만성 화농성 중이염의 세균학적 고찰

조남순,이영훈,강기훈,최제환,송태현,이병돈,장혁순,강주원,김연준 순천향의학연구소;Soonchunhyang Medical Research Institute 2000 Journal of Soonchunhyang Medical Science Vol.6 No.1

Background and Objectives : Chronic suppurative otitis media is one of the frequent diseases in otolaryngologic field. It is important to choose of antibiotics in the management of infectious disease. But the organisms in infections have been changed and resistance to antibiotics has been grown as the development of antibiotics has been achieved. And so it has been necessary to recognize the changes of organisms and resistance in antibiotics. Our study was performed to identify the pathogens isolated from discharges in chronic otitis media and evaluate the antibiotic agents, to recognize the change of to resistance to·antibiotic agents and to use the appropriate anitiotics. Materials and Methods : Retrospectively, authors reviewed the backeriologic study of 114 cases of chronic suppurative otitis media who visited the Department of Otolaryngology, Soonchunhyang University in Seoul from Nov. 1996 to Oct. 1999 and analyzed 101 strains and its sensitivity test to various antibiotics. Result : In 93 cases in which pathogenic organism was isolated, single infection was 85 cases(91.4%) and mixed infection was 8 cases(8.6%). The most frequent pathogenic organism was Staphylococcus aureus(59.4%), Pseudomonas aeruginosa(13.9%), Providencia(4.8%), Alcaligenes(3.0%) and Streptococcus pneumoniae(2.9%) were the next. Methicilline-Resistance Staphylococcus aureus was 34 cases(57.6%) of Staphylococcus aureus. Staphylococcus aureus was sensitive to Vancomycin(96.7%), Trimethoprim-Sulfamethoxazole (57.6%), Cefuroxime(42.4%) and Ciprofloxacin(40.7%) but resistant to Penicillin(94.9%). Pseudomonas aeruginosa was sentitive Amikacin(100%), Ciprofloxacin(100%) and Gentamicin(67%). Conclusion : As MRSA recently was wide spread in community accquired infection as well as nosocomial infection, we must consider strict control of MRSA.

Endoscopy and Imaging Modalities/Basic Science of Gastrointestinal Disorders/Miscellaneous : Changing Pattern Of Digestive And Liver Disease In Korea, 1990-2006 Year; A Single Center Study

( Jung Hyun Kwon ),( Sang Woo Kim ),( In Sik Chung ),( Myung Gyu Choi ),( Kwan Woo Nam ),( Jung Pil Suh ),( Jae Hyuck Chang ),( Won Haing Hur ),( Yu Kyung Cho ),( Jae Myung Park ),( In Seok Lee ) 대한소화기학회 2007 SIDDS Vol.9 No.-

Background/Aims: Westernization in many Asian countries have changed lifestyles and diets, so once rare diseases have now become prevalent. The aim of this study is to investigate the changing pattern of digestive and liver disease in Korea, from 1990 to 2006. Methods: We extracted data specific gastrointestina (GI) disease based on the International Classification of Diseases code from the in-patients records at the Kangnam St. Mary`s Hospital in 1990, 1996 and 2006. This hospital is a tertiary-care hospital in Seoul, Korea, which has a capacity of 800 beds. Results: The admission rate for GI disease increased between 1990 and 2006. Overall in-patients were 1,623 persons in 1990, 2,368 persons in 1996 and 4,166 persons in 2006. The mean age of in-patients increased as time went by. A stomach cancer was the most common diagnosis during all periods, but its prevalence has decreased. Colon cancer ranked the 7th in 1990, but markedly increased and now ranks the second. The third was a hepatocellular carcinoma. The bile duct and gallbladder cancer, pancreas and esophageal cancer ranking followed with little interval change. In cases of cancer patients, a regular admission dramatically increased for chemotherapy. The number of patients admitted with pre-malignant neoplasm of stomach and colon increased remarkably with the development of endoscopy. The liver transplant, inflammatory bowel discase, and reflux esophagitis emerged form mid-1990s with greater frequencies, yet much below the levels found in the West. The admission rate for peptic ulcer, especially ulcer bleeding remained relatively stable, despite a decreased rate for ulcer perforation. Liver cirrhosis, hepatitis, cholelithiasis with cholecystitis-cholangitis, appendicitis, hemorrhoid and gastritis all decreased. Conclusions: The stomach cancer is the leading cause of admission, despite a recent decline. Colon cancer showed a marked rise. The liver transplant, inflammatory bowel disease and reflux esophagitis were new diagnosis with an increased tendency.

체인형 합성고무탄성재의 탄성력 감쇄

허창혁,성재현,권오원,경희문 대한치과교정학회 2003 대한치과교정학회지 Vol.33 No.5

본 연구는 체인형 합성고무탄성재의 시간에 따른 탄성력 감쇄의 양상을 평가하여, 이들 재료의 임상적용시 적절한 교정력의 적용을 위해 참고가 될 만한 기준을 구해보려는 목적으로 시행되었다. 공간폐쇄시 사용되는 체인형 합성고무탄성재의 탄성감쇄정도를 알아보기 위하여, 임상에 널리 사용되는 두가지의 체인형 합성고무탄성재를 구강내 상태와 유사한 조건하에서 4주간 신장시켜 관찰한 결과 다음과 같이 요약할 수 있었다. 1. 시간에 따른 탄성력 감쇄양상은 전형적인 log함수의 형태를 보이며, 4주후 잔존탄성력은 원래의 41.2~64.6 %이며 제품에 따라 차이가 있었다. 2. 신장후 초기 10분동안 탄성력의 급격한 감소를 보여서, 초기힘의 20~25 %를 상실하였으며, 이후 감소량이 줄어들어 1주이후부터 4주까지의 평균감소량은 1.5 %정도로 거의 일정한 힘의 크기를 보여주었다. 3. 동일한 재료를 사용하더라도, 탄성재의 신장량이 증가할수록 잔존탄성력이 감소하여 탄성감쇄율이 증가하였다. The purpose of this study was to evaluate the force degradation rate of synthetic elastomeric chains during space closing phase of orthodontic treatment. Two kinds of synthetic elastomeric chains(RMO, 3M) were selected which were commonly used in clinics. All of the samples were extended and tested for 4 weeks under the simulated intraoral condition. The results can be summarized as follows : 1. Time related residual force showed typical logarithm function. Residual force after 4 weeks was 41.2~64.6 % of original force, and difference between two kinds of elastomeric chain existed. 2. Elastic force decreased greatly during first 10 minutes, so 20-25 % of original force disappeared After that, this decreasing tendency was diminished significantly, average rate of elastic force after 1 week to 4 weeks were 1.5 % demonstrating rather constant force. 3. Even though the same brand of elastomeric chiain was used, as extension rate of elastomeric chain increased, force degradation rate increased by decreasing of residual force.

폐렴구균의 용혈능 변화와 pneumolysin 유전자의 변이 양상

오원섭,장현하,정숙인,김연숙,이혁,김신우,김성민,백경란,이남용,송재훈 대한화학요법학회 2002 대한화학요법학회지 Vol.20 No.3

목적 : 폐렴구균은 인체에서 폐렴, 수막염 및 패혈증 등을 일으키는 중요한 병원균으로 현재 전 세계적으로 항균제 내성이 큰 문제가 되고 있다. 하지만 폐렴구균의 항균제 내성에 따라 병독성이 어떻게 변화하는지에 대해서는 구체적으로 알려져 있지 않다. 이에 기능적 및 구조적 분석을 통하여 폐렴구균의 주요 병독성 인자인 pneumolysin의 병인론적 역할을 규명하고자 하였다. 방법 : 임상 검체에서 분리된 페니실링 감수성 균주 20주와 내성 균주 20주를 대상으로 하였다. Pneumolysin의 세포 독성의 변화를 관찰하기 위하여 각각의 균주들의 용혈능을 측정하였고, pneumolysin 유전자를 중합효소 연쇄반응으로 증폭한 후 증폭 산물의 유전자 구조를 분석하였다. 결과 : 페니실린 감수성 균주와 내성 균주간의 용혈능은 유의한 차이를 보이지 않았으나, 일부 용혈능이 매우 낮은 균주에서 Lys152→Thr, Thr-172→Ile, Lys-224→Arg와 같은 변이가 관찰되었다. 결론: pneumolysin의 세포 독성의 변화는 항균제 내성 정도와는 무관하였으나, 일부 용혈능이 저하된 균주에서 발견된 pneumolysin 유전자의 변이가 pneumolysin의 세포 독성에 영향을 주는 것으로 보인다. Background : Pnumolysin (Ply) is one of the most important virulence factors of Streptococcus pneumoniae. To investigate the functional and structural variation of Ply, hemolytic activity (HA) and gene sequences of pneumolvsin were determined. Methods : A total of 40 invasive pneumococcal isolated (20 penicillin-susceptible & 20-resistant strains) were analyzed. HA of each isolate was measured in crude extracts (1×10^8 CFU/mL) hourly from the time of inoculation to 9h. Crude extracts (50㎕) and DTT buffer (100㎕) were serially diluted in 96-well plate and mixed with 1% sheep blood (50㎕). HA was represented as the reciprocal of the greatest dilution, which resulted in the complete lysis. Two sets of oligonucleotide primers were used to amplify a 1,474-bp fragment containing the coding region and a 578-bp fragment of upstream region of ply gene, respectively. Amplified products were directly sequenced. Results : HA showed a wide variation from 0 to 87,480 regardiess of penicillin MICs, serotypes or specimen sources. Two bacteremic strains showed completely no hemolytic activity. No significant differences in HA between penicillin-susceptible (Mean± SE : 15,468± 4,693) and penicillin-resistant strains (21,384± 4,087) were found (p > 0.05).Sequencing of the coding region showed unique alterations in amino acids in strains with markedly reduced hemolytic activity (≤ 40): Thr-172-Ile and Lys-224-Arg. However, upstream region of ply gene was highly conserved. Conclusions : Ply activity was not related with antibiotic resistance. Absence of HA in some strains was associated with unique alterations in amino acid sequences in ply gene. Relationnship between genomic alteration and functional changes in pneumolysin should be further investigated.

Vibrio parahaemolyticus와 Vibrio vulnificus 중복 감염에 의한 급성 위장관염 1예

이남용,기창석,이 혁,송재훈 대한감염학회 1998 감염 Vol.30 No.5

비브리오속의 중복 감염은 대부분의 병원성 비브리오속이 해수에서 잘 증식하는 호염성 세균이며 30℃ 이하의 낮은 온도에서 잘 자랄 뿐만 아니라 생굴과 어패류에서 자주 분리되는 등 동일한 생태를 보이는데 반해 매우 드물다. 그러나, 비브리오속은 여러 가지 질병 양상을 보일 수 있으며 인체 침습성, 병원성 및 항균제 감수성이 다르기 때문에 중복 감염을 진단하는 것은 환자 치료에 매우 중요하다. 저자들은 밴댕이(Herklotsichthys zunasi)회를 먹은 후 점액성 설사와 복통 및 구토를 보인 환자에서 Vibiro parahaemolyticus와 Vibrio vulnificus를 동시에 분리하였기에 증례와 함께 보고한다. Acute gastroenteritis caused by more than one Vibrio species has been rarely reported although most pathogenic Vibrio species share the same natural habitats. Recognition of multiple Vibrio species in one or more infectious processes is crucial in the management of patients because invasiveness, virulence, and resistance to antimicrobials can vary from species to species. We report a case of acute gastroenteritis by Vibrio parahaemolyticus and Vibrio vulnificus. The patient was a previously healthy 47-year old man who presented with watery mucoid diarrhea, abdominal cramps, and vomiting. On the previous day, he had eaten raw fish and developed the above symptoms about 10 hours later. The patient received only supportive therapy and was discharged on the same day with improvement. V. parahaemolyticus and V. vulnificus were isolated from stool specimen. The patient was fully recovered and subsequent stool culture demonstrated no pathogenic microorganisms.

실크 생지직물의 정련발염날염에 관한 연구

박건용,박창혁,서기성,김재현,김동철 호서대학교 반도체제조장비국산화연구센터 2001 반도체장비학술심포지움 Vol.2001 No.-

실크 생지직물에 대해 정련날염호로 무늬를 인날하고 증열 처리함으로써 무늬 부분만 정련이 되도록 하는 정련날염 기술을 개발하여 모시 섬유와 같이 뻣뻣하면서 시원한 질감이 나는 정련되지 않은 생직물 부분과 정련에 의해 유연하고 매끄러우면서 광택이 나는 비단 부분이 동시에 한 직물에 공존하면서 입체적인 무늬 표현이 가능한 독특하고 새로운 실크 직물을 개발하였다. 또한 산성염로 등의 합성염료로 염색된 실크 생지직물과 천연염fy로 염색된 실크 생지직물에 대해서 정련날염과 동시에 무늬 부분의 바탕색을 빼내고 착색을 고착시키는 발염의 특수날염 기술을 개발하여 다양한 색상에 의한 무늬 표현이 가능하게 함으로써 고부가가치 실크직물을 생산할 수 있도록 되었다.

신부전이 동반된 당뇨병 환자에서 발생된 침습성 모균증 : 수술과 Liposomal amphotericin B 및 GM-CSF 병합 요법에 의한 성공적인 치험 1예

이원영,오기원,임국희,장재혁,이동건,최정현,강무일,신완식,차봉연,이광우,손호영,강성구 대한화학요법학회 1999 대한화학요법학회지 Vol.17 No.4

저자들은 신부전이 동반된 당뇨병 환자에서 발생된 부비동형 모균증에 대하여 수술과 함께 liposomal amphotericin B 및 GM-CSF의 복합치료를 하여 성공적으로 치료한 1예를 경험하였기에 문헌 고찰과 함께 보고하는 바이다. Mucormycosis (zygomycosis) primarily affects diabetic or immunocompromised patients and typically progresses rapidly, necessitating surgical excision and antifungal therapy with amphotericin B. Large doses of amphotericin B are needed for cure, but it has the risk of causing significant renal toxicity. The recent development of liposomal amphotericin B allows antifungal therapy to be administered with potentially improved efficacy and reduced nephrotoxicity. We have experienced a case of paranasal mucormycosis successfully treated with surgery, liposomal amphotericin B and GM-CSF. A 59-year-old male suffering from diabetes mellitus for 6 years was admitted with pain at left maxillary area. He was diagnosed as mucormycosis after cytologic exam on the necrotic nasal mucosa, which showed typical hyphae. He have had diabetic nephropathy with macroproteinuria and had rapidly rising serum creatinine levels with the amphotericin B treatment: creatinine levels reverted to basal level with the use of liposomal amphotericin B. Despite surgical excision and continued antifungal therapy, his infection was not effectively controlled. Therefore, GM-CSF was administered additionally to improve phagocytic activity of leukocytes. He was finally cured after receiving a combination of aggressive surgery, liposomal amphotericin B and GM-CSF. To our knowledge, this is the first detailed clinical description of the treatment of mucormycosis with liposomal amphotericin B in Korea.

Small Cell Lung Cancer Cell Line을 이용한 Xenoplanted nude mice에서 방서선 치료후 종양의 변화 관찰에 관한 연구

김동욱,유명상,김재욱,이병돈,장혁순 순천향의학연구소 2002 Journal of Soonchunhyang Medical Science Vol.8 No.1

Recently, combination of ionizing radiation with inhibitors of angiogenesis has been reported to improve tumor eradication compared to treatment with irradiation alone. However, the mechanism of this effect have not been defined. For this pupose we established a non-small cell lung cancer model in nude mice. Tumor vascularization was visualized in vivo by MRI using gadolinium-DTPA as contrast agent. Further, cryosections were produced exactly in the MRI slice positions. Since we were interested to examine formation of recurrent tumor irradiation was performed with a single fraction of 6 Gy. This dose caused a partial remission followed by recurrent tumor growth 25 to 35 days after therapy. The process of partial remission as well as formation of the recurrent tumor was examined in 35 nude mice analysing the following parameters: (1) contrast agent enhancement using high-resolution MRI, (2) proliferation of tumor cells and fibroblast using Ki-67 immunohistochemistry, (3) formation of microvessels using CD31 immunohistochemistry. The latter analyses lead to differentiation of three stages. Stage 1(day 1 to 15 after irradiation) was characterized by increasing area of dead cell mass in hematoxylin-eosin stained slides that corresponded to a decrease in tumor cellproliferation as well as contrast agent enhancement. The percentage of Ki-67 positive tumor cells decreased from initially 45.1 ±6.0 to 1.4 %±1.2 % on day 15. Stage 2(days 6 to 20 after irradiation; overlapping with stage 1) was characterized by proliferation of fibroblast leading to formation of fibrotic septae with abundant microvessels. Already during late stage 2 MRI identified new contrast agent enhancing areas. Stage 3(day 20 to 40 after irradiation) was characterized by new tumor cell proliferation. Interestingly, tumor cells almost exclusively proliferated in the direct neighbourhood of the fibroblasts and blood vessels was a condition prior to foramtion of recurrent tumor tissue. Thus our results are in contrast with the view that tumors or recurrent tumors begin as avascular masses that later induce neovascularization. With respect to clinical practice our results suggest that (1) adjuvant anti-angiogenic therapy should not be limited to the day of irradiation but should cover a critical period until day 5 to day 20 after radiotherapy, (2) adjuvant therapy should also include inhibition of fibroblast proliferation, (3) MRI can identify a recurrent tumor 10 to 15 days before occurrence of new tumor growth.

뇌경색을 동반한 Haemophilus parainfluenzae에 의한 감염성 심내막염 1예

오은영,배상수,정윤재,이창근,이혁,김성민,박승우,백경란,송재훈 대한화학요법학회 1998 대한화학요법학회지 Vol.16 No.3

저자들은 뇌경색을 동반한 H. parainfluenzae에 의한 심내마염을 ampicillin과 gentamicin의 병합요법으로 치료한 1예를 경험하였기에, 이를 문헌고찰과 함께 보고하는 바이다. We experienced a case of infective endocarditis due to Haemophilus parainfluenzae complicated by cerebral infarction. A 40 year-old woman was admitted because of right-sided hemiparesis and dysarthria, which was accompanied by high fever up to 40 C with chills. She had been suffering from low-grade fever and general weakness for one month prior to admission. Blood cultures grew H. parainfluenzae, and the brain CT scan demonstrated cerebral infarction of MCA territory. Transesophageal echocardiogram showed mitral valve prolapse with regurgitation, and no vagetation was found. She was successfully treated with ampicillin and gentamicin for six weeks. To our knowledge, this is the first case of infective endocarditis caused by H. parainfluenzae in Korea.

국내 대학병원에서 정주용 Ciprofloxacin 사용의 적정성 평가

김신우,박효정,오원섭,김연숙,장현하,정숙인,정두련,이혁,염준섭,기현균,손준성,백경란,우건조,송재훈 대한감염학회 2004 감염과 화학요법 Vol.36 No.6

목적 : 국내 병원에서의 정주 ciprofloxacin 사용의 적정성을 평가하고자 하였다. 재료 및 방법 : 2003년 9월 25일부터 8개의 대학병원에서 정주 ciprofloxacin을 받았던 290명의 연속적으로 모집한 성인환자를 대상으로 약제사용 평가(DUE)를 전향적으로 수행하였다. 이 연구에 사용된 DUE 기준은 미국병원약사회의 기준을 국내 실정에 맡게 수정하여 사용하였으며 1) 사용의 정당성에 관한 항목, 2) 사용 시 준수되거나 시행되어야 할 사항에 대한 항목, 3) 부작용에 대한 항목, 4) 치료 효과에 대한 항목으로 나누어 조사하였다. 결과 : 환자의 평균 나이는 54세였다. 33예(26.9%)에서만 약제 사용의 적정성 측면에서 기준을 만족하였고 91예(73.1%)에서는 사용이 적절하지 않았다. 정주 cipro-floxacin의 부적절한 사용의 흔한 원인은 수술 전후의 예방약 사용, 비뇨기계 처치 전의 예방적 사용, 열성 질환에 대한 경험적 사용 등의 순이었다. 사용 시 준수사항 의 측면에서는 사용 전 배양검사(73.8%)와 사용 중 배양검사(68.6%)가 낮은 수행 정도를 보였으나 그 외는 비교적 높은 적정성(82.4-100%)을 보여주었다. 정주 ciprofloxacin사용의 합병증은 드물었다. 치료 효과의 면에서 치료반응은 93.3%였다. 결론 : 약제 사용의 정당성 기준에 따른 정주 cipro-floxacin의 부적절한 사용은 연구에 포함된 대학병원에서 매우 흔하였다(73.1%). 그러므로 적절한 항생제 사용에 대한 교육과 제도적 장치가 매우 필요한 것으로 판단되었다. Background : To evaluate the appropriateness of intravenous (IV) ciprofloxacin usage in university hospitals in Korea. Materials and Methods : We prospectively evaluated the appropriateness of drug usage in 290 consecutive adult patients who received IV ciprofloxacin in eight teaching hospitals during the period from September 25, 2003 to November 15, 2003. Drug use evaluation (DUE) in this study was based on the modified standard by the American Society of Hospital Pharmacy with regard to the justification of drug use, critical and process indications, complications, and outcome measures. Results : Average age of the patients was 54 years. The use of IV ciprofloxacin was appropriate only in 33 cases (26.9%). Common reasons for inappropriate use of IV ciprofloxacin include perioperative uses or prophylactic injection before urologic procedures, and empirical therapy for febrile episodes. Most of the "critical indications" and "process indications" showed high rate of appropriateness (82.4-100%). However, the rate of taking culture and sensitivity test before (73.8%) and during ciprofloxacin use (68.6%) were low. Complications with ciprofloxacin use were rare. In 93.3% of cases, ciprofloxacin treatment was clinically effective. Conclusion : Use of intravenous ciprofloxacin is frequently inappropriate in tertiary care hospitals in Korea. Implementation of education program and antibiotic control system is critical in improving the appropriateness of antimicrobial use.