20세기 한국 임상의학의 발자취

宣熙湜 대한의사협회 1999 대한의사협회지 Vol.42 No.12

임신여성을 제외한 성인에서의 B군 연쇄구균 감염에 관한 임상적 고찰

고경식,권선희,안우석,이원욱,김구엽,서환조 대한감염학회 1995 감염 Vol.27 No.4

목적:B군 연쇄구균은 최근 보고에 의하면 만성 기저질환(당뇨병, 악성종양등)이 있는 성인에서 감염빈도 및 사망률, 이환율이 증가하고 있는 추세이며 그 중요성이 대두되고 있다. 이에 저자들은 B군 연쇄구균 감염의 임상양상, 기저질환(위험인자)을 알아보고, B군 연쇄구균 항균제 감수성등을 규명하고자 하였다. 방법:1986년 1월부터 1993년 12월까지 경희대학교 부속병원에서 B군 연쇄구균이 배양된 274예를 대상으로 의무기록지를 검토하였다. 결과: 1) 전체 연구대상은 274예로 98예(35.8%)가 남자였고, 176예(64.2%)가 여자였다. 이들의 연령분포를 보면 신생아군에서 감염이 많이 발생하였다 이후 감소추세를 보이다가 20대 이상에서 다시 증가 하는 추세를 보였다. 2) 감염 양상은 274명중 명확한 감염이 156명(56.9%), 추정감염이 55명(20.1%), 비감염이 63명(23.0%)이었다. 임신을 제외한 18세 이상의 성인은 231명으로 남자가 83명, 여자가 148명이었고 남여 비율은 1:1.78이었다. 이중 133예(57.6%)에서 명확한 감염이었고, 46명(19.9%)에서 추정 감염, 52명(22.5%)에서 비감염이었다. 명확한 감염환자 133명중 31명(23.3%)이 병원내 감염이였다. 3) 18세 이상의 성인 231명에서 Group B Streptococcus가 분리 동정된 감염 부위는 자궁 경부 77예(33.3%), 요 73예(31.6%), 객담및 상기도 39예(16.9%), 농 24예(10.4%)등이었다. 4) 명확한 감염을 가지고 있었던 성인 133명의 임상양상은 요로 감염 37명(28%), 자궁 경부염 37명(28%), 피부, 연조직 감염 23명(17%), 폐렴 10명(8%), 패혈증 8명(6%)등이었다. 5) 명확한 감염을 가지고 있었던 성인 133명중 92명(69%)에서 한가지 이상의 만성 기저질환이 있었으며, 이중 당뇨병 32%, 뇌 혈관 질환 21%, 고혈압 19%, 신부전 12%, 악성종양 5%등을 차지하였다. 6) 항균제 감수성 검사(251예)에서 penicillin 98.4%, cephalothin 99.6%, cefamandol 98.8%, erythromycin 96.0%, clindamycin 89.4%, oxacillin 88.8%, lincomycin 87.8%, methicillin 86.8%, minocycline 49.4%, trimethoprim-sulfamethoxazole 15.5%의 감수성을 보였다. 7) 명확한 성인 감염 133명중 6명(4.5%)이 사망하였다. 결론:B군 연쇄구균은 만성 기저질환이 있는 성인에서 감염 빈도가 높고, 치명적인 결과를 초래할수 있으므로 감염 예방 및 조기 발견, 적절한 항균제 감수성 검사에 따라 조기 치료로 사망률을 줄여야 할것으로 생각된다. Background: Several reports have suggested that the incidence of diseases caused by Group B streptococcus is increasing in nonpregnant adults, particularly those with serious underlying diseases. The objectives of this study were to define the clinical manifestations, underlying conditions(risk factors) of definite group B streptococcal diseases in nonpregnant adults and to obtain antimicrobial sensitivity of these infections. Methods: We analyzed the records of 274 cases of the Group B streptococcus isolated in Kyung-Hee University hospital between 1986 and 1993. Results: 1) Total Group B streptococcal isolates were 274 cases : Of these cases, 7 percent were 1 month of age or younger, 3 percent were older than 1 month but younger than 18 years of age, and 91 percent were 18 or older. 2) Men and nonpregnant women accounted for 87 percent (n=231) : 133 cases (57.6%) with definite infection, 46 cases(19.9%) with possible infection, and 52 cases(22.5%) with no infection. 31 cases of 133 (23.3%) nonpregnant adult with definite infection apeared to have acquired the disease nosocomially. 3) In the 133 nonpregnant adult patients, the most common clinical diagnosis were urinary tract infection(28%), and cervicitis(28%). 4) In the 133 nonpregnant adult patients, the underlying diseases or conditions were diabetes mellitus(32%), cerebrovascular accident(21%), hypertension(19%), renal failure(12%), and malignant neoplasm(5%), Sixty-nine percent of the cases had one or more underlying diseases. 5) In the antimicrobial sensitivity tests, 98.4% of isolates were sensitive to penicillin, 99.6% to cephalothin, 98,8% to cefamandol, 96.0% to erythromycin, 89.4% to clindamycin, and 49.4% to minocycline. 6) The case mortality rate was 4.5%(6 of 133). Conclusion:We found group B streptococcal infection to be a significant and apparently increasing cause of definite diseases in nonprognant adults, particularly in those with serious underlying diseases. Recognizing these infections early in the groups with serious underlying diseases will be helpful in lowering mortality.

구속된 비행 청소년들의 특성 및 석방 후 6개월간 재범여부와 관련된 변인

정선주,김원식,고승희,구영진,김홍창,서동혁 대한소아ㆍ청소년정신의학회 1999 소아청소년정신의학 Vol.10 No.2

간세포암과 감별이 어려웠던 악성중피종 치험 1예

김선문,허원석,채경훈,강윤세,정재훈,김연수,박기오,문희석,이엄석,김석현,성재규,이병석,이헌영,신경숙,조준식,송인상,강대영 충남대학교 의학연구소 2003 충남의대잡지 Vol.30 No.2

Malignant peritoneal mesothelioma is a rare neoplasm that arises from the mesothelium of a serosal cavity and is a rapidly fatal disease with a median survival of 4 to 12 months for untreated cases. Recently, we experienced a case with malignant peritoneal mesothelioma who was suspected hepatocelluar carcioma by abdominal CT scan and was confirmed by biopsy including immunohistochemical stain(calretinin) after surgery. We performed tumor excisions and wedge resection of the liver(segment Ⅷ)and inserted Tencoff catheter in abdominal cavity at 25th day of post-operation. We treated with intraperitoneal paclitaxel(25mg/m^(2)/day for 5 days) six courses monthly. She was well tolerable and is still living without any evidence of recurrence for 14th month of post-operation.

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.

부산대학교 재학생의 학업성취에 영향을 미치는 요인

전윤식,이성해,정영홍,박선자,김상구 釜山大學校 學生生活硏究所 1988 硏究報 Vol.24 No.1

The purpose of this study was to explain the factors that effect on a academic achievement of Pusan National University(PNU) students. In order to achieve the above purpose, two research problems were established as follows: 1. What are the personal-internal factors which effect on a academic achievement of PNU students? 2. What are the personal-exteranl factors which effect on a academic achievement of PNU students? Statistical methods applied were general descriptive statistics, Pearson's correlation method, multiple regression analysis. The statistical computations were done by SPSS. The results of this study are summarized as follows: 1.The personal-internal factor that effect on a academic achievement of PNU students is the learning skill. 2. The personal-external factors that effect on a academic achievement of PNU students are professor's fulfilling prophecy and the times of review of studies.

치과기공사들의 호흡기 자각증상 및 관련요인

정희선,이무식,김남송 대한보건협회 2002 대한보건연구 Vol.28 No.2

본 연구는 치과기공사들의 호흡기 및 근골격계 자각증상에 관한 호소율과 관련요인을 조사 분석하여 직업성 질병을 예방하고 효율적인 건강관리와 작업 환경 개선을 위한 기초자료를 제공하고자 실시하였다. 연구대상을 전국의 치과기공소(실)에 근무하고있는 치과기공사를 무작위로 추출하여 우편 설문조사에 응답한 265명 이었으며 조사기간은 2000년 12월부터 2001년 3월 까지였다. 수집된 자료는 Spss 8.0프로그램을 사용하여 X2-test와 로지스틱 회기분석을 통하여 다음과 같은 결론을 얻었다. 조사대상자의 성별에 따른 일반적 특성을 분석한 결과 연령, 결혼상태, 흡연여부, 음주여부와 유의성이 있었고 직무특성 분포에서는 치과기공경력, 담당업무, 직위에 따라 유의성이 있었다. 호흡기 장애 호소율을 분석한 결과 평소시침 호소율(55.5%)이 가장 높게 나타났고 다음은 담.가래(52.5%), 숨참.숨헐떡임(42.6%), 콧물.코감기(39.2%), 숨쉴 때 소리(23.4%)순이었다. 로지스틱 회귀분석에서 평소기침 호소율에 유의한 영향을 준 요인으로는 직위였고, 담.가래는 직장소재지였으며, 콧물.코감기는 성별, 연령, 결혼상태, 직위였다. 이상의 결과로 볼 때 치과기공사들의 신체 자각증상 호소율은 비교적 ?? 나타났으며 효율적인 건강 관리와 작업환경 개선을 위해 치과기공과 재학생들에게도 치과기공 재료들의 유해성에 대한 보건관리 교육 실시 및 재료등의 유해성 방지를 위한 전문 연국기관이 요구되며 치과기공사들의 적극적 자기관리와 치과기공소 운영자의 정기적인 작업환경 측정으로 쾌적한 환경유지가 필요하다. 또한 치과기공사들의 직업적 특성을 고려한 건강관리 교육 및 전용의료기관을 지정하고, 정기 건강검진을 실시하여 질병 예방의 제도적 장치가 필요할 것으로 판단된다. The purpose of this study was to serve as a basis for the protection of dental technicians from occupational diseases, more successful health care for them, and the betterment of working environment, by examining their complaints about respiratory subjective symptom and the relevant factors. The study subjects were 265 dental technicians who were randomly selected from dental technology shops nationwide and respondent to a mail survey. The survey was conducted from December 2000 to March 2001. The collected data were analyzed with SPSS 8.0 program, and X^2-test and logistic regression analysis procedures were utilized. Dental technicians suffered coughing in ordinary time(55.5%), phlegm and sputum(52.5%%), shortness of breath(42.6%), nasal discomfort(39.2%). Major predictors to suffer coughing in ordinary time on multiple logistic regression analysis were position in the office, phlegm and sputum were location of work area and nasal discomfort were sex, age, marital status and position in the office. The above-mentioned findings showed that the dental technicians suffered highly from physical subjective symptoms of respiratory system. S0 there are some suggestions about mere efficient health care and better working environment: dental technology students should receive healthcare education to leam the harmfulness of dental technology materials, and a specialized research institution is needed to make a deep study of addressing the harmfulness of the materials. Dental technicians have to pay more attention to their own health care, and dental technology manager should check out working environment on a regular basis to maintain a comfortable environment. In addition, healthcare education should be provided to dental technicians in consideration of their vocational characteristics, and specific medical institutions for dental technicians should be designated. And a regular health examination should be conducted to prevent any possible occupational diseaede.

도시환경조성용 옛 농작물 선발

이정식,김양희,노희선 서울市立大學校 1996 論文集 Vol.30 No.-

To create good urban environment using old agricrltural crops, eight old crops were evaluated for growth and pollution injury at five districts in Seoul. The results are summarized as follows ; 1. In investigation of ten air pollutants in July and August, it was detected heavy contents at Kuroku districts, while Kwangzinku and Songpaku showed the least contents. There have resulted SO2 to be the most detection in Kuroku during experiment period. Whereas O3 showed them the most at Songpaku in August, while it was Soedaemunku in July. In dust content, Kuroku had the least in July, while Yongsanku was in August. 2. In the growths during three months of five districts in Seoul, Nicotiana tabacum was the worst, while five crops such as Perilla frutescens, Ricinis communis, Zea mays, Sorghum bicolor, Cassis tora were the best for growth. Yongsanku out of five districts was the worst them in general, however, there were the best growth in Sedaemunku. Perilla frutescens, Sorghum bicolor, Loix mayuen showed good overall everywhere. In pollution injury, it was quite different from distticts and crops, there showed more 3.0 grade of severe infury Gossypium nankion at Songpaku, Cassia tora at Kuroku, Nicoriana tabacum at Kuroku and Songpaku respectively. There were shown at Kuroku and Songpaku to be the heavy injury while three districts such as Seadaemunku, Yongsanku, Kwangzinku showed a little injury. 3. In contents of sulfur absorption in leaves among them, they were quite different from districts and crops. Sorghum bicolor, in Kwangzinku absorbed it the most, whereas there were the least it in Seodaemunku and Songpaku. Sorghum bicolor was the most absorption for it at Kwangzinku, while Ricinus communis at Kwangzinku, and Zea mays at Seodaemunku were analyzed the least for them. 4. Pollutant that showed overall the highest correlation coefficients with plant growths was O3, next was SO2 and NOx in order of them. The most crops had high correlation coefficients with O3. The crop which had high correlation coefficients for growth with O3 was particulary Perilla frutescens. They had correlation negatively between them in plant height, and plant width, while there were positively correlation between them with pollution injury. Sorghum bicolor showed also th have high correlation with O3, and Ricinus communis negatively correlation between O3 and plant width, and to have correlation positively between dust contents and no. of branches. Zea mays also gave results positively high correlation between O3 and injury leaves due to pollution while there were negatively high correlation for growth with it. Cassia tora showed also positively high correlation between pollution injury and O3.

태권도 수련 프로그램 적용에 따른 정신력 효과

김응식,윤오남,선석령,구희성 朝鮮大學校 스포츠科學硏究所 2003 스포츠科學硏究 Vol.14 No.-

This study had a purpose to define an effect of mental strength according to the application of Taekwondo Training Programs. In order to achieve this study objective, the Delphi Technique Analysis and the Quantitative Research were carried out. For this purpose, firstly, experts' opinions about the programs which were practiced in the Taekwondo gym was analyzed. Secondly, the background variable and training level, the training programs, and the difference of Taekwondo mental strength were analyzed. And thirdly, the relations between the Taekwondo training level, the training program, and the Taekwondo mental strength, etc. were analyzed. The analysis of Taekwondo training programs by the DeIphi Technique was performed by means of the 3rd analysis with 30 experts. And as for the Quantitative Research, the study subjects were targeted for the total 265 pupils composed of 224 boys and 41 girls who were selected by the Group Random Sampling. This study took the primary school students in 4-6 years as the population who were training Taekwondo in the gym which was located in Gwangju. The measurement instrument for research survey consisted of five (5) question items for background variables, three (3) question items for training level, three (3) question items for training programs, and twenty-five (25) question items for Taekwondo mental strength, that is, which totaled thirty-six (36) question items in all. As for the relationship model settings between the related variables, gender, school year, income level, academic records, training motive variables were established. As for the independent variables, the medium variables for Taekwondo training level were set up by the training programs. And, the Taekwondo mental strength variables were established for the dependent variables. The data which were collected by using questionnaires were dealt with according to the research objectives. As for the statistical techniques for analysing the treated data, skill statistics, unitary variance analysis, multiple regression analysis were employed. As for the relation of mental strength according to the application of Taekwondo training programs based on the method and procedure of this study, the following results were obtained in accordance with the basis of the Delphi Technique Analysis and result of the Quantitative Research. First, in the program analysis through the Delphi Technique, it was investigated that the following factors were achieved. In the body-centered programs, factors such as curiosity, creative power, interest, etc. were achieved. In the mind-centered programs, factors such as social nature, character, etiquette. sense of cooperation, creative power, and interest etc. were achieved. In the play-centered programs, factors such as meditation, personal relations, creative power, self-esteem, and reliance etc. were achieved. Second, in the differences of Taekwondo programs on the basis of the background variables, school year and income level showed the statistically significant differences in the body-centered and the mind-centered programs among the types of Taekwondo training programs. And the statistically significant difference was shown about the income level in the play-centered programs. This result showed the fact that, in training Taekwondo, pupils showed differences for adapting themselves to the contents of body-, mind-, and play-centered programs according to the contents of programs based on school year and income level which were parts of the background variables. Third, in the relations between the Taekwondo training level and the programs, for the great influence which they had on the body-centered programs about the period, frequency, and the intensity. pupils could adapt themselves well to the training as the period became longer in the body-centered programs. They could also adapt themselves well to the high-intensity training when they were not absent and trained more frequently. As for the period, about the thing which it influenced the mind-centered programs, as they were trained longer in the mind-centered programs, the training period became longer. Also, as for the period and frequency. it was considered that what influenced the play-centered programs was the fact that, as pupils were trained longer, the training period became longer in the play-centered programs. And they seemed to feel more pleasure and interest as the training period became longer and when they were not absent, and when they were trained more frequently. Fourth in the relation between the Taekwondo training level and the mental strength, for the period and the frequency which belongs to the training level, the thing which had significant impact on the sub-factors of the mental strength such as patience, courage, and etiquette was the fact that patience, courage and etiquette which were the sub-factors of mental strength were improved as the Taekwondo training period was longer, and they were trained more frequently. Fifth, in the relation between the type of Taekwondo program and the mental strength, patience, courage, and etiquette was highly improved in the body-centered programs. And courage was highly improved in the mind-centered programs. Also, what had significant impact on patience, courage and etiquette was the body of the Taekwondo program type in the play-centered programs. Likewise, for the mind- and play-centered programs, the mental strength such as patience, courage and etiquette was highly improved as they were trained more frequently.

빌트인 모터를 이용한 2축 제어 미세 가공기 개발

김건희,김효식,양순철,이상용,국명호,이선규,김윤중,홍권희 한국공작기계학회 2007 한국공작기계학회 추계학술대회논문집 Vol.2007 No.-

This paper describes development of low cost precision machine that has combined the Build-in Motor with a vacuum chuck. This study mainly aims to find out a cutting condition for maintaining optimum surface condition and to examine cutting characteristics of the precision machine that is equipped by diamond bites. The cutting materials is Al alloy. Several experiments were carried out to find out the main factors that affect the surface roughness such as principal axis RPM(rotation per minute), feeding speed, and cutting depth. As a result, we obtain The optimum cutting condition of the developed precision machine.