세월호특별법의 여 · 야대표간 합의 처리의 헌법적 문제점과 대안

조원용(Cho, Won-Young) 한양법학회 2014 漢陽法學 Vol.25 No.4

Men have designed representative system to realize “res publica” through deliberation of a legislative bill and our Consistutional law Article 40 defines legislation rights to the National Assembly, which is the decision making organization based on the representative system. Legislation process in House around ‘Sewol ferry’ disaster went differently from the purpose of representative system, though. It’s been based on the “agreement”, between the Government and the Opposition parties, not through the deliberation of each member of National Assembly. Only very few representatives from each party made up their own agreement through more than 3 times trials, still not reflecting the opinions of all the people, stakeholders of the special laws and members of the National Assembly and this kind of highly disputable bill can ruin many of other proposed laws and whole of regular proceedings, we learned again. It’s the case to show common(共) interest was pursued but public(公) was not because of the value difference between the Government and Opposition party. Under the deliberation bill, public-common interest is not “recognized” but “decided” But indispensable condition of “decision” is deliberation, which should be made through enough time and discussion on the whole House.

신 증후 출혈열에서 신장 조직 검사의 임상적 의의

조원용(Won Yong Cho),이은주(Eun Joo Lee),김용섭(Yong Sup Kim),권현민(Hyun Min Kim),권영주(Young Joo Kwon),김형규(Hyung Kyu Kim),원남희(Nam Hee Won) 대한내과학회 1991 대한내과학회지 Vol.40 No.5

N/A To evaluate the relationship between derangement of renal function and the pathological findings in hemorrhagic fever with renal syndrome (HFRS), renal biopsy and functional studies were performed in 23 cases of HFRS. To correlate the pathologic findings with renal funtion, serum creatinine, creatinine clearance, and proteinurea were measured, and also an immunohisto-chemical study in kidney tissue was performed. The results were as follows: 1) The study population included 9 oliguric HFRS cases and 14 nonoliguric HFRS cases. Clinical manifestations at admission were more severe in oliguric cases. 2) Serum creatinine in oliguric cases at admission were 12.5±4.5 mg/dl, higher than the nonoliguric cases, 8.4±3.9 mg/dl (p<0.05). 3) There were no significant differences in the pathologic findings between oliguric and nonliguric HFRS. Pathologic findings were focal infiltration of inflammatory cells and edema of interstitium and destructive changes of tubular structure. 4) The infiltrating inflammatory cells were mostly T-lymphocytes. From the above findings, we can conclude that renal functional changes in HFRS are not related with the severity of the pathologic lesion. It is also sugsseted that infiltrating T-lymphocytes in the interstitium may be related with renal functional derangement ant the pathogenesis of proteinuria.

싸이클로포린에 의한 흰쥐 신손상에서 아포토시스의 역할

이영호(Young Ho Lee),김난희(Nam Hee Kim),윤종우(Jong Woo Yoon),이영기(Young Ki Lee),조상경(Sang Kyung Jo),김용섭(Yong Sup Kim),차대룡(Dae Ryong Cha),조원용(Won Yong Cho),김애리(Ae Ree Kim),원남희(Nam Hee Won),구자룡(Ja Ryong Ku),김형규( 대한내과학회 1997 대한내과학회지 Vol.52 No.6

N/A Objectives: Apoptosis is a physiologic or programmed cell death in contrast with necrotic cell death. Recently it has been known that apoptosis are concerned in the effects of chemotherapeutic agents or radiation therapy on tumor cells. Cyclosporine a(CsA), a potent immunosuppressant, has been effectively used in organ transplantaion, but it also has a significant toxicity in the kidneys. However the exact mechanism of CsA nephrotoxicity has not been ellucidated yet. This study was performed to investigate whether apoptosis particiates in CsA nephrotoxicity or not. Methods: Twenty seven Sprague-Dawley rats were divided into 5 groups. 1) Vehicle group(n=7) as a control: Cremopbor 50mg/kg/day/subcutaneously (sc) for 7 days, 2) CsA4 groupin=5): CsA 50mg/kg/ day/sc for 4 days, 3) CsA7 group(n=5): CsA 50mg/ kg/day/sc for 7 days, 4) R4 group(n=5): 4 days after CsA 50mg/kg/day/se for 7 days, and 5) R8 group (n=5): 8 days after CsA 50mg/kg/day/sc for 6 days, Biochemical parameters including blood pressure were measured in each group and the cell count of apoptosis in rat kidney was evaluated by in situ end labelling(ISEL) method. Results: 1) The increase of serum creatinine, blood pressure and decrease of creatinine clearance appeared in CsA4 and CsA7 groups. 2) The ce11 counts of apoptosis on tubular cells in CsA4 and CsA7 groups were significantly increased more than in control group(79.0±16.9, 98.4±11.4 vs 35.4±8.8, p<0.05), and the cell counts of apoptosis on tubular cells in R4 and R8 groups were not significantly different from that in control group(53.8±12.5, 65.2±7.1 vs 35.4±8.8, p>0.05), 3) The cell count of apoptosis on the interstitium in each group was not significantly different from that in control group(p>0.05). 4) The cell count of apaptosis on tubular cells was increased more than that on the interstitium in all groups. 5) The cell count of apoptosis on cortex only in CsA7 group was significantly increased more than that io control group(57.8±11.5 vs 21.8±2.6, p<0.05), 6) The cell count of apoptosis on medulla only in CsA4 group was significantly increased more than that in control group(636. ±17.9 vs 22.6±9.7, p<0.05). 7) Total cell counts of apoptosis only in CsA4 and CsA7 groups were significantly increased more than in contral group(96.0±21.1, 99.8±11.8 vs 46.6±11.4, p<0.05). Conclusion: CsA caused apoptosis mainly on tubular cells rather than the interstitial cells and apoptotic cells in CsA nephrotoxicity were not in- creased during the recovery phase. With the results apoptosis may play an important role in CsA nephrotoxicity.

실험적 허혈성 급성 신부전 모델에 대한 칼슘 길항제의 효과

권영주(Young Joo Kwon),이규백(Kyu Back Lee),권현민(Hyun Min Kyeon),조원용(Won Yong Cho),김형규(Hyoung Kyu Kim),노정우(Chung Woo Noh) 대한내과학회 1989 대한내과학회지 Vol.37 No.4

N/A Recently, much attention has been focused on the role of calcium in mediating or propagating ischemic cell injury. Modifying alterations in cell calcium redistribution or cellular calcium influx with a variety of agents have been beneficial in ameliorating the degree of cell injury in a number of experimental settings. But studies on animal models about ischemic acute renal failure (ARF) produced either by infusion of vasoconstrictors or by interrupting renal artery blood flow have provided conflicting results. The purpose of this study was to evaluate the effect of calcium entry blockers in an ischemic ARF model by the renal artery clamp in rats. Nine cats were anesthetized with pentobarbital sodium (40mg/kg, I.M,) and a tracheostomy, an IV line and a urinary catheter were placed in position. Temperature was maintained at 37.5 degrees C. By an abdominal approach, both renal arteries were isolated. Four cats were used as controls and received saline for 2 hours before bilateral renal artery clamping. Another five cats were treated with verapamil (5㎍/kg/min.) systemically for 2 hours before bilateral renal artery clamping. All nine cats underwent 1 hour of renal artery clamp followed by 3 hours of reperfusion and hydration with saline. Before clamping and after reperfusion, blood and urine were sampled for creatinine, Na and K, and urine volume was measured. The results were as follows: In the control group, the serum creatinine level was 1.28㎍0.33㎎/dl before clamping and increased to 1.63±0.73㎎/dl after clamping; in the experimental group, the serum creatinine level was 1.20±0.33㎎/dl before clamping and increased to 1.75±0.50㎎/dl after clamping. In the control group, the Ccr value was 13.08±9.25ml/min before clamping and decreased to 0.41±0.22ml/min after clamping; in the experimental group, the Ccr value was 6.24±6.18ml/min before clamping and decreased to 0.14±0.09ml/min after clamping. But these results were not significant statistically. Our results suggested that systemic pretreatment with a calcium entry blocker (verapamil) may be ineffective in an ischemic ARF model by renal artery clamping in cats.

힌지-레버형 변위확대 액추에이터의 응답특성 측정

함영복(Young-Bog Ham),윤동원(Dong-Won Youn),조원용(Won-Yong Cho),박중호(Jung-Ho Park),윤소남(So-Nam Yun),안국영(Kook-Young Ahn) 대한기계학회 2006 대한기계학회 춘추학술대회 Vol.2006 No.11

Recently, piezoelectric actuator has been applied in the various fields of industry such as life science, automotive, IT and telecom. The PZT actuator is used by the reverse piezoelectric effect, which generated a mechanical displacement in the electric field. Because the displacement of this actuator is 1/1000 times of PZT element thickness or height with high voltage, this actuator has to combine with a displacement amplified mechanism. In this paper, the PZT actuator has 10 times amplified displacement using hinge-lever magnification mechanism. The free load displacement of multilayer PZT is 56㎛ at input voltage of 100Vdc, and the proposed mechanism has maximum amplified displacement of 684㎛ through the experiment. The frequency response of PZT actuator having hinge-lever mechanism is measured as resonance frequency. As a result, the resonance frequency of PZT actuator is 209.7㎐ in simulation and 204㎐ in experiment.

힌지-레버 기구를 이용한 소형 압전펌프에 관한 연구

함영복(Young-Bog Ham),송종진(Jong-Jin Song),조원용(Won-Yong Cho),박중호(Jung-Ho Park),윤소남(So-Nam Yun) 대한기계학회 2006 대한기계학회 춘추학술대회 Vol.2006 No.6

In precision machinery systems for electronic devices, due to the generation of heat, cooling system is essentially needed. Miniaturized pumps have been demanded for cooling water circulation and a low power consumption. To obtain sufficient performance for practical applications, in this paper, a piezoelectric pump composed of hinge-lever using multilayer PZT actuator to generate large displacement and two sheet type check valves to control flow direction are designed. First, hinge-lever mechanism consists of a pin hinge-lever and two multilayer PZT actuators. The metal bellows is used as a flexible pump chamber. The hinge-lever mechanism produces a 550㎛ displacement with free load. Second, a check valve with high response is applied and the basic characteristics are experimentally investigated with various shapes and thickness. As a result, the maximum flow rate of 1.3 l/min and maximum pumping pressure of 10 ㎪ are obtained with the driving frequency of 80 ㎐ at 100 V<SUB>p-p</SUB>.

혈액투석, 복막투석 : 투석환자의 단핵구에서 기원한 유도 수지상 세포를 이용한 획득성 면역 장애에 대한 연구

우영석 ( Young Seok Woo ),최혜민 ( He Min Choi ),부창수 ( Chang Su Bu ),조상경 ( Sang Kyung Jo ),조원용 ( Won Yong Cho ),김형규 ( Hyoung Kyu Kim ) 대한신장학회 2008 춘계학술대회 초록집 Vol.28 No.1

지속적 신대체요법 ( Continuous Renal Replacement Therapy ) 을 시행 받은 환자들의 임상적 특성에 대한 연구

강영선(Young Sun Kang),이소영(So Young Lee),한상엽(Sang Youp Han),조상경(Sang Kyung Jo),신진호(Jin Ho Shin),차대룡(Dae Ryong Cha),권영주(Young Joo Kwon),조원용(Won Yong Cho),표희정(Hee Jung Pyo),김형규(Hyoung Kyu Kim) 대한신장학회 2002 Kidney Research and Clinical Practice Vol.21 No.1

목 적 : 급성신부전 환자에서 지속적 신대체요법은 간헐적 혈액투석에 비해 많은 장점에도 사용이 적다. 저자는 지속적 신대체요법 환자의 생존·사망에서 각 특성과 신대체요법 상태를 조사하였다. 방 법 : 1992년 5월부터 2000년 2월까지 지속적 정정맥 혈액여과법(continuous venovenous hemofiltration, CVVH)을 받은 51명의 동반질환, 시작 후 저혈압정도를 조사하고, 사망여부에 따라 CVVH 시작시 혈압, APACHE Ⅲ score, 장기부전수를 비교하였다. 결 과 : 남녀 각 30명, 21명, 평균연령은 56.3±15.6세로 대부분의 환자가 사망하였다(44명, 86.3%). 동반질환은 패혈증 66.7%, 급성신부전 62.7%, 간부전 33.3%, 울혈성 심부전 17.6%, 성인형 호흡곤란증후군 9.8%였다. 시작 후의 평균 동맥압은 59.3±21.5 ㎜Hg로 시작 전에 비해 떨어졌으나 차이는 없었다(p=0.076). 다장기부전은 86.3%였고, 평균 장기부전수는 사망 2.6±1.0, 생존 1.9±1.3(p=0.072), APACHE Ⅲ score는 사망 59.5±13.5, 생존 56.0±20.9로 차이는 없었다. CVVH 시작시 평균 동맥압은 사망 63.49±17.04 ㎜Hg, 생존 87.86±23.15 ㎜Hg로 사망군이 낮았다(p=0.002). 결 론 : 지속적 신대체요법 시행 환자 상당수가 다장기부전을 동반하였다. APACHE Ⅲ score는 사망·생존간에 차이가 없으나 평균 동맥압은 사망자군에서 낮고 평균장기부전수는 사망자군에서 높은 경향으로 질병의 중한 정도가 예후와 관련을 보인다. Purpose : Continuous renal replacement therapy (CRRT ) has been developed and it has advant ages, although the patient s receiving CRRT still have a high mortality. This study was designed to compare the clinical char acteristics of patient s treated with CRRT between survivors and non - survivors. Methods : From May 1992 to February 2000, continuous venovenous hemofiltr ation (CVVH) treatment was applied to 51 patients . Underlying disease, duration of CVVH treatment , blood pressure before and after the treatment were reviewed and APACHE Ⅲ score, number of org an failures, blood pressure at the begining were compared between two groups. Results : The average age was 56.3±15.6 years and the mort ality was 86.3%(44 patient s ). The comorbid conditions were sepsis (66.7% of total patients ), hepatic failure (33.3%), congestive heart failure (17.6%) and adult respiratory distress syndrome (9.8%). Mean arterial pressure (MAP ) at the begining was 66.9±19.7 ㎜Hg and MAP 2 hour s after the treatment was 59.3±21.5 ㎜Hg (p=0.076). APACHE Ⅲ score was 59.5±13.5 in non - survivors and 56.0±20.9 in survivors and mean number of org an failures was 2.63±0.98 in non - survivors and 1.68± 1.34 in survivors, but there was no difference between two groups (p=0.072). MAP at begining was significantly higher in survivors than that of non- survivors (87.86±23.15 vs . 63.49±17.04)(p=0.002). Conclusion : Most of the patient s receiving CVVH have more than two org an failures . There were no significant difference in the number of organ failures and APACHE Ⅲ score between survivor group and non - survivor group. It may be due to underlying disease of patient s that MAP at the begining was lower in non - survivors than survivors . APACHE Ⅲ score would not be a good prognostic predictor

혈액투석 : 투석 환자에서 만성적 저도의 염증과 선천성 면역 반응 감소에 대한 연구

우영석 ( Young Seok Woo ),최혜민 ( He Min Choi ),부창수 ( Chang Su Bu ),조상경 ( Sang Kyung Jo ),조원용 ( Won Yong Cho ),김형규 ( Hyoung Kyu Kim ) 대한신장학회 2008 춘계학술대회 초록집 Vol.28 No.1

말기 신부전 환자의 혈액투석에서 Tunneled Cuffed Catheter ( Permcath ) 사용 성적에 대한 연구

강영선(Young Sun Kang),이소영(So Young Lee),한상엽(Sang Yup Han),조상경(Sang Kyung Jo),신진호(Jin Ho Shin),차대룡(Dae Ryong Cha),권영주(Young Joo Kwon),조원용(Won Yong Cho),표희정(Heui Jung Pyo),김형규(Hyoung Kyu Kim) 대한신장학회 2001 Kidney Research and Clinical Practice Vol.20 No.2

목적 : 혈액투석을 받는 만성 신부전 환자에게 혈관 접속장치의 확보는 환자의 생명을 유지시키기 위한 중요한 요소이다. 그러나 충분한 사전 준비 없이 시행되는 응급 혈액 투석시 흔히 사용되는 polyurethan teflon double lumen catheter는 비교적 사용기간이 짧으며, 사용 중 여러 가지 중한 합병증을 동반할 수 있다. 따라서 최근 피하에 매몰시킬 수 있는 dacron cuff를 갖고 있는 tunneled cuffed catheter(Permcath®)가 사용 중 합병증이 적고 충분한 기간 동안 사용할 수 있어 동정맥 문합 수술 후 혈관이 성숙되기까지 충분히 기다릴 수 있는 시간이 있고, 반 영구적인 목적으로 사용할 수 있다고 알려져 있다. 이에 이 연구에서는 tunneled cuffed catheter사용의 합병증 및 성적에 대해 조사하였다. 방법 : 1995년 1월부터 1999년 8월까지 환자 86명에 대하여 시행한 총 101예를 대상으로 조사하였으며 86명 중 27명은 다른 병원으로 전원하였다. 86명에 포함되지 않는 8명은 추적이 중단되어 조사대상에서 제외되었으며 전원된 환자는 병원이나 환자를 통한 전화 인터뷰를 시행하였다. 결과 : 전체 환자 86명의 평균 연령은 58세이고 남녀가 각각49명, 37명이었다. 이 중 35명은 당뇨병이 있었다. 대상환자 86명 중 4회 시행이 1명, 3회 시행이 1명, 2회가 10명이 있어 도관삽입은 101예에서 시행되었다. 사용 목적은 동정맥 문합술 후 혈관 성숙을 위해 대기하는 경우가 46%로 가장 많았고 혈관상태가 좋지 않아 혈관 수술을 할 수 없어 시행한 경우가 31%, 복막투석 중 합병증 발생의 경우가 15%였다. 혈관 수술을 위한 경우가 5%였으며 신장이식을 준비하는 경우도 있었다. 합병증은 시술환자 중 51%에서 발생하였으며, 이 중 국소 출혈이 70%로 많았으나 모든 예에서 도관관련 균혈증 가능성(possible catheter-related bacteremia, possible CRB)이 30%, 출구 감염이 14%, 기계적인 합병증이 7%를 차지했다. 카테터를 제거한 이유의 20%에서는 상기한 합병증 때문이었고 54%에서는 사용 목적이 사라져 의도적으로 제거한 경우였다. 내경 정맥 및 쇄골하정맥 등 카테터의 삽입 위치와 당뇨병 유무, 연령, 성별에 따른 전체 합병증의 차이는 없었다. 그리고 각각에 따른 출혈, 균혈증 등의 합병증에도 차이는 없었다. 그러나 출구 감염의 경우 쇄골하 정맥을 사용했을 때 더 흔히 발생하였다. 평균 사용기간은 4.5개월로 가장 긴 기간은 20개월이었다. 결론 : Tunneled cuffed catheter는 혈액투석을 필요로 하는 만성 신부전 환자에서 경한 합병증을 유발하면서 장기간 사용할 수 있어 장기적으로 유지투석을 시행해야 하는 만성 신부전 환자에서 일시적 또는 반영구적 혈관 접속장치로 유용할 것으로 생각되며, 향후 이의 적극적인 시도가 필요하리라 여겨진다. Background : Mortality and morbidity of ESRD patients depend on a maintenance of vascular access for dialysis. Polyurethane teflon double lumen catheters have been used for a temporary vascular access for hemodialysis. But, their use has a high rate of complications and a limited duration. Recently developed tunneled cuffed catheter(Permcath®) have lesser complications and longer durability and it could be an alternative for double lumen polyurethan catheter. This study evaluated the usefulness and complica- tions of a tunneled cuffed catheter as a long-term vascular access at the Korea University Medical Center. Methods: The study was done retrospectively through rnedical chart review and telephone interview to investigate age, sex, the absence or presence of diabetes mellitus, catheter performance, indications for a insertion, complications, causes of catheter removal. 101 catheters were inserted in 86 ESRD patients(80 jugular, 21 subclavian) from February, 1995 to August, 1999. The complication rates and it's association with diabetes mellitus and the location of catheter insertion were reviewed. Results: The rnean age of patients was 58 years (49 men, 37 women). 35 patients were diabetics. The purpose of catheters insertion were : 1) waiting for the maturation of an arteriovenous fistula(46%), 2) no other available vascular access(31%), 3) after a removal or insertion of peritoneal dialysis catheters (15%), 4) waiting for the better vascular access operation(5%). Catheters were removed because of mechanical obstructions(8%), infections(12%), deaths of patients(16%). 51% of patients had catheter related complications. Local bleeding(70%) was the most common complication. Bacteremia and exit site infection rate were 30% and 14% respectively. The complication rates had no association with age, sex, the absence or presence of diabetes mellitus and the location of catheter insertion. However, a subcalvian catheter was more vulnerable to exit site infection than an internal jugular catheter. Conclusions: A tunneled cuffed catheter is safer, and more durable than a polyurethane teflon double lumen catheter. It could be used for a short-term vascular access, or for a permanent vascular access in person otherwise with no other alternatives.