서울의 Penicillinase Producing Neisseria gonorrhoeae 발생빈도(1997)

김재홍,문득곤,김정수,김용준,임동진,박상훈,김희성,이민수,송기훈,김갑형,김형석,성소영,이인섭,김석우,황지환,조창근,김경문,부태성 대한화학요법학회 2000 대한화학요법학회지 Vol.18 No.3

Background : In recent years, gonorrhea has been pandemic and remains one of the most common STDs in the world, especially in developing countries. Objective & Methods : For the detection of a more effective therapeutic regimen and assessing the prevalence of PPNG, we have been trying to study the patients who have visited the Venereal Disease Clinic of Choong-Ku Public Health Center in Seoul since 1980 by means of the chromogenic cephalosporin method. Results : In 1997. 99 strains of N. gonorrhoeae were isolated, among which 45(45.5%) were PPNG. Conclusion : The prevalence of PPNG in Seoul, which had been decreased to 39% in 1996 after a peak of 74.3% in 1993, is increased to 45.5% in 1997.

중증 재생불량성 빈혈 환자에서 신우신염에 대한 광범위항생제치료 중에 속발한 Saccharomyces cerevisiae 진균감염 1예

김철희,이정호,이정찬,강정현,곽상혁,배광봉,김현수,김종숙,조덕연,김삼용 충남대학교 의과대학 지역사회의학연구소 1999 충남의대잡지 Vol.26 No.1

Most patients with aplastic anemia who do not respond to immunosuppressive treatment or are not candidates for bone marrow transplantation die of infection or bleeding. The neutropenia in acute leukemia, aplastic anemia, or occurring subsequently to chemotherapy and bone marrow transplantation increases susceptibility to infection. In general, the number of infectious episodes correlate with the degree and duration of neutropenia. Global immunosuppression produced by conditioning for bone marrow transplantation or graft-versus-host disease, is associated with unusual bacterial and fungal pathogens, or serious viral and protozoan infections. In addition, repeated treatment with broad-spectrum antibiotics is associated with the emergence of resistant organisms and fungal diseases because of the altered microbial microenvironment of the host. The incidence of invasive fungal infection caused by Saccharomycetes eerevisiae in immunosuppressed patients is very rare, compared with that of infection by candida or aspcrgillus species. Cases of Saccharomycetes cerevisiae fungemia occurring in the course of treatment with broad-spectrum antibiotics are reported in patients with extensive burn or with prosthetic valve endocarditis. We experienced a case of urinary tract infection by Saccharomycetes cerevisiae in a 27-year old female patient with severe aplastic anemia. We report the case with a review of relevant literatures.

대퇴동맥을 통한 경피적 관동맥 중재시술 환자의 천자부위 지혈을 위한 Angioseal^(�) 사용과 고식적 용수 압박법의 비교 : 전향적 연구

김용훈,권현철,김필호,안석진,유철웅,최진호,이상철,김준수,김덕경,전은석,이상훈,홍경표,박정의,서정돈 대한내과학회 2004 대한내과학회지 Vol.66 No.5

목적 : 경피적 관동맥 중재술은 최근 양적 및 질적으로 급격한 발전을 보였지만 시술 시 천자부위의 혈관 합병증은 아직 해결해야 할 문제점이다. 저자들은 대퇴동맥을 통한 경피적 관동맥 중재술을 환자에게 천자부위 지혈을 위한 혈관폐쇄기구인 안지오실의 안전성과 유용성을 고식적인 용수 압박법과 비교 연구하고자 하였다. 방법 : 2002년 4월부터 2003년 5월 사이에 삼성서울병원 심장혈관센터에서 대퇴동맥을 통한 경피적 관동맥 중재술을 성공적으로 시행한 200명의 환자(안지오실 사용군: A군, 100명, 고식적 용수압박법 사용군 B군, 100명)를 대상으로 시술 후 주요 합병증 및 경한 합병증, 지혈 후 환자가 자리에 앉기까지의 시간, 보행개시 가능시간, 총 재원 기간과 시술 1주 후의 합병증을 전향적으로 조사하여 비교 연구하였다. 결론 : 두 군에서 연령, 성별, 기저질환, 심혈관 질환의 위험요소, 시술의 종류, 시술 중 사용한 헤파린의 양, clopidogrel의 양, ticlopidine의 양, 지혈 시 수축기와 확장기혈압, ACT (activated clotting time)는 차이가 없었다. A군이 B군에 비해 시술 후 자리에 앉기까지의 시간 (A군: 4.3±0.3시간, B군: 13.7±0.8시간, p=0.004) 및 보행개시까지의 시간(A군: 6.8±0.5시간, B군: 18.8±2.1시간, p=0.013)이 유의하게 짧았다. 시술 후 주요 합병증은 두군 모두에서 관찰되지 않았으며, 경한 합병증의 전체발생은 A군에서 유의하게 적었다(A군: 28명, B군: 19명, p=0.003). 반상출혈의 경우는 A군에서 유의하게 낮았지만(A군: 3명, B군: 12명, p=0.01), 혈종, 출혈의 발생은 두군간에 차이가 없었다. 총 재원기간에는 두 군간에 차이가 없었다(p=0.239). 시술 1주 후 경과관찰에서 주요합병증은 역시 두 군 모두에서 관찰되지 않았으며, 경한 합병증의 전체발생은 두 군에서 차이가 없었다(A군: 15명, B군: 13명 p=0.418), 반상출혈의 빈도는 차이가 없었지만 혈종의 발생은 A군에서 더 낮았다(A군: 2명, B군:6명, p=0.004). 두 군 모두에서 출혈은 발생하지 않았다. 결론 : 대퇴동맥을 통한 경피적 관동맥 중재술을 시행한 환자에서 안지오실의 사용은 고식적 용수 압박법에 비해 환자의 침상 안정시간을 줄여 조기 활동개시가 가능하게 하였으며 국소합병증의 위험도를 일부 낮추어, 시술에 따른 환자의 불편을 현저하게 감소시킬 수 있다고 할 수 있을 것으로 기대된다. Background : Although the number and the quality of percutaneous coronary intervention have been recently increased dramatically, the vascular complication at puncture site is still the major cause of patients' morbidity. We evaluated the safety and efficacy of newly of newly-developed collagen-based arterial closure device, Angioseal after transfemoral percuatenous coronary intervention. Methods : This study was designed as a prospective single center non-randomized comparative study. A total 200 patients undergoing transfemoral percutaneous coronary intervention were enrolled between April 2002 and May 2003. They were divided into two groups; Angioseal group (group A, n=100) and manual compression group (group B, n=100). The baseline clinical and angiographic characteristics were reviewed. The time to sit up, the time to ambulation, the duration of hospital stay, major and minor vascular puncture site complications were monitored. The patients were followed-up for 1 week after procedure by telephone. Results : The baseline clinical characteriwtics, clinical diagnosis, cardiocascular risk factors, typesof procedure, doses and numbers of anticoagulants were similar between two groups. The blood pressure and activated clotting time were also similar. The time to sit up (group A: 4.3±0.3 hours, group B: 13.7±0.8 hours, p=0.004) and the time to ambulation (group A: 6.8±0.5 hours, group B: 18.8±2.1 hours, p=0.013) were shorter in group A. No major vascular complications were noted. The incidence of hematoma and bleeding were not significantly different between two groups. The incidence of ecchymosis, however, was significantly lower in group A (group A:12%, group B: 3%, p=0.001) The duration of gospital stay was similar between groups. During 7 days of follow-up period incidence of hematoma was significantly lower in group A (p=0.004). Although the incidence of ecchymosis was not significantly different between two groups. Conclusion : The angioseal may be associated with earlier ambulation and less patients' morbidity with low incidence of local complication rate compared to manual compression after transfemoral percutaneous coronary intervention.

열 변화에 의한 구리전선의 미세조직 및 상 변화에 관한 연구(Ⅲ)

박성우,김윤회,김상현,박남규,김수철,김영만 內務部 國立科學搜査硏究所 2002 國立 科學 搜査 硏究所 年報 Vol.34 No.-

항암화학요법을 받는 암 환자에 대한 Nucare^R의 영양지지효과

조덕연,김현수,곽상혁,강정현,김철희,배광봉,김종숙,박상준,윤환중,김삼용 충남대학교 의과대학 지역사회의학연구소 1997 충남의대잡지 Vol.24 No.1

Purpose : The purpose of this study was to evaluate the effect of nutritional support with enteral liquid supplement in cancer patients receving chemotherapy for possible benefit in nutritional, immunologic and golbal function of patients. Patients and Methods : From October 1995 to February 1997, 30 advanced cancer patients receving chemotherapy were divided two roups. The Nycare group, in addition to normal diet, Nucare^R enteral supplement was given for 1week right after chemotherapy for the duration of 2 chemotherapy cycles. Control group received only normal diet without parenteral fluid supplement for 2 chemotherapy cycles. Results : Median ages were 53 end 56 years for Nucare group and Contrl group respectively. Performance scores was less than 2 by ECOG scale. All patients were stage Ⅲ or Ⅳ. The physical parameters, such as weight, arm muscle circumference(AMC) and triceps skin fold(TSF) were decreased in both groups after 2 cycles of anticancer therapy. but it was less severe in Nucare group(p<0.05). Serum transferrin was maintained in mild deficit state in Nucare group, whereas it aggravated form mild to moderate deficit in Control group(p<0.05). Serum albumin level increased in Nucare group without statistical significance. but it decreased from normal to mild deficit in Control group. Serum total protein did not change significantly in Nucare group. but in Control group, serum total protein was decreased from 7.24±0.9 to 6.52±0.5(P<0.05). Total lymphocyte count did not change significantly in both groups. Conclusion : This study shows that the nutritional support with Nucare^R was effective in the prevention of nutritional deficit status in patients receving a nticancer chemotherapy.

Plasma estradiol-17βand estrogen receptor increased during the artificial induce sexual maturation and it influence choriocapillary layer of eye in Japanese eel, Anguilla japonica

Ji-Yeon Hyeon,Sung-Pyo Hur,Jun-Hwan Byun,Eun-Su Kim3,Shin-Kwon Kim,Han-Jun Kim,Se-Jae Kim,Akihiro Takemura 한국수산해양기술학회(구 한국어업기술학회) 2018 한국수산해양기술학회 학술발표대회 Vol.2018 No.11

FCL(5-FU, Carboplatin, Leucovorin) 항암 화학요법에서 Gm-CSF의 효과

최지영,김현수,김종숙,박상준,윤환중,조덕연,남상륜,김삼용 忠南大學校 癌共同硏究所 1998 癌共同硏究所 硏究誌 Vol.2 No.1

Background: One of the major side effects of cancer chemotherapy is myelosuppression. Neutropenia and/or thrombocytopenia are dose-limiting factors in chemotherapy. Colony-stimulating factor induces proliferation and functional maturation of hematopoietic progenitor cells. GM-CSF is primarily active on progenitor cells of granulocytic and monocytic lineage. Methods: Fifteen patients with histologically proven malignancy diagnosed at Chungnam National University Hospital from January 1993 to August 1995 were included in this study. We could evaluate the clinical efficacy of GM-CSF in 13 patients undergoing FCL(5-FU, Carboplatin and Leucovorin) chemotherapy; the first cycles involved no GM-CSF while the second cycles involved GM-CSF on day 6 through 15 of chemotherapy. Results: 1) The subjects were fifteen patients in all, there were five patients with head and neck cancer, which was the most common types of maligancy. There were four patients with colon cancer, two patients with stomach cancer, and one patient with breast cancer, gallbladder cancer, cervix cancer and cholangiocarcinoma respectively, two patients, who did not complete two cycles of chemotherapy were excluded. 2) Age distribution was from 38 years to 78 years with a median age of 57. 3) In FCL chemotherapy cycles with GM-CSF, the duration of neutropenia(<500/μL) was 0.5±0.3 day, while FCL chemotherapy cycles without GM-CSF, it was 2.9±0.7 day(P=0.008). 3) There was no significant difference in platelet count between the two chemotherapy cycles(P=0.133). 4) Febrile duration without GM-CSF was 4.9±2.1 day, but with GM-CSF the duration was 1.3±0.7 day, which was significantly different(P=0.003). The duration of antibiotics use with GM-CSF was 1.7±1.2 day and without GM-CSF was 6.8±3.2 day, also significantly different(P=0.002). But hospital stay between the two cycles were not significantly different(P=0.064). Conclusion: GM-CSF was effective in preventing or restoring bone marrow depression after FCL chemotherapy.

혈액암환자에서 조혈모세포 이식 후 따르는 헤르페스 바이러스 감영 양상

이호섭,탁희상,신성훈,김양수,남성진,김혜수,박진희,정수현,김성빈,김예나 고신대학교 의과대학 2010 고신대학교 의과대학 학술지 Vol.25 No.1

배경 : 헤르페스바이러스과에는 단순포진 바이러스(HERPES SIMPLEX VIRUS, HSV), 수두대상포진 바이러스 (VARICELLA-ZOSTER VIRUS, VZV), 엡스타인-바 바이러스 (EPSTEIN-BARR VIRUS, EBV), 그리고 거대세포 바이러스 (CYTOMEGALOVIRUS, CMV) 등이 있다. 헤르페스바이러스 감염은 혈액암환자에서 조혈모세포 이식 환자에서 전파 (dissemination), 이차감염, 세균 중복 감염의 심각한 합병증을 일으킬 수 있다. 하지만 항암약물치료를 받는 림파종 환자에서 항 바이러스 약제의 사용 용량과 기간에 대한 concensus는 없다. 헤르페스바이러스 감염에 대한 발생율과 위험인자를 후향성으로 분석하였다. 방법 : 고신대학교 복음 병원에서 1995년 6월부터 2009 년 2월 사이에 새롭게 진단되어 조혈모세포 이식을 받은 전체 58명의 환자들이 후향적으로 현 연구에 등록했다. 헤르페스 바이러스 감염은 임상적 진단, 혈청학적 검사 또는 병리학적 진단에 기초하여 확진한다. 환자들의 특성은 다음과 같다: 평균 연령은 44세 (범위 19-62세)였고 남녀비는 30:28이었다. 등록된 질환은 백혈병 (n=9, 15.5%), 림프종 (n=30, 51.7%), 다발성 골수종 (n=12, 20.7%), 재생불량성 빈혈 (n=6, 10.3%) 그리고 골수이형성증후군 (n=1, 1.7%)이 포함되었다. 결과는 chi-squre test나 independent samples T test를 사용하여 분석되었다. Multivariate analysises에 대해 logistic regression test를 사용하였다. 결과 : 15명의 환자들 (25.9%)에서 조혈모세포 이식후 헤르페스 바이러스 감염이 발생하였다. 조혈모세포 이식 5년간 누적 발생율은 53.9%였다. Univariate analyses에서 헤르페스 바이러스 감염에 대한 유의한 위험 인자는 없었다. 하지만 조혈모세포 이식후 생존 기간(40.18 ± 30.14 months vs 20.06 ± 26.67 months, p=0.018)은 헤르페스 바이러스 감염의 낮은 발병율과 유의한 관련성이 있었다. 이식 편대 숙주질환 (GVHD)의 존재 (37.5% in developed GVHD vs 0% in no GVHD, p=0.200), 동종조혈 모세포 이식에서 면역억제요법의 기간 (15.98 ± 14.02 months vs 6.78 ± 3.67 months, p = 0.374)은 헤르페스 바이러스 감염에 대한 위험인자가 아니었다. 결론 : 조혈모세포 이식 후 생존 기간은 어사이클로비어 예방을 받은 혈액암 환자에서 헤르페스 바이러스 감염의 낮은 발병율과 연관성이 있는 것으로 보인다. 저용량의 어사이클로비어 예방은 헤르페스 바이러스 감염의 고위험군인 조혈모세포 이식을 받은 혈액암 환자에 필요하리라 생각된다. Background : Herpesviridae family includes herpes simplex virus, varicella zoster virus, Epstein-Barr virus, and cytomegalovirus, etc. Herpesviridae viral infection (HVI) can lead to serious complications including dissemination, secondary infection, bacterial superinfection in patients with hematologic malignancy following hematopoietic stem cell transplantation (HSCT). But there was no consensus on the dose and duration of antiviral agents prophylaxis in patients undergoing chemotherapy. We retrospectively analyzed the incidence and the risk factors for HVI. Method : A total of 58 patients who newly diagnosed and received HSCT with prophylaxis of acyclovir at the Kosin University Gospel Hospital, Busan, Korea between June 1995 and February 2009 were enrolled retrospectively in the current study. HVI was confirmed based on clinical diagnosis, serologic test or pathologic diagnosis. The characteristics of the patients were as follows: the median age was 44 years (range 19-62 years) with a female-to-male ratio of 30:28. The enrolled diseases included leukemia (n=9, 15.5%), lymphoma (n=30, 51.7%), multiple myeloma (n=12, 20.7%), aplastic anemia (n=6, 10.3%) and myelodysplastic syndrome (n=1, 1.7%). The results were analyzed using a chi-square test and independent samples T test. For the multivariate analysis, we used logistic regression test. Results : Fifteen patients (25.9%) developed HVI after HSCT. The cumulative incidence of HVI was 53.8% at 5 years after HSCT. In univariate analysis, there was no significant risk factor for HVI. The presence of graft-versus-host disease (GVHD) (37.5% in developed GVHD vs. 0% in no GVHD, p=0.200), duration of immunosuppressive therapy (IST) in allo-SCT (15.98 ± 14.02 months vs. 6.78 ± 3.67 months, p = 0.374) were not risk factors for HVI. Conclusion : The incidence of HVI was similar to that in historical other studies. There was no risk factor associated with development of HVI. Most of the HVI occurred within the first 24 months after transplantation. So long term use of antiviral prophylaxis may be needed to prevention of HVI after HSCT.

안근성 중증근무력증이 동반된 갑상선 기능항진증의 임상상 : Report of Six Cases

서지영,김두만,김현규,최철수,임성희,유재명,최문기,유형준,박성우,김형철,송홍기,김덕환 대한내분비학회 2000 Endocrinology and metabolism Vol.15 No.4·5

Azathioprine에 반응을 보인 류마티양 관절염에 의한 경막염(Pachymeningitis)1예

배광봉,이정호,이정찬,곽상혁,강정현,김철희,김현수,김종숙,조덕연,김삼용 충남대학교 의과대학 지역사회의학연구소 1999 충남의대잡지 Vol.26 No.1

Rheumatoid arthritis frequently involves the cervical spine and may lead to neurologic impairement. However, direct involvement of CNS structures by inflammatory cells has been reported infrequently. The prevalence of this complication of rheumatoid arthritis is unknown. Inflammatory CNS involvement in rheumatoid arthritis reportedly occurs in the setting of longstanding, active, erosive articular disease and is accompanied by extracranial and extraspinal nodules and vasculitis. This is diagnosed by radiologic finding of CNS nodules or meningeal thickening and by biopsy or autopsy. Treatment with corticosteroid, cytotoxic agent or surgical decompression is helpful. But the majority of patients die within several months of onset of neurologic symptom. Recently, we experienced a case of pachymeningitis caused by rheumatoid arthritis, which resolved repeatedly with azathioprine treatment.