사용기간, 혈액투석동정맥루의 위치와 협착의 길이, 잔여협착의 정도 등이 장기개통률에 미치는 영향을 Kaplan-Meier method에 의한 log-rank test를 이용하여 평가하였고, multivariate analysis로 Cox Regression Model을 사용하여 평가하였다. 통계적 유의성 검정은 p값이 0.05 미만인 경우로 하였다. 경피경관혈관성형술을 실패한 경우의 정맥조영술 소견과 시술 전후의 합병증을 조사하였다. 결 과 : 시술의 성공률은 80.7%(46/57)였으며 성공한 예의 추적 검사에서 개통률(postintervention primary patency)은 6, 12, 24개월 각각 68, 38, 5%였다. 재협착으로 인해 2번의PTA를 시행받은 환자가 8명 있었으며, 이들 경우를 포함했을 때의 개통률(postintervention assisted primary patency)은 6, 12, 24개월 각각 69, 40, 10%였다. 환자의 연령, 당뇨병의 유무, 만성신부전의 병력기간, 동정맥루의 종류와 사용기간, 혈액투석동정맥루의 위치와 협착의 길이, 잔여협착의 정도 등이 장기 개통률에 미치는 영향은 통계학적으로 유의한 경우는 없었다(p>0.05). 혈관성형술을 실패한 경우는 총 11예로 대량혈전으로 인한 완전폐쇄가 6예, 광범위한 과도한 혈관협착이 5예였다. 시술과 연관된 합병증은 없었다. 결 론 : 이상의 결과로 동정맥루 협착이 동반된 혈액투석 환자에서 경피적경관혈관성형술은 안전하고 비교적 효과적인 치료법으로 사료되며, 장기 개통률에 영향을 미치는 요소는 없었다. Purpose : The purpose of this study was to evaluate the effect of percutaneous transluminal angioplasty( PTA) and to determine patency rates and the factors affecting the long-term patency rates in the management of insufficient arteriovenous fistulae. Methods : Sixty-one cases of insufficient dialysis shunts in 53 patients underwent venography of the fistula. These patients' indications of venographys were reviewed. Forty-six cases of insufficient dialysis shunts in 38 patients were treated by PTA. These patients' clinical characteristics and patency rates were evaluated. According to the patient's age, history of diabetes mellitus, duration of renal failure, type and age of the arteriovenous fistula, the site of AVF and length of the stenosis, and to the degree of residual stenosis, patency rates were compared within each subgroup using the Kaplan-Meier logrank test. To estimate reasons for the incidence of vascular access failure, Cox regression model was used. Venographic findings of failed PTAs and PTA related complications were evaluated. Results : The success rate was 80.7%. In cases in which initial success was obtained, postintervention primary patency rate at 6, 12 and 24 months were 68%, 38% and 5% respectively. With repeatitive PTAs, postintervention assisted primary patency rate at 6, 12 and 24 months were 69%, 40% and 10% respectively. The effect of the above mentioned factors(age, DM, duration of CRF etc.) on long-term patency was not statistically significant(p>0.05). Among 11 cases of failed PTA, there were 6 cases of total obstruction due to massive thrombosis and 5 cases of extensive vascular stenosis(>5 cm of length, >4 sites of stenosis and >75% of stenosis in all cases). There were no PTA related complications. Conclusion : PTA is considered to be an effective and safe treatment modality for shunt stenosis. No factors affected long-term patency rates in our study. (Korean J Nephrol 2002;21(2):276-284)

政治學의 科學的 方法論 批判的 檢討

鄭然植,梁淳彰 경북대학교 사회과학연구소 1992 社會科學硏究 Vol.8 No.-

The paper is designed to analyze the so-called scientific approach in Political Science and through its criticism present a general framework for a new methodology mostly focused on the Marxist perspectives. To meet the basic requirements for the fulfilment of the above mentioned purpose, the paper sets the history of modern Western philosophy with respect to methodology on the opposition between the problem of value and that of fact. Historicism was mostly wrapped up in the problem of value, while positivism that of fact. The so-called scientific approach can be understood in the positivist tradition, dealing solely with the problem of fact and thus excluding that of value, as was shown in Max Weber and Talcott Parsons. Scientific approach in contemporary Political Science is integrated under the comprehensive category of behavioralism, which is composed of two main trends, that is, System Analysis and Structral-functional Analysis. Contrary to its original project, scientific approach only made it clear that objective investigation of fact cannot be indifferent to the problem of value. Post-behavioral revolution aims at the dialectical synthesis of value and fact. Till the present time, despite various theoretical attempts such as behavioralist revisionism and the revival of political philosophy, the dialectical synthesis of value and fact is possible only within the Marxist perspectives. However, apart from the validity of its philosophical premises, Marxist perspectives bring forth a complexity of problems when applied to the actual political research. This revolves around the interpretation of Social Formation. To present the Marxist perspectives as a refined methodology both in domestic and international political researches, it is necessary to make sure that the interpretation of Social Formation should be performed within the following three categories : determination of superstructure by economic base, relative autonomy of superstructure, and interactions between economic base and superstructure.

다발성 간종괴의 형태로 나타난 특발성 과호산구 증후군 치험1예

최승오,연규민,이승민,김순제,왕준호,박형석,이재동,진춘조,이창훈,신현준,김정은 건국대학교 의과학연구소 2004 건국의과학학술지 Vol.14 No.-

Hypereosinophilic syndrome is characterized by persistent blood eosinophilia of 1,500/ul or more in the absence of known causes and multiorgan dysfunction by eosinophil-related tissue damage. In Korea, some cases of hypereosinophilic syndrome with hepatic involvement have been described with prolonged benign clinical courses. Most of them were diffuse or multifocal lesions in imaging studies, and a few case presenting as a single mass has been described. Here we report a case of hypereosinophilic syndrome with hepatic involvement in a 65-year-old man who presented with multifocal mass lesions. By abdominal US and CT scan, multiple, ill-defined nodules were detected in throughout the liver. Liver biopsy revealed severe eosinophilic hepatitis, suggestive of hypereosinophilic syndrome. Hepatic mass lesions improved after steroid administration for several weeks.

비파괴적 분석법을 활용한 활음진 함유 에멀젼의 인체효능평가

배지현,안성연,이해광,안순애,문성준,장이섭 한국비파괴검사학회 2004 학술대회 논문집 Vol.- No.-

최근 한방화장품이 각광을 받으면서 한방에서 말하는 피부개선효과에 대한 적절한 평가법을 찾는 연구가 많이 수행되고 있다. 본 연구에서는 피부 항산화 효과가 우수한 산사자, 당귀, 홍화, 두충, 숙지황의 초임계추출물 (활음진, 活陰眞)의 혈액순환 개선효과를 적외선 열화상 이미지 분석 및 LaserDoppler Perfusion Imager를 이용한 분석을 통해 평가하였다. 평소 손발이 차가운 여성 11명을 대상으로 활음진을 포함한 에멀젼을 1주일간 도포하게 하였으며, 도포전과 1주일간 사용한 후 피부 온도와 혈류량을 비교하였다. 그 결과 얼굴의 피부 온도가 증가하였고, 이마, 눈위, 뺨정면 부위에서 시료 사용 후 유의한 증가를 보였다. 본 연구를 통하여 활음진 성분을 포함한 에멀젼의 혈액순환 개선효과를 확인하였을 뿐만 아니라 한방적 접근을 통한 피부개선효과를 평가하는데 적절한 실험모델을 수립하였다.

종격동 종괴를 의심케한 우대동맥궁 1례

김만우,백학연,정춘해,장경식,홍순표,조건국,김종진 朝鮮大學校 附設 醫學硏究所 1987 The Medical Journal of Chosun University Vol.12 No.1

Developmental anomalies of the aortic arch, commonly known as vascular rings, are relatively rare congenital vascular anomalies which can compress the trachea and esophagus. One routine chest film of a patient who was checked and hepatoma-diagnosed in Internal Medicine, Chosun University Hospital left the room for doubt of mediastinal mass. But no subjective symptoms for the mass was told by the patient. This is to report our experience of a patient having right side aortic arch with aberrant left subclavian artery, as proved by diagnosis, but none of congenital heart disease. This right side aortic arch with aberrant left subclavian artery is the most frequent type among right aortic arch, the anomaly of which is usually detected from the incidental suspicion for mediastinal mass at routine chest film; because no symptoms are accompanied therewith.