국가예방접종전산등록체계 개발을 위한 민간의료 기관 하부구조 및 환경 조사연구

이무식,김은영,이건세,이석구,홍지영,김건엽,김대경,신의철,이연경,기몽서,나백주,김영택 한국모자보건학회 2003 한국모자보건학회지 Vol.7 No.2

아미노글리코사이드 사용제한에 따른 병원성 균혈증 유발 그람음성간균의 내성변화 및 임상적 의의

오종택,김신우,손종원,도병훈,한승우,신병철,박지현,이종명,김능수 대한감염학회 2003 감염과 화학요법 Vol.35 No.4

목적 : 항균제 오남용으로 인한 내성균의 출현, 약물부작용의 발생 및 약제 비용의 증가는 환자 개인뿐만 아니라 사회적으로 문제가 되고 있다. 본 연구는 항생제의 오남용을 막기 위한 제도의 일환으로 시행한 아미노글리코사이드 사용 제한정책의 비용 효과적인 측면을 조사하고 그람음성간균에 의해 병원성 균혈증이 발생한 환자들을 대상으로 이 정책이 항생제 내성률과 환자 사망률에 미치는 영향을 연구하였다. 방법 : 930병상 규모의 3차 병원인 일개 대학병원에서 아미노글리코사이드 사용제한정책이 시행된 직후인 2002년 3월에서 9월 사이에 그람음성간균(Acinetobacter baumannii, Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli, Enterobacter cloacae, Enterobacter aerogenes, Serratia marcescens, Stenotrophomonas maltophilia, Burkholderia cepacia)에 의해 발생한 병원성 균혈증 환자 60명(실험군)과, 이 정책이 시행되기 전에 입원한 환자들 중 균주별로 같은 수만큼 선별한 병원성 균혈증 환자 60명(대조군)의 의무기록을 후향적으로 조사하였다. 결과 : 아미노글리코사이드 사용제한정책이 시행된 시기인 2002년 3월에서 9월 사이에 처방된 아미노글리코사이드 사용량 및 비용을 이 정책이 시행되기 전인 2001년 3월에서 9월 사이와 비교한 결과, 아미노글리코사이드의 사용량(antimicrobial utilization density)은 사용제한 후 225.2에서 130.3으로 42% 감소하였고 약제 비용은 44% 감소하였다. 아미노글리코사이드 사용제한 후 병원성 균혈증을 유발한 그람 음성간균의 이 항생제에 대한 내성률은 유의한 변화를 보이지 않았으며 균혈증과 직접 연관된 사망률도 환자의 나이, 성별, 기저질환 및 원발병소 등을 보정할 경우 유의한 차이를 보이지 않았다(40.4% vs. 24.1%, P=0.11). 결론 : 아미노글리코사이드를 5일을 초과한 사용 시 감염전문가의 사전 승인을 필요로 하는 사용제한정책은 아미노글리코사이드의 사용량과 비용을 유의하게 감소시켰다. 또한 이 정책 시행 후 그람음성간균에 의한 균혈증 환자에서 균혈증으로 인한 사망률과 아미노글리코사이드에 대한 내성률은 유의한 차이가 없었다. Objective : To evaluate the effects of an aminoglycoside restriction policy on expenditures for aminoglycosides, antimicrobial resistance rates and clinical outcome of nosocomial bacteremia caused by Gram-negative bacilli (GNB). Methods : Starting in February, 2002, a prior consultation with an infectious disease specialist for using aminoglycoside antibiotics over 5 days was required in a 930-bed university hospital. In retrospective analysis of medical records 7 months after initiation of the aminoglycoside restriction policy, sixty cases of clinically relevant nosocomial bacteremia caused by GNB were found. These bacteremic patients were compared with sixty, species-matched, control patients with nosocomial Gramnegative bacteremia before the policy for total expenditures for aminoglycosides, susceptibility to antibiotics and clinical outcomes of bacteremia. Results : During the same period of 7 months before and after the restriction policy, total expenditures for aminoglycosides decreased by 44% in cost (from 465,030,841 Won to 259,618,337 Won) and the antimicrobial utilization density of aminoglycosides decreased by 42% (from 225,2 to 130.3). On the other hand, the patterns of antibiotic susceptibility and bacteremia-related in-hospital mortality rates after the policy did not show a significant change, compared with those before the policy. Conclusion : Antibiotic restrictions are among the most popular methods to diminish the practice of antibiotic overuse in hospitals. In this study, requirement for prior approval of aminoglycoside use over 5 days led to a significant decrease in the amount and cost of total aminoglycosides without a significant change in susceptibility patterns and bacteremia-related mortality rates.

Warfarin skin necrosis mimicking calciphylaxis in a patient with secondary hyperparathyroidism undergoing peritoneal dialysis

( Jee Eun Park ),( Seong Gyu Byeon ),( Hee Kyung Kim ),( Seong Mi Moon ),( Ji Hoon Moon ),( Kee-taek Jang ),( Byung-jae Lee ),( Hye Ryoun Jang ),( Woo Seong Huh ),( Dae Joong Kim ),( Yoon-goo Kim ),( 대한신장학회 2016 Kidney Research and Clinical Practice Vol.35 No.1

Warfarin skin necrosis (WSN) is an infrequent complication of warfarin treatment and is characterized by painful ulcerative skin lesions that appear a few days after the start of warfarin treatment. Calciphylaxis also appears as painful skin lesions caused by tissue injury resulting from localized ischemia caused by calcification of small- to medium-sized vessels in patients with end-stage renal disease. We report on a patient who presented with painful skin ulcers on the lower extremities after the administration of warfarin after a valve operation. Calciphylaxis was considered first because of the host factors; eventually, the skin lesions were diagnosed as WSN by biopsy. The skin lesions improved after warfarin discontinuation and short-term steroid therapy. Most patients with end-stage renal disease have some form of cardiovascular disease and some require temporary or continual warfarin treatment. It is important to differentiate between WSN and calciphylaxis in patients with painful skin lesions.

The correlation between retinal sensitivity assessed by microperimetry and contrast sensitivity in diabetic macular oedema

Kim, Young Ho,Yun, Cheolmin,Kim, Jee Taek,Kim, Seong-Woo,Oh, Jaeryung,Huh, Kuhl British Medical Association 2014 British journal of ophthalmology Vol.98 No.12

<P><B>Aim</B></P><P>To investigate the relationship between contrast sensitivity (CS) and retinal sensitivity (RS) assessed by microperimetry (MP) in diabetic retinopathy (DR) with clinically significant macular oedema (CSME).</P><P><B>Methods</B></P><P>A retrospective study was performed with 35 eyes of 35 patients with DR and CSME. Retinal thickness (RT) and MP were tested with the spectral SD-optical coherence topography/scanning laser ophthalmoscope system. Mean central RT at the fovea centre's 1 mm zone (CRT) and at the fixation centre's 1 mm zone (FCRT) was measured. RS was tested at the fixation centre, within 2° and 4° areas. CS was measured with six target sizes (6.3°, 4.0°, 2.5°, 1.6°, 1.0°, 0.64°) with a contrast glare tester.</P><P><B>Results</B></P><P>The mean CRT and FCRT were 344.3±136.2 and 359.9±135.5 μm, respectively. Mean log CSs (−log10) with the six target sizes ranged from 0.19 to 1.32. The mean RS at the fixation centre, within 2°, and within 4° area were 8.51±4.81 dB, 8.58±3.88 dB and 9.22±3.56 dB, respectively. RS at all tested areas were significantly correlated to log CS with all target sizes (range, r=0.366–0.755; p=0.0001–0.030). CRT and FCRT were not significantly correlated to log CS or RS.</P><P><B>Conclusions</B></P><P>CS and RS showed moderately significant correlations in CSME. However, neither CS nor RS was correlated with RT in patients with CSME. It could be that CS and MP are complementary to each other and are useful tools in the evaluation of functional vision.</P>

Who should be admitted to the intensive care unit? The outcome of intensive care unit admission in stage IIIB–IV lung cancer patients

Kim, Yu Jung,Kim, Mi-Jung,Cho, Young-Jae,Park, Jong Sun,Kim, Jin Won,Chang, Hyun,Lee, Jeong-Ok,Lee, Keun-Wook,Kim, Jee Hyun,Yoon, Ho Il,Bang, Soo-Mee,Lee, Jae Ho,Lee, Choon-Taek,Lee, Jong Seok STOCKTON 2014 MEDICAL ONCOLOGY -NORTHWOOD THEN BASINGSTOKE THEN Vol.31 No.3

Thermally controlled wettability of a nanoporous membrane grafted with catechol-tethered poly(<i>N</i>-isopropylacrylamide)

Kim, Jee Seon,Kim, Taek Gyung,Kong, Won Ho,Park, Tae Gwan,Nam, Yoon Sung The Royal Society of Chemistry 2012 Chemical communications Vol.48 No.74

<P>A nanoporous membrane is coated with catechol-tethered poly(<I>N</I>-isopropylacrylamide). The thermosensitive variation of surface wettability determines the hindered diffusivity of dextran (40 kDa) through the nanopores.</P> <P>Graphic Abstract</P><P>A nanoporous membrane coated with catechol-tethered poly(<I>N</I>-isopropylacrylamide) regulates the diffusivity of macromolecules <I>via</I> thermally controlled wettability. <IMG SRC='http://pubs.rsc.org/services/images/RSCpubs.ePlatform.Service.FreeContent.ImageService.svc/ImageService/image/GA?id=c2cc32233a'> </P>

Free Paper Presentation : OS-5 ; Clinical Characteristics of Rituximab-Induced Interstitial Lung Disease

( Jee Min Kim ),( Jong Sun Park ),( Se Joong Kim ),( Yeon Joo Lee ),( Yeong Jae Cho ),( Ho Il Yoon ),( Jae Ho Lee ),( Choon Taek Lee ) 대한결핵 및 호흡기학회 2014 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.118 No.-

Background: Rituximab, monoclonal antibody to CD20, has been a cornerstone in the treatment of lymphoma and many connective tissue diseases. Although rituximab has been safely used for over 15years, rituximab-induced interstitial lung disease(R-ILD) is not infrequent and can be fatal in real clinical practice. We investigated clinical characteristics and risk factors for R-ILD. Methods: We identified patients who received rituximab as either monotherapy or part of combination therapy between March, 2003 and March, 2014 in Seoul National University Bundang Hospital. We retrospectively reviewed demographics, laboratory, and clinical course of patients with R-ILD. Results: Of 509 patients who received rituximab, 37 patients were compatible with R-ILD, with incidence being 7%. Most common clinical presentations were fever (51%) and dyspnea (48%), but about 12% were clinically asymptomatic except newly appeared bilateral gound-glass opacities in chest CT. The mean number of cycles of rituximab before disease onset was four (4.18th±0.57), and their bronchoalveolar lavage showed lymphocyte-dominant cellular components (58.84%±16.63). 5 patients died for respiratory failure even after steroid therapy. There were no statistically significant differences between patients with R-ILD and without R-ILD in terms of age, sex, disease status or extent, cumulative rituximab dose, underlying comorbidities, presence of pulmonary involvement of lymphoma. Conclusions: R-ILD might not be as rare as previously reported. Because some of the patients may be fatal, R-ILD should be promptly suspected if patients present respiratory symptoms or their radiologic imaging shows any changes.

The Korean Academy of Tuberculosis and Respiratory Diseases : Slide Session ; OS-005 : DILD ; Clinical Characteristics of Rituximab-Induced Interstitial Lung Disease

( Jee Min Kim ),( Jong Sun Park ),( Se Joong Kim ),( Yeon Joo Lee ),( Yeong Jae Cho ),( Ho Il Yoon ),( Jae Ho Lee ),( Choon Taek Lee ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Rituximab, monoclonal antibody to CD20, has been a cornerstone in the treatment of lymphoma and many connective tissue diseases. Although rituximab has been safely used for over 15years, rituximab-induced interstitial lung disease(R-ILD) is not infrequent and can be fatal in real clinical practice. We investigated clinical characteristics and risk factors for R-ILD. Methods: We identifi ed patients who received rituximab as either monotherapy or part of combination therapy between March, 2003 and March, 2014 in Seoul National University Bundang Hospital. We retrospectively reviewed demographics, laboratory,and clinical course of patients with R-ILD. Results: Of 509 patients who received rituximab, 37 patients were compatible with R-ILD, with incidence being 7%. Most common clinical presentations were fever (51%) and dyspnea (48%), but about 12% were clinically asymptomatic except newly appeared bilateral gound-glass opacities in chest CT. The mean number of cycles of rituximab before disease onset was four (4.18th±0.57), and their bronchoalveolar lavage showed lymphocyte-dominant cellular components (58.84%±16.63). 5 patientsdied for respiratory failure even after steroid therapy. There were no statistically signi fi cant differences between patients with R-ILD and without R-ILD in terms of age, sex, disease status or extent, cumulative rituximab dose, underlying comorbidities, presence of pulmonary involvement of lymphoma.Conclusions: R-ILD might not be as rare as previously reported. Because some of the patients may be fatal, R-ILD should be promptly suspected if patients present respiratory symptoms or their radiologic imaging shows any changes.

전치봉합이 실리콘기름 제거 후 일시적 초기 저안압에 미치는 영향

Jee Taek Kim,Hyun Seung Yang,June-Gone Kim 한국망막학회 2016 Journal of Retina Vol.1 No.1

목적: 평면부를 통한 실리콘기름제거술 시 시행한 전치봉합이 실리콘기름 제거 후 일시적 초기 저안압에 미치는 영향에 대해 알아보고자 하였다. 대상과 방법: 2000년 1월부터 2011년 6월 사이에 실리콘기름 제거술을 받은 환자를 대상으로 실리콘기름 제거 전 관류관에 전치봉합을 시행한 경우(1군)와 전치봉합을 시행하지 않은 경우(2군)로 나누어 병록 기록을 후향적으로 조사하고, 실리콘기름 제거 후의 안압 변화를 살펴보았다. 실리콘기름 제거 후 가스 또는 공기를 주입한 경우는 안압과 상처 치유 등에 영향이 있을 수 있어 배제하였다. 일시적초기 저안압은 수술 1주 내 안압이 6 mmHg 미만의 저안압과 9 mmHg 미만의 저안압으로 분류하였다. 결과: 1군에는 118안, 2군에는 27안이 포함되었다. 안압 6 mmHg 미만의 저안압은 1군에서 5안(4.23%), 2군에서 3안(11.11%)이었으나 통계적 차이는 없었다(Fisher’s exact test, p=0.168). 안압 9 mmHg 미만의 저안압은 1군에서 13안(11.01%), 2군에서 7 안(25.92%)이었으며, 1군에서 유의하게 적었다(Chi-square, p=0.038). 결론: 실리콘기름 제거 전 전치봉합을 사용하여 초기 저안압을 낮출 수 있을 것으로 생각된다. Purpose: To report the effects of a preplaced suture on postoperative transient hypotony after pars plana silicone oil (SO) removal. Methods: We retrospectively reviewed the medical records of patients who underwent pars plana silicone oil removal between January 2000 and June 2011. The patients were divided into two groups: the preplaced suture group before SO removal (group 1) and the no preplaced suture group (group 2). The changes of intraocular pressure (IOP) after surgery were recorded. Patients who underwent tamponade of gas or air were excluded. Transient postoperative hypotony was defined as an IOP less than 6 mmHg, or less than 9 mmHg within 1 week after surgery. Results: 118 eyes and 27 eyes were included in group 1 and group 2, respectively. The number of eyes with transient hypotony according to an IOP less than 6 mmHg was 5 eyes in group 1 (4.23%) and 3 eyes in group 2 (11.11%). However, the difference was not statistically significant (Fisher’s exact test, p = 0.168). The number of eyes with transient hypotony according to an IOP less than 9 mmHg was 13 eyes in group 1 (11.01%) and 7 eyes in group 2 (11.11%), and the difference was statistically significant (Chi-square p = 0.038). Conclusions: A preplaced suture before SO removal could prevent the incidence of postoperative transient hypotony.

A Genome-Wide Association Study in Koreans Identifies Susceptibility Loci for Allergic Nickel Dermatitis

Kim, Dae Suk,Kim, Dong Hyun,Lee, Hemin,Jee, Hyunjoong,Lee, Young,Chang, Min-youl,Kwak, Taek-jong,Kim, Chul-Hong,Shin, Young-Ah,Lee, Jeung-Hoon,Yoon, Tae-jin,Lee, Min-Geol S. Karger AG 2013 International archives of allergy and immunology Vol.162 No.2

<P>Abstract
</P><P>No abstract available
</P><P>Copyright © 2012 S. Karger AG, Basel</P>