감염질환 이외의 원인에 의한 불명열

鄭文現 대한의사협회 1998 대한의사협회지 Vol.41 No.1

7개 대학 병원에서 조사한 지역사회 폐렴의 원인균

정문현,김성민,강문원,최희정,정희진,이경원,한성우,송재훈,신형식,김의종,최강원,김민자,박승철,배현주,정윤섭,김준명,백경란,신완식,이규만,김양리 대한감염학회 1997 감염 Vol.29 No.5

목 적 : 폐렴은 많이 발생하면서 사망률이 크게 줄지 않는 질환이며, 이를 적절히 치료하기 위해서는 원인균의 상대적 빈도, 기저 질환에 따른 변화, 항균제 내성률, 사망에 관련된 인자들을 알아야 한다. 원인균의 빈도는 지역마다 차이가 있고 국내에서는 항균제 내성률이 높아 지역사회에서 발생한 폐렴을 치료하기 위한 경험적 항균제 선택에 도움이 되기 위해 서울 소재 6개 대학 병원과 천안의 1개 대학 병원이 참여하여 위의 사항들에 대해 조사를 하였다. 방 법 : 1995년에 내과에 입원했던 16세 이상 환자를 대상으로 했다. 퇴원 진단명이 폐렴 또는 폐결핵인 병록지을 찾았고, 이중에서 병원 감염을 제외하였다. 특이도를 높이기 위해, 이들 중에서 호흡기 증상이 있고 발열이나 저체온이 있으면서 흉부 X-선에서 이상 음영이 있는 환자만을 대상으로 했다. 폐결핵은 위의 기준에 입원 초기에 항균제 치료를 하고 입원 7일 이후에야 항결핵제가 투여된 경우만을 폐렴의 원인균으로 하였다. 혈액 배양에서 양성, 객담에서 항상균이나 M. tuberculosis가 증명된 경우, 혈청학적으로 항체가가 4배 이상 증가된 경우, 조직에서 원인균이 진단된 경우는 확정(definitive) 원인균으로 하였고, 객담에서 배양된 균이 그람 도말과 일치할때, 항결액제에 대한 반응으로 진단한 폐결핵, 단일 항체가 양성이고 이에 대해 항균제를 사용했을 때는 가능(probable) 원인균으로 정의하였다. 다세균 감염균은 각각 다 른 원인균으로 처리하였다. 임상 조사와 함께 임상병리과에서 S. pneumoniae, H. influenzae, M. catarrhalis, mycoplasma, 항상균에 대해 검사 의뢰 건수, 배양 양성수, 항균제 감수성 결과를 조사하였다. 결 과 : 폐렴의 증례 정의에 부합하지 않은 135명과 폐결핵의 정의에 해당하지 않는 230명을 제외하고 남은 246명의 평균 나이는 58.2세이고 남성이 142명(58.2%) 이었고, 71%의 환자에서 기저 질환이 있었다. 진단 방법의 시행 횟수는 혈액 배양 77.6%, 혈청 검사 18.3%, 기관지경 검사는 4.1%였고, 세균의 항원 검사를 한 예는 없었다. 원인균이 밝혀진 예는 77명(31.3%)이었다. 다세균 감염이 4명에서 있었고, 원인균의 상대적 빈도는 결핵 20명(확정 17, 가능 3: 6개 병원 자료), 폐렴구균 18(확정8 가능 10)명과 폐렴구균이 아닌 Streptococcus 3명 (모두 확정), H. influenzae 11명(모두 가능), 그람음성간균 11명(확정 7, 가능 4) (K. pneumoniae 8건), Mycoplasma 5명(확정 1, 가능 4), S. aureus 4명(확정 2, 가능 2), mucormycosis 1명(확정)이었다. 평균 입원 기간은 19일이고, 중환자실 입원률과 인공 호흡기 사용율은 각각 18%와 9.3%였다. 사망률은 13.8%였고 사망까지 평균 기간은 14.6일 이었다. 다변량 분석에서 사망을 예측할 수 있는 인자는 저체온과 빈호흡이었다. 임상병리과에서 배양되었던 모든 폐렴구균의 Penicillin 내성률은 서울 3개 병원에서 82-88%, 천안에서 72%였다. 폐렴 환자의 혈액에서 배양된 7주는 모두 Penicillin에 감수성이 있었다. K. pneumoniae 8주 모두 cefotaxime과 gentamicin에 감수성을 보였다. 결 론 : 후향적 조사이고 병원마다 원인균 진단에 차이가 있지만, 원인이 밝혀진 경우에는 결핵과 폐렴균이 흔하였고, 무균 부위에서 배양된 폐렴구균의 항균제 내성률은 낮았다. 원인이 밝혀지지 않은 경우가 많고, 혈청검사로 진단되는 원인균이 드물며, 분리균주가 적어 항균제 내성 정도를 추정하기 어려워, 이를 밝히기 위한 전향적 조사가 필요하다. Background : Community-acquired pneumonia (CAP) is one of the leading causes of mortality and morbidity, but its management is still challenging. The limitation of diagnostic methods to identify etiologic agents rapidly make it necessary to use empiric antibiotics in almost all patients, and furthermore the discovery of new respiratory pathogens and the emergence of antibiotic-resistant organisms pose difficulties to the selection of an empiric regimen. To clarify the factors necessary for the optimal choice of empirical antibiotics, such as the frequency of etiologic agents, the attributable rates to death and antimicrobial resistance rates in the community, six university hospitals in Seoul and one university hospital in Cheonan were participating in this study. Methods : medical records of adults (>15 years of age) hospitalized for CAP or pulmonary tuberculosis between April 1995 and March 1996, were reviewed. Patients who satisfied all of the following criteria were included in the study: (1) fever or hypothermia; (2) respiratory symptoms; and (3) pulmonary infiltrates on chest roentgenogram. To exclude cases of pulmonary tuberculosis whose roentgenographic features were so typical that it could be easily differentiated from conventional pneumonia, two additional criteria were required for inclusion: antibiotic treatment during the first week of hospital admission and initiation of anti-tuberculosis medications thereafter. Organisms isolated from sterile body sites, acid-fast bacilli or Mycobacterium tuberculosis isolated from sputum, pathogens diagnosed by a 4-fold rising titer of antibodies to “atypical”pathogens, or pathogens revealed by histopathology were defined as definitive cause of pneumonia; isolates from sputum withcompatible Gram stain, pathogens diagnosed by a single diagnostic titer plus use of a specific antimicrobial agent, or tuberculosis diagnosed by clinucal response to anti- tuberculosis medications were considered probable cause of pneumonia. The records of the clinical microbiology were reviewed for isolates of S. pneumoniae, H. influenzae, M. catarrhalis, Mycobacterium or acid-fast bacilli, and Mycoplasma. Then the frequency of these agents, antimicrobial resistance rates of resiratory pathogens from all body sites, and their clinical significance were evaluated. Results: After excluding 365 patients (230 with pulmonary tuberculosis and 135 with CAP) who were screened for inclusion but did not meet the inclusion criteria,246 persons were enrolled in this study. Their mean age was 58.2 years old with slight male predominance (58.2%), and 171(71%) patients had underlying illnesses. Blood cultures were performed on 191 (77.6%) patients and serologic tests on 44(18.3%) patients. The etiologic agents were identified in 31.3%, and the list of individual agents, in decreasing order, was pulmonary tuberculosis (17 definite and 3 probable: data of six hospitals), S. pneumoniae (8 definite and 10 probable), non-pneumococci (3 definite), aerobic gram-negative bacilli (7 definite and 4 probable), Haemophilus spp. (11 probable), mycoplasma (1 definite and 4 probable), polymicrobial infections (2 definite and 2 probable: E. coli and S. agalactiae, M. tuberculosis and S. aureus, S. pneumoniae and H. influenzae and A. baumannii and K. pneumonias), S. aureus (2 definite and 2 probable) , and mucormycosis (1 definite). Among gram-negative bacilli, K. pneumoniae was the most common agent (8isolates). therates of admission to the intensive care unitand of using assisted ventilation were 18% and 9.3%, respectively. The mortality was 13.8% and logistic regression analysis showed that hypothermia and tachypnea were associated with death. Hospital stay averaged 19 days. Susceptible rates of S. pneumoniae isolated from all body sites to penicillin ranged from 8% to 28% but seven isolated from blood of patients with pneumonia were susceptible to penicillin. Also all 8 isolated of k> pneumoniae from patients with pneumonia were susceptible to cefotaxime and gentamicin. Conclusion: In Korea, in addition to S. pneumoniae, M. tuberculosis is an important agent causing community-acquired pneumonia. The low incidence of etiologic diagnosis is probably related to infrequent requesting of test "atypical" pathogens and does not represent the true incidence of infections by "atypical" pathogens, which well be answered by a prospective study. The antimicrobial resistance rates of major respiratory pathogens from sterile body sites are low, however, because of a small number of the isolates this result needs confirmation by a nationwide surveillance of antimicrobial resistance.

노인의 갑상선기능저하증에 대한 임상적 연구

정윤석,남문석,이은직,김경래,이현철,김현승,허갑범 한국노화학회 1993 한국노화학회지 Vol.3 No.1

흰쥐 편도체에서 칼슘결합단백인 calbindin-D28K함유 신경세포의 생후 발달에 관한 면역조직학적 연구

정윤영,김종중,문정석,박영란,정상봉,김현곤,박상수 조선대학교 2001 The Medical Journal of Chosun University Vol.26 No.1

Background and Objectives : The calcium-binding protein, calbindin-D28K(CB) is widely distribution of CB in rat amygdala during postnatal maturation, in order to provide an insight into the developmental role it may play in the amygdaloid neurons. Materials and Methods : The present study is based on 28 postnatal cases ranging from the day of birth, postnatal day 0 (P0) to 30 days (P5, P10, P15, P20, P30), and these cases were compared with adult rat amygdala. Cryostat sections processed free-floating with monoclonal antibody by immunohistochemistry. Results : CB-immunoreactive neurons were already found at birth in all amygdaloid nuclei except the intercalated nucleus. The intensity and number of immunoreactivity of CB-containing neurons increased during the first 10 days of postnatal life but dramatically decreased at P15. Mature patterns of CB-immunoreactive neurons were achieved at P20. In the adult amygdala, CB-immunoreactive neurons were distributed in almost all amygdaloid nuclei except the intercalated nucleus. Conclusion : The present results show early appearance of CB immunoreactivity in the amygdala. It may be related to the early appearance of CB immunoreactivity in many other brain regions, and suggests that CB may play a functional role during the development of the nervous system including amygdala.

都市 및 農村의 腸內 寄生蟲 感染에 關한 比較硏究 : 光州市 및 羅州郡 鳳凰面 地域을 中心으로

文宰奎,金宗中,文正錫,鄭駐炫 조선대학교 1981 The Medical Journal of Chosun University Vol.6 No.-

From the 1st of March to the 30th of April, 1979, this study on intestinal helminthic infections was carried ont on thc inhabitants, in Gwang-ju City and thc Bong-hwang Myun, Na-ju Gun area. The methods employed were Kato's cellophane thick smear technique in 603 cases (Gwang-ju City : 310, Bong-hwang Myun : 293) for the prevalence rate of various intestinal helminths ; the Scotch tape anal swab techniquu in 459 cases (Gwang-ju City : 223, Bong-hwang Myun : 236) for the prevalence rate of Enterobius vermicularis and Stoll's dilution egg-counting technique in all positive cases for the evaluation of the worm burden of some helminths. The results are as follows : 1. The positive rate of intestinal helminths of any kin was 80.1%(male: 75.0%, female : 85.1%) in Gwang-ju City ahd 92.6% (male : 90.6%, female : 94.5%) in the Bong-hwang Myun area by the cellophane thick smear technique. 2. The prevalence rate of Ascaris lumbricoides was 48.7% (male : 43.4:%, female : 52.9%, in Gwanag-ju City and 52.6%(rnale : 63.3%, female : 42.9%)in the Bong-hwang Myun area. 3. The prevalenec rate of Trichuris trichiura was 66.5%(male : 58.8%, female : 74.1%) in Gwang-ju City and 72.6%(male : 69.8%, female : 75.3%)in the Bong-hwang Myun. The highest prevalence rateamong helminths was in this area. 4. The prevalence rate of hookworm was 5.0%(male : 3.7%, female : 6.3%) in Gwang-ju City and 9.6%(male : 7.2%, female : 11.7%) in the Bong-hwang Myun area. 5. The prevalcncc raLe of Trichostrongylus orientalis was 4.8%(male : 4.4%., female : 5.2%) in Gwang-ju City and 6.2%(male : 7.2%, female : 5.2%) in the Bong-hwang Myun area. 6. The prevalence tate of Clonorchis sinensis was 1.4% (male : 2.2%, female : 0.6%.) in Gwang-ju City and 2.4%(male : 4.3%, female : 0.4%) in the Bong-hwang Myun area. It is higher in males than in femaless in the surveyed areas. 7. Taenia spp. was not foun in Gwang-.ju City and only 2 cases were found in the Bong-hwang Myun area. 8. The prevalence rate of Enterobious vermicularis was 29.1 %(male : 29.3%, female : 28.9%) in Gwang jn City and 31.3% (male : 29.5%, female : 33.1%) in the Bong-hwang Myun area by the Scotch tape anal technique. 9. The mean E.P.G. in Gwang-ju City be Stoll's dilution egg-counting technique was Ascaris lumbricoidis : 6,465 ; Trichuris trichiura : 600 : Hookworm : 392 ; Trichostrongylus orientalis : 256; and Clonorchis sinesis : 741. 10. The mean E.P.G. in the Bonag-hwang Myun area by the Stoll's dilution egg-counting technique wa s Ascaris lumbricoides : 7,231; Trichuris trichiura : 820 ; Hookworm : 592 ; Trichostrongylus orientalis : 341; and Clonorchis sinensis : 10,851.

智異山 緬羊牧場 造成을 爲한 氣象調査

文勝式,鄭鉉丞 진주산업대학교 1970 論文集 Vol.4 No.-

本 調査는 智異山 地區 緬羊 牧場 造成에 對한 適否를 判斷하기 爲하여 그 氣象 狀態를 調査한 것이며, 다음과 같은 結果를 얻었다. ① 晩霜日; 4月 22日, 初霜日 10月 16日 ② 氣溫: 年 平均氣溫 9.2℃ 最高는 8月에 26.6℃ 最低는 1月에 -12℃. ③ 降雨量: 2,346㎜. ④ 風速; 年 平均風速 6.2m/sec ⑤ 風向; 冬季는 北西風, 夏季는 南東風으로 이는 1年間의 調査이므로 短片的인 結論을 내릴수 없으나, 大關嶺 및 濟州島의 氣象과 對比하여 緬羊의 飼育이 可能함을 나타내었다. This survey was carried out to detect the availability for the sheep range and observe the meteological phenomenon in Mt.Chi-ri. Results obtained were as fellows; 1. Frosty period; from Actober 16 to April 22, 2. Yearly air temperature; 9.2℃, ranging from 26.6℃ in August to-12℃ in January, annual rainfall; 2,346㎜. 3. Yearly mean wind velocity; 6.2m/sec. 5. Direction of the wind; north-west in winter and south-east in summer. According to the above results from only one year observation,the meteological conditions of this region were similar to those of Dae-Kwan Ryung and Cheju Do, and were estimated tobe favorable for sheep rasing.

고장식염수가 토끼 공장 점막 술잔세포의 미세구조에 미치는 영향

문정석,정윤영,장인엽,김종중,정주현,김흥중 대한해부학회 1995 Anatomy & Cell Biology Vol.28 No.3

새로운 알랄아민 항진균제의 합성과 생물학적 평가

정병호,박은주,문현주,유진철 朝鮮大學校 1997 藥學硏究誌 Vol.18 No.2

Some allylamine compounds which are benzothiazole substituants in stead of naphthylring in naftifine, antifungal agents, were sythesized as potential antimycotics. The intermediate Schiff bases that were obtained by condensation of 2-aminobenzothiazole and trans-cinnamaldehyde, were reduced to imine compounds to give allylamines(5a-5d) after mrthylation. These compounds which were tested in vitro against five fungal cell lines containing Trichophyton mentagrophytes. showed no activity in 0.1∼100 μg/ml range.

過蓋咬合, 開咬合 및 正常咬合의 咬筋沈默期에 關한 硏究

문철현,정현수 대한치과교정학회 1987 대한치과교정학회지 Vol.17 No.1

The present study was carried out to investigate the relationships between the depth of overbite and the masseteric silent period. Normal subjects of 44 were selected, which consisted of 9 open bites, 24 normal overbites and 11 deep bites, all were 19-29 years of age. EMG activity was recorded on the bilateral masseteric muscles and craniofacial radiography was done. The following results were obtained. 1. The mean duration of masseteric silent period was 18.58±4.50 msec in open bite, 17.37±7.05 msec in normal overbite and 19.30±7.62 msec in deep bite groups. 2. There were no significant differences on masseteric silent period among open bite, normal overbite and deep bite groups. 3. There were no significant correlations between masseteric silent period and craniofacial variables.

빈혈판정 지표로서의 헤모글로빈, 헤마토크릿 및 혈청 페리틴

정해랑,문현경,송범호,김미경 이화여자대학교 생명과학연구소 1991 생명과학연구논문집 Vol.2 No.-

본 연구는 생화학적 검사에 의한 철 영양상태의 판정시 검사항목에 따른 판정의 정확도를 보기 위하여 외견상 건강한 18!21세의 여대생 57명을 대상으로 혈액성분 중 Hb, Hct, serum ferritin을 측정하고 그 상관성을 분석하였다. 1) 조사대상자의 Hb는 평균이 13.9±0.96g/dl, 중앙값이 14.2g/dl였다. Hct의 평균은 41.4±2.85%, 중앙값은 42.0%였고,ferritin은 평균 20.7±15.5ng/ml, 중앙값 16.5ng/ml,최빈값 3.40ng/ml였다. Hb, Hct, ferritin값 모두 Kolmogorov-Smirnov test결과 정규분포 하는 것으로 나타났다. 2) Hb와 Hct간에는 r=0.9467(p<0.001)로 <Hct=2.28+2.81×Hb>의 회귀관계를 보였다. Hb와 ferritin간에 r=0.5591((P<0.001)로 <log(ferritin)= -1.73+0.07×Hct>의 회귀식이 구해졌다. 3) 빈혈발현율은 Hb 12g/dl를 기준시 5.3%, Hct 36% 기준시 10.5%, ferritin 12ng/ml 기준시 36.8%였다. 4) fFerritin함량을 기준하여 Hb, Hct판정에 대한 신뢰도를 분석한 결과, 빈혈 판정시 많이 이용되는 Hb 12g/dl 미만이나 Hct 36% 이하를 기준했을 때 두 방법 모두 sensitivity가 매우 낮았으며 specificity는 매우 높은 값을 보여, 빈혈 발현율이 높은 우리나라의 경우 Hb나 Hct의 판정기준치를 높일 필요가 있는 것으로 나타났다. 5) 빈혈 판정을 위한 검사방법으로서의 Hb측정은 sensitivity, specificity등을 고려할 때 판정 기준치를 14g/dl로 하는 것이 타당할 것으로 보인다. Hct의 경우 판정치를 40%로 높일 경우에 false-negative rate가 42.9로 낮아졌다. The iron status of 57female college students was evaluated by measurements of hemoglobin(Hb). hematocrit(Hct) and serum ferritin(Ferritin). Mean values for Hb. Hct and Ferritin were 13.9±0.96g/dl. 41.4±2.85% and 20.7±15.5ng/ml. respectively. Ferritin as well as Hb. Hct were not statistically different from normal distribution. although ferritin were skewed to the right. The prevalence of anemia defined by Hb<12g/dl. Hct≤36% and Ferritin<12ng/ml were found to be 5.3,10.3 and 36.8%. respectively. By using Hb as a screening tool at a cutoff point fo 12g/dl. 2.8% of healthy subjects will be incorrectly classified as anemic and 90.5% of anemic as healthy. Sensitivity and specificity were calculated at various cutoff points of Hb and Hct. The estimates of sensitivity and specificity allow Hb 14.0g/dl as cutoff point for good predictor of anemia.