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.

상황의 모호성에 따른 표적인물에 대한 책임부여

고재홍,장정희 慶南大學校 人文科學硏究所 1993 人文論叢 Vol.5 No.-

공황장애의 임상적 특성

고은정,최영희,박기환,이정흠 대한생물치료정신의학회 2000 생물치료정신의학 Vol.6 No.2

Objectives : To clarify clinical features of panic disorder and to compare the characteristics of cognitive patterns, avoidance behaviors, and coping strategies among patients who have panic disorder with or without agoraphobia. Methods : Family backgrounds, cognitive patterns in the first panic attack, coping strategies, and avoidance behaviors were compared among the three groups classified by panic patients with mild agoraphobia(mild PDA=66), severe agoraphobia(severe PDA=71), and without agoraphobia(PD=21) Results : 1) Severe PDA reported significantly high panic attack frequency and more dysfunctional level than PD. 2) Catastrophic thinking of 'dying' in PD was significantly frequent than the other groups. Other fears of 'going craze or loss of control' in severe PDA were the highest among the three groups, though it was not significant. Specific thinking process or interpretation in the first panic attack was not significantly different among the three groups. 3) As avoidance behaviors became worse, the frequency of avoidance behaviors and the patters of avoidance behaviors increased. Conclusions : The results suggested that as avoidance behaviors became worse, the frequency of panic, maladaptive functioning and the patterns of avoidance behaviors increase. This might be why we need to decrease avoidance behaviors through exposure as the treatment.

폐결핵 환자 혈청에서 수용성 Interleukin 2 수용체 및 Adenosine Deaminase 활성도에 관한 연구

고정희,박성규,백상현,박찬권,박병수,안진영,최우석,박정규 충남대학교 의과대학 지역사회의학연구소 1993 충남의대잡지 Vol.20 No.1

Interleukin-2 (IL-2) induces T cell proliferation in an autocrine manner and provides a means by which antigen triggered T cells can be clonally expanded in vitro. During the following activation, the activity of IL-2 is mediated by specific high affinity IL-2 binding membrane receptors which are expressed shortly after activation. In this process, a 42 KD-fragment (soluble IL-2R) is continuously cleaved off and circulates as a soluble marker of T lymphocyte activation. Elevated level of soluble IL-2R has been identified in the serum of patients with malignant autoimmune and allergic disorders, systemic parasitic infection, undergoing graft versus host disease, acute or chronic lymphocytic leukemia and HIV-infection. ADA (adenosine deaminase) completes the process of differentiation of T cell and is essential for progression of T cell maturation. Therefore level of ADA is to correlated with magnitude of T cell immune response. The fact that expression of sIL-2R and ADA activity increases in peripheral blood T-lymphocytes of patients with active pulmonary tuberculosis suggests that T cell activation might have a major role in the pathogenesis of pulmonary tuberculosis. In order to evaluate the T cell immune response in pulmonary tuberculosis, we measured the serum concentration of sIL-2R and ADA activity in 17 patients with current pulmonary tuberculosis, 10 chronic inactive pulmonary tuberculosis, 10 as normal controls. (1) Current pulmonary tuberculosis had significantly higher levels of sIL-2R (237.24±95.47)when compared with those of inactive tuberculosis (78.6±11.06). and the control (68.17±15.4) group. (2) ADA activity in current pulmonary tuberculosis was significantly increased (34.41±20.63) when compared with those of inactive tuberculosis (24.7±14.36) and control (17.65± 5.94) group. (3) There was good correlation between sIL-2R concentration and ADA activity in serum in current pulmonary tuberculosis group. (4) sIL-2R concentration and ADA activity was decreased significantly 6 months after anti-tuberculosis drug medication. In conclusion, sIL-2R concentration and ADA activity in serum in current pulmonary tuberculosis group was increased when compared with those of inactive pulmonary tuberculosis and the control group. By the way, T cell mediated immune response was enhanced in current pulmonary tuberculosis, but in inactive chronic pulmonary tuberculosis who had treated by antituberculosis drug medication, the concentration of sIL-2R and ADA activity was nearly normal.

패션산업의 신속대응(Quick Response)시스템 도입현황 및 도입사례에 관한 연구

강희정,고은주 창원대학교 생활과학연구소 1997 생활과학연구 Vol.- No.1

Environmental changes (e.g., threat of imports, rivalry among existing competitiors) have increased the difficulties in operating an apparel business. To manage the environmental changes, Quick Response System (QRS) has been proposed. QRS is defined as a business strategy to speed up the information and product between business partners for maximizing consumer satisfaction by information technologies(e.g., EDI, Bar code) and partnership (Ko, 96, VICS, 1989). The purpose of this study are to review the current development of QRS(i.e., background, concepts, benefits, adoption problems), to analyze two cases (in Japan and Korean), and to suggest the future directions for the new adopters of QRS. The information from this study can be used when apparel companies do strategic planning and evaluate the adoption of QRS. Informed decision are critical when companies do make a decision for the best choice.

뇌실외 배액술 관리에 대한 이해 및 업무수행 실태

김정숙,윤미선,송소이,이지은,문경선,고지운,임분남,김경희,박경숙 중앙대학교 간호과학연구소 2001 중앙간호논문집 Vol.5 No.2

The objective of this study was to investigate the managing realities of EVD and provide a descriptive survey with the attempt to obtain basic data needed for the standardization of EVD management. For that purpose, 220 questionnaire copies were distributed to those nurses who were working with intensive care units at university hospitals, general hospitals, semi-general hospitals in Seoul, Kyongki-de and local areas. Of 158 returned questionnaire copies, 139 were used for analysis. Data were collected during the term of academic seminars of Neurosurgery Nursing Committee and KICA (Korea Intensive Care Association), ranging from Oct. 26 through 27. 2000. The tools utilized a structured questionnaire form consisting of 21 questions on general characteristics, the level of understanding, the level of work performance, standard management guidelines, etc. The data collected were analysed with frequency, percentage, mean vague, chi -square test using the SPSS 10.0 program Findings were revealed, as follows: For managing the prevention of EVD infection, aseptic technique was found to be of the most importance (48.9%),'the technique should be carried out at an operation room'(92.8%), but it was actually performed at intensive care units (over 51.5%). 'The term of antibiotics use should be less than 7 days' (81.8%), while it was actually executed for less than 7 days (49.5%). 'The proper time of quittance from it should be within less than 7 days'(74.1%) but actual quittance was executed only by 51.1%. 'Set exchange is needed' by 54.0% but actual exchange was implemented merely by 28.1%. 'The subject of management should be nurses' was reflected by 40% but actually 52.0% were carried out. As a result of hating analysed the understanding of the management of EVD by general characteristics, a significant difference was found in the necessity for set exchange by hospitals, in the time of quittance of a catheter, and in ablution items by work experience. The result of hating analysed the work performance levels of EVD management by general characteristics revealed that a significant difference in administration facilities of medicine by the classification of hospitals, especially the use of antibiotics and the quitting time of a catheter by the classification of intensive care units, and in the use of antibiotics and ablution items by the standard management guidelines.

H-形鋼 斷面性向을 考廬한 트러스 構造物의 퍼지 最適化

柳熙仲,高七順 호남대학교산업기술연구소 1997 산업기술연구논문집 Vol.4 No.-

본 연구는 H-형강 단면성향을 고려하여 중량의 목적함수 그리고 불확실성을 포함한 제약조건을 갖는 강 프러스 구조물을 퍼지이론에 의해 최적설계를 하는 데 목적을 두고 있다. 구조적 설계는 공학의사결정의 문제 중 하나로서 여러 가지 불확실성이 내포되어야 한다. 그러므로 본 연구에서는 인간의 주관적인 판단에 기인하여 애매함과 모호함에 대해 취급하는데 유용한 퍼지이론을 도입하여, 불확실성이 포함된 최적설계를 시도하였다. 트러스 구조물의 최적화 문제는 부재의 단면적을 설계변수로 하는 목적함수와 퍼지정보가 포함된 제약조건식으로 형성되며, 퍼지집합을 이용하여 제약조건이 변화함에 따라 허용방향기법에 의해 여러 가지 최적 목적함수가 얻어진다. 본 연구에서는 H-형강 제품의 단면성향을 고려하여 2부재, 7부재의 트러스 구조물에 적용하여 본 결과, 본 연구의 알고리즘은 적용성, 타당성 및 효율성이 있다고 판단된다. This study aims at the optimum disign of the steel truss structures having the objective function of weight and the constraint which inclueds uncertainties considering the sectional properties of H shape steel products using fuzzy theory. Structural design is one of engineering decision making problems that it necessarily includes various kinds of uncertainties. The fuzzy theory is useful in dealing with vagueness and ambiguities concerned with subjective judgement of human beings, therefore the optimization of the section area of truss structure has been tested in this study by fuzzy optimization method. The optimizing problems of truss structures are formulated with the objective function and with the constraints containing fuzzy information which has the section areas of member as the design variables. According to chaining constraint conditions linearly with fuzzy set, various optimum object functions will be obtained by feasible direction method. This study was applied practically to truss structure of the 2-member 7-member considering the sectional properties of H shape steel products and it was judged that the algorithm of this research was for the applicability, propriety and efficiency.

2-Acetylaminofluorene으로 유발된 실험적 간암의 TGF-a 및 EGF발혈에 관한 연구

박정희,고영혜,이중달 한양대학교 의과대학 1995 한양의대 학술지 Vol.15 No.2

Transforming growth factor-α(TgF-α) and epidermal growth factor (EGF) are growth factors acting on proliferation and differentiation of cells and expressed in various types of cancer. TGF-αmay be a physiological regulaor during liver development and liver regeneration in injured liver and known as increased in hepatocellular carcinoma. To investigate the role of TGF-αand EGF in hapatocarcinogenesis, author had undertaken an experimental study of hepatic carcinogenesis induced in 50 rats by feeding 2-acetylaminofluorene(2-AAF) in diet. The animals were sacrificed periodically after 2-AAF administration, and each liver was examined grossly and microscopically and immunostained with monoclonal antibody for TGF-αpolyclonal antibody for EGF. 1. At the third week of the experiment, the oval cells were markedly proli ferated and extended from the periphery to central areas of hepatic lobules. The altered hepatic foci, including acidophilic cell area on the fourth week and clear cell area on the second month were noted. At the third month, hype rplastic nodules developed. At the seventh month, one case of hepatocellular carcinoma and angiosarcoma were noted. At the eighth month, four cases of hepatocellular carcinoma of trabecular type were noted. Among these, three cases of squamous cell carcinoma on the neck skin occurred. 2. The control livers expressed only a few scattered hepatocytes positive for TGF-αin hepatic lobule. At the third week after 2-AAF administration, the hepatocytes exihibiting positive reaction were more widely distributed along the portal areas and around central veins. At the third month, several of the hyperplastic nodules showed strong to moderate positive reaction for TGF-α. The relationship between the TGF-αexpression and cytomorphologic changes in nodular hepatocytes was not present. All of the hepatocellular carcinoma cells and cells in the neighboring nodules at the seventh and eighth months expressed TGF-α. Oval cells were negative for TGF-αand bile ductular cells showed only focal positivity. 3. EGF was negative in cells of the centrol livers and most experimental livers. At the eighth month, one case of hepatocellular carcinoma and tree cases of squamous cell carconoma showed positive reaction for EGF. Above results suggest that TGF-α, may play a role in hepatocarcinogenesis by the mechanism that TGF-αacts as promotor for the transformation of initiated hepatocytes by 2-AAF in multistep of hepatocarcinogenesis.

심리적 계약이 구성원의 태도에 미치는 영향

이동영,고명희,백정숙,김희선 서울여자대학교 대학원 1999 論文集 Vol.- No.7

금속가공유 사용 근로자에서 발생한 과민성폐장염 1예

이선웅,고동희,진구원,박동욱,이정탁,송윤희,이상윤 大韓産業醫學會 2008 대한직업환경의학회지 Vol.20 No.1

서론: 과민성폐장염의 원인물질로 금속가공유는 외국의 경우 작업장의 집단발병 사례들을 중심으로 많은 보고가 되어 왔으나 우리나라에서는 아직 보고되지 않았으며,저 자들은 금속가공유에 1년간 노출된 근로자에서 발생한 과민성폐장염 1예를 발견하였기에 작업환경측정을 시행한 후 작업관련성을 평가하여 보고하는 바이다. 증례: 64세 남자 환자가 1년간 강관을 절단하는 작업을 한 후 호흡곤란을 주소로 내원하였다 노출력,임상적 소견 및 방사선학적 소견을 토대로 과민성폐장염으로 진단되었다. 작업환경 측정결과 공기 중 금속가공유,엔도 톡신,총 세균 및 곰팡이는 각각 0.531 mg/m³, 6.33 EU/m³ 100 CFU/m³ 및 75 CFU/m³이었고,금속가 공유 내 엔도톡신,총세균 및 곰팡이는 각각 1.5x10⁴EU/mL,4.6x10^(5) CFU/mL 및 1.8×10^(5) CFU/mL이었다. 고찰: 금속가공유 내의 원인항원에 대한 침강항체를 검사하지 못했으나,작업환경 측정결과 금속가공유가 일반적인 허용가능 수준 이상으로 오염되었으며,기존의 과민성폐장염 발생 사례들과 비슷한 수준 또는 그 이상으로 오염되어 있었다. 공기 중 금속가공유 농도 역사 NIOSH의 REL과 ACGIH의 NIC를 초과하고,기존의 사례들에 비해서도 대체적으로 높은 수준 이었다. 금속가공유 이외의 다른 원인에 대한 감별과 기존의 발생사례들과의 노출수준 비교를 통하여,저자들은 환자가 금속가공유에 의한 미생물 항원에 노출되어 과민성폐장염이 발생한 것으로 판단하였다. Introduction: There have been no reports of hypersensitivity pneumonitis caused by metal working fluids in Korea, despite their existence in other countries. Here, we report the first such case, along with an assessment of work-relatedness through exposure assessment. Case report: A 64-year old male patient visited the hospital with dyspnea after metal pipe cutting for about a year. He was diagnosed with hypersensitivity pneumonitis from the evidence of specific exposure history, clinical symptoms, and radiologic findings. The air exposure levels of the oil mist, endotoxin, total bacteria and fungus in the work environment was TWA(8-hr) 0.531 mg/m³, 6.33 EU/m³, 100 CFU/m₃ and 75 CFU/m³, respectively. The concentrations of the endotoxin, total bacteria and fungus within the metal working fluid was 1.5 X 10⁴EU/mL, 4.6 X 10^(5) CFU/mL and 1.8 X 10^(5) CFU/mL, respectively. Discussion: Although the patient did not receive a specific precipitating antibody test, the microbial concentration within the metal working fluid was higher than normal and similar to previous case reports, The oil mist level in the air exceeded the NIOSH REL and ACGIH NIC, and were similar or higher than previous cases. By excluding other causes of hypersensitivity pneumonitis, we concluded that the disease developed from exposure to microbial antigens in the metal working fluid.