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.

랫드에서 단일시험법을 이용한 반하 물추출물의 생식독성시험

이기남,유욱준,백인정,연정민,남상섭,이범준,남상윤,김윤배,강현규,안병우,김대중,황방연,노재섭,홍정섭,성하정,김순선,조대현,윤영원 충북대학교 동물의학연구소 2006 Journal of Biomedical and Translational Research Vol.7 No.1

본문참조

충돌사고 사례분석을 통한 구난시스템 개선에 관한 연구

정창현(Chang-Hyun, Jung),남택근(Taek-Kun, Nam),정중식(Jung-Sik, Jeong) 한국항해항만학회 2012 한국항해항만학회지 Vol.36 No.10

세계 해상교통량의 증가와 고속선의 증가로 해양사고 발생 가능성이 점점 높아지고 있으며, 그 피해 규모도 상대적으로 커지고 있는 추세이다. 국내에서는 2007년 허베이 스피리트호 사고, 2010년 천안함 사고에서와 같이 해양사고 발생시 초기대응의 미흡, 비상대응체계의 부재, 적절한 구조체계의 부족, 사고현장의 혼란 등으로 구난 활동이 지연됨으로써 막대한 인명 또는 재산상의 피해를 가져왔다. 사고 발생 후 적절한 피난처의 제공이나 신속한 사고처리는 사고선박으로부터 발생 가능한 잠재적인 환경오염 및 2차적인 피해로의 확산을 막을 수 있다. 따라서 최근 남해부근에서 발생한 선박 충돌사고의 구난과정을 살펴보고, 그 과정에서 도출된 문제점을 바탕으로 현재 국내 구난시스템에서 개선이 요구되는 부분을 제시하였다. 그 주요 내용으로는 외국의 피난처 지정 사례와 IMO 관련 지침을 바탕으로 피난처 제공에 대한 절차 수립의 당위성을 제시하였으며, 사고선박을 항내 또는 피난처로 이동시키기 위한 사고선박 예인지원시스템의 필요성을 제시하였다. 또한, ISU 가입을 위한 국가적인 지원방안의 검토와 사고 발생시 국내업체가 구난활동에 적극적으로 참여할 수 있도록 제도적 보완이 요구된다. There has been increasing the possibility of occurring the marine accident and become bigger the extent of damage with the growing number and high speed of ships. Also, there were tremendous loss of lives and properties in accidents of Hebei spirit in 2007 and Cheon Ahan war ship in 2010 with the insufficient salvage response and the lack of emergency response systems. When a ship has suffered an incident, the best way of preventing damage or pollution from its progressive deterioration would be to providing a place of refuge and to repair the damage rapidly. Therefore, it was examined the recent collision accident broken out near the Nam-Hae, and then suggested that it was necessary to be improved of the domestic salvage systems. It requires the procedures of providing a place of refuge, and the towing support system which make the damaged ship moved to the safe area, and joining of the ISU.

Lithium 중독증상에 대한 고찰

南正鉉 大韓神經精神醫學會 1979 신경정신의학 Vol.18 No.3

The author has tried to evaluate clinical correlation between toxic symptoms and serum level of lithium from an experience of mass intoxication. The intoxication was accidentally observed grom seven in-patients who had received lithium carbonate for the management of their manic symptoms. The accident occurred by measurement errer in capsuling of the lithium salt, resulting in doubling of its prescribed dosage. Moderate degree of toxic symptoms were noticed even at the serum level of 1.5mEq/L, severe degree symptoms such as confusion, muscle twitching and speech impairment at 1.5-3.0 mEq/L and far advanced degree symptoms with coma and generalized convulsion at 3.5mEq/L and higher. For the safer and effective therapeutic use of lithium, the serum level should be maintained at 1.4mEq/L and below. The toxic symptoms continued for over seven to ten days after dropping down of serum level to safe range Continuous observation and intensive care were should be recommended even after recovery of safe serum levelfor considerable period. Remedication of the lithium salt after disappearance of the toxic symptoms always resulted in reappearance of the symptoms even on the serum level under 1.0mEq/L. Remedication could be safely started at least two for our weeks after disappearance of the toxic symptoms. Poor food intake and previous cerebrovascular disorder were considered to be vulnarable to more severe intoxi cation, and the previous vascular disorder resulted in reappearance of the previous symptoms. The above findings were discussed in terms of possible correlation between clinical and laboratory data of the previous authors.

Familial hypophosphatemia 환아의 증례보고 : A CASE REPORT

남순현,조윤정,김은정,김현정,김영진 大韓小兒齒科學會 2006 大韓小兒齒科學會誌 Vol.33 No.1

가족성 저인산혈증(famiial hypophosphatemia)은 근위 세뇨관의 인산 재흡수 기전의 결핍으로 혈청 칼슘 농도는 정상이나 혈청 인산 농도가 낮아져 저인산혈증을 나타내는 가장 흔한 유전성 구루병이다. 혈청 인산이 낮음에도 불구하고, 소변으로의 인산 배출이 증가되어 있고 혈청 알칼리성 인산 분해 효소의 상승이 현저하다. 주로 반성 우성 유전이며 보통 남아에서 여아보다 임상 증상이 심하다. 이러한 가족성 저인산혈증 환자의 전신적 소견으로는 앞이마의 돌출, 사각형 머리, 작은 키, 휜 다리가 나타나며, 치과적 소견으로 치조백선과 치낭의 비박, 얇은 법랑질, 확장된 치수강과 근관, 치근단 농양과 치주 농양의 높은 발생률, 원인불명의 치근단 희박화 골염이 나타난다. 본 증례는 유치 충치 치료를 위해 내원한 환아가 임상적으로 작은 키와 휜 다리, 방사선적으로 많이 확장된 치수강과 근관이 관찰되어 소아과에 의뢰한 바 가족성 저인산혈증으로 진단받아 그 임상적 소견과 치과적 치료에 대해 보고하는 바이다. Familial hypophosphatemia is the most common hereditary rickets which occur hypophosphatemia as the calcium concentration in the blood serum is normal but the phosphate concentration in the blood serum decreases by dysfunction of renaltubular phosphorus reabsorption. In spite of the low concentration of phosphate in the blood serum discharge of phosphate by urine and alkaline phosphatase increases remarkably. It is a sex-linked and normally male show severe clinical symptoms than female. This kind of familial hypophosphatemia patients show frontal bossing. square head, short of status for general finding, and for dental finding, thinning of limina dura and dental follicle, thin and hypoplastic enamel, enlarged pulp chamber and canal, high occurance rate of periapical and periodontal abscess and unknown cause of rarefying osteitis. This case is to report about the clinical finging and dental treatment of a child patient, who came to the hospital for treatment of deciduous teeth caries but was refered to pediatrics because the child showed clinically short of status, bow-leg and radiographically enlarged pulp chamber and canal, there as diagnosed as familial hypophosphatemia.

Escherichia coli 패혈증 환자에 합병된 대칭적 하지 말단 괴사증 1예

남해성,유진홍,권순석,민준기,조현선,박민경,심병주,남유정,이지인,김진수,길욱현,조근종,신완식 대한감염학회 2005 감염과 화학요법 Vol.37 No.6

We have encountered a rare case of symmetrical peripheral gangrene complicating Escherichia coli sepsis in a 47-years-old male. He was successfully treated with antibiotics, anticoagulants, and vasodilator. To our knowledge, this is the first report on symmetrical peripheral gangrene complicating E. coli sepsis in Korea.

지역사회 정신보건사업을 위한 환자 발견 체계에 관한 연구 : Case Detection and Delivery Method

남정현,박준혁,박용천,신영전 漢陽大學校 精神健康硏究 1998 精神健康硏究 Vol.17 No.-

조대술에 의한 하마종의 치료

강동균,황경문,김은정,김현정,김영진,남순현 大韓小兒齒科學會 2006 大韓小兒齒科學會誌 Vol.33 No.1

하마종은 구강저에 발생하는 점액 남종으로 주로 설하선과 관련된다. 즉, 하마종은 설하선 분비도관의 파열로 인하여 타액이 분비도관에서 빠져나와 주위의 연조직 내에 저류됨으로써 발생하는 가성 낭으로 정의 되며, 원인은 설하선 도관의 파열이나 폐색이다. 하마종의 임상소견은 청색의 투명한 종창이 구강저의 소대를 중심으로 편측으로 발생하며, 무통성이며, 촉진시 파동성을 나타낸다. 조직소견은 결합 조직 내 와동이 형성되지만, 낭 벽은 상피세포가 아닌 육아조직으로 구성되는 가성 낭을 관찰할 수 있다. 하마종의 첫 번째 치료법으로는 하마종의 내벽이 구강점막의 일부가 되도록 만들어 주는 조대술을 고려할 수 있다. 본 증례는 특징적인 하마종의 임상소견을 보이는 환아에게 gauze-packing등을 동반한 조대술을 이용하여 치료한 증례로써 양호한 치료결과를 보여 보고하고자 한다. Ranula is a mucocele which occurs at the mouth floor and mostly related to sublingual gland. In other words ranula is definded as a pseudocyst which occurs as the secretion duct of sublingual gland is destructed there as the saliva from the the secretion duct flows out and retention in the soft tissue. The cause of ranula is destruction or obstruction of the duct. The clinical findings of ranula is a painless, unilateral bluish transparent swelling around the frenum and shows fluctuation when palpated. Histological finding represent a formation of cavity inside the connective tissue. but a pseudo-cyst can be seen which the wall of the cyst is composed of granulation tissue rather than epithelial cells. The first treatment of ranula can be considered as marsupialization. which induces the inner wall of the Ranula to be a part of oral mucosa. This case report shows a treatment of marsupialization with gauze packing in a young patient representing a clinical finding of characteristic ranula.

부적응 도식과 우울간의 관계에서 정서조절방략의 매개효과

정미현,김남재 덕성여자대학 학생생활지도연구소 2008 學生生活硏究 Vol.24 No.-

This research explored cognitive emotion condition tactic, behavioral emotion control tactic, and empirical emotion condition tactic, each media effect and causal effects in he relation of maladjustment diagram and depression and tactic more affecting depression. 388 women's university students were given to answer to the maladjustment diagram Questionnaire, Emotion Regulation Strategy Questionnaire(ERSQ) and Self-Rating Depression Scale(SDS). Depression were 48 scores over, selected from among the 388 students. To explore the relation of maladjustment diagram, each emotion condition tactic(cognitive, behavioral, empirical), a correlational analysis was conducted and a regression analysis was conducted. And based on that, a structural equation model was built and the adequacy was verified. The correlational analysis showed static correlation with depression in emotion deficiency, desertion/unrest, distrust/abuse, social isolation/alienation, deficiency/value, failure, risk/disease vulnerability, fusion/immaturity self-sacrifice, emotional depression, and the selection of negative thinking, inactive thinking, blaming others in cognitive emotion control tactics, and the selection of emotion acceptance in behavioral emotion control tactic, and the selection of indulgence and overeating in empirical emotion condition tactic. The regression analysis, showed the selection of emotion deficiency, distrust/abuse, social isolation/alienation, defect value, risk/disease vulnerability as maladjustment diagram variables affecting depression via cognitive emotion control tactics(negative thinking, inactive thinking, blaming others), and that of social isolation/alienation, failure, risk/disease vulnerability as maladjustment diagram variables affecting depression via. Thus structural equation model verification was conducted to confirm the causality affecting depression using these maladjustment diagram variables and each emotion control tactic. The analysis showed that maladjustment diagram affects depression via partial media of cognitive emotion control tactics(negative thinking, inactive thinking, blaming others), and significantly affects depression partial media of empirical emotion control tactics(indulgent activity and overeating) whose adequacy was supported. The causal effect indicated that the route of maladjustment diagram and depression via partial media of cognitive emotion control tactics rather than via empirical emotion control tactics had a higher effect. Regardless of correlation with depression in behavioral emotion condition tactic(emotion acceptance), it showed insignificant result of media effect between maladjustment diagram and behavioral tactic, which was discussed.

한방약물로부터 항고지혈증 치료약물개발(3) : In vitro에서 가미과루해백황금탕 및 구성약물의 항고지혈증 활성 Antihyperlipidemic Effects of Gamigwaruhaebaekwhanggum-Tang and Its Constituent Herbal Medicines in vitro

정은아,김남재,김윤경,김동현,이상인 경희대학교 동서의학연구소 2001 東西醫學硏究所 論文集 Vol.2001 No.-

80% extract of Gamigwaruhaebaekbaekju-Tang (GGHBT), Gagamgwaruhaebaekbaekju-Tang (GGGHBT) and Gamigwaruhaebaekwhanggum-Tang (GGHWT) remarkably showed inhibitory effects on HMG-CoA reductase, lipid peroxidation of rat liver and LDL oxidation, and DPPH free radical scavenging effect in a dose-dependent manner. Especially, GGHWT which is formulated with Trichosanthis Fructus, Pinelliae Tuber, Aurantii Immaturus Fructus, Magnolia Cortex, Allii Macrostemi Bulbus, Cinnamomi Ramulus and Scutellariae Radix on the basis of Gwaruhaebaekbaekju-Tang listed on the traditional medicinal references showed more effective hypocholesterolemic activities in vitro bioassay than the other prescriptions.