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김서우,이석정,류연주,이진화,장중현,최선영,강병철 대한결핵 및 호흡기학회 2013 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.116 No.-
Background: Hemoptysis is a serious complication that may present as a life-threatening emergency of tuberculosis (TB) patient. Bronchial artery embolization (BAE) has been well known as an effective management for immediate and recurrent hemoptysis. The aim of this study was to determine the risk factors contributing to rebleeding after BAE in patients with active or post tuberculosis sequelae. Methods: Following a retrospective review of clinical data of 253 patients who underwent BAE between 2006 and 2012, 167 patients were either a history of TB or current diagnosis of active TB enrolled. Follow up periods was 14.9 months. Results: The median age diagnosed of active TB was 38 years and the age experienced first hemoptysis was 53 years. Of 42 patients (25%) who recurred symptom, 13 patients showed rebleeding within 1 month, and 12 patients after 1year. The reactivation of TB, combined TB destroyed lung and consolidation in chest CT were risk factors of rebleeding after BAE in multivariate logistic regression analyses. The median non recurrence time was 9 months. The factors of significantly associated with the recurrence free time after BAE were TB destroyed lung (HR, 2.4; 95% CI, 1.3-4.5; p=0.005) and hypertrophied vessels in chest CT (HR, 3.6; 95% CI, 1.1-11.9; p=0.036) based on a Cox proportional hazard model. Conclusion: BAE was very effective treatment for the control of hemptysis in TB patients. In patient with severe TB sequelae, such as TB destroyed lung or hypertrophied vessels in chest CT, considered a high risk of rebleeding, should be required closed observation. Background: Hemoptysis is a serious complication that may present as a life-threatening emergency of tuberculosis (TB) patient. Bronchial artery embolization (BAE) has been well known as an effective management for immediate and recurrent hemoptysis. The aim of this study was to determine the risk factors contributing to rebleeding after BAE in patients with active or post tuberculosis sequelae. Methods: Following a retrospective review of clinical data of 253 patients who underwent BAE between 2006 and 2012, 167 patients were either a history of TB or current diagnosis of active TB enrolled. Follow up periods was 14.9 months. Results: The median age diagnosed of active TB was 38 years and the age experienced first hemoptysis was 53 years. Of 42 patients (25%) who recurred symptom, 13 patients showed rebleeding within 1 month, and 12 patients after 1year. The reactivation of TB, combined TB destroyed lung and consolidation in chest CT were risk factors of rebleeding after BAE in multivariate logistic regression analyses. The median non recurrence time was 9 months. The factors of significantly associated with the recurrence free time after BAE were TB destroyed lung (HR, 2.4; 95% CI, 1.3-4.5; p=0.005) and hypertrophied vessels in chest CT (HR, 3.6; 95% CI, 1.1-11.9; p=0.036) based on a Cox proportional hazard model. Conclusion: BAE was very effective treatment for the control of hemptysis in TB patients. In patient with severe TB sequelae, such as TB destroyed lung or hypertrophied vessels in chest CT, considered a high risk of rebleeding, should be required closed observation.
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김서우 ( Seo Woo Kim ),김현경 ( Hyun Kyung Kim ),전승정 ( Sung Joung Jeun ),박혜성 ( Hye Sung Park ),장중현 ( Jung Hyun Jang ),이진화 ( Jin Hwa Lee ),류연주 ( Yon Ju Ryu ),심성신 ( Sung Shin Sim ),천은미 ( Eun Mi Chun ) 대한결핵 및 호흡기학회 2010 Tuberculosis and Respiratory Diseases Vol.68 No.4
Lymphadenopathy in the thoracic cavity is frequently caused by inflammatory diseases. In very rare cases, the node-bronchial fistula has been reported to be the cause of complications of pulmonary tuberculosis. A male patient with necrotizing pneumonia and mediastinal lymph node enlargements identified by chest computed tomography was also found to have a node-bronchial fistula caused by lung cancer. The patient was treated for tuberculosis with pneumonia for one week before a definitive diagnosis was made. A further investigation revealed him to have non-small cell lung cancer (NSCLC, adenocarcinoma) and multiple mediastinal lymphadenopathies accompanied with the node-bronchial fistula. We report this specific case that had been previously treated for tuberculosis but was later revealed to be NSCLC accompanied with a node-bronchial fistula.
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김서우,장중현,김새인,이석정,이진화,류연주,심신애,김유경,이미애,심성신 대한결핵및호흡기학회 2015 Tuberculosis and Respiratory Diseases Vol.78 No.1
Background: The incidence of tuberculosis (TB) in Korea is relatively high compared to the other Organisation for Economic Co-operation and Development (OECD) countries, with a prevalence of 71 per 100,000 in 2012, although the incidence is declining. Real-time polymerase chain reaction (PCR) has been introduced for the rapid diagnosis of TB. Recently, its advantage lies in higher sensitivity and specificity for the diagnosis of TB. This study evaluated the clinical accuracy of real-time PCR using respiratory specimens in a clinical setting. Methods: Real-time PCR assays using sputum specimens and/or bronchoscopic aspirates from 2,877 subjects were reviewed retrospectively; 2,859 subjects were enrolled. The diagnosis of TB was determined by positive microbiology, pathological findings of TB in the lung and pleura, or clinical suspicion of active TB following anti-TB medication for more than 6 months with a favorable response. Results: Sensitivity, specificity, and accuracy were 44%, 99%, and 86% from sputum, and 65%, 97%, and 87% from bronchoscopic aspirates, respectively. For overall respiratory specimens, sensitivity was 59%, specificity was 98%, and accuracy increased to 89%. Conclusion: Positivity in real-time PCR using any respiratory specimens suggests the possibility of active TB in clinically suspected cases, guiding to start anti-TB medication. Real-time PCR from selective bronchoscopic aspirates enhances the diagnostic yield much more when added to sputum examination.
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중국 단독 두 자녀 정책의 출범 배경과 그에 따른 법률문제에 관한 연구
최금해,류서우 한중법학회 2016 中國法硏究 Vol.25 No.-
지난 40년간 시행한 계획출산으로 하여 4억에 달하는 중국 인구 증가가 억제되었고 60억을 향해 달리는 세계 인구에 4년간 제동을 걸었으며 경제성장을 위해 40년에 달하는 인구보너스기(人口红利期)를 마련하였다. 따라서 계획출산이 가져오는 인구 구성의 변화와 일련의 사회변화로 말미암아 중국 정부는 단독 두 자녀 정책을 실행해 오고 있다. 이러한 정책적인 배경하에 본 연구에서는 중국의 단독 두 자녀 정책 및 법률문제에 대해 연구를 실시하였다. 그 결과 단독 두 자녀 정책의 출범부터 실행되는 과정에는 아래와 같은 몇 가지 구체적인 문제가 존재한다. 1. 단독 두 자녀 정책의 출범에 많은 권위 있는 인사들이 강력한 반발에 나서고 있다. 일부 전문가들은 대량으로 남아도는 노동력으로 인해 현재는 두 자녀 정책을 실행하는 최적의 시기가 아닐 뿐더러 지금 두 자녀 정책을 실행하게 되면 설상가상으로 더욱 큰 취업난을 불러올 것이라고 말했다. 2. 전국 각 지방마다 단독 두 자녀 정책은 서로 달라 각 지방 사이의 모순을 불러 올수 있다. 구체적으로 첫째, 각 지방의 정책 중 단독 두 자녀에 내포된 정의가 서로 다르다. 둘째, 단독 두 자녀 정책으로 인해 각 지방에서는 「인구와 가족계획법(人口与计划生育法)」에 관해 적극적인 수정 및 보완 절차를 거쳤으며 본 법률 중에서 여성의 출산시간, 출산연령에 관해서도 서로 다른 정의를 내리고 있다. 마지막으로 단독 두 자녀 정책은 각 지방의 출산정책 변화에 영향을 끼쳐 지방사이의 인구이동을 초래한다. 3. 단독 두 자녀 정책 시행에 관하여 시범하는 방식을 적용하였다. 시범 방식을 적용한 본 정책은 시범구에 대한 우대로서 출산권리를 인위적인 정책의 틀에 가두어 법률적으로 출산권리를 가진 국민에 대한 침해라고 할수 있다. 단독 두 자녀 정책의 시범은 법률적으로 명시된 규정하에 실행된 것이 아니라 지방정부의 묵인 혹은 추진하에 실행된 것이다. 때문에 이러한 인위적인 요소가 개입된 출산권리는 그 어떠한 법률에 의해 부여받은 권리이거나 명백하게 명시된 규정이라 할지라도 국민의 이익을 가벼이 한다는 소지가 다분하다. 4. 단독 두 자녀 정책의 배경하에 현재의 법률법규는 미비한 상태이다. 단독 두 자녀 정책은 기존의 가족계획정책을 견지하는 전제하에 제기된 것으로 계획출산정책하의 미비한 법률법규는 단독 두 자녀 정책의 효과적인 실행에 직접적인 영향을 미친다. 따라서 본 연구에서는 중국 단독 두 자녀 정책의 제정과 시행 과정에 존재하는 문제에 관하여 본 연구에서는 아래와 같은 몇 가지 제언을 제시하고자 한다. 1. 관련 입법체계를 개선하고 여성에 대한 법률 보호 역량을 강화한다. 2. 단독 두 자녀 정책 개념을 명확히 하고 시범 시스템을 개선한다. 3. 관련된 사회 공공서비스의 시스템을 개선해야 한다. 4. 의료위생 서비스 지식을 널리 보급하고 의료보험제도를 개선해야 한다. In 2013, selective two-child policy was finally concerned in China. The selective two-child policy in China fundamentally changed the orientation and trend of the one-child and “one child”family planning policy, it is the turning point of China’s Family Planning Policy. One-child policy has been implemented for more than forty years, and this policy has prevented 400 million births, delayed the world’s six billion population day’s arrival four years, and this policy has created a demographic dividend period of 40 years for economic growth. But in the meantime, China also triggered a series of social problems in the implementation of Family Planning Policy. For example, there were hundreds of millions of one child families accumulated, labor shortage caused by the low birth rate, aging, sex ratio imbalance between men and women and so on. Especially from the legal aspect, the selective two-child policy had the following problems from the introduction to the implementation of the process. (1) The selective two-child policy has been strongly opposed by many authorities from the beginning. They advocated that the timing of opening the selective two-child policy just in the fourth peak of the birth of the population in China, release the selective two-child policy will make women’s fertility rate to rise, lead to another climax of the women’s fertility rate, and when this two climax occur repeatedly, its growth momentum and momentum of inertia will again seriously impact on China’s established population growth target, cause the loss that cannot be saved, and it also make the fertility level of women will be restored to the replacement level, and make the time of zero population growth delay greatly. (2) The local selective two-child policy are not the same, and this easily lead to the contradiction between the locality. The concept of use, female fertility time, child-bearing age and birth numbers in this selective two-child policy are different in locals, so it easily cause the problems to occur such as the discrimination, prejudice, population ratio imbalance, as well as the illegal floating birth and so on between the locality. (3) The pilot implementation method that the selective two-child policy implemented was a violation of the citizens who has the childbearing rights. The selective two-child policy pilot implementation has no clear legal provisions, it was executed in the case of local government’s tacit approval or support. The reproductive rights which are interfered by human factors are likely to ignore the interests of the people. Because the pilot work lack related programs, it can not reflect the purpose of service aims of people wholeheartedly. (4) The selective two-child policy is put forward under the background of family planning policy. This policy did not put forward relevant legal guarantee and welfare services which can enjoy to the people who wanted to a second child. And to some extend, this is hard to mobilize their enthusiasm who want to bear second child, and it is difficult to ensure the effective implementation of the selective two-child policy. In view of the above policies and the legal problems, this study proposes the following solutions. (1) Perfect the system of the relevant legislation, increase the legal protection of women. The China government can learn from the good experience of foreign countries, and the enterprises can also implement flexible work system for female workers. It not only can improve the flexible operation of enterprises, but also can reasonably allocate human resources of enterprises. (2) It is very important to clear related concepts of selective two-child policy and improve the pilot mechanism. Establish a sound system of democratic participation, hold hearing in view of the formulation of this selective two-child policy, improve the mass participation and discussion, and ensure the quality of the pilot work. Mass participation behavior is actually a process of discussion and collective reflection. (3) Improve the relevant social and public service mechanism. The selective two-child policy introduced to solve the problem of “bear”, but “parenting”is a long process. So the Chinese government should popularize compulsory education, at the same time also should solve the difficulties of going to a nursery an so on, expand the prevalence rate of high school education comprehensively, avoid the phenomenon of “reverse elimination”. (4) Popularize medical and health service knowledge, improve the medical insurance system. The government should set the time for maternity leave of bearing second child, modify the childbearing leave and protect women’s rights and interests who wants a second child. At the same time, the government should improve the medical insurance system, support the hospital capital and technology and help the hospital provide full-service to the clients and provide perfect protection for more newborns.
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