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.

돼지 신장세포(PK15)의 이종이식 거부반응에 대한 재조합 IL-18의 영향

최연실,김은미,김영관,박상연,심정현,윤도영,강형식,명평근 충남대학교 형질전환복제돼지연구센터 2004 논문집 Vol. No.8

Various cytokines including IL-1β, IL-2, IL-4, IL-10, IL-12p40, IFN-r, and TNF-α have been recently reported to play important roles in both host and donor cell activations during xenotransplantation. Interleukin (IL)-18, a proinflammatory cytokine, can induce IL-4 and IL-13 production in T cells, NK cells, B cells, mast cells, and basophils. IL-18 has the capacity to stimulate innate immunity and both Th1-and Th2- mediated responses, but little is known to involve in the xenograft rejection. In order to investigate the role of IL-18 in xenograft rejection, we transplanted the pig kidney (PK15) cells to C57BL/6 mouse with or without intraperitoneal injection of mouse recombinatant IL-18, It was analyzed the population of T cell, B cell and NK cell in the mice transplanted with PK 15 cells and recombinant IL-18 by flow cytometry. We found that splenic CD3+ T cells were increased in mice injected PKl5 cells with recombinant IL-18. These results suggest that recombinant IL-18 is critical in the xenograft rejection by increasing T cell population of the recipients.

돼지 신장세포(PK15)의 이종이식 거부반응에 대한 재조합 IL-18의 영향

최연실,김은미,김영관,박상연,심정현,윤도영,강형식,명평근 충남대학교 생물공학연구소 2004 생물공학연구지 Vol.10 No.1

Various cytokines including IL-1β, IL-2, IL-4, IL-10, IL-12p40, IFN-γ, and TNF-α have been recently reported to play important roles in both host and donor cell activations during xenotransplantation. Interleukin (IL)-18, a proinflammatory cytokine, can induce IL-4 and IL-13 production in T cells, NK cells, B cells, mast cells, and basophils. IL-18 has the capacity to stimulate innate immunity and both Th1-and Th2- mediated responses, but little is known to involve in the xenograft rejection. In order to investigate the role of IL-18 in xenograft rejection, we transplanted the pig kidney (PK15) cells to C57BL/6 mouse with or without intraperitoneal injection of mouse recombinatant IL-18. It was analyzed the population of T cell, B cell and NK cell in the mice transplanted with PK 15 cells and recombinant IL-18 by flow cytometry. We found that splenic CD3+ T cells were increased in mice injected PK15 cells with recombinant IL-18. These results suggest that recombinant IL-18 is critical in the xenograft rejection by increasing T cell population of the recipients.

시스템 다이내믹스를 이용한 간호단위별 간호인력 산정에 관한 연구

김문실,성영희,권경자,김도형,김정아,신덕신,유인자,유재국,이현숙 병원간호사회 2006 임상간호연구 Vol.11 No.2

Purpose: The purpose of the study was to forecast manpower by building the nursing manpower-staffing model(surgical-medical nursing unite). Method: The system dynamics approach was adapted to build a simulation model for calculating medical-surgical nursing manpower-staffing. The model was built up on Venism 5.0b DSS. Result: The results in the basic circumstance are in following. The level of nursing service quality, patientsatisfaction, and nurse job satisfaction maintains higher at medical-surgical nursing unit of the tertiary hospitals with the ratio of bed to nurse 2.5:1-3.0:1 than at any other situations. The level of nursing service quality, patient satisfaction, and nurse job satisfaction maintains higher at madical nursing unit of the secontary hospotals with the ratio of bed to nurse 3.0:1 and at surgical nursing unit of the secondary hospitals with the ratio of bed to nurse 3.0:1-3.5:1 than at any other situations in the fundamental from. The results in the simulation circumstance are in following, As author raises the operating rate of bed into 95-100%, and cut skilled nursing staff down, the level of nursing-service quality, patient satisfaction, and nurse job satisfaction drops slightly. Conclusion: In terms of economic efficiency on tertiary hospotals, the ratio of bed to nurse for the best reasonable medical-surgical nursing manpower-staffing is 3.0:1. In terms of economic efficiency on secondary hospitals, the ratio of bed to nurse for the best reasonable medical nursing manpower-staffing is 3.0:1 and surgical nursing manpower-staffing is 3.5:1

정신병적 증상이 동반된 기면병 1예

홍승철,송정민,정종현,권용실,한진희,이성필 大韓神經精神醫學會 2003 신경정신의학 Vol.42 No.5

Narcolepsy is a sleep disorder characterized by excessive daytime sleepiness, cataplexy, sleep paralysis, hypnagogic hallucinations and disrupted nocturnal sleep. We report a patient with a diagnosis of schizophrenia who was subsequently diagnosed as narcolepsy. A case of a 22-year-old woman with concomitant narcolepsy and psychotic symptoms was discussed from a perspective of the diagnosis and therapeutic challenges, particularly on pharmcological treatment dealing with issues raised by their coexistence.

동시성 공유정신병 : 일란성 쌍생아 자매의 역할반전 Case Formulation of Role Reversal

신화식,유희정,김헌수,김현실,민병근 울산대학교 의과대학 1995 울산의대학술지 Vol.4 No.1

The twin sisters case of folie simultanee is reported here in this paper. A case of folie simultanee is described as two or more people becoming psychotic simultaneously and sharing the same delusion. The results of psychodynamic approach for this case are as follows. 1. There are a variety of conflicting hypotheses on the orgin of the disorder, ranging from the etiological explanation of organic factor to various psychodynamic approach. In this case, there is no evidence of hereditary factor on the laboratory findings and family history. Therefore the authors stressed that the psychodynamic formulation of the disorder is on the importance .of the etiological rol. It seem significant to describe that the etiology is multidimensional and includes factors such as character structure formation in processing of object relations, the emotional relationship between the partners, socio-environmental conditions and hereditary predisposition. 2. There are two issues in folie simultanee. The one is related to diagnosis. It is consider to distinguish the inductor from the recipient. The other is subject to treatment. It is important to determine whether separate the inductor and recipient by admitting the inductor for a psychiatric center or not. Furthermore, the inductor and recipient's weak ego state should be recognized in planning various psychiatric treatments. 3. It could be found in the role reversal phenomenon between the inductor and recipient during long-term course.

성인초보자들을 위한 영어프로그램 구성에 관한 고찰

박민선,송정실,이정현 신라대학교 교육과학연구소 2004 교육과학연구 Vol.- No.9

전경대원에서 발생한 결핵의 임상 양상

문창기,박상준,조민구,김영중,김소연,김윤권,정준오,안석진,김은실,서승오,김지훈,최원제,이윤영,박형기,최규영,김현근 대한감염학회 2006 감염과 화학요법 Vol.38 No.6

Background: The purpose of this study was to document the incidence and clinical characteristics of patients with tuberculosis (TB) in combat and auxiliary police, living in a group, in Korea where the incidence rate of active TB in a general population is higher than in Western countries. Materials and Methods:We retrospectively reviewed the medical records of all tuberculosis patients diagnosed at National Police Hospital from January 2002 through December 2004. Results:In 2002-2004, a total of 156 cases of tuberculosis were identified with the mean (Standard deviation) age of 20.6 (±1.0) years. Of these, 134 (85.9%) patients were registered as new cases, 11 (7.1%) as relapse, 2 (1.3%) as failure, 5 (3.1%) as treatment-after-default cases whereas 4 (2.6 %) patients were not included in any categories. Average annual new TB rate and smear-positive TB rate were 86.5/10^(5) and 17.4/10^(5) person-years, respectively. In 12 of 31 smear-positive cases, time from onset of symptoms to diagnosis was more than 30 days. Two multidrug-resistance TB cases were identified and two suspected outbreak episodes of TB had occurred during 3 years. Conclusion:There was no statistically significant difference in the incidence rate of new cases of TB between the general population aged 20 to 29 years and combat and auxiliary police in Korea. 배경 : 국내 결핵의 발생은 감소 추세에 있으나 여전히 후진국형 발생양상을 보이고 있다. 특히 집단생활을 하는 젊은이들에서 발생하는 결핵의 유행이 간헐적으로 알려지고 있어 우려를 낳고 있다. 이에 저자들은 최근 전경대원의 결핵 발병 양상에 대해 알아보고자 본 연구를 시행하였다. 재료 및 방법 : 2002년 1월부터 2004년 12월까지 3년간 경찰병원에서 결핵 진료를 받은 전경대원의 의무기록을 후향적으로 분석하여 연도별 결핵 신환발생률, 도말양성결핵 신환율, 진단 지연, 집단발병, 다제내성결핵을 조사하였다. 결과 : 연도별 결핵 신환자 수(10만명당 발생추정치)는 2002년 50명(83.6명), 2003년 42명(83.7명), 2004년 42명(93.5명)이었고 도말양성 폐결핵 신환자 수는 2002년 10명(16.7명), 2003년 11명(21.9명), 2004년 6명(13.4명)이었다. 3년간 도말양성 폐결핵 환자는 31명이 있었고 그 중 12명은 호흡기 증상 발생 30일이 지나서 진단을 받았다. 다제내성 결핵은 2명이 있었으며 결핵의 집단발병이 의심되는 사례는 2차례 있었다. 결론 : 전경대원과 20-29세 연령군 일반인의 결핵 신환발생률, 도말양성 폐결핵 발생률의 통계적으로 유의한 차이는 없었다.

The Distribution and Morphology of Calbindin D28K- and Calretinin-immunoreactive Neurons in the Visual Cortex of Mouse

Hyun-Jung Park,Jee-Hyun Kong,Youn-Sil Kang,Won-Mee Park,Seong-Ah Jeong,So-Min Park,Jin Kyu Lim,Chang Jin Jeon 한국분자세포생물학회 2002 Molecules and cells Vol.14 No.1

We studied the distribution and morphology of cal-bindin D28K- and calretinin-immunoreactive (IR) neurons in the mouse visual cortex with immunocyto-chemistry. Most of the calbindin D28K-IR neurons were located in layers II/III and V, while calretinin-IR neurons were predominantly located in layers II/III. The labeled neurons showed variations in morphology. The majority of the calbindin D28K-IR neurons were stellate and round or oval cells with multipolar den-drites. The majority of calretinin-IR neurons were ver-tical fusiform cells with long processes traveling per-pendicular to the pial surface. In the mouse visual cor-tex, 20.2% of calbindin D28K-IR neurons contained calretinin and 27.2% of calretinin-IR neurons con-tained calbindin D28K. These results indicate that the calcium-binding proteins, calbindin D28K and cal-retinin are distributed in specific layers and in selec-tive cell types of the mouse visual cortex.

Drug-Induced Liver Injury: Twenty Five Cases of Acute Hepatitis Following Ingestion of <i>Polygonum multiflorum</i> Thunb

Jung, Kyoung Ah,Min, Hyun Ju,Yoo, Seung Suk,Kim, Hong Jun,Choi, Su Nyoung,Ha, Chang Yoon,Kim, Hyun Jin,Kim, Tae Hyo,Jung, Woon Tae,Lee, Ok Jae,Lee, Jong Sil,Shim, Sang Goon The Korean Society of Gastroenterology; the Korean 2011 Gut and Liver Vol.5 No.4

<P><B>Background/Aims</B></P><P>Complementary medicines, including herbal preparations and nutritional supplements, are widely used without prescriptions. As a result, there has been growing interest in the risk of hepatotoxicity with these agents. It is difficult to determine causal relationships between these herbal preparations and hepatotoxicity. We report on 25 patients diagnosed with toxic hepatitis following ingestion of <I>Polygonum multiflorum</I> Thunb.</P><P><B>Methods</B></P><P>Twenty-five patients (median age, 48 years [24 to 65 years]; M:F=18:7) with suspected <I>P. multiflorum</I> Thunb-induced liver injury were admitted to our hospital between 2007 and 2009. We analyzed clinical and histological data, including the types and the duration of <I>P. multiflorum</I> Thunb intake and the duration of hospital care. We also determined the type of liver injury using the R ratio (serum activity of ALT/serum activity of ALP).</P><P><B>Results</B></P><P>The types of complementary medicine used included tea (n=16), liquor (n=5), tea and liquor (n=2), powder (n=1), and honeyed pudding (n=1). The most common presenting sign was jaundice (76%), and 18 patients (72%) had evidence of hepatocellular liver injury. Histological findings were consistent with acute hepatitis in all cases (n=10) for which liver biopsy was performed. Twenty-three patients (91.6%) recovered with conservative management, 1 patient (4%) had a liver transplant, and 1 patient (4%) died of hepatic failure.</P><P><B>Conclusions</B></P><P>In our cases, we found that <I>P. multiflorum</I> Thunb could be hepatotoxic and could lead to severe drug-induced liver injury, and even death.</P>