광범위 베타 락탐계 항생제 분해 효소를 생성하는 폐렴간균에 의한 균혈증이 발생한 환자에서 감영의 위험 인자 및 치료 결과

강철인,김성한,방지환,김홍빈,박상원,최영주,오명돈,김의종,최강원 대한감염학회 2003 감염과 화학요법 Vol.35 No.2

목적 : 본 연구는 ESBL을 생성하는 K. pneumoniae에 의한 균혈증 환자에서 감염의 위험 인자 및 치료 결과를 알아보고자 시행하였다. 방법 : 1998년 1월부터 2002년 4월까지 혈액 배양 검사에서 동정된 K. pneumoniae를 대상으로 NCCLS guidelines과 이중 디스크 확산법(double-disk diffusion test)을 이용하여 ESBL 생성 여부를 확인하였다. ESBL 생성 균주에 의한 균혈증 환자 60명(환자군)에 대해 ESBL을 생성하지 않는 균주에 의한 균혈증 환자들(대조군)을 연령, 성별, 균혈증 발생 시점을 고려하여 1:2 또는 1:3으로 배정하였다. 총 159명의 대조군을 선정하였고 후향적인 환자-대조군 연구를 시행하였다. 결과 : 환자군과 대조군 사이에 연령, 성별, APACHE Ⅱ score, 주된 감염 부위의 유의한 차이는 없었다. ESBL을 생성하는 K. pneumoniae에 의한 균혈증이 발생할 독립적인 위험 인자에는 요관 삽입, 균혈증 발생 이전 72시간 동안 침습적인 시술을 받은 경우, 균혈증 발생 이전 30일 동안 투여받은 항생제 개수가 있었다. 초기 항생제 치료 72시간 후의 반응을 평가하였을 때, 완전 반응(complete response)은 대조군에서 더 많았고(13.3% vs. 40.3%, P<0.001), 치료 실패(treatment failure)는 환자군에서 더 많았다(33.3% vs. 11.9%, P<0.001). 7일 사망률은 환자군에서 20% (12/60), 대조군에서 15.6% (25/159)이었고(P=0.451), 30일 사망률은 환자군에서 30% (18/60), 대조군에서 24.5% (39/159)이었다(P=0.410). ESBL 생성 균주에 의한 균혈증이 있는 환자들에서 최종 항생제 치료가 부적절했던 환자들을 제외하고 30일 사망률을 분석하였을 때 효과적인 항생제 치료의 지연은 사망률을 높이지 않았다(11.1% vs. 9.1%, P=1.000). 결론 : ESBL을 생성하는 K. pneumoniae에 의한 균혈증이 있는 환자에서 초기 항균제 치료 72시간 후의 치료 반응률은 낮지만 사망률은 유의하게 증가하지 않았다. 원인균이 동정된 후 최종 치료 항생제의 선정이 적절하다면 초기에 효과적인 항생제 투여의 지연은 사망률을 유의하게 증가시키지는 않았다. Background : This study was conducted to evaluate risk factors for infection and treatment outcome of bloodstream infection due to extended spectrum β-lactamases(ESBL)-producing K. pneumoniae. Methods: ESBL production was evaluated by NCCLS guidelines and/or double-disk synergy test in K. pneumoniae blood isolates stored from January, 1998 to April, 2002. Sixty patients with bloodstream infection due to ESBL-producing K. pneumoniae (case patients) were compared with 159 matched control patients with bloodstream infection of non-ESBL-producing K. pneumoniae. Retrospective case-control study was performed. Results : There were no significant differences in age, sex, APACHE Ⅱ score, and the primary site of infection between the case and control groups. In multivariate analysis, significant independent risk factors associated with bloodstream infection due to ESBL-producing K. pneumoniae were urinary catheterization, invasive procedure within previous 72 hours, and the number of antibiotics administered within previous 30 days. In clinical response at 72 hours after initial antibiotic treatment, complete response rate was higher in the controls (13.3% vs. 40.3%, respectively, P<0.001), however, treatment failure rate was higher in the cases (33.3% vs. 11.9%, respectively, P<0.001). Overall 7-day mortality rates in the cases and the controls were was 20% (12/60) and 15.7% (25/159) (P=0.451), respectively, and overall 30-day mortality rates were 30% (18/60) and 24.5% (39/159), respectively (P=0.410). When the patients with bloodstream infection of ESBL-producing organism were evaluated and the patients who received inadequate definitive antibiotic treatment were excluded, delayed effective antibiotic treatment was found to be not associated with higher mortality. Conclusion : In patients infected with ESBL-producing K. pneumoniae bacteremia, clinical response rate at 72 hours after antimicrobial therapy was lower, but the increase of mortality rate was not significant. Delayed effective antibiotic treatment was not associated with higher mortality, when definitive appropriate antibiotic treatment was prescribed.

선택적 함구증 아동의 임상특성 및 치료경과

홍강의,정선주 대한소아·청소년정신의학회 1995 소아청소년정신의학 Vol.6 No.1

재발성 일과성 허혈 발작을 주소로 내원한 비-안와-대뇌 모균증 1예

강우열,이주헌,성영희,최일수,송홍기,이병철 대한노인병학회 2002 대한노인병학회지 Vol.6 No.3

나사형 임플란트 고정체의 길이, 직경, 플랫폼 형태에 따른 임플란트와 주위조직의 응력분포

강지은,정현주,양홍서 전남대학교 치의학연구소 2002 구강과학 Vol.14 No.1

Seven finite element models were constructed in mandible having single screw-type implant fixture connected to the second premolar-shaped superstructure, in order to evaluate how the length, diameter and platform shape of a screw-type fixture influence the stress in the supporting tissue around fixtures. The superstructure were made using UCLA abutment, and connected to the fixture with abutment screw. Each finite element model was varied in terms of length, diameter, and platform shape of the fixture according to the commercial fixture(3i Implant Innovations Inc, Palm Beach Gardens, FL33410, USA) while the superstructure and the mandible with a single fixture placed in it shared no difference in terms of appearance. In each model, 250N of vertical load was placed on the central pit of an occlusal plane and 250N of oblique load placed on the buccal cusp. The stress distribution in the supporting tissue and the other components was analysed using 2-dimensional Finite element analysis and the maximum stress in each reference area was compared. 1. Under lateral loading, the stress was larger in the larger in the abutment/fixture interface, and in the crestal bone, compared to the stress pattern under vertical loading. 2. The amount of stress at the superstructure was similar regardless of the length, diameter and platform shape of a fixture. 3. Around the longer fixture, the stress was decreased at the bone crest and subjacent cancellous bone and increased in the cancellous bone area apical to the fixture. 4. Around the wider fixture, the stress was decreased at the abutment/fixture interface, and the bone crest and increased in the cancellous bone area apical to the fixture. 5. Around the fixture having wider platform, less stress was resulted at the abutnent/fixture interface and the upper part of the cortical bone, compared to the fixture having standard platform. In short, the stress distribution of the supporting tissue was affected by length, diameter, and platform shape of a fixture, and the fixture which was larger in diameter and length could reduce the stress in the supporting tissues at the bone-fixture interface and bone crest area.

남자대학생의 흡연태도와 행동에 관한 연구

강경진,김정미,민혜영,안소진,오경숙,은경희,이현,이희선,홍주미,김수지 이화여자대학교 간호과학대학 2003 이화간호학회지 Vol.- No.37

There have been so many researches about problems of cigarettes and relation of smoking and heath since 1950's and generally known that smoking is one of the worst factor of increasing disease and mortality. No matter what such many proofs about various problems of smoking have been researched, smoking rate of current male collage students has not been decreased. Besides, most of the researches about cigarette use and its addiction have been focused on the adolescent or adult women smokers or adult male, not male collage student. Therefore, the subject of this study is about smoking attitude and smoking behavior of male collage students by general features. Smoking attitude was analyzed by modifying 'Guidelines for the content of tobacco smoking surveys of the general population'(WHO, 1982). Two hundred of male collage students participated to the distributed questionnaire for one week in May. The smoking attitude was categorized into duration of smoking and number of cigarette per day(CPD), and nicotine dependency, investigated by Fagerstrom Tolerance Questionnaire(FTQ) (Fagerstorm & Schneider, 1989). All statistics were performed by procedure of SAS according to number, percentage, mean, standard deviation, and ANOVA. The results are as follows: 1. Smoking attitude level was mean 25.73±5.15 marks, ranging from 13 to 39 marks of the total 40 marks. 2. Duration of cigarettes, number of cigarette per day, and nicotine dependency were mean 5.14±2.84 years, 12.88±6.85 pieces, and 4.78±1.69, respectively. 3. Smoking attitude showed significance according to general features such as marital state and allowance, but the significance according to marital state is not valuable because the numerical difference is so big between married one and single that they cannot be compared with each other. 4. Duration of smoking was significant according to general features such as age and allowance. 5. Smoking amount showed significance the factors of age only. 6. ll1ere was no significance in nicotine dependency according to general features. As a result, smoking attitude of male collage student in this study shows moderate level. Smoking attitude and duration is significant according to allowance, and smoking amount is significant according to age. Nicotine dependency according to general features is not significant but comparing with the preceding study about adult male, male collage students in this study are respectively more nicotine-dependent than adult male smokers. In conclusion, the right allowance usage strategies and effective heath education focused on the young are needed. In addition, helpful programs and information spreading strategies are necessary for establishing higher level of smoking attitude. At last, systemic regulations in daily living for ""anti-nico-dependent"" and perspective reforming of male university student are needed for reducing nicotine dependency.

셋트 제품의 컨테이너 적재 알고리즘 개발에 관한 연구

김홍배,노재정,강주선 慶星大學校 1998 論文集 Vol.19 No.1

This study is focused on the methodology for the determination of the loading pattern for set products which can be charactertized by the fact that various kinds of parts should be provided together in order to function as one product such as home appliances or military supplies. This study is composed of the development of the mathematical model and its solution algorithm. The model tries to maximize the utilization rate of the loading space under the condition that the same number of the components of each set product should be loaded. This study can give the loading pattern and present the quantity information on the sub-set products to the user. The result of this study is compared with George & Robinson's algorithm under the same condition that this study is performed.

黃連의 Streptococcus Mutans 10449의 성장 및 pH변화에 미치는 영향

金康柱,禹元洪,田炳薰 대한동의병리학회 1993 동의생리병리학회지 Vol.8 No.-

연구배경 : 최근에는 의학, 약학, 생물학 등의 여러 분야에서 한의학, 특히 한약을 이용한 새로운 치료제의 개발에 많은 관심을 가지게 되었다. 한의학계에서도 한의학의 국제화, 또는 제재의 다양화를 위해서 이러한 노력을 하여야 할 때이라고 사료된다. 이러한 연구의 일환으로 구강세정 및 치아우식증을 예방하기 위한 한약제의 개발을 위하여 항미생물작용을 지닌 생약제가 구강내 세균에 미치는 영향을 연구하게 되었다. 방법 : 黃連抽出液을 제조하여 Streptococcus mutans 10449의 성장에 미치는 영향을 측정하기 위하여 Todd-Hewitt배지를 이용하여 균집락 형성에 미치는 영향을 측정하였다. 결과 : 黃連이 Streptococcus mutans 10449의 성장을 억제하는 효과를 보였으며 рH의 감소를 유발하여 산생성을 억제함을 알 수 있었다. 결론 : 위의 결과를 근거로 하여 黃連이 치아우식증의 새로운 구강세정제 및 치아우식증예방에 치료제로서 개발할 수 있을 것으로 생각된다. It has been reported that Coptidis Rhizama have an antibacterial effect. The purpose of this study is to know the growth rate &the рH change of Streptococcus mutans 10449 by Coptidis Rhizama. Growth rate was measured by optical densith and рH change was measured by рH meter. The growth of Streptococcus mutans 10449 in the absence of Coptidis Rhizama was more than that in the presence of Coptidis Rhizama irrespective of their concentration. The рH of Streptococcus mutans 10449 in the 10% of Coptidis Rhizama was less than that in the control and 1% of Copyidis Rhizama. These results suggest that Coptidis Rhizama might have an inhibitory effect of growth and acid production of S. mutans 10449. Further study is needed to know the effect onb human gingival fibroblast by Coptidis Rhizama.

전산화 신경인지기능검사를 이용한 주의력결핍/과잉운동 장애의 주의력결핍특성에 관한 연구

정선주,신민섭,하규섭,홍강의 대한소아ㆍ청소년정신의학회 1997 소아청소년정신의학 Vol.8 No.2

다량의 하부위장관출혈이 병발된 Vibrio vulnificus 패혈증 1예

최주연,유진홍,한석원,이대훈,최민호,박순민,김연식,김선우,신완식,강문원,강성구 대한화학요법학회 1996 대한화학요법학회지 Vol.14 No.2

최근 저자들은 Vibrio vulnificus 감염에 의해 패혈증 및 이차성 피부 병변을 보인 42세의 남자 환자의 치료중 하부 위장관 출혈이 병발된 1예를 경험하였기에 보고하는 바이다. We experienced a case of Vibrop vulnificus septicemia which showed an unusual manifestation such as hematochezia. The patient was a 42-year-old man with chronic liver disease. The blood and wound culture revealed the organism. During intensive care, he suffered from massive hematochezi for several days. Colonoscopy and abdominal CT showed findings suspicious of ischemic colitis. To our knowledge, this is the first unusual case of V.vulnificus infection which showed massive lower gastrointestinal bleeding.

주의력결핍/과잉운동장애, 주 부주의형과 혼합형간의 지속적 주의력 및 과잉운동의 비교

정선주,서동혁,홍강의 가천의과대학 2000 가천의학 Vol.2 No.1