발열을 동반한 호중구감소증에서 Cefepime 단독투여와 Ceftazidime 및 Tobramycin 병합투여의 효능비교

정현욱,채제욱,강미라,양정채,문치숙,기현균,장현하,오원섭,김기현,백경란,이남용,송재훈 대한감염학회 2004 감염과 화학요법 Vol.36 No.6

목적 : 국내에서 발열을 동반한 호중구감소증이 있는 악성 종양환자에게 경험적 항생제로 베타락탐계 항생제와 아미노배당체의 병합요법의 사용이 일반적이다. Cefepime은 광범위 항균 작용을 가지고 있어, 그람 음성균 뿐만 아니라 그람 양성균에 대해서도 우수한 효과를 나타낸다. 재료 및 방법: 발열을 동반한 호중구감소증이 있는 악성 종양환자를 대상으로 무작위, 공개, 비교 연구를 시행하였다. 대상 환자를 무작위로 cefepime 단독요법군과 ceftazidime 및 tobramycin 병합요법군으로 나누어 투여하고 각각의 임상적 효능과 안전성을 비교하였다. 구강및 인후 점막염이 있는 환자에서 분리된 녹색 연쇄알 구균에 대한 항생제 내성 정도를 조사하였다. 결과 : 대상환자 89명 중 CA 투여군이 48예(53.9%), CT 투여군이 41예(46.1%)이었다. 발열의 유형별로 MDI는 18예(20.2%), CDI는 9예(10.1%), UF는 62예(69.7%)로 두 군 간에 차이가 없었다. CA 투여군과 CT 투여군의 임상적 호전률은 시험약 투여 후 2-4일째 각각 91.7%, 85.4% (P=0.31), 치료 종료 시 각각 91.7%, 100% (P=0.15)로 두 군간에 유의한 차이가 없었다. 치료 종료 시 CA 투여군과 CT 투여군의 세균학적 소실률은 모두 100%로 두 군간의 유의한 차이가 없었다(P=0.78). 점막염이 있는 환자로부터 녹색 연쇄알 구균이 분리된 경우는 25예(28.1%)이었으며, 분리된 녹색 연쇄알 구균은 penicillin, ceftriaxone, cefepime, vancomycin에 모두 감수성을 보였다. 약제 관련 이상 반응의 발생 빈도도 두 군간에 유의한 차이가 없었다. 결론 : 발열을 동반한 호중구감소증이 있는 악성 종양환자의 경험적 항생제로서 cefepime 단독요법은 ceftazidime 및 아미노배당체의 병합요법만큼 효과적이고 안전하였다. Background : Broad-spectrum antibiotic therapy has been recommended as an empirical regimen in cancer patients with febrile neutropenia. Cefepime is a fourth generation cephalosporin with good activity against both gram-positive cocci and gram-negative bacilli. Materials and Methods : To compare the efficacy and safety of cefepime alone with ceftazidime plus tobramycin as empirical regimen for adult cancer patients with febrile neutropenia, a randomized, open label, comparative trial was performed. If the patient showed clinical improvent 72 hours, antibiotic could be changed to oral ciprofloxacin. Clinical and microbiological responses were determined at 72 hours and at the end of therapy. To investigate the antimicrobial resistance of viridans streptococci, swab cultures were obtained from throat in all enrolled patients and antimicrobial susceptibility tests were performed by using microdilution method according to the NCCLS. Results : A total of 89 patients were enrolled. Forty-eight patients received cefepime alone (CA), and 41 patients received ceftazidime plus tobramycin (CT). Demographic and baseline clinical characteristics were similar in both groups (P>0.05). The initial clinical success rate at day 2-4 in group CA (91.7%) was similar with that in CT group (85.4%) (P=0.31). At the end of therapy, the final clinical success rate in CA group (91.7%) was similar to that in CT group (100%) (P=0.15). In 18 patients, with microbiologically defined infections, the eradication rate was 100% in both groups. Adverse events including liver dysfunction (21.3%) and renal dysfunction (2.2%), were similar in both groups (P=0.87). Viridans streptococci were isolated from the throat cultures in 25 cases, and all of these strains were susceptible to penicillin (MIC_(90) 0.12 ㎍/mL), cefepime (1 ㎍/mL), and vancomycin (0.12 ㎍/mL). Conclusion : Efficacy and safety of cefepime monotherapy was comparable to the combination of ceftazidime and tobramycin. It could be used as an alternative empirical regimen for treating cancer patients with febrile neutropenia.

판막 질환에서의 심근 섬유화 : 심근 조직을 이용한 형태학적 연구 및 혈청 생화학적 지표의 분석

강수진,박덕우,송재관,박경민,송종민,강덕현,한기훈,송현,이재원,주석중,송명근,김정선 대한순환기학회 2004 Korean Circulation Journal Vol.34 No.2

중독한 추체로 증상을 보인 cyclosporine에 의한 뇌증 1예

강정현,곽승근,신현영,김성은,이정호,이정찬,곽상혁,윤환중,조덕연,김삼용,김제,송창준 충남대학교 의과대학 지역사회의학연구소 2000 충남의대잡지 Vol.27 No.1

The use of cyclosporine(CsA), a potent immunosuppressive agent, is associated with numerous side effects. Neurotoxicity was earlier less well known, but with growing experience central nervous system side effects are now reported up to 40% of patients. Among various CsA-induced neurotoxicities, tremor is most common and posterior leukoencephalopathy is well characterized. An encephalopathy presenting with pyramidal weakness, however, seems to be rare and poorly documented. We report here a case of encephalopathy presenting with multiple generalized seizures followed by fluctuating quadriparesis developed a few days after starting CsA and resolved spontaneously after withdrawal of the drug . A 48-year-old woman with aplastic anemia was placed upon immmunosuppressive treatment consisting of antithymocyte globulin(ATG), CsA, and methylprednisolone. Two days after starting the therapy, she developed a generalized seizure. The next day she developed 2 more episodes of seizure and the therapy was stopped. Computed tomogram of the brain was normal. Six days after starting therapy, she developed mild motor weakness and paresthesia of both lower extremities, which progressed to a definite quariparesis confining her to a bed in 3 days. Magnetic resonance imaging(MRI) of the brain revealed asymmetric, bilateral high-signal abnormalites in the subcortical white matter of fronto-temporal areas. After reaching to a maximum with some fluactuation(14 days after starting the therapy) the motor weakness started to be resolved. She was discharged with a almost complete resolution of the weakness 45 days after starting the therapy. Five months later she did well and brain MRI was negative.

반복적인 급성 신부전을 유발한 호산구성 장염 1 예

정혜진;김현태;김유선;정현걸;강윤경;문정섭 인제대학교 2011 仁濟醫學 Vol.32 No.-

Eosinophilic gastroenteritis is a rare disorder of unknown etiology characterized by presence of gastrointestinal symptoms, eosinophilic infiltratio n of one or more parts of gastrointestinal tract without involvement of other organs and absence of parasitic infestation. The clinical presentation depends on the extents and depths of eosinophilic infiltration. Mucosal involvement may result in abdominal pain, nausea, vomiting, diarrhea and weight loss. We report a case of eosinophilic enterocolitis in a 55-year-old female presented with abdominal pain and watery diarrhea resulting in recurrent acute renal failure.

원위 대퇴골의 고립성 골연골종에서 발생한 속발성 연골 육종 1례 보고

정필현,황장수,강석,김용민,오형호,채동주,김종필 동국대학교 경주대학 1996 東國論集 Vol.15 No.-

연골육종은 비교적 서서히 자라며 늦게 전이하는 악성 연골 종양으로 알려져 있다. 골 연골종에서 발생한 속발성 연골육종은 발생빈도는 드물며 타부위로의 전이가 적고 악성도가 낮은 경우가 많아 적합한 수술적 치료로서 좋은 예후를 보이는 것으로 보고되고 있다. 본 동국대학교 정형외과학 교실에서는 우측 대퇴골 원위부 골간단부에 생긴 고립성 골 연골종에서 이차적으로 발생한 연골육종을 치험한 바 문헌고찰과 함께 보고하는 바이다. A case of Secondary Chondrosarcoma Arising from Solitary Osteochondroma of the Distal Femur Department of Orthopaedic Surgery, College of Medicine, DongGuk University Phil Hyun Chung M.D., Jung Su Hwang M.D., Suk Kang M.D., Yang Mln Kim M.D., Hyung Ho Oh M.D., Dong Ju Chae M.D., Jong Pil Kim M.D. Chondrpsarcoma is a malignant cartilage-forming tumor that grows slowly and metastasis of this tumor occurs in late stage. Secondary chondrosarcomas arising from a solitary osteocartilaginous exostosis are rare and those have a better prognosis than other chondrosarcomas, and they rarely metastasize. We present our experience with a case of secondary chondrpsarcoma arising in solitary osteochondroma of distal metaphysis of right femur with clinical details.

위암 환자의 복강내 투여를 위한 Activated Charcoal-Alginate Bead 제형으로부터 Mitomycin C의 용출 거동

이진호,최선웅,서중기,김동민,정경수,오정연,김진향,노승무,민병무,김용백,김창식,박근성,강대영,송규상,양준묵,조준식,정현용,김학용,인현빈 충남대학교 의과대학 지역사회의학연구소 1998 충남의대잡지 Vol.25 No.1

Locoregional recurrence is the most common type of recurrence in surgical operation of gastric adenocarcinoma, and peritoneal dissemination is one of the most difficult problems in advanced gastric adenocarcinoma treatment. Because the peritoneal cavity is the most common site of the first recurrence after gastric cancer resection, intraperitoneal chemotherapy seems a logical choice for cancer chemotherapy. In this study, Mitomycin C (MMC)-activated charcoal (CH)-alginate (ALG) beads were prepared by the mixtures of CH particles adsorbed with MMC as an anti-cancer drug and aqueous alginate solution. The alginate is recognized as biodegradable, nontoxic, and biocompatible. The release of MMC from the beads in 0.1 M Tris buffer was stable and continuous until about 1 week. The MMC-CH-ALG beads can be applied in the peritoneal cavity for intraperitoneal chemotherapy since they provide a good adhesiveness on the tissue and controlled release pattern of the drugs.

치아 석회화 단계와 골 성숙도 단계간의 상관관계에 대한 연구

강동균,김태완,김영진,남순현,김현정 大韓小兒齒科學會 2008 大韓小兒齒科學會誌 Vol.35 No.2

본 연구는 성장 중인 부정교합 환자의 진단이나 치료계획의 수립,치료방법 및 시기,예후 등을 결정하는데 중요한 판단 지침이 되는 치아 석회화 단계와 경추 및 수완부골 성숙도간의 연관성을 규명하여 개인의 보다 정확하고 효율적인 사춘기 성장 정도를 평가하기 위해 시행하였다. 전신 질환이 없고 교정 치료 경험이 없는 7-16세의 여아 154명,남아 179 명,총 333명의 파노라마 방사선사진,측모 두부규격 방사선사진,수완부 방사선사진을 분석하여 평가하였다. 연구 결과,파노라마 방사선사진의 치아 석회화 단계를 통하여 사춘기 성장 정도를 평가하는 것은 부정교합 환자의 진단 및 치료계획을 수립하는데 임상적으로 유용한 정보를 제공할 것으로 판단되었다. The purpose of this study was to investigate the relationship between the stages of calcification of various teeth and skeletal maturity stages among Korean individuals. The study subjects consisted 154 female and 179 male ranging from 7 years to 16 years of age. A total of 333 hand-wrist, cephalo-lateral and panoramic radiographs were obtained and analyzed. The tooth development of the mandibular canines, first, second premolars, and second molars were assessed according to the Dermijian' s system. Skeletal maturity stages were determined from hand-wrist radiographs by using the SMI system and cephalo-lateral radiographs by using the CVMS, respectively. The results were as follows 1. The mean ages of each stage of skeletal maturity were consistently younger in female subjects. 2. There was a high correlation between skeletal maturity of hand-wrist and cervical vertebrae in the both sexes. 3. There was a high correlation between skeletal maturity and dental calcification stage of mandibular canines, first premolar, second premolars, and second molar. 4. The mandibular second molar was tooth showing the highest correlation. 5. Percent distributions of the relationship between calcification stages of individual teeth and stages of skeletal maturity were obtained in both sexes. In summary, this suggests that tooth calcification stages from panoramic radiographs might be clinically useful as a maturity indicator of the pubertal growth period.

벼의 혹명나방의 성 유인 물질의 합성과 생물활성시험

강석구,박정민,이정운,고현관 成均館大學校 科學技術硏究所 1983 論文集 Vol.34 No.2

벼의 혹명나방의 성 유인 물질인 (Z)-13-옥타데센-1-올 아세테이트를 새로운 방법으로 합성하였다. 즉, 1-헥신의 리튬 음이온을 보호된 12-브로모-1-도데칸을 THP 에테르와 반응시켜, 13-옥타데신-1-올 THP에테르를 만든후 Lindlar 촉매에 의한 수소화 반응을 시켜 (Z)-13-옥타데센-1-올 THP에테르를 얻는다. 산촉매하에서 보호기를 제거한 후 피리딘 용매하에서 무수아세트산을 반응시켜 최종 생성물인 (Z)-13-옥타데센-1-올 아세테이트를 좋은 수율로 얻었다. 농촌진흥청의 곤충과와 공동으로 상기에서 합성된 성 유인 물질을 이용하여 혹명 나방의 숫컷에 대한 성 유인 효과를 실험해본 결과 성 유인 작용이 있는 것으로 나타났다. A new method is described for the synthesis of (Z)-13-octadecen-1-ol acetate(1), the sex pheromone of the Rice Leaf Folder moth. Lithium acetylide of 1-hexyne was alkylated with 12-bromo-1-dodecanol THP ether. 13-Octadecyn-1-ol THP ether was stereoselectively reduced over Lindlar catalyst(Pd/BaSO_4) to give (Z)-13-octadecen-1-ol THP ether. (Z)-13-octadecen-1-ol THP ether was deprotected and acetylated with acetic anhydride and pyridine to afford the final product, (Z)-13-octadecen-1-ol acetate. Biological activity test of the synthetic compound, (Z)-13-octadecen-1-ol acetate was tested in the field using polyethylene capsules as containers. The numbers of moths trapped with pheromone vials were counted.

초등학교 교실에서의 창의적 시 읽기 지도 방안 연구

강현국,정우기 대구교육대학교 2004 論文集 Vol.39 No.-

Rat의 복강내에 투여한 5-fluorouracil-polyglycolic acid 제형이 장기에 미치는 영향에 관한 연구

강대영,송규상,최정목,노승무,정경수,오정연,김진향,양준묵,최선웅,이진호,조준식,민병무,김용백,김창식,박근성,김승영,김학용,인현빈 충남대학교 의과대학 지역사회의학연구소 1998 충남의대잡지 Vol.25 No.1

For more effective intraperitoneal chemotherapy, the authers made 5-fluorouracil-polyglycolic acid composite disks(FU-PGA disks) with 5-fluorouracil and polyglycolic acid, a biodegradable polymer. We inserted the FU-PGA disk into the peritoneal cavites of Sprague-Dawley male rats, the control and three experimental groups; one FU-PGA disk insert group(300mg/kg), two FU-PGA disk insert group(600mg/kg), and three FU-PGA disk insert group(900mg/kg). The control group received a similar number of PGA disk inserts. A pharmacokinetic study was performed to measure the 5-fluorouracil concentration in the peritoneal fluid, blood, and tissues(liver, kidney and heart) at 24 hours, 72hours and 168 hours after insertion of the FU-PGA disk. Light and electron microscopic studies were done. The results were as follows: 1) The number of white blood cells and platelets decreased after FU-PGA insertion. The degree was proportional to the duration and amounts inserted. The change in the number of red blood cells varied slightly. 2) Light microscopically, slight changes were noted at 168 hours in the 3 disk insert group (900mg/kg). Mild fatty change and hepatocyte degeneration around the central veins of the liver were noted, with vacuolar degeneration in the proximal convoluted tubules of the kidney. 3) Electron microscopically,the liver showed focal increases of lipid droplets in the hepatocytes, and irregular nuclear membrane with focal nucleolar segregation of the fibrillar and granular elements. Also the double membranous structure of the hepatocytes and Kupffer cells was widened with bleb formation. The kidney showed wide separation of the nuclear double membrane in the proximal convoluted tubular cells and mesangial cells, with vacuolation and myelin figure formation in the mitochondria of the proximal convoluted tubular cells, at 72 hours and 168 hours in the 2 to 3 FU-PGA insert groups. The heart showed focal loss of cristae,vacuolation and myelin figure formation in the mitochondria of the 2 to 3 FU-PGA insert groups. In conclusion, despite the large amont of FU-PGA inserted, the histopathological changes in the liver, kidney and heart were slight, and consonant with the very low amount of 5-fluorouracil concentrations detected in the liver, kidney and heart. The above results suggest that the FU-PGA composite can serve as a new device for releasing drugs in a controlled manner and easily targeted to intraperitoneal organs. This device can improve the efficacy of intraperitoneal chemotherapy for gastric cancer.