• 한국임상약학회지
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• 제23권4호
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• pp.307-315
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• 2013

Objective: Colistimethate was first became available in 1950s and used until the early 1980s to treat infections caused by gram-negative bacteria and was abandoned due to its nephrotoxicity and neurotoxicity. However, it was recently reintroduced into the clinical practices due to emergence of multidrug-resistance gram-negative bacteria, particularly Pseudomonas aeruginosa and Acinetobacter baumanii. Therefore, it is increasingly used in the intensive care unit settings as a salvage therapy. This study was designed to investigate the incidence rates and risk factors of acute kidney injury associated with colistimethate by using the standardized definition in critically ill patients. Methods: This study retrospectively reviewed the electronic medical records of 71 adult patients above 18 years old receiving intravenous colistimethate at least 48 hours at intensive care unit, university-affiliated hospital from Nov 2012 to Aug 2013 and excluded patients with end-stage renal disease (ESRD) and required renal replacement therapy before initiation of the colistimethate therapy. Acute kidney injury (AKI) was determined by using the standardized RIFLE criteria, classified with risk, injury, failure, loss and ESRD according to serum creatinine (Scr) levels. Results: Among the 71 patients included in the analysis, AKI developed in 40 patients (56.3%) and 6 patients (8.4%) had irreversible kidney injury. AKI occurred within 5 days in 20 patients (50.0%). Maximum Scr level showed a significant increase in the patients with AKI ($1.92{\pm}0.86mg/dL$ vs. $1.12{\pm}0.46mg/dL$ p=0.001), maximum BUN also increased ($64.2{\pm}28.7mg/dL$ vs. $48.4{\pm}24.9mg/dL$ p=0.017) and minimum creatinine clearance (CLcr) was significantly decreased in the patients with AKI than non-AKI ($34.5{\pm}18.6ml/min$ vs. $64.4{\pm}33.7ml/min$ p=0.185). The patients with AKI had significantly longer duration of colistimethate therapy ($21.1{\pm}17.0$ days vs. $13.0{\pm}11.5$ days, p=0.020) and larger cumulative doses of colistimethate ($6465.9{\pm}4717.0mg$ vs. $4438.1{\pm}3426.7mg$, p=0.040). Conclusion: The incidence and severity of AKI associated with colistimethate in critically ill patients was high and serious. Drug monitoring program should be performed to shorten duration of therapy and reduce cumulative dose from initiation of colistimethate therapy for minimizing AKI of colistimethate.

• 한국임상약학회지
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• 제23권4호
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• pp.365-372
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• 2013

Background: Malnutrition of inpatients has been associated with higher morbidity, mortality, cost, and longer hospital stay. Total parenteral nutrition (TPN) therapy plays an important role in decreasing morbidity and mortality among critical inpatients in hospitals, and has been commonly used to improve clinical outcomes. However, only a few studies were conducted regarding patients' nutritional improvement by TPN. Method: This study therefore evaluated the changes in nutritional parameters by TPN therapy for early malnourished inpatients. Data from early malnourished inpatients who were treated with TPN therapy between January 2012 and June 2013 at the ${\bigcirc}{\bigcirc}$ university Hospital were studied retrospectively. Information regarding sex, age, underlying diseases, division, TPN (peripheral and central), and changes in nutritional parameters were collected by reviewing electronic medical records. The criteria for evaluation of the changes in nutritional parameters were included physical marker, body mass index (BMI), and biochemical markers, including albumin (Alb), total lymphocyte count (TLC), and cholesterol. Nutritional parameters were collected three times: pre-TPN, mid-TPN and end-TPN. A total of 149 patients (peripheral, 97; central, 52) was evaluated. Results: In all patients, the malnutrition number was significantly decreased following the complete TPN therapy (peripheral patients, pre-TPN: $3.33{\pm}0.12$, mid-TPN : $3.06{\pm}0.17$, and end-TPN: $2.85{\pm}0.21$ (p < 0.05); central patients, pre-TPN: $3.38{\pm}0.11$, mid-TPN: $3.06{\pm}0.13$, and end-TPN: $2.75{\pm}0.21$ (p < 0.05). The malnutrition number means number of nutrition parameters below normal range of malnutrition. In addition, all of the four nutritional parameters (BMI, Alb, TLC and cholesterol) were increased with duration of TPN periods for all patients, and the changes in the early stage were larger than in the late stage (p < 0.05). The nutritional parameters of non-cancer patients were increased to a greater extent compared to cancer patients with longer TPN therapy, but it was not significant. The nutritional parameters of younger patients (50-60 years) were also increased more than of older patients (70-80 years), but it was not significant. Conclusion: In conclusion, the TPN therapy decreases malnutritional status and improves nutritional parameters in malnourished patients, thereby decreasing morbidity and mortality. The combined evaluation of all four nutritional parameters is more accurate for nutritional assessment than a single one.

• 대한소아치과학회지
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• 제41권2호
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• pp.134-144
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• 2014

본 연구는 환자분포 및 치료경향을 조사하여 소아치과의 변화하는 진료 양상을 알기 위해 시행하였다. 2008년 1월부터 2012년 12월까지 연세대학교 치과대학병원 소아치과에 내원한 환자를 대상으로 전자의무기록을 수집하고 분석하였다. 조사 결과 초진환자와 비선택 진료의사 1인당 환자 수는 감소하였고 외국인 환자수가 급증하였다. 신환은 만 0~2세의 연령층이 가장 많았고, 내원 주소는 치아우식증, 외상, 부정교합 순으로 높게 나타났다. 수복치료의 분포 결과 복합레진 수복, 아말감 수복, 치면열구전색술은 감소하였고, 자가중합형 글라스아이오노머, 예방적 레진수복이 증가하는 추세였다. 다내원근관치료가 감소하고 당일발수 근관 충전이 증가했으며, 치수복조술과 치수절단술과 같은 보존적 치수치료의 비율이 증가하였다. 환자의 불안을 감소시키기 위해 진정법을 선택하는 경우가 증가하였으며 아산화질소의 이용이 주를 이루었다. 내원 환자의 분포 및 특성을 파악하고, 최신 치료 경향을 제공함으로써 환자의 요구에 부합하는 적절한 치료계획을 수립하는데 도움이 될 것으로 생각된다.

• Tuberculosis and Respiratory Diseases
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• 제79권4호
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• pp.295-301
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• 2016

Background: Specific immunoglobulin E (IgE) sensitization to staphylococcal enterotoxin (SE) has been recently considered to be related to allergic disease, including asthma. Despite studies on specific IgE (sIgE) to SE and its relationship to asthma diagnosis and severity, the association of sIgE to SE with airway hyperresponsiveness (AHR) remains unclear. Methods: We enrolled 81 asthma patients admitted to the Severance Hospital in Korea from March 1, 2013, to February 28, 2015 and retrospectively reviewed the electronic medical records of the enrolled subjects. The serum levels of sIgE to SE (A/B) of all subjects was measured using the ImmunoCAP 250 (Phadia) system with SE-sIgE positive defined as >0.10 kU/mL. Results: The SE-sIgE level was not significantly correlated with asthma severity (forced expiratory volume in 1 second [$FEV_1$], $FEV_1$/forced vital capacity, sputum eosinophils, and serum eosinophils), whereas the SE-sIgE level in patients with positive AHR ($mean{\pm}standard$ error of the mean, $0.606{\pm}0.273kU/mL$) was significantly higher than that in patients with negative AHR ($0.062{\pm}0.015kU/mL$, p=0.034). In regression analysis, SE sensitization (sIgE to SE ${\geq}0.010kU/mL$) was a significant risk factor for AHR, after adjustment for age, sex, $FEV_1$, and sputum eosinophils (odds ratio, 7.090; 95% confidence interval, 1.180-42.600; p=0.032). Prevalence of SE sensitization was higher in patients with allergic rhinitis and non-atopic asthma patients, as compared to patients without allergic rhinitis and atopic asthma patients, respectively, but without statistical significance. Conclusion: SE sensitization is significantly associated with AHR.

• 대한한방내과학회지
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• 제38권6호
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• pp.971-979
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• 2017

Objectives: The aim of this study was to analyze the effects of Cheongsimyeonja-tang on the human body. Methods: This was a retrospective study, conducted using electronic medical records (EMR). Appropriate clinical cases were identified and databased through EMR. Changes of vital signs, blood tests, and functional tests before and after taking Cheongsimyeonja-tang were determined. Results: There were several significant changes after taking Cheongsimyeonja-tang. Hemoglobin, total blood proteins, and total bilirubin were increased. Eosinophil, aspartate aminotransferase, total cholesterol, and low-density lipoprotein cholesterol were decreased. Conclusions: Cheonseomyeonja-tang had significant effects, including improvement of blood cell count (increase of red blood cells and hemoglobin), improvement of blood lipid level (decrease of total cholesterol and LDL-cholesterol), and blood pressure control (reduction of systolic blood pressure).

• Journal of Korean Neurosurgical Society
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• 제40권5호
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• pp.336-341
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• 2006

Objective : The authors conducted a retrospective study to evaluate the preservation rates of serviceable hearing and to determine its prognostic factors after gamma knife stereotactic radiosurgery[GK SRS] in the patient with vestibular schwannomas. Methods : Between December 1997 and March 2005, 54 patients with a sporadic vestibular schwannoma and serviceable hearing [Gardner Robertson grade I-II] were enrolled in this study. Electronic database of medical records and radiological examinations before and after GK SRS were investigated to the last follow up. The mean marginal dose was $12.3{\pm}0.7Gy$. The mean maximum dose delivered to the tumor center was 24.7Gy [$22{\sim}30Gy$]. The median tumor volume was 2cc [$0.1{\sim}9.1cc$]. The median follow-up period of magnetic resonance[MR] imaging was 31 months [$6{\sim}99\;months$], and the mean follow-up period of audiometry was 24 months [$4{\sim}70\;months$]. Results : The tumor control rate was 100% in the patients with the follow up period more than 2 years. The trigeminal and facial nerve preservation rates were 98% and 100%, respectively. Twenty-eight [52%] of the 54 patients preserved serviceable hearing and 16 [30%] patients retained their pre-GK G-R grade level after GK SRS. In the univariate and multivariate analysis, there was no significant prognostic factor in preservation of the serviceable hearing. Conclusion : The hearing preservation rate is still unsatisfactory compared with the results of other cranial nerve preservation and tumor control in the treatment of vestibular schwannoma by GK SRS. More sophisticated strategy during and after GK SRS is necessary to improve long-term hearing preservation.

• Journal of Nutrition and Health
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• 제51권2호
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• pp.132-139
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• 2018

본 연구는 일반병동에 입원하여 3일 이상 경장영양을 시행한 성인 환자 95명을 대상으로 영양집중지원팀의 중재 효과를 평가하기 위해 영양중재를 받은 중재군과 받지 못한 군으로 분류하여 열량 및 단백질 지원율과 생화학적 지표를 비교 분석 하였다. 연구결과를 통해 환자의 입원초기부터 적절한 영양관리를 계획하고, 영양집중지원팀의 영양중재로 체계적인 관리를 실시하면 환자의 영양상태가 개선되는 것을 확인할 수 있었다. 결론적으로 영양불량 문제가 있는 환자에게 영양집중지원팀의 중재를 받아 문제를 개선할 수 있도록 절차를 마련한다면, 이는 환자의 임상적 치료에 긍정적인 영향을 줄 것으로 생각된다. 본 연구는 국내에서 경장영양을 시행한 일반병동 환자를 대상으로 영양집중 지원팀의 중재 효과에 대한 초기 연구이며, 집중영양치료료 수가 신설 이후 진행된 연구다. 추후 일반병동 환자를 대상으로 영양집중지원팀의 중재효과에 대한 연구가 다양하게 시행된다면 의료진의 관심이 증대 될 것이고, 나아가 영양집중지원팀의 중재를 통해 진료의 질을 높일 수 있을 것이다.

• 대한소아치과학회지
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• 제43권3호
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• pp.254-263
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• 2016

지금까지 완전탈구된 치아의 예후에 대해 많은 연구가 발표되었으나, 국내의 소아와 청소년을 대상으로 한 추적 조사 연구는 거의 없다. 이에 본 연구에서는 6-14세 환자 142명의 재식치 184개를 대상으로 전자의무기록지와 치근단 방사선 사진을 평가함으로써 재식된 영구 절치의 치유와 예후에 영향을 미치는 인자에 대해 분석하였다. 재식치의 치근 발육 단계가 낮을수록 치수의 재혈관화 가능성이 높았다. 구외 시간이 60분 이상인 경우 염증성 치근 흡수의 발생률은 미성숙 치아에서 높게 나타났으며, 대치성 치근 흡수의 발생률은 성숙 치아에서 높게 나타났다. 20일 이상 경과하여 발수한 경우 염증성 치근 흡수의 발생률이 증가하였으며, 대치성 치근 흡수에 비해 염증성 치근 흡수가 생존 기간의 감소에 더 큰 영향을 미치는 것으로 나타났다. 치근의 발육 단계와 재식치의 생존 기간 간에 상관관계는 없었으나, 대치성 치근 흡수가 발생한 경우 미성숙 치아의 생존 기간은 성숙 치아에 비해 짧았다. 본 연구는 장기간의 추적 조사를 통해 수행한 연구로서, 완전탈구된 치아의 치료 지침과 예후 평가에 대한 기초 자료로 활용될 수 있으리라 생각된다.

• 한국임상약학회지
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• 제27권2호
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• pp.92-98
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• 2017

Background: Nebulized colistimethate is increasingly used, because there are problems such as renal dysfunction and low distribution within the lungs when colistimethate is administered intravenously. This study was designed to compare and analyze the changes in renal function by of nebulized colistimethate treatment for its safe administration. Methods: This study retrospectively reviewed the electronic medical records of adult patients above 19 years old, receiving only the nebulized colistimethate at least 4 days in Yonsei university health system from Nov 2014 to Aug 2015. Acute kidney injury (AKI) was determined by using the RIFLE criteria (Risk, Injury, Failure, Loss and End-stage renal disease) according to serum creatinine (SCr) levels before and after use of nebulized colistimethate. Results: 48 patients were included our study and their SCr increased significantly after nebulized colistimethate treatment ($SCr_0$ vs. $SCr_1$; $0.85{\pm}0.80$ vs. $1.00{\pm}0.82mg/dL$, n=48, p<0.001), but the changes were in normal range according to the standards at Yonsei university health $system^a$. Among 48 patients, 38 patients were in the non-AKI group (79.2%), and 10 patients developed AKI (20.8%). Within the AKI group, 2 patients were in the Injury group (20%) and the other 8 in the Risk group (80%). Conclusion: There was no significant difference in age, dosage and duration of treatment between AKI group and non-AKI group (p>0.05). The study has a significance in that it reviewed the safety of nebulized colistimethate only treatment to national patients, analyzing its nephrotoxicity. It has confirmed that nebulized colistimethate is a safer method than intravenous injection, and requires to establish a guideline for the use of nebulized colistimethate in further studies with broader patient groups. $^a$ : SCr Male 0.68-1.19 mg/dL, Female 0.49-0.91 mg/dL.

• 대한두개안면성형외과학회지
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• 제21권5호
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• pp.288-293
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• 2020

Background: Pilomatrixoma is a benign tumor that originates from the hair follicle matrix. It usually presents as a hard, slow growing, solitary mass that can be easily misdiagnosed as other skin masses. The aim of this study was to clinically analyze a case series of pilomatrixoma in pediatric patients from Korea. Methods: A total of 165 pediatric patients from 2011 to 2018 with a histological diagnosis of pilomatrixoma were included. A retrospective review was performed using the electronic medical records, including patient demographics, number and location of the mass, clinical and imaging presentation, and postoperative outcomes. Results: There were 61 male and 104 female patients with 152 solitary and 13 multiple pilomatrixomas. Among solitary pilomatrixomas, the lesion commonly occurred in the head and neck (84.2%), followed by upper limbs (11.2%), lower limbs (3.3%), and trunk (1.3%). The pilomatrixoma lesion presented as the following types based on our clinical classification: mass (56.02%), pigmentation (25.31%), mixed (12.65%), ulceration (4.82%), and keloid-like (1.2%). Ultrasonography showed a high positive predictive value (95.56%). There were no specific complications observed except for two cases of recurrence. Conclusion: Pilomatrixoma has various clinical feature presentations and commonly occurs in the head and neck. Ultrasonography is a helpful diagnostic tool. Surgical removal of the lesion is the main treatment method with a low recurrence rate.