서울의 Penicillinase Producing Neisseria gonorrhoeae 발생빈도(1997)

김재홍,문득곤,김정수,김용준,임동진,박상훈,김희성,이민수,송기훈,김갑형,김형석,성소영,이인섭,김석우,황지환,조창근,김경문,부태성 대한화학요법학회 2000 대한화학요법학회지 Vol.18 No.3

Background : In recent years, gonorrhea has been pandemic and remains one of the most common STDs in the world, especially in developing countries. Objective & Methods : For the detection of a more effective therapeutic regimen and assessing the prevalence of PPNG, we have been trying to study the patients who have visited the Venereal Disease Clinic of Choong-Ku Public Health Center in Seoul since 1980 by means of the chromogenic cephalosporin method. Results : In 1997. 99 strains of N. gonorrhoeae were isolated, among which 45(45.5%) were PPNG. Conclusion : The prevalence of PPNG in Seoul, which had been decreased to 39% in 1996 after a peak of 74.3% in 1993, is increased to 45.5% in 1997.

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.

소규모사업장 용접근로자들의 소음·용접흄·망간 노출에 관한 연구

김동구,문덕환,이채관,박명희,함성애,손병철,김대환,이창희,김휘동,이채언 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.5

Objective : This study was conducted for the purpose of investigating the level exposure of welders to noise, welding fume and Manganese(Mn) related to this process. Methods and Material : All subjects in this study were welders engaged in CO2 arc and coated arc welding process especially in small-scale enterprises classified by type of manufacture of ship building, repairing and of other fabricated metal products, which is located in Gimhae and Milyang of Kyeongsang province in south Korea. Air sampling of welding fume was measured, shipped and analyzed on the basis of national institute for occupational safety and health(NIOSH) method in U.S. and work environment measurement method established in south Korea. To measure Noise in the work environment, Noise dosimeter was used on the basis of work environment measurement method established in south Korea. Result : This study was performed during a period from January, 2000 to December, 2001 and Results were as follows: 1. Noise level measured in this work environment was higher than national criteria for permissible exposure limit on health examinations related to hearing loss. 2. The concentration of welding fume and Mn in manufacture of ship building and repairing was higher than those in manufacture of other fabricated metal products. 3. In conditions of existing in ventilation system installed and operated, the concentration of welding fume and Mn was slightly lower than those of not existing. 4. In conditions of existing in sufficient air supply from out door into the work place relied on natural exhaust system, the concentration of welding fume and Mn was slightly lower than those of in not sufficient. 5. In all subjects, a rate of wearing ear plug and respiratory mask for dust and fume was lower than that of not wearing. Conclusion : According to above results, this study suggests that more positive work environment managements such as the use of portable local ventilation system, the supply of highly qualified personal protective equipment, and consecutive education and training related to health protection should be need to acquire suitable health protection program for welders engaged in small-scale enterprises in Korea.

제한된 적응증의 대퇴골 간부 골절에 사용된 역행적 골수정 삽입술

김성중,오창욱,인주철,김희수,전인호,경희수,박일형,김경훈 대한골절학회 2003 대한골절학회지 Vol.16 No.1

목 적 : 전향적 골수강내 고정술로는 치료가 힘들었던 대퇴골 간부 골절에 대해 역행적 골수강내 고정술을 시행한 후 그 결과를 분석하였다. 연구 대상 및 방법 : 대퇴골 간부 골절로 진단 후 슬관절에서 역행적으로 비확공성 골수강내 금속정(Unreamed femoral nail, Synthes R)으로 치료한 환자 중 최소 1년 이상 추시(평균; 21개월, 범위; 13개월-28개월)가 가능하였던 21명 24례의 환자를 대상으로 임상적, 방사선학적 평가를 시행하였다. 남자가 16명, 여자가 5명이었으며, 수술시 평균 연령은 41세(18-76세)이었다. Winquist-Hansen의 분류상 제1형이 10례, 제2형이 5례, 제3형이 3례, 제4행이 6례 이었으며, 전 례에서 동반된 골절 손상이 있었으며, 적용된 적응층에 따르면 동측 경골 골절이 8명, 동측 근위 대퇴골 골절)경부 및 전자부 골절) 5명, 동측 골반부 및 비구 골절 4명, 양측 대퇴골 골절 3명, 동측 슬관절 손상이 1명이었다. 방사선 소견상 골유합 시기 및 불유합, 부정유합 등을 평가하였고, 임상적 평가는 슬관절의 동통을 포함한 Neer 등에 의한 방법을 이용하였다. 결 과 : 대부분(87.5%)에서 일차적인 골유합을 얻을 수 있었으며, 평균 골유합 기간은 15.8주(범위; 12-20주)이었다. 추가적인 술식이 요구된 지연유합 또는 불유합은 3례가 있었으며, 그 외 ㎝ 이상의 단축이나 10도 이상의 부정유합 술 후 슬관절 감염 또는 불안정성이 발생한 경우는 없었다. 슬관절의 운동 평가에서 Neer score는 평균 86.9점으로, 모든 례에서 양호한 결과를 나타내었다. 평균 슬관절 운동영역은 120.2도 이었고, 3례에서 경미한 슬관절 동통을 나타냈다. 결 론 : 역행성 골수정은 동측 하지의 동반된 골절이나 다발성 골절이 있는 환자에서 대퇴골 간부 골절에 대하여 제한적으로 이용될 수 있는 유용한 방법으로 사료된다. Purpose : This is a retrospective study to analyze the results after retrograde intramedullary(IM) nailing in femoral shaft fractures with limited indications. Materials and Methods : Twenty-four femoral shaft fractures(21 patients) were operated with unreamed IM nail(Unreamed femoral nail, SynthesR) in a retrograde method and were followed for more than 1 years. There were 16 men and 5 women, and the mean age at index operation was 41 years (range 18-76 years). In Winquist-Hansen classifications, there were 10 of type Ⅰ, five of type Ⅱ, three of type Ⅲ, and ix of type Ⅳ. All the patients had associated fractures or injuries, and there were eight ipsilateral tibia fractures, five ipsilateral proximal femoral fractures(including neck and trochanter), four ipsilateral pelvic or acetabular fracture, three bilateral femoral fractures, and one ipsilateral knee injury according to the used indication, and clinical evaluation with Neer's criteria was done. Results : Most fracture(87.5%) were primarily united cases, and the mean time for union was 15.8% weeks(range 12-20 weeks). Three cases of delayed union or nonunion were developed, but a shortening over 1㎝ or malunion over 10 degrees angular deformity were not found. Evaluating the knee functions, the Neer score wes 86.9 in average and all the cases were above satisfactory grade. The average range of knee motion was 120.2 degrees, and the mild knee pain was developed in three cases. Conclusion : The retrograde IM nailing can be a useful option for femoral shaft fracture with limited indications, including ipsilateral fractures of other areas or multiple fractures.

[논문]Operational Characteristics of CO2 Laser Adopted by Superposing-Discharge

Hee-Je Kim,Hyun-Ju Chung,Byoung-Dae Min,Jong-Han Joung,Sung- lun Park 釜山大學校生産技術硏究所 2003 生産技術硏究所論文集 Vol.62 No.-

오늘날 현저한 CO2 레이저의 응용 추세에 발맞추어 보다 다양한 형태의 출력 제어 기술이 대두되고 있다. 본연구에서는multi-Pulse Superposing-Discharge 기술을 이용하여 다양한형태의 CO2 레이저의 펄스를 성형 하였다. 펄스 성형을 위한 방법으로 PIC one-chip microprocessor를 이용하여 삼중 PFN 모률의 SCR을 각각 고유의 지연시간을 가지도록 제어하였다. 실험에 사용된 삼중 PFN 모률의 전원 회로는 각각 캐패시터 인덕터,SCR,고압 펄스 트랜스 그리고 고압 트랜스 2차측에 브릿지 정류기로 구성 하였다. 고압 펼스 트랜스의 1차측을 제어하므로서 PFN 모률의 동작을 저 전압에서 수행 할 수 있다. 트랜스의 2차측에 연결된 전파 정류기는 펄스 에너지를 부하에 지속적으로 전달한다. 본 연구에서는 삼중 PFN 모률의 각각의 SCR을 다른 시간 가격을 두고 트리거 하므로서 다양한 Long pulse shaping을 실현하였다. 또한 약 250-1000μs 의 주기를 가지는 다양한 펄스형 레이저 빔을 얻었다.

Assessment of In Vitro Assay System for Thyroid HormoneDisruptors Using Rat Pituitary GH3 Cells

Hee Jin Kim1,Hae Young Park1,Jeonga Kim1,Il Hyun Kang2,Tae Sung Kim2,Soon Young Han2,Tae Seok Kang2,Kui Lea Park2,Hyung Sik Kim1 한국독성학회 2006 Toxicological Research Vol.22 No.4

The development of in vitro assays has been recommended to screening and test-ing the potential endocrine disruptors (EDs). These assay systems focus only on identifying thethe thyroid hormone (TH) disruptors. The aim of this study was to evaluate a test system to detectTH disruptors using rat pituitary tumor GH3 cells. The test system is based on the TH-dependentincrease in growth rate. As expected, L-3,5,3-triiodothyronine (T3) markedly induced a morphologicalchange in GH 3 cells from flattened fibroblastic types to rounded or spindle-shaped types. T3 stimu-lated GH3 cell growth in a dose-dependent manner with the maximum growth-stimulating effect9 M. In addition, T3 increased the release of growth hor-mone and prolactin into the medium of the GH3 cells culture. Using this assay system, the TH-dis-rupting activities of bisphenol A (BPA) and its related compounds were examined. BPA,dimethylbisphenol A (DMBPA), and TCI-EP significantly enhanced the growth of GH3 cells in therange of 1 × 10-5M to 1 × 10-6M concentrations. In conclusion, this in vitro assay system might bestandardization before it can be used as a broad-based screening tool.

만성 승모판 패쇄부전증 환자에서의 안지오텐신 전환효소 억제제의 장기 투여 효과

김대희,이명묵,이해영,조현재,박승정,서재빈,서정원,양한모,윤창환,조상호,이준희,김용진,김명아,손대원,오병희,박영배 대한순환기학회 2004 Korean Circulation Journal Vol.34 No.2

조혈모세포이식 환자에서 침습성 진균 감염에 대한 Micafungin의 예방 효과 및 안전성

김시현,이동건,최수미,권재철,박선희,최정현,유진홍,이성은,조병식,김유진,이석,김희제,민창기,조석구,김동욱,이종욱,민우성,박종원 대한감염학회 2010 감염과 화학요법 Vol.42 No.3

Background: Micafungin, a potent inhibitor of 1,3-β-D-glucan synthase, is a novel antifungal agent of the echinocandin class. In vitro study showed that micafungin was effective against Aspergillus species as well as Candida species, but clinical data on the prophylactic efficacy against invasive fungal infections (IFIs) other than candidiasis are still lacking. Materials and Methods: We identified 60 consecutive adult hematopoietic stem cell transplantation (HSCT) recipients who received at least 3 doses of micafungin during neutropenic period. Micafungin was started as an alternative in patients who were intolerant or had adverse events (AEs) to primary prophylactic antifungal agents. We retrospectively reviewed the medical records and analyzed the efficacy and safety of micafungin for prophylaxis against IFIs. Results: The patients either had autologous (n=9) or allogeneic (n=51: 1 syngeneic, 24 sibling, 26 unrelated donor) HSCT. Itraconazole oral solution (n=58) was the most frequently used first line antifungal agent for prophylaxis and was administered for median 11 days. The most frequent cause of switch to micafungin was vomiting (n=42). The duration of neutropenia and micafungin administration was median 13 and 12 days, respectively. A successful outcome was achieved in 45 (75%) patients. Empirical antifungal therapy was initiated in 13 (22%) patients. There were 2 cases (3.3%) of breakthrough fungal infections which comprised a probable invasive pulmonary aspergillosis and a possible invasive fungal sinusitis. There was no case of invasive candidiasis. A total of 53 (88%) patients experienced at least one AE regardless of causality during micafungin administration. The most frequent AEs were hypokalemia, vomiting, diarrhea, and elevated serum aspartate aminotransferase or alanine aminotransferase. Among the aforementioned AEs, only 1 case of diarrhea could be classified as a probable relation with micafungin when causality was assessed. There was no AEs that caused discontinuation of micafungin. Conclusions: Micafungin seems to be a safe and effective agent for prophylaxis of IFIs including aspergillosis as well as candidiasis in HSCT recipients. However, further large, prospective, and randomized comparative studies are warranted for aspergillosis.

An Improved Speech Processing Strategy for Cochlear Implants Based on an Active Nonlinear Filterbank Model of the Biological Cochlea

Kim $^$, Kyung Hwan,Choi, Sung Jin,Kim, Jin Ho,Kim, Doo Hee IEEE 2009 IEEE Transactions on Biomedical Engineering Vol.56 No.3

<P>The purpose of this study was to improve the speech processing strategy for cochlear implants (CIs) based on a nonlinear time-varying filter model of a biological cochlea. The level-dependent frequency response characteristic of the basilar membrane is known to produce robust formant representation and speech perception in noise. A dual resonance nonlinear (DRNL) model was adopted because it is simpler than other adaptive nonlinear models of the basilar membrane and can be readily incorporated into the CI speech processor. Spectral analysis showed that formant information is more saliently represented at the output of the proposed CI speech processor compared to the conventional strategy in noisy conditions. Acoustic simulation and hearing experiments showed that the DRNL-based nonlinear strategy improves speech performance in a speech-spectrum-shaped noise.</P>

위절제술 환자의 표준진료지침 개발 및 적용 효과

김은희,김철규,이순교,김순덕,이혜옥,권정순,이경미,이민미,심순미,유용만,신종식,강은희,이상일,김병식,오성태,육정환,박수길 한국의료QA학회 2003 한국의료질향상학회지 Vol.10 No.2

Background : Gastric cancer is the most common malignant tumor in Korea. surgical operation is one of the major treatment modalities for gastric cancer patients. Therefore, gastrectomy is one of the most common procedures in General Surgery. There were variation in length of hospital stay and medical treatment for gastrectomy between three surgeons at Asan Medical Center. Clinical pathways have received considerable attention as a tool for recucing the medical practice variation, increasing the efficiency of care process, and improving the quality of care. The aim of this study was to evaluate the effect of a clinical pathway for gastrectomy in gastric cancer patients. Methods : The clinical pathway for gastrectomy was developed and implemented by a multidisciplinary group in Asan Medical Center. A computerized clinical pathway program was developed and revised after a pilot test. A total of 145 patients underwent gastrectomy by three surgeons at Asan Medical Center. We compared the length of hospital stay, patient satisfaction, and unplanned readmission rate between the pre-pathway group(n=67) and the post-pathway group(n=78). We also investigated the degree of satisfaction among the physicians and nurses who were main end-users of the clinical pathway. Results : The clinical pathway was applied to all target patients. The average length of hospital stay was shortened from 12.7days to 10.6days(p<0.01). The degree of patient satisfaction with the care process changed from 90.3% to 89.2% after the implementation of the clinical pathway, but the difference was of satistically significant(p=0.761). Unplanned readmission rate was 2.9% in the pre-pathway group. More than 90% of physicians and nurses answered that the clinical pathway had been a useful tool in their medical practice. Conclusions : The findings of the study demonstrated that implementation of the clinical pathway for gastrectomy produced substantial reduction in the length of hospital stay while improving the quality of patient outcomes. The computerized clinical pathway program can be used as one of the powerful patient management tools for reducing the practice variations and increasing the efficiency of care process in Korea hospital settings.