항갑상선제로 치료한 그레이브스병 환자의 관해예측인자

남일송,윤여일,김선규,김용현,이주영,목지오,윤석기,김철희,김영선,변동원,서교일,유명희 순천향의학연구소 2001 Journal of Soonchunhyang Medical Science Vol.7 No.2

Background: Most cases of Graves' disease have been treated by antithyroid drugs in Korea. The major drawbacks of antithyroid drugs are the relative high rate of relapse and the inconvinience of long term therapy. Measurement of TBII and TRH stimulation test have been considered as the most reliable tests predicting relapse, but the predictive power is not high enough to use in clinical situation. This study was performed to find good prognostic indicators in Graves' disease patients after the discontinuation of antithyroid drug therapy. Subjects and methods : We restrospectively evaluated 96 patients with Graves' disease who showed normal TRH test at the end of antithyroid drug therapy and were followed for more than one year. Serum T3, T4, T3/T4 ratio, TBII, Anti-TPO Ab and TGAb levels were measured at the time of diagnosis and at the end of therapy. Two to three months after withdrawal of antithyroid medication, serum TSH and free T3 responses to TRH were examined. These parameters were compared between the relapse group and the remission group. Results : Among the 96 patients, 22 patients(22.9%) relapsed(Group Ⅱ) and 74 patients(77.1%) remained in remmision(Group Ⅰ). No significant difference was observed between the relapse and the remission group in clinical parameters, serum T3, T4, TSH, T3/T4 ratio, TBⅡ and Anti-TPO Ab determined before and after treatment. Serum TSH and free T3 levels measured after TRH stimulation were also similar in both groups. Serum TGAb levels determined at the end of treatment were significantly higher in the remission group(p<0.05). Relapse following the discontinuation of therapy occured within 24 months in 72.7% of the relapsed cases. After 24 months, relapse rate was reduced significantly. Conclusion : These results suggest that high serum TGAb levels could be a favorable prognostic indicator for the long term remission of Graves' disease treated with antithyroid drugs, and may suggest that Hashimoto's thyroiditis is combined with Graves' disease in those patients.

폐암환자 말초혈액의 자연살해세포 표현형(Natural Killer Cell Phenotypes)과 T임파구 아형 (T-Cell Subsets)의 의의

남재만,서지원,김남재,김주옥,김선영 충남대학교 의과대학 지역사회의학연구소 1989 충남의대잡지 Vol.16 No.2

The authors studied the NK cell phenotype and T cell subsets in 36 patients with bronchogenic carcinoma and 11 healthy controls. The results were summarized as follows. 1. The percentage of lymphocyte and total lymphocyte counts significantly decreased in cancer patients compared to normal control(p<0.05). 2. The OKT4^+(%) was significantly decreased in patients according to celltype (especially squamous cell cancer, adenocarcinoma and large cell carcinoma) and extended stage(stageⅢ) (p<0.05), but no change in limited stage(stage Ⅰ&Ⅱ). 3. The OKT8^+(%) and OKT4^+ ratio were not significantly changed in cancer patient. 4. According to cell type, there was no significant difference of NK cell phenotype between cancer patients and controls. 5. According to stage, there was no significant difference of NK cell phenotype between cancer patients and controls. 6. There was no significant difference of NK cell phenotype in cancer patients compared to normal controls. We concluded that NK cell phenotype had no significant difference between cancer patients and healthy controls. Further studies (including NK cell activity or other function tests of lymphocyte) are needed to analyze the roles of immunologic responses in patients with lung cancer.

환기정도에 따른 수술실용 신발 종류가 수술실 오염에 미치는 영향 : How to Choose Suitable Shoes?

남경동,정혜선,박영신,원진희,주미자,성화신,이지혜,이병희,조경숙,배재춘 한국의료QA학회 2000 한국의료질향상학회지 Vol.7 No.1

Background : Various types of protective footwear have been used to minimize bacterial contamination in operating rooms. In recent years, debate has arisen concerning the need for use of such protective footwear. This study was designed to provide useful data about choosing shoes most suitable for the surgical environment. Methods : Between November, 1999 and January, 2000, we performed this experimental study by comparing effect of three types of shoes (i.e., disposable shoescover, operating room-restricted shoes, and ordinary shoes) on bacterial contamination of operating rooms equipped with two different ventilation systems (i.e., high air-change, low air-change) respectively. Data were collected during two-hour sham operations in which subjects and their activities were strictly standardized. Bacterial flora were sampled from the study area floor and air colony-counts were measured. Results : In experiments involving high air-change ventilation system, there was a significant difference of floor contamination between three types of shoes, but no difference of air contamination. Under low air-change system, there was a significant difference of both floor and air contamination between three types of shoes. Conclusion : The results show that protective footwear would be unnecessary in the operating room with high air-change ventilation system, but it is important to choose suitable shoes carefully under low air-change system. Therefore, the use of outdoor shoes can be considered under high air-change system, but it would seem sensible to apply their first use in less bloody operations at the day surgery center or out-patient department to prevent transfer of body fluid into the outside environment.

Saccharomyces cerevisiae에서 Trichoderma Endoglucanase의 발현과 분비

남수완,김병우,신동하,김재범,신지원,정대균,정춘수 동의대학교 기초과학연구소 1999 基礎科學硏究論文集 Vol.9 No.1

The endoglucanase gene, egl6, of Trichoderma sp. was connected with the yeast ADH1 promoter, and the resultant plasmid, pVT-C4, was introduced into three S. cerevisiae host strains (YNN27, 2805, and SEY2102). Among each 80 transformants, the cell growth and expression level of endoglucanase were compared in test-tube cultivation, and three respective transformants for each host cells showing the highest expression level and cell growth were selected. When three recombinant yeast cells were batchwise cultivated for 48 hr in flask, the total activities of endoglucanase expressed were about 1140 unit/1 with 2805/pVT-C4, 1020 unit/l with SEY2102/pVT-C4, and 590 unit/l with (YNN27/pVT-C4. Irrespective of host strain, about 80% of the expressed endoglucanase was detected in the extracellular medium. In addition, it was also found that the recombinant enzyme was secreted into the culture medium as two major forms of lightly and heavily glycosylated proteins.

국내 의료기관의 항생제 사용 실태와 규제 시스템 조사

방지환,송경호,박완범,김성한,조재현,김홍빈,김남중,오명돈,최강원 대한감염학회 2006 감염과 화학요법 Vol.38 No.6

목적 : 이전 연구들에 따르면 아직까지 국내에서 불필요한 항생제 사용은 무시할 수 없는 수준이며, 특히, 수술환자들에 대한 예방적 항생제 투여가 문제로 지적되고 있다. 많은 병원에서 불필요한 항생제 처방을 제한하려는 노력을 하고 있지만 구체적인 현황에 대한 자료는 적은 실정이다. 이에 본 연구자 등은 국내 의료기관의 항생제 규제 시스템의 현황과 수술시 예방적 항생제 사용의 적정성을 알아보고자 한다. 재료 및 방법 : 전임 감염내과 전문의가 근무하는 의료기관 55곳에 대해 설문조사를 시행하였다. 설문의 내용은 적정한 항생제 사용을 유도하기 위한 정책 및 규제 프로그램, 실제 각 의료기관의 예방적 항생제 사용 현황 등으로 이루어져 있다. 결과 : 55개의 의료기관에 보낸 설문 중 44개가 회수되었다. 회신한 의료기관에서 항생제 처방 관리는 제한항생제 시스템을 가장 많이 이용하고 있었고(95.5%), 항생제에 대한 교육(79.5%), 전산시스템에서 관리(59.1%), 감염내과에 의뢰(54.5%), 항생제 사용 실적 검토(52.3%) 등의 순이었다. 대개의 병원에서 glycopeptides (100.0%), carbapenems (93.0%), quinupristin/dalfopristin 또는 linezolid(93.0%), 4세대 cephalosporin (74.4%), caspofungin 또는 voriconazole (62.8%), liposomal amphotericin B (60.5%) 등을 제한항생제로 분류하여 관리하고 있었다. 모든 의료기관에서 위절제술 및 유방절제술시에 불필요하게 예방적 항생제를 사용하고 있었다. 슬관절치환술의 경우 2세대 cephalosporin을 예방적으로 사용하는 경우가 가장 많았으며(30.2%), 관상동맥우회술의 경우 3세대 cephalosporin을 예방적으로 사용하는 경우가 가장 많았다(47.2%). 예방적 항생제의 투여 기간을 살펴보면 위절제술시 70.5%에서 4일을 초과하여 사용하고 있었고, 유방절제술시에는 63.6%에서, 슬관절치환술시에는 81.8%에서, 관동맥우회술시에는 81.1%에서 4일을 초과하여 장기간 예방적 항생제를 투여하고 있었다. 한편, 예방적 항생제 투여시 aminoglycoside계 항생제를 병용하는 경우도 많았다. 결론 : 아직까지 국내 의료기관에서 항생제 오남용을 막기 위한 노력이 더 필요할 것으로 생각되며, 특히 수술시 예방적 항생제의 올바른 투여에 많은 관심이 필요하다. Background : Previous studies in Korea showed that unnecessary antibiotic use could not be neglected, especially in prophylactic use. Currently many hospitals employ diverse antibiotic stewardship programs, but there are few studies on surveillance of such programs. So, we planned this study to evaluate current status of antimicrobial stewardship and adequacy of antimicrobial prophylaxis in surgery. Materials and Methods : We sent questionnaires about policy on antibiotic usage, control program for adequate antibiotic prescription, and actual status of prophylactic antibiotic usage to 55 infectious disease physicians in each hospital. Results : Of 55 contacted infectious diseases clinicians, 44 answered the questionnaire. Majority of hospitals employed restricted antimicrobial system (95.5%), education (79.5%), control by order communicating system (59.1%), consult to infectious disease physicians (59.1%), and review of cumulative antimicrobial usage (52.3%) to prevent inadequate antibiotic use. Glycopeptides were designated as a restricted antimicrobial agent in 100.0% of hospitals; carbapenems, 93.0%; quinupristin/ dalfopristin or linezolid, 93.0%; the 4th generation cephalosporins, 74.4%; caspofungin or voriconazole, 62.8%; liposomal amphotericin B, 60.5%, and so on. Unnecessary perioperative prophylactic antimicrobial agents were prescribed in gastrectomy and mastectomy in all the hospitals. The second generation cephalosporins and the third generation cephalosporins were the most commonly prescribed prophylactic antimicrobial agents in total knee replacement arthroplasty (TKRA) and coronary artery bypass graft surgery (CABG) respectively. In 70.5% of institutes they use prophylactic antimicrobial agents more than four days in gastrectomy; 63.6% in mastectomy; 81.8% in TKRA; 81.1% in CABG. Unnecessary combination of aminoglycosides with other antimicrobial agents for prophylactic use was another common problem. Conclusion : This study shows that more effort is required to diminish antimicrobial misuse or overuse, especially in prophylactic use for surgical patients.

치과기공사의 스트레스 증상 관련 요인분석

김지환,이원철,이강숙,이철,진기남 大韓産業醫學會 2000 대한직업환경의학회지 Vol.12 No.4

목 적 : 치과기공사에서의 직무 스트레스 증상과 관련된 요인을 알아보기 위하여 본 연구를 수행하였다. 방 법 : 전국에 등록되어 있는 치과기공사 4861명중 786명을 대상으로 생활습관, 직무에서 오는 스트레스, 사회적 지원, 자아 존중감, 성격 및 스트레스증상 평가를 위한 설문조사를 시행하였다. 결 과 : 스트레스 증상지수는 80 percentile을 기준으로 하위척도들의 절단점을 선정하였으며, Receiver Operating Chacteristic Curve를 그려 민감도 81.5 %, 특이도 86.1 % 되는 55점을 절단점으로 선정하였다. 생활습관 및 상태 항목으로는 흡연자에서 OR=1.49(1.11-2.00), 주관적 건강상태가 좋지 않은 군에서 OR=1,53(1.06-2.21)로 유의하게 스트레스 증상이 높았다. 직업관련 스트레서(stressor)로는 역할 과부하 (OR=6.69, 4.74-9.44), 작업 요구(OR=8.34, 5.82-11.97), 작업과정(OR=9.89, 6.76-14.94), 작업환경(OR=8.27, 5.80-11.79), 대인관계(OR=5.82, 4.04-8.39), 직업갈등(OR=8.34, 5.82-11.97), 봉급(OR=5.70, 4.04-8.04), 역할갈등(OR=7.58, 5.37-10.71) 등이 높은군에서 스트레스 증상이 높았으며, 사회적 지원이 높은 군에서 OR꼰.39(0.27-0.57), 자아 존중감이 높은 군에서 OR=0.41(0.290.60)로 스트레스 증상이 유의하게 낮았다. 결 론 : 직업관련 스트레스 경험을 많이 한 사람일수록 직업성 스트레스 증상의 정도도 높았으며, 사회적 지원을 많이 받고 자아존중감이 높은 사람일수록 스트레스 증상을 느끼는 정도가 낮았다. 직장 내에서는 스트레스를 감소시킬 수 있는 다양한 대처 전략 프로그램의 개발과 개인을 위한 스트레스 관리교육이 필요하며, 전문화된 직장 내에서 근로자가 도움을 받을 수 있는 정보체계와 직장내의 지원이 필요함을 제시하고 있다. Objectives To investigate the factors associated with symptoms from job stress among Korean dental laboratory technicians. Methods : We collected the data of 786 technicians for life-style, job stressor, social support, self-esteem, personality, and various dimension of stress symptoms included roomatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, and hostility by self-administerd questionnaire. Global severity index of dental technician (GSID) was calculated by total sum of sub-dimension. Results We used 80 percentile as a cut-off point, and got the 81.5 % of sensitivity, 86.1 % of specificity by receiver operating characteristic curve. The odds ratios of various factors in high group of GSID compared with low group were 1,49(95 % Cl 1.00-2.00) for smoker, 1,53 (1.06-2.21) for unhealthy group, 6,69 (4.74-9.44) for work overload, 8.34(5.82-11.97) for work demand, 9.89 (6.76-74.94) for work process, 8.27 (5.80-11,79) for work environment, 5.82 (4.04-8.39) for interpersonal relationship, 8.34 (5.82-11.97) for occupational conflict, 5.70 (4.04-8.04) for labor remuneration, 7.58 (5.37-10.71) for role conflict, but 0.39 (0.27-0.57) for social support, 0.41 (0.29-0.60) for self-esteem. By multiple logistic regression, factors were significantly associated with GSID were age, working area, role overload, work demand, work procedure, physical environment, occupational conflict, role conflict, social support, personality traits. Conclusions : Factors associated with symptoms from stress were role overload, work demand, work procedure, occupational conflict, interpersonal relationship, labor remuneration and role conflict in Korean dental laboratory technicians. It is suggested that health promotion program to reduce job stress and to enforce social support and self-esteem should be developed.

골수염으로 발현된 재발성 콕시디오이데스 진균증 1예

백지현,박은영,정윤숙,홍재원,채윤태,진성준,최희경,신소연,한상훈,진범식,김창오,최준용,송영구,조남훈,김준명 대한감염학회 2009 감염과 화학요법 Vol.41 No.4

Coccidioidomycosis is a fungal infection that results from inhaling the airborne arthroconidia of the Coccidioides species. It is an endemic disease in the southwest part of North America and rarely diagnosed in Korea. As tourism to endemic areas and the number of immunocompromised patients have been increasing, the incidence of this infection has increased in non-endemic areas. Treatment is usually successful with antifungal agents; however, recurrence is common. It is difficult to decide when to discontinue the antifungal treatment especially in non-endemic areas where doctors are not familiar with the disease. We report a case of recurrent coccidioidomycosis manifesting as osteomyelitis after the treatment of the patient for disseminated coccidioidal infection. The complement fixation test was a useful tool for the assessment of patient response and to evaluate suspected recurrence.

항결핵 6개월 단기요법의 성과 고찰

서지원,정연채,김남재,홍석철,김주옥,김선영,노흥규 충남대학교 의과대학 지역사회의학연구소 1990 충남의대잡지 Vol.17 No.1

To evaluate the effect of 6-month short term antituberculosis chemotherapy with INH, Rifampin, Ethambutol, and Pyrazinamide(2HREZ/4HRE) in the patients with pulmonary and/or extrapulmonary tuberculosis, the authors prescribed 2HREZ/4HRE regimen in 79 tuberculosis patients for 6 months with measuring the sputum staining for AFB, chest X-ray findings, recurrence rates and possible side reactions of the treatment. The result were as follow; 1. Pulmonary Tuberculosis 1) Among the 56 pulmonary tuberculosis patients who had taken 2HREZ/4HRE regimen. 32 patients showed initial positivity in sputum AFB smear stain(57.2%). Negative conversion occurred usually within 2 months after initiation of chemotherapy and the mean period of negative conversion was 1.4 months. 2) Among the 56 pulmonary tuberculosis patients, chest X-ray finding changed in 41 patients (37.21%). From these 41 patients 39 patients showed continuous improvements in chest X-ray finding, though 3 patients showed initial aggravation in spite of continuous medication. The remainder 2 cases aggravated due to the failure of treatment. 3) Treatment failure occurred in 2 patients (3.57%) during the chemotherapy among 56 patients of pulmonary tuberculosis and they were infected with secondary drug-resistant strains of M. tuberculosis. 2. Extrapulmonary tuberculosis. Among 8 patients with tuberculous pleurisy and 15 patients with superficial tuberculous lymphadenitis, there were no evidence of treatment failure after completion of antituberculosis chemotherapy for 6 months with 2HREZ/4HRE regimen. 3. Follow-up study was performed from 6 months to 50 months after completion of antituberculosis chemotherapy and the relapse was not noted in both pulmonary and extrapulmonary tuberculosis patients group during this period. 4. Serum AST/ALT elevated in 9 patients(11.4%) during the treatment and this occurred usually within 3 months after the initiation of antituberculosis chemotherapy. However treatment interruption occurred in 2 patients (2.5%) due to the development of hepatitisone due to drug-induced hapatitis and the other due to type B viral hepatitis. In conclusion, we could find this 2HREZ/4HRE 6-months short-term antituberculosis regimen is effective and could be recommanded as a promising regimen for the treatment of tuberculosis.

실내사무환경의 환경성담배연기(ETS)의 지표물질에 관한 연구

하권철,백남원,박동욱,윤충식,김원,최상준,박지영,최인자,김신범,강태선 한국산업위생학회 2003 한국산업보건학회지 Vol.13 No.2

The purpose of this research is to evaluate indoor office environment using the concentrations of nicotine, 3-enthenyl-pyridine(3-EP), and respirable suspended particulate(RSP), which are indicators for environmental tobacco smoke(ETS) and the correlations between indicators and environmental conditions(smoking density, smoking index). The mean air charge per hour (ACH) in smoking rooms was 10.4 and most of the smoking rooms showed non-compliance withe ASHRAE standard value except only one smoking rooms. The concentrations of RSP, 3-EP, nicotine showed log=normal distributions, and became different statistically depending on smoking condition(p〈0.01). The geometric mean concentration of RSP in smoking room was 441.7 ug/㎡ that is far exceeded environmental standard(150 ug/㎡). This implies that fine particulate in smoking room should be carefully controlled considering smoking density and ventilation fate. The mean concentrations of nicotine and 3-EP were 93.4 ug/㎥, respectively. The correlation coefficients between RSP and SI, 3-EP and SI, and Nicotine and SI were 0.67, 0.84 and 0.74, respectively. The correlation coefficient between nicotine and 3-EP, nicotine and RSP, and RSP and 3-EP were 0.76,0.78 and 0.57 respectively.

가상현실을 이용한 뇌졸중 환자의 균형장애 평가와 임상평가 지수와의 상관성 연구

김연희,박지원,정준용,우영근,최종덕,김남균 최신의학사 2003 最新醫學 Vol.46 No.11-12