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.

혼수상태의 외상환자에서 초음파를 이용한 흉부 및 복부손상의 진단

임경수,이강현,이진웅,이부수,황성오,유수영,강성준 대한응급의학회 1995 대한응급의학회지 Vol.6 No.1

The need for rapid diagnosis and treatment of life-threatening thoracic and intra-abdominal injury result in controversy over the appropriate triage of unconscious blunt trauma patients. To aid in early decisions for these patients, a prospective analysis of 98 patients with glasgow coma scale(GCS) scores≤8 was undertaken. Although intra-thoracic and intra-abdominal injuries were frequently identified based on systolic blood ressure, the use of clinical signs alone resulted in more missed injuries than did using the emergency ultrasonography. In normotensive patients(n=34), intra-thoracic injuries was identified in one patient(2.9%), and intra-abdominal injuries were in 7 patients(20.6%). In shock(systolic blood pressure<90mmHg) Pa-tients(n=64), thoracic injuries and intra-abdominal injuries were diagnosed in 8(12.5%) and 27 patients(42.3%), thoracic and abdominal combined injuries were identified in 11 patients(17.2%). The sensitivity, specificity, and accuracy of emergency ultrasonography were 96.3%, 91.7%, 94.9%. This study suggests that all unconscious trauma patients undergo immediate emergency ultrasonography to prevent missing life-threatening injuries.

성균관대학교 물리학과 방음실의 설계 및 제작

朴興秀,尹錫旺,李聖壽,朴光俊,吳世珍 성균관대학교 기초과학연구소 1986 論文集 Vol.37 No.1

An anechoic chamber was constructed to make to condition of acoustic free field at the Department of Physics, Sung Kyun Kwan University. In this paper the criteria for the design and construction of the anechoic chamber are described. 48cm long wedges of density 15.3kg/㎥ glasswool attached to the 40×20×20㎤ base were used for the lining of anechoic chamber with the cutoff frequency of 125Hz. The interior space of the chamber is 3.56m long, 3.38m wide and 2.37m high.

생약제제인 이공산(異功散)의 Cisplatin 유도 신장독성 보호 및 항산화 효과

Lee, Kyung-Tae,Ahn, Kyoo-Seok,Chang, Sung-Goo,Oh, Soo-Myung,Jung, Jee-Chang 경희대학교 동서의학연구소 1999 INTERNATIONAL SYMPOSIUM ON EAST-WEST MEDICINE Vol.1999 No.1

Kyung-Tae Lee, Kyoo-Seok Ahn¹, Sung-Goo Chang², Soo-Myung Oh²and Jee-Chang Jung²¹College of Pharmacy, ²Oriental Medicine and ³College of Medicine, and East-West Medical Reserch Institute, Kyung Hee University, Seoul, Korea. Preventive and Antioxidative Effects of Crude Drug Preparation(E-kong-san) on Cisplatin Induced Nephrotoxicity. Proceedings of International Symposium on East-West Medicine, Seoul. 201-211, 1999. -Nephroprotective effects of a crude drug-prearation (E-kong-san) were determined from cisplatin on rabbit kidney proximal tubule and human renal cortical cells by MTT assays and sustained glucose consumption on ciplatin-induced human renal cortical tissue. Levels of creatinine and blood ure nitrogen(BUN) in serum after administration of cisplatin(0.75mg/kg,i.p.) to E-kong-san(0.75g/kg/day,p.o.)-pretreated rats were markedly lower compared to those of cisplatin-treated rats. Moreover, the administration of E-kong-san significantly inhibited the loss of body weight of cisplatin injected rts. These findings suggest that E-kong-san on the cisplatin induced nephrotoxicity led us to investigate whether the effect of this water extract was a result of anti-oxidation. E-kong-san showed strong free radical scavenger activities on 1,1-dipheny1-2picrylhydrazil(DPPH) radical and xanthine/xanthine oxidase(XOD) generated superoxide anion radical(O2-). We further studied the effects of E-kong-san on lipid peroxidation in rat liver microsomes induced by enzymatic and nonenzymatic methods. E-kong-san exhibited significant inhibition on both ascorbic acid/Fe2+and ADP/NADPH/Fe3+ induced lipid peroxidation in rat liver microsomes. Based on these results, we suggest that-E-kong-san attenuate the cisplatin induced cytotoxicity and its mechanism can be eplained by antioxidant.

구강악안면 영역의 치성 감염 환자에 대한 세균학적 연구

김일규,윤승환,오성섭,최진호,오남식,김의성,이성호,배수환,강문수 대한악안면성형재건외과학회 2000 Maxillofacial Plastic Reconstructive Surgery Vol.22 No.4

Oral & maxillofacial infections are most commonly odontogenic in origin. Although such infections are usually self-limiting, they may occasionally spread deeply into fascial spaces or planes far from the initial site of involvement. If early diagnosis and appropriate therapy is delayed, complications such as mediastinal extension, retropharyngeal spread and airway obstruction could happen to the patients. For the study of the microbiology, we have retrospectively analysed the oral & maxillofacial infected patients in the Dept. of Oral & Maxillofacial Surgery, In-Ha University Hospital from 1997 September to 2000 April. The results were as follows 1.The male patients were more common than female, with male 61.9% and female 38.1%. 2.Dental originated infections were most common cause with the incidence of 62%. 3.Most common fascial space involved was buccal space 42cases(37.2%) followed by submandibular space 13cases(11.5%), infraorbital space 13cases(11.5%), masseteric space 11cases(9.7%) , periapical abscess 11cases(9.7%) . 4.The causative organisms isolated from the pus culture were Gram Positive Bacterial species, which were 46cases(31.9%) of Streptococcus viridans, 16cases(8.6%) of α and β-hemolytic streptococcus, 4cases(3.1%) of Strep.-group D non enterococci, 7cases(5.1%) of Staphylococcus Coa. Neg., 5cases(3.9%) of Staphylococcus aureus, 3cases(2.3%) of Enterococcus faecalis, 1case(0.8%) of Bacillus species, 1case(0.8%) of Peptostreptococcus, 1case(0.8%) of Clostridium and Gram negative bacterial species, which were 4cases(3.1%) of Acinetobacter baumannii, 2cases(1.6%) of Pseudomonas aeruginosa, 2cases(1.6%) of Burkholderia cepacia, 1case(0.8%) of Neisseria species, 1case(0.8%) of Klebsiella pneumoniae, 1case(0.8%) of Klebsiella oxytoca, 1case(0.8%) of Escherichia coli. 5.In drug sensitivity test, high resistant tendency was found in Penicillin system(Penicillin G 83.3%, Ampicillin 60%) and Aminoglycosides (Gentamycin 50%, Tobramycin 45.5%), but tertiary Cephalosporin system(Cefoperazone 9.1%, Ceftazidime 18.2%), and glycopeptides system (Teicoplanin 0% , Vancomycin 0%) showed lower resistancy.

The HBV DNA Amounts in Serum Have No relationship with ALT level and Hetergeneous Population Coexits in Chronic Hepatitis B Virus Infection

Chun, Yoon-Keun,Ha, Joo-hun,Hong-Jung-Woo,Oh, Soo-Myung,Kim, Sung-Soo 경희대학교 동서의학연구소 1999 INTERNATIONAL SYMPOSIUM ON EAST-WEST MEDICINE Vol.1999 No.1

Yoon-Keun Chun¹,Joohun Ha□Hong-Jung Woo□, Soo Myung Oh□,Sung Soo Kim□ ¹Department of Molecular Biology, College of Medicine,²Department of Surgery, college of Medicine,³Department of Internal Medicine, College of Oriental Medicine,and ⁴East-Weat Medical Reserch Institute,Kyung Hee University, Seoul, Korea. The HBV DNA Amounts in Serum Have No relationship with ALT level and Hetergeneous Population Coexits in Chronic Hepatitis B Virus Infection. Proceedings of International Symposium on East-West Medicine, Seoul. 212-230, 1999. -Hepatitis B is caused by hepadnavirus. Hepatitis B virus replicates through 3.5kb pregenomic RNA intermediate which is regulated by core promoter. Pathogenesis of hepatitis B virus has been bilieved the result of host immune response. But recently many studies have reported that high level of viral replication caused by mutation in core promoter might result in severs hepatitis. But these studies were performed in vitro, not in vivo. So there is yet debate about which factor, viral of host factor, is more important in pathogenesis of hepatitis B virus. So we measured real viral replication level in 204 chronic hepatitis B patients by quantifying HBV DNA from sera by our novel PCR-based more sensitive method, and compared these results with ALT level measured from same sera, which indicates liver cell damage. Surprisingly there are no significant correlation between HBV DNA quantity and ALT level. Then we cloned core promoter region. In SSCP, we found that many viral mutants coexist in one patient. Base on SSCP result, we chose main viral core promoter type in each patients, which is thought to determine overall viral replication level in this patient. Main type of core promoter region of each 41 patients were directly sequenced. And with these we measured promoter activity by luciferase assay system and compared promoter activity with on another. We found tha there were some differences in promoter activity according to core promoter sequences. And we constructed replication-competent viral constructs with core promoter from 41 patients and Transfected these into HepG2 cell and measured HBV DNA by southern blot. There were also differences in HBV DNA quantity according to core promoter sequences. On these all results we investigated correlation between the effect of HBV core promoter on viral replication in vitro and HBN DNA quantity, ALT level from sera of each patients. We found there is no significant correlation among them. As a result, we concluded that in determining severity chronic hepatitis B patients, host factors of each patient is more important rather than replicative activity of virus itself.

서울의 Penicillinase Producing Neisseria Gonorrhoeae 발생빈도(1996)

김재홍,황동규,전재홍,김윤석,김중환,김용준,이창균,임동진,김현수,조창근,김경문,박상훈,전우형,김희성,이호정,차명수,김갑형,김형석,김석우,황지환,박병순,권오상,이민수,송기훈,성소영,이인섭,부태성 대한화학요법학회 1999 대한화학요법학회지 Vol.17 No.2

Background : In recent years, gonorrhea has been panedemic and remains one of the most commom 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 VD Clinic of Choong-Ku Public Health Center in Seoul since 1980 by means of the chromogenic cephalosporin method. Results: In 1996, 139 strains of N. gonorrhoeae were isolated, among which 53(39.0%) were PPNG. Conclusion: Our results suggests that after a peak of 74.3% in 1993, the prevalence of PPNG in Seoul is gradually declining.

E-M을 이용한 개선된 혼합영상의 분리

오범진,김성수,유정웅 충북대학교 컴퓨터정보통신 연구소 2002 컴퓨터정보통신연구 Vol.10 No.2

이 논문에서는, 기존의 독립성분해석기법 이노베이션을 이용한 혼합영상분리의 기법을 EM알고리즘을 첨가하여 새롭게 향상된 혼합영상분리 방법을 제안한다. 독립성분해석기법은 통계적으로 독립된 랜덤변수들의 선형조합으로 측정대상 랜덤신호를 표기하는 여러 통계신호처리 기법 중의 하나로, 정보의 분리, 특징 추출 등의 응용분야에 적용되고 있다. 기술적으로는, 독립성분기법은 주성분 분리기법의 확장이라 볼 수 있고, 근래에 혼합정보의 분리에 관련하여 많이 연구되고 있다. 현재까지의 연구 결과로는 혼합영상의 분리에 있어 독립성분해석기법만으로는 혼합영상분리의 해를 얻지 못하고 있다. 이러한 독립성분해석기법의 약점을 보완하는 방법으로, 최근에 이노베이션 프로세서를 전처리로 하는 독립성분해석기법을 혼합한 시스템을 이용한 혼합영상 분리가 시도되었다. 이노베이션 프로세서를 전처리로 첨가한 혼합영상분리의 과정도 독립성분해석기법만을 사용한 경우 보다는 향상된 혼합영상분리를 하지만, 분류된 영상들이 원래의 혼합 전의 영상과 많이 다른 결과를 내고 있다. 기존의 방법들인 독립성분해석기법이나 이노베이션이 전처리로 적용된 경우에도 혼합이전의 영상간의 상관관계가 클 경우, 혼합영상의 분류가 잘 이루어지지 않는다. 본 논문에서는 이 약점을 보완하기 위하여, EM이론을 기존의 시스템에 전처리로 첨가하여 혼합 영상의 분리를 향상시키고자 하였다. 실험 결과에서는 최근에 연구된 이노베이션의 방법보다 EM을 적용시킨 경우가 향상된 혼합영상의 분리의 결과를 보여 주고 있다. In this paper, a new method for the improvement of mixed image separation scheme is presented adding the expectation-maximization algorithm to the scheme consists of the independent component analysis and the innovation process. In general, the independent component analysis (ICA) is one of the widely used statistical signal processing schemes, which represents the information from observations as a set of random variables in the form of linear combinations of another statistically independent component variables. In various useful applications, ICA provides a more meaningful representation of the data than the principal component analysis through the transformation of the data to be quasi-orthogonal to each other, which can be utilized in linear projection. However, it has been known that ICA does not establish good performance in source separation by itself. Thus, in order to overcome this limitation, there have been many techniques that are designed to reinforce the good properties of ICA. The innovation process is one of the methods that were employed in image separation using ICA, which improves the mixed image separation. Unfortunately, the innovation process still needs to be studied since it yields inconsistent result due to the randomness of images mixing weights. In order to improve the performance of the conventional method, the expectation and maximization process is added to the system. The results presented in this paper show that the proposed improves the image separation as presented in experiments.

모 제약회사 근로자들의 직업성 천식 유병률과 약제 분말 노출수준

오성수,최용휴,김은아,이영목,장재길,유장진,박승현,김태균,정수영,김규상,강성규 大韓産業醫學會 2006 대한직업환경의학회지 Vol.18 No.2

목적: 제약회사에서 직업상 천식의 유병 규모를 파악하고 작업공정에 대한 작업환경 측정을 통해 제약회사의 약제 분말에 대한 노출수준을 평가하고자 하였다. 방법: 제약회사에서 약제 분말에 노출되는 근로자를 대상으로 천식을 선별하기 위하여 설문조사 및 진찰, 혈액검사, 폐기능 검사 그리고 피부단자시험을 실시하였고, 각 부서별 공정에 따라서 총분진과 항생제 또는 효소제 분말에 대한 작업환경 측정을 실시하였다. 직업상 천식이 의심되는 근로자에 대하여 기관지과민성에 대한 검사(메타콜린을 이용한 비특이 기관지유발시험)와 약제 분말 기관지유발시험을 실시하여 확진하였다. 결과: 설문조사 및 진찰에서 작업 관련 천식 증상이 있는 근로자는 11명(34.4%)이었고, 약제 분말을 이용한 피부단자시험에서 1+ 이상 반응을 보인 근로자 10명(31.2%)이었다. 비특이 기관지유발시험 결과 8명(25.0%)이 양성(PC20 ≤16 mg/ml)이었다. 약제 분말 기관지유발시험을 통해 직업상 천식으로 확진된 근로자는 5명(15.6%)이었다. 작업환경 측정에서 원료를 충진하거나 투입하는 작업 그리고 정립작업에서 약제 분말에 대한 노출이 많았다. 결론: 제약회사에서 직업상 천식은 주로 제조공정 중 약제 분말에 노출된 근로자에서 발생하여, 증상 및 직업성 천식의 유병률이 높았다. 따라서 원료를 충진 또는 투입하는 작업과 정립작업 등 제조과적에서 약제 분말 노출을 줄이기 위한 세심한 주의가 필요하여, 약제 분말을 취급하는 근로자에 대해서는 천식 증상 조사뿐 아니라 정기적으로 피부단자시험, 비특이 기관지유발시험 등을 실시하여야 할 것이다. Objectives: After the investigation of one worker with occupational asthma, we surveyed the preva- lence of occupational asthma and the exposure level of pharmaceutical dust of 32 workers in a pharmaceutical company. Methods: Thirty-two of the 90 employees participated in the survey which consisted of questionnaire, blood sampling, spirometry and skin prick tests with 8 common allergens as well as 9 antibiotics and 2 enzymes. Various indices of the working environment were also measured. Subjects who had a symptom suggestive of work-related asthma or positive skin prick test were further investigated by PC20 methacholine. Nine subjects who had a PC20 result of 16 mg/ml or less (n=7) or had work-related symptoms and positive skin prick test (n=2) were referred to undergo a specific bronchial provocation test to phar- maceutical dust in an academic allergic disease center. Results: Eleven of 32 workers (34.4%) had a work-related symptom suggestive of occupational asthma. Ten (31.2%) showed positive skin prick test. 8 (25.0%) had a PC20 result of 16 mg/ml or less (indicative of significant bronchial hyperresponsiveness), and 5 (15.6%) had a positive result on the specific bronchial provocation test. Exposure levels of stuffing, input of raw materials and screening process were relatively high. Conclusions: This survey showed that pharmaceutical workers have an increased risk of occupational asthma. Although pharmaceutical factories maintain a relatively good working environment, careful control of respiratory tract exposures, especially during stuffing, input or raw materials and screening process, is important to prevent occupational asthma. Pharmaceutical workers need to undergo regular skin prick and methacholine bronchial provocation tests, as well as asthmatic symptom survey, to ensure the early detection and prevention of occupational asthma.

Midfacial degloving approach을 이용한 양측성 상악골절제술의 치험례

오재권,류동목,이상철,김여갑,이백수 大韓顎顔面成形再建外科學會 2001 Maxillofacial Plastic Reconstructive Surgery Vol.23 No.6

Maxillary cancer accounts for only 0.3% of all cancers and tumors of the nose and paranasal sinuses are 80% of maxillary neoplasms. The complexes of midfacial anatomical landmarks make the extension of the maxillary cancer more easy. In 1826 since Lazar first made unilateral maxillectomy for the maxillary cancer, various developments were evoluated and in the surgical approach of these lesions most oral & maxillofacial surgeons have used the vestibular approach or Weber-Fergusson approach and also unilateral lesions are common but bilateral lesons are rare. In 1992 Sjovall introduced the bilateral maxillectomy and for the preventions of the facial scar, In 1927 Portmann and Retrouvey reported the sublabial approach and In 1979 Price reported the midfacial degloving approach and in 1981 Allen and Siegel used the term "Midfacial degloving approach". Unlike the previous used Weber-Fergusson approach and Caldwell-Luc method, midfacial degloving method can make the intraoral approach of midfacial structure exposure without facial incision and has populated gradually for the removal of tumors and facial plastic surgery. In this case, two male pt. with bilaterally extensive malignant neoplasm on maxillary sinus was treated with pre or post op. radiotherapy and then underwent the bilateral subtotal maxillectomy via midfacial degloving approach and relatively satisfactory results were obtained.