Extended-spectrum β Lactamase (ESBL) 음성과 양성인 Klebsiella pneumoniae 혈류 감염증 환자의 임상적 특성 및 예후 비교

곽희원 외 중앙대학교 의과대학 의과학연구소 2009 中央醫大誌 Vol.34 No.1/2

ESBL-producing Klebsiella pneumoniae are resistant to many antibiotics, and bloodstream infections by ESBL-producing Klebsiella pneumoniae are known to increase the treatment failure and the mortality rate, but further Korean studies are required. We conducted this study to test the hypothesis that the clinical outcomes and prognosis amomg patients with bloodstream infection by ESBL-non-producing Klebsiella pneumoniae and by ESBL-producing Klebsiella pneumoniae are different. One hundred forty two patients with a bloodstream infection by Klebsiella pneumoniae were enrolled in this study from January, 2003 to May, 2007 at Chung-Ang University Hospital. Demographic characteristics, the mortality rate, hospitalization, site of infection, underlying disease and source of infection were assessed and compared between patients with bloodstream infection by ESBL-non-producing Klebsiella pneumoniae and by ESBL-producing Klebsiella pneumoniae by a retrospective analysis. Age, sex, site of infection, underlying disease showed no significant difference between patients with bloodstream infection by ESBL-non-producing Klebsiella pneumoniae and by ESBL-producing Klebsiella pneumoniae. But the infections by ESBL-producing organism more developed among patients with longer hospitalization and longer recovery period than the infections by ESBL-non-producing organism, but the motality rate showed no significant difference. The infections by ESBL-nonroducing organism were mostly community acquired, whereas the infections by ESBL-producing organismswere mostly hospital acquired. In intensive care units, the infections by ESBL-producing organism needed significantly longer Intensive Care Unit hospitalization, but the motality rate showed no significant difference.

시상부위에 발생한 단일성 뇌농양 : 증례 보고 및 문헌고찰 Report of Two Cases and Review of the Literature

곽호신,김동규,이상형,정희원,이현구,김현집,한대희 대한신경외과학회 1992 Journal of Korean neurosurgical society Vol.21 No.12

The authors present two cases of solitary thalamic abscess which were intially diagnosed as malignant thalamic glioma. After treatment with steroids and osmotic agents, the patients' clinical conditions improved after two to three days. However, sudden deterioration of consciousness level developed and the CT scan showed acute hydrocephalus with increment of thalamic low-density lesions. We performed extraventricular drainage and obtained CSF containing numerous inflammatory cells. This suggested the possibility that the lesion was a pyogenic abscess. which progressed to ventriculitis, rather than a malignant glioma. Stereotactic aspiration of the lesion confirmed thalamic abscess. These findings and review of previous reports of thalamic abscess suggested that early diagnosis and stereotactic drainage of the thalamic abscess is of primary importance.

대장균에서 재조합 Rat Guanine deaminase 유전자의 발현, 정제 및 분석

성연선,곽상준,박대성,김향원,이희영 단국대학교 1998 論文集 Vol.33 No.-

Guanine deaminase(EC, 3.5.4.3, ;Guanine aminohydrolase, GAH, GDA) catalyzes the deamination reaction of guanine to xanthine irreversibly. The cDNA encoding rat guanine deaminase had been isolated from a λZAPII rat brain expression library using antibody generated against purified rat guanine deaminase. Toe obtain recombinant GDA and analyze the property of catalytically conserved retion, here we expressed the recombinant GDA in E.coli and showed the retention of its catalytic activity similar to native rat GDA. To make the construct carrying coding region to GDA in pGEX4T prokaryotic expression vector, the region encompassing open reading frame of pBlue-GDA was PCR amplified and subcloned into pGEX4T prokaryotic expression vector with correct reading frame of fusion carrier glutathione S-transferase. After transformation to E.coli DH5a. The bacteria carrying pGEX-GDA was grwon in the condition of IPTG induction. The fusion protein GST-GDA was purified with GSH-sepharose affinity chromatography. The purified GST-GDA was subsequently digested with biotin-conjugated thrombin, and thrombin was removed by streptavidin agarose. Then sample were treated with GSH-sepharose affinity chromatography to remove the contaminant GST and GST-GDA. The purified recombinant GDA showed 70% of specific activity relative to that of purified rat GDA. The recombinant GDA showed identical molecular weight with rat GDA in SDS-PAGE.

핵연료 수송용기의 방사선 차폐해석

조건우,김희원,권석근,곽은호,문석형 대한방사선 방어학회 1985 방사선방어학회지 Vol.10 No.2

KSC-1 핵연료 수송용기에 대한 방사선차폐해석을 QAD-CG, ANISN-KA, DOT 3.5등의 전산코드와 DLC-23/CASK의 핵단면적 자료를 사용하여 수행하였다. 운반물인 사용후 핵연료집합체로부터 방출되는 중성자 및 감마선의 방사선원항은 ORIGEN-79전산코드를 이용하여 평가하였다. 방사선차폐해석 결과, 1개의 가압경수로 사용후 핵연료집합체를 운반할 수 있는 KSC-1핵연료 수송용기는 정상적인 수송조건에서 뿐만 아니라 가상적인 사고수송조건하에서도 관련 법령에서 정하는 기준을 만족하고 있어 방사선차폐해석의 관점에서 볼 때, 그 안전성이 입증된다. Radiation shield design for a shipping cask, KSC-1, was evaluated to verify that the cask can be used in the transportation of a spent fuel assembly discharged from KNU 5 & 6. Radiation source term of the spent fuel assembly was calculated with the computer program ORIGEN-79, QAD-CG, ANISN-KA and DOT 3.5 codes were used in the shielding calculations and the nuclear cross section data needed was extracted from the DLC-23/CASK library. It is concluded that KSC-1 shipping cask satisfies the requirements specified in the relevant regulations under normal conditions of transport and under accident conditions in transport.

한국인에 있어서 상부식도의 이소성 위점막의 빈도 및 임상적 양상

이동욱(Dong Wook Lee),김은영(Eun Young Kim),박정모(Jung Mo Park),이원석(Won Suk Lee),곽동협(Dong Hyup Kwak),김정희(Jung Hee Kim) 대한내과학회 1998 대한내과학회지 Vol.54 No.1

N/A Objectives: This study was performed to investigate the incidence and the clinical significance of inlet patch of heterotopic gastric mucosa in Koreans. This lesion can be found by close observation around the upper esophageal sphincter during upper gastrointestinal endoscopy. Methods: From March 1, 1996 to July 8, 1996, at Kwak's hospital, randomly selected 271 patients undergoing routine diagnostic upper gastrointestinal endoscopy were included in this study. Patients with the inlet patch were confirmed by histology. Clinical symptoms observed through medical history were recorded. Results: Twenty-six cases(9.6%) of the 271 patients studied had heterotopic gastric mucosa which was found at or just below the upper esophageal sphincter, varing from 3 to 30mm in diameter. It was velvety red in color and distinct from the surrounding normal squamous esophageal mucosa, resembling the Z-line at the esophagogastric junction. Parietal cells were identified in all 18 cases in which biopsy specimen contained deep glands, and chief cells were found in 14 eases. Histologically, fundic gland type was most frequent. The symptoms were relatively mild, 5 out of 6 patients who complained of throat discomfort were relieved by H2 antagonists. Conclusion: In Koreans the incidence of heterotopic gastric mucosa in the upper esophagus was similar to the reports from western countries unlike Barrett's esophagus, The etiology of these patches appeared to be congenital rather than acquired from reflux of gastric acid. This was supported by its location in the proximal esophagus and lack of correlation with reflux esophagitis. It must be considered as one of the differential diagnosis of a patient who complains of throat discomfort during diagnostic upper gastrointestinal endoscopy. Attention needs to be paid to find possible development of complications such as stricture and adenocarcinoma in patients with the inlet patch of heterotopic gastric mucosa.

Inhibition of Metarhizium anisopliae infection of Protaetia brevitarsis seluensis larvae using several effective microorganisms

Kwak, Kyu-Won,Kwon, Soon Woo,Nam, Sung-Hee,Park, Kwan-Ho,Kim, Eun-Sun,Lee, Hee-Sam,Choi, Ji-Young,Han, Myung-Sae Korean Society of Sericultural Science 2018 International Journal of Industrial Entomology Vol.36 No.1

The purpose of this study was to determine the best method for minimizing the occurrence of Metarhizium anisopliae infection of Protaetia brevitarsis seluensis during mass breeding on agricultural farms. There is a high demand for the use of P. b. seluensis larvae in animal feed and as food for humans. However, mass breeding results in the entomopathogenic fungal (usually M. anisopliae) infection of P. b. seluensis. A mixture of microorganisms (Bacillus subtilis, Lactobacillus plantarum, and Saccharomyces cerevisiae) delayed fungal infection by M. anisopliae, which infected fewer P. b. seluensis when the microorganism mixture was added to sawdust as feed for P. b. seluensis. When sawdust with the effective microorganisms (EM) was given to P. b. seluensis for 30 d, their mortality rate was approximately 35 % less than that of the control group, which was fed sawdust without the EM. In addition, the growth of M. anisopliae on agar media spread with each bacterium as inhibited by up to 80 % more than those spread with 4 % sodium hypochlorite, which is a harmless fungal inhibitor generally used in agricultural farms for disinfection.

HCC : O-046 ; Changes of characteristics and management in a revised cohort of hepatocellular carcinoma patients of National Cancer Center, Korea

( Hee Won Kwak ),( Joong Won Park ),( Bo Hyun Kim ),( Tae Hyun Kim ),( Seong Hoon Kim ),( Young Hwan Koh ),( Hyun Beom Kim ),( Sang Jae Park ),( Byung Ho Nam ),( Chang Min Kim ) 대한간학회 2012 춘·추계 학술대회 (KASL) Vol.2012 No.1

Background: Hepatocellular carcinoma (HCC) is a major health problem in Korea. We have reported the first, characteristics and survival analysis of HCC cohort study and six years passed. This revised cohort documents the present experience and changes of HCC patients from diagnosis to death in a single Korean institute. Methods: This longitudinal cohort study includes 2530 HCC patients newly diagnosed between January 2004 and December 2009 and treated at National Cancer Center, Korea, and they were followed till March 2011. Results: The mean age of the patients was 56.4 years and 2096 patients (82.8%) were male. Seventy-five percent were HBVpositive. Child-Pugh A class was 80.6%. The predominant BCLC stage and modified UICC stage at diagnosis was stage C (56.8%) and stage II (28.7%), followed by stage A (21.4%) and stage III, respectively. First recorded treatments were resection (16.8%), transplantation (2.1%), TACE (60.4%), RFA (4.0%), external beam radiation (4.5%) and systemic therapy (5.1%). One thousand five hundred eighteen (60.4%) patients died and the overall 5-year survival rate (5-YSR) was 30.8%. The 5-YSRs of the patients with modified UICC stage I, II and III were 64.4%, 41.2% and 33.3%, respectively, and the median survival time was 17.3 and 16.1 months for the stage IVa and IVb patients, respectively. The results including statistical analysis of prognosis will be updated and comparison between the old cohort and the new cohort will be presented. Conclusions: The present, large cohort study provides valuable insights into Korean HCC disease characteristics and patient management. The results of this study will be useful for development of treatment strategies and prognosis system for HCC patients in HBV-endemic area.

Localized pulmonary edema in the right upper lobe with left atrial myxoma (초)

( Hee Won Kwak ) 대한내과학회 2008 대한내과학회 추계학술대회 Vol.2008 No.-

HCC : Characteristics of Patients with Non-B Non-C Non-alcoholic Hepatocellular Carcinoma

( Hee Won Kwak ),( Hye Ryung Yang ),( Joong Won Park ) 대한간학회 2013 춘·추계 학술대회 (KASL) Vol.2013 No.1

Background: The major risk factors of hepatocellular carcinoma (HCC) are hepatitis B virus (HBV), hepatitis C virus (HCV), alcohol, and non-B non-C non-alcohol (NBNCNA) including non-alcoholic fatty liver disease (NAFLD) in Korea. Recently, a high prevalence of metabolic diseases may increase the incidence of NBNCNA HCC in Korea. In this study, we studied clinical characteristics of NBNCNA HCC in a single center cohort. Methods: A cohort of 1,972 patients newly diagnosed with HCC and treated at the National Cancer Center, Korea between January 2004 and December 2009 was used for this study. We retrospectively reviewed clinical records in the aspect of metabolic factors. Results: A total of NBNCNA HCC was 172 patients (8.7%); median age was 63.0 years old and 132 (76.7%) was male. Patients with NBNCNA HCC showed overweight (BMI > 23) at nearly half (49.3%), and high fasting glucose level (mean level was 161.7 mg/dL). The NBNCNA HCC had the largest tumor size (mean size 7.5 cm) and showed worse survival (median survival 23.1 months, 95% Confidence Interval 13.3-32.0) in comparison with other etiologies. However, 5-year survival rate was 35.1%, which ranked the 2nd place in four etiologies. Further comparison between etiologies will be updated. Conclusions: This study provides clinical characteristics of patients with NBNCNA HCC and may be useful in understanding and management of NBNCNA HCC.

Localized pulmonary edema in the right upper Lobe with Left atrial myxoma (초)

( Kwak Hee Won ) 대한내과학회 2008 대한내과학회지 Vol.75 No.1S