조혈모세포이식 후 발생한 주폐포자층 폐렴에 대한 고찰

주지현,최정현,이동건,백지연,고윤호,이혜정,김세희,신호진,박윤희,박지영,김유진,신완식,김춘추 대한감염학회 2001 감염 Vol.33 No.4

Background : Pneumocytitis cainii pneumonia (PCP) can occur in immunocompromised hosts especially such as AIDS or cancer patients. Although recent research had focused on PCP in AIDS patients, few studies have described the clinical presentations of PCP in recipients of stem cell transplantation (SCT). We evaluated the clinical manifestations of PCP in SCT patients admitted at St. Mary's hospital, Seoul, Korea. Methods : The medical records of 17 PCP patients undergoing SCT between Feb. 1998 and Feb. 2000 were reviewed. The diagnosis of PCP was confirmed through the demonstration of Pneumocytitis cainii via either cytology of brochoalveolar lavage (BAL) or histological technique of lung biopsy. CMV disease and CMV infection were confirmed by BAL culture and antigenemia respectively . Results : Seventeen patients were all recipients of allogeneic SCT and 7 of 17 patients were performed non-sibling SCT. Patients presented with symptoms including brief period (4 ∼23 days) of fever (76%), dyspnea (70%), cough (64%), and signs such as rare(58.8%), Sixteen patients (94%) had been receiving immunosuppressive agent such as cyclosporine A (64%) or Fk506 (35%) without PCP prophylaxis. Eleven patients (64%) were treated with corticosteroid with mean dose of 16 mg/day prednisolone and mean duration of 4.6 months after post-SCT period. Twelve patients were co-infected with CMV. Another co-infected miCroorganisms were Pseudomonas aeruginosa, Mycobacterium tuberculosis, herpes simplex virus, parainfluenza virus, Average duration of treatment with trimethoprim-sulfamethoxazole (TMP/SMX) was 21 ±9 days. Four patients died, and three of them were related with PCP. Conclusion : PCP developed frequently in patients who were taking immunosuppressive drug due to graft versus host disease or were not taking TMP/SMX prophylaxis. High risk patients showing fever, cough, or dyspnea should be considered to take early bronchoscopic intervention for detection of PCP. When treat for PCP, it also be considered to the possibility of coinfection such as CMV. (Korean J Infect Dis 33:273∼279, 2001)

그레이트 데인에서 발생한 위확장염전 증례

신희승,안지영,이영원,최호정 忠南大學校 獸醫科大學 附設 動物醫科學硏究所 2009 動物醫科學硏究誌 Vol.16 No.1

A 4-month-old female Great Dane dog with abdominal distention and non-productive retching after gulping of food and water yesterday was referred to the Veterinary Medical Teaching Hospital of Chungnam National University. Depression and abdominal distention with tympany were observed on physical examination. Decreased RBC and PCV were observed on CBC. And ALKP, BUN, Glu and P were increased on a serum chemistry. Severe gas filled distention of the stomach and intestines were shown on the abdominal radiographs. Pylorus was displaced craniodorsally toward the left side and gastric body was deviated to the right side on the abdominal radiographs. Deviating cranially of the diaphragm and decreased size of the heart were observed on thoracic radiographs. Therefore this case was diagnosed as gastric dilatation-volvulus.

섬유강화형 포스트를 이용한 치관-치근 파절의 치료: 증례 보고

임화신,라지영,이광희,안소연,김윤희,금기석,이상봉 大韓小兒齒科學會 2012 大韓小兒齒科學會誌 Vol.39 No.1

The crown-root fracture is defined as a fracture of tooth that contains enamel, dentin and cementum with or without pulp exposure. Generally the fracture lines place obliquely from labial surface, between incisal edge of the crown and marginal gingiva, to palatal surface subgingivally. If the fracture line is located supragingivally, the removal of tooth fragment and supragingival restoration can be performed. In subgingival fracture line, the surgical exposure, orthodontic eruption or surgical eruption can be considered. If the fracture line is too deep to restorate, extraction or decoronation can be selected. In children and adolescents, the extraction should be the last option. Another option to select before extraction is the restoration using fiber-reinforced post and the reattachment of tooth fragment. The fiber-rainforced post enhances the retention and the durability of tooth fragment. The reattachment of crown fragment using resin adhesive system is considered minimal invasive treatment biologically. This case reports the treatment of crown-root fracture using the reattachment of crown fragment and the insertion of fiber-reinforced post. 치관-치근 파절은 법랑질, 상아질, 백악질이 모두 포함된 치아의 파절로, 파절선이 대부분 절단연이나 순측의 변연부 치은 에서 구개측 치은열구 하방으로 사선으로 진행된다. 파절선의 위치가 치은 연상이라면 파절편의 제거 및 치은연상 수복을 시 행하고, 치은 연하라면 파절면의 외과적 노출술, 교정적 정출술, 외과적 정출술을 이용한 치아의 수복이 이루어진다. 그 외에 섬유 강화형 포스트를 삽입하여 치관 수복물의 유지력을 높이고, 레진 접착 시스템을 사용하여 치관 파절편을 재부착함으로 써 생물학적으로 최소한으로 침습적인 치료를 하는 방법도 있다. 만약 파절의 정도가 치은 연하로 깊은 경우 발치나 치관절제 술을 이용한 치근의 유지 등을 고려할 수 있다. 본 증례는 치관-치근파절로 내원한 12세 환아로 섬유강화형 포스트를 사용하여 치관 파절편 재부착을 시행하였으며 양호 한 경과를 보여 이를 보고하는 바이다.

하악 매복 지치의 외과적 발거시 Methylprednisolone의 안면 부종 감소 효과에 대한 임상적 연구

신지훈,박진배,한지용,윤혜경,김우형,이희철 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.4

Objective : The third molars, expecially mandibular wisdom teeth, are commonly obliquely impacted, and surgical procedure with odontomy and osteotomy is necessary for their extraction. The surgical extracion of impacted wisdom teeth occasionally in duces variable discomfort. Especially, postoperative swelling, pain and limitation of mouth opening determine the degree of discomfort. For the reduction of these complicaions, drug therapy(antihistamine, enzyme, steroid), cole pack and pressure technique have been studied. It is known that the steroids are the most effective. Methods and Meterial : We selected fifty patients in their twenties, who visited Department of Dentistry, Pusan Paik Hospital from March to August in 1998. All of 50 patients has no other medical problems. Total 50 patients were randomly divided to 30 of experimental group and 20 of control group. The experimental group had orally administration of methyprednisolone 5㎎ every 8 hours 2 times preoperatively and 7 times postoperatively. Five points were marked on the patients' face, and the distances between the points were measured just before operation and 48 hours after operation. Results : Methyprednisolone reduces swelling about 50% after surgical extraction of obliquely impacted mandibular third molars with osteotomy and odontomy. The difference in the amount of tissue edema between experimental and control group was significant(p<0.01). However, there was no significant difference according to the operation time. Conclusion : It seems that the use of methylprednisolone is effective to reduce postoperative swelling following surgical extraction of third molars.

골수염으로 발현된 재발성 콕시디오이데스 진균증 1예

백지현,박은영,정윤숙,홍재원,채윤태,진성준,최희경,신소연,한상훈,진범식,김창오,최준용,송영구,조남훈,김준명 대한감염학회 2009 감염과 화학요법 Vol.41 No.4

Coccidioidomycosis is a fungal infection that results from inhaling the airborne arthroconidia of the Coccidioides species. It is an endemic disease in the southwest part of North America and rarely diagnosed in Korea. As tourism to endemic areas and the number of immunocompromised patients have been increasing, the incidence of this infection has increased in non-endemic areas. Treatment is usually successful with antifungal agents; however, recurrence is common. It is difficult to decide when to discontinue the antifungal treatment especially in non-endemic areas where doctors are not familiar with the disease. We report a case of recurrent coccidioidomycosis manifesting as osteomyelitis after the treatment of the patient for disseminated coccidioidal infection. The complement fixation test was a useful tool for the assessment of patient response and to evaluate suspected recurrence.

알부민이 첨가된 시험관내 약역학 감염모델을 이용한 폐렴알균 치료에서 Ceftriaxone 일일 1회 요법

허지안,전혜선,박선희,최수미,김시현,이동건,최정현,유진홍,신완식 대한감염학회 2006 감염과 화학요법 Vol.38 No.6

배경 : Penicillin 내성 폐렴알균이 증가하는 지역에서 대안 중의 하나로 사용되는 ceftriaxone (CTR)의 적절한 용법, 용량을 파악하는 것이 중요하다. 본 연구는 임상에서 분리된 폐렴알균을 대상으로 시험관내 약역학 감염모델을 이용하여 알부민이 첨가된 경우와 첨가되지 않은 경우 CTR의 일일 1회 요법의 효과를 비교해 보고자 하였다. 재료 및 방법 : Penicillin 감수성(SM24), 중간내성(SM47), 내성(SM60)주를 대상으로 2-구획 시험관내 약역학 감염모델을 적용하였다. CTR 주입은 2 g씩 24시간마다로 사람의 약동학을 모의하였다. 알부민은 모델에서 4g/ dL가 유지되도록 하였다. 살균효과는 0, 2, 4, 6, 24, 30, 48시간째 집락수 변화로 측정하였다. 결과 : 모든 균주에서 알부민이 첨가되지 않은 경우 6시간 이내에 살균력이 관찰되었다. 최저억제농도 및 알부민 첨가유무에 관계없이 3주 모두 24시간째 살균력이 관찰되었고, 48시간째는 모두 측정한계 이하의 집락수로 감소하였다. 전 실험과정에서 CTR에 대한 내성주는 출현하지 않았다. 결론 : CTR의 일일 1회 요법은 알부민이 첨가되었을 때, 감수성, 중간내성, 내성주 모두에서 살균력 발현이 지연되었으나 최종효과는 알부민이 없을 때와 다르지 않았다. 앞으로 알부민 결합효과와 관련된 기초적인 추가 연구가 필요할 것으로 생각된다. Background : During the era of increasing penicillin resistant Streptococcus pneumoniae, it is important to have knowledge about adequate dosage and dosing interval of ceftriaxone (CTR). We examined efficacies of once-daily CTR and compared results in an in vitro pharmacodynamic infection model (IVPDIM) supplemented with albumin and those without albumin. Methods : Using three clinically isolated S. pneumoniae that were susceptible (SM24), intermediate (SM47) and resistant (SM60) against CTR, we utilized a two-compartment IVPDIM. CTR 2 g was administered intravenously every 24 h. Human albumin was added with concentration of 4 g/dL. Samples were removed at multiple time points over a 48-h period to determine the colony counts. Results : In SM24 and SM60, bactericidal effects were observed within 6 hours in groups without albumin. The number of colonies during 1st 6 hours were more decreased in albumin-free groups than in albumin-supplemented groups (P<0.05). In SM47, similar results were found during 1st 6 hours (P=0.03). But, regrowth was observed in albumin supplemented group at 30 h. Irrespective of results of minimal inhibitory concentrations and albumin supplementation, bactericidal effects were shown at 24 h in all 3 strains. All groups were decreased below the detection limit at 48 h. Development of resistance was not detected throughout the entire study period in either strain. Conclusions : Although extents of killing in albumin supplemented broth of once-daily CTR dosing were delayed in all 3 strains compared with those of albumin free broth, final efficacies were not different between the two groups.

산발성 장형 위선암 환자의 Microsatellite Instability와 병리학적 양상

조창희,홍유찬,안지현,최경현,이상호,신영명,윤기영,정민정,장희경 고신대학교의과대학 2007 고신대학교 의과대학 학술지 Vol.22 No.2

Background : Through many researches, microsatellite is expected to be a good diagnositic and prognostic factor in colorectal cancer, endometrial cancer, gastric cancer, and the others. The prevalence of microsatellite instability (MSI) in gastric carcinoma has reported variously, 13~44%. Purpose : We aimed to determine the prevalence of MSI-high and the relationship between MSI and pathological characteristics of sporadic intestinal type adenocarcinoma of stomach. Material and Methods : We analyzed 106 sporadic intestinal type adenocarcinoma specimens excised from patients who were over thirty-five years old to determine the statue of microsatellite by DNA sequencing. The tissues were formalin-fixed and paraffin embedded. DNA were extracted and amplified by polymerase chain reaction (PCR). MSI was determined using five markers recommended by National Cancer Institute (NCI). Specimens were also studied with five patholical factors-differenciation of tumor cells, depth of invasion, lymph node metastasis, vessel invasion, and perineural invasion- to determine pathological state. Result : The microsatellite statue was determined as MSI-High in 5 cases (4.7%), no MSI-low, and MSS (microsatellite stable) in 101 cases (95.3%). Within the frequency, there was no large gap in the distinction of gender in MSI cases, but in MSS cases, there was three-times more cases in male. MSI cases had moderate-to-poor differenciation and trend to invade toward serosa. All MSI cases showed no perineural invasion. But we could not find any statistical significance between MSI and pathological characteristics of sporadic intestinal type adenocarcinoma. Conclusion : Results suggest that MSI can not make any certain pathological significance in sporadic intestinal type adenocarcinoma. Even though less than 5% of sporadic intestinal type adenocarcinoma patients showed MSI, it can be used as a influential prediagnostic factor of gastric cancer. Further study with large scale of cases will be followed to verify these results.

백혈병환자에서 Liposomal Amphotericin B로 치료된 파종성 Fusarium 감염 1예

이지연,김성범,박대원,신성희,김용현,윤소영,엄중식,최철원,정희진,김우주,김준석,김장수,이갑노 대한감염학회 2003 감염과 화학요법 Vol.35 No.5

Fusarium spp.는 사람에서 드물게 각막염, 조갑진균증, 상처나 화상부위감염 등을 유발하는 것으로 알려져 있으나 최근에는 면역저하자에서 기회감염의 원인균으로 증가하고 있는 추세이다. 면역저하자에서 파종성 감염이 있는 경우에 예후는 치명적이나, 증례가 많지 않고 진단방법이 제한되어 있어 조기 진단과 신속한 치료가 쉽지 않다. 그러나 특징적으로 피부병변의 동반이 흔하여 면역저하자에서는 피부 병변의 면밀한 관찰과 함께 Fusarium 감염을 조기에 의심하여 피부생검이나 배양을 하는 것이 진단에 도움이 되리라 생각된다. 파종성 Fusarium 감염의 치료로는 감염 부위의 국소적 외과적 절제와 전신적 항진균제의 사용이 필요하고 현재까지는 amphotericin B가 비교적 효율적인 항진균제로 알려져 있으나 면역저하자에서 이에 반응을 하지 않는 경우가 많다. 저자들은 급성골수성백혈병 환자에서 관해유도화학요법 시행 후 호중구감소상태에서 피부병변과 폐침윤이 발견되었고 피부의 중심부 궤양을 동반한 구진성 병변에서 배양검사를 통해 파종성 Fusarium 감염을 진단하였으며 liposomal amphotericin B (AmBisome )를 사용하여 성공적으로 치료한 예를 경험하여 보고하는 바이다. Fusarium spp., basically a superficial pathogen, is a newly emerging fungal pathogen of opportunistic infections in immunocompromised patients. At present, although Fusarium spp. are relatively resistant to amphotericin B, the combination of amphotericin B and surgical debridement appear to be optimal treatment for disseminated infection. Recently we experienced a 32-year-old neutropenic patient after induction chemotherapy for acute myelocytic leukemia presented with skin lesions and infiltrations in both lungs. We diagnosed with disseminated fusariosis by skin culture and successfully treated the patient with liposomal amphotericin B. We emphasize a high index of suspicion for skin lesions especially in immunocopromised patients.

액시드 캅셀(니자티딘 150 mg)에 대한 넥스 캅셀의 생물학적 동등성

김지만,이상봉,전성실,신영희 한국약제학회 2004 Journal of Pharmaceutical Investigation Vol.34 No.1

The purpose of the present study was to evaluate the bioequivalence of two nizatidine capsules, Axid (Lilly Korea Pharm. Co., Ltd.) and Nex (Bi-nex Pharm. Co., Ltd.), according to the guidelines of Korea Food and Drug Administration (KFDA). The nizatidine release from the two nizatidine capsules in vitro was tested using KP Apparatus method with various dissolution media (pH 1.2, 4.0, 6.8 buffer solutions and water). The dissolution profiles of two nizatidine capsules were very similar at all dissolution media. Twenty four normal male volunters were divided into two groups with a randomized 22 cross-over study. After two capsules (300 ㎎ nizatidine) were orally administrated, blood as taken and the concentrations of nizatidine in serum were determined using HPLC with UV detector. The pharmacokinetic parameters such as AUC_(t), C_(max) T_(max) were determined. The result showed that the differences in AUC_(t), C_(max) and T_(max) between two nizatidine capsules absed on the Axid were-6.16%, -8.26% and -1.82%, respectively. There were no sequence effects between two capsules in these parameter. The 90% confidence intervals using logarithmically transformed data were within the acceptance range of log(0.8) to log(1.25)(e.g., log(0.91) ∼log(0.97) and log(0.85)∼log(0.99) for AUC_(t) and C_(max), respectively), indicating that Nex capsule is bioequivalent to Axid capsule.

다중지능 프로그램이 유아영재의 엉어, 수, 사회성에 미치는 효과

이신동,오연경,박지희 순천향대학교 인문과학연구소 2008 순천향 인문과학논총 Vol.22 No.-

The purpose of this study is to investigate the effect of a multiple intelligence program on the language, mathematics, and social behaviors of the gifted. The subjects were 20 gifted children who attended the Education Center in Seoul. They were 3-5 years old and their intelligence quotients were ranged between 125 and 140 measured by the K-WPPSI. Three tests were used in the study. First, the language ability test constructed by Young-Ae Jang (1981) was used for 4-6 years old children. Second, the test for the concept of numbers was designed to find out the achievement level of the number concept developed by Young-Hee Yeo (1995). Third, for the social behavior test questions that correspond to children aged between 3 and 5 were used. The results of this study were as followings: First, the multiple intelligence program positively affected the development of linguistic ability of the gifted children, with a significant difference in the development of linguistic expression. Second, the program based on multiple intelligence positively influenced the development of number concept of the gifted children. And third, multiple intelligence program has positively influenced the development of socialization of the gifted children, especiallv in terms of communication abilities.