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.

Nonlinear Cardiac Dynamics and Morning Dip : 위험한 일중리듬 An Unsound Circadian Rhythm

염명걸,김남수,오재원,김창렬,이재웅,김순길,이철범,노정일,최정연,윤용수 대한순환기학회 1998 Korean Circulation Journal Vol.28 No.3

Original Article : Geographic difference of epidemiological features of HCV infection in Korea

( Kyung Ah Kim ),( Sook Hyang Jeong ),( Eun Sun Jang ),( Young Seok Kim3 ),( Youn Jae Lee ),( Eun Uk Jung ),( In Hee Kim ),( Sung Bum Cho ),( Mee Kyung Kee ),( Chun Kang ) 대한간학회 2014 Clinical and Molecular Hepatology(대한간학회지) Vol.20 No.4

Background/Aims: The prevalence of hepatitis C virus (HCV) infection in Korea exhibits significant geographic variation, with it being higher in Busan and Jeonam than in other areas. The reason for this intranational geographic difference was investigated in this study by conducting a comparative analysis of the risk factors related to HCV infection among three geographic areas: the capital (Seoul), Busan, and the province of Jeolla. Methods: In total, 990 patients with chronic HCV infection were prospectively enrolled at 5 university hospitals located in Seoul (n=374), Busan (n=264), and Jeolla (n=352). A standardized questionnaire survey on the risk factors for HCV infection was administered to these three groups of patients, and a comparative analysis of the findings was performed. Results: The analysis revealed significant regional differences in exposure to the risk factors of HCV infection. By comparison with patients in Seoul as a control group in the multivariate analysis, patients in Busan had significantly more experience of invasive medical procedures, acupuncture, cosmetic procedures, and multiple sex partners. In contrast, patients in Jeolla were significantly older, and they had a higher prevalence of hepatocellular carcinoma, a lower prevalence of multiple sex partners, and had experienced fewer invasive procedures. Conclusions: There was a significant geographic difference in the exposure to potential risk factors of HCV infection between patients from the three studied regions. This may explain the regional variation of the prevalence of HCV infection in Korea, and should be taken into account when planning strategies for the prevention and management of HCV infection. (Clin Mol Hepatol 2014;20:361-367)

다제내성 그람양성균에 대한 Linezolid(Zyvox^(�))의 시험관내 항균력 비교

박대원,정희진,엄중식,황병연,김성범,이재갑,이연주,정혜원,정성주,박재형,이진수,손장욱,김우주,김민자,박승철 대한감염학회 2003 감염과 화학요법 Vol.35 No.5

배경 : MRSA, VRE, VRSA같은 다제 내성 그람 양성균의 등장에 따라 glycopeptide를 대체할 새로운 항생제의 개발이 필요하게 되었고 결과적으로 새로운 항생제인 linezolid라는 항생제가 개발되었다. Linezolid는 이전의 항생제와는 다른 새로운 계열의 oxazolidinone으로 경구 이용률이 우수하다. 원내 및 원외감염의 중요한 원인균이 되고 있는 MRSA, VRE에 대한 적절한 경구용 항균제가 없는 국내에서 폐렴 및 피부 연조직 감염에서 경구용으로 사용해 볼 수 있는 약제이다. 본 연구에서는 고대 구로 병원에서 분리된 MRSA, VRE 등을 대상으로 다른 여러 항균제와 비교한 linezolid의 시험관내 항균력을 조사하고자 하였다. 재료 및 방법 : 연구대상은 1998년 1월부터 2000년 12월까지 본원에서 입원 및 외래를 통하여 피부 연조직 감염증 및 호흡기 감염증, 요로감염증으로 진단된 환자들의 가검물로부터 분리된 MRSA 60균주, VRE 43균주, PRSP 25균주를 액체배지 또는 한천배지 희석법을 통하여 linezolid 및 기타 항균제에 대한 최소발육억제농도를 구하였다. 결과 : 실험에 사용한 S. aureus는 모두 MRSA였고 이들은 linezolid에 대해 MIC_(90) 2㎍/㎖(MIC 범위 1-2㎍/㎖), Enterococcus spp는 모두 VRE로 linezolid의 MIC_(90)은 2㎍/㎖로 MIC 범위는 1-4㎍/㎖였다. 한 개의 균주에서 MIC 4㎍/㎖로 중등도 감수성을 보였으나 MIC breakpoint가 (8㎍/㎖인 내성균주는 없고 모두 감수성을 보였다. S. pneumoniae의 경우 penicillin 내성이었고, linezolid MIC_(90) 1㎍/㎖ (MIC 범위 0.5-1㎍/㎖)로 전부 감수성을 보였다. 결론 : Linezolid는 MRSA를 위시한 VRE, PRSP 등의 다제 내성 그람 양성균에 대하여 우수한 시험관내 항균력을 보임을 알 수 있었다. Background : The emergence of multi-drug resistant Gram-positive cocci, such as MRSA, VRE, and VRSA, necessitated to develop new antibiotics, which could replace the glycopeptide. As a result, a new antibiotics named linezolid was developed. Linezolid is different line of oxazolidinones with a good oral bioavailability, compared to other antibiotics. Since appropriate oral antibiotics are not presently available for MRSA, which is a major cause of nosocomial and community acquired infections, the introduction of linezolid will have favorable effect on treatment of infections such as pneumonia or skin infections. In this study, we investigated the antibiotic effect of linezolid on MRSA and VRE isolated from patients who were treated in Korea University Guro Hospital. Material and Methods : By using broth microdilution and agar dilution method we measured minimum inhibitory concentration (MIC) with sixty S. aureus, forty three Enterococcus spp., and twenty five S. pneumoniae isolates from patients who were diagnosed as skin, soft tissue, respiratory, and urinary infections in Korea University Guro Hospital from January, 1998 to December, 2002. Results : All of S. aureus used in this study were MRSA, and MIG_(90) of linezolid was below 2 ㎍/㎖ (MIC ranged between 1-2 ㎍/㎖). All of Enterococcus spp. were VRE, and had MIG_(90) of 2 ㎍/㎖ (MIC ranged between 1 to 4 ㎍/㎖). One of the VRE showed intermediate susceptibility with MIC of 4 ㎍/㎖. However, none was resistant with MIC breakpoint above 8 ㎍/㎖. All of S. pneumoniae were resistant to penicillin, but they were susceptible to linezolid with MICao of 1 ㎍/㎖(MIC range 0.5-1㎍/㎖). Conclusion : In conclusions, linezolid has an excellent in vitro antibiotic effect on multi-drug resistant Gram-positive cocci, such as MRSA, PRSP, and VRE.

응급실내 중환자의 단기간 진정을 위한 Midazolam의 지속적 정주

김범주,정태오,진영호,이재백 大韓應急醫學會 1999 대한응급의학회지 Vol.10 No.2

Background: The mechanically ventilated patient's stay in the emergency department(ED) is brief but ventilatory management and intervention must be optimal. Agitation, anxiety, distress, and discomfort are common complications for the ventilated patient. So, sedation is necessary to reduce these complications. Methods: Patients were monitored and mechanically ventilated. Midazolam was intravenously administered as loading dose(3-5mg), followed by continuous infusion at a rate of 0.06mg/kg/hr, titrated to achieve a predetermined sedation level(Ramsay's sedation score: 2-5 points, Glasgow coma score scale: 8-11 points). Results: After onset of predetermined sedation, systolic and diastolic blood pressure and heart rate remained stable during continuous infusion when compared with those of the initial state. Arterial blood gas and peak inspiratory pressure remained unchanged but respiratory rate was decreased to allowable ranges. Conclusion: A short-term continuous infusion of midazolam was a safe and effective method for sedation of ventilated patients in ED.

폐쇄성 황달로 내원한 담관내 증식을 동반한 간세포암 1예

김승범,김태년,이호찬,박재현,은종렬,장병익,이헌주,윤성수,배영경 영남대학교 의과대학 2008 Yeungnam University Journal of Medicine Vol.25 No.2

The incidence of hepatocellular carcinoma presenting as obstructive jaundice is 0.7 -9% The mechanisms of obstructive jaundice include bile duct invasion by tumor, tumor thrombi, blood clots, direct bile duct compression by tumor, and intraductal tumor growth. We report a rare case of hepatocellular carcinoma with intraductal growth A 46-year-o1d woman was admitted due to colicky right upper abdominal pain and jaundice for 4 days Computed tomography showed dilatation of the left intrahepatic duct, and endoscopic retrograde cholangiography showed a filhng defect in the left main intrahepatic duct. We performed a left lobectomy with a Roux-en-Y hepaticojejunostomy. The tumor was diagnosed as a hepatocellular carcinoma with intraductal growth.

海砂 混合率 變化에 따른 水中不分離性 콘크리트의 特性에 관한 硏究

김명식,윤재범,김광민,이상명 釜慶大學校 1999 釜慶大學校 論文集 Vol.4 No.1

The objective of this study is to investigate the characteristics change of antiwashout underwater concrete with variation of blen ratio of sea sand to total fine aggregates through experimental studies. The flowability(slump flow test), antiwashout properties(pH and suspension test), filling property(box test), air and chloride contents property, and the unit weight and the compressive strength of both cast-in-fresh water and cast-in-sea water have been examined experimentally. According to the experimental results, when sea sand are mixed in antiwashout underwater concrete mixture by about 40% per total fine aggregates, it is found that the flowability fit and the compressive strength is higher than others.

급격한 온도 증가에 대해 단기간 순응시 꺽지(Coreoperca herzi) 젖산탈수소효소 활성과 동위효소의 변화

김재범,조성규,염정주 청주대학교 2004 産業科學硏究 Vol.22 No.1

The metabolism of LDH and function of eye-specific C₄ isozyme in tissues of Coreoperca herzi acclimated to acute increase Of temperature were studied. The LDH activity of tissue acclimated to 10 ℃, pH5, DOlOppm was detected higher than those acclimated to 20℃ pH5, DO10ppm. The LDH activity of liver tissue was measured low. LDH A₄, B₄, A₂B₂, C₄ and isozyme containing subunit C were expressed but A₃B and AB₃ isozyme were absent. When the temperature was acutely increased, the LDH activity in skeletal muscle and heart were changed to maximum state within 2 hours and were restored to the base level within 4-6 hours. However, LDH activity in eye tissue was decreased slowly and was restored slowly to the base level than other tissues. The activity of LDH isozyme in skeletal muscle, kidney and eye tissue showed large variation but those in heart and brain tissue changed a little. The B₄ isozyme was decreased in kidney tissue but B₄ and C₄ isozymes were increased in other tissues. First, the subunit C was increased and subunit B was slowly increased in eye tissue. Therefore, C₄ isozyme was played role as lactate oxidase. As a result, the change of LDH activity and isozyme to acute increase of temperature might be the acclimation process to the control of metabolism with surroundings.

표백에 의한 라디에타소나무의 청변 제거

김규혁,김형준,나종범,김재진 한국목재공학회 2003 목재공학 Vol.31 No.1

본 연구는 라디에타소나무 제재목의 균 변색을 제거하기 위한 표백처리의 사용 가능성을 조사하기 위하여 수행하였다. 염소계 표백제인 아염소산나트륨과 차아염소산나트륨은 표백조건(약제농도, 처리온도, 처리시간)의 조절에 따라 만족할만한 변색제거 효과를 얻을 수 있었다. 비염소계 표백제인 과산화수소는 표백조건의 조절만으로는 변색제거가 불가능하였으나 규산나트륨과 수산화나트륨을 활성제로 첨가하는 경우에는 염소계 표백제보다 탁월한 변색제거 효과를 나타내었다. 그러나 활성제 첨가에 따라 재색의 녹색화 문제가 발생하였는데, 앞으로 이러한 문제점을 해결하기 위한 연구가 진행되어야 할 것이다. 또한, 앞으로 본 연구를 통해 개발된 변색제거방법의 현장 적용을 후속 연구도 필요하다고 본다. The feasibility of using bleaching treatments for removing fungal stain was evaluated on heavily stained raiadta pine sapwood. Sodium chlorite and sodium hypochlorite appeared to destain fungal discoloration by providing proper treatment conditions (chemical concentration, treatment temperature, and treatment time), while hydrogen peroxide did not remove fungal stain under the bleaching regimes evaluated. The addition of sodium silicate and sodium hydroxide in the hydrogen peroxide solution as a buffer could remove fungal discoloration completely:; however, the color of wood surface turned faint green after bleaching, thereby reducing the lightness of bleached samples. The results suggest that hydrogen peroxide bleaching could be a feasible method for removing fungal discoloration of stained radiata pine sapwood, although further research is needed to solve the problem of color change after bleaching Also, further tests under field conditions are recommended.

허혈 유사 조건이 심방근의 활동전위 특성에 미치는 영향

김재하,주정민,조용범,신동호,안병희,주신배,김상형 대한순환기학회 1999 Korean Circulation Journal Vol.29 No.11