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외과계 감염증에 대한 Sulperazon(Sulbactam/cefoperazone) 및 Cefoperazone의 임상효과 비교연구
박규주,노동영,김상준,권오중,정중기,홍인규 대한화학요법학회 1990 대한화학요법학회지 Vol.8 No.2
Despite recent advances in development of antibiotics and antiseptic techniques, infection still remains to be one of the major problems in the surgical field. Due to development of bacterial resistance to commonly used antibiotics, there is always a need to develop a new antimicrobial agent which would overcome such resistance. Sulperazon (Sulbactam/Cefoperazone) is a combination drug of potent β-lactamase inhigitor, sulbactam, and cefoperazone which has broad antibacterial spectrum, which was developed to combat against β-lactamase producing microorganisms. In an effort to evaluate the efficacy and safety of sulperazone, we have randomly divided 40 patients (12 with perforated appendicitis, 10 with peritionitis, 6 with GB empyema, 6 with periproctal abscess, 3 with wound infection, 1 liver abscess, 1 pancreatic abscess, and 1 acute cholangitis) into 2 groups (20 patients in each group). One group received daily dose of 2 to 3 grams of sulperazon and the other group received daily dose of 2 to 3 grams of cefoperazone. Following results were obtained : 1. Clinical effect of sulperazon was cure in 16 patients (80%), improvement in 3 patients (15%), compaired to cure in 14 patients (70%), improvement in 4 patients (20%) for the cefoperazone group. 2. Using disc diffusion method, sulperazon was sensitive to all of the isolated microorganisms except β-hemolytic streptococci, which was moderately sensitive. Cefoperazone was sensitive to only E. coli, Pseudomonas aeruginosa and Serratia. 3. Microbiological effect of sulperazon was eradication of offending microorganisms in 16 patients (80%), compared to 14 patients (70%) in Cefoperazone group. 4. Overall clinical efficacy of sulperazon was 95%, compared to 80% for cefoperazone. 5. Adverse effects due to sulperazon was nausea and diarrhea which occurred in 1 patient respectively. 2 patients receiving cefoperazone experienced diarrhea. It can be concluded that sulperazon is a safe and effective antibiotic agent which can be used in surgical infection patients.
혈액 투석을 위한 이중내강카세터 (Dual Lumen Catheter; DLC)천자와 관련된 합병증
김상준,권오중,서준석,정중기,강한성 대한혈관외과학회 1998 Vascular Specialist International Vol.14 No.2
Introduction: Central venous catheterization by dual lumen catheter (DLC, Perm Cath^ⓡ) is used for temporary or permanent vascular access. Although it has many advantages such as rapid insertion, emergent usage or long-term maintenance, there are still clinically important complications associated with insertion procedure and maintaining period. Purpose: To define and manage the various kinds of complications is important to avoid repetition of them and to guide for selection of vascular access in long-term hemodialysis patients. Materials and Methods: Between May 1993 and April 1996, we experienced 95 cases of DLC in 88 uremic patients for the following reasons: 12 cases in 12 patients for ARF and 83 cases in 76 patients for ESRD. We used external or internal jugular veins and the method of insertion was percutaneous venipuncture in internal jugular vein (88 cases, Rt.=84, Lt.=4) and venotomy in external jugular vein (7 cases Rt=7). The complications and their therapeutic options were analyzed retrospectively. Results: Group I complication is associated with insertion procedure, including cardiac arrhythmia (n=65, 68.4%), minor air embolism (n=3, 3.2%), hematoma on puncture site (n=15, 15.8%) and difficult catheterization on multipunctured patients (n=3, 3.2%). Group II complication is associated with long term maintanence use of catheters(mean period=8.3 mos) and includes catheter thrombosis (n=15, 15.8%), inadvertent cuff exposure (n=10, 10.5%) and bacteremia (n=16, 16.6%). The management of complications were as followings. Cardiac arrhythmia occurred during guidewire insertion was completely resolved with wire retraction and clinically detected minor air embolism was recovered spontaneously in all cases. Hematoma on puncture site was controlled by compression in 13 cases and 2 cases were resolved after catheter removal. All of the difficult catheterization was solved with fluoroscopic guide insertion. Most of catheter thrombosis were controlled with urokinase infusion (n=13), but in 2 cases, catheter removal was required. All cases of inadvertent cuff exposure led to ascending infection, among them 6 cases were controlled with catheter removal and the rest of them was controlled with aseptic dressing and antibiotics. Five out of 16 cases (5.3%) with bacteremia were not controlled with antibiotics and resulted in catheter removal. Conclusion: To avoid unfavorable complications such as uncontrolled hematoma or bacteremia, fluoroscopic guide insertion and aseptic handling of exit site is important. And it should be remembered that location of cuff should be far from the exit site (>2 cm) to avoid inadvertent traction.
김광식,김상준,윤형진,권오중,서준석,하종원,정중기,홍인규 대한혈관외과학회 1995 Vascular Specialist International Vol.11 No.2
Long patency of vascular access in hemodialysis (HD) patients is crucial for life saving. There are some difficulties in identifying risk factors influencing patency of arteriovenous fistula (AVF). Vein characteristics and technical delicacies as well as patients factors are involved. Among them, surgical factors which may influence at patency rates (PR) of arteriovenous fistula (AVF), should be evaluated. We analysed clinical data of patients who were diagnosed as ESRD and had got AVF operation to maintain HD from January 1988 to December 1994. Results are as follow; Comparing male group and female group, PR are similar and comparing young age ($lt;50) group and old (≥50) age group, aging effect is not definite and frequency of operation had not definite impact on PR. Kind of graft (autogenous or PTFE), number of operation (1st or not), level of operation (forearm or upper arm) were evaluated but results were not confirmative because of large case differences. Diabetic patents had poorer PR significantly (P$lt;0.005) comparing with non -diabetic patients. Concerning anastomotic procedures, side to side group and side to end group had similar PR and group of side to side with distal vein ligation had slightly poorer PR. Considering venous hypertension after side to side procedures in long term follow up periods, side to end procedure may be more suitable procedure.
혈액투석 환자에서 쌍내강 영구도관(Permcath) 사용의 임상적 고찰
서경석,김상준,이건욱,서준석,정중기,홍인규,권오중 대한혈관외과학회 1995 Vascular Specialist International Vol.11 No.1
Between October 1993 and December 1994, we have inserted 57 dacron cuffed double lumen catheters(Permcath, Quinton, Seattle, WA) in 55 renal failure patients for hemodialysis for a mean duration of 2.2 months (range 17 days to 13 months). 4 cases were inserted by surgical venotomy technique and 53 cases by percutaneous technique. Insertion complications were only local hematoma especially in percutaneous technique. Catheters were intentionally removed in 52 patients and two catheters were removed due to complications (infection one catheter, thrombosis one catheter) and the remaining 3 catheters are still placed to pateints. Minor flow problems occurred in 5 cases(9%) and required urokinase infusion (at least once). Local exit site infection occurred 4 cases (7%) and septicemia (at least once) in 3 case (5%). There is no clinical sign of central venous stenosis or thrombosis, such as arm swelling, prominent cataneous collateral veins or increased venous pressure at dialysis even in 3 casees using catheters more than 10 months. This study confirms the low rate of infection and obstruction of the catheter, so we concluded that Permcath is an acceptable vascualr assess device to acute renal failure patients and end stage renal disease patients for hemodialysis waiting for the maturation of arterio-venous fistula or synthetic graft and in whom it is impossible to create an arterio-venous fistula.