일산화탄소 중독시 고압산소치료가 혈액가스상에 미치는 영향

최보율,이현숙,박항배 한양대학교 의과대학 1987 한양의대 학술지 Vol.7 No.2

Nowadays hyperbaric oxygenation is generally accepted as the treatment of choice and is applied routinely in most general hospitals in Korea. The purpose of this study is to clarify in the therapeutic mechanism and the effect of hyperbaric oxygen through a sectional analysis of blood gas changes during the exposure to carbon monoxide and the treatment with hyperbaric oxygen. Twenty two rabbits were exposed to carbon monoxide gas of 4,500 ppm for one hour. The half of the rabbits (experimental group) was treated with hyperbaric oxygen of 3 ata for one hour and then were observed for the next hour in the room air. Another half (control group) were left in the room air for two hours after CO exposure. Blood sampling was done from both internal carotid artery and external jugular vein shortly before CO exposure and then in every twenty minutes for the first two hours and every thirty minutes for the last hour. The findings were as follows. 1. While the arterial PO₂increased by 20 mmHg during CO exposure, PCO₂decreased by 12 mmHg suggesting that the rabbit hyperventilated to compensate hypoxia. 2. At the end of CO exposure, pH (7.16), PCO₂(16mmHg), ??(1.57mEq/L) and base excess (-21 mEq/L), all decreased suggesting the condition to be partially compensated metabolic acidosis. 3. Elevation of PO₂in arterial blood (113 mmHg) with concomitant drop in venous blood (11 mmHg) is most likely the result of increased utilization of dissolved oxygen instead of hemoglobin combined oxygen. The significance of cytochrome a₃ inactivation as the mechanism of CO poisoning should be re-evaluated. 4. The half life of HbCO in experimental and control group were 7.8 and 17.2 minutes respectively; in other words, dissociation of HbCO in hyperbaric oxygen (3 ata) environment was 2.2 times as fast as that in the room air. 5. With hyperbaric oxygenation, arteriovenous difference of PO₂increased to 1,350 mmHg, which means about 4.2 volume percent of dissolved oxygen was utilized to result in almost immediate relief of tissue hypoxia. 6. Comparing the changes in pH and base excess of experimental and control group, it is obvious that hyperbaric oxygen accelerates the relief of metabolic acidosis in CO poisoning.

정관수술과 동맥경화증과의 상관관계에 관한 역학적 예비조사연구

고응린,이정균,박항배 한양대학교 의과대학 1983 한양의대 학술지 Vol.3 No.1

In Korea, the vasectomy has been adopted by the government as a means of family planning program since early 1960's and approximately 750,000 vasectomies were performed up to 1982 without being noticed of any significant clinical adverse outcomes. However, recent studies on vasectomized monkeys by alexandar and Clarkson have indicated an increased risk and accelerated rates of atherogenesis and the researchers hypothesized that the immunologic reaction to sperm antigen might have produced vascular damage. These findings have aroused considerable concern among the providers of vasctomy services and their past and prospective clients. The primary unresolved problem is whether the alleged higher risk applies to men. Considering world wide publicity about the animal findings there are both programmatic and svientific reasons to conduct epidemiologic studies of this issue in our country and compare the the results with those derived from the similar studies made in other countries. In view of complicated nature of such study, however, it is generally agreed that a pilot study is needed in preparation for the future large scale survey anticipated in Korea, and the study was conducted according to the following design and methodology. Basically the hospital based "Case-Control Study" method was used. The cases and the controls were chosen from the ever married male patients aged 40-60 whose sociodemographic and some variables possibly related to the atherosclerotic diseases were investigated through face to interview. The cases are the patients treated at Han Yang University Hospital of one of the diseases listed below. 1. Ischemic Heart Diseases (I.C.D Codes: 410, 411, 413, 414) 2. Cerebrovascular Diseases (I.C.D Codes: 433, 434, 435, 437) 3. Diseases of Arteries, Arteriols and Capillaries (I.C.D Codes: 440, 441, 442, 443.1, 443.9, 444) The controls are consisted of the male patients aged 40-60 with diseases not listed above. The findings of this pilot stududy are anticpated to give us the answers to the following questions. 1. Sample size needed for the case-control study on the vasectomy-atherosclerotic relationship. 2. Size of case group collectable in a hospital setting. 3. Possibility of utilizing medical record system for a follow-up study. 4. Association between the selected factors and atherosclerotic siseases. A summary of the study is as follows. 1. The sample sizes required for the analysis of the association between vasectomy and atherosclerotic diseases under specified conditions are given in Table 2 in the main text. 2. The analysis of statistics of a hospital with 800 beds showed that the number of patients falling into the diseases category defined above could be estimated 200-260 per year. The combination of the findings on the sample size and this patient statistics lead us to predict that at least 3 hospitals of 700-800 beds each are required to participate into the study in order to collect an adequate amount of data for meaningful analysis. It was also revealed that the hospital record system was so efficiently operated that patients' records for specified disease were easily retrievable to make it feasible for the follow up study. 3. A total of 107 cases and 110 controls were interviewed during the period of November 1, 1981 to May 31, 1982, and the comparative analysis has shown that only one factor, that is, "coffee drinking status" has turned out to be statistically significant and enabling us to interpret the relationship in reasonable terms. The sample size and the number of vasectomized were too small to do any further statistical analysis for testing the association and for measuring the relative risk.

순회진료사업(巡回診療事業)의 문제점(問題点)과 개선방향(改善方向) (일부(一部) 무의지역에 대(對)한 지역사진단(地域社診斷)을 중심(中心)으로)

박항배,최동욱,Park, Hung-Bae,Choi, Dong-Wook 대한예방의학회 1978 예방의학회지 Vol.11 No.1

The mobile medical service has been operated for many years by a number of medical schools and hospitals as a most convenient means of medical service delivery to the people residing in such area where the geographical and socioeconomic conditions are not good enough to enjoy modern medical care. Despite of official appraisal showing off simply with numbers of outpatients treated and medical persons participated, however, as well recognized, the capability (in respect of budget, equipment and time) of those mobile medical teams is so limitted that it often discourages the recipients as well as medical participants themselves. In the midst of rising need to secure medical service of good quality to all parts of the country, and of developing concept of primary health care system, authors evaluated the effectiveness of and problems associated with mobile medical servies program through the community diagnosis of a village (Opo-myun, Kwangju-gun) to obtain the information which may be halpful for future improvement. 1. Owing to the nationwide Sae-Maul movement powerfully practiced during last several years, living environment of farm villages generally and remarkably improved including houses, water supply and wastes disposal etc. Neverthless, due to limitations in budget time and lack of knowledge (probably the most important), these improvements tend to keep up appearances only and are far from the goal which may being practical benefit in promoting the health of the community. 2. As a result of intensive population policy led by the government since 1962, there has been considerable advances in understanding and the rate of practicing family planning through out the villages and yet, one should see many things, especially education, to be done. Fifty eight per cent of mothers have not received prenatal check and the care for most (72%) delivery was offered by laymen at home. 3. Approximately seven per cent of the population was reported to have chronic illness but since only a few (practically none) of the people has had physical check up by doctors, the actual prevalence of chronic diseases may reach many times of the reported. The same fact was observed also in prevalence of tuberculosis; the patients registered at local health center totaled 31 comprising only 0.51% while the numbers in two neighboring villages (designated as demonstration area of tuberculosis control and mass examination was done recently) were 3.5 and 4.0% respectively. Prevalence rate of all dieseses and injuries expereinced during one month (July, 1977) was 15.8%. Only one tenth of those patients received treatment by physicians and one fifth was not treated at all. The situation was worse as for the chronic patients; 84% of all cases either have never been treated or discontinued therapy, and the main reasons were known to be financial difficulty and ignorance or indifference. 4. Among the patients treated by our mobile clinic, one third was chronic cases and 45% of all patients, by the opinion of doctors attended, were those who may be treated by specially trained nurses or other paramedics (objects of primary care). Besides, 20% of the cases required professional managements of level beyond the mobile team's capability and in this sense one may conclude that the effectiveness (performance) of present mobile medical team is quite limitted. According to above findings, the authors would like to suggest following for mobile medical service and overall medicare program for the people living in remote country side. 1. Establishment of primary health care system secured with effective communication and evacuation (between villages and local medical center) measures. 2. Nationwide enforcement of medical insurance system. 3. Simple outpatient care which now constitutes the main part of the most mobile medical services should largely be yielded up to primary health care unit of the village and the mobile team itself should be assigned on new and more urgent m

풍진항체 검사법의 신뢰도에 관한 연구 : Comparison of the Methods between the Abbott RUBAZYME kit and the Abboutt IMx Automated Analyzer

신영전,최보율,최은주,박항배 한양대학교 의과대학 1995 한양의대 학술지 Vol.15 No.2

Abbott Rubazyme and Abbott IMx, which are most used to prevent Rubella IgG and IgM thesedays, were evaluated for their reliability. Both methods were tested on 305 women, 287 and 18 number of each pregnant and non-pregnant women, in Yangpyong county from March 1993 through September 1993. In addition, they had 14. 3 weeks of pregnant period and 25.8 of average age. It appeared that there was a significant correlation between the titers of Rubazyme and IMx for Rubella IgG (Coefficient Correlation 0.6167, p=0.000) but not for IgM(C. C. 0.0668, p=0.245). Additionally, the correlation coefficient of the two methods for IgG titer of 1st and 4th quartile, 0.6829, p=0.000, were higher than that of 2nd and 3rd, 0.4600, p=0.000, So does IgM : 0.1081, p=0.181 for ist and 4th quartile and 0.0230, p=0.780 for 2nd and 3rd quartile. The agreement rate of positivity was 92.5% for IgG and 99.0% for IgM. The kappa index for IgG was 0.51338. The agreement point of titer, where the number of a people who showed positivity for IgG in IMx test and that in Rubazyme kit test became equal, was 31.3 IU/ml, which was 315% of the original point, 9.949 IU/ml. The agreement rate of both tests for 1gG was decreased to 92.13% but the kappa index was increased to 0.66869 in rasing cut off point of the IMx up to 31.3 IU/ml. Abbott Rubazyme and Abbott IMx tests play important roles in determining the infection of pregnant women and even the prevention of deformation of child and artificial abortion. However, since these two methods turns out not to be reliable to be used through this experiment, physicians should examine the reliability of both methods, and even the possibility of technical errors of them before actual use.

宇宙船室 大氣環境

朴恒培 대한의학협회 1969 대한의학협회지 Vol.12 No.5

일산화탄소 중독시 과산화수소 관장에 의한 혈액가스의 변동

윤경선,고응린,박항배 한양대학교 의과대학 1985 한양의대 학술지 Vol.5 No.2

The administration of hydrogen peroxide as the means of correcting tissue hypoxia has been studied by many researchers since early 1920's. The purpose of this study is to investigate the validity of clinical application of H₂O₂ enema for the treatment of carbon monoxide poisoning which, in Korea, is one of the most serious life threatening maladies. Sixty rabbits were exposed to carbon monoxide (7,000 ppm) for fifty minutes and the arterial blood gas pictures before and after the exposure were observed. Immediately after the exposure, half of the animals were given with 10ml of 0.5% H₂O₂ solution per kg plus 1 ml of human whole blood by enema and the other half(control) simply with 10 ml of physiologic saline per kg by the same route. A series of blood sampling and gas analysis in every thirty minutes (up to 2 hours) following the enema were carried out and comparison was made between the two groups. The conclusions were as follows: 1) The arterial blood gas picture after the exposure(poisoning) to carbon monoxide was suggestive of partially compensated metabolic acidosis which is interpreted as the result of lactic acid formation by anaerobic tissue metabolism. 2) Immediately after the exposur, extreme reduction of arterial PaCO₂ was observed. The reduced tissue metabolism through aerobic pathway and hyperventilation to overcome the hypoxic condition, both are considered to be the cause of this drop in arterial CO₂ tension. 3) Arterial PaO₂ of the experimental group at 30 minutes after the enema with 0.5% H₂O₂ solution was 19.5 mmHg higher than that of control group and this difference decreased gradually to 10.3 mmHg at 120 minutes. Even though the result of tissue oxygenation by H₂O₂ enema is far less satisfactory than that of 100% oxygen inhalation, the application of this method may be considered as substitute of (or supplement to) oxygen treatment in some particular situations when oxygen equipment is not available or pulmonary function is significantly inhibited (e.g. burn to the respiratory tract, pneumonia etc).

일산화탄소폭로시 농도와 치사시간의 관계에 관한 실험적 연구

김영오,송재철,박항배 大韓産業醫學會 1991 대한직업환경의학회지 Vol.3 No.1

The carbon monoxide(CO) is a chemical asphyxiant which serves as a major cause of death in Korea. Authors evaluated the Haber's(CχT=K :C : concentration, T : time to death) & Sidorenko's(CaχT=K; a,k : constants) equations for establishing the concentration-time to death relationship in exposure. Eighty four rats(Sprague-Dawley) were exposed to 14 different concentrations in the range of 1,600-11,100 ppm. The Sidorenko's constants 'a' was 1.79(p<0.05, r²=0.87) and 'k' was e19.41(p<0.05) for the time to respiratory arrest ; 1.61(p<0.05, r²=0.85) and e18.14(p<0.05) respectively for the time to cardiac arrest. But the results of the analysis for various concentration ranges proved that the constants were applicable only to the range from 4,100 to 11,100 ppm(a=1.76, r²=0.67, p<0.05; k=e19.13, p<0.05 for respiratory arrest and a=1.64, r²=0.62, p<0.05; k=e18.28, p<0.05 for cardiac arrest). Also, the Haber's equation was considered inappropriate for this relationship, for which the 95% confidence interval for constant a's didn't include one.

巡回診療事業의 問題點과 改善方向 : 一部 無醫地域에 對한 地域社會診斷을 中心으로

朴恒培 漢陽大學校 1979 論文集 Vol.13 No.-

The mobile medical service has been operated for many years by a number of medical schools and hospitals as a most convenient means of medical service delivery to the people residing in such area where the geographical and socioeconomic conditions are not good enough to enjoy modern medical care. Despite of official appraisal showing off simply with numbers of outpatients treated and medical persons participated, however, as well recognized, the capability (in respect of budget, equipment and time) of those mobile medical teams is so limitted that it often discourages the recipients as well as medical participants themselves. In the midst of rising need to secure medical service of good quality to all parts of the country, and of developing concept of primary health care system, authors evaluated the effectiveness of and problems associated with mobile medical aerivice program through the community diagnosis of a village (Opo-myun, Kwangju-gun) to obtain the information which may be helpful for future improvement. 1. Owing to the nationwide Sae-Maul movement powerfully practiced during last several years, living environment of farm villages generally and remarkably improved including houses, water supply and wastes disposal etc. Neverthless, due to limitations in budget, tome and lack of knowledge (probably the most important), these improvements tend to keep up appearances only and are far from the goal which may bring practical benefit in promoting the health of the community. 2. As a result of intensive population policy led by the government since 1962, there has been considerable advances in understanding and the rate of practicing family planning through out the villages and yet, one should see many things, especially education, to be done. Fifty eight per cent of mothers have not received prenatal check and the care for most (72%) delivery was offered by laymen at home. 3. Approximately seven per cent of the population was reported to have chronic illness but since only a few (practically none) of the people has had physical check up by doctors, the actual prevalence of chronic diseases may reach many times of the reported. The same fact was observed also in prevalence of tuberculosis; the patients registered at local health center totaled 31 comprising only 0.51% while the numbers in two neighboring villages (desganated as demonstration area of tuberculosis control and mass examination was done recently) were 3.5 and 4.0% respectively. Prevalence rate of all diseases and injuries experienced during one month (July, 1977) was 15.8%. Only one tenth of those patients received treatment by physicians and one fifth was not treated at all. The situation was worse as for the chronic patient; 84% of all cases have never been treated or discontinued therapy, and the main reasons were known to be financial difficulty and ignorance or indifference. 4. Among the patients treated by our mobile clinic, one third was chronic cases and 45% of all patients, by the opinion of doctors attended, were those who may be treated by specially trained nurses or other paramedidcs (objects of primary care). Besides, 20 % of the cases required professional managements of level beyond the mobile team's capability and in this sense one may couclude that the effectiveness (performance) of present mobile medical team is quite limitted. According to above findings, the authors would like to suggest followings for mobile medical service and overall medicare program for the people living in remote country side. 1. Establishment of primary health care system secured with effective communication and evacuation (between villages and local medical center) measures. 2. Nationwide enforcement of medical insurance system. 3. Simple outpatient care which now constitutes the main part of the most mobile medical services should largely be yieled up to primary health care unit of the village and the mobile services should largely be yieled up to primary health care unit of the village and the mobile team itself should be assigned on new and more urgent missions such as mass screening health examination of .the villagers, health education with modern and effective audiovisual aids, professional training and consultant services for the primary health care organization.

농촌지역 응급환자의 특성에 관한 조사연구 : 한 종합병원 응급실 방문환자를 중심으로

고응린,김홍우,최보율,박항배 한양대학교 의과대학 1986 한양의대 학술지 Vol.6 No.1

While the general hospital in a countryside is expected to play an important role as the secondary medical care facility in the remote rural community, operational difficulties due to regional conditions such as lack of professional manpower, budgetary problems and so forth, have often been encountered. To obtain informations to be utilized for the establishment or management of these hospital, the author investigated patients visiting the emergency unit of a general hospital in Nonsan County (Choongnam Province) during April 1984 to March 1985. Analysis was done for the characteristics of emergency diseases, of patients themselves and the urgency rate was determined. Conclusions; 1. Much more men (62.1%) visited emergency unit than women (37.9%) and this was true in all age groups. Higher frequency of trauma among males after the age of 10 is a part of the reason but for the groups under 10, some extra-medical factors such as boy-favoring by the parent may concern. 2. The number of emergency patient per hospital bed was 38.7 and the number of admission via emergency unit per bed 14.7 per year. These numbers are far greater than those of hospitals in large cities and suggest the importance of the role of this emergency service not only for the community but for the operation of hospital itself too. 3. The avearage number of emergency visit per day varied from 21.7 (September) to 13.4 (January) and the rush was on holidays and at evening when most local clinics are closed. 4. One third of the patient arrived at the hospital within one hour and more than half (53.2%) in 3 hours from the onset of symptom. Owing to the high proportion of trauma cases, the time lapse before the arrival at hospital was shorter than reported by former researchers. 5. The number of visiting patient increased as the distance between the hospital and their residence decreased, and the town people visited the emergency unit more often than villagers did. 6. The most frequent cause of emergency illness was injury and poisoning occupying 49.5% and of these, 62.4% was consisted of age group between 15 and 39, 76.4% of man. More than 34% of all emergency cases belonged to neurosurgery and orthopedics, and this again shows that trauma is the leading cause of medical emergency. 7. The patient (1,002 in number) visited hospital during September and October was classified by the degree of urgency (triage). In urgent cases, there were more men than women, and trauma cases and those visited between 10 at night and 6 in the morning occupied larger proportion than others. Nearly two thirds of medical insurance holders was classified as non-urgent suggesting further increase of utilization of emergency service by these people as medical insurance population expand in future. 8. After the treatment in emergency room, 50.5% of the patient returned home and 37.9% was admitted to the ward.

일부 농촌지역 학동의 B형 간염 감염률에 대한 조사 연구

최보율,김동준,박항배 한양대학교 의과대학 1986 한양의대 학술지 Vol.6 No.2

The positive rate of hepatitis B surface antigen (HBsAg) in Korea reported to be ranging from five to eleven per cent by the age composition, residential area of the group examined and by the method of study. As for the children, the positive rates reported were 4.5% (Kwon et al, 1977; of the pediatric patients hospitalized due to illnesses other than hepatic diseases), 4.2%, 4.8% (Hong et al, 1979 and Heon et al, 1983), 5.8% in farm villages and 2.9% in urban area (Kim et al, 1986). To grasp the rate and nature of hepatitis B virus infection in rural area of this country, authors examined 474 children in two elementary school and one middle school located in relatively isolated, remote agricultural district of the HBsAg and anti-HBs positive rates. The summary is as follows: 1. The overall positive rates of HBsAg and anti-HBs were 5.9% and 9.7% respectively. 2. While the positive rate of HBsAg didn't show the tendency to increase with age, that of anti-Hbsdid. 3. In age group below 14, the HBsAg positive rate was higheringirls than in boys but in 15 to 17 age group, the higher positive rate was noted among boys. Anti-HBs positive rate was higher in males throughout all age groups. 4. Since remarkably higher positive rates (both HBsAg and anti-HBs) were observed in certain villages, school or even in specific classes, one could conjecture that the source of infection was in those specific community and transmitted through close bodily contact between the children in, to and from the school.