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.

조혈모세포이식 환자에서 발생한 Cytomegalovirus 질환의 특징 : 일개 대학변원에서 최근 10년간의 경험

최수미,이동건,박선희,김시현,김유진,민창기,김희제,이석,최정현,유진홍,김동욱,이종욱,민우성,신완식,김춘추 대한감염학회 2009 감염과 화학요법 Vol.41 No.1

Background : Studies on cytomegalovirus (CMV) diseases in Korean hematopoietic stem cell transplant (HSCT) recipients are lacking and do not reflect the recent trends of advances and changes. Therefore, we tried to analyze the clinical features of CMV diseases in HSCT recipients over the past 10 years at a tertiary university hospital in Korea. Methods : Retrospective review of medical records was done for all adult HSCT patients who received transplant at the Catholic HSCT Center from January 1998 to January 2008. Results : Forty-four cases (2.2%) of CMV diseases were identified. CMV pneumonia was diagnosed in 17 patients, retinitis in 16 patients, enterocolitis in 7 patients, esophagitis 1 patient, gastritis in 1 patient, duodenitis in 1 patient, and hepatitis in 1 patient. The median onset of symptom was 90 days after transplantation. Late CMV diseases accounted for 47.7%. CMV related death varied from 0 to 58.8% according to the involved organ. CMV retinitis was diagnosed relatively later in the course of transplantation mostly in patients who had chronic graft versus host disease (GVHD). On the contrary, CMV enterocolitis mainly occurred in patients who suffered from acute GVHD. The overall concurrent CMV reactivation was documented to be 63.6%: the concurrent CMV reactivation was observed only in 37.5% of patients with retinitis. Conclusions : We observed some differences in the pattern of CMV disease manifestation according to the involved organ and reconfirmed the fact that CMV pneumonia is the most common and fatal disease in HSCT recipients. Additionally, CMV retinitis was not uncommon in HSCT recipients. Since specific marker does not exist in predicting retinitis, regular ocular examination should be done thoroughly, especially in patients with chronic GVHD.

조혈모세포이식 환자에서 침습성 진균 감염에 대한 Micafungin의 예방 효과 및 안전성

김시현,이동건,최수미,권재철,박선희,최정현,유진홍,이성은,조병식,김유진,이석,김희제,민창기,조석구,김동욱,이종욱,민우성,박종원 대한감염학회 2010 감염과 화학요법 Vol.42 No.3

Background: Micafungin, a potent inhibitor of 1,3-β-D-glucan synthase, is a novel antifungal agent of the echinocandin class. In vitro study showed that micafungin was effective against Aspergillus species as well as Candida species, but clinical data on the prophylactic efficacy against invasive fungal infections (IFIs) other than candidiasis are still lacking. Materials and Methods: We identified 60 consecutive adult hematopoietic stem cell transplantation (HSCT) recipients who received at least 3 doses of micafungin during neutropenic period. Micafungin was started as an alternative in patients who were intolerant or had adverse events (AEs) to primary prophylactic antifungal agents. We retrospectively reviewed the medical records and analyzed the efficacy and safety of micafungin for prophylaxis against IFIs. Results: The patients either had autologous (n=9) or allogeneic (n=51: 1 syngeneic, 24 sibling, 26 unrelated donor) HSCT. Itraconazole oral solution (n=58) was the most frequently used first line antifungal agent for prophylaxis and was administered for median 11 days. The most frequent cause of switch to micafungin was vomiting (n=42). The duration of neutropenia and micafungin administration was median 13 and 12 days, respectively. A successful outcome was achieved in 45 (75%) patients. Empirical antifungal therapy was initiated in 13 (22%) patients. There were 2 cases (3.3%) of breakthrough fungal infections which comprised a probable invasive pulmonary aspergillosis and a possible invasive fungal sinusitis. There was no case of invasive candidiasis. A total of 53 (88%) patients experienced at least one AE regardless of causality during micafungin administration. The most frequent AEs were hypokalemia, vomiting, diarrhea, and elevated serum aspartate aminotransferase or alanine aminotransferase. Among the aforementioned AEs, only 1 case of diarrhea could be classified as a probable relation with micafungin when causality was assessed. There was no AEs that caused discontinuation of micafungin. Conclusions: Micafungin seems to be a safe and effective agent for prophylaxis of IFIs including aspergillosis as well as candidiasis in HSCT recipients. However, further large, prospective, and randomized comparative studies are warranted for aspergillosis.

조혈모세포이식 환자에서 침습성 진균 감염에 대한 이트라코나졸 액과 플루코나졸 시럽의 예방 효과 : 전향적, 무작위, 비교 임상시험

최수미,이동건,최정현,박선희,엄기성,김유진,김희제,민창기,유진홍,김동욱,이종욱,민우성,신완식,김춘추 대한감염학회 2005 감염과 화학요법 Vol.37 No.2

목적 : 조혈모세포이식 환자에서 호중구 감소 기간 동안 이트라코나졸 액(ITZS)과 플루코나졸 시럽(FCZS)의 진균 감염에 대한 예방 효과를 전향적으로 비교해 보고자 하였다. 재료 및 방법 : 2001년 8월부터 2002년 6월까지 가톨릭 조혈모세포이식센터에 입원하여 동종 조혈모세포이식을 받은 만 18세 이상의 환자들을 각각 ITZS와 FCZS군으로 무작위 배정하여 침습성 진균 감염 발생과 약제 관련 부작용을 전향적으로 조사하였다. 결과 : ITZS군에 40명, FCZS군에 38명이 배정되었고, FCZS군 환자의 평균 나이가 더 많았다. 시험 약제 평균투여기간은 ITZS군 16.4일, FCZS군 21.9일로 ITZS군이 더 짧았다. 이는 ITZS군에서 소화기 부작용으로 인한 약제 중단이 더 많았기 때문으로 보인다. 시험 약제 투여 후 총 빌리루빈 수치의 유의한 증가가 관찰되었으나, 약제 관련 부작용은 모든 환자에서 가역적이었다. 호중구감소 기간동안 표재성 진균 감염은 두 군에서 모두 발생하지 않았고, 침습성 진균 감염은 ITZS군 5명(12.5%), FCZS군 8명(21.1%)으로 FCZS군에서 많았으나, 통계학적으로 유의하지 않았고, 사망률에도 유의한 차이는 없었다. 결론 : 침습성 진균 감염에 대한 이트라코나졸 액과플루코라졸 시럽의 예방 효과에 유의한 차이는 없었으나, 앞으로 더 많은 환자를 대상으로 잘 짝지어진 대조군 연구가 필요할 것으로 보인다. 부작용 중 간독성과 관련하여 이식시 투여되는 여러 약제들과의 상호작용에 대한 연구도 필요할 것이다. Background : Though fluconazole is widely used for antifungal prophylaxis, it is ineffective against mould infections including Aspergillus species. Itraconazole has a broader spectrum than fluconazole but the capsule form shows erratic bioavailability in neutropenic patients. In this study, we compared itraconazole oral solution (ITZS) with fluconazole syrup (FCZS) for the prevention of invasive fungal infection (IFI) in allogeneic hematopoietic stem cell transplant recipients. Materials and Methods : Adults receiving allogeneic hematopoietic stem cell transplantation (HSCT) from september 2001 to June 2002, were randomly allocated to either the ITZS group or the FCZS group. We prospectively evaluated the safety and efficacy of each drug. Results : Out of 78 patients (40 patients in the ITZS group and 38 patients in the FCZS group) who were eligible for this study, 37 patients completed the course of prophylaxis without any evidence of IFI. The mean duration of prophylaxis was 16.4 days for the ITZS group and 21.9 days for the FCZS group (P<0.006). Drug-related adverse events occurred in 28 patients (70.0%) and 19 patients (50.0%) in the ITZS group and the FCZS group, respectively. Common adverse events of ITZS were nausea, vomiting, and diarrhea. Drug-related reversible hepatotoxicity occurred in 4 patients in the ITZS group. There was a significant elevation of total bilirubin level in the ITZS group. The incidence of suspected IFI occurred in 5 patients (12.5%) who received ITZS, compared with 8 (21.1%) who received FCZS (P=0.372). There were no proven IFIs or superficial (oral/vaginal) fungal infections in both groups. Overall mortality was not different between the two groups (2.5% in the ITZS group versus 5.3% in the FCZS group, P=0.610). Conclusion : ITZS and FCZS showed similar protection against IFI during pre-engraftment period. Poor tolerability due to gastrointestinal troubles of ITZS might limit its success as prophylactic therapy. Well matched controlled study with large number of patients will be required in the future.

IMF에 관련된 경제적 스트레스가 정신 건강에 미치는 영향

유희정,황성훈,홍진표,김헌수,이철,한오수 大韓神經精神醫學會 2000 신경정신의학 Vol.39 No.1

본 연구는 IMF에 관련된 경제적 스트레스가 정신 건강에 미치는 영향과 그 과정을 밝히기 위해 설계되었다. 스트레스 과정에 관여하는 요인으로 사회적 지지와 문제 해결 양식, 그리고 무망감을 도입했으며, 이들에 의해 스트레스의 영향이 매개되는지를 검증하였다. 경제적 스트레스의 수준에 따라 표집된 221명의 일반인들을 대상으로 우울, 불안, 신체화, 적대감, 사회적 지지, 그리고 문제 해결 양식 등을 측정하였다. 가정한 대로 실직으로 대표되는 경제적 스트레스는 정신 건강에 부정적 영향을 미치는 것으로 나타났다. 그 구체적인 양상을 살펴보면 다음과 같다. 먼저, 사회적 지지는, 높은 스트레스 조건에서 증상의 발현을 억제하는 완충 효과가 있음이 입증되었다. 두번째로, 남성이 여성에 비해 경제적 스트레스의 부정적 영향에 더 취약한 것으로 나타났다. 세번째, 경제적 스트레스는 문제 해결 양식의 다양한 구성요소중 문제 해결에 대한 무기력감에만 영향을 미치는 것으로 나타났다. 네번째, 무망감은 경제적 스트레스와 정신 건강간의 관계를 매개하는 변인임이 인과모형 검증을 통해 확인되었다. 끝으로, 이러한 결과가 스트레스 개입 프로그램 개발을 위한 이론적 기초를 제공한다는 의의가 있음을 논의 했고, 본 연구의 몇 가지 한계점을 지적하였다. This study was designed to investigate the influence of the so-called IMF-related economic stress upon the mental health and to analyze the process of the influence. As the possible variables moderating the stress process, social resource, problem solving style, and hopelessness were included. 221 male and female subjects were recruited according to the intensity of economic stress and classified into four groups(employees of solid companies, employees of the companies at risk, short-term unemployed and long-term unemployed). Relevant measures including economic stress scale, selected SCL-90R subscales(somatization, depression, hostility, anxiety), social support scale, problem-solving scale, and job hopelessness scale were administered. As assumed, it was proved that economic stress had adverse effects on the mental health. In addition to this basic causal relationship, moderating effects of several variables were found as follows: First, social support had the buffering effect upon the economic stress. That is, strong social support played the role suppressing the development of psychiatric symptoms under high stress. Second, men were more vulnerable to the adverse effects of economic stresses than women. Third, economic stresses had influence on the helplessness concerning the problem solving. However other problem solving strategies such as creative style, approach style, avoidance style, etc were proven to have no relationship with the economic stress. Fourth, in the analysis of unemployed group, it was found that hopelessness mediates the relationship between economic stress and mental health. In conclusion, the clinical implications of such findings in economic stress process were discussed and several limitations and the suggestions for future researches were also addressed.

흰쥐 뇌줄기에 분포하는 Nitric Oxide Synthase 신경세포에 관한 면역조직화학적 연구

나준희,허영범,박찬,김정혜,유진화,안희경,이원규 대한해부학회 1999 Anatomy & Cell Biology Vol.32 No.2

일 대학 부속병원 간호사들의 연구장애 요인

유연희,배수정,김진선 朝鮮大學校 附設 醫學硏究所 2006 The Medical Journal of Chosun University Vol.31 No.1

Background and Objectives: Evidence based practice is a hallmark of professional nursing. However, low levels of research utilization are problematic in nursing. The purposes of this study were to identify the facilitators and barriers to research utilization and to identify factors associated with research utilization among nurses. Methods: A descriptive study was conducted with a sample of 227 nurses in a university hospital located in a metropolitan city. The questionnaire included the Barriers Scale and questions about research activities, research related educational needs, and resources used to obtain information for clinical decision making. Results: The main barriers to research utilization identified by the respondents were: the fact that most research is published in a foreign language; implications for practice are not made clear; the research has not been replicated. The greatest mean score of each of the sub-scales was the communication factor followed by the organization, research, and nurse factors. Nurses who had received education for research methods, statistics, and reference search and who had participated research activities reported lower barrier score than those who did not. Conclusions: Although the nurses perceived the importance of research utilization in their practice, there was a poor application in their work. Decreasing known barriers would facilitate research-based practice. The implications for nursing to decrease the barriers to research utilization are discussed.

모발의 부위별 분석을 통한 Methamphetamine 남용자의 복용시기 추정에 관하여

유영찬,정희선,최화경,진원택,이한선 內務部 國立科學搜査硏究所 1996 國立 科學 搜査 硏究所 年報 Vol.28 No.-

소화기 Behcet병: 13예의 임상분석

정희원,유빈,문희범,이인철,김병식,박건춘,김진천 대한대장항문학회 1995 Annals of Coloproctolgy Vol.11 No.1

류마티스성 심장판막질환, 우심방혈전 및 대동맥 협착증과 합병된 만성 혈전색전성 폐동맥고혈압 1예

유근배,심준,임양희,이진화,신길자 梨花女子大學校 醫科大學 醫科學硏究所 1998 EMJ (Ewha medical journal) Vol.21 No.4

폐동맥 혈전색전증은 비교적 드문 질환으로 주로 심부 정맥혈전에서 발생하는 것으로 알려져 있으며 류마티스성 심장판막질환을 가진 경우 합병되는 우심방 혈전이 드물게 폐혈전색전증의 원인이 될 수 있는데, 저자들은 대동맥의 동맥경화성 협착증을 동반한 류마티스성 심판막질환 환자에서 우심부전 및 우심방혈전에서 발생한 만성 혈전색전성 폐동맥고혈압1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Most pulmonary thromboemboli arise from the deep vein thrombosis, which have complete clinical and at least near complete roentgenographic and angiographic resolution within four to six week of the acute event. But chronic pulmonary hypertension and cor pulmonale from unresolved pulmonary embo-lism complicate acute embolic episode with a frequency of less than 1 percent. Rarely pulmo-nary thromboemboli can result from right atrial thrombi. We experienced a case of chronic thromoboembolic pulmonary hypertension, which wrose from right atrial thrombi in the patient with rheumatic valvaular heart disease and thoracic aorta atherosclerotics stenosis.