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.

만성신부전 환자에서 발생한 파종결핵

정가영,나선경,윤혜원,송하응,류정화,류동열 이화여자대학교 의과학연구소 2013 EMJ (Ewha medical journal) Vol.36 No.1

Patients with chronic renal failure (CRF) are known to be more susceptible to tuberculosis infection due to impairment of the host defense mechanism. Although extrapulmonary tuberculosis is more prevalent in those subjects and it may induce dismal outcome, its diagnosis has been challenging since there is no specific symptoms of the disease and the clinical course is usually atypical. Herein, We report a case of disseminated tuberculosis diagnosed by ultrasound-guided liver biopsy in a 31-year-old CRF patient presenting sustained fever despite broad-spectrum antimicrobial therapy and progressive cholestatic jaundice.

건축설계과정에서 나타나는 협업프로세스에 관한 연구 : 파빌리온 설계사례를 중심으로

김정훈,김소희,임병민,김진아,송정화,오건수 남서울대학교 2007 남서울대학교 논문집 Vol.13 No.4

This study aims to deduce the effective collaborative process of architectural design process based on the specific pavilion design case. The study schematizes the collaborative procedure which is generated at the early stage of design process, analyzes the decision support system and suggests the method for reaching a compromise.Finally, this study suggested collaborative process method of architectural design and provided the basic concept that can be used for the similar projects. Keywords : Collaborative Design, Design Process

비호지킨씨 림프종에서 COPBLAM-V 복합화학요법의 치료효과

송홍석,정화영,남계윤 啓明大學校 醫科大學 1993 계명의대학술지 Vol.12 No.2

1989년 3월부터 1992년 6월사이에 계명대학교 의과대학 내과학교실에서 stage II, III 및 IV의 intermediate-grade 림프종환자 29례를 대상으로 COPBLAM-V 복합화학요법으로 치료한 결과 다음과 같은 결과를 얻었다. 총 29례 환자 중 18례(62.1%)에서 완전관해,11례(37.9%)에서 부분관해로 총관해율은 100%였고, 나이 조직형 병기 B증상유무에 따른 차이는 없으나 남자는 완해율을 보였다. 전체환자의 중앙생존기간은 36.8개월로 1년, 2년, 3년 4년 생존율은 각기 68.0%, 68.0%, 54.4%, 40.8%였고, 조직형에 따른 생존율의 차이는 없으나 남자와 여자(P 0.025), stage II III IV (p 0.001), Stage A와 B(p 0.001)사이는 유의한 차이를 나타내어, 여자이거나 나이가 많거나 진행병기 그리고 B증상이 동반된 경우 생존율이 낮았다. 각 약제의 RDI는 Cyclophosphamide 0.722, oncovin 0.773, dexamethasone o.785, bleomycin o.763, adriamycin 0.720, procarbazine 0.776로 남녀 연령 조직형 B증상유무 재발유무 및 치료반응에 따른 각 약제의 RDI의 차이는 없었고, RDI와 생존기간과는 서로 상관관계가 없었으나 총림프구수와 생존기간 사이에는 유의한 (p 0.001) 상관관계를 나타내었다. COPBLAM-V치료후 grade III 및 IV의 부작용은 빈혈 13.6%, 백혈구감소증 44.9%, 구토 22.8%, 탈모증 34.5% 그리고 간기능저하와 감염이 각기 3.4%에서 동반되었으며, 이 중 1례에서 패혈증으로 인하여 사망하였다. Between March 1989 and June 1992, 29 patients with advanced stage, intermdiate-grade non Hodgkin's lymphoma were treated with a COPBLAM-V regimen including cyclophosphamide, oncovin, prednisolone, bleomycin, adriamycin, procarbazine. Median age was 45.7 years and 5 patients were 60 years or old. 18 patients(62.1%) achieved a complete response(CR) and 11 patients(37.9%) had a partial response. Of the 18 CRs, 7 patients(38.9%) suffered a relapse. The median survival time was 36.8 months, and 4-year survival rate was 40.8% ad disease free survival for CRs was 55.2% with a median follow-up of 18.6 months. Male gender was negatively associated with respones rate and age greater than 60 years, female sex, stage Ⅲ and Ⅳ, B symptoms, decreased lymphocyte count significantly decreased survival rate. But relative dose intensity of drugs did not influence the outcome. Overall toxicity was acceptible with 1 treatment- related death due to sepsis. The incidence of nonfatal infection was 17.2%.

수종의 BRACKET(DBS)제거방법에 따른 법랑질 표면에 대한 주사전자현미경적 연구

송정국,손병화 대한치과교정학회 1985 대한치과교정학회지 Vol.15 No.2

With modification of the acid etch technique and improvements of the physical and mechanical properties of the acrylic resin, the removal of directly bonded attachments and the finishing of the underlying enamel have become an acute clinical problem. This study was to evaluation the efficacy of recently introduced instrumentation and techniques to remove bonded brackets and residual resin, and restore the affected enamel surface to an acceptable clinical condition. Forty-eight premolar which were scheduled for extraction for orthodontic purposes were bonded with brackets using super-C ortho Four additional premolars with untreated surfaces were used as controls . After one weak the brackets were removed and the residual resin removed by hand scaler, green stone, green rubber wheel, sandpaper disc, tungsten carbide bur, Sof-lex disc. Half the experimental teeth were given a final pumicing and then all were extracted and stored in 50 percent ethanol. The scanning electron microscopy was used to evaluated the enamel surface. Following results were obtained; 1. A satisfactory result was obtained by means of the Sof-lex disc. 2. The order of the scratch formation was the procedure using hand scaler, green stone, tungsten carbide bur, sandpaper disc, green rubber wheel, and Sof-lex disc. 3. The procedures using green stone and tungsten carbide bur showed many groove formations and the other procedures showed none. 4. Final pumicing serves effectively to remove residual abhesive and restore the enamel surface.

두피에 발생한 악성림프종 1례

정화영,송홍석,정강호 啓明大學校 醫科大學 1993 계명의대학술지 Vol.12 No.3

A case of primary non-Hodgkin's lymphoma of scalp is presented. The patient is 16-year-old male who has develped 10×15cm huse scalp tumor on left frontal head with both cervical lymph node enlagement. The CT presentation of slightly isodense soft tissue mass lesion without rim enhancement on left scalp was found. Magnetic resonance imaging of head showed that tumors invaded outer table of the skull focally. There were no other extra cutaneous manifestations. Biopsy of tumor revealed diffuse poorly differentiated lymphocytic type of malignant lymphoma. The patient was treated with six cycles of COPBLAM-V chemotherapy that resulted in complete remission. Four months after the completion of chemotherapy, the left preauricular lymph node was enlarged. Biopsy revealed same pathology with that of scalp. Again he obtained a complete response with combination chemotherapy.

결핵군 55 kDa 항원의 면역학적 분석

김화중,김홍성,임재현,조은경,송창화,박정규 충남대학교 의과대학 지역사회의학연구소 1999 충남의대잡지 Vol.26 No.1

Identification and characterization of mycobacterial antigens are critical for evaluation of their role in diagnosis, vaccination, and pathogenesis of mycobacterial diseases. An attempt has been made to immunologic characterize the 55 kDa protein antigen of Mycobacterium tuberculosis H37Rv which attracted our interest because it is present in high concentration in 50-80% ammonium sulfate fraction of the culture filtrate. Two monoclonal antibodies (MAbs) directed to 55 kDa antigen were produced. MAbs MT55-1 and MT55-2 reacted with a single 55 kDa protein band. On examination of degree for cross-reactivity with other mycobacterial species by enzymelinked immunosorbent assay (ELISA) and immunoblotting, these antibodies reacted strongly with M. tuberculosis and M. bovis BCG, and reacted weakly with M. marinum and M. smegmatis. To investigated the subcellular distribution of MAbs defined epitopes in the 55 kDa antigen within the mycobacterium, we isolated three major subcellular factions of M. tuberculosis, namely, cell wall, cytoplasmic membrane, and cytosol, by a simple fractionation procedure. MAb MT55-1 reactive cpitope was found in the cytosol when tested by immunoblotting. A sandwich ELISA was initially developed for detecting 55 kDa antigen using MT55-1 MAb in mycobacterial culture filtrate before detecting it in clincal specimens. The minimal detectable concentration was 1.0 ㎍/m1 for M. tuberculosis culture filtrate and 100 ㎍/ml for sonic extracts of M. bovis BCG and M. marinum, respectively. But the 55 kDa antigen was not detected in sonic extracts of other mycobacterial species examined. Although further evaluations are required, this study suggests that the 55 kDa antigen may be of interest as potential diagnostic reagent.

여성의 브래지어 착용에 관한 연구 : 대구시내를 중심으로 The centering Taegu city

오화자,이송자,홍정민,김정원 대구효성가톨릭대학교 1988 연구논문집 Vol.37 No.1

The purpose of this study was to obtain the material for a right selecting buying, care of brassier, and for a right production of brassier. The questionaires in this study were administered to a sample of 10 age -50 age women in Taegu city. The result were as follows; 1. In the degree of wearing the brassier, the old age was lower than the younger age. The first time of wearing is around fifteen. The number of brassier for each a person is 4∼5. 2. In the degree of wearing the brassier as a rule the older age was lower than the younger age on the other hand at the time going out, the degree of wearing the brassier was high. 3. Most of women was wearing a round type brassier, and teen-age and twenty age prepared to asid strech type brassier and thirty age, fourty age, fifty age prepared to a cup side stretch type brassier, semi-long brassier in order. 4. In the feeling of wearing the brassier, the best brassier was round type brassier, semi-long type brassier, cup side stretch type brassier, tape type in order. 5. The reason of wearing the brassier was for a maintenance of figure, habit courtesy, harmony of out of garment in order. 6. The case of knowing of one's bust size and one's brassier size was about 40%. 7. In the place of buying the brassier, there was no difference between department and market, agency In a brassier, buying point was material, maker, advertsement, price in order. 8. The washing of brassier was per a 2 day∼3 day, not only summer but winter after washing, the change of brassier was change of lace, color fastness, twist of abuld strap, change of figure of cup in order. 9. The reason of abandonment of brassier was change of lace, discomfort, color fastness in order.

자료포락분석(DEA)를 이용한 보건의료의 효율성 측정

김남송,박홍섭,김은진,김설화,김정숙,김현아,김경숙,신지혜,최은정,양은진,유선미,유수진 圓光大學校 醫科學硏究所 2007 圓光醫科學 Vol.22 No.1

고등급 이형성을 보인 편평톱니샘종

권경주,정성애,심기남,정정화,강석형,송도경,전승정,김혜인 이화여자대학교 의과학연구소 2012 EMJ (Ewha medical journal) Vol.35 No.1

Until recently, colorectal polyps were classified predominantly as hyperplastic or adenomatous. While adenomatous polyps are well-characterized precursor lesions of adenocarcinomas, hyperplastic polyps have been considered as benign lesion. However, some hyperplastic polyps with serrated morphology of the crypts have been recognized to have distinctive features and these polyps were termed ‘serrated adenomas’. Recent data show that sessile serrated adenomas (SSA) might be the precursors of serrated colonic cancers, underlining the necessity of identifying them. SSA is approximately 3% of all polyps, commonly appears as flat or sessile and yellowish due to mucus production. In the pathogenesis of SSA, progression to high grade dysplasia or early invasive carcinoma may be associated with serrated neoplasia pathway different from adenoma-carcinoma sequence. We report a case with a colon polyp diagnosed as sessile serrated adenoma with high grade dysplasia after endoscopic submucosal dissection.