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.

정신분열병 환자의 신경인지 결함의 특성

정성원,김희철,김정범 대한생물치료정신의학회 2001 생물치료정신의학 Vol.7 No.2

Objective : This study compared the neurocognitive functions between schizophrenic patients and normal controls by verbal fluency test, auditory verbal learning test, and Vienna computerized neuropsychological test. Method : The subjects were 19 schizophrenic patients who were hospitalized in Keimyung University Medical Center from February 2001 to July 2001, and were diagnosed as schizophrenia by the DSM-Ⅳ diagnostic criteria. They were all clinically stable and cooperative patients whose drug dosages were not changed at least for 2 weeks. Twenty normal controls were all healthy volunteers who were matched in sex and age to patients group. The cinical symptoms of schizophrenic patients were evaluated with the PASS and BPRS. Results : The neurocognivite functions of schizophrenic group were impaired in verbal fluency, auditory verbal learning test, continuous attention test, perseveration test, standard progressive matrix, reaction text, Corsi block taping test, visual pursuit test, and cognitrone. The performance of Wisconsin Card Sorting Test was not impaired in schizophrenic group. In schizophrenic group, the positive PANSS scores had no relation with any other neurocognitive test, however the negative and general PANSS scores had relation with verbal fluency test, auditory verbal learning test, standard progressive matrices, visual pursuit test, and cognitrone. Conclusions : There results suggest that the schizophrenic patients have more pervasive neurocognitive deficits and the negative symptoms are related with neurocognitive deficits.

재발성 호흡기 유두종증의 임상양상과 보조 치료의 유용성

성명훈,최병윤,진정욱,성원진,박범정,노종렬,김대우,원태빈,김광현 대한이비인후과학회 2001 대한이비인후과학회지 두경부외과학 Vol.44 No.12

감염된 가축과의 직접 접촉 없이 발생한 브루셀라증 환자1례와 축산 부산물 시장에서의 역학조사 : Sero-epidemiology Study on Market, by-product, Stock-raising

정성주,김성범,박대원,정혜원,기세윤,권정아,박만석,박미연,정희진,김우주 대한감염학회 2004 감염과 화학요법 Vol.36 No.3

브루셀라증은 전 세계적으로 발생하는 인수공통 전염병중에 하나로서, 본 증례는 국내에서 감염된 가축에 대한 노출력이 없는 집단에서 현증 브루셀라증이 발생한 첫 증례이기에 문헌 고찰과 함께 보고한다. 또한 환자가 근무하였던 축산물 부산물 시장에서 역학 조사를 실시하여, 현증환자 및 기감염자를 발견하여 축산물 부산물 시장 근무자에서 현증 브루셀라증이 발생할 위험성을 평가하였다. 역학 조사 결과 축산물 부산물을 다루는 일을 하는 사람들에서 감염된 가축과의 직접 접촉이 없이도 브루셀라증이 발생할 수 있음을 알 수 있었다. Brucellosis is a world-wide zoonotic disease. We report the first case of brucellosis in South Korea that is not related to direct contract with intected cattles. The patient had been working in the market of by-product, stock raising for twenty years and complained of 1-month history of fever, chill, and intermittent epistaxis. We confirmed brucellosis by anti-brucella antibody test and PCR. After 6 weeks' treatment with rifampicin and doxycycline, fever and chilling subsided, and, generalized weakness and oral intake improved. We performed seroepidemiology study against workers who were working in the same market as the patient. However, we couldn't find out other cases with seropositivity. We concluded that although the workers of by-product market have a risk of getting brucellosis, the risk is low.

공동주택 유지관리 FCI 모니터링에 관한 연구

범성우,정영한,박태근 대한건축학회 2004 대한건축학회 학술발표대회 논문집 - 계획계/구조계 Vol.24 No.1

After the 1980' s governmental housing business policy was vigorously attained, demand of apartment housing is still on the increase, but systematic maintenance is not following this current incerase trend. A promotion about the realization on the importance of maintenance due to life-time degradation of apartment housing and a plan of life-long practice of maintenance established together with longterm stratergy for maintance upkeep must be imperative. Purpose of this study presents application plan about FCI from rifle cycle viewpoint of building. Expect that is used laying plan that is middle part of a song miracle in actuality and expense arbor in the mountains of longtimer line plan of apartment house. As administration subject establishes well-timed repair time and more strategic budget, may behave better maintenance.

정중과잉치로 인해 회전된 상악 중절치의 치험례

이범의,김영재,김정욱,장기택,이상훈,김종철,한세현 大韓小兒齒科學會 2004 大韓小兒齒科學會誌 Vol.31 No.4

정중과잉치의 원인은 잘 알려지지는 않았지만 dental lamina의 hyperactivity에 의해 발생한다는 가설이 가장 많이 받아들여지고 있다. 이러한 정중과잉치의 병발증으로는 주변 영구절치의 맹출 장애, 만곡 치근, 치근흡수, primordial 혹은 follicular cyst의 형성, 회전, 이환된 부위의 총생 및 비정상적인 정중이개를 일으킬 수 있다. 이러한 이유로 영구전치의 회전이 야기되면 보통 공간의 부족은 적거나 없으며 재발이 흔하므로 과개선이 요구된다. 재발의 방지를 위해서는 조기치료, 과개선, 긴 보정기간, 적절한 접촉면의 형성, 짝힘의 사용, 그리고 수술적인 방법 등이 제안되어왔다. 이에 저자는 정중과잉치로 인하여 심하게 회전된 상악중절치를 주소로 내원한 환아에서 교정적, 외과적 술식을 이용하여 양호한 결과를 얻은 두 증례를 보고하는 바이다. The etiology of mesiodens is unknown but the most widely accepted theory is the hyperactivity of the dental lamina. Complications of mesiodens are delayed or prevented eruption of maxillary central incisors, displacement or rotation of permanent teeth, crowding of affected region, abnormal diastema or permanent space closure, dilaceration or abnormal root development of permanent teeth, primordial or follicular cyst formation, root resorption of adjacent teeth, eruption into nasal cavity. If mesiodens rotate the maxillary central incisors, space deficiency is not common and relapse is very common. So overcorrection is needed. To prevert the rotational relapse, early treatment, overcorrection, long retention period, properly formed proximal surface, use of coupled force, and surgical techniques have been suggested. The authors present two cases, whose chief complain were severely rotated maxillary incisors by mesiodens, treated by orthodontic and surgical technique and showed good results.

급성 출혈성 대장염으로 오인된 궤양성 대장염 1예

문희정,장병익,김승범,이호찬,박재현,은종렬,김태년 영남대학교 의과대학 2008 Yeungnam University Journal of Medicine Vol.25 No.2

Ulcerative colitis (UC) is a chronic inflammatory disorder of the gastrointestinal tract that affects the large bowel, Its etiology remains controversial. However, an infectious or immunologic origin is considered the primary cause. The onset of UC is typically slow and insidious, but some patients may present acutely with symptoms mimicking infectious colitis. We report a case of ulcerative colitis mimicking acute hemorrhagic colitis at initial presentation. A 60-year-old man was referred to Yeungnam University Hospital for bloody diarrhea and abdominal pain. Sigmoidoscopy revealed mildly edematous mucosa in the rectum and hyperemic mucosa with petechiae in the sigmoid colon. The patient was treated with antibiotics for several days, and his symptoms improved. However, after one month, his bloody diarrhea relapsed. Follow-up sigmoidoscopy revealed mucosal friability in the rectum and sigmoid colon. He was diagnosed with ulcerative colitis, and his symptoms were improved with mesalazine and a steroid enema.

새로운 경구용 세파로스포린의 합성 및 항균작용

나성범,정명희,김완주,지웅길 충남대학교 약학대학 의약품개발연구소 1993 藥學論文集 Vol.9 No.-

In order to develop oral cephalosporin having a new substituent at 3 position, the synthesis of cephalosporins modified at C-3 and the effect of the substituents on the oral absorption is studied. 7-[(Z)-2-(2-Aminothiazole-4-yl)-2-methoxyiminoacetamido]-3-[4-(2-pyridyl)piperazinyl]thiocarbonylthiomethyl-3-cephem-4-carboxylic acid (CEN1) and 7-[(Z)-2-(2-aminothiazole-4-yl)-2-methoxyiminoacetamido]-3-[4-(2-pyrimidyl)piperazinyl]thiocarbonylthiomethyl-3-cephem-4-carboxylic acid (CEN2) were synthesized from 4-(2-piridyl)piperazinyl dithiocarbamate potassium salt or 4-(2-pirimidyl)piperazinyl dithiocarbamate potassium salt and cefotaxime. Also pivaloyloxymethyl esters of CEN1 and CEN2, pivaloyloxymethyl 7-[(Z)-2-(2-aminothiazole-4-yl)-2-methoxyiminoacetamido]-3-[4-(2-pyridyl)piperazinyl]thiocarbonylthiomethyl-3-cephem-4-carboxylate (CEN1P) and pivaloymethyl 7-[(z)-2(2-amnothiazole-4-yl)-2-methoxyiminoacetamido]-3[4-(2-pyrimidyl)pioerazinyl] thio carbonylthinoethyl-3-cephem-4-caroxylate (CEN2P) were synthesized. The in vitro activities of two new oral cephalosporins, CEN1 and CEN2, were compared with the in vitro activities of cefaclor and cefotaxime against a variety of bacterial species. CEN2 has a broad antibacterial spectrum covering Gram-positive and Gram-negative bacteria, similar to that exhibited by CEN1 and cefotaxime. CEN1 and CEN2 were more active in vitro than cefaclor against Streptococcus pyogenes, Klebsiella aerogenes and Enterobacter cloacae.

성장기 흰쥐의 족삼리(ST-36) 침자가 혈액성분에 미치는 영향

이성동,윤범철,류정록,최태암 高麗大學校 倂設 保健大學 保健科學硏究所 2000 保健科學論集 Vol.26 No.1

Acupuncture, an important branch of oriental medicine, has been practiced for many centuries and has been proved to be an effective treatment for all sorts of disease. However, the exact mechanism on effects of acupuncture was uncertain. Recently investigation for the mechanism of acupuncture has concentrated to human and animals. So, This study was to determine effects of ST-36 acupuncture stimulation on blood component in growing rats. For this study, 24 male Sprague-Dawley rats weighting 159?13g were randomly assigned into three groups; A4 group, A10 group, and control group. In A4 group, four times acupuncture were performed at both ST-36 every other days and in A10 group, ten times acupuncture. The results obtained were as follows; 1. Total protein level was significantly increased, particularly in A10 group; albumin level was also significantly increased. 2. Serum glucose level was significantly increased. 3. Triglyceride level was significantly increased in A4 group; phospholipid level had no changes; free fatty acid level was significantly decreased particularly in A10 group. 4. Total cholesterol level was rarely affected by acupuncture: HDL-C and LDL-C levels were affected by the number of times of acupuncture, that is, HDL-C levels were increased, and LDL-C level decreased in A4 group, while HDL-C level decreased and LDL-C level increased in A10 group. 5. Serum amylase activity was not significantly changed.

산후에 발병한 특발성 부갑상선 기능저하증 I 예

김정인,김상용,신병철,김경남,서영욱,이범주,김진화,배학연 朝鮮大學校 附設 醫學硏究所 2002 The Medical Journal of Chosun University Vol.27 No.2

Hypoparathyroidism is usually the result of an inadvertent surgical removal of all the parathyroid glands, In some instances, not all the tissues are removed, but the remainder undergoes vascular supply compromise secondary to the fibrotic changes in the neck after surgery, Previously, the surgery for hyperthyroidism was the most frequent cause of acquired hypoparathyroidism. Idiopathic hypoparathyroidism is a relatively rare disease that is characterized by hypocalcemia and hyperphosphatemia due to a parathyroid hormone deficiency of an unknown cause, It usually develops at a young age, and shows various clinical symptoms and signs accompanied with hypocalcemia. In addition, it is rarely associated with polyglandular autoimmune syndrome during the follow-up. Hypocalcemia and idiopathic hypoparathyroidism associated with labor and lactation are rarely reported condition previously. We here describe a case of a woman in whom the symptomatic severe hypocalcemia appeared after her delivery. We reviewed all the previously reported cases and suggest a possible physiological explanation for the association between pregnancy, lactation, and the appearance of symptomatic hypocalcemia.