아미노글리코사이드 사용제한에 따른 병원성 균혈증 유발 그람음성간균의 내성변화 및 임상적 의의

오종택,김신우,손종원,도병훈,한승우,신병철,박지현,이종명,김능수 대한감염학회 2003 감염과 화학요법 Vol.35 No.4

목적 : 항균제 오남용으로 인한 내성균의 출현, 약물부작용의 발생 및 약제 비용의 증가는 환자 개인뿐만 아니라 사회적으로 문제가 되고 있다. 본 연구는 항생제의 오남용을 막기 위한 제도의 일환으로 시행한 아미노글리코사이드 사용 제한정책의 비용 효과적인 측면을 조사하고 그람음성간균에 의해 병원성 균혈증이 발생한 환자들을 대상으로 이 정책이 항생제 내성률과 환자 사망률에 미치는 영향을 연구하였다. 방법 : 930병상 규모의 3차 병원인 일개 대학병원에서 아미노글리코사이드 사용제한정책이 시행된 직후인 2002년 3월에서 9월 사이에 그람음성간균(Acinetobacter baumannii, Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli, Enterobacter cloacae, Enterobacter aerogenes, Serratia marcescens, Stenotrophomonas maltophilia, Burkholderia cepacia)에 의해 발생한 병원성 균혈증 환자 60명(실험군)과, 이 정책이 시행되기 전에 입원한 환자들 중 균주별로 같은 수만큼 선별한 병원성 균혈증 환자 60명(대조군)의 의무기록을 후향적으로 조사하였다. 결과 : 아미노글리코사이드 사용제한정책이 시행된 시기인 2002년 3월에서 9월 사이에 처방된 아미노글리코사이드 사용량 및 비용을 이 정책이 시행되기 전인 2001년 3월에서 9월 사이와 비교한 결과, 아미노글리코사이드의 사용량(antimicrobial utilization density)은 사용제한 후 225.2에서 130.3으로 42% 감소하였고 약제 비용은 44% 감소하였다. 아미노글리코사이드 사용제한 후 병원성 균혈증을 유발한 그람 음성간균의 이 항생제에 대한 내성률은 유의한 변화를 보이지 않았으며 균혈증과 직접 연관된 사망률도 환자의 나이, 성별, 기저질환 및 원발병소 등을 보정할 경우 유의한 차이를 보이지 않았다(40.4% vs. 24.1%, P=0.11). 결론 : 아미노글리코사이드를 5일을 초과한 사용 시 감염전문가의 사전 승인을 필요로 하는 사용제한정책은 아미노글리코사이드의 사용량과 비용을 유의하게 감소시켰다. 또한 이 정책 시행 후 그람음성간균에 의한 균혈증 환자에서 균혈증으로 인한 사망률과 아미노글리코사이드에 대한 내성률은 유의한 차이가 없었다. Objective : To evaluate the effects of an aminoglycoside restriction policy on expenditures for aminoglycosides, antimicrobial resistance rates and clinical outcome of nosocomial bacteremia caused by Gram-negative bacilli (GNB). Methods : Starting in February, 2002, a prior consultation with an infectious disease specialist for using aminoglycoside antibiotics over 5 days was required in a 930-bed university hospital. In retrospective analysis of medical records 7 months after initiation of the aminoglycoside restriction policy, sixty cases of clinically relevant nosocomial bacteremia caused by GNB were found. These bacteremic patients were compared with sixty, species-matched, control patients with nosocomial Gramnegative bacteremia before the policy for total expenditures for aminoglycosides, susceptibility to antibiotics and clinical outcomes of bacteremia. Results : During the same period of 7 months before and after the restriction policy, total expenditures for aminoglycosides decreased by 44% in cost (from 465,030,841 Won to 259,618,337 Won) and the antimicrobial utilization density of aminoglycosides decreased by 42% (from 225,2 to 130.3). On the other hand, the patterns of antibiotic susceptibility and bacteremia-related in-hospital mortality rates after the policy did not show a significant change, compared with those before the policy. Conclusion : Antibiotic restrictions are among the most popular methods to diminish the practice of antibiotic overuse in hospitals. In this study, requirement for prior approval of aminoglycoside use over 5 days led to a significant decrease in the amount and cost of total aminoglycosides without a significant change in susceptibility patterns and bacteremia-related mortality rates.

맹출성 복잡치아종 : 증례보고 A Case Report

오유향,박종휘,박헌동,설재헌,이병채 조선대학교 구강생물학연구소 2003 口腔生物學硏究 Vol.27 No.1

Odontomas, hamartomas of odontogenic origin, are composed of all the structures that make up teeth The WHO distinguishes odontoma into two types. The complex odontoma is defined as "a malformation in which all the dental tissues are represented. individual tissues being mainly well-formed but occurring in a more or less disorderly Pattern." The compound odomtoma is defined as "a malformation in which all the dental tissues are represented in a more orderly pattern than in the complex odontoma so that the lesion consists of many tooth-like structures. Most of these structures do not resemble morphologically the teeth of normal dentition, but in each one enamel, dentin, cementum and pulp are arranged as in the normal tooth." Although these tumora occur frequently and constitute 22% of all odontogenic tumors, reports on erupted odontomas are very rare. Erupted odontoma are defined as tumors that it occurs a calcified mass may be defected on the alveolar ridge. The final diagnosis should be confirmed by biopsy. The treatment of choice is complete surgical excision, similarly to intraosseous odontoma and it does nat tend to recur. The histopathological report confirmed the diagnosis of complex odontoma. This report presents a case of 8-year-old girl with the calcified mass within the operculum covered the central fossa of the mandibular left fkrst molar. And it was diagnosed as erupted complex odontoma by excisional biopsy.

평면연삭에서 숫돌의 종류와 연삭조건에 따른 표면거칠기 및 연삭숫돌의 파괴

오동석,이병곤,이종훈 한국공작기계학회 2001 한국생산제조학회지 Vol.10 No.4

In this study, the variation of surface roughness was tested in surface grinding for the three winking materials SM45C, heat-treated SM45C, and gray cast iron. It was performed for the various grinding wheels with two grain size #60, #100, and three grade I,O,R and various grinding depths and feeds. The fractural grinding depths which were obtained when the grinding wheels were destructed in surface grinding works, were examined and compared with the calculated value sug-gested in this study. The results showed that the surface roughness was decreased by decreasing grinding depth, and feed, and increasing grain size and grades. The fracture grinding depths were increased by increasing grain size, grade and feed.

내인성 혈장 리튬 농도와 정신분열병

오채근,김종인,이병학,윤재항,김창현,김성재 大韓神經精神醫學會 2007 신경정신의학 Vol.46 No.1

Objectives : The aim of this study was to compare endogenous plasma lithium concentrations among schizophrenic patients classified by DSM-IV subtype and control groups and to investigate the correlation of endogenous plasma lithium concentration and psychotic symptoms in schizophrenia. Methods : Schizophrenic patients were selected among psychiatric inpatients without lithium medication and then classified by DSM-IV schizophrenia subtype, Schizophrenic patient groups were composed of 15 disorganized type, 15 paranoid type and 15 undilferentiated type schizophrenic patients. The control group was composed of 15 healthy subjects without any psychiatric disease,Endogenous plasma lithium concentrations were estimated by inductively coupled plasma atomic emission spectrometer. The psychotic symptoms in schizophrenic patients were classified as positive symptoms, negative symptoms and disorganized symptoms according to andreasen classificationl about SANS and SAPS items. Endogenous plasma lithium Con-centration among three subtypes of schizophrenia and control group was compared, and correlation between endogenous plasma lithium concentrations and psychotic symptoms was examined. Rcsults : 1) Schizoprenic patients showed higher endogenous plasma lithium concentration than control groups (p=0.033). Endogenous plasma lithium concentrations were significantly different among three subtypes of schizophrenia (p=0.001). Compared with the control group, disorganized type showed higher endogenous plasma lithium concentration, but paranoid type and undifferentiated type were not significantly different. 2) Disorganized symptoms correlated with endogenous plasma lithium concentration (r=0.416, P=0.004), but negative symptom and positive symptom did not significantly correlate with endogenous plasma lithium concentration (r=0.202, P=0.184. r= -0.216, P=0.155). Conclusion : These results suggested that schizophrenic patients with disorganized symptom show the differences in utilization or distribution of endogenous lithium.

도시 성장에 따른 공간구조 변화에 관한 연구 : 광주시를 중심으로

오병태,노한종 호남대학교 1998 호남대학교 학술논문집 Vol.19 No.2

This is a study to look at the transition of spatial structure with urban growth. The procedure of urban growth has been clarified by tracing the historical urban planning of Kwang Joo from 1930 to 1998. The purpose of this study is to predict the direction of spatial change and urban expansion by examining the urban form, pattern of function of Kwang Joo with articles on the planning. The size of population, the changing pattern of land use planning and zonning are compared and analyzed to justify the relation with the urban comprehensive planning and circulation planning.

수은폭로 근로자의 조기 신기능 장해 지표로서의 요중 β-Galactosidase 활성도에 관한 연구

오연희,김광종,천병철,박종태 大韓産業醫學會 1995 대한직업환경의학회지 Vol.7 No.1

The objective of this study was to evaluate the relationship between β-galactosidase activity in urine, in serum and urinary N-acetyl-β-glucosaminidase activity as an early indicator of renal effect and mercury concentration in urine and blood, reflecting the intensity of exposure to or the amount of body burden of mercury. This study was carried out among 70 workers exposed to mercury vapor and 63 non-exposed workers as a reference. The results were as follows; 1. The mean concentration of urinary mercury(43.5 ㎍/l) in exposed subjects was about nine times higher than that of non-exposed subjects, but the mean values of blood mercury were not different from each other. 2. The mean values of β-galactosidase activity in urine(119.7μmolMU/h/g creatinine) and in blood(73.7 molMU/h/l) of mercury-exposed subjects were significantly higher than those of non-exposed subjects. 3. In mercury-exposed subjects, β-galactosidase activities in urine(r=0.38, P<0.01) and in serum(r=0.26, P<0.05) were correlated to urinary mercury concentration, but not to blood mercury concentration. The urinary excretion of β-galactosidase activity was closely associated with urinary mercury concentration in the result of the multiple regression analysis. 4. The urinary β-galactosidase activity in exposed subjects increased as the urinary mercury increased, and in the exposed subjects with more than 50㎍/l of urinary mercury was highly related to urinary β-galactosidase activity(r=0.47, P<0.05). 5. Among exposed subjects with more than 50㎍/l of urinary mercury, 20.0% of them showed abnormal value of urinary β-galactosidase activity.

제강 전로 Slag 복토재의 중금속 흡착 특성 연구

손병현,조용말,오광중,정종현 부산대학교 환경문제연구소 1995 環境硏究報 Vol.13 No.-

It has been known that blast furnace slag has abilities to remove heavy metal ions like Cd??,Cr??, and Cr?? in wastewaters and leachate. However the removal efficiency by basic oxygen furnace process slag has not been reported. The removal chcracteristics of heavy metals on BOF-Slag were investigated to develop the landfill leachate attenuation process by the slag cover soil. Specific surface area and pore volume of the BOF-Slag were in the range of 20.27-41.43㎡/g and was increased with decreasing of the particle size. The removal rates of Cr??, Zn??, and Pb?? were affected by reaction temerature, slag particle size, and pH of various heavy metal solution but the effect of temperature was negligible. Freundlich isotherm data indicated that BOF-Slag provided better sorptive for Cr??, Zn??, and Pb?? than BF-Slag did. These results were utilized in developing suggestions for the disposal of industrial waste sludges and dusts in sanitary landfills and for the use of BOF-Slag cover soil.

뇌실외 배액술 시행과 관련된 뇌실염 : 원인균주와 경험적 치료약제의 적절성

도병훈,김신우,오종택,손종원,하상우,이응갑,장현하,이종명,김능수 대한감염학회 2005 감염과 화학요법 Vol.37 No.2

목적 : 본 연구는 뇌실외 배액술을 시행한 신경외과 환자들에서 뇌실염 발생 빈도, 원인균주와 감수성 추이 및 경험적 치료로 사용되는 항생제인 ceftazidime과 vancomycin의 적절성 여부에 대하여 조사하였다. 재료 및 방법 : 2000년 12월부터 2003년 10월까지 EVD를 시행한 경북대학교병원 신경외과 입원환자 340명 중 뇌실염이 발생한 39명을 대상으로 후향적으로 조사하였다. 결과 : 340명 중 39예 (11.5%)에서 뇌실염이 발생하였고 이들 가운데 4명이 뇌실염과 연관하여 사망하였다(10.3%). EVD 시행일로부터 뇌실염 발생까지는 평균 8.4일이었다. 원인균은 33예(87.1%)에서 확인되었으며 Aci-netobacter (19예, 45%), methicillin-resistant coagulase negative Staphylococcus (9예, 22%), methicillin-resistant Staphylococcus aureus (9예, 22%) 등의 순이었다. 가장 많이 동정된 Acinetobacter 19예 중에서 8예(42.1%)가 ceftriaxone에 내성을 보였으며 현재 경험적으로 널리 사용되는 ceftazidime에 대해서는 11예중 3예(27%)가 내성을 보였다. 결론 : 최근 EVD 시행과 관련된 뇌실염 뇌실염 최근 그람음성 non-fermenter 특히 Acinetobacter에 의한 경우가 증가하고 있으며, 이들 그람음성 non-fermenter는 현재까지 경험적으로 사용되는 ceftazidime에 점차 내성을 보이고 있다. 경험적 치료제에 대한 성공률을 높이기 위해서는 각 병원별 내실염의 원인균주의 감수성에 대한 검사가 필요하겠다. Purpose : To investigate the etiologic microorganisms of external ventricular drain (EVD)-related ventriculitis and the appropriateness of using ceftazidime and vancomycin as an empiric therapy in neurosurgical patients with EVD-related ventriculitis. Materials and Methods : Retrospective analysis of 39 patients with EVD-related ventriculitis among 340 neurosurgical patients to whom EVD had been placed during December 2000 and October 2003 at Kyungpook National University Hospital. Results : Thirty-nine EVD-related infections (39/340, 11.5%) occurred and the attributable mortality rate was 10.3% (4/39). The average duration from the ventricular catheter placement to the development of ventriculitis was 8.4 days. All patients with EVD infection had fever and 89.7% (35/39) of the patients showed nuchal rigidity. The positive culture rate in CSF was 87.1% (34/39) and the frequency of individual organism is as follows : Acinetobacter 45% (19 cases), methicillin-resistant coagulase negative Staphylococcus 22% (9 cases), methicillin-resistant Staphylococcus aureus 22% (9 cases), Enterococcus 5% (2 cases), Streptococcus pneumoniae 3% (1 case), non-fermenting gram-negative bacilli 3% (1 case). The polymicrobial infection rate was 15.4% (6/39). Among 19 cases of Acinetobacter infection, 42.1% (8/19) of the strains showed resistance to ceftriaxone and 15.7% (3/11) to ceftazidime. However, all cases were sensitive to meropenem. Conclusion : These findings show that the major etiologic organisms causing EVD-related ventriculitis have recently changed to Gram-negative non-fermenters, especially Acinetobacter. Because Gram-negative non-fermenting rods resistant to ceftazidime are increasing, an immediate change from ceftazidime plus vancomycin, the widely accepted empiric antibiotic therapy, to meropenem plus vancomycin should be considered when clinical symptoms and signs show no improvement or even deterioration.

본교 대학원 발전방안에 관한 연구

김종달,전도웅,전인철,조병권,박영규,오준석,나영일 龍仁大學校 1998 용인대학교 논문집 Vol.15 No.-

The purpose of this study was to suggest the developmental ideas for graduate school in Yougin University. For the methods of this study, the researches in administration of graduate students, personal researches in socialization of graduate school, and evaluation materials for graduate school were utilized. Additionally, the questionnaire survey about graduate students leas administered and analyzed and the ideas constructed from staff meeting for the development of graduate school were applied in preparing developmental plan. The results of this study are summarized as follow: 1. 1-2 years preparation - offers annual credits upto 30 - jop marketing upto 70% - advisor and student ratio 1 : 7 - professors' doctoral degree possession upto 90% - graduate school professors' research achievement upto 2 articles annually - research space per student upto 10m/2 3-4 years preparation - offers annual credits unto 33 - advisor and student ratio 1:4 - professors' doctoral degree possession upto 95% - graduate school professors' research achievement upto 2.5 articles annually 2. The educational goals of graduate school should be recognized among graduate students and the professionality of faculty members should be emphasized to teach graduate students in their relative major areas. The evaluation procedures for graduate class lecture and class administration in graduate school. 3. To reach unto lecture system, field study should be expanded and inter-credit system between Yongin universities and foreign university should be contracted. 4. Expanding of graduate school facilities should be cranked in to provine the optimal environment for the student education and schoolship should be widely offered to the students. 5. To promote the administrational development, the staff system should be changed from reverse hierarchy system to hierarchy system. Therfore, the number in lower administrational staffs should be larger than upper positions. And, the classification of authorities into department could be suggested for the efficacy of administration and management of graduate shool. 6. The specialization in each major should be emphasized. In the calc of graduate stool of physical education, the administration live should be unified in one body system. In the case of graduate school of business, one department of administration could be classified into management of sightseeing and tourism, management of distribution, tax accounting, then the specialty of the department can be forced. In the case of graduate school of art, the specialty can be forced by teaching highly performed skills and needed to switch from special graduate school to professional graduate school. The graduate school of health and school of environmental science are recommended to be built after all. Therefore, the connection between undergraduate and graduate curiculum can be established and open 2-3 more majors in the graduate school.

농산물의 지역브랜드화 및 마케팅전략 개발

李炳旿,高鍾泰 韓國農業政策學會 1999 농업경영정책연구 Vol.26 No.1