간문부 담관암 환자에서 경피경관 양측성 금속 배액관의 효과

김금래,김주형,박원규,장재천,조재호,김태년,김준화,장병익 영남대학교 의과대학 2005 Yeungnam University Journal of Medicine Vol.22 No.2

Background: The purpose of this study was to determine the effectiveness of percutaneously place self-expanding metallic stent for the relief of biliary obstruction in patients with hilar cholangiocarcinoma. Materials and Methods: From November 2001 to December 2004, 48 patients with hilar cholangiocarcinoma were prospectively studied. After percutaneous placement of bilateral self-expanding, uncovered metallic stents, follow-up evaluation was carried out until July 2005. Results: There were 4 cased of Bismuth type Ⅱ,21 cases of Bismuth typeⅢa 8 cases of Bismuth type Ⅲb and 15 cases of Bismuth type Ⅳ. Stent placement was technically successful in all patients All patients had satisfactory biliary drainage, resulting in one week drainage rate of 72.8% and final drainage of 91.9% There were 12 cases (21.3%) of abdominal pain requiring analgesics and 1 case (7.1%) of cholangitis; both were successfully managed with conservative treatments. Late complications occurred in four patient (8.3%), including two patients with cholangitis, one patient with liver abscess, and one patient with biloma; all were appropriately managed by percutaneous drainage. The average length and median durations of stent patency and median survival time were 303 days (range, 60~815) and 338 days (range, 60 ~1175), respectively. Conclusion: Placement of a percutaneous metallic stent is an effective and safe method of palliation of patients with hilar cholangiocarcinoma.

최근 病院可檢物에서 분리되는 중요 細菌의 抗生劑感受性

李源吉,金在崇,金重明,金在植 慶北大學校 醫科大學 1982 慶北醫大誌 Vol.23 No.2

1981년 본 대학 부속병원 임상병리 細菌檢査室에 의뢰된 검체에서 분리된 35種의 총 菌株수는 891株이었으며 소변에서 분리된 것이 301株(33.8%)로 가장 많았고 다음은 喀痰, 膿 및 咽喉순이었다. 100株 이상씩 분리된 菌種은 S. epidermidis, Micrococcus, S. aureus와 E. coli 순이었고 S. epidermidis는 小便과 喀痰, Micrococcus는 喀痰에서 S.aureus는 膿과 小便에서 E. coli는 小便에서 분리된 것이 대부분이었다. Streptococcus는 α-hemolyticus가 99株로서 喀痰에서 주로 분리되었고 50株 내외로 분리된 K. pneumoniae, Ent.cloacae, Ps. fluorescens, Citrobacter freundii와 Acinetobacter calcoaceticus는 각각 小便과 喀痰, 小便과 膿, 膿과 小便, 小便 및 小便에서 대부분 분리되었고 기타 菌種은 소수에서 분리되었다. 7種의 중요 菌種으로 부터 각각 무작위로 선택한 총 258株를 대상으로 하여 9種의 抗生劑에 대하여 disk diffusion(DD)와 agar dilution(AD)법으로 感受性을 조사하였다. E. coli 는 amikacin(AMK)에 매우 높은 感受性을 gentamycin(GAM)과 tobramycin(TOB)에 비교적 높은 感受性을 보였고 ampicillin(AMP), chloramphenicol(CAM) 및 tetracyaline(TET)에 비교적 높은 耐性을 나타내었고 K. pneumoniae는 AMK에 높은 感受性을 CEP, GAM 및 TOB에 비교적 높은 感受性을 보였고 AMP에 고도의 耐性, CAM과 TET에는 비교적 높은 感受性을 CAM과 GAM에는 중등도의 感受性을 penicillin과 TET에 고도의 耐性을 보였다. Ser. marces-cens 는 AMK에 중등도의 感受性을 GAM에 낮은 感受性을 보이나 나머지 抗生劑에 고도의 耐性을 보였다. Ps. aeruginosa는 AMK에 비교적 높은 感受性을 GAM, TOB 및 carbenicillin에 비교적 낮은 感受性을 보였고 Salmonella group A는 AMK, GAM, AMP, CEP, CAM 및 TOB에 매우 높은 感受性의 경향을 나타내었고 TET에도 비교적 높은 感受性의 경향을 나타내었다. Shigella group B는 AMK CEP, GAM 및 TOB에 매우 높은 感受性의 경향을 그리고 AMP, CAM 및 TET에 매우 높은 耐性의 경향을 보였다. Amikacin이 모든 供試菌들에 대하여 가장 强한 抗菌力을 보였고 Serratia 菌種과 Pseudomonas菌種은 다른 供試菌種에 비하여 확실히 耐性의 傾向을 나타내었다. Agar dilution 法과 disk diffusion 法에서 이 두방법은 서로 잘 일치하는 경향이나 DD법이 AD법에 비하여 안정성을 보이는 것 같았다. 검체에 의한 각 菌種사이에 있어서 感受性의 차이는 볼 수 없었다. Total numbers of isolated bacteria were 35 species and were 891 strains. The highest isolates were 301 strains (33.8%) which were from urine specimens and followed by sputum, pus and throat. S. epidermidis, Micrococcus, S. aureus and E. coli in order were over 100 strains. S.epidermidis strains were isolated mainly from urine and sputum, Micrococcus strains from sputum, S. aureus strains from pus, and urine and E. coli from urine, and Streptococcus (α-hemolyticus) were 99 strains which were isolated from mainly sputum. K. Preumoniae, Ent. cloacae, Ps. fluorescens, Citrobacter freundii and Acinetobacter calcoaceticus were more or less 50 strains and isolated mainly from urine and sputum, urine and pus, and urine, urine and urine respectively. Others were in small numbers. Totally 258 strains selected at random from 7 important bacteriae which were selected recently and antibiotic susceptibility testings to these orgamisms were performed. E. coli was very sensitive to amikacin (AMK), moderately sensitive to gentamycin (GAM) tobramycin (TOB) and moderately risistant to ampicillin (AMP), chloramphenicol (CAM) and tetraciclin (TET). K. pneumoniae was highly sensitive to AMK, moderately sensitive to cephalothin (CEP), gentamycin (GAM) and TOB, very highly resistantce to ampicillin (AMP) and highly resistant to CAM and TET. S. aureus was very sensitive to AMK, and CEP, moderately sensitive to CAM and GAM, and very highly resistant to penicillin and TET. Ser. marcescens revealed low sensitivity to AMK and GAM but resistances to the other antibiotics. Salmonella group A showed very high sensitivity to AMK, GAM, AMP, CEP, CAM and TOB and high sensitivity even in TET. Shigella group B were very highly sensitive to AMK, CEP, GAM and TOB, but very highly resistant to AMP, CAM and TET. AMK showed the highest sensititity to the most organism but Serratia and Pseudomonas revealed distinctively high resistances to antibiotics even in the new potent antibiotics of broad spectrum. The disk diffusion and agar dilution method were generally corresponding but the former appeared to be more reliable. There were no remarkable difference in susceptibility from specimen to specimen.

HBsAg양성 원발성간암에 있어서 HBV-DNA표지자의 PCR성적

이원길,김재식,김정철,서장수,강은자,이중원,김기연,송경은,양정선 慶北大學校 醫科大學 1997 慶北醫大誌 Vol.38 No.2

목적 : HBV-DNA를 정성적 그리고 정량적으로 검출함으로써 강한 전염성과 높은 유병율로 인해 사회적으로 문제가 되는 B형 간염과 원발성간암의 연관성을 알아보고자 하였다. 대상 및 방법 : B형 간염 표면항원(HBsAg)이 양성을 보이는 원발성간암 환자 38명을 대상으로 하였으며 HBV-DNA 중합효소연쇄반응법을 이용하여 정성적 검출 그리고 luminometry법을 이용하여 정량적 검출을 하였다. 결과 : HBV-DNA 중합효소연쇄반응법과 luminometry법의 양성율은 각각 57.9%, 39.5%를 보였다. 그리고 HBsAg과 HBeAg가 동시에 양성을 보인 11명에서는 HBV-DNA 양성율이 81.8%를 보였다. 결론: HBV-DNA 중합효소연쇄반응법의 양성율이 luminometry법에 의한 양성율보다 높은 결과를 보였고 HBV-DNA 검사는 B형 간염을 조기 발견하고 치료하여 만성간질환으로의 진행을 예방하고 특히 원발성간암의 병율을 낮추는데 많이 기여할 것으로 사료되었다. Background : Primary hepatocellular carcinoma(PHCC) is the most common malignant neoplasm in most countries of Asia and Africa. Hepatitis B virus is known to be strongly related to the pathogenesis of PHCC. HBV-DNA PCR and HBV-DNA quantitation assay were attempted to apply to 38 cases of HBsAg positive PHCC. Methods : The ordinary HBV markers(HBsAg, anti-HBs, anti-HBc(Ig-G and -M), HBeAg and anti-HBe) were examined with ELISA. Qualitative screening of HBV-DNA PCR and HBV-DNA quantitation-luminometric measurement were performed. Results : Among 38 cases of HBsAg positive PHCC, positive rates for HBV DNA-PCR and HBV DNA-quantitation were 57.9% and 39.5%, respectively. And 11 cases which were positive for both HBsAg and HBeAg showed 81.8% positive rate in HBV-DNA PCR. Conclusion : For 38 cases of HBsAg positive PHCC, the positive rate for HBV DNA-PCR was higher than HBV-DNA quantitation-luminometry. In HBV-DNA PCR, both HBsAg and HBeAg positive cases showed high positive rate.

소규모 도시의 생활폐기물 발생특성 : 동해시를 중심으로 For Donghae City

김승호,원철희,김병욱,임재명 江原大學校 産業技術硏究所 2002 産業技術硏究 Vol.22 No.B

This research was performed to investigate the generation and physico-chemical characteristics of municipal solid wastes. The results were as follows: i) The generation rate and bulk density were 0.157 kg/cap/d and 147.8 g/L in residential zone, respectively. In non-residential zone, the generation and bulk density were 1.71 kg/cap/d and 85.6 g/L, respectively. Consequently, bulk density of non-residential zone was lower than that of residential zone. ii) The wastes consisted of 90% of combustibles and 10% of incombustibles in residential zone. And the wastes from non-residential zone was composed 85% of combustibles and 15% of incombustibles. iii) Water content was estimated at 47∼50% in residential zone and restaurants. In non-residential zone, except restaurants, water content was in the range of 10∼30%. Ash content was nearly 10% in overall zone.

원내감염 실태조사 경험 : 원내감염과 원내환경

김재식,이원길,박정한,이건일 慶北大學校 醫科大學 1996 慶北醫大誌 Vol.37 No.3

목적 : 원내감염실태를 조사한 경험을 당시 노출되었을 때 발생하였을 주변사정 때문에 시간이 상당히 경과한 지금에 와서 겨우 당시 경북대학교병원내 병원감염을 조사한 것을 앞으로 병원감염관리에 참고 자료로 하기 위하여 본 경험을 발표한다. 재료 및 방법 : 400명의 대상 환자들이 신규로 입원할 때 부터 퇴원을 할 때까지 매일 한 번씩 병력지를 검토하고 환자를 방문하여 작성하고 작성된 조사표에 해당 항목별로 기록하고 원내감염의 감별은 Senic project의 기준에 의하였으며 원내감염발생율과 원내환경으로 구분하여 조사하였고 후자는 균배양 동정을 시행하였다. 결과 : 운내감염발생율에 있어서는 당시 1983년 전후 일정기간동안 원내감염 발생률은 9.0%이었으며 원내감염 발생은 의료수기의 빈도가 큰 정형외과와 일반외과에서 특히 높았다. 원내환경에 있어서는 수술과정, 수술실내와 병동내에서 사용되고 있는 의료기자재와 소독약 zephirane에서 균배양 양성이었다. 균종으로는 Serratia, Pseudornas, Klebsiela와 Staphylococcus등이었다. 결론 : 이상의 성적을 종합하면 결론적으로 비교적 높은 원내감염율은 관련의사, 진료보조원 및 신중한 항생물질의 사용 등에 대한 대책을 필요로 하며 항생제 남용을 피하고 그때 그때 병력지 기록의 중요성을 암시하며 원내감염의 근원이 되는 원내환경의 철저한 관리가 필요하다. One experience of investigation of hospital infection in Kyungpook National University Hospital around 1983 was summarized as follows though postponed report with surrounding conditions was inevitable. The patient charts were reviwed daily and recorded the hospital infection data collection sheet according to items by visiting patients. The hospital infection was differentiated on the basis of Senic project. In incidence of hospital infection the rate of hospital infection of in-patient was 9.0% and it was nore high in more frequent usage of medical manipulation like surgical dressing and instrumentation. The use of antibiotic was more frequent in more frequent hospital infection sites. Medical recording was inapproproate in most cases. In hospital environment bacterial organisms were cultivated from various conditions on sites as surgical operation and dressing and ward procedure like urethral catheterization in operation room and ward. Bacterial organisms were cultivated from various conditions in operating room and ward and particularly from zephirane(antisepic). Organisms were Serratia, Pseudomonas, Klebsiella and Staphylococcus etc. A cautious prevention of hospital infedtion was highoy recommended against medical doctors especially and related paramedical personnel as nurse, as well as satistactory medical recording. The hospital environment control is strongly reccmmended.

도심지 하수관거의 I/I 및 CSOs 특성

김병욱,최승철,원철희,임재명 강원대학교 부설 석재복합신소재 제품연구센터 2003 석재연 논문집 Vol.8 No.-

본 연구에서는 도심지 하수관거의 특성을 파악하기 위하여 원주시를 대상으로 수질 및 유량 조사를 통하여 기존 하수관거의 침입수/유입수(I/I) 분석 및 하수관거 정비사업시 우선순위 결정을 위한 자료제공과 강우시 CSOs의 발생특성을 분석, 결과를 고찰하였다. 그 결과 원주시의 조사지점별 평균 BOD는 원주하수종말 처리장 설계기준과 비교하여볼 때 26.O~60.7%로 매우 낮게 배출되는 것으로 조사되었으며, 평가기법에 의한 원주시 도심지역의 I/I율은 평균하수량의 35.7~74.6%로 매우 높은 것으로 조사되었다. 또한, 강우시 발생하는 CSOs는 배수유역의 크기와 강우량, 강우강도, 차집용량에 따라 큰 유량차이를 보였으며, CSOs의 수질분석결과 강우초반부 초기세척(First-flush)현상으로 수질이 급격히 상승하였다가 감소하는 것으로 나타났으며, CSOs의 BOD부하를 살펴보면 일평균 BOD부하의 18.7~38.5%이상으로 인근수역으로 미처리되어 배출되는 것으로 조사되었다. 이와같이 하수관거의 I/I율과 CSOs의 발생특성은 조사지점의 특성에 따라 큰 차이가 있으므로 관거정비사업시 이에 대한 충분한 조사 및 분석이 이루어져야 할 것이다. Infiltration/Inflow(I/I) is the major deterrent to the successful performance of the sewer and the treatment systems. An excessive I/I in a sanitary sewer system can hydraulically overload the sewer lines and the wastewater treatment plants and combined sewer overflows(CSOs) are untreated wastewater during storm events. The characteristics of the CSOs are extremely variable, depending upon local physical conditions such as topography, soil conditions, degree of development and imperviousness of surface. As a result of the flow rate and water quality monitoring, biochemical oxygen demand(BOD) concentration was significantly low as 26.0-60.7% of 173mg/L which is a design standard of wastewater treatment plant. I/I rate of sewer in the center of Wonju city evaluated by assessment method was very high as 35.7-74.6% of total flow. Furthermore, 18.7-385% of BOD load of CSOs during wet weather was discharged into watershed with being untreated. As stated above, I/I running into sewer system should be considered before everything when sewer system is improved and CSOs generated during wet weather should be necessarily deliberated for design of water treatment plant and improvement of sewer system.

UASB 공정에 의한 고농도 축산폐수 처리시 유기물 제거와 메탄생성에 관한 연구

원철희,김승호,박은영,임재명 江原大學校 産業技術硏究所 2002 産業技術硏究 Vol.22 No.B

This research was performed to investigate the COD removal efficiency and methane production in slurry-typed swine wastes using UASB(upflow anaerobic sludge blanket)reactor. The USAB reactor was operated from 0.8 through 3.3days of HRT in a range of 3 to 15 kg TCOD/m³/day of volumetric organic loading rate. The removal rate of TCOD was increased with the increase of the HRT. The removal rate of TCOD at an HRT over 2days, became greater than 68% with the methane contents being from 70 to 80%. Methane production rates were increased from 0.27 to 0.36 m³CH₄/kg CODrem. as HRTs were increased from 0.8 to 3.3days.

SWPP Media를 이용한 BNR 공정의 동력학 인자 및 유출수의 수질예측

김병욱,원철희,임재명 江原大學校 附設 環境硏究所 2003 環境硏究 Vol.20 No.-

This study was performed to estimate effluent concentration and kinetic parameters in biological nutrient removal(BNR) process using SWPP media. These systems were operated with HRT of 5hrs through 14hrs at internal recycle of 50%. The removal efficiencies of BOD, at four HRT of 5,8,10, 14 hrs, were 82.4, 89.9, 929,9 and 94.8%, respectively. The overall nitrogen removal efficiencies were 39.1%∼82.8% for T-N and 44.8%∼95.4% for NH_(4)^(+)-N. And it was found that high removal efficiency of nitrogen was obtained by long HRT. Phosphorous removal efficiencies were very low during overall operation. Therefore, further study is needed to enhance the phosphorous removal efficiency in this process. The Stover-Kincannon model was adapted to the aerobic tank. The kinetic equations, removal of NH_(4)^(+)-N and COD, were similar to monod equation. The specific maximalNH_(4)^(+)-N removal effiency(M) and proportionality constant(k) were 4.95g NH_(4)^(+)-N/㎡/day, respectively. And for the organic matters, M and K were 17.0 g COD/㎡/day and 18.0g COD/㎡/day and it was found that the experimental and the estimated values corresponded well. In the organic loading rate increased, the removal rate decreased. Thus, it was found that the adaption of the stover-Kincannon model was inadequate, because experimental and estimated value did not correspond.

부착증식 공정에서 여재의 개선에 따른생물막 특성

권재혁,김병욱,조원태,임재명 江原大學校 附設 環境硏究所 1999 環境硏究 Vol.16 No.-

This study was conducted to investigate the performance and biofilm characteristics of modified media(RUN 2) in comparison with conventional media(RUN 1) on wastewater treatment system. The results were as follows ; At four different HRT of 6, 12, 18 and 24hr, BOD removal efficiency was 65.5, 85.6, 92.2 and 91.9% in RUN 1 and 70.7, 88.7, 94.7 and 95.9% in RUN 2. Biofilm characteristics in each treatment system could be classed as following : i) In RUN 1, the biomass was 2.54 to 3.01㎎/㎥ and its thickness was 342 to 907μm and in RUN 2, this was 560 to 1,180μm and that was 2.54~3.01㎎/㎥. ii) The biofilm dry density was 32.60㎎/㎥ in RUN 1 and 39.06㎎/㎥ in RUN2, respectively. iii) The VSS contents pe unit area were 2,675~2,822㎎VSS/㎠ in RUN 1 AND 2,954~3,123㎎VSS/㎠ in RUN 2. In consider of organic removal rates and biofilm attachment characteristics, it was proved that modified media in RUN 2 was higher than conventional media in RUN 1.

임상가검물에서 분리된 효모의 임상적 의의

유병용,이원길,김재식,전효진,노략균,이장백,김중명 慶北大學校 醫科大學 1990 慶北醫大誌 Vol.31 No.4

1988년 1월부터 동년 12월말까지 경북대학교병원 임상병리과에 의뢰된 가검물 중에서 효모가 분리되었던 환자는 159명이었고, 남자와 여자의 비율은 1.8이었으며 1세 이하와 30세 이상에서 많았다. 또 분리 동정된 효모 총 159주 중 객담에서 78주(49.1%), 요에서 64주(40.3%), 복막액 5주(3.1%) 편도와 대변 각각 4주(2.5%), 농에서 3주(1.9%) 뇌척수액에서 1주(0.6%) 순으로 분리되었다. 분리된 효모로는 Candida albicans가 68주(42.8%), Candida tropicalis 33주(20.8%) Torulopsis glabrata 20주(12.6%), Candida parapsilosis 17주(10.7%), Trichosporon beigelli 7주(4.4%), Torulopsis candida 5주(3.1%), Torulopsis inconspicua와 Saccharomyces cerevisiae가 각 4주(2.5%), Candida guilliermondii 1주(0.6%) 순으로 있었다. 환자들의 기존질병은 폐질환이 70예, 요로질환이 40예 악성종양 및 당뇨병이 각 22예, 간질환 16예, 순환기 질환이 12예 등으로 나타났으며, 유인중 항생제 사용은 114예(80.0%), 수술 49예(34.3%), 카테터 46예(32.2%), 스테로이드사용 28예(19.6%) 악성종양과 당뇨병이 22예(15.4%), 항암제 사용이 10예(7.0%)로 나타났다. 유인이 2개 중복된 경우는 43예, 3개 중복은 38예, 4개는 11예, 5개는 2예로 나타났다. Yeast infection is commonest fungal infection of human. And their incidence becomes to be increased as the frequency of altered host immune system is increased. Antibiotics, cytotoxic drug, malignancy, diabetes mellitus, operative procedures and catherizations are predisposition of fungal infection. Since antifungal drug within a selective or narrow range of activity are available, it is important that speciation of yeast in routine clinical microbiology practice should be effected rapidly and reliably. Author isolated 159 strains of yeast and that were identified by API 20C Auxanogram®. Patient charts were reviewed retrogradely in order to find predisposing factors of isolated yeast cells. Yeast isolation is 1.8(102:57) of male to female rtio and is more frequently below 1 year-old and above 30 year-old in both sexes. Septum(49.1%). urine(40.3%) were major specimens in which yeast isolated. Candida albicans(42.8%), Candida tropicalis(20.8%), Torulopsis glabrata(12.6%), Candida parapsilosis(10.7%) were frequently identified species in order. Candida albicans and Candida parapsilosis were frequently isolated species among various specimens. Pulmonary diseases, urinary tract diseases, malignancy, and diabetes mellitus were major underlying diseases. And antibiotic(80.0%), operative procedure(34.3%), catherterization(32.2%), steroid(19.6%), malignancy(15.4%), diabetes mellitus(15.4%) and cytotoxic drug(7.0%) were predisposed in order.