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.

송파농산 기본계획

서주환,변성진,김상범,최미진 경희대학교 디자인연구원 2000 예술· 디자인학연구 Vol.3 No.1

As the standard of living rises and spare time grows, the demand Pattern to the leisure tends, which are on the variety, a high life and a wide area, is changing into total recreation form. As a result, we are so willing to build up sightseeing-leisure site elevating the standard of living in accordance with faciiities and program satisfying desire of new sightseeing form that can contribute development of local society and residents earnings. And according to using the maximum local resource, we are to propose model of minimum-damaged tourist site.

Alginate Bead를 이용한 고분자 약물의 제어방출형 약물수송체

황성주,이계주,조항범,이기명,김종국 충남대학교 약학대학 의약품개발연구소 1993 藥學論文集 Vol.9 No.-

The purpose of this paper is to explore the possible applicability of alginate beads as an oral controlled release system of polymeric drugs. Cellulases was used as a model polymeric drug. The release of cellulase from alginate beads was moderately affected by the ratio of cellulase to sodium alginate and strongly affected by CaCl_2 concentration. However, the release was not particularly affected by the other factors such as sodium alginate concentration and curing time. The drug was not released from alginate beads at pH 1.2 but was released continuously up to 8 hr at pH 6.8. At pH 6.8, the beads were swollen highly up to 3 hr, thereafter, were eroded into the bulk solution up to 6 hr, completely. Drug release from the beads can be caused due to diffusion and erosion of the matrix. Activity of cellulase was reduced when alginate beads containing cellulase were stored in simulated gastric juice. Further investigation would be necessary to improve the acid resistance of beads. Since the release of cellulase as a model polymeric drug could be controlled by tthe regulation of the preparation conditions of alginate beads, the alginate beads may be used for a potential oral controlled release system of such polymeric drugs as polypeptide drugs.

수술의 함정 : 중심성 신경세포종 2례 2 Cases of Central Neurocytoma

김범태,주교성,장채칠,신원한,최순관,변박장 대한신경외과학회 1999 Journal of Korean neurosurgical society Vol.28 No.3

뇌졸중과 동반된 병원감염

한범기,이지용,이성수,김헌주 연세대학교 원주의과대학 2000 원주의대논문집 Vol.13 No.1

상악 결손부 수복을 위한 측두피판의 이용

정창주,진국범,이동근,윤성필,김귀희,김영조 大韓顎顔面成形再建外科學會 1994 Maxillofacial Plastic Reconstructive Surgery Vol.16 No.1

The functional deformity following removal of the maxilla is considerable, especially following maxilla cancer excision. Rehabilitation of oral and maxillofacial region used to be very difficult with prosthesis or traditional flaps. Temporal muscle and fascia flaps have been described for immediate reconstruction following hemi-maxillectomy, but not total maxillectomy. The muscle and superficial fascia of the temporal area differ in their physical characteristics, vascular supply and clinical applications. Both can be employed independently or simultaneously as regional flaps in the reconstruction of a variety of complex craniofacial defects. Four case is presented in which 3 case maxilla cancer, one case non-union after maxilla fracture, and all case showed successful use of this flap. Only one patient developed partial necrosis of the flap ; significant necrosis did not occur in any other patient. This present paper reviews the anatomy, surgical technique and utilisation of temporal muscle and fascia flaps.

경관계획에서 GIS의 활용에 관한 소고

서준환,김상범 경희대학교 디자인연구원 2000 예술· 디자인학연구 Vol.3 No.1

This study was carried out to investigate the system of landscape planning and to find the using method of GIS. In other country they have been to use for GIS in the landscape planning. As a result they have know-how on the basis of constant efforts, But in korea there are a lot of problems about the using GIS. For example, One is an inaccurate data. the other is an deficient baseline in landscape planning. Therefore we must to look for the baseline of landscape planing and to make inaccurate data of landscape to the smallest. It was indispensable to use GIS in landscape planning.

메토트렉세이트가 표면수식된 알부민 미립구의 제조 및 특성

황성주,조항범,이계주,김종국 충남대학교 약학대학 의약품개발연구소 1995 藥學論文集 Vol.11 No.-

The surface of albumin microspheres could be modified with methotrexate (MTX) by using 1.3-dicyclohexylcarbodiimide (DCC). Surface-modified albumin microspheres entrapping no MTX (SAMS), free MTX (SAMSF) and MTX-bovine serum albumin (BSA) conjugates (SAMSC) were prepared, respectively, and their release characteristics were investigated in the presence of trypsin using a dissolution tester. The mean diameters of all the microspheres were 5~8 μm, and their shapes was small and uniform. MTX bound to their surfaces was released slower than the entrapped free MTX, and faster than the entrapped MTX-BSA conjugates. Also, surface-modified MTX was scarcely released in the absence of a proteolytic enzyme. Therefore, the surface-modified MTX may be released rapidly from SAMSC at the target site, and thereafter MTX may be released slowly from the encapsulated MTX-BSA conjugates in SAMSC for a long period.

감염된 가축과의 직접 접촉 없이 발생한 브루셀라증 환자1례와 축산 부산물 시장에서의 역학조사 : Sero-epidemiology Study on Market, by-product, Stock-raising

정성주,김성범,박대원,정혜원,기세윤,권정아,박만석,박미연,정희진,김우주 대한감염학회 2004 감염과 화학요법 Vol.36 No.3

브루셀라증은 전 세계적으로 발생하는 인수공통 전염병중에 하나로서, 본 증례는 국내에서 감염된 가축에 대한 노출력이 없는 집단에서 현증 브루셀라증이 발생한 첫 증례이기에 문헌 고찰과 함께 보고한다. 또한 환자가 근무하였던 축산물 부산물 시장에서 역학 조사를 실시하여, 현증환자 및 기감염자를 발견하여 축산물 부산물 시장 근무자에서 현증 브루셀라증이 발생할 위험성을 평가하였다. 역학 조사 결과 축산물 부산물을 다루는 일을 하는 사람들에서 감염된 가축과의 직접 접촉이 없이도 브루셀라증이 발생할 수 있음을 알 수 있었다. Brucellosis is a world-wide zoonotic disease. We report the first case of brucellosis in South Korea that is not related to direct contract with intected cattles. The patient had been working in the market of by-product, stock raising for twenty years and complained of 1-month history of fever, chill, and intermittent epistaxis. We confirmed brucellosis by anti-brucella antibody test and PCR. After 6 weeks' treatment with rifampicin and doxycycline, fever and chilling subsided, and, generalized weakness and oral intake improved. We performed seroepidemiology study against workers who were working in the same market as the patient. However, we couldn't find out other cases with seropositivity. We concluded that although the workers of by-product market have a risk of getting brucellosis, the risk is low.

Swanson의 주의력결핍 장애척도의 한국판 표준화

이종범,박성찬,정성덕,김진성,서완석,배대석,주열 대한생물치료정신의학회 2002 생물치료정신의학 Vol.8 No.2

연구목적 : 한국판 Swanson의 주의력 결핍 장애 척도(이하 SNAP)의 신뢰도와 타당도를 검증하고, 이를 국내 실정에서 주의력결핍 과잉행동장애 환자를 선별할 수 있는 평가용 도구로서 적합한지 여부와 연구에 사용할 수 있는지를 알아보고자 하였다. 방 법 : 1998년 7월 1일부터 2001년 9월 30일까지 영남대학교 의료원 신경정신과 외래를 방문한 주의력결핍 과잉행동장애 환자 392명과 정상대조군 432명을 대상으로 SNAP을 시행하였다. 결 과 : 남녀 간의 SNAP 척도 점수비교에서, 환자군에서는 유의한 차이가 없었으나 정상 대조군에서는 남자가 유의하게 높게 나타났다(p<.01 ∼ .001). 검사-재검사 신뢰도 검증에서 신뢰도 계수는 각 하위 척도에서 .85에서 .92로 모두 만족할 만큼 높았다(p<.05). 내적일관성에 의한 신뢰도 검증에서 정상 및 환자군에서 각 하위척도별로 Cronbach α값이 .80(p.05)이상으로 나타났고, 반분신뢰도는 정상 및 환자군에서 각 하위척도별로 0.731에서 .866사이였다(p<.05). 주의결핍장애 평가 척도-가정관(Attention Deficit Disorder Evaluation Scale-Home Version) 및 소아기 집중력 문제 척도(Childhood Attentin Problem Scale)와의 준거 타당도는 ADHD 환자군에서 .342에서 .713사이였고(p<.05), 정상 대조군에서 .551에서 .789였다(p<.05). 요인분석을 해 본 결과 본 척도는 3개의 요인으로 분류되었는데, 부주의(inattention) 요인, 충동성/과잉행동(impulsivity/hyperactivity)요인, 또래 관계(peer interaction)요인으로 구분되었다. 본 척도가 정상인과 환자를 감별할 수 있는 척도인가를 알아보기 위한 감별 타당도 검사를 해본 결과 87.5%를 분류하여 높게 나타났다. 환자와 정상인을 구분하는 점수인 절단점은 표준편차 1.5를 절단점으로 잡을 때 이는 백분율로 93percentile에 해당하는 점수로서 각 소척도 점수에서 남자(0.98∼1.65)와 여자(0.64∼1.38)의 절단점이 다르게 나타났으며 남자가 높게 나타났다. 결 론 : 이상의 결과에서 볼 때 한국판 SNAP 평가 척도의 신뢰도와 타당도가 입증되었고 환자를 판별하는 능력이 우수하여 향후 ADHD 연구에 유용한 도구로 사료된다. Objectives : The purpose of this study was to examine reliability and validity of Swanson's attention deficit disorder sacale(SNAP). Method : SNAP was administered to 432 elementary school students and 392 patients who were diagnosed as attention deficit hyperactivity disorder in Yeungnam university hospital from 1998 July to 2001 September. Results : In the reliability test, the test-retest reliability coefficient was significantly high and that of inattention was 0.85, that of impulsivity was 0.90, that of hyperactivity was 0.90 and that of peer interaction was 0.92(p<.05). In the reliability test by internal consistency, the Cronbach α coefficient was above 0.80 at each subscale in both patients and normal control group(p<.05). The split-half reliability coefficient by first-second half method showed high correlation and those of each scales were from 0.731 to 0.866 in both patients and normal control group(p<.05). The criterion validity of SNAP with Attention Deficit Disorder Evaluation Scale-Home Version(ADDES-HA) and Childhood Attention Problem Scale(CAP) scale was from 0.342 to 0.713 in patients group, from 0.551 to 0.789 in normal control group(p<0.05). The discriminant ability between ADHD and normal subjects by SNAP was 87.5%. Conclusion : In this point of view, SNAP scale showed high reliability and validity in applying to Korean subjects and was proved to be useful screening tool for attention deficit hyperactivity disorder reserch.