최근 4년간 서부 경남지역의 소아에서 발생한 쯔쯔가무시열의 임상적 고찰

주혜영,이준수,김정희,유황재,김천수,Ju, Hye Young,Lee, Jun Su,Kim, Jeong Hee,Yoo, Hwang Jae,Kim, Chun Soo 대한소아감염학회 2001 Pediatric Infection and Vaccine Vol.8 No.2

목 적 : 급성 열성 질환으로 입원한 환아들 중 임상적 또는 혈청학적 소견상 쯔쯔가무시열로 진단된 17례의 임상양상을 조사하여 소아에서 발진을 동반한 급성 발열성 질환의 감별에 있어서 쯔쯔가무시열의 조기진단과 치료에 도움을 주고자 본 연구를 시행하였다. 방 법 : 1997년 9월부터 2000년 12월까지 성균관대학교 마산삼성병원 소아과에 급성 열성 질환으로 입원한 환아들 중 임상적 또는 혈청학적 소견상 쯔쯔가무시열로 진단된 17례를 대상으로 성별 및 연령 분포, 발생시기, 임상증상, 검사소견, 치료결과 등을 후향적으로 분석하였다. 쯔쯔가무시열의 임상적 진단기준은 1일 이상의 발열을 주소로 입원한 환아들 중 최근 3주내 유행지역에 노출된 병력이 있으면서 반점 구진상의 피부 발진과 가피, 림프절 종대 등의 특징적인 진찰소견이 동반된 환아들로 제한하였다. 혈청학적 진단기준은 O.tsutsugamushi 항원 감작 면양 적혈구를 이용한 수동혈구응집반응검사(PHA)인 Genedia tsutsugamushi PHA 2 kit(녹십자, 한국)를 이용하였는데 O.tsutsugamushi 항체가 가 1 : 80 이상이면 양성으로 판정하였고, 양성으로 판정된 검체는 1 : 5,120까지 계단 희석하여 항체가의 변화를 정량 분석하였다. 또한 Hantann virus와 Leptospira에 대한 혈청학적 검사도 동시에 시행하였다. 결 과 : 연구군 17례의 연령 분포는 6개월부터 12세까지로 평균 연령은 $6.9{\pm}3.6$세였으며 성별은 남아가 10례(58.8%), 여아가 7명(41.2%)으로 남아에서 많았다. 발생 시기는 10월에 7명, 11월에 10명으로 전례에서 10~11월에 발생하였고, 환아들 중 14명은 유행지역의 외부환경에 노출된 병력이 있었다. 임상증상은 발열이 전례에서 있었는데 입원 전 발열기간은 2~8(평균 $5.2{\pm}1.7$)일의 분포를 보였고 그 외에 두통, 기침, 소양감, 콧물, 복통, 구토, 설사 등이 있었으며 진찰소견은 피부 발진이 전례에서 있었고 그 외에 가피, 림프절 종대, 결막 충혈, 인후 발적, 피부의 막양 낙설, 간 비대, 발의 부종 등의 순으로 관찰되었다. 가피는 14례에서 관찰되었는데 등과 서혜부가 각각 3례로 가장 많았고 그 외에 경부, 가슴, 슬와부, 두부, 대퇴부 등에서 발견되었다. 말초혈액 검사상 빈혈은 1례에서 관찰되었고 백혈구 감소와 혈소판 감소는 각각 5례에서 보였다. 소변검사에서는 혈뇨와 단백뇨가 각각 1례에서 있었고, 급성기 반응으로 ESR은 단지 2례에서 상승되었으나 CRP는 12례에서 양성이었으며, 간기능 검사상 AST와 ALT치는 각각 9례와 7례에서 증가되었다. 혈청학적 검사(PHA)상 입원 당시의 양성반응은 8례(47%)였으며 발열기간에 따른 양성율은 7일 미만군(38.5%)에 비해서 7일 이상군(75%)에서 더 높았으나 유의성은 없었고 입원 당시 음성반응이었던 9례 중 발병 후 2~3주경에 추적검사한 4명에서는 모두 양성반응으로 전환되었다. 치료는 8세 미만인 9례에서는 chloramphenicol(25 mg/kg)을 8시간 간격으로 정맥 주사하였고, 8세 이상인 8례에서는 doxycycline(5 mg/kg/day)을 2회로 나누어서 경구 투여하였으며 해열 후 4일까지 투여하였다. 치료 후 해열에 걸리는 기간은 chloramphenicol군 : $1.3{\pm}0.6$일, doxycycline군 : $1.5{\pm}1.0$일로 두 군에서 비슷하였다. 합병증은 간질성 폐렴이 1명, 무균성 뇌수막염이 3명 있었으나 17명 전례에서 휴유증이나 재발 없이 완쾌되었다. 결 론 : 소아 쯔쯔가무시열의 발생시기와 임상양상은 성인과 유사하나 소아에서는 남아에서 발생율이 더 높은 Propose : Tsutsugamushi fever is a acute febrile disease, which is caused by O. tsutsugamushi. Recently, this disease is increasingly reported in children. This study was undertaken to investigate clinical features of tsutsugamushi fever in children. Methods : This study involved 17 children with tsutsugamushi fever who were admitted to Masan Samsung hospital between September 1997 and December 2000. We investigated the age, sex ratio, clinical manifestations, laboratory findings, response of therapy and prognosis. Results : The age of patients was $6.9{\pm}3.6$ years, ranging from 6 months to 12 years and male predilection(58.8%) was noted and all cases of patients occured in October or November. The most common symptoms were fever in all cases and headache in 8(47.1%). The most common signs were skin rash in all cases, eschar in 14(82.4%) and lymphadenopathy 8(47.1%). Locations of the eschars were back and inguinal area in each 3 cases, neck and chest in each 2, popliteal area in 2, scalp and thigh in each 1. Laboratory findings included anemia in 1 case, leukopenia and thrombocytopenia in each 5, hematuria and proteinuria in each 1, ESR elevation in 2 and positive CRP in 12, AST elevation in 9 and ALT elevation in 7. Serologic diagnosis was made by passive hemagglutination assay(PHA) in 8 cases(47%) on admission, 4 cases in initial negative group were performed follow-up test at 2nd or 3rd weeks of illness and then all cases of 4 were converted to positive reaction. Clinical improvement was noticed in all cases after treatment to chloramhenicol or doxycycline. Mean duration for defervescence after treatment was $1.4{\pm}0.8$ days. Complications were interstitial pneumonia in 1 case and aseptic meningitis in 3, but all cases of patients were recovered without sequelae or recurrence. Conclusions : Tsutsugamushi fever in children was similiar to adult in the clinical features except male predilection. Early diagnosis and empirical treatment based on clinical manifestations such as fever, skin rash, eschar, lymphadenopathy is important and serologic diagnosis need to perform follow-up test at 2nd or 3rd weeks of illness.

장애영유아 가족지원에 관한 방향모색

주혜영 ( Ju Hae-young ),김현정 ( Kim Hyun-jeong ) 한국유아특수교육학회 2002 유아특수교육연구 Vol.2 No.1

유아특수교육의 패러다임은 ‘아동-중심‘교육에서 ‘가족-중심’교육으로 변화되었다. 따라서 전문가들은 장애아동의 교육에 있어, 가족을 매우 중요한 파트너로 인식하게 되었다. 이 글은 가족의 강점과 자원에 초점을 두는 관점보다 진보된 개념으로서 1990년대와 21세기의 전문가와 가족 관계의 새로운 패러다임인 공유된 권한 모형을 소개하였다. 또한 장애영유아 가족지원에 대한 최근의 연구동향을 살펴보고, 가족보다는 개인에게 초점이 맞추어진 서비스를 제공하고 있는 우리나라의 실정에 활용가능한 자원에 대해 살펴봄으로써 우리나라 장애영유아 가족지원의 방안을 모색하려 하였다. The paradigm of early childhood special education has moved from the ‘child- centered’ education to the ‘family-centered’ education. The family is thus thought to be the important partner in the education of children with disabilities. This paper introduces the collective empowerment model, which is more advanced than the concept emphasizes the strength and the resource of the family. The recent trend of research on the family service is reviewed, and solutions of supporting families of infant and preschooler with disabilities are studied using the available resources applicable to our situation in which services are focused on the individual rather than family.

두피에 발생한 소낭성 피부부속기암

주혜영 ( Hye Young Ju ),김시용 ( Si Yong Kim ),강석진 ( Seok Jin Kang ),김경문 ( Gyong Moon Kim ) 대한피부과학회 2008 대한피부과학회지 Vol.46 No.10

Microcystic adnexal carcinoma is a rare, locally aggressive tumor with a high potential for local recurrence. It usually presents in elderly patients as a solitary, slowly growing, firm, indurated plaque on the face, and particularly on the upper lip or central face. It has occasionally been found in extra-facial locations, including the nipple, axilla and lower extremities, yet scalp involvement has been rarely reported. Histopathologically, it is a poorly circumscribed dermal tumor that shows both follicular and ductal differentiation, and it may extend into the subcutis and skeletal muscle. We report here on a case of microcystic adnexal carcinoma at an unusual site: the scalp. A 42-year-old woman presented with a 6-month history of a painful, solitary, 1 cm-sized, firm, fixed, dome-shaped nodule on the scalp, and this was accompanied by ulceration and oozing. A biopsy specimen demonstrated features of microcystic adnexal carcinoma, with both follicular and ductal differentiation. Immunohistochemical staining for CEA (carcinoembryonic antigen) was positive in the ductal structures, but this was negative in the follicular structures. (Korean J Dermatol 2008;46(10):1376∼1380)

피부에 침윤된 T세포 림프모구림프종

주혜영 ( Hye Young Ju ),김혜성 ( Hei Sung Kim ),김형옥 ( Hyung Ok Kim ),박종원 ( Jong Won Park ),박영민 ( Young Min Park ) 대한피부과학회 2008 대한피부과학회지 Vol.46 No.6

Lymphoblastic lymphoma is a malignant neoplasm of precursor lymphocytes with a B- or T cell phenotype. T cell lymphoblastic lymphoma is a clinically aggressive disease with frequent involvement of extranodal sites, but the involvement of the skin is rare. The clinical appearance of skin lesions usually includes single or multiple papular or nodular lesions preferentially located on the head and neck. Herein, we report the case of a 31-year-old man presenting with skin involvement of T cell lymphoblastic lymphoma. The lesions manifested as asymptomatic, multiple, round, reddish brown macules, and patches on both extremities. Histology examination showed dense, diffuse infiltration of medium sized lymphoid cells into the entire dermis. The tumor cells had irregular nuclei, finely dispersed chromatin, inconspicuous nucleoli, scant cytoplasm, and expressed TdT, CD3 and CD5. (Korean J Dermatol 2008;46(6):842∼845)

간헐적 운동이 초등학교 저체력 학생의 건강관련체력과 신체적 자기효능감에 미치는 영향

주혜영(Ju, Hye Young),안민지(An, Min Ji),이민기(Lee, Min Ki) 학습자중심교과교육학회 2018 학습자중심교과교육연구 Vol.18 No.11

이 연구의 목적은 12주간의 간헐적인 운동이 초등학교 저체력 학생의 건강관련체력 및 신체적 자기효능감에 미치는 영향을 분석하여, 학교에서의 신체활동시간을 확보하는 것을 연구의 주요 목적으로 하였다. 연구의 목적을 달성하기 위해 G시에 소재한 J초등학교 11-12세 여학생 40명을 운동집단 20명, 비교집단 20명으로 임의로 선정한 후 간헐적 운동 전․후 건강관련체력과 신체적 자기효능감을 측정하였다. 간헐적 운동은 유산소 운동(플래그 풋볼)으로 주 3회, 일 3회 15분씩, 12주간 실시하였으며, t검증을 이용해 집단 내, 집단 간 변화량 및 차이를 분석하였다. WIN SPSS Ver. 18.0 통계프로그램을 대응표본 t검증과 독립표본 t검증으로 통계 처리한 결과 아래와 같은 결과를 도출하였다. 12주간의 간헐적 운동을 통해 운동집단의 심폐지구력, 유연성, 근력, 체질량지수에서 통계적으로 유의미한 차이가 나타났다. 12주간의 간헐적 운동을 통해 운동집단의 인지된 신체 능력과 신체적 자기표현 자신감에서 통계적으로 유의미한 차이가 나타났다. The main object of this study is to secure the physical activity time in the school by researching the effect of 12 week intermittent exercise to the low physical fitness students’ health related fitness and physical self-efficacy. In order to accomplish the purpose of this study, 40 female students in the age of 11 to 12 from J elementary school located in G city, After the students were selected into 2 groups randomly as 20 persons in the comparison group and the health group, health related fitness and physical self-efficacy were measured before and after intermittent exercise. Intermittent exercise was carried out as aerobic exercise(flag football) for three times a week with 3 sets of 15 minutes each day for 12 weeks. The t-test was used to analyze the changes and differences between the groups. The result of the preliminary and postmortem results through the WIN SPSS Ver. 18.0 statistical program by analyzing with the corresponding sample t-test and the independent sample t-test revealed the following results in the health related fitness and physical self-efficacy of elementary school low physical fitness students. The 12 week intermittent exercise showed statistically significant differences in cardiorespiratory endurance, flexibility, strength, and body mass index(BMI) of the exercise group. The 12 week intermittent exercise showed a statistically significant difference in perceived physical ability and physical self-confidence in the exercise group.

피부과 의사의 스테로이드 외용제 처방에 대한 설문조사

주혜영 ( Hye Young Ju ),김혜성 ( Hye Seung Kim ),임숙희 ( Sook Hee Lim ),이승동 ( Seung Dong Lee ),강훈 ( Hoon Kang ),김형옥 ( Hyung Ok Kim ),박영민 ( Young Min Park ) 대한피부과학회 2009 大韓皮膚科學會誌 Vol.47 No.9

Background: A recent survey on dermatology outpatients, which assessed their knowledge and behavior for topical steroid use, showed that topical steroids were often used without sufficient information or guidelines. Objective: Our study aimed to evaluate the general pattern of which dermatologists prescribe topical steroids, the prevalence of topical steroid phobia among the dermatology outpatients and the way dermatologists managed such patients. Methods: 236 dermatologists, including those in private clinics and those in the secondary and tertiary hospitals, were asked via mail or e-mail to fill in a questionnaire on their topical steroid prescription. Results: About sixty percent of the total respondents answered that they prescribed topical steroid to more than half of their outpatients, with excluding those patients who came to the office for cosmetic purposes. Most respondents informed their patients about their prescription of topical steroids (85.61%), they explained the mechanism of its action and the clinical effects (65%), the potency and duration of application (70%), and the side effects (82%). But most respondents forgot or did not tell their patients about their steroid formulation (46%), the optimal amount to apply (74%) and the means and duration of optimal storage (82%). 45% of the respondents assumed that more than half of the outpatients to have topical steroid phobia. Yet 80% of the respondents replied that less than 10% of their outpatients had experienced side effects of topical steroids. 73% of the respondents in private clinics and 62% in secondary and tertiary hospitals were influenced by the patients` negative attitude on topical steroid prescription. Conclusion: The results show that the information on topical steroids, in terms of formulation, the optimal amounts to apply and the means and duration of optimal storage, were not sufficiently provided by dermatologists. The topical steroid phobia of patients has been exaggerated despite the low incidence of side effects. (Korean J Dermatol 2009;47(9):1004∼1011)

카포시육종 환자에서 방사선치료 후 발생한 박탈피부염 1예

주혜영 ( Hye Young Ju ),김혜성 ( Hye Sung Kim ),김형옥 ( Hyung Ok Kim ),박영민 ( Young Min Park ) 大韓皮膚科學會 2008 대한피부과학회지 Vol.46 No.8

보육시설 유형에 따른 질적 수준 비교연구

주혜영(Ju Hye Young),이대균(Lee Dae Kyun) 한국열린유아교육학회 2001 열린유아교육연구 Vol.6 No.1

본 연구는 영유아를 위한 보육시설이 질적으로 어떤 수준에서 운영되고 있으며 보육 시설의 설립 유형에 따라 질적으로 어떠한 차이를 보이는가를 규명하는데 목적을 두었다. 이를 위하여 첫째, 보육시설 유형별 종사자들의 자격보유실태. 둘째, 보육시설 유형별 지역사회요구와의 연계 실태. 셋째, 보육시설 유형별 평가 요인에 따른 질적 수준에 관한 설문지를 작성하였다. 이를 무선표집한 충청남도의 보육시설 340곳에 배포하여 회수된 225부 중에서 본 연구에 적합하지 않은 21부를 제외한 204부를 분석대상으로 하였다. The primary purpose of this study is to investigate the quality of the day care centers in Chung-Nam Province. The subjects of investigation are national and public day care centers, private day care centers and corporation day care centers. For attaining the purpose, questionnaire survey were carried Out against the heads of the day care centers. By making reference to the day care center directory, 340 day care centers were randomly sampled. By 66.2 percent of return rate 225 questionnaires were collected and 204 questionnaires excluding 21 were analyzed by SPSS. As a result of analyzing the outcome, the following findings were given: First, the differences of a certificate of qualification among the type of centers ars as follow. The percents of head certificate of qualification are 88.9 % for national and public day care center, 80.6 % for private day care center and 84.8 % for corporation day care center. And the number of nurse certificate of qualification is I for corporation day care center, which is the least. And the number of nutritionist certificate of qualification is 2 for national and public day care center, which is the least. Second the differences of connection with community among the type of centers are as follow. About the question of the number's appropriateness of day care center, private day care centers answers it's too many. And the percent of livelihood assistance family and dual-income family is 11%, 36% for national and public day care center, which is the least. And the percent of deficit family is 8% for private day care center, which is the least. Finally, the differences of quality among the type of centers are as follow. Corporation day care centers show higher rate than the others in indoor organization, indoor facilities and equipments, materials, outdoor organization, outdoor facilities and equipments, health and sanitation, management. A private day care center has a higher rate than the others in interaction between teachers and children. And a national and public day care center has a higher rate than the others in workers's certificate of qualification.

부틸글리시딜에테르와 이산화탄소의 부가반응에 대한 이온성 액체의 촉매 성능 고찰

주혜영 ( Hye Young Ju ),이미경 ( Mi Kyung Lee ),박대원 ( Dae Won Park ) 한국유화학회 2008 한국응용과학기술학회지 Vol.25 No.4

피부전이를 동반한 외투막세포(Mantle Cell) 림프종 1예

주혜영 ( Hye Young Ju ),김혜성 ( Hye Seung Kim ),이준영 ( Jun Young Lee ),김형옥 ( Hyung Ok Kim ),박영민 ( Young Min Park ) 大韓皮膚科學會 2010 大韓皮膚科學會誌 Vol.48 No.2

Mantle cell lymphoma is a malignant lymphoma derived from a subset of B-cells that are localized in the mantle area of the lymphoid follicle. Extranodal involvement is frequent, and especially in the bone marrow, spleen, gastrointestinal tract and Waldeyer`s ring, but skin is rarely affected. A 47-year-old male presented with a 40 day history a nodule on the abdomen on the abdomen. The histopathologic examination showed numerous atypical, small to medium sized lymphoid cells in the entire dermis. Immunohistochemically, the tumor cells were positive for CD20, CD5, CD79a and cyclin D. Our patient showed complete disappearance of his skin lesions and lymphadenopathy after combination chemotherapy. (Korean J Dermatol 2010;48(2):158∼160)