토끼 수막염 모델을 이용한 다제내성 폐렴구균에 대한 Meropenem의 치료 효과

김신우,진정화,강수정,정숙인,김연숙,기현균,김춘관,이혁,김성민,백경란,송재훈 대한화학요법학회 2001 대한화학요법학회지 Vol.19 No.1

목적 : 다제내성 폐렴구균에 의한 수막염은 기존과 단일 항생제로는 근치가 어려워 ceftriaxone과 vancomycin 혹은 rifampin의 병용요법이 권유되고 있다. 다제내성 폐렴구균에 사용할 수 있는 다른 약제 중 meropenem은 시험관내 폐렴구균에 대한 항균력이 좋고 경련 등의 중추신경계 부작용이 거의 없어 다제내성 폐렴구균에 의한 수막염의 치료에 이용할 수 있을 것으로 기대되나 이에 대한 자료가 매우 부족한 상태이다. 이에 연자 등은 meropenem과 meropenem+vancomycin의 병용요법이 다제내성 폐렴구균 수막염의 치료에 효과가 있는지를 토끼 수막염 동물 모델을 이용하여 검증하고자 하였다. 방법 : 인체에서 수막염을 일으킨 다제내성 폐렴구균 균주(penicillin MIC 2, ceftriaxone MIC 4, meropenem MIC 0.5㎍/㎖)를 토끼 척수강 내에 직접 주입하여 수막염을 유발한 후 ceftriaxone, vancomycin, rifampin, meropenem의 단일 항균요법, ceftriaxone+vancomycin, ceftriaxone+rifampin, meropenem+vancomycin의 병용요법 간에 치료 효과의 차이를 비교 하였다. 각 치료군은 6 마리의 토끼를 대상으로 하였다. 각각의 항생제는 5 시간 간격으로 2번 정주하였으며, ceftriaxone은 1회 투여하였다. 균주 주입 후 각 치료군이 토끼에서 치료 후 0, 5, 10, 24 시간에 척수액을 채취하여 균주의 수를 측정하여 24시간째의 살균 여부를 최종 치료 효과로 판정하였다. 결과 : meropenem 단독 요법은 10시간째에 모든 균주를 살균하였으나 24시간 째에 다시 균의 성장이 관찰되었으며, meropenem+vancomycin의 병용요법은 단독 약제보다 우수한 살균효과를 보였으나 상승작용은 없었다. 결론 : meropenem+vancomycin의 병용요법은 기존의 ceftriaxone+vancomycin보다 24시간째에 더 큰 균의 감소 경향을 보여(P=0.054) 임상에서 사용이 가능할 것으로 기대되며 향후 실제 수막염 환자에서의 임상효과를 증명하는 연구가 필요할 것으로 생각된다. Background : Because antimicrobial monotherapy for pneumococcal meningitis caused by penicillin-resistant strains is not satisfactory, ceftriaxone+vancomycin [C+V] or ceftriaxone+rifampin [C+R] regimens are recommended. Meropenern [M] is one of the monotherapy options for penicillin-resistant pneumococcal meningitis due to good in-vitro activity against pneumococci and rare adverse reactions in CNS. But there have been few reports in the efficacy of meropenern against pneumococcal meningitis. We evaluated therapeutic efficacy of the meropenern and meropenem+vancomycin in a rabbit model of meningitis caused by penicillin-resistant S. pneumoniae (PRSP). Methods : Meningitis was induced by intracistemal inoculation of a pneumococcal strain isolated from a patient with meningitis (MIC; penicillin 2, ceftriaxone 4, meropenem 0.5 g/㎖). Bacterial concentrations in the CSF were measured at 0, 5, 10, and 24 h after therapy was started. Therapeutic efficacy was evaluated by the final bacterial concentration in the CSF at 24 h. Results : C+V cleared the CSF at 10 h, but regrowth of bacteria was noted at 24 h. Meropenem monotherapy resulted in sterilization at 10 h but regrowth at 24 h. M+V was superior to M or V monotherapy but did not show synergism. Therapeutic efficacy of M+V was at least equal or superior to that of C+V (P = 0.054). Conclusion : Meropenem+vancomycin regimen could be one of the useful options in the treatment of PRSP meningitis. Clinical trials to evaluate the M or M +V are warranted in the future.

조직학적 진단된 chronic necrotizing pulmonary aspergillosis 2예

김연숙,정숙인,기현균,김춘관,김신우,한정호,김성민,백경란,송재훈 대한화학요법학회 2000 대한화학요법학회지 Vol.18 No.1

CNPA는 기존의 폐질환 및 폐절제술로 인해 국소방어기전에 저하가 있거나 비특이적 전신면역상태저하를 갖고 있는 환자들에게서 주로 발생하는 만성적인 공동성 폐질환이다. 현재까지 우리나라에서는 CNPA의 보고가 없는 상태이고, 저자들은 최근 조직학적으로 진단된 CNPA 2예를 경험하였기에 보고하는 바이다. 저자들이 경험한 CNPA 환자들은 만성알코올 중독 및 기관지확장증과 같은 기저질환과 폐절제술을 받은 병력이 있었다. Aspergillus가 폐실질을 침윤하고 있는 조직소견과 조직배양에서 Aspergillus가 검출되어 조직학적 진단이 가능하였고, amphotericin B의 정주요법 및 경구 itraconazole 투여와 폐절제술 등으로 성공적으로 치료되었다. 아직 많은 임상의들에게는 낯선 질환인 CNPA의 치료성적은 환자의 동반질환 및 CNPA 자체의 중증도, 진단과 치료 시작의 지연 등에 의해 크게 좌우되므로 만성적으로 진행하는 공동성 폐병변을 갖고 있는 환자에게서 CNPA를 감별하는 것이 중요하다. Chronic necrotizing pulmonary aspergillosis (CNPA) is a chronic cavitary form of pulmonary aspergillosis. Dozens of CNPA cases have been reported in patients with systemic immunologic dysfunction or altered local defense mechanism from preexisting pulmonary disease. Review of literatures revealed that no CNPA cases have been reported in Korea yet. We experienced two cases of CNPA proven by lung biopsy. A 53-year-old alcoholic male in poor nutritional state was admitted with generalized weakness and weight loss. Chest CT revealed a cavitary nodule surrounded with ground-glass attenuation. CT-guided fine needle aspiration and biopsy was done. The biopsy specimen demonstrated dichotomously branching septated hyphae consistent with those of Aspergillus sp. Another case was a 39-year-old man with bronchiectasis who was admitted with persistent hemoptysis. He had a past history of pulmonary tuberculosis. A parahilar lesion with intracavitary soft tissue mass was incidentally detected in high-resolution GT. Left lingular segmentectomy was done due to uncontrolled hemoptysis and CNPA was histologically diagnosed. Both patients were successfully treated with intravenous amphotericin B followed by oral itraconazole. Even though CNPA is unfamiliar to most clinicians, it should be included in differential diagnoses of chronic progressive cavitary pulmonary lesion, especially in patients with immunologic dysfunction.

일개 대학병원에서 경험한 방선균증의 임상상

정숙인,김연숙,기현균,김춘관,김신우,이혁,김성민,백경란,송재훈 대한화학요법학회 1999 대한화학요법학회지 Vol.17 No.3

배경 : 방선균증은 혐기성의 그람양성 간균에 의한 만성 화농성 감염으로, 경안면부, 흉부, 복부, 골반부 등을 주로 침범한다. 최근 구강 위생의 향상과 항생제의 사용으로 인해 방선균증의 빈도의 감소와 함께 그 임상양상 또한 크게 변화하였다. 저자들은 국내에서의 방선균증의 임상상을 분석하기 위해 본 연구를 시행하였다. 방법 : 1995년 5월부터 1998년 9월까지 삼성서울병원에서 방선균증으로 진단받은 환자를 대상으로 임상기록지를 토대로 감염병소와 임상경과 등을 후향적으로 조사하였다. 결과 : 방선균증 환자는 모두 12명으로 경안면부 1례, 흉부 3례, 복부 3례, 골반부 5례였다. 임상양상은 주로 종괴의 형태로 나타나 진단을 내리기까지 종양과의 감별에 어려웠으며 진단은 모두 조직검사나 흡인액에서 유황과립을 확인함으로써 이루어졌다. 방선균증으로 진단된 환자는 모두 호전소견을 보였다. 결론 : 국내에서도 방선균증이 드물지 않게 발생하고 있으며 임상양상이 다양하여 가장 많이 오진되는 질환 중의 하나이다. 방선균증은 조직검사나 균배양검사를 통해 진단하고 항생제를 통해 완치될 수 있는 질환이므로 환자 진단에 관심을 가지면 불필요한 수술을 피할 수 있을 것으로 생각된다. Background: Actinomycosis is an indolent, slowly progressive bacterial infection, caused by Actinomyces. a gram-positive, non-spore-forming anaerobic or microaerophilic rod. Actinomycosis affects nearly every organ and body site. The disease is classically divided into four types, depending on the anatomic sites involved: cervicofacial, thoracic, abdominal, and pelvic. It has been considered as a rare disease, and only several cases have been reported in Korea. We performed this study to analyse the clinical manifestations of actinomycosis in Korea. Method: We retrospectively reviewed the medical records of patients with actinomycosis at the Samsung Medical Center from May 1995 to December 1998. Results: During the study period, actinomycosis was diagnosed in 12 patients: 1 patient had cervicofacial lesion, 3 thoracic, 3 abdominal, and 5 pelvic. The male and female ratio was 1 : 2 and the mean age was 47.2 years. Sulfur granule was observed in the pathologic specimens from all cases, but organism did not grow at all. It was very difficult to differentiate actinomycosis from tumorous conditions without pathologic diagnosis. All patients were clinically improved with antibiotics or surgical procedures. Conclusion: Actinomycosis is not a rare disease nowadays and has various clinical manifestations. It can be diagnosed by pathologic examination or culture and cured by antibiotics without surgical management.

中都市와 農村地域 學童의 溶血性 連鎖球菌의 分布狀態에 關한 硏究

高春明,金命鎬,등영건,劉寬凞,朴淳一 최신의학사 1981 最新醫學 Vol.24 No.5

λ-경쇄형 다발성 골수종 1예

박용관,김태원,장영,김진호,강정원,천영욱,박유환,정춘해 조선대학교 1995 The Medical Journal of Chosun University Vol.20 No.1

Multiple myeloma is a disease caused by neoplastic plasma cells that synthesize abnormal amouts of immunoglobulin or immunoglobulin fragments. Light chain myeloma are regarded as a separate category characterized by a more malignant clinical course. Light chain myelomas are said to grow fastest of all and are associated with more osteolytic lesions, more hypercalcemia, and a higher incidence of renal failure and amyloidsis than either the IgG, IgA varienties The authors experienced a case of patients with λ-light chain myeloma. A 43-year-old male patient admitted to our hospital with the chief complaint of both rib and lower back pain. The radiologic findings showed multiple pathologic fracture in ribs. osteolytic lesions in 2nd, 3rd cervical spineimmuture plasma cells. Serum electrophoresis showed normal finding. Urine electrophoresis evealed an M-spike. Urine immunoelectrophoress demonstrated λ-monoclonal protein. With the cycle of melphalan, prednisone and α-interferon chemotherapy improved of pain was observed. So we reported the case with brief review of previous literature.

피부 병변을 동반한 악성조직구증 1예

조은택,박용관,김진호,강정원,천영욱,전익섭,박유환,전춘해 조선대학교 1995 The Medical Journal of Chosun University Vol.20 No.1

Malignant histiocytosis, originally described in 1939 as histiocytic medullary reticulosis by Scott and Robb-Smith, is a rare histiocytic proliferative disorder that often shows an acute onset and used to progress to death within a few months. This disorder characterized clinically by fever, generalized weakness, lymphadenopathy and hepatosplenomegaly, and shows a variable range of pancytopenia. Extranodal involvement is common, with an incidence ranging from 50% to as high as 90%, skin involves8ment was noted in 10% to 15%. Typical skin lesions were mainly founded in extremity. i.e. erythematous papule and nodule occasionally become to necrosis and ulceration. We experienced one case of malignant histiocytosis in a 46-years-old female. The major clinical findings are fever, malaise, hepatosplenomegaly and erythematous skin lesion. In the laboratory study, pancytopenia is noted on the peripheral blood. And also aggregation of many atypical histiocytes were shown on skin and bone marrow biopsy. So we reported one related case with malignant histiocytosis as well as reviewing literature .

약제 내성 폐렴구균의 비율이 높은 지역에서 발생한 하기도 감염 치료에 대한 Levofloxacin의 효능 및 안정성

조황래,오원섭,김춘관,김연숙,정숙인,김성민,백경란,송재훈 대한화학요법학회 2001 대한화학요법학회지 Vol.19 No.3

목적 : Levofloxacin은 지역성 호흡기 감염의 흔한 원인인 폐렴구균과 같은 그람 양성균뿐만 아니라, 그람 음성균, atypical organisms에 대해서도 넓은 항균 스펙트럼을 갖는 항균제로 알려져 있다. MDRSP의 빈도가 증가하고 있는 국내에서의 지역성 호흡기 감염에 대한 levofloxacin의 유효성과 안전성을 평가하기 위해 계획하였다. 방법 : 본 임상시험은 전향적 방법으로 2000년 1월부터 2001년 4월까지 삼성서울병원에 내원한 지역사회 획득 폐렴, 만성 기관지염에 병발된 급성 세균성 감염 환자 60명을 대상으로 하였다. 투여량 및 투여방법은 Levofloxacin 500㎎을 하루에 한번씩 12.6일(±3.3일)간 투여 하여 임상적으로 호전된 경우, 경구제로 전환하였으며(500㎎ q 24hrs), 신기능 장애시(Ccr 20-50㎖/min) 주사 및 경구제 500㎎을 48시간 간격을 두고 투여하였다. 임상효과, 미생물학적 평가, 및 부작용을 관찰하였다. 결과 : 총 60명의 환자가 시험을 완료 하였고, 결핵환자로 판명된 3명과 NK/T cell lymphoma로 확인된 1명, 투약 후 피부발진 발생으로 2일만에 중단된 환자 1명을 제외하고 55명을 평가하였다. 증상의 치료 및 개선을 임상적 유효성이 있는 경우로 하였을 때 55예 중 49예(89%)에서 만족할 만한 결과를 얻었다. 미생물학적 평가에서 10예중 10예(100%) 모두에서 미생물학적 소실을 보였다. 부작용으로는 간염 4예, 피부 발진 1예로 모두 5예(9%)가 발생 하였다. 결론 : 약제 내성 폐렴구균의 빈도가 증가하고 있는 국내에서의 지역성 호흡기 감염에 대하여 levofloxacin은 비교적 효과적이고 안전한 치료 방법이라 할 수 있다. Background: To evaluate the efficacy and safety of levofloxacin in the treatment of lower respiratory infections in the area with high prevalence of multidrug-resistant Streptococcus pneumoniae(MDBSP) Methods: Outpatients of over 18 years old with a confirmed diagnosis of a community acquired pneumonia and an acute bacterial exacerbation of chronic bronchitis were enrolled. Patients were treated with parenteral levofloxacin(500㎎ once a day) followed by oral levofloxacin(500㎎ once a day) for about 2weeks and evaluated. Results: Total number of 60 patients received levofloxacin for a mean of 12.6days. Successful clinical response(cured and improved) was 89.1%(49/55) of patients. Microbiologic eradication rate was achieved in 100% of patients whose pathogens were isolated. Hepatitis was developed in 4 cases and drug eruption occurred in I case. Conclusion: A once a day of 500㎎ of levofloxacin for lower respiratory infections developed in the region of high prevalence of MDRSP was effective and safe.

Effects of rosiglitazone and metformin on inflammatory markers and adipokines: decrease in interleukin-18 is an independent factor for the improvement of homeostasis model assessment-beta in type 2 diabetes mellitus

Kim, Hyeong Jin,Kang, Eun Seok,Kim, Dae Jung,Kim, So Hun,Ahn, Chul Woo,Cha, Bong Soo,Nam, Moonsuk,Chung, Choon Hee,Lee, Kwan Woo,Nam, Chung Mo,Lee, Hyun Chul Blackwell Publishing Ltd 2007 Clinical endocrinology Vol.66 No.2

<P>Summary</P><P>Objective </P><P>We examined the individual pharmacological effects of the addition of rosiglitazone and metformin to glimepiride on inflammatory markers and adipokines in patients with type 2 diabetes mellitus. We analysed the relationships between these variables, the measurements of insulin sensitivity and &bgr;-cell function in patients treated with rosiglitazone plus glimepiride.</P><P>Design and patients </P><P>One hundred twenty (120) patients with type 2 diabetes mellitus were randomized and treated with glimepiride plus rosiglitazone or glimepiride plus metformin for 12 weeks. The plasma concentrations of the inflammatory markers and adipokines were measured at baseline and after 12 weeks.</P><P>Measurements </P><P>Markers of insulin sensitivity and &bgr;-cell function were determined by the quantitative insulin sensitivity check index (QUICKI) and the homeostasis model assessment of &bgr;-cell function (HOMA-&bgr;), respectively. Plasma concentrations of adiponectin were measured by radioimmunoassay. Plasma concentrations of resistin, tumour necrosis factor-α (TNF-α), interleukin-6 (IL-6) and interleukin-18 (IL-18) were measured using ELISA.</P><P>Results </P><P>Improvements in fasting insulin level, QUICKI and HOMA-&bgr; were noted in the rosiglitazone-treated group. Only the QUICKI value improved in the metformin-treated group. Adiponectin concentrations significantly increased in the rosiglitazone-treated group after 12 weeks. Significant decreases in resistin, C-reactive protein, TNF-α, IL-6 and IL-18 were seen in the rosiglitazone-treated patients but not in the metformin-treated patients. The independent risk factor for the HOMA-&bgr; change according to stepwise multivariate regression analysis was a change in IL-18.</P><P>Conclusions </P><P>Rosiglitazone, but not metformin, improved the plasma concentrations of inflammatory markers and adipokines in patients with type 2 diabetes mellitus. A decrease in IL-18 is an independent factor for the improvement of HOMA-&bgr; in type 2 diabetes mellitus.</P>

공복혈당 110 ~ 139mg/dL 를 대상으로 당뇨병 진단에 관한 새로운 권고기준과 NDDG/WHO 진단기준의 비교

김현만,허갑범,이현철,김용성,이관우,조용욱,김경래,정춘희,김미림,남문석,남수연,차봉수,김여주,권삼 대한당뇨병학회 1998 Diabetes and Metabolism Journal Vol.22 No.2

발작성 야간혈색소뇨증의 동종 골수이식 2 예

김성희,박종원,김관우,이문철,박원,이범우,김춘추,홍영선,김동집,한창순,장대환,장규만 대한내과학회 1989 대한내과학회지 Vol.36 No.3

Two cases of paroxymal nocturnal hemoglobinuria (PNH) were treated with allogeneic bone marrow transplantation. With respect to rejection, they were in a high risk group, because of sensitization to the allo-antigen by multiple transfusions for several years. The sex of the donors differed from that of the recipients. The conditioning regimen consisted of cyclophosphamide, procarbazine and brsrlfan, and cyclosporin A was administered for the purpose of preventing graft versus host disease (GVHD). Engraftment was observed on the 16th and 15th day (WBC$gt;1000/㎣). Acute and chronic GVHD were noted in both cases. The first case expired on the 184th day, because of chronic GVHD-associated sepsis and the second case is alive on the 529th day with 100% karnofsky status. Although our experience was limited, we could make the following conclusions: 1) Our conditioning regimen was sufficient to allow engraftment with total chimerism, which was confirmed by conventional clinical guides and the cytogenetic study. 2) Post-transplantation clinical courses were eventful with bacterial and viral infection, as well as chronic GVHD-associated morbidity or mortality, possibly because of previous massive transfusion and buffy coat, etc. 3) We observed hematuria in both cases and dissemination of viral warts, possibly due to reactivation of the papilloma virus. 4) PNH may be treated by bone marrow transplantation, with careful selection of the cases.