리네졸리드와 반코마이신을 교대로 투여하여 치료한 지속성 메티실린 내성 황색포도알균 균혈증 1예

김낙현,김문석,장은선,강유민,김가연,장희창,박완범,김의종,김남중,오명돈 대한감염학회 2009 감염과 화학요법 Vol.41 No.6

Persistent Staphylococcus aureus bacteremia is frequently defined as bacteremia persisting for ≥7 days despite proper antibiotic therapy. Its treatment includes removal of all infection foci and proper antibiotic therapy. Vancomycin remains the antibiotic of choice in MRSA bacteremia. Alternative agents, linezolid or daptomycin, are available, but a consensus regarding management of persistent MRSA bacteremia on vancomycin failure is still lacking. We report a case of a 60-year-old male who received thoracoabdominal aorta replacement operation due to dissecting aneurysm of the ascending and descending aorta. Surgical site infection and bacteremia caused by MRSA occured, and wound debridement operations were performed. The patient was treated with vancomycin in therapeutic doses but MRSA bacteremia persisted for 168 days in a row. Although the inserted aortic graft was the most probable source of persistent bacteremia, surgical removal was impossible. Linezolid was administered as an alternative antibiotic but had to be discontinued from time to time due to thrombocytopenia induced by this agent. In the end, MRSA bacteremia was successfully managed by alternating vancomycin-linezolid therapy.

국내 다기관에서 조사한 지역사회획득 메티실린내성 황색포도알균의 빈도와 임상적 특성

송진수,최평균,송경호,조재현,김성한,방지환,이창섭,박경화,박경운,신수,최희정,김의석,김동민,이미숙,박완범,김남중,오명돈,김의종,김홍빈,최강원 대한감염학회 2006 감염과 화학요법 Vol.38 No.6

목적 : 최근 전세계적으로 지역사회획득 메티실린내성 황색포도알균(community-associated methicillin-resistant Staphylococcus aureus, CA-MRSA)의 보고가 증가하고 있다. 하지만, 우리나라에서는 CA-MRSA 감염증에 대한 증례보고만 있을 뿐 아직까지 체계적인 연구결과가 없는 실정이다. 저자들은 국내에서 CA-MRSA의 빈도, 감염증의 임상적 양상, 분리된 균주의 항균제내성 양상을 조사하였다. 재료 및 방법 : 2005년 1월부터 2005년 6월까지 7개 병원에서 MRSA가 분리된 환자의 명단을 파악한 후 의무기록지와 건강보험심사평가원의 자료를 검토하였다. 외래나 응급실에서 혹은 입원 후 72시간 이내에 균주가 분리되고 MRSA 획득과 관련된 위험인자가 없는 경우 CA-MRSA로 정의하였으며, 분리된 균주의 임상적 의미에 따라 원인병원체(pathogen), 집락화(colonizer), 미결정(undetermined)으로 분류하였다. Penicillin과 oxacillin을 제외하고 3개 이상의 다른 계열 항균제에 내성이면 다제내성으로 정의하였다. 결과 : 연구기간동안 총 3,251주의 황색포도알균이 분리되었으며, 이 중 MRSA는 1,900주(58.4%)였다. MRSA 가운데 CA-MRSA는 114주(6.0%) 였으며, 이들이 분리된 부위는 귀(62주), 비뇨기계(14주), 피부 및 연부조직(11주), 호흡기계(10주), 혈액(3주) 등이었다. CA-MRSA 균주 가운데 집락균은 22주, 원인병원체는 22주였으며, 나머지 균주에 대해서는 그 임상적 의미를 결정할 수 없었다. 항균제 감수성 검사를 시행한 73균주 중 47주(64.4%)는 다제내성이었다. CA-MRSA 감염증 22예 중 피부 및 연부조직 감염(9예)과 중이염/외이도염(9예)이 가장 흔하였다. 침습적 감염증(invasive infection)은 4명(원발성 균혈증 3예, 감염성 관절염 1예)에서 확인되었지만, CA-MRSA 감염증으로 사망한 환자는 없었다. 결론 : 병원내 감염증에서는 MRSA가 심각한 문제이지만, 아직까지 지역사회 감염증에서 CA-MRSA는 흔하지 않았다. Background : Methicillin-resistant Staphylococcus aureus (MRSA) infection has emerged in patients who do not have the established risk factors. In Korea, little is known about the epidemiology and clinical features of community-associated MRSA (CA-MRSA). Material and Methods : Clinical microbiology laboratory databases of 7 hospitals were reviewed to identify the patients from whom MRSA was isolated during the period of January to July 2005. Only one isolate per patient was enrolled. In order to identify the risk factors of MRSA acquisition, the medical records and the Health Insurance Review Agency databases were reviewed. CA-MRSA was defined as MRSA isolated from patient without established risk factors. We analyzed patient demographics, underlying medical conditions, characteristics of infection, and antimicrobial susceptibility profiles. Results : Of total 3,251 S. aureus isolates, 1900 (58.4%) were MRSAs. Of the MRSA isolates, 114 (6.0%) were CA-MRSA. Of 114 CA-MRSA isolates, 22 (19.3%) were colonizers, 22 (19.3%) were pathogens, and the clinical significance of remaining 70 (61.4%) could not be determined. Median age of the 22 patients with CA-MRSA disease was 47 years. Nine patients had skin and soft tissue infections, 9 ear infections, 3 bacteremia, 1 septic arthritis. Seven patients had underlying medical disease. None died of the CA-MRSA infections. Of the 73 isolates of CA-MRSA, 47 (64.4%) were resistant to more than 3 classes of antibiotics besides β-lactams. Conclusion : Although MRSA is highly prevalent among hospital-associated S. aureus infection, CA-MRSA infections are not common.

유전특성에 미치는 선형 저밀도 폴리에틸렌과 에틸렌 비닐 아세테이트 혼합비 영향

김원종,정의남,임윤희,심낙순,박하용 三陟大學校 2002 論文集 Vol.35 No.-

The physical and electrical properties of electrical insulating materials due to the mixing ratio of linear low density polyethylene(LLDPE) and ethylene vinyl acetate(EVA) are studied. Specimens are selected as LLDPE and EVA of mixing ratio of 50 : 50, 60 40, 70 : 30, 80 20 and virgin. To analyze the physical properties of specimens, Fourier transform infra-red spectrum, X-ray diffraction and differential scanning calorimetry are used. To investigate the influence on dielectric characteristic due to Physical structural change of specimens, we investigated the frequency and temperature dependency of tan f for virgin specimen and mixture specimens in the temperature range of 25[t]~120['c], frequency range of 30[Hz] ~l.5×10s[Hz]. For the value of tan 3, dielectric loss, at each temperature of 35, 75, 100, 120[℃], it is confirmed that as applied voltage increase, α and β peak moved to low frequency area at high temperature area, and also moved to high frequency at low temperature areas, the width of peak widen. it is considered to be caused by the molecular vibration, reduction of side-branch density, reduction of crystalline with increasing temperature.

악관절 융기 증강술을 통한 습관성 악관절 탈구환자의 치험례

김일규,신주호,오성섭,최진호,김형돈,오남식,김의성 대한악안면성형재건외과학회 2000 Maxillofacial Plastic Reconstructive Surgery Vol.22 No.2

Recurrent mandibular dislocation is frequent morbidity of temporomandibular joint relatively. There are many etiologic causes in TMJ disorders but, difficult to find obvious one. Various treatment methods have been utilized for a mandibular dislocation. It is categorized into two groups broadly - nonsurgical or surgical methods. The basic rationale of the surgical method is to allow free movement of the condyle by reducing height of articular eminence or to limit anterior excessive movement of the condyle by increasing height of articular eminence or soft tissue anchoring procedure. In this case, 69 year-old woman was treated by augmentation of the articular eminence with mandibular symphysial bone graft leading to osteosynthesis without difficulty. As a result, favorable postoperative outcome was obtained functionally without any complication or recurrence.

신 손상 환자의 고식적 요법에 관한 임상적 고찰

김희철,전윤수,김민의,이남규,박영호 순천향의학연구소 1996 Journal of Soonchunhyang Medical Science Vol.2 No.2

Recently according to the increase of the traumatic patient there is a trent for the prevalence of renal injuries to increase. The key point in managing the renal injuries is that we should make decision the treatment plan after accurate diagnosis from clinical symptoms, physical examination, radiologic studies. The goal of the management is the conservation of the renal function. The management of renal injuries by nonoperative or operative methods has been a subject of controversy for more than 2 decades. A aggressive immediated operative approach is generally advocated in some centers, while a more watchful conservative approach is endorsed in others. From January 1985 to May 1995, 159 patients with renal injury had been managed at Soonchunhyang University Hospital. Among 159 patients, 83 patients were classified with minor renal injury and 76 patients major renal injury. The Computerized Tomography was useful in diagnosing stage of injuries and detecting combined injuries which were not detected in excretory urography. All stabilized patients were managed by careful continuous observation, bed rest, appropriate fluid resuscitation and prophylactic antibiotic coverage, but unstabilized patients(17 cases) were managed by immediate operation. Complications occurred in 10 patients with a major renal injury associated with a devascularized fragment but not in other patients. In conclusion, the accurate diagnosis and treatment plan of renal injury with computerized tomography are important to avoid improper treatment. I conclude that conservative management of minor renal injury and major renal injury associated with vascularized fragment is a proper method of treatment. However, early surgical intervention should be considered in patients with major renal injury associated with devascularized fragment because of high complication rate and delayed surgical intervention rate.

RF 스퍼터링법에 의한 SCT박막의 전기적 특성

김원종,정의남,심상흥,박하용 三陟大學校 2001 論文集 Vol.34 No.1

In this study, The (Sr1-xCax)TiO3(SCT) thin films are deposited on Pt-coated electrode (Pt/TiN/SiO2/Si) using RF magnetron sputtering method with substitutional contents of Ca at various substrate temperature. The structural properties of SCT thin films are analyzed using SEM, XRD, and EDS, and the electrical properties are studied by measuring the dielectric properties and the electrical properties are studied by measuring the dielectric properties and electrical conduction. The experimental results of electrical properties are summarized as follow. The dielectric constant is increased with increasing the substitutional contents of Ca, while it is decreased if the substitutional contents Ca exceeded over 15[mol%]. The maximum dielectric constant of thin film is obtained by annealing at 600[℃]. The dielectric constant changes almost linearly in temperature ranges of -80~+90[℃]. The temperature properties of the dielectric loss have a stable value within 0.1 independent of the substitutional contents of Ca. The capacitance characteristics had a stable value within ±5[℃]. The drastic decrease of dielectric constant and increase of dielectric loss in SCT thin films is observed above 200[㎑]. All SCT thin films used in this study show the phenomena of dielectric relaxation with the increase of the increase of frequency. Ⅴ-Ⅰ characteristics of SCT thin films show the increasing leakage current with the increases of deposition temperature.

첨단 연구 망(KOREN)에서의 병렬 전송 성능 분석

김영신;허의남 서울여자대학교 컴퓨터과학연구소 2004 정보기술논문지 Vol.2 No.-

한 호스트에서 네트워크 상으로 데이터를 전송할 경우에 bandwidth나 bottleneck등의 네트워크의 환경 요소, 트래픽 양과 같은 네트워크 상황, 그리고 호스트의 성능에 따라 전송 속도가 달라질 수 있다. 따라서 데이터 전송 능력을 향상시키기 위해 연구되고 있는 TCP buffer tuning 와 parallel sockets와 같은 기술들을 이러한 요소들을 효율적으로 이용함으로써 그 효과를 얻고 있다. 그러나 연구의 대부분이 네트워크의 환경 요소나 상황을 중심으로 연구되고 있는 실정으로 호스트 성능에 대해서는 고려되지 않고 있다. 게다가 병렬 전송 시 호스트 시스템 성능과 데이터 전송 능력과의 관계 분석은 미진한 편이다. 따라서 본 논문에서는 네트워크 성능 향상 기법 중에 하나인 parallel sockets를 이용하여 데이터를 전송할 경우 호스트의 상태를 실험을 통하여 조사하였으며, 이를 바탕으로 호스트 성능이 데이터 전송 능력과의 관계를 분석하였다. 본 실험에서 시스템의 성능이 데이터 전송 능력에는 큰 영향을 미치지 못하며, 네트워크의 부하에 의해서 발생되는 시스템의 부하가 여러 개의 channel로 인해 발생된 시스템 부하 보다 더 크게 영향을 미친다는 것을 알 수 있었다. The end-to-end data transmission times between two hosts are various by network environment elements, network condition, and the performance of the host. The method -TCP buffer tuning and parallel sockets- studied to improve of data transmission ability. Those methods can obtain improvement of the data transmission performance by appling those elements more efficiently. However, in the present time, most researchers consider with network environment elements and condition while on the other they don't consider a performance of the host. Furthermore, in the relation analysis ??? studies between the performance of a system and data transmission time the week. In this paper, we measure a load of the send side host system in case of data transmission through the Parallel sockets. And we analyzed the relationship between the performance of host system and data transmission ability by collecting results of experimental. Finally, we observed that the system overhead does not affect data transmission rate, and overall performance is dependent on network load rattier than system load.

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.

항생제 사용과 관련된 Clostridium difficile 감염증

김홍빈,김남중,최희정,오명돈,김의종,최강원 대한화학요법학회 1997 대한화학요법학회지 Vol.15 No.1

목적 : Clostridium difficile 감염증은 중요한 원내 감염중의 하나로 최근 들어 항균제 사용의 증가와 함께 그 빈도가 늘어나고 있어 Clostridium difficile 감염의 빈도 및 임상양상을 알기 위해 본 연구를 시행하였다. 방법 : 102명의 정상 성인으로부터 대변에서 Clostridium difficile 배양을 시행하였으며, 92년 3월부터 93년 9월까지 서울대학교 병원에 입원한 환자중 대변배양 검사에서 Clostridium difficile이 배양된 61명의 환자를 대상으로 병록지를 토대로 조사하였다. 결과 : 정상 성인 중 3%에서 Clostridium difficile이 분리되었다. 대상환자의 기저 질환은 악성고형종양(29%), 혈액종양(6.5%), 뇌혈관 질환(6.5%), 간경변(4.9%) 등의 순이었으며, 대상 환자의 75%에서 균이 분리되기 6주 이내에 항균제가 사용되었다. 사용된 항균제는 aminoglycoside(60.8%), 1세대 cephalosporin(56.5%), 3 세대 cephalosporin(43.4%), ampicillin(15.2%), metronidazole(15.2%), clindamycin(8.6%)의 순이었다. 흔한 증상은 설사(77%), 복통(53.8%), 오심(37%), 빈맥(25%) 등이었며, 혈액 검사상 백혈구증가증은 21.6%, 저알부민혈증은 3.03%에서 관찰되었다. 44명의 환자중 24명의 환자가 대증적 치료 후 호전되었고, vancomycin이나 metronidazole을 투여받은 17명의 환자중 15명의 환자가 증상의 호전을 보였다. 4예가 사망하였으며, 3예(4.9%)는 재발하였다. 결론 : Clostridium difficile 장염은 항균제 사용시 흔히 발생하는 질환이다. 정상 성인의 3%에서 Clostridium difficile이 분리되었다. Objective : Clostridium difficile gastrointestinal disease is an important nosocomial infection and is associated with antibiotic use. This study evaluated the incidence and clinical characteristics of Clostridium difficile infections. Methods : Stool specimens from 102 normal adults were cultured for Clostridium difficile. Sixty-one patients with Clostridium difficile isolated from stool specimens were reviewed retrospectively. The patients were seen at the Seoul National University Hospital during the period from Mar., 1592 to Sep., 1993. Results : Clostridium difficile was isolated in 3% (3/102) of normal adult Population. Underlying diseases of the patients included solid tumor(29%), hematologic malignancy(6.5%), corebrovascular disease(6.5%), and liver cirrhosis(4.9%). Antibiotics associated with Clostridium difficile infections included aminoglycosides (60.8%), first generation cephalosporin(56.5%), third generation cephalosporin(43.4%), ampicillin(15.2%), metronidazole(15.2%), and clindamycin(8.6%). In 3/4 of the cases, these antibiotics had beer) administered within 6 weeks before Clostridium difficile isolated. Associated symptoms included diarrhea(77%), abdominal pain(53.8%), nausea(37%), fever(37.7%), and tachycardia(25%). Leukocytosis and hypealbuminemia were observed in 21.6% and 30.3%. Out of 44 cases received symptomatic treatment, 54% (24/44) improved. Of 17 cases treated with metronidazole or vancomycin, 88% (15/17) improved. Four cases expired and 3 cases(4.9%)were relapsed. Conclusion : Clostridium difficile gastroenteritis is frequently associated with antibiotic treatment. Three percent of normal adult population had Clostridium difficile.

합기도 수련생의 수련 지속 요인에 관한 연구

김의영,남승현,김석일,정용우,정천규 龍仁大學校 武道硏究所 1998 武道硏究所誌 Vol.9 No.1

This study investigated participants who have taken part in Hapkido continuously, in view of age, carrier in exercise, and gender and then analysed how these factors affect continuous participation in Hapkido. 1) The significant factors which enable the participants to continue Hapkido were revealed as health/physical fitness(71.67%), enjoyment / interrest (58.13%), self-protetio / guard(48.28%), phychological benefits(20.94%) 2) The factors of continuing Hapkido were different in ages, which showed significant differences in phychological benefits, skill fulfilment / challenge, accomplishment / position, charm, recreational activity. The response represented specifically in one or two areas in case of younger participants. The more aged, it showed relatively even distribution to the various responses due to the broaden span of thoughts. 3) The factors of continuing Hapkido were different in carrier, which showed significant differences in self-protection / grard, skill fulfillment / challenge, accomplishment/ position in different experiences in exercise. By the time of reaching first phase and second phase, it is thought to show the psychological effect of continuing exercise unconsciously in various areas. 4) The factors of continuing Hapkido were not different in gender, which implicated the fact that the overall attitude and thoughts on Hapkido of female participants and male participants are similar.