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.

경상남도 창녕에서 집단 발생한 피부 탄저병의 임상양상

박찬원,박정래,정종윤,이선희,장철훈,오차재,조병만,임재영,오창근,권경술 대한감염학회 2002 감염 Vol.34 No.4

상 이동촉매를 이용한 할로겐화 시클로헥실의 아지드화 반응

金昌培,鄭喜瓊,金鍾奎 단국대학교 1990 論文集 Vol.24 No.-

Formation of cyclohexyl azide from the corresponding chloride and bromide under phase transfer catalyst condition was investigated. Nine quaternary ammonium and phosphonium salts were used. Azidations were complete within 5 to 30 hrs depending upon the kind of catalyst and the amount of water. Aliquat 336 and tetrabutyllammonium salts showed the best result. The coversion of cyclohexyl halide to azide was accompanied with the formation of cyclohexene, the elimination product. 10∼20% of this product was formed when farely good catalysts were employed. When saturated aqueous NaN_3 solution was used, the best yield of substitution product could be obtained, and reactions took longer hours as the aqueous layer was diluted.

신 손상환자에서 혈관조영술의 역할

박청희,송창준,김종철 충남대학교 의과대학 지역사회의학연구소 1988 충남의대잡지 Vol.15 No.2

We analyzed angiographic findings of 18 patients with renal injury, and also excretory urography. Angiography is advocated for better definition of previously identified urographic abnormality and for assessment of active bleeding in patients with suspected damage to renal vessels. It also can be therapeutic as transcatheter embolization for control of hemorrhage.

Increased expression of P53 and Bax in the spinal cords of rats with experimental autoimmune encephalomylitis

문창종,김승준,위명복,김희석,정종태,박전홍,지영흔,Tanumab, Naoyuki,Matsumoto, Yoh,신태균 濟州大學校 農科大學 動物科學硏究所 2000 動物科學論叢 Vol.15 No.1

The expression of pro-apoptotic molecules, p53 and Bax, in the spinal cord of rats with experimental autoimmune encephalomyelitis (EAE) was examined. Apoptosis was confirmed by the terminal deoxynucleotidyl transferasemediated dUTP nick end-labeling (TUNEL) method. TUSEL (+) apoptotic cells were mainly either ED1 (+) macrophages or T-cells in the parenchyma of E N . Western blot analysis showed that both p53 and Bax expression significantly ( p < 0.01) increased in the spinal cords of EAE rats at the peak stage, and thereafter declined. An immunohistochemical study showed that inflammatory cells (notably T cells) in the parenchyma express p53 and Bax, while brain cells, includng neurons and glia, were devoid of these nuclear staining of these molecules. The nuclear expression of p53 largely matches apoptotic cells in the parenchyma of EAE. These finchngs suggest that pro-apoptotic molecules, p53 and Bax, may play an important role in eliminating T cells in the parenchyma in EAE.

성인에서 Haemophilus influenzae 감염증의 임상양상과 미생물학적 특성

이종섭,황병연,정희진,김우주,박승철,이도현,이창규,신종희,황규잠,이영희 대한화학요법학회 2000 대한화학요법학회지 Vol.18 No.2

목적 : H. influenzae는 성인에서 흔히 호흡기 감염을 일으키는 균주로, 최근 ampicillin 내성 β-lactamase 생성 균주들이 지속적인 증가를 보이고 있어, 이에 국내 성인에서 H. influenzae에 의한 감염의 임상양상과 분리된 균주들의 미생물학적 특성을 조사하고자 하였다. 방법 : 1998년 3월부터 1999년 9월까지 고려대 구로병원에 내원한 환자중에서 H. influenzae가 분리된 68명을 대상으로 임상양상을 조사하고 항균제 감수성 검사를 시행하였다. 분리된 33주에 대해서 혈청형, 생물형, 세포외막 단백분석을 시행하였고, β-lactamase 생성여부에 따른 감염 환자군간 임상상 및 예후의 차이를 비교하였다. 결과 : 환자의 평균연령은 68세였고, 지역사회 획득감염이 전체의 85%를 차지하였다. 폐렴과 기관지염과 같은 하기도 감염이 전체환자의 75%를 차지하였고 분리 검체 역시 객담이 84%로 가장 많았다. 환자의 71%가 기저질환을 가지고 있었으며, 그 중에 만성 폐쇄성 폐질환, 심혈관 질환, 악성종양, 당뇨병이 대부분이었다. 혈청형으로는 nontypeable 형이 68%로 가장 많았고 b형은 한 예도 없었다. β-lactamase 생성율은 63.2%였고, β-lactamase 양성균주의 항균제 내성율이 음성균주에 비하여 높았으나 β-lactamase 생성 여부에 관계없이 cefotaxime, azithromycin, ciprofloxacin에 대하여 100%의 감수성을 나타내었고 cefaclor, cefuroxime에 대해서는 10% 이하의 낮은 내성율을 보여 이들 항균제들이 치료에 효과적일 것으로 사료된다. 세포외막 단백분석에서는 C형과 D형이 전체의 64%로 가장 많았으며, 혈청형과의 유의한 연관성은 보이지 않았다. 결론 : 성인에서 H. influenzae는 주로 만성 기저질환자에서 급성 호흡기감염 또는 만성 폐쇄성 폐질환의 급성 악화를 유발한다. 기존의 보고에 비해 β-lactamase 양성율이 증가하였고, 이에 따른 항균제 내성율도 증가하여 항균제의 선택에 유의하여야 할 것으로 생각된다. 세포외막 단백분석상 특정한 유형의 균주에 의해 감염이 집중적으로 발생하고 있어 향후 역학 조사의 도구로 이용할 수 있겠다. Purpose : H. influenzae is one of the common causative microorganisms of respiratory tract infections in adults. Recently. β-lactamase producing, ampicillin-resistant H. infiuenzae has become worldwide problem as well as in Korea. We studied to investigate the clinical features and microbiologic characteristics of H. infiuenzae infections in adults. Materials & Methods : From March 1998 to September 1999, 68 patients were enrolled in this study. Clinical features of H. infiuenzae infections were investigated, 68 isolates were subjected to the β-lactamase test, and 33 isolates were used for serotyping. biotyping, antibiotic susceptibility and outer membrane protein (OMP) analysis. Results : Mean age of study patients was 68 years-old and the acquisition rate in community was 85%. Pneumonia and bronchitis were the most common type of infection such as 80%, sputum was the most common clinical specimen for H. mQuenzae isolation. 70% of patients had chronic underlying diseases. Non-typeable strains were 68% and β-lactamase producing rate was 63%. There was no difference in the clinical features and prognosis of H. influenzae infection between the β-lactamase positivie and -negative groups. The susceptibility of cefotaxime, azithromycin, and ciprofloxacin was 100% and that of cefaclor, cefuroxime was under 10% in spite of β-lactamase positivity. In OMP analysis, C and D types were dominant (64%). Conclusion : H. influenzae caused acute respiratory infections in adults with chronic underlying disorders. This study shows higher β-lactamase producing rate and antibiotic-resistance rate than that were reported previously. OMP analysis shows that two major types of strains cause clinical infections intensively.

일개 대학병원에서 일년간 분리된 반코마이신 내성 장구균의 임상 분자역학적 연구

송진영,김창억,김성욱,우흥정,김미란,이규만,이란,장미화,정희진,김우주 대한화학요법학회 2001 대한화학요법학회지 Vol.19 No.4

목적 : 한강성심병원에서는 2000년 3월 반코마이신내성 장구균이 처음 분리되어, 원내전파를 막기 위한 노력을 하였으나, 분리가 지속되었다. 따라서 이에 대한 좀더 자세하고 객관적인 자료를 얻기 위해 본원에서 분리된 반코마이신내성 장구균에 대한 임상분자 역학적 연구를 시행하게 되었다. 방법 : 2000년 3월부터 2001년 2월까지 한림대학교 한강성심병원에서 분리된 장구균을 대상으로 디스크 확산법, 최소발육억제 농도등의 측정을 통해 반코마이신 내성여부를 확인하였으며, 반코마이신내성 장구균을 대상으로 PFGE를 시행하여 형별 분석을 하였다. 결과 : 분리된 균주는 총 32균주로 모두 E. faecium이었다. 항생제 내성 검사 결과 모두 Van A형이었다. PFGE 결과 1a형이 8검체, 1b형이 5검체, 2a형이 4검체, 2b형이 4검체, 3a형이 2검체, 3b형이 5검체였고, 그 외 4, 5, 6형이 각각 1검체씩이었다. 총 32균주 중 56%(18/32)의 균주가 같은 시기, 같은 병실에서 동일한 PFGE 형을 보이면서 분리되었다. 결론 : 반코마이신내성 장구균의 PFGE 분석 결과 여러 종류의 반코마이신내성 장구균이 유행하였음을 알 수 있다. 그러나 같은 기간, 같은 병실에서 분리된 균주의 PFGE 형이 같은 것이 상당수 있었다. 이는 반코마이신내성 장구균의 원내 전파가 있었음을 의미한다. 따라서 반코마이신내성 장구균의 전파의 발생 및 전파 방지를 위해서는 보다 효과적인 감염관리 활동이 필요할 것으로 생각된다. Background: Vancomycin-resistant enterococci(VRE) have been a rising problem worldwide. In March 2000, VRE was first isolated from a patient in Hangang Sacred Heart hospital. Although efforts to prevent transmission of VRE were performed, isolations continued. So molecular epidemiological study of VRE was done. Method : The minimal inhibitory concentration(MIC) to vancomycin and teicoplanin, and pulsed field gel electrophoresis(PFGE) pattern of VRE isolated from March 2000 to February 2001 were evaluated. Results : 32 VRE were isolated. All of the VRE were Enterococcus faecium and showed Van A resistance phenotype. We found out that a significant number of VRE isolated during same period and in same room, were same PFGE patterns. (18 cases/ 32 isolates= 56%) Conclusion: This study demonstrated the spread of VRE of same PFGE patterns. It suggests the nosocomial spreads of VRE.

의료환경 변화에 따른 감염성 심내막염의 양상 변화

신소연 ( So Youn Shin ),박윤수 ( Yoon Soo Park ),최준용 ( Jun Yong Choi ),조정호 ( Cheong Ho Cho ),박윤선 ( Yoon Seon Park ),김창오 ( Chang Oh Kim ),윤희정 ( Hee Jung Yoon ),김효열 ( Hyo Yul Kim ),염준섭 ( Jun Sup Yum ),이꽃실 ( K 대한내과학회 2005 대한내과학회지 Vol.68 No.2

목적 : 2000년 7월 국민 건강 증진, 보건 관련 비용의 감소, 약물 오 남용 방지 등의 취지로 의약분업이 시행되었다. 의약분업 이전에는 항생제의 구입에 별 다른 제약이 없었으나, 의약분업 이후 대부분의 항생제가 전문의약품으로 분류되면서 항생제의 구입시 의사의 처방전이 필요하게 되었다. 감염성 심내막염은 비특이적인 초기 임상증상으로 환자들이 내원 전 경구 항생제를 복용하는 경우가 많았다. 혈액배양 음성 감염성 심내막염의 가장 흔한 원인으로 내원 전 Background : In July 2000, there was a dramatic change in Korean health care system with the medical reform, the separation system of pharmacies and prescriptions. Before then, patients could easily get antibiotics without doctors` prescriptions. Since th

Studies on Self-Perceived Health and Appearance, Health-Related Lifestyles and Dietary Behaviors of Korean College Students Attending Web Class

Cheong, Sun-Hee,Kim, Jin-Sook,Lee, Mi-Young,Lee, Jeong-Hee,Chang, Kyung-Ja Korean Society of Community Nutrition 2001 Journal of community nutrition Vol.3 No.2

The purpose of this study was to investigate self-perception and practices of health and appearance, health-related lifestyles and dietary behaviors of college students(137 male, 115 female) attending web class via the Internet. This cross-sectional survey was conducted by a self-administered questionnaire and data was analyzed by SPSS program. The average height, weight and BMI of the male and female college students were 174.4cm, 67.8kg, 22.3kg/㎡ and 162.3cm, 52.1kg, 19.8kg/㎡, respectively. Male collage students perceived their health statuses significantly better compared to female students. As for self-evaluation of anemia, female college students perceived significantly more anemia symptoms compared to male college students. Female college students perceived their body image to be obese compared to male college students. Underweight college students perceived significantly less healthy statuses, more anemia symptoms, and worse hair conditions compared to other college students. The rate of male students who exercise was significantly higher compared to that of female students. Male students reported significantly more smoking and drinking of alcohol compared to female students. The rate of female college students skipping meals was significantly higher than that of male college students. Frequency of eating out in female college students was significantly higher compared to that in male students. These results may provide some basic information in developing a nutrition education program for Korean college students using Internet.

A Study on Dietary Intake and Vitamin and Mineral Supplement Use by Korean College Students Attending Web Class

Cheong, Sun-Hee,Kim, Jin-Sook,Lee, Mi-Young,Lee, Jeong-Hee,Chang, Kyung-Ja The Korean Nutrition Society 2001 Nutritional Sciences Vol.4 No.2

The Purpose of this study was to investigate the dietary intake of nutrients and the use of vitamin and mineral supplements by Korean college students attending Web class and the socioeconomic, dietary and health-related factors involved. The subjects were 137 male and 115 female students amending a health and nutrition-related Web class at a cycler university. This cross-sectional survey was conducted by self-administered questionnaire and the data were analyzed by SAS and SPSS PC package programs. Nutrient intake data collected using three-day recall method were analyzed by the Computer Aided Nutritional Analysis Program. Average intake by male students of most nutrients except energy, vitamin B$_2$ and calcium and intake by female students of those except energy, vitamin $B_2$, calcium and iron was higher than Korean RDA. Nutrient intake of male students was significantly influenced by the mother s job, skipping meals, exercise, vitamin and mineral supplement use, flood supplement use and self-evaluated anemia. Skipping meals and flood supplement use significantly influenced the nutrient intake of female students. A total of 47.4% of male students and 53.9% of female students were vitamin and mineral supplement users. In female students, socioeconomic characteristics such as the father s education level and household income were significantly different between vitamin and mineral supplement users and non-users. In both male and female students, there were significant differences in cross analysis between vitamin and mineral supplement use and flood supplement use. As for the self-reported health status of male and female students, vitamin and mineral supplement users perceived their health status to be worse compared to non-users. Therefore, nutrition education via the Internet is necessary in order to encourage college students to practice optimal nutrition strategies, including maintaining well-balanced diets by choosing various floods wisely.