아미노글리코사이드 사용제한에 따른 병원성 균혈증 유발 그람음성간균의 내성변화 및 임상적 의의

오종택,김신우,손종원,도병훈,한승우,신병철,박지현,이종명,김능수 대한감염학회 2003 감염과 화학요법 Vol.35 No.4

목적 : 항균제 오남용으로 인한 내성균의 출현, 약물부작용의 발생 및 약제 비용의 증가는 환자 개인뿐만 아니라 사회적으로 문제가 되고 있다. 본 연구는 항생제의 오남용을 막기 위한 제도의 일환으로 시행한 아미노글리코사이드 사용 제한정책의 비용 효과적인 측면을 조사하고 그람음성간균에 의해 병원성 균혈증이 발생한 환자들을 대상으로 이 정책이 항생제 내성률과 환자 사망률에 미치는 영향을 연구하였다. 방법 : 930병상 규모의 3차 병원인 일개 대학병원에서 아미노글리코사이드 사용제한정책이 시행된 직후인 2002년 3월에서 9월 사이에 그람음성간균(Acinetobacter baumannii, Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli, Enterobacter cloacae, Enterobacter aerogenes, Serratia marcescens, Stenotrophomonas maltophilia, Burkholderia cepacia)에 의해 발생한 병원성 균혈증 환자 60명(실험군)과, 이 정책이 시행되기 전에 입원한 환자들 중 균주별로 같은 수만큼 선별한 병원성 균혈증 환자 60명(대조군)의 의무기록을 후향적으로 조사하였다. 결과 : 아미노글리코사이드 사용제한정책이 시행된 시기인 2002년 3월에서 9월 사이에 처방된 아미노글리코사이드 사용량 및 비용을 이 정책이 시행되기 전인 2001년 3월에서 9월 사이와 비교한 결과, 아미노글리코사이드의 사용량(antimicrobial utilization density)은 사용제한 후 225.2에서 130.3으로 42% 감소하였고 약제 비용은 44% 감소하였다. 아미노글리코사이드 사용제한 후 병원성 균혈증을 유발한 그람 음성간균의 이 항생제에 대한 내성률은 유의한 변화를 보이지 않았으며 균혈증과 직접 연관된 사망률도 환자의 나이, 성별, 기저질환 및 원발병소 등을 보정할 경우 유의한 차이를 보이지 않았다(40.4% vs. 24.1%, P=0.11). 결론 : 아미노글리코사이드를 5일을 초과한 사용 시 감염전문가의 사전 승인을 필요로 하는 사용제한정책은 아미노글리코사이드의 사용량과 비용을 유의하게 감소시켰다. 또한 이 정책 시행 후 그람음성간균에 의한 균혈증 환자에서 균혈증으로 인한 사망률과 아미노글리코사이드에 대한 내성률은 유의한 차이가 없었다. Objective : To evaluate the effects of an aminoglycoside restriction policy on expenditures for aminoglycosides, antimicrobial resistance rates and clinical outcome of nosocomial bacteremia caused by Gram-negative bacilli (GNB). Methods : Starting in February, 2002, a prior consultation with an infectious disease specialist for using aminoglycoside antibiotics over 5 days was required in a 930-bed university hospital. In retrospective analysis of medical records 7 months after initiation of the aminoglycoside restriction policy, sixty cases of clinically relevant nosocomial bacteremia caused by GNB were found. These bacteremic patients were compared with sixty, species-matched, control patients with nosocomial Gramnegative bacteremia before the policy for total expenditures for aminoglycosides, susceptibility to antibiotics and clinical outcomes of bacteremia. Results : During the same period of 7 months before and after the restriction policy, total expenditures for aminoglycosides decreased by 44% in cost (from 465,030,841 Won to 259,618,337 Won) and the antimicrobial utilization density of aminoglycosides decreased by 42% (from 225,2 to 130.3). On the other hand, the patterns of antibiotic susceptibility and bacteremia-related in-hospital mortality rates after the policy did not show a significant change, compared with those before the policy. Conclusion : Antibiotic restrictions are among the most popular methods to diminish the practice of antibiotic overuse in hospitals. In this study, requirement for prior approval of aminoglycoside use over 5 days led to a significant decrease in the amount and cost of total aminoglycosides without a significant change in susceptibility patterns and bacteremia-related mortality rates.

쇼트피닝 가공 최적조건 탐색을 위한 실험적 연구

신용승,김태형,윤종학,노승남,이철구 서울産業大學校 2002 논문집 Vol.53 No.1

The shot peening process is most often used to improve fatigue properties of metal parts. In order to achieve optimum, repeatable and reliable fatigue enhancement from the shot peening process, the important shot peening parameters must be controlled. In this paper, the optimum shot peening condition is investigated. Rotary bending fatigue test was accomplished to investigate the effects of shot peening on the fatigue strength. Experimental results show that the fatigue strength was tremendously increased by optimum peening.

敗醬草가 癌細胞柱에 미치는 影響

申大澈,權貞南,金瑩均,韓宗鉉,김재석,김재섭 동의대학교 한의학연구소 1997 동의한의연구 Vol.1 No.-

The purpose of this study was to investigate effect of water extract of Patriniae Herba on the poliferation of human cancer cell-lines. The effects of Patriniae Herba on the poliferation of A43l, HeLa, MOLT-4, K562 cells, Balb/c 3T3 cells, mouse thymocytes, splenocytes and human lymphocytes were estimated by MTT colorimetric assay, The results were as follows; 1. Patriniae Herbs did not effect A43l, HeLa, MOLT-4, K562 cells. 2. The cytotoxicity of mitomycin C on MOLT-4 cells was increased by the combination of Patriniae Herba. 3. Patriniae Herba inhibited the proliferation of Balb/c 3T3 cells. 4. Patriniae Herba stimulated the proliferation of thymocytes. 5. Patriniae Herba stimulated the proliferation of splenocytes. 6. Patriniae Herba stimulated the proliferation of human lymphocytes.

요부수핵탈출증에서 Thermography의 진단적 가치

신현택,신승우,송재철,정석희,이종수,김성수,신현대 경희대학교 동서의학연구소 2001 東西醫學硏究所 論文集 Vol.2000 No.-

Objectives : Lumbar radiculopathy is a common disease in oriental rehabilitation medicine. It can be diagnosed by physical examination, plain X-ray, Myelography, CT, MRI, EMG etc. But those methods are not useful in observing the clinical procedure. Objectvie evaluating the clinical procedure is very important in treatment of lumbar radiculopathy. Mehthods : We studied the clinical efficacy of thermography in lumbar radiculopathy during conservative managements. We studied 36 patients with lumbar radiculopathy convinced by MRI. The had low back pain and radiating pain on one side. Thermography had taken before an after 4 weeks treatments, and compared with clinical procedure Results and conclusions : Thermography is not pertinent as a primary diagnostic method in lumbar radiculopathy, but useful in observing the clinical procedure. And it can be recommended as a objective evaluation for lumbar radiculopathy.

인슐린 비의존형 당뇨병 환자에서 혈장 Endothelin-1농도의 변화

신양수,조희충,김원식,국기용,김용화,정종훈,문철웅,배학연,양성훈 朝鮮大學校 附設 醫學硏究所 1992 The Medical Journal of Chosun University Vol.17 No.2

Endothelin(ET) is a 21-residue peptide originally isolated from the cultured porcine endothelial cells. There are at least three genes for endothelin:endothelin-1(ET-1), endothelin-2(ET-2), and endothelin-3(ET-3). Endothelins are present in various human biological fluids including plasma, urine, breast milk, and saliva and have been found elevated plasma ET concentrations in patients with diabetes mellitus, Patients undergoing maintenance hemodialysis due to chronic renal failure, patients with acute myocardial infarction, and patients with subarachnoid hemorrhage. Endothelial cell damage is suspected to occur in diabetic patients and may be one important cause of angiopathy, a major complication in diabetes mellitus. The elevation of ET in diabetic patients may be a marker of, and further exacerbate, their vascular disease. We measured the levels of ET-1 in plasma of 50 patients with non-insulin dependent diabetes mellitus(NIDDM) and 25 normal subjects by radioimmunoassay. The plasma ET-1 concentration (mean±S.D.) in NIDDM was 6.461 A2.510 f㏖/ ㎖, and was significantly higher than in normal subjects (4.567±1.155f㏖/㎖) (P<0.05). The plasma ET-1 concentration (mean±S.D.) in diabetic retinopathy group( 7.15±2.454 f㏖/ml) was significantly elevated than those in otherwise uncomplicated groups (5.348±2.390 f㏖/㎖)(P<0.01). The correlation between any clinical parameters and plasma ET-1 levels in NIDDM was not significant, In conclusion, this study suggest that the elevated levels of ET-1 in diabetic patients may be play a important role in the pathogenesis of diabetic complications.

全蝎 抽出物의 抗癲癎效果에 關한 硏究

신현철,윤철호,김종대,정지천,신억섭,허근 한국한의학연구원 1997 한국한의학연구원논문집 Vol.3 No.1

In convulsion state by PTZ in rat, anticonvulsive effect and some γ-aminobutyric acid (GABA)-related mechanisms of Bythus extract in brain was experimented. It was ingibited GABA-T activity, lipid peroxide generation and xanthine oxidase activity as scheduled administration in vitro and vivo. And the content of brain gutathione was increased as scheduled administration in rat. In convulsion state by PTZ of previously managed rat by Buthus extract, onset eime and duration were non-specific changes but recovery time and severity was remarkably reduced. In conclusion speculated that Buthus extract inhibits convulsion by control of GABA content in brain.

Computer Graphics에 의한 3성분계 Wilson, NRTL 및 UNIQUAC 방식을 이용한 VLE 추정방식의 비교

신형섭,박종철 慶熙大學校 1988 論文集 Vol.17 No.-

The purpose of this study is to estimate VLE by means of the Wilson, NRTL, UNIQUAC equations and to compare with these three methods for two ternary systems: ethanol-benzene-cyclohexane, cyclohexanone-cyclohexanol-phenol, by the computer graphic technology. The temperatures and compositions of two systems were estimated by means of three TPTT equations. Isothermal lines of these two ternary systems were graphically illustrated from these estimated values and the reported experimental values. As a result of the analysis of the parameters and computer graphics, these parameter pairs changing with respect to the temperature and composition of the solutions. From the result of plotting the parameter pairs, A_12, vs, A_21, a locus contour between two parameters is observed, therefore numerous number of roots to satisfy these TPTT equations are found. These phenomena is nearly identical with the previously reported results that there are some correlation between these parameter pairs.

추간판 응력분포에 대한 광탄성 해석

신현국,이재창,안면환,안종철,인주철 영남대학교 의과대학 1989 Yeungnam University Journal of Medicine Vol.6 No.2

요추의 중립위, 굴곡위 및 신전위에서의 응력 분포의 차이와 수핵의 유무에 따른 응력 분포의 변화를 관찰하기 위해 본 연구를 시행 하였으며 등색선의 양상을 관찰하고 그 응력을 해석하여 다음과 같은 결론을 얻었다. 1. 기립 중립위에서는 수핵이 있는 경우는 전방 부위보다 후방부위에 고응력이 집중되었으며, 전후방 모두 내측부와 중간부위가 고응력이고 외측부로 이동할수록 적응력이 관찰되었다. 수핵이 없는 경우는 후방보다 전방부에 고응력이 집중되었으며 국소적으로 응력이 집중되는 양상을 보이고 있다. 2. 최대 굴곡위에서는 수핵의 존재에 관계없이, 전방보다 후방부에 고응력이 집중되었으며, 수핵 유무 비교시 수핵이 있는 경우가 없는 경우보다 전방이 저응력, 후방은 거의 동등한 응력 분포를 나타냈었다. 응력 분포도의 분석에 의하면 전반적으로 균등한 응력 분포 양상을 나타냈다. 3. 최대 신전위에서는 수핵 유무에 관계없이 전방부에 고응력, 후방부에 저응력, 내측에 고응력, 외측은 저응력을 나타내었으며, 수핵이 있는 경우 없는 경우보다 고응력을 나타냈다. 4. 기립 중립위와 최대 굴곡위의 비교에서는 기립 중립위보다 굴곡시 수핵의 유무에 관계없이 전반적으로 후방부 응력이 2차 정도 현저히 감소하는 양상을 보이면서 비교적 균등한 응력 분포를 나타냈다. 5. 최대 신전위와 최대 굴곡위의 비교에서는 수핵 존재시 최대 신전위보다 최대 굴곡위에서 응력 분포가 전후방 모두 2차 정도 감소되고 수핵이 없는 경우는 최대 신전위가 굴곡위보다 응력이 전후방 0.5차 정도 감소되었다. To observe the change in the status of stresses according to three different postural angulation of an intervertebral disc with or without nucleus pulposus, 6 specimens of a 3-dimensional photoelastic model of the spine were made of epoxy. The nucleus pulposus portion was replaced with silicon in three models, and the three were made without silicon. Through axial application of a vertical compressive load of 8㎏, the peculiar patterns of the isochromatic fringes were observed, Stresses on the intervertebral disc were analyzed according to three different postural angulations of the intervertebral disc with the nucleus pulposus and without the nucleus pulposus. The results of these study are as follow : 1. In an erect neutral posture with the nucleus pulposus, the stress concentration was much increased at the posterior portion rather than at the anterior portion. Also, the high stress was concentrated at the medial and central portion. In an erect neutral posture without the nucleus pulposus, the stress concentration was much increased at the anterior portion rather than at the posterior portion and the stress distribution seemed to be locally concentrated. 2. In a maximal flexed posture, the stress concentration was much increased at the posterior portion rather than at the anterior portion. Comparing the presence of the nucleus pulposus with the absence of the nucleus pulposus, the stress concentration was lower at the anterior portion in the presence of the nucleus pulposus than in the absence of the nucleus pulposus. However, the stress distribution at the posterior portion was nearly same in the two groups. According to the analysis of the stress distribution diagram, as a whole, the stress pattern around the disc was evenly distributed. 3. In a maximal extended posture, the higher concentration of the stress distribution at the anterior and medial portion rather than in the posterior and lateral portion was observed. The stress concentration was higher in the presence of the nucleus pulposus than in the absence of the nucleus pulposus. 4. Comparing the maximal flexed posture with the erect neutral posture, the stress concentration in the flexed posture was much decreased in the posterior portion rather than in the erect neutral posture, and an even distribution of the stress pattern in the flexed posture was observed. 5. In the absence of the nucleus pulposus, at the anterior and posterior portion, the stress concentration in the extended posture was much decreased compared with the flexed posture. In the absence of the nucleus pulposus, at the anterior and posterior portion, the stress concentration in the extended posture was much decreased compared with the flexed posture.

정신병적 증상을 동반한 기면병 1례

신일선,양종철,윤진상 大韓神經精神醫學會 1999 신경정신의학 Vol.38 No.4

저자들은 정신병적 증상이 동반된 기면병 환자를 경험하였다. 본 증례에서 정신병적 증상은 methyl-phenidate에 의해 유발 및 악화되었지만, 또한 기면병과는 별개로 서서히 진행되어온 정신분열병의 증상이기도 하였다. 진단 및 치료 특히 약물치료와 관련된 어려움을 외국문헌의 고찰과 함께 보고한다. The case of a 19-year-old man with coexistent narcolepsy and psychotic symptoms was presented. The psychotic symptoms were induced and / or exacerbated by methylphenidate. In addition, they were considered as symptoms of schizophrenia which had been developed regardless of the use of methylphenidate. The case illustrates the difficulties in diagnosing and treating, in particular, pharmacotherapy.

볼리비아 로즈목에 의한 다형홍반 양상을 보인 직업성 알레르기 접촉피부염 증례

신주연,홍윤철,임종한,박신구,이지나,김환철 大韓産業醫學會 2004 대한직업환경의학회지 Vol.16 No.2

배경 : 로즈목(rosewoods) 중 볼리비아 로즈목(Machaerium Scleroxyon)은 강력한 감작물질을 함유하고 있어서 외국에서는 이로 인한 자극 또는 알레르기 접촉피부염의 발생이 증가하고 있음에도 불구하고 지금까지 우리나라에서는 볼리비아 로즈목을 비롯한 수입목재에 의한 직업성 피부질환의 보고가 부족하였고, 이에 저자들이 볼리비아 로즈목에 의한 다형홍반 양상을 보인 직업성 알레르기 접촉피부염의 증례를 경험하였기에 보고하고자 한다. 증례 : 49세 남자로서 여러 가지 수입목재를 절단하고, 다듬는 작업을 하다가 소양감을 동반한 홍반성의 피부 증상이 발현되었고, 전신으로 증상부위가 확대되어 2주 동안 병원 입원 치료를 하게 되었으며, 이후 본원 산업의학과에서 피부첩포 검사 후 최종적으로 볼리비아 로즈목에 의한 알레르기 접촉피부염으로 확진되었다. 결론 : 수입목재들로 인한 직업성 피부질환 발생에 대한 광범위한 실테 조사가 필요하며, 이를 토대로 작업장에서의 직업성 피부질환의 발생을 감소시키기 위한 다각적인 예방, 관리 대책의 수립이 필요하다. Background: Woods are capable of causing allergic or irritant contact dermatitis which typically occurs on exposed areas. Because Bolivian rosewood exclusively contains the strong sensitizer R-3,4-dimethoxdalbergione, an increasing number of cases of initant and allergic contact dermatitis has been reported. Case report: A 49-year-old, male, wood worker, who handled a variety of woods, developed allergic contact dermatitis. A patch test confirmed a positive reaction to one of the exotic woods, Bolivian rosewood. Allergens found in Bolivian rosewood caused this patient's dermatitis, which cleared when he avoided &is wood. Conclusion: Exotic woods such as Bolivian rosewood can induce occupaiional contact dermatitis. Measures to lower the incidence of work-related dermatitis are needed in the workplace. Especially, when cutting or sanding woods, workers should wear proper personal protection.