신이식후 발생하는 감염에 대한 고찰

김재필(Jae Phil Kim),조대옥(Dae Ok Cho),고경식(Kyung Sik Ko),안재형(Jai Hyung Ahn),이태원(Tae Won Lee),임천규(Chun Gyoo Ihm),김명재(Myung Jae Kim) 대한내과학회 1995 대한내과학회지 Vol.49 No.1

N/A Objectives: Renal transplantation is a major therapeutic advance for patients with chronic renal failure. But recipients of renal transplantation are prone to infection with both common and unusual organisms. And infectious diseases remain a major cause of morbidity and mortality in renal transplant recipients. This study was to analyze the infections in renal transplant recipients; its occurrence according to sites and organisms; comparison among immunosuppressive agents; prognostic differences of urinary tract infections(UTI) between those developed during 1 month after transplantation and those not developed; graft outcome; and patients mortality. Mothods: 181 renal transplant recipients were examined. They received renal transplantion between january 1979 and December 1992 at the Kyung-Hee University Hospital. 158 of them received transplantation from living-related donors, 22 from living-unrelated donors, and 1 from cadaver donor. Their age at the time of transplantation ranged from 14 to 66 years(mean 35.6 years), and the male to female ratio was 2.3: 1. The observation period ranged from 1 to 144 months(41.26±31.71, mean±S. D.). Results: 1) 110 recipients(60.7% of total) had 232 episodes of infectious complications whereas 71(39.3% of total) had no infectious episodes. About half of infectious episodes(128 episodes, 55.2% ) occurred during 1 month after transplantation. 2) The most common site of infection was urinary tract(138 episodes, 59.2%) whth the next sites coming in this order, bacteremia(32 episodes, 13.8%), pulmonary(21 episodes, 9.1%), and skin(21 episodes, 9.1%). 3) The causative organisms of UTI ranked in this order E. coli 21.7%, staphylococcus spp 14.5%, and pseudomonas spp 13.0%. 4) The causative organisms of bacteremia ranked in this order E. coli 34.4% salmonella spp 18.8%, pseudomonas spp 12.5 %, and staphylococcus spp 12.5%. 5) There was no significant differences of infectious episodes among immunosuppressive regimens. 6) Early UTI group(UTI occurred during 1 month after transplantation) recorded significantly higher incidence of urinary tract infections after 1 month that followed than non-UTI group. But there was no differences between two groups on graft and patients outcome. 7) The major cause of death was life-threatening infections(63.2 %). Conclusion: Most infections due to various organisms may occur during 1 month after transplantation. And still they constitute a major cause of death in renal transplant recipients.

고농도 포도당과 Angiotensin 2 및 차단제가 Angiotensin 2 차단제가 인체 메산지움 세포의 IL - 6 및 Fibronectin 생산에 미치는 영향

고경식(Kyung Sik Ko),임천규(Chun Gyoo Ihm),김희진(Hee Jin Kim),이태원(Tae Won Lee),김명재(Myung Jae Kim) 대한내과학회 2001 대한내과학회지 Vol.61 No.4

N/A Background: Diabetic nephropathy is a leading cause of end-stage renal disease and is characterized by activation of some growth factors (e.g., angiotensin 2, endotelin-1, IL-8, and TGF-β) and deposition of extracellular matrix proteins . Both ACE inhibit or s and AT 1 receptor blockers partially prevent renal hypertrophy in diabetes. Recently, IL-6 is thought to act as an autocrine growth fact or for the mesangial cells. Angiotensin 2 (Ang 2) is one of the non-inflammatory stimulators of IL-6 release from mesangial cells. IL-6 have been implicated in glomerulonephritis, including mesangioproliferative glomerulonephritis. IL-6 may be associated with renal damage, especially mesangioproliferative diabetic nephropathy. However, little is known about the pathogenetic relations between IL-6 and diabetic nephropathy. Methods: To evaluate the effects of high glucose concentration, Ang 2 and its blockers on IL-6 and fibronectin production, human mesangial cells were cultured in various conditions. Normal concentration (100 mg/dL) and high concentration of D-glucose (450 mg/dL), Ang 2 (10-7M), high glucose with Ang 2, captopril (10-6M), and losartan (10-6M) were added. After 48 hours, IL-6 and fibronectin concentration in the supernatant were measured by ELISA method. Results: The effects of various conditions on the production of IL-6 and fibronectin in cultured human mesangial cells were as follows: 1. The concentration of IL-6 in the supernatant was significantly low in high glucose group (9.9±0.2 pg/mL) compared to that in control group (18.0±6.2 pg/mL) (p<0.05), and there was no difference in the supernatant concentration of fibronectin between the groups of high glucose and control. 2. The concentration of IL-6 in the supernatant of Ang 2 group (28.0±5.0 pg/mL) was significantly higher than that in control group (18.0±6.2 pg/mL) (p<0.05), and there was no difference in the supernatant concentration of fibronectin between the groups of Ang 2 and control. 3. In the supernatant of high glucose with Ang 2 group, the concentration of IL-6 (20.0±4.0 pg/mL) was significantly higher than that of high glucose group (9.9±0.2 pg/mL) (p<0.05), and the concentration of fibronectin (3,100±50 pg/mL) was significantly higher than that of control group (2,840±290 pg/mL) (p<0.05). 4. The concentration of IL-6 in the supernatant was significantly lowered after the addition of captopril (10.7±1.8 pg/mL) and losartan (9.3±2.4 pg/mL) in high glucose with Ang 2 group (20.0±4.0 pg/mL) (p<0.05). 5. The concentration of fibronectin was significantly lowered after the addition of captopril (2,640±30 pg/mL) and losartan (2,440±230 pg/mL) in high glucose with Ang 2 group (3,100±50 pg/mL) (p<0.05). 6. There was no difference in the concentration of supernatant IL-6 and fibronectin between the groups of captopril and losartan. Conclusion: High glucose concentration decreases and Ang 2 increases the production of IL-6 by cultured human mesangial cells. Captopril and losartan decrease the production of IL-6 and fibronectin which have been stimulated by high glucose concentration and Ang 2. These drugs may be useful in the treatment of renal disease, especially diabetic nephropathy, in which Ang 2 and high blood glucose are cooperative in the progression of nephropathy. (Korean J Med 61:399-408, 2001)

Multi-Access Memory System(MAMS)의 속도 향상을 위한 아키텍처 설계

고경식(Kyung-sik Ko),김재희(Jae Hee Kim),이스라엘(S-Ra-El Lee),박종원(Jong Won Park) 대한전자공학회 2017 전자공학회논문지 Vol.54 No.6

대용량 고화질의 영상 응용분야에서는 많은 양의 데이터를 고속으로 처리하는 기술이 필요하며, 이를 위해 고속화된 병렬처리 시스템이 요구된다. 2004년 park[2]은 병렬처리 메모리의 충돌 없이 여러 처리기에 데이터를 접속할 수 있는 방법을 제안하였다. 제안된 MAMS(Multi-Access Memory System) 는 이후 MAMS-PP16 및 MAMS-PP64 등으로 추가적인 연구가 이루어졌다. MAMS는 병렬처리를 위한 메모리 아키텍처로써 One-chip으로 구성되어야하기 때문에 기존 MAMS와 동일한 기능을 수행하면서 아키텍처의 최소화 하는 방법의 연구가 필요하다. 주소 계산 (ACR : Address Calculation and Routing) circuit과 MMS(Memory Module Selection)circuit의 아키텍처는 메모리에 있는 데이터를 병렬처리기(Prossing Elements)들에게 전달한다. 본 논문에서는 MMS circuit을 사용하지 않고 ACR circuit 내부에 1개의 쉬프트와 메모리 모듈의 개수만큼의 조건문으로 구성하는 방법을 통해 아키텍처를 최소화 하는 방법을 제안한다. 구현한 아키텍처의 검증을 위해 Image correlation 실험을 하였다. 실험을 통하여 제안된 MAMS-PP64의 처리시간을 측정 하였으며, 그 결과 Ratio가 평균 1.05향상 된 결과를 확인 할 수 있었다. High-capacity, high-definition image applications need to process considerable amounts of data at high speed. Accordingly, users of these applications demand a high-speed parallel execution system. To increase the speed of a parallel execution system, Park (2004) proposed a technique, called MAMS (Multi-Access Memory System), to access data in several execution units without the conflict of parallel processing memories. Since then, many studies on MAMS have been conducted, furthering the technique to MAMS-PP16 and MAMS-PP64, among others. As a memory architecture for parallel processing, MAMS must be constructed in one chip; therefore, a method to achieve the identical functionality as the existing MAMS while minimizing the architecture needs to be studied. This study proposes a method of miniaturizing the MAMS architecture in which the architectures of the ACR (Address Calculation and Routing) circuit and MMS (Memory Module Selection) circuit, which deliver data in memories to parallel execution units (PEs), do not use the MMS circuit, but are constructed as one shift and conditional statements whose number is the same as that of memory modules inside the ACR circuit. To verify the performance of the realized architecture, the study conducted the processing time of the proposed MAMS-PP64 through an image correlation test, the results of which demonstrated that the ratio of the image correlation from the proposed architecture was improved by 1.05 on average.

다중 접근 메모리 시스템을 이용한 고속 지문인식 특징추출 시스템

박종선(Jong Seon Park),김재희(Jea Hee Kim),고경식(Kyung-Sik Ko),박종원(Jong Won Park) 한국멀티미디어학회 2013 멀티미디어학회논문지 Vol.16 No.8

증례 : 귀국후 발병한 수입성 말라리아 1 예 ( Cases Report : A Case of Imported Malaria Occurred after Returning from Malaria Endemic Area )

서환조(Hwan Jo Suh),정형근(Hyung Keun Chung),박명재(Myung Jae Park),고경식(Kyung Sik Ko),김구엽(Koo Youp Kim),양현종(Hyun Jong Yang),조유정(You Jung Cho),백영한(Young Han Paik) 경희대학교 경희의료원 1993 慶熙醫學 Vol.9 No.2

황색포도구균혈증의 임상적 고찰

홍화정(Hwa Jeong Hong),이정환(Chung Hwan Lee),박종오(Chong Oh Park),정일우(Il Woo Jung),이승호(Seung Ho Lee),고경식(Kyung Sik Ko),김구엽(Koo Yeop Kim),서환조(Hwan Jo Suh) 대한내과학회 1997 대한내과학회지 Vol.53 No.3

N/A Objective: Staphylococcus aureus has persisted and is now resurging as an important hospital and community pathogen. Nosocomial infection caused by methicillin-resistant S.aureus(MRSA) is a major problem which may be connected with heavy or prolonged use of antibiotics S.aureus bacteremia caused acute complications, which occasionally resulted in death, and infectious/suppurative complications, which necessitated prolonged antibiotic therapy, sometimes in conjunction with surgery. Therefore, S.aureus bacteremia is a serious medical problem in association with high morbidity and mortality. Methods: 130 patients with S.aureus bacteremia who were admitted in the Kyung Hee University Hospital from January, 1991 to December, 1994 were analyzed retrospectively. We compared the clinical and laboratory characteristics, and antibiotics resistances between MRSA and MSSA bacteremia and also we evaluated risk factors that contribute to fatal outcome in patients with S.aureus bacteremia. Results : 1) of 130cases, 80 were male and 50 were female. The mean age was 44.5±25.1 years. 2) 84(65%) of S.aureus bacteremia were nosocomial and 46(35%) were community-acpuired. The percentage of MRSA stains studied was 55%(71/130) and The percentage of MRSA bacteremia in hospital-acpuired and community-accquired S. aureus bacteremia were 64% (54/84) and 36%(17/46), respectively. Sources of bacteremia were uncertain in 85(65%) with intravascular catheter(20%) and skin wound sites (8%) being the most common sources in remainder(35%) 3) 110(85%) of 130 patients had one or more underlying diseases. Common underlying dieases were cerebrovascular disease(33%), malignancy(17%), Diabetes mellitus(15%), chronic renal failure(8%) and liver cirrhosis(6%). 4) Acute complications occurred in 35 patients and were fatal in 21 5) The risk factors associated with MRSA bacteremia were various severe underlying diseases, vairous invasive procedures, IV catheter-associated infection, hypoalbuminemia, previous use of antibiotics, male sex and old age. 6) The Case fatality rate for patients with S. aureus bacteremia was 18% and those for patients with MRSA and MSSA bactermia were 20% and 12%, respectively. The risk factors that contribute to the increment of mortality rate in patients with S. aureus bacteremia were acute complication, low serum level of total protein, hypoalbuminemia, various invasive procedures and IV catheter-associated infection, 7) In the antibiotic sensitivity test S. aureus was resistant to penicillin in 98.5%, ofloxacin in 73%, cefotaxime in 67%, erythromycin in 58%, aztreonam in 56%, clindamycin in 52%, vancomycin in 0%. 8) In the multiple antibiotic resistance of S. aureus, 43(68%) of MRSA was resistant to more than 10 antibotics, revealing multiply resistant nature of strains, While all but one MSSA was resistant to 1 to 4 antibiotics, one revealing resistance to 8 antibiotics. Conclusion: S. aureus bacteremia is a cause of considerable morbidity and mortality in hospitalized patients who especially, exposed to various risk factors. MRSA revealed higher resistance rate to most antibiotics tested and more marked multiply resistant nature than MSSA. But there was no significant difference in case fatality rate between patients with MRSA and MSSA bacteremia.

병원성 칸디다 혈증에 관한 임상적 고찰

고경식,권선희,김병준,김구엽,서환조 대한감염학회 1995 감염 Vol.27 No.5

목 적 : 최근 칸디다혈증의 발생율이 매우 증가하여 병원 감염의 중요한 원인으로 대두되고 있다. 이에 저자등은 칸디다혈증에 대한 임상적 특성을 알아보기위하여 다음과 같이 연구하였다. 방 법 : 1988년 1월부터 1993년 12월까지 경희대학부속병원에서 발생하였던 병원성 칸디다혈증 61예를 대상으로 의무기록지를 검토하였다. 결 과 : 1) 연도별 발생 빈도는 1988년 부터 1933년까지 각각 2예, 7예, 9예, 11예, 15예, 17예로 증가하였으며, 최근에는 non-albicans 균주에 의한 감염이 증가하고 있었다. 2) 연령분포는 4-83세였으며 평균연령은 51.0±17.4세였고, 남자 32예, 여자 29예였다. 50대와 60대가 57.3%로 가장 많았다. 3) 균주별 발생빈도는 C. albicans 30예, C. tropicalis 13예, C. parapsilosis 10예, C. glabrata 6예, C. guilliermondii 1예, C. krusei 1예로서 C. albicans가 가장 많았다. 4) 기저질환으로 뇌혈관계질환이 25예(41%)로 가장 많았으며, 외과적질환 11예(18%), 고형악성종양 10예(16.4%), 혈액종양질환 9예(14.8%), 기타 내과적질환 6예(9.8%)였다. 5) 균주간 선행인자는 비슷하였으나, C. albicans와 C. tropicalis에서는 수술을 시행받은 예가 많았고, C. parapsilosis는 정주 영양 공급을 받은 경우가 많았다. 6) Amphotericin B 치료군(20예)과 fluconazole 치료군(11예) 사이에 예후에서 유의한 차이는 없었다. 7) 총 61예중 28예에서 사망하여 사망율은 45.9%였으며 정형외과적 수술을 시행받은 경우(83.3%)와 C. glabrata인 경우 사망율이 가장 높았다(83.3%). 결 론 : 칸디다 혈증은 중요한 병원 감염으로 대두되고 있으며 최근에는 non-albicans 진균주에 의한 병원성 칸디다 혈증의 발생율이 증가하는 추세이다. Background : The aim of this study is to determine the annual occurrence of nosocomial candidemia, the relation between Candida species and underlying illness, the relation bewteen Candida species and predisposing factors, and also to compare between the outcome of candidemia of the amphotericin B treatment group and that of the fluconazole treatment group. Methods : We reviewed medical records of 61 cases with nosocomial candidemia between 1988 and 1993 in Kyung Hee University Hospital retrospectively. Results : Two cases occurred in 1988, 7 in 1989, 9 in 1990, 11 in 1991, 15 in 1992, and 17 in 1993. The incidence of candidemia by non-albicans species has increased during this period and accounted for 64.7% in 1993. The infecting candida species were C. albicans(30 cases, 49.2%), C. tropicalis(13 cases, 21.3%), C. parapsilosis(10 cases, 16.4%), C. glabrata(6 cases, 9.8%), C. guilliermondii(1 case, 1.8%), and C. krusei(1 case, 1.8%). The most common underlying disease was cerebrovascular disease(41%) followed by surgical disease(18%), solid cancer(16.4%), hematological malignancies(14.8%), and other medical illness. There were no significant differences between the amphotericin B treatment group(n=20) and the fluconazole treatment group(n=11) in mortality. Overall mortality was 45.9%. The highest mortality was in patients with previous orthopaedic surgery(83.3%) and with C. glabrata candidemia(83.3%). Conclusion : Candidemia emerged as an important hospital infection and candidemia caused by non-albicans species has significantly increased in recent years.

임신여성을 제외한 성인에서의 B군 연쇄구균 감염에 관한 임상적 고찰

고경식,권선희,안우석,이원욱,김구엽,서환조 대한감염학회 1995 감염 Vol.27 No.4

목적:B군 연쇄구균은 최근 보고에 의하면 만성 기저질환(당뇨병, 악성종양등)이 있는 성인에서 감염빈도 및 사망률, 이환율이 증가하고 있는 추세이며 그 중요성이 대두되고 있다. 이에 저자들은 B군 연쇄구균 감염의 임상양상, 기저질환(위험인자)을 알아보고, B군 연쇄구균 항균제 감수성등을 규명하고자 하였다. 방법:1986년 1월부터 1993년 12월까지 경희대학교 부속병원에서 B군 연쇄구균이 배양된 274예를 대상으로 의무기록지를 검토하였다. 결과: 1) 전체 연구대상은 274예로 98예(35.8%)가 남자였고, 176예(64.2%)가 여자였다. 이들의 연령분포를 보면 신생아군에서 감염이 많이 발생하였다 이후 감소추세를 보이다가 20대 이상에서 다시 증가 하는 추세를 보였다. 2) 감염 양상은 274명중 명확한 감염이 156명(56.9%), 추정감염이 55명(20.1%), 비감염이 63명(23.0%)이었다. 임신을 제외한 18세 이상의 성인은 231명으로 남자가 83명, 여자가 148명이었고 남여 비율은 1:1.78이었다. 이중 133예(57.6%)에서 명확한 감염이었고, 46명(19.9%)에서 추정 감염, 52명(22.5%)에서 비감염이었다. 명확한 감염환자 133명중 31명(23.3%)이 병원내 감염이였다. 3) 18세 이상의 성인 231명에서 Group B Streptococcus가 분리 동정된 감염 부위는 자궁 경부 77예(33.3%), 요 73예(31.6%), 객담및 상기도 39예(16.9%), 농 24예(10.4%)등이었다. 4) 명확한 감염을 가지고 있었던 성인 133명의 임상양상은 요로 감염 37명(28%), 자궁 경부염 37명(28%), 피부, 연조직 감염 23명(17%), 폐렴 10명(8%), 패혈증 8명(6%)등이었다. 5) 명확한 감염을 가지고 있었던 성인 133명중 92명(69%)에서 한가지 이상의 만성 기저질환이 있었으며, 이중 당뇨병 32%, 뇌 혈관 질환 21%, 고혈압 19%, 신부전 12%, 악성종양 5%등을 차지하였다. 6) 항균제 감수성 검사(251예)에서 penicillin 98.4%, cephalothin 99.6%, cefamandol 98.8%, erythromycin 96.0%, clindamycin 89.4%, oxacillin 88.8%, lincomycin 87.8%, methicillin 86.8%, minocycline 49.4%, trimethoprim-sulfamethoxazole 15.5%의 감수성을 보였다. 7) 명확한 성인 감염 133명중 6명(4.5%)이 사망하였다. 결론:B군 연쇄구균은 만성 기저질환이 있는 성인에서 감염 빈도가 높고, 치명적인 결과를 초래할수 있으므로 감염 예방 및 조기 발견, 적절한 항균제 감수성 검사에 따라 조기 치료로 사망률을 줄여야 할것으로 생각된다. Background: Several reports have suggested that the incidence of diseases caused by Group B streptococcus is increasing in nonpregnant adults, particularly those with serious underlying diseases. The objectives of this study were to define the clinical manifestations, underlying conditions(risk factors) of definite group B streptococcal diseases in nonpregnant adults and to obtain antimicrobial sensitivity of these infections. Methods: We analyzed the records of 274 cases of the Group B streptococcus isolated in Kyung-Hee University hospital between 1986 and 1993. Results: 1) Total Group B streptococcal isolates were 274 cases : Of these cases, 7 percent were 1 month of age or younger, 3 percent were older than 1 month but younger than 18 years of age, and 91 percent were 18 or older. 2) Men and nonpregnant women accounted for 87 percent (n=231) : 133 cases (57.6%) with definite infection, 46 cases(19.9%) with possible infection, and 52 cases(22.5%) with no infection. 31 cases of 133 (23.3%) nonpregnant adult with definite infection apeared to have acquired the disease nosocomially. 3) In the 133 nonpregnant adult patients, the most common clinical diagnosis were urinary tract infection(28%), and cervicitis(28%). 4) In the 133 nonpregnant adult patients, the underlying diseases or conditions were diabetes mellitus(32%), cerebrovascular accident(21%), hypertension(19%), renal failure(12%), and malignant neoplasm(5%), Sixty-nine percent of the cases had one or more underlying diseases. 5) In the antimicrobial sensitivity tests, 98.4% of isolates were sensitive to penicillin, 99.6% to cephalothin, 98,8% to cefamandol, 96.0% to erythromycin, 89.4% to clindamycin, and 49.4% to minocycline. 6) The case mortality rate was 4.5%(6 of 133). Conclusion:We found group B streptococcal infection to be a significant and apparently increasing cause of definite diseases in nonprognant adults, particularly in those with serious underlying diseases. Recognizing these infections early in the groups with serious underlying diseases will be helpful in lowering mortality.

Salmonella Typhi에 의한 고관절염 1예

고경식,서환조 대한감염학회 1992 감염 Vol.24 No.1

Arthritis caused by salmonellosis is rare in Korea. A 26-year-old male patient was admitted to Department of Orthopedic Surgery, Kyung Hee University Hospital, Seoul, because of high fever and joint pain in right hip. The culture of blood, stool and urine were negative. The widal test was 1:320 (O titer). The culture of the operative specimens yielded Salmonella typhi.

보신 관광에서 감염된 수입성 Sparganosis 1예 : Intake of Thailand Snake during Trip

서환조,박명재,고경식,백영한,조유정,양현종,류경남,정형근,전정열 대한감염학회 1992 감염 Vol.24 No.1

Human sparganosois was reported more than 100 cases in Korean population. However no case reported yet in Korea as a patient was infected by sparganum from other geographical area, such as Thailand. The case we are reported here is a 38 year-old Korean male who had been suffered from mass being a small, round and soft consistance in upper portion of his right thigh. The patients stated that he had an opportunity to eat living snake in Bangkok, Thailand during trip. As therapy praziquantel (75㎎/㎏/day) was given p.o. for 14 days, but in vain to cure. Following medical treatment, surgical exicision was performed to remove a alive, soft, whitish-milky, mobile and elongated sparganum. Serlogical test by micro-ELISA for sparganum-specific antibody revealed a high serum antibody level of absorbance 0.67 (positive criterion: absorbance 0.22).