당뇨병과 동반된 화농성 간농양의 임상상 및 예후인자

오은숙,강무일,이원영,오기원,임동준,이소영,이정민,고승현,김성래,안유배,손현식,윤건호,차봉연,이광우,손호영,강성구 대한당뇨병학회 2000 임상당뇨병 Vol.1 No.1

연구배경: 감염질환은 혈관질환과 함께 당뇨병의 중요한 사망원인의 하나이며, 혈당조절이 불량할수록 감염 빈도가 증가됨은 잘 알려져 있다. 간농양의 발생이 있어서도 당뇨병은 중요한 기저질환 중의 하나이다. 일반적으로 간농양의 가장 흔한 원인균은 Escherichi coli라고 알려져 있으나, 최근 당뇨병을 가진 간농양 환자에서 Klesiella pneumoniae의 검출이 증가되고 있다. 또 최근 연구에 의하면 K.pneumonie가 간농양의 가장 흔한 원인균이며, K. pneumoniae에 의한 간농양은 K.pneumoniae 이외의 균주에 의한 간농양보다 당뇨병과 밀접히 관련되어 있다고 보고된 바 있다. 이에 저자들은 간농양 환자를 대상으로 당뇨병환자의 빈도를 알아보고, 그 원인균 및 특징을 비당뇨병 환자들의 경우와 비교해 보고자 하였다. 방법: 1992년 1월부터 1999년 6월까지 방사선학적 검사 혹은 수술에 의해 간농양이 확인되거나, 경피적 천자나 수술을 통한 배농액 배양, 혹은 혈액 검사에서 원인균이 증명된 182명의 환자를 대상으로 후향적 임상고찰을 실시하였다. 결과: 화농성 농양을 가진 167명의 환자(남:94명, 여:73명)중 당뇨병을 가진 환자는 54명 (남:30명, 여:24명)으로 32.3%를 차지하였다. 환자의 평균나이는 당뇨군에서 62.1 ± 13.4세, 비당뇨군에서는 55.1 ±15.5세로 당뇨군에서 높았으며(p=0.0021), 남녀간의 평균나이 비교 시 두 군 모두 여성의 나이가 의미있게 높았다. 비당뇨군에 비하여 당뇨군의 경우 저알부민혈증의 빈도와 aspartate transaminase가 증가되어있었다. 원인균주는 K. pneumoniae (당뇨군54%, 비당뇨군 39.1%), E. coli(당뇨군 17.5%, 비당뇨군 18.8%), Pseudomonas aeruginosa, Streptococcus viridans, Enterococcus 순이었으며 두 군간의 의미는 차이는 없었으나 K. pneumoniae의 경우 다른 균종에 비해 단독감염의 빈도가 높았다(82.8%). 사망률은 당뇨군에서 16.7%, 비당뇨군에서 7.1%로 당뇨군에서 의미있게 높았으며(p=0.019), 당뇨군에서의 사망환자는 모두 패혈증이 동반되어 있었다. 당뇨환자의 사망군은 생존군에 비해 당뇨병 이환기간이 길고 혼합감염의 빈도가 높았다(p=0.046). 검사실 소견에서는 총 빌리루빈 및 알카리성 포스파타제의 증가가 관찰되어 있었다. 결론: E. coli가 간농양의 주된 원인균이라는 기존 보고와는 달리 당뇨군과 비당뇨군 모두 K. pneumoniae가 간농양의 주된 원인균이었다. 또한 당뇨 유병기간이 길고 당뇨조절이 불량한 환자에서 혼합감염이며 총 빌리루빈 및 알카리성 포스파타제의 증가등과 같은 위험인자가 존재할 경우 사망률이 증가될 수 있으므로 이들 군에서는 적극적인 치료가 필요할 것으로 사료된다. Background: Liver abscesses are commonly associated with underlying disease, particularly diabete mellitus. The number of the liver abscesses caused by Klebslella pneumoniae in diabetic patient has been increased in Korea nowadays. This study was conducted to clarify the clinical presentation and prognostic factors of pyogenic liver abscesses, especially in diabetic patients and to determine the proportion of K. pneunomiae as a pathogen in liver abscess in Korea. Methods: Medical records of 167 patients treated for pyogenic liver abscess from January, 1992 through June, 1999 were reviewed retrospectively in detail. Major Pathogenic organism, clinical manifestations, prognostic factors, the importance of diabetes mellilus as an underlying disease and its effect on clinical features and prognosis were analyzed. Results: Among 167 cases of pyogenic liver abscess, underlying diabetes mellitus was present in 32.3%. The mean age of patients was 62.7 13.4 years in diabetic liver abscess group and 55.1 15.5 years in non-diabetic liver abscess group. Most liver abscesses were cryptogenic in origin or secondary to the billary tree diseases. The clinical presentations among the two groups were not significantly different. When compared to patients without diabetes, patients with diabetes had significantly higher proportions of hypoalbuminemia and elevated aspartate transaminase level. The most common organism of the pyogenic abscess was K. pneumoniae in both groups. Percutaneous drainage of the abscess with appropriate antibiotics was the most commonly used therapeutic modality in liver abscess. The mortality rate of diabetic liver abscess is 16.1 % and 7.1% in nondiabetic liver abscess. Complications, especially septicemla, were found more frequently in patients with diabetes than in patients without diabetes (64.8% vs 28.3%, septicemia : 31.5% vs 9.7%). The factors influencing mortality in the diabetic liver abscess were disease duration, mixed infection, presence of septicemia, elevated bilirubin and alkaline phosphatase. Conclusions: In contrast to prior report that the E. coli was the most common pathogen in liver abscess, we found that K. pneumoniae was the most common organism cultured in liver abscess. Diabetic patients have more complications and higher mortality than patients without diabetes. Early detection and proper treatment are needed to improve the outcome for diabetic patient with liver abscess.

주상골 골절에서 Herbert/Whipple 나사못의 바람직한 위치 : 모형연구 A Model Study

유재두,김종오,윤여헌,고영도,배서영,이정준 대한골절학회 2002 대한골절학회지 Vol.15 No.4

목 적 : 주상골 골절 치료에 사용하는 Herbert/Whipple 나사못의 바람직한 삽입 위치를 알아보고자 하였다. 대상 및 방법 : 4개의 사체에서 분리한 주상골을 이용하여 각 주상골마다 12개씩 주물 모형을 제작하여 대상으로 하였다. 각 모형에서 핀 삽입 안내 장치(jig, Zimmer??)를 이용하여 안내핀(guide wire)을 원위부에서 근위부를 향해 삽입하되 원위부에 A, B, C, D의 4개 근위부에 0, 5, 10의 3개의 지점을 설정하여 총 12가지 방법으로 삽입하였다. 각 모형은 주상골의 장축에 직각인 방향으로 근위부, 요부, 원위부의 세 단면을 만들고 핀 삽입의 흔적과 가장 가까운 피질골 표면과의 거리를 측정하여 이 거리가 대적으로 길 때 안전한 것으로 평가 하였다. 결 과 : 핀 삽입의 흔적과 가장 가까운 표면과의 거리가 근위부에서는 D5, 원위부에서는 C10이 유의하게 길었다. 원위 삽입 위치를 기준으로 하였을 때 근위부에서 C가 유의하게 거리가 길었고 요부, 원위부, 그리고 근위 목표 지점을 기준으로 하였을 때의 측정된 거리는 유의한 차이가 없었다. 결 론 : Herbert/Whipple 나사못의 삽입 위치는 근위부 골절에서는 D5군, 원위부 골절에서는 C5군이 가장 바람직한 위치라고 할 수 있엇고 요부 골절에서는 A0군과 D0군을 제외하면 별 다른 차이 없이 비교적 안전하다고 할 수 있다. 바람직한 위치 선정을 위해서는 근위부의 목표지점보다 원위부의 지점을 정확히 하는 것이 중요하다고 사료된다. Purpose : To evaluate optimal placement of the Herbert/Whipple screw in scaphoid fracture Materials and Methods: Forty eight model molded from four cadaver scaphoids were used for this study. Using the Herbert/Whipple jig, the guide wire was placed distal to proximal into each scaphoid with twelve method which were four entry points and three target points. Guide wire placement was then evaluated with three planes in the proximal, middle, distal planes and distance from the nearest cortex. Results : The most concentric position in the proximal plane was D5, in the middle plane C10. As distal entry point, the most concentric position in proximal plane was C. There were no statistical concentric, as middle, distal plane, and proximal entry point, Conclusion : The most ideal placement were D5 in proximal fractures of the scaphoid, C5 in distal fractures. In waist fractures of the scaphoid, there were relatively safe, except A0 and D0. The position of entry points was more important than that of target points for ideal screw placement.

오스테나이트계 스테인리스강과 SM45C의 연속파형 Nd:YAG 레이저 용접특성비교

유영태,오용석,노경보,임기건 한국공작기계학회 2003 한국생산제조학회지 Vol.12 No.3

Welding characteristics of austienite 304 stainless steel and SM45C using a continuous wave Nd:YAG laser are experimentally investigated. Laser beam welding is increasingly being used in welding of structural steels. The laser welding process is one of the most advanced manufacturing technologies owing to its high speed and deep penetration. The thermal cycles associated with laser welding are generally much faster than those involved in conventional welding processes, leading to a rather small weld zone. Experiments are performed for 304 stainless steel plates changing several process parameter such as laser power, welding speed, shielding gas flow rate, presence of surface pollution, with fixed or variable gap and misalignment between the similar and dissimilar and plates, etc. The Nd:YAG laser welding process is one of the most advanced manufacturing technologies owing to its high speed and penetration. This paper describes the weld ability of SM45C carbon steel for machine structural use by Nd:YAG laser. The follow conclusions can be drawn that laser power and welding speed have a pronounced effect on size and shape of the fusion zone. Increase in welding speed resulted in an increase in weld depth/aspect ratio and hence a decrease in the fusion zone size. The penetration depth increased with the increase in laser power.

오스테나이트계 304 스테인레스강과 Nd-YAG 레이저빔과의 상호작용

유영태,오용석,노경보,임인호 조선대학교 에너지.자원신기술연구소 2002 에너지·자원신기술연구소 논문지 Vol.24 No.1

Laser beam welding is increasingly being used in welding of structural steels. The laser welding process is one of the most advanced manufacturing technologies owing to its high speed and penetration. The thermal cycles associated with laser welding are generally much faster than those involved in conventional arc welding processes, leading to a rather small weld zone. The experiments are performed for 304 stainless steel plate applying variation of : laser power(600~2000W), welding speed (3~10m/min), shielding gas flow rate, presence of surface pollution, with fixed or variable gap and misalignment between the similar and dissimilar and plates, etc. The variation of brightness temperature versus modification of operational parameters is found, certain typical welding defects can be detected.

오스테나이트계 304 스테인레스강의 Nd:YAG 레이저 초점크기와 용접특성

유영태,오용석,노경보 조선대학교 에너지.자원신기술연구소 2002 에너지·자원신기술연구소 논문지 Vol.24 No.2

Laser beam welding is increasingly being used in welding of structural steels. The laser welding process is one of the most advanced manufacturing technologies owing to its high speed and penetration. The thermal cycles associated with laser welding are generally much faster than those involved in conventional arc welding processes, leading to a rather small weld zone. The experiments are performed for 304 stainless steel plate applying variation of : laser power(1500~2000W), welding speed (3~5m/min), shielding gas flow rate, presence of surface pollution, with fixed or variable gap and misalignment between the similar and dissimilar and plates, etc. The follow conclusions can be drawen that unlikely laser power, welding speed has a pronounced effect on size and shape of the fusion zone. Increase in welding speed resulted inan increase in weld depth/ welding ratio and hence a decrease in the fusion zone size. The penetration depth increased with the increase in laser power.

연속파형 Nd:YAG SM45C 레이저 용접의 결함 감소연구

유영태,오용석,노경보,신호준 朝鮮大學校 機械技術硏究所 2003 機械技術硏究 Vol.6 No.1

본 연구에서는 Nd:YAG 연속파형 레이저를 이용하여 레이저 용접시 레이저빔의 출력에 대한 레이저범의 이송속도를 변화시켜 심입용접을 실시했다. 열처리를 하지 않고 용접을 실시했을 경우 매우 조대한 기공이 많이 발생하였지만 열처리 후 용접을 실시했을 때는 몇몇 미세한 기공만 발생하였다. Present investigation reports on the effect of incorporating pre-heating on the mechanical properties of laser weldi'ng joints. The Nd:YAG laser in combination with the optical fiber increase the automation and the flexibility of a whole industry. The Nd:YAG laser welding process is one of the most advenced menufacturing technologies owing to its high sped and penetration. This paper describes the weldability of Sh4456 carbon steel fox machine structural use by Nd:YAG laser. Optical microscopy SEM were performed to observe the micro structures and to determine the structures of welded zone. In addtion, mechanical propreties, were measured by tensile test to evaluate the formablity of the welded specimen. The results show that proper selection of the control parameters for per-heating technique can result the porosity and cracking of the welding significantly, and improve the welded joints mechanical properties, such as higher tensile strength and better durability.

플륨 모니터링에 의한 SM45C 레이저 용접특성 평가

유영태,김재열,노경보,양동조,오용석,임기건,김지환 한국공작기계학회 2003 한국생산제조학회지 Vol.12 No.6

With the increased use of lasers in industrial welding applications, techniques for monitoring and controlling these processes become increasingly important. It is very important that we understand the dynamic behaviors of the laser induced plume in welding because the laser induced plume has considerable effects on welding efficiency and the quality of materials. As the plume fluctuation was associated with keyhole instability, unstable vapor plume indicated the process was unstable and would result in poor welds. An Infrared Themal-vision Camera can be utilized compensate for incurracies encountered in real-time monitoring during laser welding. We have results that instabilities of plume are closely dated with hot cracking and defect of laser welding.

모 제약회사 근로자들의 직업성 천식 유병률과 약제 분말 노출수준

오성수,최용휴,김은아,이영목,장재길,유장진,박승현,김태균,정수영,김규상,강성규 大韓産業醫學會 2006 대한직업환경의학회지 Vol.18 No.2

목적: 제약회사에서 직업상 천식의 유병 규모를 파악하고 작업공정에 대한 작업환경 측정을 통해 제약회사의 약제 분말에 대한 노출수준을 평가하고자 하였다. 방법: 제약회사에서 약제 분말에 노출되는 근로자를 대상으로 천식을 선별하기 위하여 설문조사 및 진찰, 혈액검사, 폐기능 검사 그리고 피부단자시험을 실시하였고, 각 부서별 공정에 따라서 총분진과 항생제 또는 효소제 분말에 대한 작업환경 측정을 실시하였다. 직업상 천식이 의심되는 근로자에 대하여 기관지과민성에 대한 검사(메타콜린을 이용한 비특이 기관지유발시험)와 약제 분말 기관지유발시험을 실시하여 확진하였다. 결과: 설문조사 및 진찰에서 작업 관련 천식 증상이 있는 근로자는 11명(34.4%)이었고, 약제 분말을 이용한 피부단자시험에서 1+ 이상 반응을 보인 근로자 10명(31.2%)이었다. 비특이 기관지유발시험 결과 8명(25.0%)이 양성(PC20 ≤16 mg/ml)이었다. 약제 분말 기관지유발시험을 통해 직업상 천식으로 확진된 근로자는 5명(15.6%)이었다. 작업환경 측정에서 원료를 충진하거나 투입하는 작업 그리고 정립작업에서 약제 분말에 대한 노출이 많았다. 결론: 제약회사에서 직업상 천식은 주로 제조공정 중 약제 분말에 노출된 근로자에서 발생하여, 증상 및 직업성 천식의 유병률이 높았다. 따라서 원료를 충진 또는 투입하는 작업과 정립작업 등 제조과적에서 약제 분말 노출을 줄이기 위한 세심한 주의가 필요하여, 약제 분말을 취급하는 근로자에 대해서는 천식 증상 조사뿐 아니라 정기적으로 피부단자시험, 비특이 기관지유발시험 등을 실시하여야 할 것이다. Objectives: After the investigation of one worker with occupational asthma, we surveyed the preva- lence of occupational asthma and the exposure level of pharmaceutical dust of 32 workers in a pharmaceutical company. Methods: Thirty-two of the 90 employees participated in the survey which consisted of questionnaire, blood sampling, spirometry and skin prick tests with 8 common allergens as well as 9 antibiotics and 2 enzymes. Various indices of the working environment were also measured. Subjects who had a symptom suggestive of work-related asthma or positive skin prick test were further investigated by PC20 methacholine. Nine subjects who had a PC20 result of 16 mg/ml or less (n=7) or had work-related symptoms and positive skin prick test (n=2) were referred to undergo a specific bronchial provocation test to phar- maceutical dust in an academic allergic disease center. Results: Eleven of 32 workers (34.4%) had a work-related symptom suggestive of occupational asthma. Ten (31.2%) showed positive skin prick test. 8 (25.0%) had a PC20 result of 16 mg/ml or less (indicative of significant bronchial hyperresponsiveness), and 5 (15.6%) had a positive result on the specific bronchial provocation test. Exposure levels of stuffing, input of raw materials and screening process were relatively high. Conclusions: This survey showed that pharmaceutical workers have an increased risk of occupational asthma. Although pharmaceutical factories maintain a relatively good working environment, careful control of respiratory tract exposures, especially during stuffing, input or raw materials and screening process, is important to prevent occupational asthma. Pharmaceutical workers need to undergo regular skin prick and methacholine bronchial provocation tests, as well as asthmatic symptom survey, to ensure the early detection and prevention of occupational asthma.

병·의원에서 분리한 메티실린 내성 황색포도알균에서 SCCmec 유형과 Aminoglycoside 변형효소 유전자의 분포

정영희,김광욱,차정옥,이경민,유재일,유정식,김봉수,노영주,윤혜령,이영선 대한감염학회 2008 감염과 화학요법 Vol.40 No.1

목적 : 대부분의 AME 효소 유전자는 transposon이나 plasmid 상태로 전달되며 staphylococcal chromosomal cassette mec (SCCmec) 내에도 삽입되어 있다. 최근 MRSA의 SCCmec 유형에 따라 다양한 내성유전자를 가지는 것으로 보고되고 있다. 따라서 1, 2차 의료기관에서 분리된 황색포도알균의 항생제 내성률을 조사하고 MRSA에서 SCCmec type에 따른 AME 효소 유전자의 분포를 확인하였다. 재료 및 방법 : 2004년 1, 2차 의료기관에서 분리된 황색포도알균 640주를 대상으로 methicillin의 내성유전자 mecA와 AME 효소 유전자 aac(6')-aph(2"), aph(3')-IIIa, ant(4')-Ia 등을 multiplex PCR 방법을 이용하여 확인하였다. 항생제 감수성 시험과 MIC 값은 한천배지 희석법으로 확인하였고 SCCmec type도 결정하였다. 결과 : 640주의 황색포도알균 중 MRSA을은 39.7%였으며 MRSA 분리주 모두 mecA 유전자가 검출되었다. Aminoglycoside 중 kanamycin, tobramycin에 대한 내성률은 98.1%이었고, gentamicin 68.7%, amikacin 30.8%, netilomicin 2.8%이었으며 vancomycm에는 모두 감수성이었다. Oxacillin MIC_50과 MIC_90은 각각 128 ug/mL, 256 ug/mL이었으며 254주의 MRSA 중 214주를 선별하여 AME 효소 유전자를 확인한 결과 aph(3')-IIIa 13.1%, aad(6')-aph(2") 77.1%, ant(4)-Ia 53.3%이었으며 SCCmec type에 따라서는 type II, type III, type IV가 각각 50.9%, 16.4%, 32.7%였다. SCCmec type에 따른 AME 효소 유전자의 분포는 SCCmec type II에서는 aac(6')-aph(2")와 aac(6')-aph(2")/ant(4')-Ia가 각각 49.5%, 36.7%에서 검출되었고 type III에서는 aph(3')-IIIa/aac(6')-aph(2")가 60%, aac(6')-aph(2")가 31.4%, type IV에서는 aac(6')-aph(2")/ant(4')-Ia와 ant(4')-Ia가 각각 41.4%, 50%로 나타났다. 결론 : 1, 2차 의료기관에서 분리한 황색포도알균 분리주의 메티실린 내성률은 39.7%이었다. MRSA 분리주 중 SCCmec type II와 III에서는 aac(6')-aph(2")가, SCCmec type IV에서는 ant(4')-Ia가 90% 이상 검출되어 SCCmec type과 AME 효소 유전자 분포와는 연관성이 있는 것으로 나타났다. Background : Many genes encoding aminoglycoside modifying enzymes (AMEs) on transposon or plasmid were transferred from one strain to another strain and inserted into a staphylococcal chromosomal cassette mec (SCCmec). There are very diverse subtypes in SCCmec type to the insertion of resistant genes. Therefore, we researched the resistance rates of antibiotics and distribution of AME genes according to SCCmec type in MRSA strains. Materials and Methods : We isolated 640 Staphylococcus aureus from non-tertiary hospitals in 2004, detected mecA, aac(6')-aph(2"), aph(3')-llla, and ant(4')-la using the multiplex PCR method, tested antibacterial susceptibility disk diffusion and minimal inhibitory concentration, and determined SCCmec type. Results : Of 640 S. aureus isolates, MRSA rate was 39.7% and all MRSA isolates carried mecA gene. Among 214 MRSA selected, aminoglycoside-resistant rates were 98.1% in kanamycin and tobramycin, 68.7% in gentamicin, 30.8% in amikacin, and 2.8% in netilmicin. The detection rates for aac(6')-aph(2"), aph(3')-llla, and ant(4')-la were 77.1%, 13.1%, and 53.3%, respectively. Also, SCCmec type was 50.9% in SCCmec type II, 16.4% in type Ill, and 32.7% in type IV. The genes encoding AMEs were distributed aac(6')-aph(2") (49.5%) and aac(6')-aph(2")/ant(4')-la (36.7%) in SCCmec type II, aph(3')-llla/aaac(6')-aph(2") (60%) and aac(6')-aph(2") (31.4%) in type III, and aac(6')-aph(2")/ant(4')-la (41.4%) and ant(4')-la (50%) in type IV. Conclusion : 39.7% of S. aureus isolated from non-tertiary hospitals was resistant to methicillin. More than 90% of MRSA isolates were detected aac(6')-aph(2") in SCCmec type II and Ill, and ant(4')-la in type IV. With these results, the genes encoding AMEs may be closed related to SCCmec type.

서울지역 여대생들의 떡에 대한 인식 및 섭취 실태 조사

김영순,오순덕,김향미,신지홍,김현경,배유미,조규영,조성환 高麗大學校 倂設 保健大學 保健科學硏究所 2003 保健科學論集 Vol.29 No.1

This study conducted a survey of the improvement and popularization for Korea Rice Cakes, a Korean traditional food, on two hundred women students in five colleges in Seoul, Korea. It was investigated to get the information of the recognition, preference, and consumption patterns for the succession and improvement of Korean Rice Cakes. The results are as follows: 1. A portion of 41.5% among responders knows from three to six kinds of Korean Rice Cakes, and of 28% can make at least one among the kinds of Korean Rice Cakes. 2. A portion of 91% recognizes that Korean Rice Cakes are one of well-nourished food, but of 42% answers that Korean Rice Cakes cannot be replaced with the principle food. Also, there are no significant differences in the recognition of Korean Rice Cakes as the kinds of religions. 3. The frequency of purchase is about one or twice in a month (35.5%). Consumers (36.5%) intend to purchase Korean Rice Cakes for the commemoration of national holidays or anniversaries. 4. The reasons for the preference of other foods more than Korean Rice Cakes are the easiness of purchase (36.0%), the deliciousness (21.5%), the diverse kindness (17.5%), and the proper package (9.5%). It is important that constant and particular school / home education is need to improve and success Korean Rice Cakes.