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.

난소암의 조기진단

남주현,목정은 울산대학교 의과대학 1993 울산의대학술지 Vol.2 No.2

Ovarian cancer is the leading cause of death from gynecologic malignancies. In 1992, it has been reported that the incidence of ovarian cancer was 3% of all female malignancies in Korea. During the last decade, the incidence of cervical cancer which is the most common one of female malignancies was gradually declining, however that of ovarian cancer tended to be slightly increasing probably because of changes in socioeconomic status of this country. Despite of aggressive debulking operation and intensive platinum-based combination chemotherapy, the overall survival rate for ovarian cancer has not changed appreciably over the last twenty years. One of the reasons for poor prognosis of ovarian cancer is that greater than 70% of patients with ovarian cancer is unfortunately detected after the disease has already spreaded beyond the pelvis because of the lack of early symptoms. The cure rate for these patients with advanced ovarian cancer is only 15-20%, This low survival rate is in marked contrast to that of as high as 90% with stage I disease. Therefore, development of early detection method for ovarian cancer would be the best way to reduce the mortality rate of this disease. Ultrasonography and serum tumor marker, CA 125 have been extensively studied for early detection of ovarian cancer. Recently, combined use of transvaginal color Doppler technique is studied to increase the specificity of the screening test. However, the value of these methods as a screening test is still debating. So far, unfortunately there is no conclusive method which has cost-effectiveness and perfect sensitivity and specificity for ovarian cancer screening. Moreover, the optimal population and interval for ovarian cancer screening are not currently defined. In this review, recent data of studies using ultrasound and serum marker, CA 125 and debating issues for ovarian cancer screening are discussed.

폐렴구균 감염증에서 항생제 내성의 임상적 의미 : Asian Network for Surveillance of Resistant Pathogens(ANSORP) Study

정숙인,기현균,손준성,고관수,김나영,장현하,오원섭,백경란,이남용,김신우,이혁,--,송재훈 대한감염학회 2003 감염과 화학요법 Vol.35 No.5

목적 : 전 세계적으로 폐렴구균의 페니실린을 포함한 β-lactam과 마크로라이드 및 퀴놀론 계열의 항생제에 대한 내성이 급격히 증가하여 임상적으로 문제가 되고 있으나, 시험관내 내성이 실제 임상적 예후에 미치는 영향에 대해서는 아직까지 논란이 되고 있다. 본 연구는 폐렴구균의 항생제 내성률이 높은 아시아 지역에서 항생제 내성이 폐렴구균 감염증의 임상경과에 미치는 영향을 평가하기 위하여 시행되었다. 방법 : ANSORP에서 주관한 전향적 임상 연구로서 1999년 11월부터 2001년 8월까지 아시아 지역 11개국의 14개 기관에서 진단된 침습성 폐럼구균 감염증 환자를 대상으로 내성 균주 감염의 위험요인, 임상양상, 예후 등의 임상적 분석을 시행하였다. 결과 : 총 646명 환자의 평균연령은 30.1세(6일-89세)였고, 이전 3개월 내에 항생제 사용력이 있는 환자는 159명(32.4%)이었다. 질환별로는 폐렴이 377예(58.4%)로 가장 많았고, 중이염 67예, 뇌수막염 66예(10.2%), 일차성 균혈증 65예(10.1%)였다. 총 646균주 중 347균주(53.7%)가 페니실린 비감수성(중등도 내성 23.1%, 고도 내성 23.1%)이었고, 페니실린에 대한 MIC_(90)은 0.03㎍/mL에서 4㎍/mL까지의 분포를 보였다. 페니실린 비감수성 균주에 의한 감염증과 차이가 없었다. 페니실린 내성 폐렴구균 폐렴에 의한 사망률은 페니실린 감수성 폐렴구균 폐렴에 의한 사망률과 차이가 없었다(p=0.846). Erythromycin에 대한 고도 내성을 보이는 균주의 비율이 매우 높았으나, 실제 임상상이나 치사율에는 영향을 미치지 않았다(p=0.092). 페니실린 비감수성 폐렴구균에 의한 뇌수막염의 치사률도 감수성 균주에 의한 사망률과 차이가 없었다(p=0.059). 결론 : 본 연구의 결과 페니실린 및 베타 락탐 제제에 대한 시험관 내성은 폐렴구균 폐렴이나 뇌수막염의 임상상이나 치사율에 영향을 미치지 않는 것으로 확인되었다. 이는 내성의 정도와 연관될 것으로 생각되므로, 향후 고도 내성 균주가 증가할 때 추가 검증을 요한다. 아울러 macrolide 및 퀴놀론계 항생제 내성의 임상적 의미에 대한 후속 연구가 필요할 것으로 사료된다. Background : Despite the widespread emergence of antimicrobial resistance among pneumococcal strains worldwide, clinical implications of in vitro resistance still remain an open question. To evaluate the clinical impact of pneumococcal resistance in Asian countries where the prevalence of pneumococcal resistance was reported to be highest in the world, ANSORP has performed a prospective, multinational surveillance study with cases with invasive pneumococcal diseases in Asian countries. Methods : In vitro susceptibility of pneumococcal isolates was determined by broth microdilution tests with 16 antimicrobial agents. All enrolled cases of pneumococcal infections were analyzed with regard to demographic data, clinical features, risk factors and mortality. Results : A total of 646 patients with pneumococcal infections were enrolled from 14 centers in 12 countries between the period from November 1999 to August 2001. Pneumonia (58.4%) was the most common clinical disease followed by bacteremia (33.4%), otitis media (10.4%), and meningitis (10.2%). Among 646 isolates, 347 (53.7%) were penicillin non-susceptible (intermediate 23.1%, resistant 30.7%). MIG_(90)s for penicillin ranged from 0.03 (India) to 4.0 ㎍/mL (Korea, Taiwan, Vietnam, and Hong Kong). Overall mortality from pneumococcal diseases by penicillin non-susceptible strains was not different from that by susceptible strains. Pneumococcal pneumonia caused by penicillin- or erythromycin-resistant strains showed similar mortality, severity of illness, or complications to that by susceptible strains. Mortality from pneumococcal meningitis caused by penicillin non-susceptible strains was also similar to that by susceptible strains. Conclusion : Data suggest that current situation of in vitro resistance to penicillin or macrolides may not affect the mortality from pneumococal pneumonia or meningitis caused by antibiotic-resistant strains.

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.

가미과루해백황금탕의 항고지혈증 효과

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

Gamigwaruhaebaekwhanggum-Tang (GGHWT) have been evaluated for antihyperlipidemic effects on experimental hyperlipidemic rats and mice induced by Triton WR-1339, corn oil and high cholesterol-diet. Especially, GGHWT is formulated with Trichosanthis Fructus, Pinelliae Tuber, Aurantii Immaturus Fructus, Magnoliae Cortex, Allii Macrostemi Bulbus, Cinnamomi Ramulus and Scutellariae Radix. Oral administration of GGHWT at 500 mg/kg/day for 3 days significantly inhibited the increase of serum triglyceride and LDL-cholesterol, liver triglyceride in hyperlipidemic rats induced by Triton WR-1339. And, GGHWT significantly inhibited the increase of serum triglyceride in hyperlipidemic rats induced by corn oil. Also, administration of GGHWT (500 mg/kg, once daily for 1 week, p.o.) prevented the increase of serum total cholesterol, triglyceride, LDL-cholesterol, liver total cholesterol and triglyceride in 1% cholesterol-diet fed mice. These results suggest that GGHWT is effective for the treatment of hyperlipidemia.

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.

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.

중학교 남자 테니스 선수의 운동기능수준별 시합 전 경쟁상태불안

남인수,최인태,전중기,윤재만,고성경,이종삼,임승현 대구대학교 인문과학연구소 2008 人文科學硏究 Vol.31 No.-

The purpose of this study was to investigate if there is any difference in the level of competitive state anxiety according to the level of motor skill before the game and to provide the players with basic data for the mental practice. The subjects of this study consist of 20 men's a middle school tennis players. The experimental group was divided into superior players group and inferior players group. And then by using a CSAI-2 questionnaire, three subfactors of competitive state anxiety, or cognitive state anxiety, somatic state anxiety and state self-confidence were measured. The method of measurement was carried out three times, or one week, one day and two hours before the game. The results of this study were as follows. First, About both cognitive state anxiety and somatic state anxiety, inferior players were significantly higher than superior players. Second, About state self-confidence, superior players were significantly higher than inferior players. Third, As the game was around, both cognitive state anxiety and somatic state anxiety which all the players including superior and inferior players had increased. But the state self-confidence of all players decreased.