비글개에서 분만 후 자궁수복의 연속적 초음파상

손형원, 김홍석, 김형진, 김일화, 이기창, 이청산, 강현구 충북대학교 동물의학연구소 2006 Journal of Biomedical and Translational Research Vol.7 No.2

본문참고

개에서 디스템퍼 바이러스와 톡소플라즈마의 혼합 감염

강홍원,강상철,양형석,배종희,김재훈 한국임상수의학회 2004 한국임상수의학회지 Vol.21 No.1

A 3 month-old male dog with clinical signs of anorexia, soft stool, ocular and nasal discharge, cough and respiratory distress was submitted to the Cheju National University for diagnosis. At necropsy, tan to purple-red sublobar to lobar consolidations were presented in apical and cardiac lobe of lung. Histopathologically, severe diffuse bronchointerstitial pneumonia with necrotic bronchiolitis was noted in the lung. The demyelinating encephalitis and astrocytosis were presented in cerebellum and cerebrum. Numerous round, ovoid or cluster of tachyzoites were also identified in alveolar lumen, alveolar wall and cytoplasm of macrophages in the lung. The orgasnisms were demonstrated as Toxoplasma (T) gondii by immunohistochemistry. Intranuclear or intracytoplasmic eosinophilic inclusion bodies were seen in the glial cells of the cerebellum. Canine distemper virus (CDV) specific antigens were demonstrated in the cerebellum by the immunohistochemistry. In our knowledge, this is believed to be the first confirmed report of co-infection of CDV and T gondii in dog in Korea.

병원근무자에서 홍역,풍진 및 수두 항체양성률에 관한 연구

최강원,김성민,오명돈,이환종,오향순,최희정,김남중,신형식 대한감염학회 1997 감염 Vol.29 No.1

목적: 홍역, 풍진, 및 수두의 병원감염 발생위험도를 평가하고 병원근무자 예방접종지침을 고안하는데 필요한 기초자료를 얻고자, 홍역, 풍진, 및 수두에 대한 병원근무자의 항체양성률을 조사하였다. 방법: 1995년 3월 서울대학교병원 산부인과 병동과 서울대학교 어린이병원에 근무하고 있는 여성을 대상으로 홍역, 풍진, 및 수두의 감염 과거력과 예방접종 과기력을 설문조사하였다. 정맥혈을 채혈하여 효소결합면역흡착검시(Enzyme linked immunosorbent assay, Behring ??? IgG kit)로 IgG 항체를 측정하였다. 결과: 홍역, 풍진, 및 수두에 대한 항체양성률은 각각 95.6%, 87.9%, 96.2% 이었다. 연령, 감염 과거력, 예방접종 과거력에 따른 항체양성률의 차이는 유의하지 않았다. 결론: 저자 등의 연구결과는 홍역과 수두, 특히 풍진의 병원감염 위험도가 높음을 시사하며, 각 개인의 건강과 전염병의 전파를 막기 위하여 병원근무자 예방접종지침이 필요하다. Background: To assess the risk of hospital outbreak and to guide immunization policy, seroprevalences of antibody to measles, rubella, and varicella-zoster were determined in hospital personnel. Methods: A cross-sectional study of 290 workers in Seoul National University Hospital was conducted in June 1995. IgG antibody status was determined with commercially available enzyme linked immunosorbent assay(Behring ??? IgG kit). Results: Seropositive rates of measles, rubella and varicella-zoster were 95.6%, 87.9% and 96.2%, respectively. There was no statistical difference in seropositive rate according to historical information. Conclusion: These results suggest potential for hospital outbreak of measles an varicella-zoster, especially of rubella. Immunization policy will be needed in hospital personnel.

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.

한국인 직무 스트레스 측정도구의 개발 및 표준화

장세진,고상백,강동묵,김성아,강명근,이철갑,정진주,조정진,손미아,채창호,김정원,김정일,김형수,노상철,박재범,우종민,김수영,김정연,하미나,박정선,이경용,김형렬,공정옥,김인아,김정수,박준호,현숙정,손동국 大韓産業醫學會 2005 대한직업환경의학회지 Vol.17 No.4

Background and Purposes: Over the past three decades, numerous studies performed in Korea have reported that job stress is a determinant risk factor for chronic diseases and work disability. Every society has its own culture and occupational climate particular to their organizations, and hence experiences different occupational stress. An occupational stress measurement tool therefore needs to be developed to estimate it objectively. The purpose of this study is to develop and standardize the Korean Occupational Stress Scale (KOSS) which is considered to be unique and specific occupational stressors in Korean employees. Subjects and Methods: Data were obtained from the National Study for Development and Standardization of Occupational Stress (NSDSOS Project: 2002-2004). A total of 12,631 employees from a nationwide sample proportional to the Korean Standard Industrial Classification and the Korean Standard Occupational Classification were administered. The KOSS was developed for 2 years (2002-2004). In the first year, we collected 255 items from the most popular job stress measurement tools such as JCQ, ERI, NIOSH and OSI, and 44 items derived from the a qualitative study (depth interview). Forty-three items of KOSS, in the second year, were retained for use in the final version of the KOSS by using Delphi and factor analysis. Items were scored using conventional 1-2-3-4 Likert scores for the response categories. Results: We developed eight subscales by using factor analysis and validation process: physical environment (3 items), job demand (8 items), insufficient job control (5 items), interpersonal conflict (4 items), job insecurity (6 items), organizational system (7 items), lack of reward (6 items), and occupational climate (4 items). Together they explained 50.0% of total variance. Internal consistency alpha scores were ranged from 0.51 to 0.82. Twenty-four items of the short form of the KOSS (KOSS-SF) were also developed to estimate job stress in the work setting. Because the levels of the subscales of occupational stress were gender dependent, gender-specific standard norms for both the 43-item full version and the 24-item short form using a quartile for the subscales of KOSS were presented. Conclusion: The results of this study suggest that KOSS might be an appropriate measurement scale to estimate occupational stress of Korean employees. Further and more detailed study needs to be conducted to improve the validity of this scale.

후천성 면역부전증후군 환자에서 발생한 Cryptosporidium parvum 감염 2예의 보고

오명돈,최강원,신형식,김성민,최희정,강현재,김윤준,채종일 대한감염학회 1996 감염 Vol.28 No.5

Cryptosporiduim is an intracellular protozoan parasite and known as an important pathogen causing diarrheal illness in animals and man since 1970's. With the advance of epidemic of Acquired Immunodeficiency Syndrome(AIDS), Cryptosporidium has emerged as one of important pathogens in AIDS patients and is responsible for chronic diarrhea, cholecystitis, biliary tree obstruction and respiratory illness. Despite frequent reports of cryptosporidial diarrhea in other countries there has been no report of human cryptosporidial infection in AIDS patients so far in Korea. We report two cases with chronic cryptosporidial diarrheal illness in AIDS patients. C. parvum oocyst was identified by fecal smear with modified acid fast staining. In one patient the diarrheal illness was improved after 4 weeks supportive management only. But fecal excretion of oocyst continued after clinical improvement of the diarrheal illness. Another patient was died of respiratory failure after recurrent diarrheal illness. Cryptosporidial infection should be considered in differential diagnosis of chronic diarrhea especially, in AIDS patients.

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.

백혈구 감소증하 발열시 경험적 항진균요법의 효과

배현주,김양수,신형식,백경란,정문현,오명돈,최강원,우준희 대한화학요법학회 1991 대한화학요법학회지 Vol.9 No.2

The clinical value of empiric therapy of amphotericin B in 19 patients who were still febrile and granulocytopenic despite coverage of broad-spectrum antibiotics for 6 days was investigated. The clinical response rate was 52.6% on NCI criteria and 21% on EORTC criteria. The mortality rate was 36.8%.

새로운 항생제 개발을 위한 일부 동의 약제의 항균력 검색

오명돈,김성민,신형식,최강원 대한화학요법학회 1996 대한화학요법학회지 Vol.14 No.2

Water or methanolic extracts of twenty herbs were screened for antoibacterial activity against ten pathogenic bacteria(S. aureus, S. pneumoniae, S. pyogenes, S. faecalis, E. coli, K. pneumoniae, P. vulgaris, P. aeruginosa, S. typhi, H. influenzae) by broth microdilution susceptibility test. Two of them-methanolic extract of the Lithespermum and Polygonum-were found to exhibit relatively broad antibacterial activity. But, neither CH₂CI₂ nor H₂O parts of methanolic extracts of them showed significant antibacterial activity.

중합효소연쇄 반응법에 의한 인형거대세포바이러스(human cytomegalovirus)의 신속한 검출

김의종,오명돈,박기호,신형식,이환종,김남중,최강원 대한감염학회 1996 감염 Vol.28 No.4

목 적 : 인형거대세포바이러스(HCMV)는 면역 저하 환자에서 폐렴, 망막염, 간염 등 치명적인 감염증의 원인이다. 전통적인 세포 배양법으로 HCMV를 분리하기까지는 1주에서 4주가 걸리므로 이 바이러스에 의한 질환이 의심되는 경우 신속한 진단법을 이용한 진단이 바람직하다. 저자들은 한국에서 분리되는 야생주 HCMV를 검출하는데 중합효소 연쇄 반응법을 이용할 경우의 진단적 유용성을 알기 위하여, 전통적인 세포배양법으로 HCMV가 분리된 검체를 이용하여 중합효소 연쇄 반응법의 특이도와 민감도를 평가하였다. 방 법 : 국내 야생주 HCMV 15주, 그리고 전통적인 바이러스 배양법으로 HCMV가 분리된 소변 15검체를 대상으로 중합효소 연쇄 반응을 실시하였다. 중합효소 연쇄 반응은 Towne주의 immediate early antigen의 유전자에서 유리된 primer MIE와 AD169주의 immediate early antigen의 유전자에서 유리된 primer IE를 이용하였다. 증폭 산물은 겔 전기영동 후 EtBR으로 염색하여 자외선 하에서 관찰하였다. Primer IE에 의한 증폭산물은 또한, DNA blot hybridization 방법으로 확인하였다. 결 과 : 1) 국내 HCMV 야생주 15주를 대상으로 중합효소 연쇄 반응을 한 결과 primer IE를 이용한 경우에는 100%(15/15)에서 177bp의 증폭 산물이 관찰되었고, 이들 증폭 산물은 모두 probe IE와 보합 결합되었다. primer MIE를 이용한 경우에는 93%(14/15)에서 435bp의 증폭 산물이 관찰되었다. 2) 세포 배양법으로 HCMV가 분리된 소변 15검체를 대상으로 primer IE를 이용하여 중합효소 연쇄 반응을 한 결과 direct gel analysis 법으로는 73%(11/15)에서, 보합 결합법으로는 87%(13/15)에서 관찰되었다. Primer MIE를 이용한 경우에는 direct gel analysis법으로 87%(13/15)에서 435bp의 증폭 산물이 검출되었다. 결 론 : Primer IE와 MIE를 이용한 중합효소 연쇄 반응법은 국내 야생주 HCMV를 신속히 검출하는데 유용한 검사법이다. Background : Human cytomegalovirus(HCMV) can cause pneumonitis, hepatitis, retinitis and other serious diseases in the immunocompromised patients. It takes 1 to 4 weeks to diagnose HCMV infection by conventional virus culture. Therefore, when HCMV diseases are suspected, a rapid diagnostic method such as polymerase chain reaction(PCR), antigen assay or shell vial culture is desirable. We evaluate the sensitivity and specificity of a PCR for the rapid detection of HCMV wild strains in Korea. Methods : We used 2 sets of primers ; primer IE and primer MIE derived from the sequence for immediate early gene of AD169 strain and Towne strain, respectively. Fifteen clinical isolates of HCMV, suspended in MRC-5 cells, were amplified by PCR. Fifteen urine specimens which were positive for HCMV by conventional virus culture were also amplified. Amplification products were analyzed by polyacrylamide gel electrophoresis. The products from PCR with primer IE were also identified by DNA blot hybridization. Results : PCR using primer IE gave the PCR products in all of the 15 HCMV wild strains. All of these were hybridized with probe IE. When primer MIE were used, 93%(14/15) of the wild strains showed amplified bands by direct gel analysis. When the urine specimens were amplified by PCR with primer IE, amplified bands were seen in 73%(11/15) by direct gel analysis ; 87%(13/15) by hybridization method. When primer MIE were used, 87%(13/15) of the urine specimens showed the PCR products by direct gel analysis. Conclusion : Polymerase chain reaction with primer IE and MIE may be a specific and sensitive diagnostic method for rapid detection of HCMV wild strains in Korea.