• 대한임상검사과학회지
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• 제53권4호
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• pp.309-316
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• 2021

패혈증은 감염원에 의한 생리학적 반응으로 장기의 기능을 손상시켜 조기에 치료하지 않으면 사망에 이르게 하는 기전을 유발한다. 이에 높은 감도, 특이도, 신속 정확도를 가진 바이오마커는 병원균의 미생물학적 검증에 필요한 제한성과 경과 시간을 감안할 때 패혈증을 비감염성 전신성 염증 반응 증후군(SIRS)과 구별하는 것이 획기적일 것으로 판단된다. 또한 항생제를 사용하기 전에 정확한 감염 진단이 중요하고 임상적으로 요구된다. 해당하는 후보물질인 프로칼시토닌, 젖산, C-반응성 단백질, 사이토카인, 프로아드레노매듈린(ProADM)이 진단에 활용된다. 급성 호흡기 감염 환자에서 프로칼시토닌으로 유도되는 항생제 치료는 항생제 노출과 항생제 부작용을 효과적으로 감소시키면서 사망률을 개선한다. 입원환자에 있어서 패혈증 선별검사에 대한 근거 마련은 제한적이다. 임상의사, 연구원 및 건강검진 의사의 전문가 집단은 일반 입원 환자의 패혈증 인식에 대한 스크리닝 도구, 향후 연구 또는 정책을 시행할 때 새로운 바이오마커의 발견과 한계점을 고려해야 한다. 바이오마커 사용은 항상 임상 평가와 상관관계가 있어야 하지만 소아 패혈증에서도 특히 바이오마커의 사용은 기대된다. 따라서 바이오마커의 활용에 있어서 특정된 전염증성 사이토카인 및 단백질 수준이 상승하는 것에 대해 패혈증의 초기 단계에서 사망률을 예측하는 것에 대해 향상된 진단법을 제공할 수 있다.

• 한국임상수의학회지
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• 제19권2호
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• pp.228-235
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• 2002

유방염은 젖소에 있어서 유량의 감소, 유질 저하로 인한 우유 폐기문제, 젖소의 도태, 치료비 및 노동력의 부담등을 초래하는 가장 경제적 손실이 큰 질환이다. 현재까지 비유기 최종 착유 후에 항생제를 주입하는 건유기 치료법이 유방염 관리에 가장 효과적이며 폭넓게 쓰이고 있는 방법으로 알려져 있다. 하지만, 건유기 치료는 건유기 주입 항생제 제품들이 건유기 초기에만 지속적인 활성을 지니기 때문에 건유기 말기와 분만 전기에 있어서의 신규 감염은 방어할 수 없다. 따라서 본 연구는 건유기 유방염 관리를 위해 PLGA를 이용한 서방형 생분해 cephalexin microsphere를 제조하여 이의 임상적 효능을 평가하고자 하였다. PLGA는 무독성의 조직 반응을 일으키지 않는 특성으로 인해 약물 방출 조절 체계의 일환으로 인정을 받아왔다. 본 연구에서 cephalexin microsphere는 표면에 특징적인 구멍을 가지고 있는 구형 모양으로 확인이 되었으며 약물 방출 시험에서 초기 과다 방출 이후로 21일간 약물의 방출이 점차 감소한 뒤 3주와 4주 사이에 2차 방출을 보이는 맥동성 방출 양상이 관찰되었다. 현장적용 시험에서는 cephalexin microsphere를 주입한 실험군에서 대조군에 비해 분만 후 신규 감염율 및 치료율, 평균 체세포 수의 변화의 측면에서 볼 때 유의성 있는 차이가 있음을 확인하였다. 따라서 생분해 microsphere를 이용한 건유기 치료법은 건유기 동안 신규 감염을 예방하고 기감염을 감소시킴으로써 종전의 건유기 치료를 좀 더 효과적으로 증진시킬 수 있을 것으로 사료된다.

• 의료관련감염관리
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• 제21권2호
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• pp.50-56
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• 2016

ESBL을 생성하는 균주에 의한 요로 감염에서 카바페넴 계열 이외의 항생제를 사용할 수 있는 지를 후향적으로 평가한 연구이다. 만약 in vitro 결과에서 감수성이 있다면 사용이 가능하다는 결과이나 환자의 중증도가 높다면 실패할 수 있음을 강조하였다. 이번 연구 결과를 바탕으로 전향적 연구를 기대해 본다.

• 대한기관식도과학회지
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• 제13권2호
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• pp.77-81
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• 2007

Foreign body aspiration is a cause of the accidental death at home. Therefore, early intervention and proper management is important. A bronchoscopy is indicated whenever there is a suggestive history and medical opinion. Occasionally, foreign body removal with bronchoscopy may be fail. But, on the situation, there is no definite recommended standard management. We experienced two cases of bronchial foreign body could not be removed with bronchoscopy at first intervention. The one was diagnosed too late. Endobronchial granulation tissue and edema made it impossible to find the foreign body at first bronchoscopy. After steroid and antibiotic therapy, foreign body could be removed with secondary bronchoscopy. Another was bronchial foreign body jammed tightly bronchus intermedius. Even after medical therapy, patient got aggravated. So foreign body was removed with bronchotomy.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제16권1호
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• pp.104-111
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• 1994

Necrotizing fascitis is a severe soft tissue infection characterized by extensive necrosis of superficial fascia, suppurative fascitis, vascular thrombosis, widespread undermining of surrounding tissues. Associated systemic problems are widespread undermining of surrounding tissues, Associated systemic problems are common, with chronic alcoholism and diabetes being most prominent. Most commonly this disease presents in the extremities, trunk, and perineum. Necrotizing fascitis of dental origing is rare and its fulminating clinical course is not well documented in the dental literature. The present report is a case of necrotizing fascitis following vital extirpation of the pulp in a patient with uncontrolled diabetes mellitus and liver cirrhosis. Originally throught to be caused by hemolytic streptococcus organism or stphylococcus aureus, advances in anaerobic culturing have shown it to be a synergistic bacterial infection involving aerobic and ovligate anaerobes. it is relatively rare in relatively rare in haea and neck regions. If it was not diagnosed and treated in early stages, necrotizing fascitis can be potentially fetal, with a mortality rate approaching 40%. It's treatment requires early recognition, prompt and aggressive surgical debriment and proper supportive cares, such as, antibiotic therapy, fluid resuscitation and correction of metabolic and electrolyte disorder, resolving of the underlying systemic disease. Recently, we experienced two cases of necrotizing fascitis in cervicofacial region, One patient was 60 years old male with uncontrolled Diabetes Mellitus and other patient was 48 years old with steroid therapy during 30 years. Local surgical wound healing was successful but, patients were died after admission, because of lung abscess, gastrointestinal bleeding, septic shock and respiration hold.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제36권2호
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• pp.62-66
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• 2014

Osteoradionecrosis is one of the most serious complications of patients receiving radiation therapy. It is characterized by hypovascularity, hypocellularity, and hypoxia-inducing necrosis of bone and soft tissue following delayed healing. In this case, a 72-year-old man was referred to the Department of Oral and Maxillofacial Surgery complaining of trismus following extraction three months before first visit. He had a history of right tonsillectomy, radical neck dissection and radiotherapy performed due to right tonsillar cancer seven years prior. After the diagnosis of osteoradionecrosis on right mandibular body and angle, conservative antibiotic therapy was used first, but an orocutaneous fistula gradually formed, and extensive bony destruction and sequestrum were observed. Sequestrectomy, free particulated iliac bone and umbilical fat pad graft were performed via a submandibular approach under general anesthesia. Preoperative regular exams and delicate wound care led to secondary healing of the wound without vascularized free flap reconstruction.

• 한국의료질향상학회지
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• 제1권1호
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• pp.32-43
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• 1994

The 'Pharmacy and Therapeutic Committee' decided to restrict the use of vancomycin which was categorized into restricted antimicrobials, among general, reserved and restricted antimicrobials. The committee also established prescribing guidelines of vancomycin in Seoul National University Hospital, May, 1991. Especially, the restricted antimicrobials should be used after approval by infectious disease specialist physician. A retrospective drug use evaluation (DUE) on vancomycin has been conducted to compare with the previous vancomycin DUE study in 1990. 'Criteria for DUE on vancomycin' was modified from Am J Hosp Pharm. Total 65 charts of patients were retrospectively reviewed from July 1991 to June 1992 in Seoul National University Children's Hospital. The justification of use was improved from 56% to 75% comparing with the previous study. In analyzing process indicators, several criteria including body temperature monitoring, WBC monitoring and use of concomitant antibiotics were well documented, but serum creatinine monitoring, culture and sensitivity test and level monitoring were infrequently performed, while the accepted level has been improved. Accepted level for appropriate initial dosage and duration of therapy were decreased. In outcome analysis, blood culture after discontinuing the drug was relatively well documented compared with the previous study. As the results, the approval vancomycin use was shown to be effective and rational in antibiotic therapy. And it is suggested that the above findings should be communicated to the medical staff, and a active intervention, such as feedback control, also be necessary for rational drug use.

• Tuberculosis and Respiratory Diseases
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• 제52권3호
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• pp.283-287
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• 2002

Scrub typhus is an acute, febrile disease of humans that is caused by Orientia Tsutsugamushi. It is transmitted through the bite of chiggers. The spectrum of the clinical severity for scrub typhus ranges from mild to severe with fatal complication such as meningoencephalitis, pneumonitis, myocarditis. Severe pulmonary involvement e.g. acute respiratory distress syndrome(ARDS) and meningoencephalitis have rarely been observed since the introduction of specific antibiotic therapy. We experienced a case of scrub typhus manifested with ARDS and meningoencephalitis. The patient was treated with doxycycline, anticonvulsant and mechanical ventilator therapy.

• IMMUNE NETWORK
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• 제2권4호
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• pp.233-241
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• 2002

Background: Monoclonal antibodies (mAb) of rodent origin are produced with ease by hybridoma fusion technique, and have been successfully used as therapeutic reagents for humans after humanization by genetic engineering. However, utilization of these antibodies for therapeutic purpose has been limited by the fact that they act as immunogens in human body causing undesired side effects. So far, there have been several attempts to produce human mAbs for effective in vivo diagnostic or therapeutic reagents including the use of humanized xenomouse that is generated by mating knockout mice which lost Ig heavy and light chain genes by homologous recombination and transgenic mice having both human Ig heavy and light gene loci in their genome. Methods: Genomic DNA fragments of mouse Ig heavy and light chain were obtained from a mouse brain ${\lambda}$ genomic library by PCR screening and cloned into a targeting vector with ultimate goal of generating Ig knockout mouse. Results: Through PCR screening of the genomic library, three heavy chain and three light chain Ig gene fragments were identified, and restriction map of one of the heavy chain gene fragments was determined. Then heavy chain Ig gene fragments were subcloned into a targeting vector. The resulting construct was introduced into embryonic stem cells. Antibiotic selection of transfected cells is under the progress. Conclusion: Generation of xenomouse is particularly important in medical biotechnology. However, this goal is not easily achieved due to the technical difficulties as well as huge financial expenses. Although we are in the early stage of a long-term project, our results, at least, partially contribute the successful generation of humanized xenomouse in Korea.

• Journal of Korean Biological Nursing Science
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• 제5권1호
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• pp.35-44
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• 2003

Objectives : Though Tsutsugamushi disease has been reported with increasing frequencies in rural communities in Korea, it is not easy to find the nursing investigations. Methods : We have conducted a survey on 30 cases who had the fever as a chief complaint, then clinically ruled out the Tsutsugamushi disease in autumn of $2000{\sim}2001$. Data were collected retrospectively by investigation of the general characteristics, clinical and laboratory findings, their nursing care. Findings: Of 30 cases, 46.7% were farmers, and 60.0% had chances of exposure to fields or mountains. The characteristic symptoms and signs were febrile sense and chill(100.0%), headache(80.0%), and eschar(66.7%). Abnormal laboratory findings were anemia (23.3%), elevated AST(60.6%), ALT(63.3%), and abnormal urinalysis findings(50.0%). 53.3% were serologically confirmed as Tsutsugamushi disease. Therapeutic nursing cares were composed with warm up by blancket(50.0%), Ice bag(50.0%) and doxycycline antibiotic therapy(100.0%). Other nursing care for them included fluid therapy(100.0%) and nutritional support with regular(56.7%) or soft diet(43.3%). Conclusion: The above results indicate nurses who take care of acute febrile clients should make her responsible for the fever and pain management as well as give education for infection control for the community inhabitants.