토끼 수막염 모델을 이용한 다제내성 폐렴구균에 대한 Meropenem의 치료 효과

김신우,진정화,강수정,정숙인,김연숙,기현균,김춘관,이혁,김성민,백경란,송재훈 대한화학요법학회 2001 대한화학요법학회지 Vol.19 No.1

목적 : 다제내성 폐렴구균에 의한 수막염은 기존과 단일 항생제로는 근치가 어려워 ceftriaxone과 vancomycin 혹은 rifampin의 병용요법이 권유되고 있다. 다제내성 폐렴구균에 사용할 수 있는 다른 약제 중 meropenem은 시험관내 폐렴구균에 대한 항균력이 좋고 경련 등의 중추신경계 부작용이 거의 없어 다제내성 폐렴구균에 의한 수막염의 치료에 이용할 수 있을 것으로 기대되나 이에 대한 자료가 매우 부족한 상태이다. 이에 연자 등은 meropenem과 meropenem+vancomycin의 병용요법이 다제내성 폐렴구균 수막염의 치료에 효과가 있는지를 토끼 수막염 동물 모델을 이용하여 검증하고자 하였다. 방법 : 인체에서 수막염을 일으킨 다제내성 폐렴구균 균주(penicillin MIC 2, ceftriaxone MIC 4, meropenem MIC 0.5㎍/㎖)를 토끼 척수강 내에 직접 주입하여 수막염을 유발한 후 ceftriaxone, vancomycin, rifampin, meropenem의 단일 항균요법, ceftriaxone+vancomycin, ceftriaxone+rifampin, meropenem+vancomycin의 병용요법 간에 치료 효과의 차이를 비교 하였다. 각 치료군은 6 마리의 토끼를 대상으로 하였다. 각각의 항생제는 5 시간 간격으로 2번 정주하였으며, ceftriaxone은 1회 투여하였다. 균주 주입 후 각 치료군이 토끼에서 치료 후 0, 5, 10, 24 시간에 척수액을 채취하여 균주의 수를 측정하여 24시간째의 살균 여부를 최종 치료 효과로 판정하였다. 결과 : meropenem 단독 요법은 10시간째에 모든 균주를 살균하였으나 24시간 째에 다시 균의 성장이 관찰되었으며, meropenem+vancomycin의 병용요법은 단독 약제보다 우수한 살균효과를 보였으나 상승작용은 없었다. 결론 : meropenem+vancomycin의 병용요법은 기존의 ceftriaxone+vancomycin보다 24시간째에 더 큰 균의 감소 경향을 보여(P=0.054) 임상에서 사용이 가능할 것으로 기대되며 향후 실제 수막염 환자에서의 임상효과를 증명하는 연구가 필요할 것으로 생각된다. Background : Because antimicrobial monotherapy for pneumococcal meningitis caused by penicillin-resistant strains is not satisfactory, ceftriaxone+vancomycin [C+V] or ceftriaxone+rifampin [C+R] regimens are recommended. Meropenern [M] is one of the monotherapy options for penicillin-resistant pneumococcal meningitis due to good in-vitro activity against pneumococci and rare adverse reactions in CNS. But there have been few reports in the efficacy of meropenern against pneumococcal meningitis. We evaluated therapeutic efficacy of the meropenern and meropenem+vancomycin in a rabbit model of meningitis caused by penicillin-resistant S. pneumoniae (PRSP). Methods : Meningitis was induced by intracistemal inoculation of a pneumococcal strain isolated from a patient with meningitis (MIC; penicillin 2, ceftriaxone 4, meropenem 0.5 g/㎖). Bacterial concentrations in the CSF were measured at 0, 5, 10, and 24 h after therapy was started. Therapeutic efficacy was evaluated by the final bacterial concentration in the CSF at 24 h. Results : C+V cleared the CSF at 10 h, but regrowth of bacteria was noted at 24 h. Meropenem monotherapy resulted in sterilization at 10 h but regrowth at 24 h. M+V was superior to M or V monotherapy but did not show synergism. Therapeutic efficacy of M+V was at least equal or superior to that of C+V (P = 0.054). Conclusion : Meropenem+vancomycin regimen could be one of the useful options in the treatment of PRSP meningitis. Clinical trials to evaluate the M or M +V are warranted in the future.

조직학적 진단된 chronic necrotizing pulmonary aspergillosis 2예

김연숙,정숙인,기현균,김춘관,김신우,한정호,김성민,백경란,송재훈 대한화학요법학회 2000 대한화학요법학회지 Vol.18 No.1

CNPA는 기존의 폐질환 및 폐절제술로 인해 국소방어기전에 저하가 있거나 비특이적 전신면역상태저하를 갖고 있는 환자들에게서 주로 발생하는 만성적인 공동성 폐질환이다. 현재까지 우리나라에서는 CNPA의 보고가 없는 상태이고, 저자들은 최근 조직학적으로 진단된 CNPA 2예를 경험하였기에 보고하는 바이다. 저자들이 경험한 CNPA 환자들은 만성알코올 중독 및 기관지확장증과 같은 기저질환과 폐절제술을 받은 병력이 있었다. Aspergillus가 폐실질을 침윤하고 있는 조직소견과 조직배양에서 Aspergillus가 검출되어 조직학적 진단이 가능하였고, amphotericin B의 정주요법 및 경구 itraconazole 투여와 폐절제술 등으로 성공적으로 치료되었다. 아직 많은 임상의들에게는 낯선 질환인 CNPA의 치료성적은 환자의 동반질환 및 CNPA 자체의 중증도, 진단과 치료 시작의 지연 등에 의해 크게 좌우되므로 만성적으로 진행하는 공동성 폐병변을 갖고 있는 환자에게서 CNPA를 감별하는 것이 중요하다. Chronic necrotizing pulmonary aspergillosis (CNPA) is a chronic cavitary form of pulmonary aspergillosis. Dozens of CNPA cases have been reported in patients with systemic immunologic dysfunction or altered local defense mechanism from preexisting pulmonary disease. Review of literatures revealed that no CNPA cases have been reported in Korea yet. We experienced two cases of CNPA proven by lung biopsy. A 53-year-old alcoholic male in poor nutritional state was admitted with generalized weakness and weight loss. Chest CT revealed a cavitary nodule surrounded with ground-glass attenuation. CT-guided fine needle aspiration and biopsy was done. The biopsy specimen demonstrated dichotomously branching septated hyphae consistent with those of Aspergillus sp. Another case was a 39-year-old man with bronchiectasis who was admitted with persistent hemoptysis. He had a past history of pulmonary tuberculosis. A parahilar lesion with intracavitary soft tissue mass was incidentally detected in high-resolution GT. Left lingular segmentectomy was done due to uncontrolled hemoptysis and CNPA was histologically diagnosed. Both patients were successfully treated with intravenous amphotericin B followed by oral itraconazole. Even though CNPA is unfamiliar to most clinicians, it should be included in differential diagnoses of chronic progressive cavitary pulmonary lesion, especially in patients with immunologic dysfunction.

일개 대학병원에서 경험한 방선균증의 임상상

정숙인,김연숙,기현균,김춘관,김신우,이혁,김성민,백경란,송재훈 대한화학요법학회 1999 대한화학요법학회지 Vol.17 No.3

배경 : 방선균증은 혐기성의 그람양성 간균에 의한 만성 화농성 감염으로, 경안면부, 흉부, 복부, 골반부 등을 주로 침범한다. 최근 구강 위생의 향상과 항생제의 사용으로 인해 방선균증의 빈도의 감소와 함께 그 임상양상 또한 크게 변화하였다. 저자들은 국내에서의 방선균증의 임상상을 분석하기 위해 본 연구를 시행하였다. 방법 : 1995년 5월부터 1998년 9월까지 삼성서울병원에서 방선균증으로 진단받은 환자를 대상으로 임상기록지를 토대로 감염병소와 임상경과 등을 후향적으로 조사하였다. 결과 : 방선균증 환자는 모두 12명으로 경안면부 1례, 흉부 3례, 복부 3례, 골반부 5례였다. 임상양상은 주로 종괴의 형태로 나타나 진단을 내리기까지 종양과의 감별에 어려웠으며 진단은 모두 조직검사나 흡인액에서 유황과립을 확인함으로써 이루어졌다. 방선균증으로 진단된 환자는 모두 호전소견을 보였다. 결론 : 국내에서도 방선균증이 드물지 않게 발생하고 있으며 임상양상이 다양하여 가장 많이 오진되는 질환 중의 하나이다. 방선균증은 조직검사나 균배양검사를 통해 진단하고 항생제를 통해 완치될 수 있는 질환이므로 환자 진단에 관심을 가지면 불필요한 수술을 피할 수 있을 것으로 생각된다. Background: Actinomycosis is an indolent, slowly progressive bacterial infection, caused by Actinomyces. a gram-positive, non-spore-forming anaerobic or microaerophilic rod. Actinomycosis affects nearly every organ and body site. The disease is classically divided into four types, depending on the anatomic sites involved: cervicofacial, thoracic, abdominal, and pelvic. It has been considered as a rare disease, and only several cases have been reported in Korea. We performed this study to analyse the clinical manifestations of actinomycosis in Korea. Method: We retrospectively reviewed the medical records of patients with actinomycosis at the Samsung Medical Center from May 1995 to December 1998. Results: During the study period, actinomycosis was diagnosed in 12 patients: 1 patient had cervicofacial lesion, 3 thoracic, 3 abdominal, and 5 pelvic. The male and female ratio was 1 : 2 and the mean age was 47.2 years. Sulfur granule was observed in the pathologic specimens from all cases, but organism did not grow at all. It was very difficult to differentiate actinomycosis from tumorous conditions without pathologic diagnosis. All patients were clinically improved with antibiotics or surgical procedures. Conclusion: Actinomycosis is not a rare disease nowadays and has various clinical manifestations. It can be diagnosed by pathologic examination or culture and cured by antibiotics without surgical management.

한국인에서의 mefloquine(Lariam^�)내약성에 관한 연구

기현균,김연숙,정숙인,김춘관,김신우,김성민,백경란,송재훈 대한화학요법학회 2000 대한화학요법학회지 Vol.18 No.3

목적 : Mefliquine은 가장 널리 사용되는 말라리아의 화학적 예방약이지만 경련, 정신병 증상 등의 심각한 신경학적 부작용을 포함한 여러 가지 부작용을 일으킬 수 있다. 이러한 부작용은 인종간에 차이가 있는 것으로 알려져 있으나 아직까지 우리나라에서는 mefloquine에 대한 내약성에 관한 구체적인 자료가 없다. 이에 저자 등은 한국인에서의 mefloquine의 내약성을 전향적으로 조사하였다. 방법 : 1997년 6월부터 1999년 4월까지 삼성서울병원 여행의학 클리닉에 내원한 총 180명의 열대열 말라리아 위험지역으로 여행하고자 하는 여행객들을 대상으로 하였으며 이들은 여행 1주전부터 귀국 후 4주까지 mefloquine을 주 1회 복용하였다. 이들에게 여행자 수첩을 배부하고 약제 복용 후 발생한 증상을 기록하도록 하였고 동시에 여행자들에 대한 전향적 관찰 및 병록지 검토를 시행하였으며 귀국 후 3개월째 전화조사를 시행하여 mefloquine복용 당시의 부작용과 동반증상 여부에 관하여 평가하였다. 성적 : 총 180명의 여행자가 연구에 포함되었으며 이중 166명에 대하여 평가를 시행하였다(166/180, 92.2%). 연구대상 중 남자가 104명(104/166, 62.7%), 여자가 62명이었고(62/166, 37.3%) 평균연령은 36.4세였다(36.4±15.2). Mefloquine은 평균 6주간 투여하였다. 평가에 포함된 여행자 166명 중 4명에서 부작용이 나타났으며(2.4%) 부작용 발현건수는 6건이었다(3.6%). 나타난 부작용은 현기증이 2건(1.2%), 비정상적인 꿈, 수면장애, 기분저하, 발열이 각각 1건씩 발생하였다. 이중 증상과 약제와의 관련성이 있는 경우는 1명에서만 나타났으며(0.6%) 투약을 중지한 후 증상이 소실되었다. 나머지 3명의 여행자는 모두 mefloquine을 처음 복용할 당시에 일시적인 증상이 있었으나 부작용과의 인과관계는 확실하지 않았고 증상은 곧 소실되었다. 연구대상 환자 중 말라리아가 발병한 증례는 없어 100%의 예방효과를 보였다. 결론 : 총 166명의 연구대상 중에서 mefloquine에 대한 내약성이 불량한 경우는 1예 였으며(0.6%), 심각한 신경학적, 정신과적 부작용은 나타나지 않았다. 이러한 결과는 한국인 여행객들의 mefloquine에 대한 내약성이 우수함을 시사한다. Background : Mefloquine is the most commonly used chemoprophylactic agent against malaria. Many kinds of adverse reactions of mefloquine including neuropsychiatric adverse reactions, have been reported. It has been thought that the incidence of mefloquine-related adverse reactions may be different among the races. Since data on Korean people are not available, we investigated the incidence of mefloquine-related adverse reactions in Korean travelers prospectively. Methods : We gave a notebook to each visitor to Travel Medicine Clinic of the Samsung Medical Center, who had a plan to take a trip to the endemic area of malaria by Plasmodium falciparum. The study duration was from June 1997 to April 1999. They took mefloquine weekly from I week before the trip to 4 weeks after the trip. They wrote any adverse reactions on the notebooks by themselves. We surveyed the travelers by clinical observation, reviewing the medical records and telephone interview at 3 months after the trip. Results : One hundred eighty travelers were included in the study and 166 of them were evaluable (166/180. 92.2%). One hundren four travelers were male (104/166, 62.7%). The mean age of travelers were 36.4 years (36.4±15.2 years). The median duration of chemoprophylaxis were 6 weeks. Four of the enrolled travelers had adverse reactions (4/166, 2.4%) and six episodes of adverse reactions were occurred (6/166, 3.6%) : dizziness (2 cases), bizzare dream (1 case), sleep disturbance (1 case), mood change (1 case), and febrile sense (1 case). Only one traveler with persistent dizziness stopped mefloquine, and then dizziness was relieved. The other symptoms were transient, which were relieved despite continuation of mefloquine. No case of malaria was found in this study. Conclusion : Only one episode of adverse reactions was thought to be related to the mefloquine (0.6%). No case of severe neuropsychiatric adverse reactions was observed. This study suggests that mefloquine tolerance in Korean travelers is excellent.

웹 기반을 통한 동시설계 구현에 관한 연구

김준안,이종춘,심재형 慶南專門大學 2001 論文集 Vol.29 No.1

학교중심 특수교육과정 편성·운영의 실태와 문제점

김춘일,이유훈,정재권 국립특수교육원 1995 연구보고서 Vol.- No.6

The School Based Curriculum(SBC) in the special schools and classrooms has been marked only three years in Korea since the revised curriculum of 1992. The SBC in special education has profound legal base of development and management in the special schools of nation-wide. However, the short and superficial experieces sometimes hang down dark shadows growing out from the problems and difficulties being hidden in the unfamiliar SBC. The purpose of the present study was to identify some problems and hindrance in the actual practices of developing and managing the SBC in special schools and classrooms. The 155 subject schools and classrooms were selected from nation-wide. Questionnaires devised by the researchers were distributed and collected to analyse the problems that teachers thought important in the curriculum practice. Some clear and general tendencies of teachers' understanding and awareness reflected in the responses to the questionnaires were processed in percentages and interpreted according to the analysing scales developed by the researchers. Some results of the analysis are showing the clear problems and difficulties that teachers aware important in the present and future development of the curriculum. Main findings of the study are as follows : (1) The SBC is listed as an important alternative in the current curriculum research since the 1980's. The SBC experiences in some advanced countries n education such as UK, USA, Canada, and Australia. The study shows positive way of practices for pioneering the curriculum in this country Korea, especially in the field of special education. (2) Innovation in the system of conducting the curriculum in terms of 'democratization of school curriculum' is found to be earnestly requested by the most of the special school teachers. (3) The actual practies of the curriculum in developing, managing, and evaluting show defects and weaknesses in various aspects owing to the minunderstanding of teachers and shortage of proper assistance of government. The Ministry of Education(MOE) has a role of designing the basic scheme of the curriculum, and the Local Authority of Education(LAE) plays its role of suggesting a specified guidelines for the actualizing of the MOE curriculum. With the technical assistance and financial supply of the MOE and LAE, the special school teachers would be able to develop and manage successfully the curriculum for the first time. (4) The management of curriculum evaluation was identified negative and unsuccessful in many ways. The shortage of scales and tools for curriculum evalution and lack of proper understanding in the curriculum evalution are analysed as an important hindrance in the school curriculum improvement. (5) Administration in curriculum is considered to be revised as a more systematic and efficient one. Systematic and continual research and exchanges between schools, teachers, and the professionals must be encouraged and enlarged for the profound and substantial progress in the school curriculum. In conclusion, the belief and understanding of the teachers in the SBC were found to be profound. The teachers strongly believe that they are no longer 'the object' in the school curriculum, but are 'the subject' from now on. Some findings iedntified through the present study should be understood not as the definitive, but as the stepstone for the bright start of it.

음경골절 치험 3례

김철성,문재선,김춘곤 朝鮮大學校 附設 醫學硏究所 1986 The Medical Journal of Chosun University Vol.11 No.1

Generally, penile fracture is rare. Fracture of the penis is a lesion occurring after blunt trauma to the erect penis and the characteristic pathology consists of a rupture of the tunica albuginea with hemorrhase followed by a large hematoma formation and distortion of the penis. Many authors advocatea immediate operative intervention for fracture of the penis. Herein we report three cases of penile fracture with review of literatures.

市販 澱粉水解酵素의 活性度 比較

金春子,裵仁淑,梁濟在,李明子,李順子 梨花女子大學校 藥學硏究所 1961 梨花藥學硏究 Vol.- No.2

원발성 폐암 환자의 생존율에 관한 보고

김현태,이상무,어수택,박춘식,정성환,허승재,남충희,강창희,김용훈 순천향대학교 1994 논문집 Vol.17 No.4

We analysed 404 patients with primary lung carcinoma who were treated at Soonchunhyang University Hospital from July, 1985 to september, 1993 in order to investigate the survival rate and epidemiolgical properties of primary lung cancer. They were 330 males and 74 females. The most prevalent decade was seventh. In terms of cell type, the squamous cell was 225 patients (55%), and adenocarcinoma, small cell, mixed type was 21%, 19%, 4%, respectively. Among non-small cell lung carcinoma, stage Ⅲa was the most prevalent one(92%). In case of small cell carcinoma, the limited stage was 64%. The 12-, 24-, 36- month survival rate of total patients was 57%, 31%, 22%, respectivley and median sruvival time was 15 months. The 36-month survival rate tended to be longer in non-small cell lung carcinoma than that of small cell lung cancer, but there was no difference between two groups, statistically. In non-small cell carcinoma, The 36-month survival rate and meidan survival time were longer in the stage Ⅰ and Ⅱ than those of Ⅲa, Ⅲb, Ⅳ (80% versus 38%, 22%, 0%, p<0.05). According to involvement of lymph node, the 36-month survival rate was longer in NO and N1 than those of N2, N3 (61.9%, 48.7% versus 17.7%, 17.3%, p<0.05). In small cell carcinoma, The 36-month survival rate and median survival rate were higher and longer in limited stage than those of extensive stage(16.1% and 13 month vs 10% and 8 month, p<0.05). In conclusion, we report here the incidence of primary lung carcinoma and the survival rate of paients with primary lung carcinoma who were treated in Soonchunhyang University Hospital.

水質汚染 防止를 위한 國際法上 國家責任에 관한 硏究

金泰雲,申詠才,高春澤 東義大學校 法政硏究所 1999 공공정책연구 Vol.15 No.-