품행장애 청소년에서의 우울, 불안 증상과 부모양육특성

최경민,한성희 대한소아청소년정신의학회 1997 소아청소년정신의학 Vol.8 No.1

침습성 아스페르길수스증 진단을 위항 갈락토만난 항원검사의 유용성 평가

송경호,이신원,장희창,전재현,박완범,박경운,박상원,오명돈,최강원 대한감염학회 2009 감염과 화학요법 Vol.41 No.2

Background : Invasive aspergillosis (IA) is an important cause of morbidity and mortality among immunocompromised patients. However, 1A is difficult to diagnose, especially in the aforementioned patient group. Recently, galactomannan assay (GMA) using enzyme immunoassay has been introduced in Korea. We evaluated its diagnostic usefulness in the diagnosis of 1A and we analyzed the results according to the underlying diseases. Materials and Methods : All patients who underwent GMA during the period from October 2007 to June 2008 were evaluated retrospectively. According to the criteria of European Organization for Research and Treatment of Cancer/Mycoses Study Group, IA was classified into four clinical categories: proven', probable', possible', and 'non' IA. Patients with 'proven' and 'probable' IA were used as the reference standards for IA. GMA was performed using Platelia Aspergillus EIA (Bio-Rad, Hercules, CA, USA). Optical density index ≥0.5 was considered positive. Results : Of the 144 patients who underwent GMA, two patients were classificed as proven' IA and sixteen patients were probable' 1A. Overall sensitivity, specificity, positive predictive value, and negative predictive value of the assay were 50% (95% confidence interval [C195), 26-74%), 88% (C195, 81-93%), 38% (CI95, 19-59%), and 93% (CI95, 86-97%), respectively. Among the 99 patients with underlying hematologic diseases, GMA showed 67% (C195, 35-90%) sensitivity and 89% (C195, 80-94%) specificity, whereas in 45 patients with underlying diseases other than hematologic diseases, sensitivity and specificity of the assay were 17% (CI95, 0-64%) and 87% (CI95, 73-96%), respectively. Conclusions : GMA showed high specificity, irrespective of the patient population. However, sensitivity of GMA was low and the assay was less sensitive in patients with underlying diseases other than hematologic diseases than in patients with hematologic diseases.

반복적인 부비동염으로 내원한 Good 증후군 1예

송경호,김계형,김충종,박경운,전상훈,김홍빈,김남중,오명돈,최강원 대한감염학회 2007 감염과 화학요법 Vol.39 No.5

Good 증후군은 흉선종과 면역결핍이 동반되는 질환으로, B세포의 감소로 인한 범저감마글로불린혈증과 CD4^(+)T세포의 감소로 인한 세포성 면역저하가 동시에 나타나는 것을 특징으로 한다. 본 증례는 18개월 전부터 발생한 반복적인 부비동염을 주소로 내원한 43세 남자 환자로, 내원 1년 전 흉선종절제수술을 시행받았으며, 면역학적 검사상 범저감마글로불린혈증과 T세포의 감소 등의 이상 소견이 발견되었다. 정주 면역글로불린과 경험적 항생제(amoxicillin/clavulanic acid) 사용 후 부비동염이 호전되었으며, 예방접종과 정기적인 면역글로불린 투여 후 특이 합병증없이 경과 관찰 중이다. Good's syndrome is the association of thymoma with immunodeficiency, characterized by hypogammaglobulinemia, B-cell lymphopenia and variably defects in cellular immunity with CD4^(+) T-cell lymphopenia and an inverted CD4^(+):CD8^(+) T-cell ratio. We report a 43-year-old male patient who presented with a 18-month history of productive cough and postnasal drip. One year ago, he underwent the operation for resection of a thymoma. Despite of appropriate management, sinusitis relapsed multiple times. He was found to have hypogammaglobulinemia with nearly absent B cells(4/μL). The CD4^(+) T-cell count was 554/μL with an inverted CD4^(+):CD8^(+) T-cell ratio of 0.6. His symptoms and signs improved with antibiotic treatment and monthly administration of intravenous immunoglobulin (IVIG, 400 mg/kg).

국내 의료기관의 항생제 사용 실태와 규제 시스템 조사

방지환,송경호,박완범,김성한,조재현,김홍빈,김남중,오명돈,최강원 대한감염학회 2006 감염과 화학요법 Vol.38 No.6

목적 : 이전 연구들에 따르면 아직까지 국내에서 불필요한 항생제 사용은 무시할 수 없는 수준이며, 특히, 수술환자들에 대한 예방적 항생제 투여가 문제로 지적되고 있다. 많은 병원에서 불필요한 항생제 처방을 제한하려는 노력을 하고 있지만 구체적인 현황에 대한 자료는 적은 실정이다. 이에 본 연구자 등은 국내 의료기관의 항생제 규제 시스템의 현황과 수술시 예방적 항생제 사용의 적정성을 알아보고자 한다. 재료 및 방법 : 전임 감염내과 전문의가 근무하는 의료기관 55곳에 대해 설문조사를 시행하였다. 설문의 내용은 적정한 항생제 사용을 유도하기 위한 정책 및 규제 프로그램, 실제 각 의료기관의 예방적 항생제 사용 현황 등으로 이루어져 있다. 결과 : 55개의 의료기관에 보낸 설문 중 44개가 회수되었다. 회신한 의료기관에서 항생제 처방 관리는 제한항생제 시스템을 가장 많이 이용하고 있었고(95.5%), 항생제에 대한 교육(79.5%), 전산시스템에서 관리(59.1%), 감염내과에 의뢰(54.5%), 항생제 사용 실적 검토(52.3%) 등의 순이었다. 대개의 병원에서 glycopeptides (100.0%), carbapenems (93.0%), quinupristin/dalfopristin 또는 linezolid(93.0%), 4세대 cephalosporin (74.4%), caspofungin 또는 voriconazole (62.8%), liposomal amphotericin B (60.5%) 등을 제한항생제로 분류하여 관리하고 있었다. 모든 의료기관에서 위절제술 및 유방절제술시에 불필요하게 예방적 항생제를 사용하고 있었다. 슬관절치환술의 경우 2세대 cephalosporin을 예방적으로 사용하는 경우가 가장 많았으며(30.2%), 관상동맥우회술의 경우 3세대 cephalosporin을 예방적으로 사용하는 경우가 가장 많았다(47.2%). 예방적 항생제의 투여 기간을 살펴보면 위절제술시 70.5%에서 4일을 초과하여 사용하고 있었고, 유방절제술시에는 63.6%에서, 슬관절치환술시에는 81.8%에서, 관동맥우회술시에는 81.1%에서 4일을 초과하여 장기간 예방적 항생제를 투여하고 있었다. 한편, 예방적 항생제 투여시 aminoglycoside계 항생제를 병용하는 경우도 많았다. 결론 : 아직까지 국내 의료기관에서 항생제 오남용을 막기 위한 노력이 더 필요할 것으로 생각되며, 특히 수술시 예방적 항생제의 올바른 투여에 많은 관심이 필요하다. Background : Previous studies in Korea showed that unnecessary antibiotic use could not be neglected, especially in prophylactic use. Currently many hospitals employ diverse antibiotic stewardship programs, but there are few studies on surveillance of such programs. So, we planned this study to evaluate current status of antimicrobial stewardship and adequacy of antimicrobial prophylaxis in surgery. Materials and Methods : We sent questionnaires about policy on antibiotic usage, control program for adequate antibiotic prescription, and actual status of prophylactic antibiotic usage to 55 infectious disease physicians in each hospital. Results : Of 55 contacted infectious diseases clinicians, 44 answered the questionnaire. Majority of hospitals employed restricted antimicrobial system (95.5%), education (79.5%), control by order communicating system (59.1%), consult to infectious disease physicians (59.1%), and review of cumulative antimicrobial usage (52.3%) to prevent inadequate antibiotic use. Glycopeptides were designated as a restricted antimicrobial agent in 100.0% of hospitals; carbapenems, 93.0%; quinupristin/ dalfopristin or linezolid, 93.0%; the 4th generation cephalosporins, 74.4%; caspofungin or voriconazole, 62.8%; liposomal amphotericin B, 60.5%, and so on. Unnecessary perioperative prophylactic antimicrobial agents were prescribed in gastrectomy and mastectomy in all the hospitals. The second generation cephalosporins and the third generation cephalosporins were the most commonly prescribed prophylactic antimicrobial agents in total knee replacement arthroplasty (TKRA) and coronary artery bypass graft surgery (CABG) respectively. In 70.5% of institutes they use prophylactic antimicrobial agents more than four days in gastrectomy; 63.6% in mastectomy; 81.8% in TKRA; 81.1% in CABG. Unnecessary combination of aminoglycosides with other antimicrobial agents for prophylactic use was another common problem. Conclusion : This study shows that more effort is required to diminish antimicrobial misuse or overuse, especially in prophylactic use for surgical patients.

폐좌상시 폐단락률과 PEEP치료의 효과

김영식,황성오,최경훈,안무업,오중환,임경수,윤정환,강성준 大韓應急醫學會 1992 대한응급의학회지 Vol.3 No.1

To evaluate the physiologic extent of pulmonary contusion and effect of PEEP therapy for pulmonary contusion, we studied 16 patients received PEEP therapy with pulmonary contusion from nonpenetrating chest trauma. Hemodynamic parameters including pulmonary vascular resistance index and intrapulmonary shunt fraction were calculated from standard measurement, and arterial oxygen tension was measured. Pulmonary vascular resistance index and intrapulmonary shunt fraction were increased in patient group. Arterial oxygen tension was decreased with increase of the intrapulmonary shunt fraction(R=0.75). Arter minimal PEEP therap(5-10 ㎝H₂O), pulmonary vascular resistance index was remained unchanged and intrapulmonary shunt fraction was decreased without significant changes of pulmonary hemodynamics. Increment of arterial tension was increased with decrease of intrapulmonary shunt fraction(R=0.43). Decreased stroke volume index suggested of cardiac injury such as cardiac contusion in patient group. These results of our study suggested that increased intrapulmonary shunt fraction caused arterial hypoxia in pulmonary contusion and arterial oxygen tension was increased as a result of reduced intrapulmonary shunt by PEEP therapy.

심폐소생술중 심실기능 및 판막운동의 평가

이부수,김영식,이강현,황성오,임경수,박금수,윤정한,안무업,최경훈 대한응급의학회 1994 대한응급의학회지 Vol.5 No.2

Background : Mechanism of blood flow during cardiopulmonary resuscitation(CPR) in humans remains controversial and poorly understood, although cardiac or thoracic pump theory was proposed. We investigated cardiac movement, ventricular function and atrioventricular valve motion with aid of transesophageal echocardiography during precordial compression during CPR in humans. Methods and results : During CPR transesophageal echocardiography was performed in 14 patients with non-traumatic cardiac arrest. Manual precordial compression during CPR was performed according to American Heart Association guidelines. Mitral valve closed in 9 and did not close in 5 patients during "compression systole". Tricuspid valve closed during compression systole. Compression vector directed to right ventricle, basal portion of interventricular septum and left atrium. The heart rotated clockwise and the apex was more displaced than the base("swing motion"). Fractional shortening(FS) and ejection fraction(EF) of right ventricle exceeded those of left ventricle(FS : 55±9% vs 18±8%, p<0.05), EF : 79±9% vs 37±16%, p<0.05). FS and EF of left ventricle was higher in patients with systolic mitral valve closure than patients with persistent systolic opening of mitral valve(FS : 21±7 vs 13±7%, EF : 45±12 vs 22±12%, p<0.05), but FS and EF of right ventricle was not different. Conclusion : During precordial compression, the heart rotated clockwise and displaced. Systolic function of right ventricle exceeded left ventricle. Marked compression of right ventricle and systolic closure of tricuspid valve suggested that right ventricle functioned as a pump generating blood flow during precordial compression. Closure of mitral valve was dependant on systolic function of the left ventricle.

원주지역에서 발생한 비외상성 심정지의 일주변화

박금수,김영식,이진응,임종천,이강현,임경수,황성오,최경훈 대한응급의학회 1995 대한응급의학회지 Vol.6 No.2

To estimate the quality of the emergency medical services system of Wonju City, we studied the diurnal variations of 179 non-traumatic cardiac arrest victims who received cardiopulmonary reuscitation at the emergency center of Wonju Christian Hospital. Diurnal variations of non-traumatic cardiac arrest patients were as follows ; The occurence of cardiac arrest at day-time was higher than night-time; 18 cases (11%) from midnight to AM 4, 25 cases (14%) from AM 4 to AM 8, 42 cases (24%) from AM 8 to AM 12, 46 cases (25%) from AM 12 to PM 4, 35 cases (19%) from PM 4 to PM 8, 13 cases (7%) from PM 8 to midnight. Witness cardiac arrest was increased more during the day than night ; 40% from midnight to AM 4, 48% from AM 4 to AM 8, 57% from AM 8 to AM 12.52% from AM 12 to PM 4, 60% from PM 4 to PM 8, 38% from PM 8 to midnight. The transportation time at night-time cardiac arrest was more longer than day-time cardiac arrest ; 30±12mins from midnight to AM 4, 26±9mins from AM 4 to AM 8, 27±12mins AM 8 to Am 12, 25±11mins from AM 12 to PM 4, 25±9mins from PM 4 to PM 8, 35±15mins from PM 8 to midnight. The rate of restoration of spontaneous circulation(ROSC) in day-time cardiac arrest was higher than the night-time cardiac arrest ; 30% from midnight to AM 4, 36% from AM 4 to AM 8, 32% AM 8 to AM 12, 44% from AM 12 to PM 4, 41% from PM 4 to PM 8, 15% from PM 8 to midnight. The survival rate of cardiac arrest has been correlated with collapse time, early bystander CPR, early advanced care. To improve outcome for prehospital cardiac arrest, we concluded that early bystander CPR, and early advanced life support should be performed at the scene and during the transportation especially at night.

前腕部 經穴 取穴에서 骨度分寸法과 一夫法의 比較 硏究

박히준,채윤병,차웅석,박종배,이혜정,이향숙,인창식,고형균,김수영,최일환,김강식,문정배,배기태,유경환,육근영,정병주,손인철,임사비나 WHO COLLABORATING CENTRE FOR TRADITIONAL MEDICINE 2004 東西醫學硏究所 論文集 Vol.2004 No.-

Background : The cun measurement System, an essential and convenient method in locating acupoints, has been widely used in the practice of acupuncture. However, traditional cun measurement has been criticized for its lack of reliability. Objectives : The purposes of this study are to determine if one cun measured by the directional methods have a consistency with that of proportional methods and to investigate which factors are related with these differences, especially in forearm. Methods : The distance between the elbow crease and the wrist crease of forearm was compared to a reference value of one cun obtained by the directional method. In this method, one cun is one third of the distance between index finger and Small finger of a subject, measured at proximal interphalangeal joint. In addition, to investigate the factors influencing the differences between these two methods, we measured the height and body weight and calculated body mass index (BMI). Finally we analyzed the factors correlated with these lengths by linear regression test. Results : The results showed that one cun obtained by the directional methods were significantly different from one cun by the proportional methods in forearm. It was demonstrated that the length acquired with the directional method was more correlated with body weight and body mass index, while the length obtained by the proportional method was more correlated with the height.

Anti-atherosclerosis and Anti-obesity Effects of Zanthoxylum piperitum DC, Citrus junos Sieb ex Tanaka and Pinus koraiensis oil

Kyoung Kon Kim,Sung Mee Lee,Jae Sung Lee,Yeon Kyoung Yun,Dae Jung Kim,Tae Woo Kim,Yun Hwan Kang,Jeong Il Lee,Myeon Choe 한국식품영양과학회 2013 한국식품영양과학회 학술대회발표집 Vol.2013 No.11

Antioxidative, Anti-diabetic and Anti-obesity Activity of Smilax china L. Leaf Extract Solvent Fractions

Kyoung Kon Kim,Sung Mee Lee,Jae Sung Lee,Yeon Kyoung Yun,Dae Joung Kim,Tae Woo Kim,Yun Hwan Kang,Myeon Choe 한국식품영양과학회 2013 한국식품영양과학회 학술대회발표집 Vol.2013 No.11