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.

야뇨증 환아들의 심리사회적 특성에 대한 다기관 연구 : 행동 및 정서 문제를 중심으로

조수철,김재원,신민섭,황준원,한상원,박관현,이상돈,김경도,김건석,서홍진,이유식,정재용,김영균,문두건,남궁미경,한창희,조원열,김영식,배기수,이종국,정우영,신의진 大韓神經精神醫學會 2005 신경정신의학 Vol.44 No.6

Objectives : The aim of this study was to examine the behavioral and emotional problems associated with nocturnal enuresis in Korean children. Methods : Three hundred eighteen children with nocturnal enuresis, together with their parents, completed the Child Behavior Checklist (CBCL), Disruptive Behavior Disorder Scale according to DSM-IV (DBDS), Children's Depression Inventory (CDI), State-Trait Anxiety Inventory for Children (STAIC), and Piers-Harris Children's Self-Concept Scale (PHCSC). Ninety-three normal students were selected as the control group. Results : Compared to the normal control group, the mean scores with regard to the withdrawn, social problems, attention problems, delinquent behavior, aggressive behavior, externalizing problems and total problems profiles were significantly higher in the nocturnal enuresis group according to the CBCL results. The nocturnal enuresis group also scored significantly higher in the ADHD and ODD profiles of the DBDS. The nocturnal enuresis group was more depressed and anxious than the control group according to the results of the CDI and STAI. The mean score of the PHCSC was significantly lower in the nocturnal enuresis group when compared to the normal control group. Conclusion : The results of this study suggest that children with nocturnal enuresis in Korea have clinically relevant behavioral and emotional problems. The findings support the link between nocturnal enuresis and psychopathology in Korean children.

소화기 Behcet병: 13예의 임상분석

정희원,유빈,문희범,이인철,김병식,박건춘,김진천 대한대장항문학회 1995 Annals of Coloproctolgy Vol.11 No.1

인체대장암에서의 Cyclin 유전자의 발현

백원기,서민호,서성일,문성희,박종욱,최병길,배옥석 대한대장항문학회 1996 Annals of Coloproctolgy Vol.12 No.2

소아 요로감염 환자에서 분리된 Extended-spectrum β-lactamase 생성 Escherichia coli의 위험인자 분석

문희원,이미애,이승주 대한임상미샐물학회 2003 Annals of clinical microbiology Vol.6 No.2

혈액과 정맥도관에서 분리된 Staphylococcus lugdunensis 2례

문희원,이미애 대한임상미샐물학회 2004 Annals of clinical microbiology Vol.7 No.1

점증적 운동부하테스트를 통한 비만 아동의 운동자각도와 VO₂max 및 HRmax에 관한 연구

문희원,김정규 한국스포츠리서치 2004 한국 스포츠 리서치 Vol.15 No.6

The purpose or this study was to study or VO₂max. HRmax and RPE Following the GXT using the treadmill and cycle ergometer exercise in primary school children(BMI:25, 30% percent body rat). The results we obtained this study were as followings. 1. The change or VO₂max is higher on treadmill exercise than cycle ergometer exercise on treadmill and cycle ergometer to gradual maximum exercise. appeared 41.6±6.63 ㎖/kg/min on first treadmill exercise, 43.4±8.22 ㎖/kg/min on second treadmill exercise, 36.1±5.04 ㎖·kg/min on first cycle ergometer exercise. 37.5±3.52. ㎖/kg/min on first cycle ergometer exercise kept in mind as statistical(p<.05). 2. The change or HRmax is higher on treadmill exercise than cycle ergometer exercise on treadmill and cycle ergometer to gradual maximum exercise. appeared 199.8±5.49 beats/min on First treadmill exercise, 203.2±6.31 beats/min on second treadmill exercise. 195.0±12.71 beats/min on first cycle ergometer exercise. 195.0±6.84 beats/min on first cycle ergometer exercise kept in mind as statistical(p<.05). 3. The change of RPE is higher on treadmill exercise than cycle ergometer exercise on treadmill and cycle ergometer exercise kept in mind as statistical(p<.05).

단기간의 훈련 중단이 비만 중학생의 성장호르몬과 코티졸 분비 변화에 미치는 영향

문희원,김정규 한국스포츠리서치 2004 한국 스포츠 리서치 Vol.15 No.5

The purpose of this study was to examine the effects of short-term detraining(8 weeks, cessation of training) en serum growth hormone(GH) and cortisol secretion in obese muddle school students. The subjects of present study were divided into two groups; 10 obese middle school students and 10 non-obese Middle school students. Before the tests, the subjects were medically examined, the experimental condition was explained and their written consent was obtained. All subjects were measured body composition and blood samples were drawn from antecubital vein before taking part in the exercise training program In order to exam the body composition and blood GH and cortisol following the exercise training program and detraining periods, blood samples also were drawn from antecubital vein at training 4.8, and detraining 4.8 weeks post. 1. There were no significant differences in the changes of lean body mass following the exercise training and detraining between groups(p>.05). However, weight and % body fat were decreased following the exercise training and detraining in both groups, and so there were significant differences in the changes of height, weight, and % body fat following the exercise training and detraining. 2. The level of serum concentration of GH was decreased with experimental conditions(Training and Detraining). So, there were significant differences in the changes of means serum concentration of GH following the exercise training and detraining(p<.05). GH was decreased following the exercise training and increased following detraining 4 weeks. Furthermore, detraining B weeks also was decreased. 3. The level of serum concentration of cortisol was decreased following exercise training and increased during detraining period. However, there was no significant differences in the changes of serum cortisol concentration following the exercise training and detraining(p>.05). In this study, the aerobic exercise training for B weeks could be a caused for the increased of GH in detraining and decreased % body fat and cortisol in obese group. Furthermore, it is suggested that regular exercise training in obese middle school students might be most important factor as the regulator of energy balance and hormone metabolism related to body composition and could increase the capacity of physiological adaptation to reduce the rate of progress Syndrome X.

전기적 자극과 운동이 최대운동능력과 호르몬 및 지방대사에 미치는 영향

문희원,김정규 한국스포츠리서치 2004 한국 스포츠 리서치 Vol.15 No.4

The purpose of present study was to investigate the effects of exercise and electrical stimulation on maximal exercise capacity, lipid metabolism and hormonal changes. The subjects of this study were 21 women who never had been participated in any exercise training program. They were divided into three groups randomly; Group 1(LF=7) was electrical stimulation experimental condition; Group 2(EX=7) was bicylcle exercise experimental condition at 60% of maximal exercise capacity; Group 3(EX+LF=7) was exercise and electrical stimulation experimental condition. Blood sample were drawn from antecubital vein before and after taking part in the different experimental conditions. There were significant difference in the maximal exercise capacity among experimental conditions(p<.05). The changes of weight and fat free mass were more decreases in the EX group than other experimental conditions(p<.05). There were no significant difference in the blood TG and epinephrine concentration among experimental conditions(p>.05). However, there were significant difference in the blood free T3 and norepinephrine concentration among experimental conditions(p<.05). The results of this study indicated the regular exercise might be induced the increase of maximal exercise capacity. Also, the regular exercise could play role in the important physiological function of normal lipid metabolism. Therefore, it is suggested that exercise more efficient effector to improve the functional capacity of exercise and lipid metabolism in young women.

간세포암과 감별이 어려웠던 악성중피종 치험 1예

김선문,허원석,채경훈,강윤세,정재훈,김연수,박기오,문희석,이엄석,김석현,성재규,이병석,이헌영,신경숙,조준식,송인상,강대영 충남대학교 의학연구소 2003 충남의대잡지 Vol.30 No.2

Malignant peritoneal mesothelioma is a rare neoplasm that arises from the mesothelium of a serosal cavity and is a rapidly fatal disease with a median survival of 4 to 12 months for untreated cases. Recently, we experienced a case with malignant peritoneal mesothelioma who was suspected hepatocelluar carcioma by abdominal CT scan and was confirmed by biopsy including immunohistochemical stain(calretinin) after surgery. We performed tumor excisions and wedge resection of the liver(segment Ⅷ)and inserted Tencoff catheter in abdominal cavity at 25th day of post-operation. We treated with intraperitoneal paclitaxel(25mg/m^(2)/day for 5 days) six courses monthly. She was well tolerable and is still living without any evidence of recurrence for 14th month of post-operation.