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.

당뇨병과 동반된 화농성 간농양의 임상상 및 예후인자

오은숙,강무일,이원영,오기원,임동준,이소영,이정민,고승현,김성래,안유배,손현식,윤건호,차봉연,이광우,손호영,강성구 대한당뇨병학회 2000 임상당뇨병 Vol.1 No.1

연구배경: 감염질환은 혈관질환과 함께 당뇨병의 중요한 사망원인의 하나이며, 혈당조절이 불량할수록 감염 빈도가 증가됨은 잘 알려져 있다. 간농양의 발생이 있어서도 당뇨병은 중요한 기저질환 중의 하나이다. 일반적으로 간농양의 가장 흔한 원인균은 Escherichi coli라고 알려져 있으나, 최근 당뇨병을 가진 간농양 환자에서 Klesiella pneumoniae의 검출이 증가되고 있다. 또 최근 연구에 의하면 K.pneumonie가 간농양의 가장 흔한 원인균이며, K. pneumoniae에 의한 간농양은 K.pneumoniae 이외의 균주에 의한 간농양보다 당뇨병과 밀접히 관련되어 있다고 보고된 바 있다. 이에 저자들은 간농양 환자를 대상으로 당뇨병환자의 빈도를 알아보고, 그 원인균 및 특징을 비당뇨병 환자들의 경우와 비교해 보고자 하였다. 방법: 1992년 1월부터 1999년 6월까지 방사선학적 검사 혹은 수술에 의해 간농양이 확인되거나, 경피적 천자나 수술을 통한 배농액 배양, 혹은 혈액 검사에서 원인균이 증명된 182명의 환자를 대상으로 후향적 임상고찰을 실시하였다. 결과: 화농성 농양을 가진 167명의 환자(남:94명, 여:73명)중 당뇨병을 가진 환자는 54명 (남:30명, 여:24명)으로 32.3%를 차지하였다. 환자의 평균나이는 당뇨군에서 62.1 ± 13.4세, 비당뇨군에서는 55.1 ±15.5세로 당뇨군에서 높았으며(p=0.0021), 남녀간의 평균나이 비교 시 두 군 모두 여성의 나이가 의미있게 높았다. 비당뇨군에 비하여 당뇨군의 경우 저알부민혈증의 빈도와 aspartate transaminase가 증가되어있었다. 원인균주는 K. pneumoniae (당뇨군54%, 비당뇨군 39.1%), E. coli(당뇨군 17.5%, 비당뇨군 18.8%), Pseudomonas aeruginosa, Streptococcus viridans, Enterococcus 순이었으며 두 군간의 의미는 차이는 없었으나 K. pneumoniae의 경우 다른 균종에 비해 단독감염의 빈도가 높았다(82.8%). 사망률은 당뇨군에서 16.7%, 비당뇨군에서 7.1%로 당뇨군에서 의미있게 높았으며(p=0.019), 당뇨군에서의 사망환자는 모두 패혈증이 동반되어 있었다. 당뇨환자의 사망군은 생존군에 비해 당뇨병 이환기간이 길고 혼합감염의 빈도가 높았다(p=0.046). 검사실 소견에서는 총 빌리루빈 및 알카리성 포스파타제의 증가가 관찰되어 있었다. 결론: E. coli가 간농양의 주된 원인균이라는 기존 보고와는 달리 당뇨군과 비당뇨군 모두 K. pneumoniae가 간농양의 주된 원인균이었다. 또한 당뇨 유병기간이 길고 당뇨조절이 불량한 환자에서 혼합감염이며 총 빌리루빈 및 알카리성 포스파타제의 증가등과 같은 위험인자가 존재할 경우 사망률이 증가될 수 있으므로 이들 군에서는 적극적인 치료가 필요할 것으로 사료된다. Background: Liver abscesses are commonly associated with underlying disease, particularly diabete mellitus. The number of the liver abscesses caused by Klebslella pneumoniae in diabetic patient has been increased in Korea nowadays. This study was conducted to clarify the clinical presentation and prognostic factors of pyogenic liver abscesses, especially in diabetic patients and to determine the proportion of K. pneunomiae as a pathogen in liver abscess in Korea. Methods: Medical records of 167 patients treated for pyogenic liver abscess from January, 1992 through June, 1999 were reviewed retrospectively in detail. Major Pathogenic organism, clinical manifestations, prognostic factors, the importance of diabetes mellilus as an underlying disease and its effect on clinical features and prognosis were analyzed. Results: Among 167 cases of pyogenic liver abscess, underlying diabetes mellitus was present in 32.3%. The mean age of patients was 62.7 13.4 years in diabetic liver abscess group and 55.1 15.5 years in non-diabetic liver abscess group. Most liver abscesses were cryptogenic in origin or secondary to the billary tree diseases. The clinical presentations among the two groups were not significantly different. When compared to patients without diabetes, patients with diabetes had significantly higher proportions of hypoalbuminemia and elevated aspartate transaminase level. The most common organism of the pyogenic abscess was K. pneumoniae in both groups. Percutaneous drainage of the abscess with appropriate antibiotics was the most commonly used therapeutic modality in liver abscess. The mortality rate of diabetic liver abscess is 16.1 % and 7.1% in nondiabetic liver abscess. Complications, especially septicemla, were found more frequently in patients with diabetes than in patients without diabetes (64.8% vs 28.3%, septicemia : 31.5% vs 9.7%). The factors influencing mortality in the diabetic liver abscess were disease duration, mixed infection, presence of septicemia, elevated bilirubin and alkaline phosphatase. Conclusions: In contrast to prior report that the E. coli was the most common pathogen in liver abscess, we found that K. pneumoniae was the most common organism cultured in liver abscess. Diabetic patients have more complications and higher mortality than patients without diabetes. Early detection and proper treatment are needed to improve the outcome for diabetic patient with liver abscess.

대전시 노은 도매시장 채소류의 농약 잔류 실태 및 식이섭취량 추정

한국탁,이규승,이은경,이용재,고광용,원동준,이정원,권순덕 한국환경농학회 2003 한국환경농학회지 Vol.22 No.3

대전시 노은 도매시장에서 채취한 6종의 채소류 중 농약잔류량을 조사한 후 이에 대한 위해성 평가를 실시하였다. 전체 100건의 분석시료 중 농약이 검출된 시료의 비율은 46.0%이었고, 잔류허용기준 초과비율은 6.0% 이었다. 검출비율이 높은 시료는 상추(85.0%), 깻잎(80.0%), 오이(60.0%) 순이었고, 상추 3건, 깻잎 3건이 허용기준을 초과하였다. 살균제는 dicar-boximide계, 유기염소계, azole계 농약, 살충제는 유기인계, 합성 pyrethroid계 농약이 많이 검출되었다. 검출빈도가 높은 성분은 procymidone, chlorpyrifos, chlorothalonil, cypermethrin, EPN의 순이었다. 위해성을 평가하기 위해서 각 농작물에 대한 농약의 추정 섭취량과 ADI를 비교한 결과, 허용기준을 초과한 깻잎의 bitertanol, triflumizole, iprobenphos가 다른 성분에 비하여 높은 비율을 보였다. 그러나 각 농산물의 식이섭취량이 적어 ADI에 대한 추정섭취량의 비율이 0.46%이하로 나타나 그 영향이 매우 낮은 것으로 판단되었다. Pesticide residues in some vegetables collected at Noeun wholesale market in Daejeon were surveyed and assessed their risk In 100 samples, the detection rate of pesticide was 46.0% and the rate exceed MRL was 6.0%. Commodities showing high detection rate were lettuce(85.0%), perilla leaf(80.0%) and cucumber(60.0%). Dicarboximide, organochlorine, and azole fungicides and organophosphorus and pyrethroid insecticides were detected. Detection frequency of pesticide was in the order of procymidone, chlorpyrifos, chlerothalonil, cypermethrin and EPN. When the estimated intake amount of the pesticides were compared with ADI to assess their risk, bitertanol, triflumizole and iprobenphos in perilla leaf were higher rate than the other vegetables. However the total amounts of intake of pesticides were estimated to less than 0.46% of ADI.

Predicting postoperative total calcium requirements after parathyroidectomy in secondary hyperparathyroidism

( Byung Heon Kang ),( Soon Young Hwang ),( Jeong Yeop Kim ),( Yu Ah Hong ),( Mi Yeon Jung ),( Eun Ah Lee ),( Ji Eun Lee3 ),( Jae Bok Lee ),( Gang Jee Ko ),( Heui Jung Pyo ),( Young Joo Kwon ) 대한내과학회 2015 The Korean Journal of Internal Medicine Vol.30 No.6

Background/Aims: To prevent hypocalcemia after parathyroidectomy (PTX), parenteral calcium is required in addition to oral calcitriol and calcium. After switching to oral calcium, patients can be discharged from the hospital. The aim of this study was to analyze the clinical characteristics and outcomes of PTX performed at a single Korean center and to investigate the associated laboratory factors used to analyze the total amount of postoperative calcium required. Methods: We enrolled 91 hemodialysis patients undergoing PTX from November 2003 to December 2011. We collected clinical and laboratory data preoperatively, 12 and 48 hours postoperatively, at discharge, and 3 and 6 months postoperatively. Results: In total, 59 patients underwent PTX with autotransplantation (AT), 6 underwent total PTX without AT, 11 underwent subtotal PTX, and 15 underwent limited PTX. Total PTX without AT showed the lowest recurrence rate. At all postoperative time points, the mean levels of serum calcium, phosphorus, and intact parathyroid hormone (iPTH) decreased significantly, compared with preoperative levels; however, alkaline phosphatase (ALP) increased significantly from 48 hours postoperatively to discharge (p < 0.001). On multiple linear regression analysis, the total amount of injected calcium during hospitalization showed a significant correlation with preoperative ALP (p < 0.001), preoperative iPTH (p = 0.037), and Δphosphorus at 48 hours (p < 0.001). We developed an equation for estimating the total calcium requirement after PTX. Conclusions: Preoperative ALP, preoperative iPTH, and Δphosphorus at 48 hours may be significant factors in estimating the postoperative calcium requirement. The formula for postoperative calcium requirement after PTX may help to predict the duration of postoperative hospitalization.

일 농촌 지역 재가 노인이 지각한 사회적 지지와 무력감

고성희,이은정 성인간호학회 1999 성인간호학회지 Vol.11 No.1

This study was designed to identify the relationship between perceived social support and discernd powerlessness held by the elderly residing in a rural community. The purpose of this study was to contribute to theoretical understanding of the relationship of these two variables and eventually to the more effective adaptation of the elderly to their situation. The subjects for this study were the 89 elderly residing in a rural community. Data were collected by a questionnaire from June 2 to 20, 1998. The data were analysed by descriptive statistics, t-test, ANOVA, Pearson correlated coefficient and stepwise multiple regression using a SAS program. The results of this study can be summarized as follows. 1. The relationship between perceived social support and discernd powerlessness was significant(r=-.23502, p=0.266). Especially , discernd elderly's powerlessness shows a highly significant relationship with family and neighborhood support(family r=-.45096, p=.0001, neighborhood r=-.35681, p=.0006). In the support patterns, the discerned powerlessness of the elderly has a significant relationship to emotional, informational and evaluational support. Therefore the hypothesis that, "the lower the degree of social support perceived by the elderly, the higher the degree of discened powerlessness"was supported. 2. Stepwise multiple regression analysis revealed that the most powerful predictor of discened powerlessness was family support in support system (R²=.2034), and emotional support (R²=.0627) in support patterns. 3. General characteristic related to the degree of social support was only residential status(P<.05), but the degree of family support was related to spouse(t=2.390, p<.01), residential status(t=-2.157, p<.05), and household.

쪽파[Allium ascalonicum L.] 재배기간 중 Diazinon, Iprodione 및 Chlorfenapyr의 잔류랑 변화

고광용,나은식,김성헌,김상준,장영희,이규승 충남대학교 농업과학연구소 2005 농업과학연구 Vol.32 No.2

In order to know the residual pattern of pesticides and predict to the degradation period until below MRL, we experimented diazinon, iprodinon and chlorfenapyr for shallot. They were the most detected pesticide in shallot by NAQS (National Agricultural product Quality management Service) survey. In this experiment, we sprayed those pesticides 15days before harvest and analyzed 0, 1, 2, 3, 5, 7, 10, 14 day sample to establish logical equation and to calculate DT_(50). During the cultivating period, the residue amount of diazinon was changed from 1.02 mg/kg (0 day) to 0.01 mg/kg (14 day), DT_(50) was 2.19 days, and iprodione was changed from 1.45 mg/kg (0 day) to 0.14 mg/kg (14 day), DT_(50) was 4.15 days, and chlorfenapyr was changed from 1.5 mg/kg (0 day) to 0.01 mg/kg (14 day), DT_(50) was 1.97 days. The DT_(50) of double amount in those pesticides, diazinon was 2.24 days, iprodione was 4.82 days, and chlorfenapyr was 2.24 days, respectively.

서울시내 4개 여자대학교 학생들의 체중 조절 실태와 Diet에 대한 의식구조 조사

고영태,이은주 덕성여자대학교 학생생활연구소 1997 學生生活硏究 Vol.13 No.-

본 연구에서는 서울 시내 4개 여자대학교 재학생 933명을 대상으로 하여 여대생의 식습관, 비만 정도, 체중 조절 실태, 영양지식을 얻는 매체, 다이어트 식품에 관한 견해 등을 조사하였다. 본인의 체형에 관한 질문에는 "통통한 편", "보통", "마른편"이 각각 40.5%, 39.1%, 12.9%로 나타났으나, 브로카의 비만도 측정 법으로 계산한 결과에 의해서는 4.2%만이 "과체중"이었고, 53.2%가 "정상", 34.8%가 "저체중"이었다. 체중관리의 관심정도에 대한 질문에는 답변자의 33.5%가 "높다", 44.1%가 "보통"이라 답하였다. 그러나 답변자의 60.1%가 건강을 위해 특별히 하고 있는 것은 없었다. 답변자의 65.1%가 체중조절 경험이 있었고, 체중 조절을 하는 이유로는 답변자의 34.8%가 "비만 또는 과체중이어서", 44.3%가 "정상체중이지만 미용상"이라고 답했다. 주로 이용하는 체중 조절 방법으로는 답변자의 37.9%가 "꾸준하게 식사량을 조절" 26.8%가 "운동과 다이어트를 병행", 18.9%가 "운동"이었다. 영양에 관한 지식을 주로 얻는 매체로는 "친구나 주위사람"이 37.7%, "신문이나 월간지"가 27.9%, "TV나 방송 매체"가 27.8%로 나타났다. 답변자의 12.0%가 시중 판매 다이어트 식품 또는 약품을 섭취해 본 경험이 있다고 답했고, 그 중 33.0%는 섭취기간에만 효과를 보았고, 31.3%는 효과를 보지 못했고, 25.9%는 약간의 효과를 본 것으로 나타났다. A survey on state of dietary habit, degree of obesity, body weight control, medium of nutritional knowledge and viewpoint of diet food and drug for 933 female students in 4 women's universities in Seoul was undertaken, The results are as follows : (1) In response to the question about body shape, 40.5%, 39.1% and 12.9% of the subjects answered "plump", "normal", and "thin", respectively. However the results calculated from subjects' height and weight by Broca's method were that 4.2% of the subjects were "overweight", 53.2% were "normal", and 34.8% were "underweight". (2) Interest of body weight control was relatively high as 33.5% of the subjects answered "high", and 44.1% did "normal". But 60.1% of the subjects did not practice any particular activity for health 65.1% of the subjects had experience of body weight control. The reasons of body weight control were "obese or overweight" (34.8% of the subjects), "normal weight but for beauty" (44.3% of the subjects). In order to control body weight, 37.9% of the subjects practiced "control of eating volume constantly", 26.8% of the subjects practiced "exercise and diet together" and 18.9% of the subjects practiced "exercise". (3) Nutritional knowledge was obtained "from friends or neighboring persons" (37.7%), "from newspapers or magazines" (27.9%) and "from TV or broadcasting" (27.8%). (4) 12.0% of the subjects had experience of diet food or drug intake. 33.0% of the taken subjects had effect only during taking period. 31.3% had no effect, and 25.9% had some effect.

저온 저장 감귤에서의 MA포장의 효과

이상백,김은정,고영환,고정삼 제주대학교 공과대학 첨단기술연구소 2001 尖端技術硏究所論文集 Vol.12 No.2

The effects of MA packaging on the low temperature storage of satsuma mandarin, overwintering satsuma and Kiyomi tangor were investigated. Thickness of film, holes in film and incorporation of antimicrobial agent were considered as parameters for MA packaging. Chitosan was applied to surface of fruits to determine the effects of coation during MA storage. Thickness of film and holes in a bag did not affect decay ratios in three fruits. Decay ratio of satsuma mandarin packaged with LDPE film with 2-5% ceramic antimicrobial agent slightly decreased. Chitosan coating lowered decay ratio of fruit during MA storage. MA packaging with LDPE film was effective in lowering weight loss and preventing delamination of fruits. MA packaging did not affect qualities of fruit during storage.

洪水流出 豫測模型의 媒介變數 改善에 關한 硏究

이은태,고병욱,이주헌 慶熙大學校 1995 論文集 Vol.24 No.-

In order to improve the runoff simulation program for the Nakdong river system, which had been developed based upon the storage-function model and started its roll in 1987, the watershed and channel parameters have been reevaluated using T/M hydrologic data collected from 1987 to 1993. This paper presents the analysis of the problems found during the reevaluation of the parameters and the verification of the runoff simulation for the historical flood events using the re-evaluated parameters.

서울 시내 6개 대학 여대생의 흡연 실태 조사 및 공중보건학적 고찰

고영태,이은주 德成女子大學校 1996 德成女大論文集 Vol.26 No.-

A survey on smoking state, smoking habit and viewpoint on smoking of 897 female students in 6 universities (3 coeducational universities and 3 women's universities) in Seoul was undertaken. The results are as follows : 1) Among 897 subjects investigated, 18.1% and 81.9% of the subjects were smokers and nonsmokers, respectively. Among smokers, 44.4% were coed and 55.6% were women's university students. Among smokers, 48.1% belonged to the art and athletic departments, 34.0% belonged to the liberal arts departments and 17.9% belonged to the science departments. (2) 50.6% of the smokers smoked almost every day. Daily smoking amount of 43.8% of the smokers was less than several pieces. 80.9% of the smokers started smoking after the entrance of university. 50.6% of the smokers smoked in the university neighboring facilities. 32.7% of the smokers enjoyed the smoking. 79% of the smokers responded to yound women's smoking famorably. 49.4% of the smokers responded to the effect of smoking on health unfavorably. 32.1% of the smokers commented on the smoking in the public place and 30.9% of the smokers commented on the juvenile smoking as the social problem. (3) 33.8% of nonsmokers responded to young women's smoking favorably. 79.2% of the nonsmokers responded to the effect of smoking on health unfavorally.