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.

측두골 골절 : 임상적 및 방사선학적 분석 Clinical and Radiological Analysis

조성원,최순관,조성진,김범태,신원한,윤일규,변박장 순천향의학연구소;Soonchunhyang Medical Research Institute 2000 Journal of Soonchunhyang Medical Science Vol.6 No.1

The objective of this study is to review of the incidence of temporal bone fractures and complications resulting from temporal bone fractures and to analyze the correlation between clinical and radiological findings. A series of 49 patients who were diagnosed temporal bone fracture with rhinorrhea, bloody otorrhea, admitted to Soonchunhyang University Chon-an Hospital from January 1997 to September 1999, were studied retrospectively. Clinical analyses were focused on age, sex, type of accident, external wound site, CSF leakage, hearing loss and facial nerve palsy. The high resolution CT scan consisted of a series of 3-mm thick sections through the temporal bone using the GE CT scanner (General Electric Inc.). In radiologic analyses, fracture types of temporal bone were divided into longtudinal fracture(LF), transverse fracture(TF) and mixed fracture(MF) respectively. The CT scans were examined for mastoid antral haziness(MH), middle ear cavity haziness(MeH), ossicular chain disruption(OD), otic capsule fracture(OF), pneumocephalus(Pn). The type of facial canal fracture was classified as fracture of internal auditory canal portion(FIAC), fracture of perigeniculate portion(FPG), fracture of tympanic portion(FT), fracture of mastoid portion(FM). The correlation between clinical and radiological findings was analysed. A total of 49 fractured temporal bones resulted in 9 CSF fistula, 23 hearing loss( 13 conductive type, 7 sensorineural type), 17 facial nerve injuries ranging from mild paresis to complete paralysis. The mose common etiology of the injury was from a motor vehicle accident(28%). The type of fracture observed on high resolution CT scanning was a LF in 39(78%) patients, a TF in 7(14%) patients and a MF in 3(6%) patients. The majority of fractures terminate in the floor of the middle cranial fossa in LF and passed lateral to the otic capsule in TF. Average time of onset of delayed facial palsy was 3.5 days. No patient developed prolonged otorrhea or meningitis during hospitalization and there was no requirement of surgical management. Hearing loss was the most common complication of temporal bone fracture(48%). Conductive hearing loss was associated with middle ear cavity haziness and ossiclular chain disruption. in temporal bone CT. A total of 29 cases facial canal fracture in temporal bone CT resulted in 14 perigeniculate portion(FPG), 12 tympanic portion(FT), 3 mastoid portion(FM). There was no correlation between radiological facial canal fracture and clinical facial nerve palsy. Four of 17 patients with facial nerve injury required facial nerve exploration under general anesthesia. We thought that prognosis and therapeutic planning in patients with temporal bone fractures were based on the clinical and radiological findings.

인조 합성 테니스 바닥재의 지면 반력 분석

조승제,정미라,서국웅,박승범,윤양진,이훈식,강영택 釜山大學校 附設 體育科學硏究所 1998 體育科學硏究所 論文集 Vol.14 No.-

Some authors suggest that certain types of surfaces are the origin of such injuries. A few years after the first medical concerns about surfaces were voiced, publications of biomechanical measurements apperared, describing accleration, force, and impact measurement on different types of surfaces. In many sport activities, surfaces can be under very high dynamic load. This was the reason for the development of various methods for impact simulation, like the development of various methods for impact simulation, like the artificial athlete. Furthermore, it is important to collect information about the hardness of new and already existing surfaces in sport arenas. The idea on which this measuring system is based Is as follows: The stiffness of the material can be computed from the kinematics measurd at touch down of a rigid body onto a material sample. The results show the following The result for the artifical surfaces(Synpave ace) is surprising. It is known that these surfaces are much harder than synpave rebound classic, synpave spring. This finding suggests that it may be possible that the subjective impression is used as one criterion in the selection of landing(or style) strategies. The number of subjects in this experiment is too small to make statistically significant conclusions. It is shown analytically that when an object a deformable surface, the acceleration it experiences is inversely propotional to its mass. In future, it need to stress that the interaction between shoe and surface is important, and this aspect has now become well accepted. Considering biomechanical aspect in player's injury, it request Korean Standards for synthetic playing surfaces in sport like ASTM(America Society for Testing & Materials) standards of America, DIN 18035 standards of Germany, BSI standards of U.K.

퇴행성 척추질환으로 오인된 척수 종양

조용재,김승범,진동규,서의교,김상진 대한척추신경외과학회 2004 Neurospine Vol.1 No.1

Objectives: Symptoms arising from spinal cord tumor are often insidious in onset and nonspecific in nature. To make the subtle initial signs and symptoms of these tumors more apparent to clinicians, we retrospectively analyzed the data of spinal cord tumor patients who were misdiagnosed as degenerative spine disease. Methods: We reviewed history, symptom, sign, radiological study, and pathologic diagnosis of 19 spinal cord tumor patients who had been operated as degenerative spine disease, especially duration and description of symptoms and sign before an accurate diagnosis was made. Results: Average duration of delay before an accurate diagnosis was made was 178.4 days(range: 23~303). Common symptom and signs on neurologic examination included aggravation of pain(8 cases; 47.1 %), and neurologic decline(9 cases; 52.9%) The misdiagnosis included a herniated lumbar disc(16 cases; 94.1%), lumbar stenosis(1 case; 5.9%). Inappropriate treatment for these misdiagnoses included 5 percutaneous lazer discectomies, 9 discectomies, 3 chemonucleolysis, 2 posterior lumbar interbody fusions with cages. Conclusion: When a patient has symptoms that appear to be out of the ordinary, surgeons should suspect other spinal disease including the spinal cord tumor.

골프 드라이버 샷의 비거리 향상을 위한 웨이트 트레이닝

조상우,박범영 한국스포츠리서치 2004 한국 스포츠 리서치 Vol.15 No.5

The purpose of this study is to examine the increasement of ball carry in golf driver shot by weight training. 5 golf players, male and handicap 5-7, were selected, and they were trained 40%(lower limbs, and upper limbs) of maximum strength with weight lifting for 8weeks. They have examined isokinetic muscle strength(dorsiflexion and plantarflexion at ankle, flexion and extension at knee, elbow, wrist, and trunk, and adduction and abduction at shoulder), head speed, and ball carry of golf driver shot at pre and post. For the statistical test, the t-test was conducted. The results of this study is as follows. Statistically, there were significant increased head speed(p<.001) and ball carry(p<.01) after 8weeks.

CIM의 戰略的 統合 槪念 考察 : 獨逸 製造企業의 自動化 事例 Focused on the examples of automatization in German companies

조희영,박상범 동국대학교 경영관리연구소 1991 經營經濟論叢 Vol.15 No.-

In these day, automatization in manufacturing companies is definitely needed to promote productivity and improve quality through the way of attaining superiority in strategic competitiveness. Also, we now, without any doubt in this rapidly changing world, realize the fact that the manufacturing industry growth plays an important role on this diversification. Furthermore, the efficiency in systematic operations and integration is absolutely required. Even though the responses to this trend which is widely used are fairly favorable for their promotion of productivity and management, automatization standards are not yet perfect enough to confront with those of international competition. In near future, therefore, it is our responsibility to settle the technological gap on both scale and regional automatization. CIM is required to use computers strategically as the mean of reinforcement of competitive power and differentiation. CIM depends on the establishment of managerial strategy. Besides manufacturing businesses are divided into various kinds wuch as banks, transportation business, distribution industry, etc. Unfortunately, there are not complete setting up about CIM in any company up to now. In addition, there are a few companies which are integrated and automatized well. It is true that Germany has very low rate of companies which meet the standards gighly enough to offer real "on-the-job" experiences. Still many investigators have studied the solution of the problems. But no experts including the users who produce the computer-integrated-manufacturing could yet propose the special programs. There is one clear thing: Because the future CIM is not to create the super computer system but build up a subsystem after building it, CIM application should be made according to the plans and purposes at the same time. It is important to keep accurate information, right human resources in long-term application. That makes it possible for CIM to settle. Also, we are strongly asked to have great concern about CIM and need cooperation from both academic fields and governmental participation with positive attitudes from all the related authorities.

金剛山댐 建設에 따른 北漢江 上流 水域의 環境 모니터링에 관한 硏究

조규송,김범철,안태석,전상호,이종범 江原大學校 附設 環境硏究所 1989 環境硏究 Vol.6 No.-

Aquatic ecosystem was studies in Lake Paro to monitor the effects of the Keumkangsan Dam construction in North Korea. Water quality, primary prodectivity, and microbes were serveyed bimonthly in 1987. The texture and composition of sediments, and meterological sapects were also investigated. The most remarkable change of water quality was the increase of turbidity. due to the dam construction. Overall chemical and biological aspects were greatly changed because of the high turbidity. The concentration of phosphate increased and subsequently phytoplankto standing corp increased. The effect of phosphate increase was compensated by the decrease of light penetration, and, therefore areal primary prodectivity was not so high as expected from the chlorophyll concentration. From the standing corp of microbes, the trophic state of lake Paro was evaluated as mesotrophy. As for the horizontal variation of microbial activity, the microbial heterotrophy was higher in the upstream regions than in the downstream regions. Sediment types are almost clayey silt and the mean sizes of sediments were homogeneous through the whole lake area. Organic carbon contents of the sediment seemed to be influenced by seasonal variation of primary productivity.

Surface penetrating sealant가 치경부 수복물의미세누출에 미치는 영향

김성원,조용범,홍찬의 대한치과보존학회 2001 Restorative Dentistry & Endodontics Vol.26 No.1

Despite the improvements in bond strengths of dentin adhesives and resin-modified glass ionomers, the marginal seal of cervical restorations remains a concern. Microleakage at poorly sealed margins can result in staining, post-operative sensitivity, pulpal irritation, and recurrent caries. The objective of this study was to evaluate the effect of surface penetrating sealant(SPS) on the microleakage of cervical restorations. 45 extracted human teeth were selected, and Class V preparations were prepared on the both buccal and lingual surface of the teeth to the following dimensions : 1.5mm axially, 3mm mesiodistally, and 3mm incisogingivally. After cervical restoration with composite resin, compomer, glass ionomer, each restoration was treated as three methods: No Tx., Scotchbond Multipurpose Adhesive, Fortify The sections were examined with a stereomicroscope to determine the extent of microleakage at enamel and dentin margins. The results of this study were as follows. 1.All groups showed some microleakage. 2.Gingival cavity wall with cementum margin showed significantly higher leakage value than occlusal cavity wall with enamel margin. 3.The group treated with SPS showed significantly lower leakage value than no treated group(p<0.05). But there is no difference between Fortify and Scotchbond Multipurpose adhesive. The results of this study suggest that SPS are effective in reducing microleakage of class V restorations. But it is certain that some microleakage still occurred despite the application of SPS.

슬개골 골절에서 관절경을 이용한 정복 및 내 고정술

고상훈,조성도,나화엽,김우석,정유영,곽창렬,김범수 대한골절학회 2003 대한골절학회지 Vol.16 No.4

두가지 혈류 유발방법에 의한 새로운 심폐소생술(이중 혈류 유발 심폐소생술)장치의 개발

황성오,김현,조준휘,오범진,임종천,최경훈,윤정한,이승환,김영식,이강현,이윤선 大韓應急醫學會 1999 대한응급의학회지 Vol.10 No.2

Background: There have been many efforts to augment blood flow during cardiopulmonary resuscitation. These efforts have focused on maximizing the effect of cardiac pump or thoracic pump alone. However, considering that the heart is the biggest blood reservoir and increase of intrathoracic pressure can generate blood flow, simultaneous exploitation of both mechanisms may have synergistic effect. We hypothesized that simultaneous chest constriction in addition to sternal compression by standard CPR may have additive hemodynamic effects by preventing deformation of the chest and increase of intrathoracic pressure. Methods and results: we built a new mechanical device to perform compression and thoracic constriction simultaneously. The device consists of two main elements. Piston in the center is to depress the sternum. Strap is to constrict the thorax circumferentially. Strap is attached to both sides of the piston. When the piston is pushed down, it depresses the sternum and pulls on the thoracic strap. To determine strap width to produce optimal hemodynamic effect, we measured hemodynamic parameters with variable widths of strap in two dogs after induction of ventricular fibrillation. Result of the experiment showed that 10cm wide strap was determined to be most effective. We also determined optimal depth of compression to produce maximal hemodynamic effect with animal experiments using two dogs. Animal experiments showed that the highest aortic pressure could be generated when the stemum was depressed to 5 cm. Cardiopulmonary resusciation using a new device could generate higher systolic aortic pressure, coronary perfusion pressure and end-tidal carbon dioxide tension in comparison with standard cardiopulmonary resuscitation in a pilot animal study using two dogs. Conclusion: New cardiopulmonary resuscitation method using a mechanical device designed by us could perform sternal compression and simultaneous thoracic constriction, and generate better hemodynamic effects than standard cardiopulmonary resuscitation in pilot animal experiments.