리네졸리드와 반코마이신을 교대로 투여하여 치료한 지속성 메티실린 내성 황색포도알균 균혈증 1예

김낙현,김문석,장은선,강유민,김가연,장희창,박완범,김의종,김남중,오명돈 대한감염학회 2009 감염과 화학요법 Vol.41 No.6

Persistent Staphylococcus aureus bacteremia is frequently defined as bacteremia persisting for ≥7 days despite proper antibiotic therapy. Its treatment includes removal of all infection foci and proper antibiotic therapy. Vancomycin remains the antibiotic of choice in MRSA bacteremia. Alternative agents, linezolid or daptomycin, are available, but a consensus regarding management of persistent MRSA bacteremia on vancomycin failure is still lacking. We report a case of a 60-year-old male who received thoracoabdominal aorta replacement operation due to dissecting aneurysm of the ascending and descending aorta. Surgical site infection and bacteremia caused by MRSA occured, and wound debridement operations were performed. The patient was treated with vancomycin in therapeutic doses but MRSA bacteremia persisted for 168 days in a row. Although the inserted aortic graft was the most probable source of persistent bacteremia, surgical removal was impossible. Linezolid was administered as an alternative antibiotic but had to be discontinued from time to time due to thrombocytopenia induced by this agent. In the end, MRSA bacteremia was successfully managed by alternating vancomycin-linezolid therapy.

생활체육참여자의 여가활동 유형이 생활만족에 미치는 영향

김의영,김의영,김영숙,윤대중,이병기 龍仁大學校 體育科學硏究所 2002 體育科學硏究論叢 Vol.12 No.1

This research is designed to make a comparative analysis of the types of leisure activities and the degree of and life satisfaction by demographic background variable and to present basic materials necessary for the development of programs for local policies on leisure in accordance with the local autonomous system with a view to determining the relationship between life satisfaction by type of leisure activity. The following are the findings. First, the survey failed to test a statistically significant difference between family member's mutual satisfaction, or the subordinate variable of age, job and health and general life satisfaction, or the subordinate variable of income. But there was a statistically significant difference in life satisfaction by gender, age, education, job, income and health at a level of 1 percent. Second, the survey on the influences of the types of leisure activities on leisure satisfaction and life satisfaction revealed that there was a statistically significant influences in all the subordinate variables of and life satisfaction.

국내 다기관에서 조사한 지역사회획득 메티실린내성 황색포도알균의 빈도와 임상적 특성

송진수,최평균,송경호,조재현,김성한,방지환,이창섭,박경화,박경운,신수,최희정,김의석,김동민,이미숙,박완범,김남중,오명돈,김의종,김홍빈,최강원 대한감염학회 2006 감염과 화학요법 Vol.38 No.6

목적 : 최근 전세계적으로 지역사회획득 메티실린내성 황색포도알균(community-associated methicillin-resistant Staphylococcus aureus, CA-MRSA)의 보고가 증가하고 있다. 하지만, 우리나라에서는 CA-MRSA 감염증에 대한 증례보고만 있을 뿐 아직까지 체계적인 연구결과가 없는 실정이다. 저자들은 국내에서 CA-MRSA의 빈도, 감염증의 임상적 양상, 분리된 균주의 항균제내성 양상을 조사하였다. 재료 및 방법 : 2005년 1월부터 2005년 6월까지 7개 병원에서 MRSA가 분리된 환자의 명단을 파악한 후 의무기록지와 건강보험심사평가원의 자료를 검토하였다. 외래나 응급실에서 혹은 입원 후 72시간 이내에 균주가 분리되고 MRSA 획득과 관련된 위험인자가 없는 경우 CA-MRSA로 정의하였으며, 분리된 균주의 임상적 의미에 따라 원인병원체(pathogen), 집락화(colonizer), 미결정(undetermined)으로 분류하였다. Penicillin과 oxacillin을 제외하고 3개 이상의 다른 계열 항균제에 내성이면 다제내성으로 정의하였다. 결과 : 연구기간동안 총 3,251주의 황색포도알균이 분리되었으며, 이 중 MRSA는 1,900주(58.4%)였다. MRSA 가운데 CA-MRSA는 114주(6.0%) 였으며, 이들이 분리된 부위는 귀(62주), 비뇨기계(14주), 피부 및 연부조직(11주), 호흡기계(10주), 혈액(3주) 등이었다. CA-MRSA 균주 가운데 집락균은 22주, 원인병원체는 22주였으며, 나머지 균주에 대해서는 그 임상적 의미를 결정할 수 없었다. 항균제 감수성 검사를 시행한 73균주 중 47주(64.4%)는 다제내성이었다. CA-MRSA 감염증 22예 중 피부 및 연부조직 감염(9예)과 중이염/외이도염(9예)이 가장 흔하였다. 침습적 감염증(invasive infection)은 4명(원발성 균혈증 3예, 감염성 관절염 1예)에서 확인되었지만, CA-MRSA 감염증으로 사망한 환자는 없었다. 결론 : 병원내 감염증에서는 MRSA가 심각한 문제이지만, 아직까지 지역사회 감염증에서 CA-MRSA는 흔하지 않았다. Background : Methicillin-resistant Staphylococcus aureus (MRSA) infection has emerged in patients who do not have the established risk factors. In Korea, little is known about the epidemiology and clinical features of community-associated MRSA (CA-MRSA). Material and Methods : Clinical microbiology laboratory databases of 7 hospitals were reviewed to identify the patients from whom MRSA was isolated during the period of January to July 2005. Only one isolate per patient was enrolled. In order to identify the risk factors of MRSA acquisition, the medical records and the Health Insurance Review Agency databases were reviewed. CA-MRSA was defined as MRSA isolated from patient without established risk factors. We analyzed patient demographics, underlying medical conditions, characteristics of infection, and antimicrobial susceptibility profiles. Results : Of total 3,251 S. aureus isolates, 1900 (58.4%) were MRSAs. Of the MRSA isolates, 114 (6.0%) were CA-MRSA. Of 114 CA-MRSA isolates, 22 (19.3%) were colonizers, 22 (19.3%) were pathogens, and the clinical significance of remaining 70 (61.4%) could not be determined. Median age of the 22 patients with CA-MRSA disease was 47 years. Nine patients had skin and soft tissue infections, 9 ear infections, 3 bacteremia, 1 septic arthritis. Seven patients had underlying medical disease. None died of the CA-MRSA infections. Of the 73 isolates of CA-MRSA, 47 (64.4%) were resistant to more than 3 classes of antibiotics besides β-lactams. Conclusion : Although MRSA is highly prevalent among hospital-associated S. aureus infection, CA-MRSA infections are not common.

마이크로스트립 구조에 대한 공간영역 그린함수의 값을 구하기 위한 효율적인 수치해석 적분기법

김의중,이영순 國立金烏工科大學校附設生産技術硏究所 1997 産業技術開發硏究 Vol.13 No.-

An efficient numerical integration technique of the Sommerfeld integral, which used to evaluate the spatial-domain Green's function for the microstrip structure, is condidered. The error caused by the singular integral and slow convergence in the infinite integration interval, are improved using the folding around method and the average algorithm respectively. In order to check the validity of the present method, the results evaluated by the numerical integration of a vector potential Green's function are compared with those evaluated by the quasi-static terms in near field and the surface waves in the far field. Good agreements between them are observed.

자궁경부암에서 p53과 human papillomavirus의 분포에 관한 연구

김영식,김대중,김의한,강상균,양승하 순천향의학연구소 1996 Journal of Soonchunhyang Medical Science Vol.2 No.2

Uterine cervical carcinoma is the most common malignant tumor of woman in Korea. Cervical lesions are associated with various subtypes of human papillomavirus(HPV), and recently there is many reports for interrelationship between p53 gene and HPV in development of cervical carcinoma. HPV is associated with condyloma acuminatum, flat condyloma, cervical intraepithelial neoplasm(CIN), and invasive carcinoma in uterine cervix. Among the subtypes of HPV, type 6b and 11 are reported as low risk group and type 16 and 18 are high risk group. p53 is an one of oncogene which control the cellular proliferation. The loss of p53 function by mutation and complex binding with HPV E6 could act an important role in developmental mechanism of cervical carcinoma. To observe the relationship between expression of p53 and HPV in CIN and invasive carcinoma, we analysed CIN 26 cases and invasive squamous cell carcinoma(SCC) 62 cases processed for immunohistochemical stain using monoclonal mouse anti-p53 and polyclonal anti-bovine papillomavirus. Then positivity of p53 and HPV was compared. The results are as followings: 1) The p53 in CIN showed positive reaction in twelve cases(46.2%) of twenty-six cases. Positive rates of CIN Ⅰ, CIN Ⅱ, and CIN Ⅲ are 33.3%, 42.9%, and 50% respectively. 2) The p53 in invasive squamous cell carcinoma showed positive reaction forty-four cases(71.0%) of sixty-two cases. Positive rates of microinvasive and invasive SCC are 53.8% and 75.5%, respectively. According to cell type, keratinizing type were eighteen cases(81.2%) of twenty-two cases and nonkeratinizing type were ninteen(70.4%) of twenty-seven cases. 3) Papillomavirus revealed low expression rate in CIN(26.9%) and invasive SCC (16.1%). 4) The p53 showed positive reaction in fourteen(82.4%) of papillomavirus-positive seventeen cases. Above results revealed higher positive rate of p53 according to progression of CIN and SCC, and in keratinizing type than in nonkeratinizing type of SCC. Positive rate of papillomavirus was very low, but high positive rate in p53 positive cases which suggest that p53 and HPV corelate in development of cervical carcinoma.

사망 진단서(시체 검안서) 작성의 문제점

김규석,임용수,이중의,서길준,윤여규,어은경,염석란,정연권,이윤성 대한응급의학회 2000 대한응급의학회지 Vol.11 No.4

Background: This study was conducted to analyze the current problems in completing death certificates and to identify the correct method for completing death certificates Methods: We reviewed 262 death certificates in three hospitals from March 1 to April 30, 2000, and 119 death certificates in one hospital from March 1 to 31, 2000. We identified major and minor errors and analyzed and compared them retrospectively. Results: A total of 381 death certificates were reviewed: 59 in Seoul National University Hospital,101 in Ewha Woman's University Hospital, and 102 in Gachon Medical College Hospital, which has no education program for completing death certificates in postgraduate training, and 119 in Samsung Medical Center which has an education program for completing death certificates. 358 certificates(94.0%) had at least one error. There were only 23 death certificates(6.0%) without an error. In 182 cases(47.8%), there was one major error. In 321 death certificates(84.3%), there were more than two errors. A comparison of Samsung Medical Center with the other hospitals showed that the number of total errors was statistically different(p=0.001). Conclusion: There were few death certificates without an error in this study. In a hospital which has postgraduate training in completing death certificates, there are fewer errors than in other hospitals which have no training course. Emergency physicians actually certify many deaths, so they must know the correct method of completing death certificates for statistics on morbidity and mortality.

스코폴라민 첩포가 젊은 정상 성인 남자의 수면 구조에 미치는 영향

김의중,정도연 大韓神經精神醫學會 1995 신경정신의학 Vol.34 No.5

It is well known that the administration of scopolamine as an injection or oral form could influence the sleep architecture, especially REM sleep latency and duration. In clinical usage of scopolamine, it is the most effective single drug for the prophylaxis and treatment of motion sickness. Among the routes of administration, the patch form is preferred, because of its easy administration and the long duration of action(72hr). But there have been found no studies about the effects of scopolamine patch on sleep. In this study the authors intended to find the effects of scopolamine on sleep variables, especially REM sleep-related variables using transdermal scopolamine patch. One scopolamine patch contained 1.5mg of scopolamine. For each of the eight young adult male volunteers, the authors applied scopolamine patch and placebo alternatively in a randomized double-blind cross-over design. The subjects' sleep was studied polysomnogaphically using Grass model 78 polysomnogaph for three nights including one adaptation night. The scopolamine patches did not alter sleep architecture such as percentage of sleep stage 1, 2, 3, 4 and REM. Total wake time, sleep latency and sleep efficiency were not different between scopolamine and placebo nights. REM latency, duration of each REM sleep period and total REM sleep period did not differ between scopolamine and placebo nights. The authors conclude that the administration of a single patch of scopolamine in the evening for the night time travellers may have apparently minimal effects on sleep and does not seem to influence the major sleep architecture. However, it still remains to be answered whether scopolamine patch influences the "micro" level of sleep structure and/or function, such as phasic REM components.

차량의 방송 수신 전파 환경 분석에 관한 연구

김의태,김성철,이중근,양승완,전인학 漢陽大學校 工學技術硏究所 2001 工學技術論文集 Vol.10 No.-

본 논문에서는 이동 중인 차량의 수신 성능에 영향을 주는 전파 환경 측정을 위한 측정 셋업을 구성하고, 측정 결과 분석을 통한 수신 이상 현상의 원인을 밝혔다. 이를 위해 필요한 측정 파라메터의 정량적 설정과 측정 및 분석 방법을 제시하였다. In this paper we constitute the measurement setup of electromagnetic environment which has an effect on the radio receiver of vehicles an analyzed causes. This paper proposes various measurement and analysis methods for uncovering noise mechanism of vehicle receiver system.

방사선조사와 저칼슘식이가 치아형성시 Interleukin-1의 분포에 미치는 영향에 관한 연구

김일중,황의환,이상래 대한구강악안면방사선학회 2000 Imaging Science in Dentistry Vol.30 No.3

Purpose : To elucidate the effects of the irradiation and calcium-deficient diet on expression of interleukin (IL)-1 during tooth formation of rat molar Materials and Methods : The pregnant three-week-old Spague-Dawley rats were used for the study. The control group was non-irradiation/normal diet group, and the experimental groups were irradiation/normal diet group and irradiation/calcium-deficient diet group . The abdomen of the rats on the 9th day of pregnancy were irradiated with single dose of 350 cGy. The rat pups were sacrificed on the 14th day after delivery and the maxillae tooth germs were taken. The specimen were prepared to make sections for light microscopy, and some of tissue sections were stained immunohistochemically with anti-IL-1 antibody. Results : In the irradiation/normal diet group, dental follicle showed fewer blood vessels, mononuclear cells, and fusions of mononuclear cells than in non-irradiation/normal diet group. Alveolar bone showed a few osteoblasts and osteoclasts. Periodontal ligament showed collagen fibers and fibroblasts with irregularity. Weak immunoreactivity for IL-1 was shown in dental follicle, alveolar bone, and periodontal ligament, In the irradiation/calcium-deficient diet group, dental follicle showed sparse cellularity. Alveolar bone showed diminished number of osteoblasts. Periodontal ligament showed irregular collagen fibers and atrophy of cementoblasts and fibroblasts. No immunore-activity for IL-1 was shown in dental follicle, alveolar bone, and periodontal ligament. Conclusion : Irradiation and calcium-deficient diet seems to cause disturbance of the expression of interleukin-1 during tooth formation of rat molar. (Korean J Oral Maxillofac Radiol 2000; 30: 159-168)

X-관련성 만성육아종성질환의 진단을 위한 PMA-activated NBT 검사

김중곤,조한익,오흥범,김의종,최강원 대한감염학회 1996 감염 Vol.28 No.1

목적 : Activated NBT 검사는 만성육아종성질환을 선별하는 검사이다. 활성제로 PMA를 사용하면 X-linked CGD의 경우 보인자를 감별할 수 있다. 방법 : CGD의 가족력을 부인하는 정상인 30명을 대상으로 PMA activated NBT 슬라이드 검사를 실시하여, 정상대조에서의 formazan 형성율을 보았으며, 동일 검사를 CGD가 강력히 의심되는 환자와 그 가족에 대하여 실시하였다. 결과 : 정상대조 30명 전원에서 98% 이상의 formazan 형성세포가 관찰되었다. 환자에게 실시한 결과 세환자 모두에서 0%의 결과를 보였다. 환자의 어머니에서는 각각 57, 70, 67%의 결과를 보였다. 결론 : 본 연구를 통하여 세 환자는 X-관련성 만성육아종성질환이라는 진단을 내릴 수 있었다. PMA activated NBT 슬라이드 검사는 시행하기가 쉽고 재현성이 좋으므로, 어러 검사실에서 소아기 면역결핍증을 선별하는 검사의 하나로 시행되는게 바람직하다고 사료된다. Background : Chronic granulomatous disease(CGD) is uncommon inherited disorder in which phagocytic cells fail to produce antimicrobial superoxide(O₂) due to NADPH oxidase deficiency. This disease can be easily screened by activated nitroblue tetrazolium(NBT) test. In case of X-linked CGD, carriers also can be detected. Methods : PMA(phorbol myristate acetate) activated NBT test was performed as previously described. Test performance was evaluated in 30 normal persons who denied family history mimicking CGD. Test was also applied to the three strongly suspected cases of CGD. Two of the cases were 12 year old boy and 7 year old boy, who suffered from many infectious diseases since 6 month old and 4 month old, respectively. The other remaining case was 22 year old man who suffered from many infectious diseases since 6 year old, but now relatively in health compared to the other two cases. Results : More than 98% formazan formation was observed in all normal controls. No formazan positive cell was shown in all of the three patients. However, applied to the mothers, the test revealed 57%, 70%, 67% positive cells, respectively. Conclusion:X-linked transmission of CGD could be determined with the results of PMA activated NBT slide test. This test can be easily performed. It would be better to do this test routinely as one of the tests for the screening of the immmunodeficiency syndrome in childhood.