발열이 있는 호중구 감소증 환자에서의 위험도 예측인자

정중식,권운용,김규석,임용수,이중의,서길준,윤여규 대한응급의학회 2000 대한응급의학회지 Vol.11 No.3

Background: Most febrile neutropenic patients are treated in an aggressive manner. However, identification of low-risk patients may enable clinicians to administer risk-based treatment. The object of this study is to certify the factors associated with increased risk at the time of visiting the emergency department. Methods: This is a retrospective study. We reviewed the medical records of 101 febrile neutropenic patients who had visited the emergency department of Seoul National University Hospital from January 1998 to August 1999. We assumed 22 risk prediction factors that could be assessed at admission to the emergency department and 5 factors that could be assessed during treatment course. To find independent risk-prediction factors, we analyzed these factors respectively by using multiple regression analysis. Results: Tachycardia(aOR=136.5), altered mentality(aOR=28.8), decreased renal function(aOR=20.1), and significant comorbidity(aOR=17,2) are the independent factors associated with higher mortality. Altered mentality(aOR=31.6) and decreased renal function(CCr < 75㎖/min, aOR=5.4) are those associated with a higher incidence of septic shock. Independent factors associated with persistent(more than 3 days) fever are the early(within 10 days) onset of fever after last chemotherapy(aOR=8.8) and the existence of new pulmonary infiltrates on a simple chest X-ray(aOR=4.3). Conclusion: The stability of vital signs, the change of mentality, the renal function, the existence of significant comorbidity, the existence of new pulmonary infiltrates, and the rate of neutropenia are clinically useful risk-prediction factors in febrile neutropenia at the time of visiting the emergency department.

백서의 원위부 피편에 동맥유입의 중요성에 관한 실험적 연구

최규남,최희윤,강희문,김한중 大韓成形外科學會 1983 Archives of Plastic Surgery Vol.10 No.2

Microsurgery and myocutaneous flap have been developed recently for wide employment in plastic and reconstructive surgery. Therefore, the delay procedure has been declined in its use recently, because it has many difficult problems. If the flap is longer and larger, it should be delayed for complete survival, but delay requires considerable time. Therefore, as a substitute for delay, vascular anastomosis in the distal part of a flap will theoretically give the same effect. In this study, we investigated the importance of arterial inflow in the distal side of a flap in rats. The experiment was done in 3 different groups according to the design of flaps and in each group 3 subgroups were made. In A flap, the superficial epigastric artery was preserved or anastomosis. In V flap. the superficial epigastric vein was preserved or anastomosis. In C flap, as a control flap, both artery and vein were severed. In result, A flaps in all 3 groups were completely survived. Both V and C flaps in all 3 groups were showed distal necrosis. But C flaps were showed more necrosis than V flaps. In conclusion, we suggest the possibility that a large flap may be transposed in one stage with vascular anastomosis in the distal part-preferably artery and vein, or artery only.

사망 진단서(시체 검안서) 작성의 문제점

김규석,임용수,이중의,서길준,윤여규,어은경,염석란,정연권,이윤성 대한응급의학회 2000 대한응급의학회지 Vol.11 No.4

Background: This study was conducted to analyze the current problems in completing death certificates and to identify the correct method for completing death certificates Methods: We reviewed 262 death certificates in three hospitals from March 1 to April 30, 2000, and 119 death certificates in one hospital from March 1 to 31, 2000. We identified major and minor errors and analyzed and compared them retrospectively. Results: A total of 381 death certificates were reviewed: 59 in Seoul National University Hospital,101 in Ewha Woman's University Hospital, and 102 in Gachon Medical College Hospital, which has no education program for completing death certificates in postgraduate training, and 119 in Samsung Medical Center which has an education program for completing death certificates. 358 certificates(94.0%) had at least one error. There were only 23 death certificates(6.0%) without an error. In 182 cases(47.8%), there was one major error. In 321 death certificates(84.3%), there were more than two errors. A comparison of Samsung Medical Center with the other hospitals showed that the number of total errors was statistically different(p=0.001). Conclusion: There were few death certificates without an error in this study. In a hospital which has postgraduate training in completing death certificates, there are fewer errors than in other hospitals which have no training course. Emergency physicians actually certify many deaths, so they must know the correct method of completing death certificates for statistics on morbidity and mortality.

PCR-Select cDNA Subtraction을 이용한 Allomyces macrogynus의 팡이실의 성장 관련 유전자의 분리

박중규,구용범 인제대학교 1998 仁濟論叢 Vol.14 No.1

Allomyces macrogyuns의 이배체 꼬리홀씨들은, 공세포로 전환된 후, 실뿌리에 이어 팡이실을 형성하는데, 팡이실로 성장하는 과정에서 대기중의 산소의 고갈로 인하여 길이 성장이 급격히 촉진된다. 본 연구에서는, 길이 성장에 관련하는 유전자를 분리하기 위해서 보통의 대기 조건에서 자란 팡이실(Normoxia)과 하나의 탈산소제를 처리한 조건에서 자란 팡이실(Hypoxia)을 수확하여 PCR을 이용한 cDNA subtraction(PVR-select cDNA subtraction)을 수행하였다. PCR로 선택된 subtracted cDNA는 pGEM-T vector에 삽입 후, 대장균에 클로닝하여, 115개의 형질전환체를 무작위적으로 골라 slot blot hybridization을 하였다. 그 결과, 대부분의 클론이 Normoxic 조건에서 보다 Hypoxic 조건에서 다량 발현되는 유전자로나타났으며, 이들 중에서 60개의 클론을 DNA 염기 서열 분석하였더니 19가지의 서로 다른 염기 서열로 동정되었다. 이 유전자들을 Genbank Database와의 유사성을 조사했을 때, 염기 서열상 이미 알려진 유전자와의 유사성이 적었으나, 아미노산 서열상으로는 몇 가지 단백질들과 유사한 것으로 나타났다. 60개의 클론 중에서 높은 빈도로 나타나는 4가지 클론을 northern hybridization하였더니, 대략적으로 각각 0.9kb, 1.9kb, 1.9kb, 2.8kb의 mRNA로 전사되는 것으로, Hypoxic 조건의 팡이실에서 특이적으로 발현되는 것으로 나타났다. Diploid zoospore of Allomyces macrogynus form hyphae after encystment and rhizoid formation. It was the linear growth of hyphae that was stimulated on their growth by oxygen depletion in the atmosphere. In this study, CDNA subtraction with PCR(PCR-select cDNA subtraction) between hyphae incubated under normal atmosphere(Normoxia) and hyphae incubated with an oxygen absorbent(Hypoxia) were performed in order to isolate the genes related to the linear growth. PCR-select Subtracted cDNAs were cloned into E. coli JM 109 using pGEM-T vector. Total 115 transformants were randomly selected and analysed by slot blot hybridization. Most of them were found to be expressed in higher level in Hypoxic condition than in Normoxic condition. Of them, 60 clones were sequenced. They were identified as 19 clones, since nucleotide sequence of 60 clones was identical. Nucleotide homology search of these clones showed no significant homology with known genes, whereas amino acid sequence homology revealed that they had some homology with known proteins. Northern hybridization analysis of 4 frequently appeared clones among 60 clones confirmed that they were expressed in higher level in Hypoxic condition and their mRNA sizes were approximately 0.9kb, 1.9kb, 1.9kb, 2.8kb, respectively.

심첨부 비후 심근증에서 심근 내 미세 관상동맥의 혈류 예비력 평가 : 경흉부 도플러 심초음파를 이용한 연구 Study Using Transthoracic Doppler Echocardiography

윤호중,박철수,신재원,임상현,조은주,정해억,전희경,오용석,정욱성,김재형,최규보,홍순조 대한순환기학회 2004 Korean Circulation Journal Vol.34 No.3

엔드밀 형상에 따른 가공특성 분석을 이용한 형상설계 S/W 개발

한창규,고성림,유중학,서천석,김경배 한국공작기계학회 2004 한국공작기계학회 춘계학술대회논문집 Vol.2004 No.-

The tool geometry parameters and cutting process have complex relationships. Until now, various cutting test were needed to acquire optimal design of end mill for the purpose of high speed machining, due to the insufficient knowledge about cutting process in high speed machining. Using various tools with different geometry, relationships between tool geometry parameter (rake angle, clearance angle, length of cutter) and cutting process (cutting force, surface accuracy, surface roughness) have been studied. Acquired data can be used to design optimal tool for high speed machining and developed tool geometry design S/W.

강산 및 강알칼리 음독에서 냉각 용액을 사용한 희석 요법과 중화 요법의 가능성

이중의,송형곤,김동훈,권운용,곽영호,서길준,윤여규 대한응급의학회 2001 대한응급의학회지 Vol.12 No.3

Background: There is no effective treatment modality for caustic agent ingestion. Dilution and neutralization are prohibited because of the risk of secondary thermal injury. This experiment is designed to evaluate the amount of dilution and neutralization heat and to gauge the applicability of dilution and neutralization therapy using cold solutions to suppress the peak temperature. Methods: This is an in-vitro chemical experiment. HCl, CH3COOH, NaOH, and NH4OH are selected as representatives of strong and weak acids and strong and weak alkali, respectively. 20℃, 11.6M, 5.8M, and 2.9M solutions of each acid and alkali are made and mixed using a magnetic stirrer at a room air temperature of 28℃. The peak temperature, the duration above 40℃, and the heat amount are measured or calculated. Results: When a 11.6M HCl or NaOH solution is diluted with same amount of water, 32 or 18cal. per mL of HCl or NaOH is produced, respectively. HCl produces a significant peak temperature, but NaOH does not. The lower the concentration, the lower the amount of heat production. 11.6M CH3COOH and NH4OH solutions don't produce dilution heat.11.6M and 5.8M solutions of all acids and alkali produce destructive neutralization heat. However, 2.9M solutions produce neutralization heat which might be controllable. When a 11.6M HCl or NaOH solution is neutralized with a -10℃ 2.9 M NaOH or HCl solution, respectively, the peak temperature produced is below 40℃ and seems to add little thermal damage to viable tissue. Conclusion: Dilution and neutralization with a cold solution in cases of strong acid or alkali ingestion is a promising method to avoid thermal injury.

뇌 해마가 제거된 흰쥐의 유두체 및 내후야에서 HPLC에 의한 아미노산 신경전달물질 분석

김종규,신중호 순천향대학교 1991 논문집 Vol.14 No.2

뇌 해마가 glutamic acid, aspartic acid 및 그외 amino acid를 흥분성 신경전달물질로 사용하는지를 알기 위하여 대뇌피질을 거쳐 양쪽 해마를 제거한 흰쥐(해마군, 11마리), 해마를 덮는 대뇌피질 부분만을 제거한 흰쥐(대뇌피질 대조군, 8마리) 및 정상대조군(10마리)을 마련한 다음, HPLC를 이용하여 OPA pre-column 유도체화법으로 유두체와 내후야 조직의 아미노산들을 측정하였다. 1. 유두체 조직의 aspartic acid는 두 대조군보다 해마군에서 유의하게 감소되었으나, 두 대조군 사이에는 이렇다 할 차이가 없었다. glutamic acid는 정상 대조군보다 해마군에서 유의하게 증가되었으며, 대뇌피질 대조군에 비해서는 증가된 경향은 보였으나, 유의성은 없었고, 두 대조군 사이에는 아무런 차이가 없었다. serine, glycine, threnonine 및 alanine은 세무리 사이에서 차이가 없었다. 2. 내후야 조직에서 aspartic acid 및 glutamic acid는 두 대조군보다 해마군에서 모두 유의하게 감소 되었으나, 두 대조군들 사이에는 차이가 없었다. glycine은 해마군이 정상 대조군보다 유의하게 감소되었으나, 대뇌피질 대조군보다는 감소된 경향을 보였을뿐 유의성은 없었고, 두 대조군 사이에서는 아무런 차이가 없었다. alanine은 정상 대조군보다 대뇌피질 대조군에서 유의한 감소를 보였으며, 해마군은 정상 대조군에 비하여 감소 경향만 보였고, 해마군과 대뇌피질 대조군 사이에서는 유의한 차이가 없었다. 그리고 serine 및 threonine은 세 무리 사이에 아무런 차이가 없었다. 이상의 결과들을 종합하건데 아미노산인 aspartic acid와 glutamic acid는 해마, 유두체 및 내후야의 많은 신경섬유들이 흥분성 전달물질로 작용할 것으로 추측되어진다. A study was planned to analyze amino acid in target structure of hippocampectomized rats by HPLC. Twenty nine male rats were divided into 3 groups, of which 11 rats had their hippocampal tissue on both sides removed through an opening in the parieto-occipital cortex (hippocampal group), 8 rats received damage to the parieto-occipital cortex only(cortical control group), and 10 rats served as normal control animals. One week later, the animals were sacrificed by decapitation in the cold room. 2-3mg of tissue was obtained from the mammillary body and entorhinal area in one side of the brain. The tissue samples were homogenized in 200ul of 0.5M perchlocric acid in 1mM EDTA with ground-glass homogenizers. After centrifugation at 3,500 rpm for 15 min, an aliquot of 80ul supernatant was neutralized with 20ul of 2M KHCO₃, and then centrifuged again at 3,500 rpm for 10 min. An aliquots of 20ul was taken and diluted with 350ul of β-mercaptopropionic acid in 10ml of 100mM sodium borate buffer(pH 9.1) and 350ul of OPA solved in ethanol which was diluted with 10ml of 100mM sodium borate buffer(pH 9.1). Then 200ul of the resulting sample was injected with SIL-6B auto injector. LC-9A liquid chromatograph, FLD-6A fluorescence detector, CTO-6A column oven and SCL-6B system controller was employed. We used OPA pre-column derivatization method. Peak areas were automatically integrated and calculated by CR6A chromatopac. 1. In mammillary body, aspartic acid decreased significantly in the hippocampal group than in the normal control group(t test, p<0.05) and the cortical control group(p<0.04), while there were no significant difference between the 2 control groups. Glutamic acid increased significantly in the hippocampal group compared with the value obtained from the normal control group(p<0.03), while the difference between the hippocampal group and cortical control group values and between the 2 control group values were nonsignificant. In serine, glycine, threonine and alanine, the differences among 3 group values were nonsignificant. 2. In entorhinal area, aspartic acid and glutamic acid reduced significantly in the hippocampal group than in the normal control group(p<0.02) and the cortical control group(p<0.04), while no significant difference existed between the 2 control groups. Glycine reduced significantly in the hippocampal group compared with the value obtained from the normal control group(p<0.01). while the difference between the hippocampal group and cortical control group values and between the 2 control group values were nonsignififcant. Alanine increased significantly in the normal control group compared with the value obtained from the cortical control group(p<0.05), while no significant difference existed between the normal control group and the hippocampal group. However, the difference between the hippocampal group and the 2 control group values was nonsignificant. In serine and threonine, the difference was nonsignificant among 3 groups. It is inferred from the above mentioned results that the amino acids aspartic acid and glutamic acid are excitatory transmitter substances used by a large number of neurons in hippocampus, mammillary body and entorhinal area.

패혈증 백서 모델에서 비타민-C의 효과

이중의,신상도,표창해,서길준,정성은,윤여규 대한응급의학회 1999 대한응급의학회지 Vol.10 No.4

Background : Multi-organ failure from sepsis is very lethal disease entity, which is suspected to be caused by activated inflammatory cells. Inflammatory cells activated by endotoxins generate oxidants and cytokines such as TNF-α and IL-6, which in turn stimulate macrophages and neutrophils. Augmented inflammation makes an organ-injury deteriorate into an organ-failure, which may progress to multi-organ failure. This study is designed to evaluate the therapeutic effects of vitamin-C, a scavenger of oxidants, in sepsis. Methods : Male Sprague-Dawley rats were divided into 3 groups : a control group, a group injected intrapetoneally with LPS(lipopolysaccharide), and a group injected intraperitoneally with LPS and vitamin-C. Each eight rats were sacrified 24 hours and 48 hours after injection, and samples of the blood, the liver and the lung were obtained. Biochemical assays of TNF-α level in the blood and malondialdehyde(MDA)level, catalase activity and nitric oxide synthase(NOS)activity in the liver and the lung tissues were performed. Results : Serum TNF-α level, tissue lipid peroxidation and tissue i-NOS activity were dramatically increased, and tissue catalase activity was exhausted rapidly in sepsis. High dose vitamin-C administration decreased serum TNF-α level, tissue lipid peroxidation and tissue i-NOS induction, and protected against catalase exhaustion. Conclusion : high dose vitamin-C therapy was proved to have definite antioxidant effect in septic condition.

市場國際化를 위한 國內企業의 法的 課題로서의 製造物責任에 관한 硏究

徐圭錫,金玟中,洪春義 全北大學校 1993 論文集 Vol.35 No.-

Produkthaftung ist die durch Produkt, also durch Wirtschaftgu‥ter ausgelo‥ste Haftung. Eine Definition der Produkthaftung im Sinne des Produkthaftungsrechts enthaβlt die Verpflichtung, fu‥r Scha‥den zu haften, dieaus der Benutrung, aus den Ge-oder Verbrauch von fehlerhaHen Produkten entstehen. Da der Herstellereines Produkts nicht nur seinen unmittelbaren Vertragspartnern SorfEltspflicht schuldet, geho‥rt es zum haftungs-rechtlichen Kernbereich der Produkthatung einen Schadensersatz auch gegenu‥ber Dritten zu gewa‥hrleisten.Fu‥r die Untersuchung zur Produkthaftung als rechtliche Aufgabe der internationalen Industrie haben dieVerfasser vier mo‥gliche Themenbereiche ausgewa‥hlt. In einem ersten Kapital werden haftungsrechtliche Grund-sftze im modernen Produkthaftungsgesetz(und Produkthaftungsgesetz - Entwurf) und deren Tendenz der Ent-wicklung unter Beru‥cksichtigung der letzten internationalen Geseftgebung dargestellt. Das zweite Kapital derUntersuchung ist der Produkthaftung in den USA gewidmet. Die Produkthaftung in der EG wird im drittenKapital behandeit. Das vierte Kapitel wird sich mit der Produkthaftung in Japan beschliftigen.Aus der Untersuchung lassen sich im wesentlichen folgende herausstellen 1. Als wesentliche Tendenz unterstellt das moderne Produkthaftungsgesetz(und produkthaftungsgesetz -Ent- wurf) der yerschuldensunaba‥ngigen Gefa‥hrdungshaftung. Mit der Gefa‥hrdungsprodukthaftung sind fu‥rinternationale Industrie ku‥nftig erhebliche Belastungen verbunden. 2. Eine weitere Tendenz gegenu‥ber dem bisherigen Recht besteht darin, daβ jede Person, die sich alsHersteller ausgibt, sowie der Importeur, der aus Ausla‥nder einfu‥hrt, und auch der Lieferant der Haftungunterworfen werden. 3. Der Hersteller muβ fu‥r Entwicklungsrisiken nicht haften, wenn der Hersteller daru‥ber beweisen kann,daβ es sich im konkreten Fall um ein Entwicklungsrisiko handelt. 4. Von der Haftung ausgenommen werden landwirtschaftliche Naturprodukte, z. B. Erzeugnisse des Bodens,der Tierrucht, der Imkerei und Fischerei sowie Jagdfeugnisse, die nicht einer ersten Verarbeitung unto