http://chineseinput.net/에서 pinyin(병음)방식으로 중국어를 변환할 수 있습니다.
변환된 중국어를 복사하여 사용하시면 됩니다.
APACHE 3 를 이용한 내과 중환자실 환자의 질병 중증도 평가
유진홍(Jin Hong Yoo),김연근(Yeon Keun Kim),신완식(Wan Shik Shin),강문원(Moon Won Kang) 대한내과학회 1996 대한내과학회지 Vol.50 No.3
N/A Objectives : In order to quantify the risk for medical intensive care unit (ICU) patients and to establish the guideline for decision making by using Acute Physiology and Chronic Health Evaluation (APACHE) III score. Methods : Total 204 medical ICU patients from July-1993 to September-1993 were enrolled to this study. Patients were categorized into subgroups by major disease cateogories, We measured acute physiologic variables, age, comorbidities, and chronic health status according to the APACHE III scoring system. Logistic regression analysis was done to determine the relationship between APACHE III score and death risk. Results : The overall mortality rate of 204 medical ICU patients was 28.4% (58/204). The majority of patients showed standard distribution over 17~72 APACHE III points. The main APACHE III point of survived group(n=146) was significantly lower than that of non-survived group(n=58), 43.6 vs 69.4, respectively(p<0.01). Logistic regression analysis about the relationship between APACHE III score and death risk gave the equation like this: logn R/1-R= 0.04314×(APACHE III)-3.488 According to this equation, the estimated risk of death was over 50% at the point range of 80~85 and over 90% at 130~135. Conclusion: APACHE IU scoring system could be a useful guideline to predict and to evaluate the outcome in medical ICU patients and it would aid us in clinical decision making and proper management of ICU patients.
만성 골수성 백혈병에서 인터페론 및 화학요법의 병용과 화학요법 단독에 의한 치료효과
김동집(Dong Jip Kim),유진홍(Jin Hong Yoo),권혁호(Hyuk Ho Kwan),이일중(Ill Jung Lee),한치화(Chi Hwa Han),박종원(Chong Won Park),김춘추(Choon Choo Kim),김학기(Hak Gi Kim) 대한내과학회 1987 대한내과학회지 Vol.33 No.4
N/A Interferon`s ability to reduce the self-renewal capacity of leukemic Stem cells as well as the exgression of oncogens and to increase natural kilier cell cytotoxicity promptoly made ue study it`s synergistic therapeutic efficacy with chemotherapy on patients with chronic myelocytic leukemia, 29 patients with philadephia ehromos6me positivity had begun the study with protocol consisted with subcutaneous daily dose of 1 or 2 mega unit of interferon alpha and chemotherapy. Among them, 21 were on chronic phase, 8 on ndvaneed disease. 12 patients of chronic phase have had hematological complete response (57.1% ) and 4 of advanced diseases returned to chronic phase again. Also we had selected another 25 patients who have had chemotherapy only as a controls far comparison. Among 25 of them, 22 were on chronic phase, only 3 could enjoy hematological complete response (13,6%). 3 on advanced disease had no response with chemotherapy alone. There has been a significant slowing of the leukocyte doubling time and reduction of the hydroxyurea requirement in interferon responded patients A few (25 %) of them had psrtia1 cytogenetic remission in their bone marrow and peripheral blood. Even if our date is still in immature because of the short period of observation, it give us a speculation that our protocal of combi0ed modality might be another new thereapeutic option for patients with chronic myelocytic leukemia.
급성 백혈병 환자에서의 감염양상 - 1981 년 ~ 1984 년과 1987 년 ~ 1991 년의 비교 -
최황(Hwang Choi),유진홍(Jin Hong Yoo),신완식(Wan Shik Shin),김양리(Yang Ree Kim),강문원(Moon Won Kang),김동욱(Dong Wook Kim),이종욱(Jong Wook Lee),박종원(Jong Won Park),김춘추(Choon Choo Kim),김동집(Dong Jip Kim) 대한내과학회 1994 대한내과학회지 Vol.46 No.4
N/A Background: Infection, as a potential life-threatening factor, remains a major concern in the management of patients with acute leukemia, especially whose peripheral neutrophil counts are decreased (below 1000/mm³). The spectrum of infection has been changed by many factors. We observed the changing pattern of the spectrum of infection in patients with acute leukemia according to febrile day, number of leukocyte, infection site, pathogen, and prophylactic use of oral antibiotics for the purpose of reduction in morbidity and mortality by infection. Methods: The spectrum of infection of 200 patients with acute leukemia from January, 1987 to December, 1991 was compared with that of 90 patients from Jsnuary, 1981 to June, 1984 (reported previously). Results: 1) The most common ca of death in patients with acute leukemia was infection, The mortality due to hemorrhage was decreased in group of 1987-1991 and the death from infection was increased, relatively. 2) The more prolonged period of leukopenia was, the longer febrile days were. 3) The most common site of infection during both period was lung (58.0%, 49.6%, respectively). Bacteremia was increased from 7.1% to 20.3%. 4) Microbiologically defined infection was increased in 1987-1991 group (46.9%) compared with 1981-1984 group (17.3%), and the incidence of clinically defined infection was 28.1% in 1981-19S4 group and 35.3% in 1987-1991 group. 5) There was no statistically significant difference in the incidence of organisms causing infection in both group. In 1981-1984 group, it was 37.5% of gram-negative organism and 32.5% of gram-positive organism, and in 1987~1991 group, 40.3%, 39.7%, respectively. Pseudomonas among gram-negative organisms and Staphylococci among gram-positive organisms accounted for over 509 of pathogens and streptococcal infection was increased. Fungal infection was decreased. 6) In view of the relationship between prophylactic use of oral antibiotics and infecting organism, the ratio of gram-negative to gram-positive organism was 51.3% : 31.6% in group receiving non-absorbable antibiotics and 32.5% : 49.5% in group receiving absorbable antibiotics, therefore the frequency of infection by gram-positive organisms was higher in group receiving absorbable oral antibiotics. Conclusion: Infection has been a major cause of morbidity and mortality in acute leukemia patients, and it is closely related to the severity and duration of leukopenia. Lung was the most common site of infection, gram-negative organism was a predominant pathogen, and gram-positive organism was relatively more common in patients receiving prophylactic absorbable oral antibiotics. Since the spectrum of infection has been changed by many factors, it is necessary to understand this changing pattern and to manage the infection promptly and appropriately.
Klebsiella pneumoniae 표준균주에 대한 Ceftriaxone과 Amikacin의 단독 및 병용요법의 Postantibiotic Effect
이동건,허동호,최정현,유진홍,강문원,신완식,Lee, Dong-Gun,Huh, Dong-Ho,Choi, Jung-Hyun,Yoo, Jin-Hong,Kang, Moon-Won,Shin, Wan-Shik 대한임상약리학회 1999 臨床藥理學會誌 Vol.7 No.1
연구배경 및 방법 : PAE는 세균을 항생제에 제한된 시간 동안 노출시키고 항생제를 제거한 후에도 세균의 성장은 계속 억제되는 현상을 말하며 항생제의 효과는 항생제가 제거된 후에도 일정기간동안 유지되는 것으로 항생제 투여횟수, 시기 등을 결정하는데 중요한 요소로 알려져 있다. 그러나, 항생제와 균의 종류, 농도, 실험조건 둥에 따라 PAE가 다르고 그 길이가 측정하는 방법에 따라 많은 차이가 있다. 특히, 그람음성균에 ${\beta}$-lactam 항생제에 노출되었을 때의 PAE는 정도의 차이가 아닌 그 존재의 유무에 대해서조차 논란이 있는 실정이다. 또한, 그람음성균에 ${\beta}$-lactam과 aminoglycoside를 병용할 때 PAE가 상승작용이 있는지에 대해서도 논란이 있다. 저자들은 K. pneumoniae를 대상으로 ceftriaxone과 amikacin을 병용하였을 때 PAE가 있는지 알아보기 위하여 전통적인 집락수 측정법과 BACTEC 혈액배양법을 사용하고 이를 비교하였고 병용시 상승작용이 있는지 알아보았다. 결 과: (1) K. pneumoniae에 대한 ceftriaxone과 amikacin의 상승작용을 disk diffusion 방법, checkerboard 방법, time-kill curve 및 E-test 등을 이용하여 확인한 결과 무작용의 상관관계를 보였다. (2) 1배 MIC $(0.03\;{\mu}/mL)$의 ceftriaxone에서 집락 수 측정법으로 측정한 PAE는 -0.4시간이었으나, 4배 MIC $(4\;{\mu}/mL)$의 amikacin에서는 2.7시간의 PAE를 나타냈다. (3) 다양한 농도의 ciprofloxacin에 2시간 동안 노출시킨후 집락수 (y)와 BACTEC 혈액배양기의 GV (x)는 log y=0.0514x+4의 관계가 있었으며(r=0.88, p<0.0001), 이를 이용해 ceftriaxone의 PAE를 보정한 결과 0시간으로 정정되었다. (4) ceftriaxone과 amikacin을 병용하였을때 집락수 측정법에 의한 PAE는 3.4시간으로 상가작용을 보였다. 결 론: (1) BACTEC 혈액배양법을 이용한 PAE의 측정결과 K. pneumoniae에 대한 ceftriaxone의 PAE는 집락수 측정법에 의해 과소평가 되어있음이 확인되었고 실제적으로는 PAE를 나타내지 않았다. (2) ceftriaxone이 PAE가 없는 이유는 filament를 형성하기 때문이 아니고 본래 PAE가 없는 것으로 추론된다. Introduction & Methods : The postantibiotic effect (PAE) refers to a suppression of bacterial growth that persists after limited exposure of organisms to antimicrobial agents. The major clinical relevance of the PAE pertains to its impact on antimicrobial dose and dosing interval. There is a method-to-method variation in determination of PAE. In case of Gram negative organisms, ${\beta}$-lactams do not demonstrate PAE on the basis of viable count method, a conventional standard. However, as several Gram negative organisms aggregate to form a filament after exposure to ${\beta}$-lactams, the number of colony may not be precisely counted. To overcome this problem, we also used another indicator of assessing PAE-i.e., growth value which represents $CO_2$ generation from colony. In this study, PAE of ceftriaxone alone and in combination with amikacin were determined for the standard strain of K. pneumoniae using viable counting method and BACTEC blood culture system. Results : (1) Using the disk diffusion method, the checkerboard method, the time kill method and the E-test, we could not find synergistic effects with ceftriaxone and amikacin against K. pneumoniae. (2) On the basis of the viable counting method, PAE of ceftriaxone $({\times}1\;MIC,\;0.03\;{\mu}g/mL)$ was negative (-0.4 hours) and that of amikacin $({\times}4\;MIC,\;4\;{\mu}g/mL)$ was 2.7 hours. (3) Following 2-hour exposure to ciprofloxacin at various concentration, the correlation between the cell count (y) and GV (x) measured by BACTEC blood culture system was significantly high (log y=0.0514x+4, r=0.88, p<0.0001). Although recalculating the PAE of ceftriaxone using the above curve, the subsequently corrected PAE value was 0 hour. (4) The ceftriaxone-amikacin combination caused additive effect for PAE against K. pneumoniae compared with the PAE observed after ceftriaxone or amikacin alone measured by the viable counting method. Discussion : (1) Although it is evident that the viable count method underestimated the PAE of ${\beta}$-lactams agianst K. pneumoniae, PAE was absent in spite of correction by BACTEC blood culture system. (2) It may be possible the ceftriaxone does show no PAE against K. pneumoniae naturally not because of filament formation.
경막 내 colistimethate 투여로 치료한 다제 내성 cinetobacter baumannii 뇌실염
홍유아,유진홍,김진진,모은영,안건희,정희경,김진석,이현정,정미향,윤승배 대한감염학회 2009 감염과 화학요법 Vol.41 No.4
Acinetobacter species is a non-fermentative aerobic gram-negative coccobacillus that is an important pathogen found in nosocomial infections. Recently, multi-drug resistant Acinetobacter baumannii (MDR-AB) infections have been increasing and pose a serious problem. Most such infections present as bacteremia, pneumonia, or a wound infection; however, CNS infections are very rare. We herein present a case of ventriculitis caused by MDR-AB in a 37-year old man after a neurosurgical intervention. The patient was successfully treated with intrathecal colistimethate.