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대한내과학회> Korean Journal of Medicine(구 대한내과학회지)

Korean Journal of Medicine(구 대한내과학회지) update

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  • : 대한내과학회잡지(~1992) → 대한내과학회지(1993~) → korean journal of medicine(1996~)

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수록범위 : 1권1호(1949)~96권1호(2021) |수록논문 수 : 12,096
Korean Journal of Medicine(구 대한내과학회지)
96권1호(2021년 02월) 수록논문
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1입원전담전문의 제도, 어디로 가야 하는가?

저자 : 신동호 ( Dong-ho Shin )

발행기관 : 대한내과학회 간행물 : Korean Journal of Medicine(구 대한내과학회지) 96권 1호 발행 연도 : 2021 페이지 : pp. 1-6 (6 pages)

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2일차의료 만성질환관리 시범사업 소개 및 효과

저자 : 송은주 ( Eunju Song ) , 김영은 ( Young-eun Kim ) , 지선미 ( Seonmi Ji )

발행기관 : 대한내과학회 간행물 : Korean Journal of Medicine(구 대한내과학회지) 96권 1호 발행 연도 : 2021 페이지 : pp. 7-12 (6 pages)

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Considerable efforts have been made to prevent and manage hypertension and diabetes, but the prevalence of these diseases has not changed significantly over the past 10 years. Hypertension and diabetes are chronic conditions requiring continuous treatment and management. Controlling blood pressure and blood sugar levels can prevent life-threatening complications and a deterioration in the quality of life. Community-centered primary health care is characterized by inclusiveness and continuous contact. Well-established primary health care services can reduce the number of unnecessary emergency room visits, hospitalizations, and medical tests, and therefore minimize unnecessary medical expenses. However, the number of patients treated for mild chronic diseases at large hospitals has increased, with a concomitant decrease in the proportion of outpatient clinic visits (41.6% in 2007 vs. 37.8% in 2016). Thus, there is a clear need to strengthen primary health care, including for the treatment of chronic diseases. To establish a chronic diseases management system based on local clinics, the Ministry of Health and Welfare of Korea launched a pilot chronic diseases management program aimed at increasing patient acceptance of local primary health care. The program was implemented in 2014, 2016, and 2019. This review examines the short-term impact of the pilot program with respect to the prevention and management of hypertension and diabetes. (Korean J Med 2021;96:7-12)

3헬리코박터 파일로리 제균 치료의 최신 동향

저자 : 권용환 ( Yong Hwan Kwon )

발행기관 : 대한내과학회 간행물 : Korean Journal of Medicine(구 대한내과학회지) 96권 1호 발행 연도 : 2021 페이지 : pp. 13-21 (9 pages)

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Helicobacter pylori (H. pylori) is the main cause of most gastroduodenal diseases. Triple therapy including two antibiotics, amoxicillin and clarithromycin, and a proton pump inhibitor given for a week has been recommended as the treatment of choice since the revision of the Korean H. pylori Clinical Practice Guidelines in 2013. However, antimicrobial resistance significantly decreased the cure rate of H. pylori eradication to 63.9%. Thus, the new H. pylori treatment regimen would be needed to increase the eradication rate in Korea. Recently, the update of clinical practice guideline for treatment of H. pylori was developed by conducting a meta-analysis. In this review, the recommended H. pylori eradication regimen in current 2020 guideline will be discussed. (Korean J Med 2021;96:13-21)

4코로나19 중환자의 치료

저자 : 위승범 ( Seungbum Wi ) , 서지영 ( Gee Young Suh )

발행기관 : 대한내과학회 간행물 : Korean Journal of Medicine(구 대한내과학회지) 96권 1호 발행 연도 : 2021 페이지 : pp. 22-29 (8 pages)

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Clinical manifestations of coronavirus disease 2019 (COVID-19) is diverse ranging from asymptomatic or mild respiratory symptoms to severe acute respiratory distress syndrome (ARDS) and respiratory failure. As the pandemic progresses, the number of critically ill COVID-19 patients continues to increase. Whether or not COVID-19 ARDS patients are distinct from conventional ARDS is not settled, and there is no definite evidence that they should be treated differently from ARDS of other origins. The use of oxygen treatment with high flow nasal cannula has been increased. Invasive mechanical ventilation should be applied with lung protective strategy in mind. Prone positioning should be actively considered. Since the primary cause of death of COVID-19 patients is respiratory failure, understanding the characteristics of COVID-19 ARDS and its treatment is necessary for optimal outcome. (Korean J Med 2021;96:22-29)

5성인형 스틸병의 진단과 치료

저자 : 김세희 ( Sehee Kim ) , 김해림 ( Hae-rim Kim ) , 이상헌 ( Sang-heon Lee ) , 민홍기 ( Hong Ki Min )

발행기관 : 대한내과학회 간행물 : Korean Journal of Medicine(구 대한내과학회지) 96권 1호 발행 연도 : 2021 페이지 : pp. 30-35 (6 pages)

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Adult-onset Still's disease (AOSD) is an obscure disease that is usually diagnosed after the exclusion of other febrile diseases, including other autoimmune, infectious, and malignant diseases. Although definitive diagnostic criteria and treatment guidelines for AOSD are thus far lacking, the typical manifestations of AOSD have been identified and effective medications for remission and maintenance have been proposed. The pathophysiology of the AOSD is unclear, but diagnostic criteria and treatment guidelines for AOSD can be established by determining its core etiology and conducting clinical trials of previously tested immunosuppressants and biologics. (Korean J Med 2021;96:30-35)

6신장 질환에서 생체표지자로서의 소변의 세포외 소포체의 역할

저자 : 선인오 ( In O Sun )

발행기관 : 대한내과학회 간행물 : Korean Journal of Medicine(구 대한내과학회지) 96권 1호 발행 연도 : 2021 페이지 : pp. 36-41 (6 pages)

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Extracellular vesicles (EVs) are membrane-bound vesicles produced and released into the extracellular fluid by cells under physiological and stressful conditions. They play a role as intracellular communicators by carrying and delivering biomolecules, such as proteins, lipids, or nucleic acids. Urinary EVs have gained important recognition as potential diagnostic biomarkers in renal disease, as they can originate from diverse cell types, including glomerular podocytes, tubular epithelial cells, or endothelial cells. Accumulating evidence has emphasized the feasibility of using EVs as biomarkers for diagnostic, prognostic, and therapeutic purposes in several forms of renal disease, such as acute kidney injury, glomerulonephritis, and renal transplantation. In this review, we introduce recent studies that attempt to identify urinary EVs as candidate biomarkers for human kidney diseases and consider their potential implications as a therapeutic option in significant kidney diseases. (Korean J Med 2021;96:36-41)

7베타-락탐 항생제 알레르기: 일개 지역병원의 실제 임상

저자 : 김혜림 ( Hyerim Kim ) , 이재천 ( Jaechun Lee ) , 김세진 ( Sejin Kim )

발행기관 : 대한내과학회 간행물 : Korean Journal of Medicine(구 대한내과학회지) 96권 1호 발행 연도 : 2021 페이지 : pp. 42-47 (6 pages)

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목적: 베타-락탐 항생제는 약물이상반응의 흔한 원인 약물이다. 베타-락탐 알레르기는 처방 패턴에 따라 크게 다른 양상을 보이지만, 이에 대한 최근 국내 연구는 없다.
방법: 베타-락탐 항생제를 포함한 약물에 의한 약물이상반응 사례에서 베타-락탐 알레르기의 임상 양상을 후향적으로 조사하였다.
결과: 175명 중 약물이상반응의 원인약물로 베타-락탐 항생제가 가장 흔했다. 베타-락탐 알레르기가 확진된 79명(45.1%, 여자 53.2%, 나이 49 ± 14세) 중 두 명(2.5%)은 처방 약물조사로, 33명(41.8%)은 항생제 특이 IgE 항체 검사로, 29명(36.7%)은 피부시험으로, 15명(19.0%)은 약물유발 검사로 확진되었다. 소양감이 가장 흔하였고, 두드러기, 호흡곤란, 혈관부종, 저혈압 등의 증상 및 징후를 보였고, 대부분(61명, 77.3%) 투약 후 1시간 이내 발생하였다. 아나필락시스가 67%에서 발생하였고, 이 중 절반은 응급실을 방문하였다. 흔한 원인약물은 세파클러와 아목시실린 순이었다. 베타-락탐 항생제 이외에는 진통소염제(nonsteroidal anti-inflammatory drugs) 및 퀴놀론계 항생제가 흔한 원인약물로 확인되었다.
결론: 베타-락탐 항생제를 포함한 약물에 의해 발생하는 약물이상반응의 흔한 원인은 베타-락탐 항생제다. 응급실 방문을 요하는 아나필락시스가 흔히 발생하며, 다성분 처방으로 원인약물 확정에 어려움이 있다.


Background/Aims: Beta-lactam (BL) antibiotics are widely prescribed for controlling bacterial infections and relevant culprits of adverse drug reactions (ADRs). BL allergy may vary according to prescription patterns within a given period of time. However, BL allergy in contemporary clinical practice has rarely been a focus of research.
Methods: To investigate the clinical characteristics of BL allergy, subjects with ADRs to medicines, including BL antibiotics, were retrospectively reviewed.
Results: Among the 175 enrolled subjects, BL antibiotics as culprits were confirmed in 79 (45.1%, female 53.2%, age 49 ± 14 years). Among the patients with confirmed BL allergy, only two (2.5%) were diagnosed via a prescription survey completed as part of multi-drug administration. The others were confirmed by serologic tests in 33 patients (41.8%), skin tests in 29 (36.7%), and drug provocation tests in 15 (19.0%). Regarding the symptoms and signs, onset within an hour of taking medicines was common (61 patients, 77.3%). Itchy skin was most common, followed by hives, rash, breathing difficulty, angioedema, and hypotension. Anaphylaxis occurred in 67%, and one-half (50.6%) of patients visited the emergency room. Cefaclor and amoxicillin were common BL culprits. Among others who did not have BL allergy, nonsteroidal anti-inflammatory drugs were found to be common culprits, followed by quinolones.
Conclusions: BL allergy is common among patients who experienced ADRs to medicines including BL antibiotics. For multi-drug administration, a prescription survey hardly helped in confirming BL allergy. Anaphylaxis is common in patients with BL allergy, frequently leading to emergency room visits. Cefaclor and amoxicillin are common culprits. (Korean J Med 2021;96:42-47)

8막증식성 사구체 신염을 동반한 면역글로불린 G4 연관 신장 질환 1예

저자 : 조종태 ( Jong Tae Cho ) , 이은경 ( Eun-kyoung Lee ) , 고재향 ( Jai Hyang Go ) , 이용문 ( Yong-moon Lee ) , 이화영 ( Hwa Young Lee ) , 김소미 ( So Mi Kim )

발행기관 : 대한내과학회 간행물 : Korean Journal of Medicine(구 대한내과학회지) 96권 1호 발행 연도 : 2021 페이지 : pp. 48-52 (5 pages)

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본 증례에서는 신기능 저하, 신우의 종괴로 내원하여 혈청학적 검사, 영상의학적 검사를 바탕으로 신장 조직 검사를 통해 간질성 신염 및 막증식성 사구체 신염을 동시에 보인 IgG4 연관 신장 질환을 진단하고, 스테로이드로 치료한 1예를 경험하여 문헌고찰과 함께 보고하는 바이다.


Immunoglobulin G4 (IgG4)-related kidney disease is a chronic immune-mediated fibro-inflammatory disorder characterized by multiple organ infiltration with IgG4-positive plasma cells, storiform fibrosis, and obliterative phlebitis or tumefactive lesions. Previous studies have explored IgG4-related kidney disease, increasing our understanding of its clinical manifestations, and pathological and radiologic findings. However, IgG4-related kidney disease can be misdiagnosed since it mimics malignancies. We report a case of a 77-year-old Korean man diagnosed with IgG4-related kidney disease with membranous proliferative glomerulonephritis, presenting with a renal pelvic mass suspected of being malignant. (Korean J Med 2021;96:48-52)

9소장 폐색의 위석을 금속 스텐트 삽입 및 압박하여 제거

저자 : 최만기 ( Man Ki Choi ) , 정영주 ( Yeong Joo Jeong ) , 홍승권 ( Seung Goun Hong )

발행기관 : 대한내과학회 간행물 : Korean Journal of Medicine(구 대한내과학회지) 96권 1호 발행 연도 : 2021 페이지 : pp. 53-58 (6 pages)

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Small bowel obstructions (SBOs) that develop for various reasons often require prompt medical treatment. Migration of a gastric bezoar (indigestible foreign material that has accumulated in the stomach) is a rare cause of SBO. Treatment of a symptomatic SBO caused by a bezoar requires a multidisciplinary approach that considers the patient's physical status and comorbidities and the bezoar volume, location, and pathology. Although surgery is the treatment of choice, endoscopic treatments such as fragmentation and retrieval may serve as alternatives. We present the first case of resolution of a large phytobezoar via mechanical compression after covered metal stent insertion, followed by stent retrieval, in a patient with a symptomatic SBO that persisted even after two sessions of push-endoscopic fragmentation. (Korean J Med 2021;96:53-58)

10남성 궤양성 대장염 환자에서 발생한 흉벽의 괴저성 농피증

저자 : 최만기 ( Man Ki Choi ) , 정영주 ( Yeong Joo Jeong ) , 홍승권 ( Seung Goun Hong )

발행기관 : 대한내과학회 간행물 : Korean Journal of Medicine(구 대한내과학회지) 96권 1호 발행 연도 : 2021 페이지 : pp. 59-63 (5 pages)

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Ulcerative colitis, an inflammatory bowel disease, often exhibits extra-intestinal manifestations including various dermatological problems. Pyoderma gangrenosum (PG) is a painful ulcerative cutaneous disorder characterized by the development of rapidly enlarging nodules. The lesion may become aggravated when ulcerative colitis is active, and it commonly affects the extensor surfaces of the lower extremities but rarely the upper extremities, face, periauricular area, anterior chest, back, or buttocks. We encountered a rare case of PG of the chest wall near the left breast, on the face and pretibial area of a male patient with ulcerative colitis. He had not undergone breast surgery and had no history of trauma. The lesion and symptoms were successfully treated by steroid and mesalazine; there was no need for surgery or more potent drugs. (Korean J Med 2021;96:59-63)

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