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.

이하선 종양에 관한 임상적 연구

백승,하주원,오희균,유선열,김원재 大韓顎顔面成形再建外科學會 2002 Maxillofacial Plastic Reconstructive Surgery Vol.24 No.5

This is clinical study on 113 patients who were treated for parotid tumors at Chonnam National University Hospital over a period of 5 years from January 1996 to December 2000. The results were as follows ; The mean ages were 42.6 years old (12∼73 years) for benign parotid tumor patients and 43.9 years old (2∼74 years) for malignant patients. The ratio of male to female was 1:2 in malignant parotid tumors, but there was no difference in benign tumors. There was no difference in mean mass size and duration of illness between benign and malignant tumor patients. The combined usage of fine needle aspiration biopsy and computed tomogram was common as the diagnostic methods of parotid tumor. The parotid tumors were commonly located in the superficial lobe (69%). The ratio of benign and malignant tumors was 4:1. The most common benign tumor was pleomorphic adenoma (72% of benign tumor), followed by Warthin's tumor and monomorphic adenoma. The most common malignant tumor was mucoepidermoid carcinoma (45% of malignant tumor), followed by adenoid cystic carnoma, carcinoma ex pleomorphic adenoma, and adenocarcinoma. The most common operations were superficial parotidectomy (72%) for benign parotid tumor and total parotidectomy (45%) for malignant tumor. The most common postoperative complication was temporary facial nerve weakness (82%), followed by Frey's syndrome (14%) and permanent facial palsy (4%). Postoperative radiation therapy was done in 12 patients (60%) and the mean radiation dose was 5550±620 cGy. Of 113 cases, tumor recurrence developed in 12 cases (10%). These results suggest that the successful management of parotid gland tumors needs adequate surgical treatment on the basis of knowledge of parotid gland anatomy and preoperative diagnosis.

이하선 종양에 관한 임상적 연구

백승,오희균,박홍주,유선열,김원재 전남대학교 치의학연구소 2002 구강과학 Vol.14 No.3

This is a clinical study on 113 patients, who were treated for parotid tumors at Chonnam National University Hospital over a period of 5 years from January 1996 to December 2000. The results were as follow, 1. The mean ages were 42.6 years old (12~73 years) for benign parotid tumor patients and 43.9 years old (2~74 years) for malignant patients. 2. The ratio of male to female was 1:2 in malignant parotid tumors, but there was no difference in sex distribution of benign tumor. 3. There was no difference in mean mass size and duration of illness between benign and nalignant tumor patients. 4. The combined use of fine needle aspiration biopsy and computed tomograph was common as the diagnostic method of parotid tumor 5. The parotid tumors were commonly located in the superficial lobe(69%). 6. The ratio of benign and malignant tumors was 4:1. The most common benign tumor was pleomorphic adenoma (72% of benign tumor), followed by Warthin's tumor and monomorphic adenoma. The most common malignant tumor was rnucoeplderrnoid carcinoma(45% of malignant tumor). followed by adenoid cystic carnoma. carcinoma ex pleomorphic adenoma, and adenocarcinoma. 7. The most common operations were superficial parotidectomy (72%) for benign parotid tumor and total parotidectomy (45%) for malignant tumor 8. The most common postoperative complication was temporary facial nerve weakness (82%), followed by Frey's syndrome (14%) and permanent facial palsy (4%). 9. Postoperative radiation therapy was done in 12 patients and the mean radiation dose was 5550±620cGy. 10. Of 113 cases. tumor recurrence developed in 12 cases (10%). These results suggest that the successful management of parotid gland tumors needs adequate surgical treatment on the basis of knowledge of parotid gland anatomy and preoperative diagnosis.

가토에서 Pentoxifylline, Aspirin 및 Heparin이 피부피판의 생존 및 출혈 경향에 미치는 영향

하주원,백승,박홍주,오희균,유선열 전남대학교 치의학연구소 2002 구강과학 Vol.14 No.2

The skin flap, which has been frequently used in the maxillofacial soft tissue defects, can be failed due to insufficient blood supply to the flap. To increase its survival rate, antithrombotic agents has been used. The agents have, however, been restrictly used because of their side effects, such as bleeding tendency or hematoma formation on the operation site. The present study aimed to the effect of pentoxifylline, aspirin, and heparin on the skin flap survival rate and bleeding tendency. Twelve adult white rabbits, weighing about 2.0 kg, were used. Five random skin flaps, which is 1mm thickness, were prepared on the dorsal surface of each rabbit by using 1.5 X 7.5 cm prefabricated template. The animals were divided into 4 groups on the basis of drugs used: Control group, animals in which no drug was given (n=3); Pentoxifylline group, animals in which pentoxifylline was given intraorally (n=3); Aspirin group, animals in which aspirin was given intravenously (n=3). On the 3rd and 7th day after operation, prothrombin time (PT) and activated partial thromboplastin time (aPTT) were measured to evaluate the bleeding tendency. The animals were sacrificed on the 7th day and the mean skin flap survival rate of each group was measured. The results obtained were as follows : 1. The skin flap survival rates of pentoxifylline (84.3±7.9%) and heparin (79.5±10.9%) groups were significantly increased, compared with control group (68.0±10.8%)(ㅔ<0.05). The survival rate of aspirin group (73.0±11.1%) was not increased. 2. In bleeding tendency, the PT values were prolonged in heparin and aspirin groups at the 3rd day after operation (p<0.05), and prolonged in order of heparin group, aspirin group, and pentoxifylline group at the 7th day after operation. The aPPT values in heparin and aspirin groups were also prolonged at the 3rd day after operation (p<0.05), and prolonged in order of Aspirin group. Heparin group, and Pentoxifylline group at the 7th day after operation. These results suggest that pentoxifylline may be the most useful drug among three drugs to increase skin flap survival rate and less increase the bleeding tendency.

가토에서 Pentoxifylline, Asprin 및 Heparin이 피부피판의 생존 및 출혈 경향에 미치는 영향

하주원,백승,박홍주,오희균,유선열 大韓顎顔面成形再建外科學會 2002 Maxillofacial Plastic Reconstructive Surgery Vol.24 No.5

The skin flap, which has been frequently used in the maxillofacial soft tissue defects, can be failed due to insufficient blood supply to the flap. To increase its survival rate, antithrombotic agents has been used. The agents have, however, been restrictly used because of their side effects, such as bleeding tendency or hematoma formation on the operation site. The present study aimed to the effect of pentoxifylline, aspirin, and heparin on the skin flap survival rate and bleeding tendency. Twelve adult white rabbits, weighing about 2.0 ㎏, were used. Five random skin flaps, which is 1㎜ thickness, were prepared on the dorsal surface of each rabbit by using 1.5×7.5㎝ prefabricated template. The animals were divided into 4 groups on the basis of drugs used: Control group, animals in which no drug was given (n=3); Pentoxifylline group, animals in which pentoxifylline was given intraorally (n=3); Aspirin group, animals in which aspirin was given intravenously (n=3), and Heparin group, animals in which heparin was given intravenously (n=3). On the 3rd and 7th day after operation, prothrombin time (PT) and activated partial thromboplastin time (aPTT) were measured to evaluate the bleeding tendency. The animals were sacrificed on the 7th day and the mean skin falp survival rate of each group was measured. The results obtained were as follows : The skin flap survival rates of pentoxifylline (84.3±7.9%) and heparin (79.5±10.9%) groups were significantly increased, compared with control group (68.0±10.8%)(P<0.05). The survival rate of aspirin group (73.0±11.1%) was not increased. In bleeding tendency, the PT values were prolonged in heparin and aspirin groups at the 3rd day after operation (P<0.05), and prolonged in order of heparin group, aspirin group, and pentoxifylline group at the 7th day after operation. The aPPT values in heparin and aspirin groups were also prolonged at the 3rd day after operation (P<0.05), and prolonged in order of Aspirin group, Heparin group, and Pentoxifylline group at the 7th day after operation. These results suggest that pentoxifylline may be the most useful drug among three drugs to increase skin falp survival rate and less increase the bleeding tendency.

구개부에 발생한 다형선종의 처치

하주원,백승,송종운,박충열,이용욱,박홍주,오희균,유선열,김옥준 大韓顎顔面成形再建外科學會 2001 Maxillofacial Plastic Reconstructive Surgery Vol.23 No.6

Pleomorphic adenoma of the palate is the most common of all intraoral salivary tumors. It can occur at any age but it presents most commonly in the 40∼60 age group, and there is no significant sex preponderance. It grows slowly and is usually painless, firm, well-circumscribed nodule. Because of high rate of recurrence, extra-capsular excision including the overlying mucosa and margin of normal tissue is recommended. We report 10 cases of palatal pelomorphic adenoma which have been successfully treated by extra-capsular excision. The surgical defects smaller than 3㎝ in diameter were covered with palatal acrylic splint for the secondary healing. The larger defects were repaired using palatal island flap in 3 cases, rotation flap and buccal fat graft in each 1 case. No patient showed any recurrence or malignant change during the mean follow-up period of 4 years and 9 months. These repair methods seem to be simple, reliable and uncomplicated procedures in the palatal surgical defects.

반코마이신 내성 장구균 감염에 대한 quinupristin-dalfopristin 치료 경험

추은주,최상호,조영환,정선미,김백남,김남중,김미나,김양수,우준희,류지소 대한화학요법학회 2002 대한화학요법학회지 Vol.20 No.1

VRE 감염이 중환자에서 급속히 증가하고 있으나 이에 대한 확실한 치료제가 없어 새로운 항생제에 대한 활발한 연구가 있는데 그 중 하나가 quinupristin/dalfopristin이고, 저자들은 중증 환자들의 VRE 감염에 대해 quinupristin/dalfopristin를 투여하여 치료한 임상적 경험을 하였기에 문헌고찰과 함께 보고하는 바이다. Vancomycin-resistant enterococci (VRE) was first recognized in 1992 in Korea. VRE infection have been increasingly reported in immunosuppressed patients over the past decade and have become one of major nosocomial pathogens. Clinicians carings for patients with VRE infections face severe constraints in the selection of treatment. Quinupristin/dalfopristin is active in vitro againt vancomycin-resistant E. faecium (VREF), with a MIC_(90) of 1.0㎍/mL. We studied the clinical efficacy and safety of this agent in the treatment of VREF infection. Patients were included if they had signs and symptoms of active infection including bacteremia, intra-abdominal infection, and wound infection. A total of 13 patients with VREF infection were enrolled. A favorable clinical response (cure or improvement) occured in 10 of 11 evaluable patients. The only adverse events related to quinupristin/dalfopristin were arthralgia and myalgia, which occurred in 2 of 13 patients. These results suggest that quinupristin/dalfopristin is effective and safe as treatment for VREF infections in critically ill patients with serious underlying conditions.

The Impact of Elderly Caregiving on Marital Quality

Baek, Ju-Hee The Korean Home Economics Association 2004 International Journal of Human Ecology Vol.5 No.1

Although the relation of caregiving burden to well-being has been frequently examined, the effect of caregiving on marital quality has been virtually ignored. The current study explores the impact of parent care on the marriages of adult children by using a nationally representative longitudinal sample. It was hypothesized that parent care would negatively influence the marital quality of adult child caregivers, the effect of parent care would differ between women and men caregivers, and the nature of marital relationship variables would moderate or mediate the impact of care on marital quality. Overall, marital quality does not appear to suffer if caregiving load is light. However, the impact of parental caregiving on some dimensions of marital quality was conditioned by gender, gender role attitudes, and congruence between attitudes and behavior.

Development of HPLC methods for the analysis of evodiame and rutecarpine in Herbal Medicinal Products containing Evodia Fruit.

CHO Jung Hee,BAEK Ju Hyun,KIM Do Hoon,OH Mi Hyune,JEONG Hye Yoon,SHIM Young Hoon,CHO Chang Hee,OH Woo Yong,DO Wonim,CHOI Ho Young,LEE Byung Hee,AHN Jae Hyeong 대한약학회 2006 大韓藥學會 總會 및 學術大會 Vol.2006 No.2

The Impact of Elderly Caregiving on Marital Ouality

( Ju Hee Baek ) 대한가정학회 2004 International Journal of Human Ecology Vol.5 No.1