리네졸리드와 반코마이신을 교대로 투여하여 치료한 지속성 메티실린 내성 황색포도알균 균혈증 1예

김낙현,김문석,장은선,강유민,김가연,장희창,박완범,김의종,김남중,오명돈 대한감염학회 2009 감염과 화학요법 Vol.41 No.6

Persistent Staphylococcus aureus bacteremia is frequently defined as bacteremia persisting for ≥7 days despite proper antibiotic therapy. Its treatment includes removal of all infection foci and proper antibiotic therapy. Vancomycin remains the antibiotic of choice in MRSA bacteremia. Alternative agents, linezolid or daptomycin, are available, but a consensus regarding management of persistent MRSA bacteremia on vancomycin failure is still lacking. We report a case of a 60-year-old male who received thoracoabdominal aorta replacement operation due to dissecting aneurysm of the ascending and descending aorta. Surgical site infection and bacteremia caused by MRSA occured, and wound debridement operations were performed. The patient was treated with vancomycin in therapeutic doses but MRSA bacteremia persisted for 168 days in a row. Although the inserted aortic graft was the most probable source of persistent bacteremia, surgical removal was impossible. Linezolid was administered as an alternative antibiotic but had to be discontinued from time to time due to thrombocytopenia induced by this agent. In the end, MRSA bacteremia was successfully managed by alternating vancomycin-linezolid therapy.

Mycobacterium mageritense에 의한 당뇨병성 족부 감염증 1예

김충종,김낙현,김문석,김계형,전재현,박문석,박경운,박완범,박상원,김홍빈,김남중,오명돈,최강원 대한감염학회 2008 감염과 화학요법 Vol.40 No.6

Diabetic foot infection is one of the important complications in patients with advanced diabetes mellitus. Limb threatening infections such as osteomyelitis, abscess, and necrotizing fasciitis are frequently accompanied by the disease. Non-tuberculous mycobacterium (NTM) is a rare causative organism of diabetic foot infection. Thus, if one is not suspicious or meticulous, infection due to NTM will be easily overlooked and this will result in delayed diagnose and treat. Therefore, it is necessary to consider NTM as the causative organism if the wound does not respond to the conventional antibiotic treatment and the culture from the adequately obtained specimen reveals atypical acid-fast bacilli. We present a case of diabetic foot infection with osteomyelitis and abscess due to Mycobacterium mageritense, one of the rapid growing mycobacteria, that was successfully treated with surgical debridement and appropriate antibiotic treatment.

중추신경계 합병증을 동반한 삼일열 말라리아 1례

김문석,김가연,강유민,김낙현,전재현,박완범,김홍빈,김남중,박상원,홍윤호,오명돈 대한감염학회 2009 감염과 화학요법 Vol.41 No.5

Plasmodium vivax malaria is an endemic disease in Korea, which rarely causes severe complications including those occurring in the cerebrum. There are limited numbers of complicated cases that have been reported around the world. We experienced a case of vivax malaria with cerebral complication: cognitive impairment and ataxia. A 55-year-old female with diabetes mellitus presented to the emergency department with acute fever of two days’ duration. She did not have any history of travelling abroad or receiving blood transfusions. Peripheral blood smear revealed vivax malaria with parasitemia density of 0.53 percent. She demonstrated loss of orientation, especially regarding time and place, and ataxia. Although the initial hydroxychloroquine treatment for malaria was successful, cognitive impairment and ataxia persisted and were not recovered. Brain MRI showed no structural abnormality. Brain PET showed diffuse hypometabolism in right parieto-temporal lobe of the brain.

월경전 기분 변화와 출산후 불안-우울 증상간의 상관성

한창수,김용구,이낙우,김 탁,김해중,김 현,조숙행 대한생물치료정신의학회 2001 생물치료정신의학 Vol.7 No.1

To investigate the relationship between premenstrual mood changes and anxiety, and mood symptoms in the perinatal period , questionaire survey was carried out. There was no significant correlation between premenstrual symptom scale value and Edinburgh postpartum depression scale value. And theme was no relationship between premenstrual symptom scale value and state anxiety inventory scale value in the perinatal period. This findings suggest that premenstrual mood changes are not directly correlated with mood changes in the perinatal period.

사후분해 시체에 대한 법의학적 접근

최영식,이상용,김유훈,조갑래,이봉우,양경무,정낙은,서중석,이한영,이원태,강현욱 大韓法醫學會 2000 대한법의학회지 Vol.24 No.2

Disposal of a homicide victim by dismemberment is rare, but individual cases are on record in most major medicolegal departments. Recognition of postmortem mutilation may be of importance in the interpretation of certain murders committed by sexual perverts and other mentally deranged individuals and sometimes performed for the sole reason of easier disposal of the body. Postmortem dismemberment is usually readily recognizable as such; The edges of the injuries are dry and lack evidence of bleeding. The joints may be disarticulated without fracture, or the use of an axe or saw may be evident from examination of bones. Parallel horizontal or oblique furrows in the bone surface are caused by skipping of the saw prior to establishing depth. Such patterns on the bone may assist in identifying the particular saw involved. So we report 25 dismembered corpses that autopsied in National Institute of Scientific Investigation. This paper can help in attempting to establish not only the first criminal investigation steps but also the medicolegal approach methods in unidentified and dismembered deaths.

개인의 특성과 검사조건이 신경행동검사의 신뢰도에 미치는 영향

사공준,전만중,성낙정,김규태 大韓産業醫學會 2003 대한직업환경의학회지 Vol.15 No.2

목적: 대상자의 특성과 검사조건 중 성, 연령, 교육수준, 컴퓨터 친숙도, 검사간격 및 검사시간대의 차이가 신경행동검사의 재검사 신뢰도에 미치는 영향을 평가하였다. 방법: 의과대학생 85명(남자 45명, 여자 40명)과 병원근무자 35명(남자 23명, 여자 12명)을 대상으로 연령, 성 교육수준, 컴퓨터 친숙도를 조사하였다. 84명을 1개월 간격, 20명을 1년 간격, 16명을 3년 간격으로 검사 및 재검사를 실시하였으며 65명을 동일한 검사시간대에, 44명을 다른 시간대에 재검사를 실시하였다. 컴퓨터 신경행동검사로는 SPES-K 중 단순반응시간, 숫자더하기, 부호숫자 짝짓기, 숫자외우기 및 손가락 두드리기를, 면접식 신경행동검사 중 Benton 시각기억검사, 숫자부호 짝짓기, 숫자외우기, 목적점찍기 및 핀꽂기의 재검사 신뢰도를 요인에 따라 층화하여 비교하였다. 결과: 컴퓨터 신경행동검사 중 숫자더하기, 부호숫자 짝짓기, 숫자외우기 및 손가락 두드리기의 재검사 신뢰도가 다른 검사에 비해 연령과 성별의 영향을 적게 받았으며 손가락 두드리기의 재검사 신뢰도가 다른 검사항목에 비해 교육수준의 차이의 영향을 적게 받았다. 컴퓨터 신경행동검사항목 중 단순반응시간의 재검사 신뢰도가 다른 검사들에 비해 컴퓨터에 대한 친숙도에 따른 차이가 크게 나타났다. 부호숫자 짝짓기와 손가락 두드리기의 재검사 신뢰도는 다른 검사에 비해 검사간격의 영향을 적게 받았으며 컴퓨터 신경행동검사 중 숫자더하기, 숫자외우기와 손가락 두드리기 및 면접식의 숫자부호 짝짓기의 재검사 신뢰도가 다른 검사들에 비해 검사시간대 차이의 영향을 적게 받았다. 결론: 향후 산업장 근로자들을 대상으로 한 신경행동검사를 선택하는데 있어 면접식 신경행동검사에 비해 컴퓨터 신경행동검사의 재검사 신뢰도가 상대적으로 안정적으로 나타났으며 이는 우리 나라 근로자의 특성과 산업보건제도에 적합한 신경행동검사 배터리의 구성에 도움이 될 것으로 생각된다. Objectives: This study was conducted to select neurobehavioral tests that are more reliable and less affected by subjects characteristics and test conditions. Methods: Five computerized and five traditional neurobehavioral tests and retests were administered to 85 medical school students and 35 hospital workers. The computerized tests consisted of the Simple Reaction Time, Addition, Symbol Digit, Digit Span, and Finger Tapping Speed, while the traditional tests comprised the Benton Visual Retention test, Digit Symbol, Digit Span, Pursuit Aiming, and pegboard. In addition, the effects of various factors on the reliability of the neurobehavioral tests, including age, sex, educational level, computer familiarity, test intervals, and test time of day, were also evaluated. Results: Among the computerized neurobehavioral tests, the reliability of Addition, Symbol Digit, Digit Span, and Finger Tapping Speed were not affected significantly by age, sex, test interval, or computer familiarity. It was found that Finger Tapping Speed is not affected by educational level. When the time of retest was incongruous with the time of the first test, test-retest reliability was lower in most neurobehavioral tests except computerized Addition, Digit Span, and Finger Tapping Speed, and traditional Digit Symbol. Conclusions: These results suggest that the computerized Addition, Symbol Digit, Digit Span, and Finger Tapping Speed, and the traditional Digit Symbol are more satisfactory for our purposes. These results should facilitate selection of the most appropriate tests for periodical evaluation of the central nervous system of workers exposed to neurotoxic substances in Korea.

자동차공장 용접공의 망간폭로와 신경행동기능의 관련성

사공준,정종학,성낙정,이중정,박종태,김대성 大韓産業醫學會 2000 대한직업환경의학회지 Vol.12 No.3

목 적 : 저농도의 망간폭로가 용접작업자의 충추신 경계에 미치는 영향과 망간의 폭로수준 및 생물학적 지표와 신경행동기능과의 관련성을 평가하기 위하여 자동차공장에서 하루 한시간 이상의 용접작업을 하는 용접공 49명과 연령과 교육수준을 짝짓기한 대조군 49명을 대상으로 단면조사연구를 수행하였다. 방 법 : 두 군의 인구학적 변수, 작업관련 변수를 조사하고 용접공의 용접 작업경력, 작업량, 용접의 종류, 호흡기 보호구의 착용여부, 취급하는 유해물질의 유무를 면접을 통하여 조사하고 망간흄 농도와 혈중 망간농도를 측정하고 누적폭로지수를 산출하였다. 신경행동검사로는 SPES중 단순반응시간, 부호숫자 짝짓기, 숫자 외우기 및 손가락 두드리기를 실시하였다. 결 과 : 단순반응시간과 부호숫자 짝짓기의 평균반응시간과 숫자 외우기의 외운 숫자의 길이는 두군에서 유의한 차이가 없었다. 손가락 두드리기에서 양손 모두에서 용접공의 두드린 횟수가 적었으나 통계적으로 유의하지는 않았다. 손가락 두드리기의 두드린 횟수가 용접기간이 길수록, 하루에 수행하는 용접작업시간이 길수록 적었으며 피복아크용접을 주로 하는 용접공의 신경행동 기능이 다른 용접작업을 하는 군에 비해, 호흡기 개인보호구를 착용하지 않는 군이 착용하는 군에 비해 신경행동기능이 낮았다. 망간흄 농도가 0.02 mg/m3 이상인 군에 비해 0.01 mg/m3 이하인 군이, 혈중 망간농도 1.00 ㎍/dl 이상군에 비해 0.99 ㎍/dl 이하의 군이, 누적폭로지수 0.05 이상의 군에 비해 0.04이하의 군에서 신경행동검사 성적이 낮았다. 결 론 : 자동차 공장 용접공은 대조군에 비하여 신경행동기능이 차이가 유의하지는 않았으며, 신경행동검사 항목 중 지속적인 빠른 속도의 운동능력을 요구하는 손가락 두드리기가 용접공의 신경행동기능의 저하를 민감하게 반영하는 것으로 추정된다. Objectives . A cross sectional study was carried out in the welders exposed to manganese and control group. The aim of this study was to assess the adverse effects of manganese on central nervous system of welders. Methods : The study group consisted of 49 welders and the reference group, 49 workers matched with welders for age and educational level In automobile manufacturing company. Concentration of manganese in welding huge, in blood, and cumulative exposure index (CEI) were determined for each subject. For each group, computerized neurobehavioral test including Simple Reaction Time, Digit Symbol, Digit Span, and Finger Tapping Speed of Swedish Performance Evaluation System were applied. Results : Exposure level of manganese in welders were very low (mean CEI, 0.069) . Welders exposed to manganese had slower response speed, slower motor steadiness, and shorter memory span than control group. But these differences were not statistically sign nificant. The performance of Finger Tapping Speed tended to lower as environmental and biological exposure index got higher, Other neurobehavioral tests were found to have a little association with the exposure indices. Conclusions . There was no significant difference of neurobehavioral performance between welders and control group. This study indicates that Finger Tapping Speed mea suring motor steadiness might be a one of useful tests for early detection of adverse effects of welding on central nervous system.

자궁경부의 편평상피암이 동반된 자궁의 Mullerian adenosarcoma 1예

김철환,김영식,신중식,김해중,이낙우 대한부인종양 콜포스코피학회 1999 Journal of Gynecologic Oncology Vol.10 No.2

Mu¨llerian adenosarcoma is an uncommon variant of Mu¨llerian mixed tumors of the uterus and a mixed, biphasic neoplasia in which the mesenchymal component is malignant and the epithelial component is benign. In contrast to typical malignant Mu¨llerian mixed tumor(MMMT), Mu¨llerian adenosarcomas are usually tumors of low malignant potential. These tumors usually present as pedunculated endometrial masses in postmenopausal women with vaginal bleeding. We experienced a case of Mu¨llerian adenosarcoma of the uterus with squamous cell carcinoma of the uterine cervix and report with a brief review of literatures.

Role of MMP-2, TIMP-2 and MT1-MMP expression in recurrence of Locally advanced squamous cell carcinoma of the cervix

( Nak Woo Lee ),김재원 ( Jae Won Kim ),( Hyun Joo Seol ),( Ji Eun Lim ),( Jin Woo Shin ),( Tak Kim ),( Hae Joong Kim ),( Kyu Wan Lee ),( Young Sik Kim ) 대한산부인과학회 2004 대한산부인과학회 학술대회 Vol.90 No.-

Effects of Phage Endolysin SAL200 Combined with Antibiotics on <i>Staphylococcus aureus</i> Infection

Kim, Nak-Hyun,Park, Wan Beom,Cho, Jeong Eun,Choi, Yoon Jeong,Choi, Su Jin,Jun, Soo Youn,Kang, Chang Kyung,Song, Kyoung-Ho,Choe, Pyoeng Gyun,Bang, Ji-Hwan,Kim, Eu Suk,Park, Sang Won,Kim, Nam-Joong,Oh, American Society for Microbiology 2018 Antimicrobial Agents and Chemotherapy Vol.62 No.10

<P>Phages and their derivatives are increasingly being reconsidered for use in the treatment of bacterial infections due to the rising rates of antibiotic resistance. We assessed the antistaphylococcal effect of the endolysin SAL200 in combination with standard-of-care (SOC) antibiotics. The activity of SAL200 when it was combined with SOC antibiotics was assessed in vitro by checkerboard and time-kill assays and in vivo with murine bacteremia and Galleria mellonella infection models. SAL200 reduced the SOC antibiotic MICs and showed a >= 3-log(10)-CFU/ml reduction of Staphylococcus aureus counts within 30 min in time-kill assays. Combinations of SAL200 and SOC antibiotics achieved a sustained decrease of >2 log(10) CFU/ml. SAL200 significantly lowered the blood bacterial density within 1 h by >1 log(10) CFU/ml in bacteremic mice (P < 0.05 versus untreated mice), and SAL200 and SOC antibiotic combinations achieved the lowest levels of bacteremia. The bacterial density in splenic tissue at 72 h postinfection was the lowest in mice treated with SAL200 and SOC antibiotic combinations. SAL200 combined with SOC antibiotics also improved Galleria mellonella larva survival at 96 h postinfection. The combination of the phage endolysin SAL200 with SOC antistaphylococcal antibiotics showed synergistic effects in vitro and in vivo. The combination of SAL200 with SOC antibiotics could help in the treatment of difficult-to-treat S. aureus infections.</P>