2003년 국내 중증급성호흡기증후군 진료 현황 및 문제점 분석

이진수,김은실,정문현,백제중,정선화,안주희,최영화,이선희,고철우,김성범,김민자,박승철,기현균,송재훈,최상호,김양수,이상오,조용균,박영훈,정숙인,김연숙,이흥범,손창희,장성희,정희진,김우주 대한감염학회 2004 감염과 화학요법 Vol.36 No.3

목적 : 2002년 말 중국에서 SARS가 발생한 이후 국내에서도 2003년 10월까지 총 3명의 추정환자, 17명의 의심환자가 보고되었다. 향후 추가적인 SARS의 유행이 우려되는 상황에서, 그간의 SARS 환자 진료에 있어서의 실질적인 준비사항, 진료 현황 등에 대한 조사를 통해 문제점을 파악하여, 향후 더 나은 대비가 될 수 있도록 개선점을 제시하고자 하였다. 재료 및 방법 : SARS로 의심되는 환자를 진료 경험이 있는 병원의료진을 대상으로 2003년 10월에 설문조사를 실시하였다. 설문에는 SARS 환자 진료 시의 실질적인 조치, 진료 현황, 병실, 응급실 및 외래에서의 격리 시설과 준비사항, 보건당국의 관리와 지원에 관한 사항을 포함하였다. 결과 : 대상이 되는 22개 병원 중 17개(17/22, 77.2%) 병원이 설문에 응하였다. SARS 환자를 위한 격리실은 응급실, 외래, 일반병실 및 중환자실에서 각각 9개(9/17, 52.9%), 5개(5/17, 29.4%), 15개(15/16, 93.7%), 4개(4/16, 25%) 병원에서 음압처리가 되어있지 않은 일인실 혹은 다인실이 사용되었고, 1개(1/16, 6.3%) 병원에서만 일반병실에서 음압격리실이 운영되었다. 입원환자의 진찰 시 개인보호구의 착용은 거의 모든 의료기관에서 이루어졌다. 보건당국에서 SARS지정병원의 시설 등을 사전에 확인한 곳은 1곳(1/12, 8.3%)이였고, 14개 병원(14/15, 93.3%)에서는 보건당국에 의뢰한 검사결과를 통하 받지 못하였다. 결론 : 의료기관에서 SARS 환자용 격리실뿐만 아니라 기존의 격리실 설비 등이 미흡하였으며, 특히 중환자실 및 외래의 준비가 더욱 부족하였다. 보건당국의 의료기관에 대한 종합적인 지원이 부족하였고, 병원과의 원활한 연계가 잘 이루어지지 않았다. SARS 만이 아닌 격리를 필요로 하는 질환의 적절한 진료를 위해 향후 병원 시설의 정비와 정부차원에서의 보다 구체적이고 실질적인 대책마련이 필요하다. Background : There was an worldwide outbreak of the Severe Acute Respiratory Syndrome (SARS) originated from China in late 2002. During that period three cases of suspected SARS and 17 cases of probable SARS were reported in Korea. With the concerns about the reemergence of SARS-coV transmission, it is important to be prepared for any possibility. So, this study is aimed to analysis the past measures in managing SARS and propose the amendatory plans to improve the preparedness. Materials & Methods : Questionnaires were collected among clinicians with any experience in managing the probable or suspected SARS cases in Oct. 2003. 17 out of 22 hospitals responded to the questionnaire. The contents in the questionnaire were practical activities, personal equipments, response plans, isolation facilities in emergency centers, outpatient clinics, general wards and intensive care units, and relationship with the public health department. Results : The dedicated isolation rooms in emergency centers, outpatient clinics, general wards, and intensive care units were prepared in 9 (9/17, 52.9%), 5 (5/17, 29.4%), 15 (15/16, 93.7%), and 4 (4/16, 25.0%) hospitals, respectively. Except for one hospital that newly made negative pressure room for SARS, single or multi-bed rooms without airborne infection control were used in all the other hospitals. The personal precaution principles were kept quite well in general wards. Before the designation of SARS hospital by the public health department prior evalution to see if the hospital was suitable for managing SARS was conducted in only 1 (1/12, 8.3%) hospital. The results of laboratory diagnosis were reported back in 1 (1/15, 6.6%) hospital. Conclusions : The isolation facilities which can control airborne infection were almost deficient not only for SARS but also for other respiratory transmissible diseases. For the infection control of transmissible diseases including SARS, more investment is needed on medical facilities and comprehensive support from the public health department required.

정신분열병에 대한 리스페리돈의 효과 및 안정성

이민수,김용구,김영훈,연병길,오병훈,윤도준,윤진상,이철,정희연,강병조,김광수,김동언,김명정,김상훈,김희철,나철,노승호,민경준,박기창,박두병,백기청,백인호,손봉기,손진욱,양병환,양창국,우행원,이정호,이종범,이홍식,임기영,전태연,정영조,정영철,정인과,정인원,지익성,채정호,한상익,한선호,한진희,서광윤 大韓神經精神醫學會 1998 신경정신의학 Vol.37 No.1

연구목적 : 본 시험의 목적은 임상시험 시작전에 연구자들을 대상으로 PANSS Workshop을 통하여 PANSS, ESRS에 대한 국내에서의 표준화 작업을 구축하고 새로운 정신병 치료제인 리스페리돈의 효과와 안정성을 재확인하여 리스페리돈 사용에 대한 적정화를 이루는데 있다. 연구방법 : 1996년 4월부터 1996년 9월까지 국내 39개 대학병원 정신과에 입원중인 혹은 증상이 악화되어 입원하는 정신분열병 환자 377명을 대상으로 다시설 개방 연구를 시행하였다. 1주일간의 약물 배설기간을 가진후, 리스페리돈을 8주간 투여하였고, 기준점, 1주, 2주, 4주, 그리고 8주후에 평가되었다. 용량은 제1일에는 리스페리돈 1mg씩 1일 2회, 제2일에는 2mg씩 1일 2회, 제3∼7일에는 3mg씩 1일 2회 투여하였다. 이후 환자의 임상상태에 따라 임의로 증량할 수 있으며, 최대 일일 16mg을 초과하지 않도록 하였다. 추체외로 증상을 조절하기 위한 투약을 허용하였다. 임상증상 및 부작용의 평가는 PANSS(Positive and Negative Syndrome Scale), CGI(Clinical Global Impression) 그리고 ESRS(Extrapyramidal Symptom Rating Scale)을 사용하였다. 연구결과 : 377명중 343명(91%)이 8주간의 연구를 완결하였다. 치료 종결시점인 8주후 PANSS 총점수가 20% 이상 호전된 경우를 약물 반응군으로 정의할때, 약물반응군은 81.3%였다. 리스페리돈에 반응하는 예측인자로는 발병연령, 이전의 입원 횟수, 유병기간이 관련 있었다. 리스페리돈은 1주후부터 PANSS양성, 음성, 및 일반정신병리 점수상에 유의한 호전을 보여 효과가 빨랐다. CGI의 경우도 기준점에 비해 1주후부터 유의한 감소를 나타내었다. ESRS의 경우, 파킨슨 평가점수는 기준점과 비교해 투여 1주, 2주, 4주후 유의하게 증가되었다가 8주후 기준점과 차이가 없었다. Dystonia 평가점수는 1주후만 유의한 증가를 보였으며, dyskinesia 평가점수는 유의한 차이가 없었다. 혈압, 맥박수의 생명징후 및 일반 혈액학 검사, 생화학적 검사, 심전도 검사에서 유의한 변화는 없었다. 결 론 : 이상의 다시설 개방 임상 연구를 통해 리스페리돈은 정신분열병 환자에서 양성증상뿐만 아니라 음성증상 및 전반적인 증상에도 효과적인 것으로 사료된다. 보다 명확한 평가를 위해서는 다른 항정신병약물과의 이중맹검 연구가 필요할 것으로 생각되며, 또한 장기적 치료에 대한 평가도 함께 이루어져야 하겠다. Objective : The purpose of this study was to investigate the efficacy and safety of risperidone in the treatment of Korean schizophrenic patients. Method : This multicenter open study included 377 schizophrenic patients drawn from 39 university hospitals. After a wash-out period of 1 week, the schizophrenic patients were treated with risperidone for 8 weeks and evaluated at 5 points ; at baseline, and 1, 2, 4 and 8 weeks of treatment. The dose was increased from 2mg/day(1mg twice daily) to 6mg/day(3mg twice daily) during the first week and adjusted to a maximum of 16mg/day over the next 7 weeks according to the patient's clinical response. Medication to control extrapyramidal symptoms was permitted. The psychiatric and neurological status of the patients was assessed by PANSS, CGI, and ESRS scales. Results : 343(91%) of 377 patients completed the 8-week trial period. Clinical improvement, as defined by a 20% or more reduction in total PANSS score at end point, was shown by 81.3% of patients. The predictors of response to risperidone were associated older age, shorter duration of illness, fewer previous hospitalization. Risperidone had rapid onset of action ; a significant decrease of the total PANSS and three PANSS factor(positive, negative, general), and CGI was already noticed at the end of first week. For the ESRS, parkinsonism rating scores were significantly increased until week 4 comparing with baseline. Dystonia rating scores were significantly increased until week 1, and dyskinesia rating scores were not significantly changed during the study. Laboratory parameters including vital sign, EKG, hematological, and biochemical values showed no significant changes during the trial. Conclusions : This study suggests that risperidone is generally safe and effective against both the positive and negative symptoms in our group of patients.

무우자갈버섯(Hebeloma crustulineforme)을 위시한 한국산 담자균류 46종의 용혈활성 검색

양희정,정수현,김진향,정경수 충남대학교 약학대학 의약품개발연구소 1997 藥學論文集 Vol.13 No.-

To elucidate the hemolytic toxicities of Korean basidiomycetes, the cold-water extracts of 46 wild mushrooms were tested for hemolytic activity on mouse erythrocytes. Twelve species including Amanita esculenta, A. griseofarinosa, A. longistriata, A. melleicepe, A. phalloides, A. rubescence, A. spissacea, A. vaginata, Hebeloma crustuliniforme, Lepiota cygnea, Macrolepiota procera, and Oudemansiella platyphylla showed strong hemolytic activities. Of these, A. griseofarinosa and H. crustuliniforme showed no decrease in their hemolytic activity even after five minutes' boiling.

전해환원수 음용이 마우스의 혈액과 장기조직에 미치는 영향

정한석,김동희,윤양숙,등영건,장병수,이규재 韓國電子顯微鏡學會 2008 Applied microscopy Vol.38 No.4

본 연구는 전해환원수 음용에 대한 안전성을 조사하기 위하여 실험동물을 이용하여 사망률 확인, 체중 비교, 혈액의 생화학적 변화, 염증, 면역세포의 비교, 내부 장기의 형태적 변화, 장기의 무게 변화 및 조직학적 검사를 통하여 전해환원수가 생체에 미치는 영향을 확인한 결과 다음과 같은 결론을 얻었다. 전해환원수를 급이한 실험군에서 사망, 행동 및 외형 이상 유무 관찰 결과 아무런 증상이 나타나지 않았으며, 체중은 감소하는 경향을 보였다. 실험군에서 혈액의 생화학적요소인 K^(+), Cl^(-),Ca^(2+), GPT, GOT, CRE 및 ALP에서는 유의한 수준의 변화가 관찰되지 않았으나 Na^(+)와 BUN에서는 실험군이 대조군에 비해 더 감소되었다. 혈액 내 면역세포를 비교한 결과 호염기구, 호산성구 및 단핵구 등은 큰 차이가 없으며, 실험군에서 호중구는 감소하였고, 림프구는 증가하는 경향을 보였다. 또한 위, 소장, 심장 및 간을 조직학적으로 관찰한 결과 모든 장기에서 병리적 이상 소견은 관찰되지 않았다. 따라서 본 연구를 통하여 전해환원수는 생체에서 큰 문제를 유발시키지 않는 안전한 물임을 알 수 있었고 국내에서 전해환원수에 대한 연구가 거의 없는 실정이기 때문에 전해환원수의 안전성을 입증하기 위한 기초자료 마련 및 제공에 의의가 있다고 할 수 있다. The main purpose of this study is to investigate the effects of electrolyzed reduced water (ERW) on blood components and electrolytes, as well as elected tissues on mice. The mice were supplied either tap water (control group) and ERW (experimental group) for two months. There were no significant different between two groups anatomically and physiologically. In the blood electrolyte study, the experimental group had less Na and BUN compared to the control group. In the blood component study, the experimental group had less neutrophiles and the control group had more lymphocytes. In histological study, no tissue changes were noticed in various organs, including the stomach, small intestine, heart, and liver tissues. In conclusion, ERW has no noticable side affects on blood and organ tissues, and might be safe to a living body.

정상교하 아동의 두개안면부 성장에 관한 종적 연구

양규호,박창헌,손정수,김낙현,최남기,김선미,김기백,신혜성 大韓小兒齒科學會 2009 大韓小兒齒科學會誌 Vol.36 No.3

혼합치열기 정상교합 아동 24명(남:14명 여:10명 초진 시 평균 나이 9±1.3세, 평균 관찰 기간: 13±1.3개월)에 대한 성장량을 측정하여 기능적 교정장치의 순수 치료효과를 평가하는데 도움이 되기 위해 3회(5~8개월 간격) 촬영한 측모 두부 방사선 규격 사진에 대한 분석 결과 다음과 같은 결론을 얻었다. 1. 남아는 상악골은 전하방, 하악골은 전방성장하였고, 여아는 상하악골이 전하방 성장하였다(p<0.05). 2. 상하악골의 남녀간 차이에서 수평적 성장상태는 여아가 컸고(A point 여아: 2.39mm, 남아: 1.26mm, p<0.05), 수직적 성장상태는 유의한 차이가 없었다. 3. 상악 전치의 치축은 두개저에 대해서 순측 경사하였고(p<0.01) 하악 전치의 치축은 큰 변화가 없었다. The purpose of this study was to provide the reference data evaluating the treatment effect of orthopedic appliances. The skeletal and dental growth increments were measured in 24 normal mixed dentition children(boys: 14, girls: 10) by three serial lateral cephalograms: initial mean age: 9±1.3 years, mean observation period: 13±1.3 months, Cephalometric changes were analysed. The results were as follows: 1. In boys, the maxilla showed forward and downward growth pattern and the mandible showed forward growth pattern(p<0.05). In girls, the maxilla and mandible showed forward and downward growth pattern(p<0.05). 2. Horizontal growth of both maxilla and mandible in girls was superior to those in boys(A point: girls: 2.39mm, boys: 1.26mm, with p<0.05), whereas vertical growth of both maxilla and mandible in boys was similar to those in girls. 3. The change in tooth axis showed labioversion of upper incisor(p<0.01) and comparatively stable lower incisor position.

여성 요실금에서 Kontinence™와 Compact Elite™의 치료효과 비교

양상국,정상원,오미희,노용수,김홍섭,우응제,박승훈,이수열 건국대학교 의과학연구소 1999 건국의과학학술지 Vol.9 No.-

Biofeedback and pelvic floor electrical stimulation are new modalities that have been advocated for the treatment of female urinary incontinence. The aim of this study was to compare prospectively the therapeutic effect of Kontinence™(HMT Co., Korea) with Compact Elite™(ECL Co., France) in female urinary incontinence. All patients were evaluated with a complete history, physical examination, urinalysis, urine culture and urodynamic study. Eighteen patients were treated with Compact Elite™, and thirteen patients with Kontinence™. Enrolled patients had completed 8 office sessions consisting of biofeedback and intravaginal electrical stimulation according to the program of each machines. Overall treatment response was graded by patients on a scale of complete cure to aggravation. At two weeks after last session, overall improvement rate was 78% in Compact Elite™group and 92% in Kontinence™group(p>0.05). Overall patients' acceptability during treatment course was greater than 80% in both machines(p>0.05). There were no unexpected clinical findings during Kontinence™ treatment. After Kontinence™treatment, there were no laboratory changes including electrocardiography, complete blood count, liver function profile, and chest PA. These results showed that the biofeedback and electrical stimulation with Kontinence™was safe and moderately effective for female urinary incontinence comparable to Compact Elite™. However, long-term results of a larger patients are needed to ensure the therapeutic effect of Kontinence™.

豚內 副産物의 特性과 加工利用에 關한 硏究 : Ⅱ. 加熱處理가 物理的 性質과 嗜好에 미치는 영향

양철영,이상건,윤정의,허윤행,채수규,노완섭 서울保健大學 1989 論文集 Vol.9 No.1

신경병증성 통증 모델쥐 뒤뿌리신경절의 Nitric Oxide Synthase 아형 및 NADPH-diaphorase 발현에 관한 연구

정성균,김수일,양은진,류택근,권오유,박경란,이영호,김원식 충남대학교 의과대학 지역사회의학연구소 1998 충남의대잡지 Vol.25 No.2

Injury to peripheral nerve somtimes lead to neuropathic pain. Nitric oxide(NO) is increased in the dorsal root ganglia (DRG) of neuropathic pain models, and L-NAME, a nitric oxide synthase (NOS) inhibitor, reduces neuropathic pain. However, it is not known that underlying mechanism of NO involvement in development and maintanence of neuropathic pain. It was found that there were three NOS isoforms-nNOS, eNOS, and iNOS. It is also necessary to investigate NOS isoforms in neuropathic pain. The aim of this study is to investigate NOS isoforms and NADPH-diaphorase expressions and underlying mechanism of NO involvement in neuropathic pain. The 5^th lambar (L5) DRG were obtaind after tight ligation of L5 an L6 spinal nerves for 7 days. Toluidine blue stain, immunohistochemistry for nNOS, eNOS, and iNOS, and NADPH-diaphorase histochemistry were performed. All specimens were observed under light microscope. nNOS expression was increased significantly in the cytoplasm of the DRG of ligated side at 7 day post-ligation (7D PL). eNOS expression was also increased in the blood vessel, a few neurons or satellite cells, and cell membrane of Schwann cells in the DRG of ligated side at 7D PL. iNOS expression was increased in a few blood vessels and cytoplasm of small neurons in the DRG of ligated side at 7D PL. NADPH-diaphorase expression was increased significantly in the neurons of the DRG of ligate side at 7D PL, but NADPH-diaphorase expressions were weak or absent in the blood vessel and Schwann cell in the contralateral DRG and the DRG of ligated side at 7D PL. It is suggested that NOS isoforms may be closely related to development and mantanence of neuropathic pain in order of nNOS>eNOS>iNOS.

간이식 환자에서 발생한 Candida tropicalis 척수골수염 1예

양성연,조용균,김백남,정두련,김양수,류지소 대한감염학회 1996 감염 Vol.28 No.1

저자들은 간이식 후 면역억제제를 투여받던 중 이식 후 초기에 일시적인 C. tropicalis 진균혈증이 있던 환자에서 수 개월 후에 발병한 C. tropicalis 척추 골수염을 외과적치료 없이 amphotericin B로 치료한 1예를 보고한다. Invasive fungal infection is a well-recognized, life-threatening complication after orthotopic liver transplantation (OLT). Most cases with invasive fungal infections occur in the first 2 months after OLT, which are most frequently caused by candida species. The majority of isolated candida infections are due to Candida albicans, and rarely to Candida tropicalis. Clinical patterns of fungal infections include disseminated infection, peritonitis, pneumonia, fungemia, and others. Although there have been a few reports of candida osteomyelitis complicating solid organ transplantations, none in OLT was found in the MEDLINE search. Moreover, osteomyelitis caused by C. tropicalis was reported only once in a renal transplant recipient. We had experienced the first case of vertebral osteomyelitis caused by C. tropicalis after transient fungemia complicating OLT, which was successfully treated with amphotericin B without surgery.

효소 전처리 BCTMP 시트의 노화 거동

양봉숙,김형진,강규영,조병묵,오정수 동국대학교 생명자원과학대학 연습림 2000 연습림논문집 Vol.- No.6

It was generally known that the aging treatment of paper is accompanied with the reductions in physical and optical properties of individual fibers and sheet. In particular, the paper prepared with mechanical pulps occurs the yellowing of sheet, during aging, due to the absorption of light or temperature, and finally has limitation in widely applicable functions of paper. The aging behaviors of paper can be discussed with three groups of factor. One is considered to external factors, like heat, light and moisture. Another is commented with environmental factors, like oxygen, nitrogen, sulfur, and other air pollutant materials. The other is explained by internal factors, like pulp types, lignin contents, and so on. In this paper, the aging behaviors of paper prepared with BCTMP were studied in order to know how to affect in physical and optical properties of paper. For modification of fibers properties, a commercial enzyme was pretreated in the slurry of BCTMP, before handsheet-making. Sheets were aged by accelerated heat treatment. The comparisons were carried out in mechanical strength properties and color reversions. Aging treatments were resulted in higher brightness reductions, in enzyme pretreated paper.