Disaster Management and Role of Local Government: Lesson from Hull's Experience

Hyun Woong Lee(李賢雄),Hyun Jae Choi(李賢雄),Jong Eop Kim(金鍾業) 위기관리 이론과 실천 2013 Crisisonomy Vol.9 No.7

최근 들어 글로벌 기후변화와 그 영향으로 이전과는 비교하기 어려운 규모의 자연적 재난이 빈번하게 발생하고 있다. 이러한 자연적 재난의 발생에 효과적으로 대응하기 위해 정부의 계획과 대응이 필요하게 되었다. 2007년 영국은 이전에 보기 어려운 폭우로 인해 홍수 피해를 입었는데, 헐 시티(Hull City)는 그 피해가 가장 극심한 곳 중의 하나였다. 홍수 피해를 입으면서 헐 시티는 새로운 형태와 규모의 이전에 볼 수 없었던 홍수로 인한 자연적 재난에 대비하기 위한 방안을 마련하기 시작했다. 2011년 서울시도 기록적인 폭우로 인해 도시의 일부가 물에 잠기고, 산사태로 큰 피해를 입었다. 본 연구는 헐 시티와 서울시의 폭우로 인한 홍수 피해를 중심으로 지방정부의 재난관리 방안, 특히 홍수 재난 관리에 대한 방안을 도출하였다. 본 연구의 결과는 기후변화로 인해 예측하기 힘든 자연적 재난에 대한 지방정부의 역할과 대응방안에 도움을 줄 수 있을 것이다. In these times of escalating concern over global warming and its effects on weather patterns, as well as the size and frequency of natural disasters, it seems fitting to analyse and discuss how effectively governments are planning for disasters and whether they are responding to them appropriately. During the summerof 2007 the United Kingdom experienced some of the worst flooding in its history, with the city of Hull amongst the worst affected. An examination of the government handling of mitigation measures and disaster response in this instance raises comparisons to the 2011 heavy rain related flooding in Seoul, South Korea. These events are especially appropriate for comparison given the vulnerability of each city and general feeling of dissatisfaction among residents. This paper examines each event individually and presents a comparison of the actions and inactions of each local government. The result is a call for stronger and more decisive measures to combat climate change and protect vulnerable populations more efficiently against natural disasters.

성인에서 발생한 원발 간 Burkitt 림프종 1예

이승현 ( Seung Hyun Lee ),김형준 ( Hyung Joon Kim ),문장식 ( Jang Sik Mun ),오형철 ( Hyoung Chul Oh ),이현웅 ( Hyun Woong Lee ),최창환 ( Chang Hwan Choi ),김정욱 ( Jeong Wook Kim ),도재혁 ( Jae Hyuk Do ),김재규 ( Jae Gyu Kim ) 대한소화기학회 2008 대한소화기학회지 Vol.51 No.4

Burkitt 림프종은 비호지킨 림프종에 속하는 드문 질환으로 주로 소아에서 발생한다. 간은 원발 악성 림프종이 잘 발생하지 않는 장기이며 원발 간 림프종은 림프절 이외 림프종의 0.4%를 차지한다고 알려져 있다. 저자들은 B형 간염 보균자에서 발생한 항암치료에 완전 관해를 보였던 원발 간 Burkitt 림프종 1예를 경험하였기에 보고하는 바이다. 19세의 남자가 2개월간의 심한 피곤함과 내원 1일 전부터 시작된 우상복부 통증을 주소로 내원하였다. 신체검사에서 3횡지의 간비대가 촉지되었으나 림프절은 만져지지 않았고 야간발한, 발열, 체중감소는 호소하지 않았다. 혈액 검사에서 혈색소 12.4 g/dL의 경도의 빈혈을 보였으며 생화학 간기능 검사에서 AST 53 IU/L, ALT 52 IU/L였으며 ALP 192 IU/L, LDH는 437 IU/L로 증가되어 있었다. 혈청 바이러스 표지자 검사에서 HBsAg, anti-HBs, anti-HBc (IgG)이 양성이었으며 Anti-HCV, anti-HIV는 음성이었다. 암종배아항원(CEA), 알파태아단백(AFP), CA19-9은 정상범위였다. HBV DNA 정량검사는 1.3×109 copies/mL였다. 복부 및 흉부 전산화 단층촬영에서 다양한 크기의 저밀도 음영을 갖는 결절들이 간에서 관찰되었으며 간에서 가장 큰 것은 11×7 cm였고 복강 및 흉강 내 림프절 비대는 관찰되지 않았다. 자기 공명영상에서 T1영상에서 저신호강도 T2영상에서 불균일한 고신호강도를 갖는, 조영증가가 잘되지 않는 결절들이 관찰되었다. 초음파 유도하 세침간생검에서 미만으로 침윤하는 세포들이 관찰되었고, 침윤된 세포는 중간크기이며 세포질은 호염 기성이었고 거친 염색질의 핵과 호염기성이며 중간크기인 핵소체를 가지고 있었다. 면역조직화학 염색에서 백혈구 공통항원, B세포에 양성이었고, T세포에는 소수의 세포들만이 양성 반응을 보였으며, Ki-67에 95% 이상의 세포에서 양성반응을 보여 Burkitt 림프종으로 진단되었다. 흉부 CT 및 골수, 척수검사에서 전이는 관찰되지 않았다. 환자는 15회의 CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) 복합항암화학요법과 cytosine arabinoside와 methotrexate를 이용한 중추신경계 항암화학예방요법치료를 받았으며 완전 관해 후 관찰 중이다. Burkitt`s lymphoma is a rare disease that belongs to the aggressive non-Hodgkin`s lymphoma. Herein, we report a case of primary hepatic Burkitt`s lymphoma. A 19-year-old man visited the hospital for right upper quadrant pain. He felt fatigue for two months. Physical examination revealed hepatomegaly and no palpable lymph node. He had no fever, weight loss, or night sweating. Laboratory finding showed mild anemia (hemoglobin, 12.4 g/dL), mild elevated transaminase (ALT, 52 IU/L), elevated lactate dehydrogenase (LDH, 437 IU/L), and alkaline phosphatase (ALP, 129 IU/L). The viral marker was positive for HBsAg, HBeAg, anti-HBs, and anti-HBc (IgG), and negative for anti-HBe, anti-HCV, and anti-HIV. CEA, AFP, and CA19-9 levels were within normal ranges. The HBV DNA quantitation was 1.3×109 copies/ml. Abdominal-Pelvis CT scan and abdominal MRI finding were compatable with malignant lymphoma. Liver biopsy examination confirmed Burkitt`s lymphoma. No metastasis was detected in the thoracic cavity, bone marrow, and spinal fluid. The patient was treated with the combination regimen of cyclophosphamide, doxorubicin, vincristine, prednisone and high dose methotrexate. Cytosine arabinoside and methotrexate were added for CNS prophylaxis by intrathecal installation. Chemotherapy was administered every 3 weeks for fifteen cycles. Serial follow-up CT scan showed a marked decrease in the size of hepatic lesions. Follow-up CT scan and PET-CT scan were perfomed 4 weeks after the final cycle disclosed no definite residual or active lesion confirming the state of complete remission. (Korean J Gastroenterol 2008;51:259-264)

궤양성 대장염의 임상경과 진단 첫해의 임상경과에 영향을 미치는 인자 및 5 년간 임상경과의 변화 양상

최창환(Chang Hwan Choi),정혜원(Hae Won Chung),이재훈(Jae Hoon Lee),박정엽(Jeong Youp Park),이현웅(Hyun Woong Lee),박영수(Young Soo Park),김태일(Tae Il Kim),김원호(Won Ho Kim) 대한소화기학회 2001 대한소화기학회지 Vol.38 No.3

Background/Aims: Previous reports on ulcerative colitis in Korea were mostly about clinical features at the time of diagnosis. In this study, we analyzed not only clinical features of Korean patients with ulcerative colitis at the time of diagnosis, but also clinical courses during 5 years after diagnosis. Methods: The yearly sum of monthly symptom scores (annual disease burden index, ADBI), annual symptomatic period, and clinical severity were evaluated during 5 years after diagnosis, and factors affecting the clinical courses during first year were also analyzed. Results: The averages of ADBI, symptomatic period, and the proportion of patients in remission during the first follow-up year were 5.8±4.4, 4.0±3.1 months, and 22.1%, Those were 3.7±4.1, 3.0±3.4 months, and 32.4%, during the fifth year. The average of ADBI during the second year was significantly higher in patients with high ADBI (>4) during the first year compared with that in patients with low ADBI (6.3±5.5 vs. 2.6±3.8, p<0.01). Conclusions: From these results, we can conclude that the clinical course of ulcerative colitis, assessed by ADBI and symptomatic period, tends to improve with time and the preceding clinical course is significantly correlated to subsequent course. (Korean J Gastroenterol 2001;38: 169-176)

당뇨병 유무와 치료 방법에 따른 대장 선종의 빈도

김상중 ( Sang Jung Kim ),최창환 ( Chang Hwan Choi ),문홍주 ( Hong Ju Moon ),문장식 ( Jang Sik Mun ),이현웅 ( Hyun Woong Lee ),김형준 ( Hyung Joon Kim ),도재혁 ( Jae Hyuk Do ),장세경 ( Sae Kyung Chang ) 대한장연구학회 2008 Intestinal Research Vol.6 No.1

Background/Aims: Diabetes mellitus (DM) is associated with an increased incidence of colon cancer. However, the relationship between DM and colorectal adenoma is not definite. In this study, we sought to determine the association between DM and the prevalence of colorectal adenoma. Methods: We enrolled 606 patients with DM and 606 asymptomatic adults who underwent colonoscopy for routine health evaluations from June 2003 to June 2007. The frequency and characteristics of the colorectal adenomas were analyzed and compared between the two groups. Results: The sex ratio and mean age were 1.67:1 (M:F) and 58.1±10.6 years, respectively, in patients with DM, and 1.68:1 and 57.6±8.9 years, respectively, in patients without DM, and these values were similar. The frequency of colorectal adenoma was 33.2% for the patients with DM and 32.3% for the patients without DM. The frequency, location, number, size and histopathologic findings of the colorectal adenomas were not different between the two groups. Among the patients with DM, the frequency of colorectal adenoma was 35.7% in the patients treated with oral hypoglycemic agents and 31.4% in the patients treated with insulin. Also, the other characteristics of the colorectal adenomas were not different according to the treatment method. Conclusions: The frequency and characteristics of colorectal adenomas were not different between the patients with and without DM. (Intest Res 2008;6:50-55)

증례 : 소화기 ; 췌장의 파골세포양 거대세포 미분화 암종 1예

양서윤 ( Suh Yoon Yang ),도재혁 ( Jae Hyuk Do ),오인수 ( In Soo Oh ),이현웅 ( Hyun Woong Lee ),최창환 ( Chang Hwan Choi ),장세경 ( Sae Kyung Chang ),반언섭 ( Eon Sub Park ) 대한내과학회 2011 대한내과학회지 Vol.80 No.1

저자들은 상복부 불편감과 소화불량을 있는 환자에서 췌장 미부에 선암종을 동반한 파골세포양 거대세포 미분화 암종을 진단하였고, 수술적 절제 후 방사선 치료와 항암화학요법을 시행한 예를 경험하였기에 문헌고찰과 함께 보고한다. Undifferentiated carcinomas with osteoclast-like giant cells are rare pancreatic and periampullary neoplasms that mimic giant cell tumors of bone morphologically. Recently, we experienced an osteoclast-like giant cell tumor arising in the tail of the pancreas. A 76-year-old male was admitted with epigastric discomfort and indigestion. Abdominal computed tomography (CT) and abdominal magnetic resonance imaging (MRI) showed a 3×3-cm mass containing necrotic and hemorrhagic areas in the tail of the pancreas. A distal pancreatectomy and splenectomy were performed. Histological examination showed tumor cell components consisting of mononuclear pleomorphic cells admixed with osteoclastic giant cells. The final diagnosis was undifferentiated carcinoma with osteoclast-like giant cells with ductal adenocarcinoma in the pancreas. (Korean J Med 2011;80:82-86)

안검하수를 유발한 두개저 해면정맥동 전이 간세포암종 1예

김상중 ( Sang Jung Kim ),김형준 ( Hyung Joon Kim ),이현웅 ( Hyun Woong Lee ),최창환 ( Chang Hwan Choi ),김정욱 ( Jung Uk Kim ),도재혁 ( Jae Hyuk Do ),김재규 ( Jae Kyu Kim ),장세경 ( Sae Kyung Chang ) 대한소화기학회 2008 대한소화기학회지 Vol.52 No.6

The cavernous sinus of skull base is a extremely rare metastastatic site for hepatocellular carcinoma (HCC). A 51-year-old man was diagnosed with HCC by liver biopsy and palliative radiotherapy on HCC including main portal vein was performed. One month later, he was admitted due to sudden onset ptosis. Neurologic findings were normal except for abnormal movement of right eye, and it raised the possibility of abnormality in the right occulomotor, trochlear and the abducens nerves. Contrast-enhanced CT scan of brain showed a mass with homogeneous enhancement involving the right cavernous sinus. T2-weighted axial MR images demonstrated a homogeneous mass with intermediate signal intensity, and contrast-enhanced axial T1-weighted MR images demonstrated a mass with homogeneous enhancement in the right cavernous sinus. We describe a case of HCC metastasis to the cavernous sinus with symptoms of ptosis and disturbance of right eyeball movement.

최근 3년간 서울 지역 단일기관에서 급성 바이러스 간염의 원인

문장식 ( Jang Sik Mun ),김형준 ( Hyung Joon Kim ),허채 ( Chae Hue ),김상중 ( Sang Joong Kim ),문홍주 ( Hong Ju Moon ),이현웅 ( Hyun Woong Lee ),최창환 ( Chang Hwan Choi ),도재혁 ( Jae Hyuk Do ),장세경 ( Sae Kyung Chang ) 대한내과학회 2008 대한내과학회지 Vol.74 No.6

목적: 최근 급성 바이러스 간염 중 급성 A형 간염이 급격히 증가하고 있으며, 급성 E형 간염바이러스 간염도 드물지 않게 보고되고 있다. 이에 최근 3년간 단일기관에서의 급성 바이러스성 간염의 원인과 이 중 급성 A형과 E형 간염의 중복감염의 임상적 특징을 알아보고자 하였다. 방법: 2005년 1월부터 2007년 7월까지 중앙대학교병원에서 IgM anti-HAV, IgM anti-HBc, HCV RNA, IgM anti-HEV의 검사들 중 한 가지 이상에서 양성인 급성 바이러스성 간염으로 입원한 111명 환자들을 후향적으로 조사하였다. 결과: 전체 111예 중 A형 간염은 105예(94.6%), B형 간염 5예(4.5%), C형 간염 1예(0.9%)였다. 급성 A형 간염 105예 중 27예(24.3%)에서 IgM anti-HEV가 양성으로 급성 A형 및 E형 간염의 중복감염으로 확인되었고, 이중 9예(8.6%)에서 추적검사상 IgM anti-HEV가 음전되었다. 급성 A형 단독 간염(78예)과 급성 A형과 E형 간염의 중복감염(27예)의 임상양상을 비교 분석한 결과 급성 A형 단독 간염과 급성 A형 및 E형 간염의 중복감염의 평균연령(29세 vs 28세), 재원기간(12일 vs 10일), 남녀의 비(51:27 vs 14:13)는 두군 간에 차이가 없었다. 입원 당시 임상증상과 생화학적 간기능 검사 및 일반혈액소견은 두 군 간에 차이가 없었다. 두 군 모두 전격성 간부전, 사망 등의 중대한 합병증은 없었으며 8주내에 생화학적 간기능 검사가 정상화 되었다. 결론: 국내에서 최근 발생하는 급성바이러스 간염의 대부분의 원인은 A형 간염 바이러스이며, 흥미롭게도 급성 A형 간염과 E형 간염의 중복 감염 예가 관찰되었으며, 급성 A형 단독간염과 급성 A형과 E형 간염의 중복 감염에서 두 군 간의 임상 증상 및 경과에 큰 차이가 없었다. Background/Aims: Hepatitis A is increasing during the recent years in Korea, and sporadic cases of hepatitis E are not rare. We investigated the etiology of acute viral hepatitis, including 27 cases of coinfection with hepatitis A and E, during the last 3 years. Methods: Retrospective analysis of one hundred eleven patients with acute viral hepatitis at Chung-Ang University Hospital was done from January 2005 to July 2007. The patients were positive for any one of the following tests: IgM anti-HAV, IgM anti-HBc, HCV RNA and IgM anti-HEV. Results: The proportions of acute viral hepatitis A, B and C were 94.6% (105/111), 4.5% (5/111) and 0.9% (1/111), respectively. Among the patients with hepatitis A, 27 patients (24.3%) were positive for IgM anti-HEV. We analyzed 105 patients with either hepatitis A only or they had coinfection of hepatitis A and E. The mean age, the duration of the hospital stay, the mean levels of serum transaminase, bilirubin and albumin and the protrombin time were similar between the patients with hepatitis A only and those with coinfection of hepatitis A and E. All the patients were discharged without serious complication such as fulminant hepatic failure. The biochemical liver function tests were normalized in all patients within 8 weeks. Conclusions: The most common etiology of acute viral hepatitis in Koreans was the hepatitis A virus. Patients coinfected with hepatitis A and E were observed. The patients with coinfection of hepatitis A and E showed no significant difference in their clinical features and laboratory parameters, as compared to the patients with hepatitis A only.(Korean J Med 74:624-631, 2008)

만성 B 형 간염과 신장질환의 조직학적 상관관계

박영수,최창환,안상훈,송건훈,전재윤,한광협,문영명,박영년,정준원,이관식,이현웅,손주혁,정재연 대한간학회 2001 Clinical and Molecular Hepatology(대한간학회지) Vol.7 No.4

Background / Aims : The relationship between HBV infection and nephropathy has been reported with some differences according to the investigators and regions studied. Liver biopsis were not performed in most of the reports. In this study both liver and kidney biopsis were performed. The histologic correlation was analyzed between chronic B viral hepatitis and nephropathy. Methods : From January 1985 ro june and hebaturia. Also, a new histopathologic calssification of chronic hepatitis was applied in the assessment of liver disease. Results : Light microscopy of kidneys showed IgA nephropathy in 7 cases(27%) ; minimal change nephrotic syndrome(MCNS) in 1 case (3.8%); and membranous glomerulonephritis(MGN) in 9 cases(34.6%), membranoproliferative glomerulonephritis (MPGN) in 9 cases (34.6%). Among the cases with a higher hepatitis activity index and fibrosis score, the frequency of MGN and MPGN was higher. The hepatitis activity index of cases with MGN was significantly higher than IgA nephropathy and MPGN (p=0.011, p=0.039). The fibrosis score of cases with MGN and MPGN was significantly higher than IgA nephropathy (p=0.011, p=0.003). The positivity of HBeAg was highest in cases with MGN.Serum C3 level was low in all cases but the serum C4 level was within normal range. Immunofluorescence studies showed granular deposition of Ig G and C3 in the capillary loops in MGN. Conclusion : The frequency of MGN and MPGN was higher when the liver disease was more severe. It was suggested that HBeAg, IgG AND C3 might ci\ontribute to the pathogenesis of MGN in HBsAg positive patients.

한국인에서 간세포암종 발생의 위험요인 및 개인별 간세포암종 발생 예측모형

박영수,송기준,최창환,안상훈,김동기,전재윤,한광협,문영명,백용한,이현웅,정재연 대한간학회 2001 Clinical and Molecular Hepatology(대한간학회지) Vol.7 No.4

Background / Aim : We identified risk factors for hepatocellular carcinoma(HCC)through a nine-year follow-up study, ending last year, of 4,339 patients with chronic liver disease. The aim of this study was to establish an individual prediction model according to risk factors for the development of HCC. Methods : We studied a total of 1994 patients who had regular check-ups from January 1990 to December 1998. We analyzed the risk factors and established the individual prediction model to predict the risk rate for HCC using logistic regression analysis. We applied the model to patients who were enrolled over the next two years. Results : 90(9.05%) out of 994 patients developed HCC during a mean of 33 months of follow-up. The risk index for individual patients was made by considering the relative risk level of statistically significant risk factors. From 1999 to 2000, 480 patients were newly enrolled and divided into a low risk group(less than 5% probability), an intermediate risk group(5% to 10% probability), and a high risk group(more than 10% probability). According to this classification, 1 of 191 patients in the low risk group(0.523%), 5 of 176 patients intermediate risk group(2.84%), and 21 of 113 patients in the high risk group(18.6%) were diagnosed with HCC. Conclusion : We confirmed the reliability of the newly established individual prediction model for the screening of HCC. This model may help screening programs to be done effectively by focusing on high risk groups for HCC.

발병 연령에 따른 궤양성 대장염의 임상적 특성

정혜원,김원호,최창환,한창훈,이재훈,서정훈,이충렬,이현웅 대한소화기학회 2001 대한소화기학회지 Vol.37 No.3

Background/Aims: Ulcerative colitis (UC) exhibits a bimodality in age-specific incidence rates, with a first peak in the young age and a second peak in the old age. We attempted to determine whether UC actually behaves differently in the elderly compared with the young. Methods: Patients with UC were divided into two groups (early vs. late onset) by the onset age of 40. Results: Incidence rate reached a peak in the forth decade in female patients, whereas it showed a bimodal age distribution with a first peak in the third decade and a second peak in fifth decade in male patients. Symptom duration before diagnosis was longer in the patients with late-onset UC than in the patients with early-onset UC (p value$lt;0.05). There were no significant differences in the extent of lesion, the positive rate of serum anti-neutrophil cytoplasmic antibody, the disease activity, the frequency of admission, the use of steroid, and concern about the disease between the patients with early and late-onset UC. Conclusions: Age and sex distribution in this study were similar to those in other countries, and a bimodal age distribution was noted in males. The late-onset patients had longer duration from the onset of symptoms to diagnosis than the early-onset patients. However, there was no significant difference in clinical characteristics between the patients with early-onset UC and the patients with late-onset UC.