브루셀라균에 노출된 미생물 검사실 직원들에 대한 예방적 항생제 요법과 혈청학적 추적검사

이창섭,이혜수,이재현,박진희,최영실,황규잠,이흥범 대한감염학회 2008 감염과 화학요법 Vol.40 No.2

The aerozolization is one of possible Brucella transmission mechanisms, particularly in air-borne exposed laboratory workers. In this study, seven laboratory workers were potentially exposed to B. abortus via aerosols. Two laboratory workers who sniffed an agar plate several times were considered to be at high risk for acquiring the disease, 5 workers who did not work directly with the strain were be considered at low risk of infection. Prophylactic antibiotics of doxycycline 200 mg/day and rifampin 600 mg/day were offered for 6 weeks in high risk workers and 3 weeks for low risk workers respectively. Enrolled workers were advised to check for serological testing of Brucella species every 3 weeks during a total period of 12 weeks. Compliance with taking medicine was 57.1% (4/7) and compliance for completing the serological tests was 85.7% (6/7). None of the laboratory workers developed clinical disease or tested positive serologically during 3 months of seroloaical testing and 1 year of clinical follow-up.

국내 사람 브루셀라증 환자에 대한 3년 간의 추적 관찰 연구

이창섭,권근상,백병걸,박상원,이흥범 대한감염학회 2007 감염과 화학요법 Vol.39 No.4

목적 : 2002년 증례 보고 이후, 사람 브루셀라증 환자는 급격하게 증가하고 있는 실정임에도, 이와 관련된 장기간의 임상 증상과 혈청학적 추적 관찰에 대해서는 아직까지 보고된 적이 없다. 본 연구에서는 2003년 전북 일부 지역에서 집단 감염된 11명의 사람 브루셀라증 환자를 대상으로 장기간의 임상 경과와 혈청학적 변화를 알아보고자 하였다. 재료 및 방법 : 2003년 전라북도 정읍 지역에서 사람 브루셀라증으로 진단된 11명의 환자를 대상으로 10명의 환자가 임상 증상에 대한 추적 관찰에, 11명의 환자가 혈청학적 추적 검사에 포함되었다. 사람 브루셀라증의 추적검사는 standard tube agglutination test (SAT)로 시행하였고, 혈청학적 음성 전환은 SAT titer 1:40 이하로 정의하였으며, 브루셀라의 임상 증상이 진단 전 1년 미만으로 지속되었던 경우를 조기 회복기로, 1년 이상 지속되었던 경우를 지연 회복기로 정의하였다 결과 : 대상은 남자 8명, 여자는 3명이었고 이들의 평균 연령은 45세였다. 11명 중 10명이 축산업자였으며, 1명은 수의사였다. 3년 후 까지도 임상 증상이 남아 있다고 호소하는 환자는 8명(80%)이었으며, 만성 피로, 관절통이대부분이었고, 그 외 발열(1), 두통(2), 안통(1), 체중감소(1), 어지럼증(2)이 일부 있었다. 그러나 3년 후 추적 관찰에서 60% 이상 지속적으로 남아있는 증상은 만성 피로와 관절통이었다. 치료 기간은 최소 6주에서 최고 52주까지 다양하였으며, 중앙값은 11주였다. 혈청학적 추적 검사는 최소 11개월에서 최고 39개월까지 실시하였으며, 중앙값은 22개월이었다. 혈청학적 음성으로 전환된 시점은 치료시작 후 최소 5개월에서 최고 16개월이었으며 중앙값은11개월이었다. 결론 : 사람 브루셀라증에 걸렸던 환자들은 피로나 관절통과 같은 임상 증상이 지속적으로 남아 있을 수 있다. 그러나 이러한 증상이 재발을 의미하는 것은 아니기 때문에 항생제의 지속 복용은 필요하지 않다. 본 연구에서 혈청학적으로 마지막 음전된 시점이 치료 시작 후 16개월이라는 점으로 보아, 혈청학적 추적 검사는 치료 시작 후 최소 16개월 이상은 필요하다고 생각된다. Background : The first probable case of human brucellosis in Korea was reported in 2002. Since then there has been a gradual increase in the incidence and prevalence of the disease. There has not been any long-term follow-up investigation of the clinical course and serologic profiles of the disease in Korea. The present investigation is a 3 year clinical and serologic follow-up of human brucellosis patients in Chonbuk province. Materials and Methods : The investigation involved a total of 11 patients who were positively diagnosed with brucellosis in 2003. Clinical manifestations were evaluated either directly or via telephone interviews. The serologic follow-up was done by standard tube agglutination test (SAT). Negative sero-conversion was defined as an SAT titer less than 1:40. Early convalescence was defined as clinical manifestations of brucellosis observed within 12 months of diagnosis, and delayed convalescence was defined as clinical symptoms persisting longer than 12 months. Results : A total of eleven patients (8 males and 3 females; with a mean age of 45 years) participated in the study. Ten patients were livestock workers and one was a practicing veterinarian. Three years after the initial diagnosis, chronic fatigue and arthralgia were persistently observed in more than 60% of the patients in delayed convalescence. There was no evidence of relapse or reinfection of the disease. The median duration of antibiotics treatment and serologic follow-up were 11 weeks and 22 months, respectively. Negative sero-conversion was noted between 5 and 16 months after the initiation of treatment (with a median 11 months). Conclusion : Although the human brucellosis patients developed chronic symptoms such as fatigue and arthralgia even after negative sero-conversion, there was no evidence of any relapse or reinfection. This may mean that antibiotic intervention is not a justifiable recommendation. We also suggest that serologic monitoring be performed for at least 16 months after the initiation of treatment.

리네졸리드로 치료한 반코마이신 내성 Enterococcus faecium 뇌수막염 : 증례보고 및 문헌고찰

이창섭,박성주,이용철,이양근,이흥범 대한감염학회 2010 감염과 화학요법 Vol.42 No.3

Vancomycin-resistant enterococci (VRE) infection is a serious problem because optimal therapy has not been established. Different agents in various combinations, including teicoplanin, chloramphenicol, and quinupristin/dalfopristin, have been used to treat patients with VRE meningitis, but the efficacy of these agents is not satisfactory because of their limited ability to penetrate into the cerebrospinal fluid. We report a case of nosocomial vancomycin-resistant Enterococcus faecium meningitis in a patient with ventriculoperitoneal shunt that was successfully treated with linezolid. We will also review previously reported cases of vancomycinresistant E. faecium meningitis treated by linezolid.

1. 06㎛ Nd : YAG Laser를 이용한 요추간판탈출증의 경피적 수핵감압술

이흥선,변박장,최순관,신원한,권귀향,이인수,이경석,김범태 순천향대학교 1994 논문집 Vol.17 No.4

The 1.06㎛ Neodymium-YAG Laser(800 micron hemisherical) is revealed a useful tool for percutaneous laser disc decompression(PLDD). Especially PLDD would be applied to the management of lumbar disc herniation with minimal intervention. Total irradiated energy to one level of disc space was bout 1000 to 2000 joules. We performed this method at 10 levels, in 7 cases of patients, consisting of 4 males and 3 females with an average age of 37.7 years. Five cases showed excellent and good results, were observed. In two cases, open surgery was required because of unsatisfactory results. The best results were obtained in the protrusion type of disc herniation. We have summarized some advantages of PLDD: a) safe and simple procedure in an outpatient setting, b) avoiding general anesthesia, late spinal instability, c) possibility of repetitive use.

쯔쯔가무시병의 진단에 사용되는 피동혈구응집법과 간접면역형광법의 비교 연구

이창섭,권근상,나상언,이흥범 대한감염학회 2008 감염과 화학요법 Vol.40 No.1

The gold standard for the serologic detection of scrub typhus is the indirect immunofluorescence assay (IFA), however the passive hemagglutination assay (PHA) is commonly used method in Korea because of its availability, easy handling. We compared the sensitivity of PHA and IFA to compare their effectiveness in diagnosing scrub typhus. Out of 35 patients who were eventually diagnosed of scrub typhus by positive IFA, 19 patients (54%) were also tested positive for PHA during the acute phase (titer=1:80). Whereas 30 patients (85%) were positive in IFA during the acute phase. During the recovery phase 30 (85%) patients were positive in PHA, whereas all patients were found to be positive in IFA. Patients with 4-fo1d or greater rise of antibody were 12 (34.3%) in PHA, and 19 (54.3%) in IFA. We note that IFA has better sensitivity over PHA in detecting scrub typhus.

경계성 난소 종양의 임상적 고찰

노흥태,이종범 충남대학교 의과대학 지역사회의학연구소 1999 충남의대잡지 Vol.26 No.2

Approximately 10 20% of epithelial ovarian tumors are tumor of borderline malignancy or carcinoma of low malignancy potential. Epithelial stratification, cellular atypia, mitotic activity, and absence of ovarian stromal invasion set the histologic criteria for diagnosis. The aim of this study was to analyse the group of patients with borderline ovarian tumors. The analysis included 39 patients, operated for ovarian tumor of borderline malignancy in the Gynecological Department of Chungnam National University Hospital from May 1992 to April 1999. The study takes into account comparison of: age of patients, obstetrical past, clinical signs and symptoms, clinical stage(according to FIGO), type of surgery, tumor pathology, post- surgical treatment. Furthermore, long-term follow-up was assessed. The incidence of borderline malignant ovarian tumor was 28.3%. The mean age was 39.2 years (range, 15 to 79). The most common chief complaint was palpable mass(41.0%). 94.8% of tumors were recognised in stage I (FIGO). 74.4% of the tumors were histological mucinous, 25.6% were serous. All patients were treated by surgery and 17.9% received cisplatin-containing chemotherapy.

만성 신부전환자의 혈청 갑상선홀몬 농도의 변화

김민범,이정호,신영태,김삼용,노흥규 충남대학교 의과대학 지역사회의학연구소 1989 충남의대잡지 Vol.16 No.1

To investigate the thyroid hormonal changes and their mechanisms in patients with chronic renal failure (CRF), the author measured serum levels of the thyroid hormones using radioimmu-noassay and calculated each ratio of serum thyroid hormones in 17 patients with CRF. Ten patients were on hemodialysis therapy and seven patients had not undergone hemodialysis. The following results were obtained. 1) The serum T3 and T4 concentrations were significantly lower in patients with CRF(0.7±0.47㎍/1 and 5.53±2.95㎍/dl, respectively) than in normal subjects(1.21±0.18㎍/1 and 9.46±1.92㎍/dl, respectively. 2) The serum FT4(free T4) concentration was significantly lower in patients with CRF(1.20±0.50μu/dl) than in normal subjects(1.01±0.48μu/dl). 4) The serum rT3(reverse T3) concentration in patients with CRF(285.7±148.1pg/ml) tends to be greater than normal subjects(204.6±43.3pg/ml). But is was not significant statistically. 5) The calculated serum concentration ratio of T3/T4 in patients with CRF(0.17±0.04: presented as Mean±SEM) did not differ significantly from that of normal subjects(0.13±0.01). But the serum concentration ratio of rT3/T4 in patients with CRF(78.78±18.98) was significantly greater than in normal subjects(21.90±1.04). 6) There was no significant difference in thyroid functions between male and female patients with CRF, and also between patients on hemodialysis and non-dialyzed uremic patients. It was concluded that the serum T3, T4, FT4 concentration were significantly decreased in patients with CRF, while the serum TSH concentration was significantly increased. The calculated serum concentration ratio of rT3/T4 was also significantly increased in patients with CRF. Thus is appears that abnormalities found in patients with CRF may reflect both the possible intrathyroidal abnormalities and alteration of serum rT3 metabolism with increased peripheral generation of rT3 from T4.

Na+/H+ exchanger와 HCO-₃Transporter에 의한 흰쥐 타액선 선세포내 pH 조절

서정택,박동범,손흥규,이종갑 大韓小兒齒科學會 1998 大韓小兒齒科學會誌 Vol.25 No.2

Intracellular pH (pHi) plays an important role in the regulation of cellular processes by influencing the activity of various enzymes in cells. Therefore, almost every type of mammalian cell possesses an ability to regulate its pHi. One of the most prominent mechanisms in the regulation of pHi is Na+/H+ exchanger. This exchanger has been known to be activated when cells are stimulated by the binding of agonist to the muscarinic receptors. Therefore, the aims of this study were to compare the rates of H+ extrusion through Na+/H+ exchanger before and during muscarinic stimulation and to investigate the possible existence of HCO-₃ transporter which is responsible for the continuous supply of HCO-₃ ion to saliva. Acinar cells were isolated from the rat mandibular salivary glands and loaded with pH-sensitive fluoroprobe, 2', 7' -bis(2-carboxyethyl)-5(6)-carboxyfluorescein(BCECF), for 30min at room temperature. Cells were attached onto the coverglass in the perfusion chamber and the changes in pHi were measured on the iverted microscope using spectrofluormeter. 1. By switching the perfusate from HCO-₃-free to HCO-₃-buffered solution, pHi decreased by 0.39±0.02 pH units followed by a slow increase at an initial rate of 0.04±0.007 pH units/min. the rate of pHi increase was reduced to 0.01±0.002 pH units/min by the simultaneous addition of 1 mM amilorede and 100μM DIDS. 2. An addition and removal of NH+₄ caused a decrease in pHi which was followed by an increase in pHi. The increase of pHi was almost completely blocked by 1mM amiloride in HCO-₃-free perfusate which implied that the pHi increase was entired dependent on the activation of Na+/H+ exchanger in HCO-₃=free condition. 3. An addition of 10μM carbachol increased the initial rate of pHi recovery from 0.16±0.01 pH units/min to 0.28±0.03pH units/min. 4. The initial rate of pHi decrease induced by 1mM amilorede was also increased by the exposure of the acinar cells 10μM carbachol(0.06±0.008pH unit/min) compared with that obtained before carbachol sitmulation (0.03±0.004pH unit/min). 5. The intracellular buffering capacity β1 was 14.31±1.82 at pHi 7.2-7.4 and β1 increased as pHi decreased. 6. The rate of H+ extrusion through Na+/H+ exchanger was greatly enhanced by the stimulation of the cells with 10μM carbachol and there was an alkaline shift in the activity of the exchanger. 7. An intrusion mechanism of HCO-₃ was identified in rat mandibular salivary acinar cells. Taken all together, I observed 3-ford increased in Na+/H+ exchanger by the stimulation of the acinar cells with 10μM carbachol at pH 7.25. In addition, I have found an additional mechanism for the regulation of pHi which transported HCO-₃ into the cells.

한국인 정신분열병과 HLA-DRB1 대립유전자의 관련성

황나영,김종원,오흥범,조지희,오선영,홍진표,박종익,이동은 大韓神經精神醫學會 2000 신경정신의학 Vol.39 No.5

연구목적: 유전이 정신분열병의 중요한 원인이라는 것은 널리 인정되어 왔다. 본 연구는 한국인 정신분열병과HLA-DRB1 유전자좌와의 관련성을 알아보고 외국인 대상의 보고들과 비교함으로써 한국인 정신분열병의 유전적 특성을 밝히고자 시행하였다. 방법: 정신분열병 환자 70명을 대상으로 HLA-DRB1 대립유전자를 고해상도 수준까지 분석하였다. 저해상도 수준의 HLA-DR결과는 정상 한국인 2,000명의 연구 보고와 비교하였으며 고해상도 수준의 HLA-DRB1 결과는 정상 한국인 229명의 연구 보고와 비교하였다. 결과: 저해상도 수준에서는 HLA-DR11이 정신분열병 환자군에서 9.0%, 정산인에서는 3.8%의 빈도를 보여 환자군에서 통계적으로 유의하게 높은 빈도를 보였으며(p=0.005), 고해상도 수준에서는 HLA-DRB1*1101이 환자군에서 9.0%로 정상인의 1.8%보다 유의하게 높은 빈도를 보였다(p<0.001). 결론: 본 연구에서는 한국인 정신분열병과 HLA-DR11(HLA-DRB1*1101)이 양적 상관관계를 보여 백인에서 DR4와 부정적 상관관계를 보인 결과나 일본인에서 DR1(DRB1*0101)과 양적 상관관계를 보인 결과와 상이하였다. 이러한 한국인 정신분열병 환자의 유전적 특성은 가족연구 혹은 더 많은 수의 환자를 대상으로 한 관련연구를 통하여 재확인되어야 할 것이다. 중심단어:정신분열병·HLA-DRB1·관련연구. Objective: A genetic predisposition is widely accepted in schizophrenia. This study was intended to fine any association of HLA-DRB1 alleles with korean schizophrenics and thereby compare the results of other ethni groups. Method: The subjects were 70 unrelated Korean patients. Low and high resolution typing of HLA-DRB1 alleles were performed. The comparison groups were 2,000 unrelated healthy Koreans for low resolution HLA-DR and 229 unrelated healthy Koreans for HLA-DRB1 alleles. Results: Gene frequencies of HLA-DR11(patients 9.0%, healthy control 3.8%, p=0.005) and HLA-DRB1*1101(patients 9.0%, healthy control 1.8%, p<0.001) were significantly higher in Korean schizophrenics. Conclusion: The frequency of HLA-DR11(HLA-DRB1*1101) is significantly higher in Korean schizophrenics than in healthy Koreans. HLA-DR4 and HLA-DR1, which were known to be associated with Caucasian and Japanese schizophrenics, respectively, did not show statistical association with Korean schizophrenics. This association need to be reassured though further studies with families or association study with larger numbers of subjects. KEY WORDS:Schizophrenia·HLA-DRB1·Association study.

운동유발성 천식과 위식도역류와의 연관성

이흥범 ( Heung Bum Lee ),이양덕 ( Yang Deok Lee ),김현철 ( Hyun Chul Kim ),이용철 ( Yong Chul Lee ),이수택 ( Soo Teik Lee ),이양근 ( Yang Keun Rhee ) 대한결핵 및 호흡기학회 2000 Tuberculosis and Respiratory Diseases Vol.48 No.2