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.

간세포암과 하대정맥 막성폐쇄의 치료 후 호전된 백혈구파괴혈관염 1예

이준엽 ( Jun Yeob Lee1 ),이주원 ( Ju Won Lee1 ),이진욱 ( Jin Wook Lee ),박현준 ( Hyun Joon Park ),장국환 ( Gook Hwan Jang ),김다정 ( Da Jung Kim ),김선민 ( Sun Min Kim ),한병훈 ( Byung Hoon Han ),정규식 ( Gyoo Sik Jung ),김근태 ( 대한류마티스학회 2015 대한류마티스학회지 Vol.22 No.5

저자들은 하지 자색반과 고환 통증으로 내원한 알코올성 간경화증 환자에서 LCV의 원인 감별하는 과정에서 HCC와 하대정맥 막성폐쇄를 진단하고 이에 대한 치료 후 LCV의 호전된 증례를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Vasculitis is a heterogeneous group of diseases that destroy blood vessel walls by inflammation. Approximately half of vasculitis cases are idiopathic, but sometimes associated with genetic factors, medicines, chronic infection, autoimmune diseases, and malignancies. Although the mechanism remains unclear, vasculitis secondary to malignancy, also known as paraneoplastic vasculitis, has been reported. It is generally associated with hematologic malignancies rather than solid malignancies and commonly presents as leukocytoclastic vasculitis or polyarteritis nodosa. We experienced a case of leukocytoclastic vasculitis in a patient with hepatocellular carcinoma and membranous obstruction of the inferior vena cava. Here, we report this case with a brief review of literature. (J Rheum Dis 2015;22:322-326)

구개편도에 발생한 결핵

이병돈,강주원,장혁순,박철규,김장묵 순천향의학연구소 1996 Journal of Soonchunhyang Medical Science Vol.2 No.1

Tonsillar tuberculosis, almost always secondary to pulmonary tuberculosis is very rare disease in otolaryngologic fields. Authors have experienced a case of tonsillar tuberculosis associated with miliary pulmonary tuberculosis. The patient had cough, sputum and sore throat for 1 month. On physical examinations, palatine tonsils were slightly hypertrophied, smoothly surfaced, but crypt ulceration or patches were not seen. Diffuse discrete nodules were seen in both lung fields by simple chest X-ray. In high resolution computed tomography, miliary tuberculosis was suspected and in pleural needle biopsy, granulomatous inflammaiton was diagnosed as tuberculosis. AFB smear of sputum was two positive. Histopatholoigic finding of right tonsil was consistent with tuberculosis. He was cured of it with antituberculosis medications for one year. We report the case with review of the literatures.

국부성 또는 침투성 액아억제제에 의한 연초식물의 액아억제

장종오,엄유리,이이,신주식,석영선 충북대학교 연초연구소 2006 煙草硏究 Vol.20 No.-

본 실험에서는 황색종 KF-118을 사용하여 적심 후 발생하는 액아의 생장을 약제처리법을 이용하여 억제하였다. 약제로는 침투성 액아억제제, 접촉성 액아억제제, 국부성 액아억제제 등 세 종류의 약제를 활용하였다. 약제를 처리한 후 액아의 길이, 생장률, 생중량, 건중량 등을 측정하여 액아억제제의 효과를 측정하였다. A, B, C, D, E 총 5가지의 액아억제제를 처리하였으며 무처리구를 포함한 총 6개의 처리구로 나누어 시험하였고, 각 처리구는 적심 직후, 적심 후 액아가 2 cm 이하로 자랐을 때와 4 cm 이하로 자랐을 때로 분류하여 5주씩 3반복으로 처리구당 총 15주를 시험하였다. 실험 결과 무처리구와 처리구는 액아생장에 있어 유의성 있는 차이를 보였으며 처리효과는 적심 직후에 약제를 처리했을 때 가장 높았으며, 다음으로 적심 후 액아가 2 cm 이하로 자랐을 때, 4 cm 이하로 자랐을 때의 차례로 나타났다. 또한 적심 직후 약제를 처리한 경우 A약제를 제외한 모든 액아억제제가 억제율 90 %를 넘는 우수한 결과를 보였다. Suckers were controled by suckercide treatment using a flue-cured tobacco cultivar, KF-118. Three types of suckercides, systemic suckercide, contact suckercide and local suckercide, were used. Length, growth rate, fresh weight and dry weight of sucker were measured after suckercide treatment. Five kinds of suckercides (A, B, C, D, E) were treated directly after topping, when sucker length shorter than 2 cm after topping, and when sucker length shorter than 4 cm after topping. Five plants were treated and three times repeated. The sucker growth rates of treated plant were significantly lower than those of untreated plant. The smaller the sucker size, the higher the treatment effect. All suckercides, except for suckercide A, showed more than 90 % sucker control rate when they were treated directly after topping.

구강에서 채취한 혐기성 세균에 대한 서양산 고추냉이(Horseradish, Armoracia rusticana) 뿌리 추출물의 항균효과

장용걸,박호원,신일식,이주현,서현우 大韓小兒齒科學會 2010 大韓小兒齒科學會誌 Vol.37 No.2

서양산 고추냉이 (Horseradish, Armoracia rusticana)의 주성분인 allylisothiocyanate(AIT)는 각종 세균에 대한 살균 효과로 주목받고 있다. 이전 연구들을 통해 구강내 다양한 세균 및 진균류에 대한 항균성이 입증되었으나 근단내 병소를 유발하는 혐기성 세균에 대한 연구는 미진한 실정이다. 본 연구에서는 사람의 근단 병소에서 직접 분리한 E. faecalis와 F. nucleatum에 대한 서양산 고추냉이 뿌리 추출물의 항균활성을 표준균주와 비교해보고 이를 대표적인 항균제인 클로르헥시딘과 비교하여 다음과 같은 결론을 얻었다. 1. 서양산 고추냉이 뿌리 추출물은 E. faecalis 임상 분리균주에 대하여 표준균주와 같거나 약간 높은 농도에서 항균효과를 나타냈고, 625.0~1,250.0 μg/ml의 농도에서 클로르헥시딘 (7.8~15.6 μg/ml)과 대등한 항균효과를 가지는 것으로 나타났다. 2. 서양산 고추냉이 뿌리 추출물은 F. nucleatum 임상 분리균주에 대하여 표준균주와 같거나 약간 높은 농도에서 항균효과를 나타냈고, 78.1~312.5 μg/ml의 농도에서 클로르헥사딘 (7.8~15.6 μg/ml)과 대등한 항균효과를 가지는 것으로 나타났다. 이번 연구로 표준균주 뿐만 아니라 구강에서 직접 분리한 혐기성 세균에 대한 서양산 고추냉이 뿌리 추출물의 항균성을 확인할 수 있었고, 추후 근관 세척제나 소독제로 서양산 고추냉이 뿌리 추출물을 이용할 수 있는 가능성을 보여주었다. Objective : The aim of this study was to determine the antimicrobical effect of horseradish root extracts against Enterococcus faecalis and Fusobacterium nucleatum isolated from oral cavity compared with reference strain, and compared with that of chlorhexidine. Method : Horseradish root extracts and chlorhexidine were sequentially diluted and tested against anaerobes(E. faecalis, F. nucleatum) isolated from children's oral cavity. The microbes were anaerobically incubated and the minimum inhibitory concentration(MIC) and minimum bactericidal concentration(MBC) were detected. Results: 1. Horseradish root extracts showed antimicrobial effect against E. faecalis isolated strain at same or slightly higher concentration compared with MIC of reference strain. 2. 625.0~1.250.0 ㎍/ml horseradish root extracts showed similar antimicrobial effect with chlorhexidine(7.8~15.6 ㎍/ml). 3. Horseradish root extracts showed antimicrobial effect against F. nucleatum isolated strain at same or slightly higher concentration compared with MIC of reference strain. 4. 78.1~312.5 ㎍/ml horseradish root extracts showed similar antimicrobial effect with chlorhexidine(7.8~15.6 ㎍/ml). Conclusions : The results of this study confirm that horseradish root extracts has antimicrobial effect against anaerobes isolated from oral cavity as well as reference strain. And we found the potential of horseradish root extracts as a canal irrigant or disinfectant.

요양병원 입원환자 평가도구의 타당도와 신뢰도

이지윤,윤주영,장사랑 노인간호학회 2008 노인간호학회지 Vol.10 No.1

Purpose: The purpose of this study was to evaluate the validity and reliability of a patient assessment instrument for patients in long-term care hospitals. Method: The participants in this study were 90 patients admitted to 3 long-term care hospitals. The data were collected in May and June 2007. Criterion related validity of the K-ADL (Korean Activities of Daily Living) was tested using Spearman correlation with the K-MBI (Korean Modified Barthel Index). Inter-rater reliability between two nurses was tested using weighted kappa and agreement percentage. Results: Criterion related validity of the K-ADL with the K-MBI was good with average Spearman correlation coefficient =0.96. Correlation coefficients of items were between 0.63 and 0.96. Inter-rater reliability was satisfactory with the average weighted kappa equal to 0.76. Items with weighted kappa of more than 0.4 numbered 122 (86.5%) and of more than 0.75, 74 (52.5%) Conclusion: The patient assessment instrument for patients in long-term care hospitals is reliable and K-ADL is valid for classifying these patients based on resource utilization, and for quality monitoring indicators.

Clozapine 투여후 발생한 급성 간염

장순주,이호택,백주희,이상연 대한신경정신의학회 1999 신경정신의학 Vol.38 No.1

Clozapine 투여 후에 급성 간염이 발생했던 두 명의 환자에 대한 증례로, 두 명 모두 이전에 약물에 이한 간염이 발생한 과거력이 있었던 환자로서 무증사의 급성 간염이 발생한 후에 보존적 치료 후에 호전 되었다. 간염이 발생한 후에 간효소수치에 대해 정기적으로 검사를 하면서, 사용하고 있던 clozapine의 용량을 낮춘 후 간장제를 투여함으로써 간효소수치는 정상화되었다. Clozapine과 비교하면 clozapine은 간세포의 cytochrome P450에 영향을 미치는 것으로 생각되고 있고 chlorpromazine은 간내 담즙저류에 영향을 미치는 것으로 생각된다. 과거 약물에 의한 간염을 경험한 환자는 clozapine에 의해 유도된 감염에 보다 취약성을 보일 가능성이 있으며, 이런 관점에서 이전의 간 기능 이상을 경험했거나 물질 사용 장애 등의 병발이 있을 경우 정기적인 간기능 평가가 임상적으로 중요할 것으로 판단된다. The authors report two cases of clzapine-induced acute hepatitis. Two patients developed asymptomatic hepatitis and got better with conservative care. We decreased the dosage of clozapine and added hepatic protections, resulting in normalized laboratory findings. The authors also reviewed side effects of clozapine in this report. We reviewed the suggested mechanism of either clozapine or chlorpromazine-induced hepatitis. clozapine influences the liver cell via cytochrome P 450 and chlorpromazine does so via mild cholestasis. There may be a possibility that a patient who has experienced drug-induced hepatitis is vulnerable to clozapine-induced acute hepatitis. In this respect, those who have experienced drug-induced hepatitis must be observed more closely.

손상평가도를 이용한 용접구조물의 균열형 결함에 대한 사용적합성 평가

李精錫,朱章福,張宰溢,金禹植,고영대,權東一 대한금속재료학회 2002 대한금속·재료학회지 Vol.40 No.10

Flaws nucleated during operation of structures such as nuclear power plants, petroleum facilities and gas equipment raise many safety problems, and thus the integrity assessment of crack-like flaws in structures has been very important. Since large-scale structures include weldments with complex micro-structures and inhomogeneous material properties, it is essential to consider both metallurgical and mechanical factors. In this study, a methodology for integrity assessment in welded structures was developed based on API 5L X65 grade natural gas pipeline (an approximately 2400 ㎞ pipeline in Korea). A failure assessment diagram(FAD), which includes all failure modes from linear elastic fracture to plastic collapse, was used for integrity and fitness-for-service(FFS) assessment of the pipeline. Since tensile properties and fracture toughness of base metal, weld metal and heat affected zone(HAZ) are required for the FAD, tensile tests and fracture toughness tests were performed on each region. In particular, the evaluation of representative properties of HAZ make it possible to assess FFS accurately by using the HAZ-based FAD when crack-like flaws exist in HAZ. This HAZ-based FAD is different from current codes, which assess integrity by the material properties of weld metal or base metal even when flaws exist in HAZ.

장기간의 장거리 달리기가 골대사 마커에 미치는 영향

장성동,이은희,홍명엽,문성진,김주혁,이윤관,김영준 한국스포츠리서치 2004 한국 스포츠 리서치 Vol.15 No.1

This study is purposed to analyse the effects of long-term & one-time 10km running exercise from bone metabolic marker change on bone metabolism. 7 male members(18.6±1.08) from a marathon club were subjected to the study. They were allowed to do long-term 10 km running training once a week for 6 months. And bone metabolism mark was determined according to the respective times : before/after 6 months training, before/after 10 km race, one day after the race, 3 days after the race. The examination items of bone metabolism mark were serum calcium, phosphorus, paratyroid hormone, osteocalcin, calcitonin, alkaline phosphatase in blood and calcium, phosphorus, deoxypyridinolin in urine. The results of study were as follows; 1) There was no change in deoxypyridinolin and alkaline phosphatase but there was significant change in calcitonin, paratyroid hormone and osteocalcin(p<.01). 2) There was no change of Calcium in serum and urine but there was significant change of phosphorus in blood(p<.01). To make a conclusion, it is determined that long-term 10 km running at low intensity and low frequency tends to restrict bone metabolism circulation, but exercise at a little high level activates bone metabolism into building up bones and absorbing bones and finally shows up high bone metabolism circulation, which is inferred to have an effective influence on bone health. It is considered there is a possibility that different exercise intensity, even same kind of exercise, influences on bone metabolism sdifferently.

Bone-supported pendulum을 이용한 상악대구치 원심이동

장용걸,박호원,이주현,서현우 大韓小兒齒科學會 2009 大韓小兒齒科學會誌 Vol.36 No.3

상악 대구치의 원심이동이 요구되는 경우, 구외견인, Wilson distalizing arches, 가철식 스프링 장치 그리고 Schwarz plate-type 장치 등을 사용 할 수 있다. 그러나 이러한 전통적인 대구치의 원심이동 장치들로 치료에 성공하기 위해서는 환자의 협조가 필수적이기 때문에 많은 소아치과 의사들은 환자 의존성을 최소화하고 임상가가 통제 할 수 있는 장치들로 전환하고 있다. 이 중 가장 일반적인 것이 pendulum 장치인데, 고정원이 되는 전방치아의 원하지 않는 이동과 고정원 소실, 그리고 구개부 고정원이 좋지 않은 경우 원하는 정도의 구치부 원심이동을 얻기 어렵다는 단점이 있다. 이와 같은 전통적인 pendulum의 단점을 해결하고자, SAS(Skeletal Anchorage System)를 pendulum에 접목하여 골에서 직접 지지를 얻는 변형된 형태의 pendulum, 즉 bone supported pendulum을 제작하여 장착 시킨 후 주기적인 관찰을 시행하였다. 본 증례는 혼합치열기 환자를 대상으로 bone supported pendulum을 사용하여 안정된 고정원 유지, 원치 않는 치아이동의 최소화 및 양호한 상악 대구치 원심이동 등을 관찰하였기에 이를 보고하는 바이다. To distalize the maxillary molars. the traditional techniques such as extra-oral traction. Wilson distalizing arches. removable spring appliances and Schwarz plate-type appliances have been used. But, these need considerable patient cooperation. For minimal patient compliance. many practitioners use the pendulum appliances. Several clinical studies demonstrated pendulum is effective molar distalization appliance in the growing patient(using the premolars and the palate as anchorage). But unfortunately, maxillary anterior teeth also shift mesially as the molar moves distally. As a result anchorage loss is occurred. To overcome these disadvantages, we used bone-supported pendulum, combined the conventional pendulum with Skeletal Anchorage System(SAS). The miniscrew was implanted in the anterior paramedian region of the median palatal suture, which has comparatively sufficient bone thickness and is low risk to damage on the dental follicles. We report three cases, using bone-supported pendulum for the maxillary molar distalization in children. After treatment, we find out anchorage stability, minimal unfavorable anterior tooth movement and sufficient molar distalization.