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.

관절염 환자의 민속요법이용 형태

은영,강현숙,이은옥,이인숙,이종수 서울대학교 간호대학 간호과학연구소 1997 간호학 논문집 Vol.11 No.1

This sty was undertaken to explore the utilization patterns of medical treatment and herb medicine in patients with arthrits. The data were collected from 995 patients who were registered either in a center of rheumatology or resided in community with arthritis. The data were analyzed by percentile, t-test and chi-square test using SAS PC program. The results of this study were as follows; 1. According to characteristics of sample-population, mean age was 57.7 years, duration of arthritis 9.7 years and mean duration of pain 2.4 hours per day at present. 2. First diagnosis was identified at department of orthopedic surgery or local clinic. But 85.2% of patients have transferred to the center of reumatology currently. But ironically over 70% of patients experienced the herb treatment and herb treatment had hern medicine simultaneous with medical treatment. This indicated that they were shopping around of treatment during the first one year. 3. Mean cost of medical treatment was 67,400 won, while they payed to herb medicine as much as two or three times. The utilization rate of herb medicine was 36.5% of patients per one year. Costs of herb-treatment were 182,000 Won and herb medicine was 36.6% of patients per one year. Costs of herb -treatment were 182,000 Won and herb medicine 149,100 Won. 4. Eighty point six percent of patients were experienced herb medicine during life-time. One hundred and seventy four kinds herb medicine were found to be used by patients, most of which were nutrients, muscle relaxants, andtiphlogistics and analgesics. Thirty two point six percent of users recognized that herb medicine were effective but 51.7% did not. In conclusion, arthritis patients have been experienced various kinds of drug and remedies for treatment. And they wasted their limited medical and economical resources on these unresonable remedies. Therefore, they should be guided for wise decision about treatment. Futher studies in nursing will be required to explore the value system of patients about herb medicine, the determinant factors of shopping-around patterns of treatment, and the coping mechanism for chronic pain or aggravating symptom.

複合生藥製劑의 止血作用및 摘出子官筋에 미치는 影響(第4) : 壽脾煎 및 歸脾양에 대하여 On Soo-Bi-Jeon and Kwi-Bi-Tang

殷載淳,李東熙,黃甲洙 又石大學校 1990 論文集 Vol.12 No.-

These experiments were conducted to investigate the pharmacological difference between Soo-Bi-Jeon and Kwi-Bi-Tang extract,, clinically used in gynecology, on the hemostasis and the contractile force of the isolated uterine muscle. For this purpose, the effects of the extracts on the bleeding time in mouse tail and prothrombin time in vitro were estimated. Forthermore, its activity on the isolated uterine muscle in rats were investigated. The results obtained were as following; The bleeding time and prothrombin time were significantly shortened compared with the control group in all samples, The uterotonic action produced by Kwi-Bi-Tang(Sample II), Sample III and IV (the same component crude drugs between not blocked by atropine (10^(-7)M) and cyproheptadine (10^(-7)M). but inlhibited by pretreatment of verapamil (10^(-7)M). On the oter hand, Soo-Bi-Jeon(Sample I) extract relaxed the uterine muscle.

수입각증후군에 의한 급성 복증 1례

정은욱,지삼룡,이영태,박지훈,김동기,제인수,채두근,박성재,박은택,이연재,이상혁,설상영,정정명 白中央醫療院 2005 仁濟醫學 Vol.26 No.1

Afferent loop syndrome is an uncommon complication of a gastrectomy and Billroth Ⅱ reconstruction. It may cause symtoms at any time from the first postoperative day to many years after the gastrectomy. Afferent loop syndrome is characterized by abdominal pain, vomiting and elevation of serum amylase. Thus, it is difficult to differentiate afferent loop syndrome from other cause of acute pancreatitis. However, the history of gastrectomy can be an important clue for diagnosing afferent loop syndrome. We experienced one case of chronic afferent loop syndrome with acute pancreatitis. After appropriate management, the abdominal pain disappeared and serum amylase level decreased. We report this case with a review of relevant literatures.

횡문근융해증과 급성 신부전 및 범발성 혈관내 응고장애를 동반한 열사병 1예

최대은,박수진,권오경,이한규,이영모,이상주,나기량,이강욱,신영태 충남대학교 의학연구소 2003 충남의대잡지 Vol.30 No.2

Heat stroke is a life-threatening illness characterized by an elevated core body temperature that rises above 40% and central nervous system dysfunctions that results in delirium, convulsions, or coma. Heat stroke is subdivided into two forms, classic and exertional. Since strenuous exercise is one of the major exacerbating and precipitating factors, the incidence of exertional heat stroke is high among young adult, especially military personnel undergoing military training. Exertional heat stroke commonly causes rhabdomyolysis, lactic acidosis, acute renal failure, shock and pulmonary edema. We report a case of heat stroke with rhabdomyolysis, acute renal failure, disseminated intravascular coagulopathy(DIC) after strenuous exercise. A 18 year old man was admitted to the hospital because of loss of consciousness. He was a wrestler and he had tried to lose 6kg in weight by jogging and strenuous exercise on that summer day with hot temperature. The development of this illness was favoured by much clothes inappropriate for that environmental condition with a purpose to enhance sweating, and by restricted intake of water and food. On admission, the blood pressure was 80/50mmHg, and body temperature was 39.4℃ with stuporous mentality. Laboratory finding were as follows : in complete blood cell count, hemoglobin was 16.7g/dL and platelet count was 158,000/ mm³. In blood chemistry, AST 1061U/L, ALT 201U/L, BUN 30mg/dL, Cr 2.2mg/dL, LDH 941IU/L, CK 696IU/L were resulted. In arterial blood gas analysis, pH 7.39, pCO₂ 30mmHg pO₂ 86mmHg, HCO₃ 18.4mEq/L, O₂ saturation 96.7% were resulted. In urinalysis, specific gravity 1.025, protein 3+, erythrocyte 2+ were resulted. In brain imaging study, brain CT finding was normal. After appropriate treatments with rapid cooling, hydration and supportive care, he improved with alert mental status. On 2nd hospital day, in laboratory result, thrombocytopenia and coagulopathy were appeared and renal insufficiency was aggravated. So he was treated with platelet concentrate and fresh frosen plasma for DIC, and enough hydration for appropriate urine volume preservation. After all, On 22nd hospital day, he fully recovered and discharged. Nowadays, with followed for some duration, he is wellbeing with no complications.

Bortezomib과 Dexamthasone으로 치료한 골수외 형질세포종 4예

백종현,이은영,장리라,손창배,신은경,서정아,이지숙,이호섭,이상민,신성훈,김양수 고신대학교의과대학 2007 고신대학교 의과대학 학술지 Vol.22 No.2

Despite the use of aggressive local and systemic treatment including autologous stem cell transplantation in multiple myeloma, extramedullary recurrences are common and the prognosis of these patients is poor. Many novel drugs such as thalidomide, lenalidomide and bortezomib improve the response of treatment of multiple myeloma, but some reports failed to describe thalidomide has effect in extramedullary plasmacytoma. Recent data report on the successful treatment plasmacytomas with bortezomib in patients with advanced multiple myeloma. We treated 4 relapsed or refractory extramedullary plasmacytomas with bortezomib at our institution. We recognized all these extramedullary plasmacytomas decreased and showed more than partial response. This report lends support to the efficacy of bortezomib in the treatment of plasmacytoma and describes the safe use of bortezomib. Responses may, however, be of short duration. Therefore, despite our limited experience, we propose that bortezomib may be considered a therapeutic option for such patients who have risk of radiation therapy

하루 콩단백질 25g 섭취를 위한 메뉴작성 및 영양성분 분석

한재숙,김정애,서봉순,이연정,서향순,조연숙,한경필,이신정,오옥희,우경자,조은자,구성자,김수진,李承彦,南出隆久 동아시아식생활학회 2002 동아시아식생활학회지 Vol.12 No.2

The purpose of this study was to develop menus for daily intake of 25g soybean protein and to analyse nutrients of these foods. Analytical values were compared to the theoretical one using the food composition table and recommended dietary allowances for Koreans (7th revision). The results are as follows. 1. Soybean curd residue stew, Soybean curd, Kimchi saute, and hard boiled soybean and lotus root were selected for the menu for January, of which the content of soy bean protein(SBP) was 33.1g, soybean stew, soybean curd and soybean sprout saute, and Italian deep fried soybean curd were for February, of which the content of SBP was 35.0g. The content of SBP in soybean paste soup with soybean curd, fried soybean curd and fried soybean curd roll, the menu for March, was 24.9g. That of April were soybean curd gratin with soymilk, soybean curd and ham with garlic dressing and the content of SBP was 26.3g. That of May were soybean porridge, soybean flour cake with honey (Dasik), soybean sprout soup and the content of SBP was 26.7g. That of June were soymilk, pan-fried soybean curd, steamed soybean curd with chicken and the content of SBP was 28.4g. That of July were noodle with soymilk, mapatofu, soybean curd salad and the content of SBP was 24.7g. That of August were soybean sprout with mustard dressing, Tossed green pepper with raw soybean flour, Tofu and Kimchi stew, soybean curd steak and the content of SBP was 26.2g. That of September were Chinese cabbage soup with raw soybean flour, sweet and sour tofu and the content of SBP was 23.2g. That of Oct. were Fermented soybean stew, soybean pan cake and the content of SBP was 24.3g. That of November were not-pressed soybean curd casserole, pan-fried mashed soybean curd with egg, stir frying deep-fried soybean curd with vegetables and the content of SBP was 22.4g. That of December were soybean curd and mushroom casserole, fried soybean curd and vegetables, hard boiled soybean curd and the content of SBP was 28.9g. 2. The ratio of the analytical value over theoretical value (A/B%) of one serving in kcal, carbohydrate, protein, fat, ash and dietary fiber were 57.7~107.7%, 42.9~131.9%, 79.2~118.3%, 54.5~100%, 40.7~80.8% and 42.1~113.2%, respectively. 3. The ratio of A/B% of one serving in Ca, K, Na, P and Fe were 44.1~93.6%, 59.0~153.1%, 53.1~117.7% 64.6%~138.8 and 33.8~77.3%, respectively. That in Fe was the lowest among minerals. 4. The ratio of analytical value over Korean R.D.A(A/C%) in Ca was relatively higher (22.0~85.9%) than that in kcal(18~63%). 5. The ratio of A/C% in Fe was 25.1~64.3% and lower than that in Ca and protein in general.

공황장애에서 Paroxetine 단기약물치교가 심리적 상태에 미치는 영향

이소영,김지혜,김율리,강은호,이동수,유범희 大韓神經精神醫學會 2004 신경정신의학 Vol.43 No.3

복합재료 하니콤 샌드위치 구조의 열응력 해석

은성수,이수용 한국항공대학교 1998 論文集 Vol.36 No.-

온도하중이 작용할 때 복합재료 하니콤 샌드위치 쉘 구조물의 거동을 파악하기 위해서 3차원 응축쉘 이론 그리고 일차전단 변형이론에 입각한 유한요소 해석이 수행되었다. 본 연구에서는 하니콤을 탄성보강재로 가정하여 온도가 증가함에 따라 하니콤과 적층쉘 사이에서 발생하는 분리현상을 규명하였다. 이러한 파손현상은 적층각도와 적층쉘 두께이 따라 다르게 나타났다. 준등방성 그리고 직교이방성 보다도 angle-ply 적층순서에서 파손이 많이 발생하였고 또한 적층쉘의 두께가 증가함에 따라 파손현상이 많이 발생하였다. Finite element analysis based on 3-D degenerated shell theory and first shear deformation theory was peformed to investigate the behavior of composite and honeycomb sandwich shell structures under thermal loading. In this study, the honeycomb was regarded as an elastic foundation and delamination phenomenon occurring between the laminated shell and the honeycomb was examined as temperature increases. The results shows that the delamination depends on lay-up angle and thickness in the composite shell. A lot of failure was occurred for angle-ply stacking sequence rather than for quasi-isotropic and cross-ply stacking sequences and a lot of failure was occurred as the thickness of the composite shell increases.

중미 국가의 노사관계 및 노동법제 연구 : 과테말라, 엘살바도르, 온두라스를 중심으로

이철수,박귀천,박은정 梨花女子大學校 法學硏究所 2003 法學論集 Vol.7 No.2

In these days, our labor-intensive industries in Korea such as fiber and sewing industries are being transferred to the overseas countries. In such a tendency, three countries in the Central America including Guatemala, the Public El Salvador and Honduras which are the subjects of this study provided the companies whose target is to export their goods to America, a motive to find a market in the Central America, because of the following factors: (ⅰ) being benefited by no tax pursuant to the Caribbean Sea district development plan; (ⅱ) a geographical condition of a neighboring country of USA, as well as (ⅲ) a factor of a country abundant in cheap labor force. Accordingly, the number of formal investments in their countries currently reached to 100 cases, and the Korean companies of various sizes have invested in these countries. However, actually, the information concerning the investment and the labor related laws for such countries are very insufficient. Therefore, the purpose of this study is to introduce the labor-management relationship and labor related laws of such countries. In case of the labor laws in Guatemala, the collective labor-management relations and individual labor relations are provided for in a law, and the characteristic of each law is as follows. In case of the collective labor-management relations, the administrative authority intervenes in the establishment of a labor union or the execution of the collective bargaining agreement. For the establishment of a labor union, the written consents of 20 or more employees are required. The establishment of multiple trade unions is permitted, but joining two or more union is not allowed. Union shop is not allowed, either. With respect to the collective bargaining, the bargaining bodies are unified in accordance with a job type, and general binding power in the local view of the collective bargaining has been introduced. They allow the right to strike to general workers. Unusually, they guarantee the wages during the labor disputes, so the principle of No Work, No Pay is not accepted. For the labor dispute, they have the system under which the labor court judges the lawfulness of the labor dispute in advance. Furthermore, it is provided for in the law that the labor dispute shall not be caused due to the issue related to the conflict for the rights. In order to go on a strike, the employees should go through the procedures of settlement-mediation-arbitration.. The law related to unfair labor practice does not exist. However, the employer shall not interfere the employees in joining or withdrawing from a labor union. Employers are prohibited from dismissing the employees for the reason of their participation in the establishment of a labor union. With respect to the individual labor-management relation, the administrative authority is expected to be participated in executing the employment agreement. The reasons for the just dismissal are also prescribed in the law. If an employer intends to dismiss an employee for a reason not provided for in the law, the employer shall pay the separation allowance, differentially in accordance with the consecutive years of service of the employee concerned. Besides, it is unusual that they have introduced the indirect dismissal system under which the employee may terminate his/her employment agreement in case where there occurs a reason attributable to the employer. They also guarantee the employees’ right for the paid leave, the annual leave and the minimum wage system like Korea. In case of Honduras and the Public El Salvador, their labor laws are similar to those of Guatemala in the view of basic contents thereof. However, there are some differences in the detailed contents. In Honduras, 30 employees are required for the establishment of a labor union, but in the Public El Salvador, 35 employees are required for the establishment of a labor union. With respect to the collective bargaining by the multiple trade union, in Honduras, they have the single-multiple delegate system, while in the Public El Salvador, they have the exclusive bargaining delegate system. Unlike Guatemala, Honduras and the Public El Salvador do not have the provision on the payment of wages during the labor disputes. In addition, the three countries are similar in the following aspects: (ⅰ) there practically exists the unfair labor practice; (ⅱ) they all provide for the reasons for just dismissal in the law; and (ⅲ) they all have introduced the indirect dismissal system. The countries intends to invest in the said three countries in the Central America is required to pay attention to the following. It is of course important to observe the labor laws of the country in which the companies intends to invest, and to avoid the unnecessary conflicts with the local employees. However, if the main purpose of their investment is to export their goods to USA, they need to understand that since the owner company of USA who places an order plays a role of labor inspector due to the power of influence of the citizen groups and human right groups of USA, the relationship with the American buyers and the maintenance of proper working environment to the degree requested by such buyers are important factors.