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.

업종에 따른 연 취급 사업장의 기중 연 농도 및 연 노출 수준 평가

이병국,김용배,리갑수,안현철,김화성,이용진,황규윤,장봉기,이성수,안규동 순천향대학교 산업의학연구소 1999 순천향산업의학 Vol.5 No.1

In order to obtain an useful information for health management and biological monitoring of lead exposed workers, Authors tried to investigate air lead level and the lead exposed level of workers in lead industry according to occupational category. The subjects in our study were 2074 workers in 7 lead-using industries, and study subjects were divided into 4 occupational categories such as storage battery industry (type 1), primary smelting industry (type 2), secondary smelting industry (type 3) and litharge making industry (type 4). Blood zincprotoporphyrin concentration (ZPP), blood lead concentration (PbB) and urinary δ -aminolevulinic acid (ALAU), hemoglobin (Hb), hematocrit (Hct) were selected as the indices of lead exposure. Personal variables such as age, work duration were also collected. The results were as follows. 1. The geometric mean air lead in 9 lead-using industry was 0.1133±4.3120 ㎎/㎥, and that in type 1, 2, 3 and 4 was 0.1038±3.4952 ㎎/㎥, 0.0429±3.4329 ㎎/㎥, 0.1877±2.5123 ㎎/㎥ and 0.9961±5.2910 ㎎/㎥, respectively. 2. The mean ZPP in 9 lead-using industry was 53.1±28.0 ㎍/㎗, and that in type 1, 2, 3 and 4 was 52.0±24.8 ㎍/㎗, 48.0±16.4 ㎍/㎗, 109.8±85.6 ㎍/㎗ and 74.3±37.8 ㎍/㎗, respectively. There was significant difference in ZPP according to occupational category (P<0.01). The percents of lead workers whose ZPP were above 100 ㎍/㎗ in type 1, 2, 3 and 4 were 4.0%, 1.7%, 34.3% and 21.6%, respectively. 3. The mean PbB in lead-using industry was 26.0±11.2 ㎍/㎗, and that in type 1, 2, 3 and 4 was 25.3±11.1 ㎍/㎗, 26.7±8.8 ㎍/㎗, 50.3±15.2 ㎍/㎗ and 36.4±11.0 ㎍/㎗, respectively. There was significant difference in PbB according to occupational category (P<0.01). The percents of lead workers whose PbB were above 40 ㎍/㎗ in type 1, 2, 3 and 4 were 10.4%, 7.7% 71.9% and 43.2%, respectively. 4. While the correlation of Hb corrected PbB with ZPP was higher than non corrected PbB, the correlation of log-transformed ZPP with PbB was higher than non corrected ZPP. 5. Simple linear regressions of PbB and corrected PbB as independent variable with ZPP, log-transformed ZPP and ALAU as dependent variable were statistically significant (P0.01). Coefficient of determination of corrected PbB with other variables was higher than non corrected PbB. As the result of this study, it was suggested that reconsideration of environmental and biological monitoring program was highly recommended for secondary smelting and litharge making industry.

납 폭로 근로자에서 δ-aminolevulinic acid dehydratase 유전형질이 zinc protoporphyrin 및 δ-aminolevulinic acid에 미치는 영향

이병국,황규윤,장봉기,김용배,리갑수,안현철,김화성,이성수,안규동,박종범 순천향대학교 산업의학연구소 1999 순천향산업의학 Vol.5 No.1

The inhibition of δ-aminolevulinic acid dehydratase (ALAD) in the heme synthetic pathway results in increased protophoryphyrin (ZPP) and δ-aminolevulinic acid (ALA) and is responsible for some of toxicological effects of lead. This enzyme is coded by the ALAD gene containing 2 co-dominant alleles. The polymorphisms of ALAD gene may be related to differential effects of lead on ZPP and ALA, ALAD genotype was measured in 975 Korean male lead workers, of whom 897 were homozygous for ALAD1 (ALAD 1-1 genotype) and 96 were heterozygous for ALAD2 (ALAD 1-2 genotype). Blood lead in subjects with ALAD1 was significantly higher than those with ALAD2 (p = 0.01). No difference between ALAD genotypes was found for age, exposure duration, ZPP, ALA, hemoglobin, hematocrit, body mass index, tobacco and alcohol use. After adjustment for possible confounders, ALA and ZPP became significantly elevated in ALAD1 subjects (p = 0.004 and 0.055, respectively). This result suggests that ALAD1 subjects may be more susceptible to the hematotoxicologic effects of lead than ALAD2 subjects.

중환자실에 입원한 세균성 폐렴환자에서 반정량적 procalcitonin 검사의 유용성

이승화,김철홍,김지연,박선욱,김용욱,현인규,우흥정,김현수 대한감염학회 2009 감염과 화학요법 Vol.41 No.6

Background : In pulmonary infection, serum procalcitonin levels increase rapidly, probably in response to sepsis-related cytokine release from neuroendocrine cells of bronchial epithelium and inflammatory cells. We applied procalcitonin assay in critically ill patients with bacterial pneumonia. Materials and Methods : Patients admitted to the intensive care unit (ICU) and show diffuse infiltrations in their chest X-ray were included. Quantitative bronchoalveolar lavage (BAL) culture (≥10⁴ CFU/mL) was performed in all cases on the 5^(th) day of ICU admission. We excluded patients with structural lung disease, non-infectious lung infiltrations, and atypical infections such as Mycobacterium tuberculosis, Pneumocystis jiroveci, and viruses. Serum procalcitonin levels were measured semi-quantitatively by using PCT-Q kit. Results : A total of 28 adult patients (M:F=23:5) were included: 11 (39.3%) medically-ill patients, 7 (25%) surgically-ill patients, and 10 (35.7%) burn patients. Serum procalcitonin level was <0.5 ng/mL in half of the cases (14/28) and ≥0.5 ng/mL in the remaining half of the cases. Compared to those with serum procalcitonin level of <0.5 ng/mL, patients with serum procalcitonin level of ≥0.5 ng/mL had more frequent mechanical ventilation, higher CRP/APACHE II scores/number of organ failure (P<0.05), and showed increased tendency for death (P=0.052). Positive bacterial BAL cultures were noted in 17 cases (60.7%). Of these, 7 cases (41.2%) showed serum procalcitonin level ≥0.5 ng/mL. Conclusions : High serum procalcitonin level seems to be closely associated with the severity and poor prognosis in critically ill patients with bacterial pneumonia. However, pneumonia could not be excluded with low level of procalcitonin among ICU patients.

鐵筋 콘크리트 有孔보의 擧動에 관한 실험적 연구

이화직,최종만,하영철,곽윤근 金烏工科大學校 1993 論文集 Vol.14 No.-

Openings through beams are required for the passage of utility ducts and pipes, and they are frequently encountered in the design of modern buildings. They are particularly important in multistory buildings where the use of openings in beams can mean lower story heights, leading in turn to a multiplicity of savings. Therefore, the designers are often faced with the necessity of providing adequate openings in the buildings. However, provision of openings may cause problems of excessive cracking and deflection, and may severely affect the strength of a beam. An experimental investigation is carried out on ten reinforced concrete beams with rectangular openings. The size of opening and it's location are considered as major variables. The specimens were tested under two point loading. Loads were usually applied in steps of 0.5 ton up to failure to observe the crack initiation and propagation, initial diagonal cracking midspan deflection, concrete strain and reinforcement strain.

직업성 만성폐쇄성폐질환의 업무관련성 심의 사례들과 산업의학적 평가에 대한 고찰

이화평,고동희,이의철 大韓産業醫學會 2009 대한직업환경의학회지 Vol.21 No.1

목적 많은 연구들을 통하여 만성폐쇄성폐질환의 직업성 원인에 대한 역학적 근거들이 제시되고 있지만 산재로 인정받는 경우는 아직 적은 편이다 본 연구에서는 산업안전보건연구원에서 근로복지공단의 의뢰를 받아 시행한 업무관련성 여부에 대한 심의 사례들을 조사하였으며 만성폐쇄성폐질환의 직업성 원인에 대한 근거들을 함께 고찰하여 직업성 만성폐쇄성폐질환에 대한 산업의학적 평가의 시행에 도움을 주고자 하였다 방법 1998년부터 2007년까지 10년간 산업안전보건연구원에서 이루어진 업무상 질병 여부에 대한 심의 기록들을 담고 있는 전산자료에서 만성폐쇄성폐질환을 진단명으로 하는 13건의 사례들을 수집하였다 이들 13건의 기록들로부터 질병명 병력 직업력 흡연력 해당 유해인자 사업장의 작업환경측정 기록 업무관련성 평가에 대한 심의 결과를 파악하였다 결과 총 13건의 사례들 중에서 업무관련성이 높다고 평가된 4건의 사례들은 다음과 같다 1) 도로상 미세 분진과 일반쓰레기 분진에 노출된 비흡연자인 환경미화원 2) 카드뮴 흄에 의해 폐손상을 입은 용접공 3) 방적공장의 면 분진에 의해 발생한 천식이 장기노출에 의해서 만성화되면서 비가역적으로 폐기능이 저하된 공조기 공기필터 관리작업자 4) 개인보호장구와 국소배기장치 없이 작업한 흡연력이 있는 주물공장 사상공 다음의 9건의 사례는 업무관련성이 낮은 것으로 평가되었다 1) 직업성 요인보다는 흡연에 의한 만성폐쇄성폐질환으로 판단된 경우 4례 2) 기존 질환(심한 결핵)의 악화에 의한 질병 발생의 가능성이 큰 경우 1례 3) 잘못 진단된 경우 1례 4) 작업 환경상 유해인자에 대한 노출의 정도가 너무 낮은 경우 2례 5) 유해인자에 노출되기 이전에 이미 발병한 경우 1례 흡연력이 있고 진폐가 없는 사상공의 경우 2006년에는 업무관련성이 낮은 것으로 평가되었으나 2007년에는 높은 것으로 평가되었다 결론 만성폐쇄성폐질환의 산업의학적 평가에 필요한 요소들은 다음과 같다 1) 폐기능 검사와 방사선학적 검사를 통한 만성폐쇄성폐질환의 정확한 진단과 다른 질환들의 배제 2) 해당 유해인자와 질병 발병 사이의 인과관계에 대한 충분한 근거 확보 3) 노출의 정도에 대한 평 가 4) 흡연으로 인한 발병가능성의 평가 산업의는 이러한 요소들을 충분히 고려하여 직업성 여부를 평가하여야한다 또한 환자가 흡연자라고 할지라도 직업성 유해인자에 의한 폐기능의 감소가 평균수명 혹은 건강수명의 실질적인 단축을 가져왔는가라는 문제를 충분히 고려하여 만성폐쇄성폐질환의 직업성 여부를 평가하여야 할 것이다 Objectives To analyse the characteristics of occupational COPD (Chronic obstructive pulmonary disease) cases that were evaluated by the Occupational Safety and Health Research Institute (OSHRI) of the Korea Occupational Safety & Health Agency (KOSHA) Methods Using the OSHRI database from KOSHA we collected 13 cases of occupational COPD that had been evaluated from 1998 to 2007 Results Four cases had been evaluated as occupational COPD 1) a nonsmoking road sweeper exposed to automobile exhaust gases and trash dust 2) an oxygen welding worker exposed to cadmium fumes 3) a cotton mill air conditioner cleaning worker exposed to cotton dust and 4) a foundry grinding worker exposed to dust gases vapors and fumes Nine cases had been evaluated as non-occupational COPD 1) 4 cases in which smoking was determined to be the main cause rather than occupational expo sure, 2) 1 case that was evaluated as another respiratory disease (severe tuberculosis sequelae) 3) 1 case that had been misdiagnosed as COPD 4) 2 cases in which the exposure levels in the workplace environments were too low and 5) 1 case that had developed before the employment Among these 13 cases a shipyard grinding worker had been evaluated in 2006 as having had a low occupational hazard but a similar case (a foundry grinding worker) was evaluated as having had a high hazard in 2007 Conclusions Proper evaluation of occupational COPD demands an accurate diagnosis of COPD itself and also the exclusion of other respiratory diseases that have similar symptoms an investigation of the relevant occupatioonal hazards and the amount of the exposure and a consideration of smoking history The evaluation should also take into account any substantial loss of life due to occupational hazards as well as any disease-free periods

TSD 半剛接 接合部를 適用한 超大型 浮遊式 上部構造物의 2次 彈性解析

宋和澈,李恩淑 韓國海洋大學校 附設 海洋科學技術硏究所 2002 硏究論文集 Vol.11 No.1

In general, the semi-rigid connections are preferred for low rise structure, If semi-rigid connections are used for superstructures of very large floating structures(VLFS), the number of rigid connections can be reduced and more economical construction will be possible. In this study, considering service load and wave load in VLFS, the applicability of mixed use of rigid and semi-rigid connections has been studied using TSD connections for a four-bay eight-story frame. ABAQUS(Finite element analysis program) is used for conduction second order elastic analysis.

인간 타액선세포 및 선암종세포주의 분화 유도시 Transglutaminase발현과 고정의존성 성장과의 관계

박대열,이선경,이화정,장현주,민승기,김은철 大韓顎顔面成形再建外科學會 2003 Maxillofacial Plastic Reconstructive Surgery Vol.25 No.2

Transglutaminase(TGase) catalyzes the Ca^2+ dependent acyl transfer reaction to from γ-glutamyl lysine cross-links between substrate proteins. we have examined the expression of TGase 1 and TGase 2 enzyme activity and protein expression in differentiation induced salivary gland cells(HSG), and human salivary adenocarcinoma cell lines(SGT)in reation to anchorage independent growth. The TGase1 and TGase 2 activity in SGT was higher than in HSG, and there is no significant difference between TGase 2 and TGase1 cells. HSG cells showed no increase in TGase 1 and TGase 2 upon reaching post confluence and in 1.8mM Ca^2+. Expression of the TGase 1 and TGase 2 was induced by high cell density or by high calcium in SGT. No induction of TGase 1 & 2 protein was observed in postconfiuent HSG cells, but there was notable increases in TGase 1 & 2 protein in post confiuent SGT cells. This pattern of TGase 1 & 2 protein expression correlates with the pattern of particulate activity. SGT cells showed more colony size and colony forming activity in soft agar rather than HSG cells. The ability of SGT cells, containing high levels of TGase 2 and TGase1,to form colonies in soft agar suggests a role for this enzyme in anchorage independence.

鐵筋 콘크리트 有孔보의 거동에 관한 실험적 연구(Ⅱ)

최종만,이화직,하영철,곽윤근 國立金烏工科大學校附設生産技術硏究所 1994 産業技術開發硏究 Vol.10 No.-

Openings through beams are required for the passage of utility ducts and pipes, and they are freqently encountered in the design of modern buildings. They are particularly important in multistory buildings where the use of openings in beams can mean lower story heights, leading in turn to a multiplicity of savings. Therefore, the designers are often faced with the necessity of providing adequate openings in the buildings. However, provision of openings may cause problems of excessive cracking and deflection, and may severly affect the strength of a beam. An experimental investigation is carried out on twelve reinforced concrete beams with square openings. The size of opening, and it's location are considered as major variables. The specimens were tested under two point loading. Loads were usually applied in steps of 0.5 ton up to failure to observe the crack initiation and propagation, initial diagonal cracking, midspan deflection, concrete strain and reinforcement strain.

개에서 피지선 과형성의 진단 및 치료 증례

박희서,손화영,정성목,송근호,조종기,이영원,신상태,김명철,김덕환,박성준 충남대학교 수의과대학 동물의과학연구소 2004 動物醫科學硏究誌 Vol.12 No.-

An eleven year old castrated male Maltese was presented to the Veterinary Medical Teaching Hospital of Chungnam National University. In physical examination, approximately 0.5 cm round mass was observed on tail base. This small elevated mass has also shown alopecic and firm configuration. It was differentially diagnosed as sebaceous adenoma and hyperplasia by fine needle aspiration. After surgical removal, the sample was diagnosed as sebaceous hyperplasia by histopathological examination. It has not yet shown any signs of recurrence and prognosis has teen good.