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.

豚皮를 添加한 Sausage의 製品特性 및 豚皮 安定性에 관한 硏究

정인철,문윤희 慶星大學校 1991 論文集 Vol.12 No.2

Experiments were carried out to investigate properties of product among pork sausage not added pork skin and pork sausage, fish sausage, mixtured sausage added 10% pork skin, and analyzed the storage stability of these products of 3。C and 20。C . The results obtained are summerized as follow : 1.Sausages added pork skin were high in processing yield and moisture content, but there were low in the contents of crude fat and protein. The total contents of moisture, crude fat and crude protein were above 90% in all products. 2. There was not over the permitted value of remainder content of NO₂for all products, and the concentration of salt of mixtured sausage was relative higher than other products. 3. Water-holding capacity and gel strength of sausage added pork skin were lower than sausage added pork skin, but the percentage of fat loss was lower. 4. The extractability of salt soluble protein and water soluble protein was high generally in fish, but the extractability of stroma protein was high slightly in pork sausage added pork skin. There are significant differences the pattern of using sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) of salt soluble and water soluble protein between pork and fish sausage. 5. During the storage periods, moisture content and water activity was decreased and there showed large in high storage temperature. 6. During the storage periods, both pork sausage added pork skin and pork sausage not added pork skin were not different in pH value and VBN content. The pH value wes great slightly in fish and mixtured sausage and VBN content seemed to be not difference in all products until 6 weeks. 7. The TBA value was higher in pork sausage added pork skin than in pork sausage not added pork skin, and in fish sauasge than pork asausage. 8. Fish sausage was relative lower than other products in total plate counts. The coliform groups were not found until the end of storage.

응집공정에 적합한 In-Line 정적혼화기를 이용한 혼화공정의 개선

정철우,강민수,최시환,정수일,손인식,강임석 대한상하수도학회 2003 상하수도학회지 Vol.17 No.3

The rapid mixing process for coagulation is a critical component in a water treatment plant. However, at the present time a detailed understanding of the rapid mixing by in-line mixer or generally accepted criteria for the design of in-line static mixer are not available. The aim of this work is therefore to improve the understanding of how the in-line static mixer works and how to better utilize it in coagulation process in water treatment. To investigate the performance of static mixer, coagulation experiments were conducted to compare the static mixer to the traditional backmixer under several coagulation conditions. Experiments were also performed to compare the coagulation efficiency of different mixing type of static mixer which were made using different flow rates and the number of elements equipped in a pipe. The static mixer performed better than the backmixer for all coagulation and mixing conditions tested. Especially, the static mixer was very effective in the surface charge neutralization, as showing higher reduction of negative charge with increasing mixing intensity. However, little difference was observed in the performance of the static mixer equipped with 2, 3, and 5 elements. Also, in a series of bench-scale studies of rapid mixing, the in-line static mixer performed better than the traditional backmixer for both adsorption and charge neutralization (A/N) mechanism and sweep coagulation mechanisms. Especially, the static mixer was more efficient at producing A/N mechanism conditions as a result of its fast and uniform dispersion of the coagulant.

살균방법을 달리한 시유의 저장성

정인철,권수득,문윤희 慶星大學校 1994 論文集 Vol.15 No.2

Experiments were carried out to investigate market milk treated by LTLT, HTST, UHT methods and analysed storage stability of these products at 5℃ and 30℃ by 24 hour interval. In case of LTLT, storage periods were possible to 6 days in 5℃, thermophile bacteria was more than HTST and UHT. Storage stability during stored in 30℃ was impossible only one day, psychrophile bacteria was more than HTST and UHT. In case of HTST, storage periods were possible to 6 days in 5℃, psychrophile bacteria was more than LTLT and UHT. Storage stability during stored in 30℃ was impossible only one day. In case of UHT, storage periods were possible to 7 days in 5℃, storage stability except boiling test was safe to 1st and thermophile bacteria was more than LTLT, HTST during stored in 30℃.

정신분열병 환자의 우울증에서 Paroxetine과 삼환계 항우울제 병용치료

심주철,공보금,박정환,윤영란,신재국,김정익,안동성,김용관,차인준,김영훈 大韓神經精神醫學會 1997 신경정신의학 Vol.36 No.4

저자들은 마산동서병원에 입원중인 우울증이 동반된 정신분열증 환자 10명을 대상으로 사용중인 항정신병약물에 paroxetine과 저용량의 삼환계 항우울제를 6주간 병용투여한 후 우울증상에 대한 효과와 치료의 안전성 및 약물상호작용을 알아보았다. Paroxetine은 고정량의 항정신병약물과 삼환계 항우울제에 부가하여 일일 20㎎을 6주간 병용하게 하였으며, 임상상태는 HDRS, HARS, UKU Side Effect Rating Scale등의 평가척도를 사용하여 평가하였다. 또한 약동학적 약물상호작용은 삼환계 항우울제들의 혈장농도를 HPLC로 측정하여 분석하였다. 결과는 다음과 같다. 1) 10명의 전체 대상환자에서의 HDRS 평균점수는 TCA와 paroxetine 병용투여 6주후에 통계적으로 유의하게 감소되었다. 이중 40%의 환자에서는 병용투여 6주후에 HDRS 점수상 50% 이상의 감소를 보여, 일부의 환자들에서는 정신분열병에 동반된 우울증상의 치료에 소량의 삼환계 항우울제와 paroxetine의 병용치료가 효과가 있음을 확인하였다. 2) 두 명의 환자에게서 심각한 약물독성이 발생하였다. 이중 한 명은 삼환계 항우울제의 높은 혈중농도로 인한 항콜린성 위기(anticholinergic crisis) 소견을 보였으며, 다른 한 명은 인지기능 및 의식수준은 명료하였으나 망상과 환각증상이 약화되는 소견을 보였다. 따라서 본 연구에서 시도된 복합적 약물치료의 경우, 삼환계 항우울제의 혈중농도의 측정을 포함한 세심한 임상적 추적이 필요하다고 생각된다. 3) 기저치의 amitriptyline과 그 대사물인 nortriptyline의 농도합. imipramine과 대사물인 desipramine의 농도합은 각각 47.8-226.5ng/㎖. 80.5-395.6ng/㎖였으며 일반적으로 이들 약물들의 단독사용시에 문헌에 보고된 혈중농도를 훨씬 상회하고 있었다. 이는 병용투여된 항정신병 약물 약시 강력한 CYP2D6 효소억제제로서 기저치의 삼환계 항우울제들의 혈장농도를 이미 상당히 증가시켰던 것으로 판단되며, 그러한 결과로 인해 본 연구에서는 paroxetine이 이전의 문헌보고들과는 달리 뚜렷하게 삼환계 항우울제들의 혈장농도를 증가시키지 못하였다. 본 연구는 SSRI와 삼환계 항우울제의 병합 투여가 우울증의 개선 효과를 빠르게 하고, 치료역을 넓히고, 약물상호작용의 결과 paroxetine이 삼환계 항우울제의 혈중농도를 증가시킨다는 기존의 연구결과를 이용하여 정신분열병 우울증상의 치료에 parotextine과 소량의 삼환계 항우울제를 병용하는 방법을 시도해 본 연구이다. 저자들은 이러한 약물치료가 일부의 환자들에게서 효과가 있음을 관찰하였으나, 항정신병약물과 삼환계 항우울제를 병용투여 할 경우는 물론 이에 paroxetine과 같은 선택적 세로토닌 재흡수 억제제를 병용할 경우 복합약물상호작용의 결과로 약물독성의 위험성이 크며 세심한 주의가 필요함을 경험하였다. Depression is well-known to comorbid with several psychiatric disorders. Many schizophrenics also suffer from depression in the course of their illness. Combined therapy of SSRI and tricyclic antidepressants were reported to have benefits in some depressed patients. Paroxetine, a potent CYP2D6 inhibitor, increases the blood levels of tricyclic antidepressant markedly. Using paroxetine, we tried this combined therapy in the treatment of depressive symptoms in 10 chronic schizophrenic inpatients and evaluated its efficacy and drug interactions between paroxetine and tricyclic antidepressants. The following results were obtained : 1) The mean score of Hamilton's Depression Rating Scale(HDRS) was reduced significantly after 6 weeks-trials of this combined therapy for the mild depressive symptoms in 10 chronic schizophrenics. In four patients, 50% or more reductions in the scores of HDRS were noticed at final evaluation. 2) Two among our 10 subjects experienced severe toxic behavioral problems. Anticholinergic crisis with toxic confusion due to high blood levels of tricyclics was found in one patient and the other showed rapid clinical deterioration in his psychotic symptoms such as delusion and hallucination without any consciousness alternation. 3) Baseline plasma levels of tricyclics before adding paroxetine were higher than expected in our chronic schizophrenic subjects maintained with their antipsychotic medications. Several antipsychotics were also known as a potent CYP2D6 inhibitors and to increase the blood levels of tricyclics. Because the blood levels of tricyclics had already increased significantly by the use of antipsychotics, adding paroxetine to antipsychotics and tricyclic antidepressant in our subjects could increase the blood levels of tricyclics not so much as previously reported in the literatures.

신장수여자의 수술경과시간에 따른 자기존경감, 희망감, 염려 및 스트레스원의 차이

이 철,김창윤,한오수,박인호,유희정,한덕종 울산대학교 의과대학 1993 울산의대학술지 Vol.2 No.2

This study attempted to examine the differences of self - esteem, hopes, concerns and total stress scores of 110 kidney recipients in before(N=32) and fellowing kidney transplantation [1 to 6 months(N=29), 6 to 12 months(N=23), 12 to 36 months(N=26)] and utilizing severity rating scale of 44 potential stressors on a 5-point scale of 110 kidney recipients in before(N=32) and following kidney transplantation operation [1 to 6 months(N=29), 6 to 12 months(N=23), 12 to 24 months(N=15) and 24 to 36 months(N=11)]. On scores of hopes and total stress, pretransplant group exhibited significantly higher scores than three posttransplant recipient groups. But, it was found that there was no significant differences among four transplant kidney recipient groups on the scores of self - esteem and concerns. In the pretransplant group, craving for foods was identified as the most stressful event, on the contrary, changes in friends was identified as the lowest stressful events. In the 1 to 6 months posttransplant group, side effect of medications was identified as the most stressful event, however, loss of contact with dialysis patients was identified as the lowest stressful event. In the 6 to 12 months posttransplant group, cost of medication, changes in body appearance were identified as the most stressful event, on the other hand, managing of medications at home was identified as the lowest stressful event. In the 12 to 24 months posttransplant group, cost of medication and insurance coverage were identified as the most stressful event, but possibility of dying and competence of nursing staff were identified as the lowest stressful event. In the 24 to 36 months posttransplant group, changes of body appearance was identified as the most stressful event, on the contrary, possibility of infection was identified as the lowest stressful event. Insurance coverage was a continuing concern throughout posttransplant period.

석탄회 및 석고첨가가 퇴비화에 미치는 영향

유현철,김정섭,곽명화,윤철종,이희인,박승조 동아대학교 환경문제연구소 2001 硏究報告 Vol.24 No.1

Problems of wastes that pigs produce are increasing rapidly in the hog raising industry nowadays. consequently, the generation volume of excreta also is increasing but most of that is not disposed appropriately and exposed in eco-system therefore the disposal of stock excreta is becoming more and more serious. considering the physical and chemical characteristics of livestock excreta, the pollution loading rate - BOD, COD etc. - is very high. as alternative plan, that is, as one method kind of composisting, the utilization of the soil reformation agent will become one solution in managing the upper problems. also, the flyash of 3.7 million tons are producing every year and about 32.2% of that, 1.18 million ton is recycled as concrete, cement, cementassistance, road etc. consequently, the discharged flyash is not abandoned and a plan of recycling is needed acutely. gypsum of 4.16 million tons in 1998 presently was produced and about 57.2% of that, 2.38 million tons was recycled as cement, construction materials. the present stock is 25 million tons. therefore, in this study, because organic materials can be obtained in pig excreta and calciums can be obtained in gypsum, the small amount of elements can be acquired in flyash for the soil reformation agents, mixing the three materials - pig excreta, gypsum, flyash - adequately, investigated technique of making the soil reformation agents and described below in comparrision with the changes of temperature, PH TOC, T-N, TOC/T-N ratio etc.

유지 투석중인 만성 신부전환자에서 허혈성 심질환의진단 지표로서의 심장트로닌-I의 유용성

신병철,강대웅,정지용,류봉관,서영욱,김정인,김범윤,김현리,정종훈 朝鮮大學校 附設 醫學硏究所 2004 The Medical Journal of Chosun University Vol.29 No.1

Background : Coronary disease is highly prevalent in patient with end stage renal disease (ESRD) and account for much of their observed morbidity and mortality. Troponin-I consistently maintains a high sensitivity and specificity and is most sensitive marker for ischemic heart disease (IHD). Method : We examed 49 hernodialyzed patients (22 male, 27 female) without evidence of acute coronary syndrome (ACS) for 6 months. Biochemical markers were measured in serial predialysis blood samples. For analysis, we used two cardio-specific assays for troponin-T (cTnT) as well as for troponin-I (cTnI) and compared the results with CK-MB (reference value ≤ 4.0 ng/mL) concentration. Results : Myocardial ischemia was observed in 47% (23/49) of patients. cTnT level above 0.1 ng/mL. and cTnI level above 0.5 ng/mL, were observed in 22% (11/49) and 20% (10/49) of patients respectively. cTnI revealed significantly higher positive rate in patients with myocardial ischemia than the patients without myocardial ischemia (43 % vs 30%) (p<0.05). cTnT and CK-MB revealed no difference in positive rate between the patients with and without myocardial ischemia (cTnT : 30% vs 15% and CK-MB : 30% vs 19%). The sensitivity and specificity of cTnI to myocardial ischemia were higher than those of cTnT and CK-MB (sensitivity 43% vs 30% and 30%. specificity 100% vs 85% and 81%). Conclusion: Both cTnT and cTnI are useful in ruling out myocardial injury in chronic renal failure patients. But. cTnI is a more sensitivity and excellent specificity of ischemic heart disease than cTnT and CK-MB in hemodialyzed patients. In patients with ischemic heart disease, the presences of DM and advanced age were higher than those in patients without ischemic heart disease (p<0.05). Among the baseline characteristics old age, elevated LDH and diabeties were significant more frequent in the patients with elevation of cardiac troponin-I (p>0.5 ng/mL) than those with cardiac troponin-I (p<0.5 ng/mL), p=0.038, p=0.049, and p=0.045, respectively. Our results suggest that these cTnI is the potential diagnostic marker for the prediction of IHD in ESRD patients.

수직냉각면을 가진 함수정방형내에서 초기온도가 동결량에 미치는 영향에 관한 실험적 연구

김병철,주동인,손정배,박영훈 조선대학교 에너지.자원신기술연구소 1997 에너지·자원신기술연구소 논문지 Vol.19 No.2

The effect of initial temperature on freezing with vertical cold wall in rectangular cavity was studied. When the initial temperature was below the 4℃, the frozen thickness in the upper part was thicker than that of lower part from the beginning of freezing and above the 4℃, at beginning the frozen thickness in the upper part was thinner than that of lower part but with time the frozen thickness in the upper part was thicker than that of lower part. And when it was above the 8℃, at the beginning of freezing the upper part of frozen thickness was thinner than that of lower part with concave but with time the concave in the upper part became thicker and the frozen thickness in the upper part was thicker than that of lower part too. The effect of initial temperature had no effect on the increasing of ice volume with time because in the beginning of freezing the more initial temperature was low, the more frozen thickness grew but the heat resistance increased in proportion as the frozen thickness grew.

주요 우울장애가 동반된 혈액 종양 환자에서 Paroxetine의 효과 및 안정성

배치운,이혁재,김정진,이창욱,이수정,이철,백인호 大韓神經精神醫學會 2003 신경정신의학 Vol.42 No.4

Objectives : The efficacy and safety of paroxetine in the treatment of depressive disorders are well known, however its efficacy and safety for the treatment of depression in patients with cancer has been poorly studied. This study therefore aimed to evaluate the efficacy and safety of paroxetine in treatment of depressed patients with hematological malignancy (HM). Methods : Fifty-two patients with major depressive disorder (MDD) based on DSM-IV criteria along with comorbid HM were allotted to 8 weeks trial with a flexible-dose regime of paroxetine in combination with their chemotherapy or supportive pharmacotherapy. Treatment response was assessed at baseline, week 2, week 4, and week 8 with 17-item Hamilton Rating Scale for Depression (HAM-D17), Montgomery A sberg Depression Rating Scale (MADRS), and Clinical Global Impression-severity (CGI-S). Side effects were collected with the reported adverse events and laboratory test throughout the study period. Results : 44.2% of 52 patients completed the eight weeks trial. Scores on the HAM-D17, MADRS, and CGI-s (last Observation carried forward, LOCF) at baseline were significantly reduced with mean reduction of 30.5%, 32.8%, and 39.1%, respectively, after 8 weeks treatment with paroxetine. Forty-six patients (88.5%) reported at least one adverse event. The most common adverse event observed in this study was nausea and no serious adverse event was found. Conclusion : In this preliminary study, overall results showed paroxetine could be used for the treatment of depressed patients with HM, but more controlled study is needed to confirm the efficacy and safety of paroxetine in this area.