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.

일부 성인의 치과 공포감 관련 요인

김수경 ( Soo Kyung Kim ),김미희 ( Mi Hee Kim ),최현지 ( Hyun Ji Choi ),황정근 ( Jung Geun Hwang ) 한국치위생학회(구 한국치위생교육학회) 2014 한국치위생학회지 Vol.14 No.6

Objectives: The purpose of the study was to investigate the related factors to dental fear in some adults. Methods: A self-reported questionnaire was filled out by 320 adults in Seoul and Gyeonggi-do from April to June, 2013. Except 14 incomplete answers, data were analyzed by SPSS 18.0 program. The questionnaire consisted of general characteristics of the subjects(7 questions), dental fear related factor(18 questions), distrust for dentist(15 questions), and distrust for dental hygienist(11 questions). The instrument for dental treatment fear was Dental fear Survey(DFS) adapted from Kleinknecht and partly modified by Choi. Out of 20 questions, 18 questions were reconstructed and score by Likert 5 scale. Higher score means higher dental fear. Cronbach alpha was 0.959 in the study. The distrust for dentist and dental hygienist was adapted from Choi and reconstructed and score by Likert 5 scale. Higher score means higher distrust for dentist and dental hygienist. Cronbach alpha was 0.937 in distrust for dentist and 0.874 in distrust for dental hygienist in the study. Results: Those who experienced dental pain tended to have dental fear. The reasons for dental fear were as follows; bad breath(2.96 out of 5 points, hereafter represented as of 2.96/5), dental caries(2.88/5), missing teeth(2.87/5) and tooth pain(2.77/5). The distrust for the dentist was the main dental fear in the adults. Conclusions: The dental fear was closely related to gender, experience of dental pain, oral symptoms and distrust for the dentist. As the psychological pain in the patients was mainly influenced by the trustful atmosphere, it is necessary to make the patient easy before treatment.

Hypophosphatasia 환아의 치료 증례

최병제,최형준,이제호,김기덕,박수정 大韓小兒齒科學會 1998 大韓小兒齒科學會誌 Vol.25 No.3

1. Hypophosphatasia 는 골조직 및 치아조직의 비정상적인 석회화를 나타내는 대사장애로, 특징적구강내 소견 인 우치의 조기탈락 양상으로 치과에서 조기진단이 가능하다. 2. 본 증례에서 상악궁 확장을 동반한 의치 제작으로 심미적, 기능적으로 양호한 결과를 얻었으며, 영구치열기 까지 장기적 관찰 및 치료가 필요할 것으로 사료된다. hypophosphatasia is a rare metabolic disorder which manifests characteristics such as abnormal mineralization of bone and dental tissues, diminished serum and tissue alkline phosphatase, and increased urinary secretion of PEA. It ingerited as an autosomal recessive or dominant trait and occurs in all races. In general, hypophosphatasia can be classified in 4 subtypes which are the perinatal, infantile, childhood, adult type depending upon the age at presentation and severity. In young children with Hypophosphatasia the long bones show irregular defects, and the skull showes poor calcification. In older children with premature closure of the skull sutures there may ve multiple lucent area called gyral or convolutional markings, described as resimbling beaten copper, presumably resulting from increased intracranial pressure,Examination of the jaws reveals a generalized lucency of the maxilla and mandible, the cortical bone and lamina dura are thin, and the alveolar bone may be deficient. Clinical features of Hypophosphatasia imclude premature loss of deciduous teeth, especially incisors, hypoplasia of aplasia of root cementum, enamel hypoplasia, irregular calcification of dentin, large pulp chamber, and resorption of marginal alveolar bone and roots. Our report involves a patient with a chief complaint of early loss of both Mx. and Mn. deciduous ncisors. after conducting a through clinical and radiographic examination this patient was referred to pediatrics under the suspicion of hypophosphatasia, the diagnosis proved to be correct and successful results were accomplished through a denture made to improve esthetics and function.

부재료 첨가에 따른 갓김치의 항산화성

최영숙,황정희,김재이,전영수,최홍식 부산대학교 김치연구소 2000 김치의 과학과 기술 Vol.6 No.-

Antioxidative activities (AA) of mustard leaf kimchi (MLK) by the addition of optional ingredients among selected minor materials were studied. In order to determine AA of MLK with different spices, the model systems of ground cooked beef with green onion, garlic, and red pepper powder were prepared and stored for 4 weeks at 4℃. AA of red pepper added group was stronger than those of others. AA of red MLK was relatively higher than that of (green) MLK. For the enhancement of AA of MLK, another model systems were prepared with the selected antioxidative optional ingredients, which were bonnet bellflower root, leek, burdock, sea tangle, sea mustard, seastaghorn at the level of 2% or 4%. The extracts of water, 75% methanol and hexane of MLK, bonnet bellflower root added MLK, and seastaghorn added MLK had a considerable AA with the inhibition of peroxide formation during the autioxidation of linoleic acid mixtures in aqueous model systems at 37℃. Therefore, AA was more effective in MLK containing specific optional ingredients than that of MLK alone significantly.

핸드볼 선수의 상해에 관한 조사 연구 : 남자 중학교 핸드볼 선수를 중심으로

최금석,김정수 公州大學校스포츠科學硏究所 1995 스포츠科學硏究所論文集 Vol.- No.9

This study was aimed at the research of the sports injuries with 140 handball players in boys' middle school who took part in the 23rd National Athletic Meeting in 1994. With the analysis of their reply for the questions, we could found the time, the causes, the region, the sort and the treatment of the sports injuries. Analysis of these data was used by the percentage and χ²verification(p< .05). The results are as follows; 1) There were 135 players gotten sports injuries among 140 members (96%) and we found 382 times' sports injuries, that is, 2.7 times per all players and 2.8 times per injured players. 2) We found that 70.9% of the target players were injured in training and 29.1% in the game. By the player's experience, we could see that the more experience, the less injuries in training and the more injures in the game. With the season, there were a lot of injuries players in spring. 3) The causes for the sports injuries, in warming up, turned out to be 39.3% by the players carelessness, 24.5% by the lack of enough warming-up and 13.4% by the excessive will for winning the game. 4) With the regions of the sports injuries, some players (38.5%) had injured on their arms, some players (30.1%) on their legs and others (17.0%) on their abdomen. With the playing positions, many players got injured on their arms and legs. 5) In the kinds of the sports injuries, we found that many players had injured on the part of joint (37.2%), the muscle (25.9%), the bone (18.6%) and on the skin (18.3%). As the playing positions, most goal-keepers had injured on the part of muscle and many field-players had on the joint and muscle regardless of the playing positions. There seemed to be no difference between the playing positions and the kinds of sports injuries in range of p>0.05. With the injuries of the bone, we could found the bruise (69.0%) and the fracture of the bone (28.2%). But among the target players, there were found only two players who had the osteomyelitis. In the sports injuries of the joint, many players got the asprain (50.7%), the injury of ligament (29.6%) and the luxation (16.9%). Most goal-keepers got the the injury of ligament (45.0%) but most field players got the injuries of the the part of skin, we could get the results of laceration (54.3%), abrasion (35.7%) and the fracture (10.0%) for all playing positions. In the injuries of muscle, there were the muscle bruise (67.7%) and the muscle regidity (32.3%). 6) In the methods of the first aids, after gotten the sports injuries, most players were treated for themselves (49.0%), and some players (3.4%) by a herb doctors.

人乳中의 高分子糖蛋白質에 관한 硏究

崔禎延,李守遠 成均館大學校 科學技術硏究所 1992 論文集 Vol.42 No.2

This study was carried out to compare the high molecular weight glycoprotein isolated from human milk fat globule membrane and whey, and to investigate biochemical or immunological properties of two materials. The results are summerized as follows : 1. The milk fat globule membrane (MFGM) of human milk contained about 15 proteins and 5∼6 major glycoproteins, while human whey contained about 10 proteins and 3∼4 major glycoproteins. 2. Human MFGM and whey contained a high molecular weight glycoprotein, termed PAS-O, which did not migrate in 10% SDS-acrylamide gel elecrophoresis. 3. PAS-O isolated by Sepharose CL-4B chromatography had maximum absorption at 208nm and no absorption at 280nm. 4. On the agglutination test with eight lectins, WGA, PNA, LPA reacted with PAS-O and HM-glycoprotein that suggested to act as surface receptor of them in human milk. 5. Serine, glycine, alanine and glutamic acid were predominant amino acids in the both high-Mr glycoprotein, PAS-O and HM-glycoprotein. On the other hand, sulfur containing amino acids were present in very small amount. 6. The patterns of reactivity of these two glycoproteins, PAS-O and HM-glycoproteins, with some lectins, the similarities in their amino acid compositions and electrophoretic mobilities, suggested that they may be the same molecules.

고위험 유방암환자에서 CPB(Cyclophosphamide, Cisplatin, BCNU) 고용량 화학요법과 자가조혈모세포이식술 : A Phase II Multi-Center Trial

최정혜,안명주,조은경,신동복,이재훈,이문희,김철수 대한조혈모세포이식학회 2001 대한조혈모세포이식학회지 Vol.6 No.2

배경: 림프절 전이가 많은 고위험군 유방암환자에서 CPB(cyclophosphamide, cisplatin, BCNU)를 이용한 고용량화학요법 및 자가조혈모세포이식술이 무병생존율에 미치는 영향과 안전성을 규명하기 위하여 연구를 시행하였다. 방법: 1998년 2000년 까지 한양대학병원, 가천의대병원과 인하대학병원에서 4개 이상 림프절을 침범한 유방암으로 근치적 절제술 시행 후 고용량 화학요법과 자가조혈모세포이식을 시행 받은 13명의 환자를 대상으로 하였고 대조군은 4개 이상 림프절을 침범한 유방암으로 보조화학요법을 받은 환자들 중 39명을 무작위로 선택하여 비교분석하였다. 고용량 화학요법은 제-6일에 BCNU 450 mg/m², 제-5일부터 3일까지 cyclophosphamide 2.0 g/m²와 cisplatin 55 mg/m²를 각각 투여하였다. 결과: 채집된 단핵구수의 중앙값은 8.5 x 10^(8)/kg (범위 2.44-17.90)이었고 CD34양성세포수의 중앙값은 11.0 x 10^(6)/kg (범위 0.8-78.35)이었다. 모든 환자가 이식 후 중앙치 10.0일(범위 8-15)에 말초혈액 과립구가 500 /mm³에 도달하였고 중앙치 9.0일(범위 0-18)에 혈소판이 20,000 /mm³에 도달하였다. 고용량 화학요법을 시행 받은 환자군의 추적기간의 중앙값은 24.6 개월 (범위 15.5-40.5)이었으며 총 13명의 환자 중 1명이 뇌전이로 인하여 사망하였으며 3명(23.1%)에서 재발이 관찰되었다. 대조군은 재발율이 25.6%이었고 무병생존율은 고용량 화학요법을 시행 받은 군(70.5%)과 대조군(78.8%) 사이에서 통계학적으로 의미 있는 차이를 나타내지 않았다 (P=0.744). 고용량 화학요법을 시행 받은 환자 중 10명 76.9%에서 발열이 관찰되었고 WHO 기준 3도 및 4도의 부작용은 혈액학적 부작용이 6예, 소화기적 부작용이 6예에서 관찰되었다. 결론: 고위험군 유방암 환자에서 CPB를 이용한 고용량화학요법 및 자가조혈모세포이식술은 안전하게 적용할 수 있는 치료의 한 방법이나 고용량 화학요법의 효과에 대해서는 앞으로 발표될 대규모 3상 연구의 결과를 주시해야 할 것으로 생각된다. Background: Despite the improvement of prognosis by multimodality therapy for the treatment of breast cancer, primary breast cancer patients with multiple involved axillary lymph node still have a high risk of recurrence. Methods: Between January 1998 and May 2000, we treated 13 women with histologically proven stage II or III breast cancer with 4 or more axillary lymph nodes at the time of primary mastectomy with high-dose chemotherapy and autologous stem cell transplantation. Results: The median age was 45 years (range: 32-57) and the median number of involved lymph node was 13 (range: 6-31). Ten patients were premenopausal state and 40 percent were positive hormone receptor. Seven patients received radiation therapy. Patients were treated with high-dose CPB (cyclophosphamide 2 g/m² D-5--3, cisplatin 55 mg/m² D-5--3, BCNU 450 mg/m² D-6) with autologous peripheral blood stem cell transplantation after 2-4 cycles of adjuvant chemotherapy (CAF, CEF or AC). We compared those patients with age and other clinical factors-matched 39 patients who received conventional adjuvant chemotherapy. The median follow-up for surviving patients who received high-dose chemotherapy was 25.6 months. The relapse rate and 2-year relapse-free survival was 23.1%, 25.6% and 70.5%, 78.8% for high-dose and conventional dose chemotherapy, respectively, but there was no significant difference between two groups (P>0.05). Conclusion: Further follow-up and additional studies are required to resolve the role of high-dose chemotherapy with autologous stem cell transplantation in high-risk breast cancer.

응급실내에서 발생한 폭력의 실태

최웅지,조남수,조수형,김성중,박광철,박진실 朝鮮大學校 附設 醫學硏究所 2004 The Medical Journal of Chosun University Vol.29 No.1

Background and Objectives: The objective of this study was to obtain circumstances about violence providers and cause of the violence in emergency room. Materials and Methods: Reports were provided to emergency department doctors, nurses and emergency medical technicians working in Chosun University Hospital Emergency Center during the sixty days from 26 May 2003 to 24 July 2003. Report form consisted of the degree of violence, the reason for the violence, dermographic information about violence providers, outbreak time of violence and response of emergency personnels. Results: SixtyUeight case of violence in the emergency department were reported. Almost all of the violence was due to the male gender and high incidence in third and fourth decade. The violence occured mostly in the night shift. 55.9% of violence was done by patient and 41.2% was done by patient's guardians. The leading cause of violence were alcohol drunken and delay of laboratory test and treatment. Verbal abuse and threats were the most concern form of violence, Conclusion: It is necessary to solve the problems faced in the emergency department not only administrative and financial aid but also regular preventive education and further study.

그람양성구균에 대한 Teicoplanin과 Vancomycin의 시험관내 항균력

최태열,김경숙,전용관,서일혜,김정욱,이웅수,안정열,김홍석,정재용,최효선,김덕언,유진우 대한감염학회 1994 감염 Vol.26 No.1

An increasing frequency of methicillin resistant S. aureus(MRSA), methicillin resistant coagulase negative staphylococci(MRCNS) and Enterococcal infection have been observed in recent years. Teicoplanin is a new glycopeptide antibiotic obstained from the Actinoplanes teicomycetius. The molecular structure and spectrum of antimicrobial activity of teicoplanin is simillar to those of vancomycin, and has been reported to have an excellent in vitro and in vivo effect against various gram-positive infections. Therefore, we evaluated the in vitor susceptibility of gram positive cocci, such as, S. aureus, coagulase negative Staphylococci(CNS), and Enterococci to teicoplanin and vancomycin. The total 253 strains consisted of MSSA(40), MRSA(53), MSCNS(47), MRCNS(48), and Enterococci(65). They were assayed by disc diffusion and agar dilution. During the study, 57% of S. aureus and 49% of CNS showed resistance to methicillin. The inhibitory diameter of teicoplanin was 15-20mm in MSSA, 12-19mm in MRSA, 13-24mm in MSCNS, 11-23mm in MRCNS, and 15-22mm in Enterococci respectively, and showed sensitivity in all but 8 strains(3.2%). The range of the minimum inhibitory concentration (MIC) of teicoplanin to MSSA, MRSA, MSCNS, MRCNS and Enterococci were 9.12-2.0㎍/ml, 0.25-2.0㎍/ml, & 0.25-32㎍/ml, 0.12-1.0㎍/ml respectively. One case of S. haemolyticus was resistant to teicoplanin (32㎍/ml) by the agar dilution method. Eight minor (3.2%) and one major(0.4%) error was observed when the MIC and disk diffusion data were correlated with teicoplanin. As for vancomycin the inhibitory diameter was 17-21mm in MSSA, 15-21mm in MRSA, 18-26mm in MSCNS, 18-25mm in MRCNS, and 16-22mm in Enterococci respectively. The range of the MIC of vancomycin to MSSA, MRSA, MSCNS, MRCNS, and Enterococci were 0.25-1.0㎍/ml, 0.25-4.0㎍/ml, 0.5-2.0㎍/ml and 0.5-2.0㎍/ml respectively. One minor error (0.4%) was seen with the vancomycin disk. The MIC90 of MSSA and MRSA exhibited the same results in teicoplanin (1.0㎍/ml, 1.0㎍/ml), and vancomycin(2.0㎍/ml, 2.0㎍/ml). MSCNS and MRCNS exhibited greater MIC90 with teicoplanin(4.0㎍/ml, 8.0㎍/ml) than vancomycin(2.0㎍/ml, 2.0㎍/ml). Incontrase Enterococci were more susceptible to teicoplanin(0.5㎍/ml) than to vancomucin (2.0㎍/ml). Results from this analysis indicated that both teicoplanin and vancomycin were very excellent for gram positive infections, especially those resistant to methicillin.

난소의 유피낭포에서 발생한 편평세포암종 1례

최병관,정일균,최동수,목정은 慶熙大學校 1984 論文集 Vol.13 No.-

A case of squamous cell carcinoma arising in dermoid cyst of the ovary is presented with a brief review of the literatures.