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.

조직구성 수성망상증 2예

최연수,박일,죄희충,김원식,양태영,허경,안기완,정춘해 조선대학교 1993 The Medical Journal of Chosun University Vol.18 No.2

Histiocytic medullary reticulosis (HMR) is a malignant noeplastic process, with tumor cells belonging to the histiomonocytic line, and originally described by Scott and Robb-Smith in 1939 characterized by its acute onset, progression to death within a few months and its clinical features are fever, lymphadenopathy, hepatosplenomegaly, jaundice, and purpura common laboratory findings are characterized by severe anemia, leukopenia, thrombocytopenia and histologically by systemic progressive invasion of morphologically atypical histiocytes or of their precursor. 61 and 37-year-old males were admitted with camplaints of high fever and chilling sensation and were treated by cyclophosphamide, vincristine, prednison and antiobiotics, but patients all died 17 and 14 days after admission due to probably sepsis and respiratory failure.

인슐린 비의존형 당뇨병 환자에서 혈장 Endothelin-1농도의 변화

신양수,조희충,김원식,국기용,김용화,정종훈,문철웅,배학연,양성훈 朝鮮大學校 附設 醫學硏究所 1992 The Medical Journal of Chosun University Vol.17 No.2

Endothelin(ET) is a 21-residue peptide originally isolated from the cultured porcine endothelial cells. There are at least three genes for endothelin:endothelin-1(ET-1), endothelin-2(ET-2), and endothelin-3(ET-3). Endothelins are present in various human biological fluids including plasma, urine, breast milk, and saliva and have been found elevated plasma ET concentrations in patients with diabetes mellitus, Patients undergoing maintenance hemodialysis due to chronic renal failure, patients with acute myocardial infarction, and patients with subarachnoid hemorrhage. Endothelial cell damage is suspected to occur in diabetic patients and may be one important cause of angiopathy, a major complication in diabetes mellitus. The elevation of ET in diabetic patients may be a marker of, and further exacerbate, their vascular disease. We measured the levels of ET-1 in plasma of 50 patients with non-insulin dependent diabetes mellitus(NIDDM) and 25 normal subjects by radioimmunoassay. The plasma ET-1 concentration (mean±S.D.) in NIDDM was 6.461 A2.510 f㏖/ ㎖, and was significantly higher than in normal subjects (4.567±1.155f㏖/㎖) (P<0.05). The plasma ET-1 concentration (mean±S.D.) in diabetic retinopathy group( 7.15±2.454 f㏖/ml) was significantly elevated than those in otherwise uncomplicated groups (5.348±2.390 f㏖/㎖)(P<0.01). The correlation between any clinical parameters and plasma ET-1 levels in NIDDM was not significant, In conclusion, this study suggest that the elevated levels of ET-1 in diabetic patients may be play a important role in the pathogenesis of diabetic complications.

열처리시 냉간가공된 Zircaloy-4합금의 미세조직 및 재결정 거동

林潤洙,崔洋鎭,鄭蓮眺,魏明鏞 大田産業大學校 1999 한밭대학교 논문집 Vol.16 No.1

Effects of heat-treatment on the microstructure and recrystallization behavior of cold-worked Zircaloy-4 were studied. We used 70% cold-rolled, thin strip specimens. Heat-treatment of the specimens were performed at temperatures between 300℃ and 800℃ for 30 to 5,000 minutes. The recrystallization behavior were observed by means of polarized optical microscopy and TEM. Hardness were measurement by Micro-victors hardness tester. As the annealing time increased, the temperature region of hardness drop moved to lower, because the recovery and recrystallization could occur in lower temperature. The recrysatllization of cold-worked Zircaloy-4 alloys was completed between 500℃ and 600℃ for 60 min. The size of recrystallized grain visibly increased at 800℃ for above 600 min. The activation energy(Q) for recrystallization of Zircaloy-4 alloys was determined by the time for constant fraction technique and it was 253KJ/mo1.

직업재활 프로그램이 만성 정신분열병 환자의 삶의 질에 미치는 영향

황태연,한은선,이충순,한양순,이민수,이대희 용인정신의학연구소 1995 용인정신의학보 Vol.2 No.2

두개강내 출혈을 동반한 불응성 특발성 혈소판감소성 자반증의 CYCLOPHOSPHAMIDE 치험 1예

서정철,양태영,최연수,박유환,김완중,허경,정원영,정춘해 朝鮮大學校 附設 醫學硏究所 1993 The Medical Journal of Chosun University Vol.18 No.1

Idiopathic thrombocytopenic purpura(ITP) is an autoimmune bleeding disorder characterized by the development of antibodies to one's own platelets, which are then destroyed by phagocytosis in the spleen and liver. Its clinical manifestations are characterized by bleeding and the most serious complication is hemorrhage into the central nervous system, but which is rarely seen below 1%. In treating IPT, the therapy of first chice is administration of adrenocorticosteroid and r-globuline. If satisfactory results are not obtained, then splenectomy is recommended. If this also proves inadequate, then administration of immunosuppressants is carried out. 16-year-old male was admitted with complaints of left hemiplegia and nasal bleeding. This case may be developed spontaneous intracerebral hemorrhage causing thrombocytopenia and was treated by steroid, r-globuline and splenectomy, but satisfactory results are not obtained. After all, the paient was successfully treated with cyclophosphamide.

동일한 시료에 대한 국내 기관간의 STR 분석결과 비교 : STR 유전자좌 분석법의 표준화 설정을 위하여

박종태,신경진,양윤석,우광만,이숭덕,이승환,이정빈,정연보,조승희,한길로,한면수,홍승범 大韓法醫學會 2001 대한법의학회지 Vol.25 No.1

This paper described a collaborative exercise intended to see what kinds of short tandem repeat (STR) loci are used in different DNA typing laboratories in Korea and to compare their results for the demonstration whether uniformity of DNA profiling results from different laboratory could be achieved in Korea Laboratories were asked to test five tissue DNAs using methods routinely used in each laboratory and to report the results to the coordinating laboratory. The exercise demonstrated that each laboratory was using different STR loci for the typing with different STR numbers,2 VNTRS,36 STRs and amelogenin in total, and the direct comparison of the results from all the laboratory for the 18 loci could not be done as only one laboratory submitted typing results. Among 21 loci for which several laboratories submitted typing results, results for 14 loci were the same and results for the other 7 loci were different depending on the participating laboratory. D1S80, F13A01, D16S539, D21S11, D18S51, D3S1744 were the loci with different typing results. Even in the cases where commercial kits were used, the results were not the same depending on the machines used, that is the capillary electrophoresis or the gel based electrophoresis. The reason for the different results, points about the standardization of the methods arid the profiling data were described.

최근 10년간 원광의대병원에서 시행한 소아 심장혈관 수술의 임상적 고찰

윤향석,정수미,최두영,오광수,오연균,김종덕,양현웅,이삼윤,김형곤,최종범,최순호,노병석 圓光大學校 醫科學硏究所 1995 圓光醫科學 Vol.11 No.2

We reviewed 10 years experiences of the clinical aspects and early postoperative results in 544 pediatric patients(age less than 16 years old). Among them. 529 cases had the congenital heart diseases, and 15 had the acquired diseases. Open heart surgery was performed in 413 patients. 115 cases were treated with non-open heart surgery. 16 with interventional catheterization. Annual increase of the cardiac patients was not significant in recent 10 years, except slight increase in 1994. The mean age of the study patients had been evidently changed to younger year by year. Total mortality rate of the open heart surgery was 6.4%. The cyanotic congenital heart diseases were high in early postoperative mortality by 25.7%, whereas 4% in acyanotic group. The age group less than one month was most highest in surgical mortality(66.7%). There were no deaths in patients with patent ductus arteriosus(103 cases), atrial septal defect(83 cases) or pulmonary stenosis(17 cases). Among 220 patients with ventricular septal defects(VSD). 10(4.5%) were died early postoperatively. In cyanotic group, the patients with pulmonary atresia with ventricular septal defects(PAVSD), transposition of the great arteries(TGA), interrupted aortic arch(IAA), complex cardiac anomalies with isomerism seemed to be most susceptible to an early death.

경부외측종괴의 감별진단 및 접근에 대한 고찰

이경호,박현진,강지연,최희원,조용석,김경원,양수남 大韓顎顔面成形再建外科學會 2002 Maxillofacial Plastic Reconstructive Surgery Vol.24 No.6

Most neck masses of specific cause occur in rather predictable locations within typical age groups. This allows a systematic approach to developing a working diagnosis and a differential diagnosis and management plan for the patient presenting with a neck mass. Pathologic masses of the neck will be divided into the following segment: 1. Masses of nonspecific location. 2. Masses in the submandibular region, 3. Masses in the parotid region, 4. Masses in the median-paramedian region, 5. Masses in the lateral neck region. The lateral neck region is the area posterior to the hyolaryngotracheal conduit, below the posterior belly of the digastric muscle and tip of the parotid gland, and extends down to the clavicle. The contents of this region include the large vessels, nerves and greatest number of lymph nodes of the neck, and lymph node metastasis in this region is usually from a primary lesion at the base of the tongue or elsewhere in the oropharynx. Common lateral neck masses include branchial cleft cyst, carotid body tumor, neurogenic tumor, pan-neck infection, cystic hygroma, hemangioma, lipoma and lymphoma. Especially lymphosarcoma. Hodgkin's disease, cystic hygroma, hemangioma and branchial cleft cyst and more common and often manifest in the young patients. Many head and neck disease processes manifest as neck masses. These conditions are treated by surgical excision, except for some inflammatory masses, and often those also must be excised before a diagnosis can be made. We retrospectively reviewed 5-year experiences in the treatment of lateral neck masses at our department to define better clinical characteristics of the masses and the optimal diagnostic and therapeutic approaches to these rare diseases.

성인에서 발병한 지역사회폐렴의 원인으로서 호흡기 바이러스의 역할

김지희,곽영호,나병국,이주연,신구철,정혜선,홍정연,오명돈,정희진,김민자,배현주,김양리,신완식,강재명,우준희,어수택,이환종 대한감염학회 2001 감염 Vol.33 No.1

Purposes : To investigate the viral etiology of community-acquired pneumonia in Korean adults, we have detected respiratory viruses (Respiatory syncytial virus, adenovirus, influenza virus and parainfluenza virus) in the way of prospective, multi-center study. Methods : From July 1997 to April 2000, nasal aspirates or sputum were obtained from adults patients with community pneumonia admitted to the participating hospitals and transferred immediately to the central laboratory at the Seoul National University Children's Hospital. The specimens were divided into three parts. One part was used for indirect immunofluorescent test for respiratory viruses, the other part for the culture of RSV and adenovirus in HEp-2 cell monolayer. The other part was used for the culture of influenza virus and parainfluenza virus in MDCK or LLC-MK2 cell monolayers. Results : Of 317 samples, 32 (10.1%) specimens were positive for viral agent by indirect IF staining or culture, including one dual-infected specimen (adenovirus and parainfluenza virus). Influenza virus was most commonly detected (16 specimens). Parainfluenza virus, adenovirus and RSV were detected in 10, 4 and 3 patients, respectively. All isolated influenza viruses were type A (H3N2 in 9 patients, HIN1 in 2 and unspecified in 5), and 8 out of 10 parainfluenza virus isolates were type 3. Conclusion : Similar to previous reports from other countries, a significant portion of community-acquired pneumonia in Korean adult is caused by respiratory viruses. (Korean J Infect Dis 33:8~14, 2001)