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      • 서울의 Penicillinase Producing Neisseria gonorrhoeae 발생빈도(1998)

        김재홍,김준호,반재용,이정우,황성주,정준규,정성태,강진문,조흔정,홍창의,정혜신,이한승,김이선,이봉길,이종호,선영우,한기덕,윤성필,이성훈,안종성,박석범,문승현,조항래,김형섭,류지호,황재영,박준홍,손상욱 한양대학교 의과대학 2001 한양의대 학술지 Vol.21 No.1

        In recent years, gonorrhea has been pandemic and remains one of the most common STDs in the world, especially in developing countries. For the detection of a more effective therapeutic regimen and assessing the prevalence of Penicillinase Producing Neisseria gonorrhoeae(PPNG), we have been trying to study the patients who have visited the Venereal Disease Clinic of Choong-Ku Public Health Center in Seoul since 1980 by menas of the chromogenic cephalosporin method. In 1998, 93 strians of N. genorrhoeae were isolated, among which 60(64.5%) were PPNG. The prevalence of PPNG in Seoul, which had been decreased to 39% in 1996 after a peak of 74.3% in 1993, is increased to 64.5% in 1998.

      • 서울의 PPNG 발생 빈도(1991-1992)

        김재홍,윤기범,박평원,김영진,전경민,김영태,김중환,곽호,구상완,송민석,유옥,지혜구,김동원,문상은,박영립,정승호,성범진,성순제,엄주용,황정열,이기홍,이주협,전태진 대한화학요법학회 1994 대한화학요법학회지 Vol.12 No.1

        The prevalence of PPNG among pretreated gonorrhea cases isolated at the STD clinic of Choong-Ku Public Health Center in Seoul has been studied and reported annually since 1981. In 1991, 123 strains of N.gonorrhoeae were isolated, among which 58(47.1%) were PPNG. In 1992, 98 starains of N.gonorrhoeae were isolated, among which 51(52.0%) were PPNG. In all, 109(49.3%) strains were found to be PPNG among 221 strains isolated between 1991-1992. The prevalence of PPNG in Seoul showed increased tendency till 1989, thereafter, it has been stationary or slightly decreasing.

      • KCI등재후보
      • 급성 백혈병 환자에서 감염증의 양상 및 예후인자에 관한 연구 : 1988년∼1995년까지

        정희진,김병수,신상원,김열홍,김우주,김민자,김준석,박승철,김권범 대한감염학회 1998 감염 Vol.30 No.3

        목적 : 급성 백혈병의 경우 골수기능이 억제되고 항암화학요법에 따른 골수기능 저하로 감염의 위험이 증가하며 감염의 치료가 환자의 생존에 큰 영향을 미치게 된다. 이에 저자들은 1988년부터 1995년까지 고대 구로병원에 급성 백혈병으로 입원했던 환자들 중 입원 기간 내 감염이 있었던 경우를 대상으로 하여 감염의 위험인자 및 감염증의 예후를 후향적으로 분석함으로써 향후 급성 백혈병환자의 감염의 치료에 대한 지침을 얻고자 하였다. 방법 : 급성 백혈병으로 확진된 환자들 중 감염병에 이환된 경우를 대상으로 하여 각각을 미생물학적 확인감염, 임상적 확인감염, 그리고 설명 불가열로 구분하였다. 각각의 경우에서 감염 당시의 호중구 수, 호중구 감소 기간, 항암화학요법과의 연관성, 감염 병소, 배양된 검체 및 원인균, 선택적 소화관 살균법의 사용여부 및 골수회복 여부 등을 조사한 후 환자의 예후와 어떤 관계가 있는 지 조사하였다. 결과 : 연구 대상은 총 113예로 남녀비는 46:67 이었고 평균연령은 34±13세, 진단은 급성 골수성 백혈병 (AML)이 84예, 급성 림프구성 백혈병(ALL)이 29예였으며, 감염시 평균 호중구수는 663±1678/㎣이었고, 호중구 감소 기간은 평균 18±13일이었다. 감염양상은 항암화학요법과 연관된 감염이 84예로 대부분이었고 미생물학적 확인 감염이 40예로서 35%였으며, 폐렴과 원발성 패혈증이 각각 20예와 19예로 가장 많았고, 카테터 연관 감염이 7예로 나타났다. 배양된 균주는 E. coli가 10예(25%)로서 가장 많았으며, 전체적으로 E. coli, P. aeruginosa, K. pneumoniae 등의 그람음성균이 63%로 대부분을 차지하였으나 최근 그람양성구군 및 진균의 분리율이 증가하는 양상을 보였다. 감염증의 예후를 분석한 결과 진균 감염인 경우나 호중구 감소 기간이 긴 경우 사망률이 높았으며 그 중에서도 골수 기능이 회복 여부가 환자들의 생존과 통계적으로 유의한 연관이 있었다.(P=0.01). 결론 : 급성 백혈병 환자들에서의 감염은 관해유도화학요법 후 초래되는 호중구 감소와 유의한 관계가 있으며, 폐렴 및 패혈증의 임상양상을 보이는 경우가 흔하고, 원인균별로는 그람 음성균이 주류를 이루나 최근 그람 양성균 감염이 증가하는 추세를 보였다. 감염의 예후 인자로는 진균 감염인 경우나 호중구 감소 기간이 긴 경우 사망률이 높았으나 골수 기능의 회복여부가 결정적인 역할을 하는 것으로 나타나, 향후 급성 백혈병 환자의 치료에 있어 감염 빈도의 감소와 감염에서의 조속한 회복을 위해서는 골수 기능의 회복에 중점을 두어야 할 것으로 사료된다. Background : Infection is one of the most important and fatal complications in patients with acute leukemia. The characteristics of infection in acute leukemic patients are different from those in other diseases by the lack of normal inflammatory responses or distinct clinical evidence except fever. To improve the outcome of acute leukemia, it is very important to recognize the risk factors, patterns and prognostic factors of acute leukemia. Methods : We analyzed retrospectively the patterns of infection from 113 febrile patients with acute leukemia from January, 1988 to December, 1995. To determine the prognostic factors and the outcome of infection, the following variables were analyzed: the presence of neutropenia, use of chemotherapeutic agents, type and site of infections, isolated organisms, gastrointestinal decontamination, duration of neutropenia, and bone marrow recovery. Results : Out of 113 febrile patients with acute leukemia, 84 infection episodes(74%) occurred after chemotherapy. The mean duration of neutropenia was 18±13 days. The incidence of microbiologically-documented infection(MDI) was 35%(40/113). Pneumonia was the most common infection(26%), followed by primary sepsis(24%), catheter-related infection(9%). In cases of MDI, 63% were caused by gram-negative bacteria, followed by gram-positive bacteria(28%), and fungi(10%). Escherichia coli(25%) was the most common isolated in MDI. Regarding the prognostic factors in cases with infections, the recovery of bone marrow function was the only statistically significant factor(P=0.01). Conclusion : Infection has been a major cause of morbidity and mortality in acute in acute leukemic patients. To prevent infection and thereby improve the prognosis of acute leukemia, restoration of bone marrow function at early stage is important.

      • 내시경적 점막절제술로 치험한 식도 과립상 세포종 1례

        강혁주,김성욱,최석진,이중현,장재식,서영범,윤병구,박건욱,김성자,김용섭,강승완,이구,양창헌,이창우,김욱년,이광헌,서정일 동국대학교 의학연구소 2000 東國醫學 Vol.7 No.-

        과립상 세포종은 Schwann 세포 기원으로 생각되며 인체에 비교적 드물게 발생한다. 과립상 세포종은 전신 어느 곳에서나 발견될 수 있으나 주로 혀, 구강, 피부 혹은 유방 등에서 호발하며 드물게 위장관에서 발견된다. 위장관에서는 식도에서 가장 호발하며 다음으로 위, 대장 순이다. 과립상 세포종은 대부분, 특히 위장관에서는 양성이며 소수의 악성 병변이 보고되었다. 이러한 이유와 함께 수술 전의 진단이 어렵기 때문에 과립상 세포종에 대한 근본적인 치료는 현재까지 외과적 절제술이다. 최근에 시도되는 치료방법들로는 내시경적 레이저 치료, 용종절제술, 내시경적 점막 절제술 등이 있다. 저자들은 상부 소화관 내시경검사를 시행하여 식도 과립상 세포종을 진단하고 내시경적 점막 절제술을 시행하여 합병증 없이 퇴원하여 현재 재발없이 경과 관찰중인 1례를 경험하였기에 보고하는 바이다. Granular cell tumors, which occur infrequently, are probably of Schwann cell origin. They can occur almost anywhere in the body but usually affect the tongue, oral cavity, skin, or breasts and are rarely found in the gastrointestinal tracts. The esophagus is the most frequent gastrointestinal site, followed by the stomach and the colon. Granular cell tumors are generally benign, especially in the gastrointestinal tract, some malignant lesions have been reported. For this reason, and also because preoperative diagnosis is difficult, the standard treatment for granular cell tumor has until now been surgical excision. In recent years, other therapeutic methods is endoscopic laser therapy (ELT), polypectiomy, endoscopic mucosal resection (EMR). We report a case of esophageal granular cell tumor which was diagnosed by an endoscopy and managed using an endoscopic mucosal resection without complication.

      • 부산시 가로수 현황과 토양환경개선에 관한 연구

        김석규,박승범,남정칠,김승환,강영조 동아대학교 건설기술연구소 1999 硏究報告 Vol.23 No.2

        The purpose of this study is to analyze the correlation between soil hardness, soil acidity, and the vitality of street trees. This data was investigatived in 40 areas on 10 main street routes of Pusan; Chungang-ro, Naktong-ro, Suyeong-ro, Taejong-ro, Konghang-ro, Kudeok-ro, Kumjeong-ro, Mandeok-ro, Kaya-ro, Chungjang-ro. The findings are as follows : 1. The average soil hardness where tree grates have been built was shown to be 22.23㎜. In the absence of tree grates, the average soil hardness was 24.60㎜. These figures do not exceed the accepted parameters for acceptable soil hardness when rearing trees (22∼25㎜). However, soil hardness was measured higher in areas where tree grates were absent. Consequently, tree grates are necessary. 2. Soil acidity was measured as satisfactory(pH 5.5), mediocre(pH 5.5∼5.0), inferior(pH 5.0∼4.5), very inferior(pH 4.5). No areas were measured as satisfactory soil acidity. Four areas were measured as mediocre(10%), 19 areas as inferior(47.5%), and 17 areas as very inferior (42.5%). This indicates a requirement to improve soil acidity as about 90% of the investigatived areas were measured as either inferior or very inferior. 3. The following is an analysis of correlation between soil hardness, soil acidity and the vitality of the Ginkgo biloba ; The Ginkgo biloba was found to have a positive correlation was measured with the diagram (R²). In conclusion, the results of the analysis show a strong influence of soil hardness and soil acidity upon the vitality of Street Tree.

      • 상부구조물의 금원주를 레진시멘트로 접착시킨 임프란트 보철물의 파절에 대한 연구

        김승범,배정식 전남대학교 치과대학 1995 전남치대논문집 Vol.7 No.1

        This study was performed to determine the failure strength and pattern of implant prosthesis luted with resin cement between gold cylinder and superstructure, and to evaluate the bonding strength of resin cement. To evaluate failure strength and pattern, the groups were divided into 2. Group 1 : Casted gold cylinder Group 2 : Luted with resin cement between gold cylinder and superstructure. To evaluate effects of the bond strength of the implant prosthesis luted with resin cement according to storage condition, the groups were divided into 3 ; Group A : Stored in water at 37℃ for 24 hours. Group B : 1000 cycles thermocycled between 5℃ and 55℃ in water. Group C : Stored in water at 37℃ for 30 days. The results were as follows ; 1. Failure was found at gold screw in all specimens of group1 & 2. 2. The bond strength in group 1 and 2 was 189.86 and 188.14Kgf. There was no statistically significant difference between group 1 and 2(P>0.05). 3. The bond strength of group A, B and C was 53.28, 45.86 and 39.29Kgf. There was a statistically significant difference among the bond strength in groups A, B and C(P<0.05). The result suggest the advantage of an improved fit of superstructure to the abutment an a simple procedure. But there was a measurable decrease of the bond strength according to storage conditon. So, Further research is necessary to evaluate the implant prosthesis luted with resin cement between gold cylinder and superstructure.

      • KCI등재

        악성종양 적출술과 방사선치료후 형성된 구강내의 관통창의 폐쇄 : 증례보고

        김종배,유재하,김태우,김승범 大韓顎顔面成形再建外科學會 2001 Maxillofacial Plastic Reconstructive Surgery Vol.23 No.6

        The orocutaneous perforated wound can be occurred after the so-called "pull-through" operation involving the resection of intraoral tumor, radical neck dissection and reconstruction, owing to inaccurate coaptation of soft tissue and wound infection. The postoperative orocutaneous through and through open wound is healed & closed by homeostatic wound contraction if soft tissue drainage was well established, which seldom is interfered with local or systemic abnormalities. But, the fistula may not be closed owing to the accumulated damage of radiation theraphy, because the therapy induce the 3-H(hypoxic, hypocellular, hypovascular) condition in future. Because the hyperbaric oxygen therapy has the improved effects of the 3-H condition, such as , fibroblast proliferation, neovascularization and increased phagocytosis of leukocytes, the therapy is useful for the control of radiation-induced ischemic orocutaneous wound infection. If the refractory orocutaneous fistula is remained in spite of the infection control by use of the continuous wound drainage and hyperbaric oxygen therapy, the fistula should be closed with the two-flap technique. Its operative procedure is suturing the minor flap to line oral floor and then transposing the larger flap to provide skin coverage. The authors treated the male patients with the refractory orocutaneous fistula by these methods, such as, continuous drainage, hyperbaric oxygen therapy and two flap technique. The prognosis of these therpies was favorable during 10years.

      • KCI등재후보

        삼출성 늑막액에서 양악성 감별지표로서 CEA, TPA, SCC Ag 측정의 의의

        김경찬,김민수,김미정,권두영,한승범,전영준 啓明大學校 醫科大學 1998 계명의대학술지 Vol.17 No.4

        상피 세포에서 기원한 대표적인 종양표지자인 carcinoembryonic antigen (이하 CEA로 약함)은 삼출성 늑막액 환자의 양악성 감별에 보고적으로 사용되고 있다. CEA 이외에 혈청에서 양악성감별의 보조적 지표로 알려진 tissue polypeptide antigen (이하 TPA로 약함)과 squamous cell carcinoma antigen (이하 SCC Ag으로 약함)을 혈청과 늑막에서 동시 측정하여 늑막삼출액의 악성 감별에 어느 정도의 임상적인 유용성이 있는지를 알아보기 위하여 이 연구를 시행하였다. 1997년 1월 1일부터 동년 8월 31일까지 계명대학교 동산의료원에 입원한 환자들 중 삼출성늑막액을 가진 61명을 대상으로 하여 혈청과 늑막액에서 CEA, TPA, SCC Ag의 수치를 방사면역법으로 측정하였다. 각각의 조양표지자들은 악성과 양성군으로 구분한 뒤 분석하였으며 악성군이 28례, 양성군이 33례이었다. 그리고 진단양성기준치를 설정한 뒤 종양표지자들의 특이도, 민감도를 산출하였고 상기 지표들을 종양표지자와 늑막액 세포검사르 조합한 경우에도 산출하여 비교 분석하였다. 혈청 CEA 와 TPA는 각각 7.0 ng/ml, 80.0 ng/ml, 늑막액 CEA와 TPA는 각각 50. ng/ml, 4700.0 ng/ml로 진단양성기준치를 설정하였을 때 특이도를 낮추지 않으면서 가장 높은 민감도를 보였다. 늑막액 세포검사와 동시에 혈청 TPA 도는 늑막액 CEA를 측정하였을 때 특이도는 떨어뜨리지 않으면서 민감도를 높이는 좋은 조합인 것으로 나타났으며 혈청 CEA 및 TPA수치를 늑막액 세포검사와 도시에 시행하였을 때 특이도를 떨어뜨리지 않으면서 가장 높은 민감도를 얻었다. 늑막액 세포검사가 음성인 경우에도 혈청 CEA와 TPA를 동시에 측정하여 높은 민감도와 특이도를 얻을 수 있었다. 따라서 CEA와 TPA는 늑막삼출액의 양악성 감별 진단 유용한 보조적 지표로서 사용할 수 있을 것으로 판단된다. Carcinoembryonic antigen(CEA), the most widely used tumor marker was measured in pleural fluid of patients with exudative pleural effusions in order to differentiate malignant from benign effusions. This study was performed to find out if there is any clinical utility in differential diagnosis of malignancy by measuring simultaneously CEA, tissue polypeptide antigen(TPA) and squamous cell carcinoma antigen(SCC Ag) in serum and pleural fluid. The study population was 61 patients with exudative pleural effusions who were admitted to Keimyung University Hospital from January 1 to August 31, 1997. Each CEA, TPA and SCC Ag level in serum and pleural fluid were measured using radioimmunoassay method. These patients were divided to malignant and benign group. Malignant group consists of 28 cases and benign group consists of 33 cases. And the sensitivity and specificity of each tumor marker was obtained using cut-off value and that combining tumor markers and pleural fluid cytology were also obtained and analyzed. When the cut-off value was applied to CEA and TPA in serum using 7.0 ng/ml and 80.0 ng/ml respectively, the highest sensitivity was obtained without specificity being lowered. The same result was obtained when the cut-off value was applied to CEA and TPA in pleural fluid using 5.0 ng/ml and 4700.0 ng/ml respectively. When CEA in pleural fluid or TPA in serum were measured in combining with pleural fluid cytology sensitivity was increased without decreasing specificity than measured in pleural fluid cytology alone. When CEA in serum and TPA in serum were measured in combining with pleural fluid cytology simultaneously, the highest sensitivity was produced without decreasing specificity than measured in any other combinations. In addition, when serum CEA and TPA in serum were measured in the negative group of pleural fluid cytology, high sensitivity and specificity were obtained. These data suggest that CEA and TPA can be used as useful tumor markers for the differential diagnosis of malignancy and benign condition in patients with exudative pleural effusions.

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