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대한내과학회> Korean Journal of Medicine(구 대한내과학회지)

Korean Journal of Medicine(구 대한내과학회지) update

  • : 대한내과학회
  • : 의약학분야  >  내과학
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  • : 1738-9364
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  • : 대한내과학회잡지(~1992)→대한내과학회지(1993~)→Korean Journal of Medicine(1996~)

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수록범위 : 1권1호(1949)~95권3호(2020) |수록논문 수 : 12,055
Korean Journal of Medicine(구 대한내과학회지)
95권3호(2020년 06월) 수록논문
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1한국의 의료 전달체계 개편 방향

저자 : 김영삼 ( Young Sam Kim )

발행기관 : 대한내과학회 간행물 : Korean Journal of Medicine(구 대한내과학회지) 95권 3호 발행 연도 : 2020 페이지 : pp. 129-133 (5 pages)

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2코로나19 유행의 방역

저자 : 최성호 ( Seong-ho Choi )

발행기관 : 대한내과학회 간행물 : Korean Journal of Medicine(구 대한내과학회지) 95권 3호 발행 연도 : 2020 페이지 : pp. 134-140 (7 pages)

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Respiratory tract infections caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) originating from China began in late 2019 and became prevalent worldwide in early 2020. Korea was one of the closest countries to China and was forced to go through this pandemic. In the absence of vaccines or effective antiviral drugs, we have no choice but to re-use the old preventive measures used by humans in the past. In this review, I would like to discuss the preventive measures used in Korea during the pandemic. (Korean J Med 2020;95:134-140)

3기관지확장증의 진단 및 치료: 최신 진료지침을 기반으로

저자 : 이현 ( Hyun Lee ) , 오연목 ( Yeon-mok Oh )

발행기관 : 대한내과학회 간행물 : Korean Journal of Medicine(구 대한내과학회지) 95권 3호 발행 연도 : 2020 페이지 : pp. 141-150 (10 pages)

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Non-cystic fibrosis bronchiectasis is a common respiratory disease that is frequently encountered in daily practice. However, it has been regarded as an orphan lung disease and had been often neglected by the physicians. Fortunately, recent studies have unveiled many important clinical aspects of bronchiectasis. Accordingly, international evidence-based practice guideline such as the European Respiratory Society guideline and the British Thoracic Society (BTS) guideline have been published recently. However, as there is no domestic evidence-based guideline, we introduce clinical approaches to diagnose bronchiectasis and discuss important aspects of bronchiectasis based on most recently published the BTS guideline. In addition, we cover the treatment of bronchiectasis based on the BTS guideline. We hope newly assembled a Korean bronchiectasis study group, name the Korean Multicenter Bronchiectasis Audit and Research Collaboration (KMBARC) would contribute to publishing Korean bronchiectasis guideline, soon. (Korean J Med 2020;95:141-150)

4전신홍반루푸스의 새로운 분류 기준

저자 : 이연아 ( Yeon-ah Lee )

발행기관 : 대한내과학회 간행물 : Korean Journal of Medicine(구 대한내과학회지) 95권 3호 발행 연도 : 2020 페이지 : pp. 151-161 (11 pages)

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Systemic lupus erythematosus (SLE) is a prototypic autoimmune disease with highly variable clinical and immunological manifestations. Classification and diagnosis of SLE are complicated by the multi-organ nature of the disease and by our incomplete understanding of its pathophysiology. The 1997 update of the 1982 American College of Rheumatology (ACR) criteria for SLE has been widely used for classification of SLE. In order to improve clinical relevance and early diagnosis, the Systemic Lupus Erythematosus International Collaborating Clinics (SLICC) group suggested the 2012 SLICC criteria. These sets of classification criteria have unweighted lists of various serological and clinical findings typical of SLE, can be fulfilled by reaching a sum score of points. The only exception is biopsy-proven lupus nephritis with autoantibodies in the 2012 SLICC criteria. In an attempt to overcome limitations of the previous sets of SLE classification criteria, the new 2019 SLE European League Against Rheumatism/American College of Rheumatology (EULAR/ACR) classification criteria for SLE have been recently published. The 2019 EULAR/ACR criteria include positive ANA at least once as obligatory entry criterion; followed by additive hierarchically clustered and weighted criteria. The structure and weighting of criteria constitute a paradigm shift in the classification of SLE. In the validation cohort, the new criteria had a sensitivity of 96.1% and specificity of 93.4%. This review attempts to delineate the history, performance and limitations of the current sets of SLE criteria. (Korean J Med 2020;95:151-161)

5전신홍반루푸스의 치료

저자 : 김보영 ( Bo Young Kim ) , 김성수 ( Sung-soo Kim )

발행기관 : 대한내과학회 간행물 : Korean Journal of Medicine(구 대한내과학회지) 95권 3호 발행 연도 : 2020 페이지 : pp. 162-169 (8 pages)

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Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by the production of autoantibodies that result in the inflammation of multiple organs, including the skin and musculoskeletal, renal, nervous, cardiovascular, respiratory, and gastrointestinal systems. Treatment includes the use of immunomodulatory and immunosuppressive agents to target specific organ manifestations. The treatment goal in SLE is to reduce disease activity and prevent organ damage and death. Optimal long-term outcomes require not only treatment of the disease, but also the management of comorbidities. This paper reviews treatments of SLE with the aim of improving outcomes. (Korean J Med 2020;95:162-169)

6루푸스 환자에서 예방접종

저자 : 손창남 ( Chang-nam Son ) , 김상현 ( Sang-hyon Kim )

발행기관 : 대한내과학회 간행물 : Korean Journal of Medicine(구 대한내과학회지) 95권 3호 발행 연도 : 2020 페이지 : pp. 170-175 (6 pages)

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Systemic lupus erythematosus (SLE) is a chronic inflammatory autoimmune disease that affects various organs. SLE patients have an increased risk of infection compared to the general population. Immunosuppressive agents commonly used in SLE increase the risk of infection. Vaccination is a good way to reduce the risk of infection. However, some SLE patients are concerned that vaccination may worsen lupus disease activity or cause side effects. The latest SLE patient vaccination data were reviewed in this study, which focused on the safety, immunogenicity, and efficacy of influenza, pneumococcal, tetanus, hepatitis A, herpes zoster, and human papillomavirus vaccines. Korean immunization recommendations were also compared to those of other countries. (Korean J Med 2020;95:170-175)

7임신 전후 갑상선항진증의 진단 및 치료

저자 : 신동엽 ( Dong Yeob Shin )

발행기관 : 대한내과학회 간행물 : Korean Journal of Medicine(구 대한내과학회지) 95권 3호 발행 연도 : 2020 페이지 : pp. 176-180 (5 pages)

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Thyroid function fluctuates during pregnancy. Thus, assessments of thyroid activity during childbearing years represent an important health metric. Since anti-thyroid drugs are potentially teratogenic, drug dosing and timing should be carefully calculated. Normally, diagnosis and treatment of hyperthyroidism is performed to determine underlying causes (i.e., Graves' disease), to predict disease course and to make appropriate therapeutic decisions. In cases of maternal hyperthyroidism, these same measures also require the insight regarding the relationship between pregnancy and thyroid function, the effects of anti-thyroid drugs on pregnancy outcomes. (Korean J Med 2020;95:176-180)

8대변 미생물총 이식의 기증자 선별 검사

저자 : 이한희 ( Han Hee Lee ) , 조영석 ( Young-seok Cho )

발행기관 : 대한내과학회 간행물 : Korean Journal of Medicine(구 대한내과학회지) 95권 3호 발행 연도 : 2020 페이지 : pp. 181-187 (7 pages)

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Fecal microbiota transplantation (FMT), which has been established as the standard treatment for recurrent Clostroides difficile infection, may also play a role in the management of other diseases associated with dysbiosis of the gut microbiota. To ensure efficacy and safety of FMT, an appropriate donor screening process is required. The main purpose of donor screening is to check for infectious diseases that could be transmitted to the recipient. The screening process involves a medical history questionnaire, and blood and stool testing. Several randomized clinical trials and large case series on FMT reported no, or few, adverse events related to infection by following this donor screening process. However, there is still concern over the transmission of antibiotic-resistant bacteria. In addition, a low donor acceptance rate due to rigorous screening makes donor recruitment difficult, and also imposes a significant cost burden. A consensus on the most crucial elements of donor screening is needed for wide application of FMT. (Korean J Med 2020;95:181-187)

9급성 심근경색증 환자에서 관상동맥 중재술 후 허혈성 심근병증 예측인자

저자 : 김혜숙 ( Hye Sook Kim ) , 정명호 ( Myung Ho Jeong ) , 윤현주 ( Hyun Ju Yoon ) , 김용철 ( Yongcheol Kim ) , 손석준 ( Seok-joon Sohn ) , 김민철 ( Min Chul Kim ) , 심두선 ( Doo Sun Sim ) , 홍영준 ( Young Joon Hong ) , 김주한 ( Ju Han Kim ) , 안영근 ( Youngkeun Ahn ) , 조재영 ( Jae Young Cho

발행기관 : 대한내과학회 간행물 : Korean Journal of Medicine(구 대한내과학회지) 95권 3호 발행 연도 : 2020 페이지 : pp. 188-200 (13 pages)

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목적: 급성 심근경색증 환자에서 적극적인 치료에도 불구하고 허혈성 심근병증으로 진행한 환자는 많은 육체적, 사회경제적인 어려움을 겪게 된다. 이 연구의 목적은 급성 심근경색증 환자에서 성공적인 관상동맥 중재술 후에 허혈성 심근병증이 발생하는 예측인자에 대하여 알아보고자 하였다.
방법: 2011년 11월부터 2015년 10월까지 Korea Acute Myocardial Infarction Registry-National Institute of Health(KAMIR-NIH)에 등록된 환자 중 급성 심근경색증으로 전남대학교병원에 내원 후 성공적인 관상동맥 중재술을 시행 받고, 퇴원 전 심장초음파를 시행한 후 추적 심장초음파 검사가 시행된 환자 547명(63.1 ± 12.3세, 남자 71.1%)을 대상으로 하였다. 추적 심장초음파 검사에서 허혈성 심근병증이 발생한 환자군 66명(Ⅰ군: 67.1 ± 11.9세, 남자 78.8%)과 발생하지 않은 환자군 481명(Ⅱ군: 62.5 ± 12.2세, 남자 70.1%)으로 분류하여, 양군 간의 임상적 특성, 혈액 검사 특성, 심장초음파 및 관상동맥 조영술 소견 및 주요심장사건을 비교·분석하였다. 허혈성 심근병증은 심장초음파 검사에서 좌심실 이완기말 직경(left ventricular end-diastolic dimension, LVEDD) > 55 mm이고, 좌심실 구혈률(left ventricular ejection fraction, LVEF) < 50%로 저하되어 있는 경우로 정의하였다.
결과: Ⅰ군에서 평균연령(67.1 ± 11.9세 vs. 62.5 ± 12.2세, p = 0.004)이 높았으며, ST-분절 상승 심근경색증(65.2% vs. 46.2%, p = 0.004), Killip class (p = 0.008), 병원 내 심장사건(48.5% vs. 22.7%, p < 0.001)에서 유의한 차이를 보였다. 백혈구(12,340 ± 4,235 mm3 vs. 10,560 ± 4,057 mm³, p = 0.001)와 혈당(201.7 ± 104.4 mg/dL vs. 164.7 ± 75.7 mg/dL, p = 0.007), CK-MB (163.9 ± 124.6 U/L vs. 87.8 ± 102.9 U/L p < 0.001), troponine-I (124.2 ± 113.5 ng vs. 44.5 ± 113.5 ng, p < 0.001)는 Ⅰ군에 비하여 Ⅱ군에서 의미있게 높았다. LVEF (41.7 ± 10.5 vs. 55.4 ± 10.3%, p < 0.001), LVEDD (54.1 ± 7.2 vs. 49.3 ± 5.3 mm, p < 0.001), E/A 비(1.19 ± 0.67 vs. 0.95 ± 0.45, p =0.017), E/e' ratio (16.7 ± 7.8 vs. 12.7 ± 6.1, p = 0.001)가 유의한 차이가 있었으나, 관상동맥 조영술 및 중재술 소견은 두군 간에 유의한 차이는 없었다. 다변량 회귀분석 결과 LVEF < 50% (OR 8.722, CI 2.986-25.478, p < 0.001), LVEDD > 55 mm (OR 4.511, CI 1.561-13.038, p = 0.005), E/e' ratio ≥ 15 (OR 3.270, CI 1.168-9.155, p = 0.024)이 허혈성 심근병증 발생의 독립적 예측인자였다.
결론: 급성 심근경색증 환자에서 허혈성 심근병증 발생의 독립적인 예측인자는 LVEF < 50%, LVEDD > 55 mm, E/e' ratio ≥ 15였다. 따라서, 내원 시 예측인자를 갖고 있는 환자에 대해서는 급성 심근경색증 발생초기부터 보다 적극적인 치료가 필요할 것으로 사료된다.


Background/Aims: Many patients with acute myocardial infarction (AMI) suffer from heart failure due to progressive ischemic left ventricular (LV) remodeling. This study investigated the predictors of ischemic cardiomyopathy (ICMP) in patients with AMI who underwent successful percutaneous intervention.
Methods: A total of 547 patients with AMI were divided into two groups: ICMP (n = 66, 67.1 ± 11.9 years, 78.8% males) and non-ICMP (n = 481, 62.5 ± 12.2 years, 70.1% males).
Results: On echocardiography, the LVEF was significantly decreased (41.7 ± 10.5 vs. 55.4 ± 10.3%, p < 0.001) but the LV end-diastolic (54.1 ± 7.2 vs. 49.3 ± 5.3 mm, p < 0.001) and systolic (42.1 ± 8.0 vs. 33.5 ± 6.0 mm, p < 0.001) dimensions significantly increased in the ICMP group compared with the non-ICMP group. According to multivariate logistic regression analysis, LVEF < 50% (odds ratio [OR] 8.722, 95% confidence interval [CI] 2.986-25.478, p < 0.001), LV end-diastolic dimension > 55 mm (OR 4.511, 95% CI 1.561-13.038, p = 0.005), and ratio of early mitral inflow velocity to mitral annular early diastolic velocity (E/e') ≥ 15 (OR 3.270, 95% CI 1.168-9.155, p = 0.024) were independent predictors of ICMP development.
Conclusions: The present study demonstrates that a larger LV size, lower LV function, and increased E/e' (≥ 15) were independent predictors of ICMP. Therefore, the development of ICMP should be carefully monitored in AMI patients with these features. (Korean J Med 2020;95:188-200)

10복막투석 환자에서 발생한 후천성 천공성 피부병의 성공적 치료 1예

저자 : 김희서 ( Hui Seo Kim ) , 이상희 ( Sanghee Lee ) , 이미지 ( Miji Lee ) , 주민숙 ( Mihnsook Jue ) , 이동영 ( Dong Young Lee ) , 문경협 ( Kyoung Hyub Moon ) , 김범 ( Beom Kim )

발행기관 : 대한내과학회 간행물 : Korean Journal of Medicine(구 대한내과학회지) 95권 3호 발행 연도 : 2020 페이지 : pp. 201-204 (4 pages)

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Acquired perforating dermatosis (APD) triggers severe itching, and is observed most often in patients with diabetes mellitus (DM) and chronic kidney disease (CKD). Various treatments, such as topical steroids, topical and oral retinoids, allopurinol, and ultraviolet B (UVB) phototherapy, have been used. However, as the precise etiology is unknown, there are a lack of well-established treatment guidelines. We report a peritoneal dialysis patient with a diagnosis of APD who was resistant to topical steroids, phototherapy, allopurinol, and topical retinoids. Severe pruritus persisted, which compromised his ability to lead a normal life. As a final treatment option, we used oral isotretinoin and the patient experienced a dramatic improvement. (Korean J Med 2020;95:201-204)

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