산림자원 및 산림의 공익기능량 추정을 위한 시스템다이내믹스 모형 개발

조윤숙 ( Yoon Sook Cho ) 한국시스템다이내믹스학회 2014 한국시스템다이내믹스 연구 Vol.15 No.3

The purpose of this paper is to develop a System Dynamics model for estimating the volume of forest resources in the future and simulating the volume of function of public benefit linked to forest resources in dynamic manner. Also it is to analyze the impact when the volume of forest land conversion is controlled by policy using the SD model. The analysis was done at nation-wide for the simulation period 2000 to 2040. Estimated forest area was 6.2 million ha and estimated growing stock was 4.7 billion m3 in 2040 from the future forecast without policies. Changing of forest resources, 13.9 billion tons of forest-ground-water storage was estimated, 1.8 million m3 of erosion control of forest was estimated and 377 million tons of CO2 absorption was estimated. As a result of simulation with two alternatives, forest area was less reduced and growing stock was bigger than do nothing policy. Also, function of public benefit reflected by changes of forest resources was enhanced. This study contributes to estimate the quantitatively measured volume of forest resources and function of public benefit over the 30 years in Korean forest land in scientific way. Using this SD model, decision maker would develop forest land policies more delicately for deserving forest resources and increasing the volume of function of public.

에페리손에 의한 즉시형 과민반응 증례 보고

강동윤 ( Dong Yoon Kang ),이진 ( Jin Lee ),손경희 ( Kyoung-hee Sohn ),강성윤 ( Sung Yoon Kang ),조윤숙 ( Yoon Sook Cho ),강혜련 ( Hye-ryun Kang ) 대한천식알레르기학회(구 대한알레르기학회) 2017 Allergy Asthma & Respiratory Disease Vol.5 No.4

Eperisone is a widely used muscle relaxant and believed to be relatively free of adverse drug reactions. However, a rare case of fatal anaphylaxis has been reported in the literature. Poor awareness due to its rarity and combined administration with other drugs are the major hurdles in diagnosing eperisone-induced anaphylaxis. We experienced 3 cases of immediate hypersensitivity reaction occurring after eperisone administration. Case 1, a 63-year-old female, was admitted via the Emergency Department with urticaria, generalized erythroderma, sore throat, chest discomfort, and dyspnea within 1 hour after administration of common cold remedy. Case 2, a 58-year-old male, visited our allergy clinic to detect culprit drugs. He experienced itching, urticaria, hypotension for several hours after administration of the pills for back pain in the last 3 years. Case 3, a 58-year-old male developed urticaria and dyspnea after administration of medication for a headache. He also experienced urticaria and facial edema after administration of the common cold remedy. Among the medications, eperisone hydrochloride was proven as the culprit drug and others were excluded through oral provocation tests. We advised them to avoid eperisone and issued drug safety card. Clinicians should be aware that eperisone hydrochloride is a potential culprit agent of fatal anaphylaxis. (Allergy Asthma Respir Dis 2017;5:228-231)

Laparoscopic Cholecystectomy 수술 후 Sugammadex와 Neostigmine 간에 첫 자발호흡과 부작용 발현 연구

박현숙,박문수,김민정,김귀숙,조윤숙,배성심,이정연,Park, HyunSuk,Park, Moon Soo,Kim, Min Jung,Kim, Kwi Suk,Cho, Yoon Sook,Bae, Seng Sim,Rhie, Sandy Jeong 한국임상약학회 2018 한국임상약학회지 Vol.28 No.2

Objective: The purpose of the study was to investigate the time from the injection of muscle relaxants to the first spontaneous respiration between sugammadex and conventional reversal for patients undergoing laparoscopic cholecystectomy. Methods: This study was retrospectively conducted on patients who were diagnosed with gallbladder stone (N802) between January 2014 and April 2017. The data were collected from the electronic medical records of a total of 186 patients (84 patients in the neostigmine group and 102 patients in the sugammadex group). Results: The time required for the first spontaneous respiration in the sugammadex group was shorter than that in the neostigmine group (3.6 min vs 4.9 min; p<0.05). After the injection of intermediate muscle relaxants, the comparison of heart rate and mean arterial pressure in the sugammadex and neostigmine groups revealed that the heart rate in the neostigmine group was higher than in the sugammadex group after 5 min (p<0.05). The mean arterial pressure in the neostigmine group was higher than in the sugammadex group after 10 min (p<0.05). A significant adverse effect of tachycardia was observed in the neostigmine group (p<0.05), but the frequency of rescue antiemetic in the sugammadex group was significantly higher than in the neostigmine group (p<0.05). Conclusion: In this study, the unwanted effect of neostigmine group was tachycardia; therefore, in the case of patients with hemodynamic instability, sugammadex is recommended. At 12 hours after the injection of sugammadex to patients, more antiemetics were required than in the neostigmine group; therefore, more research should be conducted on postoperative nausea and vomiting.

십이지장궤양 환자에서 Helicobacer pylori 의 박멸이 궤양 재발에 미치는 영향에 관한 연구

김나영(Na Young Kim),윤여학(Yeo Hak Yoon),조윤숙(Yun Suk Cho),채봉남(Bong Nam Chae),최진용(Chin Yong Choi),이계희(Kye Heui Lee),손인(In Son),박성훈(Sung Hoon Park),구명숙(Myoung Sook Koo),최신은(Shin Eun Choi) 대한내과학회 1993 대한내과학회지 Vol.45 No.3

N/A Background: The recurrence rate of duodenal ulcer (DU) within 12 months after treatment is 70~90%. Since the identification of Helicobacter pylori (H. pylori) which has been confirmed to be the major causal agent of chronic antral gastritis, the close linkage between the chronic antral gastritis and DU, and the presence of H. pylori in the stomach of more than 90% of patients with DV have stimulated studies on the use of anti-H. pylori antimicrobial agents in DU. However, the definition of eradication related with the time at which assessment is made after the completion of therapy has not been unified, and moreover, there is no general agreement on how H. pylori should be eradicated. Methods: This study was performed for 190 DU patients and four different methods -culture, Gram stain of touch print, H&E stain, mucosal urease test-were taken for H. pylori test just before treating to identify the infection rate of H. pylori in DU patients, immediately after each 6 week ulcer therapy to assess the negative conversion rate of H. pylori, and 4 weeks later after the completion of ulcer therapy to find the eradication rate of H. pylori in each treatment group (cimetidine, omeprazole, colloidal bismuth subcitrate (CBS), CBS and metronidazole double therapy, CBS, metronidazole and amoxicillin triple therapy). To detect DU recurrence, the gastroscopy was performed at 6, 12 and 18 months after therapy. Results : 1) The infection rate of H. pylori in DU patients in Korea was 94.2%. 2) The negative conversion rate of U. pylori immediately after the therapy in cimetidine group was 0%, and that of omeprazole group was 16.7% but one half of the negative converted cases was converted to be positive 4 weeks later after the completion of therapy, so the eradication rate was 8.3%. In CBS group, the negative conversion rate was 33.3% but in all of these patients H. pylori convereted to be positive, so the eradication rate was 0%. In double therapy group, the negative conversion rate was 81.0% but 61.5% of these patients persisted to be negative 4 weeks later after therapy, so the eradication rate was 47.1% which is higher than that of cimetidine, of omeprazole, of CBS group. In triple therapy group, the negative conversion rate of H. pylori was 96.7%, and 92% of these patients persisted to be negative, so the eradication rate was 88.5%, which is higher than that of double therapy group. 3) The DU recurrence rate of cimetidine group was 63.6% in 1 year and 81.8% in 18 months later, respectively, and in omeprazole group that was 58.3% both in 1 year and 18 months later. In CBS group, that was 33.3% in 1 year and 44.4% in 1H months later. In double therapy group, that was 12.5% in 1 year and 18.8% in 18 months later, respectively. In triple therapy group, that was both 3.8% in 1 year and 18 months later. 4) When all of these patients were classified into two groups according to the eradication of H. pylori, the recurrence rate was 0% in the 32 patients with H. pylori eradicated, and that WBS 57.1% (24 patients) in the 42 patients with H. pylori not eradicated. Conclusion : From these results, we can conclude that in order to evaluate the eradication of H. pylori, it is more precise to assess the H. pylori 4 weeks later after the completion of therapy than immediately after the therapy, and the eradication of H. pylori in DU patients reduces the recurrence of DU.

십이지장궤양 치료방법에 따른 Helicobacter pylori의 박멸에 관한 연구

최진용(Jin Yong Choi),김나영(Na Young Kim),윤여학(Yeo Hak Yoon),조윤숙(Yun Sook Cho),채봉남(Bong Nam Chae),이계희(Kye Heui Lee) 대한소화기학회 1994 대한소화기학회지 Vol.26 No.1

N/A The recurrence rate of duodenal ulcer(DU) within 12 months after treatment has been re- duced to 0-27% with eradication of Helicobacter pylori(H. pylori) from 50-90% without eradi- cation. This study was conducted to find the ideal method of treatment in the aspects of erad- ication of H. pylori, symptom reduction, and side effect among the three treatment methods. This study was performed for 73 patients with DU, and four different methods, for identifying H. Pylori infection-Gram stain of touch print, culture, H&E stain, CLO test-were taken just be- fore treatment and taken 4 weeks later after the completion of ulcer therapy to find the eradi- cation rate of H. pylori in three treatment groups. The first treatment group consisted of col- loidal bismuth subcitrate(CBS) 240mg twice a day, metronidazole 250mg thrice, and amoxicillin 500mg thrice for 6 weeks(Group I, n=28), the second group omeprazole 20mg once a day for 6 weeks and amoxicillin 500mg thrice for the first two weeks(Group II, n=l3), and the third group ranitidine 150mg twice a day or omeprazole 20mg once for 4 weeks and thereafter CBS 120mg four times a day, metronidazole 500mg thrice and amoxicillin 500mg four times for 2 weeks(Group III, n=32). The degree of symptom reduction and frequency of side effect in each treatment group were evaluated during the treatment period. The eradication rate of H. pylori was 89.3% in Group I, 23.1% in Group II, and 87.5% in Group Ill, In Group I, more than 50% of symptom reduction within 1 week was 55.6%, within 2 weeks 22.2% and after 2 weeks 22.2%; in Group II, more than 50% of symptom reduction within 1 week was 100%; in Group III, the same rate of reduction within 1 week was 96.6% and within 2 weeks 3.4%. The frequency of side effect in Group I was 21.2% including 5 patients (15.2%) in whom the medication could not be completed due to major side effect; the frequen- cy of side effect in Group II was 0%; that in Group lIl was 21.9/, in all of whom the side effect was minor so the medication could be completed. From these results, we concluded that in the aspect of eradication of H. pylori, the triple therapies for 6 or 2 weeks(Group I and Ill) are better than omeprazole and amoxicillin therapy(Group II), and in the aspect of symptom reduction, the triple therapy for 2 weeks after ranitidine or omeprazole for 4 weeks(Group Ill) is better than the triple therapy for 6 weeks (Grup I ). (Korean J Gastroenterol 1994; 26: 47 55)

정맥영양의 조제와 감염관리

최지형 ( Ji Hyeong Choe ),백진희 ( Jin Hee Baek ),조윤희 ( Yun Hee Jo ),조윤숙 ( Yoon Sook Cho ) 한국정맥경장영양학회 2018 한국정맥경장영양학회지 Vol.10 No.2

Recently, in Korea, the importance of preparation and use of injectable drugs has been emphasized due to successive fatal accidents caused by injection infections. Parenteral nutrition (PN) has also been identified as a cause of infection. Cases of infection due to PN have been reported not only in Korea, but also abroad, and contamination occurs mainly during the preparation of PN. Because sterile preparation and compounding of injections are very important for infection control and patient safety, this article reviews the major guidelines outlined thus far. The Korea Ministry of Food and Drug Safety in 2006 published guidelines and the KSHP (Korean Society of Health-System Pharmacists) recently issued guidelines for the aseptic preparation of injections. In addition, as US guidelines, the ASHP (American Society of Health-System Pharmacists) guidelines and United States Pharmacopeia (USP) <797> are also reviewed. The recent guidelines published by the KSHP have significance in that they were adopted in accordance with the domestic reality, even though they conform to foreign guidelines, and are expected to be guidelines for hospital pharmacists performing aseptic preparation work. In addition, the Korea Ministry of Health and Welfare is considering appropriate guidelines for the safe management of medications, training staff for infection prevention and strengthening staff capacity. Furthermore, the gradual expansion of aseptic compounding facilities and human resources, as well as the provision of adequate medical costs are also considered. Based on the establishment and standardization of injectable drugs compounding guidelines for Korean hospitals, it is believed that if human resources and facilities are supported and medical charges are improved, it will be possible to expect the safer preparation and use of injections.

고음이온차 대사성산증에서 요 삼투질농도차와 요증 암모늄 배설의 상관성 ; 요 음이온차와 비교

정용영(Yong Young Jung),한성우(Sung Woo Han),박민숙(Min Sook Park),김권수(Gwan Soo Kim),김근호(Gheun Ho Kim),조윤숙(Yoon Sook Cho),주권욱(Kwon Wook Joo),한진석(Jin Suk Han),김성권(Suhng Gwon Kim),이정상(Jung Sang Lee) 대한내과학회 1997 대한내과학회지 Vol.53 No.1

N/A Objectives: Urine anion gap(UAG) and urine osmolal gap(UOG) were proposed as indirect measures of urine ammonium(NF4+). While the former is known to have its usefulness limited to hyperchloremic metabolic acidosis, the latter is reported to have its correlation with urine NE4+ in ketoacidosis. This study was undertaken to evaluate the correlation of urine NH with IJOG in high anion gap metabolic acidosis(AGMA) and to compare it with UAG. Methods: We measured urine NH' by enzymatic determination, UOG(=0.5×[urine osmolality-{2×(Na++K+)+urea+glucose)]), and UAG(=Na++K+-Cl-) in 18 patients(serum AG=24.4±1.6mmol/L ) with AGMA. Results: When they were grouped into those with acute disorders(n=11) and those with chronic disorder(n=7), urine Nk4+ concentration was higher (p<0.05) in the acute(35.6±7.7mmol/L) than in the chronic(3.8±0.9mmol/L) group. The UOG was higher (p<0.05) in the acute(73.2±18.9mmol/L) than in the chronic(6.3±8.7mmol/L) group, but the UAG had no difference between the two groups. When both groups of the patients were considered together, urine NH concentration correlated with the UOG (r=0.90, p<0.01), but not with the UAG. While the patients with lower urine NH4+ excretion(<30mmol/d) had the UOG<40mmol/L, those with higher urine NH' excretion(>40mmol/d) had the UOG>40mmol/L. Conclusion: In contrast to the UAG, the UOG has a significant correlation with urine NH4+ in AGMA.

극소 저출생 체중아에서 SMOFlipid의 투여가 미숙아 질환 예방에 미치는 영향: Cholestasis 예방 중심으로

김문진 ( Moon Jin Kim ),배혜정 ( Hye Jung Bae ),조윤숙 ( Yoon Sook Cho ),김귀숙 ( Kwi Suk Kim ),김향숙 ( Hyang Suk Kim ),이혜숙 ( Hye Suk Lee ),이주영 ( Ju Young Lee ),김이경 ( Ee Kyung Kim ),김한석 ( Han Suk Kim ) 한국정맥경장영양학회 2013 한국정맥경장영양학회지 Vol.5 No.2

Purpose: Very low birth weight infants (VLBWI) are found to have a higher incidence of cholestasis due to long-term total parenteral nutrition (TPN). Although there have been some studies on relationships between omega-3 fatty acids and reduced incidence of cholestasis, the advantages that the fatty acids provide for premature infant diseases have not yet been fully understood. The aim of this study was to evaluate the advantages of SMOFlipid, a lipid emulsion product that contains omega-3 over other lipid emulsion products that do not. Methods: The medical records of 182 newborn (127 boys and 55 girls) were reviewed retrospectively between April 2010 and August 2012. These infants were born with a birth weight of <1,500 g and administered either of lipid emulsions (Intra MCT 20% or SMOFlipid) from birth to a full-feeding condition at our neonatal intensive care unit. Cholestasis is defined as serum direct bilirubin (DB) >1.0 mg/dL when total bilirubin (TB) is <5 mg/dL or DB/TB ratio is >20% when TB >5 mg/dL. Results: The incidence of cholestasis was found to be lower in the SMOFlipid group than in the medium-chain triglyceride/long chain triglyceride (MCT/LCT) group (7.3% [4/55] versus 18.9% [24/127], P=0.046). At the start of lipid emulsion administration (day 0), the baseline bilirubin level showed no significant difference between the two groups. However, the maximum value of DB on days 7∼ 14 was lower in the SMOFlipid group than in the MCT/ LCT group (0.8 [0.3∼2.2] versus 1.1 [0.3∼2.8] mg/dL, P= 0.030). The DB/TB ratio was also lower in the SMOFlipid group than in the MCT/LCT group (10.2% [4.9%∼40.0%] versus 24.1% [5.1%∼62.5%], P=0.002). Conclusion: This study concluded that SMOFlipid was effective in the prevention of cholestasis in VLBWI. Therefore, omega-3-containing lipid emulsion can be highly recommended in premature babies, especially in VLBWI who require TPN support. (JKSPEN 2013;5(2):67-75)

약물이상반응 감시 현황: 단일기관 10년 자료 분석

박수빈 ( Soo Been Park ),문미라 ( Mira Moon ),김현화 ( Hyun Hwa Kim ),박가윤 ( Ga-Yoon Park ),강동윤 ( Dong Yoon Kang ),이주연 ( Ju-yeun Lee ),조윤숙 ( Yoon Sook Cho ),강혜련 ( Hye-ryun Kang ),조상헌 ( Sang-heon Cho ) 대한내과학회 2021 대한내과학회지 Vol.96 No.4

목적: 의약품의 적절한 사용에도 불구하고 약물이상반응(ADR)은 발생할 수 있으며, 이는 환자의 안전과 직접적으로 관련된 문제를 야기할 수 있다. 이 연구의 목적은 단일 3차 의료기관에서 약물이상반응과 중대한 이상사례의 특성을 분석하는 것이다. 방법: 서울대학교병원 약물안전센터에 2010년 1월 1일부터 2019년 12월 31일까지 보고된 약물이상반응 평가자료를 분석하였다. 약물 사용과 이상사례 발생의 인과성은 세계보건기구 웁살라 모니터링센터(World Health Organization-Uppsala Monitoring Centre, WHO-UMC) 인과성 평가 기준을 기반하여 확실함(certain), 가능성 높음(probable), 가능성 있음(possible)으로 평가된 사례들만 분석에 포함하였다. 연령, 성별, 증상 발생 시기, 중증도 및 위중도 그리고 약물이상반응, 중대한 이상사례의 신체기관계 분류가 분석되었다. 결과: 연구 기간 동안 총 49,955건의 약물이상반응 평가지가 가능성 있음, 가능성 높음, 확실함으로 평가되었다. 위장관계 증상(25.9%)은 전체 보고 건수에 비해 중증(2.6%)의 비율이 낮았던 반면, 혈액학적 질환(6.6%)은 중증(39.2%)의 비율이 상대적으로 높았다. 약물이상반응 중 10.2%가 중대한 이상사례로 평가되었으며, 양 극단의 연령대에서 중대한 이상사례의 비율이 높았다. 신체기관계 분류로 분류하였을 때는 전신 질환이 가장 많이 보고되었으며 그 뒤로 피부와 부속기관 장애가 많았다. 항암제와 항생제가 중대한 유해사례의 의심약제로 가장 많이 보고되었다. 아나필락시스 반응이 가장 흔한 중대한 이상사례였다(6.5%). 결론: 중대한 이상사례의 비율은 신체기관계 분류와 약제 별로 다르게 나타났다. 양 극단의 연령대에서 중대한 유해사례의 비율이 높았으므로 어린이와 노인에서는 잠재적인 중대한 유해사례가 발생할 가능성이 있어 세심한 주의가 필요하다. Background/Aims: Despite proper use of pharmaceuticals, adverse drug reactions (ADRs) can lead to problems related to patient safety. We analyzed the characteristics of ADRs, particularly serious adverse events (SAEs), in a single tertiary medical institution. Methods: Spontaneous ADR report data collected from 2010 to 2019 in Seoul National University Hospital were assessed. Causality was evaluated according to the World Health Organization-Uppsala Monitoring Centre criteria. Age, sex, onset, severity, seriousness, and system organ class (SOC) of ADRs and SAEs were analyzed. Results: During the study period, a total of 49,955 individual case safety reports were assessed as possible, probable, or certain. Although the number of gastrointestinal ADR reports was high (25.9%), severe cases were uncommon (2.6%). By contrast, the number of hematologic disorders was low (6.6%) but 39.2% of them were severe. Among ADRs, 10.2% were assessed as SAEs, the proportion of which was high at extreme ages and in males. Body as a whole-general disorders were the most frequently reported SOC for SAEs, followed by skin and appendage disorders. Antineoplastic agents and antibiotics were the most common causative agents of SAEs and ADRs. Anaphylactic reaction was the most frequent SAE (6.5%). Conclusions: The proportion of SAE differs according to SOC and drug. Attention should be paid to SAEs in children and older adults because the rate of SAEs is significantly higher at extreme ages. (Korean J Med 2021;96:341-351)

약물유해반응 이후 처방의 변경 유형과 치료 결과: Lamotrigine 관련 사례 분석

강정은 ( Jeong Eun Kang ),이경훈 ( Kyeong Hun Lee ),서비취 ( Bi Chwi Seo ),임정미 ( Jung Mi Lim ),서성연 ( Sung Yeon Suh ),조윤숙 ( Yoon Sook Cho ),서동인 ( Dong In Suh ) 대한천식알레르기학회 2023 Allergy Asthma & Respiratory Disease Vol.11 No.2

Purpose: This study aimed to describe the desperate situation where the clinician should make decisions to further manage patients having experienced adverse drug reaction (ADR) to lamotrigine that is indicated to not easily controlled neuropsychiatric diseases. Methods: A descriptive analysis was done by thoroughly reviewing medical records of patients who were reported to have ADR to lamotrigine in a regional drug-safety center between 2010 and 2018. Results: Eighty-four cases of lamotrigine-related ADRs occurred in 80 patients. Skin lesions were most commonly observed in 70 cases (83.3%) and 14 cases (16.7%) had severe ADRs. Sixty-three subjects (78.8%) discontinued lamotrigine, while 17 (21.3%) continued it. At the time of discontinuation, 30.0% were prescribed aromatic antiepileptic drugs. Among 4 subjects who were eventually prescribed lamotrigine again after a period of discontinuation, 3 (75.0%) experienced its recurrence. Among patients who had taken alternative medications, the incidence of ADRs was higher in those being prescribed aromatic antiepileptic drugs than in the others being prescribed other than aromatic antiepileptic drugs (P=0.013). Regarding the control of underlying diseases, as many as 65 (86.7%) and 68 (90.7%) failed to reach maintaining the resolved state from 6 months and 12 months after the substitution, respectively. Conclusion: Patients can be easily trapped between the recurrence of ADRs and the treatment failure to a certain drug like lamotrigine, in which we can hardly find a reasonable alternative to manage them. (Allergy Asthma Respir Dis 2023;11:72-76)