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.

3차원 좌표 측정기의 측정 자동화 시스템 개발

신재혁,류영선,강희준 울산대학교 1998 공학연구논문집 Vol.29 No.2

본 논문은 10㎛ 정밀도를 가진 수동형 3차원 좌표 측정기(Coordinate Measuring Machine, CMM)에 다음의 기능을 부가함으로써, 자동화하고자한다. 그것들은 디스풀레이 제어, 키보드나 조이스틱을 통한 Man-Machine Interface 기능 그리고 서보 모터 제어 등이다. 이와같은 기능을 부가하기위하여, 8031 원칩 마이크로프로세서 시스템을 설계 제작하였고, Yasukawa 모터를 이용한 서보 제어 시스템은 일반적인 PID 알고리즘과 최종점에서 부가적인 Impulse 제어를 수행함으로써, 본 시스템의 요구 조건인 위치 오차 10㎛이내의 정밀 제어가 가능토록하였다. This paper works toward the development of an Automatic Coordinate Measuring Machine(CMM) by adding to a manually driven CMM machine with measuring accuracy of 10㎛ the following functions. a display control, man-machine interface with a joystick and a keypad, and servo motor control. 8031 one chip microprocessor system is designed to control the above functions and A servo motor control system with Yasukawa servo motors allows to control a probe with 10㎛ accuracy by using conventional PID control algorithm and an additional impulse control algorithm.

벼 흰잎마름病 低抗性 Near-isogenic lines의 國內 菌株에 대한 評價

申東一,洪性贊,姜熙慶,金成敏 公州大學校 資源科學硏究所 1994 資源科學硏究論文集 Vol.2 No.-

IRRI에서 育成한 벼 흰잎마름病 抵抗性 near-isogenic lines의 國內 菌株에 대한 反應을 生育時期別로 評價한 結果는 다음과 같다. 1. Xa-1 遺傳子를 갖는 NIL은 K1 race에 속하는 HB 9298 菌株에 대해 抵抗性 反應을 나타내었고, Xa-2 遺傳子를 갖는 NIL은 K2 race에 속하는 HB 9223 菌株에 대해 抵抗性 反應을 나타내었다. 2. Xa-3 遺傳子를 갖는 NIL은 HB 9298 및 HB 9223 菌株에 대해 出穗期때 抵抗性 反應을 나타내었고 成體抵抗性이 認定되었다. 3. Xa-4, xa-5 및 Xa-7 抵抗性 遺傳子를 各各 갖는 NIL은 HB 9298 및 HB 9223 菌株에 대해 出穗期때 抵抗性 反應을 나타내었고 幼苗期와 最高分蘗期설의 反應은 反復親에 따라 相異하였다. 4. xa-8 및 Xa-11 抵抗性 遺傳子를 各各 갖는 NIL은 HB 9298 및 HB 9223 菌株에 대한 抵抗性 反應이 反復親에 따라 相異하였고 一定한 傾向이 없었다. 5. Xa-10을 갖는 NIL은 HB 9298 및 HB 9223 菌株에 대해 모든 生育時期에 罹病性을 나타내었다. This study was conducted to evaluate the reaction of near-isogenic rice lines with single genes for bacterial blight resistance to two Korean isolates of Xanthomonas oryzae pv. oryzae belong respectively to K1 and K2 race at different growth stage. The results obtained were summaried as follows; 1. Near-isogenic rice lines with Xa-1 gene showed resistance to HB 9298 isolate belong to K1 race and near-isogenic rice lines with Xa-2 gene showed resistance to HB 9223 isolate belong to K2 race at different growth stage respectively. 2. Near-isogenic rice lines with Xa-3 gene showed resistance to HB 9298 and HB 9223 isolates at flowering stage and adult resistance was recognized in these lines. 3. Three near-isogenic rice lines with Xa-4, xa-5 and Xa-7 gene respectively showed resistance to HB 9298 HB 9223 isolates at flowering stage and the reactions of three lines to above two isolates were different each other according to recurrent parents at seedling stage and maximum tillering stage. 4. Two near-isogenic rice lines with xa-8 and Xa-11 gene respectively showed different reactions to HB 9298 and HB 9223 isolates according to recurrent parents and did not show constant tendency. 5. Near-isogenic rice lines with Xa-10 gene showed susceptability to HB 9298 and HB 9223 isolates at different growth stage.

관해유도 화학요법을 받는 급성 백혈병 환자에서 발생한 감염증에서 Imipenem 단독요법과 Ceftizoxime + Amikacin 병용요법의 효과 및 안전성에 관한 전향적 비교 연구

신형식,김성민,이기형,최희정,김남중,오명돈,박선량,김병국,최강원 대한화학요법학회 1996 대한화학요법학회지 Vol.14 No.2

A total of 40 febrile granulocytopenic patients with acute leukemia were randomized to receive imipenem-cilastatin or ceftizoxime plus amikacin as initial empirical therapy to compare the efficacy and safety of imipenem monotherapy with that of ceftizoxime/amikacin combination therapy. 21 patients were randomized to the imipenem monotherapy, while 19 patients to the ceftizoxime/amikacin combination therapy. On 72 hour assessment success rates accordings to NCI criteria were 100% in both groups, success rates according to IHS (Immunocompremised Host Society) criteria were 55.0% in imipenem group and 66.7% in ceftizoxime/amikacin group. On overall assessment success rates according to NCI criteria were 90.0% in imipenem group and 94.7% in combination group, success rates according to IHS criteria were 50% in both groups. There was no statistical difference in success rate between two groups. Hepatotoxicity was the most common side effect in both groups(imipenem 15.0% vs. ceftizoxime/amikacin 15.8%). There was no CNS tixicity in both groups. Nausea and vomiting occurred in 9.5% of imipenem recipients, and 1 patients was unable to complete therapy due to intolerance. In summary, imipemem monotherapy was effective and safe empirical antibiotic therapy as compared with ceftizoxime/amikacin combination therapy.

嶺東ㆍ太白地區 炭鑛會社의 勞使協力에 관한 實態와 그 改善方案

申斗休,姜熙甲,白喆鉉 관동대학교 1976 關大論文集 Vol.4 No.1

Korea has made great progress in anthracite producing capacity since past decade. Neverthless its promotion is critically desired and has become one of the great concerns of the government in carrying out the present national economic development plan because of shortage in our energy resources. Increase of anthracite production results from cooperation between management and labor instead of useless and excessive labor disputes. In this article has been dealt with real conditions and improvement ways of Labor-Management cooperation of coal mining corporations in Yong Dong Area only. To point out some of them to be considered and examined, are as follows. Firstly, in Collective Bargaining, labor union's organization being prerequisite to it should be induced to all the coal mining enterprise, its organization activity should be trained and the operative labor union law needs to be amended so that employees may have the right to reqire nationwide collective bargainning. Furthermore, it is desirable to adopt minimum wage system and widen span of collective barginning to workers' participation in management. Secondly, in Consultation of Labor-Management, even the labor union unformed enterprise should have the duty to organize a consultation instrument between employers and empoyees, moreover the existing consultation meeting should be strengthened effectively to actualize workers' participation in management. Lastly, in view of social welfare for workers. prompt enforcement of minimum wage system, investment inducement to welfare facilities by the government and the enterprise concerned, and widening application of existing workers' compensation insurance will be needed. The true labor-management harmony is contribute not only to increase of coal production capacity, but to just distribution of business performance through democratization of industry.

藿香과 廣藿香의 精油成分 比較硏究

辛民敎,姜熙相 대한본초학회 1996 大韓本草學會誌 Vol.11 No.1

KWAKHYANG(藿香) is one of the oriental medicine that has been habitually used for the treatment of such vomiting, diarrhea, an intestinal convulsion, dyspepsia and a cold. The origin of KWAKHYANG(藿香) is HERBA AGASTACHIS(藿香, 排香草), and substitute HERBA POGOSTEMONIS(廣藿香), but the origin and the chemical constuents of the volatile oils of the two are greatly different. Current imported Kwakhyang are discriminated because of its flavor. Hence, an author analyze individual ingredients of volatile oils about kwakhyang grown in korea and impoted kwakhyang from china and from Indonesia This paper was supported by Won Kwang University in 1996. The results are as follow; 1. The chemical constituents of the volatile oil from the kwakhyang grown in korea have been studied by GC-MS. Main constituents are estragole(23.45%), pulegone(20.41%), limonene(dl,9.74%), menthone (trans,9.20%), menthone(cis,3.19%) caryophyl-lene (2.07) and 1-octen-3-ol(1.31%), and some minor constituents are 3-octanone, myrcene (bata), p-mentha-6, 8-dien-2-ol, acetate, linalool, terpinolene(alpha), linalool, piperitone, piperite- none, cadinene(delta), spathulenol(HERBA POGOSTEMONIS) and patchouli alcohol. 2. Main constuents of the china sample(HERBA POGOSTEMONIS) contain patchouli alcohol(41.66%), guaiene(delta, 5.52%), seychellene(5.41%), patchoulene(bata,3.47%), patchoulene(alpha,2.65%), guaiene(bata, 1.50%) and caryophyllene(trans, 1.10%), and some minor constituents are pinene(alpha), pinene(2-bata), limonene and selinene(delta). 3. Main constituents of the indonesia sample(HERBA POGOSTEMONIS) contain patchouli alcohol(40.65%), seychellene(6.21%), guaiene(delta,4.81%), patchoulene(alpha,4.12%), guaiene(alpha,3.55%), patchoulene(alpha,3.13%), aciphyllene(1.64%) caryophyllene(trans,1.17%), and some minor constituents are benzene, 1,2-dimethyl-, 3-carene(delta) and selinene(bata).

原乳의 세균수 等級制 실시에 따른 미생물학적 품질개선

姜國熙,朴信仁,鄭忠一 성균관대학교 생명과학자원연구소 1994 生命資源科學硏究 Vol.1 No.2

Raw milk grading system based on the bacterial count was started in Korea from June 1, 1993. The production ratio of first class which has 100,000/ml below in the bacterial counts of raw milk increased from 21% to 60% during 6 months. But, the ratio of the first class which has 250,000/ml below in the somatic cells did not change and became to be worse. In somatic cells the ratio of the first class milk was 42% in June 1993 and after 6 months it was decreased to 30%, Because current grade system based on the somatic cells give an penalty only to the off-grade milk which contains more of 750,000cell/ml. The system should be changed to pay different money according to the different classes of somatic cells in the raw milk.

Ni-Zn 페라이트의 透磁率과 磁氣抵抗에 미치는 添加物의 影響

강재덕,최희태,서강수,신용진 明知大學校 産業技術硏究所 1990 産業技術硏究所論文集 Vol.9 No.-

This paper is studied on the effects of additive of permeability and magnetic reluctance of Ni-Zn ferrites. Ni-Zn ferrites was composed of 20mo1% NiO, 30mo1% ZnO, 50mo1% Fe₂O₃, and 0.0025n1o1%, 0.005mo1%, 0.01 mol% ??, Bi₂O₃, ?? were used as minor additive Sintering was carried oui at 1100℃. As results from the experiments, the initial permeability was proportional inversely to magnetic reluctance. It was observed that the better magnetic properties of initial permeability anti magnetic reluctance could be achieved by the additive ??.

漸進的·急進的 運動負荷가 血液의 pH, Sugar 및 Lactate에 미치는 影響

姜炯基,辛元太,白永守,殷熙寬,宋基成,河哲秀 漢陽大學校 體育科學硏究所 1986 體育科學 Vol.6 No.6

The purpose of this study is to in-vestigate the effects of gradual and radical exercise load on the treadmill for PH, Sugar and Lactate in Blood by selecting 14 subjects in H university, All subjects began exercise by 6mPH for 4 minutes at start and increased exercise speed up to HR 140 by increasing every minute as gradual load. And subjects began exercise by 9mPH at first and increased load up to HR 140 as radical exercise load. The results are as follows: (1) In PH in Blood, gradual exercise load is lower than radical training in all subjects. (p<0.05) (2) In Sugar in Blood, radical exercise load is higher than gradual exercise load in all subjects. (p<0.05) (3) In Lactic Acid in Blood, gradual training is higher than radical exercise load in all subjects. (p<0.01) (4) In Lactic Acid, all subjects showed high value and its is also in Sugar, than the method of exercise load is according to anaerobic energy metabolism.

광섬유 변형센서 개발과 시뮬레이션

강신원,이상룡,이정희,박재희 경북대학교 센서기술연구소 1997 연차보고서 Vol.1997 No.-