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      • 성인에서 Haemophilus influenzae 감염증의 임상양상과 미생물학적 특성

        이종섭,황병연,정희진,김우주,박승철,이도현,이창규,신종희,황규잠,이영희 대한화학요법학회 2000 대한화학요법학회지 Vol.18 No.2

        목적 : H. influenzae는 성인에서 흔히 호흡기 감염을 일으키는 균주로, 최근 ampicillin 내성 β-lactamase 생성 균주들이 지속적인 증가를 보이고 있어, 이에 국내 성인에서 H. influenzae에 의한 감염의 임상양상과 분리된 균주들의 미생물학적 특성을 조사하고자 하였다. 방법 : 1998년 3월부터 1999년 9월까지 고려대 구로병원에 내원한 환자중에서 H. influenzae가 분리된 68명을 대상으로 임상양상을 조사하고 항균제 감수성 검사를 시행하였다. 분리된 33주에 대해서 혈청형, 생물형, 세포외막 단백분석을 시행하였고, β-lactamase 생성여부에 따른 감염 환자군간 임상상 및 예후의 차이를 비교하였다. 결과 : 환자의 평균연령은 68세였고, 지역사회 획득감염이 전체의 85%를 차지하였다. 폐렴과 기관지염과 같은 하기도 감염이 전체환자의 75%를 차지하였고 분리 검체 역시 객담이 84%로 가장 많았다. 환자의 71%가 기저질환을 가지고 있었으며, 그 중에 만성 폐쇄성 폐질환, 심혈관 질환, 악성종양, 당뇨병이 대부분이었다. 혈청형으로는 nontypeable 형이 68%로 가장 많았고 b형은 한 예도 없었다. β-lactamase 생성율은 63.2%였고, β-lactamase 양성균주의 항균제 내성율이 음성균주에 비하여 높았으나 β-lactamase 생성 여부에 관계없이 cefotaxime, azithromycin, ciprofloxacin에 대하여 100%의 감수성을 나타내었고 cefaclor, cefuroxime에 대해서는 10% 이하의 낮은 내성율을 보여 이들 항균제들이 치료에 효과적일 것으로 사료된다. 세포외막 단백분석에서는 C형과 D형이 전체의 64%로 가장 많았으며, 혈청형과의 유의한 연관성은 보이지 않았다. 결론 : 성인에서 H. influenzae는 주로 만성 기저질환자에서 급성 호흡기감염 또는 만성 폐쇄성 폐질환의 급성 악화를 유발한다. 기존의 보고에 비해 β-lactamase 양성율이 증가하였고, 이에 따른 항균제 내성율도 증가하여 항균제의 선택에 유의하여야 할 것으로 생각된다. 세포외막 단백분석상 특정한 유형의 균주에 의해 감염이 집중적으로 발생하고 있어 향후 역학 조사의 도구로 이용할 수 있겠다. Purpose : H. influenzae is one of the common causative microorganisms of respiratory tract infections in adults. Recently. β-lactamase producing, ampicillin-resistant H. infiuenzae has become worldwide problem as well as in Korea. We studied to investigate the clinical features and microbiologic characteristics of H. infiuenzae infections in adults. Materials & Methods : From March 1998 to September 1999, 68 patients were enrolled in this study. Clinical features of H. infiuenzae infections were investigated, 68 isolates were subjected to the β-lactamase test, and 33 isolates were used for serotyping. biotyping, antibiotic susceptibility and outer membrane protein (OMP) analysis. Results : Mean age of study patients was 68 years-old and the acquisition rate in community was 85%. Pneumonia and bronchitis were the most common type of infection such as 80%, sputum was the most common clinical specimen for H. mQuenzae isolation. 70% of patients had chronic underlying diseases. Non-typeable strains were 68% and β-lactamase producing rate was 63%. There was no difference in the clinical features and prognosis of H. influenzae infection between the β-lactamase positivie and -negative groups. The susceptibility of cefotaxime, azithromycin, and ciprofloxacin was 100% and that of cefaclor, cefuroxime was under 10% in spite of β-lactamase positivity. In OMP analysis, C and D types were dominant (64%). Conclusion : H. influenzae caused acute respiratory infections in adults with chronic underlying disorders. This study shows higher β-lactamase producing rate and antibiotic-resistance rate than that were reported previously. OMP analysis shows that two major types of strains cause clinical infections intensively.

      • KCI등재후보

        부신피질 자극호르몬 단독결핍 1례

        박경식,이승현,최석영,박태규,이동화,이찬우,정성복,이인규 啓明大學校 醫科大學 1997 계명의대학술지 Vol.16 No.3

        부신피질 자극호르몬 단독결핍은 국내에서 7례만이 보고된 희귀 질환이며 병인 및 경과 등 아직 불분명한 측면이 많다. 이는 질환지체의 희귀성도 있지만 치료후 자연경과에 대한 장기적인 추적검사가 이루어진 경우가 드물기 때문이기도 하다. 저자들은 비특이적인 전신증상을 주소로 내원한 폐경기후의 56세 여자 환자에서 자가면역질환의 증거없이 고프로릭틴혈증을 보인 부신피질 자극호르몬 단독결핍 1례를 경험하고 1년간의 부신피질호르몬 대치요법후 추적검사를 실시하였기에 문헌 고찰과 함께 보고하는 바이다. Isolated ACTH deficiency is a rare disorder which shows secondary adrenal insufficiency with normal states of other pituitary hormones. A 56-year-old postmenopausal woman complaining general weakness and intermittent mental confusion presented negligible serum cortisol and ACTH level with hyperprolactinemia and mild hyponatremia. Rapid ACTH stimulation test did not show significant increase of serum cortisol level. Combined pituitary stimulation test showed negligible response of cortisol and ACTH, and slightly decreased response of prolactin and gonadotropin. But the responses of TSH and GH were normal. There was no evidence of organic pituitary of hypothalamic lesion in brain MRI and antithyroid autoantibody was not detected in serum. After receiving 12 months of glucocorticoid replacement therapy, she skipped the medicine for 3 weeks and we performed follow-up endocrinologic tests. Serum ACTH and cortisol level was also negligible and prolonged ACTH simulation test showed normal response of serum cortisol. CRF stimulation test showed no response of serum ACTH. Basal prolactin level was decreased to near normal and combined pituitary stimulation test showed normal response of prolactin with slightly blunted response of TSH and GH. We concluded that the case was nonautoimmune origined isolated ACTH deficiency which was accompanied by hyperprolactinemia and resultant deficiency of gonadotropin, so we report this case with review of literatures.

      • KCI등재

        대전시 노은 도매시장 채소류의 농약 잔류 실태 및 식이섭취량 추정

        한국탁,이규승,이은경,이용재,고광용,원동준,이정원,권순덕 한국환경농학회 2003 한국환경농학회지 Vol.22 No.3

        대전시 노은 도매시장에서 채취한 6종의 채소류 중 농약잔류량을 조사한 후 이에 대한 위해성 평가를 실시하였다. 전체 100건의 분석시료 중 농약이 검출된 시료의 비율은 46.0%이었고, 잔류허용기준 초과비율은 6.0% 이었다. 검출비율이 높은 시료는 상추(85.0%), 깻잎(80.0%), 오이(60.0%) 순이었고, 상추 3건, 깻잎 3건이 허용기준을 초과하였다. 살균제는 dicar-boximide계, 유기염소계, azole계 농약, 살충제는 유기인계, 합성 pyrethroid계 농약이 많이 검출되었다. 검출빈도가 높은 성분은 procymidone, chlorpyrifos, chlorothalonil, cypermethrin, EPN의 순이었다. 위해성을 평가하기 위해서 각 농작물에 대한 농약의 추정 섭취량과 ADI를 비교한 결과, 허용기준을 초과한 깻잎의 bitertanol, triflumizole, iprobenphos가 다른 성분에 비하여 높은 비율을 보였다. 그러나 각 농산물의 식이섭취량이 적어 ADI에 대한 추정섭취량의 비율이 0.46%이하로 나타나 그 영향이 매우 낮은 것으로 판단되었다. Pesticide residues in some vegetables collected at Noeun wholesale market in Daejeon were surveyed and assessed their risk In 100 samples, the detection rate of pesticide was 46.0% and the rate exceed MRL was 6.0%. Commodities showing high detection rate were lettuce(85.0%), perilla leaf(80.0%) and cucumber(60.0%). Dicarboximide, organochlorine, and azole fungicides and organophosphorus and pyrethroid insecticides were detected. Detection frequency of pesticide was in the order of procymidone, chlorpyrifos, chlerothalonil, cypermethrin and EPN. When the estimated intake amount of the pesticides were compared with ADI to assess their risk, bitertanol, triflumizole and iprobenphos in perilla leaf were higher rate than the other vegetables. However the total amounts of intake of pesticides were estimated to less than 0.46% of ADI.

      • 노인의 영적 간호요구

        최미혜,김경희,김귀옥,김기숙,김수강,김정신,김춘숙,노흥진,박지연,성혜연,오명선,이선희,이원옥,이윤영,이현수,장명재,차혜경,채정선,홍상희 중앙대학교 의과대학 간호학과 간호과학연구소 2001 중앙간호논문집 Vol.5 No.1

        This study was designed to exam the aged's needs for spiritual nursing care. The purpose was to serve as a basis for the development of spiritual nursing practice. The major findings are as follows : 1. The degree of needs for spiritual nursing care as area was that needs of love and relationship mean 22.0, needs of meaning and object mean 28.2, needs of forgiving mean 13.5. Total needs for spiritual nursing care mean 63.7, which was on the upper middle level. The needs of meaning and object was rated highest. 2. Among the general characteristics of the subjects, needs of love and relatiohship wasn't significanlty different. 3. Among the general characteristics of the subjects, needs of meaning and object was significantly different according to two factors : age(F=7.260, p=0.001), religion(F=5.275, p=0.001). Higher needs of meaning and object was possessed by the older than the younger, by the one who have religion than the other. 4. Among the general characteristics of the subjects, four factors made a significantly difference to needs of forgiving : sex(t=-2.851, p=0.006), age(F=8.201, p=0.001), religion(F=6.928, p=0.000), disease(t=2.327, p=0.024). Higher needs of forgiving was possessed by man than woman, by the older than the younger, by the one who have religion than the other, by the one who have disease than the other.

      • 정신분열병에 대한 Risperidone의 효과 및 안전성에 관하여

        신석철,왕성근,지익성,이선우,이규광,이봉희,이진영,황선희,신용재,배경도,김정란 충남대학교 의과대학 지역사회의학연구소 1997 충남의대잡지 Vol.24 No.1

        In order to evaluate the efficacy and safety of risperidone, 10 patients with chronic schizophrenia were examined for 8 weeks in a silgle-open study. After the wash-out period of 1 week, risperidone was administered. Efficacy was evaluated by means of Positive and Negative syndrome Scale for Schizophernia(PANSS) and Clinical Global Impression(CGI). Safety assessment included the Extrapyramidal Symptom Rating Scale(ESRS), vital signs, body weight, ECG, and laboratory tests. The results were as follows 1) On the PANSS total score, there was significant improvement of total score after 1 week (P<.05) of administratiom. 2) On the PANSS positive and negative subscal, there were significant improvement of posotive and negative scores after 2 weeks (P<.05) of administration. 3) On the PANSS general psychopatholgy subscals, there were significant improvement of general psychopathologyscores after 1 week (P<.05) of administratiom. 4) On the CGI, there was significant decreasement of clinical impression of severity of schizophrenia score after 2 week (P<.05) of administration. 5) A statistically significant increase in body weight (P<.05) was observed after 8 weeks of administration. 6) EPS reached the peak at the end of the 1st week of administration of risperidone (11.8± 24.25) but they were easily relieved by addition of benztropine and clonazepam. There was not significant change in laboratory tests, vital sign, ECG after 8 weeks of administration. These results suggest that Risperidone is an effective antipsychotics and clinically safe except for increased body weight in chronic schizophrenia.

      • Vincristine Sulfate가 백서 척수내 신경원의 Acetylcholinesterase 활성에 미치는 영향

        이규식,이군자,정호삼,김승현,백태경 漢陽大學校 環境科學硏究所 1992 環境科學論文集 Vol.13 No.-

        Vincristine은 협죽도과에 속하는 열대식물인 Madagascum periwinkle에서 추출한 천연 alkaloid계 항암제로서 암세포의 미소관 형성을 억제하고 미소관을 파괴하며 또한 핵산 및 단백질합성을 방해하여 암세포의 증식을 억제하므로 현재 백혈병 및 임파종등 혈액종양과 여러 충실성종양의 치료에 유용하게 사용된다. 그러나 다른 항암제와 마찬가지로 암세포에만 특이하게 작용하지 않고 정상세포에도 손상을 야기하므로 vincristinc을 투여받은 암환자에서 혈액독작용, 소화기장애, 피부장애 및 신경독작용등 여러 부작용이 유발되고 특히 신경독 작용은 vincristine을 사용을 제한하는 가장 심각한 장애로 알려져있다. 저자는 백서에 vincristine을 투여하면 vincristine이 실험동물의 척수내 신경원에 손상을 야기하여 척수내 신경원의 acetylcholinesterase활성에 변화가 초래될 것으로 사료되어 본 실험을 시도하였다. 실험동물로는 체중 200gm내외의 Wistar계의 웅성 백서 35마리를 사용하여 백서 체중 kg당 0.5mg의 vincristine sulfate(Abic Ltd.) 0.2cc를 1일 1회씩 5일간 복강내로 주사하였고 정상대조군 백서에는 동량의 생리적 식염수를 같은 방법으로 투여하였다. 실험동물은 최종 주사후 24시간 및 72시간 경과 후에 후두부 강타로 도살하고 10% neutral buffered formaline으로 관류시킨 후 육안으로 해부하여 척수를 절취하고 10% neutral buffered formaline에 4℃에서 18시간 고정후 일부 조직은 paraffin에 포매하여 Nissl체를 관찰하기 위한 cresyl violet염색을 시행하고, 일부조직은 -20℃로 조절된 cryostat로 두께 10㎛의 동결절편을 제작하여 Gredtzoff(1959)의 방법에 따라 acetyl-cholinesterase활성을 관찰하기 위한 조직화학적 처리를 한 후 광학현미경으로 관찰하여 다음과 같은 결과를 얻었다. 1. Vincristine투여군 백서의 척수내 체성운동신경원 및 내장성운동신경원에 chromatolysis가 유발되었으며, 소신경원의 수와 cresyl violet 에 대한 염색성이 감소되었다. 2. Vincristine투여군 백서 척수경부의 acetylcholinesterase활성은 1일 경과군의 복측각내 체성 운동신경원에서는 강한 양성반응을 나타내었고 배측각에서는 약한 양성반응을 나타내었으며 중간부에서는 미약한 양성반응을 나타내었으나 3일 경과군의 복측각내 체성운동신경원과 배측각내 교양질부에서는 중등도 양성반응을 나타내었으며 중간부에서는 미약한 양성반응을 나타내었다. 3. Vincristine투여군 백서 척수흉부의 acetylcholinesterase활성은 1일 경과군의 복측각내 체성운동신경원과 외측각내 내장성운동신경원에서는 약한 혹은 중등도 양성반응을 나타내었고 배측각에서는 약한 양성반응을 나타내었으며 척수수질의 중간부에서는 미약한 양성반응을 나타내었으나, 3일 경과군의 복측각내 체성운동신경원에서는 중등도 양성반응을 나타내었고 외측각내 내장성 운동신경원에서는 강한 양성반응을 나타내었으며 배측각내 교양질부에서는 중등도 양성반응을 나타내었으나 배측각의 나머지 부분에서는 약한 양성반응을 나타내었고 척수수질의 중간부에서는 미약한 혹은 약한 양성반응을 나타냈었다. 4. Vincristine 투여군 백서 척수요부의 acetylcholinesterase활성은 1일 경과군의 복측각내 체성운동신경원에서는 중등도 혹은 강한 양성반응을 나타내었고 배측각의 교양질부와 Lamina Ⅳ에서는 중등도 양성반응을 나타내었으며 배측각의 나머지 부분은 약한 양성반응을 나타내었고 척수수질의 중간부에서는 미약한 양성반응을 나타내었으나, 3일경과군의 복측각내 체성운동 신경원에서는 약한 혹은 중등도 양성반응을 나타내었고 배측각내 교양빌부와 Lamina Ⅳ에서는 약한 양성반응을 나타내었으며 척수수질의 중간부에서는 미약한 혹은 약한 양성반응을 나타내었다. 이상의 소견을 종합한 바, vincristine은 백서 척수내 신경원에 세포독으로 작용하여 신경원 손상을 초래하고 신경원의 acetylchlinesterase활성을 억제 하나, 이러한 손상은 시간이 경과함에 따라 일부 회복되는 것으로 사료된다. Vincristine, one vinca alkaloids, is widely used for chemotherapy of a variety of malignancy. The mechanism of anticancerous activity of this agent is based on inhibition of mitosis by interference with development of microtuble, of syntheses of nucleic acid and protein, and of destruction of cytoplasic membrane and microtubule. However, these inhibitory effects on cancer cell proliferation are non-specific, so clinical use of vincristine is frequently limited due to its toxic effects on the hematopoietic and nervous system especially. The author had undertaken this study to pursue the effect of vincristine on the nuerons in rat spinal cord histolgically and histochemically. Totals of 35 healthy male Wistar stain albino rats, weighing about 200 gm, were used as experimental animals. The experimental animals were divided into normal control and vincristine treated groups, and then vincristine treated rats were subdivided into 24 hours and 72hours groups by time passage. All vincristine treated rats were abministrated intraperitoreally with 0.5mg of vincristine per kg of rat body weight diluted in 0.2cc of normal saline for 5 days and rats of vincristine treated group were sacrificed by occipital blow at 24 hours and 72 hours after administration and then perfused by 10% neutral buffered formaline. The spedimen, spinal cord was collected and them fixed with 10% neutral buffered formaline during 18 hours at 4℃. For observing the histological change, cresyl violet stain was performed by routine pareffin method, and for histochemical study of acetylcholinesterase, frozen sedtions of 10 ㎛ in thickness were treated with Gerebtwoff method(1959). The results obtained were as follows : 1. In vincristine treated rat, a part of the somatic and visceral motor neurons were brought on chromatolysis. And the numer and the stain activities of small neurons were decreased in cresyl violet stain. 2. The activities of acetylcholinesterase of cervical segment in vincristine treated rat spinal cord were strongly positive at somatic motor meuron, weakly positive at dorsal horn and tracely positive at intermediate zone in 1 day passed group after the final administration, and moderately positive at somatic motor neuron and substantia gelatinosa, weakly positive at remainder of dorsal horn and tracely positive at intermediate zone in 3 days passed group. 3. The activities of acetylcholinesterase of thoracic segment in vincristine treated rat spinal cord weakly or moderately positive at somatic and visceral motor neurons, weakly positive at dorsal horn and tracely positive at intermdeiate zone in 1 day passed group after the final administration, and moderately positive at somatic motor mourons, strongly positive at visceral motor meurons, moderately positive in substantia gelatinosa, weakly positive at remainder of dorsal horn and tracely positive at intermediate zone in 3 days passed group. 4. The activities of acetylcholinesterase of lumbar segment in vincristine treated rat spinal cord were moderately or strong positive at somatic motor meurons, weakly positive at substantia gelatinosa and lamina Ⅳ, weakly positive at remainder of dorsal horn and tracely positive at intermediate zone in 1 day pssed group after the final administration, weakly or moderately positive at somatic motor neurons, weakly positive at sugstantia gelationsa and lamia Ⅳ and tracely or weakly positive at remainder of spinal medulla in 3 days passed group. It is consequently suggested that vincristine would induce the degeneration of neurons and inhibit acetylcholinesterase activity resulting from its neurotoxic effects on neurons in spinal cord of albino rats, but this damage would partially recover by time passage.

      • ATM 망에서 Best Effort와 Guaranteed 버스트 서비스 클래스에 대한 폭주제어 방식

        이우승,문규춘,박광채 조선대학교 에너지.자원신기술연구소 2000 에너지·자원신기술연구소 논문지 Vol.22 No.1

        In ATM networks, we must distribute the bandwidth to use efficiently the channel and to satisfy the communication QoS(Qua1ity of Service) of traffics. However, since the required communication QoS is different according to traffics, it is expected that the congestion control scheme is improved by assigning priorities in each traffic and by controlling the priority. In this paper, congestion control schemes using the adaptive rate control for ATM LANs are presented. It is preferable for hosts in LANs to be able to send bursts at the same speed as the interface link speed in a lightly loaded condition, and as the network load increases, to reduce their traffic rate adaptively in order to avoid network congestion. We propose to apply such a rate control concept for two different traffic classed in the ATM LANs. For the first traffic class requiring no bandwidth reservation, i.e, a best effort service class, a combination of the end-to-end adaptive peak rate control with the link-by-link backpressure control is proposed. For the second traffic class, requiring the bandwidth reservation for the burst transmission, i.e. a guaranteed burst service class, a combination of the adaptive peak rate control with the fast bandwidth reservation is proposed.

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