고신의료원에서 1986~1988년에 분리된 병원성세균들의 항생제 감수성

이진숙,김형,박준현,박숙자 고신대학교(의대) 고신대학교 의과대학 학술지 1989 고신대학교 의과대학 학술지 Vol.5 No.1

Antibiotic susceptibility of 15,383 strains isolated from 1986 to 1988 in Kosin Medical College Hospital were studies by disk diffusion method, results are as follow 1. The most frequently isolated microorganisms was E.coli, and Staphylococcus aureus, Pseudomonal aeruginosa were next frequently isolated organisms. And, The frequencies of Pseudomonas aeruginosa, Staphylococcus aureus, Klebsiella pneumoniae and Streptococcus faecalis were continuously increased during 3 years. 2. Methicillin resistant staphylococci were increased during 3 years, and Vancomycinin was most effectice antibioic for gram positive organisms in vitro Antibiotics resistant Streptococcus pneumoniae were few. 3. Most enterobacteriaceae were highly sensitive for amikacin, cefoperazon, moderately high sensitive for gentamycin, tobramycin, cefamandole, whereas Serratia marcescence, Enterobacter cloacae, Citrobacter freundii showed low sensitivity to these antibiotics. 4. Pseudomonas aeruginosa was sensitive for cefoperazon(75%) and amikacin(65%), and Acinetobacter calcoaceticus var. anitratus was sensitive for amikacin(74%) and gentamycin(64%), but less sensitive for cefoperazone(33%). There were no effective antibiotic for Acinetobacter calcoaceticues var. lwoffi and Flavobacterium species in vitro at this study.

최근 10년간 고신대학교 복음병원 일반외과에서 치험한 대장 및 직장암의 추세 변화

이승현,안병권,백승언 고신대학교(의대) 고신대학교 의과대학 학술지 2002 고신대학교 의과대학 학술지 Vol.17 No.1

Background : In western countries, colorectal cancers are one of the most common malignant tumors. In Korea, colorectal cancers are the fourth common malignancy following gastric cancer, hapatoma, and lung cancer. It's incidence and importance has been rising over the past 10 years. We reviewed colorectal cancer patients to study the changing pattern in the last decade. Methods : We reviewed 1453 patients with primary colorectal cancers who were operated at Gospel Hospital, School of Medicine, Kosin University between 1991 and 2000, retrospectively. The colorectal patients were divided into two groups. First group was the patients who were operated in the first half of the decade, between 1991 to 1995. The second group was the patients who were operated in the second half of the decade, between 1996 to 2000. We compared the two groups according to sex, age, location, tumor size, preoperative serum carcinoembryonic antigen (CEA), and stages of the patients. Results : We operated the 1453 colorectal cancer patients in the last decade. Males were accounted for 734 of the cases, and females were accounted for 719 of the cases (sex ratio was 1:1). The Peak age incidence was 7th decade (30.4%). Of the tumor location, colon cancer cases totalled 598 (48.7%), rectal cancer cases totalled 630 (51.3%). Of the rectal cancer operation, the number of the low anterior resection were 337 (67.0%), the abdominoperineal resection were 166 (33.0%). The incidence of stage 1,2,3 and 4 were 10.9%, 35.4%, 36.2% and 16.3%, respectively. In comparison of the 2 group, the number of the patients who were operated in the first half of the decade were 519, in the second half of the decade were 934 (1:1.8). The sex ratio was 1:1 and peak age incidence was 6th decade in the first half of the decade. In the second half of the decade, sex ration was 1:1 and peak age incidence was 7th decade. The number of colon cancers were 194 (49.7%), rectal cancers were 196 (50.3%) in the first half of the decade. In the second half of the decade, the number of the colon cancer were 404 (48.2%), rectal cancers were 434 (51.8%). Of the rectal cancer operation comparing low anterior resection and abdominoperineal resection, the incidence of the lower anterior resection was 56.8% (83/146) in the first half of the decade, 71.1% (254/357) in the second half of the decade. In the preoperative serum CEA level, 177 cases (37.2%) were more than 5ng/ml in the first half of the decade, 254 cases (43.5%) in the second half of the decade. The incidence of stage 1,2,3 and 4 were 8.8%, 34.2%, 36.2% and 19.8% in the first half of the decade, 12.3%, 36.1%, 36.1% and 14.2% in the second half of the decade. Conclusion : During the second half of the decade, there was a significant increase of the incidence of the total number, the older patients, the higher CEA level in colorectal cancers. And the incidence of low anterior resection was increased in rectal cancer operations. The incidence of stage 1,2 was slightly increased in the second half of the decade, but not significant. There was no difference of the distributions according to age, sex, tumor location, size.

간호대학생들의 삶의 의미와 목적

강은실 고신대학교(의대) 고신대학교 의과대학 학술지 2001 고신대학교 의과대학 학술지 Vol.16 No.1

Background : The purpose of this study was to investigate meaning and purpose in life of nursing students by means of PIL (purpose in life) test and to provide informative data for effective guidance and counselling for nursing students. Methods : The subjects of research were 149 nursing students of K university in Pusan. The data were collected at Jan. 1998 by means of PIL test. The data were analyzed by frequency, percentile, mean score, t-test, ANOVA using SPSS WIN 8.0 program. Results : The results of this study were as follows: 1. The mean scores of PIL of nursing students were high (M=103.74) 2. There were significant differences between PIL and religious variables in satisfaction to their major, religious status, importance of faith, conviction of their salvation. 3. Most of nursing students have not been found to be a state of lack for meaning and purpose in life (64.4%). Only 35.6% of nursing students have been found to be in a state of existential vaccum. Conclusion : There were significant difference between PIL of nursing student and religious characteristics. Therefore to increase PIL of nursing student, it is needed to reinforce religious education, spiritual guidance.

소화효소가 Helicobacter pylori의 증식과 공포화독소 생성에 미치는 영향

홍대식,강경희,장명웅 고신대학교(의대) 고신대학교 의과대학 학술지 2001 고신대학교 의과대학 학술지 Vol.16 No.1

Background : Global high prevalence rate of Helicobacter pylori infection is well-known fact. However, a large discrepancies exist between the diagnostic data obtained by the PCR and culture method, because the coccoid form of H.pylori which represent the majority form in the biological samples are not viable in the standard BHI broth with 5% horse serum. The component parts of saliva and gastric juice acted as neither stimulator nor inhibitor to the growth of H.pylori remain unclear. Objective : The purpose of this study was to evaluate the influence of amylase, pepsin, mucin, and lysozyme on the growth and vacuolating toxin production and titer of H.pylori in vitro. Materials and Methods : H.pylori 13,39,46,59,72,94,98 and 125 strains were isolated from patients with gastric disease. The digestive enzymes were inoculated in the 5% horse serum-BHI broth following final concentration of amylase (A; 0.20ug/ml), pepsin (P; 0.25ug/ml), mucin (M; 2,5ug/ml), and lysozyme (L; 1.5ug/ml). The vacuolating toxin titers of the culture supernatant were evaluated in the monolayer culture of RK-13 cells. Results : The morphologic conversion from bacillary to horse-shoe to coccoid forms of H.pylori was observed in the BHI broth containing 5% horse serum on day 5 culture. Half of H.pylori was changed from bacillary to coccoidal form on day 7 culture, most population of H.pylori was changed to coccoidal form on day 10 culture, and almost all H.pylori was changed to coccoidal form on day 14 culture. The growth of H.pylori 72, and 94 strains was increased in BHI broth containing each enzyme such as amylase, pepsin, mucin and mixture of two or three enzymes on day 5 and 7 culture. The growth of H.pylori 94 strains was increased in BHI broth containing each enzyme such as amylase, pepsin, mucin, and mixture of two or three enzymes on day 10 and 14 culture. The vacuolating toxin production of H.pylori strains was not influenced by the addition of amylase, pepsin, mucin, and lysozye or mixture of two or three enzymes. The neutralization of vacuolating toxin of H.pylori was not affected by the addition of amylase, pepsin, mucin, and lysozyme or mixture of two or three enzymes. Conclusion : We found that coccoid forms of H.pylori were viable in the standard 5% horse serum BHI media in the presence of amylase, pepsin, mucin, and lysozyme. The present study demonstrates that gastric juice of the stomach supports the viability of H.pylori and that oral route of infection is a plausible hypothesis. This work also demonstrates that gastric environment may not provide a selective advantage for the toxigenic strains of H.pylori.

위 MALT 림프종에서 다발성 림프절 전이로 오인된 동시성 림프절 결핵 1예

김성은,김규종,김도현,송준영,문대성,장리라,유찬희,문원,박무인,박선자,김영옥 고신대학교의과대학 2008 고신대학교 의과대학 학술지 Vol.23 No.2

28세 남자가 내시경적 점막절제술을 통해 저등급 위MALT 림프종으로 진단되었다. 병기설정을 위해 18F-FDG PET 검사를 시행하였고 우측 쇄골상부, 우측상/하부 기관주위, AP window 부위에 강한 섭취가 관찰되어 전이성 림프절로 판단하였다. 그러나, 우측 쇄골상부 림프절에서 시행한 절제생검에서 만성육아종성염증소견이 관찰되었고 조직의 결핵 중합효소연쇄반응에서도 양성 반응을 보였다. 2개월간 항결핵제의 사용 후 시행한 추적 컴퓨터단층촬영 검사에서 림프절 크기의 감소를 보여 최종적으로 위 MALT 림프종에서 광범위 림프절 전이로 오인된 동시성 림프절 결핵으로 진단되었다. A 28-year-old man was diagnosed as gastric MALT lymphoma in diagnostic EMR (endoscopic mucosal resection). He subsequently underwent an 18F-FDG PET. 18F-FDG PET showed intense multifocal uptake in right supraclavicular, right upper and lower paratracheal, and AP window areas that was considered radiologically to represent widespread metastatic lymphadenopathy. Excisional biopsy of a supraclavicular lymph node, however, revealed chronic granulomatous lymphadenitis with a positive reaction of Tb-nested PCR. After antituberculosis treatment for 2 months, a follow-up CT scan showed complete resolution of the lesions. Intense 18F-FDG uptake could be due to an infectious process such as synchronous tuberculous lymphadenitis. Therefore, this could mimic a malignant condition such as lymphoma with extensive lymph node metastasis due to a false-positive finding, which may lead to a misdiagnosis.

고신의료원에서의 위암의 술전 병기 결정

신연명,심인수,이상호,최경현,이승도,김종민,조영덕 고신대학교(의대) 고신대학교 의과대학 학술지 1995 고신대학교 의과대학 학술지 Vol.10 No.2

-Abstract- Determination of the extent of gastric cancer may assist in making decisions regarding therapeutic intervention. Several diagnostic tools were used for preoperative staging in Kosin medical center. Authors retrospectively analyzed the preoperative checked tumor markers, endoscopic findings and abdominal CT findings in 449 cases of pathologically stage-made gastric adenocarcinoma after surgery for 12 months from January to December 1993 at department of surgery, Kosin medical center. The purpose of this report is assessment of commonly used preoperative studies for staging of gastric cancer. The results were as follows : 1. The preoperative serum CEA, CA 19-9 levels were not correlated with stage except stage Ⅳ. In case of aFP, there were no positive correlation with staging. 2. 74 (63.2%) of 117 cases diagnosed endoscopically were T1 cancer histologically, whereas among 332 cases, which diagnosed advanced gastric cancer endoscopically, 28 cases (8.4%) were T1 cancer. 3. 188 of 275 cases showed wall thickness greater than 1츠 on abdominal CT scan. 167 of 188 cases were advanced gastric cancer (89%) and 21 cases were T1 gastric cancer (11%). 4. In a comparison of enlargement of regional lymph node by CT scan to tumor infiltration of regional lymph node by histology, sensitivity was 52.7%, specificity was 73.3% and accuracy was 63.6%. 5. CT images of distant metastasis had a sensitivity of 22.2%, specificity of 98%, accuracy of 93.1%, false-negative of 77.8% and false-positive of 1.9%. 6. 125 patients (45%) were correctly staged with CT scan, 77 patients (29%) overstaged and 72 patients (26%) understaged comparing to pathologic staging. These results showed that conventional diagnostic tools alone does not accurately displayed the true extent of disease in patients with gastric carcinoma. The results of multiple studies each other must be combined and it can provide valuable information in management of gastric cancer.

비침습적 일회박출량(stroke volume) 측정방법의 비교분석 : 임피던스 심장도 검사(impedance cardiography) 와 FinometerⓇ

박창민 고신대학교 의과대학 2009 고신대학교 의과대학 학술지 Vol.24 No.1

Background: Impedance cardiography(ICG) and FinometerⓇ is a noninvasive continuous monitoring of obtaining hemodynamic parameters such as stroke volume(SV) that requires little technical expertise. The aim of this study is to assess the agreement between SV measurements made by using ICG and FinometerⓇ. Materials and Methods: A total of 35 healthy volunteers, the SV measured by using ICG were compared with the corresponding measurements simultaneously using FinometerⓇ. Results: The mean stroke volumes were 89.5 ± 13.4ml by ICG, and 89.6 ± 10.8ml by FinometerⓇ. The mean difference in stroke volume between ICG and FinometerⓇ was 0.1±6.3ml. The correlation coefficient for stroke volume between ICG and FinometerⓇ was 0.887. Conclusion: The comparison between ICG and FinometerⓇ showed a good correlation and limits of agreement for stroke volume 목 적: 임피던스 심장도 검사(Impedance cardiography)와 FinometerⓇ 는 응급의료센터에서 손쉬우면서도 연속적인 측정이 가능한 비침습적 혈역학 감시 장비들이며 두장비의 일회박출량에 대한 상호 일치도를 서로 비교해 보고자 이 연구를 계획하였다. 대상 및 방법: 2008년 5월 4주간 고신대학교 의과대학 재학생 중 연구에 동의한 20,30대의 건강한 남성 35명을 대상으로 하였다. 임피던스 심장도 검사와 FinometerⓇ를 각각의 연구대상에게 연속적으로 적용하여 일회박출량을 측정하였으며, 측정값은 Bland-Altman 분석을 통해 일치도를 평가하였다. 결 과: 연구대상자의 평균연령은 24.0 ± 2.4세이었고, 평균키와 몸무게는 각각 175.5 ± 5.2 cm, 69.5 ± 8.5 kg이었으며, 평균 수축기 및 이완기 혈압은 110.7 ± 8.0 mmHg와 71.0 ± 6.3 mmHg이었다. FinometerⓇ와 임피던스 심장도 검사에 의한 평균 일회박출량은 각각 89.6 ± 10.8 ml와 89.5 ± 13.4 ml로 통계적으로 유의한 차이를 보이지 않았다.(p=0.961) 두 검사법에 의한 일회박출량의 상관분석 결과 상관계수가 0.887(p<0.0001)로 유의한 양의 상관관계를 보였다. 평균 일회박출량의 차이는 0.1 ± 6.3 ml (95% 신뢰구간: -2.117∼2.223)이었고, 일치의 한계치(limits of agreement)는 각각 -12.3 ml (95% 신뢰구간: -16.0745∼-8.5851)와 12.4 ml (95% 신뢰구간: 8.6914∼16.1808) 이었다. 결 론: FinometerⓇ와 임피던스 심장도 검사에 의한 일회 박출량은 뚜렷한 양의 상관관계를 보일 뿐만 아니라 서로 매우 좋은 일치도를 나타내었다.

1986년 고신의료원에서 분리된 각종 병원성 세균과 그 항생제 감수성에 대한 고찰

박준현,박숙자 고신대학교(의대) 고신대학교 의과대학 학술지 1988 고신대학교 의과대학 학술지 Vol.4 No.1

Antibiotic susceptibility of 3600 strains isolated during the period of January, 1986 through November, 1986 from Kosin Medical College Hospital were studied. The frequently isolated microorganisms are E. coli, Staphylococcus aureus, Pseudomonal aeruginosa in order. More than 70% of Staphylococcus aureus strains were sensitive to methicillin, cephalothin, cefamandol, and 95.9% were sensitive to vancomycin. 86.7% of Streptococcus faecalis strains were sensitive to ampicillin, and all of Streptococcus faecalis strains were sensitive to ampicillin, and all of Streptococcus pneumoniae strains were sensitive to penicillin, cephalothin, methcillin. More than 80% of E. coli strains were sensitive to gentamicin, tobramycin, amikacin, cefamandol, cefoperazone, All of salmonella typhi strains were sensitive to ampicillin, cephalothin, gentamicin, tobramycin, tetracycllin, but one of 12 strains was resistant to cefoperazone, cefamandol, chloramphenicol, kanamycin. All of Salmonella paratyphi A strains were sensitive to chloramphenicol, gentamicin, kanamycin, tobramycin, but 3 to 6 of 30 strains were resistant to tetracyclin, ampicillin, cephalothin, cefoperazon, cefamandol. Among the gram negative bacilli strains, 71.2% were sensitive to gentamicin, 70.2% were sensitive to tobramycin, 85.6% were sensitive to amikacin, 77.3% were sensitive to cefoperazon.

A Case of Tolosa-Hunt Syndrome Misdiagnosed as Migraine

Jae-Ho Yoo,Soo-Young Kim,Sang-Joon Lee 고신대학교 의과대학 2010 고신대학교 의과대학 학술지 Vol.25 No.2

단순 편두통으로 오진된 톨로사 헌트 증후군을 보고 하는 바이다. 21세 여성이 지속적인 좌측 편두통 및 안구통을 주소로 내원하였다. 환자는 내원 40일 전 두통과 안구통으로 타 병원을 내원하여 안와 및 두부 MRI 시행하였으나 특이소견이 발견되지 않았다. 증상 발생 30일 후 좌안의 안검하수와 안근마비가 발생하였다. 3번, 4번, 6번 뇌신경 마비와 함께 좌안의 시력저하가 동반되었다. 안와 MRI에서 좌안 상직근과 안와내에 이상소견이 발견되었다. 스테로이드 치료와 함께 외안근 기능과 시력이 호전되었고, 안와 MRI에서 상직근과 안와내에 보이던 고신호 강도도 감소하였다. 톨로사 헌트 증후군의 발병빈도는 낮지만, 만약 환자가 두통을 호소할 경우 반드시 배제해야하는 양성 경과를 보이는 질환이다. MRI는 톨로사 헌트 증후군의 확진 검사로서 한계점은 있으나, 진단 및 경과관찰을 위해 필수적이다. A case report on Tolosa-Hunt syndrome misdiagnosed as migraine. A 21 year old woman presented with persistent unilateral headache and ocular pain. She visited a general hospital with headache and ocular pain, and underwent orbital and brain magnetic resonance imaging (MRI). However, there was no significant abnormality. She was diagnosed with migraine and relied on analgesics to control pain. After 30 days, ptosis and ophthalmoplegia began to develop. Her visual acuity was decreased in left eye, associated with 3rd, 4th and 6th cranial nerve palsy. Orbital MRI showed pathologic findings in the left superior rectus muscle and the orbit. With steroid therapy, extraocular muscle movement and visual acuity in left eye was improved. High signal in the superior rectus muscle and orbit decreased in follow-up orbital MRI. Tolosa-Hunt syndrome is a rare, benign condition, which should be excluded in patients with headache. MRI is essential to diagnosis and follow-up of this condition, although not confirmatory of this disease.

우발성으로 투여된 척수강내 고용량 모르핀에 의한 호흡정지 : 증례보고

성상훈,유수봉,류시정 고신대학교 의과대학 2010 고신대학교 의과대학 학술지 Vol.25 No.1

Epidural or intrathecal morphine injection is a useful method for management of postoperative pain and cancer pain. But the effect of intrathecal morphine is ten to twenty times more potent than epidural morphine. So inadvertent intrathecal injection of morphine during epidural injection can induce serious side effect. The authors report a patient who experienced respiratory arrest and loss of consciousness due to inadvertent intrathecal injection of high dose morphine during epidural injection for management of cancer pain. The patient was treated with intravenous bolus and infusion of naloxone for 8 hours and assisted ventilation with Ambu and she was recovered completely without any sequela.