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.

정신분열병에 대한 리스페리돈의 효과 및 안정성

이민수,김용구,김영훈,연병길,오병훈,윤도준,윤진상,이철,정희연,강병조,김광수,김동언,김명정,김상훈,김희철,나철,노승호,민경준,박기창,박두병,백기청,백인호,손봉기,손진욱,양병환,양창국,우행원,이정호,이종범,이홍식,임기영,전태연,정영조,정영철,정인과,정인원,지익성,채정호,한상익,한선호,한진희,서광윤 大韓神經精神醫學會 1998 신경정신의학 Vol.37 No.1

연구목적 : 본 시험의 목적은 임상시험 시작전에 연구자들을 대상으로 PANSS Workshop을 통하여 PANSS, ESRS에 대한 국내에서의 표준화 작업을 구축하고 새로운 정신병 치료제인 리스페리돈의 효과와 안정성을 재확인하여 리스페리돈 사용에 대한 적정화를 이루는데 있다. 연구방법 : 1996년 4월부터 1996년 9월까지 국내 39개 대학병원 정신과에 입원중인 혹은 증상이 악화되어 입원하는 정신분열병 환자 377명을 대상으로 다시설 개방 연구를 시행하였다. 1주일간의 약물 배설기간을 가진후, 리스페리돈을 8주간 투여하였고, 기준점, 1주, 2주, 4주, 그리고 8주후에 평가되었다. 용량은 제1일에는 리스페리돈 1mg씩 1일 2회, 제2일에는 2mg씩 1일 2회, 제3∼7일에는 3mg씩 1일 2회 투여하였다. 이후 환자의 임상상태에 따라 임의로 증량할 수 있으며, 최대 일일 16mg을 초과하지 않도록 하였다. 추체외로 증상을 조절하기 위한 투약을 허용하였다. 임상증상 및 부작용의 평가는 PANSS(Positive and Negative Syndrome Scale), CGI(Clinical Global Impression) 그리고 ESRS(Extrapyramidal Symptom Rating Scale)을 사용하였다. 연구결과 : 377명중 343명(91%)이 8주간의 연구를 완결하였다. 치료 종결시점인 8주후 PANSS 총점수가 20% 이상 호전된 경우를 약물 반응군으로 정의할때, 약물반응군은 81.3%였다. 리스페리돈에 반응하는 예측인자로는 발병연령, 이전의 입원 횟수, 유병기간이 관련 있었다. 리스페리돈은 1주후부터 PANSS양성, 음성, 및 일반정신병리 점수상에 유의한 호전을 보여 효과가 빨랐다. CGI의 경우도 기준점에 비해 1주후부터 유의한 감소를 나타내었다. ESRS의 경우, 파킨슨 평가점수는 기준점과 비교해 투여 1주, 2주, 4주후 유의하게 증가되었다가 8주후 기준점과 차이가 없었다. Dystonia 평가점수는 1주후만 유의한 증가를 보였으며, dyskinesia 평가점수는 유의한 차이가 없었다. 혈압, 맥박수의 생명징후 및 일반 혈액학 검사, 생화학적 검사, 심전도 검사에서 유의한 변화는 없었다. 결 론 : 이상의 다시설 개방 임상 연구를 통해 리스페리돈은 정신분열병 환자에서 양성증상뿐만 아니라 음성증상 및 전반적인 증상에도 효과적인 것으로 사료된다. 보다 명확한 평가를 위해서는 다른 항정신병약물과의 이중맹검 연구가 필요할 것으로 생각되며, 또한 장기적 치료에 대한 평가도 함께 이루어져야 하겠다. Objective : The purpose of this study was to investigate the efficacy and safety of risperidone in the treatment of Korean schizophrenic patients. Method : This multicenter open study included 377 schizophrenic patients drawn from 39 university hospitals. After a wash-out period of 1 week, the schizophrenic patients were treated with risperidone for 8 weeks and evaluated at 5 points ; at baseline, and 1, 2, 4 and 8 weeks of treatment. The dose was increased from 2mg/day(1mg twice daily) to 6mg/day(3mg twice daily) during the first week and adjusted to a maximum of 16mg/day over the next 7 weeks according to the patient's clinical response. Medication to control extrapyramidal symptoms was permitted. The psychiatric and neurological status of the patients was assessed by PANSS, CGI, and ESRS scales. Results : 343(91%) of 377 patients completed the 8-week trial period. Clinical improvement, as defined by a 20% or more reduction in total PANSS score at end point, was shown by 81.3% of patients. The predictors of response to risperidone were associated older age, shorter duration of illness, fewer previous hospitalization. Risperidone had rapid onset of action ; a significant decrease of the total PANSS and three PANSS factor(positive, negative, general), and CGI was already noticed at the end of first week. For the ESRS, parkinsonism rating scores were significantly increased until week 4 comparing with baseline. Dystonia rating scores were significantly increased until week 1, and dyskinesia rating scores were not significantly changed during the study. Laboratory parameters including vital sign, EKG, hematological, and biochemical values showed no significant changes during the trial. Conclusions : This study suggests that risperidone is generally safe and effective against both the positive and negative symptoms in our group of patients.

거주자우선주차제의 관리시스템 개발

금기정,이근희,이홍범,김명수 明知大學校 産業技術硏究所 2000 産業技術硏究所論文集 Vol.19 No.-

Increase of incoming level and improvement of welfare caused by rapid economic growth make a sudden increase of car-owners. Such according to vehicle increases, arose many social Problems centering around metropolis. This in Problems, the most parking problem mainly raise in relation between unequality of parking demand and supply. Though it is important that increase the quantity of parking zone in metropolis that develope rapidly motorization it is more meaningful that manage systematically at limited parking area in urban. With these problems, in developing The Parking Management Assistant System improve the problem that The Residential Parking Permit Program(RPPP)that carrying out in Seoul. The Parking & Geographic Management System(P&GMS) is constituted to develope systematically Parking Use Information that intend to use the parking area efficiently. Consequently improve indicated problem which existing system and improving of use efficiency. Furthermore The Parking Management System is expected to help the improvement of transportation information through connection to ITS, such as ATIS, that recognized as central function in The Parking Permit Zone Project which is executed in Seoul now.

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.

정상임신 산모와 중증자간전증 산모의 혈소판지수 비교

박용범,한지수,정동근,이인식,김암,민원기,지현숙,목정은 울산대학교 의과대학 1993 울산의대학술지 Vol.2 No.1

The purpose of this retrospective study was to define platelet indices in severe preeclampsia(N=98) and to compare them to normal nonpregnant values(N=93) during the years 1990-1993 in the Department of Obstetrics and Gynecology, College of medicine, University of Ulsan, Asan Medical Center. Indices evaluated included platelet count, mean platelet volume, and platelet distribution width. Means platelet volume was statistically different between two groups, however mean platelet count was significantly decreased(p=0.029) and platelet distribution width was significantly increased(p=0.0001) and platelet distribution width was significantly increased(p=0.0001) in severe preeclampria. Mean platelet volume versus platelet count in normal pregnancy showed a significant inverse nonlinear relationship(r=-0.39, 9<0.001) and that in preeclampsia was congruent with notmal nonpregnant valus. With same mean platelet volume, platelet distribution width showed tendency to shift to right in severe preeclampsia. These findings support the concept of severe preeclampsia as a compensated state of increased platelet comsumption comparing with normal pregnancy. We concluded from above results that quantification of platelet indices may have some value in screening for and following severe preeclampsia.

염산 Bleomycin 병변내 주입을 이용한 사마귀 치료

강민정,임연순,최혜영,명기범 梨花女子大學校 醫科大學 醫科學硏究所 1999 EMJ (Ewha medical journal) Vol.22 No.2

연구목적 : 지금까지 난치성을 보이는 사마귀의 치료로 Bleomycin 행변내 주사의 효과가 많은 연구에서 보고된 바 있다. 이에 저자들은 본 치료방법의 효과를 사마귀의 크기, 숫자, 위치 및 유병기간에 따라 판정하여 보다 효과적인 적응 대상을 알아보고자 했다. 방법 : 1995년 3월부터 1998년 2월까지 이화여자대학교 목동병원 피부과에 비성기성 사마귀로 내원한 환자중 다른 치료에 반응하지 않았거나, 재발한 경우, 크기가 0.5㎝ 이상이거나 7개 이상의 다발성 병변 , 혹은 조감 주위 병변을 보인 133명의 환자를 대상으로 Bleomycin 병변내 주사로 치료하였다. 1회 치료후 효과와 치료 종결후 완치율을 병변은 크기, 숫자, 위치, 유병기간에 따라 비교하였다. 결과 : 1) 환자의 연령 분포는 4세에서 45세였고, 남자 59명 여자 74명으로 1:1.24 비율이었다. 2) 첫 주사 치료후 96명의 환자에서 50% 이상의 병변의 수나 크기의 감소를 보였다. 크기별로는 0.5~0.9㎝의 87.5%에서, 병소의 수별로는 단일 병소의 76.9%에서 50% 이상의 병변의 크기나 수의 감소를 보여 가장 좋은 효과를 보였으나 통계적 유의성은 없었다. 또한 조갑주의 병변은 79.1%에서, 수부는 75.8%, 족부는 72.9%에서 50% 이상의 호전을 보였으나 족서부 병변은 53.4%로 가장 낮은 낮은 효과를 보였다. 유행병 기간은 6개월 이하인 31명(86.2%)에서 50% 이상의 효과를 보여 유병기간이 짧을수록 치료효과가 유의하게 증가하였다(p<0.05) 3) 치료 종결시 3개월 이후까지 재발없이 완치된 경우는 총 93명으로 69.9%였고 치료받은 병변의 수가 증가할 수록 완치율이 감소하였다, 부위별로는 조감주위가 77.1%로 가장 높았으며, 병변의 크기에 따른 일괄된 완치율의 차이는 없었다. 병변의 기간에 따른 완치율은 6개월 이하에서 80.6%로 가장 높았으며, 유병기간이 길수록 완치율은 감소하는 양상을 보였다. 4) 부작용은 환자 중 18.4%인 24명의 환자에서 발생하였으며, 유형별로는 3일 이상 지속된 동통과 홍반, 색소 침착 및 감염이 관찰되었으나, 모두 이후 호전되었으며, 1명에서 경한 조갑 능선을 동반한 변형이 관찰되었다. 결론 : 본 연구에서 사마귀에 대한 Bleomycin 병변내 주사효과가 병변의 크기에 따라 뚜렷한 차이를 보이지 않았으며, 심한 부작용이나 전신적인 독작용없이 조감주위병변 및 급성기 병변에서 높은 완치율을 보여 좋은 적응증이 됨을 확인하였다. 아울러 Bleomycin 병변내 주사의 효과 및 안정성에 있어서 시술자가 적당한 양의 약물을 주변부위로 부터 과도한 침습없이 정확히 병변의 기저부에 도달시키는 기술이 또하나의 중요한 변수가 됨을 반영하는 결과라 사료된다. Purpose:This study was to designed to evaluate the efficacy of intralesional injection of bleomycin for common warts and plantar warts according to size, number, location, and duration and to determine the appropriate indication of this treatment for warts. Materials & Methods : The objective patients had warts being refractory to previous treatment or large than 0.5cm in size or 7 or more lesions or periungal lesions. The intralesional injection with bleomycin hydrochloride 1㎎/㎖ had been performed single to six times at 3 week interval until complete resolution. Age of the patients ranged from 4 to 45 years, and male to female ratio was 1 : 1.25(59 : 74). Results : After first treatment of bleomycin intralesional injection, a reduction of 50% or more of the primary wart area was observed in 96(72.2%) of 133 patients. 93(69.9%) of 133 treated patients experienced complete cure after 1 to 7 injections. The efficacy of intralesional bleomycin injection for warts was not closely associated with the size of warts. However the duration and number of warts was inversely correlated with the efficacy of treatment. The highest cure rate was shown in patients with periungal warts(77.1%), and lowest in patients with plantar warts(53.3%). The side effects were observed in 18.4%(24 of 133) including persistent pain(17.3%), pigmentation(3.0%), erythema(1.5%), and mild nail dystrophy(0.8%), but no evidence of systemic toxicity was found. Conclusions : The efficacy of intralesional injection of bleomycin was not significantly related to the size, but closely related to the duration, number and site of the lesion. These results partly suggest that there is some important factors affecting the efficacy of treatment of bleomycin such as duration of the lesion and skillful injection of the agent into the wart tissue.

말초혈액 내 백혈구수와 대사증후군과의 연관성

황상태,김범수,황상준,서정열,김병진,이원영,성기철,강진호,김선우,이만호,박정로 대한순환기학회 2004 Korean Circulation Journal Vol.34 No.3

수입소동맥 저항과 수출소동맥 저항의 상호 작용에 대한 연구

양훈모,민영기,이정범 순천향의학연구소 2004 Journal of Soonchunhyang Medical Science Vol.10 No.1

It has generally been accepted that efferent arteriolar constriction increase GFR. However, it has also been shown in mathematical studies that increases in efferent arteriolar resistance beyond some extent causes GFR to decrease. The aim of the present study is to investigate the occurrence of physiological and/or pathophysiological conditions in which GFR is decreased by efferent constriction. The renal hemodynamic data obtained by several investigators were analyzed with a mathematical model of single nephron GFR (SNGFR). The glomerular model is based on a simulation of flow along a glomerular capillary with negligible resistance and uniform ultrafiltration coefficient (K_(f), 0.09 nl · sec^(-1) · mmHg^(-1)). The data analyzed are from rats which have been shown to achieve filtration pressure equilibrium(FPE) during filtration along the glomerular capillary. The hemodynamic states of rat kidney is characterized by a high K_(f), low RBF, and high vascular resistance. In these animals, inhibition of the renin-angiotensin system was associated with increases in GFR. This was mainly contributed to the increase in K_(f). Analysis with the present model has shown that lowered efferent arteriolar resistance during angiotensin inhibition augmented GFR response to K_(f). The analysis of the data obtained by manipulating efferent resistance during aortic constriction demonstrated the importance of pregiomerular resistance(R_(PRE)) related to efferent resistance (R_(E)). in this hemodynamic condition. The FPE which determines the sensitivity of SNGFR to SNBF and K_(f) is attained nearer the afferent end as R_(PRE) increases further: On the other hand, R_(PRE) had no effect on FPE. In conclusion, certain physiological manipulation affects R_(PRE) and K_(f) in such fashion that a decrease in R_(E) may have a beneficial effect on GFR and vice versa. This analysis indicates that it is not limited to theoretical importance; it demonstrated that in rat kidneys which have low flow and high afferent resistance the efferent arteriolar dilation can be associated with the promotion of GFR.

한의진단명과 진단요건의 표준화 연구 III : 3차년도 연구결과 보고

최선미,양기상,최승훈,박경모,박종현,심범상,김성우,노석선,이인선,정진홍,이진용,김달래,임형호,김윤범,박성식,송태원,김종우,이승기,최윤정,신순식 한국한의학연구원 1997 한국한의학연구원논문집 Vol.3 No.1

The diagnostic requirements were suggested and explained regarding the systems of differentiation of symptoms and signs in the third year study of standardization and unification of the terms and conditions used for diagnosis in oriental medicine. The systems were as follows : - analyzing and differentiating of epidemic febrile disease - analyzing and differentiating in accordance with the Sasang constitution medicine based on four-type recognition - differentiation of disease according to pathological changes of Chong and Ren channels - standards for diagnosis of women's disease - standards for diagnosis of children's disease - standards for diagnosis of motor and sensor disturbance (-muscle. born, joint, etc.) - standards for diagnosis of neuropsychiatric disease - standards for diagnosis of five sense organ disease - standards for diagnosis of external disease The indivisual diagnosis pattern was arranged by the diagnostic requirements in the following order : another name, notion of diagnosis pattern, index of differentiation of symptoms and signs, the main point of diagnosis, analysis of diagnosis pattern, discrimination of diagnosis pattern, prognosis, a way of curing a disease, prescription, herbs in common use, disease appearing the diagnosis pattern, documents. The standards for diagnosis of each disease was arranged by the diagnostic requirements in the following order : another name, notion of disease, the main point of diagnosis, analyzing and differentiating of disease, analysis of disease, discrimination of disease, prognosis, a way of curing and prescription of disease, disease in western medicine appearing the disease in oriental medicine, documents.

표준치료에도 불구하고 3차례나 반복해서 발생한 삼일열 말라리아

이해영,한주용,이기덕,박완범,김성한,강철인,문정주,오명돈,최강원 대한감염학회 2002 감염 Vol.34 No.6