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.

GO-62 : Lower extremity edema in patients with endometrial cancer

( Myong Cheol Lim ),( Jeong Seon Lee ),( Jung Nam Joo ),( Sang Soo Seo ),( Sok Bom Kang ),( Sang Yoon Park ) 대한산부인과학회 2012 대한산부인과학회 학술대회 Vol.99 No.-

The objective of this study was to investigate clinical manifestations of lower extremity edema (LEE) in endometrial cancer Medical records for LEE and/or responses to the Gynecologic Cancer Lymphedema Questionnaire (GCLQ) were evaluated in 177 patients with endometrial cancer Patients had a median age of 53 years. Sixty-seven patients (37.9%) had past (9 patients, 13.4%) and/or current patient-reported LEE (58 patients, 86.6%). Symptoms reported on the GCLQ in over 20% of respondents were swelling, numbness, aching , and heaviness. GCLQ total symptoms score was significantly higher in patients with current LEE. Most of the LEE (43/67, 64.2%) developed within 12 months after surgery and LEE lasted more than 6 months in most patients (56/59, 94.9%) Prospective clinical trials are needed to know the clinical significance, impact on quality of life, and preventive strategy of LEE in patients with endometrial cancer

생약제제인 이공산(異功散)의 Cisplatin 유도 신장독성 보호 및 항산화 효과

Lee, Kyung-Tae,Ahn, Kyoo-Seok,Chang, Sung-Goo,Oh, Soo-Myung,Jung, Jee-Chang 경희대학교 동서의학연구소 1999 INTERNATIONAL SYMPOSIUM ON EAST-WEST MEDICINE Vol.1999 No.1

Kyung-Tae Lee, Kyoo-Seok Ahn¹, Sung-Goo Chang², Soo-Myung Oh²and Jee-Chang Jung²¹College of Pharmacy, ²Oriental Medicine and ³College of Medicine, and East-West Medical Reserch Institute, Kyung Hee University, Seoul, Korea. Preventive and Antioxidative Effects of Crude Drug Preparation(E-kong-san) on Cisplatin Induced Nephrotoxicity. Proceedings of International Symposium on East-West Medicine, Seoul. 201-211, 1999. -Nephroprotective effects of a crude drug-prearation (E-kong-san) were determined from cisplatin on rabbit kidney proximal tubule and human renal cortical cells by MTT assays and sustained glucose consumption on ciplatin-induced human renal cortical tissue. Levels of creatinine and blood ure nitrogen(BUN) in serum after administration of cisplatin(0.75mg/kg,i.p.) to E-kong-san(0.75g/kg/day,p.o.)-pretreated rats were markedly lower compared to those of cisplatin-treated rats. Moreover, the administration of E-kong-san significantly inhibited the loss of body weight of cisplatin injected rts. These findings suggest that E-kong-san on the cisplatin induced nephrotoxicity led us to investigate whether the effect of this water extract was a result of anti-oxidation. E-kong-san showed strong free radical scavenger activities on 1,1-dipheny1-2picrylhydrazil(DPPH) radical and xanthine/xanthine oxidase(XOD) generated superoxide anion radical(O2-). We further studied the effects of E-kong-san on lipid peroxidation in rat liver microsomes induced by enzymatic and nonenzymatic methods. E-kong-san exhibited significant inhibition on both ascorbic acid/Fe2+and ADP/NADPH/Fe3+ induced lipid peroxidation in rat liver microsomes. Based on these results, we suggest that-E-kong-san attenuate the cisplatin induced cytotoxicity and its mechanism can be eplained by antioxidant.

정신분열병 환자에서 얼굴 영상의 작동기억 장애 : 기능자기공명영상연구

이창욱,김태석,주라형,박주미,박여진,김종진,전신수,배치운,김정진,이수정,이철,백인호 大韓神經精神醫學會 2005 신경정신의학 Vol.44 No.2

Objectives : Impaired processing of facial information is one of the broad ranges of cognitive deficits seen in patients with Schi-zophrenia. We aimed to elucidate the differences in brain activities involved in the process of facial working memory between schizophrenic patients and healthy comparison subjects. Methods : Twelve patients with schizophrenia were recruited along with twelve demographically matched healthy volunteers as a comparison group. Functional magnetic resonance imaging (fMRI) was used to assess cortical activities during the Perfor-mance of a 2-back working memory paradigm using images of neutral faces as mnemonic content. Rcsults : The patient group performed the tasks with reduced accuracy. Group analysis revealed that the left fusiform gyrus, the right superior frontal gyrus, the bilateral middle frontal gyri/insula, the left middle temporal gyrus, the precuneus, the quadrangular lobules and the vermis of cerebellum showed decreased cortical activities in the patient group. On the other hand, an increased level of activation in the lateral prefrontal cortex and the pahetal lobule was observed from the patient group, all in the right hemisphere. Conulusion : A decreased level of activity in the left fusiform gyrus among the patient group implicates inefficient processing of facial information. An increased level of activation in prefrontal and parietal neural networks from the patient group confirms earlier findings on the impaired working memory of patients with schizophrenia.

전자부품 제조업 근로자들의 시력변화에 대한 연구

이용만,안규동,이성수,함정오,김화성,리갑수,이병국 순천향의학연구소 1996 Journal of Soonchunhyang Medical Science Vol.2 No.2

근접작업이 시력약화의 원인이 될 수 있는가를 알아보기 위하여 전자부품을 제조하는 2개 사업장에서 1991년에서 1993년까지 입사한 근로자들 중에서 근접작업으로 인정되는 마이크로칩을 조립하는 근접작업자 306명을 조사군으로, 대조군은 세탁기 타이머 및 일반 기계기구를 조립하는 작업자 154명, 계 460명을 선정하였다. 이들 대상자는 1991년 입사자는 1993, 1994, 1995년 시력을 조사하였으며, 1992년 입사자는 1993, 1994, 1995년 3년동안 조사를 하였으며, 1993년 입사자는 1994, 1995년 2년간 시력을 조사하였다. 대상자 중에서 입사시 안경을 착용한 근로자는 82명(17.8%)이었다. 따라서 남자 근로자와 안경착용자를 제외한 여성 근로자들 335명만을 추적 조사하여 다음과 같은 결론을 얻었다. 조사군에서 입사시 시력 1.0 이상이었던 근로자의 분포는 취업 1년 후 약 25-35% 정도 감소하였으며, 2년후에는 약 40-60% 정도의 감소를 나타내었고, 3년 후 약 50-65% 정도로 감소하였고 4년후에는 약 65% 이상 감소하였다. 그러나 대조군에서는 1.0 이상의 시력을 보였던 근로자들의 비율이 취업 1년 또는 2년 후 15-30%의 감소를 보이고 있으나 그 이후에는 큰 변동이 없었다. 이들의 시력변화를 근무년수에 따라 알아보기 위하여 조사된 시력을 순위변수로 하여 Kruskall-Wallis 검정을 시행한 결과 조사군, 대조군 모두에서 근속년수에 따른 순위의 합의 평균이 년차적으로 유의하게 감소하였으나, 입사시부터 근속년수에 따른 조사군과 대조군과의 순위합의 평균에 의한 시력차 비교에서 입사시 조사군의 순위합의 평균이 유의하게 높았던 것이 근무기간에 따라 대조군의 평균이 높아지면서 통계적 유의성이 없고 대체적으로 1년 이후부터 변화가 적은 것으로 나타나 근접작업으로 인한 시력약화를 추정할 수 있었다. This study was carried out to investigate that the close distance works were associated with decreased visual acuity. 306 workers were subjects who had been recruited from 1991 to 1993 in two electronic parts manufacturing factories, and 154 workers were controls who had been employed from 1991 to 1993 in launder machine timer and general machine assembly factories. Subjects who had been employed in 1991 and 1992 were follow up from 1993 to 1995, and subjects who had been employed in 1993 were from 1994 to 1995. The male workers as well as glasses wearing workers were excluded. Only 335 female workers were followed up to study the change of visual acuity. The results were as follows; The rate of workers with visual acuity over 1.0 at recruit year in subjects group was decreased about 25-35% after 1 year, 40-60% after 2 years, 50-65% after 3 years, and 65% after 4 years. While, the rate of workers with visual acuity over 1.0 at recruit year in control group was decreased about 15-30% after 1 or 2 years, and there was no more additional visual acuity reduction after then. Kruskall-Wallis test was performed to investigate the change of visual acuity in subject and control group by work duration. The means scores of ranks in both group were significantly decreased by work duration. The mean scores of ranks in subject group at recruit year were significantly higher than those in control group at recruit year, but these differences were disappeared after 1 year work. Therefore, this suggest that close distance workers may be affected their visual acuity.

Microstructure‑Strengthening Interrelationship of an Ultrasonically Treated Hypereutectic Al–Si (A390) Alloy

Soo‑Bae Kim,Young‑Hee Cho,Jae‑Gil Jung,Woon‑Ha Yoon,Young‑Kook Lee,Jung‑Moo Lee 대한금속·재료학회 2018 METALS AND MATERIALS International Vol.24 No.6

Ultrasonic melt treatment (UST) was applied to an A390 hypereutectic Al–Si alloy in a temperature range of 750–800 °Cand its influence on the solidification structure and the consequent increase in strength was investigated. UST at such a hightemperature, which is about 100 °C above the liquidus temperature, had little effect on the grain refinement but enhanced thehomogeneity of the microstructure with the uniform distribution of constituent phases (e.g. primary Si, α-Al and intermetallics)significantly refined. With the microstructural homogeneity, quantitative analysis confirmed that UST was found tosuppress the formation of Cu-bearing phases, i.e., Q-Al5Cu2Mg8Si6, Al2Cuphases that form in the final stage of solidificationwhile notably increasing the average Cu contents in the matrix from 1.29 to 2.06 wt%. A tensile test exhibits an increasein the yield strength of the as-cast alloy from 185 to 208 MPa, which is mainly associated with the solute increment withinthe matrix. The important role of UST in the microstructure evolution during solidification is discussed and the mechanismcovering the microstructure-strengthening interrelationship of the ultrasonically treated A390 alloy is proposed.

한국인에게서 그레이브스병 약물치료의 적정기간

이형숙,이동훈,정희선,이종우,김정은,신승수,정윤석,이관우,김현만 대한내분비학회 2003 Endocrinology and metabolism Vol.18 No.1

연구배경: 그레이브스병의 치료에는 항갑상선제, 수술 및 방사성 요오드법이 선택되어 사용되고 있다. 이중 항갑상선제는 가장 많이 선호되고 있으나 낮은 관해율과 높은 재발율로 장기간 치료기간이 요구된다. 저자들은 그레이브스병 환자에게서, 선택되는 치료법의 선호도와 각 치료법의 관해율을 조사하고자 본 연구를 시행하였다. 또한 본 연구에서는 항갑선제 치료의 적정기간을 평가하고자 하였다. 방법: 아주대학교병원에 내원한 환자 중 1년 이상 추적관찰이 가능한 205명의 그레이브스병 환자를 대상으로 조사하였다. 항갑상제군, 수술군 및 방사성 요오드군은 각각 170명, 29명 그리고 6명이었다. ROC curve를 이용하여 약물치료의 예후예측인자를 분석하였다. 결과: 1) 그레이브스병 환자의 치료 방법의 선택은 항갑상선제군, 수술군 및 방사성 요오드군 각각 170명(83.0%), 29명(14.1%) 그리고 6명(2.9%)으로 항갑상선제 치료가 가장 선호되었다. 2) 그레이브스병의 관해율은 항갑상선제군, 수술군 및 방사성 요오드군에서 각각 60.0%(102/170명), 96.5%(28/29명) 그리고 83.0%(5/6명)으로 수술군이 가장 높았다. 3) ROC curve의 AUC는 치료기간과 진단시 TBII가 각각 0.709 및 0.648이었고 적절한 약물투여 추적 관찰기간은 26개월이었다. 결론: 그레이브스병의 일차 치료법으로는 항갑상선제가 선호되고 있으나 수술 및 방사성 요오드 치료군에 비해 상대적으로 낮은 관해율을 보였다. 따라서 항갑상선제 치료로 26개월 이상 관해가 되지 않을 경우에는 치료 방법의 변경을 고려하는 것이 관해율을 높이는데 도움이 될 것으로 생각된다. Background: Graves' disease in an organ specific autoimmune disease. Three kinds of therapeutic modalities (antithyroid drugs, ablation with radioactive iodine and subtotal thyroidectomy) are frequently performed for the management of this disease. The most popular therapeutic policy for the disease in Korea is antithyroid treatment. We analysed and compared the remission rates of all three modalities for Graves' disease, and evaluated the antithyroid modality to determine the correct duration of treatment. Subjects & Methods : The medical records of 205 patients with Graves' disease were reviewed. For the evaluation of the antithyroid modality medical treatment, antithyroid drugs were administered for more than 1 year. The prognostic factors associated with remission were analysed by means of an ROC curve. Results: 1) Of the 205 patients, proportions that received medical therapy, subtotal thyroidectomy and radioiodine therapy were 83.0, 14.1 and 2.9%, respectively. 2) The remission rates of the medical therapy, surgery and radioiodine therapy were 60.0, 96.5 and 83.0%, respectively. 3) The remission rate of the medical therapy was associated with the duration of medication and TBII activity. The determined proper duration for the antithyroid treatment was 26 months from the ROC curve analysis. Conclusion: The above results suggest that the proper duration of antithyroid treatment for Graves' disease is 26 months, after which time the subtotal thyroidectomy or radioiodine therapy should be considered if the disease has not remitted (J Kor Soc Endocrinol 18:24∼31, 2003).

Effect of Ultrasonic Melt Treatment on Solidification Microstructure of Al–5Ti–1B Alloy Containing Numerous Inoculant Particles

Soo‑Bae Kim,Jae‑Gil Jung,Young‑Hee Cho,Su‑Hyeon Kim,Kwangjun Euh,Jung‑Moo Lee 대한금속·재료학회 2022 METALS AND MATERIALS International Vol.28 No.7

The effect of ultrasonic melt treatment (UST) on the solidification microstructure of an Al–5Ti–1B alloy containing highvolumefractions of Al3Tiand TiB2particles is investigated for various UST times with different melt holding times. Theas-cast Al–5Ti–1B alloy is composed of TiB2and polygonal Al3Tiparticles (present prior to UST), plate-like Al3Tiparticles,and Al grains (formed during UST and/or solidification). The UST causes a size reduction and homogeneous distributionof the TiB2-agglomerated region containing many submicron-sized TiB2particles pushed to the grain boundaries. The USTslightly decreases the size and improves the distribution of polygonal Al3Tiparticles enriched in the TiB2-agglomeratedregion. Unlike the TiB2and polygonal Al3Tiparticles, which exhibit a minor refining effect, the plate-like Al3Tiparticlesshow a significant refinement with UST application. The UST has a significant effect on the size distribution of Al grains byinducing the formation of medium-sized grains at the expense of small and large grains; however, it only has a slight effecton grain refinement. The degree of microstructure modification increases with increasing UST time but decreases with meltholding time after UST. The mechanisms for the refinement and dispersion of the TiB2and Al3Tiparticles and Al grains arediscussed considering fragmentation, nucleation, and growth behaviors induced by the UST and subsequent solidification.

반복적인 실신 및 실신전환자의 기립경사 검사시 뇌혈류 변화

조수진,김준수,이광호,정진상,송희정,이상철,서정돈,이원로 대한신경과학회 1999 대한신경과학회지 Vol.17 No.3