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      • 췌장염에 의한 가성낭종내에 생긴 가성동맥류 : 1례 보고

        오연희,이채경,김승현,이성우,양창현,이정호,이영현 동국대학교 경주대학 1996 東國論集 Vol.15 No.-

        만성 췌장염의 합병증으로 생긴 가성동맥류는 드문질환으로, 반복적으로 다량의 출혈을 일으킬 수 있으며, 치료를 하지 않을 경우 사망율이 높기 때문에, 조기 진단과 치료가 필수적이다. 저자들은 38세 남자 환자에서 췌장염의 합병증으로 생긴 가성낭종내에서 발생한 가성동맥류 1예를 경험하였기에 보고하는 바이다. 가성 동맥류의 색혈류도플러상 낭종내에 양방향 흐름의 와류를 볼 수 있었다. Pancreatic Pseudoaneurysm within Pseudocyst from Pancreatitis: 1 Case Department of Diagnostic Radiology and Internal Medicine, College of Medicine,DongGuk University Yeon Hee OH M.D., Chae Kyeong Lee M.D., Seoung Hyeon Kim M.D., Sung Woo Lee M.D., Chang Heon Yang M.D., Jung Ho Lee M.D., Young Hyun Lee M.D. Pseudoaneurysm from pancreatitis is uncommon, but it can cause recurrent and massive hemorrhage. Because of high morbidity and mortality, early detection and treatment of the pseudoaneurysm is needed. We report a case of pseudoaneurysm within pseudocyst from pancreatitis. Color-flow Doppler sonography shows bidirectional flow and turbulent arterial flow, within anechoic mass.

      • 高麗中期의 民族敍事詩 : 東明王篇과 帝王韻紀의 硏究 A Study of old Korean Gests Dong-Myung-Pyun and Je-Wang-Woon-Ki

        李佑成 成均館大學校 1962 論文集 Vol.7 No.-

        Korean literature reaped a precious harvest of two splendid and long epic poems during the one century period from the late 12th to the late 13th century. These are Dong-Myung-Wang-Pyun (東明王篇), the Geste of King Dong-Myung by Yi, Kyu-Bo (1168-1241), and Je-Wang-Woon-Ki (帝王韻紀), the Geste of the Kings by Yi, Sung Hyoo (1224-1300). The Geste of King Dong-Myung clarifies in the opening chapters the remote genealogy of King Dong-Myung, hero and the founder of Koguryo; and in the main chapters, it depicts the King's history from the birth to his great work of foundation; and finally in the closing chapters, his history up to the coronation of King Luri who succeeded to his heroic works and also the impressing comments expressed by the poet. The Geste is written in Chinese poetry, composed of the main part of a little over two hundred and eighty lines and of the descriptive part of four hundred and thirty some lines. Each being a five-word line, the total Chinese word-characters used in the Geste amount to a length of three thousand six hundred (3,600). Je-Wang-Woon-Ki, the Geste of the Kings,(hereafter referred to as simply the Kings), consists of two volumes. The first volume carols the history of the ancient Chinese dynasties, from Bango (盤古) to Kum (金) and in the second volume, the history of Korea. The second volume is of two parts. The first part deals with the rise and fall of the Korean dynasties, starting from Dan-Goon (檀君), the remotes founder of Korea, to the dynasties of Wiman (衛滿), Sagoon (四群), Samhan (三韓) (Three-Kingdoms), Silla (新羅), Koguryo (高句麗), Bekje (百濟), later Koguryo, later Bekje and Balhe (渤海). The first part consists of two hundred and ten (210) seven-word lines, total character-words amounting to one thousand four hundred and sixty. The second part deals with the history of the period from the foundation of Koryo (高麗) down to the reign of King Choongyul (忠烈王) under which the poet lived. The second part is of seven hundred character-words in total, in one hundred and twenty (120) lines, each containing five words. The Geste and The Kings have attracted the attention of the scholar historians, both domestic and foreign, as the historical documents since much earlier days, but it is quite recently that they have come to be considered valuable from the viewpoint of literature. In fatc, they began to be revaluated as "folk epic" when the present author of this thesis published "A Study of the Generation of Yi, Kyu-Bo and Yi, Sung-Hyoo", at Pusan in 1956, and in the following year, Professor Chang, Duk-Soon made his thesis public under the title of "King Dong-Myung, an Epic", which found its place later in his "General Survey of Korean Literature". Quite recently, Professor Yi, Byung-gi presented a new viewpoint, in his "Complete History of Korean Literautre", that the Geste and the Kings are the truthful origin of "Kasa" (歌辭), the ancient folk poetry. About this new theory, however, the author would refrain from mentioning because it has no direct relation with the following thesis of the present author. The present author's interest lies rather in that these two poems in Chinese style should find a position with importance in the system of Korean literature, which has been so far neglected by the Korean literary scholars. A word about the thesis of Professor Chang, Duk-Soon. The thesis is sufficient enough to give the readers a profound understanding of the "Geste of King Dong-Myung" through his structural analysis of the narrative of King Dong-Myung and its detailed comparison with the western getse, which are done in his fluent, rich style. To the regret of the present writer, however, Professor Chang's studies on the Geste ended only in the field of said "analysis" and said "comparison", largely destitute of the due historical background of it. As the result, he ventured to ascribe the motive of the creation to a "nostalgic fidelity" of a Koryo-man to the prceeding Dynasty, Koguryo, and also to determine that the epic poem of the Koryo era was entirely an "accidental eruption of the 13th century". All the literary heritage is the products of the history. We cannot easily be contented by hastily treating our literary heritage. Therefore, the present writer particularly intends to examine the historical background of the Geste to comprehend the position of the poet's subjecthood and furhtermore grasp the true significance of the work from the viewpoint of resuscitated moving history of that age. A rough survey of the dynastic history of Koryo shows us that the Dynasty, since its foundation in 919 A.D., aimed high at expanding its territory towards the North as its state principle. This enterprising spirit of early Koryo had constantly been checked by the powerful suppression on the part of "Kuran"(契丹), and "Yojin"(女眞), two northern races. And without any chance, the Dynasty had to meet the Mongolian Aggression (1231-1256). In this warfare, the regime of "Choi"(崔氏) family ruled Koryo standing siege in KangWha Island. Choi's regime had resisted against the Aggressors thirty, long years before the Dynasty met its total defeat. And the former, the failure of the expansion policy was caused by the corruption and inability of the then ruling aristocracy; and the latter, the defeat at the hands of Mongolians, was brought about by the decrepitude of Royal House, and also by the reactionary bureaucrats who overthrew the Choi regime through treason. In the history of Koryo, however, we should not fail to observe the strong flow of the people's movements. During the period, 1128-1135, people urged the government to transfer the capital to Pyungyang, a border city, to face and suppress the enemy nation, "Kum" (金) (Yojin), and also they advocated that Koryo's King should be retitled as "emperor" like in China, setting up Koryo's own new era, which, till then, had been forbidden by Great China, the powerful dominator. Another incident of the people's movement is seen in heroic resistance against the enemy throughout the Mongolian Aggression. People fought at every part of the country in conjunction with the army, refusing to surrender to the Mongolians till the last. The high spirit and energy of the people had led to the formation of "Sam-Byul-Cho" Army which continued, in isolation from the government, its resistance war for four years until 1273. The 12th and 13th centuries mark the period of great trials suffered by the Korean race. The great spirit of resistance oppressed by the realities inevitably found it way to inwardness, and again was fermented to find its spout in the essence of literature. Yi, Kyu-Bo and Yi, Sung-Hyoo were the writers representing this troubled age, both of whom reached the greatness under favorable care of the Choiregime. They were "Rising Intellectuals" who heralded" New Officials", that is, the class of "Literary Intellectuals" during the second half period of Koryo. They were entirely different in character, from those old aristocrats who had held power during the first half period of the Dynasty. Therefore, these two literary men belonged to the transitional, progressive group of people who later prepared the seed-bed for the new culture. The new culture meant the culture for the people, while the old culture meant the culture forthe aristocrats. No wonder that folk epic such as the Geste and the Kings should be written by these "Rising Intellectuals", and not "accidental" at all. There is no objection in concluding that the Geste and the Kings both are the folk epic. However, we should discern the considerable difference which exists between these two poetical works, either in their subjects or either in their structure. The Geste carols one and single prototype, King Dong-Myung who was the hero of dynastic foundation; while the Kings deals with various, important historical happenings during the entire period from the earliest mythical foundation of the country by "Dangoon" down to the author's age. Here, just for the convenience's sake, the present writer take the liberty of calling the Geste a heroic poem; and the Kings, a history poem, regardless of the fact that a heroic poem and a history poem are essentially the same. Firstly, the writer desires to deal with the Geste laying stress on the following two points: (1) the method of the plot development, and (2) the characteristic of the prototype. In the heroic poem, the development of the plot differs according to the singularity or plurality of the hero prototype. When single, the plot develops towards the direction of the will of the hero; meanwhile, when plural, the plot becomes a succession of human contrasts, and collisions. In the Geste which is a biographic description of a King, the only prototype is King Dong-Myung himself. And the principal actions of the King are narrated in chronological order. However, Yi, Kyu-Bo, the author of the Geste tactfully dealt with the single hero additionally presenting his counterparts to produce a variety in the plot-flow. As the result, contrasts, collision occurs in succession constantly taking a new turn towards a third phase. The plot, therefore, constantly flows breaking the stalmate deadlock. Thus the Geste, which otherwise would have ended by an individuals biography, is heightened up to a realm of heroic poem. In the Geste, the poet succeeded in portraying the character of the hero. The willpower and ambition of the King as a hero are successfully expressed in his escape from Buyo,(扶餘) the capital, and in his founding of a new counrty and a new capital in the South and also in his fight against a neighboring state, "Biru-Kuk"(沸流國). The portrayal of the King's character as hero is vivid and acute in his strategy, violence, cruelty and egotism. The violent hero who exhausts every mean to accomplish his purpose falls easily, like a child, in the arms of his tender mother. Readers of the Geste are struck to find themselves disposed to agree with the hero's strategy, egotism and violence. In this, we are obliged to acknowledge the author's success in sculpturing the fresh, healthy, original humanity of the ancient type. The Geste is a success as a hero poem, but is still insufficient as a folk epic, that is, an epic of the Korean Race. The present writer is of opinion that King Dong-Myung certainly is a hero of a tribe, but not the common patriarch of the entire Korean Race. He is a heroic chief of the tribe of Koguryo which is the predecessor of Koryo "people" since it is evident, in history, that Koryo is the successor of Koguryo. And the author of the Geste so treated the King. In this strict sence, the Geste is, the present writer concludes, more of "heroic poem" than of "history poem". The great task of discovering the common patriarch of the entire race of this land was possible at the hand of Yi, Sung-Hyoo, a little later than Yi, Kyu-Bo's time. Yi, Sung-Hyoo described, with his wider range of view, the total historical activities of the entire Korean Race. In this sence, Je-Wang-Woon-Ki, the Kings is the comprehensive compilation of "folk epic", or perhaps, more properly, of "racial epic", and is characteristic of history poem. The Kings sets in its uttermost beginning Dangoon, as the sole patriarch of the entire Korean race, and clarifies that all the tribal states, which had ever existed in this land covering from northern end to south, are the equal descendants of Dangoon, the Great Patriarch. These tribal states mentioned in the Kings are Shira" (尸羅), "Koye" (高禮), "Ye" (濊), "Mek" (貊), "Buyo" (扶餘) and "Okju" (沃沮). Here, the position of Dangoon far surpasses, in height, that of King Dong-.Myunp. In Sam-Kuk-Sa-Ki (三國史記) (The History of Three-Kingdoms), not a word is mentioned about the racial patriarch. In Sam-Kuk-Yu.-Sa (三國遺事), another old history book, Dangoon is breifly mentioned but his dominion and successors are not intelligibly stated. It is very interesting to find that in the Kings, which was written only ten years later than Sam-Kuk-Yu-Sa, the myth of Dangoon is so surprisingly concrete. The formation of racial consciousness having its base on common Patriarch influenced greatly on the view of history to awaken the various tribes in constant conflict to the sense of homologue. History was no longer regarded by the dynastic unit. A new insight, after the Kings, was given to the view of history that a consistent flow of racial life, regardless of the rises and the falls of dynasties, formed the unending history of the Race. This new consciousness motivated the author of the Kings to begin at the remotest origin of the Race and trace all the way down through to his age, and have a long view towards the future of the race. Thus, the author viewed the complexity of the racial history, the extensiveness of its crosswise comprehension, the remoteness of its lengthwise survey, but he integrated them all in his Kings and reduced them all to Dangoon, the Racial Patriarch. . The Kings, this history poem, is indeed the greatest and the most valuable among all the works including Sam-Kuk-Sa-Ki and Sam-Kuk-Yu-Sa, that have ever been written by the hands of Korean prose writers. The 12th and 13th centuries represented by Yi, Kyu-Bo and Yi, Sung-Hyoo were the golden age of epic poetry in Korea. We regret, however, that this literary trend was not succeeded by their posterity. Epic poem died out with the death of those two poets, which results from the historical reality of Koryo Dynasty. Epic poetry is above all characteristic of collective consciousness rather than individual, for essentially it is a product of collective consciousness. The cosufferings and the co-resistance of the Korean race in the 12th and 13th centuries led the Race to the racial consciousness of common destiny-to the formation of a collective consciousness. Both heroic and history poems were based on this collective consciousness. Unless comes any split in this homologue, collective consciousness can be maintained. However, the historical reality of Koryo was different. The Mongolian invaders were the common enemy of the people of Koryo. Therefore the entire people rose and fought. But the ruling class of Koryo government forsook the people's volition to resist and shamelessly surrendered to the foreign aggressors. The government, even allied with the Mongolian army to destroy its own resisting army and people. By these means, the ruling class once more enjoyed the wealth and power under the grace of the Mongolian Empire; on the other hand, the detressed people suffered under the duplicated tax privations by both Koryo government and Mongolian colonial government. Here, the interests of the government and people were seriously conflicting. A total collapse came in the collective consciousness of the people as a race with common destiny. This tragic collapse, it meant the loss of the base on which was to grow the epic poetry. Thereafter, no epics were ever produced in the literature of Koryo, but its literature took two different flows: the one was Kyong-Ki-Che-Ka (景幾體歌), the literature of the ruling class; and the other, Chang-Ka (長歌) (meaning long ballad), which was the literature of the people. - The End -

      • 급성골수성 백혈병에서 CD34와 P-당단백의 발현

        이제환,김우건,김상위,이정신,이규형,장대영,최종수,김상희,김성배,서철원,지현숙 울산대학교 의과대학 1995 울산의대학술지 Vol.4 No.1

        Backgrounds : The expression of the MDR-1(multidrug resistance)encoded P-170 glycoprotein(p-170)and CD34 have been well known to be associated with drug resistance in AML(acute myelogenous leukemia). P-170 and CD34 expression in AML have been reported as unfavorble prognostic parameters separately. Methods : P-170 glycoprotein expression was analyzed in correlation with CD34 expression and clinical response in 15 consecutive patients with de novo acute myelgenous leukemia (AML). They were measured with flow cytometry after direct and indirect immunofluorescence staining simultaneously. Results : 1) The positive rate of P-glycoprotein and CD34 were in two of 15 patients(13%), seven of 15 patients(46%), respectively. 2) One of two P-170 positive patients as compared with 7 of 13 P-170 negative patients achieved a complete remission(CR), which showed no clinical significant difference. 3) There was no significant correlation between P-glycoprotein and CD34 expression(r=0.29, p=0.28). 4) In de novo acute myelogenous leukemia, there was no case which expressed both P-170 and CD34 simultaneously. 5) P-glycoprotein and CD34 were not expressed in acute promyelocytic leukemia group. 6) Cytogenetic abnormalities did not show any significant difference in the rate of P-glycoprotein expression, CD34 expression and complete remission. Conclusion : CD34 and P-glycoprotein in acute myelogenous leukemia were independent parameter in this study. Further investigations are warranted for clinical implication.

      • 사면의 안정도 해석을 위한 입체투영법

        이성대,이철우,이동우,이성규 公州大學校 基礎科學硏究所 1996 自然科學硏究 Vol.5 No.-

        암반 사면의 안정성을 해석하는데 입체투영기법을 이용하였다. 안정도에 영향을 미치는 요인으로는 절리의 경사, 암석의 밀도, 내부마찰각등이 있으나, 가장 중요한 요인은 절리면의 경사이다. 이 연구에서는 암석의 점착력은 무시하고 단지 내부마찰각과 절리의 주향 및 경사만을 이용하였다. 그 결과 입체투영도에서 나타나는 암반사면의 안정도는 이동력과 저항력의 상대적인 크기에 의하여 좌우되는 것으로 나타났다. 동시에, 지반진동에 의한 영향도 입체 투영기법으로 찾아낼수 있다는 것이 밝혀졌다. Stereographic projection technique was used to analyze rock slope stability. Strike and dip of joints, rock strength, and internal frictional angle are major factor on slope stability. Among them, the most important factor is strike and dip of joints. In stereographgic projection technique, only internal frictional angle, and strike and dip of joints were used to interprete slope stability. Cohesion of rock was not considered. It is suggested that the rock slope stability on stereographic projection depends upon only the differential stress between driving and resisting force. At the same time, Stereographic projection technique on seismic loading was proposed in this study.

      • SCOPUSKCI등재

        동종골수이식 후 혈당 및 혈중 지질농도의 변화양상 및 관련인자

        이원영,강무일,오은숙,오기원,손현식,윤건호,차봉연,이광우,손호영,강성구,신완식,민우성,김춘주 대한당뇨병학회 2002 Diabetes and Metabolism Journal Vol.24 No.6

        연구배경:골수이식은 비교적 젊은 연령의 환자들을 대상으로 하며 면역억제제의 사용기간이 비교적 짧으므로, 주로 고령의 만성 질환 환자에서 시행되는 고형장기이식에서와는 달리 당대사 및 지단백 대사에 있어서 많은 차이점이 있을 것으로 추측된다. 저자들은 전향적 연구를 통하여 골수이식 후 시기별로 혈당 및 혈중지단백 변화 양상을 알아보고 이와 관련된 임상인자들을 규명하고자 하였다. 방법:1998년 10월부터 1999년 8월까지 가톨릭대학교 성모병원에서 동종골수이식을 시행한 환자들 중 43명을 대상으로 이식 전 및 이식 후 1, 2, 3, 4주와 3개월, 6개월에 공복 혈당, 혈중 총 콜레스테롤, 중성지방, 고밀도지단백을 측정하여 골수이식 후 시기별 변화를 관찰하고 여러 임상인자들에 따른 차이를 알아보았다. 결과:1. 공복혈당은 골수이식 수 첫4주 동안 상승하였고 이후 감소하였으나 이식 6개월 시점의 평균 공복혈당은 이식 전보다 유의하게 높게 관찰되었다. 혈중 총 콜레스테롤은 이식 후 1주에 최고치를 형성하였고 이후 기저수준으로 회복되었다가 이식 수 3,6개월에 다시 증가하여 기저치에 비해 유의하게 높았다. 혈중 중성지방은 이식 후 1개월까지 유의하게 증가하였고 이후 감소하여, 3,6개월에는 기저치와 유의한 차이가 관찰되지 않았다. 혈중 고밀도지단백은 이식 후 2,3주에 이식 전보다 유의하게 감소하였고 이후 이식 전 수준으로 회복되었다. 혈중 저밀도지단백은 총 콜레스테롤의 변화와 매우 유사하였다. 2. 골수이식 후 6개월 시점에서 공복 혈당이 126㎎/dL이상인 환자는 7명(16%)이었다. 이들 환자들과 공복혈당 126㎎/dL 미만의 환자 36명을 비교한 결과, 공복혈당이 126㎎/dL 이상인 환자군에서 스테로이드 평균 투여량이 많았고 고밀도지단백이 유의하게 낮았다. 3. 이식편대숙주질환이 발생한 환자는 그렇지 않은 환자보다 이식 후 1, 2, 3주 및 6개월의 총 콜레스테롤이 더 낮았고, 3개월의 공복혈당이 더 높았다. 혈연골수이식 환자군은 비혈연골수이식 환자에 비해 투여된 스테로이드 용량이 더 적음에도 불구하고 이식 후 1, 2, 3주 및 6개월의 총 콜레스테롤 수치가 더 높았다. 스테로이드 고용량 투여군(하루 평균 7.5㎎기준)은 저용량군보다 이식 후 3개월 시점의 공복혈당이 더 높았으나 나머지 시점의 혈당, 혈중 지질농도에 있어서는 유의한 차이가 관찰되지 않았다. 결론:골수이식 후 초기시기에 주로 당 대사 및 지질대사이상이 관찰되며 이는 면역억제제 투여와 관련이 있음을 알 수 있었다. 면역억제제가 고용량 투여되는 합병증 발생 시 이들 대사이상에 관심을 기울여 대처해야 할 것이다. Background: In bone marrow transplantation(BMT), recipients are usually younger and immunosuppressants are open used in shorter period than in solid organ transplantation. Therefore, there might be a difference in glucose and lipid metabolism between BMT and solid organ transplantation. However, the serial changes of metabolic parameters following BMT have not been studied. Therefore, the aim of this study is to investigate the serial changes of blood glucose, lipids and the putative factors that are related with these changes after BMT. Methods: We have prospectively investigated 43 patients who underwent allogeneic BMT. Fasting plasma glucose(FPG), total cholesterol, triglyceride and high-density lipoprotein(HDL) were measured before BMT, and at 1, 2, 3, 4, 12 weeks and 6 months after BMT. The serial changes of these metabolic parameters according to clinical factors including type of BMT, mean daily steroid dosage, and occurrence of graft versus host disease (GVHD) were examined. Results: 1. Mean FPG level increased during 4 weeks after BMT and remained above basal value at post-transplant 6 months. Total Cholesterol level was increased during initial 4 weeks after BMT and was above basal value at post-BMT of 3 and 6 months. Triglyceride level was progressively increased during initial 4 weeks after BMT, but returned to basal value there after. HDL-cholesterol level was significantly decreased during initial 4 weeks after BMT, but returned to basal value there after. 2. Patients with FPG above 126 mg/dL and the other patients, the former received larger amounts of daily steroid and had lower HDL-cholesterol level. 3. The changes of metabolic parameters were different according to type of BMT, steroid dose, and occurrence of GVHD. Conclusion: Although there was increase of FPG, TC, TG and decrease of HDL-C during initial 4 weeks after BMT, these metabolic changes recovered slowly thereafter. Immunosuppressants are thought to be associated with these changes. Further observation will be needed for the long-term effect of BMT on metabolic changes(J Kor Diabetes Asso 24:689~698, 2000).

      • KCI등재후보

        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.

      • 메스암페타민 사용 환자의 정신과적 증상에 영향을 미치는 요인

        이춘우,권성민,조성남,권도훈,임효덕,이성국 대한생물치료정신의학회 2004 생물치료정신의학 Vol.10 No.1

        목 적 : 본 연구는 메스암페타민 남용 또는 의존 환자의 사회인구학적 특성과 이에 따른 동반된 정신장애를 알아보고, 메스암페타민 사용이 정신과적 증상에 미치는 영향을 알아보기 위함이다. 방 법 : 2002년 7월부터 2003년 7월까지 국립부곡병원 약물중독진료소에 입원한 환자 중 DSM-Ⅳ 진단 기준에 의하여 메스암페타민 남용 또는 의존으로 진단된 44명의 남자 환자를 대상으로 사회인구학적 변인과 물질 의존의 병력, SCL-90-R, BPRS, HRSD, YMRS, Impulsive scale 등을 측정하였다. 결 과 : 메스암페타민 사용 환자들의 93.2%가 우울하였으며, 59.1%는 치료가 필요한 정도의 우울증을 가지고 있었다. 20대 연령층에서는 대인예민성, 적대감 및 공포증에서 유의하게 높았고, 중졸 이하의 교육 수준에서는 대인예민성, 충동성에서 유의하게 높았으며, 무직인 경우는 강박증, 불만, 적대감 및 조중 척도에서 유의하게 높았다. 처음 사용한 연령은 사용 횟수, 유병 기간과 유의한 상관 관계를 보였으나, 수감 횟수와는 낮은 상관 관계를 보였다. 사용 횟수와 적대감, 공포증, 편집증은 서로 유의한 정상관을 보였다. 우울증 척도와 정신병 척도 및 충동성 척도는 서로 유의한 정상관을 보였다. 100회 미만보다 500회 이상 사용했을 경우에 불안, 적대감, 공포증 및 편집증에서 유의하게 높았다. 결 론 : 메스암페타민 남용 또는 의존 환자에서 우울증 유병률이 매우 높게 나타났고, 20대 연령층과 중졸 이하의 교육 수준 그리고 무직인 경우 정신과적 증상이 많이 동반되었으며, 사용 횟수에 따라 불안, 적대감, 공포증, 편집증에서 유의한 차이를 보였다. 그러므로 모든 메스암페타민 사용자에 대해 적절한 정신과적 평가가 필요할 것으로 생각한다. Objectives : The purpose of this study was to examine the sociodemographic characteristics and the comorbid psychiatric disorders and the effect of methamphetamine use on psychiatric symptoms in methamphetamine abuse or dependent patients. Methods : The study subjects were 44 hospitalized male patients who met the DSM-Ⅳ criteria for methamphetamine abuse or dependence. The study included items assessing the sociodemographic profiles, history of substance use, and psychiatric symptomatology. Psychiatric assessments were based on SCL-90-R, BPRS, HRSD, YMRS and Impulsive scale. Results : In methamphetamine use patients, 93.2% were depressed and 59% had moderate to severe depression There were significant differences in interpersonal- sensitivity, hostility and phobia in the 3rd decade age group, interpersonal-sensitivity and impulsive scale in .under the middle school education group, and obsession-compulsion, anxiety, hostility and. YMRS in no-job group, respectively compared to the other groups. Age of the first use was correlated with the frequency of use, and also with the duration of illness, but not with the number of incarceration. There were positive correlations among HRSD, BPRS and impulsive scale. In the above 500 times used group there were significant differences in anxiety, hostility, phobia and paranoia compared to the below 100 times used group. Conclusion : In methamphetamine abuse or dependent patients, the incidence rate of comorbid depression was 93.2%. In the 3rd decade age group, under the middle school education group and no-job group showed higher diverse psychiatric symptoms compared to the other groups. Frequency of use was positively correlated with the symptoms such as anxiety, hostility, phobia and paranoia. We suggest that relevant psychiatric evaluations are needed for all methamphetamine users.

      • KCI등재

        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.

      • 인터페론 치료에 반응이 없었던 예들을 포함한 만성 B형 간염 환자에서 lamivudine의 단기 치료 효과

        이상우,이엄석,김선문,서승원,양현웅,성재규,이승민,이병석,김남재,이헌영 충남대학교 의과대학 지역사회의학연구소 2000 충남의대잡지 Vol.27 No.1

        The efficacy and safety of lamivudine administration according to the presence or abscence of past history of interferon treatment were studied in 22 patients with chronic active hepatitis B who were diagnosed at ChungNam National Univerity Hospital. Nine of these patiens were no responders to interferon treatment. The change of HBV DNA, serum ALT and HBeAg values was analyzed during 12 weeks of lamivudine treatment. The results were as follow : 1. The mean values of HBV DNA and serum ALT were significantly reduced from 1793 9 to 2.0 pg/ml and from 202.5 to 36.3 IU/L after lamivudine treatment (p<0.001). The mean reduction rates of serum HBV DNA and serum ALT were 99.7% and 70.4%. 2. HBV DNA was undetectable in 18 patierits(81.8%) and serum ALT was normalized in 16 patients(68.2%%) after 12 weeks of lamivudine treatment. But there were temporary elevations of serum ALT value comparing to pretreatment value in 5 patients. 3. HBeAg was undetectable in 4 patients(18.1%) and in these 4 patients, anti-HBe was detected after 12 weeks treatment. 4. There was no significant difference of HBV DNA clearance rate and normalization rate of serum ALT between above and below 200 pg/mI group according to pretreatment HBV DNA values(p=0.74, p=0.08). 5. Each clearance rates of HBV DNA in patients without previous interferon treatment and patients with previous interferon treatment were 84.6% and 77.8%(p=0.68). Each clearance rates of HBeAg in patients without previous interferon treatment and with previous interferon treatment were 15.5% and 22.2%(p=0.683). 6. During the treatment periods, adverse effects of lamivudine were negligible in most patients except temporary leukopenia in one patient. Conclusively, lamivudine treatment over the short term period for patients with chronic active hepatitis B was effective in suppression of viral replication and improvement of abnormal serum ALT. Also the efficacy of lamivudine treatment was out of all relation to previous interferon treatment and adverse effects of this drug were negliable. But further study for the efficacy of long term period-lamivudine treatment and appearance of mutant shoud be necessary.

      • KCI등재후보

        임상 검체에서 분리된 nontyphoid Salmonella에서의 integron의 빈도와 특징

        이정은,박수진,김성한,김미나,이남용,이복권,이상오,김양수,우준희,최상호 대한감염학회 2009 감염과 화학요법 Vol.41 No.3

        Background : Nontyphoid Salmonella (NTS) is a leading cause of human food-borne enteritis, It has been known that integron, a naturally occurring gene capture and expression element, Plays an important role in the development and dissemination of multidrug-resistance. In this study, we investigated the prevalences and molecular characteristics of integrons in NTS clinical strains. Materials and Methods : Between 1995-96 and 2000-03, a total 261 NTS clinical strains comprising 39 serotypes were collected from clinical specimens. All strains were serotyped, and the MICs of ampicillin, chloramphenicol, streptomycin, sulfamethoxazole, tetracycline, and trimethoprim were determined by agar dilution method. Integrons were detected by PCR amplification of integrase genes, and gene cassettes were determined by PCR and sequencing, Conjugation experiments were performed using E. coli J53 as a recipient. The clonal relationship was analyzed by pulsed-field gel electrophoresls (PFGE). Results : Of the 261 strains tested, class 1 integrons were present in 21 strains (8.0%). Class 2 and class 3 integrons were not found. The integron-positive rate was higher in S. Typhimurium (24.2% [8/33]) than in S. Enteritidis (2.0% [3/153]). Overall rates of antimicrobial resistance were higher in integron-positive strains. dhfr12-orfF-aadA2gene cassette was detected in 5 strains, aadA2in 4 strains, dhfr17-orfF-aadA5 in 2 strains, and addA1 in 1 strain. Ten integron-positive transconjugants were successfully selected. Among 8 integron-positive strains of S. Typhimurium, 7 had similar PFGE patterns. Conclusion: This study suggests that integrons are already playing a significant role in antimicrobial resistance in NTS. Continuous monitoring is needed to detect the emergence and spread of integron-mediated antimicrobial resistance.

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