7개 대학 병원에서 조사한 지역사회 폐렴의 원인균

정문현,김성민,강문원,최희정,정희진,이경원,한성우,송재훈,신형식,김의종,최강원,김민자,박승철,배현주,정윤섭,김준명,백경란,신완식,이규만,김양리 대한감염학회 1997 감염 Vol.29 No.5

목 적 : 폐렴은 많이 발생하면서 사망률이 크게 줄지 않는 질환이며, 이를 적절히 치료하기 위해서는 원인균의 상대적 빈도, 기저 질환에 따른 변화, 항균제 내성률, 사망에 관련된 인자들을 알아야 한다. 원인균의 빈도는 지역마다 차이가 있고 국내에서는 항균제 내성률이 높아 지역사회에서 발생한 폐렴을 치료하기 위한 경험적 항균제 선택에 도움이 되기 위해 서울 소재 6개 대학 병원과 천안의 1개 대학 병원이 참여하여 위의 사항들에 대해 조사를 하였다. 방 법 : 1995년에 내과에 입원했던 16세 이상 환자를 대상으로 했다. 퇴원 진단명이 폐렴 또는 폐결핵인 병록지을 찾았고, 이중에서 병원 감염을 제외하였다. 특이도를 높이기 위해, 이들 중에서 호흡기 증상이 있고 발열이나 저체온이 있으면서 흉부 X-선에서 이상 음영이 있는 환자만을 대상으로 했다. 폐결핵은 위의 기준에 입원 초기에 항균제 치료를 하고 입원 7일 이후에야 항결핵제가 투여된 경우만을 폐렴의 원인균으로 하였다. 혈액 배양에서 양성, 객담에서 항상균이나 M. tuberculosis가 증명된 경우, 혈청학적으로 항체가가 4배 이상 증가된 경우, 조직에서 원인균이 진단된 경우는 확정(definitive) 원인균으로 하였고, 객담에서 배양된 균이 그람 도말과 일치할때, 항결액제에 대한 반응으로 진단한 폐결핵, 단일 항체가 양성이고 이에 대해 항균제를 사용했을 때는 가능(probable) 원인균으로 정의하였다. 다세균 감염균은 각각 다 른 원인균으로 처리하였다. 임상 조사와 함께 임상병리과에서 S. pneumoniae, H. influenzae, M. catarrhalis, mycoplasma, 항상균에 대해 검사 의뢰 건수, 배양 양성수, 항균제 감수성 결과를 조사하였다. 결 과 : 폐렴의 증례 정의에 부합하지 않은 135명과 폐결핵의 정의에 해당하지 않는 230명을 제외하고 남은 246명의 평균 나이는 58.2세이고 남성이 142명(58.2%) 이었고, 71%의 환자에서 기저 질환이 있었다. 진단 방법의 시행 횟수는 혈액 배양 77.6%, 혈청 검사 18.3%, 기관지경 검사는 4.1%였고, 세균의 항원 검사를 한 예는 없었다. 원인균이 밝혀진 예는 77명(31.3%)이었다. 다세균 감염이 4명에서 있었고, 원인균의 상대적 빈도는 결핵 20명(확정 17, 가능 3: 6개 병원 자료), 폐렴구균 18(확정8 가능 10)명과 폐렴구균이 아닌 Streptococcus 3명 (모두 확정), H. influenzae 11명(모두 가능), 그람음성간균 11명(확정 7, 가능 4) (K. pneumoniae 8건), Mycoplasma 5명(확정 1, 가능 4), S. aureus 4명(확정 2, 가능 2), mucormycosis 1명(확정)이었다. 평균 입원 기간은 19일이고, 중환자실 입원률과 인공 호흡기 사용율은 각각 18%와 9.3%였다. 사망률은 13.8%였고 사망까지 평균 기간은 14.6일 이었다. 다변량 분석에서 사망을 예측할 수 있는 인자는 저체온과 빈호흡이었다. 임상병리과에서 배양되었던 모든 폐렴구균의 Penicillin 내성률은 서울 3개 병원에서 82-88%, 천안에서 72%였다. 폐렴 환자의 혈액에서 배양된 7주는 모두 Penicillin에 감수성이 있었다. K. pneumoniae 8주 모두 cefotaxime과 gentamicin에 감수성을 보였다. 결 론 : 후향적 조사이고 병원마다 원인균 진단에 차이가 있지만, 원인이 밝혀진 경우에는 결핵과 폐렴균이 흔하였고, 무균 부위에서 배양된 폐렴구균의 항균제 내성률은 낮았다. 원인이 밝혀지지 않은 경우가 많고, 혈청검사로 진단되는 원인균이 드물며, 분리균주가 적어 항균제 내성 정도를 추정하기 어려워, 이를 밝히기 위한 전향적 조사가 필요하다. Background : Community-acquired pneumonia (CAP) is one of the leading causes of mortality and morbidity, but its management is still challenging. The limitation of diagnostic methods to identify etiologic agents rapidly make it necessary to use empiric antibiotics in almost all patients, and furthermore the discovery of new respiratory pathogens and the emergence of antibiotic-resistant organisms pose difficulties to the selection of an empiric regimen. To clarify the factors necessary for the optimal choice of empirical antibiotics, such as the frequency of etiologic agents, the attributable rates to death and antimicrobial resistance rates in the community, six university hospitals in Seoul and one university hospital in Cheonan were participating in this study. Methods : medical records of adults (>15 years of age) hospitalized for CAP or pulmonary tuberculosis between April 1995 and March 1996, were reviewed. Patients who satisfied all of the following criteria were included in the study: (1) fever or hypothermia; (2) respiratory symptoms; and (3) pulmonary infiltrates on chest roentgenogram. To exclude cases of pulmonary tuberculosis whose roentgenographic features were so typical that it could be easily differentiated from conventional pneumonia, two additional criteria were required for inclusion: antibiotic treatment during the first week of hospital admission and initiation of anti-tuberculosis medications thereafter. Organisms isolated from sterile body sites, acid-fast bacilli or Mycobacterium tuberculosis isolated from sputum, pathogens diagnosed by a 4-fold rising titer of antibodies to “atypical”pathogens, or pathogens revealed by histopathology were defined as definitive cause of pneumonia; isolates from sputum withcompatible Gram stain, pathogens diagnosed by a single diagnostic titer plus use of a specific antimicrobial agent, or tuberculosis diagnosed by clinucal response to anti- tuberculosis medications were considered probable cause of pneumonia. The records of the clinical microbiology were reviewed for isolates of S. pneumoniae, H. influenzae, M. catarrhalis, Mycobacterium or acid-fast bacilli, and Mycoplasma. Then the frequency of these agents, antimicrobial resistance rates of resiratory pathogens from all body sites, and their clinical significance were evaluated. Results: After excluding 365 patients (230 with pulmonary tuberculosis and 135 with CAP) who were screened for inclusion but did not meet the inclusion criteria,246 persons were enrolled in this study. Their mean age was 58.2 years old with slight male predominance (58.2%), and 171(71%) patients had underlying illnesses. Blood cultures were performed on 191 (77.6%) patients and serologic tests on 44(18.3%) patients. The etiologic agents were identified in 31.3%, and the list of individual agents, in decreasing order, was pulmonary tuberculosis (17 definite and 3 probable: data of six hospitals), S. pneumoniae (8 definite and 10 probable), non-pneumococci (3 definite), aerobic gram-negative bacilli (7 definite and 4 probable), Haemophilus spp. (11 probable), mycoplasma (1 definite and 4 probable), polymicrobial infections (2 definite and 2 probable: E. coli and S. agalactiae, M. tuberculosis and S. aureus, S. pneumoniae and H. influenzae and A. baumannii and K. pneumonias), S. aureus (2 definite and 2 probable) , and mucormycosis (1 definite). Among gram-negative bacilli, K. pneumoniae was the most common agent (8isolates). therates of admission to the intensive care unitand of using assisted ventilation were 18% and 9.3%, respectively. The mortality was 13.8% and logistic regression analysis showed that hypothermia and tachypnea were associated with death. Hospital stay averaged 19 days. Susceptible rates of S. pneumoniae isolated from all body sites to penicillin ranged from 8% to 28% but seven isolated from blood of patients with pneumonia were susceptible to penicillin. Also all 8 isolated of k> pneumoniae from patients with pneumonia were susceptible to cefotaxime and gentamicin. Conclusion: In Korea, in addition to S. pneumoniae, M. tuberculosis is an important agent causing community-acquired pneumonia. The low incidence of etiologic diagnosis is probably related to infrequent requesting of test "atypical" pathogens and does not represent the true incidence of infections by "atypical" pathogens, which well be answered by a prospective study. The antimicrobial resistance rates of major respiratory pathogens from sterile body sites are low, however, because of a small number of the isolates this result needs confirmation by a nationwide surveillance of antimicrobial resistance.

KAL기 추락에 의한 대량재해의 개인식별

강신몽,이원태,고영창,최상규,김윤희,이홍석,서재관,윤중진,이혜경,최득린,김종열,윤창육,변명식,이장홍 大韓法醫學會 1991 대한법의학회지 Vol.15 No.2

Individual identification is an important part in medicolegal field especially in mass disaster. At July, 27, 1989, KAL KE-803 was crashed on landing at Tripoli International Airport, Liba. The plane was caught in fire and sixty eight Koreans were sacrified. The majority of victims were severely charred and injured. The authors examed all dead bodies and successfully identified all the cases through visual, anthropological, odontological, radiological and pathological methods including fingerprint and blood typing.

하수 슬러지 건조 공정의 경제성 평가에 관한 연구

姜宇政,申澈洙,梁晶模 충주대 2004 産業科學論文集 Vol.12 No.-

To solve the water pollution prevention problems, sewage and wastewater disposal system as the basic facilities are required strongly. However, the production of sewage sludge, a by-product of sewage and wastewater disposal system, is tending to increase. Therefore, efficient disposal method of sewage and wastewater is needed. At present, there are many problems in current disposal methods such as open dumping, ocean disposal, and incineration. These cause secondary environmental problems. Recycling sewage sludge is an alternative method to solve these problems thoroughly and prevent environmental disruption and maximize economic usefulness. This study presents LCA(Life Cycle Assesment) application to analyze the environmental loads and economy of sewage sludge drying process. The obtained results are applied to prepare fundamental understanding and judgement in view of environmental and economical consideration on drying process of sewage sludge by local authorities. The results are as follows; The economic assessment showed that the expense of drying process of sewage sludge was 45,603 won per ton. Among the expense items, the fuel cost is around 35%(15,961 won per ton) and it is the main cause. It is regarded that reducing the fuel can obtain the reduction of the cost and carbon dioxide, major environmental pollution discharge.

교수-학습 지원을 위한 웹 에이전트(web agent)의 개발

강신천,한승록,박정환 한국컴퓨터교육학회 2003 컴퓨터교육학회 논문지 Vol.6 No.1

최근 에이전트를 교육에 활용하려는 연구와 노력이 시도되고 있다. 에이전트는 컴퓨터가 사용자를 대신하여 주어진 일을 수행하는 대행자(proxy)나 중개자(middle ware) 역할을 하는 컴퓨터 프로그램을 통칭하는 개념이다[1]. 근래에 다양한 장르에서 에이전트가 활용되고 있으며 교수·학습분야 역시 그러한 것 중의 하나에 해당된다. 웹 상에서 교사의 역할을 대신할 수 있는 프로그램이나 엔진의 개념이 교수·학습을 지원하는 웹 에이전트이다. 웹 상에서 에이전트는 교사의 역할을 수행할 뿐만 아니라 학습자를 도와 주는 도우미 역할을 수행한다. 웹 에이전트가 적용된 웹 기반 교수·학습 환경은 학습자나 교사에게 적응적이고 개별화된 환경을 제공한다. Recently there are many tries and researches for using web agent in education. The agent is a computer program as a common name which takes a role like a proxy or a middle ware for accomplishing the given something on behalf of user [1]. Lately the agent is being used in the various fields. The teaching and learning Is the one of those. It is the web agent that support the teaching and learning on the web. It has a concept of the program or the engine is able to do teachers roles on the behalf of him on the web. Not only the web agent is able to do teachers roles on the behalf of him, but also it is a helper that helps learners on the web. The web based teaching and learning environment has the web agent offers the personal and the adaptive information, interface, or contents.

1,8-디메틸 및 1,8-디에틸-1,3,6,8,10,13-헥사아자시클로테트라데칸 니켈(II) 착화합물의 팔면체-평면사각형 평형

姜信杰,鄭守炅 大邱大學校附設 基礎科學硏究所 1988 基礎科學硏究 Vol.5 No.-

Nickel(Il) complexes of 1, 8-dimethyl-1, 3, 6, 8, 10,1 3-hexaazacyclotetradecane (L_(8)) and LS-diethyl-1,3,6,8,10, 13-hexaazacyclotetradecane(L.) exist as an equilibrium mixture of high spin, octahedral and low spin, square planar species in coordinating solvents. The equilibrium constants and thermodynamic parameters have been determined at various solutions from detailed analysis of the temperature-dependence of the electronic spectra. The octahedral-to-square planar conversion is endothermic and exoentropic. The effects of ligand structure and of solvent on the equilibrium are described.

신경회로망을 이용한 LAPS 시스템의 특성 분석

정원봉,이민호,강신원 경북대학교 센서기술연구소 1998 센서技術學術大會論文集 Vol.9 No.1

A LAPS (Light Addressable Potentiometric Sensor) system using a neural network was proposed for the sensing a hydrogen ion concentration. A multilayer neural network is used for enhancing a resolution of LAPS which is limited by a hardware device including a AD converter, low-pass filter etc. Also, an experimental results is compared and analyzed with an analytic result.

공원묘지 유실에 의한 대량재해의 개인식별

강신몽,이한영,윤중진,이원태,김종열,이영석,서재관,최득린,서지석,이혜경 大韓法醫學會 1992 대한법의학회지 Vol.16 No.1

Individual identification of severely decomposed or skeletonized bodies is an important part in medicolegal field. 142 bodies were torn up and carried away by flood in a park cemetry, Kwang-Ju, Kyunggi province, Korea at Sept., 10, 1990. The authors examed the 56 bodies, which were gained, through medical, anthropological, odontological, radiological methods, and superimposition for individual identification. Among them, 41 cases were successfully identified, and remaining 15 cases were not identified because of sever destruction and no adequate information.

중독한 추체로 증상을 보인 cyclosporine에 의한 뇌증 1예

강정현,곽승근,신현영,김성은,이정호,이정찬,곽상혁,윤환중,조덕연,김삼용,김제,송창준 충남대학교 의과대학 지역사회의학연구소 2000 충남의대잡지 Vol.27 No.1

The use of cyclosporine(CsA), a potent immunosuppressive agent, is associated with numerous side effects. Neurotoxicity was earlier less well known, but with growing experience central nervous system side effects are now reported up to 40% of patients. Among various CsA-induced neurotoxicities, tremor is most common and posterior leukoencephalopathy is well characterized. An encephalopathy presenting with pyramidal weakness, however, seems to be rare and poorly documented. We report here a case of encephalopathy presenting with multiple generalized seizures followed by fluctuating quadriparesis developed a few days after starting CsA and resolved spontaneously after withdrawal of the drug . A 48-year-old woman with aplastic anemia was placed upon immmunosuppressive treatment consisting of antithymocyte globulin(ATG), CsA, and methylprednisolone. Two days after starting the therapy, she developed a generalized seizure. The next day she developed 2 more episodes of seizure and the therapy was stopped. Computed tomogram of the brain was normal. Six days after starting therapy, she developed mild motor weakness and paresthesia of both lower extremities, which progressed to a definite quariparesis confining her to a bed in 3 days. Magnetic resonance imaging(MRI) of the brain revealed asymmetric, bilateral high-signal abnormalites in the subcortical white matter of fronto-temporal areas. After reaching to a maximum with some fluactuation(14 days after starting the therapy) the motor weakness started to be resolved. She was discharged with a almost complete resolution of the weakness 45 days after starting the therapy. Five months later she did well and brain MRI was negative.

관해유도 화학요법을 받는 급성 백혈병 환자에서 발생한 감염증에서 Imipenem 단독요법과 Ceftizoxime + Amikacin 병용요법의 효과 및 안전성에 관한 전향적 비교 연구

신형식,김성민,이기형,최희정,김남중,오명돈,박선량,김병국,최강원 대한화학요법학회 1996 대한화학요법학회지 Vol.14 No.2

A total of 40 febrile granulocytopenic patients with acute leukemia were randomized to receive imipenem-cilastatin or ceftizoxime plus amikacin as initial empirical therapy to compare the efficacy and safety of imipenem monotherapy with that of ceftizoxime/amikacin combination therapy. 21 patients were randomized to the imipenem monotherapy, while 19 patients to the ceftizoxime/amikacin combination therapy. On 72 hour assessment success rates accordings to NCI criteria were 100% in both groups, success rates according to IHS (Immunocompremised Host Society) criteria were 55.0% in imipenem group and 66.7% in ceftizoxime/amikacin group. On overall assessment success rates according to NCI criteria were 90.0% in imipenem group and 94.7% in combination group, success rates according to IHS criteria were 50% in both groups. There was no statistical difference in success rate between two groups. Hepatotoxicity was the most common side effect in both groups(imipenem 15.0% vs. ceftizoxime/amikacin 15.8%). There was no CNS tixicity in both groups. Nausea and vomiting occurred in 9.5% of imipenem recipients, and 1 patients was unable to complete therapy due to intolerance. In summary, imipemem monotherapy was effective and safe empirical antibiotic therapy as compared with ceftizoxime/amikacin combination therapy.

驅動部 動特性을 高慮한 可變構造 制御 알고리듬

강익호,김정욱,신휘범,이정훈,고상호 慶尙大學校生産技術硏究所 1997 生産技術硏究所論文集 Vol.13 No.-

In this paper, the dynamics of actuators for generating the input of plants is considered in a design of the variable structure systems. While the input for plants is usually implemented by means of a certain actuator, the actuator dynamics is not incorporated in most of the VSS researches until now. The control algorithm of a VSS incorporating actuator dynamics is presented. and the simulation is given the usefulness of the algorithms.