신생아 세균성 뇌막염의 원인균에 따른 치료와 예후

김동준,이광훈,이형원,김길현,이학수,Kim, Dong Joon,Lee, Gwang Hoon,Lee, Hyung Won,Kim, Gil Hyun,Lee, Hak Soo 대한소아감염학회 1997 Pediatric Infection and Vaccine Vol.4 No.1

목 적 : 신생아 세균성 뇌막염은 임상 증상이 비특이적이며 여러가지 신경학적 후유증을 남길 수 있는 질환으로 본 저자들은 원인균 특히 그람 양성균과 음성균에 의한 뇌막염을 비 교 분석하여 치료 및 예후의 개선을 도모하고자 본 연구를 시행하였다. 방 법 : 1991년 1월부터 1996년 6월까지 중앙 길병원 신생아 중환자실과 소아과 병동에서 뇌척수액 검사상 균이 배양되었거나 latex agglutination test상 균이 밝혀진 24례를 대상으로 후향적으로 분석하였다. 결 과 : 1) 환아의 분포는 남아 17명, 여아 7명이었고, 그람 양성균에 의한 뇌막염 환아의 평균 출생 체중과 재태 기간은 $2.91{\pm}0.79kg$, $38.4{\pm}2.74$주, 그람 음성균군에서는 $3.30{\pm}0.90kg$, $37.7{\pm}3.33$ 주로 두 군간에 유의한 차이는 보이지 않았다. 2) 선행 요인으로는 미숙아, 태변 착색, 조기 양막 파수, 산모 당뇨병, 임신성 고혈압 등이 있었으며, 임상 증상 및 증후로는 발열, 경련, 수유량 감소, 대천문 팽대 등이 있었고, 증상 발현 시기는 조기 발현형이 11례(그람 양성균 4례, 그람 음성균 7례), 지연 발현형이 13례 (그람 양성균 7례, 그람 음성균 6례)였다. 3) 원인균은 그람 양성균이 11례로 coagulase-negative staphylococci와 group B streptococci가 각 3례, Staphyolococcus aureus와 Streptococcus viridans가 각 2례, enterococci가 1례가 있었으며, 그람 음성균은 13례로 Escherichia coli가 7례, Klebsiella pneumoniae가 3례 Pseudomonas aeruginosa, Acinetobactor, Emterobacter가 각 1례씩 있었다. 4) 뇌척수액 검사상 백혈구 수치는 그람 음성균군에서 통계적으로 유의하게 높았으나 단백 수치와 당 수치는 두 군간에 통계적으로 유의한 차이를 보이지 않았다. 5) 뇌초음파 검사상 그람 양성균군에서는 7례(63.6%)에서, 그람 음성균군에서는 10례 (76.9%)에서 비정상 소견을 보였으나 두 군간에 뇌초음파 검사상 비정상 소견의 빈도에 있어서는 통계적으로 유의한 차이를 보이지 않았다. 6) 항생제 감수성 검사에서 그람 양성균군에서는 penicillin계통, 1세대 cephalosporin, vancomycin에, 그람 음성균군에서는 amikacin과 3세대 cephalosporin에 대해 비교적 높은 감수성을 보였다. 7) 사망율(병원내 사망이나 hopeless discharge)은 20.8%(5례)였으며, 예후는 그람 양성균 군과 그람 음성균군에서 통계적으로 유의한 차이를 보이지 않았다. 결 론 : 신생아 세균성 뇌막염은 그람 양성균과 그람 음성균 간의 빈도와 예후의 차이는 보이지 않았고 예후가 불량하므로 세균성 뇌막염이 의심되는 환아에서는 적극적인 치료가 필요하리라 사료된다. Purpose : Neonatal bacterial meningitis is the disease which clinical manifestations are nonspecific and several neurologic complications may occur. We studied neonatal bacterial meningitis, particularly in treatment and prognosis according to causative organisms -gram positive and gram negative bacteria- to assist in treatment of neonatal bacterial meningitis. Methods : We analysed twenty-four cases retrospectively who had been admitted in NICU or pediatric ward in Chung-ang Gil hospital from Jan. 1991 to Jun. 1996, and who had proven causative organisms in culture or latex agglutination[n test in CSF. Results : 1) The ratio of male to female was 2.4: 1. The mean birth weight and gestational age in cases with gram positive bacterial meningitis were $2.91{\pm}0.79kg$ and $38.4{\pm}2.74$ weeks and those in cases with yam negative bacterial meningitis were $3.30{\pm}0.90kg$ and $37.7{\pm}3.33$weeks respectively. There was no significant difference between the two groups. 2) The perinatal predisposing factors were pematurity, mecoinium staining amnionic fluid, matemal diabetes and pregnancy-induced hypertension, etc. The clinical manifestations Were fever, seizure, poor oral intake and fontanel bulging, etc. There were eleven cases with early onset bacterial meningitis(four cases by gram positive bacteria, seven cases by gram negative bacteria), and thirteen cases with late onset bacterial meningitis(seven cases by gram positive bacteria, six cases by gram negative bacteria). There was no significant difference between the two groups in terms of onset. 3) There were eleven cases with yam positive bacterial meningitis and they were coagulase-negative staphylococci(three cases), group B streptococci(three cases), Staphylococcus aureus(two cases), Streptococcus viridans(two cases), and enterococci(one case). And there were thirteen cases with gram negative bacterial menir gitis and they were Escherichia coli(seven cases), Klevsiella pneumoniae(three cases), Pseudomonas aeruginosa(one case), Acinetobactor(one case) and Enterobacter(one case). 4) The initial CSF WBC counts in cases with yam negative bacterial meningitis were significantly higher than those in cases with gram positive bacterial meningitis but the CSF protein and glucose levels were no significant difference in the two groups statistically. 5) The number of cases with abnormal findings in brain ultrasonography was seven in gram positive bacterial meningitis and ten in gram negative bacterial meningitis. 6) There were relatively high sensitivity to penicillin derivatives, the first generation cephalosporin and vancomycin in gram positive bacteria and to the third generation cephalosporin and amikacin in gram negative bacteria. 7) The mortality rate was 20.8%(5 cases were expired or discharged hopelessly). There was no significant difference between the two groups in prognosis. Conclusions : We recommend active treatment in noenatal bacterial meningitis to improve prognosis because the prognosis is poor.

종자골이 감입된 족무지 지관절 탈구 -2예 보고-

김동준,문상호,서병호,공규민,Kim, Dong-Joon,Moon, Sang-Ho,Suh, Byoung-Ho,Kong, Gyu-Min 대한족부족관절학회 2006 대한족부족관절학회지 Vol.10 No.2

Irreducible dislocation of great toe interphalangeal joint with incarcerated sesamoid is a rare condition, with only a few cases reported in literature. We describe two cases of dislocation of interphalangeal joint which were diagnosed by plain radiographs and three dimensional computed tomography (3D-CT) and successfully treated with open reduction without excision of sesamoid through dorsal approach along with literature pertinent to this condition.

TAURODONTISM

김동준,Kim, Dong-Joon 대한소아치과학회 1978 大韓小兒齒科學會誌 Vol.5 No.1

This is to report of a case of bilateral taurodontism of mandibular right & left 1st deciduous molars of 4 year-old female. Taurodontism is a morphologic condition of tooth, it seems to be caused by delayed or incomplete union of horizontal epithelial flaps of the epithelial diaphragm. This union is necessary in order to initiate dentinogenesis in the bifurcation area.

모래지반에서 팽창각에 따른 연속기초와 원형기초의 지지력계수 N_γ와 형상계수에 대한 수치해석 연구

김동준,윤준웅,지성현,최재형,이진선,김동수,Kim, Dong-Joon,Youn, Jun-Ung,Jee, Sung-Hyun,Choi, Jaehyung,Lee, Jin-Sun,Kim, Dong-Soo 한국지반공학회 2014 한국지반공학회논문집 Vol.30 No.1

모래지반의 지표면에 위치한 거친 바닥면을 가진 강체 연속기초와 원형기초에 대하여 수치해석을 이용하여 팽창각 변화에 따른 지지력계수 $N_{\gamma}$와 형상계수를 구하였다. 양해법(explicit method)에 기반한 유한차분해석을 이용하여 지지력계수를 산정하기 위한 수치모델과 해석절차를 개발하고, Mohr-Coulomb 소성모델을 이용하여 다양한 내부마찰각(${\phi}$)과 팽창각(${\psi}$) 범위에 대하여 지지력계수를 도출하였다. 팽창각이 감소됨에 따라 지지력도 감소하는 것으로 나타났으며, 보편적인 지지력계수 제안식들이 가정하고 있는 관련흐름법칙(associated flow-rule)이 적용된 경우(${\psi}={\phi}$)를 기준으로 비관련흐름법칙(nonassociated flow-rule)이 적용된 경우(${\psi}$ < ${\phi}$)의 상대적인 지지력 비율을 산출하였고, 일반적인 모래에 대한 관계식을 제안하였다. 원형기초의 형상계수는 연속기초의 평면변형률 조건의 고려 여부에 따라 크게 변하였으며, 평면변형률 조건을 고려하여 내부마찰각을 증가시킨 경우가 기존의 실험 결과와 유사한 경향을 나타내었다. 형상계수 제안식들의 경향이 차이를 나타내는 원인에 대하여 고찰하고 설계시 적용 방안을 제시하였다. Bearing capacity factor $N_{\gamma}$ and shape factor were studied for rigid strip and circular footings with a rough base on sand by numerical modelling considering the effect of dilation angle. The numerical model was developed with an explicit finite difference code. Loading procedures and interpretation methods were devised in order to shorten the running time while eliminating the exaggeration of the reaction caused by the explicit scheme. Using the Mohr-Coulomb plasticity model with associated (${\psi}={\phi}$) and nonassociated (${\psi}$ < ${\phi}$) flow-rules, the bearing capacity factor $N_{\gamma}$ was evaluated for various combinations of internal friction angles and dilation angles. Bearing capacity factor decreased as the dilation angle was reduced from the associated condition. An equation applicable to typical sands was proposed to evaluate the relative bearing capacity for the nonassociated condition compared to the associated condition on which most bearing capacity factor equations are based. The shape factor for the circular footing varied substantially when the plane-strain effect was taken into account for the strip footing. The numerical results of this study showed closer trends with the previous experimental results when the internal friction angle was increased for the strip footing. Discussions are made on the reason that previous equations for the shape factor give different results and recommendations are made for the appropriate design shape factor.

광역정전사고 방지를 위한 무효전력 한계시험과 계전기 동작 사례 분석

김동준(Dong-Joon Kim),이종주(Jong-Joo Lee),문영환(Young-Hwan Moon) 대한전기학회 2014 대한전기학회 학술대회 논문집 Vol.2014 No.7

호텔브랜드이미지가 고객만족 및 구매의도에 미치는 영향에 관한 연구

김동준(Dong-Joon Kim) 한국엔터테인먼트산업학회 2014 한국엔터테인먼트산업학회 학술대회 논문집 Vol.2014 No.5

본 연구에서는 호텔브랜드이미지가 고객만족 및 구매의도에 미치는 영향관계를 분석하기 위하여 호텔브랜드이미지의 하위요인으로 호텔서비스, 호텔분위기, 호텔인지도, 전체이미지를 도출하고 실증분석을 실시하였다. 실증분석 결과를 요약하면 다음과 같다. 첫째, 호텔브랜드이미지의 호텔서비스, 호텔분위기 요인이 고객만족에 영향을 미치는 것으로 나타났고, 호텔인지도와 전체이미지 요인은 영향을 미치지 않았다. 둘째, 호텔브랜드이미지의 전체이미지, 호텔서비스, 호텔분위기 요인이 구매의도에 영향을 미치는 것으로 분석되었고, 호텔인지도 요인은 영향을 미치지 않았다. 마지막으로, 고객만족은 구매의도에 영향을 미치는 것으로 나타났다. 결론적으로, 본 연구는 서울시내 특1급호텔의 이용고객을 대상으로 하였고, 호텔브랜드이미지의 요인들이 고객에 미치는 영향관계를 실증분석 한 의의가 있다 하겠다. 그리고 그동안 주로 연구되어 온 외식분야에서 벗어나 호텔을 대상으로 하여 브랜드이미지를 분석함으로써 호텔고객에게 만족과 다시 이용할 수 있는 전략을 수립하는데 기초적인 자료를 제공한다는 점이 시사점이라 하겠다. This research is to find out the effect of hotel brand image on customer satisfaction and purchase intention. Based on the relevant literature review, this study posits four characteristics, that is, hotel service, hotel atmosphere, hotel awareness, general image of hotel brand image, customer satisfaction and purchase intention as key variables to describe the post acceptance behavior in hotel service. The results of this study are summarized as follows. First, hotel service and hotel atmosphere factors have positive influence on customer satisfaction. Second, general image, hotel service and hotel atmosphere factors have positive influence on purchase intention. Lastly, customer satisfaction have positive effect on the purchase intention. The findings have significant implications for hotel service providers and academic researchers.

디지털 휴먼 모델링 도구를 이용한 작업 개선에 관한 연구

김동준 ( Dong Joon Kim ),박주용 ( Ju Yong Park ),김현우 ( Hyun Woo Kim ),장성록 ( Seong Rok Chang ) 한국안전학회 2008 한국안전학회지 Vol.23 No.2

디지털 건축에서 유기적 형태의 구축특성에 관한 연구

김동준(Kim Dong-Joon),정재욱(Chong Jae-Uk) 대한건축학회 2007 대한건축학회논문집 Vol.23 No.12

This study seeks to integrate the principles of expression and the constructive system in the past with the technique of digital shape extraction. Then it continues to analyze cases by means of codification. The study provides objective data on organic characteristics and principles of digital architecture and its construction process based on the findings of the aforementioned processes. The scope of selection at each stage and corresponding criteria are as follows: First, the technique of shape deduction is analyzed by using the criteria digital architects have been applying in their designs since 1990 in consideration of the link such shape deduction technique has to the organic expressive principles. Second, this study draws factors of organic architecture based on its formative relationships. The identified factors are used along with the digital shape techniques to form approaches to the shape structure system. Third, techniques of obtaining shapes in the shape structure system are classified using principles of expression and formative relations in digital architecture. Fourth, the findings from the preceding process are codified into various stages in order to form a set of criteria required to analyze the principles and characteristics of digital architecture. The process of codification is where the stages of analysis are summarized, classified, and integrated. Fifth, cases are selected according to the scope which cases are determined. Cases are then run through basic analysis process to reach the final conclusion of the study by applying the criteria of analysis formed in the previous process.

독성 간손상의 평가

김동준 ( Dong Joon Kim ) 대한소화기학회 2009 대한소화기학회지 Vol.53 No.1

Liver injury due to prescription and nonprescription medications is a growing medical, scientific and public health problem. Drug-induced liver injury (DILI) is the single most common reason for regulatory actions, including failure of approval, removal from the marketplace and restriction of prescription. Worldwide, the estimated annual incidence rate of DILI is 13.9-24.0 per 100,000 inhabitants. At the same time, there is increasing concern about the potential risk for hepatotoxicity from complementary and alternative medicines (CAM) including herbal products because they are unregulated and not standardized with regard to their contents. Determining hepatotoxicity remains a major challenge in clinical practice due to a lack of reliable markers. The RUCAM/CIOMS scale have been proposed to establish a causal relationship between offending drug and liver injury. The efforts of Drug-Induced Liver Injury Network (DILIN, USA) directed toward the development of an abridged instrument in evaluating suspected drug-induced hepatotoxicity were presented at the National Institute of Health (NIH) Workshop, titled "Drug-induced liver injury: Standardization of nomenclature and causality assessment", December, 2008. The main contents of the presentations and discussions at the NIH workshop are introduced in this article. This fine-tuned operations of RUCAM/CIOMS scale would enable a more confident assessment of causality and facilitate the collection of bona fide cases of drug-induced hepatotoxicity in Korea. Several demanding tasks for the near future in Korea are also proposed at the end. (Korean J Gastroenterol 2009;53:5-14)

47,000톤급 중형 크루즈선의 추진방식에 따른 선미부 형상과 저항특성 비교

김동준(DONG-JOON KIM),박현수(HYUN-SOO PARK),현범수(BEOM-SOO HYUN),김무롱(MOO-LONG KIM),최경식(KYUNG-SIK CHOI) 한국해양공학회 2004 韓國海洋工學會誌 Vol.18 No.5

Various propulsion systems, applicable for a G/T 47,000 class mid-size cruise ship, are discussed and a comparative study on stern forms and hull resistance characteristics is carried out, in relation to these propulsion systems. Based on shipyard production logs on similar cruise ships, a reference hull form of a single shaft propulsion system with center-skeg, is generated. Then two new stern hull forms are derived by using a hull transform technique: consisting of one stern form using a twin-skeg system and the other using the Azipod system. Using a CFD-based commercial flow analysis program, WAVIS (WAve and VIScous flow analysis system for hull form development), various hydrodynamic characteristics, including wave profiles and ship hull resistance, are compared for three hull forms.