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고형암에 대한 항암화학요법 치료 중 병발한 결핵의 특성
김덕겸 ( Deog Kyeom Kim ),이세원 ( Sei Won Lee ),강영애 ( Young Ae Kang ),윤영순 ( Young Soon Yoon ),유철규 ( Chul Gyoo Yoo ),김영환 ( Young Whan Kim ),한성구 ( Sung Koo Han ),심영수 ( Young Soo Shim ),임재준 ( Jae Joon Yim ) 대한결핵 및 호흡기학회 2005 Tuberculosis and Respiratory Diseases Vol.58 No.3
연구 배경 : 면역 기능 저하를 초래하여 결핵의 재활성화에 관여할 것으로 생각되는 주기적인 항암화학요법치료 중인 고형암 환자에서 발생한 결핵의 임상적 특징과 치료 반응을 파악하고자 하였다. 대상 및 방법 : 2000년 1월부터 2004년 7월까지 국내 일개 3차 병원에서 항암화학요법 치료 중에 세균학적으로, 병리학적으로 또는 임상적으로 진단된 결핵 환자 중 기존에 알려진 결핵 재활성화의 위험 요인이 없는 22명을 대상으로 후향적 연구를 시행하였다. 결과 Background : Some malignancies including lymphoma, head and neck cancer, and lung cancer are believed to be associated with the reactivation of tuberculosis (TB) because cyclic anti-cancer chemotherapy can induce the leukopenia or immunological deteriorat
국내 민간병원에서 치료한 다제내성결핵 환자의 치료 결과 및 예후 인자
박진경 ( Jin Kyeong Park ),고원중 ( Won-Jung Koh ),김덕겸 ( Deog Kyeom Kim ),김은경 ( Eun Kyung Kim ),김유일 ( Yu Il Kim ),김희진 ( Hee Jin Kim ),김태형 ( Tae-Hyung Kim ),김재열 ( Jae Yeol Kim ),박무석 ( Moo Suk Park ),박이내 ( I- 대한결핵 및 호흡기학회 2010 Tuberculosis and Respiratory Diseases Vol.69 No.2
Background: The increasing rate of drug-resistant tuberculosis (TB) is a threat to the public health and TB control. In Korea, about 75~80% of TB patients are treated in private hospitals and the rate has been continuously increasing since 2000. Methods: On a retrospective basis, we enrolled 170 newly diagnosed with or retreated for multidrug-resistant TB (MDR-TB) in 2004 from 21 private hospitals. We extracted the following demographics and treatment history from patient medical records: initial treatment outcomes, cumulative survival rates, treatment outcomes, and prognostic factors. Results: Of the 170 patients, the majority were male (64.1%), the mean age was 44.5 years old, and mean body-mass-index was 20.2kg/m2. None of the patients tested positive for HIV. Eleven (6.5%) were confirmed to have extensively drug-resistant TB (XDR-TB) at treatment initiation. Treatment success rates were not different between XDR-TB (36.4%, 4/11) and non-XDR MDR-TB (51.6%, 82/159). Default rate was high, 21.8% (37/170). Far advanced disease on X-ray was a significant negative predictor of treatment success; advanced disease and low BMI were risk factors for all-cause mortality. Conclusion: In private hospitals in Korea, the proportion of XDR-TB in MDR-TB was comparable to previous data. The treatment success rate of MDR-/XDR-TB remains poor and the failure rate was quite high. Adequate TB control policies should be strengthened to prevent the further development and spread of MDR-/XDR-TB in Korea.
김덕겸,권성연,이석영,박계영,정경해,이춘택,유철규,김영환,한성구,심염수,Kim, Deog-Kyeom,Kwon, Sung-Youn,Lee, Suk-Young,Park, Gye-Young,Jung, Kyung-Hae,Lee, Chun-Taek,Yoo, Churl-Gyoo,Kim, Young-Whan,Han, Sung-Koo,Shim, Yong-Soo 대한결핵및호흡기학회 1999 Tuberculosis and Respiratory Diseases Vol.47 No.5
연구배경: 객담 도말 및 배양 검사나 방사선학적 검사 등의 기존의 결핵 진단 방법은 낮은 민감도와 진단까지 소요되는 기간이 길다는 단점이 있어서 결핵의 조기 진단 및 치료에 제한점이 있었다. 최근에 혈청학적 진단 방법의 하나로 개발된 immunochromatographic assay 기구들이 소개되고, 외국에서 비교적 높은 진단율를 보여, 결핵 유병율이 높은 국내에서 그 유용성을 평가하고, 질병 양상에 따른 차이점을 조사하여, 기존의 결핵 진단 방법들의 문제점을 해결할 수 있는지 알아보고자하였다. 연구방법: 환자군을 폐결핵 환자군(36명), 폐외결핵 환자군(3명) 및 두 가지 모두 이환된 군(22명)으로 나누었으며, 대조군은 과거 결핵 병력이 있는 비활동성 결핵환자(17명), 결핵이외의 폐질환자(16명) 및 폐질환이 없는 심장 환자(14명)를 대상으로 38kDa 항체를 포함한 ICT tuberculosis 또는 BioSign$^{TM}$TB를 이용하여 혈청화적 검사를 시행하였다. 결 과: ICT tuberculosis를 사용한 경우, 환자군 56명 및 대조군 47명에 대하여 64.3%의 민감도 및 91.5%의 특이도를 나타내었으며, 폐결핵만 있는 환자군에서 76.5%의 민감도를 보여, 폐외 결핵만 있는 환자군(33.3%)나 두 가지 모두 이환된 군(47.4%)에 비하여 더 높은 민감도를 나타내었다(p=0.039). BioSign$^{TM}$TB를 이용한 경우, 환자군 43명 및 대조군 43 명에 대하여 74.4%의 민감도 및 95.3%의 특이도를 보였으며, 폐질환이 없는 환자군에서는 100%의 특이도를 나타내었다. 환자군중에서 초발환자 및 과거 폐결핵 병력이 있는 환자군 사이에는 민감도에 차이가 없었으며, 공동성 폐결핵 환자와 비공동성 폐결핵 환자사이에 검사상 민감도 차이는 통계적으로 유의하지 않았다(73.3% vs. 69.6%, p>0.05). 결 론: 혈청학적 방법의 하나인 immunochromatographic assay 기구는 높은 특이도와 양성 예측도를 보여 임상적 유용성이 기대되나, 상대적으로 낮은 민감도와 음성 예측도를 고려할 때, 단독 사용보다는 기존 방법과의 상보적 사용이 결핵진단에 더 도움이 될 것으로 생각된다. Background: Many diagnostic tests have developed to diagnose tuberculosis and other mycobacterial diseases but the diagnosis of tuberculosis relies largely on radiological findings and acid-fast staining of sputum and/or culture. Recently, new serologic diagnostic methods, which are safe and easy to use have been introduced into Korea. In this study, the usefulness of serologic diagnosis for tuberculosis and the disease pattern induced variation of the test were evaluated. Methods: Serological assay was performed upon 108 patients with two test kits, the ICT tuberculosis and the BioSign$^{TM}$TB, which are based upon a rapid immunochromatographic assay technique, capable of being interpreted within 15 minutes. The case groups consisted of 61 patients with active pulmonary tuberculosis(36 patients), extrapulmonary tuberculosis(3 patients), or both(22 patients). Control groups consisted of 47 patients with inactive old pulmonary tuberculosis(17 patients), nontuberculous pulmonary disease(16 patients) and nonpulmonary cardiac disease(14 patients). Results : The diagnostic sensitivity, specificity, positive predictive value(PPV) and negative predictive value(NPV) of the ICT tuberculosis were 64.3%, 91.5%, 90.0% and 68.3% respectively. The diagnostic sensitivity, specificity, PPV and NPV of the BioSign$^{TM}$TB were 76.5%, 95.3%, 94.1 % and 78.8% respectively. Differences in sensitivity were not significant between patients with previous history of tuberculosis or patients without prior history of tuberculosis. The ICT tuberculosis test showed higher sensitivity in pulmonary tuberculosis patients(76.5%) than extrapulmonary tuberculosis patients(33.3%). There was no difference in sensitivity between patients with or without cavitary lesion by chest X-ray. Conclusion: Considering high specificity and PPV, serologic diagnosis using a rapid immunochromatographic assay device is another helpful diagnostic method in the diagnosis of tuberculosis, when combined with previous diagnostic methods such as chest X-ray, microbiologic study but it has limitation in terms of confirming the diagnosis for tuberculosis as the only diagnostic method because of relatively low sensitivity and NPV.
Evidence of Periostitis in Joseon Dynasty Skeletons
Yi-Suk Kim(김이석),Deog Kyeom Kim(김덕겸),Chang Seok Oh(오창석),Myeung Ju Kim(김명주),Hye-Ri Kim(김혜리),Dong Hoon Shin(신동훈) 대한체질인류학회 2013 해부·생물인류학 (Anat Biol Anthropol) Vol.26 No.2
뼈막염은 고고학 유골에서 가장 흔히 발견되는 질병 중의 하나이며, 유골의 생전 건강상태를 가늠할 수 있게 해주는 중요한 생물학적 지표이다. 조선시대 뼈모음을 조사한 결과, 총 101명의 뼈대 중 5명의 뼈대(#4, #29, #137, #175, #290)에서 기저질환이나 손상을 보지 못하는 일차뼈막염이 발견되었다. 한편, 매독에 속발된 뼈막염을 관찰할 수 없었는데 향후 뼈모음의 수가 늘어난다면 이 부분에 대한 중요한 고병리학적 발견을 기대할 수 있을 것으로 생각하였다. 이상으로 조선시대 고인골에서 발견된 뼈막염을 처음으로 보고하게 되었으며, 앞으로 다양한 고병리학적 소견에 대한 형태학적 연구를 진행할 예정이다. Periostitis is one of the human diseases commonly encountered in archaeological samples. It is known to be an important health indicator for paleopathologists examining skeletal remains. In our recent study on a Joseon skeletal series (n=101), non-specific, primary periostitis was observed only in five individuals (#4, #29, #137, #175, and #290). Notably, there were no secondary periostitis-suggestive signs (e.g. syphilis), except for those caused by fractures (#33 and #41). As this is the inaugural Korean-skeletal-series report on periostitis, the results presented in these pages should prove significant to interested paleopathologists.
김명아 ( Myung A Kim ),김덕겸 ( Deog Kyeom Kim ),이창훈 ( Chang Hoon Lee ),정희순 ( Hee Soon Chung ) 대한결핵 및 호흡기학회 2010 Tuberculosis and Respiratory Diseases Vol.68 No.5
Background: Pulmonary hypertension is considered as a poor prognosis factor in patients with chronic obstructive pulmonary disease (COPD). There has been reported brain natriuretic peptide (pro-BNP) is related with increased right ventricular (RV) workloads. However, there are few studies that evaluate the relationship between BNP and pulmonary arterial pressure (PAP), RV function and St. George Respiratory Questionnaire (SGRQ) score in patients with COPD, and the effects of angiotensin converting enzyme inhibitor (ACEI) on these parameters. Methods: Pulmonary function test, echocardiography, blood BNP, and SGRQ score were evaluated in stabilized moderate degree COPD patients (FEV1/FVC<70%, 50%≤FEV1<80%) aged 45 years and over, without worsening of symptoms within recent 3 months. After treating with ramipril 10 mg for 3 months, the same evaluation was repeated. Results: Twenty-two patients were included in this study. BNP was significantly correlated with PAP (Pearson coefficient ρ=0.51, p=0.02), but not with RV ejection fraction (EF) and predicted FEV1%. The values for predicted FEV1% showed significant correlation with SGRQ total score and activity score, but not with BNP or PAP. After ramipril treatment, PAP showed significant decrease (42.8±8.1vs.34.5±4.5 mm Hg p=0.0003), tricuspid annular plane systolic excursion significant increase (21.5±3.3vs.22.7±3.1 mm p=0.009). BNP showed a tendency to decrease without statistical significance (40.8±59.6vs.18.0±9.1 pg/mL p=0.55). SGRQ scores showed no significant change. Conclusion: BNP showed significant correlation with resting PAP, which means BNP could be used as markers for pulmonary hypertension. Treatment with ACEI didn`t show significant change in the Level of BNP, while pulmonary hypertension and RV function were improved.
Toll-Like Receptor 2 유전자의 Microsatellite 유전자 다형성과 만성폐쇄성폐질환 발생과의 연관성 결여
이희석 ( Hee Seok Lee ),이혜원 ( Hye Won Lee ),김덕겸 ( Deog Kyeom Kim ),고동석 ( Dong Seok Ko ),박근민 ( Gun Min Park ),황용일 ( Yong Il Hwang ),이상민 ( Sang Min Lee ),유철규 ( Chul Gyu Yoo ),김영환 ( Young Whan Kim ),한성구 ( S 대한결핵 및 호흡기학회 2005 Tuberculosis and Respiratory Diseases Vol.58 No.4
호흡기 내과계 중환자실 전공의 수와 중환자실 사망률의 관련성
이병준 ( Byoung Jun Lee ),이창훈 ( Chang Hoon Lee ),김덕겸 ( Deog Kyeom Kim ),김경희 ( Kyoung Hee Kim ),김은선 ( Eun Sun Kim ),박태연 ( Tae Yun Park ),정근범 ( Keun Bum Chung ),강효재 ( Hyo Jae Kang ),정윤정 ( Yun Jeong Jeong ) 대한내과학회 2010 대한내과학회지 Vol.79 No.2
Background/Aims: The treatment outcome of patients hospitalized in intensive care units (ICUs) can be influenced by physician factors, including both intensivists and resident physicians. We evaluated the association between the number of residents who are exclusively responsible for the ICU and the mortality rate in a medical ICU. Methods: The data obtained from an open medical ICU in a teaching hospital from Jan. 2005 to Dec. 2009 were analyzed retrospectively. We evaluated the associations between the ICU mortality rate and both the number of resident physicians and the number of patient-days per resident physician using multivariate Poisson regression analysis adjusted for year and month. Results: The months with fewer than two residents tended to have a higher ICU mortality rate, although this difference was not significant in the univariate analyses. Multivariate Poisson regression analysis showed that months with fewer than two residents had a significantly higher ICU mortality rate compared with months with two residents (incidence risk ratio (IRR) 1.59, 95% confidence interval (CI) 1.05-2.41; p=0.029). The number of ICU patient-days per resident physician was not associated with the ICU mortality rate (IRR; 1.00, 95% CI, 0.99-1.01; p=0.649). Conclusions: The presence of fewer than two residents exclusively responsible for the medical ICU was an independent risk factor of a higher ICU mortality rate. However, no association was found between the number of ICU patient-days per resident physician and the ICU mortality rate. (Korean J Med 79:155-162, 2010)