성인에서 Haemophilus influenzae 감염증의 임상양상과 미생물학적 특성

이종섭,황병연,정희진,김우주,박승철,이도현,이창규,신종희,황규잠,이영희 대한화학요법학회 2000 대한화학요법학회지 Vol.18 No.2

목적 : H. influenzae는 성인에서 흔히 호흡기 감염을 일으키는 균주로, 최근 ampicillin 내성 β-lactamase 생성 균주들이 지속적인 증가를 보이고 있어, 이에 국내 성인에서 H. influenzae에 의한 감염의 임상양상과 분리된 균주들의 미생물학적 특성을 조사하고자 하였다. 방법 : 1998년 3월부터 1999년 9월까지 고려대 구로병원에 내원한 환자중에서 H. influenzae가 분리된 68명을 대상으로 임상양상을 조사하고 항균제 감수성 검사를 시행하였다. 분리된 33주에 대해서 혈청형, 생물형, 세포외막 단백분석을 시행하였고, β-lactamase 생성여부에 따른 감염 환자군간 임상상 및 예후의 차이를 비교하였다. 결과 : 환자의 평균연령은 68세였고, 지역사회 획득감염이 전체의 85%를 차지하였다. 폐렴과 기관지염과 같은 하기도 감염이 전체환자의 75%를 차지하였고 분리 검체 역시 객담이 84%로 가장 많았다. 환자의 71%가 기저질환을 가지고 있었으며, 그 중에 만성 폐쇄성 폐질환, 심혈관 질환, 악성종양, 당뇨병이 대부분이었다. 혈청형으로는 nontypeable 형이 68%로 가장 많았고 b형은 한 예도 없었다. β-lactamase 생성율은 63.2%였고, β-lactamase 양성균주의 항균제 내성율이 음성균주에 비하여 높았으나 β-lactamase 생성 여부에 관계없이 cefotaxime, azithromycin, ciprofloxacin에 대하여 100%의 감수성을 나타내었고 cefaclor, cefuroxime에 대해서는 10% 이하의 낮은 내성율을 보여 이들 항균제들이 치료에 효과적일 것으로 사료된다. 세포외막 단백분석에서는 C형과 D형이 전체의 64%로 가장 많았으며, 혈청형과의 유의한 연관성은 보이지 않았다. 결론 : 성인에서 H. influenzae는 주로 만성 기저질환자에서 급성 호흡기감염 또는 만성 폐쇄성 폐질환의 급성 악화를 유발한다. 기존의 보고에 비해 β-lactamase 양성율이 증가하였고, 이에 따른 항균제 내성율도 증가하여 항균제의 선택에 유의하여야 할 것으로 생각된다. 세포외막 단백분석상 특정한 유형의 균주에 의해 감염이 집중적으로 발생하고 있어 향후 역학 조사의 도구로 이용할 수 있겠다. Purpose : H. influenzae is one of the common causative microorganisms of respiratory tract infections in adults. Recently. β-lactamase producing, ampicillin-resistant H. infiuenzae has become worldwide problem as well as in Korea. We studied to investigate the clinical features and microbiologic characteristics of H. infiuenzae infections in adults. Materials & Methods : From March 1998 to September 1999, 68 patients were enrolled in this study. Clinical features of H. infiuenzae infections were investigated, 68 isolates were subjected to the β-lactamase test, and 33 isolates were used for serotyping. biotyping, antibiotic susceptibility and outer membrane protein (OMP) analysis. Results : Mean age of study patients was 68 years-old and the acquisition rate in community was 85%. Pneumonia and bronchitis were the most common type of infection such as 80%, sputum was the most common clinical specimen for H. mQuenzae isolation. 70% of patients had chronic underlying diseases. Non-typeable strains were 68% and β-lactamase producing rate was 63%. There was no difference in the clinical features and prognosis of H. influenzae infection between the β-lactamase positivie and -negative groups. The susceptibility of cefotaxime, azithromycin, and ciprofloxacin was 100% and that of cefaclor, cefuroxime was under 10% in spite of β-lactamase positivity. In OMP analysis, C and D types were dominant (64%). Conclusion : H. influenzae caused acute respiratory infections in adults with chronic underlying disorders. This study shows higher β-lactamase producing rate and antibiotic-resistance rate than that were reported previously. OMP analysis shows that two major types of strains cause clinical infections intensively.

부신피질 자극호르몬 단독결핍 1례

박경식,이승현,최석영,박태규,이동화,이찬우,정성복,이인규 啓明大學校 醫科大學 1997 계명의대학술지 Vol.16 No.3

부신피질 자극호르몬 단독결핍은 국내에서 7례만이 보고된 희귀 질환이며 병인 및 경과 등 아직 불분명한 측면이 많다. 이는 질환지체의 희귀성도 있지만 치료후 자연경과에 대한 장기적인 추적검사가 이루어진 경우가 드물기 때문이기도 하다. 저자들은 비특이적인 전신증상을 주소로 내원한 폐경기후의 56세 여자 환자에서 자가면역질환의 증거없이 고프로릭틴혈증을 보인 부신피질 자극호르몬 단독결핍 1례를 경험하고 1년간의 부신피질호르몬 대치요법후 추적검사를 실시하였기에 문헌 고찰과 함께 보고하는 바이다. Isolated ACTH deficiency is a rare disorder which shows secondary adrenal insufficiency with normal states of other pituitary hormones. A 56-year-old postmenopausal woman complaining general weakness and intermittent mental confusion presented negligible serum cortisol and ACTH level with hyperprolactinemia and mild hyponatremia. Rapid ACTH stimulation test did not show significant increase of serum cortisol level. Combined pituitary stimulation test showed negligible response of cortisol and ACTH, and slightly decreased response of prolactin and gonadotropin. But the responses of TSH and GH were normal. There was no evidence of organic pituitary of hypothalamic lesion in brain MRI and antithyroid autoantibody was not detected in serum. After receiving 12 months of glucocorticoid replacement therapy, she skipped the medicine for 3 weeks and we performed follow-up endocrinologic tests. Serum ACTH and cortisol level was also negligible and prolonged ACTH simulation test showed normal response of serum cortisol. CRF stimulation test showed no response of serum ACTH. Basal prolactin level was decreased to near normal and combined pituitary stimulation test showed normal response of prolactin with slightly blunted response of TSH and GH. We concluded that the case was nonautoimmune origined isolated ACTH deficiency which was accompanied by hyperprolactinemia and resultant deficiency of gonadotropin, so we report this case with review of literatures.

노인의 영적 간호요구

최미혜,김경희,김귀옥,김기숙,김수강,김정신,김춘숙,노흥진,박지연,성혜연,오명선,이선희,이원옥,이윤영,이현수,장명재,차혜경,채정선,홍상희 중앙대학교 의과대학 간호학과 간호과학연구소 2001 중앙간호논문집 Vol.5 No.1

This study was designed to exam the aged's needs for spiritual nursing care. The purpose was to serve as a basis for the development of spiritual nursing practice. The major findings are as follows : 1. The degree of needs for spiritual nursing care as area was that needs of love and relationship mean 22.0, needs of meaning and object mean 28.2, needs of forgiving mean 13.5. Total needs for spiritual nursing care mean 63.7, which was on the upper middle level. The needs of meaning and object was rated highest. 2. Among the general characteristics of the subjects, needs of love and relatiohship wasn't significanlty different. 3. Among the general characteristics of the subjects, needs of meaning and object was significantly different according to two factors : age(F=7.260, p=0.001), religion(F=5.275, p=0.001). Higher needs of meaning and object was possessed by the older than the younger, by the one who have religion than the other. 4. Among the general characteristics of the subjects, four factors made a significantly difference to needs of forgiving : sex(t=-2.851, p=0.006), age(F=8.201, p=0.001), religion(F=6.928, p=0.000), disease(t=2.327, p=0.024). Higher needs of forgiving was possessed by man than woman, by the older than the younger, by the one who have religion than the other, by the one who have disease than the other.

정신분열병에 대한 Risperidone의 효과 및 안전성에 관하여

신석철,왕성근,지익성,이선우,이규광,이봉희,이진영,황선희,신용재,배경도,김정란 충남대학교 의과대학 지역사회의학연구소 1997 충남의대잡지 Vol.24 No.1

In order to evaluate the efficacy and safety of risperidone, 10 patients with chronic schizophrenia were examined for 8 weeks in a silgle-open study. After the wash-out period of 1 week, risperidone was administered. Efficacy was evaluated by means of Positive and Negative syndrome Scale for Schizophernia(PANSS) and Clinical Global Impression(CGI). Safety assessment included the Extrapyramidal Symptom Rating Scale(ESRS), vital signs, body weight, ECG, and laboratory tests. The results were as follows 1) On the PANSS total score, there was significant improvement of total score after 1 week (P<.05) of administratiom. 2) On the PANSS positive and negative subscal, there were significant improvement of posotive and negative scores after 2 weeks (P<.05) of administration. 3) On the PANSS general psychopatholgy subscals, there were significant improvement of general psychopathologyscores after 1 week (P<.05) of administratiom. 4) On the CGI, there was significant decreasement of clinical impression of severity of schizophrenia score after 2 week (P<.05) of administration. 5) A statistically significant increase in body weight (P<.05) was observed after 8 weeks of administration. 6) EPS reached the peak at the end of the 1st week of administration of risperidone (11.8± 24.25) but they were easily relieved by addition of benztropine and clonazepam. There was not significant change in laboratory tests, vital sign, ECG after 8 weeks of administration. These results suggest that Risperidone is an effective antipsychotics and clinically safe except for increased body weight in chronic schizophrenia.

65세 이상의 노령층에서 고지혈증의 위험요인

김용배,장원기,황보영,김화성,안규동,이병국,이용진,김세훈,김승수,김승훈,김영록,김웅빈,이성수 순천향의학연구소 2006 Journal of Soonchunhyang Medical Science Vol.12 No.1

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급성단순성방광염 여성 환자에서 분리된 요로감염균에 대한 Tosufloxacin과 Ofloxacin, Levofloxacin의 항균력 비교

이승주,이규성,정성진,이상은,조용현 대한감염학회 2007 감염과 화학요법 Vol.39 No.4

목적 : Tosufloxacin은 기존의 퀴놀론계 항생제보다 높은 항균력을 가진 퀴놀론계 항생제이다. 그러나 요로감염의 원인균에 대한 tosufloxacin의 감수성은 잘 알려져 있지 않다. 급성단순성방광염 여성 외래환자의 소변에서 분리된 원인균에 대한 tosufloxacin의 최소억제농도(minimum inhibitory concentration, MIC)를 levofloxacin과 ofloxacin의 그것과 비교분석하고자 본 연구를 실시하였다. 재료 및 방법 : 2006년 8월부터 2006년 11월까지 수도권 4개의 병원에서 수거한 소변검체에 대하여 배양검사와 항생제 감수성검사를 실시하였다. 분리된 총 89개 균주의 tosufloxacin, levofloxacin 그리고 ofloxacin에 대한 MIC를 한천희석방법을 통해 측정하였다. 결과 : 원인 균주 중 E. coli가 70.8%로 가장 흔한 원인균이었다. Tosufloxacin과 levofloxacin의 MIC는 대체적으로 2개의 최다값을 갖는 bimodal 양상을 보였는데, tosufloxacin은 0.03과 32 ㎍/mL, levofloxacin은 0.03과 16 ㎍/mL에서 최다값을 가졌다. 반면에 ofloxacin은 0.5 ㎍/mL에서 또 하나의 최다값을 가지는 분포를 나타냈다. E. coli에 대한 tosufloxacin, levofloxacin 그리고 ofloxacin MIC_(50) 값은 각각 0.03 ㎍/mL, 0.06 ㎍/mL, 0.125 ㎍/mL로 나타나 tosufloxacin의 MIC_(50) 값이 가장 우수함을 알 수 있었다. 새로운 퀴놀론계 항생제인 tosufloxacin은 기존의 퀴놀론계 항생제에 비해 상대적으로 더 우수한 항균력을 보이고 있음을 알 수 있었다. 결론 : 본 연구결과 tosufloxacin은 levofloxacin과 ofloxacin에 비해 요로감염 원인균들에 대한 더 낮은 MIC값을 나타냈으며, 이는 요로감염의 치료에 있어 기존의 퀴놀론계 항생제와 더불어 효과적인 약물이 될 수 있음을 시사하는 바이다. Background : Tosufloxacin is one of the fluoroquinolones with higher antibacterial activity against many organisms than other fluoroquinolones developed previously. However, the antimicrobial susceptibilities of tosufloxacin against uropathogens are not well known. The objective of this study was to compare minimum inhibitory concentrations (MICs) of tosufloxacin with those of levofloxacin and ofloxacin for uropathogens cultured from the urine of female outpatients with acute uncomplicated cystitis. Materials and Methods : We collected and cultured urine samples from four metropolitan hospitals between August 2006 and November 2006. The MICs of tosufloxacin, levofloxacin and ofloxacin were determined for 89 isolates using an agar dilution method. Results : The most prevalent causative organism was Escherichia coli (70.8%). The MIC distribution of tosufloxacin and levofloxacin showed a bimodal distribution for E. coli. The two modes for E. coli were 0.03 and 32 ㎍/mL for tosufloxacin and 0.03 and 16 ㎍/mL for levofloxacin. However, ofloxacin had one more peak at MIC 0.5 ㎍/mL. MIC50s of tosufloxacin, levofloxacin and ofloxacin for E. coli were 0.03 ㎍/mL, 0.06 ㎍/mL and 0.125 ㎍/mL, respectively. Tosufloxacin, the newer fluoroquinolone, was more active than levofloxacin and ofloxacin against both E. coli and Gram-positive bacteria. Conclusion : Of the studied fluoroquinolones tosufloxacin had the lowest MICs against uropathogens and could be considered a promising alternative fluoroquinolone agent for the treatment of urinary tract infection.

위에서 발생한 원발성 순수편평상피암 1예

이수형,배용목,권균홍,조용건,이현승,김규종 고신대학교의과대학 2007 고신대학교 의과대학 학술지 Vol.22 No.2

A case of pure squamous cell carcinoma of the stomach in a 41-year-old female is reported. Its pathogenesis is still unknown and epidermoid carcinomas of the stomach without a glandular cell component are a rare tumor described in only about 20 patients since 1905. In Korea, six patients have reported to date. In this case upper gastrointestinal endoscopy showed a large ulceroinfiltrating mass with marginal irregularities in the lower body of the stomach. Histologic finding of biopsy specimen was squamous cell carcinoma. Abdominal computerd CT showed metastatic invasions to the spleen, abdominal wall and small bowel loop.

지방자치와 지역사회 복지

이승규 조선대학교 지역사회발전연구원 1997 地域發展硏究 Vol.2 No.1

위장관을 침범한 Henoch-Sch o¨nlein purpura 1예

이승곤,김채규,서종옥,이호영,이호준,정회상,박유환,정춘해 朝鮮大學校 附設 醫學硏究所 1996 The Medical Journal of Chosun University Vol.21 No.2

Henoch-Scho¨nlein purpura(H-S purpura) is a systemic necrotizing vasculitis of small vessels that is characterized by nonthrombocytopenic palpable purpura on the buttocks and extremities, arthritis of knees and ankles, glomerulonephritis, and colicky abdominal pain, histologically characterized by leukocytoclastic vasculitis. Gastrointestinal involvement with colicky abdominal pain and GI bleeding, most frequently in jejunum and ileum, occurs in above a half of all patients, but common in children. We performed GI endoscopy in a case of H-S Purpura. Gastroduodenoscopic findings showed erythemas and erosions in gastric antrum, and mucosal edema and petechiae in duodenal 2nd portion. Colonoscopic findings showed 5-10㎜ sized multiple shallow hemorrhagic ulcers in transverse and descending colons We report a case of H-S purpura involving colon with literatural review.

제조합 대장균에서 과발현된 Citrobacter freundii KCTC2006 유래의 β-Tyrosinase를 이용한 3,4-Dihydroxyphenyl-L-alanine의 생산

이승구,노현수,홍승표,이규종,왕지원,태동년,엄기남,방상구,김영준,성문희 한국미생물생명공학회 ( 구 한국산업미생물학회 ) 1996 한국미생물·생명공학회지 Vol.24 No.1

재조합 대장균에서 대량발현 시킨 Citrobacter freundii KCTC 2006 유래이 효소 β-tyrosinase를 이용하여 pyrocatechol, sodium pyruvate, ammonium acetate로부터 3,4-dihydroxy phenyl-L-alanine을 생산하기 위한 연구를 수행하였다. 이 효소반응에 적합한 온도 및 pH 조건은 각각 18℃와 8.5로 결정되었고, 반응액 중의 ammonium acetate와 sodium pyruvate의 농도는 각각 300 mM, 50 mM 이상으로 조절하는 것이 적합하였다. Pyrocatechol의 경우는 20 mM에서 가장 높은 반응성을 나타냈으나, 기질을 반복적으로 첨가하며 장시간 동안 효소반응을 수행하는 경우에는 pyrocatechol의 고갈을 피하기 위하여, 20 mM에서 50 mM 사이로 조절하였다. 한편, 반응액 중에 ethanol을 10% 첨가한 경우에는 반응속도가약 20% 증가하였다. 이상과 같은 효소반응특성에 기초하여 조제한 기질용액에 β-tyrosinase를 1 unit/㎖ 농도로 가하고, pyrocatechol과 pyruvate가 고갈되지 않도록 간헐적으로 첨가하면서 효소반응을 수행한 결과, 24시간 만에 85.2%의 수율로 31.6g/ℓ의 3,4-dihydroxyphenyl-L-alanine를 생산할 수 있었다. By using the β-tyrosinase of Citrobacter freundii KCTC2006, which was cloned and overexpressed in Escherichia coli, 3,4-dihydroxy phenyl-L-alanine (L-DOPA) was synthesized efficiently from pyrocatechol, sodium pyruvate, and ammonium acetate. Optimal temperature and pH for the reaction were determined to be about 18℃ and 8.5, respectively. The effects of substrate concentrations were also examined at different concentrations of ammonium acetate, sodium pyruvate, and pyrocatechol. Ammonium acetate and sodium pyruvate increased the reaction rate until the concentrations reached to 300 mM and 50 mM, respectively. Although pyrocatechol showed the optimal concentration at 20 mM, it was controlled between 20 mM and 50 mM to avoid the depletion of substrate during the enzymatic synthesis. Based on above results, a reaction medium for the production of L-DOPA was prepared and incubated with 1 unit/㎖ of β-tyrosinase. Pyrocatechol and sodium pyruvate was added to the reaction solution intermittently to avoid the substrate depletion during the enzymatic reaction. After 24 hour of reaction, 31.6 g/ℓ L-DOPA was accumulated in the reaction solution as soluble and precipitated ones and the conversion yield was about 85.2%.