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.

트레드밀 운동시 흡기근 테이핑이 폐활량에 미치는 영향

김민지,신수영,송월섭,조수진,최동락,황미진,황진규,박진현,김경,Dennis W. Fell 대구대학교 특수교육재활과학연구소 2011 再活科學硏究 Vol.29 No.1

이 연구는 트레드밀 운동과 키네시오 테이핑의 효과에 따른 폐활량의 변화를 알아보기 위해 26명의 비흡연자가 참가하였으며 키네시오 테이핑을 적용하지 않은 그룹과 키네시오 테이핑을 적용한 두 그룹으로 무작위로 배정하고 각 군들을 주 3회 6주간의 트레드밀 훈련을 실시하였다. 실험 전과 후, 스파이로미터를 사용하여 키네시오 테이핑의 적용 따른 폐활량 변화 효과를 측정하였다. 이 연구의 결과를 종합해보면 키네시오 테이핑을 적용 그룹에서 적용하지 않은 그룹에 비해 FVC, FEV1에서 유의한 증가를 보였다. 이러한 결과는 건강한 성인에서 키네시오 테이핑을 적용한 경우 키네시오 테이핑을 적용하지 않고 트레드밀 운동을 한 경우보다 폐활량의 향상에 효과적이라고 생각되어진다. The purpose of this study was to investigate the variation of vital capacity(VC) according to the effects of kinesio taping with treadmill exercise. Twenty-six non-smokers were participated in this research and these subjects were randomly assigned into two groups. To measure the VC variation effects of kinesio taping, spirometer was used. The collected data were analyzed statistically by using a paired Mauchly test and repeated measure ANOVA. The results of this study were as follows; A group: treadmill with kinesio taping B group: treadmill without kinesio taping. Between A and B, there were significant differences. In the case of A group, there was 11.66% increase of VC, during 3 weeks experiment(p<.01). In the case of B group, there were significant differences, 3.35% increase of VC, during 3 weeks taping intervention(p<.01). After 6 weeks experiment, the improvement of VC shown a significant difference with intergroup (p<.05). From this result, it was revealed that treadmill exercise with kinesio taping was effective to improve VC to healthy adult than treadmill exercise without kinesio taping.

하청 근로자들의 건강수준 평가

최홍열,고상백,장세진,차봉석,임형준,이상윤,김재용,강동묵,조수헌 大韓産業醫學會 2001 대한직업환경의학회지 Vol.13 No.1

목 적 : 하청노동을 이용한 노동 유연화 전략은 근로자들의 고용을 불안정시키고, 근로자들의 삶에 부정적 영향을 미치고 있다. 따라서 이 연구는 하청업체 근로자들의 고용현황을 조사하고, 기존의 업체중심의 건강평가의 문제점을 지적하고자 하였다. 또한 하청업체 근로자들의 건강평가의 현재적 의미와 사회적 배제의 특성을 알아보고자 하였다. 방 법 : 모기업과 하청업체 근로자들의 건강수준을 비교하기 위하여, 정기건강진단(일반, 특수)과 채용건강진단 자료를 이용하고자 하였다. 건강진단에서 누락된 비정규직을 포괄하기 위하여 SF-36을 이용하여 건강설문조사를 시행하였다.결 과 : 조선업 하청업체 근로자들의 고용기간은 짧고, 빈번한 노동이동 현상을 보였다. 3년간 건강진단 수검 현황을 통해 살펴볼 때, 1998년 수검자중 2000년까지 연속해서 검진 받은 수검자는 40.3%였다. 건강진단 결과 유소견자 규모를 통해 모기업과 하청업체간의 건강수준을 비교해 보았다. 모기업은 일반질병 요관찰자와 질병자를 포함한 유소견자가 1,011명으로 약 10 %의 유소견율을 보이고 있고, 질병자의 경우 596명으로 유병률이 5 %를 상회하고 있다. 반면 하청업체의 경우 1,967명의 수검자중 유소견자가 115명으로 6 %의 유소견율을 보이고있고, 질병자는 82명으로 4 %의 유병률을 보이고있다 채용건강진단을 받은 수검자는 6,260명 이었으며, 이 중 유소견자 수는 2,373명으로 전체 수검자의 37.9 %를 차지하였다. 건강설문지의 경우는 전체 건강수준의 총합은 하청보다 원청 근로자가 높았고 통계적으로 유의하였다. 결 론' 정기건강검진 결과는 하청근로자들이 고용형태에 따라 검진을 받지 못한 경우가 많아, 건강 근로자 효과로 표현될 가능성이 있다. 따라서 채용건강진단 결과는 다른 측면에서 하청업체 근로자들의 건강수준의 현실적 반영이라고 할 수 있다. 향후 하청업체 근로자들의 건강문제를 감시하고 개선하려면 기존의 업체 중심의 접근으로는 하청 근로자의 건강문제를 제대로 다룰 수 없고, 업종과 지역을 동시에 고려하여 접근할 필요가 있다. 또한 단기 고용 근로자 및 비정규직 근로자를 사회보장의 확충과 모기업의 연대책임 강화 및 기업복지 차원에서 포괄하는 방안이 모색되어야 하겠다. Objectives : The strategy for the labor flexibility through subcontracted labor have brought a negative effect on the lives of the workers, such as the increase of the unstable employment. This study was conducted to analyze the relationship between the employment of subcontracted firms and the health status of them, and to find out some problems which have been caused in the process of health evaluation and the characteristics of social exclusion. Methods : We reviewed the periodical health examination and preemployment health examination in order to compare health status of the subcontracted workers with those of the parent firm workers. The SF-36 questionnaire was administered to assess the self-perceived health status. Results : The result shows that compared to the working duration of the parent firm workers, those of the subcontracted workers were shorter, and the job transfer rate was higher. In the periodical health examination, the prevalence of occupational and general disease was higher in the parent firm(10%) than in the subcontracted firms(6%). Preemployment health examination plays an important role in worker's health manage- ment. Among 6,260 workers who received preemployment health examination, the prevalence of disease was 37.9%. Mean scores of health status measured by SF-36 were lower in the subcontracted firm than in the parent firm. Conclusions : Due to social exclusion of the subcontracted workers from the periodical health examination, there is a possibility that the periodical health examination have the healthy worker effect. These results suggests that the preemployment health examination could be a more appropriate indicator which is able to assess the health status of the subcontracted workers than the periodical health examination.

부적절한 예방화학요법 후 지연 발현된 Plasmodium vivax 말라리아 1 예

최수철,장상필,김상화,서환조,서진태,김구엽 대한내과학회 1998 대한내과학회지 Vol.54 No.3

Malaria is the world's most important parasitic infection. Although it has been erw5cated from temperate zones including Korea, increasing numbers of travellers visit tropical malarious countries and imported malaria becomes important medical problem in the developed countries. In Korea with increasing travellers to malaria-endemic area, the incidence of imported malaria shows rising tendency same as the developed countries. It becomes important to personal general personal protective measures and chemoprophylaxis to trevellers, when employed in appropriate manner, that can be highly effective in preventing malaria. We recently experienced a case of in Plasmodium vivax malaria with delayed manifestations due to inadequate chemoprophylaxis. A 53-year-old woman with history of trevel to East Africa 4 months ago and chief complaint of fever was diagnosed as tertian malaria. She had irregularly taken prophylatic antimalarial during travel and had not taken it after return but should have taken it at least 4 weeks after return.

프레탈^(R)정(실로스타졸 50mg)에 대한 실로졸^(R)정의 생물학적 동등성

최한곤,권기철,이승호,김학미,박병주,유봉규,이종달,이경희,하정희,우종수,박인숙,최진석,용철순 한국병원약사회 2003 병원약사회지 Vol.20 No.1

Bioequivalence of two cilostazol tablets, the Pletaal^(R)(Korea Otsuka Pharmaceutical Co., Ltd.) and the Cilozol^(R)(Hanmi Pharmaceutical Co., Ltd.), was evaluated according to the guideline of KFDA, Sixteen normal male volunteers(age 20~29 years old) were divided into two groups and a randomized 22 cross-over study was employed. After two tablets containing 50㎎ of cilostazol were orally administered. blood was taken at predetermined time intervals and the concentration of cilostazol in plasma was determined with an HPLC method using UV detector. The pharmacokinetic parameters(C_(max), T_(max) and AUC_(t)) were calculated and ANOVA was utilized for the statistical analysis of parameters. The results showed that the differences in C_(max), T_(max) and AUC_(t) between two tablets were 4.99%, 1.74% and 7.68%, respectively. The powers(1-β) for C_(max), T_(max) and AUC_(t) were83.92%, 80.12% and 85.03%, respectively. Detectable differences(Δ) and confidence intervals were all less than 20%, and confidence interval of all the parameters were also less than 20% at the significance level(α) of 0.05. All of these parameters met the criteria of KFDA for bioequivalence, indicating that Cilozol^(R) tablet is bioequivalent to Pletaal^(R) tablet.

Ethephon 및 Aminoethoxyvinylglycine 처리가 ‘원황’ 배 모의 수출 환경에서의 품질 및 생리장해 발생에 미치는 영향

최진호,이욱용,안영직,황용수,천종필 충남대학교 농업과학연구소 2013 농업과학연구 Vol.40 No.2

We investigate the effect of preharvest spray of aminoethoxyvinylglycine (AVG), an inhibitor of ACC synthase activity, on fruit quality of ‘Wonhwang’ pear (Pyrus pyrifolia Nakai). And the effects were compared with ethephon which releasing ethylene to elucidate treatment efficacy of ethylene biosynthesis inhibitor on Asian pears. Chemicals were sprayed on 30 days before harvest with AVG (75 and 150 mg/L) and ethephon (100 mg/L), respectively. Highest flesh firmness during 21 days of shelf-life at 25℃ after 30 days of cold storage was attained in the fruit treated with 150 mg/L AVG (26.5N) when compared with untreated control (16.7N), while the fruits treated with 100 mg/L ethephon completely lost their marketability within 14 days of shelf-life by mass drop of firmness down to 11.6N. Low incidence of physiological disorders including pithiness and core browning were attained at the fruits treated with 150 mg/L AVG when we compared with untreated control. No occurrence of mealiness found in the fruits treated with AVG but ethephon treated fruits showed 36.4% during 14 days of shelf-life. Consequently, AVG spray at the concentration of 150mg/L on Asian pear ‘Wonhwang’ fruit regarded as useful preharvest management approach for keeping quality during marketing period after simulated exportation.

횡문근융해증과 급성 신부전 및 범발성 혈관내 응고장애를 동반한 열사병 1예

최대은,박수진,권오경,이한규,이영모,이상주,나기량,이강욱,신영태 충남대학교 의학연구소 2003 충남의대잡지 Vol.30 No.2

Heat stroke is a life-threatening illness characterized by an elevated core body temperature that rises above 40% and central nervous system dysfunctions that results in delirium, convulsions, or coma. Heat stroke is subdivided into two forms, classic and exertional. Since strenuous exercise is one of the major exacerbating and precipitating factors, the incidence of exertional heat stroke is high among young adult, especially military personnel undergoing military training. Exertional heat stroke commonly causes rhabdomyolysis, lactic acidosis, acute renal failure, shock and pulmonary edema. We report a case of heat stroke with rhabdomyolysis, acute renal failure, disseminated intravascular coagulopathy(DIC) after strenuous exercise. A 18 year old man was admitted to the hospital because of loss of consciousness. He was a wrestler and he had tried to lose 6kg in weight by jogging and strenuous exercise on that summer day with hot temperature. The development of this illness was favoured by much clothes inappropriate for that environmental condition with a purpose to enhance sweating, and by restricted intake of water and food. On admission, the blood pressure was 80/50mmHg, and body temperature was 39.4℃ with stuporous mentality. Laboratory finding were as follows : in complete blood cell count, hemoglobin was 16.7g/dL and platelet count was 158,000/ mm³. In blood chemistry, AST 1061U/L, ALT 201U/L, BUN 30mg/dL, Cr 2.2mg/dL, LDH 941IU/L, CK 696IU/L were resulted. In arterial blood gas analysis, pH 7.39, pCO₂ 30mmHg pO₂ 86mmHg, HCO₃ 18.4mEq/L, O₂ saturation 96.7% were resulted. In urinalysis, specific gravity 1.025, protein 3+, erythrocyte 2+ were resulted. In brain imaging study, brain CT finding was normal. After appropriate treatments with rapid cooling, hydration and supportive care, he improved with alert mental status. On 2nd hospital day, in laboratory result, thrombocytopenia and coagulopathy were appeared and renal insufficiency was aggravated. So he was treated with platelet concentrate and fresh frosen plasma for DIC, and enough hydration for appropriate urine volume preservation. After all, On 22nd hospital day, he fully recovered and discharged. Nowadays, with followed for some duration, he is wellbeing with no complications.

健康한 韓國人의 動脈血液 가스 및 酸一鹽基 平衡値에 對한 觀察

崔震守,曺方煥,朴喜淑,金顯承,金瑛,白正敏,徐錫助 순천향의과대학 1979 Journal of Soonchunhyang Medical Science Vol.2 No.3

The purpose of this paper is to make an attempt in this investigation to determine normal adult values of arterial blood gas and acid-base balance in 53 healthy Korean male and female subjects of varying age and then compare with the data obtained by others. Determinations of the acid-base status of the arterial blood were performed at 37℃ by the Astrup method using a radiometer instruments, consisted of BGA2A/3-MK 2 system. The mean and standard errors of each component were as follows: pH 7.42±0.043, oxygen saturation 96.96±0.089%, pO?? 97.66±0.91mmHg, pCO?? 37.08±0.68mmHg, CO?? content 24.29±0.43mM/L, bicarbonate 23.26±0.68mM/L, buffer base 46.56±0.66mEg/L, and base excess -0.024±0.001mEg/S. Compared with normal adult values in literatures, all the components of the data appear to be in the same range without any significant difference.

고층건물의 구조설계에서 물량재분배를 통한 변위조절 자동화 시스템 개발에 관한 기초연구

최진원,이일주,김활수 대한건축학회 2003 대한건축학회 학술발표대회 논문집 - 계획계/구조계 Vol.23 No.2(구조계)

The purpose of this study is to explore drift control methods and design an automated drift control system. In recent years, various drift design methods have been developed the high-rise buildings. However, the process related to the drift design methods for the high-rise buildings is time-consuming and labor intensive trial-and-error processes because any system to support drift design automatically had not yet been developed. To improve the method of structural analysis and optimal design in the tall buildings, drift design stages based on the component resizing technique are presented and tested. Based on that, we develop an extended building structure data model which can be easily translated into other structure design system such as MIDAS. The user interface is designed intuitively to transfer designer's intension.

魚油함유 飼料에 첨가한 α- 토코페롤의 含量이 흰쥐 血液의 肢質過酸化反應에 미치는 影響

崔鎭浩,金一星,金在一,金東右,朴泉洙,尹泰憲 부경대학교 기초과학연구소 1993 기초과학연구논문집 Vol.4 No.-

어유와 돈지의 혼합지질(3 : 1, wt/wt: P/S : 1.6)에 α-토코페롤을 용량별(0, 50, 100, 200, 400, 800mg/kg diet)로 첨가하여 조제한 어유 함유 사료로써 7주간 사육하여 이 사료에 혼합한 α-토코페롤의 첨가량이 혈청 중의 지질대사에 미치는 영향을 검토하였다. 중성지질(TG)과 인지질의 함량은 α-토코페롤 200mg 이상의 첨가군은 대조군에 비하여 유의적으로 감소하였고, 또한 총콜레스테롤의 함량은 α-토코페롤의 첨가에 따라 감소하는 경향이었지만 낮은 첨가농도에서만 유의성이 인정되었다. HDL-콜레스테롤의 함량은 100mg 이상의 α-토코페롤 첨가군에서 총콜레스테롤에 대한 HDL-콜레스테롤의 비(HDL-chol/T. chol)도 α-토코페롤의 모든 첨가군에서 유의적으로 증가효과가 인정되었다. 따라서 동맥경화 지표가 α-토코페롤 첨가군에서 유의적으로 감소하였다. 중성지질에 대한 과산화지질(TBA value/TG)의 비는 10mg 이상의 α-토코페롤의 첨가군에서 유의적으로 억제되???고, 중성지질에 대한 α-토코페롤(α-tocopherol/TG)의 비는 100mg 이상의 α-토코페롤 첨가군에서 유의적으로 증가되었다(p<0.001). 어유 함유 사료에 α-토코페롤을 첨가함으로써 C20 : 5/C20 : 4의 비를 효과적으로 억제할수 있었다. 따라서 혈액 중의 적절한 지질대사를 위해서는 이들 어유 함유 사료에 100mg 이상의 α-토코페롤이 첨가되어야 할것으로 생각된다. To evaluate the vitamin E requirement, Fischer 344 male rats were fed diets containing the fish oil-lard (3 : I, wt/wt: P/S ratio : 1.6) supplemented with 0, 50, 100, 200. 400 and 800 mg/kg diet of a-tocopherol for 7 weeks. The effects of a-tocopherol levels supplemented to fish oil rich diets on the lipid metabolism in serum were investigated. Triglyceride (TG) and total cholesterol significantly decreased by supplementation of a-tocopherol. The a-tocopherol supplementation of abme 100 mg diet caused an incressis in HDL-cholesterol. and HDL-cholesterol : T. chol ratio, and a decrease in the atherogenic index. The lipid peroxide : TG ratio significantly inhibited by a-tocopherol supplementation of above 100 mg. The ratios of α-tocopherol/TG or n-3 fatty acid (EPA+ DHA) significantly increased in all α-tocopherol supplemented groups. The ratio of eicosapentaenoic acid : arachidonic acid effectively inhibited by a-tocopherol supplementation of above 100 mg. The results suggest that a-tocopherol supplementation of above 100 mg to fish oil-rich diets map be requisite for adequate lipid metabolism.