말초성 안면마비 입원환자 250례에 대한 임상적 고찰

강나루,탁명림,변석미,고우신,윤화정,Kang, Na-Ru,Tark, Myoung-Rim,Byun, Soek-Mi,Ko, Woo-Shin,Yoon, Hwa-Jung 대한한방안이비인후피부과학회 2010 한방안이비인후피부과학회지 Vol.23 No.3

Objectives : This study was performed to analysis the effect of oriental medical care for inpatients with facial paralysis that had visited Dept. of Otolaryngology Oriental medical hospital Dong-eui university. Methods : From January 2008 to September 2010, a clinical study was done on 250 inpatients who were treated as facial nerve paralysis at the Dept. of Otolaryngology Oriental medical hospital Dong-eui university. This study was assessed using the chart analysis. Results : 1. The distribution of sex : female 54.8%, male 45.2%. The distribution of age was pregented that fifty to sixty was the most in 67 cases(26.8%). 2. The distribution of the period of admission : female 12.5 days, male 9.9 days. 3. The distribution of past history : hypertention(18.8%), diabetes-mellitus(10.85%), facial paralysis(9.25%), cerebrovascular disease(4.4%), liver disease(5.6%), hyperlipidemia(1.2%), otitis media(1.2%), herpes zoster(1.2%), cardiac disease(2.45%), thyroid disease(1.2%). 4. The distribution of the region of facial paralysis : Rt(55.36%), Lt(56.52%). 5. Check the mastoid pain : 66.8%(female 73.91%, male 58.04%). 6. Out of prescription(Ko-Bang, 古方), Galgeun-Tang(葛根湯) and Gaejigeogaegayoungchul-Tang was used most in each 34 cases, Daesiho-Tang(大柴胡湯) 30 cases, Galgeungabanha-Tang(葛根加半夏湯) 27 cases, Sihogaeji-Tang(柴胡桂枝湯) 14 cases, Hwanggigaejiomul-Tang 12 cases, Odu-Tang(烏頭湯) 10 cases, Chijadaehwangsi-Tang 10 cases, Gaejigagalgeun-Tang(桂枝加葛根湯) 7 cases, Banhasasim-Tang(半夏瀉心湯) 5 cases, Injinho-Tang(茵蔯蒿湯) 5 cases in order. 7. The distribution of herb group : Mahwang-Jae(麻黃劑) 31.72%, Gaeji-Jae(桂枝劑) 26.00%, Siho-Gae(柴胡劑) 20.70%, Chija-Gae(梔子劑) 7.49%, Buja-Jae(附子劑) 4.41%, Banhahwanggeum-Gae(半夏黃芩劑) 3.08%, Daehwang-Gae(大黃劑) 2.64%, Bockryeong-Gae(茯笭劑) 1.76%, Jisil-Gae(枳實劑) 1.32%, Insam-Gae(人蔘劑) 0.88% in order. 8. The distribution of House-Brackmann grade of admission : Gr Ⅳ 74.85%, Gr.III 13.6%, Gr.V 11.6% in order. 9. The distribution of House-Brackmann grade of discharge : Gr.III 56%, Gr.IV 38.4%, Gr.II 5.6% in order. 10. The average number of OPD follow up is 6.46. Conclusion : This results indicated that oriental medical treatment with Ko-bang(古方) can be an effective way to treat facial paralysis. The more patients we treat with Ko-bang(古方), the more clinical report is accumulated. Then it would be helpful to map out a systematic treatment on facial paralysis.

화폐상 습진 한방 치험 1례

탁명림,강나루,고우신,윤화정,Tark, Myoung-Rim,Kang, Na-Ru,Ko, Woo-Shin,Yoon, Hwa-Jung 대한한방안이비인후피부과학회 2011 한방안이비인후피부과학회지 Vol.24 No.2

Objective : The purpose of this study is to know the effect of Ko-Bang(古方) on nummular eczema. Methods : We decided the treatment principle through the abdominal examination and symptoms. We gave Ko-Bang to the patient and observed the progress. We used visual analogue scale(VAS). Results : After the treatment the grade of VAS was decreased and the symptoms of nummular eczema were significantly improved. Conclusion : After the treatment of Hwanggijakyakgyejigoju-Tang(黃耆芍藥桂枝苦酒湯), the symptoms of nummular eczema were disappeared and Ko-Bang was effective on the treatment of intractable skin diseases.

고방(古方)으로 치료한 두드러기 환자 39례의 임상보고(臨床報告)

탁명림,김미보,변석미,고우신,윤화정,Tark, Myoung-Rim,Kim, Mi-Bo,Byun, Seok-Mi,Ko, Woo-Shin,Yoon, Hwa-Jung 대한한방안이비인후피부과학회 2009 한방안이비인후피부과학회지 Vol.22 No.3

Objectives : This study was designed to investigate the chronical features of urticaria and the effects of urticaria treatment with Ko-Bang(古方). Methods : We treated 39 patients for urticaria with Ko-Bang(古方), who visited to care urticaria at the Dept. of Dermatology Oriental medical hospital Dong-eui university from Jan, 2008 to Sep, 2009. This study was assessed using the chart analysis and the follow-up survey by telephone. Results & Conclusions : 1. 39 outpatients were surveyed, who were 20 males and 19 females. And patients who were ages 21-30 were the largest group, 11(28.21%). Among the 39 patients, acute urticaria patients were 8(20.5%), chronic urticaria patients were 31(79.5%), and contraction of a disease period between 6 weeks with 3 months was 17.9%. 2. The causes of urticaria were measured unknown 37.5%, foods 37.5%, drugs 25% in acute and unknown 35.5%, a change of temperature 29%, foods 16% in chronic. And suspected provocation factors were measured unknown and foods each 12 cases. The most of accompanied symptoms was itching sign(34 cases), the second most was self-conscious fever(10 cases). 3. Out of treat prescription(Ko-Bang,古方), Injinho-Tang(茵蔯蒿湯) was used most in 5 cases, Daehwanghwangryunsasim-Tang(大黃黃連瀉心湯), Hwangryun-Tang(黃連湯), Daesiho-Tang(大柴胡湯) were used in each 4 cases, Galgeun-Tang(葛根湯), Chijadaehwangsi-Tang(梔子大黃?湯), Sosiho-Tang(小柴胡湯) were used in each 3 cases, Gaemagakban-Tang(桂麻各半湯), Chijasi-Tang(梔子?湯),Oryeongsan(五笭散) were used in each 2 cases. 4. When the processes of treatment were classified by one poison(一毒), there were the 19 cases (48.7%) which was caused by Bun(煩), the 12 cases(30.8%) by Water(水) and the 4 cases(10.3%) by Gyur(結).

한의진단명과 진단요건의 표준화 연구 II (표준화 실례) : 2차년도 연구결과 중간 보고

양기상,최선미,최승훈,안규석,박경모,박종현,김성우,신승호,정우열,전병훈,고현,김정범,신상우,김성훈,김동희,권영규,엄현섭,장혜옥 한국한의학연구원 1996 한국한의학연구원논문집 Vol.2 No.1

The diagnostic requirements were suggested and explained regarding the systems of differentiation of symptoms and signs in the second year study of standardization and unification of the terms and conditions used for diagnosis in oriental medicine. The systems were as follows; - differential diagnosis according to condition of body fluid, differentiation of syndromes according to the state of qi and blood, differential diagnosis according to relative excessiveness or deficiency of yin and yang(氣血陰陽津液辨證) - differentiation of diseases according to pathological changes of the viscera and their interrelation - analyzing and differentiating of febrile diseases in accordance with the theory of the six channels(傷寒辨證) The individual diagnosis pattern was arranged by the diagnostic requirements in the following order : another name(異名), notion of diagnosis pattern, index of differentiation of symptoms and signs(辨證指標), the main point of diagnosis, analysis of diagnosis pattern(證候分析), discrimination of diagnosis pattern(證候鑑別), a way of curing a diseases(治法), prescription(處方), herb in common use(常用藥物), diseases appearing the diagnosis pattern(常見疾病), documents(文獻調査). This study was carried out on the basis of the Chinese documents and references.

에덴피아 펜션단지 활성화 방안

김신원,남광우,박수영,고윤권,박준경 경희대학교 디자인연구원 2006 예술· 디자인학연구 Vol.9 No.1

People who get tired of life notice the importance of leisure in modern society. Moreover, several social systems for improving qualify of life give people the chance to enjoy their leisure time. The culture which is large-scale oriented tourism is getting smaller as family-oriented culture, the concept of lodging is changing to the part of the leisure as well. Pension industry which started since 1999 is dramatically increasing, and finally becomes the most important thing in the tourist industry This paper will not only look at relatively limited programs and management of the pension complex, but also look for the way to develop the pension industry with 'Edenpia' in Pyung-chang city, Gangwon-do.

3분 및 4분 상완골근위부 골절에서의 외반형 및 내반형에 따른 임상적 비교

최창혁,권굉우,김신근,이상욱,신동규,이승진 대한골절학회 2002 대한골절학회지 Vol.15 No.4

목 적 : 수술적으로 치료한 3분, 4분 상완골 근위부 골절을 외반형과 내반형으로 재분류하여 임상적 결과를 비교하고자 하였다. 대상 및 방법 : Neer 분류상 3분, 4분 상완골근위부 골절로 분류된 21례에 대해 수술적 치료를 시행하고 12개월 이상 추시된 증례를 대상으로, 골절부위의 각형성, 상완골두의 방향성, 그리고 우세 전위결절의 양상에 따라 외반형과 내반형으로 재분류하여 UCLA shoulder rating scale에 따른 기능적 평가를 시행하였다. 결 과 : 단순 방사선 소견을 기준으로 Neer의 3, 4분 상완골 근위부골절을 외반형과 내반형 및 각각의 아형(subtype)으로 분류할 수 있었다. 견관절 반치환술을 시술한 2례를 제외하고 분석한 각 그룹의 UCLA 기능적 평가는 외반형에서 양호 이상의 결과가 9례중 8례(89%), 내반형에서 10례중 4례(40%)로 외반형에서 더 우수한 임상적 경과를 보였다. 결 론 : 상완골 근위부 골절에서 골두의 방향성은 골절의 각형성 및 우세 전위결절의 양상과 높은 상관관계를 가졌으며, 내반형의 경우 혈행과 신경장애가 좀더 빈번하고 예후도 불량한 것으로 나타났고, 이러한 경우 수술시 도달 방법, 연부조직 상태에 대한 평가가 더욱 신중하게 고려되어야 할 것으로 생각되었다. Purpose : We reclassified three-and four-part proximal humerus fracture by Neer's classification into valgus & varus type, and compared the results of these groups. Materials & methods : 21 cases classified as three- and four-part fracture in Neer's classifiation were treated surgically and followed for 12 months. We reclassified the 21 cases vlagus and varus type fractures, according to angulation of fractures, facing of humeral head, and dominant displaced tuberosity. Functional evaluation was done by UCLA shoulder rating scale. Results : Neer's three- and four-part proximal humerus fractures could be reclassified based on angulation, facing of humeral head, and dominant tuberosity displacement. The functional results according to UCLA shoulder rating scale were good or excellent in 8 of 9 cases of valgus type(89%), and at 4 in cases of varus type(40%). The clinical result of the valgus type was better than that of the varus type. Conclusion : Based on reclassification system of proximal humerus fractures, clinical results and radiographic findings including angulation, facing of head and domonant tuberosity displacement showed close relationship. Neurovascular complication were more frequent in the varus type. Therefore, careful evaluation including surgical approach and soft tissue status should be considered in the varus type of complex proximal humerus fracture.

발작을 동반한 뇌스파르가눔증 1예

서환조,고경식,양 익,최태열,최우석,신선영 대한감염학회 1993 감염 Vol.25 No.4

Human sparganosis is a rare infection caused by a tape worm larva, the genus Spirometra. Most infection occurs in the soft tissue, and sparganosis of the brain is very rare. There is no effective chemotherapy, and the best treatment for cerebral sparganosis is surgical removal of the worm, as in the case of the noncerebral form. A 40 year-old Korean man presented a 10 year history of episodic confusion followed by grand malseizure. He also had a history of consuming snake meat. Computed tomography and magnetic resonance imaging of the brain showed a lesion of the right temporoparietal lobe. Micro-ELISA test for sparganum specific antibody revealed high anitbody levels of absorbance 0.39 in serum, and 0.53 in cerebrospinal fluid. He refused operation, and a single maximal 50 Gy dose of irradiation by gamma knife was done. After 6 months, the lesion had no interval change on brain CT.

골수강내 금속정 및 나사못 맞물림을 이용한 경골의 치료

최창혁,권굉우,김신근,이상욱,강창진 대구효성카톨릭대학교 1997 연구논문집 Vol.56 No.2

Fracture of the tibial shaft is the most common among the long bone fractures, and it is difficult to treat because of a high incidence of delayed union, nonunion and malunion. Interlocking Intramedullary mailing is considered to be valuable method in treating long bone fracture such as tibial fracture these days because it enables rigid fixation, early joint motion exercise and weight bearing. Between April 1993 and March 1997, we treated 63 cases of tibia fractures with interlocking intramedullary nailing. The results were as follows: 1. Among the 63 cases, 51 cases were closed fractures and 12 cases were open fractures. 2. Static interlocking nailing was done in all cases and dynamization was done in 7 cases in postoperative 13 weeks. 3. Average union time was 19.9 weeks, 19 weeks with closed tibia fracture and 2.4 weeks with open tibia fracture. According to fracture site, 22 weeks with proximal tibia fracture, 19.2 weeks with mid-tibia fracture and 21.4 weeks with distal tibia fracture. According to the Winquist-Hansen classification, Type I was 19.8 weeks, Type Ⅱ was 20.4 weeks, Type Ⅲ was 22 weeks and Type Ⅳ was 26 weeks. 4. Weight bearing was started at the time of subsidence of pain and tenderness of the fracture site, 11.5 weeks with closed fracture and 12.3 weeks with open fracture. 5. According to the functional result of Klemm and Borner, 44 cases were excellent, 9 cases were good, 7 cases were fair and 3 cases were poor.

국내 5개 3차 병원의 β-lactam계 항생제 사용 실태 및 Klebsiella pneumoniae의 항생제 내성과의 상관 관계

정숙인,박경화,권기태,고관수,오원섭,정두련,백경란,염준섭,장현하,김신우,손준성,송재훈 대한감염학회 2007 감염과 화학요법 Vol.39 No.4

Background : This study was performed to evaluate the prescribing pattern of β-lactam antibiotics and the relationship between antimicrobial resistance and antimicrobial use in 5 tertiary care hospitals in Korea. Materials and Methods : Data on annual patient-days and annual consumption (defined daily dose (DDD) per 100 patient-days) of β-lactam antibiotics from 2003 to 2005 in 5 tertiary hospitals were analyzed. To determine the antimicrobial resistance in K. pneumoniae, broth microdilution test and double disk synergy were performed according to the CLSI performance standards. Spearman's correlation coeffient was used to determine the relationship between antibiotic consumption and resistance. Results : The prescription of β-lactam antibiotics in 5 tertiary hospitals markedly varied. In two hospitals, increase in consumption of β-lactam antibiotics was more than 30% during recent 3 years. The higher consumption of β-lactam antibiotics significantly correlated with the higher rate of antibiotic-resistant K. pneumoniae in 5 tertiary care hospitals. Conclusion : Continuous surveillance of antibiotic use is needed to encourage appropriate prescribing of antibiotics and to reduce antibiotic resistance. 목적 : 항생제의 오남용으로 인한 내성균의 발현 및 급속한 확산이 전세계적으로 문제시 되고 있다. 특히 병원은 항생제 내성의 중심점에 있는 것으로 여겨진다. 본 연구에서는 최근 3년간 국내 5개 3차 병원의 β-lactam계 항생제의 사용량을 조사하고, 각 병원별 항생제 사용량과 K. pneumoniae의 항생제 내성률과의 상관관계를 알아보고자 하였다. 재료 및 방법 : 국내 5개 3차 병원에서 2003년 1월부터 2005년 12월까지 병원 입원 환자를 대상으로 연도별 재원연인원수와 각 β-lactam계 항생제의 총사용량을 수집하여 DDD (defined daily dose) per 100 patient-days로 환산하여 비교하였다. 2005년 6월부터 8월까지 각 병원의 임상검체에서 동정된 K. pneumoniae를 수집하여 액체배지미량희석법으로 항생제 감수성 검사를 시행하였고 ESBL(extended-spectrum β-lactamase) 생성 여부는 double disk synergy test를 시행하였다. 항생제 사용량과 내성의 상관관계는 Spearman 상관관계 분석을 시행하였다. 결과 : 5개 병원 중 3개 병원에서는 연도별 β-lactam계 항생제 사용량이 비슷하게 유지되었으나, 2개 병원에서는 2003년에 비해 2005년에 항생제 사용량이 30% 이상 증가하였다. β-lactam계 항생제 중 제제별 비율은 각 병원마다 차이가 있었으나, 3세대 cephaosporin의 사용이 가장 많았고 2세대 ceaphlosporin, β-lactam/β-lactamase inhibitor, 1세대 cephalosporin 순이었다. 경구용 β-1actam계 항생제의 사용량(r=0.900, P<0.037)과 2세대 cephalosporin의 사용량(r=0.900, P<0.037)은 각각 K. pneumoniae의 ESBL 생성과 양의 상관관계가 있었다. Ceftazidime의 사용량은 K. pneumoniae의 ceftazidime 내성률과 양의 상관관계가 있었다(r=0.900, P<0.037). 반면 imipenem의 사용량은 piperacillin/tazobactam 내성과 음의 상관관계가 있었다(r=-0.900, P<0.037). 결론 : 최근 3개년간 항생제 사용량은 병원별로 차이가 있으나 일부 병원에서는 증가하였다. β-lactam계 항생제의 사용량은 K. pneumoniae의 항생제 내성과 상관관계가 있었다. 항생제 사용을 줄임으로써 항생제 내성을 감소시킬 수 있을 것으로 기대되며, 병원별로 항생제 사용에 대한 지속적인 감시가 필요할 것이다.

국내에서 발생하고 있는 사람 브루셀라증의 임상적 특성

김연숙,최영실,오원섭,권기태,이혁,이선희,손준성,김신우,장현하,정숙인,고관수,박미연,백경란,송재훈 대한감염학회 2006 감염과 화학요법 Vol.38 No.6

배경 : 2002년 내국인에서의 첫 사람 브루셀라증의 증례 보고 이후 국내에서 사람 브루셀라증이 빠른 증가를 보이고 있다. 이에 연구자들은 국내에서 발생하는 브루셀라증의 임상적 특성을 연구하고자 하였다. 방법 : 2003년부터 2006년 7월까지 7개 대학병원에 내원한 환자들을 대상으로 WHO의 진단기준에 의하여 확진된 브루셀라증 환자들의 의무기록을 후향적으로 조사분석 하였다. 배양된 균은 삼성서울병원에 의뢰하여 16S rRNA 유전자 분석방법을 이용하여 종을 확인하였고, 표준시험관응집검사는 국립보건원에 의뢰하여 시행하였다. 결과 : 34예의 환자들이 브루셀라증으로 확진되었고, 31명이 남자였다. 혈액에서 B. abortus가 증명된 경우가 8예, 표준시험관 응집검사상 의미 있는 항체가 상승을 보인경우가 26예이었다. 환자들은 대부분 축산업관련 종사자였고, 추후 브루셀라증으로 확진된 소와의 직접 접촉을 통해 감염된 것으로 여겨진다. 국내 사람 브루셀라증의 가장 흔한 증상은 발열이었고, 위장관계 합병증이 가장 흔히 동반되었다. 치료로는 doxycycline/rifampicin이 24예의 환자에서 doxycycline/aminoglycoside (streptomycin 혹은 gentamicin)이 10예의 환자에서 6주 이상의 기간 동안 투여되었다. 치료에 반응을 보이지 않는 환자는 없었고, 재발이 1예 있었다. 결론 : 국내에서 발생하는 사람 브루셀라증의 원인균으로 현재까지 분리 동정된 것은 B. abortus이며, 소 브루셀라증의 증가로 인해 인체감염사례가 함께 증가하는 것으로 사료된다. 위험 직업군 종사자들에서 감염된 소와의 직접 접촉을 통해 주로 발생하고 있는 브루셀라증의 임상종상은 국외에서 발생하는 경우와 유사한 양상을 보이고 있으며 치료에 대한 반응은 비교적 좋은 편이긴 하나, 추후 보다 많은 환자들을 대상으로 한 연구가 필요하리라 사료된다. 사람 브루셀라증의 조절을 위해서는 소 브루셀라증의 조절이 필수적이며, 브루셀라증의 조절에 성공한 선진국의 사례를 적극적으로 도입해야 할 것으로 생각된다. Background : Since the first Korean case of human brucellosis was reported in 2002, the incidence of human brucellosis has been rapidly increasing. We performed this study to evaluate the clinical characteristics of human brucellosis occurring in South Korea. Materials and Methods : Demographic features, clinical manifestations, and therapeutic outcomes of cases confirmed as brucellosis according to WHO diagnostic criteria were evaluated. Species of Brucella isolates were identified with 16S rRNA gene sequencing method. Serologic diagnosis was performed with standard tube agglutination test (STA). Results : A total of 34 cases were enrolled from 2003 to 2006 in six hospitals. Eight cases were confirmed with the isolation of Brucella from blood and 26 cases were confirmed with titer of antibodies ≥1:160 by STA. Male (31) was predominant and most of the patients were cattle farmers. The most common transmission route was direct contact with infected or their cattle byproducts. Fever was the most prominent symptom and fatigue followed. Gastrointestinal and musculoskeletal systems were commonly complicated. Patients were treated with doxycycline and rifampin or aminoglycosides for more than 6 weeks. All patients responded well to the therapeutic regimens, but one patient relapsed 10 months after treatment. Conclusion : Brucellosis occurring in Korea has been caused by B. abortus, whose preferred natural host animals are cattle. Korean patients were infected through direct contact with bovine brucellosis. Clinical manifestations of brucellosis were similar to those occurring worldwide. Therapeutic outcomes were good among patients with brucellosis in Korea. In order to prevent human brucellosis, measures to eradicate bovine brucellosis should precede.