• Title/Summary/Keyword: 외래에서 시행하는

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Combined Primary IgA nephropathy and Membranous Glomerulonephritis in a Child (소아에서 IgA 신병증과 막성 사구체신염이 병발한 사구체신염 1례)

  • Kim Mi-Kyung;Choi Jeong-Hoon;Won Nam-Hee;Yoo Kee-Hwan
    • Childhood Kidney Diseases
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    • v.3 no.2
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    • pp.232-236
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    • 1999
  • IgA 신병증은 사구체 중맥에 IgA가 침착하는 것이 특징적인 질환이며 막성 사구체 신염은 IgG가 사구체 기저막의 상피하에 미만성으로 침착하는 질환이다. 원발성 사구체 질환중 IgA 신병증과 막성 사구체신염은 비교적 흔한 질환이나 전체적인 빈도는 낮은 편으로, 한 환자의 사구체에서 두 질환이 동시에 발생하는 경우는 매우 드물다. IgA 신병증과 막성 사구체신염의 중복 신염은 Doi등이 1983년 원발성 신질환으로서 처음 보고한 이래, 성인에서 20여례가 보고되었다. 저자들은 신증후군이 발생한 환아에서 신생검을 시행한 결과 원발성 신질환으로서 IgA 신병증과 막성 사구체신염의 소견이 동시에 보이는 중복신염의 드문 예를 경험하였기에 보고하는 바이다. 환아는 7세된 남아로 내원 한달 전부터 발생한 전신부종을 주소로 내원하였다. 가족력과 과거력상 특이 소견없었으며, 내원시 이학적 소견상 전신적인 허약감과 안와부종, 복부팽만, 하지의 함요부종이 관찰되었고, 검사소견에서는 WBC $19,800/mm^3$, Hb 14.1g/dL, Platelet $397,000/mm^3$, BUN/Cr 10/0.4mg/dL, protein/albumin 4.43/2.73g/dL, cholesterol 429mg/dL, IgA 85mg/dL, $C_3$ 68.8mg/dL, $C_4$ 13.4mg/dL, ANA(-), ANCA(-), RF(-), HBsAg/Ab(-/-)이었다. 뇨검사에서는 RBC many/HPF, WBC 2-3/HPF, protein ${\le}\;300mg/dL$ 였으며, 24시간 소변 검사상 protein 9.18g/day, Ccr 66.67ml/min의 소견을 보였다. 신생검을 시행한 결과 광학현미경상에서 몇몇 사구체의 분절성 경화와 중맥역의 증식이 관찰되었고, 면역형광현미경검사에서는 IgA(3+)가 과립상으로 미만성 분포를 보이며 중맥역에 침착되어 있고, 미세한 과립상과 위선의 양상으로 IgG(1+)가 모세혈관벽에 침착되어 있었으며, 전자현미경 소견상 중맥역과 모세혈관 기저막 상피하에 소량의 전자 고밀도 침착이 함께 관찰되었다. 환아는 prednisolone을 경구 투여 받았으나 단백뇨와 혈뇨가 지속되어 solumedrol pulse therapy, captopril과 cyclophophamide로 치료 받은 후, 전신 상태 호전되고, 혈뇨가 사라졌으며, 24시간 소변 검사상 단백뇨가 487.5mg/day로 감소하여 외래에서 추적 관찰 중이다.

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Changes in Causative Organisms and Antimicrobial Susceptibility of the Urinary Tract Infection (요로감염의 주요 원인균과 항생제 감수성의 변화에 관한 고찰)

  • Ha, Tae Uk;Hwang, Yong;Park, Seung Chol;Lee, Jea Whan
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.18 no.3
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    • pp.85-93
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    • 2017
  • The urinary tract infection (UTI) is one of the most important infections in hospital. The overuse and misuse of antimicrobial agents and the resulting emergence of resistant microorganisms have made choices regarding antimicrobial therapy more difficult. This study examined the changes in the antibiotic susceptibility to the causative organisms of urinary tract infections to provide useful information on the choice of adequate drugs in the treatment of urinary tract infections. The medical records of 2,707 patients with more than $10^5/ml$ microorganism in urine culture between January 2010 and December 2015 were reviewed retrospectively. The most common pathogenic organism was E. coli (28.1%). In the case of E.coli, there were no differences in frequency from 2010 to 2015 in men, but since 2014, the frequency decreased gradually since 2014 in women. For E. coli, the resistance rates to antibiotics were 72.2% in ampicillin, 44.9% in trimethoprim/sulfamethoxazole (TMP/SMX), and 41.3% in ciprofloxacin, but the 2nd, 3rd, and 4th cephalosporin (5%) had low antibiotic resistance rates. The pathogens of urinary tract infection are becoming diverse and their frequencies are also changing over time. These results suggest that the recommended drugs for UTI should be selected more carefully for in-patients and out-patients.

Effects of the Modified Fasting Therapy Using Gamrosu and Herbal Medicine on Changes of Body Compositions in Women: Case Series (한약을 결합한 감로수 절식요법이 여성의 체성분 변화에 미치는 영향: 증례보고)

  • Baek, Seon-Eun;Park, Eun-Ji;Kim, Hae-Won;Yoo, Jeong-Eun
    • Journal of Korean Medicine for Obesity Research
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    • v.18 no.2
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    • pp.152-158
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    • 2018
  • The purpose of this study was to investigate the effects of modified fasting therapy using Gamrosu and herbal medicine on the changes of body compositions in women. We analyzed the medical records of 11 patients, who carried out modified fasting therapy at Dunsan Korean Medicine Hospital of Daejeon University. Body compositions (body weight, body mass index, body fat mass, skeletal muscle mass, basal metabolic rate, extracellular water ratio, abdominal circumference, thickness of abdominal subcutaneous fat, visceral fat area) were reviewed before and after modified fasting therapy. The body composition values (body weight, body mass index, body fat mass, skeletal muscle mass, basal metabolic rate, extracellular water ratio, abdominal circumference, thickness of abdominal subcutaneous fat, visceral fat area) decreased after modified fasting therapy. Results from this investigation showed that modified fasting therapy using Gamrosu and herbal medicine has positive effects on changes of body compositions.

Changes in Icthyofauna of Hapcheon Lake and Characteristics of the Bluegill, Lepomis macrochirus Population (합천호의 어류상 변화와 블루길(Lepomis macrochirus) 개체군의 특성)

  • Jang, Chang-Ryeol;Bae, Yang-Seop
    • Korean Journal of Environment and Ecology
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    • v.34 no.6
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    • pp.543-550
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    • 2020
  • This study aimed to identify the characteristics of fish inhabiting Hapcheon Dam and surrounding rivers and the Bluegill population, an invasive species, and provide basic data. The survey of fish living in Hapcheon Dam and surrounding tributaries in the Ulsan area from 2016 to 2017 identified a total of 1,785 individuals of 30 species of 10 families and identified 8 Korea's endemic species (21.8% indigenization rate), 3 exotic species, and 2 ecosystem disturbance species. The comparison of this study with the past survey showed that 36 species of 12 families were reported in the past survey, but 14 species of them were not found in this study. We believe that a more detailed survey of Lake Hapcheon should identify most of them. The analysis of the length-weight relationship for the Bluegill population, identified as the dominant species in the Hapcheon Lake, showed that a large number of populations was in the stage of rapid growth as a large number of populations aged 1 to 2 years was found. Since the obesity level and the length-weight relationship were confirmed to be in good condition, it was necessary to prepare a plan to control the Bluegill population. We expect that this study's results can be useful data for understanding the growth and trends of the Bluegill population inhabiting the Hapcheon Dam and surrounding rivers.

Utilization Behavior of Medical Services According to Socioeconomic Characteristics and Prevalence (사회경제적 특성 및 유병에 따른 의료서비스 이용 행태)

  • Lee, Ko-Eun;Im, Bok-Hee
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.19 no.7
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    • pp.443-452
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    • 2018
  • The purpose of this study was to investigate the utilization behavior of medical services according to the characteristics of socioeconomic status (SES) and prevalence by using the 6th National Health and Nutrition Survey data for adults over 25 years old. Frequency and technical statistical analysis, ANOVA, ${\chi}^2$-test, and regression analysis were performed using SPSS 23.0. The results were as follows: more female than male, 65 years old and over, high school graduate, and unemployed and income quintiles were similar. The SES score considering education level, function, and income quintiles was the highest at 7-8, and most of the respondents felt moderate about their subjective health condition. The mean number of prevalence was $1.07{\pm}1.497$, the mean utilization of outpatient services was $0.50{\pm}0.045$, and the mean number of inpatient services use was $0.12{\pm}0.454$. Depending on general characteristics, there was a significant difference between subjects with prevalence and subjective health conditions. Higher age was associated with lower education, skill level, income, and SES score, and average prevalence was associated with poor subjective health conditions. More serious prevalence was associated with greater utilization of inpatient services. More chronic prevalence was associated with utilization of outpatient services. In other words, higher SES score was associated with lower overall use of medical services. Lower SES score was associated with higher use of medical services. In conclusion, we must develop appropriate health education programs that can prevent diseases in groups with low socioeconomic characteristics. There is the need to construct and implement a community-based appropriate health service system so that proper medical services can be used.

Viral Etiology and Epidemiology of Outpatients with Acute Respiratory Illnesses in Busan: 2007-2008 (부산지역 급성 호흡기 증상으로 외래 방문한 환자의 바이러스 원인과 역학: 2007-2008년)

  • Jeong, Jin Woo;Hwang, Youn Ha;Cho, Kyung Soon;Jung, Myung Ju;Min, Sang Kee;Kim, Seong Joon;Chung, Woo Sik
    • Pediatric Infection and Vaccine
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    • v.17 no.2
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    • pp.130-136
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    • 2010
  • Purpose : The purpose of this study is to identify the viral etiology of acute respiratory illnesses and to determine epidemiology in outpatients in Busan, Korea. Methods : We collected nasal wash samples from 990 patients who visited the hospital for acute respiratory illnesses between January 2007 and December 2008. Extracted DNA or RNA from specimens was used for viral detection by an RT-PCR method. Results : Of a total of 990 samples, viruses were detected in 351 cases (35.5%). The ratio of male to female was 1.6:1 and 93.7% were less than 5 years old. Rhinovirus was detected year-round in 202 cases (57.5%), respiratory syncytial virus from October to March in 57 cases (16.2%), adenovirus year-round in 37 cases (10.5%), influenza virus from December to April in 21 cases (6%), bocavirus from January to August in 15 cases (4.3%), parainfluenza virus from April to July in 9 cases (2.6%), coronavirus from January to July in 7 cases (2%), and enterovirus from June to September in 3 cases (0.9%). Conclusion : We identified the etiology and epidemiology of viruses that caused the acute respiratory diseases that were prevalent in Busan, 2007-2008. Further surveillance will be necessary.

Study on the neurodevelopmental predictors for the results of the Bayley Scales of Infant Development II in high-risk neonates (고위험 신생아에서 Bayley 발달 검사 결과에 영향을 미치는 신경발달 예후인자에 대한 연구)

  • Woo, Mi Kyeong;Kim, Dong Wook;Huh, Kyoung;Shim, Gyu Hong;Chey, Myoung Jae
    • Clinical and Experimental Pediatrics
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    • v.52 no.11
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    • pp.1221-1227
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    • 2009
  • Purpose:To identify the risk factors for poor neurodevelopmental outcomes in high-risk neonates. Methods:We studied 94 infants admitted to the neonatal intensive care unit at the Sanggye Paik Hospital between January 2002 and November 2005 and evaluated the follow-up data. The following events were considered as risk factors: ${\leq}32$ weeks of gestation, very low birth weight, Apgar scores of less than 5, neonatal resuscitation, neonatal seizure, congenital infection, and abnormalities in cranial ultrasound or magnetic resonance imaging (MRI). The infants who had any one of these risk factors were included. They were evaluated at their mean corrected age of 13.84${\pm}$8.03 months. Mental and Psychomotor Developmental Indices (MDI, PDI) were determined by a clinical psychologist using the Bayley Scales of Infant Development II. Results:The mean MDI and PDI of all the patients were 96.28${\pm}$26.70 and 94.00${\pm}$22.80, respectively. Abnormalities on cranial ultrasound or MRI were significant predictors of both low MDI (P<0.05) and low PDI (P<0.001). These abnormalities showed a stronger association with low PDI than with low MDI. The infants with periventricular leukomalacia had the lowest MDI and PDI ($70.10{\pm}28.68$ and $69.70{\pm}24.91$, respectively). Apgar score at 1 minute and very low birth weight were also significant predictors for low PDI (P<0.05, P<0.05, respectively). Conclusion:Image findings with cranial ultrasound or MRI were the strongest predictors of neurodevelopmental outcome. Periventricular leukomalacia was the best predictive factor for mental and psychomotor development.

The Agreements between FEV1 and PEFR in the Patients of Mild Bronchial Asthma (외래 진료가 가능한 경증 천식 환자에서 1초간 노력성 호기량(FEV1)과 최대 호기유속(PEFR)간의 연관성)

  • Chang, Won Chul;Kim, Byung Kook;Kim, Soon Jong;Yoo, Kwang Ha;Lee, Tae-Hun;Lee, Jung Yeon;Lee, Kye Young
    • Tuberculosis and Respiratory Diseases
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    • v.59 no.6
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    • pp.638-643
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    • 2005
  • Background : Several studies have shown considerable disagreement when using the $FEV_1$ and PEFR to assess the severity of an airflow obstruction. A differential classification of the severity of asthma would lead to serious differences in the evaluation and management of asthma. The aim of this study was to examine the relationship between the $FEV_1$ and PEFR in asthma patients with mild symptoms. Methods : In this study, the PEFR and $FEV_1$ were obtained from 92 adult asthma patients with mild symptoms attending an outpatient pulmonary clinic. The mean differences and the limits of agreement in the paired measurements of the $FEV_1$ and PEFR were calculated. Results : There was a considerable correlation between the $FEV_1$ and PEFR measurements when expressed as a % of the predicted values (r=0.686, p<0.01). The 95% limit of agreement (mean difference ${\pm}1.96SD$) between the $FEV_1$ % and PEFR % were acceptable(-27.4%~33.8%). In addition, the weighted ${\kappa}$(kappa) coefficient for the agreement between the $FEV_1$ % and PEFR % was 0.74 (95% CI, 0.63-0.81), indicating excellent agreement between the two measurements. Conclusion : The spirometer ($FEV_1$) and the Mini-Wright peak flow meter (PEFR) can be used interchangeably in adult asthma patients with mild symptom.

A Comparative Study Concerning the Psychopathologies between the Patients with Peptic Ulcer and Those with Essential Hypertension - Focused on Medically-Ill Out Patients - (소화성 궤양과 본태성 고혈압 환자의 정신병리에 관한 비교 연구 - 내과외래환자를 중심으로 -)

  • Choi, Hyun-Kyoung;Kim, Chan-Woo;Lee, Dong-Gun;Kwak, Chung-Whan;Park, Seung-Ken;Park, Hee-Ouk;Ok, Jong-Whan;Kim, Jeong-Gee
    • Korean Journal of Psychosomatic Medicine
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    • v.11 no.2
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    • pp.149-158
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    • 2003
  • Objectives: The authors studied the anxiety, depression and psychological characteristics of medical out-patients, which are diagnosed as peptic ulcer disorder and essential hypertension. We also examined the state of psychiatric consultation. Methods: The subjects were composed of 56 patients with peptic ulcer disorder, 44 patients with essential hypertension and 116 controls. STAI, BDI and SCL-90R was administered to all subjects. Chart review, telephone interview and Self report questionnaire of etiology and severity of illness, drug compliance and so forth were performed in disease groups. Results: Considerable depression was noticed in 39.3% among the patients with peptic ulcer disorder, 27.7% in hypertension and 12.1% in control group by BDI. State anxiety was noticed in 44.6% among the patients with peptic ulcer disorder, 54.5% in hypertension and 18.1% in control group by State anxiety. Trait anxiety was noticed in 42.9% among the patients with peptic ulcer disorder, 34.1% in hypertension and 25.8% in control group by Trait anxiety. The higher SOM, BDI, STAI, the lower drug compliance and rapport. Psychological problems are considered of the most important etiology in 48.2% of peptic ulcer group and 45.7% of hypertensive group. But psychiatric consultation is made only in 1.8% of peptic ulcer group and 2.3% of hypertensive group. Conclusions: Anxiety and depression are common phenomena in medical outpatients. In comparison with the normal control group, peptic ulcer group showed significantly higher trait anxiety and depression and hypertensive group higher state anxiety. These characteristics are related to the drug compliance and doctor-patient relationship. These results suggested the needs of active psychiatric consultation.

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Double Bypass of Esophagus and Descending Thoracic Aorta for the Treatment of Esophagapleural and Aortopleural Fistula (식도파열 후 발생한 식도 흉막루와 대동맥루의 수술적 치료: 식도 및 대동맥 이중 우회술)

  • Park, Sung-Joon;Kang, Chang-Hyun;Kim, Kyung-Hwan;Yao, Byung-Su;Kim, Young-Tae;Kim, Joo-Hyun
    • Journal of Chest Surgery
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    • v.43 no.6
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    • pp.753-757
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    • 2010
  • We report hereon a case of double bypass of the esophagus and descending thoracic aorta for the treatment of esophagopleural fistula and aortopleural fistula due to an infected aortic aneurysm after esophageal rupture. A 48 year old man was diagnosed as having esophageal rupture after an accidental explosion. Although he had been treated by esophageal repair and drainage at another hospital, the esophageal leakage could not be controlled and subsequent empyema developed in the left pleura. Further, bleeding from the descending thoracic aorta had developed and he was managed with endovascular stent insertion to the descending thoracic aorta. He was transferred to our hospital for corrective surgery. We performed esophago - gastrostomy via the substernal route, without exploring posterior mediastinum and we let the empyema resolve spontaneously. While he was being managed postoperatively Without any signs and symptoms of infection, sudden bleeding developed from the left pleural cavity. After evaluation for the bleeding focus, we discovered an Infected aortic aneurysm and an aortospleural fistula at the stent insertion site. We performed a second bypass procedure for the infected descending thoracic aorta from the ascending aorta to the descending abdominal aorta via the right pleural cavity. We found leakage at the distalligation site during the immediate postoperative period, and we occluded the leakage using a vascular plug. He discharged without complications and he is currently doing well without any more bleeding or other complications.