기관내관 소독방법 개선에 따른 간호업무 시간단축 및 비용 절감 효과

이행선,김해리나,김은숙,김보람,성선숙 한국의료QA학회 2008 한국의료질향상학회지 Vol.14 No.1

Background: The purposeof innercannula is to protect the upperair wayand permitair to pass freely, in addition, to provideendotrachealsuction, artificial respiration and to maintain adequate oxygensaturation. The tubeneeds to be sterilizedformaintenanceand cleannessof air wayand forprevention of bronchospasm. However, it has been reportedthat there is no guideline forsterilization and manyhospitalsconducttheirown sterilization methods, forexample, oncea day(13's generalhospital), three timesa day(TheCatholic University of Korea STMary's hospital) or evenno cleansing. Consequently, the QI team of our hospitalsuggested the SOP(standard operatingprocedure) of sterilization and evaluate cost and timeeffect in nursing. Method: 1) Benchmarking of 13's neurosurgery departmentof generalhospital in Seoul 2) Investigation of test recordsof sputumculture from patientswith intubation for tracheotomy 3) Checkof resultsof 02 Sat. monitoring to confirm of maintainingopenedair way Result : 1) Improvement of process: decrease of excess sterilization of inner cannula (from 3 timesa day to oncea day) 2) Costeffects: saving over10 million wonper oneyear 3) Providing better nursing: time effects (30 mina day) permit to conductmorenursing activities Conclusion: Itcan get Costand timeeffectsin nursing withimproved sterilization methodof innercannula It needs to do researchon improvement of the monthly exchangeprotocol of outercannula and providesupportingdata forthe properexchangeschedule. The resultof additionalmicroorganism detection frompatients withnewprocessneeds to be evaluated furthermore.

CT-26 선암을 접종한 마우스에서 Iodine-131-Iodomisonidazole 의 생체분포 및 종양저산소증의 영상화

Yang, David J,Kim, E Edmund,김혜원,김창근,윤권하,김현정,정선관,노병석,Lee, Hyun-Chul 대한핵의학회 1999 핵의학 분자영상 Vol.33 No.3

urpose: Misonidazole is a radiosensitizer that binds in hypoxic cells. The purpose of this study was to find out the feasibility of I-131-Iodomisonidazole (IMISO) for imaging of tumor hypoxia. Materials and Methods: Tosyl precursor was dissolved in acetonitrile and I-131-NaI was added to synthesize IMISO. Balb/c mice inoculated with CT-26 adenocarcinoma were injected with IMISO. Mice were sacrificed at 1,2,4,24 hr and % of injected dose per gram of tissue (%ID/g) was determined. For scintigraphy and MRI, mouse bearing CT-26 adenocarcinoma was administered with IMISO and imaging was performed 4 hr after. Then, mouse body was fixed and microtomized slice was placed on radiographic film for autoradiography. Results: %ID/g of tumor was 1.64 (1h), 0.98 (2h), 0.85 (4h) and 0.20 (24h), respectively. At 24h, %ID/g of tumor was higher than that of all other tissues except thyroid. Tumor to muscle ratio increased with time and tumor to blood ratio also increased with time and reached 1.53 at 24 hr. On autoradiogram, tumor was well visualized as an increased activity in central hypoxic area of the tumor which corresponds to the area of high signal intensity on T2-weighted MR image. On scintigraphy, tumor uptake was visualized. Conclusion: This results suggest that IMISO may have a potential for tumor hypoxia imaging in mouse model. However, further study is needed to improve it's localization in tumor tissue and to achieve acceptable images of tumor hypoxia.

대장내시경 전처치제로서 Sodium Phosphate 와 Polyethylene Glycol 용액의 전향적 비교 분석

이헌경,김승용,홍원선,민영일,정훈용,김해련,정성애,김석균,심기남,양석균,박의련,조문경 대한소화기내시경학회 1999 Clinical Endoscopy Vol.19 No.3

Background/Aims: Although some authors have suggested that sodium phosphate (NaP) is more effective than polyethylene glycol (PEG) in bowel cleansing, there has been no crossover study proving the superiority of NaP over PEG in bowel cleansing and patients' compliance. The aim of this study was to compare the two solutions for colonoscopy, PEG and NaP, through crossover design with regard to patients' compliance, cleansing ability and side effects. Methods: Thirty patients underwent two separate colonoscopies for colonic polyp(s) with PEG and NaP, respectively. Before and after bowel preparation, blood pressure, body weight, and serum biochemical parameters were measured in all patients. In addition, a detailed questionnaire was used to assess side effects and the patients' preference. The presence of bubbles, types of residual stool, and overall quality of colon cleansing were assessed by one endoscopist blinded to the type of preparation used. In each colonoscopy, two biopsy specimens were taken at rectum. Results: In the NaP group, but not in the PEG group, there were significant changes in several biochemical parameters including sodium (+3.0±3.0 mEq/L), potassium (-0.3±0.3mEq/L), calcium (-0.5±0.5 mg/dL), phosphorus (+3.9±2.2 mg/dL) and osmolarity ( +10.1±9.3 mOsm/kg) after bowel preparation. In addition, the degree of body weight change was greater with NaP (-2.2±2.3 kg) than with PEG (-1.2±2.0 kg) (p=0.06) and the formation of bubbles that disturb luminal observation was more frequently found in the NaP group (p$lt;0.01). There was no difference, however, in the type of residual stool and the overall quality of bowel preparation between the two groups and no significant mucosal change was noted after bowel preparation in both groups. Moreover, PEG was found to be more difficult to take than NaP (p$lt;0.05) and among the 30 patients, 26 (87%) preferred NaP, while only two favored PEG (p$lt;0.01). Conclusions: We conclude that NaP can replace PEG at least in patients with good general condition. Further studies to decrease the incidence of bubbles and to establish subgroups suitable for NaP are needed.

청소년 정신분열증 환자 모친의 정신병리

김영진,이무석,주선희 大韓神經精神醫學會 1994 신경정신의학 Vol.33 No.5

To evaluate the family functioning of schizophrenics and the relationship of the mother's psychopathological characteristics with their children's schizophrenic morbidity, 30 mothers of schizophrenic adolescent who admitted in the National Na-Ju Mental Hospital and 30 mothers of the mental retardations and 30 mothers of normal controls were tested with MMPI and family adaptability and cohesion evaluation scale-Ⅲ and family satisfaction scale for family functioning. The results of this study were as follows : 1) Mothers of the schizophrenics were noted to have more broken marriage and marital dissatisfaction than mothers of the mental retardations and normal controls. Prevalence of psychiatric illness in the families of schizophrenic patients were higher than the families of mental retardations and normal controls. 2) Mothers of mental retardations showed higher scores on F, Pa, Pt, Sc, Si scales of the MMPI than mothers of normal controls. 3) In the family adaptability and cohesion evaluation scale-Ⅲ and family stsatisfaction scale, schizophrenics mothers showed lower scores than mental retards mothers, mental retards mothers showed lower scores than normal control's mothers in the FACES-Ⅲ, FS.

치태 형성과 휘발성 유황화합물 생성을 억제하는 Lactobacillus salivarius의 분리 및 동정

김미형,양규호,최남기,김선미,오종석 大韓小兒齒科學會 2005 大韓小兒齒科學會誌 Vol.32 No.2

우리 인체에는 의학적으로 유용한 기능을 가진 세금들이 정상적으로 존재하며 구강내에도 독특한 기능을 나타내는 세균들이 상재한다. 본 연구에서는 치아우식증이 없는 소아의 타액에서 분리한 유산균 2주가 Streptococcus mutans에 의한 인공치태 형성과 혐기성 세균에 의한 휘발성 유황화합물 생성을 억제하는 것을 화인하고, API 50 CHL medium kit를 이용한 생화학적 검사와 165 rDNA sequencing으로 동정하여 다음과 같은 결과를 얻었다 1. 분리균주는 2주 모두 그람양성 간균으로 과산화수소를 생성하였다. 2. 인공치태의 무게는 Streptococcus 단독 배양시 124.4土30.4mg이었으나, 분리균주와 병합 배양시에는 각각 5.2±2.0mg, 10.6±6.6mg으로 현저하게 감소하였다(p<0.05). 3. Steptococcus mutans의 생균수는 단독 배양시 ml단 3.4×10^(9)이었으나, 분리균주와 병합 배양시에는 각각 ml당 4.6x1과 2.4×10^(8)으로 감소하였다. 4. Fusobacterium nucleatum을 30분간 진탕한 후 측정한 상청액의 흡광도는 1.286이었으나, Fusobacterium nucleatum과 분리균주를 병합으로 30분간 진탕한 후 측정한 상청액의 흡광 도는 각각 0.628과 0.497로 감소하였으며, 상호결합 정도는 29.4%와 57.8%이었다 5. Fusobacterium nucleatum 단독 배양시 cysteine과 FeSO₄를 첨가한 배지를 가한 후 측정한 침전물의 배지 흡광도는 1.794이었으나, 분리균주와 병합 배양시 측정한 침전물의 배지 흡광도는 각각 1.144와 0.915로 감소하였으며, Porphyromonas gingivalis단독 배양시 침전물의 배지 흡광도는 1.932이었으나 분리균주와 병합 배양시에는 침전물의 배지 흡광도가 각각 1 170과 1.266으로 감소하였다. 6. 분리균주를 API 50 CHL medium kit로 탄수화물 발효검사를 시행한 결과, 분리균주 1주는 Lactobacillus salivarius로, 다른 분리균주는 Lactobacillus delbruekii subsp. salicinius로 동정되었다. 7. 분리균주를 165 rDNA partial sequencing으로 동정 한 결과, 2주 모두 Lactobacillus salivarius subsp. sailcinius와 유전자 유사치가 99.60% 99.73%를 보여 Lactobacillus salivarius subsp. salicinius로 동정되었다. 이상의 결과를 종합하면 치아우식증이 없는 소아의 타액에서 분리된 유산균 중 과산화수소를 분비하여 인공치태 형성과 휘발성 유황화합물 생성을 억제하는 분리균주는 Lactobacillus salivarius subsp. Salicinius로 동정되었다. There are normal inhabitants doing medically useful functions in the body. There are many kinds of bacteria performing specific functions in the oral cavity. Two strains of lactic acid bacteria were isolated from inhabitants of caries-free children's oral cavity, which inhibited the formation of artificial plaque by Streptococcus mutans and the production of volatile sulfur compounds by anaerobic bacteria. The isolates were identified by the test using API 50 CHL medium kit and 16S rDNA partial sequencing. 1. Two isolates were Gram-positive bacilli and produced hydrogen peroxide. 2. When Streptococcus mutans was cultured in the media, the mean weight of formed artificial plaque on the orthodontic wires was 124.4±30.4 mg. whereas being reduced to 5.2±2.0mg and 10.6±6.6mg in the media cultured with Streptococcus mutans and each isolate, respectively (pW.05). 3. The number of viable cells of Streptococcus mutans was 3.4 x 10^(9) per ml in the cultured solution, whereas those of Streptococcus mutans in the combined culture with each of isolates were 4.6x 10^(8) and 2.4x 10^(8) per ml. 4. The optical density was 1.286 in the supernatant of Fusobacteriumn nucleatum after vortexing fol 30minutes, whereas in the supernatant of combined Fusobacterium nucleatum and each isolate, they were reduced to 0.628 and 0.497, which the percentages of coaggregation between them were 29.4% and 57.8%, respectively. 5. The optical density of Fusobacterium nucleatum precipitate was 1.794 in the culture media containing cysteine and FeSO4, being reduced to 1.144 and 0.915 in the coaggregated precipitates of Fusobacterium nucleatum and each isolate. The optical density of Porphyromonas gingivalis precipitate was 1,932 in the culture media, being reduced to 1.170 and 1.266 in the coaggregated precipitates of Porphyromonas gingivalis and each isolate, 6. When two isolates were tested with API 50 CHL medium kit, those were identified as Lactobaciallius salivarius and Lactobacillus delbrueckii subsp. lactis. 7. The similarity values of 16S rDNA sequence between each of isolates and Lactobacillus salivarius subsp. salicinius were 99.60% and 99.73%, respectively, meaning that isolates were Lactobacillus salivarius sub-sp. salicinius. These results indicated that two strains isolated from caries-free children's saliva, which inhibited the formation of artificial plaque and the production of volatile sulfur compounds, were identified as Lactobacillus salivarius subsp. salicinius.

다운증후군 환자의 치주질환 원인균의 출현율

김선미,양규호,최남기,오종석,강미선 大韓小兒齒科學會 2005 大韓小兒齒科學會誌 Vol.32 No.4

다운증후군 환자는 치주질환의 진행이 빠르고 치주조직의 파괴가 심하다. 다운증후군 환자의 치주질환 원인균의 출현율을 알아보고자 7~19세 다운증후군 환자 27명과 대조군으로 나이가 비슷한 정신지체자 27명을 대상으로 치태지수와 치은염 정도를 나타내는 치은지수를 측정하고 치은연하 치태에 존재하는 P. gingivalis, T. forsythia, T. denticola, F. nucleatum, A. actinomycetemcomitans균을 중합효소연쇄반응을 이용, 검사하고 다음과 같은 결론을 얻었다. 1. 다운증후군 환자와 대조군의 치태지수와 치은지수간에 통계적 유의성은 없었다(p>0.05). 2. 다운증후군 환자에서 F. nucleatum의 출현율이 96.3%로 가장 높았으며 그 다음이 T. forsythia 74.1%, P. gingivalis는 63.0%였으며 A. actinomycetemcomitans는 55.6%, T. denticola는 40.7%로 출현하였다. 정신지체자는 다운증후군 환자와 비슷한 순서로 치주질환 원인균이 출현하였다. 다운증후군 환자가 대조군에 비해 T. denticola를 제외한 4종의 균에서 놓은 비율로 나타났으나 치주질환 원인균 출현율에서 유의한 차이를 나타내지 않았다(p>0.05). 3. 연령에 따른 연구에서 7~10세군에서 다운증후군환자의 P. gingivalis는 16.7%로 낮은 출현율을 보였으나 연령의 증가에 따라 출현율이 평균 63.0%로 높아졌다. 반면 A. actinomycetemcomitans균은 7~10세군부터 83.3%로 높은 비율을 보였다(p<0.05). 같은 연령대에서 다운증후군 환자는 대조군에 비해 치주질환 원인균의 출현율이 더 높은 경향을 보였으나 A. actinomycetemcomitans를 제외하고는 통계적인 유의차를 보이지 않았다(p>0.05). 4. P. gingivalis, T. forsythia, T. denticola가 함께 나타난 경우는 다운증후군 환자와 대조군 모두 33%를 나타내었다. red complex에 A. actinomycetemcomitans까지가 나타난 경우는 다운증후군 환자에서 22%, 대조군에서 14%로 다운증후군 환자에서 더 높았다. 이상의 결과를 요약해보면 다운증후군 환자군과 정신지체자 대조군 모두에서 치주질환 원인균이 어린 시기부터 매우 높게 출현하였으나 전체적인 두 군간 치태지수, 치은지수, 치주질환 원인균 출현율에서 유의한 차이를 나타내지 않았다. 하지만 A. actinomycetem comitans균은 7~10세군 다운증후군 환자에서 대조군에 비해 높은 비율을 보였다. It is widely known that individuals with Down's syndrome(DS) often develop early onset severe periodontal diseases. In this study. We examined the prevalence of periodontopathic bacteria in DS patients to compare controls with mental disabilities(MD). The subjects were 27 DS patients (7 to 19 years old) and 27 age-matched controls with MD. Plaque index and gingival index were measured. And 5 pathogens, Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, Fusobacterium nucleatum, were surveyed in subgingival plaque samples using a polymerase chain reaction. No significant difference in plaque index and gingival index were observed between the DS and control group. The prevalence in DS was 96.3% for F. nucleatum, 74.1% for T. forsythia, 63.0% for P. gingivalis, 55.6% for A. actinomycetemcomitans, 40.7% for T. denticola. No significant differences were observed in the prevalence of periodontopathic bacterias between the DS and control. Prevalence of P.g(16.7) at age 7~10 is lower than other age group in DS, but its prevalence increased with age. Prevalence of A.a(83.3%) is peak at age 7~10 in DS. These results suggest that various periodontopathic pathogens can colo nize in the very early childhood of DS and MD patients. But no significant difference was observed in the prevalence of periodontopathic bacterias between the DS and control.

간 허혈성괴상의 CT소견에 대한 실험적 연구 : 간실질 및 피막의 경시적 변화와 병리조직의 비교 Changes of CT Findings of Liver Parenchyama and Capsule with Time Lapse Correlated with Histopathology

김창근,김강득,최시성,정선관,노병석,원종진 圓光大學校 醫科學硏究所 1994 圓光醫科學 Vol.10 No.1-2

In order to evaluate CT findings with time and to confirm the capsular structure correlating with its histopathologic findings, we experimentally induced ischemic necrosis of liver in 20 rabbits. Incision of the abdomen was performed under anesthesia. Ligation of hepatic artery, portal vein and hepatic duct of right inferior posterior lobe of the liver after injection of macroaggregated albumin into right inferior posterior portal vein in order to prevent from developing collateral circulation as possible. Precontrast and postcontrast enhanced CT images were obtained at 1. 2. 4 days and 1, 2. 4. 6 weeks after induction of ischemic necrosis. Necrotic area in the liver showed homogeneous low density compared to normal liver, and no contrast enhancement after contrast material administration, and marked volume loss with time. CT attenuation value of necrotic area at 1 day(36.7±6.4 M±SD, Hounsfield unit) approached to two third of that of normal liver(56.3±7.3) and showed no significant change until two weeks but increased significantly after four weeks. On contrast enhanced CT images, capsular structure was obsereved as a high density rim along the liver surface of the necortic area in 8 of 15 cases. From the first day on, homogenous ischemic or coagulation necrosis was observed but rarely findings of edema, hemorrhage and cystic change were observed on histopathologic specimen. In all of the histologic samples taken from 10 cases during th 2nd to 6th week, fibrous thickening with rich vascularity was observed along the surface of the necrotic area. In conclusion, ischemic necrosis of the liver showed homogeneous low density and no contrast enhancement. CT attenuation value of necrotic area increased significantly with time associated with markedly decrease in volume. Capsular structure attributed to the hypertrophy of the liver capsule and rich vascularity within it.

2-Deoxy-D-Glucose에 의한 대사성 쇼크가 무우스의 면역 반응에 미치는 영향

김양숙,장선일,박래길,조성경,정헌택 최신의학사 1991 最新醫學 Vol.34 No.2

다운증후군 환자의 치아우식증과 치아우식 원인균 및 타액내 면역항체의 연관성

김선미,양규호,최남기,강미선,임회순,오종석 대한소아치과학회 2007 大韓小兒齒科學會誌 Vol.34 No.1

다운증후군 환자의 치아우식증과 구강내 여러 요인들과의 연관성을 평가하고자 9-18세의 다운증후군 환자 25명과 정상인 63명을 대상으로 치아우식경험지수, 치태지수를 조사하고 효소면역분석법을 이용하여 타액의 면역항체 IgA와 뮤탄스 연쇄상구균-특이 IgA 농도를 측정하고, Dentocult 키트를 이용하여 뮤탄스 연쇄상구균과 유산간균의 수, 타액의 완충능을 측정하여 두 군의 각 값들을 독립 t-test와 카이제곱 검정을 시행하였다. 다운증후군 환자에서 유치우식경험은 정상인에 비해 유의하게 낮았으나(p<0.001), 영구치우식경험은 유의한 차이를 보이지 않았다. 치태지수와 타액의 IgA의 농도는 두 군 간에 차이를 보이지 않았으며, 뮤탄스 연쇄상구균 특이-IgA 농도와 타액 완충능은 다운증후군환자에서 낮았다(p<0.05), 뮤탄스 연쇄상구균 수와 유산간균 수는 두 군간에 유의한 차이는 없었다. 9-11세 군에서 뮤탄스 연쇄상구균의 수는 다운증후군 환자에서 정상인보다 낮았으며(p<0.001), 뮤탄스 연쇄상구균 특이-IgA는 다운증후군 환자에서 유의하게 낮았다(p<0.05), 유치의 치아우식경험치면지수는 완충능, 뮤탄스 연쇄상구균의 수와 유의한 상관관계를 보였다. This study investigated the relationship between dental caries and various oral factors in subjects with Down' s syndrome. We compared 25 subjects with Down's syndrome with 63 healthy control. The dental caries index and plaque index were examined, and the total salivary immunoglobulin A and S. mutans specific salivary immunoglobulin A concentration were measured using ELISA. The S. mutans counts, Lactobacillus counts and buffer capacity were measured with Dentocult test medium. The decayed and filled surface index of deciduous teeth in subjects with Down' s syndrome was lower than in controls(p<0.001). The plaque index and total salivary immunoglobulin A concentration showed no difference, S. mutans specific salivary immunoglobulin A concentration and buffer capacity in subjects with Down' s syndrome were lower than in controls(p<0.001). There was no significant difference between two groups in the S. mutans counts and Lactobacillus counts. In 9-11 year age group, S. mutans counts in subjects with Down' s syndrome was lower than in controls(p(0.001) and S. mutans specific salivary immunoglobulin A concentration was lower(p(0.05). There was a high correlation among deciduous dental caries index and buffering capacity and S. mutans counts.

Real-time PCR을 이용한 치주질환 원인균의 정량적 분석

김선미,양규호,최남기,강미선,오종석 大韓小兒齒科學會 2008 大韓小兒齒科學會誌 Vol.35 No.3

Real-time PCR 기법을 이용하여 구강내 치태에서 특정 세균의 존재여부를 알 수 있을 뿐 아니라 정량적 분석이 가능하게 되었다. 이 연구는 real-time PCR 기법을 이용하여 8-18세의 청소년에서 치주질환 원인균의 조성을 알아보고자 전신질환이 없는 어린이 및 청소년 65명을 대상으로 치은연하의 치태를 채취하여 5종의 치주질환 원인균의 출현율과 그 양을 측정하고,또한 함께 측정한 치태지수 및 치은지수와의 상관관계를 조사하여 다음과 같은 결론을 얻었다. 1. 치태지수의 평균은 1.33이었으며,치은지수의 평균은 0.97이었다. 치태지수는 나이가 증가할수록 낮아졌다(p<0.05). 2. 치주질환 원인균의 출현율은 P. gingivalis 61.5%, T. forsythia 53.8%, T. denticola 29.2%, A. actinomycetemcomitans 15.4%. F. nucleatum은 100%였다. P. gingivalis, T. denticola는 10세 이후 출현율이 증가하였고 A. actinomycetemcomitans는 8-10세 군에서 출현율이 높았다(p<0.05). 3. 정량적 분석에서 치태지수와 치은지수는 F. mucleatum의 양과 유의한 상관성이 있었으며,치태지수는 치은지수와 유의한 상관성이 있었다. T. forsythia는 A. actinomycetemcomitans, T. denticola양과 강한 상관성을 보였으며, T. denticola양과 A. actinomycetemcomitans도 강한 상관관계를 가지고 있었다. The detection of special bacteria of oral plaque and quantitative analysis are possible through the real-time PCR technique. The aim of this study was to investigate the prevalence and the amount of five periodontopathic bacteria using real-time PCR, and evaluate the relationship among amount of bacteria, plaque index and gingival index. Sixty five subjects ranging from 8 to 18 years old were enrolled. Plaque index and gingival index were examined and five pehodontopathic bacteria were surveyed in subgingival plaque samples. The results were analyzed by ANOVA and Pearson's correlation. Results: The prevalence of P. gingivalis was 61.5%, T. forsythia was 53.8%, T. denticola was 29.2%, A.actinomycetemcomitans was 15.4% and F. nucleatum was 100%. Plaque index and gingival index have a significant relationship with the amount of F. nucleatum. The amount of T,forsythia has a strong relationship with the amount of T, denticola and A, actinomycetemcomitans(p<.0.05).