Two Cases of Humoral Hypercalcemia of Malignancy in Metastatic Cholangiocarcinoma

Humoral hypercalcemia of malignancy (HHM) is rarely associated with cholangiocarcinoma (CC), and represents dismal prognosis. A 63-year-old male was admitted for evaluation of an intrahepatic mass. He was diagnosed with HHM associated with locally advanced CC. As the tumor responded to the concurrent chemoradiotherapy with capecitabine and cisplatin, serum calcium level was normalized. However, according to the disease progression, he suffered recurrence of HHM and he expired approximately one year after initial diagnosis. A 68-year-old male who presented with abdominal pain was diagnosed with metastatic CC. After the eighth cycle of gemcitabine and cisplatin, progression of the disease was found with HHM. He was treated with the best supportive care, until his demise approximately one month after the diagnosis of HHM. We report on two cases of HHM associated with CC that demonstrate strong correlation between hypercalcemia and disease burden.ope

Prediction of methicillin-resistant Staphylococcus aureus in patients with non-nosocomial pneumonia

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is recognized as an important cause of not only hospital acquired pneumonia, but also non-nosocomial pneumonia. However, the risk factors for non-nosocomial MRSA pneumonia are not clearly defined. Our objective was to identify risk factors at admission that were associated with non-nosocomial MRSA pneumonia. METHODS: We evaluated 943 patients admitted to a university-affiliated hospital with culture-positive bacterial pneumonia developed outside the hospital from January 2008 to December 2011. We compared the clinical characteristics between MRSA and non-MRSA pneumonia, and identified risk factors associated with MRSA pneumonia. RESULTS: Of 943 patients, MRSA was identified in 78 (8.2%). Higher mortality was observed in MRSA than in non-MRSA patients (33.3% vs. 21.5%; P = 0.017). In a logistic regression analysis, MRSA pneumonia was observed more frequently in patients with a previous history of MRSA infection (OR = 6.05; P < 0.001), a PSI score ≥120 (OR = 2.40; P = 0.015), intravenous antibiotic treatment within 30 days of pneumonia (OR = 2.23; P = 0.018). By contrast, non-MRSA pneumonia was observed more often in patients with a single infiltrate on chest radiography (OR = 0.55; P = 0.029). CONCLUSIONS: Anti-MRSA antibiotics could be considered in hospitalized non-nosocomial patients with several risk factors identified herein. The presence or absence of these factors would provide useful guidance in selecting initial empirical antibiotics.ope

Utility of Routine Culture for Tuberculosis from Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration in a Tuberculosis Endemic Country

BACKGROUND: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a technique developed to allow mediastinal staging of lung cancer and also to evaluate intrathoracic lymphadenopathy. In a tuberculosis-endemic area, tuberculosis should be considered as an etiology of mediastinal lymphadenopathy. The aim of this study was to investigate the utility of the routine culture for tuberculosis from specimens of EBUS-TBNA. METHODS: We prospectively performed routine culture for tuberculosis from aspiration or core biopsy specimens got from 86 patients who had undergone EBUS-TBNA due to mediastinal lymphadenopathy between March 2010 and March 2011. RESULTS: A total of 135 lymph node aspiration and 118 core biopsy specimens were included in this analysis. We confirmed the malignancy in 62 (72.9%), tuberculosis in 7 (8.1%), sarcoidosis in 7 (8.1%), asperogillosis in 2 (2.3%) and pneumoconiosis in 2 (2.3%) patients. One lung cancer patient had pulmonary tuberculosis coincidentally and 5 patients had unknown lymphadenopathy. The number of positive culture for Mycobacterium tuberculsosis by EBUS-TBNA is 2 (1.5%) from 135 lymph node aspiration specimens and 2 (1.7%) from 118 core biopsy specimens. Out of eight patients confirmed with tuberculosis, only one patient had positive mycobacterial culture of aspiration specimen from EBUS-TBNA without histopathologic diagnosis. CONCLUSION: These results propose that routine culture for tuberculosis from EBUS-TBNA may not provide additional information for the diagnosis of coincident tuberculous lymphadenitis. However, if there is any possibility of tuberculous lymphadenopathy or pulmonary tuberculosis, it should be considered to perform EBUS-TBNA in patients who have negative sputum AFB smears or no sputum production.ope

Comparison of Methicillin-Resistant Staphylococcus aureus Community-Acquired and Healthcare-Associated Pneumonia

PURPOSE: Methicillin-resistant Staphylococcus aureus (MRSA) is recognized as an important cause of not only healthcare-associated pneumonia (HCAP) but also community-acquired pneumonia (CAP). We determined the impact of MRSA on differences in clinical characteristics, courses, and outcomes between CAP and HCAP. MATERIALS AND METHODS: We conducted a retrospective observational study on 78 adult patients admitted with MRSA pneumonia at a university-affiliated tertiary hospital between January 2008 and December 2011. We compared baseline characteristics, chest radiographs, treatment outcomes, and drug resistance patterns between the CAP and HCAP groups. RESULTS: Of the 78 patients with MRSA pneumonia, 57 (73.1%) were HCAP and 21 (26.9%) were CAP. MRSA infection history in the previous year (29.8% vs. 14.3%, p=0.244) tended to be more common in HCAP than in CAP. Despite similar Pneumonia Severity Index scores (151 in CAP vs. 142 in HCAP), intubation rates (38.1% vs. 17.5%; p=0.072) and intensive care unit admission (42.9% vs. 22.8%; p=0.095) tended to be higher in the CAP group, while 28-day mortality was higher in the HCAP group (14.3% vs. 26.3%; p=0.368), although without statistical significance. All patients showed sensitivity to vancomycin and linezolid; meanwhile, HCAP patients showed greater resistance to gentamicin than CAP patients (58.3% vs. 16.6%; p=0.037). The median total hospital charges were 6899 American dollars for CAP and 5715 American dollars for HCAP (p=0.161). CONCLUSION: MRSA pneumonia showed significantly differences in baseline characteristics, chest radiographs, treatment outcomes, and medical expenses between HCAP and CAP groups.ope

Prognostic Implications of Serum Lipid Metabolism over Time during Sepsis

BACKGROUND: Despite extensive research and an improved standard of care, sepsis remains a disorder with a high mortality rate. Sepsis is accompanied by severe metabolic alterations. METHODS: We evaluated 117 patients with sepsis (severe sepsis [n = 19] and septic shock [n = 98]) who were admitted to the intensive care unit. Serum cholesterol, triglyceride (TG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), free fatty acid (FFA), and apolipoprotein (Apo) A-I levels were measured on days 0, 1, 3, and 7. RESULTS: Nonsurvivors had low levels of cholesterol, TG, HDL, LDL, and Apo A-I on days 0, 1, 3, and 7. In a linear mixed model analysis, the variations in TG, LDL, FFA, and Apo A-I levels over time differed significantly between the groups (p = 0.043, p = 0.020, p = 0.005, and p = 0.015, resp.). According to multivariate analysis, TG levels and SOFA scores were associated with mortality on days 0 and 1 (p = 0.018 and p = 0.008, resp.). CONCLUSIONS: Our study illustrated that TG levels are associated with mortality in patients with sepsis. This may be attributable to alterations in serum lipid metabolism during sepsis, thus modulating the host response to inflammation in critically ill patients.ope

A Case of Prothionamide Induced Hepatitis on Patient with Multi-Drug Resistant Pulmonary Tuberculos

The prevalence of multi-drug resistant tuberculosis (MDR-TB), which is resistant to isoniazid and rifampin, has been increasing in Korea. And the side effects of 2nd line anti-tuberculosis medications, including drug-induced hepatitis, are well known. Although prothionamide (PTH) is one of the most useful anti-TB medications and although TB medication-induced acute hepatitis is a severe complication, there are only a few published case reports about prothionamide induced hepatitis. In this case report, a 22 year old male was diagnosed with pulmonary MDR-TB and was administered 2nd line anti-TB mediations, including PTH. Afterwards, he had a spiking fever and his liver enzymes were more than 5 times greater than the upper limit of the normal range. He was then diagnosed with drug-induced hepatitis by liver biopsy. His symptoms and liver enzyme elevation were improved after stopping PTH. Accordingly, we report this case of an association between PTH and acute hepatitisope

The Governance Theory of U Chŏng-Kyu

기존의 연구는 대체로 우정규가 경제야언에서 제시한 제도 개 선안의 내용을 필자의 관심분야에 따라 소개하는 것이었다. 이 논문에서는 우정규의 제도 개선안을 변통론으로 명명하고, 그 기저를 관류하고 있는 사유의 논리적 맥락을 복구함으로써 그 특징을 확인하려 하였다. 그 결과 이 연구에서 얻은 결론은 다음과 같다. 첫째, 우정규의 변통론은 부세의 경감, 군비의 축소, 지방관의 선택, 군주의 수양을 핵심 축으로 하여 구성 되어 있다. 둘째, 그의 변통론은 지방관의 견지에서 본 민생안정론이라는 성격을 띤다. 셋째, 우정규는 갖가지 제도 개선책을 제시하면서도 지배 계 층의 도덕성 회복을 가장 근원적인 처방으로 제시한다. 넷째, 경제야언 의 논지 구성은 이이의 영향을 받아서 작성된 부분이 많다. 다섯째, 우정 규 변통론의 논리적 추이는 이이는 물론 주희 등 신유학자들의 경세론과 유사한 구조를 보인다. 여섯째, 이상과 같은 점으로 미루어 우정규의 제도 개선책은 신유학자 일반이 제시하는 제도 개선론의 범위 안에 있는 것으로 판단되며, 실학으로 규정하기는 힘들다고 볼 수 있다

서경덕과 그 학파의 선천 이론

이 글은 서경덕(1489~1546)의 철학을 도덕성의 문제와 관련지어 고찰하려는 의도로 쓰여지는 것이다. 이 고찰이 성공적으로 수행되기 위해서는 필자의 이 글이 다음의 두 가지 질문에 대답할 수 있어야 한다고 생각한다. 그 첫번째는 "서경덕의 우주론은 도덕적 우주론인가?"하는 것이다. 이 질문은 기존의 서경덕 연구에 대한 반성을 토대로 하고 있다. 80년대에 들어 서경덕의 윤리설에 주목하는 연구가 나타나긴 했지만, 그의 우주론은 여전히 '순수한 형이상학적 관심의 산물'로 남아있다고 할 수 있다

Growth, development and recovery rate of Gymnophalloides seoi (Digenea Gymnophallidae) in C3H mice

학위논문(박사)--서울대학교 대학원 :의학과 기생충학전공,1995.Docto

The Theory of the Seven Emotions and the Theory that Human Nature is Evil

글에서는 예기 ｢예운｣의 7정을 성악설의 맥락에서 이해하는 연구 시각이 과연 타당한 것인지를 두 측면에서 검토하였다. 첫째, 7정이 성립하는 과정을 고찰했다. 좌전 에서 감정 일반을 지칭하는 말은 좋아함, 싫어함, 기쁨, 성냄, 슬픔, 즐거움[好惡喜怒哀樂] 등의 6정이었다. 여기서 6정이 근본적으로는 몸의 욕구[欲] 때문에 생겨난 것이라고 파악하고, 6정에 욕구를 보탬으로써 순자의 7정이 성립한다. 욕구에 따른 반응인 7 정을 방치할 경우 무질서와 혼란이 생겨난다고 봄으로써 순자의 7정은 성악설의 주장을 함축하는 것이 된다. 한편, ｢예운｣의 7정은 감정을 나열한 순서가 순자의 7정과 일치하며, 7정 전체를 부정적으로 보면서 예의 역할을 강조한다는점에서 역시 성악설에 닿아 있는 것으로 생각될 수 있다. 반면, 7정 중에서 욕구하고 싫어함[欲惡]이라는 두 가지 대립하는 감정이 다른 감정들의 중심이 될 수 있음을 시사하는 구절은 7정과 성악설을 관련짓기 어렵게 하는 점이다. 둘째, ｢예운｣의 7정에 대한 여러 유학자들의 해석을, 세 흐름으로 나누어 살펴보았다. 공영달을 제외하면 대부분의 유학자들은 ｢예운｣의 7정은 육체적 욕구에 근거하여 나온 감정이며, 도덕적으로는 악을 초래하는 것이라고 여겼다. 곧 ｢예운｣의 7정을 성악설의 견지에서 바라보는 것은 유학사에서 매우 오래 이어져 온 생각이었음을 알 수 있다. 결론적으로 예기 ｢예운｣의 7정을 성악설의 맥락에서 이해하는 기존의 연구는 상당한 정도로 타당성이 있음을 확인할 수 있었다